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

<2>
Accession Number
628694384
Title
Landscape of Cardiovascular Device Registries in the United States.
Source
Journal of the American Heart Association. 8 (11) (no pagination), 2019.
Article Number: e012756. Date of Publication: 04 Jun 2019.
Author
Rajan P.V.; Holtzman J.N.; Kesselheim A.S.; Yeh R.W.; Kramer D.B.
Institution
(Rajan, Holtzman, Yeh, Kramer) Richard A. and Susan F. Smith Center for
Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Rajan, Holtzman, Kesselheim, Yeh, Kramer) Harvard Medical School, Boston,
MA, United States
(Kesselheim) Program on Regulation, Therapeutics, and Law (PORTAL),
Department of Pharmacoepidemiology and Pharmacoeconomics, Brigham and
Women's Hospital, Boston, MA, United States
Publisher
American Heart Association Inc.
Abstract
Background: Regulators increasingly rely on registries for decision making
related to high-risk medical devices in the United States. However, the
limited uniform standards for registries may create substantial
variability in registry implementation and utility to regulators. We
surveyed the current landscape of US cardiovascular device registries and
chart the extent of inconsistency in goals, administration, enrollment
procedures, and approach to data access. Methods and Results: A
systematic review using Preferred Reporting Items for Systematic Reviews
and Meta-Analysis (PRISMA) guidelines identified studies (1995-2017)
referencing cardiovascular device registries with a US-based institution.
Registries were then evaluated by reviewing associated articles and
websites. Extracted data included device type, primary scientific aim(s),
funding, stewardship (eg, administration of registry procedures),
enrollment procedures, informed consent process, and mechanisms to access
data for research. The 138 cardiovascular device registries in the cohort
covered devices addressing interventional cardiology (65.9%), arrhythmias
(15.2%), heart failure (10.1%), and valvular disease (10.1%). While the
majority (55.8%) were industry-funded, stewardship was predominantly
overseen by academic centers (74.0%). Most registry participation was
voluntary (77.5%), but a substantial minority (19.7%) were required as a
condition of device implantation. Informed consent requirements varied
widely, with written consent required in only 55.1% of registries.
Registry data were primarily accessible only to stewards (84.1%), with
13.8% providing pathways for external applications. Conclusion(s):
The majority of cardiovascular device registries were funded privately
under the auspices of academic institutions, which set the rules for data
access. The substantial variation between cardiovascular device registries
suggests a role for regulators to further strengthen guidelines to improve
quality, consistency, and ethical standards. Copyright © 2019 The
Authors. Published on behalf of the American Heart Association, Inc., by
Wiley.

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

<4>
Accession Number
628998142
Title
Myocardial viability and long-term outcomes in ischemic cardiomyopathy.
Source
New England Journal of Medicine. 381 (8) (pp 739-748), 2019. Date of
Publication: 22 Aug 2019.
Author
Panza J.A.; Ellis A.M.; Al-Khalidi H.R.; Holly T.A.; Berman D.S.; Oh J.K.;
Pohost G.M.; Sopko G.; Chrzanowski L.; Mark D.B.; Kukulski T.; Favaloro
L.E.; Maurer G.; Farsky P.S.; Tan R.-S.; Asch F.M.; Velazquez E.J.;
Rouleau J.L.; Lee K.L.; Bonow R.O.
Institution
(Panza) Division of Cardiology, Westchester Medical Center, 100 Woods Rd.,
Macy Pavillion, Valhalla, NY 10595, United States
(Ellis, Al-Khalidi, Mark, Lee) Duke Clinical Research Institute, Durham,
NC, United States
(Holly, Bonow) Northwestern University, Chicago, United States
(Berman) Cedars Sinai Medical Center
(Pohost) University of Southern California, Los Angeles, United States
(Oh) Mayo Clinic, Rochester, MN, United States
(Sopko) National Heart, Lung, and Blood Institute, Bethesda, MD, United
States
(Chrzanowski) Medical University of Lodz, Lodz, Poland
(Kukulski) Medical University of Silesia, Silesian Center for Heart
Diseases, Zabrze, Poland
(Favaloro) University Hospital Favaloro Foundation, Buenos Aires,
Argentina
(Maurer) Medical University of Vienna, Vienna, Austria
(Farsky) Institu-to Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Tan) National Hear t Center, Singapore, Singapore
(Asch) MedStar Washington Hospital Center, Washington, DC, United States
(Velazquez) Yale University School of Medicine, New Haven, CT, United
States
(Rouleau) Montreal Heart Institute, Montreal, Canada
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The role of assessment of myocardial viability in identifying
patients with ischemic cardiomyopathy who might benefit from surgical
revascularization remains controversial. Furthermore, although improvement
in left ventricular function is one of the goals of revascularization, its
relationship to subsequent outcomes is unclear. METHODS Among 601 patients
who had coronary artery disease that was amenable to coronary-artery
bypass grafting (CABG) and who had a left ventricular ejection fraction of
35% or lower, we prospectively assessed myocardial viability using
single-photon-emission computed tomography, dobutamine echocardiography,
or both. Patients were randomly assigned to undergo CABG and receive
medical therapy or to receive medical therapy alone. Left ventricular
ejection fraction was measured at baseline and after 4 months of follow-up
in 318 patients. The primary end point was death from any cause. The
median duration of follow-up was 10.4 years. RESULTS CABG plus medical
therapy was associated with a lower incidence of death from any cause than
medical therapy alone (182 deaths among 298 patients in the CABG group vs.
209 deaths among 303 patients in the medical-therapy group; adjusted
hazard ratio, 0.73; 95% confidence interval, 0.60 to 0.90). However, no
significant interaction was observed between the presence or absence of
myocardial viability and the beneficial effect of CABG plus medical
therapy over medical therapy alone (P=0.34 for interaction). An increase
in left ventricular ejection fraction was observed only among patients
with myocardial viability, irrespective of treatment assignment. There was
no association between changes in left ventricular ejection fraction and
subsequent death. CONCLUSIONS The findings of this study do not support
the concept that myocardial viability is associated with a long-term
benefit of CABG in patients with ischemic cardiomyopathy. The presence of
viable myocardium was associated with improvement in left ventricular
systolic function, irrespective of treatment, but such improvement was not
related to long-term survival. Copyright © 2019 Massachusetts
Medical Society.

<5>
Accession Number
2002662559
Title
Heart rate recovery and morbidity after noncardiac surgery: Planned
secondary analysis of two prospective, multi-centre, blinded observational
studies.
Source
PLoS ONE. 14 (8) (no pagination), 2019. Article Number: e0221277. Date of
Publication: 2019.
Author
Ackland G.L.; Abbott T.E.F.; Minto G.; Clark M.; Owen T.; Prabhu P.; May
S.M.; Reynolds J.A.; Cuthbertson B.H.; Wijesundera D.; Pearse R.M.
Institution
(Ackland, Abbott, May, Reynolds, Pearse) William Harvey Research
Institute, Queen Mary University of London, London, United Kingdom
(Minto) Department of Anaesthesia, Derriford Hospital, Plymouth Hospitals
NHS Trust, Peninsula Schools of Medicine and Dentistry, Plymouth
University, Plymouth, United Kingdom
(Clark) Department of Anaesthesia, Royal Bournemouth Hospital,
Bournemouth, United Kingdom
(Owen) Department of Anaesthesia, Royal Preston Hospital, Lancashire
Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
(Prabhu) Department of Anaesthesia, Royal Surrey County Hospital,
Guildford, United Kingdom
(Cuthbertson, Wijesundera) Department of Critical Care Medicine,
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Cuthbertson, Wijesundera) Department of Anesthesia, University of
Toronto, Toronto, ON, Canada
(Wijesundera) Li Ka Shing Knowledge Institute, St. Michael's Hospital,
Toronto, ON, Canada
(Wijesundera) Department of Anesthesia and Pain Management, Toronto
General Hospital, Toronto, ON, Canada
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Impaired cardiac vagal function, quantified preoperatively as
slower heart rate recovery (HRR) after exercise, is independently
associated with perioperative myocardial injury. Parasympathetic (vagal)
dysfunction may also promote (extra-cardiac) multi-organ dysfunction,
although perioperative data are lacking. Assuming that cardiac vagal
activity, and therefore heart rate recovery response, is a marker of
brainstem parasympathetic dysfunction, we hypothesized that impaired HRR
would be associated with a higher incidence of morbidity after noncardiac
surgery. Methods In two prospective, blinded, observational cohort
studies, we established the definition of impaired vagal function in terms
of the HRR threshold that is associated with perioperative myocardial
injury (HRR 12 beats min-1 (bpm), 60 seconds after cessation of
cardiopulmonary exercise testing. The primary outcome of this secondary
analysis was all-cause morbidity three and five days after surgery,
defined using the Post-Operative Morbidity Survey. Secondary outcomes of
this analysis were type of morbidity and time to become morbidity-free.
Logistic regression and Cox regression tested for the association between
HRR and morbidity. Results are presented as odds/hazard ratios [OR or HR;
(95% confidence intervals). Results 882/1941 (45.4%) patients had
HRR12bpm. All-cause morbidity within 5 days of surgery was more common in
585/822 (71.2%) patients with HRR12bpm, compared to 718/1119 (64.2%)
patients with HRR>12bpm (OR:1.38 (1.14-1.67); p = 0.001). HRR12bpm was
associated with more frequent episodes of pulmonary (OR:1.31 (1.05-1.62);p
= 0.02)), infective (OR:1.38 (1.10-1.72); p = 0.006), renal (OR:1.91
(1.30-2.79); p = 0.02)), cardiovascular (OR:1.39 (1.15-1.69); p<0.001)),
neurological (OR:1.73 (1.11-2.70); p = 0.02)) and pain morbidity (OR:1.38
(1.14-1.68); p = 0.001) within 5 days of surgery. Conclusions Multi-organ
dysfunction is more common in surgical patients with cardiac vagal
dysfunction, defined as HRR 12 bpm after preoperative cardiopulmonary
exercise testing. Copyright © 2019 Ackland et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<6>
Accession Number
2000985879
Title
Left Main Revascularization With PCI or CABG in Patients With Chronic
Kidney Disease: EXCEL Trial.
Source
Journal of the American College of Cardiology. 72 (7) (pp 754-765), 2018.
Date of Publication: 14 August 2018.
Author
Giustino G.; Mehran R.; Serruys P.W.; Sabik J.F.; Milojevic M.; Simonton
C.A.; Puskas J.D.; Kandzari D.E.; Morice M.-C.; Taggart D.P.; Gershlick
A.H.; Genereux P.; Zhang Z.; McAndrew T.; Redfors B.; Ragosta M.; Kron
I.L.; Dressler O.; Leon M.B.; Pocock S.J.; Ben-Yehuda O.; Kappetein A.P.;
Stone G.W.
Institution
(Giustino, Mehran) The Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicine at Mount Sinai, New York, New York,
United States
(Giustino, Mehran, Genereux, Zhang, McAndrew, Redfors, Dressler, Leon,
Ben-Yehuda, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, New York, United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland,
Ohio, United States
(Milojevic, Kappetein) Erasmus University Medical Center, Rotterdam,
Netherlands
(Simonton) Abbott Vascular, Santa Clara, California, United States
(Puskas) Mount Sinai Heart at Mount Sinai St. Luke's, New York, New York,
United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Morice) Ramsay Generale de Sante Hopital Prive Jacques Cartier, Massy,
France
(Taggart) Department Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
(Gershlick) University Hospitals of Leicester, Leicester, United Kingdom
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, New Jersey, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Ragosta, Kron) Division of Cardiovascular Medicine, University of
Virginia Health System, Charlottesville, Virginia, United States
(Leon, Ben-Yehuda, Stone) New York-Presbyterian Hospital/Columbia
University Medical Center, New York, New York, United States
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
Publisher
Elsevier USA
Abstract
Background: The optimal revascularization strategy for patients with left
main coronary artery disease (LMCAD) and chronic kidney disease (CKD)
remains unclear. Objective(s): This study investigated the
comparative effectiveness of percutaneous coronary intervention (PCI)
versus coronary artery bypass graft (CABG) surgery in patients with LMCAD
and low or intermediate anatomical complexity according to baseline renal
function from the multicenter randomized EXCEL (Evaluation of XIENCE
Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization) trial. Method(s): CKD was defined as an estimated
glomerular filtration rate <60 ml/min/1.73 m2 using the CKD
Epidemiology Collaboration equation. Acute renal failure (ARF) was defined
as a serum creatinine increase >=5.0 mg/dl from baseline or a new
requirement for dialysis. The primary composite endpoint was the composite
of death, myocardial infarction (MI), or stroke at 3-year follow-up.
 Result(s): CKD was present in 361 of 1,869 randomized patients
(19.3%) in whom baseline estimated glomerular filtration rate was
available. Patients with CKD had higher 3-year rates of the primary
endpoint compared with those without CKD (20.8% vs. 13.5%; hazard ratio
[HR]: 1.60; 95% confidence interval [CI]: 1.22 to 2.09; p = 0.0005). ARF
within 30 days occurred more commonly in patients with compared with those
without CKD (5.0% vs. 0.8%; p < 0.0001), and was strongly associated with
the 3-year risk of death, stroke, or MI (50.7% vs. 14.4%; HR: 4.59; 95%
CI: 2.73 to 7.73; p < 0.0001). ARF occurred less commonly after
revascularization with PCI compared with CABG both in patients with CKD
(2.3% vs. 7.7%; HR: 0.28; 95% CI: 0.09 to 0.87) and in those without CKD
(0.3% vs. 1.3%; HR: 0.20; 95% CI: 0.04 to 0.90; p<inf>interaction</inf> =
0.71). There were no significant differences in the rates of the primary
composite endpoint after PCI and CABG in patients with CKD (23.4% vs.
18.1%; HR: 1.25; 95% CI: 0.79 to 1.98) and without CKD (13.4% vs. 13.5%;
HR: 0.97; 95% CI: 0.73 to 1.27; p<inf>interaction</inf> = 0.38).
 Conclusion(s): Patients with CKD undergoing revascularization for
LMCAD in the EXCEL trial had increased rates of ARF and reduced event-free
survival. ARF occurred less frequently after PCI compared with CABG. There
were no significant differences between PCI and CABG in terms of death,
stroke, or MI at 3 years in patients with and without CKD. (EXCEL Clinical
Trial [EXCEL]; NCT01205776) Copyright © 2018 American College of
Cardiology Foundation

<7>
Accession Number
620323110
Title
Expert consensus document: A 'diamond' approach to personalized treatment
of angina.
Source
Nature Reviews Cardiology. 15 (2) (pp 120-132), 2018. Date of Publication:
01 Feb 2018.
Author
Ferrari R.; Camici P.G.; Crea F.; Danchin N.; Fox K.; Maggioni A.P.;
Manolis A.J.; Marzilli M.; Rosano G.M.C.; Lopez-Sendon J.L.
Institution
(Ferrari) Centro Cardiologico Universitario, University Hospital of
Ferrara, Via Aldo Moro 8, Cona, Ferrara 44124, Italy
(Ferrari) Maria Cecilia Hospital, GVM Care and Research, Via Corriera 1,
Cotignola (RA), Italy
(Camici) Vita Salute University, San Raffaele Hospital, Via Olgettina
Milano, 58-60, Milan 20132, Italy
(Crea) Department of Cardiovascular and Thoracic Sciences, Catholic
University, Largo Francesco Vito, 1, Rome 00168, Italy
(Danchin) Cardiology, European Hospital Georges-Pompidiou, 20 Rue Leblanc,
Paris 75015, France
(Fox) National Heart and Lung Institute, Imperial College, Institute of
Cardiovascular Medicine and Science, Royal Brompton Hospital, Sydney
Street, London SW3 6NP, United Kingdom
(Maggioni) ANMCO Research Center, Via A. La Marmora, 36, Florence 50121,
Italy
(Manolis) Department of Cardiology, Asklepeion General Hospital, 1, Vas.
Pavlou Street, Voula, Athens 16673, Greece
(Marzilli) Cardiothoracic Department, Lungarno Antonio Pacinotti, 43, Pisa
56126, Italy
(Marzilli) Nottola Cardiology Division, Localita Nottola, Ospedali Riuniti
Valdichiana Sudest Siena 53045, Italy
(Rosano) Clinical Academic Group, St George's Hospitals NHS Trust,
Blackshaw Road, London SW17 0QT, United Kingdom
(Rosano) Department of Medical Sciences IRCCS San Raffaele, Via della
Pisana, 235, Rome 00163, Italy
(Lopez-Sendon) Cardiology Department, Hospital Universitario la Paz,
IdiPaz, Paseo de la Castellana 261, Madrid 28036, Spain
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
In clinical guidelines, drugs for symptomatic angina are classified as
being first choice (beta-blockers, calcium-channel blockers, short-acting
nitrates) or second choice (ivabradine, nicorandil, ranolazine,
trimetazidine), with the recommendation to reserve second-choice
medications for patients who have contraindications to first-choice
agents, do not tolerate them, or remain symptomatic. No direct comparisons
between first-choice and second-choice treatments have demonstrated the
superiority of one group of drugs over the other. Meta-analyses show that
all antianginal drugs have similar efficacy in reducing symptoms, but
provide no evidence for improvement in survival. The newer, second-choice
drugs have more evidence-based clinical data that are more contemporary
than is available for traditional first-choice drugs. Considering some
drugs, but not others, to be first choice is, therefore, difficult.
Moreover, double or triple therapy is often needed to control angina.
Patients with angina can have several comorbidities, and symptoms can
result from various underlying pathophysiologies. Some agents, in addition
to having antianginal effects, have properties that could be useful
depending on the comorbidities present and the mechanisms of angina, but
the guidelines do not provide recommendations on the optimal combinations
of drugs. In this Consensus Statement, we propose an individualized
approach to angina treatment, which takes into consideration the patient,
their comorbidities, and the underlying mechanism of
disease. Copyright © 2018 Macmillan Publishers Limited, part of
Springer Nature. All rights reserved.

<8>
Accession Number
619188996
Title
Frailty and Clinical Outcomes in Advanced Heart Failure Patients
Undergoing Left Ventricular Assist Device Implantation: A Systematic
Review and Meta-analysis.
Source
Journal of the American Medical Directors Association. 19 (3) (pp
255-261.e1), 2018. Date of Publication: March 2018.
Author
Tse G.; Gong M.; Wong S.H.; Wu W.K.K.; Bazoukis G.; Lampropoulos K.; Wong
W.T.; Xia Y.; Wong M.C.S.; Liu T.; Woo J.
Institution
(Tse, Wong, Woo) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, SAR, Hong Kong
(Tse, Wong, Wu) Li Ka Shing Institute of Health Sciences, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, SAR, Hong Kong
(Gong, Liu) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Wu) Department of Anaesthesia and Intensive Care, State Key Laboratory of
Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong
Kong
(Bazoukis, Lampropoulos) Second Department of Cardiology, Laboratory of
Cardiac Electrophysiology, Evangelismos General Hospital of Athens,
Athens, Greece
(Wong) School of Life Sciences, The Chinese University of Hong Kong, Hong
Kong, Hong Kong
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Wong) JC School of Public Health and Primary Care, The Chinese University
of Hong Kong, Hong Kong, Hong Kong
(Wong) State Key Laboratory of Digestive Disease, Chinese University of
Hong Kong, Hong Kong
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Frailty has been identified as a risk factor for adverse
clinical outcomes after cardiac intervention or surgery. However, whether
it increases the risk of adverse outcomes in patients undergoing left
ventricular assist device (LVAD) therapy has been controversial.
Therefore, we conducted a systematic review and meta-analysis of the
frailty measures and clinical outcomes of length of stay and mortality in
this setting. Method(s): PubMed and Embase were searched until
September 11, 2017, for studies evaluating the association between frailty
and clinical outcomes in advanced heart failure patients undergoing LVAD
implantation. Result(s): A total of 46 and 79 entries were retrieved
from our search strategy. A total of 13 studies involving 3435 patients
were included in the final meta-analysis (mean age: 57.7 +/- 15.3 years;
79% male, follow-up duration was 13 +/- 14 months). Compared to nonfrail
patients (n = 2721), frail patients (n = 579) had significantly longer
time-to-extubation (n = 3; mean difference: 45 +/- 6 hours; I2:
0%) and hospital length of stay (n = 4; mean difference: 2.9 +/- 1.2 days;
P =.001; I2: 21%). Frailty was not a predictor of inpatient or
short-term mortality [n = 3; hazard ratio (HR): 1.22, 95% confidence
interval (CI): 0.66-2.26; P >.05; I2: 0%] but predicted
long-term mortality (n = 7; HR: 1.44, 95% CI: 1.15-1.80; P =.001;
I2: 0%). Conclusion(s): Frailty leads to significantly
longer time to extubation, hospital length of stay, and long-term
mortality in advanced heart failure patients who have undergone LVAD
implantation. Older patients being considered for LVAD implantation should
therefore be assessed for frailty status. The risk and benefit of the
procedure should be explained to the patient, emphasizing that frailty
increases the likelihood of adverse clinical outcomes. Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine

<9>
Accession Number
623222438
Title
Periprocedural cardiopulmonary bypass or venoarterial extracorporeal
membrane oxygenation during transcatheter aortic valve replacement: A
systematic review.
Source
Journal of the American Heart Association. 7 (14) (no pagination), 2018.
Article Number: e009608. Date of Publication: 01 Jul 2018.
Author
Patlolla S.H.; Sandhyavenu H.; Vallabhajosyula S.; Barsness G.W.; Dunlay
S.M.; Greason K.L.; Holmes D.R.; Eleid M.F.
Institution
(Vallabhajosyula, Patlolla, Sandhyavenu, Vallabhajosyula, Barsness,
Dunlay, Holmes, Eleid) Departments of Cardiovascular Medicine, Mayo
Clinic, Rochester, MN, United States
(Greason) Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United
States
Publisher
American Heart Association Inc.
Abstract
Background-There are limited data on the use of venoarterial
extracorporeal membrane oxygenation (VA-ECMO) or cardiopulmonary bypass
(CPB) to provide hemodynamic support periprocedurally during transcatheter
aortic valve replacement. This study sought to evaluate patients receiving
transcatheter aortic valve replacement with concomitant use of
CPB/VA-ECMO. Methods and Results-We systematically reviewed the published
literature from 2000 to 2018 for studies evaluating adult patients
requiring CPB/VA-ECMO periprocedurally during transcatheter aortic valve
replacement. Studies reporting short-term and long-term mortality were
included. Given the significant methodological and statistical differences
between published studies, meta-analysis of the association of CPB/VA-ECMO
with mortality was not performed. Of the 537 studies identified, 9 studies
representing 5191 patients met our inclusion criteria. Median ages were
between 75 and 87 years with 33% to 75% male patients. Where reported, the
Edwards SAPIENTM transcatheter heart valve was the most frequently used. A
total of 203 (3.9%) patients received periprocedural hemodynamic support
with CPB/VA-ECMO. Common indications for CPB/VA-ECMO included left
ventricular or aortic annular rupture, rapid hemodynamic deterioration,
aortic regurgitation, cardiac arrest, and left main coronary artery
obstruction. The use of CPB/VA-ECMO was predominantly an emergent strategy
and was used for durations of 1 to 2 hours. Short-term mortality
(in-hospital and 30-day) was 29.8%, and 1-year mortality was 52.4%. Major
complications such as bleeding, vascular injury, tamponade, stroke, and
renal failure were noted in 10% to 50% of patients.
Conclusions-CPB/VA-ECMO was used in 4% in the early experience of patients
undergoing transcatheter aortic valve replacement, most commonly for
periprocedural complications. There are limited data on preprocedural
planned use of VA-ECMO, and the characteristics of this population remain
poorly defined. Copyright © 2018 The Authors.

<10>
Accession Number
2000790595
Title
Transcaval approach for endovascular aortic interventions: A systematic
review.
Source
Journal of Cardiology. 72 (5) (pp 369-376), 2018. Date of Publication:
November 2018.
Author
Wee I.J.Y.; Syn N.; Choong A.M.T.L.
Institution
(Wee, Syn, Choong) SingVaSC, Singapore Vascular Surgical Collaborative,
Singapore
(Wee) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
The caval-aortic path is a novel access route for endovascular aortic
interventions in aortic interventions, particularly for patients
unsuitable for traditional access routes including femoral, subclavian,
transapical, and aortic. A systematic review was conducted as per the
PRISMA guidelines utilizing three electronic databases: Medline, Embase,
and Cochrane database. There were 10 studies identified, including 7
retrospective studies, 1 prospective cohort study, and 2 case reports.
Data on 209 patients (mean age 79.5 +/- 5.1 years; 51.2% male) were
abstracted including preoperative work-up, technical procedure details,
and outcomes. The overall technical success rate for all procedures is
96.2%, with a 4.3% mortality rate and a mean follow up of 17.9 +/- 19.8
months. Individually in the various interventions, the technical success
rate of transcaval endoleak repair and transcatheter aortic valve
implantation (TAVI) was 94.4% and 97.5% respectively, with a low 30-day
mortality rate of 7.6% in the TAVI intervention. There is encouraging
evidence regarding the rates of mortality and complications in the
transcaval approach for endovascular aortic interventions. It presents a
feasible alternative for a judiciously select group of patients who are
not suitable for other access routes. Copyright © 2018 Japanese
College of Cardiology

<11>
Accession Number
2000945744
Title
Transcatheter Aortic Valve Replacement of Failed Surgically Implanted
Bioprostheses: The STS/ACC Registry.
Source
Journal of the American College of Cardiology. 72 (4) (pp 370-382), 2018.
Date of Publication: 24 July 2018.
Author
Tuzcu E.M.; Kapadia S.R.; Vemulapalli S.; Carroll J.D.; Holmes D.R.; Mack
M.J.; Thourani V.H.; Grover F.L.; Brennan J.M.; Suri R.M.; Dai D.;
Svensson L.G.
Institution
(Tuzcu, Suri) Cleveland Clinic, Abu Dhabi, United Arab Emirates
(Kapadia, Svensson) Cleveland Clinic, Cleveland, Ohio, United States
(Vemulapalli, Brennan, Dai) Duke University Medical Center, Duke Clinical
Research Institute, Durham, North Carolina, United States
(Carroll) University of Colorado, Anschutz Medical Campus, School of
Medicine, Aurora, Colarado, United States
(Holmes) Mayo Clinic, Rochester, Minnesota, United States
(Mack) Baylor Scott and White Health, Plano, Texas, United States
(Thourani) Medstar Washington Hospital Center, Washington, DC, United
States
(Grover) Department of Surgery, School of Medicine, University of
Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
(Grover) Denver Department of Veterans Affairs Medical Center, Denver,
Colorado, United States
Publisher
Elsevier USA
Abstract
Background: Valve-in-valve (ViV) transcatheter aortic valve replacement
(TAVR) has been shown to be feasible, yet the safety and efficacy in
relation to native valve (NV) TAVR are not known. Objective(s): This
study sought to evaluate the safety and effectiveness of ViV TAVR for
failed surgical aortic valve replacement (SAVR) by comparing it with the
benchmark of NV TAVR. Method(s): Patients who underwent ViV-TAVR (n =
1,150) were matched 1:2 (on sex, high or extreme risk, hostile chest or
porcelain aorta, 5-m-walk time, and Society of Thoracic Surgeons Predicted
Risk of Mortality for reoperation) to patients undergoing NV-TAVR (n =
2,259). Baseline characteristics, procedural data, and in-hospital
outcomes were obtained from the Transcatheter Valve Therapy Registry. The
30-day and 1-year outcomes were obtained from linked Medicare
administrative claims data. Result(s): Unadjusted analysis revealed
lower 30-day mortality (2.9% vs. 4.8%; p < 0.001), stroke (1.7% vs. 3.0%;
p = 0.003), and heart failure hospitalizations (2.4% vs. 4.6%; p < 0.001)
in the ViV-TAVR compared with NV-TAVR group. Adjusted analysis revealed
lower 30-day mortality (hazard ratio: 0.503; 95% confidence interval:
0.302 to 0.839; p = 0.008), lower 1-year mortality (hazard ratio: 0.653;
95% confidence interval: 0.505 to 0.844; p = 0.001), and hospitalization
for heart failure (hazard ratio: 0.685; 95% confidence interval: 0.500 to
0.939; p = 0.019) in the ViV-TAVR group. Patients in the ViV-TAVR group
had higher post-TAVR mean gradient (16 vs. 9 mm Hg; p < 0.001), but less
moderate or severe aortic regurgitation (3.5% vs. 6.6%; p < 0.001).
Post-TAVR gradients were highest in small SAVRs and stenotic SAVRs.
 Conclusion(s): Comparison with the benchmark NV-TAVR shows ViV-TAVR
to be a safe and effective procedure in patients with failed SAVR who are
at high risk for repeat surgery. Copyright © 2018 American
College of Cardiology Foundation

<12>
Accession Number
623937971
Title
Use of low-dose dexmedetomidine in combination with opioids and midazolam
in pediatric cardiac surgical patients: Randomized controlled trial.
Source
Minerva Anestesiologica. 84 (9) (pp 1053-1062), 2018. Date of Publication:
September 2018.
Author
Garisto C.; Ricci Z.; Tofani L.; Benegni S.; Pezzella C.; Cogo P.
Institution
(Garisto, Ricci, Benegni) Pediatric Cardiac Intensive Care Unit,
Department of Cardiology and Cardiac Surgery, Bambino Gesu Children's
Hospital, IRCCS, Rome, Italy
(Tofani) Department of Neurosciences, Psychology, Drug Research and Child
Health, University of Florence, Florence, Italy
(Pezzella) ASLTO3, Susa-Rivoli Hospital, Rivoli, Italy
(Cogo) Department of Medicine, University of Udine, Udine, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Dexmedetomidine is a selective agonist of alpha2 receptors
that induces hypnotic, sedative and mild analgesic effect. The aim of our
study was to test the effects of dexmedetomidine in combination with
opioids and benzodiazepines compared to benzodiazepine-opioids alone.
 METHOD(S): Arandomized controlled trial was conducted. Patients
(children >30 days and <24 months undergoing correction of complex
congenital heart diseases [CHD]) were randomized to receive 0.5 mcg/kg/h
dexmedetomidine in addition to half dose of opioids and benzodiazepines
(D-CASES) or standard dose opioids and benzodiazepines (CONTROLs).
 Primary Outcome: to compare the duration of mechanical ventilation
(MV) in D-CASEs and CONTROLs. Secondary Outcomes: 1) the degree of
sedation; 2) the onset of withdrawal symptoms; 3) the occurrence
bradycardia and hypotension. RESULT(S): Overall, 48 patients, 26 in
CONTROLs group and 22 in D-CASEs group were ultimately included in the
analysis after enrollment. The median duration of MV was 33.5 (16.7-75)
hours in CONTROLs and 41.5 (23.7-71.2) hours in D-CASEs (P=0.51).
Dexmedetomidine did not affect COMFORTand FLACCscales but it reduced the
SOSscale in 15 D-CASEs vs. 11 CONTROLs (P=0.001). The incidence of
bradycardia and hypotension and vasoactive support did not show
significant differences in the two groups. CONCLUSION(S): Low dose of
dexmedetomidine in combination with morphine and midazolam was safe in a
high-risk cohort of CHD children after cardiac surgery and reduced the
onset of withdrawal symptoms. However, it did not decrease MV time and the
total amount of other sedative and analgesic drugs required in the
post-operative period. Copyright © 2018 Edizioni Minerva Medica.

<13>
Accession Number
372485215
Title
Aspirin and clonidine in non-cardiac surgery: Acute kidney injury substudy
protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised
controlled trial.
Source
BMJ Open. 4 (2) (no pagination), 2014. Article Number: 004886. Date of
Publication: 2014.
Author
Garg A.X.; Kurz A.; Sessler D.I.; Cuerden M.; Robinson A.; Mrkobrada M.;
Parikh C.; Mizera R.; Jones P.M.; Tiboni M.; Rodriguez R.G.; Popova E.;
Gomez M.F.R.; Meyhoff C.S.; Vanhelder T.; Chan M.T.V.; Torres D.; Parlow
J.; De Nadal Clanchet M.; Amir M.; Bidgoli S.J.; Pasin L.; Martinsen K.;
Malaga G.; Myles P.; Acedillo R.; Roshanov P.; Walsh M.; Dresser G.; Kumar
P.; Fleischmann E.; Villar J.C.; Painter T.; Biccard B.; Bergese S.;
Srinathan S.; Cata J.P.; Chan V.; Mehra B.; Leslie K.; Whitlock R.;
Devereaux P.J.
Institution
(Garg, Mrkobrada, Jones, Acedillo, Roshanov, Dresser) Western University,
London Health Sciences Centre, London, ON, Canada
(Kurz, Sessler) Cleveland Clinic, Cleveland, OH, United States
(Cuerden) University of Waterloo, Waterloo, Canada
(Robinson, Mizera, Tiboni, Vanhelder, Walsh, Whitlock, Devereaux)
Population Health Research Institute, McMaster University, Hamilton Health
Sciences/St Joseph's Healthcare, Hamilton, ON, Canada
(Parikh) Yale University, CT, United States
(Rodriguez, Popova) Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
(Gomez) Fundacion Oftalmologica de Santander (FOSCAL), Bucaramanga,
Colombia
(Meyhoff) Copenhagen University Hospital Herlev, Herlev, Denmark
(Chan) Chinese University of Hong Kong, Hong Kong Special Administrative
Region, Hong Kong
(Torres) Clinica Santa Maria, Santiago, Chile
(Parlow) Kingston General Hospital, Kingston, Canada
(De Nadal Clanchet) Hospital Vall d'Hebron, Barcelona, Spain
(Amir) Shifa International Hospitals Limited, Islamabad, Pakistan
(Bidgoli) CHU Brugmann, Brussels, Belgium
(Pasin) San Raffaele Scientific Institute, Milan, Italy
(Martinsen) Vejle Hospital, Vejle, Denmark
(Malaga) Hospital Nacional Cayetano Heredia, Lima, Peru
(Myles) Monash University, Melbourne, VIC, Australia
(Kumar) University of North Carolina Medical School, Chapel Hill, NC,
United States
(Fleischmann) Vienna General Hospital, Medical University of Vienna,
Vienna, Austria
(Villar) Fundacion Cardioinfantil (FCI), Bogota, Colombia
(Painter) Royal Adelaide Hospital, Adelaide, SA, Australia
(Biccard) Nelson R Mandela School of Medicine, Durban, South Africa
(Bergese) Ohio State University Medical Center, Columbus, OH, United
States
(Srinathan) University of Manitoba, Winnipeg, MB, Canada
(Cata) University of Texas, MD Anderson Cancer Center, Houston, TX, United
States
(Chan) University of Toronto, Toronto, ON, Canada
(Mehra) Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra,
India
(Leslie) Royal Melbourne Hospital, Melbourne, VIC, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Perioperative Ischaemic Evaluation-2 (POISE-2) is an
international 2x2 factorial randomised controlled trial of low-dose
aspirin versus placebo and low-dose clonidine versus placebo in patients
who undergo non-cardiac surgery. Perioperative aspirin (and possibly
clonidine) may reduce the risk of postoperative acute kidney injury (AKI).
Methods and analysis: After receipt of grant funding, serial postoperative
serum creatinine measurements began to be recorded in consecutive patients
enrolled at substudy participating centres. With respect to the study
schedule, the last of over 6500 substudy patients from 82 centres in 21
countries were randomised in December 2013. The authors will use logistic
regression to estimate the adjusted OR of AKI following surgery (compared
with the preoperative serum creatinine value, a postoperative increase
>=26.5 mumol/L in the 2 days following surgery or an increase of >=50% in
the 7 days following surgery) comparing each intervention to placebo, and
will report the adjusted relative risk reduction. Alternate definitions of
AKI will also be considered, as will the outcome of AKI in subgroups
defined by the presence of preoperative chronic kidney disease and
preoperative chronic aspirin use. At the time of randomisation, a
subpopulation agreed to a single measurement of serum creatinine between 3
and 12 months after surgery, and the authors will examine intervention
effects on this outcome. Ethics and dissemination: The authors were
competitively awarded a grant from the Canadian Institutes of Health
Research for this POISE-2 AKI substudy. Ethics approval was obtained for
additional kidney data collection in consecutive patients enrolled at
participating centres, which first began for patients enrolled after
January 2011. In patients who provided consent, the remaining longer term
serum creatinine data will be collected throughout 2014. The results of
this study will be reported no later than 2015. Clinical Trial
Registration Number: NCT01082874.

<14>
Accession Number
2001254585
Title
Prophylactic Effect of Amiodarone Infusion on Reperfusion Ventricular
Fibrillation After Release of Aortic Cross-Clamp in Patients with Left
Ventricular Hypertrophy Undergoing Aortic Valve Replacement: ARandomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1205-1213),
2019. Date of Publication: May 2019.
Author
Mita N.; Kagaya S.; Miyoshi S.; Kuroda M.
Institution
(Mita, Kagaya, Miyoshi) Department of Anesthesiology, Saitama
Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
(Kuroda) Department of Anesthesiology, Saiseikai Utsunomiya Hospital,
Utsunomiya City, Tochigi, Japan
Publisher
W.B. Saunders
Abstract
Objective: To investigate whether prophylactic amiodarone infusion
prevents ventricular fibrillation after aortic cross-clamp release and
attenuates cytokine production in patients with left ventricular
hypertrophy undergoing cardiac surgery. Design(s): Prospective,
randomized controlled trial. Setting(s): A public hospital.
 Participant(s): The study comprised 68 patients undergoing aortic
valve replacement for severe aortic stenosis. Intervention(s):
Patients were randomly assigned to receive a 150mg bolus then 30mg/h
continuous infusion of amiodarone (amiodarone group) or a 1 mg/kg bolus
then 1 mg/kg/h continuous infusion of lidocaine (lidocaine group). The
primary outcome was the ventricular fibrillation incidence rate after
aortic cross-clamp release. Secondary outcomes included perioperative
serum interleukin-6 and tumor necrosis factor-alpha levels.
 Measurements and Main Results: The ventricular fibrillation incidence
rate was significantly lower in the amiodarone than in the lidocaine group
(20.6% v 50%, relative risk 0.41; 95% confidence interval [CI] 0.20-0.86;
p = 0.021). Interleukin-6 levels 1hour after aortic cross-clamp release
and at intensive care unit admission were significantly lower in the
amiodarone than in the lidocaine group (geometric mean [95% CI] 117.4pg/mL
[87.1-158.4] v 339.5pg/mL [210.6-547.2]; p < 0.01 and 211.1pg/mL
[162.8-73.6] v 434.1pg/mL [293.7-641.5]; p < 0.01, respectively). Tumor
necrosis factor-alpha levels 1hour after aortic cross-clamp release were
significantly lower in the amiodarone than in the lidocaine group
(geometric mean [95% CI] 1.624pg/mL [1.359-1.940] v 2.283pg/mL
[1.910-2.731]; p = 0.02). Conclusion(s): Amiodarone prevented
reperfusion ventricular fibrillation in patients with left ventricular
hypertrophy undergoing aortic valve replacement to a greater extent than
did lidocaine. Furthermore, amiodarone inhibited postoperative
interleukin-6 and tumor necrosis factor-alpha production. Copyright
© 2018 Elsevier Inc.

<15>
Accession Number
2001457219
Title
Fragility of Red Blood Cells Collected Under Different Conditions With a
Cell Saver Device.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1224-1229),
2019. Date of Publication: May 2019.
Author
Chung Y.S.; Kim H.R.; Kang H.; Ryu C.; Park B.; Hong J.
Institution
(Chung, Park, Hong) Department of Thoracic and Cardiovascular Surgery,
Chung-Ang University Hospital, Seoul, South Korea
(Kim) Department of Laboratory Medicine, Chung-Ang University Hospital,
Seoul, South Korea
(Kang, Ryu) Department of Anesthesiology and Pain Medicine, Chung-Ang
University Hospital, Seoul, South Korea
Publisher
W.B. Saunders
Abstract
Objective: To quantify the degree of lethal and sublethal damage to red
blood cells (RBCs) by cell saver (CS) processing among different
conditions of shed blood in cardiac surgery. Design(s): Prospective
randomized, double-blinded, controlled study. Setting(s): Single
university hospital. Participant(s): Twenty rabbits were divided
randomly into non-heparinized and heparinized groups. Thereafter, each
group was subdivided into non-gauze and gauze groups based on whether the
blood was collected with gauze and squeezed out. Intervention(s):
Blood from each group was aspirated directly from the heart and underwent
CS processing. Mechanical fragility index (MFI) and percent hemolysis were
measured pre- and post-CS processing. Measurements and Main Results:
In RBCs after CS processing, the MFI and percent hemolysis were increased
significantly in both the non-heparinized and heparinized groups compared
to pre-CS processing. The MFI was significantly higher in the heparinized
group than in the non-heparinized group (p = 0.002). However, no
differences in percent hemolysis were detected between groups (p = 0.696).
The MFI and percent hemolysis of the non-gauze and gauze groups did not
differ. Conclusion(s): This study reports the increase in sublethal
and lethal injuries to RBCs from heparinized and non-heparinized blood
after CS processing. CS-processed heparinized blood contained more
sublethally injured RBCs compared to CS-processed non-heparinized blood.
RBCs collected by squeezing blood-saturated gauze did not exhibit
additional trauma. Further investigation is required to determine the
clinical implications of transfusing rescued but injured RBCs using a
CS. Copyright © 2018 Elsevier Inc.

<16>
Accession Number
2001111602
Title
Perioperative Anxiety and Stress in Children Undergoing Congenital Cardiac
Surgery and Their Parents: Effect of Brief Intervention-A Randomized
Control Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1244-1250),
2019. Date of Publication: May 2019.
Author
Kumar A.; Das S.; Chauhan S.; Kiran U.; Satapathy S.
Institution
(Kumar, Das, Chauhan, Kiran) Department of Cardiac Anaesthesia, All India
Institute of Medical Sciences, New Delhi, India
(Satapathy) Department of Clinical Psychology, All India Institute of
Medical Sciences, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: To know the effects of psychological preparation on
perioperative stress, anxiety, and mood in children undergoing cardiac
surgery and their parents. Design(s): Prospective randomized control
nonblinded trial. Setting(s): Single-center tertiary teaching
hospital. Participant(s): A total of 60 children aged 5 to 15 years
undergoing cardiac surgery were included in the study. One of the parents,
preferably the father, was selected from the respective children.
 Intervention(s): Subjects were randomized into 2 groups:
noninterventional (group 1) and interventional (group 2). Intervention was
in the form of toys and video games in children, and counseling and
information in parents. Preoperative and postoperative anxiety in parents
was measured using the State-Trait Anxiety Inventory (STAI), stress using
the Index of Clinical Stress (ICS) scale by Abell, and the Ottawa mood
scale. In children, the STAI-C (child version of STAI), Ottawa mood and
Ottawa stress scales, and Wong-Baker faces pain scale were applied and
serum cortisol was measured. Measurements and Main Results: Group 2
children had significantly less (p < 0.001) stress, anxiety, and pain and
improved mood. Group 2 parents had a significant reduction in state
anxiety (42 +/- 4.4 v 54.5 +/- 7.8; p < 0.001) and ICS score (68.1+/-9.6 v
84.2 +/- 9.2; p < 0.001) and an improvement in mood (7.5 +/- 0.7 v 5.9 +/-
1; p < 0.001) compared with group 1. Postoperatively, cortisol levels in
group 2 were lower than group 1 (571.3 nmol/L [123.3 -1247.14] v 718.9
nmol/L [53-1642.0]). Conclusion(s): Providing video games and toys
preoperatively reduced postoperative stress and anxiety and improved mood
in children undergoing congenital cardiac surgery. Parents were relieved
of anxiety and stress with proper counseling and
information. Copyright © 2018 Elsevier Inc.

<17>
Accession Number
2001116317
Title
Establishment of Predictive Models for Nonocclusive Mesenteric Ischemia
Comparing 8,296 Control with 452 Study Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1290-1297),
2019. Date of Publication: May 2019.
Author
Bomberg H.; Stroeder J.; Karrenbauer K.; Groesdonk H.V.; Wagenpfeil S.;
Klingele M.; Bucker A.; Schafers H.-J.; Minko P.
Institution
(Bomberg, Karrenbauer, Schafers) Department of Thoracic and Cardiovascular
Surgery, Saarland University Medical Center, Homburg/Saar, Germany
(Bomberg, Groesdonk) Department of Anesthesiology, Intensive Care Medicine
and Pain Medicine, Saarland University Medical Center, Homburg/Saar,
Germany
(Stroeder, Bucker, Minko) Department of Diagnostic and Interventional
Radiology, Saarland University Medical Center, Homburg/Saar, Germany
(Wagenpfeil) Institute for Medical Biometry, Epidemiology and Medical
Informatics, Saarland University Medical Center, Homburg/Saar, Germany
(Klingele) Department of Medicine, Division of Nephrology and
Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
(Klingele) Department of Nephrology, Hochtaunus-Kliniken, Bad Homburg,
Germany
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to develop clinical preoperative,
intraoperative, and postoperative scores for early identification of
patients who are at risk of nonocclusive mesenteric ischemia (NOMI).
 Design(s): A retrospective analysis. Setting(s): Single center.
 Participant(s): From January 2008 to December 2014, all patients from
the Department of Thoracic and Cardiovascular Surgery were included on the
basis of the hospital database. Intervention(s): All mesenteric
angiographically identified NOMI patients were compared with non-NOMI
patients. Measurements and Main Results: The study population of
8,748 patients was randomized into a cohort for developing the scores
(non-NOMI 4,214 and NOMI 235) and a cohort for control (non-NOMI 4,082 and
NOMI 217). Risk factors were identified using forward and backward Wald
test and were included in the predictive scores for the occurrence of
NOMI. C statistic showed that the scores had a high discrimination for the
prediction of NOMI preoperatively (C statistic 0.79; p < 0.001),
intraoperatively (C statistic 0.68; p < 0.001), and postoperatively (C
statistic 0.85; p < 0.001). A combination of the preoperative,
intraoperative, and postoperative risk scores demonstrated the highest
discrimination (C statistic 0.87; p < 0.001). The combined score included
the following risk factors: renal insufficiency (preoperative); use of
cardiopulmonary bypass and intra-aortic balloon pump support
(intraoperative); and reexploration for bleeding, renal replacement
therapy, and packed red blood cells >= 4 units (postoperative). The
results were similar in the control group. Conclusion(s): These
scores could be useful to identify patients at risk for NOMI and promote a
rapid diagnosis and therapy. Copyright © 2018 Elsevier Inc.

<18>
Accession Number
2001352697
Title
Optimal Position of Inferior Vena Cava Cannula in Pediatric Cardiac
Surgery: A Prospective, Randomized, Controlled, Double-Blind Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1253-1259),
2019. Date of Publication: May 2019.
Author
Seino Y.; Ohashi N.; Imai H.; Baba H.
Institution
(Seino, Ohashi, Imai, Baba) Division of Anesthesiology, Niigata University
Graduate School of Medical and Dental Sciences, Asahimachi, Niigata, Japan
Publisher
W.B. Saunders
Abstract
Objective: To examine the authors' hypothesis that during the
cardiopulmonary bypass (CPB) in children, the inferior vena cava cannula
tip placed proximal to the right hepatic vein orifice would produce a
higher venous drainage compared with that placed distally. Design(s):
A prospective, randomized, controlled, double-blind study.
 Setting(s): Single university hospital. Participant(s):
Thirty-two patients aged <6years, scheduled for elective cardiac surgery
using CPB for congenital heart disease. Intervention(s): Participants
were randomized to 2 groups: the proximal group with the cannula tip
placed proximally within 1cm of the right hepatic vein orifice and the
distal group with the cannula placed distally within 1cm of the right
hepatic vein orifice. Measurements and Main Results: The primary
outcome of this study was the perfusion flow rate at the time of
establishment of total CPB with cardioplegia. The authors initially
planned to enroll 60 patients, but before reaching the target sample size,
the authors terminated this study owing to patient safety, and 18 patients
in the proximal group and 14 patients in the distal group finally were
analyzed. No significant differences in patient characteristics were
observed between the 2 groups. The mean perfusion flow rate in the
proximal group was significantly greater (2.55 +/- 0.27
L/min/m2) than that in the distal group (2.37 +/- 0.20
L/min/m2, p = 0.04). Conclusion(s): The inferior vena cava
cannula tip placed in the proximal position was clinically superior,
compared with a distal placement, in producing higher perfusion flow in
children. Copyright © 2018 Elsevier Inc.

<19>
Accession Number
2002482077
Title
Peritoneal Dialysis Vs Diuretics in Children After Congenital Heart
Surgery.
Source
Annals of Thoracic Surgery. 108 (3) (pp 806-812), 2019. Date of
Publication: September 2019.
Author
Flores S.; Loomba R.S.; Elhoff J.J.; Bronicki R.A.; Mery C.M.; Alsaied T.;
Alahdab F.
Institution
(Flores, Elhoff, Bronicki) Section of Critical Care Medicine and
Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor
College of Medicine, Houston, TX, United States
(Loomba) Advocate Children's Heart Institute/Advocate Children's Hospital,
Oak Lawn, IL, United States
(Mery) Section of Congenital Heart Surgery, Department of Surgery, Texas
Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Alsaied) Department of Pediatrics, Cincinnati Children's Hospital Heart
Institute, University of Cincinnati, Cincinnati, OH, United States
(Alahdab) Mayo Evidence-based Practice Center, Mayo Clinic, Rochester, MN,
United States
Publisher
Elsevier USA
Abstract
Background: This study sought to evaluate outcomes of patients undergoing
congenital heart surgery who underwent peritoneal dialysis (PD) vs a
diuretic regimen. Method(s): This study conducted a comprehensive
search in Medline, EMBASE, Scopus, the Cochrane Central Register of
Controlled Trials, and the Cochrane Database of Systematic Reviews from
the databases' inception through April 24, 2018. Independent reviewers
selected studies and extracted data. A random effects meta-analysis was
performed to pool the outcomes of interest across studies. Result(s):
A total of 8 studies (2 prospective studies, 2 randomized clinical trials,
and 4 retrospective studies) with 507 patients were included in this
review. A total of 204 (40%) patients underwent PD, whereas the remaining
patients underwent fluid removal with diuretics. The analyses demonstrated
a significantly shorter time of mechanical ventilation in those patients
who underwent PD (mean difference, -1.25 days; 95% confidence interval,
-2.18 to -0.33; P =.008) and increased odds of mortality (odds ratio,
2.27; 95% confidence interval, 1.13 to 4.56; P =.02) compared with the
diuretic group. No differences were identified in terms of incidence of
negative fluid balance by postoperative day 1, presence of peritonitis,
and intensive care unit length of stay. Conclusion(s): The
meta-analysis did not identify differences between the 2 groups with
regard to negative fluid balance after postoperative day 1, incidence of
peritonitis, or length of intensive care unit stay. There is a need for
large, prospective, multicenter studies to evaluate the benefits and
complications associated with PD use further in selected children after
congenital heart surgery. Because some of the outcomes were present in
only 2 studies, results from the pooled analysis may be
underpowered. Copyright © 2019 The Society of Thoracic Surgeons

<20>
[Use Link to view the full text]
Accession Number
629036869
Title
Fentanyl-based intravenous patient-controlled analgesia with low dose of
ketamine is not inferior to thoracic epidural analgesia for acute
post-Thoracotomy pain following video-Assisted thoracic surgery: A
randomized controlled study.
Source
Medicine (United States). 98 (28) (no pagination), 2019. Article Number:
e16403. Date of Publication: 01 Jul 2019.
Author
Tseng W.-C.; Lin W.-L.; Lai H.-C.; Huang T.-W.; Chen P.-H.; Wu Z.-F.
Institution
(Tseng, Lin, Lai, Chen, Wu) Department of Anesthesiology, No. 901,
Zhonghua Road, Tainan 71004, Taiwan (Republic of China)
(Huang) Division of Chest Surgery, Department of Surgery, Tri-Service
General Hospital and National Defense Medical Center, Taiwan (Republic of
China)
(Chen) Graduate Institute of Public Health, National Defense Medical
Center, Taiwan (Republic of China)
(Wu) D Department of Anesthesiology, Chi Mei Medical Center, Tainan,
Taiwan, R.O.C., Taiwan (Republic of China)
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Thoracic epidural analgesia is the preferred method for
postoperative analgesia following thoracic surgery. However, intravenous
patient-controlled analgesia (IVPCA) may be an effective alternative. This
study was conducted because few scientific reports exist comparing
fentanyl-based IVPCA including a low dose of ketamine (fk-IVPCA) with
thoracic patient-controlled epidural analgesia (t-PCEA) for the treatment
of postoperative pain after video-Assisted thoracic surgery (VATS).
 Method(s):This prospective, and randomized study included 70 patients
randomized into fk-IVPCA and t-PCEA groups. Pain at rest and during
movement, successful and unsuccessful triggers after pressing the PCA
device button, the need for rescue analgesia, drug-related adverse events,
and patient satisfaction were recorded for 48hours postoperatively.
 Result(s):No significant differences in the intensity of pain at rest
or during movement were observed between the 2 groups within 48hours
postoperatively. The number of unsuccessful PCA triggers in the t-PCEA
group 0 to 4hours after surgery was significantly higher than that in the
fk-IVPCA group. However, the numbers of successful PCA triggers in the
fk-IVPCA group at 4 to 12 and 0 to 24hours after surgery were
significantly higher than those in the t-PCEA group. The incidence of
analgesic-related side effects and patient satisfaction were similar in
both groups. Conclusion(s):Compared with t-PCEA, the addition of a
subanesthetic dose of ketamine to fentanyl-based IVPCA resulted in similar
pain control after VATS with no increase in the incidence of drug-related
adverse effects. The results confirm that both multimodal intravenous
analgesia and epidural analgesia can provide sufficient pain control and
are safe strategies for treating acute post-Thoracotomy
pain. Copyright © 2019 the Author(s).

<21>
Accession Number
623948724
Title
Viscoelastic testing: It's not the measurement, it's what you do with it!.
Source
Canadian Journal of Anesthesia. 65 (12) (pp 1283-1287), 2018. Date of
Publication: 01 Dec 2018.
Author
Sniecinski R.M.
Institution
(Sniecinski) Department of Anesthesiology, Emory University School of
Medicine, 1364 Clifton Rd, NE, Atlanta, GA 30322, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)

<22>
[Use Link to view the full text]
Accession Number
629148325
Title
Application of virtual histological intravascular ultrasound in plaque
composition assessment of saphenous vein graft diseases.
Source
Chinese Medical Journal. 132 (8) (pp 957-962), 2019. Date of Publication:
20 Apr 2019.
Author
Gao J.; Wang Y.-Y.; Liu Y.
Institution
(Gao) Cardiovascular Institute, Tianjin Chest Hospital, Tianjin 300222,
China
(Wang) Graduate School of Medicine, Tianjin Medical University, Tianjin
300070, China
(Liu) Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222,
China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective:Saphenous vein grafts disease (SVGD) is a common complication
after coronary artery bypass graft (CABG) and normally treated by
percutaneous coronary intervention (PCI). The most common complication
after SVG-PCI is slow or no-reflow. It is known that the no-reflow
phenomenon occurs in up to 15% of the SVG-PCI and is associated with high
risk of major adverse cardiac events (MACEs) and mortality, therefore, it
is important to investigate the factors that could predict the clinical
outcome of PCI for risk stratification and guiding interventions. In
recent years, the spectral analysis of intravascular ultrasound (IVUS)
radiofrequency data (virtual histology-IVUS [VH-IVUS]) has been used to
provide quantitative assessment on both plaque compositions and
morphologic characteristics.Data sources:The PubMed, Embase, and Central
databases were searched for possible relevant studies published from 1997
to 2018 using the following index keywords: "Coronary artery bypass
grafting," "Saphenous venous graft disease," "Virtual
histology-intravascular ultrasound," "Virtual histology-intravascular
ultrasound," and "Percutaneous coronary intervention."Study selection:The
primary references were Chinese and English articles including original
studies and literature reviews, were identified and reviewed to summarize
the advances in the application of VH-IVUS techniques in situ vascular and
venous graft vascular lesions. Result(s):With different plaque
components exhibiting a defined spectrum, VH-IVUS can classify
atherosclerotic plaque into four types: fibrous tissue (FT), fibro fatty
(FF), necrotic core (NC), and dense calcium (DC). The radiofrequency
signal is mathematically transformed into a color-coded representation,
including lipid, fibrous tissue, calcification, and necrotic core. Several
studies have demonstrated the independent relationship between
VH-IVUS-defined plaque classification or plaque composition and MACEs, but
a significant association between plaque components and no-reflow after
PCI in acute coronary syndrome. In recent years, VH-IVUS are applied to
assess the plaque composition of SVGD, based on the similarity of
pathophysiological mechanisms between coronary artery disease (CAD) and
SVGD, further studies with the larger sample size, the long-term
follow-up, multicenter clinical trials may be warranted to investigate the
relationship between plaque composition of saphenous vein graft (SVG) by
VH-IVUS and clinical outcomes in patients with SVGD undergoing PCI.
 Conclusion(s):In degenerative SVG lesions, VH-IVUS found that plaque
composition was associated with clinical features, future studies need to
explore the relationship between VH-IVUS defined atherosclerotic plaque
components and clinical outcomes in SVGD patients undergoing PCI, an
innovative prediction tool of clinical outcomes can be
created. Copyright © 2019 The Chinese Medical Association,
produced by Wolters Kluwer, Inc.

<23>
Accession Number
629147287
Title
Cardiopulmonary bypass and dual antiplatelet therapy: a strategy to
minimise transfusions and blood loss.
Source
Perfusion (United Kingdom). (no pagination), 2019. Date of Publication:
2019.
Author
Karlsson M.; Hannuksela M.; Appelblad M.; Hallgren O.; Johagen D.; Wahba
A.; Svenmarker S.
Institution
(Karlsson, Appelblad, Hallgren, Johagen, Svenmarker) Department of Public
Health and Clinical Medicine, Heart Centre, Umea University, Umea, Sweden
(Hannuksela) Department of Surgical and Perioperative Sciences, Heart
Centre, Umea University, Umea, Sweden
(Wahba) Department of Circulation and Medical Imaging, Norwegian
University of Science and Technology, Trondheim, Norway
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Patients with preoperative dual antiplatelet therapy prior to
coronary artery bypass surgery are at risk of bleeding and blood component
transfusion. We hypothesise that an optimised cardiopulmonary bypass
strategy reduces postoperative blood loss and transfusions.
 Method(s): In total, 60 patients admitted for coronary artery bypass
grafting with ticagrelor and aspirin medication withdrawn <96 hours before
surgery were prospectively randomised into two equal sized groups.
Cardiopulmonary bypass combined a closed Cortiva heparin-coated
circuit with low systemic heparinisation (activated clotting time < 250
seconds) and intraoperative cell salvage in the study group, whereas the
control group used a Balance coated open circuit, full systemic
heparinisation (activated clotting time > 480 seconds) and conventional
cardiotomy suction. This perfusion strategy was evaluated by the chest
drain volume after 24 hours, perioperative haemoglobin and platelet loss
accompanied by global coagulation assessments. Result(s): Patients in
the study group demonstrated significantly better outcomes signified by
lower blood loss 554 +/- 224 versus 1,100 +/- 989 mL (p < 0.001), reduced
packed red cell transfusion 7% versus 53% (p < 0.001), reduced haemoglobin
-28 +/- 15 versus -40 +/- 14 g/L (p = 0.004) and platelet loss -35 +/- 36
versus -82 +/- 67 x 109/L (p = 0.001). Indices of rotational
thromboelastometry indicated shorter clotting times within the internal
and external pathways. Adenosine diphosphate activated platelet function
was within normal range based on Multiplate aggregometry, while
ROTEM platelet analyses indicated inhibited function both
preoperatively and post-bypass. Platelet inhibition by aspirin was
verified throughout the perioperative period. Platelet function showed no
intergroup differences. Conclusion(s): A stringent perfusion strategy
reduced blood loss and transfusions in dual antiplatelet therapy patients
requiring urgent surgery. Copyright © The Author(s) 2019.

<24>
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.
 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.
 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. 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. Copyright © 2019

<25>
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. Copyright © 2019 Elsevier Inc.

<26>
Accession Number
628442109
Title
Generalizing causal inferences from individuals in randomized trials to
all trial-eligible individuals.
Source
Biometrics. 75 (2) (pp 685-694), 2019. Date of Publication: 01 Jun 2019.
Author
Dahabreh I.J.; Robertson S.E.; Tchetgen E.J.; Stuart E.A.; Hernan M.A.
Institution
(Dahabreh, Robertson) Center for Evidence Synthesis in Health, Brown
University School of Public Health, Providence, RI, United States
(Dahabreh) Departments of Health Services, Policy & Practice and
Epidemiology, Brown University, Providence, RI, United States
(Dahabreh, Hernan) Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, MA, United States
(Tchetgen) Department of Statistics, University of Pennsylvania, Wharton
Business School, Philadelphia, PA, United States
(Stuart) Departments of Mental Health, Biostatistics, Health Policy and
Management, Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD, United States
(Hernan) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Hernan) Harvard-MIT Division of Health Sciences and Technology, Boston,
MA, United States
Publisher
NLM (Medline)
Abstract
We consider methods for causal inference in randomized trials nested
within cohorts of trial-eligible individuals, including those who are not
randomized. We show how baseline covariate data from the entire cohort,
and treatment and outcome data only from randomized individuals, can be
used to identify potential (counterfactual) outcome means and average
treatment effects in the target population of all eligible individuals. We
review identifiability conditions, propose estimators, and assess the
estimators' finite-sample performance in simulation studies. As an
illustration, we apply the estimators in a trial nested within a cohort of
trial-eligible individuals to compare coronary artery bypass grafting
surgery plus medical therapy vs. medical therapy alone for chronic
coronary artery disease. Copyright © 2019 The International
Biometric Society.

<27>
Accession Number
626013008
Title
Effects of Selenium Supplementation on Metabolic Status in Patients
Undergoing for Coronary Artery Bypass Grafting (CABG) Surgery: a
Randomized, Double-Blind, Placebo-Controlled Trial.
Source
Biological Trace Element Research. 191 (2) (pp 331-337), 2019. Date of
Publication: 15 Oct 2019.
Author
Kamali A.; Amirani E.; Asemi Z.
Institution
(Kamali) Department of Anesthesiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Amirani, Asemi) Research Center for Biochemistry and Nutrition in
Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran,
Islamic Republic of
Publisher
Humana Press Inc. (E-mail: humana@humanapr.com)
Abstract
This study was carried out to evaluate the effects of selenium
supplementation on glycemic control, lipid profiles, and biomarkers of
inflammation and oxidative stress in patients undergoing for coronary
artery bypass grafting (CABG) surgery. This randomized, double-blind,
placebo-controlled trial was performed among 33 patients undergoing for
CABG surgery, aged 40-85 years old. Subjects were randomly allocated into
two groups to intake either 200 mug/day selenium supplements as selenium
yeast (n = 17) or placebo (n = 16) for 4 weeks. Glycemic control, lipid
profiles, and biomarkers of inflammation and oxidative stress were
assessed at baseline and at the end of trial. After the 4-week
intervention, selenium supplementation significantly decreased fasting
plasma glucose (FPG) (beta, 6.76 mg/dL; 95% CI, - 13.13, - 0.40; P =
0.03), insulin (beta, - 1.14 muIU/mL; 95% CI, - 2.01, - 0.28; P = 0.01);
homeostasis model of assessment-estimated insulin resistance (HOMA-IR)
(beta - 0.35; 95% CI, - 0.62, - 0.08; P = 0.01); and
total-/HDL-cholesterol ratio (beta - 0.31; 95% CI, - 0.51, - 0.09; P =
0.008); and significantly increased HDL-cholesterol levels (beta, 2.72
mg/dL; 95% CI, 0.89, 4.55; P = 0.005) compared with the placebo. Moreover,
selenium supplementation led to a significant reduction in
high-sensitivity C-reactive protein (hs-CRP) (beta, - 0.68 mg/L; 95% CI, -
1.18, - 0.17; P = 0.01) and malondialdehyde (MDA) (beta, - 0.27 mumol/L;
95% CI, - 0.47, - 0.07; P = 0.009), and a significant elevation in total
glutathione (GSH) levels (beta, 77.33 mumol/L; 95% CI, 56.11, 98.55; P <
0.001) compared with the placebo. Selenium supplementation did not affect
other metabolic profiles. Overall, our study demonstrated that selenium
supplementation for 4 weeks to patients undergoing for CABG surgery had
beneficial effects on FPG, insulin, HOMA-IR, total-/HDL-cholesterol ratio,
HDL-cholesterol, hs-CRP, GSH, and MDA levels, but did not affect other
metabolic profiles. Clinical trial registration number:
http://www.irct.ir: IRCT2017090533941N22. Copyright © 2019,
Springer Science+Business Media, LLC, part of Springer Nature.

<28>
Accession Number
2001737193
Title
Glycated Hemoglobin and the Risk of Sternal Wound Infection After Adult
Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. 31 (3) (pp 465-467),
2019. Date of Publication: Autumn 2019.
Author
Biancari F.; Giordano S.
Institution
(Biancari) Heart Center, Turku University Hospital and Department of
Surgery, University of Turku, Turku, Finland
(Biancari) Department of Surgery, University of Oulu, Oulu, Finland
(Giordano) Department of Surgery, Satakunta Central Hospital, Pori,
Finland
(Giordano) Department of Plastic and General Surgery, Turku University
Hospital and University of Turku, Turku, Finland
Publisher
W.B. Saunders
Abstract
Increased glycated hemoglobin (HbA1c) has been shown to increase the risk
of mortality, myocardial infarction, and stroke after cardiac surgery,
whereas its impact on the development of sternal wound infection (SWI) is
less clear. A systematic review and meta-analysis were performed to
evaluate the impact of preoperative HbA1c levels on the occurrence of SWI
after adult cardiac surgery. Fourteen studies including 17,609 patients
fulfilled the inclusion criteria and were included in this analysis.
Diagnostic test meta-analysis of studies evaluating baseline HbA1c cut-off
values ranging from 6% to 7% DCCT units (42-53 mmol/mol IFCC units) showed
that the diagnostic odds ratio for deep SWI was 3.02 (95% confidence
interval [CI] 2.10-4.35), while the diagnostic odds ratio for any SWI was
2.81 (95% CI 2.02-3.93). Binary meta-analysis confirmed that baseline
HbA1c cut-off values ranging from 6% to 7% increased the risk for deep SWI
(pooled incidence 2.7% vs 0.8%, risk ratio [RR] 3.01, 95% CI 2.32-3.90,
I2 0%). Six studies included only diabetics and their pooled RR
for deep SWI was 2.94 (1.59-5.45, I2 0%). Nine studies
evaluated an HbA1c cut-off value of 7% and their RR for deep SWI was 3.22
(95% CI 2.38-4.37, I2 0%). The RR for any SWI was 2.92 (95% CI
2.42-3.53, I2 0%). This pooled analysis showed that the risk of
SWI is substantially increased when preoperative HbA1c levels are over
6-7%. Future studies should evaluate whether postponing surgery for
optimization of the glycemic control can reduce the risk of SWI in
patients with increased levels of HbA1c. Copyright © 2019
Elsevier Inc.

<29>
Accession Number
2001438005
Title
Postoperative Outcomes in SAVR/TAVR Patients With Cognitive Impairment: A
Systematic Review.
Source
Seminars in Thoracic and Cardiovascular Surgery. 31 (3) (pp 370-380),
2019. Date of Publication: Autumn 2019.
Author
Luan Erfe B.M.; Erfe J.M.; Brovman E.Y.; Boehme J.; Bader A.M.; Urman R.D.
Institution
(Luan Erfe, Bader) Harvard Medical School, Boston, MA, United States
(Erfe) Yale School of Medicine, New Haven, CT, United States
(Brovman, Boehme, Bader, Urman) Department of Anesthesiology,
Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA,
United States
Publisher
W.B. Saunders
Abstract
To assess the predictive value of preoperative cognitive impairment on
postoperative in-hospital, short-term, and mid-term outcomes among
patients undergoing surgical or transcatheter aortic valve replacement.
The review was conducted according to PRISMA guidelines. Articles were
identified in EMBASE, Medline, and PubMed. Eligible articles compared the
outcomes of patients with and without preoperative cognitive impairment
who underwent aortic valve replacement and were published in English
between January 1, 1997 and November 1, 2017. The quality of included
observational studies was evaluated using the Newcastle-Ottawa scale. The
strength of the body of evidence was also assessed. A total of 6163
abstracts were screened by 2 independent reviewers and 31 full-text
articles were reviewed. Eight studies met inclusion criteria. The studies
included 1 case-control, 5 prospective cohort, and 2 retrospective cohort
studies. Given the paucity and heterogeneity of studies, meta-analysis was
not possible. Five studies were of good quality. Preoperative cognitive
impairment is a risk factor for postoperative delirium in 2 studies,
increased mid-term mortality in 2 studies, and increased length of stay,
risk of discharge to a health-care facility or progressive disability in 1
study. However, given the paucity and methodological flaws of the included
studies, the body of evidence on the predictive value of preoperative
cognitive impairment on postoperative outcomes remains weak. This
systematic review highlights the need for more good quality studies to
provide evidence regarding the incidence of cognitive impairment and
associations with poor outcomes after aortic valve
replacement. Copyright © 2018 Elsevier Inc.

<30>
Accession Number
2001331845
Title
Effect of Perioperative Neuromuscular Electrical Stimulation in Patients
Undergoing Cardiovascular Surgery: A Pilot Randomized Controlled Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. 31 (3) (pp 361-367),
2019. Date of Publication: Autumn 2019.
Author
Kitamura H.; Yamada S.; Adachi T.; Shibata K.; Tamaki M.; Okawa Y.; Usui
A.
Institution
(Kitamura, Tamaki, Okawa) Department of Cardiovascular Surgery, Nagoya
Heart Center, Nagoya, Japan
(Yamada) Department of Health Science, Nagoya University Graduate School
of Medicine, Nagoya, Japan
(Adachi, Shibata) Program in Physical and Occupational Therapy, Nagoya
University Graduate School of Medicine, Nagoya, Japan
(Shibata) Department of Cardiac Rehabilitation, Nagoya Heart Center,
Nagoya, Japan
(Usui) Department of Cardiac Surgery, Nagoya University Graduate School of
Medicine, Nagoya, Japan
Publisher
W.B. Saunders
Abstract
A randomized, controlled trial was conducted to examine the effects of
perioperative neuromuscular electrical stimulation on muscle proteolysis
and physical function using blinded assessment of physical function.
Consecutive patients undergoing cardiovascular surgery were screened for
eligibility as study subjects. Participants were randomly assigned to
receive either neuromuscular electrical stimulation or the usual
postoperative mobilization program. The intervention group received
neuromuscular electrical stimulation on bilateral legs 8 times before and
after surgery. The primary outcomes were the mean 3-methylhistidine
concentration corrected for urinary creatinine content from baseline to
postoperative day 6, and knee extensor isometric muscle strength on
postoperative day 7. Secondary outcomes were usual walking speed and grip
strength. Physical therapists blinded to patient allocation performed
measurements of physical function. Of 498 consecutive patients screened
for eligibility, 119 participants (intervention group, n = 60; control
group, n = 59) were enrolled. In the overall subjects, there were no
differences in any outcomes between the intervention and control groups.
The results demonstrated no significant effects of neuromuscular
electrical stimulation on muscle proteolysis and physical function after
cardiovascular surgery, suggesting the need to explore indications for
neuromuscular electrical stimulation and to clarify the effects in terms
of the dose-response relationship. Copyright © 2018 The Authors

<31>
Accession Number
629139107
Title
Effectiveness and harms of pharmacological interventions for the treatment
of delirium in adults in intensive care units after cardiac surgery: A
systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. (no
pagination), 2019. Date of Publication: 2019.
Author
Leigh V.; Stern C.; Elliott R.; Tufanaru C.
Institution
(Leigh, Stern) Joanna Briggs Institute, Faculty of Health and Medical
Sciences, University of Adelaide, Adelaide, Australia
(Leigh) Adelaide Nursing School, Faculty of Health and Medical Sciences,
University of Adelaide, Adelaide, Australia
(Elliott) Malcolm Fisher Intensive Care Unit, Royal North Shore Hospital,
Sydney, Australia
(Elliott) Nursing and Midwifery Directorate, Northern Sydney Local Health
District, St Leonards, Australia
(Elliott) Faculty of Health, University of Technology Sydney, Ultimo,
Australia
(Tufanaru) Australian Institute of Health Innovation, Macquarie
University, Sydney, Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: The objective of this review was to synthesize the best
available evidence on the effectiveness and harms of pharmacological
interventions for the treatment of delirium in adult patients in the
intensive care unit (ICU) after cardiac surgery. Introduction: Patients
who undergo cardiac surgery are at high risk of delirium (incidence:
50-90%). Delirium has deleterious effects, increasing the risk of death
and adversely affecting recovery. Clinical interventional trials have been
conducted to prevent and treat postoperative delirium pharmacologically
including antipsychotics and sedatives. These trials have provided some
evidence about efficacy and influenced clinical decision making. However,
much reporting is incomplete and provides biased assessments of efficacy;
benefits are emphasized while harms are inadequately reported. Inclusion
criteria: Participants were >= 16 years, any sex or ethnicity, who were
treated postoperatively in a cardiothoracic ICU following cardiac surgery
and were identified as having delirium. Any pharmacological intervention
for the treatment of delirium was included, regardless of drug
classification, dosage, intensity or frequency of administration. Outcomes
of interest of this review were: mortality, duration and severity of
delirium, use of physical restraints, quality of life, family members'
satisfaction with delirium management, duration/severity of the aggressive
episode, associated falls, severity of accidental self-harm,
pharmacological harms, harms related to over-sedation, ICU length of stay,
hospital length of stay (post ICU), total hospital length of stay, need
for additional intervention medication and need for rescue medication.
Randomized controlled trials were considered first and in their absence,
non-randomized controlled trials and quasi-experimental would have been
considered, followed by analytical observational studies. Method(s):
A search was conducted in PubMed, Embase, CINAHL, Web of Science, Cochrane
Central Register of Controlled Trials, Scopus, Epistemonikos, Australian
New Zealand Clinical Trials Registry, ClinicalTrials.gov, Clinical Trials
in New Zealand, and ProQuest Dissertations and Theses to locate both
published and unpublished studies. There was no date limit for the search.
A hand search for primary studies published between January 1, 2012 and
November 17, 2018 in relevant journals was also conducted. Only studies
published in English were considered for inclusion. Two reviewers
independently assessed the methodological quality using standardized
critical appraisal instruments from JBI and McMaster University.
Quantitative data were extracted using the standardized JBI data
extraction tool. A meta-analysis was not performed, as there was too much
clinical and methodological heterogeneity in the included studies. Results
have been presented in a narrative form. Standard GRADE (Grading of
Recommendations, Assessment, Development, and Evaluation) evidence
assessment of outcomes has been reported. Result(s): Three RCTs
investigating morphine versus haloperidol (n = 53), ondansetron versus
haloperidol (n = 72), and dexmedetomidine versus midazolam (n = 80) were
included. Due to heterogeneity and incomplete reporting, a meta-analysis
was not feasible. Overall, the methodological quality of these studies was
found to be low. Additionally, this review found reporting of harms to be
inadequate and superficial for all three studies and did not meet the
required standards for harms reporting, as defined by the CONSORT
statement extension for harms. Conclusion(s): It was not possible to
draw any valid conclusions regarding the effectiveness of morphine vs
haloperidol, ondansetron vs haloperidol or dexmedetomidine vs midazolam in
treating delirium after cardiac surgery. This is due to the low number of
studies, the poor methodological quality in conducting and reporting and
the heterogeneity between the studies. Copyright © 2019 Wolters
Kluwer Health, Inc. All rights reserved.

<32>
Accession Number
2002663111
Title
Transcatheter aortic valve replacement in low-risk patients: A
meta-analysis of randomized controlled trials.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Al-Abdouh A.; Upadhrasta S.; Fashanu O.; Elias H.; Zhao D.; Hasan R.K.;
Michos E.D.
Institution
(Al-Abdouh, Upadhrasta, Fashanu, Elias) Department of Medicine, Saint
Agnes Hospital, Baltimore, MD, United States
(Fashanu, Michos) The Ciccarone Center for the Prevention of
Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD,
United States
(Zhao, Michos) Department of Epidemiology, Johns Hopkins University,
Baltimore, MD, United States
(Hasan, Michos) Division of Cardiology, Johns Hopkins School of Medicine,
Baltimore, MD, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has become the
standard treatment option for patients with symptomatic severe aortic
stenosis (AS) with high surgical risk and a reasonable option for
intermediate surgical risk as an alternative to surgical aortic valve
replacement (SAVR). The role of TAVR in lower risk patients is less
established but has been the focus of recent randomized controlled trials
(RCTs). We performed a meta-analysis of RCTs to assess TAVR outcomes among
low surgical risk patients. Methods and Results: Systematic search of
RCTs was done using PubMed, EMBASE, and Cochrane Library databases.
Statistical analysis was performed with RevMan v5.3 software using a
random effects model to report risk ratio (RR) with 95% confidence
interval (CI). A total of three RCTs including 2698 patients (1375 TAVR
and 1323 SAVR) were analyzed. Compared to SAVR, TAVR was not associated
with all-cause mortality [RR 0.86 (95% CI 0.61-1.19); P = 0.36;
I2 = 8%] or stroke [RR 0.82 (0.48-1.43); P = 0.49;
I2 = 42%]. However, TAVR was significantly associated with
lower risk of acute kidney injury [RR 0.27 (0.13-0.54); P = 0.0002;
I2 = 0%], new-onset atrial fibrillation [RR 0.26 (0.18-0.39); P
< 0.00001; I2 = 80%], and life-threatening or disabling
bleeding [RR 0.35 (0.22-0.55); P < 0.00001; I2 = 57%], but a
higher risk of moderate-severe paravalvular leak [RR 4.40 (1.22-15.86); P
= 0.02; I2 = 26%] and permanent pacemaker insertion [RR 2.73
(1.41-5.28); P = 0.003; I2 = 83%]. Conclusion(s): There is
no difference in all-cause mortality or stroke between TAVR and SAVR, but
TAVR is associated with lower risk of other perioperative complications
except for moderate-severe paravalvular leak and the need for permanent
pacemaker implantation. Copyright © 2019

<33>
Accession Number
2002659429
Title
Viscoelastic Blood Tests Use in Adult Cardiac Surgery: Meta-Analysis,
Meta-Regression, and Trial Sequential Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Meco M.; Montisci A.; Giustiniano E.; Greco M.; Pappalardo F.; Mammana L.;
Panisi P.; Roscitano C.; Cirri S.; Donatelli F.; Albano G.
Institution
(Meco, Panisi, Roscitano, Albano) Anesthesia and Intensive Care
Department, Humanitas Gavazzeni Clinic, Bergamo, Italy
(Montisci, Cirri) Department of Anesthesia and Intensive Care,
Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milano, Italy
(Montisci, Donatelli) Cardiac Surgery, University of Milan, Milano, Italy
(Giustiniano, Greco) Department of Anesthesia and Intensive Care, IRCCS
Humanitas Clinical and Research Center, Rozzano, Italy
(Pappalardo) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute and Vita-Salute San Raffaele University,
Milano, Italy
(Mammana, Donatelli) Department of Cardiac Surgery, Cardiothoracic Center,
Istituto Clinico Sant'Ambrogio, Milano, Italy
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative hemorrhage in cardiac surgery is a significant
cause of morbidity and mortality. Standard laboratory tests fail as
predictors for bleeding in the surgical setting. The use of viscoelastic
(VE) hemostatic assays thromboelastography (TEG) and rotational
thromboelastometry (ROTEM) could be an advantage in patients undergoing
cardiac surgery. The objective of this meta-analysis was to analyze the
effects (benefits and harms) of VE-guided transfusion practice in cardiac
surgery patients. Design(s): A meta-analysis of randomized trials.
 Setting(s): For this study, PubMed, EMBASE, Scopus, and the Cochrane
Collaboration database were searched, and only randomized controlled
trials were included. A systematic review and meta-analysis were performed
in accordance with the standards set forth by the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses statement, using a
random-effects model. Participant(s): The study comprised adult
cardiac surgery patients. Intervention(s): VE-hemostatic assays
transfusion algorithm compared with transfusion algorithms based on
clinicians' discretion. Measurements and Main Results: Seven
comparative randomized controlled trials were considered, including a
total of 1,035 patients (522 patients in whom a TEG- or ROTEM-based
transfusion algorithm was used). In patients treated according to
VE-guided algorithms, red blood cell (odds ratio 0.61; 95% confidence
interval [CI]: 0.37-0.99; p: 0.04; I2: 66%) and fresh frozen
plasma transfusions (risk difference 0.22; 95% CI: 0.11-0.33; p < 0.0001;
I2: 79%) use was reduced; platelets transfusion was not reduced
(odds ratio 0.61; 95% CI: 0.32-1.15; p: 0.12; I2 74%).
 Conclusion(s): This study demonstrated that the use of VE assays in
cardiac surgical patients is effective in reducing allogenic blood
products exposure, postoperative bleeding at 12 and 24 hours after
surgery, and the need for redo surgery unrelated to surgical
bleeding. Copyright © 2019 Elsevier Inc.

<34>
Accession Number
2002549390
Title
Regional analgesia for minimally invasive cardiac surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Yu S.; Valencia M.B.; Roques V.; Aljure O.D.
Institution
(Yu, Aljure) Department of Anesthesiology, Jackson Memorial
Hospital/University of Miami, Miami, FL, United States
(Valencia) Department of Cardiac and Transplant Anesthesiology, London
Health Sciences Centre, London, ON, Canada
(Roques) Department of Intensive Care and Chronic Pain Treatment,
University Hospital Virgen de la Arrixaca, Murcia, Spain
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Minimally invasive cardiac surgery (MICS) has expanded during
the recent years due to interest in improved patient satisfaction and
decreased stay in the hospital. To assist in these interests,
postoperative pain control is aimed at decreasing opioid usage but
maintaining adequate pain control. Regional anesthesia has the ability to
provide these goals. This review article will describe different regional
anesthesia techniques and discuss the evidence of their use in MICS.
 Method(s): A literature search was conducted in MEDLINE (PubMed) and
EMBASE with keywords and narrowed to publications between 1998 and 2018.
The results are reviewed, analyzed, and discussed in this paper.
 Result(s): Thoracic epidurals provide improved pain control and
decreased stay in the intensive care unit. Thoracic paravertebral blocks
are as effective as thoracic epidurals for postoperative pain control.
Serratus anterior plane block provides adequate pain control but does not
control pain as well as paravertebral blocks. Intrapleural blocks provide
sufficient pain control and can be placed by the surgeon. Pectoral fascial
blocks, intercostal blocks, and erector spinae plane blocks described in
case reports seem to be viable options for postoperative pain control.
 Conclusion(s): As cardiac surgery moves toward smaller incisions and
MICS with the goal of enhanced recovery, multimodal analgesic techniques
should be explored for postoperative pain control. The regional techniques
discussed in this article show a trend toward improved pain control and
decreased stay in the intensive care unit. Copyright © 2019 Wiley
Periodicals, Inc.

<35>
Accession Number
2001384178
Title
Heparin-Induced Thrombocytopenia and Cardiac Surgery.
Source
Seminars in Thoracic and Cardiovascular Surgery. 31 (3) (pp 335-344),
2019. Date of Publication: Autumn 2019.
Author
Solanki J.; Shenoy S.; Downs E.; Palkimas S.; Goldman S.; Sharma A.M.
Institution
(Solanki) Department of Medicine, University of Virginia, Charlottesville,
VA, United States
(Shenoy) Division of Cardiovascular Medicine, University of Arizona,
Tuscan, AZ, United States
(Downs) Department of Surgery, University of Virginia, Charlottesville,
VA, United States
(Palkimas, Goldman) Department of Pharmacy, University of Virginia,
Charlottesville, VA, United States
(Sharma) Division of Cardiovascular Medicine, University of Virginia,
Charlottesville, VA, United States
Publisher
W.B. Saunders
Abstract
Heparin-induced thrombocytopenia (HIT) is an immune-mediated condition
characterized by thrombocytopenia with possible arterial and/or venous
thrombosis. The overall incidence of HIT is low but ranges from 0.1% to
5%.1,2 The incidence can be as high as 3% in patients
undergoing cardiac surgery. The use of unfractionated heparin (UFH) is
ubiquitous in patients who undergo cardiac procedures and carries a
10-fold higher incidence of HIT over low molecular weight heparin.
Patients undergoing cardiac surgery thus form a unique group that warrants
specific attention to this clinicopathologic entity considering the
relatively high incidence and associated morbidity and mortality with a
delay in diagnosis. In this article, we will discuss 5 clinical aspects
pertinent to the diagnosis and management of HIT in cardiac surgery
patients and review the current literature. Copyright © 2018
Elsevier Inc.

<36>
[Use Link to view the full text]
Accession Number
629158785
Title
Antiplatelet therapy and coronary artery bypass grafting: Protocol for a
systematic review and network meta-analysis.
Source
Medicine. 98 (34) (pp e16880), 2019. Date of Publication: 01 Aug 2019.
Author
Gupta S.; Belley-Cote E.P.; Rochwerg B.; Bozzo A.; Panchal P.; Pandey A.;
Mbuagbaw L.; Mehta S.; Schwalm J.-D.; Whitlock R.P.
Institution
(Gupta, Bozzo, Whitlock) Department of Surgery, United Arab Emirates
(Gupta, Rochwerg, Bozzo, Whitlock) Department of Health Research Methods
(Belley-Cote, Rochwerg, Mehta, Schwalm) Department of Medicine, United
States
(Belley-Cote, Mbuagbaw, Mehta, Schwalm, Whitlock) Population Health
Research Institute, Hamilton, ON, Canada
(Panchal, Pandey) Faculty of Health Sciences, McMaster University, Czechia
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Saphenous vein graft (SVG) is the most common conduit used
for coronary artery bypass grafting (CABG) surgery. Unfortunately, SVG are
associated with poor long-term patency rates; a significant predictor of
re-operation rates and survival. As such, medical therapy to prevent SVG
narrowing or occlusion is of paramount importance. Aspirin (ASA)
monotherapy is the standard of care after CABG, to improve long-term major
adverse cardiovascular events (MACE) and graft patency. Benefits of dual
antiplatelet therapy (DAPT) have not been well established in all CABG
patients. We present a protocol for a network meta-analysis (NMA)
comparing the effects of various antiplatelet therapy regimens on SVG
patency, mortality, and bleeding among adult patients following CABG.
 METHOD(S): We will search CENTRAL, MEDLINE, EMBASE, CINAHL ACPJC, and
grey literature sources (AHA, ACC, ESC, and CCC conference proceedings,
ISRCTN Register, and WHO ICTRP) for randomized controlled trials (RCTs)
which fit our criteria. RCTs that evaluate different antiplatelet regimens
at least 3-months after CABG and have any of SVG patency, mortality, MACE,
and major bleeding as outcomes will be selected. We will perform title and
abstract screening, full-text screening, and data extraction independently
and in duplicate. Two independent reviewers will also assess risk of bias
(ROB) for each study, as well as evaluate quality of evidence using the
GRADE framework. We will use R to perform the NMA and use low-dose ASA as
reference within our network. We will report results as odds ratios with
confidence intervals for direct comparisons, and credible intervals for
indirect or mixed comparisons. We will use the surface under the
cumulative ranking curve (SUCRA) to estimate the ranking of interventions.
DISCUSSION: Given the limited direct comparison of various antiplatelet
regimens, a network approach is ideal to clarify the optimum antiplatelet
therapy after CABG. We hope that our NMA will be the largest quantitative
synthesis evaluating antiplatelet regimens among patients requiring CABG.
It should inform clinicians and guideline developers in selecting the most
effective and safest antiplatelet regimen.Systematic Review registration:
International Prospective Register for Systematic Reviews
(PROSPERO)-CRD42019127695.

<37>
Accession Number
629152017
Title
Early Experience With Transcatheter Mitral Valve Replacement: A Systematic
Review.
Source
Journal of the American Heart Association. 8 (17) (pp e013332), 2019. Date
of Publication: 03 Sep 2019.
Author
Del Val D.; Ferreira-Neto A.N.; Wintzer-Wehekind J.; Dagenais F.; Paradis
J.-M.; Bernier M.; O'Connor K.; Beaudoin J.; Freitas-Ferraz A.B.;
Rodes-Cabau J.
Institution
(Del Val, Ferreira-Neto, Wintzer-Wehekind, Dagenais, Paradis, Bernier,
O'Connor, Beaudoin, Freitas-Ferraz, Rodes-Cabau) Quebec Heart & Lung
Institute Laval University Quebec City Quebec Canada
Publisher
NLM (Medline)
Abstract
Background Transcatheter mitral valve replacement (TMVR) has emerged as an
alternative therapeutic option for the treatment of severe mitral
regurgitation in patients with prohibitive or high surgical risk. The aim
of this systematic review is to evaluate the clinical procedural
characteristics and outcomes associated with the early TMVR experience.
Methods and Results Published studies and international conference
presentations reporting data on TMVR systems were identified. Only records
including clinical characteristics, procedural results, and 30-day and
midterm outcomes were analyzed. A total of 16 publications describing 308
patients were analyzed. Most patients (65.9%) were men, with a mean age of
75 years (range: 69-81 years) and Society for Thoracic Surgery Predicted
Risk of Mortality score of 7.7% (range: 6.1-8.6%). The etiology of mitral
regurgitation was predominantly secondary or mixed (87.1%), and 81.5% of
the patients were in New York Heart Association class III or IV. A
transapical approach was used in 81.5% of patients, and overall technical
success was high (91.7%). Postprocedural mean transmitral gradient was 3.5
mm Hg (range: 3-5.5 mm Hg), and only 4 cases (1.5%) presented residual
moderate to severe mitral regurgitation. Procedural and all-cause 30-day
mortality were 4.6% and 13.6%, respectively. Left ventricular outflow
obstruction and conversion to open heart surgery were reported in 0.3% and
4% of patients, respectively. All-cause and cardiovascular-related
mortality rates were 27.6% and 23.3%, respectively, after a mean follow-up
of 10 (range: 3 to 24) months. Conclusions TMVR was a feasible, less
invasive alternative for treating severe mitral regurgitation in patients
with high or prohibitive surgical risk. TMVR was associated with a high
rate of successful valve implantation and excellent hemodynamic results.
However, periprocedural complications and all-cause mortality were
relatively high.

<38>
Accession Number
2002475354
Title
Comparison of dexmedetomidine versus propofol-based anaesthesia for
controlled hypotension in functional endoscopic sinus surgery.
Source
Southern African Journal of Anaesthesia and Analgesia. 25 (2) (pp 37-40),
2019. Date of Publication: 23 Apr 2019.
Author
Bharathwaj D.K.; Kamath S.S.
Institution
(Bharathwaj, Kamath) Department of Anaesthesiology, Kasturba Medical
College, Mangalore, India
(Bharathwaj, Kamath) Manipal Academy of Higher Education, Manipal,
Karnataka, India
Publisher
Medpharm Publications (PO Box 14804, Lyttelton, Gauteng 0157, South
Africa)
Abstract
Background: Increased intraoperative bleeding during functional endoscopic
sinus surgery (FESS) affects operative field visibility, which increases
both duration of surgery and frequency of complications. Controlled
hypotension is an anaesthetic technique in which there is deliberate
reduction of systemic blood pressure during anaesthesia. The aim of the
study was to compare the efficacy of dexmedetomidine against propofol
infusion when used for controlled hypotension during FESS. Method(s):
A randomised, prospective, and single-blinded study was carried out, which
included 80 patients of either sex of ASA grade I & II who underwent
elective FESS. Patients were randomly assigned to two groups: Group A
(dexmedetomidine), Group B (propofol). Intraoperative mean arterial
pressure (MAP), heart rate (HR), surgical grade of bleeding (based on the
Fromme- Boezzart scale), and amount of bleeding were recorded.
 Result(s): Groups were well matched for their demographic data. There
was a statistically significant difference (p < 0.05) between Group A and
Group B in heart rate, mean arterial pressure (MAP) and mean total blood
loss, with Group A being effectively in controlled on all three parameters
during FESS. However, there was no significant difference (p > 0.05) in
terms of surgical grade of bleeding between Group A and Group B.
 Conclusion(s): Both dexmedetomidine and propofol infusion are
efficacious to facilitate controlled hypotension and haemodynamic
stability intraoperatively. Copyright © 2019 The Author(s).

<39>
Accession Number
2002749222
Title
Evaluation of the effect of adherence to treatment regimen program on
quality of life in atrial fibrillation patients hospitalized in Shahid
Chamran Hospital in Isfahan in 2017.
Source
Revista Latinoamericana de Hipertension. 14 (3) (pp 297-304), 2019. Date
of Publication: 2019.
Author
Zadeh F.Y.; Moeini M.; Shafie D.
Institution
(Zadeh) Department of Adult Health Nursing. School of Nursing and
Midwifery, Isfahan University of Medical Science, Isfahan, Iran, Islamic
Republic of
(Moeini) Nursing and Midwifery Care Research Center, Isfahan University of
Medical Sciences, Nursing and Midwifery Faculty, Isfahan, Iran, Islamic
Republic of
(Shafie) Heart Failure Research Center, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Revista Latinoamericana de Hipertension
Abstract
Background and objective: Atrial fibrillation is the most common cardiac
arrhythmia, which is associated with reduced quality of life due to
prolonged treatment and its recurrence. One of the key goals in the care
of patients with atrial fibrillation is increasing adherence to treatment
regimen program and the recommendations provided by the treatment group.
Thus, the present study was designed and carried out with the aim of
determining the effect of treatment regimen program on quality of life in
atrial fibrillation patients hospitalized in Shahid Chamran Hospital in
Isfahan in 2017. Methodology: This clinical trial study was conducted on
patients with atrial fibrillation arrhythmia in the Cardiac Care Unit
(CCU) and Post CCU Unit and Internal Heart Surgery Unit of Shahid Chamran
Hospital in Isfahan. A total of 50 people were randomly selected as sample
of study and assigned to two groups of test and control. The test group
received two 45-minute sessions of adherence and educational booklet and
they were followed-up for one month through phone call. The control group
also received one session of usual care training individually with regard
to the illness. Demographic data and quality of life data were collected
through Atrial Fibrillation Effects on Quality of Life (AFEQT) before
intervention, and one and three month after the intervention. Data were
analyzed by descriptive and inferential statistics. Result(s): There
was no significant difference between two groups in terms of quality of
life and demographic information before the intervention. However,
significant difference was seen between the two groups in terms of quality
of life one month and three months after the intervention.
 Conclusion(s): The results suggest the positive effects of adherence
to treatment regimen program and follow-up of the patients by experienced
nurses on quality of life in these patients one and three months after
discharge. Copyright © 2019 Revista Latinoamericana de
Hipertension. All rights reserved.

<40>
Accession Number
629067177
Title
Systemic review and meta-analysis of diagnostic efficacy of fractional
flow reserve using computed tomography angiography for first-time
diagnosis of coronary artery disease.
Source
Research in Cardiovascular Medicine. 7 (4) (pp 159-164), 2018. Date of
Publication: October-December 2018.
Author
Kumar N.; Sinha A.K.; Kumar P.; Jha A.K.; Arunachalam K.; Kumar S.;
Zakariya A.; Mostafa S.
Institution
(Kumar) Department of Cardiology, Artemis Hospital, Sector 51, Gurugram,
Haryana, India
(Sinha) Department of Cardiology, Paras HMRI Hospitals, NH 30 Bailey Road,
Raja Bazar, Patna, Bihar, India
(Kumar) Department of Cardiology, Fortis Hospital, A Block Ring Road,
Shalimar Bagh, New Delhi, India
(Jha) Department of Cardiology, Indira Gandhi Institute of Cardiology,
Ashok Raj Path, Patna, Bihar, India
(Arunachalam) Department of Cardiology, Warren Alpert Medical School,
Brown University, Providence, RI, United States
(Kumar) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Science, Patna, Bihar, India
(Zakariya) Department of Cardiology, Northern Devon Healthcare NHS Trust,
Raleigh Park, Barnstaple, Devon EX31 4JB, United Kingdom
(Mostafa) Department of Cardiology, Benha University, Faculty of Medicine,
Banha, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Coronary artery disease is a leading global cause of mortality. It can be
diagnosed by fractional flow reserve (FFR) estimation using computed
tomography (CT) angiography. This systematic review aims to review the
literature about the diagnostic efficacy of FFR estimation using CT scan
(FFR-CT) for the diagnosis of coronary artery disease. The dual databases
of Medline and Cochrane Central Register of Controlled Trials were
searched for relevant literature from their inception till August 15,
2017. The methodological quality was assessed using the Cochrane risk of
bias tool. Pooled estimates of specificity and sensitivity were assessed
with the corresponding 95% confidence intervals (CI). After careful
screening, five studies involving a total of 296 patients were included in
the study. For FFR-CT, on meta-analysis of the pooled risk ratio per
patient, random-effects model value was 3.79 (95% CI, 2.93-4.90) and odds
ratio per patient was 11.78 (95% CI, 8.08-17.17). The odds ratio by year
to see if heterogeneity is due to sample size was 2.50 (95% CI,
1.06-5.91). FFR-CT appears to be a reliable and efficacious noninvasive
imaging modality, as it demonstrates high accuracy in the determination of
anatomy and lesion-specific ischemia, which justifies the performance of
additional randomized controlled trials to evaluate the clinical benefits
of FFR-CT-guided coronary revascularization. Copyright © 2018
Research in Cardiovascular Medicine.

<41>
Accession Number
2002698023
Title
Mortality risk following acute coronary syndrome among patients with
schizophrenia: A meta-analysis.
Source
Progress in Neuro-Psychopharmacology and Biological Psychiatry. 96 (no
pagination), 2020. Article Number: 109737. Date of Publication: 10 January
2020.
Author
Shao M.; Tian H.; Wang L.; Jiang D.; Ji F.; Zhuo C.
Institution
(Shao) National Integrated Traditional and Western Medicine Center for
Cardivascular Disease, China-Japan Friendship Hospital, Beijing 100101,
China
(Tian, Wang, Zhuo) Department of Psychiatric-Neuroimaging-Genetics and
Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding
Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital,
Tianjin Medical University, Tianjin 300222, China
(Jiang, Zhuo) Department of Psychiatry, Wenzhou Seventh People's Hospital,
Wenzhou 325000, China
(Ji, Zhuo) Department of Psychiatry, School of Mental Health, Psychiatric
Genetics Laboratory (PSYG-Lab), Jining Medical University, Jining 272191,
China
(Zhuo) Department of China, Canada Biological Psychiatry Lab, Xiamen
Xianyue Hospital, Xiamen 361000, China
(Zhuo) Department of Psychiatry, College of Basic Medical Research,
Tianjin Medical University, Tianjin 300000, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with schizophrenia have a higher incidence of coronary artery
disease. This meta-analysis was performed to evaluate the influence of a
prior diagnosis of schizophrenia on mortality following acute coronary
syndrome (ACS). Relevant longitudinal follow-up studies were obtained via
systematic search of PubMed and Embase databases. A random effect model
was used to perform the meta-analysis. This meta-analysis included
3,611,343 hospitalized patients with ACS from nine follow-up studies. The
results show that, in patients with schizophrenia, ACS was associated with
a significantly higher risk of mortality (multivariate adjusted risk ratio
[RR]: 1.66, p <.001) with significant heterogeneity (I2 = 93%) compared to
the results of mentally healthy patients. Subgroup analyses demonstrated
that patients with schizophrenia were associated with higher ACS mortality
within one month (RR: 1.68, p <.001) and during a follow-up period of
>=one year (RR: 1.71, p =.01), in studies with (RR: 1.65, p =.06) and
without the adjustment of revascularization treatments (RR: 1.68, p
=.004), as compared with the results of mentally healthy patients. These
results indicate that patients with schizophrenia have a higher than
expected mortality risk in the case of acute coronary
events. Copyright © 2019

<42>
Accession Number
2002349038
Title
Efficacy and safety of robot-assisted thoracic surgery (RATS) compare with
video-assisted thoracoscopic surgery (VATS) for lung lobectomy in patients
with non-small cell lung cancer.
Source
Combinatorial Chemistry and High Throughput Screening. 22 (3) (pp
169-178), 2019. Date of Publication: 2019.
Author
Hu X.; Wang M.
Institution
(Hu) Department of Thoracic Surgery, The Second Hospital of Jiaxing,
Jiaxing, Zhejiang 314000, China
(Wang) Department of Thoracic Surgery, Shulan (Hangzhou) Hospital,
Hangzhou, Zhejiang, China
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: In the past decade, many researchers focused on
Robotic-Assisted Thoracoscopic Surgery (RATS), which has been introduced
as an alternative minimally invasive approach, versus VideoAssisted
Thoracoscopic Surgery (VATS) for lung lobectomy in patients with non-small
cell lung cancer. However, the advantage of RVATS compared to VATS is
still under investigation. The results are unclear. Aim(s): The aim
of this study is to compare the efficacy and safety of Robot-assisted
Thoracic Surgery (RATS) lobectomy versus Video-assisted Thoracic Surgery
(VATS) for lobectomy in patients with NonSmall Cell Lung Cancer (NSCLC).
 Method(s): A systematic electronic search of online electronic
databases: Pubmed, Embase, Cochrane library updated in June 2017. The
meta-analysis was performed including the studies are designed as
randomized or non-randomized controlled. Result(s): Twenty
retrospective cohort studies met our inclusion criteria. The pooled
analysis of mortality showed that RATS lobectomy significantly reduced the
mortality rate when compared with VATS lobectomy (RR =0.53, 95% CI 0.37 -
0.76; P = 0.0005). With the pooled result of duration of surgery indicated
that RATS has a tendency towards longer surgery time (SMD= 0.52, 95% CI
0.23- 0.81; P < 0.0004=). However, the meta-analysis on the median length
of hospital stay (MD =0.00, 95% CI-0.03 - 0.03; P = 0.91), number of
dissected lymph nodes station (SMD =0.39, 95% CI-0.60 - 1.38; P = 0.44),
the number of removed lymph nodes (SMD =0.98, 95% CI-0.61 - 2.56; P =
0.23), mean duration of drainage (SMD =0.29, 95% CI-0.15 - 0.73; P =
0.20), prolonged air leak (RR =1.01, 95% CI 0.84 - 1.21; P = 0.93),
arrhythmia (RR =1.06, 95% CI 0.88 - 1.26; P = 0.54) (P= 0.54), pneumonia
(RR =0.89, 95% CI 0.69 - 1.13; P = 0.33), the incidence of conversion (RR
=0.82, 95% CI 0.54 - 1.26; P = 0.37) and morbidity (RR =1.05, 95% CI 0.90
- 1.23; P = 0.055) all showed no significant differences between RATS and
VATS lobectomy. Conclusion(s): RATS result in better mortality as
compared with VATS. However, robotics seems to have longer operative time
and higher hospital costs, without superior advantages in morbidity rates
and oncologic efficiency. Since the advantages of RATS has been performed
in some area, the continuation of a comparative investigation with VATS
may be necessary. And some efforts need to be taken into consideration to
reduce the operative time and cost. Copyright © 2019 Bentham
Science Publishers.

<43>
Accession Number
627140813
Title
Protective ventilation with high versus low positive end-expiratory
pressure during one-lung ventilation for thoracic surgery (PROTHOR): Study
protocol for a randomized controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 213. Date of
Publication: 11 Apr 2019.
Author
Kiss T.; Wittenstein J.; Becker C.; Birr K.; Cinnella G.; Cohen E.; El
Tahan M.R.; Falcao L.F.; Gregoretti C.; Granell M.; Hachenberg T.;
Hollmann M.W.; Jankovic R.; Karzai W.; Krassler J.; Loop T.; Licker M.J.;
Marczin N.; Mills G.H.; Murrell M.T.; Neskovic V.; Nisnevitch-Savarese Z.;
Pelosi P.; Rossaint R.; Schultz M.J.; Serpa Neto A.; Severgnini P.;
Szegedi L.; Vegh T.; Voyagis G.; Zhong J.; Gama De Abreu M.; Senturk M.
Institution
(Kiss, Wittenstein, Becker, Birr, Gama De Abreu) Department of
Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group,
University Hospital Carl Gustav Carus, Technische Universitat Dresden,
Dresden, Germany
(Cinnella) Department of Anesthesia and Intensive Care, OO Riuniti
Hospital, University of Foggia, Foggia, Italy
(Cohen) Department of Anesthesiology, Mount Sinai Hospital, New York,
United States
(El Tahan) Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
(Falcao) Federal University of Sao Paulo, Sao Paulo, Brazil
(Gregoretti) UOC Anestesia e Rianimazione A.O.Universitaria p. Giaccone,
Dipartimento Di.Chir.On.S., Universita Degli Studi di Palermo, Palermo,
Italy
(Granell) Hospital General Universitario de Valencia, Valencia, Spain
(Hachenberg) University Hospital Magdeburg, Magdeburg, Germany
(Hollmann) Department of Anesthesiology, Amsterdam UMC, Location AMC,
Amsterdam, Netherlands
(Jankovic) Clinic for Anesthesia and Intensive Therapy, Clinical Center
Nis, School of Medicine, University of Nis, Nis, Serbia
(Karzai) Zentralklinik Bad Berka, Bad Berka, Germany
(Krassler) Thoracic Center Coswig, Coswig, Germany
(Loop) Department of Anesthesiology and Intensive Care Medicine Clinic,
Medical Center, University of Freiburg, Faculty of Medicine, University of
Freiburg, Freiburg, Germany
(Licker) University Hospital Geneva, Geneva, Switzerland
(Marczin) Section of Anaesthetics, Pain Medicine and Intensive Care,
Department of Surgery and Cancer, Faculty of Medicine, Imperial College
London, London, United Kingdom
(Marczin) Department of Anaesthesia, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield, G-Middlesex, United
Kingdom
(Marczin) Centre of Anaesthesia and Intensive Care, Semmelweis University,
Budapest, Hungary
(Mills) Department of Anaesthesia and Intensive Care Medicine, Sheffield
Teaching Hospitals, Sheffield University, Sheffield, United Kingdom
(Murrell) Department of Anesthesiology, Weill Cornell Medicine, New York,
United States
(Neskovic) Military Medical Academy, Belgrade, Serbia
(Nisnevitch-Savarese) Penn State Hershey Anesthesiology and Perioperative
Medicine, Hershey, United States
(Pelosi) Department of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
(Pelosi) IRCCS San Martino Policlinico Hospital, Genoa, Italy
(Rossaint) Department of Anaesthesiology, University Hospital Aachen,
Aachen, Germany
(Schultz) Department of Intensive Care and Laboratory of Experimental
Intensive Care and Anesthesiology, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Schultz) Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol
University, Bangkok, Thailand
(Serpa Neto) Department of Critical Care, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Severgnini) Dipartimento di Biotecnologie e Scienze della Vita,
Universita Degli Studi dell'Insubria, Varese, Italy
(Szegedi) Department of Anesthesiology, Centre Hospitalier Universitaire
de Charleroi, Charleroi, Belgium
(Vegh) Department of Anesthesiology and Intensive Care, University of
Debrecen, Debrecen, Hungary
(Vegh) Outcomes Research Consortium, Cleveland, United States
(Voyagis) Department of Anaesthesia, Postoperative ICU, Pain Relief and
Palliative Care Clinic, Sotiria Chest Diseases Hospital, Athens, Greece
(Voyagis) Department of Anaesthesiology and Critical Care Medicine,
University of Patras, Patra, Greece
(Zhong) Department of Anesthesiology, Fudan University Shanghai Cancer
Center, Shanghai, China
(Zhong) Department of Oncology, Shanghai Medical College, Fudan
University, Shanghai, China
(Senturk) Department of Anaesthesiology and Intensive Care, Istanbul
University, Istanbul Medical Faculty, Istanbul, Turkey
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications (PPC) may result in
longer duration of in-hospital stay and even mortality. Both thoracic
surgery and intraoperative mechanical ventilation settings add
considerably to the risk of PPC. It is unclear if one-lung ventilation
(OLV) for thoracic surgery with a strategy of intraoperative high positive
end-expiratory pressure (PEEP) and recruitment maneuvers (RM) reduces PPC,
compared to low PEEP without RM. Method(s): PROTHOR is an
international, multicenter, randomized, controlled, assessor-blinded,
two-arm trial initiated by investigators of the PROtective VEntilation
NETwork. In total, 2378 patients will be randomly assigned to one of two
different intraoperative mechanical ventilation strategies. Investigators
screen patients aged 18 years or older, scheduled for open thoracic or
video-assisted thoracoscopic surgery under general anesthesia requiring
OLV, with a maximal body mass index of 35 kg/m2, and a planned
duration of surgery of more than 60 min. Further, the expected duration of
OLV shall be longer than two-lung ventilation, and lung separation is
planned with a double lumen tube. Patients will be randomly assigned to
PEEP of 10 cmH<inf>2</inf>O with lung RM, or PEEP of 5 cmH<inf>2</inf>O
without RM. During two-lung ventilation tidal volume is set at 7 mL/kg
predicted body weight and, during OLV, it will be decreased to 5 mL/kg.
The occurrence of PPC will be recorded as a collapsed composite of single
adverse pulmonary events and represents the primary endpoint.
 Discussion(s): PROTHOR is the first randomized controlled trial in
patients undergoing thoracic surgery with OLV that is adequately powered
to compare the effects of intraoperative high PEEP with RM versus low PEEP
without RM on PPC. The results of the PROTHOR trial will support
anesthesiologists in their decision to set intraoperative PEEP during
protective ventilation for OLV in thoracic surgery. Trial registration:
The trial was registered in clinicaltrials.gov (NCT02963025) on 15
November 2016. Copyright © 2019 The Author(s).

<44>
Accession Number
2002311391
Title
Meta-Analysis for Impact of Statin on Mortality After Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. 124 (6) (pp 920-925), 2019. Date of
Publication: 15 September 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To determine whether statin (hydroxymethylglutaryl-CoA reductase
inhibitor) therapy is associated with better midterm survival after
transcatheter aortic valve implantation (TAVI), the first meta-analysis of
currently available studies was performed. To identify all observational
comparative studies and randomized controlled trials (RCTs) of statin
versus control (no statin) therapy or cohort studies investigating statin
treatment as one of covariates in patients undergoing TAVI, PubMed, Web of
Science, and Google Scholar were searched through March 2019. Adjusted (if
unavailable, unadjusted) hazard ratios (HRs) with their confidence
interval (CIs) of midterm (>=1 year) all-cause mortality after TAVI for
statin therapy were extracted from each study. Study-specific estimates
were combined by means of inverse variance-weighted averages of
logarithmic HRs in the random-effects model. Eight eligible studies with a
total of 5,170 TAVI patients were identified and included in the present
meta-analysis. The primary meta-analysis (including HRs for high intensity
statin from 3 studies together with other HRs) demonstrated that statin
treatment was associated with significantly lower midterm mortality (HR,
0.74; 95% CI, 0.60 to 0.91; p = 0.005). The secondary meta-analysis
(including HRs for low/moderate intensity statin from 3 studies together
with other HRs) also indicated an association of statin therapy with
significantly lower midterm mortality (HR, 0.80; 95% CI, 0.69 to 0.93; p =
0.005). No funnel plot asymmetry for the primary meta-analysis (p = 0.64)
was identified, which suggested probably no publication bias. In
conclusion, statin therapy is associated with better midterm survival
after TAVI. Copyright © 2019 Elsevier Inc.

<45>
Accession Number
2002218954
Title
A comparison of angina symptoms reported by clinicians and patients, pre
and post revascularisation: Insights from the Stent or Surgery Trial.
Source
International Journal of Cardiology. 293 (pp 25-31), 2019. Date of
Publication: 15 October 2019.
Author
Kemp I.; Appleby C.; Lane S.; Lisboa P.; Stables R.H.
Institution
(Kemp, Appleby, Stables) Institute of Cardiovascular Medicine and Science,
Liverpool Heart and Chest Hospital NHS Foundation Trust, United Kingdom
(Lane) Department of Biostatistics, University of Liverpool, United
Kingdom
(Lisboa) Dept. of Applied Mathematics, Faculty of Engineering and
Technology, Liverpool John Moores University, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: There are limited data comparing the consistency of angina
reporting by patients and clinicians. Method(s): We performed a
retrospective analysis of data from the randomised Stent or Surgery (SoS)
trial. The trial required reporting of angina using the Canadian
Cardiovascular Society (CCS) classification by both patients and
clinicians at baseline and twelve months. We compared paired observations
to describe the magnitude and direction of differences in clinician and
patient reporting. The difference in CCS grade was expressed as the
clinician minus patient value. We also examined the proportion of trial
subjects reported as being free from angina (CCS = 0) in clinician and
patient reporting. Result(s): Paired CCS data was available for 912
and 887 cases at baseline and 12 months respectively. At baseline,
clinicians reported freedom from angina in a single case (1/912 = 0.1%)
compared to 70/912 (7.7%) patients (Delta 7.6% 95% CI 5.8 to 9.3, P
<=0.001). At 12 months, the position was reversed, with clinicians
reporting 639/887 (72%) angina free compared to 449/887 (50.6%) for
patients (Delta -21.4 95% CI -17.1 to -25.8 P <= 0.001). For the reported
CCS grade at follow-up, the weighted linear kappa for overall agreement
was 0.312. Discordant reporting involved the clinician suggesting less
angina rather than more (36% v 8% of cases). Conclusion(s): These
findings have implications for our perception of previous research which
has, in the main, focussed on clinician reporting. This emphasises the
importance of patient reporting and a need to better understand reasons
for discordance. Copyright © 2019 Elsevier B.V.

<46>
Accession Number
2002663747
Title
Non-opioid analgesics as adjuvants to opioid for pain management in adult
patients in the ICU: A systematic review and meta-analysis.
Source
Journal of Critical Care. 54 (pp 136-144), 2019. Date of Publication:
December 2019.
Author
Zhao H.; Yang S.; Wang H.; Zhang H.; An Y.
Institution
(Zhao, Yang, Wang, An) Department of Critical Care Medicine, Peking
University People's Hospital, Beijing, China
(Zhang) Epidemiology Center, Peking University Third Hospital, Beijing,
China
Publisher
W.B. Saunders
Abstract
Purpose: To identify the impact of non-opioid analgesics as adjuvants to
opioid on opioid consumption and its side effects, as well as the
analgesic effectiveness in adult patients in the ICU. Method(s): Only
randomized clinical trials using non-opioid analgesics for analgesia in
the ICU were included. Pooled analyses with 95% CI were determined.
 Result(s): Twelve studies (mainly surgical and Guillain-Barre
syndrome patients) were included. Non-opioid analgesics as adjuvants to
opioid were associated with a significant reduction in the consumption of
opioids when compared with opioid use alone at Day 1 (MD -15.40; 95% CI
-22.41 to -8.39; P <.001) and Day 2 (MD -22.93; 95% CI -27.70 to -18.16; P
<.001). Non-opioid analgesics as adjuvants to opioid were associated with
a significantly lower incidence of nausea and vomiting when compared with
opioid use alone (RR 0.46; 95% CI 0.30 to 0.68; P <.001). Non-opioid
analgesics as adjuvants to opioid significantly decreased the pain score
at Day 1 (MD -0.68; 95% CI -1.28 to -0.08; P =.03) and Day 2 (MD -1.36;
95% CI -2.47 to -0.24; P =.02). Conclusion(s): Non-opioid analgesics
as adjuvants to opioid reduced the consumption and the side effects of
opioids in adult surgical and Guillain-Barre syndrome patients in the ICU.
Trial review registration: PROSPERO international prospective register of
systematic reviews on January 23, 2017, registration number
CRD42017055768. Copyright © 2019

<47>
Accession Number
629016316
Title
The role of paravertebral blocks in ambulatory surgery: Review of the
literature.
Source
Acta Clinica Croatica. 58 (Supplement 1) (pp 43-47), 2019. Date of
Publication: 2019.
Author
Zupcic M.; Dedic D.; Zupcic S.G.; Duzel V.; Simurina T.; Sakic L.;
Grubjesic I.; Sutic I.; Korusic A.
Institution
(Zupcic, Grubjesic) Clinical Hospital Centre Rijeka, Clinic of
Anesthesiology and Intensive Care Medicine, Rijeka, Croatia
(Zupcic, Zupcic, Sutic) University of Rijeka, Faculty of Medicine,
Department of Physiology and Immunology, Rijeka, Croatia
(Zupcic, Simurina, Korusic) J. J. Strossmayer University, Faculty of
Medicine, Osijek, Croatia
(Dedic, Korusic) Clinical Hospital Dubrava, Clinic of Anaesthesiology,
Reanimatology and Intensive Care Medicine, Zagreb, Croatia
(Zupcic) Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka,
Croatia
(Duzel) Barking, Havering and Redbridge University Hospitals NHS Trust,
Department of Anaesthesia, London, United Kingdom
(Simurina) General Hospital Zadar, Department of Anesthesiology and
Intensive Care Medicine, Zadar, Croatia
(Simurina) Department of Health Studies, University of Zadar, Zadar,
Croatia
(Sakic) Department of Anaesthesiology, Reanimatology and Intensive
Medicine, University Hospital "Sveti Duh", Zagreb, Croatia
(Sutic) University of Rijeka, Faculty of Medicine, Department of Family
medicine, Rijeka, Croatia
Publisher
Klinicka Bolnica Sestre Milosrdnice
Abstract
Ambulatory surgery often involves surgical procedures on the thorax,
abdomen and limbs, which can be associated with substantial postoperative
pain. The aim of this narrative review is to provide an analysis of the
effectiveness of paravertebral block (PVB) alone or in combination with
general anaesthesia, in this setting, with an emphasis on satisfactory
postoperative analgesia in comparison to other modalities. We have
conducted a search of current medical literature written in English
through PubMed, Google Scholar and Ovid Medline. Peer-reviewed
professional articles, review articles, retrospective and prospective
studies, case reports and case series were systematically searched for
during the time period between November 2003 and February 2019. The
literature used for the purpose of creating this review showed that
utilisation of paravertebral block either alone or in combination with
general anaesthesia, has a positive effect on satisfactory analgesia in
ambulatory surgery. With a multimodal analgesic approach of PVB and other
techniques of anaesthesia and analgesia there is a reduction in
postoperative opioid consumption, fewer side effects, lower pain scores,
decreased mortality, earlier mobilisation of patients and reduced hospital
stay. Copyright © 2019, Klinicka Bolnica Sestre Milosrdnice. All
rights reserved.

<48>
Accession Number
2002288243
Title
Rare distant metastatic disease of ovarian and peritoneal carcinomatosis:
A review of the literature.
Source
Cancers. 11 (8) (no pagination), 2019. Article Number: 1044. Date of
Publication: August 2019.
Author
Thomakos N.; Diakosavvas M.; Machairiotis N.; Fasoulakis Z.; Zarogoulidis
P.; Rodolakis A.
Institution
(Thomakos, Diakosavvas, Fasoulakis, Rodolakis) 1st Department of
Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit,
University of Athens, Athens 115 28, Greece
(Machairiotis) Department of Obstetrics & Gynecology, Department of
Obstetrics-Gynaecology, Royal Oldham Hospital, Pennine Accute Trust,
Oldham OL12JH, United Kingdom
(Zarogoulidis) 3rd Department of Surgery, "AHEPA" University Hospital,
Aristotle University of Thessaloniki, Thessaloniki 546 36, Greece
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Background: Although metastases of ovarian and peritoneal carcinomatosis
are most commonly found within the peritoneal cavity, there is a number of
other rare distant sites that have been reported. Our goal is to provide
an evidence-based summary of the available literature considering the rare
distant metastatic sites of ovarian and peritoneal carcinomatosis.
 Method(s): A comprehensive search of the literature was conducted,
with Medline/PubMed being searched for cases of rare metastatic disease
originated from primary ovarian and peritoneal cancer with related
articles up to 2019 including terms such as "ovarian cancer",
"metastases", "peritoneal" and others. Result(s): The most common
mechanism of ovarian cancer metastases consists of primarily dissemination
within the peritoneal cavity, while, rare and distant sites can either
occur at the beginning or during the course of the disease and they are
usually associated with hematogenous route and lymphatic invasion, having
poor prognosis, with the least common sites being skin, bone, CNS, eye,
placenta, central airways, rare lymph nodes, intra-abdominal organs, heart
and breast. Conclusion(s): The occurrence of metastatic sites
described in this review represents the most common rare distant
metastatic sites, and even though their patterns of metastases are still
not fully clarified due to the rarity of the reports, they offer valuable
information considering the pathophysiology of the disease. Copyright
© 2019 by the authors. Licensee MDPI, Basel, Switzerland.

<49>
Accession Number
626733829
Title
Multivessel coronary revascularization strategies in patients with chronic
kidney disease: A meta-analysis.
Source
CardioRenal Medicine. 9 (3) (pp 145-159), 2019. Date of Publication: 01
Mar 2019.
Author
Wu P.; Luo F.; Fang Z.
Institution
(Wu, Luo, Fang) Department of Cardiovascular Medicine, Second Xiangya
Hospital, Central South University, Changsha, Hunan 410011, China
Publisher
S. Karger AG
Abstract
Background: Early revascularization can lead to better prognosis in
multivessel coronary artery disease (CAD) patients with chronic kidney
disease (CKD). However, whether coronary artery bypass grafting (CABG) or
percutaneous coronary intervention (PCI) is better remains unknown.
 Method(s): We searched PubMed and the Cochrane Library database from
inception until December 9, 2017, for articles that compare outcomes of
CABG and PCI in multivessel CAD patients with CKD. We pooled the odds
ratios with a fixed-effects model when I2 < 50% or a
random-effects model when I2 > 75% and conducted heterogeneity
and quality assessments as well as publication bias analyses.
 Result(s): A total of 17 studies with 62,343 patients were included.
Compared with CABG, the pooled analysis showed that PCI had a lower risk
of short-term all-cause death (OR, 0.56; 95% CI, 0.37-0.84) and
cerebrovascular accidents (OR, 0.65; 95% CI, 0.53-0.79) but a higher risk
of cardiac death (OR, 1.29; 95% CI, 1.21-1.37), myocardial infarction (MI)
(OR, 1.73; 95% CI, 1.35-2.21), and repeat revascularization (RR) (OR, 3.9;
95% CI, 2.99-5.09). There was no significant difference in the risk of
long-term all-cause death (OR, 1.08; 95% CI, 0.95-1.23) and major adverse
cardiac and cerebrovascular events (MACCE) (OR, 1.58; 95% CI, 0.99-2.52)
between the PCI and CABG groups. A subgroup analysis restricted to
patients treated with dialysis or with PCI-drug-eluting stent yielded
similar results. Conclusion(s): PCI for patients with CKD and
multivessel disease (multivessel CAD) had advantages over CABG with regard
to short-term all-cause death and cerebrovascular accidents, but
disadvantages regarding the risk of myocardial death, MI, and RR; there
was no significant difference in the risk of long-term all-cause death and
MACCE. Large randomized controlled trials are needed to confirm our
findings. Copyright © 2019 S. Karger AG, Basel. All rights
reserved.

<50>
Accession Number
628856684
Title
Surgical site infections in Eastern Mediterranean region: a systematic
review and meta-analysis.
Source
Infectious Diseases. 51 (10) (pp 719-729), 2019. Date of Publication:
2019.
Author
Maleknejad A.; Dastyar N.; Badakhsh M.; Balouchi A.; Rafiemanesh H.; Al
Rawajfah O.; Rezaie Keikhaie K.; Sheyback M.
Institution
(Maleknejad) Department of General Surgery, Clinical Immunology Research
Center, Ali-Ebne Abitaleb Hospital, Zahedan University of Medical
Sciences, Zahedan, Iran, Islamic Republic of
(Dastyar) Department of Midwifery, Jiroft University of Medical Sciences,
Jiroft, Iran, Islamic Republic of
(Badakhsh) Department of Midwifery, School of Nursing and Midwifery, Zabol
University of Medical Sciences, Zabol, Iran, Islamic Republic of
(Balouchi) Student Research Committee, Nursing and Midwifery School, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Rafiemanesh) Department of Epidemiology, Student Research Committee,
School of Public Health and Safety, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Al Rawajfah) College of Nursing, Sultan Qaboos University, Muscat, Oman
(Rezaie Keikhaie) Zabol Medicinal Plants Research Center, Zabol University
of Medical Sciences, Zabol, Iran, Islamic Republic of
(Sheyback) Bushehr University of Medical Sciences, Bushehr, Iran, Islamic
Republic of
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background: Surgical site infections (SSIs) are the most common and costly
type of hospital-acquired infections (HAIs) worldwide. Despite individual
studies, there is also no clear statistics on the SSI prevalence rate in
the East Mediterranean region. The aim of this study was to investigate
the prevalence of SSI in the Eastern Mediterranean region. Method(s):
This systematic review and meta-analysis were performed by searching three
international databases (Web of Science, PubMed and Scopus) from 1 January
2001 to 31 December 2018. The keywords used included 'Prevalence' OR
'incidence' OR 'surgical site infection' OR 'wound infection' OR
'Postoperative Wound Infections' and 'Middle east'. The Hoy et al.'s tool
was used to evaluate the quality of the articles. Result(s): Out of
889 initial studies, 40 studies from 12 countries of the Eastern
Mediterranean region were included in the final stage of the study. Based
on the results of random effect method, the overall prevalence of SSI in
137,452 patients was 7.9% (95% Confidence Interval (CI): 7.1, 8.8;
I2=96.7%). The prevalence of SSI in cardiac surgery and general
surgery wards was 10 and 9.2%, respectively. The prevalence of SSI was
lower in women than in males, although this difference was related to
caesarean section. Conclusion(s): Considering the high prevalence of
SSI in the Eastern Mediterranean region, timely diagnosis, proper
prevention and postoperative control are necessary in the region using the
same international guides in all countries. Copyright © 2019,
© 2019 Society for Scandinavian Journal of Infectious Diseases.

<51>
Accession Number
2002349811
Title
Video-assisted thoracoscopic surgery versus thoracotomy for non-small cell
lung cancer: A meta-analysis.
Source
Combinatorial Chemistry and High Throughput Screening. 22 (3) (pp
187-193), 2019. Date of Publication: 2019.
Author
Ye B.; Wang M.
Institution
(Ye) Department of Thoracic Surgery, Hangzhou Red Cross Hospital,
Hangzhou, Zhejiang, China
(Wang) Department of Thoracic Surgery, Shulan (Hangzhou) Hospital,
Hangzhou, Zhejiang, China
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Patients undergoing surgery for non-small cell lung cancer
(NSCLC) are often elderly and have co-morbidity conditions and decreased
performance status. Compared with open thoracotomy, video-assisted
thoracoscopic lobectomy is associated with fewer postoperative
complications. Despite encouraging results for patients with NSCLC who
underwent VATS, the procedure is still not widely accepted, and large
retrospective studies have yielded conflicting results. Objective(s):
In video-assisted lobectomy for NSCLC, it has remained controversial
whether mediastinal lymphadenectomy can be performed as effectively as an
open procedure via thoracotomy. To deal with inherent biases in any
non-randomized comparison, we analyzed propensity-matched studies and
randomized controlled trials. The aim of this study was to evaluate the
treatment outcomes of VATS and open thoracotomy for NSCLC patients.
 Method(s): We collected publications on comparison of VATS versus
open thoracotomy for NSCLC patients from 2007 to 2017. All trials analyzed
the summary Hazard Ratios (HRs) of the endpoints of interest, including
perioperative mortality and morbidity, and individual postoperative
complications. Revman 5.3 software was used to analyze the combined pooled
HRs using fixed-or random-effects models according to heterogeneity.
 Result(s): A systematic literature search was conducted including 15
studies. The results indicated that VATS was associated with lower
postoperative morbidity and mortality, and significantly lower rates of
prolonged pneumonia, atrial arrhythmias and renal failure.
 Conclusion(s): Compared with lobectomy by thoracotomy, thoracoscopic
lobectomy is associated with a lower incidence of major complications,
including lower rates of prolonged pneumonia, atrial arrhythmias and renal
failure. Lobectomy via VATs may be the preferred strategy for
appropriately selected NSCLC patients. The determinants of this advantage
should be analyzed to improve the safety and outcomes of other thoracic
procedures. Copyright © 2019 Bentham Science Publishers.

<52>
Accession Number
2001037363
Title
Outcomes of Patients Receiving Downstream Revascularization After Initial
Medical Management for Non-ST-Segment Elevation Acute Coronary Syndromes
(From the TRILOGY ACS Trial).
Source
American Journal of Cardiology. 122 (8) (pp 1322-1329), 2018. Date of
Publication: 15 October 2018.
Author
Hinohara T.T.; Roe M.T.; White H.D.; Fox K.A.A.; Bhatt D.L.; Hamm C.;
Gurbel P.A.; Aylward P.E.; Wiviott S.D.; Huber K.; Neely M.L.; Ohman E.M.
Institution
(Hinohara) Division of General Internal Medicine, Duke University School
of Medicine, Durham, NC, United States
(Roe, Ohman) Division of Cardiology, Department of Medicine, Duke
University School of Medicine, Durham, NC, United States
(Roe, Neely, Ohman) Duke Clinical Research Institute, Duke University
School of Medicine, Durham, NC, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital, New
Zealand
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Bhatt, Wiviott) Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Bhatt) VA Boston Healthcare System, Boston, MA, United States
(Hamm) Kerckhoff Heart and Thoraxcenter, Bad Nauheim, Germany
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, MD, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University Medical Centre, Adelaide, SA, Australia
(Huber) Third Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, and Sigmund Freud University, Medical
School, Vienna, Austria
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS)
are sometimes treated with medical management alone rather than an
invasive strategy. Among those medically managed without revascularization
and discharged, a proportion will require revascularization later on, but
little is known about this population. In TRILOGY ACS, 9,326 patients with
NSTE ACS who were selected for medical management alone were randomized to
treatment with prasugrel or clopidogrel and discharged without
revascularization. Patient characteristics and ischemic and bleeding
outcomes through 30 months were compared between patients who underwent
downstream revascularization after the index hospitalization and those who
did not. A total of 662 patients (7.1%) underwent later revascularization
by percutaneous coronary intervention (73.1%), coronary artery bypass
graft surgery (26.4%), or the two (0.5%). Median time to revascularization
was 121 days (twenty-fifth, seventy-fifth percentiles: 41, 326).
Revascularized patients were younger, more likely to be male, and had
higher rates of hyperlipidemia, diabetes mellitus, prior myocardial
infarction, and prior revascularization compared with those not
revascularized. Europe and North America had the highest rates of
revascularization. During the follow-up period, those who underwent
revascularization had a higher rate of the composite outcome of
cardiovascular death, myocardial infarction, or stroke occurring after
revascularization compared with those not revascularized (hazard ratio
[HR] 2.73 [95% confidence interval {CI} 2.21 to 3.38], p < 0.001) as well
as a higher rate of each of the individual outcomes. Major bleeding was
also higher in those who underwent revascularization (GUSTO severe or
life-threatening: HR 2.61 [95% CI 1.02 to 6.67], p = 0.045; TIMI major: HR
2.24 [95% CI 1.12 to 4.48], p = 0.022). There was no evidence that
bleeding and ischemic outcomes varied by treatment with clopidogrel versus
prasugrel. In conclusion, among patients initially medically managed after
NSTE ACS, a small proportion later require revascularization and have a
high rate of ischemic and major bleeding outcomes compared with those not
requiring downstream revascularization. Copyright © 2018

<53>
Accession Number
2001189109
Title
Meta-Analysis Comparing Dual Antiplatelet Therapy Versus Single
Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 122 (8) (pp 1401-1408), 2018. Date of
Publication: 15 October 2018.
Author
Siddamsetti S.; Balasubramanian S.; Yandrapalli S.; Vij A.; Joshi U.; Tang
G.; Kodumuri V.
Institution
(Siddamsetti, Balasubramanian, Yandrapalli, Vij, Joshi, Tang, Kodumuri)
Division of Cardiology, John H. Stroger Jr. Hospital of Cook County,
Chicago, IL, United States
(Yandrapalli) Westchester Medical Center/New York Medical Center,
Valhalla, NY, United States
(Tang) Icahn School of Medicine at Mount Sinai Hospital, New York, NY,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The present American College of Cardiology/American Heart Association
guidelines (Grade IIb, level of evidence C) recommend dual antiplatelet
therapy (DAPT) with aspirin and clopidogrel for 6 months followed by
lifelong aspirin after transcathter aortic valve implantation (TAVI).
However, studies that have compared DAPT to single antiplatelet therapy
(SAPT) after TAVI have questioned this recommendation as DAPT has been
associated with more bleeding events compared with SAPT. We performed a
meta-analysis of all the trials that compared DAPT to SAPT in patients who
underwent TAVI. Three randomized trials and 4 nonrandomized studies were
included. The primary endpoint was the rate of ischemic stroke. Secondary
end points were the rates of myocardial infarction, life threatening
bleeding (LTB), significant bleeding (LTB and major bleeding), and death.
The Mantel-Haenszel random effects model was used to calculate the
combined odds ratios (OR) and 95% confidence intervals (CI) for outcomes
at 30 days and up to 6 to 12 months follow-up. The LTB (OR 2.73, 95% CI
1.31 to 5.69, p = 0.007) and significant bleeding rates (OR 2.76, 95% CI
1.57 to 4.85, p = 0.0004) were significantly higher in DAPT arm at 30
days. Significant bleeding (OR 2.24, 95% CI 1.33 to 3.79, p = 0.002) was
still significantly higher in the DAPT arm but there was only a
nonsignificant trend toward higher LTB (OR 1.93 95% CI 0.61 to 6.03, p =
0.26) at 6 to 12 month follow up. There was no difference in mortality,
ischemic stroke and myocardial infarction at 30 days or 6 to 12 month
follow up. In conclusion, our meta-analysis shows that DAPT after TAVI
does not confer any additional benefit over SAPT in TAVI. Copyright
© 2018

<54>
[Use Link to view the full text]
Accession Number
624068468
Title
Hyperinsulinemic Normoglycemia during Cardiac Surgery Reduces a Composite
of 30-day Mortality and Serious In-hospital Complications: A Randomized
Clinical Trial.
Source
Anesthesiology. 128 (6) (pp 1125-1139), 2018. Date of Publication: 01 Jun
2018.
Author
Duncan A.E.; Sessler D.I.; Sato H.; Sato T.; Nakazawa K.; Carvalho G.;
Hatzakorzian R.; Codere-Maruyama T.; Abd-Elsayed A.; Bose S.; Said T.;
Mendoza-Cuartas M.; Chowdary H.; Mascha E.J.; Yang D.; Gillinov A.M.;
Schricker T.
Institution
(Duncan) Departments of Cardiothoracic Anesthesia and Outcomes Research,
Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave-J4, Cleveland,
OH 44195, United States
(Sessler, Abd-Elsayed, Bose, Said, Mendoza-Cuartas, Chowdary, Mascha,
Yang) Outcomes Research, United States
(Mascha, Yang) Quantitative Health Sciences, United States
(Gillinov) Thoracic and Cardiovascular Surgery, Cleveland Clinic,
Cleveland, OH, United States
(Sato, Sato, Nakazawa, Carvalho, Hatzakorzian, Codere-Maruyama, Schricker)
Department of Anesthesia, Royal Victoria Hospital, McGill University,
Montreal, Canada
(Abd-Elsayed) Department of Anesthesiology, University of Wisconsin,
School of Medicine and Public Health, Madison, WI, United States
(Bose) Department of Anesthesia and Critical Care, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Said) Departments of Family Medicine and Geriatric Medicine, Metro Health
Medical Center, Cleveland, OH, United States
(Mendoza-Cuartas) Southern Arizona Anesthesia, Tucson, AZ, United States
(Chowdary) Department of Anesthesiology, University of Cincinnati,
Cincinnati, OH, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Hyperinsulinemic normoglycemia augments myocardial glucose
uptake and utilization. We tested the hypothesis that hyperinsulinemic
normoglycemia reduces 30-day mortality and morbidity after cardiac
surgery. Method(s): This dual-center, parallel-group, superiority
trial randomized cardiac surgical patients between August 2007 and March
2015 at the Cleveland Clinic, Cleveland, Ohio, and Royal Victoria
Hospital, Montreal, Canada, to intraoperative glycemic management with (1)
hyperinsulinemic normoglycemia, a fixed high-dose insulin and concomitant
variable glucose infusion titrated to glucose concentrations of 80 to 110
mg . dl-1; or (2) standard glycemic management, low-dose
insulin infusion targeting glucose greater than 150 mg . dl-1.
The primary outcome was a composite of 30-day mortality, mechanical
circulatory support, infection, renal or neurologic morbidity. Interim
analyses were planned at each 12.5% enrollment of a maximum 2,790
patients. Result(s): At the third interim analysis (n = 1,439;
hyperinsulinemic normoglycemia, 709, standard glycemic management, 730;
52% of planned maximum), the efficacy boundary was crossed and study
stopped per protocol. Time-weighted average glucose concentration (means
+/- SDs) with hyperinsulinemic normoglycemia was 108 +/- 20 versus 150 +/-
33 mg . dl-1 with standard glycemic management, P < 0.001. At
least one component of the composite outcome occurred in 49 (6.9%)
patients receiving hyperinsulinemic normoglycemia versus 82 (11.2%)
receiving standard glucose management (P < efficacy boundary 0.0085);
estimated relative risk (95% interim-adjusted CI) 0.62 (0.39 to 0.97), P =
0.0043. There was a treatment-by-site interaction (P = 0.063); relative
risk for the composite outcome was 0.49 (0.26 to 0.91, P = 0.0007, n =
921) at Royal Victoria Hospital, but 0.96 (0.41 to 2.24, P = 0.89, n =
518) at the Cleveland Clinic. Severe hypoglycemia (less than 40 mg .
dl-1) occurred in 6 (0.9%) patients. Conclusion(s):
Intraoperative hyperinsulinemic normoglycemia reduced mortality and
morbidity after cardiac surgery. Providing exogenous glucose while
targeting normoglycemia may be preferable to simply normalizing glucose
concentrations. Copyright © 2018, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<55>
Accession Number
625580520
Title
Coronary CTA reduced risk for coronary events at 5 years in patients with
stable chest pain.
Source
Annals of Internal Medicine. 169 (12) (pp JC70), 2018. Date of
Publication: 18 Dec 2018.
Author
Newby D.E.; Hudson M.P.
Institution
(Newby) University of Edinburgh, Edinburgh, United Kingdom
(Hudson) Henry Ford Hospital, Detroit, MI, United States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<56>
Accession Number
625580513
Title
In patients with chest pain, HEART Pathway-guided and usual care did not
differ for MACE or health care use.
Source
Annals of Internal Medicine. 169 (12) (pp JC69), 2018. Date of
Publication: 18 Dec 2018.
Author
Stopyra J.P.; Limkakeng A.T.; Granger C.B.
Institution
(Stopyra) Wake Forest School of Medicine, Winston-Salem, NC, United States
(Limkakeng, Granger) Duke University, Durham, NC, United States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<57>
Accession Number
625580493
Title
Changing to oral antibiotics was noninferior to continuing IV antibiotics
in left-sided infective endocarditis.
Source
Annals of Internal Medicine. 169 (12) (pp JC65), 2018. Date of
Publication: 18 Dec 2018.
Author
Bundgaard H.; Zar F.A.
Institution
(Bundgaard) Copenhagen University Hospital, Copenhagen, Denmark
(Zar) University of Illinois at Chicago, Chicago, IL, United States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<58>
Accession Number
2001005129
Title
Meta-Analysis Comparing the Frequency of Stroke After Transcatheter Versus
Surgical Aortic Valve Replacement.
Source
American Journal of Cardiology. 122 (7) (pp 1215-1221), 2018. Date of
Publication: 1 October 2018.
Author
Shah K.; Chaker Z.; Busu T.; Badhwar V.; Alqahtani F.; Alvi M.; Adcock A.;
Alkhouli M.
Institution
(Shah, Alqahtani, Alkhouli) Division of Cardiology, West Virginia School
of Medicine, Morgantown, WV, United States
(Chaker, Busu) Department of Medicine, West Virginia School of Medicine,
Morgantown, WV, United States
(Badhwar) Department of Cardiothoracic Surgery, West Virginia School of
Medicine, Morgantown, WV, United States
(Alvi, Adcock) Department of Neurology, West Virginia School of Medicine,
Morgantown, WV, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Stroke is one of the most feared complications of aortic valve
replacement. Although the outcomes of transcatheter aortic valve
implantation (TAVI) improved substantially over time, concerns remained
about a potentially higher incidence of stroke with TAVI compared with
surgical replacement (SAVR). However, comparative data are sparse. We
performed a meta-analysis comparing the incidence of stroke among patients
undergoing TAVI versus SAVR. Of the 5067 studies screened, 28 eligible
studies (22 propensity-score matched studies and 6 randomized trials) were
analyzed. Primary endpoints were 30-day stroke and disabling stroke.
Secondary endpoints were 1-year stroke and disabling stroke. A total of
23,587 patients were included, of whom 47.27% underwent TAVI and 52.72%
underwent SAVR. For each endpoint, pooled estimates of odds ratio (OR)
with 95% confidence interval (CI) were calculated. The pooled estimates
for stroke (2.7% vs 3.1%, OR 0.86; 95% CI 0.72 to 1.02; p=0.08) and
disabling stroke (2.5% vs 2.9%, OR 0.96; 95% CI 0.57 to 1.62; p=0.89) were
comparable following TAVI versus SAVR at 30 days. Similarly, the pooled
estimates for stroke (5.0% vs 4.6%, OR 1.01; 95% CI 0.79 to 1.28; p=0.96)
and disabling stroke (4.1% vs 4.5%, OR 0.92; 95% CI 0.92 to 1.39; p=0.71)
were similar at 1 year. A sensitivity analysis including only RCTs yielded
similar results. Our meta-analysis documents comparable rates of strokes
and disabling strokes following TAVI or SAVR both at 30 days and 1
year. Copyright © 2018

<59>
Accession Number
2002630344
Title
Comparison of efficacy and tolerability of pentoxifylline and cilostazole
on peripheral arterial disease.
Source
JK Practitioner. 22 (3-4) (pp 30-35), 2017. Date of Publication: 2017.
Author
Singh S.; WaheedMir A.; Singh G.
Institution
(Singh) Department of Clinical Pharmacology, SKIMS, Soura, Srinagar, India
(WaheedMir) Department of Anesthesiology and Critical Care, SKIMS, Soura
Srinagar, India
(Singh) Department of Cardiothoracic and Vascular Surgery, Govt. Medical
College Associated Hospital Jammu, India
Publisher
JK Practitioner
Abstract
Aim:To compare the efficacy and tolerability of cilostazole and
pentoxifylline in patients with moderately severe peripheral arterial
disease. Material(s) and Method(s):It is a prospective, randomized,
open label parallel study conducted in Postgraduate Department of
Pharmacology and Therapeutics in collaboration with Cardiothoracic and
Vascular Surgery Department, Govt. Medical College Jammu for a period of
one year. Result(s):out of 53 patientswith grade I chronic limb
ischemia, 26 patients were assigned pentoxifylline 400mg, and 28 patients
were given cilostazole 100mg. Both pentoxifylline as well as cilostazole
raised initial as well as absolute claudication distances significantly
from baseline, but on comparison, cilostazole was significantly more
effective compared to pentoxifylline. Cilostazole also had significant
beneficial effect on lipid profile (decreasing triglycerides and raising
HDL-Cholesterol), whereas pentoxifylline was lacking such effect. There
were no differences in patient's assessment, physician's assessment as
well as side effects between two groups. Conclusion(s):cilostazole is
found to be an effective treatment for patients of peripheral arterial
disease with intermittent claudication. It also has favorable effect on
lipid profile.However, long term randomized trials are required to further
substantiate our findings. Copyright © 2017 JK Practitioner. All
rights reserved.

<60>
Accession Number
2002710347
Title
Everolimus-Eluting Biodegradable Polymer Versus Everolimus-Eluting Durable
Polymer Stent for Coronary Revascularization in Routine Clinical Practice.
Source
JACC: Cardiovascular Interventions. 12 (17) (pp 1665-1675), 2019. Date of
Publication: 9 September 2019.
Author
Zanchin C.; Ueki Y.; Zanchin T.; Haner J.; Otsuka T.; Stortecky S.;
Koskinas K.C.; Siontis G.C.M.; Praz F.; Moschovitis A.; Hunziker L.;
Valgimigli M.; Pilgrim T.; Heg D.; Windecker S.; Raber L.
Institution
(Zanchin, Ueki, Zanchin, Haner, Otsuka, Stortecky, Koskinas, Siontis,
Praz, Moschovitis, Hunziker, Valgimigli, Pilgrim, Windecker, Raber) Swiss
Cardiovascular Center Bern, Department of Cardiology, Bern University
Hospital, Bern, Switzerland
(Heg) Clinical Trials Unit, University of Bern, Bern, Switzerland
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to compare the efficacy and safety
of a thin-strut, biodegradable-polymer everolimus-eluting stent (BP-EES)
(Synergy, Boston Scientific, Marlborough, Massachusetts) and a thin-strut,
durable-polymer everolimus-eluting stent (DP-EES) (XIENCE, Abbott
Vascular, Abbott Park, Illinois) in an all-comers population.
 Background(s): BP-EES have been shown to be noninferior to DP-EES in
randomized trials in patients at low to moderate risk. Method(s):
Among 7,042 consecutive patients who underwent percutaneous coronary
intervention between December 2012 and December 2016, 3,870 patients were
exclusively treated with BP-EES (n = 1,343) or with DP-EES (n = 2,527).
After propensity score matching, the final study population consisted of
1,041 matched patients. The primary endpoint was the device-oriented
composite endpoint (cardiac death, target vessel myocardial infarction,
and target lesion revascularization) at 12 months. Result(s): The
device-oriented composite endpoint did not differ between the 2 groups
(7.8% with BP-EES vs. 7.1% with DP-EES; hazard ratio: 1.12; 95% confidence
interval: 0.81 to 1.53; p = 0.49). There were no differences in rates of
cardiac death (3.0% vs. 3.0%; p = 1.00), target vessel myocardial
infarction (3.6% vs. 3.1%; p = 0.53), and target lesion revascularization
(3.0% vs. 2.5%; p = 0.41). The rate of acute stent thrombosis was
significantly higher in the BP-EES group compared with the DP-EES group
(1.2% vs. 0.3%; hazard ratio: 4.00; 95% confidence interval: 1.13 to
14.19; p = 0.032). At 12 months, the frequency of definite stent
thrombosis did not differ (1.5% vs. 0.9%; hazard ratio: 1.67; 95%
confidence interval: 0.73 to 3.82; p = 0.22). Conclusion(s): In this
consecutively enrolled percutaneous coronary intervention population
reflecting routine clinical practice, no difference in the device-oriented
composite endpoint between BP-EES and DP-EES was observed throughout 12
months. There was a higher rate of acute stent thrombosis with the BP-EES,
a difference that disappeared at 1 year. (CARDIOBASE Bern PCI Registry;
NCT02241291) Copyright © 2019 American College of Cardiology
Foundation

<61>
[Use Link to view the full text]
Accession Number
629144183
Title
Postoperative outcomes of patients with chronic obstructive pulmonary
disease undergoing coronary artery bypass grafting surgery: A
meta-analysis.
Source
Medicine (United States). 98 (6) (no pagination), 2019. Article Number:
e14388. Date of Publication: 01 Feb 2019.
Author
Zhao H.; Li L.; Yang G.; Gong J.; Ye L.; Zhi S.; Zhang X.; Li J.; Dalar L.
Institution
(Zhao, Li, Yang, Gong, Ye, Zhi, Li) Department of Respiratory Medicine,
Second Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, China
(Zhang) Department of Plastic Surgery, Plastic Surgery Hospital, Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing 100144,
China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction:Chronic obstructive pulmonary disease (COPD) is a frequent
comorbid disease in patients undergoing coronary artery bypass grafting
(CABG) surgery, with an incidence ranging from 4% to 20.5%.
Conventionally, COPD was recognized as a surgical contraindication to
CABG. Because of the recent improvements in surgical techniques,
anesthesia, and postoperative management, CABG has been performed more
commonly in patients with COPD. However, studies have shown the various
effects of COPD on postoperative morbidity and mortality after CABG, and
this remains to be well defined. Objective(s):To compare the
postoperative outcomes after CABG between patients with and those without
COPD. Method(s):A systematic search was conducted in the Cochrane
Library, PubMed, EmBase, and Ovid databases (until May 10, 2018). Studies
comparing perioperative results and mortality outcomes after CABG between
patients with and those without COPD were evaluated independently by 2
reviewers to identify the potentially eligible studies. Review Manager and
STATA software were used for statistical analyses. Result(s):No
significant difference in the mortality rates were found between patients
with and those without COPD. COPD was associated with a higher respiratory
failure rate (odds ratio [OR]=4.01; 95% CI: 1.19-13.51, P=.03; P<.001 for
heterogeneity), higher pneumonia rate (OR=2.92; 95% CI: 2.37-3.60,
P<.00001; P=.73 for heterogeneity), higher stroke rate (OR=2.91; 95% CI:
1.37-6.18, P=.005; P=.60 for heterogeneity), higher renal failure rate
(OR=1.60; 95% CI: 1.30-1.97, P<.00001; P=.19 for heterogeneity), and
higher wound infection rate (OR=2.16; 95% CI: 1.21-3.88, P=.01; P=.53 for
heterogeneity) after CABG. Conclusion(s):Patients with COPD were at
higher risks for developing postoperative morbidities, particularly
pneumonia, respiratory failure, stroke, renal failure, and wound
infection. Although COPD was not associated with a higher risk of
mortality, caution should be taken when a patient with COPD is indicated
for CABG, considering the higher odds of postoperative complications
involving the respiratory system and others. Copyright © 2019 the
Author(s). Published by Wolters Kluwer Health, Inc..

<62>
Accession Number
629143336
Title
Effects of thoracic epidural anesthesia/analgesia on the stress response,
pain relief, hospital stay, and treatment costs of patients with
esophageal carcinoma undergoing thoracic surgery: A single-center,
randomized controlled trial.
Source
Medicine (United States). 98 (7) (no pagination), 2019. Article Number:
e14362. Date of Publication: 01 Feb 2019.
Author
Li Y.; Dong H.; Tan S.; Qian Y.; Jin W.
Institution
(Li, Dong, Tan, Qian, Jin) Department of Anesthesiology, First Affiliated
Hospital of Nanjing Medical University, Nanjing 210029, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Appropriate postoperative pain management can improve outcomes
in patients with esophageal cancer (EC). Objective(s):To compare
different combinations of anesthesia and analgesia techniques in patients
with EC undergoing open thoracotomy. Method(s):This randomized,
controlled, open-label trial enrolled 100 patients with EC (aged 40-65
years; American Society of Anesthesiologists [ASA] grade I/II) receiving
elective surgery at Jiangsu Province Hospital (China) between July 2016
and December 2017. Patients were randomized to 4 groups (n=25 per group):
total intravenous general anesthesia plus patient-controlled intravenous
analgesia (TIVA/PCIA); TIVA plus patient-controlled epidural analgesia
(TIVA/PCEA); thoracic epidural anesthesia with intravenous general
anesthesia plus PCIA (TEA-IVA/PCIA); and TEA-IVA/PCEA (TEA-IVA plus PCEA).
Primary outcomes were plasma cortisol level (measured at baseline, 2h
after skin incision, surgery completion, and 24 and 48h post-surgery) and
pain (assessed at 24, 48, and 72hours post-surgery using a visual analog
scale). Secondary outcomes included time to first flatus, hospital stay
and treatment costs. Postoperative adverse events (AEs) were analyzed.
 Result(s):Baseline and operative characteristics were similar between
the 4 groups. Plasma cortisol level increased (P<.05 vs baseline) earlier
in the TIVA groups (2h after skin incision) than in the TEA-IVA groups
(24h after surgery). At 48hours after surgery, plasma cortisol had
returned to baseline levels in the PCEA groups but not in the PCIA groups.
VAS pain scores at rest and during coughing were lower in the PCEA groups
than in the PCIA groups (P<.05). Compared with the PCIA groups, the PCEA
groups had shorter time to first flatus and shorter hospital stay, while
use of TEA-IVA lowered the costs of intraoperative anesthesia (P<.05).
However, the PCEA groups had a higher incidence of nausea, vomiting, and
pruritus. Conclusion(s):Thoracic epidural anesthesia/analgesia can
reduce the stress response, improve postoperative recovery and reduce
hospital stay and costs for patients with EC. Copyright © 2019
the Author(s). Published by Wolters Kluwer Health, Inc.

<63>
Accession Number
2002705382
Title
Aortic valvular imaging with cardiovascular magnetic resonance: Seeking
for comprehensiveness.
Source
British Journal of Radiology. 92 (1101) (no pagination), 2019. Article
Number: 20170868. Date of Publication: 2019.
Author
De Rubeis G.; Galea N.; Ceravolo I.; Dacquino G.M.; Carbone I.; Catalano
C.; Francone M.
Institution
(De Rubeis, Galea, Ceravolo, Dacquino, Carbone, Catalano, Francone)
Department of Radiological, Oncological and Pathological Sciences,
Sapienza University of Rome, Rome, Italy
(Galea) Department of Experimental Medicine, Sapienza University of Rome,
Rome, Italy
Publisher
British Institute of Radiology (E-mail: publications@bir.org.uk)
Abstract
Cardiovascular magnetic resonance (CMR) has an emerging role in aortic
valve disease evaluation, becoming an all-in-one technique. CMR evaluation
of the anatomy and flow through the aortic valve has a higher
reproducibility than echocardiography. Its unique ability of in vivo
myocardial tissue characterization, significantly improves the risk
stratification and management of patients. In addition, CMR is equivalent
to cardiac CT angiography for trans-aortic valvular implantation and
surgical aortic valve replacement planning; on the other hand, its role in
the evaluation of ventricular function improving and post-treatment
complications is undisputed. This review encompasses the existing
literature regarding the role of CMR in aortic valve disease, exploring
all the aspects of the disease, from diagnosis to prognosis. Copyright
© 2019 The Authors.

<64>
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. Copyright © 2019
Elsevier Inc.

<65>
Accession Number
2002604850
Title
Impact of complete percutaneous revascularization in elderly patients with
chronic total occlusion.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Valenti R.; Migliorini A.; De Gregorio M.G.; Martone R.; Berteotti M.;
Bernardini A.; Carrabba N.; Vergara R.; Marchionni N.; Antoniucci D.
Institution
(Valenti, Migliorini, De Gregorio, Martone, Berteotti, Bernardini,
Carrabba, Vergara, Marchionni, Antoniucci) Cardiothoracic and Vascular
Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The aim of the study was to assess the prognostic impact of
successful chronic total occlusion (CTO) percutaneous coronary
intervention (PCI) and completeness of revascularization in the elderly.
 Background(s): Successful CTO-PCI is associated with clinical
benefit. Notwithstanding elderly patients are currently underrepresented
in CTO-PCI randomized controlled trials and registries. Method(s):
From the Florence CTO-PCI registry 1,405 patients underwent CTO-PCI
between 2004 and 2015; out of these, 460 consecutive patients were >=75
years. End point of the study was long-term cardiac survival. The
prognostic impact of successful CTO-PCI and complete revascularization on
survival was assessed by Kaplan-Meier estimation and by Cox multivariable
regression analysis. Result(s): Patients were stratified according to
success (72%) or failure of CTO-PCI. Completeness of revascularization was
achieved in 57% of patients. Five-year cardiac survival was significantly
higher in the successful CTO-PCI group (84 +/- 3% vs. 72 +/- 6%; p =.006)
and it was further improved if complete coronary revascularization was
achieved (90 +/- 3% vs. 68 +/- 5%; p <.001). At multivariable analysis,
increasing age (hazard ratio [HR] 1.08; p =.001), diabetes (HR 1.55; p
=.033), chronic kidney disease (HR 1.96, p =.002), left ventricular
ejection fraction <0.40 (HR 2.10; p <.001), and completeness of
revascularization (HR 0.58; p <.005) resulted independently associated
with long-term cardiac survival. Conclusion(s): In the elderly
successful CTO-PCI is associated with a long-term survival benefit. The
results of this study suggest that, even in the elderly, a CTO-PCI attempt
should be considered to achieve complete coronary
revascularization. Copyright © 2019 Wiley Periodicals, Inc.

<66>
Accession Number
628802615
Title
Incidence, predictors and cerebrovascular consequences of leaflet
thrombosis after transcatheter aortic valve implantation: a systematic
review and meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (3) (pp 488-494),
2019. Date of Publication: 01 Sep 2019.
Author
D'Ascenzo F.; Salizzoni S.; Saglietto A.; Cortese M.; Latib A.; Franzone
A.; Barbanti M.; Nietlispach F.; Holy E.W.; Burriesci G.; De Paoli A.;
Fonio P.; Atzeni F.; Moretti C.; Perl L.; D'Amico M.; Rinaldi M.; Conrotto
F.
Institution
(D'Ascenzo, Saglietto, Cortese, Moretti, D'Amico, Conrotto) Division of
Cardiology, Department of Medical Sciences, University of Turin, Citta
della Salute e della Scienza, Turin, Italy
(Salizzoni, Atzeni, Rinaldi) Division of Cardiac Surgery, Cardiovascular
and Thoracic Department, University of Turin, Citta della Salute e della
Scienza, Turin, Italy
(Latib) Interventional Cardiology Unit, Cardiothoracic and Vascular
Department, San Raffaele Scientific Institute, Milan, Italy
(Franzone) Department of Cardiology, Swiss Cardiovascular Center Bern,
Bern University Hospital, Bern, Switzerland
(Barbanti) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Nietlispach, Holy) Cardiology Clinic, University Hospital of Zurich,
Zurich, Switzerland
(Burriesci) UCL Mechanical Engineering, University College London, London,
United Kingdom
(Burriesci) Ri.MED Foundation, Palermo, Italy
(De Paoli, Fonio) Radiology Unit, Department of Surgical Science,
University of Turin, Turin, Italy
(Perl) Department of Cardiology, Rabin Medical Center, Petach-Tikva,
Israel
(Perl) Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We examined the incidence, the impact of subsequent
cerebrovascular events and the clinical or procedural predictors of
leaflet thrombosis (LT) in patients undergoing transcatheter aortic valve
implantation (TAVI). METHOD(S): MEDLINE/PubMed was systematically
screened for studies reporting on LT in TAVI patients. Incidence [both
clinical and subclinical, i.e. detected with computed tomography (CT)] of
LT was the primary end point of the study. Predictors of LT evaluated at
multivariable analysis and impact of LT on stroke were the secondary ones.
 RESULT(S): Eighteen studies encompassing 11 124 patients evaluating
incidence of LT were included. Pooled incidence of LT was 0.43% per month
[5.16% per year, 95% confidence interval (CI) 0.21-0.72, I2 = 98%]. Pooled
incidence of subclinical LT was 1.36% per month (16.32% per year, 95% CI
0.71-2.19, I2=94%). Clinical LT was less frequent (0.04% per month, 0.48%
per year, 95% CI 0.00-0.19, I2=93%). LT increased the risk of stroke [odds
ratio (OR) 4.21, 95% CI 1.27-13.98], and was more frequent in patients
with a valve diameter of 28-mm (OR 2.89: 1.55-5.8), for balloon-expandable
(OR 8: 2.1-9.7) or after valve-in-valve procedures (OR 17.1: 3.1-84.9).
Oral anticoagulation therapy reduced the risk of LT (OR 0.43, 95% CI:
0.22-0.84, I2=64%), as well as the mean transvalvular gradient.
 CONCLUSION(S): LT represents an infrequent event after TAVI, despite
increasing risk of stroke. Given its full reversal with warfarin, in
high-risk patients (those with valve-in-valve procedures, balloon
expandable or large-sized devices), a protocol which includes a control CT
appears reasonable. Copyright © The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<67>
[Use Link to view the full text]
Accession Number
628941195
Title
Donor Simvastatin Treatment in Heart Transplantation.
Source
Circulation. 140 (8) (pp 627-640), 2019. Date of Publication: 20 Aug 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, Holmstrom, Tuuminen, Krebs, Dhaygude, Syrjala, Lemstrom)
Transplantation Laboratory (A.I.N., R.T., S.O.S., University of Helsinki
and Helsinki University Hospital, Finland
(Nykanen, Syrjala, Lemstrom) Department of Cardiothoracic Surgery (A.I.N.,
S.O.S., University of Helsinki and Helsinki University Hospital, Finland
(Nykanen, Holmstrom, Tuuminen, Krebs, Dhaygude, Kankainen, Syrjala,
Lemstrom) Translational Immunology Program Research Programs Unit (A.I.N.,
R.T., S.O.S., University of Helsinki and Helsinki University Hospital,
Finland
(Kankainen) Medical and Clinical Genetics (M.K.), University of Helsinki
and Helsinki University Hospital, Finland
(Kankainen) Institute for Molecular Medicine Finland, University of
Helsinki (M.K.)
(Jokinen) Department of Cardiology (J.L.), University of Helsinki and
Helsinki University Hospital, Finland
(Jokinen) Paijat-Hame Central Hospital, Department of Surgery, Finland
(J.J.J.), Lahti, Finland
(Helantera) Transplantation and Liver Surgery (I.H.), University of
Helsinki and Helsinki University Hospital, Finland
(Raisanen-Sokolowski) Pathology (A.R.-S.), University of Helsinki and
Helsinki University Hospital, Finland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Ischemia-reperfusion injury may compromise the short-term and
long-term prognosis after heart transplantation. Experimental studies show
that simvastatin administered to the organ donor is vasculoprotective and
inhibits cardiac allograft ischemia-reperfusion injury. METHOD(S):
Eighty-four multiorgan donors were randomly assigned to receive 80 mg of
simvastatin (42 donors) via nasogastric tube after declaration of brain
death and upon acceptance as a cardiac donor, or to receive no simvastatin
(42 donors). The primary efficacy end point was postoperative plasma
troponin T and I levels during the first 24 hours after heart
transplantation. Secondary end points included postoperative hemodynamics,
inflammation, allograft function, rejections and rejection treatments, and
mortality. Results: Organ donor simvastatin treatment significantly
reduced the heart recipient plasma levels of troponin T by 34% (14900 +/-
12100 ng/L to 9800 +/- 7900 ng/L, P=0.047), and troponin I by 40% (171000
+/- 151000 ng/L to 103000 +/- 109000 ng/L, P=0.023) at 6 hours after
reperfusion, the levels of NT-proBNP (N-terminal pro-B-type natriuretic
peptide) by 36% (32800 +/- 24300 ng/L to 20900 +/- 15900 ng/L; P=0.011) at
1 week, and the number of rejection treatments with hemodynamic compromise
by 53% within the first 30 days (P=0.046). Donor simvastatin treatment did
not affect donor lipid levels but was associated with a specific
transplant myocardial biopsy gene expression profile, and a decrease in
recipient postoperative plasma levels of CXCL10 (C-X-C motif chemokine
10), interleukin-1alpha, placental growth factor, and platelet-derived
growth factor-BB. Postoperative hemodynamics, biopsy-proven acute
rejections, and mortality were similar. No adverse effects were seen in
recipients receiving noncardiac solid organ transplants from
simvastatin-treated donors. CONCLUSION(S): Donor simvastatin
treatment reduces biomarkers of myocardial injury after heart
transplantation, and-also considering its documented general safety
profile-may be used as a novel, safe, and inexpensive adjunct therapy in
multiorgan donation. CLINICAL TRIAL REGISTRATION: URL:
https://www.clinicaltrials.gov. Unique identifier: NCT01160978.

<68>
Accession Number
620697056
Title
Cognitive Outcomes After Transcatheter Aortic Valve Implantation: A
Metaanalysis.
Source
Journal of the American Geriatrics Society. 66 (2) (pp 254-262), 2018.
Date of Publication: Februaryy 2018.
Author
Khan M.M.; Herrmann N.; Gallagher D.; Gandell D.; Fremes S.E.;
Wijeysundera H.C.; Radhakrishnan S.; Sun Y.R.; Lanctot K.L.
Institution
(Khan, Herrmann, Sun, Lanctot) Neuropsychopharmacology Research Group,
Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto,
ON, Canada
(Khan, Sun, Lanctot) Department of Pharmacology and Toxicology, University
of Toronto, Toronto, ON, Canada
(Herrmann, Gallagher, Lanctot) Department of Psychiatry, Sunnybrook Health
Sciences Centre and University of Toronto, Toronto, ON, Canada
(Gandell) Department of Geriatric Medicine, Sunnybrook Health Sciences
Centre, Toronto, ON, Canada
(Fremes, Wijeysundera, Radhakrishnan) Schulich Heart Centre, Sunnybrook
Health Sciences Centre, Toronto, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To quantitatively summarize changes in cognitive performance
in individuals with severe aortic stenosis undergoing transcatheter aortic
valve implantation (TAVI). Design(s): Metaanalysis.
 Participant(s): Individuals undergoing TAVI (N = 1,065 (48.5% male)
from 18 studies, average age >=80). Measurements: The MEDLINE, EMBASE, and
Cochrane Central databases were searched for original peer-reviewed
reports assessing cognitive performance using standardized cognitive tests
before and after TAVI. Data were extracted for cognitive scores before
TAVI; perioperatively (within 7 days after TAVI); 1, 3, and 6 months after
TAVI, and 12 to 34 months after TAVI (over the long term). Standardized
mean differences (SMDs) were generated using random-effects models for
changes in cognition at each time point. Metaregression analyses were
conducted to assess the association between population and procedural
characteristics and cognitive outcomes. Risk of bias was assessed.
 Result(s): There were no significant changes from baseline in
perioperative cognitive performance (SMD = 0.05, 95% confidence interval
(CI) = -0.08-0.18; z = 0.75, P =.46), although overall cognitive
performance had improved significantly 1 month after TAVI (SMD = -0.33,
95% CI = -0.50 to -0.16; z = 3.83, P <.001). There were no differences in
cognitive performance 3 and 6 months after TAVI or over the long term.
Cognitive outcomes were not associated with any covariates in regression
analyses. Conclusion(s): Cognitive performance is preserved after
TAVI, suggesting TAVI is not detrimental to cognition. © 2017,
Copyright the Authors Journal compilation © 2017, The American
Geriatrics Society

<69>
Accession Number
2001011185
Title
Meta-Analysis of the Prognostic Value of Psoas-Muscle Area on Mortality in
Patients Undergoing Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 122 (8) (pp 1394-1400), 2018. Date of
Publication: 15 October 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We performed a meta-analysis of currently available studies assessing
prognostic value of psoas-muscle area (PMA) on mortality in patients who
underwent transcatheter aortic valve implantation (TAVI). MEDLINE and
EMBASE were searched through May 2018 to identify studies reporting
>=1-year all-cause mortality in PMA-stratified TAVI patients. A hazard
ratio of follow-up (including early) mortality for "lowest-quantile"
versus "higher-quantiles" PMA. Study-specific estimates were combined in
the random-effects model. Our search identified 6 eligible studies
enrolling a total of 1,237 TAVI patients with 1-year to 2-year (midterm)
follow-up. A primary meta-analysis pooling all hazard ratios for
"lowest-quantile versus higher-quantiles" PMA demonstrated significantly
higher mortality in "lowest-quantile" than "higher-quantiles" patients (p
<0.0001). A subgroup meta-analysis indicated no significant difference in
mortality between "<50th- and >=50th-percentile" patients (p = 0.95), but
significantly higher mortality in "lowest-tertile" than "higher-tertiles"
patients (p = 0.0009) and in "lowest-quartile" than "higher- quartiles"
patients (p = 0.0003). A secondary meta-analysis revealed significantly
higher mortality in "lowest-tertile" than "mid-tertile" patients (p =
0.01) and in "lowest-tertile" than "highest-tertile" patients (p = 0.01).
A gender-stratified meta-analysis showed significantly higher mortality in
"lowest-quantile" than "higher-quantiles" patients in both men (p =
0.0008) and women (p = 0.01). In conclusion, low PMA, especially
"lowest-tertile/quartile" PMA, is a predictor of high all-cause mortality
at midterm follow-up after TAVI for both men and women. However, PMA
categorization into 50th percentiles may be invalid to predict
mortality. Copyright © 2018

<70>
Accession Number
629098432
Title
Hemodynamic or thromboembolic stroke - What have we learned from cardiac
surgery?.
Source
Journal of Cerebral Blood Flow and Metabolism. Conference: 29th
International Symposium on Cerebral Blood Flow, Metabolism and Function
and the 14th International Conference on Quantification of Brain Function
with PET. Japan. 39 (1 Supplement) (pp 254), 2019. Date of Publication:
July 2019.
Author
Paulson O.B.; Vedel A.G.; Holmgaard F.; Rasmussen L.S.; Danielsen E.R.;
Langkilde A.; Lange T.; Olsen P.S.; Ravn H.B.; Nilsson J.C.
Institution
(Paulson) Neurobiology Research Unit, Rigshospitalet, Copenhagen
University Hospital
(Vedel, Holmgaard, Ravn, Nilsson) Department of Cardiothoracic
Anaesthesiology, Rigshospitalet, Copenhagen University Hospital
(Rasmussen) Department of Anesthesia, Center of Head and Orthopedics,
Rigshospitalet
(Danielsen, Langkilde) Department of Radiology, Rigshospitalet, Copenhagen
University Hospital
(Lange) Department of Biostatistics, Rigshospitalet, Copenhagen University
Hospital
(Olsen) Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen
University Hospital
Publisher
SAGE Publications Ltd
Abstract
Introduction: Stroke is a common disease caused by some degree of focal
cerebral ischemia. The thromboembolic occlusion of cerebral vessels is a
well known cause of stroke. Here the occlusion of the cerebral vessel may
arise from an embolus from the heart or from effects of a localised
endothelial lesion in the cerebral or extracranial arteries. The
hemodynamic stroke caused by stenosis of a cerebral or extracranial
vessels and episodic blood pressure drop, has generally been considered
less frequent (1, 2). But, fluctuations in blood pressure with episodic
drop may lead to manifest neurological deficits, transitory or permanent.
 Objective(s): To use results obtained from our recent study on
cerebral lesions following cardiopulmonary bypass surgery to discuss the
general likelihood of hemodynamic vs. thromboembolic stroke Methods: In a
patient- and assessor-blinded randomized trial, patients were allocated to
a higher (70-80 mm Hg) or lower (40-50 mm Hg) target for mean arterial
pressure by the titration of norepinephrine during cardiopulmonary bypass.
Pump flow was fixed at 2.4 L.min-1 m-2. The primary
outcome was the total volume of new ischemic cerebral lesions (summed in
millimetres cubed), expressed as the difference between diffusion-weighted
imaging (DWI) conducted preoperatively and again postoperatively between
days 3 and 6 (3). In a secondary analysis we compared cerebral metabolism
using magnetic resonance spectroscopy (4). Further secondary analyses
investigated postoperative cognitive dysfunction (POCD) and its
association with DWI detected brain lesions (5). Result(s): Among the
197 enrolled patients, mean (SD) age was 65.0 (10.7) years in the
low-target group (n = 99) and 69.4 (8.9) years in the high-target group (n
= 98). Overall, DWI revealed new cerebral lesions in 52.8% of patients in
the low-target group versus 55.7% in the high-target group (P =0.76). The
primary outcome of volume of new cerebral lesions was comparable between
groups, 25 mm3 in the low-target group versus 29 mm3
in the high-target group (P=0.99). MRS revealed a decrease in GM-NAA/Cr in
the high-target group, (P = 0.014). In a subset of the patients (89 in the
low-target and 80 in the high-target group) no statistically significant
between-group differences were found when comparing the overall rate of
POCD or the proportion of patients with a domain-specific deterioration
over the pre-defined critical level in 7 individual test variables at
discharge. Conclusion(s): Overall, we found no major
neuroradiological or cognitive outcome differences when targeting higher
vs lower blood pressure during full-flow cardiopulmonary bypass. Still, a
tendency was observed towards a better outcome in the low-target group
both for primary and secondary outcomes. These insights obtained from
cardiac surgery research indicate that stroke caused by a hemodynamic
mechanism in the elderly population seems to be uncommon in contrast to
the much more frequent thromboembolic stroke.

<71>
[Use Link to view the full text]
Accession Number
629133569
Title
Blood Leukocyte DNA Methylation Predicts Risk of Future Myocardial
Infarction and Coronary Heart Disease.
Source
Circulation. 140 (8) (pp 645-657), 2019. Date of Publication: 20 Aug 2019.
Author
Agha G.; Mendelson M.M.; Ward-Caviness C.K.; Joehanes R.; Huan T.;
Gondalia R.; Salfati E.; Brody J.A.; Fiorito G.; Bressler J.; Chen B.H.;
Ligthart S.; Guarrera S.; Colicino E.; Just A.C.; Wahl S.; Gieger C.;
Vandiver A.R.; Tanaka T.; Hernandez D.G.; Pilling L.C.; Singleton A.B.;
Sacerdote C.; Krogh V.; Panico S.; Tumino R.; Li Y.; Zhang G.; Stewart
J.D.; Floyd J.S.; Wiggins K.L.; Rotter J.I.; Multhaup M.; Bakulski K.;
Horvath S.; Tsao P.S.; Absher D.M.; Vokonas P.; Hirschhorn J.; Fallin
M.D.; Liu C.; Bandinelli S.; Boerwinkle E.; Dehghan A.; Schwartz J.D.;
Psaty B.M.; Feinberg A.P.; Hou L.; Ferrucci L.; Sotoodehnia N.; Matullo
G.; Peters A.; Fornage M.; Assimes T.L.; Whitsel E.A.; Levy D.; Baccarelli
A.A.
Institution
(Agha, Baccarelli) Department of Environmental Health Sciences, Columbia
University Mailman School of Public Health, Rwanda
(Mendelson, Joehanes, Levy) Population Sciences Branch, National Heart,
Lung, and Blood Institute, NIH, Bethesda, MD (M.M.M., D.L., R.J.)
(Mendelson, Levy) Framingham Heart Study, United States
(Mendelson) Department of Cardiology, Boston Children's Hospital, United
States
(Ward-Caviness) National Health and Environmental Effects Research
Laboratory, Environmental Public Health Division, Chapel Hill, Australia
(Ward-Caviness) Institute of Epidemiology II, Helmholtz Institute, Germany
(C.K.W.C.), Ingolstaedter Landstrasse 1, Neuherberg
(Joehanes) Hebrew SeniorLife, Harvard Medical School, Boston, United
Kingdom
(Huan) Population Sciences Branch, Division of Intramural Research,
National Heart, Lung and Blood Institute, Bethesda, United States
(Gondalia) Department of Epidemiology (R.G.), University of North
Carolina, Chapel Hill, Australia
(Salfati, Tsao) Department of Medicine, Stanford University School of
Medicine, United Kingdom
(Brody, Floyd, Wiggins) Cardiovascular Health Research Unit, Department of
Medicine, University of Washington, Australia
(Fiorito, Guarrera) Italian Institute for Genomic Medicine (IIGM/HuGeF)
and Department of Medical Sciences, University of Turin, S.G.
(Bressler) Human Genetics Center, School of Public Health, University of
Texas Health Science Center at Houston (J.B.)
(Chen, Tanaka) Translational Gerontology Branch, National Institute on
Aging, National Institutes of Health, Baltimore, Canada
(Ligthart) Department of Epidemiology, Erasmus MC University Medical
Center, Rotterdam, Netherlands
(Colicino, Just) Department of Environmental Medicine and Public Health,
Icahn School of Medicine at Mount Sinai, NY, United States
(Wahl, Gieger) Research Unit Molecualr Epidemiology, Germany (S.W.,
Helmholtz Zentrum Munchen
(Vandiver, Multhaup) Center for Epigenetics, Johns Hopkins University
School of Medicine, Baltimore, Canada
(Hernandez, Singleton) Laboratory of Neurogenetics, National Institute on
Aging, National Institutes of Health, Bethesda, United States
(Pilling) Epidemiology and Public Health Group, University of Exeter
Medical School, United Kingdom (L.C.P.)
(Sacerdote) Unit of Cancer Epidemiology, Citta della Salute e della
Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin,
Italy
(Krogh) Epidemiology and Prevention Unit, Fondazione IRCCS Istituto
Nazionale dei Tumori, Milan, United States
(Panico) Dipartimento di Medicina Clinica e Chirurgia, Federico II
University, Naples, Italy
(Tumino) Cancer Registry And Histopathology Department, Civic- M.P.
Arezzo2 Hospital, Asp Ragusa
(Li) Department of Genetics, Department of Biostatistics, Department of
Computer Science (Y.L.), University of North Carolina, Chapel Hill,
Australia
(Zhang) Curriculum in Bioinformatics and Computational Biology, Department
of Genetics, Department of Statistics (G.Z.), University of North
Carolina, Chapel Hill, Australia
(Stewart) Carolina Population Center and Department of Epidemiology
(J.D.S.), University of North Carolina, Chapel Hill, Australia
(Rotter) Institute for Translational Genomics and Population Sciences,
Departments of Pediatrics and Medicine, LABioMed at Harbor-UCLA Medical
Center, Torrance, United States
(Bakulski) Department of Epidemiology, School of Public Health, University
of Michigan, United States
(Horvath) Department of Human Genetics, David Geffen School of Medicine,
University of California Los Angeles (S.H.)
(Absher) HudsonAlpha institute of Biotechnology, AL (D.M.A.), Huntsville,
Canada
(Vokonas) VA Normative Aging Study, VA Boston Healthcare System,
Department of Medicine, Boston University School of Medicine, United
Kingdom
(Hirschhorn) Department of Medicine, Division of Endocrinology, Boston
Children's Hospital, United States
(Hirschhorn) Departments of Medicine and Pediatrics, Harvard Medical
School, Boston, United Kingdom
(Fallin) Department of Mental Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, Canada
(Liu) Department of Biostatistics, Boston University School of Public
Health, United States
(Bandinelli) Azienda Sanitaria, USL Centro Firenze
(Boerwinkle) Human Genetics Center, School of Public Health, University of
Texas Health Science Center at Houston (E.B.)
(Boerwinkle) Human Genome Sequencing Center, Baylor College of Medicine,
Germany
(Dehghan) Department of Epidemiology and Biostatistics, MRC-PHE Centre for
Environment & Health, School of 346 Public Health, Imperial College
London, United Kingdom (A.D.)
(Schwartz) Department of Epidemiology and Department of Environmental
Health, Harvard T.H. Chan School of Public Health, Boston, United Kingdom
(Psaty) Cardiovascular Health Research Unit, Departments of Medicine,
Epidemiology, Health Services, University of Washington, Australia
(Psaty) Kaiser Permanente Washington Health Research Institute
(Feinberg) Departments of Medicine, Biomedical Engineering, Johns Hopkins
University, and Mental Health, Baltimore, Canada
(Hou) Center for Population Epigenetics, Robert H. Lurie Comprehensive
Cancer Center and Department of Preventive Medicine, Northwestern
University, Feinberg School of Medicine, Chicago, United States
(Ferrucci) Intramural Research Program, National Institute on Aging,
National Institutes of Health, Baltimore, Canada
(Sotoodehnia) Division of Cardiology, Departments of Medicine and
Epidemiology, Cardiovascular Health Research Unit, University of
Washington, Australia
(Peters) Helmholtz Zentrum Munchen, Institute of Epidemiology, Neuherberg,
Germany; German Research Center for Cardiovascular Disease (DzHK e.V. -
partner site Munich), Germany (A.P.)
(Peters) Ludwig-Maximilians University, Institute for Biometry, Medical
Information Science and Epidemiology, Germany (A.P.), Munich, Germany
(Fornage) Brown Foundation Institute of Molecular Medicine McGovern
Medical School, Human Genetics Center, School of Public Health, University
of Texas Health Science Center at Houston (M.F.)
(Assimes) Department of Medicine (Cardiovascular Medicine), Department of
Health Research & Policy, Stanford University School of Medicine, United
Kingdom
(Whitsel) Department of Epidemiology, Gillings School of Global Public
Health, Department of Medicine, School of Medicine, University of North
Carolina, Chapel Hill (E.A.W.), United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: DNA methylation is implicated in coronary heart disease (CHD),
but current evidence is based on small, cross-sectional studies. We
examined blood DNA methylation in relation to incident CHD across multiple
prospective cohorts. METHOD(S): Nine population-based cohorts from
the United States and Europe profiled epigenome-wide blood leukocyte DNA
methylation using the Illumina Infinium 450k microarray, and prospectively
ascertained CHD events including coronary insufficiency/unstable angina,
recognized myocardial infarction, coronary revascularization, and coronary
death. Cohorts conducted race-specific analyses adjusted for age, sex,
smoking, education, body mass index, blood cell type proportions, and
technical variables. We conducted fixed-effect meta-analyses across
cohorts. RESULT(S): Among 11461 individuals (mean age 64 years, 67%
women, 35% African American) free of CHD at baseline, 1895 developed CHD
during a mean follow-up of 11.2 years. Methylation levels at 52 CpG
(cytosine-phosphate-guanine) sites were associated with incident CHD or
myocardial infarction (false discovery rate<0.05). These CpGs map to genes
with key roles in calcium regulation (ATP2B2, CASR, GUCA1B, HPCAL1), and
genes identified in genome- and epigenome-wide studies of serum calcium
(CASR), serum calcium-related risk of CHD (CASR), coronary artery
calcified plaque (PTPRN2), and kidney function (CDH23, HPCAL1), among
others. Mendelian randomization analyses supported a causal effect of DNA
methylation on incident CHD; these CpGs map to active regulatory regions
proximal to long non-coding RNA transcripts. CONCLUSION(S):
Methylation of blood-derived DNA is associated with risk of future CHD
across diverse populations and may serve as an informative tool for
gaining further insight on the development of CHD.

<72>
Accession Number
629133512
Title
A meta-analysis of the performance of small tissue versus mechanical
aortic valve prostheses.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (3) (pp 510-517),
2019. Date of Publication: 01 Sep 2019.
Author
Moscarelli M.; Fattouch K.; Speziale G.; Nasso G.; Santarpino G.; Gaudino
M.; Athanasiou T.
Institution
(Moscarelli) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Moscarelli, Fattouch, Speziale, Nasso, Santarpino) Department of Cardiac
Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, USA
(Athanasiou) Department of Surgery and Cancer, Imperial College,
Paddington, London, UK
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Small aortic prosthetic valves have been associated with
suboptimal performance due to patient-prosthesis mismatch (PPM). This
meta-analysis compared the outcomes of patients with a small root who
received tissue versus mechanical aortic valves. METHOD(S): A
systematic literature review identified 7 candidate studies; of these, 5
met the meta-analysis criteria. We analysed outcomes for a total of 680
patients (227 tissue valves and 453 mechanical valves) using random
effects modelling. Each study was assessed for heterogeneity and quality.
The primary end point was mortality at follow-up. Secondary end points
included intraoperative and postoperative outcomes, the rate of PPM and
left ventricle mass regression and major cardiac and prosthesis-related
adverse events at follow-up. RESULT(S): There was no between-group
difference in mortality at follow-up [incidence rate ratio 1, 95%
confidence interval (CI) 0.50-2.01; P=0.99]. The tissue group had a higher
rate of PPM (odds ratio 17.19, 95% CI 8.6-25.78; P=0.002) and
significantly less reduction in ventricular mass (weighted mean difference
40.79, 95% CI 4.62-76.96; P=0.02). There were no significant differences
in the incidence of structural valve disease at follow-up compared to that
in the mechanical valve group. There was also no between-group difference
in aggregated adverse events at follow-up (P=0.68). CONCLUSION(S):
Tissue and mechanical valves were associated with similar mortality rates;
however, patients receiving tissue valves had a higher rate of PPM and
significantly less left ventricle mass regression. These findings indicate
that patients receiving small tissue valves may require closer clinical
surveillance than those receiving mechanical valves. Copyright ©
The Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<73>
Accession Number
2002466872
Title
Cardiovascular complications of nasal packing after septoplasty. A
randomized clinical trial.
Source
Investigacion Clinica (Venezuela). 60 (2) (pp 153-159), 2019. Date of
Publication: 2019.
Author
Taheri A.; Farahani M.M.; Saeedi M.; Banaei-Boroujeni S.; Hosseini S.M.
Institution
(Taheri, Saeedi, Banaei-Boroujeni) Department of Otorhinolaryngology Head
and Neck Surgery, Baqiyatallah University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Farahani) Department of Cardiology, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Hosseini) Dept. of Psychology, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Instituto de Investigaciones Clinicas (P.O. Box 1151, Maracaibo, Zulia
4001-A, Venezuela. E-mail: riclinicas@gmail.com)
Abstract
A common method employed in nasal surgery is the anterior nasal packing.
One of the complications debated today is about the cardiovascular effects
due to the use of this method. The purpose of this study was to evaluate
some cardiac parameters in different groups of patients subjected to
septoplasty, to identify the safest way to use nasal packing in
postoperative treatment and to minimize its cardiovascular complications.
In this clinical trial, 104 candidates for septoplasty were initially
screened, of which, 14 patients were excluded and 90 patients were
selected by block randomization. Different assessors monitored blood
pressure, heart rate and cardiac rhythm three times before surgery. Then a
classic septoplasty was performed in all patients, after which patients
were randomly divided into three groups: 1) without nasal packing, 2) with
nasal packing, and 3) with nasal packing that had an airway. Blood
pressure and heart rate were monitored, following surgery, by a 24-hour
Holter. The monitoring data were analyzed and interpreted by a
cardiologist. The significance criteria of data were assumed as p-values
<= 0.05. Mean diastolic blood pressures after surgery in groups 1-3 was:
73.4+/-7.3 mmHg, 76.4+/-5.8 mmHg and, 80.9+/-6 mmHg, respectively, showing
lower values in patients without nasal packing and a significant
difference in patients that had nasal packing with an airway (p=0.03).
Mean heart rates after surgery in groups 1-3 were 71.8+/-11.3, 77.7+/-7.9
and 79.1+/-6.7, respectively, showing a significant difference of the
first group with respect to group 3 (p=0.043). This research showed that
the use of anterior nasal packing with or without airway leads to
cardiovascular changes such as increased diastolic blood pressure and
heart rate. More studies should be conducted for a definitive conclusion,
so the balance of its risks and benefits must be considered, when using
nasal packing after septoplasty surgery. Copyright © 2019,
Instituto de Investigaciones Clinicas. All rights reserved.

<74>
Accession Number
629128485
Title
The combined effect of vitamin C and omega-3 polyunsaturated fatty acids
on fatigue following coronary artery bypass graft surgery: a triple-blind
clinical trial.
Source
Journal of complementary & integrative medicine. (no pagination), 2019.
Date of Publication: 21 Aug 2019.
Author
Gholami M.; Najafizadeh H.; Teimouri H.; Ardalan A.; Pooria A.; Tarrahi
M.J.
Institution
(Gholami) School of Nursing and Midwifery, Lorestan University of Medical
Sciences, Khorramabad, Iran, Islamic Republic of
(Najafizadeh) Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran, Islamic Republic of
(Teimouri, Pooria) Department of Cardiac Surgery, School of Medicine,
Lorestan University of Medical Sciences, Khorramabad, Iran, Islamic
Republic of
(Ardalan) 563 hampshire Rd, Apt 273 Westlake Village, CA 91361, United
States
(Tarrahi) Department of Epidemiology and Biostatistics, School of Health,
Isfahan university of Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
Background Fatigue is a common compliant among patients who undergo
coronary artery bypass graft (CABG) surgery. This may affect patients'
function in all aspects. A few studies have already assessed the influence
of complementary therapies on minimizing fatigue. This study aimed to
investigate the combined effect of vitamin C and omega-3 polyunsaturated
fatty acids (n-3 PUFA) on fatigue following CABG surgery. Methods In this
randomized, triple-blind placebo-controlled trial, 160 patients who
already underwent CABG surgery were randomly assigned into an experimental
or a control groups. Each group consisted of 80 patients. The experimental
group was given both n-3 PUFA and vitamin C the day before surgery. They
also received the same supplements in the first 5 days of operation. The
control group received only placebo. Subjects in both groups responded to
Multidimensional Fatigue Inventory (MFI-20) scale in the beginning, and at
the end of the intervention as well as on the fifth day of the operation.
Chi-square test and independent t-test were used for data analysis.
Results The mean fatigue score in experimental and control groups came up
to 62.01+/-4.06 and 67.92+/-4.95 (p<0.0001), respectively, which was
greater than that of the values we had before intervention. The mean
difference of fatigue score was 3.97+/-3.49 and 9.56+/-6.41 (p<0.0001)
prior and following the intervention, correspondingly. Conclusion
Combination of vitamin C and n-3 PUFA effectively reduces post-operative
fatigue among patients who undergo CABG surgery.

<75>
Accession Number
629127446
Title
Efficacy and safety of tacrolimus in de novo pediatric transplant
recipients randomized to receive immediate- or prolonged-release
tacrolimus.
Source
Clinical transplantation. (no pagination), 2019. Date of Publication: 22
Aug 2019.
Author
Vondrak K.; Parisi F.; Dhawan A.; Grenda R.; Webb N.J.; Marks S.D.; Debray
D.; Holt R.C.; Lachaux A.; Kelly D.; Kazeem G.; Undre N.
Institution
(Vondrak) University Hospital Motol, Prague, Czechia
(Parisi) Osp Pediatrico Bambino Gesu, Rome, Italy
(Dhawan) King's College Hospital, London, United Kingdom
(Grenda) Children's Memorial Health Institute, Warsaw, Poland
(Webb) Manchester University Foundation Trust, Manchester, United Kingdom
(Marks) NHS Foundation Trust, Great Ormond Street Hospital for Children,
London, United Kingdom
(Debray) APHP-Hopital Universitaire Necker, Paris, France
(Holt) Alder Hey Children's Hospital, Liverpool, United Kingdom
(Lachaux) Universite Lyon, et Hospices Civils de Lyon, Lyon, France
(Kelly) Birmingham Women's & Children's Hospital, Birmingham, United
Kingdom
(Kazeem, Undre) Astellas Pharma Europe Ltd, Chertsey, United Kingdom
(Kazeem) BENKAZ Consulting Ltd, Cambridge, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND AND AIMS: This multicenter trial compared immediate-release
tacrolimus (IR-T) versus prolonged-release tacrolimus (PR-T) in de novo
kidney-, liver-, and heart-transplant recipients aged <16 years. Each
formulation had similar pharmacokinetic (PK) profiles. Follow-up efficacy
and safety results are reported herein. MATERIALS AND METHODS: Patients,
randomized 1:1, received once-daily, PR-T or twice-daily, IR-T within 4
days of surgery. After a 4-week PK assessment, patients continued
randomized treatment for 48 additional weeks. At Year 1, efficacy
assessments included the number of clinical acute rejections,
biopsy-confirmed acute rejection (BCAR) episodes (including severity),
patient and graft survival, and efficacy failure (composite of death,
graft loss, BCAR, or unknown outcome). Adverse events were assessed
throughout. RESULT(S): The study included 44 children. At Year 1,
mean +/- standard deviation tacrolimus trough levels were 6.6+/-2.2 and
5.4+/-1.6 ng/mL, and there were 2 and 7 acute rejection episodes in the
PR-T and IR-T groups, respectively. No cases of graft loss or death were
reported during the study. The overall efficacy failure rate was 18.2%
(PR-T n=1; IR-T n=7). CONCLUSION(S): In pediatric de novo solid organ
recipients, the low incidence of BCAR and low efficacy failure rate
suggests that PR-T-based immunosuppression is effective and well tolerated
to 1-year post transplantation. This article is protected by copyright.
All rights reserved.

<76>
Accession Number
629124219
Title
Ezetimibe Lipid-Lowering Trial on Prevention of Atherosclerotic
Cardiovascular Disease in 75 or Older (EWTOPIA 75): A Randomized
Controlled Trial.
Source
Circulation. (no pagination), 2019. Date of Publication: 22 Aug 2019.
Author
Ouchi Y.; Sasaki J.; Arai H.; Yokote K.; Harada K.; Katayama Y.; Urabe T.;
Uchida Y.; Hayashi M.; Yokota N.; Nishida H.; Otonari T.; Arai T.; Sakuma
I.; Sakabe K.; Yamamoto M.; Kobayashi T.; Oikawa S.; Yamashita S.; Rakugi
H.; Imai T.; Tanaka S.; Ohashi Y.; Kuwabara M.; Ito H.
Institution
(Ouchi, Kuwabara) Toranomon Hospital, Tokyo, Japan
(Sasaki) International University of Health and Welfare, Fukuoka, Japan
(Arai) National Center for Geriatrics and Gerontology, Obu, Japan
(Yokote) Chiba University, Chiba, Japan
(Harada, Ito) Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
(Katayama) General Tokyo Hospital, Tokyo, Japan
(Urabe) Juntendo University Urayasu Hospital, Chiba, Japan
(Uchida) Saga Memorial Hospital, Saga, Japan
(Hayashi) Nagahama City Hospital, Japan
(Yokota) MiyazakiJapan
(Nishida) NeyagawaJapan
(Otonari) Otonari Clinic, Chikushino, Japan
(Arai) YamagataJapan
(Sakuma) Caress Sapporo Hokko Memorial Clinic, Sapporo, Japan
(Sakabe) KyotoJapan
(Yamamoto) Yamamoto Clinic, Japan
(Kobayashi) Jyuzen General Hospital, Niihama, Japan
(Oikawa) Fukujuji Hospital, Tokyo, Japan
(Yamashita) Rinku General Medical Center, Izumisano, Japan
(Rakugi) Osaka University, Osaka, Japan
(Imai, Tanaka) Kyoto University, Kyoto, Japan
(Ohashi) Chuo University, Tokyo, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Evidence regarding the primary prevention of coronary artery
disease (CAD) events by LDL-C-lowering therapy in older individuals aged
>=75 years is insufficient. This trial tested whether LDL-C-lowering
therapy with ezetimibe is useful for the primary prevention of
cardiovascular events in older patients. METHOD(S): This multicenter,
prospective, randomized, open-label, blinded end-point evaluation
conducted at 363 medical institutions in Japan examined the preventive
efficacy of ezetimibe for patients aged >=75 years with elevated LDL-C
without history of coronary artery disease. Patients, who all received
dietary counseling, were randomly assigned (1:1) to receive ezetimibe (10
mg once daily) versus usual care with randomization stratified by site,
age, sex, and baseline LDL-C. The primary outcome was a composite of
sudden cardiac death, myocardial infarction, coronary revascularization,
or stroke. RESULT(S): Overall, 3,796 patients were enrolled between
May 2009 and December 2014, and 1,898 each were randomly assigned to
ezetimibe versus control. Median follow-up was 4.1 years. After exclusion
of 182 and 203 patients because of lack of appropriate informed consent
and other protocol violations, 1,716 (90.4%) and 1,695 (89.3%) patients
were included in the primary analysis, respectively. Ezetimibe reduced the
incidence of the primary outcome (hazard ratio [HR], 0.66; 95% confidence
interval [CI], 0.50-0.86; P=0.002). Regarding the secondary outcomes, the
incidences of composite cardiac events (HR, 0.60; 95% CI, 0.37-0.98;
P=0.039) and coronary revascularization (HR, 0.38; 95% CI, 0.18-0.79;
P=0.007) were lower in the ezetimibe group than in the control group;
however, there was no difference in the incidence of stroke, all-cause
mortality, or adverse events between trial groups. CONCLUSION(S):
LDL-C-lowering therapy with ezetimibe prevented cardiovascular events,
suggesting the importance of LDL-C lowering for primary prevention in
individuals aged >=75 years with elevated LDL-C. Given the open label
nature of the trial, its premature termination and issues with follow up,
the magnitude of benefit observed should be interpreted with caution.
CLINICAL TRIAL REGISTRATION: URL: https://www.umin.ac.jp Unique
identifier: UMIN000001988.

<77>
Accession Number
2002753202
Title
Percutaneous coronary intervention for left main coronary disease in New
Zealand: National linkage study of characteristics and in-hospital
outcomes (ANZACS-QI 38).
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Wang T.K.M.; Kerr A.; Kasargod C.; Chan D.; Cicovic S.; Dimalapang E.;
Webster M.; Somaratne J.
Institution
(Wang, Kasargod, Chan, Cicovic, Dimalapang, Webster, Somaratne) Green Lane
Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
(Wang, Kerr) Department of Cardiology, Middlemore Hospital, Auckland, New
Zealand
(Kerr) Department of Medicine, University of Auckland, Auckland, New
Zealand
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Approximately 5% of coronary angiographies detect LMS disease
>50%. Recent randomized trials showed PCI has comparable outcomes to
coronary artery bypass grafting (CABG) in low or intermediate risk
candidates. In clinical practice, PCI is frequently utilized in those with
prohibitive surgical risk. We reviewed contemporary national results of
percutaneous coronary intervention (PCI) for left main coronary disease
(LMS) disease in New Zealand. Method(s): All patients undergoing PCI
for LMS disease from 01/09/2014-24/09/2017 were extracted from the All New
Zealand Acute Coronary Syndrome-Quality Improvement registry with national
dataset linkage, analyzing characteristics and in-hospital outcomes.
 Result(s): The cohort included 469 patients, mean age 70.8 +/- 10.7
years, male 331 (71%), and the majority 339 (72%) were unprotected LMS.
Indications include ST-elevation myocardial infarction (STEMI) 83 (18%)
and NSTEMI or unstable angina 229 (49%). Compared with protected LMS,
unprotected LMS were more likely to present with an acute coronary
syndrome (73% versus 48%, P < 0.001), and to die in-hospital (9.4% versus
3.9%, P = 0.045). In those with unprotected LMS, in-hospital mortality
after acute STEMI PCI was higher than for other indications (21.1% versus
6.1%, P < 0.001). Independent predictors of in-hospital death and major
adverse cardiovascular events included STEMI, femoral access and worse
renal function. Conclusion(s): Our LMS PCI cohort had high mortality
rates, especially those presenting with STEMI and an unprotected LMS. This
reflects the contemporary real-world practice of LMS PCI being
predominantly performed in high risk patients which differs from
randomized trial populations, and this should be considered before
comparing with CABG outcomes. Copyright © 2019 Elsevier Inc.

<78>
Accession Number
2002656690
Title
A meta-analysis of impact of mitral stenosis on outcomes after
transcatheter aortic valve implantation.
Source
Journal of Cardiac Surgery. (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
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To determine whether concomitant mitral stenosis (MS) impairs
outcomes after transcatheter aortic valve implantation (TAVI) in patients
with severe aortic stenosis (AS), we performed a meta-analysis of
currently available evidence. Method(s): To identify all
observational comparative studies of outcomes after TAVI for AS in
patients with MS vs patients with no-MS, we searched databases (MEDLINE
and EMBASE) using web-based search engines (PubMed and OVID). Studies
meeting the following criteria were included; the design was an
observational study; the study population was patients undergoing TAVI for
AS; outcomes in patients with MS were compared with those in patients with
no-MS. Study-specific estimates were then pooled using inverse
variance-weighted averages of logarithmic odds and hazard ratios in the
random-effects model. Result(s): We identified six eligible studies
including 111 621 patients undergoing TAVI. In pooled analyses,
postprocedural incidence of >= moderate paravalvular aortic regurgitation
(PAR) (P =.02), early all-cause mortality (P =.008), early incidence of
myocardial infarction (MI) (P =.01), and midterm all-cause mortality (P
=.03) after TAVI were significantly higher in patients with MS than in
patients with no-MS. There were no significant differences in early
incidence of stroke, major bleeding, acute kidney injury, and new
permanent pacemaker implantation after TAVI between patients with MS and
patients with no-MS. When the study for mitral annular calcification was
excluded in the pooled analyses, no results except for MI were
substantially altered but the significance for early incidence of MI
disappeared (P =.10). Conclusion(s): Postprocedural incidence of >=
moderate PAR, early all-cause mortality, early incidence of MI, and
midterm all-cause mortality after TAVI are higher in patients with MS than
in patients with no-MS. Copyright © 2019 Wiley Periodicals, Inc.

<79>
[Use Link to view the full text]
Accession Number
628946813
Title
Post percutaneous coronary interventional outcomes on proximal vs
non-proximal lesions of the left and right coronary arteries: A systematic
review and meta-analysis.
Source
Medicine (United States). 98 (33) (no pagination), 2019. Article Number:
e16905. Date of Publication: 01 Aug 2019.
Author
Tang B.; Yang H.; Bil J.
Institution
(Tang, Yang) Department of Cardiology, Jingzhou Central Hospital, Second
Clinical Medical College, Yangtze University, Jingzhou, Hubei 434020,
China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:The prognosis of patients with coronary artery disease is
mainly related to the extent of myocardium at risk. Proximal coronary
arteries, especially the proximal left anterior descending coronary artery
(LAD), supply a large part of the myocardium. In this analysis, we aimed
to systematically compare the post percutaneous coronary interventional
(PCI) outcomes observed with proximal vs non-proximal lesions of the left
and right coronary arteries. Method(s):MEDLARS Online, Excerpta
Medica database, www.ClinicalTrials.gov, and the Cochrane databases were
searched for relevant studies comparing the post PCI outcomes reported on
proximal vs non-proximal lesions of the coronary arteries. RevMan software
version 5.3 was used to analyze the data to generate respective results.
Odds ratios (OR) and 95% confidence intervals (CI) were derived to
represent the results appropriately. Result(s):Six studies with a
total number of 11,109 participants who were enrolled between 1990 and
2015 were included in this analysis. The current results showed major
adverse cardiac events (MACEs) (OR: 1.28, 95% CI: 1.14-1.45; P =.0001) and
mortality (OR: 1.70, 95% CI: 1.43-2.03; P = .00001) to be significantly
higher with proximal compared to non-proximal coronary lesions
irrespective of the follow-up time periods. However, re-infarction (OR:
1.05, 95% CI: 0.80-1.38; P = .71), repeated revascularization (OR: 1.08,
95% CI: 0.92-1.27; P = .35) and stent thrombosis (OR: 0.59, 95% CI:
0.27-1.31; P = .20) were not significantly different.When patients
specifically with LAD lesions were compared with associated non-proximal
lesions, mortality was still significantly higher with proximal lesions
(OR: 2.26, 95% CI: 1.52-3.36; P = .0001). However, when patients with
right proximal coronary artery lesions were compared with the
corresponding non-proximal lesions, no significant difference was observed
in mortality. Conclusion(s):In-hospital and long-term MACEs and
mortality were significantly higher in patients with proximal compared to
non-proximal coronary lesions following PCI. In addition, mortality was
significantly higher in patients with proximal LAD lesions whereas no
significant difference was observed in patients with right proximal
coronary artery lesions. Larger trials should further confirm these
hypotheses. Copyright © 2019 the Author(s).

<80>
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. 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. Copyright © 2019
Elsevier Inc.

<81>
Accession Number
621948822
Title
Perioperative pain management in cardiac surgery: A systematic review.
Source
Minerva Anestesiologica. 84 (4) (pp 488-503), 2018. Date of Publication:
April 2018.
Author
Bignami E.; Castella A.; Pota V.; Saglietti F.; Scognamiglio A.; Trumello
C.; Pace M.C.; Allegri M.
Institution
(Bignami, Castella, Saglietti) Department of Anesthesia and Intensive
Care, San Raffaele Scientific Institute for Research and Care, Via
Olgettina 60, Milan 20132, Italy
(Pota, Pace) Department of Woman, Child, General, and Specialty Surgery,
L. Vanvitelli University of Campania, Naples, Italy
(Scognamiglio) Section of Anesthesia and Intensive Care, Department of
Neurosciences, Reproductive, and Odontostomatological Sciences, Federico
II University of Naples, Naples, Italy
(Trumello) Department of Cardiac Surgery, San Raffaele Scientific
Institute for Research and Care, Milan, Italy
(Allegri) Anesthesia, Intensive Care and Pain Therapy Unit, Division of
Surgical Sciences, Department of Medicine and Surgery, University of
Parma, Parma, Italy
(Allegri) Study in Multidisciplinary Pain Research (SIMPAR) Group, Pavia,
Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Every year, more than 1.5 million patients, who undergo
cardiac surgery worldwide, are exposed to a series of factors that can
trigger acute postoperative pain associated with hemodynamic instability,
respiratory complications, and psychological disorders. Through an
evaluation of literature data about postoperative pain in cardiac surgery
we define unmet needs and potential objectives for future research on this
often-underestimated problem. METHOD(S): Following PRISMA Guidelines,
a systematic literature search was carried out by two independent
researchers on Scopus, CINAHL, the Cochrane Library, and PubMed using the
key words: (perioperative OR postoperative) analgesia AND "cardiac
surgery." Papers concerning children, or published prior to 2000, were
considered ineligible, as well as abstracts, animal studies, and studies
written in languages other than English. RESULT(S): Fifty-four papers
were selected and subsequently divided into two main categories: systemic
analgesic drugs and regional anesthesia techniques. CONCLUSION(S):
Over the past 17 years, opioids are still the most extensively used
therapy, whereas we found only few trials investigating other drugs (e.g.
paracetamol). Regional anesthesia techniques, especially thoracic epidural
analgesia and intrathecal morphine administration, can effectively treat
pain, but have not yet showed any significant impact on major clinical
outcomes, with several concerns related to their potential complications.
To date multimodal analgesia with implementation of regional analgesia
seems to be the best choice. In the future, better-designed studies should
consider other drugs stratifying groups according to comorbidities and
risk factors, as well as using standardized units of
measurement. Copyright © 2017 Edizioni Minerva Medica.

<82>
Accession Number
621948449
Title
Physiology, intervention, and outcome: Three critical questions about
cerebral tissue oxygen saturation monitoring.
Source
Minerva Anestesiologica. 84 (5) (pp 599-614), 2018. Date of Publication:
May 2018.
Author
Meng L.; Gruenbaum S.E.; Dai F.; Wang T.
Institution
(Meng, Gruenbaum) Division of Neuro Anesthesia, Department of
Anesthesiology, Yale University School of Medicine, 333 Cedar Street, New
Haven, CT 06520, United States
(Dai) Department of Biostatistics, Yale University School of Public
Health, Yale Center for Analytical Sciences, New Haven, CT, United States
(Wang) Department of Anesthesiology, Xuanwu Hospital, Capital Medical
University, Beijing, China
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
The balance between cerebral tissue oxygen consumption and supply can be
continuously assessed by cerebral tissue oxygen saturation
(SctO<inf>2</inf>) monitor. A construct consisting of three sequential
questions, targeting the physiology monitored, the intervention
implemented, and the outcomes affected, is proposed to critically appraise
this monitor. The impact of the SctO<inf>2</inf>-guided care on patient
outcome was examined through a systematic literature search and
meta-analysis. We concluded that the physiology monitored by
SctO<inf>2</inf> is robust and dynamic, fragile (prone to derangement),
and adversely consequential when deranged. The inter-individual
variability of SctO<inf>2</inf> measurement advocates for an intervention
threshold based on a relative, not absolute, change. The intra-individual
variability has multiple determinants which is the foundation of
intervention. A variety of therapeutic options are available; however,
none are 100% efficacious in treating cerebral dys-oxygenation. The
therapeutic efficacy likely depends on both an appropriate differential
diagnosis and the functional status of the regulatory mechanisms of
cerebral blood flow. Meta-analysis based on five randomized controlled
trials suggested a reduced incidence of early postoperative cognitive
decline after major surgeries (RR= 0.53; 95% CI: 0.33-0.87; I2 =82%;
P=0.01). However, its effects on other neurocognitive outcomes remain
unclear. These results need to be interpreted with caution due to the high
risks of bias. Quality RCTs based on improved intervention protocols and
standardized outcome assessment are warranted in the future. Copyright
© 2018 Edizioni Minerva Medica.

<83>
Accession Number
629017647
Title
Effects of pulsatile minimal invasive extracorporeal circulation on
fibrinolysis and organ protection in adult cardiac surgery - A prospective
randomized trial.
Source
Journal of Thoracic Disease. 11 (Supplement10) (pp S1453-S1463), 2019.
Date of Publication: 01 Jun 2019.
Author
Grassler A.; Bauernschmitt R.; Guthoff I.; Kunert A.; Hoenicka M.;
Albrecht G.; Liebold A.
Institution
(Grasler, Bauernschmitt, Guthoff, Kunert, Hoenicka, Albrecht, Liebold)
Department of Cardiothoracic and Vascular Surgery, University of Ulm
Medical Center, Ulm, Germany
(Grasler) RoMed Clinical Center Rosenheim, Department of Internal Medicine
III, Rosenheim, Germany
(Bauernschmitt) MediClin Herzzentrum, Department of Cardiothoracic and
Vascular Surgery, Lahr, Germany
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Minimal invasive extracorporeal circulation (MiECC) reduces
the impact of cardiopulmonary bypass during cardiac surgery on
inflammation and hemostasis. Pulsatile perfusion may enhance organ
perfusion and help to prevent renal and neuronal damage. The present study
investigated the impact of pulsatile MiECC in low-risk coronary artery
bypass grafting (CABG) patients. Method(s): CABG patients were
prospectively randomized for non-pulsatile (np: n=19) and pulsatile (p:
n=21) MiECC. Blood and urine samples were collected at several time points
until 72 h post-operative and analyzed for biochemical markers of
fibrinolytic capacity, renal damage, and neuronal damage. Result(s):
Although intraoperative tissue plasminogen activator (tPA) levels tended
to be higher in the p group, none of the fibrinolysis markers including
plasminogen activator inhibitor (PAI-1) and the PAI-1/ tPA ratio were
significantly affected by pulsation. Hemolysis and markers of renal and
neuronal damage were comparable between groups. Intraoperative urinary
excretion [np: 400 mL (355 to 680) vs. p: 530 mL (360 to 900)] and
cumulative 24 h volume intake [np: 7,090 mL (5,492 to 7,544) vs. p: 7,155
mL (6,682 to 8,710)] were increased by pulsation whereas blood losses up
to 12 h post-operative [np: 365 mL (270 to 515) vs. p: 310 mL (225 to
470)] and up to 24 h post-operative [np: 760 mL (555 to 870) vs. p: 520 mL
(460 to 670)] were attenuated. Conclusion(s): The present study did
not find evidence for a beneficial effect of pulsation on markers of
fibrinolysis, renal damage, and neuronal damage. However, pulsatile
perfusion increased intraoperative urinary secretion and reduced
post-operative blood losses. Copyright © Journal of Thoracic
Disease. All rights reserved.

<84>
Accession Number
2002384549
Title
Amiodarone in the treatment of atrial fibrillation of patients with
rheumatic heart disease after valve replacement.
Source
Pakistan Journal of Medical Sciences. 35 (4) (pp 918-922), 2019. Date of
Publication: July-August 2019.
Author
Chen K.; Qin L.; Lu X.; Xia T.; Gu Q.
Institution
(Chen, Qin, Lu, Xia, Gu) Department of Cardiovascular Surgery, Taian
Central Hospital, Shandong 271000, China
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objectives: To explore the efficacy of amiodarone in the treatment of
atrial fibrillation for patients with rheumatic heart disease after valve
replacement. Method(s): Eighty-six patients with rheumatic heart
disease who were hospitalized between June 2016 and June 2017 and
developed atrial fibrillation after valvular heart valve replacement were
randomly divided into a control group and an observation group, 42 cases
in each group. The control group was treated with routine medical
treatment, while the observation group was given amiodarone on the basis
of routine treatment. The cardiac function of the two groups were observed
and recorded. Postoperative atrial fibrillation conversion rate, sinus
rhythm maintenance rate, intensive care unit (ICU) monitoring time and
hospital stay were compared between the two groups. Result(s):
Compared with the control group, the improvement of cardiac function
indexes of the observation group was better, and the difference was
statistically significant (P<0.05). The atrial fibrillation conversion
rate and the maintenance rate of sinus rhythm of the observation group
were 76.2% and 47.6% respectively, which were significantly higher than
57.1% and 33.3% of the control group; the differences had statistical
significance (P<0.05). The ICU monitoring time and hospitalization time of
the patients in the observation group were (1.69+/-0.91) d and
(10.24+/-1.11) d respectively, which were significantly shorter than
(2.83+/-0.95) d and (14.07+/-1.17) d in the control group (P<0.05); the
differences were statistically significant (P<0.05). Conclusion(s):
Amiodarone can effectively treat valve replacement associated atrial
fibrillation of patients with rheumatic heart disease. It can
significantly improve the heart function, prevent the recurrence of atrial
fibrillation, maintain sinus rhythm after operation, and shorten the time
of ICU monitoring and hospitalization. Copyright © 2019,
Professional Medical Publications. All rights reserved.

<85>
Accession Number
2002602786
Title
A meta-analysis of randomized and observational studies: Aspirin protects
from cardiac surgery-associated acute kidney injury.
Source
Heart Surgery Forum. 22 (4) (pp E301-E307), 2019. Date of Publication:
2019.
Author
Liu H.; Li J.; Chen M.; Yang T.; Ruan Z.; Su J.; Xing Y.
Institution
(Liu, Li, Chen, Yang, Ruan) Department of Department of Critical Care
Medicine, Zhongshan City People's Hospital, Zhongshan City 528403, China
(Su) Department of Neurosurgery, Zhongshan City People's Hospital,
Zhongshan City, Guangdong Province 528403, China
(Xing) Department of Gynecology, Sun Yat-sen Memorial Hospital, Guangzhou
5105120, China
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: Antiplatelet therapy is critical in the management of coronary
artery diseases. For patients undergoing cardiac surgeries, including
coronary artery bypass graft (CABG) and valve replacement, controversy
remains in preoperative antiplatelet therapy concerning risk of bleeding.
For safety concern, aspirin is recommended to be withdrawn 5 to 10 days
before a cardiac surgery. Recent studies, however, indicate that
preoperative aspirin may have a protective effect on cardiac
surgery-associated acute kidney injury (CSA-AKI). Objective(s): To
estimate the efficacy of preoperative aspirin in preventing CSA-AKI.
 Methods and Results: Eligible studies included randomized controlled
trials (RCTs) and observational studies (OSs) of patients, who had
undergone CABG, valve replacement, or combined surgery. These studies
compared preoperative aspirin with placebo/no aspirin and reported the
least incidence of CSA-AKI. One RCT and five OSs met the inclusion
criteria. Data retrieved suggested that aspirin prescribed within five
days before cardiac surgery decreased post-operative renal failure [odds
ratio (OR), 0.67; 95% confidence interval (CI), 0.50-0.89; P < 0.01] and
30-day mortality (OR, 0.64; 95% CI, 0.53-0.77; P < 0.01). One RCT and
three OSs suggested aspirin protected from major adverse cardiocerebral
events (MACE) (OR, 0.88; 95% CI, 0.76-1.01; P = 0.07). One RCT and two OSs
suggested aspirin did not increase risk of re-exploration for bleeding
(OR, 1.01; 95% CI, 0.76-1.34; P = 0.95). Conclusion(s): Preoperative
low-dose aspirin decreases postoperative CSA-AKI, mortality, and MACE
without increasing the risk of re-exploration. But most of the studies are
observational. They lack a uniformed standard on prescription of aspirin
and outcomes measurement. No stratification analysis is performed
concerning different types of surgical procedures and comorbidities. More
randomized controlled trials are necessary to confirm the efficacy and
safety of preoperative aspirin prescription. Copyright © 2019
Forum Multimedia Publishing, LLC.

<86>
Accession Number
2001741120
Title
MitraClip device for patients with functional mitral valve regurgitation:
A systematic review.
Source
Hellenic Journal of Cardiology. 60 (2) (pp 101-107), 2019. Date of
Publication: March - April 2019.
Author
Chatzistergiou K.T.; Papanastasiou C.A.; Kokkinidis D.G.; Ziakas A.G.;
Karvounis H.I.; Karamitsos T.D.
Institution
(Chatzistergiou) Service de Cardiologie, Hopital Simone Veil, Paris,
France
(Papanastasiou, Ziakas, Karvounis, Karamitsos) 1st Department of
Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital,
Thessaloniki, Greece
(Kokkinidis) Department of Medicine, Jacobi Medical Center, Albert
Einstein College of Medicine, NY, United States
Publisher
Hellenic Cardiological Society
Abstract
Background: MitraClip device is a novel therapeutic option for patients
with degenerative mitral valve regurgitation. Nevertheless, several
studies have also focused on the safety and efficacy of this method in
functional mitral valve regurgitation (FMR). Aim(s): To
systematically review all original studies that provided mortality data
among FMR patients treated with MitraClip. Material(s) and Method(s):
We conducted an in-depth literature search of 3 electronic databases
(Medline, Scopus and Cochrane Library) in order to identify studies
investigating the efficacy of MitraClip in FMR. Thirty-day and 12-month
mortality after MitraClip implantation were the measured outcomes.
 Result(s): Twenty-eight studies, involving 2383 patients, were
included. The phenotype of the studied population was characterized by
clinical and echocardiographic parameters suggesting severe FMR (NYHA
III-IV: 91%, MR>=3+: 98%) with high surgical risk (mean Euroscore: 24.6%).
The Mitraclip device was successfully implanted in 95.8% of patients,
resulting in a reduction of two or more degrees of MR. Thirty day and
12-month mortality rates were estimated to be 2.3% and 18.9%,
respectively. Conclusion(s): MitraClip appears to be a safe
therapeutic option for patients with FMR who are considered to be at high
surgical risk. Copyright © 2019 Hellenic Society of Cardiology

<87>
Accession Number
2002681661
Title
Randomized Comparison of Clinical Effectiveness of Pharmacologic SPECT and
PET MPI in Symptomatic CAD Patients.
Source
JACC: Cardiovascular Imaging. 12 (9) (pp 1821-1831), 2019. Date of
Publication: September 2019.
Author
Patel K.K.; Al Badarin F.; Chan P.S.; Spertus J.A.; Courter S.; Kennedy
K.F.; Case J.A.; McGhie A.I.; Heller G.V.; Bateman T.M.
Institution
(Patel, Al Badarin, Chan, Spertus, McGhie, Bateman) Department of
Cardiology, University of Missouri-Kansas City, Kansas City, MO, United
States
(Patel, Al Badarin, Chan, Spertus, Kennedy, McGhie, Bateman) Department of
Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Courter, Case) Cardiovascular Imaging Technologies, Kansas City, MO,
United States
(Heller) Department of Cardiology, Gagnon Cardiovascular Institute,
Morristown Medical Center, Morristown, NJ, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study compared the clinical effectiveness of
pharmacologic stress myocardial perfusion imaging (MPI) plus positron
emission tomography (PET) with single-photon emission computed tomography
(SPECT) in patients with known coronary artery disease (CAD) presenting
with symptoms suggestive of ischemia. Background(s): Although PET MPI
has been shown to have higher diagnostic accuracy in detecting
hemodynamically significant CAD than SPECT MPI, whether this impacts
downstream management has not been formally evaluated in randomized
trials. Method(s): This study consisted of a single-center trial in
which patients with known CAD and suspected ischemia were randomized to
undergo PET or attenuation-corrected SPECT MPI between June 2009 and
September 2013. Post-test management was at the discretion of the
referring physician, and patients were followed for 12 months. The primary
endpoint was diagnostic failure, defined as unnecessary angiography
(absence of >=50% stenosis in >=1 vessel) or additional noninvasive
testing within 60 days of the MPI. Secondary endpoints were post-test
escalation of antianginal therapy, referral for angiography, coronary
revascularization, and health status at 3, 6, and 12 months.
 Result(s): A total of 322 patients with an evaluable MPI were
randomized (n = 161 in each group). At baseline, 88.8% of patients were
receiving aspirin therapy, 76.7% were taking beta-blockers, and 77.3% were
taking statin therapy. Diagnostic failure within 60 days occurred in only
7 patients (2.2%) (3 [1.9%] in the PET group and 4 [2.5%] in the SPECT
group; p = 0.70). There were no significant differences between the 2
groups in subsequent rates of coronary angiography, coronary
revascularization, or health status at 3, 6, and 12 months of follow-up
(all p values >=0.20); however, when subjects were stratified by findings
on MPI in a post hoc analysis, those with high-risk MPI on PET testing had
higher rates of angiography and revascularization on follow-up than those
who had SPECT MPI, whereas those undergoing low-risk PET studies had lower
rates of both procedures than those undergoing SPECT (interaction between
randomized modality *high-risk MPI for 12-month catheterization [p =
0.001] and 12-month revascularization [p = 0.09]). Conclusion(s): In
this contemporary cohort of symptomatic CAD patients who were optimally
medically managed, there were no discernible differences in rates of
diagnostic failure at 60 days, subsequent coronary angiography,
revascularization, or patient health status at 1 year between patients
evaluated by pharmacologic PET compared with those evaluated by SPECT MPI.
Downstream invasive testing rates with PET MPI were more consistent with
high-risk features than those with SPECT MPI. (Effectiveness Study of
Single Photon Emission Computed Tomography [SPECT] Versus Positron
Emission Tomography [PET] Myocardial Perfusion Imaging;
NCT00976053) Copyright © 2019 American College of Cardiology
Foundation

<88>
Accession Number
2002660818
Title
Effectiveness of polypill for primary and secondary prevention of
cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial.
Source
The Lancet. 394 (10199) (pp 672-683), 2019. Date of Publication: 24 - 30
August 2019.
Author
Roshandel G.; Khoshnia M.; Poustchi H.; Hemming K.; Kamangar F.; Gharavi
A.; Ostovaneh M.R.; Nateghi A.; Majed M.; Navabakhsh B.; Merat S.;
Pourshams A.; Nalini M.; Malekzadeh F.; Sadeghi M.; Mohammadifard N.;
Sarrafzadegan N.; Naemi-Tabiei M.; Fazel A.; Brennan P.; Etemadi A.;
Boffetta P.; Thomas N.; Marshall T.; Cheng K.K.; Malekzadeh R.
Institution
(Roshandel, Khoshnia, Poustchi, Gharavi, Ostovaneh, Nateghi, Majed,
Navabakhsh, Pourshams, Nalini, Malekzadeh, Malekzadeh) Digestive Disease
Research Center, Digestive Disease Research Institute, Shariati Hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Poustchi, Pourshams, Malekzadeh) Digestive Oncology Research Center,
Digestive Disease Research Institute, Shariati Hospital, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Merat, Malekzadeh) Liver and Pancreaticobiliary Disease Research Center,
Digestive Disease Research Institute, Shariati Hospital, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Roshandel, Khoshnia, Naemi-Tabiei, Fazel) Golestan Research Center of
Gastroenterology and Hepatology, Golestan University of Medical Sciences,
Gorgan, Iran, Islamic Republic of
(Hemming, Thomas, Marshall, Cheng) Institute of Applied Health Research,
University of Birmingham, Birmingham, United Kingdom
(Kamangar) Department of Biology, School of Computer, Mathematical, and
Natural Sciences, Morgan State University, Baltimore, MD, United States
(Sadeghi) Cardiac Rehabilitation Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Mohammadifard) Isfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Sarrafzadegan) Heart Failure Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Brennan) Section of Genetics, International Agency for Research on
Cancer, WHO, Lyon, France
(Etemadi) Division of Cancer Epidemiology and Genetics, National Cancer
Institute, National Institutes of Health, Bethesda, MD, United States
(Boffetta) Tisch Cancer Institute, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Boffetta) Department of Medical and Surgical Sciences, University of
Bologna, Italy
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: A fixed-dose combination therapy (polypill strategy) has been
proposed as an approach to reduce the burden of cardiovascular disease,
especially in low-income and middle-income countries (LMICs). The PolyIran
study aimed to assess the effectiveness and safety of a four-component
polypill including aspirin, atorvastatin, hydrochlorothiazide, and either
enalapril or valsartan for primary and secondary prevention of
cardiovascular disease. Method(s): The PolyIran study was a
two-group, pragmatic, cluster-randomised trial nested within the Golestan
Cohort Study (GCS), a cohort study with 50 045 participants aged 40-75
years from the Golestan province in Iran. Clusters (villages) were
randomly allocated (1:1) to either a package of non-pharmacological
preventive interventions alone (minimal care group) or together with a
once-daily polypill tablet (polypill group). Randomisation was stratified
by three districts (Gonbad, Aq-Qala, and Kalaleh), with the village as the
unit of randomisation. We used a balanced randomisation algorithm,
considering block sizes of 20 and balancing for cluster size or natural
log of the cluster size (depending on the skewness within strata).
Randomisation was done at a fixed point in time (Jan 18, 2011) by
statisticians at the University of Birmingham (Birmingham, UK),
independent of the local study team. The non-pharmacological preventive
interventions (including educational training about healthy lifestyle-eg,
healthy diet with low salt, sugar, and fat content, exercise, weight
control, and abstinence from smoking and opium) were delivered by the
PolyIran field visit team at months 3 and 6, and then every 6 months
thereafter. Two formulations of polypill tablet were used in this study.
Participants were first prescribed polypill one (hydrochlorothiazide 12.5
mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg). Participants
who developed cough during follow-up were switched by a trained study
physician to polypill two, which included valsartan 40 mg instead of
enalapril 5 mg. Participants were followed up for 60 months. The primary
outcome-occurrence of major cardiovascular events (including
hospitalisation for acute coronary syndrome, fatal myocardial infarction,
sudden death, heart failure, coronary artery revascularisation procedures,
and non-fatal and fatal stroke)-was centrally assessed by the GCS
follow-up team, who were masked to allocation status. We did
intention-to-treat analyses by including all participants who met
eligibility criteria in the two study groups. The trial was registered
with ClinicalTrials.gov, number NCT01271985. Finding(s): Between Feb
22, 2011, and April 15, 2013, we enrolled 6838 individuals into the
study-3417 (in 116 clusters) in the minimal care group and 3421 (in 120
clusters) in the polypill group. 1761 (51.5%) of 3421 participants in the
polypill group were women, as were 1679 (49.1%) of 3417 participants in
the minimal care group. Median adherence to polypill tablets was 80.5%
(IQR 48.5-92.2). During follow-up, 301 (8.8%) of 3417 participants in the
minimal care group had major cardiovascular events compared with 202
(5.9%) of 3421 participants in the polypill group (adjusted hazard ratio
[HR] 0.66, 95% CI 0.55-0.80). We found no statistically significant
interaction with the presence (HR 0.61, 95% CI 0.49-0.75) or absence of
pre-existing cardiovascular disease (0.80; 0.51-1.12;
p<inf>interaction</inf>=0.19). When restricted to participants in the
polypill group with high adherence, the reduction in the risk of major
cardiovascular events was even greater compared with the minimal care
group (adjusted HR 0.43, 95% CI 0.33-0.55). The frequency of adverse
events was similar between the two study groups. 21 intracranial
haemorrhages were reported during the 5 years of follow-up-ten
participants in the polypill group and 11 participants in the minimal care
group. There were 13 physician-confirmed diagnoses of upper
gastrointestinal bleeding in the polypill group and nine in the minimal
care group. Interpretation(s): Use of polypill was effective in
preventing major cardiovascular events. Medication adherence was high and
adverse event numbers were low. The polypill strategy could be considered
as an additional effective component in controlling cardiovascular
diseases, especially in LMICs. Funding(s): Tehran University of
Medical Sciences, Barakat Foundation, and Alborz Darou. Copyright
© 2019 World Health Organization. Published by Elsevier Ltd/Inc/BV.
All rights reserved.

<89>
Accession Number
2002707759
Title
Predictors of delirium after cardiac surgery in patients with sleep
disordered breathing.
Source
European Respiratory Journal. 54 (2) (no pagination), 2019. Article
Number: 1900354. Date of Publication: 01 Aug 2019.
Author
Tafelmeier M.; Knapp M.; Lebek S.; Floerchinger B.; Camboni D.;
Creutzenberg M.; Wittmann S.; Zeman F.; Schmid C.; Maier L.S.; Wagner S.;
Arzt M.
Institution
(Tafelmeier, Knapp, Lebek, Maier, Wagner, Arzt) Dept of Internal Medicine
II (Cardiology, Pneumology and Intensive Care), University Medical Center
Regensburg, Regensburg, Germany
(Floerchinger, Camboni, Schmid) Dept of Cardiothoracic Surgery, University
Medical Center Regensburg, Regensburg, Germany
(Creutzenberg, Wittmann) Dept of Anesthesiology, University Medical Center
Regensburg, Regensburg, Germany
(Zeman) Center for Clinical Studies, University Medical Center Regensburg,
Regensburg, Germany
Publisher
European Respiratory Society (E-mail: info@ersnet.org)
Abstract
Introduction: Delirium ranks among the most common complications after
cardiac surgery. Although various risk factors have been identified, the
association between sleep disordered breathing (SDB) and delirium has
barely been examined so far. Here, our objectives were to determine the
incidence of postoperative delirium and to identify the risk factors for
delirium in patients with and without SDB. Method(s): This
subanalysis of the ongoing prospective observational study CONSIDER-AF
(ClinicalTrials.gov identifier NCT02877745) examined risk factors for
delirium in 141 patients undergoing cardiac surgery. The presence and type
of SDB were assessed with a portable SDB monitor the night before surgery.
Delirium was prospectively assessed with the validated Confusion
Assessment Method for the Intensive Care Unit on the day of extubation and
for a maximum of 3 days. Result(s): Delirium was diagnosed in 23% of
patients: In 16% of patients without SDB, in 13% with obstructive sleep
apnoea and in 49% with central sleep apnoea. Multivariable logistic
regression analysis showed that delirium was independently associated with
age >>70 years (OR 5.63, 95% CI 1.79-17.68; p=0.003), central sleep apnoea
(OR 4.99, 95% CI 1.41-17.69; p=0.013) and heart failure (OR 3.3, 95% CI
1.06-10.35; p=0.039). Length of hospital stay and time spent in the
intensive care unit/intermediate care setting were significantly longer
for patients with delirium. Conclusion(s): Among the established risk
factors for delirium, central sleep apnoea was independently associated
with delirium. Our findings contribute to identifying patients at high
risk of developing postoperative delirium who may benefit from intensified
delirium prevention strategies. Copyright © ERS 2019.

<90>
Accession Number
2002731909
Title
Meta-Analysis Evaluating Outcomes of Surgical Left Atrial Appendage
Occlusion During Cardiac Surgery.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Ibrahim A.M.; Tandan N.; Koester C.; Al-Akchar M.; Bhandari B.; Botchway
A.; Abdelkarim J.; Maini R.; Labedi M.
Institution
(Ibrahim, Tandan, Koester, Al-Akchar, Bhandari, Abdelkarim, Maini)
Department of Internal Medicine, SIU School of Medicine, Springfield, IL,
United States
(Botchway) Center for Clinical Research, SIU School of Medicine,
Springfield, IL, United States
(Labedi) Division of Cardiology, Department of Internal Medicine, SIU
School of Medicine, Springfield, IL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Surgical left atrial appendage occlusion (S-LAAO) has become a common
procedure performed in patients undergoing cardiac surgery; however,
evidence to support this procedure remains inconclusive. This
meta-analysis aims to assess the efficacy of S-LAAO in terms of ischemic
stroke, postoperative atrial fibrillation, and all-cause mortality. A
thorough literature review was performed according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses statement. We
identified 10 relevant studies for our meta-analysis. It included 6,779
patients who underwent S-LAAO and 6,573 who did not undergo LAAO. In terms
of ischemic stroke, the S-LAAO cohort had a lower events (pooled odds
ratio [OR] 0.655 (0.518 to 0.829), p = 0.0004) compared with the non-LAAO
cohort. S-LAAO cohort also had lower events of all-cause mortality (pooled
OR 0.74 (95% confidence interval 0.55 to 0.99), p = 0.0408) when compared
with the non-LAAO cohort. In regards to postoperative atrial fibrillation,
there was no difference between the 2 groups (pooled OR 1.29 (95%
confidence interval 0.81 to 2.06), p = 0.2752). In conclusion, S-LAAO was
associated with lower events of ischemic stroke or systemic embolism and
all-cause mortality when compared to the non-LAAO group. Copyright
© 2019 Elsevier Inc.

<91>
Accession Number
2002641242
Title
Clinical outcomes of automated anastomotic devices: A metanalysis.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Micali L.R.; Matteucci F.; Parise O.; Tetta C.; Moula A.I.; de Jong M.;
Londero F.; Gelsomino S.
Institution
(Micali, Matteucci, Parise, Tetta, Moula, de Jong, Londero, Gelsomino)
Cardiothoracic Department, Maastricht University Hospital, Maastricht,
Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aims: We investigated neurological events, graft patency,
major adverse cardiovascular events (MACEs), and mortality at 1 year
following coronary artery bypass grafting (CABG) surgery using automated
proximal anastomotic devices (APADs) and compared the overall rates with
the current literature. Method(s): A systematic review of all
available reports of APADs use in the literature was conducted. Cumulative
incidence and 95% confidence interval (CI) were the main statistical
indexes. Nine observational studies encompassing a total of 718 patients
were included at the end of the selection process. Result(s): The
cumulative event rate of neurological complications was 4.8% (lower-upper
limits: 2.8-8.0, P <.001; I2 = 72.907%, P =.002; Egger's test:
intercept = -2.47, P = 0.16; Begg and Mazumdar test: tau = -0.20, p =
0.57). Graft patency was 90.5% (80.4 to 95.7, P <.001; I2 =
76.823%, P =.005; Egger's test: intercept = -3.04, P =.10; Begg and
Mazumdar test: tau = -0.67, P =.17). Furthermore, the overall incidence of
MACEs was 3.7% (1.3-10.4, P <.001; I2 = 51.556%, P =.103;
Egger's test: intercept = -1.98, P = <.11; Begg and Mazumdar test: tau =
-0.67, P =.17). Finally, mortality within 1 year was 5% (3.5-7, P <.001;
I2 = 29.675%, P =.202; Egger's test: intercept = -0.91, P =.62;
Begg and Mazumdar test: tau = -0.04, P =.88). Conclusion(s): APADs do
not seem to be correlated with a reduction of either neurological events
or mortality. By contrast, these tools showed satisfactory one-year graft
patency and a low incidence of MACEs. Further research on this topic is
warranted. Copyright © 2019 The Authors. Journal of Cardiac
Surgery published by Wiley Periodicals, Inc.

<92>
Accession Number
2002636130
Title
Comprehensive literature review of anomalies of the coronary arteries.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Harky A.; Noshirwani A.; Karadakhy O.; Ang J.
Institution
(Harky, Noshirwani) Department of Cardiothoracic Surgery, Liverpool Heart
and Chest Hospital, Liverpool, United Kingdom
(Karadakhy) School of Medicine, Manchester University, United Kingdom
(Ang) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Coronary artery anomalies (CAA) are vanishingly rare, affecting less than
1% of the general population. While the majority of anomalies do not cause
significant symptoms; those that do, have devastating outcomes on the
patient. Seventeen percent of deaths from exercise is attributed to CAA,
and over half of these present as sudden death making CAA the second most
common cause of sudden cardiac death in individuals. Computed tomography
is generally regarded as the first-line investigation due to its superior
ability to delineate the course of the coronary vessels and the
surrounding structures, while intravascular coronary angiography can be
helpful in assessing the vessels if there is evidence of stenosis. A
multidisciplinary approach is adopted with patient expectations at the
core of the management. Once the decision to operate has been made, there
are multiple techniques available to the surgeon for the management of
anomalous vessels. Surgical repair forms the key management step in such
patients. Currently, surgery in elective cases is associated with
extremely low morbidity and mortality and it is considered a safe option
with a fantastic long-term prognosis. The ideal approach for assessment
and risk stratification remains uncertain, and the inherent variability of
coronary anomalies and patient factors demands a multidisciplinary team
with an individualized approach. Copyright © 2019 Wiley
Periodicals, Inc.

<93>
Accession Number
2002625742
Title
Early Aortic Valve Replacement versus Watchful Waiting in Asymptomatic
Severe Aortic Stenosis: A Study-Level Meta-Analysis.
Source
Structural Heart. (no pagination), 2019. Date of Publication: 2019.
Author
Sa M.P.B.O.; Cavalcanti L.R.P.; Escorel Neto A.C.A.; Perazzo A.M.;
Simonato M.; Clavel M.-A.; Pibarot P.; Lima R.C.
Institution
(Sa, Cavalcanti, Escorel Neto, Perazzo, Lima) Division of Cardiovascular
Surgery of Pronto Socorro Cardiologico de Pernambuco-PROCAPE, Recife,
Brazil
(Sa, Cavalcanti, Escorel Neto, Perazzo, Lima) University of
Pernambuco-UPE, Recife, Brazil
(Sa, Lima) Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Instituite-FCM/ICB,
Recife, Brazil
(Simonato) Escola Paulista de Medicina-UNIFESP, Sao Paulo, Brazil
(Clavel, Pibarot) Institut Universitaire de Cardiologie et de Pneumologie
du Quebec, Quebec, Canada
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: The management of patients with asymptomatic, severe aortic
stenosis (AS) is controversial. We performed a meta-analysis to examine
the impact on outcomes of early aortic valve replacement (AVR) in patients
with severe asymptomatic AS versus a watchful-waiting (WW) approach.
 Method(s): Databases were searched for studies published until April
2019. Main outcome of interest was death during follow-up. Result(s):
The search yielded 1,889 studies for inclusion. Of these, seven articles
were analyzed and their data extracted. The total number of patients
included was 3,839. The overall HR (95% CI) for death showed a
statistically significant difference between the groups, with lower risk
in the "early AVR" group (random effect model: HR 0.280; 95% CI
0.159-0.494, P < 0.001). There was evidence of significant statistical
heterogeneity of treatment effect among the studies for death. Funnel plot
analysis disclosed no asymmetry around the axis for the outcome of
interest, which means that we have low risk of publication bias related to
this outcome. Sensitivity analysis showed that none of the studies had a
particular impact on the results. The meta-regression coefficients for the
modulating factors age, male sex, presence of hypertension and presence of
diabetes were significant for mortality, showing that the early
intervention becomes even more protective in comparison with the
conservative approach when we take these factors into consideration.
 Conclusion(s): Early AVR seems to be a better approach than WW in the
treatment of asymptomatic patients with severe AS, but we would still
advocate a case-by-case decision-making process. Copyright ©
2019, © 2019 Cardiovascular Research Foundation.

<94>
Accession Number
629094153
Title
Radial Versus Femoral Approach in Women Undergoing Coronary Angiography: A
Meta-Analysis of Randomized Controlled Trials.
Source
The Journal of invasive cardiology. (no pagination), 2019. Date of
Publication: 15 Aug 2019.
Author
Al Halabi S.; Burke L.; Hussain F.; Lopez J.; Mathew V.; Bernat I.; Shroff
A.
Institution
(Shroff) Division of Cardiology, Department of Medicine University of
Illinois Hospital & Health Sciences System, 740 West Taylor Street,
Chicago
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We sought to compare outcomes with radial vs femoral approach
in female patients undergoing coronary angiography. BACKGROUND: Women
undergoing cardiac procedures have increased risk of bleeding and vascular
complications, but are under-represented in randomized clinical trials
(RCTs) involving coronary angiography. METHOD(S): We performed a
meta-analysis of RCTs comparing outcomes in women undergoing angiography
with radial vs femoral approaches. The primary outcome was non-coronary
artery bypass graft (CABG) related bleeding at 30 days. Secondary outcomes
included major adverse cardiovascular or cerebrovascular events (MACCE; a
composite of death, stroke or myocardial infarction), vascular
complications, procedure duration, and access-site crossover.
 RESULT(S): Four studies (n = 6041 female patients) met the inclusion
criteria. In female patients undergoing coronary angiography, radial
access decreased non-CABG related bleeding (odds ratio [OR], 0.56; 95%
confidence interval [CI], 0.44-0.72; P<.001), MACCE (OR, 0.73; 95% CI,
0.58-0.93; P=.01), vascular complications (OR, 0.49; 95% CI, 0.32-0.75;
P<.001) with no significant difference in procedure time (mean difference,
0.04; 95% CI, -0.97 to 0.89; P=.93). There was an increase in access-site
crossover using the radial approach (OR, 2.86; 95% CI, 2.24-3.63; P<.001).
Patients undergoing radial approach were more likely to prefer radial
access for the next procedure (OR, 6.96; 95% CI, 5.70-8.50; P<.001).
 CONCLUSION(S): In female patients undergoing coronary angiography or
intervention, the radial approach is associated with decreased bleeding,
MACCE, and vascular complications. These data suggest that radial access
should be the preferred approach for women.

<95>
Accession Number
629106898
Title
The Thoracic Surgery Social Media Network: Early Experience and Lessons
Learned.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 09 Aug 2019.
Author
Luc J.G.Y.; Ouzounian M.; Bender E.M.; Blitz A.; Stamp N.L.; Varghese
T.K.; Cooke D.T.; Antonoff M.B.
Institution
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, BC, Canada
(Ouzounian) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University of Toronto, Toronto, ON, Canada
(Bender) Department of Cardiothoracic Surgery, Stanford University, Palo
Alto, CA, United States
(Blitz) Division of Cardiac Surgery, University of Cincinnati Medical
Center, Cincinnati, OH, United States
(Stamp) Department of Cardiothoracic Surgery & Transplantation, Fiona
Stanley Hospital, Murdoch, WA, Australia
(Varghese) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
(Cooke) Section of General Thoracic Surgery, University of California
Davis Health, Sacramento, CA, United States
(Antonoff) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson Cancer Center, Houston, TX, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Thoracic Surgery Social Media Network (TSSMN) is a social
media collaborative formed in 2015 by The Annals of Thoracic Surgery and
The Journal of Thoracic and Cardiovascular Surgery to bring social media
attention to key publications from both journals and to highlight major
accomplishments in the specialty. Our aim is to describe TSSMN's
preliminary experience and lessons learned. METHOD(S): Twitter
analytics was used to obtain information regarding the @TSSMN Twitter
handle and #TSSMN hashtag. TweetChat and general hashtag #TSSMN analytics
were measured using Symplur (Symplur LLC, Los Angeles, CA). A TSSMN
Tweeter App was created, and its use and downloads were analyzed.
 RESULT(S): Hashtag #TSSMN has a total of 17,181 tweets, 2,100 users,
and 32,226,280 impressions, with peaks in tweeting activity corresponding
to TweetChats. Thirteen 1-hour TweetChats drew a total of 489
participants, 5195 total tweets, and 17,297,708 total impressions. The top
demographic category of TweetChat participants included Doctors (47%),
Advocates/Supports (11%), and Unknown (10%), with 3% characterized as
patients. The TSSMN Tweeter iTunes App (Apple, Cupertino, CA) was
downloaded 3319 times with global representation. A total of 859 articles
were viewed through the App, with 450 articles from The Annals of Thoracic
Surgery and 409 from The Journal of Thoracic and Cardiovascular Surgery.
 CONCLUSION(S): We demonstrate that TSSMN further enhances the ability
for the journals to connect with their readership and the cardiothoracic
community. Ongoing studies to correlate social media attention with
article reads, article-level metrics, citations, and journal impact factor
are eagerly awaited. Copyright © 2019 The Society of Thoracic
Surgeons and The American Association for Thoracic Surgery. Published by
Elsevier Inc. All rights reserved.

<96>
Accession Number
629106206
Title
Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 14 Aug 2019.
Author
Biancari F.; Santini F.; Tauriainen T.; Bancone C.; Ruggieri V.G.;
Perrotti A.; Gherli R.; Demal T.; Dalen M.; Santarpino G.; Rubino A.S.;
Nardella S.; Nicolini F.; Zanobini M.; De Feo M.; Onorati F.; Mariscalco
G.; Gatti G.
Institution
(Biancari) Heart Center, Turku University Hospital and Department of
Surgery, University of Turku, Turku, Finland; Department of Surgery,
University of Oulu, Oulu, Finland
(Santini) Division of Cardiac Surgery, University of Genoa, Genoa, Italy
(Tauriainen) Department of Surgery, University of Oulu, Oulu, Finland
(Bancone, Rubino) Department of Cardiothoracic Sciences, University of
Campania "Luigi Vanvitelli", Naples, Italy
(Ruggieri, De Feo) Division of Cardiothoracic and Vascular Surgery, Robert
Debre University Hospital, Reims, France
(Perrotti) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Gherli) Department of Cardiovascular Sciences, Cardiac Surgery Unit, S.
Camillo-Forlanini Hospital, Rome, Italy
(Demal) Hamburg University Heart Center, Hamburg, Germany
(Dalen) Department of Molecular Medicine and Surgery, Department of
Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital,
Stockholm; Sweden
(Santarpino) Cardiovascular Center, Paracelsus Medical University,
Nuremberg, Germany; Citta di Lecce Hospital, GVM Care & Research, Lecce,
Italy, (12)Mediterranean Institute for Transplantation and Advanced
Specialized Therapies, Palermo, Italy
(Nardella) Department of Cardiac Surgery, St. Anna Hospital, Catanzaro,
Italy
(Nicolini) Division of Cardiac Surgery, University of Parma, Parma, Italy
(Zanobini) Department of Cardiac Surgery, Centro Cardiologico - Fondazione
Monzino IRCCS, Milan, Italy
(Onorati) Division of Cardiovascular Surgery, Verona University Hospital,
Verona, Italy
(Mariscalco) Department of Cardiovascular Sciences, University of
Leicester, Clinical Sciences WingGlenfield Hospital, Leicester, United
Kingdom
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Epiaortic ultrasound (EAU) is a valid imaging method to detect
atherosclerotic changes of the ascending aorta and to guide surgical
strategies for prevention of cerebral embolism in patients undergoing
isolated coronary artery bypass grafting (CABG). However, its use is not
widespread. METHOD(S): The impact of EAU on the outcome after
isolated CABG has been investigated in patients from the multicenter
E-CABG registry. A systematic review and meta-analysis of the literature
was performed to substantiate the findings of this observational study.
 RESULT(S): Out of 7241 patients from the E-CABG registry, EAU was
performed intraoperatively in 673 patients (9.3%). In the overall series,
the rates of stroke without and with aortic manipulation were 0.3% and
1.3% (p=0.003). In 660 propensity score matched pairs, EAU was associated
with significantly lower risk of stroke (0.6% vs. 2.6%, p=0.007).
Literature search yielded five studies fulfilling the inclusion criteria.
These studies along with the present one included 11496 patients, of whom
3026 (25.7%) underwent intraoperative EAU and their rate of postoperative
stroke was significantly lower than in patients not investigated with EAU
(pooled rate, 0.6% vs. 1.9%; RR 0.40, 95%CI 0.24-0.66, I2 0%). Based on
these pooled rates, the number needed to treat to prevent one stroke is
76.9. CONCLUSION(S): Avoiding aortic manipulation is associated with
the lowest risk of stroke in patients undergoing CABG. When manipulation
of the ascending aorta is planned, EAU is effective in guiding the
surgical strategy to reduce the risk for embolic stroke in these
patients. Copyright © 2019. Published by Elsevier Inc.

<97>
Accession Number
629107827
Title
The Thoracic Surgery Social Media Network: Early experience and lessons
learned.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination), 2019.
Date of Publication: 10 Aug 2019.
Author
Luc J.G.Y.; Ouzounian M.; Bender E.M.; Blitz A.; Stamp N.L.; Varghese
T.K.; Cooke D.T.; Antonoff M.B.
Institution
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, BC, Canada
(Ouzounian) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University of Toronto, Toronto, ON, Canada
(Bender) Department of Cardiothoracic Surgery, Stanford University, Palo
Alto, Calif, United States
(Blitz) Division of Cardiac Surgery, University of Cincinnati Medical
Center, Cincinnati, OH, United States
(Stamp) Department of Cardiothoracic Surgery & Transplantation, Fiona
Stanley Hospital, Murdoch, Australia
(Varghese) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
(Cooke) Section of General Thoracic Surgery, University of California
Davis Health, Sacramento, Calif, United States
(Antonoff) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson Cancer Center, Houston, Tex, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Thoracic Surgery Social Media Network (TSSMN) is a social
media collaborative formed in 2015 by The Annals of Thoracic Surgery and
The Journal of Thoracic and Cardiovascular Surgery to bring social media
attention to key publications from both journals and to highlight major
accomplishments in the specialty. Our aim is to describe TSSMN's
preliminary experience and lessons learned. METHOD(S): Twitter
analytics was used to obtain information regarding the @TSSMN Twitter
handle and #TSSMN hashtag. TweetChat and general hashtag #TSSMN analytics
were measured using Symplur (Symplur LLC, Los Angeles, Calif). A TSSMN
Tweeter App was created, and its use and downloads were analyzed.
 RESULT(S): Hashtag #TSSMN has a total of 17,181 tweets, 2100 users,
and 32,226,280 impressions, with peaks in tweeting activity corresponding
to TweetChats. Thirteen 1-hour TweetChats drew a total of 489
participants, 5195 total tweets, and 17,297,708 total impressions. The top
demographic category of TweetChat participants included Doctors (47%),
Advocates/Supports (11%), and Unknown (10%), with 3% characterized as
patients. The TSSMN Tweeter iTunes App (Apple, Cupertino, Calif) was
downloaded 3319 times with global representation. A total of 859 articles
were viewed through the App, with 450 articles from The Annals of Thoracic
Surgery and 409 from The Journal of Thoracic and Cardiovascular Surgery.
 CONCLUSION(S): We demonstrate that TSSMN further enhances the ability
for the journals to connect with their readership and the cardiothoracic
community. Ongoing studies to correlate social media attention with
article reads, article-level metrics, citations, and journal impact factor
are eagerly awaited. Copyright © 2019. Published by Elsevier Inc.

<98>
[Use Link to view the full text]
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.
 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. 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. 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. Copyright © 2019 by the Shock Society. Unauthorized
reproduction of this article is prohibited.

<99>
Accession Number
2002560975
Title
Comparison of early and delayed invasive strategies in short-medium term
among patients with non-ST segment elevation acute coronary syndrome: A
systematic review and meta-analysis.
Source
PLoS ONE. 14 (8) (no pagination), 2019. Article Number: e0220847. Date of
Publication: 2019.
Author
Zhang M.-B.; Guo C.; Li M.; Lv Y.-H.; Fan Y.-D.; Wang Z.-L.
Institution
(Zhang, Guo, Li, Lv, Wang) First Medical Clinical College of Lanzhou
University, Lanzhou, China
(Fan) Department of Cardiology, Emergency General Hospital, Beijing, China
(Wang) Department of Cardiology, First Hospital of Lanzhou University,
Lanzhou, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background and objectives An invasive approach is recommended as the
treatment of patients with non-ST elevated acute coronary syndromes
(NSTE-ACS). However, it remains unclear that the optimal time of
angiography and intervention for patients with NSTE-ACS at present. This
study was designed to compare the effect of early and delayed invasive
strategies on short-medium term prognosis in patients with those. Methods
Pubmed, Cochrane Library and Embase were searched up to Dec-30-2018.
Randomized clinical trials comparing an early versus a delayed invasive
strategy in patients with NSTEACS were included. The primary endpoint
(all-cause death and recurrent myocardial infarction) and secondary
endpoint (major bleeding and recurrent revascularization), as well as
composite endpoint were assessed by random or fixed effected meta-analysis
with software RevMan 5.3 version after short-medium term follow up. Result
A total of six randomized clinical trials involving 4,277 early or delayed
invasive strategies patients with NSTE-ACS were included in the
meta-analysis. Time to coronary angiography varied from 0.5 to 24 h in the
early invasive strategy and from 18.6 to 72 h in the delayed invasive
strategy. There was a statistical difference in the primary endpoint of
all-cause death among patients with NSTE-ACS between early and delayed
invasive strategies (4.6% vs 6%; OR:0.76; 95% CI:0.58 to 1.00; P = 0.05;
I2 = 0%), but not for recurrent myocardial infarction (6.0% vs 6.3%; OR:
0.94; 95% CI: 0.55 to 1.61; P = 0.82; I2 = 60%). The major bleeding in
patients with NSTE-ACS was similar between both invasive strategies (2.7%
vs 3.1%; OR:0.88; 95% CI:0.59 to 1.31; P = 0.54; I2 = 0%). However, the
composite endpoint in the early invasive strategy patients with NSTE-ACS
was significantly lower than that of the delayed invasive strategy (10.9%
vs 13.9%; OR:0.76; 95% CI:0.63 to 0.92; P = 0.006; I2 = 0%), and the
recurrent revascularization between both strategies was just the opposite
(8.7% vs 5.9%; OR:1.5; 95%CI:1.15 to 1.97; P = 0.003; I2 = 0%). Conclusion
The systematic review and meta-analysis demonstrated that the early
invasive strategy had a beneficial trend on all-cause death and
significantly reduced the composite endpoint in patients with NSTE-ACS,
but increased the rate of revascularization. These data could provide a
solution for patients with those. Copyright © 2019 Zhang et al.

<100>
Accession Number
620955530
Title
Bispectral index and non-bispectral index anesthetic protocols on
postoperative recovery outcomes.
Source
Minerva Anestesiologica. 84 (2) (pp 216-228), 2018. Date of Publication:
February 2018.
Author
Chiang M.-H.; Wu S.-C.; Hsu S.-W.; Chin J.-C.
Institution
(Chiang, Wu, Chin) Department of Anesthesiology, Kaohsiung Chang Gung
Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei
Road, Niao-Song District, Kaohsiung 833, Taiwan (Republic of China)
(Hsu) Department of Radiology, Kaohsiung Chang Gung Memorial Hospital,
Chang Gung University College of Medicine, Kaohsiung, Taiwan (Republic of
China)
(Chin) Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
(Republic of China)
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: The study aimed to compare Bispectral Index (BIS) and
non-BISanesthetic protocols on postoperative recovery outcomes.
EVIDENCEACQUISITION: Medline, PubMed, Cochrane, EMBASE, and Google Scholar
databases were searched until January 21, 2016. EVIDENCESYNTHESIS:
Twenty-six studies were included with a total of 9537 patients.
BISmonitoring was significantly associated with shorter time to eye
opening (P=0.001), time to extubation (P<0.001), and time to orientation
(P=0.002) compared with non-BIS monitoring. No difference between groups
was seen with respect to hypoxemia, postoperative nausea and vomiting
(PONV), time to oral fluid intake, and length of Postanesthesia Care Unit
(PACU) stay (P values =0.185). CONCLUSION(S): The use of
BIS-monitoring is superior to non-BISmonitored anesthesia in terms of
shorter time to eye-opening, extubation, and orientation. BISmonitor may
be considered a safe and effective method for monitoring depth of
anesthesia during surgery. Copyright © 2017 Edizioni Minerva
Inervainerva Medica.

<101>
Accession Number
2001063536
Title
Automated Titanium Fasteners Versus Hand-Tied Knots: A Randomized
Controlled Trial.
Source
Annals of Thoracic Surgery. 106 (4) (pp 1160-1163), 2018. Date of
Publication: October 2018.
Author
Etiwy M.; Javadikasgari H.; Houghtaling P.; Gillinov M.
Institution
(Etiwy, Javadikasgari, Gillinov) Department of Thoracic and Cardiovascular
Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio,
United States
(Houghtaling) Department of Quantitative Health Sciences, Research
Institute, Cleveland Clinic, Cleveland, Ohio, United States
Publisher
Elsevier USA
Abstract
Background: The relative benefits of automated titanium fasteners (LSI
Solutions, Victor, NY) have not been examined in patients undergoing
sternotomy. The aim of this study was to assess the time and cost required
for suture fixation with the automated device versus conventional hand
tying in sternotomy for mitral or tricuspid ring annuloplasty.
 Method(s): Fifty patients scheduled to undergo primary mitral or
tricuspid, or both, ring annuloplasty-based valve repair operation by a
single surgeon were randomly assigned to receive either conventional
hand-tied knots or automated titanium fasteners, with 25 patients in each
group. The primary outcome variable was the time required to affix the
annuloplasty device to the valve annulus. Result(s): The times taken
to affix a mitral annuloplasty band or ring were 6.1 +/- 0.9 min for
manual tying versus 3.1 +/- 0.4 min for automated fasteners (p < 0.0001);
when calculated per annuloplasty stitch, the values were 22 +/- 2 s versus
12 +/- 1.1 s, respectively (p < 0.0001). The corresponding values for
tricuspid annuloplasty were 4.2 +/- 1.2 min (hand tying) versus 2.2 +/-
0.3 min (automated fasteners) (p = 0.0005), and the times for each suture
were 20 +/- 2.1 s versus 13 +/- 2 s, respectively (p = 0.0004). The use of
the automated fastener had no significant impact on aortic cross-clamp
time or cardiopulmonary bypass duration. Total cost associated with
annuloplasty fixation with automated titanium fasteners (device cost in
addition to operating room time cost) was significantly higher than with
hand tying ($1,190 +/- 374 vs $164 +/- 60; p < 0.0001).
 Conclusion(s): Using the automated fastener to facilitate
annuloplasty fixation through a sternotomy resulted in a small procedural
time savings (average of 10 s/stitch) that had no overall impact on
cardiopulmonary bypass or cross-clamp times but added an average cost of
$1,026 to the operation. Copyright © 2018 The Society of Thoracic
Surgeons

<102>
Accession Number
622989595
Title
Infective endocarditis after melody valve implantation in the pulmonary
position: A systematic review.
Source
Journal of the American Heart Association. 7 (13) (no pagination), 2018.
Article Number: e008163. Date of Publication: 01 Jul 2018.
Author
Abdelghani M.; Nassif M.; Blom N.A.; Van Mourik M.S.; Straver B.;
Koolbergen D.R.; Kluin J.; Tijssen J.G.; Mulder B.J.M.; Bouma B.J.; de
Winter R.J.
Institution
(Abdelghani, Nassif, Blom, Van Mourik, Tijssen, Mulder, Bouma, de Winter)
Department of Cardiology, Academic Medical Center, University of
Amsterdam, Netherlands
(Straver) Department of Pediatric Cardiology, Academic Medical Center,
University of Amsterdam, Netherlands
(Blom) Department of Pediatric Cardiology, Leiden University Medical
Center, Leiden, Netherlands
(Koolbergen, Kluin) Department of Cardiothoracic Surgery, Academic Medical
Center, Amsterdam, Netherlands
(Mulder) Interuniversity Cardiology Institute of the Netherlands, Utrecht,
Netherlands
Publisher
American Heart Association Inc.
Abstract
Background--Infective endocarditis (IE) after transcatheter pulmonary
valve implantation (TPVI) in dysfunctioning right ventricular outflow
tract conduits has evoked growing concerns. We aimed to investigate the
incidence and the natural history of IE after TPVI with the Melody valve
through a systematic review of published data. Methods and
Results--PubMed, EMBASE, and Web of Science databases were systematically
searched for articles published until March 2017, reporting on IE after
TPVI with the Melody valve. Nine studies (including 851 patients and 2060
patient-years of follow-up) were included in the analysis of the incidence
of IE. The cumulative incidence of IE ranged from 3.2% to 25.0%, whereas
the annualized incidence rate ranged from 1.3% to 9.1% per patient-year.
The median (interquartile range) time from TPVI to the onset of IE was
18.0 (9.0-30.4) months (range, 1.0-72.0 months). The most common findings
were positive blood culture (93%), fever (89%), and new, significant,
and/or progressive right ventricular outflow tract obstruction (79%);
vegetations were detectable on echocardiography in only 34% of cases. Of
69 patients with IE after TPVI, 6 (8.7%) died and 35 (52%) underwent
surgical and/or transcatheter reintervention. Death or reintervention was
more common in patients with new/ significant right ventricular outflow
tract obstruction (69% versus 33%; P=0.042) and in patients with
non-streptococcal IE (73% versus 30%; P=0.001). Conclusions--The incidence
of IE after implantation of a Melody valve is significant, at least over
the first 3 years after TPVI, and varies considerably between the studies.
Although surgical/percutaneous reintervention is a common consequence,
some patients can be managed medically, especially those with
streptococcal infection and no right ventricular outflow tract
obstruction. Copyright © 2018 The Authors.

<103>
Accession Number
2000604759
Title
Preventing Postoperative Atrial Fibrillation After Noncardiac Surgery: A
Meta-analysis.
Source
American Journal of Medicine. 131 (7) (pp 795-804.e5), 2018. Date of
Publication: July 2018.
Author
Oesterle A.; Weber B.; Tung R.; Choudhry N.K.; Singh J.P.; Upadhyay G.A.
Institution
(Oesterle, Weber, Tung, Upadhyay) Center for Arrhythmia Care, The
University of Chicago, Ill, United States
(Choudhry) Department of Medicine, Brigham and Women's Hospital, Boston,
Mass, United States
(Singh) Massachusetts General Hospital Heart Center, Boston, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Although postoperative atrial fibrillation is common after
noncardiac surgery, there is a paucity of data regarding prophylaxis. We
sought to determine whether pharmacologic prophylaxis reduces the
incidence of postoperative atrial fibrillation after noncardiac surgery.
 Method(s): We performed an electronic search of Ovid MEDLINE, the
Cochrane central register of controlled trials database, and SCOPUS from
inception to September 7, 2016 and included prospective randomized studies
in which patients in sinus rhythm underwent noncardiac surgery and
examined the incidence of postoperative atrial fibrillation as well as
secondary safety outcomes. Result(s): Twenty-one studies including
11,608 patients were included. Types of surgery included vascular surgery
(3465 patients), thoracic surgery (2757 patients), general surgery (2292
patients), orthopedic surgery (1756 patients), and other surgery (1338
patients). Beta-blockers (relative risk [RR] 0.32; 95% confidence interval
[CI], 0.11-0.87), amiodarone (RR 0.42; 95% CI, 0.26 to 0.67), and statins
(RR 0.43; 95% CI, 0.27 to 0.68) reduced postoperative atrial fibrillation
compared with placebo or active controls. Calcium channel blockers (RR
0.55; 95% CI, 0.30 to 1.01), digoxin (RR 1.62; 95% CI, 0.95 to 2.76), and
magnesium (RR 0.73; 95% CI, 0.23 to 2.33) had no statistically significant
effect on postoperative atrial fibrillation incidence. The incidence of
adverse events was comparable across agents, except for increased
mortality (RR 1.33; 95% CI, 1.03 to 1.37) and bradycardia (RR 2.74; 95%
CI, 2.19 to 3.43) in patients receiving beta-blockers. Conclusion(s):
Pharmacologic prophylaxis with amiodarone, beta-blockers, or statins
reduces the incidence of postoperative atrial fibrillation after
noncardiac surgery. Amiodarone and statins have a relatively low overall
risk of short-term adverse events. Copyright © 2018 Elsevier Inc.

<104>
Accession Number
611113665
Title
Optimal duration of dual antiplatelet therapy after drug-eluting stent
implantation: Meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 220 (pp 895-900), 2016. Date of
Publication: 01 Oct 2016.
Author
Fei Y.; Tsoi M.F.; Cheung T.T.; Cheung B.M.Y.
Institution
(Fei, Tsoi, Cheung, Cheung) Division of Clinical Pharmacology and
Therapeutics, Department of Medicine, The University of Hong Kong,
Pokfulam, Hong Kong
(Cheung, Cheung) Partner State Key Laboratory of Pharmaceutical
Biotechnology, The University of Hong Kong, Pokfulam, China
(Cheung) Research Centre of Heart, Brain, Hormone and Healthy Aging, The
University of Hong Kong, Pokfulam, Hong Kong
(Cheung) Institute of Cardiovascular Science and Medicine, The University
of Hong Kong, Pokfulam, Hong Kong
Publisher
Elsevier Ireland Ltd
Abstract
Objective After implantation of drug-eluting stents (DES), patients
usually receive 6-12 months of dual antiplatelet therapy (DAPT). However,
the optimal duration of DAPT is controversial. Therefore, we performed a
meta-analysis of randomized controlled trials to assess the risks and
benefits of different DAPT durations. Methods We searched the literature
using MEDLINE, Scopus, EMBASE, ISI Web of Science, Cochrane Library,
ClinicalTrials.gov and recent conference proceedings, and included those
trials randomizing patients to receive different durations of DAPT after
DES implantation and reporting frequencies of cardiovascular and bleeding
events. Data from eleven trials were analyzed using RevMan. Results
Compared to 12-month DAPT treatment, extended DAPT significantly reduced
the frequencies of myocardial infarction (OR 0.54 95% CI: 0.43-0.66; p <
0.00001) and stent thrombosis (OR 0.36 95% CI: 0.24-0.55; p < 0.00001),
but the risks of major bleeding (OR 1.54 95% CI 1.22-1.96) and all-cause
mortality (OR 1.43 95% CI 1.14-1.81) were substantially increased. There
was no significant difference in stroke, cardiovascular mortality or
repeat revascularization. Compared to short-term DAPT, 12-month DAPT or
longer was associated with increased major bleeds (OR 1.98 95% CI:
1.26-3.11). No significant differences were found in the risk of other
primary outcomes. Conclusion 12-month DAPT appears to be a pragmatic
compromise between preventing stent thrombosis and increasing bleeding
risk. Patients at high bleeding risk should have shorter duration DAPT
while those with low bleeding risk can be considered for DAPT beyond 12
months. Copyright © 2016 Elsevier Ireland Ltd

<105>
Accession Number
628989836
Title
Vascular trauma of the hand - a systematic review.
Source
Vasa - European Journal of Vascular Medicine. 48 (3) (pp 205-215), 2019.
Date of Publication: 2019.
Author
Wahl U.; Kaden I.; Kohler A.; Hirsch T.
Institution
(Wahl) BG Hospital Bergmannstrost Halle, Department of Internal Medicine,
Halle, Germany
(Kaden) BG Hospital Bergmannstrost Halle, Department of Diagnostic Imaging
and Interventional Radiology, Halle, Germany
(Kohler) Cardiology and Vascular Diseases, Halle, Germany
(Hirsch) Internal Medicine and Vascular Diseases, Vein Competence Centre,
Halle, Germany
Publisher
Hogrefe Verlag GmbH & Co. KG (E-mail: verlag@hogrefe.de)
Abstract
Hypothenar or thenar hammer syndrome (HHS) and hand-arm vibration syndrome
(HAVS) are diseases caused by acute or chronic trauma to the upper
extremities. Since both diseases are generally related to occupation and
are recognised as occupational diseases in most countries, vascular
physicians need to be able to distinguish between the two entities and
differentiate them from other diagnoses. A total of 867 articles were
identified as part of an Internet search on PubMed and in non-listed
occupational journals. For the analysis we included 119 entries on HHS as
well as 101 papers on HAVS. A professional history and a job analysis were
key components when surveying the patient's medical history. The
Doppler-Allen test, duplex sonography and optical acral pulse oscillometry
were suitable for finding an objective basis for the clinical tests. In
the case of HHS, digital subtraction angiography was used to confirm the
diagnosis and plan treatment. Radiological tomographic techniques provided
very limited information distal to the wrist. The vascular component of
HAVS proved to be strongly dependent on temperature and had to be
differentiated from the various other causes of secondary Raynaud's
phenomenon. The disease was medicated with anticoagulants and vasoactive
substances. If these were not effective, a bypass was performed in
addition to various endovascular interventions, especially in the case of
HHS. Despite the relatively large number of people exposed, trauma-induced
circulatory disorders of the hands can be observed in a comparatively
small number of cases. For the diagnosis of HHS, the morphological
detection of vascular lesions through imaging is essential since the
disorder can be accompanied by critical limb ischaemia, which may require
bypass surgery. In the case of HAVS, vascular and sensoneurological
pathologies must be objectified through provocation tests. The main
therapeutic approach to HAVS is preventing exposure. Copyright ©
2018 Hogrefe.

<106>
Accession Number
628018996
Title
Topical application of magnesium to prevent intubation-related sore throat
in adult surgical patients: a systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. 66 (9) (pp 1082-1094), 2019. Date of
Publication: 15 Sep 2019.
Author
Kuriyama A.; Maeda H.; Sun R.
Institution
(Kuriyama) Emergency and Critical Care Center, Kurashiki Central Hospital,
Miwa, Kurashiki, Okayama 710-8602, Japan
(Maeda) Department of Emergency Medicine, Sugita Genpaku Memorial Obama
Municipal Hospital, Fukui, Japan
(Sun) Department of Anesthesiology, Tongji Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Hubei, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Postoperative sore throat negatively affects patient
satisfaction and recovery. We conducted a systematic review and
meta-analysis to examine the efficacy of preoperative topical
administration of magnesium sulfate in preventing postoperative sore
throat in adult patients. Method(s): We searched Medline, EMBASE,
China National Knowledge Infrastructure, and the Cochrane Central Register
of Controlled Trials from inception to 6 October, 2018. We included
randomized-controlled trials that assessed the efficacy and safety of
topical application of magnesium preoperatively in adult patients who
underwent endotracheal intubation for general anesthesia. We then pooled
the data using a random-effects model and conducted a trial sequential
analysis on the incidence of sore throat. Our primary outcome was the
incidence of sore throat at 24 hr after surgery/extubation. Our secondary
outcomes included the severity of sore throat at 24 hr after
surgery/extubation and adverse events. Result(s): Eleven
randomized-controlled trials involving 1,096 patients were included in
this study. Topical application of magnesium was associated with reduced
incidence of postoperative sore throat (risk ratio, 0.31; 95% confidence
interval [CI], 0.21 to 0.45) as well as reduced severity of postoperative
sore throat (standardized mean difference, - 2.66; 95% CI, - 3.89 to -
1.43). Three studies reported that significant adverse events were not
associated with topical magnesium. The trial sequential analysis suggested
that there is adequate evidence supporting the efficacy of topical
magnesium in preventing postoperative sore throat. Conclusion(s): Our
study suggests that preoperative topical magnesium can effectively prevent
postoperative sore throat. Trial registration: PROSPERO (CRD42018110019);
registered 26 September, 2018. Copyright © 2019, Canadian
Anesthesiologists' Society.

<107>
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). 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. 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. 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. Copyright © 2019 John Wiley & Sons A/S. Published
by John Wiley & Sons Ltd

<108>
Accession Number
2002467574
Title
Comparison of the effect of 80 vs 40 mg atorvastatin in patients with
isolated coronary artery bypass graft surgery: A randomized clinical
trial.
Source
Journal of Cardiac Surgery. 34 (8) (pp 670-675), 2019. Date of
Publication: 2019.
Author
Shekari A.; Forouzannia S.K.; Davarpasand T.; Talasaz A.H.; Jalali A.;
Gorabi A.M.; Lotfi-Tokaldany M.; Bagheri J.
Institution
(Shekari, Forouzannia, Davarpasand, Talasaz, Jalali, Gorabi,
Lotfi-Tokaldany, Bagheri) Department of Cardiovascular Research, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Atorvastatin can decrease cardiac injury after coronary artery
bypass graft (CABG) surgery. We compared the effects of 80 and 40 mg of
atorvastatin per day on the levels of cardiac troponin T (cTnT) and
creatine kinase-MB (CK-MB) after an isolated CABG. Method(s): This
randomized single-blind parallel clinical trial enrolled 125 patients
(mean age = 60.59 +/- 8.37 years) who were candidates for elective
isolated CABG at the Tehran Heart Center between May 2017 and December
2017. Patients were randomly allocated into two groups to receive either
80 mg (n = 62) or 40 mg of atorvastatin (n = 63) per day, 5 days before
surgery. The levels of cTnT and CK-MB, used as myocardial injury markers,
were measured at baseline and then at 8 and 24 hours after CABG.
 Result(s): The levels of CK-MB and cTnT at baseline and at 8 and 24
hours following CABG were not significantly different between the two
groups. Our repeated measures analysis of variance showed that the levels
of CK-MB and cTnT increased significantly over time (P <.001). No
significant interaction was observed between time and the atorvastatin
dosage on the levels of either CK-MB (P =.159) or cTnT (P =.646). In
addition, the between-group effects were not significant for CK-MB (P
=.632) and cTnT (P =.126). Conclusion(s): The higher dose of
atorvastatin (80 mg) did not exert a more protective effect than the
standard dose of atorvastatin (40 mg) after CABG surgery. Copyright
© 2019 Wiley Periodicals, Inc.

<109>
Accession Number
2002138087
Title
Incidence, determinants and impact of acute kidney injury in patients with
diabetes mellitus and multivessel disease undergoing coronary
revascularization: Results from the FREEDOM trial.
Source
International Journal of Cardiology. 293 (pp 197-202), 2019. Date of
Publication: 15 October 2019.
Author
Arbel Y.; Fuster V.; Baber U.; Hamza T.H.; Siami F.S.; Farkouh M.E.
Institution
(Arbel) Department of Cardiology, Tel Aviv Medical Center, Affiliated with
the University of Tel Aviv, Tel Aviv, Israel
(Fuster, Baber) Icahn School of Medicine at Mount Sinai, New York, United
States
(Fuster, Baber) Centro Nacional de Investigaciones Cardiovasculares,
Madrid, Spain
(Hamza, Siami) New England Research Institute (NERI), United States
(Farkouh) Peter Munk Cardiac Centre, and Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background: The incidence and prognostic significance of acute kidney
injury (AKI) in patients with diabetes mellitus and multivessel coronary
artery disease undergoing coronary revascularization is not well known.
The current analysis included patients randomized to PCI vs. CABG as part
of the FREEDOM trial. We sought to examine the impact of AKI and its
predictors in diabetic patients with multivessel coronary artery disease
undergoing PCI vs. CABG. Method(s): We conducted a pre-specified
subgroup analysis of the FREEDOM trial to examine the incidence,
correlates and impact of AKI according to revascularization strategy. AKI
predictors were identified using multivariable logistic regression and
associations between AKI and outcomes were examined using Cox regression.
The primary endpoint was the composite occurrence of all-cause death,
stroke or myocardial infarction at 5 years of follow-up. Result(s):
KI occurred more frequently in patients following CABG (15.6%) compared
with PCI (9.1%) (p < 0.001). AKI was associated with a higher risk for
major cardiovascular events (MACE) at 5 years (34.6% vs. 20.5%, p <
0.001), an effect that remained large and significant irrespective of CABG
(HR = 2.18 95% CI 1.44-3.31, p <=0.001) or PCI (HR = 2.08 95% CI
1.35-3.21, p < 0.0001). There was a non-significant interaction (p-value =
0.89) between the revascularization method and AKI, supporting that AKI is
a significant risk factor in both revascularization methods.
 Conclusion(s): Although risk for AKI was higher in patients
undergoing CABG, the impact of AKI on MACE was substantial irrespective of
revascularization strategy. Preventive strategies to identify patients at
risk for AKI are warranted to mitigate the long-term effects of this
complication. Copyright © 2019 Elsevier B.V.

<110>
Accession Number
627731878
Title
Native kidney BK virus nephropathy, a systematic review.
Source
Transplant Infectious Disease. 21 (4) (no pagination), 2019. Article
Number: e13083. Date of Publication: 2019.
Author
Shah A.; Kumar V.; Palmer M.B.; Trofe-Clark J.; Laskin B.; Sawinski D.;
Hogan J.J.
Institution
(Shah, Trofe-Clark, Sawinski, Hogan) Division of Nephrology, University of
Pennsylvania, Philadelphia, PA, United States
(Kumar, Palmer, Trofe-Clark, Laskin, Sawinski, Hogan) Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA, United States
(Palmer) Department of Pathology, University of Pennsylvania,
Philadelphia, PA, United States
(Trofe-Clark) Department of Pharmacy Services, Hospital of the University
of Pennsylvania, University of Pennsylvania, Philadelphia, PA, United
States
(Laskin) Division of Nephrology, Children's Hospital of Philadelphia,
University of Pennsylvania, Philadelphia, PA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: There is a growing base of literature describing BK
nephropathy (BKVN) in patients outside of the setting of kidney
transplant. Previous systematic reviews of the literature have been
limited by methodology or by the scope of patients included. Study Design
and Methods: Systematic Review (Prospero # CRD42018088524). Setting &
Population: Patients without kidney transplant who had biopsy-proven BKVN.
Selection Criteria for Studies: Full-text articles that describe native
BKVN patient cases. Analytical Approach: Descriptive synthesis.
 Result(s): The search identified 630 unique articles of which 51 were
included in the final review. Sixty-five cases (including two new cases
presented in this review) were identified, all but one occurred in the
setting of known immunosuppression. Limitation(s): The primary
limitation was the exclusion of studies that did not fulfill the stringent
review criteria. We excluded reports with only a clinical diagnosis of
BKVN, such as those with viruria and/or viremia without biopsy.
 Conclusion(s): As of May 2018, there are 65 reported cases of BKVN in
native kidneys. This represents the most comprehensive description of
biopsy-proven BKVN in native kidneys to date. Evaluation for BK
nephropathy should be considered in immunocompromised patients who exhibit
unexplained renal failure. Copyright © 2019 John Wiley & Sons
A/S. Published by John Wiley & Sons Ltd

<111>
Accession Number
2001913331
Title
A Systematic Review and International Web-Based Survey of Randomized
Controlled Trials in the Perioperative and Critical Care Setting:
Interventions Increasing Mortality.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (10) (pp 2685-2694),
2019. Date of Publication: October 2019.
Author
Sartini C.; Lomivorotov V.; Pisano A.; Riha H.; Baiardo Redaelli M.;
Lopez-Delgado J.C.; Pieri M.; Hajjar L.; Fominskiy E.; Likhvantsev V.;
Cabrini L.; Bradic N.; Avancini D.; Wang C.Y.; Lembo R.; Novikov M.;
Paternoster G.; Gazivoda G.; Alvaro G.; Roasio A.; Wang C.; Severi L.;
Pasin L.; Mura P.; Musu M.; Silvetti S.; Votta C.D.; Belletti A.; Corradi
F.; Brusasco C.; Tama S.; Ruggeri L.; Yong C.-Y.; Pasero D.; Mancino G.;
Spadaro S.; Conte M.; Lobreglio R.; Di Fraja D.; Saporito E.; D'Amico A.;
Sardo S.; Ortalda A.; Yavorovskiy A.; Riefolo C.; Monaco F.; Bellomo R.;
Zangrillo A.; Landoni G.
Institution
(Sartini, Baiardo Redaelli, Pieri, Fominskiy, Cabrini, Lembo, Votta,
Belletti, Tama, Ruggeri, Ortalda, Riefolo, Monaco, Zangrillo, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Lomivorotov) E. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
(Pisano, Di Fraja) Division of Cardiac Anesthesia and Intensive Care Unit,
AORN dei Colli - Monaldi Hospital, Naples, Italy
(Riha) Institute for Clinical and Experimental Medicine, Prague, Czechia
(Lopez-Delgado) Hospital Universitari de Bellvitge, Barcelona, Spain
(Hajjar) Instituto do Coracao do Hospital das Clinicas, Sao Paulo, Brazil
(Likhvantsev, Yavorovskiy) Department of Anesthesiology and Intensive
Care, Sechenov First Moscow State Medical University, Moscow Regional
Clinical and Research Institute, Moscow, Russian Federation
(Bradic) Department of Cardiovascular Anesthesiology and Cardiac Intensive
Medicine, University Hospital Dubrava, Zagreb, Croatia
(Avancini) San Raffaele Telethon Institute for Gene Therapy (SR-Tiget),
IRCCS San Raffaele Scientific Institute, Milan, Italy
(Wang) Anaesthesia and Intensive Care, University of Malaya, Kuala Lumpur,
Malaysia
(Novikov) Saint Petersburg State University, Saint Petersburg, Russian
Federation
(Paternoster) Anaesthesia and Intensive Care, San Carlo Hospital, Potenza,
Italy
(Gazivoda) Institute of Cardiovascular Diseases "Dedinje", Belgrade,
Serbia
(Alvaro, Saporito, D'Amico) AOU Mater Domini Germaneto, Catanzaro, Italy
(Roasio) Department of Anaesthesia and Intensive Care, Ospedale Cardinal
Massaia di Asti, Asti, Italy
(Wang) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Severi) Anesthesia and Intensive Care, Azienda Ospedaliera San Camillo
Forlanini, Rome, Italy
(Pasin) S. Antonio Hospital, Padova, Italy
(Mura) Department of Anesthesia and Intensive Care Unit, Policlinico
Duilio Casula AOU, Cagliari, Italy
(Musu, Sardo) Department of Medical Sciences and Public Health, University
of Cagliari, Monserrato, Italy
(Silvetti) IRCCS Istituto Giannina Gaslini, Ospedale Pediatrico, Genoa,
Italy
(Corradi, Brusasco) E.O. Ospedali Galliera, Genova, Italy and Universita
degli Studi di Pisa, Italy
(Yong) Anaesthesia and Intensive Care, Hospital Pulau Pinang, Georgetown,
Malaysia
(Pasero) Department of Anesthesia and Intensive Care, A.O.U. Cittadella
Salute e della Scienza, Turin, Italy
(Mancino) Hospital Santa Chiara, Pisa, Italy
(Spadaro) Department Morphology, Surgery and Experimental Medicine,
Intensive Care Unit, University of Ferrara, Italy
(Conte) Mater Dei Hospital, Bari, Italy
(Lobreglio) Anesthesia and Intensive Care A.O.U Citta della salute e della
Scienza, Turin, Italy
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Melbourne, Australia
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Publisher
W.B. Saunders
Abstract
Objective: Reducing mortality is a key target in critical care and
perioperative medicine. The authors aimed to identify all nonsurgical
interventions (drugs, techniques, strategies) shown by randomized trials
to increase mortality in these clinical settings. Design(s): A
systematic review of the literature followed by a consensus-based voting
process. Setting(s): A web-based international consensus conference.
 Participant(s): Two hundred fifty-one physicians from 46 countries.
 Intervention(s): The authors performed a systematic literature search
and identified all randomized controlled trials (RCTs) showing a
significant increase in unadjusted landmark mortality among surgical or
critically ill patients. The authors reviewed such studies during a
meeting by a core group of experts. Studies selected after such review
advanced to web-based voting by clinicians in relation to agreement,
clinical practice, and willingness to include each intervention in
international guidelines. Measurements and Main Results: The authors
selected 12 RCTs dealing with 12 interventions increasing mortality:
diaspirin-crosslinked hemoglobin (92% of agreement among web voters),
overfeeding, nitric oxide synthase inhibitor in septic shock, human growth
hormone, thyroxin in acute kidney injury, intravenous salbutamol in acute
respiratory distress syndrome, plasma-derived protein C concentrate,
aprotinin in high-risk cardiac surgery, cysteine prodrug, hypothermia in
meningitis, methylprednisolone in traumatic brain injury, and albumin in
traumatic brain injury (72% of agreement). Overall, a high consistency
(ranging from 80% to 90%) between agreement and clinical practice was
observed. Conclusion(s): The authors identified 12 clinical
interventions showing increased mortality supported by randomized
controlled trials with nonconflicting evidence, and wide agreement upon
clinicians on a global scale. Copyright © 2019 Elsevier Inc.

<112>
Accession Number
2002213850
Title
Five-year outcomes in cardiac surgery patients with atrial fibrillation
undergoing concomitant surgical ablation versus no ablation. The long-term
follow-up of the PRAGUE-12 Study.
Source
Heart Rhythm. 16 (9) (pp 1334-1340), 2019. Date of Publication: September
2019.
Author
Osmancik P.; Budera P.; Talavera D.; Hlavicka J.; Herman D.; Holy J.;
Cervinka P.; Smid J.; Hanak P.; Hatala R.; Widimsky P.
Institution
(Osmancik, Herman, Widimsky) Cardiocenter, IIIrd Internal -
Cardiology Clinic, Third Faculty of Medicine, Charles University and
University Hospital Kralovske Vinohrady, Prague, Czechia
(Budera, Talavera, Hlavicka) Cardiocenter, Dept. of Cardiac Surgery, Third
Faculty of Medicine, Charles University and University Hospital Kralovske
Vinohrady, Prague, Czechia
(Holy, Cervinka) Department of Cardiology, Masaryk Hospital in Usti nad
Labem, Krajska Zdravotni and UJEP in Usti na Labem, Usti nad Labem,
Czechia
(Smid) Cardiology Department, University Hospital and Faculty of Medicine
Pilsen, Pilsen, Czechia
(Hanak, Hatala) Department of Arrhythmias and Cardiac Pacing, National
Institute for Cardiovascular Disease, Bratislava, Slovakia
Publisher
Elsevier B.V.
Abstract
Background: The long-term effect of concomitant surgical ablation (SA) on
clinical outcomes in an unselected population of patients has not been
sufficiently reported in randomized studies. Objective(s): The aim of
this study was to assess clinical outcomes of the SA after 5 years of
follow-up. Method(s): The PRAGUE-12 study was a prospective,
randomized clinical trial assessing cardiac surgery with ablation for AF
vs cardiac surgery alone. Patients with AF who were also indicated for
cardiac surgery (coronary artery disease [CAD], valve surgery) were
randomized to SA or control (no ablation) group. All patients were
followed for 5 years. The primary endpoint was a composite of
cardiovascular death, stroke, hospitalization for heart failure, or severe
bleeding. Secondary endpoint was a recurrence of AF. Result(s): A
total of 207 patients were analyzed (SA group = 108 patients, control
group = 99 patients). Both groups were similar relative to important
clinical characteristics except for CAD, which was more common in the
control group. Cumulative incidence curves showed a higher incidence of
the primary endpoint in the control group (P = .024, Gray's test).
However, after adjusting for all covariables, the difference between
groups was not significant (subhazard ratio [SHR] 0.69 [0.47-1.02], P =
.068). The incidence of stroke and AF recurrences were significantly
reduced in the SA group, and remained significant even after adjustment
for all covariables, including CAD (stroke: SHR 0.32 [0.12-0.84], P = .02,
AF recurrences: SHR 0.44 [0.31-0.62], P < .001). Conclusion(s):
Concomitant SA of AF is associated with a greater likelihood of
maintaining sinus rhythm and a decreased risk of stroke. Copyright
© 2019 Heart Rhythm Society

<113>
Accession Number
628429793
Title
Impact of cell saver during cardiac surgery on blood transfusion
requirements: a systematic review and meta-analysis.
Source
Vox Sanguinis. 114 (6) (pp 553-565), 2019. Date of Publication: 2019.
Author
Al Khabori M.; Al Riyami A.; Siddiqi M.S.; Sarfaraz Z.K.; Ziadinov E.; Al
Sabti H.
Institution
(Al Khabori, Al Riyami) Department of Hematology, Sultan Qaboos University
Hospital, Muscat, Oman
(Siddiqi, Sarfaraz, Ziadinov, Al Sabti) Department of Cardiac Surgery,
Sultan Qaboos University Hospital, Muscat, Oman
(Al Sabti) Oman Medical Specialty Board, Muscat, Oman
Publisher
Blackwell Publishing Ltd
Abstract
Objective: We performed a systematic review and meta-analysis of
randomized clinical trials on adult patients undergoing cardiac surgery
and compared the rates of red blood cell (RBC), platelet and fresh frozen
plasma (FFP) transfusion between the cell saver (CS) and the standard of
care groups. Method(s): MEDLINE , The Cochrane Central Register of
Controlled Trials (CENTRAL), American Society of Hematology (ASH) and
bibliographies of relevant studies were searched. We used random-effect
model. Result(s): Our search strategy returned 624 citations, of
which 15 studies were selected. The use of CS did not decrease the rate of
RBC transfusion (odds ratio [OR]: 0.69; 95% CI: 0.48-1.00), albeit with a
substantial heterogeneity (I2 = 60%). The year of publication
explained most of the heterogeneity (P for subgroup effect <0.001).
Although the rate of platelet transfusion was lower in the CS group, the
difference was not statistically significant (OR: 0.83; 95% CI: 0.57-1.2;
I2 = 0%). The rate of FFP transfusion was numerically higher in
the CS group; however, this difference did not reach statistical
significance (OR: 1.26; 95% CI: 0.82-1.94; I2 = 15%). Only two
studies scored five on the Jadad score. There was no indication of a
publication bias using the funnel plot and Egger test (P = 0.34, 0.87, and
0.62 for RBC, platelet and FFP, respectively). Conclusion(s): The use
of CS during cardiac surgery does not have an impact on the rates of RBC,
platelet and FFP transfusion; however, this should be interpreted in the
light of the study limitations. Copyright © 2019 International
Society of Blood Transfusion

<114>
Accession Number
2002678316
Title
Walking pace is inversely associated with risk of death and cardiovascular
disease: The Physicians' Health Study.
Source
Atherosclerosis. 289 (pp 51-56), 2019. Date of Publication: October 2019.
Author
Imran T.F.; Orkaby A.; Chen J.; Selvaraj S.; Driver J.A.; Gaziano J.M.;
Djousse L.
Institution
(Imran) Boston Medical Center, Boston University School of Medicine, 72 E
Concord St, Boston, MA 02118, United States
(Imran, Orkaby, Chen, Selvaraj, Driver, Gaziano, Djousse) Boston Veterans
Affairs Healthcare System, 150 S Huntington Ave, Boston, MA 02130, United
States
(Imran, Orkaby, Chen, Selvaraj, Driver, Gaziano, Djousse) Department of
Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical
School, 1620 Tremont St, Boston, MA 02120, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Walking pace is increasingly being used to assess functional
status in ambulatory settings. Method(s): We conducted a prospective
analysis within the Physicians' Health Study to examine whether walking
pace is associated with mortality and incident cardiovascular disease
(fatal or nonfatal myocardial infarction, coronary artery bypass grafting
and percutaneous transluminal coronary angioplasty). Participants included
21,919 male physicians with a mean age of 67.8 +/- 9.0 years.
 Result(s): After a median follow-up of 9.4 years (IQR: 7.9-10.3),
3906 deaths and 2487 incident CVD events occurred. In a multivariable Cox
proportional hazards model adjusting for age, body mass index, smoking,
exercise frequency, and prevalent hypertension, diabetes mellitus, heart
failure, peripheral vascular disease, cancer, and total weekly walking
time, hazard ratios for mortality were 0.72 (95% CI: 0.64-0.81) for
walking pace of 2-2.9mph, 0.63 (95% CI: 0.55-0.73) for walking pace of
3-3.9mph and 0.63 (95% CI: 0.48-0.83) for walking pace of >=4mph compared
to the group that reported not walking regularly (p trend <0.0001).
Similar findings were observed for incident CVD: HRs were 0.88 (95% CI:
0.75-1.03) for a walking pace of 2-2.9mph, 0.75 (95% CI: 0.63-0.89) for a
walking pace of 3-3.9mph and 0.70 (0.53-0.94) for a walking pace of >=4mph
compared to the group that reported not walking regularly (p trend
0.0001). These associations persisted after excluding those who exercised
regularly. Conclusion(s): We found that walking pace is inversely
associated with risk of mortality and CVD among US male
physicians. Copyright © 2019 Elsevier B.V.

<115>
Accession Number
2000822243
Title
Anticoagulation and Antiplatelet Strategies After On-X Mechanical Aortic
Valve Replacement.
Source
Journal of the American College of Cardiology. 71 (24) (pp 2717-2726),
2018. Date of Publication: 19 June 2018.
Author
Puskas J.D.; Yanagawa B.; Ely J.; Puskas J.; Gerdisch M.; Nichols D.;
Graeve A.; Fermin L.; Rhenman B.; Kapoor D.; Copeland J.; Quinn R.; Hughes
G.C.; Azar H.; McGrath M.; Wait M.; Kong B.; Martin T.; Douville E.C.;
Meyer S.; Jamieson W.R.E.; Ye J.; Landvater L.; Trotter T.; Armitage J.;
Askew J.; Accola K.; Levy P.; Duncan D.; Sethi G.; Razi A.; Hagberg R.;
Hamman B.; Swistel D.; Shoukfeh M.F.; Tutuska P.; Sai-Sudhakar C.B.;
Damiano R.; Pettersson G.; Campbell M.; Gregoric I.; Cameron D.; Blackwell
R.; Allen K.
Institution
(Puskas) Icahn School of Medicine at Mount Sinai, New York, New York,
United States
(Gerdisch) Franciscan St. Francis Health, Indianapolis, Indiana, United
States
(Nichols, Graeve) Multicare Tacoma General, Tacoma, Washington, United
States
(Fermin, Rhenman, Kapoor) Southern Arizona Veterans Affairs Hospital,
Tucson, Arizona, United States
(Copeland) University of Arizona, Tucson, Arizona, United States
(Quinn) Maine Medical, Portland, Maine, United States
(Hughes) Duke University, Durham, North Carolina, United States
(Azar, McGrath) Sentara Norfolk General, Norfolk, Virginia, United States
(Wait) University of Texas Southwestern, Dallas, Texas, United States
(Kong) St. Joseph Mercy Hospital, Ann Arbor, Michigan, United States
(Martin) University of Florida, Gainesville, Florida, United States
(Douville) Providence Portland, Portland, Oregon, United States
(Meyer) University of Alberta, Edmonton, Alberta, Canada
(Ye) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Jamieson) Vancouver General Hospital, Vancouver, British Columbia, Canada
(Landvater) Carolina Cardiovascular, Raleigh, North Carolina, United
States
(Hagberg) Hartford Hospital, Hartford, Connecticut, United States
(Trotter) Oklahoma City VA, Oklahoma City, Oklahoma, United States
(Armitage, Askew) Mary Washington, Fredericksburg, Virginia, United States
(Accola) Florida Hospital, Orlando, Florida, United States
(Levy) New Mexico Heart Institute, Albuquerque, New Mexico, United States
(Duncan) Novant Health Forsyth Medical Center, Winston-Salem, North
Carolina, United States
(Yanagawa) St. Michael's Hospital, Toronto, Ontario, Canada
(Ely) On-X Life Technologies, Austin, Texas, United States
Publisher
Elsevier USA
Abstract
Background: The burden oral anticoagulation is a limitation of mechanical
valve prostheses. Objective(s): The aim of this study was to test
whether patients could be safely managed with dual-antiplatelet therapy
(DAPT) (aspirin 325 mg and clopidogrel 75 mg) or lower warfarin after On-X
mechanical aortic valve replacement (mAVR). Method(s): PROACT
(Prospective Randomized On-X Anticoagulation Trial) (n = 576) is a
multicenter (41 sites) noninferiority trial. From June 2006 through
February 2014, 201 patients >=18 years of age without thromboembolic risk
factors undergoing mAVR were randomized to receive DAPT (n = 99) or
standard warfarin plus aspirin (n = 102) 3 months after mAVR (low-risk
arm). From June 2006 through October 2009, 375 patients with 1 or more
thromboembolic risk factors were also randomized to lower intensity
warfarin plus aspirin (international normalized ratio 1.5 to 2.0; n = 185)
or standard warfarin plus aspirin (international normalized ratio 2.0 to
3.0; n = 190) 3 months after mAVR (high-risk arm). Result(s): The
low-risk arm was terminated for excess cerebral thromboembolic events
(3.12% per patient-year vs. 0.29% per patient-year, p = 0.02) in the DAPT
group at up to 8.8-year follow-up (631.6 patient-years), with no
differences in bleeding or all-cause mortality. High-risk arm patients
experienced significantly lower major (1.59% per patient-year vs. 3.94%
per patient-year, p = 0.002) and minor (1.27% per patient-year vs. 3.49%
per patient-year, p = 0.002) bleeding up to 8.7-year follow-up (2,035.2
patient-years), with no differences in thromboembolism (0.42% per
patient-year vs. 0.09% per patient-year, p = 0.20) and all-cause
mortality. Conclusion(s): DAPT was associated with higher rates of
thromboembolism and valve thrombosis compared with control in the low-risk
arm. International normalized ratios were safely maintained at 1.5 to 2.0
in high-risk patients, without differences in mortality or thromboembolic
complications. (Randomized On-X Anticoagulation Trial [PROACT];
NCT00291525) Copyright © 2018

<116>
Accession Number
627922163
Title
Are carbohydrate drinks more effective than preoperative fasting: A
systematic review of randomised controlled trials.
Source
Journal of clinical nursing. 28 (17-18) (pp 3096-3116), 2019. Date of
Publication: 01 Sep 2019.
Author
Noba L.; Wakefield A.
Institution
(Noba) Department of Surgery, North Middlesex University Hospital NHS
Trust, London, United Kingdom
(Wakefield) University of Manchester, Manchester, United Kingdom
Publisher
NLM (Medline)
Abstract
AIMS AND OBJECTIVES: To evaluate current evidence to determine whether
oral preoperative carbohydrate drinks shorten hospital stays, reduce
insulin resistance and/or improve postoperative discomfort for patients
undergoing abdominal or cardiac surgery. BACKGROUND: Criticisms of
standard preoperative fasting have forced practitioners to explore new
ways of preparing patients for theatre. Consequently, the use of
preoperative carbohydrate drinks prior to elective surgery has gained
momentum. Current evidence regarding the efficacy of this treatment has
been inconsistent and contradictory which prompted a review of the current
literature. DESIGN: A systematic review of randomised clinical trials
(RCTs). METHOD(S): In accordance with Prisma guidelines, the review
incorporated a systematic, comprehensive search of English-language-only
texts published between 2001-2018. The search focused on five databases
(MEDLINE, EMBASE, CINAHL, British Nursing Index and ASSIA). Reference
lists of relevant systematic reviews and studies located were also
hand-searched for eligibility and further references. All RCTs
investigating the effect of preoperative carbohydrate drinks on adult
patients undergoing cardiac or abdominal surgery were included. The review
excluded RCTs conducted on patients with type 1 or 2 diabetes mellitus and
patients under the age of 18. RESULT(S): The review included 22 RCTs
with a total sample of 2,065 patients across thirteen countries. Nine
different types of surgery were identified. No significant reductions in
hospital stay were noted in 8 of the ten trials. Preoperative carbohydrate
drinks significantly reduced insulin resistance and improved postoperative
discomfort especially in patients undergoing laparoscopic cholecystectomy.
No definite conclusion regarding the impact of preoperative carbohydrate
drinks on gastric volume and gastric pH was noted. Similarly, no adverse
events such as pulmonary aspiration were reported. CONCLUSION(S):
Preoperative carbohydrate drinks were found to be safe and can be
administered up to 2 hr before surgery. Such drinks were also found to
reduce insulin resistance and improve postoperative discomfort especially
in patients undergoing laparoscopic cholecystectomy. However, there is
insufficient evidence to definitively conclude what impact they have on
length of hospital stay. RELEVANCE TO CLINICAL PRACTICE: Patients
undergoing surgery are often required to fast from midnight, while in some
extreme cases patients are fasted for up to 24 hr prior to surgery. The
main purpose of asking patients to undergo this prolonged fasting is to
reduce the risk of aspiration. However, there is a general consensus that
this traditional practice is out of date, and it is often associated with
postoperative complications. On the other hand, current evidence suggests
oral intake of fluids up to 90-180 min prior to surgery is safe and
consumption of a preoperative carbohydrate drinks does not delay gastric
emptying or affect gastric acidity. Copyright © 2019 John Wiley &
Sons Ltd.

<117>
Accession Number
2002381750
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
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 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, DC, United States
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Saito) Shonan Kamakura General Hospital, Kamakura, Japan
(Saito) Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia, Georgia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
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. Copyright © 2019

<118>
Accession Number
2002379732
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: 2019.
Author
Jiritano F.; Santarpino G.; Serraino G.F.; Ten Cate H.; Matteucci M.; Fina
D.; Mastroroberto P.; Lorusso R.
Institution
(Jiritano, Matteucci, Fina, Lorusso) Cardio-Thoracic Surgery Dept., Heart
& Vascular Centre, Maastricht University Medical Centre, and
Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Jiritano, Serraino, Mastroroberto) Cardiac Surgery Unit, University
"Magna Graecia" of Catanzaro, Catanzaro, Italy
(Santarpino) Citta di Lecce Hospital, GVM Care & Research, Lecce, 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) Department of Cardiac Surgery, Circolo Hospital, University of
Insubria, Varese, Italy
(Fina) University of Milan, IRCCS San Donato, Milan, Italy
Publisher
Elsevier Ireland Ltd
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. 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. 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. 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. Copyright © 2019 The Authors

<119>
Accession Number
2001716430
Title
Impact of Chronic Kidney Disease on Decision Making and Management in
Transcatheter Aortic Valve Interventions.
Source
Canadian Journal of Cardiology. 35 (9) (pp 1188-1194), 2019. Date of
Publication: September 2019.
Author
Hensey M.; Murdoch D.J.; Sathananthan J.; Wood D.A.; Webb J.G.
Institution
(Hensey, Murdoch, Sathananthan, Wood, Webb) Centre for Heart Valve
Innovation, St Paul's Hospital, University of British Columbia, Vancouver,
British Columbia, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The coexistence of chronic kidney disease (CKD) and severe aortic stenosis
(AS) is common, and the prevalence of both is rising. The 2 conditions are
inherently linked in that significant CKD may accelerate the development
of AS and severe AS may result in deteriorating kidney function. The
volume of and indications for transcatheter aortic valve implantation
(TAVI) procedures are ever-increasing, and there are many challenges that
need to be considered in patients with concomitant severe AS and CKD being
assessed for TAVI. Throughout the process of working these patients up for
definitive management of their valvular heart disease, the presence of CKD
impacts on diagnostic investigations, treatment decisions, and therapeutic
interventions. Herein we review the current literature regarding TAVI in
patients with CKD focusing on the decision-making process and specific
risks involved in TAVI and CKD. We also provide specific practical
strategies to best manage this challenging patient cohort. Copyright
© 2018

<120>
Accession Number
2002503389
Title
The Effect of Steroids in Patients Undergoing Cardiopulmonary Bypass: An
Individual Patient Meta-Analysis of Two Randomized Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Whitlock R.P.; Dieleman J.M.; Belley-Cote E.; Vincent J.; Zhang M.;
Devereaux P.J.; Kalkman C.J.; van Dijk D.; Yusuf S.
Institution
(Whitlock, Belley-Cote, Vincent, Zhang, Devereaux, Yusuf) Population
Health Research Institute, Hamilton Health Sciences and McMaster
University, Hamilton, Ontario, Canada
(Whitlock) Department of Surgery, McMaster University, Hamilton, Ontario,
Canada
(Whitlock, Devereaux) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, Ontario, Canada
(Belley-Cote, Devereaux, Yusuf) Department of Medicine, McMaster
University, Hamilton, Ontario, Canada
(Dieleman, Kalkman, van Dijk) University Medical Center, Utrecht,
Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Steroids suppress the inflammatory response to cardiopulmonary
bypass, but the impact on death at 30 days, myocardial infarction or
injury, stroke, renal failure, respiratory failure, new atrial
fibrillation, transfusion requirement, infection, and length of intensive
care unit (ICU) and hospital stays are uncertain. Design(s):
Patient-level data meta-analysis of 2 randomized trials. Setting(s):
Eighty-eight cardiac surgical centers in 19 countries.
 Participant(s): A total of 11,989 participants, from the Steroids in
Cardiac Surgery trial and the Dexamethasone in Cardiac Surgery study,
undergoing cardiac surgery with the use of cardiopulmonary bypass.
 Intervention(s): Participants were randomly assigned to steroid or
placebo. Measures and Main Results: Outcomes assessed were mortality at 30
days, myocardial infarction or injury, stroke, renal failure, respiratory
failure, new atrial fibrillation, transfusion requirement, infection, and
length of ICU and hospital stays. There was no significant difference in
death at 30 days between the steroid and placebo groups (odds ratio [OR],
0.87; 95% confidence interval [CI], 0.72-1.07). Myocardial infarction did
not differ significantly (OR, 1.17; 95% CI, 0.93-1.47); however,
myocardial injury was higher in the steroid group (OR, 1.25; 95% CI,
1.12-1.40). There were no significant differences for the outcomes of
stroke, renal failure, new atrial fibrillation, or transfusion. Steroids
significantly reduced respiratory failure (OR, 0.83; 95% CI, 0.75-0.99),
infection (OR, 0.80; 95% CI, 0.72-0.89), and length of ICU (p < 0.001) and
hospital stays (p = 0.006). Conclusion(s): This patient-level
meta-analysis does not support the routine use of steroids in cardiac
surgery. Steroid administration did not decrease the risk of death,
myocardial infarction, stroke, renal failure, new atrial fibrillation, or
transfusion. Steroids increased the risk of myocardial injury in both the
Steroids in Cardiac Surgery and Dexamethasone in Cardiac Surgery trials.
Finally, steroids lowered the risk of respiratory failure and infection,
and reduced length of ICU and hospital stay. Copyright © 2019
Elsevier Inc.

<121>
Accession Number
628159081
Title
Oral anticoagulants in atrial fibrillation with valvular heart disease and
bioprosthetic heart valves.
Source
Heart. 105 (18) (pp 1432-1436), 2019. Date of Publication: 01 Sep 2019.
Author
Malik A.H.; Yandrapalli S.; Aronow W.S.; Panza J.A.; Cooper H.A.
Institution
(Malik) Department of Medicine, New York Medical College in Westchester
Medical Center, Valhalla, NY, United States
(Yandrapalli, Aronow, Panza, Cooper) Department of Cardiology, New York
Medical College, Valhalla, NY, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Current guidelines endorse the use of non-vitamin K antagonist
oral anticoagulants (NOACs) in patients with atrial fibrillation (AF).
However, little is known about their safety and efficacy in valvular heart
disease (VHD). Similarly, there is a paucity of data regarding NOACs use
in patients with a bioprosthetic heart valve (BPHV). We, therefore,
performed a network meta-analysis in the subgroups of VHD and
meta-analysis in patients with a BPHV. Methods PubMed, Cochrane and Embase
were searched for randomised controlled trials. Summary effects were
estimated by the random-effects model. The outcomes of interest were a
stroke or systemic embolisation (SSE), myocardial infarction (MI),
all-cause mortality, major adverse cardiac events, major bleeding and
intracranial haemorrhage (ICH). Results In patients with VHD, rivaroxaban
was associated with more ICH and major bleeding than other NOACs, while
edoxaban 30 mg was associated with least major bleeding. Data combining
all NOACs showed a significant reduction in SSE, MI and ICH (0.70, [0.57
to 0.85; p<0.001]; 0.70 [0.50 to 0.99; p<0.002]; and 0.46 [0.24 to 0.86;
p<0.01], respectively). Analysis of 280 patients with AF and a BPHV showed
similar outcomes with NOACs and warfarin. Conclusions NOACs performed
better than warfarin for a reduction in SSE, MI and ICH in patients with
VHD. Individually NOACs performed similarly to each other except for an
increased risk of ICH and major bleeding with rivaroxaban and a reduced
risk of major bleeding with edoxaban 30 mg. In patients with a BPHV,
results with NOACs seem similar to those with warfarin and this needs to
be further explored in larger studies. Copyright © 2019
Author(s).

<122>
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.
 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. 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. 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. Copyright
© 2017 British Association of Critical Care Nurses.

<123>
Accession Number
629086078
Title
Effect of pre-operative fluid therapy on hemodynamic stability.
Source
Acta Anaesthesiologica Scandinavica. Conference: 35th Congress for the
Scandinavian Society of Anaesthesiology and Intensive Care Medicine, SSAI
2019. Denmark. 63 (8) (pp e17), 2019. Date of Publication: September 2019.
Author
Myrberg T.; Lindelof L.; Hultin M.
Institution
(Myrberg, Lindelof, Hultin) Department of Surgical and Perioperative
sciences, Anesthesiology and Intensive Care, Umea University, Umea, Sweden
Publisher
Blackwell Munksgaard
Abstract
Background: Preserving perfusion pressure during anesthesia induction is
crucial. Standardized anesthesia methods, alert fluid therapy and
vasoactive drugs may help maintain adequate hemodynamic conditions
throughout the induction procedure. In this randomized study
(ClinicalTrials NCT03394833), we hypothesized that, in non-morbidly obese
patients planned for non-cardiac surgery, a pre-operative volume bolus
based on lean body weight would decrease the incidence of significant
blood pressure drops (BPD) after induction with target-controlled infusion
(TCI) or rapid sequence induction (RSI). In addition, patients with signs
of affected hemodynamics were hypothesized to have a higher incidence of
BPDs. Method(s): Eighty individuals scheduled for non-cardiac surgery
were randomized to either a pre-operative colloid fluid bolus of 6 mL/kg
lean body weight or no bolus, and then anesthetized by means of TCI or
RSI. The main outcome measure was blood pressure drops below mean arterial
pressure 65 mm Hg during the first 20 minutes after anesthesia induction.
 Result(s): Pre-operative fluid therapy decreased the incidence of
BPDs fivefold. There was no difference in hemodynamic stability between
TCI and RSI. No correlation was shown between incidence of BPDs and
increasing age, medication, hypertension, diabetes, renal failure, or low
physical capacity. Conclusion(s): Pre-operative fluid bolus decreased
the incidence of significant blood pressure drops during TCI and RSI
induction of anesthesia.

<124>
Accession Number
629085557
Title
Obstetric anaesthesia to parturient with heart transplant.
Source
Acta Anaesthesiologica Scandinavica. Conference: 35th Congress for the
Scandinavian Society of Anaesthesiology and Intensive Care Medicine, SSAI
2019. Denmark. 63 (8) (pp e34-e35), 2019. Date of Publication: September
2019.
Author
Carlberg N.
Institution
(Carlberg) Anestesi och Intensivvard, Sahlgrenska Universitetssjukhuset
Ostra, Goteborg, Sweden
(Carlberg) Anestesi och Intensivvard, V SSAI-program in Obstetric
Anaesthesia, Goteborg, Sweden
Publisher
Blackwell Munksgaard
Abstract
Background: Parturients with coexisting diseases such as heart transplant
are becoming increasingly common and pose challenges to anaesthetists. The
aim of this article is to review literature and present a case report.
 Method(s): PubMed was searched for "pregnancy and heart
transplantation"; "heart transplantation and obstetric anesthesia or
anaesthesia" and "heart recipient and obstetric anesthesia or anaesthesia"
and Cochrahne Database of Reviews for "heart transplantation" and
"obstetric anesthesia or anaesthesia". In Cochrahne no literature was
found. In PubMed nine articles were found. Chestnut's and Clark's
textbooks of obstetric anaesthesia was read and references followed up.
 Result(s): In 1988 the first successful pregnancy after heart
transplantation was described, in 1995, 22 known cases were published.
Most of them were successful vaginal deliveries at full-term. Reported
risks to the mothers are cardiovascular and hemodynamical, rejection and
infections. The incidence of hypertension and pre-eclampsia is increased.
Risks to the foetus include preterm birth, small for gestational age and
infection. Anaesthetic management focus on maintaining preload and good
pain relief to reduce afterload. Phenylephrine is recommended, but no
decrease in heart rate will be seen. The response to ephedrine may be
blunt. Atropine will cause no increase in heart rate nor cardiac output.
Oxytocin and metylergometrine should be used, but with care as
unfavourable perfusion-demand situations might arise and no angina will be
described by the patient. ECG-registration is extra important. Misoprostol
and carboprost could be used as normal. Cardiac ultrasound should be
performed before and after the operation. The case report is about a
27-year- old parturient with a heart transplant that during emergency
caesarean section suffered severe bleeding. Conclusion(s): Save
anaesthesia could be provided to parturients with heart transplant even
when complications occur.

<125>
Accession Number
629085092
Title
Mannitol in cardiopulmonary bypass prime solution-a randomized study.
Source
Acta Anaesthesiologica Scandinavica. Conference: 35th Congress for the
Scandinavian Society of Anaesthesiology and Intensive Care Medicine, SSAI
2019. Denmark. 63 (8) (pp e7), 2019. Date of Publication: September 2019.
Author
Skold A.; Ljunggren M.; Dardashti A.; Hyllen S.
Institution
(Skold, Ljunggren, Dardashti, Hyllen) Department of Cardiothoracic
Anesthesia and Intensive care, Skane University Hospital, Lund, Sweden
(Dardashti, Hyllen) Department of Cardiac Surgery, Lund University, Lund,
Sweden
Publisher
Blackwell Munksgaard
Abstract
Background: The optimal prime solution for the cardiopulmonary bypass
(CPB) circuit in adult cardiac surgery has still not been defined.
Mannitol is widely used in the priming solution for CPB despite the fact
that there is no clear consensus on the role of mannitol in cardiac
surgery. The aim of this study was to investigate the effect of mannitol
in the CPB prime solution. Method(s): This prospective, randomized,
double-blind study included 40 patients with normal cardiac and renal
functions, who underwent coronary artery bypass grafting. One group
received 1200 mL of a prime solution based on Ringer's acetate (n = 20),
and the other a prime consisting of 1000 mL Ringer's acetate with 200 mL
mannitol (n = 20). Changes in osmolality, acid-base status, electrolytes
and renal-related parameters were monitored. Result(s): No
significant differences were found in osmolality between the Ringer's
acetate group and the mannitol group at any time. The mannitol group
showed a pronounced decrease in sodium, from 138.7 +/- 2.8 mmol/L at
anesthesia onset, to 133.9 +/- 2.6 mmol/L after the start of CPB (P <
.001). No differences were seen in the renal parameters between the
groups, apart from a short-term effect of mannitol on perioperative urine
production (P = .003). Conclusion(s): We observed no effects on
osmolality of a prime solution containing mannitol compared to Ringer's
acetate based prime in patients with normal cardiac and renal function.
The use of mannitol in the prime resulted in a short term, significant
decrease in sodium level. No clear benefit of including mannitol in the
CPB prime solution could be found. The role of mannitol in cardiac surgery
thus requires further investigation.

<126>
Accession Number
629081323
Title
The use of adenosine stress perfusion cardiac magnetic resonance in
determining incomplete revascularization post-coronary artery bypass
grafting and the importance of anterior septal vessels.
Source
European Heart Journal - Case Reports. 3 (2) (no pagination), 2019. Date
of Publication: 2019.
Author
Le Page P.T.; Bellenger N.G.
Institution
(Le Page, Bellenger) Cardiology Department, Royal Devon and Exeter NHS
Trust, Barrack Road, Exeter EX2 5DW, United Kingdom
Publisher
Oxford University Press
Abstract
Incomplete revascularization post-coronary artery bypass grafting (CABG)
may occur in up to one quarter of patients,1 and metaanalyses
suggest this is associated with poor outcomes.1,2 ESC
guidelines now prioritize complete revascularization when deciding between
CABG or percutaneous coronary intervention (PCI).3 Adenosine
stress perfusion cardiac magnetic resonance (MR) is well suited to
determine the burden and location of ischaemia over and above scar, which
may guide further revascularization after CABG. In our magnetic resonance
experience, patients may receive bypass grafts that inadvertently leave
proximal branches of the main coronary arteries trapped between a distal
bypassed stenosis, and a proximal native stenosis. Copyright ©
The Author(s) 2019.

<127>
Accession Number
2002453876
Title
Association between marfan syndrome and oral health status: A systematic
review and meta-analysis.
Source
Medicina Oral Patologia Oral y Cirugia Bucal. 24 (4) (pp e473-e482), 2019.
Article Number: 23037. Date of Publication: July 2019.
Author
Galletti C.; Camps-Font O.; Teixido-Tura G.; Llobet-Poal I.; Gay-Escoda C.
Institution
(Galletti, Camps-Font) Faculty of Medicine and Health Sciences, University
of Barcelona, Barcelona, Spain
(Teixido-Tura, Llobet-Poal, Gay-Escoda) Department of Cardiology, Hospital
Universitari Vall d'Hebron, University Autonoma de Barcelona, Spain
(Gay-Escoda) EHFRE International University, FUCSO, Spain
(Gay-Escoda) Bellvitge Biomedical Research Institute, Spain
(Gay-Escoda) Oral Surgery, Implantology and Maxillofacial Surgery
Department, Teknon Medical Center, Barcelona, Spain
Publisher
Medicina Oral S.L. (E-mail: jced@jced.es)
Abstract
Background: The purpose was to identify and assess the existing scientific
evidence from epidemiologic, nonexperimental, observational studies of
associations between Marfan's syndrome and oral diseases. Material(s)
and Method(s): Electronic literature searches in MEDLINE (OVID), The
Cochrane Library, Scopus and the Web of Science were conducted to identify
all relevant articles. Eligibility was based on inclusion criteria, and
quality assessments were conducted. The outcome variables were probing
depth, gingival margin, clinical attachment level, bleeding on probing,
gingival status, periodontal status, tooth mobility, furcation involvement
and decayed, missing and filled teeth index. After extracting data,
meta-analyses were carried out. Result(s): Out of 527 potentially
eligible papers, 3 cross-sectional studies were included. No statistically
significant differences were found in the number of sites with bleeding on
probing (OR: 1.26; 95% CI: 0.47 to 3.42; P = 0.65; I2: 0%), probing depth
(MD: -0.14 mm; 95% CI: -0.24 to 0.53; P = 0.46; I2: 93%), periodontal
status (WMD: 0.68 points; 95% CI: -0.48 to 1.83; P = 0.25; I2: 98%) nor
number of decayed, missing and filled teeth index score (MD: 1.08 points.;
95% CI: -1.27 to 3.42; P = 0.37; I2: 0%). Conclusion(s): Patients
diagnosed with Marfan's syndrome do not seem to have worsened oral health
status. Due to the high number of patients with Marfan's syndrome that
have prosthetic heart valves, an adequate dental monitoring as well as a
strict maintenance therapy program should be implemented. Copyright
© Medicina Oral S. L. C.I.F. B.

<128>
Accession Number
2002716122
Title
Clinical Decision Support to Reduce Contrast-Induced Kidney Injury During
Cardiac Catheterization: Design of a Randomized Stepped-Wedge Trial.
Source
Canadian Journal of Cardiology. 35 (9) (pp 1124-1133), 2019. Date of
Publication: September 2019.
Author
James M.T.; Har B.J.; Tyrrell B.D.; Ma B.; Faris P.; Sajobi T.T.; Allen
D.W.; Spertus J.A.; Wilton S.B.; Pannu N.; Klarenbach S.W.; Graham M.M.
Institution
(James, Ma) Department of Medicine, Cumming School of Medicine, University
of Calgary, Calgary, Alberta, Canada
(James, Faris, Sajobi, Wilton) Department of Community Health Sciences,
Cumming School of Medicine, University of Calgary, Calgary, Alberta,
Canada
(James, Har, Sajobi, Wilton) Libin Cardiovascular Institute of Alberta,
Cumming School of Medicine, University of Calgary, Calgary, Alberta,
Canada
(James, Sajobi, Wilton) O'Brien Institute of Public Health, Cumming School
of Medicine, University of Calgary, Calgary, Alberta, Canada
(Har, Wilton) Department of Cardiac Sciences, Cumming School of Medicine,
University of Calgary, Calgary, Alberta, Canada
(Tyrrell, Pannu, Klarenbach, Graham) Department of Medicine, University of
Alberta, Edmonton, Alberta, Canada
(Tyrrell) CK Hui Heart Centre, University of Alberta, Edmonton, Alberta,
Canada
(Faris) Alberta Health Services, Calgary, Alberta, Canada
(Allen) Department of Cardiac Sciences, University of Manitoba, Winnipeg,
Manitoba, Canada
(Spertus) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Graham) Mazankowski Heart Centre, University of Alberta, Edmonton,
Alberta, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Contrast-induced acute kidney injury (CI-AKI) is a common and
serious complication of invasive cardiac procedures. Quality improvement
programs have been associated with a lower incidence of CI-AKI over time,
but there is a lack of high-quality evidence on clinical decision support
for prevention of CI-AKI and its impact on processes of care and clinical
outcomes. Method(s): The Contrast-Reducing Injury Sustained by
Kidneys (Contrast RISK) study will implement an evidence-based
multifaceted intervention designed to reduce the incidence of CI-AKI,
encompassing automated identification of patients at increased risk for
CI-AKI, point-of-care information on safe contrast volume targets,
personalized recommendations for hemodynamic optimization of intravenous
fluids, and follow-up information for patients at risk. Implementation
will use cardiologist academic detailing, computerized clinical decision
support, and audit and feedback. All 31 physicians practicing in all 3 of
Alberta's cardiac catheterization laboratories will participate using a
cluster-randomized stepped-wedge design. The order in which they are
introduced to this intervention will be randomized within 8 clusters. The
primary outcome is CI-AKI incidence, with secondary outcomes of CI-AKI
avoidance strategies and downstream adverse major kidney and
cardiovascular events. An economic evaluation will accompany the main
trial. Conclusion(s): The Contrast RISK study leverages information
technology systems to identify patient risk combined with evidence-based
protocols, audit, and feedback to reduce CI-AKI in cardiac catheterization
laboratories across Alberta. If effective, this intervention can be
broadly scaled and sustained to improve the safety of cardiac
catheterization. Copyright © 2019 The Authors

<129>
Accession Number
2002711426
Title
Meta-Analysis Comparing Transcatheter Aortic Valve Implantation With
Balloon Versus Self-Expandable Valves.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Osman M.; Ghaffar Y.A.; Saleem M.; Kheiri B.; Osman K.; Munir M.B.;
Alkhouli M.
Institution
(Osman, Ghaffar, Saleem, Munir, Alkhouli) Division of Cardiology, West
Virginia University, Morgantown, WV, United States
(Kheiri) Oregon Knight Cardiovascular Institute, Portland, OR, United
States
(Osman) Michigan Health Specialist, Michigan State University, Flint, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Two transcatheter aortic valve systems are currently in use in the United
States; balloon-expandable valves (BEV) and the self-expanding valve
(SEV). However, comparative data outcomes between the 2 systems are
limited, as only one randomized trial (RCT) performed a head-to-head
comparison between BEVs and SEVs. However, there are several RCTs
comparing BEV or SEV to surgical valve replacement. In this analysis, we
used Bayesian network meta-analysis techniques to compare BEVs and SEVs.
The primary outcome was all-cause mortality at maximum follow-up.
Secondary outcomes were cardiovascular mortality, stroke, pacemaker
implantation, reintervention, heart failure hospitalization, and
moderate-severe paravalvular leak (PVL.). Eight RCTs with 8,095 patients
were included. With the exception of less pacemaker implantation in BEV
versus SEV (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.11 to
0.77, I2 = 51%), there was no difference between BEV and SEV in
30-day outcomes. During long-term follow-up (mean 3 +/- 2 years); there
was no difference between BEV and SEV in all-cause mortality (hazard ratio
[HR] 1.1, 95% CI 0.87 to 1.5, I2 = 19.6%), cardiovascular
mortality (HR 1.1, 95% CI 0.73 to 1.6, I2 = 18.5%), stroke (HR
1.3, 95% CI 0.73 to 2.1, I2 = 16.9%), hospitalization (HR 0.87,
95% CI 0.41 to 1.6, I2 = 62%), and reintervention (HR 0.68, 95%
CI 0.2 to 2.3, I2 = 62%). New pacemaker implantation and PVL
were significantly less in BEV group (HR 0.45, 95% CI 0.24 to 0.80,
I2 = 38.2%), and (HR 0.03, 95% CI 0.0004 to 0.28, I2
= 79%), respectively. In conclusion, similar outcomes were seen following
transcatheter aortic valve implantation with BEV and SEV with the
exception of higher rates of pacemaker implantation and PVL in SEV
group. Copyright © 2019 Elsevier Inc.

<130>
Accession Number
2002431288
Title
Percutaneous Coronary Intervention Versus Medical Therapy for Chronic
Total Occlusion of Coronary Arteries: A Systematic Review and
Meta-Analysis.
Source
Current Atherosclerosis Reports. 21 (10) (no pagination), 2019. Article
Number: 42. Date of Publication: 01 Oct 2019.
Author
Li K.H.C.; Wong K.H.G.; Gong M.; Liu T.; Li G.; Xia Y.; Ho J.;
Nombela-Franco L.; Sawant A.C.; Eccleshall S.; Tse G.; Vassiliou V.S.
Institution
(Li, Wong, Tse) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong
(Li, Wong, Ho, Tse) Li Ka Shing Institute of Health Sciences, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong
(Li) Faculty of Medicine, Newcastle University, Newcastle, United Kingdom
(Gong, Liu, Li) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211,
China
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Ho) Department of Microbiology, The Chinese University of Hong Kong, Hong
Kong
(Nombela-Franco) Cardiology Department, Instituto Cardiovascular, Hospital
Clinico San Carlos, IdISSC, Madrid, Spain
(Sawant) Division of Interventional Cardiology, Banner University Medical
Center, Phoenix, AZ, United States
(Eccleshall, Vassiliou) Norfolk and Norwich University Hospital and
Norwich Medical School, University of East Anglia, Norwich, United Kingdom
(Vassiliou) Royal Brompton Hospital and Imperial College London, London,
United Kingdom
(Vassiliou) Bob Champion Research and Education, Second Floor, University
of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Chronic total occlusion (CTO) of the coronary arteries
is a significant clinical problem and has traditionally been treated by
medical therapy or coronary artery bypass grafting. Recent studies have
examined percutaneous coronary intervention (PCI) as an alternative
option. Recent Findings: This systematic review and meta-analysis compared
medical therapy to PCI for treating CTOs. Summary: PubMed and Embase
were searched from their inception to March 2019 for studies that compared
medical therapy and PCI for clinical outcomes in patients with CTOs.
Quality of the included studies was assessed by Newcastle-Ottawa scale.
The results were pooled by DerSimonian and Laird random- or fixed-effect
models as appropriate. Heterogeneity between studies and publication bias
was evaluated by I2 index and Egger's regression, respectively.
Of the 703 entries screened, 17 studies were included in the final
analysis. This comprised 11,493 participants. Compared to PCI, medical
therapy including randomized and observational studies was significantly
associated with higher risk of all-cause mortality (risk ratio (RR) 1.99,
95% CI 1.38-2.86), cardiac mortality (RR 2.36 (1.97-2.84)), and major
adverse cardiac event (RR 1.25 (1.03-1.51)). However, no difference in the
rate of myocardial infarction and repeat revascularization procedures was
observed between the two groups. Univariate meta-regression demonstrated
multiple covariates as independent moderating factors for myocardial
infarction and repeat revascularization but not cardiac death and
all-cause mortality. However, when only randomized studies were included,
there was no difference in overall mortality or cardiac death. In CTO,
when considering randomized and observational studies, medical therapy
might be associated with a higher risk of mortality and myocardial
infarction compared to PCI treatment. Copyright © 2019, The
Author(s).

<131>
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. Copyright ©
2019 Georg Thieme Verlag KG.

<132>
[Use Link to view the full text]
Accession Number
624837633
Title
Fibrinogen concentrate in cardiovascular surgery: A meta-analysis of
randomized controlled trials.
Source
Anesthesia and Analgesia. 127 (3) (pp 612-621), 2018. Date of Publication:
2018.
Author
Li J.-Y.; Gong J.; Zhu F.; Moodie J.; Newitt A.; Uruthiramoorthy L.; Cheng
D.; Martin J.
Institution
(Li) Department of Anesthesiology, Xiangya Hospital, Central South
University, Changsha, Hunan, China
(Li, Gong, Zhu, Moodie, Newitt, Cheng, Martin) Centre for Medical
Evidence, Decision Integrity and Clinical Impact (MEDICI), Department of
Anesthesia and Perioperative Medicine, University of Western Ontario,
London, ON, Canada
(Gong) Department of Anesthesiology, Fuwai Hospital, Chinese Academy of
Medical Sciences, Peking Union Medical College, Beijing, China
(Uruthiramoorthy, Martin) Department of Epidemiology and Biostatistics,
University of Western Ontario, London, ON, Canada
(Cheng, Martin) Department of Anesthesia and Perioperative Medicine,
Schulich School of Medicine and Dentistry, Western University, University
Hospital, Room C3-412, 339 Windermere Rd., London, ON N6A 5A5, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Postoperative bleeding remains a frequent complication after
cardiovascular surgery and may contribute to serious morbidity and
mortality. Observational studies have suggested a relationship between low
endogenous plasma fibrinogen concentration and increased risk of
postoperative blood loss in cardiac surgery. Although the transfusion of
fibrinogen concentrate has been increasing, potential benefits and risks
associated with perioperative fibrinogen supplementation in cardiovascular
surgery are not fully understood. METHOD(S): PubMed, Cochrane
Library, Ovid MEDLINE, Embase, Web of Science, and China National
Knowledge Infrastructure were searched on January 15, 2017, with automated
updates searched until February 15, 2018, to identify all randomized
controlled trials (RCTs) of fibrinogen concentrate, whether for
prophylaxis or treatment of bleeding, in adults undergoing cardiovascular
surgery. All RCTs comparing fibrinogen infusion versus any other
comparator (placebo/standard of care or another active comparator) in
adult cardiovascular surgery and reporting at least 1 predefined clinical
outcome were included. The random-effects model was used to calculate risk
ratios and weighted mean differences (95% confidence interval [CI]) for
dichotomous and continuous variables, respectively. Subgroup analyses by
fibrinogen dose and by baseline risk for bleeding were preplanned.
 RESULT(S): A total of 8 RCTs of fibrinogen concentrate in adults (n =
597) of mixed risk or high risk undergoing cardiovascular surgery were
included. Compared to placebo or inactive control, perioperative
fibrinogen concentrate did not significantly impact risk of all-cause
mortality (risk ratio, 0.41; 95% CI, 0.12-1.38; I2 = 10%; P
=.15). Fibrinogen significantly reduced incidence of allogeneic red blood
cell transfusion (risk ratio, 0.64; 95% CI, 0.49-0.83; I2 = 0%;
P =.001). No significant differences were found for other clinical
outcomes. Subgroup analyses were unremarkable when analyzed according to
fibrinogen dose, time of infusion initiation, mean cardiopulmonary bypass
time, and rotational thromboelastometry/fibrinogen temogram use (all P
values for subgroup interaction were nonsignificant). CONCLUSION(S):
Current evidence remains insufficient to support or refute routine
perioperative administration of fibrinogen concentrate in patients
undergoing cardiovascular surgery. Fibrinogen concentrate may reduce the
need for additional allogeneic blood product transfusion in cardiovascular
surgery patients at high risk or with evidence of bleeding. However, no
definitive advantage was found for reduction in risk of mortality or other
clinically relevant outcomes. The small number of clinical events within
existing randomized trials suggests that further well-designed studies of
adequate power and duration to measure all-cause mortality, stroke,
myocardial infarction, reoperation, and thromboembolic events should be
conducted. Future studies should also address cost-effectiveness relative
to standard of care. Copyright © 2018 International Anesthesia
Research Society.

<133>
Accession Number
2000990587
Title
Patient-Controlled Paravertebral Block for Video-Assisted Thoracic
Surgery: A Randomized Trial.
Source
Annals of Thoracic Surgery. 106 (3) (pp 888-894), 2018. Date of
Publication: September 2018.
Author
Wu Z.; Fang S.; Wang Q.; Wu C.; Zhan T.; Wu M.
Institution
(Wu, Fang, Wang, Zhan, Wu) Department of Thoracic Surgery, the Second
Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou,
China
(Wu) Department of Medical Quality Management, the Women's Hospital,
Zhejiang University School of Medicine, Hangzhou, China
Publisher
Elsevier USA
Abstract
Background: Paravertebral block (PVB) has been proven to be an efficient
way to control postoperative pain in patients who have undergone a
thoracotomy. This study explored whether the use of a patient-controlled
PVB can provide benefits over intravenous patient-controlled analgesia
(PCA) for 3-port single-intercostal video-assisted thoracic surgery.
 Method(s): From May 2015 to December 2016, patients who had solitary
pulmonary nodules or spontaneous pneumothorax and underwent
single-intercostal video-assisted thoracic surgery were randomly allocated
to receive patient-controlled PVB or intravenous PCA. Intramuscular
dezocine (10 mg) was used as a rescue medication. None of the surgeons,
patients, or investigators assessing outcomes or analyzing the data were
blinded to the group assignments. Pain level was measured by the visual
analog score. Result(s): There were 86 patients assigned to the PVB
group and 85 patients assigned to the PCA group. The difference in the
mean visual analog score between these two groups was not significant (p =
0.115). For patients who needed rescue medication, the cumulative dezocine
dose in the PVB group was significantly lower than that in the PCA group
(21.7 mg vs 30.9 mg, p = 0.001) throughout the 4 postoperative days. The
frequencies of severe vomiting (p = 0.003) and hypotension (p = 0.005)
were significantly lower in the PVB group. Conclusion(s): PVB, which
resulted in lower cumulative dezocine doses and produced fewer side
effects than PCA, can provide effective pain relief for patients
undergoing video-assisted thoracic surgery. Copyright © 2018 The
Society of Thoracic Surgeons

<134>
Accession Number
2001007544
Title
Is the Venner-PneuX Endotracheal Tube System a Cost-Effective Option for
Post Cardiac Surgery Care?.
Source
Annals of Thoracic Surgery. 106 (3) (pp 757-763), 2018. Date of
Publication: September 2018.
Author
Andronis L.; Oppong R.A.; Manga N.; Senanayake E.; Gopal S.; Charman S.;
Giri R.; Luckraz H.
Institution
(Andronis) Population, Evidence and Technologies Group, Division of Health
Sciences, University of Warwick, Coventry, United Kingdom
(Oppong) Health Economics Unit, Institute of Applied Health Research,
University of Birmingham, Birmingham, United Kingdom
(Manga) RTI Health Solutions, Manchester, United Kingdom
(Senanayake, Luckraz) Cardiothoracic Surgery, Heart and Lung Centre, New
Cross Hospital, Wolverhampton, United Kingdom
(Gopal) Intensive Care Unit, New Cross Hospital, Wolverhampton, United
Kingdom
(Charman) Department of Health Services Research & Policy, London School
of Hygiene and Tropical Medicine, London, United Kingdom
(Giri) Cardiothoracic Anaesthesiology, Heart and Lung Centre, New Cross
Hospital, Wolverhampton, United Kingdom
Publisher
Elsevier USA
Abstract
Background: Ventilator-associated pneumonia (VAP) is common and costly. In
a recent randomized controlled trial, the Venner-PneuX (VPX) endotracheal
tube system (Qualitech Healthcare Limited, Maidenhead, United Kingdom) was
found to be superior to standard endotracheal tubes (SET) in preventing
VAP. However, VPX is considerably more expensive. We evaluated the costs
and benefits of VPX to determine whether replacing SET with VPX is a
cost-effective option for intensive care units. Method(s): We
developed a decision analytic model to compare intubation with VPX or SET
for patients requiring mechanical ventilation after cardiac operations.
The model was populated with existing evidence on costs, effectiveness,
and quality of life. Cost-effectiveness and cost-utility analyses were
conducted from a National Health Service hospital perspective. Uncertainty
was assessed through deterministic and probabilistic sensitivity analyses.
 Result(s): Compared with SET, VPX is associated with an expected cost
saving of 738 per patient. VPX led to a small increase in quality-adjusted
life years, indicating that the device is overall less costly and more
effective than SET. The probability of VPX being cost-effective at 30,000
per quality-adjusted life year is 97%. VPX would cease to be
cost-effective if (1) it led to a risk reduction smaller than 0.02
compared with SET, (2) the acquisition cost of VPX was as high as 890, or
(3) the cost of treating a case of VAP was lower than 1,450.
 Conclusion(s): VPX resulted in improved outcomes and savings that far
offset the cost of the device, suggesting that replacing SET with VPX is
overall beneficial. Findings were robust to extreme values of key
variables. Copyright © 2018 The Society of Thoracic Surgeons

<135>
Accession Number
2001007539
Title
Surgical Management of Tricuspid Valve Infective Endocarditis: A
Systematic Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 106 (3) (pp 708-714), 2018. Date of
Publication: September 2018.
Author
Yanagawa B.; Elbatarny M.; Verma S.; Hill S.; Mazine A.; Puskas J.D.;
Friedrich J.O.
Institution
(Yanagawa, Elbatarny, Verma, Hill, Mazine) Division of Cardiac Surgery,
St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai Hospital, New
York, New York, United States
(Friedrich) Department of Critical Care and Medicine, St. Michael's
Hospital, University of Toronto, Toronto, Ontario, Canada
Publisher
Elsevier USA
Abstract
Background: This meta-analysis compares the early and late outcomes of
valve repair versus replacement, the primary surgical strategies for
tricuspid valve infective endocarditis (IE). Method(s): We searched
MEDLINE and EMBASE databases until 2016 for studies comparing tricuspid
valve repair and replacement. Result(s): The main outcomes were
mortality, recurrent IE, and need for reoperation. There were 12 unmatched
retrospective observational studies with 1,165 patients (median follow-up
3.8 years, interquartile range: 2.1 to 5.0). The most common indications
for surgery were septic pulmonary embolism, left-sided IE, right-side
heart failure, and persistent bacteremia. Median repair proportion was 59%
and replacement was 41% among studies. The primary repair strategies are
vegetectomy, De Vega procedure, annuloplasty ring, bicuspidization, and
leaflet patch augmentation. Of valve replacements, 83% were bioprosthetic
and 17% mechanical prostheses. There were no differences in perioperative
mortality between tricuspid valve repair versus replacement (relative risk
[RR] 0.62, 95% confidence interval [CI]: 0.26 to 1.46, p = 0.3). Long-term
all-cause mortality was not different (RR 0.61, 95% CI: 0.22 to 1.72, p =
0.4). Valve repair was associated with lower recurrent IE (RR 0.17, 95%
CI: 0.05 to 0.57, p = 0.004) and need for reoperation (RR 0.26, 95% CI:
0.07 to 0.92, p = 0.04) but a trend toward greater risk of moderate to
severe tricuspid regurgitation (RR 4.14, 95% CI: 0.80 to 21.34, p = 0.09).
Furthermore, tricuspid valve repair is associated with lower need for
permanent pacemaker (RR 0.20, 95% CI: 0.11 to 0.35, p < 0.001).
 Conclusion(s): Tricuspid valve repair and replacement offer similar
long-term survival. Valve repair may offer greater freedom from recurrent
IE and reoperation as well as freedom from pacemaker and should be the
preferred approach for patients with tricuspid valve IE. Copyright
© 2018 The Society of Thoracic Surgeons

<136>
[Use Link to view the full text]
Accession Number
627081063
Title
Resuscitation of endotheliopathy and bleeding in thoracic aortic
dissections: The VIPER-OCTA randomized clinical pilot trial.
Source
Anesthesia and Analgesia. 127 (4) (pp 920-927), 2018. Date of Publication:
2018.
Author
Stensballe J.; Ulrich A.G.; Nilsson J.C.; Henriksen H.H.; Olsen P.S.;
Ostrowski S.R.; Johansson P.I.
Institution
(Stensballe, Henriksen, Ostrowski, Johansson) Section for Transfusion
Medicine, Capital Region Blood Bank, Copenhagen University Hospital,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Stensballe) Department of Anesthesia, Centre of Head and Orthopedics,
Copenhagen University Hospital, Copenhagen, Denmark
(Ulrich, Nilsson) Departments of Cardiothoracic Anesthesia, Copenhagen
University Hospital, Copenhagen, Denmark
(Olsen) Departments of Cardiothoracic Surgery, Heart Centre, Copenhagen
University Hospital, Copenhagen, Denmark
(Johansson) Division of Acute Care Surgery, University of Texas, Medical
School at Houston, Houston, TX, United States
(Johansson) Center for Systems Biology, School of Engineering and Natural
Sciences, University of Iceland, Reykjavik, Iceland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Thoracic aorta dissection is an acute critical condition
associated with shockinduced endotheliopathy, coagulopathy, massive
bleeding, and significant morbidity and mortality. Our aim was to compare
the effect of coagulation support with solvent/detergent-treated pooled
plasma (OctaplasLG) versus standard fresh frozen plasma (FFP) on
glycocalyx and endothelial injury, bleeding, and transfusion requirements.
 METHOD(S): Investigator-initiated, single-center, blinded, randomized
clinical pilot trial of adult patients undergoing emergency surgery for
thoracic aorta dissection. Patients were randomized to receive OctaplasLG
or standard FFP as coagulation factor replacement related to bleeding. The
primary outcome was glycocalyx and endothelial injury. Other outcomes
included bleeding, transfusions and prohemostatics at 24 hours, organ
failure, length of stay in the intensive care unit and in the hospital,
safety, and mortality at 30 and 90 days. RESULT(S): Fifty-seven
patients were included to obtain 44 evaluable on the primary outcome. The
OctaplasLG group displayed significantly reduced damage to the endothelial
glycocalyx (syndecan- 1) and reduced endothelial tight junction injury
(sVE-cadherin) compared to standard FFP. In the OctaplasLG group compared
to the standard FFP, days on ventilator (1 day [interquartile range, 0-1]
vs 2 days [1-3]; P = .013), bleeding during surgery (2150 [1600-3087] vs
2750 [2130-6875]; P = .046), 24-hour total transfusion and platelet
transfusion volume (3975 mL [2640-6828 mL] vs 6220 mL [4210-10,245 mL]; P
= .040, and 1400 mL [1050-2625 mL] vs 2450 mL [1400-3500 mL]; P = .027),
and goal-directed use of prohemostatics (7/23 [30.4%] vs 13/21 [61.9%]; P
= .036) were all significantly lower. Among the 57 patients randomized,
30-day mortality was 20.7% (6/29) in the OctaplasLG group and 25% (7/28)
in the standard FFP group (P = .760). No safety concern was raised.
 CONCLUSION(S): In this randomized, clinical pilot trial of patients
undergoing emergency surgery for thoracic aorta dissections, we found that
OctaplasLG reduced glycocalyx and endothelial injury, reduced bleeding,
transfusions, use of prohemostatics, and time on ventilator after surgery
compared to standard FFP. An adequately powered multicenter trial is
warranted to confirm the clinical importance of the
findings. Copyright © 2018 The Author(s).

<137>
Accession Number
623487362
Title
ABO-incompatible kidney transplant outcomes: A meta-analysis.
Source
Clinical Journal of the American Society of Nephrology. 13 (8) (pp
1234-1243), 2018. Date of Publication: 07 Aug 2018.
Author
de Weerd A.E.; Betjes M.G.H.
Institution
(de Weerd, Betjes) Department of Nephrology and Kidney Transplantation,
Erasmus Medical Center, Rotterdam, Netherlands
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Background and objectives ABO blood group-incompatible kidney
transplantation is considered a safe procedure, with noninferior outcomes
in large cohort studies. Its contribution to living kidney transplantation
programs is substantial and growing. Outcomes compared with center-matched
ABO blood group-compatible control patients have not been ascertained.
Design, setting, participants, & measurements Comprehensive searches were
conducted in Embase, Medline, Cochrane, Web-of-Science, and Google
Scholar. Meta-analyses Of Observational Studies in Epidemiology study
guidelines for observational studies and Newcastle Ottawa bias scale were
implemented to assess studies. Meta-analysis was performed using Review
Manager 5.3. A subgroup analysis on antibody removal technique was
performed. Results After identifying 2728 studies addressing
ABO-incompatible kidney transplantation, 26 studies were included,
describing 1346 unique patients who were ABO-incompatible and 4943
ABO-compatible controls. Risk of bias was low (all studies >=7 of 9
stars). Baseline patient characteristics revealed no significant
differences in immunologic risk parameters. Statistical heterogeneity of
studies was low (I2 0% for graft and patient survival).
One-year uncensored graft survival of patients who were ABO-incompatible
was 96% versus 98% in ABO compatible controls (relative risk, 0.97; 95%
confidence interval, 0.96 to 0.98; P<0.001). Forty-nine percent of
reported causes of death in patients who were ABO-incompatible were of
infectious origin, versus only 13% in patients who were ABO-compatible
(P=0.02). Antibody-mediated rejection (3.86; 95%confidence interval, 2.05
to 7.29; P<0.001), severe nonviral infection (1.44; 95%confidence
interval, 1.13 to 1.82; P=0.003), and bleeding (1.92; 95%confidence
interval, 1.36 to 2.72; P<0.001) were also more common after
ABO-incompatible transplantation. Conclusions ABO-incompatible kidney
transplant recipients have good outcomes, albeit inferior to center
matched ABO-compatible control patients. Copyright © 2018 by the
American Society of Nephrology.

<138>
Accession Number
2001039483
Title
A Systemic Review and Meta-Analysis of Sutureless Aortic Valve Replacement
Versus Transcatheter Aortic Valve Implantation.
Source
Annals of Thoracic Surgery. 106 (3) (pp 924-929), 2018. Date of
Publication: September 2018.
Author
Shinn S.H.; Altarabsheh S.E.; Deo S.V.; Sabik J.H.; Markowitz A.H.; Park
S.J.
Institution
(Shinn) Department of Thoracic and Cardiovascular Surgery, Cheju Halla
General Hospital, Jeju, Republic of Korea, South Korea
(Altarabsheh) Department of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Deo, Sabik, Markowitz, Park) Division of Cardiac Surgery, Harrington
Heart and Vascular Institute, Case Western University Hospital, Cleveland,
Ohio, United States
Publisher
Elsevier USA
Abstract
Background: Sutureless aortic valve replacement (SU-AVR) and transcatheter
aortic valve implantation (TAVI) are increasingly adopted methods to treat
high-risk patients with severe aortic valve stenosis. We conducted a
systematic review and meta-analysis to compare the clinical outcomes
between these two recent methods to treat aortic valve disease.
 Method(s): We systematically searched multiple databases (January
2000 to October 2016) to identify original studies comparing clinical
outcome between SU-AVR and TAVI. End points studied were early mortality,
development of paravalvular leak, early stroke, bleeding events, and the
need for pacemaker insertion. A random-effect inverse-variance weighted
analysis was performed. Event rates were compared as odds ratio (OR) and
95% confidence interval (CI). Result(s): The meta-analysis included
seven observational studies comprising 617 SU-AVR and 621 TAVI patients.
Early mortality was 2.5% and 5% in the SU-AVR and TAVI cohorts,
respectively (OR, 0.52; 95% CI, 0.30 to 0.90; p = 0.02; I2 =
2%). Postprocedural significant paravalvular leak was much lower after
SU-AVR (OR, 0.18l; 95% CI, 0.11 to 0.30; p < 0.0001). Postprocedural
stroke (OR, 0.71; 95% CI, 0.24 to 2.08; p = 0.53) and the need for
pacemaker insertion (OR, 0.884; 95% CI, 0.364 to 2.18; p = 0.7) were
comparable between the two cohorts. Conclusion(s): Our meta-analysis
of observational studies demonstrates that early mortality is lower after
SU-AVR than after TAVI in selected patients. The rates of stroke and
pacemaker implant are comparable between procedures; however, the
incidence of paravalvular leak is higher after TAVI. Copyright ©
2018 The Society of Thoracic Surgeons

<139>
Accession Number
614111733
Title
Impact of Oral Chlorhexidine on Bloodstream Infection in Critically Ill
Patients: Systematic Review and Meta-Analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 2236-2244),
2017. Date of Publication: December 2017.
Author
Silvestri L.; Weir W.I.; Gregori D.; Taylor N.; Zandstra D.F.; van Saene
J.J.M.; van Saene H.K.F.
Institution
(Silvestri) Department of Anaesthesia and Intensive Care, S. Giovanni di
Dio Hospital, Gorizia, Italy
(Silvestri, Taylor, van Saene, van Saene) Institute of Ageing and Chronic
Disease, University of Liverpool, Liverpool, UK, United Kingdom
(Weir) Department of Cardiothoracic Surgery, London Chest Hospital,
London, UK, United States
(Gregori) Department of Cardiological, Thoracic and Vascular Sciences,
Unit of Biostatistics Epidemiology and Public Health, University of
Padova, Padova, Italy
(Zandstra) University of Amsterdam, Amsterdam, Netherlands
Publisher
W.B. Saunders
Abstract
Objectives Oropharyngeal overgrowth of microorganisms in the critically
ill is a risk factor for lower respiratory tract infection and subsequent
invasion of the bloodstream. Oral chlorhexidine has been used to prevent
pneumonia, but its effect on bloodstream infection never has been assessed
in meta-analyses. The authors explored the effect of oral chlorhexidine on
the incidence of bloodstream infection, the causative microorganism, and
on all-cause mortality in critically ill patients. Design Systematic
review and meta-analysis of published studies. Setting Intensive care
unit. Participants The study comprised critically ill patients receiving
oral chlorhexidine (test group) and placebo or standard oral care (control
group). Interventions PubMed and the Cochrane Register of Controlled
Trials were searched. Odds ratios (ORs) were pooled using the
random-effects model. Measurements and Main Results Five studies including
1,655 patients (832 chlorhexidine and 823 control patients) were
identified. The majority of information was from studies at low or unclear
risk bias; 1 study was at high risk of bias. Bloodstream infection and
mortality were not reduced significantly by chlorhexidine (OR 0.74; 95%
confidence interval [CI] 0.37-1.50 and OR 0.69; 95% CI 0.31-1.53,
respectively). In the subgroup of surgical, mainly cardiac, patients,
chlorhexidine reduced bloodstream infection (OR 0.47; 95% CI 0.22-0.97).
Chlorhexidine did not affect any microorganism significantly. Conclusion
In critically ill patients, oropharyngeal chlorhexidine did not reduce
bloodstream infection and mortality significantly and did not affect any
microorganism involved. The presence of a high risk of bias in 1 study and
unclear risk of bias in others may have affected the robustness of these
findings. Copyright © 2016 Elsevier Inc.

<140>
Accession Number
604918312
Title
Ezetimibe added to statin therapy after acute coronary syndromes.
Source
New England Journal of Medicine. 372 (25) (pp 2387-2397), 2015. Date of
Publication: 18 Jun 2015.
Author
Cannon C.P.; Blazing M.A.; Giugliano R.P.; McCagg A.; White J.A.; Theroux
P.; Darius H.; Lewis B.S.; Ophuis T.O.; Jukema J.W.; De Ferrari G.M.;
Ruzyllo W.; De Lucca P.; Im K.; Bohula E.A.; Reist C.; Wiviott S.D.;
Tershakovec A.M.; Musliner T.A.; Braunwald E.; Califf R.M.; Musliner T.;
Tershakovec A.; Gurfinkel E.; Aylward P.; Tonkin A.; Maurer G.; Van de
Werf F.; Nicolau JC.; Genest J.; Armstrong P.; Corbalan R.; Isaza D.;
Spinar J.; Grande P.; Voitk J.; Bassand JP.; Farnier M.; Keltai M.; Mathur
A.; Mittal S.; Reddy K.; White H.; Pedersen T.; Britto F.; Carrageta M.;
Duris T.; Dalby A.; Seung KB.; Lopez-Sendon J.; Dellborg M.; Mach F.;
Guneri S.; Parkhomenko A.; Brady A.; Ballantyne C.; de Lemos J.; Kleiman
N.; McGuire DK.; Centeno E.; Casalins M.; Cartasegna L.; Beltrano MC.;
Guerrero R.; Fanuele M.; Berra F.; Egido J.; Colombo H.; Dellatorre M.;
Terns P.; Blumberg E.; Reges P.; Azize G.; Ramos H.; Fernandez R.;
Carlessi C.; Milesi R.; Schmuck R.; Duronto E.; Procopio G.; Carlevaro O.;
Maffeo H.; Beloscar J.; Viso M.; Hominal M.; Castoldi M.; Bluguermann J.;
Mauro D.; Macin S.; Cocco N.; Ruiz N.; Ricart J.; Lozada A.; Nani S.;
Turri D.; Fernandez H.; Caruso O.; Zarandon R.; Bono J.; Arias V.; Allall
O.; Marino J.; Cusimano S.; Schygiel P.; Buzetti C.; Penaloza N.; Berli
M.; Worthley S.; Roach A.; Chew D.; Wright T.; Leitch J.; Hicks E.; Rankin
J.; Venn-Edmonds C.; Lehman R.; Morrison H.; Shaw J.; Mak V.; Hii C.;
Smith K.; Cross D.; Lilwall L.; Nelson G.; Loxton A.; Horowitz J.; Rose
J.; Steinwender C.; Leisch F.; Kammler J.; Brussee H.; Zweiker R.; Niederl
E.; Weihs W.; Giorgio G.; Lang I.; Drexel H.; Zanolin D.; Hoppe U.;
Atzenhofer-Baumgartner K.; Pichler M.; Hainzer D.; Eber B.; Pichler F.;
Foeger B.; Wechselberger T.; Mayr H.; Hofer J.; Stockenhuber F.; Warlits
B.; Huber K.; Egger F.; Weidinger F.; Ziegler B.; Jirak P.; Metzler B.;
Pachinger O.; Wanitschek M.; Auer J.; Grabscheit G.; Podczeck-Schweighofer
A.; Priesnitz T.; Frank H.; El Allaf D.; Marechal P.; Roosen J.; Joly E.;
Lefebvre P.; Arend C.; Sinnaeve P.; De Velder L.; Hellemans S.;
Vanhauwaert B.; Van Dorpe A.; Heyse A.; Vantomme C.; Striekwold H.; Van
Den Broeck D.; Lancellotti P.; Schoors D.; Lemoine I.; Taeymans Y.; De
Wolf L.; Brike C.; Vercauteren S.; Tahon S.; Vervoort G.; Mestdagh I.;
Pirenne B.; Cardinal F.; Lips S.; Dujardin K.; Debrouwer K.; Dhooghe G.;
Holvoet G.; van de Borne P.; Renard M.; De Clippel M.; Lesseliers H.; Van
Miert N.; Saraiva J.; Vicente C.; Rossi P.; Dos Santos LB.; Duda N.;
Tognon AP.; Serrano C.; Gomes FL.; Manenti ER.; Silveira DS.; Maia L.;
Mouco OM.; Paiva M.; Antonangelo A.; de Souza J.; Lino EA.; Leaes P.;
Blacher MG.; Kormann A.; Ultramari FT.; Dutra O.; Mendelski AM.; Morgado
S.; Ardito W.; Greque G.; Ardito RV.; Pimentel Filho P.; Zucchetti C.;
Alves A.; Seabra AM.; Mattos M.; Miranda LF.; Silva D.; Uehara RM.; Marin
Neto J.; Schmidt A.; Braga J.; Rodrigues A.; Abrantes J.; Pinheiro L.;
Bodanese L.; Magedanz E.H.; Piegas L.; Dos Santos ES.; Wainstein M.;
Ribeiro J.; Stein R.; Marino R.; Machado VM.; Moraes Junior J.; Guimaraes
S.; da Costa FA.; Ferraz RF.; Albuquerque D.; Rocha RM.; de Carvalho
Moreira R.; Dohmann H.; Costantini C.; Tarastchuk JC.; Coelho O.; Cirillo
W.; Sousa A.; Almeira AS.; Stefanini E.; Silva F.; Teixeira M.; da Cunha
C.; Precoma D.; Facchi TL.; Rupka D.; Thiessen S.; Warnica J.; Smith B.;
Della Siega A.; Klinke P.; Nelson S.; Dion D.; Gilbert N.; Hui W.; Kvill
L.; Sussex B.; Luther A.; Dupuis R.; Ouimet F.; Pandey A.; Clarus S.;
Senaratne M.; Ferdinandis H.; Mukherjee A.; Bozek B.; Vizel S.; Markov G.;
Zimmermann R.; Stephens W.; Tremblay B.; Wong G.; Uchida N.; Brossoit R.;
Peck C.; Van Kieu C.; Forgione M.; Bata I.; Cossett J.; Kostuk W.; Arnold
M.; Bone C.; Grondin F.; Bilodeau N.; Gosselin G.; David M.; Giannoccaro
J.; Beresford P.; Polasek P.; Roberts P.; Doucet M.; Beaudry M.; Cheung
S.; Cleveland T.; Bhargava R.; McCallum A.; Ma P.; Morrissette J.;
Cleveland D.; Chadwyn D.; Nigro F.; Weeks A.; Cryderman C.; Leader R.;
Houde G.; Rousseau S.; Pearce M.; Radyk M.; Lonn E.; Magi A.; Lefkowitz
C.; Sandrin F.; Coffin N.; Lubelsky B.; Coldwell J.; Habot J.; McPherson
C.; De Larochelliere R.; Roy M.; Haichin R.; Barber C.; Bhesania T.;
Kitagawa H.; To T.; Donnelly B.; Tymchak W.; Harris L.; Kouz S.; Huynh T.;
St Jacques B.; Lamy A.; Rizzo A.; Stein J.; Childs C.; Wong B.; Poirier
R.; Gupta M.; Dela Cruz C.; Constance C.; Gauthier M.; Ervin F.; Ouellette
M.; Kokis A.; Lemay C.; Kwok K.; Leung C.; Lee D.; Nesmith J.; Renton J.;
Syan G.; Turek M.; Hogan D.; Griffin P.; Lipson A.; Winestock J.; Abramson
B.; Fogel A.; Gagne C.; Bergeron J.; Clarke A.; Slipp S.; Darcel I.;
Carling-Chambers L.; Kannampuzha P.; Pallie S.; Krekorian S.; Vertes G.;
Roth S.; Lai K.; Heath J.; Arriagada G.; Castro P.; Villa F.; Ramos G.;
Baraona F.; Nunez A.; Garcia M.; Jofre C.; Silva P.; Lamich R.; Yovaniniz
P.; Escobar E.; Dussaubat A.; Segura E.; Ramirez M.; Lapostol C.; Palma
A.; Encina L.; Zapata M.; Baeza N.; Varela P.; Perez L.; Jaramillo C.;
Ruiz S.; Sanchez G.; Perdomo I.; Manzur F.; Cohen LE.; Velasquez J.; Arana
C.; Alvarez Y.; Triana M.; Balaguera J.; de Salazar D.; Rendon N.; Botero
R.; Ruiz A.; Saaibi J.; Medina J.; Jaramillo M.; Calderon M.J.; Delgado
J.; Bohorquez R.; Medina MF.; Herrera M.; Rosales D.; Mendoza F.; Martinez
S.; Ternera A.; Castro R.; Baiz A.; Martinez M.; Orozco A.; Suarez M.;
Fonseca Y.; Beltran R.; Cepeda M.; Jaramillo N.; Valenzuela C.; Gutierrez
M.; Sanchez A.; Vitovec J.; Hlinomaz O.; Poloczek M.; Mayer O.; Veselka
J.; Vejvoda J.; Soucek M.; Spac J.; Novobilsky K.; Srp V.; Francek L.;
Branny M.; Sknouril L.; Motovska Z.; Rohac F.; Stankova A.; Fiala T.;
Holub M.; Zeman K.; Pohludkova L.; Pospisilova E.; Tuma P.; Cihalik C.;
Oral I.; Podpera I.; Stepanovova R.; Uricar M.; Solar M.; Pelouch R.;
Porzer M.; Grussmannova K.; Stipal R.; Reichert P.; Hradec J.; Kral J.;
Sejkova B.; Janek B.; Pitha J.; Linhart A.; Polacek P.; Koeber L.;
Clemmensen P.; Hebin CH.; Schmidt E.; Pedersen MS.; Roseva-Nielsen N.;
Kristensen K.; Bang-Hansen T.; Jensen J.; Laage-Petersen J.; Nielsen H.;
Stokholm E.; Thayssen P.; Cappelen H.; Jensen T.; Winther-Friis B.;
Klausen I.; Hedegaard B.; May O.; Andersen M.; Bottzauw J.; Lush A.;
Markenvard J.; Vestager KM.; Bronnum-Schou J.; Hempel H.; Petersen J.;
Nielsen AJ.; Thomsen K.; Nielsen T.; Nygaard A.; Sykulski R.; Jensen BS.;
Ralfkiaer N.; Gottschalck H.; Rasmussen S.; Pedersen LR.; Dodt K.;
Skovsbol M.; Andersen O.; Tuxen C.; Meier AW.; Kristensen T.; Rasmussen
O.; Lopez J.; Salazar D.; Sanchez L.; Rosero F.; Penaherrera E.; Duarte
YC.; Marmol R.; Andrade G.; Guzman E.; Morillo A.; Aug L.; Loogna I.;
Laanmets P.; Mustonen J.; Mantyla P.; Kesaniemi A.; Ukkola O.; Kervinen
H.; Juhela S.; Juvonen J.; Toppinen A.; Jarvenpaa J.; Syvanne M.; Svahn
T.; Voutilainen S.; Huotari A.; Nikkila M.; Raiskinmaki S.; Kotila M.;
Rajala A.; Laukkanen J.; Hiltunen P.; Melin J.; Nyman K.; Luukkonen J.;
Kosonen P.; Huttunen M.; Seppanen V.; Airaksinen J.; Juonala M.; Lehto S.;
Savolainen K.; Halkosaari M.; Sia J.; Palomaki A.; Luoma J.; Utriainen S.;
Valpas S.; Tiensuu T.; Lilleberg J.; Kainulainen R.; Schiele F.; Bassand
J.; Meneveau N.; Galinier M.; Jean M.; Martelet M.; Mouallem J.; Elbaz M.;
Puel J.; Carrie D.; Coisne D.; Varroud-Vial N.; Jaboureck O.; Dujardin J.;
Leroy F.; Mansourati J.; Funck F.; Jourdain P.; Guillard N.; Coviaux F.;
Gay A.; Dourmap-Collas C.; Froger-Bompas C.; Paillard F.; Tricot O.;
Maquin-Mavier I.; Dubois-Rande J.L.; Pongas D.; Paris AP.; Delahaye F.;
Ovize M.; Benyahya L.; Bonnet J.; Belle L.; Mangin L.; Lafitte B.; Zemour
G.; Doux N.; Agraou B.; El Mansour N.; Traisnel G.; El Jarroudi M.;
Ohlmann P.; Diadema B.; Escande M.; Legros G.; Demarcq JM.; Haftel Y.;
Alsagheer S.; Dambrine P.; Cottin Y.; Ghostine S.; Caussin C.; Gacem A.;
Bouvier JM.; Poulard J.; Davy J.; Furber A.; Prunier F.; Muenzel T.;
Genth-Zotz S.; Appel K.; Kretzschmar D.; Ferrari M.; Terres W.; Uher T.;
Schulze H.; Ochs H.; Morbach S.; Duengen H.; Gross M.; Oezcelik C.;
Tahirovic E.; Heuer H.; Laschewski B.; Kadel C.; Rahn G.; Steiner S.;
Kreuzer J.; Tsoy I.; Zeiher A.; Muegge A.; Hanefeld C.; Boehm S.; Boudriot
E.; Hodenberg E.; Lippe B.; Hausdorf C.; Sydow K.; Baldus S.; Schlesner
C.; Tiroch K.; Haltern G.; Guelker H.; Wilhelm J.; Dietz S.; Ebelt H.;
Buerke M.; Rupprecht H.; Rittgen J.; Schaeufele T.; Meinhardt G.; Schieber
M.; Honold M.; Sieprath S.; Nienaber C.; Hacker J.; Butter C.; Lapp H.;
Hirn S.; Pauschinger M.; Zahn R.; Scheffler U.; Schaefer A.; Schieffer B.;
Tebbe U.; Kriete M.; Mudra H.; Raeder T.; Braun P.; Zeymer U.; Kouraki K.;
Reppel M.; Schunkert H.; Weil J.; Olbrich H.; Schwaiger P.; Mueller O.;
Blessing E.; Buss I.; Bohlscheid V.; Kaddatz J.; Skowasch D.; Nickenig G.;
Twelker K.; Osterhues H.; Varghese T.; Burghard S.; Kaeaeb S.; Klauss V.;
Sohn HY.; Hauptmann K.; Schulze M.; Gall K.; Felix S.; Doerr M.; Mante J.;
Gulba D.; Freick M.; Werner G.; Kleinertz K.; Hobbach HP.; Halbach M.;
Mueller-Ehmsen J.; Mueller ME.; Mitrovic V.; Peil A.; Laufs U.; vom Dahl
J.; Baumanns S.; Scholtz W.; Wiemer M.; Haude M.; Van de Loo A.; Pistorius
K.; Schaefer J.; Schwinger R.; Goeing O.; Jung W.; Birkemeyer R.; Lee W.;
Kong S.; Yu C.; Chui K.; Merkely B.; Szelenyi Z.; Polgar P.; Svab S.;
Herczeg B.; Bajcsi E.; Vertes A.; Davidovits S.; Nagy A.; Kiraly C.;
Lupkovics G.; Kenez A.; Poor F.; Takacs J.; Kirschner R.; Simonyi G.;
Koncz J.; Edes I.; Gergely S.; Katona A.; Nagy E.; Kovacs Z.; Gyetvai I.;
Salamon C.; Kolman E.; Sitkei E.; Csapo K.; Molnar K.; Mezo I.; Sereg M.;
Reddy P.; Manjunath C.; Narayanappa S.; Kumar S.; Sinha N.; Kapoor A.;
Christopher J.; Reddy G.; Rani M.; Oomman A.; Ramamurthee K.; Kumar N.;
Pasha SS.; Rao C.; Murty GS.; Chopra A.; Kapila D.; Bali H.; Chattree K.;
Hasan O.; Suryaprakash G.; Rao D.; Babu R.; Bhargavi M.; Naik S.; Khan S.;
Chopra V.; Sapra R.; Kaul U.; Ghose T.; Menon R.; Battikadi S.; Mullasari
A.; Subban VK.; Dani S.; Iby M.; Chandra P.; Sethi S.; Bhargava M.; Arora
P.; Tyagi G.; Padmanabhan T.; Malhotra S.; Talwar K.; Shafiq N.; Kasliwal
R.; Bansal M.; Eldar M.; Berger M.; Shechter M.; Atar S.; Roguin N.;
Kilimnik M.; Hayek T.; Hamoud S.; Katz A.; Plaev T.; Shotan A.; Vazan A.;
Weiss A.; Leibowitz D.; Zimlichman R.; Ben-Aharon J.; Hammerman H.; Dragu
R.; Rozenman Y.; Witzling V.; Tzivoni D.; Moriel M.; Halkin A.; Sheps D.;
Bogomolny N.; Mosseri M.; Khudyak Y.; Halabi S.; Uziel-Iunger K.; Yuval
R.; Shimoni S.; Caspi A.; Botwin S.; Gavish D.; Sandler A.; Pollak A.;
Kreisberg B.; Hussein O.; Jabal K.; Henkin Y.; Grosbard A.; Rosenschein
U.; Rivlin E.; Zeltser D.; Platner N.; Porter A.; Harel N.; Lishner M.;
Elis A.; Karny M.; Fuchs S.; Stein G.; Grossman E.; Gealel Z.; Schlaeffer
F.; Liberty I.; Golik A.; Tzuman O.; Pavesi C.; Poggio L.; Damiano S.;
Pazzano AS.; Mennuni M.; Paloscia L.; Mascellanti M.; Piovaccari G.;
Grosseto D.; Mascia F.; Vetrano A.; Zingarelli A.; Mazzantini S.; Visconti
L.; Terzi G.; Senni M.; Gavazzi A.; Scuri P.; Carmelo M.; De Caterina R.;
Conti M.; Novo S.; Graceffa A.; Arvigo L.; Lunetta M.; Filardi P.;
Chiariello M.; Scala O.; Pirozzi E.; Musella F.; Moretti L.; Testa M.;
Vicentini A.; De Feo S.; Biasucci L.; Cardillo MT.; Puccioni E.; Galli M.;
Menegato A.; Margheri M.; Maresta A.; Gatti C.; Guarini P.; Damiano M.;
Golino P.; Porcu M.; Fele N.; Gensini G.; Lombardi A.; Ciuti G.; Bernardi
D.; Mariani P.; Paolini E.; Marenzi G.; Moltrasio M.; Terrosu P.; Chessa
P.; Guglielmino G.; Miccoli F.; Oldoino E.; Ragni M.; Poli M.; Basso V.;
Rapezzi C.; Branzi A.; Gallelli I.; Perna G.; Guazzarotti F.; Marra S.;
Usmiani T.; Olivari Z.; Calzolari D.; Santoro G.; Minneci C.; Achilli A.;
Nassiacos D.; Sommariva L.; Romeo F.; Fedele F.; Foschi ML.; Bruno N.;
Centurion C.; Patrizi G.; De Maria E.; Gonnelli S.; Vichi V.; Cassadonte
F.; Rotella G.; Capucci A.; Villani G.; Gaspardone A.; Ferrante R.; Scollo
V.; Pancaldi L.; Sacca S.; Gabrielli D.; Ciliberti D.; Savini E.; Binaghi
G.; Di Biase M.; Ieva R.; Fattore L.; Cicia G.; Cavallini C.; Tamburino
C.; Sacco A.; Mafrici A.; Di Pasquale G.; Pavesi PC.; Scioli R.; Lioy E.;
Occhiuzzi E.; Matino MG.; Russo V.; Moscogiuri MG.; Cuccia C.; Forgione
C.; Volpe M.; Palano F.; Branca G.; Rossi R.; Modena M.; Olaru IA.; Zanini
R.; Cianflone D.; Cristell N.; Pantaleoni M.; Guiducci U.; Menozzi C.;
Gaddi O.; Fasulo A.; Indolfi C.; Emanuele V.; Guerra F.; Iliceto S.;
Marotta C.; Morocutti G.; Presbitero P.; Rossi M.; Bonatti S.; Grieco A.;
Chiodi L.; Betti I.; Zuppiroli A.; Fanelli R.; Stanco G.; Azzolini P.;
Ruggieri C.; Bocconcelli P.; Airoldi F.; Tavano D.; Brunelli C.; Caso P.;
Scalzone A.; Ghigliotti G.; Facciorusso A.; Sim K.; Kiam O.; Chee K.; Bin
Ismail O.; Zambahari R.; Ophuis T.; van Nes E.; Werter CJ.; Ophuis AJ.;
Troquay RP.; Hamer BJ.; Lenderink T.; Feld RJ.; van Hessen MW.; Viergever
EP.; van der Sluis A.; Lok DJ.; Badings EA.; Nierop PR.; Danse IY.;
Hermans WR.; Holwerda NJ.; Thijssen HJ.; Theunissen LJ.; van der Zwaan C.;
Van Den Berg BJ.; Hendriks IH.; Ronner E.; Withagen AJ.; Dijkshoorn-Giesen
AH.; Ezechiels JP.; Kuijper AF.; Den Hartog FR.; Van Kalmthout P.M.; Buijs
EM.; van der Zeijst M.; Zwart PA.; Zuidgeest JA.; van Eck M.; Daniels MC.;
van der Ven-Elzebroek N.; Van't Hof A.; van Boven AJ.; van der Weerdt A.;
Dunselman PH.; Alings MA.; van Es RF.; The SH.; Gurlek C.; Liem AH.; van
Lennep HW.; Van Vlies B.; Kalkman C.; Swart HP.; van der Bij P.; Taverne
R.; Ciampricotti R.; van Dam C.; Spierenburg H.; van Ruijven I.; van
Kempen L.H.; Willems FF.; Dirkali A.; Stoel I.; Plomp J.; Veldmeijer S.;
Tjeerdsma G.; Nijmeijer R.; Van Hal JM.; Bartels GL.; Posma JL.; Linssen
GC.; Fauser CG.; Waalewijn RA.; Groenemeijer BE.; Pos L.; Fast JH.; Droste
HT.; Westenburg J.; Veenstra W.; Koolen J.; van Loo LW.; Smits W.; Milhous
JG.; van Rossum P.; Stuij S.; Scott R.; Richards AM.; Morrison Z.; Devlin
G.; Fisher R.; Stewart R.; Benetar J.; Voss J.; Wong S.; Scott D.; Luke
R.; Tang E.; Davidson L.; Hamer A.; Wilson S.; Price R.; Hart H.; Turner
A.; Jortveit J.; Calic S.; Gundersen T.; Brunvand H.; Fosse L.; Nygaard
O.; Gjellefall B.; Gravdal SA.; Ringstad R.; Atar D.; Clausen H.; Hysing
J.; Arvesen K.; Topper M.; Flagstad E.; Graven T.; Haug HH.; Dalin L.;
Al-Ani R.; Otterstad J.; Ausen K.; Aaser E.; Olufsen M.; Halvorsen S.;
Gullestad L.; Stueflotten W.; Waage K.; Stodle R.M.; Hall C.; Aase O.;
Nordeng J.; Soyland E.; Fageraas ER.; Lied A.; Aske R.; Raouf N.;
Johansson J.; Herrscher T.; Skogrand E.; Bjornstad H.; Aagnes I.; Arntsen
BI.; Vegsundvaag J.; Skjold ME.; Velle H.; Aambakk MB.; Skjetne O.;
Byfuglien A.; Rodriguez J.; Galvez D.; Medina F.; Hernandez HA.; Chavez
V.; Morales R.; Huapalla E.; Velasquez D.; Torres F.; Aguirre O.; Yanez
L.; Andrade M.; Campos C.; Arce R.; Mogrovejo W.; Osores F.; Bustamante
G.; Rodriguez M.; Berrospi P.; Talledo M.; Navarro P.; Horna M.; Herrera
V.; Kadziela J.; Rybicka-Musialik A.; Trusz-Gluza M.; Berger-Kucza A.;
Musial W.; Tycinska A.; Gil R.; Gziut A.; Gorny J.; Tyllo M.; Reszka Z.;
Mickiewicz-Pawlowska M.; Wrzosek B.; Kosior J.; Staneta P.; Korzeniak R.;
Kalarus Z.; Markowicz E.; Miekus P.; Konarzewski M.; Kleinrok A.; Puzniak
M.; Grajek S.; Janus M.; Krzyzanowski M.; Hoffmann A.; Muzalewski P.;
Polonski L.; Kazik A.; Nowalany-Kozielska E.; Wojciechowska C.; Ponikowski
P.; Nawrocka S.; Filipiak K.; Serafin A.; Dubiel J.; Mielecki W.; Ogorek
M.; Kopcik D.; Jaworska K.; Skonieczny G.; Kawecka-Jaszcz K.; Bryniarski
L.; Tracz W.; Lesniak-Sobelga A.; Jankielewicz J.; Zaluska R.; Trojnar R.;
Kawalek P.; Gaciong Z.; Pulkowski G.; Anaszewicz M.; Samul W.; Adamus J.;
Cholewa M.; Kubik L.; Szczechowicz R.; Rekosz J.; Kwiatkowska D.; Gajek
J.; Mazurek W.; Kominek M.; Siminiak T.; Guzniczak E.; Monteiro P.;
Providencia L.; Monteiro S.; Pinho T.; Gavina C.; Sousa C.; Loureiro J.;
Ferreira AR.; Cardoso A.; Araujo J.; Rebolo I.; Catarino C.; Santos J.;
Nunes LP.; Mimoso J.; Marques N.; Leitao M.; Pais J.; Fernandes A.; Diogo
A.; Nobrega J.; Moreira JI.; Mateus P.; Oliveira J.; Selas M.; Ribeiro V.;
Albuquerque A.; Reis R.; Ramos A.; Salazar F.; Nair D.; Ng CK.; Yeo D.;
Wong A.; Funiak S.; Belicova M.; Striezova I.; Krajci P.; Sojka G.; Herman
O.; Zemberova A.; Pella D.; Fedacko J.; Banikova A.; Micko K.; Macek V.;
Moscovic M.; Vahala P.; Vykoukalova T.; Dzupina A.; Marusakova M.; Stevlik
J.; Akubzanova E.; Hatalova K.; Burgess L.; Coetzee C.; Mabin T.; Roos J.;
Mohamed Z.; Pillay T.; Corbett C.; Bodenstein W.; Tayob F.; Ebrahim I.;
Bolsman C.; Horak A.; Lloyd E.; Pretorius M.; Commerford P.; De Andrade
M.; Roux J.; Murray A.; Soma P.; Delport E.; Cassel G.; Van Zyl L.; Cronje
T.; Sarvan M.; Moodley R.; Guerra M.; Swanepoel N.; Bayat J.; Klug E.;
Hellig S.; Yoon J.; Kim J.; Chung W.; Choi Y.; Cho M.; Lee S.; Kwon H.;
Hong B.; Seung K.; Chang K.; Rha S.; Jeong MH.; Hong Y.; Lee C.; Seong I.;
Jeong J.; Tahk S.; Yoon M.; Chae SC.; Kim H.; Lopez V.; Roldan JM.;
Mancisidor P.; Froufe J.; Lopez A.; Franco S.; Molina A.; Soriano F.;
Cobos M.; Mejia H.D.; Sanz R.; Vazquez A.; Garri F.; Esteban I.; Marco P.;
Artaecheverria J.; Cequier A.; Esplugas E.; Gonzalez J.; de Sa E.; Armada
E.; Worner F.; Hernandez I.; Roncales F.; Gomollon J.; del Rio A.; Alameda
J.; Basilio E.; Rafols M.; Ferres R.; Molla C.; Pascual J.; Cortada J.;
Garcia C.; Iglesias G.; Villa E.; Aros F.; Goya I.; Bueno M.; Pereira RV.;
Clavero X.; Pasaron CD.; Jorda R.; Pereira R.; Perez O.; de Teresa E.;
Navarro M.; de la Guia F.; Lozano T.; Antorrena I.; Aranda M.; Alonso L.;
Mirelis J.; Alcasena S.; Paniagua VA.; Juanatey J.; Gregorian L.; Munoz
J.; Escorihuela A.; Sanz A.; Flores A.; Garcia PA.; Alfonso F.; Marin E.;
Lozano A.; Bethencourt A.; Grau A.; Rubio A.; Sala J.; Royuela N.; San
Jose J.; Bugos V.; de Valdecilla H.; Martin J.; Jimenez R.; Felgueres M.;
Escalera P.; Ruiz R.; Bescos L.; Sanchez I.; Chavarri M.; Casares G.;
Johanson P.; Hultsberg-Olsson G.; Witt N.; Samad B.; Damm T.; Risenfors
M.; Ortgren L.; Henareh L.; Jernberg T.; Berglund M.; Karlsson J.; Koch
A.; Lycksell M.; Lundgren C.; Herlitz J.; Sjolin M.; Erlinge D.; Matson
E.; Cizinsky S.; Carlsson F.; Ryttberg B.; Johansson K.; Tygesen H.;
Bergsten J.; Naslund U.; Sundholm C.; Timberg I.; Wikstrom P.; Hardhammar
P.; Lisbeth A.; Lund L.; Hage C.; Rosenqvist U.; Grandas M.; Larsson L.;
Hammerman A.; Andersson G.; Johansson S.; Bennermo M.; Tjerneld H.;
Forsgren M.; Eriksson K.; Eriksson M.; Bengtsson PO.; Yu W.; Ceder-Brolin
K.; Stafberg C.; Andersson E.; Roussine V.; Angman K.; Melin B.; Thorsen
S.; Lundell L.; Buijs F.; Ostberg S.; Sigaud P.; Moccetti T.; Bondio M.;
Kuehlkamp V.; Pieper M.; Gallino A.; Zender H.; Genne D.; Gauthey J.;
Wilhelm M.; Saner H.; Trachsel L.; Roethlisberger C.; Schlaepfer H.;
Kujawski T.; Pagnamenta A.; Meyer-Monard S.; Krapf R.; Biedermann B.;
Schneider H.; Rickli H.; Ramsay D.; Linka A.; Ballmer P.; Oswald M.; Girod
G.; Charng M.; Shu-Ling H.; Ping-Han L.; Wu C.; Liu S.; Lin M.; Chian-Yi
W.; Yeh H.; Mei-Juan C.; Hsieh I.; Wang Y.; Ural E.; Sahin T.; Yildiz Z.;
Kayikcioglu M.; Kultursay H.; Yigit Z.; Calpar I.; Ata N.; Goktekin O.;
Senol U.; Yalcin R.; Timurkaynak T.; Kaya U.; Yildirir A.; Karacaglar E.;
Faynyk A.; Sorokivskyy M.; Koval O.; Kaplan P.; Kraiz I.; Popova K.; Kyyak
Y.; Barnett O.; Karpenko O.; Todoriuk L.; Tseluyko V.; Kopytsya M.;
Petyunina O.; Kovalskyy I.; Zhukova Y.; Katerenchuk I.; M'yakinkova L.;
Lutay Y.; Syvolap V.; Kyselov S.; Vakaliuk I.; Nesterak R.; Nikonov V.;
Feskov O.; Goloborodko B.; Golovtsev Y.; Berezniakov I.; Lebedynska M.;
Rudenko L.; Tutov I.; Ahsan A.; Burton J.; Levy T.; Lakeman N.; Spratt J.;
Langford E.; Sutcliffe S.; Khwanda A.; Davis G.; Rodrigues E.; Dickinson
D.; Been M.; Trouton T.; Riddell J.; Moriarty A.; McEneaney D.; Squire I.;
Narayan H.; Goode G.; Helliwell L.; Boos C.; Greaves K.; Knops K.; Pegge
N.; Signy M.; Wong Y.; Moore S.; Fluck D.; Atkinson C.; Adgey A.; McKeag
N.; Bishop A.; Glover J.; Barbir M.; Breen J.; Robson H.; Townend J.;
Dwenger E.; Ekpo E.; Shakespeare C.; Barr C.; McClements B.; McAllister
A.; De Belder M.; Cooke J.; Williams S.; Daniel D.; Pye M.; Griffith K.;
Wright L.; Trevelyan J.; Doughty A.; Hughes E.; Phillips C.; Penny W.;
Groves P.; Kardos A.; Purvis J.; McNeill A.; Jones A.; Brown J.; Saeed B.;
Sprigings D.; Herity N.; Brown C.; Unks M.; Cauthren T.; Bertolet B.;
Jones M.; Decker S.; Chambers J.; Stahlberg J.; Varma S.; Gencheff N.;
Price A.; McElroy D.; Chu A.; Crutchfield B.; Eaton G.; Looney A.; Qureshi
M.; Wilks J.; Drenning D.; Overman A.; Andreou C.; Russo P.; Stuckey T.;
Pruitt H.; D'Urso M.; DeRaad R.; Rogers W.; Thorington S.; Pasquini J.;
Iwaoka R.; Tannenbaum M.; Prouty D.; Wiseman A.; Sharow A.; Graham B.; Ali
MI.; Dale H.; Tarsi D.; Picone M.; Juarez S.; Hamroff G.; Hollenweger L.;
Scirica B.; Sabatine M.; Marti J.; Perlman R.; Pavlides A.; Joffe I.;
Albirini A.; Campbell T.; Puri S.; Lopez C.; Pearce D.; Shah D.; McPherson
J.; Donegan R.; Murdock D.; Block D.; Malik A.; Musina R.; Dauber I.;
Varner C.; Bach R.; Palazzolo M.; Bhalla H.; Thompson M.; Pollock S.;
Johnson S.; Lipson L.; Brunk S.; Karas S.; Vicari R.; Kuvin J.; Mooney P.;
Aycock G.; Lane B.; Sharma M.; Gibson T.; Chang G.; DiVito P.; Mehta R.;
Watkins K.; Chiu A.; Gunderson J.; Tedder B.; Williams P.; Hage-Korban E.;
Childs A.; Banerjee S.; Kazi F.; Bennett J.; Barnes D.; Wohns D.; Noorman
C.; Aggarwal K.; Lau-Sickman A.; Paulowski J.; Amos M.; Rider J.; Fenton
S.; Schantz M.; Hakas J.; Mcsorley J.; Felten W.; Bitzer V.; Russell J.;
Loyo J.; Adjei A.; Mehta K.; Uretsky B.; Hale M.; Shaikh S.; Miller M.;
Hollenbaugh D.; Crawford K.; Fortuin D.; Galindo A.; Del Core M.; Butkus
E.; Collins J.; Prior J.; Hahn R.; Greene-Nashold J.; Alexander J.; Genova
E.; MacDonell A.; Broadwater S.; Kereiakes D.; White D.; Lopez M.; Schenks
R.; Lui H.; Gibbons P.; Davis B.; Thornton K.; Daley P.; Budzon S.;
McCullum K.; Delio-Cox B.; Nadar V.; Keim S.; McLaurin B.; Davis C.; Betzu
R.; Al-Jumaily J.; Bolli R.; Alshaher M.; Leesar M.; Collins T.; Akkad H.;
Bilazarian S.; Marsters M.; Kennett J.; Melegrito K.; Mostel E.; Harris
R.; Chang M.; Hatfield G.; Makam S.; Garvey M.; Levite H.; Abdel-Latief
A.; Pelletier L.; Carr K.; Mckenna K.; Soto G.; Kozina J.; Harris D.;
Vlastaris A.; Bittel B.; Riba A.; Gugudis J.; Singh N.; Qureshi I.; Doty
W.; Lehmann J.; Lieber I.; Martin S.; Nicu M.; Bhalodkar N.; Ravi P.;
Canto J.; Bass M.; Campbell C.; Steinhubl S.; Moles K.; Harjai K.;
Stapleton DD.; Hoey K.; Erwin J.; Fikes W.; Stein B.; Sabatino K.;
Teklinski A.; Colfer H.; Ward P.; Langevin E.; Faucett S.; Mamdani S.;
DeSimone L.; Tuohy E.; Cullen T.; Eisenberg S.; Chronos N.; Allen RP.;
Erickson B.; Mahon K.; Kirby A.; Siegel C.; Stroud L.; Johnson J.; Panchal
V.; Pearson A.; Abell T.; De Gregorio M.; Boomer L.; Vahdat O.; VanNatta
B.; Long P.; Chalavarya G.; Skatrud L.; Carey C.; Wright W.; Mechem C.;
Matthews B.; Adams A.; Vora K.; Wead J.; Koren M.; Gregory D.; El Khadra
M.; Peacock G.; Kieval J.; Barron M.; Lewis D.; Grice R.; Bobek M.; Moore
C.; Nygaard T.; Fischell T.; Salman W.; Schneider C.; Muhlestein B.;
Peeler D.; Chang D.; Todd A.; Chilakamarri V.; Hanley P.; Gelormini J.;
Iacona MA.; Effron B.; Mazzurco S.; Mazzella M.; Wyman P.; Orchard R.;
Battin D.; Rezkalla S.; Bishop C.; Sharp S.; Gredler F.; Knap P.; Fadel
M.; Saucedo J.; Keng A.; Imburgia M.; Blank E.; Effat M.; Khoury S.;
Mardis R.; Baldari D.; Tafuri L.; Mascolo R.; Taylor D.; Mandviwala M.;
Khan W.; Mumford T.; Mayer N.; Mitchell B.; Oliver T.; Lombardi W.;
Zimmerman T.; Rohrbeck S.; Cooke L.; Craig M.; Mego D.; Griffin B.; Perez
J.; LeClerc K.; Addington J.; Aboufakher R.; Ahmed A.; Westecott B.; Steel
K.; Hawkins K.; Shah A.; Ward U.; McGreevy M.; Goldberg R.; Prashad R.;
McDonough C.; Silver K.; Josephson R.; Witsaman S.; Labib S.; Woodhead G.;
Schrank J.; Bell K.; Chandna H.; Bethea C.; Fife B.; Gruberg L.; Singer
A.; Ramgadoo M.; Lalonde T.; Morin R.; French W.; Barillas O.; Gradner G.;
Kahn Z.; Gress J.; Rocco D.; Thew S.; Stifter W.; Fisher M.; McNamara J.;
Kupfer J.; Agocha A.; Cush S.; Jones S.; Whitaker T.; Stover T.; Kumkumian
G.; Kent K.; Greenberg A.; Pandey P.; Pytlewski G.; Matsumura M.; Kai W.;
Sameshima S.; Thomas J.; MacNicholas D.; Pillai K.; Jones D.; Navas JP.;
Laskoe B.; Patel P.; Fini G.; Minor S.; Shipwash T.; Cabrera-Santamaria
A.; Rivera E.; Mincher L.; Jafar M.; Yen M.; Finkle C.; Rahimtoola A.;
Severson L.; Labroo A.; Jinich D.; Tam K.; Vogel C.; Aggarwal R.; Zakhary
B.; Curtis S.; Lyster M.; Humphrey K.; Lavine P.; Fujise K.; Birnbaum Y.;
Allen J.; Kesselbrenner M.; Michel K.; Staniloae C.; Liu M.; Sonel A.;
Macioce-Caffas A.; Amidon T.; Leggett J.; Yedinak S.; Gudmundsson G.;
Sabharwal J.; Dagefoerde N.; Wu W.; Meyerrose G.; Roongsritong C.; Jenkins
L.; Lieberman S.; Sokol S.; Gutierrez C.; Nelson C.; Barrett J.; Hotchkiss
D.; Farley A.; Atassi K.; Christy L.; Baig M.; Di Fazio J.; Meengs M.;
Thomas K.; Surmitis J.; DeVault S.; Farhat N.; Hulyalkar A.; Riddell L.;
Rivera W.; Sheynberg B.; Kobayashi J.; Katsaropoulos J.; Jan M.; Krucoff
M.; Paterno C.; Chandrasekaran S.; Curry R.; Cassavar D.; Wheeler M.;
McGarvey J.; Schwarz L.; Miller E.; Andrea B.; Carswell BS.; Lurie M.;
Patti J.; Bowden W.; Vasiliauskas T.; Latham R.; Schwartz B.; Bradford L.;
Mattleman S.; Wertheimer J.; Goulden D.; Khan M.; Hawkins B.; Ostfeld R.;
Mueller H.; Ash Y.; Wilson V.; Bayer M.; Marshall J.; Dobies D.; Dawson
G.; Osman A.; Saba F.; Costello T.; Fuentes F.; Underwood C.; Vijay N.;
Washam M.; Dietz W.; Glasgow B.; Mukherjee S.; Hinchion N.; Speirs S.;
Thornley A.; Lee K.; Movahed M.; Strootman D.; Chernick R.; Parrott C.;
Flock C.; Marques V.; Syzmanski E.; Rama P.; Domingo D.; Holly D.; Wu L.;
Bauer B.; Dionisopoulos P.; Aggarwal A.; Holcomb R.; Foster R.; Hancock
T.; Hargrove J.; Fletcher A.; Stine R.; Bullivant M.; Adams K.; Lohman J.;
Klepper V.; Kabour A.; Neidhardt J.; Phillips W.; Tardiff S.; Aji J.;
Corut S.; Foster G.; Firek C.; St Goar F.; Sumner R.; Davis T.; Schneider
R.; Schneider W.; Villa A.; Desai V.; Chhabra A.; Banks K.; Herzog W.;
Burley T.; Quyyumi A.; Smiley W.; Manocha P.; Fishbein G.; Weller C.;
Coffman A.; Kim C.; Kedia A.; Firth B.; Rizvi M.; Dahiya R.; Foster B.;
Balcells E.; Metzger DC.; Lester J.; Bissett J.; Fahdi I.; Sides EA.;
Azrin M.; Martin C.; Quick A.; Conaway D.; Garg M.; Schallert G.;
Lancaster L.; Mckissick S.; Atieh M.; Garbarino J.; Eisenberg D.;
Uusinarkaus K.; Wirtemburg P.; Ellis J.; Cristaldi J.; Berglund R.; Negus
B.; Pappas J.; Rocha R.; Nguyen T.; Stone J.; Janosik D.; Labovitz A.;
Elmore N.; Dave R.; Loffredo K.; Gabriel G.; Snyder C.; Ahmed O.; Stone
H.; Kelley M.; Diffenback M.; Friedman B.; Zirkle J.; Severa L.; Sample
S.; Dignen K.; Raisinghani A.; Ben-Yehuda O.; Ghannadian B.; Moscoso R.;
Mankowski J.; Boliek W.; Rukavina M.; Davis W.; Ledbetter S.; Handel F.;
Mastouri R.; Mahenthiran J.; Foltz J.; Malhotra V.; Jonas J.; Berk M.;
Singh V.; Nelson M.; Elsner G.; Gall J.; Kondo N.; Frank S.; Chandraratna
P.; Ranasinghe S.; Ebrahimi R.; Treadwell M.; Walters B.; Hughes L.;
Kramer J.; Kumar K.; Mente T.; Lachterman B.; Schifferdecker B.; Munshi
K.; Sease D.; Waldo D.; Chandler G.; Manns D.; Nahhas A.; Kamalesh M.;
Williams V.; Reich D.; Desalca M.; Sharma S.; Liston M.; Gupta K.; Costa
M.; Altschuller A.; Lemmertz K.; Shanes J.; Hansen C.; Therrien M.;
Mendelson R.; Ramnarine R.; Myers G.; Donovan C.; Klein M.; Fine D.; Owens
S.; Murray C.; Ketroser R.; Heifetz S.; Darnell Z.; Touchon R.; Taghizadeh
B.; Bohle D.; Norwood D.; Forrest T.; Jackson S.; Shumate K.; Bayles A.;
Masroor M.; North WK.; Fishberg R.; Merveil-Ceneus B.; Butcher R.;
Menapace F.; Kilbride S.; Ramabadran RS.; Loukinen K.; Khalil J.;
Ramabadran R.; Walsh S.; Gill S.; Cyncar R.; McLachlan J.; Surakanti V.;
Rusterholtz L.; Shoukfeh F.; Stephenson L.; Tsang M.; Nolan V.; Gilchrist
I.; Jefferson D.; Feldman T.; Reyes L.; Santos R.; Little W.; Wesley D.;
Gharib W.; Mendell A.; Esham G.; Kakavas P.; Whitcomb C.; Book K.; Bazzi
A.; Alvarez J.; Cohen Y.; Ayres T.; Rhule V.; Labib A.; Schuler P.;
Zughaib M.; Telck K.; Bikkina M.; Turnbull K.; Sharma T.; Orosz S.; Shah
R.; Petrino M.; Hughes M.; Hershey J.; Hudock D.; Hui P.; Von Bakonyi A.;
Arnold A.; Kappel D.; Pennock G.; Cloud B.; Tucker K.; Harp L.; Hoover C.;
Eisenhauer M.; Roth J.; Young C.; Thai H.; Escalante A.; Bautista J.;
Gazmuri R.; Nyland J.; Cubeddu L.; DeFranco A.; Dias D.; Fielding M.;
Reeves R.; Hermany P.; Meissner-Dengler S.; Evans M.; Flores E.;
Tannenbaum A.; McGarr K.; Moran J.; Stout E.; Allred S.; Henderson D.;
Crandall L.; Strote J.; Voyles W.; Robeson D.; Bedoya R.; Omar B.;
Pettyjohn F.; Revere C.; Coy K.; Margolis J.; Sotolongo C.; Scheffel M.;
Munir A.; Shirwany A.; Douglas L.; Girala R.; Humphreys R.; Agarwal J.;
Bankowski D.; Watson R.; Bishop B.; Klementowicz P.; Blais D.; Cohen B.;
Lobur E.; Dimenna J.; Dempsey K.; Izzo M.; Bondi L.; Carell E.; Eaton C.;
Saltiel F.; Grewal G.; Connolly T.; Little T.; Wiegman P.; Gips S.; Held
J.; Paraschos A.; Quesada R.; Goudreau E.; Sears M.; Istfan P.; Holt S.;
McClung J.; Nguyen N.; Quintana O.; Gottlieb D.; Knutson T.; Barringhaus
K.; Lester F.; Sullivan P.; Rodriguez-Ospina L.; Daniels C.J.; Aboulhosn
J.A.; Bozkurt B.; Broberg C.S.; Colman J.M.; Crumb S.R.; Dearani J.A.;
Fuller S.; Gurvitz M.; Khairy P.; Landzberg M.J.; Saidi A.; Valente A.M.;
Van Hare G.F.; Asirvatham S.J.; Book W.M.; Gidding S.S.; Kim Y.Y.;
Raghuveer G.; Warnes C.A.; Bartz P.J.; Cohen M.I.; Jacobs M.L.; Latson
L.A.; Mavroudis C.; McElhinney D.B.; Oechslin E.N.; Triedman J.K.;
Al-Khatib S.M.; Ammash N.; Baumgartner H.; Blankenship J.C.; Brindis R.G.;
Campbell R.M.; Curtis L.H.; Fitzgerald K.K.; Fleisher L.A.; Gentile F.;
Hlatky M.A.; January C.T.; Joglar J.A.; Jones T.K.; Kogon B.E.; Kumar G.;
Krieger E.V.; Levine G.N.; Lin C.H.; Mancone M.; Marelli A.; Niwa K.;
Oster M.; Otto C.M.; Page R.L.; Perry J.; Pressler S.J.; Silversides C.K.;
Wijeysundera D.N.; Zaidi A.N.; Zaragoza-Macias E.
Institution
(Cannon, Giugliano, McCagg, Im, Bohula, Wiviott, Braunwald) Thrombolysis
in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital,
Harvard Medical School, Boston, United States
(Blazing, White, Reist, Califf) Duke Clinical Research Institute (DCRI),
Durham, NC, United States
(Theroux) Montreal Heart Institute, Montreal, Canada
(Darius) Vivantes Neukolln Medical Center, Berlin, Germany
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Ophuis) Canisius-Wilhelmina Ziekenhuis, Nijmegen, Netherlands
(Jukema) Netherlands Leiden University Medical Center, Leiden, Netherlands
(De Ferrari) Fondazione IRCCS Policlinico San Matteo, University of Pavia,
Pavia, Italy
(Ruzyllo) National Institute of Cardiology, Warsaw, Poland
(De Lucca, Tershakovec, Musliner) Merck, Kenilworth, NJ, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL)
cholesterol levels and the risk of cardiovascular events, but whether the
addition of ezetimibe, a nonstatin drug that reduces intestinal
cholesterol absorption, can reduce the rate of cardiovascular events
further is not known. METHOD(S): We conducted a double-blind,
randomized trial involving 18,144 patients who had been hospitalized for
an acute coronary syndrome within the preceding 10 days and had LDL
cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per
liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per
deciliter (1.3 to 3.2 mmol per liter) if they were not receiving
lipid-lowering therapy. The combination of simvastatin (40 mg) and
ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin
(40 mg) and placebo (simvastatin monotherapy). The primary end point was a
composite of cardiovascular death, nonfatal myocardial infarction,
unstable angina requiring rehospitalization, coronary revascularization
(>=30 days after randomization), or nonfatal stroke. The median follow-up
was 6 years. RESULT(S): The median time-weighted average LDL
cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per
liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per
deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group
(P<0.001). The Kaplan-Meier event rate for the primary end point at 7
years was 32.7% in the simvastatin-ezetimibe group, as compared with 34.7%
in the simvastatin-monotherapy group (absolute risk difference, 2.0
percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to
0.99; P = 0.016). Rates of pre-specified muscle, gallbladder, and hepatic
adverse effects and cancer were similar in the two groups.
 CONCLUSION(S): When added to statin therapy, ezetimibe resulted in
incremental lowering of LDL cholesterol levels and improved cardiovascular
outcomes. Moreover, lowering LDL cholesterol to levels below previous
targets provided additional benefit. Copyright © 2015
Massachusetts Medical Society.

<141>
Accession Number
627345848
Title
High-resolution respirometry in human endomyocardial biopsies shows
reduced ventricular oxidative capacity related to heart failure.
Source
Experimental and Molecular Medicine. 51 (2) (no pagination), 2019. Article
Number: 16. Date of Publication: 01 Feb 2019.
Author
Scheiber D.; Jelenik T.; Zweck E.; Horn P.; Schultheiss H.-P.; Lassner D.;
Boeken U.; Saeed D.; Kelm M.; Roden M.; Westenfeld R.; Szendroedi J.
Institution
(Scheiber, Zweck, Horn, Kelm, Westenfeld) Division of Cardiology,
Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine
University, Dusseldorf, Germany
(Scheiber, Jelenik, Zweck, Roden, Szendroedi) Institute for Clinical
Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research,
Heinrich Heine University, Dusseldorf, Germany
(Scheiber, Jelenik, Zweck, Roden, Szendroedi) German Center for Diabetes
Research (DZD e.V.), Munchen-Neuherberg, Partner Dusseldorf, Dusseldorf,
Germany
(Schultheiss, Lassner) Institute for Cardiac Diagnostics and Therapy
(IKDT), Berlin, Germany
(Boeken, Saeed) Clinic for Cardiovascular Surgery, Medical Faculty,
Heinrich-Heine University, Dusseldorf, Germany
(Kelm) Cardiovascular Research Institute Dusseldorf, Medical Faculty,
Heinrich-Heine University, Dusseldorf, Germany
(Roden, Szendroedi) Division of Endocrinology and Diabetology, Medical
Faculty, Heinrich-Heine University, Dusseldorf, Germany
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
The lifetime risk of developing heart failure is approximately 20%, and
survival rates remain poor. Myocardial mitochondrial function has been
suggested to play a pivotal role in heart failure pathophysiology. Human
studies on ex vivo mitochondrial function have mostly been limited to
atrial tissue obtained during open heart surgery and have provided
contradictory results. This study aimed at measuring myocardial
mitochondrial function in transcatheter ventricular endomyocardial
biopsies and assessing the relationship between oxidative capacity and
heart function. We enrolled 40 heart failure patients undergoing
ventricular assist device surgery or heart transplantation (34 males, age
57 +/- 11 years, body mass index 26.6 +/- 4.8 kg/m2) and 29
heart transplant recipients of comparable age and body mass index with
normal left ventricular function undergoing surveillance biopsies (23
males, 57 +/- 12 years, body mass index 26.2 +/- 4.1 kg/m2).
High-resolution respirometry was established in the myocardium to measure
oxidative capacity ex vivo. The mitochondrial oxidative capacity was 90%
higher in ventricular compared to atrial tissues (n = 11, p < 0.01) of
explanted hearts. Respiration rates were comparable in ventricular samples
of heart failure patients obtained during open heart surgery by standard
tissue preparation or ex vivo endomyocardial biopsy (r = 0.9988, p <
0.0001, n = 8), and the mitochondrial oxidative capacity in samples from
these patients remained stable for 8 h when stored in either of two common
preservation buffers. The oxidative capacity was 44% lower in heart
failure than in transplant recipients (67 +/- 3 vs. 97 +/- 5 pmol/[s mg],
p < 0.0001) and correlated positively with heart function (r = 0.49, p <
0.01). High-resolution respirometry of ventricular tissue is feasible in
transcatheter biopsies, facilitating clinical studies on myocardial
mitochondrial function in patients not undergoing heart
surgery. Copyright © 2019, The Author(s).

<142>
Accession Number
627837035
Title
Myectomy with mitral valve repair versus replacement in adult patients
with hypertrophic obstructive cardiomyopathy: a systematic review and
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 465-472),
2019. Date of Publication: 2019.
Author
Afanasyev A.; Bogachev-Prokophiev A.; Lenko E.; Sharifulin R.; Ovcharov
M.; Kozmin D.; Karaskov A.
Institution
(Afanasyev, Bogachev-Prokophiev, Lenko, Sharifulin, Ovcharov, Karaskov)
National Medical Research Center, Rechkunovsky St. 15, Novosibirsk 630055,
Russian Federation
(Kozmin) Cardiac surgery department, Federal Center for Cardiovascular
Surgery, Astrakhan, Russian Federation
Publisher
Oxford University Press
Abstract
We evaluated the differences in mitral valve (MV) plasty (MVP) and MV
replacement (MVR) with respect to death, postoperative MV dysfunction,
reoperation rates and thromboembolic events (DFRE) in patients with
hypertrophic obstructive cardiomyopathy and systolic anterior motion of
the anterior mitral leaflet-mediated MV regurgitation (HOCM & MR). We
followed the Preferred Reporting Items for Systematic Reviews and
Meta-analyses guidelines, searching PubMed, Cochrane library and
ClinicalTrials.gov for studies that evaluated DFRE in adults with HOCM &
MR after MVP/MVR. We used a risk of bias assessment tool for
non-randomized studies, and analyses were performed using Cochrane Review
Manager 5.3.5 for I2 statistics, funnel plots and forest plot
and the generic inverse variance method for hazard ratios (HRs). We
developed qualitative and quantitative syntheses of 35 and 23 studies,
respectively, including levels of evidence of 1=2/3/4/5 = 3/1/11/11/9 and
1=2/3/4/5 = 0/1/11/11/0, respectively, from January 1980 to August 2017. A
statistically significant difference between MVP and MVR favoured MVP for
the prevention of DFRE in patients with HOCM & MR, on the basis of a
significant reduction of the HR for DFRE: HR = 0.68 (0.57, 0.82),
I2 = 68% (P = 0.002). The findings were as follows: (i) MVP
should be the first-line treatment in patients with HOCM & MR (accuracy
LEVEL A) and (ii) MVR may be harmful if it is used as the first-line
treatment (accuracy LEVEL A). Copyright © The Author(s) 2018.

<143>
Accession Number
2001567659
Title
Cardiovascular effects of liraglutide.
Source
Current Hypertension Reviews. 15 (1) (pp 64-69), 2019. Date of
Publication: 2019.
Author
Mikhail N.
Institution
(Mikhail) David-Geffen School of Medicine, OliveView-UCLA Medical Center,
14445 Olive View Dr, Sylmar, CA 91342, United States
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Liraglutide is a glucagon-like 1 (GLP-1) agonist approved for
treatment of type 2 diabetes and obesity. Objective(s): To review the
cardiovascular effects of liraglutide including macrovascular and
microvascular events, its use in heart failure, and its effects on heart
rate and blood pressure. Result(s): The impact of liraglutide on
cardiovascular outcomes was examined in a large welldesigned study
published in 2016, the LEADER trial. This study included 9,340 patients
with advanced type 2 diabetes and high baseline cardiovascular risk. The
primary outcome was the first occurrence of death from cardiovascular
causes, non-fatal myocardial infarction, or non-fatal stroke. After a
median follow-up of 3.8 years, patients randomized to liraglutide had
significant reduction in the composite primary outcome compared to
patients randomized to placebo, hazard ratio (HR) 0.87; 95% CI 0.78-0.97.
Death from cardiovascular causes was significantly reduced with
liraglutide therapy (HR, 0.78; 95% CI 0.66-0.93), as well as death from
any cause (HR, 0.85; 95% CI 0.74-0.97). In 2017, the LEADER investigators
reported that nephropathy events were significantly lower after
liraglutide therapy than placebo (HR 0.78; 95% CI 0.67-0.92), but there
was no significant difference in retinopathy events. Meanwhile, other
studies suggested that the use of liraglutide may be harmful in patients
with severe heart failure, in part due to increase in heart rate.
 Conclusion(s): Liraglutide is a useful therapy in patients with
advanced type 2 diabetes complicated by cardiovascular disease, except
patients with severe heart failure. Further studies are needed to evaluate
the long-term effects of liraglutide, and to see whether its beneficial
effects extend to patients with type 2 diabetes and low cardiac
risk. Copyright © 2019 Bentham Science Publishers.

<144>
Accession Number
2001817942
Title
Efficacy of preoperative amino acid supplements on postoperative physical
function and complications in open heart surgery patients: A study
protocol for a randomized controlled trial.
Source
Journal of Cardiology. 74 (4) (pp 360-365), 2019. Date of Publication:
October 2019.
Author
Ogawa M.; Yoshida N.; Satomi-Kobayashi S.; Tsuboi Y.; Komaki K.; Wakida
K.; Gotake Y.; Inoue T.; Tanaka H.; Yamashita T.; Sakai Y.; Izawa K.P.;
Takahashi M.; Ogawa W.; Hirata K.-I.
Institution
(Ogawa, Tsuboi, Komaki) Division of Rehabilitation Medicine, Kobe
University Hospital, Kobe, Japan
(Ogawa, Izawa) Department of Public Health, Kobe University Graduate
School of Health Sciences, Kobe, Japan
(Yoshida, Satomi-Kobayashi, Yamashita, Hirata) Division of Cardiovascular
Medicine, Department of Internal Medicine, Kobe University Graduate School
of Medicine, Kobe, Japan
(Wakida, Takahashi, Ogawa) Department of Nutrition, Kobe University
Hospital, Kobe, Japan
(Gotake, Inoue, Tanaka) Division of Cardiovascular Surgery, Department of
Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
(Sakai) Division of Rehabilitation Medicine, Kobe University Graduate
School of Medicine, Kobe, Japan
(Takahashi, Ogawa) Division of Diabetes and Endocrinology, Department of
Internal Medicine, Kobe University Graduate School of Medicine, Kobe,
Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Elderly patients undergoing cardiac surgery often show poor
nutritional status, muscle wasting, and sarcopenia, which are reported to
affect postoperative functional recovery and incidence of complications.
Amino acids are essential in maintaining nutritional status, synthesizing
muscle protein, and promoting beneficial energy balance of the heart
muscle. beta-Hydroxy beta-methylbutyric acid (HMB) is a leucine metabolite
known to increase muscle protein synthesis and inhibit protein catabolism;
it has been used to more effectively support patients with muscle wasting
due to wearing diseases. However, the efficacy of amino acid
administration comprising HMB in patients undergoing open heart surgery
remains unclear. This study aims to examine whether preoperative
short-term aggressive amino acid administration helps support
postoperative recovery of physical function and prevent complications.
 Method(s): This is a single-center prospective randomized controlled
trial (UMIN000030490). Patients aged >=65 years who will be hospitalized
for medical examination before cardiac surgery will be recruited. The
participants will be randomly assigned to the experimental or control
group. The experimental group will be administered with an amino acid
supplement with HMB 1200 mg, L-glutamine 7000 mg, and L-arginine 7000 mg
once or twice per day depending on the degree of renal dysfunction, for
14-28 days preoperatively. The control group will not receive any
nutritional intervention. The main outcome will be a change in the 6-min
walking test distance pre- and postoperatively as a sign of functional
recovery. Secondary outcomes such as the incidence of complications;
physical, nutritional, and psychological states; mortality; and length of
hospital stay will also be evaluated. Conclusion(s): This clinical
study will determine the effects of preoperative short-term oral amino
acid supplementation with HMB, L-glutamine, and L-arginine on
postoperative physical function in elderly patients undergoing cardiac
surgery. Copyright © 2019

<145>
Accession Number
627898638
Title
Epidural analgesia versus paravertebral block in video-assisted
thoracoscopic surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 404-406),
2019. Date of Publication: 2019.
Author
Harky A.; Clarke C.G.; Kar A.; Bashir M.
Institution
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Liverpool Road, Chester CH2 1UL, United Kingdom
(Clarke) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Kar) Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's
Hospital, London, United Kingdom
(Bashir) Department of Aortovascular Surgery, Manchester Royal Infirmary,
Manchester, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: In patients undergoing
video-assisted thoracoscopic surgery, is paravertebral block (PVB)
superior to epidural analgesia (EP) in terms of pain control and its
postoperative complication rates? Altogether, 153 papers were found using
the reporting search, of which 4 represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. At present, there are a limited
number of studies directly comparing pain control and postoperative
outcomes between PVB and EP, and no large-scale randomized trials have
been reported. Three of the 4 papers are small prospective randomized
trials, with a small cohort study featuring as the final piece of
literature. There is no conclusive body of evidence to recommend either
route as more efficacious from a pain control perspective; one study
demonstrated significantly lower levels of pain with EP (P = 0.01), with a
second study demonstrating significantly better pain control with PVB (P <
0.01) and a third failing to demonstrate any significant difference (P =
0.899). The frequency of requiring supplemental analgesia was similar
between the PVB and EP cohorts (56% vs 48%, P = 0.26). PVB is associated
with lower rates of postoperative complications compared to EP,
specifically urinary retention (64% vs 34.6%, P = 0.0036) and hypotension
(32% vs 7%, P = 0.0031; 21% vs 3%, P = 0.02). In summary, PVBs appear to
offer an equivalent level of analgesic effect following video-assisted
thoracoscopic surgery, with a more favourable side-effect profile,
compared to EP. This does need to be contextualized in light of the
scarcity of published material, with the available studies each containing
a small number of participants. Copyright © 2018 The Author(s).

<146>
Accession Number
627895169
Title
Does the use of a hot-shot lead to improved outcomes following adult
cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 473-477),
2019. Date of Publication: 2019.
Author
Volpi S.; Ali J.M.; De Silva R.
Institution
(Volpi, Ali, De Silva) Department of Cardiothoracic Surgery, Royal
Papworth Hospital, Cambridge CB23 3RE, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: Does the use of a
'hot-shot' (terminal warm blood cardioplegia) lead to improved outcomes
following adult cardiac surgery? Altogether, 567 papers were found using
the reported search, of which 9 represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. We conclude that evidence
supporting the use of a hot-shot prior to weaning from cardiopulmonary
bypass is rather limited. All 8 of the randomized trials to date are small
studies which examine heterogeneous groups of patients, and unfortunately,
the conclusions are inconsistent, perhaps in part related to the inability
to demonstrate statistical significance with small group size. From the
evidence, it appears likely that the use of a hot-shot results in more
rapid biochemical, electrical and possibly functional myocardial recovery
from cardiopulmonary bypass. However, no study has been able to
demonstrate that this leads to improved clinical outcomes other than lower
incidence of atrial fibrillation. Copyright © 2018 The Author.

<147>
Accession Number
627895159
Title
Intravenous iron does not effectively correct preoperative anaemia in
cardiac surgery: A pilot randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 447-454),
2019. Date of Publication: 2019.
Author
Padmanabhan H.; Siau K.; Nevill A.M.; Morgan I.; Cotton J.; Ng A.; Brookes
M.J.; Luckraz H.
Institution
(Padmanabhan, Siau, Brookes) Department of Gastroenterology, Royal
Wolverhampton NHS Trust, Wolverhampton WV10 0QP, United Kingdom
(Nevill) Faculty of Education, Health and Wellbeing, University of
Wolverhampton, Wolverhampton, United Kingdom
(Morgan, Luckraz) Department of Cardiothoracic Surgery, Heart and Lung
Centre, Wolverhampton, United Kingdom
(Cotton) Department of Cardiology, Heart and Lung Centre, Wolverhampton,
United Kingdom
(Ng) Department of Cardiothoracic Anaesthesiology, Heart and Lung Centre,
Wolverhampton, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: Preoperative anaemia is a strong predictor of blood
transfusion requirements and must be assessed for appropriate optimization
before elective surgery. Iron therapy is a transfusion-sparing approach
effective for increasing haemoglobin concentrations. However, its role in
elective cardiac surgery and the optimal route of administration remain
unknown. This single-centre, non-blinded, randomized, controlled trial
compared the effectiveness of intravenous ferric carboxymaltose therapy
with oral iron for anaemic patients undergoing elective cardiac surgery.
 Method(s): Fifty anaemic patients scheduled for elective cardiac
surgery were randomized to receive either oral or intravenous iron therapy
3-8 weeks preoperatively. Changes in haemoglobin concentration were
measured. Blood transfusion and postoperative outcome data were collected.
 Result(s): Preoperative median increases in haemoglobin were 1.0 g/l
(interquartile range -3.25 to 7.25 g/l) and 3.0 g/l (interquartile range
-1.25 to 6.25 g/l) for patients receiving intravenous and oral iron,
respectively (P = 0.42). The median first 12-h blood loss was
significantly higher in the intravenous group (655 ml; interquartile range
162-1540 ml) compared to the oral group (313 ml; interquartile range
150-1750 ml; P < 0.007). Median increments in serum ferritin were superior
for the intravenous group (median difference 313 mug/l; interquartile
range 228-496) compared to the oral group (median difference 5.5 mug/l;
interquartile range -1.4 to 19.4; P < 0.001). Conclusion(s):
Increases in ferritin after intravenous iron administration were
significantly greater than those after oral iron administration. There was
no significant difference in haemoglobin increments between groups.
Despite significantly higher intraoperative blood loss in the group
receiving intravenous iron, blood transfusion requirements for both groups
were not statistically different. Copyright © The Author(s) 2018.

<148>
Accession Number
627340221
Title
Drug-Eluting Stent Versus Coronary Artery Bypass Grafting for Diabetic
Patients With Multivessel and/or Left Main Coronary Artery Disease: A
Meta-Analysis.
Source
Angiology. 70 (8) (pp 765-773), 2019. Date of Publication: 01 Sep 2019.
Author
Cui K.; Lyu S.; Song X.; Liu H.; Yuan F.; Xu F.; Wang W.; Zhang M.; Zhang
D.; Tian J.
Institution
(Cui, Lyu, Song, Liu, Yuan, Xu, Zhang, Wang, Zhang, Zhang, Tian)
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing Institute of Heart, Lung and Blood Vessel Diseases,
Beijing, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
With the development of stent design and surgical techniques, the relative
benefit of percutaneous coronary intervention (PCI) versus coronary artery
bypass grafting (CABG) in patients with diabetes and complex coronary
artery disease are highly debated. This meta-analysis was conducted to
compare the outcomes of drug-eluting stent (DES) implantation and CABG in
these cohorts. A comprehensive search of PubMed, Embase, and Cochrane
Library up to January 4, 2018, was performed. Only randomized controlled
trials (RCTs), subgroup analysis from RCTs, or adjusted observational
studies were eligible. Five RCTs and 13 adjusted observational studies
involving 17 532 patients were included. Overall, PCI with DES was
significantly associated with higher risk of all-cause mortality (hazard
ratio [HR]: 1.16, 95% confidence interval [CI]: 1.05-1.29), myocardial
infarction (MI; HR: 1.69, 95% CI: 1.43-2.00), and repeat revascularization
(HR: 3.77, 95% CI: 2.76-5.16) compared with CABG. Nevertheless, the risk
of stroke was significantly lower in the DES group (HR: 0.67, 95% CI:
0.54-0.83). The incidence of the composite end point of death, MI, or
stroke was comparable between the 2 groups (HR: 0.99, 95% CI: 0.84-1.17).
Despite the higher risk of stroke, CABG was better than PCI with DES for
diabetic patients with multivessel and/or left main coronary artery
disease. Copyright © The Author(s) 2019.

<149>
[Use Link to view the full text]
Accession Number
624071697
Title
Unraveling the Underlying Arrhythmia Mechanism in Persistent Atrial
Fibrillation: Results from the STARLIGHT Study.
Source
Circulation: Arrhythmia and Electrophysiology. 11 (6) (no pagination),
2018. Article Number: e005897. Date of Publication: 01 Jun 2018.
Author
Child N.; Clayton R.H.; Roney C.H.; Laughner J.I.; Shuros A.; Neuzil P.;
Petru J.; Jackson T.; Porter B.; Bostock J.; Niederer S.A.; Razavi R.S.;
Rinaldi C.A.; Taggart P.; Wright M.J.; Gill J.
Institution
(Child, Roney, Jackson, Porter, Niederer, Razavi) Department of Imaging
Sciences and Biomedical Engineering, King's College London, United Kingdom
(Clayton) INSIGNEO Institute for in Silico Medicine, University of
Sheffield, United Kingdom
(Laughner, Shuros) Boston Scientific Corp, St. Paul, MN, United States
(Neuzil, Petru) Department of Cardiology, Na Holmolce Hospital, Prague,
Czechia
(Child, Bostock, Rinaldi, Wright, Gill) Department of Cardiology, Guy's
and St Thomas' Hospital, London SE1 7EH, United Kingdom
(Taggart) University College London, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The mechanisms that initiate and sustain persistent atrial
fibrillation are not well characterized. Ablation results remain
significantly worse than in paroxysmal atrial fibrillation in which the
mechanism is better understood and subsequent targeted therapy has been
developed. The aim of this study was to characterize and quantify patterns
of activation during atrial fibrillation using contact mapping.
 Method(s): Patients with persistent atrial fibrillation (n=14; mean
age, 61+/-8 years; ejection fraction, 59+/-10%) underwent simultaneous
biatrial contact mapping with 64 electrode catheters. The atrial
electrograms were transformed into phase, and subsequent spatiotemporal
mapping was performed to identify phase singularities (PSs).
 Result(s): PSs were located in both atria, but we observed more PSs
in the left atrium compared with the right atrium (779+/-302, 552+/-235;
P=0.015). Although some PSs of duration sufficient to complete >1 rotation
were detected, the maximum PS duration was only 1150 ms, and the vast
majority (97%) of PSs persisted for too short a period to complete a full
rotation. Although in selected patients there was evidence of PS local
clustering, overall, PSs were distributed globally throughout both
chambers with no clear anatomic predisposition. In a subset of patients
(n=7), analysis was repeated using an alternative established atrial PS
mapping technique, which confirmed our initial findings.
 Conclusion(s): No sustained rotors or localized drivers were
detected, and instead, the mechanism of arrhythmia maintenance was
consistent with the multiple wavelet hypothesis, with passive activation
of short-lived rotational activity. Copyright ©2018 American
Heart Association, Inc.

<150>
Accession Number
624144220
Title
Clinical complete response after chemoradiotherapy for carcinoma of
thoracic esophagus: Is esophagectomy always necessary? A systematic review
and meta-analysis.
Source
Thoracic Cancer. 9 (12) (pp 1638-1647), 2018. Date of Publication:
December 2018.
Author
Wang J.; Qin J.; Jing S.; Liu Q.; Cheng Y.; Wang Y.; Cao F.
Institution
(Wang, Jing, Liu, Cheng, Wang, Cao) Department of Radiation Oncology, The
Fourth Hospital of Hebei Medical University, Shijiazhuang, China
(Qin) Department of Thoracic Surgery, Cancer Hospital of Chinese Academy
of Medical Sciences, Beijing, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Although a clinical complete response (cCR) after
chemoradiotherapy (CRT) could lead to a better prognosis, the choice of a
following strategy, such as surgical or non-surgical approach, remains
controversial. Method(s): All articles relevant to a comparison of
surgical and non-surgical treatment (including further definitive
chemoradiotherapy or active surveillance) for esophageal carcinoma
patients with a cCR after CRT were retrieved for meta-analysis. The final
date for data retrieval was 30 June 2018. Result(s): Four
retrospective studies including 648 patients met the inclusion criteria:
620 with squamous cell carcinoma and 28 with adenocarcinoma. The CRT +
surgery group had an advantage over the non-surgery group in regard to
two-year disease-free survival (DFS); however, the two groups showed
similar results in five-year DFS. The CRT + surgery group had an advantage
over the non-surgery group in two-year overall survival (OS);
nevertheless, the two groups showed similar results in five-year OS.
 Conclusion(s): Based on the available evidence, the addition of
surgery to thoracic locally advanced esophageal carcinoma patients with a
cCR after neoadjuvant CRT provided no advantage to long-term survival. As
an exception, the two-year DFS and OS could be improved. This research
conclusion might be more suitable to patients with squamous cell
carcinoma. Copyright © 2018 The Authors. Thoracic Cancer
published by China Lung Oncology Group and John Wiley & Sons Australia,
Ltd

<151>
Accession Number
2000574321
Title
Dual antiplatelet therapy versus single antiplatelet therapy after
transaortic valve replacement: Meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (6 Supplement) (pp 47-52),
2018. Date of Publication: September 2018.
Author
Alrifai A.; Soud M.; Kabach A.; Jobanputra Y.; Masrani A.; El Dassouki S.;
Alraies M.C.; Fanari Z.
Institution
(Alrifai, Jobanputra) University of Miami/JFK Medical Center, Atlantis,
FL, United States
(Soud) MedStar Heart and Vascular Institute, MedStar Washington Hospital
Center, Washington, DC, United States
(Kabach) Creighton University, School of Medicine, Omaha, NE, United
States
(Masrani) Mallinckrodt Institute of Radiology, Washington University in St
Louis, St Louis, MO, United States
(El Dassouki) Jackson Memorial Hospital/University of Miami, Miller School
of Medicine, Division of Cardiovascular Medicine, Miami, FL, United States
(Alraies) Wayne State University, Detroit Medical Center, Detroit, MI,
United States
(Fanari) Heartland Cardiology/Wesley Medical Center, University of Kansas
School of Medicine, Wichita, KS, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The current guidelines recommend empirical therapy with DAPT
of aspirin and clopidogrel for six months after TAVR. This recommendation
is based on expert consensus only. Giving the lack of clear consensus on
treatment strategy following TAVR. Goal of this meta-analysis is to assess
the efficacy and safety of mono-antiplatelet therapy (MAPT) versus dual
antiplatelet therapy (DAPT) following transcatheter aortic valve
replacement (TAVR). Methods and Materials: We performed a meta-analysis
from randomized clinical trials (RCTs) and prospective studies that tested
DAPT vs. MAPT for all-cause mortality and major bleeding of 603 patients.
The primary efficacy outcomes were 30 days mortality and stroke. The
primary safety outcomes were major bleeding and major vascular
complications. Result(s): We included 603 patients from 4 studies.
The use of MAPT was associated with similar mortality rate (5.9% vs. 6.6%;
RR = 0.92; 95% CI 0.49-1.71; P = 0.68) and stroke rate compared with DAPT
(1.3% vs. 1.3%; RR 1.04; 95% CI 0.27 to 4.04; P = 0.81). There was no
difference in major vascular complication (4.2% vs. 8.9%; RR 0.52; 95% CI
0.23 to 1.18; P = 0.17) or minor vascular complication (4.2% vs. 7.3%; RR
0.58; 95% CI 0.25 to 1.34; P = 0.14). However, MAPT was associated with
significantly less risk of major bleeding (4.9% vs. 14.5%; RR 0.37; 95% CI
0.20 to 0.70; P < 0.01) but no difference in minor bleeding (4.2% vs.
3.6%; RR 1.16; 95% CI 0.43 to 3.10; P = 0.85). Conclusion(s): MAPT
use after TAVR is associated with lower rates of major bleeding compared
with DAPT with no significant difference in mortality, stroke or vascular
complications. Copyright © 2018 Elsevier Inc.

<152>
Accession Number
2000541708
Title
Safety and efficacy of cerebral protection devices in transcatheter aortic
valve replacement: A clinical end-points meta-analysis.
Source
Cardiovascular Revascularization Medicine. Part A. 19 (7) (pp 785-791),
2018. Date of Publication: October 2018.
Author
Mohananey D.; Sankaramangalam K.; Kumar A.; Jobanputra Y.; Villablanca P.;
Krishnaswamy A.; Mick S.; Svensson L.G.; Tuzcu E.M.; Kapadia S.R.
Institution
(Mohananey, Sankaramangalam, Jobanputra, Krishnaswamy, Kapadia) Department
of Cardiovascular Medicine, Cleveland Clinic, OH, United States
(Kumar) Department of Cardiovascular Medicine, Emory University, GA,
United States
(Villablanca) Division of Cardiology, New York University, NY, United
States
(Mick, Svensson) Department of Cardiothoracic surgery, Cleveland Clinic,
OH, United States
(Tuzcu) Department of Cardiovascular Medicine, Cleveland Clinic, Abu
Dhabi, United Arab Emirates
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Stroke after transcatheter aortic valve replacement (TAVR)
occurs with an incidence of 4-11% and is a particularly devastating
adverse event associated with the procedure. Several cerebral protection
devices (CPD) have been developed to prevent cerebrovascular events during
TAVR. While most studies have shown CPD to be associated with decreased
number and volume of lesions on diffusion weighted magnetic resonance
imaging, the clinical benefit of these devices remains uncertain.
 Method(s): We aimed to use meta-analysis techniques to study the
clinical safety and efficacy of these CPD in prospective randomized and
non-randomized studies. Data was summarized as Mantel-Haenszel relative
risk (RR) and 95% confidence intervals (CI). We used the Higgins'
I2 statistic to evaluate heterogeneity. Result(s): We
found no evidence of difference between patients with and without CPD [RR
0.70 (95% CI 0.40-1.21)] for the primary composite outcome of stroke and
mortality at 30 days. The two groups were also comparable in
peri-procedural strokes [RR 0.53 (95% CI 0.27-1.07)], stroke at 30 days
[RR 0.69(95% CI 0.38-1.26)], mortality [RR 0.59 (95% CI 0.22-1.59) at 30
days, AKI [RR 0.68(95% CI 0.28-1.62)], major bleeding [RR 0.56 (95% CI
0.26-1.18)], life threating bleeding [0.54 (95% CI 0.19-1.53)] and major
vascular complications [RR 0.80 (95% CI 0.52-1.24)]. The risk of strokes
within the first week of TAVR was significantly lower in the CPD group
[0.56(95% CI 0.33-0.96)]. Conclusion(s): CPD are associated with a
decreased incidence of strokes within 1 week of follow-up without showing
any evidence of increased risk of other peri-procedural adverse
events. Copyright © 2018 Elsevier Inc.

<153>
Accession Number
623713797
Title
Adverse clinical outcomes associated with double dose clopidogrel compared
to the other antiplatelet regimens in patients with coronary artery
disease: A systematic review and meta-analysis.
Source
BMC Pharmacology and Toxicology. 19 (1) (no pagination), 2018. Article
Number: 54. Date of Publication: 03 Sep 2018.
Author
Zhuo X.; Zhuo B.; Ouyang S.; Niu P.; Xiao M.
Institution
(Zhuo, Ouyang, Niu, Xiao) Affiliated Changsha Hospital of Hunan Normal
University, The Fourth Hospital of Changsha, Department of Cardiology,
Changsha, Hunan 410006, China
(Zhuo) People's Hospital of Laibin, Department of Pharmacology, Laibin,
Guangxi 546100, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recently, several newer antiplatelet treatment strategies have
been used in patients with coronary artery disease (CAD). Apart from the
dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel,
double dose clopidogrel (DDC), triple antiplatelet therapy (TAPT)
consisting of aspirin, clopidogrel and cilostazol and other newer
antiplatelet agents have shown to be effective in different ways. In this
analysis, we aimed to systematically compare the adverse clinical outcomes
and the bleeding events which were observed when DDC was compared to the
other antiplatelet regimens in patients with CAD. Method(s): English
publications comparing DDC with other antiplatelet regimens were searched
from MEDLARS/MEDLINE, EMBASE, www.ClinicalTrials.gov and Google Scholar.
Adverse cardiovascular outcomes and bleeding events were the study
endpoints. Statistical analysis was carried out by the RevMan 5.3 software
whereby odds ratios (OR) with 95% confidence intervals (CIs) were
calculated. Result(s): A total number of 23,065 participants were
included. Results of this analysis showed major adverse cardiac events
(MACEs), all-cause mortality, cardiac death, stroke, stent thrombosis,
revascularization and myocardial infarction (MI) to have been similarly
manifested in patients who were treated with DDC versus the control group
with OR: 0.98, 95% CI: 0.78-1.22; p = 0.83, OR: 0.95, 95% CI: 0.77-1.17; p
= 0.62, OR: 0.97, 95% CI: 0.79-1.20; p = 0.81, OR: 0.98, 95% CI:
0.65-1.48; p = 0.94, OR: 0.84, 95% CI: 0.40-1.75; p = 0.64, OR: 0.88, 95%
CI: 0.52-1.49; p = 0.63, and OR: 0.89, 95% CI: 0.65-1.21; p = 0.45
respectively. Any minor and major bleedings were also similarly
manifested. When DDC was compared to DAPT, no significant difference was
observed in any bleeding event with OR: 1.58, 95% CI: 0.86-2.91; p = 0.14.
Even when DDC was compared with either ticagrelor or prasugrel or TAPT,
still no significant difference was observed in terms of bleeding
outcomes. Conclusion(s): In patients with CAD, adverse clinical
outcomes were not significantly different when DDC was compared to the
other antiplatelet regimens. In addition, bleeding events were also
similarly manifested when DDC was compared to DAPT, TAPT or
ticagrelor/prasugrel. Copyright © 2018 The Author(s).

<154>
Accession Number
621391592
Title
Can tolvaptan protect renal function in the early postoperative period of
cardiac surgery?: - Results of a single-center randomized controlled study
-.
Source
Circulation Journal. 82 (4) (pp 999-1007), 2018. Date of Publication:
2018.
Author
Kishimoto Y.; Nakamura Y.; Harada S.; Onohara T.; Kishimoto S.; Kurashiki
T.; Fujiwara Y.; Nishimura M.
Institution
(Kishimoto, Nakamura, Harada, Onohara, Kishimoto, Kurashiki, Fujiwara,
Nishimura) Department of Cardiovascular Surgery, Tottori University
Faculty of Medicine, Yonago, Japan
Publisher
Japanese Circulation Society
Abstract
Background: Oral administration of tolvaptan, a vasopressin V<inf>2</inf>
receptor antagonist, significantly reduces deterioration of renal
function, which has recently been highlighted as an exacerbating factor
for adverse events in patients with acute heart failure. In the present
study we tested the hypothesis that concomitant administration of
tolvaptan with a conventional diuretic is beneficial for perioperative
body fluid management in patients who have undergone cardiac surgery.
 Methods and Results: In all, 280 patients who underwent cardiac
surgery were prospectively randomized to concomitant treatment with
tolvaptan and a conventional diuretic (tolvaptan group; 147 patients) or
treatment with a conventional diuretic alone (control group; 133
patients). Groups were compared in terms of the time required to restore
preoperative body weight and the incidence of worsening renal function
(WRF), defined as an increase in the serum creatinine level >=0.3 mg/dL.
The time required to restore preoperative body weight was significantly
shorter in the tolvaptan than control group (mean [+/-SD] 3.97+/-1.95 vs.
5.02+/-2.83 days, respectively; P<0.001). The incidence of WRF was
significantly lower in the tolvaptan than control group (n=11 [7.5%] vs.
n=25 [18.8%], respectively; P=0.011). Conclusion(s): Administration
of tolvaptan with conventional diuretics in the early postoperative period
after cardiac surgery could be beneficial in maintaining urine output
without affecting renal function and may thus help avoid
WRF. Copyright © 2018, Japanese Circulation Society. All rights
reserved.

<155>
Accession Number
617408818
Title
Operative strategies to reduce cerebral embolic events during on- and
off-pump coronary artery bypass surgery: A stratified, prospective
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (4) (pp 1278-1285.e1),
2017. Date of Publication: October 2017.
Author
Halkos M.E.; Anderson A.; Binongo J.N.G.; Stringer A.; Lasanajak Y.;
Thourani V.H.; Lattouf O.M.; Guyton R.A.; Baio K.T.; Sarin E.; Keeling
W.B.; Cook N.R.; Carssow K.; Neill A.; Glas K.E.; Puskas J.D.
Institution
(Halkos, Thourani, Lattouf, Guyton, Baio, Keeling, Cook, Carssow, Neill)
Division of Cardiothoracic Surgery, Emory University School of Medicine,
Atlanta, Ga, United States
(Anderson) Department of Neurology, Emory University School of Medicine,
Atlanta, Ga, United States
(Stringer) Department of Rehabilitation Medicine, Emory University School
of Medicine, Atlanta, Ga, United States
(Glas) Department of Anesthesiology, Emory University School of Medicine,
Atlanta, Ga, United States
(Binongo, Lasanajak) Rollins School of Public Health, Emory University
School of Medicine, Atlanta, Ga, United States
(Sarin) Department of Cardiothoracic Surgery, Inova Fairfax Healthcare
System, Falls Church, Va, United States
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai University
School of Medicine, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To determine the impact of different aortic clamping strategies
on the incidence of cerebral embolic events during coronary artery bypass
grafting (CABG). Methods Between 2012 and 2015, 142 patients with
low-grade aortic disease (epiaortic ultrasound grade I/II) undergoing
primary isolated CABG were studied. Those undergoing off-pump CABG were
randomized to a partial clamp (n = 36) or clampless facilitating device
(CFD; n = 36) strategy. Those undergoing on-pump CABG were randomized to a
single-clamp (n = 34) or double-clamp (n = 36) strategy. Transcranial
Doppler ultrasonography (TCD) was performed to identify high-intensity
transient signals (HITS) in the middle cerebral arteries during periods of
aortic manipulation. Neurocognitive testing was performed at baseline and
30-days postoperatively. The primary endpoint was total number of HITS
detected by TCD. Groups were compared using the Mann-Whitney U test.
Results In the off-pump group, the median number of total HITS were higher
in the CFD subgroup (30.0; interquartile range [IQR], 22-43) compared with
the partial clamp subgroup (7.0; IQR, 0-16; P <.0001). In the CFD
subgroup, the median number of total HITS was significantly lower for
patients with 1 CFD compared with patients with >1 CFD (12.5 [IQR, 4-19]
vs 36.0 [IQR, 25-47]; P =.001). In the on-pump group, the median number of
total HITS was 10.0 (IQR, 3-17) in the single-clamp group, compared with
16.0 (IQR, 4-49) in the double-clamp group (P =.10). There were no
differences in neurocognitive outcomes across the groups. Conclusions For
patients with low-grade aortic disease, the use of CFDs was associated
with an increased rate of cerebral embolic events compared with partial
clamping during off-pump CABG. A single-clamp strategy during on-pump CABG
did not significantly reduce embolic events compared with a double-clamp
strategy. Copyright © 2017 The American Association for Thoracic
Surgery

<156>
[Use Link to view the full text]
Accession Number
624600751
Title
Effect of Everolimus Initiation and Calcineurin Inhibitor Elimination on
Cardiac Allograft Vasculopathy in De Novo Heart Transplant Recipients.
Source
Circulation. Heart failure. 11 (9) (pp e004050), 2018. Date of
Publication: 01 Sep 2018.
Author
Arora S.; Andreassen A.K.; Karason K.; Gustafsson F.; Eiskjaer H.; Botker
H.E.; Radegran G.; Gude E.; Ioanes D.; Solbu D.; Dellgren G.; Ueland T.;
Aukrust P.; Gullestad L.
Institution
(Arora, Andreassen, Gude, Gullestad) Department of Cardiology, Oslo
University Hospital, E.G., Rikshospitalet
(Arora) Center for Heart Failure Research, University of Oslo and Faculty
of Medicine, University of Oslo, Germany
(Karason, Ioanes) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Germany
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer, Botker) Department of Cardiology, Aarhus University Hospital,
Sweden
(Radegran) Section for Heart Failure and Valvular Disease, VO Heart and
Lung Medicine, Skane University Hospital and Department of Clinical
Sciences, Lund University, Denmark
(Solbu) Novartis Norge AS, Oslo, Norway
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Germany
(Ueland, Aukrust) Research Institute of Internal Medicine, Oslo University
Hospital, Rikshospitalet, Norway
(Ueland, Aukrust) K.G. Jebsen Inflammatory Research Center, Faculty of
Medicine, University of Oslo, Germany
(Ueland, Aukrust) K. G. Jebsen Thrombosis Research and Expertise Center,
University of Tromso
(Ueland, Aukrust, Gullestad) Faculty of Medicine, University of Oslo, P.A,
United States
(Aukrust) Section of Clinical Immunology and Infectious Diseases, Oslo
University Hospital, Rikshospitalet, Norway
Publisher
NLM (Medline)
Abstract
Background Cardiac allograft vasculopathy (CAV) limits survival after
heart transplantation, and the effect of different immunosuppressive
regimens on CAV is not fully understood. The randomized SCHEDULE trial
(Scandinavian Heart Transplant Everolimus De Novo Study With Early
Calcineurin Inhibitors Avoidance) evaluated whether initiation of the
proliferation signal inhibitor everolimus and early cyclosporine
elimination can reduce CAV development. Methods and Results The SCHEDULE
trial was a multicenter Scandinavian trial, where 115 de novo heart
transplantation recipients were randomized to everolimus with complete
cyclosporine withdrawal 7 to 11 weeks after heart transplantation or
standard cyclosporine-based immunosuppression. Seventy-six (66%) patients
had matched intravascular ultrasound examinations at baseline and 12 and
36 months. Intravascular ultrasound analysis evaluated maximal intimal
thickness, percent atheroma volume, and total atheroma volume. Qualitative
plaque analysis using virtual histology assessed fibrous, fibrofatty, and
calcified tissue as well as necrotic core. Serum inflammatory markers were
measured in parallel. The everolimus group (n=37) demonstrated
significantly reduced CAV progression as compared with the cyclosporine
group (n=39) at 36 months (DELTA maximal intimal thickness, 0.09+/-0.05
versus 0.15+/-0.16 mm [ P=0.03]; DELTA percent atheroma volume, 5.3+/-2.8%
versus 7.6+/-5.9% [ P=0.03]; and DELTA total atheroma volume, 33.9+/-71.2
versus 54.2+/-96.0 mm3 [ P=0.34], respectively]. At 36 months the number
of everolimus patients with rejection graded >=2R was 15 (41%) as compared
with 5 (13%) in the cyclosporine group ( P=0.01). Everolimus did not
affect CAV morphology or immune marker activity during the follow-up
period. Conclusions The SCHEDULE trial demonstrates that everolimus
initiation and early cyclosporine elimination significantly reduces CAV
progression at 12 months, and this beneficial effect is clearly sustained
at 36 months. Clinical trial registration URL:
https://www.clinicaltrials.gov . Unique identifier: NCT01266148.

<157>
Accession Number
625733608
Title
Effects of Massage in Reducing the Pain and Anxiety of the Cardiac Surgery
Critically Ill-a Randomized Controlled Trial.
Source
Pain medicine (Malden, Mass.). 19 (12) (pp 2556-2569), 2018. Date of
Publication: 01 Dec 2018.
Author
Boitor M.; Martorella G.; Maheu C.; Laizner A.M.; Gelinas C.
Institution
(Boitor, Maheu, Laizner, Gelinas) Ingram School of Nursing, McGill
University, 680 Sherbrooke West, Montreal, Quebec, Canada
(Martorella) College of Nursing, Florida State University, 104F - Vivian
M. Duxbury Hall, FL, United States
Publisher
NLM (Medline)
Abstract
Objective: To evaluate the effectiveness of hand massage on the pain and
anxiety of the cardiac surgery critically ill. Design(s): A three-arm
randomized controlled trial. Setting(s): This study was conducted in
a medical-surgical intensive care unit in Canada. Subjects: Adult patients
who underwent elective cardiac surgery, who were able to speak
French/English and to self-report symptoms, without a high risk of
postoperative complications were eligible. Method(s): Patients were
randomly allocated to standard care plus either two 20-minute hand
massages (experimental), two 20-minute hand holdings (active control), or
two 20-minute rest periods (passive control/standard care). Pain
intensity, pain unpleasantness, anxiety, muscle tension, and vital signs
were evaluated before, after, and 30minutes later for each intervention.
 Result(s): From the 83 patients recruited, 60 were randomized (20
massage, 19 hand holding, 21 standard care). After controlling for
baseline scores, the massage group reported significantly lower pain
intensity, pain unpleasantness, and anxiety for the first data collection
set compared with both hand holding and standard care (analysis of
covariance, P<0.02), with an average decrease of two points on a 0-10
scale. No statistically significant differences were noted between hand
holding and standard care for any of the symptoms. Similar results were
observed for the second data collection set (N=43). Patients had decreased
muscle tension post massage. Vital signs did not differ significantly
between groups. Conclusion(s): Findings suggest that a 20-minute hand
massage in addition to routine postoperative pain management can
concomitantly reduce pain intensity, pain unpleasantness, and anxiety by
two points on average on a 0-10 scale.

<158>
Accession Number
620274642
Title
Perioperative ultrasound applied to diagnosis and decision making in
anesthesia.
Source
Minerva Anestesiologica. 84 (1) (pp 94-107), 2018. Date of Publication:
January 2018.
Author
Albuquerque Costa N.T.F.; Sancho C.G.
Institution
(Albuquerque Costa) Department of Anesthesiology, Resuscitation and Pain
Treatment, Vic University Hospital, Carrer de Francesc Pla el Vigata 1,
Vic, Barcelona 08500, Spain
(Sancho) Department of Anesthesiology, Resuscitation and Pain Treatment,
Hospital Clinic, University of Barcelona, Barcelona, Spain
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Ultrasound is a portable and safe technology that is
increasingly used to assist anesthetic procedures and has been integrated
into the routine practice of a wide range of invasive procedures. As a
complementary diagnostic tool, publications related to perioperative
support other than vascular access and nerve blocks are currently lacking.
EVIDENCE ACQUISITION: Given the growing interest of anesthesiologists in
acquisition of knowledge and skills of ultrasound, we propose a systematic
review of the diagnosis, decision making or change in perioperative
management of non-cardiac surgical patients derived from ultrasound
practice. Of 1112 references found in electronic databases, 62 studies
resulted from the screening process. EVIDENCE SYNTHESIS: A complete
critical reading of 19 full-text publications was carried out with
quantitative analysis of 1825 ultrasound examinations including
echocardiography, neck and laryngeal ultrasound, pulmonary ultrasound and
abdominal ultrasound, all of them performed by anesthesiologists.
Diagnosis applied ultrasound and decision making during perioperative
period resulted in change in the management of 31% with 95% CI of 21.06 to
42.04 and odds ratio of 2.68 (1.77 to 4.06) related to hemodynamic, airway
and respiratory perioperative management. CONCLUSION(S): Since most
of the articles included in this review are observational studies with
inherent design concerns, there is an urgent requirement for randomized
controlled trials in this area. As anesthesiologists become more
comfortable and knowledgeable in ultrasound applied to the perioperative
support, emergence of protocols with multidisciplinary ultrasound
exploration is expected to allow an improvement in perioperative
safety. Copyright © 2017 EDIZIONI MINERVA MEDICA.

<159>
Accession Number
629061101
Title
Dual-filter cerebral protection device for stroke prevention during
transcatheter aortic valve replacement: An updated meta-analysis.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. Conference: American
Heart Association's Vascular Discovery: From Genes to Medicine 2019
Scientific Sessions. United States. 39 (Supplement 1) (no pagination),
2019. Date of Publication: May 2019.
Author
Ndunda P.M.; Vindhyal M.; Khayyat S.; Muutu T.; Fanari Z.
Institution
(Ndunda, Vindhyal, Khayyat, Muutu, Fanari) Univ of Kansas, Sch of Med-
Wichita, Wichita, KS, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Stroke remains a significant cause of morbidity and
mortality in patients undergoing transcatheter aortic valve replacement
(TAVR). The risk of stroke at 30 days is 2 - 5% and its occurrence
increases mortality up to 5-fold. We updated our previous meta-analysis of
the only FDA approved cerebral embolic protection device (CEPD), the
Sentinel Cerebral Protection System (CPS) (Claret Medical Inc., Santa
Rosa, CA. USA). Method(s): We searched the following online databases
for relevant studies: Cochrane Library, MEDLINE, Google Scholar and Web of
Science. Two authors independently screened and considered studies that
were randomized controlled trials or controlled observational studies that
compared the use of Sentinel CPS with no CEPD during TAVR. They also
independently extracted data and assessed the risk of bias of the trials
using the Cochrane Collaboration tools (RoB2.0 and ROBINS-I).
 Result(s): Six studies (3 randomized controlled trials and 3
propensity score matched observational studies) comprising 2541 patients
were included in the meta-analysis. The CPS arm had 1349 patients while
the control arm had 1192 patients. Patients in whom Sentinel CPS was used
had lower odds of the composite of 30-day all-cause mortality and stroke
[4.2% vs 8.6% OR 0.48 (95% CI 0.34 - 0.68, P < 0.0001) I2= 0%],
30-day stroke [3.5% vs 6.6% OR 0.50 (95% CI 0.32 - 0.77, P < 0.001)
I2= 0%], and major or life-threatening bleeding [ 3.3% vs 6.6%;
RR 0.50 (0.26 - 0.98, P = 0.04) I2= 16%]. There was no
significant difference in 30-day mortality [2.7% vs 4.0% OR 0.76 (95% CI
0.48 - 1.20, P = 0.23) I2= 0%], acute kidney injury [ 0.8% vs
1%; OR 0.85 (95% CI 0.22 - 3.24, P=0.81) I2= 0%], major
vascular complications [5.1% vs 6%; OR 0.71 (0.30 - 1.73%, P = 0.45)
I2= 47] and permanent pacemaker [14.3% vs 10.4%; OR 1.46 (95%
CI 0.80 - 2.69, P = 0.22) I2= 0%]. There was a trend towards a
higher mean difference in pre- and post-procedural mini mental status
examination score in favor of Sentinel CPS [MD 0.69 (95% CI -0.06 - 1.44,
P = 0.07) I2= 0%]. Conclusion(s): The use of Sentinel CPS
during TAVR may be associated with lower odds of 30-day stroke, major or
life-threatening bleeding, and the composite of 30-day mortality and
stroke.

<160>
Accession Number
629060891
Title
Vascular outcomes of transcarotid versus alternative approaches to
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. Conference: American
Heart Association's Vascular Discovery: From Genes to Medicine 2019
Scientific Sessions. United States. 39 (Supplement 1) (no pagination),
2019. Date of Publication: May 2019.
Author
Ndunda P.M.; Vindhyal M.; Muutu T.; Khayyat S.; Fanari Z.
Institution
(Ndunda, Vindhyal, Muutu, Khayyat, Fanari) 1Univ of Kansas Sch of Med-
Wichita, Wichita, KS2Univ of Kansas Sch of Med-Wichita/Heartland
Cardiology, Wichita, KS
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Thirteen to 25% of transcatheter aortic valve replacement
(TAVR) patients are precluded from transfemoral access. Transthoracic TAVR
(TT-TAVR) (transaortic and transapical) may be associated with poorer
outcomes compared with transfemoral TAVR (TF-TAVR). Transcarotid approach
(TC-TAVR) has been studied as an alternative. We conducted a systematic
review and meta-analysis comparing outcomes of transcarotid transcatheter
aortic valve replacement (TC-TAVR) and TF-TAVR and TT-TAVR.
 Method(s): We comprehensively searched four online databases for
controlled randomized and nonrandomized studies. Data was presented using
Mantel-Haenszel odds ratios (95% confidence intervals) and measured
heterogeneity using Higgins' I . Result(s): Four studies comparing
TC-TAVR and TF-TAVR and five studies comparing TC-TAVR and TT-TAVR were
included in the meta-analysis. There was no significant difference between
TF-TAVR and TC-TAVR in 30-day: MACE [8.4% vs 6.7%; OR 1.32 (95% CI 0.71 -
2.46 P=0.38) I2 =0%], mortality [5.6% vs 4.0%; OR 0.42 (95% CI
0.60 - 3.37, P=0.42) I2 =0%], stroke [0.7% vs 2.3%; OR 0.49
(95% CI 0.09 - 2.56, P=0.40) I2 =0%], major vascular
complications [0.7% vs 3%; OR 0.55 (95% CI 0.06 - 5.29, P=0.61)
I2 =39%], and major bleeding [0.7% vs 3.8%; OR 0.39 (95% CI
0.09 - 1.67, P=0.21) I2 =0%]. Compared with TT-TAVR, TC-TAVR
patients had lower odds of 30-day MACE [7.8% vs 13.7%; OR 0.54 (95% CI
0.29 - 0.99 , P=0.05) I2 =0%] and major or life-threatening
bleeding [4.0% vs 14.2%; OR 0.25 (95% CI 0.09 - 0.67 , P=0.006)
I2 =0%]. TC-TAVR showed a trend towards lower 30-day mortality
[4.5% vs 8.8%; OR 0.53 (95% CI 0.28 - 1.03, P=0.06) I2 =0%] and
major vascular complications [3.0% vs 7.8%; OR 0.42 (95% CI 0.16 - 1.12,
P=0.08) I2 =0%]. There was no significant difference between
stroke or transient ischemic attack [2.7% vs 3.8%; OR 0.70 (95% CI 0.30 -
1.67, P=0.42) I2 =0%]. Conclusion(s): TC-TAVR may have a
lower risk of 30-day: MACE, major or life-threatening bleeding and a trend
towards lower mortality and major vascular complications, compared to
TT-TAVR. There may no significant difference between TC-TAVR and TF-TAVR
outcomes.

<161>
[Use Link to view the full text]
Accession Number
629076668
Title
More- Versus Less-Intensive Lipid-Lowering Therapy.
Source
Circulation. Cardiovascular quality and outcomes. 12 (8) (pp e005460),
2019. Date of Publication: 01 Aug 2019.
Author
Toyota T.; Morimoto T.; Yamashita Y.; Shiomi H.; Kato T.; Makiyama T.;
Nakagawa Y.; Saito N.; Shizuta S.; Ono K.; Kimura T.
Institution
(Toyota) Department of Cardiovascular Medicine, Kobe City Medical Center
General Hospital, Japan (T.T.), Kobe, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Japan (T.O.M.), Nishinomiya, Japan
(Yamashita, Shiomi, Kato, Makiyama, Nakagawa, Saito, Shizuta, Ono, Kimura)
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto
University, Kyoto, Japan (Y.Y., H.S., T.K., T.A.M., Y.N., N.S., S.S.,
K.O., T.K.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: It has not been yet adequately addressed whether the addition
of the nonstatin LDL-C (low-density lipoprotein cholesterol)-lowering
agents on top of statins has the same magnitude of risk reduction in the
cardiovascular events as compared with more-intensive statin therapy.
METHODS AND RESULTS: We performed a systematic review and meta-analysis of
RCTs (randomized controlled trials) comparing more- versus less-intensive
lipid-lowering therapy (LLT) on clinical outcomes in patients with
atherosclerotic cardiovascular risk. We included 23 studies involving
133037 patients (more-intensive LLT: 67691 patients and less-intensive
LLT: 65346 patients). We evaluated 3 types of more- versus less-intensive
LLT including more versus less statins (57672 patients), combination
therapy of ezetimibe versus statins alone (20688 patients), or a PCSK9
(proprotein convertase subtilisin-kexin type 9) inhibitor with statins
versus statins alone (54677 patients). The odds for major adverse
cardiovascular events (MACE; equivalent to the composite of coronary heart
death, nonfatal myocardial infarction, stroke, or coronary
revascularization) were significantly lower in the more-intensive LLT
group compared with the less-intensive LLT group in the entire study
population (odds ratio, 0.84; 95% CI, 0.79-0.88; P<0.001), and in all the
3 categories of more-intensive LLT strategies (more-intensive statin
therapy: odds ratio, 0.83; 95% CI, 0.76-0.90; P<0.001, ezetimibe: odds
ratio, 0.90; 95% CI, 0.85-0.96; P<0.001, and PCSK9 inhibitors: odds ratio,
0.81; 95% CI, 0.73-0.90; P<0.001) with numerically greater relative odds
reduction by more-intensive statin therapy and PCSK9 inhibitors than by
ezetimibe. Odds reduction for MACE per 20 mg/dL LDL-C reduction was also
different across the 3 types of more-intensive LLT (more-intensive statin
therapy: 17.4%, ezetimibe: 11.0%, and PCSK9 inhibitors: 6.6%).
 CONCLUSION(S): In this meta-analysis, more-intensive LLT as compared
with less-intensive LLT was associated with significant odds reduction for
MACE in the entire study population and in all the 3 categories of
more-intensive LLT such as more-intensive statin therapy, ezetimibe, and
PCSK9 inhibitors. However, overall odds reduction for MACE and odds
reduction for MACE per 20 mg/dL LDL-C reduction were different across the
3 types of more-intensive LLT. Registration: URLs:
https://www.crd.york.ac.uk/PROSPERO/ and http://www.umin.ac.jp/ctr. Unique
identifiers: PROSPERO: CRD42018081196, and UMIN-CTR: R000036229.

<162>
[Use Link to view the full text]
Accession Number
629043339
Title
Ripple-AT Study.
Source
Circulation. Arrhythmia and electrophysiology. 12 (8) (pp e007394), 2019.
Date of Publication: 01 Aug 2019.
Author
Luther V.; Agarwal S.; Chow A.; Koa-Wing M.; Cortez-Dias N.; Carpinteiro
L.; de Sousa J.; Balasubramaniam R.; Farwell D.; Jamil-Copley S.;
Srinivasan N.; Abbas H.; Mason J.; Jones N.; Katritsis G.; Lim P.B.;
Peters N.S.; Qureshi N.; Whinnett Z.; Linton N.W.F.; Kanagaratnam P.
Institution
(Luther, Koa-Wing, Mason, Katritsis, Lim, Peters, Qureshi, Whinnett,
Linton, Kanagaratnam) Imperial College Healthcare, G.K., P.B.L., N.S.P.
(Agarwal) Papworth Hospital, Canada
(Chow, Srinivasan, Abbas) Barts Heart Centre, United Kingdom (A.C.,
London, N.S, Canada
(Cortez-Dias, Carpinteiro, de Sousa) Hospital de Santa Maria, L.C.,
Lisbon, Portugal
(Balasubramaniam, Jones) Royal Bournemouth & Christchurch Hospital (R.B.
(Farwell) Essex Cardiothoracic Centre
(Jamil-Copley) Nottingham University Hospital, United Kingdom (S.J.-C.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Ripple mapping (RM) is an alternative approach to activation
mapping of atrial tachycardia (AT) that avoids electrogram annotation. We
tested whether RM is superior to conventional annotation based local
activation time (LAT) mapping for AT diagnosis in a randomized and
multicenter study. METHOD(S): Patients with AT were randomized to
either RM or LAT mapping using the CARTO3v4 CONFIDENSE system. Operators
determined the diagnosis using the assigned 3D mapping arm alone, before
being permitted a single confirmatory entrainment manuever if needed. A
planned ablation lesion set was defined. The primary end point was AT
termination with delivery of the planned ablation lesion set. The
inability to terminate AT with this first lesion set, the use of more than
one entrainment manuever, or the need to crossover to the other mapping
arm was defined as failure to achieve the primary end point.
 RESULT(S): One hundred five patients from 7 centers were recruited
with 22 patients excluded due to premature AT termination, noninducibility
or left atrial appendage thrombus. Eighty-three patients (pts; RM=42,
LAT=41) completed mapping and ablation within the 2 groups of similar
characteristics (RM versus LAT: prior ablation or cardiac surgery n=35
[83%] versus n=35 [85%], P=0.80). The primary end point occurred in 38/42
pts (90%) in the RM group and 29/41pts (71%) in the LAT group (P=0.045).
This was achieved without any entrainment in 31/42 pts (74%) with RM and
18/41 pts (44%) with LAT (P=0.01). Of those patients who failed to achieve
the primary end point, AT termination was achieved in 9/12 pts (75%) in
the LAT group following crossover to RM with entrainment, but 0/4 pts (0%)
in the RM group crossing over to LAT mapping with entrainment (P=0.04).
 CONCLUSION(S): RM is superior to LAT mapping on the CARTO3v4
CONFIDENSE system in guiding ablation to terminate AT with the first
lesion set and with reduced entrainment to assist diagnosis. CLINICAL
TRIALS REGISTRATION: https://www.clinicaltrials.gov. Unique identifier:
NCT02451995.

<163>
Accession Number
2002387318
Title
Effects of serratus anterior plane block for postoperative analgesia after
thoracoscopic surgery compared with local anesthetic infiltration: A
randomized clinical trial.
Source
Journal of Pain Research. 12 (pp 2411-2417), 2019. Date of Publication:
2019.
Author
Chen G.; Li Y.; Zhang Y.; Fang X.
Institution
(Chen, Li, Zhang, Fang) Department of Anesthesiology and Intensive Care,
The First Affiliated Hospital, School of Medicine, Zhejiang University,
Hangzhou 310003, China
(Chen, Li, Zhang) Department of Anesthesiology, Zhejiang Province Hospital
of Integrated Traditional Chinese and Western Medicine, Hangzhou 310003,
China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Serratus anterior plane (SAP) block is a relatively novel
technique that can block the lateral cutaneous branches of the intercostal
nerves as well as the long thoracic nerve. Purpose(s): Our study
aimed to evaluate the effects of SAP block on postoperative pain after
thoracoscopic surgery compared with local anesthetic (LA) infiltration.
 Patients and Methods: Forty adult patients undergoing video-assisted
thoracic surgery were randomized to receive either SAP block (n=20) or LA
infiltration of incision (n=20). The primary outcome was postoperative
visual analog scale (VAS) score at the 2nd, 8th, 16th, 24th, and 48th hour
after surgery. The secondary outcomes were the consumption of sufentanil
at 8th, 16th, 24th hours postoperative. In addition, rescue analgesia,
drug-related adverse effects after surgery was also analyzed.
 Result(s): The SAP group showed lower VAS scores at the 2nd hour (at
rest: SAP group 11 [8-13] vs LA group 28 [26-32], P=0.01; on coughing: 15
[13-18] vs 33 [26-38], P=0.01) and the 8th hour (at rest: 13 [12-18] vs 36
[32-46], P=0.01; on coughing: 19 [16-23] vs 42 [36-53], P=0.01) after
surgery. Postoperative sufentanil consumption in the SAP group during 0-8
hrs was significantly lower compared with the LA group (P<0.01). The use
of rescue analgesia was also significantly lower in the SAP group (P=0.02)
during 0-12 hrs. Conclusion(s): Compared to LA infiltration,
ultrasound-guided SAP block may provide better pain relief as well as
reduce opioid consumption after thoracoscopic surgery. Copyright
© 2019 Chen et al.

<164>
Accession Number
629078793
Title
An international survey of the nutrition management of chylothorax: a time
for change.
Source
Cardiology in the young. (pp 1-10), 2019. Date of Publication: 15 Aug
2019.
Author
Marino L.V.; Bell K.L.; Woodgate J.; Doolan A.
Institution
(Marino) Department of Dietetics/SLT
(Marino) NIHR Biomedical Research Centre Southampton, Faculty of Health
Sciences, Canada
(Marino) University Hospital Southampton NHS Foundation Trust and
University of Southampton
(Marino) University of Southampton, Australia
(Bell) Child Health Research Centre, University of Queensland, South
Brisbane, QLD, Australia
(Bell, Woodgate, Doolan) Dietetics and Food Services, Children's Health
Queensland Hospital and Health Service, South Brisbane, QLD, Australia
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Although chylothorax is an uncommon complication following
paediatric cardiothoracic surgery, it has significant associated
morbidities and increased in-hospital mortality, as well as results in
higher costs. A lack of prospective evidence or consensus guidelines for
management of chylothorax further hinders optimal management. The aim of
this survey was to characterise variations in practice in the management
of chylothorax and to identify areas for future research. MATERIALS AND
METHODS: A descriptive, observational survey investigating conservative
management practices of chylothorax was distributed internationally to
health-care professionals in paediatric intensive care and cardiology
units. The survey investigated five domains: the first providing general
information about health-care professionals and four domains focusing on
clinical practice including diet composition and duration. RESULT(S):
In total, sixty-four health-care professionals completed the survey,
representing 38 organisations from 16 countries. The respondents were
dietitians (80%), physicians (19%), and nurses (1%). In Australia and New
Zealand, management was most commonly directed by physicians' preference
(67%) as compared to unit protocols in Europe (67%), United States of
America (67%), and Other regions (55%). Dietitians in Australia/New
Zealand, United Kingdom, and Ireland followed the most restrictive diet
therapy recommending <5 g long chain triglyceride fat per day (p <
0.00001). The duration of diet therapy significantly varied between
regions: Australia/New Zealand: 4 weeks (36%) and 6 weeks (43%); Europe: 4
weeks (25%) and 6 weeks (57%); and North America: 4 weeks (18%) and 6
weeks (75%) (p < 0.00001). CONCLUSION(S): This survey highlights
international variations in practice in the management of chylothorax,
particularly with respect to treatment duration and dietary fat
restriction. Future research should include a multi-centre randomised
controlled trial to inform evidence-based practice and reduce morbidity,
particularly poor growth.

<165>
Accession Number
629071958
Title
Social Media Improves Cardiothoracic Surgery Literature Dissemination:
Results of a Randomized Trial.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 09 Aug 2019.
Author
Luc J.G.Y.; Archer M.A.; Arora R.C.; Bender E.M.; Blitz A.; Cooke D.T.;
Hlci T.N.; Kidane B.; Ouzounian M.; Varghese T.K.; Antonoff M.B.
Institution
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, BC, Canada
(Archer) Department of Thoracic Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Arora) Section of Cardiac Surgery, Department of Surgery, Max Rady
College of Medicine, University of Manitoba, St. Boniface Hospital,
Winnipeg, MB, Canada
(Bender) Department of Cardiothoracic Surgery, Stanford University, Palo
Alto, CA, United States
(Blitz) Division of Cardiac Surgery, University of Cincinnati Medical
Center, Cincinnati, OH, United States
(Cooke) Section of General Thoracic Surgery, UC Davis Health, Sacramento,
CA, United States
(Hlci) Department of Cardiothoracic Surgery, Morriston Hospital, ABMU,
Swansea, United Kingdom
(Kidane) Section of Thoracic Surgery, Department of Surgery, University of
Manitoba, Winnipeg, MB, Canada
(Ouzounian) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University of Toronto, Toronto, ON, Canada
(Varghese) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
(Antonoff) Department of Thoracic and Cardiovascular Surgery, UT MD
Anderson Cancer Center, Houston, TX, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Thoracic Surgery Social Media Network (TSSMN) represents a
collaborative effort of leading journals in cardiothoracic surgery to
highlight publications via social media, specifically Twitter. We
conducted a prospective randomized trial to determine the effect of
scheduled tweeting on non-traditional bibliometrics of dissemination.
 METHOD(S): A total of 112 representative original articles
(2017-2018) were selected and randomized 1:1 to an intervention group to
be tweeted via TSSMN or a control (non-tweeted) group. Four articles per
day were tweeted by TSSMN delegates for 14 days. Primary endpoints
included change in Altmetric score pre and post-tweet compared to
controls. Secondary endpoints included change in Twitter analytics day one
post-tweet and day seven post-tweet for each article compared to baseline.
 RESULT(S): Tweeting via TSSMN significantly improved article
Altmetric scores (Pre-tweet 1 vs. Post-tweet 8, p<0.001), Mendeley reads
(Pre-tweet 1 vs. Post-tweet 3, p<0.001), and Twitter impressions (Day 1
post-tweet 1599 vs. Day 7 post-tweet 2296, p<0.001). Subgroup analysis
demonstrates that incorporating photos into the tweets trended towards
increased link clicks to the full-text article (p=0.08) whereas tweeting
at 1pmEST and 9pmEST generated the highest and lowest audience reach
(p=0.022), respectively. Articles published in adult cardiac surgery
achieved the highest change in Altmetric score (p=0.028), Mendeley reads
(p=0.028) and were more likely to be retweeted (p=0.042) than those
published on education, general thoracic surgery, and congenital surgery.
 CONCLUSION(S): Social media highlights of scholarly literature via
TSSMN Twitter activity improves article Altmetric scores, Mendeley reads,
and Twitter analytics, with dissemination to a greater
audience. Copyright © 2019. Published by Elsevier Inc.

<166>
Accession Number
629063397
Title
Safety and Efficacy of Biatrial vs. Left Atrial Surgical Ablation During
Concomitant Cardiac Surgery: A Meta-Analysis of Clinical Studies With a
Focus on the Causes of Pacemaker Implantation.
Source
Journal of cardiovascular electrophysiology. (no pagination), 2019. Date
of Publication: 11 Aug 2019.
Author
Cappabianca G.; Ferrarese S.; Tutino C.; Corazzari C.; Matteucci M.;
Mantovani V.; Musazzi A.; De Ponti R.; Beghi C.
Institution
(Cappabianca, Ferrarese, Tutino, Corazzari, Matteucci, Mantovani, Musazzi,
De Ponti, Beghi) Department of Heart and Vessels, University of Insubria,
Ospedale di Circolo, Varese, Italy
(Cappabianca, Ferrarese, Tutino, Corazzari, Matteucci, Mantovani, Musazzi,
De Ponti, Beghi) Cardiac Surgery Research Center, University of Insubria,
Varese, Italy
Publisher
NLM (Medline)
Abstract
INTRODUCTION: the latest STS guidelines recommend concomitant AF ablation
not only during mitral surgery (Class IA) but also during
other-than-mitral cardiac surgery procedures (Class IB) in patients with
preoperative AF. Conventional Cox-Maze III/IV procedures are performed on
both atria (BA), but several studies reported excellent results with left
atrial only (LA) ablations: the scope of this study is to compare the
safety and efficacy of BA vs. LA approach. METHODS AND RESULTS: Pubmed,
Scopus and WOS were searched from inception to November 2018: 28 studies
including 7065 patients and comparing the performance of BA vs. LA
approaches were identified: of these, 16 (57.1%) enrolled exclusively
patients with non-paroxysmal AF forms, 10 (35.7%) focused on mitral
surgery as main procedure and 16 (57.1%) regarded patients undergone
Cox-Maze with radiofrequency. Six and 12-months prevalence of sinus rhythm
were higher in the BA group (OR 1.37, CI 1.09-1.73, p=0.008 and OR 1.37,
CI 0.99-1.88, p=0.05 respectively). Permanent pacemaker (PPM) implantation
(OR 1.85, CI 1.38-2.49, p<0.0001) and reopening for bleeding (OR 1.70, CI
1.05-2.75, p=0.03) were higher in the BA group. Among patients undergone
PPM implantation, BA group had significantly higher risk of sino-atrial
node dysfunction (OR 3.01, CI 1.49-6.07, p=0.002). CONCLUSION(S):
concomitant BA ablation appears superior to LA ablation in terms of
efficacy but is associated to higher risk of bleeding and of PPM
implantation, more frequently due to sino-atrial node dysfunction. LA
approach should be preferable in patients with higher risk of bleeding or
with perioperative risk factors for PPM implantation. This article is
protected by copyright. All rights reserved.

<167>
Accession Number
629054120
Title
Impact of Aortic Atherosclerosis Burden on Outcomes of Surgical Aortic
Valve Replacement.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 07 Aug 2019.
Author
Iribarne A.; Pan S.; McCullough J.N.; Mathew J.P.; Hung J.; Zeng X.;
Voisine P.; O'Gara P.T.; Sledz N.M.; Gelijns A.C.; Taddei-Peters W.C.;
Messe S.R.; Moskowitz A.J.; Thourani V.H.; Argenziano M.; Groh M.A.;
Giustino G.; Overbey J.R.; DiMaio J.M.; Smith P.K.
Institution
(Iribarne, McCullough) Dartmouth-Hitchcock Medical Center, NH, Lebanon
(Pan, Sledz, Gelijns, Moskowitz, Giustino, Overbey) Icahn School of
Medicine at Mount Sinai, New York, NY
(Mathew, Smith) Duke University Medical Center, Durham, NC, United States
(Hung, Zeng) Massachusetts General Hospital, Boston, MA, United States
(Voisine) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Canada
(O'Gara) Brigham and Women's Hospital, Boston, MA, United States
(Taddei-Peters) National Heart, Lung, and Blood Institute, Bethesda, MD
(Messe) Perelman School of Medicine, University of Pennsylvania,
Philadelphia, United States
(Thourani) Medstar Heart and Vascular Institute, WA, United States
(Argenziano) New York-Presbyterian Hospital/Columbia University Medical
Center, New York, NY
(Groh) Mission Health and Hospitals, Asheville, NC, United States
(DiMaio) Baylor Scott & White Health, Plano, TX, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Epiaortic ultrasound detects and localizes ascending aortic
atherosclerosis. In this analysis we investigated the association between
epiaortic ultrasound-based atheroma grade during surgical aortic valve
replacement (SAVR) and perioperative adverse outcomes. METHOD(S):
SAVR patients in a randomized trial of two embolic protection devices
underwent a protocol-defined 5-view epiaortic ultrasound read at a
core-laboratory. Aortic atherosclerosis was quantified with Katz atheroma
grade and patients were categorized into mild (grade I-II) versus
moderate/severe (grade III-V). Multivariable logistic regression was used
to estimate associations between atheroma grade and adverse outcomes
including death, clinically apparent stroke, cerebral infarction on
diffusion-weighted magnetic resonance imaging (DW-MRI), delirium, and
acute kidney injury (AKI) by 7 and 30 days. RESULT(S): Of the 383
randomized patients, 326 (85.1%) had pre-cannulation epiaortic ultrasound
data available. Of these, 106 (32.5%) had moderate/severe Katz atheroma
grade at any segment of the ascending aorta. While there were no
significant differences in the composite of death, stroke or cerebral
infarction on DW-MRI by 7 days, moderate/severe atheroma grade was
associated with a greater risk of AKI by 7 days (adjusted odds ratio [OR]:
2.63; 95% confidence interval [CI]: 1.24-5.58; p=0.01). At 30 days,
patients with moderate/severe atheroma grade had a greater risk of death,
stroke or AKI (adjusted OR: 1.97; 95%CI: 1.04-3.71; p=0.04).
 CONCLUSION(S): Moderate/severe aortic atherosclerosis was associated
with an increased risk of adverse events following SAVR. Epiaortic
ultrasound may serve as a useful adjunct for identifying patients who may
benefit from strategies to reduce atheroembolic complications during
SAVR. Copyright © 2019. Published by Elsevier Inc.

<168>
Accession Number
629052570
Title
Combined Coronary Artery Bypass Surgery with Bone Marrow Stem Cell
Transplantation - Are We There Yet?.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 06 Aug 2019.
Author
Ayyat K.S.; Argawi A.; Mende M.; Steinhoff G.; Borger M.A.; Deebis A.M.;
McCurry K.R.; Garbade J.
Institution
(Ayyat) Department of Thoracic and Cardiovascular Surgery & Department of
Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation,
Cleveland, USA; Department of Cardiothoracic Surgery, Zagazig University,
Zagazig, Egypt
(Argawi, Borger, Garbade) Department of Cardiac Surgery, Heart Center
University, Medicine Leipzig, Leipzig, Germany
(Mende) Coordination Centre for Clinical Trials, University of Leipzig,
Leipzig, Germany
(Steinhoff) Department of Cardiac Surgery, Reference and Translation
Center for Cardiac Stem Cell Therapy, University Medicine Rostock,
Rostock, Germany
(Deebis) Department of Cardiothoracic Surgery, Zagazig University,
Zagazig, Egypt
(McCurry) Department of Thoracic and Cardiovascular Surgery & Department
of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation,
Cleveland, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although the safety and feasibility of combined coronary
artery bypass grafting (CABG) and bone marrow stem cell (BMSC)
transplantation have been proven, the efficacy of this approach remains
controversial. We, therefore, conducted an updated meta-analysis of
randomized controlled trials to evaluate the efficacy of this procedure.
 METHOD(S): Electronic databases were systematically searched for
randomized trials comparing 4-6 month follow-up outcomes in patients who
underwent isolated CABG "CABG group" and patients who received BMSC
transplantation with CABG "BMSC group". A random-effects meta-analysis was
conducted across eligible studies. Meta-regression and subgroup analyses
were utilized to identify sources of data heterogeneity. RESULT(S):
Thirteen trials were eligible with a total number of 292 patients in "BMSC
group" and 247 patients in "CABG group". Compared to CABG group, BMSC
group showed significant improvement of follow-up left ventricular
ejection fraction [n=539, 4.8%, 95% confidence interval (CI): 2.3% to
7.3%, p=0.001]. The analyzed data showed significant heterogeneity
(I2=74.2%, p<0.001). The reduction in scar size and the improvement in the
6 minute walk test did not reach statistical significant (n=120, -2.2ml,
95%CI: -18.2 to 13.7, p=0.44; n=212, 41m, 95%CI: -13 to 95, p=0.10,
respectively). No significant correlation was found between the number of
the injected BMSC or the method of injection and the change in ejection
fraction. CONCLUSION(S): The present evidence suggests that combined
CABG and BMSC transplantation is associated with improvement of left
ventricular ejection fraction. However, the heterogeneity in the data
suggests variations in patient response to this therapy. Further studies
are required to understand these variations. Copyright © 2019.
Published by Elsevier Inc.

<169>
Accession Number
629050790
Title
Effect of Cardiac Rehabilitation on Sexual Satisfaction Among Patients
After Coronary Artery Bypass Graft Surgery.
Source
Journal of cardiopulmonary rehabilitation and prevention. (no pagination),
2019. Date of Publication: 07 Aug 2019.
Author
Rakhshan M.; Toufigh A.; Dehghani A.; Yaktatalab S.
Institution
(Rakhshan) Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
Publisher
NLM (Medline)
Abstract
PURPOSE: After coronary artery bypass graft (CABG) surgery, many patients
experience diminished sexual function and satisfaction. The present study
aimed to investigate the effect of outpatient cardiac rehabilitation (OCR)
on the level of sexual satisfaction among post-CABG patients.
 METHOD(S): A clinical trial was performed at the Al-Zahra Hospital,
Shiraz, Iran, from July 2017 to January 2018. Based on the inclusion
criteria, 104 post-CABG patients were recruited into the study. The
participants were randomly assigned to the intervention (OCR) group (n =
52) or the usual care group (n = 52). The intervention group received 20
sessions of OCR, whereas the usual care group received the routine
hospital care and education. Data were collected using the Index of Sexual
Satisfaction and a demographic data sheet. The data were analyzed using
the SPSS software, v23.0 (IBM) and the independent sample t test,
paired-samples t test, and chi test. RESULT(S): There was no
statistically significant difference in the mean pre-intervention score
for sexual satisfaction between the groups. However, a statistically
significant difference in the mean post-intervention score for sexual
satisfaction was observed between the groups (P < .001). The difference in
the mean pre- and post-intervention scores for sexual satisfaction in the
intervention group was statistically significant (P < .001), whereas there
was no significant difference in the usual care group. CONCLUSION(S):
Post-CABG patients who completed the OCR program experienced an increased
level of sexual satisfaction. It is, therefore, recommended to include an
OCR program as part of the patient treatment and aftercare following CABG
surgery.

<170>
Accession Number
629041784
Title
Multiarterial coronary artery bypass grafting: is the radial artery
fulfilling the unkept promise of the right internal thoracic artery?.
Source
Current opinion in cardiology. (no pagination), 2019. Date of Publication:
05 Aug 2019.
Author
Affronti A.; Ruel M.; Gaudino M.F.L.
Institution
(Affronti, Ruel) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, Canada
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York City, NY, United States
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: The debate on the second best conduit for CABG is still
intense. In this review, we discuss the role of the radial artery and the
right internal thoracic artery (RITA) compared with saphenous vein grafts
(SVG). RECENT FINDINGS: The recent RADIAL STUDY has been the first
evidence based on randomized trials of a clinical benefit using a second
arterial graft in CABG.On the other hand, the definitive 10-year results
of the ART trial failed to show a clinical advantage associated with the
use of bilateral internal thoracic artery (BITA). A thorough and
contextualized analysis of this and other studies, however, may offer a
different perspective. SUMMARY: Arterial conduits in CABG have shown
better patency rates than SVG. Whether this leads to better clinical
outcomes is still debated. In this setting, the radial artery and the RITA
seem to offer a similar advantage, although with different indications and
contraindications.

<171>
Accession Number
2002702062
Title
Meta-Analysis of Transthoracic Echocardiography Versus Cardiac Magnetic
Resonance for the Assessment of Aortic Regurgitation After Transcatheter
Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Papanastasiou C.A.; Kokkinidis D.G.; Jonnalagadda A.K.; Oikonomou E.K.;
Kampaktsis P.N.; Garcia M.J.; Myerson S.G.; Karamitsos T.D.
Institution
(Papanastasiou, Karamitsos) 1st Department of Cardiology, Aristotle
University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
(Kokkinidis) Department of Medicine, Jacobi Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
(Jonnalagadda) Division of Cardiology, Medstar, Washington Hospital
Center, Washington, DC, United States
(Oikonomou) Department of Internal Medicine, Yale New Haven Hospital, Yale
School of Medicine, New Haven, CT, United States
(Kampaktsis) Department of Medicine, New York Presbyterian Hospital/Weil
Cornell Medical College, NY, United States
(Garcia) Division of Cardiology, Department of Medicine, Jacobi Medical
Center, Albert Einstein College of Medicine, Bronx, NY, United States
(Myerson) Division of Cardiovascular Medicine, Radcliffe Department of
Medicine, University of Oxford, Oxford, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Residual aortic regurgitation (AR) is a major complication after
transcatheter aortic valve implantation (TAVI). Although the
echocardiographic assessment of post-TAVI AR remains challenging, cardiac
magnetic resonance (CMR) allows direct quantification of AR. The aim of
this study was to review the level of agreement between 2-dimensional
transthoracic echocardiography (2D TTE) and CMR on grading the severity of
AR after TAVI, and determine the accuracy of TTE in detecting moderate or
severe AR. Electronic databases were searched in order to identify studies
comparing 2D TTE to CMR for post-TAVI AR assessment. Kappa coefficient was
used to determine the level of agreement between the 2 imaging modalities.
CMR was used as the reference standard in order to assess the diagnostic
accuracy of 2D TTE. Seven studies were included in this systematic review.
Six studies reported a low correlation between 2D TTE and CMR (kappa
coefficient ranging from -0.02 to 0.41), whereas one study showed good
agreement with a kappa coefficient of 0.72. Given the heterogeneity in the
included studies the diagnostic accuracy of TTE was evaluated by
estimating the hierarchical summary receiver operator characteristic
curve. The area under the curve for detection of moderate or severe AR
with TTE was 0.83 (95% confidence interval 0.79 to 0.86). In conclusion,
despite the reported significant disconcordance between TTE and CMR
grading of AR, TTE has sufficient ability to discriminate moderate or
severe AR from mild or none AR after TAVI in the clinical setting. CMR
should be considered when TTE results are equivocal. Copyright ©
2019 Elsevier Inc.

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