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<1>
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.

<2>
Accession Number
2001494502
Title
Septal Myectomy With Vs Without Subvalvular Apparatus Intervention in
Patients With Hypertrophic Obstructive Cardiomyopathy: A Prospective
Randomized Study.
Source
Seminars in Thoracic and Cardiovascular Surgery. 31 (3) (pp 424-431),
2019. Date of Publication: Autumn 2019.
Author
Bogachev-Prokophiev A.; Afanasyev A.V.; Zheleznev S.; Pivkin A.;
Sharifulin R.; Kozmin D.; Karaskov A.
Institution
(Bogachev-Prokophiev, Afanasyev, Zheleznev, Pivkin, Sharifulin, Karaskov)
Heart Valve Surgery Department, Meshalkin National Medical Research
Center, Novosibirsk, Russian Federation
(Kozmin) Cardiac Surgery Department, Federal Center for Cardiovascular
Surgery, Astrakhan, Russian Federation
Publisher
W.B. Saunders
Abstract
Surgical septal myectomy is a standard treatment option for patients with
hypertrophic obstructive cardiomyopathy. Subvalvular abnormalities of the
mitral valve might play an important role in residual left ventricular
outflow tract obstruction. This randomized study aimed to compare the
surgical outcomes of septal myectomy with vs without subvalvular
interventions. Between July 2015 and December 2016, 80 eligible patients
were randomly assigned to undergo septal myectomy with vs without
subvalvular intervention. The peak gradient was 92.3 +/- 16.9 and 88.1 +/-
15.4 mm Hg, respectively (P = 0.281). The mean septum thickness was 26.8
+/- 4.5 and 26.1 +/- 4.2 mm, respectively (P = 0.504). Moderate or severe
systolic anterior motion syndrome-mediated mitral regurgitation was
observed in all patients. There was no residual mitral regurgitation in
the group with subvalvular intervention, while 15% of patients in the
control group had regurgitation (P = 0.013). Residual systolic anterior
motion syndrome was observed in 5% and 27.5% of patients, respectively (P
= 0.007). The median postoperative gradient was 13 (interquartile range
9-16) mm Hg and 8 (interquartile range 4-12) mm Hg, respectively (P = 0.
0.019). At the 12-month follow-up, all patients were alive. There were
87.5% vs 77.5%, and 12.5% vs 22.5% of patients categorized as having New
York Heart Association functional classes I and II, respectively (P =
0.378). The prevalence rate of residual mitral regurgitation was 10% and
32.5%, respectively (P = 0.010). Concomitant subvalvular intervention
during septal myectomy more effectively eliminates left ventricular
outflow tract obstruction, providing better freedom from residual mitral
regurgitation without clinical benefit 1 year after surgery. Copyright
© 2019 Elsevier Inc.

<3>
Accession Number
625544649
Title
Glycaemic efficacy and safety of linagliptin compared to a basal-bolus
insulin regimen in patients with type 2 diabetes undergoing non-cardiac
surgery: A multicentre randomized clinical trial.
Source
Diabetes, Obesity and Metabolism. 21 (4) (pp 837-843), 2019. Date of
Publication: April 2019.
Author
Vellanki P.; Rasouli N.; Baldwin D.; Alexanian S.; Anzola I.; Urrutia M.;
Cardona S.; Peng L.; Pasquel F.J.; Umpierrez G.E.; Bakhtiari H.; Wang
C.L.; Jones J.; Modzelewski K.; Ensminger E.; Haw J.S.; Fayfman M.; Ramos
C.; Gomez P.
Institution
(Vellanki, Anzola, Urrutia, Cardona, Pasquel, Umpierrez) Division of
Endocrinology, Metabolism and Lipids, Department of Medicine, Emory
University School of Medicine, Atlanta, GA, United States
(Rasouli) Division of Endocrinology, Metabolism and Diabetes, Department
of Medicine, University of Colorado-Denver, Denver, CO, United States
(Baldwin) Division of Endocrinology, Department of Medicine, Rush
University Medical Center, Chicago, IL, United States
(Alexanian) Division of Endocrinology, Diabetes and Nutrition, Department
of Medicine, Boston University, Boston, MA, United States
(Peng) Department of Biostatistics, Rollins School of Public Health, Emory
University, Atlanta, GA, United States
(Bakhtiari, Wang) University of Colorado, Division of Endocrinology,
United States
(Jones) Rush University, Division of Endocrinology, United States
(Modzelewski, Ensminger) Boston University, Division of Endocrinology,
United States
(Haw, Fayfman, Ramos, Gomez) Emory University, Division of Endocrinology,
Metabolism and Lipids, United States
Publisher
Blackwell Publishing Ltd
Abstract
Aims: The use of incretin-based therapy, rather than or complementary to,
insulin therapy is an active area of research in hospitalized patients
with type 2 diabetes (T2D). We determined the glycaemic efficacy and
safety of linagliptin compared to a basal-bolus insulin regimen in
hospitalized surgical patients with T2D. Material(s) and Method(s):
This prospective open-label multicentre study randomized T2D patients
undergoing non-cardiac surgery with admission blood glucose (BG) of 7.8 to
22.2 mmol/L who were under treatment with diet, oral agents or total
insulin dose (TDD) <= 0.5 units/kg/day to either linagliptin (n = 128)
daily or basal-bolus (n = 122) with glargine once daily and rapid-acting
insulin before meals. Both groups received supplemental insulin for BG >
7.8 mmol/L. The primary endpoint was difference in mean daily BG between
groups. Result(s): Mean daily BG was higher in the linagliptin group
compared to the basal-bolus group (9.5 +/- 2.6 vs 8.8 +/- 2.3 mmol/L/dL, P
= 0.03) with a mean daily BG difference of 0.6 mmol/L (95% confidence
interval 0.04, 1.2). In patients with randomization BG < 11.1 mmol/L (63%
of cohort), mean daily BG was similar in the linagliptin and basal-bolus
groups (8.9 +/- 2.3 vs 8.7 +/- 2.3 mmol/L, P = 0.43); however, patients
with BG >= 11.1 mmol/L who were treated with linagliptin had higher BG
compared to the basal-bolus group (10.9 +/- 2.6 vs 9.2 +/- 2.2 mmol/L, P <
0.001). Linagliptin resulted in fewer hypoglycaemic events (1.6% vs 11%, P
= 0.001; 86% relative risk reduction), with similar supplemental insulin
and fewer daily insulin injections (2.0 +/- 3.3 vs 3.1 +/- 3.3, P < 0.001)
compared to the basal-bolus group. Conclusion(s): For patients with
T2D undergoing non-cardiac surgery who presented with mild to moderate
hyperglycaemia (BG < 11.1 mmol/L), daily linagliptin is a safe and
effective alternative to multi-dose insulin therapy, resulting in similar
glucose control with lower hypoglycaemia. Copyright © 2018 John
Wiley & Sons Ltd

<4>
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

<5>
Accession Number
618782328
Title
Peri-operative continuation of metformin does not improve glycaemic
control in patients with type 2 diabetes: A randomized controlled trial.
Source
Diabetes, Obesity and Metabolism. 20 (3) (pp 749-752), 2018. Date of
Publication: March 2018.
Author
Hulst A.H.; Polderman J.A.W.; Ouweneel E.; Pijl A.J.; Hollmann M.W.;
DeVries J.H.; Preckel B.; Hermanides J.
Institution
(Hulst, Polderman, Ouweneel, Hollmann, Preckel, Hermanides) Department of
Anaesthesiology, Academic Medical Centre, University of Amsterdam,
Amsterdam, Netherlands
(Pijl) Department of Anaesthesiology, Medical Centre Slotervaart,
Amsterdam, Netherlands
(DeVries) Department of Internal Medicine, Academic Medical Centre,
University of Amsterdam, Amsterdam, Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
Historically, metformin was withheld before surgery for fear of
metformin-associated lactic acidosis. Currently, however, this risk is
deemed to be low and guidelines have moved towards the continuation of
metformin. We hypothesized that continuing metformin peri-operatively
would lower postoperative serum glucose level without an effect on plasma
lactate levels. We performed a single-blind multicentre randomized
controlled trial in people with type 2 diabetes mellitus scheduled for
non-cardiac surgery and continued (MF+ group) or withheld (MF- group)
metformin before surgery. The main outcome measures were the differences
in peri-operative plasma glucose and lactate levels. We randomized 70
patients (37 MF+ group and 33 MF- group) with type 2 diabetes mellitus.
Postoperative glucose levels were similar in the MF+ and the MF- groups
(8.2 +/- 1.8 vs 8.3 +/- 2.3 mmol/L P =.95) Although preoperative lactate
levels were slightly higher in the MF+ group compared with the MF- group
(1.5 vs 1.2 mmol/L; P =.02), the postoperative lactate levels were not
significantly different (1.2 vs 1.0 mmol/L; P =.18). In conclusion,
continuation of metformin during elective non-cardiac surgery does not
improve glucose control or raise lactate levels to a clinically relevant
degree. Copyright © 2017 John Wiley & Sons Ltd

<6>
Accession Number
628206345
Title
Effects and Tolerance of Protein and Energy-Enriched Formula in Infants
Following Congenital Heart Surgery: A Randomized Controlled Trial.
Source
Journal of Parenteral and Enteral Nutrition. 42 (1) (pp 196-204), 2018.
Date of Publication: January 2018.
Author
Cui Y.; Li L.; Hu C.; Shi H.; Li J.; Gupta R.K.; Liang H.; Chen X.; Gong
S.
Institution
(Cui, Gupta, Gong) The First Affiliated Hospital of Jinan University,
Guangzhou, China
(Cui, Li, Hu, Li, Chen) Cardiac Intensive Care Unit, Heart Center,
Guangzhou Women and Children's Medical Center, Guangzhou Medical
University, Guangzhou, China
(Shi, Liang) Institute of Pediatrics, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
(Gong) Department of Gastroenterology, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Nutrition support is important for clinical management to
improve outcomes of infants following congenital heart surgery.
Protein-enriched and energy-enriched formula (PE-formula) may help provide
adequate nutrition and promote wound healing. However, the effects and
tolerance of increased protein and energy intakes of these infants have
not been well defined. Objective(s): To evaluate nutrition effects
and tolerance of a PE-formula compared with the standard formula
(S-formula) in infants in the first 5 days after congenital heart surgery.
 Method(s): Fifty infants were randomly assigned to S-formula
(S-group, n = 24) or PE-formula (PE-group, n = 26). Daily nutrient intakes
and tolerance were recorded. Plasma amino acid concentrations were
measured. Cumulative energy balance and nitrogen balance were calculated.
 Result(s): Nutrient intakes were significantly higher in the PE-group
after day 1, and all met the adequate intakes as early as day 2. Nitrogen
balance in the PE-group met positive balance from day 2, whereas in the
S-group, this was not until day 5. The PE-group also had a significantly
higher increase in many essential amino acids. With the exception of
tolerable diarrhea (multivariate adjusted hazard ratio, 3.16; 95%
confidence interval, 1.24-8.01), the PE-group did not have a significantly
higher incidence of intolerable events. Conclusion(s): In infants
during the early postoperative period after congenital heart surgery,
early administration of PE-formula was as well tolerated as S-formula and
effective in achieving higher nutrition intakes and earlier nitrogen
balance. Further research is warranted to support the use of PE-formula in
this special group of infants. Copyright © 2017 American Society
for Parenteral and Enteral Nutrition

<7>
Accession Number
2000680316
Title
Rigid Plate Fixation Versus Wire Cerclage: Patient-Reported and Economic
Outcomes From a Randomized Trial.
Source
Annals of Thoracic Surgery. 105 (5) (pp 1344-1350), 2018. Date of
Publication: May 2018.
Author
Allen K.B.; Thourani V.H.; Naka Y.; Grubb K.J.; Grehan J.; Patel N.; Guy
T.S.; Landolfo K.; Gerdisch M.; Bonnell M.; Cohen D.J.
Institution
(Allen) Department of Cardiothoracic Surgery, Saint Luke's Mid America
Heart Institute, Kansas City, Missouri, United States
(Thourani) Division of Cardiothoracic Surgery, Department of Surgery,
Emory University School of Medicine, Atlanta, United States
(Naka) Division of Cardiothoracic Surgery, Department of Surgery, Columbia
University Medical Center, New York, New York, United States
(Grubb) Department of Cardiovascular and Thoracic Surgery, University of
Louisville, Louisville, Kentucky, United States
(Grehan) Department of Cardiothoracic Surgery, Allina Health, St. Paul,
Minnesota, United States
(Patel) Department of Cardiothoracic Surgery, Lenox Hill Hospital, New
York, New York, United States
(Guy) Department of Cardiothoracic Surgery, Temple University,
Philadelphia, Pennsylvania, United States
(Landolfo) Department of Cardiothoracic Surgery, Mayo Clinic,
Jacksonville, Florida, United States
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan St. Francis
Health, Indianapolis, Indiana, United States
(Bonnell) Department of Cardiothoracic Surgery, University of Toledo,
Toledo, Ohio, United States
(Cohen) Department of Cardiology, Saint Luke's Mid America Heart
Institute, Kansas City, Missouri, United States
Publisher
Elsevier USA
Abstract
Background: In a multicenter randomized trial, sternal closure after
cardiac operations using rigid plate fixation (RPF) compared with wire
cerclage (WC) resulted in improved sternal healing, reduced sternal
complications, and was cost neutral at 6 months. Additional secondary end
points are presented from this trial. Method(s): Twelve United States
centers randomized 236 patients to RPF (n = 116) or WC (n = 120).
Patient-reported outcomes measures, including pain, function, and quality
of life scores, were assessed through 6 months and correlated to computed
tomography-derived sternal healing scores using logistic regression. Cost
analysis through 90 days was performed to mimic bundled care models.
 Result(s): All patient-reported outcomes measures were numerically
better in RPF patients than in WC patients at all assessments. RPF
resulted in more patients reporting no sternal pain after coughing at 3
weeks (41.1% vs 19.6%; p = 0.001) and 6 weeks (54.5% vs 35.1%; p = 0.005)
and at rest at 6 weeks (74.1% vs 58.8%; p = 0.02) and 3 months (87.6% vs
75.9%; p = 0.03) compared with WC. Better sternal healing scores
correlated to having no sternal pain at rest (odds ratio, 1.6; 95%
confidence interval, 1.2 to 2.2; p = 0.002) and after coughing (odds
ratio, 1.6; 95% confidence interval, 1.2 to 2.2; p = 0.0007). RPF resulted
in improvements in the 36-Item Short Form Health Survey quality of life
scores at 3 weeks (53.5 +/- 8.7 vs 50.5 +/- 10.4; p = 0.03), 6 weeks (45.3
+/- 8.4 vs 42.7 +/- 8.4; p = 0.03), and 6 months (56.4 +/- 6.8 vs 53.9 +/-
9.0; p = 0.04) compared with WC. Through 90 days, RPF compared with WC was
$1,888 less (95% confidence interval, -$8,889 to $4,273; p = 0.52).
 Conclusion(s): In patients undergoing sternal closure after median
sternotomy, RPF compared with WC resulted in reduced sternal pain,
improved upper extremity function, and similar total 90-day
costs. Copyright © 2018 The Authors

<8>
Accession Number
617604749
Title
Effect of continuous exenatide infusion on cardiac function and
peri-operative glucose control in patients undergoing cardiac surgery: A
single-blind, randomized controlled trial.
Source
Diabetes, Obesity and Metabolism. 19 (12) (pp 1818-1822), 2017. Date of
Publication: December 2017.
Author
Lips M.; Mraz M.; Klouckova J.; Kopecky P.; Dobias M.; Krizova J.; Lindner
J.; Diamant M.; Haluzik M.
Institution
(Lips, Kopecky, Dobias) Department of Anaesthesiology, Resuscitation and
Intensive Care, First Faculty of Medicine, Charles University and General
University Hospital, Prague, Czechia
(Mraz, Haluzik) Department of Diabetes, Diabetes Centre, Institute for
Clinical and Experimental Medicine, Prague, Czechia
(Mraz, Klouckova, Haluzik) Institute of Medical Biochemistry and
Laboratory Diagnostics, First Faculty of Medicine, Charles University and
General University Hospital, Prague, Czechia
(Klouckova, Haluzik) Department of Experimental Diabetology, Centre for
Experimental Medicine, Institute for Clinical and Experimental Medicine,
Prague, Czechia
(Krizova) 3rd Department of Medicine - Department of Endocrinology and
Metabolism, First Faculty of Medicine, Charles University and General
University Hospital, Prague, Czechia
(Lindner) 2nd Department of Surgery - Department of Cardiovascular
Surgery, First Faculty of Medicine, Charles University and General
University Hospital, Prague, Czechia
(Diamant) VU University Medical Centre, Amsterdam, Netherlands
(Haluzik) Department of Obesitology, Institute of Endocrinology, Prague,
Czechia
Publisher
Blackwell Publishing Ltd
Abstract
We performed a randomized controlled trial with the glucagon-like
peptide-1 (GLP-1) receptor agonist exenatide as add-on to standard
peri-operative insulin therapy in patients undergoing elective cardiac
surgery. The aims of the study were to intensify peri-operative glucose
control while minimizing the risk of hypoglycaemia and to evaluate the
suggested cardioprotective effects of GLP-1-based treatments. A total of
38 patients with decreased left ventricular systolic function (ejection
fraction <=50%) scheduled for elective coronary artery bypass grafting
(CABG) were randomized to receive either exenatide or placebo in a
continuous 72-hour intravenous (i.v.) infusion on top of standard
peri-operative insulin therapy. While no significant difference in
postoperative echocardiographic variables was found between the groups,
participants receiving exenatide showed improved peri-operative glucose
control as compared with the placebo group (average glycaemia 6.4 +/- 0.5
vs 7.3 +/- 0.8 mmol/L; P <.001; percentage of time in target range of
4.5-6.5 mmol/L 54.8% +/- 14.5% vs 38.6% +/- 14.4%; P =.001; percentage of
time above target range 39.7% +/- 13.9% vs 52.8% +/- 15.2%; P =.009)
without an increased risk of hypoglycaemia (glycaemia <3.3 mmol/L: 0.10
+/- 0.32 vs 0.21 +/- 0.42 episodes per participant; P =.586). Continuous
administration of i.v. exenatide in patients undergoing elective CABG
could provide a safe option for intensifying the peri-operative glucose
management of such patients. Copyright © 2017 John Wiley & Sons
Ltd

<9>
Accession Number
611124576
Title
Lipoprotein-associated phospholipase A<inf>2</inf> activity is a marker of
risk but not a useful target for treatment in patients with stable
coronary heart disease.
Source
Journal of the American Heart Association. 5 (6) (no pagination), 2016.
Article Number: e003407. Date of Publication: 01 Jun 2016.
Author
Wallentin L.; Held C.; Armstrong P.W.; Cannon C.P.; Davies R.Y.; Granger
C.B.; Hagstrom E.; Harrington R.A.; Hochman J.S.; Koenig W.; Krug-Gourley
S.; Mohler E.R.; Siegbahn A.; Tarka E.; Steg P.G.; Stewart R.A.H.; Weiss
R.; Ostlund O.; White H.D.; Budaj A.; Ardissino D.; Avezum A.; Aylward
P.E.; Bryce A.; Chen H.; Chen M.-F.; Corbalan R.; Dalby A.J.; Danchin N.;
De Winter R.J.; Denchev S.; Diaz R.; Elisaf M.; Flather M.D.; Goudev A.R.;
Grinfeld L.; Husted S.; Kim H.-S.; Linhart A.; Lonn E.; Lopez-Sendon J.;
Manolis A.J.; Nicolau J.C.; Pais P.; Parkhomenko A.; Pedersen T.R.; Pella
D.; Ramos-Corrales M.A.; Ruda M.; Sereg M.; Siddique S.; Sinnaeve P.;
Sritara P.; Swart H.P.; Sy R.G.; Teramoto T.; Tse H.-F.; Douglas Weaver
W.; Viigimaa M.; Vinereanu D.; Zhu J.
Institution
(Wallentin, Held, Hagstrom) Department of Medical Sciences, Cardiology,
Uppsala University, Uppsala, Sweden
(Wallentin, Held, Hagstrom, Siegbahn, Ostlund) Uppsala Clinical Research
Center (UCR), Uppsala University, Uppsala, Sweden
(Siegbahn) Department of Medical Sciences, Clinical Chemistry, Uppsala
University, Uppsala, Sweden
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
(Cannon) Cardiovascular Division, Brigham and Women's Hospital, Boston,
MA, United States
(Cannon) Harvard Clinical Research Institute, Boston, MA, United States
(Davies, Krug-Gourley) Metabolic Pathways and Cardiovascular Therapeutic
Area, GlaxoSmithKline, King of Prussia, PA, United States
(Tarka) Former Employee of Metabolic Pathways and Cardiovascular
Therapeutic Area, GlaxoSmithKline, King of Prussia, PA, United States
(Granger) Medical Center, Duke University, Durham, NC, United States
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
(Hochman) Department of Medicine, NYU Langone Medical Center, New York,
NY, United States
(Koenig) Department of Internal Medicine II-Cardiology, University of Ulm
Medical Center, Ulm, Germany
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Koenig) DZHK (German Centre for Cardiovascular Research), Partner Site
Munich Heart Alliance, Munich, Germany
(Mohler) Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Steg) FACT (French Alliance for Cardiovascular Trials), Paris, France
(Steg) DHU FIRE, Universite Paris-Diderot, Sorbonne Paris-Cite, Paris,
France
(Steg) Hopital Bichat, INSERUM U-1148, Paris, France
(Steg) NHLI, ICMS, Imperial College, Royal Brompton Hospital, London,
United Kingdom
(Stewart, White) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Stewart, White) University of Auckland, New Zealand
(Weiss) Maine Research Associates, Auburn, ME, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland University, Auckland, New Zealand
(Wallentin) Department of Medical Sciences and Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Budaj) Grochowski Hospital, Warsaw, Poland
(Cannon) TIMI Study Group, Brigham and Women's Hospital, Boston, MA,
United States
(Harrington) Stanford University, Stanford, CA, United States
(Steg) INSERM-Unite, APHP, Hopital Bichat and Universite Paris-Diderot,
Paris, France
(Davies) GlaxoSmithKline, King of Prussia, PA, United States
(Tarka) GlaxoSmithKline, King of Prussia, PA, United States
(Ardissino) Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
(Armstrong) University of Alberta, Edmonton, CA, Canada
(Avezum) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, SA, Australia
(Bryce) Cardiogolf/Clinica El Golf, Lima, Peru
(Chen) Peking University People's Hospital, Beijing, China
(Chen) National Taiwan University Hospital, Taipei, Taiwan (Republic of
China)
(Corbalan) Pontificia Universidad Catolica de Chile, Santiago, Chile
(Dalby) Milpark Hospital, Johannesburg, South Africa
(Danchin) AP-HP and Universite Paris Descartes, Paris, France
(De Winter) University of Amsterdam, Amsterdam, Netherlands
(Denchev) University Hospital Alexandrovska, Sofia, Bangladesh
(Diaz) ECLA Estudios Cardiologicos, Latinoamerica, Rosario, Argentina
(Elisaf) University of Ioannina, Ioannina, Greece
(Flather) University of East Anglia and Norfolk, Norwich University
Hospital, United Kingdom
(Goudev) Queen Giovanna University Hospital, Sofia, Bangladesh
(Granger) Duke University, Medical Center, Durham, NC, United States
(Grinfeld) University of Buenos Aires, School of Medicine, Buenos Aires,
Argentina
(Held) Department of Medical Sciences, Cardiology, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Hochman) NYU Langone Medical Center, New York, NY, United States
(Husted) Hospital Unit West, Herning/Holstebro, Denmark
(Kim) Seoul National University Hospital, Seoul, South Korea
(Koenig) University of Ulm Medical Center, Ulm, Germany
(Linhart) Charles University in Prague, Prague, Czechia
(Lonn) McMaster University, Hamilton, ON, Canada
(Lopez-Sendon) Hospital Universitario La Paz, Madrid, Spain
(Manolis) Asklepeion Hospital, Athens, Greece
(Mohler) University of Pennsylvania, Philadelphia, PA, United States
(Nicolau) University of Sao Paulo Medical School, Sao Paulo, Brazil
(Pais) St. John's Medical Collage, Bangalore, India
(Parkhomenko) Institute of Cardiology, Kiev, Ukraine
(Pedersen) University of Oslo, Oslo University Hospital, Oslo, Norway
(Pella) PJ Safarik University, Kosice, Slovakia
(Ramos-Corrales) San Jose Satelite Hospital, Naucalpan, Mexico
(Ruda) Russian Cardiologic Research and Production Complex of
Rosmedtechnology, Moscow, Russian Federation
(Sereg) St. George Hospital, Szekesfehervar, Hungary
(Siddique) Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan
(Sinnaeve) University Hospitals Leuven, Leuven, Belgium
(Sritara) Mahidol University, Bangkok, Thailand
(Stewart) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland University, Auckland, New Zealand
(Swart) Antonius Hospital Sneek, Netherlands
(Sy) University of the Philippines, Manila, Philippines
(Teramoto) Teikyo Academic Research Center, Itabashi-ku, Tokyo, Japan
(Tse) University of Hong Kong, Hong Kong
(Douglas Weaver) Henry Ford Heart and Vascular Institute, Wayne State
University, Detroit, MI, United States
(Weiss) Maine Research Associates, Auburn, ME, United States
(Viigimaa) Tallinn University of Technology, Tallinn, Estonia
(Vinereanu) University of Medicine and Pharmacy, University and Emergency
Hospital, Bucharest, Romania
(Zhu) Fudan University, Shanghai, China
(Steg) Royal Brompton Hospital, London, United Kingdom
Publisher
John Wiley and Sons Inc.
Abstract
Background--We evaluated lipoprotein-associated phospholipase
A<inf>2</inf> (Lp-PLA<inf>2</inf>) activity in patients with stable
coronary heart disease before and during treatment with darapladib, a
selective Lp-PLA<inf>2</inf> inhibitor, in relation to outcomes and the
effects of darapladib in the STABILITY trial. Methods and Results--Plasma
Lp-PLA<inf>2</inf> activity was determined at baseline (n=14 500); at 1
month (n=13 709); serially (n=100) at 3, 6, and 18 months; and at the end
of treatment. Adjusted Cox regression models evaluated associations
between Lp-PLA<inf>2</inf> activity levels and outcomes. At baseline, the
median Lp-PLA<inf>2</inf> level was 172.4 lmol/min per liter
(interquartile range 143.1-204.2 lmol/min per liter). Comparing the
highest and lowest Lp-PLA<inf>2</inf> quartile groups, the hazard ratios
were 1.50 (95% CI 1.23-1.82) for the primary composite end point
(cardiovascular death, myocardial infarction, or stroke), 1.95 (95% CI
1.29-2.93) for hospitalization for heart failure, 1.42 (1.07-1.89) for
cardiovascular death, and 1.37 (1.03-1.81) for myocardial infarction after
adjustment for baseline characteristics, standard laboratory variables,
and other prognostic biomarkers. Treatment with darapladib led to a =65%
persistent reduction in median Lp-PLA<inf>2</inf> activity. There were no
associations between on-treatment Lp-PLA<inf>2</inf> activity or changes
of Lp-PLA<inf>2</inf> activity and outcomes, and there were no significant
interactions between baseline and on-treatment Lp- PLA<inf>2</inf>
activity or changes in Lp-PLA<inf>2</inf> activity levels and the effects
of darapladib on outcomes. Conclusions--Although high Lp-PLA<inf>2</inf>
activity was associated with increased risk of cardiovascular events,
pharmacological lowering of Lp-PLA<inf>2</inf> activity by =65% did not
significantly reduce cardiovascular events in patients with stable
coronary heart disease, regardless of the baseline level or the magnitude
of change of Lp-PLA<inf>2</inf> activity. Copyright © 2016 The
Authors.

<10>
Accession Number
362827128
Title
Differential response between diabetes and stress-induced hyperglycaemia
to algorithmic use of detemir and flexible mealtime aspart among stable
postcardiac surgery patients requiring intravenous insulin.
Source
Diabetes, Obesity and Metabolism. 13 (12) (pp 1130-1135), 2011. Date of
Publication: December 2011.
Author
Dungan K.; Hall C.; Schuster D.; Osei K.
Institution
(Dungan, Hall, Schuster, Osei) Division of Endocrinology, Diabetes and
Metabolism, The Ohio State University, Columbus, OH, United States
Publisher
Blackwell Publishing Ltd
Abstract
Aim: To determine whether an insulin algorithm could be used in a similar
manner in the setting of diabetes and stress hyperglycaemia following
cessation of intravenous (IV) insulin after cardiac surgery.
 Method(s): Subjects who were clinically stable, requiring >=1 unit/h
of IV insulin 48 h after surgery, were randomized to once daily detemir at
50, 65 or 80% of IV insulin requirements and received aspart according to
carbohydrate intake. Diabetes was defined as any history of diabetes or
preoperative HbA1c 6.5%. Result(s): The morning glucose in patients
with diabetes was 143 mg/dl (n = 61) vs. 124 mg/dl in those with stress
hyperglycaemia (n = 21, p = 0.05) on day 1 and 127 vs. 110 mg/dl over 72 h
(p = 0.01). This was unaffected by adjustment for initial dosing group. At
72 h, 56% of patients with stress hyperglycaemia reached AM (80-130 mg/dl)
and 87% reached overall (80-180 mg/dl) glucose targets, compared to 90 and
100% of patients with stress hyperglycaemia, respectively. There was no
difference in hypoglycaemia in patients with stress hyperglycaemia or
diabetes. The percentage of patients with diabetes receiving insulin was
46% on admission and 77% at discharge, compared to 0 and 42% of patients
with stress hyperglycaemia. Conclusion(s): Following cardiac surgery,
patients with stress hyperglycaemia may be converted from IV insulin to
detemir with a 50% conversion factor, while patients with diabetes may
require a higher conversion factor. Stress hyperglycaemia may be
prolonged; the intensity and duration of insulin therapy required for
optimal outcomes warrants further examination. © 2011 Blackwell
Publishing Ltd.

<11>
Accession Number
2002790064
Title
Intravascular ultrasound versus angiogram guided drug eluting stent
implantation. A systematic review and updated meta-analysis with trial
sequential analysis.
Source
IJC Heart and Vasculature. 25 (no pagination), 2019. Article Number:
100419. Date of Publication: December 2019.
Author
Kumar A.; Shariff M.; Adalja D.; Doshi R.
Institution
(Kumar, Shariff) Department of Critical Care Medicine, St John's Medical
College Hospital, Bengaluru, Karnataka, India
(Adalja) Department of Medicine, Gotri Medical Education and Research
Centre, Vadodara, Gujarat, India
(Doshi) Department of Internal Medicine, University of Nevada Reno School
of Medicine, Reno, NV, United States
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: Further advances have been achieved in the field of
intravenous ultrasound (IVUS) guided drug eluting stent (DES) implantation
and hence there was a need to rejuvenate the evidence. Hence, we performed
a cumulative meta-analysis with trial sequential analysis (TSA) of
randomized controlled trials (RCTs) comparing IVUS versus angiogram guided
DES implantation. Methodology: We searched PubMed/Medline and Cochrane
database for relevant articles using predefined inclusion and exclusion
criteria. Outcomes of interest were cardiovascular mortality, myocardial
infarction (MI), target lesion revascularisation (TLR), stent thrombosis
(ST). We used Mantel-Haenszel method with random error model to calculate
odds ratio (OR) with 95% confidence interval (CI). We also performed TSA
to accommodate for possible type I error. Result(s): A total of 11
RCTs with 5352 patients were included in the final analysis. Follow up
duration of included studies varied from 12 to 24 months. IVUS use was
associated with significantly reduced incidence of cardiovascular
mortality [OR: 0.45, CI: 0.25-0.80, p value = 0.007, I2 = 0%,
chi2 p-value = 0.98], TLR [OR: 0.56, CI: 0.41-0.77, p value =
0.0004, I2 = 0%, chi2 p-value = 0.95] and ST [OR:
0.47, CI: 0.24-0.94, p value = 0.03, I2 = 0%, chi2
p-value = 0.75]. IVUS use had no effect on incidence of MI on follow up.
The cumulative z curve crosses the TSA boundary indicating sufficient
evidence without type I error for reduced incidence of cardiovascular
mortality and TLR with the use IVUS. Conclusion(s): IVUS-guided DES
implantation should be the standard of care as it significantly reduced
cardiovascular mortality and TLR. Copyright © 2019 The Authors

<12>
[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..

<13>
Accession Number
628775534
Title
Mediastinitis in open heart surgery: a systematic review and meta-analysis
of risk factors.
Source
Scandinavian Cardiovascular Journal. 53 (5) (pp 226-234), 2019. Date of
Publication: 03 Sep 2019.
Author
Abdelnoor M.; Sandven I.; Vengen O.; Risnes I.
Institution
(Abdelnoor) Centre of Clinical Heart Research, Oslo University Hospital,
Oslo, Norway
(Abdelnoor) Epidemiology and Biological Statistics, Independent Health
Research Unit, Oslo, Norway
(Sandven) Oslo Centre of Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Vengen, Risnes) Department of Cardiovascular Surgery, Oslo University
Hospital, Oslo, Norway
(Risnes) Department of Cardiovascular Surgery, LHL Hospital, Gardemoen,
Norway
Publisher
Taylor and Francis Ltd
Abstract
Objective. We aimed to summarize the evidence from observational studies
examining the risk factors of the incidence of mediastinitis in open heart
surgery. Design. The study was a systematic review and meta-analysis of
cohorts and case-control studies. Material and methods. We searched the
literature and 74 studies with at least one risk factor were identified.
Both fixed and random effects models were used. Heterogeneity between
studies was examined by subgroup and meta-regression analysis. Publication
bias or small study effects were evaluated and corrected by limit
meta-analysis. Results. When correcting for small study effect, presence
of obesity as estimated from 43 studies had Odds Ratio OR = 2.26. (95% CI:
2.17-2.36). This risk was increasing with decreasing latitude of study
place. Presence of diabetes mellitus from 63 studies carried an OR = 1.90
(95% CI: 1.59-2.27). Presence of Chronic Obstructive Pulmonary Disease
(COPD) from 30 studies had an OR = 2.59 (95% CI: 2.22-2.85). Presence of
bilateral intramammary graft (BIMA) from 23 studies carried an OR = 2.54
(95% CI: 2.07-3.13). This risk was increasing with increasing frequency of
female patients in the study population. Conclusion. Evidence from this
study showed the robustness of the risk factors in the pathogenesis of
mediastinitis. Preventive measures can be implemented for reducing
obesity, especially in lower latitude countries. Furthermore, it is
mandatory to monitor perioperative hyperglycemias with continuous insulin
infusion. Use of skeletonized BIMA carries higher risk of mediastinitis
especially in female patients without evidence of beneficial effect on
survival for the time being. Copyright © 2019, © 2019
Informa UK Limited, trading as Taylor & Francis Group.

<14>
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.

<15>
Accession Number
2002725056
Title
The effects of preoperative aspirin on coronary artery bypass surgery: A
systematic meta-analysis.
Source
Korean Circulation Journal. 49 (6) (pp 498-510), 2019. Date of
Publication: 2019.
Author
Hwang D.; Lee J.M.; Rhee T.-M.; Kim Y.-C.; Park J.; Ahn C.; Song Y.B.;
Hahn J.-Y.; Kim K.-B.; Lee Y.-T.; Koo B.-K.
Institution
(Hwang, Rhee, Kim, Park, Park, Koo) Department of Internal Medicine,
Cardiovascular Center, Seoul National University Hospital, 101, Daehak-ro,
Jongno-gu, Seoul 03080, South Korea
(Lee, Song, Hahn) Department of Internal Medicine, Cardiovascular Center,
Samsung Medical Center, Sungkyunkwan University, School of Medicine,
Seoul, South Korea
(Ahn) Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD, United States
(Kim) Department of Thoracic and Cardiovascular Surgery, Seoul National
University Hospital, Seoul, South Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
(Koo) Institute of Aging, Seoul National University, Seoul, South Korea
Publisher
Korean Society of Circulation (E-mail: herz4@circulation.or.kr)
Abstract
Background and Objectives: Aspirin plays an important role in the
maintenance of graft patency and the prevention of thrombotic event after
coronary artery bypass graft surgery (CABG). However, the use of
preoperative aspirin is still under debate due to the risk of bleeding.
 Method(s): From PubMed, EMBASE, and Cochrane Central Register of
Controlled Trials, data were extracted by 2 independent reviewers.
Meta-analysis using random effect model was performed. Result(s): We
performed a systemic meta-analysis of 17 studies (12 randomized controlled
studies and 5 non-randomized registries) which compared clinical outcomes
of 9,101 patients who underwent CABG with or without preoperative aspirin
administration. Preoperative aspirin increased chest tube drainage
(weighted mean difference 177.4 mL, 95% confidence interval [CI],
41.3-313.4; p=0.011). However, the risk of re-operation for bleeding was
not different between the preoperative aspirin group and the control group
(3.2% vs. 2.4%; odds ratio [OR], 1.23; 95% CI, 0.94-1.60; p=0.102). There
was no difference in the rates of all-cause mortality (1.6% vs. 1.5%; OR,
0.98; 95% CI, 0.64-1.49; p=0.920) and myocardial infarction (MI) (8.7% vs.
10.4%; OR, 0.83; 95% CI, 0.66-1.04; p=0.102) between patients with and
without preoperative aspirin administration. Conclusion(s): Although
aspirin increased the amount of chest tube drainage, it was not associated
with increased risk of re-operation for bleeding. In addition, the risks
of early postoperative all-cause mortality and MI were not reduced by
using preoperative aspirin. Copyright © 2019. The Korean Society
of Cardiology This is an Open Access article distributed under the terms
of the Creative Commons Attribution Non-Commercial License
(https://creativecommons.org/licenses/by-nc/4.0) which permits
unrestricted noncommercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.

<16>
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.

<17>
Accession Number
626643755
Title
Remote ischaemic preconditioning ameliorates sinus rhythm restoration rate
through Cox maze radiofrequency procedure associated with inflammation
reaction reduction.
Source
Basic Research in Cardiology. 114 (3) (no pagination), 2019. Article
Number: 14. Date of Publication: 01 May 2019.
Author
Jiang Q.; Xiang B.; Wang H.; Huang K.; Kong H.; Hu S.
Institution
(Jiang, Xiang, Wang, Huang) Department of Cardiac Surgery, Sichuan
Provincial People's Hospital, Affiliated Hospital of University of
Electronic Science and Technology, #32, Western Section 2, 1st Ring Road,
Chengdu 610072, China
(Kong) Department of Heart Failure, Sichuan Provincial People's Hospital,
Affiliated Hospital of University of Electronic Science and Technology,
#32, Western Section 2, 1st Ring Road, Chengdu 610072, China
(Hu) Department of Cardiac Surgery, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing 100037, China
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Remote ischaemic preconditioning (RIPC) as adjuvant to selective heart
surgery attenuates cardiac injury and atrial fibrillation (AF) occurrence.
We investigated its effect on sinus rhythm (SR) restoration rate in
permanent AF patients undergoing Cox maze (CM) radiofrequency ablation
with concomitant mitral valve surgery. From May 2013 to May 2017, 206
patients with rheumatic valve disease concomitant with permanent AF were
randomized to receive prosthesis valve replacement and CM radiofrequency
ablation procedure with (n = 104) or without (n = 102) RIPC (intermittent
arm ischaemia through three cycles of 5-min inflation, followed by 5-min
deflation of a blood pressure cuff). The primary end point of the study
was freedom from cumulative AF without using antiarrhythmic drugs 1 year
after operation; the secondary end points included inflammation reaction
index over 48 h postoperatively and clinical outcomes. Baseline
characteristics and preoperative data did not differ between groups. The
SR restoration rates were significantly higher in the RIPC group, 85.6%,
83.7%, and 82.7%, than those in the control group, 72.5%, 70.6%, and
69.6%, at discharge, 6 months and 12 months, respectively, after the
radiofrequency ablation procedure (P < 0.05). The serum concentration of
high sensitivity C-reactive protein and neutrophil-lymphocyte ratio were
significantly decreased at 12 h, 24 h, and 48 h postoperatively in the
RIPC group compared to those in the control group (P < 0.05). RIPC induced
by brief ischaemia and reperfusion of the arm ameliorated SR restoration
rate in patients with permanent AF through CM radiofrequency ablation
procedure and was associated with reduction of postoperative systemic
inflammation reaction index. Copyright © 2019, Springer-Verlag
GmbH Germany, part of Springer Nature.

<18>
Accession Number
2002376256
Title
Total arterial revascularization strategies: A meta-analysis of propensity
score-matched observational studies.
Source
Journal of Cardiac Surgery. 34 (9) (pp 837-845), 2019. Date of
Publication: 01 Sep 2019.
Author
Urso S.; Sadaba R.; Gonzalez J.M.; Nogales E.; Pettinari M.; Tena M.A.;
Paredes F.; Portela F.
Institution
(Urso, Tena, Paredes, Portela) Cardiac Surgery Department, Hospital
Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
(Sadaba) Cardiac Surgery Department, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Gonzalez) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
(Nogales) Cardiology Department, Hospital Universitario Insular, Las
Palmas de Gran Canaria, Spain
(Pettinari) Cardiac Surgery Department, Ziekenhuis Oost Limburg, Genk,
Belgium
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim of the Study: We explored the current evidence
available on total arterial revascularization (TAR) carrying out a
meta-analysis of propensity score-matched studies comparing TAR versus
non-TAR strategy. Method(s): PubMed, EMBASE, and Google Scholar were
searched for propensity score-matched studies comparing TAR vs non-TAR.
The generic inverse variance method was used to compute the combined
hazard ratio (HR) of long-term mortality. The Der-Simonian and Laird
method were used to compute the combined risk ratio (RR) of 30-day
mortality, deep sternal wound infection, and reoperation for bleeding.
 Result(s): Eighteen TAR vs non-TAR matched populations were included.
Meta-analysis showed a significant benefit in terms of long-term survival
of the TAR group over the non-TAR group (HR: 0.73; 95% confidence interval
[CI]: 0.68-0.78). Better long-term survival over non-TAR strategy was
confirmed by both subgroups: TAR with the bilateral internal mammary
artery (BIMA) and TAR without BIMA. Meta-regression suggests that TAR may
offer a higher protective survival effect in diabetic patients
(coefficient: -0.0063; 95% CI: -0.01 to 0.0006), when carried out with
BIMA (coefficient: -0.15; 95% CI: -0.27 to -0.03) or using three arterial
conduits (coefficient: -0.12; 95% CI: -0.25 to 0.007). A TAR strategy
carried out using BIMA, differently from TAR without BIMA, increases the
risk of deep sternal infection (RR: 1.44; 95% CI: 1.17-1.77).
 Conclusion(s): TAR provides a long-term survival benefit compared
with the non-TAR strategy. Also, compared with TAR without BIMA, TAR with
BIMA may offer a higher protective long-term survival effect at the
expense of a higher risk of sternal deep wound infection. Copyright
© 2019 Wiley Periodicals, Inc.

<19>
Accession Number
2002709224
Title
Nontraumatic tension pneumopericardium in nonventilated pediatric
patients: a review.
Source
Journal of Cardiac Surgery. 34 (9) (pp 829-836), 2019. Date of
Publication: 01 Sep 2019.
Author
Bonardi C.M.; Spadini S.; Fazio P.C.; Galiazzo M.; Voltan E.; Coscini N.;
Padalino M.; Daverio M.
Institution
(Bonardi, Spadini, Fazio, Galiazzo, Voltan, Daverio) Department of Woman's
and Child's Health, Pediatric Intensive Care Unit, University Hospital of
Padua, Padua, Italy
(Coscini) Department for Community Child Health, Royal Children's
Hospital, Melbourne, Australia
(Padalino) Department of Cardiac, Thoracic and Vascular Sciences,
Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua,
Italy
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aims: Pneumopericardium is a rare air leak syndrome caused
by the abnormal presence of air in the pericardial sac, with a high risk
of morbidity and mortality. It is clinically divided into nontension and
tension pneumopericardium, with the latter resulting in a decreased
cardiac output and circulatory failure. There are limited data regarding
nontraumatic pneumopericardium in nonventilated pediatric patients.
Therefore, we aimed to describe a case of tension pneumopericardium and
review the available literature. Method(s): Case report and
literature review of nontraumatic pneumopericardium in nonventilated
pediatric patients. Result(s): A 2-month-old infant developed cardiac
tamponade secondary to tension pneumopericardium 11 days after cardiac
surgery promptly resolved with pericardium drainage. We reviewed the
literature on this topic and retrieved 50 cases, of which 72% were
nontension whereas a minority were tension pneumopericardium (28%).
Patients with tension pneumopericardium were mostly neonates (35.7% vs
22.2%), presented with an isolated air leak (64.3% vs 36.1%), and had a
history of surgery (28.6% vs 8.3%) or hematological disease (28.6% vs
11.1%). In all nontension cases, treatment was conservative, whilst in all
other cases, pericardiocentesis/pericardium drainage was carried out.
There was a high survival rate (86.0%), which was lower in patients with
tension pneumopericardium (71.4% vs 91.6%). Conclusion(s):
Pneumopericardium is a rare condition with a higher mortality rate in
patients with tension pneumopericardium, which requires immediate
diagnosis and treatment. In nonventilated patients, tension
pneumopericardium occurred more frequently in neonates, as an isolated air
leak, and in those with a history of surgery or hematological
disease. Copyright © 2019 Wiley Periodicals, Inc.

<20>
Accession Number
2002709223
Title
The 100 most cited manuscripts in coronary artery bypass grafting.
Source
Journal of Cardiac Surgery. 34 (9) (pp 782-787), 2019. Date of
Publication: 01 Sep 2019.
Author
Chan J.; Mak T.L.A.; Chu T.S.M.; Hui T.L.Y.; Kwan L.Y.A.
Institution
(Chan) Department of Cardiothoracic Surgery, Morriston Hospital, Swansea,
United Kingdom
(Mak, Kwan) Institute of Medical and Biomedical Education, St George's,
University of London, London, United Kingdom
(Chu) School of Medical Education, Newcastle University, Newcastle upon
Tyne, United Kingdom
(Hui) College of Medicine and Health, University of Exeter Medical School,
Exeter, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: To gain a better understanding of the progression of
coronary artery bypass grafting (CABG) and its impact on clinical
practice, bibliometric citation analysis can be performed. Bibliometric
citation analysis is a method of determining the most influential papers
on a topic based on several citations and impact factor. Method(s): A
search of the Thomson Reuters Web of Science citation indexing database
and research platform was completed using the terms "CABG," "Coronary
artery bypass graft," "Coronary artery," "bypass," and/or "bypass
grafting." The returned dataset was sorted by the number of citations.
 Result(s): The search yielded a total of 11 560 papers which were
ranked in order of citations. New England Journal of Medicine published
the most papers in the top 100 and generated the most significant number
of citations with 20 papers in total followed by Journal of the American
College of Cardiology. It also has the highest impact factor and 5-year
impact fact in 2007 of 79.26 and 67.513, respectively. Conclusion(s):
The most cited manuscripts by Serruys et al described a randomised trial
comparing percutaneous coronary intervention and CABG for treating severe
coronary artery disease. This work provides the most influential
references related to CABG and serves as a guide as to the area of focus
in CABG. Copyright © 2019 Wiley Periodicals, Inc.

<21>
Accession Number
2002709218
Title
Concomitant severe carotid and coronary artery diseases: a separate
management or concomitant approach.
Source
Journal of Cardiac Surgery. 34 (9) (pp 803-813), 2019. Date of
Publication: 01 Sep 2019.
Author
Chan J.S.K.; Shafi A.M.A.; Grafton-Clarke C.; Singh S.; Harky A.
Institution
(Chan, Singh) Faculty of Medicine, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong
(Shafi) Department of Cardiothoracic Surgery, Barts Heart Centre, St
Bartholomew's Hospital, London, United Kingdom
(Grafton-Clarke) Department of Surgery, Northampton General Hospital,
Northampton, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Chan) Division of Cardiology, Department of Medicine and Therapeutics,
Prince of Wales Hospital, Shatin, New Territories, Hong Kong
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To systematically compare outcomes between patients with
asymptomatic carotid artery diseases (>80% stenosis) that had undergone
staged carotid endarterectomy (CEA) before coronary artery bypass grafting
(CABG) vs simultaneous CEA and CABG. Method(s): A comprehensive
electronic search of MEDLINE, Scopus, EMBASE, and Ovid from their
inception up till August 2018 was performed to identify all studies
comparing staged CEA followed by CABG to simultaneous CEA and CABG.
Primary outcome measure was postoperative stroke, and secondary measures
were myocardial infarction (MI) and 30-day mortality rates.
 Result(s): A total of 67 953 patients were analyzed from 11 articles.
There was higher rate of previous stroke in the staged cohort (2.64% vs
2.32%; odds ratio [OR], 0.81; 95% confidence interval [CI; 0.66, 0.99]; P
=.040). There was no difference in previous MI (P =.57) or unstable angina
(P =.08) among both cohorts. Postoperatively, there were higher stroke
rates (3.64% vs 2.83%; OR, 0.72; 95% CI [0.62-0.89]; P <.0001), operative
mortality (4.32% vs 3.58%; OR, 0.90; 95% CI [0.83-0.98]; P =.02), and
30-day mortality (4.40% vs 3.58%; OR, 0.86; 95% CI [0.78-0.96]; P =.006)
in the simultaneous cohort. However, length of stay was significantly
shorter in the simultaneous cohort (11.9 days vs 12.6 days; weighted mean
difference 3.14 [0.77-5.51]; P =.009). There were no significant
differences in 1-year mortality (P =.33), MI rates (P =.08), and rates of
transient neurological deficits (P =.06). Conclusion(s): The results
from this study favors staged CEA with CABG with lower incidence of
postoperative stroke, operative, and 30-day mortality. A larger study,
ideally a randomized controlled trial, is required to address the
superiority of each technique. Copyright © 2019 Wiley
Periodicals, Inc.

<22>
Accession Number
628223195
Title
Comparison of Outcomes after Transcatheter vs Surgical Aortic Valve
Replacement among Patients at Intermediate Operative Risk with a History
of Coronary Artery Bypass Graft Surgery: A Post Hoc Analysis of the
SURTAVI Randomized Clinical Trial.
Source
JAMA Cardiology. 4 (8) (pp 810-814), 2019. Date of Publication: August
2019.
Author
Reardon M.J.; Heijmen R.H.; Van Mieghem N.M.; Williams M.R.; Yakubov S.J.;
Watson D.; Kleiman N.S.; Conte J.; Chawla A.; Hockmuth D.; Petrossian G.;
Robinson N.; Kappetein A.P.; Li S.; Popma J.J.
Institution
(Reardon, Kleiman) Houston Methodist de Bakey Heart, Vascular Center, 6550
Fannin St, Houston, TX 77030, United States
(Heijmen) St Antonius Hospital, Nieuwegein, Netherlands
(Van Mieghem) Erasmus University Medical Center, Rotterdam, Netherlands
(Williams) NYU Langone Medical Center, New York, NY, United States
(Yakubov, Watson) OhioHeath Riverside Methodist Hospital, Columbus, OH,
United States
(Conte) Johns Hopkins University, Baltimore, MD, United States
(Chawla, Hockmuth) Iowa Heart Center, Des Moines, United States
(Petrossian, Robinson) St Francis Hospital, Roslyn, NY, United States
(Kappetein, Li) Medtronic, Minneapolis, MN, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Surgical aortic valve replacement (SAVR) has increased risk
for patients with aortic stenosis (AS) and a history of coronary artery
bypass graft (CABG) surgery. Transcatheter aortic valve replacement (TAVR)
may be an alternative. Objective(s): To compare TAVR with SAVR
outcomes in patients at intermediate operative risk with prior CABG
surgery. Design, Setting, and Participant(s): In this post hoc
analysis of the Surgical Replacement and Transcatheter Aortic Valve
Implantation (SURTAVI) noninferiority randomized clinical trial, patients
with severe, symptomatic AS at intermediate operative risk were enrolled
from 87 centers across the United States, Europe, and Canada from June
2012 to June 2016 and followed-up with up to July 2017. Those with a
history of CABG surgery were considered for analysis. Data were analyzed
from September to December 2017. Intervention(s): A total of 1746
patients were enrolled and randomized 1:1 to self-expanding TAVR or SAVR.
An implant was attempted in 1660 patients, of whom 273 had prior CABG
surgery, including 136 who underwent attempted TAVR and 137 who underwent
attempted SAVR. Main Outcomes and Measures: The primary outcome was
all-cause mortality or disabling stroke at 1-year follow-up. Efficacy
outcomes included quality of life, measured using the Kansas City
Cardiomyopathy Questionnaire at 30 days, 6 months, and 1 year, and
distance walked in 6 minutes, measured using the 6-minute walk test at 30
days and 1 year. Result(s): Of the 136 patients in the TAVR cohort,
111 (81.6%) were male, and the mean (SD) age was 76.9 (6.5) years; of the
137 in the SAVR cohort, 117 (85.4%) were male, and the mean (SD) age was
76.6 (6.5) years. The mean (SD) Society of Thoracic Surgeons Predicted
Risk of Mortality score was 5.0% (1.6%) in the TAVR cohort and 5.2% (1.7%)
in the SAVR cohort. All-cause mortality or disabling stroke at 1-year
follow-up was 8.9% (95% CI, 5.2-15.2) in the TAVR cohort and 6.7% (95% CI,
3.5-12.8) in the SAVR cohort (log-rank P =.53). Compared with patients
receiving SAVR, the mean (SD) Kansas City Cardiomyopathy Questionnaire
summary score was significantly better among patients receiving TAVR at 30
days (81.4 [19.2] vs 69.7 [22.6]; P <.001); treatments were similar at 1
year (85.7 [14.6] vs 82.8 [18.4]; P =.19). Compared with patients in the
SAVR cohort, those in the TAVR cohort showed greater mean (SD) improvement
in distance walked at 1 year (48.3 [120.6] m vs 16.8 [88.7] m; P =.04).
 Conclusions and Relevance: Both TAVR and SAVR were safe for
intermediate-risk patients with AS and prior CABG surgery. The
transcatheter approach facilitated faster improvement in quality of life
and better exercise capacity at 1-year follow-up. Trial Registration:
ClinicalTrials.gov identifier: NCT01586910. Copyright © 2019
American Medical Association. All rights reserved.

<23>
Accession Number
628490917
Title
Rejuvenation of RBCs: validation of a manufacturing method suitable for
clinical use.
Source
Transfusion. 59 (9) (pp 2952-2963), 2019. Date of Publication: 01 Sep
2019.
Author
Smethurst P.A.; Jolley J.; Braund R.; Proffitt S.; Lynes T.; Hazell M.;
Mellor P.; Ridgwell K.; Procter S.; Griffiths A.; Marinaki A.M.; New H.V.;
Murphy G.J.; Edmondson D.; Cardigan R.; Gray A.D.; Landrigan M.; Aujla H.;
Kumar T.; Wozniak M.; Bullock T.; Hodge R.; Deary A.
Institution
(Smethurst, Jolley, Proffitt, Cardigan) Component Development Laboratory,
NHS Blood and Transplant, Cambridge, United Kingdom
(Braund, Mellor, Edmondson) Manufacturing & Development, NHS Blood and
Transplant, Bristol, United Kingdom
(Lynes, Hazell) Red Cell Immunohaematology, NHS Blood and Transplant,
Bristol, United Kingdom
(Ridgwell) IBGRL Protein Development & Production Unit, NHS Blood and
Transplant, Bristol, United Kingdom
(Procter) Quality Monitoring, NHS Blood and Transplant, London, United
Kingdom
(Griffiths) Clinical Trials Unit, NHS Blood and Transplant, Bristol,
United Kingdom
(Marinaki) Purine Research Laboratory, St Thomas' Hospital, London, United
Kingdom
(New) Clinical Directorate, NHS Blood and Transplant, London, United
Kingdom
(New) Department of Haematology, Imperial College London, London, United
Kingdom
(Murphy) Department of Cardiovascular Sciences and NIHR Leicester
Biomedical Research Centre, Glenfield General Hospital, University of
Leicester, Leicester, United Kingdom
(Cardigan) Department of Haematology, University of Cambridge, Cambridge,
United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Rejuvenation of stored red blood cells (RBCs) increases levels
of adenosine 5'-triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) to
those of fresh cells. This study aimed to optimize and validate the
US-approved process to a UK setting for manufacture and issue of
rejuvenated RBCs for a multicenter randomized controlled clinical trial in
cardiac surgery. STUDY DESIGN AND METHODS: Rejuvenation of leukoreduced
RBC units involved adding a solution containing pyruvate, inosine,
phosphate, and adenine (Rejuvesol, Zimmer Biomet), warming at 37degreeC
for 60 minutes, then "manual" washing with saline adenine glucose mannitol
solution. A laboratory study was conducted on six pools of ABO/D-matched
units made the day after donation. On Days 7, 21, and 28 of 4 +/- 2degreeC
storage, one unit per pool was rejuvenated and measured over 96 hours for
volume, hematocrit, hemolysis, ATP, 2,3-DPG, supernatant potassium,
lactate, and purines added (inosine) or produced (hypoxanthine) by
rejuvenation. Subsequently, an operational validation (two phases of 32
units each) was undertaken, with results from the first informing a trial
component specification applied to the second. Rejuvenation effects were
also tested on crossmatch reactivity and RBC antigen profiles.
 RESULT(S): Rejuvenation raised 2,3-DPG to, and ATP above, levels of
fresh cells. The final component had potassium and hemolysis values below
those of standard storage Days 7 and 21, respectively, containing 1.2%
exogenous inosine and 500 to 1900 mumoles/unit of hypoxanthine. The second
operational validation met compliance to the trial component
specification. Rejuvenation did not adversely affect crossmatch reactivity
or RBC antigen profiles. CONCLUSION(S): The validated rejuvenation
process operates within defined quality limits, preserving RBC
immunophenotypes, enabling manufacture for clinical trials. Copyright
© 2019 Crown copyright. Transfusion © 2019 AABB

<24>
Accession Number
629078793
Title
An international survey of the nutrition management of chylothorax: a time
for change.
Source
Cardiology in the young. 29 (9) (pp 1127-1136), 2019. Date of Publication:
01 Sep 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
(Marino) University Hospital Southampton NHS Foundation Trust and
University of Southampton
(Marino) University of Southampton
(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.

<25>
Accession Number
628341593
Title
Effect of preoperative fluid therapy on hemodynamic stability during
anesthesia induction, a randomized study.
Source
Acta Anaesthesiologica Scandinavica. 63 (9) (pp 1129-1136), 2019. Date of
Publication: 01 Oct 2019.
Author
Myrberg T.; Lindelof L.; Hultin M.
Institution
(Myrberg, Lindelof, Hultin) Department of Surgical and Perioperative
Sciences, Anesthesiology and Intensive Care Medicine, Sunderby Research
Unit, Umea University, Umea, Sweden
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
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, we
hypothesized that 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). Method(s): Eighty individuals scheduled for
non-cardiac surgery were randomized to either a pre-operative colloid
fluid bolus of 6 ml kg-1 lean body weight or no bolus, and then
anesthetized by means of TCI or RSI. The main outcome measure was blood
pressure drops below the mean arterial pressure 65 mm Hg during the first
20 minutes after anesthesia induction. ClinicalTrials.com Identifier:
NCT03394833. Result(s): Pre-operative fluid therapy decreased the
incidence of BPDs fivefold, from 23 of 40 (57.5%) individuals without
fluids to 5 of 40 (12.5%) with fluid management, P <.001. The mean BPD was
greater in the groups without pre-operative fluids compared to the groups
with fluid management; 53 +/- 18 mm Hg vs 43 +/- 14 mm Hg, P =.007. The
overall mean volume of pre-operative fluid bolus infused was 387 +/- 52
ml. 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 general anesthesia. Copyright © 2019 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<26>
[Use Link to view the full text]
Accession Number
629253111
Title
Aspirin Resistance: Cardiovascular Risk Game Changer.
Source
American journal of therapeutics. 26 (5) (pp 593-599), 2019. Date of
Publication: 01 Sep 2019.
Author
Yassin A.S.; Abubakar H.; Mishra T.; Subahi A.; Hartman M.; Ahmed A.;
Ibrahim W.; Singh M.; Pahuja M.
Institution
(Yassin, Abubakar, Mishra, Subahi, Ahmed, Ibrahim, Singh) Department of
Internal Medicine, Wayne State University, Detroit, MI, United States
(Hartman) Radboud University, School of Medicine, Nijmegen, Netherlands
(Pahuja) Department of Cardiovascular Medicine, Wayne State University,
Detroit, MI, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Aspirin (ASA) is the most used medication on the globe. ASA is
a primary pillar of the secondary prevention of cardiovascular
atherothromboembolic events. However, a fraction of the population does
not respond to ASA as expected in a unique phenomenon called ASA
resistance. Multiple mechanisms were described and studied in the
literature to explain this phenomenon. AREA OF UNCERTAINTY: ASA resistance
is an interesting phenomenon that is worth studying and reviewing.
Mechanisms behind this resistance are various and although the rarity of
some, it is crucial for the modern health provider to be aware of such
phenomenon and its possible explanations to provide more efficient
preventive cardiology practice. Our study aimed to review and conclude the
evidence behind ASA resistance and its implication on the cardiovascular
health. DATA SOURCES: We searched databases like PubMed, EMBASE, Ovid by
midline, and Google Scholar for published articles and abstracts.
 RESULT(S): Our systemic search revealed more than 100 articles in
relation to ASA resistance. We selected 40 articles, which were relevant
for this review. Various mechanisms were described in the literature, with
few of them very well documented and understood. Main mechanisms include
medication nonadherence, interaction with proton pump inhibitors,
esterase-mediated ASA inactivation, post-coronary artery bypass grafting
(CABG) MRP-4-mediated ASA consumption, cyclooxygenase-1 (COX-1)
polymorphisms, high platelet turnover-associated regeneration of platelet
COX-1, and the documented platelet ability of de novo COX-1 synthesis in
response to thrombin and fibrinogen. CONCLUSION(S): Multiple
mechanisms of ASA resistance were described in the literature. Awareness
of such interaction is important for medical practitioners. Bottom line,
further studies and reviews are needed to further study this phenomenon
and its implication on the cardiovascular health and hence reaching a
valid evidence-based conclusion that might change the practice and improve
the patient preventive health care.

<27>
Accession Number
629255967
Title
Left Main Coronary Artery Disease Revascularization According to the
SYNTAX Score.
Source
Circulation. Cardiovascular interventions. 12 (9) (pp e008007), 2019. Date
of Publication: 01 Sep 2019.
Author
Shlofmitz E.; Genereux P.; Chen S.; Dressler O.; Ben-Yehuda O.; Morice
M.-C.; Puskas J.D.; Taggart D.P.; Kandzari D.E.; Crowley A.; Redfors B.;
Mehdipoor G.; Kappetein A.P.; Sabik J.F.; Serruys P.W.; Stone G.W.
Institution
(Shlofmitz, Genereux, Chen, Dressler, Ben-Yehuda, Crowley, Redfors,
Mehdipoor, Stone) Cardiovascular Research Foundation, O.D., A.C., B.R.,
G.M., S.C, United States
(Shlofmitz, Ben-Yehuda, Stone) New York-Presbyterian Hospital/Columbia
University Medical Center (E.S.
(Genereux) Morristown Medical Center
(Genereux) Hopital du Sacre-Coeur de Montreal, Quebec, Canada
(Morice) Institut Cardiovasculaire Paris Sud, Ramsay Generale de Sante,
Massy, France
(Puskas) Mount Sinai Saint Luke's
(Taggart) John Radcliffe Hospital, United Kingdom (D.P.T.), Oxford, Canada
(Kandzari) Piedmont Heart Institute, Atlanta, United States
(Redfors) Sahlgrenska University Hospital, Gothenburg, Germany
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) UH Cleveland Medical Center, Cleveland, Australia
(Serruys) Imperial College London, United Kingdom (P.W.S.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The SYNTAX (Synergy Between Percutaneous Coronary Intervention
With Taxus and Cardiac Surgery) score (SS), a measure of anatomic coronary
artery disease (CAD) extent and complexity, has proven useful in past
studies to determine the absolute and relative prognosis after
revascularization with percutaneous coronary intervention (PCI) versus
coronary artery bypass grafting (CABG). We sought to assess contemporary
outcomes after PCI and CABG in patients with left main CAD according to SS
and revascularization type from a large randomized trial. METHOD(S):
The EXCEL trial (Evaluation of XIENCE Versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization) randomized
patients with left main CAD and site-assessed SS<=32 to PCI with
everolimus-eluting stents or CABG. Four-year outcomes were examined
according to angiographic core laboratory-assessed SS using multivariable
Cox proportional hazards regression. RESULT(S): A total of 1840
patients with left main CAD randomized to PCI (n=914) versus CABG (n=926)
had angiographic core laboratory SS assessment. The mean SS was 26.5+/-9.3
(range 5-74); 24.1% of patients had angiographic core laboratory-assessed
SS >=33. The 4-year rate of the primary major adverse cardiac event end
point of death, stroke, or myocardial infarction was similar between PCI
and CABG (18.6% versus 16.7%, respectively; P=0.40) and did not vary
according to SS (Pinteraction=0.33). Rates of ischemia-driven
revascularization rose with increasing SS after PCI, but not after CABG.
As a result, the major secondary composite end point of major adverse
cardiac or cerebrovascular events (major adverse cardiac event or
ischemia-driven revascularization) occurred more frequently with PCI than
CABG (28.0% versus 22.0%, P=0.01), a difference which rose progressively
with increasing SS (Pinteraction=0.03). CONCLUSION(S): In the EXCEL
trial, the 4-year primary composite major adverse cardiac event end point
of death, myocardial infarction, or stroke was similar after PCI with
everolimus-eluting stents and CABG and was independent of the baseline
anatomic complexity and extent of CAD. In contrast, the relative and
absolute hazard of major adverse cardiac or cerebrovascular events with
PCI compared with CABG rose progressively with the SS. These data should
be considered by the heart team when deciding between PCI versus CABG for
revascularization in patients with left main CAD. CLINICAL TRIAL
REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier
NCT01205776.

<28>
Accession Number
629246325
Title
Complications Associated with Surgery for Thoracic Disc Herniation: A
Systematic Review and Network Meta-Analysis.
Source
World neurosurgery. (no pagination), 2019. Date of Publication: 04 Sep
2019.
Author
Brotis A.G.; Tasiou A.; Paterakis K.; Tzerefos C.; Fountas K.N.
Institution
(Brotis) Department of Neurosurgery, University Hospital of Larissa,
Larissa, Thessaly. Electronic address: amprotis@med.uth.gr
(Tasiou, Tzerefos) Department of Neurosurgery, University Hospital of
Larissa, Larissa, Thessaly
(Paterakis, Fountas) Department of Neurosurgery, University Hospital of
Larissa, Larissa, Thessaly; Medical School, University of Thessaly
Publisher
NLM (Medline)
Abstract
STUDY DESIGN: A systematic review and network meta-analysis (Prospero ID:
CRD42018106936). OBJECTIVE(S): The selection of the appropriate
surgical approach for the management of thoracic disc herniation (TDH) is
often challenging due to the frequency and variability of the associated
complications. We evaluated the safety of the surgical approaches for TDH
by estimating the mortality (Q1) and morbidity (Q2), and frequency of the
most common complications (Q3). METHOD(S): Thus, we searched the
Medical Literature for randomized controlled trials and observational
studies, reporting on the management of TDH. Postoperative complications
were the outcome of interest. The absolute and relative risk estimates,
along with the rank probability scores, were estimated for each approach,
through a network meta-analysis. The results were read under the light of
the quality of the available evidence. RESULT(S): Fifteen studies
with a total of 1036 patients fulfilled our eligibility criteria. Three
deaths were reported. The overall morbidity rate was as high as 29%,
largely attributed to medical (21%; 95% CI: 10-38%), surgical site (11%;
5-22%), CSF-related (8%; 3-8%), and neurological complications (5%;
1-24%). The anterior and lateral approaches were associated with a higher
risk for medical and surgical complications when compared to the
postero-lateral approach. CONCLUSION(S): Surgery for thoracic disc
herniation is associated with minimal mortality but significant morbidity,
with large variations among the available approaches. Apprehension of the
perioperative complications rates is important to develope
complication-avoidance strategies and in accurate patient-to-doctor
communication. Copyright © 2019. Published by Elsevier Inc.

<29>
Accession Number
629243410
Title
Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen
after successful coronary stenting in patients with atrial fibrillation
(ENTRUST-AF PCI): a randomised, open-label, phase 3b trial.
Source
Lancet (London, England). (no pagination), 2019. Date of Publication: 02
Sep 2019.
Author
Vranckx P.; Valgimigli M.; Eckardt L.; Tijssen J.; Lewalter T.; Gargiulo
G.; Batushkin V.; Campo G.; Lysak Z.; Vakaliuk I.; Milewski K.; Laeis P.;
Reimitz P.-E.; Smolnik R.; Zierhut W.; Goette A.
Institution
(Vranckx) Department of Cardiology and Intensive Care, Jessa Ziekenhuis,
Faculty of Medicine and Life Sciences at the Hasselt University, Hasselt,
Belgium
(Valgimigli) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Eckardt) Atrial Fibrillation Network, Munster, Germany; Department of
Cardiology and Angiology, Division of Electrophysiology, University of
Munster, Munster, Germany
(Tijssen) Department of Cardiology, Amsterdam University Medical Centers,
University of Amsterdam, Amsterdam, Netherlands; Cardialysis, Rotterdam,
Netherlands
(Lewalter) Atrial Fibrillation Network, Munster, Germany; Department of
Cardiology, Hospital Munich South, Munich, Germany; University of Bonn,
Bonn, Germany
(Gargiulo) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland; Department of Advanced
Biomedical Sciences, Federico II University of Naples, Naples, Italy
(Batushkin) Department of Cardiology, Kyiv City Clinical Hospital #5,
Kiev, Ukraine
(Campo) Cardiovascular Institute, Azienda Ospedaliero-Universitaria di
Ferrara, Cona, Venice, Italy; Maria Cecilia Hospital, GVM Care and
Research, Cotignola, Italy
(Lysak) Department of Cardiac Rehabilitation, Oleksandrivska Kyiv City
Clinical Hospital, Kiev, Ukraine
(Vakaliuk) Department Internal Medicine No2 and Nursing, Ivano-Frankivsk
National Medical University, Ivano-Frankivsk, Ukraine; Department of
Anesthesiology with Wards of Intensive Care, Ivano-Frankivsk Regional
Clinical Cardiological Clinic, Ivano-Frankivsk, Ukraine
(Milewski) Center for Cardiovascular Research and Development, American
Heart of Poland Katowice, Poland; The Jerzy Kukuczka Academy of Physical
Education, Faculty of Physiotherapy, Katowice, Katowice, Poland
(Laeis, Reimitz, Smolnik, Zierhut) Daiichi Sankyo Europe, Munich, Germany
(Goette) Atrial Fibrillation Network, Munster, Germany; Cardiology and
Intensive Care Medicine, St Vincenz-Hospital, Paderborn, Germany; Working
Group of Molecular Electrophysiology, University Hospital Magdeburg,
Magdeburg, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: We aimed to assess the safety of edoxaban in combination with
P2Y12 inhibition in patients with atrial fibrillation who had percutaneous
coronary intervention (PCI). METHOD(S): ENTRUST-AF PCI was a
randomised, multicentre, open-label, non-inferiority phase 3b trial with
masked outcome evaluation, done at 186 sites in 18 countries. Patients had
atrial fibrillation requiring oral anticoagulation, were aged at least 18
years, and had a successful PCI for stable coronary artery disease or
acute coronary syndrome. Participants were randomly assigned (1:1) from 4
h to 5 days after PCI using concealed, stratified, and blocked web-based
central randomisation to either edoxaban (60 mg once daily) plus a P2Y12
inhibitor for 12 months or a vitamin K antagonist (VKA) in combination
with a P2Y12 inhibitor and aspirin (100 mg once daily, for 1-12 months).
The edoxaban dose was reduced to 30 mg per day if one or more factors
(creatinine clearance 15-50 mL/min, bodyweight <=60 kg, or concomitant use
of specified potent P-glycoprotein inhibitors) were present. The primary
endpoint was a composite of major or clinically relevant non-major (CRNM)
bleeding within 12 months. The primary analysis was done in the
intention-to-treat population and safety was assessed in all patients who
received at least one dose of their assigned study drug. This trial is
registered with ClinicalTrials.gov, NCT02866175, is closed to new
participants, and follow-up is completed. FINDINGS: From Feb 24, 2017,
through May 7, 2018, 1506 patients were enrolled and randomly assigned to
the edoxaban regimen (n=751) or VKA regimen (n=755). Median time from PCI
to randomisation was 45.1 h (IQR 22.2-76.2). Major or CRNM bleeding events
occurred in 128 (17%) of 751 patients (annualised event rate 20.7%) with
the edoxaban regimen and 152 (20%) of 755 patients (annualised event rate
25.6%) patients with the VKA regimen; hazard ratio 0.83 (95% CI 0.65-1.05;
p=0.0010 for non-inferiority, margin hazard ratio 1.20; p=0.1154 for
superiority). INTERPRETATION: In patients with atrial fibrillation who had
PCI, the edoxaban-based regimen was non-inferior for bleeding compared
with the VKA-based regimen, without significant differences in ischaemic
events. FUNDING: Daiichi Sankyo. Copyright © 2019 Elsevier Ltd.
All rights reserved.

<30>
Accession Number
2002841812
Title
The Eternal Debate With a Consistent Answer: CABG vs PCI.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Farina P.; Gaudino M.F.L.; Taggart D.P.
Institution
(Farina) Department of Cardiothoracic Surgery, Mater Misericordiae
University Hospital, Dublin, Ireland
(Gaudino) Department of Cardiothoracic Surgery, John Radcliffe Hospital,
Oxford, United Kingdom
(Taggart) Department of Cardiothoracic Surgery, Weill Cornell Medical
College, New York, NY, United States
Publisher
W.B. Saunders
Abstract
An ongoing debate exists over the role of percutaneous coronary
intervention and coronary artery bypass grafting for revascularization in
patients with multivessel or left main disease. Despite improvements in
stent technology, bypass surgery still provides the best long-term results
in the majority of patients. The present review focuses on randomized
controlled trials and a meta-analysis published over the last 4
years. Copyright © 2019 Elsevier Inc.

<31>
Accession Number
2002841390
Title
Efficacy of Bilateral Erector Spinae Plane Block in Management of Acute
Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a
Midline Sternotomy.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Kaushal B.; Chauhan S.; Magoon R.; Krishna N.S.; Saini K.; Bhoi D.; Bisoi
A.K.
Institution
(Kaushal, Chauhan, Magoon, Krishna) Department of Cardiac Anesthesiology,
Cardio, and Neurosciences Center, AIIMS, New Delhi, India
(Saini, Bhoi) Department of Anesthesiology, Pain Medicine and Critical
Care, AIIMS, New Delhi, India
(Bisoi) Department of Cardiothoracic and Vascular Surgery, Cardio, and
Neurosciences Center, AIIMS, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: Regional analgesia continues to evolve with the introduction of
ultrasound-guided fascial plane blocks. Erector spinae plane block (ESPB)
is a novel technique gaining recent acceptability as a perioperative
modality of analgesia in various thoracic and abdominal surgeries.
However, literature on the use of ESPB in pediatric cardiac surgery is
limited. Design(s): A prospective, randomized, single-blind,
comparative study. Setting(s): Single-institution tertiary referral
cardiac center. Participant(s): Eighty children with acyanotic
congenital heart disease undergoing cardiac surgery through midline
sternotomy. Intervention(s): The subjects were allocated randomly
into 2 groups: ESPB (group B, n = 40) received ultrasound-guided bilateral
ESPB at the level of T<inf>3</inf> transverse process and control (group
C, n = 40) receiving no block. Measurements and Main Results: The
postoperative pain was assessed using Modified Objective Pain Scores
(MOPS) which were evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours after
extubation. Group B demonstrated significantly reduced MOPS as compared
with group C until the 10th postoperative hour (p < 0.0001), with
comparable MOPS at the 12th hour. The consumption of postoperative rescue
fentanyl was also significantly less in group B in comparison to group C
(p < 0.0001) with a longer duration to first rescue dose requirement in
group B. In addition, the group B showed lower postoperative sedation
scores and intensive care unit stay in contrast to group C.
 Conclusion(s): Ultrasound-guided bilateral ESPB presents a simple,
innovative, reliable, and effective postoperative analgesic modality for
pediatric cardiac surgeries contemplated through a midline
sternotomy. Copyright © 2019 Elsevier Inc.

<32>
Accession Number
2002634958
Title
Effects of Alirocumab on Cardiovascular Events After Coronary Bypass
Surgery.
Source
Journal of the American College of Cardiology. 74 (9) (pp 1177-1186),
2019. Date of Publication: 3 September 2019.
Author
Goodman S.G.; Aylward P.E.; Szarek M.; Chumburidze V.; Bhatt D.L.; Bittner
V.A.; Diaz R.; Edelberg J.M.; Hanotin C.; Harrington R.A.; Jukema J.W.;
Kedev S.; Letierce A.; Moryusef A.; Pordy R.; Ramos Lopez G.A.; Roe M.T.;
Viigimaa M.; White H.D.; Zeiher A.M.; Steg P.G.; Schwartz G.G.
Institution
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton,
Alberta, Canada and St. Michael's Hospital, University of Toronto,
Toronto, Ontario, Canada
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, South Australia, Australia
(Szarek) State University of New York, Downstate School of Public Health,
Brooklyn, NY, United States
(Chumburidze) Chapidze Emergency Cardiology Center, Tbilisi, Georgia
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Bittner) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
(Diaz) Estudios Cardiologicos Latinoamerica, Instituto Cardiovascular de
Rosario, Rosario, Argentina
(Edelberg, Moryusef) Sanofi, Bridgewater, NJ, United States
(Hanotin, Letierce) Sanofi, Chilly-Mazarin, France
(Harrington) Stanford Center for Clinical Research, Department of
Medicine, Stanford University, Stanford, CA, United States
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Kedev) University Clinic of Cardiology, Skopje, Macedonia
(Pordy) Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
(Ramos Lopez) Medical Office, Guadalajara, Jalisco, Mexico
(Roe) Duke Clinical Research Institute, Duke University Medical Center,
Durham, NC, United States
(Roe) Division of Cardiology, Department of Medicine, Duke University
School of Medicine, Durham, NC, United States
(Viigimaa) SA Pohja-Eesti Regionaalhaigla, Tallinn, Estonia
(White) Green Lane Cardiovascular Services Auckland City Hospital,
Auckland, New Zealand
(Zeiher) Department of Medicine III, Goethe University, Frankfurt am Main,
Germany
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris,
France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Schwartz) Division of Cardiology, University of Colorado School of
Medicine, Aurora, CO, United States
Publisher
Elsevier USA
Abstract
Background: Patients with acute coronary syndrome (ACS) and history of
coronary artery bypass grafting (CABG) are at high risk for recurrent
cardiovascular events and death. Objective(s): This study sought to
determine the clinical benefit of adding alirocumab to statins in ACS
patients with prior CABG in a pre-specified analysis of ODYSSEY OUTCOMES
(Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome
During Treatment With Alirocumab). Method(s): Patients (n = 18,924) 1
to 12 months post-ACS with elevated atherogenic lipoprotein levels despite
high-intensity statin therapy were randomized to alirocumab or placebo
subcutaneously every 2 weeks. Median follow-up was 2.8 years. The primary
composite endpoint of major adverse cardiovascular events (MACE) comprised
coronary heart disease death, nonfatal myocardial infarction, ischemic
stroke, or unstable angina requiring hospitalization. All-cause death was
a secondary endpoint. Patients were categorized by CABG status: no CABG (n
= 16,896); index CABG after qualifying ACS, but before randomization (n =
1,025); or CABG before the qualifying ACS (n = 1,003). Result(s): In
each CABG category, hazard ratios (95% confidence intervals) for MACE (no
CABG 0.86 [0.78 to 0.95], index CABG 0.85 [0.54 to 1.35], prior CABG 0.77
[0.61 to 0.98]) and death (0.88 [0.75 to 1.03], 0.85 [0.46 to 1.59], 0.67
[0.44 to 1.01], respectively) were consistent with the overall trial
results (0.85 [0.78 to 0.93] and 0.85 [0.73 to 0.98], respectively).
Absolute risk reductions (95% confidence intervals) differed across CABG
categories for MACE (no CABG 1.3% [0.5% to 2.2%], index CABG 0.9% [-2.3%
to 4.0%], prior CABG 6.4% [0.9% to 12.0%]) and for death (0.4% [-0.1% to
1.0%], 0.5% [-1.9% to 2.9%], and 3.6% [0.0% to 7.2%]). Conclusion(s):
Among patients with recent ACS and elevated atherogenic lipoproteins
despite intensive statin therapy, alirocumab was associated with large
absolute reductions in MACE and death in those with CABG preceding the ACS
event. (ODYSSEY OUTCOMES: Evaluation of Cardiovascular Outcomes After an
Acute Coronary Syndrome During Treatment With Alirocumab;
NCT01663402) Copyright © 2019 American College of Cardiology
Foundation

<33>
Accession Number
2001464156
Title
Intracuff pressure during one-lung ventilation in infants and children.
Source
Journal of Pediatric Surgery. 54 (9) (pp 1929-1932), 2019. Date of
Publication: September 2019.
Author
Shafy S.Z.; Hakim M.; Kamata M.; Tumin D.; Krishna S.G.; Naguib A.; Tobias
J.D.
Institution
(Shafy, Hakim, Kamata, Tumin, Krishna, Naguib, Tobias) Department of
Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus,
OH, United States
(Tumin, Tobias) Department of Pediatrics, The Ohio State University
College of Medicine, Columbus, OH, United States
(Krishna, Naguib, Tobias) Department of Anesthesiology & Pain Medicine,
The Ohio State University College of Medicine, Columbus, OH, United States
Publisher
W.B. Saunders
Abstract
Objective: We prospectively evaluated intracuff pressure (IP) during
one-lung ventilation (OLV) to characterize potential risk associated with
overinflation of the cuff used for OLV. Design(s): Prospective
observational study over a 2-year period, in infants and children
undergoing thoracic surgery. The IPs of the tracheal and bronchial balloon
were measured using a manometer and compared to a previously recommended
threshold of 30 cmH2O. Data were compared by the device type used to
achieve OLV. Setting(s): Freestanding tertiary-care pediatric
hospital. Participant(s): Patients <= 18 years of age undergoing
thoracic procedures requiring OLV. Intervention(s): Measurement of
IP. Measurements and Main Results: Thirty patients were enrolled (age
5 months-18 years) with a median weight of 28 kg. Median tracheal and
bronchial IPs were 32 cmH2O (range: 11, 90) and 44 cmH2O (range: 10, 100),
respectively. The tracheal and bronchial IPs exceeded 30 cmH2O in 13 of 20
patients (65%) and 21 of 30 patients (70%), respectively.
 Conclusion(s): IP was high and in excess of recommended levels in
most children undergoing OLV. Continuous monitoring of IP may be indicated
during OLV to address the risks involved and ensure the prevention of
complications related to high IP. Type of Study: Prospective
comparative study. Level of Evidence: Level II. Copyright ©
2018 Elsevier Inc.

<34>
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

<35>
Accession Number
2001383361
Title
Current status of simulation-based training in pediatric surgery: A
systematic review.
Source
Journal of Pediatric Surgery. 54 (9) (pp 1884-1893), 2019. Date of
Publication: September 2019.
Author
Patel E.A.; Aydin A.; Desai A.; Dasgupta P.; Ahmed K.
Institution
(Patel, Aydin, Dasgupta, Ahmed) MRC Centre for Transplantation, Guy's
Hospital, King's College London, London, United Kingdom
(Desai) Dept. of Paediatric Surgery, King's College London NHS Foundation
Trust, London, United Kingdom
Publisher
W.B. Saunders
Abstract
Background: Simulation based training enables pediatric surgical trainees
to attain proficiency in surgical skills. This study aims to identify the
currently available simulators for pediatric surgery, assess their
validation and strength of evidence supporting each model. Method(s):
Both Medline and EMBASE were searched for English language articles either
describing or validating simulation models for pediatric surgery. A level
of evidence (LoE) followed by a level of recommendation (LoR) was assigned
to each validation study and simulator, based on a modified Oxford Centre
for Evidence-Based Medicine classification for educational studies.
 Result(s): Forty-nine articles were identified describing 44 training
models and courses. Of these articles, 44 were validation studies. Face
validity was evaluated by 20 studies, 28 for content, 24 demonstrated
construct validity and 1 showed predictive validity. Of the validated
models, 3 were given an LoR of 2, 21 an LoR of 3 and 12 an LoR of 4. None
reached the highest LoR. Conclusion(s): There are a growing number of
simulators specific to pediatric surgery. However, these simulators have
limited LoE and LoR in current studies. The lack of NoTSS training is also
apparent. We advocate more randomized trials to validate these models, and
attempts to determine predictive validity. Type of Study: Original /
systematic review. Level of Evidence: 1. Copyright © 2018
Elsevier Inc.

<36>
Accession Number
2000561784
Title
Using decision thresholds for ranking treatments in network meta-analysis
results in more informative rankings.
Source
Journal of Clinical Epidemiology. 98 (pp 62-69), 2018. Date of
Publication: June 2018.
Author
Brignardello-Petersen R.; Johnston B.C.; Jadad A.R.; Tomlinson G.
Institution
(Brignardello-Petersen) Department of Health Research Methods, Evidence,
and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S
4L8, Canada
(Brignardello-Petersen) Evidence-Based Dentistry Unit, Faculty of
Dentistry, University of Chile, Sergio, Livingstone 943, Independencia,
Santiago, Chile
(Johnston, Jadad, Tomlinson) Institute of Health Policy, Management and
Evaluation, University of Toronto, 155 College Street, Toronto, Ontario
M5T 3M6, Canada
(Johnston) Child Health Evaluative Sciences, Hospital for Sick Children
Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay
Street, Rm 11.9859 West, Toronto, Ontario M5G 0A4, Canada
(Johnston) Department of Anesthesia and Pain Medicine, Hospital for Sick
Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
(Jadad) Institute for Global Health Equity and Innovation, Dalla Lana
School of Public Health, University of Toronto, 155 College Street,
Toronto, Ontario M5T 3M6, Canada
(Jadad) Centre for global eHealth Innovation, R Fraser Elliot Building,
190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
(Tomlinson) Department of Medicine, University Health Network and Mt Sinai
Hospital, Toronto, Eaton North, 10th floor, room 235, 200 Elizabeth
Street, Toronto, Ontario M5G 2C4, Canada
Publisher
Elsevier USA
Abstract
Objectives: To evaluate how the rank probabilities obtained from network
meta-analysis (NMA) change with the use of increasingly stringent criteria
for the relative effect comparing two treatments which ranks one treatment
better than the other. Study Design and Setting: Systematic survey and
reanalysis of published data. We included all systematic reviews (SRs)
with NMA from the field of cardiovascular medicine that had trial-level
data available, published in Medline up to February 2015. We reran all the
NMAs and determined the probabilities of each treatment being the best.
For the best treatment, we examined the effect on these probabilities of
varying, what we call the decision threshold, the relative effect required
to declare two treatments different. Result(s): We included 14 SRs,
having a median of 20 randomized trials and 9 treatments. The best
treatments had probabilities of being best that ranged from 38% to 85.3%.
The effect of changing the decision thresholds on the probability of a
treatment being best varied substantially across reviews, with relatively
little decrease (~20 percentage points) in some settings but a decline to
near 0% in others. Conclusion(s): Rank probabilities can be fragile
to increases in the decision threshold used to claim that one treatment is
more effective than another. Including these thresholds into the
calculation of rankings may aid their interpretation and use in clinical
practice. Copyright © 2018 Elsevier Inc.

<37>
[Use Link to view the full text]
Accession Number
619925093
Title
A randomized trial of bifurcation stenting technique in chronic total
occlusions percutaneous coronary intervention.
Source
Coronary Artery Disease. 29 (1) (pp 30-38), 2018. Date of Publication:
2018.
Author
Baystrukov V.I.; Kretov E.I.; Boukhris M.; Osiev A.G.; Grazhdankin I.O.;
Biryukov A.V.; Najjar H.; Verin V.V.; Zubarev D.D.; Naryshkin I.A.;
Bogachev-Prokophiev A.V.; Mashayekhi K.; Galassi A.R.; Prokhorikhin A.A.
Institution
(Baystrukov, Kretov, Grazhdankin, Zubarev, Naryshkin, Bogachev-Prokophiev,
Prokhorikhin) E.N. Meshalkin Siberian Federal Biomedical Research Center,
Novosibirsk 630090, Russian Federation
(Osiev) Moscow Regional Research and Clinical Institute ('Moniki'),
Moscow, Russian Federation
(Biryukov) Pavlov First Saint Petersburg State Medical University, Saint
Petersburg, Russian Federation
(Verin) Primorskiy Regional Hospital No. 1, Vladivostok, Russian
Federation
(Mashayekhi) Division of Cardiology and Angiology II, University Heart
Center Freiburg, Bad Krozingen, Germany
(Galassi) Department of Clinical and Experimental Medicine, University of
Catania, Catania, Italy
(Galassi) Department of Cardiology, University Heart Center, University
Hospital Zurich, Zurich, Switzerland
(Boukhris, Najjar) Department of Cardiology, Abderrahmen Mami Hospital,
Ariana, Tunisia
(Boukhris, Najjar) Faculty of Medicine of Tunis, University Tunis El
Manar, Tunis, Tunisia
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background The optimal strategy to treat bifurcation lesions (BFLs) in a
percutaneous coronary intervention (PCI) for chronic total occlusions
(CTOs) remains unknown. Aims We sought to assess whether T-provisional or
mini-crush is appropriate for BFLs within CTO vessels. Patients and
methods From January 2011 to December 2013, patients who underwent
successful CTO guidewire crossing and with a BFL within the CTO target
vessel were enrolled prospectively and assigned randomly to either
T-provisional stenting or the mini-crush technique for BFL treatment.
One-year clinical follow-up was performed. Major adverse cardiac and
cerebrovascular events (MACCE) were defined as the composite of
cardiovascular death, myocardial infarction, target vessel
revascularization, and stroke. Results The prevalence of BFLs was 54.3%. A
total of 146 patients with BFLs within CTO vessel were enrolled
prospectively and assigned randomly to either T-provisional stenting
(N=73) or the mini-crush technique (N=73). Angiographic and clinical
success rates were similar in the two groups: 91.8 versus 97.2% (P=0.27)
and 91.8 versus 94.5% (P=0.67), respectively. Although T-provisional
stenting was associated with a nonsignificantly lower incidence of MACCE
in case of BFLs located far from the CTO (9.3 vs. 22.2%; P=0.426), the
mini-crush technique resulted in higher MACCE-free survival at 1 year in
the presence of BFLs within the CTO body or close to the proximal or the
distal cap (89.1 vs. 64.9%; P=0.007). Conclusion The mini-crush technique
appeared to be associated with improved 1-year clinical and angiographic
outcomes, particularly when used to treat BFLs located within the CTO body
or close to the proximal or the distal cap. Copyright © 2017
Wolters Kluwer Health, Inc. All rights reserved.

<38>
[Use Link to view the full text]
Accession Number
621738909
Title
Effects of preoperative intrathecal morphine on postoperative intravenous
morphine dosage: A systematic review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 16 (4) (pp
867-870), 2018. Date of Publication: 01 Apr 2018.
Author
Pitre L.; Garbee D.; Tipton J.; Schiavo J.; Pitt A.
Institution
(Pitre, Garbee, Tipton, Schiavo, Pitt) Louisiana Ctr. for Prom. of Optimal
Health Outcomes: A Joanna Briggs Institute Center of Excellence,
Switzerland
Publisher
Joanna Briggs Institute (E-mail: kathiest.clai@apta.org)
Abstract
Review question/objective: The purpose of this systematic review is to
describe the effect of preoperative intrathecal morphine (ITM) on
postoperative intravenous (IV) morphine dosage during the first
postoperative day. This systematic review will compare the postoperative
IV morphine dosage of patients receiving ITM plus morphine morphine-based
patient-controlled analgesia (PCA), to patients receiving PCA morphine
without ITM. This will establish the magnitude of the postoperative
morphine sparing effect of ITM. This review aims to answer the following
specific question: In adult abdominal and thoracic surgery patients
undergoing general anesthesia (GA), what is the effect of ITM plus PCA
morphine, compared to PCA morphine alone, on total IV morphine dosage (in
milligrams) during the first 24 hours after surgery? Copyright ©
2018 THE JOANNA BRIGGS INSTITUTE.

<39>
[Use Link to view the full text]
Accession Number
622491250
Title
Effectiveness of dexmedetomidine versus propofol on extubation times,
length of stay and mortality rates in adult cardiac surgery patients: A
systematic review and meta-analysis.
Source
JBI Database of Systematic Reviews and Implementation Reports. 16 (5) (pp
1220-1239), 2018. Date of Publication: 01 May 2018.
Author
Nguyen J.; Nacpil N.
Institution
(Nguyen, Nacpil) School of Nurse Anesthesia, Texas Christian University,
Fort Worth, United States
(Nguyen, Nacpil) Center for Translational Research, Joanna Briggs
Institute Center of Excellence, United Kingdom
Publisher
Joanna Briggs Institute (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To determine the effects of dexmedetomidine versus propofol on
extubation time, intensive care unit (ICU) length of stay, total hospital
length of stay and in-hospital mortality rates in cardiac surgery
patients. Introduction: Recovery from cardiovascular surgery involves
weaning from mechanical ventilation. Mechanical ventilation decreases the
work of breathing for patients by inhaling oxygen and exhaling carbon
dioxide via a ventilator or breathing machine. Prolonged mechanical
ventilation is associated with complications, such as pneumonia and lung
injury, and increases the risk of morbidity and mortality. Major risk
factors that contribute to lung injury are due to high tidal volumes and
barotrauma. Cardiac surgery patients remain on the ventilator
postoperatively due to the high dose opioid-based anesthesia and the
initial vulnerable hemodynamic state. An important component of
postoperative management following cardiac surgery is the use of sedation
to reduce the stress response, facilitate assisted ventilation, and
provide anxiolysis. Propofol and dexmedetomidine are two common sedative
agents with differing pharmacological profiles used to provide comfort and
minimize hemodynamic disturbances during this recovery phase. Choice of
drug may have an impact on length of mechanical ventilation, length of
stay and mortality. Inclusion criteria: Participants included were >=18
years, of any gender or ethnicity, undergoing valvular surgery, coronary
artery bypass graft (CABG) surgery, or valvular surgery and CABG. Studies
were excluded if participants received both dexmedetomidine and propofol
concurrently as a primary sedative. Interventions were propofol compared
to dexmedetomidine as continuous infusions for sedation after cardiac
surgery. All variations of dosages and duration of both sedative agents
were included. Outcomes of interest were: total time (hours) of mechanical
ventilation after cardiac surgery, specifically from end of surgery to
extubation; total length of stay (LOS) in the ICU (hours) following
cardiac surgery, specifically from ICU admission to transfer to medical
ward; total hospital LOS (hours) following cardiac surgery, from date of
admission to date of discharge; and in-hospital mortality rates, from date
of admission to date of discharge. Randomized controlled trials (RCTs),
controlled trials, and prospective and retrospective cohort studies were
considered for inclusion. Method(s): A search was conducted in
MEDLINE via PubMed, Embase, Trip Database, ProQuest Nursing and Allied
Health Source Database, Web of Science, ProQuest Dissertations and Theses
Global, and MedNar to locate both published and unpublished studies
between January 1, 1999 and November 23, 2017. Two reviewers assessed the
methodological quality using standardized critical appraisal instruments
from the Joanna Briggs Institute System for the Unified Management,
Assessment and Review of Information (JBI SUMARI). Quantitative data were
extracted using the standardized data extraction tool from JBI SUMARI.
Data were pooled using Comprehensive Meta-Analysis Software Version 3
(Biostat, NJ, USA). Mean differences (95% confidence interval [CI]) and
effect size estimates were calculated for continuous outcomes.
Meta-analysis using a random-effects model was performed for length of
mechanical ventilation, ICU LOS, and hospital LOS. Results have been
presented in narrative form when findings could not be pooled using
meta-analysis. Standard GRADE (Grading of Recommendations, Assessment,
Development, and Evaluation) evidence assessment of outcomes has been
reported. Result(s): A total of four studies were included in the
review. Meta-analysis of three cohort studies revealed dexmedetomidine to
be superior to propofol with an average reduction of 4.18 hours (95%
CI-6.69 to-1.67, p = 0.001) on the extubation times, an average 9.89 hour
(95% CI-18.6 to-1.19, p = 0.03) reduction in ICU LOS, and an average 37.9
hour (95% CI,-60.41 to-15.46, p = 0.00) reduction in overall hospital LOS.
A RCT was excluded from pooling for meta-analysis, but its results were
congruent with meta-analysis results. There was lack of sufficient data to
perform meta-analysis on in-hospital mortality rates. Conclusion(s):
In postoperative cardiac surgery patients, dexmedetomidine is associated
with a shorter time to extubation, shorter ICU LOS, and shorter hospital
LOS in postoperative cardiac surgery patients compared to propofol. The
quality of evidence for these findings however is low and no
recommendations can be made to change current practice. There was
insufficient evidence to determine significant differences in-hospital
mortality rates. Sedation protocols still need to be formulated. There are
significant gaps in the literature. Areas of further research include
additional well-designed and appropriately powered RCTs with wide
inclusion criteria to reflect this surgical population; quantitative,
transparent, and standardized sedation, weaning, and extubation protocols;
precise and standardized methods and measurements for interventions and
outcomes, and short-and long-term morbidity and mortality
follow-up. Copyright © 2018 THE JOANNA BRIGGS INSTITUTE.

<40>
[Use Link to view the full text]
Accession Number
622491123
Title
Effectiveness and harms of pharmacological interventions in the treatment
of delirium in adults in intensive care units post cardiac surgery: A
systematic review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 16 (5) (pp
1117-1125), 2018. Date of Publication: 01 May 2018.
Author
Leigh V.; Tufanaru C.; Elliott R.
Institution
(Leigh) Joanna Briggs Institute, Faculty of Health and Medical Sciences,
University of Adelaide, Adelaide, Australia
(Leigh, Tufanaru) Cardiothoracic Unit, Malcolm Fisher Intensive Care Unit,
Royal North Shore Hospital, Sydney, Australia
(Elliott) Malcolm Fisher Intensive Care Unit, Royal North Shore Hospital,
Sydney, Australia
(Elliott) Nursing and Midwifery Directorate, Northern Sydney Local Health
District, Sydney, Australia
(Elliott) Faculty of Health, University of Technology Sydney, Sydney,
Australia
Publisher
Joanna Briggs Institute (E-mail: kathiest.clai@apta.org)
Abstract
Review question/objective: The review objective is to synthesize the best
available evidence on the effectiveness and harms of pharmacological
interventions in the treatment of delirium in adults in intensive care
units (ICU) after cardiac surgery. The specific review question is: What
is the effectiveness and what are the harms of pharmacological
interventions in relation to the duration and severity of delirium
episodes, length of stay in ICU, length of stay in hospital, functional
capacity and quality of life and mortality for critically ill adult
patients treated in intensive care after cardiac surgery? Copyright
© 2018 THE JOANNA BRIGGS INSTITUTE.

<41>
Accession Number
619331470
Title
Impact of age, sex, therapeutic intent, race and severity of advanced
heart failure on short-term principal outcomes in the MOMENTUM 3 trial.
Source
Journal of Heart and Lung Transplantation. 37 (1) (pp 7-14), 2018. Date of
Publication: January 2018.
Author
Goldstein D.J.; Mehra M.R.; Naka Y.; Salerno C.; Uriel N.; Dean D.; Itoh
A.; Pagani F.D.; Skipper E.R.; Bhat G.; Raval N.; Bruckner B.A.; Estep
J.D.; Cogswell R.; Milano C.; Fendelander L.; O'Connell J.B.; Cleveland J.
Institution
(Goldstein) Department of Cardiothoracic Surgery, Montefiore Medical
Center, Bronx, New York, United States
(Mehra) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, Boston, Massachusetts, United States
(Naka) Division of Cardiothoracic Surgery, Columbia University College of
Physicians & Surgeons, New York, New York, United States
(Salerno) Department of Cardiothoracic Surgery, St. Vincent Heart Center,
Indianapolis, Indiana, United States
(Uriel) Section of Cardiology, University of Chicago School of Medicine
and Medical Center, Chicago, Illinois, United States
(Dean) Division of Cardiothoracic Surgery, Piedmont Heart Institute,
Atlanta, Georgia, United States
(Itoh) Division of Cardiothoracic Surgery, Washington University School of
Medicine, St. Louis, Missouri, United States
(Pagani) Department of Cardiac Surgery, University of Michigan Health
System, Ann Arbor, Michigan, United States
(Skipper) Department of Thoracic and Cardiovascular Surgery, Danger Heart
and Vascular Institute, Carolinas Medical Center, Charlotte, North
Carolina, United States
(Bhat) Division of Cardiology, Advocate Christ Medical Center, Oak Lawn,
Illinois, United States
(Raval) Cardiology Department, Florida Hospital, Orlando, Florida, United
States
(Bruckner, Estep) Department of Cardiology, Houston Methodist Hospital,
Houston, Texas, United States
(Cogswell) Division of Cardiology, University of Minnesota, Minneapolis,
Minnesota, United States
(Milano) Department of Surgery, Duke Heart Center, Duke University,
Durham, North Carolina, United States
(Fendelander, O'Connell) Abbott, Chicago, Illinois, United States
(Cleveland) Division of Cardiothoracic Surgery, University of Colorado
School of Medicine, Aurora, Colorado, United States
Publisher
Elsevier USA
Abstract
Background Primary outcomes analysis of the Multicenter Study of MagLev
Technology in Patients Undergoing MCS Therapy With HeartMate 3 (MOMENTUM
3) trial short-term cohort demonstrated a higher survival rate free of
debilitating stroke and reoperation to replace/remove the device (primary
end-point) in patients receiving the HeartMate 3 (HM3) compared with the
HeartMate (HMII). In this study we sought to evaluate the individual and
interactive effects of pre-specified patient subgroups (age, sex, race,
therapeutic intent [bridge to transplant/bridge to candidacy/destination
therapy] and severity of illness) on primary end-point outcomes in
MOMENTUM 3 patients implanted with HM3 and HMII devices. Methods Cox
proportional hazard models were used to analyze patients enrolled in the
"as-treated cohort" (n = 289) of the MOMENTUM 3 trial to: (1) determine
interaction of various subgroups on primary end-point outcomes; and (2)
identify independent variables associated with primary end-point success.
Results Baseline characteristics were well balanced among HM3 (n = 151)
and HMII (n = 138) cohorts. No significant interaction between the
sub-groups on primary end-point outcomes was observed. Cox multivariable
modeling identified age (<=65 years vs >65 years, hazard ratio 0.42 [95%
confidence interval 0.22 to 0.78], p = 0.006]) and pump type (HM3 vs HMII,
hazard ratio 0.53 [95% confidence interval 0.30 to 0.96], p = 0.034) to be
independent predictors of primary outcomes success. After adjusting for
age, no significant impact of sex, race, therapeutic intent and INTERMACS
profiles on primary outcomes were observed. Conclusions This analysis of
MOMENTUM 3 suggests that younger age (<=65 years) at implant and pump
choice are associated with a greater likelihood of primary end-point
success. These findings further suggest that characterization of
therapeutic intent into discrete bridge-to-transplant and destination
therapy categories offers no clear clinical advantage, and should ideally
be abandoned. Copyright © 2018 The Authors

<42>
Accession Number
2000597707
Title
Utility of troponin assays for exclusion of acute cellular rejection after
heart transplantation: A systematic review.
Source
Journal of Heart and Lung Transplantation. 37 (5) (pp 631-638), 2018. Date
of Publication: May 2018.
Author
Fitzsimons S.; Evans J.; Parameshwar J.; Pettit S.J.
Institution
(Fitzsimons, Evans, Parameshwar, Pettit) Transplant Unit, Papworth
Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom
(Fitzsimons, Evans, Parameshwar, Pettit) Department of Public Health and
Primary Care, University of Cambridge, Cambridge, United Kingdom
Publisher
Elsevier USA
Abstract
Background: Acute cellular rejection (ACR) is a common complication in the
first year after heart transplantation (HT). Routine surveillance for ACR
is undertaken by endomyocardial biopsy (EMB). Measurement of cardiac
troponins (cTn) in serum is an established diagnostic test of cardiac
myocyte injury. This systematic review aimed to determine whether cTn
measurement could be used to diagnose or exclude ACR. Method(s):
PubMed, Google Scholar and the JHLT archive were searched for studies
reporting the result of a cTn assay and a paired surveillance EMB.
Significant ACR was defined as International Society for Heart and Lung
Transplantataion (ISHLT) Grade >=3a/>=2R. Considerable heterogeneity
between studies precluded quantitative meta-analysis. Individual study
sensitivity and specificity data were examined and used to construct a
pooled hierarchical summary receiver-operator characteristic (ROC) curve.
 Result(s): Twelve studies including 993 patients and 3,803 EMBs, of
which 3,729 were paired with cTn levels, had adequate data available for
inclusion. The overall rate of significant ACR was 12%. There was wide
variation in diagnostic performance. cTn assays demonstrated sensitivity
of 8% to 100% and specificity of 13% to 88% for detection of ACR. The
positive predictive value (PPV) was low but the negative predictive value
(NPV) was relatively high (79% to 100%). High-sensitivity cTn assays had
greater sensitivity and NPV than conventional cTn assays for detection of
ACR (sensitivity: 82% to 100% vs 8% to 77%; NPV: 97% to 100% vs 81% to
95%, respectively). Conclusion(s): cTn assays do not have sufficient
specificity to diagnose ACR in place of EMB. However, hs-cTn assays may
have sufficient sensitivity and negative predictive value to exclude ACR
and limit the need for surveillance EMB. Further research is required to
assess this strategy. Copyright © 2018 International Society for
the Heart and Lung Transplantation

<43>
Accession Number
616542972
Title
Innovation in pediatric clinical trials: The need to rethink the
end-point.
Source
Journal of Heart and Lung Transplantation. 37 (4) (pp 431-432), 2018. Date
of Publication: April 2018.
Author
Glass L.; Conway J.
Institution
(Glass, Conway) Department of Pediatrics, Stollery Children's Hospital,
University of Alberta, Edmonton, Alberta, Canada
Publisher
Elsevier USA

<44>
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

<45>
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

<46>
Accession Number
626735574
Title
The epidemiology of multicomponent blood transfusion: a systematic review.
Source
Transfusion Medicine. 29 (2) (pp 80-94), 2019. Date of Publication: April
2019.
Author
Perelman I.; Khair S.; Dermer E.; Tinmouth A.; Saidenberg E.; Fergusson D.
Institution
(Perelman, Khair, Dermer, Tinmouth, Saidenberg, Fergusson) Faculty of
Medicine, University of Ottawa, Ottawa, ON, Canada
(Perelman, Tinmouth, Saidenberg, Fergusson) Clinical Epidemiology, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
(Tinmouth, Saidenberg) Ottawa Hospital, Ottawa, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
We performed a systematic review to describe the prevalence of
multicomponent blood transfusion and, as a secondary objective, to
determine patient characteristics and outcomes associated with
multicomponent transfusion. There is a lack of literature on the
epidemiology of multicomponent transfusion as most studies concentrate on
a single blood product and its utilisation. Patient care and blood
management can be optimised by better understanding the patients who
receive multicomponent transfusions. The databases Medline, EMBASE and the
Cochrane Library of Systematic Reviews were searched. Observational cohort
and cross-sectional studies of hospital patients reporting on
multicomponent transfusion prevalence or on patient characteristics and
outcomes associated with multicomponent transfusion were included. A
descriptive synthesis of studies was performed. A total of 37 eligible
studies were included. It was found that multicomponent transfusion
prevalence varied greatly by patient population and by the combination of
blood products given in the multicomponent transfusion.
Multicomponent-transfused patients included burn, cardiac surgery, liver
surgery and transplant, cancer, infectious diseases, trauma and intensive
care unit patients. Five studies found associations between multicomponent
transfusion and adverse health outcomes; however, these findings are
likely confounded by indication. The overall quality of evidence was low
given a fair-to-poor individual study quality, inconsistent multicomponent
transfusion prevalence estimates and confounding by indication. Further
research is needed to better understand the epidemiology of multicomponent
transfusion, including studies on multicomponent transfusion in
haematological cancer patients and studies looking for patient
characteristics that can better predict multicomponent transfusion
need. Copyright © 2019 British Blood Transfusion Society

<47>
[Use Link to view the full text]
Accession Number
629138842
Title
Multimodal Patient Blood Management Program Based on a Three-pillar
Strategy: A Systematic Review and Meta-analysis.
Source
Annals of Surgery. 269 (5) (pp 794-804), 2019. Date of Publication: 01 May
2019.
Author
Althoff F.C.; Neb H.; Herrmann E.; Trentino K.M.; Vernich L.; Fullenbach
C.; Freedman J.; Waters J.H.; Farmer S.; Leahy M.F.; Zacharowski K.;
Meybohm P.; Choorapoikayil S.
Institution
(Althoff, Neb, Fullenbach, Zacharowski, Meybohm, Choorapoikayil)
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy,
University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590,
Germany
(Herrmann) Institute of Biostatistics and Mathematical Modelling, Goethe
University Frankfurt, Frankfurt, Germany
(Trentino) Data and Digital Innovation, East Metropolitan Health Service,
Perth, WA, Australia
(Vernich) Division of Epidemiology, Dalla Lana School of Public Health,
University of Toronto, Toronto, Canada
(Freedman) St Michael's Hospital, University of Toronto, Toronto, Canada
(Waters) Department of Anesthesiology and Bioengineering, McGowan
Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh,
PA, United States
(Farmer) Medical School, CTEC and Division of Surgery, Faculty of Health
and Medical Sciences, University of Western Australia, Perth, WA,
Australia
(Farmer) Faculty of Health Sciences, Centre for Population Health
Research, Curtin University, Perth, WA, Australia
(Leahy) Department of Hematology, School of Medicine and Pharmacology,
PathWest Laboratory Medicine Royal Perth Hospital, University of Western
Australia, Perth, WA, Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
To determine whether a multidisciplinary, multimodal Patient Blood
Management (PBM) program for patients undergoing surgery is effective in
reducing perioperative complication rate, and thereby is effective in
improving clinical outcome. Background(s):PBM is a medical concept
with the focus on a comprehensive anemia management, to minimize
iatrogenic (unnecessary) blood loss, and to harness and optimize
patient-specific physiological tolerance of anemia. Method(s):A
systematic review and meta-analysis was performed. Eligible studies had to
address each of the 3 PBM pillars with at least 1 measure per pillar, for
example, preoperative anemia management plus cell salvage plus rational
transfusion strategy. The study protocol has been registered with PROSPERO
(CRD42017079217). Result(s):Seventeen studies comprising 235,779
surgical patients were included in this meta-analysis (100,886 pre-PBM
group and 134,893 PBM group). Implementation of PBM significantly reduced
transfusion rates by 39% [risk ratio (RR) 0.61, 95% confidence interval
(CI) 0.55-0.68, P < 0.00001], 0.43 red blood cell units per patient (mean
difference -0.43, 95% CI -0.54 to -0.31, P < 0.00001), hospital length of
stay (mean difference -0.45, 95% CI -0.65 to -0.25, P < 0,00001), total
number of complications (RR 0.80, 95% CI 0.74-0.88, P <0.00001), and
mortality rate (RR 0.89, 95% CI 0.80-0.98, P = 0.02).
 Conclusion(s):Overall, a comprehensive PBM program addressing all 3
PBM pillars is associated with reduced transfusion need of red blood cell
units, lower complication and mortality rate, and thereby improving
clinical outcome. Thus, this first meta-analysis investigating a
multimodal approach should motivate all executives and health care
providers to support further PBM activities. Copyright © 2018 The
Author(s). Published by Wolters Kluwer Health, Inc.

<48>
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).

<49>
[Use Link to view the full text]
Accession Number
628535281
Title
Home-based cardiac rehabilitation: A scientific statement from the
American association of cardiovascular and pulmonary rehabilitation, the
American Heart Association, and the American college of cardiology.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 39 (4) (pp
208-225), 2019. Date of Publication: 01 Jul 2019.
Author
Thomas R.J.; Beatty A.L.; Beckie T.M.; Brewer L.C.; Brown T.M.; Forman
D.E.; Franklin B.A.; Keteyian S.J.; Kitzman D.W.; Regensteiner J.G.;
Sanderson B.K.; Whooley M.A.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Cardiac rehabilitation (CR) is an evidence-based intervention that uses
patient education, health behavior modification, and exercise training to
improve secondary prevention outcomes in patients with cardiovascular
disease. CR programs reduce morbidity and mortality rates in adults with
ischemic heart disease, heart failure, or cardiac surgery but are
significantly underused, with only a minority of eligible patients
participating in CR in the United States. New delivery strategies are
urgently needed to improve participation. One potential strategy is
home-based CR (HBCR). In contrast to center-based CR services, which are
provided in a medically supervised facility, HBCR relies on remote
coaching with indirect exercise supervision and is provided mostly or
entirely outside of the traditional center-based setting. Although HBCR
has been successfully deployed in the United Kingdom, Canada, and other
countries, most US healthcare organizations have little to no experience
with such programs. The purpose of this scientific statement is to
identify the core components, efficacy, strengths, limitations, evidence
gaps, and research necessary to guide the future delivery of HBCR in the
United States. Previous randomized trials have generated low- to
moderate-strength evidence that HBCR and center-based CR can achieve
similar improvements in 3- to 12-month clinical outcomes. Although HBCR
appears to hold promise in expanding the use of CR to eligible patients,
additional research and demonstration projects are needed to clarify,
strengthen, and extend the HBCR evidence base for key subgroups, including
older adults, women, underrepresented minority groups, and other
higher-risk and understudied groups. In the interim, we conclude that HBCR
may be a reasonable option for selected clinically stable low- to
moderate-risk patients who are eligible for CR but cannot attend a
traditional center-based CR program. Copyright © 2019 Wolters
Kluwer Health, Inc. All rights reserved.

<50>
Accession Number
2002071922
Title
Exercise Parameters and Outcome Measures Used in Cardiac Rehabilitation
Programs Following Median Sternotomy in the Elderly: A Systematic Review
and Meta-Analysis.
Source
Heart Lung and Circulation. 28 (10) (pp 1560-1570), 2019. Date of
Publication: October 2019.
Author
Pengelly J.; Pengelly M.; Lin K.-Y.; Royse C.; Karri R.; Royse A.; Bryant
A.; Williams G.; El-Ansary D.
Institution
(Pengelly, Royse, Royse, El-Ansary) Department of Health Professions,
Swinburne University of Technology, Melbourne, Vic, Australia
(Pengelly) Independent Researcher, Melbourne, Vic, Australia
(Lin) Department of Physiotherapy, School of Primary and Allied Health
Care, Faculty of Medicine, Nursing and Health Science, Monash University,
Melbourne, Vic, Australia
(Royse, Karri, Royse, El-Ansary) Department of Surgery, University of
Melbourne, Melbourne, Vic, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, Vic, Australia
(Bryant, Williams) Department of Physiotherapy, University of Melbourne,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Objective: The aim of this systematic review was to identify exercise
parameters and outcome measures used in cardiac rehabilitation programs
following median sternotomy, in the elderly cardiac population. Data
Sources: Five (5) electronic databases were searched for relevant studies
published in English after 1997. Study Selection: The screening process
was completed by two independent researchers, with a third independent
reviewer for overall agreement. Studies were selected if they included
only cardiac patients aged >=65 years who had undergone valve surgery
and/or coronary artery bypass grafting via median sternotomy, and who had
undertaken a postoperative cardiac rehabilitation exercise intervention
assessing physical function and/or cognitive recovery as outcomes.
 Data Extraction: Two researchers independently completed the data
extraction and quality assessment. Quality was assessed using a modified
Downs and Black tool. Data Synthesis: In total, 11 articles were
included for appraisal with respect to the quality of the study. Only two
randomised controlled trials were suitable for meta-analysis. A higher
volume of exercise was shown to have a positive effect on functional
recovery, assessed using the 6-minute walk test (6MWT) (mean difference =
26.97 m; 95% confidence interval [CI], 6.96-46.97; p = 0.008;
I2 = 0%). No significant improvement was shown between
additional exercise compared to standard care in improving
VO<inf>2peak</inf>, maximal power output or quality of life. No studies
evaluated the effect of exercise on cognitive recovery.
 Conclusion(s): Exercise significantly improves functional recovery in
the post-surgical elderly cardiac population, however uncertainty still
exists with regard to which modes of exercise and their specific
parameters are most effective in improving cognitive
recovery. Copyright © 2019 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<51>
Accession Number
618786080
Title
Electrical support during outdoor cycling in patients with coronary artery
disease: impact on exercise intensity, volume and perception of effort.
Source
Acta Cardiologica. 73 (4) (pp 343-350), 2018. Date of Publication: 04 Jul
2018.
Author
Hansen D.; Soors A.; Deluyker V.; Frederix I.; Dendale P.
Institution
(Hansen, Soors, Deluyker, Frederix, Dendale) Faculty of Medicine and Life
Sciences, Hasselt University, Agoralaan gebouw D, Diepenbeek, Belgium
(Hansen, Frederix, Dendale) Department of Cardiology/Heart Centre Hasselt,
Jessa Hospital, Hasselt, Belgium
(Frederix) Faculty of Medicine and Health Sciences, Antwerp University,
Antwerp, Belgium
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background: Electrical assisted bicycles (EAB's) could be used to overcome
barriers and difficulties to outdoor cycling and thus assist in achieving
a sufficient physical activity level in coronary artery disease (CAD)
patients, but it is unknown whether sufficient exercise intensities and
volumes could be elicited during cycling on EAB's. In this study we
examined, for the first time, the acute physiological impact of electrical
support during outdoor cycling in CAD patients (ISRCTN32238279).
 Method(s): Fifteen CAD patients (13 males), aged 64 +/- 7 years
executed a maximal cardiopulmonary exercise test and afterwards cycled a
predefined outdoor route of 10 km, in three different conditions:
classical cycling (no support), EAB with low support (EAB<inf>low</inf>)
and high support (EAB<inf>high</inf>). Oxygen uptake (VO<inf>2</inf>) and
carbon dioxide output (VCO<inf>2</inf>) was measured continuously by a
portable gas-analysing system. Cycling time was recorded and ratings of
perceived exertion (RPE) was assessed at 3 and 7 km. Result(s): Mean
VO<inf>2</inf> during EAB<inf>high</inf> (1721 +/- 537
ml*min-1) was significantly lower compared to EAB<inf>low</inf>
(1890 +/- 619 ml*min-1, p <.05), but no differences were found
between EAB<inf>low</inf> and classical cycling (1846 +/- 523
ml*min-1). EAB<inf>low</inf> and EAB<inf>high</inf> elicited a
sufficient volume and intensity (6.6 +/- 2.0 MET's (74 +/- 6%
VO<inf>2peak</inf>) and 6.0 +/- 1.8 MET's (68 +/- 7% VO<inf>2peak</inf>),
respectively) to adhere to the guidelines for secondary prevention in CAD.
RPE was significantly lower p <.05) during EAB<inf>high</inf> (9 +/- 2),
than during EAB<inf>low</inf> (11 +/- 2) or classical cycling (11 +/- 2).
 Conclusion(s): Outdoor cycling with electrical support leads to a
sufficiently high exercise intensity and volume in CAD patients, and may
be considered as an alternative exercise modality. Copyright ©
2017, © 2017 Belgian Society of Cardiology.

<52>
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.

<53>
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.

<54>
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.

<55>
Accession Number
627905355
Title
Children's Heart Assessment Tool for Transplantation (CHAT) Score: A Novel
Risk Score Predicts Survival After Pediatric Heart Transplantation.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 10 (3) (pp
296-303), 2019. Date of Publication: 01 May 2019.
Author
Fraser C.D.; Grimm J.C.; Zhou X.; Lui C.; Giuliano K.; Suarez-Pierre A.;
Crawford T.C.; Magruder J.T.; Hibino N.; Vricella L.A.
Institution
(Fraser, Grimm, Zhou, Lui, Giuliano, Suarez-Pierre, Crawford, Magruder,
Hibino, Vricella) Division of Cardiac Surgery, The Johns Hopkins Hospital,
Baltimore, MD, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Given the shortage of donor organs in pediatric heart
transplantation (HTx), pretransplant risk stratification may assist in
organ allocation and recipient optimization. We sought to construct a
scoring system to preoperatively stratify a patient's risk of one-year
mortality after HTx. Method(s): The United Network for Organ Sharing
database was queried for pediatric (<18 years) patients undergoing HTx
between 2000 and 2016. The population was randomly divided in a 4:1
fashion into derivation and validation cohorts. A multivariable logistic
regression model for one-year mortality was constructed within the
derivation cohort. Points were then assigned to independent predictors (P
<.05) based on relative odds ratios (ORs). Risk groups were established
based on easily applicable, whole-integer score cutoffs. Result(s): A
total of 5,700 patients underwent HTx; one-year mortality was 10.7%. There
was a similar distribution of variables between derivation (n = 4,560) and
validation (n = 1,140) cohorts. Of the 12 covariates included in the final
model, nine were allotted point values. The low-risk (score 0-9),
intermediate-risk (10-20), and high-risk (>20) groups had a 5.18%, 10%,
and 28% risk of one-year mortality (P <.001), respectively. Both
intermediate-risk (OR = 2.46, 95% confidence interval [95% CI]: 1.93-3.15;
P <.001) and high-risk (OR = 9.24, 95% CI: 6.92-12.35; P <.001) scores
were associated with an increased risk of one-year mortality when compared
to the low-risk group. Conclusion(s): The Children's Heart Assessment
Tool for Transplantation score represents a pediatric-specific,
recipient-based system to predict one-year mortality after HTx. Its use
could assist providers in identification of patients at highest risk of
poor outcomes and may aid in pretransplant optimization of these
children. Copyright © The Author(s) 2019.

<56>
Accession Number
2002703112
Title
Concurrent presentation of a hemorrhagic pericardial effusion and venous
thromboembolism in malignancy: a systematic review of case studies.
Source
Journal of Thrombosis and Thrombolysis. (no pagination), 2019. Date of
Publication: 2019.
Author
Pabba K.; Rojas-Hernandez C.M.
Institution
(Pabba) Department of Internal Medicine, McGovern Medical School at The
University of Texas Health Science Center at Houston, Houston, TX, United
States
(Rojas-Hernandez) Section of Benign Hematology, The University of Texas MD
Anderson Cancer Center, 1515 Holcombe Blvd., Suite 1464, Houston, TX
77030, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The concurrent presentation of symptomatic malignant pericardial
hemorrhage and venous thromboembolism is a rare event that poses a
clinical dilemma. Existing VTE guidelines do not indicate when, or if,
anticoagulation therapy should be started after the treatment of the
pericardial bleed. We performed a systematic review to compile the
published clinical evidence on the occurrence of coexisting pericardial
hemorrhage and VTE in cancer patients and to describe the clinical
presentations and bleeding and thrombosis outcomes before and after
anticoagulation therapy. We studied published case reports on patients
with cancer who presented to the hospital with pericardial hemorrhage and
VTE through April 11, 2019. We found seven published case reports. All
patients had suffered from a pulmonary embolism and had pericardiocentesis
during hospitalization. Five patients (71%) had lung cancer. Four patients
(57%) were started on anticoagulation after pericardial drainage and
survived the index event. Two patients (29%) were not started on
anticoagulation after pericardiocentesis; only one of these patients
survived the hospitalization. Pericardial bleeding risk in cancer may be
inherent to malignancy, and it is unclear if anticoagulation use increases
the risk of recurrent pericardial bleeding. The management of pericardial
bleeding typically requires pericardiocentesis, and clinical registries,
prospective collaboration projects, and case adjudication are needed to
establish the safety of initiation of antithrombotic therapy in such
patients. Copyright © 2019, Springer Science+Business Media, LLC,
part of Springer Nature.

<57>
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.

<58>
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.

<59>
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.

<60>
[Use Link to view the full text]
Accession Number
628800100
Title
A meta-analysis of impact of low-flow/low-gradient aortic stenosis on
survival after transcatheter aortic valve implantation.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 20 (10) (pp
691-698), 2019. Date of Publication: 01 Oct 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, NY,
United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
NLM (Medline)
Abstract
AIMS: To determine whether low-flow/low-gradient (LF/LG) aortic stenosis
affects survival after transcatheter aortic valve implantation (TAVI), we
performed a meta-analysis of currently available studies. METHOD(S):
MEDLINE and EMBASE were searched through January 2019 using PubMed and
OVID. Observational studies comparing all-cause mortality after TAVI for
patients with classical LF/LG (C/LF/LG) aortic stenosis versus
normal-flow/high-gradient (NF/HG) aortic stenosis, paradoxical LF/LG
(P/LF/LG) aortic stenosis versus NF/HG aortic stenosis, and (3) C/LF/LG
aortic stenosis versus P/LF/LG aortic stenosis were included.
Study-specific estimates, risk and hazard ratios of mortality, were
combined in the random-effects model. RESULT(S): Our search
identified nine eligible studies including a total of 5512 TAVI patients.
Pooled analysis demonstrated significantly higher early mortality in
C/LF/LG aortic stenosis than NF/HG aortic stenosis (risk ratio, 1.72; P =
0.02) and no statistically significant difference in early mortality
between P/LF/LG aortic stenosis and NF/HG aortic stenosis (P = 0.67) and
between C/LF/LG aortic stenosis and P/LF/LG aortic stenosis (P = 0.51).
Midterm mortality in C/LF/LG (risk ratio/hazard ratio, 1.73; P = 0.0003)
and P/LF/LG aortic stenosis (risk ratio/hazard ratio, 1.48; P < 0.0001)
was significantly higher than that in NF/HG aortic stenosis. There was no
statistically significant difference in midterm mortality between C/LF/LG
aortic stenosis and P/LF/LG aortic stenosis (P = 0.63).
 CONCLUSION(S): After TAVI, C/LF/LG aortic stenosis is associated with
increased early mortality compared with NF/HG, and C/LF/LG and P/LF/LG
aortic stenosis is associated with increased midterm mortality compared
with NF/HG aortic stenosis despite no difference in early mortality
between P/LF/LG aortic stenosis and NF/HG aortic stenosis. There is no
difference in early and midterm mortality between C/LF/LG aortic stenosis
and P/LF/LG aortic stenosis.

<61>
Accession Number
628307275
Title
The Effect of Modified Cardiac Rehabilitation on Erectile Dysfunction and
Coping with Stress in Men Undergoing Coronary Artery Bypass Graft (CABG):
A Clinical Trial.
Source
Sexuality and Disability. 37 (3) (pp 455-467), 2019. Date of Publication:
01 Sep 2019.
Author
Kaikhosro Doulatyari P.; Gholami M.; Toulabi T.; Birjandi M.; Abdi A.
Institution
(Kaikhosro Doulatyari) Student Research Committee, Lorestan University of
Medical Sciences, Khorramabad, Iran, Islamic Republic of
(Gholami, Toulabi) School of Nursing and Midwifery, Social Determinants of
Health Research Center, Lorestan University of Medical Sciences,
Khorramabad, Iran, Islamic Republic of
(Birjandi) Biostatistics Department, School of Health, Lorestan University
of Medical Sciences, Khorramabad, Iran, Islamic Republic of
(Abdi) School of Nursing and midwifery, Student Research Committee,
Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic
Republic of
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Erectile dysfunction and stress are among common post-CABG surgery
complications. The present study was conducted to assess the effect of
modified cardiac rehabilitation on "erectile dysfunction" and "coping with
stress". In the present clinical trial study, 126 male patients undergoing
CABG surgery were randomly assigned to treatment (63 patients) and control
(63 patients) groups. Control group received conventional cardiac
rehabilitation program over 26 sessions. Treatment group received modified
cardiac rehabilitation program, including Kegel exercise and training on
stress coping strategies in the first four sessions of their
rehabilitation program. Patients were assessed before and after cardiac
rehabilitation program using the International Index of Erectile
Dysfunction (IIEF-5) questionnaire and Endler and Parker Coping with
Stress Scale. Data were analyzed in SPSS using ANOVA, T, and Chi square
tests. Mean erectile function score significantly increased in both
treatment and control groups, but the difference in mean scores for
improvement in erectile function was greater in treatment group (P <
0.001). Analysis showed no significant difference in mean differences
between two groups in all subscales of stress coping. Intragroup analysis
showed significant differences in both groups between mean differences
before and after intervention in task-oriented styles {treatment group (P
< 0.002), control group (P < 0.001)}, and social diversion-oriented. The
results showed that conventional and modified cardiac rehabilitation can
be effective in improving erectile dysfunction and stress coping in
task-oriented and social diversion-oriented styles in the men patients
with left ventricular ejection fraction over 30% following CABG surgery.
However, modified cardiac rehabilitation has greater benefits for
improving erectile dysfunction. Copyright © 2019, Springer
Science+Business Media, LLC, part of Springer Nature.

<62>
Accession Number
627751710
Title
Impact of Early (<24h) Surgical Decompression on Neurological Recovery in
Thoracic Spinal Cord Injury: A Meta-Analysis.
Source
Journal of neurotrauma. 36 (18) (pp 2609-2617), 2019. Date of Publication:
15 Sep 2019.
Author
Ter Wengel P.V.; Martin E.; De Witt Hamer P.C.; Feller R.E.; van
Oortmerssen J.A.E.; van der Gaag N.A.; Oner F.C.; Vandertop W.P.
Institution
(Ter Wengel, Martin, De Witt Hamer, Feller, van Oortmerssen, Vandertop)
Neurosurgical Center Amsterdam, Amsterdam University Medical Center, VUmc,
Amsterdam, Netherlands
(Ter Wengel, van der Gaag) Department of Neurosurgery, Leiden University
Medical Center, Leiden, Netherlands
(van der Gaag) Department of Neurosurgery, HagaZiekenhuis, the Hague,
Netherlands
(Oner) Department of Orthopedic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Vandertop) Neurosurgical Center Amsterdam, Amsterdam University Medical
Center, AMC, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
The impact of surgical timing in neurological recovery in thoracic and
thoracolumbar traumatic spinal cord injury (tSCI) is still a subject of
discussion. While in cervical tSCI one may expect a beneficial effect of
early intervention within 24h, especially in complete cases, this has not
yet been demonstrated clearly for thoracic tSCI. This study addresses
neurological improvement after early and late surgery for thoracic and
thoracolumbar tSCI. A systematic search retrieved 14 publications of
observational studies reporting outcome measurements after surgery in 1075
patients with thoracic and thoracolumbar tSCI from PubMed and Embase
databases. Surgery was considered early within 24h and late thereafter. An
improvement of at least one and two grades on the American Spinal Injury
Association Impairment Scale (ASIA) was evaluated. The Meta-Analyses and
Systematic Reviews of Observational Studies guidelines were followed.
Improvement rates were summarized using individual patient data in a
Bayesian random effects model and compared for those with early and late
surgery. In the qualitative analysis, six of seven studies, which
investigated the effect of surgical timing, observed a significant effect
of early surgery on at least one ASIA grade improvement. Quantitative
analysis in 948 patients with thoracic and thoracolumbar tSCI data,
however, did not reveal a significant increase in odds of >=1 ASIA grade
recovery in early surgery (66.8% [95% confidence interval (CI):
45.0-87.8%] compared with late surgery (48.9% [95% CI: 25.1-70.7%; odds
ratio (OR) 2.2 (95% CI: 0.6-14.0]). This study did not observe a
significant beneficial effect of surgical decompression within 24h in
patients with thoracic and thoracolumbar tSCI.

<63>
Accession Number
628508211
Title
Inspiratory Muscle Training after Heart Valve Replacement Surgery Improves
Inspiratory Muscle Strength, Lung Function, and Functional Capacity: A
RANDOMIZED CONTROLLED TRIAL.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. (no pagination),
2019. Date of Publication: 2019.
Author
Cargnin C.; Karsten M.; Guaragna J.C.V.D.C.; Dal Lago P.
Institution
(Cargnin, Dal Lago) Programa de Pos-graduacao em Ciencias da Saude,
Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Porto
Alegre, Brazil
(Karsten, Dal Lago) Programa de Pos-graduacao em Ciencias da Reabilitacao
(UFCSPA), Porto Alegre, Brazil
(Karsten) Departamento de Fisioterapia, Universidade Do Estado de Santa
Catarina (UDESC), Florianopolis, Brazil
(Karsten) Programa de Pos-graduacao em Fisioterapia (UDESC),
Florianopolis, Brazil
(Guaragna, Dal Lago) Faculdade de Medicina, Pontificia Universidade
Catolica Do Rio Grande Do sul (PUCRS), Porto Alegre, Brazil
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: The aim of this study was to analyze the effects of inspiratory
muscle training (IMT) as a therapeutic strategy after heart valve
replacement surgery (HVRS). Method(s): A double-blind, randomized,
clinical trial that included patients undergoing elective HVRS, without
post-operative complications, were allocated to 2 groups: IMT group
(IMT-G) and IMT placebo group (IMT-PG). The IMT started 3 d after surgery
and was performed twice daily for 4 wk. Lung function, maximum inspiratory
pressure (MIP) as a measure of inspiratory muscle strength, functional
capacity, and quality of life were assessed pre-operatively and at the end
of training. Result(s): The IMT-G recovered pre-operative MIP and
lung function values after 4 wk of training. This group also increased the
distance walked during the 6-min walk test (6MWD). In the IMT-PG, the
values of MIP were below those found pre-operatively, with impairment of
lung function and lower 6MWD in the final evaluation. At the end of IMT,
MIP was correlated with the 6MWD and with the spirometry variables.
 Conclusion(s): IMT performed for 4 wk after HVRS was effective in
restoring the values of inspiratory muscle strength and lung function to
the pre-operative level and increasing the functional capacity assessed by
the 6MWD. Furthermore, an association between lung function and functional
capacity was observed, demonstrating the clinical relevance of the use of
IMT in the rehabilitation process of these patients. Copyright ©
2019 The Academy of Geriatric Physical Therapy, APTA. Unauthorized
reproduction of this article is prohibited.

<64>
Accession Number
2002311153
Title
Early outcomes for low-risk pediatric heart transplant recipients and
steroid avoidance: A multicenter cohort study (Clinical Trials in Organ
Transplantation in Children - CTOTC-04).
Source
Journal of Heart and Lung Transplantation. 38 (9) (pp 972-981), 2019. Date
of Publication: September 2019.
Author
Lamour J.M.; Mason K.L.; Hsu D.T.; Feingold B.; Blume E.D.; Canter C.E.;
Dipchand A.I.; Shaddy R.E.; Mahle W.T.; Zuckerman W.A.; Bentlejewski C.;
Armstrong B.D.; Morrison Y.; Diop H.; Ikle D.N.; Odim J.; Zeevi A.; Webber
S.A.
Institution
(Lamour, Hsu) Division of Pediatric Cardiology, Children's Hospital at
Montefiore, Bronx, New York, NY, United States
(Mason, Armstrong, Morrison, Diop, Ikle) Rho Federal Systems Division,
Chapel Hill, NC, United States
(Feingold) Departments of Pediatrics and Clinical and Translational
Science, University of Pittsburgh School of Medicine, Pittsburgh, PA,
United States
(Blume) Department of Pediatric Cardiology, Boston Children's Hospital,
Boston, MA, United States
(Canter) Division of Pediatric Cardiology, Washington University School of
Medicine, St. Louis, MO, United States
(Dipchand) Department of Paediatrics, Labatt Family Heart Center, Hospital
for Sick Children, Toronto, Ontario, Canada
(Shaddy) Division of Pediatric Cardiology, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Mahle) Division of Pediatric Cardiology, Children's Healthcare of
Atlanta, Atlanta, Georgia, Georgia
(Zuckerman, Bentlejewski) Division of Pediatric Cardiology, Columbia
University Medical Center, New York, NY, United States
(Odim) Transplantation Branch, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, MD, United
States
(Zeevi) Department of Pathology, University of Pittsburgh Medical Center,
Pittsburgh, PA, United States
(Webber) Department of Pediatrics, Vanderbilt University School of
Medicine, Nashville, TN, United States
Publisher
Elsevier USA
Abstract
BACKGROUND: Immunosuppression strategies have changed over time in
pediatric heart transplantation. Thus, comorbidity profiles may have
evolved. Clinical Trials in Organ Transplantation in Children-04 is a
multicenter, prospective, cohort study assessing the impact of
pre-transplant sensitization on outcomes after pediatric heart
transplantation. This sub-study reports 1-year outcomes among recipients
without pre-transplant donor-specific antibodies (DSAs). METHOD(S):
We recruited consecutive candidates (<21 years) at 8 centers.
Sensitization status was determined by a core laboratory.
Immunosuppression was standardized as follows: Thymoglobulin induction
with tacrolimus and/or mycophenolate mofetil maintenance. Steroids were
not used beyond 1 week. Rejection surveillance was by serial biopsy.
 RESULT(S): There were 240 transplants. Subjects for this sub-study (n
= 186) were non-sensitized (n = 108) or had no DSAs (n = 78). Median age
was 6 years, 48.4% were male, and 38.2% had congenital heart disease.
Patient survival was 94.5% (95% confidence interval, 90.1-97.0%). Freedom
from any type of rejection was 67.5%. Risk factors for rejection were
older age at transplant and presence of non-DSAs pre-transplant. Freedom
from infection requiring hospitalization/intravenous anti-microbials was
75.4%. Freedom from rehospitalization was 40.3%. New-onset diabetes
mellitus and post-transplant lymphoproliferative disorder (PTLD) occurred
in 1.6% and 1.1% of subjects, respectively. There was no decline in renal
function over the first year. Corticosteroids were used in 14.5% at 1
year. CONCLUSION(S): Pediatric heart transplantation recipients
without DSAs at transplant and managed with a steroid avoidance regimen
have excellent short-term survival and a low risk of first-year diabetes
mellitus and PTLD. Rehospitalization remains common. These contemporary
observations allow for improved caregiver and/or patient counseling and
provide the necessary outcomes data to help design future randomized
controlled trials. Copyright © 2019 International Society for
Heart and Lung Transplantation

<65>
Accession Number
2002721645
Title
Effect of increasing age on percutaneous coronary intervention vs coronary
artery bypass grafting in older adults with unprotected left main coronary
artery disease: A meta-analysis and meta-regression.
Source
Clinical Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Khan M.R.; Kayani W.T.; Ahmad W.; Manan M.; Hira R.S.; Hamzeh I.; Jneid
H.; Virani S.S.; Kleiman N.; Lakkis N.; Alam M.
Institution
(Khan) Division of Cardiology, McLaren-Flint/Michigan State University,
Flint, MI, United States
(Kayani, Hamzeh, Jneid, Virani, Lakkis, Alam) Section of Cardiology,
Department of Internal Medicine, Baylor College of Medicine, Houston, TX,
United States
(Ahmad) Department of Internal Medicine, Nishtar Medical University,
Multan, Pakistan
(Manan) Department of Internal Medicine, King Edward Medical University,
Lahore, Pakistan
(Hira) Division of Cardiology, University of Washington, Seattle, WA,
United States
(Jneid, Virani) Section of Cardiology, Michael E. DeBakey Veterans Affairs
Medical Center, Houston, TX, United States
(Kleiman) Houston Methodist DeBakey Heart and Vascular Center, Houston
Methodist Hospital, Houston, TX, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Older adults (>=70-year-old) are under-represented in the
published data pertaining to unprotected left main coronary artery disease
(ULMCAD). Hypothesis: Percutaneous coronary intervention (PCI) might be
comparable to coronary artery bypass grafting (CABG) for revascularization
of ULMCAD. Method(s): We compared PCI versus CABG in older adults
with ULMCAD with an aggregate data meta-analyses (4880 patients) of
clinical outcomes [all-cause mortality, myocardial infarction (MI), repeat
revascularization, stroke and major adverse cardiac and cerebrovascular
events(MACCE)] at 30 days, 12-24 months & >=36 months in patients with
mean age >=70 years and ULMCAD. A meta-regression analysis evaluated the
effect of age on mortality after PCI. Odds ratios (OR) and 95% confidence
intervals (CI) were estimated using random-effects model. Result(s):
All-cause mortality between PCI and CABG was comparable at 30-days
(OR0.77, 95% CI 0.42- 1.41) and 12-24-months (OR 1.22, 95% CI 0.78-1.93).
PCI was associated with a markedly lower rate of stroke at 30-day
follow-up in octogenarians (OR 0.14, 95% CI 0.02-0.76) but an overall
higher rate of repeat revascularization. At >=36-months, MACCE (OR
1.26,95% CI 0.99-1.60) and all-cause mortality (OR 1.39, 95% CI 1.00-1.93)
showed a trend favoring CABG but did not reach statistical significance.
On meta-regression, PCI was associated with a higher mortality with
advancing age (coefficient=0.1033, p=0.042). Conclusion(s): PCI was
associated with a markedly lower rate of early stroke in octogenarians as
compared to CABG. All-cause mortality was comparable between the two arms
with a trend favoring CABG at >=36-months.PCI was however associated with
increasing mortality with advancing age as compared to CABG. Copyright
© 2019 The Authors. Clinical Cardiology published by Wiley
Periodicals, Inc.

<66>
Accession Number
2002712331
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: 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, Ospedale di Circolo,
University of Insubria, Varese, Italy
(Cappabianca, Ferrarese, Tutino, Corazzari, Matteucci, Mantovani, Musazzi,
De Ponti, Beghi) Cardiac Surgery Research Center, University of Insubria,
Varese, Italy
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: The latest STS guidelines recommend concomitant atrial
fibrillation (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. The 6- and 12-months prevalence of
sinus rhythm were higher in the BA group (OR, 1.37, CI, 1.09-1.73, P =.008
and OR, 1.37, CI, 0.99-1.88, P =.05 respectively). Permanent pacemaker
(PPM) implantation (OR, 1.85, CI, 1.38-2.49, P <.0001) and reopening for
bleeding (OR, 1.70, CI, 1.05-2.75, P =.03) were higher in the BA group.
Among patients undergone PPM implantation, BA group had a significantly
higher risk of sinoatrial node dysfunction (OR, 3.01, CI, 1.49-6.07, P
=.002). Conclusion(s): Concomitant BA ablation appears superior to LA
ablation in terms of efficacy but is associated with a higher risk of
bleeding and of PPM implantation, more frequently due to sinoatrial node
dysfunction. LA approach should be preferable in patients with a higher
risk of bleeding or with perioperative risk factors for PPM
implantation. Copyright © 2019 Wiley Periodicals, Inc.

<67>
Accession Number
2002700619
Title
Intra-aortic balloon pump in acute chest pain and cardiogenic shock-a
long-term follow-up.
Source
Scandinavian Cardiovascular Journal. (no pagination), 2019. Date of
Publication: 2019.
Author
Bendz B.; Gude E.; Ragnarsson A.; Endresen K.; Aaberge L.; Geiran O.;
Simonsen S.
Institution
(Bendz, Gude, Ragnarsson, Endresen, Aaberge, Simonsen) Department of
Cardiology, Heart-Lung Clinic, Oslo University Hospital, Rikshospitalet,
Oslo, Norway
(Geiran) Department of Cardio-Thoracic Surgery, Heart-Lung Clinic, Oslo
University Hospital, Rikshospitalet, Oslo, Norway
(Bendz, Geiran) Institute of Clinical Medicine, University of Oslo, Oslo,
Norway
Publisher
Taylor and Francis Ltd
Abstract
Objectives. Coronary revascularisation and intra-aortic balloon pump
(IABP) has been considered the gold standard treatment of acute coronary
syndrome with cardiogenic shock, recently challenged by the SHOCK II
study. The aim of this non-randomised study was to investigate the long
term prognosis after immediate IABP supported angiography, in patients
with acute chest pain and cardiogenic shock, treated with percutaneous
coronary intervention (PCI), cardiac surgery or optimal medical treatment.
We assessed data from 281 consecutive patients admitted to our department
from 2004 to 2010. Results. Mean (+/-SD) age was 63.8 +/- 11.5 (range
30-84) years with a follow-up of 5.6 +/- 4.4 (0-12.7) years. Acute
myocardial infarction was the primary diagnosis in 93% of the patients, 4%
presented with unstable angina pectoris and 3% cardiomyopathy or
arrhythmias of non-ischemic aetiology. Systolic blood pressure at
admittance was 85 +/- 18 mmHg and diastolic 55 +/- 18 mmHg. Thirty day,
one- and five-year survival was 71.2%, 67.3% and 57.7%, respectively. PCI
was performed immediately in 70%, surgery was done in 17%, and 13% were
not eligible for any revascularisation. Independent variables predicting
mortality were medical treatment vs revascularisation, out-of-hospital
cardiac arrest, and advanced age. Three serious non-fatal complications
occurred due to IABP treatment, i.e. 0.001 per treatment day. Conclusions.
We report the use of IABP in patients with acute chest pain admitted for
angiography. Long-term survival is acceptable and discriminating factors
were no revascularisation, out-of-hospital cardiac arrest and age. IABP
was safe and feasible and the complication rate was low. Copyright
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis
Group.

<68>
Accession Number
2002700130
Title
Can Direct Oral Anticoagulants Be Used for Stroke Prevention Among
Patients with Valvular Atrial Fibrillation?.
Source
Current Cardiology Reports. 21 (10) (no pagination), 2019. Article Number:
118. Date of Publication: 01 Oct 2019.
Author
Anderson S.L.; Marrs J.C.
Institution
(Anderson, Marrs) Department of Clinical Pharmacy, University of Colorado
Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, United
States
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: To review the clinical evidence underlying the efficacy
and safety of the use of direct oral anticoagulants (DOACs) for the
treatment of patients with valvular atrial fibrillation (AF). Recent
Findings: The recent focused update to the 2014 AHA/ACC/HRS Atrial
Fibrillation Guidelines defines valvular AF as AF in the setting of
moderate-to-severe mitral stenosis (MS) and/or in the presence of a
mechanical heart valve. Landmark clinical trials of DOACs in patients with
AF systematically excluded these patient populations. However, there are
trial data in both animals and humans regarding the use of DOACs in
patients with MS and in those with mechanical heart valves. Summary:
Based on sub-analyses and meta-analyses of clinical trial data in patients
with AF, the use of DOACs in valvular AF is not recommended. Patients with
moderate-to-severe MS or a mechanical heart valve and AF should be
anticoagulated with dose-adjusted warfarin. DOACs are reasonable
alternatives to warfarin in patients with AF and other types of valvular
disease, including mild MS and bioprosthetic valves. Copyright ©
2019, Springer Science+Business Media, LLC, part of Springer Nature.

<69>
[Use Link to view the full text]
Accession Number
629065265
Title
Cardiac Arrest and Mortality Related to Intubation Procedure in Critically
Ill Adult Patients: A Multicenter Cohort Study.
Source
Critical care medicine. 46 (4) (pp 532-539), 2018. Date of Publication: 01
Apr 2018.
Author
De Jong A.; Rolle A.; Molinari N.; Paugam-Burtz C.; Constantin J.-M.;
Lefrant J.-Y.; Asehnoune K.; Jung B.; Futier E.; Chanques G.; Azoulay E.;
Jaber S.
Institution
(De Jong, Rolle, Chanques, Jaber) Anesthesiology and Intensive Care,
Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital,
Centre Hospitalier Universitaire Montpellier, Universite Montpellier 1
,Universite Montpellier 2, Montpellier, France
(De Jong, Jung, Chanques, Jaber) INSERM U1046, CNRS UMR 9214, Montpellier,
France
(Rolle) Department of Intensive Care & Anesthesiology, University of
Pointe a Pitre Hospital. Guadeloupe, France
(Molinari) Department of Statistics, University of Montpellier Lapeyronie
Hospital, Montpellier, France
(Paugam-Burtz) Department of Intensive Care & Anesthesiology, University
of Paris Diderot, Sorbonne Paris Cite, Paris, France
(Paugam-Burtz) AP-HP, Hopital Beaujon, Paris, France
(Constantin, Futier) Department of Intensive Care & Anesthesiology,
Hotel-Dieu Hospital, University Hospital of Clermont Ferrand,
Clermont-Ferrand, France
(Lefrant) Department of Intensive Care & Anesthesiology, University of
Montpellier, Nimes Hospital, Nimes, France
(Asehnoune) Department of Intensive Care & Anesthesiology, University of
Nantes, Hotel-Dieu Hospital, Nantes, France
(Jung) Medical Intensive Care Unit, Lapeyronie Teaching Hospital, Centre
Hospitalier Universitaire Montpellier, Montpellier, France
(Azoulay) Medical Intensive Care Unit, University of Paris-Diderot, Saint
Louis Hospital, Paris, France
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To determine the prevalence of and risk factors for cardiac
arrest during intubation in ICU, as well as the association of ICU
intubation-related cardiac arrest with 28-day mortality. DESIGN:
Retrospective analysis of prospectively collected data. SETTING:
Sixty-four French ICUs. PATIENTS: Critically ill patients requiring
intubation in the ICU.None. MEASUREMENTS AND MAIN RESULTS: During the
1,847 intubation procedures included, 49 cardiac arrests (2.7%) occurred,
including 14 without return of spontaneous circulation (28.6%) and 35 with
return of spontaneous circulation (71.4%). In multivariate analysis, the
main predictors of intubation-related cardiac arrest were arterial
hypotension (systolic blood pressure < 90mm Hg) prior to intubation (odds
ratio = 3.406 [1.797-6.454]; p = 0.0002), hypoxemia prior to intubation
(odds ratio = 3.991 [2.101-7.583]; p < 0.0001), absence of preoxygenation
(odds ratio = 3.584 [1.287-9.985]; p = 0.0146), overweight/obesity (body
mass index > 25kg/m; odds ratio = 2.005 [1.017-3.951]; p = 0.0445), and
age more than 75 years old (odds ratio = 2.251 [1.080-4.678]; p = 0.0297).
Overall 28-day mortality rate was 31.2% (577/1,847) and was significantly
higher in patients who experienced intubation-related cardiac arrest than
in noncardiac arrest patients (73.5% vs 30.1%; p < 0.001). After
multivariate analysis, intubation-related cardiac arrest was an
independent risk factor for 28-day mortality (hazard ratio = 3.9
[2.4-6.3]; p < 0.0001). CONCLUSION(S): ICU intubation-related cardiac
arrest occurs in one of 40 procedures with high immediate and 28-day
mortality. We identified five independent risk factors for cardiac arrest,
three of which are modifiable, possibly to decrease intubation-related
cardiac arrest prevalence and 28-day ICU mortality.

<70>
Accession Number
2002831651
Title
Temporal Trends and Outcomes of Transcatheter Versus Surgical Aortic Valve
Replacement for Bicuspid Aortic Valve Stenosis.
Source
JACC: Cardiovascular Interventions. 12 (18) (pp 1811-1822), 2019. Date of
Publication: 23 September 2019.
Author
Elbadawi A.; Saad M.; Elgendy I.Y.; Barssoum K.; Omer M.A.; Soliman A.;
Almahmoud M.F.; Ogunbayo G.O.; Mentias A.; Gilani S.; Jneid H.; Aronow
H.D.; Kleiman N.; Abbott J.D.
Institution
(Elbadawi, Almahmoud, Gilani) Department of Cardiovascular Medicine,
University of Texas Medical Branch, Galveston, TX, United States
(Elbadawi, Saad) Department of Cardiovascular Medicine, Ain Shams
University, Cairo, Egypt
(Saad, Aronow, Abbott) Division of Cardiology, Cardiovascular Institute,
Warren Alpert Medical School at Brown University, Providence, RI, United
States
(Elgendy) Division of Cardiology, Massachusetts General Hospital and
Harvard Medical School, Boston, MA, United States
(Barssoum) Department of Internal Medicine, Rochester General Hospital,
Rochester, NY, United States
(Omer) Department of Cardiovascular Medicine, University of Missouri
Kansas City, Kansas City, MO, United States
(Soliman, Kleiman) Division of Cardiovascular Medicine, Houston Methodist
Hospital, Houston, TX, United States
(Ogunbayo) Department of Cardiovascular Medicine, University of Kentucky,
Lexington, KY, United States
(Mentias) Division of Cardiovascular Medicine, University of Iowa, Iowa
City, IA, United States
(Jneid) Division of Cardiovascular Medicine, Baylor College of Medicine,
Houston, TX, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The purpose of this study was to assess the temporal trends of
transcatheter aortic valve replacement (TAVR) in patients with bicuspid
aortic stenosis (AS), and to compare the outcomes between TAVR and
surgical aortic valve replacement (SAVR) in this population.
 Background(s): Randomized trials comparing TAVR to SAVR in AS with
bicuspid valve are lacking. Method(s): The study queried the National
Inpatient Sample database (years 2012 to 2016) to identify
hospitalizations for bicuspid AS who underwent isolated aortic valve
replacement. A propensity-matched analysis was used to compare outcomes of
hospitalizations for TAVR versus SAVR for bicuspid AS and TAVR for
bicuspid AS versus tricuspid AS. Result(s): The analysis included
31,895 hospitalizations with bicuspid AS, of whom 1,055 (3.3%) underwent
TAVR. TAVR was increasingly utilized during the study period for bicuspid
AS (p<inf>trend</inf> = 0.002). After matching, TAVR and SAVR had similar
in-hospital mortality (3.1% vs. 3.1%; odds ratio: 1.00; 95% confidence
interval: 0.60 to 1.67). There was no difference between TAVR and SAVR in
the rates of cardiac arrest, cardiogenic shock, acute kidney injury,
hemopericardium, cardiac tamponade, or acute stroke. TAVR was associated
with lower rates of acute myocardial infarction, post-operative bleeding,
vascular complications, and discharge to nursing facility as well as a
shorter length of hospital stay. On the contrary, TAVR was associated with
a higher incidence of complete heart block and permanent pacemaker
insertion. TAVR for bicuspid AS was associated with similar in-hospital
mortality compared with tricuspid AS. Conclusion(s): This nationwide
analysis showed similar in-hospital mortality for TAVR and SAVR in
patients with bicuspid AS. TAVR for bicuspid AS was also associated with
similar in-hospital mortality compared with tricuspid AS. Further studies
are needed to evaluate long-term outcomes of TAVR for bicuspid
AS. Copyright © 2019 American College of Cardiology Foundation

<71>
Accession Number
2002453586
Title
Comparison of effects of general anesthesia and combined spinal/epidural
anesthesia for cesarean delivery on umbilical cord blood gas values: A
double-blind, randomized, controlled study.
Source
Medical Science Monitor. 25 (pp 5272-5279), 2019. Date of Publication:
2019.
Author
Chen Y.; Liu W.; Gong X.; Cheng Q.
Institution
(Chen, Liu, Gong) Department of Anesthesiology, The First People's
Hospital of Jingzhou, The First Affiliated Hospital of Yangtze University,
Jingzhou, Hubei, China
(Cheng) Department of Anesthesiology, Guangzhou Women and Children's
Medical Center, Guangzhou, Guangdong, China
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Background: The objective of this study was to analyze the effects of
general anesthesia in cesarean section on the umbilical cord blood gas
values and intraoperative hemodynamics of parturient women.
Material/Methods: A total of 112 parturient women who received cesarean
section were eventually randomized into 2 groups, GA (general anesthesia)
group (n=56), and SE (combined spinal and epidural anesthesia) group
(n=56). The umbilical cord blood gas values, postpartum Apgar score,
intraoperative blood loss, mean arterial pressure, heart rate, total
operative time, time intervals from anesthesia to delivery and from skin
incision to delivery, the incidences of adverse reactions and neonatal
asphyxia, and the postoperative patient satisfaction were compared between
the 2 groups. Result(s): There were no significant differences
between the 2 groups in total operative time, Apgar score, neonatal
asphyxia rate, umbilical arterial and venous cord blood gas values,
intraoperative blood loss, and time interval from skin incision to
delivery (all P>0.05). The GA group was significantly shorter in the time
interval from anesthesia to delivery than the SE group (P<0.05). The
incidences of nausea, vomiting, and chills in the GA group were
significantly lower than those in the SE group (all P<0.05). The GA group
was significantly higher in postoperative patient satisfaction than the SE
group (P<0.05). Conclusion(s): General anesthesia has little impact
on the umbilical cord blood gas values and Apgar score, and ensures better
hemodynamic stability in cesarean section. Moreover, general anesthesia is
characterized by rapid induction and is therefore valuable for use in
clinical procedures. Copyright © Med Sci Monit.

<72>
Accession Number
2002540459
Title
Comparative evaluation of the constant and variable regimen of vacuum
therapy in the treatment of postoperative sternomediastinitis in cardiac
patients.
Source
Clinical and Experimental Surgery. 7 (2) (pp 71-78), 2019. Date of
Publication: 2019.
Author
Wagon A.A.; Muratov R.M.; Shchava S.P.; Little thing N.K.; Bernatov Yu.M.;
Silaev A.A.; Mishchenko E.P.; Sorokin V.A.
Publisher
GEOTAR Media (E-mail: popova@geotar.Ru)
Abstract
The aim of the study was to compare the immediate and long-term results of
the treatment of postoperative sternomediastinitis with the use of vacuum
therapy in variable and continuous mode and an open method of management.
Material and methods. Vacuum therapy treatment data are prospectively
collected; with open wound management - retrospectively. The study is not
randomized. Level of Evidence II. Patients were divided into 3 groups: 1st
- vacuum therapy in a variable mode (13 people); 2nd - continuous vacuum
therapy (14 people); 3rd - open wound management (30 people). There were
38 men (66.7%) and 19 (33.3%) women. The average age was 63.2 +/- 7.8
years. The number of patients with diabetes is 8 (57%) in the 1st group, 5
(38.5%) in the 2nd and 8 (26.6%) in the 3rd group. Results. The time from
the start of treatment to wound healing: 1st group - 25.4 +/- 11.3 days;
2nd group - 77.9 +/- 53.4 days; 3rd group - 37.5 +/- 20 days (p = 0.004).
The time from the start of treatment to bacterial wound cleansing: group 1
- 11.9 +/- 5.6 days; 2nd group - 28.8 +/- 20.1 days; 3rd group - 29.9 +/-
17.4 days (p < 0.05). Freedom from long-term complications (relapses /
formation of chronic fistula of the chest wall / development of chronic
osteomyelitis of the sternum and ribs): 1st group - 100% (n = 14); 2nd
group 85% (n = 12); 3rd group - 67% (n = 20) (p = 0.037). 1 case of death
in the 2nd group was noted; it was not associated with complications of
vacuum therapy (p <0.218). Dynamics of the level of leukocytosis: group 1
- from 15.3 +/- 2.8 x 109 (day of diagnosis) to 7.8 +/- 0.6 x 109 (30th
day of treatment); 2nd group - from 12.6 +/- 3.8 x 109 to 9.8 +/- 2.7 x
109; 3rd group - from 10.7 +/- 2.8 x 109 to 7.7 +/- 2.2 x 109 (p = 0.197).
Dynamics of the erythrocyte sedimentation rate: 1st group - from 23.7 +/-
9.7 (day of diagnosis) to 22.8 +/- 15.8 mm / h (20th day of treatment);
2nd group - from 37.2 +/- 17.2 to 31.7 +/- 15.2 mm / h; 3rd group - from
41.8 +/- 8.9 to 34.6 +/- 16.5 mm / h (p = 0.197). Histologically, the 1st
group was characterized by the lowest degree of edema and a higher growth
rate of granulation tissue. Conclusion Vacuum therapy in alternating mode
showed the best results. The use of this method allows you to accelerate
the closure of the wound and its bacterial cleansing, reduce the frequency
of formation of fistulas and the development of osteomyelitis, and also
reduces the period of hospitalization. Copyright © 2019 GEOTAR
Media. All rights reserved.

<73>
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

<74>
Accession Number
2001285620
Title
Long-term clinical outcomes of valsartan in patients with a systemic right
ventricle: Follow-up of a multicenter randomized controlled trial.
Source
International Journal of Cardiology. 278 (pp 84-87), 2019. Date of
Publication: 1 March 2019.
Author
van Dissel A.C.; Winter M.M.; van der Bom T.; Vliegen H.W.; van Dijk
A.P.J.; Pieper P.G.; Sieswerda G.T.; Roos-Hesselink J.W.; Zwinderman A.H.;
Mulder B.J.M.; Bouma B.J.
Institution
(van Dissel, Winter, van der Bom, Mulder, Bouma) Department of Cardiology,
Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam,
Netherlands
(van Dissel, Mulder) Netherlands Heart Institute, Utrecht, Netherlands
(Vliegen) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(van Dijk) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Pieper) Department of Cardiology, University Medical Center Groningen,
Groningen, Netherlands
(Sieswerda) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus Medical Center,
Rotterdam, Netherlands
(Zwinderman) Department of Clinical Epidemiology, Biostatistics and
Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam,
Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: In the VAL-SERVE (Valsartan in Systemic Right Ventricle)
trial, three-year valsartan treatment improved systemic ventricular
function only in symptomatic patients with congenitally or with an atrial
switch corrected transposition of the great arteries. The aim of the
current study was to investigate the longer-term clinical outcomes after
valsartan treatment. Method(s): From 2006 to 2009, 88 adults were
randomly allocated 1:1 to either valsartan or placebo for three
consecutive years. Endpoints were defined as overall survival and freedom
from clinical events (arrhythmia, heart failure, tricuspid valve surgery,
death). Result(s): Cardiac drug use and median follow-up after trial
close-out (8.3 years) was similar between the randomization groups. Six
patients (valsartan n = 3, placebo n = 3) died in 364 and 365 person-years
(P = 0.999). No difference in the composite or separate clinical endpoints
was found between the randomization groups, with corresponding long-term
event-free survival rates of 50% and 34%. Nevertheless, in symptomatic
patients valsartan significantly reduced the risk for events compared to
placebo (HR 0.37, 95% CI 0.17-0.92). Analysis for repeated events and
on-treatment analysis with any
renin-angiotensin-aldosterone-system-inhibitor did not alter these
results. Conclusion(s): Valsartan treatment in systemic RV patients
did not result in improved survival at longer-term follow-up, but was
associated with decreased risk of events in symptomatic
patients. Copyright © 2018

<75>
Accession Number
2001155837
Title
Meta-analysis of Prevalence and Risk Factors for Delirium After
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 122 (11) (pp 1917-1923), 2018. Date of
Publication: 1 December 2018.
Author
Tilley E.; Psaltis P.J.; Loetscher T.; Davis D.H.; Harrison S.L.; Kim S.;
Keage H.A.D.
Institution
(Tilley, Loetscher, Keage) Cognitive Ageing and Impairment Neurosciences
Lab, University of South Australia, Adelaide, South Australia, Australia
(Psaltis) School of Medicine, University of Adelaide, Adelaide, South
Australia, Australia
(Psaltis, Kim) Vascular Research Centre, Heart Health Theme, South
Australian Health and Medical Research Institute, SAHMRI, Adelaide, South
Australia, Australia
(Davis) MRC Unit for Lifelong Health and Ageing at UCL, London, United
Kingdom
(Harrison) Department of Rehabilitation, Aged and Extended Care, Flinders
University, Adelaide, South Australia, Australia
(Kim) Flinders Centre for Epidemiology and Biostatistics, College of
Medicine and Public Health, Flinders University, Australia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Delirium is a severe and common complication following transcatheter
aortic valve implantation (TAVI). We sought to identify the prevalence and
risk factors associated with the development of postprocedural delirium in
patients aged over 60 years who underwent elective TAVI for aortic
stenosis. Overall, 1,051 articles were searched, from which 9 studies were
included. The prevalence of delirium following TAVI was higher in studies
that assessed delirium for a minimum of 3 consecutive days (24.9%)
compared with the studies that did not (2%). There were large effect sizes
(d > 0.8) for 3 risk factors: acute kidney injury (odds ratio [OR] 5, p <
0.001), transapical approach (OR 4, p < 0.001) and carotid artery disease
(OR 4, p < 0.001), whilst small effect sizes were found for a history of
atrial fibrillation, prior stroke/transient ischemic attack, peripheral
artery disease, hypertension, and prior cognitive impairment. In
conclusion, 23% of patients 60 years and over who underwent TAVI
experience delirium, a preventative cause of cognitive impairment and
dementia. Recognition of risk factors for delirium after TAVI, such as a
history of carotid artery disease, development of acute kidney injury, or
use of a transapical approach, provides an opportunity to implement proven
delirium preventative measures. Copyright © 2018

<76>
Accession Number
625462429
Title
High-sensitivity troponin T is a prognostic marker of hemodynamic
instability in patients undergoing valve surgery.
Source
Biomarkers in Medicine. 12 (12) (pp 1303-1309), 2018. Date of Publication:
December 2018.
Author
Duchnowski P.; Hryniewiecki T.; Kozma M.; Mariusz K.; Piotr S.
Institution
(Duchnowski, Hryniewiecki, Kozma, Piotr) Department of Acquired Cardiac
Defects, Institute of Cardiology, Warsaw, Poland
(Mariusz) Department of Cardiosurgery and Transplantology, Institute of
Cardiology, Warsaw, Poland
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Aim: The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor
of perioperative hemodynamic instability is currently unknown.
 Method(s): A prospective study was conducted on a group of 708
consecutive patients with significant valvular heart disease that
underwent elective valve surgery. The primary end point was postoperative
hemodynamic instability. The secondary end point was death from all causes
in patients with perioperative hemodynamic instability. Result(s):
The postoperative hemodynamic instability occurred in 131 patients. At
multivariate analysis hs-TnT measured immediately after surgery and New
York Heart Association classes remained independent predictors of the
primary end point. Age and hs-TnT measured immediately after surgery were
associated with an increased risk of death. Conclusion(s): Elevated
postoperative hs-TnT was associated with a higher risk of postoperative
hemodynamic instability and death. Copyright © 2018 2018 Future
Medicine Ltd.

<77>
Accession Number
2001162502
Title
Outcomes of Acute Myocardial Infarction in Heart Transplant Recipients.
Source
American Journal of Cardiology. 122 (12) (pp 2080-2085), 2018. Date of
Publication: 15 December 2018.
Author
Enezate T.; Omran J.; P. Chang P.; Patel M.; Chien C.; Bacon R.R.; Adler
E.
Institution
(Enezate) Division of Cardiovascular Medicine, University of Missouri
School of Medicine, Columbia, MO, United States
(Omran, Patel, Adler) Sulpizio Cardiovascular Center, University of
California at San Diego, San Diego, CA, United States
(P. Chang, Chien) University of North Carolina, Chapel Hill, NC, United
States
(Bacon) Department of Information Technology, University of Missouri,
Columbia, MO, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Heart transplantation (HT) recipients represent a growing patient
population. Although mechanisms might differ, coronary artery disease is
an important cause of morbidity in this group. Limited data are available
on the outcomes of acute myocardial infarction (AMI) in HT in comparison
to general population (non-HT). The study population was extracted from
the National Readmissions Data 2014 using International Classification of
Diseases, Ninth Revision, Clinical Modification codes for AMI and HT. The
study outcomes included in-hospital all-cause mortality, length of
hospital stay (LOS), cardiogenic shock, acute kidney injury, the
likelihood of receiving invasive left-sided cardiac catheterization with
and/or without percutaneous coronary intervention (PCI) and 30-day
readmission rates. A total of 259,794 discharges with a principal
diagnosis of AMI were identified, in which 789 had a history of HT. In
comparison to non-HT, HT group was associated with longer LOS (5.9 vs 4.9
days, p <0.01), more cardiogenic shock (8.8% vs 6.4%, p <0.01), more acute
kidney injury (26.2% vs 17.6%, p <0.01), less catheterization (59.7% vs
75.1%, p <0.01), less use of PCI (35.2% vs 50.0%, p <0.01), and higher
30-day readmission rate (21.3% vs 14.4%, p <0.01). However, there was no
statistically significant difference in all-cause mortality (6.8% vs 5.4%,
p = 0.07). In conclusion, compared with non-HT, HT with AMI was associated
with longer LOS, more in-hospital morbidity, lower likelihood of receiving
invasive treatment (including PCI), and higher 30-day readmission rates.
There was no significant difference in all-cause mortality. Copyright
© 2018

<78>
Accession Number
2001166034
Title
Patient-Centered Decision-Making of Revascularization Strategy for Left
Main or Multivessel Coronary Artery Disease.
Source
American Journal of Cardiology. 122 (12) (pp 2005-2013), 2018. Date of
Publication: 15 December 2018.
Author
Kim C.; Hong S.-J.; Ahn C.-M.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi D.;
Jang Y.; Hong M.-K.
Institution
(Kim, Hong, Ahn, Kim, Kim, Ko, Choi, Jang, Hong) Division of Cardiology,
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul,
South Korea
(Kim, Kim, Ko, Choi, Jang, Hong) Cardiovascular Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patient preference plays an important role in daily practice; however, its
implication has not been well investigated regarding treatment strategy
for complex coronary artery disease. We prospectively evaluated a trend of
patient-centered decision-making of revascularization strategy in patients
with multivessel or unprotected left main coronary artery disease. A
standardized protocol that favors coronary artery bypass graft surgery
(CABG) as the primary treatment of choice, rather than percutaneous
coronary intervention, was adopted. According to the protocol, patients
decided whether or not they received CABG. Among the 763 consecutively
enrolled patients, 293 patients (38%) consented to receive CABG. Fifty-six
percent of patients with a high Synergy between PCI with Taxus and Cardiac
Surgery (SYNTAX) score chose CABG. SYNTAX score was independently
correlated with consent to receive CABG in each patient SYNTAX score
stratum. In-stent restenosis was an independent predictor of choosing CABG
in patients with low and intermediate SYNTAX scores. Unprotected left main
coronary artery disease was negatively correlated with the decision to
choose CABG in patients with intermediate SYNTAX score. Reasons for
declining CABG included refusal of open-heart surgery in 318 patients
(68%), mild presentation of angina symptoms in 132 patients (28%), low
self-confidence to expect long-term survival in 120 patients (26%), and
economic factors in 10 patients (2%). Short-term major adverse cardiac and
cerebrovascular events occurred in about 1% of patients without
significant differences between the 2 groups. In conclusion, despite the
preferred use of the CABG protocol, more than half of the patients
declined CABG. Patient-centered decision-making as well as heart team
approach should be considered in real-world practice
situations. Copyright © 2018

<79>
Accession Number
2001161926
Title
Meta-Analysis Comparing Outcomes of Drug Eluting Stents Versus Single and
Multiarterial Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. 122 (12) (pp 2018-2025), 2018. Date of
Publication: 15 December 2018.
Author
Gaudino M.; Rahouma M.; Abouarab A.; Tam D.Y.; Di Franco A.; Leonard J.;
Benedetto U.; Iannaccone M.; D'Ascenzo F.; Biondi-Zoccai G.; Vallely M.;
Girardi L.N.; Fremes S.E.; Taggart D.P.
Institution
(Gaudino, Rahouma, Abouarab, Di Franco, Leonard, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Toronto, Ontario, Canada
(Benedetto) School of Clinical Sciences, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Iannaccone, D'Ascenzo) Citta della Scienza e della Salute, Department of
Cardiology, University of Turin, Torino, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Vallely) Sydney Medical School, The University of Sydney, Sydney, New
South Wales, Australia
(Taggart) University of Oxford, Oxford, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Relative benefits of coronary artery bypass (CABG) using single and
multiple arterial grafting (SAG, MAG) and drug eluting stent (DES) in
multivessel coronary disease remain uncertain. We compared SAG, MAG, and
DES in a pairwise and network meta-analysis. Randomized trials and
adjusted observational studies comparing CABG versus DES were included
(primary end point: long-term mortality; secondary end points: operative
mortality, perioperative stroke, and follow-up repeated revascularization
[RR]). Studies with >=1.7 arterial grafts and/or patient were classified
as MAG. Bayesian network meta-analyses and random-model pairwise
meta-analyses were performed. A total of 53,239 patients (8 randomized, 17
observational studies) were included (26,306 DES; 26,933 CABG). In
pairwise comparison (mean follow-up: 5.42 years), CABG (MAG + SAG) was
associated with lower long-term mortality (incident rate ratio [IRR] 0.77,
95% confidence interval [CI] 0.66 to 0.90), lower RR (IRR 0.37, 95% CI
0.27 to 0.51), increased perioperative stroke (odds ratio [OR] 3.18, 95%
CI 1.70 to 5.97), and similar operative mortality (OR 1.04, 95% CI 0.64 to
1.70) compared with DES. There was a nonsignificant trend toward lower
long-term mortality for studies with higher mean number of arterial
grafts. In network meta-analyses, compared with DES, MAG was associated
with lower long-term mortality (IRR 0.72, 95% credible interval [CrI] 0.57
to 0.92) and late RR (IRR 0.32, 95% CrI 0.21 to 0.49), SAG was associated
with lower long-term mortality and RR (IRR 0.80, 95% CrI 0.66 to 0.97 and
IRR 0.42, 95% CrI 0.29 to 0.61, respectively). In conclusion, CABG was
associated with reduced 5-year mortality and need for RR compared with
DES. MAG was ranked as the best treatment for the primary and all
secondary outcomes. Copyright © 2018

<80>
Accession Number
2001229889
Title
Genotype-Guided Warfarin Dosing in Patients With Mechanical Valves: A
Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. 106 (6) (pp 1774-1781), 2018. Date of
Publication: December 2018.
Author
Xu Z.; Zhang S.-Y.; Huang M.; Hu R.; Li J.-L.; Cen H.-J.; Wang Z.-P.; Ou
J.-S.; Yin S.-L.; Xu Y.-Q.; Wu Z.-K.; Zhang X.
Institution
(Xu, Wang, Ou, Yin, Xu, Wu, Zhang) Division of Cardiac Surgery, Key
Laboratory on Assisted Circulation, Ministry of Health, the First
Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
(Zhang, Huang, Hu, Li) Institute of Clinical Pharmacology, School of
Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
(Cen) Guangzhou Women and Children's Medical Center, Guangzhou Medical
University, Guangzhou, China
Publisher
Elsevier USA
Abstract
Background: The clinical utility of genotype-guided warfarin dosing
remains controversial. The objective of this trial was to evaluate the
efficacy and safety of genotype-guided warfarin dosing in East Asians.
 Method(s): A double-blind, randomized control trial was performed to
compare a genotype-guided dosing algorithm (CYP2C9, VKORC1, and CYP4F2)
with a clinical-guided one in the initiation treatment for patients with
mechanical heart valves. The primary outcomes included the time to reach a
stable dose and the percentage of time in the therapeutic range (TTR).
 Result(s): Two hundred one patients were randomly assigned to
treatment, 101 to control and 100 to study. The major bleeding and
thromboembolic event-free rate in the study group was 97.0% (95%
confidence interval: 90.9% to 99.2%). Compared with the control group, the
study group shortened the time to reach a stable dose (mean: 42.09 +/-
23.655 days versus 33.52 +/- 20.044 days, p = 0.009). The TTRs were
47.257% and 47.461% in the control and study group (p = 0.941),
respectively. Patients with the CYP2C9 *1/*3 genotype had higher
international normalized ratio (INR) variability than patients with the
CYP2C9 *1/*1 genotype (p = 0.024). Compared with normal and sensitive
responders, the highly sensitive responders were at increased risk of an
INR of 4.0 or greater (p < 0.05). Conclusion(s): The genotype-guided
warfarin dosing was safe and might be more efficient for the time to reach
a stable dose. Pharmacogenomic testing might be beneficial to identify the
patients with the CYP2C9 *1/*3 genotype and the highly sensitive
responders, who were in the high-risk subgroup of patients with mechanical
heart valves. An appropriately powered study is needed to further confirm
these findings. Copyright © 2018 The Society of Thoracic Surgeons

<81>
Accession Number
2001283404
Title
Minimally Invasive Approaches to Surgical Aortic Valve Replacement: A
Meta-Analysis.
Source
Annals of Thoracic Surgery. 106 (6) (pp 1881-1889), 2018. Date of
Publication: December 2018.
Author
Chang C.; Raza S.; Altarabsheh S.E.; Delozier S.; Sharma U.M.; Zia A.;
Khan M.S.; Neudecker M.; Markowitz A.H.; Sabik J.F.; Deo S.V.
Institution
(Chang) School of Medicine, Case Western Reserve University, Cleveland,
OH, United States
(Raza, Delozier, Markowitz, Sabik, Deo) Division of Cardiac Surgery,
Department of Surgery, University Hospitals Cleveland Medical Center,
Cleveland, OH, United States
(Altarabsheh) Department of Cardiac Surgery, Queen Alia Heart Institute,
Amman, Jordan, Jordan
(Sharma) Community Division of Hospital Medicine, Mayo Clinic Health
System, Rochester, MN, United States
(Zia) Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
(Khan) Division of Internal Medicine, Cook County Hospitals, Chicago, IL,
United States
(Neudecker) Medical Librarian, Core Library, University Hospitals
Cleveland Medical Center, Cleveland, OH, United States
Publisher
Elsevier USA
Abstract
Background: Limited data exist studying the outcomes of the 2 minimally
invasive aortic valve replacement (AVR) strategies-mini-sternotomy
(AVR-st) and right anterior thoracotomy (AVR-th). We conducted an indirect
meta-analysis to compare the outcomes of these minimally invasive
approaches with each other and with conventional AVR (cAVR).
 Method(s): We Searched Medline, PubMed, Embase, and Web of Science in
December 2017 for studies comparing AVR-st, AVR-th, and cAVR. Clinical
outcomes were compared between cohorts with inverse weighted random
effects modeling. Endpoints studied included hospital mortality, stroke,
atrial fibrillation, cardiopulmonary bypass (CPB) time, and length of
stay. Result(s): A total of 19 studies (>10,000 pooled patients) met
the inclusion criteria. Mortality (p = 0.06) and stroke (p = 0.15) were
comparable between minimally invasive and conventional AVR. CPB times were
longer with AVR-th versus cAVR (12.4 minutes [range, 5 to 19]; p < 0.01).
In the AVR-th cohort, CPB duration was weakly inversely related to study
size (p = 0.06). Atrial fibrillation was much less after AVR-th (odds
ratio 0.47 [0.35 to 0.63]; p < 0.001). Hospital stay was significantly
lower after minimally invasive surgery (0.8 [0.4 to 1.3] days; p < 0.01).
AVR-th patients were dismissed 2.1 (1.6 to 2.7) days earlier than cAVR
patients. Conclusion(s): Minimally invasive approaches to AVR yield
excellent outcomes in high-volume centers. They reduce hospital stay and
incidence of postoperative atrial fibrillation, and therefore should be
considered in patients undergoing AVR. The operative approach should be
selected according to surgeon's technical expertise and what is best for
specific patient profile, however. Copyright © 2018 The Society
of Thoracic Surgeons

<82>
Accession Number
2001102320
Title
Meta-Analysis Comparing Complete or Culprit Only Revascularization in
Patients With Multivessel Disease Presenting With Cardiogenic Shock.
Source
American Journal of Cardiology. 122 (10) (pp 1661-1669), 2018. Date of
Publication: 15 November 2018.
Author
Bertaina M.; Ferraro I.; Omede P.; Conrotto F.; Saint-Hilary G.; Cavender
M.A.; Claessen B.E.; Henriques J.P.S.; Frea S.; Usmiani T.; Grosso Marra
W.; Pennone M.; Moretti C.; D'Amico M.; D'Ascenzo F.
Institution
(Bertaina, Ferraro, Omede, Conrotto, Frea, Usmiani, Grosso Marra, Pennone,
Moretti, D'Amico, D'Ascenzo) Department of Cardiology, Citta della Salute
e della Scienza, Molinette Hospital, Turin, Italy
(Saint-Hilary) Department of Mathematical Sciences "G. L. Lagrange,",
Politecnico di Torino, Turin, Italy
(Cavender) Department of Medicine, Division of Cardiology, University of
North Carolina, Chapel Hill, NC, United States
(Claessen, Henriques) Department of Cardiology, Academic Medical Center,
Amsterdam, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The optimal strategy for patients with an acute myocardial infarction (MI)
and multivessel (MV) coronary artery disease complicated by cardiogenic
shock (CS) remains unknown. We conducted a meta-analysis of all randomized
controlled trials and observational studies that reported adjusted effect
measures to evaluate the association of MV-PCI (percutaneous coronary
intervention), compared with culprit only (C)-PCI, with cardiovascular
events in patients admitted for CS and MV disease. We identified 12
studies (n = 1 randomized controlled trials, n = 11 observational) that
included 7,417 patients (n = 1,809 treated with MV-PCI and n = 5,608 with
C-PCI). When compared with C-PCI, MV-PCI was not associated with an
increased risk of short-term death (odds ratio [OR] 1.14, 95% confidence
interval [CI] 0.87 to 1.48, p = 0.35 and adjusted OR [OR<inf>adj</inf>]
1.00, 95% CI 0.70 to 1.43, p = 1.00). In-hospital and/or short-term
mortality tended to be higher with MV-PCI, when compared with C-PCI, for
CS patients needing dialysis (s 0.12, 95% CI from 0.049 to 0.198; p=
0.001), whereas MV-PCI was associated with lower in-hospital and/or
short-term mortality in patients with an anterior MI (s -0.022, 95% CI
-0.03 to -0.01; p <0.001). MV-PCI strategy was associated with a more
frequent need for dialysis or contrast-induced nephropathy after
revascularization (OR 1.36, 95% CI 1.06 to 1.75, p = 0.02). In conclusion,
MV-PCI seems not to increase risk of death during short- or long-term
follow-up when compared with C-PCI in patients admitted for MV coronary
artery disease and MI complicated by CS. Furthermore, it appears a more
favorable strategy in patients with anterior MI, whereas the increased
risk for AKI and its negative prognostic impact should be considered in
decision-making process. Further studies are needed to confirm our
hypothesis on in these subpopulations of CS patients. Copyright ©
2018

<83>
Accession Number
2001101575
Title
Meta-Analysis Comparing Percutaneous Coronary Revascularization Using
Drug-Eluting Stent Versus Coronary Artery Bypass Grafting in Patients With
Left Ventricular Systolic Dysfunction.
Source
American Journal of Cardiology. 122 (10) (pp 1670-1676), 2018. Date of
Publication: 15 November 2018.
Author
Cui K.; Zhang D.; Lyu S.; Song X.; Yuan F.; Xu F.; Zhang M.
Institution
(Cui, Zhang, Lyu, Song, Yuan, Xu, Zhang) Department of Cardiology, Beijing
Anzhen Hospital, Capital Medical University and Beijing Institute of
Heart, Lung and Blood Vessel Diseases, Beijing, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The relative safety and efficacy of percutaneous coronary intervention
(PCI) with drug-eluting stent (DES) and coronary artery bypass grafting
(CABG) in patients with left ventricular (LV) systolic dysfunction remains
controversial; therefore we conducted this meta-analysis to identify the
optimal strategy for such cohorts. A comprehensive search of the
electronic databases including PubMed, EMBASE, and Cochrane Library from
January 1, 2003 to March 1, 2018 was performed to identify the eligible
adjusted observational studies. The primary end point was all-cause death
during the longest follow-up, and the generic inverse variance
random-effect model was used to estimate the pooled hazard ratios (HRs)
with 95% confidence intervals (CIs). Eight adjusted observational studies
involving 10,268 patients were included. Compared with CABG, PCI with DES
was associated with higher risk of all-cause mortality (HR 1.36, 95% CI
1.16 to 1.60), cardiac mortality (HR 2.20, 95% CI 1.63 to 2.95),
myocardial infarction (HR 1.69, 95% CI 1.28 to 2.24), and repeat
revascularization (HR 4.95, 95% CI 3.28 to 7.46) in patients with coronary
artery disease and LV systolic dysfunction. Besides, separate analysis of
patients with LV ejection fraction <35% or left main and/or multivessel
disease obtained similar results compared with the overall analysis.
However, DES and CABG shared similar rates of stroke (HR 0.92, 95% CI 0.67
to 1.26). In conclusion, CABG appears to be superior to PCI with DES for
patients with coronary artery disease and LV systolic dysfunction,
particularly in patients with severe LV systolic dysfunction or those with
left main and/or multivessel disease. Copyright © 2018

<84>
Accession Number
2001173776
Title
Impact of Baseline Atrial Fibrillation on Outcomes Among Women Who
Underwent Contemporary Transcatheter Aortic Valve Implantation (from the
Win-TAVI Registry).
Source
American Journal of Cardiology. 122 (11) (pp 1909-1916), 2018. Date of
Publication: 1 December 2018.
Author
Guedeney P.; Chieffo A.; Snyder C.; Mehilli J.; Petronio A.S.; Claessen
B.E.; Sartori S.; Lefevre T.; Presbitero P.; Capranzano P.; Tchetche D.;
Iadanza A.; Sardella G.; Van Mieghem N.M.; Chandrasekhar J.; Vogel B.;
Sorrentino S.; Kalkman D.N.; Meliga E.; Dumonteil N.; Fraccaro C.;
Trabattoni D.; Mikhail G.; Ferrer M.C.; Naber C.; Kievit P.; Baber U.;
Sharma S.; Morice M.C.; Mehran R.
Institution
(Guedeney, Snyder, Claessen, Sartori, Chandrasekhar, Vogel, Sorrentino,
Kalkman, Baber, Mehran) Icahn School of Medicine at Mount Sinai, New York
City, NY, United States
(Guedeney) ACTION Study Group, Sorbonne Universite, Institut de
Cardiologie, Departement de Cardiologie, Pitie Salpetriere Hospital
(AP-HP), Paris, France
(Chieffo) San Raffaele Scientific Institute, Milan, Italy
(Mehilli) Munich University Clinic, Ludwig-Maximilians-University and
German Centre for Cardiovascular Research (DZHK), partner site Munich
Heart Alliance, Munich, Germany
(Petronio) AOUP Cisanello, University Hospital, Pisa, Italy
(Lefevre, Morice) Institut Hospitalier Jacques Cartier, Ramsay Generale de
Sante, Massy, France
(Presbitero) Istituto Clinico Humanitas, Milan, Italy
(Capranzano) University of Catania, Catania, Italy
(Tchetche) Clinique Pasteur, Toulouse, France
(Iadanza) Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte,
Siena, Italy
(Sardella) Policlinico "Umberto I", "Sapienza" University of Rome, Rome,
Italy
(Van Mieghem) Erasmus Medical Center, Thorax center, Rotterdam,
Netherlands
(Meliga) Mauriziano Hospital, Turin, Italy
(Dumonteil) Rangueil University Hospital, Toulouse, France
(Fraccaro) University of Padova, Padova, Italy
(Trabattoni) Centro Cardiologico Monzino, Milan, Italy
(Mikhail) Imperial College Healthcare NHS Trust, Hammersmith Hospital,
London, United Kingdom
(Ferrer) Hospital Universitario Miguel Servet, Zaragoza, Spain
(Naber) Contilia Heart and Vascular Centre, Elisabeth Krankenhaus, Essen,
Germany
(Kievit) Department of Cardiology, Radboud University Nijmegen Medical
Center, Nijmegen, Netherlands
(Sharma) Mount Sinai Hospital, New York City, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Pre-existing atrial fibrillation (AF) is common among patients who
underwent transcatheter aortic valve implantation (TAVI) and has been
associated with adverse outcomes. The specific impact of AF at baseline in
women who underwent TAVI, however, remains unknown. The Women's
International Transcatheter Aortic Valve Implantation is a prospective,
multinational registry evaluating the safety and performance of
contemporary TAVI in women in 19 centers between January 2013 and December
2015. Patients with available electrocardiogram at baseline were compared
according to the presence of AF. All events were adjudicated according to
the Valve Academic Research Consortium 2 criteria. Associations between AF
and outcomes were tested using multivariate Cox regression model. Of the
993 women with available baseline electrocardiogram included in the study,
200 (20.1%) presented with AF. Patients with AF at baseline had higher
Euroscore I score values and more frequently had chronic kidney disease or
prior stroke. Patients without AF more frequently had coronary artery
disease. There was no difference regarding in-hospital events between the
two groups aside from longer length of stay for patients with AF (13.3 +/-
11 vs 11.5 +/- 7.1 days, p = 0.01). In multivariate analysis, AF at
baseline was associated with an increase of all-cause and cardiovascular
death at 12 months (<inf>adj</inf>HR 1.67 95%CI 1.11 to 2.50, p = 0.013
and <inf>adj</inf>HR 1.85 95%CI 1.19 to 2.86, p = 0.006 respectively). In
conclusion, in this prospective registry of women who underwent
contemporary TAVI, the presence of AF at baseline was associated with
significantly increased 12-month mortality. Copyright © 2018

<85>
[Use Link to view the full text]
Accession Number
627025221
Title
Blood Pressure in De Novo Heart Transplant Recipients Treated With
Everolimus Compared With a Cyclosporine-based Regimen: Results From the
Randomized SCHEDULE Trial.
Source
Transplantation. 103 (4) (pp 781-788), 2019. Date of Publication: 01 Apr
2019.
Author
Andreassen A.K.; Broch K.; Eiskjaer H.; Karason K.; Gude E.; Molbak D.;
Stueflotten W.; Gullestad L.
Institution
(Andreassen, Broch, Gude, Stueflotten, Gullestad) Department of
Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
(Andreassen, Gullestad) Faculty of Medicine, University of Oslo, Oslo,
Norway
(Eiskjaer, Molbak) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Karason) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: Systemic hypertension is prevalent in heart transplant
recipients and has been partially attributed to treatment with calcineurin
inhibitors (CNIs). SCandinavian HEart transplant De-novo stUdy with earLy
calcineurin inhibitors avoidancE trial was the first randomized trial to
study early withdrawal of CNIs in de novo heart transplant recipients,
comparing an everolimus-based immunosuppressive regimen with conventional
CNI-based treatment. As a prespecified secondary endpoint, blood pressure
was repeatedly compared across treatment arms. METHOD(S): The The
SCandinavian HEart transplant De-novo stUdy with earLy calcineurin
inhibitors avoidancE trial was a prospective, multicenter, randomized,
controlled, parallel-group, open-label trial in de novo adult heart
transplant recipients, undertaken at transplant centers in Scandinavia.
Blood pressure was assessed with 24-hour ambulatory blood pressure
monitoring up to 3 years after heart transplantation (HTx) in 83 patients.
 RESULT(S): Overall, systolic blood pressure fell with time, from 138
+/- 15mm Hg 2 weeks after HTx to 134 +/- 11mm Hg after 12 months and 132
+/- 14mm Hg after 36 months (P = 0.003). Diastolic blood pressure did not
change over time. After 12 months, there was a numerically larger fall in
systolic blood pressure in the everolimus arm (between-group difference
8mm Hg; P = 0.053), and after 36 months, there was a significant between
group difference of 13mm Hg (P = 0.02) in favor of everolimus.
 CONCLUSION(S): In this first, randomized trial with early CNI
avoidance in de novo HTx recipients, we observed a modest fall in systolic
blood pressure over the first 1 to 3 years after transplantation. The fall
in systolic blood pressure was more pronounced in patients allocated to
everolimus.

<86>
Accession Number
623048379
Title
Can Cerebral Near-infrared Spectroscopy Predict Cerebral Ischemic Events
in Neurosurgical Patients? A Narrative Review of the Literature.
Source
Journal of Neurosurgical Anesthesiology. (no pagination), 2018. Date of
Publication: 11 Jul 2018.
Author
Khozhenko A.; Lamperti M.; Terracina S.; Bilotta F.
Institution
(Khozhenko, Lamperti) Department of General Anesthesiology, Cleveland
Clinic Abu Dhabi, Abu Dhabi, UAE United Arab Emirates
(Terracina, Bilotta) Department of Anesthesiology and Intensive Care
Medicine, University of Rome 'La Sapienza', Rome, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Cerebral near-infrared spectroscopy (NIRS) is considered a valuable
noninvasive modality for cerebral oxygenation monitoring during
cardiovascular surgery and cardiac arrest. We assessed the capability of
cerebral NIRS to predict cerebral desaturation and the related
neurological outcomes in neurosurgical patients. A literature search in
different electronic medical databases was performed from inception to
January 2018. A total of 286 citations were found and finally 48 studies
were retrieved, only 7 of these were eligible and included for review. A
meta-analysis was not feasible because of high heterogeneity of patients'
groups, different NIRS techniques used in the studies and different
outcome criteria selected. The qualitative assessment showed controversial
data on the threshold value of cerebral near-infrared spectroscopy used
for detecting cerebral ischemia in neurosurgical patients. The evidence on
the selected studies is not strong enough, at the moment, to recommend
cerebral NIRS as a mandatory monitor to detect cerebral deoxygenation able
to predict the future neurological outcome in neurosurgical patients.
Further studies are needed to validate a threshold value for cerebral
ischemia and the relationship between NIRS-detected cerebral desaturation
and clinical outcome in the neurosurgical population. Copyright ©
2018 Wolters Kluwer Health, Inc. All rights reserved.

<87>
Accession Number
625889456
Title
Clinical application and effect of dexmedetomidine in combination with
continuous positive airway pressure on one-lung ventilation in lung
surgery of elder patients.
Source
Pakistan journal of pharmaceutical sciences. 31 (6) (pp 2879-2883), 2018.
Date of Publication: 01 Nov 2018.
Author
Lin J.; Li J.-B.; Lu Z.
Institution
(Lin, Li, Lu) Department of Anesthesiology, Zhangzhou Municipal Hospital
Affiliated to Fujian Medical University, Shengxi Road, Zhangzhou, Fujian,
China
Publisher
NLM (Medline)
Abstract
In this study, 126 elder patients who underwent thoracic surgery under
general anesthesia were divided into three groups randomly, i.e.
dexmedetomidine group, positive ventilation group and combination group.
All patients received varying strategies in addition to the one-lung
ventilation, and changes in oxidative stress and indicators of
inflammation at different time points were observed. In comparison to the
dexmedetomidine group and the positive ventilation group, patients in the
combination group at T2-3 had lower levels of malonaldehyde, cortisol,
C-reaction protein, interleukin-6 (IL-6) and tumor necrosis factor alpha
in serum (p<0.05); one day after surgery, the incidence of complications
in lungs of patients in the combination group was significantly lower than
those in the dexmedetomidine group and the positive ventilation group
(p<0.05). Dexmedetomidine in combination with continuous positive airway
pressure can alleviate the oxidative stress and inflammation of lung
tissues in one-lung ventilation during the thoracic surgery of elder
patients, thus, reducing the incidence of postoperative complications.

<88>
Accession Number
625889159
Title
Preoperative antiplatelet drugs on the hemorrhage and allogenic blood
transfusion condition after coronary artery bypass graft surgery.
Source
Pakistan journal of pharmaceutical sciences. 31 (6) (pp 2819-2822), 2018.
Date of Publication: 01 Nov 2018.
Author
Zhu P.; Chen Y.; Wang H.; Song B.
Institution
(Zhu, Song) Department of Cardiovascular, First Clinical Medical College
of Lanzhou University (The First Hospital of Lanzhou University), Lanzhou,
China
(Chen, Wang) Department of Cardiovascular, Jinan Central Hospital
Affiliated to Shandong University, Ji'nan, China
Publisher
NLM (Medline)
Abstract
Aim of the study was to observe and evaluate the postoperative hemorrhage
and allogenic blood transfusion condition in patients who were exposed to
different levels of clopidogrel and aspirin beforeon-pump coronary artery
bypass graft surgery (CABG). A total of 180 patients underwent on-pump
CABG at our hospital were enrolled and divided into treatment group,
discontinuation group and control group based on their preoperative use of
clopidogrel and aspirin, with 60 patients in each group. And the
postoperative hemorrhage and allogenic blood transfusion condition were
observed and evaluated. Compared with the control group, the postoperative
total drainage and the occurrence of major bleeding were significantly
higher in the treatment group (p<0.05). The transfusion volume and
infusion rates of packed red blood cells and fresh frozen plasma and the
total blood transfusion rate were decreased progressively in accordance
with the treatment group, discontinuation group and control group. The
transfusion volume and infusion rates of packed red blood cells and fresh
frozen plasma, and the total blood transfusion rate were significantly
higher in the treatment group when compared with the control group
(p<0.05). And the total blood transfusion rate was significantly higher in
the treatment group when compared with the discontinuation group (p<0.05).
The postoperative hemorrhage and allogenic blood transfusion rate would be
significantly up-regulated when patients were exposed to clopidogrel and
aspirin in the week before on-pump CABG.

<89>
Accession Number
629224966
Title
Routinary use of fibrin sealants to prevent prolonged air leak in thoracic
surgery: our experience.
Source
Il Giornale di chirurgia. 40 (3) (pp 170-173), 2019. Date of Publication:
01 May 2019.
Author
Porrello C.; Iadicola D.; Grutta E.M.; Palazzolo M.; Vaglica A.; Gagliardo
C.; Giangregorio F.; Gulotta E.; Lo Faso F.; Gullo R.; Carini F.;
Tomasello G.; Cocorullo G.
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Prolonged air leak (PAL) is one of the most common
postoperative complications after lung surgery. It is associated with
increased significant morbidity, lower quality of life, longer hospital
stay and higher hospital costs. Since its great clinical and economic
burden, it is important to establish the feasibility and the effectiveness
of the routinary preventive use of a fibrin sealant in order to reduce the
incidence of prolonged air leaks. PATIENTS AND METHODS: This is a
randomized study on 189 adult patients - 118 men (62.4%) and 71 women
(37.6%) aged from 39 to 87 y.o. (mean age 68.3 y.o.) - who underwent lung
surgery (lobectomy or bilobectomy) with intraoperatory detection of air
leakage, from January 2013 to December 2017, at Department of Thoracic
Surgery in "Ospedale Maggiore Carlo Alberto Pizzardi" (Bologna, Italy) and
Department of Thoracic Surgery in "Paolo Giaccone" Teaching Hospital
(Palermo, Italy). Patients were randomly assigned to the "Glue" arm (90
patients) or the "Control" group (99 patients). We only used stapler or
manual suture to achieve aerostasis. In addition, we used a fibrin sealant
("glue") to cover the suture line on patients in the "Glue" arm. The
primary endpoints were incidence of prolonged air leaks, days with chest
tube and mean hospital stay. RESULT(S): In the "Glue" arm we
experienced only 1 prolonged air leak (1.1%), while in the "Control" group
there were 8 leaks (8.1%). Patients kept chest tube for average 4.15 days
in the "Glue" arm and 4.45 days in the "Control" group. The mean hospital
stay was average 7.4 days for the "Glue" arm, while 9.1 days in the
"Control" group. CONCLUSION(S): According to our experience it seems
that the routinary preventive use of a fibrin sealant results in a lower
incidence of prolonged air leaks, a shorter hospital stay with lower
hospital costs, representing a cost-effective, feasible and effective
system to decrease morbility and mortality among surgical patients.

<90>
Accession Number
629214663
Title
Timing of device reimplantation and reinfection rates following cardiac
implantable electronic device infection: a systematic review and
meta-analysis.
Source
BMJ open. 9 (9) (pp e029537), 2019. Date of Publication: 03 Sep 2019.
Author
Chew D.; Somayaji R.; Conly J.; Exner D.; Rennert-May E.
Institution
(Chew, Exner) Department of Cardiac Sciences, University of Calgary,
Calgary, AB, Canada
(Chew, Exner) Libin Cardiovascular Institute of Alberta, University of
Calgary, Calgary, AB, Canada
(Somayaji, Conly, Rennert-May) Department of Medicine, University of
Calgary, Calgary, AB, Canada
(Somayaji, Conly, Rennert-May) O'Brien Institute for Public Health,
University of Calgary, Calgary, AB, Canada
(Somayaji, Conly) Snyder Institute for Chronic Diseases, University of
Calgary, Calgary, AB, Canada
(Somayaji, Conly, Exner, Rennert-May) Department of Community Health
Sciences, University of Calgary, Calgary, AB, Canada
(Conly) Department of Microbiology, Immunology and Infectious Diseases,
University of Calgary, Calgary, AB, Canada
(Conly) Department of Pathology & Laboratory Medicine, University of
Calgary, Calgary, AB, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Initial management of cardiac implantable electronic device
(CIED) infection requires removal of the infected CIED system and
treatment with systemic antibiotics. However, the optimal timing to device
reimplantation is unknown. The aim of this study was to quantify the
incidence of reinfection after initial management of CIED infection, and
to assess the effect of timing to reimplantation on reinfection rates.
DESIGN: Systematic review and meta-analysis. INTERVENTIONS: A systematic
review and meta-analysis was performed of studies published up to February
2018. Inclusion criteria were: (a) documented CIED infection, (b) studies
that reported the timing to device reimplantation and (c) studies that
reported the proportion of participants with device reinfection. A
meta-analysis of proportions using a random effects model was performed to
estimate the pooled device reinfection rate. PRIMARY AND SECONDARY OUTCOME
MEASURES: The primary outcome measure was the rate of CIED reinfection.
The secondary outcome was all-cause mortality. RESULT(S): Of the 280
screened studies, 8 met inclusion criteria with an average of 96
participants per study (range 15-220 participants). The pooled incidence
rate of device reinfection was 0.45% (95% CI, 0.02% to 1.23%) per person
year. A longer time to device reimplantation >72 hours was associated with
a trend towards higher rates of reinfection (unadjusted incident rate
ratio 4.8; 95% CI 0.9 to 24.3, p=0.06); however, the meta-regression
analysis was unable to adjust for important clinical covariates. There did
not appear to be a difference in reinfection rates when time to
reimplantation was stratified at 1 week. Heterogeneity was moderate
(I2=61%). CONCLUSION(S): The incident rate of reinfection following
initial management of CIED infection is not insignificant. Time to
reimplantation may affect subsequent rates of device reinfection. Our
findings are considered exploratory and significant heterogeneity limits
interpretation. PROSERO REGISTRATION NUMBER: CRD4201810960. Copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC
BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

<91>
Accession Number
629213241
Title
Meta-analysis for the value of colchicine for the therapy of pericarditis
and of postpericardiotomy syndrome.
Source
BMC cardiovascular disorders. 19 (1) (pp 207), 2019. Date of Publication:
02 Sep 2019.
Author
Lutschinger L.L.; Rigopoulos A.G.; Schlattmann P.; Matiakis M.; Sedding
D.; Schulze C.; Noutsias M.
Institution
(Lutschinger, Schulze, Noutsias) Department of Internal Medicine I,
Division of Cardiology, Pneumology, Angiology and Intensive Medical Care,
University Hospital Jena, Friedrich-Schiller-University Jena, Jena,
Germany
(Rigopoulos, Matiakis, Sedding, Noutsias) Mid-German Heart Center,
Department of Internal Medicine III (KIM III), Division of Cardiology,
Angiology and Intensive Medical Care, University Hospital Halle,
Martin-Luther-University Halle-Wittenberg ,Ernst-Grube-Strasse 40, Halle
(Saale) D-06120, Germany
(Schlattmann) Institute of Medical Statistics, Informatics and Data
Science (IMSID), University Hospital Jena, Friedrich-Schiller University
Jena, Jena, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Colchicine has been used as anti-inflammatory agent in
pericardial effusion (PE). We sought to perform a meta-analysis of
randomized trials assessing the efficacy and safety of colchicine in
patients with pericarditis or postpericardiotomy syndrome (PPS).
 METHOD(S): In the systematic literature search following the PRISMA
statement, 10 prospective randomized controlled studies with 1981 patients
with an average follow-up duration of 13.6months were identified.
 RESULT(S): Colchicine reduced the recurrence rate of pericarditis in
patients with acute and recurrent pericarditis and reduced the incidence
of PPS (RR: 0.57, 95% CI: 0.44-0.74). Additionally, the rate of
rehospitalizations as well as the symptom duration after 72h was
significantly decreased in pericarditis (RR 0.33; 95% CI 0.18-0.60; and RR
0.43; 95% CI 0.34-0.54; respectively), but not in PPS. Treatment with
colchicine was associated with significantly higher adverse event (AE)
rates (RR 1.42; 95% CI 1.05-1.92), with gastrointestinal intolerance being
the leading AE. The reported number needed to treat (NNT) for the
prevention of recurrent pericarditis ranged between 3 and 5. The reported
NNT for PPS prevention was 10, and the number needed to harm (NNH) was 12,
respectively. Late colchicine administration >7days after heart surgery
did not reduce postoperative PE. CONCLUSION(S): Our meta-analysis
confirms that colchicine is efficacious and safe for prevention of
recurrent pericarditis and PPS, while it reduces rehospitalizations and
symptom duration in pericarditis. The clinical use of colchicine for the
setting of PPS and postoperative PE after heart surgery should be
investigated in further multicenter RCT.

<92>
Accession Number
629230888
Title
Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A
Systematic Review and Meta-Analysis.
Source
Nutrients. 11 (9) (no pagination), 2019. Date of Publication: 04 Sep 2019.
Author
Hill A.; Clasen K.C.; Wendt S.; Majoros AG.; Stoppe C.; Adhikari N.K.J.;
Heyland D.K.; Benstoem C.
Institution
(Hill, Clasen, Majoros, Stoppe, Benstoem) Department of Intensive Care
Medicine, Medical Faculty RWTH Aachen, Aachen D-52074, Germany
(Hill, Clasen, Wendt) Department of Anesthesiology, Medical Faculty RWTH
Aachen, Aachen D-52074, Germany
(Hill, Clasen, Wendt, Stoppe, Benstoem) 3CARE-Cardiovascular Critical Care
and Anesthesia Evaluation and Research, Aachen D-52074, Germany
(Majoros) Medical Student of the Medical Faculty RWTH Aachen University,
Aachen D-52074, Germany
(Adhikari) Department of Critical Care Medicine, Sunnybrook Health
Sciences Centre, Interdepartmental Division of Critical Care Medicine,
University of Toronto, Toronto, ON M4N 3M5, Canada
(Heyland) Clinical Evaluation Research Unit, Kingston General Hospital,
Kingston, CA K7L 2V7, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac surgery is associated with oxidative stress and
systemic inflammation, which both contribute to postoperative organ
dysfunction. Vitamin C is a pleiotropic, antioxidant, and potentially
organ-protective micronutrient. Past clinical trials and meta-analyses
have focused predominantly on occurrence of postoperative atrial
fibrillation. Therefore, we investigated the influence of perioperative
vitamin C administration on clinically relevant parameters closer related
to the patient's recovery, especially organ function, and overall outcomes
after cardiac surgery. METHOD(S): Randomized controlled trials (RCTs)
comparing perioperative vitamin C administration versus placebo or
standard of care in adult patients undergoing cardiac surgery were
identified through systematic searches in Pubmed, EMBASE, and CENTRAL on
23 November 2018. Published and unpublished data were included. Assessed
outcomes include organ function after cardiac surgery, adverse events,
in-hospital mortality, intensive care unit, and hospital length-of-stay.
Data was pooled only when appropriate. RESULT(S): A total of 19 RCTs
with 2008 patients were included in this meta-analysis. Vitamin C
significantly decreased the incidence of atrial fibrillation (p = 0.008),
ventilation time (p < 0.00001), ICU length-of-stay (p = 0.004), and
hospital length-of-stay (p < 0.0001). However, on average, vitamin C had
no significant effects on in-hospital mortality (p = 0.76), or on the
incidence of stroke (p = 0.82). High statistical heterogeneity was
observed in most analyses. CONCLUSION(S): Vitamin C impacts
clinically and economically important outcomes, such as ICU and hospital
length-of-stay, duration of mechanical ventilation and lowers the
incidence of atrial fibrillation. Due to missing reports on organ
dysfunction, this meta-analysis cannot answer the question, if vitamin C
can improve single- or multiorgan function after cardiac surgery.

<93>
Accession Number
2002700393
Title
Efficacy and safety of erythropoietin and iron therapy to reduce red blood
cell transfusion in surgical patients: a systematic review and
meta-analysis.
Source
Canadian Journal of Anesthesia. 66 (6) (pp 716-731), 2019. Date of
Publication: 15 Jun 2019.
Author
Kei T.; Mistry N.; Curley G.; Pavenski K.; Shehata N.; Tanzini R.M.;
Gauthier M.-F.; Thorpe K.; Schweizer T.A.; Ward S.; Mazer C.D.; Hare
G.M.T.
Institution
(Kei, Mistry, Mazer, Hare) Department of Anesthesia, St. Michael's
Hospital, University of Toronto, Toronto, ON, Canada
(Curley) Department of Anesthesia and Critical Care Medicine, Royal
College of Surgeons in Ireland, Dublin, Ireland
(Schweizer, Mazer, Hare) Keenan Research Centre for Biomedical Science in
the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto,
ON, Canada
(Pavenski) Department of Laboratory Medicine and Pathobiology, St.
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Pavenski, Hare) St. Michael's Hospital, Centre of Excellence in Patient
Blood Management, Toronto, ON, Canada
(Shehata) Departments of Medicine and Laboratory Medicine and
Pathobiology, Institute of Health Policy Management and Evaluation, Mount
Sinai Hospital, Toronto, ON, Canada
(Tanzini) Department of Pharmacy, St. Michael's Hospital, Toronto, ON,
Canada
(Gauthier) Department of Pharmacy, Montfort Hospital, Ottawa, ON, Canada
(Thorpe) Applied Health Research Centre, St. Michael's Hospital, Dalla
Lana School of Public Health, University of Toronto, Toronto, ON, Canada
(Ward) Division of Orthopedic surgery, Department of Surgery, St.
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Mazer, Hare) Department of Physiology, University of Toronto, Toronto,
ON, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Iron restricted anemia is prevalent in surgical patients and is
associated with an increased risk of allogeneic red blood cell (RBC)
transfusion and adverse events. Treatment of anemia includes oral and
intravenous iron and erythropoiesis stimulating agents (ESAs). More recent
studies have focused on the use of intravenous iron as the primary
approach to treating anemia. Nevertheless, the optimal treatment strategy
for anemia remains to be established. Our primary objective was to
evaluate the efficacy and safety of ESA and iron therapy relative to iron
therapy alone in reducing RBC transfusion in surgical patients. Source: We
searched the Cochrane Library, MEDLINE, EMBASE, and ClinicalTrials.gov
from inception to May 2018. We included randomized-controlled trials in
which adult surgical patients received an ESA and iron, vs iron alone,
prior to cardiac and non-cardiac surgery. Our primary outcome was RBC
transfusion rate. Secondary outcomes included hemoglobin concentration
(post-treatment and postoperatively), number of RBC units transfused,
mortality, stroke, myocardial infarction (MI), renal dysfunction,
pulmonary embolism (PE), and deep vein thrombosis (DVT). Principal
findings: In total, 25 studies (4,719 participants) were included.
Erythropoiesis stimulating agents and iron therapy reduced RBC transfusion
relative to iron therapy (relative risk [RR] 0.57; 95% confidence interval
[CI], 0.46 to 0.71) without any change in mortality (RR 1.31; 95% CI, 0.80
to 2.16), stroke (RR 1.91; 95% CI, 0.63 to 5.76), MI (RR 1.12; 95% CI,
0.50 to 2.50), renal dysfunction (RR 0.96; 95% CI, 0.72 to 1.26), PE (RR
0.92; 95% CI, 0.15 to 5.83), or DVT (RR 1.48; 95% CI, 0.95 to 2.31).
 Conclusion(s): Administration of ESA and iron therapy reduced the
risk for RBC transfusion compared with iron therapy alone in patients
undergoing cardiac and non-cardiac surgery. Nevertheless, publication bias
and heterogeneity reduces the confidence of the finding. Although the
analysis was probably under-powered for some outcomes, no difference in
the incidence of serious adverse events was observed with ESA and iron
compared with iron alone. Further large prospective trials are required to
confirm these findings. Copyright © 2019, Canadian
Anesthesiologists' Society.

<94>
Accession Number
629230788
Title
Ticagrelor in patients with diabetes and stable coronary artery disease
with a history of previous percutaneous coronary intervention
(THEMIS-PCI): a phase 3, placebo-controlled, randomised trial.
Source
Lancet (London, England). (no pagination), 2019. Date of Publication: 30
Aug 2019.
Author
Bhatt D.L.; Steg P.G.; Mehta S.R.; Leiter L.A.; Simon T.; Fox K.; Held C.;
Andersson M.; Himmelmann A.; Ridderstrale W.; Chen J.; Song Y.; Diaz R.;
Goto S.; James S.K.; Ray K.K.; Parkhomenko A.N.; Kosiborod M.N.; McGuire
D.K.; Harrington R.A.
Institution
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School Boston, MA, United States
(Steg) French Alliance for Cardiovascular Trials, Departement
Hospitalo-Universitaire FIRE, AP-HP, Hopital Bichat, Universite de Paris,
Institut National de la Sante et de la Recherche Medicale U-1148, Paris,
France; National Heart and Lung Institute, Royal Brompton Hospital,
Imperial College London, London, UK
(Mehta) Population Health Research Institute, Hamilton Health Sciences,
Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
(Leiter) Li Ka Shing Knowledge Institute, St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Simon) Department of Clinical Pharmacology-Clinical Research Platform
(URCEST-CRB-CRCEST), AP-HP, Hopital Saint Antoine, Sorbonne-Universite,
Paris, France
(Fox) National Heart and Lung Institute, Royal Brompton Hospital, Imperial
College London, London, United Kingdom
(Held) Department of Medical Sciences, Cardiology, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Andersson, Himmelmann, Ridderstrale) AstraZeneca BioPharmaceuticals
Research & Development, Late-stage Development, Cardiovascular, Renal and
Metabolic, Molndal, Sweden
(Chen) AstraZeneca BioPharmaceuticals Research & Development, Late-stage
Development, Cardiovascular, Renal and Metabolic, Gaithersburg, MD, United
States
(Song) Baim Institute for Clinical Research, Boston, MA, United States
(Diaz) Department of Medicine, Estudios Clinicos Latino America, Rosario,
Argentina
(Goto) Department of Medicine (Cardiology), Tokai University School of
Medicine, Isehara, Japan
(James) Department of Medical Sciences, Cardiology and Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Ray) Department of Primary Care and Public Health, Imperial Centre for
Cardiovascular Disease Prevention, Imperial College London, London, United
Kingdom
(Parkhomenko) Institute of Cardiology, Emergency Cardiology Department,
Kiev, Ukraine
(Kosiborod) Saint Luke's Mid-America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, USA; The George Institute for
Global Health, University of New South Wales, Sydney, NSW, Australia
(McGuire) University of Texas Southwestern Medical Center, Dallas, TX,
United States
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients with stable coronary artery disease and diabetes with
previous percutaneous coronary intervention (PCI), particularly those with
previous stenting, are at high risk of ischaemic events. These patients
are generally treated with aspirin. In this trial, we aimed to investigate
if these patients would benefit from treatment with aspirin plus
ticagrelor. METHOD(S): The Effect of Ticagrelor on Health Outcomes in
diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3
randomised, double-blinded, placebo-controlled trial, done in 1315 sites
in 42 countries. Patients were eligible if 50 years or older, with type 2
diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with
stable coronary artery disease, and one of three other mutually
non-exclusive criteria: a history of previous PCI or of coronary artery
bypass grafting, or documentation of angiographic stenosis of 50% or more
in at least one coronary artery. Eligible patients were randomly assigned
(1:1) to either ticagrelor or placebo, by use of an interactive
voice-response or web-response system. The THEMIS-PCI trial comprised a
prespecified subgroup of patients with previous PCI. The primary efficacy
outcome was a composite of cardiovascular death, myocardial infarction, or
stroke (measured in the intention-to-treat population). FINDINGS: Between
Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS
trial) with a history of previous PCI were enrolled in the THEMIS-PCI
trial. Median follow-up was 3.3 years (IQR 2.8-3.8). In the previous PCI
group, fewer patients receiving ticagrelor had a primary efficacy outcome
event than in the placebo group (404 [7.3%] of 5558 vs 480 [8.6%] of 5596;
HR 0.85 [95% CI 0.74-0.97], p=0.013). The same effect was not observed in
patients without PCI (p=0.76, pinteraction=0.16). The proportion of
patients with cardiovascular death was similar in both treatment groups
(174 [3.1%] with ticagrelor vs 183 (3.3%) with placebo; HR 0.96 [95% CI
0.78-1.18], p=0.68), as well as all-cause death (282 [5.1%] vs 323 [5.8%];
0.88 [0.75-1.03], p=0.11). TIMI major bleeding occurred in 111 (2.0%) of
5536 patients receiving ticagrelor and 62 (1.1%) of 5564 patients
receiving placebo (HR 2.03 [95% CI 1.48-2.76], p<0.0001), and fatal
bleeding in 6 (0.1%) of 5536 patients with ticagrelor and 6 (0.1%) of 5564
with placebo (1.13 [0.36-3.50], p=0.83). Intracranial haemorrhage occurred
in 33 (0.6%) and 31 (0.6%) patients (1.21 [0.74-1.97], p=0.45). Ticagrelor
improved net clinical benefit: 519/5558 (9.3%) versus 617/5596 (11.0%),
HR=0.85, 95% CI 0.75-0.95, p=0.005, in contrast to patients without PCI
where it did not, pinteraction=0.012. Benefit was present irrespective of
time from most recent PCI. INTERPRETATION: In patients with diabetes,
stable coronary artery disease, and previous PCI, ticagrelor added to
aspirin reduced cardiovascular death, myocardial infarction, and stroke,
although with increased major bleeding. In that large, easily identified
population, ticagrelor provided a favourable net clinical benefit (more
than in patients without history of PCI). This effect shows that long-term
therapy with ticagrelor in addition to aspirin should be considered in
patients with diabetes and a history of PCI who have tolerated
antiplatelet therapy, have high ischaemic risk, and low bleeding risk.
FUNDING: AstraZeneca. Copyright © 2019 Elsevier Ltd. All rights
reserved.

<95>
Accession Number
629229829
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
in patients with three-vessel or left main coronary artery disease:
10-year follow-up of the multicentre randomised controlled SYNTAX trial.
Source
Lancet (London, England). (no pagination), 2019. Date of Publication: 30
Aug 2019.
Author
Thuijs D.J.F.M.; Kappetein A.P.; Serruys P.W.; Mohr F.-W.; Morice M.-C.;
Mack M.J.; Holmes D.R.; Curzen N.; Davierwala P.; Noack T.; Milojevic M.;
Dawkins K.D.; da Costa B.R.; Juni P.; Head S.J.
Institution
(Thuijs, Milojevic) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Rotterdam, Netherlands; Medtronic, Maastricht, Netherlands
(Serruys) Department of Cardiology, Imperial College London, London,
United Kingdom
(Mohr, Davierwala, Noack) University Department of Cardiac Surgery, Heart
Centre Leipzig, Leipzig, Germany
(Morice) Department of Cardiology, Cardiovascular Institute Paris-Sud,
Hopital Prive Jacques Cartier, Ramsay Generale de Sante, Massy, France
(Mack) Department of Cardiothoracic Surgery, Baylor University Medical
Centre, Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Curzen) University Hospital Southampton NHS Foundation Trust and School
of Medicine, University of Southampton, Southampton, United Kingdom
(Dawkins) Santa ClaraCAUnited States
(da Costa) Applied Health Research Centre, Li Ka Shing Knowledge Institute
of St Michael's Hospital, University of Toronto, Toronto, ON, Canada;
Institute of Primary Health Care, University of Bern, Bern, Switzerland
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, University of Toronto, Toronto, ON, Canada;
Department of Medicine, Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, ON, Canada
(Head) Department of Cardiothoracic Surgery, Erasmus University Medical
Centre, Rotterdam, Netherlands; Medtronic, Minneapolis, MN, USA
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Synergy between PCI with Taxus and Cardiac Surgery
(SYNTAX) trial was a non-inferiority trial that compared percutaneous
coronary intervention (PCI) using first-generation paclitaxel-eluting
stents with coronary artery bypass grafting (CABG) in patients with
de-novo three-vessel and left main coronary artery disease, and reported
results up to 5 years. We now report 10-year all-cause death results.
 METHOD(S): The SYNTAX Extended Survival (SYNTAXES) study is an
investigator-driven extension of follow-up of a multicentre, randomised
controlled trial done in 85 hospitals across 18 North American and
European countries. Patients with de-novo three-vessel and left main
coronary artery disease were randomly assigned (1:1) to the PCI group or
CABG group. Patients with a history of PCI or CABG, acute myocardial
infarction, or an indication for concomitant cardiac surgery were
excluded. The primary endpoint of the SYNTAXES study was 10-year all-cause
death, which was assessed according to the intention-to-treat principle.
Prespecified subgroup analyses were performed according to the presence or
absence of left main coronary artery disease and diabetes, and according
to coronary complexity defined by core laboratory SYNTAX score tertiles.
This study is registered with ClinicalTrials.gov, NCT03417050. FINDINGS:
From March, 2005, to April, 2007, 1800 patients were randomly assigned to
the PCI (n=903) or CABG (n=897) group. Vital status information at 10
years was complete for 841 (93%) patients in the PCI group and 848 (95%)
patients in the CABG group. At 10 years, 244 (27%) patients had died after
PCI and 211 (24%) after CABG (hazard ratio 1.17 [95% CI 0.97-1.41],
p=0.092). Among patients with three-vessel disease, 151 (28%) of 546 had
died after PCI versus 113 (21%) of 549 after CABG (hazard ratio 1.41 [95%
CI 1.10-1.80]), and among patients with left main coronary artery disease,
93 (26%) of 357 had died after PCI versus 98 (28%) of 348 after CABG (0.90
[0.68-1.20], pinteraction=0.019). There was no treatment-by-subgroup
interaction with diabetes (pinteraction=0.66) and no linear trend across
SYNTAX score tertiles (ptrend=0.30). INTERPRETATION: At 10 years, no
significant difference existed in all-cause death between PCI using
first-generation paclitaxel-eluting stents and CABG. However, CABG
provided a significant survival benefit in patients with three-vessel
disease, but not in patients with left main coronary artery disease.
FUNDING: German Foundation of Heart Research (SYNTAXES study, 5-10-year
follow-up) and Boston Scientific Corporation (SYNTAX study, 0-5-year
follow-up). Copyright © 2019 Elsevier Ltd. All rights reserved.

<96>
Accession Number
629229443
Title
Antiplatelet strategy after transcatheter aortic valve replacement: an
updated meta-analysis.
Source
The Journal of cardiovascular surgery. (no pagination), 2019. Date of
Publication: 03 Sep 2019.
Author
Ma X.; Xu Z.; Li J.; Zhao D.; Kong X.; Ma J.; Ma H.; Yun Y.; Sun L.; Zhang
Y.; Wei D.; Jiao Q.; Zou C.; Wang Z.
Institution
(Ma) Department of Cardiovascular Surgery, Shandong Provincial Hospital
affiliated to Shandong First Medical University, Jinan, Shandong, China
(Ma) Department of Cardiovascular Surgery, Shandong Provincial Hospital
affiliated to Shandong University, Jinan, Shandong, China
(Xu, Li, Zhao, Sun, Wei, Zou, Wang) Department of Cardiovascular Surgery,
Shandong Provincial Hospital affiliated to Shandong First Medical
University, Jinan, Shandong, China
(Xu, Li, Zhao, Sun, Zou, Wang) Department of Cardiovascular Surgery,
Shandong Provincial Hospital affiliated to Shandong University, Jinan,
Shandong, China
(Kong) Department of Vascular Surgery, Shandong Provincial Hospital
affiliated to Shandong University, Jinan, Shandong, China
(Ma) Department of Pathology, Shandong Provincial Hospital affiliated to
Shandong University, Jinan, Shandong, China
(Ma) Qingdao University Medical College, Qingdao University, Qingdao,
Shandong, China
(Yun) Department of Neurology, Qilu Hospital of Shandong University,
Jinan, Shandong Province, China
(Zhang) Emergency Center, Shandong Provincial Hospital affiliated to
Shandong University, Jinan, Shandong, China
(Jiao) Department of Anesthesiology, Shandong Provincial Hospital
affiliated to Shandong University, Jinan, Shandong, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Recently transcatheter aortic valve replacement (TAVR) has
emerged as a feasible alternative for tranditional surgical aortic valve
replacement (SAVR) in patients with intermediate to high risk. There is
currently no clear consensus regarding the optimal antiplatelet strategy
after TAVR. The primary objective of this updated meta-analyses was to
compare the outcomes of dual antiplatelet therapy (DAPT) versus single
antiplatelet therapy (SAPT) following TAVR. METHOD(S): A
meta-analysis of eligible studies of patients undergoing TAVR which
reported our outcomes of postoperative DAPT in comparison with SAPT, was
carried out. The outcomes included the all-cause mortality, stroke,
major/life-threatening bleeding, myocardial infarction and a composite
endpoint of mortality, stroke, bleeding and myocardial infarction.
 RESULT(S): 3 randomized controlled trials (RCTs, n=421) and 5
observational studies (n=6683) were included in this updated
meta-analysis. All-cause mortality was comparable between the two groups
[OR 1.13 (95% CI 0.70-1.81), P=0.619]. Besides, DAPT resulted in an
augmented risk of major/life-threatening bleeding [OR 2.45 (95% CI
1.08-5.59), P=0.032]. No statistically significant difference was found
between the two groups in the rates of stroke [OR 0.83 (95% CI 0.62-1.10),
P=0.212] and myocardial infarction [OR 1.17 (95% CI 0.47- 2.91), P=0.728].
And DAPT led to an increased rate of the composite endpoint [OR 2.39 (95%
CI 1.63-3.50), P<0.0001]. CONCLUSION(S): The updated meta-analysis
presents the evidence that post-TAVR DAPT increases bleeding events, with
no benefit in survival and ischemic events, in comparison with SAPT.
Nevertheless, it is currently difficult to evaluate by a meta-analysis the
effectiveness of DAPT versus SAPT to prevent the valve thrombosis
resulting in leaflet dysfunction , due to a limited number of existing
publication. Additional RCTs are needed to determine the optimal
antiplatelet strategy after TAVR.

<97>
Accession Number
629227464
Title
Fibrinogen Concentrate as an Alternative to Cryoprecipitate in a
Postcardiopulmonary Transfusion Algorithm in Infants Undergoing Cardiac
Surgery: A Prospective Randomized Controlled Trial.
Source
Anesthesia and analgesia. (no pagination), 2019. Date of Publication: 03
Sep 2019.
Author
Downey L.A.; Andrews J.; Hedlin H.; Kamra K.; McKenzie E.D.; Hanley F.L.;
Williams G.D.; Guzzetta N.A.
Institution
(Downey, Guzzetta) From the Department of Anesthesiology, Perioperative
and Pain Medicine, Emory University, Children's Healthcare of Atlanta,
Atlanta, Georgia
(Andrews) Departments of Pathology, Microbiology, Immunology
(Andrews) Pediatrics, Vanderbilt University Medical Center, Nashville, TN,
United States
(Hedlin) Department of Quantitative Sciences Unit, Stanford University
School of Medicine, Palo Alto, CA, United States
(Kamra, Williams) Department of Anesthesiology, Stanford University School
of Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, United
States
(McKenzie) Division of Congenital Heart Surgery, Department of Surgery,
Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United
States
(Hanley) Departments of Cardiovascular Surgery
Publisher
NLM (Medline)
Abstract
BACKGROUND: Infants undergoing cardiac surgery are at risk for bleeding
and massive transfusion due to an immature coagulation system, complex
surgeries, and cardiopulmonary bypass (CPB) effects. Hemodilution from CPB
promotes an acquired hypofibrinogenemia that results in impaired fibrin
formation, inadequate clot formation, and increased bleeding. In North
America, the current standard of care to supplement fibrinogen is
cryoprecipitate. An alternative option is the off-label use of fibrinogen
concentrate (FC; RiaSTAP; CSL Behring, Marburg, Germany), a purified
fibrinogen. Because perioperative allogenic transfusions are associated
with increased morbidity and mortality, we sought to determine whether FC
would be an acceptable alternative to cryoprecipitate in a post-CPB
transfusion algorithm in infants undergoing open-heart surgery.
 METHOD(S): We randomized 60 infants (<12 months) undergoing
nonemergent cardiac surgery with CPB at 2 tertiary care children's
hospitals to receive either cryoprecipitate or FC in a post-CPB
transfusion algorithm. Infants underwent a stratified randomization based
on institution and surgical complexity. The primary outcome was the
difference in number of intraoperative allogenic blood product
transfusions. Secondary outcomes included 24-hour chest tube output (CTO),
mechanical ventilation time, adverse events (AEs), intensive care unit
(ICU) length of stay (LOS), hospital LOS, postoperative thrombosis, and
death within 30 days of surgery. The primary analysis followed the
intent-to-treat (ITT) principle and was performed using linear regression
adjusted for institution and complexity of surgery. A per-protocol (PP)
analysis was also performed. RESULT(S): Between June 2016 and January
2018, we enrolled 60 patients with complete data available for 25 patients
who received cryoprecipitate and 29 patients who received FC. Patients in
the cryoprecipitate group (median age: 4 months [2-6 months]) received 5.5
(4.0-7.0) allogeneic blood units in the ITT analysis and 6.0 units
(5.0-7.0 units) in the PP analysis. Patients in the FC group (median age:
4 months [2-5]) received 4 units (3.0-5.0 units) in the ITT analysis and
4.0 units (3.0-5.0 units) in the PP analysis. In the adjusted ITT
analysis, the FC group received 1.79 units (95% confidence interval [CI],
0.64-2.93; P = .003) less than the cryoprecipitate group. In the adjusted
PP analysis, the FC group received 2.67 units (95% CI, 1.75-3.59; P <
.001) less than the cryoprecipitate group. There were no significant
differences in secondary outcomes or AEs. CONCLUSION(S): Our findings
suggest that FC may be considered as an alternative to cryoprecipitate for
the treatment of hypofibrinogenemia in infants with bleeding after CPB.
Although we found no significant differences between secondary outcomes or
AEs, further studies are needed to assess safety.

<98>
Accession Number
629218414
Title
Pharmacological interventions for the treatment of delirium in critically
ill adults.
Source
The Cochrane database of systematic reviews. 9 (pp CD011749), 2019. Date
of Publication: 03 Sep 2019.
Author
Burry L.; Hutton B.; Williamson D.R.; Mehta S.; Adhikari N.K.; Cheng W.;
Ely E.W.; Egerod I.; Fergusson D.A.; Rose L.
Institution
(Burry) Department of Pharmacy, Leslie Dan Faculty of Pharmacy, University
of Toronto, Room 18-377, Mount Sinai Hospital600 University Avenue,
Toronto, ON M5G 1X5, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although delirium is typically an acute reversible cognitive
impairment, its presence is associated with devastating impact on both
short-term and long-term outcomes for critically ill patients. Advances in
our understanding of the negative impact of delirium on patient outcomes
have prompted trials evaluating multiple pharmacological interventions.
However, considerable uncertainty surrounds the relative benefits and
safety of available pharmacological interventions for this population.
 OBJECTIVE(S): Primary objective1. To assess the effects of
pharmacological interventions for treatment of delirium on duration of
delirium in critically ill adults with confirmed or documented high risk
of deliriumSecondary objectivesTo assess the following:1. effects of
pharmacological interventions on delirium-free and coma-free days; days
with coma; delirium relapse; duration of mechanical ventilation; intensive
care unit (ICU) and hospital length of stay; mortality; and long-term
outcomes (e.g. cognitive; discharge disposition; health-related quality of
life); and2. the safety of such treatments for critically ill adult
patients. SEARCH METHOD(S): We searched the following databases from
their inception date to 21 March 2019: Ovid MEDLINE, Ovid MEDLINE
In-Process & Other Non-Indexed Citations, Embase Classic+Embase, and
PsycINFO using the Ovid platform. We also searched the Cochrane Library on
Wiley, the International Prospective Register of Systematic Reviews
(PROSPERO) (http://www.crd.york.ac.uk/PROSPERO/), the Cumulative Index to
Nursing and Allied Health Literature (CINAHL), and Web of Science. We
performed a grey literature search of relevant databases and websites
using the resources listed in Grey Matters developed by the Canadian
Agency for Drugs and Technologies in Health (CADTH). We also searched
trial registries and abstracts from annual scientific critical care and
delirium society meetings. SELECTION CRITERIA: We sought randomized
controlled trials (RCTs), including quasi-RCTs, of any pharmacological
(drug) for treatment of delirium in critically ill adults. The drug
intervention was to be compared to another active drug treatment, placebo,
or a non-pharmacological intervention (e.g. mobilization). We did not
apply any restrictions in terms of drug class, dose, route of
administration, or duration of delirium or drug exposure. We defined
critically ill patients as those treated in an ICU of any specialty (e.g.
burn, cardiac, medical, surgical, trauma) or high-dependency unit. DATA
COLLECTION AND ANALYSIS: Two review authors independently identified
studies from the search results; four review authors (in pairs) performed
data extraction and assessed risk of bias independently. We performed data
synthesis through pairwise meta-analysis and network meta-analysis (NMA).
Our hypothetical network structure was designed to be analysed at the drug
class level and illustrated a network diagram of 'nodes' (i.e. drug
classes) and 'edges' (i.e. comparisons between different drug classes from
existing trials), thus describing a treatment network of all possible
comparisons between drug classes. We assessed the quality of the body of
evidence according to GRADE, as very low, low, moderate, or high. MAIN
RESULTS: We screened 7674 citations, from which 14 trials with 1844
participants met our inclusion criteria. Ten RCTs were placebo-controlled,
and four reported comparisons of different drugs. Drugs examined in these
trials were the following: antipsychotics (n = 10), alpha2 agonists (n =
3; all dexmedetomidine), statins (n = 2), opioids (n = 1; morphine),
serotonin antagonists (n = 1; ondansetron), and cholinesterase (CHE)
inhibitors (n = 1; rivastigmine). Only one of these trials consistently
used non-pharmacological interventions that are known to improve patient
outcomes in both intervention and control groups.Eleven studies (n = 1153
participants) contributed to analysis of the primary outcome. Results of
the NMA showed that the intervention with the smallest ratio of means
(RoM) (i.e. most preferred) compared with placebo was the alpha2 agonist
dexmedetomidine (0.58; 95% credible interval (CrI) 0.26 to 1.27; surface
under the cumulative ranking curve (SUCRA) 0.895; moderate-quality
evidence). In order of descending SUCRA values (best to worst), the next
best interventions were atypical antipsychotics (RoM 0.80, 95% CrI 0.50 to
1.11; SUCRA 0.738; moderate-quality evidence), opioids (RoM 0.88, 95% CrI
0.37 to 2.01; SUCRA 0.578; very-low quality evidence), and typical
antipsychotics (RoM 0.96, 95% CrI 0.64 to1.36; SUCRA 0.468; high-quality
evidence).The NMAs of multiple secondary outcomes revealed that only the
alpha2 agonist dexmedetomidine was associated with a shorter duration of
mechanical ventilation (RoM 0.55, 95% CrI 0.34 to 0.89; moderate-quality
evidence), and the CHE inhibitor rivastigmine was associated with a longer
ICU stay (RoM 2.19, 95% CrI 1.47 to 3.27; moderate-quality evidence).
Adverse events often were not reported in these trials or, when reported,
were rare; pair-wise analysis of QTc prolongation in seven studies did not
show significant differences between antipsychotics, ondansetron,
dexmedetomidine, and placebo. AUTHORS' CONCLUSION(S): We identified
trials of varying quality that examined six different drug classes for
treatment of delirium in critically ill adults. We found evidence that the
alpha2 agonist dexmedetomidine may shorten delirium duration, although
this small effect (compared with placebo) was seen in pairwise analyses
based on a single study and was not seen in the NMA results. Alpha2
agonists also ranked best for duration of mechanical ventilation and
length of ICU stay, whereas the CHE inhibitor rivastigmine was associated
with longer ICU stay. We found no evidence of a difference between placebo
and any drug in terms of delirium-free and coma-free days, days with coma,
physical restraint use, length of stay, long-term cognitive outcomes, or
mortality. No studies reported delirium relapse, resolution of symptoms,
or quality of life. The ten ongoing studies and the six studies awaiting
classification that we identified, once published and assessed, may alter
the conclusions of the review.

<99>
Accession Number
629217733
Title
Minimal access versus sternotomy for complex mitral valve repair: A
meta-analysis.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 31 Aug 2019.
Author
Moscarelli M.; Fattouch K.; Gaudino M.; Nasso G.; Paparella D.; Punjabi
P.; Athanasiou T.; Benedetto U.; Angelini G.D.; Santarpino G.; Speziale G.
Institution
(Moscarelli, Fattouch, Nasso, Paparella, Santarpino, Speziale) GVM Care &
Research, Department of Cardiovascular Surgery, Italy
(Gaudino) Department of Cardio-Thoracic Surgery Weill Cornell Medicine New
York City, NY, United States
(Punjabi, Athanasiou) Imperial College of London, Hammersmith Hospital,
London, United Kingdom
(Benedetto, Angelini) Bristol Heart Institute, University of Bristol,
United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is high demand for minimally invasive mitral valve
repair; however, it is unclear whether the minimally invasive approach
provides the same performance of conventional sternotomy in a context of
complex mitral valve disease. Here, we compared outcomes of minimally
invasive and sternotomy procedures for bileaflet and Barlow's mitral valve
disease. METHOD(S): We performed a pooled meta-analysis of studies
reporting early and late follow-up of mitral valve repair for complex
mitral valve regurgitation (MR). The primary outcome was moderate MR
recurrence and need for re-operation. Secondary outcomes included:
operation time, reopening for bleeding, associated tricuspid procedures,
failed repair, and in-hospital mortality. Incidence rates (IRs) were
calculated for long-term follow-up. Effect estimates were calculated as
IRs with 95% confidence intervals. When Kaplan-Meier curves were
available, event rates were estimated from the curves with Plot Digitizer
software; otherwise, reported event rates were used to calculate IRs.
 RESULT(S): Eighteen studies including 1905 patients (654 minimally
invasive and 1251 sternotomy) with a mean follow-up of 51.6 months (range,
14-138 months) were meta-analyzed with a random model. There were no
significant between-group differences in moderate MR recurrence and
re-operation (minimally invasive vs. sternotomy, 1.7%, [1.0-2.9%] vs. 1.3%
[0.9-1.8%], p = 0.22). Patients in the minimally invasive group were
exposed to significantly longer cross clamp and cardiopulmonary bypass
times (p < 0.01); however, there were no additional between-group
differences in secondary outcomes. CONCLUSION(S): This is the first
meta-analysis to demonstrate that minimally invasive and sternotomy
approaches produce comparable results for complex mitral valve
repair. Copyright © 2019. Published by Elsevier Inc.

<100>
Accession Number
629216405
Title
Current state of leadless pacemakers: state of the art review.
Source
Expert review of cardiovascular therapy. (no pagination), 2019. Date of
Publication: 04 Sep 2019.
Author
Afzal M.R.; Shah N.; Daoud G.; Houmsse M.
Institution
(Afzal, Daoud, Houmsse) Division of Cardiovascular Medicine, Wexner
Medical Center at the Ohio State University Medical Center, Columbus, OH,
United States
(Shah) St. Mary Mercy Hospital, Livonia, MI, United States
Publisher
NLM (Medline)
Abstract
Introduction: Leadless pacemakers (LPs) are the latest advancement in the
field of pacing. Experience from pivotal trials and post-marketing studies
has proven the feasibility and safety of these devices. The LPs obviate
the need of pulse generator pocket and leads, which translates into lower
incidence of lead related complications and pocket related infections.
This review will summarize the existing literature on the LPs,
specifically indications; implant procedure, unique situations and long-
term follow up. Areas covered: This review will summarize the results of
published pivotal trials. Several multicenter studies where LP was used in
the unique situations such as during concomitant AV node ablation and
across bioprosthetic valve will also be discussed. An extensive search
using PUBMED was performed to identify the relevant articles. Expert
opinion: The use of LPs is expanding and the published results a
preferential use of such devices for patients who need single ventricle
pacing. Additionally, the use of these devices in several unique
situations such as patients with inferior vena cava filters, bioprosthetic
tricuspid valves and concomitant atrio-ventricular nodal (AV) ablation has
also been shown to be safe.

<101>
Accession Number
629211768
Title
Comparison of a Complete Percutaneous versus Surgical Approach to Aortic
Valve Replacement and Revascularization in Patients at Intermediate
Surgical Risk: Results from the Randomized SURTAVI Trial.
Source
Circulation. (no pagination), 2019. Date of Publication: 03 Sep 2019.
Author
Sondergaard L.; Popma J.J.; Reardon M.J.; Van Mieghem N.M.; Deeb G.M.;
Kodali S.; George I.; Williams M.R.; Yakubov S.J.; Kappetein A.P.; Serruys
P.W.; Grube E.; Schiltgen M.B.; Chang Y.; Engstrom T.
Institution
(Sondergaard, Engstrom) Department of Cardiology, Heart Centre,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Popma) Department of Internal Medicine, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Reardon) Department of Cardiovascular Surgery, Methodist DeBakey Heart
and Vascular Center, Houston, TX, United States
(Van Mieghem) Departments of Cardiology and Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Deeb) Department of Cardiac Surgery, University of Michigan, Ann Arbor,
MI, United States
(Kodali, George) Department of Surgery, Columbia University Medical
Center, New York, NY
(Williams) Departments of Medicine (Cardiology) and Cardiothoracic
Surgery, NYU-Langone Medical Center, New York, NY
(Yakubov) Department of Cardiology, OhioHealth Riverside Methodist
Hospital, Columbus, OH, United States
(Kappetein) Departments of Cardiology and Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, The Netherlands; Structural Heart,
Medtronic plc, Minneapolis, MN
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
(Grube) Department of Medicine II, Heart Center Bonn, Bonn, Germany
(Schiltgen, Chang) Structural Heart, Medtronic plc, Minneapolis, MN,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: For patients with severe aortic stenosis (AS) and coronary
artery disease (CAD), the completely percutaneous approach to aortic valve
replacement and revascularization has not been compared to the standard
surgical approach. METHOD(S): The prospective SURTAVI trial enrolled
intermediate-risk patients with severe AS from 87 centers in the United
States, Canada, and Europe between June 2012 and June 2016. Complex
coronary artery disease with SYNTAX score >22 was an exclusion criterion.
Patients were stratified according to need for revascularization and then
randomized to treatment with transcatheter aortic valve replacement (TAVR)
or surgical aortic valve replacement (SAVR). Patients assigned to
revascularization in the TAVR group underwent percutaneous coronary
intervention (PCI), while those in the SAVR group had coronary artery
bypass grafting (CABG). The primary endpoint was the rate of all-cause
mortality or disabling stroke at two years. RESULT(S): Of 1,660
subjects with attempted aortic valve implants, 332 (20%) were assigned to
revascularization. They had a higher STS risk score for mortality
(4.8+/-1.7% vs 4.4+/-1.5%; p<0.01) and were more likely to be male (65.1%
vs 54.2%; p<0.01) than the 1,328 patients not assigned to
revascularization. After randomization to treatment, there were 169 TAVR
and PCI patients, 163 SAVR and CABG patients, 695 TAVR patients, and 633
SAVR patients. No significant difference in the rate of the primary
endpoint was found between TAVR and PCI and SAVR and CABG (16.0%; 95% CI
11.1 - 22.9 vs. 14.0%; 95% CI 9.2 - 21.1; p=0.62), or between TAVR and
SAVR (11.9%; 95% CI 9.5 - 14.7 vs. 12.3%; 95% CI 9.8 - 15.4; p=0.76).
 CONCLUSION(S): For patients at intermediate surgical risk with severe
AS and non-complex CAD (SYNTAX score <= 22), a complete percutaneous
approach of TAVR and PCI is a reasonable alternative to SAVR and CABG.
CLINICAL TRIAL REGISTRATION: URL: www.clinicaltrials.gov Unique
Identifier: NCT01586910.

<102>
Accession Number
629211075
Title
Percutaneous Repair or Medical Treatment for Secondary Mitral
Regurgitation: Outcomes at 2years.
Source
European journal of heart failure. (no pagination), 2019. Date of
Publication: 02 Sep 2019.
Author
Iung B.; Armoiry X.; Vahanian A.; Boutitie F.; Mewton N.; Trochu J.-N.;
Lefevre T.; Messika-Zeitoun D.; Guerin P.; Cormier B.; Brochet E.;
Thibault H.; Himbert D.; Thivolet S.; Leurent G.; Bonnet G.; Donal E.;
Piriou N.; Piot C.; Habib G.; Rouleau F.; Carrie D.; Nejjari M.; Ohlmann
P.; Etienne C.S.; Leroux L.; Gilard M.; Samson G.; Rioufol G.;
Maucort-Boulch D.; Obadia J.F.
Institution
(Iung, Messika-Zeitoun, Brochet, Himbert) APHP, Hopital Bichat, DHU FIRE,
Paris, France
(Iung, Vahanian) Universite de Paris and INSERM 1148, Paris, France
(Armoiry) Pharmacy Department and Laboratoire MATEIS, Hospices Civils de
Lyon and Claude Bernard University, Lyon, France
(Boutitie, Maucort-Boulch) Service de Biostatistique - Bioinformatique,
Pole Sante Publique, Hospices Civils de Lyon, F-69003, Lyon; Universite
Lyon 1, F-69100, Villeurbanne, France ; CNRS, UMR5558, Laboratoire de
Biometrie et Biologie Evolutive, Equipe Biostatistique-Sante, F-69100,
Villeurbanne, France
(Mewton, Samson) Hopital Cardiovasculaire Louis Pradel, Clinical
Investigation Center & Heart Failure Department, INSERM 1407, Hospices
Civils de Lyon and Claude Bernard University, Lyon, France
(Trochu, Guerin, Piriou) CHU Nantes, INSERM, Clinique cardiologique et des
maladies vasculaires, CIC 1413, Institut du thorax, Nantes F-44000, France
(Lefevre, Cormier) Institut Jacques Cartier, Massy, France
(Messika-Zeitoun) University of Ottawa Heart Institute, Division of
Cardiology, Ottawa, Canada
(Thibault, Thivolet) Hopital Cardiovasculaire Louis Pradel, Service des
explorations fonctionnelles cardiovasculaires, Hospices Civils de Lyon and
Claude Bernard University, Lyon, France
(Leurent, Donal) CHU Rennes, Hopital Pontchaillou, Rennes, France
(Bonnet, Habib) APHM, Hopital de la Timone, Marseille, France
(Piot) Clinique du Millenaire, Montpellier, France
(Rouleau) CHU Angers, Angers, France
(Carrie) CHU Toulouse, Hopital Rangueil, Toulouse, France
(Nejjari) Centre Cardiologique du Nord, Saint-Denis, France
(Ohlmann) Hopitaux Universitaires de Strasbourg, Nouvel Hopital Civil,
Strasbourg, France
(Etienne) Hopital Trousseau, Tours, CHRU de Tours, France
(Leroux) CHU Bordeaux, Hopital Haut-Leveque, Pessac, France
(Gilard) CHRU Brest, Hopital de La Cavale Blanche, Brest, France
(Rioufol) Hopital Cardiovasculaire Louis Pradel, Service d'Hemodynamique
et Cardiologie Interventionnelle, Hospices Civils de Lyon and Claude
Bernard University, Lyon, France
(Obadia) Hopital Cardiovasculaire Louis Pradel, Chirurgie
Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon
and Claude Bernard University, Lyon, France
Publisher
NLM (Medline)
Abstract
AIMS: The MITRA-FR trial showed that among symptomatic patients with
severe secondary mitral regurgitation, percutaneous repair did not reduce
the risk of death or hospitalization for heart failure at 12 months
compared with guideline-directed medical treatment alone. We report the
24-month outcome from this trial. METHODS AND RESULTS: At 37 centers, we
randomly assigned 304 symptomatic heart failure patients with severe
secondary mitral regurgitation (effective regurgitant orifice area >20mm2
or regurgitant volume >30 mL), and left ventricular ejection fraction
between 15% and 40% to undergo percutaneous valve repair plus medical
treatment (intervention group, n=152) or medical treatment alone (control
group, n=152). The primary efficacy outcome was the composite of all-cause
death and unplanned hospitalization for heart failure at 12 months. At 24
months, all-cause death and unplanned hospitalization for heart failure
occurred in 63.8% of patients (97/152) in the intervention group and 67.1%
(102/152) in the control group (hazard ratio, 1.01; 95% confidence
interval [CI], 0.77 to 1.34). All-cause mortality occurred in 34.9% of
patients (53/152) in the intervention group and 34.2% (52/152) in the
control group (hazard ratio, 1.02; 95% CI, 0.70 to 1.50). Unplanned
hospitalization for heart failure occurred in 55.9% of patients (85/152)
in the intervention group and 61.8% (94/152) in the control group (hazard
ratio, 0.97; 95% CI 0.72 to 1.30). CONCLUSION(S): In patients with
severe secondary mitral regurgitation, percutaneous repair added to
medical treatment did not significantly reduce the risk of death or
hospitalization for heart failure at two years compared with medical
treatment alone. Copyright This article is protected by copyright. All
rights reserved.

<103>
Accession Number
629209233
Title
Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary
Disease.
Source
The New England journal of medicine. (no pagination), 2019. Date of
Publication: 02 Sep 2019.
Author
Yasuda S.; Kaikita K.; Akao M.; Ako J.; Matoba T.; Nakamura M.; Miyauchi
K.; Hagiwara N.; Kimura K.; Hirayama A.; Matsui K.; Ogawa H.
Institution
(Yasuda, Kaikita, Akao, Ako, Matoba, Nakamura, Miyauchi, Hagiwara, Kimura,
Hirayama, Matsui, Ogawa) From the National Cerebral and Cardiovascular
Center, Osaka Police Hospital, Graduate School of Medical Sciences,
Kumamoto University (K. Kaikita), the Department of General Medicine,
Kumamoto University Hospital (K. Matsui), National Hospital Organization
Kyoto Medical Center, Kitasato University School of Medicine, Department
of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka (T.M.),
Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
(M.N.), Department of Cardiology, Juntendo University School of Medicine
(K. Miyauchi), the Department of Cardiology, Tokyo Women's Medical
University (N.H.), the Cardiovascular Center, Yokohama City University
Medical Center, Yokohama (K. Kimura) - all in Japan, Kumamoto, Tokyo,
Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: There are limited data from randomized trials evaluating the
use of antithrombotic therapy in patients with atrial fibrillation and
stable coronary artery disease. METHOD(S): In a multicenter,
open-label trial conducted in Japan, we randomly assigned 2236 patients
with atrial fibrillation who had undergone percutaneous coronary
intervention (PCI) or coronary-artery bypass grafting (CABG) more than 1
year earlier or who had angiographically confirmed coronary artery disease
not requiring revascularization to receive monotherapy with rivaroxaban (a
non-vitamin K antagonist oral anticoagulant) or combination therapy with
rivaroxaban plus a single antiplatelet agent. The primary efficacy end
point was a composite of stroke, systemic embolism, myocardial infarction,
unstable angina requiring revascularization, or death from any cause; this
end point was analyzed for noninferiority with a noninferiority margin of
1.46. The primary safety end point was major bleeding, according to the
criteria of the International Society on Thrombosis and Hemostasis; this
end point was analyzed for superiority. RESULT(S): The trial was
stopped early because of increased mortality in the combination-therapy
group. Rivaroxaban monotherapy was noninferior to combination therapy for
the primary efficacy end point, with event rates of 4.14% and 5.75% per
patient-year, respectively (hazard ratio, 0.72; 95% confidence interval
[CI], 0.55 to 0.95; P<0.001 for noninferiority). Rivaroxaban monotherapy
was superior to combination therapy for the primary safety end point, with
event rates of 1.62% and 2.76% per patient-year, respectively (hazard
ratio, 0.59; 95% CI, 0.39 to 0.89; P=0.01 for superiority).
 CONCLUSION(S): As antithrombotic therapy, rivaroxaban monotherapy was
noninferior to combination therapy for efficacy and superior for safety in
patients with atrial fibrillation and stable coronary artery disease.
(Funded by the Japan Cardiovascular Research Foundation; AFIRE UMIN
Clinical Trials Registry number, UMIN000016612; and ClinicalTrials.gov
number, NCT02642419.). Copyright © 2019 Massachusetts Medical
Society.

<104>
Accession Number
629207604
Title
Post-operative Atrial Fibrillation following Noncardiac Surgery Increases
Risk of Stroke.
Source
The American journal of medicine. (no pagination), 2019. Date of
Publication: 29 Aug 2019.
Author
Koshy A.N.; Hamilton G.; Theuerle J.; Teh A.W.; Han H.-C.; Gow P.J.; Lim
H.S.; Thijs V.; Farouque O.
Institution
(Koshy, Teh, Han, Lim) Department of Cardiology, Austin Health, Melbourne,
Victoria, Australia; Department of Medicine, The University of Melbourne,
Victoria, Australia
(Hamilton, Theuerle, Farouque) Department of Cardiology, Austin Health,
Melbourne, Victoria, Australia
(Gow) Department of Medicine, The University of Melbourne, Victoria,
Australia; Victorian Liver Transplant Unit, Austin Health, Melbourne,
Victoria, Australia
(Thijs) Department of Medicine, The University of Melbourne, Victoria,
Australia; Stroke Division, Florey Institute of Neuroscience and Mental
Health and Department of Neurology, Austin Health, Melbourne, Victoria,
Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: New-onset post-operative atrial fibrillation is well
recognized to be an adverse prognostic marker in patients undergoing
noncardiac surgery. Whether post-operative atrial fibrillation confers an
increased risk of stroke remains unclear. METHOD(S): A systematic
review and meta-analysis was performed to assess the risk of stroke after
post-operative atrial fibrillation in noncardiac surgery. MEDLINE,
Cochrane and EMBASE databases were searched for articles published up to
May 2019 for studies of patients undergoing noncardiac surgery that
reported incidence of new atrial fibrillation and stroke. Event rates from
individual studies were pooled and risk ratios (RR) were pooled using a
random-effects model. RESULT(S): Fourteen studies of 3,536,291
patients undergoing noncardiac surgery were included in the quantitative
analysis (mean follow-up 1.4+/-1year). New atrial fibrillation occurred in
26,046 (0.74%) patients with a higher incidence following thoracic
surgery. Stroke occurred in 279 (1.5%) and 6199 (0.4%) patients, with and
without post-operative atrial fibrillation, respectively. On pooled
analysis, post-operative atrial fibrillation was associated with a
significantly increased risk of stroke (RR 2.51, 95%CI 1.76-3.59) with
moderate heterogeneity. The stroke risk was significantly higher with
atrial fibrillation following non-thoracic compared to thoracic surgery
(RR 3.09 vs RR 1.95; p=0.01). CONCLUSION(S): New post-operative
atrial fibrillation following noncardiac surgery was associated with a
2.5-fold increase in the risk of stroke. This risk was highest among
patients undergoing non-thoracic noncardiac surgery. Given the documented
efficacy of newer anticoagulants, randomized controlled trials are
warranted to assess whether they can reduce the risk of stroke in these
patients. Copyright © 2019. Published by Elsevier Inc.

<105>
Accession Number
629205264
Title
Durability of Mitral Valve Bioprostheses: A meta-analysis of long-term
follow-up studies.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 28 Aug 2019.
Author
Malvindi P.G.; Mastro F.; Kowalewski M.; Ringold M.; Margari V.; Suwalski
P.; Speziale G.; Paparella D.
Institution
(Malvindi, Margari) GVM Care & Research, Department of Cardiovascular
Surgery, Santa Maria Hospital, Spain
(Mastro, Ringold) Department of Emergency and Organ Transplant, University
of Bari Aldo Moro
(Kowalewski) Department of Cardiac Surgery, Central Clinical Hospital of
the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw
- Poland; Cardiothoracic Research Centre, Innovative Medical Forum,
Bydgoszcz - Poland; Cardio-Thoracic Surgery Department, Heart and Vascular
Centre, Maastricht University Medical Centre, Maastricht - The Netherland
(Suwalski) Department of Cardiac Surgery, Central Clinical Hospital of the
Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw -
Poland
(Speziale) GVM Care & Research, Department of Cardiovascular Surgery,
Anthea Hospital, Italy
(Paparella) GVM Care & Research, Department of Cardiovascular Surgery,
Santa Maria Hospital, Bari - Italy; Department of Emergency and Organ
Transplant, University of Bari Aldo Moro, Bari - Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Porcine and pericardial valves exhibited similar freedom from
structural valve deterioration after aortic valve replacement. Limited
data exists regarding their durability at long-term follow-up in the
mitral position. METHOD(S): A literature search was performed through
online databases. Papers reporting freedom from tissue valve deterioration
after mitral valve replacement with a follow-up longer than five years
were retrieved. Four porcine valves (Carpentier-Edwards, Hancock, Hancock
II, Mosaic) and one pericardial prosthesis (Carpentier-Edwards) were the
objects of the study. The structural valve deterioration rate (SVD) per
year was calculated for each type of prosthesis. Kaplan-Meier curves and
log-rank test analysis were performed to compare the long-term durability
of porcine and pericardial valves. RESULT(S): Forty full-text papers
including more than 15,000 patients were considered for the meta-analysis.
Porcine valves were generally implanted in younger patients in the first
period after their introduction. The mean age of the patients receiving a
mitral bioprosthesis increased from 50 to 70 years over the decades. In
patients operated after 1980 who had similar mean age at the time of
implant, freedom from SVD was higher in the group of porcine valves with
Mosaic prosthesis, showing the lowest rate of SDV. Long-term survival was
higher for Mosaic porcine and Carpentier pericardial valves.
 CONCLUSION(S): In surgical populations that underwent mitral valve
replacement after 1980 with new generation tissue valves and similar mean
age at the implant time, we found, at long-term follow up, a higher
freedom from SVD in the group of porcine prostheses. Copyright ©
2019. Published by Elsevier Inc.

<106>
Accession Number
629203587
Title
Toward a robust tool for pharmacokinetic-based personalization of
treatment with tacrolimus in solid organ transplantation: a model-based
meta-analysis approach.
Source
British journal of clinical pharmacology. (no pagination), 2019. Date of
Publication: 31 Aug 2019.
Author
Nanga T.M.; Doan T.T.P.; Marquet P.; Musuamba F.T.
Institution
(Nanga, Doan, Marquet, Musuamba) Universite de Limoges 87025, France
Publisher
NLM (Medline)
Abstract
PURPOSE: The objective of this study is to develop a generic model for
tacrolimus pharmacokinetics modeling using a meta-analysis approach, that
could serve as a first step towards a prediction tool to inform PK-based
optimal dosing of tacrolimus in different populations and indications.
 METHOD(S): A systematic literature review was performed and a
meta-model developed with NONMEM software using a top-down approach.
Historical (previously published) data were used for model development and
qualification. In- house individual rich and sparse tacrolimus blood
concentration profiles from adult and pediatric kidney, liver, lung, and
heart transplant patients were used for model validation. Model validation
was based on successful numerical convergence, adequate precision in
parameter estimation, acceptable goodness of fit with respect to measured
blood concentrations with no indication of bias, and acceptable
performance of visual predictive checks. External validation was performed
by fitting the model to independent data from 3 external cohorts and
remaining previously published studies. RESULT(S): A total of 76
models were found relevant for meta-model building from the literature and
the related parameters recorded. The meta-model developed using patient
level data was structurally a two-compartment model with first order
absorption, absorption lag time and first time varying elimination.
Population values for clearance, intercompartmental clearance, central and
peripheral volume were 22.5 L/h, 24.2 L/h, 246.2 L and 109.9 L,
respectively. The absorption first-order rate and the lag time were fixed
to 3.37 h-1 and 0.33 h respectively. Transplanted organ and time after
transplantation were found to influence drug apparent clearance whereas
body weight influenced both the apparent volume of distribution and the
apparent clearance. The model displayed good results as regards the
internal and external validation. CONCLUSION(S): A meta-model was
successfully developed for tacrolimus in solid organ transplantation that
can be used as a basis for the prediction of concentrations in different
groups of patients, and eventually for effective dose individualization in
different subgroups of the population. Copyright This article is
protected by copyright. All rights reserved.

<107>
Accession Number
629201420
Title
Preoperative high-intensity interval training is effective and safe in
deconditioned patients with lung cancer: A randomized clinical trial.
Source
Journal of rehabilitation medicine. (no pagination), 2019. Date of
Publication: 29 Aug 2019.
Author
Bhatia C.; Kayser B.
Institution
(Bhatia) Respiratory Care Service, University Hospitals of Geneva, Geneva
1205, Switzerland
Publisher
NLM (Medline)
Abstract
BACKGROUND: The outcome of surgery in deconditioned patients can be
improved through prehabilitation. This study examined the effect of
prehabilitation in patients diagnosed with lung cancer. METHOD(S):
Candidates for lung cancer resection were assigned to high-intensity
interval training (n=74) or usual care (n=77). Cardiopulmonary exercise
testing and 6-min walk test were performed before and after training.
High-intensity interval training consisted of 2-3-weekly, 2x10-min series
of cycling at peak power, measured with cardiopulmonary exercise testing
prior to training, with a 15-s on-off duty cycle, preceded by a 5-min
warm-up and followed by a 5-min cool-down. Work-rate, heart-rate,
saturation, dyspnoea and leg effort were monitored. RESULT(S):
Waiting time (median 25 days) allowed a median of 8 high-intensity
interval training sessions to be performed. Adherence to mean
high-intensity interval training was 87% (18%) (mean (standard deviation;
SD)). High-intensity interval training power increased (23 watt, 95%
confidence interval (95% CI): 20-26 watt), as did heart rate (14 bpm, 95%
CI 11-16 bpm). Resting heart rate (-6 bpm, 95% CI -4 to -7 bpm) and heart
rate 1 min post-cool-down decreased (-5 bpm, 95% CI -4 to -7 bpm). Aerobic
capacity increased after high-intensity interval training (14%, 95% CI
3-26%), as did peak power output (median 7%, 95% CI 2-13%), but not after
usual care. Six-min walk test score increased after high-intensity
interval training (median 20%, 95% CI 14-26%), but not after usual care.
 CONCLUSION(S): Short-term high-intensity interval training is
feasible in deconditioned patients and increases cardio-respiratory
fitness and walking capacity.

<108>
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.

<109>
Accession Number
2002710301
Title
Thin, Very Thin, or Ultrathin Strut Biodegradable or Durable
Polymer-Coated Drug-Eluting Stents: 3-Year Outcomes of BIO-RESORT.
Source
JACC: Cardiovascular Interventions. 12 (17) (pp 1650-1660), 2019. Date of
Publication: 9 September 2019.
Author
Buiten R.A.; Ploumen E.H.; Zocca P.; Doggen C.J.M.; Danse P.W.; Schotborgh
C.E.; Scholte M.; van Houwelingen K.G.; Stoel M.G.; Hartmann M.; Tjon Joe
Gin R.M.; Somi S.; Linssen G.C.M.; Kok M.M.; von Birgelen C.
Institution
(Buiten, Ploumen, Zocca, van Houwelingen, Stoel, Hartmann, Kok, von
Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum
Twente, Enschede, Netherlands
(Buiten, Ploumen, Zocca, Doggen, Kok, von Birgelen) Department of Health
Technology and Services Research, Faculty BMS, Technical Medical Centre,
University of Twente, Enschede, Netherlands
(Danse, Tjon Joe Gin) Department of Cardiology, Rijnstate Hospital,
Arnhem, Netherlands
(Schotborgh, Somi) Department of Cardiology, Haga Hospital, The Hague,
Netherlands
(Scholte) Department of Cardiology, Albert Schweitzer Hospital, Dordrecht,
Netherlands
(Linssen) Department of Cardiology, Hospital Group Twente, Almelo and
Hengelo, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to assess the 3-year safety and
efficacy of treating all-comer patients with 3 contemporary drug-eluting
stents (DES). Background(s): The BIO-RESORT (Comparison of
Biodegradable Polymer and Durable Polymer Drug-Eluting Stents in an All
Comers Population) (TWENTE III) randomized trial (NCT01674803) found
similar 1-year safety and efficacy for the 2 biodegradable-polymer DES
(i.e., ultrathin-strut cobalt-chromium Orsiro sirolimus-eluting stent
[SES] and very-thin-strut platinum-chromium Synergy everolimus-eluting
stent) compared with the durable-polymer thin-strut cobalt-chromium
Resolute Integrity zotarolimus-eluting stent (ZES). Two-year follow-up
suggested that the SES might reduce repeat revascularizations beyond 1
year compared with the ZES. Method(s): A total of 3,514 all-comer
patients were treated at 4 centers for coronary intervention. The main
clinical endpoint, target vessel failure, was a composite of safety
(cardiac death or target vessel-related myocardial infarction) and
efficacy (target vessel revascularization). Secondary endpoints included
the individual components of target vessel failure and stent thrombosis.
 Result(s): Three-year follow-up data were available for 3,393 of
3,514 patients (96.6%). Target vessel failure occurred in 8.5% with SES
and 10.0% with ZES (p<inf>log rank</inf> = 0.22) and in 8.8% with
everolimus-eluting stents (vs. ZES, p<inf>log rank</inf> = 0.32). Rates of
cardiac death, target vessel myocardial infarction, and target vessel
revascularization were similar between stent groups. Landmark analyses
found no statistically significant between-stent difference in repeat
revascularization between 1 and 3 years. Definite or probable stent
thrombosis rates were low (SES, 1.1%; everolimus-eluting stent, 1.1%; ZES,
0.9%) and similar with all 3 DES. Conclusion(s): Despite substantial
differences in stent backbone and polymer coating, all 3 DES showed
favorable 3-year safety and efficacy in all comers, without significant
between-stent differences. Further follow-up is required to definitely
answer the question of whether one stent might improve clinical outcomes
at a later stage. Copyright © 2019 American College of Cardiology
Foundation

<110>
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.

<111>
Accession Number
2002646088
Title
Cangrelor or Clopidogrel in Patients with Type 2 Diabetes Mellitus
Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of
Randomized Controlled Trials.
Source
Diabetes Therapy. 10 (3) (pp 937-950), 2019. Date of Publication: 01 Jun
2019.
Author
Lu H.; Guan W.; Zhou Y.; Tang Z.; Bao H.
Institution
(Lu, Guan) Jingzhou Central Hospital of Cardiology, The Second Clinical
Medical College, Yangtze University, Jingzhou, Hubei, China
(Zhou) Department of Hematology, Jingzhou First People's Hospital, The
First Affiliated Hospital of Yangtze University, Jingzhou, China
(Tang) Institute of Cardiovascular Disease, Xiangya Hospital, Central
South University, Changsha, Hunan, China
(Bao) Jiangling County People's Hospital of Cardiology, Jingzhou, Hubei,
China
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: With recent advances in interventional cardiology where
percutaneous coronary intervention (PCI) has become the most preferred
invasive strategy and with advances in adjunctive pharmacotherapy, several
newer oral P2Y<inf>12</inf> inhibitors have reached the market. In this
analysis, we aimed to compare the cardiovascular outcomes and bleeding
events which were associated with the use of cangrelor versus clopidogrel
in patients with type 2 diabetes mellitus (T2DM) 48 h after PCI.
 Method(s): The electronic databases MEDLINE (PubMed),
www.ClinicalTrials.gov, EMBASE, and Cochrane central were searched for
relevant publications comparing canagrelor with clopidogrel during PCI.
Patients with T2DM were extracted. Adverse cardiovascular outcomes and
bleeding events at 48 h follow-up were considered as the end points. This
meta-analysis was carried out with the latest RevMan software (5.30). Odds
ratios (OR) and 95% confidence intervals (CI) were used to represent the
data. Result(s): This analysis consisted of a total number of 5031
participants with T2DM (enrolled between the years 2006 and 2012).
Compared to clopidgrel, use of cangrelor in these patients with T2DM was
not associated with significantly different primary end point (OR 0.94,
95% CI 0.75-1.16; P = 0.55), myocardial infarction (OR 0.96, 95% CI
0.76-1.20; P = 0.71), all-cause death (OR 0.70, 95% CI 0.25-1.96; P =
0.49), ischemia-driven revascularization (OR 0.66, 95% CI 0.32-1.36; P =
0.26), and stent thrombosis (OR 0.45, 95% CI 0.17-1.17; P = 0.10).
Thrombolysis in myocardial infarction (TIMI)-defined major and minor
bleedings were similarly manifested: (OR 1.02, 95% CI 0.38-2.74; P = 0.96)
and (OR 1.39, 95% CI 0.70-2.79; P = 0.35), respectively. Global use of
strategies to open occluded arteries (GUSTO)-defined moderate and severe
bleeding were also not significantly different: (OR 1.36, 95% CI
0.70-2.67; P = 0.37) and (OR 1.21, 95% CI 0.41-3.59; P = 0.74),
respectively. However, GUSTO-defined mild bleeding and acute
catheterization and urgent intervention triage strategy (ACUITY)-defined
major and minor bleedings were significantly in favor of clopidogrel in
comparison to cangrelor in these patients with T2DM: (OR 1.28, 95% CI
1.09-1.50; P = 0.003), (OR 1.43, 95% CI 1.05-1.94; P = 0.02), and (OR
1.23, 95% CI 1.04-1.46; P = 0.02), respectively. Other bleeding outcomes
were not significantly different. Conclusion(s): In these patients
with T2DM, cangrelor was comparable to clopidogrel in terms of efficacy at
48 h following PCI. However, it was associated with significantly higher
mild GUSTO bleeding and major and minor ACUITY bleeding, therefore
requiring further workups on its safety side. This hypothesis should be
explored further and confirmed in other forthcoming trials based strictly
on patients with T2DM. Copyright © 2019, The Author(s).

<112>
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.

<113>
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.

<114>
Accession Number
2002111967
Title
Resistance Training Following Median Sternotomy: A Systematic Review and
Meta-Analysis.
Source
Heart Lung and Circulation. 28 (10) (pp 1549-1559), 2019. Date of
Publication: October 2019.
Author
Pengelly J.; Pengelly M.; Lin K.-Y.; Royse C.; Royse A.; Bryant A.;
Williams G.; El-Ansary D.
Institution
(Pengelly, El-Ansary) Department of Health Professions, Swinburne
University of Technology, Melbourne, Vic, Australia
(Pengelly) Independent Researcher, Melbourne, Vic, Australia
(Lin) Department of Physiotherapy, School of Primary and Allied Health
Care, Faculty of Medicine, Nursing and Health Science, Monash University,
Melbourne, Vic, Australia
(Royse, Royse, El-Ansary) Department of Surgery, University of Melbourne,
Melbourne, Vic, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, Vic, Australia
(Bryant, Williams) Department of Physiotherapy, University of Melbourne,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Objective: Despite no evidence to support weight limitations following
median sternotomy, sternal precautions continue to be routinely
prescribed. Moreover, international cardiac rehabilitation guidelines lack
sufficient detail for the implementation of resistance training. This
systematic review and meta-analysis aimed to determine what the literature
defines as resistance training; how resistance training is applied,
progressed and evaluated; and, whether resistance training improves
physical and functional recovery postoperatively in the cardiac surgical
population. Data Sources: Five (5) electronic databases were searched
from inception to 28 September 2018 for studies published in English that
investigated the effects of a resistance training intervention on physical
and functional recovery following median sternotomy. Result(s):
Eighteen (18) trials (n = 3,462) met eligibility criteria and were
included in the analysis. Seven (7) randomised controlled trials shared
common outcome measures, allowing meta-analysis. The performance of
resistance training appears to be safe and feasible, and resulted in
similar improvements in both cardiopulmonary capacity and anthropometry,
when compared to aerobic training alone. However, the definition and
application of resistance training is frequently a lower intensity and
volume than recommended by the American College of Sports Medicine.
Furthermore, sternal precautions are not reflective of the kinematics and
weights used when performing many activities of daily living. For this
reason, resistance training needs to be task-specific, reflecting
functional tasks to promote recovery. Conclusion(s): Resistance
training, in isolation or when combined with aerobic training, may lead to
greater improvements in physical and functional recovery following cardiac
surgery via median sternotomy; however, further research is required to
inform clinical guidelines. Copyright © 2019 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<115>
Accession Number
629190689
Title
Association of preoperative renin-angiotensin system inhibitors with
prevention of postoperative atrial fibrillation and adverse Events A
Systematic Review and Meta-analysis.
Source
JAMA Network Open. 2 (5) (no pagination), 2019. Article Number: e194934.
Date of Publication: May 2019.
Author
Chen S.; Acou W.-J.; Kiuchi M.G.; Meyer C.; Sommer P.; Martinek M.;
Schratter A.; Andrea B.R.; Ling Z.; Liu S.; Yin Y.; Hindricks G.;
Purerfellner H.; Krucoff M.W.; Schmidt B.; Julian Chun K.R.
Institution
(Chen, Schmidt, Julian Chun) Cardioangiologisches Centrum Bethanien,
Frankfurt Academy for Arrhythmias, Agaplesion Markus Krankenhaus,
Wilhelm-Epstein Strase 4, Frankfurt am Main 60431, Germany
(Acou) Department of Cardiology, AZ Delta, Roeselare, Belgium
(Kiuchi) School of Medicine, Royal Perth Hospital Unit, University of
Western Australia, Perth, Australia
(Meyer) Klinik fur Kardiologie mit Schwerpunkt Elektrophysiologie,
Universitares Herzzentrum Hamburg, Universitatsklinikum Hamburg-Eppendorf,
Hamburg, Germany
(Meyer) German Centre for Cardiovascular Research, Partner Site
Hamburg/Kiel, Lubeck, Germany
(Sommer) Klinik fur Elektrophysiologie/ Rhythmologie, Herz- und
Diabeteszentrum Nordrhein-Westfalen, Universitatsklinik der
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Sommer, Hindricks) Abteilung der Elektrophysiologie, Herzzentrum
Universitat Leipzig, Leipzig, Germany
(Martinek, Purerfellner) Abteilung der Kardiologie, Akademisches
Lehrkrankenhaus der Elisabethinen, Ordensklinikum Linz Elisabethinen,
Linz, Austria
(Schratter) Medizinische Abteilung mit Kardiologie, Krankenhaus Hietzing
Wien, Vienna, Austria
(Andrea) Department of Cardiology, Sul Fluminense University Hospital,
Vassouras, Brazil
(Ling, Yin) Department of Cardiology, Second Affiliated Hospital,
Chongqing Medical University, Chongqing, China
(Liu) Shanghai General Hospital, Shanghai Jiao Tong University, School of
Medicine, Shanghai, China
(Krucoff) Department of Medicine and Cardiology, Duke University Medical
Center, Duke Clinical Research Institute, Durham, NC, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Postoperative atrial fibrillation (POAF) is a well-known
complication after cardiac surgery. Renin-angiotensin system inhibitors
(RASIs) have been suggested as an upstream therapy for selected patients
with AF; however, evidence in the surgical setting is limited. OBJECTIVE
To evaluate the role of preoperative RASIs in prevention of POAF and
adverse events for patients undergoing cardiac surgery. DATA SOURCES The
PubMed database and the Cochrane Library from inception until December 31,
2018, were searched by using the keywords renin-angiotensin system
inhibitors OR angiotensinconverting enzyme inhibitors OR angiotensin
receptor blocker OR aldosterone antagonist AND cardiac surgery.
ClinicalTrials.gov was searched from inception until December 31, 2018, by
using the keywords postoperative atrial fibrillation. STUDY SELECTION
Randomized clinical trials (RCTs) and observational studies comparing the
association between preoperative RASI treatment vs no preoperative RASI
treatment (control group) and the incidence of POAF were identified.
Eleven unique studiesmet the selection criteria. DATA EXTRACTION AND
SYNTHESIS Pooled analysis was performed using a random-effects model.
Sensitivity and subgroup analyses of RCTs were performed to test the
stability of the overall effect. Metaregression was conducted to explore
potential risk of bias. MAIN OUTCOMES AND MEASURES The primary outcome was
POAF, and the secondary outcomes included rates of stroke and mortality
and duration of hospitalization. RESULTS Eleven unique studies involving
27 885 unique patients (74.4%male; median age, 65 years [range, 58.5-74.5
years]) were included. Compared with the control group, the RASI group did
not have a significantly reduced risk of POAF (odds ratio [OR], 1.04;
95%CI, 0.91-1.19; P = .55; z = 0.60), stroke (OR, 0.86; 95%CI, 0.62-1.19;
P = .37; z = 0.90; without significant heterogeneity, P = .11), death (OR,
1.07; 95%CI, 0.85-1.35; P = .56; z = 0.59; without significant
heterogeneity, P = .12), composite adverse cardiac events (OR, 1.04;
95%CI, 0.91-1.18; P = .58; z = 0.56), or a reduced hospital stay (weighted
mean difference, -0.04; 95%CI, -1.05 to 0.98; P = .94; z = 0.07) using a
random-effects model. Pooled analysis focusing on RCTs showed consistent
results. The primary overall effect was maintained in sensitivity and
subgroup analyses. Metaregression showed that male sex was significantly
associated with POAF (tau2 = 0.0065; z = 3.47; Q = 12.047; P <
.001) and that use of beta-blockers was associated with a significantly
reduced risk in developing POAF (tau2 = 0.018; z = -2.24; Q =
5.0091; P = .03). CONCLUSIONS AND RELEVANCE The findings from this study
suggest that preoperative RASI treatment does not offer additional benefit
in reducing the risk of POAF, stroke, death, and hospitalization in the
setting of cardiac surgery. The results provide no support for
conventional use of RASIs for the possible prevention of POAF and adverse
events in patients undergoing cardiac surgery; further randomized data,
particularly among those patients with heart failure, are
needed. Copyright © 2019 JAMA Network Open.All right reserved.

<116>
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

<117>
Accession Number
2002547974
Title
Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter
Aortic Valve Replacement in Patients With Atrial Fibrillation.
Source
JACC: Cardiovascular Interventions. 12 (16) (pp 1580-1589), 2019. Date of
Publication: 26 August 2019.
Author
Kosmidou I.; Liu Y.; Alu M.C.; Liu M.; Madhavan M.; Chakravarty T.; Makkar
R.; Thourani V.H.; Biviano A.; Kodali S.; Leon M.B.
Institution
(Kosmidou, Liu, Liu, Madhavan, Kodali, Leon) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Kosmidou, Alu, Madhavan, Biviano, Kodali, Leon) Department of Medicine,
NewYork-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Chakravarty, Makkar) Department of Medicine, Cedars-Sinai Medical Center,
Los Angeles, CA, United States
(Thourani) Department of Cardiac Surgery, Medstar Heart and Vascular
Institute/Georgetown University, Washington, DC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The study sought to determine the patterns of antithrombotic
therapy and association with clinical outcomes in patients with atrial
fibrillation (AF) and CHA<inf>2</inf>DS<inf>2</inf>-VASc (congestive heart
failure, hypertension, age >=75 years, diabetes mellitus, prior stroke or
transient ischemic attack or thromboembolism, vascular disease, age 65-74
years, sex category) score >=2 following transcatheter aortic valve
replacement (TAVR). Background(s): The impact of antithrombotic
regimens on clinical outcomes in patients with AF and severe aortic
stenosis treated with TAVR is unknown. Method(s): In the randomized
PARTNER II (Placement of Aortic Transcatheter Valve II) trial and
associated registries, 1,621 patients with prior AF and
CHA<inf>2</inf>DS<inf>2</inf>-VASc score >=2 comprised the study cohort.
Outcomes were analyzed according to antithrombotic therapy.
 Result(s): During the 5-year enrollment period, 933 (57.6%) patients
were discharged on oral anticoagulant therapy (OAC). Uninterrupted
antiplatelet therapy (APT) for at least 6 months or until an endpoint
event was used in 544 of 933 (58.3%) of patients on OAC and 77.5% of
patients not on OAC. At 2 years, patients on OAC had a similar rate of
stroke (6.6% vs. 5.6%; p = 0.53) and the composite outcome of death or
stroke (29.7% vs. 31.8%; p = 0.33), compared with no OAC. OAC with APT was
associated with a reduced rate of stroke (5.4% vs. 11.1%; p = 0.03) and
death or stroke (29.7% vs. 40.1%; p = 0.01), compared with no OAC or APT.
Following adjustment, OAC with APT and APT alone were both associated with
reduced rates of stroke compared with no OAC or APT (hazard ratio for
OAC+APT: 0.43, 95% confidence interval: 0.22 to 0.85; p = 0.015; hazard
ratio for APT alone: 0.32, 95% confidence interval: 0.16 to 0.65; p =
0.002), while OAC alone was not. Conclusion(s): Among patients with
prior AF undergoing TAVR, antiplatelet with or without anticoagulant
therapy was associated with a reduced risk of stroke at 2 years,
implicating multifactorial stroke mechanisms in this
population. Copyright © 2019 American College of Cardiology
Foundation

<118>
Accession Number
2002582943
Title
A systematic review and meta-analysis of risk factors for and incidence of
30-day readmission after revascularization for peripheral artery disease.
Source
Journal of Vascular Surgery. 70 (3) (pp 996-1006.e7), 2019. Date of
Publication: September 2019.
Author
Smith S.L.; Matthews E.O.; Moxon J.V.; Golledge J.
Institution
(Smith, Moxon, Golledge) Queensland Research Centre for Peripheral
Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Australia
(Matthews, Golledge) Department of Vascular and Endovascular Surgery, The
Townsville Hospital, Townsville, Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Readmission to the hospital after revascularization for
peripheral artery disease (PAD) is frequently reported. No consensus
exists as to the exact frequency and risk factors for readmission. This
review aimed to determine the incidence of and risk factors for 30-day
readmission after revascularization for PAD. Method(s):
PubMed/Medline (Ovid), Scopus, Web of Science, the Cochrane Library, and
CINAHL were searched systematically from inception until May 20, 2018.
Studies were eligible for inclusion if they included patients with
diagnosed PAD undergoing revascularization and reported the readmission
rate and a statistical evaluation of the association of at least one risk
factor with readmission. Studies were excluded if data for other
procedures could not be distinguished from revascularization. Two authors
undertook study selection independently with the final inclusion decision
resolved through consensus. The PRISMA and Meta-analyses of Observational
Studies in Epidemiology guidelines were followed regarding data extraction
and quality assessment, which was performed by two authors independently.
Data were pooled using a random effects model. Result(s): The primary
outcome was readmission within 30 days of revascularization. Fourteen
publications reporting the outcomes of 526,008 patients were included.
Reported readmission rates ranged from 10.9% to 30.0% with a mean of 16.4%
(95% confidence interval [CI], 15.1%-17.9%). Meta-analyses suggested the
following risk factors had a significant association with readmission:
female sex (odds ratio [OR], 1.13; 95% CI, 1.05-1.21), black race (OR,
1.36; 95% CI, 1.28-1.46), dependent functional status (OR, 1.72; 95% CI,
1.43-2.06), critical limb ischemia (OR, 2.12; 95% CI, 1.72-2.62),
emergency admission (OR, 1.75; 95% CI, 1.43-2.15), hypertension (OR, 1.39;
95% CI, 1.26-1.54), heart failure (OR, 1.82; 95% CI, 1.50-2.20), chronic
pulmonary disease (OR, 1.19; 95% CI, 1.08-1.32), diabetes (OR, 1.47; 95%
CI, 1.32-1.63), chronic kidney disease (OR, 1.93; 95% CI, 1.62-2.31),
dialysis dependence (OR, 2.08; 95% CI, 1.75-2.48), smoking (OR, 0.83; 95%
CI, 0.78-0.89), postoperative bleeding (OR, 1.70; 95% CI, 1.23-2.35), and
postoperative sepsis (OR, 4.13; 95% CI, 2.02-8.47). Conclusion(s):
Approximately one in six patients undergoing revascularization for PAD are
readmitted within 30 days of their procedure. This review identified
multiple risk factors predisposing to readmission, which could potentially
serve as a way to target interventions to reduce
readmissions. Copyright © 2019

<119>
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

<120>
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.

<121>
Accession Number
2000733772
Title
Complete Revascularization During Primary Percutaneous Coronary
Intervention Reduces Death and Myocardial Infarction in Patients With
Multivessel Disease: Meta-Analysis and Meta-Regression of Randomized
Trials.
Source
JACC: Cardiovascular Interventions. 11 (9) (pp 833-843), 2018. Date of
Publication: 14 May 2018.
Author
Pasceri V.; Patti G.; Pelliccia F.; Gaudio C.; Speciale G.; Mehran R.;
Dangas G.D.
Institution
(Pasceri, Speciale) San Filippo Neri Hospital, Rome, Italy
(Pasceri, Pelliccia, Gaudio, Speciale) La Sapienza University, Rome, Italy
(Patti) Campus Bio-Medico University, Rome, Italy
(Mehran, Dangas) Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, New York, United States
(Mehran, Dangas) Cardiovascular Research Foundation, New York, New York,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to compare complete
revascularization with a culprit-only strategy in patients presenting with
ST-segment elevation myocardial infarction (MI) and multivessel disease by
a meta-analysis of randomized trials. Background(s): Although several
trials have compared complete with culprit-only revascularization in
ST-segment elevation MI, it remains unclear whether complete
revascularization may lead to improvement in hard endpoints (death and
MI). Method(s): Randomized trials comparing complete
revascularization with culprit-only revascularization in patients with
ST-segment elevation MI without cardiogenic shock were identified by a
systematic search of published research. Random-effects meta-analysis was
performed, comparing clinical outcomes in the 2 groups. Result(s):
Eleven trials were identified, including a total of 3,561 patients.
Compared with a culprit-only strategy, complete revascularization
significantly reduced risk for death or MI (relative risk [RR]: 0.76; 95%
confidence interval [CI]: 0.58 to 0.99; p = 0.04). Meta-regression showed
that performing complete revascularization at the time of primary
percutaneous coronary intervention (PCI) was associated with better
outcomes (p = 0.016). The 6 trials performing complete revascularization
during primary PCI (immediate revascularization) were associated with a
significant reduction in risk for both total mortality (RR: 0.62; 95% CI:
0.39 to 0.97; p = 0.03) and MI (RR: 0.40; 95% CI: 0.25 to 0.66; p <
0.001), whereas the 5 trials performing only staged revascularization did
not show any significant benefit in either total mortality (RR: 1.02; 95%
CI: 0.65 to 1.62; p = 0.87) or MI (RR: 1.04; 95% CI: 0.48 to 1.68; p =
0.86). Conclusion(s): When feasible, complete revascularization with
PCI can significantly reduce the combined endpoint of death and MI.
Complete revascularization performed during primary PCI was also
associated with significant reductions in both total mortality and MI,
whereas staged revascularization did not improve these
outcomes. Copyright © 2018 American College of Cardiology
Foundation

<122>
Accession Number
618265935
Title
A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health
Device Assessments in Modern Structural Heart Disease Clinics.
Source
JACC: Cardiovascular Imaging. 11 (4) (pp 546-557), 2018. Date of
Publication: April 2018.
Author
Bhavnani S.P.; Bhavnani S.; Adams D.; Sengupta P.P.; Ryan T.; Narula J.;
Thomas J.; Lang R.; Pellikka P.; Choudhary V.; Iyer V.R.; Dash P.K.;
Barooah B.; Sola S.; Varyani R.; Lingan A.; Murugan V.; Kini P.;
Venkateshvaran A.; Srinivas N.; Barooah A.C.; Subbarao G.V.R.; Shivakumar
C.; Subramaniyan M.; Sengupta S.P.; Bansal M.; Rahaman A.; Patil V.N.;
Kumar N.R.; Gahlot M.Y.; Damani I.M.; Gulati R.; Joshi S.S.; Dubey S.;
Krupa J.; Irfan S.; Vidhyakar R.B.; Bidarkar N.; Shantesh B.K.; Chavan
S.S.; Chandramohan R.; Kumar V.; Tirkey S.; Prasad G.; Lakshmana S.S.;
Malkar R.M.; Manjunath V.; Kumar Reddy K.; Ramesha L.G.; Kumbhalkar S.;
Thadlani J.A.; Basha T.M.N.; Hafeez S.A.; Leelavathi V.; Mathews R.;
Daubert M.; Cleve J.; Burdulis E.; Fauss N.; Lammertin G.; Patel B.;
Petrovets E.; Shah D.; Thurmond K.; Tomberlin D.; Umamaheswar H.; Kadakia
A.
Institution
(Bhavnani) Scripps Clinic and Research Foundation, San Diego, California,
United States
(Sola, Venkateshvaran, Dash) Sri Sathya Sai Institute of Higher Medical
Sciences, Whitefield, Bangalore, India
(Adams) Duke University School of Medicine, Durham, North Carolina, United
States
(Sengupta) West Virginia University Heart and Vascular Institute at West
Virginia University School of Medicine, Morgantown, West Virginia, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to determine whether mobile health (mHealth)
device assessments used as clinical decision support tools at the
point-of-care can reduce the time to treatment and improve long-term
outcomes among patients with rheumatic and structural heart diseases
(SHD). Background(s): Newly developed smartphone-connected mHealth
devices represent promising methods to diagnose common diseases in
resource-limited areas; however, the impact of technology-based care on
long-term outcomes has not been rigorously evaluated. Method(s): A
total of 253 patients with SHD were randomized to an initial diagnostic
assessment with wireless devices in mHealth clinics (n = 139) or to
standard-care (n = 114) in India. mHealth clinics were equipped with
point-of-care devices including pocket-echocardiography,
smartphone-connected-electrocardiogram blood pressure and oxygen
measurements, activity monitoring, and portable brain natriuretic peptide
laboratory testing. All individuals underwent comprehensive transthoracic
echocardiography to assess the severity of SHD. The primary endpoint was
the time to referral for therapy with percutaneous valvuloplasty or
surgical valve replacement. Secondary endpoints included the probability
of a cardiovascular hospitalization and/or death over 1 year.
 Result(s): An initial mHealth assessment was associated with a
shorter time to referral for valvuloplasty and/or valve replacement (83
+/- 79 days vs. 180 +/- 101 days; p <0.001) and was associated with an
increased probability for valvuloplasty/valve replacement compared to
standard-care (34% vs. 32%; adjusted hazard ratio: 1.54; 95% CI: 0.96 to
2.47; p = 0.07). Patients randomized to mHealth were associated with a
lower risk of a hospitalization and/or death on follow-up (15% vs. 28%,
adjusted hazard ratio: 0.41; 95% CI: 0.21 to 0.83; p = 0.013).
 Conclusion(s): An initial mHealth diagnostic strategy was associated
with a shorter time to definitive therapy among patients with SHD in a
resource-limited area and was associated with improved outcomes. (A
Randomized Trial of Pocket-Echocardiography Integrated Mobile Health
Device Assessments in Modern Structural Heart Disease Clinics;
NCT02881398) Copyright © 2018 American College of Cardiology
Foundation

<123>
Accession Number
2000887106
Title
Outcomes After Coronary Stenting or Bypass Surgery for Men and Women With
Unprotected Left Main Disease: The EXCEL Trial.
Source
JACC: Cardiovascular Interventions. 11 (13) (pp 1234-1243), 2018. Date of
Publication: 9 July 2018.
Author
Serruys P.W.; Cavalcante R.; Collet C.; Kappetein A.P.; Sabik J.F.;
Banning A.P.; Taggart D.P.; Sabate M.; Pomar J.; Boonstra P.W.; Lembo
N.J.; Onuma Y.; Simonton C.A.; Morice M.-C.; McAndrew T.; Dressler O.;
Stone G.W.
Institution
(Serruys) Imperial College London, London, United Kingdom
(Cavalcante, Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Collet) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Collet) Department of Cardiology, Universitair Ziekenhuis Brussel,
Brussels, Belgium
(Sabik) The Cleveland Clinic Foundation, Cleveland, Ohio, United States
(Banning, Taggart) Oxford University Hospitals, Oxford, United Kingdom
(Sabate, Pomar) Hospital Clinico y Provincial de Barcelona, Barcelona,
Spain
(Boonstra) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Lembo) Piedmont Hospital Atlanta, Atlanta, Georgia
(Onuma) Cardialysis BV, Rotterdam, Netherlands
(Simonton) Abbott Vascular, Santa Clara, California, United States
(Morice) Ramsay Generale de Sante, Hopital Prive Jacques Cartier, Massy,
France
(McAndrew, Dressler, Stone) New York Presbyterian Hospital, Columbia
University Medical Center, the Cardiovascular Research Foundation, New
York, New York, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of the present study was to assess outcomes after
coronary artery bypass grafting surgery (CABG) and percutaneous coronary
intervention (PCI) according to sex in a large randomized trial of
patients with unprotected left main disease. Background(s): In the
SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and
Cardiac Surgery) trial, sex had a significant interaction effect with
revascularization strategy, and women had an overall higher mortality when
treated with PCI than CABG. Method(s): The EXCEL (Evaluation of
XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left
Main Revascularization) trial was a multinational randomized trial that
compared PCI with everolimus-eluting stents and CABG in patients with
unprotected left main disease. The primary endpoint was the composite of
all-cause death, myocardial infarction, or stroke at 3 years.
 Result(s): Of 1,905 patients randomized, 1,464 (76.9%) were men and
441 (23.1%) were women. Compared with men, women were older; had higher
prevalence rates of hypertension, hyperlipidemia, and diabetes; and were
less commonly smokers but had lower coronary anatomic burden and
complexity (mean SYNTAX score 24.2 vs. 27.2, p < 0.001). By multivariate
analysis, sex was not independently associated with either the primary
endpoint (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 0.82 to
1.48; p = 0.53) or all-cause death (HR: 1.39; 95% CI: 0.92 to 2.10; p =
0.12) at 3 years. At 30 days, all-cause death, myocardial infarction, or
stroke had occurred in 8.9% of woman treated with PCI, 6.2% of women
treated with CABG, 3.6% of men treated with PCI, and 8.4% of men treated
with CABG (p for interaction = 0.003). The 3-year rate of the composite
primary endpoint was 19.7% in women treated with PCI, 14.6% in women
treated with CABG, 13.8% in men treated with PCI, and 14.7% in men treated
with CABG (p for interaction = 0.06). These differences were driven by
higher periprocedural rates of myocardial infarction in women after PCI
and in men after CABG. Conclusion(s): In patients with unprotected
left main disease in the EXCEL trial, sex was not an independent predictor
of adverse outcomes after revascularization. However, women undergoing PCI
had a trend toward worse outcomes, a finding related to associated
comorbidities and increased periprocedural complications. Further studies
are required to determine the optimal revascularization modality in women
with complex coronary artery disease. Copyright © 2018 American
College of Cardiology Foundation

<124>
Accession Number
619130547
Title
The Effect of a 2-Year Intervention Consisting of Diet, Physical Exercise,
Cognitive Training, and Monitoring of Vascular Risk on Chronic
Morbidity-the FINGER Randomized Controlled Trial.
Source
Journal of the American Medical Directors Association. 19 (4) (pp
355-360.e1), 2018. Date of Publication: April 2018.
Author
Marengoni A.; Rizzuto D.; Fratiglioni L.; Antikainen R.; Laatikainen T.;
Lehtisalo J.; Peltonen M.; Soininen H.; Strandberg T.; Tuomilehto J.;
Kivipelto M.; Ngandu T.
Institution
(Marengoni) Department of Clinical and Experimental Sciences, University
of Brescia, Brescia, Italy
(Marengoni, Rizzuto, Fratiglioni, Kivipelto) Aging Research Center,
Department of Neurobiology, Care Sciences and Society, Karolinska
Institutet, Stockholm University, Stockholm, Sweden
(Fratiglioni) Stockholm Gerontology Research Center, Stockholm, Sweden
(Antikainen, Strandberg) Center for Life Course Health
Research/Geriatrics, University of Oulu, Oulu, Finland
(Antikainen, Strandberg) Medical Research Center Oulu, Oulu University
Hospital, Oulu, Finland
(Antikainen) Oulu City Hospital, Oulu, Finland
(Laatikainen, Lehtisalo, Peltonen, Tuomilehto, Kivipelto, Ngandu)
Department of Public Health Solutions, Chronic Disease Prevention Unit,
National Institute for Health and Welfare, Helsinki, Finland
(Laatikainen) Institute of Public Health and Clinical Nutrition,
University of Eastern Finland, Kuopio, Finland
(Laatikainen) Joint municipal authority for North Karelia social and
health services, Joensuu, Finland
(Lehtisalo, Tuomilehto) Department of Public Health, University of
Helsinki, Helsinki, Finland
(Soininen, Kivipelto) Institute of Clinical Medicine/Neurology, University
of Eastern Finland, Kuopio, Finland
(Strandberg) University of Helsinki, Helsinki University Hospital,
Helsinki, Finland
(Tuomilehto) South Ostrobothnia Central Hospital, Seinajoki, Finland
(Tuomilehto) Dasman Diabetes Institute, Dasman, Kuwait
(Tuomilehto) Diabetes Research Group, King Abdulaziz University, Jeddah,
Saudi Arabia
(Kivipelto, Ngandu) Division of Clinical Geriatrics, Center for Alzheimer
Research, Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet, Stockholm, Sweden
(Kivipelto) Stockholms Sjukhem, Research & Development unit, Stockholm,
Sweden
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To verify whether a multidomain intervention lowers the risk of
developing new chronic diseases in older adults. Method(s):
Multicenter, double-blind randomized controlled trial started in October
2009, with 2-year follow-up. A total of 1260 people aged 60 to 77 years
were enrolled in the Finnish Geriatric Intervention Study to Prevent
Cognitive Impairment and Disability (FINGER). Participants were randomly
assigned in a 1:1 ratio to a 2-year multidomain intervention (n = 631)
(nutritional guidance, exercise, cognitive training, and management of
metabolic and vascular risk factors) or a control group (n = 629) (general
health advice). Data on most common chronic diseases were collected by a
physician at baseline and 2 years later. Result(s): At 2-year
follow-up, the average number of new chronic diseases was 0.47 [standard
deviation (SD) 0.7] in the intervention group and 0.58 (SD 0.8) in the
control group (P <.01). The incidence rate per 100 person-years for
developing 1+ new disease(s) was 17.4 [95% confidence interval (CI) =
15.1-20.1] in the intervention group and 20.5 (95% CI = 18.0-23.4) in the
control group; for developing 2+ new diseases, 4.9 (95% CI = 3.7-6.4) and
6.1 (95% CI = 4.8-7.8); and for 3+ new diseases, 0.7 (95% CI = 0.4-1.5)
and 1.8 (95% CI = 1.1-2.8), respectively. After adjustment for age, sex,
education, current smoking, alcohol intake, and the number of chronic
diseases at baseline, the intervention group had a hazard ratio ranging
from 0.80 (0.66-0.98) for developing 1+ new chronic disease(s) to 0.38
(0.16-0.88) for developing 3+ new chronic diseases compared to the control
group. Conclusion(s): Findings from this randomized controlled trial
suggest that a multidomain intervention could reduce the risk of
developing new chronic diseases in older people. Copyright © 2017
AMDA - The Society for Post-Acute and Long-Term Care Medicine

<125>
Accession Number
2000644989
Title
Hybrid Coronary Revascularization in Selected Patients With Multivessel
Disease: 5-Year Clinical Outcomes of the Prospective Randomized Pilot
Study.
Source
JACC: Cardiovascular Interventions. 11 (9) (pp 847-852), 2018. Date of
Publication: 14 May 2018.
Author
Tajstra M.; Hrapkowicz T.; Hawranek M.; Filipiak K.; Gierlotka M.; Zembala
M.; Gasior M.; Zembala M.O.
Institution
(Tajstra, Hawranek, Gierlotka, Gasior) 3rd Chair and Department of
Cardiology, SMDZ in Zabrze, Silesian Center for Heart Diseases, Medical
University of Silesia, Katowice, Poland
(Hrapkowicz, Filipiak, Zembala, Zembala) Department of Cardiac, Vascular
and Endovascular Surgery and Transplantology, Silesian Center for Heart
Diseases, Medical University of Silesia, Zabrze, Poland
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study aimed to investigate the 5-year clinical follow-up
of the HYBRID (Hybrid Revascularization for Multivessel Coronary Artery
Disease) trial. Background(s): The HYBRID trial, the only randomized
study involving thorough analysis of outcome after the 2 procedures,
suggested that hybrid coronary revascularization (HCR) is feasible in
selected patients with multivessel coronary disease referred for
conventional coronary artery bypass grafting (CABG). There are currently
no long-term outcome data from randomized trials in this setting.
 Method(s): A total of 200 patients with multivessel coronary disease
referred for conventional surgical revascularization were randomly
assigned to undergo HCR or CABG. The primary endpoint was the occurrence
of all-cause mortality at 5 years. Result(s): Nine patients (4 in HCR
and 5 in CABG group) were lost to the 5-year follow-up. Finally, 191
patients (94 in HCR and 97 in CABG group) formed the basis of this study.
The groups were well balanced in terms of pre-procedural characteristics.
All-cause mortality at 5-year follow-up was similar in the 2 groups (6.4%
for HCR vs. 9.2% for CABG; p = 0.69). The rates of myocardial infarction
(4.3% vs. 7.2%; p = 0.30), repeat revascularization (37.2% vs. 45.4%; p =
0.38), stroke (2.1% vs. 4.1%; p = 0.35), and major adverse cardiac and
cerebrovascular events (45.2% vs. 53.4%; p = 0.39) were also similar in
the 2 groups. Conclusion(s): HCR has similar 5-year all-cause
mortality when compared with conventional coronary bypass grafting (Safety
and Efficacy Study of Hybrid Revascularization in Multivessel Coronary
Artery Disease; NCT01035567) Copyright © 2018 American College of
Cardiology Foundation

<126>
Accession Number
52220173
Title
Design and rationale of the MR-INFORM study: Stress perfusion
cardiovascular magnetic resonance imaging to guide the management of
patients with stable coronary artery disease.
Source
Journal of Cardiovascular Magnetic Resonance. 14 (1) (no pagination),
2012. Article Number: 65. Date of Publication: 2012.
Author
Hussain S.T.; Paul M.; Plein S.; McCann G.P.; Shah A.M.; Marber M.S.;
Chiribiri A.; Morton G.; Redwood S.; MacCarthy P.; Schuster A.; Ishida M.;
Westwood M.A.; Perera D.; Nagel E.
Institution
(Hussain, Paul, Shah, Marber, Chiribiri, Morton, Redwood, MacCarthy,
Schuster, Ishida, Perera, Nagel) Joint Imaging and Cardiovascular
Division, National Institute for Health Research (NIHR), St. Thomas'
Hospital, Lambeth Wing, London SE1 7EH, United Kingdom
(Plein) Multidisciplinary Cardiovascular Research Centre, Leeds Institute
of Genetics Health and Therapeutics, University of Leeds, Leeds, United
Kingdom
(McCann) NIHR Leicester Cardiovascular Biomedical Research Unit,
Leicester, United Kingdom
(Westwood) London Chest Hospital, London, United Kingdom
(Schuster) Department of Cardiology and Pneumology and Heart Research
Center, Georg-August-University, Gottingen, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In patients with stable coronary artery disease (CAD),
decisions regarding revascularisation are primarily driven by the severity
and extent of coronary luminal stenoses as determined by invasive coronary
angiography. More recently, revascularisation decisions based on invasive
fractional flow reserve (FFR) have shown improved event free survival.
Cardiovascular magnetic resonance (CMR) perfusion imaging has been shown
to be non-inferior to nuclear perfusion imaging in a multi-centre setting
and superior in a single centre trial. In addition, it is similar to
invasively determined FFR and therefore has the potential to become the
non-invasive test of choice to determine need for revascularisation. Trial
design. The MR-INFORM study is a prospective, multi-centre, randomised
controlled non-inferiority, outcome trial. The objective is to compare the
efficacy of two investigative strategies for the management of patients
with suspected CAD. Patients presenting with stable angina are randomised
into two groups: 1) The FFR-INFORMED group has subsequent management
decisions guided by coronary angiography and fractional flow reserve
measurements. 2) The MR-INFORMED group has decisions guided by stress
perfusion CMR. The primary end-point will be the occurrence of major
adverse cardiac events (death, myocardial infarction and repeat
revascularisation) at one year. Clinical trials.gov identifier
NCT01236807. Conclusion(s): MR INFORM will assess whether an initial
strategy of CMR perfusion is non-inferior to invasive angiography
supplemented by FFR measurements to guide the management of patients with
stable coronary artery disease. Non-inferiority of CMR perfusion imaging
to the current invasive reference standard (FFR) would establish CMR
perfusion imaging as an attractive non-invasive alternative to current
diagnostic pathways. © 2012 Hussain et al.; licensee BioMed Central
Ltd.

<127>
Accession Number
628227010
Title
Utility of preoperative exercise therapy in reducing postoperative
morbidity after surgery; a clinical overview of current evidence.
Source
Expert Review of Cardiovascular Therapy. 17 (6) (pp 395-412), 2019. Date
of Publication: 03 Jun 2019.
Author
Topal B.; Smelt H.J.M.; Van Helden E.V.; Celik A.; Verseveld M.; Smeenk
F.; Pouwels S.
Institution
(Topal) Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Smelt) Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
(Van Helden, Verseveld, Pouwels) Department of Surgery, Franciscus
Gasthuis & Vlietland, Rotterdam/Schiedam, Netherlands
(Celik) Department of Metabolic Surgery, Metabolic Surgery Clinic, Sisli,
Istanbul, Turkey
(Smeenk) Department of Respiratory Medicine, Catharina Hospital,
Eindhoven, Netherlands
(Smeenk) SHE School of Health Professions Education, Maastricht
University, Maastricht, Netherlands
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Surgery is a major stressor especially for older patients
that are prone for postoperative complications and mortality.
Hospitalization due to surgery and illness can be major life events, and
the age-related impairments in physiological function and the decreased
ability to respond to metabolic and hormonal perturbations in response to
surgery often lead to a longer convalescence. Areas covered: This article
gives an overview of the effects of PET in various surgical fields and
also what to account for and expect of PET after various types of surgery.
A comprehensive literature search was performed in Pubmed, Embase,
Medline, Cochrane Library, and PEDro database (from the earliest date of
each database to March 2019) using search words 'Preoperative Exercise
Therapy', 'Physical Therapy' and 'surgery'. Secondly, the literature
searches were modified depending on the surgical specialty. Expert
opinion: Evidence is growing that preoperative exercise therapy in various
surgical specialties is well tolerated and effective, with by far the most
evidence in the cardiac surgical field. Future improvements in standards
of care and optimal pre-operative preparation should not only focus on the
surgical team and the hospital organization but also on incorporating the
active role of the patient. Copyright © 2019, © 2019 Informa
UK Limited, trading as Taylor & Francis Group.

<128>
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.

<129>
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).

<130>
[Use Link to view the full text]
Accession Number
628563159
Title
Unselected use of ultrathin strut biodegradable polymer sirolimus-eluting
stent versus durable polymer everolimus-eluting stent for coronary
revascularization.
Source
Circulation: Cardiovascular Interventions. 11 (9) (no pagination), 2018.
Article Number: e006741. Date of Publication: 2018.
Author
Yamaji K.; Zanchin T.; Zanchin C.; Stortecky S.; Koskinas K.C.; Hunziker
L.; Praz F.; Blochlinger S.; Moro C.; Moschovitis A.; Seiler C.;
Valgimigli M.; Billinger M.; Pilgrim T.; Heg D.; Windecker S.; Raber L.
Institution
(Yamaji, Zanchin, Zanchin, Stortecky, Koskinas, Hunziker, Praz,
Blochlinger, Moro, Moschovitis, Seiler, Valgimigli, Billinger, Pilgrim,
Windecker, Raber) Swiss Cardiovascular Center Bern, Department of
Cardiology, Bern University Hospital, Bern 3010, Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, University of Bern, Switzerland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Biodegradable polymer sirolimus-eluting stents (BP-SESs) have
been reported to be noninferior compared with durable polymer
everolimus-eluting stents (DP-EES) in a randomized clinical trial. We
sought to compare the efficacy and safety of an ultrathin strut BP-SES
with a DP-EES in an all-comers population. METHODS AND RESULTS: Among 7640
consecutive patients who underwent percutaneous coronary intervention
between March 2011 and June 2015, 4638 patients were exclusively treated
with BP-SES (N=1896; 3137 lesions) or DP-EES (N=2742; 4468 lesions). After
propensity score matching within strata of clinical indications, the final
study population consisted of 2902 matched patients (BP-SES 2406 lesions
and DP-EES 2368 lesions). The primary device-oriented composite end point
(DOCE) included cardiac death, target vessel myocardial infarction, and
target lesion revascularization at 1 year. BP-SES (6.9%) was noninferior
to DP-EES (8.0%) with respect to device-oriented composite end point
(hazard ratio [HR], 0.85; 95% CI, 0.65-1.11; P for noninferiority <0.001;
P for superiority=0.24). No differences in cardiac death (BP-SES, 2.3%
versus DP-EES, 3.0%; HR, 0.76; 95% CI, 0.49-1.20; P=0.25), myocardial
infarction (BP-SES, 4.6% versus DP-EES, 4.6%; HR, 1.00; 95% CI, 0.71-1.40;
P=0.99), or target lesion revascularization (BP-SES, 2.8% versus DP-EES,
2.5%; HR, 1.11; 95% CI, 0.71-1.74; P=0.65) were observed. The rate of
periprocedural myocardial infarction was comparable between the 2 groups
(2.1% versus 2.2%; HR, 0.97; 95% CI, 0.59-1.58; P=0.89). The rate of
definite stent thrombosis was similarly low throughout 1 year (BP-SES,
0.8% versus DP-EES, 0.8%; HR, 1.00; 95% CI, 0.45-2.22; P=1.00).
 CONCLUSION(S): In a consecutively enrolled percutaneous coronary
intervention population reflecting routine clinical practice, BP-SES was
noninferior to DP-EES for device-oriented composite end point at 1
year. Copyright © 2018 American Heart Association, Inc.

<131>
[Use Link to view the full text]
Accession Number
628563131
Title
Benefit and risk of prolonged DAPT after coronary stenting in women:
Results from the DAPT study.
Source
Circulation: Cardiovascular Interventions. 11 (8) (no pagination), 2018.
Article Number: e005308. Date of Publication: 2018.
Author
Berry N.C.; Kereiakes D.J.; Yeh R.W.; Gabriel Steg P.; Cutlip D.E.; Jacobs
A.K.; Dawn Abbott J.; Hsieh W.-H.; Massaro J.M.; Mauri L.
Institution
(Berry, Mauri) Division of Cardiovascular Medicine, Department of
Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St,
Boston, MA 02115, United States
(Berry, Yeh, Cutlip, Mauri) Harvard Medical School, Boston, MA, United
States
(Berry, Yeh, Cutlip, Hsieh, Massaro, Mauri) Baim Institute for Clinical
Research, Boston, MA, United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Cutlip) Division of Cardiology, Department of Medicine, United States
(Yeh) Smith Center for Outcomes Research in Cardiology, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(Gabriel Steg) Universite Paris-Diderot, Sorbonne Paris Cite, INSERM
Unite-1148, Departement Hospitalo-Universitaire Fibrosis Inflammation
Remodeling, Hopital Bichat, Assistance Publique-Hopitaux de Paris, France
(Gabriel Steg) National Heart and Lung Institute, Institute of
Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial
College, London, United Kingdom
(Massaro) Boston University School of Public Health, MA, United States
(Jacobs) Boston University School of Medicine, Boston, MA, United States
(Dawn Abbott) Rhode Island Hospital, Brown University School of Medicine,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Women may derive differential benefit from prolonged DAPT
(dual antiplatelet therapy) after coronary stenting than men. We assessed
whether the risks/benefits of prolonged DAPT differ between women and men.
METHODS AND RESULTS: The DAPT study was a randomized double-blind,
placebo-controlled trial comparing continued thienopyridine versus placebo
beyond 12 months after coronary stenting. We compared rates of myocardial
infarction, stent thrombosis, major adverse cardiovascular and
cerebrovascular events, and bleeding by sex and randomized treatment. Of
11648 patients, women (N=2925) were older, with higher prevalence of
diabetes mellitus and lower rates of acute coronary syndrome than men. At
12 to 30 months, women had similar adjusted ischemic and bleeding events
as men. The effects of continued thienopyridine therapy did not differ
significantly by sex for stent thrombosis (women: hazard ratio [HR], 0.54;
95% confidence interval [CI], 0.22-1.36; men: HR, 0.26; 95% CI, 0.15-0.44;
interaction P=0.17), myocardial infarction (women: HR, 0.75; 95% CI,
0.50-1.14; men: HR, 0.46; 95% CI, 0.36-0.60; interaction P=0.052), major
adverse cardiovascular and cerebrovascular events (women: HR, 0.87; 95%
CI, 0.62-1.22; men: HR, 0.70; 95% CI, 0.58-0.85; interaction P=0.26), and
bleeding (women: HR, 1.45; 95% CI, 0.88-2.40; men: HR, 1.78; 95% CI,
1.28-2.49; interaction P=0.50). CONCLUSION(S): Women had similar late
risks of ischemia and bleeding as men after coronary stent
procedures. Copyright © 2018 American Heart Association, Inc.

<132>
Accession Number
2001003267
Title
Prognostic value of late gadolinium enhancement on CMR in patients with
severe aortic valve disease: a systematic review and meta-analysis.
Source
Clinical Radiology. 73 (11) (pp 983.e7-983.e14), 2018. Date of
Publication: November 2018.
Author
Chen H.; Zeng J.; Liu D.; Yang Q.
Institution
(Chen, Zeng, Liu, Yang) Department of Radiology, The Yongchuan Affiliated
Hospital, Chongqing Medical University, Xuan hua Road, Yongchuan District,
Chongqing 402160, China
Publisher
W.B. Saunders Ltd
Abstract
Aim: To evaluate the predictive value of late gadolinium enhancement (LGE)
on cardiac magnetic resonance (CMR) in patients with severe aortic valve
disease. Material(s) and Method(s): PubMed, EMBASE, and Web of
Science were searched for studies applying LGE-CMR to assess prognostic
significance in patients with severe aortic valve disease and to measure
myocardial fibrosis (MF). The association of LGE with outcomes was
estimated for each study by an odds ratio (OR) along with its 95%
confidence interval (CI). Pooled estimates of ORs were calculated using a
Mantel-Haenszel fixed-effects model. Result(s): Six studies including
626 patients were included in the meta-analysis. The follow-up period was
from 0.5 to 5.7 years. The pooled OR was 3.28 (95% CI: 2.02-5.32; p<0.001)
for LGE (+) versus LGE (-) in predicting patients with aortic valve
disease in all-cause mortality. The presence of LGE was associated with
cardiovascular mortality (pooled OR: 3.10, 95% CI: 1.73-5.56; p<0.001).
The presence of LGE was associated with all-cause mortality in patients
with severe aortic stenosis after aortic valve replacement (pooled OR:
2.30, 95% CI: 1.06-4.99; p=0.036). CONCLUSION(S): LGE on CMR is a
promising risk stratification method, as it could predict all-cause
mortality and cardiovascular mortality in patients with aortic valve
disease, especially for aortic stenosis. LGE-CMR also has significant
prognostic value in patients after aortic valve replacement. Copyright
© 2018 The Royal College of Radiologists

<133>
Accession Number
2001075224
Title
Preoperative STOP-BANG Scores and Postoperative Delirium and Coma in
Thoracic Surgery Patients.
Source
Annals of Thoracic Surgery. 106 (4) (pp 966-972), 2018. Date of
Publication: October 2018.
Author
Wang S.; Sigua N.L.; Manchanda S.; Gradney S.; Khan S.H.; Perkins A.;
Kesler K.; Khan B.
Institution
(Wang) Department of Psychiatry, Indiana University School of Medicine,
Indiana University Health Neuroscience Center, Indianapolis, Indiana,
United States
(Wang, Khan) Sandra Eskenazi Center for Brain Care Innovation, Eskenazi
Hospital, Indianapolis, Indiana, United States
(Sigua, Manchanda, Gradney, Khan, Khan) Division of Pulmonary, Critical
Care, Sleep and Occupational Medicine, Department of Internal Medicine,
Indiana University School of Medicine, Indianapolis, Indiana, United
States
(Khan, Khan) Indiana University Center for Aging Research, Regenstrief
Institute, Indianapolis, Indiana, United States
(Perkins) Department of Biostatistics, Indiana University School of
Medicine, Indianapolis, Indiana, United States
(Kesler) Department of Cardiothoracic Surgery, Indiana University School
of Medicine, Indianapolis, Indiana, United States
Publisher
Elsevier USA
Abstract
Background: Obstructive sleep apnea (OSA) is associated with higher rates
of postoperative delirium. The relationship between preoperative OSA risk
and postoperative delirium and coma in thoracic surgery patients
hospitalized in the intensive care unit (ICU) is not well understood. This
study tests the hypothesis that thoracic surgery patients hospitalized in
ICU with a higher preoperative risk for OSA are more likely to develop
postoperative delirium and coma, resulting in longer hospital stays.
 Method(s): Preoperative OSA risk was measured using the STOP-BANG
questionnaire. STOP-BANG scores of greater than or equal to 3 were defined
as intermediate-high risk for OSA; 128 patients who underwent major
thoracic surgery completed the STOP-BANG questionnaire preoperatively. The
Richmond Agitation and Sedation Scale was used to assess level of
consciousness. The Confusion Assessment Method for the ICU was used to
assess for delirium. Linear regression was used to assess the relationship
between risk of OSA and outcome measures. Results were adjusted for age,
sex, body mass index, Charlson Comorbidity Index, instrumental activities
of daily living, and surgery type. Result(s): A total of 96 of 128
patients (76%) were in the intermediate-high-risk OSA group. Adjusted
analyses showed that the intermediate-high-risk OSA group had a longer
duration of postoperative ICU delirium and coma compared with the low-risk
OSA group (1.4 +/- 1.3 days versus 0.9 +/- 1.4 days; P = 0.04). Total
number of hospital days was not significantly different.
 Conclusion(s): Higher preoperative risk for OSA in thoracic surgery
patients was associated with a longer duration of postoperative delirium
and coma. Copyright © 2018 The Society of Thoracic Surgeons

<134>
[Use Link to view the full text]
Accession Number
627080165
Title
Prothrombin complex concentrates for perioperative Vitamin K antagonist
and non-Vitamin K anticoagulant reversal.
Source
Anesthesiology. 129 (6) (pp 1171-1184), 2018. Date of Publication: 2018.
Author
Levy J.H.; Douketis J.; Steiner T.; Goldstein J.N.; Milling T.J.
Institution
(Levy) Department of Anesthesiology, Cardiothoracic Intensive Care Unit,
Duke University School of Medicine, Durham, NC 27710, United States
(Douketis) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Steiner) Department of Neurology, Heidelberg University Hospital,
Heidelberg, Germany
(Goldstein) Department of Emergency Medicine, Massachusetts General
Hospital, Boston, MA, United States
(Milling) Departments of Neurology and Surgery and Perioperative Care,
Seton dell Medical School Stroke Institute, Austin, TX, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Vitamin K antagonist therapy is associated with an increased bleeding
risk, and clinicians often reverse anticoagulation in patients who require
emergency surgical procedures. Current guidelines for rapid
anticoagulation reversal for emergency surgery recommend four-factor
prothrombin complex concentrate and vitamin K coadministration. Te authors
reviewed the current evidence on prothrombin complex concentrate treatment
for vitamin K antagonist reversal in the perioperative setting, focusing
on comparative studies and in the context of intracranial hemorrhage and
cardiac surgery. Te authors searched Cochrane Library and PubMed between
January 2008 and December 2017 and retrieved 423 English-language papers,
which they then screened for relevance to the perioperative setting; they
identifed 36 papers to include in this review. Prothrombin complex
concentrate therapy was consistently shown to reduce international
normalized ratio rapidly and control bleeding effectively. In comparative
studies with plasma, prothrombin complex concentrate use was associated
with a greater proportion of patients achieving target international
normalized ratios rapidly, with improved hemostasis. No differences in
thromboembolic event rates were seen between prothrombin complex
concentrate and plasma, with prothrombin complex concentrate also
demonstrating a lower risk of fluid overload events. Overall, the studies
the authors reviewed support current recommendations favoring prothrombin
complex concentrate therapy in patients requiring vitamin K antagonist
reversal before emergency surgery. Copyright © 2018, the American
Society of Anesthesiologists, Inc.

<135>
Accession Number
623247796
Title
The interplay between permanent pacemaker implantation and mortality in
patients treated by transcatheter aortic valve implantation: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (3) (pp E159-E167),
2018. Date of Publication: 01 Sep 2018.
Author
Ueshima D.; Nai Fovino L.; Mojoli M.; Napodano M.; Fraccaro C.; Tarantini
G.
Institution
(Ueshima, Nai Fovino, Mojoli, Napodano, Fraccaro, Tarantini) Cardiology
Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of
Padua Medical School, Padua, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Previous implantation of a permanent pacemaker (PPM) is common
among patients undergoing transcatheter aortic valve implantation (TAVI).
Moreover, onset of conduction disturbances needing new PPM implantation
after TAVI is frequent. The interplay of pre-existing and new-PPM on
mortality after TAVI remains controversial. Method(s): We performed a
systematic review and study-level meta-analysis on the influence of PPM on
mortality after TAVI. Patients were divided into 3 groups: pre-existing
PPM, new-PPM (implantation within 30 days after TAVI) and no-PPM (without
PPM up to 30 days after TAVI). Outcomes were compared using pairwise and
network meta-analysis. Result(s): A total of 28 studies including
40,016 subjects were eligible. Patients of the no-PPM group had a lower
mortality outcome compared to the rest of the study population (relative
risk [RR] 0.76, 95% confidence interval [CI] 0.68-0.85, P < 0.0001) at
median follow up of 16.3 months. In particular, patients with a
pre-existing PPM (RR 1.43, 95% CI 1.26-1.62, P < 0.0001), but not those
with a newly implanted PPM (RR 1.08, 95% CI 0.99-1.18, P = 0.10), had a
significantly higher mortality compared to patients of the no-PPM group.
Moreover, meta-regression analysis showed that the transapical approach
rate had a detrimental interaction with pre-existing PPM on mortality (P =
0.03). Conclusion(s): Compared to patients without PPM, those with a
pre-existing PPM before TAVI had higher mortality, in particular if
treated by the transapical approach. New-PPM implantation did not have a
negative relation on mid-term outcome. Copyright © 2018 Wiley
Periodicals, Inc.

<136>
Accession Number
622088151
Title
Infective endocarditis following transcatheter edge-to-edge mitral valve
repair: A systematic review.
Source
Catheterization and Cardiovascular Interventions. 92 (3) (pp 583-591),
2018. Date of Publication: 01 Sep 2018.
Author
Asmarats L.; Rodriguez-Gabella T.; Chamandi C.; Bernier M.; Beaudoin J.;
O'Connor K.; Dumont E.; Dagenais F.; Paradis J.-M.; Rodes-Cabau J.
Institution
(Asmarats, Rodriguez-Gabella, Chamandi, Bernier, Beaudoin, O'Connor,
Dumont, Dagenais, Paradis, Rodes-Cabau) Quebec Heart and Lung Institute,
Laval University, Quebec City, QC, Canada
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To assess the clinical characteristics, management, and
outcomes of patients diagnosed with infective endocarditis (IE) after
edge-to-edge mitral valve repair with the MitraClip device.
 Background(s): Transcatheter edge-to-edge mitral valve repair has
emerged as an alternative to surgery in high-risk patients. However, few
data exist on IE following transcatheter mitral procedures.
 Method(s): Four electronic databases (PubMed, Google Scholar, Embase,
and Cochrane Library) were searched for original published studies on IE
after edge-to-edge transcatheter mitral valve repair from 2003 to 2017.
 Result(s): A total of 10 publications describing 12 patients with
definitive IE (median age 76 years, 55% men) were found. The mean logistic
EuroSCORE/EuroSCORE II were 41% and 45%, respectively. The IE episode
occurred early (within 12 months post-procedure) in nine patients (75%;
within the first month in five patients). Staphylococcus aureus was the
most frequent (60%) causal microorganism, and severe mitral regurgitation
was present in all cases but one. Surgical mitral valve replacement (SMVR)
was performed in most (67%) patients, and the mortality associated with
the IE episode was high (42%). Conclusion(s): IE following
transcatheter edge-to-edge mitral valve repair is a rare but
life-threatening complication, usually necessitating SMVR despite the
high-risk profile of the patients. These results highlight the importance
of adequate preventive measures and a prompt diagnosis and treatment of
this serious complication. Copyright © 2018 Wiley Periodicals,
Inc.

<137>
Accession Number
618953137
Title
Clinical and procedural outcomes with the SAPIEN 3 versus the SAPIEN XT
prosthetic valves in transcatheter aortic valve replacement: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (3) (pp E149-E158),
2018. Date of Publication: 01 Sep 2018.
Author
Tummala R.; Banerjee K.; Sankaramangalam K.; Mick S.; Krishnaswamy A.;
White J.; Fares M.; Mehta A.; Popovic Z.; Svensson L.G.; Kapadia S.R.
Institution
(Tummala) Department of Internal Medicine, St. Vincent Charity Medical
Center, An Affiliate of Case Western Reserve University, Cleveland, OH,
United States
(Banerjee, Sankaramangalam, Mick, Krishnaswamy, White, Fares, Mehta,
Popovic, Svensson, Kapadia) Heart and Vascular Institute, Cleveland
Clinic, Cleveland, OH, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The SAPIEN 3 valve (S3V) was designed to overcome the
shortcomings of its predecessor, the SAPIEN XT (SXT) valve. We conducted a
meta-analysis to compare their clinical outcomes and procedural
characteristics. Method(s): PUBMED, EMBASE, and Cochrane CENTRAL were
searched by two independent reviewers. The clinical outcomes of interest
were paravalvular leakage (PVL), major vascular complications (MVC),
bleeding, acute kidney injury (AKI), device success, need for post
dilation all-cause mortality and procedural details. Result(s):
Fifteen observational cohort studies were included in the analysis
involving a total of 4,496 patients. Of these, 1,700 were S3V recipients
and 2,796 were SXT recipients. The S3V group showed fewer complications
compared to the SXT group with respect to PVL (5.58% vs. 19.35%, OR: 0.27,
P: 0.000), MVC (4.07% vs. 9.13%, OR: 0.44, P: 0.002), bleeding (6.40% vs.
12.03%, OR: 0.50, P: 0.003), 30-day mortality (3.29% vs. 5.68%, OR: 0.51,
P: 0.000), and stroke (1.48% vs. 2.86%, OR: 0.49, P: 0.014). Device
success was higher in the S3V (98.18% vs. 93.76%, OR: 3.14, P: 0.000).
Cardiovascular mortality, myocardial infarction, AKI and post-dilatation
were not significantly different. Permanent pacemaker implantation (PPI)
was higher in S3V recipients (13.29% vs. 9.23%, OR: 1.58, P: 0.000).
Procedure time was shorter for the S3V (71.94 vs. 86.85, P: 0.016) and
used less contrast volume (129.36 vs. 161.18, P: 0.049).
 Conclusion(s): Patients receiving the S3V had lower risk of PVL, MVC,
bleeding, mortality, and stroke. PPI was somewhat higher in the S3V group.
S3V implantation was faster and used less contrast. Copyright ©
2017 Wiley Periodicals, Inc.

<138>
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.

<139>
Accession Number
2002771411
Title
Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in
Patients Aged 70 Years or Older.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Biancari F.; Saeed D.; Fiore A.; Dalen M.; Ruggieri V.G.; Jonsson K.;
Gatti G.; Zipfel S.; Dell'Aquila A.M.; Chocron S.; Bounader K.; Amr G.;
Settembre N.; Palve K.; Loforte A.; Gabrielli M.; Livi U.; Lechiancole A.;
Pol M.; Netuka I.; Spadaccio C.; Pettinari M.; De Keyzer D.; Reichart D.;
Ragnarsson S.; Alkhamees K.; Lichtenberg A.; Fux T.; El Dean Z.;
Fiorentino M.; Mariscalco G.; Jeppsson A.; Welp H.; Perrotti A.
Institution
(Biancari, Palve) Heart Center, Turku University Hospital and Department
of Surgery, University of Turku, Turku, Finland
(Biancari) Department of Surgery, University of Oulu, Oulu, Finland
(Saeed, Lichtenberg) Department of Cardiovascular Surgery, University
Hospital of Dusseldorf, Dusseldorf, Germany
(Fiore) Department of Cardiothoracic Surgery, Henri Mondor University
Hospital, AP-HP, Paris-Est University, Creteil, France
(Dalen, Fux) Department of Molecular Medicine and Surgery, Department of
Cardiac Surgery, Karolinska Institute, Karolinska University Hospital,
Stockholm, Sweden
(Ruggieri, Amr) Division of Cardiothoracic and Vascular Surgery, Robert
Debre University Hospital, Reims, France
(Jonsson, Jeppsson) Department of Cardiac Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Gatti, Gabrielli) Division of Cardiac Surgery, Ospedali Riuniti, Trieste,
Italy
(Zipfel, Reichart) Hamburg University Heart Center, Hamburg, Germany
(Dell'Aquila, Welp) Department of Cardiothoracic Surgery, Munster
University Hospital, Munster, Germany
(Chocron, Perrotti) Department of Thoracic and Cardio-Vascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Bounader) Division of Cardiothoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
(Settembre) Department of Vascular Surgery, Nancy University Hospital,
University of Lorraine, Nancy, France
(Loforte, Fiorentino) Department of Cardiothoracic, Transplantation, and
Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna,
Italy
(Livi, Lechiancole) Cardiothoracic Department, University Hospital of
Udine, Udine, Italy
(Pol, Netuka) Institute of Clinical and Experimental Medicine, Prague,
Czechia
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Pettinari, De Keyzer) Department of Cardiovascular Surgery, Ziekenhuis
Oost-Limburg, Genk, Belgium
(Ragnarsson) Department of Cardiothoracic Surgery, University of Lund,
Lund, Sweden
(Alkhamees) Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
(El Dean, Mariscalco) Department of Cardiac Surgery, Glenfield Hospital,
University Hospitals of Leicester, Leicester, United Kingdom
Publisher
Elsevier USA
Abstract
Background: There is uncertainty whether venoarterial extracorporeal
membrane oxygenation (VA-ECMO) should be used in older patients with
cardiopulmonary failure after cardiac surgery. Method(s): This was a
retrospective multicenter study of 781 patients who required
postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac
surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel
systematic review with meta-analysis of the literature was performed.
 Result(s): The hospital mortality in the overall Postcardiotomy
Venoarterial Extracorporeal Membrane Oxygenation (PC-ECMO) series was
64.4%. A total of 255 patients were 70 years old or older (32.7%), and
their hospital mortality was significantly higher than in younger patients
(76.1% vs 58.7%; adjusted odds ratio, 2.199; 95% confidence interval [CI],
1.536 to 3.149). Arterial lactate level greater than 6 mmol/L before
starting VA-ECMO was the only predictor of hospital mortality among
patients 70 years old or older in univariate analysis (82.6% vs 70.4%; P
=.029). Meta-analysis of current and previous studies showed that early
mortality after postcardiotomy VA-ECMO was significantly higher in
patients aged 70 years or older compared with younger patients (odds
ratio, 2.09; 95% CI, 1.59 to 2.75; 5 studies including 1547 patients;
I2, 5.9%). The pooled early mortality rate among patients aged
70 years or older was 78.8% (95% CI, 74.1 to 83.5; 6 studies including 617
patients; I2, 41.8%). Two studies reported 1-year mortality
(including hospital mortality) of 79.9% and 75.6%, respectively, in
patients 70 years old or older. Conclusion(s): Advanced age should
not be considered a contraindication for postcardiotomy VA-ECMO. However,
in view of the high risk of early mortality, meaningful scrutiny is needed
before using VA-ECMO after cardiac surgery in older
patients. Copyright © 2019 The Society of Thoracic Surgeons

<140>
Accession Number
2002683140
Title
Network meta-analysis of new-generation valves for transcatheter aortic
valve implantation.
Source
Heart and Vessels. (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, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611,
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
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
To comprehensively compare and rank new-generation valves (NGVs) for
transcatheter aortic valve implantation, we performed a network
meta-analysis (NMA) of all eligible comparative studies. MEDLINE and
EMBASE were searched through September 2018. We included all studies
comparing 4 NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3) and an early
generation valve (CoreValve) as the reference transcatheter heart valve
(THV) each other and reporting at least one of postprocedural incidence of
all-cause death, >= moderate aortic regurgitation (AR), and new permanent
pacemaker implantation (PMI). To compare different THVs, a random-effects
restricted-maximum-likelihood NMA based on a frequentist framework for
indirect and mixed comparisons was used. Using surface under the
cumulative ranking curve (SUCRA), the relative ranking probability of each
THV was estimated and the hierarchy of competing THVs was obtained. We
identified 29 eligible studies enrolling a total of 17,817 patients. In
accordance with the estimated SUCRA probability, SAPIEN 3 was the best
effective for a reduction in death (80.6%) and the second best for
decreased >= moderate AR (74.4%) and PMI (74.1%) compared with the other
THVs. Lotus was ranked the best for a reduction in >= moderate AR
(94.5%;), whereas the worst for decreased PMI (1.2%) and the second worst
for a reduction in mortality (38.6%). ACURATE was the best for decreased
PMI (99.2%) and the second best for a reduction in mortality (77.9%). As a
whole, SAPIEN 3 may be the best effective NGV among the 4 examined NGVs
(ACURATE, Evolut R, Lotus, and SAPIEN 3). Copyright © 2019,
Springer Japan KK, part of Springer Nature.

<141>
Accession Number
2002679775
Title
Fresh frozen plasma and platelet concentrate storage duration not
associated with in hospital mortality risk.
Source
Vox Sanguinis. (no pagination), 2019. Date of Publication: 2019.
Author
Ng M.S.Y.; Hay K.; Choy J.; Middelburg R.A.; Tung J.-P.; Fraser J.F.
Institution
(Ng, Tung, Fraser) Critical Care Research Group, The Prince Charles
Hospital, Chermside, QLD, Australia
(Ng, Choy, Tung, Fraser) Faculty of Medicine, Oral Health Centre,
University of Queensland, Herston, QLD, Australia
(Ng, Tung) Research and Development, Australian Red Cross Blood Service,
Kelvin Grove, QLD, Australia
(Hay) QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
(Choy) Royal Brisbane & Women's Hospital, Herston, QLD, Australia
(Middelburg) Centre for Clinical Transfusion Research, Sanquin Research,
Leiden, Netherlands
(Middelburg) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objectives: To date, the effects of FFP and PC storage
duration on mortality have only been studied in a few studies in limited
patient subpopulations. The aim of the current study was to determine
whether FFP and PC storage duration is associated with increased in
hospital mortality risk across cardiac surgery, acute medicine, ICU and
orthopaedic surgery patients. Material(s) and Method(s): Two-stage
individual patient data meta-analyses were performed to determine the
effects of FFP and PC storage duration on in hospital mortality. Preset
random effects models were used to determine pooled unadjusted and
adjusted (adjusted for age, gender and units of product transfused) effect
estimates. Result(s): The FFP storage duration analysis included 3625
patients across four studies. No significant association was observed
between duration of storage and in hospital mortality in unadjusted
analysis, but after adjusting for patient age, gender and units of product
a small increased risk of in hospital mortality was observed for each
additional month of storage (OR: 1.05, 95% CI: 1.01-1.08). This effect was
no longer statistically significant when donor ABO blood group was
incorporated into the random effects model on post hoc analyses. A total
of 547 patients across five studies were incorporated in the PC storage
duration analysis. No association was observed between PC storage duration
and odds of in hospital morality (adjusted OR: 0.94, 95% CI: 0.79-1.11).
 Conclusion(s): There is insufficient evidence to support shortening
FFP or PC shelf life based on in hospital mortality. Copyright ©
2019 International Society of Blood Transfusion

<142>
[Use Link to view the full text]
Accession Number
629170173
Title
Ultrasound-guided vs. palpation-guided techniques for radial arterial
catheterisation in infants: A randomised controlled trial.
Source
European Journal of Anaesthesiology. 36 (3) (pp 200-205), 2019. Date of
Publication: 01 Mar 2019.
Author
Min J.J.; Tay C.K.; Gil N.-S.; Lee J.-H.; Kim S.; Kim C.S.; Yang J.-H.;
Jun T.-G.
Institution
(Min, Gil, Lee, Kim, Kim) Department of Anaesthesiology and Pain Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine, 81
Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
(Yang, Jun) Department of Thoracic and Cardiovascular Surgery, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Tay) Department of Respiratory and Critical Care, Singapore General
Hospital, Singapore, Singapore
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUNDThe usefulness of ultrasound-guided techniques for radial
arterial catheterisation has been well identified; however, its usefulness
has not been completely evaluated in infants under 12 months of age, who
are generally considered the most difficult group for arterial
catheterisation.OBJECTIVEWe evaluated whether ultrasound guidance would
improve success rates and reduce the number of attempts at radial arterial
catheterisation in infants.DESIGNA randomised, controlled and
patient-blinded study.SETTINGSingle-centre trial, study period from June
2016 to February 2017.PATIENTSSeventy-four infants undergoing elective
cardiac surgery.INTERVENTIONPatients were allocated randomly into either
ultrasound-guided group (group US) or palpation-guided group (group P)
(each n=37) according to the technique applied for radial arterial
catheterisation. All arterial catheterisations were performed by one of
two experienced anaesthesiologists based on group assignment and were
recorded on video.MAIN OUTCOME MEASURESThe primary endpoint was the
first-pass success. The number of attempts and total duration of the
procedure until successful catheterisation were also analysed.RESULTSThe
first-pass success rate was significantly higher in the group US than in
the group P (68 vs. 38%, P = 0.019). In addition, fewer attempts were
needed for successful catheterisation in the group US than in the group P
(median 1 [IQR 1 to 2] vs. 2 [1 to 4], P = 0.023). However, the median
[IQR] procedural time (s) until successful catheterisation in the two
groups was not significantly different (102 [49 to 394] vs. 218 [73 to
600], P = 0.054).CONCLUSIONThe current study demonstrated that the
ultrasound-guided technique for radial arterial catheterisation in infants
effectively improved first-pass success rate and also reduced the number
of attempts required.TRIAL REGISTRATIONClinicalTrials.gov
NCT02795468. Copyright © 2019 European Society of
Anaesthesiology. All rights reserved.

<143>
Accession Number
629168285
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 and Integrative Medicine. (no pagination), 2019.
Date of Publication: 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, 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, Iran, Islamic Republic of
(Ardalan) 563 hampshire Rd, Apt 273, Westlake Village, CA, United States
(Tarrahi) Department of Epidemiology and Biostatistics, School of Health,
Isfahan University of Medical Sciences, Iran, Islamic Republic of
Publisher
De Gruyter (E-mail: peter.golla@degruyter.com)
Abstract
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. 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. 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. Combination of Vitamin C and
n-3 PUFA effectively reduces post-operative fatigue among patients who
undergo CABG surgery. Copyright © 2019 Walter de Gruyter GmbH,
Berlin/Boston.

<144>
Accession Number
628176265
Title
Patency of Individual and Sequential Coronary Artery Bypass in Patients
with Ischemic Heart Disease: A Meta-analysis.
Source
Brazilian journal of cardiovascular surgery. 34 (4) (pp 420-427), 2019.
Date of Publication: 27 Aug 2019.
Author
Li Z.; Liu L.
Institution
(Li) Shandong Provincial PKUcare Luzhong Hospital Department of Thoracic
and Cardiovascular Surgery Zibo Shandong People's Republic of China
Department of Thoracic and Cardiovascular Surgery, Shandong Provincial
PKUcare Luzhong Hospital, Zibo, Shandong, China
(Li, Liu) Shandong University Shandong Provincial Qianfoshan Hospital
Department of Cardiac Surgery Jinan Shandong People's Republic of China
Department of Cardiac Surgery, Shandong Provincial Qianfoshan Hospital,
Shandong University, Jinan, Shandong, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the patency of individual and sequential coronary
artery bypass in patients with ischemic heart disease. METHOD(S): We
searched PubMed, Cochrane Library, Excerpta Medica Database, and
ClinicalTrials.gov databases for controlled trials. Endpoints included
graft patency, anastomosis patency, occluded rates in left anterior
descending (LAD) system and right coronary artery (RCA) system,
in-hospital mortality, and follow-up mortality. Pooled risk ratios (RRs)
and standardized mean difference (SMD) were used to assess the relative
data. RESULT(S): Nine cohorts, including 7100 patients and 1440
grafts under individual or sequential coronary artery bypass. There were
no significant differences between individual and sequential coronary
artery bypass in the graft patency (RR=0.96; 95% CI=0.91-1.02; P=0.16;
I2=87%), anastomosis patency (RR=0.95; 95% CI=0.91-1.00; P=0.05; I2=70%),
occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16; P=0.58; I2=37%),
occluded rate in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35; I2=95%),
in-hospital mortality (RR=1.57; 95% CI=0.92-2.69; P=0.10; I2=0%), and
follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93; I2=0%).
 CONCLUSION(S): No significant differences on clinical data were
observed regarding anastomosis patency, occluded rate in LAD system,
occluded rate in RCA system, in-hospital mortality, and follow-up
mortality, indicating that the patency of individual and the patency of
sequential coronary artery bypass are similar to each other.

<145>
[Use Link to view the full text]
Accession Number
629169717
Title
Effectiveness of protection strategies for reducing radiation exposure in
proceduralists during cardiac catheterization procedures: A systematic
review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 17 (5) (pp
660-666), 2019. Date of Publication: 01 May 2019.
Author
Fernandez R.; Ellwood L.; Barrett D.; Weaver J.
Institution
(Fernandez, Ellwood) Centre for Evidence Based Initiatives in Health Care,
A Joanna Briggs Centre of Excellence, Australia
(Fernandez, Ellwood) Centre for Research in Nursing and Health, St George
Hospital, Sydney, Australia
(Fernandez) School of Nursing, University of Wollongong, Sydney, Australia
(Barrett) Interventional Cardiology, St Andrews Private Hospital, Ipswich,
Australia
(Weaver) Cardiology Department, St George Hospital, Sydney, Australia
(Weaver) School of Medicine, University of New South Wales, Sydney,
Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Review question:What is the effectiveness of radiation protection
strategies for reducing the radiation dose received by the proceduralist
during cardiac catheterization procedures? Copyright © 2019
Joanna Briggs Institute.

<146>
Accession Number
629177198
Title
Dexmedetomidine in Adult Patients in Cardiac Surgery Critical Care: An
Evidence-Based Review.
Source
AACN advanced critical care. 30 (3) (pp 259-268), 2019. Date of
Publication: 01 Sep 2019.
Author
Brock L.
Institution
(Brock) Surgical Intensive Care Unit, University Hospitals of Cleveland
Ahuja Medical Center, Lyndsay Brock is Acute Care Nurse Practitioner3999
Richmond Rd, Beachwood, OH 44122 (), United States
Publisher
NLM (Medline)
Abstract
Although several options are available for postoperative sedation in the
intensive care unit, the selective alpha2-adrenoceptor agonist
dexmedetomidine may offer advantages for patients after cardiac surgery.
The author conducted a review of the literature on the use of
dexmedetomidine in the cardiac surgery population to determine possible
advantages and disadvantages in this patient population. Although the use
of dexmedetomidine has not been conclusively shown to change overall
morbidity and mortality and may be associated with higher drug cost, its
other demonstrated effects offer advantages for postoperative cardiac
surgery patients that other forms of sedation cannot match. Copyright
©2019 American Association of Critical-Care Nurses.

<147>
Accession Number
629178925
Title
Synchronous Carotid Endarterectomy and Coronary Artery Bypass Graft (CABG)
versus staged Carotid Artery Stenting and CABG for Patients with
Concomitant Severe Coronary and Carotid Stenosis: a Systematic Review and
Meta-analysis.
Source
Annals of vascular surgery. (no pagination), 2019. Date of Publication: 23
Aug 2019.
Author
Texakalidis P.; Charisis N.; Jonnalagadda A.K.; Chaitidis N.; Giannopoulos
S.; Kaskoutis C.; Machinis T.; Koullias G.J.
Institution
(Giannopoulos) 251 HAF and VA Hospital, Athens, Greece
(Texakalidis) Department of Neurosurgery, Emory University School of
Medicine, Atlanta, GA, United States
(Charisis) Division of Surgical Oncology, Department of Surgery, Stony
Brook University Hospital, Stony Brook, NY, United States
(Jonnalagadda) Division of Cardiology, Medstar Washington Hospital Center,
DC, United States
(Chaitidis, Kaskoutis) 401 General Army Hospital, Athens, Greece
(Giannopoulos) School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
(Machinis) Department of Neurosurgery, Virginia Commonwealth University,
Richmond, VA, United States
(Koullias) Division of Vascular and Endovascular Surgery, Department of
Surgery, Stony Brook University Hospital, Stony Brook, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Due to the systemic nature of atherosclerosis, medium and
large arteries at different sites are commonly simultaneously affected. As
a result, severe coronary artery disease (CAD) requiring coronary artery
bypass graft (CABG) frequently coexists with significant carotid stenosis
that warrants revascularization. OBJECTIVE(S): To compare synchronous
carotid endarterectomy (CEA) and CABG vs. staged carotid artery stenting
(CAS) and CABG for patients with concomitant CAD and carotid artery
stenosis in terms of peri-operative (30-day) outcomes. METHOD(S):
This study was performed according to the PRISMA guidelines. Eligible
studies were identified through a search of PubMed, Scopus and Cochrane
until July, 2018. A meta-analysis was conducted with the use of a random
effects model. The I-square statistic was used to assess heterogeneity.
 RESULT(S): Five studies comprising 16,712 patients were included in
this meta-analysis. Peri-operative stroke (odds ratio (OR): 0.84; 95%
confidence interval (CI): 0.43- 1.64; I2= 39.1%), transient ischemic
attack (TIA) (OR: 0.32; 95% CI: 0.04- 2.67; I2= 27.6%) and myocardial
infarction (MI) rates (OR: 0.56; 95% CI: 0.08- 3.85; I2= 68.9%) were
similar between the two groups. However, patients who underwent
simultaneous CEA and CABG were at a statistically significant higher risk
for peri-operative mortality (OR: 1.80; 95% CI: 1.05- 3.06; I2= 0.0%).
 CONCLUSION(S): The current meta-analysis did not detect statistically
significant differences in the rates of peri-operative stroke, TIA and MI
between the groups. However, patients in the simultaneous CEA and CABG
group had a significantly higher risk of 30-day mortality. Future
randomized trials or prospective cohorts are needed to validate our
results. Copyright © 2019 Elsevier Inc. All rights reserved.

<148>
Accession Number
629173803
Title
What will surgical coronary revascularization look like in 25 years?.
Source
Current opinion in cardiology. (no pagination), 2019. Date of Publication:
28 Aug 2019.
Author
Caliskan E.; Emmert M.Y.; Falk V.
Institution
(Caliskan, Emmert, Falk) Department of Cardiovascular Surgery,
Charite-Universitatsmedizin Berlin, Hungary
(Caliskan, Emmert, Falk) Department of Cardiothoracic and Vascular
Surgery, German Heart Institute Berlin, Germany
(Falk) DZHK (German Centre for Cardiovascular Research), Partner Site
Berlin, Berlin, Germany
(Falk) Department of Health Sciences and Technology, ETH Zurich,
Translational Cardiovascular Technologies, Zurich, Switzerland
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Coronary artery bypass grafting evolved in incremental
but significant steps since its introduction. Here, we provide an update
on operative techniques, choice of conduits, patient
selection/decision-making and primary and secondary prevention measures
with potential of influencing the future of coronary artery bypass
grafting (CABG) surgery. RECENT FINDINGS: Associated mortality of off-pump
CABG (OPCAB) procedures performed in high-volume OPCAB centers (>=164
cases per year) and by experienced surgeons (>=48 cases per year) was
reduced compared with on-pump CABG with two or more grafts suggesting a
volume-based dependency of outcomes in CABG procedures with high-technical
complexity. Ten-year results from the recent Arterial Revascularization
Trial showed no significant between-group difference for the primary and
secondary outcome. Total arterial revascularization using composite
bilateral internal mammary artery-Y-conduits through a limited access
mini-thoracotomy was not only shown to be feasible but a safe and
reproducible procedure with excellent midterm outcomes. The most recent
Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for
Coronary-Artery Bypass (REGROUP) trial demonstrated no significant
difference between open vein-graft harvesting and endoscopic vein-graft
harvesting in the occurrence of major adverse cardiac events. SUMMARY:
Adherence to the most recent guidelines on myocardial revascularization is
a key component for providing state-of the CABG surgery. Trends to lesser
invasiveness in surgical coronary revascularization will gain momentum and
is expected - with further improvements - to be the mainstay of future
surgical coronary revascularization strategies.

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