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<1>
Accession Number
2002855387
Title
Effect of selective BET protein inhibitor apabetalone on cardiovascular
outcomes in patients with acute coronary syndrome and diabetes: Rationale,
design, and baseline characteristics of the BETonMACE trial.
Source
American Heart Journal. 217 (pp 72-83), 2019. Date of Publication:
November 2019.
Author
Ray K.K.; Nicholls S.J.; Ginsberg H.D.; Johansson J.O.; Kalantar-Zadeh K.;
Kulikowski E.; Toth P.P.; Wong N.; Cummings J.L.; Sweeney M.; Schwartz
G.G.
Institution
(Ray) Imperial Centre for Cardiovascular Disease Prevention, Imperial
College, London, United Kingdom
(Nicholls) MonashHeart, Monash University, Melbourne, Australia
(Ginsberg) Irving Institute for Clinical and Translational Research,
Columbia University, New York, NY, United States
(Johansson, Kulikowski, Wong, Sweeney) Resverlogix Corporation, Calgary,
Alberta, Canada
(Kalantar-Zadeh) Division of Nephrology and Hypertension, University of
California Irvine, United States
(Toth) CGH Medical Center Sterling, Illinois, and Cicarrone Center for the
Prevention of Cardiovascular Disease, Johns Hopkins University School of
Medicine, Baltimore, United States
(Cummings) Neurological Institute, Cleveland Clinic Lerner School of
Medicine, Cleveland, OH, United States
(Schwartz) Division of Cardiology, University of Colorado School of
Medicine, Aurora, CO, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
After an acute coronary syndrome (ACS), patients with diabetes remain at
high risk for additional cardiovascular events despite use of current
therapies. Bromodomain and extra-terminal (BET) proteins are epigenetic
modulators of inflammation, thrombogenesis, and lipoprotein metabolism
implicated in atherothrombosis. The BETonMACE trial tests the hypothesis
that treatment with apabetalone, a selective BET protein inhibitor, will
improve cardiovascular outcomes in patients with diabetes after an ACS.
 Design(s): Patients (n = 2425) with ACS in the preceding 7 to 90
days, with type 2 diabetes and low HDL cholesterol (<=40 mg/dl for men,
<=45 mg/dl for women), receiving intensive or maximum-tolerated therapy
with atorvastatin or rosuvastatin, were assigned in double-blind fashion
to receive apabetalone 100 mg orally twice daily or matching placebo.
Baseline characteristics include female sex (25%), myocardial infarction
as index ACS event (74%), coronary revascularization for index ACS (76%),
treatment with dual anti-platelet therapy (87%) and renin-angiotensin
system inhibitors (91%), median LDL cholesterol 65 mg per deciliter, and
median HbA1c 7.3%. The primary efficacy measure is time to first
occurrence of cardiovascular death, non-fatal myocardial infarction, or
stroke. Assumptions include a primary event rate of 7% per annum in the
placebo group and median follow-up of 1.5 years. Patients will be followed
until at least 250 primary endpoint events have occurred, providing 80%
power to detect a 30% reduction in the primary endpoint with apabetalone.
BETonMACE will determine whether the addition of the selective BET protein
inhibitor apabetalone to contemporary standard of care for ACS reduces
cardiovascular morbidity and mortality in patients with type 2 diabetes.
Results are expected in 2019. Copyright © 2019

<2>
Accession Number
2001024416
Title
Oral thyroxin supplementation in infants undergoing cardiac surgery: A
double-blind placebo-controlled randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (3) (pp 1209-1217.e3),
2018. Date of Publication: September 2018.
Author
Talwar S.; Bhoje A.; Khadagawat R.; Chaturvedi P.; Sreenivas V.; Makhija
N.; Sahu M.; Choudhary S.K.; Airan B.
Institution
(Talwar, Bhoje, Khadagawat, Chaturvedi, Sreenivas, Makhija, Sahu,
Choudhary, Airan) Cardiothoracic Center, All India Institute of Medical
Sciences, New Delhi, India
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Decreases in serum total thyroxin and total triiodothyronine
occurs after cardiopulmonary bypass, and is reflected as poor immediate
outcome. We studied effects of oral thyroxin supplementation in infants
who underwent open-heart surgery. Method(s): In this prospective
study, 100 patients were randomized into 2 groups: 50 in the thyroxin
group (TH) and 50 in the placebo group (PL). Patients in the TH group
received oral thyroxin (5 mug/kg) 12 hours before surgery and once daily
for the remainder of their intensive care unit (ICU) stay. Data on
intraoperative and postoperative variables were recorded. Cardiac index
(CI) was measured. Perioperative serum thyroid hormone levels and serum
interleukin-6 and tumor necrosis factor-alpha were measured. Secondary
analysis was performed by dividing patients into simple and complex
subcategories. Result(s): Results of the primary analysis indicated a
higher CI in the TH compared with the PL. In the complex category, the
mean duration of mechanical ventilation was 3.85 +/- 0.93 and 4.66 +/-
1.55 days in the TH and PL, respectively (P =.001). Mean ICU stay was 6.79
+/- 2.26 and 8.33 +/- 3.09 days (P =.03), and mean hospital stay was 15.70
+/- 4.77 and 18.90 +/- 4.48 days (P =.01) in the TH and PL, respectively.
There were no significant differences between the TH and the PL in the
simple category. CI was higher in the TH at all time points (P =.004). The
average therapeutic intervention scoring system scores for the first 2
days were higher in the PL in the complex category. Conclusion(s):
Oral thyroxin supplementation improves the CI and reduces the inotropic
requirement. In addition, it reduces the duration of mechanical
ventilation, ICU and hospital stay, and therapeutic intervention scoring
system in infants after surgery for complex congenital heart
defects. Copyright © 2018 The American Association for Thoracic
Surgery

<3>
Accession Number
2000823087
Title
Lower versus upper leg saphenous vein composite grafts based on the left
internal thoracic artery: A randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (3) (pp 986-994.e2),
2018. Date of Publication: September 2018.
Author
Chang H.W.; Hwang H.Y.; Seo J.-W.; Kim K.-B.
Institution
(Chang) Department of Thoracic and Cardiovascular Surgery, Sejong General
Hospital, Bucheon-si, Gyeonggi-do, South Korea
(Hwang, Kim) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Seo) Department of Pathology, Seoul National University Hospital, Seoul
National University College of Medicine, Seoul, South Korea
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The "lower versus upper leg saphenous vein (SV) composite
graft based on the left internal thoracic artery (ITA) for coronary artery
bypass grafting" trial was designed to compare the histologic,
immunohistochemical, and angiographic findings of lower versus upper leg
SV composite grafts. Method(s): Twenty-six patients with multivessel
coronary artery disease were prospectively randomized to undergo
revascularization using a lower leg (n = 13) or upper leg (n = 13) SV
composite graft based on the in situ left ITA. The SV was harvested with a
"no-touch" technique, and 2 excess segments were removed from the distal
and proximal portions of each SV conduit. Another proximal segment was
removed from the reversed SV composite graft, which had been dilated by
the native ITA pressure. Hematoxylin and eosin staining,
immunohistochemistry, and early and 1-year postoperative angiographic
results were compared. Result(s): The histologic study showed that
the proximal and dilated proximal SV conduit lumen diameters were smaller
in the lower leg group than in the upper leg group (proximal, 623 +/- 143
mum vs 858 +/- 266 mum; P =.008; dilated proximal, 1138 +/- 419 mum vs
1477 +/- 353 mum; P =.047). However, there were no differences in the
lumen diameters of the distal SV segments in terms of immunohistochemical
comparisons, diameters, patency rates, or filling frame counts of the SV
conduits on early and 1-year postoperative angiograms between the 2
groups. Conclusion(s): Although the proximal segment luminal
diameters were smaller in the lower leg SV, there were no differences in
the immunohistochemical results or patency rates on early and 1-year
postoperative angiograms between the lower and upper leg "no-touch" SV
conduits. Copyright © 2018 The American Association for Thoracic
Surgery

<4>
Accession Number
2000626507
Title
Concomitant surgical closure of left atrial appendage: A systematic review
and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (3) (pp 1071-1080.e2),
2018. Date of Publication: September 2018.
Author
Ando M.; Funamoto M.; Cameron D.E.; Sundt T.M.
Institution
(Ando, Funamoto, Cameron, Sundt) Division of Cardiac Surgery,
Massachusetts General Hospital and Harvard Medical School, Boston, Mass,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Although percutaneous closure of the left atrial appendage is
supported as a potential alternative to lifelong anticoagulation in
patients with atrial fibrillation, comprehensive evidence on surgical left
atrial appendage closure in heart surgery is limited. Method(s): We
conducted a meta-analysis of studies comparing patients who underwent open
cardiac surgery with or without left atrial appendage closure. A
literature search was performed on PubMed, Embase, and Cochrane Trials
databases. Outcomes of interest were 30-day/in-hospital mortality and
cerebrovascular accident. I2 statistics were used to evaluate
heterogeneity, and publication bias was evaluated by Begg's and Egger's
tests. Result(s): We reviewed 1284 articles and selected for main
analysis 7 articles including 3897 patients (1963 in the left atrial
appendage closure group and 1934 in the non-left atrial appendage closure
group). Among the 7 studies, 3 were randomized-controlled studies, 3 were
propensity-matched studies, and 1 was a case-matching study. At
30-day/in-hospital follow-up, left atrial appendage closure was
significantly associated with decreased risk of mortality and
cerebrovascular accident (odds ratio, 0.384, 95% confidence interval,
0.233-0.631 for mortality, and odds ratio, 0.622, 95% confidence interval,
0.388-0.998 for cerebrovascular accident). Stratified analysis
demonstrated that this association was more prominent in preoperative
atrial fibrillation strata. Conclusion(s): Concomitant surgical left
atrial appendage closure should be considered at the time of open cardiac
surgery, particularly among those in atrial fibrillation preoperatively.
The benefit of left atrial appendage closure for patients not in atrial
fibrillation and for those undergoing nonvalvular surgery is still
unclear. Further prospective investigations are indicated. Copyright
© 2018 The American Association for Thoracic Surgery

<5>
Accession Number
609610960
Title
Remifentanil Compared With Sufentanil Does Not Enhance Fast-Track
Possibilities in Cardiac Surgery-A Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (5) (pp 1212-1220),
2016. Date of Publication: 01 Oct 2016.
Author
Bhavsar R.; Ryhammer P.K.; Greisen J.; Rasmussen L.A.; Jakobsen C.-J.
Institution
(Bhavsar, Ryhammer, Greisen, Rasmussen, Jakobsen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus,
Denmark, Denmark
Publisher
W.B. Saunders
Abstract
Objective Progressive cost containment has resulted in a growing interest
for fast-track cardiac surgery. Ventilation time and length of stay (LOS)
in the intensive care unit (ICU) are important factors in patient
turnover, a more efficient use of resources, and early patient
mobilization. However, LOS in ICU is not an objective measure because, in
addition to medical factors, patient discharge may be guided by logistics
and policy, and thus more objective measures are warranted. The authors
hypothesized that remifentanil compared with sufentanil would reduce
ventilation time and LOS in the ICU and that remifentanil would have
beneficial effects on the overall quality of recovery. Design A
randomized, prospective study. Participants Sixty patients scheduled for
elective coronary artery bypass grafting with or without aortic valve
replacement. Setting A university hospital. Interventions Patients were
assigned randomly to receive either remifentanil or sufentanil combined
with propofol. Measurements and Main Results Patients with ejection
fraction<0.3, myocardial infarction within the last 4 weeks, diabetes, and
severe pulmonary or arterial hypertension were excluded. The primary
outcome variables were ventilation time and time to eligibility of
discharge from the cardiac recovery unit. Secondary outcomes were actual
LOS in the cardiac recovery unit and quality of recovery. The groups were
comparable in selected demographics and perioperative parameters. There
were no differences in ventilation time or eligible ICU discharge time
between the groups. Remifentanil patients received more morphine than did
the sufentanil patients during recovery (20 mg v 10 mg; p = 0.040). No
difference was found in pharmacologic support or use of a pacemaker.
Conclusion In a fast-track protocol, remifentanil did not seem to be
superior to a standard moderate- to high-dose sufentanil
regimen. Copyright © 2016 Elsevier Inc.

<6>
Accession Number
629252264
Title
What is the best graft to supplement the bilateral internal thoracic
artery to the left coronary system? A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 56 (1) (pp 21-29), 2019. Date
of Publication: 2019.
Author
Di Mauro M.; Lorusso R.; Di Franco A.; Foschi M.; Rahouma M.; Soletti G.;
Calafiore A.M.; Gaudino M.
Institution
(Di Mauro, Foschi) Heart Department, SS Annunziata Hospital, Via dei
Vestini, Chieti 66100, Italy
(Lorusso) Cardiac Surgery Department, Maastricht University Medical
Center, Maastricht, Netherlands
(Di Franco, Rahouma, Soletti, Gaudino) Cardiothoracic Surgery Department,
New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY,
United States
(Calafiore) Cardiac Surgery Department, Fondazione 'Papa Giovanni Paolo
II', Campobasso, Italy
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This meta-analysis was designed to assess the effect of the use of
arterial conduits (ACs) versus great saphenous vein (GSV) grafts as a
third conduit for revascularization of the right coronary artery system,
in addition to the bilateral internal mammary artery on the left coronary
artery. PubMed and OVID's version of MEDLINE were searched from January
2000 to September 2017 for relevant publications. The primary end point
was the long-term mortality rate. The secondary end point was early
mortality, defined as either in-hospital death or death within 30 days
after the operation. Meta-regression was used to evaluate the effect of
female gender and diabetes on the primary and secondary outcomes. A total
of 10 studies (4121 patients) were selected for the systematic review and
meta-analysis comparing ACs (1619) versus the GSV (2502), 6 (2548)
comparing the GSV (2548) versus the right gastroepiploic artery (1023) and
5 comparing the GSV (2548) versus the radial artery (596). The pooled
analysis did not show any difference between ACs and the GSV in terms of
long-term mortality rates [hazard ratio (HR) = 0.75, 95% confidence
interval (CI) = 0.56-1.01; P = 0.061]. When using the leave-one-out
analysis, after the exclusion of 1 study (outlier), ACs were significantly
associated with lower long-term mortality rates (HR = 0.67, 95% CI =
0.54-0.83; P < 0.001). When the results were stratified according to the
type of study, no differences with regard to long-term results were found
between ACs and the GSV, either in the pooled analysis of the 6 propensity
score-matched studies (HR = 0.69, 95% CI = 0.43-1.08; P = 0.107) or in the
pooled analysis of the 4 non-propensity score-matched studies (HR = 0.88,
95% CI = 0.62-1.23; P = 0.438). Again, when the outlier was excluded, the
pooled analysis of the propensity score-matched studies confirmed that ACs
were associated with lower long-term mortality rates (HR = 0.58, 95% CI =
0.43-0.80; P < 0.001). Comparisons between the GSV and either the right
gastroepiploic artery or the radial artery showed similar results. No
publication bias was found. This meta-analysis is the first to compare the
GSV to the radial artery and the right gastroepiploic artery for right
coronary artery grafting in patients receiving a bilateral internal
mammary artery to left coronary artery. The choice of a third AC seems to
be preferable in order to achieve better long-term survival. Copyright
© 2019 The Author(s). Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<7>
Accession Number
629252250
Title
Surgical aortic valve replacement and patient-prosthesis mismatch: A
meta-analysis of 108 182 patients.
Source
European Journal of Cardio-thoracic Surgery. 56 (1) (pp 44-54), 2019. Date
of Publication: 2019.
Author
Sa M.P.B.D.O.; De Carvalho M.M.B.; Sobral Filho D.C.; Cavalcanti L.R.P.;
Rayol S.D.C.; Diniz R.G.S.; Menezes A.M.; Clavel M.-A.; Pibarot P.; Lima
R.C.
Institution
(Sa, Cavalcanti, Rayol, Diniz, Menezes, Lima) Division of Cardiovascular
Surgery of Pronto Socorro Cardiologico de Pernambuco - PROCAPE, Av. Eng.
Domingos Ferreira no 4172, Recife, Pernambuco 51021-040, Brazil
(Sa, De Carvalho, Sobral Filho, Cavalcanti, Rayol, Diniz, Menezes, Lima)
University of Pernambuco - UPE, Recife, Brazil
(Sa, De Carvalho, Sobral Filho, Lima) Nucleus of Postgraduate and Research
in Health Sciences, Faculty of Medical Sciences and Biological Sciences
Institute - FCM/ICB, Recife, Brazil
(Clavel, Pibarot) Institut Universitaire de Cardiologie et de Pneumologie
de Quebec, Universite Laval, Canada
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Objectives: This study sought to evaluate the impact of patient-prosthesis
mismatch (PPM) on the risk of perioperative, early-, mid- and long-term
mortality rates after surgical aortic valve replacement. Method(s):
Databases were searched for studies published until March 2018. The main
outcomes of interest were perioperative mortality, 1-year mortality,
5-year mortality and 10-year mortality. Result(s): The search yielded
3761 studies for inclusion. Of these, 70 articles were analysed, and their
data were extracted. The total number of patients included was 108 182 who
underwent surgical aortic valve replacement. The incidence of PPM after
surgical aortic valve replacement was 53.7% (58 116 with PPM and 50 066
without PPM). Perioperative mortality [odds ratio (OR) 1.491, 95%
confidence interval (CI) 1.302-1.707; P < 0.001], 1-year mortality (OR
1.465, 95% CI 1.277-1.681; P < 0.001), 5-year mortality (OR 1.358, 95% CI
1.218-1.515; P < 0.001) and 10-year mortality (OR 1.534, 95% CI
1.290-1.825; P < 0.001) were increased in patients with PPM. Both severe
PPM and moderate PPM were associated with increased risk of perioperative
mortality, 1-year mortality, 5-year mortality and 10-year mortality when
analysed together and separately, although we observed a higher risk in
the group with severe PPM. Conclusion(s): Moderate/severe PPM
increases perioperative, early-, mid- and long-term mortality rates
proportionally to its severity. The findings of this study support the
implementation of surgical strategies to prevent PPM in order to decrease
mortality rates. Copyright © 2019 The Author(s). Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<8>
Accession Number
2001425748
Title
Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent
Implantation: The ULTIMATE Trial.
Source
Journal of the American College of Cardiology. 72 (24) (pp 3126-3137),
2018. Date of Publication: 18 December 2018.
Author
Zhang J.; Gao X.; Kan J.; Ge Z.; Han L.; Lu S.; Tian N.; Lin S.; Lu Q.; Wu
X.; Li Q.; Liu Z.; Chen Y.; Qian X.; Wang J.; Chai D.; Chen C.; Li X.;
Gogas B.D.; Pan T.; Shan S.; Ye F.; Chen S.-L.
Institution
(Zhang, Gao, Kan, Ge, Tian, Lin, Liu, Pan, Shan, Ye, Chen) Department of
Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing,
China
(Han, Wang) Department of Cardiology, Changshu NO.1 People's Hospital,
Changshu, China
(Lu, Chai) Department of Cardiology, The First People's Hospital of
Taicang, Taicang, China
(Lu) Department of Cardiology, The Second Hospital of Shandong University,
Jinan, China
(Wu, Chen) Department of Cardiology, Wuxi Third People's Hospital, Wuxi,
China
(Li, Li) Department of Cardiology, Changzhou Traditional Chinese Medicine
Hospital, Changzhou, China
(Chen) Department of Cardiology, Fuwai Central China Cardiovascular
Hospital, Zhengzhou, China
(Qian) Department of Cardiology, The First People's Hospital of
Zhangjiagang, Zhangjiagang, China
(Gogas) Department of Cardiology, Emory University Hospital, Atlanta,
Georgia
Publisher
Elsevier USA
Abstract
Background: Intravascular ultrasound (IVUS)-guided drug-eluting stent
(DES) implantation is associated with fewer major adverse cardiovascular
events compared with angiography guidance for patients with individual
lesion subset. However, the beneficial effect on major adverse
cardiovascular event outcome of IVUS guidance over angiography guidance in
all-comers who undergo DES implantation still remains understudied.
 Objective(s): This study aimed to determine the benefits of IVUS
guidance over angiography guidance during DES implantation in all-comer
patients. Method(s): A total of 1,448 all-comer patients who required
DES implantation were randomly assigned (1:1 ratio) to either an IVUS
guidance or angiography guidance group. The primary endpoint was
target-vessel failure (TVF) at 12 months, including cardiac death,
target-vessel myocardial infarction, and clinically driven target-vessel
revascularization (TVR). The procedure was defined as a success if all
IVUS-defined optimal criteria were met. Result(s): At 12 months
follow-up, 60 TVFs (4.2%) occurred, with 21 (2.9%) in the IVUS group and
39 (5.4%) in the angiography group (hazard ratio [HR]: 0.530; 95%
confidence interval [CI]: 0.312 to 0.901; p = 0.019). In the IVUS group,
TVF was recorded in 1.6% of patients with successful procedures, compared
with 4.4% in patients who failed to achieve all optimal criteria (HR:
0.349; 95% CI: 0.135 to 0.898; p = 0.029). The significant reduction of
clinically driven target-lesion revascularization or definite stent
thrombosis (HR: 0.407; 95% CI: 0.188 to 0.880; p = 0.018) based on
lesion-level analysis by IVUS guidance was not achieved when the
patient-level analysis was performed. Conclusion(s): The present
study demonstrates that IVUS-guided DES implantation significantly
improved clinical outcome in all-comers, particularly for patients who had
an IVUS-defined optimal procedure, compared with angiography guidance.
(Intravascular Ultrasound Guided Drug Eluting Stents Implantation in
"All-Comers" Coronary Lesions [ULTIMATE]; NCT02215915) Copyright
© 2018 American College of Cardiology Foundation

<9>
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.

<10>
Accession Number
2002381750
Title
Efficacy and Safety of Ultrathin, Bioresorbable-Polymer Sirolimus-Eluting
Stents Versus Thin, Durable-Polymer Everolimus-Eluting Stents for Coronary
Revascularization of Patients With Diabetes Mellitus.
Source
American Journal of Cardiology. 124 (7) (pp 1020-1026), 2019. Date of
Publication: 1 October 2019.
Author
Waksman R.; Shlofmitz E.; Windecker S.; Koolen J.J.; Saito S.; Kandzari
D.; Kolm P.; Lipinski M.J.; Torguson R.
Institution
(Waksman, Shlofmitz, Kolm, Lipinski, Torguson) MedStar Washington Hospital
Center, Washington, DC, United States
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Saito) Shonan Kamakura General Hospital, Kamakura, Japan
(Saito) Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia, Georgia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with diabetes mellitus are prone to increased adverse outcomes
after percutaneous coronary intervention, even with contemporary
drug-eluting stents. Randomized controlled trials have demonstrated
comparable clinical outcomes between an ultrathin bioresorbable-polymer
sirolimus-eluting stent (BP-SES) and a thin-strut durable-polymer
everolimus-eluting stent (DP-EES) that has specific labeling for patients
with diabetes. We aimed to evaluate the safety and efficacy of the BP-SES
in patients with diabetes mellitus. To determine the performance of the
BP-SES in diabetic patients, patient-level data from the BIOFLOW II, IV,
and V randomized controlled trials were pooled. The primary end point was
target lesion failure (TLF), defined as the composite of cardiovascular
death, target-vessel myocardial infarction, ischemia-driven target lesion
revascularization, and definite or probable stent thrombosis, at 1 year.
Among 1,553 BP-SES and 791 DP-EES patients, 757 diabetic patients were
identified. Of the diabetic patients included in this analysis (494 BP-SES
vs 263 DP-EES), the proportion of insulin- and noninsulin-treated patients
was similar between groups. The 1-year TLF rate in the diabetic population
was 6.3% in the BP-SES group and 8.7% in the DP-EES group (hazard ratio
0.82, 95% confidence interval 0.047 to 1.43, p = 0.493). There were no
significant differences, based on stent type or diabetes treatment
regimen, in TLF hazards. In a patient-level pooled analysis of the
diabetic population from randomized trials, 1-year clinical safety and
efficacy outcomes were similar in patients treated with ultrathin BP-SES
and thin-strut DP-EES. Copyright © 2019

<11>
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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. 31 (4) (pp 378-384), 2019. Date
of Publication: 01 Oct 2019.
Author
Khozhenko A.; Lamperti M.; Terracina S.; Bilotta F.
Institution
(Khozhenko, Lamperti) Department of General Anesthesiology, Cleveland
Clinic Abu Dhabi, Sowwah Square, Abu Dhabi 112412, 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 ©
2019 Wolters Kluwer Health, Inc. All rights reserved.

<12>
Accession Number
629276315
Title
Multimodal cardioprotective strategy in cardiac surgery (the ProCCard
trial): Study protocol for a multicenter randomized controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 560. Date of
Publication: 11 Sep 2019.
Author
Chiari P.; Durand M.; Desebbe O.; Fischer M.-O.; Lena-Quintard D.; Palao
J.-C.; Mercier C.; Samson G.; Varillon Y.; Pozzi M.; Mewton N.;
Maucort-Boulch D.; Ovize M.; Fellahi J.-L.
Institution
(Chiari, Fellahi) Service d'Anesthesie-Reanimation, Hopital Louis Pradel,
Hospices Civils de Lyon, Lyon F-69677, France
(Chiari, Mewton, Ovize, Fellahi) Inserm U1060, Laboratoire CarMeN, IHU
OPeRa, Lyon F-69394, France
(Durand) Pole d'Anesthesie-Reanimation, Hopital Albert Michallon, Centre
Hospitalier Universitaire de Grenoble-Alpes, Grenoble F-38043, France
(Desebbe) Service d'Anesthesie-Reanimation, Clinique de la Sauvegarde,
Ramsay Generale de Sante, Lyon F-69009, France
(Fischer) Service d'Anesthesie-Reanimation, Centre Hospitalier
Universitaire de Caen, Caen F-14033, France
(Fischer) Universite de Normandie, UNICAEN, Caen, France
(Lena-Quintard) Service d'Anesthesie-Reanimation, Institut Arnault Tzanck,
Saint Laurent du Var F-06721, France
(Palao) Service d'Anesthesie-Reanimation, Hopital Nord, Centre Hospitalier
Universitaire de Saint Etienne, Saint Etienne F-42277, France
(Mercier, Maucort-Boulch) Service de Biostatistique - Bioinformatique,
Pole Sante Publique, Hospices Civils de Lyon, Lyon F-69003, France
(Mercier, Maucort-Boulch) Universite de Lyon, Lyon F-69000, France
(Mercier, Maucort-Boulch) Universite Lyon 1, Villeurbanne F-69100, France
(Mercier, Maucort-Boulch) CNRS, UMR5558, Laboratoire de Biometrie et
Biologie Evolutive, Equipe Biostatistique-Sante, Villeurbanne F-69100,
France
(Samson, Varillon, Mewton, Ovize) Centre d'Investigation Clinique de Lyon
(CIC 1407 Inserm), Hospices Civils de Lyon, Lyon F-69677, France
(Pozzi) Service de Chirurgie Cardiaque, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon F-69677, France
(Mewton) Service d'Insuffisance Cardiaque, Lyon, France
(Ovize) Service d'Explorations Fonctionnelles Cardiovasculaires, Lyon,
France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Myocardial damage in patients undergoing cardiac surgery
increases both morbidity and mortality. Different protective strategies
dealing with either preconditioning or postconditioning or assessing a
single aspect of cardioprotection have shown conflicting results. We
tested the hypothesis that a multimodal approach would improve
cardioprotection and limit myocardial damage following cardiac surgery
with cardiopulmonary bypass. Method(s): This study is a pragmatic
multicenter (six French institutions), prospective, randomized,
single-blinded, controlled trial. The randomization is stratified by
centers. In the study, 210 patients scheduled for aortic valve surgery
with or without coronary artery bypass grafting will be assigned to a
control or a treatment group (105 patients in each group). In the control
group, patients receive total intravenous anesthesia with propofol and
liberal intraoperative blood glucose management (initiation of insulin
infusion when blood glucose, measured every 60 min, is greater than 180
mg/dl), as a standard of care. The treatment group receives a bundle of
care combining five techniques of cardioprotection: (1) remote ischemic
preconditioning applied before aortic cross-clamping; (2) maintenance of
anesthesia with sevoflurane; (3) tight intraoperative blood glucose
management (initiation of insulin infusion when blood glucose, measured
every 30 min, is greater than 140 mg/dl); (4) moderate respiratory
acidosis (pH 7.30) at the end of cardiopulmonary bypass; and (5) a gentle
reperfusion protocol following aortic unclamping. The primary outcome is
myocardial damage measured by postoperative 72-h area under the curve of
high-sensitivity cardiac troponin I. Discussion(s): The ProCCard
study will be the first multicenter randomized controlled trial aiming to
assess the role of a bundle of care combining several cardioprotective
strategies to reduce myocardial damage in patients undergoing cardiac
surgery with cardiopulmonary bypass. Trial registration:
ClinicalTrials.gov, NCT03230136. Registered on July 26, 2017. Last updated
on April 17, 2019. Copyright © 2019 The Author(s).

<13>
Accession Number
2002902141
Title
Improving Communication in Heart Failure Patient Care.
Source
Journal of the American College of Cardiology. 74 (13) (pp 1682-1692),
2019. Date of Publication: 1 October 2019.
Author
Goldstein N.E.; Mather H.; McKendrick K.; Gelfman L.P.; Hutchinson M.D.;
Lampert R.; Lipman H.I.; Matlock D.D.; Strand J.J.; Swetz K.M.; Kalman J.;
Kutner J.S.; Pinney S.; Morrison R.S.
Institution
(Goldstein, Mather, McKendrick, Gelfman, Morrison) Brookdale Department of
Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Goldstein, Gelfman, Morrison) James J. Peters Veterans Affairs Medical
Center, Bronx, NY, United States
(Hutchinson) Division of Cardiovascular Medicine, Sarver Heart Center,
University of Arizona College of Medicine Tucson, Tucson, AZ, United
States
(Lampert) Department of Internal Medicine, Section of Cardiology, Yale
University School of Medicine, New Haven, CT, United States
(Lipman) Hackensack University Medical Center, Hackensack, NJ, United
States
(Lipman) Hackensack Meridian School of Medicine at Seton Hall, Nutley, NJ,
United States
(Matlock, Kutner) Division of General Internal Medicine, Department of
Medicine, University of Colorado School of Medicine, Aurora, CO, United
States
(Matlock) VA Eastern Colorado Geriatric Research Education and Clinical
Center, Denver, CO, United States
(Strand) Division of General Internal Medicine, Department of Medicine,
Center for Palliative Medicine, Mayo Clinic, Rochester, MN, United States
(Swetz) Birmingham Veterans Affairs Medical Center, Department of Medicine
and UAB Center for Palliative and Supportive Care, University of Alabama
Birmingham, Birmingham, AL, United States
(Kalman) Lenox Hill Hospital, Northwell Health, New York, NY, United
States
(Pinney) Division of Cardiology, Samuel Bronfman Department of Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Although implantable cardioverter-defibrillators (ICDs) reduce
sudden death, these patients die of heart failure (HF) or other diseases.
To prevent shocks at the end of life, clinicians should discuss
deactivating the defibrillation function. Objective(s): The purpose
of this study was to determine if a clinician-centered teaching
intervention and automatic reminders increased ICD deactivation
discussions and increased device deactivation. Method(s): In this
6-center, single-blinded, cluster-randomized, controlled trial, primary
outcomes were proportion of patients: 1) having ICD deactivation
discussions; and 2) having the shocking function deactivated. Secondary
outcomes included goals of care conversations and advance directive
completion. Result(s): A total of 525 subjects were included with
advanced HF who had an ICD: 301 intervention and 224 control. At baseline,
52% (n = 272) were not candidates for advanced therapies (i.e., cardiac
transplant or mechanical circulatory support). There were no differences
in discussions (41 [14%] vs. 26 [12%]) or deactivation (33 [11%] vs. 26
[12%]). In pre-specified subgroup analyses of patients who were not
candidates for advanced therapies, the intervention increased deactivation
discussions (32 [25%] vs. 16 [11%]; odds ratio: 2.90; p = 0.003). Overall,
99 patients died; there were no differences in conversations or
deactivations among decedents. Secondary Outcomes: Among all
participants, there was an increase in goals of care conversations (47%
intervention vs. 38% control; odds ratio: 1.53; p = 0.04). There were no
differences in completion of advance directives. Conclusion(s): The
intervention increased conversations about ICD deactivation and goals of
care. HF clinicians were able to apply new communication techniques based
on patients' severity of illness. (An Intervention to Improve Implantable
Cardioverter-Defibrillator Deactivation Conversations [WISDOM];
NCT01459744) Copyright © 2019

<14>
Accession Number
629333585
Title
Impact of Perioperative Levosimendan Administration on Risk of Bleeding
After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials.
Source
American journal of cardiovascular drugs : drugs, devices, and other
interventions. (no pagination), 2019. Date of Publication: 16 Sep 2019.
Author
Yan S.-B.; Wang X.-Y.; Shang G.-K.; Wang Z.-H.; Deng Q.-M.; Song J.-W.;
Sai W.-W.; Song M.; Zhong M.; Zhang W.
Institution
(Yan, Shang, Wang, Deng, Song, Sai, Song, Zhong, Zhang) The Key Laboratory
of Cardiovascular Remodeling and Function Research, Chinese Ministry of
Education, Chinese National Health Commission and Chinese Academy of
Medical Sciences, The State and Shandong Province Joint Key Laboratory of
Translational Cardiovascular Medicine, Department of Cardiology, Qilu
Hospital of Shandong University, No.107, Wen Hua Xi Road, Jinan, 250012,
China
(Wang) Department of Pharmacy, Qilu Children's Hospital of Shandong
University, Children's Hospital of Jinan, Jinan, Shandong, China
(Wang) Department of Geriatric Medicine, Qilu Hospital of Shandong
University, Key Laboratory of Cardiovascular Proteomics of Shandong
Province, Jinan, Shandong, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Levosimendan, a calcium sensitizer and potassium channel
opener, has been demonstrated to improve myocardial function without
increasing oxygen consumption and to show protective effects in other
organs. Recently, a prospective, randomized controlled trial (RCT)
revealed an association between levosimendan use and a possible increased
risk of bleeding postoperatively. Levosimendan's anti-platelet effects
have been shown in in vitro studies. Current studies do not provide
sufficient data to support a relation between perioperative levosimendan
administration and increased bleeding risk. PURPOSE: Our goal was to
investigate the relation between perioperative levosimendan administration
and increased bleeding risk using a meta-analysis study design.
 METHOD(S): The PubMed, Ovid, EMBASE and Cochrane Library databases
were searched for relevant RCTs before July 1, 2019. The outcome
parameters included reoperation secondary to increased bleeding in the
postoperative period, the amount of postoperative recorded blood loss, and
the need for transfusion of packed red blood cells (RBCs) and other blood
products. RESULT(S): A total of 1160 patients in nine RCTs (576 in
the levosimendan group and 584 in the control group) were included
according to our inclusion criteria. Analysis showed that perioperative
levosimendan administration neither increased the rate of reoperation
secondary to bleeding nor increased the amount of postoperative chest tube
drainage when compared with the control group. In terms of blood product
transfusion, levosimendan did not influence the requirement for RBC
transfusion, platelet transfusion nor fresh frozen plasma (FFP)
transfusion. Levosimendan also did not shorten or prolong the aortic
cross-clamp time or the cardiopulmonary bypass time. CONCLUSION(S):
The analyzed parameters, including reoperations due to bleeding,
postoperative chest drainage and the requirement for blood products,
revealed that levosimendan did not increase postoperative bleeding risk.
More studies with a larger sample size are needed to address a more
reliable conclusion due to study limitations.

<15>
Accession Number
629332546
Title
The Smoker's Paradox Revisited: A Patient-Level Pooled Analysis of 18
Randomized Controlled Trials.
Source
JACC. Cardiovascular interventions. (no pagination), 2019. Date of
Publication: 05 Sep 2019.
Author
Yadav M.; Mintz G.S.; Genereux P.; Liu M.; McAndrew T.; Redfors B.;
Madhavan M.V.; Leon M.B.; Stone G.W.
Institution
(Yadav) Department of Medicine, Division of Cardiology, Bronx Lebanon
Hospital Center, NY
(Mintz, Liu, McAndrew, Redfors) Clinical Trials Center, Cardiovascular
Research Foundation, NY
(Genereux) Clinical Trials Center, Cardiovascular Research Foundation, New
York, New York; Gagnon Cardiovascular Institute, Morristown Medical
Center, Morristown, New Jersey; Hopital du Sacre-Coeur de Montreal,
Montreal, Canada
(Madhavan) Department of Medicine, Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Medical Center, NY
(Leon) Clinical Trials Center, Cardiovascular Research Foundation, New
York, New York; Department of Medicine, Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Medical Center, New
York, New York
(Stone) Clinical Trials Center, Cardiovascular Research Foundation, New
York, New York; Department of Medicine, Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Medical Center, New
York, New York. Electronic address: gs2184@columbia.edu
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The study examined the smoker's paradox using patient-level
data from 18 prospective, randomized trials of patients undergoing
percutaneous coronary intervention (PCI) with stent implantation.
BACKGROUND: Studies on the effects of smoking and outcomes among patients
undergoing PCI have reported conflicting results. METHOD(S): Data
from the RAVEL, E-SIRIUS, SIRIUS, C-SIRIUS, TAXUS IV and V, ENDEAVOR II to
IV, SPIRIT II to IV, HORIZONS-AMI, COMPARE I and II, PLATINUM, and TWENTE
I and II randomized trials were pooled. Patients were stratified by
smoking status at time of enrollment. One- and 5-year ischemic outcomes
were compared. RESULT(S): Among 24,354 patients with available data
on smoking status, 6,722 (27.6%) were current smokers. Smokers were
younger and less likely to have diabetes mellitus; hypertension;
hyperlipidemia; or prior myocardial infarction (MI), PCI, or coronary
artery bypass grafting. Angiographically, smokers had longer lesions, more
complex lesions, and more occlusions, but were less likely to have
moderate or severe calcification or tortuosity. At 5 years, smokers had
significantly higher rates of MI (7.8% vs. 5.6%; p < 0.0001) and definite
or probable stent thrombosis (3.5% vs. 1.8%; p < 0.0001); however, there
were no differences in the rates of death, cardiac death, target lesion
revascularization, or composite endpoints (cardiac death, target vessel
MI, or ischemic target lesion revascularization). After multivariable
adjustment for potential confounders, smoking was a strong independent
predictor of death (hazard ratio [HR]: 1.86, 95% confidence interval [CI]:
1.63 to 2.12; p < 0.0001), cardiac death (HR: 1.68; 95% CI: 1.38 to 2.05;
p < 0.0001), MI (HR: 1.38; 95% CI: 1.20 to 1.58; p < 0.0001), stent
thrombosis (HR: 1.60; 95% CI: 1.28 to 1.99; p < 0.0001), and target lesion
failure (HR: 1.17; 95% CI: 1.05 to 1.30; p = 0.005). CONCLUSION(S):
The present large, patient-level, pooled analysis with 5-year follow-up
clearly demonstrates smoking to be an important predictor of adverse
outcomes after PCI. Copyright © 2019 American College of
Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

<16>
Accession Number
629332407
Title
Three-Year Outcomes of the DKCRUSH-V Trial Comparing DK Crush With
Provisional Stenting for Left Main Bifurcation Lesions.
Source
JACC. Cardiovascular interventions. (no pagination), 2019. Date of
Publication: 05 Sep 2019.
Author
Chen X.; Li X.; Zhang J.-J.; Han Y.; Kan J.; Chen L.; Qiu C.; Santoso T.;
Paiboon C.; Kwan T.W.; Sheiban I.; Leon M.B.; Stone G.W.; Chen S.-L.
Institution
(Chen, Li, Zhang, Kan) Division of Cardiology, Nanjing First Hospital,
Nanjing Medical University, Nanjing, China
(Han) Division of Cardiology, Shenyang Northen Hospital, Shenyang, China
(Chen) Division of Cardiology, United Hospital, Fujian Medical University,
Fuzhou, China
(Qiu) Division of Cardiology, Zhengzhou University First Hospital,
Zhengzhou, China
(Santoso) Division of Cardiology, Medistra Hospital, University of
Indonesia Medical School, Jakarta, Indonesia
(Paiboon) Division of Cardiology, Bangkok General Hospital, Bangkok,
Thailand
(Kwan) Division of Cardiology, Beth Israel Hospital, NY
(Sheiban) Division of Cardiology, Verona, Italy
(Leon) Division of Cardiology, Columbia University Medical Center and the
Cardiovascular Research Foundation, NY
(Stone) Division of Cardiology, Columbia University Medical Center and the
Cardiovascular Research Foundation, NY
(Chen) Division of Cardiology, Nanjing First Hospital, Nanjing Medical
University, Nanjing, China; Key Laboratory of Cardiovascular and
Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University,
Nanjing, China. Electronic address: chmengx@126.com
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The present study aimed to investigate the difference in
target lesion failure (TLF) at 3 years after double kissing (DK) crush
stenting versus provisional stenting (PS) for unprotected left main distal
bifurcation (UPLMb) lesions. BACKGROUND: The multicenter and randomized
DKCRUSH-V (Double Kissing Crush versus Provisional Stenting for Left Main
Distal Bifurcation Lesions: The DKCRUSH-V Randomized Trial) study showed
fewer 1-year TLF after DK crush for UPLMb lesions compared with PS. The
study reports the 3-year clinical outcome of the DKCRUSH-V study.
 METHOD(S): A total of 482 patients with UPLMb lesions who were
randomly assigned to either the DK crush group (DK group) or PS group in
the DKCRUSH-V study were followed for 3 years. The primary endpoint was
the occurrence of a TLF at 3 years. Stent thrombosis (ST) was the safety
endpoint. Patients were classified by lesion's complexity and NERS (New
Risk Stratification) II or SYNTAX (Synergy Between Percutaneous Coronary
Intervention With TAXUS and Cardiac Surgery) score. RESULT(S): At 3
years, TLF occurred in 41 (16.9%) patients in the PS group and in 20
(8.3%) patients in the DK group (p = 0.005), mainly driven by increased
target vessel myocardial infarction (5.8% vs. 1.7%; p = 0.017) and target
lesion revascularization (10.3% vs. 5.0%; p = 0.029). Definite or probable
ST rate at 3 years was 4.1% in the PS group and 0.4% in the DK group (p =
0.006). Notably, DK crush was associated with a significant reduction in
both primary and secondary endpoints for patients with complex lesions or
at high risk. CONCLUSION(S): Provisional stenting for UPLMb lesions
was associated with significantly increased rates of TLF and ST over 3
years of follow-up. Further randomized study is warranted to confirm the
benefits of DK crush stenting for complex UPLMb lesions. (Double Kissing
and Double Crush versus Provisional T Stenting Technique for the Treatment
of Unprotected Distal Left Main True Bifurcation Lesions: A Randomized,
International, Multi-center Clinical Trial;
ChiCTR-TRC-11001213). Copyright © 2019 American College of
Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

<17>
Accession Number
629332193
Title
CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year
Follow-Up of the STICH Trial.
Source
JACC. Heart failure. (no pagination), 2019. Date of Publication: 07 Sep
2019.
Author
Howlett J.G.; Stebbins A.; Petrie M.C.; Jhund P.S.; Castelvecchio S.;
Cherniavsky A.; Sueta C.A.; Roy A.; Pina I.L.; Wurm R.; Drazner M.H.;
Andersson B.; Batlle C.; Senni M.; Chrzanowski L.; Merkely B.; Carson P.;
Desvigne-Nickens P.M.; Lee K.L.; Velazquez E.J.; Al-Khalidi H.R.
Institution
(Howlett) Libin Cardiovascular Institute and University of Calgary Medical
Centre, Calgary, Canada
(Stebbins, Lee, Al-Khalidi) Duke Clinical Research Institute and
Department of Biostatistics and Bioinformatics, Durham, NC, Canada
(Petrie, Jhund) British Heart Foundation Cardiovascular Research Centre,
University of Glasgow, Glasgow, United Kingdom
(Castelvecchio) Istituto Di Ricovero e Cura a Carattere Scientifico
Policlinico San Donato, San Donato Milanese, Milan, Italy
(Cherniavsky) E. Meshalkin National Medical Research Center of the
Ministry of Health of the Russian Federation, Novosibirsk, Russian
Federation
(Sueta) University of North Carolina School of Medicine, Chapel Hill, NC
(Roy) All India Institute of Medical Sciences, New Delhi, India
(Pina) Albert Einstein College of Medicine, Montefiore Medical Center, New
York City, NY, United States
(Wurm) Medical University of Vienna, Vienna, Austria
(Drazner) University of Texas Southwestern Medical Center, Dallas, TX,
Jamaica
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Goteborg, Sweden
(Batlle) Centro de Investigacion Cardiovascular Uruguayo Casa De Galicia,
Montevideo, Uruguay
(Senni) Papa Giovanni XXIII Hospital, Bergamo, Italy
(Chrzanowski) Medical University of Lodz, Lodz, Poland
(Merkely) Semmelweis University, Budapest, Hungary
(Carson) Washington VA Medical Center, DC, WA
(Desvigne-Nickens) Division of Cardiovascular Sciences, National
Institutes of Health, National Heart, Lung, Blood Institute, Bethesda, MD,
United States
(Velazquez) Section of Cardiovascular Medicine, Department of Internal
Medicine, Yale University School of Medicine, New Haven, CT, Jamaica
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The authors investigated the impact of coronary artery bypass
grafting (CABG) on first and recurrent hospitalization in this population.
BACKGROUND: In the STICH (Surgical Treatment for Ischemic Heart Failure)
trial, CABG reduced all-cause death and hospitalization in patients with
and ischemic cardiomyopathy and left ventricular ejection fraction <35%.
 METHOD(S): A total of 1,212 patients were randomized (610 to CABG +
optimal medical therapy [CABG] and 602 to optimal medical therapy alone
[MED] alone) and followed for a median of 9.8 years. All-cause and
cause-specific hospitalizations were analyzed as time-to-first-event and
as recurrent event analysis. RESULT(S): Of the 1,212 patients, 757
died (62.4%) and 732 (60.4%) were hospitalized at least once, for a total
of 2,549 total all-cause hospitalizations. Most hospitalizations (66.2%)
were for cardiovascular causes, of which approximately one-half (907 or
52.9%) were for heart failure. More than 70% of all hospitalizations
(1,817 or 71.3%) were recurrent events. The CABG group experienced fewer
all-cause hospitalizations in the time-to-first-event (349 CABG vs. 383
MED, adjusted hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.74
to 0.98; p = 0.03) and in recurrent event analyses (1,199 CABG vs. 1,350
MED, HR: 0.78, 95% CI: 0.65 to 0.94; p < 0.001). This was driven by fewer
total cardiovascular (CV) hospitalizations (744 vs. 968; p < 0.001,
adjusted HR: 0.66, 95% CI: 0.55 to 0.81; p = 0.001), the majority of which
were due to HF (395 vs. 512; p < 0.001, adjusted HR: 0.68, 95% CI:
0.52-0.89; p = 0.005). We did not observe a difference in non-CV events.
 CONCLUSION(S): CABG reduces all-cause, CV, and HF hospitalizations in
time-to-first-event and recurrent event analyses. (Comparison of Surgical
and Medical Treatment for Congestive Heart Failure and Coronary Artery
Disease [STICH]; NCT00023595). Copyright © 2019 American College
of Cardiology Foundation. All rights reserved.

<18>
Accession Number
629332161
Title
The REDUCE FMR Trial: A Randomized Sham-Controlled Study of Percutaneous
Mitral Annuloplasty in Functional Mitral Regurgitation.
Source
JACC. Heart failure. (no pagination), 2019. Date of Publication: 07 Sep
2019.
Author
Witte K.K.; Lipiecki J.; Siminiak T.; Meredith I.T.; Malkin C.J.; Goldberg
S.L.; Stark M.A.; von Bardeleben R.S.; Cremer P.C.; Jaber W.A.; Celermajer
D.S.; Kaye D.M.; Sievert H.
Institution
(Witte, Malkin) Leeds Institute for Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom
(Lipiecki) Clermont Ferrand, France
(Siminiak) Poznan University of Medical Sciences, HCP Medical Center,
Poznan, Poland
(Meredith) Faculty of Medicine, Nursing and Health Sciences, Monash
University, Melbourne, Australia
(Goldberg) Tyler Heart Institute at Community Hospital of the Monterey
Peninsula, Monterey, California; Cardiac Dimensions, Kirkland, Washington
(Stark) KirklandWACanada
(von Bardeleben) Department of Cardiology, University Medical Centre
Mainz, Mainz, Germany
(Cremer, Jaber) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Celermajer) Faculty of Medicine and Health, University of Sydney, NSW,
Australia
(Kaye) Department of Cardiology, Alfred Hospital, Melbourne, VIC,
Australia
(Sievert) CardioVascular Center Sankt Katherinen, Frankfurt, Germany;
Anglia Ruskin University, Chelmsford, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study sought to evaluate the effects of the Carillon
device on mitral regurgitation severity and left ventricular remodeling.
BACKGROUND: Functional mitral regurgitation (FMR) complicates heart
failure with reduced ejection fraction and is associated with a poor
prognosis. METHOD(S): In this blinded, randomized, proof-of-concept,
sham-controlled trial, 120 patients receiving optimal heart failure
medical therapy were assigned to a coronary sinus-based mitral annular
reduction approach for FMR or sham. The pre-specified primary endpoint was
change in mitral regurgitant volume at 12 months, measured by quantitative
echocardiography according to an intention-to-treat analysis.
 RESULT(S): Patients (69.8 +/- 9.5 years of age) were randomized to
either the treatment (87) or the sham-controlled (33) arm. There were no
significant differences in baseline characteristics between the groups. In
the treatment group, 73 of 87 (84%) had the device implanted. The primary
endpoint was met, with a statistically significant reduction in mitral
regurgitant volume in the treatment group compared to the control group
(decrease of 7.1 ml/beat [95% confidence interval [CI]: -11.7 to -2.5] vs.
an increase of 3.3 ml/beat [95% CI: -6.0 to 12.6], respectively; p =
0.049). Additionally, there was a significant reduction in left
ventricular volumes in patients receiving the device versus those in the
control group (left ventricular end-diastolic volume decrease of 10.4 ml
[95% CI: -18.5 to -2.4] vs. an increase of 6.5 ml [95% CI: -5.1 to 18.2];
p = 0.03 and left ventricular end-systolic volume decrease of 6.2 ml [95%
CI: -12.8 to 0.4] vs. an increase of 6.1 ml [95% CI: -1.42 to 13.6]; p =
0.04). CONCLUSION(S): The Carillon device significantly reduced
mitral regurgitant volume and left ventricular volumes in symptomatic
patients with functional mitral regurgitation receiving optimal medical
therapy. (Carillon Mitral Contour System for Reducing Functional Mitral
Regurgitation [REDUCE FMR]; NCT02325830). Copyright © 2019 The
Authors. Published by Elsevier Inc. All rights reserved.

<19>
Accession Number
629332037
Title
Social Media Improves Cardiothoracic Surgery Literature Dissemination:
Results of a Randomized Trial (Commentary).
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 12 Sep 2019.
Author
Hill A.C.
Institution
(Hill) University of California, San Francisco, Surgery, Division of
Cardiothoracic Surgery, 1 Pine Street, Suite 2410 San Francisco, CA 94111
Publisher
NLM (Medline)

<20>
Accession Number
629331671
Title
CHA<inf>2</inf>DS<inf>2</inf>-VASc Score for Identifying Patients at high
risk of Postoperative Atrial Fibrillation after Cardiac Surgery: A
Meta-analysis.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 12 Sep 2019.
Author
Chen Y.-L.; Zeng M.; Liu Y.; Xu Y.; Bai Y.; Cao L.; Ling Z.; Fan J.; Yin
Y.
Institution
(Chen, Zeng, Xu, Cao, Ling, Yin) Department of Cardiology, 2nd Affiliated
Hospital of Chongqing Medical University
(Liu) Biostatistics & Bioinformatics Shared Resource at Winship Cancer
Institute, Emory University; Department of Biostatistics & Bioinformatics,
Rollins School of Public Health, Emory University
(Bai) Department of Respiratory and Critical Care Medicine,
1(st)Affiliated Hospital of Chongqing Medical University
(Fan) Department of Cardiology, the 2nd Affiliated Hospital of Chongqing
Medical University; Department of Biomedical Engineering and Pediatrics,
Emory University
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) is a common
complication following cardiac surgery, resulting in an increased risk of
morbidity and longer hospital stay. Pharmacologic prophylaxis has been
recommended to improve outcome in patients at high risk of developing POAF
after cardiac surgery. Several studies have applied CHA2DS2-VASc score in
the risk stratification of POAF but yielded contradicting results. This
study aims to determine the association between CHA2DS2-VASc score and
POAF, and further to explore its discriminative ability for the prediction
of POAF. METHOD(S): We systematically searched the Medline, Embase,
Cochrane library and other data sources with key terms "CHA2DS2-VASc",
"atrial fibrillation" and "cardiac surgery". Studies were designed for
CHA2DS2-VASc score in stratifying the risks for POAF in patients
undergoing cardiac surgery were included. Statistical analyses were
performed using R 3.5.1 and STATA 13.0. RESULT(S): 721 studies were
identified, out of which 12 studies with 18,086 patients were finally
included in our analysis. The CHA2DS2-VASc score was found to be an
independent predictor of POAF following cardiac surgery (OR 1.46, 95% CI
1.25 to 1.72), and exhibited a relatively strong specificity (0.70, 95% CI
0.61 to 0.78) and sensitivity (0.72, 95% CI 0.54 to 0.85) for predicting
POAF. The bivariate model-based pooled area under the ROC was estimated to
be 0.76 (95% CI 0.72 to 0.79). CONCLUSION(S): The CHA2DS2-VASc score
has relatively good performance in predicting POAF after cardiac surgery
and may help identify the patients at high risk of POAF. Copyright
© 2019. Published by Elsevier Inc.

<21>
Accession Number
629331666
Title
Minimal access versus sternotomy for complex mitral valve repair: A
meta-analysis (Commentary).
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 12 Sep 2019.
Author
Mesana T.
Institution
(Mesana) University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa ON
K1Y 4W7, Canada
Publisher
NLM (Medline)

<22>
Accession Number
629329891
Title
Adjuvant Radiation Therapy for Thoracic Soft-Tissue Sarcomas: A
Population-Based Analysis.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 11 Sep 2019.
Author
Rehmani S.S.; Raad W.; Weber J.; Lazarev S.; Ayub A.; Al-Ayoubi A.M.;
Bhora F.Y.
Institution
(Rehmani, Raad, Weber, Ayub, Al-Ayoubi, Bhora) Department of Thoracic
Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health
System, NY, NY, Sweden
(Lazarev) Department of Radiation Oncology, Icahn School of Medicine at
Mount Sinai, Mount Sinai Health System, NY, NY, Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: The role of adjuvant radiation therapy (RT) in the management
of thoracic soft-tissue sarcomas (STS) remains unclear. We aimed to study
the characteristics of patients with thoracic STS who received RT
following surgical resection and investigate the impact of RT on survival
outcomes. METHOD(S): We queried National Cancer Database (NCDB) to
identify patients with surgically resected thoracic STS from 2004-2012.
Factors associated with receiving adjuvant RT were identified. Analyses
were performed to identify prognostic factors and compare overall survival
(OS) in both unmatched and propensity-score matched cohorts.
 RESULT(S): Overall 1215 patients were identified, of whom 557(45.8%)
cases received adjuvant RT. Tumor grade (OR=2.87;95%CI=2.18-3.77), tumor
size (OR=1.82;95%CI=1.36-2.42), and tumor margins
(OR=1.97;95%CI=1.43-2.72) were found to be significant predictors of
receiving RT. Mean OS of patients receiving RT in the unmatched cohort was
91 vs. 88 months for patients who did not (p=0.556). When adjusted for all
variables, adjuvant RT was found to be associated with improved survival
(HR=0.79;95%CI=0.61-0.96). Survival analysis of the matched cohort also
demonstrated improved survival with adjuvant RT (120 vs 100months,
p=0.02). Subgroup analysis in both unmatched and matched cohorts showed
patients with high-grade tumors more likely to benefit from adjuvant RT.
 CONCLUSION(S): This population-based analysis is the largest dataset
of primary thoracic STS to date and suggests significant survival benefit
associated with adjuvant RT. The improvement in overall survival was more
notable in patients with high-grade tumors. Randomized prospective studies
are warranted to further understand the benefit of RT in this
group. Copyright © 2019. Published by Elsevier Inc.

<23>
Accession Number
624502290
Title
Prospective randomized evaluation of preoperative angiotensin-converting
enzyme inhibition (PREOP-ACEI).
Source
Journal of Hospital Medicine. 13 (10) (pp 661-667), 2018. Date of
Publication: October 2018.
Author
Shiffermiller J.F.; Monson B.J.; Vokoun C.W.; Beachy M.W.; Smith M.P.;
Sullivan J.N.; Vasey A.J.; Guda P.; Lyden E.R.; Ellis S.J.; Pang H.;
Thompson R.E.
Institution
(Shiffermiller, Vokoun, Beachy, Smith, Thompson) Section of Hospital
Medicine, University of Nebraska Medical Center, Omaha, NE, United States
(Monson, Guda) Department of Internal Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
(Sullivan, Ellis, Pang) Department of Anesthesiology, University of
Nebraska Medical Center, Omaha, NE, United States
(Vasey) Division of General Internal Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
(Lyden) Department of Biostatistics, University of Nebraska Medical
Center, Omaha, NE, United States
Publisher
Society of hospital medicine
Abstract
BACKGROUND: Intraoperative hypotension is associated with an increased
risk of end organ damage and death. The transient preoperative
interruption of angiotensin-converting enzyme inhibitor (ACEI) therapy
prior to cardiac and vascular surgeries decreases the occurrence of
intraoperative hypotension. OBJECTIVE(S): We sought to compare the
effect of two protocols for preoperative ACEI management on the risk of
intraoperative hypotension among patients undergoing noncardiac,
nonvascular surgeries. DESIGN: Prospective, randomized study. SETTING:
Midwestern urban 489-bed academic medical center. PATIENTS: Patients
taking an ACEI for at least six weeks preoperatively were considered for
inclusion. INTERVENTIONS: Randomization of the final preoperative ACEI
dose to omission (n = 137) or continuation (n = 138). MEASUREMENTS: The
primary outcome was intraoperative hypotension, which was defined as any
systolic blood pressure (SBP) < 80 mm Hg. Postoperative hypotensive (SBP <
90 mm Hg) and hypertensive (SBP > 180 mm Hg) episodes were also recorded.
Outcomes were compared using Fisher's exact test. RESULT(S):
Intraoperative hypotension occurred less frequently in the omission group
(76 of 137 [55%]) than in the continuation group (95 of 138 [69%]) (RR:
0.81, 95% CI: 0.67 to 0.97, P = .03, NNH 7.5). Postoperative hypotensive
events were also less frequent in the ACEI omission group (RR: 0.49, 95%
CI: 0.28 to 0.86, P = .02) than in the continuation group. However,
postoperative hypertensive events were more frequent in the omission group
than in the continuation group (RR: 1.95, 95%: CI: 1.14 to 3.34, P = .01).
 CONCLUSION(S): The transient preoperative interruption of ACEI
therapy is associated with a decreased risk of intraoperative hypotension.
REGISTRATION: ClinicalTrials.gov: NCT01669434. Copyright © 2018
Society of Hospital Medicine.

<24>
Accession Number
623492820
Title
Dietary Nitrate Supplementation Reduces Circulating Platelet-Derived
Extracellular Vesicles in Coronary Artery Disease Patients on Clopidogrel
Therapy: A Randomised, Double-Blind, Placebo-Controlled Study.
Source
Thrombosis and Haemostasis. 118 (1) (pp 112-122), 2018. Date of
Publication: 01 Jan 2018.
Author
Burnley-Hall N.; Abdul F.; Androshchuk V.; Morris K.; Ossei-Gerning N.;
Anderson R.; Rees D.A.; James P.E.
Institution
(Burnley-Hall, Abdul, Androshchuk) Department of Biomedical Science,
School of Medicine, Cardiff University, Cardiff, United Kingdom
(Morris, James) Department of Biomedical Science, Cardiff School of Health
Sciences, Cardiff Metropolitan University, Cardiff CF5 2SG, United Kingdom
(Ossei-Gerning, Anderson) Department of Cardiology, University Hospital of
Wales, Heath Park, Cardiff, United Kingdom
(Rees) Neurosciences and Mental Health Research Institute, School of
Medicine, Cardiff University, Cardiff, United Kingdom
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Extracellular vesicles (EVs) are implicated in the pathogenesis of
cardiovascular disease (CVD). Specifically, platelet-derived EVs are
highly pro-coagulant, promoting thrombin generation and fibrin clot
formation. Nitrate supplementation exerts beneficial effects in CVD, via
an increase in nitric oxide (NO) bioavailability. Clopidogrel is capable
of producing NO-donating compounds, such as S-nitrosothiols (RSNO) in the
presence of nitrite and low pH. The aim of this study was to assess the
effect of nitrate supplementation with versus without clopidogrel therapy
on circulating EVs in coronary artery disease (CAD) patients. In this
randomized, double-blind, placebo-controlled study, CAD patients with (n =
10) or without (n = 10) clopidogrel therapy received a dietary nitrate
supplement (SiS nitrate gel) or identical placebo. NO metabolites and
platelet activation were measured using ozone-based chemiluminescence and
multiple electrode aggregometry. EV concentration and origin were
determined using nanoparticle tracking analysis and time-resolved
fluorescence. Following nitrate supplementation, plasma RSNO was elevated
(4.7 +/- 0.8 vs 0.2 +/- 0.5 nM) and thrombin-receptor mediated platelet
aggregation was reduced (-19.9 +/- 6.0 vs 4.0 +/- 6.4 U) only in the
clopidogrel group compared with placebo. Circulating EVs were
significantly reduced in this group (-1.183e 11 +/- 3.15e
10 vs -9.93e 9 +/- 1.84e 10 EVs/mL),
specifically the proportion of CD41+ EVs (-2,120 +/- 728 vs 235 +/- 436
RFU [relative fluorescence unit]) compared with placebo. In vitro
experiments demonstrated clopidogrel-SNO can reduce platelet-EV directly
(6.209e 10 +/- 4.074e 9 vs 3.94e 11 +/-
1.91e 10 EVs/mL). In conclusion, nitrate supplementation
reduces platelet-derived EVs in CAD patients on clopidogrel therapy,
increasing patient responsiveness to clopidogrel. Nitrate supplementation
may represent a novel approach to moderating the risk of thrombus
formation in CAD patients. Copyright © 2018 Schattauer.

<25>
Accession Number
613231151
Title
Transcatheter Aortic Valve Replacement With Early- and New-Generation
Devices in Bicuspid Aortic Valve Stenosis.
Source
Journal of the American College of Cardiology. 68 (11) (pp 1195-1205),
2016. Date of Publication: 13 Sep 2016.
Author
Yoon S.-H.; Lefevre T.; Ahn J.-M.; Perlman G.Y.; Dvir D.; Latib A.;
Barbanti M.; Deuschl F.; De Backer O.; Blanke P.; Modine T.; Pache G.;
Neumann F.-J.; Ruile P.; Arai T.; Ohno Y.; Kaneko H.; Tay E.; Schofer N.;
Holy E.W.; Luk N.H.V.; Yong G.; Lu Q.; Kong W.K.F.; Hon J.; Kao H.-L.; Lee
M.; Yin W.-H.; Park D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.; Lee C.W.;
Park S.-W.; Kim H.-S.; Butter C.; Khalique O.K.; Schaefer U.; Nietlispach
F.; Kodali S.K.; Leon M.B.; Ye J.; Chevalier B.; Leipsic J.; Delgado V.;
Bax J.J.; Tamburino C.; Colombo A.; Sondergaard L.; Webb J.G.; Park S.-J.
Institution
(Yoon, Ahn, Park, Kang, Lee, Kim, Lee, Park, Park) Division of Cardiology,
University of Ulsan, Asan Medical Center, Seoul, Korea, South Korea
(Lefevre, Arai, Chevalier) Generale de Sante, Institut Cardiovasculaire
Paris Sud, Hopital Prive Jacques Cartier, Massy, France
(Perlman, Dvir, Blanke, Ye, Leipsic, Webb) Department of Cardiology, St
Paul's Hospital, University of British Columbia, Vancouver, British
Columbia, Canada
(Latib, Colombo) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, San Raffaele Scientific Institute, Italy San Raffaele Hospital,
Milan, Italy
(Barbanti, Ohno, Tamburino) Division of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Deuschl, Schofer, Schaefer) Department for General and Interventional
Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf
(UKE), Hamburg, Germany
(De Backer, Luk, Sondergaard) The Heart Centre, Rigshospitalet University
Hospital, Copenhagen, Denmark
(Modine) Department of Cardiovascular Surgery, Hospital Cardiologique,
Lille, France
(Pache) Department of Radiology, Section of Cardiovascular Radiology,
University of Freiburg, Bad Krozingen, Germany
(Neumann, Ruile) Department of Cardiology & Angiology II, University Heart
Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Kaneko, Butter) Heart Center Brandenburg in Bernau, Bernau, Germany
(Tay, Kong, Hon) Department of Cardiology, National University Heart
Centre, Singapore
(Holy, Nietlispach) University Heart Center, Cardiology and Cardiovascular
Surgery, University Hospital Zurich, Zurich, Switzerland
(Yong) Division of Cardiology, Royal Perth Hospital, Perth, Western
Australia, Australia
(Lu) Division of Vascular Surgery, Changhai Hospital, Shanghai, China
(Kong) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Kao, Delgado, Bax) Department of Internal Medicine, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
(Lee) Division of Cardiology, Queen Elizabeth Hospital, Kowloon, Hong Kong
(Yin) Division of Cardiology, Heart Center, Cheng Hsin General Hospital,
Taipei, Taiwan (Republic of China)
(Kim) Department of Internal Medicine and Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Khalique, Kodali, Leon) Columbia University Medical Center/New York
Presbyterian Hospital, New York, New York, United States
Publisher
Elsevier USA
Abstract
Background Few studies have evaluated the clinical outcomes of
transcatheter aortic valve replacement (TAVR) in patients with bicuspid
aortic valve stenosis (AS). Particularly, limited data exist comparing the
results of TAVR with new-generation devices versus early-generation
devices. Objectives This study sought to evaluate the clinical outcomes of
TAVR for bicuspid AS with early- and new-generation devices. Methods The
Bicuspid TAVR Registry is an international multicenter study enrolling
consecutive patients with bicuspid AS undergoing TAVR between April 2005
and May 2015. Results Of 301 patients, 199 patients (71.1%) were treated
with early-generation devices (Sapien XT [Edwards Lifesciences
Corporation, Irvine, California]: n = 87; CoreValve [Medtronic,
Minneapolis, Minnesota]: n = 112) and 102 with new-generation devices
(Sapien 3 [Edwards Lifesciences Corporation]: n = 91; Lotus [Boston
Scientific Corporation, Marlborough, Massachusetts]: n = 11). The mean
Society of Thoracic Surgeons score was 4.7 +/- 5.2 without significant
differences between groups (4.6 +/- 5.1 vs. 4.9 +/- 5.4; p = 0.57).
Overall, all-cause mortality rates were 4.3% at 30 days and 14.4% at 1
year. Moderate or severe paravalvular leak was absent and significantly
less frequent with new-generation compared to early-generation devices
(0.0% vs. 8.5%; p = 0.002), which resulted in a higher device success rate
(92.2% vs. 80.9%; p = 0.01). There were no differences between early- and
new-generation devices in stroke (2.5% vs. 2.0%; p > 0.99),
life-threatening bleeding (3.5% vs. 2.9%; p > 0.99), major vascular
complication (4.5% vs. 2.9%; p = 0.76), stage 2 to 3 acute kidney injury
(2.5% vs. 2.9%; p > 0.99), early safety endpoints (15.1% vs. 10.8%; p =
0.30), and 30-day all-cause mortality (4.5% vs. 3.9%; p > 0.99).
Conclusions The clinical outcomes of TAVR in patients with bicuspid AS
were favorable. New-generation devices were associated with less
paravalvular leak and, hence, a higher device success rate than
early-generation devices. (The Bicuspid Aortic Stenosis Following
Transcatheter Aortic Valve Replacement Registry [Bicuspid TAVR];
NCT02394184) Copyright © 2016 American College of Cardiology
Foundation

<26>
Accession Number
629195233
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) (no pagination), 2019. Article Number: e029537. Date of
Publication: 01 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, 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 and Laboratory Medicine, University of
Calgary, Calgary, AB, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
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. Results 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 (I 2 =61%). Conclusions
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.

<27>
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.

<28>
Accession Number
2002842879
Title
Safety of a restrictive versus liberal approach to red blood cell
transfusion on the outcome of aki in patients undergoing cardiac surgery:
A randomized clinical trial.
Source
Journal of the American Society of Nephrology. 30 (7) (pp 1294-1304),
2019. Date of Publication: 2019.
Author
Garg A.X.; Badner N.; Bagshaw S.M.; Cuerden M.S.; Fergusson D.A.; Gregory
A.J.; Hall J.; Hare G.M.T.; Khanykin B.; McGuinness S.; Parikh C.R.;
Roshanov P.S.; Shehata N.; Sontrop J.M.; Syed S.; Tagarakis G.I.; Thorpe
K.E.; Verma S.; Wald R.; Whitlock R.P.; Mazer C.D.
Institution
(Garg, Cuerden, Sontrop) Division of Nephrology, Department of Medicine,
London Health Sciences Centre and Western University, Westminster Tower,
800 Commissioner's Road East, ELL-215, London, ON N6A 4G5, Canada
(Badner) Department of Anesthesia and Clinical Pharmacology, University of
British Columbia, Kelowna, BC, Canada
(Bagshaw) Department of Critical Care Medicine, University of Alberta,
Edmonton, AB, Canada
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine,
University of Calgary, Calgary, AB, Canada
(Hall, Hare, Thorpe, Verma, Wald, Mazer) Li Ka Shing Knowledge Institute,
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Khanykin) Cardiothoracic Anesthesiology Department, Copenhagen University
Hospital, Copenhagen, Denmark
(McGuinness) Cardiothoracic and Vascular Intensive Care and High
Dependency Unit, Auckland City Hospital, Auckland, New Zealand
(Parikh) Division of Nephrology, Department of Medicine, Johns Hopkins
School of Medicine, Baltimore, MD, United States
(Roshanov, Syed, Whitlock) Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Shehata) Department of Medicine, Mount Sinai Hospital, University of
Toronto, Toronto, ON, Canada
(Tagarakis) Department of Cardiothoracic Surgery, Aristotle University
Hospital of Thessaloniki, Thessaloniki, Greece
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Background: Safely reducing red blood cell transfusions can prevent
transfusion-related adverse effects, conserve the blood supply, and reduce
health care costs. Both anemia and red blood cell transfusion are
independently associated with AKI, but observational data are insufficient
to determine whether a restrictive approach to transfusion can be used
without increasing AKI risk. Method(s): In a prespecified kidney
substudy of a randomized noninferiority trial, we compared a restrictive
threshold for red blood cell transfusion (transfuse if hemoglobin<7.5
g/dl, intraoperatively and postoperatively) with a liberal threshold
(transfuse if hemoglobin<9.5 g/dl in the operating roomor intensive care
unit, or if hemoglobin<8.5 g/dl on the nonintensive care ward). We studied
4531 patients undergoing cardiac surgery with cardiopulmonary bypass who
had a moderate-to-high risk of perioperative death. The substudy's primary
outcome was AKI, defined as a postoperative increase in serum creatinine
of >=0.3 mg/dl within 48 hours of surgery, or >=50% within 7 days of
surgery. Result(s): Patients in the restrictive-threshold group
received significantly fewer transfusions than patients in the
liberal-threshold group (1.8 versus 2.9 on average, or 38% fewer
transfusions in the restrictedthreshold group compared with the
liberal-threshold group; P<0.001). AKI occurred in 27.7% of patients in
the restrictive-threshold group (624 of 2251) and in 27.9% of patients in
the liberal-threshold group (636 of 2280). Similarly, among patients with
preoperative CKD, AKI occurred in 33.6% of patients in the
restrictive-threshold group (258 of 767) and in 32.5% of patients in the
liberal-threshold group (252 of 775). Conclusion(s): Among patients
undergoing cardiac surgery, a restrictive transfusion approach resulted in
fewer red blood cell transfusions without increasing the risk of
AKI. Copyright © 2019 by the American Society of Nephrology.

<29>
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.

<30>
Accession Number
2001424395
Title
Ultrathin Bioresorbable Polymer Sirolimus-Eluting Stents Versus Thin
Durable Polymer Everolimus-Eluting Stents.
Source
Journal of the American College of Cardiology. 72 (25) (pp 3287-3297),
2018. Date of Publication: 25 December 2018.
Author
Kandzari D.E.; Koolen J.J.; Doros G.; Massaro J.J.; Garcia-Garcia H.M.;
Bennett J.; Roguin A.; Gharib E.G.; Cutlip D.E.; Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Doros) Department of Biostatistics and Epidemiology, Boston University
School of Public Health, Baim Institute for Clinical Research, Boston, MA,
United States
(Massaro) Department of Biostatistics and Epidemiology, Boston University
School of Public Health, Boston, MA, United States
(Garcia-Garcia, Waksman) Division of Interventional Cardiology, MedStar
Cardiovascular Research Network, MedStar Washington Hospital Center,
Washington, DC, United States
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Roguin) Department of Cardiology, Rambam Medical Center, Haifa, Israel
(Gharib) Charleston Area Medical Center, Charleston, WV, United States
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, United States
Publisher
Elsevier USA
Abstract
Background: Coronary drug-eluting stent development has introduced new
metal alloys, changes in stent architecture, and bioresorbable polymers.
Whether these advancements improve long-term clinical safety and efficacy
has been inconsistent in prior studies. Objective(s): The authors
sought to compare late-term clinical outcomes among patients treated with
an ultrathin strut (60 mum) bioresorbable polymer sirolimus-eluting stent
(BP SES) and a thin strut (81 mum) durable polymer everolimus-eluting
stent (DP EES) in a large randomized trial. Method(s): BIOFLOW V
(Biotronik Prospective Randomized Multicenter Study to Assess the Safety
and Effectiveness of the Orsiro Sirolimus Eluting Coronary Stent System in
the Treatment of Subjects with Up to Three De Novo or Restenotic Coronary
Artery Lesions V) was an international randomized trial comparing coronary
revascularization with BP SES and DP EES regarding the primary endpoint of
12-month target lesion failure (TLF). Analysis of pre-specified 2-year
clinical outcomes was performed. Result(s): Among 1,334 patients
randomized to treatment with BP SES (n = 884) or DP EES (n = 450), the
2-year TLF rate was 7.5% for BP SES and 11.9% for DP EES (-4.33% treatment
difference; 95% confidence interval: -8.16% to -0.91%; p = 0.015), driven
by differences in target vessel myocardial infarction (MI) (5.3% vs. 9.5%;
p = 0.01) and ischemia-driven target lesion revascularization (2.6% vs.
4.9%; p = 0.04). Rates of cardiac death or MI were 7.0% versus 10.4% for
BP SES and DP EES, respectively (p = 0.047). Late/very late definite stent
thrombosis was statistically lower for BP SES compared with DP EES (0.1%
vs. 1.0%; p = 0.045). Conclusion(s): In a large randomized trial,
significant differences in both TLF and target vessel-related MI persisted
through 2 years, favoring treatment with BP SES over DP EES. Significantly
lower cumulative target lesion revascularization and late/very late stent
thrombosis were also observed with BP SES. (Safety and Effectiveness of
the Orsiro Sirolimus Eluting Coronary Stent System in Subjects With
Coronary Artery Lesions [BIOFLOW-V]; NCT02389946) Copyright ©
2018 The Authors

<31>
Accession Number
2001289036
Title
Echocardiographic Screening for Pulmonary Hypertension in Congenital Heart
Disease: JACC Review Topic of the Week.
Source
Journal of the American College of Cardiology. 72 (22) (pp 2778-2788),
2018. Date of Publication: 4 December 2018.
Author
Dimopoulos K.; Condliffe R.; Tulloh R.M.R.; Clift P.; Alonso-Gonzalez R.;
Bedair R.; Chung N.A.Y.; Coghlan G.; Fitzsimmons S.; Frigiola A.; Howard
L.S.; Jenkins P.; Kenny D.; Li W.; MacDonald S.T.; McCabe C.; Oliver J.J.;
Spence M.S.; Szantho G.V.; von Klemperer K.; Wilson D.G.; Wort S.J.
Institution
(Dimopoulos, Alonso-Gonzalez, Li) Adult Congenital Heart Centre and Centre
for Pulmonary Hypertension, Royal Brompton Hospital and Imperial College
London, London, United Kingdom
(Condliffe) Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital,
Sheffield, United Kingdom
(Tulloh, Bedair) Bristol Heart Institute, University Hospitals Bristol,
Bristol, United Kingdom
(Clift) Department of Cardiology, Queen Elizabeth Hospital Birmingham,
Birmingham, United Kingdom
(Chung, Frigiola) Adult Congenital Heart Disease Service, Guy's and St
Thomas' Hospital, London, United Kingdom
(Coghlan) National Pulmonary Hypertension Service, Royal Free Hospital,
London, United Kingdom
(Fitzsimmons) Adult Congenital Heart Disease Unit, Southampton University
Hospital, Southampton, United Kingdom
(Howard) National Pulmonary Hypertension Service, Hammersmith Hospital,
Imperial College Healthcare NHS Trust, London, United Kingdom
(Jenkins) Adult Congenital Heart Disease Unit, Manchester Royal Infirmary,
Manchester, United Kingdom
(Kenny) Our Lady's Children's Hospital and Mater Hospital, Dublin, Ireland
(MacDonald) East Midlands Congenital Heart Centre, Leicester
Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester,
United Kingdom
(McCabe, Wort) Department of Pulmonary Hypertension, Royal Brompton
Hospital, London, United Kingdom
(Oliver) Leeds Congenital Heart Unit, Leeds Teaching Hospitals, Leeds,
United Kingdom
(Spence) Department of Cardiology, Royal Victoria Hospital, Belfast,
Northern Ireland, United Kingdom
(Szantho, Wilson) Cardiology Department, University Hospital of Wales,
Cardiff, United Kingdom
(von Klemperer) Grown-up Congenital Heart Disease Service, Barts Heart
Centre, St. Bartholomew's Hospital, London, United Kingdom
Publisher
Elsevier USA
Abstract
Echocardiography is the mainstay in screening for pulmonary hypertension
(PH). International guidelines suggest echocardiographic parameters for
suspecting PH, but these may not apply to many adults with congenital
heart disease (ACHD). PH is relatively common in ACHD patients and can
significantly affect their exercise capacity, quality of life, and
prognosis. Identification of patients who have developed PH and who may
benefit from further investigations (including cardiac catheterization)
and treatment is thus extremely important. A systematic review and survey
of experts from the United Kingdom and Ireland were performed to assess
current knowledge and practice on echocardiographic screening for PH in
ACHD. This paper presents the findings of the review and expert statements
on the optimal approaches when using echocardiography to assess ACHD
patients for PH, with particular focus on major subgroups: patients with
right ventricular outflow tract obstruction, patients with systemic right
ventricles, patients with unrepaired univentricular circulation, and
patients with tetralogy of Fallot with pulmonary atresia. Copyright
© 2018 The Authors

<32>
Accession Number
2001289028
Title
Fractional Flow Reserve Versus Angiographically-Guided Coronary Artery
Bypass Grafting.
Source
Journal of the American College of Cardiology. 72 (22) (pp 2732-2743),
2018. Date of Publication: 4 December 2018.
Author
Thuesen A.L.; Riber L.P.; Veien K.T.; Christiansen E.H.; Jensen S.E.;
Modrau I.; Andreasen J.J.; Junker A.; Mortensen P.E.; Jensen L.O.
Institution
(Thuesen, Veien, Junker, Jensen) Department of Cardiology, Odense
University Hospital, Odense, Denmark
(Riber, Mortensen) Department of Cardiothoracic Surgery, Odense University
Hospital, Odense, Denmark
(Christiansen) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Jensen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Modrau) Department of Cardiothoracic Surgery, Aarhus University Hospital,
Skejby, Denmark
(Andreasen) Department of Cardiothoracic Surgery, Aalborg University
Hospital, Aalborg, Denmark
(Andreasen) Department of Clinical Medicine, Aalborg University, Aalborg,
Denmark
Publisher
Elsevier USA
Abstract
Background: The value of fractional flow reserve (FFR) evaluation of
coronary artery stenosis in coronary artery bypass grafting (CABG) is
uncertain, and stenosis assessments usually rely on visual estimates of
lesion severity. Objective(s): This randomized clinical trial
evaluated graft patency and clinical outcome after FFR-guided CABG versus
angiography-guided CABG. Method(s): A total of 100 patients referred
for CABG were randomly assigned to FFR-guided or angiography-guided CABG.
Based on the coronary angiogram, a heart team made a graft plan for all
patients, and FFR evaluations were performed. In FFR-guided CABG, coronary
lesions with FFR >0.80 were deferred, and a new graft plan was designed
accordingly, whereas the surgeon was blinded to the FFR values in patients
who underwent angiography-guided CABG. The primary endpoint was graft
failure in the percentage of all grafts after 6 months. Result(s):
Angiographic follow-up at 6 months was available for 72 patients (39 vs.
33 in the FFR-guided and angiography-guided groups, respectively). Graft
failures of all grafts were similar in both groups (16% vs. 12%; p =
0.97). Rates of death, myocardial infarction, and stroke were also similar
in the study groups, and no difference was seen in revascularization
before angiographic follow-up. After 6 months, deferred lesions (n = 24)
showed a significant reduction in mean FFR from index to follow-up (0.89
+/- 0.05 vs. 0.81 +/- 0.11; p = 0.002). Index FFR did not influence graft
patency. Conclusion(s): FFR-guided CABG had similar graft failure
rates and clinical outcomes as angiography-guided CABG. However, FFR was
reduced significantly after 6 months in deferred lesions. (Fractional Flow
Reserve Versus Angiography Randomization for Graft Optimization [FARGO];
NCT02477371) Copyright © 2018 American College of Cardiology
Foundation

<33>
Accession Number
2001289022
Title
Endocarditis After Transcatheter Pulmonary Valve Replacement.
Source
Journal of the American College of Cardiology. 72 (22) (pp 2717-2728),
2018. Date of Publication: 4 December 2018.
Author
McElhinney D.B.; Sondergaard L.; Armstrong A.K.; Bergersen L.; Padera
R.F.; Balzer D.T.; Lung T.-H.; Berger F.; Zahn E.M.; Gray R.G.;
Hellenbrand W.E.; Kreutzer J.; Eicken A.; Jones T.K.; Ewert P.
Institution
(McElhinney) Lucile Packard Children's Hospital Stanford, Palo Alto, CA,
United States
(Sondergaard) The Heart Center, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Armstrong) Nationwide Children's Hospital, Columbus, OH, United States
(Bergersen) Boston Children's Hospital, Boston, MA, United States
(Padera) Brigham and Women's Hospital, Children's Hospital Boston and
Harvard Medical School, Boston, MA, United States
(Balzer) St. Louis Children's Hospital, St. Louis, MO, United States
(Lung) Medtronic, Santa Rosa, CA, United States
(Berger) Deutsches Herzzentrum Berlin, Berlin, Germany
(Zahn) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Gray) University of Utah, Salt Lake City, UT, United States
(Hellenbrand) Yale School of Medicine, New Haven, CT, United States
(Kreutzer) Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA,
United States
(Eicken, Ewert) German Heart Center Munich, Munich, Germany
(Jones) Seattle Children's Hospital, Seattle, WA, United States
Publisher
Elsevier USA
Abstract
Background: Endocarditis has emerged as one of the most concerning adverse
outcomes in patients with congenital anomalies involving the right
ventricular outflow tract (RVOT) and prosthetic valves. Objective(s):
The aim of this study was to evaluate rates and potential risk factors for
endocarditis after transcatheter pulmonary valve replacement in the
prospective Melody valve trials. Method(s): All patients in whom a
transcatheter pulmonary valve (TPV) was implanted in the RVOT as part of 3
prospective multicenter studies comprised the analytic cohort. The
diagnosis of endocarditis and involvement of the TPV were determined by
the implanting investigator. Result(s): A total of 309 patients
underwent transcatheter pulmonary valve replacement (TPVR) and were
discharged with a valve in place. The median follow-up duration was 5.1
years, and total observation until study exit was 1,660.3 patient-years.
Endocarditis was diagnosed in 46 patients (median 3.1 years after TPVR),
and a total of 35 patients were reported to have TPV-related endocarditis
(34 at the initial diagnosis, 1 with a second episode). The annualized
incidence rate of endocarditis was 3.1% per patient-year and of
TPV-related endocarditis was 2.4% per patient-year. At 5 years post-TPVR,
freedom from a diagnosis of endocarditis was 89% and freedom from
TPV-related endocarditis was 92%. By multivariable analysis, age <=12
years at implant (hazard ratio: 2.3; 95% confidence interval: 1.2 to 4.4;
p = 0.011) and immediate post-implant peak gradient >=15 mm Hg (2.7; 95%
confidence interval: 1.4 to 4.9; p = 0.002) were associated with
development of endocarditis and with development of TPV-related
endocarditis (age <=12 years: 2.8; 95% confidence interval: 1.3 to 5.7; p
= 0.006; gradient >=15 mm Hg: 2.6; 95% confidence interval: 1.3 to 5.2; p
= 0.008). Conclusion(s): Endocarditis is an important adverse outcome
following TVPR in children and adults with post-operative congenital heart
disease involving the RVOT. Ongoing efforts to understand, prevent, and
optimize management of this complication are paramount in making the best
use of TPV therapy. (Melody Transcatheter Pulmonary Valve [TPV] Study:
Post Approval Study of the Original Investigational Device Exemption [IDE]
Cohort; NCT00740870; Melody Transcatheter Pulmonary Valve Post-Approval
Study; NCT01186692; and Melody Transcatheter Pulmonary Valve [TPV]
Post-Market Surveillance Study; NCT00688571) Copyright © 2018
American College of Cardiology Foundation

<34>
[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.

<35>
Accession Number
627739255
Title
Drug Use and Postoperative Mortality Following Valve Surgery for Infective
Endocarditis: A Systematic Review and Meta-analysis.
Source
Clinical infectious diseases : an official publication of the Infectious
Diseases Society of America. 69 (7) (pp 1120-1129), 2019. Date of
Publication: 13 Sep 2019.
Author
Hall R.; Shaughnessy M.; Boll G.; Warner K.; Boucher H.W.; Bannuru R.R.;
Wurcel A.G.
Institution
(Hall, Shaughnessy, Boucher) Tufts University School of Medicine, Boston,
MA, United Kingdom
(Boll, Warner) Division of Cardiac Surgery, Department of Surgery, Tufts
University School of Medicine, Boston, MA, United Kingdom
(Boucher, Wurcel) Division of Geographic Medicine and Infectious Diseases,
Department of Medicine, Tufts University School of Medicine, Boston, MA,
United Kingdom
(Bannuru) Center for Treatment Comparison and Integrative Analysis, Tufts
University School of Medicine, Tufts Medical Center, Boston, MA, United
Kingdom
(Wurcel) Department of Public Health and Community Medicine, Tufts
University School of Medicine, Boston, MA, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Infective endocarditis (IE) often requires surgical
intervention. An increasingly common cause of IE is injection drug use
(IDU-IE). There is conflicting evidence on whether postoperative mortality
differs between people with IDU-IE and people with IE from etiologies
other than injection drug use (non-IDU-IE). In this manuscript, we compare
short-term postoperative mortality in IDU-IE vs non-IDU-IE through
systematic review and meta-analysis. METHOD(S): The review was
conducted according to the Cochrane Handbook for Systematic Reviews of
Interventions and the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. Publication databases were queried for key terms
included in articles up to September 2017. Randomized controlled trials,
prospective cohorts, or retrospective cohorts that reported on 30-day
mortality or in-hospital/operative mortality following valve surgery and
that compared outcomes between IDU-IE and non-IDU-IE were included.
 RESULT(S): Thirteen studies with 1593 patients (n = 341 [21.4%]
IDU-IE) were included in the meta-analysis. IDU-IE patients more
frequently had tricuspid valve infection, Staphylococcus infection, and
heart failure before surgery. Meta-analysis revealed no statistically
significant difference in 30-day postsurgical mortality or in-hospital
mortality between the 2 groups. CONCLUSION(S): Despite differing
preoperative clinical characteristics, early postoperative mortality does
not differ between IDU-IE and non-IDU-IE patients who undergo valve
surgery. Future research on long-term outcomes following valve replacement
is needed to identify opportunities for improved healthcare delivery with
IDU-IE. Copyright Published by Oxford University Press for the
Infectious Diseases Society of America 2018.

<36>
Accession Number
2001632235
Title
Preoperative chlorhexidine mouthwash to reduce pneumonia after cardiac
surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (4) (pp 1094-1100),
2019. Date of Publication: October 2019.
Author
Bardia A.; Blitz D.; Dai F.; Hersey D.; Jinadasa S.; Tickoo M.;
Schonberger R.B.
Institution
(Bardia, Blitz, Schonberger) Department of Anesthesiology, Yale School of
Medicine, New Haven, Conn, United States
(Dai) Department of Biostatistics, Yale School of Public Health, New
Haven, Conn, United States
(Hersey) Science Libraries, Scholarly Collections and Research Services,
Princeton University, Princeton, NJ, United States
(Jinadasa) Department of Surgery, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, Mass, United States
(Tickoo) Pulmonary and Critical Care Medicine, Department of Internal
Medicine, Yale School of Medicine, New Haven, Conn, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Postoperative pneumonia is one of the most common complications
after cardiac surgery, entailing increased patient morbidity, mortality,
and health care burden. The primary aim of this study was to assess
whether preoperative chlorhexidine mouthwash is associated with reduced
postoperative pneumonia after cardiac surgery. Method(s): A
comprehensive systematic search of NLM Pubmed, Embase, Scopus, and
Cumulative Index of Nursing and Allied Health was executed to include the
studies since inception to June 27, 2017, which assessed the effects of
preoperative chlorhexidine gluconate mouthwash on postoperative pneumonia.
Studies were identified by 2 independent reviewers, and data were
extracted using a predefined protocol. Random effects models were run to
obtain risk ratios with 95% confidence intervals. Quality of evidence was
evaluated using Grading of Recommendations Assessment, Development and
Evaluation criteria. Postoperative pneumonia after cardiac surgery was the
primary outcome of the study. Result(s): Five studies including a
cumulative of 2284 patients were included. A total of 1125 patients
received preoperative chlorhexidine. Use of chlorhexidine gluconate was
associated with reduced risk of postoperative pneumonia compared with the
patients who did not receive it (risk ratio, 0.52; 95% confidence
interval, 0.39-0.70; P < .001). No adverse effects from chlorhexidine
gluconate mouthwash were reported by any of these studies.
 Conclusion(s): Among the patients receiving preoperative
chlorhexidine mouthwash, the risk of postoperative pneumonia is reduced by
approximately one-half; its adoption in preoperative protocols could help
improve patient outcomes. Copyright © 2019 The American
Association for Thoracic Surgery

<37>
Accession Number
2001440615
Title
Trifecta has lower gradient and less prosthesis-patient mismatch than
Mosaic Ultra in the aortic position: A prospective randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (4) (pp 1032-1039),
2019. Date of Publication: October 2019.
Author
Braathen B.; Husebye T.; Lunde I.G.; Tonnessen T.
Institution
(Braathen, Tonnessen) Department of Cardiothoracic Surgery, Oslo
University Hospital, Ulleval, Norway
(Husebye) Department of Cardiology, Oslo University Hospital, Ulleval,
Norway
(Lunde) Institute for Experimental Medical Research and Center for Heart
Failure Research, Oslo, Norway
(Lunde, Tonnessen) University of Oslo, Oslo, Norway
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: When aortic valve replacement is needed, a biological valve is
usually implanted in patients older than age 60 to 65 years. A large
valvular opening area is important to avoid prosthesis-patient mismatch
and facilitate reverse left ventricular remodeling. The Trifecta
biological valve (St Jude Medical, St Paul, Minn) is, because of its
design, believed to reduce transvalvular gradient compared with other
biological valves, especially in smaller annuli. Several retrospective
studies have compared transvalvular gradients of implanted valves
prostheses using the respective manufacturers given size and not the
actual annulus size measured by a metric sizer. This makes comparison of
the hemodynamic properties of different valve brands and sizes difficult.
We therefore performed a prospective randomized study, using the same
metric sizer to measure annulus size, and compared hemodynamic profiles of
the Trifecta to our standard Mosaic Ultra biological valve (Medtronic,
Minneapolis, Minn). Method(s): Ninety elective patients with small to
medium annulus diameter undergoing aortic valve replacement were
randomized to either Trifecta or Mosaic Ultra. After native valve removal
and decalcification, a Hegar-sizer was used to measure true annulus size.
Then the largest possible valve of either brand was implanted according to
the randomization protocol. Echocardiography was performed 6 months
postoperatively. Result(s): Baseline parameters of the 2 cohorts were
comparable. There were lower transvalvular gradients in the Trifecta
compared with the Mosaic Ultra group for the given annulus sizes. Severe
prosthesis-patient mismatch was present in 28% of patients in the Mosaic
group and 3% of patients in the Trifecta group. Conclusion(s):
Trifecta showed lower transvalvular gradients and less severe
prosthesis-patient mismatch compared with Mosaic Ultra for the given
annulus sizes. ClinicalTrials.gov Protocol ID:
2011/2596/REK. Copyright © 2018 The American Association for
Thoracic Surgery

<38>
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.

<39>
Accession Number
2002296598
Title
Perioperative clinical utility of myocardial deformation imaging: a
narrative review.
Source
British Journal of Anaesthesia. 123 (4) (pp 408-420), 2019. Date of
Publication: October 2019.
Author
Abuelkasem E.; Wang D.W.; Omer M.A.; Abdelmoneim S.S.; Howard-Quijano K.;
Rakesh H.; Subramaniam K.
Institution
(Abuelkasem, Wang, Howard-Quijano, Rakesh, Subramaniam) Department of
Anesthesiology and Perioperative Medicine, University of Pittsburgh School
of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Omer) Department of Cardiology, Saint-Luke's Mid America Heart Institute,
Kansas City, MO, United States
(Abdelmoneim) Cardiovascular Ultrasound Imaging and Hemodynamic
Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(Abdelmoneim) Cardiology Department, Orman Heart Center Assiut University,
Assiut, Egypt
Publisher
Elsevier Ltd
Abstract
Preoperative cardiac function is an important predictor of postoperative
outcomes. Patients with heart failure are at higher risk of perioperative
morbidity and mortality. Left ventricular ejection fraction, derived by
standard echocardiography, is most frequently used to assess cardiac
function in the intraoperative and postoperative periods. Myocardial
strain analysis, a measurement of myocardial deformation, can provide
additional information to left venricular eject fraction estimation. Here,
we provide an overview of myocardial strain and different methods used to
evaluate strain, including speckle tracking echocardiography. Speckle
tracking echocardiography is an imaging modality that can analyse and
track small segments of the myocardium, which provides greater detail for
assessing global and regional cardiac motion and function. We further
review the literature to illustrate the value of speckle tracking
echocardiography-derived myocardial strain in describing cardiac function
and its association with adverse surgical outcomes in the perioperative
period, including low cardiac output states, need for inotropic support,
postoperative arrhythmias, subclinical myocardial ischaemia, and length of
hospital stay. Copyright © 2019 British Journal of Anaesthesia

<40>
Accession Number
2002901808
Title
The Thoracic Surgery Social Media Network: Early experience and lessons
learned.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (4) (pp 1127-1136),
2019. Date of Publication: October 2019.
Author
Luc J.G.Y.; Ouzounian M.; Bender E.M.; Blitz A.; Stamp N.L.; Varghese
T.K.; Cooke D.T.; Antonoff M.B.
Institution
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, British Columbia, Canada
(Ouzounian) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
(Bender) Department of Cardiothoracic Surgery, Stanford University, Palo
Alto, Calif, United States
(Blitz) Division of Cardiac Surgery, University of Cincinnati Medical
Center, Cincinnati, OH, United States
(Stamp) Department of Cardiothoracic Surgery & Transplantation, Fiona
Stanley Hospital, Murdoch, Australia
(Varghese) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
(Cooke) Section of General Thoracic Surgery, University of California
Davis Health, Sacramento, Calif, United States
(Antonoff) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson Cancer Center, Houston, Tex, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The Thoracic Surgery Social Media Network (TSSMN) is a social
media collaborative formed in 2015 by The Annals of Thoracic Surgery and
The Journal of Thoracic and Cardiovascular Surgery to bring social media
attention to key publications from both journals and to highlight major
accomplishments in the specialty. Our aim is to describe TSSMN's
preliminary experience and lessons learned. Method(s): Twitter
analytics was used to obtain information regarding the @TSSMN Twitter
handle and #TSSMN hashtag. TweetChat and general hashtag #TSSMN analytics
were measured using Symplur (Symplur LLC, Los Angeles, Calif). A TSSMN
Tweeter App was created, and its use and downloads were analyzed.
 Result(s): Hashtag #TSSMN has a total of 17,181 tweets, 2100 users,
and 32,226,280 impressions, with peaks in tweeting activity corresponding
to TweetChats. Thirteen 1-hour TweetChats drew a total of 489
participants, 5195 total tweets, and 17,297,708 total impressions. The top
demographic category of TweetChat participants included Doctors (47%),
Advocates/Supports (11%), and Unknown (10%), with 3% characterized as
patients. The TSSMN Tweeter iTunes App (Apple, Cupertino, Calif) was
downloaded 3319 times with global representation. A total of 859 articles
were viewed through the App, with 450 articles from The Annals of Thoracic
Surgery and 409 from The Journal of Thoracic and Cardiovascular Surgery.
 Conclusion(s): We demonstrate that TSSMN further enhances the ability
for the journals to connect with their readership and the cardiothoracic
community. Ongoing studies to correlate social media attention with
article reads, article-level metrics, citations, and journal impact factor
are eagerly awaited. Copyright © 2019

<41>
[Use Link to view the full text]
Accession Number
629307958
Title
Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac
Surgery Patients: A Randomized Clinical Trial.
Source
Critical care medicine. 46 (8) (pp e742-e750), 2018. Date of Publication:
01 Aug 2018.
Author
Rocha Ferreira G.S.; de Almeida J.P.; Landoni G.; Vincent J.L.; Fominskiy
E.; Gomes Galas F.R.B.; Gaiotto F.A.; Dallan L.O.; Franco R.A.; Lisboa
L.A.; Palma Dallan L.R.; Fukushima J.T.; Rizk S.I.; Park C.L.; Strabelli
T.M.; Gelas Lage S.H.; Camara L.; Zeferino S.; Jardim J.; Calvo Arita
E.C.T.; Caldas Ribeiro J.; Ayub-Ferreira S.M.; Costa Auler J.O.; Filho
R.K.; Jatene F.B.; Hajjar L.A.
Institution
(Rocha Ferreira, de Almeida, Gomes Galas, Franco, Fukushima, Rizk, Park,
Camara, Zeferino, Jardim, Calvo Arita, Caldas Ribeiro, Costa Auler)
Surgical Intensive Care Unit and Department of Anesthesiology, Heart
Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da
Universidade de Sao Paulo, Sao Paulo, Brazil
(Landoni, Fominskiy) Department of Anesthesia and Intensive Care, IRCCS
San Raffaele Scientific Institute, Milan, Italy
(Landoni) Faculty of Medicine and Surgery, Vita-Salute San Raffaele
University of Milan, Milan, Italy
(Vincent) Department of Intensive Care, Erasme Hospital, Universite Libre
de Bruxelles, Brussels, Belgium
(Gaiotto, Dallan, Lisboa, Palma Dallan, Jatene) Department of
Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clinicas da
Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
(Strabelli) Department of Infectious Diseases, Heart Institute (InCor),
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao
Paulo, Sao Paulo, Brazil
(Gelas Lage, Ayub-Ferreira, Filho, Hajjar) Department of Cardiology, Heart
Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da
Universidade de Sao Paulo, Sao Paulo, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to evaluate the efficacy of
perioperative intra-aortic balloon pump use in high-risk cardiac surgery
patients. DESIGN: A single-center randomized controlled trial and a
meta-analysis of randomized controlled trials. SETTING: Heart Institute of
Sao Paulo University. PATIENTS: High-risk patients undergoing elective
coronary artery bypass surgery. INTERVENTION: Patients were randomized to
receive preskin incision intra-aortic balloon pump insertion after
anesthesia induction versus no intra-aortic balloon pump use. MEASUREMENTS
AND MAIN RESULTS: The primary outcome was a composite endpoint of 30-day
mortality and major morbidity (cardiogenic shock, stroke, acute renal
failure, mediastinitis, prolonged mechanical ventilation, and a need for
reoperation). A total of 181 patients (mean [SD] age 65.4 [9.4] yr; 32%
female) were randomized. The primary outcome was observed in 43 patients
(47.8%) in the intra-aortic balloon pump group and 42 patients (46.2%) in
the control group (p = 0.46). The median duration of inotrope use (51hr
[interquartile range, 32-94 hr] vs 39hr [interquartile range, 25-66 hr]; p
= 0.007) and the ICU length of stay (5 d [interquartile range, 3-8 d] vs 4
d [interquartile range, 3-6 d]; p = 0.035) were longer in the intra-aortic
balloon pump group than in the control group. A meta-analysis of 11
randomized controlled trials confirmed a lack of survival improvement in
high-risk cardiac surgery patients with perioperative intra-aortic balloon
pump use. CONCLUSION(S): In high-risk patients undergoing cardiac
surgery, the perioperative use of an intra-aortic balloon pump did not
reduce the occurrence of a composite outcome of 30-day mortality and major
complications compared with usual care alone.

<42>
Accession Number
629252216
Title
Remote ischaemic preconditioning in isolated aortic valve and coronary
artery bypass surgery: A randomized trial.
Source
European Journal of Cardio-thoracic Surgery. 55 (5) (pp 905-912), 2019.
Date of Publication: 2019.
Author
Moscarelli M.; Fiorentino F.; Suleiman M.-S.; Emanueli C.; Reeves B.C.;
Punjabi P.P.; Angelini G.D.
Institution
(Moscarelli, Suleiman, Reeves, Angelini) Faculty of Health Sciences,
Bristol Heart Institute, Bristol Medical School, University of Bristol,
Level 7, Bristol Royal Infirmary, Marlborough St, Bristol BS28HW, United
Kingdom
(Fiorentino, Emanueli, Punjabi) Imperial College, National Heart and Lung
Institute, London, United Kingdom
(Moscarelli) GVM Care and Research, Anthea Hospital, Bari, Italy
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: This trial was designed and patients were recruited at a time
when the benefits of remote ischaemic preconditioning during open-heart
surgery were still controversial. We focused on a homogeneous patient
population undergoing either isolated aortic valve replacement or coronary
artery bypass grafting (CABG) surgery by investigating cardiac injury,
metabolic stress and inflammatory response. METHOD(S): A 2-centre
randomized controlled trial recruited a total of 124 patients between
February 2013 and April 2015. Of them, 64 patients underwent CABG and 60
patients underwent aortic valve replacement. Patients were randomized to
either sham or preconditioning. Remote ischaemic preconditioning was
applied following anaesthesia and before sternotomy. Myocardial injury and
inflammatory response were assessed by serially measuring cardiac troponin
I, and interleukin-6, 8, 10 and the tumour necrosis factor (TNF-alpha).
Biopsies from the left and the right ventricles were harvested after
ischaemic reperfusion injury for nucleotides analysis. RESULT(S):
Application of remote ischaemic preconditioning did not alter the degree
of troponin I release, levels of inflammatory markers and cardiac
energetics in both the CABG and the aortic valve replacement groups.
 CONCLUSION(S): Preconditioning did not confer any additional
cardioprotection in terms of reducing the levels of troponin I and
inflammatory markers and preserving left and right ventricle energy
metabolites in patients undergoing isolated CABG or aortic valve surgery.
Clinical trial registration number: International Standard Randomized
Controlled Trial Number (ISRCTN) registry ID 33084113 (doi:
10.1186/ISRCTN33084113) and UK controlled randomized trial number (UKCRN)
registry ID 13672. Copyright © 2018 The Author(s). Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<43>
Accession Number
629252212
Title
Mid-term results of a randomized trial of tricuspid annuloplasty for
less-than-severe functional tricuspid regurgitation at the time of mitral
valve surgery.
Source
European Journal of Cardio-thoracic Surgery. 55 (5) (pp 851-858), 2019.
Date of Publication: 2019.
Author
Pettinari M.; De Kerchove L.; Lazam S.; Pasquet A.; Gerber B.;
Vanoverschelde J.-L.; El-Khoury G.
Institution
(Pettinari) Cardiac Surgery Department, Ziekenhuis Oost Limburg, Schiepse
Bos 6, Genk 3600, Belgium
(De Kerchove, El-Khoury) Cardiac Surgery Department, Universitair Clinique
St. Luc, Brussel, Belgium
(Lazam, Pasquet, Gerber, Vanoverschelde) Cardiology Department,
Universitair Clinique St. Luc, Brussel, Belgium
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The optimal management of functional tricuspid regurgitation
(FTR) in the setting of mitral valve operations remains controversial. The
current practice is both centre specific and surgeon specific with
guidelines based on non-randomized data. A prospective randomized trial
was performed to evaluate the worth of less-than-severe FTR repair during
mitral valve procedures. METHOD(S): A single-centre randomized study
was designed to allocate patients with less-than-severe FTR undergoing
mitral valve surgery to be prophylactically treated with or without
tricuspid valve annuloplasty (TVP-or TVP+). These patients were analysed
using longitudinal cardiopulmonary exercise capacity, echocardiographic
follow-up and cardiac magnetic resonance. The primary outcome was freedom
from more than or equal to moderate tricuspid regurgitation with vena
contracta >=4 mm. Secondary outcomes were maximal oxygen uptake and right
ventricular (RV) dimension and function. RESULT(S): A total of 53
patients were allocated to receive concomitant TVP+, and 53 patients were
treated conservatively (TVP-). At 5 years, tricuspid regurgitation was
observed to be greater than mild in 10 patients in the TVP-group and no
patients in the TVP+ group (P < 0.01). Maximal oxygen uptake, RV basal
diameter, end-diastolic diameter and end-systolic diameter and fractional
area changes were similar in both groups. Cardiac magnetic resonance
confirmed no differences in RV end-diastolic volume, RV end-systolic
volume and RV ejection fraction. CONCLUSION(S): This single-centre
prospective randomized trial demonstrated that prophylactic tricuspid
annuloplasty irrespective of annular dilatation at the time of mitral
surgery reduced the recurrence of moderate or severe FTR at 5-year
follow-up and reduced the pulmonary pressure. Nevertheless, the functional
capacity, the RV function and the RV dimension remained
similar. Copyright © 2018 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<44>
Accession Number
629319569
Title
Preoperative B-Blockers as a coronary surgery quality metric: the lack of
evidence of efficacy.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 09 Sep 2019.
Author
Filardo G.; da Graca B.; Sass D.M.; Hamilton J.; Pollock B.D.; Edgerton
J.R.
Institution
(Filardo) Epidemiology Department, Baylor Scott & White Health, Dallas,
TX; Robbins Institute for Health Policy & Leadership Baylor University,
Waco, TX; Department of Cardiothoracic Surgery, The Heart Hospital Baylor
Plano, Plano, TX. Electronic address: giovanfi@baylorhealth.edu
(da Graca, Pollock) Epidemiology Department, Baylor Scott & White Health,
Dallas, TX; Robbins Institute for Health Policy & Leadership Baylor
University, Waco, TX
(Sass, Edgerton) Epidemiology Department, Baylor Scott & White Health,
Dallas, TX
(Hamilton) University of North Carolina, NC, Chapel Hill, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Two quality measures used in public-reporting and value-based
payment programs require beta-blockers be administered <24 hours before
isolated coronary artery bypass graft surgery (CABG) to prevent atrial
fibrillation (AF) and mortality. Questions have arisen about continued use
of these measures. METHOD(S): We conducted a systematic search for
randomized controlled trials (RCTs) examining the impact of pre-operative
beta-blockers on AF or mortality following isolated CABG to determine what
evidence of efficacy supports the measures. RESULT(S): We identified
11 RCTs. All continued B-blockers post-operatively, making it unfeasible
to separate the benefits of pre- vs post-operative administration.
Meta-analysis was precluded by methodological variation in beta-blocker
utilized, timing and dosage, and supplemental and comparison treatments.
Of the 8 comparisons of beta-blockers/beta-blocker+digoxin versus placebo
(n=826 patients), 6 showed significant reductions in AF/supraventricular
arrhythmias. Of the 3 comparisons (n=444) of beta-blockers versus
amiodarone, 2 found no significant difference in AF; the third showed
significantly lower incidence with amiodarone. One RCT compared
beta-blocker+amiodarone versus each of those drugs separately; the
combination reduced AF significantly better than the beta-blocker alone,
but not amiodarone alone. 7 RCTs reported short-term mortality, but this
outcome was too rare and the sample sizes too small to provide any
meaningful comparisons. CONCLUSION(S): Existing RCT evidence does not
support the structure of quality measures that require B-blocker
administration specifically within 24 hours prior to CABG to prevent
post-operative AF or short-term mortality. Quality measures should be
revised to align with the evidence, and further studies conducted to
determine optimal timing and method of prophylaxis. Copyright ©
2019. Published by Elsevier Inc.

<45>
Accession Number
2002885901
Title
A Pilot, Double-Blind, Randomized, Controlled Trial of High-Dose
Intravenous Vitamin C for Vasoplegia After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Yanase F.; Bitker L.; Hessels L.; Osawa E.; Naorungroj T.; Cutuli S.L.;
Young P.J.; Ritzema J.; Hill G.; Latimer-Bell C.; Hunt A.; Eastwood G.M.;
Hilton A.; Bellomo R.
Institution
(Yanase, Bitker, Hessels, Osawa, Naorungroj, Cutuli, Eastwood, Hilton,
Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Yanase, Bellomo) Australian and New Zealand Intensive Care Research
Centre, Monash University School of Public Health and Preventive Medicine,
Melbourne, Australia
(Bitker) Service de medecine intensive et reanimation, Hopital de la Croix
Rousse, Hospices Civils de Lyon, Lyon, France
(Hessels) Department of Critical Care, University of Groningen, University
Medical Center Groningen, Groningen, Netherlands
(Naorungroj) Department of Intensive Care, Siriraj Hospital, Mahidol
University, Bangkok, Thailand
(Young, Ritzema, Hill, Latimer-Bell, Hunt) Department of Intensive Care,
Wellington Hospital, Wellington, New Zealand
(Bellomo) Centre for Integrated Critical Care, Department of Medicine &
Radiology, University of Melbourne, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objective: To conduct a pilot feasibility and physiologic efficacy study
of high-dose vitamin C in patients with vasoplegia after cardiac surgery.
 Design(s): Prospective, double-blind, randomized, controlled trial.
 Setting(s): Two tertiary intensive care units (ICUs).
 Participant(s): Post-cardiac surgery patients with vasoplegia.
 Intervention(s): The authors randomly assigned the patients to
receive either high-dose intravenous vitamin C (1,500 mg every 6 hours) or
placebo. The primary outcome was time from randomization to resolution of
vasoplegia. Secondary outcomes included total norepinephrine equivalent
dose in the first 2 days, ICU length of stay, ICU mortality, and
in-hospital mortality. Measurements and Main Results: The authors
studied 50 patients (25 patients in each arms). The mean (standard
deviation) time to resolution of vasoplegia was 27.0 (16.5) hours in the
vitamin C group versus 34.7 (41.1) hours in the placebo group (mean
decrease with vitamin C of 7.7 hours, 95% confidence interval -10.5 to
25.9, p = 0.40). The median (interquartile range) norepinephrine
equivalent dose in the first 2 days was 64.9 (23.5-236.5) micro g/kg
versus 47.4 (21.4-265.9) micro g/kg in the vitamin C and placebo group
(p = 0.75). The median duration of ICU admission was similar (1.4
[0.5-2.5] days and 1.5 [0.5-3.3] days in the vitamin C and placebo group;
p = 0.36). Only 1 patient, in the vitamin C arm, died. Conclusion(s):
In patients with post-cardiac surgery vasoplegia, high-dose vitamin C
infusion was feasible, appeared safe, and, within the limitations of a
pilot study, did not achieve statistically faster resolution of
vasoplegia. Copyright © 2019 Elsevier Inc.

<46>
Accession Number
2000533314
Title
Rapid deployment or sutureless versus conventional bioprosthetic aortic
valve replacement: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (6) (pp 2402-2412.e5),
2018. Date of Publication: June 2018.
Author
Sohn S.H.; Jang M.-J.; Hwang H.Y.; Kim K.H.
Institution
(Sohn, Hwang, Kim) Department of Thoracic and Cardiovascular Surgery,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: This meta-analysis was conducted to compare the early and
follow-up outcomes of aortic valve replacement using rapid deployment or
sutureless (RD) valves (RDAVR group) with aortic valve replacement using
conventional bioprostheses (CAVR group). Method(s): A literature
search of 5 online databases was conducted. The primary outcomes were
postoperative complications and the secondary outcomes included the aortic
cross-clamp (ACC) and cardiopulmonary bypass (CPB) times and early
mortality and all-cause mortality during follow-up. Result(s):
Twenty-one articles (RDAVR group = 1297 patients; CAVR group = 1488
patients) were selected. The pooled analyses showed that the ACC and CPB
times were significantly shorter in the RDAVR group than in the CAVR group
(mean difference, -26.34; 95% confidence interval [CI], -31.86 to -20.82
and mean difference, -25.33; 95% CI, -30.79 to -19.87, respectively). The
pooled risk ratios (RRs) of any paravalvular leak and permanent pacemaker
(PPM) insertion were significantly higher in the RDAVR group than in the
CAVR group (RR, 2.32; 95% CI, 1.53-3.51 and RR, 2.08; 95% CI, 1.49-2.90,
respectively). The pooled analysis showed that the risk of a paravalvular
leak grade >=2 in the RDAVR group did not significantly differ between the
RDAVR and CAVR groups (RR, 2.05; 95% CI, 0.71-5.93). The risk of PPM
insertion remained significant when only studies reporting adjusted
outcomes were pooled. The risks of other postoperative complications,
early mortality, and all-cause mortality during follow-up were not
significantly different between the RDAVR and CAVR groups.
 Conclusion(s): RDAVR is associated with significantly shorter ACC and
CPB times than CAVR, although this difference did not translate into
improved postoperative outcomes, early mortality, and all-cause mortality
during follow-up. Care might be needed when implanting RD valves because
they are associated with a higher incidence of PPM insertion, regardless
of the RD valve type. Copyright © 2018 The American Association
for Thoracic Surgery

<47>
Accession Number
618863087
Title
Long-Term Outcomes With Transcatheter Aortic Valve Replacement in Women
Compared With Men: Evidence From a Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 11 (1) (pp 24-35), 2018. Date of
Publication: 08 Jan 2018.
Author
Saad M.; Nairooz R.; Pothineni N.V.K.; Almomani A.; Kovelamudi S.; Sardar
P.; Katz M.; Abdel-Wahab M.; Bangalore S.; Kleiman N.S.; Block P.C.;
Abbott J.D.
Institution
(Saad, Pothineni, Almomani, Kovelamudi) Division of Cardiovascular
Medicine, University of Arkansas for Medical Sciences, Little Rock,
Arkansas, United States
(Nairooz) Division of Cardiology, University of Southern California, Los
Angeles, California, United States
(Sardar) Division of Cardiovascular Medicine, University of Utah, Salt
Lake City, Utah, United States
(Katz) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Abdel-Wahab) Heart Center, Segeberger Kliniken (Academic Teaching
Hospital of the Universities of Kiel, Lubeck, and Hamburg), Bad Segeberg,
Germany
(Bangalore) Division of Cardiovascular Medicine, New York University
School of Medicine, New York, New York, United States
(Kleiman) Houston Methodist DeBakey Heart and Vascular Center, Houston
Methodist Hospital, Houston, Texas, United States
(Block) Division of Cardiovascular Medicine, Emory University School of
Medicine, Atlanta, United States
(Abbott) Division of Cardiovascular Medicine, Warren Alpert School of
Medicine at Brown University, Providence, Rhode Island, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to examine long-term outcomes with
transcatheter aortic valve replacement (TAVR) in women versus men.
Background TAVR is commonly performed in women. Previous studies have
shown conflicting results with respect to sex differences in outcomes with
TAVR. In addition, short-term outcomes have primarily been reported.
Methods Electronic search was performed until March 2017 for studies
reporting outcomes with TAVR in women versus men. Random effects
DerSimonian-Laird risk ratios were calculated. Outcomes included all-cause
mortality and major cardiovascular events at short- (30 days) and
long-term (>1 year) follow-up. Results Seventeen studies (8 TAVR
registries; 47,188 patients; 49.4% women) were analyzed. Women were older
but exhibited fewer comorbidities. At 30 days, women had more bleeding (p
< 0.001), vascular complications (p < 0.001), and stroke/transient
ischemic attack (p = 0.02), without difference in all-cause (p = 0.19) or
cardiovascular mortality (p = 0.91) compared with men. However, female sex
was associated with lower all-cause mortality at 1 year (risk ratio: 0.85;
95% confidence interval: 0.79 to 0.91; p < 0.001), and longest available
follow-up (mean 3.28 +/- 1.04 years; risk ratio: 0.86; 95% confidence
interval: 0.81 to 0.92; p < 0.001), potentially caused by less
moderate/severe aortic insufficiency (p = 0.001), and lower cardiovascular
mortality (p = 0.009). The female survival advantage remained consistent
across multiple secondary analyses. The risk of stroke, moderate/severe
aortic insufficiency, and all-cause mortality seemed to vary based on the
type of valve used; however, without significant subgroup interactions.
Conclusions Despite a higher upfront risk of complications, women derive a
better long-term survival after TAVR compared with men. Copyright
© 2018 American College of Cardiology Foundation

<48>
[Use Link to view the full text]
Accession Number
624837847
Title
Peer support in critical care: A systematic review.
Source
Critical Care Medicine. 46 (9) (pp 1522-1531), 2018. Date of Publication:
2018.
Author
Haines K.J.; Beesley S.J.; Hopkins R.O.; McPeake J.; Quasim T.; Ritchie
K.; Iwashyna T.J.
Institution
(Haines) Department of Physiotherapy, Western Health, Sunshine Hospital,
St Albans, Melbourne, VIC, Australia
(Haines) Australian and New Zealand Intensive Care Research Centre, School
of Public Health and Preventive Medicine, Monash University, Melbourne,
VIC, Australia
(Beesley, Hopkins) Division of Pulmonary and Critical Care, Department of
Medicine, Intermountain Medical Center, Murray, UT, United States
(Beesley) Division of Pulmonary and Critical Care, Department of Medicine,
University of Utah, Salt Lake City, UT, United States
(Beesley, Hopkins) Center for Humanizing Critical Care, Intermountain
Health Care, Murray, UT, United States
(Hopkins) Department of Psychology, Neuroscience Center, Brigham Young
University, Provo, UT, United States
(McPeake, Quasim) Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde,
United Kingdom
(McPeake, Quasim) School of Medicine, Dentistry and Nursing, University of
Glasgow, United Kingdom
(Ritchie) Library Service, Western Health, Melbourne, VIC, Australia
(Iwashyna) Division of Pulmonary and Critical Care, Department of
Medicine, University of Michigan, Ann Arbor, MI, United States
(Iwashyna) Center for Clinical Management Research, VA Ann Arbor
Healthcare System, Ann Arbor, MI, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Identifying solutions to improve recovery after critical
illness is a pressing problem. We systematically evaluated studies of peer
support as a potential intervention to improve recovery in critical care
populations and synthesized elements important to peer support model
design. Data Sources: A systematic search of Medical Literature
Analysis and Retrieval System Online, Cumulative Index to Nursing and
Allied Health Literature, PsychINFO, and Excertpa Medica Database was
undertaken May 2017. Prospective Register of Systematic Reviews
identification number: CRD42017070174. Study Selection: Two independent
reviewers assessed titles and abstracts against study eligibility
criteria. Studies were included where 1) patients and families had
experienced critical illness and 2) patients and families had participated
in a peer support intervention. Discrepancies were resolved by consensus
and a third independent reviewer adjudicated as necessary. Data
Extraction: Two independent reviewers assessed study quality with the
Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool, and data were
synthesized according to the Preferred Reporting Items for Systematic
Reviews guidelines and interventions summarized using the Template for
Intervention Description and Replication Checklist. Data Synthesis:
Two-thousand nine-hundred thirty-two studies were screened. Eight were
included, comprising 192 family members and 92 patients including adults
(with cardiac surgery, acute myocardial infarction, trauma), pediatrics,
and neonates. The most common peer support model of the eight studies was
an in-person, facilitated group for families that occurred during the
patients' ICU admission. Peer support reduced psychologic morbidity and
improved social support and self-efficacy in two studies; in both cases,
peer support was via an individual peer-to-peer model. In the remaining
studies, it was difficult to determine the outcomes of peer support as the
reporting and quality of studies was low. Conclusion(s): Peer support
appeared to reduce psychologic morbidity and increase social support. The
evidence for peer support in critically ill populations is limited. There
is a need for well-designed and rigorously reported research into this
complex intervention. Copyright © 2018 by the Society of Critical
Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

<49>
Accession Number
2000592933
Title
Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting.
Source
Journal of the American College of Cardiology. 71 (9) (pp 983-991), 2018.
Date of Publication: 6 March 2018.
Author
Smart N.A.; Dieberg G.; King N.
Institution
(Smart, Dieberg) School of Science and Technology, University of New
England, Armidale, Australia, Australia
(King) School of Biomedical and Healthcare Sciences, Plymouth University
Peninsula Schools of Medicine and Dentistry, University of Plymouth,
Plymouth, United Kingdom
Publisher
Elsevier USA
Abstract
Background: When comparing effects of on- versus off-pump coronary artery
bypass grafting (CABG), it is important to assess the long-term clinical
outcomes. However, most research conducted thus far has concentrated on
short-term outcomes and ignored the long-term clinical outcomes,
especially the 5-year outcomes of the largest randomized controlled
trials. Objective(s): The aim of this systematic review and
meta-analysis was to investigate the long-term clinical outcomes of on-
versus off-pump CABG. Method(s): To identify potential studies
systematic searches were carried out using various databases. The search
strategy included the key concepts of cardiopulmonary bypass AND off-pump
AND long term OR 5-year outcomes. This was followed by a meta-analysis
investigating mortality, incidence of myocardial infarction, incidence of
angina, need for revascularization, and incidence of stroke.
 Result(s): Six studies totaling 8,145 participants were analyzed. In
the on-pump group mortality was 12.3%, compared with 13.9% in the off-pump
group. The odds ratio (OR) for this comparison was 1.16 (95% confidence
interval [CI]: 1.02 to 1.32; p = 0.03; 13.9% vs. 12.3%). In contrast,
there were no differences in the incidence of myocardial infarction (OR:
1.06: 95% CI: 0.91 to 1.25; p = 0.45; 8.4% vs. 7.9%), incidence of angina
(OR: 1.09; 95% CI: 0.75 to 1.57; p = 0.65; 2.3% vs. 2.1%), need for
revascularization (OR: 1.15; 95% CI: 0.95 to 1.40; p = 0.16; 5.9% vs.
5.1%), and the incidence of stroke (OR: 0.78; 95% CI: 0.56 to 1.10; p =
0.16; 2.2% vs. 2.8%). Conclusion(s): Statistically, on-pump CABG
appeared to offer superior long-term survival, although the clinical
significance of this may be more uncertain. Copyright © 2018
American College of Cardiology Foundation

<50>
[Use Link to view the full text]
Accession Number
625311440
Title
MicroRNA-155 amplifies nitric oxide/cGMP signaling and impairs vascular
angiotensin II reactivity in septic shock.
Source
Critical Care Medicine. 46 (9) (pp E945-E954), 2018. Date of Publication:
2018.
Author
Vasques-Novoa F.; Laundos T.L.; Cerqueira R.J.; Quina-Rodrigues C.;
Soares-dos-Reis R.; Baganha F.; Ribeiro S.; Mendonca L.; Goncalves F.;
Reguenga C.; Verhesen W.; Carneiro F.; Paiva J.A.; Schroen B.;
Castro-Chaves P.; Pinto-do-o P.; Nascimento D.S.; Heymans S.;
Leite-Moreira A.F.; Roncon-Albuquerque R.
Institution
(Vasques-Novoa, Cerqueira, Quina-Rodrigues, Baganha, Ribeiro, Mendonca,
Goncalves, Castro-Chaves, Leite-Moreira, Roncon-Albuquerque) Department of
Surgery and Physiology, Faculty of Medicine, University of Porto, Porto,
Portugal
(Vasques-Novoa, Castro-Chaves) Department of Internal Medicine, Sao Joao
Hospital Center, Porto, Portugal
(Vasques-Novoa, Paiva, Castro-Chaves) Department of Medicine, Faculty of
Medicine of Porto, Porto, Portugal
(Vasques-Novoa, Laundos, Soares-dos-Reis, Reguenga, Carneiro, Pinto-Do-O,
Nascimento) Instituto de Investigacao e Inovacao em Saude (i3S),
University of Porto, Porto, Portugal
(Vasques-Novoa, Laundos, Pinto-do-o, Nascimento) Instituto de Engenharia
Biomedica (INEB), University of Porto, Porto, Portugal
(Laundos, Pinto-do-o) Instituto de Ciencias Biomedicas Abel Salazar
(ICBAS), University of Porto, Porto, Portugal
(Cerqueira, Leite-Moreira) Department of Cardiothoracic Surgery, Sao Joao
Hospital Center, Porto, Portugal
(Quina-Rodrigues) Department of Cardiology, Hospital de Braga, Braga,
Portugal
(Soares-dos-Reis, Reguenga) Department of Biomedicine-Experimental Biology
Unit, Faculty of Medicine, University of Porto, Porto, Portugal
(Soares-dos-Reis, Reguenga) Instituto de Biologia Molecular e Celular
(IBMC), University of Porto, Porto, Portugal
(Verhesen, Schroen, Heymans) Center for Heart Failure Research,
Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Netherlands
(Carneiro) Department of Pathology, Sao Joao Hospital Center, Porto,
Portugal
(Carneiro) Institute of Molecular Pathology and Immunology, University of
Porto (IPATIMUP), Porto, Portugal
(Paiva, Roncon-Albuquerque) Department of Emergency and Intensive Care
Medicine, Sao Joao Hospital Center, Porto, Portugal
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Septic shock is a life-threatening clinical situation
associated with acute myocardial and vascular dysfunction, whose
pathophysiology is still poorly understood. Herein, we investigated
microRNA-155-dependent mechanisms of myocardial and vascular dysfunction
in septic shock. Design(s): Prospective, randomized controlled
experimental murine study and clinical cohort analysis. Setting(s):
University research laboratory and ICU at a tertiary-care center.
 Patient(s): Septic patients, ICU controls, and healthy controls.
Postmortem myocardial samples from septic and nonseptic patients. Ex vivo
evaluation of arterial rings from patients undergoing coronary artery
bypass grafting. Subjects: C57Bl/6J and genetic background-matched
microRNA-155 knockout mice. Intervention(s): Two mouse models of
septic shock were used. Genetic deletion and pharmacologic inhibition of
microRNA-155 were performed. Ex vivo myographic studies were performed
using mouse and human arterial rings.Measurements and Main Results: We
identified microRNA-155 as a highly up-regulated multifunctional mediator
of sepsisassociated cardiovascular dysfunction. In humans, plasma and
myocardial microRNA-155 levels correlate with sepsis-related mortality and
cardiac injury, respectively, whereas in murine models, microRNA-155
deletion and pharmacologic inhibition attenuate sepsis-associated
cardiovascular dysfunction and mortality. MicroRNA-155 up-regulation in
septic myocardium was found to be mostly supported by microvascular
endothelial cells. This promoted myocardial microvascular permeability and
edema, bioenergetic deterioration, contractile dysfunction,
proinflammatory, and nitric oxide-cGMP-protein kinase G signaling
overactivation. In isolate cardiac microvascular endothelial cells,
microRNA-155 up-regulation significantly contributes to LPSinduced
proinflammatory cytokine up-regulation, leukocyte adhesion, and nitric
oxide overproduction. Furthermore, we identified direct targeting of CD47
by microRNA-155 as a novel mechanism of myocardial and vascular
contractile depression in sepsis, promoting microvascular endothelial cell
and vascular insensitivity to thrombospondin-1-mediated inhibition of
nitric oxide production and nitric oxide-mediated vasorelaxation,
respectively. Additionally, microRNA-155 directly targets angiotensin type
1 receptor, decreasing vascular angiotensin II reactivity. Deletion of
microRNA-155 restored angiotensin II and thrombospondin-1 vascular
reactivity in LPS-exposed arterial rings. Conclusion(s): Our study
demonstrates multiple new microRNA- 155-mediated mechanisms of
sepsis-associated cardiovascular dysfunction, supporting the translational
potential of microRNA-155 inhibition in human septic shock. Copyright
© IAEME Publication

<51>
Accession Number
610553950
Title
Cholesterol lowering in intermediate-risk persons without cardiovascular
disease.
Source
New England Journal of Medicine. 374 (21) (pp 2021-2031), 2016. Date of
Publication: 26 May 2016.
Author
Yusuf S.; Bosch J.; Dagenais G.; Zhu J.; Xavier D.; Liu L.; Pais P.;
Lopez-Jaramillo P.; Leiter L.A.; Dans A.; Avezum A.; Piegas L.S.;
Parkhomenko A.; Keltai K.; Keltai M.; Sliwa K.; Peters R.J.G.; Held C.;
Chazova I.; Yusoff K.; Lewis B.S.; Jansky P.; Khunti K.; Toff W.D.; Reid
C.M.; Varigos J.; Sanchez-Vallejo G.; McKelvie R.; Pogue J.; Jung H.; Gao
P.; Diaz R.; Lonn E.
Institution
(Yusuf, Bosch, McKelvie, Pogue, Jung, Gao, Lonn) Population Health
Research Institute, Hamilton Health Sciences, McMaster University, 237
Barton St. E., Hamilton, ON L8L 2X2, Canada
(Yusuf, McKelvie, Lonn) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Pogue) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
(Bosch) School of Rehabilitation Science, McMaster University, Hamilton,
ON, Canada
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Universite Laval, Quebec, QC, Canada
(Leiter) Li Ka Shing Knowledge Institute, Keenan Research Centre for
Biomedical Science, St. Michael's Hospital, University of Toronto,
Toronto, Canada
(Zhu, Liu) Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking
Union Medical College, Beijing, China
(Xavier) St. John's Medical College, Bangalore, India
(Xavier, Pais) St. John's Research Institute, Bangalore, India
(Lopez-Jaramillo) Fundacion Oftalmologica de Santander, Instituto Masira,
Medical School, Universidad de Santander, Bucaramanga, Colombia
(Sanchez-Vallejo) University of Quindio, Armenia
(Dans) College of Medicine, University of the Philippines, Manila,
Philippines
(Avezum) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Piegas) HCor-Heart Hospital, Sao Paulo, Brazil
(Parkhomenko) Institute of Cardiology, Kiev, Ukraine
(Keltai, Keltai) Hungarian Institute of Cardiology, Semmelweis University,
Budapest, Hungary
(Sliwa) Hatter Institute for Cardiovascular Research in Africa, Department
of Medicine, University of Cape Town, Soweto Cardiovascular Research
Group, Cape Town, South Africa
(Peters) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Held) Department of Medical Sciences, Cardiology, Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Chazova) Institute of Clinical Cardiology, Russian Cardiology Research
Complex, Moscow, Russian Federation
(Yusoff) Universiti Teknologi Majlis Amansh Rakyat, Selayang, Malaysia
(Yusoff) University College Sedaya International University, Kuala Lumpur,
Malaysia
(Lewis) Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School
of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
(Jansky) University Hospital Motol, Prague, Czechia
(Khunti) Diabetes Research Centre, Leicester, United Kingdom
(Toff) Department of Cardiovascular Sciences, Leicester, United Kingdom
(Toff) University of Leicester, National Institute for Health Research,
Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital,
Leicester, United Kingdom
(Reid) School of Public Health, Curtin University, Perth, WA, Australia
(Reid) Primary Care Diabetes and Vascular Medicine, Monash Centre of
Cardiovascular Research and Education in Therapeutics, Australia
(Varigos) Department of Epidemiology and Preventive Medicine, Australia
(Varigos) Monash University, Melbourne, VIC, Australia
(Diaz) Instituto Cardiovascular de Rosario, Rosario, Argentina
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Previous trials have shown that the use of statins to lower
cholesterol reduces the risk of cardiovascular events among persons
without cardiovascular disease. Those trials have involved persons with
elevated lipid levels or inflammatory markers and involved mainly white
persons. It is unclear whether the benefits of statins can be extended to
an intermediate-risk, ethnically diverse population without cardiovascular
disease. METHODS In one comparison from a 2-by-2 factorial trial, we
randomly assigned 12,705 participants in 21 countries who did not have
cardiovascular disease and were at intermediate risk to receive
rosuvastatin at a dose of 10 mg per day or placebo. The first coprimary
outcome was the composite of death from cardiovascular causes, nonfatal
myocardial infarction, or nonfatal stroke, and the second coprimary
outcome additionally included revascularization, heart failure, and
resuscitated cardiac arrest. The median follow-up was 5.6 years. RESULTS
The overall mean low-density lipoprotein cholesterol level was 26.5% lower
in the rosuvastatin group than in the placebo group. The first coprimary
outcome occurred in 235 participants (3.7%) in the rosuvastatin group and
in 304 participants (4.8%) in the placebo group (hazard ratio, 0.76; 95%
confidence interval [CI], 0.64 to 0.91; P = 0.002). The results for the
second coprimary outcome were consistent with the results for the first
(occurring in 277 participants [4.4%] in the rosuvastatin group and in 363
participants [5.7%] in the placebo group; hazard ratio, 0.75; 95% CI, 0.64
to 0.88; P<0.001). The results were also consistent in subgroups defined
according to cardiovascular risk at baseline, lipid level, C-reactive
protein level, blood pressure, and race or ethnic group. In the
rosuvastatin group, there was no excess of diabetes or cancers, but there
was an excess of cataract surgery (in 3.8% of the participants, vs. 3.1%
in the placebo group; P = 0.02) and muscle symptoms (in 5.8% of the
participants, vs. 4.7% in the placebo group; P = 0.005). CONCLUSIONS
Treatment with rosuvastatin at a dose of 10 mg per day resulted in a
significantly lower risk of cardiovascular events than placebo in an
intermediate-risk, ethnically diverse population without cardiovascular
disease. Copyright © 2016 Massachusetts Medical Society. All
rights reserved.

<52>
Accession Number
600029584
Title
Effect of darapladib on major coronary events after an acute coronary
syndrome: The SOLID-TIMI 52 randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 312 (10) (pp
1006-1015), 2014. Date of Publication: 10 Sep 2014.
Author
O'Donoghue M.L.; Braunwald E.; White H.D.; Lukas M.A.; Tarka E.; Steg
P.G.; Hochman J.S.; Bode C.; Maggioni A.P.; Im K.; Shannon J.B.; Davies
R.Y.; Murphy S.A.; Crugnale S.E.; Wiviott S.D.; Bonaca M.P.; Watson D.F.;
Weaver W.D.; Serruys P.W.; Cannon C.P.; Steen D.P.; Lamp J.M.; McCourt A.;
Barakat D.; Mezzetti J.; Morrison C.; Stevens M.; Ward C.; Ardissino D.;
Aylward P.E.; Babilonia N.; Britto F.; Budaj A.; Chen S.A.; Corbalan R.;
Dalby A.J.; Dellborg M.; deWinter R.J.; Dorobantu M.; Duris T.; Gao R.;
Goudev A.R.; Grande P.; Gratsiansky N.; Guneri S.; Hamm C.; Husted S.;
Isaza D.; Kimura T.; Kiss R.; Lewis B.; Lopez-Sendon J.; Mancini G.B.;
Mathur A.; Mittal S.; Montalescot G.; Nicolau J.C.; Ophuis T.O.; Paolasso
E.; Parkhomenko A.; Ray K.; Reddy K.; Seung K.B.; Somaraju B.; Spinar J.;
Sritara P.; Theroux P.; Wijns W.; Collins R.; DeMets D.; Ganz P.;
Sandercock P.; Weber M.; Fisher M.; Buhr K.; Diegel S.; Schultz M.; Lowe
C.; Mills K.; Ruvido J.; Alkhalil M.; Rehman M.Q.; Stebletsova I.; Shimmer
M.; Forni D.; Awtry E.; Berger C.J.; Croce K.; Desai A.; Gelfand E.; Ho
C.; Leeman D.E.; Link M.S.; Pande A.; Ruberg F.; Vita J.A.; Gignac G.;
Hochberg E.; Lane A.; Rosenberg C.; Wagner A.; Wolpin B.M.; Goessling W.;
Acquilano D.E.; Waltemyer R.; Kunder S.; Syed A.; Aigbogun J.; Taylor M.;
Daga S.; Cicconetti G.; Nandy I.; Deenadayalu N.; Koduru S.; Zhou J.;
Abraham L.; Beloscar J.; Bettinotti M.; Dumont C.; Fernandez R.;
Fuentealba V.J.; Covelli G.; Garcia Duran R.; Hominal M.A.; Jure H.;
Litvak M.; Luciardi H.; Macin S.; MacKinnon I.; Milesi R.; Montana O.;
Olavegogeascoechea P.; Prado A.; Sala J.; Gorosito V.; Sassone S.; Maffei
L.; Schmuck R.; Vico M.; Vita N.; Arstall M.; Ashby D.; Colquhoun D.;
Cross D.; Farshid A.; Freeman M.; New G.; Hammett C.; Kanna R.; Lehman R.;
Roberts-Thomson P.; William M.; Yamen E.; Beauloye C.; Beunk J.; Boland
J.; Charlier F.; Claeys M.; Dujardin K.; Friart A.; Legrand V.; Schoors
D.; Sinnaeve P.; Vandenbossche J.L.; Abrantes J.; Alves da Costa F.;
Ardito W.; Bodanese L.; Braga J.C.; Carvalho A.; Dutra O.; Feitosa G.;
Guimaraes A.E.; Hernandes M.; Leaes P.; Lima F.; Lotufo P.; Maia L.;
Manenti E.; Mattos M.A.; Michalaros Y.; Paiva M.S.; Piegas L.; Pimentel
Filho P.; Precoma D.; Rabelo Alves Junior A.; Rassi S.; Reis G.; Resende
E.; Rossi P.; Saraiva J.F.; Silva Junior D.; Silva F.A.; Souza J.;
Wainstein M.; Ribeiro J.; Benov H.; Chompalova B.; Goshev E.; Raev D.;
Goudev A.; Grigorov M.; Grigorova V.; Mihov A.; Nikolov F.; Petrov I.;
Postadzhiyan A.; Ramshev K.; Tisheva S.; Tzekova M.; Bhargava R.; Cha J.;
Constance C.; Della Siega A.; Klinke P.; Dong R.; Dupuis R.; Gyenes G.;
Huynh T.; Labonte R.; Lai C.; Leader R.; Leiter L.; Lonn E.; Nguyen M.;
Pandey A.; Polasek P.; Ramanathan K.; Rose B.; Rupka D.; Sabbah E.; Syan
G.; Tishler S.; Vizel S.; Zeman P.; Albornoz Alarcon F.J.; Castro Galvez
P.; Florenzano Urzua F.; Pedemonte Villablanca O.A.; Perez Pino L.;
Pincetti C.; Rodriguez Venegas M.; Romero Castro C.; Lamich R.; Sepulveda
Varela P.A.; Stockins B.; Chen Y.; Dong Y.; Fu G.; Hao Y.; Huang D.; Jiao
Y.; Ke Y.; Li C.; Li H.; Li T.; Li X.; Li Z.; Liao D.; Liu L.; Lu Q.; Qu
P.; Shen Z.; Shi H.; Wu S.; Xiang M.; Xu J.; Yang X.; Yu J.; Yuan Z.;
Zhang Y.; Zhou S.; Accini Mendoza J.L.; Bohorquez R.; Botero R.; Cano
Lopez N.; Hernandez H.; Jaramillo C.; Jaramillo M.; Jaramillo N.; Manzur
F.; Mendoza F.; Reynales H.; Sanchez Vallejo G.; Ternera A.; Urina M.;
Cermak O.; Coufal Z.; Dedek V.; Francek L.; Grunfeldova H.; Gregor P.;
Kellnerova I.; Klimsa Z.; Kuchar L.; Linhart A.; Mayer O.; Taborsky M.;
Vitovec J.; Andersen U.; Kristensen K.; Bang L.; Bronnum-Schou J.; Egstrup
K.; Frost L.; Galatius S.; Jeppesen J.; Rokkedal J.; Klarlund K.; Laursen
R.; Nielsen T.; Melchior T.; Mickley H.; Nielsen H.; Nielsen W.; Schmidt
E.; Sjol A.; Skagen K.; Sykulski R.; Zeuthen E.; Nyvad O.; Agraou B.;
Bayet G.; Caussin C.; Coisne D.; Cottin Y.; Decoulx E.; Delahaye F.;
Delarche N.; D'Houdain F.; Dourmap-Collas C.; Dubois-Rande J.L.; Elbaz M.;
Martelet M.; Nallet O.; Cattan S.; Ohlmann P.; Schiele F.; Traisnel G.;
Tricot O.; Berrouschot J.; Duengen H.D.; Elsaesser A.; Erbel R.;
Moehlenkamp S.; Franz N.; Frey N.; Hambrecht R.; Haude M.; Janssens U.;
Joost A.; Schunkert H.; Kadel C.; Katus H.; Koenig W.; Laufs U.; Loew A.;
Klauss V.; Koenig A.; Sohn H.Y.; Mudra H.; Neumann F.J.; Olbrich H.G.;
Plehn A.; Buerke M.; Ebelt H.; Schaefer A.; Fischer D.; Schaeufele T.;
Steiner S.; Kreuzer J.; Tsoy I.; Stellbrink C.; Sydow K.; Baldus S.;
Tiroch K.; Guelker H.; Haltern G.; Voehringer H.F.; Weber D.; Werner G.;
Zeiher A.M.; Zeymer U.; Zirlik A.; Csapo K.; Herczeg B.; Katona A.; Keltai
K.; Kiss R.G.; Laszlo Z.; Lupkovics G.; Medvegy M.; Merkely B.; Muller G.;
Nagy A.; Nagy L.; Palinkas A.; Sziliczei-Nemeth; Sereg M.; Valco J.;
Vertes A.; Zamolyi K.; Arora P.; Bali H.; Banker D.; Chaganti V.R.;
Chandra P.K.; Chopra A.; Christopher J.; Dani S.; Gupta S.; Shah S.;
Hiremath S.; Kaul U.; Koduganti S.; Kumar N.; Kumar S.; Mandala G.; Naik
S.; Oomman A.; Padmanabhan T.N.; Parikh K.; Reddy R.P.; Roy S.; Sankardas
M.; Sapra R.; Chopra V.; Sathe S.; Sawhney J.; Atar S.; Banai S.; Eldar
M.; Elis A.; Gavish D.; Goldhaber A.; Gottlieb S.; Hayek T.; Hussein O.;
Katz A.; Klutstein M.; Kracoff O.; Lishner M.; Lotan C.; Meisel S.;
Mosseri M.; Qarawani D.; Hasin Y.; Rozenman Y.; Schiff E.; Oliven A.;
Weiss A.; Baldin M.G.; Berni A.; Biasucci L.M.; Bongo A.; Campo G.;
Valgimigli M.; Colivicchi F.; De Servi S.; Esposito G.; Gavazzi A.;
Marzilli M.; Merlini P.; Moretti L.; Morocutti G.; Mos L.; Patrizi G.;
Rapezzi C.; Branzi A.; Terrosu P.; Domae H.; Fujii S.; Furukawa Y.; Goto
Y.; Hirokami M.; Ito H.; Kawajiri K.; Kimura K.; Kuramochi T.; Miyauchi
K.; Muroya T.; Hata S.; Yoshida T.; Oku K.; Okutsu M.; Ooie T.; Saito T.;
Shimomura H.; Shinozaki N.; Shishido K.; Sugitatsu K.; Tanaka S.; Suwa S.;
Takenaka T.; Tamada A.; Tanabe K.; Tanaka Y.; Takahashi S.; Yamazaki S.;
Chae S.C.; Hong T.J.; Jeong J.O.; Jeong M.; Kim H.S.; Kim Y.H.; Ko Y.G.;
Lee S.H.; Yoon J.; Bartels L.; Basart D.; De Nooijer C.; Dijkgraaf R.; de
Graaf J.J.; Groutars R.; Visser J.; Hamer B.J.; Hamraoui K.; Heijmeriks
J.; Huizenga A.; Herrman J.P.; Knufman N.M.; Frederiks J.; Kuijper A.F.;
Lenderink T.; van der Meer P.; Milhous G.J.; Nierop P.; Oude Ophuis A.J.;
Peerenboom P.; Peters R.; Plomp J.; Prins P.; Schaap A.; van der Sluis A.;
Smeele F.J.; van Hal J.M.; Swart H.P.; Tjeerdsma G.; Troquay R.; Van Eck
M.; Viergever E.; de Weerd G.J.; van Daele M.; de Winter R.J.;
Zoet-Nugteren S.K.; van der Zwaan C.; Zwart P.; Devlin G.; Elliott J.;
Harrison N.; Hart H.; O'Meeghan T.; Stewart R.; Ternouth I.; Tisch J.; van
Pelt N.; Wilkins G.; Chen V.; Alarco Leon W.; Rodriguez Chavez V.E.; Rojas
Canamero R.; Rotta Rotta A.; Toce L.; Anonuevo J.; Barcinas R.; Coching
R.M.; Matiga G.; Sulit D.J.; Uy N.; Bronisz M.; Buszman P.; Dalkowski M.;
Derlaga B.; Fijalkowski M.; Rynkiewicz A.; Firek B.; Gil R.; Jaworska K.;
Kasprzak J.; Krzeminska-Pakula M.; Kleinrok A.; Kopaczewski J.; Kuc K.;
Kusnierz B.; Lewczuk J.; Lysek R.; Miekus P.; Mirek-Bryniarska E.;
Mlodziankowski A.; Musial W.; Mysiak A.; Napora P.; Piepiorka M.; Pluta
W.; Prochaczek F.; Przewlocki T.; Rekosz J.; Rusicka T.; Galaj A.;
Sciborski R.; Szelemej R.; Szpajer M.; Wojewoda P.; Wrzosek B.; Zurakowski
A.; Arsenescu Georgescu C.M.; Benedek I.; Capalneanu R.; Cinteza M.; Craiu
E.; Cristea M.; Dimulescu D.; Fruntelata A.G.; Ginghina C.; Minescu B.;
Musetescu R.; Ionescu D.; Pop C.; Radoi M.; Sinescu C.; Vinereanu D.;
Arkhipov M.; Barbarash O.; Bessonova N.; Boldueva S.; Boyarkin M.; Demko
A.; Duplyakov D.; Ermoshkina L.; Glezer M.; Goloshchekin B.; Gordeev I.;
Grinshtein Y.; Karpov Y.; Kobalava Z.; Konstantinov V.; Kostenko V.;
Kuimov A.; Kuznetsov V.; Libis R.; Markov V.; Motylev I.; Novikova N.;
Orlikova O.; Panchenko E.; Panov A.; Ruda M.; Sementsov D.; Shalaev S.;
Shvarts Y.; Simanenkov V.; Skorichenko V.; Sukmanova I.; Smolenskaya O.;
Tsyba L.; Vishnevsky A.; Yakhontov D.; Yakusevich V.; Zadionchenko V.;
Zateyshchikov D.; Zateyshchikova A.; Zrazhevskiy K.; Fridrich V.; Gaspar
L.; Hasilla J.; Hranai M.; Kokles M.; Pella D.; Basson M.; Bayat J.;
Blignaut S.; Burgess L.; Corbett C.; Da Silva A.; Dalby A.; De Jong D.;
Mabin T.; Manga P.; Oosthuysen W.; Ranjith N.; Roodt A.; Roux J.; Soma P.;
Swanepoel N.; Theron H.; van Zyl L.; Barrabes Riu J.A.; Figueras Bellot
J.; Bayon Fernandez J.; Simarro Martin-Ambrosio E.; Benedicto Buendia A.;
Castro Conde A.; Iniguez Romo A.; Jimenez Navarro M.; Lopez Garcia-Aranda
V.; Mainar Tello V.; Marco Garde P.; Mayordomo Lopez J.; Molla Jimenez C.;
Anton Pascual J.L.; Plaza Perez I.; Ridocci Soriano F.; Viles Beltran D.;
Bandh S.; Christensen K.; Herlitz J.; Karlsson J.E.; Mooe T.; Persson B.;
Timberg I.; Witt N.; Cheng C.C.; Hung H.H.; Lai W.T.; Tu C.M.; Li A.H.; Wu
C.F.; Wu C.J.; Yin W.H.; Buakhamsri A.; Kaewsuwanna P.; Kiatchoosakun S.;
Kuanprasert S.; Wongpraparut N.; Bayata S.; Yavuzgil O.; Amosova E.;
Batushkin V.; Dyadyk O.; Goloborodko B.; Karpenko O.; Kononenko L.;
Kopytsya M.; Koval O.; Kovalskyy I.; Legkonogov O.; Malynovsky Y.;
Shershnyova O.; Netiazhenko V.; Nikonov V.; Parkhomenko O.; Prokhorov O.;
Rebrov B.; Potapenko P.; Rudenko L.; Shcherbak V.; Stanislavchuk M.;
Tseluyko V.; Yagensky A.; Ahsan A.; Been M.; Bethell H.; Senior R.; Cox
D.; Findlay I.; Gandhi M.; Gorog D.; Jacques A.; Keeling P.; O'Rourke B.;
Pell A.; Spratt J.; Trouton T.; Wong Y.K.; Abadier R.; Abrahams L.; Afonso
L.; Aggarwal A.; Aggarwal K.; Ahmed A.; Ahmed S.; Albirini A.; Anderson
J.; Angiolillo D.; Ansari S.; Applegate R.; Arif I.; Leesar M.; Aronow H.;
Asbill B.; Ashraf R.; Atalay H.; Atassi K.; Atieh M.; Babayan Z.; Harjai
K.; Baker S.; Barr L.; Barringhaus K.; Bayron C.; Benjamin S.; Benton R.;
Berglund R.; Conn E.; Bertolet B.; Bhagwat R.; Biederman R.; Bisher E.;
Blanchard A.; Brown C.; Butman S.; Campbell C.; Canaday D.; Carlson T.;
Casale P.; Cashion W.; Chandler A.; Chandna H.; Chandrasekaran S.; Chang
G.; Chronos N.; Chang M.; Chhabra A.; Chin J.; Cochran D.; Cohen K.;
Cucher F.; Dauber I.; De Gregorio M.; Del Core M.; Dewhurst R.; Rodriguez
R.; Dionisopoulos P.; Donovan D.; Doty W.; Drossner M.; East C.; Eaton G.;
Ebrahimi R.; Effron B.; Elkhadra M.; Elsner G.; Erickson B.; Fehrenbacher
G.; Feldman R.; Fernandes V.; Fishberg R.; Flores A.; Foreman R.; Frankel
R.; French W.; Fuentes F.; Fujise K.; Fulmer J.; Gabry M.; Baig M.; Curran
P.; Garcia Pulido J.; Gatien L.; Gazmuri R.; Gencheff N.; Gilmore R.;
Giugliano G.; Goldberg R.; Goldman S.; Movahed M.R.; Goldstein M.;
Gonzalez D.; Gottlieb D.; Grabarczyk M.; Graham B.; Gruberg L.; Gumm D.;
Lee D.; Hage-Korban E.; Hakas J.; Hamroff G.; Harris B.; Hearne S.; Held
J.; Henderson D.A.; Hermany P.; Herzog W.; Hinchman D.; Fry S.; Hockstad
E.; Hodson R.; Hollenbaugh D.; Horwitz P.; Hurst P.; Ibrahim H.; Imburgia
M.; Izzo M.; Jaffrani N.; Jan M.; Janout M.; Ring M.; Jones S.; Kahn B.;
Kakavas P.; Kates A.; Bach R.; Katopodis J.; Kazimir M.; Kennett J.;
Kereiakes D.; Kersh R.; Kershner D.; Meilman H.; Kerwin P.; Khera A.;
Kieval J.; Kim E.; Kobayashi J.; Nelson R.; Kosinski E.; Kovacich D.;
Kraft P.; Kramer J.; Kruse K.; Kuvin J.; Labib A.; Labroo A.; Langer M.;
Lau T.; Lee K.; Lee T.; Levite H.; Lewis D.; Lieber I.; Loh I.; Lopez M.;
Lui H.; Malkowski M.; Mammen G.; Mascolo R.; Matsumura M.; Matthews G.;
Corbelli J.; Mayer T.; McAlhany C.; McCullum K.; Meholick A.; Mehta V.;
Melhado M.; Menees D.; Miller M.; Minisi A.; Minor S.; Moore C.; Nygaard
T.; Morcos N.; Morris P.; Morrow D.; Mostel E.; Murdock D.; Nadar V.;
Nahhas A.; Navas J.; Nukta E.; Oberoi M.; O'Donnell P.; Ostfeld R.;
Pacheco T.; Panchal V.; Parang P.; Paraschos A.; Pasquini J.; Williams J.;
Patlola R.; Peart B.; Penny W.; Pepine C.; Perlman R.; Pavlides A.; Popeil
L.; Prashad R.; Price D.; Price R.; Puleo P.; Puri S.; Raikhel M.;
Ramachandran A.; Ramos M.; Concha M.; Randhawa P.; Reichek N.; Riba A.;
Ricciardi M.; Rider J.; Fenton S.; Rizvi M.A.; Dahiya R.; Rogers W.; Roth
D.; Rowe W.; Saba F.; Sabri M.; Patel P.; Sandoval J.; Sangrigoli R.;
Schwartzbard A.; Seidner M.; Shah A.; Shanes J.; Sharma M.; Siegel C.;
Singal D.; Singh N.; Smith A.; Panetta C.; Smith S.; Whitaker J.; Snell
J.; Snyder H.; Soffer A.; Sonel A.; Spencer R.; Staniloae C.; Stephenson
C.; Sundaram S.; Sutton L.; Letts D.; Swint R.; Tallet J.; Tami L.; Taylor
R.; Hanovich G.; Tedder B.; Teufel E.; Brett C.; Thomas J.; Thompson P.;
Polk D.; Tilkian A.; Tinkel J.; Pandya U.; Tobiansky J.; Trippi J.; Tuohy
E.; Uretsky B.; Uusinarkaus K.; Varma S.; Velasquez E.; Vogel C.; Voyce
S.; Wainwright W.; Hancock H.; Walder J.; Wali A.; Watkins S.; Weiss R.;
Wickemeyer W.; Wilson D.; Wilson V.; Wiseman A.; Wright W.; Xenakis M.;
Zelenka J.; Zilz N.; Amidon T.
Institution
(O'Donoghue, Braunwald, Steen, Im, Murphy, Crugnale, Wiviott, Bonaca,
Cannon) TIMI Study Group, Cardiovascular Division, Brigham AndWomen's
Hospital, 350 Longwood Ave, Boston, MA 02115, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland University, Auckland, New Zealand
(Lukas) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Philadelphia, PA, United States
(Tarka, Davies) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, King of Prussia, PA, United States
(Steg) Departement Hospitalo-Universitaire FIRE, Hopital Bichat,
Universite Paris-Diderot, Paris, France
(Steg) NHLI Imperial College, ICMS Royal Brompton Hospital, United Kingdom
(Hochman) Department of Medicine, NYU Langone Medical Center, New York,
NY, United States
(Bode) Heart Center, Department for Cardiology and Angiology I, University
of Freiburg, Freiburg, Germany
(Maggioni) ANMCO Research Center, Florence, Italy
(Shannon, Watson) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Research Triangle Park, NC, United States
(Weaver) Henry Ford Heart and Vascular Institute, Detroit, MI, United
States
(Serruys) Erasmus University, Thoraxcentrum, Rotterdam, Netherlands
(Serruys) International Center for Circulatory Health, Imperial College,
London, United Kingdom
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Lipoprotein-associated phospholipase
A<inf>2</inf>(Lp-PLA<inf>2</inf>) has been hypothesized to be involved in
atherogenesis through pathways related to inflammation. Darapladib is an
oral, selective inhibitor of the Lp-PLA<inf>2</inf>enzyme.
 OBJECTIVE(S): To evaluate the efficacy and safety of darapladib in
patients after an acute coronary syndrome (ACS) event. DESIGN, SETTING,
AND PARTICIPANTS: SOLID-TIMI 52was a multinational, double-blind,
placebo-controlled trial that randomized 13 026 participants within 30
days of hospitalization with an ACS (non-ST-elevation or
ST-elevationmyocardial infarction [MI]) at 868 sites in 36 countries.
INTERVENTIONS: Patients were randomized to either once-daily darapladib
(160mg) or placebo on a background of guideline-recommended therapy.
Patients were followed up for a median of 2.5 years between December 7,
2009, and December 6, 2013. MAIN OUTCOMES AND MEASURES: The primary end
point (major coronary events)was the composite of coronary heart disease
(CHD) death, MI, or urgent coronary revascularization formyocardial
ischemia. Kaplan-Meier event rates are reported at 3 years.
 RESULT(S): During a median duration of 2.5 years, the primary end
point occurred in 903 patients in the darapladib group and 910 in the
placebo group (16.3%vs 15.6%at 3 years; hazard ratio [HR], 1.00 [95%CI,
0.91-1.09]; P = .93). The composite of cardiovascular death, MI, or stroke
occurred in 824 in the darapladib group and 838 in the placebo group
(15.0%vs 15.0%at 3 years; HR, 0.99 [95%CI, 0.90-1.09]; P = .78). There
were no differences between the treatment groups for additional secondary
end points, for individual components of the primary end point, or in
all-cause mortality (371 events in the darapladib group and 395 in the
placebo group [7.3%vs 7.1%at 3 years; HR, 0.94 [95%CI, 0.82-1.08]; P =
.40). Patients were more likely to report an odor-related concern in the
darapladib group vs the placebo group (11.5%vs 2.5%) and also more likely
to report diarrhea (10.6%vs 5.6%). CONCLUSIONS AND RELEVANCE: In patients
who experienced an ACS event, direct inhibition of Lp-PLA<inf>2</inf>with
darapladib added to optimal medical therapy and initiated within 30 days
of hospitalization did not reduce the risk of major coronary events. TRIAL
REGISTRATION: clinicaltrials.gov Identifier: NCT01000727 Copyright 2014
American Medical Association. All rights reserved.

<53>
Accession Number
369396833
Title
The impact of integration of a multidetector computed tomography annulus
area sizing algorithm on outcomes of transcatheter aortic valve
replacement: A prospective, multicenter, controlled trial.
Source
Journal of the American College of Cardiology. 62 (5) (pp 431-438), 2013.
Date of Publication: 30 Jul 2013.
Author
Binder R.K.; Webb J.G.; Willson A.B.; Urena M.; Hansson N.C.; Norgaard
B.L.; Pibarot P.; Barbanti M.; Larose E.; Freeman M.; Dumont E.; Thompson
C.; Wheeler M.; Moss R.R.; Yang T.-H.; Pasian S.; Hague C.J.; Nguyen G.;
Raju R.; Toggweiler S.; Min J.K.; Wood D.A.; Rodes-Cabau J.; Leipsic J.
Institution
(Binder, Webb, Willson, Barbanti, Freeman, Thompson, Wheeler, Moss, Yang,
Hague, Nguyen, Raju, Toggweiler, Leipsic) St. Paul's Hospital, University
of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
(Urena, Pibarot, Larose, Dumont, Pasian, Rodes-Cabau) Quebec Heart and
Lung Institute, Laval University, Quebec City, QC, Canada
(Hansson, Norgaard) Aarhus University Hospital Skejby, Aarhus, Denmark
(Min) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Wood) Vancouver General Hospital, University of British Columbia,
Vancouver, BC, Canada
Publisher
Elsevier USA
Abstract
Objectives This study prospectively investigated the impact of integration
of a multidetector computed tomography (MDCT) annular area sizing
algorithm on transcatheter aortic valve replacement (TAVR) outcomes.
Background Appreciation of the 3-dimensional, noncircular geometry of the
aortic annulus is important for transcatheter heart valve (THV) sizing.
Methods Patients being evaluated for TAVR in 4 centers underwent
pre-procedural MDCT. Recommendations for balloon-expandable THV size
selection were based on an MDCT sizing algorithm with an optimal goal of
modest annulus area oversizing (5% to 10%). Consecutive patients who
underwent TAVR with the algorithm (MDCT group) were compared with
consecutive patients without the algorithm (control group). The primary
endpoint was the incidence of more than mild paravalvular regurgitation
(PAR), and the secondary endpoint was the composite of in-hospital death,
aortic annulus rupture, and severe PAR. Results Of 266 patients, 133
consecutive patients underwent TAVR (SAPIEN XT THV) in the MDCT group and
133 consecutive patients were in the control group. More than mild PAR was
present in 5.3% (7 of 133) of the MDCT group and in 12.8% (17 of 133) in
the control group (p = 0.032). The combined secondary endpoint occurred in
3.8% (5 of 133) of the MDCT group and in 11.3% (15 of 133) of the control
group (p = 0.02), driven by the difference of severe PAR. Conclusions The
implementation of an MDCT annulus area sizing algorithm for TAVR reduces
PAR. Three-dimensional aortic annular assessment and annular area sizing
should be considered for TAVR.

<54>
Accession Number
364593001
Title
Vorapaxar in the secondary prevention of atherothrombotic events.
Source
New England Journal of Medicine. 366 (15) (pp 1404-1413), 2012. Date of
Publication: 12 Apr 2012.
Author
Morrow D.A.; Braunwald E.; Bonaca M.P.; Ameriso S.F.; Dalby A.J.; Fish
M.P.; Fox K.A.A.; Lipka L.J.; Liu X.; Nicolau J.C.; Ophuis A.J.O.;
Paolasso E.; Scirica B.M.; Spinar J.; Theroux P.; Wiviott S.D.; Strony J.;
Murphy S.A.; McCabe C.H.; Morin S.; Lamp J.; Gershman E.; Deenadayalu N.;
Skene A.; Hill K.; Bennett L.; Plat F.; Berman G.; Kilian A.; He W.;
Aylward P.; Bassand J.P.; Betriu A.; Bounameaux H.; Corbalan R.; Creager
M.; De Ferrari G.; Dellborg M.; Diehm C.H.; Dietz R.; Goto S.; Grande P.;
Hankey G.; Isaza D.; Jensen P.; Kiss R.; Lewis B.; Merlini P.; Moliterno
D.; Morais J.; Nieminen M.; Nilsen D.; Olin J.; Ophuis T.O.; Pichler M.;
Shinohara Y.; Teal P.; Tendera M.; Thomassen L.; Van de Werf F.; White H.;
Wilcox R.; Alberts M.; Diener H.; Mohr J.; Welch M.; Awtry E.; Berger C.;
Desai A.; Gelfand E.; Ho C.; Leeman D.; Link M.; Norden A.; Pande A.; Rost
N.; Ruberg R.; Silverman S.; Singhal A.; Vita J.; Frye R.L.; Bailey K.R.;
Easton J.; Hochman J.; Steg P.G.; Verheught F.; Lee K.; Mauro D.O.;
Centurion A.; Carlevaro O.; Cardozo E.; Cartasegna L.; Soccini N.; Farras
H.A.; Molina Aguirre E.; Duronto E.; Arrechavala L.; Rey R.; Stilman A.;
Fernandez H.; Marinsalta G.; Tartaglione J.; Chekherdemian M.; Povedano
G.; Casares E.; Kantor P.; Reges P.; Cuneo C.; Martinez G.; MacKinnon I.;
Bagnato B.; Fernandez A.; Funosas C.; Lozada A.; Barilati P.; Ferrari J.;
Ferrari N.; Llanos J.; Casaccia G.; Giannaula R.; Garcia Mendez C.; Cirio
J.; Garcia Davila C.; Estol C.; Chiezzo D.; Ramirez J.; Garrido S.;
Hominal M.; Bianchini M.V.; Ramos M.; Verdini E.; Herrera G.; Monne H.;
Ioli P.; Samudio M.A.; Rotta Escalante R.; Tarulla A.; Reich E.; Perez G.;
Milesi R.; Berli M.; Marino J.; Funes I.; Prado A.; Bezi M.; Fernandez R.;
Rojas M.; Cimbaro Canella J.P.; Galarza Salazan M.; Chew D.; Horsfall L.;
Claxton A.; French J.; O'Brien K.; Nelson G.; Loxton A.; McCann A.; Downey
C.; Aroney C.; Cleave P.; Worthley S.; Roach A.; Amerena J.; Long A.;
Thompson P.; Ferguson L.; Fitzpatrick M.; Mackenzie M.; Youssef G.;
Goldsmith H.; Jayasinghe R.; Quinlan S.; Arstall M.; Rose J.; Counsell J.;
Martin M.; Crimmins D.; Slattery A.; Anderson C.; Paraskevaidis T.; Davis
S.; Silver G.; Gerraty R.P.; Gapper J.; Donnan G.; Petrolo S.; Whelan A.;
Tulloch G.; Singh B.; Campo M.A.; Dick R.; Savage C.; Hill A.; Conway B.;
Waites J.; Keays P.; Kopp K.; Hainzer D.; Podczeck-Schweighofer A.;
Priesnitz T.; Drexel H.; Hagspiel V.; Foeger B.; Hilbe C.; Trinka E.;
Sinadinoska D.; Pilger E.; Brodmann M.; Stollberger C.; Jungbauer L.V.;
Koppensteiner R.; Hoke M.; Grisold W.; Berger O.; Gaul G.B.; Fazekas N.;
Wandaller C.; Stockenhuber F.; Rek A.; Willeit J.; Zangerle A.; Kiechl S.;
Sturm W.; Theurl M.; Gruber F.; Schacherl S.; Auer J.; Primus C.; Eber B.;
Ammer M.; Hofer J.F.; Mayr H.; Moser S.; Hoellmueller I.; Van der Werf F.;
Motte S.; Jorion M.; Schroe H.; Zwinnen W.; Vermassen F.; Geenens M.; De
Wolf L.; Brike C.; De Deyn P.; Ongena P.; De Klippel N.; Meeuwissen K.;
Desfontaines P.; Tincani G.; Vandermeeren Y.; de Fays K.; Pandolfo M.;
Alaerts N.; Peeters A.; Findik A.; Tack P.; deGrande E.; Thijs V.;
Marcelis E.; Van Landegem W.; Vanhagendoren S.; Vanhooren G.; Schotte V.;
Celen H.; Bes N.; De Letter J.; Holvoet G.; Claerbout B.; Verhamme P.;
Debaveye B.; Bourgeois P.; Debrabandere K.; Stalpaert S.; Dhondt E.; De
Maeseneire S.; De Bleecker J.; de Koning K.; Vincent M.; Tahon S.; Monte
C.; Maes J.; Vossaert R.; Vandenhoven C.; Roosen J.; Vissers C.; Sinnaeve
P.; de Velder L.; Thoeng J.; Cauwenberghs J.; Deceuninck F.; Ardito W.R.;
Queirantes C.; de Araujo Filho J.D.; Queirantes C.S.; Ribeiro J.P.;
Guizzardi S.P.; Chaves M.L.; Titton N.F.; Pereira A.H.; Webber I.; da
Silva D.G.; Uehara R.M.; Brasileiro J.; Maia L.N.; Souza A.; Bodanese
L.C.; Homem R.; Friedrich M.A.; Macagnan A.P.; Dutra O.P.; Brum A.B.;
Rossi P.R.; Herek L.; Feitosa G.S.; Bernardes Ade S.; Braga J.; Rodrigues
D.; Guimaraes A.; Teixeira A.B.; Marin Neto J.A.; Tonani M.; Piegas L.S.;
Amato V.; Leaes P.; Osorio R.L.; Ganem F.; Vieira A.P.; Leao P.; Kanashiro
V.; Franken R.A.; Martins E.P.; Gagliardi R.J.; Silva L.; Caffaro R.A.;
Novaes G.S.; Carvalho A.; Laet V.L.; Miranda F.; Crippa B.A.; Saraiva
J.F.; Ormundo C.T.; Speciali J.G.; Guandolini G.; de Albuquerque D.C.;
Silva V.; Abrantes J.A.; Pinheiro L.; Teixeira M.S.; Guanaes D.F.; Resende
E.S.; Andrade S.F.; Alves A.R.; Oliveira O.M.; Tauil C.B.; Araujo E.; de
Souza J.; de Freitas G.R.; Horokosky A.P.; Barbosa E.C.; Muniz P.; de
Moraes J.B.; Cabral M.; Faria Neto J.R.; Belemer A.; Paiva M.S.; Brito A.;
Hernandes M.E.; Amorim R.; Pittella F.J.; Brito H.H.; Kouz S.; Roy M.;
Gosselin G.; David M.; Huynh T.; Boudreault C.; Heath J.; Scott L.;
Bhargava R.; Stafford C.; Klinke W.P.; Martin L.; Chan Y.K.; Zaniol D.;
Rebane T.; Abramovich M.; Vizel S.; Fox B.; Kornder J.; Breakwell L.;
Constance C.; Gauthier M.; Cleveland D.; Valley S.; Dion D.; Morissette
A.; Vertes G.; Ross B.; Pandey A.S.; Byrne M.; Abramson B.; Sodhi N.;
Ervin F.; Thiessen S.; Halperin F.; Stedham V.; Pesant Y.; Sardin V.; Saw
J.; Tarry L.; Pouliot J.; Marquette S.; Belisle P.; Gagne D.; Ducas J.;
Munoz A.; Sussex B.; Newman S.; Madan M.; Hsu E.; Bata I.; Cossett J.;
Glanz A.; Vilag C.; Paddock V.; Collings E.; Sabbah E.; Chausse I.; Fortin
C.; Lepage C.; Chehayeb R.; Viau C.; Ma P.; Seib M.; Lamy A.; Rizzo A.;
Rajakumar A.R.; Eikel L.; Nigro F.; Stoger S.; Welsh R.; Lindholm L.;
Parker J.D.; Webber S.; Winkler L.; Hannah G.; Gupta M.; Kubiak A.;
Mukherjee A.; Bozek B.; Nguyen M.; Dufort L.; Haichin R.; Toyota V.;
Bujold S.; Syan G.; Chinnasane S.; Houde G.; Rousseau S.; Poirier P.;
Lariviere M.; Dupuis R.; Ouimet F.; Audet J.; Darveau C.; Labonte R.; Rice
T.; Nawaz S.; Cantor W.; Robbins K.; Boucher P.; Roberge J.; Zadra R.;
McPherson C.; Prieto J.C.; Noriega V.; Cereno C.; Mestas M.; Yovaniniz P.;
Ferrada W.; Pincetti C.; Torres G.; Perez L.; Villan C.; Escobar E.;
Martin R.; Padilla I.; Ramirez M.; Hormazabal R.; Pedemonte O.; Suazo E.;
Hasbun S.; Mejias M.; Cardenas F.; Donoso L.; Godoy I.; Henriquez P.;
Marine L.; Vergara T.; Juri C.; Vergara E.; Munoz M.; Solano E.; Toro J.;
Cardenas S.; Mendoza F.; Martinez S.; Saaibi J.F.; Castillo K.M.; Ruiz
N.P.; Castillo T.; Orozco A.; Munoz C.; Martinez J.; Lopez D.; Ochoa J.;
Andrade J.; Jaramillo C.; Garces G.P.; Botero R.; Caceres A.; Jaramillo
M.; Mejia C.; Schlesinger A.; Munevar V.; Rodriguez J.; Granados L.M.;
Jaramillo N.; Aristizabal C.; Cano N.; Salazar J.C.; Urina M.; Manco T.;
Valenzuela C.; Hernandez H.J.; Delgado P.S.; Vagner B.; Castano L.A.;
Ucros P.; Tellez M.; Delgado J.A.; Piedrahita C.A.; Crump J.; Fernandez
V.; Quintero C.A.; Moreno M.; Hernandez Triana E.; Cuentas I.; Accini
J.L.; Accini M.; Manzur F.; Rivera E.; Reynales H.; Huertas D.; Hovorka
J.; Filipovsky J.; Hirmerova J.; Peska S.; Jura R.; Kanovsky P.; Herzig
R.; Jansky P.; Fiala R.; Kalita Z.; Gatkova A.; Bauer J.; Fiksa J.;
Sedlacek J.; Monhart Z.; Bren J.; Linhart A.; Skalicka L.; Vitovec J.;
Hlinomaz O.; Parenica J.; Soucek M.; Rihacek I.; Branny M.; Sknouril L.;
Klimsa Z.; Holub M.; Linkova H.; Rektor I.; Mikulik R.; Mayer O.; Novakova
B.; Bar M.; Brodova P.; Polasek R.; Sabl P.; Kos P.; Lorenc Z.; Macel I.;
Graversen K.H.; Galatius S.; Soderberg L.H.; Sillesen H.; Madelung S.;
Overgard K.; Stan V.; Rasmussen L.H.; Mortensen B.; Iversen H.K.; Back C.;
Olesen C.; Christensen H.; Pedersen A.; Nielsen T.; Hasain M.; Tanggaard
L.; Husted S.; Christensen L.L.; Haas L.; Mickley H.; Hosbond S.;
Rosenlund I.; Jepsen J.; Kaspersen B.B.; Bronnum-Schou J.; Hempel H.;
Nyvad O.; Feldthaus B.; Jensen B.S.; Jensen M.K.; Andersen G.; Thomsen
R.B.; Rokkedal J.; Joergensen A.; Bulow M.; Jeppesen J.; Lederballe O.;
Scheibel I.; Sjol A.; Larsen J.; Graner M.; Svahn T.; Melin J.; Kaakkomaki
A.; Airaksinen J.; Vasankari T.; Tatlisumak T.; Metso M.; Remes A.; Nappa
M.; Jakala P.; Sivenius J.; Kalinen M.; Roine R.O.; Ketola R.; Pales D.;
Coisne D.; Berger N.; Galinier M.; Rosolin N.; Elbaz M.; Lacassagne L.;
Montalescot G.; Vignolles N.; Gully C.; Lepage I.; Roynard J.; Hamon M.;
Brucato S.; Macquin-Mavier I.; Beitar T.; Berthezene P.; Medkour T.;
Amarenco P.; Gueblaoui N.; Timsit S.; Riou D.; Mahagne M.; Suissa L.;
Quere I.; Clouzot S.; Emmerich J.; Martinez I.; Moulin T.; Cole M.;
Hosseini H.; Monod V.; Cottin Y.; Bichat F.; Galley D.; Beltra C.; Samson
Y.; Pires R.; Bura-Riviere A.; Pelvet B.; Giroud M.; Lecheneaut C.;
Ohlmann P.; Ait-m-bark Z.; Farah B.; Petit F.; Caussin C.; Braun C.;
Mehrhof F.; Inkrot S.; Darius H.; Heinze H.; Radke P.; Kulikowsky C.;
Ferrari M.; Utschig S.; Strasser R.; Haacke K.; Felix S.B.; Bruder M.;
Nienaber C.; Pfaff H.; Sohn H.; Baylacher M.; Mudra H.; Setzer P.;
Konstantinides S.; Hallmann A.; Kreuzer J.; Tsoy I.; Schneider P.; Appel
K.F.; Habermeier A.; Zeiher A.M.; Kretschmer T.; Mitrovic V.; Lehinant S.;
Bohlscheid V.; Palme B.; Heuer H.; Espinola-Klein C.; Savvidis S.;
Kleinertz K.; Hanel J.; Schmidt E.; Schmidt A.; Ringleb P.A.; Ludwig I.;
Dietzold M.; Schaffranka A.; Ranft J.; Cegla C.; Berrouschot J.; Stoll A.;
Tanislav C.; Brandtner M.A.; Rosenkranz M.; Otto D.; Gortler M.; Barleben
M.; Haberl R.; Miedl S.; Maschke M.; Schroder K.; Aral-Becher B.;
Herzog-Hauff S.; Guenther A.; Herzau C.; Hoffmann U.; Roth-Zetzsche S.;
Grond M.; Becker M.; Hamann G.; Simon K.; Kohrmann M.; Glahn J.; Wuttig
H.; Nabavi D.G.; Seraphin D.; Schellong S.; Frommhold R.; Dichgans M.;
Doerr A.; Blessing E.; Buss I.; Butter C.; Bettin D.; Grosch B.; Blank E.;
Wong L.; Liu R.; Lee S.; Kong S.; Yu C.; So E.; Jakal A.; Masszi G.;
Czuriga I.; Kapocsi J.; Soos E.; Csiba L.; Fekete K.; Valikovics A.;
Dioszeghy P.; Muskoczki E.; Csanyi A.; Matoltsy A.; Yuval R.; Bornstein
N.; Elimelech R.; Chajek-Shaul T.; Bursztyn M.; Hayek T.; Hazbon K.;
Gavish D.; Anat N.; Wexler D.; Azar P.; Mosseri M.; Tsirulnikov E.;
Rozenman Y.; Logvinenko S.; Tanne D.; Don A.; Gross B.; Feldman Y.;
Klainman E.; Genin-Dmitrishin I.; Eldar M.; Eizenberg N.; Atar S.; Lasri
E.; Hammerman H.; Aharoni G.; Zimlichman R.; Zuker S.; Telman G.;
Afanasiev S.; Katz A.; Biton A.; Goldhaber A.; Goldhaber M.; Elian D.;
Linor A.; Meyuhas S.; Tsalihin D.; Kissos D.; Lampl Y.; Israelson M.;
Gottlieb S.; Dotan L.; Elis A.; Karny M.; Hussein O.; Shestatski K.;
Brenner H.; Segal E.; Baldini U.; Gavazzi A.; Poloni M.; Censori B.;
Aiazzi L.; Maraglino C.; Marenzi G.; Specchia G.; Tritto I.; Golino P.;
Cianflone D.; Martignoni A.; Tamburino C.; Rubartelli P.; Ardissino D.;
Tadonio I.; Stramba-Badiale M.; Cernuschi P.; Nardulli R.; Sommariva L.;
Giordano A.; Berni A.; Cavallini C.; Fiscella A.; Azzarelli S.; Esposito
G.; Cassese S.; Danzi G.; Fattore L.; Barbieri E.; De Caterina R.; Odero
A.; Puttini M.; Corrada E.; Monzini N.; Vadala A.; Pistarini C.; Scrutinio
D.; Ferratini M.; Marcheselli S.; Moretti L.; Partemi L.; Pupilella T.;
Lazzari A.; Ledda A.; Geraci G.; Rasura M.; Beccia M.; Cassadonte F.;
Vatrano M.; Bongiorni D.; Mos L.; Marcuzzi G.; Murena E.; Uguccioni L.;
Ferretti C.; Piti A.; Terrosu P.; Perrone P.F.; Marconi R.; Grasso L.;
Severi S.; Evola R.; Russo N.; Agnelli G.; Paci C.; Carugo S.; Silvestri
O.; Testa R.; Novo S.; Itamoto K.; Niinuma Y.; Okada Y.; Oshiba S.; Takano
K.; Maruyama J.; Kouno M.; Nakagawara J.; Chiba M.; Takeda R.; Suzuki A.;
Segawa M.; Nagata K.; Ichikawa S.; Aoki M.; Mihara B.; Akuzawa M.; Sano
M.; Ando M.; Kotera M.; Kurosaki E.; Araki N.; Oono Y.; Takagi S.;
Nakamura M.; Hashimoto K.; Hirayama K.; Itagaki T.; Funama M.; Ohta K.;
Matsumoto M.; Sakaida H.; Nishimura N.; Ino T.; Yokoyama M.; Asoshima K.;
Mekaru S.; Inafuku N.; Iha K.; Irei T.; Yoshioka K.; Hirano Y.; Hirokami
M.; Ito T.; Hiraoka Y.; Nanri K.; Takaki M.; Adachi T.; Wakabayashi K.;
Hatashita S.; Sasaki A.; Morioka N.; Yukimoto M.; Tanahashi N.; Kusano S.;
Nakamura T.; Uchiyama S.; Komatsu M.; Nakagawa S.; Katayama S.; Kawano S.;
Hamanaka I.; Honda Y.; Kamitani T.; Ishigaki C.; Taguchi S.; Yonezawa E.;
Ishige N.; Tanabe K.; Yagi H.; Kuroda S.; Kanda M.; Kanbe T.; Sakota S.;
Hamada M.; Yoshioka A.; Nagata H.; Ishigami M.; Takahashi S.; Nakagawa H.;
Honda T.; Manabe Y.; Nomura T.; Chee K.H.; Loke L.; Ong T.K.; Sekon M.;
Kandasamy B.; Radzali N.; Ophuis A.O.; Hamer B.; van Doorn M.; Tan T.; van
der Spoel A.; van Stralen R.; van der Zeijst M.; Dunselman P.;
Lauwerijssen I.; van Dijkman P.; de Lange H.; Wardeh A.; Dille-Amo C.;
Westendorp P.; Stuij S.; van Hessen M.; Engelen W.; Bartels G.; Hendriks
M.; Prins F.; Van Gent M.; Kuijper A.; Schiks M.; Romer T.; Kerssen E.;
Schut A.; Nierop P.; Danse I.; Leenders C.; Swets E.; Freericks M.;
Brilman C.F.; van Daele M.; Bouwens M.; Swart H.; Meijlis P.; van der
Zwaan C.; Havenaar H.; Holwerda N.; van de Loo R.; Hamraoui K.; Dabrowska
K.; Werner H.; Wittekoek M.; Ronner E.; Dijkshoorn A.; Herrman J.; Bosman
F.; Basart D.; Scholtze A.; Post J.; Hendrix H.; Troquay R.; Daniels R.;
van den Berg J.; van Vemde G.; ten Berg J.; Helwig J.; Schreuder T.;
Simons T.; Groenemeijer B.; Mulder R.; Heymeriks J.; Ketting P.; Keizer
K.; Bongenaar H.; Welten R.; Dahlmans A.; Jukema J.; van der Willik E.;
Smits P.; Jones B.; Cunningham L.P.; Scott D.S.; Eadie P.; Hart H.; Turner
A.; Devlin G.; Peek D.; Tisch J.; Arnold W.; Hamer A.; Tomlinson J.;
Elliott J.; Hume M.; Ternouth I.; Vickers C.; Williams M.; Schmid D.;
Harrison N.; Coleman W.; O'Meeghan T.; Dewar J.; Singh G.P.; Austin S.;
Bonarjee V.V.; Nilsen J.M.; Nordrehaug J.E.; Falun N.B.; Opdal A.;
Birkeland B.; Kaalaas A.M.; Otterstad J.E.; Hansen V.H.; Halvorsen S.;
Semb G.A.; Rolstad O.J.; German M.; Gullestad L.; Stueflotten W.; Larsen
T.; Skarpenes I.; Kontny F.; Olsen B.B.; Graven T.; Haug H.H.; Morsund
A.H.; Sivertsen S.; Hysing J.; Flagstad E.; Sirnes P.A.; Nilsen V.V.;
Indredavik B.; Storvold J.B.; Saetre T.; Guevara C.; Schuler S.; Utvik
M.S.; Sandvik J.E.; Thunhaug H.; Kozakiewicz K.; Pluta W.; Kania M.;
Kubica J.; Kozinski M.; Gil R.J.; Pawlak A.; Gasior Z.; Szymanski L.;
Loboz-Grudzien K.; Jaroch J.; Nowalany-Kozielska E.; Glanowska G.; Ziaja
K.; Bolkowski T.; Napora P.; Molski S.; Molski M.; Staszkiewicz W.;
Slowinski P.; Krzeminska-Pakula M.; Bednarkiewicz Z.; Gruszka A.; Fiszer
U.; Palasik W.; Kornacewicz-Jach Z.; Wojtarowicz A.; Ponikowski P.; Szajn
G.; Domzal-Stryga A.; Nowak M.; Dabrowski M.; Szybka W.; Opolski G.; Roik
M.; Rynkiewicz A.; Sobiczewski W.; Czlonkowska A.; Blazejewska-Hyzorek B.;
Kawecka-Jaszcz K.; Bryniarski L.; Chmielak Z.; Kadziela J.; Pasierski T.;
Ramotowski B.; Psuja P.; Wroblewski D.; Mirek-Bryniarska E.; Koralewska
A.; Szczudlik A.; Zwolinska G.; Oszkinis G.; Snoch M.; Zaleski P.;
Stachnio U.; Milnerowicz A.; Cale A.; Almeida P.; Lopes R.; dos Santos
J.N.; Vale M.; Marques A.L.; Gomes P.; Salgado V.; Cardoso H.; Canhao P.;
Escrivanes M.; Cunha L.; Barreto D.; Vazquez-Tanus J.B.; Laboy N.;
Rodriguez-Ospina L.F.; Pedrosa C.; Banchs H.L.; Pintado M.;
Colon-Hernandez P.; Vazquez N.; Ufret R.; Diaz V.; Garcia-Rinaldi R.;
Quinones S.; Bragin-Sanchez D.E.; Fradera L.; Zayas Torres C.R.; Negron
H.; Wong A.S.; Chua J.; Allman J.; Blomerus P.; Erasmus L.; Mabin T.;
Stemmett J.; Mohamed Z.; Solomons D.; Essop M.; Nunkoo T.; Basson M.;
Terblanche M.; Da Silva A.; Tau T.; Burgess L.; Laubscher P.; Ebrahim I.;
Bobak C.; Van Zyl L.; Ellis T.; Corbett C.; Fouche L.; Ranjith N.; Murally
A.; Retief C.; Barnard W.; Saaiman J.; Swart Y.; Roux P.; Du Toit E.;
Manga P.; Schultz O.; Blignaut S.; Snyman J.; Roodt A.; Coetsee E.; Soma
P.; Jooste E.; Sarvan M.; Govender P.; Gardiner J.; Pearson J.; Adler D.;
Trickett C.; Steingo L.; Boggett L.; Horak A.; Henley L.; Mynhardt J.;
Elliott S.; Bayat J.; Bedhram M.; Guerra M.; Kuhn A.; Freeman V.; Johnson
W.; Zambakides C.; Archer V.; Heras M.; de Mingo E.; Jimenez Navarro M.;
Isasti G.; Diez Tejedor E.; Perez Guevara M.; Egido J.; Simal P.; Del Rio
Ligorit A.; Ferreira F.; Gamero M.; Geniz Clavijo M.; Alonso Garcia M.;
Salcedo I.; Iglesias Cubero G.; Villa E.; Ridocci F.; Galve E.; Nieto E.;
Salvador A.; Rueda D.; Alonso de Lecinana M.; Sogorb F.; Arrarte Esteban
V.; Puras Mallagray E.; Gutierrez Baz M.; Lekuona Goya I.; Alarcon J.;
Revilla A.; Mota P.; Fernandez-Vazquez F.; Larrode O.; Bruguera Cortada
J.; Cabero Cereto P.; Worner F.; Barta L.; Marin Araez E.; Ramos Sanchez
M.; Pedreira Perez M.; Moure M.; San Jose J.; Gutierrez J.; Gallego J.;
Ajuria I.; Balaguer J.; Arroyo R.; Tembl J.; Alvarez J.; Ortega G.; Lopez
Garcia V.; Barquero R.; Roquer J.; Llop M.; Ruiz Salmeron R.; Campuzano
Ruiz R.; Kulisevsky J.; Campolongo A.; Pons J.; Segura Martin T.; Ayo
Martin O.; Mostacero E.; Perez C.; Aladro Benito Y.; Escolar E.;
Fernandez-Bolanos R.; Ossorno P.; Casado Naranjo I.; Portilla Cuenca J.;
Gil Nunez A.; Garcia Pastor A.; Marti Vilalta J.; Marin R.; Millan M.;
Reverte S.; Garcia-Moll X.; Terns M.; Dachs M.; Svensson H.; Cederin B.;
Elgasen A.; Jonasson T.; Brock A.; Lindblad B.; Karlsson J.; Sundqvist Y.;
Tyden P.; Stensgaard E.; Erlinge D.; Wagner H.; Hakansson A.; Svensson P.;
Andersson I.; Jernberg T.; Berglund M.; Mooe T.; Carlsson B.; Bandh S.;
Andersson C.; Wahlgren C.M.; Johansson M.; Lund L.; Lidin M.; Hellberg A.;
Fallden-Gunnnarsson A.; Konrad P.; Jarl L.; Tygesen H.; Bergsten J.;
Christensen K.; Johansson K.; Samad B.; Lof P.; Lannemyr O.; Magyarovari
I.; Persson B.; Moodh J.; Welin L.; Pettersson U.; Ercegovac V.; Wedeen
G.; Engstrom A.; Bjurling E.; Wahlgren N.; Gottsater A.; Eriksson M.; Blom
K.B.; Andersson R.; Amann-Vesti B.; Gitzelmann-Saxer G.; Banyai M.; Probst
E.; Baumgartner-Peuker I.; Zinger T.; Beer H.; Hischier D.; Krapf R.;
Kofmel A.; Spycher R.; Cerny A.; Fossati E.; Eberli F.; Frey C.; Frank U.;
Genne D.; Kundig F.; Grochenig E.; Sidler L.; Jager K.; Widmer S.;
Moccetti T.; Rossi M.; Mueller C.; Haaf P.; Pieper M.; Weber K.; Rickli
H.; Schefer M.; Mazzolai L.; Jaltier A.; Michel M.; D'Ambrogio S.; Gallino
A.; Moccetti M.; Levy T.; Lakeman N.; Squire I.; Parker E.; Brady A.;
McAdam M.; de Belder M.; Atkinson B.; Penny W.; Davies L.; Bellenger N.;
Renouf A.; Mcintyre H.; Bacon S.; Dutka D.; Pugh J.; Davies J.; Covell W.;
Gorog D.; Gregory T.; Khattar R.; Maciver K.; Ahsan A.; Burton J.; Sulke
N.; Large J.; Pye M.; Hairsine B.; Cohen A.; Wilmott R.; Riddell J.;
Hunter B.; Spratt J.; Taylor F.; Been M.; De Burca B.; Roberts D.;
Helliwell L.; Soo L.; Arbenser E.; O Rourke B.; Young J.; Pell A.;
Anderson J.; Oldroyd K.; Fraser D.; Senior R.; Young G.; Keeling P.;
Hughes D.; Scott D.; Dewhirst N.; Brittenden J.; Herd V.; Rowlands D.;
Hamill S.; Rees A.; Jones L.; MacLeod M.; McGhee C.; Krishnamoorthy S.;
Cochrane H.; Prakash K.; Swart E.; Jenkinson D.; Orpen A.; Henriksen P.;
Rif B.; Sprigings D.; O' Callaghan J.; Manoharan G.; McAllister P.; Kaski
J.; Brown S.; Storey R.; Steele H.; Calvert J.; Brodie K.; Tindall H.;
Serghides H.; Manoj A.; Ledger A.; Bamford J.; Bellfield R.; Bath P.; Cox
P.; Connor M.; McCormick K.; Connolly D.; Lambley-Burke R.; Rowley J.;
Aldred J.; Qureshi N.; Nolt J.; Bank A.; LaRock J.; Aggarwal K.;
Lau-Sieckman A.; Ashraf R.; Frew S.; Atassi K.; Christy L.; Aycock G.R.;
Tatum D.; Lafferty J.; Acevedo L.; Bertolet B.; McDuffie D.; Broadwater
S.R.; Edwards M.; Carr K.; Peek M.; Chandler A.B.; Hansen J.;
Chandrashekhar Y.; Tetrick L.; Cohen M.; Strout B.; Comerota A.; Shuman
S.; Vicari R.M.; Jordan J.; Corbelli J.C.; Galla A.; Weiss R.J.; Crawford
M.; Wohns D.; Singh V.; Marlow L.; Bresee S.B.; Alexander J.; Stella J.;
Garvey M.L.; Suresh D.P.; Cook V.; Tilkian A.; Parker S.; Unks D.M.;
Blakely J.; Rogers W.; Saag L.; Blonder R.D.; Graf E.; Roth E.M.; Baumann
M.; Saenz C.; Stastny C.; Saucedo J.; Clark J.; Seigel P.; Riofrio K.D.;
deLemos J.; Kelly C.; Peart B.; Peart K.; Pollock S.; Johnson S.; Harris
J.S.; Abell T.; Puri S.; Antonio-Drabek C.; Qureshi M.A.; Marentette C.;
Ramachandran A.; Kelso K.; Rezkalla S.; Johnson M.; Ring M.; Barnett S.;
Minisi A.; Jeter D.; Strootman D.; Tadros G.; Antolick A.; Nadar V.;
Darrow K.A.; Drenning D.; Lamb B.; Nash S.; Wallace H.; D'Urso M.; Southam
D.; Niederman A.; Vujanic S.; Eaton G.M.; Looney A.; Denning S.M.; Cuenot
N.; French W.; Barillas O.; Gelormini J.; Hejna E.; Gilmore R.; Bruney C.;
Lopez M.; Schenks R.; Goodman M.A.; Cappelli J.; Mahmud E.; Judd C.;
Gordon P.; Desimone L.; Gupta D.; Trussell C.; McGuinn W.P.; Walton A.;
Hakas J.F.; Horne W.; McLaurin B.T.; Davis C.; Hamroff G.S.; Hollenweger
L.; Harris J.O.; Scott M.; Khan N.; Sutton B.; Henderson D.; Crandall L.;
Langer M.; Mack M.; Hermany P.; Dengler S.; Jan M.; Warrener C.; Jones S.;
Stover T.; Kase C.; Lau H.; Kereiakes D.J.; Francis K.; Kim E.; Rasmussen
H.; Kleiman N.; Hernandez E.; Korban E.; Manns D.; Clark W.; Foley J.;
Prashad R.; McDonough C.; House K.W.; Hobbs-Williams J.; Mayer T.A.;
Genova E.; Lui H.K.; Holman L.; Ravi R.C.; Diederick M.; Hughes R.;
Applegate M.; Cucher F.H.; Gerrish S.; Kirkhuff B.; Pacheco T.;
Kuchenrither C.; Josephson R.; Warnick K.; Doty W.D.; Parsons T.;
Vlastaris A.; Bittel B.; Ziada K.; Oremus R.; Moles E.K.; Mugmon M.A.;
Latteri J.; Nygaard T.; White J.; Thomas J.C.; Tetrault A.L.; Campbell
W.B.; Dekoff N.; Chilakamarri V.; Park T.; Hodson R.; Payne C.; DelCore
M.; Butkus E.; Lewis D.; Jacobson D.; Helmy T.; Werner C.; Gurbel P.;
Gesheff T.; McCullum K.; Delio-Cox B.; Chaturvedi S.; Mada F.; Shaikh
S.R.; Shepler A.; Moursi M.; Brock S.; Ledbetter L.; Royse H.; Quartner
J.; Downing J.; Haddad T.M.; Overbeck D.; Langer M.M.; Fritsch J.;
Drossner M.N.; Simmons T.; Katzan I.; Turczyk J.; Oliver T.; Lapsansky J.;
Goldstein M.A.; Lutz H.; Yousuf K.A.; Nash M.N.; Previto L.; Levin K.;
Warnock L.; Alberts M.J.; Muskovich K.; Sotolongo C.; Domingo D.; Ford A.;
Serna J.; Chandna H.; Holly D.; Labroo A.; Lopez C.; Carlini W.G.; Jaasko
K.; Picone M.F.; Musick P.; Vora K.N.; Hillard T.; Varma S.K.; Collins S.;
Kuvin J.T.; Mooney P.; Porterfield J.; Katopodis J.; Knap P.; Madison J.;
Morgan J.; Cochran D.; Swafford S.; Lloyd B.F.; Lehmann J.; Wiseman A.;
Whited C.; Muhlestein J.B.; Johnson E.; Hack T.; Sullivan S.L.; Mehta
R.H.; Watkins K.; Lee-Kwen P.; McGowan P.; Pratt R.; Neeper L.; Gencheff
N.E.; Nease J.; Felten W.; Braem J.; Perlmutter N.; Rees J.; Das D.; Byrd
J.; Abrahams L.; Leone C.; Chen C.; Gilbert C.; Banish D.H.; Nicely V.L.;
Chokshi S.; Holbrook V.; Misra V.; Brott B.; Harshberger J.; Horwitz P.;
Wilson R.K.; Bacharach J.M.; Farley R.; Verro P.; Lim S.; Peterson J.G.;
Pape G.; Bach R.; Palazzolo M.; Cooper M.D.; Lord S.; Lim M.; Weber E.;
Koch S.; Lichtenberger M.; Prior J.; Carlson T.A.; Cashion W.R.; Cherry
R.; Minor S.T.; Shipwash T.; MacDonald L.; Derbyshire S.; Kraft P.;
Tessmar C.; Fraizer M.; French D.; Leimbach W.; Durham J.; Fintel D.;
Chippendale T.J.; Soto E.; Jacoby D.; Donovan S.E.; Haskel E.J.; Powell
J.; Shirwany A.; Wilson J.; Cole J.F.; Fisher M.; Bayron C.J.; Kochounian
C.; Williams L.; Kasner S.E.; DeSanto M.L.; Altafullah I.; Lemm J.; Rabiee
H.; Shirley T.; Iteld B.J.; Dureau D.; Concha M.; Martinez E.; Teklinski
A.; Shaw C.; Bradley A.J.; Terry P.S.; Rashid J.; Pierson M.; Silliman S.;
Stegmaier M.; Lee T.; Burton C.; Dietrich D.W.; Schaefer V.; Madison J.D.;
MacDonald H.; Kmetzo J.; Pierce K.; Ostfeld R.; Rosal-Greif V.; Chaudhuri
P.; Kelley M.; Adams K.; Lohman J.; Schrank J.; Ebreo N.; Brooks R.B.;
Sadekoski C.; Kozlowski J.; Kozlowski R.; Tietjen G.; Korsnack A.;
Albirini A.; Moore A.; Holt W.; Goldberg R.K.; Barrett M.; Gips S.J.;
Davis M.; Fertels S.; Jeffers H.; Gelernt M.; Vogt T.; Baron S.; Gros C.;
Koren M.J.; Givens L.; Gupta A.; Seaton D.; Staniloae C.S.; Liu M.H.;
Howell G.J.; Howell S.T.; Thadani U.; Alexander D.; Reyes P.; Black L.;
Sharma M.K.; Gibson T.; Libman R.; DeMers C.; Ebrahimi R.; Mirshkarlo
H.B.; Ellis J.; Mooney J.; Gomez C.R.; Lewis A.; Bilazarian S.; Langone
L.; Lowenkopf T.; Rodriguez M.; Abadier R.; Gray L.; Desai V.; Myers C.;
Altschuller A.; Oliveira K.S.; Patel P.; Fini G.; Bhagwat R.; Winterrowd
D.; Chu A.A.; Edwards N.; Wilson W.W.; Needham J.; Lieberman S.; Perez
J.A.; Addington J.; Adams H.P.; Sieren J.; Katz R.; Marshall L.; Stein
M.J.; Dagher E.; O'Dea D.J.; Landi T.; McKay R.; Cloutier J.; Hinchman
D.A.; Ross J.; Sanderson J.N.; House K.; Schidemantle E.; H'Doubler P.;
Barnes C.; Rohrbeck S.; Howard A.; Odhav A.; Schmitz N.; Schneck M.J.;
Chadwick L.R.; Sewing P.; Portelli J.; Mansouri V.; Duncan R.; Osborne J.;
Gonzalez M.; Gillespie E.L.; Rhoades S.; Zweifler R.M.; Spady M.A.;
Whitney R.; Gocke B.; Angirekula M.; Bridges D.; Reen B.M.; Marshall E.;
Saba F.; Dunaway B.; Berlowitz M.; Nuce R.; Whitaker J.; Brooks J.;
Kumkumian G.; Murphy M.; Brown C.S.; Smith M.A.; Mostel E.; Harris R.;
Camp A.; Sheets L.; Steinhoff J.; Renaud K.; Mayer N.J.; Escallier K.;
Tang A.; Green C.; Taheri H.; Morgan K.; Galloway J.; Dauer M.; Arthur A.;
Hogan C.; Kozak M.; Jefferson D.; Carter E.; Moore R.; Isserman S.M.;
Moore C.; Kersh R.I.; DaCosta A.; Frey A.; Short L.; Stein B.; McGee R.;
Schneider D.; Chadwick L.; Puleo P.; Tarsi D.; Singh N.; Logwood D.
Institution
(Morrow, Braunwald, Bonaca, Fish, Scirica, Wiviott, Murphy) TIMI Study
Group, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis
St., Boston, MA 02115, United States
(Ameriso) Institute for Neurological Research, FLENI, Buenos Aires,
Argentina
(Dalby) Milpark Hospital, Johannesburg, South Africa
(Fox) Division of Cardiovascular Research, University of Edinburgh,
Edinburgh, United Kingdom
(Lipka, Liu, Strony) Merck Research Laboratories, Rahway, NJ, United
States
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Ophuis) Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
(Paolasso) Instituto de Investigaciones Clinicas Rosario, Rosario,
Argentina
(Spinar) University Hospital Brno, Masaryk University, Brno, Czechia
(Theroux) Montreal Heart Institute, University of Montreal, Montreal,
Canada
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Thrombin potently activates platelets through the
protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent
that selectively inhibits the cellular actions of thrombin through
antagonism of PAR-1. METHOD(S): We randomly assigned 26,449 patients
who had a history of myocardial infarction, ischemic stroke, or peripheral
arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo
and followed them for a median of 30 months. The primary efficacy end
point was the composite of death from cardiovascular causes, myocardial
infarction, or stroke. After 2 years, the data and safety monitoring board
recommended discontinuation of the study treatment in patients with a
history of stroke owing to the risk of intracranial hemorrhage.
 RESULT(S):At 3 years, the primary end point had occurred in 1028
patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the
placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence
interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial
infarction, stroke, or recurrent ischemia leading to revascularization
occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients
(12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P
= 0.001). Moderate or severe bleeding occurred in 4.2% of patients who
received vorapaxar and 2.5% of those who received placebo (hazard ratio,
1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of
intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the
placebo group; P<0.001). CONCLUSION(S):Inhibition of PAR-1 with
vorapaxar reduced the risk of cardiovascular death or ischemic events in
patients with stable atherosclerosis who were receiving standard therapy.
However, it increased the risk of moderate or severe bleeding, including
intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50
ClinicalTrials.gov number, NCT00526474.) Copyright © 2012
Massachusetts Medical Society.

<55>
Accession Number
359837373
Title
Unrecognized pretransplant and donor-derived cryptococcal disease in organ
transplant recipients.
Source
Clinical Infectious Diseases. 51 (9) (pp 1062-1069), 2010. Date of
Publication: 01 Nov 2010.
Author
Sun H.-Y.; Alexander B.D.; Lortholary O.; Dromer F.; Forrest G.N.; Lyon
G.M.; Somani J.; Gupta K.L.; Del Busto R.; Pruett T.L.; Sifri C.D.; Limaye
A.P.; John G.T.; Klintmalm G.B.; Pursell K.; Stosor V.; Morris M.I.; Dowdy
L.A.; Munoz P.; Kalil A.C.; Garcia-Diaz J.; Orloff S.L.; House A.A.;
Houston S.H.; Wray D.; Huprikar S.; Johnson L.B.; Humar A.; Razonable
R.R.; Fisher R.A.; Husain S.; Wagener M.M.; Singh N.
Institution
(Sun, Singh) Infectious Diseases Section, VA Pittsburgh Healthcare System,
University Drive C, Pittsburgh, PA 15240, United States
(Husain, Wagener, Singh) University of Pittsburgh, Pittsburgh, PA, United
States
(Alexander) Duke University Medical Center, Durham, NC, United States
(Forrest) University of Maryland School of Medicine, Baltimore, MD, United
States
(Lyon, Somani) Emory University, Atlanta, GA, United States
(Del Busto) Henry Ford Hospital, Detroit, MI, United States
(Johnson) St. John Medical Center, Detroit, MI, United States
(Pruett, Sifri) University of Virginia, Charlottesville, VA, United States
(Fisher) Virginia Commonwealth University, Richmond, VA, United States
(Limaye) University of Washington, Seattle, WA, United States
(Klintmalm) Baylor University Medical Center, Dallas, TX, United States
(Pursell) University of Chicago, Chicago, IL, United States
(Stosor) Northwestern University, Chicago, IL, United States
(Morris, Dowdy) University of Miami Miller School of Medicine, Miami, FL,
United States
(Houston) Tampa General Hospital, Tampa, FL, United States
(Kalil) University of Nebraska, Omaha, NE, United States
(Garcia-Diaz) Ochsner Clinic, New Orleans, LA, United States
(Forrest, Orloff) Oregon Health Sciences University, Portland, OR, United
States
(Wray) Medical University of South Carolina, Charleston, SC, United States
(Huprikar) Mount Sinai Medical Center, New York, NY, United States
(Razonable) Mayo Clinic, Rochester, MN, United States
(Sun) Department of Internal Medicine, National Taiwan University
Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
(Republic of China)
(Lortholary) Institut Pasteur, Faculte de Medecine Paris Descartes,
Hopital Necker-Enfants Malades, Paris, France
(Dromer) Institut Pasteur, Paris, France
(Gupta) Postgraduate Institute of Medical Education and Research,
Chandigarh, India
(John) Christian Medical College Hospital, Vellore, India
(Munoz) Hospital General Universitario Gregorio Maranon, CIBER de
Enfermedades Respiratorias (CIBERES), Madrid, Spain
(House) University of Western Ontario, London, ON, Canada
(Humar, Husain) University Health Network, Toronto General Hospital,
Toronto, ON, Canada
(Humar) University of Alberta, Edmonton, AB, Canada
Publisher
Oxford University Press
Abstract
Background. Cryptococcosis occurring <=30 days after transplantation is an
unusual event, and its characteristics are not known. Methods. Patients
included 175 solid-organ transplant (SOT) recipients with cryptococcosis
in a multicenter cohort. Very early-onset and late-onset cryptococcosis
were defined as disease occurring <=30 days or >30 days after
transplantation, respectively. Results. Very early-onset disease developed
in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation.
Overall, 55.6% (5 of 9) of the patients with very early-onset disease
versus 25.9% (43 of 166) of the patients with late-onset disease were
liver transplant recipients (P = .05). Very early cases were more likely
to present with disease at unusual locations, including transplanted
allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001).
Two very early cases with onset on day 1 after transplantation (in a liver
transplant recipient with Cryptococcus isolated from the lung and a heart
transplant recipient with fungemia) likely were the result of undetected
pretransplant disease. An additional 5 cases involving the allograft or
surgical sites were likely the result of donor-acquired infection.
Conclusions. A subset of SOT recipients with cryptococcosis present very
early after transplantation with disease that appears to occur
preferentially in liver transplant recipients and involves unusual sites,
such as the transplanted organ or the surgical site. These patients may
have unrecognized pretransplant or donor-derived cryptococcosis. ©
2010 by the Infectious Diseases Society of America. All rights reserved.

<56>
Accession Number
627556786
Title
Platelet to Lymphocyte Ratio in Cardiovascular Diseases: A Systematic
Review.
Source
Angiology. 70 (9) (pp 802-818), 2019. Date of Publication: 01 Oct 2019.
Author
Kurtul A.; Ornek E.
Institution
(Kurtul) Cardiology Department, Tayfur Ata Sokmen Faculty of Medicine,
Hatay Mustafa Kemal University, Hatay, Antakya, Turkey
(Ornek) Cardiology Department, Ankara Numune Education and Research
Hospital, Health Sciences University, Ankara, Turkey
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The platelet to lymphocyte ratio (PLR) is an integrated reflection of 2
opposite thrombotic/inflammatory pathways that are easily calculated from
a complete blood count. The PLR initially served as a systemic
inflammatory biomarker to predict the prognosis of neoplastic diseases. In
recent years, the PLR has been used as a prognostic marker in
cardiovascular (CV) conditions. In this review, we consider the evidence
regarding the association of the PLR with CV disease (CVD) and its
possible use as a prognostic marker of CVD. The role of PLR has been
investigated in CV conditions in several studies. We assessed clinical
trials using PubMed, EMBASE, and Web of Science (up to April 18, 2018) to
evaluate the association between PLR and mortality/major adverse cardiac
events in these conditions. Most of these studies reported significant
relationships between a high PLR and diverse outcomes. In conclusion, we
suggest that PLR is a cheap and easily available systemic inflammatory
marker that can predict distinct outcomes in different types of
CVD. Copyright © The Author(s) 2019.

<57>
Accession Number
629143336
Title
Effects of thoracic epidural anesthesia/analgesia on the stress response,
pain relief, hospital stay, and treatment costs of patients with
esophageal carcinoma undergoing thoracic surgery: A single-center,
randomized controlled trial.
Source
Medicine (United States). 98 (7) (no pagination), 2019. Article Number:
e14362. Date of Publication: 01 Feb 2019.
Author
Li Y.; Dong H.; Tan S.; Qian Y.; Jin W.
Institution
(Li, Dong, Tan, Qian, Jin) Department of Anesthesiology, First Affiliated
Hospital of Nanjing Medical University, Nanjing 210029, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Appropriate postoperative pain management can improve outcomes
in patients with esophageal cancer (EC). Objective(s):To compare
different combinations of anesthesia and analgesia techniques in patients
with EC undergoing open thoracotomy. Method(s):This randomized,
controlled, open-label trial enrolled 100 patients with EC (aged 40-65
years; American Society of Anesthesiologists [ASA] grade I/II) receiving
elective surgery at Jiangsu Province Hospital (China) between July 2016
and December 2017. Patients were randomized to 4 groups (n=25 per group):
total intravenous general anesthesia plus patient-controlled intravenous
analgesia (TIVA/PCIA); TIVA plus patient-controlled epidural analgesia
(TIVA/PCEA); thoracic epidural anesthesia with intravenous general
anesthesia plus PCIA (TEA-IVA/PCIA); and TEA-IVA/PCEA (TEA-IVA plus PCEA).
Primary outcomes were plasma cortisol level (measured at baseline, 2h
after skin incision, surgery completion, and 24 and 48h post-surgery) and
pain (assessed at 24, 48, and 72hours post-surgery using a visual analog
scale). Secondary outcomes included time to first flatus, hospital stay
and treatment costs. Postoperative adverse events (AEs) were analyzed.
 Result(s):Baseline and operative characteristics were similar between
the 4 groups. Plasma cortisol level increased (P<.05 vs baseline) earlier
in the TIVA groups (2h after skin incision) than in the TEA-IVA groups
(24h after surgery). At 48hours after surgery, plasma cortisol had
returned to baseline levels in the PCEA groups but not in the PCIA groups.
VAS pain scores at rest and during coughing were lower in the PCEA groups
than in the PCIA groups (P<.05). Compared with the PCIA groups, the PCEA
groups had shorter time to first flatus and shorter hospital stay, while
use of TEA-IVA lowered the costs of intraoperative anesthesia (P<.05).
However, the PCEA groups had a higher incidence of nausea, vomiting, and
pruritus. Conclusion(s):Thoracic epidural anesthesia/analgesia can
reduce the stress response, improve postoperative recovery and reduce
hospital stay and costs for patients with EC. Copyright © 2019
the Author(s). Published by Wolters Kluwer Health, Inc.

<58>
Accession Number
629167410
Title
Pharmacological interventions for the treatment of delirium in critically
ill adults.
Source
Cochrane Database of Systematic Reviews. 2019 (9) (no pagination), 2019.
Article Number: CD011749. Date of Publication: 03 Sep 2019.
Author
Burry L.; Hutton B.; Williamson D.R.; Mehta S.; Adhikari N.K.J.; Cheng W.;
Wes Ely E.; Egerod I.; Fergusson D.A.; Rose L.
Institution
(Burry) Department of Pharmacy, Mount Sinai Hospital, Leslie Dan Faculty
of Pharmacy, University of Toronto, Toronto, Canada
(Hutton, Cheng) Knowledge Synthesis Group, Ottawa Hospital Research
Institute, Ottawa, Canada
(Williamson) Faculty of Pharmacy / Department of Pharmacy, Universite de
Montreal / Hopital du Sacre-Coeur de Montreal, Montreal, Canada
(Mehta) Interdepartmental Division of Critical Care Medicine, Mount Sinai
Hospital, University of Toronto, Toronto, Canada
(Adhikari) Interdepartmental Division of Critical Care Medicine,
University of Toronto, Toronto, Canada
(Adhikari) Department of Critical Care Medicine, Sunnybrook Health
Sciences Centre, Toronto, Canada
(Wes Ely) Center for Health Services Research, Vanderbilt University
School of Medicine, Nashville, TN, United States
(Egerod) Intensive Care Unit 4131, Rigshospitalet, University of
Copenhagen, Copenhagen O, Denmark
(Fergusson) Ottawa Hospital Research Institute, Ottawa, Canada
(Rose) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre and Sunnybrook Research Institute, Toronto, Canada
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
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. Objectives Primary objective 1. 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 delirium Secondary objectives To assess the following: 1. effects of
pharmacological interventions on delirium-free and coma-free days; days
with coma; delirium relapse; duration of me- chanical 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); and 2. the safety of such treatments for critically ill
adult patients. Search methods 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
alpha<inf>2</inf> 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'
conclusions 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. Copyright
© 2019 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<59>
Accession Number
629196374
Title
Glucose-insulin-potassium improves left ventricular performances after
aortic valve replacement: A secondary analysis of a randomized controlled
trial.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 175.
Date of Publication: 06 Sep 2019.
Author
Licker M.; Diaper J.; Sologashvili T.; Ellenberger C.
Institution
(Licker, Diaper, Ellenberger) Department of Anesthesiology, Pharmacology
and Intensive Care, University Hospital of Geneva, Geneva CH-1211,
Switzerland
(Licker) Faculty of Medicine, University of Geneva, Geneva CH-1211,
Switzerland
(Sologashvili) Division of Cardiovascular Surgery, University Hospital of
Geneva, Geneva, Switzerland
(Licker) Department of Anesthesiology, Pharmacology and Intensive Care,
University Hospital Geneva, Faculty of Medicine, Geneva CH-1206,
Switzerland
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Patients with left ventricular (LV) hypertrophy may suffer
ischemia-reperfusion injuries at the time of cardiac surgery with
impairment in left ventricular function. Using transesophageal
echocardiography (TEE), we evaluated the impact of glucose-insulin
potassium (GIK) on LV performances in patients undergoing valve
replacement for aortic stenosis. Method(s): In this secondary
analysis of a double-blind randomized trial, moderate-to-high risk
patients were assigned to receive GIK (20 IU insulin with 10 mEq KCL in 50
ml glucose 40%) or saline over 60 min upon anesthetic induction. The
primary outcomes were the early changes in 2-and 3-dimensional left
ventricular ejection fraction (2D and 3D-LVEF), peak global longitudinal
strain (PGLS) and transmitral flow propagation velocity (Vp).
 Result(s): At the end of GIK infusion, LV-FAC and 2D- and 3D-LVEF
were unchanged whereas Vp (mean difference [MD + 7.9%, 95% confidence
interval [CI] 3.2 to 12.5%; P < 0.001) increased compared with baseline
values. After Placebo infusion, there was a decrease in LV-FAC (MD -2.9%,
95%CI - 4.8 to - 1.0%), 2D-LVEF (MD -2.0%, 95%CI - 2.8 to - 1.3%, 3D-LVEF
(MD -3.0%, 95%CI - 4.0 to - 2.0%) and Vp (MD - 4.5 cm/s, 95%CI - 5.6 to -
3.3 cm/s). After cardiopulmonary bypass, GIK pretreatment was associated
with preserved 2D and 3D-LVEF (+ 0.4%, 95% 95%CI - 0.8 to 1.7% and + 0.4%,
95%CI - 1.3 to 2.0%), and PGLS (- 0.9, 95%CI - 1.6 to - 0.2) as well as
higher Vp (+ 5.1 cm/s, 95%CI 2.9 to 7.3), compared with baseline. In
contrast, in the Placebo group, 2D-LVEF (- 2.2%, 95%CI - 3.4 to - 1.0),
3D-LVEF (- 6.0%, 95%CI - 7.8 to - 4.2), and Vp (- 7.6 cm/s, 95%CI - 9.4 to
- 5.9), all decreased after bypass. Conclusion(s): Administration of
GIK before aortic cross-clamping resulted in better preservation of
systolic and diastolic ventricular function in patients with LV
hypertrophy undergoing aortic valve replacement. Trial registration:
ClinicalTrials.gov: NCT00788242, registered on November 10,
2008. Copyright © 2019 The Author(s).

<60>
Accession Number
2002201971
Title
Association of baseline LDL-C with total and cardiovascular mortality in
patients using proprotein convertase subtilisin-kexin type 9 inhibitors: A
systematic review and meta-analysis.
Source
Journal of Clinical Lipidology. 13 (4) (pp 538-549), 2019. Date of
Publication: July - August 2019.
Author
Khan S.U.; Riaz H.; Rahman H.; Khan M.U.; Khan M.S.; Alkhouli M.; Kaluski
E.; Leucker T.M.; Blaha M.J.
Institution
(Khan, Khan) Department of Medicine, West Virginia University, Morgantown,
WV, United States
(Riaz) Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Rahman) Department of Medicine, Guthrie Health System, Robert Packer
Hospital, Sayre, PA, United States
(Khan) Department of Medicine, John H. Stroger, Jr. Hospital of Cook
County, Chicago, IL, United States
(Alkhouli) Department of Cardiovascular Medicine, West Virginia
University, Morgantown, WV, United States
(Kaluski) Department of Cardiovascular Medicine, Guthrie Health System,
Robert Packer Hospital, Sayre, PA, United States
(Leucker, Blaha) Division of Cardiology, Department of Medicine, Johns
Hopkins University, School of Medicine, Baltimore, MD, United States
Publisher
Elsevier Ltd
Abstract
Background: The objective of this study was to investigate whether
baseline low-density lipoprotein cholesterol (LDL-C) levels influence
total and cardiovascular mortality reduction associated with proprotein
convertase subtilisin-kexin type 9 (PCSK9) inhibitor therapy.
 Method(s): In this meta-analysis, 9 randomized controlled trials were
selected using Medline, Embase, and CENTRAL until November 2018. Analyses
were stratified by mean baseline LDL-C (<100 mg/dL and >= 100 mg/dL).
Stepwise prespecified sensitivity analyses were performed after excluding
the SPIRE trials and by regrouping ODYSSEY OUTCOME mortality data
according to the baseline LDL-C (< and >=100 mg/dL). Result(s): In
83,321 patients, PCSK9 inhibitor therapy was not associated with a
reduction in the risk of all-cause mortality (relative risk [RR], 0.94,
95% confidence interval [CI], 0.81-1.09, P =.41). These results remained
consistent after excluding the SPIRE trials (RR, 0.89, 95% CI, 0.75-1.05,
P =.18). However, the RR varied by baseline LDL-C, with significant RR
reduction only in patients with LDL-C >= 100 mg/dL (RR, 0.39, 95% CI,
0.20-0.76) (P-interaction =.01). Meta-regression showed RR of 0.97 for
all-cause mortality per 1 mg/dL higher baseline LDL-C (95% CI, 0.94-0.99).
PCSK9 inhibitor therapy showed no significant effect on cardiovascular
mortality, with no effect when excluding the SPIRE trials. However, after
regrouping ODYSSEY OUTCOME estimates, there was a significant reduction in
cardiovascular mortality restricted to patients with LDL-C >= 100 mg/dL
(RR, 0.67, 95% CI, 0.51-0.87) (P-interaction =.006). Conclusion(s):
PCSK9 inhibitor therapy on a background statin treatment may reduce the
risk of total and cardiovascular mortality in patients with baseline LDL-C
>= 100 mg/dL. These results support current guidelines reserving PCSK9
inhibitors for high-risk patients with residually high
LDL-C. Copyright © 2019 National Lipid Association

<61>
Accession Number
628742614
Title
Lower vs higher transfusion threshold in septic shock patients of
different ages: A study protocol.
Source
Acta Anaesthesiologica Scandinavica. 63 (9) (pp 1247-1250), 2019. Date of
Publication: 01 Oct 2019.
Author
Jonsson A.B.; Granholm A.; Rygard S.L.; Holst L.B.; Moller M.H.; Perner A.
Institution
(Jonsson, Granholm, Rygard, Holst, Moller, Perner) Department of Intensive
Care, Copenhagen University Hospital, Rigshospitalet, Denmark
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Current evidence indicates that it is safe to use a lower
haemoglobin (Hb) threshold for red blood cell (RBC) transfusion as
compared to a higher Hb-threshold. However, the recent Transfusion
Requirements in Cardiac Surgery (TRICS-3) trial reported a significant
interaction between patient age and the effect of lower vs higher
Hb-thresholds for RBC transfusion. The interaction between patient age and
transfusion strategy appears to differ between trials. Method(s):
This is the protocol and statistical analysis plan for a post hoc analysis
of the Transfusion Requirements in Septic Shock (TRISS) trial. We will
assess the effect of a lower vs a higher Hb-threshold for RBC transfusion
in patients of different ages with septic shock. The primary and secondary
outcomes are 1-year mortality and 90-day mortality respectively. We will
assess age divided into six age groups and as a continuous variable and
present baseline characteristics and odds ratios derived from both simple
and adjusted (for the Sequential Organ Failure Assessment score,
haematological malignancy, age and trial site) logistic regression models
and P-values for the test-of-interaction. Furthermore, we will compare
outcomes according to Hb-threshold in each age group using Kaplan-Meier
curves and log-rank tests. Discussion(s): The outlined study will
make a detailed assessment of potential interaction of patient age with
transfusion strategy in patients with septic shock. This may inform future
trials on the benefits and harms of RBC transfusion. Copyright ©
2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John
Wiley & Sons Ltd

<62>
[Use Link to view the full text]
Accession Number
629232793
Title
Guidewire-assisted vs. direct radial arterial cannulation in neonates and
infants: A randomised controlled trial.
Source
European Journal of Anaesthesiology. 36 (10) (pp 738-744), 2019. Date of
Publication: 01 Oct 2019.
Author
Jang Y.-E.; Kim E.-H.; Lee J.-H.; Kim H.-S.; Kim J.-T.
Institution
(Jang, Kim, Lee, Kim, Kim) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul National University, College of
Medicine, 101 Daehakno, Jongnogu, Seoul 03080, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUNDCannulation of the radial artery is challenging to perform in
neonates and infants because of the small vessel size.OBJECTIVETo compare
guidewire-assisted with direct radial artery cannulation in neonates and
infants.DESIGNA randomised controlled study.SETTINGA tertiary university
hospital from 7 August 2017 to 4 July 2018.PATIENTSNinety neonates and
infants who required radial artery cannulation during general
anaesthesia.INTERVENTIONSAll patients were allocated randomly into the
guidewire group (guidewire-assisted cannulation, n=45) or control group
(direct cannulation, n=45). Radial artery cannulation was performed under
general anaesthesia. The contralateral radial artery was used if the
arterial cannulation was not successful within two attempts. After the
second failure in the contralateral radial artery, the case was considered
a failure.MAIN OUTCOME MEASURESThe primary outcome was the first-attempt
success rate of radial artery cannulation. The secondary outcomes included
the overall success rate, overall procedure time, number of attempts and
use of the contralateral radial artery for radial artery
cannulation.RESULTSThe guidewire group showed a higher first-attempt
success rate [76 vs. 56%; P=0.046; odds ratio (OR) 2.47, 95% confidence
interval (CI) of odds 1.01 to 6.08] and overall success rate (96 vs. 76%;
P=0.007; OR 6.96; 95% CI 1.44 to 33.52) than the control group. The
overall procedure time was not significantly different between the
guidewire group (median [IQR] 36 [28.0 to 70.5]s) and control group (98
[23.5 to 465.0]s; P=0.400). There was no difference in the median number
of attempts between the two groups (P=0.454). However, use of the
contralateral radial artery was significantly lower in the guidewire group
(17.8%) than in the control group (40%; P=0.020; OR 0.324, 95% CI 0.12 to
0.86). Kaplan-Meier analysis of the overall procedure time to successful
radial artery cannulation showed that the overall success rate was
significantly higher in the guidewire group than in the control group
(P=0.019).CONCLUSIONFor radial artery cannulation in neonates and infants,
guidewire-assisted radial artery cannulation showed superiority over the
direct technique in terms of first-attempt success rate and overall
success rate without delaying the procedure time. Copyright ©
2019 European Society of Anaesthesiology.

<63>
Accession Number
2002496939
Title
Utilization of percutaneous mechanical circulatory support devices in
cardiogenic shock complicating acute myocardial infarction and high-risk
percutaneous coronary interventions.
Source
Journal of Clinical Medicine. 8 (8) (no pagination), 2019. Article Number:
1209. Date of Publication: August 2019.
Author
Asleh R.; Resar J.R.
Institution
(Asleh, Resar) Division of Cardiology, Department of Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD 21205, United States
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Given the tremendous progress in interventional cardiology over the last
decade, a growing number of older patients, who have more comorbidities
and more complex coronary artery disease, are being considered for
technically challenging and high-risk percutaneous coronary interventions
(PCI). The success of performing such complex PCI is increasingly
dependent on the availability and improvement of mechanical circulatory
support (MCS) devices, which aim to provide hemodynamic support and left
ventricular (LV) unloading to enable safe and successful coronary
revascularization. MCS as an adjunct to high-risk PCI may, therefore, be
an important component for improvement in clinical outcomes. MCS devices
in this setting can be used for two main clinical conditions: Patients who
present with cardiogenic shock complicating acute myocardial infarction
(AMI) and those undergoing technically complex and high-risk PCI without
having overt cardiogenic shock. The current article reviews the
advancement in the use of various devices in both AMI complicated by
cardiogenic shock and complex high-risk PCI, highlights the available
hemodynamic and clinical data associated with the use of MCS devices, and
presents suggestive management strategies focusing on appropriate patient
selection and optimal timing and support to potentially increase the
clinical benefit from utilizing these devices during PCI in this high-risk
group of patients. Copyright © 2019 by the authors. Licensee
MDPI, Basel, Switzerland.

<64>
Accession Number
2001322828
Title
SYNTAX Score in Patients With Diabetes Undergoing Coronary
Revascularization in the FREEDOM Trial.
Source
Journal of the American College of Cardiology. Part A. 72 (23) (pp
2826-2837), 2018. Date of Publication: 11 December 2018.
Author
Esper R.B.; Farkouh M.E.; Ribeiro E.E.; Hueb W.; Domanski M.; Hamza T.H.;
Siami F.S.; Godoy L.C.; Mathew V.; French J.; Fuster V.
Institution
(Esper, Ribeiro, Hueb, Godoy) Heart Institute of the University of Sao
Paulo Medical School, Sao Paulo, Brazil
(Esper) Prevent Senior Institute, Sao Paulo, Brazil
(Farkouh, Godoy) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
(Domanski) Department of Medicine, Mount Sinai Medical Center, New York,
NY, United States
(Hamza, Siami) New England Research Institutes, Watertown, MA, United
States
(Mathew) Division of Cardiology, Loyola University Stritch School of
Medicine, Maywood, IL, United States
(French) Department of Cardiology, University of New South Wales,
Liverpool Hospital, Sydney, New South Wales, Australia
(Fuster) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Fuster) Centro Nacional de Investigaciones Cardiovasculares, Madrid,
Spain
Publisher
Elsevier USA
Abstract
Background: Diabetes mellitus (DM) is associated with complex coronary
artery disease (CAD), which in turn results in increased morbidity and
mortality from cardiovascular disease. Objective(s): This study
sought to evaluate the utility of SYNTAX score (SS) for predicting future
cardiovascular events in patients with DM and complex CAD undergoing
either coronary artery bypass grafting (CABG) or percutaneous coronary
intervention (PCI). Method(s): The FREEDOM (Future REvascularization
Evaluation in patients with Diabetes mellitus: Optimal management of
Multivessel disease) trial randomized patients with DM and multivessel CAD
to undergo either PCI with drug-eluting stents or CABG. The SS was
calculated retrospectively by a core laboratory. The endpoint of hard
cardiovascular events (HCE) was a composite of death from any cause,
nonfatal myocardial infarction, and nonfatal stroke, while the endpoint of
major adverse cardiac and cerebrovascular events (MACCE) was a composite
of HCE and repeat revascularization. Result(s): A total of 1,900
patients were randomized to PCI (n = 953) or CABG (n = 947). The SS was
considered an independent predictor of 5-year MACCE (hazard ratio per unit
of SS: 1.02; 95% confidence interval: 1.00 to 1.03; p = 0.014) and HCE
(hazard ratio per unit of SS: 1.03; 95% confidence interval: 1.01 to 1.04;
p = 0.002) in the PCI cohort, but not in the CABG group. There was a
higher incidence of MACCE in PCI patients with low, intermediate, and high
SS compared with those who underwent CABG (36.6% vs. 25.9%, p = 0.02;
43.9% vs. 26.8%, p < 0.001; 48.7% vs. 29.7%, p = 0.003, respectively).
 Conclusion(s): In DM patients with multivessel CAD, the complexity of
CAD evaluated by the SS is an independent risk factor for MACCE and HCE
only in patients undergoing PCI. The SS should not be utilized to guide
the choice of coronary revascularization in patients with DM and
multivessel CAD. (Comparison of Two Treatments for Multivessel Coronary
Artery Disease in Individuals With Diabetes [FREEDOM];
NCT00086450) Copyright © 2018

<65>
Accession Number
624079113
Title
Safety and Efficacy of Adult Stem Cell Therapy for Acute Myocardial
Infarction and Ischemic Heart Failure (SafeCell Heart): A Systematic
Review and Meta-Analysis.
Source
Stem Cells Translational Medicine. 7 (12) (pp 857-866), 2018. Date of
Publication: December 2018.
Author
Lalu M.M.; Mazzarello S.; Zlepnig J.; Dong Y.Y.R.; Montroy J.; McIntyre
L.; Devereaux P.J.; Stewart D.J.; David Mazer C.; Barron C.C.; McIsaac
D.I.; Fergusson D.A.
Institution
(Lalu, McIsaac) Department of Anesthesiology and Pain Medicine, The Ottawa
Hospital, Ottawa, ON, Canada
(Lalu, Mazzarello, Montroy, McIntyre, McIsaac, Fergusson) Blueprint
Translational Research Group, Clinical Epidemiology Program, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
(Lalu, Stewart) Regenerative Medicine Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Zlepnig, Dong, Fergusson) Faculty of Medicine, University of Ottawa,
Ottawa, ON, Canada
(McIntyre) Division of Critical Care, The Ottawa Hospital, Ottawa, ON,
Canada
(Devereaux) Population Health Research Institute, David Braley Cardiac,
Vascular, and Stroke Research Institute, Departments of Medicine and
Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON,
Canada
(Lalu, Stewart) Department of Cellular and Molecular Medicine, University
of Ottawa, Ottawa, ON, Canada
(David Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, University of Toronto, Department of Physiology,
Toronto, ON, Canada
(Barron) Department of Medicine, McMaster University, Hamilton, ON, Canada
Publisher
John Wiley and Sons Ltd. (E-mail: contentdelivery@wiley.com)
Abstract
Preclinical and clinical evidence suggests that mesenchymal stem cells
(MSCs) may be beneficial in treating both acute myocardial infarction
(AMI) and ischemic heart failure (IHF). However, the safety profile and
efficacy of MSC therapy is not well-known. We conducted a systematic
review of clinical trials that evaluated the safety or efficacy of MSCs
for AMI or IHF. Embase, PubMed/Medline, and Cochrane Central Register of
Controlled Trials were searched from inception to September 27, 2017.
Studies that examined the use of MSCs administered to adults with AMI or
IHF were eligible. The Cochrane risk of bias tool was used to assess bias
of included studies. The primary outcome was safety assessed by adverse
events and the secondary outcome was efficacy which was assessed by
mortality and left ventricular ejection fraction (LVEF). A total of 668
citations were reviewed and 23 studies met eligibility criteria. Of these,
11 studies evaluated AMI and 12 studies evaluated IHF. There was no
association between MSCs and acute adverse events. There was a significant
improvement in overall LVEF in patients who received MSCs (SMD 0.73, 95%
CI 0.24-1.21). No significant difference in mortality was noted (Peto OR
0.68, 95% CI 0.38-1.22). Results from our systematic review suggest that
MSC therapy for ischemic heart disease appears to be safe. There is a need
for a well-designed adequately powered randomized control trial (with
rigorous adverse event reporting and evaluations of cardiac function) to
further establish a clear risk-benefit profile of MSCs. Stem Cells
Translational Medicine 2018;7:857-866. Copyright © 2018 The
Authors. Stem Cells Translational Medicine published by Wiley Periodicals,
Inc. on behalf of AlphaMed Press

<66>
Accession Number
626156595
Title
Chronic kidney disease is associated with increased mortality and
procedural complications in transcatheter aortic valve replacement: a
systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 94 (3) (pp E116-E127),
2019. Date of Publication: 01 Sep 2019.
Author
Rattanawong P.; Kanitsoraphan C.; Kewcharoen J.; Riangwiwat T.;
Chongyangyuenvong P.; Vutthikraivit W.; Mannem S.R.; Chung E.H.
Institution
(Rattanawong, Kanitsoraphan, Kewcharoen) Department of Internal Medicine,
University of Hawaii Internal Medicine Residency Program, Honolulu, HI,
United States
(Rattanawong, Chongyangyuenvong) Department of Internal Medicine, Faculty
of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
(Riangwiwat) Geisinger Commonwealth School of Medicine, Scranton, PA,
United States
(Vutthikraivit) Department of Internal Medicine, Texas Tech University
Health Sciences Center, Lubbock, TX, United States
(Mannem) Division of Cardiology, Queen's Medical Center, Honolulu, HI,
United States
(Chung) Department of Internal Medicine, Michigan Medicine, University of
Michigan, Ann Arbor, MI, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We performed a systematic review and meta-analysis to explore
the association between chronic kidney disease (CKD) and mortality and
procedural complications in transcatheter aortic valve replacement (TAVR).
 Background(s): The impact of varying stages of CKD or end-stage renal
disease (ESRD) on patients receiving TAVR is not clearly identified.
 Method(s): We searched the databases of MEDLINE and EMBASE from
inception to May 2018. Included studies were published TAVR studies that
compared the risk of mortality and procedural complications in CKD
patients compared to control patients. Data from each study were combined
using the random-effects model. Result(s): Twelve studies (42,703 CKD
patients and 51,347 controls) were included. Compared with controls, CKD
patients had a significantly higher risk of 30-day overall mortality (risk
ratio [RR] = 1.56, 95% confidence interval [CI]: 1.34-1.80, I2
= 60.9), long-term cardiovascular mortality (RR = 1.44, 95% CI: 1.22-1.70,
I2 = 36.2%), and long-term overall mortality (RR = 1.66, 95%
CI: 1.45-1.91, I2 = 80.3), as well as procedural complications
including pacemaker requirement (RR = 1.20, 95% CI: 1.03-1.39,
I2 = 56.1%) and bleeding (RR = 1.60, 95% CI: 1.26-2.02,
I2 = 86.0%). Risk of mortality and procedural complications
increased with severity of CKD for stages 3, 4, and 5, respectively, in
terms of long-term overall mortality (RR = 1.28, 1.82, and 2.12), 30-day
overall mortality (RR = 1.26, 1.89, and 1.93), 30-day cardiovascular
mortality (RR = 1.18, 1.75, and 2.50), and 30-day overall bleeding (RR =
1.19, 1.63, and 2.12). Conclusion(s): Our meta-analysis demonstrates
a significant increased risk of mortality and procedural complications in
patients with CKD who underwent TAVR compared to controls. Copyright
© 2019 Wiley Periodicals, Inc.

<67>
Accession Number
623980828
Title
Comparison of Automated Titanium Fasteners to Hand-Tied Knots in Open
Aortic Valve Replacement.
Source
Innovations (Philadelphia, Pa.). 13 (1) (pp 29-34), 2018. Date of
Publication: 01 Jan 2018.
Author
Lee C.Y.; Johnson C.A.; Siordia J.A.; Lehoux J.M.; Knight P.A.
Institution
(Lee) From the Division of Cardiac Surgery, University of Rochester
Medical Center, Rochester, United States
Abstract
OBJECTIVE: Aortic cross-clamp and cardiopulmonary bypass times are
independent predictors of postoperative morbidity and mortality. Reducing
ischemic times with automated titanium fasteners may improve surgical
outcomes. This study compared operative times and costs of titanium
fasteners versus hand-tied knots for prosthesis securement in open aortic
valve replacement.
METHODS: A randomized control trial was conducted during a 16-month period
at a single university medical center. Patients undergoing elective aortic
valve replacement were randomized to the titanium fastener (n = 37) or
hand-tied groups (n = 36). Knotting, aortic cross-clamp, cardiopulmonary
bypass, and total operating room times were recorded. Hospital charges
were also calculated for these procedures.
RESULTS: Baseline characteristics, concomitant procedures, prosthetic
valve size, and sutures were similar between groups. The titanium fastener
group had significantly reduced knotting (7.4 vs. 13.0 minutes, P <
0.001), aortic cross-clamp (69 vs. 90 minutes, P < 0.05), cardiopulmonary
bypass (86 vs. 114 minutes, P < 0.05), and total operating room times (234
vs. 266 minutes, P < 0.05). Intraoperative complications occurred more
frequently in the hand-tied group compared with the titanium fastener
group. Postoperative complications were similar between groups. Operating
room costs were significantly higher in the titanium fastener group (US
$10,428 vs. US $9671, P = 0.01). Hospitalization costs did not differ
significantly between the titanium fastener and hand-tied group (US
$23,987 vs. US $21,068, P = 0.12).
CONCLUSIONS: Titanium fastener use was associated with shorter knotting,
aortic cross-clamp, cardiopulmonary bypass, and operating room times and
fewer intraoperative complications in open aortic valve replacement,
without significantly increasing hospitalization cost.

<68>
[Use Link to view the full text]
Accession Number
629303178
Title
Dynamic Changes in the Molecular Signature of Adverse Left Ventricular
Remodeling in Patients With Compensated and Decompensated Chronic Primary
Mitral Regurgitation.
Source
Circulation. Heart failure. 12 (9) (pp e005974), 2019. Date of
Publication: 01 Sep 2019.
Author
McCutcheon K.; Dickens C.; van Pelt J.; Dix-Peek T.; Grinter S.;
McCutcheon L.; Patel A.; Hale M.; Tsabedze N.; Vachiat A.; Zachariah D.;
Duarte R.; Janssens S.; Manga P.
Institution
(McCutcheon, Grinter, McCutcheon, Tsabedze, Vachiat, Zachariah, Manga)
Division of Cardiology, Department of Internal Medicine (K.M., S.G., L.M.,
A.V., Charlotte Maxeke Johannesburg Academic Hospital & University of the
Witwatersrand, Johannesburg, South Africa
(McCutcheon, Janssens) Department of Cardiovascular Diseases, University
Hospitals Leuven
(Dickens, Dix-Peek, Duarte) Molecular Biology Laboratory, Department of
Internal Medicine (C.D., University of the Witwatersrand, Johannesburg,
South Africa
(van Pelt) Department of Clinical Digestive Oncology, Faculty of Medicine,
Katholieke Universiteit, Leuven, Belgium
(Patel) Department of Cardiothoracic Surgery (A.P.), Charlotte Maxeke
Johannesburg Academic Hospital & University of the Witwatersrand,
Johannesburg, South Africa
(Hale) Department of Anatomical Pathology (M.H.), University of the
Witwatersrand, Johannesburg, South Africa
(Janssens) Department of Cardiovascular Sciences, Katholieke Universiteit,
Leuven, Belgium
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is no proven medical therapy that attenuates adverse
left ventricular remodeling in patients with chronic primary mitral
regurgitation (CPMR). Identification of molecular pathways important in
the progression of left ventricular remodeling in patients with CPMR may
lead to development of new therapeutic strategies. METHODS AND RESULTS: We
performed baseline echocardiographic, cardiac catheterization, and serum
NT-pro-BNP analysis in patients with severe CPMR awaiting mitral valve
surgery and stratified the study population into compensated or
decompensated CPMR. We obtained left ventricular endomyocardial biopsies
(n=12) for mRNA expression analysis, and compared baseline transcript
levels of 109 genes important in volume-overload left ventricular
remodeling with levels in normal hearts (n=5) and between patients with
compensated (n=6) versus decompensated (n=6) CPMR. Patients were then
randomized to treatment with and without carvedilol and followed until the
time of surgery (mean follow-up 8.3 months) when repeat endomyocardial
biopsies were obtained to correlate transcriptional dynamics with indices
of adverse remodeling. CPMR was associated with increased NPPA expression
levels (21.6-fold, P=0.004), decreased transcripts of genes important in
cell survival, and enrichment of extracellular matrix genes. Decompensated
CPMR was associated with downregulation of SERCA2 (0.77-fold, P=0.009) and
mitochondrial gene expression levels and upregulation of genes related to
inflammation, the extracellular matrix, and apoptosis, which were
refractory to carvedilol therapy. CONCLUSION(S): Transition to
decompensated CPMR is associated with calcium dysregulation, increased
expression of inflammatory, extracellular matrix and apoptotic genes, and
downregulation of genes important in bioenergetics. These changes are not
attenuated by carvedilol therapy and highlight the need for development of
specific combinatorial therapies, targeting myocardial inflammation and
apoptosis, together with urgent surgical or percutaneous valve
interventions.

<69>
Accession Number
629251264
Title
Risk factors for vasoplegia after cardiac surgery: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (6) (pp 838-844),
2019. Date of Publication: 2019.
Author
Dayan V.; Cal R.; Giangrossi F.
Institution
(Dayan) Centro Cardiovascular Universitario, Hospital de Clinicas, 26 de
Marzo, Montevideo 3459/602, Uruguay
(Dayan, Cal, Giangrossi) Instituto Nacional de Cirugia Cardiaca,
Montevideo, Uruguay
Publisher
Oxford University Press
Abstract
OBJECTIVES: Postoperative vasoplegia (PV) is a common haemodynamic
disorder after cardiac surgery and is associated with high operative
mortality. Preventive and potent therapeutic measures are critical to
improve the outcome. Identification of risk factors for PV may increase
awareness and prompt therapeutic action. Our objective was to pool the
available evidence on the risk factors for PV in cardiac surgery and to
perform a meta-analysis. METHOD(S): PubMed, Embase, Ovid and Google
Scholar databases were searched for studies published between 1965 and
2017. Three investigators independently screened the studies and extracted
the data. Pooled estimates were obtained by a random effects model.
Preoperative and operative patient data were gathered to determine their
association with PV. RESULT(S): The search yielded 109 potential
studies for inclusion. Of these, 10 articles were analysed and their data
extracted. The total number of patients included was 30 035 patients (1524
with vasoplegia and 28 511 without vasoplegia). The only preoperative
variable that was significantly associated with PV was renal failure [odds
ratio (OR) 1.47; 95% confidence interval (CI) 1.17-1.86]. Patients with
isolated coronary artery bypass grafting had a lower risk for PV (OR 0.36;
95% CI 0.22-0.59), whereas previous cardiac surgery (OR 2.03; 95% CI
1.27-3.26) and combined procedures increased its incidence (OR 2.12; 95%
CI 1.82-2.47). PV increased with higher use of red blood cells (OR 2.12;
95% CI 1.82-2.47), longer aortic cross-clamp (mean difference 8.15 min;
95% CI 8.79-27.50 min) and cardiopulmonary bypass (mean difference 25.72
min; 95% CI 12.75-38.69 min) duration. CONCLUSION(S): Patients with
renal failure, higher use of red blood cell, longer and combined cardiac
surgery procedures are at a higher risk for PV. Measures to promptly
identify and treat PV in these patients should be
considered. Copyright © 2019 The Author(s).

<70>
Accession Number
629290016
Title
Impact of early (<24 h) 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
(Van Der Gaag) Department of Neurosurgery, HagaZiekenhuis, The Hague,
Netherlands
(Ter Wengel, Van Der Gaag) Department of Neurosurgery, Leiden University
Medical Center, Albinusdreef 2, Leiden 2333 ZA, Netherlands
(Oner) Department of Orthopedic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Vandertop) Neurosurgical Center Amsterdam, Amsterdam University Medical
Center, AMC, Amsterdam, Netherlands
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
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 24 h, 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 24 h 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 24 h in
patients with thoracic and thoracolumbar tSCI. © Copyright 2019,
Mary Ann Liebert, Inc., publishers 2019.

<71>
Accession Number
2002545985
Title
Safety of a restrictive versus liberal approach to red blood cell
transfusion on the outcome of AKI in patients undergoing cardiac surgery:
A randomized clinical trial.
Source
Journal of the American Society of Nephrology. 30 (7) (pp 1294-1304),
2019. Date of Publication: July 2019.
Author
Garg A.X.; Badner N.; Bagshaw S.M.; Cuerden M.S.; Fergusson D.A.; Gregory
A.J.; Hall J.; Hare G.M.T.; Khanykin B.; McGuinness S.; Parikh C.R.;
Roshanov P.S.; Shehata N.; Sontrop J.M.; Syed S.; Tagarakis G.I.; Thorpe
K.E.; Verma S.; Wald R.; Whitlock R.P.; Mazer C.D.
Institution
(Garg, Cuerden, Sontrop) Division of Nephrology, Department of Medicine,
London Health Sciences Centre and Western University, London, ON, Canada
(Badner) Department of Anesthesia & Clinical Pharmacology, University of
British Columbia, Kelowna, BC, Canada
(Bagshaw) Department of Critical Care Medicine, University of Alberta,
Edmonton, AB, Canada
(Fergusson) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine,
University of Calgary, Calgary, AB, Canada
(Hall, Hare, Thorpe, Verma, Wald, Mazer) Li Ka Shing Knowledge Institute,
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Khanykin) Cardiothoracic Anesthesiology Department, Copenhagen University
Hospital, Copenhagen, Denmark
(McGuinness) Cardiothoracic and Vascular Intensive Care and High
Dependency Unit, Auckland City Hospital, Auckland, New Zealand
(Parikh) Division of Nephrology, Department of Medicine, Johns Hopkins
School of Medicine, Baltimore, MD, United States
(Roshanov, Syed, Whitlock) Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Shehata) Department of Medicine, Mount Sinai Hospital, University of
Toronto, Toronto, ON, Canada
(Tagarakis) Department of Cardiothoracic Surgery, Aristotle University
Hospital of Thessaloniki, Thessaloniki, Greece
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Background Safely reducing red blood cell transfusions can prevent
transfusion-related adverse effects, conserve the blood supply, and reduce
health care costs. Both anemia and red blood cell transfusion are
independently associated with AKI, but observational data are insufficient
to determine whether a restrictive approach to transfusion can be used
without increasing AKI risk. Methods In a prespecified kidney substudy of
a randomized noninferiority trial, we compared a restrictive threshold for
red blood cell transfusion (transfuse if hemoglobin<7.5 g/dl,
intraoperatively and postop-eratively) with a liberal threshold (transfuse
if hemoglobin<9.5 g/dl in the operating room or intensive care unit, or if
hemoglobin<8.5 g/dl on the nonintensive care ward). We studied 4531
patients undergoing cardiac surgery with cardiopulmonary bypass who had a
moderate-to-high risk of perioperative death. The substudy's primary
outcome was AKI, defined as a postoperative increase in serum creatinine
of >=0.3 mg/dl within 48 hours of surgery, or >=50% within 7 days of
surgery. Results Patients in the restrictive-threshold group received
significantly fewer transfusions than patients in the liberal-threshold
group (1.8 versus 2.9 on average, or 38% fewer transfusions in the
restricted-threshold group compared with the liberal-threshold group;
P<0.001). AKI occurred in 27.7% of patients in the restrictive-threshold
group (624 of 2251) and in 27.9% of patients in the liberal-threshold
group (636 of 2280). Similarly, among patients with preoperative CKD, AKI
occurred in 33.6% of patients in the restrictive-threshold group (258 of
767) and in 32.5% of patients in the liberal-threshold group (252 of 775).
Conclusions Among patients undergoing cardiac surgery, a restrictive
transfusion approach resulted in fewer red blood cell transfusions without
increasing the risk of AKI. Copyright © 2019 by the American
Society of Nephrology.

<72>
Accession Number
629305158
Title
Sevoflurane- and propofol-based regimens show comparable effect on
oxygenation in patients undergoing cardiac valve replacement with
cardiopulmonary bypass.
Source
Cardiovascular journal of Africa. 30 (pp 1-4), 2019. Date of Publication:
11 Sep 2019.
Author
Luo Z.; Wei X.; Zuo Y.; Du G.
Institution
(Luo, Wei) Department of Anaesthesiology, West China Hospital, Sichuan
University, Chengdu, China
(Zuo) Department of Anaesthesiology, West China Hospital, Sichuan
University, Chengdu, China
(Du) Department of Anaesthesiology, West China Hospital, Sichuan
University, Chengdu, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Our study aimed to compare the effects of Sevoflurane- and
propofol-based anaesthetic regimens on oxygenation during the early period
of cardiopulmonary bypass (CPB) in patients undergoing cardiac
valve-replacement surgery. METHOD(S): Patients undergoing mechanical
mitral, aortic or double valve replacement were enrolled and randomly
divided into two groups: the sevoflurane-based anaesthetic regimen group
consisted of patients who received 1-3% sevoflurane inhalation during
anaesthesia maintenance and the propofol-based anaesthetic regimen group
consisted of patients who received 6-10 mg/kg/h of propofol infusion
during anaesthesia maintenance. The partial pressure of oxygen/fraction of
inspired oxygen (PaO2/FiO2), respiratory mechanics and haemodynamics were
recorded during CPB. RESULT(S): Forty-two patients met the
eligibility criteria for the study. The groups did not differ in terms of
clinical and demographic characteristics, and pre- and intra-operative
features. Changes in oxygenation were mild (mean PaO2/FiO2 from 358 +/- 82
to 471 +/- 106 mmHg) within one hour of CPB in our patients. There were no
differences in PaO2/FiO2, respiratory mechanics and haemodynamics between
the sevoflurane and propofol groups. CONCLUSION(S): In patients
undergoing cardiac valve replacement with CPB, lung injury was mild, and
sevoflurane- and propofol-based anaesthetic regimens showed similar effect
on oxygenation, respiratory mechanics and haemodynamics during the early
stage of CPB.

<73>
Accession Number
628237729
Title
Can postoperative massage therapy reduce pain and anxiety in cardiac
surgery patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (5) (pp 716-721),
2019. Date of Publication: 2019.
Author
Grafton-Clarke C.; Grace L.; Roberts N.; Harky A.
Institution
(Grafton-Clarke) School of Medicine, Department of Life Sciences,
University of Liverpool, Liverpool, United Kingdom
(Grace, Roberts) Department of Cardiac Surgery, Barts Heart Centre, St
Bartholomew's Hospital, London, United Kingdom
(Harky) Department of Vascular Surgery, Countess of Chester, Chester,
United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was, 'In patients undergoing
cardiac surgery, is postoperative massage therapy effective in reducing
pain, anxiety and physiological parameters?' Altogether, 287 papers were
found using the reported search, of which 7 papers represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and the results of these papers are tabulated. The specific
therapy protocols widely varied between studies, with differences in
frequency, specific timing in the postoperative period, techniques used
and experience of therapy provider. These variations limit the
generalization and transferability of the conclusions. The effect of
massage therapy on anxiety levels was reported in 5 studies. All but one
demonstrated a significant improvement in anxiety. Pain was also reported
in 5 studies, with significant improvement demonstrated in 4 studies.
Importantly, a number of these studies failed to report on analgesic
requirements nor demonstrate a reduction in opioid requirements, thus
limiting the validity of the drawn conclusions. There is significant
heterogeneity in randomized trials reporting on the effects of massage
therapy. Although there is evidence to suggest that massage therapy
reduces pain and anxiety following cardiac surgery, there are often
caveats to the conclusions drawn with other studies reporting no
significant difference. Therefore, in light of this, it would not be
logical to recommend massage therapy as an effective therapy. There is no
current evidence to suggest that massage therapy improves physiological
parameters, including the onset of atrial fibrillation
postoperatively. Copyright © 2018 The Author(s). Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<74>
Accession Number
2000533589
Title
Preoperative atrial fibrillation portends poor outcomes after coronary
bypass graft surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (4) (pp 1524-1533.e2),
2018. Date of Publication: April 2018.
Author
Saxena A.; Virk S.A.; Bowman S.; Chan L.; Jeremy R.; Bannon P.G.
Institution
(Saxena, Chan, Bannon) Department of Cardiothoracic Surgery, Royal Prince
Alfred Hospital, Sydney, Australia
(Jeremy) Department of Cardiology, Royal Prince Alfred Hospital, Sydney,
Australia
(Saxena, Virk, Bannon) The Baird Institute, Sydney, Australia
(Bowman) Melbourne Medical School, University of Melbourne, Melbourne,
Australia
(Bannon) Institute of Academic Surgery, The University of Sydney, Sydney,
Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<75>
Accession Number
2000613974
Title
Risk factors for reinsertion of urinary catheter after early removal in
thoracic surgical patients.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (1) (pp 430-435),
2018. Date of Publication: July 2018.
Author
Young J.; Geraci T.; Milman S.; Maslow A.; Jones R.N.; Ng T.
Institution
(Young, Geraci, Milman, Ng) Department of Surgery, The Warren Alpert
Medical School of Brown University, Providence, RI, United States
(Maslow) Department of Anesthesiology, The Warren Alpert Medical School of
Brown University, Providence, RI, United States
(Jones) Department of Psychiatry and Human Behavior, The Warren Alpert
Medical School of Brown University, Providence, RI, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: To reduce the incidence of urinary tract infection, Surgical
Care Improvement Project 9 mandates the removal of urinary catheters
within 48 hours postoperatively. In patients with thoracic epidural
anesthesia, we sought to determine the rate of catheter reinsertion, the
complications of reinsertion, and the factors associated with reinsertion.
 Method(s): We conducted a prospective observational study of
consecutive patients undergoing major pulmonary or esophageal resection
with thoracic epidural analgesia over a 2-year period. As per Surgical
Care Improvement Project 9, all urinary catheters were removed within 48
hours postoperatively. Excluded were patients with chronic indwelling
catheter, patients with urostomy, and patients requiring continued strict
urine output monitoring. Multivariable logistic regression analysis was
used to identify independent risk factors for urinary catheter
reinsertion. Result(s): Thirteen patients met exclusion criteria. Of
the 275 patients evaluated, 60 (21.8%) required reinsertion of urinary
catheter. There was no difference in the urinary tract infection rate
between patients requiring reinsertion (1/60 [1.7%]) versus patients not
requiring reinsertion (1/215 [0.5%], P =.389). Urethral trauma during
reinsertion was seen in 1 of 60 patients (1.7%). After reinsertion,
discharge with urinary catheter was required in 4 of 60 patients (6.7%).
Multivariable logistic regression analysis found esophagectomy, lower body
mass index, and benign prostatic hypertrophy to be independent risk
factors associated with catheter reinsertion after early removal in the
presence of thoracic epidural analgesia. Conclusion(s): When applying
Surgical Care Improvement Project 9 to patients undergoing thoracic
procedures with thoracic epidural analgesia, consideration to delayed
removal of urinary catheter may be warranted in patients with multiple
risk factors for reinsertion. Copyright © 2018 The American
Association for Thoracic Surgery

<76>
Accession Number
629151186
Title
Meta-Analysis for the value of colchicine for the therapy of pericarditis
and of postpericardiotomy syndrome.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 207. 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, University Hospital Jena, Jena, Germany
(Rigopoulos, Matiakis, Sedding, Noutsias) Mid-German Heart Center,
Department of Internal Medicine III (KIM III), 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, Jena, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
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 13.6 months 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 72 h 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 > 7 days 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. Copyright © 2019 The
Author(s).

<77>
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.

<78>
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.

<79>
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.

<80>
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.

<81>
Accession Number
2001846705
Title
Medical graphic narratives to improve patient comprehension and
periprocedural anxiety before coronary angiography and percutaneous
coronary intervention: A randomized trial.
Source
Annals of Internal Medicine. 170 (8) (pp 579-581), 2019. Date of
Publication: 2019.
Author
Brand A.; Gao L.; Hamann A.; Crayen C.; Brand H.; Squier S.M.; Stangl K.;
Kendel F.; Stangl V.
Institution
(Brand, Stangl, Stangl) Charite - Universitatsmedizin Berlin, DZHK (German
Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
(Gao, Brand, Kendel) Charite - Universitatsmedizin Berlin, Berlin, Germany
(Hamann) Mintwissen BerlinGermany
(Crayen) Freie Universitat Berlin, Berlin, Germany
(Squier) Pennsylvania State University University, Park, PA, United States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<82>
Accession Number
625415470
Title
Transcatheter Aortic Valve Replacement for Pure Native Aortic Valve
Regurgitation: A Systematic Review.
Source
Cardiology (Switzerland). 141 (3) (pp 132-140), 2019. Date of Publication:
01 Feb 2019.
Author
Jiang J.; Liu X.; He Y.; Xu Q.; Zhu Q.; Jaiswal S.; Wang L.; Hu P.; Gao
F.; Sun Y.; Liu C.; Lin X.; Liang J.; Ren K.; Wang J.
Institution
(Jiang, Liu, He, Xu, Zhu, Jaiswal, Wang, Hu, Gao, Liu, Lin, Liang, Ren,
Wang) Department of Cardiology, Second Affiliated Hospital, Zhejiang
University, School of Medicine, Hangzhou, China
(Sun) Department of Cardiology, Guangdong People's Hospital, Guangdong,
China
Publisher
S. Karger AG
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a recent and
an effective treatment option for high- or extreme-surgical-risk patients
with symptomatic severe aortic stenosis. However, pure severe native
aortic valve regurgitation (NAVR) without aortic stenosis remains a
contraindication to TAVR. The aim of our systemic review analysis was to
evaluate TAVR in patients with pure NAVR. Method(s): We searched the
published articles in the PubMed and Web of Science databases (2002-2017)
using the Boolean operators for studies of NAVR patients undergoing TAVR.
Reference lists of all returned articles were searched recursively for
other relevant citations. Pooled estimates were calculated using a
random-effects meta-analysis. Result(s): Finally, a total of 10
studies were included in this analysis. The CoreValve was more frequently
used with a lower rate of device success and a higher rate of residual
aortic regurgitation. The new-generation transcatheter heart valves (THVs)
performed a significantly higher rate with less residual aortic
regurgitation and a success rate close to 100%. The 30-day all-cause
mortality rates ranged from 0 to 30% with an estimate summary rate of 9%
(95% CI: 5-15%; I2 = 33%). Cerebrovascular events, major or
life-threatening bleeding, major vascular complications, acute kidney
disease, and new permanent pacemaker implantation occurred similarly in
both the new- and old-generation THV devices. Conclusion(s): Aortic
regurgitation remains a challenging pathology for TAVR. TAVR is a feasible
and reasonable option for carefully selected patients with pure aortic
regurgitation. Copyright © 2018 S. Karger AG, Basel.

<83>
Accession Number
629280862
Title
What will surgical coronary revascularization look like in 25 years?.
Source
Current Opinion in Cardiology. (no pagination), 2019. Date of Publication:
2019.
Author
Caliskan E.; Emmert M.Y.; Falk V.
Institution
(Caliskan, Emmert, Falk) Department of Cardiovascular Surgery,
Charite-Universitatsmedizin Berlin, Berlin, Germany
(Caliskan, Emmert, Falk) Department of Cardiothoracic and Vascular
Surgery, German Heart Institute Berlin, 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
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
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. Copyright © 2019
Wolters Kluwer Health, Inc.

<84>
Accession Number
629280313
Title
Randomized trial of ticagrelor vs. aspirin in patients after coronary
artery bypass grafting: The TiCAB trial.
Source
European Heart Journal. 40 (29) (pp 1-10), 2019. Date of Publication:
August 2019.
Author
Schunkert H.; Boening A.; Von Scheidt M.; Lanig C.; Gusmini F.; DeWaha A.;
Kuna C.; Fach A.; Grothusen C.; Oberhoffer M.; Knosalla C.; Walther T.;
Danner B.C.; Misfeld M.; Zeymer U.; Wimmer-Greinecker G.; Siepe M.;
Grubitzsch H.; Joost A.; Schaefer A.; Conradi L.; Cremer J.; Hamm C.;
Lange R.; Radke P.W.; Schulz R.; Laufer G.; Grieshaber P.; Pader P.;
Attmann T.; Schmoeckel M.; Meyer A.; Ziegelhoffer T.; Hambrecht R.;
Kastrati A.; Sandner S.E.
Institution
(Schunkert, Von Scheidt, Lanig, Gusmini, DeWaha, Kuna, Lange, Kastrati)
Department of Cardiology, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Lazarettstrasse 36, Munich 80636, Germany
(Schunkert, Von Scheidt, Lange, Kastrati) DZHK (German Center for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Boening, Grieshaber) Department of Cardiovascular Surgery, Justus-Liebig
University Giesen, Ludwigstrase 23, Giesen 35390, Germany
(Fach, Pader, Hambrecht) Department of Cardiology and Angiology, Klinikum
Links der Weser, Senator-Wesling-Strase 1, Bremen 28277, Germany
(Grothusen, Cremer, Attmann) Department of Cardiovascular Surgery,
University Hospital of Schleswig-Holstein, Arnold-Heller-Strase 3, Kiel
24105, Germany
(Oberhoffer, Schmoeckel) Department of Cardiac Surgery, Asklepios Klinik
St. Georg, Lohmuhlenstrase 5, Hamburg 20099, Germany
(Knosalla, Meyer) Department of Cardiothoracic and Vascular Surgery,
German Heart Institute Berlin, Augustenburger Platz 1, Berlin 13353,
Germany
(Knosalla, Meyer) DZHK (German Center for Cardiovascular Research),
Partner Site Berlin, Berlin, Germany
(Walther, Ziegelhoffer) Department of Cardiac Surgery, Kerckhoff Heart and
Thorax Center, Benekestrase 2-8, Bad Nauheim 61231, Germany
(Danner) Department of Thoracic and Cardiovascular Surgery, University
Medical Cente, Robert-Koch-Strase 40, Gottingen 37075, Germany
(Misfeld) University Department of Cardiac Surgery, Leipzig Heart Center,
Strumpellstrase 39, Leipzig 04289, Germany
(Zeymer) Klinikum Ludwigshafen, Institut fur Herzinfarktforschung
Ludwigshafen, Bremserstrase 79, Ludwigshafen 6706, Germany
(Wimmer-Greinecker) Department for Cardiothoracic Surgery, Heart and
Vessel Center Bad Bevensen, Romstedter Strase 25, Bad Bevensen 2954,
Germany
(Siepe) Department of Cardiovascular Surgery, Heart Centre Freiburg
University, University of Freiburg, Hugstetter Strase 55, Freiburg 79106,
Germany
(Grubitzsch) Department of Cardiovascular Surgery, Charite
Universitatsmedizin Berlin, Chariteplatz 1, Berlin 10117, Germany
(Joost) Department of Cardiology, Angiology and Intensive Care Medicine,
Medical Clinic II, University Hospital Schleswig-Holstein, Ratzeburger
Allee 160, Lubeck 23538, Germany
(Schaefer, Conradi) Department of Cardiovascular Surgery, University Heart
Center Hamburg, Hamburg, Germany
(Hamm) Justus-Liebig University Giesen, Kerckhoff Campus, Ludwigstrase 23,
Giesen 35390, Germany
(Hamm) DZHK (German Center for Cardiovascular Research), Partner Site
Rhein-Main, Rhein-Main, Germany
(Radke) Department of Internal Medicine-Cardiology, Schon Klinik Neustadt
SE and Co. KG, Am Kiebitzberg 10, Neustadt 23730, Germany
(Schulz) Institute of Physiology, Justus-Liebig University Giesen,
Ludwigstrase 23, Giesen 35390, Germany
(Laufer, Sandner) Division of Cardiac Surgery, Medical University Vienna,
Spitalgasse 23, Wien 1090, Austria
Publisher
Oxford University Press
Abstract
Aims The antiplatelet treatment strategy providing optimal balance between
thrombotic and bleeding risks in patients undergoing coronary artery
bypass grafting (CABG) is unclear. We prospectively compared the efficacy
of ticagrelor and aspirin after CABG. Methods and results We randomly
assigned in double-blind fashion patients scheduled for CABG to either
ticagrelor 90mg twice daily or 100mg aspirin (1:1) once daily. The primary
outcome was the composite of cardiovascular death, myocardial infarction
(MI), repeat revascularization, and stroke 12 months after CABG. The main
safety endpoint was based on the Bleeding Academic Research Consortium
classification, defined as BARC >=4 for periprocedural and hospital
stay-related bleedings and BARC >=3 for post-discharge bleedings. The
study was prematurely halted after recruitment of 1859 out of 3850 planned
patients. Twelve months after CABG, the primary endpoint occurred in 86
out of 931 patients (9.7%) in the ticagrelor group and in 73 out of 928
patients (8.2%) in the aspirin group [hazard ratio 1.19; 95% confidence
interval (CI) 0.87-1.62; P= 0.28]. All-cause mortality (ticagrelor 2.5%
vs. aspirin 2.6%, hazard ratio 0.96, CI 0.53-1.72; P=0.89), cardiovascular
death (ticagrelor 1.2% vs. aspirin 1.4%, hazard ratio 0.85, CI 0.38-1.89;
P= 0.68), MI (ticagrelor 2.1% vs. aspirin 3.4%, hazard ratio 0.63, CI
0.36-1.12, P= 0.12), and stroke (ticagrelor 3.1% vs. 2.6%, hazard ratio
1.21, CI 0.70-2.08; P= 0.49), showed no significant difference between the
ticagrelor and aspirin group. The main safety endpoint was also not
significantly different (ticagrelor 3.7% vs. aspirin 3.2%, hazard ratio
1.17, CI 0.71-1.92; P= 0.53). Conclusion In this prematurely terminated
and thus underpowered randomized trial of ticagrelor vs. aspirin in
patients after CABG no significant differences in major cardiovascular
events or major bleeding could be demonstrated. Copyright © The
Author(s) 2019.

<85>
Accession Number
627413382
Title
Impact of risk factors and surgical techniques in coronary endarterectomy:
a network meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 29 (3) (pp 355-364),
2019. Date of Publication: 01 Sep 2019.
Author
Wang C.; Chen J.; Gu C.; Qiao R.; Li J.
Institution
(Wang, Gu, Qiao, Li) Department of Cardiac Surgery, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
(Chen) People's Hospital of Deyang City, Sichuan, China
Publisher
NLM (Medline)
Abstract
The goal of this network meta-analysis was to compare the early mortality
rate of patients who underwent coronary endarterectomy (CE) combined with
coronary artery bypass grafting (CABG) with different techniques and with
isolated CABG. This analysis also evaluated potential risk factors in
patients who undergo CE. Eighteen studies were included, covering 21 752
different patients, among whom 3352 underwent CE+CABG with either open or
closed techniques and 18 400 underwent isolated CABG. Patients who had
CE+CABG had a statistically significant higher mortality rate [odds ratio
(OR) 1.76; P<0.001]. Subgroup analyses showed that, with closed CE,
mortality was 52% (OR 1.52, P=0.001) more likely to occur, whereas with
open CE, mortality was 279% (OR 3.79, P<0.001) more likely to occur, when
both were compared with isolated CABG. A network meta-analysis indicated
that both the open and closed methods had poorer results than CABG alone
and that the open method had a higher risk of mortality than the closed
one. For risk factors, diabetes mellitus (DM), hypertension, prior
myocardial infarction, peripheral vascular disease and renal failure were
significant contributors to inclusion in the CE group, whereas other risk
factors showed no significant difference. However, none of these factors
indicated significant correlations with the incidence of mortality between
the groups. CE+CABG has a significantly higher risk of death than isolated
CABG, and open CE is more risky than closed CE, even though most of the
individual studies did not show that CE had a higher risk of mortality.
Moreover, DM, hypertension, prior myocardial infarction, peripheral
vascular disease and renal failure were more common in the patients who
had CE+CABG, but these factors may not necessarily increase the mortality
risk of patients who have CE. Copyright © The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<86>
Accession Number
626906700
Title
Prophylactic implantable cardioverter-defibrillator in the very elderly.
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. 21 (7)
(pp 1063-1069), 2019. Date of Publication: 01 Jul 2019.
Author
Zakine C.; Garcia R.; Narayanan K.; Gandjbakhch E.; Algalarrondo V.;
Lellouche N.; Perier M.-C.; Fauchier L.; Gras D.; Bordachar P.; Piot O.;
Babuty D.; Sadoul N.; Defaye P.; Deharo J.-C.; Klug D.; Leclercq C.;
Extramiana F.; Boveda S.; Marijon E.
Institution
(Zakine, Narayanan, Perier, Marijon) Paris Cardiovascular Research Center,
Paris, France
(Garcia) University Hospital of Poitiers, Poitiers, France
(Narayanan) Maxcure Hospitals, Hyderabad, India
(Gandjbakhch) La Pitie Salpetriere Hospital, Paris, France
(Algalarrondo) Antoine-Beclere Hospital, Paris, France
(Lellouche) Henri Mondor Hospital, Paris, France
(Perier, Marijon) European Georges Pompidou Hospital, Cardiology
Department, Paris, France
(Fauchier, Babuty) Tours University Hospital, Tours, France
(Gras) Hopital prive du Confluent, Nantes, France
(Bordachar) University Hospital od Bordeaux, Bordeaux, France
(Piot) Centre Cardiologique du Nord, Saint Denis, France
(Sadoul) Nancy University Hospital, Nancy, France
(Defaye) University Hospital of Grenoble, Grenoble, France
(Deharo) La Timone University Hospital, Marseille, France
(Klug) Lille University Hospital, Lille, France
(Leclercq) Rennes University Hospital, Universite de Rennes, CIC-IT,
Rennes, France
(Extramiana) Bichat-Claude-Bernard Hospital, Paris, France
(Boveda) Clinique Pasteur, Toulouse, France
(Marijon) Paris Descartes University, Paris, France
Publisher
NLM (Medline)
Abstract
AIMS: Current guidelines do not propose any age cut-off for the primary
prevention implantable cardioverter-defibrillator (ICD). However, the
risk/benefit balance in the very elderly population has not been well
studied. METHODS AND RESULTS: In a multicentre French study assessing
patients implanted with an ICD for primary prevention, outcomes among
patients aged >=80years were compared with <80years old controls matched
for sex and underlying heart disease (ischaemic and dilated
cardiomyopathy). A total of 300 ICD recipients were enrolled in this
specific analysis, including 150 patients >=80years (mean age
81.9+/-2.0years; 86.7% males) and 150 controls (mean age
61.8+/-10.8years). Among older patients, 92 (75.6%) had no more than one
associated comorbidity. Most subjects in the elderly group got an ICD as
part of a cardiac resynchronization therapy procedure (74% vs. 46%,
P<0.0001). After a mean follow-up of 3.0+/-2years, 53 patients (35%) in
the elderly group died, including 38.2% from non cardiovascular causes of
death. Similar proportion of patients received >=1 appropriate therapy
(19.4% vs. 21.6%; P=0.65) in the elderly group and controls, respectively.
There was a trend towards more early perioperative events (P=0.10) in the
elderly, with no significant increase in late complications (P=0.73).
 CONCLUSION(S): Primary prevention ICD recipients >=80years in the
real world had relatively low associated comorbidity. Rates of appropriate
therapies and device-related complications were similar, compared with
younger subjects. Nevertheless, the inherent limitations in interpreting
observational data on this particular competing risk situation call for
randomized controlled trials to provide definitive answers. Meanwhile, a
careful multidisciplinary evaluation is needed to guide patient selection
for ICD implantation in the elderly population. Copyright Published on
behalf of the European Society of Cardiology. All rights reserved. ©
The Author(s) 2019. For permissions, please email:
journals.permissions@oup.com.

<87>
Accession Number
628237732
Title
Music therapy following cardiac surgery-is it an effective method to
reduce pain and anxiety?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (5) (pp 722-727),
2019. Date of Publication: 2019.
Author
Grafton-Clarke C.; Grace L.; Harky A.
Institution
(Grafton-Clarke) School of Medicine, University of Liverpool, Liverpool,
United Kingdom
(Grace) Department of Cardiac Surgery, Barts Heart Centre, St
Bartholomew's Hospital, London, United Kingdom
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Chester, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: In patients undergoing
cardiac surgery, is postoperative music therapy effective in reducing pain
and anxiety? Altogether, 153 papers were found using the reported search
method, of which 7 represented the best evidence to answer the clinical
question. Six of the included studies were randomized trials, with 1
further non-randomized trial. The specific music protocols utilized widely
varied, ranging from 1 short session on day 1 postoperatively to multiple
sessions per day over a 72-h period. Most therapies involved music of a
relaxing type, typically between 50 and 60 dB. All 7 studies reported on
pain, with 4 demonstrating significant differences in pain score; however,
3 of these were not associated with reduction in analgesia requirements.
Five studies reported on anxiety, with 2 demonstrating a statistically
significant improvement in levels of anxiety. These results need to be
contextualized by the small number of participants within each study and
the heterogeneity in the therapy protocols utilized. The current best
available evidence fails to support the benefits of music therapy as an
effective non-pharmacological option in reducing pain and anxiety
following open-heart surgery. While there is scarce evidence demonstrating
efficacy, the current literature contains very small-sample-sized studies
in utilizing music therapy protocols which in turn have wide range of
variability in terms of duration, frequency, timing in the postoperative
period and specific choice of music utilized in each
protocol. Copyright © 2018 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<88>
Accession Number
628439265
Title
Reported outcomes after aortic valve resuspension for acute type A aortic
dissection: a systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 29 (3) (pp 331-338),
2019. Date of Publication: 01 Sep 2019.
Author
Chen S.-K.; Qiu Z.-H.; Fang G.-H.; Wu X.-J.; Chen L.-W.
Institution
(Chen, Qiu, Fang, Wu, Chen) Department of Cardiac Surgery, Union Hospital,
Fujian Medical University, Fuzhou, Fujian, China
Publisher
NLM (Medline)
Abstract
In the majority of patients presenting with acute type A aortic dissection
(AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can
be preserved by AV resuspension. A meta-analysis was performed to
investigate the outcomes following AV resuspension for AAD. A systematic
literature search for publications reporting outcomes after AV
resuspension in AAD published between January 1998 and June 2018 was
conducted. Early outcome events and linearized occurrence rates for late
outcome events were derived. The retrieval process yielded 18 unique
studies involving 3295 patients with a total of 17 532 patient-years
(pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95%
CI) 11.5-19.4%, I2 = 91.9%], and the linearized late mortality rate was
3.21%/pt-yrs (95% CI 2.49-3.77, I2 = 29%). The linearized occurrence rates
for aortic root reintervention was 1.4%/pt-yrs (95% CI 0.88-1.79, I2 =
48%); for recurrent significant aortic valve insufficiency (>2+), it was
1.12%/pt-yrs (95% CI 0.79-1.45, I2 = 68%); and for endocarditis, it was
0.01%/pt-yrs (95% CI 0-0.04, I2 = 7%). The composite rate of
thromboembolism and bleeding was 1.41%/pt-yrs (95% CI 0.18-2.63, I2 =
82%). A more recent surgical period was associated with a decreased hazard
of reoperation on the aortic root (P<0.001). Requirement of AV
resuspension alone in AAD is a risk factor for mortality. The long-term
durability of AV resuspension is excellent, with low rates of endocarditis
and thromboembolism and bleeding. Root reoperation hazard has become
acceptable in recent years. Preoperative aortic valve insufficiency grade
exceeding 2+ is a predictor for root reoperation. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<89>
Accession Number
628212487
Title
Analysis of survival after coronary endarterectomy combined with coronary
artery bypass grafting compared with isolated coronary artery bypass
grafting: a meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 29 (3) (pp 393-401),
2019. Date of Publication: 01 Sep 2019.
Author
Wang C.; Chen J.; Gu C.; Li J.
Institution
(Wang, Gu, Li) Department of Cardiac Surgery, Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
(Chen) People's Hospital of Deyang City, Sichuan, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this analysis was to compare survival outcomes of
coronary endarterectomy (CE) combined with coronary artery bypass grafting
(CABG) with those of conventional CABG. METHOD(S): Eight
observational studies were included in this analysis, including 10 529
different patients in Asia, Europe and North America, from 1985 to 2012,
among whom 1925 underwent CE+CAGB and 8604 underwent conventional CAGB.
The follow-up period ranged from 4 to 14years. This meta-analysis was
performed with the fixed-effects model. RESULT(S): After rigorous
assessment of the quality of the studies included, this analysis showed
that CE+CABG had a statistically significant weaker short-term outcome,
with a higher risk of mortality [odds ratio (OR)] 1.61; P=0.002]. Further,
this phenomenon was exacerbated in the midterm. One-year and 2-year
results indicated that death was, respectively, 163% (OR 2.63; P<0.001)
and 133% (OR 2.60; P<0.001) more likely to occur in the CE+CABG group.
However, the long-term results indicated no difference between the 2
groups. The 4-year hazard ratio (1.13; P=0.10) did not show significant
differences between the groups, and the Kaplan-Meier survival curves had
the same level and pattern. CONCLUSION(S): CE+CABG had a
significantly weaker short-term outcome than conventional CABG, and this
trend continued in the midterm. The survival rate had the largest gap in
the midterm. However, there was no significant difference between these 2
groups in the long run. Copyright © The Author(s) 2019. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<90>
[Use Link to view the full text]
Accession Number
624600525
Title
Randomized Controlled Trial of Surgical Versus Catheter Ablation for
Paroxysmal and Early Persistent Atrial Fibrillation.
Source
Circulation. Arrhythmia and electrophysiology. 11 (10) (pp e006182), 2018.
Date of Publication: 01 Oct 2018.
Author
Adiyaman A.; Buist T.J.; Beukema R.J.; Smit J.J.J.; Delnoy P.P.H.M.;
Hemels M.E.W.; Sie H.T.; Ramdat Misier A.R.; Elvan A.
Institution
(Adiyaman, Buist, Beukema, Smit, Delnoy, Hemels, Ramdat Misier, Elvan)
Department of Cardiology, Isala Heart Centre, Zwolle, Netherlands
(Sie) Department of Cardiothoracic Surgery, Isala Heart Centre, Zwolle,
Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Current guidelines recommend both percutaneous catheter
ablation (CA) and surgical ablation in the treatment of atrial
fibrillation, with different levels of evidence. No direct comparison has
been made between minimally invasive thoracoscopic pulmonary vein
isolation with left atrial appendage ligation (surgical MIPI) versus
percutaneous CA comprising of pulmonary vein isolation as primary
treatment of atrial fibrillation. We, therefore, conducted a randomized
controlled trial comparing the safety and efficacy of these 2 treatment
modalities. METHOD(S): Eighty patients were enrolled in the study and
underwent implantable loop recorder implantation. Twenty-eight patients
did not reach randomization criteria. A total of 52 patients with
symptomatic paroxysmal or early persistent atrial fibrillation were
randomized, 26 to CA and 26 to surgical MIPI. The primary end point was
defined as freedom of atrial tachyarrhythmias, without the use of
antiarrhythmic drugs. The safety end point was freedom of complications.
 RESULT(S): Median age was 57 years (range, 37-75), and 78% were men.
Paroxysmal atrial fibrillation was present in 74%. Follow-up duration was
>=2 years in all patients. CA was noninferior to MIPI in terms of
single-procedure arrhythmia-free survival after 2 years of follow-up
(56.0% versus 29.2%; HR, 0.56; 95% CI, 0.26-1.20; log-rank P=0.059).
Procedure-related major adverse events occurred significantly more often
in MIPI than CA (20.8% versus 0%; P=0.029). CONCLUSION(S):
Percutaneous pulmonary vein isolation was noninferior to MIPI in terms of
efficacy and resulted in less complications. CLINICAL TRIAL REGISTRATION:
URL: https://www.clinicaltrials.gov . Unique identifier: NCT00703157.

<91>
Accession Number
2002859928
Title
COMPARATIVE STUDY BETWEEN CONVENTIONAL FASTING VERSUS OVERNIGHT INFUSION
OF LIPID OR CARBOHYDRATE ON INSULIN AND FREE FATTY-ACIDS IN OBESE PATIENTS
UNDERGOING ELECTIVE ON-PUMP CORONARY ARTERY BYPASS GRAFTING. A PROSPECTIVE
RANDOMIZED TRIAL.
Source
Clinical Nutrition. Conference: 41st ESPEN Congress. Poland. 38
(Supplement 1) (pp S59), 2019. Date of Publication: September 2019.
Author
Abdelmonem A.; Hosny H.; Ibrahim M.; El-Siory W.
Institution
(Abdelmonem, Hosny, Ibrahim, El-Siory) Anaesthesia and Surgical Intensive
Care, Faculty of Medicine, Cairo University, Giza, Egypt
Publisher
Churchill Livingstone
Abstract
Rationale: Postoperative insulin resistance represents a major component
of postoperative metabolic disorder. The authors compared the effects of
preoperative infusion of lipid emulsion or carbohydrate to conventional
preoperative fasting on postoperative insulin and free fatty acid (FFA)
levels. Method(s): Design: A prospective randomized double-blinded
study. Setting(s): Tertiary university hospital. Participant(s):
Sixty-three patients undergoing coronary artery bypass grafting.
 Intervention(s): Participants were randomized into 3 equal groups.
Group G received 500 mL of glucose 10% (50 g glucose). Group L received
100 mL of 2% lipid emulsion (soybean 30%, medium chain triglycerides (TG)
30%, olive oil 25%, fish oil 15%, and 20 mg vitamin E). Group C fasted
overnight except for clear fluids allowed until 4 hours preoperatively.
Serum insulin at the start of infusion (T<inf>1</inf>), 1-hour
preinduction (T<inf>2</inf>), on admission to the intensive care unit
(T<inf>3</inf>), after 24 hours of admission (T<inf>4</inf>), and after 48
hours of admission (T<inf>5</inf>), and FFA at T<inf>1</inf> and
T<inf>2</inf> were measured. Serum very-low-density lipoprotein (VLDL),
serum TG, and blood sugar were all measured (T<inf>1</inf>-T<inf>4</inf>).
Bypass time, ischemic time, need for inotropic support, and length of
intensive care unit stay also were measured. Result(s):
 Measurements and Main Results: At the end of infusion FFAs were
significantly lower in the L group (1.1 7 0.76 mg/dL) compared with G
(1.64 7 0.85 mg/dL) and C groups (1.48 7 0.76 mg/dL). Insulin levels were
significantly lower in the L group compared with levels in the G and C
groups at T<inf>2</inf>, T<inf>3</inf>, and T<inf>4</inf>. Also, TG, VLDL,
and random blood sugar levels decreased significantly at T<inf>2</inf>,
T<inf>3</inf>, and T<inf>4</inf> in the L group compared with the other 2
groups and compared with baseline value within the same group.
 Conclusion(s): Preoperative lipid infusion lowered postoperative FFA,
insulin, TG, VLDL, and random blood sugar in obese patients undergoing
coronary artery bypass grafting surgeries. & 2017 Elsevier Inc. All rights
reserved. Copyright © 2019 Elsevier Ltd and European Society for
Clinical Nutrition and Metabolism

<92>
Accession Number
626912525
Title
Graft Patency after Robotically Assisted Coronary Artery Bypass Surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 14 (2) (pp 117-123), 2019. Date of Publication: 01 Apr 2019.
Author
Kitahara H.; Nisivaco S.; Balkhy H.H.
Institution
(Kitahara, Nisivaco, Balkhy) Cardiothoracic Surgery, University of Chicago
Medicine, Chicago, IL, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective With advances in robotic instrumentation and technology, both
robotically assisted minimally invasive direct coronary artery bypass
(RMIDCAB) and totally endoscopic coronary artery bypass (TECAB) have been
widely used over the past 20 years. Graft patency is the most important
outcome in coronary bypass surgery and is associated with long-term
prognosis. In this article we reviewed all experts' studies in the field
of robotic assisted coronary artery bypass and investigated graft patency
in patients who underwent RMIDCAB or TECAB. Methods We performed a
literature search in PubMed from 1999 to 2018 using the terms "Robotic"
and "Coronary bypass" and/or "Minimally invasive" and/or "Totally
endoscopic." Of the articles found, studies investigating graft patency
were specifically selected. Results In 33 articles, a total of 4,000
patients underwent robotic assisted coronary artery bypass surgery either
by a RMIDCAB (2,396) or by a TECAB (1,604) approach. The graft patency was
assessed by invasive angiography or computed tomographic angiography in
all studies. The mean graft patency at early (<1 month), midterm (<5
years), and long-term (>5 years) follow-up was 97.7%, 96.1%, and 93.2% in
RMIDCAB and 98.8%, 95.8%, and 93.6% in TECAB, respectively. Conclusions
The graft patency of robotic assisted coronary artery bypass was
equivalent to reported outcomes of the conventional approach. These
results should encourage the adoption of robotic approaches in coronary
bypass surgery. Copyright © International Society for Minimally
Invasive Cardiothoracic Surgery. All rights reserved.

<93>
Accession Number
629282017
Title
Antithrombotic therapy in patients with atrial fibrillation undergoing
coronary artery stenting.
Source
American journal of health-system pharmacy : AJHP : official journal of
the American Society of Health-System Pharmacists. 76 (18) (pp 1395-1402),
2019. Date of Publication: 03 Sep 2019.
Author
Lacoste J.L.; Hansen C.L.
Institution
(Lacoste) Department of Pharmacy, WVU Medicine, Morgantown, United States
(Hansen) BCPS AQ-Cardiology, Intermountain Healthcare-Utah Valley
Hospital, Provo, UT
Publisher
NLM (Medline)
Abstract
PURPOSE: Updates to the primary literature and clinical practice
guidelines on use of antithrombotic combinations for patients with atrial
fibrillation (AF) undergoing percutaneous coronary intervention (PCI) and
stenting are reviewed. SUMMARY: Up to 8% of patients undergoing PCI have
AF and thus require both antiplatelet and anticoagulation therapies, which
put them at increased risk for bleeding. Current literature suggests that
using a single antiplatelet agent in combination with oral anticoagulation
with a direct-acting oral anticoagulant (i.e., dual therapy) is effective
and associated with less bleeding risk than triple therapy (dual
antiplatelet therapy plus an oral anticoagulant) in patients with AF
undergoing PCI with stent placement. The most recently studied dual
therapy regimens consist of clopidogrel in combination with apixaban,
rivaroxaban, or dabigatran. Guidelines recommend use of an oral
anticoagulant plus clopidogrel and aspirin for a short period of time. In
general, aspirin should be discontinued in most patients at discharge. In
patients with a high risk of thrombosis, aspirin can be continued for up
to 1 month. Dual therapy should be continued for 12 months, with oral
anticoagulant monotherapy continued thereafter. CONCLUSION(S): A
review of current literature on antithrombotic therapy in patients with AF
undergoing PCI and subsequent coronary artery stenting indicates that the
favored regimen is dual therapy consisting of clopidogrel with
rivaroxaban, apixaban, dabigatran, or a vitamin K antagonist. Aspirin may
be used in the periprocedural period but should be discontinued thereafter
to reduce the risk of bleeding. Decisions regarding specific agents and
duration of treatment should be based on thrombotic risk, bleeding risk,
and patient preference. Copyright © American Society of
Health-System Pharmacists 2019. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com.

<94>
Accession Number
626733807
Title
Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Systematic
Review of Clinical Outcomes from the Past two Decades.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 14 (1) (pp 5-16), 2019. Date of Publication: 01 Feb 2019.
Author
Gobolos L.; Ramahi J.; Obeso A.; Bartel T.; Hogan M.; Traina M.; Edris A.;
Hasan F.; Banna M.E.; Tuzcu E.M.; Bonatti J.
Institution
(Gobolos, Ramahi, Obeso, Bonatti) Department of Cardiac Surgery, Heart and
Vascular Institute, Cleveland Clinic Abu Dhabi, Sowwah Square, Al Maryah
Island, Abu Dhabi, United Arab Emirates
(Bartel, Traina, Edris, Hasan, Banna, Tuzcu) Department of Cardiology,
Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab
Emirates
(Hogan) Departments of Anaesthesia, Intensive Care, Cleveland Clinic, Abu
Dhabi, United Arab Emirates
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Robotic totally endoscopic coronary artery bypass grafting (TECAB) was
introduced in 1998 and has over a period of two decades gradually emerged
from single-vessel revascularization to multivessel bypass grafting.
Dedicated centers have continuously evolved and further developed this
minimally invasive method of coronary bypass surgery. A literature review
was conducted to assess intra- and postoperative outcomes of TECAB. PubMed
returned 19 comprehensive articles on TECAB. Investigation was focused on
perioperative outcome parameters, i.e.: operative time, conversion to
larger incision, revision for bleeding, atrial fibrillation, stroke, acute
renal failure, and mortality. Outcome from the analysis of 2,397 reported
cases showed an average operative time of 291 +/- 57 minutes (range 112 to
1,050), conversion rate to larger incisions at 11.5%, and perioperative
mortality at 0.8%. Pooled data demonstrated 4.2% operative revision rate
due to postoperative hemorrhage, 1.0% stroke incidence, 1.6% acute renal
failure, and 13.3% de novo atrial fibrillation. The mean length of
hospital stay measured 5.8 +/- 1.7 days. Conversion rates and operative
times decreased over time. According to data in the literature, coronary
bypass surgery carried out in completely endoscopic fashion utilizing
robotic assistance can require relatively extensive operative times and
conversion rates are somewhat higher than in other robotic cardiac
surgery. However, major postoperative events lie in an acceptable range.
TECAB remains the surgical revascularization method with the least tissue
trauma and represents an opportunity for coronary artery bypass grafting
via port access. Rates of major complications are at least similar to
conventional surgical access procedures. Copyright ©
International Society for Minimally Invasive Cardiothoracic Surgery. All
rights reserved.

<95>
Accession Number
627250473
Title
One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve
Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A
Meta-Analysis and Meta-Regression.
Source
Journal of Interventional Cardiology. 2019 (no pagination), 2019. Article
Number: 8947204. Date of Publication: 2019.
Author
Quintana R.A.; Monlezun D.J.; Dasilva-Deabreu A.; Sandhu U.G.; Okwan-Duodu
D.; Ramirez J.; Denktas A.E.; Jneid H.; Paniagua D.
Institution
(Quintana, Okwan-Duodu) Division of Cardiology, Department of Medicine,
Emory University School of Medicine, Atlanta, GA, United States
(Monlezun) Division of Cardiology, Department of Medicine, University of
Texas MD Anderson Cancer Center, Houston, TX, United States
(Dasilva-Deabreu) Division of Cardiology, John Ochsner Heart and Vascular
Institute, New Orleans, LA, United States
(Sandhu) Division of Cardiology, Department of Medicine, University of
California San Francisco-Fresno, Fresno, CA, United States
(Ramirez) Department of Pediatrics, Affiliated with Weil Cornell College
of Medicine, Lincoln Medical and Mental Health Center, Bronx, NY, United
States
(Denktas, Jneid, Paniagua) Division of Cardiology, Department of Medicine,
Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston,
TX, United States
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objective. To assess 1-year mortality after transcatheter aortic valve
replacement (TAVR) in patients with bicuspid aortic stenosis (AS).
Background. Clinical trials have proven the beneficial effect of TAVR on
mortality in patients with tricuspid AS. Individuals with bicuspid AS were
excluded from these trials. Methods. A meta-analysis using literature
search from the Cochrane, PubMed, ClinicalTrials, SCOPUS, and EMBASE
databases was conducted to determine the effect of TAVR on 1-year
mortality in patients with bicuspid AS. Short-term outcomes that could
potentially impact one-year mortality were analyzed. Results. After
evaluating 380 potential articles, 5 observational studies were selected.
A total of 3890 patients treated with TAVR were included: 721 had bicuspid
and 3,169 had tricuspid AS. No statistically significant difference
between the baseline characteristics of the two groups of patients was
seen outside of mean aortic gradient. Our primary endpoint of one-year
all-cause mortality revealed 85 deaths in 719 patients (11.82%) with
bicuspid AS compared to 467 deaths in 3100 patients (15.06%) with
tricuspid AS, with no difference between both groups [relative risk (RR)
1.03; 95% CI 0.70-1.51]. Patients with bicuspid AS were associated with a
decrease in device success (RR 0.62; 95% CI 0.45-0.84) and an increase in
moderate-to-severe prosthetic valve regurgitation (RR 1.55; 95% CI
1.07-2.22) after TAVR compared to patients with tricuspid AS. The effect
of meta-regression coefficients on one-year all-cause mortality was not
statistically significant for any patient baseline characteristics.
Conclusion. When comparing TAVR procedure in tricuspid AS versus bicuspid
AS, there was no difference noted in one-year all-cause
mortality. Copyright © 2019 Raymundo A. Quintana et al.

<96>
Accession Number
627248090
Title
Clinical Outcomes of Transcatheter Aortic Valve Replacement in
Nonagenarians: A Systematic Review and Meta-Analysis.
Source
Journal of Interventional Cardiology. 2019 (no pagination), 2019. Article
Number: 5819232. Date of Publication: 2019.
Author
Liu Y.; Du Y.; Fu M.; Ma Y.; Wang D.; Zhang J.; Liu W.; Zhao Y.; Zhou Y.
Institution
(Liu, Du, Fu, Ma, Wang, Zhang, Liu, Zhao, Zhou) Department of Cardiology,
12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing
Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory
of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center
for Coronary Heart Disease, Beijing 100029, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objectives. To compare the incidence of mortality and complications
between nonagenarians and younger patients undergoing transcatheter aortic
valve replacement (TAVR). Background. TAVR has become an alternative
treatment for nonagenarian patients with severe aortic stenosis. Previous
studies have reported conflicting results regarding the clinical outcomes
between nonagenarians and younger patients who underwent TAVR. Methods. We
searched PubMed, EMBASE, and Cochrane Library databases with predefined
criteria from the inception dates to July 8, 2018. The primary clinical
endpoint was 30-day and 1-year all-cause mortalities. Secondary outcomes
were considered the rates of stroke, myocardial infarction, any bleeding,
any acute kidney injury, any vascular complications, new pacemaker
implantation, and conversion to surgical aortic valve replacement.
Results. A total of 5 eligible studies with 25,371 patients were included
in this meta-analysis. Compared with younger patients who underwent TAVR,
nonagenarians had a significantly higher mean Society of Thoracic Surgeons
score (STS score) (MD, 2.80; 95%CI: 2.58, 3.30; P<0.00001) and logistic
European System for Cardiac Operative Risk Evaluation (logistic EuroSCORE)
(MD, 2.72; 95%CI: 1.01, 4.43; P=0.002). Nonagenarians were associated with
significantly higher 30-day mortality (6.2% vs. 3.7%; OR, 1.73; 95%CI:
1.49, 2.00) and 1-year mortality (15.5% vs. 11.8%; OR, 1.39; 95%CI: 1.26,
1.53), without significant statistical heterogeneity. Nonagenarians were
associated with significantly increased rates of major or life-threatening
bleeding, vascular complications and stroke of 20%, 35%, and 32%,
respectively. There were no significant differences in the rate of
myocardial infarction, stage 2 or 3 acute kidney injury, new pacemaker
implantation, or conversion to surgical aortic valve replacement.
Conclusions. Nonagenarians showed worse clinical outcomes than younger
patients after TAVR, while the incidence of mortality was acceptable. TAVR
remains an option for nonagenarian patients with severe aortic stenosis
and should be comprehensively evaluated by the heart valve
team. Copyright © 2019 Yan Liu et al.

<97>
Accession Number
627607461
Title
Meta-Analysis Comparing Renal Outcomes after Transcatheter versus Surgical
Aortic Valve Replacement.
Source
Journal of Interventional Cardiology. 2019 (no pagination), 2019. Article
Number: 3537256. Date of Publication: 2019.
Author
Shah K.; Chaker Z.; Busu T.; Shah R.; Osman M.; Alqahtani F.; Alkhouli M.
Institution
(Shah, Shah, Osman, Alqahtani, Alkhouli) Division of Cardiology, West
Virginia School of Medicine, Morgantown, WV, United States
(Chaker, Busu) Department of Medicine, West Virginia School of Medicine,
Morgantown, WV, United States
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Acute kidney injury (AKI) is a common complication of aortic
valve replacement. However, comparative on the incidence of (AKI)
following transcatheter (TAVR) versus surgical valve replacement (SAVR) is
sparse. Methods. We performed a meta-analysis of the randomized controlled
trials (RCT) and propensity-matched observational studies comparing (A)
incidence of AKI and (B) incidence of dialysis-requiring AKI at 30 days
after TAVR and SAVR. Results. Twenty-six studies (20 propensity-matched
studies; 6 RCTs) including 19,954 patients were analyzed. The incidence of
AKI was lower after TAVR than after SAVR (7.1% vs. 12.1%, OR 0.52; 95%CI,
0.39-0.68; p<0.001, I2=57%), but the incidence of
dialysis-requiring AKI was similar (2.8% vs. 4.1%, OR 0.78; 95%CI,
0.49-1.25; p=0.31, I2=70%). Similar results were observed in a
sensitivity analysis including RCTs only for both AKI ([5 RCTs; 5,418
patients], 2.0% vs. 5.0%, OR 0.39; 95%CI, 0.28-0.53; p<0.001,
I2=0%), and dialysis-requiring AKI ([2 RCTs; 769 patients];
2.9% vs. 2.6%, OR 1.1; 95%CI, 0.47-2.58; p=0.83, I2=0%).
However, in studies including low-intermediate risk patients only, TAVR
was associated with lower incidence of AKI ([10 studies; 6,510 patients],
7.6% vs. 12.4%, OR 0.55, 95%CI 0.39-0.77, p<0.001, I2=57%), and
dialysis-requiring AKI, ([10 studies; 12,034 patients], 2.0% vs. 3.6%, OR
0.57, 95%CI 0.38-0.85, p=0.005, I2=23%). Conclusions. TAVR is
associated with better renal outcomes at 30 days in comparison with SAVR,
especially in patients at low-intermediate surgical risk. Further studies
are needed to assess the impact of AKI on long-term outcomes of patients
undergoing TAVR and SAVR. Copyright © 2019 Kuldeep Shah et al.

<98>
Accession Number
627607460
Title
Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in
Patients with Functional Mitral Regurgitation: A Systematic Review and
Meta-Analysis.
Source
Journal of Interventional Cardiology. 2019 (no pagination), 2019. Article
Number: 2753146. Date of Publication: 2019.
Author
Lodhi M.U.; Usman M.S.; Siddiqi T.J.; Khan M.S.; Khan M.A.A.; Khan S.U.;
Syed I.A.; Rahim M.; Naidu S.S.; Doukky R.; Alkhouli M.
Institution
(Lodhi, Syed) Department of Internal Medicine, Raleigh General Hospital,
West Virginia University, WV, United States
(Usman, Siddiqi, Khan) Department of Internal Medicine, Civil Hospital,
Dow University, Karachi, Pakistan
(Khan, Doukky) Department of Internal Medicine, John H Stroger Jr.
Hospital of Cook County, Chicago, IL, United States
(Khan, Rahim) Department of Internal Medicine, West Virginia University,
WV, United States
(Naidu) Division of Cardiology, Westchester Medical Center, Valhalla, NY,
United States
(Doukky) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
(Alkhouli) Division of Cardiology, West Virginia University, Morgantown,
WV, United States
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objectives. To compare percutaneous mitral valve repair (PMVR) with
optimal medical therapy (OMT) in patients with heart failure (HF) and
severe functional mitral regurgitation (FMR). Background. Many patients
with HF and FMR are not suitable for surgical valve replacement and remain
symptomatic despite maximal OMT. PMVR has recently emerged as an
alternative solution. Methods. We performed a systematic review and a
meta-analysis to address this question. Cochrane CENTRAL, MEDLINE, and
Scopus were searched for randomized (RCT) and nonrandomized studies
comparing PMVR with OMT in patients with HF and FMR. Primary endpoint was
all-cause midterm mortality (at 1 and 2 years). Secondary endpoints were
30-day mortality and cardiovascular mortality and HF hospitalizations, at
maximum follow-up. Studies including mixed cohort of degenerative and
functional MR were allowed initially but were excluded in a secondary
sensitivity analysis for each of the study's end points. This
meta-analysis was performed following the publication of two RCTs
(MITRA-FR and COAPT). Results. Eight studies (six observational, two RCTs)
comprising 3,009 patients were included in the meta-analysis. In
comparison with OMT, PMVR significantly reduced 1-year mortality (RR: 0.70
[0.56, 0.87]; p=0.002; I2=47.6%), 2-year mortality (RR: 0.63
[0.55, 0.73]; p<0.001; I2=0%), and cardiovascular mortality
(RR: 0.32 [0.23, 0.44]; p<0.001; I2=0%). No significant
difference between PMVR+OMT and OMT was noted in HF hospitalization (HR:
0.69 [0.40, 1.20]; p=0.19; I2=85%) and 30-day mortality (RR:
1.13 [0.68, 1.87]; p=0.16; I2=0%). Conclusions. In comparison
with OMT, PMVR significantly reduces 1-year mortality, 2-year mortality,
and cardiovascular mortality in patients with HF and severe
MR. Copyright © 2019 Muhammad Uzair Lodhi et al.

<99>
Accession Number
2002855370
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk
Patients.
Source
Journal of the American College of Cardiology. 74 (12) (pp 1532-1540),
2019. Date of Publication: 24 September 2019.
Author
Kolte D.; Vlahakes G.J.; Palacios I.F.; Sakhuja R.; Passeri J.J.;
Inglessis I.; Elmariah S.
Institution
(Kolte, Palacios, Sakhuja, Passeri, Inglessis, Elmariah) Cardiology
Division, Department of Medicine, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Vlahakes) Cardiac Surgery Division, Department of Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as a
safe and effective therapeutic option for patients with severe aortic
stenosis (AS) who are at prohibitive, high, or intermediate risk for
surgical aortic valve replacement (SAVR). However, in low-risk patients,
SAVR remains the standard therapy in current clinical practice.
 Objective(s): This study sought to perform a meta-analysis of
randomized controlled trials (RCTs) comparing TAVR versus SAVR in low-risk
patients. Method(s): Electronic databases were searched from
inception to March 20, 2019. RCTs comparing TAVR versus SAVR in low-risk
patients (Society of Thoracic Surgeons Predicted Risk of Mortality
[STS-PROM] score <4%) were included. Primary outcome was all-cause death
at 1 year. Random-effects models were used to calculate pooled risk ratio
(RR) and corresponding 95% confidence interval (CI). Result(s): The
meta-analysis included 4 RCTs that randomized 2,887 patients (1,497 to
TAVR and 1,390 to SAVR). The mean age of patients was 75.4 years, and the
mean STS-PROM score was 2.3%. Compared with SAVR, TAVR was associated with
significantly lower risk of all-cause death (2.1% vs. 3.5%; RR: 0.61; 95%
CI: 0.39 to 0.96; p = 0.03; I2 = 0%) and cardiovascular death
(1.6% vs. 2.9%; RR: 0.55; 95% CI: 0.33 to 0.90; p = 0.02; I2 =
0%) at 1 year. Rates of new/worsening atrial fibrillation,
life-threatening/disabling bleeding, and acute kidney injury stage 2/3
were lower, whereas those of permanent pacemaker implantation and
moderate/severe paravalvular leak were higher after TAVR versus SAVR.
There were no significant differences between TAVR versus SAVR for major
vascular complications, endocarditis, aortic valve re-intervention, and
New York Heart Association functional class >=II. Conclusion(s): In
this meta-analysis of RCTs comparing TAVR versus SAVR in low-risk
patients, TAVR was associated with significantly lower risk of all-cause
death and cardiovascular death at 1 year. These findings suggest that TAVR
may be the preferred option over SAVR in low-risk patients with severe AS
who are candidates for bioprosthetic AVR. Copyright © 2019
American College of Cardiology Foundation

<100>
Accession Number
629195175
Title
Sitagliptin for the prevention of stress hyperglycemia in patients without
diabetes undergoing coronary artery bypass graft (CABG) surgery.
Source
BMJ Open Diabetes Research and Care. 7 (1) (no pagination), 2019. Article
Number: e00703. Date of Publication: 01 Aug 2019.
Author
Cardona S.; Tsegka K.; Pasquel F.J.; Fayfman M.; Peng L.; Jacobs S.;
Vellanki P.; Halkos M.; Guyton R.A.; Thourani V.H.; Galindo R.J.;
Umpierrez G.
Institution
(Cardona, Tsegka, Pasquel, Fayfman, Jacobs, Vellanki, Galindo, Umpierrez)
Medicine, Emory University School of Medicine, Atlanta, GA, United States
(Peng) Biostatitics, Rollins School of Public Health, Atlanta, GA, United
States
(Halkos, Guyton, Thourani) Thoracic Surgery, Emory University School of
Medicine, Atlanta, GA, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Aims To determine if treatment with sitagliptin, a dipeptidyl peptidase-4
inhibitor, can prevent stress hyperglycemia in patients without diabetes
undergoing coronary artery bypass graft (CABG) surgery. Methods We
conducted a pilot, double-blinded, placebo-controlled randomized trial in
adults (18-80 years) without history of diabetes. Participants received
sitagliptin or placebo once daily, starting the day prior to surgery and
continued for up to 10 days. Primary outcome was differences in the
frequency of stress hyperglycemia (blood glucose (BG) >180 mg/dL) after
surgery among groups. Results We randomized 32 participants to receive
sitagliptin and 28 to placebo (mean age 64+/-10 years and HbA1c:
5.6%+/-0.5%). Treatment with sitagliptin resulted in lower BG levels prior
to surgery (101+/-mg/dL vs 107+/-13 mg/dL, p=0.01); however, there were no
differences in the mean BG concentration, proportion of patients who
developed stress hyperglycemia (21% vs 22%, p>0.99), length of hospital
stay, rate of perioperative complications and need for insulin therapy in
the intensive care unit or during the hospital stay. Conclusion The use of
sitagliptin during the perioperative period did not prevent the
development of stress hyperglycemia or need for insulin therapy in
patients without diabetes undergoing CABG surgery. 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.

<101>
Accession Number
628249428
Title
Management of Less-Than-Severe Aortic Stenosis During Coronary Bypass: A
Systematic Review and Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 14 (4) (pp 291-298), 2019. Date of Publication: 01 Aug 2019.
Author
Yanagawa B.; An K.R.; Ouzounian M.; Gaudino M.; Puskas J.D.; Asaoka N.;
Verma S.; Friedrich J.O.
Institution
(Yanagawa, An, Asaoka, Verma) Divisions of Cardiac Surgery, St Michael's
Hospital, University of Toronto, ON, Canada
(Ouzounian) Division of Cardiac Surgery, Toronto General Hospital,
University of Toronto, ON, Canada
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Heart at Mount
Sinai Saint Luke's, New York, NY, United States
(Friedrich) Divisions of Critical Care, St Michael's Hospital, University
of Toronto, ON, Canada
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: The management of concomitant mild-to-moderate aortic stenosis
(AS) at the time of coronary artery bypass graft (CABG) is controversial.
Here we perform a systematic review and meta-analysis of CABG and aortic
valve replacement (AVR) versus CABG alone in patients with mild-moderate
AS. Method(s): We searched MEDLINE and EMBASE databases until July
2018 for studies comparing CABG & AVR versus CABG in patients with
mild-moderate AS undergoing coronary bypass. Data were extracted by 2
independent investigators. The main outcomes were operative mortality,
long-term survival, and reintervention for AS. Result(s): There were
6 unmatched retrospective observational studies with 1,172 patients
(median follow-up 4.7 [interquartile range: 4.3 to 5.3] years). Patients
undergoing CABG & AVR had less severe coronary artery disease. There were
no differences in operative mortality (relative risk [RR]: 1.07; 95% CI,
0.59 to 1.94; P = 0.8). CABG & AVR was associated with greater incidence
of stroke, bleeding, renal failure, and mediastinitis. At median follow-up
of 5 years, there was no difference in long-term mortality (incidence rate
ratio [IRR]:1.44; 95% CI, 0.83 to 2.51; P = 0.19), but CABG & AVR was
associated with 73% lower risk of reoperation for AS (n = 13/485 versus n
= 71/702; IRR: 0.27; 95% CI, 0.14 to 0.51; P < 0.001). Conclusion(s):
In patients undergoing CABG with mild-moderate AS, combining AVR with CABG
was associated with no difference in operative mortality but with
increased risk of stroke, bleeding, renal failure, and mediastinitis.
Long-term mortality was not different, but a risk of reoperation for AS at
5 years was 73% lower. Given the increasingly wide availability and safety
of transcatheter aortic valve replacement (TAVR), one may consider a
conservative approach toward concomitant mild-moderate AS. Copyright
© The Author(s) 2019.

<102>
Accession Number
628189698
Title
--Statins in the perioperative period [version 1; peer review: 3
approved].
Source
F1000Research. 8 (no pagination), 2019. Article Number: 688. Date of
Publication: 2019.
Author
Mohebi R.; Rosenson R.
Institution
(Mohebi, Rosenson) Department of Medicine (Cardiology), Icahn school of
Medicine at Mount Sinai, New York 10029, United States
Publisher
F1000 Research Ltd
Abstract
In this review, we discuss clinical evidence-based data regarding the
potential benefit of statin therapy in the perioperative period of
non-cardiac surgery. Results from meta-analyses of prospective
observational studies have provided conflicting evidence. Moreover,
comparison among studies is complicated by varying data sources, outcome
definitions, types of surgery, and preoperative versus perioperative
statin therapy. However, results of two recent large prospective cohort
studies showed that statin use on the day of or the day after non-cardiac
surgery (or both) is associated with lower 30-day all-cause mortality and
reduction in a variety of postoperative complications, predominantly
cardiac, compared with non-use during this period. There is a paucity of
data from randomized controlled trials assessing the benefit of statin
therapy in non-cardiac surgery. No randomized controlled trials have shown
that initiating a statin in statin-naive patients may reduce the risk of
cardiovascular complications in non-cardiac surgeries. One randomized
clinical trial demonstrated that the use of a preoperative statin in
patients with stable coronary heart disease treated with long-term statin
therapy had a significant reduction in the incidence of myocardial
necrosis and major adverse cardiovascular events after non-cardiac
surgery. In conclusion, it is important that all health-care professionals
involved in the care of the surgical patient emphasize the need to resume
statin therapy, particularly in patients with established atherosclerotic
cardiovascular disease. However, initiating a statin in statin-naive
patients undergoing non-cardiac surgery needs more evidence-based
data. Copyright © 2019 Mohebi R and Rosenson R.

<103>
Accession Number
627653230
Title
Transcutaneous electrical acupoint stimulation improves immunological
function during the perioperative period in patients with non-small cell
lung cancer undergoing video-assisted thoracic surgical lobectomy.
Source
Technology in Cancer Research and Treatment. 17 (no pagination), 2018.
Date of Publication: January 2018.
Author
Tu Q.; Yang Z.; Gan J.; Zhang J.; Que B.; Song Q.; Wang Y.
Institution
(Tu, Gan) Department of Anesthesiology, Tangshan People's Hospital, North
China University of Science and Technology, Tangshan, China
(Tu) The Graduate School of NorthChina University of Science and
Technology, Tangshan, China
(Yang) Department of Gastrointestinal Surgery, Sichuan Academy of Medical
Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
(Zhang) Department of Anesthesiology, The Third People's Hospital of
Chengdu, Southwest Jiao Tong University, Chendu, China
(Que) Department of Anesthesiology, Hangzhou Hospital of Traditional
Chinese Medicine, Hangzhou, China
(Song) Department of Cardiology, Tangshan People's Hospital, North China
University of Science and Technology, Tangshan, China
(Wang) Department of Neurology, Tangshan People's Hospital, North China
University of Science and Technology, Tangshan, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The immunological function of patients with malignant tumors may be
suppressed during the perioperative period. However, details on the
effects of transcutaneous electrical acupoint stimulation (TEAS) on
immunological function are relatively lacking. We designed this study to
examine the effects of TEAS on the immunological function of patients with
non-small cell lung cancer (NSCLC) during the perioperative period.
Participants (n = 144) were enrolled and randomly assigned into group TEAS
or group sham TEAS. TEAS on bilateral Feishu (BL13), Hegu (L14), and
Zusanli (ST36) was performed continuously throughout the procedure. The
primary outcome was the quantities of natural killer (NK) cells at 30
minutes before induction (T<inf>0</inf>), 5 minutes after intubation
(T<inf>1</inf>), at the beginning of the operation (T<inf>2</inf>), at the
beginning of the lobectomy (T<inf>3</inf>), at the beginning of the
lymphadenectomy (T<inf>4</inf>), and immediately after extubation
(T<inf>5</inf>). The secondary outcomes were the serum levels of tumor
necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) at
T<inf>0</inf> to T<inf>5</inf>, the mean arterial pressure (MAP) and heart
rate (HR), the intraoperative consumption of propofol and remifentanil,
the incidence of hypoxemia, postoperative nausea and vomiting (PONV), and
the length of hospital stay. The quantities of NK cells were decreased in
group sham TEAS after intubation compared to that in group TEAS, while the
quantities of NK cells in group TEAS were similar at T<inf>0</inf> to
T<inf>5</inf>. Meanwhile, the quantities of NK cells in group sham TEAS at
T<inf>1</inf> (P =.012), T<inf>2</inf> (P <.001), T<inf>3</inf> (P =.027),
T<inf>4</inf> (P =.045), and T<inf>5</inf> (P =.021) were lower than those
in group TEAS. In group TEAS, the serum levels of TNF-alpha were lower at
T<inf>1</inf> to T<inf>5</inf>, while the levels of IL-6 were lower at
T<inf>2</inf> to T<inf>5</inf>. Furthermore, the intraoperative MAP and HR
were more stable, the total propofol and remifentanil consumptions were
lower, and the length of hospital stay was shorter than those in group
sham TEAS. The application of TEAS can effectively reverse the decrease in
NK cells, decrease the serum levels of TNF-alpha and IL-6, maintain
hemodynamic stability during the perioperative period, decrease the
consumption of propofol and remifentanil, and shorten the length of the
hospital stay. Copyright © The Author(s) 2018.

<104>
Accession Number
629284336
Title
Treatment of idiopathic chylothorax in dogs and cats: A systematic review.
Source
Veterinary surgery : VS. (no pagination), 2019. Date of Publication: 11
Sep 2019.
Author
Reeves L.A.; Anderson K.M.; Luther J.K.; Torres B.T.
Institution
(Reeves, Luther, Torres) Department of Small Animal Medicine and Surgery,
College of Veterinary Medicine, University of Missouri, Columbia, MO,
United States
(Anderson) Zalk Veterinary Medical Library, College of Veterinary
Medicine, University of Missouri, Columbia, MO, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the evidence published on the treatment of
idiopathic chylothorax (IC) in small animals. STUDY DESIGN: Systematic
literature review. SAMPLE POPULATION: Dogs and cats with IC.
 METHOD(S): A literature search was performed in three bibliographic
databases in July 2018 for publications on IC in dogs and cats. Articles
meeting criteria for inclusion were evaluated for treatment, survival,
outcome data, and level of evidence (LoE) with a modified Oxford Level of
Evidence (mOLE) and GRADE (Grading of Recommendations, Assessment,
Development and Evaluations) system. RESULT(S): Eleven of 313
identified articles met the inclusion criteria. Only one study was
identified in dogs as having higher LoE by using the mOLE system, whereas
no study was identified as such in either species with the GRADE system.
Surgery was the primary treatment in all dogs and in 93% (68/73) of cats.
Medical therapy was the primary treatment in 7% (5/73) of cats. The most
common surgical treatment combined thoracic duct ligation (TDL) and
subtotal pericardiectomy (SP; 40%; 34/84) in dogs and TDL in cats (51%
[37/73]). CONCLUSION(S): The body of literature for IC treatment in
small animals was limited to one higher LoE study in dogs and none in
cats. No strong conclusion could be drawn regarding the effectiveness of
any one surgical method in dogs or cats, and no evidence was found to
support medical therapy as a primary treatment. CLINICAL SIGNIFICANCE: The
best available evidence regarding the treatment of IC is published in dogs
and provides some support for surgical treatment with either TDL+ cisterna
chyli ablation or TDL+SP. Additional evidence is required to confirm this
finding. Copyright © 2019 The American College of Veterinary
Surgeons.

<105>
Accession Number
629283423
Title
Early Emotional, Behavioural and Social Development of Infants and Young
Children with Congenital Heart Disease: A Systematic Review.
Source
Journal of clinical psychology in medical settings. (no pagination), 2019.
Date of Publication: 10 Sep 2019.
Author
Clancy T.; Jordan B.; de Weerth C.; Muscara F.
Institution
(Clancy) Department of Pediatrics, University of Melbourne, Melbourne,
Australia
(Jordan, Muscara) Brain and Mind, Murdoch Children's Research Institute,
Melbourne, Australia
(Jordan, Muscara) Royal Children's Hospital, Melbourne, Australia
(de Weerth) Donders Institute for Brain, Cognition and Behaviour, Radboud
University Medical Center, Nijmegen, Netherlands
Publisher
NLM (Medline)
Abstract
The experiences of diagnosis of congenital heart disease (CHD), cardiac
surgery and hospitalisation(s) are distressing and represent a significant
stressor for a child and family, which may impact psychosocial
development. This systematic review provides a synthesis of psychosocial
outcomes of infants and young children with congenital heart disease who
had cardiac surgery early in life. Twenty-eight studies related to infant
and young children's psychosocial development, specifically emotional,
social and behavioural functioning were identified. Variability was
related to methodological factors including differences in study design,
varying measurement tools and heterogeneous samples. Despite these
limitations, the majority of studies were of high quality. The most common
finding was a high prevalence of low-severity emotional and behavioural
dysregulation. Young children with severe CHD or comorbid conditions
experienced greater impairment, with higher rates of externalising
behaviour problems, although internalising behaviour problems were also
evident. This review integrates findings from literature in the past 28
years on the psychosocial well-being of infants and young children with
CHD and demonstrates a risk for emotional, social and behavioural
development difficulty, and, importantly, that symptoms of psychosocial
impairment are detectable very early in infancy. We advocate for
assessment and monitoring of emotional and behavioural regulation and
social development to be routinely conducted from infancy to enable
prevention and early intervention.

<106>
Accession Number
629281605
Title
Does transatrial-transpulmonary approach improve outcomes compared with
transventricular approach in non-neonatal patients undergoing tetralogy of
Fallot repair?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 22 Aug 2019.
Author
Ye X.T.; Buratto E.; Konstantinov I.E.; d'Udekem Y.
Institution
(Ye, Buratto, Konstantinov, d'Udekem) Cardiac Surgery Unit, Royal
Children's Hospital, Melbourne, VIC, Australia
(Ye, Buratto, Konstantinov, d'Udekem) Department of Paediatrics,
University of Melbourne, Melbourne, VIC, Australia
(Ye, Buratto, Konstantinov, d'Udekem) Murdoch Children's Research
Institute, Melbourne, VIC, Australia
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether the
transatrial-transpulmonary approach to tetralogy of Fallot repair in
non-neonatal patients provides superior outcomes compared with the
transventricular approach. Altogether, 175 papers were found using the
reported search, of which 11 represented the best evidence to answer the
clinical question. Two randomized controlled trials (RCTs) and 3
observational studies showed that the transatrial approach resulted in
better preservation of right ventricular (RV) function, whereas 4
observational studies showed no significant difference. Three
observational studies showed better attenuation of RV dilatation, whereas
3 showed no difference. One RCT and 2 observational studies showed lower
incidence of postoperative ventricular arrhythmias, while 1 RCT and 4
observational studies showed no difference. Two observational studies
demonstrated greater freedom from reoperation, 1 RCT and 2 observational
studies showed no difference, while 1 retrospective study observed a
higher incidence of residual RV outflow tract obstruction and lower
freedom from reoperation in infants. Two observational studies reported
lower risk of requiring pulmonary valve replacement, whereas 2 reported no
difference. Three observational studies reported superior exercise
capacity, while 1 reported no difference. No difference in long-term
survival was demonstrated. The results presented suggest that transatrial
repair of tetralogy of Fallot confers superior or equivalent outcomes in
terms of preservation of RV function and volume, ventricular arrhythmias,
need for pulmonary valve replacement, and exercise capacity compared with
transventricular repair. However, the incidence of residual RV outflow
tract obstruction may be higher in infants undergoing transatrial
repair. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<107>
Accession Number
619679405
Title
Effect of administration of allopurinol on postoperative outcomes in
patients undergoing intracardiac repair of tetralogy of Fallot.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 335-343),
2018. Date of Publication: January 2018.
Author
Talwar S.; Selvam M.S.; Makhija N.; Lakshmy R.; Choudhary S.K.; Sreenivas
V.; Airan B.
Institution
(Talwar, Selvam, Makhija, Lakshmy, Choudhary, Sreenivas, Airan)
Cardiothoracic Center and Department of Biostatistics, All India Institute
of Medical Sciences, New Delhi, India
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To determine effects of allopurinol administration on outcomes
following intracardiac repair of tetralogy of Fallot (TOF). Materials and
Methods Fifty patients undergoing TOF repair were randomized to 2 groups
of 25 each: the allopurinol group (n = 25) and the placebo group (n = 25).
Postoperatively, inotropic score, rhythm, duration of mechanical
ventilation, cardiac output, intensive care unit (ICU) stay, and hospital
stay were assessed. Plasma troponin-I, superoxide dismutase (SOD),
interleukin (IL) 1-s, IL-6, and malondialdehyde were measured serially.
Results Inotropic score was lower in the allopurinol compared with placebo
group (11.04 +/- 5.70 vs 17.50 +/- 7.83; P =.02). Duration of ICU and
hospital stay was lower in the allopurinol group. Plasma levels of SOD
preoperative were (2.87 +/- 1.21 U/mL vs 4.5 +/- 2.08 U/mL; P =.012),
immediately following release of crossclamp (2.32 +/- 0.98 U/mL vs 5.32
+/- 2.81 U/mL; P <.001), and after termination of CPB (2.18 +/- 1.0.78
U/mL vs 3.44 +/- 1.99 U/mL; P =.003) between the placebo versus
allopurinol group, respectively. Postoperative levels of IL1-s and IL-6
were lower in the allopurinol group. Malondialdehyde levels following CPB
were lower in the allopurinol group (11.80 +/- 2.94 pg/mL in the placebo
vs 9.16 +/- 3.02 g/mL in the allopurinol group; P <.001). Conclusions
Allopurinol administration in patients undergoing intracardiac repair of
TOF is associated with reduced inotropic scores, duration of mechanical
ventilation, ICU stay, and hospital stay and favorable biochemical markers
of inflammation. Further studies in multiple setups are needed before
recommending it as a routine practice. Copyright © 2017 The
American Association for Thoracic Surgery

<108>
[Use Link to view the full text]
Accession Number
624135335
Title
The five-year clinical and angiographic follow-up outcomes of
intracoronary transfusion of circulation-derived cd34+ cells for patients
with end-stage diffuse coronary artery disease unsuitable for coronary
intervention - Phase i clinical trial.
Source
Critical Care Medicine. 46 (5) (pp e411-e418), 2018. Date of Publication:
01 May 2018.
Author
Sung P.-H.; Lee F.-Y.; Tong M.-S.; Chiang J.Y.; Pei S.-N.; Ma M.-C.; Li
Y.-C.; Chen Y.-L.; Wu C.-J.; Sheu J.-J.; Lee M.S.; Yip H.-K.
Institution
(Sung, Tong, Li, Chen, Wu, Yip) Division of Cardiology, Department of
Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung
University College of Medicine, Kaohsiung, Taiwan (Republic of China)
(Sung, Yip) Center for Shockwave Medicine and Tissue Engineering,
Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Republic of
China)
(Lee, Sheu) Division of Thoracic and Cardiovascular Surgery, Department of
Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
College of Medicine, Kaohsiung, Taiwan (Republic of China)
(Chiang) Department of Computer Science and Engineering, National Sun
Yat-sen University, Kaohsiung, Taiwan (Republic of China)
(Chiang) Department of Healthcare Administration and Medical Informatics,
Kaohsiung Medical University, Kaohsiung, Taiwan (Republic of China)
(Pei, Ma) Division of Hema-Oncology, Department of Internal Medicine,
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of
Medicine, Kaohsiung, Taiwan (Republic of China)
(Lee) Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital,
Chang Gung University, College of Medicine, Kaohsiung, Taiwan (Republic of
China)
(Yip) Institute for Translational Research in Biomedicine, Kaohsiung Chang
Gung Memorial Hospital, Chang Gung University, College of Medicine,
Kaohsiung, Taiwan (Republic of China)
(Yip) Department of Medical Research, China Medical University Hospital,
China Medical University, Taichung, Taiwan (Republic of China)
(Yip) Department of Nursing, Asia University, Taichung, Taiwan (Republic
of China)
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: This study investigated the clinical and angiographic
long-term outcomes of intracoronary transfusion of circulation-derived
CD34+ cells for patients with end-stage diffuse coronary artery disease
unsuitable for coronary intervention. Design and Setting: A single-center
prospective randomized double-blinded phase I clinical trial. Thirty-eight
patients undergoing CD34+ cell therapy were allocated into groups 1 (1.0 x
10 7 cells/each vessel; n = 18) and 2 (3.0 x 10 7 cells/each vessel; n =
20). Patient(s): Those with end-stage diffuse coronary artery disease
were unsuitable for percutaneous and surgical coronary revascularization.
 Intervention(s): Intracoronary delivery of circulation-derived CD34+
cells. Measurements and Main Results: We prospectively evaluated
long-term clinical and echocardiographic/angiographic outcomes between
survivors and nonsurvivors. By the end of 5-year follow-up, the survival
rate and major adverse cardio/cerebrovascular event were 78.9% (30/38) and
36.8% (14/38), respectively. During follow-up period, 31.6% patients
(12/38) received coronary stenting for reason of sufficient target vessel
size grown-up after the treatment. Endothelial function was significantly
reduced in the nonsurvivors than the survivors (p = 0.039). Wimasis image
analysis of angiographic findings showed that the angiogenesis was
significantly and progressively increased from baseline to 1 and 5 years
(all p < 0.001). The 3D echocardiography showed left ventricular ejection
fraction increased from baseline to 1 year and then remained stable up to
5 years, whereas left ventricular chamber diameter exhibited an opposite
pattern to left ventricular ejection fraction among the survivors. The
clinical scores for angina and heart failure were significantly
progressively reduced from baseline to 1 and 5 years (all p < 0.001).
 Conclusion(s): CD34+ cell therapy for end-stage diffuse coronary
artery disease patients might contribute to persistently long-term effects
on improvement of left ventricular function, angina/heart failure, and
amelioration of left ventricular remodeling. Copyright © 2018 by
the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All
Rights Reserved.

<109>
Accession Number
618198316
Title
Factors associated with postoperative atrial fibrillation and other
adverse events after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 242-251.e10),
2018. Date of Publication: January 2018.
Author
Akintoye E.; Sellke F.; Marchioli R.; Tavazzi L.; Mozaffarian D.
Institution
(Akintoye) Department of Internal Medicine, Wayne State University School
of Medicine, Detroit, Mich, United States
(Sellke) Department of Cardiothoracic Surgery, Alpert Medical School,
Brown University, Providence, RI, United States
(Marchioli) Department of Hematology and Oncology, Therapeutic Science and
Strategy Unit, Quintiles, Milan, Italy
(Tavazzi) Department of Cardiology and LTTA Centre, University of Ferrara,
Ferrara, Italy; Maria Cecilia Hospital- GVM Care & Research, E.S. Health
Science Foundation, Cotignola, Italy
(Mozaffarian) Friedman School of Nutrition Science & Policy, Tufts
University, Boston, Mass, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The study objective was to evaluate the impact of various
surgical characteristics and practices on the risk of postoperative atrial
fibrillation and other adverse outcomes after cardiac surgery. Methods By
using the prospectively collected data of patients who underwent cardiac
surgery in 28 centers across the United States, Italy, and Argentina, the
details of surgery characteristics were collected for each patient and the
outcomes, including postoperative atrial fibrillation, major adverse
cardiovascular events, and mortality. These were evaluated via
multivariable-adjusted models. Results In 1462 patients, a total of 460
cases of postoperative atrial fibrillation, 33 major adverse
cardiovascular events, 23 cases of 30-day mortality, and 46 cases of
1-year mortality occurred. We found that type of surgery and
cardiopulmonary bypass use predicted the occurrence of postoperative
atrial fibrillation. Compared with coronary artery bypass grafting alone,
there was a higher risk of postoperative atrial fibrillation with valvular
surgery alone (odds ratio, 1.4; 95% confidence interval, 1.1-1.9), and the
risk was even higher with concomitant valvular and coronary artery bypass
grafting surgery (odds ratio, 1.8; 95% confidence interval, 1.2-2.7).
Compared with no bypass, use of cardiopulmonary bypass was associated with
higher risk of postoperative atrial fibrillation (odds ratio, 2.4; 95%
confidence interval, 1.7-3.5), but there were significant age and sex
differences of the impact of bypass use among patients undergoing coronary
artery bypass grafting (P for interaction =.04). In addition, compared
with spontaneous return of rhythm, ventricular pacing was associated with
a higher risk of major adverse cardiovascular events (odds ratio, 5.0; 95%
confidence interval, 1.4-18), whereas concomitant coronary artery bypass
grafting and valvular surgery was associated with a higher risk of 30-day
mortality (hazard ratio, 4.3; 95% confidence interval, 1.2-14) compared
with coronary artery bypass grafting alone. Occurrence of postoperative
atrial fibrillation was associated with greater length of stay and 1-year
mortality (hazard ratio, 2.2; 95% confidence interval, 1.2-3.9).
Conclusions In this multicenter trial, we identified specific adverse
outcomes that are associated with concomitant valvular and coronary artery
bypass graft surgery, cardiopulmonary bypass, ventricular pacing, and
occurrence of postoperative atrial fibrillation. Copyright © 2017
The American Association for Thoracic Surgery

<110>
Accession Number
618634479
Title
Systematic review of transcatheter aortic valve replacement after previous
mitral valve surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 63-65.e5),
2018. Date of Publication: January 2018.
Author
Squiers J.J.; Potluri S.; Brinkman W.T.; DiMaio J.M.
Institution
(Squiers, DiMaio) Baylor Scott & White Research Institute, The Heart
Hospital Baylor Plano, Plano, Tex, United States
(Potluri) Department of Cardiology, The Heart Hospital Baylor Plano,
Plano, Tex, United States
(Brinkman, DiMaio) Department of Cardiothoracic Surgery, The Heart
Hospital Baylor Plano, Plano, Tex, United States
(Squiers) Department of General Surgery, Baylor University Medical Center,
Dallas, Tex, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<111>
Accession Number
2000595311
Title
Mitral valve repair with resection versus neochordae: A call for
high-quality evidence.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (2) (pp 601-602),
2018. Date of Publication: February 2018.
Author
Mazine A.; Verma S.; Yanagawa B.
Institution
(Mazine, Verma, Yanagawa) Division of Cardiac Surgery, Department of
Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario,
Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<112>
Accession Number
618500434
Title
Efficacy and effectiveness of on- versus off-pump coronary artery bypass
grafting: A meta-analysis of mortality and survival.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 172-179.e5),
2018. Date of Publication: January 2018.
Author
Filardo G.; Hamman B.L.; da Graca B.; Sass D.M.; Machala N.J.; Ismail S.;
Pollock B.D.; Collinsworth A.W.; Grayburn P.A.
Institution
(Filardo, Sass, Machala, Ismail, Pollock) Department of Epidemiology,
Baylor Scott & White Health, Dallas, Tex, United States
(da Graca, Collinsworth) Center for Clinical Effectiveness, Baylor Scott &
White Health, Dallas, Tex, United States
(Filardo, da Graca, Pollock, Collinsworth) Robbins Institute for Health
Policy and Research, Baylor University, Waco, Tex, United States
(Filardo) Department of Statistics, Southern Methodist University, Dallas,
Tex, United States
(Hamman) Department of Cardiothoracic Surgery, Baylor Heart and Vascular
Institute, Baylor University Medical Center, Dallas, Tex, United States
(Grayburn) Department of Cardiology, Baylor Heart and Vascular Institute,
Baylor University Medical Center, Dallas, Tex, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Despite many studies comparing on- versus off-pump coronary
artery bypass graft (CABG), there is no consensus as to whether one of
these techniques offers patients better outcomes. Methods We searched
PubMed from inception to June 30, 2015, and identified additional studies
from bibliographies of meta-analyses and reviews. We identified 42
randomized controlled trials (RCTs) and 31 rigorously adjusted
observational studies (controlling for the Society of Thoracic
Surgeons-recognized risk factors for mortality) reporting mortality for
off-pump versus on-pump CABG at specified time points. Trial data were
extracted independently by 2 researchers using a standardized form.
Differences in probability of mortality (DPM) were estimated for the RCTs
and observational studies separately and combined, for time points ranging
from 30 days to 10 years. Results RCT-only data showed no significant
differences at any time point, whereas observational-only data and the
combined analysis showed short-term mortality favored off-pump CABG (n =
1.2 million patients; 36 RCTs, 26 observational studies; DPM [95%
confidence interval (CI)], -44.8% [-45.4%, -43.8%]) but that at 5 years it
was associated with significantly greater mortality (n = 60,405 patients;
3 RCTs, 5 observational studies; DPM [95% CI], 10.0% [5.0%, 15.0%]). At 10
years, only observational data were available, and off-pump CABG showed
significantly greater mortality (DPM [95% CI], 14.0% [11.0%, 17.0%]).
Conclusions Evidence from RCTs showed no differences between the
techniques, whereas rigorously adjusted observational studies (with >1.1
million patients) and the combined analysis indicated that off-pump CABG
offers lower short-term mortality but poorer long-term survival. These
results suggest that, in real-world settings, greater operative safety
with off-pump CABG comes at the expense of lasting survival
gains. Copyright © 2017 The American Association for Thoracic
Surgery

<113>
Accession Number
618483110
Title
Systematic review and meta-analysis of chordal replacement versus leaflet
resection for posterior mitral leaflet prolapse.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 120-128.e10),
2018. Date of Publication: January 2018.
Author
Mazine A.; Friedrich J.O.; Nedadur R.; Verma S.; Ouzounian M.; Juni P.;
Puskas J.D.; Yanagawa B.
Institution
(Mazine, Nedadur, Verma, Yanagawa) Division of Cardiac Surgery, Department
of Surgery, St Michael's Hospital, University of Toronto, Toronto,
Ontario, Canada
(Friedrich) Department of Critical Care Medicine, St Michael's Hospital,
University of Toronto, Toronto, Ontario, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute, St
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Ouzounian) Division of Cardiac Surgery, Department of Surgery, Peter Munk
Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto,
Ontario, Canada
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai Saint Luke's,
New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives To compare outcomes of chordal replacement versus leaflet
resection techniques for repair of isolated posterior mitral leaflet
prolapse. Methods We searched MEDLINE and EMBASE databases for studies
that compared chordal replacement ("neo-chord" group) versus leaflet
resection ("resection" group) techniques for the treatment of posterior
mitral leaflet prolapse. Data were extracted by 2 independent
investigators and subjected to a meta-analysis using a random-effects
model. Results One randomized controlled trial (RCT), 1 propensity-matched
study, and 6 unadjusted observational studies, with a total of 1926
patients, met our inclusion criteria. Two studies reported only
perioperative outcomes; mean follow-up ranged from 1.0 to 5.9 years in the
remaining studies. In pooled data from unadjusted observational studies,
annuloplasty ring diameter was higher in the neo-chord group (+1.5 mm; P
=.0003), but with high heterogeneity (I2 = 91%). Based on
limited data, postprocedural left ventricular ejection fraction may be
greater in the neo-chord group, but this difference reached statistical
significance only in the RCT (+3.4%; P =.03), and not in 2 observational
studies that reported this outcome (+2.7%; P =.10). There was no
difference in recurrent mitral regurgitation at follow-up between the
resection and neo-chord groups; however, patients in the neo-chord group
had a lower rate of mitral valve reoperation at follow-up in the
unadjusted observational studies (incidence rate ratio, 0.22; P =.0008
[I2 = 0%; 4 studies, 1331 patients]). Conclusions Chordal
replacement may be associated with greater freedom from reoperation and
may lead to improved postoperative left ventricular function compared with
leaflet resection. However, these conclusions are supported primarily by
data from unadjusted observational studies, and high-quality RCTs of
chordal replacement versus leaflet resection are needed. Copyright
© 2017 The American Association for Thoracic Surgery

<114>
Accession Number
618685470
Title
A prospective randomized trial of the cut-and-sew Maze procedure in
patients undergoing surgery for rheumatic mitral valve disease.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (2) (pp 608-617),
2018. Date of Publication: February 2018.
Author
Wang H.; Han J.; Wang Z.; Yin Z.; Liu Z.; Jin Y.; Han H.
Institution
(Wang, Han, Wang, Yin, Jin, Han) Department of Cardiovascular Surgery,
General Hospital of Shenyang Military Area Command, Shenyang, China
(Liu) TEDA International Cardiovascular Hospital, Tianjin, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To evaluate the safety and efficacy of the addition of the
cut-and-sew Maze III procedure (CSM) for mitral valve replacement (MVR) in
patients with atrial fibrillation (AF) associated with rheumatic mitral
valve disease (RMVD). Method(s): A total of 130 patients with
persistent or long-standing persistent AF associated with RMVD were
assigned at random to either the CSM plus MVR (Maze III) group or MVR
alone (non-Maze) group. The primary endpoint was a composite of freedom
from stroke and death at 1 year. Result(s): There were no significant
differences between the Maze III and non-Maze groups in terms of major
complications and in-hospital mortality. One-year freedom from stroke or
death was better in the Maze III group compared with the non-Maze group (P
=.0028; hazard ratio, 0.2653; 95% confidence interval, 0.1122 to 0.6270).
The risk of AF recurrence in the Maze III group was 0.002-fold that in
non-Maze group (P =.000). Conclusion(s): Addition of the CSM to an
MVR procedure can decrease the risk of stroke or death and high sinus
rhythm at 1 year without increasing the operative risk. CSM is a safe and
effective approach to treating AF associated with RMVD. Copyright
© 2017 The American Association for Thoracic Surgery

<115>
Accession Number
617493096
Title
Eight-year follow-up of the Clopidogrel After Surgery for Coronary Artery
Disease (CASCADE) trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 212-222.e2),
2018. Date of Publication: January 2018.
Author
Hage A.; Voisine P.; Erthal F.; Larose E.; Glineur D.; Chow B.; Tremblay
H.; Fortier J.; Ko G.; Une D.; Farkouh M.; Mesana T.G.; LeMay M.; Kulik
A.; Ruel M.
Institution
(Hage, Voisine, Tremblay) Division of Cardiac Surgery, Quebec Heart and
Lung Institute, Quebec City, Quebec, Canada
(Larose) Division of Cardiology, Quebec Heart and Lung Institute, Quebec
City, Quebec, Canada
(Erthal, Chow, LeMay) Division of Cardiology, University of Ottawa Heart
Institute, Ottawa, Ontario, Canada
(Glineur, Fortier, Ko, Mesana, Ruel) Division of Cardiac Surgery,
University of Ottawa Heart Institute, Ottawa, Ontario, Canada
(Une) Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato,
Japan
(Farkouh) Division of Cardiology, Mount Sinai Hospital, New York, NY,
United States
(Kulik) Division of Cardiovascular Surgery, Lynn Heart & Vascular
Institute, Boca Raton, Fla, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective In this 8 years' follow-up study, we evaluated the long-term
outcomes of the addition of clopidogrel to aspirin during the first year
after coronary artery bypass grafting, versus aspirin plus placebo, with
respect to survival, major adverse cardiac, or major cerebrovascular
events, including revascularization, functional status, graft patency, and
native coronary artery disease progression. Methods In the initial
Clopidogrel After Surgery for Coronary Artery Disease trial, 113 patients
were randomized to receive either daily clopidogrel (n = 56) or placebo (n
= 57), in addition to aspirin, in a double-blind fashion for 1 year after
coronary artery bypass grafting. All patients were re-evaluated to collect
long-term clinical data. Surviving patients with a glomerular filtration
rate > 30 mL/min were asked to undergo a coronary computed tomography
angiogram to evaluate the late saphenous vein graft patency and native
coronary artery disease progression. Results At a median follow-up of 7.6
years, survival rate was 85.5% +/- 3.8% (P =.23 between the 2 groups). A
trend toward enhanced freedom from all-cause death or major adverse
cardiac or cerebrovascular events, including revascularization, was
observed in the aspirin-clopidogrel group (P =.11). No difference in
functional status or freedom from angina was observed between the 2 groups
(P >.57). The long-term patency of saphenous vein graft was 89.11% in the
aspirin-clopidogrel group versus 91.23% in the aspirin-placebo group (P
=.79). A lower incidence of moderate to severe native disease progression
was observed in the aspirin-clopidogrel group versus the aspirin-placebo
group (7 out of 122 vs 13 out of 78 coronary segments that showed
progression, respectively [odds ratio, 0.3 +/- 0.2; 95% confidence
interval, 0.1-0.8; P =.02]). Conclusions At 8 years' follow-up, the
addition of clopidogrel to aspirin during the first year after coronary
artery bypass grafting exhibited a lower incidence of moderate to severe
progression of native coronary artery disease and a trend toward higher
freedom from major adverse cardiac or cerebrovascular events, including
revascularization, or death in the aspirin-clopidogrel group. Clinical
Trial Registration http://www.clinicaltrials.gov. Unique identifier:
NCT00228423. Copyright © 2017 The American Association for
Thoracic Surgery

<116>
Accession Number
618263742
Title
Short-term effects of preoperative beta-blocker use for isolated coronary
artery bypass grafting: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (2) (pp 620-629.e1),
2018. Date of Publication: February 2018.
Author
Wang L.; Wang H.; Hou X.
Institution
(Wang, Wang, Hou) Center for Cardiac Intensive Care, Capital Medical
University Affiliated Anzhen Hospital, Beijing, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The use of preoperative beta-blockers has been used as a
quality standard for patients undergoing coronary artery bypass grafting
(CABG). However, the benefits of beta-blockers use before CABG remain
controversial. We performed a systematic review and meta-analysis to
investigate the short-term effects of preoperative beta-blocker use for
patients undergoing isolated CABG. Method(s): We searched PubMed,
Embase, and the Cochrane Library for English articles published from
inception to August 16, 2016. Observational studies comparing preoperative
beta-blockers therapy or non-beta-blockers therapy were considered
eligible for the current study. Result(s): Six observational studies
with 1,231,850 patients were included. The pooled analyses of unadjusted
outcome (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.71-0.95; P
=.007) or risk-adjusted outcome (OR, 0.95; 95% CI, 0.92-0.97; P =.000)
showed slight reduction in operative mortality, whereas an insignificant
difference in mortality rate was observed in pooling postoperative data
from propensity score analysis (OR, 0.97; 95% CI, 0.94-1.00; P =.088).
Removing one study that used propensity-score covariate adjustment,
subgroup analysis of propensity-matched patients (313,417 in each group)
still generated a statistically nonsignificant benefit for preoperative
beta-blocker use (OR, 0.97; 95% CI, 0.94-1.00; P =.093). Furthermore, the
preoperative use of beta-blockers did not reduce the incidence of major
postoperative complications, such as postoperative myocardial infarction,
stroke, atrial fibrillation, reoperation, renal failure, prolonged
ventilation, and sternal wound infection. Conclusion(s): Our study
suggests that the use of preoperative beta-blockers did not reduce either
operative mortality or the incidence of postoperative complications in
patients undergoing CABG. Copyright © 2017 The American
Association for Thoracic Surgery

<117>
Accession Number
2002198071
Title
Concomitant vs staged orthotopic liver transplant after cardiac surgical
procedures.
Source
Transplantation Reviews. 33 (4) (pp 231-236), 2019. Date of Publication:
October 2019.
Author
Reddy H.G.; Choi J.H.; Maynes E.J.; Carlson L.A.; Gordon J.S.; Horan D.P.;
Khan J.; Weber M.P.; Bodzin A.S.; Morris R.J.; Massey H.T.;
Tchantchaleishvili V.
Institution
(Reddy, Choi, Maynes, Carlson, Gordon, Horan, Khan, Weber, Morris, Massey,
Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Bodzin) Division of Transplant Surgery, Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
W.B. Saunders
Abstract
Background: In patients who require orthotopic liver transplant (OLT),
cardiac surgery may be needed to optimize preoperative cardiac status for
OLT. The aim of this systematic review was to evaluate patient
characteristics and outcomes of those undergoing staged versus concomitant
cardiac procedures with OLT. Method(s): An electronic search was
performed to identify all case reports and series, from which
patient-level data was extracted regarding cardiac procedures associated
with OLT. After assessment for inclusion and exclusion criteria, 26
articles were pooled for systematic review. Result(s): Overall, 49
patients were included in the analysis, of whom 12 (24%) underwent staged
procedures and 37 (76%) underwent concomitant procedures. The median age
was lower in the staged group [staged: 51 (IQR, 43.8-59.2) years vs.
concomitant: 60 (IQR, 55.0-64.0) years, p = .02]. Other baseline
characteristics were comparable between the two groups. For staged
procedures, the median time between heart procedures and OLT was 2 (IQR,
1.0-3.5) months. The most commonly reported cardiac procedures were
coronary artery bypass graft (CABG) [staged: 4/12 (33.3%) vs. concomitant:
21/37 (56.8%), p = .28], aortic valve replacement (AVR) [staged: 3/12
(25.0%) vs. concomitant: 19/37 (51.2%), p = .21], and transcatheter aortic
valve replacement (TAVR) [staged: 4/12 (33.3%) vs. concomitant: 0/37 (0%),
p = .002]. Regarding outcomes, there was a significantly shorter post-OLT
hospital stay for those who had staged procedures versus those who had
concomitant procedures [staged: 8 (IQR, 5-13) days vs. concomitant: 17
(IQR, 14-24) days, p = .007]. However, both groups had similar in-hospital
mortality rates [staged: 1/12 (8.3%) vs. concomitant: 4/37 (10.8%), p =
1.0]. Overall survival stratified between the two groups was comparable.
 Conclusion(s): Patients who underwent the staged approach had a
shorter post-transplant hospital stay, but comparable survival with
respect to those who underwent concomitant cardiac procedures and
OLT. Copyright © 2019 Elsevier Inc.

<118>
Accession Number
623698432
Title
Syphilitic aortic aneurysm.
Source
Zeitschrift fur Rheumatologie. (no pagination), 2018. Date of Publication:
2018.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, The First Hospital of Putian,
Teaching Hospital, Fujian Medical University, 389 Longdejing Street,
Chengxiang District, Putian, Fujian Province 351100, China
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
The aim of this study was to outline the clinical features of syphilitic
aortic aneurysm. The study materials were based on a comprehensive
literature review of publications on syphilitic aortic aneurysm published
between 2000 and 2017. Syphilitic aortic aneurysm occurred most commonly
in the ascending aorta in either a saccular or a fusiform shape.
Syphilitic aortic aneurysm was often complicated by aortic valve
insufficiency (in almost half of the patients), and by a coronary
artery/ostium lesion in 16.5% of the patients. Aortic valve operation was
necessary in one fourth, and coronary artery surgery accounted for less
than one fifth of patients warranting a surgical treatment. Although there
was no difference in the survival rates between the surgically and
conservatively treated patients, an aggressive treatment should be
performed when diagnosis is made due to the potential risks of aneurysm
rupture and sudden death. Copyright © 2018, Springer Medizin
Verlag GmbH, ein Teil von Springer Nature.

<119>
Accession Number
629264195
Title
Applying CIRS-BRAT framework in a regulatory setting: Updated benefit risk
assessment for fibrinogen concentrate in the setting of complex cardiac
surgery.
Source
Pharmacoepidemiology and Drug Safety. Conference: 35th International
Conference on Pharmacoepidemiology and Therapeutic Risk Management. United
States. 28 (Supplement 2) (pp 468), 2019. Date of Publication: August
2019.
Author
Gilsenan A.W.; Brainsky A.; Colilla S.
Institution
(Gilsenan) RTI Health Solutions, Research Triangle Park, NC, United States
(Brainsky, Colilla) CSL Behring, King of Prussia, PA, United States
Publisher
John Wiley and Sons Ltd
Abstract
Background: Fibrinogen concentrate (FCH) has been successfully used in
perioperative bleeding in complex cardiac surgery (CCS), as reported in
several single center trials; a global, multicenter randomized clinical
trial did not show efficacy superiority over placebo, while the safety
endpoints were favorable to FCH. As part of the 2015 periodic safety
update report (PSUR) submitted to the European Medicines Agency (EMA), the
sponsor conducted a benefit-risk assessment (BRA) using the CIRS-BRAT
framework, to evaluate the evidence for the use of FCH in cardiac surgery.
The EMA agreed that the benefit-risk profile was favorable and requested
an update of the BRA for the 2018 PSUR. Objective(s): To update the
benefit-risk profile of FCH in the clinical setting of CCS taking into
account all published evidence and completed clinical trials as of April
2018. Method(s): The CIRS-BRAT framework was followed to establish
the decision frame, identify key benefits and risks and gather and
interpret data. and produce visualizations to display the results. An
updated systematic literature review was conducted to identify new studies
published since the original BRA. Forest plots were generated to show the
benefits and risks of FCH compared to placebo or standard of care in
randomized and observational studies by key benefits and risks, by study,
and by crude pooled analyses of identified placebo-controlled clinical
trials. Result(s): The original BRA included 6 studies and the
updated literature search identified 1 new randomized clinical trial and 1
new observational study that met criteria included in the decision frame.
The updated BRA showed that the evaluated benefits (avoidance of
allogeneic blood product transfusion within 24 hours, survival at 30 days
and avoidance of re-operation due to bleeding) favored FCH in most
studies. For the risk outcomes, in all studies the point estimates for
TEEs and anaphylactic and hypersensitivity reactions were similar in the
FCH and comparator groups. The benefit-risk profile of FCH in the setting
of complex cardiac surgery was determined to still be favorable.
 Conclusion(s): The use of a structured approach (CIRS-BRAT framework)
facilitated assessment of a large volume of information in a complex
setting, including both randomized trials and observational studies. The
favorable benefit-risk profile of FCH in the setting of complex cardiac
surgery was reconfirmed.

<120>
Accession Number
629260112
Title
Efficacy and safety of different prosthesis aortic valve replacement in
patients with aortic stenosis: A systematic review and meta-analysis.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe (CIRSE) 2019. Spain. 42
(3 Supplement) (pp S243), 2019. Date of Publication: August 2019.
Author
Salahia S.; Riffai M.; Shehata M.; Hassaballa A.S.
Institution
(Salahia, Riffai) Faculty of Medicine, Ain Shams University, Alain, Egypt
(Shehata) Faculty of Medicine, Zagazig University, Alain, Egypt
(Hassaballa) Cardiothoracic Institute, Ain Shams University, Alain, Egypt
Publisher
Springer New York LLC
Abstract
Purpose: The aim of this systematic review and Meta-analysis was to assess
the efficacy and safety while comparing variable protheses after aortic
valve replacement. Material(s) and Method(s): We searched PubMed,
MEDLINE in Process, Scopus and Web of Science (previously ISI) for
relevant studies, published up to January 2018. We included randomized
controlled trials (RCTs) that compared different types of prostheses
valves. Data were pooled as odds ratios (OR) or mean differences (MD) with
their 95% confidence intervals (CI) between compared groups in a random
meta-analysis model. Subgroup and sensitivity analysis were conducted. We
assessed heterogeneity by a Chi square test and I2 statistic.
 Result(s): Regarding efficacy outcomes, transvalvular mean gradient
at 1 year was significantly lower in Cryolife O'Brien than Toronto (MD=
-4.50 mmhg, 95% CI [-6.64, -2.36]), lower in Edwards Perimount Magna (EPM)
than Medtronic Mosaic (MM) (MD= -6.42 mmhg, 95% CI [-8.11, -4.72]), and
lower in ROSS than MIRA (MD= -6.70 mmhg, 95% CI [-8.38, -5.02]). Regarding
safety outcomes, CarboMedics was associated with significantly higher
cardiac valve not related deaths (OR= 2.04, 95% CI [1.04, 3.97]), higher
early mortality (OR= 2.72, 95% CI [1.18, 6.32]), and lower hemorrhage (OR=
0.41, 95% CI [0.17, 0.98]) compared to St. Jude Medical.
 Conclusion(s): Our findings showed that Cryolife O'Brien had lower
transvalvular mean gradient at 1 year than Toronto. CM had higher early
mortality, cardiac valve not related deaths, and lower haemorrhage than
SJM.

<121>
Accession Number
629259729
Title
Perivascular hyaluronan-new cure for venous insufficiency.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe (CIRSE) 2019. Spain. 42
(3 Supplement) (pp S495-S496), 2019. Date of Publication: August 2019.
Author
Grunwald J.P.C.; Ragg J.C.
Institution
(Grunwald) Interventional Phlebology, Angioclinic, Berlin, Germany
(Ragg) Interventional Radiology, Angioclinic Vein Centers, Berlin, Germany
Publisher
Springer New York LLC
Abstract
Purpose: Injectable hyaluronan gels offer three options to treat venous
insufficiency: 1) Percutaneous Valvuloplasty (PVP), aiming at the
restoration of local valve function; 2) Focal Venoplasty (FVP), aiming at
diameter reduction to reduce reflux, and 3) Segmental Venoplasty (SVP),
aiming to reduce venous diameters as an adjunct to endoluminal procedures.
 Material(s) and Method(s): PVP was studied in 22 patients (14 f, 8 m,
32 - 54 y., GSM valves, diameter 7.0 - 12.0 mm), using a prototype
hyaluronan (XL type, Vivacy). FVP was evaluated in 16 patients (11 f, 5 m,
46 - 69 y.) for reflux reduction in GSV or sidebranch insufficiency
(L-type, Vivacy). SVP was investigated in 20 cases (13 f, 7 m, 41 - 72
yrs.) with GSV or SSV insufficiency, adjunctive to Biomatrix sclerofoam
(Venartis), using another hyaluronan (S-Type, short durability, Vivacy).
For this collective, target segments were split and randomized to
hyaluronan vs. NaCl 0,9%. Result(s): PVP established orthograde flow
in 22/22 cases. With FVP, 13/16 cases were successful (81.3%) in obtaining
alternate (n = 10) or orthograde flow (n = 4), correlating well with
clinical improvement. With SVP, technical success (> 50% lumen reduction)
was obtained in all cases (20/20). In all hyaluronan compressed segments,
there were no postinterventional complaints, compared to 18/20 cases (90%)
after standard procedures. All hyaluronan applications were without
adverse reactions. Conclusion(s): PVP is effective and safe to
restore valve function. Also FVP for hemodynamic purposes showed
feasibility, effectivity and safety, while clear indications need further
studies. SVP adjunctive to endovenous ablation significantly improves
post-treatment comfort.

<122>
Accession Number
629256686
Title
Modified Single-Patch versus Two-Patch Repair for Atrioventricular Septal
Defect: A Systematic Review and Meta-Analysis.
Source
World journal for pediatric & congenital heart surgery. 10 (5) (pp
616-623), 2019. Date of Publication: 01 Sep 2019.
Author
Loomba R.S.; Flores S.; Villarreal E.G.; Bronicki R.A.; Anderson R.H.
Institution
(Loomba) Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn,
IL, United States
(Flores, Villarreal, Bronicki) Critical Care and Cardiology, Pediatrics,
Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Anderson) Institute of Genetics, Newcastle University, Newcastle Upon
Tyne, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: We performed a meta-analysis of studies to determine whether
the modified single-patch technique offers benefits when compared to the
two-patch repair. The postoperative outcomes examined in this study were
cardiopulmonary bypass time, cross-clamp time, duration of mechanical
ventilation, intensive care unit length of stay, total hospital length of
stay, need for reoperation, need for reoperation for left ventricular
outflow tract obstruction or left atrioventricular valve regurgitation,
need for pacemaker implantation, and mortality during follow-up.
 METHOD(S): A review was conducted to identify studies comparing a
modified single-patch repair versus two-patch repair. A fixed-effects
model was utilized for end points with low heterogeneity and a
random-effects model for end points with significant heterogeneity.
Meta-regression was also performed to determine the influence of other
factors on the variables of interest. RESULT(S): A total of 964
unique manuscripts were screened, with 10 being included in the final
analyses. There were a total of 724 patients, with 353 (49%) having
undergone repair utilizing a modified single-patch repair. Mean age at
repair for modified single-patch repair and two-patch repair was 8.81 and
9.03 months, respectively. Significant differences were noted in
cardiopulmonary bypass time and cross-clamp time with mean difference of
-28.53 and -22.69 minutes, respectively. In comparison to the two-patch
repair, both times were decreased in modified single-patch repair. No
significant difference was noted in any other variables.
 CONCLUSION(S): Modified single-patch repair for atrioventricular
septal defects requires less cardiopulmonary bypass and cross-clamp time
but does not significantly impact the examined postoperative outcomes.

<123>
Accession Number
629256392
Title
Congenital Heart Disease and Thyroid Dysfunction: Combination,
Association, and Implication.
Source
World journal for pediatric & congenital heart surgery. 10 (5) (pp
604-615), 2019. Date of Publication: 01 Sep 2019.
Author
Lerner R.K.; Gruber N.; Pollak U.
Institution
(Lerner) Department of Pediatrics, Edmond and Lily Safra Children's
Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
(Lerner, Gruber) Sackler Faculty of Medicine, Tel Aviv University, Tel
Aviv, Israel
(Gruber) Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra
Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
(Pollak) Pediatric Cardiac Critical Care Unit, Hadassah University Medical
Center, Ein Kerem, Jerusalem, Israel
(Pollak) Pediatric Cardiology, Hadassah University Medical Center, Ein
Kerem, Jerusalem, Israel
(Pollak) Pediatric Extracorporeal Support Program, Hadassah University
Medical Center, Ein Kerem, Jerusalem, Israel
(Pollak) Hebrew University Hadassah Medical School, Jerusalem, Israel
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients with congenital heart disease have higher prevalence
of thyroid dysfunction due to embryonic and genetic coexistence. Marked
changes in cardiac function occur secondary to alternations in thyroid
hormone levels. Cardiac catheterizations or cardiac surgeries with
cardiopulmonary bypass can cause abnormalities in the circulating
hormones, in the absence of primary thyroid disease. Therefore, monitoring
of thyroid function should be routinely performed in children with
congenital heart disease. Thyroid hormone supplementation has been
postulated as a possible therapeutic option; however, the therapeutic
decisions should be made based on individual circumstances, symptoms, and
the severity of the thyroid dysfunction. OBJECTIVE(S): To describe
the correlation between congenital heart disease in children and thyroid
dysfunction and the debate on monitoring, intervention, and treatment.
 METHOD(S): PubMed, Clinical Key, and the Cochrane Library were
searched using keywords relevant to congenital heart disease/surgery,
cardiopulmonary bypass, thyroid hormones, sick euthyroid syndrome, and
cardiac catheterization. Studies were limited to the English language and
to children 0 to 18 years old. Studies in adults with important findings
were reviewed as well. All clinical studies believed to have relevance
were considered. All relevant studies were reviewed, and the most
pertinent data were incorporated in this review. CONCLUSION(S): There
is lack of significant evidence concerning treatment for thyroid
dysfunction in children with a congenital cardiac diagnosis. Adequately
powered studies are needed before a uniform recommendation about treatment
can be made.

<124>
Accession Number
629243369
Title
Comparison of Scientific Publications from Three Different Clinical
Disciplines of German Universities.
Source
The Thoracic and cardiovascular surgeon. 67 (6) (pp 488-493), 2019. Date
of Publication: 01 Sep 2019.
Author
Schwarzer M.; Alscher L.; Doenst T.
Institution
(Schwarzer, Alscher, Doenst) Department of Cardiothoracic Surgery,
University Hospital Jena, Jena, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Scientific publications are important for the advancement in
medicine. Surgical disciplines including cardiac surgery are frequently
considered not scientifically leading. However, a specific comparison
between surgical and nonsurgical disciplines has not yet been performed.
We thus compared scientific output of German departments of cardiac
surgery with nonsurgical cardiology departments and surgical departments
not addressing the heart (general surgery) of 34 universities in Germany.
 METHOD(S): For each university, the personnel working at the
different departments were identified on the internet homepage in 2014. We
searched for publications of these persons in 2011 to 2013 on PubMed,
identified author position, coauthors, and type of article, as well as
journal impact factor (JIF). RESULT(S): There were 931 academic
persons in cardiac surgery, 1,486 in general surgery, and 1,814 in
cardiology with 12,096 publications related to these persons on PubMed.
Cardiology published most manuscripts, including manuscripts from research
conducted (first author), initiated (senior author), or both. Cardiac
surgery had the least publications and had fewer authors from other
departments or institutions. The average JIF was higher in cardiology
compared with the two surgical disciplines. However, relating the number
of publications to the number of employees in the departments, the
differences were no longer apparent. CONCLUSION(S): We conclude that
the number of publications in German universities appears to be a function
of the number of academic personnel and not of the discipline. The lower
JIFs in surgery may be due to the smaller surgical fields and/or due to
less high impact interdisciplinary/interinstitutional publications in
surgery. Copyright Georg Thieme Verlag KG Stuttgart . New York.

<125>
[Use Link to view the full text]
Accession Number
626540941
Title
Ischemia and perioperative infarction.
Source
Colombian Journal of Anesthesiology. 46 (Supplement 2) (pp 39-45), 2018.
Date of Publication: 01 Mar 2018.
Author
Navarro-Vargas J.R.; Borrero L.M.G.
Institution
(Navarro-Vargas) School of Medicine, Universidad Nacional de Colombia,
Bogota, Colombia
(Navarro-Vargas) Hospital Universitario de Colombia, Universidad Nacional
de Colombia, Bogota, Colombia
(Borrero) Sindicato Antioqueno de Anestesiologia (Anestesiar), Medellin,
Colombia
(Navarro-Vargas) National Resuscitation Committee, Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.), Carrera 15a No. 120-74, Bogota,
Colombia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction: Perioperative medicine has provided anesthetists with a
proactive role in the prevention of perioperative complications, in
particular cardiovascular events such as myocardial injury after
non-cardiac surgery. Objective(s): Using cardiovascular risk
concepts, pre-operative assessment for non-cardiac surgery, optimization
of the hemodynamic status, determination of differences between elective
and urgent patients, monitoring, close follow-up after surgery, and
measurements of ultrasensitive troponin in the first 48 hours
postoperatively, anesthetists are now able to identify and address early
clinical manifestations of perioperative ischemia and myocardial
infarction (MI) in patients at risk. Material(s) and Method(s):
Narrative review: Queries in various databases on perioperative ischemia
and non-fatal infarction in Pubmed, Science Direct, and Ovid.
 Result(s): The analysis of cardiac troponin levels is of the utmost
importance in the prognosis of perioperative MI. Diagnosis can be made
earlier, and it has been shown that the majority of these perioperative
events have their onset within the first 48 hours of the postoperative
period, when the physiological stress is highest in patients taken to
non-cardiac surgery. Copyright © 2018 Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.). Published by Wolters Kluwer.
This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

<126>
Accession Number
629268945
Title
Hybrid Coronary Artery Revascularization: A Review and Current Evidence.
Source
Innovations (Philadelphia, Pa.). (pp 1556984519872998), 2019. Date of
Publication: 10 Sep 2019.
Author
Kiaii B.; Teefy P.
Institution
(Kiaii) Department of Cardiac Surgery, London Health Sciences Centre,
London, ON, Canada
(Teefy) Department of Cardiology, London Health Sciences Centre, London,
ON, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The role of hybrid coronary revascularization (HCR), which
utilizes the combination of minimally invasive surgical coronary artery
bypass grafting of the left anterior descending artery and percutaneous
coronary intervention (PCI) of non-left anterior descending vessels to
treat multivessel coronary artery disease, is expanding. We set out to
provide a review of this technology. METHOD(S): We conducted a
retrospective analysis of all minimally invasive hybrid operations
performed at our institution from September 2004 to December 2018. An
effective analysis comparing patients undergoing HCR vs off-pump or
on-pump surgical coronary artery revascularization was undertaken using an
adjusted analysis with inverse-probability weighting based on the
propensity score. Outcomes that were assessed include death, myocardial
infarction, stroke, atrial fibrillation, renal failure, requirement of
blood transfusion, conversion to open procedure (in the hybrid group),
length of stay in intensive care unit, and total length of stay in
hospital. Intention-to-treat analysis was performed. An up-to-date
literature review of HCR complements this study. RESULT(S): Since
2004 a total of 191 consecutive patients (61.4+/-11.1 years; 142 males and
49 females) underwent HCR (robotic-assisted coronary artery bypass graft
of the left internal thoracic artery to the left anterior descending
coronary artery (LAD) and PCI of a non-LAD vessel) in a single- or
double-stage fashion. Successful HCR occurred in 183 of the 191 patients
(8 patients required intraoperative conversion to conventional coronary
bypass). From our comparative analysis and literature review we found no
significant difference between HCR and coronary artery bypass grafting
groups with respect to in-hospital and 1-year follow-up.
 CONCLUSION(S): Current evidences suggest that HCR is a feasible,
safe, and effective coronary artery revascularization strategy in selected
patients with multivessel coronary artery disease.

<127>
Accession Number
629255779
Title
Effect of Two Different Colloid Priming Strategies in Infants Weighing
Less Than 5 kg Undergoing On-pump Cardiac Surgeries.
Source
Artificial organs. (no pagination), 2019. Date of Publication: 08 Sep
2019.
Author
Zhou C.; Tong Y.; Feng Z.; Cui Y.; Zhao M.; Hu J.; Liu K.; Zhao J.; Liu J.
Institution
(Zhou, Tong, Feng, Cui, Zhao, Hu, Liu, Zhao, Liu) State Key Laboratory of
Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To explore the effect of two different priming strategies
(artificial colloid only vs. artificial colloid combined with human serum
albumin) on the prognosis of children weighing less than 5 kg undergoing
on-pump congenital heart disease (CHD) surgery. METHOD(S): A total of
65 children weighing less than 5 kg who underwent on-pump CHD surgery in
our hospital from September 2016 to December 2017 were enrolled in this
study. The children were randomly divided into two groups: artificial
colloid priming group (AC group, n=33) and artificial colloid combined
albumin priming group (ACA group, n=32). The primary clinical endpoint was
the peri-CPB colloid osmotic pressure (COP). Secondary clinical endpoints
included perioperative blood product & hemostatic drug consumption,
postoperative renal function, coagulation function, postoperative renal
function and postoperative recovery parameters. RESULT(S): COP values
were not significant in the priming system as well as peri-CPB time points
between the two groups (P>0.05). Platelet consumption in the AC group was
significantly lower than that in the ACA group (P<0.05). There were no
significant differences in the use of other blood products and hemostatic
drugs as well as perioperative coagulation parameters between the two
groups (P>0.05). Postoperative length of stay in the AC group was
significantly lower than that in the ACA group (P<0.05). There were no
significant differences in mortality, postoperative mechanical ventilation
time, ICU time and perioperative adverse event (including postoperative
AKI) occurrences between the two groups (P>0.05). CONCLUSION(S): In
the on-pump cardiac surgeries of patients weighting less than 5kg, total
colloidal priming would not affect peri-CPB COP values, postoperative
coagulation function and blood products consumption. Total artificial
colloidal priming strategy is feasible in low-weight
patients. Copyright This article is protected by copyright. All rights
reserved.

<128>
Accession Number
2002849890
Title
Predicting Postoperative Lung Function Following Lung Cancer Resection: A
Systematic Review and Meta-analysis.
Source
EClinicalMedicine. (no pagination), 2019. Date of Publication: 2019.
Author
Oswald N.K.; Halle-Smith J.; Mehdi R.; Nightingale P.; Naidu B.; Turner
A.M.
Institution
(Oswald, Naidu) Institute of Inflammation and Ageing, University of
Birmingham, Edgbaston, Birmingham B15 2TT, Ireland
(Halle-Smith) College of Medical and Dental Sciences, University of
Birmingham, Edgbaston, Birmingham B15 2TT, Ireland
(Mehdi) Department of Thoracic Surgery, Heartlands Hospital, Bordesley
Green East, Birmingham B9 5SS, Ireland
(Nightingale) Institute of Translational Medicine, University Hospitals
Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, Ireland
(Turner) Institute of Applied Health Research, University of Birmingham,
Edgbaston, Birmingham B15 2TT, Ireland
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Lung resection remains the gold standard treatment for early
stage lung cancer; prediction of postoperative lung function is a key
selection criterion for surgery with the aim of determining risk of
postoperative dyspnoea. We aimed to identify the different prediction
techniques used, and compare their accuracy. Method(s): A systematic
review and meta-analysis sought to synthesise studies conducted that
assess prediction of postoperative lung function up to 18/02/2018 (n =
135). PROBAST was used to assess risk of bias in studies, 17 studies were
judged to be at low risk of bias. Finding(s): Meta-analysis revealed
CT volume and density measurement to be the most accurate (mean difference
71 ml) and precise (standard deviation 207 ml) of the reported techniques
used for predicting FEV1; evidence for predicting gas transfer was
lacking. Interpretation(s): The evidence suggests using CT volume and
density is the preferred technique in the prediction of postoperative
FEV1. Further studies are required to ensure that the methods and
thresholds we propose are linked to patient reported outcomes.
 Funding(s): Salary support for NKO, RM, PN, BN, and AMT was provided
by University Hospitals Birmingham NHS Foundation Trust. Copyright
© 2019

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