EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2002911092
Title
Parenteral amino acid supplementation with high-dose insulin prevents
hypoaminoacidemia during cardiac surgery.
Source
Nutrition. 69 (no pagination), 2020. Article Number: 110566. Date of
Publication: January 2020.
Author
Hong M.; Wykes L.; Shum-Tim D.; Nitschmann E.; Bui H.; Nakazawa K.;
Codere-Maruyama T.; Schricker T.; Hatzakorzian R.
Institution
(Hong, Wykes, Nitschmann, Schricker) School of Human Nutrition, McGill
University, Montreal, Canada
(Shum-Tim) Department of Cardiac Surgery, McGill University Health Center,
Montreal, Canada
(Bui) Department of Endocrinology, McGill University Health Center,
Montreal, Canada
(Nakazawa, Codere-Maruyama, Schricker, Hatzakorzian) Department of
Anesthesia, McGill University Health Center, Montreal, Canada
(Hatzakorzian) Department of Critical Care Medicine, McGill University
Health Center, Montreal, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: Surgery triggers a stress response that produces insulin
resistance and hyperglycemia. During cardiac surgery, the administration
of high-dose insulin along with dextrose titration maintains
normoglycemia, but dramatically decreases plasma amino acids (AAs)
compared with preoperative fasting levels. Hypoaminoacidemia limits
protein synthesis and prevents anabolic responses after surgery. We
investigated whether parenteral infusion of AAs during and immediately
after cardiac surgery would prevent hypoaminoacidemia in patients who
receive high-dose insulin therapy. <br/>Method(s): Sixteen patients
undergoing coronary artery bypass grafting surgery were randomly allocated
to receive AAs with % kcal equivalent to either 20% (n = 8) or 35% (n = 8)
of their measured resting energy expenditure (REE). Insulin was infused at
a constant rate of 5 mU/(kg x min), whereas dextrose was titrated to
maintain normoglycemia during and until 5 h after surgery. Plasma AA
concentrations were measured at baseline before and after surgery.
<br/>Result(s): Compared with the 20% AA group after surgery, AA
concentrations were significantly higher in the 35% AA group for 12 of 20
AAs (P < 0.032), including all branched-chain AAs. In the 20% AA group,
total essential AAs decreased by 21% and nonessential AAs decreased by 14%
after surgery compared with preoperative fasting levels. In contrast,
giving 35% AAs prevented this unfavorable decrease in AAs, and in fact
allowed for a 23% and 12% increase in essential and nonessential AAs,
respectively. <br/>Conclusion(s): AA supplementation at 35% REE, but not
20% REE, can effectively prevent hypoaminoacidemia caused by high-dose
insulin therapy during cardiac surgery.<br/>Copyright &#xa9; 2019 Elsevier
Inc.

<2>
Accession Number
372831437
Title
Clonidine in patients undergoing noncardiac surgery.
Source
New England Journal of Medicine. 370 (16) (pp 1504-1513), 2014. Date of
Publication: 2014.
Author
Devereaux P.J.; Sessler D.I.; Leslie K.; Kurz A.; Mrkobrada M.;
Alonso-Coello P.; Villar J.C.; Sigamani A.; Biccard B.M.; Meyhoff C.S.;
Parlow J.L.; Guyatt G.; Robinson A.; Garg A.X.; Rodseth R.N.; Botto F.;
Lurati Buse G.; Xavier D.; Chan M.T.V.; Tiboni M.; Cook D.; Kumar P.A.;
Forget P.; Malaga G.; Fleischmann E.; Amir M.; Eikelboom J.; Mizera R.;
Torres D.; Wang C.Y.; VanHelder T.; Paniagua P.; Berwanger O.; Srinathan
S.; Graham M.; Pasin L.; Le Manach Y.; Gao P.; Pogue J.; Whitlock R.; Lamy
A.; Kearon C.; Chow C.; Pettit S.; Chrolavicius S.; Yusuf S.
Institution
(Devereaux, Mrkobrada, Robinson, Botto, Lurati Buse, Eikelboom, Le Manach,
Gao, Pogue, Whitlock, Lamy, Pettit, Chrolavicius, Yusuf) Population Health
Research Institute, Hamilton Health Sciences and McMaster University,
Hamilton, ON, Canada
(Devereaux, Guyatt, Cook, Eikelboom, Le Manach, Pogue, Kearon, Yusuf)
Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
(Devereaux, Guyatt, Tiboni, Cook, Eikelboom, Mizera, Le Manach, Pogue,
Kearon, Yusuf) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Devereaux, Guyatt, Cook, Eikelboom, VanHelder, Le Manach, Kearon, Yusuf)
Department of Anesthesia, McMaster University, Hamilton, ON, Canada
(Whitlock, Lamy) Department of Surgery, McMaster University, Hamilton, ON,
Canada
(Whitlock) Department of Critical Care, McMaster University, Hamilton, ON,
Canada
(Mrkobrada) Department of Medicine, London Health Sciences Centre, London,
ON, Canada
(Parlow) Department of Anesthesiology and Perioperative Medicine, Kingston
General Hospital, Queen's University, Kingston, ON, Canada
(Garg) Department of Medicine, Division of Nephrology, University of
Western Ontario, London, ON, Canada
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Graham) Department of Medicine, University of Alberta, Edmonton, AB,
Canada
(Sessler, Kurz) Department of Outcomes Research, Anesthesiology Institute,
Cleveland Clinic, Cleveland, United States
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Alonso-Coello) Iberoamerican Cochrane Center, Biomedical Research
Institute (IIB-Sant Pau), Barcelona, Spain
(Paniagua) Anesthesiology Department, Biomedical Research Institute
(IIB-Sant Pau), Barcelona, Spain
(Villar) Universidad Autonoma de Bucaramanga, Fundacion Cardioinfantil,
Bogota, Colombia
(Sigamani, Xavier) Department of Pharmacology, Division of Clinical
Research and Training, St. John's National Academy of Health Sciences,
Bangalore, India
(Biccard, Rodseth) Department of Anaesthetics, Nelson R. Mandela School of
Medicine, University of KwaZulu-Natal, Durban, South Africa
(Meyhoff) Department of Anesthesiology, Herlev Hospital, University of
Copenhagen, Herlev, Denmark
(Botto) Estudios Clinicos Latino America (ECLA), Instituto Cardiovascular
de Buenos Aires (ICBA), Buenos Aires, Argentina
(Lurati Buse) Department of Anesthesia, University Hospital Basel, Basel,
Switzerland
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong, Hong Kong
(Kumar) Department of Anesthesiology, University of North Carolina, Chapel
Hill, NC, United States
(Forget) Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels,
Belgium
(Malaga) Universidad Peruana Cayetano Heredia, Lima, Peru
(Fleischmann) Department of Anesthesia and Intensive Care, Medical
University Vienna, Vienna, Austria
(Amir) Department of Surgery, Shifa International Hospital, Islamabad,
Pakistan
(Torres) Department of Anesthesiology, Clinica Santa Maria, Santiago,
Chile
(Wang) Department of Anesthesiology, University of Malaya, Kuala Lumpur,
Malaysia
(Berwanger) Research Institute HCor (Hospital do Coracao), Sao Paulo,
Brazil
(Pasin) Anesthesia and Intensive Care, San Raffaele Scientific Institute,
Milan, Italy
(Chow) George Institute for Global Health, University of Sydney, Sydney,
Australia
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Marked activation of the sympathetic nervous system occurs
during and after non-cardiac surgery. Low-dose clonidine, which blunts
central sympathetic outflow, may prevent perioperative myocardial
infarction and death without inducing hemodynamic instability.
<br/>METHOD(S): We performed a blinded, randomized trial with a 2-by-2
factorial design to allow separate evaluation of low-dose clonidine versus
placebo and low-dose aspirin versus placebo in patients with, or at risk
for, atherosclerotic disease who were undergoing noncardiac surgery. A
total of 10,010 patients at 135 centers in 23 countries were enrolled. For
the comparison of clonidine with placebo, patients were randomly assigned
to receive clonidine (0.2 mg per day) or placebo just before surgery, with
the study drug continued until 72 hours after surgery. The primary outcome
was a composite of death or nonfatal myocardial infarction at 30 days.
<br/>RESULT(S): Clonidine, as compared with placebo, did not reduce the
number of primary-outcome events (367 and 339, respectively; hazard ratio
with clonidine, 1.08; 95% confidence interval [CI], 0.93 to 1.26; P=0.29).
Myocardial infarction occurred in 329 patients (6.6%) assigned to
clonidine and in 295 patients (5.9%) assigned to placebo (hazard ratio,
1.11; 95% CI, 0.95 to 1.30; P=0.18). Significantly more patients in the
clonidine group than in the placebo group had clinically important
hypotension (2385 patients [47.6%] vs. 1854 patients [37.1%]; hazard ratio
1.32; 95% CI, 1.24 to 1.40; P<0.001). Clonidine, as compared with placebo,
was associated with an increased rate of nonfatal cardiac arrest (0.3% [16
patients] vs. 0.1% [5 patients]; hazard ratio, 3.20; 95% CI, 1.17 to 8.73;
P=0.02). <br/>CONCLUSION(S): Administration of low-dose clonidine in
patients undergoing noncardiac surgery did not reduce the rate of the
composite outcome of death or nonfatal myocardial infarction; it did,
however, increase the risk of clinically important hypotension and
nonfatal cardiac arrest. Copyright &#xa9; 2014 Massachusetts Medical
Society.

<3>
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.<br/>Copyright &#xa9; The
Author(s) 2019.

<4>
Accession Number
629340931
Title
Impact of surgical aortic root enlargement on the outcomes of aortic valve
replacement: A meta-analysis of 13 174 patients.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (1) (pp 74-82), 2019.
Date of Publication: 2019.
Author
Sa M.P.B.O.; Carvalho M.M.B.; Filho D.C.S.; Cavalcanti L.R.P.; Diniz
R.G.S.; Rayol S.C.; Soares A.M.M.N.; de Araujoe Sa F.B.C.; Menezes A.M.;
Clavel M.-A.; Pibarot P.; Lima R.C.
Institution
(Sa, Cavalcanti, Diniz, Rayol, Soares, de Araujoe Sa, Menezes, Lima)
Division of Cardiovascular Surgery of Pronto Socorro Cardiologico de
Pernambuco - PROCAPE, Recife, Brazil
(Sa, Carvalho, Filho, Cavalcanti, Diniz, Rayol, Soares, de Araujoe Sa,
Menezes, Lima) University of Pernambuco - UPE, Recife, Brazil
(Sa, Carvalho, Filho, Lima) Faculty of Medical Sciences and Biological
Sciences Instituite - FCM/ICB, Recife, Brazil
(Clavel, Pibarot) Institut Universitaire de Cardiologie e de Pneumologie
du Quebec, Quebec City, QC, Canada
Publisher
Oxford University Press
Abstract
OBJECTIVES: This study sought to evaluate the impact of surgical aortic
root enlargement (ARE) on the perioperative outcomes of aortic valve
replacement (AVR). <br/>METHOD(S): Databases were searched for studies
published until April 2018 to carry out a systematic review followed by
meta-analysis of results. <br/>RESULT(S): The search yielded 1468 studies
for inclusion. Of these, 10 articles were analysed and their data
extracted. A total of 13 174 patients (AVR with ARE: 2819 patients; AVR
without ARE: 10 355 patients) were included from studies published from
2002 to 2018. The total rate of ARE was 21.4%, varying in the studies from
5.7% to 26.3%. The overall odds ratio (OR) [95% confidence interval (CI)]
for perioperative mortality showed a statistically significant difference
between the groups (among 10 studies), with a higher risk in the 'AVR with
ARE' group (OR 1.506, 95% CI 1.209-1.875; P < 0.001), but not when
adjusted for isolated AVR + ARE without any concomitant procedures such as
mitral valve surgery, coronary artery bypass surgery, etc. (OR 1.625, 95%
CI 0.968-2.726; P = 0.066-among 6 studies). The 'AVR with ARE' group
showed an overall lower risk of significant patient-prosthesis mismatch
among 9 studies (OR 0.472, 95% CI 0.295-0.756; P = 0.002) and a higher
overall difference in means of indexed effective orifice area among 10
studies (random-effect model: 0.06 cm²/m², 95% CI
0.029-0.103; P < 0.001). <br/>CONCLUSION(S): Surgical ARE seems to be
associated with increased perioperative mortality but with lower risk of
patient-prosthesis mismatch.<br/>Copyright &#xa9; The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<5>
Accession Number
628578019
Title
Comparison of Major Adverse Cardiac Events between Instantaneous Wave-Free
Ratio and Fractional Flow Reserve-Guided Strategy in Patients with or
Without Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical
Trial.
Source
JAMA Cardiology. 4 (9) (pp 857-864), 2019. Date of Publication: September
2019.
Author
Lee J.M.; Choi K.H.; Koo B.-K.; Dehbi H.-M.; Doh J.-H.; Nam C.-W.; Shin
E.-S.; Cook C.M.; Al-Lamee R.; Petraco R.; Sen S.; Malik I.S.; Nijjer
S.S.; Mejia-Renteria H.; Alegria-Barrero E.; Alghamdi A.; Altman J.;
Baptista S.B.; Bhindi R.; Bojara W.; Brugaletta S.; Silva P.C.; Di Mario
C.; Erglis A.; Gerber R.T.; Going O.; Harle T.; Hellig F.; Indolfi C.;
Janssens L.; Jeremias A.; Kharbanda R.K.; Khashaba A.; Kikuta Y.;
Krackhardt F.; Laine M.; Lehman S.J.; Matsuo H.; Meuwissen M.; Niccoli G.;
Piek J.J.; Ribichini F.; Samady H.; Sapontis J.; Seto A.H.; Sezer M.;
Sharp A.S.P.; Singh J.; Takashima H.; Talwar S.; Tanaka N.; Tang K.; Van
Belle E.; Van Royen N.; Vinhas H.; Vrints C.J.; Walters D.; Yokoi H.;
Samuels B.; Buller C.; Patel M.R.; Serruys P.; Escaned J.; Davies J.E.
Institution
(Lee, Choi) Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, South Korea
(Koo) Seoul National University Hospital and Institute on Aging, Seoul
National University, 101 Daehang-ro, Chongno-gu, Seoul 110-744, South
Korea
(Dehbi) Cancer Research UK and University College London Cancer Trials
Centre, University College London, London, United Kingdom
(Doh) Inje University Ilsan Paik Hospital, Daehwa-Dong, South Korea
(Nam) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Shin) Ulsan Hospital, Ulsan South Korea and Ulsan University Hospital,
University of Ulsan College of Medicine, Ulsan, South Korea
(Cook, Al-Lamee, Petraco, Sen, Malik, Nijjer, Serruys, Davies) Hammersmith
Hospital, Imperial College London, London, United Kingdom
(Mejia-Renteria, Escaned) Hospital Clinico San Carlos, IDISSC and
Universidad Complutense de Madrid, Madrid, Spain
(Alegria-Barrero) Hospital Universitario de Torrejon, Universidad
Francisco de Vitoria, Madrid, Spain
(Alghamdi) King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi
Arabia
(Altman) Colorado Heart and Vascular, Lakewood, CO, United States
(Baptista) Doutor Fernando Fonseca, Amadora, Portugal
(Bhindi) Royal North Shore Hospital, Sydney, Australia
(Bojara) Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz,
Germany
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
(Silva) Hospital Santa Maria, Lisbon, Portugal
(Di Mario) Royal Brompton Hospital, Imperial College London, London,
United Kingdom
(Di Mario) University of Florence, Florence, Italy
(Erglis) Pauls Stradins Clinical University Hospital, Riga, Latvia
(Gerber) Conquest Hospital, St Leonards-on-Sea, United Kingdom
(Going) Sana Klinikum Lichtenberg, Lichtenberg, Germany
(Harle) Klinikum Oldenburg, European Medical School, Carl von Ossietzky
University, Oldenburg, Germany
(Hellig) Sunninghill Hospital, Johannesburg, South Africa
(Indolfi) University Magna Graecia, Catanzaro, Italy
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Jeremias) Stony Brook University Medical Center, New York, NY, United
States
(Kharbanda) John Radcliffe Hospital, Oxford University Hospitals
Foundation Trust, Oxford, United Kingdom
(Khashaba) Ain Shams University, Cairo, Egypt
(Kikuta) Fukuyama Cardiovascular Hospital, Fukuyama, Japan
(Krackhardt) Charite Campus Virchow Klinikum, Universitaetsmedizin,
Berlin, Germany
(Laine) Helsinki University Hospital, Helsinki, Finland
(Lehman) Flinders University, Adelaide, SA, Australia
(Matsuo) Gifu Heart Center, Gifu, Japan
(Meuwissen) Amphia Hospital, Breda, Netherlands
(Niccoli) Catholic University of the Sacred Heart, Rome, Italy
(Piek) AMC Heart Center, Academic Medical Center, Amsterdam, Netherlands
(Ribichini) University Hospital Verona, Verona, Italy
(Samady) Emory University, Atlanta, GA, United States
(Sapontis) Monash Heart, Monash University, Melbourne, VIC, Australia
(Seto) Veterans Affairs Long Beach Healthcare System, Long Beach, CA,
United States
(Sezer) Istanbul University, Istanbul Faculty of Medicine, Istanbul,
Turkey
(Sharp) Royal Devon and Exeter Hospital, Exeter, United Kingdom
(Sharp) University of Exeter, Exeter, United Kingdom
(Singh) Washington University School of Medicine in St Louis, St Louis,
MO, United States
(Takashima) Aichi Medical University Hospital, Aichi, Japan
(Talwar) Royal Bournemouth General Hospital, Bournemouth, United Kingdom
(Tanaka) Tokyo Medical University, Tokyo, Japan
(Tang) Essex Cardiothoracic Centre, Basildon, United Kingdom
(Tang) Anglia Ruskin University, Chelmsford, United Kingdom
(Van Belle) Institut Coeur Poumon, Lille University Hospital, Lille,
France
(Van Belle) INSERM Unite 1011, Lille, France
(Van Royen) VU University Medical Center, Amsterdam, Netherlands
(Vinhas) Hospital Garcia de Horta, Lisbon, Portugal
(Vrints) Antwerp University Hospital, Antwerp, Belgium
(Walters) Prince Charles Hospital, Brisbane, QLD, Australia
(Yokoi) Fukuoka Sannou Hospital, Fukuoka, Japan
(Samuels) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Buller) St Michaels Hospital, Toronto, ON, Canada
(Patel) Duke University, Durham, NC, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Invasive physiologic indices such as fractional flow reserve
(FFR) and instantaneous wave-free ratio (iFR) are used in clinical
practice. Nevertheless, comparative prognostic outcomes of iFR-guided and
FFR-guided treatment in patients with type 2 diabetes have not yet been
fully investigated. <br/>Objective(s): To compare 1-year clinical outcomes
of iFR-guided or FFR-guided treatment in patients with and without
diabetes in the Functional Lesion Assessment of Intermediate Stenosis to
Guide Revascularization (DEFINE-FLAIR) trial. <br/>Design, Setting, and
Participant(s): The DEFINE-FLAIR trial is a multicenter, international,
randomized, double-blinded trial that randomly assigned 2492 patients in a
1:1 ratio to undergo either iFR-guided or FFR-guided coronary
revascularization. Patients were eligible for trial inclusion if they had
intermediate coronary artery disease (40%-70% diameter stenosis) in at
least 1 native coronary artery. Data were analyzed between January 2014
and December 2015. <br/>Intervention(s): According to the study protocol,
iFR of 0.89 or less and FFR of 0.80 or less were used as criteria for
revascularization. When iFR or FFR was higher than the prespecified
threshold, revascularization was deferred. <br/>Main Outcomes and
Measures: The primary end point was major adverse cardiac events (MACE),
defined as the composite of all-cause death, nonfatal myocardial
infarction, or unplanned revascularization at 1 year. The incidence of
MACE was compared according to the presence of diabetes in iFR-guided and
FFR-guided groups. <br/>Result(s): Among the total trial population (2492
patients), 758 patients (30.4%) had diabetes. Mean age of the patients was
66 years, 76% were men (1868 of 2465), and 80% of patients presented with
stable angina (1983 of 2465). In the nondiabetes population (68.5%; 1707
patients), iFR guidance was associated with a significantly higher rate of
deferral of revascularization than the FFR-guided group (56.5% [n = 477 of
844] vs 46.6% [n = 402 of 863]; P <.001). However, it was not different
between the 2 groups in the diabetes population (42.1% [n = 161 of 382] vs
47.1% [n = 177 of 376]; P =.15). At 1 year, the diabetes population showed
a significantly higher rate of MACE than the nondiabetes population (8.6%
vs 5.6%; adjusted hazard ratio [HR], 1.88; 95% CI, 1.28-2.64; P <.001).
However, there was no significant difference in MACE rates between
iFR-guided and FFR-guided groups in both the diabetes (10.0% vs 7.2%;
adjusted HR, 1.33; 95% CI, 0.78-2.25; P =.30) and nondiabetes population
(4.7% vs 6.4%; HR, 0.83; 95% CI, 0.51-1.35; P =.45) (interaction P =.25).
<br/>Conclusions and Relevance: The diabetes population showed
significantly higher risk of MACE than the nondiabetes population, even
with the iFR-guided or FFR-guided treatment. The iFR-guided and FFR-guided
treatment showed comparable risk of MACE and provided equal safety in
selecting revascularization target among patients with diabetes. Trial
Registration: ClinicalTrials.gov identifier: NCT02053038.<br/>Copyright
&#xa9; 2019 American Medical Association. All rights reserved.

<6>
Accession Number
628573832
Title
Effect of Simvastatin-Ezetimibe Compared with Simvastatin Monotherapy
after Acute Coronary Syndrome among Patients 75 Years or Older: A
Secondary Analysis of a Randomized Clinical Trial.
Source
JAMA Cardiology. 4 (9) (pp 846-854), 2019. Date of Publication: September
2019.
Author
Bach R.G.; Cannon C.P.; Giugliano R.P.; White J.A.; Lokhnygina Y.; Bohula
E.A.; Califf R.M.; Braunwald E.; Blazing M.A.
Institution
(Bach) Cardiovascular Division, Department of Medicine, Washington
University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110,
United States
(Cannon, Giugliano, Bohula, Braunwald) TIMI Study Group, Cardiovascular
Division, Brigham and Women's Hospital, Boston, MA, United States
(White, Lokhnygina, Califf, Blazing) Duke Clinical Research Institute,
Department of Medicine, Duke University, Durham, NC, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Limited evidence is available regarding the benefit and hazard
of higher-intensity treatment to lower lipid levels among patients 75
years or older. As a result, guideline recommendations differ for this age
group compared with younger patients. <br/>Objective(s): To determine the
effect on outcomes and risks of combination ezetimibe and simvastatin
compared with simvastatin monotherapy to lower lipid levels among patients
75 years or older with stabilized acute coronary syndrome (ACS). Design,
Setting, Participants: In this prespecified secondary analysis of the
global, multicenter, prospective clinical randomized Improved Reduction of
Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), outcomes and
risks were compared by age among patients 50 years or older after a
hospitalization for ACS. Data were collected from October 26, 2005,
through July 8, 2010, with the database locked October 21, 2014. Data were
analyzed May 29, 2015, through March 13, 2018, using Kaplan-Meier curves
and Cox proportional hazards models. <br/>Intervention(s): Double-blind
randomized assignment to combined simvastatin and ezetimibe or simvastatin
and placebo with follow-up for a median of 6 years (interquartile range,
4.3-7.1 years). <br/>Main Outcomes and Measures: The primary composite end
point consisted of death due to cardiovascular disease, myocardial
infarction (MI), stroke, unstable angina requiring hospitalization, and
coronary revascularization after 30 days. Individual adverse ischemic and
safety end points and lipid variables were also analyzed. <br/>Result(s):
Of 18144 patients enrolled (13 728 men [75.7%]; mean [SD] age, 64.1 [9.8]
years), 5173 (28.5%) were 65 to 74 years old, and 2798 (15.4%) were 75
years or older at randomization. Treatment with simvastatin-ezetimibe
resulted in lower rates of the primary end point than simvastatin-placebo,
including 0.9% for patients younger than 65 years (HR, 0.97; 95% CI,
0.90-1.05) and 0.8% for patients 65 to 74 years of age (hazard ratio [HR],
0.96; 95% CI, 0.87-1.06), with the greatest absolute risk reduction of
8.7% for patients 75 years or older (HR, 0.80; 95% CI, 0.70-0.90) (P =.02
for interaction). The rate of adverse events did not increase with
simvastatin-ezetimibe vs simvastatin-placebo among younger or older
patients. <br/>Conclusions and Relevance: In IMPROVE-IT, patients
hospitalized for ACS derived benefit from higher-intensity therapy to
lower lipid levels with simvastatin-ezetimibe compared with simvastatin
monotherapy, with the greatest absolute risk reduction among patients 75
years or older. Addition of ezetimibe to simvastatin was not associated
with any significant increase in safety issues among older patients. These
results may have implications for guideline recommendations regarding
lowering of lipid levels in the elderly. Trial Registration:
ClinicalTrials.gov identifier: NCT00202878.<br/>Copyright &#xa9; 2019
American Medical Association. All rights reserved.

<7>
Accession Number
629385587
Title
Complex interaction of obesity, intentional weight loss and heart failure:
A systematic review and meta-analysis.
Source
Heart. (no pagination), 2019. Date of Publication: 2019.
Author
Mahajan R.; Stokes M.; Elliott A.; Munawar D.A.; Khokhar K.B.;
Thiyagarajah A.; Hendriks J.; Linz D.; Gallagher C.; Kaye D.; Lau D.;
Sanders P.
Institution
(Mahajan, Stokes, Elliott, Munawar, Khokhar, Thiyagarajah, Hendriks, Linz,
Gallagher, Lau, Sanders) Centre for Heart Rhythm Disorders, University of
Adelaide, Adelaide, SA, Australia
(Mahajan) Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale,
SA, Australia
(Stokes, Elliott, Munawar, Khokhar, Thiyagarajah, Hendriks, Linz,
Gallagher, Lau, Sanders) Department of Cardiology, Royal Adelaide
Hospital, Adelaide, SA, Australia
(Kaye) Department of Cardiology, Alfred Hospital, Melbourne, VIC,
Australia
(Kaye) Heart Research, Baker IDI Heart and Diabetes Institute, Melbourne,
VIC, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: The aim of the meta-analysis was to determine the association
of obesity and heart failure (HF) and the cardiac impact of intentional
weight loss following bariatric surgery on cardiac structure and
myocardial function in obese subjects. <br/>Method(s): MEDLINE, Embase and
Web of Science were searched up to 3 April 2018. Studies reporting
association and prognostic impact of obesity in HF and the impact of
intentional weight loss following bariatric surgery on cardiac structure
and myocardial function in obesity were included in the meta-analysis.
<br/>Result(s): 4959 citations were reviewed. After exclusions, 29 studies
were analysed. A a J curve' relationship was observed between body mass
index (BMI) and risk of HF with maximum risk in the morbidly obese (1.73
(95% CI 1.30 to 2.31), p<0.001, n=11). Although a obesity paradox' was
observed for all-cause mortality, the overweight group was associated with
lower cardiovascular (CV) mortality (OR=0.86 (95% CI 0.79 to 0.94), n=11)
with no significant differences across other BMI groups. Intentional
weight loss induced by bariatric surgery in obese patients (n=9) without
established HF, atrial fibrillation or known coronary artery disease, was
associated with a reduction in left ventricular mass index (p<0.0001),
improvement in left ventricular diastolic function (p<=0.0001) and a
reduction in left atrial size (p=0.02). <br/>Conclusion(s): Despite the
increased risk of HF with obesity, an a obesity paradox' is observed for
all-cause mortality. However, the nadir for CV mortality is observed in
the overweight group. Importantly, intentional weight loss was associated
with improvement in indices of cardiac structure and myocardial function
in obese patients. Trial registration number: APP 74412.<br/>Copyright
&#xa9; Author(s) (or their employer(s)) 2019. No commercial re-use. See
rights and permissions. Published by BMJ.

<8>
Accession Number
624533182
Title
Anaemia and mortality in patients with transcatheter aortic valve
replacement: a systematic review and meta-analysis.
Source
Acta Cardiologica. (no pagination), 2018. Date of Publication: 2018.
Author
Kanjanahattakij N.; Rattanawong P.; Krishnamoorthy P.; Sirinvaravong N.;
Chongsathidkiet P.; Lapumnuaypol K.; George J.C.; Witzke C.; Figueredo
V.M.
Institution
(Kanjanahattakij, Sirinvaravong, Lapumnuaypol) Department of Medicine,
Einstein Medical Center, Philadelphia, PA, United States
(Rattanawong) University of Hawaii Internal Medicine Residency Program,
Honolulu, HI, United States
(Krishnamoorthy, George, Witzke, Figueredo) Division of Cardiology,
Department of Medicine, Einstein Medical Center, Philadelphia, PA, United
States
(Chongsathidkiet) Department of Pathology, Duke University Medical Center,
Durham, NC, United States
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Objective: This study was done to determine the relationship between
pre-procedural anaemia and mortality post transcatheter aortic valve
replacement (TAVR). Introduction: TAVR is now a treatment option for
patients with severe aortic stenosis (AS) with high surgical risk. Anaemia
is a common comorbidity in the TAVR population. Small studies have
suggested that anaemia is associated with worse short-term and long-term
mortality in patients who underwent TAVR. However, there are no
meta-analyses to further assess this association. <br/>Method(s): Studies
were systematically searched from electronic databases (EMBASE and
MEDLINE). Inclusion criteria were adult population with aortic stenosis
who underwent TAVR, and number of patients with pre-procedural anaemia
reported. Outcomes were short-term mortality or long-term mortality.
Pooled effect size was calculated with a random-effect model, weighted for
the inverse of variance. Heterogeneity was assessed with I².
<br/>Result(s): Six studies were included in the final analysis. Of these,
pooled analysis of four studies examining association between anaemia and
30-day mortality did not show a statistically significant relationship. A
pooled analysis of four studies examining the association of anaemia and
long-term mortality after TAVR showed pooled adjusted risk ratio (RR) of
1.43, 95% CI 1.22-1.67 with low heterogeneity (I² = 33%).
Subgroup analysis after exclusion of one smaller study showed that the
association remained significant (RR 1.41, 95% CI 1.27-1.56) with
decreased heterogeneity (I² = 0%). <br/>Conclusion(s): This
systematic review and meta-analysis found an association between
pre-procedural anaemia and increased long-term but not short-term
mortality after TAVR. Further study of the pathophysiology underlying this
association is needed.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Belgian
Society of Cardiology.

<9>
Accession Number
629386773
Title
Systematic review of surgical wound class reveals marked service-related
discrepancies and can improve appropriateness of classifcation impacting
the expected number of infections and the Standardized Infection Ratio
(SIR).
Source
Open Forum Infectious Diseases. Conference: Infectious Diseases Week, ID
Week 2018. United States. 5 (Supplement 1) (pp S629), 2018. Date of
Publication: November 2018.
Author
Abuihmoud A.; Linchangco P.; Wise E.; Boldyga A.; Nachman K.; Gomez B.T.;
Parada J.P.
Institution
(Abuihmoud, Linchangco, Wise, Boldyga, Nachman, Gomez, Parada) Loyola
University Medical Center, Maywood, IL, United States
Publisher
Oxford University Press
Abstract
Background. During surgical operations, surgical wounds are classifed
according to the wound classifcation system (I-clean;
II-clean/contaminated; III-contaminated; and IV-dirty). Accuracy in
assessing the degree of wound contamination is crucial since it greatly
impacts the risk of a surgical site infection (SSI). Tus, wound
classifcations (WC) are determinant in calculating the expected number of
SSIs. At our institution we suspected that surgical wounds were not always
accurately classifed, and were skewed toward under-classifying wound
class. Tis contributed to incorrect and reduced expected SSIs and an
infated SSI Standardized Infection Ratio (SIR). Methods. An independent
team reviewed 273 surgical cases from our top priority SSI reduction
areas: Prosthetic knees (KPRO), coronary artery bypass grafs (CABG),
abdominal hysterectomies (HYST) and colorectal surgery (COLO). Whenever
there was discordance in surgeon vs. review team WC, an arbitrator
reviewed the case with the surgeon and corrected misclassifed cases as
appropriate. Reclassifcations were documented in the medical record as
well as in the National Healthcare Safety Network (NHSN) system. Results.
Figure 1 shows all WC reviews. Overall, 14% of all surgeries were
mis-classifed and 95% of misclassifcations were under-classifcations.
Appropriateness of WC varied widely by surgical service, with 100%
concordant WC for KPRO, while 9% of HYST and CABG were misclassifed, and
fully 38% of COLOs were misclassifed (Figure 1). Tese errors led to under
predicting expected SSIs and, if not corrected, would have a measurable
impact on our SSI SIR. Conclusion. The inaccurate classifcations vary by
service/surgery but in COLO we found them to be common and overwhelmingly
skewed toward under-classifca-tion, which had a measurable impact on the
number of expected SSIs and on SSI SIR. Focusing eforts on surgeries more
prone to misclassifcation (such as COLO rather than KPRO) may be a
worthwhile focused quality improvement efort.

<10>
Accession Number
629395564
Title
Standard restrictive sternal precautions and modified sternal precautions
had similar effects in people after cardiac surgery via median sternotomy
('SMART' Trial): a randomised trial.
Source
Journal of physiotherapy. 64 (2) (pp 97-106), 2018. Date of Publication:
01 Apr 2018.
Author
Katijjahbe M.A.; Granger C.L.; Denehy L.; Royse A.; Royse C.; Bates R.;
Logie S.; Nur Ayub M.A.; Clarke S.; El-Ansary D.
Institution
(Katijjahbe) Department of Physiotherapy, The University of Melbourne,
Australia; Department of Physiotherapy, Hospital Canselor Tunku Mukhriz,
University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
(Granger) Department of Physiotherapy, The University of Melbourne,
Australia; Physiotherapy Department, Royal Melbourne Hospital, Australia
(Denehy) Department of Physiotherapy, University of Melbourne, Australia
(Royse) Department of Surgery, The University of Melbourne, Australia;
Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Australia
(Royse) Department of Surgery, The University of Melbourne, Australia;
Department of Anaesthesia, Royal Melbourne Hospital, Australia
(Bates) Physiotherapy Department, Royal Melbourne Hospital, Australia
(Logie) Physiotherapy Department, Melbourne Private Hospital, Australia
(Nur Ayub) Heart and Lung Centre, University Kebangsaan Malaysia Medical
Centre, Kuala Lumpur, Malaysia
(Clarke) Statistical Consulting Centre, School of Mathematics and
Statistics, University of Melbourne, Australia
(El-Ansary) Department of Physiotherapy, The University of Melbourne,
Australia; Department of Surgery, The University of Melbourne, Australia;
Department of Health Professions, Swinburne University, Melbourne,
Australia
Publisher
NLM (Medline)
Abstract
QUESTION: In people who have undergone cardiac surgery via median
sternotomy, does modifying usual sternal precautions to make them less
restrictive improve physical function, pain, kinesiophobia and
health-related quality of life? DESIGN: Two-centre, randomised, controlled
trial with concealed allocation, blinded assessors and intention-to-treat
analysis. PARTICIPANTS: Seventy-two adults who had undergone cardiac
surgery via a median sternotomy were included. INTERVENTION: Participants
were randomly allocated to one of two groups at 4 (SD 1) days after
surgery. The control group received the usual advice to restrict their
upper limb use for 4 to 6 weeks (ie, restrictive sternal precautions). The
experimental group received advice to use pain and discomfort as the safe
limits for their upper limb use during daily activities (ie, less
restrictive precautions) for the same period. Both groups received
postoperative individualised education in hospital and via weekly
telephone calls for 6 weeks. OUTCOME MEASURES: The primary outcome was
physical function assessed by the Short Physical Performance Battery.
Secondary outcomes included upper limb function, pain, kinesophobia, and
health-related quality of life. Outcomes were measured before hospital
discharge and at 4 and 12 weeks postoperatively. Adherence to sternal
precautions was recorded. <br/>RESULT(S): There were no statistically
significant differences in physical function between the groups at 4 weeks
(MD 1.0, 95% CI -0.2 to 2.3) and 12 weeks (MD 0.4, 95% CI -0.9 to 1.6)
postoperatively. There were no statistically significant between-group
differences in secondary outcomes. <br/>CONCLUSION(S): Modified (ie, less
restrictive) sternal precautions for people following cardiac surgery had
similar effects on physical recovery, pain and health-related quality of
life as usual restrictive sternal precautions. Similar outcomes can be
anticipated regardless of whether people following cardiac surgery are
managed with traditional or modified sternal precautions. TRIAL
REGISTRATION: Australian and New Zealand Clinical Trials Registry
ANZCTRN12615000968572. [Katijjahbe MA, Granger CL, Denehy L, Royse A,
Royse C, Bates R, Logie S, Nur Ayub MA, Clarke S, El-Ansary D (2018)
Standard restrictive sternal precautions and modified sternal precautions
had similar effects in people after cardiac surgery via median sternotomy
('SMART' Trial): a randomised trial. Journal of Physiotherapy 64:
97-106].<br/>Crown Copyright &#xa9; 2018. Published by Elsevier B.V. All
rights reserved.

<11>
Accession Number
2002942924
Title
Frequency and impact of incidental findings on computed tomography during
work-up for transcatheter aortic valve implantation: Single centre
experience and review of the literature.
Source
British Journal of Radiology. 92 (1102) (no pagination), 2019. Article
Number: 20190344. Date of Publication: 2019.
Author
Hinton J.; Gough S.; Ahmed H.; Gabara L.; Rawlins J.; Calver A.; Shah
B.N.; Rakhit D.; Shambrook J.; Harden S.; Peebles C.; Abbas A.; Curzen N.
Institution
(Hinton, Gough, Ahmed, Gabara, Rawlins, Calver, Shah, Rakhit, Curzen)
Coronary Research Group, University Hospital Southampton, NHS Foundation
Trust, United Kingdom
(Hinton, Curzen) Faculty of Medicine, University of Southampton, United
Kingdom
(Shambrook, Harden, Peebles, Abbas) Cardiothoracic Radiology, University
Hospital Southampton, NHS Foundation Trust, United Kingdom
Publisher
British Institute of Radiology (E-mail: publications@bir.org.uk)
Abstract
Objective: To assess the frequency and impact of incidental findings (IF)
on CT during work-up for transcatheter aortic valve intervention (TAVI).
<br/>Method(s): A consecutive cohort of patients referred for
consideration of TAVI who underwent a CT scan between 2009 and 2018 were
studied retrospectively. CT reports were reviewed for the presence of IFs
and categorised based upon their clinical significance: (a) insignificant
- findings that did not require specific treatment or follow-up; (b)
intermediate - findings that did not impact on the decision-making process
but required follow-up; (c) significant - findings that either required
urgent investigation or meant that TAVI was clinically inappropriate.
<br/>Result(s): A total of 652 patients were included, whose median age
was 82 years. One or more insignificant IF was found in 95.6% of patients.
Intermediate IFs were documented in 5.4%. 91 (14%) patients had at least
one significant IF. These included possible malignancy in 67 (74%). The
ultimate decision to offer aortic valve intervention was only changed by
the presence of an IF in 3.5% of cases. <br/>Conclusion(s): Clinically
significant IFs are detected in more than 1 in 10 of patients undergoing
CT as part of a TAVI work-up, although just over half of these patients
still receive aortic valve intervention. Advances in knowledge: This study
is the largest UK cohort, which, when combined with a review of existing
literature, provides a clear picture of the frequency and clinical impact
of IFs found at CT for TAVI assessment.<br/>Copyright &#xa9; 2019 The
Authors.

<12>
Accession Number
629366089
Title
Antithrombotic therapy for atrial fibrillation with stable coronary
disease.
Source
New England Journal of Medicine. 381 (12) (pp 1103-1113), 2019. Date of
Publication: 19 Sep 2019.
Author
Yasuda S.; Kaikita K.; Akao M.; Ako J.; Matoba T.; Nakamura M.; Miyauchi
K.; Hagiwara N.; Kimura K.; Hirayama A.; Matsui K.; Ogawa H.
Institution
(Yasuda, Ogawa) National Cerebral and Cardiovascular Center, Suita, Japan
(Hirayama) Department of Cardiology, Osaka Police Hospital, Osaka, Japan
(Kaikita) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, Kumamoto, Japan
(Matsui) Department of General Medicine, Kumamoto University Hospital,
Kumamoto, Japan
(Akao) Department of Cardiology, National Hospital Organization, Kyoto
Medical Center, Kyoto, Japan
(Ako) Department of Cardiovascular Medicine, Kitasato University, School
of Medicine, Sagamihara, Japan
(Matoba) Department of Cardiovascular Medicine, Kyushu University
Hospital, Fukuoka, Japan
(Nakamura) Division of Cardiovascular Medicine, Toho University, Ohashi
Medical Center, Tokyo, Japan
(Miyauchi) Department of Cardiology, Juntendo University, School of
Medicine, Tokyo, Japan
(Hagiwara) Department of Cardiology, Tokyo Women's Medical University,
Tokyo, Japan
(Kimura) Cardiovascular Center, Yokohama City University Medical Center,
Yokohama, Japan
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND There are limited data from randomized trials evaluating the
use of antithrombotic therapy in patients with atrial fibrillation and
stable coronary artery disease. METHODS In a multicenter, open-label trial
conducted in Japan, we randomly assigned 2236 patients with atrial
fibrillation who had undergone percutaneous coronary intervention (PCI) or
coronary-artery bypass grafting (CABG) more than 1 year earlier or who had
angiographically confirmed coronary artery disease not requiring
revascularization to receive monotherapy with rivaroxaban (a non-vitamin K
antagonist oral anticoagulant) or combination therapy with rivaroxaban
plus a single antiplatelet agent. The primary efficacy end point was a
composite of stroke, systemic embolism, myocardial infarction, unstable
angina requiring revascularization, or death from any cause; this end
point was analyzed for noninferiority with a noninferiority margin of
1.46. The primary safety end point was major bleeding, according to the
criteria of the International Society on Thrombosis and Hemostasis; this
end point was analyzed for superiority. RESULTS The trial was stopped
early because of increased mortality in the combination-therapy group.
Rivaroxaban monotherapy was noninferior to combination therapy for the
primary efficacy end point, with event rates of 4.14% and 5.75% per
patient-year, respectively (hazard ratio, 0.72; 95% confidence interval
[CI], 0.55 to 0.95; P<0.001 for noninferiority). Rivaroxaban monotherapy
was superior to combination therapy for the primary safety end point, with
event rates of 1.62% and 2.76% per patient-year, respectively (hazard
ratio, 0.59; 95% CI, 0.39 to 0.89; P=0.01 for superiority). CONCLUSIONS As
antithrombotic therapy, rivaroxaban monotherapy was noninferior to
combination therapy for efficacy and superior for safety in patients with
atrial fibrillation and stable coronary artery disease.<br/>Copyright
&#xa9; 2019 Massachusetts Medical Society.

<13>
Accession Number
629357328
Title
Tranexamic acid in cardiac surgery: A systematic review and meta-analysis
(protocol).
Source
BMJ Open. 9 (9) (no pagination), 2019. Article Number: e028585. Date of
Publication: 01 Sep 2019.
Author
Alaifan T.; Alenazy A.; Wang D.X.; Fernando S.M.; Spence J.; Belley-Cote
E.; Fox-Robichaud A.; Ainswoth C.; Karachi T.; Kyeremanteng K.;
Zarychanski R.; Whitlock R.; Rochwerg B.
Institution
(Alaifan, Alenazy, Fox-Robichaud, Karachi, Rochwerg) Department of
Medicine Critical Care, McMaster University, Hamilton, ON, Canada
(Wang) Schulich School of Medicine and Dentistry, University of Western,
London, ON, Canada
(Fernando) Division of Critical Care, Department of Medicine, University
of Ottawa, Ottawa, ON, Canada
(Spence) Departments of Anesthesia and Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
(Spence, Belley-Cote, Whitlock) Population Health Research Institute,
McMaster University, Hamilton, ON, Canada
(Belley-Cote, Ainswoth) Department of Medicine Critical Care, Cardiology,
McMaster University, Hamilton, ON, Canada
(Belley-Cote, Whitlock) Department of Health Research Methods Evidence and
Impact, McMaster University, Hamilton, ON, Canada
(Kyeremanteng) Critical Care, University of Ottawa, Faculty of Medicine,
Ottawa, ON, Canada
(Kyeremanteng) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Zarychanski) Department of Internal Medicine, Sections of Critical Care
Medicine and of Hematology/Medical Oncology, University of Manitoba,
Winnipeg, MB, Canada
(Whitlock) Department of Surgery, Division of Cardiac Surgery, McMaster
University, Hamilton, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Bleeding during cardiac surgery is associated with increased
morbidity and mortality. Tranexamic acid is an antifibrinolytic with
proven efficacy in major surgeries. Current clinical practice guidelines
recommend intraoperative use in cardiac procedures. However, several
complications have been reported with tranexamic acid including seizures.
This review intends to summarise the evidence examining the efficacy and
safety of tranexamic acid in patients undergoing cardiac surgery.
Methods/design We will search MEDLINE, Embase, PubMED, ACPJC, CINAHL and
the Cochrane trial registry for eligible randomised controlled trials, the
search dates for all databases will be from inception until 1 January
2019, investigating the perioperative use of topical and/or intravenous
tranexamic acid as a stand-alone antifibrinolytic agent compared with
placebo in patients undergoing open cardiac surgery. We categorised
outcomes as patient critical or patient important. Selected
patient-critical outcomes are: mortality (intensive care unit, hospital
and 30-day endpoints), reoperation within 24 hours, postoperative bleeding
requiring transfusion of packed red blood cells, myocardial infarction,
stroke, pulmonary embolism, bowel infarction, upper or lower limb deep
vein thrombosis and seizures. Those outcomes, we perceived as clinical
experts to be most patient valued and patients were not involved in
outcomes selection process. We will not apply publication date, language,
journal or methodological quality restrictions. Two reviewers will
independently screen and identify eligible studies using predefined
eligibility criteria and then review full reports of all potentially
relevant citations. A third reviewer will resolve disagreements if
consensus cannot be achieved. We will present the results as relative risk
with 95% CIs for dichotomous outcomes and as mean difference or
standardised mean difference for continuous outcomes with 95% CIs. We will
assess the quality of evidence using the Grading of Recommendations,
Assessment, Development and Evaluation approach. Ethics and dissemination
Formal ethical approval is not required as primary data will not be
collected. The results will be disseminated through a peer-reviewed
publication Trial registration number CRD42018105904.<br/>Copyright &#xa9;
2019 Author(s).

<14>
Accession Number
629394526
Title
An In-hospital Mortality Risk Model for Patients Undergoing Coronary
Artery Bypass Grafting in China.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 18 Sep 2019.
Author
Hu Z.; Chen S.; Du J.; Gu D.; Wang Y.; Hu S.; Zheng Z.
Institution
(Hu, Chen, Du, Gu, Hu, Zheng) Department of Cardiovascular Surgery, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
(Wang) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, MA, US. Center for Outcomes Research and Evaluation, Yale New
Haven Health, CT, Boston, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: To meet the demand of increasing surgical volume and changing
of patient's risk profiles of coronary artery bypass grafting in China, we
develop a new risk model that predicts in-hospital mortality.
<br/>METHOD(S): The analysis included patients who underwent coronary
artery bypass grafting between January 2013 and December 2016 at 87
hospitals in the Chinese Cardiac Surgery Registry. Patients in years
2013-2015 were randomly divided into training (n=31297, 75%) and test
(n=10432, 25%) samples; 2016 patients (n=15047) comprised the validation
sample. Demographic and clinical risk factors were identified . Harrell's
C-statistic was used to evaluate model discrimination, and the
Hosmer-Lemeshow goodness-of-fit test was used to assess calibration.
<br/>RESULT(S): The 56776 patients had a mean age of 61.8 (standard
deviation 8.8) years, and 24.6% were female. Overall, in-hospital
mortality was 2.1%. The final model included 21 risk factors represented
by 16 unique variables. The model achieved good discrimination, with a
C-statistic of 0.79 (95% CI 0.77-0.80) in the training sample, 0.79 (95%
CI 0.76-0.82) in the test sample, and0.78 (95% CI 0.76-0.81) in the
validation sample. Model calibration was good according to the
Hosmer-Lemeshow test (P>0.05 in the three samples). When compared with the
SinoSCORE and EuroSCORE II, the model had better discrimination and
calibration. <br/>CONCLUSION(S): We developed and evaluated a model with
16 risk factors that predicted in-hospital mortality risk after coronary
artery bypass grafting in China. This updated model may help surgeons and
hospitals better identify high-risk patient.<br/>Copyright &#xa9; 2019.
Published by Elsevier Inc.

<15>
Accession Number
2002932867
Title
A Comparison of the Arterial Blood Concentration of Isoflurane During
Cardiopulmonary Bypass Between 2 Polypropylene Oxygenators.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Alston R.P.; Kitchen C.; McKenzie C.; Homer N.
Institution
(Alston, McKenzie) Department of Anaesthesia, Critical Care and Pain
Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
(Kitchen) School of Medicine and Veterinary Medicine, University of
Edinburgh, Edinburgh, United Kingdom
(Homer) Clinical Research Facility Mass Spectrometry Core Centre for
Cardiovascular Research, Queens Medical Research Institute, University of
Edinburgh, Edinburgh, United Kingdom
Publisher
W.B. Saunders
Abstract
Objective: The primary objective was to compare arterial blood
concentration of isoflurane during cardiopulmonary bypass (CPB) between 2
polypropylene oxygenators of different designs. Secondary objectives were
to compare levels of Bispectral Index Score (BIS) during CPB between the 2
oxygenators and to examine the relationships between oxygenator exhaust
and arterial blood concentrations of isoflurane and BIS. <br/>Design(s):
Single, blinded, randomized control trial. <br/>Setting(s): Teaching
hospital. <br/>Participant(s): Twenty-five patients undergoing cardiac
surgery with CPB. <br/>Intervention(s): Subjects were randomly assigned
(1:1) to Inspire 8F (Sorin) or Affinity Fusion (Medtronic) oxygenators.
<br/>Measurements and Main Results: The mean arterial blood concentration
in the Inspire 8F (Sorin) group was 59 (standard deviation [SD] 23)
micro&#32;g/mL, compared with 53 (SD 17) micro&#32;g/mL in the Affinity
Fusion (Medtronic) group with a nonsignificant mean difference of 6 (95%
confidence interval = -11, 22) micro&#32;g/mL (t[23] = 0.676, p = 0.50).
No significant difference in BIS was found between the groups (p = 0.896).
Moderate and strong, negative correlations respectively, were found
between arterial and oxygenator exhaust correlations and BIS (r = -0.472,
p < 0.05; r = -0.812, p < 0.001). A strong, positive correlation was found
between arterial and exhaust isoflurane concentration (r = 0.810, p <
0.0005). <br/>Conclusion(s): No significant difference in arterial blood
concentration of isoflurane or BIS was found between the Inspire 8F
(Sorin) and Affinity Fusion (Medtronic) oxygenators. A significant
positive correlation was found between arterial blood and oxygenator
exhaust concentrations of isoflurane, as well as significant negative
correlations between both arterial and oxygenator exhaust concentrations
of isoflurane and BIS.<br/>Copyright &#xa9; 2019

<16>
Accession Number
2002932577
Title
Official statement of the Spanish society of pulmonology and thoracic
surgery (SEPAR) on electronic cigarettes and IQOS.
Source
Archivos de Bronconeumologia. (no pagination), 2019. Date of Publication:
2019.
Author
Signes-Costa J.; de Granda-Orive J.I.; Pinedo A.R.; Escrig A.C.; Martinez
E.D.H.; Castedo C.R.; Cesar E.C.; Jimenez-Ruiz C.A.
Institution
(Signes-Costa) Servicio de Neumologia, Hospital Clinico Universitario
INCLIVA, Universidad de Valencia, Valencia, Spain
(de Granda-Orive) Servicio de Neumologia Hospital Universitario 12 de
Octubre, Universidad Complutense, Madrid, Spain
(Pinedo, Martinez) Unidad de Neumologia, Hospital Universitario Fundacion
Alcorcon, Universidad Rey Juan Carlos, Madrid, Spain
(Escrig) Unidad de Neumologia, Hospital Universitario del Vinalopo, Elche,
Spain
(Castedo) Servicio de Neumologia, Complejo Hospitalario de Santiago de
Compostela, Santiago de Compostela, Spain
(Cesar) Servicio de Neumologia, Hospital Universitario Virgen de la
Victoria, Malaga, Spain
(Jimenez-Ruiz) Unidad Especializada en Tabaquismo, Hospital Clinico San
Carlos, Madrid, Spain
Publisher
Elsevier Doyma
Abstract
The use of novel tobacco products, particularly the electronic cigarette
(EC) and partial tobacco combustion devices (HnB systems: Heat not Burn),
has increased exponentially, particularly among adolescents and young
people. The health authorities and scientific societies have shown concern
about issues surrounding safety and effectiveness (as a method of smoking
cessation). A study of the available scientific evidence has concluded
that the safety of the vapor or fumes inhaled by the users of these
devices cannot be guaranteed. Contradictory results from various clinical
trials and meta-analyses also mean that these devices cannot be
recommended for their effectiveness in cessation, especially when safe and
effective treatments are available to help quit smoking (varenicline,
nicotine replacement therapy, and bupropion, combined with psychological
counseling).<br/>Copyright &#xa9; 2019 SEPAR

<17>
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). <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2018 The American Association for
Thoracic Surgery

<18>
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.
<br/>Objective(s): This study sought to perform a meta-analysis of
randomized controlled trials (RCTs) comparing TAVR versus SAVR in low-risk
patients. <br/>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). <br/>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. <br/>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.<br/>Copyright &#xa9; 2019
American College of Cardiology Foundation

<19>
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. <br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2019 The American
Association for Thoracic Surgery

<20>
Accession Number
622826738
Title
What surgeons should know about non-Vitamin K oral anticoagulants a
review.
Source
JAMA Surgery. 153 (6) (pp 577-585), 2018. Date of Publication: June 2018.
Author
Verma A.; Ha A.C.T.; Rutka J.T.; Verma S.
Institution
(Ha) Department of Medicine, University of Toronto, Toronto, ON, Canada
(Verma, Rutka, Verma) Department of Surgery, University of Toronto, 30
Bond St, Toronto, ON M5B 1W8, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Non-vitamin K oral anticoagulants (NOACs) are increasingly
prescribed for patients to treat or prevent arterial or venous
thromboembolism. The following 4 NOAC agents are approved by the US Food
and Drug Administration for clinical use: dabigatran etexilate, apixaban,
edoxaban tosylate, and rivaroxaban. A good understanding of these agents'
pharmacologic properties is important for surgeons given their marked
differences compared with warfarin sodium. This review highlights key
practical issues surrounding the use of NOACs in the perioperative
setting. OBSERVATIONS The PubMed and Cochrane Library databases were
searched for English-language studies from May 1, 2009, until May 1, 2017,
for randomized clinical trials, meta-analyses, systematic reviews,
observational studies, and clinical guidelines. From a systematic review
of the published literature that included 70 articles and 166 404
patients, this study identified 5 key practical issues surrounding the use
of NOACs in the perioperative setting. These include patient populations
for which NOAC use is indicated and contraindicated, the timing of NOAC
treatment cessation before invasive interventions, management of
NOAC-treated patients requiring urgent interventions, the need for
"bridging," and the timing of NOAC treatment's reinitiation after invasive
interventions. Important findings are as follows: NOAC agents are not
recommended for patients with mechanical heart valves or advanced kidney
disease (creatinine clearance, <15 mL/min); minimal to no anticoagulant
effect remains when therapy with a NOAC is withheld for 48 to 72 hours
before surgery in the context of normal kidney function; a reversal agent
is clinically available for dabigatran, while reversal agents for
apixaban, edoxaban, and rivaroxaban are under regulatory review; and
laboratory testing of the anticoagulant effects of NOACs are not routinely
available. There is a paucity of high-quality data on the optimal timing
of NOAC cessation and resumption in the perioperative period, particularly
for patients who undergo procedures with high bleeding risk. CONCLUSIONS
AND RELEVANCE The anticoagulant effect of NOAC agents is predictable but
not readily measurable in routine clinical practice. A number of
uncertainties remain surrounding the use of these agents in the
perioperative setting. Ongoing prospective studies and randomized clinical
trials will provide greater clarity on these management issues in the near
future.<br/>Copyright &#xa9; 2018 American Medical Association. All rights
reserved.

<21>
Accession Number
2002924070
Title
Role of topical vancomycinin reduction of sternal wound infection in
patients undergoing cardiac surgery.
Source
Medical Forum Monthly. 30 (7) (pp 83-86), 2019. Date of Publication: 2019.
Author
Khan I.A.; Jalal-Ud-Din; Ehsanullah S.
Institution
(Khan) Department of Cardiac Surgery, Sandeman Provincial Hospital,
Quetta, Pakistan
(Jalal-Ud-Din) Department of Cardiology, Boland Medical Complex Hospital
Quetta, Pakistan
(Ehsanullah) Department of Medicine, Boland Medical Complex Hospital,
Quetta, Pakistan
Publisher
Medical Forum Monthly (Gujjar Singh, Lahore 5460, Pakistan)
Abstract
Objective: To examine the effectiveness of topical vancomycin to reduce
the rate of wound infection in patients undergoing open heart surgery.
<br/>Study Design: Randomized controlled trial. Place and Duration of
Study: This study was conducted at the Department of Cardiac Surgery,
Sandeman Provincial Hospital Quetta from June 2018 to December 2018.
<br/>Material(s) and Method(s): One hundred and eighty patients of both
genders undergoing open heart surgery were included in this study. Patient
ages ranged from 40 to 70 years. All the patients were divided into two
groups. Group I consistedof 90 patients and received topical
vancomycinpaste on the sternal wound, Group II also consisted of 90
patients who received topical normal saline before sternal wound closure.
The rate of sternal wound infection was examined. <br/>Result(s): There
were 133 (73.89%) males and 26.11% females. Patients who received
vancomycin had less superficial and deep sternal wound infections than the
patients who didn't received vancomycin (2.22% vs 6.67%) and (1.11% vs
4.4%). <br/>Conclusion(s): The use of vancomycin paste to the sternal
edges with perioperative antibiotics helps to reduce the sternal wound
infection rate.<br/>Copyright &#xa9; 2019 Medical Forum Monthly. All
rights reserved.

<22>
Accession Number
2002507302
Title
Visceral bed involvement in thromboangiitis obliterans: A systematic
review.
Source
Vascular Health and Risk Management. 15 (pp 317-353), 2019. Date of
Publication: 2019.
Author
Fakour F.; Fazeli B.
Institution
(Fakour) Immunology and Microbiology Department, Mashhad Azad University
of Medical Sceinces, Mashhad, Iran, Islamic Republic of
(Fazeli) Immunology Research Center, Inflammation and Inflammatory
Diseases Division, Immunology Department, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Fazeli) Vascular Independent Research and Education, European Foundation,
Department of Angiology, L. Sacco Hospital, Milan, Italy
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
One of the challenges of thromboangiitis obliterans (TAO) management is in
the patients whose other vascular beds are involved and it remains a
challenge to know whether to pursue invasive procedures or to continue
medical treatment for such TAO patients. The aim of this review was to
investigate reports of the involvement of the visceral vessels in TAO and
the related clinical manifestations, management approaches and outcomes.
According to our systematic review, the frequency of published articles,
the organs most commonly involved were the gastrointestinal tract, the
heart, the central nervous system, the eye, the kidneys, the urogenital
system, the mucocutaneous zones, joints, lymphohematopoietic system and
the ear. Notably, reports of the involvement of almost all organs have
been made in relation to TAO. There were several reports of TAO
presentation in other organs before disease diagnosis, in which the
involvement of the extremities presented after visceral involvement. The
characteristics of the visceral arteries looked like the arteries of the
extremities according to angiography or aortography. Also, in autopsies of
TAO patients, the vascular involvement of multiple organs has been noted.
Moreover, systemic medical treatment could lead to the recovery of the
patient from the onset of visceral TAO. This study reveals that TAO may be
a systemic disease and patients should be aware of the possible
involvement of other organs along with the attendant warning signs. Also,
early systemic medical treatment of such patients may lead to better
outcomes and reduce the overall mortality rate.<br/>Copyright &#xa9; 2019
Fakour and Fazeli.

<23>
Accession Number
627030890
Title
Improving coronary artery bypass grafting: a systematic review and
meta-analysis on the impact of adopting transit-time flow measurement.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (4) (pp 654-663),
2019. Date of Publication: 01 Oct 2019.
Author
Thuijs D.J.F.M.; Bekker M.W.A.; Taggart D.P.; Kappetein A.P.; Kieser T.M.;
Wendt D.; Di Giammarco G.; Trachiotis G.D.; Puskas J.D.; Head S.J.
Institution
(Thuijs, Bekker, Kappetein, Head) Department of Cardiothoracic Surgery,
Erasmus MC, University Medical Centre, Rotterdam, Netherlands
(Taggart) Department of Cardiovascular Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, United Kingdom
(Kieser) Division of Cardiac Surgery, Department of Cardiac Sciences,
Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary,
Canada
(Wendt) Department of Thoracic and Cardiovascular Surgery, West German
Heart and Vascular Centre, University of Duisburg-Essen, Duisburg, Germany
(Di Giammarco) Department of Cardiac Surgery, Chieti, Italy
(Trachiotis) Department of Cardiothoracic Surgery, Veterans Affairs
Medical Centre, DC, WA, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Saint Luke's,
NY, NY, United States
Publisher
NLM (Medline)
Abstract
Despite there being numerous studies of intraoperative graft flow
assessment by transit-time flow measurement (TTFM) on outcomes after
coronary artery bypass grafting (CABG), the adoption of contemporary TTFM
is low. Therefore, on 31 January 2018, a systematic literature search was
performed to identify articles that reported (i) the amount of grafts
classified as abnormal or which were revised or (ii) an association
between TTFM and outcomes during follow-up. Random-effects models were
used to create pooled estimates with 95% confidence intervals (CI) of (i)
the rate of graft revision per patient, (ii) the rate of graft revision
per graft and (iii) the rate of graft revision among grafts deemed
abnormal based on TTFM parameters. The search yielded 242 articles, and 66
original articles were included in the systematic review. Of those
articles, 35 studies reported on abnormal grafts or graft revisions (8943
patients, 15 673 grafts) and were included in the meta-analysis. In 4.3%
of patients (95% CI 3.3-5.7%, I2=73.9) a revision was required and 2.0% of
grafts (95% CI 1.5-2.5%; I2=66.0) were revised. The pooled rate of graft
revisions among abnormal grafts was 25.1% (95% CI 15.5-37.9%; I2=80.2).
Studies reported sensitivity ranging from 0.250 to 0.457 and the
specificity from 0.939 to 0.984. Reported negative predictive values
ranged from 0.719 to 0.980 and reported positive predictive values ranged
from 0.100 to 0.840. This systematic review and meta-analysis showed that
TTFM could improve CABG procedures. However, due to heterogeneous data,
drawing uniform conclusions appeared challenging. Future studies should
focus on determining the optimal use of TTFM and assessing its diagnostic
accuracy.<br/>Copyright &#xa9; The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<24>
Accession Number
629107827
Title
The Thoracic Surgery Social Media Network: Early experience and lessons
learned.
Source
The Journal of thoracic and cardiovascular surgery. 158 (4) (pp
1127-1136), 2019. Date of Publication: 01 Oct 2019.
Author
Luc J.G.Y.; Ouzounian M.; Bender E.M.; Blitz A.; Stamp N.L.; Varghese
T.K.; Cooke D.T.; Antonoff M.B.
Institution
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, BC, Canada
(Ouzounian) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University of Toronto, Toronto, ON, Canada
(Bender) Department of Cardiothoracic Surgery, Stanford University, Palo
Alto, Mexico
(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, Mexico
(Antonoff) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson Cancer Center, Houston
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Thoracic Surgery Social Media Network (TSSMN) is a social
media collaborative formed in 2015 by The Annals of Thoracic Surgery and
The Journal of Thoracic and Cardiovascular Surgery to bring social media
attention to key publications from both journals and to highlight major
accomplishments in the specialty. Our aim is to describe TSSMN's
preliminary experience and lessons learned. <br/>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.
<br/>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.
<br/>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.<br/>Copyright &#xa9; 2019. Published by Elsevier Inc.

<25>
Accession Number
627674953
Title
The effect of guided imagery on physiological and psychological outcomes
of adult ICU patients: A systematic literature review and methodological
implications.
Source
Australian critical care : official journal of the Confederation of
Australian Critical Care Nurses. 31 (2) (pp 73-86), 2018. Date of
Publication: 01 Mar 2018.
Author
Hadjibalassi M.; Lambrinou E.; Papastavrou E.; Papathanassoglou E.
Institution
(Hadjibalassi, Lambrinou, Papastavrou) Department of Nursing, Cyprus
University of Technology, Limassol, Cyprus
(Papathanassoglou) Faculty of Nursing, University of Alberta, AB,
Edmonton, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Guided imagery (GI) is a relaxation technique that is being
increasingly explored in various patients' populations. We systematically
reviewed evidence on the effects of GI on physiological and psychological
outcomes of adult critically ill patients and extracted implications for
future research. REVIEW METHOD USED: Systematic literature review of
published studies based on the Cochrane Guidelines. DATA SOURCES: Studies
were located through literature searches of CINAHL, PubMed, Embase,
Cochrane Database of Systematic Reviews and Psych-Info. REVIEW METHODS: We
explored effects of GI in critically illness. The outcome measures
included pain, anxiety, hemodynamic measurements, stress neuropeptides,
length of stay, sleep quality, inflammatory markers, patient satisfaction
and cost of care. The Cochrane Collaboration's tool for assessing risk of
bias was employed. Extracted data included pathophysiological framework,
sample, diagnoses of participants, specifics of intervention, design,
experimental groups, analyses and main outcomes. <br/>RESULT(S): Based on
the selection criteria, 10 studies were identified, involving N=1391
critically ill patients. The main limitations include incomplete outcome
data and selective reporting, incomplete blinding and lack of experimental
group allocation concealment. Due to heterogeneity and incomplete
reporting, a meta-analysis was not feasible. Our findings included: (a)
favourable effects of the intervention with regard to decrease of pain,
anxiety and LOS; (b) many studies employing randomised controlled trial
designs; (c) a predominant focus on patients with cardiac surgery; (d)
large heterogeneity in measurement of outcomes. Moreover, the evidence
suggests that improvements in sleep quality, patient satisfaction and cost
of care merit further investigation. Methodological implications include
the need to clarify the underlying physiological framework, the use of
repeated measure designs and the adjustment for confounders.
<br/>CONCLUSION(S): On the basis of these results, and of the absence of
reported side-effects, we conclude that GI is a promising patient-centered
approach for the improvement of a number of patients' outcomes that merits
further investigation in critical care.<br/>Copyright &#xa9; 2017
Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd.
All rights reserved.

<26>
Accession Number
2002921731
Title
Outcomes after Free Fibula Flaps for Pediatric Mandibular Reconstruction:
A Systematic Review.
Source
Journal of the American College of Surgeons. Conference: The American
College of Surgeons 2019 Annual Clinical Congress. United States. 229 (4
Supplement 1) (pp S226-S227), 2019. Date of Publication: October 2019.
Author
Firriolo J.M.; Dang R.R.; Nuzzi L.C.; Caldroney S.J.; Labow B.I.
Institution
(Firriolo, Dang, Nuzzi, Caldroney, Labow) Boston Children's Hospital,
Harvard Medical School, Boston, MA; Boston Medical Center, Boston, MA;
University of California, Davis Medical Center, Sacramento, CA, United
States
Publisher
Elsevier Inc.
Abstract
Introduction: The purpose of this study is to describe the outcomes of
pediatric patients who have undergone mandibular reconstruction using free
fibular flaps. <br/>Method(s): We performed a comprehensive literature
review and selected articles relevant to pediatric mandibular
reconstruction using free fibula flaps. <br/>Result(s): A total of 403
English-language articles were identified in the initial query. Of those,
23 articles met the inclusion criteria. Our analyses included 129
pediatric patients who underwent mandibular reconstruction using a total
of 131 free fibular flaps. Most mandibular defects were caused by either
neoplasia (68.2%) or congenital anomalies (16.3%). Mean patient age at the
time of reconstruction was 10.2 +/- 4.4 years; patients were followed
postoperatively for a median of 49 months (interquartile range 24 to 60
months). The overall flap success rate was 96.9%; 4 patients experienced
flap failure (aged 6 to 18 years; 3 with neoplastic pathology and 1 with
an arteriovenous malformation). Approximately 12% of patients experienced
postoperative complications. A total of 4 patients died: 3 due to
progression of malignancy, the other after a heart transplantation.
Information on postoperative occlusion was available for only 60 patients,
of which 11.6% (n = 7) experienced malocclusion. There was insufficient
information on eating and speaking outcomes. <br/>Conclusion(s): Pediatric
mandibular reconstruction with free fibular flaps is safe and reliable.
However, long-term outcomes data are limited in the current literature.
Additional research to better characterize these outcomes is necessary to
improve surgical decision-making and to better inform patients and their
families.<br/>Copyright &#xa9; 2019

<27>
Accession Number
629382869
Title
Heart Rehabilitation in patients awaiting Open heart surgery targeting to
prevent Complications and to improve Quality of life (Heart-ROCQ): study
protocol for a prospective, randomised, open, blinded endpoint (PROBE)
trial.
Source
BMJ open. 9 (9) (pp e031738), 2019. Date of Publication: 18 Sep 2019.
Author
Hartog J.; Blokzijl F.; Dijkstra S.; DeJongste M.J.L.; Reneman M.F.;
Dieperink W.; van der Horst I.C.C.; Fleer J.; van der Woude L.H.V.; van
der Harst P.; Mariani M.A.
Institution
(Hartog, Blokzijl, Dijkstra, Mariani) Department of Cardio-thoracic
Surgery, University of Groningen, University Medical Center Groningen,
Groningen, Netherlands
(DeJongste) University of Groningen, University Medical Center Groningen,
Groningen, Netherlands
(Reneman, van der Woude) Department of Rehabilitation Medicine, University
of Groningen, University Medical Center Groningen, Groningen, Netherlands
(Dieperink, van der Horst) Department of Critical Care, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
(Fleer) Department of Health Psychology, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
(van der Woude) Center for Human Movement Sciences, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
(van der Harst) Department of Cardiology, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The rising prevalence of modifiable risk factors (eg,
obesity, hypertension and physical inactivity) is causing an increase in
possible avoidable complications in patients undergoing cardiac surgery.
This study aims to assess whether a combined preoperative and
postoperative multidisciplinary cardiac rehabilitation (CR) programme
(Heart-ROCQ programme) can improve functional status and reduce surgical
complications, readmissions and major adverse cardiac events (MACE) as
compared with standard care. METHODS AND ANALYSIS: Patients (n=350) are
randomised to the Heart-ROCQ programme or standard care. The Heart-ROCQ
programme consists of a preoperative optimisation phase while waiting for
surgery (three times per week, minimum of 3 weeks), a postoperative
inpatient phase (3 weeks) and an outpatient CR phase (two times per week,
4 weeks). Patients receive multidisciplinary treatment (eg, physical
therapy, dietary advice, psychological sessions and smoking cessation).
Standard care consists of 6 weeks of postsurgery outpatient CR with
education and physical therapy (two times per week). The primary outcome
is a composite weighted score of functional status, surgical
complications, readmissions and MACE, and is evaluated by a blinded
endpoint committee. The secondary outcomes are length of stay, physical
and psychological functioning, lifestyle risk factors, and work
participation. Finally, an economic evaluation is performed. Data are
collected at six time points: at baseline (start of the waiting period),
the day before surgery, at discharge from the hospital, and at 3, 7 and 12
months postsurgery. ETHICS AND DISSEMINATION: This study will be conducted
according to the principles of the Declaration of Helsinki (V.8, October
2013). The protocol has been approved by the Medical Ethical Review Board
of the UMCG (no 2016/464). Results of this study will be submitted to a
peer-reviewed scientific journal and can be presented at national and
international conferences. TRIAL REGISTRATION NUMBER:
NCT02984449.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2019.
Re-use permitted under CC BY. Published by BMJ.

<28>
Accession Number
629378280
Title
Cost-utility analysis of minimally invasive surgery for lung cancer: a
randomized controlled trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (4) (pp 754-761),
2019. Date of Publication: 01 Oct 2019.
Author
Bendixen M.; Kronborg C.; Jorgensen O.D.; Andersen C.; Licht P.B.
Institution
(Bendixen, Jorgensen, Licht) Department of Cardiothoracic and Vascular
Surgery, Odense University Hospital., Odense, Denmark
(Kronborg) Centre of Health Economic Research, University of Southern
Denmark, Odense, Denmark
(Andersen) Department of Thoracic Anaesthesiology, Odense University
Hospital, Odense, Denmark
(Licht) Odense Patient data Explorative Network (OPEN), University of
Southern Denmark, Odense, Denmark
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Minimally invasive video-assisted thoracic surgery (VATS) was
first introduced in the early 1990s. For decades, numerous non-randomized
studies demonstrated advantages of VATS over thoracotomy with lower
morbidity and shorter hospital stay, but only recently did a randomized
trial document that VATS results in lower pain scores and better quality
of life. Opposing arguments for VATS have always been increased costs and
concerns about oncological adequacy. In this paper, we aim to investigate
the cost-effectiveness of VATS. <br/>METHOD(S): The study was designed as
a cost-utility analysis of the first 12months following surgery and was
performed together with a clinical randomized controlled trial of VATS
versus thoracotomy for lobectomy of stage 1 lung cancer during a 6-year
period (2008-2014). All health-related expenses were retrieved from a
national database (Statistics Denmark) including hospital readmissions,
outpatient clinic visits, prescription medication costs, consultations
with general practitioners, specialists, physiotherapists, psychologists
and chiropractors. <br/>RESULT(S): One hundred and three VATS patients and
103 thoracotomy patients were randomized. Mean costs per patient operated
by VATS were 103 108 Danish Kroner (Dkr) (13 818) and 134 945 Dkr (18 085)
by thoracotomy, making the costs for VATS 31 837 Dkr (4267) lower than
thoracotomy (P<0.001). The difference in quality-adjusted life years
gained over 52weeks of follow-up was 0.021 (P=0.048, 95% confidence
interval -0.04 to -0.00015) in favour of VATS. The median duration of the
surgical procedure was shorter after thoracotomy (79 vs 100min; P<0.001).
The mean length of hospitalization was shorter following VATS (4.8 vs
6.7days; P=0.027). The use of other resources was not significantly
different between groups. The costs of resources were lower in the VATS
group. This difference was primarily due to reduced costs of readmissions
(VATS 29 247 Dkr vs thoracotomy 51 734 Dkr; P<0.001) and costs of
outpatient visits (VATS 51 412 Dkr vs thoracotomy 61 575 Dkr; P=0.012).
<br/>CONCLUSION(S): VATS is a cost-effective alternative to thoracotomy
following lobectomy for stage 1 lung cancer. Economical outcomes as
measured by quality-adjusted life years were significantly better and
overall costs were lower for VATS. CLINICAL TRIAL REGISTRATION NUMBER:
NCT01278888.<br/>Copyright &#xa9; The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<29>
Accession Number
629376089
Title
Association of Acute Venous Thromboembolism With In-Hospital Outcomes of
Coronary Artery Bypass Graft Surgery.
Source
Journal of the American Heart Association. 8 (19) (pp e013246), 2019. Date
of Publication: 01 Oct 2019.
Author
Panhwar M.S.; Ginwalla M.; Kalra A.; Gupta T.; Kolte D.; Khera S.; Bhatt
D.L.; Sabik J.F.
Institution
(Panhwar) Tulane University Heart and Vascular Institute Tulane University
School of Medicine New Orleans LA
(Ginwalla) Division of Cardiovascular Medicine Harrington Heart & Vascular
Institute University Hospitals Cleveland Medical Center Case Western
Reserve University School of Medicine Cleveland OH
(Kalra) Department of Cardiovascular Medicine Cleveland Clinic Cleveland
Clinic Lerner College of Medicine of Case Western Reserve University
Cleveland OH
(Gupta) Montefiore Medical Center Albert Einstein College of Medicine New
York NY
(Kolte) Massachusetts General Hospital Harvard Medical School Boston MA
(Khera) Division of Cardiology Icahn School of Medicine at Mount Sinai New
York New York
(Bhatt) Brigham & Women's Hospital Heart & Vascular Center Harvard Medical
School Boston MA
(Sabik) Department of Surgery Harrington Heart & Vascular Institute
University Hospitals Cleveland Medical Center Case Western Reserve
University School of Medicine Cleveland OH
Publisher
NLM (Medline)
Abstract
Background While venous thromboembolism (VTE) prophylaxis is a strong
recommendation after most surgeries, it is controversial in cardiac
surgeries such as coronary artery bypass grafting (CABG), because of
perceived low VTE incidence and increased bleeding risk. Prior studies may
not have been adequately powered to study outcomes of VTE in this
population. We sought to investigate the postoperative incidence and
outcomes of CABG patients using a large national inpatient database.
Methods and Results We utilized the 2013 to 2014 National Inpatient Sample
to identify all patients >18 years of age who underwent CABG (without
concomitant valvular procedures), and had VTE during the hospital stay. We
then compared clinically relevant outcomes in patients with and without
VTE. We identified 331 950 CABG procedures. Of these, 1.3% (n=4205) had
VTE. Patients with VTE were more likely to be older (mean 67.2+/-10.4
years versus 65.2+/-10.4 years, P<0.001). VTE was associated with higher
incidence of inpatient mortality (6.8% versus 1.7%; adjusted odds ratio
1.92 [95% CI 1.40-2.65]; P<0.001) and complications. VTE was also
associated with higher cost (mean+/-SE $81 995+/-$923 versus $48
909+/-$55) and longer length of stay (mean+/-SE 17.06+/-0.16 days versus
8.52+/-0.01 days). Conclusions Our analysis of >330 000 CABG procedures
suggests that while postoperative VTE after CABG is rare, it is associated
with increased morbidity and mortality. Randomized controlled trials are
needed to identify optimal strategies for VTE prophylaxis in these
patients.

<30>
Accession Number
629375253
Title
Transthoracic clamp versus endoaortic balloon occlusion in minimally
invasive mitral valve surgery: a systematic review and meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (4) (pp 643-653),
2019. Date of Publication: 01 Oct 2019.
Author
Rival P.M.; Moore T.H.M.; McAleenan A.; Hamilton H.; Du Toit Z.; Akowuah
E.; Angelini G.D.; Vohra H.A.
Institution
(Rival, Hamilton, Du Toit) University of Bristol Medical School, Bristol,
United Kingdom
(Moore) National Institute for Health Research Collaboration for
Leadership in Applied Health Research and Care West, University Hospitals
Bristol NHS Foundation Trust, Bristol, United Kingdom
(McAleenan) Population Health Sciences, Bristol Medical School, University
of Bristol, Bristol, United Kingdom
(Akowuah) Department of Cardiac Surgery, James Cook Hospital,
Middlesbrough, United Kingdom
(Angelini, Vohra) Department of Cardiac Surgery, Bristol Heart Institute,
Bristol, United Kingdom
Publisher
NLM (Medline)
Abstract
This systematic review and meta-analysis aims to determine outcomes
following aortic occlusion with the transthoracic clamp (TTC) versus
endoaortic balloon occlusion (EABO) in patients undergoing minimally
invasive mitral valve surgery. A subgroup analysis compares TTC to EABO
with femoral cannulation separately from EABO with aortic cannulation. We
searched Medline and Embase up to December 2018. Two people independently
and in duplicate screened title and abstracts, full-text reports,
extracted data and assessed the risk of bias using the Cochrane
risk-of-bias tool for non-randomized studies. We identified 1564 reports
from which 11 observational studies with 4181 participants met the
inclusion criteria. We found no evidence of difference in the risk of
postoperative death or cerebrovascular accident (CVA) between the 2
techniques. Evidence for a reduction in aortic dissection with TTC was
found: 4 of 1590 for the TTC group vs 19 of 2492 for the EABO group [risk
ratio 0.33, 95% confidence interval (CI) 0.12-0.93; P=0.04]. There was no
difference in aortic cross-clamp (AoX) time between TTC and EABO [mean
difference (MD) -5.17min, 95% CI -12.40 to 2.06; P=0.16]. TTC was
associated with a shorter AoX time compared to EABO with femoral
cannulation (MD -9.26min, 95% CI -17.00 to -1.52; P=0.02). EABO with
aortic cannulation was associated with a shorter AoX time compared to TTC
(MD 7.77min, 95% CI 3.29-12.26; P<0.001). There was no difference in
cardiopulmonary bypass (CPB) time between TTC and EABO with aortic
cannulation (MD -4.98min, 95% CI -14.41 to 4.45; P=0.3). TTC was
associated with a shorter CPB time compared to EABO with femoral
cannulation (MD -10.08min, 95% CI -19.93 to -0.22; P=0.05). Despite a
higher risk of aortic dissection with EABO, the rates of survival and
cerebrovascular accident across the 2 techniques are similar in minimally
invasive mitral valve surgery.<br/>Copyright &#xa9; The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<31>
Accession Number
629371775
Title
Low-dose anticoagulation after isolated mechanical aortic valve
replacement with Liva Nova Bicarbon prosthesis: A post hoc analysis of
LOWERING-IT Trial.
Source
Scientific reports. 8 (1) (pp 8405), 2018. Date of Publication: 30 May
2018.
Author
Torella M.; Aquila I.; Chiodini P.; Amarelli C.; Romano G.; Della Ratta
E.E.; De Feo M.; Della Corte A.; Indolfi C.; Torella D.; De Santo L.S.
Institution
(Torella, Della Ratta, De Feo, Della Corte) Department of Cardio-Thoracic
Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
(Aquila, Indolfi, Torella) Cardiovascular Institute, Department of Medical
and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
(Chiodini) Department of Medicine and Public Health, University of
Campania "Luigi Vanvitelli", Naples, Italy
(Amarelli, Romano) Department of Cardiovascular Surgery and Transplants,
V. Monaldi Hospital, Naples, Italy
(De Santo) Department of Medical and Surgical Sciences, Chair of Cardiac
Surgery, University of Foggia, Foggia, Italy
(De Santo) Casa di Cura Montevergine, GVM, Care & Research, Avellino,
Italy
Publisher
NLM (Medline)
Abstract
Thromboembolic complications after cardiac valve replacement are due to a
complex interplay between patients' characteristics, device features and
anticoagulation intensity. Subtle design and material differences in
available prostheses may thrombosis. We conducted a post-hoc sub-analysis
of the LOWERING-IT database to test the safety and feasibility of a
low-level oral anticoagulant regime in low-risk patients with aortic
LivaNova prosthetic valve replacement. The study population included 148
patients randomized to a low INR target (1.5-2.5; LOW-INR group), and 144
patients to the standard INR (2.0-3.0; CONVENTIONAL-INR group). The
non-inferiority of thromboembolic events between LOW-INR and
CONVENTIONAL-INR groups was tested. Cumulative follow-up reached 1,545
patient/years. The mean INR was 1.91+/-0.23 in the LOW-INR group, and
2.59+/-0.26 in the CONVENTIONAL-INR group (P<0.001). There were 3
thromboembolic events, all in the CONVENTIONAL-INR group. Comparison of
thromboembolic events was not significant. The 1-sided 97.5% exact CI for
the difference in primary event proportion was 0.54%, satisfying criteria
non-inferiority. Bleeding events were significantly different: 6.61 per
1,000 patient-year in LOW-INR group vs 18.65 per 1,000 patient-year in
CONVENTIONAL-INR group (p<0.045, RR 0.37). In conclusions these data
suggest that low-dose anticoagulation is safe in selected patients after
aortic LivaNova Bicarbon prosthesis implantation.

<32>
Accession Number
629379105
Title
A meta-analysis of pharmacological neuroprotection in noncardiac surgery:
focus on statins, lidocaine, ketamine, and magnesium sulfate.
Source
European review for medical and pharmacological sciences. 22 (6) (pp
1798-1811), 2018. Date of Publication: 01 Mar 2018.
Author
Zeng Z.-W.; Zhang Y.-N.; Lin W.-X.; Zhang W.-Q.; Luo R.
Institution
(Zeng) First Anesthesia Department, Meizhou People's Hospital, Guangdong
Province, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Non-cardiac surgery is associated with perioperative cerebral
complications (delirium, postoperative cognition dysfunction, stroke).
While rare, these complications can lead to disabilities and deaths.
Information is ambiguous as to whether pharmacological preoperative
treatment exerts neuroprotection. We wished to systematically assess
potential modulation by statins, lidocaine, ketamine or magnesium sulfate
of the relative risk of cerebral complications in noncardiac surgery.
Selection of these pharmacological agents was based on their known
neuroprotective abilities. <br/>PATIENTS AND METHODS: By searching
Medline, EMBASE and Cochrane databases, we identified 4 suitable
publications that collectively enrolled 1358 patients (intent-to-treat
population), of which 679 patients were treated preoperatively with
statins (404 patients on atorvastatin and 275 on rosuvastatin) and 679
patients with preoperative placebo. The reported cerebral outcome was
stroke, assessed either within 30 days (4 publications) or 6 months (2
publications) after surgery. <br/>RESULT(S): Episodes of stroke within 30
days and 6 months postoperatively were observed in several publications,
enabling aggregate analyses. No modulation by statins of the relative risk
of stroke at 30 days was observed (risk ratio 1.59, 95% confidence
interval 0.08-30.97; p = 0.76). At 6 months, statins showed an
insignificant trend toward neuroprotection (risk ratio 0.33, 95%
confidence interval 0.05-2.10; p = 0.24). <br/>CONCLUSION(S): The
available clinical data are still scarce. Our analyses indicate no
protective effects by statins against perioperative stroke but some
favorable trends toward delayed stroke. Further randomized trials are
needed to unequivocally assess the neuroprotective potential of current
pharmacological agents in non-cardiac surgery.

<33>
Accession Number
629372240
Title
Transcatheter aortic valve replacement with a focus on transcarotid: A
review of the current literature.
Source
Annals of Translational Medicine. 7 (17) (no pagination), 2019. Article
Number: 420. Date of Publication: 01 Sep 2019.
Author
Pour-Ghaz I.; Raja J.; Bayoumi M.; Manolukas T.; Khouzam R.N.; Ibebuogu
U.N.
Institution
(Pour-Ghaz, Raja, Bayoumi, Manolukas) Department of Internal Medicine,
Department of Medicine, University of Tennessee Health Science Center,
PGY-2, 956 Court Ave., Memphis, TN 38163, United States
(Khouzam, Ibebuogu) Division of Cardiovascular Diseases, Department of
Medicine, University of Tennessee Health Science Center, Memphis, TN,
United States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Valve replacement in high-risk patients with severe aortic stenosis has
undergone a huge paradigm shift in the recent years in terms of procedural
details and vascular access site for patients who have poor peripheral
access. Carotid artery is one of the more promising access sites which has
been proven to provide a good alternative site with comparable outcomes to
transfemoral approach. In this manuscript, we will provide a review of the
current literature on transaortic, transapical, transaxillary and
transcarotid approaches to transcatheter aortic valve replacement (TAVR)
while focusing on the transcarotid approach.<br/>Copyright &#xa9; Annals
of Translational Medicine. All rights reserved.

<34>
Accession Number
629383463
Title
Preoperative VolumE Replacement therapy in DIabetic patients undergoing
coronary artery bypass grafting surgery: results from an open parallel
group randomized Controlled Trial (VeRDiCT).
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 20 Sep 2019.
Author
Sarkar K.; Harris R.A.; Wells S.; Harris T.; Clout M.; Taylor J.;
Culliford L.; Angelini G.D.; Pike K.; Ashton K.; Narayan P.; Reeves B.;
Hillier J.; Rogers C.A.; Ascione R.
Institution
(Sarkar, Narayan) Rabindranath Tagore International Institute of Cardiac
Sciences (RTIICS), Kolkata, India
(Harris, Wells, Harris, Clout, Taylor, Culliford, Pike, Ashton, Reeves,
Rogers) Clinical Trials and Evaluation Unit, Bristol Trials Centre,
University of Bristol, Bristol, United Kingdom
(Angelini, Hillier, Ascione) Faculty of Health Sciences, Bristol Heart
Institute, University of Bristol, Bristol, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To investigate the effect of preoperative volume replacement
therapy (VRT) on renal function, health outcome and time to fitness for
discharge in diabetic patients undergoing coronary artery bypass grafting
(CABG). <br/>METHOD(S): In 2 parallel randomized controlled trials,
diabetic patients were allocated to preoperative VRT (1ml/kg/h of
Hartmann's solution for 12h) or usual care. Primary outcome was time to
fitness for discharge. Secondary outcomes included acute kidney injury,
postoperative complications, patient-reported quality of life (QoL),
hospital resource use and markers of renal, cardiac and inflammatory
injury. <br/>RESULT(S): In total, 169 patients were randomized (84 VRT, 85
usual care; mean age 64years; 88% male). Time to fitness for discharge was
similar between groups [median 6days; interquartile range 5.0-9.0 in both
groups; hazard ratio 0.95, 95% confidence interval (CI) 0.65-1.38;
P=0.78]. Postoperative acute kidney injury was not statistically different
(VRT: 27.7% vs usual care: 18.8%, odds ratio 1.72, 95% CI 0.82-3.59;
P=0.15). Estimated glomerular filtration rate (mean difference -0.92, 95%
CI -4.18 to 2.25; P=0.56), microalbumin/creatinine ratio [geometric mean
ratio (GMR) 1.16, 95% CI 0.94-1.42; P=0.16],
N-acetyl-beta-d-glucosaminidase (GMR 1.08, 95% CI 0.83-1.40; P=0.57),
C-reactive protein (GMR 1.00, 95% CI 0.88-1.13; P=0.94), troponin T
(Trop-T; GMR 1.18, 95% CI 0.78-1.79; P=0.39) and other secondary health
outcomes were similar between groups. QoL improved in both groups at 3
months with no difference observed. <br/>CONCLUSION(S): The use of
preoperative VRT is not superior to usual care in diabetic patients
undergoing CABG. CLINICAL TRIAL REGISTRATION NUMBER:
ISRCTN02159606.<br/>Copyright &#xa9; The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<35>
Accession Number
629377425
Title
The RADial artery International ALliance (RADIAL) extended follow-up
study: rationale and study protocol.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 18 Sep 2019.
Author
Gaudino M.; Benedetto U.; Fremes S.; Ballman K.; Biondi-Zoccai G.;
Sedrakyan A.; Nasso G.; Raman J.; Buxton B.; Hayward P.A.; Moat N.;
Collins P.; Webb C.; Peric M.; Petrovic I.; Yoo K.J.; Hameed I.; Di Franco
A.; Moscarelli M.; Speziale G.; Girardi L.N.; Hare D.L.; Taggart D.P.
Institution
(Gaudino, Hameed, Di Franco, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, NY, NY, United States
(Benedetto) Department of Cardiac Surgery, Bristol Heart Institute,
Bristol, United Kingdom
(Fremes) Department of Surgery, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, Canada
(Ballman, Sedrakyan) Department of Healthcare Policy and Research, Weill
Cornell Medicine, NY, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) NaplesItaly
(Nasso, Moscarelli, Speziale) Anthea Hospital, Bari, Italy
(Raman, Hare) Austin Hospital, Melbourne, VIC, Australia
(Buxton, Hayward, Hare) Department of Surgery, University of Melbourne,
Melbourne, VIC, Australia
(Moat, Collins, Webb) NHLI, Imperial College London, Royal Brompton and
Harefield NHS Foundation Trust, London, United Kingdom
(Peric, Petrovic) Dedinje Cardiovascular Institute and Belgrade University
School of Medicine, Belgrade, Serbia
(Yoo) Yonsei University College of Medicine, Seoul, South Korea
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
Oxford, United Kingdom
Publisher
NLM (Medline)
Abstract
It is generally accepted that radial artery (RA) grafts have better
mid-term patency rate compared to saphenous vein grafts. However, the
clinical correlates of the improved patency rate are still debated.
Observational studies have suggested increased survival and event-free
survival for patients who receive an RA rather than a saphenous vein, but
they are open to bias and confounders. The only evidence based on
randomized data is a pooled meta-analysis of 6 randomized controlled trial
comparing the RA and the saphenous vein published by the RADial artery
International Alliance (RADIAL). In the RADIAL database, improved freedom
from follow-up cardiac events (death, myocardial infarction and repeat
revascularization) was found at 5-year follow-up in the RA arm. The most
important limitation of the RADIAL analysis is that most of the included
trials had an angiographic follow-up in the first 5 years and it is
unclear whether the rate of repeat revascularization (the main driver of
the composite outcome) was clinically indicated due to per-protocol
angiographies. Here, we present the protocol for the long-term analysis of
the RADIAL database. By extending the follow-up beyond the 5th
postoperative year (all trials except 1 did not have angiographic
follow-up beyond 5 years), we aim to provide data on the role of RA in
coronary artery bypass surgery with respect to long-term
outcomes.<br/>Copyright &#xa9; The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<36>
Accession Number
2002946741
Title
Sustained High-dose Thiamine Supplementation in High-risk Cardiac Patients
Undergoing Cardiopulmonary Bypass: A Pilot Feasibility Study (The APPLY
trial).
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Lomivorotov V.V.; Moroz G.; Ismoilov S.; Shmyrev V.; Efremov S.;
Abubakirov M.; Batalov V.; Landoni G.; Lembo R.; Bogachev-Prokophiev A.;
Sapegin A.; Bellomo R.
Institution
(Lomivorotov, Moroz, Ismoilov, Shmyrev, Abubakirov, Batalov,
Bogachev-Prokophiev, Sapegin) E. Meshalkin National Medical Research
Center, Novosibirsk, Russian Federation
(Lomivorotov) Novosibirsk State University, Novosibirsk, Russian
Federation
(Efremov) Saint Petersburg State University Hospital, Saint Petersburg,
Russian Federation
(Landoni, Lembo) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Bellomo) Centre for Integrated Critical Care, The University of
Melbourne, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objective: To test the feasibility and investigate possible cardiovascular
effects of a sustained high-dose intravenous thiamine protocol in patients
undergoing combined valvular and coronary artery bypass graft surgery.
<br/>Design(s): Randomized, placebo-controlled, pilot feasibility trial.
<br/>Setting(s): Cardiac surgery department of a tertiary hospital.
<br/>Participant(s): Forty patients undergoing combined valvular and
coronary artery bypass surgery. <br/>Intervention(s): Intravenous thiamine
(600 mg on the day of surgery, and 400 mg/day on postoperative days 1, 2,
and 3) or placebo. <br/>Measurements and Main Results: The primary
feasibility endpoints were recruitment rate and protocol compliance.
Secondary endpoints included markers of possible biological and
physiological effects. The mean recruitment rate was 8 patients per month
and protocol compliance was 97.5%. There were no differences in median
peak postoperative lactate (2.7 mmol/L [interquartile range [IQR] 1.4-4.6]
for thiamine v 2.5 mmol/L [IQR 1.4-3.6] for placebo; p = 0.53), median
peak postoperative creatinine (104 micro&#32;mol/L [IQR 92.5-129] for
thiamine v 99 micro&#32;mol/L [IQR 86.5-109.5] for placebo; p = 0.53),
median nadir postoperative cardiac index (1.8 L/min/m² [IQR
1.5-2.1] for thiamine v 2.2 L/min/m² [IQR 1.5-2.5] for placebo;
p = 0.25), or the number of patients on vasopressor/inotropic agents
(thiamine, 12 [63%]; placebo, 12 [60%]; p = 0.80), or in the total
inotrope/vasopressor dose 0.14 micro&#32;g/kg for thiamine v 0.12
micro&#32;g/kg for placebo; p = 0.88). <br/>Conclusion(s): A double-blind
trial of sustained high-dose intravenous thiamine supplementation in
higher-risk cardiac surgery patients was feasible and appeared to be safe.
However, such treatment did not demonstrate evidence of biological or
physiological effects.<br/>Copyright &#xa9; 2019

<37>
Accession Number
620308544
Title
Prophylactic use of non-invasive mechanical ventilation in lung resection.
Source
European Review for Medical and Pharmacological Sciences. 22 (1) (pp
190-198), 2018. Date of Publication: 2018.
Author
Hernandez E.G.; Perez A.R.; Gilard J.F.; Alamo M.N.M.; Socorro M.E.;
Suarez P.R.; Esquinas A.M.
Institution
(Hernandez, Perez) Anesthesiology Service, Hospital Universitario de Gran
Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
(Gilard, Suarez) Thoracic Surgery Service, Hospital Universitario de Gran
Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
(Perez, Gilard) Department of Medical and Surgical Sciences, School of
Medicine, University of Las Palmas de Gran Canaria, Spain
(Alamo, Socorro) Physical Medicine and Rehabilitation Service, Hospital
Universitario de Gran Canaria, Doctor Negrin, Spain
(Esquinas) Intensive Care and Non Invasive Ventilatory Unit, Hopital
Morales Meseguer, Murcia, Spain
Publisher
Verduci Editore s.r.l (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: To evaluate if the prophylactic application of BiPAP previous
to lung resection and 17 hours postoperatively improves respiratory
function. In order to do this, we studied the results of arterial blood
gases and portable spirometry in the immediate postoperative period and at
the first and third postoperative day. Secondary objectives included
evaluating whether this same pattern decreases the incidence of
postoperative pulmonary complications (PPC) and hospital stay.
<br/>PATIENTS AND METHODS: This was a prospective, randomized clinical
study. Between January 2012 and June 2013, 50 patients who had undergone
lung resection with posterolateral thoracotomy were assigned to one of two
groups by a random number generator according to whether or not they would
receive prophylactic BiPAP pre- and postoperatively. <br/>RESULT(S): The
results of the gasometric and spirometric values were similar in both
groups. There were no statistically significant differences (p > 0.05).
There was not a decrease in the incidence of PPC in the group that
received prophylactic BiPAP. Likewise, postoperative stay was similar in
both groups. The BiPAP group was 6.60 +/- 4 days and the non BiPAP group
was 6.84 +/- 3.94 days (p = 0.63). <br/>CONCLUSION(S): One drawback of
this work was the limited number of hours that BiPAP was employed, and
when compared to other studies, the application of low-pressure support.
We did not find any significant differences between using prophylactic
BiPAP or not, suggesting that such treatment should not be performed
indiscriminately. More investigations are needed with a larger number of
patients in order to better evaluate the possible benefits of using
prophylactic BiPAP in thoracic surgery.

<38>
[Use Link to view the full text]
Accession Number
622577731
Title
Clinical Outcomes and Cost-Effectiveness of Fractional Flow Reserve-Guided
Percutaneous Coronary Intervention in Patients with Stable Coronary Artery
Disease.
Source
Circulation. 137 (5) (pp 480-487), 2018. Date of Publication: 30 Jan 2018.
Author
Fearon W.F.; Nishi T.; De Bruyne B.; Boothroyd D.B.; Barbato E.; Tonino
P.; Juni P.; Pijls N.H.J.; Hlatky M.A.
Institution
(Fearon, Nishi, Hlatky) Division of Cardiovascular Medicine, Stanford
Cardiovascular Institute, Stanford University School of Medicine, 300
Pasteur Dr, H2103, Stanford, CA 94305-5218, United States
(Boothroyd) Quantitative Sciences Unit, United States
(Hlatky) Department of Health Research and Policy, United States
(De Bruyne, Barbato) Stanford University School of Medicine, Stanford
Cardiovascular Institute, CA. Cardiovascular Center Aalst, United States
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Italy
(Tonino, Pijls) Catharina Hospital, Eindhoven, Netherlands
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, University of Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Previous studies found that percutaneous coronary intervention
(PCI) does not improve outcome compared with medical therapy (MT) in
patients with stable coronary artery disease, but PCI was guided by
angiography alone. FAME 2 trial (Fractional Flow Reserve Versus
Angiography for Multivessel Evaluation) compared PCI guided by fractional
flow reserve with best MT in patients with stable coronary artery disease
to assess clinical outcomes and cost-effectiveness. <br/>Method(s): A
total of 888 patients with stable single-vessel or multivessel coronary
artery disease with reduced fractional flow reserve were randomly assigned
to PCI plus MT (n=447) or MT alone (n=441). Major adverse cardiac events
included death, myocardial infarction, and urgent revascularization. Costs
were calculated on the basis of resource use and Medicare reimbursement
rates. Changes in quality-adjusted life-years were assessed with utilities
determined by the European Quality of Life-5 Dimensions health survey at
baseline and over follow-up. <br/>Result(s): Major adverse cardiac events
at 3 years were significantly lower in the PCI group compared with the MT
group (10.1% versus 22.0%; P<0.001), primarily as a result of a lower rate
of urgent revascularization (4.3% versus 17.2%; P<0.001). Death and
myocardial infarction were numerically lower in the PCI group (8.3% versus
10.4%; P=0.28). Angina was significantly less severe in the PCI group at
all follow-up points to 3 years. Mean initial costs were higher in the PCI
group ($9944 versus $4440; P<0.001) but by 3 years were similar between
the 2 groups ($16 792 versus $16 737; P=0.94). The incremental
cost-effectiveness ratio for PCI compared with MT was $17 300 per
quality-adjusted life-year at 2 years and $1600 per quality-adjusted
life-year at 3 years. The above findings were robust in sensitivity
analyses. ConclusionS: PCI of lesions with reduced fractional flow reserve
improves long-term outcome and is economically attractive compared with MT
alone in patients with stable coronary artery disease. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT01132495.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<39>
[Use Link to view the full text]
Accession Number
616669989
Title
Off-pump Versus On-pump Coronary Artery Bypass Surgery: Graft Patency
Assessment with Coronary Computed Tomographic Angiography.
Source
Journal of Thoracic Imaging. 32 (6) (pp 370-377), 2017. Date of
Publication: 2017.
Author
Noiseux N.; Stevens L.-M.; Chartrand-Lefebvre C.; Soulez G.; Prieto I.;
Basile F.; Mansour S.; Dyub A.M.; Kieser T.M.; Lamy A.
Institution
(Noiseux, Stevens, Chartrand-Lefebvre, Soulez, Mansour) Research Center,
Centre Hospitalier, Universite de Montreal (CRCHUM), Montreal, QC, Canada
(Noiseux, Stevens, Prieto, Basile) Division of Cardiac Surgery, Centre
Hospitalier, Universite de Montreal, 3840 Saint-Urbain Street, Montreal,
QC H2W1T8, Canada
(Chartrand-Lefebvre, Soulez) Department of Radiology, Centre Hospitalier,
Universite de Montreal, Montreal, QC, Canada
(Mansour) Division of Cardiology, Centre Hospitalier, Universite de
Montreal, Montreal, QC, Canada
(Dyub, Lamy) Division of Cardiac Surgery, McMaster University, Hamilton,
ON, Canada
(Lamy) Population Health Research Institute (PHRI), Hamilton Health
Sciences, Hamilton, ON, United States
(Kieser) University of Calgary, Calgary, AB, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: A large multicenter randomized trial (RCT) is needed to assess
off-pump coronary artery bypass graft (CABG) patency when performed by
skilled surgeons. This prospective multicenter randomized pilot study
compares graft patency after on-pump and off-pump techniques and addresses
the feasibility of such an RCT. <br/>Material(s) and Method(s):
Consecutive patients were prospectively recruited for >=64-slice computed
tomography angiography graft patency assessment 1 year after randomization
to off-pump or on-pump CABG. Blinded assessment of graft patency was
performed, and the results were categorized as normal, >=50% stenosis, or
occlusion. A multilevel model with random effects on the patient was used
to account for correlation of results in patients with multiple grafts.
<br/>Result(s): A total of 157 patients (3 centers, 84 off-pump and 73
on-pump patients, 512 grafts, assessability rate 98.4%) were included.
Patency index (% nonoccluded grafts) was 89% for the off-pump technique
and 95% for the on-pump technique (P=0.09). Patency was similar for
arterial and vein grafts (both 92%; P=0.88), as well as between target
territories (89% to 94%; P=0.53). <br/>Conclusion(s): In this pilot study,
1-year graft patency results after off-pump and on-pump surgery were
similar. This feasibility trial demonstrates that a large multicenter RCT
to compare CABG patency after on-pump with that after off-pump techniques
is feasible and can be reliably undertaken using computed tomography
angiography.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All
rights reserved.

<40>
Accession Number
606363161
Title
Remote ischemic preconditioning and outcomes of cardiac surgery.
Source
New England Journal of Medicine. 373 (15) (pp 1408-1417), 2015. Date of
Publication: 08 Oct 2015.
Author
Hausenloy D.J.; Candilio L.; Evans R.; Ariti C.; Jenkins D.P.; Kolvekar
S.; Knight R.; Kunst G.; Laing C.; Nicholas J.; Pepper J.; Robertson S.;
Xenou M.; Clayton T.; Yellon D.M.
Institution
(Hausenloy, Candilio, Xenou, Yellon) Hatter Cardiovascular Institute,
University College London, 67 Chenies Mews, London WC1E 6HX, United
Kingdom
(Hausenloy, Yellon) National Institute of Health Research, University
College London Hospitals, Biomedical Research Centre, United Kingdom
(Evans, Knight, Nicholas, Robertson, Clayton) Clinical Trials Unit, London
School of Hygiene and Tropical Medicine, United Kingdom
(Ariti) Nuffield Trust, United Kingdom
(Kolvekar) Heart Hospital, University College London Hospital, United
Kingdom
(Kunst) King's College London and King's College Hospital, United Kingdom
(Laing) Royal Free Hospital, United Kingdom
(Pepper) National Institute of Health Research Cardiovascular Biomedical
Research Unit, Royal Brompton and Harefield NHS Trust, London, United
Kingdom
(Jenkins) Papworth Hospital, Cambridge, United Kingdom
(Hausenloy) National Heart Research Institute Singapore, National Heart
Centre Singapore, Singapore
(Hausenloy) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore, Singapore
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Whether remote ischemic preconditioning (transient ischemia and
reperfusion of the arm) can improve clinical outcomes in patients
undergoing coronary-artery bypass graft (CABG) surgery is not known. We
investigated this question in a randomized trial. METHODS We conducted a
multicenter, sham-controlled trial involving adults at increased surgical
risk who were undergoing on-pump CABG (with or without valve surgery) with
blood cardioplegia. After anesthesia induction and before surgical
incision, patients were randomly assigned to remote ischemic
preconditioning (four 5-minute inflations and deflations of a standard
blood-pressure cuff on the upper arm) or sham conditioning (control
group). Anesthetic management and perioperative care were not
standardized. The combined primary end point was death from cardiovascular
causes, nonfatal myocardial infarction, coronary revascularization, or
stroke, assessed 12 months after randomization. RESULTS We enrolled a
total of 1612 patients (811 in the control group and 801 in the ischemic-
preconditioning group) at 30 cardiac surgery centers in the United
Kingdom. There was no significant difference in the cumulative incidence
of the primary end point at 12 months between the patients in the remote
ischemic preconditioning group and those in the control group (212
patients [26.5%] and 225 patients [27.7%], respectively; hazard ratio with
ischemic preconditioning, 0.95; 95% confidence interval, 0.79 to 1.15; P =
0.58). Furthermore, there were no significant between- group differences
in either adverse events or the secondary end points of perioperative
myocardial injury (assessed on the basis of the area under the curve for
the high-sensitivity assay of serum troponin T at 72 hours), inotrope
score (calculated from the maximum dose of the individual inotropic agents
administered in the first 3 days after surgery), acute kidney injury,
duration of stay in the intensive care unit and hospital, distance on the
6-minute walk test, and quality of life. CONCLUSIONS Remote ischemic
preconditioning did not improve clinical outcomes in patients undergoing
elective on-pump CABG with or without valve surgery.<br/>Copyright &#xa9;
2015 Massachusetts Medical Society. All rights reserved.

<41>
Accession Number
2002702062
Title
Meta-Analysis of Transthoracic Echocardiography Versus Cardiac Magnetic
Resonance for the Assessment of Aortic Regurgitation After Transcatheter
Aortic Valve Implantation.
Source
American Journal of Cardiology. 124 (8) (pp 1246-1251), 2019. Date of
Publication: 15 October 2019.
Author
Papanastasiou C.A.; Kokkinidis D.G.; Jonnalagadda A.K.; Oikonomou E.K.;
Kampaktsis P.N.; Garcia M.J.; Myerson S.G.; Karamitsos T.D.
Institution
(Papanastasiou, Karamitsos) 1st Department of Cardiology, Aristotle
University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
(Kokkinidis) Department of Medicine, Jacobi Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
(Jonnalagadda) Division of Cardiology, Medstar, Washington Hospital
Center, Washington, DC, United States
(Oikonomou) Department of Internal Medicine, Yale New Haven Hospital, Yale
School of Medicine, New Haven, CT, United States
(Kampaktsis) Department of Medicine, New York Presbyterian Hospital/Weil
Cornell Medical College, NY, United States
(Garcia) Division of Cardiology, Department of Medicine, Jacobi Medical
Center, Albert Einstein College of Medicine, Bronx, NY, United States
(Myerson) Division of Cardiovascular Medicine, Radcliffe Department of
Medicine, University of Oxford, Oxford, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Residual aortic regurgitation (AR) is a major complication after
transcatheter aortic valve implantation (TAVI). Although the
echocardiographic assessment of post-TAVI AR remains challenging, cardiac
magnetic resonance (CMR) allows direct quantification of AR. The aim of
this study was to review the level of agreement between 2-dimensional
transthoracic echocardiography (2D TTE) and CMR on grading the severity of
AR after TAVI, and determine the accuracy of TTE in detecting moderate or
severe AR. Electronic databases were searched in order to identify studies
comparing 2D TTE to CMR for post-TAVI AR assessment. Kappa coefficient was
used to determine the level of agreement between the 2 imaging modalities.
CMR was used as the reference standard in order to assess the diagnostic
accuracy of 2D TTE. Seven studies were included in this systematic review.
Six studies reported a low correlation between 2D TTE and CMR (kappa
coefficient ranging from -0.02 to 0.41), whereas one study showed good
agreement with a kappa coefficient of 0.72. Given the heterogeneity in the
included studies the diagnostic accuracy of TTE was evaluated by
estimating the hierarchical summary receiver operator characteristic
curve. The area under the curve for detection of moderate or severe AR
with TTE was 0.83 (95% confidence interval 0.79 to 0.86). In conclusion,
despite the reported significant disconcordance between TTE and CMR
grading of AR, TTE has sufficient ability to discriminate moderate or
severe AR from mild or none AR after TAVI in the clinical setting. CMR
should be considered when TTE results are equivocal.<br/>Copyright &#xa9;
2019 Elsevier Inc.

<42>
Accession Number
2002731909
Title
Meta-Analysis Evaluating Outcomes of Surgical Left Atrial Appendage
Occlusion During Cardiac Surgery.
Source
American Journal of Cardiology. 124 (8) (pp 1218-1225), 2019. Date of
Publication: 15 October 2019.
Author
Ibrahim A.M.; Tandan N.; Koester C.; Al-Akchar M.; Bhandari B.; Botchway
A.; Abdelkarim J.; Maini R.; Labedi M.
Institution
(Ibrahim, Tandan, Koester, Al-Akchar, Bhandari, Abdelkarim, Maini)
Department of Internal Medicine, SIU School of Medicine, Springfield, IL,
United States
(Botchway) Center for Clinical Research, SIU School of Medicine,
Springfield, IL, United States
(Labedi) Division of Cardiology, Department of Internal Medicine, SIU
School of Medicine, Springfield, IL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Surgical left atrial appendage occlusion (S-LAAO) has become a common
procedure performed in patients undergoing cardiac surgery; however,
evidence to support this procedure remains inconclusive. This
meta-analysis aims to assess the efficacy of S-LAAO in terms of ischemic
stroke, postoperative atrial fibrillation, and all-cause mortality. A
thorough literature review was performed according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses statement. We
identified 10 relevant studies for our meta-analysis. It included 6,779
patients who underwent S-LAAO and 6,573 who did not undergo LAAO. In terms
of ischemic stroke, the S-LAAO cohort had a lower events (pooled odds
ratio [OR] 0.655 (0.518 to 0.829), p = 0.0004) compared with the non-LAAO
cohort. S-LAAO cohort also had lower events of all-cause mortality (pooled
OR 0.74 (95% confidence interval 0.55 to 0.99), p = 0.0408) when compared
with the non-LAAO cohort. In regards to postoperative atrial fibrillation,
there was no difference between the 2 groups (pooled OR 1.29 (95%
confidence interval 0.81 to 2.06), p = 0.2752). In conclusion, S-LAAO was
associated with lower events of ischemic stroke or systemic embolism and
all-cause mortality when compared to the non-LAAO group.<br/>Copyright
&#xa9; 2019 Elsevier Inc.

<43>
Accession Number
2002624876
Title
Meta-Analysis Comparing Transcatheter Aortic Valve Implantation to
Surgical Aortic Valve Replacement in Low Surgical Risk Patients.
Source
American Journal of Cardiology. 124 (8) (pp 1257-1264), 2019. Date of
Publication: 15 October 2019.
Author
Saleem S.; Younas S.; Syed M.A.
Institution
(Saleem) Department of Cardiovascular Disease, University of Kentucky
College of Medicine, Bowling Green, KY, United States
(Younas) Khyber Medical College, Peshawar, Pakistan
(Syed) Department of Cardiovascular Disease, University of Toledo Medical
Center, Toledo, OH, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) is recommended for
inoperable and high risk surgical patients with severe aortic stenosis. It
is noninferior to surgical aortic valve replacement (SAVR) in intermediate
risk candidates. TAVI is currently being assessed for low surgical risk
individuals. We performed a meta-analysis of randomized controlled trials
(RCTs) and matched observational studies between TAVI and SAVR in low
surgical risk patients. The primary outcomes were short-term and mid-term
mortality and neurologic events. Secondary outcomes were other
periprocedure complications. A total of 8 studies (3 RCTs and 5 matched
observational studies) totaling 6,686 patients were included. No
difference was seen in short-term mortality and neurologic events (risk
ratio [RR] 0.68, 95% confidence interval [CI] 0.45 to 1.03, p 0.07 and RR
0.76, 95% CI 0.52 to 1.13, p 0.18) as well as mid-term mortality and
neurologic events (RR 0.89, 95% CI 0.54 to 1.47, p 0.65 and RR 1.04, 95%
CI 0.55 to 1.97, p 0.9) between the 2 groups. Reduced risk of new onset
atrial fibrillation (RR 0.14, 95% CI 0.08 to 0.25, p <0.00001), acute
kidney injury (RR 0.43, 95 CI 0.23 to 0.82, p 0.01), and bleeding (RR
0.43, 95% CI 0.27 to 0.69, p 0.0005) whereas increased risk of >= moderate
aortic regurgitation (RR 6.53, 95% CI 3.48 to 12.24, p <0.00001),
pacemaker or defibrillator implantation (RR 3.11, 95% CI 1.96 to 4.94, p
<0.00001) and vascular complications (RR 5.29, 95% CI 1.58 to 17.70, p
0.007) was noted in TAVI arm. In conclusion, TAVI is comparable to SAVR in
terms of short-term and mid-term mortality and neurologic events in low
surgical risk patients. The risk of periprocedure events is
variable.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<44>
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.<br/>&#xa9; Copyright 2019,
Mary Ann Liebert, Inc., publishers 2019.

<45>
Accession Number
2002711426
Title
Meta-Analysis Comparing Transcatheter Aortic Valve Implantation With
Balloon Versus Self-Expandable Valves.
Source
American Journal of Cardiology. 124 (8) (pp 1252-1256), 2019. Date of
Publication: 15 October 2019.
Author
Osman M.; Ghaffar Y.A.; Saleem M.; Kheiri B.; Osman K.; Munir M.B.;
Alkhouli M.
Institution
(Osman, Ghaffar, Saleem, Munir, Alkhouli) Division of Cardiology, West
Virginia University, Morgantown, WV, United States
(Kheiri) Oregon Knight Cardiovascular Institute, Portland, OR, United
States
(Osman) Michigan Health Specialist, Michigan State University, Flint, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Two transcatheter aortic valve systems are currently in use in the United
States; balloon-expandable valves (BEV) and the self-expanding valve
(SEV). However, comparative data outcomes between the 2 systems are
limited, as only one randomized trial (RCT) performed a head-to-head
comparison between BEVs and SEVs. However, there are several RCTs
comparing BEV or SEV to surgical valve replacement. In this analysis, we
used Bayesian network meta-analysis techniques to compare BEVs and SEVs.
The primary outcome was all-cause mortality at maximum follow-up.
Secondary outcomes were cardiovascular mortality, stroke, pacemaker
implantation, reintervention, heart failure hospitalization, and
moderate-severe paravalvular leak (PVL.). Eight RCTs with 8,095 patients
were included. With the exception of less pacemaker implantation in BEV
versus SEV (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.11 to
0.77, I² = 51%), there was no difference between BEV and SEV in
30-day outcomes. During long-term follow-up (mean 3 +/- 2 years); there
was no difference between BEV and SEV in all-cause mortality (hazard ratio
[HR] 1.1, 95% CI 0.87 to 1.5, I² = 19.6%), cardiovascular
mortality (HR 1.1, 95% CI 0.73 to 1.6, I² = 18.5%), stroke (HR
1.3, 95% CI 0.73 to 2.1, I² = 16.9%), hospitalization (HR 0.87,
95% CI 0.41 to 1.6, I² = 62%), and reintervention (HR 0.68, 95%
CI 0.2 to 2.3, I² = 62%). New pacemaker implantation and PVL
were significantly less in BEV group (HR 0.45, 95% CI 0.24 to 0.80,
I² = 38.2%), and (HR 0.03, 95% CI 0.0004 to 0.28, I²
= 79%), respectively. In conclusion, similar outcomes were seen following
transcatheter aortic valve implantation with BEV and SEV with the
exception of higher rates of pacemaker implantation and PVL in SEV
group.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<46>
Accession Number
624327081
Title
Cognitive Outcomes After Heart Valve Surgery: A Systematic Review and
Meta-Analysis.
Source
Journal of the American Geriatrics Society. 66 (12) (pp 2327-2334), 2018.
Date of Publication: December 2018.
Author
Oldham M.A.; Vachon J.; Yuh D.; Lee H.B.
Institution
(Oldham, Lee) Department of Psychiatry, University of Rochester Medical
Center, Rochester, NY, United States
(Vachon) Oncology Department, Ingram School of Nursing, McGill University,
Montreal, QC, Canada
(Yuh) Department of Surgery, Stamford Hospital, Stamford, CT, United
States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To summarize evidence on cognitive outcomes after heart valve
surgery; secondary aim, to examine whether aortic and mitral valve surgery
are associated with different cognitive outcomes. <br/>Design(s):
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
systematic review and meta-analysis. <br/>Setting(s): Cardiac surgery.
<br/>Participant(s): Individuals undergoing heart valve surgery.
Measurements: We searched MEDLINE, EMBASE, and PsycINFO for peer-reviewed
reports of individuals undergoing heart valve surgery who underwent pre-
and postoperative cognitive assessment. Our initial search returned 1,475
articles, of which 12 were included. Postoperative cognitive results were
divided into those from 1 week to 1 month (early outcomes,
n<inf>pooled</inf> = 450) and from 2 to 6 months (intermediate outcomes;
n<inf>pooled</inf> = 722). No studies with longer-term outcomes were
identified. <br/>Result(s): Subjects had moderate early cognitive decline
from baseline (Becker mean gain effect size (ES)=-0.39 +/- 0.27) that
improved slightly by 2 to 6 months (ES=-0.25 +/- 0.38). Individuals
undergoing aortic valve surgery-who were older on average than those
undergoing mitral valve surgery (68 vs 57)-had greater early cognitive
decline than those undergoing mitral valve surgery (ES=-0.68 vs -0.12),
but both cohorts had similar decline 2 to 6 months postoperatively
(ES=-0.27 vs -0.20). <br/>Conclusion(s): Heart valve surgery is associated
with cognitive decline over the 6 months after surgery, but outcomes
beyond 6 months are unclear. These findings highlight the cognitive
vulnerability of this population, especially older adults with aortic
stenosis. &#xa9; 2018 American Geriatrics Society and Wiley Periodicals,
Inc. J Am Geriatr Soc 66:2327-2334, 2018.<br/>&#xa9; 2018, Copyright the
Authors Journal compilation &#xa9; 2018, The American Geriatrics Society

<47>
Accession Number
624272167
Title
Postoperative Delirium in Individuals Undergoing Transcatheter Aortic
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Journal of the American Geriatrics Society. 66 (12) (pp 2417-2424), 2018.
Date of Publication: December 2018.
Author
Abawi M.; Pagnesi M.; Agostoni P.; Chiarito M.; van Jaarsveld R.C.; van
Dongen C.S.; Slooter A.J.C.; Colombo A.; Kooistra N.H.M.; Doevendans
P.A.F.M.; Latib A.; Stella P.R.
Institution
(Abawi, Agostoni, van Jaarsveld, van Dongen, Kooistra, Doevendans, Stella)
Department of Cardiology, University Medical Center Utrecht, Utrecht
University, Utrecht, Netherlands
(Pagnesi, Colombo, Latib) Interventional Cardiology Unit San Raffaele
Scientific Institute, Milan, Italy
(Agostoni) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Chiarito) Cardio Center Humanitas Research Hospital, Rozzano Milan, Italy
(Slooter) Department of Intensive Care Medicine and Brain Center Rudolf
Magnus, University Medical Center Utrecht, Utrecht University, Utrecht,
Netherlands
(Doevendans) Netherlands Heart Institute, Utrecht, Netherlands
(Colombo, Latib) Interventional Cardiology Unit EMO-GVM Centro Cuore
Columbus, Milan, Italy
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To evaluate the incidence of in-hospital postoperative
delirium (IHPOD) after transcatheter aortic valve replacement (TAVR).
<br/>Design(s): Systematic review and meta-analysis. <br/>Setting(s):
Elective procedures. <br/>Participant(s): Individuals undergoing TAVR.
Measurements: A literature search was conducted in PubMed, Embase,
BioMedCentral, Google Scholar, and the Cochrane Central Register of
Controlled Trials (up to December 2017). All observational studies
reporting the incidence of IHPOD after TAVR (sample size > 25) were
included in our meta-analysis. The reported incidence rates were weighted
to obtain a pooled estimate rate with 95% confidence interval (CI).
<br/>Result(s): Of 96 potentially relevant articles, 31 with a total of
32,389 individuals who underwent TAVR were included in the meta-analysis.
The crude incidence of IHPOD after TAVR ranged from 0% to 44.6% in
included studies, with a pooled estimate rate of 8.1% (95% CI=6.7-9.4%);
heterogeneity was high (Q = 449; I = 93%; p<inf>heterogeneity</inf>
<.001). The pooled estimate rate of IHPOD was 7.2% (95% CI=5.4-9.1%) after
transfemoral (TF) TAVR and 21.4% (95% CI=10.3-32.5%) after non-TF TAVR.
<br/>Conclusion(s): Delirium occurs frequently after TAVR and is more
common after non-TF than TF procedures. Recommendations are made with the
aim of standardizing future research to reduce heterogeneity between
studies on this important healthcare problem. J Am Geriatr Soc
66:2417-2424, 2018.<br/>&#xa9; 2018, Copyright the Authors Journal
compilation &#xa9; 2018, The American Geriatrics Society

<48>
Accession Number
625122037
Title
Preventing Postoperative Delirium After Major Noncardiac Thoracic
Surgery-A Randomized Clinical Trial.
Source
Journal of the American Geriatrics Society. 66 (12) (pp 2289-2297), 2018.
Date of Publication: December 2018.
Author
Khan B.A.; Perkins A.J.; Campbell N.L.; Gao S.; Khan S.H.; Wang S.;
Fuchita M.; Weber D.J.; Zarzaur B.L.; Boustani M.A.; Kesler K.
Institution
(Khan, Khan, Fuchita, Boustani) Department of Medicine, School of
Medicine, Indiana University, Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Center for Aging
Research, Indiana University, Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Regenstrief Institute,
Inc., Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Center for Health
Innovation and Implementation Science, Indiana Clinical and Translational
Sciences Institute, Indiana University, Indianapolis, IN, United States
(Perkins, Gao) Department of Statistics, School of Medicine, Indiana
University, Indianapolis, IN, United States
(Campbell) Eskenazi Health, Indianapolis, IN, United States
(Campbell) Department of Pharmacy Practice, College of Pharmacy, Purdue
University, West Lafayette, IN, United States
(Wang) Department of Psychiatry, School of Medicine, Indiana University,
Indianapolis, IN, United States
(Weber) Department of Surgery, University of California, San Francisco,
San Francisco, CA, United States
(Zarzaur, Kesler) Department of Surgery, School of Medicine, Indiana
University, Indianapolis, IN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To assess the efficacy of haloperidol in reducing
postoperative delirium in individuals undergoing thoracic surgery.
<br/>Design(s): Randomized double-blind placebo-controlled trial.
<br/>Setting(s): Surgical intensive care unit (ICU) of tertiary care
center. <br/>Participant(s): Individuals undergoing thoracic surgery
(N=135). <br/>Intervention(s): Low-dose intravenous haloperidol (0.5 mg
three times daily for a total of 11 doses) administered postoperatively.
Measurements: The primary outcome was delirium incidence during
hospitalization. Secondary outcomes were time to delirium, delirium
duration, delirium severity, and ICU and hospital length of stay. Delirium
was assessed using the Confusion Assessment Method for the ICU and
delirium severity using the Delirium Rating Scale-Revised. <br/>Result(s):
Sixty-eight participants were randomized to receive haloperidol and 67
placebo. No significant differences were observed between those receiving
haloperidol and those receiving placebo in incident delirium (n=15 (22.1%)
vs n=19 (28.4%); p =.43), time to delirium (p =.43), delirium duration
(median 1 day, interquartile range (IQR) 1-2 days vs median 1 day, IQR 1-2
days; p =.71), delirium severity, ICU length of stay (median 2.2 days, IQR
1-3.3 days vs median 2.3 days, IQR 1-4 days; p =.29), or hospital length
of stay (median 10 days, IQR 8-11.5 days vs median 10 days, IQR 8-12 days;
p =.41). In the esophagectomy subgroup (n = 84), the haloperidol group was
less likely to experience incident delirium (n=10 (23.8%) vs n=17 (40.5%);
p =.16). There were no differences in time to delirium (p =.14), delirium
duration (median 1 day, IQR 1-2 days vs median 1 day, IQR 1-2 days; p
=.71), delirium severity, or hospital length of stay (median 11 days, IQR
10-12 days vs median days 11, IQR 10-15 days; p =.26). ICU length of stay
was significantly shorter in the haloperidol group (median 2.8 days, IQR
1.1-3.8 days vs median 3.1 days, IQR 2.1-5.1 days; p =.03). Safety events
were comparable between the groups. <br/>Conclusion(s): Low-dose
postoperative haloperidol did not reduce delirium in individuals
undergoing thoracic surgery but may be efficacious in those undergoing
esophagectomy. J Am Geriatr Soc 66:2289-2297, 2018.<br/>&#xa9; 2018,
Copyright the Authors Journal compilation &#xa9; 2018, The American
Geriatrics Society

<49>
Accession Number
629363358
Title
Solvent/detergent-treated plasma safety in orthotopic liver transplant
patients: a single-center experience.
Source
Transfusion. Conference: American Association of Blood Banks Annual
Meeting, AABB 2019. United States. 59 (Supplement 3) (pp 210A), 2019. Date
of Publication: September 2019.
Author
Milito C.; McRae H.L.; Kara F.; Baum R.A.; Refaai M.A.
Institution
(Milito, McRae, Kara, Baum, Refaai) Transfusion Medicine, University of
Rochester Medical Center
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Solvent/detergent (SD)-treated, pooled plasma
(e.g., Octaplas) is indicated and approved for coagulation factor
replacement in patients with liver disease or undergoing cardiac surgery
or liver transplantation (LT), including orthotopic LT (OLT), as well as
in plasma exchange for patients with thrombotic thrombocytopenic purpura
(TTP). The utilization of SD-treated plasma (SDP) as opposed to
conventional fresh frozen plasma (FFP) is intended to reduce the
transmission of viruses via inactivation of enveloped viruses. Study
Design/Methods: OLT patients were blindly randomized into either treatment
with FFP or SDP (n = 13 each) throughout hospitalization. Following
discharge, patient characteristics, clinical, laboratory, and transfusion
data, intensive care unit (ICU) and hospital stay, and clinical outcomes
were collected and assessed. Results/Findings: Patient demographics were
not significantly different between both groups for age, reason for
requiring liver transplantation, Model for End-Stage Liver Disease (MELD)
scores, and comorbidities. Despite a trend toward less plasma and
cryoprecipitate transfusion in the SDP group, perioperative blood product
transfusions were similar between groups. Reasons for transfusion were
mainly surgical blood loss or slow, continuous gastrointestinal bleeding.
No patients in either group had any type of transfusion reaction.
Laboratory data between both groups was comparable. Percent change of
creatinine was significantly lower in the SDP group (<0.001). ICU and
hospital stay were comparable between both groups, along with overall
outcome (Table). <br/>Conclusion(s): Overall, SDP seems to be an
acceptable alternative to FFP in OLT patients. Changes in creatinine
levels between both groups indicated better renal function in the SDP
group. Obviously, the small sample size limited the potential significance
of fewer plasma and cryoprecipitate transfusions in this group as well.
More studies are warranted in this group of patients. (Table Presented).

<50>
Accession Number
629361243
Title
Whole blood use and patient outcomes in major hemorrhage: Results from the
Australian and New Zealand massive transfusion registry (ANZ-MTR).
Source
Transfusion. Conference: American Association of Blood Banks Annual
Meeting, AABB 2019. United States. 59 (Supplement 3) (pp 32A), 2019. Date
of Publication: September 2019.
Author
Waters N.; Sparrow R.; Haysom H.; Badami K.; Charlewood R.; Dinesh D.;
Gunn K.; McLintock C.; Sadani D.; Ure B.; Willard C.; Wood E.M.; Mcquilten
Z.
Institution
(Waters, Sparrow, Haysom, Willard, Mcquilten) Department of Epidemiology
and Preventive Medicine, Monash University
(Badami, Charlewood, Sadani) New Zealand Blood Service
(Dinesh, Ure) Wellington Hospital
(Gunn, McLintock) Auckland City Hospital
(Wood) Monash University
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: New Zealand Blood Service collects whole blood
(WB) leukoreduced for prehospital emergency and cardiac surgery and
WBplasma-reduced (WBPR) for neonatal exchange transfusion. These are
transfused to other patient groups at times of increased demand. We aimed
to describe WB use in massive transfusion (MT) for any clinical
indication, and to compare transfusion requirements, laboratory parameters
and patient outcomes for MT recipients who received WB with those who
received only RBC units. Study Design/Methods: All MT recipients between
2011 and 2018 at four New Zealand sites with access to WB were included.
WB donors were male, group O, hemolysin-negative, without high-titer
anti-A/anti-B. MT recipients were identified through the ANZ-MTR, which
systematically captures data on all adult patients who have received a MT
(defined as >=5 RBCs in any 4-h period) for any type of critical bleeding
during their hospital admission. Results/Findings: Of 1947 MT recipients,
315 (16.1%) from across the sites received one or more WB units. WB
recipients were transfused a median of 2 (IQR, 1-2) WB units. WB was most
commonly used in vascular surgery (21%), trauma (17%), gastrointestinal
(14%), cardiac surgery (11%), other surgery (10%), and obstetric
hemorrhage (7%). MT recipients in whom WB units were transfused commenced
sooner relative to time of hospital admission than RBC-only recipients. WB
recipients were younger (60 [42-73] vs. 64 [50-74] years, respectively; p
< 0.01], received fewer RBC units (9 [6-16] vs. 10 [7-15]; p = 0.013),
more fresh frozen plasma (FFP) units (6 [2-11] vs. 5 [2-9]; p < 0.001) and
more recombinant FVIIa (p = 0.02) than RBC-only recipients. There were no
differences in FC, prothrombin complex, or other fresh blood products
given. In the first 4 hours of MT, WB recipients had shorter activated
partial thromboplastin time compared to RBC-only recipients (42 [34-60]
vs. 47 [36-71] seconds; p = 0.01), while the nadir hemoglobin, platelet
count, and fibrinogen were similar for the two groups. WB recipients had
higher in-hospital mortality (31.4% vs. 25.3%; p = 0.024), but similar
intensive care length of stay and ventilation time. After adjusting for
age, sex, number of RBC and FFP units, clinical context, and hospital
site, there was no significant association between WB use and mortality
(adjusted odds ratio: WBPR, 1.19 [95% CI, 0.80-1.78] and WB
leukoreduction, 1.42 [95% CI, 0.94-2.15]). <br/>Conclusion(s): WB, when
available, was used across a variety of clinical contexts. WB recipients
had higher FFP use, but similar other component use during MT. Patient
outcomes, including mortality, were similar in WB recipients compared to
RBC-only recipients after adjustment for patient characteristics, other
product support and site. Randomized controlled studies evaluating
efficacy of WB for critical bleeding should be considered.

<51>
Accession Number
629360667
Title
The fibres randomized controlled noninferiority trial of fibrinogen
concentrates versus cryoprecipitate in cardiac surgery: Subgroup and
safety analysis.
Source
Transfusion. Conference: American Association of Blood Banks Annual
Meeting, AABB 2019. United States. 59 (Supplement 3) (pp 8A), 2019. Date
of Publication: September 2019.
Author
Callum J.; Farkouh M.; Scales D.; Heddle N.M.; Crowther M.; Rao V.; Hucke
H.-P.; Carroll J.; Grewal D.; Brar S.; Bussieres J.; Grocott H.; Harle C.;
Pavenski K.; Rochon A.; Saha T.; Shephard L.; Syed S.; Tran D.; Wong D.;
Zeller M.P.; Karkouti K.
Institution
(Callum) Sunnybrook Health Sciences Centre
(Farkouh, Rao) Peter Munk Cardiac Centre, Toronto General Hospital
Research Institute
(Scales) Sunnybrook Hospital
(Heddle, Crowther, Zeller) McMaster University
(Hucke) ERGOMED DCS Gmbh
(Carroll, Grewal, Karkouti) University Health Network
(Brar) University of British Columbia
(Bussieres) Institut Universitaire De Cardiologie Et De Pneumologie De
Quebec-Universite Laval
(Grocott) University of Manitoba
(Harle) Western University
(Pavenski) St. Michael's Hospital
(Rochon) Universite De Montreal
(Saha) Kingston General Hospital Queen's University
(Shephard) Kingston Health Science Center, Queen's University
(Syed) Hamilton Health Sciences Corporation, McMaster University
(Tran) School of Epidemiology and Public Health, University of Ottawa
(Wong) University of Ottawa
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: An important cause of bleeding after cardiac
surgery is acquired hypofibrinogenemia (fibrinogen <1.5-2.0 g/L), for
which guidelines recommend fibrinogen replacement with either
cryoprecipitate (Cryo) or pathogen-reduced fibrinogen concentrate (FC).
Despite safety and logistical issues with Cryo, it remains the preferred
choice in many jurisdictions. The objective of this study was to determine
if, in cardiac surgical patients with bleeding related to acquired
hypofibrinogenemia, FC is noninferior to Cryo for number of allogeneic
blood units transfused. Study Design/Methods: In this multicenter,
single-blinded study at 11 sites, cardiac surgical patients experiencing
bleeding and hypofibrinogenemia were randomized to 4 g of FC or 10 units
of Cryo for each ordered dose for 24 hours after bypass. Primary outcome
was blood component units (RBCs, platelets, plasma) administered during 24
hours after bypass. Safety was assessed for 28 days. The following a
priori defined subgroups were evaluated: elective versus nonelective
surgery; simple versus complex surgery; and excluding those who were in
critical preoperative state. Results/Findings: Modified intention-to-treat
analysis included 735 patients (372 FC, 363 Cryo). Groups were well
balanced except for number of patients in critical state before surgery:
63 (16.9%) in the FC group versus 38 (10.5%) in the Cryo group.
Noninferiority was achieved in the entire sample and for all defined
subgroups except for the nonelective group, likely due to enrichment with
patients in a critical preoperative state. Adverse event rates, including
thromboembolic complications (fibrinogen 7.0% vs. cryo 9.6%; p = NS), were
similar between groups. <br/>Conclusion(s): FC is noninferior to Cryo for
fibrinogen replacement in all types of bleeding patients with acquired
hypofibrinogenemia. Use of pathogen-reduced FC should therefore supersede
Cryo for bleeding patients with acquired hypofibrinogenemia in part to
mitigate the risk of emerging pathogen transmission.

<52>
Accession Number
2002920153
Title
The Thoracic Surgery Social Media Network: Early Experience and Lessons
Learned.
Source
Annals of Thoracic Surgery. 108 (4) (pp 1248-1255), 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, CA, United States
(Blitz) Division of Cardiac Surgery, University of Cincinnati Medical
Center, Cincinnati, OH, United States
(Stamp) Department of Cardiothoracic Surgery & Transplantation, Fiona
Stanley Hospital, Murdoch, Western Australia, Australia
(Varghese) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
(Cooke) Section of General Thoracic Surgery, University of California
Davis Health, Sacramento, CA, United States
(Antonoff) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson Cancer Center, Houston, TX, United States
Publisher
Elsevier USA
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. <br/>Method(s): Twitter
analytics was used to obtain information regarding the @TSSMN Twitter
handle and #TSSMN hashtag. TweetChat and general hashtag #TSSMN analytics
were measured using Symplur (Symplur LLC, Los Angeles, CA). A TSSMN
Tweeter App was created, and its use and downloads were analyzed.
<br/>Result(s): Hashtag #TSSMN has a total of 17,181 tweets, 2,100 users,
and 32,226,280 impressions, with peaks in tweeting activity corresponding
to TweetChats. Thirteen 1-hour TweetChats drew a total of 489
participants, 5195 total tweets, and 17,297,708 total impressions. The top
demographic category of TweetChat participants included Doctors (47%),
Advocates/Supports (11%), and Unknown (10%), with 3% characterized as
patients. The TSSMN Tweeter iTunes App (Apple, Cupertino, CA) was
downloaded 3319 times with global representation. A total of 859 articles
were viewed through the App, with 450 articles from The Annals of Thoracic
Surgery and 409 from The Journal of Thoracic and Cardiovascular Surgery.
<br/>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.<br/>Copyright &#xa9; 2019 The Society of Thoracic
Surgeons and The American Association for Thoracic Surgery

<53>
Accession Number
629354251
Title
Levosimendan in patients with left ventricular dysfunction undergoing
cardiac surgery: a meta-analysis and trial sequential analysis of
randomized trials.
Source
Scientific reports. 8 (1) (pp 7775), 2018. Date of Publication: 17 May
2018.
Author
Xing Z.; Tang L.; Chen P.; Huang J.; Peng X.; Hu X.
Institution
(Xing, Tang, Chen, Huang, Peng, Hu) Department of Cardiovascular Medicine,
Second Xiangya Hospital, Central South University, Changsha, Hunan 410011,
China
Publisher
NLM (Medline)
Abstract
Patients with left ventricular dysfunction (LVD) undergoing cardiac
surgery have a high mortality rate. Levosimendan, a calcium sensitizer,
improves myocardial contractility without increasing myocardial oxygen
demand. It is not clear whether levosimendan can reduce mortality in
cardiac surgery patients with LVD. The PubMed, Embase, and Cochrane
Central databases were searched to identify randomized trials comparing
levosimendan with conventional treatment in cardiac surgery patients with
LVD. We derived pooled risk ratios (RRs) with random effects models. The
primary endpoint was perioperative mortality. Secondary endpoints were
renal replacement treatment, atrial fibrillation, myocardial infarction,
ventricular arrhythmia, and hypotension. Fifteen studies enrolling 2606
patients were included. Levosimendan reduced the incidence of
perioperative mortality (RR: 0.64, 95%CI: 0.45-0.91) and renal replacement
treatment (RR:0.71, 95%CI:0.52-0.95). However, sensitivity analysis,
subgroup analysis and Trial Sequential Analysis (TSA) indicated that more
evidence was needed. Furthermore, levosimendan did not reduce the
incidence of atrial fibrillation (RR:0.82, 95%CI:0.64-1.07), myocardial
infarction (RR:0.56, 95%CI:0.26-1.23), or ventricular arrhythmia (RR:0.74,
95%CI:0.49-1.11), but it increased the incidence of hypotension
(RR:1.11,95%CI:1.00-1.23). There was not enough high-quality evidence to
either support or contraindicate the use of levosimendan in cardiac
surgery patients with LVD.

<54>
Accession Number
2002935782
Title
Critical appraisal on the impact of preoperative rehabilitation and
outcomes after major abdominal and cardiothoracic surgery: A systematic
review and meta-analysis.
Source
Surgery (United States). (no pagination), 2019. Date of Publication: 2019.
Author
Kamarajah S.K.; Bundred J.; Weblin J.; Tan B.H.L.
Institution
(Kamarajah) Institute of Cellular Medicine, University of Newcastle,
Newcastle-Upon-Tyne, United Kingdom
(Kamarajah) Department of Hepatobiliary, Pancreatic, and Transplant
Surgery, Freeman Hospital, Newcastle University Trust Hospitals,
Newcastle-Upon-Tyne, United Kingdom
(Bundred) College of Medical and Dental Sciences, University of
Birmingham, United Kingdom
(Weblin) Department of Physiotherapy, Queen Elizabeth Hospital Birmingham,
United Kingdom
(Tan) Department of Upper Gastrointestinal Surgery, Queen Elizabeth
Hospital Birmingham, United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: There has been increasing interest in the prehabilitation of
patients undergoing major abdominal surgery to improve perioperative
outcomes. This systematic review and meta-analysis aims to evaluate and
compare the current literature on prehabilitation in major abdominal
surgery and cardiothoracic surgery Methods: A systematic literature search
was conducted for studies reporting prehabilitation in patients undergoing
major abdominal and cardiothoracic surgery. Meta-analysis of postoperative
outcomes (overall and major complications, pulmonary and cardiac
complications, postoperative pneumonia, and length of hospital stay) was
performed using random effects models. <br/>Result(s): Five thousand nine
hundred and twenty-one patients underwent prehabilitation in 61 studies,
of which 35 studies (n = 3,402) were in major abdominal surgery and 26
studies were in cardiothoracic surgery (n = 2,519). Only 45 studies
compared the impact of prehabilitation versus no prehabilitation on
postoperative outcomes (abdominal, n = 26; cardiothoracic, n = 19).
Quality of evidence for prehabilitation in major abdominal and
cardiothoracic surgery appear equivalent. Patients receiving
prehabilitation for major abdominal surgery have significantly lower rates
of overall (n = 10, odds ratio: 0.61, confidence interval 95%: 0.43-0.86,
P = .005), pulmonary (n = 15, odds ratio: 0.41, confidence interval 95%:
0.25-0.67, P < .001), and cardiac complications (n = 4, odds ratio: 0.46,
confidence interval 95%: 0.22-0.96, P = .044). Sensitivity analysis
including randomized controlled trials only did not alter the findings of
this study. <br/>Conclusion(s): Prehabilitation has the potential to
improve surgical outcomes in patients undergoing major abdominal and
cardiothoracic surgery. However, current evidence from randomized studies
remains weak owing to variation in prehabilitation regimes, limiting the
assessment of current postoperative outcomes.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<55>
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.<br/>Copyright &#xa9; 2019 British Journal of Anaesthesia

<56>
Accession Number
2002069083
Title
Meta-analysis of the outcomes of revascularization after intentional
coverage of the left subclavian artery for thoracic endovascular aortic
repair.
Source
Journal of Vascular Surgery. 70 (4) (pp 1330-1340), 2019. Date of
Publication: October 2019.
Author
Chen X.; Wang J.; Premaratne S.; Zhao J.; Zhang W.W.
Institution
(Chen, Wang, Zhao) Department of Vascular Surgery, West China Hospital of
Sichuan University, Chengdu, Sichuan, China
(Premaratne) Hunter Holmes McGuire Veterans Administration Medical Center,
Richmond, Va, United States
(Zhang) Division of Vascular and Endovascular Surgery, Department of
Surgery, University of Washington and Puget Sound VA Health Care System,
Seattle, Wash, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Coverage of the left subclavian artery (LSA) is often required
to achieve complete proximal sealing during thoracic endovascular aortic
repair. However, whether LSA revascularization should be performed remains
controversial. <br/>Method(s): MEDLINE, Embase, and Cochrane databases
were systematically searched to identify all the relevant studies. A
random-effects model was applied to pool the effect measures. Dichotomous
data were presented using an odds ratio (OR). <br/>Result(s): There were
32 studies included for qualitative analysis and 31 studies for
quantitative analysis. We found that patients who underwent LSA
revascularization had a significantly decreased risk of spinal cord
ischemia (OR, 0.62; 95% confidence interval [CI], 0.41-0.92; P = .02;
I² = 0%), cerebrovascular accident (OR, 0.63; 95% CI,
0.42-0.95; P = .03; I² = 22%), and left upper extremity
ischemia (OR, 0.18; 95% CI, 0.09-0.36; P < .00001; I² = 0%).
However, no significant differences were found in the risk of paraplegia
(OR, 0.91; 95% CI, 0.55-1.51; P = .71; I² = 0%) and 30-day
mortality (OR, 0.89; 95% CI, 0.59-1.36; P = .60; I² = 21%)
between the groups of patients with and without LSA revascularization.
<br/>Conclusion(s): Revascularization of the LSA is associated with
decreased risks of cerebrovascular accident, spinal cord ischemia, and
left upper limb ischemia in thoracic endovascular aortic repair with LSA
coverage at the cost of higher local complications, such as possible vocal
cord paresis.<br/>Copyright &#xa9; 2019

<57>
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).
<br/>Background(s): The impact of varying stages of CKD or end-stage renal
disease (ESRD) on patients receiving TAVR is not clearly identified.
<br/>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. <br/>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). <br/>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.<br/>Copyright
&#xa9; 2019 Wiley Periodicals, Inc.

<58>
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.
<br/>Design(s): Prospective, double-blind, randomized, controlled trial.
<br/>Setting(s): Two tertiary intensive care units (ICUs).
<br/>Participant(s): Post-cardiac surgery patients with vasoplegia.
<br/>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. <br/>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&#32;g/kg
versus 47.4 (21.4-265.9) micro&#32;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. <br/>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.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<59>
Accession Number
2002913363
Title
Meta-Analysis of AKI-CKD Transition in Perioperative Patients.
Source
Journal of the American College of Surgeons. Conference: The American
College of Surgeons 2019 Annual Clinical Congress. United States. 229 (4
Supplement 2) (pp e234), 2019. Date of Publication: October 2019.
Author
Abdala P.; Swanson E.; Hutchens M.
Institution
(Abdala, Swanson, Hutchens) Oregon Health & Science University (OHSU),
Portland, OR, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Recent research shows AKI increases the risk of incident
CKD. We hypothesized that perioperative AKI may confer increased risk of
subsequent CKD compared to nonperioperative AKI. <br/>Method(s): MEDLINE
search for "AKI, CKD, chronic renal insufficiency, burns, nephrotoxins,
sepsis, systemic inflammatory response, surgical procedures" yielded 5209
articles. 1048 relevant studies were reviewed. 1002 were excluded because
they were review, animal, or pediatric studies. 30 of 42 were excluded
because they did not meet inclusion criteria. 12 underwent analysis. 2x2
tables were constructed from AKI +/- and CKD +/- data. The R package
metafor was employed. Estimates of odds ratio (OR) were calculated, and a
random-effects model used to calculate weighted ORs. Heterogeneity was
assessed. Leave-1-out and funnel analysis were used to estimate study
heterogeneity and bias. <br/>Result(s): Nonperioperative studies included
studies of oncology, percutaneous coronary intervention, and myocardial
infarction patients. Perioperative studies comprised patients from cardiac
surgery, vascular surgery, and burns. There was significant heterogeneity
but publication bias was not evident. The OR for AKI [95% CI] vs non-AKI
patients developing CKD in all studies was 5.52 [3.15-9.67].
Nonperioperative populations demonstrated OR 3.85 [1.71-8.69] whilst
perioperative populations demonstrated OR 6.64 [3.17-13.91].
<br/>Conclusion(s): Increasing literature supports association of AKI with
subsequent CKD such that subgroup analysis may be applied. While there is
significant heterogeneity, surgical patients may experience increased risk
of AKI-CKD transition over nonsurgical patients.<br/>Copyright &#xa9; 2019

<60>
Accession Number
2002913326
Title
Effect of Left Lateral Decubitus Positioning on Urine Output in
Postoperative Patients.
Source
Journal of the American College of Surgeons. Conference: The American
College of Surgeons 2019 Annual Clinical Congress. United States. 229 (4
Supplement 2) (pp e113), 2019. Date of Publication: October 2019.
Author
Desai H.A.; Markowiak S.; Casabianca A.; Brunicardi F.C.; Allison D.; Jain
S.; Tang J.
Institution
(Desai, Markowiak, Casabianca, Brunicardi, Allison, Jain, Tang) University
of Toledo College of Medicine and Life Sciences, Toledo, OH, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Compression of major abdominal vessels leads to decreased
venous return, cardiac output, renal perfusion and increased fluid
retention. This is well documented in pregnant, hypovolemic patients,
where it may be relieved by left lateral decubitus positioning which off
loads the weight of the gravid uteri. We hypothesize that postoperative
fluid retention may also occur by this mechanism and report preliminary
results of our randomized study. <br/>Method(s): A prospective,
IRB-approved trial studied adult patients immediately after completing
non-cardiac surgical procedures in the recovery room. Exclusion criteria
were renal failure and age<40 years. Patients were randomly assigned to
either supine or left-lateral decubitus groups. All patients spent the
first and last 15-minutes of the study in the supine position, while
patients in the left lateral decubitus group spent the middle 30 minutes
in the left-lateral decubitus position. Overall fluid balances and average
urine outputs were recorded at 15 minute intervals and compared by
Chi-square analysis with a p-value<0.02 considered significant.
<br/>Result(s): Twenty-four patients gave consent and completed the study.
There was a significant difference in average urine output between the two
groups, although the difference in overall fluid balance between the
lateral and supine groups did not reach significance (p=0.16).
<br/>Conclusion(s): Left lateral decubitus positioning may reduce fluid
overload in the immediate postoperative period. Further work is needed to
see if patient positioning might be a useful adjunct for reducing
postoperative fluid retention in critically ill patients at longer
intervals after surgery.<br/>Copyright &#xa9; 2019

<61>
Accession Number
629302263
Title
Comparison of Scientific Publications from Three Different Clinical
Disciplines of German Universities.
Source
Thoracic and Cardiovascular Surgeon. 67 (6) (pp 488-493), 2019. Date of
Publication: 2019.
Author
Schwarzer M.; Alscher L.; Doenst T.
Institution
(Schwarzer, Alscher, Doenst) Department of Cardiothoracic Surgery,
University Hospital Jena, Am Klinikum 1, Jena 07747, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
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.
Methods 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). Results 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 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.<br/>Copyright &#xa9; 2019 by Thieme Medical
Publishers, Inc.

<62>
Accession Number
629351833
Title
In-Hospital Physiotherapy and Physical Recovery 3 Months After Lung Cancer
Surgery: A Randomized Controlled Trial.
Source
Integrative cancer therapies. 18 (pp 1534735419876346), 2019. Date of
Publication: 01 Jan 2019.
Author
Jonsson M.; Ahlsson A.; Hurtig-Wennlof A.; Vidlund M.; Cao Y.; Westerdahl
E.
Institution
(Jonsson, Hurtig-Wennlof, Vidlund, Cao, Westerdahl) Orebro University,
Sweden
(Ahlsson) Karolinska University Hospital, Stockholm, Sweden
(Cao) Karolinska Institutet, Stockholm, Sweden
Publisher
NLM (Medline)
Abstract
Background. Lung cancer is the most frequently diagnosed cancer and one of
the leading causes of cancer deaths. Surgery is the primary approach for
curative treatment. Postoperative complications are common, and
physiotherapy is often routinely provided for their prevention and
treatment, even though the evidence is limited. The aim of this study was
to examine the effect of in-hospital physiotherapy on postoperative
physical capacity, physical activity, and lung function among patients
undergoing lung cancer surgery. Methods. A total of 107 patients
undergoing elective thoracic surgery were included in a single-blinded
randomized controlled trial, and randomized to a study group, receiving
in-hospital physiotherapy treatment, or a control group, not receiving
in-hospital physiotherapy treatment. The patients were assessed
preoperatively and 3 months after surgery. The in-hospital physiotherapy
treatment consisted of early mobilization, ambulation, breathing
exercises, and thoracic range of motion exercises. Physical capacity was
assessed with the 6-minute walk test. Level of physical activity was
objectively assessed with an accelerometer and subjectively assessed with
the International Physical Activity Questionnaire Modified for the
Elderly. Results. Physical capacity for the whole sample was significantly
decreased 3 months postoperatively compared with preoperative values (P =
.047). There were no statistically significant differences between the
groups regarding physical capacity, physical activity, spirometric values,
or dyspnea. However, patients in the study group increased their level of
self-reported physical activity from preoperatively to 3 months
postoperatively, while the patients in the control group did not.
Conclusions. No difference in physical capacity, physical activity, or
lung function was found 3 months postoperatively in lung cancer surgery
patients receiving in-hospital physiotherapy compared with control
patients.

<63>
Accession Number
629353731
Title
The effects of multimedia education on postoperative delirium in patients
undergoing coronary artery bypass graft: A randomized clinical trial.
Source
Nursing in critical care. (no pagination), 2019. Date of Publication: 18
Sep 2019.
Author
Fahimi K.; Abbasi A.; Zahedi M.; Amanpour F.; Ebrahimi H.
Institution
(Fahimi) Shahid Sayyad Shirazi Hospital, Golestan University of Medical
Sciences, Gorgan, Iran, Islamic Republic of
(Abbasi) Department of Nursing, School of Nursing and Midwifery, Shahroud
University of Medical Sciences, Iran, Islamic Republic of
(Zahedi) Ischemic Disorders Research Center, Golestan University of
Medical Sciences, Gorgan, Iran, Islamic Republic of
(Amanpour) Clinical Research Development Unit, Bahar Hospital, Shahroud
University of Medical Sciences, Iran, Islamic Republic of
(Ebrahimi) Randomized Controlled Trial Research Center, Shahroud
University of Medical Sciences, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients undergoing cardiac surgeries are at high risk of
developing delirium. AIMS AND OBJECTIVES: The present study aimed to
determine the effects of multimedia education on postoperative delirium in
patients undergoing a coronary artery bypass graft. DESIGN: This study was
a randomized clinical trial. <br/>METHOD(S): In this study, 110 patients
undergoing a coronary artery bypass graft were assigned to two groups,
control and intervention. Patients in the intervention group received
multimedia education, and those in the control group received routine
training. The inclusion criteria were experiencing the coronary artery
bypass graft for the first time and non-development of post-operative
cardiogenic shock or myocardial rupture. After measuring the level of
consciousness, patients were examined in terms of delirium using the
confusion assessment method for the ICU scale twice a day from admission
to discharge from the ICU. The data were statistically analysed using chi2
test and Fisher's exact test. <br/>RESULT(S): Patients of both groups were
matched in terms of demographics. The highest incidence of delirium was
observed on the first day after surgery in the intervention group (14.5%)
and in the morning of the second day after surgery (29.1%) in the control
group. Moreover, there was a significant difference between the two groups
in the incidence of delirium in the morning of the second, third, and
fourth days after surgery as it was higher in the control group over these
days. <br/>CONCLUSION(S): Considering the lower incidence of
post-operative delirium in patients who experienced multimedia education
rather than control group, the use of this non-pharmaceutical method is
recommended to prevent delirium in such patients. RELEVANCE TO CLINICAL
PRACTICE: Delirium is also an acute organic brain syndrome that often
leads to complicated conditions after cardiac surgeries. Fortunately,
delirium is a preventable issue. The implementation of multimedia
education as a non-pharmacological approach had positive effects on
patients' delirium.<br/>Copyright &#xa9; 2019 British Association of
Critical Care Nurses.

<64>
Accession Number
629352980
Title
Dynamic predictive model for postoperative nausea and vomiting for
intravenous fentanyl patient-controlled analgesia.
Source
Anaesthesia. (no pagination), 2019. Date of Publication: 18 Sep 2019.
Author
Chae D.; Kim S.Y.; Song Y.; Baek W.; Shin H.; Park K.; Han D.W.
Institution
(Chae, Park) Department of Pharmacology, Severance Hospital, Anesthesia
and Pain Research Institute, Yonsei University College of Medicine, Seoul,
South Korea
(Kim, Baek, Shin) Department of Anesthesiology and Pain Medicine,
Severance Hospital, Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Song, Han) Department of Anesthesiology and Pain Medicine, Gangnam
Severance Hospital, Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
Postoperative nausea and vomiting is the most common side-effect of
opioid-based intravenous patient-controlled analgesia. Apfel's simplified
risk score is popular but it has some limitations. We developed and
validated a dynamic predictive model for nausea or vomiting up to 48
postoperative hours, available as an online web application. Fentanyl was
used by 22,144 adult patients for analgesia after non-cardiac surgery
under general anaesthesia: we randomly divided them into development (80%)
and validation (20%) cohorts, repeated 100 times. We used linear
discriminant analysis to select variables for multivariate logistic
regression. The incidences of postoperative nausea or vomiting were: 0-48
h, 5691/22,144 (26%); 0-6 h, 2749/22,144 (12%); 6-12 h, 2687/22,144 (12%);
12-18 h, 2624/22,144 (12%); 18-24 h, 1884/22,144 (9%); and 24-48 h,
1082/22,144 (5%). The median (95%CI) area under the receiver operating
characteristic curve was 0.72 (0.71-0.73) up to 48 postoperative hours
compared with 0.65 (0.64-0.66) for the Apfel model, p < 0.001. The
equivalent areas for 0-6 h, 6-12 h, 12-18 h, 18-24 h and 24-48 h were:
0.70 (0.69-0.72); 0.71 (0.69-0.73); 0.69 (0.68-0.71); 0.70 (0.67-0.72);
and 0.69 (0.66-0.71), respectively. Our web application allows clinicians
to calculate incidences of nausea and vomiting in patients receiving
intravenous fentanyl for patient-controlled analgesia.<br/>Copyright
&#xa9; 2019 Association of Anaesthetists.

<65>
Accession Number
629352949
Title
Sternal wound closure in the current era: the need of a tailored approach.
Source
General thoracic and cardiovascular surgery. (no pagination), 2019. Date
of Publication: 17 Sep 2019.
Author
Nenna A.; Nappi F.; Dougal J.; Satriano U.; Chello C.; Mastroianni C.;
Lusini M.; Chello M.; Spadaccio C.
Institution
(Nenna, Satriano, Mastroianni, Lusini, Chello) Department of
Cardiovascular Surgery, Universita Campus Bio-Medico Di Roma, Via Alvaro
del Portillo 200, Rome 00128, Italy
(Nappi) Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis,
Paris, France
(Dougal, Spadaccio) Cardiac Surgery, Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Chello) Dermatology, University of Rome "La Sapienza", Rome, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Median sternotomy remains the most common access to perform
cardiac surgery procedures. However, the experience of the operating
surgeon remains a crucial factor during sternal closure to avoid potential
complications related to poor sternal healing, such as mediastinitis.
Considering the lack of major randomized controlled trials and the
heterogeneity of the current literature, this narrative review aims to
summarize the different techniques and approaches to sternal closure with
the aim to investigate their reflections into clinical outcomes and to
inform the choice on the most effective closure method after median
sternotomy. <br/>METHOD(S): A literature search through PubMed, Embase,
EBSCO, Cochrane database of systematic reviews, and Web of Science from
its inception up to April 2019 using the following search keywords in
various combinations: sternal, sternotomy, mediastinitis, deep sternal
wound infection, cardiac surgery, closure. <br/>RESULT(S): Single wire
fixation methods, at present, seems the most useful method to perform
sternal closure in routine patients, although patients with a fragile
sternum might benefit more from a figure-of-eight technique. In high-risk
patients (e.g. chronic pulmonary disease, obesity, bilateral internal
mammary artery harvesting, diabetes, off-midline sternotomy), rigid plate
fixation is currently the most effective method, if available;
alternatively, weave techniques could be used. <br/>CONCLUSION(S): The
choice among the sternal closure techniques should be mainly inspired and
tailored on the patient's characteristics, and correct judgement and
experience play a pivotal role. A decisional algorithm has been proposed
as an attempt to overcome the absence of specific guidelines and to guide
the operative approach. This operative approach might be used also in
non-cardiac procedure in which median sternotomy is required, such as in
case of thoracic surgery.

<66>
Accession Number
2000755235
Title
Prospective, randomized, controlled trial of polymer cable ties versus
standard wire closure of midline sternotomy.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (4) (pp 1589-1595.e1),
2018. Date of Publication: October 2018.
Author
Marasco S.F.; Fuller L.; Zimmet A.; McGiffin D.; Seitz M.; Ch'ng S.;
Gangahanumaiah S.; Bailey M.
Institution
(Marasco, Zimmet, McGiffin, Seitz, Ch'ng, Gangahanumaiah) CJOB
Cardiothoracic Surgery Department, The Alfred Hospital, Melbourne,
Victoria, Australia
(Marasco, McGiffin) Department of Surgery, The Alfred Hospital, Monash
University, Melbourne, Victoria, Australia
(Fuller) Physiotherapy Department, The Alfred Hospital, Melbourne,
Victoria, Australia
(Bailey) Australian and New Zealand Intensive Care Research Centre, Monash
University, Melbourne, Victoria, Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Midline sternotomy remains the most common access incision for
cardiac operations. Traditionally, the sternum is closed with stainless
steel wires. Wires are well known to stretch and break, however, leading
to pain, nonunion, and potential deep sternal wound infection. We
hypothesized that biocompatible plastic cable ties would achieve a more
rigid sternal fixation, reducing postoperative pain and analgesia
requirements. <br/>Method(s): A prospective, randomized study compared the
ZIPFIX (De Puy Synthes, West Chester, Pa) sternal closure system (n = 58)
with standard stainless steel wires (n = 60). Primary outcomes were pain
and analgesia requirements in the early postoperative period. Secondary
outcome was sternal movement, as assessed by ultrasound at the
postoperative follow-up visit. <br/>Result(s): Groups were well matched in
demographic and operative variables. There were no significant differences
between groups in postoperative pain, analgesia, or early ventilatory
requirements. Patients in the ZIPFIX group had significantly more movement
in the sternum and manubrium on ultrasound at 4 weeks. <br/>Conclusion(s):
ZIPFIX sternal cable ties provide reliable closure but no demonstrable
benefit in this study in pain or analgesic requirements relative to
standard wire closure after median sternotomy.<br/>Copyright &#xa9; 2018

<67>
Accession Number
619924382
Title
Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design
of a Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 121-129),
2018. Date of Publication: February 2018.
Author
Shehata N.; Whitlock R.; Fergusson D.A.; Thorpe K.E.; MacAdams C.; Grocott
H.P.; Rubens F.; Fremes S.; Lellouche F.; Bagshaw S.; Royse A.; Rosseel
P.M.; Hare G.; Medicis E.D.; Hudson C.; Belley-Cote E.; Bainbridge D.;
Kent B.; Shaw A.; Byrne K.; Syed S.; Royse C.F.; McGuiness S.; Hall J.;
Mazer C.D.
Institution
(Shehata) Departments of Medicine, Laboratory Medicine and Pathobiology,
Institute of Health Policy Management and Evaluation, University of
Toronto, Division of Hematology, Mount Sinai Hospital, Toronto, Ontario,
Canada
(Whitlock) Department of Surgery, Population Health Research Institute,
McMaster University, David Braley Cardiac Vascular and Stroke Research
Institute, Hamilton, Ontario, Canada
(Fergusson) Ottawa Health Research Institute, University of Ottawa, The
Ottawa Hospital, General Campus, Centre for Practice-Changing Research,
Ottawa, Ontario, Canada
(Thorpe, Hall) Applied Health Research Center, St. Michael's Hospital,
Toronto, Ontario, Canada
(MacAdams) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, University of Melbourne, Toronto, Ontario, Australia
(Grocott) Departments of Anesthesia & Perioperative Medicine and Surgery,
University of Manitoba, St. Boniface General Hospital, Winnipeg, Manitoba,
Canada
(Rubens) Department of Surgery, University of Ottawa, Ottawa Heart
Institute, Ottawa, Ontario, Canada
(Fremes) Department of Surgery, University of Toronto, Sunnybrook Health
Sciences Centre, Toronto, Ontario, Canada
(Lellouche) Department of Medicine, University of Laval, Unite de
Recherche en Pneumologie, Quebec, Canada
(Bagshaw) Department of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, Alberta, Canada
(Royse, Royse) Department of Surgery, The University of Melbourne, The
Royal Melbourne Hospital, Parkville, Victoria, Australia
(Rosseel) Department of Anesthesia, Amphia Hospital, Breda, Netherlands
(Hare, Mazer) Department of Anesthesia, University of Toronto, St.
Michael's Hospital, Toronto, Ontario, Canada
(Medicis) Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke,
Quebec, Canada
(Hudson) Department of Anesthesia, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada
(Belley-Cote) Department of Medicine, Population Health Research
Institute, McMaster University, Hamilton, Canada
(Bainbridge) Department of Anaesthesia and Perioperative Medicine, Western
University, London, Ontario, Canada
(Kent) Department of Anesthesia, Pain Management and Perioperative
Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
(Shaw) Department of Anesthesia, Vanderbilt University Medical Center,
Nashville, TN, United States
(Byrne) Department of Anesthesia, Waikato Hospital, Hamilton, New Zealand
(Syed) Department of Anesthesia, McMaster University, Hamilton Health
Sciences, Hamilton, Ontario, Canada
(Royse) Department of Cardiothoracic Anaesthesia, Royal Melbourne
Hospital, Parkville, Victoria, Australia
(McGuiness) Medical Research Institute of New Zealand, Auckland City
Hospital, Auckland, New Zealand
Publisher
W.B. Saunders
Abstract
Objectives: To determine if a restrictive transfusion threshold is
noninferior to a higher threshold as measured by a composite outcome of
mortality and serious morbidity. <br/>Design(s): Transfusion Requirements
in Cardiac Surgery (TRICS) III was a multicenter, international,
open-label randomized controlled trial of two commonly used transfusion
strategies in patients having cardiac surgery using a noninferiority trial
design (ClinicalTrials.gov number, NCT02042898). <br/>Setting(s): Eligible
patients were randomized prior to surgery in a 1:1 ratio.
<br/>Participant(s): Potential participants were 18 years or older
undergoing planned cardiac surgery using cardiopulmonary bypass (CPB) with
a preoperative European System for Cardiac Operative Risk Evaluation
(EuroSCORE I) of 6 or more. <br/>Intervention(s): Five thousand patients;
those allocated to a restrictive transfusion group received a red blood
cell (RBC) transfusion if the hemoglobin concentration (Hb) was less than
7.5 g/dL intraoperatively and/or postoperatively. Patients allocated to a
liberal transfusion strategy received RBC transfusion if the Hb was less
than 9.5 g/dL intraoperatively or postoperatively in the intensive care
unit or less than 8.5 g/dL on the ward. <br/>Measurements and Main
Results: The primary outcome was a composite of all-cause mortality,
myocardial infarction, stroke, or new onset renal dysfunction requiring
dialysis at hospital discharge or day 28, whichever comes first. The
primary outcome was analyzed as a per-protocol analysis. The trial
monitored adherence closely as adherence to the transfusion triggers is
important in ensuring that measured outcomes reflect the transfusion
strategy. <br/>Conclusion(s): By randomizing prior to surgery, the TRICS
III trial captured the most acute reduction in hemoglobin during
cardiopulmonary bypass.<br/>Copyright &#xa9; 2018

<68>
Accession Number
2000822917
Title
A role for very low-dose recombinant activated factor VII in refractory
bleeding after cardiac surgery: Lessons from an observational study.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (4) (pp 1564-1573.e8),
2018. Date of Publication: October 2018.
Author
Hoffmann T.; Assmann A.; Dierksen A.; Roussel E.; Ullrich S.; Lichtenberg
A.; Albert A.; Sixt S.
Institution
(Hoffmann, Roussel) Transfusion Medicine and Clinical Haemostaseology,
United States
(Assmann, Dierksen, Lichtenberg, Albert) Department of Cardiovascular
Surgery, United States
(Ullrich) .05 Statistics Consultants, Life Science Centre, Duesseldorf,
Germany
(Sixt) Department of Anaesthesiology Heinrich Heine University, Medical
Faculty, Duesseldorf, Germany
(Assmann) Biomaterials Innovation Research Center, Brigham and Women's
Hospital, Department of Medicine, Harvard Medical School, Boston, Mass,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Although off-label use of recombinant activated factor VII
against refractory bleeding is incorporated in current guideline
recommendations, safety concerns persist predominantly with respect to
thromboembolic complications. We analyzed the safety and efficacy of
recombinant activated factor VII at a very low dose in cardiosurgical
patients with refractory bleeding. <br/>Method(s): This prospective study
includes 1180 cardiosurgical patients at risk of bleeding. Goal-directed
substitution was based on real-time laboratory testing and clinical
scoring of the bleeding intensity. All patients who fulfilled the criteria
for enhanced risk of bleeding (n = 281) were consequently included in the
present analysis. Patients in whom refractory bleeding developed despite
substitution with specific hemostatic compounds (n = 167) received a
single shot of very low-dose recombinant activated factor VII (<=20
mug/kg). Mortality and risk of thromboembolic complications, and freedom
from stroke and acute myocardial infarction in particular, were analyzed
(vs patients without recombinant activated factor VII) by multivariable
logistic and Cox regression analyses, as well as Kaplan-Meier estimates.
<br/>Result(s): There was no increase in rates of mortality (30-day
mortality 4.2% vs 7.0% with P =.418; follow-up survival 85.6% at 13.0
[interquartile range, 8.4-15.7] months vs 80.7% at 10.2 [interquartile
range, 7.2-16.1] months with P =.151), thromboembolic complications (6.6%
vs 9.6% with P =.637), renal insufficiency, need for percutaneous coronary
intervention, duration of ventilation, duration of hospital stay, or
rehospitalization in patients receiving very low-dose recombinant
activated factor VII compared with patients not receiving recombinant
activated factor VII. Complete hemostasis without any need for further
hemostatic treatment was achieved after very low-dose recombinant
activated factor VII administration in the majority of patients (up to
88.6% vs 0% with P <.001). The key results were confirmed after adjustment
by propensity score-based analyses. <br/>Conclusion(s): When combined with
early and specific restoration of hemostatic reserves after cardiac
surgery, very low-dose recombinant activated factor VII treatment of
refractory bleeding is effective and not associated with any apparent
increase in adverse events.<br/>Copyright &#xa9; 2018 The American
Association for Thoracic Surgery

<69>
Accession Number
2000925758
Title
Saphenous vein versus right internal thoracic artery as a Y-composite
graft: Five-year angiographic and clinical results of a randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (4) (pp 1424-1433.e1),
2018. Date of Publication: October 2018.
Author
Kim M.-S.; Hwang H.Y.; Kim J.S.; Oh S.J.; Jang M.-J.; Kim K.-B.
Institution
(Kim, Hwang, Kim, Oh, Kim) Department of Thoracic and Cardiovascular
Surgery, Seoul National University Hospital, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul, South Korea
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: We compared the 5-year graft occlusion rates and midterm
clinical outcomes of saphenous vein composite grafts with those of right
internal thoracic artery composite grafts in patients who were enrolled in
the SAphenous VEin versus Right Internal Thoracic Artery as a Y-Composite
Graft trial. <br/>Method(s): Of 224 eligible patients with multivessel
coronary artery disease who were randomized to undergo off-pump
revascularization using the saphenous vein (saphenous vein group, n = 112)
or right internal thoracic artery (right internal thoracic artery group, n
= 112) as Y-composite grafts based on the in situ left internal thoracic
artery from September 2008 to October 2011, 219 patients (saphenous vein
group, n = 109; right internal thoracic artery group, n = 110) entered the
analysis. A third limb conduit to lengthen the graft limb for complete
revascularization was used in 47 patients (saphenous vein group vs right
internal thoracic artery group, 8 vs 39). Postoperative 5-year (61.7 +/-
5.2 months) angiograms were performed in 186 patients (84.9%; saphenous
vein group = 95; right internal thoracic artery group = 91). Follow-up was
complete in 97.7% (214/219) of patients with a median follow-up of 80.7
months. <br/>Result(s): The overall graft occlusion rate was 3.6% at 5
years (3.5% in the saphenous vein group vs 3.7% in the right internal
thoracic artery group, P =.910). The 5-year occlusion rate of the second
limb conduits in the saphenous vein group was 4.3% and was noninferior to
that of the right internal thoracic artery group (2.4%) within the 95%
2-sided confidence interval of -1.4% to 5.2% (P <.001 for noninferiority).
No statistically significant differences were found in the overall
survival (P =.439) and the freedom from major adverse cardiac and
cerebrovascular event rates (P =.354) at 5 and 8 years between the 2
groups. <br/>Conclusion(s): The saphenous vein composite grafts were
noninferior to the right internal thoracic artery composite grafts in
terms of 5-year graft occlusion rates and midterm clinical
outcomes.<br/>Copyright &#xa9; 2018 The American Association for Thoracic
Surgery

<70>
Accession Number
361703830
Title
Synergy of isoflurane preconditioning and propofol postconditioning
reduces myocardial reperfusion injury in patients.
Source
Clinical Science. 121 (2) (pp 57-69), 2011. Date of Publication: July
2011.
Author
Huang Z.; Zhong X.; Irwin M.G.; Ji S.; Wong G.T.; Liu Y.; Xia Z.-Y.;
Finegan B.A.; Xia Z.
Institution
(Huang, Ji) Department of Anesthesia, Sun Yat-Sen Cardiovascular Hospital,
Shenzhen, China
(Huang, Irwin, Wong, Liu, Xia) Department of Anesthesiology, University of
Hong Kong, Hong Kong SAR, Hong Kong
(Huang, Xia, Xia) Anesthesiology Research Laboratory, Department of
Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
(Zhong) Zhongshan Ophthalmic Center, State Key Laboratory of
Ophthalmology, Sun Yat-sen University, Guangzhou, China
(Finegan) Department of Anesthesiology and Pain Medicine, University of
Alberta, Edmonton, AB, Canada
Publisher
Portland Press Ltd
Abstract
Either isoflurane preconditioning or high-dose propofol treatment has been
shown to attenuate myocardial IRI (ischaemia/reperfusion injury) in
patients undergoing CABG (coronary artery bypass graft) surgery. It is
unknown whether isoflurane and propofol may synergistically attenuate
myocardial injury in patients. The present study investigated the efficacy
of IsoPC (isoflurane preconditioning), propofol treatment
(postconditioning) and their synergy in attenuating postischaemic
myocardial injury in patients undergoing CABG surgery using CPB
(cardiopulmonary bypass). Patients (n = 120) selected for CABG surgery
were randomly assigned to one of four groups (n = 30 each). After
induction, anaesthesia was maintained either with fentanyl and midazolam
(control; group C); with propofol at 100 mug . kg^-1 of body
weight . min^-1 before and during CPB followed by propofol at 60
mug . kg^-1 of body weight . min^-1 for 15 min after
aortic declamping (group P); with isoflurane 1-1.5 % end tidal throughout
the surgery (group I) or with isoflurane 1-1.5 % end tidal before CPB and
switching to propofol at 100 mug . kg^-1 of body weight .
min^-1 during CPB followed by propofol at 60 mug .
kg^-1 of body weight . min^-1 for 15 min after aortic
declamping (group IP, i.e. IsoPC plus propofol postconditioning). A joint
isoflurane and propofol anaesthesia regimen synergistically reduced plasma
levels of cTnI (cardiac troponin I) and CK-MB (creatine kinase MB) and
f-FABP (heart-type fatty acid-binding protein) (all P < 0.05 compared with
control, group P or group I) and facilitated postoperative myocardial
functional recovery. During reperfusion, myocardial tissue eNOS
(endothelial NO synthase) protein expression in group IP was significantly
higher, whereas nitrotyrosine protein expression was lower than those in
the control group. In conclusion, a joint isoflurane preconditioning and
propofol anaesthesia regimen synergistically attenuated myocardial
reperfusion injury in patients. &#xa9; The Authors Journal compilation.
&#xa9; 2011 Biochemical Society.

<71>
Accession Number
2002842475
Title
Costs of clinical events in type 2 diabetes mellitus patients in the
Netherlands: A systematic review.
Source
PLoS ONE. 14 (9) (no pagination), 2019. Article Number: e0221856. Date of
Publication: 2019.
Author
Van Schoonhoven A.V.; Gout-Zwart J.J.; De Vries M.J.S.; Van Asselt A.D.I.;
Dvortsin E.; Vemer P.; Van Boven J.F.M.; Postma M.J.
Institution
(Van Schoonhoven, De Vries, Vemer, Postma) Unit of PharmacoTherapy,
Epidemiology and Economics (PTE2), Department of Pharmacy, University of
Groningen, Groningen, Netherlands
(Gout-Zwart, Dvortsin) Asc Academics, Groningen, Netherlands
(Gout-Zwart) Department of Nephrology, University of Groningen, University
Medical Centre Groningen (UMCG), Groningen, Netherlands
(Van Asselt, Vemer) Department of Epidemiology, University Medical Centre
Groningen, Groningen, Netherlands
(Van Asselt, Postma) Department of Health Sciences, University of
Groningen, University Medical Centre Groningen (UMCG), Groningen,
Netherlands
(Van Boven) Department of General Practice and Elderly Care, University of
Groningen, University Medical Center Groningen (UMCG), Groningen,
Netherlands
(Van Boven) Department of Clinical Pharmacy and Pharmacology, University
of Groningen, University Medical Centre Groningen (UMCG), Groningen,
Netherlands
(Postma) Department of Economics, Econometrics and Finance, University of
Groningen, Faculty of Economics and Business, Groningen, Netherlands
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Type 2 diabetes mellitus (T2DM) is an established risk factor
for cardiovascular and nephropathic events. In the Netherlands, prevalence
of T2DM is expected to be as high as 8% by 2025. This will result in
significant clinical and economic impact, highlighting the need for
well-informed reimbursement decisions for new treatments. However,
availability and consistent use of costing methodologies is limited.
Objective We aimed to systematically review recent costing data for
T2DM-related cardiovascular and nephropathic events in the Netherlands.
Methods A systematic literature review in PubMed and Embase was conducted
to identify available Dutch cost data for T2DM-related events, published
in the last decade. Information extracted included costs, source, study
population, and costing perspective. Finally, papers were evaluated using
the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).
Results Out of initially 570 papers, 36 agreed with the inclusion
criteria. From these studies, 150 cost estimates for T2DM-related clinical
events were identified. In total, 29 cost estimates were reported for
myocardial infarction (range: 196-27,038), 61 for stroke (495-54,678),
fifteen for heart failure (325-16,561), 24 for renal failure
(2,438-91,503), and seventeen for revascularisation (3,000-37,071). Only
four estimates for transient ischaemic attack were available, ranging from
587 to 2,470. Adherence to CHEERS was generally high. Conclusions The most
expensive clinical events were related to renal failure, while TIA was the
least expensive event. Generally, there was substantial variation in
reported cost estimates for T2DM-related events. Costing of clinical
events should be improved and preferably standardised, as accurate and
consistent results in economic models are desired.<br/>Copyright &#xa9;
2019 van Schoonhoven et al. This is an open access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<72>
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. <br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2018 The Author(s). Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<73>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2018 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<74>
Accession Number
629196084
Title
Effect of antiplatelet therapy on cardiovascular and kidney outcomes in
patients with chronic kidney disease: A systematic review and
meta-analysis.
Source
BMC Nephrology. 20 (1) (no pagination), 2019. Article Number: 309. Date of
Publication: 07 Aug 2019.
Author
Su X.; Yan B.; Wang L.; Lv J.; Cheng H.; Chen Y.
Institution
(Su, Cheng, Chen) Division of Nephrology, Beijing Anzhen Hospital, Capital
Medical University, No. 2, Anzhen Street, Chaoyang District, Beijing,
China
(Su, Yan, Wang) Division of Nephrology, Shanxi Medical University Second
Hospital, Shanxi Kidney Disease Institute, No.382, Wuyi Road, Xinghualing
Distirct, Taiyuan, China
(Lv) Division of Nephrology, Peking University First Hospital, Peking
University, Institute of Nephrology, No.8, Xishiku Street, Xicheng
District, Beijing, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The benefits and risks of antiplatelet therapy for patients
with chronic kidney disease (CKD) remain controversial. We undertook a
systematic review and meta-analysis to investigate the effects of
antiplatelet therapy on major clinical outcomes. <br/>Method(s): We
systematically searched MEDLINE, Embase, and the Cochrane Library for
trials published before April 2019 without language restriction. We
included rrandomized controlled trials that involved adults with CKD and
compared antiplatelet agents with controls. <br/>Result(s): Fifty eligible
trials that included at least one event were identified, providing data
for 27773patients with CKD, including 4518 major cardiovascular events and
1962 all-cause deaths. Antiplatelet therapy produced a 15% (OR, 0.85; 95%
CI 0.74-0.94) reduction in the odds of major cardiovascular events (P =
0.002), a 48% reduction for access failure events (OR, 0.52; 95% CI,
0.31-0.73), but had no significantly effect on all-cause death (OR, 0.87;
95% CI, 0.71-1.01) or kidney failure events (OR, 0.87; 95% CI, 0.32-1.55).
Adverse events were significantly increased by antiplatelet therapy,
including major (OR, 1.33; 95% CI, 1.11-1.59) or minor bleeding (OR, 1.66;
95% CI, 1.27-2.05). Among every 1000 persons with CKD treated with
antiplatelet therapy for 12 months, 23 major cardiovascular events will be
prevented while nine major bleeding events will occur. <br/>Conclusion(s):
Major prevention with antiplatelet agents (cardiovascular events and
access failure), might outweigh the risk of bleeding, and there seemed to
be an overall net benefit. Individual evaluation and careful monitoring
are required.<br/>Copyright &#xa9; 2019 The Author(s).

<75>
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.<br/>Copyright &#xa9; 2019

<76>
Accession Number
2001374431
Title
A randomized controlled trial evaluating general endotracheal anesthesia
versus monitored anesthesia care and the incidence of sedation-related
adverse events during ERCP in high-risk patients.
Source
Gastrointestinal Endoscopy. 89 (4) (pp 855-862), 2019. Date of
Publication: April 2019.
Author
Smith Z.L.; Mullady D.K.; Lang G.D.; Das K.K.; Hovis R.M.; Patel R.S.;
Hollander T.G.; Elsner J.; Ifune C.; Kushnir V.M.
Institution
(Smith, Mullady, Lang, Das, Patel, Hollander, Elsner, Kushnir) Division of
Gastroenterology, Washington University School of Medicine, St Louis, MO,
United States
(Hovis, Ifune) Department of Anesthesiology, Washington University School
of Medicine, St Louis, MO, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background and Aims: ERCP is a complex procedure often performed in
patients at high risk for sedation-related adverse events (SRAEs).
However, there is no current standard of care with regard to mode of
sedation and airway management during ERCP. The aim of this study was to
assess the safety of general endotracheal anesthesia (GEA) versus
propofol-based monitored anesthesia care (MAC) without endotracheal
intubation in patients undergoing ERCP at high risk for SRAEs.
<br/>Method(s): Consecutive patients undergoing ERCP at high risk for
SRAEs at a single center were invited to participate in this randomized
controlled trial comparing GEA and MAC. Inclusion criteria were STOP-BANG
score >=3, abdominal ascites, body mass index >=35, chronic lung disease,
American Society of Anesthesiologists class >3, Mallampati class 4 airway,
and moderate to heavy alcohol use. Exclusion criteria were preceding EUS,
emergent ERCP, tracheostomy, unstable airway, gastric outlet obstruction
or delayed gastric emptying, and altered foregut anatomy. The primary
endpoint was composite incidence of SRAEs: hypoxemia, use of airway
maneuvers, hypotension requiring vasopressors, sedation-related procedure
interruption, cardiac arrhythmia, and respiratory failure. Secondary
outcomes included procedure duration, cannulation success, in-room time,
and immediate adverse events. <br/>Result(s): Two hundred patients (mean
age, 61.1 +/- 13.6 years; 36.5% women) were randomly assigned to GEA (n =
101) or MAC (n = 99) groups. Composite SRAEs were significantly higher in
the MAC group compared with the GEA group (51.5% vs 9.9%, P <.001). This
was primarily driven by the frequent need for airway maneuvers in the MAC
group. Additionally, ERCP was interrupted in 10.1% of patients in the MAC
group to convert to GEA because of respiratory instability refractory to
airway maneuvers (n = 8) or significant retained gastric contents (n = 2).
There were no statistically significant differences in cannulation,
in-room, procedure, or fluoroscopy times between the 2 groups. All
patients undergoing GEA were successfully extubated in the procedure room
at completion of ERCP, and Aldrete scores in recovery did not differ
between the 2 groups. There were no immediate adverse events.
<br/>Conclusion(s): In patients at high risk for SRAEs undergoing ERCP,
sedation with GEA is associated with a significantly lower incidence of
SRAEs, without impacting procedure duration, success, recovery, or in-room
time. These data suggest that GEA should be used for ERCP in patients at
high risk for SRAEs (Clinical trial registration number:
NCT02850887.)<br/>Copyright &#xa9; 2019

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Accession Number
629124219
Title
Ezetimibe Lipid-Lowering Trial on Prevention of Atherosclerotic
Cardiovascular Disease in 75 or Older (EWTOPIA 75): A Randomized,
Controlled Trial.
Source
Circulation. 140 (12) (pp 992-1003), 2019. Date of Publication: 17 Sep
2019.
Author
Ouchi Y.; Sasaki J.; Arai H.; Yokote K.; Harada K.; Katayama Y.; Urabe T.;
Uchida Y.; Hayashi M.; Yokota N.; Nishida H.; Otonari T.; Arai T.; Sakuma
I.; Sakabe K.; Yamamoto M.; Kobayashi T.; Oikawa S.; Yamashita S.; Rakugi
H.; Imai T.; Tanaka S.; Ohashi Y.; Kuwabara M.; Ito H.
Institution
(Ouchi, Kuwabara) Toranomon Hospital, Japan (Y. Ouchi, Tokyo, Japan
(Sasaki) International University of Health and Welfare, Japan (J.S.),
Fukuoka, Japan
(Arai) National Center for Geriatrics and Gerontology, Japan (H.A.), Obu,
Japan
(Yokote) Chiba University, Japan (K.Y.), Chiba, Japan
(Harada, Ito) Tokyo Metropolitan Geriatric Hospital, Japan (K.H., Tokyo,
Japan
(Katayama) General Tokyo Hospital, Japan (Y.K.), Tokyo, Japan
(Urabe) Juntendo University Urayasu Hospital, Japan (T.U.), Urayasu, Japan
(Uchida) Saga Memorial Hospital, Japan (Y.U.), Saga, Japan
(Hayashi) Nagahama City Hospital, Japan (M.H.), Nagahama, Japan
(Yokota) Japan (N.Y.), Miyazaki, Japan
(Nishida) Japan (H.N.), Neyagawa, Japan
(Otonari) Otonari Clinic, Chikushino, Japan (T.O.)
(Arai) Japan (T.A.), Yamagata, Japan
(Sakuma) Caress Sapporo Hokko Memorial Clinic, Japan (I.S.), Sapporo,
Japan
(Sakabe) Japan (K.S.), Kyoto, Japan
(Yamamoto) Yamamoto Clinic, Japan (M.Y.)
(Kobayashi) Jyuzen General Hospital, Japan (T.K.), Niihama, Japan
(Oikawa) Fukujuji Hospital, Japan (S.O.), Tokyo, Japan
(Yamashita) Rinku General Medical Center, Japan (S.Y.), Izumisano, Japan
(Rakugi) Osaka University, Japan (H.R.), Suita, Japan
(Imai, Tanaka) Kyoto University, Japan (T.I.
(Ohashi) Chuo University, Japan (Y. Osachi), Tokyo, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Evidence regarding the primary prevention of coronary artery
disease events by low-density lipoprotein cholesterol (LDL-C) lowering
therapy in older individuals, aged >=75 years, is insufficient. This trial
tested whether LDL-C-lowering therapy with ezetimibe is useful for the
primary prevention of cardiovascular events in older patients.
<br/>METHOD(S): This multicenter, prospective, randomized, open-label,
blinded end-point evaluation conducted at 363 medical institutions in
Japan examined the preventive efficacy of ezetimibe for patients aged >=75
years, with elevated LDL-C without history of coronary artery disease.
Patients, who all received dietary counseling, were randomly assigned
(1:1) to receive ezetimibe (10 mg once daily) versus usual care with
randomization stratified by site, age, sex, and baseline LDL-C. The
primary outcome was a composite of sudden cardiac death, myocardial
infarction, coronary revascularization, or stroke. <br/>RESULT(S):
Overall, 3796 patients were enrolled between May 2009 and December 2014,
and 1898 each were randomly assigned to ezetimibe versus control. Median
follow-up was 4.1 years. After exclusion of 182 ezetimibe patients and 203
control patients because of lack of appropriate informed consent and other
protocol violations, 1716 (90.4%) and 1695 (89.3%) patients were included
in the primary analysis, respectively. Ezetimibe reduced the incidence of
the primary outcome (hazard ratio [HR], 0.66; 95% CI, 0.50-0.86; P=0.002).
Regarding the secondary outcomes, the incidences of composite cardiac
events (HR, 0.60; 95% CI, 0.37-0.98; P=0.039) and coronary
revascularization (HR, 0.38; 95% CI, 0.18-0.79; P=0.007) were lower in the
ezetimibe group than in the control group; however, there was no
difference in the incidence of stroke, all-cause mortality, or adverse
events between trial groups. <br/>CONCLUSION(S): LDL-C-lowering therapy
with ezetimibe prevented cardiovascular events, suggesting the importance
of LDL-C lowering for primary prevention in individuals aged >=75 years
with elevated LDL-C. Given the open-label nature of the trial, its
premature termination and issues with follow-up, the magnitude of benefit
observed should be interpreted with caution. Clinical Registration: URL:
https://www.umin.ac.jp. Unique identifier: UMIN000001988.

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Accession Number
629342657
Title
Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes
After Transcatheter Aortic Valve Replacement: Analysis of the PARTNER 2
Trials.
Source
Circulation. Heart failure. 12 (8) (pp e005809), 2019. Date of
Publication: 01 Aug 2019.
Author
Furer A.; Chen S.; Redfors B.; Elmariah S.; Pibarot P.; Herrmann H.C.;
Hahn R.T.; Kodali S.; Thourani V.H.; Douglas P.S.; Alu M.C.; Fearon W.F.;
Passeri J.; Malaisrie S.C.; Crowley A.; McAndrew T.; Genereux P.;
Ben-Yehuda O.; Leon M.B.; Burkhoff D.
Institution
(Furer, Chen, Redfors, Alu, Crowley, McAndrew, Ben-Yehuda, Leon, Burkhoff)
Cardiovascular Research Foundation, S.C., B.R., M.C.A., A.C., NY
(Furer) IDF Medical Corps Headquarters
(Furer) School of Military Medicine, Hadassah Medical Center, Jerusalem,
Israel
(Redfors) Sahlgrenska University Hospital, Goteborg
(Elmariah, Passeri) Department of Cardiology, Massachusetts General
Hospital
(Pibarot) Department of Medicine, Quebec Heart & Lung Institute Laval
University
(Herrmann) Department of Medicine, University of Pennsylvania
(Hahn, Kodali, Alu, Leon, Burkhoff) Department of Medicine, Columbia
University Medical Center, M.C.A., NY
(Thourani) MedStar Heart & Vascular Institute, Georgetown University
School of Medicine, WA
(Douglas) Duke Clinical Research Institute, Duke University Medical
Center, Durham, Canada
(Fearon) Department of Medicine (Cardiovascular Medicine), Stanford
University
(Malaisrie) Division of Cardiac Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Mexico
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center
Publisher
NLM (Medline)
Abstract
BACKGROUND: Impaired left ventricular function is associated with worse
prognosis among patients with aortic stenosis treated medically or with
surgical aortic valve replacement. It is unclear whether reduced left
ventricular ejection fraction (LVEF) is an independent predictor of
adverse outcomes after transcatheter aortic valve replacement. METHODS AND
RESULTS: Patients who underwent transcatheter aortic valve replacement in
the PARTNER 2 trials (Placement of Aortic Transcatheter Valves) and
registries were stratified according to presence of reduced LVEF (<50%) at
baseline, and 2-year risk of cardiovascular mortality was compared using
Kaplan-Meier methods and multivariable Cox proportional hazards
regression. Of 2991 patients, 839 (28%) had reduced LVEF. These patients
were younger, more often males, and were more likely to have
comorbidities, such as coronary disease, diabetes mellitus, and renal
insufficiency. Compared with patients with normal LVEF, patients with low
LVEF had higher crude rates of 2-year cardiovascular mortality (19.8%
versus 12.0%, P<0.0001) and all-cause mortality (27.4% versus 19.2%,
P<0.0001). Mean aortic valve gradient was not associated with clinical
outcomes other than heart failure hospitalizations (hazard ratio [HR],
0.99; CI, 0.99-1.00; P=0.03). After multivariable adjustment, patients
with reduced versus normal LVEF had significantly higher adjusted risk of
cardiovascular death (adjusted HR, 1.42, 95% CI, 1.11-1.81; P=0.005), but
not all-cause death (adjusted HR, 1.20; 95% CI, 0.99-1.47; P=0.07). When
LVEF was treated as continuous variable, it was associated with increased
2-year risk of both cardiovascular mortality (adjusted HR per 10% decrease
in LVEF, 1.16; 95% CI, 1.07-1.27; P=0.0006) and all-cause mortality
(adjusted HR, 1.09; 95% CI, 1.01-1.16; P=0.02). <br/>CONCLUSION(S): In
this patient-level pooled analysis of PARTNER 2 patients who underwent
transcatheter aortic valve replacement, baseline LVEF was an independent
predictor of 2-year cardiovascular mortality. CLINICAL TRIAL REGISTRATION:
URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01314313,
NCT02184442, NCT03222128, and NCT02184441.

<79>
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Accession Number
629342291
Title
Long-Term Effect of Ultrathin-Strut Versus Thin-Strut Drug-Eluting Stents
in Patients With Small Vessel Coronary Artery Disease Undergoing
Percutaneous Coronary Intervention: A Subgroup Analysis of the BIOSCIENCE
Randomized Trial.
Source
Circulation. Cardiovascular interventions. 12 (8) (pp e008024), 2019. Date
of Publication: 01 Aug 2019.
Author
Iglesias J.F.; Heg D.; Roffi M.; Tuller D.; Noble S.; Muller O.; Moarof
I.; Cook S.; Weilenmann D.; Kaiser C.; Cuculi F.; Haner J.; Juni P.;
Windecker S.; Pilgrim T.
Institution
(Iglesias, Roffi, Noble) Division of Cardiology, Geneva University
Hospitals
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, Bern University Hospital
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Muller) Department of Cardiology, Lausanne University Hospital
(Moarof) Department of Cardiology, Kantonsspital Aarau
(Cook) Department of Cardiology, University and Hospital Fribourg
(Weilenmann) Department of Cardiology, Kantonsspital St Gallen
(Kaiser) Department of Cardiology, Basel University Hospital
(Cuculi) Department of Cardiology, Kantonsspital Luzern
(Haner, Windecker, Pilgrim) Department of Cardiology, Inselspital,
University of Bern, Bern University Hospital, S.W.
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, Department of Medicine and Institute of Health
Policy, Management and Evaluation, University of Toronto
Publisher
NLM (Medline)
Abstract
BACKGROUND: Randomized trials evaluating the Orsiro biodegradable polymer
sirolimus-eluting stent (BP-SES; 60 and 80 mum strut thickness for stent
diameters <=3 and >3 mm, respectively) did not stratify according to
vessel size and failed to specify the impact of ultrathin-strut thickness
on long-term clinical outcomes compared with durable polymer
everolimus-eluting stents (DP-EES). We sought to assess the long-term
effect of ultrathin-strut (60 mum) BP-SES versus thin-strut (81 mum)
DP-EES on long-term outcomes in patients undergoing percutaneous coronary
revascularization for small vessel disease. <br/>METHOD(S): In a subgroup
analysis of the randomized, multicenter, noninferiority BIOSCIENCE trial,
patients with stable coronary artery disease or acute coronary syndrome
randomly assigned to treatment with BP-SES or DP-EES were stratified
according to vessel size (<=3 mm versus >3 mm) as a surrogate to compare
patients treated with ultrathin-strut versus thin-strut drug-eluting
stent. The primary end point was target lesion failure, a composite of
cardiac death, target vessel myocardial infarction, and clinically
indicated target lesion revascularization, within 5 years. <br/>RESULT(S):
Among 2109 patients, 1234 (59%) were treated for small vessel disease. At
5 years, target lesion failure occurred in 124 patients (cumulative
incidence, 22.3%) treated with ultrathin-strut BP-SES and 109 patients
(18.3%) treated with thin-strut DP-EES (rate ratio, 1.22; 95% CI,
0.94-1.58; P=0.13). Cumulative incidences of cardiac death, target vessel
myocardial infarction, and clinically indicated target lesion
revascularization and definite stent thrombosis at 5 years were similar in
patients treated with ultrathin-strut BP-SES and thin-strut DP-EES. After
adjustment for potential confounders, there was no significant interaction
between vessel size and treatment effect of BP-SES versus DP-EES.
<br/>CONCLUSION(S): We found no significant difference in clinical
outcomes throughout 5 years between patients with small vessel disease
treated with ultrathin-strut BP-SES versus thin-strut DP-EES. CLINICAL
TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique
identifier: NCT01443104.