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<1>
Accession Number
627609384
Title
Dynamic strength training intensity in cardiovascular rehabilitation: is
it time to reconsider clinical practice? A systematic review.
Source
European Journal of Preventive Cardiology. 26 (14) (pp 1483-1492), 2019.
Date of Publication: 01 Sep 2019.
Author
Hansen D.; Abreu A.; Doherty P.; Voller H.
Institution
(Hansen) REVAL - Rehabilitation Research Center, Hasselt University,
Belgium
(Hansen) Jessa Hospital, Heart Center Hasselt, Belgium
(Hansen) BIOMED - Biomedical Research Center, Hasselt University, Belgium
(Abreu) Cardiology Department, Hospital Santa Marta, Portugal
(Doherty) Department of Health Sciences, University of York, United
Kingdom
(Voller) Department of Cardiology, Klinik am See, Germany
(Voller) Center of Rehabilitation Research, University of Potsdam, Germany
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
When added to endurance training, dynamic strength training leads to
significantly greater improvements in peripheral muscle strength and power
output in patients with cardiovascular disease, which may be relevant to
enhance the patient's prognosis. As a result, dynamic strength training is
recommended in the rehabilitative treatment of many different
cardiovascular diseases. However, what strength training intensity should
be selected remains under intense debate. Evidence is nonetheless emerging
that high-intensity strength training (>=70% of one-repetition maximum) is
more effective to increase acutely myofibrillar protein synthesis, cause
neural adaptations and, in the long term, increase muscle strength, when
compared to low-intensity strength training. Moreover, multiple studies
report that high-intensity strength training causes fewer increments in
(intra-)arterial blood pressure and cardiac output, as opposed to
low-intensity strength training, thus potentially pointing towards
sufficient medical safety for the cardiovascular system. The aim of this
systematic review is therefore to discuss this line of evidence, which is
in contrast to current clinical practice, and to re-open the debate as to
what dynamic strength training intensities should actually be
applied. Copyright © The European Society of Cardiology 2019.

<2>
Accession Number
2002714470
Title
Evaluation of contrast nephropathy in percutaneous treatment of chronic
total occlusions.
Source
Interventional Medicine and Applied Science. 11 (2) (pp 95-100), 2019.
Date of Publication: 2019.
Author
Akturk E.; Askin L.; Tasolar H.; Kurtoglu E.; Turkmen S.; Tanriverdi O.;
Uzel K.E.
Institution
(Akturk, Askin, Turkmen, Tanriverdi, Uzel) Faculty of Medicine, Department
of Cardiology, Adiyaman University, Adiyaman 02000, Turkey
(Tasolar) Faculty of Medicine, Department of Cardiology, Inonu University,
Malatya, Turkey
(Kurtoglu) Department of Cardiology, Malatya Training and Research
Hospital, Malatya, Turkey
Publisher
Akademiai Kiado Rt. (E-mail: info@akkrt.hu)
Abstract
Background: Contrast-induced nephropathy (CIN) is a leading cause of
morbidity and mortality in patients undergoing percutaneous coronary
intervention (PCI). Chronic total occlusions (CTO) are frequently observed
among patients undergoing coronary angiography. Method(s): A total of
128 CTO patients were included. Mehran score, lesion characteristics,
interventional procedure, serological specimens and devices were recorded.
The first group was administered with 1 ml . kg-1 .
h-1 saline (0.9% NaCl) infusion that started 12 h before the
procedure and continued 12 h post procedure as recommended by the
guidelines. The second group was administered with saline infusion of 12
ml . kg-1 . h-1 only during CTO-PCI procedure, which
is called as intensive infusion. Result(s): CIN development was
similar in two groups (four patients in standard hydration group and five
patients in intensive hydration group). The amount of saline was
significantly higher in the standard group (1,767 +/- 192.2 vs. 1,043.6
+/- 375; p < 0.001). Patients with higher creatinine levels prior to PCI
had a higher rate of CIN development after procedure. Interestingly, age,
left ventricular ejection fraction, and diabetes mellitus independently
predicted CIN. Conclusion(s): Intensive hydration administration
appears to be an effective and cost-effective method in CTO-PCI patients,
especially in patients without left ventricular function
failure. Copyright © 2019 The Author(s).

<3>
Accession Number
2002974802
Title
Outcomes following balloon aortic valvuloplasty versus surgical valvotomy
in congenital aortic valve stenosis: A meta-analysis.
Source
Journal of Invasive Cardiology. 31 (6) (pp E133-E142), 2019. Date of
Publication: 2019.
Author
Saung M.T.; McCracken C.; Sachdeva R.; Petit C.J.
Institution
(Saung) Emory University, School of Medicine, Sibley Heart Center
Cardiology, Atlanta, GA, United States
(McCracken) Department of Biostatistics, Sibley Heart Center Cardiology,
Atlanta, GA, United States
(Sachdeva, Petit) Department of Pediatrics, Sibley Heart Center
Cardiology, Atlanta, GA, United States
Publisher
HMP Communications
Abstract
Background. The optimal treatment for congenital aortic stenosis (AS) has
been debated over the past three decades of experience with both balloon
aortic valvuloplasty (BAV) and surgical aortic valvotomy (SAV). While BAV
has been the mainstay of therapy for children with AS in most centers,
recent single-center reports suggest superior results following SAV.
Methods. We queried Medline, EMBASE and Web of Science for eligible
studies. Results. A total of 18 studies were included in our
meta-analysis: SAV alone (n = 3), BAV alone (n = 10), and both (n = 5).
The mean follow-up duration of BAV patients was 6.5 years, while the mean
follow-up duration for SAV patients was 7.2 years. Mortality rates
following BAV and SAV were 11% (95% CI, 8-14) and 10% (95% CI, 7-15),
respectively. Reintervention following initial procedure for treatment of
AS was higher following BAV (37% [95% CI, 30-44]) compared with SAV (25%
[95% CI, 20-31]). The predominant reintervention for both the BAV and SAV
groups was surgery (SAV or aortic valve replacement [AVR]); the surgical
reintervention rate was 59% for BAV (95% CI, 51-66) and 75% for SAV (95%
CI, 48-91). Mean time to reintervention was shorter for BAV (2.7 years
[95% CI, 1.4-4.1]) compared with SAV (6.9 years [95% CI, 4.4-9.4]). AVR
following BAV was 20% (95% CI, 17-23) and following SAV was 17% (95% CI,
12-25). Long-term and mid-term follow-up in these studies showed moderate
to severe aortic insufficiency (AI) was present in 28% (95% CI, 20-37) and
19% (95% CI, 12-27) in BAV and SAV patients, respectively. Conclusions.
The rate of reintervention following BAV is higher than following SAV.
However, survival rates, AVR, and development of late AI following BAV and
SAV are equivalent. The costs associated with the two therapies in terms
of hospital days and other morbidities should be considered in future
comparative studies. Copyright © 2019 HMP Communications. All
rights reserved.

<4>
Accession Number
2002485034
Title
A comprehensive review of randomized clinical trials in three medical
journals reveals 396 medical reversals.
Source
eLife. 8 (no pagination), 2019. Article Number: e45183. Date of
Publication: June 2019.
Author
Herrera-Perez D.; Haslam A.; Crain T.; Gill J.; Livingston C.; Kaestner
V.; Hayes M.; Morgan D.; Cifu A.S.; Prasad V.
Institution
(Herrera-Perez, Haslam, Crain, Gill, Kaestner) Knight Cancer Institute,
Oregon Health & Science University, Portland, United States
(Livingston) School of Medicine, Oregon Health & Science University,
Portland, United States
(Hayes) Division of Internal Medicine, Oregon Health & Science University,
Portland, United States
(Morgan) Department of Epidemiology & Public Health, University of
Maryland School of Medicine, Baltimore, United States
(Cifu) Department of Medicine, University of Chicago, Chicago, United
States
(Prasad) Knight Cancer Institute, The Department of Public Health and
Preventive Medicine, The Center for Health Care Ethics and the Department
of Medicine, Oregon Health & Science University, Portland, United States
Publisher
eLife Sciences Publications Ltd (E-mail: staff@elifesciences.org)
Abstract
The ability to identify medical reversals and other low-value medical
practices is an essential prerequisite for efforts to reduce spending on
such practices. Through an analysis of more than 3000 randomized
controlled trials (RCTs) published in three leading medical journals (the
Journal of the American Medical Association, the Lancet, and the New
England Journal of Medicine), we have identified 396 medical reversals.
Most of the studies (92%) were conducted on populations in high- income
countries, cardiovascular disease was the most common medical category
(20%), and medication was the most common type of intervention
(33%). Copyright © Herrera-Perez et al.

<5>
Accession Number
628283360
Title
Long-term functional outcomes after cardiac rehabilitation in older
patients. Data from the Cardiac Rehabilitation in Advanced aGE: EXercise
TRaining and Active follow-up (CR-AGE EXTRA) randomised study.
Source
European Journal of Preventive Cardiology. 26 (14) (pp 1470-1478), 2019.
Date of Publication: 01 Sep 2019.
Author
Pratesi A.; Baldasseroni S.; Burgisser C.; Orso F.; Barucci R.; Silverii
M.V.; Venturini S.; Ungar A.; Marchionni N.; Fattirolli F.
Institution
(Pratesi, Baldasseroni, Burgisser, Orso, Barucci, Silverii, Venturini,
Ungar, Marchionni, Fattirolli) Department of Experimental and Clinical
Medicine, University of Florence and Azienda Ospedaliero-Universitaria
Careggi, Italy
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aim: Cardiac rehabilitation promotes functional recovery after cardiac
events. Our study aimed at evaluating whether, compared to usual care, a
home-based exercise programme with monthly reinforcement sessions adds
long-term functional benefits to those obtained with cardiac
rehabilitation in the elderly. Method(s): After a 4-week outpatient
cardiac rehabilitation, 160 of 197 patients aged 75 years and older
screened for eligibility with different indications for cardiac
rehabilitation, were randomly assigned to a control (C) or an active
treatment (T) group. During a 12-month follow-up, C patients received
usual care, while T patients were prescribed a standardised set of
home-based exercises with centre-based monthly reinforcements for the
first 6 months. The main (peak oxygen consumption) and three secondary
outcome measures (distance walked in 6 minutes, inferior limbs peak
90degree Torque strength, health-related quality of life) were assessed at
baseline, at random assignment and at 6 and 12-month follow-ups with the
cardiopulmonary exercise test, 6-minute walking test, isokinetic
dynamometer and the Short Form-36 questionnaire, respectively.
 Result(s): Both C and T groups obtained a significant and similar
improvement from baseline to the end of the 4-week cardiac rehabilitation
programme in the three functional outcome measures. However, at
univariable and age and gender-adjusted analysis of variance for repeated
measures, changes from random assignment to 6 or 12-month follow-up in any
outcome measure were similar in the C and T groups. Conclusion(s):
Results from this randomised study suggest that a home-based exercise
programme with monthly reinforcements does not add any long-term
functional benefit beyond those offered by a conventional, 4-week
outpatient cardiac rehabilitation programme. Trial registration:
ClinicalTrial.gov Identifier: NCT00641134. Copyright © The
European Society of Cardiology 2019.

<6>
Accession Number
629408212
Title
Investigating the Impact of Early Valve Surgery on Survival in
Staphylococcus aureus Infective Endocarditis Using a Marginal Structural
Model Approach: Results of a Large, Prospectively Evaluated Cohort.
Source
Clinical Infectious Diseases. 69 (3) (pp 487-492), 2019. Date of
Publication: 18 Jul 2019.
Author
Rieg S.; Von Cube M.; Kaasch A.J.; Bonaventura B.; Bothe W.; Wolkewitz M.;
Peyerl-Hoffmann G.; Deppe A.-C.; Wahlers T.; Beyersdorf F.; Seifert H.;
Kern W.V.
Institution
(Rieg, Bonaventura, Bothe, Peyerl-Hoffmann, Beyersdorf, Kern) Division of
Infectious Diseases, Department of Medicine II, Faculty of Medicine and
Medical Center, University of Freiburg, Hugstetter Strase 55, Freiburg
D-79106, Germany
(Von Cube, Wolkewitz) Institute of Medical Biometry and Statistics,
Faculty of Medicine and Medical Center, University of Freiburg, Germany
(Kaasch) Institute of Medical Microbiology and Hospital Hygiene,
Heinrich-Heine-University Dusseldorf, Germany
(Bothe, Beyersdorf) Department of Cardiovascular Surgery, Heart Center,
Medical Center, University of Freiburg, Germany
(Deppe, Wahlers) Department of Cardiothoracic Surgery, University Hospital
of Cologne, Germany
(Seifert) Institute for Medical Microbiology, Immunology and Hygiene,
University of Cologne, Germany
(Seifert) German Centre for Infection Research, Partner Site Bonn-Cologne,
Germany
Publisher
Oxford University Press
Abstract
Background: The impact of valve surgery on outcomes of Staphylococcus
aureus infective endocarditis (SAIE) remains controversial. We tested the
hypothesis that early valve surgery (EVS) improves survival by using a
novel approach that allows for inclusion of major confounders in a
time-dependent way. Method(s): EVS was defined as valve surgery
within 60 days. Univariable and multivariable Cox regression analyses were
performed. To account for treatment selection bias, we additionally used a
weighted Cox model (marginal structural model) that accounts for
time-dynamic imbalances between treatment groups. To address survivor
bias, EVS was included as a time-dependent variable. Follow-up of patients
was 1 year. Result(s): Two hundred and three patients were included
in the analysis; 50 underwent EVS. All-cause mortality at day 30 was 26%.
In the conventional multivariable Cox regression model, the effect of EVS
on the death hazard was 0.85 (95% confidence interval [CI],. 47-1.52).
Using the weighted Cox model, the death hazard rate (HR) of EVS was 0.71
(95% CI,. 34-1.49). In subgroup analyses, no survival benefit was observed
in patients with septic shock (HR, 0.80 [CI,. 26-2.46]), in NVIE (HR, 0.76
[CI,. 33-1.71]) or PVIE (HR, 1.02 [CI,. 29-3.54]), or in patients with EVS
within 14 days (HR, 0.97 [CI,. 46-2.07]). Conclusion(s): Using both a
conventional Cox regression model and a weighted Cox model, we did not
find a survival benefit for patients who underwent EVS in our cohort.
Until results of randomized controlled trials are available, EVS in SAIE
should be based on individualized decisions of an experienced
multidisciplinary team. Clinical Trials Registration: German Clinical
Trials registry (DRKS00005045). Copyright © 2018 The Author(s)
2018. Published by Oxford University Press for the Infectious Diseases
Society of America. All rights reserved.

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

<8>
Accession Number
2002974854
Title
Four-year outcomes of multivessel percutaneous coronary intervention with
Xience v everolimus-eluting stents.
Source
Journal of Invasive Cardiology. 31 (9) (pp 240-246), 2019. Date of
Publication: 2019.
Author
Lee M.S.; Shlofmitz R.; Mahmud E.; Park K.W.; Rha S.-W.; Gaborro A.; Wang
J.; Zhao W.; Sudhir K.
Institution
(Lee) Division of Cardiology, UCLA Medical Center, Los Angeles, CA, United
States
(Shlofmitz) Division of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Mahmud) Division of Cardiology, UCSD Medical Center, San Diego, CA,
United States
(Park) Division of Cardiology, Seoul National University, Seoul, South
Korea
(Rha) Division of Cardiology, Korea University Guro Hospital, Seoul, South
Korea
(Gaborro, Wang, Zhao, Sudhir) Abbott Vascular, Santa Clara, CA, United
States
Publisher
HMP Communications
Abstract
Objectives. We evaluated the long-term outcomes of multivessel compared
with single-vessel percutaneous coronary intervention (PCI) with Xience V
everolimus-eluting stents in real-world patients. Background. Treatment
options for multivessel disease include PCI, coronary artery bypass
grafting, and medical therapy. Patients with multivessel disease are at a
higher risk for ischemic complications than those with single-vessel
disease. Methods. The XIENCE V USA study was a condition-of-approval,
single-arm, prospective study in unselected real-world patients. Patients
who underwent multivessel PCI (n = 655) were compared with those who
underwent single-vessel PCI (n = 4079). Major clinical outcomes, including
mortality, stent thrombosis, and target-lesion failure (TLF), were
evaluated at 4 years. Results. At 4 years, mortality was similar in both
groups (11.1% in multivessel patients vs 9.8% in single-vessel patients;
P=.31). The multivessel PCI group had higher rates of Academic Research
Consortium (ARC)-defined TLF (24.3% vs 16.4% in single-vessel patients;
P<.001) and ARC-defined definite and probable stent thrombosis (2.43% vs
1.11% in single-vessel patients; P=.02). The independent predictors of
ARC-defined TLF at 4 years on multivariable analysis were prior myocardial
infarction, number of treated vessels, total stent length, and sex.
Conclusion. Despite significant differences in baseline characteristics,
long-term mortality rates were similar in both groups. Although ischemic
complications were higher in the multivessel PCI group, the overall rates
were acceptable, demonstrating the safety and efficacy of Xience V
everolimus-eluting stents for the treatment of multivessel disease in a
real-world population. Copyright © 2019 HMP Communications. All
rights reserved.

<9>
Accession Number
2002974849
Title
A polymeric bioresorbable vascular scaffold versus an everolimus-eluting
stent in ST-segment elevation myocardial infarction.
Source
Journal of Invasive Cardiology. 31 (9) (pp E271-E272), 2019. Date of
Publication: 2019.
Author
Wernly B.; Latib A.; Ielasi A.; Jung C.
Institution
(Wernly) Clinic of Internal Medicine II, Department of Cardiology,
Paracelsus Medical University, Salzburg, Austria
(Latib) Division of Cardiology, Montefiore Medical Center, Albert Einstein
College of Medicine, Bronx, NY, United States
(Latib, Ielasi) Clinical and Interventional Cardiology Unit, Istituto
Clinico S. Ambrogio, Milan, Italy
(Jung) Division of Cardiology, Pulmonology, and Vascular Medicine, Medical
Faculty, University of Dusseldorf, Department of Medicine, University
Hospital Dusseldorf, Dusseldorf 40225, Germany
Publisher
HMP Communications

<10>
Accession Number
2002974821
Title
Ultrasound guidance in femoral artery catheterization: A systematic review
and a meta-analysis of randomized controlled trials.
Source
Journal of Invasive Cardiology. 31 (7) (pp E192-E198), 2019. Date of
Publication: 2019.
Author
Rashid M.K.; Sahami N.; Singh K.; Winter J.; Sheth T.; Jolly S.S.
Institution
(Rashid, Sahami, Winter, Sheth, Jolly) Population Health Research
Institute, McMaster University, Hamilton Health Sciences, Cardiology
Division, Hamilton General Hospital Site, Population Health Research
Institute (PHRI), 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
(Singh) Department of Cardiology, Gold Coast University Hospital, Griffith
University, Gold Coast, Australia
Publisher
HMP Communications
Abstract
Background. During percutaneous cardiac procedures, the use of radial
access is growing, but femoral access remains needed for large-bore,
high-risk procedures. Methods are needed to make femoral access safer. In
this systematic review and meta-analysis of randomized-controlled trials
(RCTs), we assess whether ultrasound guidance is associated with a
decreased risk of vascular complications during femoral artery
catheterization. Methods. Medline, Embase, and Cochrane Central were
searched from inception to April 2018. RCTs assessing the use of
ultrasound among adult patients undergoing a femoral artery
catheterization were included. The primary outcome was vascular-access
related complications. Secondary outcomes included major and minor
vascular access bleeding, success rate, venipuncture, number of attempts,
and successful placement into the common femoral artery. Results. Five
RCTs (n = 1553) met the inclusion criteria, with two trials using blinded
outcome assessment. Ultrasound use was associated with a reduction in the
rate of vascular-access related complications (1.9% vs 4.3%; odds ratio
[OR], 0.44; 95% confidence interval [CI], 0.24-0.81; P<.01). This was
primarily driven by a reduction in local hematomas; once hematomas were
excluded, the association was no longer significant (0.6% vs 1.7%; OR,
0.39; 95% CI, 0.15- 1.07; P=.07). There was no significant reduction in
major bleeding (0.3% vs 1.3%; OR, 0.28; 95% CI, 0.07-0.1.16; P=.08) or
minor bleeding (1.4% vs 2.8%; OR, 0.50; 95% CI, 0.24-1.05; P=.07).
Conclusions. Ultrasound guidance during femoral artery catheterization is
associated with a decreased risk of vascular complications, primarily
driven by a reduction in local hematomas. Larger trials are needed to
determine the effect of ultrasound on major bleeding and vascular
complications (excluding hematomas). Copyright © 2019 HMP
Communications. All rights reserved.

<11>
Accession Number
2002098737
Title
Ultrasound Assessment of Respiratory Workload With High-Flow Nasal Oxygen
Versus Other Noninvasive Methods After Chest Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (11) (pp 3042-3047),
2019. Date of Publication: November 2019.
Author
Laverdure F.; Genty T.; Rezaiguia-Delclaux S.; Herve P.; Stephan F.
Institution
(Laverdure) Department of Anesthesiology, Marie Lannelongue Hospital, Le
Plessis Robinson, France
(Laverdure, Genty, Rezaiguia-Delclaux, Stephan) Intensive Care Unit, Marie
Lannelongue Hospital, Le Plessis Robinson, France
(Herve) Department of Thoracic Surgery, Marie Lannelongue Hospital, Le
Plessis Robinson, France
Publisher
W.B. Saunders
Abstract
Objective: To compare the respiratory workload using the diaphragm
thickening fraction (DTf) determined by sonography during high-flow nasal
oxygen (HFNO), standard oxygen therapy (SOT), and noninvasive bilevel
positive airway pressure support (BIPAP) in patients with acute
respiratory failure (ARF) after cardiothoracic surgery. Design(s):
Prospective controlled clinical trial. Setting(s): A French 23-bed
cardiothoracic surgical intensive care unit. Participant(s):
Nonintubated patients with ARF after cardiothoracic surgery or while
awaiting lung transplantation. Intervention(s): HFNO (50 L/min), SOT
via a standard facemask, and BIPAP (pressure support, 4 cmH<inf>2</inf>O;
positive end-expiratory pressure [PEEP], 4 cmH<inf>2</inf>O), with
F<inf>I</inf>O<inf>2</inf> kept constant were successively applied and
compared. With BIPAP, pressure support or PEEP increments up to 8
cmH<inf>2</inf>O were compared with baseline settings. Each measurement
was made after stable breathing for 5 minutes. Measurements and Main
Results: Fifty patients aged 60.0 +/- 12.2 years were enrolled, including
14 (28%) with obesity. Mean PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> was
153 +/- 55 mmHg. DTf was lower with HFNO and BIPAP than with SOT
(respectively 21.2% +/- 15.1% v 30.9% +/- 21.1% and 17.8% +/- 19.1% v
30.9% +/- 21.1%, p < 0.001) and was not different with HFNO versus BIPAP
(p = 0.22). With BIPAP, increasing pressure support to 8 cmH<inf>2</inf>O
decreased DTf (21.0% +/- 14.3% v 28.8% +/- 19.8%, p = 0.009), whereas
increasing PEEP to 8 cmH<inf>2</inf>O did not (25.2% +/- 17.2% v 28.8% +/-
19.8%, p = 0.79). Tidal volume increased to 10.6 +/- 3.4 mL/kg with 8
cmH<inf>2</inf>O pressure support v 8.8 +/- 2.7 mL/kg with 4
cmH<inf>2</inf>O pressure support (p < 0.001). Conclusion(s): HFNO
provides a comparable respiratory workload decrease compared with BIPAP at
lower levels of pressure support and PEEP compared with SOT. Increasing
BIPAP pressure support may provide higher levels of assistance but carries
a risk of overdistension. Copyright © 2019 Elsevier Inc.

<12>
Accession Number
2001926683
Title
Combined Approach Versus 2 Conventional Approaches in Ultrasound-Guided
Central Venous Catheterization: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (11) (pp 2979-2984),
2019. Date of Publication: November 2019.
Author
Takeshita J.; Nishiyama K.; Fukumoto A.; Shime N.
Institution
(Takeshita) Department of Intensive Care Medicine, Osaka Prefectural
Hospital Organization, Osaka Women's and Children's Hospital, Izumi,
Osaka, Japan
(Nishiyama) Department of Emergency and Critical Care Medicine, National
Hospital Organization, Kyoto Medical Center, Mukaihata-cho, Fushimi-ku,
Kyoto, Japan
(Fukumoto) Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital,
Yamashina-ku, Kyoto, Japan
(Shime) Department of Emergency and Critical Care Medicine, Graduate
School of Biomedical & Health Sciences, Hiroshima University, Minami-ku,
Hiroshima, Japan
Publisher
W.B. Saunders
Abstract
Objective: The authors compared the occurrence of posterior wall puncture
using the short-axis out-of-plane and long-axis in-plane approaches with
that using the combined short-axis-and-long-axis approach that the authors
previously showed to be effective in observational and manikin studies.
 Design(s): Randomized controlled study. Setting(s): Single
tertiary institution. Participant(s): One hundred twenty patients who
underwent cardiac or vascular surgery under general anesthesia.
 Intervention(s): The patients were divided randomly into combined
short-axis-and-long-axis (n = 40), short-axis out-of-plane (SA-OOP) (n =
40), and long-axis in-plane (LA-IP) (n = 40) groups and received
ultrasound-guided central venous catheterization at the right internal
jugular vein. Measurements and Main Results: Successful guidewire
insertion without posterior wall puncture was performed in 40 patients
(100%) in the combined short-axis-and-long-axis approach group, 28 (70%)
in the short-axis out-of-plane approach group, and 38 (95%) in the LA-IP
approach group (combined short-axis-and-long-axis v SA-OOP, p = 0.0002
[relative risk = 1.43; 95% CI: 1.17-1.75]; combined
short-axis-and-long-axis v LA-IP, p = 0.49 [relative risk = 1.05; 95% CI:
0.98-1.13]). Procedure durations were 28.5 (24.1-36.4) seconds in the
combined short-axis-and-long-axis group, 31.7 (24.4-40.6) seconds in the
SA-OOP group, and 24.3 (20.8-32.1) seconds in the long-axis in-plane group
(combined short-axis-and-long-axis v SA-OOP, p = 0.53; combined
short-axis-and-long-axis v LA-IP, p = 0.044). Conclusion(s): The
combined short-axis-and-long-axis approach for ultrasound-guided central
venous catheterization had a lower posterior wall puncture rate than the
SA-OOP approach, but there was no significant difference with the
long-axis in-plane approach. Copyright © 2019 Elsevier Inc.

<13>
Accession Number
2001737966
Title
The Effect of Simultaneous Renal Replacement Therapy on Extracorporeal
Membrane Oxygenation Support for Postcardiotomy Patients with Cardiogenic
Shock: A Pilot Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (11) (pp 3063-3072),
2019. Date of Publication: November 2019.
Author
Li C.; Wang H.; Liu N.; Jia M.; Hou X.
Institution
(Li, Wang, Liu, Jia, Hou) Center for Cardiac Intensive Care, Beijing
Anzhen Hospital, Capital Medical University, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: The objectives of this study were to determine the feasibility
and safety of simultaneous renal replacement therapy (RRT) during
extracorporeal membrane oxygenation (ECMO) support for postcardiotomy
patients with cardiogenic shock and whether simultaneous RRT with ECMO
would improve survival and reduce morbidity. The authors hypothesized that
simultaneous RRT could facilitate effective fluid management and rapid
metabolic control in postcardiotomy patients with cardiogenic shock who
were undergoing ECMO support. Design(s): A parallel, open-label,
single-center pilot randomized trial. Setting(s):
University-affiliated cardiac surgery intensive care unit.
 Participant(s): The study comprised 41 postcardiotomy patients with
cardiogenic shock who received ECMO support. Intervention(s):
Participants were enrolled and randomly assigned via a 1:1 allocation to a
simultaneous RRT arm versus a standard care arm. The patients in the
simultaneous RRT arm received RRT within 12 hours of the start of ECMO
regardless of the conventional RRT indication. Simultaneous RRT was
delivered with the RRT machine connected to the ECMO circuit. The patients
in the standard care arm did not receive RRT at the start of ECMO unless
the conventional RRT indications were fulfilled. Measurements and
Main Results: All 41 patients enrolled were followed-up for 30 days and
the results analyzed. The primary feasibility outcome was the time from
randomization to simultaneous RRT of <12 hours in the simultaneous RRT
arm. All participants in simultaneous RRT arm fulfilled with a median time
from randomization to simultaneous RRT of 4.4 (2.7-5.6) hours. The 30-day
all-cause mortality was 61.9% in the simultaneous RRT arm and 75.0% in the
standard care arm (p = 0.51). The lactate clearance was higher in the
simultaneous RRT arm (0.56 +/- 0.4 v 0.28 +/- 0.4 mmol/L/h; p = 0.04).
There was lower cumulative fluid balance in the simultaneous RRT arm on
ECMO day 3 (-1,510 [-3560 to 1,162] v -332 [-2,027 to 2,181]; p = 0.38)
and ECMO day 5 (-2,671 [-5,197 to 3,334] v -1,509 [-3,595 to 1,162]; p =
0.41) without significance. There were no significant differences in
adverse events reported and no hemodynamic instability owing to
simultaneous RRT delivery. Conclusion(s): This pilot study suggests
the feasibility and safety of simultaneous RRT during ECMO support for
postcardiotomy patients with cardiogenic shock, providing an efficient
means for controlling fluid status and metabolics. A large trial based on
this pilot study is required to confirm the clinical
benefits. Copyright © 2019 Elsevier Inc.

<14>
Accession Number
629281766
Title
Drugs to reduce bleeding and transfusion in adults undergoing cardiac
surgery: A systematic review and network meta analysis.
Source
Cochrane Database of Systematic Reviews. 2019 (9) (no pagination), 2019.
Article Number: CD013427. Date of Publication: 12 Sep 2019.
Author
Beverly A.; Ong G.; Wilkinson K.L.; Doree C.; Welton N.J.; Estcourt L.J.
Institution
(Beverly, Ong, Doree) Systematic Review Initiative, NHS Blood and
Transplant, Oxford, United Kingdom
(Wilkinson) Paediatric and Adult Cardiothoracic Anaesthesia, Southampton
University NHS Hospital, Southampton, United Kingdom
(Welton) Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, United Kingdom
(Estcourt) Transfusion Medicine, NHS Blood and Transplant, Oxford, United
Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives
are as follows: To assess the efficacy and safety of haemostatic drugs
(including antifibrinolytics) and topical agents for reducing bleeding,
transfusion, and reoperation in adults undergoing cardiac
surgery. Copyright © 2019 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<15>
Accession Number
629182939
Title
Perioperative care of children with sickle cell disease: a systematic
review and clinical recommendations.
Source
American journal of hematology. (no pagination), 2019. Date of
Publication: 27 Aug 2019.
Author
Schyrr F.; Dolci M.; Nydegger M.; Canellini G.; Andreu-Ullrich H.; Joseph
J.-M.; Diezi M.; Cachat F.; Rizzi M.; Renella R.
Institution
(Schyrr, Diezi, Rizzi, Renella) Pediatric Hematology-Oncology Unit,
Division of Pediatrics, Department "Woman-Mother-Child", Lausanne
University Hospital and University of Lausanne, Switzerland
(Dolci, Nydegger) Division of Anesthesia, Department of Surgery, Lausanne
University Hospital and University of Lausanne, Switzerland
(Canellini, Andreu-Ullrich) Transfusion Medicine Unit, Department of
Laboratory Medicine, Lausanne University Hospital and University of
Lausanne, Switzerland
(Joseph) Division of Pediatric Surgery, Department "Woman-Mother-Child",
Lausanne University Hospital and University of Lausanne, Switzerland
(Cachat) Pediatric Nephrology Unit, Division of Pediatrics, Department
"Woman-Mother-Child", Lausanne University Hospital and University of
Lausanne, Switzerland
Publisher
NLM (Medline)
Abstract
Children with sickle cell disease (SCD) require specific perioperative
care, and clinical practice in this area remains poorly defined. We aimed
to a) conduct a systematic, PRISMA-based review of the literature and any
available clinical guidelines, practice recommendations, and extract any
valuable information for the "best of available-evidence"-based prevention
of perioperative adverse events in children with SCD, b) highlight the
most urgent priorities in clinical research. As data sources, US National
Library of Medicine, Medline, National Guideline Clearinghouse,
International Guideline Network, TRIP databases were searched for any
content until January 2019. We also included institutional, consortia and
expert group guidelines. Included were reports/guidelines in English,
French, German, Italian. Excluded were reports on obstetrical and fetal
management. We identified 202 reports/guidelines fulfilling the criteria
outlined above. A majority focused on visceral, cardiovascular and
orthopedic surgery procedures, and only five were multicenter randomized
controlled trials and two prospective randomized studies. After grading of
quality of evidence, the extracted data was summarized into clinical
recommendations for daily practice. Additionally, we designed a
risk-grading algorithm to identify contexts likely to be associated with
adverse outcomes. In conclusion, we provide a systematic PRISMA-based
review of the existing literature and any ancillary practice and delineate
a set of clinical recommendations and priorities for research. This
article is protected by copyright. All rights reserved.

<16>
Accession Number
623467896
Title
A randomized multicentre trial to compare revascularization with optimal
medical therapy for the treatment of chronic total coronary occlusions.
Source
European Heart Journal. 39 (26) (pp 2484-2493), 2018. Date of Publication:
07 Jul 2018.
Author
Werner G.S.; Martin-Yuste V.; Hildick-Smith D.; Boudou N.; Sianos G.;
Gelev V.; Rumoroso J.R.; Erglis A.; Christiansen E.H.; Escaned J.; Di
Mario C.; Hovasse T.; Teruel L.; Bufe A.; Lauer B.; Bogaerts K.; Goicolea
J.; Spratt J.C.; Gershlick A.H.; Galassi A.R.; Louvard Y.
Institution
(Werner) Klinikum Darmstadt GmbH, Medizinische Klinik i, Grafenstrasse 9,
Darmstadt D-64283, Germany
(Martin-Yuste) Hospital Clinic, Seccion de Hemodinamica Cardiaca,
Villaroel 170, Barcelona 08036, Spain
(Hildick-Smith) Royal Sussex County Hospital, Sussex Cardiac Centre,
Eastern Road, Brighton BN2 5 BE, United Kingdom
(Boudou) Hopital de Rangueil, CHU Toulouse, Department of Cardiology, 1
avenue Jean Poulhes, Toulouse Cedex 9 31059, France
(Sianos) AHEPA University Hospital, 1st Department of Cardiology,
Stilponos Kyriakidi 1, Thessaloniki 54636, Greece
(Gelev) Cardiology Clinic, MHAT, Tokuda Hospital Sofia, 51B Nikola
Vaptsarov Blvd., Sofia 1407, Bulgaria
(Rumoroso) Hospital Galdakao-Usansolo, Seccion de Hemodinamica, barrio de
labeaga s/n, Galdakao 48960, Spain
(Erglis) Pauls Stradins Clinical University Hospital, Institute of
Cardiology and Regenerative Medicine, 13 Pilsonu street, Riga LV-1002,
Latvia
(Christiansen) Aarhus University Hospital, Department of Cardiology B,
Skejby Aarhus N 8200, Denmark
(Escaned) Hospital Clinico San Carlos, Unidad de Cardiologia
Intervencionista, Profesor Martin Lagos s/n, Madrid 28040, Spain
(Di Mario) University Hospital Careggi, Division of Structural
Interventional Cardiology, Largo Brambilla 3, Florence 50139, Italy
(Hovasse, Louvard) Institut Jacques Cartier, 6 avenue Noyer Lambert, Massy
91300, France
(Teruel) Bellvitge University Hospital, Unidad de Hemodinamica y
Cardiologia, L'Hospitalet de Llobregat, C/ Feixa Llarga s/n, Barcelona
08907, Spain
(Bufe) HELIOS Klinik Krefeld, Medizinische Klinik i, Lutherplatz 40,
Krefeld 47805, Germany
(Lauer) Zentralklinik Bad Berka, Klinik fur Kardiologie, Robert-Koch-Allee
9, Bad Berka 99437, Germany
(Bogaerts) Leuven Biostatistics and Statistical Bioinformatics Centre,
L-BioStat. Kapucijnenvoer 35, Leuven 3000, Belgium
(Goicolea) Hospital Universitario Puerta de Hierro, Servicio de
Hemodinamica y Arritmias, Joaquin Rodrigo, 2, Majadahonda 28222, Spain
(Spratt) Royal Infirmary of Edinburgh, Department of Cardiology, 51 Little
France Crescent, Edinburgh EH16 4SA, United Kingdom
(Gershlick) Glenfield Hospital, Leicester Cardiovascular Biomedical
Research Unit, Groby Road, Leicester LE3 9 QP, United Kingdom
(Galassi) Department of Clinical and Experimental Medicine, University of
Catania, Via Antonello da Messina 75, Catania 95021, Italy
Publisher
Oxford University Press
Abstract
Aims The clinical value of percutaneous coronary intervention (PCI) for
chronic coronary total occlusions (CTOs) is not established by randomized
trials. This study should compare the benefit of PCI vs. optimal medical
therapy (OMT) on the health status in patients with at least one CTO.
Method and results Three hundred and ninety-six patients were enrolled in
a prospective randomized, multicentre, open-label, and controlled clinical
trial to compare the treatment by PCI with OMT with a 2:1 randomization
ratio. The primary endpoint was the change in health status assessed by
the Seattle angina questionnaire (SAQ) between baseline and 12months
follow-up. Fifty-two percent of patients have multi-vessel disease in whom
all significant non-occlusive lesions were treated before randomization.
An intention-to-treat analysis was performed including 13.4% failed
procedures in the PCI group and 7.3% cross-overs in the OMT group. At
12months, a greater improvement of SAQ subscales was observed with PCI as
compared with OMT for angina frequency [5.23, 95% confidence interval (CI)
1.75; 8.71; P= 0.003], and quality of life (6.62, 95% CI 1.78-11.46; P =
0.007), reaching the prespecified significance level of 0.01 for the
primary endpoint. Physical limitation (P= 0.02) was also improved in the
PCI group. Complete freedom from angina was more frequent with PCI 71.6%
than OMT 57.8% (P = 0.008). There was no periprocedural death or
myocardial infarction. At 12months, major adverse cardiac events were
comparable between the two groups. Conclusion Percutaneous coronary
intervention leads to a significant improvement of the health status in
patients with stable angina and a CTO as compared with OMT
alone. Copyright © The Author(s) 2018.

<17>
Accession Number
2001057077
Title
Early Versus Standard Discharge After Transcatheter Aortic Valve
Replacement: A Systematic Review and Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 11 (17) (pp 1759-1771), 2018. Date of
Publication: 10 September 2018.
Author
Kotronias R.A.; Teitelbaum M.; Webb J.G.; Mylotte D.; Barbanti M.; Wood
D.A.; Ballantyne B.; Osborne A.; Solo K.; Kwok C.S.; Mamas M.A.; Bagur R.
Institution
(Kotronias, Kwok, Mamas, Bagur) Keele Cardiovascular Research Group,
Institute for Applied Clinical Science and Centre for Prognosis Research,
Institute of Primary Care and Health Sciences, University of Keele,
Stoke-on-Trent, United Kingdom
(Kotronias) Oxford University Clinical Academic Graduate School, Oxford
University, Oxford, United Kingdom
(Teitelbaum, Ballantyne, Osborne, Bagur) London Health Sciences Centre,
London, Ontario, Canada
(Webb, Wood) Centre for Heart Valve Innovation, St. Paul's Hospital,
University of British Columbia, Vancouver, British Columbia, Canada
(Mylotte) Galway University Hospitals, National University of Ireland,
Galway, Ireland
(Barbanti) Division of Cardiology, Cardio-Thoracic-Vascular Department,
University of Catania, Catania, Italy
(Solo, Bagur) Department of Epidemiology and Biostatistics, Schulich
School of Medicine & Dentistry, Western University, London, Ontario,
Canada
(Kwok, Mamas) The Heart Centre, Royal Stoke Hospital, University Hospital
of North Midlands Trust, Stoke-on-Trent, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to assess the clinical outcomes of patients
undergoing transcatheter aortic valve replacement (TAVR) with early
discharge (ED) versus standard discharge (SD) pathways.
 Background(s): Minimalist approaches for TAVR have been developed
targeting different aspects of the procedure such as local anesthesia or
sedation, intraprocedural imaging, vascular access, post-operative
monitoring and care, and discharge planning. Their incorporation into
routine clinical practice aims to reduce length of hospital stay and
health care cost utilization without adversely affecting outcomes when
compared with standard approaches. Method(s): The authors conducted a
search of MEDLINE and EMBASE to identify studies that investigated ED (<=3
days) versus SD in TAVR patients. Random-effects meta-analyses were used
to estimate the effect of ED compared with SD with regard to 30-day
mortality after discharge, 30-day readmission rate, and need for permanent
pacemaker implantation (PPI) following discharge. Result(s): Eight
studies including 1,775 participants (ED, n = 642) fulfilled the inclusion
criteria. The mean age was 82.4 years and STS score was 6.7. Meta-analyses
evaluating discharge to 30-day mortality (odds ratio [OR]: 0.65; 95%
confidence interval [CI]: 0.23 to 1.82; I2 = 0%) and discharge
to 30-day new PPI (OR: 1.61; 95% CI: 0.19 to 13.71; I2 = 40%)
showed no significant difference in an ED compared with a SD strategy.
Notably, ED patients were less likely to be readmitted after ED when
compared with SD patients (OR: 0.63; 95% CI: 0.41 to 0.98; p = 0.04,
I2 = 0%). Conclusion(s): ED following uncomplicated TAVR
is safe in terms of discharge to 30-day mortality or need for PPI
following discharge. Moreover, ED patients experienced a lower rate of
readmissions. These data support the safety of programs aiming an ED
pathway in selected TAVR patients. Institutional protocols with the input
from different members of the multidisciplinary heart team should be
devised to optimize discharge processes to improve health care resource
utilization. Copyright © 2018 American College of Cardiology
Foundation

<18>
Accession Number
2001133016
Title
A Randomized Study of Distal Filter Protection Versus Conventional
Treatment During Percutaneous Coronary Intervention in Patients With
Attenuated Plaque Identified by Intravascular Ultrasound.
Source
JACC: Cardiovascular Interventions. 11 (16) (pp 1545-1555), 2018. Date of
Publication: 27 August 2018.
Author
Hibi K.; Kozuma K.; Sonoda S.; Endo T.; Tanaka H.; Kyono H.; Koshida R.;
Ishihara T.; Awata M.; Kume T.; Tanabe K.; Morino Y.; Tsukahara K.; Ikari
Y.; Fujii K.; Yamasaki M.; Yamanaka T.; Kimura K.; Isshiki T.
Institution
(Hibi, Kimura) Division of Cardiology, Yokohama City University Medical
Center, Yokohama, Japan
(Kozuma, Kyono) Division of Cardiology, Teikyo University School of
Medicine, Tokyo, Japan
(Sonoda) Second Department of Internal Medicine, School of Medicine,
University of Occupational and Environmental Health, Kitakyushu, Japan
(Endo) Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital,
Yokohama, Japan
(Tanaka) Department of Cardiology, Tokyo Metropolitan Tama Medical Center,
Fuchu, Japan
(Koshida) Tokeidai Memorial Hospital Cardiovascular Center, Sapporo, Japan
(Ishihara) Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
(Awata) Cardiovascular Division, Osaka National Hospital, Osaka, Japan
(Kume) Department of Cardiology, Kawasaki Medical School, Okayama, Japan
(Tanabe) Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Morino) Division of Cardiology, Department of Internal Medicine, Iwate
Medical University School of Medicine, Morioka, Japan
(Tsukahara) Division of Cardiology, Fujisawa City Hospital, Fujisawa,
Japan
(Ikari) Department of Cardiology, Tokai University, Kanagawa, Japan
(Fujii) Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka,
Japan
(Yamasaki) Department of Cardiology, NTT Medical Center Tokyo, Tokyo,
Japan
(Yamanaka) Department of Biostatistics, Yokohama City University,
Yokohama, Japan
(Isshiki) Division of Cardiology, Ageo Central General Hospital, Saitama,
Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to evaluate the utility of distal
protection during percutaneous coronary intervention (PCI) in patients
with acute coronary syndromes at high risk for distal embolization.
 Background(s): The results of previous clinical trials indicated that
the routine use of distal protection in patients with ST-segment elevation
myocardial infarction did not improve clinical outcomes. However,
selective use of distal protection by means of a filter-based distal
protection system has not been evaluated. Method(s): Two hundred
patients with acute coronary syndromes who had native coronary artery
lesions and attenuated plaque with longitudinal length >=5 mm on pre-PCI
intravascular ultrasound were randomly assigned to undergo PCI with distal
protection or conventional treatment. Result(s): The primary endpoint
(no-reflow phenomenon) occurred in 26 patients (26.5%) in the distal
protection group and 39 patients (41.7%) in the conventional treatment
group (p = 0.026), and the corrected TIMI (Thrombolysis In Myocardial
Infarction) frame count after revascularization was significantly lower in
the distal protection group (23 vs. 30.5; p = 0.0003). The incidence of
cardiac death, cardiac arrest, cardiogenic shock after revascularization
requiring defibrillation, cardiopulmonary resuscitation, or extracorporeal
membrane oxygenation was significantly lower in the distal protection
group than in the conventional treatment group (0% vs. 5.2%; p = 0.028).
 Conclusion(s): The use of distal embolic protection applied with a
filter device decreased the incidence of the no-reflow phenomenon and was
associated with fewer serious adverse cardiac events after
revascularization than conventional PCI in patients with acute coronary
syndromes with attenuated plaque >=5 mm in length. (Assessment of Distal
Protection Device in Patients at High Risk for Distal Embolism in Acute
Coronary Syndrome [ACS] [VAMPIRE3]; NCT01460966) Copyright © 2018
American College of Cardiology Foundation

<19>
Accession Number
622489096
Title
Pacemaker implantation rate after transcatheter aortic valve implantation
with early and new-generation devices: A systematic review.
Source
European Heart Journal. 39 (21) (pp 2003-2013), 2018. Date of Publication:
01 Jun 2018.
Author
Van Rosendael P.J.; Delgado V.; Bax J.J.
Institution
(Van Rosendael, Delgado, Bax) Department of Cardiology, Leiden University
Medical Center, Albinusdreef 2, Leiden 2333 ZA, Netherlands
Publisher
Oxford University Press
Abstract
Aims The incidence of new-onset conduction abnormalities requiring
permanent pacemaker implantation (PPI) after transcatheter aortic valve
implantation (TAVI) with new-generation prostheses remains debated. This
systematic review analyses the incidence of PPI after TAVI with
new-generation devices and evaluates the electrical, anatomical, and
procedural factors associated with PPI. In addition, the incidence of PPI
after TAVI with early generation prostheses was reviewed for comparison.
Methods and results According to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses checklist, this systematic review
screened original articles published between October 2010 and October
2017, reporting on the incidence of PPI after implantation of early and
new-generation TAVI prostheses. Of the 1406 original articles identified
in the first search for new-generation TAVI devices, 348 articles were
examined for full text, and finally, 40 studies (n = 17 139) were
included. The incidence of a PPI after the use of a new-generation TAVI
prosthesis ranged between 2.3% and 36.1%. For balloon-expandable
prostheses, the PPI rate remained low when using an early generation
SAPIEN device (ranging between 2.3% and 28.2%), and with the
new-generation SAPIEN 3 device, the PPI rate was between 4.0% and 24.0%.
For self-expandable prostheses, the PPI rates were higher with the early
generation CoreValve device (16.3-37.7%), and despite a reduction in PPI
rates with the new Evolut R, the rates remained relatively higher
(14.7-26.7%). When dividing the studies according to the highest (>26.0%)
and the lowest (<12.1%) quintile of PPI rate, patients within the highest
quintile were more frequently women when compared with the lowest quintile
group (50.9% vs. 46.3%, P < 0.001). Pre-existent conduction abnormalities
(electrical factor), calcification of the left ventricular outflow tract
(anatomical factor), and balloon valvuloplasty and depth of implantation
(procedural factors) were associated with increased risk of PPI.
Conclusion The rate of PPI after TAVI with new-generation devices is
highly variable. Specific recommendations for implantation of each
prosthesis, taking into consideration the presence of pre-existent
conduction abnormalities and anatomical factors, may be needed to reduce
the risk of PPI. Copyright © The European Society of Cardiology
2017. All rights reserved.

<20>
Accession Number
2002962476
Title
A Detailed Analysis of Perforations During Chronic Total Occlusion
Angioplasty.
Source
JACC: Cardiovascular Interventions. 12 (19) (pp 1902-1912), 2019. Date of
Publication: 14 October 2019.
Author
Hirai T.; Nicholson W.J.; Sapontis J.; Salisbury A.C.; Marso S.P.;
Lombardi W.; Karmpaliotis D.; Moses J.; Pershad A.; Wyman R.M.; Spaedy A.;
Cook S.; Doshi P.; Federici R.; Nugent K.; Gosch K.L.; Spertus J.A.;
Grantham J.A.
Institution
(Hirai, Salisbury, Nugent, Gosch, Spertus, Grantham) Saint Luke's Mid
America Heart Institute, Kansas City, MO, United States
(Hirai, Salisbury, Spertus, Grantham) Department of Medicine, Division of
Cardiology, University of Missouri Kansas City, Kansas City, Missouri,
United States
(Nicholson) York Hospital, York, PA, United States
(Sapontis) Monash Heart, Melbourne, Australia
(Marso) Research Medical Center, Kansas City, MO, United States
(Lombardi) University of Washington, Seattle, WA, United States
(Karmpaliotis, Moses) Columbia University, New York Presbyterian Hospital,
New York, NY, United States
(Pershad) Banner University Medical Center, Phoenix, AZ, United States
(Wyman) Torrance Medical Center, Torrance, CA, United States
(Spaedy) Boone County Hospital, Columbia, MO, United States
(Cook) Peacehealth Sacred Heart Medical Center, Springfield, OR, United
States
(Doshi) Alexian Brothers Medical Center, Chicago, IL, United States
(Federici) Presbyterian Health System, Albuquerque, New Mexico, Mexico
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to describe the angiographic
characteristics, strategy associated with perforation, and the management
of perforation during chronic total occlusion percutaneous coronary
intervention (CTO PCI). Background(s): The incidence of perforation
is higher during CTO PCI compared with non-CTO PCI and is reportedly
highest among retrograde procedures. Method(s): Among 1,000
consecutive patients who underwent CTO PCI in a 12-center registry, 89
(8.9%) had core lab-adjudicated angiographic perforations. Clinical
perforation was defined as any perforation requiring treatment. Major
adverse cardiac events (MAEs) were defined as in-hospital death, cardiac
tamponade, and pericardial effusion. Result(s): Among the 89
perforations, 43 (48.3%) were clinically significant, and 46 (51.7%) were
simply observed. MAE occurred in 25 (28.0%), and in-hospital death
occurred in 9 (10.1%). Compared with nonclinical perforations, clinical
perforations were larger in size, more often at a collateral location, had
a high-risk shape, and less likely to cause staining or fast filling.
Compared with perforations not associated with MAE, perforations
associated with MAE were larger in size, more proximal or at collateral
location, and had a high-risk shape. When the core lab attributed the
perforation to the approach used when the perforation occurred, 61% of
retrograde perforations by other classifications were actually antegrade.
 Conclusion(s): Larger size, proximal or collateral location, and
high-risk shapes of a coronary perforation were associated with MAE. Six
of 10 perforations occurred with antegrade approaches among patients who
had both strategies attempted. These finding will help emerging CTO
operators understand high-risk features of the perforation that require
treatment and inform future comparisons of retrograde and antegrade
complications. Copyright © 2019 American College of Cardiology
Foundation

<21>
Accession Number
2002958743
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement in patients at low and intermediate risk: A risk specific
meta-analysis of randomized controlled trials.
Source
PLoS ONE. 14 (9) (no pagination), 2019. Article Number: e0221922. Date of
Publication: 2019.
Author
Fang F.; Tang J.; Zhao Y.; He J.; Xu P.; Faramand A.
Institution
(Fang, Zhao, He) West China Hospital, Sichuan University, Chengdu,
Sichuan, China
(Tang) Chinese University of Hong Kong, Shenzhen, Guangdong, China
(Xu) Sichuan University Library, Chengdu, Sichuan, China
(Faramand) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Transcatheter aortic valve implantation (TAVI) is an option for
treatment for patients with severe aortic stenosis who are at high risk
for death with surgical aortic valve replacement (SAVR). It is unknown
whether TAVI can be safely introduced to intermediate-and low-risk
patients. Objective To compare the efficacy and safety of TAVI and SAVR in
patients with intermediate-and low-surgical risk. Data sources Medline,
Embase, and the Cochrane Central Register of Controlled Trials were
searched from inception to April 15, 2019. Study selection We included
randomized controlled trials comparing TAVI with SAVR in patients with
intermediate-and low-surgical risk. Data extraction Meta-analyses were
conducted using random-effects models to calculate risk ratios (RR) with
corresponding 95% confidence interval (CI). Two independent reviewers
completed citation screening, data abstraction, and risk assessment.
Primary outcome was a composite of all-cause mortality or disabling stroke
at 12 months. Data Synthesis A total of 5 trials randomizing 6390 patients
were included. In patients with low risk, TAVI was associated with a
significant reduction in the composite of all-cause mortality or disabling
stroke compared with SAVR (RR, 0.56; 95%CI, 0.40-0.79; I2 =
0%). This benefit was not replicated in patients with intermediate risk
(RR, 0.96; 95% CI, 0.80-1.15; I2 = 0%). Similar results were
seen separately in all-cause mortality and disabling stroke when TAVI was
compared with SAVR. Conclusion For patients with severe aortic stenosis
who were at low risk for death from surgery, TAVI achieved superior
clinical outcomes compared to SAVR; however, these benefits were not seen
in those with intermediate risk. This information may inform discussions
about deciding between SAVR and TAVI for patients with low to intermediate
risk separately. Copyright © 2019 Fang et al.

<22>
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. Copyright
© 2019 Massachusetts Medical Society.

<23>
Accession Number
628779598
Title
A systematic review of standardized methods for assessment of endograft
sealing on computed tomography angiography post-endovascular aortic
repair, and its influence on endograft-associated complications.
Source
Expert Review of Medical Devices. 16 (8) (pp 683-695), 2019. Date of
Publication: 03 Aug 2019.
Author
Schuurmann R.C.L.; De Rooy P.M.; Bastos Goncalves F.; Vos C.G.; De Vries
J.-P.P.M.
Institution
(Schuurmann, De Rooy, De Vries) Department of Surgery, Division of
Vascular Surgery, University Medical Centre Groningen, Groningen,
Netherlands
(Bastos Goncalves) Department of Vascular Surgery, Hospital de Santa
Marta, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal
(Vos) Department of Vascular Surgery, Martini Hospital Groningen,
Groningen, Netherlands
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Although there is much attention for proper sizing of
pre-operative anatomy before (thoracic) endovascular aneurysm repair
([T]EVAR), standardized assessment of endograft position and apposition at
postoperative imaging is seldom addressed in the international guidelines.
The highly detailed three-dimensional computed tomography angiography
(CTA) volumes contain valuable information about the apposition of the
endograft with the arterial wall and the position of the device relative
to anatomical landmarks in the proximal and distal landing zones, which is
currently hardly used. With proper assessment on CTA of the endograft
after EVAR, the risk for future endograft-related complications may be
determined, allowing patient-tailored, risk-stratified surveillance. Areas
covered: This systematic review identified three standardized methods for
assessing apposition or position of the endograft in the proximal or
distal landing zone on CTA after (T)EVAR. Quantification of apposition and
position, validation of measurement precision, and association with
endograft-related complications were extracted. Short (<10 mm apposition
length) and decreasing (>0 mm) apposition were associated with
endograft-associated complications. Expert commentary: Standardized
assessment of apposition and position of the endograft in the proximal and
distal landing zones on CTA should be incorporated in post-(T)EVAR
surveillance. A risk-stratified CTA surveillance protocol is
proposed. Copyright © 2019, © 2019 The Author(s). Published
by Informa UK Limited, trading as Taylor & Francis Group.

<24>
[Use Link to view the full text]
Accession Number
627081099
Title
Early versus standard care invasive examination and treatment of patients
with non-ST-segment elevation acute coronary syndrome verdict randomized
controlled trial.
Source
Circulation. 138 (24) (pp 2741-2750), 2018. Date of Publication: 2018.
Author
Kofoed K.F.; Kelbaek H.; Riis Hansen P.; Torp-Pedersen C.; Hofsten D.;
Klovgaard L.; Holmvang L.; Helqvist S.; Jorgensen E.; Galatius S.;
Pedersen F.; Bang L.; Saunamaki K.; Clemmensen P.; Linde J.J.; Heitmann
M.; Wendelboe Nielsen O.; Raymond I.E.; Peter Kristiansen O.; Hastrup
Svendsen I.; Bech J.; Dominguez Vall-Lamora M.H.; Kragelund C.; Fritz
Hansen T.; Dahlgaard Hove J.; Jorgensen T.; Fornitz G.G.; Steffensen R.;
Jurlander B.; Abdulla J.; Lyngbaek S.; Elming H.; Krohn Therkelsen S.;
Abildgaard U.; Skov Jensen J.; Gislason G.; Kober L.V.; Engstrom T.
Institution
(Kofoed) Department of Cardiology, Section 2014, Heart Centre,
Rigshospitalet, University of Copenhagen, Blegdamsvej 9 2100-CPH, Denmark
(Kofoed, Hofsten, Klovgaard, Holmvang, Helqvist, Jorgensen, Pedersen,
Bang, Saunamaki, Clemmensen, Linde, Kober, Engstrom) Department of
Cardiology, Heart Centre, Rigshospitalet, Roskilde, Denmark
(Riis Hansen, Torp-Pedersen, Galatius, Bech, Kragelund, Fritz Hansen,
Abildgaard, Skov Jensen, Gislason) Department of Cardiology, Herlev and
Gentofte Hospitals, Roskilde, Denmark
(Heitmann, Wendelboe Nielsen, Raymond, Peter Kristiansen, Hastrup
Svendsen, Dominguez Vall-Lamora) Department of Cardiology, Bispebjerg and
Frederiksberg Hospitals, Roskilde, Denmark
(Dahlgaard Hove, Jorgensen, Fornitz) Department of Cardiology, Hvidovre
and Amager Hospitals, Roskilde, Denmark
(Steffensen, Jurlander) Department of Cardiology, Hillerod Hospital,
Roskilde, Denmark
(Abdulla, Lyngbaek) Department of Cardiology, Glostrup Hospital, Roskilde,
Denmark
(Kelbaek, Elming, Krohn Therkelsen) University of Copenhagen, Denmark
(Kelbaek, Elming, Krohn Therkelsen) Department of Cardiology, Zealand
University Hospital, Roskilde, Denmark
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The optimal timing of invasive coronary angiography (ICA) and
revascularization in patients with non-ST-segment elevation acute coronary
syndrome is not well defined. We tested the hypothesis that a strategy of
very early ICA and possible revascularization within 12 hours of diagnosis
is superior to an invasive strategy performed within 48 to 72 hours in
terms of clinical outcomes. METHOD(S): Patients admitted with
clinical suspicion of non-ST-segment elevation acute coronary syndrome in
the Capital Region of Copenhagen, Denmark, were screened for inclusion in
the VERDICT trial (Very Early Versus Deferred Invasive Evaluation Using
Computerized Tomography) (ClinicalTrials.gov NCT02061891). Patients with
ECG changes indicating new ischemia or elevated troponin, in whom ICA was
clinically indicated and deemed logistically feasible within 12 hours,
were randomized 1:1 to ICA within 12 hours or standard invasive care
within 48 to 72 hours. The primary end point was a combination of
all-cause death, nonfatal recurrent myocardial infarction, hospital
admission for refractory myocardial ischemia, or hospital admission for
heart failure. RESULT(S): A total of 2147 patients were randomized;
1075 patients allocated to very early invasive evaluation had ICA
performed at a median of 4.7 hours after randomization, whereas 1072
patients assigned to standard invasive care had ICA performed 61.6 hours
after randomization. Among patients with significant coronary artery
disease identified by ICA, coronary revascularization was performed in
88.4% (very early ICA) and 83.1% (standard invasive care). Within a median
follow-up time of 4.3 (interquartile range, 4.1-4.4) years, the primary
end point occurred in 296 (27.5%) of participants in the very early ICA
group and 316 (29.5%) in the standard care group (hazard ratio, 0.92; 95%
CI, 0.78-1.08). Among patients with a GRACE risk score (Global Registry of
Acute Coronary Events) >140, a very early invasive treatment strategy
improved the primary outcome compared with the standard invasive treatment
(hazard ratio, 0.81; 95% CI, 0.67-1.01; P value for interaction=0.023).
 CONCLUSION(S): A strategy of very early invasive coronary evaluation
does not improve overall long-term clinical outcome compared with an
invasive strategy conducted within 2 to 3 days in patients with
non-ST-segment elevation acute coronary syndrome. However, in patients
with the highest risk, very early invasive therapy improves long-term
outcomes. Copyright © 2018 American Heart Association, Inc.

<25>
Accession Number
621226276
Title
Coronary heart disease, heart failure, and the risk of dementia: A
systematic review and meta-analysis.
Source
Alzheimer's and Dementia. 14 (11) (pp 1493-1504), 2018. Date of
Publication: November 2018.
Author
Wolters F.J.; Segufa R.A.; Darweesh S.K.L.; Bos D.; Ikram M.A.; Sabayan
B.; Hofman A.; Sedaghat S.
Institution
(Wolters, Darweesh, Bos, Hofman) Department of Epidemiology, Harvard T.H.
Chan School of Public Health, Boston, MA, United States
(Wolters, Darweesh, Bos, Ikram, Hofman, Sedaghat) Department of
Epidemiology, Erasmus Medical Centre, Rotterdam, Netherlands
(Wolters, Darweesh, Ikram) Department of Neurology, Erasmus Medical
Centre, Rotterdam, Netherlands
(Segufa, Sabayan) Department of Gerontology and Geriatrics, Leiden
University Medical Centre, Leiden, Netherlands
(Bos, Ikram) Department of Radiology and Nuclear Medicine, Erasmus Medical
Centre, Rotterdam, Netherlands
(Sabayan) Department of Neurology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Cardiovascular risk factors are closely linked with dementia
risk, but whether heart disease predisposes to dementia is uncertain.
 Method(s): We systematically reviewed the literature and
meta-analyzed risk estimates from longitudinal studies reporting the
association of coronary heart disease (CHD) or heart failure (HF) with
risk of dementia. Result(s): We identified 16 studies (1,309,483
individuals) regarding CHD, and seven studies (1,958,702 individuals)
about HF. A history of CHD was associated with a 27% increased risk of
dementia (pooled relative risk [RR] [95% confidence interval, CI]: 1.27
[1.07-1.50]), albeit with considerable heterogeneity across studies
(I2 = 80%). HF was associated with 60% increased dementia risk
(pooled RR 1.60 [1.19-2.13]) with moderate heterogeneity (I2 =
59%). Among prospective population-based cohorts, pooled estimates were
similar (for CHD, RR 1.26 [1.06-1.49], nine studies; and HF, RR 1.80
[1.41-2.31], four studies) and highly consistent (I2 = 0%).
 Conclusion(s): CHD and HF are associated with an increased risk of
dementia. Copyright © 2018 the Alzheimer's Association

<26>
Accession Number
2002982431
Title
A Prolonged Air Leak Score for Lung Cancer Resection: An Analysis of the
STS GTSD.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Seder C.W.; Basu S.; Ramsay T.; Rocco G.; Blackmon S.; Liptay M.J.;
Gilbert S.
Institution
(Seder, Liptay) Department of Cardiovascular and Thoracic Surgery, Rush
University Medical Center, Chicago, IL, United States
(Basu) Department of Internal Medicine, Rush University Medical Center,
Chicago, IL, United States
(Ramsay) Ottawa Health Research Institute, University of Ottawa, Ottawa,
Ontario, Canada
(Rocco) Memorial Sloan Kettering Cancer Center, New York, NY, United
States
(Blackmon) Division of Thoracic Surgery, Department of Surgery, Mayo
Clinic, Rochester, MN, United States
(Gilbert) Division of Thoracic Surgery, Department of Surgery, University
of Ottawa, Ottawa, Ontario, Canada
Publisher
Elsevier USA
Abstract
Background: The objective of this study was to create a simple
preoperative tool to assess the risk of prolonged air leak (PAL) using The
Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD).
 Method(s): The STS GTSD was queried for patients who underwent
elective lung cancer resection between 2009 and 2016. Exclusion criteria
included pneumonectomy, sleeve lobectomy, chest wall resection, bilateral
procedures, and patients with incomplete data sets. The primary outcome
was PAL exceeding 5 days. Multivariable logistic regression was used to
identify risk factors for a PAL. Model coefficients were used to generate
a PAL score (PALS). The approach was cross-validated in 100 replications
of a training set consisting of two-thirds of the cohort that was randomly
selected and a validation set of remaining patients. Result(s): A
total of 52,198 patients from the STS GTSD met inclusion criteria, with an
overall rate of PAL of 10.4% (n = 5453). Final variables incorporated into
the PALS included body mass index of 25 kg/m2 or less (7
points), lobectomy or bilobectomy (6 points), forced expiratory volume in
1 second of 70% predicted or less (5 points), male sex (4 points), and
right upper lobe procedure (3 points). A cumulative PALS exceeding 17
points stratified patients as high-risk or low-risk for PAL (19.6% vs 9%
rate of PAL) with a cross-validated mean negative predictive value of 91%,
positive predictive value of 19%, sensitivity of 30%, specificity of 85%,
and correctly classifies 79% of patients. Conclusion(s): The PALS is
a simple preoperative clinical tool that can reliably risk-stratify
patients for PAL who are undergoing lung cancer resection. Copyright
© 2019 The Society of Thoracic Surgeons

<27>
Accession Number
628836681
Title
Association of intra-operative hypotension with acute kidney injury,
myocardial injury and mortality in non-cardiac surgery: A meta-analysis.
Source
International journal of clinical practice. 73 (10) (pp e13394), 2019.
Date of Publication: 01 Oct 2019.
Author
An R.; Pang Q.-Y.; Liu H.-L.
Institution
(An, Pang, Liu) Department of Anesthesiology, Chongqing University Cancer
Hospital/Chongqing Cancer Institute/Chongqing Cancer Center 400030, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intra-operative hypotension might induce poor postoperative
outcomes in non-cardiac surgery, and the relationship between the level or
duration of Intra-operative hypotension (IOH) and postoperative adverse
events is still unclear. In this study, we performed a meta-analysis to
determine how IOH could affect acute kidney injury (AKI), myocardial
injury and mortality in non-cardiac surgery. METHOD(S): We searched
PubMed (Medline), Embase, Springer, The Cochrane Library, Ovid and Google
Scholar, and retrieved the related clinical trials on intra-operative
hypotension and prognosis in non-cardiac surgery. RESULT(S): Fifteen
observational studies were included. The meta-analysis showed that in
non-cardiac surgery, intra-operative hypotension (mean arterial pressure
[MAP]) <60 mm Hg for more than 1 minute was associated with an increased
risk of postoperative acute kidney injury(AKI) [1-5 minutes: odds ratio
(OR) = 1.13, 95% CI (1.04, 1.23), I2 = 0, P = .003; 5-10 minutes: OR =
1.18, 95% CI (1.07, 1.31), I2 = 0, P = .001; >10 minutes: OR = 1.35, 95%
CI (1.1, 1.67), I2 = 52.6%, P = .004] and myocardial injury [1-5 minutes:
OR = 1.16, 95% CI (1.01, 1.33), I2 = 30.6%, P = .04; 5-10 minutes: OR =
1.34, 95% CI (1.01, 1.77), I2 = 70.4%, P = .046; >10 minutes: OR = 1.43,
95% CI (1.18, 1.72), I2 = 39.4%, P < .0001]. Intra-operative hypotension
(MAP < 60 mm Hg) for 1-5 minutes was not associated with postoperative
30-day mortality [OR = 1.15, 95% CI (0.95, 1.4), I2 = 0, P = .154], but
intra-operative hypotension (MAP < 60 mm Hg) for more than 5 min was
associated with an increased risk of postoperative 30-day mortality [OR =
1.11, 95% CI (1.06, 1.17), I2 = 51.9%, P < .0001]. CONCLUSION(S):
Intra-operative hypotension was associated with an increased risk of
postoperative AKI, myocardial injury and 30-day mortality in non-cardiac
surgery. Intra-operative MAP < 60 mm Hg more than 1 minute should be
avoided. Copyright © 2019 John Wiley & Sons Ltd.

<28>
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.
 Design(s): Randomized, placebo-controlled, pilot feasibility trial.
 Setting(s): Cardiac surgery department of a tertiary hospital.
 Participant(s): Forty patients undergoing combined valvular and
coronary artery bypass surgery. Intervention(s): Intravenous thiamine
(600 mg on the day of surgery, and 400 mg/day on postoperative days 1, 2,
and 3) or placebo. 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 mol/L [IQR 92.5-129] for
thiamine v 99 micro 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 g/kg for thiamine v 0.12
micro g/kg for placebo; p = 0.88). 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. Copyright © 2019

<29>
Accession Number
2002984356
Title
REVERSED HALO SIGN IN A HEART TRANSPLANT PATIENT.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A1263), 2019. Date of Publication: October 2019.
Author
Nyquist A.; Snyder L.
Institution
(Nyquist) University of Arizona
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow
Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM
INTRODUCTION: The "Reversed Halo Sign" (RHS) is an imaging finding on CT
scan of the chest that describes a rounded area of ground-glass
attenuation surrounded by a partial or complete ring of consolidation.
Classically this was associated with organizing pneumonia, however
diagnostic possibilities now include invasive fungal infections,
granulomatous disease, and malignancy (1). Therefore, it is imperative for
clinicians to promptly and accurately diagnose the cause of a RHS. CASE
PRESENTATION: A 68 year-old male was evaluated for weakness and dyspnea
without fever, cough, or sputum production. He underwent heart
transplantation secondary to ischemic heart failure five months prior to
evaluation that was complicated by antibody-mediated rejection. His
treatments included methylprednisolone, thymoglobulin, plasmapharesis,
rituximab, and photopheresis. He was receiving infection prophylaxis with
fluconazole and trimethoprim/sulfamethoxazole. A CT scan of the chest
revealed a large round area of consolidation with central ground-glass
attenuation in the right upper lobe, consistent with RHS. This
radiographic finding and his risk factors prompted a transthoracic needle
biopsy that confirmed the diagnosis of Mucormycosis lung disease due to
Rhizopus species. He underwent right thoracotomy and upper lobectomy. He
was treated for eight weeks with Amphotericin B and Isavuconazonium before
transition to isavuconazonium for a planned one-year treatment course.
DISCUSSION: Advances in chest imaging have revolutionized the ability of
clinicians to rapidly diagnose pulmonary diseases and infections. The RHS
on CT chest imaging is an example of this and must include physician
knowledge of multiple causes and risk factors for specific diseases. The
first pathologic description of RHS was reported in 1996 and was
associated with organizing pneumonia (2). Currently, the RHS sign is
recognized as a radiologic image with diverse causes. The RHS can be seen
with invasive fungal infections in immunocompromised patients, with
pulmonary aspergillosis as the most common fungal etiology. Mucormycosis
and Pneumocystis jirovecii are other examples of fungal infections
associated with the RHS. In South America, 10% of paracoccidioidomycosis
infections have an associated RHS (3). Noninfectious causes of the RHS
include sarcoidosis and granulomatosis with polyangiitis. The RHS can be
seen in the setting of malignancy including adenocarcinoma of the lung and
lung metastases, lymphomatoid granulomatosis, and post-radiation injury.
The large number of diagnostic possibilities underscores the crucial
importance of knowledge of patient risk factors and prompt evaluation to
secure a diagnosis. CONCLUSION(S): While the RHS is an uncommon
finding on chest imaging, it has numerous important disease associations
that require prompt recognition and treatment. Reference #1: Marchiori,
Edson et al. Reversed Halo Sign. CHEST, Volume 141, Issue 5; 1260 - 1266
Reference #2: Venkata N Maturu, Ritesh Agarwal. Reversed Halo Sign: A
Systematic Review. Respiratory Care Sep 2014, 59 (9) 1440-1449; Reference
#3: Godoy MC, Viswanathan C, Marchiori E, et al. The reversed halo sign:
update and differential diagnosis. Br J Radiol. 2012;85(1017):1226-35
DISCLOSURES: No relevant relationships by Alan Nyquist, source=Web
Response No relevant relationships by Linda Snyder, source=Web
Response Copyright © 2019 American College of Chest Physicians

<30>
Accession Number
2002984220
Title
DANCING CLOT IN THE HEART WITH ACUTE PULMONARY EMBOLISM AND IMPENDING
PARADOXICAL EMBOLISM.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A231-A232), 2019. Date of Publication: October 2019.
Author
Chada C.; Kunadharaju R.; Kennedy D.; Oakley L.; Rudraraju A.
Institution
(Chada) Cheyenne Regional Medical Center
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case
Reports PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION:
Impending paradoxical embolism(IPDE) is a rare occurrence with about 200
cases reported in literature. If untreated a mortality rate of 100% has
been reported. We present a unique case with even higher mortality risk
due to associated MRSA infection. CASE PRESENTATION: 25 Female with h/o
obesity, IV drug abuse, presented to hospital with c/o severe SOB, fatigue
for 4 days and Syncope on day of presentation. On arrival to ED she had
Sao2 74%, HR 120/min, Temp 100.4 and BP 82/48 mm hg. She was intubated for
worsening hypoxia. Received IV fluid bolus and started on broad spectrum
antibiotics and levophed. CTA chest showed large bilateral proximal
pulmonary emboli. Heparin gtt was started and she underwent emergent
catheter mechanical embolectomy + tPA thrombolysis of right and left
pulmonary arteries. She had significant improved perfusion in both lungs
post tPA. TTE showed large highly mobile mass in right atrium and possible
additional mass in left atrium, severe TR, RVSP 65 mm hg and slightly
decreased RV systolic function. Her blood cultures turned + for MRSA. TEE
was done which showed a patent foramen ovale/ASD with thrombus extending
from right atrium into the left atrium. Unable to exclude mitral and
tricuspid valve vegetation's. She had right cubital abscess which was
drained. LE USG showed extensive DVT in her right femoral, popliteal
veins. IVC filter was placed and she was taken to the OR for mechanical
thromboembolectomy. A 16 cm large thrombus extending from right to left
atrium through PFO was removed. The valves showed no vegetation's. The PFO
was closed. Intraoperative TEE showed a structure in the main pulmonary
artery. The pulmonary artery was opened and 6 cm embolus removed. No
systemic embolic complication occurred. She was eventually transitioned to
Coumadin for 6 months and IV vancomycin for 8 weeks for MRSA septicemia.
DISCUSSION: IPDE is an emergency and currently there is no evidence based
guideline to direct appropriate treatment. Current options available are
anticoagulation alone vs anticoagulation + systemic thrombolysis vs
anticoagulation + surgical thromboembolectomy. Various case reports have
shown successful treatment with all the above strategies. Surgical
embolectomy carries risk of open heart surgery but recent data showed
improved mortality and lower risk of embolization, recurrence. On the
other hand, anticoagulation and systemic thrombolysis carries higher risk
for embolization and future recurrence. With our case we elected surgical
approach with good outcome. CONCLUSION(S): Based on review of
literature and outcome from our case, we recommend that patients with IPDE
be started on systemic heparinization first. In patients with acceptable
surgical risks and access to CV surgery, surgical thromboembolectomy
should be preferred. In patients with high surgical risk and limited
access to CV surgery, may be treated with anticoagulation +/-systemic
thrombolysis. Reference #1: Bushra M, Oron M. An Evasive Case of Right
Atrial Thrombus: A Need for Evidence-Based Guidelines.Insights Chest Dis.
2016,1:18. Reference #2: Embolus Entrapped in Patent Foramen Ovale:
Impending Paradoxical Embolism. Podrouzkova, Helena et al. The Annals of
Thoracic Surgery, Volume 98, Issue 6,2014, e151 - e152. Reference #3:
Patrick O. Myers, Henri Bounameaux, Aristotelis Panos, Rene Lerch,
Afksendiyos Kalangos,Impending Paradoxical Embolism: Systematic Review of
Prognostic Factors and Treatment,Chest, Volume 137, Issue 1,2010, Pages
164-170, ISSN 0012-3692. DISCLOSURES: No relevant relationships by
Chandrasekhar Chada, source=Web Response No relevant relationships by
Damon Kennedy, source=Web Response No relevant relationships by Rajesh
Kunadharaju, source=Web Response No relevant relationships by Luke Oakley,
source=Web Response No relevant relationships by Avantika Rudraraju,
source=Web Response Copyright © 2019 American College of Chest
Physicians

<31>
Accession Number
2002984093
Title
AN INTERESTING CASE OF UNILATERAL PULMONARY FIBROSIS.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A1830), 2019. Date of Publication: October 2019.
Author
Khan A.; Khan S.; Zafar R.; Hashm H.; Zaidi N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow
Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM
INTRODUCTION: Unilateral Pulmonary fibrosis is a distinct clinical entity
with interesting and confusing diagnostic dilemma. We are presenting a
case of unilateral, left sided pulmonary fibrosis presented to our
hospital. CASE PRESENTATION: 65 years old male with atrial fibrillation,
congestive heart failure and history of aortic valve replacement presented
to hospital for shortness of breath and worsening pedal edema. His Chest
x-ray showed predominantly left sided interstitial infiltrates. A chest CT
scan was done for further evaluation which showed extensive left sided
interstitial infiltrates with complete sparing of right lung. Patient
states he has been living on farm for more than 15 years and had worked as
construction worker in the past. Denied any exposure to asbestosis or
silicon. Patient had no symptoms suggestive of chronic aspiration,he was
also on acid reflux medications. Echo cardiogram did not show any systolic
anterior motion phenomenon. He underwent Wedge biopsy of left lung and
pathology results showed chronic non specific fibrotic changes but
inconsistent with any specific type of pulmonary fibrosis. DISCUSSION:
Review of literature showed only limited number of case reports available
for unilateral lung fibrosis. Possible causes of include proximal
interruption of the pulmonary artery, pulmonary vein thrombosis,
ipsilateral single lung ventilation, radiation pneumonitis or gastro
esophageal reflux disease1. Other possible causes include Local chronic
inflammatory diseases like bronchiectasis or ventilator induced lung
injury. It is important to mention that unilateral pulmonary fibrosis
should not be confused with unilateral pulmonary edema. Causes of
unilateral pulmonary edema include re-expansion phase after pneumothorax,
systemic to pulmonary shunt, unilateral symphathectomy and severe acute
mitral valve regurgitation2. Tcherakian and etal described 32 cases of
asymmetrical idiopathic pulmonary fibrosis but none of them were solely
unilateral pulmonary fibrosis. Work up should include Computed tomography
with contrast and possible pulmonary angiogram. Gastro esophageal disease
should be treated aggressively if no cause is identified3.
 CONCLUSION(S): Unilateral pulmonary fibrosis is uncommon and
diagnosis can be challenging. Physicians needs to be aware of this
condition and consider above mentioned differential diagnosis for
diagnosis work up. Reference #1: Viktor N. Lesnyak, Olesya V.
Danilevskaya, Alexander V. Averyanov and Lidia P. Ananyeva. Unilateral
Pulmonary Fibrosis and Systemic Sclerosis. Am J Respir Crit Care Med. 2014
Nov 1;190(9):1067-8. Reference #2: Hassan W1, ElShaer F, Fawzy ME, Al
Helaly S, Hegazy H, Akhras N. Cardiac unilateral pulmonary edema: is it
really a rare presentation? Congest Heart Fail. 2005 Jul-Aug;11(4):220-3.
Reference #3: Savarino E1, Carbone R, Marabotto E, Furnari M, Sconfienza
L, Ghio M, Zentilin P, Savarino V. Gastro-oesophageal reflux and gastric
aspiration in idiopathic pulmonary fibrosis patients.Eur Respir J. 2013
Nov;42(5):1322-31. Epub 2013 Mar 7. DISCLOSURES: No relevant relationships
by Hassan Hashm, source=Web Response No relevant relationships by Adnan
Khan, source=Web Response No relevant relationships by Sana Khan,
source=Web Response No relevant relationships by Ramsha Zafar, source=Web
Response No relevant relationships by Navid Zaidi, source=Web
Response Copyright © 2019 American College of Chest Physicians

<32>
Accession Number
2002984088
Title
SAPHENOUS VENOUS GRAFT ANEURYSM: AN UNDERREPORTED CORONARY ARTERY BYPASS
GRAFT LONG-TERM COMPLICATION.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A722-A723), 2019. Date of Publication: October 2019.
Author
Sanchez I.A.; Luna N.T.; Bhatti H.; Farooq I.
Institution
(Sanchez) University of Central Florida - College of Medicine
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION
TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM -
03:15 PM INTRODUCTION: Saphenous vein graft aneurysm (SVGa) are an
uncommon late complication from coronary artery bypass graft (CABG)
surgery. We report a case of SVGa 26 years after CABG. CASE PRESENTATION:
68-year-old male with history of coronary artery disease with CABG in
1992, chronic obstructive pulmonary disease, pulmonary nodules, presented
after abnormal computed tomography (CT) chest results. Review of system
included chronic productive cough at baseline related with dyspnea on
exertion. Physical exam was unremarkable. Chest CT without contrast
reported bilateral sub centimeter nodules and possible chronic main
pulmonary artery aneurysm (Fig. 1). Repeat CT chest with contrast
redemonstrated above findings. SVGa was considered with MRI demonstrating
3.7cm x 2.5cm x 2.4cm structure next to lateral wall at junction of the
distal main pulmonary-left pulmonary artery with subtle post contrast
enhancement consistent with near complete thrombosis of SVGa. Left heart
cath (LHC) was consistent with SVGa without visible outflow to the
pulmonary artery (Fig. 2). Patient underwent percutaneous intervention
with successful covered stent placement and complete occlusive coverage of
the neck of the aneurysm (Fig. 3). DISCUSSION: CABG is among the most
commonly performed surgical procedures in the US. Despite this, SVGa
remains a rare, but potentially fatal complication with an incidence <1%
(1). SVGa are defined as abnormal dilation of the vessel 1.5 times (2) the
expected normal diameter. Pathophysiology for development is uncertain.
Theories include inadequate surgical technique or secondary to evolving
atherosclerosis. SVGa presentation varies from asymptomatic to angina-like
symptoms, compression from mass-effect, fistula formation or sudden
rupture (2,3). Diagnosis is usually incidental and imaging should be
performed to establish size and rule out complications. Although there are
no clear guidelines for assessing SVGa, use of coronary angiography is
highly prevalent in case reports or small case series (3). Percutaneous
and surgical (used in over 50%) intervention are suitable options for
management (3). With emerging endovascular therapy options, patient
factors, and LHC findings (mechanical complications, occluded graft,
myocardial territory supplied), off label use of covered stents or coil
embolization can be considered. Consider surgical intervention for
symptomatic patients, diameters above 1cm or if graft flow is diminished
(3), but appropriate timing is unknown (4). Consider observation for
asymptomatic patients with SVGa less than 1cm with brisk graft flow (4).
 CONCLUSION(S): We present this case to highlight this rare and
potential life-threating long-term complication of CABG. Diagnosis
requires a high index due to overlap with other thoracic, pulmonary or
cardiac pathologies. Refinement of percutaneous techniques are less
invasive procedure with good survival in-hospital and 30-day mortality.
Reference #1: 1.Alexander JH, Smith PK. Coronary-Artery Bypass Grafting.
New Engl J Med 2016; 374:1954-1964. Reference #2: 2. Abbasi M, Soltani G,
Shomali A, Javan H. A large saphenous vein graft aneurysm one year after
coronary artery bypass graft surgery presenting as a left lung mass.
Interactive CardioVascular and Thoracic Surgery 8 2009:691-193. Reference
#3: 3. Ramirez FD, Hibbert B, Simard T et al. Natural History and
Management of Aortocoronary Saphenous Vein Graft Aneurysms: A systematic
Review of Published Cases. Circulation. 2012; 126:2248-2256. 4. Klair IK,
Palomino J. Giant Saphenous Vein Coronary Artery Bypass Graft Aneurysm. Am
J Respir Crit Care Med. 2014; 189:e8-e9. 5. Sareyyupoglu B, Schaff HV,
Ucar I et al. Surgical Treatment of Saphenous Vein Graft Aneurysms after
Coronary Artery Revascularization. Ann Thorac Surg 2009;88:1801-1805.
DISCLOSURES: No relevant relationships by Israel Acosta Sanchez,
source=Web Response No relevant relationships by Hammad Bhatti, source=Web
Response No relevant relationships by Imran Farooq, source=Web Response No
relevant relationships by Nancy Torres Luna, source=Web
Response Copyright © 2019 American College of Chest Physicians

<33>
Accession Number
2002983962
Title
A ROLE FOR HAART AND TEVAR IN HIV-INDUCED LARGE VESSEL VASCULITIS.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A622), 2019. Date of Publication: October 2019.
Author
Krupka P.; Fakess S.
Institution
(Krupka) University of Connecticut - Internal Med
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION
TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM -
03:15 PM INTRODUCTION: HIV-associated vasculitis is an extremely rare
complication of HIV infection, occurring in only 1% of HIV-infected
patients. Large-vessel vasculitis constitutes the least encountered
subtype of HIV-vasculitis, with an incidence of only 10% among all
HIV-vasculitis. In these cases, aneurysms predominate in the carotids,
femoral arteries and aorta. Aneurysms form secondary to a leukocytoclastic
vasculitis-like process, caused by luminal occlusion within the vasa
vasora and periadventitial vasculature by direct neutrophilic or
eosinophilic fibrinoid change. This causes subsequent endothelial swelling
and inflammation, deposition of fibrin in the tunica intima, tunica and
adventitial fibrosis and eventual transmural necrosis. Case reports have
documented successful repair with both endovascular and open techniques.
Of patients who developed large-vessel vasculitis, depressed CD4+ counts
and inverted CD4:CD8 ratios were common findings. CASE PRESENTATION: A 46
year old Peruvian male with HIV, non-compliant with HAART for 1 year due
to depression presented to an urgent care with flu-like symptoms, malaise
and severe chest pain. On presentation, the patient was found to be
hypotensive with severe anemia and thrombocytopenia. He underwent CTA
chest which identified a 4.6 cm dilatation of the ascending aorta and a
descending aortic aneurysm measuring 6.4 cm x 6.4 cm x 14.8cm, prompting
transfer to tertiary care center for cardiothoracic evaluation.
Incidentally, a peripheral smear revealed schistocytes, consistent with
thrombotic thrombocytopenic purpura, which was treated with emergent
plasmapheresis and steroids with ultimate recovery in erythrocyte and
platelet counts. Workup of his HIV status revealed an absolute CD4+ count
of 391 with inverted CD4:CD8 ratio of 0.51. Syphilis antibody and
hepatitis panels remained negative and he was started on
Tenofovir/emtricitabine (Truvada), Lopinavir/ritonavir (Kaletra), and
Raltegravir (Isentress). After reaching clinical stability, cardiothoracic
surgery performed endovascular thoracic aortic repair with placement of 2
telescoping Medtronic Valiant Navion stent grafts from distal left
subclavian artery to proximal celiac artery without perioperative
complications. DISCUSSION: This case demonstrates a positive outcome with
early resumption of HAART as well as the safety of endovascular repair in
HIV-induced large-vessel vasculitis of the aorta. CONCLUSION(S):
Given the paucity of reports of HIV-induced large-vessel vasculitis, data
regarding optimal timing of vascular repair, approach of open vs.
endovascular repair and the temporal relationship between the contraction
of HIV and the development of vasculitis remains unclear. Ongoing report
of new cases and investigation through systematic review of existing cases
is warranted. Reference #1: Ando, T., Makuuchi, H., Kitanaka, Y., &
Koizumi, H. (2011). Rupture of a pseudo aneurysm of the abdominal aorta in
a patient with human immunodeficiency virus infection. Annals of Thoracic
and Cardiovascular Surgery. Reference #2: Chetty, R. (2001). Vasculitides
associated with HIV infection. Journal of Clinical Pathology. Reference
#3: Nair, R., Abdool-Carrim, A. T. O., Chetty, R., & Robbs, J. V. (1999).
Arterial aneurysms in patients infected with human immunodeficiency virus:
A distinct clinicopathology entity? Journal of Vascular Surgery.
DISCLOSURES: No relevant relationships by Seth Fakess, source=Web Response
No relevant relationships by Philip Krupka, source=Web
Response Copyright © 2019 American College of Chest Physicians

<34>
Accession Number
2002983959
Title
GIANT PRIMARY LIPOSARCOMA OF THE PLEURA RESECTED THROUGH HEMI-CLAMSHELL
THORACOTOMY.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A52-A53), 2019. Date of Publication: October 2019.
Author
Barbon C.E.; Velasco R.; Albay A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Case Report Semifinalists 3 SESSION TYPE: Fellow Case
Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION:
Liposarcoma is a rare type of cancer of mesenchymal origin. These soft
tissue tumors commonly arise from the retroperitoneum and extremities in
95% of cases. Liposarcoma of the thoracic cavity usually arises from the
mediastinum and represents only 0.1-0.74% of mediastinal tumors. There is
no data yet on the incidence of primary pleural liposarcoma because of its
rarity. To the best of our review, only 38 cases of primary pleural
liposarcoma were ever reported. We present a case of a giant
well-differentiated pleural liposarcomas that was successfully resected
through a hemi-clamshell thoractomy. This is the largest
well-differentiated subtype reported in literature. CASE PRESENTATION: A
35-year-old female, non-smoker with no comorbidities presented 2 year
history of exertional dyspnea, shortness of breath, orthopnea and
substernal chest pain. Initial CT scan showed a large pleural-based
inhomogenous mass however, patient did not consent to surgery. In the
interim, there was progression of symptoms. On presentation, she was seen
in mild respiratory distress with absent breath sounds on the left. CT
scan (Fig. 1) showed a 18.1 x 16.8 x 26. cm pleural-based fatty mass with
a large cystic focus and calcifications at the left hemithorax. Routine
laboratories, Alpha feto protein, Beta HCG and abdominal ultrasound were
normal. Sputum was negative for Acid Fast Bacilli. Spirometry was
consistent with restrictive lung disease. A well encapsulated
intrathoracic mass approximately 3,200 grams (Fig. 2) was successfully
resected through a hemi-clamshell left thoracotomy. Final pathology
reported Well Differentiated Liposarcoma with positive stains for MDM 2,
s100 and Vimentin (Fig. 3), confirming primary liposarcoma of the pleura.
Patient developed postoperative atelectasis. Non-invasive positive
pressure ventilation was applied resulting to full expansion. She
underwent adjuvant radiotherapy and continuous to be well. DISCUSSION: Our
review yielded only 11 cases of primary pleural liposarcomas of the
well-differentiated type. They present equally in men and women with a
mean age of 49 years old. They grow insidiously to large sizes ranging
from 6 to 39 cm at the widest diameter and most commonly presents with
dyspnea. To date, there is no consensus on how intrathoracic liposarcomas
are approached. Most cases are treated with a combination of resection and
adjuvant radiation. Although regarded as insensitive to chemotherapy,
myxoid (48%) and pleiomorphic subtypes (33%) were noted to have better
response with doxorubicin, ifasfamide or a combination of both. Review of
literature shows that survival ranges from 7 months to 8 years with a high
risk of relapse and metastasis. CONCLUSION(S): Pleural liposarcoma,
albeit rare, must be considered as a differential among pleural based
masses. It highlights the importance of a multidisciplinary team to
finalize a treatment plan for these patients. Reference #1: Chen M, Yang
J, Zhu L, Shane H. Primary intrathoracic liposarcoma: a clinicopathologic
study and prognostic analysis of 23 cases. Journal of Cardiothoracic
Surgery. 2014;9(114):1-8. Reference #2: Okby NT, Travis WD. Liposarcoma of
the Pleural Cavity. Archives of Pathology & Laboratory Medicine.
2000;124(5):699-703. ). Reference #3: Goldsmith P, Papagiannopoulos K.
Pleural myxoid liposarcoma: features of 2 cases and associated literature
review. Journal of Cardiothoracic Surgery. 2007;2(48):1-3. DISCLOSURES: No
relevant relationships by Albert Albay, source=Web Response No relevant
relationships by Carla Emille Barbon, source=Web Response No relevant
relationships by Rogelio Velasco, source=Web Response Copyright ©
2019 American College of Chest Physicians

<35>
Accession Number
2002983765
Title
AN UNCOMMON PRESENTATION OF THROMBUS-IN-TRANSIT AND MASSIVE ACUTE
PULMONARY EMBOLISM.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A654), 2019. Date of Publication: October 2019.
Author
Prado V.; Watanabe-Tejada L.; Watanabe M.; Gueret R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION
TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM -
03:15 PM INTRODUCTION: Thrombus-in-transit is a rare presentation of
venous thromboembolism, characterized by the presence of a floating clot
traveling from the right heart into the pulmonary arterial vasculature. We
present a case associated with massive pulmonary embolism (PE) in a
patient with a contraindication to thrombolysis successfully treated with
surgical thrombectomy. CASE PRESENTATION: A 50-year-old female with the
diagnosis of Crohn's disease presented with a one-week history of
shortness of breath. On admission the patient was tachycardic, hypotensive
and hypoxemic. The patient received intravenous fluids (IVF) and
supplemental oxygen resulting in a transient stabilization of vital signs.
Electrocardiogram showed ST depressions and T wave inversions in
anteroseptal leads, Troponin- I was negative and D-dimer was elevated at
0.275 ug/mL. A chest computed tomography angiography revealed bilateral
main pulmonary artery large filling defects, extending into segmental and
sub-segmental arteries. Anticoagulation was started and the patient was
admitted to the Medical Intensive Care Unit for close hemodynamic
monitoring. A later transthoracic echocardiography showed a large
hyperechoic, highly mobile mass in the right atrium, consistent with a
thrombus-in-transit. The patient remained symptomatic and persistently
hypotensive despite IVF. Thrombolysis was considered, but patient
developed episodes of lower gastrointestinal bleeding due to Crohn's
disease flare. Cardiothoracic Surgery Service was consulted and patient
underwent surgical bilateral pulmonary artery thrombectomy and removal of
the right atrial thrombus. The patient was subsequently restarted on
anticoagulation and discharged on day 19th post-surgery with excellent
recovery. DISCUSSION: PE with thrombus-in-transit is a medical emergency
that entails a high morbidity and mortality. Mortality rates can be as
high as 50% in contrast to less than 10% in PE without a clot in transit.
Early detection and intervention may decrease the risk of a catastrophic
pulmonary embolism that can result in a poor outcome. Current therapeutic
options include anticoagulation alone, medical thrombolysis and surgical
thrombectomy. Although no randomized controlled trials have directly
compared these treatment options, a systematic review article published in
2010 described a trend toward improved survival in surgical thrombectomy
compared to thrombolysis and anticoagulation alone. On the other hand, a
large study published in 2015, showed lower mortality rates with medical
thrombolysis compared to surgical thrombectomy or anticoagulation alone
(13.7%, 18.3% vs. 37.1%). CONCLUSION(S): PE with thrombus-in-transit
is a life-threating condition that requires urgent intervention. Although
no guideline recommendations have been established, surgical thrombectomy
has shown high success rates and should be consider especially if
contraindications to thrombolysis are present. Reference #1: Athappan G,
Sengodan P, Chacko P, Gandhi S. Comparative efficacy of different
modalities for treatment of heart thrombi in transit: a pooled analysis.
Vasc Med. 2015;20(2):131-8. Reference #2: Myers PO, Bounameaux H, Panos A,
Lerch R, Kalangos A. Impending paradoxical embolism: systemic review of
prognostic factors and treatment. Chest.2010;137(1):164-70. Reference #3:
Torbicki A, Galie N, Covezzoli A, Rossi E, De Rosa M, Goldhaber SZ. Right
heart thrombi in pulmonary embolism: results from the International
Cooperative Pulmonary Embolism Registry. J Am Coll.2003;
18:41(12):2245-51. DISCLOSURES: No relevant relationships by Renaud
Gueret, source=Web Response No relevant relationships by VICTOR PRADO,
source=Web Response No relevant relationships by MARTIN WATANABE,
source=Web Response No relevant relationships by Luis Watanabe-Tejada,
source=Web Response Copyright © 2019 American College of Chest
Physicians

<36>
Accession Number
2002983693
Title
THE DIAGNOSIS AND MANAGEMENT OF PLASTIC BRONCHITIS: A SYSTEMATIC
LITERATURE REVIEW.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A1022), 2019. Date of Publication: October 2019.
Author
Aram A.; Dalal B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original
Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM
PURPOSE: Plastic bronchitis is an extremely rare respiratory disease in
which patients suffer from dyspnea, chronic cough, congested lungs,
tenacious mucus and frequent mucus plug expectoration. The pathophysiology
of plastic bronchitis is poorly understood, and diagnosing this disease is
often greatly delayed or missed entirely. Most known cases are found in
the pediatric population following congenital cardiac surgery, making the
diagnosis and treatment of plastic bronchitis in adults even more
challenging. This research study is the largest review of plastic
bronchitis cases performed to date, and seeks to better understand the
symptoms adults with plastic bronchitis suffer from, propose criteria for
earlier bronchoscopic investigation and diagnosis, and provide a literary
review of successful treatment options. METHOD(S): Online database
search (PubMed, Web of Science, Embase and Scopus) using term "adult
plastic bronchitis" was performed. Studies from 1966 till current year
were reviewed. Cases were filtered for relevance based upon adult age,
English language and a clinical plastic bronchitis diagnosis. Patient
demographics and relevant clinical history were analyzed. Successful
treatment methods were also investigated and explored to arrive at the
most commonly beneficial management options for patients with plastic
bronchitis. RESULT(S): A total of 71 adult cases of plastic
bronchitis were found after a comprehensive search of literature. Of these
only 38 had sufficient information and a credible diagnose of plastic
bronchitis. The following are the common clinical findings: symptoms of
mucus cast/plug expectoration (25/37, 68%), chronic cough (25/38, 68%),
exam findings of wheezing (9/12, 75%), decreased breath sounds (4/12,
33%), non-specific opacity on chest x-ray or CT (28/31, 90%), abnormal
lymphatic flow on lymphangiography (12/31, 39%), mucus casts/plugs found
on bronchoscopy (23/29, 79%), and mucus analysis indicating fibrinous
mucus (14/24, 58%). Treatments that most effectively relieved symptoms
were the following: Lymphatic intervention (10/11, 91%), bronchoscopy
(9/27, 33%), oral steroids (5/18, 28%), and multimodal medical treatment
(7/35, 20%). CONCLUSION(S): This study provides physicians caring for
patients presenting with unusual respiratory symptoms helpful criteria for
earlier diagnosis of plastic bronchitis, and suggests potential treatment
options for this rare disease. CLINICAL IMPLICATIONS: This study provides
physicians caring for patients presenting with unusual respiratory
symptoms helpful criteria for earlier diagnosis of plastic bronchitis, and
suggests potential treatment options for this rare disease. DISCLOSURES:
No relevant relationships by Alex Aram, source=Web Response No relevant
relationships by Bhavinkumar Dalal, source=Web Response Copyright
© 2019 American College of Chest Physicians

<37>
Accession Number
2002983650
Title
WHEN THE HEART HAS THE FLU: INFLUENZA B RESULTING IN CARDIAC TAMPONADE.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A803), 2019. Date of Publication: October 2019.
Author
Dumitrescu C.; Mehta K.; Singh V.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION
TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM -
03:15 PM INTRODUCTION: Majority of cardiac complications of influenza are
related to Influenza A., Enterovirus (Coxsackie B), Parvovirus B-19, HHV 6
and cytomegalovirus are most frequently implicated causes of viral
myocarditis related cardiac tamponade. We came across an uncommon
presentation of Influenza B related cardiac tamponade. CASE PRESENTATION:
A 47-year-old gentleman was seen at urgent care with fever, chills and
burning sensation behind the eyes. He was given a steroid course. Six days
later, he presented to our facility with shortness of breath on exertion,
nausea and fatigue. He developed chest pressure sensation within walking
ten steps. He denied chest pain. Physical exam was positive for elevated
jugular venous pulse, distant heart sounds and rhonchi in right lower lung
field. Intake EKG showed normal sinus rhythm with low voltage in the
precordial leads. Respiratory viral screen was positive for Influenza B.
Chest X-ray showed a right basilar opacity. Initial troponin was 0.39 and
BNP was 375. Transthoracic echocardiogram showed a moderate to large
circumferential pericardial effusion with hemodynamic compromise and
intermittent collapse of the right ventricle (Figures 1 and 2). Ejection
fraction was 70% with concentric left ventricular hypertrophy. Successful
pericardiocentesis was performed with removal of red straw-colored fluid
and drain placement. Fluid analysis showed glucose of 125, LDH of 750, and
protein of 5 reflecting exudative etiology. Left heart catheterization
revealed the absence of coronary disease. Other viral illnesses were ruled
out. The patient was discharged home on a 6-week course of twice-daily
colchicine and ibuprofen 3 times a day for a 6-week duration. DISCUSSION:
Reports of myocarditis and cardiogenic shock associated with Influenza B
are mostly reported from pediatric literature. We were able to find only
two previously reported cases of Influenza B related pericardial effusion.
A viral prodrome followed by cardiac symptoms should clue one in towards
this possibility. Early recognition and management of pericardial
effusions is crucial because of the risk of progression to tamponade.
Patients may have concurrent myocarditis and dilated cardiomyopathy. Some
patients progress to require mechanical circulatory support. The optimal
management of Influenza B induced pericardial effusion is unclear.
Supportive treatment and drainage of effusion to prevent tamponade was
performed. We initiated colchicine and ibuprofen and it appeared to
prevent recurrence. At one-year follow-up, patient remains healthy and
active. CONCLUSION(S): We present a rare case of Influenza B
presenting with a large pericardial effusion. Clinicians should consider
this entity when atypical cardiac symptoms are seen in the setting of a
viral prodrome. Routine use of bedside echocardiography in patients with
viral illness leading to hospital admissions can lead to rapid diagnosis.
Reference #1: Roto D, Malnoske ML, Winters S, Georas SN. A Fatal Case of
Influenza B Myocarditis with Cardiac Tamponade. Case Rep Critical Care.
2018 Aug 30;2018:8026314. Reference #2: Estabragh Z. R., Mamas M. A. The
cardiovascular manifestations of influenza: A systematic review.
International Journal of Cardiology. 2013;167(6):2397-2403. Reference #3:
Kearney MT, Cotton JM, Richardson PJ, et al Viral myocarditis and dilated
cardiomyopathy: mechanisms, manifestations, and management Postgraduate
Medical Journal 2001;77:4-10. DISCLOSURES: No relevant relationships by
Cristian Dumitrescu, source=Web Response No relevant relationships by
Kunal Mehta, source=Web Response No relevant relationships by Vipul Singh,
source=Web Response Copyright © 2019 American College of Chest
Physicians

<38>
Accession Number
2002983511
Title
WHAT 'LEADS' TO PLEURAL EFFUSION.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A1524), 2019. Date of Publication: October 2019.
Author
Gyawali B.; Grewal H.; Amzuta I.
Institution
(Gyawali) SUNY Upstate Medical University
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters
SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019
01:00 PM - 02:00 PM INTRODUCTION: Post-cardiac injury syndrome (PCIS) was
first described in 1953 in patients developing fever and pleuritic chest
pain after mitral valve surgery.1 It refers to inflammatory response to
cardiac injury and is often characterized by pleuro-pericarditis with
effusion. We report a patient who developed this syndrome following
dual-chamber pacemaker insertion. CASE PRESENTATION: A 76-year-old
Caucasian female with atrial fibrillation, hypertension and hypothyroidism
presented with lightheadedness and malaise. She was hypotensive on
presentation. EKG showed atrial fibrillation with 2:1 atrio-ventricular
conduction block with periods of sinus pause. A dual chamber pacemaker was
placed, and she was discharged from the hospital. Ten days later following
the pacemaker placement, she presented to the emergency department again
with precordial and severe left sided chest pain. She denied fever or
chills. EKG showed atrial fibrillation rhythm with electronically paced
ventricular rhythm. White cell count was within normal range. She was
found to have small pericardial effusion on transthoracic echocardiogram
without tamponade physiology. She had preserved ejection fraction and her
wall motion appeared normal. She had a new large left sided pleural
effusion on chest x-ray. Diagnostic and therapeutic thoracentesis for left
pleural effusion was performed. Pleural fluid was exudative with pH of
7.46, protein of 4 gm/dl, lactate dehydrogenase of 243, and glucose of
101. Adenosine deaminase was not elevated. Total RBC in pleural fluid was
< 10,000/uL and total neutrophil count was 180/uL. Pleural fluid gram
stain and culture was negative. Blood culture was negative. Serum
anti-nuclear antibody, anti-cyclic citrullinated peptide and rheumatoid
factor were negative. Her thyroid stimulating hormone was within normal
limit. She was started on prednisone and colchicine following which her
chest pain improved. Repeat chest x-ray did not show re-accumulation of
the pleural fluid. Pericardial effusion remained small and did not require
pericardiocentesis. DISCUSSION: PCIS is an inflammatory process that
involves the pleura and pericardium in response to cardiac injury. It has
been described after percutaneous coronary interventions and
cardiothoracic surgery. However, its association with pacemaker device
insertion is uncommon. The most common presentation is concomitant
pericardial and pleural effusion. However, only few cases of PCIS with
predominant pleural effusion have been reported. CONCLUSION(S): This
case is unusual due to large pleural effusion and absence of typical
pericardial symptoms. Early identification of this complication could
allow medical management with combination of non-steroidal
anti-inflammatory medications and colchicine.2 This could potentially
reduce morbidity and potential mortality from tamponade or constrictive
pericarditis. It can also reduce the need for surgical procedure.3
Reference #1: 1. Janton OH, Oliver RP, O'Neill TJ, et al. "Results of the
surgical treatment for mitral stenosis: analysis of 100 cases."
Circulation (Circulation), 1952: 6:321-333. Reference #2: 2. Cemin R,
Chirillo F, Comoglio C, et al. "Colchicine for prevention of
Postpericardiotomy Syndrome and Postoperative Atrial Fibrillation. The
COPPS-2 Randomized Clinical Trial." JAMA, 2014: 11026 Reference #3: 3.
Cevik C, Wilborn T, Corona R, et al. "Post-cardiac injury syndrome
following transvenous pacemaker insertion: A case report and review of the
literature." Heart Lung Circ, 2009: 18(6):379-83. DISCLOSURES: No relevant
relationships by Ioana Amzuta, source=Web Response No relevant
relationships by Himmat Grewal, source=Web Response No relevant
relationships by Bishal Gyawali, source=Web Response Copyright ©
2019 American College of Chest Physicians

<39>
Accession Number
2002983284
Title
THE HEART VS THE HOST: DONOR TRANSMISSION OF TOXOPLASMA GONDII AFTER HEART
TRANSPLANT.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A1503), 2019. Date of Publication: October 2019.
Author
Threadgill R.; Drake M.
Institution
(Threadgill) Oregon Health & Science University
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters
SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019
01:00 PM - 02:00 PM INTRODUCTION: Donor to recipient transmission of
Toxoplasma gondii is uncommon since routine use of antimicrobial
prophylaxis became standard practice. We present a case of a heart
transplant recipient who developed systemic T. gondii and review T. gondii
risk factors in solid organ transplant recipients. CASE PRESENTATION: A 66
year old woman with familial cardiomyopathy who was seronegative for T.
gondii underwent heart transplantation from a T. gondii seropositive
donor. Post-transplant immunosuppression consisted of mycophenolate
mofetil and methylprednisolone, but not tacrolimus due to acute kidney
injury. Anti-thymocyte globulin (ATG) was given on post-operative day one
and four due to concerns for acute organ rejection. Standard antimicrobial
prophylaxis was initiated including valganciclovir, fluconazole, and
pentamidine. T. gondii prophylaxis with trimethoprim-sulfamethoxazole was
held due to acute kidney injury with plans to start after improvement in
kidney function at a post-hospitalization follow up appointment. Three
weeks after transplant, she developed headache, malaise, fever, and
respiratory failure. Chest CT revealed lower lobe ground glass
opacification and septal thickening. Bronchoalveolar lavage showed a
neutrophil predominant white blood count differential (76% PMNs) and was
positive for T. gondii by PCR and microscopy with stain. Serum PCR
confirmed T. gondii as did endomyocardial biopsy. Treatment with
pyrimethamine, sulfadiazine, and leucovorin was given with good clinical
response. DISCUSSION: T. gondii is an obligate intracellular parasite.
Human infections occur via vertical transmission, by ingestion of
undercooked meat or contaminated water, exposure to feline feces, or by
reactivation of T gondii in a seronegative recipient of a seropositive
solid organ transplant. In the presence of a weakened immune system,
dormant T. gondii bradyzoites transform into active tachyzoites which
cause inflammation and necrosis. In high risk heart or lung transplant
recipients, 80% of patients without prophylaxis develop clinically
significant infection (1). Historically, donor-derived toxoplasmosis in
transplant recipients was fatal. However, recent improvements in detection
and treatment have led to improved outcomes. CONCLUSION(S): Risk
factors for toxoplasmosis after solid organ transplant include receipt of
a T. gondii positive organ into a T. gondii negative recipient, use of
anti-lymphocyte immunosuppression, such as ATG, and lack of antibiotic
prophylaxis (2). First line prophylaxis is TMP-SMX, which also covers
against P. jirovecii. Alternative regimens include atovaquone and
pyrimethamine (3). Our case highlights the risk of temporary lapses in T.
gondii prophylaxis following solid organ transplant. Reference #1: J G
Montoya, O Liesenfeld (2004) Toxoplasmosis. Lancet. 363: 1965-1976
Reference #2: O'Bryan-Coster, Laura (2013) Parasitic Infections in Solid
Organ Transplant Recipients. Infectious Diseases Clinics of North America.
27:2, 395-427 Reference #3: Senaka Rajapakse, Praveen Weeratunga,
Chaturaka Rodrigo, Nipun Lakshitha de Silva & Sumadhya Deepika Fernando
(2017) Prophylaxis of human toxoplasmosis: a systematic review, Pathogens
and Global Health, 111:7, 333-342 DISCLOSURES: No relevant relationships
by Matthew Drake, source=Web Response No relevant relationships by Ryan
Threadgill, source=Web Response Copyright © 2019 American College
of Chest Physicians

<40>
Accession Number
2002983234
Title
PREOPERATIVE RESPIRATORY MUSCLE TRAINING FOR LUNG CANCER PATIENTS
SCHEDULED FOR SURGICAL RESECTION (META-ANALYSIS).
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A1794), 2019. Date of Publication: October 2019.
Author
Batarseh H.; Pu C.; Zafron M.; Mador J.; Ray A.
Institution
(Batarseh) University at Buffalo
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Wednesday Electronic Posters 5 SESSION TYPE: Original Inv
Poster Discussion PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE:
Pulmonary complications are common after lung resection for a potential
cure in patients with stage I & II lung cancer (LC). Respiratory muscle
training (RMT) has reduced pulmonary complications after cardiac surgery
and is being studied in patients with esophageal cancer surgery. RMT can
be implemented at home and is less labor intensive than a whole-body
exercise training program. The purpose of this meta-analysis is to examine
the effect of preoperative RMT on pulmonary function, exercise capacity,
quality of life (QoL) and postoperative pulmonary complications (PPC)
after lung resection surgery in patients with LC. METHOD(S): research
librarian performed a comprehensive search in PubMed, EMBASE, Web of
Science Core Collection & Cochrane Central Register of Controlled Trials.
Final searches were run on August 3rd,2018 and limited to the English
language and humans where possible. We included studies that compared
patients who had preoperative RMT prior to LC surgical resection vs.
control group. Meta-analysis was done using Cochrane software for multiple
variables including 6-minute walk distance (6-MWD), forced expiratory
volume in 1 second (FEV1), forced vital capacity (FVC), diffusing capacity
for carbon monoxide (DLCO), length of stay (LOS), Clavien-Dindo (C-D)
classification for surgery complications, PPC, pneumonia, death and QoL
(Global, Physical, Emotional & Dyspnea) as assessed by the European
Organization for Research and Treatment of Cancer. RESULT(S): total
of 1944 studies were imported for screening, and 1562 studies remained
after removing the duplicates. Out of 107 (6.9%) full test studies
assessed for eligibility, 12 studies were included in this meta-analysis
review. Pooled data for patients who had preoperative RMT demonstrated a
three-day decrease in the mean difference (MD) of their LOS compared to
the control group (MD -3.01; 95% confidence interval [CI] -3.78, -2.23
days; P<0.001) and were less likely to have PPC (Odds Ratio [OR] 0.30; CI
0.16, 0.55; P<0.001). Although no significant differences were illustrated
in pulmonary function, 6-MWD, C-D classification, death or any of the QoL
indices, pneumonia rates showed a tendency towards reduction in patients
who received preoperative RMT (OR 0.43; CI 0.18, 1.04; P 0.06).
Heterogeneity between studies was low for all outcomes measured except
FEV1. CONCLUSION(S): Preoperative RMT reduced the LOS & PPC and
tended to reduce postoperative pneumonia in LC patients scheduled for
surgical lung resection. However, it did not affect pulmonary function,
QoL, mortality (low in both groups) or exercise tolerance. Randomized
clinical trials are needed to test the feasibility of introducing a
preoperative RMT program in similar patients' population. CLINICAL
IMPLICATIONS: Our data highlights the positive potential of preoperative
RMT in improving postoperative outcomes in LC patients undergoing surgical
lung resection. DISCLOSURES: No relevant relationships by Hanan Batarseh,
source=Web Response No relevant relationships by Jeffery Mador, source=Web
Response No relevant relationships by Chan Pu, source=Web Response No
relevant relationships by Andrew Ray, source=Web Response No relevant
relationships by Michelle Zafron, source=Web Response Copyright ©
2019 American College of Chest Physicians

<41>
Accession Number
2002983226
Title
DELAYED TRAUMATIC PERICARDIAL TAMPONADE FOLLOWING BLUNT CHEST AND
MULTISYSTEM TRAUMA.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A1500-A1501), 2019. Date of Publication: October 2019.
Author
Chow B.; Souders P.; Tyacke M.; Linsky P.; Dodgion C.; Carver T.; de Moya
M.; Gitter M.; Milia D.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters
SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019
01:00 PM - 02:00 PM INTRODUCTION: Cardiac injury can be related to sternal
fractures; however, delayed cardiac tamponade remains an extremely rare
complication (0.1%) of blunt cardiac trauma (1). Typically presenting
within 1-4 weeks, we present a case occurring 12 days after trauma. CASE
PRESENTATION: 43-year-old male with history of diverticulosis, GERD, and
bipolar transferred from referring institution one day after high-speed
rollover MVC. He underwent emergent exploratory laparotomy, left diaphragm
repair with chest tube placement, and splenectomy there. Injuries included
traumatic SAH, SDH, left rib fractures 3-10 with pulmonary contusion,
posterior lower sternal fracture, left diaphragm rupture, complex pelvic
fractures and mesenteric hematomas. Upon admission, he did not respond to
further resuscitation and returned to the OR for repair of left diaphragm
and temporary abdominal closure. Clinically, he improved and was extubated
on POD1, HR 110-120s; abdomen was closed on hospital day (HD) 2. Remained
tachycardic and hypertensive, troponin 0.027ng/ml and EKG with sinus
tachycardia (ST). He underwent prone pelvic fixation on HD 6, subsequent
EKGs with stable ST. On HD 9, he became hypotensive, tachycardic to 150s,
and returned to ICU. CXR unremarkable, bedside ultrasound (US) with
pericardial effusion without evidence of tamponade; collapsible,
hyperdynamic LV; RV not grossly enlarged. On HD 10, TTE showed borderline
tamponade-25% respiratory phasic variation of the mitral valve inflow
velocity, with small pericardial effusion adjacent to RV free wall.
Colchicine was started. On HD 11, he remained hypotensive with hypoxia,
and clinical exam was consistent with acute tamponade physiology-elevated
RA and CVPs, JVD to the mandible, and pulsus paradoxus. Bedside US with
moderate pericardial effusion. Thoracic surgery urgently performed a left
VATS with left chest washout and pericardial window. He clinically
improved and was discharged nine days later. DISCUSSION: Our patient's
symptoms could have many etiologies given the recent trauma, however,
tamponade was ultimately diagnosed with clinical exam and TTE. Pulsus
paradoxus, elevated jugular venous pressure, tachycardia, or cardiomegaly
on imaging are present in 70% of patients with pericardial effusions and
cardiac tamponade (2). Almost all of these were observed in our patient.
Notably, our TTE did not have any cardiac chamber collapse despite its
high negative predictive value, including the highly specific diastolic RV
collapse (3). Conceivably, a follow up TTE with worsening clinical signs
could have been warranted, however this case reinforces that tamponade is
a clinical diagnosis requiring timely intervention and treatment
 CONCLUSION(S): Cardiac tamponade is an elusive problem that can lead
to mortality if it is not diagnosed and treated promptly. As seen in our
case presentation, recognition in the poly-trauma population remains
especially challenging. Reference #1: Maenza, R. L., Seaberg, D., &
D'Amico, F. (1996). A meta-analysis of blunt cardiac trauma: ending
myocardial confusion. The American journal of emergency medicine, 14(3),
237-241. Reference #2: Roy, C. L., Minor, M. A., Brookhart, M. A., &
Choudhry, N. K. (2007). Does this patient with a pericardial effusion have
cardiac tamponade?. Jama, 297(16), 1810-1818. Reference #3: Alerhand, S.,
& Carter, J. M. (2019). What echocardiographic findings suggest a
pericardial effusion is causing tamponade?. The American journal of
emergency medicine, 37(2), 321-326. DISCLOSURES: No relevant relationships
by Thomas Carver, source=Web Response No relevant relationships by Bonnie
Chow, source=Web Response No relevant relationships by Marc de Moya,
source=Web Response No relevant relationships by Chris Dodgion, source=Web
Response No relevant relationships by Michael Gitter, source=Web Response
No relevant relationships by Paul Linsky, source=Web Response No relevant
relationships by David Milia, source=Web Response No relevant
relationships by Pamela Souders, source=Web Response No relevant
relationships by Marsha Tyacke, source=Web Response Copyright ©
2019 American College of Chest Physicians

<42>
Accession Number
2002982594
Title
BRONCHIAL ARTERY EMBOLIZATION: IS THE THIRD TIME THE CHARM? NOT ALWAYS.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A1433), 2019. Date of Publication: October 2019.
Author
Patel R.; Kalayanamitra R.; Abusharar S.P.; Groff A.; Shah N.; Jain R.
Institution
(Patel) Penn State Milton S. Hershey Medical Center
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters
SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019
01:00 PM - 02:00 PM INTRODUCTION: Tuberculosis (TB) and aspergillosis are
known causes of massive hemoptysis. Bronchial artery embolization is
typically a reliable treatment option with studies demonstrating an
association with decreased mortality and 6-month re-bleeding rates
compared to nonsurgical options [1]. Bronchial artery embolization has a
70-99% success rate of complete cessation of hemoptysis, especially if
bronchial, pulmonary and/or systemic arterial circulations are well
defined during the procedure [2]. This case describes a patient who
underwent and failed arterial embolization three times with continued
recurrent hemoptysis. CASE PRESENTATION: A 42-year-old male, with a
history of TB status-post treatment, recurrent hemoptysis requiring
arterial embolization twice (1.right bronchial artery (RBA); 2.RBA with
branches of right internal thoracic artery (RITA)), bronchiectasis and
biapical aspergillosis on voriconazole presented with hemoptysis. He was
afebrile and normotensive. Chest imaging revealed changes of TB with
superimposed aspergillosis. Bronchoscopy and BAL performed found evidence
of recent bleeding from the right upper lobe (RUL). AFB smear was negative
and cytology was consistent with inflammation. Angiography demonstrated
recanalization of the RBA and RITA that extended to the RUL lesions, which
were subsequently embolized. Patient was readmitted 1 month later with
recurrent hemoptysis that spontaneously resolved with additional broad
spectrum antibiotics. He was referred to Thoracic Surgery who attempted a
right upper and middle lobectomy that was aborted due to difficult
dissection and bleeding. Postoperative course was complicated by
hypotension, hypercarbic respiratory failure, persistent air leak with
subcutaneous emphysema requiring endobronchial valve placement, and
subsequent prolonged hospitalization without further noted hemoptysis. He
was then discharged home with close follow up. DISCUSSION: Although the
success rate of bronchial artery embolization is high, recurrence rates
range from 10%-57% [2]. This can be due to incomplete initial
embolization, recanalization of previously embolized arteries, and
recruitment of new collaterals [2]. A retrospective study including 223
patients with massive hemoptysis found that 64% of patients underwent at
least a second embolization and that vessel recanalization (71%) was the
most common cause of recurrent hemoptysis [3]. Nonetheless, 82% of
patients are expected to achieve full resolution of hemoptysis by their
third re-embolization, which was not observed with this patient.
 CONCLUSION(S): Our case illustrates the limitations in long term
control of hemoptysis, despite advances with directed arterial
embolization. Alternative or improved interventions must be identified to
reduce the morbidity associated with recurrent hemoptysis such as above.
Reference #1: Cahill BC, Ingbar DH. Massive hemoptysis. Assessment and
management. Clin Chest Med. 1994;15(1):147-67 Reference #2: Panda A,
Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a
systematic review. Diagn Interv Radiol. 2017;23(4):307-317. Reference #3:
Maleux G, Matton T, Laenen A, Bonne L, Cornelissen S, Dupont L. Safety and
Efficacy of Repeat Embolization for Recurrent Hemoptysis: A 16-Year
Retrospective Study Including 223 Patients. J Vasc Interv Radiol.
2018;29(4):502-509. DISCLOSURES: No relevant relationships by Andrew
Groff, source=Web Response No relevant relationships by Rohit Jain,
source=Web Response No relevant relationships by Ricci Kalayanamitra,
source=Web Response No relevant relationships by Ravi Patel, source=Web
Response No relevant relationships by Shady Piedra Abusharar, source=Web
Response No relevant relationships by Neal Shah, source=Web
Response Copyright © 2019 American College of Chest Physicians

<43>
Accession Number
2002982512
Title
ATRIO-ESOPHAGEAL FISTULA: A RARE AND GRAVE COMPLICATION OF ATRIAL
FIBRILLATION ABLATION.
Source
Chest. Conference: CHEST 2019 Annual Meeting. United States. 156 (4
Supplement) (pp A1453-A1454), 2019. Date of Publication: October 2019.
Author
Tavares M.; Donaldson S.; Otuonye G.; Ran-Castillo D.; Gottdiener A.;
Gandhi N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters
SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019
01:00 PM - 02:00 PM INTRODUCTION: Atrio-esophageal fistula (AEF) is an
extremely rare, life-threatening complication of catheter radiofrequency
ablation (RFA) which has an increasing incidence of > 50,000/year in the
US. AEF commonly causes death via cerebral air embolism, massive
gastrointestinal bleeding (GIB) and septic shock in 2 months post RFA. The
associated mortality of AEF is > 80% and requires prompt diagnosis and
intervention.(1) CASE PRESENTATION: An 80 year old female with heart
failure with reduced ejection fraction and cardiomyopathy due to
persistent atrial fibrillation (AF) despite prior interventions presented
18 days post convergent VATS, left atrial (LA) clip/LA appendage ligation
with epicardial ablation of LA posterior wall, while on Eliquis to the ER
after 1 episode of hematemesis. There was no history of PUD, melena, NSAID
use or heavy alcohol use. She had tachycardia but other vitals were
normal. Exam revealed dried blood in the mouth, generalized abdominal
tenderness but was otherwise normal. Pantoprazole infusion was commenced.
Esophagogastroduodenoscopy (EGD) revealed a large deep mid-esophageal
ulcer with clot. Post EGD, she became lethargic with acute hypoxic
respiratory failure and was intubated. Chest x-ray showed new lung
infiltrate and she was started on Zosyn and vancomycin. CTA of the chest
revealed a 2.5 cm thrombus in the posterior left atrium and air within the
right atrium. Fluconazole was added and she was taken to the OR for LA
repair. The next day she underwent esophagectomy and gastric tube
placement, during which she developed hemorrhagic shock requiring multiple
transfusions and vasopressor support. Blood cultures grew Rothia
mucinolaginosus, B6-deficient streptococcus and lactobacillus and CT head
showed an acute stroke. Unfortunately, she died after palliative
extubation 10 days post admission. DISCUSSION: AEF following RFA has an
incidence of < 0.03% and is thought to be multifactorial. Thermal injury
during the ablation, results in fistulization of the esophagus into the
atrium i.e. AEF, a 1-way valve, causing strokes more often than upper GIB.
CTA chest is the modality of choice, as EGD increases the risk of air
embolization resulting in stroke or death. Currently early surgical repair
appears to have the best survival.(2) Preventative measures such as an
esophageal temperature probe for real-time temperature monitoring was used
in this case. However, there is a 0.016% incidence of esophageal
perforation despite monitoring in 90% of patients.(3) Other strategies to
prevent AEF include: reduced power titration while ablating the posterior
LA wall, decrease delivery time and active esophageal cooling with saline.
 CONCLUSION(S): The incidence of RFA for AF is rapidly increasing for
which AEF is a rare yet grave complication that uncommonly presents as
hematemesis. Awareness is imperative for prompt diagnosis as without
urgent surgical intervention mortality approaches 100%. Reference #1:
Patricia C, Franz HM, Abel CD, et al. Atrioesophageal fistula following
ablation procedures for atrial fibrillation: systematic review of case
reports. Open Heart. 2015; 2(1), e000257. 000257. Reference #2: Singh SM,
d'Avila A, Singh SK, et al. Clinical outcomes after repair of left atrial
esophageal fistulas occurring after atrial fibrillation ablation
procedures. Heart Rhythm. 2013; 10(11):1591-1597. Reference #3: Chirag RB,
Saurabh K, Yu G, et al. Global Survey of Esophageal in Atrial
Fibrillation: Characteristics and Outcomes of Esophageal Perforation and
Fistula. JACC: Clinical Electrophysiology. 2016; 2(2):143-150.
DISCLOSURES: No relevant relationships by Sahai Donaldson, source=Web
Response No relevant relationships by Nisha Gandhi, source=Web Response No
relevant relationships by Alexandra Gottdiener, source=Web Response No
relevant relationships by Gene Otuonye, source=Web Response No relevant
relationships by Dan Ran-Castillo, source=Web Response No relevant
relationships by Matthew Tavares, source=Web Response Copyright ©
2019 American College of Chest Physicians

<44>
Accession Number
629442935
Title
Meta-analysis of survival outcomes in people who inject drugs after
cardiac surgery for infective endocarditis.
Source
Open Forum Infectious Diseases. Conference: Infectious Diseases Week, ID
Week 2018. United States. 5 (Supplement 1) (pp S324), 2018. Date of
Publication: November 2018.
Author
Goodman-Meza D.; Weiss R.E.; Gamboa S.; Gallegos A.; Landovitz R.J.; Bui
A.A.T.; Goetz M.B.; Shoptaw S.
Institution
(Goodman-Meza) Infectious Diseases, UCLA, Los Angeles, CA, United States
(Weiss) Department of Biostatistics, Fielding School of Public Health,
UCLA, Los Angeles, CA, United States
(Gamboa, Gallegos) Universidad Autonoma De Baja California, Tijuana,
Mexico
(Landovitz) UCLA Center for Clinical AIDS Research and Education,
University of California Los Angeles, Los Angeles, CA, United States
(Bui) Medical Imaging Informatics (MII) Group, Department of Radiological
Sciences, UCLA, Los Angeles, CA, United States
(Goetz) Infectious Diseases, VA Greater Los Angeles Healthcare System, Los
Angeles, CA, United States
(Shoptaw) Department of Family Medicine, David Geffen School of Medicine
at UCLA, Los Angeles, CA, United States
Publisher
Oxford University Press
Abstract
Background. The United States' opioid epidemic has led to an increase in
people who inject drugs (PWID) and opioid-associated infections, including
infectious endocarditis (IE). Cardiac surgery is often indicated in IE to
improve outcomes but is controversial in PWID due to the concerns about
continued injection drug use leading to risk for reinfection and decreased
survival. In response, we assessed the long-term survival after cardiac
valve surgery in PWID compared with people who do not inject drugs
(non-PWID) in the published literature. Methods. We performed a systematic
review and meta-analysis (MA) of studies that reported survival data after
surgery for IE in PWID. We searched PUBMED up to April 2018. We extracted
Kaplan-Meier (KM) curves from included studies. From the KM curves, we
used an algorithm to estimate individual participant data (eIPD). In a
one-step approach, we ran a Cox proportional hazards (CPH) model analysis
of the eIPD with study random effects. In a two-step approach, we fitted
CPH models by individual study; then, we ran a mixed-effects MA model of
the log hazard ratios (HR) and standard errors. Results. We identified 11
retrospective studies. Of these, six reported comparisons of PWID vs.
non-PWID, and five reported results for PWID only. Based on eIPD, we
included 407 PWID and 1,877 non-PWID. Mean age for PWID was 36.7 years
(95% CI 34.4-39.1) and for non-PWID was 52.0 years (95% CI 45.3-59.4).
There were 144 deaths (35.3%) in PWID and 559 (29.8%) deaths in non-PWID.
We present by study and by group KM curves of eIPD (Figures 1 and 2). In
one-step MA (included all 11 studies), the HR for PWID was 1.13 (95% CI
0.92-1.39). In two-step MA (included six comparison studies),
heterogeneity was high (I2 =72%); and there was no significant
between-group difference (HR 1.29, 95% CI 0.80-2.07) (Figure 3).
Conclusion. Survival time post-surgery of PWID was similar to that of non-
PWID. These estimates are concerning, as PWID on average are much younger
than non-PWID with IE. Future studies should explore interventions to
improve outcomes in PWID after surgery, including treatment of addiction
during and after the index hospitalization and provision of naloxone at
the time of discharge. (Figure Presented) .

<45>
Accession Number
629447204
Title
Preoperative Anemia and Postoperative Mortality in Patients with Aortic
Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A
Systematic Review and Meta-Analysis.
Source
Medical science monitor : international medical journal of experimental
and clinical research. 25 (pp 7251-7257), 2019. Date of Publication: 27
Sep 2019.
Author
Lv Z.; Zhou B.; Yang C.; Wang H.
Institution
(Lv, Zhou, Wang) Department of Cardiovascular Surgery, Qingdao Fuwai
Hospital, Qingdao, Shandong, China
(Yang) Department of Cardiovascular Medicine, Qingdao Fuwai Hospital,
Qingdao, Shandong, China
Publisher
NLM (Medline)
Abstract
BACKGROUND Patients with severe aortic stenosis who have comorbidities
that prevent general anesthesia and open cardiothoracic surgery are
candidates for transcatheter aortic valve implantation (TAVI). However,
TAVI can result in patient mortality following the procedure. This
systematic review of the literature and meta-analysis aimed to determine
the relationship between preoperative anemia and postoperative mortality
in patients following TAVI. MATERIAL AND METHODS PubMed, EMBASE, the
Cochrane Library, and the Web of Science were systematically searched from
their inception to February 2019 for relevant published studies that
included patients with bicuspid aortic valve stenosis and tricuspid aortic
valve stenosis who underwent TAVI and who had preoperative data on
hemoglobin levels. The pooled odds ratios (OR) and 95% confidence interval
(CI) were calculated using a random-effects generic inverse variance
method. RESULTS Six published studies that involved 6,406 patients with
aortic stenosis were included in the meta-analysis. There was no
significant difference observed for the final pooled result for patients
with and without anemia for the short-term 30-day postoperative mortality
(OR, 1.34; 95% CI, 0.77-2.35). However, long-term mortality rates were
significantly worse in patients with preoperative anemia compared with
those without anemia (OR, 1.77; 95% CI, 1.34-2.35). CONCLUSIONS Systematic
review of the literature and meta-analysis showed that pre-procedural
anemia reduced long-term mortality following TAVI. This finding supports
the need to correct preoperative anemia in patients with aortic stenosis
to improve patient outcome following TAVI.

<46>
Accession Number
629447639
Title
The incidence and prognostic implications of worsening right ventricular
function after surgical or transcatheter aortic valve replacement:
insights from PARTNER IIA.
Source
European heart journal. 39 (28) (pp 2659-2667), 2018. Date of Publication:
21 Jul 2018.
Author
Cremer P.C.; Zhang Y.; Alu M.; Rodriguez L.L.; Lindman B.R.; Zajarias A.;
Hahn R.T.; Lerakis S.; Malaisrie S.C.; Douglas P.S.; Pibarot P.; Svensson
L.G.; Leon M.B.; Jaber W.A.
Institution
(Cremer, Rodriguez, Jaber) Department of Cardiovascular Imaging, Heart and
Vascular Institute, Cleveland Clinic, 9500 Euclid Ave: DeskJ1-5,
Cleveland, OH, USA
(Zhang, Leon) Cardiovascular Research Foundation, NY, NY, United States
(Alu, Hahn, Leon) Columbia University Medical Center, NY, NY, United
States
(Lindman) Vanderbilt University Medical Center, TN, Nashville, United
States
(Zajarias) Washington University School of Medicine, St. Louis, MO, USA
(Lerakis) Emory University, Atlanta, United States
(Malaisrie) Northwestern University, Chicago, United States
(Douglas) Duke University Medical Center and Duke Clinical Research
Institute, Durham, United States
(Pibarot) Department of Medicine, Universite Laval, QC, Canada
(Svensson) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
Publisher
NLM (Medline)
Abstract
Aims: In patients randomized to transcatheter or surgical aortic valve
replacement (TAVR, SAVR), we sought to determine whether SAVR is
associated with worsening right ventricular (RV) function and whether RV
deterioration is associated with mortality. Methods and Results: In
1376 patients from PARTNERIIA with paired baseline and 30-day core lab
echocardiograms, worsening RV function was defined as decline by at least
one grade from baseline to 30days. Our primary outcome was all-cause
mortality from 30days to 2years. Among 744 patients with TAVR, 62 (8.3%)
had worsening RV function, compared with 156 of 632 patients with SAVR
(24.7%) (P<0.0001). In a multivariable model, SAVR [odds ratio (OR) 4.05,
95% confidence interval (CI) 2.55-6.44], a dilated RV (OR 2.38, 95% CI
1.37-4.14), and more than mild tricuspid regurgitation (TR) (OR 2.58, 95%
CI 1.25-5.33) were associated with worsening RV function. There were 169
deaths, and patients with worsening RV function had higher all-cause
mortality [hazard ratio (HR) 1.98, 95% CI 1.40-2.79]. This association
remained robust after adjusting for clinical and echocardiographic
variables. Among patients with worsening RV function, there was no
mortality difference between TAVR and SAVR (HR 1.16, 95% CI 0.61-2.18).
The development of moderate or severe RV dysfunction from baseline normal
RV function conferred the worst prognosis (HR 2.87, 95% CI 1.40-5.89).
 Conclusion(s): After aortic valve replacement, worsening RV function
is more common in patients with baseline RV dilation, more than mild TR,
and in patients treated with SAVR. Worsening RV function and the magnitude
of deterioration have important prognostic implications.

<47>
Accession Number
629447588
Title
Annual number of candidates for transcatheter aortic valve implantation
per country: current estimates and future projections.
Source
European heart journal. 39 (28) (pp 2635-2642), 2018. Date of Publication:
21 Jul 2018.
Author
Durko A.P.; Osnabrugge R.L.; Van Mieghem N.M.; Milojevic M.; Mylotte D.;
Nkomo V.T.; Pieter Kappetein A.
Institution
(Durko, Osnabrugge, Milojevic, Pieter Kappetein) Department of
Cardio-Thoracic Surgery, Erasmus University Medical Center, Netherlands
(Van Mieghem) Department of Interventional Cardiology, Erasmus University
Medical Center, Netherlands
(Mylotte) Galway University Hospital, Newcastle Rd, Galway, Ireland
(Nkomo) Division of Cardiovascular Diseases, Mayo Clinic, 1216 2nd St SW
Rochester, MN, United States
Publisher
NLM (Medline)
Abstract
Aims: The number of transcatheter aortic valve implantation (TAVI)
procedures is rapidly increasing. This has a major impact on health care
resource planning. However, the annual numbers of TAVI candidates per
country are unknown. The aim of this study was to estimate current and
future number of annual TAVI candidates in 27 European countries, the USA
and Canada. Methods and Results: Systematic literature searches and
meta-analyses were performed on aortic stenosis (AS) epidemiology and
decision-making in severe symptomatic AS. The incidence rate of severe AS
was determined. Findings were combined with population statistics and
integrated into a model employing Monte Carlo simulations to predict the
annual number of TAVI candidates. Various future scenarios and sensitivity
analyses were explored. Data from 37 studies (n=26402) informed the model.
The calculated incidence rate of severe AS was 4.4/year [95% confidence
interval (95% CI) 3.0-6.1] in patients>=65years. AS-related symptoms were
present in 68.3% (95% CI 60.8-75.9%) of patients with severe AS. Despite
having severe symptomatic AS, 41.6% (95% CI 36.9-46.3%) did not undergo
surgical aortic valve replacement. Of the non-operated patients, 61.7%
(95% CI 42.0-81.7%) received TAVI. The model predicted 114757 (95% CI
69380-172799) European and 58556 (95% CI 35631-87738) Northern-American
TAVI candidates annually. Conclusion(s): Currently, approximately
180000 patients can be considered potential TAVI candidates in the
European Union and in Northern-America annually. This number might
increase up to 270000 if indications for TAVI expand to low-risk patients.
These findings have major implications for health care resource planning
in the 29 individual countries.

<48>
Accession Number
629450934
Title
Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease.
Source
The New England journal of medicine. (no pagination), 2019. Date of
Publication: 28 Sep 2019.
Author
Stone G.W.; Kappetein A.P.; Sabik J.F.; Pocock S.J.; Morice M.-C.; Puskas
J.; Kandzari D.E.; Karmpaliotis D.; Brown W.M.; Lembo N.J.; Banning A.;
Merkely B.; Horkay F.; Boonstra P.W.; van Boven A.J.; Ungi I.; Bogats G.;
Mansour S.; Noiseux N.; Sabate M.; Pomar J.; Hickey M.; Gershlick A.;
Buszman P.E.; Bochenek A.; Schampaert E.; Page P.; Modolo R.; Gregson J.;
Simonton C.A.; Mehran R.; Kosmidou I.; Genereux P.; Crowley A.; Dressler
O.; Serruys P.W.
Institution
(Stone, Kappetein, Sabik, Pocock, Morice, Puskas, Kandzari, Karmpaliotis,
Brown, Lembo, Banning, Merkely, Horkay, Boonstra, van Boven, Ungi, Bogats,
Mansour, Noiseux, Sabate, Pomar, Hickey, Gershlick, Buszman, Bochenek,
Schampaert, Page, Modolo, Gregson, Simonton, Mehran, Kosmidou, Genereux,
Crowley, Dressler, Serruys) From the Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.,
R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L.,
R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint
Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia
University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus
Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden
(P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam,
Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals
Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene
and Tropical Medicine (S.J.P., J.G.) and the International Centre for
Circulatory Health, National Heart and Lung Institute, Imperial College
London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and
University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all
in the United Kingdom; Hopital Prive Jacques Cartier, Ramsay Generale de
Sante, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K.,
W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University
of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de
l'Universite de Montreal (S.M., N.N.) and Hopital du Sacre-Coeur de
Montreal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S.,
J. Pomar); Medical University of Silesia, Katowice, and American Heart of
Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of
Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA
(C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ (P.G.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Long-term outcomes after percutaneous coronary intervention
(PCI) with contemporary drug-eluting stents, as compared with
coronary-artery bypass grafting (CABG), in patients with left main
coronary artery disease are not clearly established. METHOD(S): We
randomly assigned 1905 patients with left main coronary artery disease of
low or intermediate anatomical complexity (according to assessment at the
participating centers) to undergo either PCI with fluoropolymer-based
cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or
CABG (CABG group, 957 patients). The primary outcome was a composite of
death, stroke, or myocardial infarction. RESULT(S): At 5 years, a
primary outcome event had occurred in 22.0% of the patients in the PCI
group and in 19.2% of the patients in the CABG group (difference, 2.8
percentage points; 95% confidence interval [CI], -0.9 to 6.5; P=0.13).
Death from any cause occurred more frequently in the PCI group than in the
CABG group (in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI,
0.2 to 6.1). In the PCI and CABG groups, the incidences of definite
cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5
percentage points; 95% CI, -1.4 to 2.5) and myocardial infarction (10.6%
and 9.1%; difference, 1.4 percentage points; 95% CI, -1.3 to 4.2) were not
significantly different. All cerebrovascular events were less frequent
after PCI than after CABG (3.3% vs. 5.2%; difference, -1.9 percentage
points; 95% CI, -3.8 to 0), although the incidence of stroke was not
significantly different between the two groups (2.9% and 3.7%; difference,
-0.8 percentage points; 95% CI, -2.4 to 0.9). Ischemia-driven
revascularization was more frequent after PCI than after CABG (16.9% vs.
10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0).
 CONCLUSION(S): In patients with left main coronary artery disease of
low or intermediate anatomical complexity, there was no significant
difference between PCI and CABG with respect to the rate of the composite
outcome of death, stroke, or myocardial infarction at 5 years. (Funded by
Abbott Vascular; EXCEL ClinicalTrials.gov number,
NCT01205776.). Copyright © 2019 Massachusetts Medical Society.

<49>
Accession Number
629446099
Title
Effects of high-dose vitamin D supplementation on the occurrence of
post-operative atrial fibrillation after coronary artery bypass grafting:
randomized controlled trial.
Source
General thoracic and cardiovascular surgery. (no pagination), 2019. Date
of Publication: 26 Sep 2019.
Author
Kara H.; Yasim A.
Institution
(Kara) Department of Cardiovascular Surgery, Giresun Ada Hospital,
Giresun, Turkey
(Yasim) Department of Cardiovascular Surgery, Kahramanmaras Sutcu Imam
University, Kahramanmaras, Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This study aimed to investigate the preventive effects of a
high-dose vitamin D administered preoperatively on the post-operative
atrial fibrillation (POAF) occurrence in patients with insufficient or
deficient serum vitamin D levels who underwent coronary artery bypass
grafting (CABG) surgery. METHOD(S): The study was a randomized
controlled, blinded and parallel-arm trial conducted on 116 who had
vitamin D deficiency or insufficiency during the pre-operative evaluation
were included in the study conducted between January 2018 and January
2019. Patients were divided into those who received oral vitamin D
(treatment group; n=58) and those who did not (control group; n=58) 48 h
before CABG surgery. In the treatment group, patients with vitamin D
deficiency were administered 300.000 IU vitamin D orally and those with
vitamin D insufficiency 150.000 IU 48 h preoperatively. Patients were
followed up during hospitalisation process with respect to POAF.
 RESULT(S): Both groups showed no significant differences with regard
to age, gender, body mass index, creatine level, left atrial diameter,
pre-operative drug use, calcium level, ejection fraction, diabetes
mellitus and hypertension. The ratio of POAF occurrence found in the
treatment and control groups were 12.07% and 27.59%, respectively. Vitamin
D treatment was found to reduce the risk of POAF development by 0.24 times
(p=0.034). CONCLUSION(S): In this study with sufficient sample size,
preoperative short-term high-dose vitamin D supplementation was found to
be significantly preventive to the occurrence of POAF in patients with
vitamin D insufficiency and deficiency who underwent CABG surgery.

<50>
Accession Number
629445080
Title
Prior percutaneous coronary interventions may be associated with increased
mortality after coronary bypass grafting: A meta-analysis: Prior PCI
associated with mortality after CABG.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2019.
Date of Publication: 23 Sep 2019.
Author
Luthra S.; Leiva-Juarez M.M.; Shine B.; Al-Attar N.; Ohri S.; Taggart D.P.
Institution
(Luthra) Southampton University Hospitals, Southampton, United Kingdom
(Leiva-Juarez) Department of Surgery, Brookdale University Hospital and
Medical Center, Brooklyn, NY
(Shine, Taggart) University of Oxford, Oxford, United Kingdom
(Al-Attar) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Ohri) Southampton University Hospitals, Southampton, United Kingdom
Publisher
NLM (Medline)
Abstract
There is conflicting evidence for adverse outcomes after coronary artery
bypass surgery (CABG) with prior percutaneous intervention (PCI). A
literature search was performed for 1998-2017 and articles with primary or
secondary outcomes of survival, major adverse cardiovascular events,
myocardial infarction in CABG patients with prior PCI were included.
Forest plots were generated from odds ratios for survival, major adverse
cardiovascular events and myocardial infarction for unmatched and
propensity matched data. Heterogeneity between studies was assessed for
all outcomes using I2. Funnel plots were generated for early survival,
survival at 5 years, survival at >5 years and MACE. Thirty-one studies
were included over 18 years with 194,544 patients without PCI prior to
CABG and 23,519 patients (12.09%) with prior PCI. Prior PCI did not
adversely affect survival among the included studies (IRR: 1.12, 95% CI:
0.98-1.27, p=0.110. MACE was significantly worse for those with prior PCI
(OR; 1.26, CI; 1.02-1.55, p=0.03). The relative risk of mortality
associated with prior PCI has decreased significantly over the last two
decades. Studies with higher percentage of prior PCI patients had higher
relative mortalities. There was significant heterogeneity between studies
for the treatment effects. PCI prior to CABG in recent times does not
adversely affect survival despite adverse early and late MACE rates.
However, high institutional rates of prior PCI may be associated with
increasing mortality after CABG. Copyright © 2019 Elsevier Inc.
All rights reserved.

<51>
Accession Number
2002925074
Title
Transcatheter Cardiovascular Therapeutics Abstracts.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B1-B860), 2019. Date of Publication: 1
October 2019.
Author
Anonymous
Publisher
Elsevier USA
Abstract
The proceedings contains 827 papers. The topics discussed include: TCT-1 A
Novel Risk-Based Strategy in Adopting New Technology: Pilot Study
Assessing Clinical and Quality Outcomes of Real-World Intravascular
Ultrasound (IVUS) and Instant Wave-Free Ratio (iFR) Utilization in a
Unique Risk-Sharing Program;TCT-2 Paravalvular Regurgitation After
Transcatheter Aortic Valve Replacement in Moderate-Risk Patients: A Pooled
PARTNER 2 Trial and Registry Study;TCT-3 Modified Body Mass Index, A Novel
Marker of Malnutrition and Clinical Frailty, is Associated With Outcomes
After Transcatheter and Surgical Aortic Valve Replacement;TCT-4
Transcatheter Tricuspid Valve Repair in Patients With Functional Tricuspid
Regurgitation: 2-Year Outcomes From the FORMA US Early Feasibility
Study;TCT-5 Is Surgical Aortic Valve Replacement Still an Option for
Radiation-Induced Aortic Stenosis in the Transcatheter Aortic Valve
Replacement Era?;TCT-6 Incidence and Predictors of Hemodynamic
Deterioration of Transcatheter and Surgical Bioprosthetic Aortic Valves:
Pooled Analysis From the CoreValve Pivotal Trials;TCT-7 Blinded Outcomes
Assessment of Absorb Bioresorbable Scaffolds Implanted With Improved
Technique: 2-Year Results From the ABSORB IV Randomized Trial;TCT-8
Updated 30-Day Outcomes for the U.S. Early Feasibility Study of the SAPIEN
M3 Transcatheter Mitral Valve Replacement System;TCT-9 Quantitative
Assessment of Lipid Composition by NIRS-IVUS Is Helpful for
Differentiating Among Plaque Rupture, Plaque Erosion, and Calcified Nodule
in the Culprit Lesion of ACS;TCT-10 Time and Mortality in ST-Segment
Elevation Myocardial Infarction: Insights From the TOTAL Trial;TCT-11
Everolimus-Eluting Bioresorbable Scaffolds Versus Drug-Eluting Stents in
Patients With Acute Myocardial Infarction: 2-Year Results of the
Randomized ISAR-Absorb MI Trial;TCT-12 Results From the CAMI1 Study:
Selective CRP Apheresis as a New Treatment Option in Acute Myocardial
Infarction;TCT-243 Rotablation Approach for Bifurcation Lesions

<52>
Accession Number
621703780
Title
Effect of statins and non-statin LDL-lowering medications on
cardiovascular outcomes in secondary prevention: A meta-analysis of
randomized trials.
Source
European Heart Journal. 39 (14) (pp 1172-1180), 2018. Date of Publication:
07 Apr 2018.
Author
Koskinas K.C.; Siontis G.C.M.; Piccolo R.; Mavridis D.; Raber L.; Mach F.;
Windecker S.
Institution
(Koskinas, Siontis, Piccolo, Raber, Windecker) Department of Cardiology,
University Hospital Bern, Bern 3010, Switzerland
(Mavridis) Department of Primary Education, University of Ioannina,
Ioannina, Greece
(Mavridis) Centre de Recherche Epidemiologie et Statistique Sorbonne Paris
Cite (CRESS-UMR1153), Inserm/Universite Paris Descartes, Paris, France
(Mach) Department of Cardiology, Geneva University Hospital, Geneva 1205,
Switzerland
Publisher
Oxford University Press
Abstract
Aims: Current evidence on dyslipidaemia management has expanded to novel
treatments and very low achieved levels of low-density lipoprotein
cholesterol (LDL-C). We sought to compare the clinical impact of
more-intensive vs. less-intensive LDL-C lowering by means of statins and
currently recommended non-statin medications in secondary prevention.
 Methods and Results: We searched Medline, EMBASE, and Cochrane
databases for randomized controlled trials of statins, ezetimibe,
proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, or bile
acid sequestrants with >500 patients followed for >=1 year. We employed
random-effects models using risk ratios (RRs) with 95% confidence
intervals (CIs) to compare outcomes. We included 19 trials (15 of statins,
3 of PCSK9 inhibitors, and 1 of ezetimibe) with 152 507 patients randomly
assigned to more-intensive (n = 76 678) or less-intensive treatment (n =
75 829). Moreintensive treatment was associated with 19% relative risk
reduction for the primary outcome, major vascular events (MVEs; RR 0.81,
95% CI 0.77-0.86). Risk reduction was greater across higher baseline
levels and greater achieved reductions of LDL-C. The clinical benefit was
significant across varying types of more-intensive treatment and was
consistent for statins (RR 0.81, 95% CI 0.76-0.86) and non-statin agents
(PCSK9 inhibitors and ezetimibe; RR 0.85, 95% CI 0.77-0.94) as active
(more-intensive) intervention (P-interaction = 0.38). Each 1.0 mmol/L
reduction in LDLC was associated with 19% relative decrease in MVE. Death,
cardiovascular death, myocardial infarction, stroke, and coronary
revascularization also favoured more-intensive treatment.
 Conclusion(s): Reduction of MVE is proportional to the magnitude of
LDL-C lowering across a broad spectrum of on-treatment levels in secondary
prevention. Statin intensification and add-on treatment with PCSK9
inhibitors or ezetimibe are associated with significant reduction of
cardiovascular morbidity in this very high-risk population. Copyright
© The Author 2017.

<53>
Accession Number
621499410
Title
Cardiac protective effects of remote ischaemic preconditioning in children
undergoing tetralogy of fallot repair surgery: A randomized controlled
trial.
Source
European Heart Journal. 39 (12) (pp 1028-1037), 2018. Date of Publication:
21 Mar 2018.
Author
Wu Q.; Wang T.; Chen S.; Zhou Q.; Li H.; Hu N.; Feng Y.; Dong N.; Yao S.;
Xia Z.
Institution
(Wu, Wang, Chen, Zhou, Hu, Feng, Yao) Department of Anaesthesiology,
Institute of Anaesthesiology and Critical Care Medicine, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
1277 Jiefang Avenue, Wuhan 430022, China
(Li, Xia) State Key Laboratory of Pharmaceutical Biotechnology, University
of Hong Kong, 21 Sassoon Road, Hong Kong, Hong Kong
(Li, Xia) Department of Anaesthesiology, University of Hong Kong, 102
Pokfulam Road, Hong Kong, Hong Kong
(Dong) Department of Cardiovascular Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, 1277
Jiefang Avenue, Wuhan 430022, China
Publisher
Oxford University Press
Abstract
Aims Remote ischaemic preconditioning (RIPC) by inducing brief ischaemia
in distant tissues protects the heart against myocardial
ischaemia-reperfusion injury (IRI) in children undergoing open-heart
surgery, although its effectiveness in adults with comorbidities is
controversial. The effectiveness and mechanism of RIPC with respect to
myocardial IRI in children with tetralogy of Fallot (ToF), a severe
cyanotic congenital cardiac disease, undergoing open heart surgery are
unclear. We hypothesized that RIPC can confer cardioprotection in children
undergoing ToF repair surgery. Methods and results Overall, 112 ToF
children undergoing radical open cardiac surgery using cardiopulmonary
bypass (CPB) were randomized to either a RIPC group (n = 55) or a control
group (n = 57). The RIPC protocol consisted of three cycles of 5-min lower
limb occlusion and 5-min reperfusion using a cuff-inflator. Serum
inflammatory cytokines and cardiac injury markers were measured before
surgery and after CPB. Right ventricle outflow tract (RVOT) tissues were
collected during the surgery to assess hypoxia-inducible factor
(Hif)-1alpha and other signalling proteins. Cardiac mitochondrial injury
was assessed by electron microscopy. The primary results showed that the
length of stay in the intensive care unit (ICU) was longer in the control
group than in the RIPC group (52.30 +/- 13.43 h vs. 47.55 +/- 10.34 h,
respectively, P = 0.039). Patients in the control group needed longer
post-operative ventilation time compared to the RIPC group (35.02 +/- 6.56
h vs. 31.96 +/- 6.60 h, respectively, P = 0.016). The levels of
post-operative serum troponin-T at 12 and 18 h, CK-MB at 24 h, as well as
the serum h-FABP levels at 6 h, after CPB were significantly lower, which
was coincident with significantly higher protein expression of cardiac
Hif-1alpha, p-Akt, p-STAT3, p-STAT5, and p-eNOS and less vacuolization of
mitochondria in the RIPC group compared to the control group. Conclusion
In ToF children undergoing open heart surgery, RIPC attenuates myocardial
IRI and improves the short-term prognosis. Copyright © The Author
2017. Published by Oxford University Press on behalf of the European
Society of Cardiology.

<54>
Accession Number
622110038
Title
Initial Clinical Experience Using the Low-Profile Altura Endograft System
With Double D-Shaped Proximal Stents for Endovascular Aneurysm Repair.
Source
Journal of Endovascular Therapy. 25 (3) (pp 379-386), 2018. Date of
Publication: 01 Jun 2018.
Author
Krievins D.; Kramer A.; Savlovskis J.; Oszkinis G.; Debus E.S.; Oberhuber
A.; Zarins C.K.
Institution
(Krievins) Department of Vascular Surgery, Pauls Stradins Clinical
University Hospital, University of Latvia, Riga, Latvia
(Kramer) Department of Vascular and Endovascular Surgery, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Savlovskis) Department of Invasive Radiology, Pauls Stradins Clinical
University Hospital, University of Latvia, Riga, Latvia
(Oszkinis) Department of General and Vascular Surgery, Poznan University
of Medical Sciences, Poznan, Poland
(Debus) Department for Vascular Medicine, Vascular Surgery, Angiology, and
Endovascular Therapy, University Heart Center Hamburg, University Hospital
Hamburg-Eppendorf, Hamburg, Germany
(Oberhuber) Department of Vascular and Endovascular Surgery, University
Hospital Dusseldorf, Germany
(Zarins) Department of Surgery, Stanford University Medical Center,
Stanford, CA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Purpose: To report the initial clinical results of endovascular aneurysm
repair (EVAR) using the low-profile (14-F) Altura Endograft System, which
features a double "D-shaped" stent design with suprarenal fixation and
modular iliac components that are deployed from distal to proximal.
 Method(s): From 2011 to 2015, 90 patients (mean age 72.8+/-8.3 years;
79 men) with abdominal aortic aneurysm (AAA; mean diameter 53.8+/-5.7 mm)
were treated at 10 clinical sites in 2 prospective, controlled clinical
studies using the Altura endograft. Outcomes evaluated included mortality,
major adverse events (MAEs: all-cause death, stroke, paraplegia,
myocardial infarction, respiratory failure, bowel ischemia, and blood loss
>=1000 mL), and clinical success (freedom from procedure-related death,
type I/III endoleak, migration, thrombosis, and reintervention).
 Result(s): Endografts were successfully implanted in 89 (99%)
patients; the single failure was due to delivery system malfunction before
insertion in the early-generation device. One (1%) patient died and 4
patients underwent reinterventions (1 type I endoleak, 2 iliac limb
stenoses, and 1 endograft occlusion) within the first 30 days. During a
median follow-up of 12.5 months (range 11.5-50.9), there were no aneurysm
ruptures, surgical conversions, or AAA-related deaths. The cumulative MAE
rates were 3% (3/89) at 6 months and 7% (6/89) at 1 year. Two patients
underwent coil embolization of type II endoleaks at 6.5 months and 2.2
years, respectively. Clinical success was 94% (84/89) at 30 days, 98%
(85/87) at 6 months, and 99% (82/83) at 1 year. Conclusion(s): Early
results suggest that properly selected AAA patients can be safely treated
using the Altura Endograft System with favorable midterm outcome. Thus,
further clinical investigation is warranted to evaluate the role of this
device in the treatment of AAA. Copyright © 2018, © The
Author(s) 2018.

<55>
Accession Number
623930596
Title
Commentary: The Long and Winding Road.
Source
Journal of Endovascular Therapy. 25 (5) (pp 608-610), 2018. Date of
Publication: 01 Oct 2018.
Author
Lorenzoni R.; Roffi M.
Institution
(Lorenzoni) Diagnostic and Interventional Cardiology Unit, Department of
Cardiology, San Luca Hospital, Lucca, Tuscany, Italy
(Roffi) Interventional Cardiology Unit, University Hospitals, Geneva,
Switzerland
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)

<56>
Accession Number
623882467
Title
Transradial Approach for Aortoiliac and Femoropopliteal Interventions: A
Systematic Review and Meta-analysis.
Source
Journal of Endovascular Therapy. 25 (5) (pp 599-607), 2018. Date of
Publication: 01 Oct 2018.
Author
Meertens M.M.; Ng E.; Loh S.E.K.; Samuel M.; Mees B.M.E.; Choong A.M.T.L.
Institution
(Meertens, Ng, Loh, Samuel, Choong) SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
(Meertens, Mees) Department of Vascular Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
(Meertens, Mees) European Vascular Center Aachen-Maastricht, Aachen,
Germany
(Ng) Department of Vascular Surgery, Westmead Hospital, Westmead, NSW,
Australia
(Loh) Department of Diagnostic Imaging, National University Hospital,
Singapore
(Samuel) Systematic Review Unit, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Purpose: To present a systematic review and meta-analysis comparing the
transradial approach for aortoiliac and femoropopliteal interventions to
the traditional transfemoral access. Method(s): A search of the
public domain databases MEDLINE, SCOPUS, Web of Science, and Cochrane
Library Databases was performed to identify studies related to the use of
the transradial approach for infra-aortic procedures. Meta-analysis was
used to compare the transradial to the transfemoral route in terms of
procedure success, complications, procedure parameters, and hospital
length of stay. Results are presented as the odds ratio (OR) and 95%
confidence interval (CI). Result(s): Nineteen studies containing 638
patients with transradial access for lower limb interventions were
selected. Lesions were treated from the aortic bifurcation down to the
popliteal artery. The mean technical success rate was 90.9%, conversion to
a transfemoral approach was necessary in 9.9%, and complications were
reported in 1.9%. The meta-analysis included 4 comparative studies
involving 114 transradial and 208 transfemoral procedures. There was no
significant advantage of either approach in terms of procedure success (OR
5.0, 95% CI 0.49 to 50.83, p=0.17), but the risk of developing a
complication was significantly lower (OR 0.25, 95% CI 0.07 to 0.86,
p=0.03) with the transradial approach. Conclusion(s): Transradial
access for lower limb endovascular interventions can be performed with
comparable technical success and a lower overall complication profile
compared to transfemoral access. Copyright © The Author(s) 2018.

<57>
Accession Number
623114963
Title
Five-year outcomes with PCI guided by fractional flow reserve.
Source
New England Journal of Medicine. 379 (3) (pp 250-259), 2018. Date of
Publication: 19 Jul 2018.
Author
Xaplanteris P.; Fournier S.; Pijls N.H.J.; Fearon W.F.; Barbato E.; Tonino
P.A.L.; Engstrom T.; Kaab S.; Dambrink J.-H.; Rioufol G.; Toth G.G.;
Piroth Z.; Witt N.; Frobert O.; Kala P.; Linke A.; Jagic N.; Mates M.;
Mavromatis K.; Samady H.; Irimpen A.; Oldroyd K.; Campo G.; Rothenbuhler
M.; Juni P.; De Bruyne B.
Institution
(Xaplanteris, Fournier, Barbato, Toth, De Bruyne) Cardiovascular Center
Aalst, Onze-Lieve-Vrouw Clinic, Moorselbaan 164, Aalst B-9300, Belgium
(Pijls, Tonino) Department of Cardiology, Eindhoven University of
Technology, Catharina Hospital, Eindhoven, Netherlands
(Dambrink) Isala Klinieken, Zwolle, Netherlands
(Fearon) Stanford University Medical Center and Palo Alto Veterans Affairs
(VA) Health Care Systems, Stanford, CA, United States
(Engstrom) Rigshospitalet University Hospital, D-Copenhagen, Germany
(Kaab) Klinikum Der Universitat Munchen-Campus-Innenstadt, Munich, Germany
(Linke) Heart Center Leipzig, Leipzig, Germany
(Linke) Heart Center Dresden, Dresden, Germany
(Rioufol) Cardiovascular Hospital, Lyon, France
(Toth, Piroth) Gottsegen Hungarian Institute of Cardiology, Budapest,
Hungary
(Witt) Karolinska Institutet at Sodersjukhuset, Stockholm, Sweden
(Frobert) Orebro University Hospital, Orebro, Sweden
(Kala) Masaryk University and University Hospital, Brno, Czechia
(Mates) Na Homolce Hospital, Prague, Czechia
(Jagic) Clinical Center Kragujevac, Kragujevac, Serbia
(Mavromatis) Atlanta VA Medical Center, Decatur, United States
(Samady) Emory University School of Medicine, G-Atlanta, United States
(Irimpen) Vascular Institute, Tulane University Heart, New Orleans, United
States
(Oldroyd) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Campo) Gruppo Villa Maria Care and Research, Cardiology Unit, Azienda
Ospedalieria Universitaria di Ferrara, Maria Cecilia Hospital, Ferrara,
Cotignola, Italy
(Rothenbuhler) Clinical Trials Unit Bern, University of Bern, Bern,
Switzerland
(Juni) Applied Health Research Centre, Department of Medicine and
Institute of Health Policy, Management, and Evaluation, University of
Toronto, Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Toronto, Canada
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND We hypothesized that fractional flow reserve (FFR)-guided
percutaneous coronary intervention (PCI) would be superior to medical
therapy as initial treatment in patients with stable coronary artery
disease. METHODS Among 1220 patients with angiographically significant
stenoses, those in whom at least one stenosis was hemodynamically
significant (FFR, <=0.80) were randomly assigned to FFR-guided PCI plus
medical therapy or to medical therapy alone. Patients in whom all stenoses
had an FFR of more than 0.80 received medical therapy and were entered
into a registry. The primary end point was a composite of death,
myocardial infarction, or urgent revascularization. RESULTS A total of 888
patients underwent randomization (447 patients in the PCI group and 441 in
the medical-therapy group). At 5 years, the rate of the primary end point
was lower in the PCI group than in the medical-therapy group (13.9% vs.
27.0%; hazard ratio, 0.46; 95% confidence interval [CI], 0.34 to 0.63;
P<0.001). The difference was driven by urgent revascularizations, which
occurred in 6.3% of the patients in the PCI group as compared with 21.1%
of those in the medical-therapy group (hazard ratio, 0.27; 95% CI, 0.18 to
0.41). There were no significant differences between the PCI group and the
medical-therapy group in the rates of death (5.1% and 5.2%, respectively;
hazard ratio, 0.98; 95% CI, 0.55 to 1.75) or myocardial infarction (8.1%
and 12.0%; hazard ratio, 0.66; 95% CI, 0.43 to 1.00). There was no
significant difference in the rate of the primary end point between the
PCI group and the registry cohort (13.9% and 15.7%, respectively; hazard
ratio, 0.88; 95% CI, 0.55 to 1.39). Relief from angina was more pronounced
after PCI than after medical therapy. CONCLUSIONS In patients with stable
coronary artery disease, an initial FFR-guided PCI strategy was associated
with a significantly lower rate of the primary composite end point of
death, myocardial infarction, or urgent revascularization at 5 years than
medical therapy alone. Patients without hemodynamically significant
stenoses had a favorable long-term outcome with medical therapy alone.
(Funded by St. Jude Medical and others; FAME 2 ClinicalTrials.gov number,
NCT01132495.) Copyright © 2018 Massachusetts Medical Society.

<58>
Accession Number
621966741
Title
Sildenafil for improving outcomes in patients with corrected valvular
heart disease and persistent pulmonary hypertension: A multicenter,
double-blind, randomized clinical trial.
Source
European Heart Journal. 39 (15) (pp 1255-1264), 2018. Date of Publication:
14 Apr 2018.
Author
Bermejo J.; Yotti R.; Garcia-Orta R.; Sanchez-Fernandez P.L.; Castano M.;
Segovia-Cubero J.; Escribano-Subias P.; San Roman J.A.; Borras X.;
Alonso-Gomez A.; Botas J.; Crespo-Leiro M.G.; Velasco S.; Bayes-Genis A.;
Lopez A.; Munoz-Aguilera R.; De Teresa E.; Gonzalez-Juanatey J.R.;
Evangelista A.; Mombiela T.; Gonzalez-Mansilla A.; Elizaga J.;
Martin-Moreiras J.; Gonzalez-Santos J.M.; Moreno-Escobar E.;
Fernandez-Aviles F.
Institution
(Bermejo, Yotti, Mombiela, Gonzalez-Mansilla, Elizaga, Fernandez-Aviles)
Department of Cardiology, Hospital General Universitario Gregorio Maranon,
Instituto de Investigacion Sanitaria Gregorio Maranon, Facultad de
Medicina, Universidad Complutense de Madrid, Dr Esquerdo 46, Madrid 28007,
Spain
(Garcia-Orta) Hospital Virgen de Las Nieves, Granada, Spain
(Sanchez-Fernandez, Martin-Moreiras, Gonzalez-Santos) Hospital Clinico
Universitario de Salamanca, CIBERCV Salamanca, Spain
(Castano) Hospital Universitario de Leon, Leon, Spain
(Segovia-Cubero) Hospital Puerta de Hierro Majadahonda and CIBERCV,
Majadahonda, Spain
(Escribano-Subias) Hospital 12 de Octubre and CIBERCV, Madrid, Spain
(San Roman) Hospital Clinico de Valladolid and CIBERCV, Valladolid, Spain
(Borras) Hospital Santa Creu i San Pau and CIBERCV, Barcelona, Spain
(Alonso-Gomez) Hospital Universitario de Araba-Txagorritxu, Vitoria, Spain
(Botas) Hospital Universitario Fundacion Alcorcon, Alcorcon, Spain
(Crespo-Leiro) Complejo Hospitalario Universitario de A Coruna and
CIBERCV, A Coruna, Spain
(Velasco) Hospital de Galdakao-Usansolo, Usansolo, Spain
(Bayes-Genis) Hospital Universitari Germans Trias i Pujol and CIBERCV,
Badalona, Spain
(Lopez) Hospital Universitario Reina Sofia, Cordoba, Spain
(Munoz-Aguilera) Hospital Infanta Leonor, Madrid, Spain
(De Teresa) Hospital Virgen de la Victoria and CIBERCV, Malaga, Spain
(Gonzalez-Juanatey) Hospital Clinico de Santiago de Compostela and
CIBERCV, Santiago de Compostela, Spain
(Evangelista) Hospital Universitario de la Vall d'Hebron and CIBERCV,
Barcelona, Spain
(Moreno-Escobar) Hospital Universitario San Cecilio, Granada, Spain
Publisher
Oxford University Press
Abstract
Aims We aimed to determine whether treatment with sildenafil improves
outcomes of patients with persistent pulmonary hypertension (PH) after
correction of valvular heart disease (VHD). Methods and results The
sildenafil for improving outcomes after valvular correction (SIOVAC) study
was a multricentric, randomized, parallel, and placebo-controlled trial
that enrolled stable adults with mean pulmonary artery pressure > 30mmHg
who had undergone a successful valve replacement or repair procedure at
least 1 year before inclusion. We assigned 200 patients to receive
sildenafil (40mg three times daily, n= 104) or placebo (n= 96) for
6months. The primary endpoint was the composite clinical score combining
death, hospital admission for heart failure (HF), change in functional
class, and patient global self-assessment. Only 27 patients receiving
sildenafil improved their composite clinical score, as compared with 44
patients receiving placebo; in contrast 33 patients in the sildenafil
group worsened their composite score, as compared with 14 in the placebo
group [odds ratio 0.39; 95% confidence interval (CI) 0.22-0.67; P<0.001].
The Kaplan-Meier estimates for survival without admission due to HF were
0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard
ratio 2.0, 95% CI= 1.0-4.0; log-rank P= 0.044). Changes in 6-min walk test
distance, natriuretic peptides, and Doppler-derived systolic pulmonary
pressure were similar in both groups. Conclusion Treatment with sildenafil
in patients with persistent PH after successfully corrected VHD is
associated to worse clinical outcomes than placebo. Off-label usage of
sildenafil for treating this source of left heart disease PH should be
avoided. Copyright © The Author 2017.

<59>
Accession Number
614519720
Title
Usefulness of cerebral oximetry in preventing postoperative cognitive
dysfunction in patients undergoing coronary artery bypass grafting.
Source
AANA Journal. 85 (1) (pp 49-54), 2017. Date of Publication: 2017.
Author
Kane T.; Pugh M.A.
Institution
(Kane) Texas Wesleyan Graduate Programs of Nurse Anesthesia, Fort Worth,
TX, United States
(Pugh) Texas Wesleyan University, Fort Worth, TX, United States
Publisher
AANA Publishing Inc. (E-mail: llacey@aana.com )
Abstract
Postoperative cognitive dysfunction (POCD) following coronary artery
bypass grafting has a negative impact on patients physically and
psychologically. Of increasing interest is the role that cerebral
autoregulation plays in postoperative neurologic outcomes. We sought
evidence examining the usefulness of cerebral oximetry data in preventing
POCD. Three hundred eighty potential evidence sources were located. Twelve
evidence sources (8 randomized controlled trials, 2 retrospective reviews,
and 2 prospective cohort studies with a retrospective cohort control) met
inclusion criteria. Although the neurologic assessment tools, desaturation
definitions, and interventional protocols varied, strong statistical
significance links the use of cerebral oximetry information to the
prevention of POCD.

<60>
Accession Number
613668721
Title
Five-year outcomes after off-pump or on-pump coronary-artery bypass
grafting.
Source
New England Journal of Medicine. 375 (24) (pp 2359-2368), 2016. Date of
Publication: 15 Dec 2016.
Author
Lamy A.; Devereaux P.J.; Prabhakaran D.; Taggart D.P.; Hu S.; Straka Z.;
Piegas L.S.; Avezum A.; Akar A.R.; Zanetti F.L.; Jain A.R.; Noiseux N.;
Padmanabhan C.; Bahamondes J.C.; Novick R.J.; Tao L.; Olavegogeascoechea
P.A.; Airan B.; Sulling T.A.; Whitlock R.P.; Ou Y.; Gao P.; Pettit S.;
Yusuf S.
Institution
(Lamy, Devereaux, Pettit, Yusuf) Population Health Research Institute,
Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
(Noiseux) Centre Hospitalier de l'Universite de Montral, Montreal, Canada
(Novick) University of Calgary, Calgary, AB, Canada
(Prabhakaran, Airan) Center for Chronic Disease Control, Gurgaon, India
(Taggart, Jain) SAL Hospital, Ahmedabad, India
(Hu, Padmanabhan) G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
(Tao, Airan) All India Institute of Medical Sciences, New Delhi, India
(Taggart, Straka) University of Oxford, Oxford, United Kingdom
(Hu, Piegas, Avezum) Fu Wai Cardiovascular Hospital, Xicheng
District,Beijing, China
(Akar) Wuhan Asia Heart Hospital, Wuhan, China
(Zanetti, Bahamondes) Third Faculty of Medicine Charles University,
University Hospital Kralovske Vinohrady, Prague, Czechia
(Olavegogeascoechea) Instituto Dante Pazzanese de Cardiologia, Sao Paulo,
Brazil
(Sulling) Ankara University School of Medicine, Ankara, Turkey
(Whitlock) Hospital Regional de Temuco and Universidad de la Frontera,
Temuco, Chile
(Ou) Fundacion Medica de Rio Negro y Neuquen, Rio Negro, Argentina
(Gao) North Estonia Medical Center, Tallinn, Estonia
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND We previously reported that there was no significant difference
at 30 days or at 1 year in the rate of the composite outcome of death,
stroke, myocardial infarction, or renal failure between patients who
underwent coronary-artery bypass grafting (CABG) performed with a
beating-heart technique (off-pump) and those who underwent CABG performed
with cardiopulmonary bypass (on-pump). We now report the results at 5
years (the end of the trial). METHODS A total of 4752 patients (from 19
countries) who had coronary artery disease were randomly assigned to
undergo off-pump or on-pump CABG. For this report, we analyzed a composite
outcome of death, stroke, myocardial infarction, renal failure, or repeat
coronary revascularization (either CABG or percutaneous coronary
intervention). The mean follow-up period was 4.8 years. RESULTS There were
no significant differences between the off-pump group and the onpump group
in the rate of the composite outcome (23.1% and 23.6%, respectively;
hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87
to 1.10; P = 0.72) or in the rates of the components of the outcome,
including repeat coronary revascularization, which was performed in 2.8%
of the patients in the offpump group and in 2.3% of the patients in the
on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P = 0.29). The
secondary outcome for the overall period of the trial - The mean cost in
U.S. dollars per patient - Also did not differ significantly between the
off-pump group and the on-pump group ($15,107 and $14,992, respectively;
between-group difference, $115; 95% CI, -$697 to $927). There were no
significant between-group differences in quality-of-life measures.
CONCLUSIONS In our trial, the rate of the composite outcome of death,
stroke, myocardial infarction, renal failure, or repeat revascularization
at 5 years of follow-up was similar among patients who underwent off-pump
CABG and those who underwent onpump CABG. (Funded by the Canadian
Institutes of Health Research; CORONARY ClinicalTrials.gov number,
NCT00463294.). Copyright © 2016 Massachusetts Medical Society.
All rights reserved.

<61>
Accession Number
2001615511
Title
Glycaemic variability is associated with severity of coronary artery
disease in patients with poorly controlled type 2 diabetes and acute
myocardial infarction.
Source
Diabetes and Metabolism. 45 (5) (pp 446-452), 2019. Date of Publication:
October 2019.
Author
Benalia M.; Zeller M.; Mouhat B.; Guenancia C.; Yameogo V.; Greco C.; Yao
H.; Maza M.; Verges B.; Cottin Y.
Institution
(Benalia, Mouhat, Guenancia, Greco, Yao, Maza, Cottin) Cardiology
Department, University Hospital Cente,r Dijon Bourgogne, 21000, France
(Zeller, Greco) Physiopathology and Epidemiology Cerebro-Cardiovascular
(PEC2), EA 7460 University of Bourgogne Franche-Comte, Dijon 21000, France
(Yameogo) Cardiology Department, University Hospital Center Yalgado
Ouedraogo, Ouagadougou 21000, Burkina Faso
(Verges) Endocrinology Department, University Hospital Center, Dijon
Bourgogne, 21000, France
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: In patients with type 2 diabetes (T2D), glycaemic variability
(GV), another component of glycaemic abnormalities, is a novel potentially
aggravating factor for coronary artery disease (CAD). Objective(s):
The aim of our study was to identify interactions between GV and severity
of CAD in diabetes patients admitted for acute myocardial infarction
(AMI). Method(s): All patients with T2D admitted to our university
hospital for AMI from March 2015 to February 2017 who received intravenous
(IV) insulin therapy and underwent coronary angiography were included. GV
was assessed by mean amplitude of blood glucose excursion (MAGE) values
taken within 2 days of admission. Patients with higher GV (highest MAGE
tertile) were compared with those with lower GV (first and second MAGE
tertiles). Result(s): A total of 204 patients were included: median
age was 72 (61-81) years; 32% were female; HbA<inf>1c</inf> was 7.3%
(6.4-8.2%); diabetes duration was 10 (2-17.5) years; and MAGE value was
0.65 (0.43-0.92) g/L. Compared with those with lower GV, patients with the
highest GV were more often women, treated with previous insulin, and had
higher blood glucose and HbA<inf>1c</inf> levels. In addition, patients
with elevated GV had significantly higher SYNTAX scores: 17 (10-28) vs. 12
(6-22) (P = 0.009). Indeed, SYNTAX scores (OR: 1.05, 95% CI: 1.02-1.08; P
= 0.001) remained independently associated with high GV beyond
HbA<inf>1c</inf> levels (OR: 1.51, 95% CI: 1.2-1.89; P < 0.001).
 Conclusion(s): In AMI patients with poorly controlled diabetes, GV is
associated with CAD severity beyond chronic hyperglycaemia. Although no
causality can be determined from our observational study, the results
suggest that, in AMI, early evaluation of GV might contribute to the
identification of those diabetes patients at high risk, and serve as a
therapeutic target for both primary and secondary
prevention. Copyright © 2019

<62>
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. 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. 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. 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. 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. 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).
 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. Copyright
© 2019 American Medical Association. All rights reserved.

<63>
Accession Number
627846661
Title
Effect of Targeting Mean Arterial Pressure during Cardiopulmonary Bypass
by Monitoring Cerebral Autoregulation on Postsurgical Delirium among Older
Patients: A Nested Randomized Clinical Trial.
Source
JAMA Surgery. 154 (9) (pp 819-826), 2019. Date of Publication: September
2019.
Author
Brown C.H.; Neufeld K.J.; Tian J.; Probert J.; Laflam A.; Max L.; Hori D.;
Nomura Y.; Mandal K.; Brady K.; Hogue C.W.; Shah A.; Zehr K.; Cameron D.;
Conte J.; Bienvenu O.J.; Gottesman R.; Yamaguchi A.; Kraut M.
Institution
(Brown) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, United States
(Neufeld, Bienvenu) Department of Psychiatry, Johns Hopkins University
School of Medicine, Baltimore, MD, United States
(Tian) Department of Biostatistics, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
(Probert) School of Medicine, New York University, New York, United States
(Laflam) School of Medicine, Tufts University, Medford, MA, United States
(Max) Department of Radiology, Massachusetts General Hospital, Boston,
United States
(Hori, Nomura) Department of Cardiovascular Surgery, Saitama Medical
Center, Jichi Medical University, Saitama, Japan
(Mandal, Conte) Division of Cardiac Surgery, Department of Surgery, Penn
State University Hershey Medical Center, Hershey, PA, United States
(Brady) Department of Anesthesiology, Northwestern University Feinberg
School of Medicine, Chicago, IL, United States
(Hogue) Bluhm Cardiovascular Institute, Department of Anesthesiology,
Northwestern University Feinberg School of Medicine, Chicago, IL, United
States
(Shah) Department of Cardiac Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Zehr) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Cameron) Division of Cardiac Surgery, Department of Surgery,
Massachusetts General Hospital, Boston, United States
(Gottesman) Department of Neurology, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Yamaguchi) Saitama Medical Center, Jichi Medical University, Saitama,
Japan
(Kraut) Department of Radiology and Radiological Sciences, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Delirium occurs in up to 52% of patients after cardiac surgery
and may result from changes in cerebral perfusion. Using intraoperative
cerebral autoregulation monitoring to individualize and optimize cerebral
perfusion may be a useful strategy to reduce the incidence of delirium
after cardiac surgery. Objective(s): To determine whether targeting
mean arterial pressure during cardiopulmonary bypass (CPB) using cerebral
autoregulation monitoring reduces the incidence of delirium compared with
usual care. Design, Setting, and Participant(s): This randomized
clinical trial nested within a larger trial enrolled patients older than
55 years who underwent nonemergency cardiac surgery at a single US
academic medical center between October 11, 2012, and May 10, 2016, and
had a high risk for neurologic complications. Patients, physicians, and
outcome assessors were masked to the assigned intervention. A total of
2764 patients were screened, and 199 were eligible for analysis in this
study. Intervention(s): In the intervention group, the patient's
lower limit of cerebral autoregulation was identified during surgery
before CPB. On CPB, the patient's mean arterial pressure was targeted to
be greater than that patient's lower limit of autoregulation. In the
control group, mean arterial pressure targets were determined according to
institutional practice. Main Outcomes and Measures: The main outcome
was any incidence of delirium on postoperative days 1 through 4, as
adjudicated by a consensus expert panel. Result(s): Among the 199
participants in this study, mean (SD) age was 70.3 (7.5) years and 150
(75.4%) were male. One hundred sixty-two (81.4%) were white, 26 (13.1%)
were black, and 11 (5.5%) were of other race. Of 103 patients randomized
to usual care, 94 were analyzed, and of 102 patients randomized to the
intervention 105 were analyzed. Excluding 5 patients with coma, delirium
occurred in 48 of the 91 patients (53%) in the usual care group compared
with 39 of the 103 patients (38%) in the intervention group (P =.04). The
odds of delirium were reduced by 45% in patients randomized to the
autoregulation group (odds ratio, 0.55; 95% CI, 0.31-0.97; P =.04).
 Conclusions and Relevance: The results of this study suggest that
optimizing mean arterial pressure to be greater than the individual
patient's lower limit of cerebral autoregulation during CPB may reduce the
incidence of delirium after cardiac surgery, but further study is needed.
Trial Registration: ClinicalTrials.gov identifier:
NCT00981474. Copyright © 2019 American Medical Association. All
rights reserved.

<64>
Accession Number
2002963136
Title
SGLT2 Inhibition with Empagliflozin Increases Circulating Provascular
Progenitor Cells in People with Type 2 Diabetes Mellitus.
Source
Cell Metabolism. 30 (4) (pp 609-613), 2019. Date of Publication: 1 October
2019.
Author
Hess D.A.; Terenzi D.C.; Trac J.Z.; Quan A.; Mason T.; Al-Omran M.; Bhatt
D.L.; Dhingra N.; Rotstein O.D.; Leiter L.A.; Zinman B.; Sabongui S.; Yan
A.T.; Teoh H.; Mazer C.D.; Connelly K.A.; Verma S.
Institution
(Hess, Al-Omran) Division of Vascular Surgery, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's
Hospital, Toronto, ON, Canada
(Terenzi, Trac, Quan, Mason, Dhingra, Sabongui, Teoh, Verma) Division of
Cardiac Surgery, Keenan Research Centre for Biomedical Science, Li Ka
Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
(Rotstein) Division of General Surgery, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's
Hospital, Toronto, ON, Canada
(Leiter, Teoh) Division of Endocrinology and Metabolism, Keenan Research
Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Yan, Connelly) Division of Cardiology, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's
Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesia, Keenan Research Centre for Biomedical
Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto,
ON, Canada
(Hess, Trac, Mason, Al-Omran, Verma) Department of Pharmacology and
Toxicology, University of Toronto, Toronto, ON, Canada
(Al-Omran, Rotstein, Verma) Department of Surgery, University of Toronto,
Toronto, ON, Canada
(Leiter, Zinman, Yan, Connelly) Department of Medicine, University of
Toronto, Toronto, ON, Canada
(Leiter) Department of Nutritional Sciences, University of Toronto,
Toronto, ON, Canada
(Mazer, Connelly) Department of Physiology, University of Toronto,
Toronto, ON, Canada
(Mazer) Department of Anesthesia, University of Toronto, Toronto, ON,
Canada
(Terenzi, Al-Omran, Connelly, Verma) Institute of Medical Science,
University of Toronto, Toronto, ON, Canada
(Hess) Molecular Medicine Research Laboratories, Robarts Research
Institute, London, ON, Canada
(Hess) Department of Physiology and Pharmacology, Western University,
London, ON, Canada
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Zinman) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
Toronto, ON, Canada
Publisher
Cell Press (E-mail: subs@cell.com)
Abstract
Hess et al. quantified circulating aldehyde dehydrogenase-expressing
(ALDHhi) cell subsets in people with T2DM given either
empagliflozin (EMPA) or placebo. EMPA treatment increased circulating
pro-angiogenic CD133+ progenitor cells, decreased
pro-inflammatory ALDHhi granulocyte precursors, and increased
ALDHhi monocytes with M2 polarization. EMPA treatment improved
T2DM-associated "regenerative cell depletion" contributing to enhanced
vascular health. Copyright © 2019

<65>
Accession Number
2002941859
Title
Prognostic effect of troponin elevation in patients undergoing carotid
endarterectomy with regional anesthesia - A prospective study.
Source
International Journal of Surgery. 71 (pp 66-71), 2019. Date of
Publication: November 2019.
Author
Pereira-Macedo J.; Rocha-Neves J.P.; Dias-Neto M.F.; Andrade J.P.V.
Institution
(Pereira-Macedo, Rocha-Neves, Dias-Neto) Department of Angiology and
Vascular Surgery, Centro Hospitalar Universitario de Sao Joao, Porto,
Portugal
(Rocha-Neves, Andrade) Department of Biomedicine - Unity of Anatomy,
Faculdade de Medicina da Universidade Do Porto, Portugal
(Rocha-Neves, Dias-Neto) Department of Surgery and Physiology, Faculdade
de Medicina da Universidade Do Porto, Portugal
Publisher
Elsevier Ltd
Abstract
Background: Myocardial injury after noncardiac surgery (MINS) occurs in
15% of patients undergoing carotid endarterectomy (CEA) with general
anesthesia. Short and long-term risk of myocardial infarction (MI) and
stroke have been strongly associated with the presence of MINS, with an
associated mortality rate superior to 10% in the first year. Due to the
absence of studies concerning CEA with regional anesthesia (RA), the
present study aimed to evaluate the incidence of MINS in patients with RA
and its prognostic value on cardiovascular events or death.
 Material(s) and Method(s): From January 2009 to January 2018, 156
patients from a Portuguese tertiary care medical center who underwent CEA
under RA were retrieved from a prospectively gathered database. Troponin I
or high-sensitive troponin I values were systematically measured in the
postoperative period and studied as a binary outcome in a logistic
regression model. Survival analysis was used to study the impact of MINS
in time-dependent clinical outcomes such as stroke and MI. Result(s):
The incidence of MINS after CEA was 15.3%. Multivariate analysis confirmed
that chronic heart failure was strongly associated with MINS (OR: 4.458,
95% CI: 1689-11.708, P < 0.001). A previously diagnosed MINS was
associated with the long-term risk of MI and major adverse cardiovascular
events (MACE) with hazard ratios (HR) of 3.318 (95% CI: 0.97-13.928,
Breslow: P = 0.025) and 1.955 (95% CI: 1.01-4.132, Breslow: P = 0.046),
respectively. Conclusion(s): MINS is a long-term predictor of MI and
MACE. Troponin assessment after CEA should be routinely monitored in
patients with a cardiovascular risk superior to 5%. Further studies
concerning prophylaxis and management of MINS should be carried on,
focusing on the effect of anesthetic procedure in postoperative troponin
elevation. Copyright © 2019 IJS Publishing Group Ltd

<66>
Accession Number
629373683
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) (no pagination), 2019. Article Number: e031738. Date of
Publication: 01 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
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
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. Copyright © 2019 Author(s).

<67>
Accession Number
624202716
Title
Impact of bariatric surgery on cardiovascular and renal complications of
diabetes: a focus on clinical outcomes and putative mechanisms.
Source
Expert Review of Endocrinology and Metabolism. 13 (5) (pp 251-262), 2018.
Date of Publication: 03 Sep 2018.
Author
Martin W.P.; Docherty N.G.; Le Roux C.W.
Institution
(Martin, Docherty, Le Roux) Diabetes Complications Research Centre, Conway
Institute of Biomolecular and Biomedical Research, School of Medicine,
University College Dublin, Dublin, Ireland
(Docherty, Le Roux) Department of Gastrosurgical Research and Education,
Institute of Clinical Sciences, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden
(Le Roux) Division of Investigative Science, Imperial College London,
London, United Kingdom
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Cardiovascular and renal disease accounts for a substantial
proportion of the morbidity and mortality associated with obesity and type
2 diabetes mellitus (T2DM). Bariatric surgery is associated with improved
long-term cardiovascular and renal outcomes. Areas covered: All major
case-control, cohort, and randomized controlled trial studies of bariatric
surgery in adults with T2DM were screened and data on prespecified
cardiovascular and renal outcomes collated. Bariatric surgery reduces
all-cause mortality and risk of cardiovascular disease, albuminuria and
progressive chronic kidney disease. Patients with poorer glycemic control
and established microvascular disease preoperatively may stand to benefit
the most from the surgical approach. Reduced sympathetic drive, remission
of glomerular hypertension, enhanced natriuresis, gut microbiota shifts,
reduced systemic and renal inflammation, improved lipoprotein profiles,
and reductions in chronic cardiac remodeling may all be implicated. Expert
commentary: Ongoing RCTs of bariatric surgery selectively recruiting
patients with class 1 obesity and established microvascular complications
of diabetes will help to better characterize which subgroups of patients
benefit most from this effective therapy. Copyright © 2018,
© 2018 Informa UK Limited, trading as Taylor & Francis Group.

<68>
Accession Number
628215663
Title
Does pregabalin effectively and safely relieve postoperative pain in
patients undergoing pulmonary resections?.
Source
Interactive cardiovascular and thoracic surgery. 29 (4) (pp 555-560),
2019. Date of Publication: 01 Oct 2019.
Author
Li S.; Zhang W.; Cheng S.; Li Y.
Institution
(Li, Zhang) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
(Li, Zhang, Cheng, Li) West China Medical Center, West China Hospital,
Sichuan University, Chengdu, China
Publisher
NLM (Medline)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether pregabalin could
effectively and safely reduce postoperative pain in patients undergoing
pulmonary resections. Altogether 23 papers were found using the reported
search, of which 6 randomized controlled trials represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Five of 6 randomized
controlled trials demonstrated that the application of oral pregabalin
during the perioperative period could effectively reduce postoperative
pain after pulmonary resections without compromising patients' safety. One
randomized controlled trial reported no difference in the postoperative
pain levels between the pregabalin group and the control group. The rates
of adverse effects were generally found to be decreased in patients who
received pregabalin compared to the patients who received routine
analgesia, although 2 studies reported significantly higher incidences of
mild drowsiness and dizziness among the pregabalin-treated patients.
Currently available evidence supports that the perioperative
administration of pregabalin can effectively and safely relieve
postoperative pain for patients undergoing pulmonary
resections. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<69>
Accession Number
628214302
Title
In thoracic aortic surgery, is innominate artery cannulation a safe and
effective alternative to axillary artery cannulation?.
Source
Interactive cardiovascular and thoracic surgery. 29 (4) (pp 604-607),
2019. Date of Publication: 01 Oct 2019.
Author
Harky A.; Grafton-Clarke C.; Hadlett M.; Shuttleworth E.
Institution
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Grafton-Clarke) College of Life Sciences, University of Leicester,
Leicester, United Kingdom
(Hadlett, Shuttleworth) Department of Surgery, Countess of Chester
Hospital, Chester, United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: in a patient undergoing
thoracic aortic surgery, is innominate artery cannulation superior to
axillary artery cannulation in terms of postoperative outcomes? Five
hundred and thirty-one papers were found using the reported search
strategy, of which 5 represented the best evidence to answer the clinical
question. A total of 1338 participants were included across the 5 studies.
Seven hundred and twenty-two patients were cannulated via the axillary
artery and 616 were cannulated via the innominate artery. The included 5
studies were 2 prospective observational cohorts, 2 retrospective
case-series analysis and a single-blinded randomized trial. Thirty-day or
in-hospital mortality rates were reported in all 5 studies. There were no
significant differences in mortality with innominate artery cannulation
compared to axillary artery cannulation (P>0.05), with slightly lower
mortality rates in 2 studies, slightly higher mortality rates in 2 and
equal in 1 study. Though statistical significance was not demonstrated
(P>0.05), a stroke occurred slightly less frequently in patients receiving
innominate artery cannulation compared to axillary artery cannulation in 3
of the 4 studies. Innominate artery cannulation is non-inferior to
axillary artery cannulation for thoracic aortic surgery, with a similar
level of neuroprotection and is not associated with increased levels of
mortality. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<70>
Accession Number
628172949
Title
Is local anaesthesia superior to general anaesthesia in endovascular
repair of abdominal aortic aneurysm?.
Source
Interactive cardiovascular and thoracic surgery. 29 (4) (pp 599-603),
2019. Date of Publication: 01 Oct 2019.
Author
Harky A.; Grafton-Clarke C.; Chan J.
Institution
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Chester, United Kingdom
(Grafton-Clarke) College of Life Sciences, University of Leicester,
Leicester, United Kingdom
(Chan) Department of Cardiothoracic Surgery, Morriston Hospital, Swansea,
United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiovascular surgery was written in accordance
to a structured protocol. The question addressed was: in patients
undergoing endovascular repair of abdominal aortic aneurysm (EVAR), is
local anaesthetic (LA) superior to general anaesthetic in terms of
perioperative outcomes? Altogether, 630 publications were found using the
reported search protocol, of which 3 represented the best evidence to
answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type and primary outcomes were
tabulated. The 3 included studies are systematic reviews with
meta-analyses, with no randomized trials identified. Within the studies,
there is a degree of heterogeneity in terms of surgical case-mix (elective
or emergency EVAR or both) and anaesthetic technique (LA, regional
anaesthetic, local-regional anaesthetic and general anaesthetic). With 1
study not providing pooled estimates, the second study demonstrated
statistical significance in favour of local-regional anaesthetic within
the elective setting in terms of mortality [pooled odds ratio (OR) 0.70,
95% confidence interval (CI) 0.52-0.95; P=0.02], morbidity (pooled OR
0.73, 95% CI 0.55-0.96; P=0.0006) and total length of hospital admission
(pooled mean difference: -1.53, 95% CI -2.53 to -0.53; P=0.00001). The
third study failed to demonstrate a statistically significant mortality
benefit with LA (pooled OR 0.54, 95% CI 0.21-1.41; P=0.211). While the
results of these studies fail to provide a clear answer to a complex
surgical problem, it would be appropriate, in the light of current
evidence, to recommend LA as non-inferior to general anaesthetic in both
emergency and elective settings. Copyright © The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<71>
Accession Number
628462408
Title
Annual case volume on mortality after coronary artery bypass grafting: a
dose-response meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 29 (4) (pp 568-575),
2019. Date of Publication: 01 Oct 2019.
Author
Tie H.-T.; Shi R.; Zhou Q.; Wang K.; Zheng X.-Q.; Wu Q.-C.
Institution
(Tie, Wu) Department of Cardiothoracic Surgery, First Affiliated Hospital
of Chongqing Medical University, Chongqing, China
(Shi) Department of Cardiology, First Affiliated Hospital of Chongqing
Medical University, Chongqing, China
(Zhou) Department of Science and Education, First People's Hospital of
Changde City, Hunan, China
(Wang) Department of Endocrine and Breast Surgery, First Affiliated
Hospital of Chongqing Medical University, Chongqing, China
(Zheng) Department of Chemical Biology, School of Pharmaceutical Science,
Peking University Health Science Center, Beijing, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study evaluated the effect of both hospital and surgeon
annual case volumes on patient mortality following coronary artery bypass
grafting (CABG). METHOD(S): PubMed and Embase databases were searched
for clinical studies on CABG. The outcome was mortality, including
operative mortality, in-hospital mortality and 30-day mortality.
 RESULT(S): Twenty-five studies involving 3492101 participants and
143951 deaths were included for hospital volume, and 4 studies involving
108356 participants and 2811 deaths were included for surgeon volume. The
pooled estimate revealed that both hospital and surgeon annual case
volumes were inversely associated with mortality in patients after CABG
[odds ratio (OR) for hospital: 0.62, 95% confidence interval (CI)
0.56-0.69; P<0.001; OR for surgeon: 0.51, 95% CI 0.31- 0.83; P<0.001] with
high heterogeneity (hospital: I2=90.6%, Pheterogeneity<0.001; surgeon:
I2=86.8%, Pheterogeneity<0.001). The relationship remained consistent and
robust in most subgroup and sensitivity analyses. Our meta-regression
analysis of time suggested that the strength of the negative associations
between volume and mortality for both hospitals and surgeons remained
unattenuated over time even though the CABG mortality gradually decreased
over time. The dose-response analysis suggested a non-linear relationship
between both hospital and surgeon annual case volumes and mortality (both
Pnon-linearity=0.001). CONCLUSION(S): Both higher hospital and
surgeon annual case volumes are associated with lower mortality in
patients undergoing CABG, and the negative associations remain
unattenuated over time. CLINICAL REGISTRATION NUMBER: The study was
registered at PROSPERO as CRD42017067912. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<72>
Accession Number
628848549
Title
Dilated cardiomyopathy: from epidemiologic to genetic phenotypes: A
translational review of current literature.
Source
Journal of Internal Medicine. (no pagination), 2019. Date of Publication:
2019.
Author
Reichart D.; Magnussen C.; Zeller T.; Blankenberg S.
Institution
(Reichart, Magnussen, Zeller, Blankenberg) University Heart Center
Hamburg, Hamburg, Germany
Publisher
Blackwell Publishing Ltd
Abstract
Dilated cardiomyopathy (DCM) is characterized by left ventricular
dilatation and, consecutively, contractile dysfunction. The causes of DCM
are heterogeneous. DCM often results from myocarditis, exposure to
alcohol, drugs or other toxins and metabolic or endocrine disturbances. In
about 35% of patients, genetic mutations can be identified that usually
involve genes responsible for cytoskeletal, sarcomere and nuclear envelope
proteins. Due to its heterogeneity, a detailed diagnostic work-up is
necessary to identify the specific underlying cause and exclude other
conditions with phenotype overlap. Patients with DCM show typical systolic
heart failure symptoms, but, with progress of the disease, diastolic
dysfunction is present as well. Depending on the underlying pathology, DCM
patients also become apparent through arrhythmias, thromboembolic events
or cardiogenic shock. Disease progression and prognosis are mostly driven
by disease severity and reverse remodelling within the heart. The worst
prognosis is seen in patients with lowest ejection fractions or severe
diastolic dysfunction, leading to terminal heart failure with subsequent
need for left ventricular assist device implantation or heart
transplantation. Guideline-based heart failure medication and device
therapy reduces the frequency of heart failure hospitalizations and
improves survival. Copyright © 2019 The Association for the
Publication of the Journal of Internal Medicine

<73>
Accession Number
628545849
Title
Does prehabilitation improve outcomes in cardiac surgical patients?.
Source
Interactive cardiovascular and thoracic surgery. 29 (4) (pp 608-611),
2019. Date of Publication: 01 Oct 2019.
Author
Sandhu M.S.; Akowuah E.F.
Institution
(Sandhu, Akowuah) Department of Cardiothoracic Surgery, James Cook
University Hospital, Middlesbrough, United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: does prehabilitation
improve outcomes in cardiac surgical patients? Altogether more than 483
papers were found using the reported search, of which 10 represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Four meta-analyses
concluded that prehabilitation reduced postoperative pulmonary
complications (PPCs). The 6 randomized controlled trials (RCT) included,
differed significantly in the type of prehabilitation delivered. There was
replication of some RCTs across the meta-analyses. The consensus across
the meta-analyses was a reduction in PPCs and 3 of 4 meta-analyses finding
a reduction in length of stay (LOS). There were no adverse events or
difference in mortality found. Two small RCTs showed feasibility and
modest improvements in physiological parameters. Three RCTs demonstrated a
reduction in LOS and a reduction in PPCs. One RCT found no difference in
quality of life scores, LOS or postoperative atrial fibrillation. None of
the RCTs found negative evidence of prehabilitation interventions. We
conclude that the prehabilitation is a positive preoperative intervention,
most favourably in older patients and in those who are at risk of PPCs.
Specifically inspiratory muscle training is the intervention with most
favourable evidence. Copyright © The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<74>
[Use Link to view the full text]
Accession Number
628698933
Title
Improved Compliance and Comprehension of a Surgical Safety Checklist With
Customized Versus Standard Training: A Randomized Trial.
Source
Journal of patient safety. 14 (3) (pp 138-142), 2018. Date of Publication:
01 Sep 2018.
Author
Rakoff D.; Akella K.; Guruvegowda C.; Chhajwani S.; Seshadri S.; Sola S.
Institution
(Rakoff, Akella, Sola) From the Departments of Cardiology
(Guruvegowda) Cardiothoracic and Vascular Surgery
(Chhajwani) Anesthesia and Critical Care
(Seshadri) Hospital Administration, Sri Sathya Sai Institute of Higher
Medical Sciences, Bangalore, Karnataka, India
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This study aimed to determine the effect of customized training
versus standard readily available training on surgical safety checklist
(SSCL) compliance and comprehension. BACKGROUND: The success of the SSCL
in reducing surgical mortality and morbidity depends largely on the degree
of compliance among health care workers with the checklist's components.
We hypothesized that a customized training program would improve
comprehension of the SSCL components among health care workers.
 METHOD(S): We prospectively evaluated compliance and comprehension of
a locally modified SSCL among surgeons, anesthesiologists, nurses, and
perfusionists who were randomized to standard versus customized training
in the department of cardiac and thoracic surgery. Standard training
included videos, posters, and didactic sessions obtained from the World
Health Organization. Customized training consisted of a
department-specific orientation video (using local staff as actors),
locally made posters, and didactic sessions. Comprehension was assessed by
a written exam after each training program. Verbal and written compliance
with the SSCL was measured within the operating theater by trained
observers. RESULT(S): We observed a total of 244 surgeries for SSCL
compliance. Comprehension of the didactic material provided in the
training programs was higher in the customized versus the standard
training group (75% versus 30%; P < 0.0001). Verbal compliance was higher
in the customized versus standard training groups (87% versus 49%; P <
0.0001). Written compliance was 100% for both the customized and standard
training groups. CONCLUSION(S): A customized training program
improves verbal compliance and comprehension among health care workers
when implementing an SSCL, compared with standard readily available
training.

<75>
Accession Number
629421476
Title
Streamlining the treatment of cardiac arrest after cardiac surgery.
Source
Southern African Journal of Critical Care. Conference: 2019 National
Annual Congress of the Critical Care Society of Southern Africa. South
Africa. 35 (1) (pp 29), 2019. Date of Publication: 2019.
Author
Van Der Merwe J.; Verbeek R.; Levine A.; Dunning J.
Institution
(Van Der Merwe, Verbeek) Cardia Surgical Unit Advanced Life Support
(CSU-ALS), South Africa/ Atlantic Cardiovascular and Thoracic Institute,
Netcare Blaauwberg Hospital, Cape Town, South Africa
(Levine, Dunning) James Cook University Hospital, Department of
Cardiothoracic Surgery, Middlesbrough, United Kingdom
Publisher
South African Medical Association
Abstract
Background. Cardiac arrest after cardiac surgery (CACS) is associated with
poor outcomes, and presents unique challenges to the cardiac critical care
team. Objective. It is our intention to introduce recently published
internationally endorsed CACS resuscitation protocols to South African
critical care providers and to provide a training platform from which
these principles can be incorporated into routine cardiac critical care.
Methods. Evidence to create international CACS protocols were obtained
from existing guidelines, the International Liaison Committee on
Resuscitation, international online surveys and from MEDLINE keyword
searches for human clinical studies, animal models and simulation
protocols relevant to CACS. Results. In total, 56 publications were
identified to create CACS recommendations. Internal massage (IM) is more
effective than external massage (EM) in CACS and should be used
preferentially if reversible causes are excluded. External massage (EM) is
ineffective in tamponade or hypovolemia and only salvageable by emergency
re-sternotomy (ER) within 5 minutes. CACS arrhythmias require unique
interventions, as does the administration of resuscitation medication
including Epinephrine. Conclusion. CACS requires unique skillsets, an
efficient critical care team with allocated key roles and protocols that
differ from commonly used advance cardiac life support guidelines. CACS
can potentially be prevented and effectively treated by applying
specialised protocols and principles.

<76>
Accession Number
629421342
Title
Assessment of research productivity of published articles in the critical
care unit of cardiac surgery patients.
Source
Critical Care. Conference: 10th International Symposium on Intensive Care
and Emergency Medicine for Latin America. Brazil. 23 (Supplement 3) (no
pagination), 2019. Date of Publication: 2019.
Author
Da Silva A.A.; Costa L.A.A.; Nascimento A.C.S.; Souza P.M.S.; Dias T.L.;
Pedrosa M.R.; Pimentel W.S.P.; Ranzani R.C.M.
Institution
(Da Silva, Costa, Nascimento, Souza, Dias, Pedrosa, Pimentel, Ranzani)
UNIFESP-UTI Cirurgia Cardiaca, Hospital Sao Paulo, Sao Paulo, SP, Brazil
(Da Silva, Pimentel) HIAE-Hospital Israelita Albert Einstein, Sao Paulo,
SP, Brazil
Publisher
BioMed Central Ltd.
Abstract
Background Cardiac surgery is a standard procedure worldwide. Many of the
patients have been followed in the intensive care unit (ICU) after
surgery. Many concerns about intensive care treatment could be solved by
publication in the literature. Research is an essential and unique field
that intensivists all over the world deal with, in addition to their daily
clinical practice. Published articles represent a central part of the
research process. Objective We aimed to assess the current quality of
evidence from published papers in Scopus Database of the management of
cardiac surgical patients in the critical care unit. Methods An internet
electronic search was made in the Scopus database looking for published
articles between 2004 and 2018. The search strategy involved core terms
related to CCM and the specific search strategy was as follows:
TITLE-ABS-KEY ( "cardiac surgery" ) OR TITLEABS- KEY ( "heart surgery" )
AND TITLE-ABS-KEY ( "intensive care" ) OR TITLE-ABS-KEY ( "critical care"
) AND TITLE-ABS-KEY ( adult ) AND NOT TITLE-ABS-KEY ( animal ) AND (
LIMIT-TO ( SRCTYPE , "j" ) ). There were no restrictions on language but
the abstract should be written in English. Results A total of 4326
articles were identified using predefined search words. Almost all of them
(4014) were published in English, with 1075 published in the United
States. The five most important journals were Journal of Cardiothoracic
and Vascular Anesthesia (impact factor (IF) = 0.2), Annals of Thoracic
Surgery (IF = 1.2), Critical Care Medicine (IF = 3.88), Journal of
Thoracic and Cardiovascular Surgery (IF = 2.26) and European Journal of
Cardio-Thoracic Surgery (IF = 1.5). Overall, 112 systematic reviews have
been published and only seven were published in the Cochrane Database of
Systematic Reviews (IF = 6.22). Conclusions Many cardiac surgical patients
have been monitored in the ICU, although a search on research on this has
found low numbers of good papers and systematic reviews within this group
of patients. Improving the quality of studies will provide high-quality
intensive care management after cardiac surgery.

<77>
Accession Number
629433649
Title
Angiographically Guided Complete Revascularization Versus Selective Stress
Echocardiography-Guided Revascularization in Patients With
ST-Segment-Elevation Myocardial Infarction and Multivessel Disease: The
CROSS-AMI Randomized Clinical Trial.
Source
Circulation. Cardiovascular interventions. 12 (10) (pp e007924), 2019.
Date of Publication: 01 Oct 2019.
Author
Calvino-Santos R.; Estevez-Loureiro R.; Peteiro-Vazquez J.;
Salgado-Fernandez J.; Rodriguez-Vilela A.; Franco-Gutierrez R.;
Bouzas-Mosquera A.; Rodriguez-Fernandez J.A.; Mesias-Prego A.;
Gonzalez-Juanatey C.; Aldama-Lopez G.; Pinon-Esteban P.; Flores-Rios X.;
Soler-Martin R.; Seoane-Pillado T.; Vazquez-Gonzalez N.; Muniz J.;
Vazquez-Rodriguez J.M.
Institution
(Calvino-Santos, Peteiro-Vazquez, Salgado-Fernandez, Bouzas-Mosquera,
Rodriguez-Fernandez, Aldama-Lopez, Pinon-Esteban, Flores-Rios,
Soler-Martin, Seoane-Pillado, Vazquez-Gonzalez, Vazquez-Rodriguez)
Department of Cardiology, Hospital Universitario A Coruna, INIBIC,
P.P.-E., R.S.-M., T.S.-P.
(Estevez-Loureiro) Department of Cardiology, Hospital Alvaro Cunqueiro,
Vigo, Italy
(Peteiro-Vazquez, Salgado-Fernandez, Bouzas-Mosquera, Vazquez-Gonzalez,
Muniz, Vazquez-Rodriguez) Instituto de Salud Carlos III, Madrid, Spain
(Rodriguez-Vilela, Mesias-Prego) Department of Cardiology, Hospital
Universitario Arquitecto Marcide, Ferrol, Philippines
(Franco-Gutierrez, Gonzalez-Juanatey) Department of Cardiology, Hospital
Universitario Lucus Augusti, Lugo, Italy
(Muniz) Instituto Universitario de Ciencias de la Salud, Universidad de A
Coruna, INIBIC (Instituto de Investigacion Biomedica de A Coruna)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Recent trials suggest that complete revascularization in
patients with acute ST-segment-elevation myocardial infarction and
multivessel disease is associated with better outcomes than
infarct-related artery (IRA)-only revascularization. There are different
methods to select non-IRA lesions for revascularization procedures. We
assessed the clinical outcomes of complete angiographically guided
revascularization versus stress echocardiography-guided revascularization
in patients with ST-segment-elevation myocardial infarction.
 METHOD(S): We performed a randomized clinical trial in patients with
multivessel disease who underwent a successful percutaneous coronary
intervention of the IRA to test differences in prognosis (composite end
point included cardiovascular mortality, nonfatal reinfarction, coronary
revascularization, and readmission for heart failure after 12 months of
follow-up) between complete angiographically guided revascularization
(n=154) or stress echocardiography-guided revascularization (n=152) of the
non-IRA lesions in an elective procedure before hospital discharge.
 RESULT(S): The trial was prematurely stopped after the inclusion of
77% of the planned study population. As many as 152 (99%) patients in the
complete revascularization group and 44 (29%) patients in the selective
revascularization group required a percutaneous coronary intervention
procedure of a non-IRA lesion before discharge. The primary end point
occurred in 21 (14%) patients of the stress echocardiography-guided
revascularization group and 22 (14%) patients of the complete
angiographically guided revascularization group (hazard ratio, 0.95; 95%
CI, 0.52-1.72; P=0.85). CONCLUSION(S): In patients with
ST-segment-elevation myocardial infarction and multivessel disease, stress
echocardiography-guided revascularization may not be significantly
different to complete angiographically guided revascularization, thereby
reducing the need for elective revascularization before hospital
discharge. CLINICAL TRIAL REGISTRATION: URL:
https://www.clinicaltrials.gov. Unique identifier: NCT01179126.

<78>
Accession Number
629427627
Title
Uniportal video-assisted thoracic surgery lobectomy: A consensus report
from the Uniportal VATS Interest Group (UVIG) of the European Society of
Thoracic Surgeons (ESTS).
Source
European Journal of Cardio-thoracic Surgery. 56 (2) (pp 224-229), 2019.
Date of Publication: 2019.
Author
Bertolaccini L.; Batirel H.; Brunelli A.; Gonzalez-Rivas D.; Ismail M.;
Ucar A.M.; Ng C.S.H.; Scarci M.; Sihoe A.D.L.; Ugalde P.A.; Abu Akar F.;
Bedetti B.; Nadal S.B.; Brandolini J.; Crucitti P.; Enyedi A.; Fernando
H.C.; Furak J.; Gallego-Poveda J.; Galvez-Munos C.; Hanke I.;
Hernandez-Arenas L.A.; Janik M.; Juhos P.; Libretti L.; Lucciarini P.;
Macri P.; Margaritora S.; Mahoozi H.R.; Nachira D.; Pardolesi A.; Pischik
V.; Sagan D.; Schreurs H.; Sekhniaidze D.; Socci L.; Tosi D.; Turna A.;
Vannucci F.; Zielinski M.; Rocco G.
Institution
(Bertolaccini, Brandolini) Department of Thoracic Surgery, Maggiore
Teaching Hospital, Bologna, Italy
(Batirel) Department of Thoracic Surgery, Marmara University Hospital,
Istanbul, Turkey
(Brunelli) Department of Thoracic Surgery, St. James's University
Hospital, Leeds, United Kingdom
(Gonzalez-Rivas) Minimally Invasive Thoracic Surgery Unit (UCTMI),
Department of Thoracic Surgery, Coruna University Hospital, Coruna, Spain
(Ismail) Department of Thoracic Surgery, Klinikum Ernst von Bergmann,
Potsdam, Germany
(Ucar, Socci) Thoracic Surgery Units, Sheffield Teaching Hospital,
Sheffield, United Kingdom
(Ng) Department of Surgery, Chinese University of Hong Kong, Hong Kong,
Hong Kong
(Scarci, Libretti) Department of Thoracic Surgery, San Gerardo Hospital,
Monza, Italy
(Sihoe) Department of Surgery, Li Ka Shing Faculty of Medicine, University
of Hong Kong, Hong Kong, Hong Kong
(Sihoe) Department of Thoracic Surgery, Tongji University Shanghai
Pulmonary Hospital, Shanghai, China
(Ugalde) Department of Thoracic Surgery, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Hopital Lava, Quebec, QC, Canada
(Abu Akar) Department of Cardiothoracic Surgery, Makassed Charitable
Society Hospital, East Jerusalem, Israel
(Abu Akar) Department of Cardiothoracic Surgery, Shaare Zedek Medical
Center (SZMC), Jerusalem, Israel
(Bedetti) Department of Thoracic Surgery, Malteser Hospital, Bonn, Germany
(Nadal, Galvez-Munos) Department of Thoracic Surgery, General University
Hospital, Alicante, Spain
(Crucitti) Division of Thoracic Surgery, Campus Bio-Medico University of
Rome, Rome, Italy
(Enyedi) Division of Thoracic Surgery, University of Debrecen, Debrecen,
Hungary
(Fernando) Department of Surgery, Fairfax Medical Campus, Falls Church,
VA, United States
(Furak) Department of Surgery, University of Szeged, Szeged, Hungary
(Gallego-Poveda) Department of Cardio-Thoracic, Santa Maria University
Hospital, Lisbon, Portugal
(Bertolaccini) Division of Thoracic Surgery, IEO, European Institute of
Oncology IRCCS, Via Ripamonti 465, Milan 20141, Italy
(Hanke) Department of Thoracic Surgery, University Hospital Hradec
Kralove, Hradec, Kralov, Czechia
(Hernandez-Arenas) Department of Thoracic Surgery, University Hospitals
Birmingham NHS Foundation Trust, Birmingham, United Kingdom
(Janik, Juhos) Department of Thoracic Surgery, Slovak Medical University,
University Hospital Bratislava, Bratislava, Slovakia
(Lucciarini) Department of Visceral, Transplant and Thoracic Surgery,
Medical University Innsbruck, Innsbruck, Austria
(Macri) Thoracic Surgery Unit, Istituto Clinico Humanitas CCO - Catania,
Catania, Italy
(Margaritora, Nachira) Department of General Thoracic Surgery, Fondazione
Policlinico Universitario 'A. Gemelli', Rome, Italy
(Mahoozi) Department of Thoracic Surgery, Evangelisches Krankenhaus Herne,
Herne, Germany
(Pardolesi) Department of Thoracic Surgery, National Cancer Institute,
Milan, Italy
(Pischik) Faculty of Medicine, St-Petersburg State University,
Saint-Petersburg, Russian Federation
(Sagan) Department of Thoracic Surgery, Medical University of Lublin,
Lublin, Poland
(Schreurs) Medish Centrum Alkmaar, Alkmaar, Netherlands
(Sekhniaidze) Department of Thoracic Surgery, Regional Clinic Hospital,
Tyumen, Russian Federation
(Turna) Division of Thoracic and Transplant Surgery, Fondazione Ca' Granda
Ospedale Maggiore Policlinico, Milan, Italy
(Tosi) Department of Thoracic Surgery, Cerrahpasa Medical School, Istanbul
University-Cerrahpasa, Istanbul, Turkey
(Vannucci) Department of Thoracic Surgery, Hospital Federal do Andarai,
Rio de Janeiro, Brazil
(Zielinski) Department of Thoracic Surgery, Pulmonary Hospital, Zakopane,
Poland
(Rocco) Department of Surgery, Thoracic Service, Memorial Sloan Kettering
Cancer Center, New York, NY, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Objectives: Our goal was to report the results of the first consensus
paper among international experts in uniportal video-assisted
thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi
process, the objective of which was to define and standardize the main
procedural steps, optimize its indications and perioperative management
and identify elements to assist in future training. Method(s): The 40
members of the working group were convened and organized on a voluntary
basis by the Uniportal VATS Interest Group (UVIG) of the European Society
of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the
Delphi method was applied to require 75% agreement for reaching consensus
on each question. Repeated iterations of anonymous voting continued for 3
rounds. Result(s): Overall, 31 international experts from 18
countries completed all 3 rounds of questionnaires. Although a technical
quorum was not achieved, most of the responders agreed that the maximum
size of a UniVATS incision should be <=4 cm. Agreement was reached on many
points outlining the currently accepted definition of a UniVATS lobectomy,
its indications and contraindications, perioperative clinical management
and recommendations for training and future research directions.
 Conclusion(s): The UVIG Consensus Report stated that UniVATS offers a
valid alternative to standard VATS techniques. Only longer follow-up and
randomized controlled studies will predict whether UniVATS represents a
valid alternative approach to multiport VATS for major lung resections or
whether it should be performed only in selected cases and by selected
centres. The next step for the ESTS UVIG is the establishment of a UniVATS
section inside the ESTS databases. Copyright © 2019 The
Author(s). All rights reserved.

<79>
Accession Number
629426885
Title
A comparison of pump-controlled retrograde trial off to arterio-venous
bridging for weaning from venoarterial extracorporeal membrane
oxygenation.
Source
European Journal of Cardio-thoracic Surgery. 56 (2) (pp 277-284), 2019.
Date of Publication: 2019.
Author
Pandya N.R.; Daley M.; Mattke A.; Shikata F.; Betts K.; Haisz E.; Black
A.; Anderson B.; Alphonso N.; Venugopal P.
Institution
(Pandya, Daley, Shikata, Alphonso, Venugopal) Department of Cardiac
Surgery, Lady Cilento Children's Hospital, PO Box 3474, Level 7F, 501
Stanley Street, South Brisbane, QLD 4101, Australia
(Pandya, Mattke, Shikata, Anderson, Alphonso, Venugopal) School of
Medicine, University of Queensland, Brisbane, QLD, Australia
(Mattke, Haisz) Pediatric Intensive Care Unit, Lady Cilento Children's
Hospital, Brisbane, QLD, Australia
(Mattke, Haisz) Pediatric Critical Care Research Group, Mater Mother's
Research Institute, Brisbane, QLD, Australia
(Betts) Department of Epidemiology, Institute for Social Science Research,
University of Queensland, Brisbane, QLD, Australia
(Black) Cardiac Surgery (Perfusion), Lady Cilento Children's Hospital,
Brisbane, QLD, Australia
(Anderson) Department of Cardiology, Lady Cilento Children's Hospital,
Brisbane, QLD, Australia
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Objectives: The aim of the study is to compare a technique of
pump-controlled retrograde trial off (PCRTO) to insertion of an
arterio-venous (AV) bridge to conduct a trial from venoarterial
extracorporeal membrane oxygenation (VA ECMO). Method(s): We studied
all patients who were weaned from VA ECMO using either PCRTO or AV
bridging from November 2014 to April 2018. Demographic data, indications
for ECMO, duration of ECMO, duration of trial period off ECMO and survival
were compared between the 2 groups. Result(s): Seventy-nine patients
were placed on VA ECMO from November 2014 to April 2018, of whom, 51 (65%)
patients met the study inclusion criteria: 31 (61%) patients who had a
trial period from VA ECMO using PCRTO and 20 (39%) patients who were
weaned using an AV bridge. The indications for ECMO included cardiac (n =
16 and 11, respectively) and non-cardiac aetiologies (n = 15 and 9,
respectively). There was 1 death in each group. The duration of the trial
off VA ECMO was significantly shorter in the PCRTO group (median = 88.0 vs
196.6 min, P < 0.001). There were 2 conversions from PCRTO to AV bridging
during the trial period off ECMO (2.9-kg neonate following a Norwood
procedure and 2.2-kg patient following repair of ectopia cordis).
 Conclusion(s): PCRTO is a safe, simple and reproducible approach for
enabling a trial period while preserving the circuit during weaning from
VA ECMO. In our study, the duration of the trial period off VA ECMO was
significantly shorter in the PCRTO group. PCRTO avoids manipulation of the
ECMO circuit, provides a 'stress test' to evaluate cardiorespiratory
reserve during the trial period off ECMO, is applicable for a wide variety
of cardiac and non-cardiac indications and facilitates multiple attempts
at weaning from ECMO. Copyright © 2019 The Author(s). All rights
reserved.

<80>
Accession Number
629434441
Title
Perioperative beta-blockers for preventing surgery-related mortality and
morbidity in adults undergoing non-cardiac surgery.
Source
The Cochrane database of systematic reviews. 9 (pp CD013438), 2019. Date
of Publication: 26 Sep 2019.
Author
Blessberger H.; Lewis S.R.; Pritchard M.W.; Fawcett L.J.; Domanovits H.;
Schlager O.; Wildner B.; Kammler J.; Steinwender C.
Institution
(Blessberger) Department of Cardiology, Med Campus III, Kepler University
Hospital, Medical Faculty of the Johannes Kepler University Linz,
Krankenhausstrase 9, Linz 4020, Austria
Publisher
NLM (Medline)
Abstract
BACKGROUND: Randomized controlled trials (RCTs) have yielded conflicting
results regarding the ability of beta-blockers to influence perioperative
cardiovascular morbidity and mortality. Thus routine prescription of these
drugs in an unselected population remains a controversial issue. A
previous version of this review assessing the effectiveness of
perioperative beta-blockers in cardiac and non-cardiac surgery was last
published in 2018. The previous review has now been split into two reviews
according to type of surgery. This is an update, and assesses the evidence
in non-cardiac surgery only. OBJECTIVE(S): To assess the
effectiveness of perioperatively administered beta-blockers for the
prevention of surgery-related mortality and morbidity in adults undergoing
non-cardiac surgery. SEARCH METHOD(S): We searched CENTRAL, MEDLINE,
Embase, CINAHL, Biosis Previews and Conference Proceedings Citation
Index-Science on 28 June 2019. We searched clinical trials registers and
grey literature, and conducted backward- and forward-citation searching of
relevant articles. SELECTION CRITERIA: We included RCTs and
quasi-randomized studies comparing beta-blockers with a control (placebo
or standard care) administered during the perioperative period to adults
undergoing non-cardiac surgery. If studies included surgery with different
types of anaesthesia, we included them if 70% participants, or at least
100 participants, received general anaesthesia. We excluded studies in
which all participants in the standard care control group were given a
pharmacological agent that was not given to participants in the
intervention group, studies in which all participants in the control group
were given a beta-blocker, and studies in which beta-blockers were given
with an additional agent (e.g. magnesium). We excluded studies that did
not measure or report review outcomes. DATA COLLECTION AND ANALYSIS: Two
review authors independently assessed studies for inclusion, extracted
data, and assessed risks of bias. We assessed the certainty of evidence
with GRADE. MAIN RESULTS: We included 83 RCTs with 14,967 participants; we
found no quasi-randomized studies. All participants were undergoing
non-cardiac surgery, and types of surgery ranged from low to high risk.
Types of beta-blockers were: propranolol, metoprolol, esmolol, landiolol,
nadolol, atenolol, labetalol, oxprenolol, and pindolol. In nine studies,
beta-blockers were titrated according to heart rate or blood pressure.
Duration of administration varied between studies, as did the time at
which drugs were administered; in most studies, it was intraoperatively,
but in 18 studies it was before surgery, in six postoperatively, one
multi-arm study included groups of different timings, and one study did
not report timing of drug administration. Overall, we found that more than
half of the studies did not sufficiently report methods used for
randomization. All studies in which the control was standard care were at
high risk of performance bias because of the open-label study design. Only
two studies were prospectively registered with clinical trials registers,
which limited the assessment of reporting bias. In six studies,
participants in the control group were given beta-blockers as rescue
therapy during the study period.The evidence for all-cause mortality at 30
days was uncertain; based on the risk of death in the control group of 25
per 1000, the effect with beta-blockers was between two fewer and 13 more
per 1000 (risk ratio (RR) 1.17, 95% confidence interval (CI) 0.89 to 1.54;
16 studies, 11,446 participants; low-certainty evidence). Beta-blockers
may reduce the incidence of myocardial infarction by 13 fewer incidences
per 1000 (RR 0.72, 95% CI 0.60 to 0.87; 12 studies, 10,520 participants;
low-certainty evidence). We found no evidence of a difference in
cerebrovascular events (RR 1.65, 95% CI 0.97 to 2.81; 6 studies, 9460
participants; low-certainty evidence), or in ventricular arrhythmias (RR
0.72, 95% CI 0.35 to 1.47; 5 studies, 476 participants; very low-certainty
evidence). Beta-blockers may reduce atrial fibrillation or flutter by 26
fewer incidences per 1000 (RR 0.41, 95% CI 0.21 to 0.79; 9 studies, 9080
participants; low-certainty evidence). However, beta-blockers may increase
bradycardia by 55 more incidences per 1000 (RR 2.49, 95% CI 1.74 to 3.56;
49 studies, 12,239 participants; low-certainty evidence), and hypotension
by 44 more per 1000 (RR 1.40, 95% CI 1.29 to 1.51; 49 studies, 12,304
participants; moderate-certainty evidence).We downgraded the certainty of
the evidence owing to study limitations; some studies had high risks of
bias, and the effects were sometimes altered when we excluded studies with
a standard care control group (including only placebo-controlled trials
showed an increase in early mortality and cerebrovascular events with
beta-blockers). We also downgraded for inconsistency; one large,
well-conducted, international study found a reduction in myocardial
infarction, and an increase in cerebrovascular events and all-cause
mortality, when beta-blockers were used, but other studies showed no
evidence of a difference. We could not explain the reason for the
inconsistency in the evidence for ventricular arrhythmias, and we also
downgraded this outcome for imprecision because we found few studies with
few participants. AUTHORS' CONCLUSION(S): The evidence for early
all-cause mortality with perioperative beta-blockers was uncertain. We
found no evidence of a difference in cerebrovascular events or ventricular
arrhythmias, and the certainty of the evidence for these outcomes was low
and very low. We found low-certainty evidence that beta-blockers may
reduce atrial fibrillation and myocardial infarctions. However,
beta-blockers may increase bradycardia (low-certainty evidence) and
probably increase hypotension (moderate-certainty evidence). Further
evidence from large placebo-controlled trials is likely to increase the
certainty of these findings, and we recommend the assessment of impact on
quality of life. We found 18 studies awaiting classification; inclusion of
these studies in future updates may also increase the certainty of the
evidence.

<81>
Accession Number
629434192
Title
Levosimendan or milrinone for right ventricular inotropic treatment? - a
secondary analysis of a randomised trial.
Source
Acta anaesthesiologica Scandinavica. (no pagination), 2019. Date of
Publication: 25 Sep 2019.
Author
Fredholm M.; Jorgensen K.; Houltz E.; Ricksten S.-E.
Institution
(Fredholm, Jorgensen, Houltz, Ricksten) Department of Anesthesiology and
Intensive Care Medicine at the Sahlgrenska Academy, University of
Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of the present study was to compare the effects of
milrinone and levosimendan on right ventricular (RV) inotropy and
lusitropy in patients after aortic valve replacement (AVR) for aortic
stenosis, a procedure in which an abnormal postoperative RV function may
be seen. METHOD(S): In a prospective, blinded trial, 31 patients were
randomised to receive either milrinone (0.4 and 0.8 micro g/kg/min,
n=16) or levosimendan (0.1 and 0.2 micro g/kg/min, n=15) after AVR for
aortic stenosis. RV performance, afterload (pulmonary arterial elastance),
RV strain, systolic (SR-S) and early diastolic (SR-E) strain rate were
measured by pulmonary artery thermodilution catheterization and
transoesophageal two-dimensional speckle tracking echocardiography (STE).
To circumvent the indirect effects of inodilator-induced hemodynamic
changes on RV systolic and diastolic deformation, pulmonary arterial
elastance, central venous pressure (CVP) and heart rate were maintained
constant by atrial pacing, plasma volume expansion with colloids and
phenylephrine-induced vasoconstriction during treatment with the
inotropes. RESULT(S): A dose-dependent increase in stroke volume
index and cardiac index by approximately 20% were seen with both agents at
the highest doses, with no difference between groups (p=0.792 and 0.744,
respectively). In both groups, RV strain and SR-S dose-dependently
increased by 20% and 15-19%, respectively, at the highest doses (p=0.742
and 0.259, respectively) with no difference between groups. SR-E improved
by both agents 20-24% at the highest dose with no difference between
groups (p=0.714). CONCLUSION(S): The direct RV inotropic and
lusitropic effects of levosimendan and milrinone were comparable at
clinically relevant infusion rates. Copyright © 2019 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd.

<82>
Accession Number
629161074
Title
The Choice of Treatment in Ischemic Mitral Regurgitation with Reduced Left
Ventricular Function.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 22 Aug 2019.
Author
Nappi F.; Avtaar Singh S.S.; Padala M.; Attias D.; Nejjari M.; Mihos C.G.;
Benedetto U.; Michler R.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Avtaar Singh) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Padala) Structural Heart Research & Innovation, Laboratory, Carlyle
Fraser Heart Center, Division of Cardiothoracic Surgery, Emory University
USA
(Attias) Cardiology Department, Centre Cardiologique du Nord, Saint Denis,
France
(Nejjari) Cardiology Department, Interventional Cardiology Centre
Cardiologique du Nord, Saint Denis, France
(Mihos) Echocardiography Laboratory, Columbia University Division of
Cardiology, Mount Sinai Heart Institute, Miami Beach FL
(Benedetto) Department of Cardiothoracic Surgery, Bristol Heart Institute,
University of Bristol, United Kingom, Bristol, United Kingdom
(Michler) Departments of Surgery and Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine,New York,
NY
Publisher
NLM (Medline)
Abstract
BACKGROUND: Ischemic mitral regurgitation is a condition characterized by
mitral insufficiency secondary to an ischemic left ventricular.Primarily,
the pathology is the result of perturbation of normal regional left
ventricular geometry combined with adverse remodeling.We present a
comprehensive review of contemporary surgical, medical, and percutaneous
treatment options for ischemic mitral regurgitation, rigorously examined
by current guidelines and literature. METHOD(S): We conducted a
literature search of the PubMed database, EMBASE and the Cochrane Library
(through November 2018) for studies reporting perioperative or late
mortality and echocardiographic outcomes following surgical and
non-surgical intervention for ischemic mitral regurgitation.
 RESULT(S): Treatment of this condition is both challenging and often
requires a multimodality approach.These patients usually have multiple
comorbidities that may preclude surgery as a viable option.A
multidisciplinary team discussion is crucial in optimizing outcomes.There
are several options for treatment and management of ischemic mitral
regurgitation with differing benefits and risks.Guideline-directed medical
therapy for heart failure is the treatment choice for moderate and severe
ischemic mitral regurgitation, with consideration of coronary
revascularization, mitral valve surgery, and/or cardiac resynchronization
therapy in appropriate candidates.The use of transcatheter mitral valve
therapy is considered appropriate in high risk patients with severe
ischemic mitral regurgitation, heart failure and reduced left ventricular
ejection fraction especially in those with hemodynamic instability.
 CONCLUSION(S): The role of mitral valve surgery and transcatheter
mitral valve therapy continues to evolve. Copyright © 2019.
Published by Elsevier Inc.

<83>
Accession Number
2002985927
Title
Transcatheter aortic valve replacement for bicuspid aortic valve stenosis
with first- and new-generation bioprostheses: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Ueshima D.; Nai Fovino L.; Brener S.J.; Fabris T.; Scotti A.; Barioli A.;
Giacoppo D.; Pavei A.; Fraccaro C.; Napodano M.; Tarantini G.
Institution
(Ueshima, Nai Fovino, Fabris, Scotti, Barioli, Giacoppo, Pavei, Fraccaro,
Napodano, Tarantini) Department of Cardiac, Thoracic, Vascular Sciences
and Public Health, University of Padua Medical School, Padua, Italy
(Brener) Department of Medicine, Cardiac Catheterization Laboratory, New
York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United
States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Subjects with bicuspid aortic valve (BAV) have been excluded
from transcatheter aortic valve replacement (TAVR) randomized trials.
 Method(s): With this meta-analysis of observational studies we first
compared TAVR outcomes of BAV vs. tricuspid aortic valve (TAV) patients,
stratifying the results by device generation. Then, we looked for
differences between balloon-expandable (BE) and self-expandable (SE)
bioprostheses in BAV patients. Primary outcome was 30-day mortality.
Secondary outcomes were 30-day stroke, moderate-severe paravalvular
leakage, new pacemaker implantation, vascular complications and 1-year
mortality. Result(s): Thirteen studies (11,032 patients, 7291 TAV and
3741 BAV) and seven studies (706 patients, 367 treated with BE, 339 with
SE valve) met inclusion criteria. Thirty-day (OR = 1.13; 95% CI 0.88-1.46,
p = 0.33) and 1-year mortality (OR = 1.02; 95% CI 0.77-1.37, p = 0.87)
were similar between patients receiving TAVR for BAV or TAV. Subjects
treated for BAV were at higher risk of conversion to conventional surgery
(OR = 2.35; 95% CI 1.30-4.23, p = 0.005), implantation of a second valve
(OR = 2.06; 95% CI 1.31-3.25; p = 0.002), moderate/severe paravalvular
leakage (PVL) (OR = 1.67; 95% CI 1.29-2.17; p = 0.0001) and device failure
(OR = 1.26; 95% CI 1.02-1.56; p = 0.04). Rates of adverse events decreased
significantly with the use of new-generation devices, but outcome
differences remained consistent. BAV patients treated with BE vs. SE
valves had similar 30-day and 1-year mortality, stroke and moderate-severe
PVL. Balloon-expandable valves were associated with lower rates of a
second valve and new pacemaker implantation but carried higher risk of
annular rupture. Conclusion(s): BAV patients treated with TAVR had
similar 30-day and 1-year mortality as well as stroke and new pacemaker
implantation rates compared to TAV subjects, but carried higher risk of
moderate/severe PVL, conversion to surgery and device failure. Event rates
significantly decreased with the use of new-generation devices, but TAVR
still showed better procedural results in TAV compared to
BAV. Copyright © 2019 Elsevier B.V.

<84>
Accession Number
2002984801
Title
Meta-analysis Comparing Multivessel Versus Culprit Coronary Arterial
Revascularization for Patients With Non-ST-Segment Elevation Acute
Coronary Syndromes.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Siebert V.R.; Borgaonkar S.; Jia X.; Nguyen H.L.; Birnbaum Y.; Lakkis
N.M.; Alam M.
Institution
(Siebert, Nguyen) Department of Medicine, Baylor College of Medicine,
Houston, TX, United States
(Borgaonkar, Jia, Birnbaum, Lakkis, Alam) Department of Medicine, Section
of Cardiology, Baylor College of Medicine, Houston, TX, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We present a systematic review and meta-analysis comparing efficacy and
safety outcomes between single procedure multivessel revascularization
(MVR) and culprit vessel only revascularization in patients presenting
with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). NSTE-ACS
is the most common form of acute coronary syndrome (ACS), and multivessel
disease is common. There is no consensus on the most efficacious single
procedure revascularization strategy for patients undergoing percutaneous
coronary intervention not meeting coronary artery bypass grafting
criteria. Studies in PubMed and EMBASE databases were systematically
reviewed, and 15 studies met criteria for inclusion in the meta-analysis.
Baseline characteristics between the groups were similar. A random effects
model was used to calculate odds ratios (OR) with 95% confidence intervals
(CI). Heterogeneity of studies was assessed using Cochrane's Q and Higgins
I2 tests. For short-term outcomes, patients who underwent MVR
had higher rates of major adverse cardiac events (OR 1.14; 95% CI 1.01 to
1.29; p = 0.03); and stroke (OR 1.94; 95% CI 1.01 to 3.72; p = 0.05), but
lower rates of urgent or emergent coronary artery bypass grafting (OR
0.35; 95% CI 0.29 to 0.43; p <0.00001). In the long-term, MVR patients had
less frequent major adverse cardiac events (OR 0.76; 95% CI 0.61-0.93; p =
0.009), all-cause death (OR 0.83; 95% CI 0.71 to 0.97; p = 0.03), and
repeat revascularization, (OR 0.62; 95% CI 0.42 to 0.90; p = 0.01). MVR
following NSTE-ACS was associated with higher short-term risk, but
long-term benefit. In conclusion, these results support the use of single
procedure multivessel revascularization for NSTE-ACS patients who are
suitable candidates at the time of percutaneous coronary
intervention. Copyright © 2019 Elsevier Inc.

<85>
Accession Number
629419500
Title
Transcatheter aortic valve replacement versus surgery in low-risk
patients: A meta-analysis of randomized studies.
Source
Journal of Cardiovascular Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Ferlini M.; Fortuni F.; Di Giacomo C.; Cornara S.; Somaschini A.; Oltrona
Visconti L.; Ferrario M.
Institution
(Ferlini, Fortuni, Di Giacomo, Cornara, Somaschini, Oltrona Visconti,
Ferrario) Division of Cardiology, Fondazione IRCCS Policlinico San Matteo,
Piazzale Golgi 1, Pavia 27100, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<86>
Accession Number
622950773
Title
Fentanyl Delays the Platelet Inhibition Effects of Oral Ticagrelor: Full
Report of the PACIFY Randomized Clinical Trial.
Source
Thrombosis and Haemostasis. 118 (8) (pp 1409-1418), 2018. Date of
Publication: 01 Aug 2018.
Author
Ibrahim K.; Shah R.; Goli R.R.; Kickler T.S.; Clarke W.A.; Hasan R.K.;
Blumenthal R.S.; Thiemann D.R.; Resar J.R.; Schulman S.P.; McEvoy J.W.
Institution
(Ibrahim, Hasan, Blumenthal, Thiemann, Resar, Schulman, McEvoy) Division
of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Heart
Disease, Johns Hopkins University, School of Medicine, 600 N. Wolfe
Street, Baltimore, MD 21287, United States
(Shah, Goli) Department of Medicine, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
(Kickler, Clarke) Department of Pathology, Johns Hopkins University,
School of Medicine, Baltimore, MD, United States
(Blumenthal) Ciccarone Center for the Prevention of Heart Disease, Johns
Hopkins University, School of Medicine, Baltimore, MD, United States
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Morphine delays oral P2Y <inf>12</inf> platelet inhibitor absorption and
is associated with adverse outcomes after myocardial infarction.
Consequently, many physicians and first responders are now considering
fentanyl as an alternative. We conducted a single-centre trial randomizing
cardiac patients undergoing coronary angiography to intravenous fentanyl
or not. All participants received local anaesthetic and intravenous
midazolam. Those requiring percutaneous coronary intervention (PCI) with
stenting received 180 mg oral ticagrelor intra-procedurally. The primary
outcome was area under the ticagrelor plasma concentration-time curve (AUC
<inf>0-24 hours</inf>). The secondary outcomes were platelet function
assessed at 2 hours after loading, measured by P2Y <inf>12</inf> reaction
units (PRUs) and light transmission platelet aggregometry. Troponin-I was
measured post-PCI using a high-sensitivity troponin-I assay (hs-TnI). All
participants completed a survey of pain and anxiety. Of the 212
randomized, 70 patients required coronary stenting and were loaded with
ticagrelor. Two participants in the no-fentanyl arm crossed over to
receive fentanyl for pain. In as-treated analyses, ticagrelor
concentrations were higher in the no-fentanyl arm (AUC <inf>0-24
hours</inf> 70% larger, p = 0.03). Platelets were more inhibited by 2
hours in the no-fentanyl arm (71 vs. 113 by PRU, p = 0.03, and 25% vs. 41%
for adenosine diphosphate response by platelet aggregation, p < 0.01).
Mean hs-TnI was higher with fentanyl at 2 hours post-PCI (11.9 vs. 7.0
ng/L, p = 0.04) with a rate of enzymatic myocardial infarction of 11% for
fentanyl and 0% for no-fentanyl (p = 0.08). No statistical differences in
self-reported pain or anxiety were found. In conclusion, fentanyl
administration can impair ticagrelor absorption and delay platelet
inhibition, resulting in mild excess of myocardial damage. This newly
described drug interaction should be recognized by physicians and suggests
that the interaction between opioids and oral P2Y <inf>12</inf> platelet
inhibitors is a drug class effect associated with all opioids. Clinical
Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02683707
(NCT02683707). Copyright © 2018 Georg Thieme Verlag KG Stuttgart
New York.

<87>
Accession Number
620208381
Title
Cost-effectiveness analysis in cardiac surgery: A review of its concepts
and methodologies.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (4) (pp
1671-1681.e11), 2018. Date of Publication: April 2018.
Author
Ferket B.S.; Oxman J.M.; Iribarne A.; Gelijns A.C.; Moskowitz A.J.
Institution
(Ferket, Oxman, Gelijns, Moskowitz) Department of Population Health
Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Ferket) Institute for Healthcare Delivery Science, Department of
Population Health Science and Policy, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Iribarne) Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center,
Lebanon, NH, United States
(Iribarne) The Dartmouth Institute for Health Policy and Clinical
Practice, One Medical Center Drive, Lebanon, NH, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<88>
Accession Number
2002972431
Title
Synchronous Carotid Endarterectomy and Coronary Artery Bypass Graft versus
Staged Carotid Artery Stenting and Coronary Artery Bypass Graft for
Patients with Concomitant Severe Coronary and Carotid Stenosis: A
Systematic Review and Meta-analysis.
Source
Annals of Vascular Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Texakalidis P.; Charisis N.; Jonnalagadda A.K.; Chaitidis N.; Giannopoulos
S.; Kaskoutis C.; Machinis T.; Koullias G.J.
Institution
(Giannopoulos) Department of Vascular Surgery, 251 HAF and VA Hospital,
Athens, Greece
(Texakalidis) Department of Neurosurgery, Emory University School of
Medicine, Atlanta, GA, United States
(Charisis) Division of Surgical Oncology, Department of Surgery, Stony
Brook University Hospital, Stony Brook, NY, United States
(Jonnalagadda) Division of Cardiology, MedStar Washington Hospital Center,
Washington, DC, United States
(Chaitidis, Kaskoutis) Department of Internal Medicine, 401 General Army
Hospital, Athens, Greece
(Giannopoulos) School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
(Machinis) Department of Neurosurgery, Virginia Commonwealth University,
Richmond, VA, United States
(Koullias) Division of Vascular and Endovascular Surgery, Department of
Surgery, Stony Brook University Hospital, Stony Brook, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Owing to the systemic nature of atherosclerosis, medium and
large arteries at different sites are commonly simultaneously affected. As
a result, severe coronary artery disease (CAD) requiring coronary artery
bypass graft (CABG) frequently coexists with significant carotid stenosis
that warrants revascularization. The aim of this study was to compare
synchronous carotid endarterectomy (CEA) and CABG vs. staged carotid
artery stenting (CAS) and CABG for patients with concomitant CAD and
carotid artery stenosis in terms of perioperative (30-day) outcomes.
 Method(s): This study was performed according to the Preferred
Reporting Items for Systematic reviews and Meta-Analyses guidelines.
Eligible studies were identified through a search of PubMed, Scopus, and
Cochrane until July 2018. A meta-analysis was conducted with the use of a
random-effects model. The I-square statistic was used to assess
heterogeneity. Result(s): Five studies comprising 16,712 patients
were included in this meta-analysis. Perioperative stroke (odds ratio
[OR]: 0.84; 95% confidence interval [CI]: 0.43-1.64; I2 =
39.1%), transient ischemic attack (TIA; OR: 0.32; 95% CI: 0.04-2.67;
I2 = 27.6%), and myocardial infarction (MI) rates (OR: 0.56;
95% CI: 0.08-3.85; I2 = 68.9%) were similar between the two
groups. However, patients who underwent simultaneous CEA and CABG were at
a statistically significant higher risk for perioperative mortality (OR:
1.80; 95% CI: 1.05-3.06; I2 = 0.0%). Conclusion(s): The
current meta-analysis did not detect statistically significant differences
in the rates of perioperative stroke, TIA, and MI between the groups.
However, patients in the simultaneous CEA and CABG group had a
significantly higher risk of 30-day mortality. Future randomized trials or
prospective cohorts are needed to validate our results. Copyright
© 2019 Elsevier Inc.

<89>
Accession Number
629307958
Title
Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac
Surgery Patients: A Randomized Clinical Trial.
Source
Critical care medicine. 46 (8) (pp e742-e750), 2018. Date of Publication:
01 Aug 2018.
Author
Rocha Ferreira G.S.; de Almeida J.P.; Landoni G.; Vincent J.L.; Fominskiy
E.; Gomes Galas F.R.B.; Gaiotto F.A.; Dallan L.O.; Franco R.A.; Lisboa
L.A.; Palma Dallan L.R.; Fukushima J.T.; Rizk S.I.; Park C.L.; Strabelli
T.M.; Gelas Lage S.H.; Camara L.; Zeferino S.; Jardim J.; Calvo Arita
E.C.T.; Caldas Ribeiro J.; Ayub-Ferreira S.M.; Costa Auler J.O.; Filho
R.K.; Jatene F.B.; Hajjar L.A.
Institution
(Rocha Ferreira, de Almeida, Gomes Galas, Franco, Fukushima, Rizk, Park,
Camara, Zeferino, Jardim, Calvo Arita, Caldas Ribeiro, Costa Auler)
Surgical Intensive Care Unit and Department of Anesthesiology, Heart
Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da
Universidade de Sao Paulo, Sao Paulo, Brazil
(Landoni, Fominskiy) Department of Anesthesia and Intensive Care, IRCCS
San Raffaele Scientific Institute, Milan, Italy
(Landoni) Faculty of Medicine and Surgery, Vita-Salute San Raffaele
University of Milan, Milan, Italy
(Vincent) Department of Intensive Care, Erasme Hospital, Universite Libre
de Bruxelles, Brussels, Belgium
(Gaiotto, Dallan, Lisboa, Palma Dallan, Jatene) Department of
Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clinicas da
Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
(Strabelli) Department of Infectious Diseases, Heart Institute (InCor),
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao
Paulo, Sao Paulo, Brazil
(Gelas Lage, Ayub-Ferreira, Filho, Hajjar) Department of Cardiology, Heart
Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da
Universidade de Sao Paulo, Sao Paulo, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to evaluate the efficacy of
perioperative intra-aortic balloon pump use in high-risk cardiac surgery
patients. DESIGN: A single-center randomized controlled trial and a
meta-analysis of randomized controlled trials. SETTING: Heart Institute of
Sao Paulo University. PATIENTS: High-risk patients undergoing elective
coronary artery bypass surgery. INTERVENTION: Patients were randomized to
receive preskin incision intra-aortic balloon pump insertion after
anesthesia induction versus no intra-aortic balloon pump use. MEASUREMENTS
AND MAIN RESULTS: The primary outcome was a composite endpoint of 30-day
mortality and major morbidity (cardiogenic shock, stroke, acute renal
failure, mediastinitis, prolonged mechanical ventilation, and a need for
reoperation). A total of 181 patients (mean [SD] age 65.4 [9.4] yr; 32%
female) were randomized. The primary outcome was observed in 43 patients
(47.8%) in the intra-aortic balloon pump group and 42 patients (46.2%) in
the control group (p = 0.46). The median duration of inotrope use (51hr
[interquartile range, 32-94 hr] vs 39hr [interquartile range, 25-66 hr]; p
= 0.007) and the ICU length of stay (5 d [interquartile range, 3-8 d] vs 4
d [interquartile range, 3-6 d]; p = 0.035) were longer in the intra-aortic
balloon pump group than in the control group. A meta-analysis of 11
randomized controlled trials confirmed a lack of survival improvement in
high-risk cardiac surgery patients with perioperative intra-aortic balloon
pump use. CONCLUSION(S): In high-risk patients undergoing cardiac
surgery, the perioperative use of an intra-aortic balloon pump did not
reduce the occurrence of a composite outcome of 30-day mortality and major
complications compared with usual care alone.

<90>
Accession Number
600262924
Title
The effects of perioperative beta-blockers on mortality in patients
undergoing non-cardiac surgery in real world: A meta-analysis of cohort
studies.
Source
International Journal of Cardiology. 176 (3) (pp 605-610), 2014. Date of
Publication: 20 Oct 2014.
Author
Wan Y.-D.; Zhang S.-G.; Sun T.-W.; Kan Q.-C.; Wang L.-X.
Institution
(Wan, Zhang, Sun) Department of Integrated ICU, First Affiliated Hospital
of Zhengzhou University, Zhengzhou, China
(Kan) Pharmacy, First Affiliated Hospital of Zhengzhou University, China
(Wang) School of Biomedical Sciences, Charles Sturt University, Wagga,
Australia
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite the fact that recent evidence from meta-analysis of
randomized trials indicates an increase in mortality, perioperative
treatment with beta-blockers is still widely advocated. We therefore
performed a meta-analysis of cohort studies to evaluate the effects of
perioperative beta-blockers on mortality in patients undergoing
non-cardiac surgery in the real world scenarios.
Methods We searched PubMed and Embase from the inception to April 2014 for
cohort studies, assessing the effect of perioperative beta-blockers on
mortality in patients undergoing non-cardiac surgery. Adjusted relative
risk (RR) with 95% confidence interval (CI) was pooled using random effect
models.
Results Eight cohort studies with a total of 470,059 participants (180,441
patients in the beta-blocker group and 289,618 patients in the control
group) were included in this meta-analysis. Perioperative beta-blockers
were not associated with a reduced risk of mortality (RR = 0.88, 95% CI,
0.75 to 1.04), postoperation myocardial infarction (RR = 1.30, 95% CI,
0.76 to 2.23), and postoperation stroke (RR = 1.17, 95% CI, 0.53 to 2.57).
However, in subgroup analysis of mortality, taking beta-blockers on the
day of surgery caused statistically significant increase in mortality of
91% (RR = 1.91, 95% CI, 1.01 to 3.62). Conclusions In the real world
scenarios, for patients undergoing non-cardiac surgery, the routine use of
beta-blockers does not seem to reduce the risk of death. Moreover, those
who are taking beta-blockers on the day of surgery may have an increased
risk of postoperative mortality. However, these results should be
interpreted with caution because of the significant heterogeneity across
the studies. Copyright © 2014 Elsevier Ireland Ltd. All rights
reserved.

<91>
Accession Number
629410622
Title
The feasibility of a fast-track cardiac anaesthesia protocol in a single
centre Australian teaching hospital.
Source
Anaesthesia and Intensive Care. Conference: Annual Scientific Meeting of
the Australian and New Zealand College of Anaesthetists, ANZCA 2019.
Malaysia. 47 (2 Supplement) (pp 7), 2019. Date of Publication: July 2019.
Author
Lloyd-Donald P.; Weinberg L.; Chandra N.; Yii M.; Hooper J.; Moore A.;
Warrillow S.; McCall P.; Seevanayagam S.; Matalanis G.
Institution
(Lloyd-Donald, Weinberg, Hooper, Moore, McCall) Department of Anaesthesia,
Austin Health
(Chandra, Seevanayagam, Matalanis) Department of Cardiac Surgery, Austin
Health
(Yii) Monash University Medical School
(Warrillow) Department of Intensive Care, Austin Health
Publisher
SAGE Publications Inc.
Abstract
Introduction: Fast-track cardiac anaesthesia (FTCA) (tracheal extubation
<4hours postoperatively and discharge to HDU bed on the day of surgery)
may be an acceptable model of cardiac surgical care. Advantages include
shorter ventilation and ICU times, and cost-effective utilisation and
allocation of ICU beds. Risks include delays in ICU readmission for timely
management of post-surgical complications, need to escalate vasoactive and
inotrope therapy, and duplication of ICU resources within a
well-established hospital setting. In 2016, Austin Health received
institutional support for 16 patients go undergo a FTCA programme. Primary
aim: to test whether a dedicated FTCA programme was feasible. We assessed
programme compliance, reasons for fast-track failure, and logistical
feasibility i.e. availability of a post ICU discharge bed. Secondary
Objectives: evaluate the impact on postoperative ventilation hours, length
of ICU and hospital stay, and postoperative complications. We compared the
secondary outcome to a cohort of patients undergoing usual care (UC
group). Method(s): With ethics approval, a FTCA programme was
developed by a multidisciplinary team of cardiac surgeons, anaesthetists,
and intensivists. We included adult patients (age >18years), undergoing
primary CABG or valve surgery requiring cardiopulmonary bypass. We
excluded emergency and redo-surgery, aortic surgery, patients with
abnormal preoperative ventricular function, pulmonary hypertension, and
respiratory disease. The FTCA protocol included a pre-specified FTCA
technique (no premedications, short acting opioids, reversal of all
neu-romuscular blockade with sugammadex, multimodal analgesia) and the
requirements for a-priori metrics for postoperative bleeding, haemodynamic
stability, vasoactive medications, gas exchange, and neurological and
sedations scores. Result(s): 16 patients were included in the FTCA
protocol. There were no violations in the protocol. Compared to the UC
group, patients in the FTCA group were younger (median IQR) age 56 years
(40:66) vs. 65.6 years (58:73) (p 0.008), with lower Euroscores 1.5 %
(0.9:2.2) vs. 4% (2:6). All other baseline characteristics including
preoper-ative ventricular function, and cardiopulmonary bypass and aortic
clamp times were similar. Of the 16 FTCA patients, 5 (31%) were extubated
on the operating table, 9 (56%) within 4 postoperative hours in the ICU,
and 2 (12%) within 18 hours postoperative hours in the ICU. Median (IQR)
ventilation hours was 2.1 hours (0:6.5) in the FTCA group and 8 hours
(5:11.5) in the UC group (p 0.004). 4 (25%) patients were transferred out
of ICU on the same postoperative day. Reasons for failure to transfer out
of ICU included no HDU bed available (4 patients), inadequate analgesia (2
patients), postoperative bleeding (2 patients), poor postoperative gas
exchange (3 patients), and return to theatre for bleeding (1 patient).
Median length of ICU stay was 22 hours (12.2:40.5) in the FTCA group and
37 hours (20.5:67) in the UC group; p 0.03. There no were no differences
in complications between the FTCA and UC groups. Total hospital stay was 6
days (5.2:8.5) in the FTCA group and 7 days (6:12.5) in the UC group; p
0.11. Conclusion(s): The FTCA protocol was feasible with no
violations in our proposed protocol. There was no association harm. The
FTCA protocol translated into shorter ventilation and ICU times, but no
significant differences in complications and length of hospital stay. Our
findings support this FTCA programme being validated in a randomised pilot
trial.

<92>
Accession Number
629410616
Title
Methadone provides a preventive analgesic effect in patients undergoing
cardiac surgery.
Source
Anaesthesia and Intensive Care. Conference: Annual Scientific Meeting of
the Australian and New Zealand College of Anaesthetists, ANZCA 2019.
Malaysia. 47 (2 Supplement) (pp 6-7), 2019. Date of Publication: July
2019.
Author
Murphy G.; Szokol J.
Institution
(Murphy, Szokol) Northshore
Publisher
SAGE Publications Inc.
Abstract
Preventive analgesic medications are those in which the analgesic benefits
persist beyond the clinical duration of action (defined as more than 5.5
half-lives of the agent).1 Methadone is an opioid with the
longest elimination halflife of the clinically-used opioids. Clinical
studies have reported that patients administered methadone had lower pain
scores and analgesic requirements during the first 72 postoperative hours,
compared to subjects given conventional opioids.2 The intensity
of acute postoperative pain is one of the strongest predictors for the
development of chronic postsurgical pain.1 In addition,
metha-done is a potent N-methyl-D-aspartate (NMDA) receptor antagonist and
has been reported to decrease the requirements for opioid medications (and
possible resultant opioid-induced tolerance and hyperalgesia). The aim of
the present investigation was to determine whether the analgesic benefits
of methadone persisted beyond the hospital discharge date (1, 3, 6, and 12
months postoper-atively). We hypothesized that patients administered
methadone would have a lower incidence of persistent pain, defined as
fewer episodes of pain per month. Method(s): The NorthShore
Institutional Review Board approved this follow-up clinical
investigations, and all patients gave their written consent to
participate. 156 patients undergoing cardiac surgery were enrolled in a
double-blinded clinical trial comparing pain scores and analgesic
requirements in subjects randomized to be administered either a single
intravenous dose of metha-done (0.3 mg/kg) or fentanyl (12 mcg/kg) prior
to cardio-pulmonary bypass.1 In this initial study, pain scores
and analgesic requirements were reduced for the first 72 postoperative
hours. Patients were sent a brief questionnaire 1, 3, 6, and 12 months
after their surgery. Patients were asked to record levels of pain (chest,
back and leg pain at rest, coughing, and movement) that were present at
the time the surveys were completed using an 11-point visual analog scale
(VAS) (0 no pain, 10 worst pain imaginable). The weekly frequency of pain
was recorded (primary endpoint), as well as need for analgesic medications
and pain interference with sleep and daily activities. Result(s):
Chest pain scores at rest, with coughing, and with movement were
significantly lower in the respondents in the methadone cohort at 1-month
(all P <0.0001). Similarly, leg pain scores were significantly less at
3-months at rest in the methadone group (P 0.004). The frequency of
postsurgical pain was less in the methadone group (0 (less than once a
week) compared to the fentanyl group (2 (twice per week), P 0.004)) at
1-month, but low thereafter (0 to 0.5) in both cohorts and not
significantly different. Although fewer patients in the methadone group
required postoperative opioid analgesics, the overall number of patients
by 3 months was small and no differences between respondent groups was
observed at any time. Discussion(s): Cardiac surgical patient
administered intraoperative methadone reported significantly less
postoperative pain 1-month after surgery, compared to subjects given
fentanyl. These findings support the use of metha-done as a preventive
analgesic agent.

<93>
Accession Number
2002925285
Title
TCT-237 Revascularization Options for Women With Coronary Artery Disease:
A Meta-Analysis of Randomized Controlled Trials.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B236), 2019. Date of Publication: 1 October
2019.
Author
Shah T.; Gul B.; Head S.; Abbott J.D.; Chieffo A.; Baumbach A.; Hu X.; Li
F.; Brackett A.; Gesick C.; Bisarya P.; Mehran R.; Grines C.; Geirsson A.;
Mehilli J.; Lansky A.
Institution
(Shah) Yale School of Medicine, Vestal, NY, United States
(Gul) Yale New Haven Hospital, New Haven, CT, United States
(Head) Department of Cardiothoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Abbott) Brown Medical School, Providence, RI, United States
(Chieffo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Baumbach) Barts Heart Centre, London, United Kingdom
(Hu, Li) Yale Center for Analytical Sciences, Yale School of Public
Health, New Haven, CT, United States
(Brackett) Harvey Cushing/John Hay Whitney Medical Library, Yale
University, New Haven, CT, United States
(Gesick, Bisarya, Lansky) Yale School of Medicine, New Haven, CT, United
States
(Mehran) The Zena and Michael A. Wiener Cardiovascular Institute, Mount
Sinai Hospital, New York, NY, United States
(Grines) Northwell Health, North Shore University Hospital, Manhasset, NY,
United States
(Geirsson) Yale University, New Haven, CT, United States
(Mehilli) Munich University Clinic, LMU, Munich, Germany
Publisher
Elsevier USA
Abstract
Background: Contemporary randomized clinical trials comparing coronary
artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)
for patients with multivessel coronary artery disease (MVD) and/or left
main disease (LMD) suggest similar outcomes in nondiabetic patients with
low to intermediate SYNTAX score (0 to 32). However, >75% of the patients
in these studies are men, and there is growing evidence that suggests that
revascularization outcomes may not be consistent between sexes, which may
have important treatment implications for women. The objective of this
meta-analysis is to evaluate outcomes of CABG versus PCI in female
patients. Method(s): We conducted a systematic search to identify
randomized controlled trials (RCTs) comparing the long-term outcomes after
multivessel PCI versus CABG in MVD and/or LMD. We extracted
female-specific data and calculated the primary endpoint of interest: a
composite hazard ratio (HR) of all-cause death, myocardial infarction, and
stroke. Result(s): A total of 6 RCTs including 1,909 female patients
were included in the meta-analysis, with follow-up times ranging from 12
to 60 months. The composite endpoint favored CABG compared with PCI (HR:
1.31; 95% confidence interval [CI]: 1.05 to 1.63; p = 0.017). Subgroup
analyses of LMD versus MVD, first- versus second-generation drug-eluting
stents, and patient enrollment before and after 2010 did not reveal any
significant differences. Conclusion(s): Thus, women with MVD and/or
LMD undergoing revascularization had a 30% higher hazard of long-term
ischemic complications with PCI compared with CABG, suggesting that women
with MVD and/or LMD may need to be managed differently than their male
counterparts. However, current evidence for women with MVD remains
heterogeneous and inadequate to conclusively establish recommendations and
calls for additional randomized evidence. Categories: CORONARY: Coronary
Artery Surgery Copyright © 2019

<94>
Accession Number
2002925274
Title
TCT-239 Impact of Nonrespect of SYNTAX Score II Recommendations for
Surgery in Patients With Complex Coronary Artery Disease Treated by PCI: A
Pooled Analysis of 3,280 Randomized Patients: SYNTAX, BEST, and PRECOMBAT
Trials.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B238), 2019. Date of Publication: 1 October
2019.
Author
Serruys P.; Modolo R.; Chichareon P.; Kogame N.; Chang C.-C.; Tomaniak M.;
Takahashi K.; Ahn J.-M.; Onuma Y.; Park S.-J.
Institution
(Serruys) Imperial College, London, United Kingdom
(Modolo, Chichareon, Kogame, Takahashi) Academic Medical Center,
Amsterdam, Netherlands
(Chang, Onuma) Thoraxcenter, Erasmus University Medical Center, Rotterdam,
Netherlands
(Tomaniak) Thorax Center, Erasmus MC, Department of Interventional
Cardiology, Rotterdam, the Netherlands, and Medical University of Warsaw,
First Department of Cardiology, Warsaw, Poland
(Ahn, Park) Asan Medical Center, Seoul, South Korea
Publisher
Elsevier USA
Abstract
Background: The SYNTAX Score II (SSII) was developed to predict 4-year
all-cause mortality after left main (LM) or multivessel disease
revascularization and to facilitate the decision-making process by
providing the following treatment recommendations: 1) coronary artery
bypass grafting (CABG) or percutaneous coronary intervention (PCI)
(equipoise risk); 2) CABG only (excessive risk for PCI); or 3) PCI only
(excessive risk for CABG). Method(s): Randomized clinical trials
(RCTs) assessing revascularization strategies for 3-vessel disease (3VD)
or left main (LM) performed to date have not taken into account SSII
recommendation. As such, RCTs have assigned patients to PCI in whom SSII
may have otherwise recommended CABG and vice versa. We sought to determine
the 4-year mortality impact of not abiding by the SSII recommendations in
the setting of 3 large-scale RCTs comparing PCI and CABG for treatment of
LM and/or 3VD. Result(s): SYNTAX, PRECOMBAT, and BEST comprised 3,280
patients randomized to either PCI or CABG. Among those patients who had an
SSII recommendation to undergo CABG only (n = 931), 4-year mortality was
higher when patients actually underwent PCI by randomization scheme
compared with those who underwent CABG (10.7% vs. 6.9%; adjusted hazard
ratio [aHR]: 1.68; 95% confidence interval [CI]: 1.05 to 2.69; p = 0.028).
No difference in 4-year mortality was observed between patients who
underwent PCI or CABG when SSII recommended PCI only (n = 2,044; 6.3% vs.
7.8%; aHR: 0.59; 95% CI: 0.16 to 2.27; p = 0.44, respectively), nor when
recommended "PCI or CABG - equipoise" (n = 157; 8.5% vs. 6.8%; aHR: 1.27;
95% CI: 0.92 to 1.76; p = 0.15, respectively). Conclusion(s): In
these 3 major trials of complex coronary disease patients, noncompliance
with SSII CABG treatment recommendations (i.e., treating the patient with
PCI) was associated with a higher 4-year all-cause mortality. Categories:
OTHER: Quality, Guidelines and Appropriateness Criteria Copyright
© 2019

<95>
Accession Number
629411995
Title
Low-dose CT of the patients with 80kV coronary angiography bypass grafts
using iterative model reconstruction: Evaluation of image quality and
radiation dose reduction.
Source
Journal of the American Geriatrics Society. Conference: 8th Chinese
Congress on Gerontology and Health Industry, CCGI 2019. China. 67
(Supplement 4) (pp S682), 2019. Date of Publication: September 2019.
Author
Luo C.C.; Li T.; Yang L.; Huang Z.L.; Li X.P.; Liu B.; Yang T.; Qi Y.Q.
Institution
(Luo, Li, Yang, Huang, Li, Liu, Yang, Qi) PLA General Hospital, Beijing
100853, China
Publisher
Blackwell Publishing Inc.
Abstract
Purpose: The purpose of this study is to assess the image quality and
radiation dose reduction of low-dose CT of the patients with 80kV coronary
angiography bypass grafts (CABG) using iterative model reconstruction
(IMR). Material(s) and Method(s): This study included 80 patients
with coronary artery bypass surgery, and they were randomly assigned into
the low-dose CT protocol (protocol A, 80 kV, IMR, Omnipa-que, 300 mgI/ml)
or conventional CT scan protocol (protocol B, 100 kV, iDose, Iopamidol,
370 mgI/ml) (n=40). Equipment: Philips Brilliance iCT (256). Each patient
received 60~70 ml contrast media and 30~50 ml physiological saline
intravenously at a rate of 4 ml/s. The coronary scan was a prospective
scan of the heart gate, which was scanned from the thoracic entrance to
the cardiac diaphragm. Quantitative parameters including CT attenuation,
noise, SNR and CNR of aorta, left ventricle, and grafts were compared. The
subjective image quality-image noise, steak artifacts, and margin
sharpness of each cardiovascular structure was compared. The image quality
and radiation dose reduction were assessed. Result(s): The mean
(+/-SD) effective radiation dose was 2.27+/-0.8, and 4.46+/-0.54 mSv for
low-dose CT protocol A, and conventional CT protocol B, respectively. The
body mass index of all patients (weight in kilograms divided by the square
of height in meters) was 22~30, and had no statistically significant
difference. The image noise of protocol A was lower than that of protocol
B and SNR and CNR of protocol A were better than that of protocol B in all
evaluate structures. The visual image score was higher for protocol A than
for protocol B. Conclusion(s): The low-dose CT protocol (protocol A,
80 kV, IMR, Omnipaque, 300 mgI/ml) can significantly decrease the image
noise and radiation dose, which also can improve image quality for the
patients with coronary angiography bypass grafts (CABG).

<96>
Accession Number
629410197
Title
Comparison of the expression of cluster of differentiation (CD)39 and CD73
between propofol- and sevoflurane-based anaesthesia during open heart
surgery.
Source
Scientific reports. 8 (1) (pp 10197), 2018. Date of Publication: 05 Jul
2018.
Author
Oh C.-S.; Kim K.; Kang W.-S.; Woo N.-S.; Kang P.-S.; Kim J.-S.; Kim H.-R.;
Lee S.-H.; Kim S.-H.
Institution
(Oh, Kim, Kang, Woo, Kim) Department of Anaesthesiology and Pain Medicine,
Konkuk University Medical Centre, Konkuk University School of Medicine,
Seoul, South Korea
(Kang) Department of Anaesthesiology and Pain Medicine, Konyang University
Hospital, Konyang University College of Medicine, Daejeon, South Korea
(Kim) Department of Thoracic and Cardiovascular Surgery, Konkuk University
Medical Centre, Konkuk University School of Medicine, Seoul, South Korea
(Kim) Department of Anatomy and Cell Biology, Seoul National University
College of Medicine, Seoul, South Korea
(Lee) Department of Microbiology, Konkuk University School of Medicine,
Seoul, South Korea
(Lee, Kim) Department of Medicine, Institute of Biomedical Science and
Technology, Konkuk University School of Medicine, Seoul, South Korea
(Kim) Department of Infection and Immunology, Konkuk University School of
Medicine, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
High expression of cluster of differentiation (CD)39 and CD73 has
cardio-protective effects. We hypothesised that the expression of CD39 and
CD73 would differ between propofol- and volatile anaesthetic-based
anaesthesia in patients undergoing open heart surgery (OHS). The objective
of this prospective randomized trial was to compare the changes in CD39
and CD73 levels in CD4+ T cells between propofol- and sevoflurane-based
anaesthesia during OHS. The study randomly allocated 156 patients
undergoing OHS to a propofol or sevoflurane group. Blood was obtained
preoperatively and up to 48hours after weaning from cardiopulmonary bypass
(CPB). The expression levels of CD39 and CD73 in circulating CD4+ T cells,
serum cytokines and other laboratory parameters were analysed. The primary
outcome was the expression of CD39 and CD73 on CD4+ T cells. Demographic
data and perioperative haemodynamic changes did not show significant
differences between the two groups. The expression of CD39 and CD73 in the
sevoflurane group was significantly lower than in the propofol group
(P<0.001). Other laboratory findings including cardiac enzymes and
cytokine levels, did not show significant intergroup differences. Propofol
attenuated the decrease in CD39 and CD73 in circulating CD4+ T cells
compared to sevoflurane-based anaesthesia during OHS.

<97>
Accession Number
629416104
Title
Moderate ischemic mitral incompetence: does it worth more ischemic time?.
Source
General thoracic and cardiovascular surgery. (no pagination), 2019. Date
of Publication: 24 Sep 2019.
Author
El-Hag-Aly M.A.; El Swaf Y.F.; Elkassas M.H.; Hagag M.G.; Allam H.K.
Institution
(El-Hag-Aly, Hagag) Cardiothoracic Surgery Department, Faculty of
Medicine, Menoufia University, Yassin Abdel Ghaffar Street 32511, Egypt
(El Swaf) Cardiothoracic Surgery Department, Gharbia, Egypt
(Elkassas) Cardiothoracic Surgery Department, Faculty of Medicine, Suez
Canal University, Suez, Egypt
(Allam) Public Health and Community Medicine Department, Faculty of
Medicine, Menoufia University, Egypt
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Ischemic mitral regurgitation (IMR) is a common finding
following myocardial infarction or ischemia. Management of moderate IMR is
still a hot topic. Adding mitral valve repair (MVr) to coronary artery
bypass grafting (CABG) is questionable. The goal of this study was to
assess and compare short-term clinical and echocardiographic results of
moderate IMR treated by CABG alone versus another group of patients
treated by CABG plus MVr. METHOD(S): Eighty consecutive patients with
ischemic heart disease (IHD) and moderate IMR were divided randomly into
two equal groups: group I (40) had only CABG and group II (40) had CABG
plus MVr. Patients were evaluated at 1-week, 3-months and 1-year intervals
postoperatively. RESULT(S): After 1-year follow-up, our study
revealed statistically significant improvement in the grade of mitral
regurgitation (MR) in group II than group I. The mean value for effective
regurgitant orifice area (EROA) was 0.22+/-0.13 for group I versus
0.03+/-0.03 for group II (P=0.001) and for vena contracta (VC), it was
3.8+/-2.24 for group I versus 0.4+/-0.49 for group II (P=0.000). There was
also a significant reduction in the New York Heart Association (NYHA)
functional class in both groups. CONCLUSION(S): MVr can be performed
safely and concomitantly with CABG in patients having moderate IMR, and
its addition to CABG have significant short-term impact on clinical or
echocardiographic outcome of patients.

<98>
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. Copyright ©
2019 Author(s).

<99>
Accession Number
629276315
Title
Multimodal cardioprotective strategy in cardiac surgery (the ProCCard
trial): Study protocol for a multicenter randomized controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 560. Date of
Publication: 11 Sep 2019.
Author
Chiari P.; Durand M.; Desebbe O.; Fischer M.-O.; Lena-Quintard D.; Palao
J.-C.; Mercier C.; Samson G.; Varillon Y.; Pozzi M.; Mewton N.;
Maucort-Boulch D.; Ovize M.; Fellahi J.-L.
Institution
(Chiari, Fellahi) Service d'Anesthesie-Reanimation, Hopital Louis Pradel,
Hospices Civils de Lyon, Lyon F-69677, France
(Chiari, Mewton, Ovize, Fellahi) Inserm U1060, Laboratoire CarMeN, IHU
OPeRa, Lyon F-69394, France
(Durand) Pole d'Anesthesie-Reanimation, Hopital Albert Michallon, Centre
Hospitalier Universitaire de Grenoble-Alpes, Grenoble F-38043, France
(Desebbe) Service d'Anesthesie-Reanimation, Clinique de la Sauvegarde,
Ramsay Generale de Sante, Lyon F-69009, France
(Fischer) Service d'Anesthesie-Reanimation, Centre Hospitalier
Universitaire de Caen, Caen F-14033, France
(Fischer) Universite de Normandie, UNICAEN, Caen, France
(Lena-Quintard) Service d'Anesthesie-Reanimation, Institut Arnault Tzanck,
Saint Laurent du Var F-06721, France
(Palao) Service d'Anesthesie-Reanimation, Hopital Nord, Centre Hospitalier
Universitaire de Saint Etienne, Saint Etienne F-42277, France
(Mercier, Maucort-Boulch) Service de Biostatistique - Bioinformatique,
Pole Sante Publique, Hospices Civils de Lyon, Lyon F-69003, France
(Mercier, Maucort-Boulch) Universite de Lyon, Lyon F-69000, France
(Mercier, Maucort-Boulch) Universite Lyon 1, Villeurbanne F-69100, France
(Mercier, Maucort-Boulch) CNRS, UMR5558, Laboratoire de Biometrie et
Biologie Evolutive, Equipe Biostatistique-Sante, Villeurbanne F-69100,
France
(Samson, Varillon, Mewton, Ovize) Centre d'Investigation Clinique de Lyon
(CIC 1407 Inserm), Hospices Civils de Lyon, Lyon F-69677, France
(Pozzi) Service de Chirurgie Cardiaque, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon F-69677, France
(Mewton) Service d'Insuffisance Cardiaque, Lyon, France
(Ovize) Service d'Explorations Fonctionnelles Cardiovasculaires, Lyon,
France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Myocardial damage in patients undergoing cardiac surgery
increases both morbidity and mortality. Different protective strategies
dealing with either preconditioning or postconditioning or assessing a
single aspect of cardioprotection have shown conflicting results. We
tested the hypothesis that a multimodal approach would improve
cardioprotection and limit myocardial damage following cardiac surgery
with cardiopulmonary bypass. Method(s): This study is a pragmatic
multicenter (six French institutions), prospective, randomized,
single-blinded, controlled trial. The randomization is stratified by
centers. In the study, 210 patients scheduled for aortic valve surgery
with or without coronary artery bypass grafting will be assigned to a
control or a treatment group (105 patients in each group). In the control
group, patients receive total intravenous anesthesia with propofol and
liberal intraoperative blood glucose management (initiation of insulin
infusion when blood glucose, measured every 60 min, is greater than 180
mg/dl), as a standard of care. The treatment group receives a bundle of
care combining five techniques of cardioprotection: (1) remote ischemic
preconditioning applied before aortic cross-clamping; (2) maintenance of
anesthesia with sevoflurane; (3) tight intraoperative blood glucose
management (initiation of insulin infusion when blood glucose, measured
every 30 min, is greater than 140 mg/dl); (4) moderate respiratory
acidosis (pH 7.30) at the end of cardiopulmonary bypass; and (5) a gentle
reperfusion protocol following aortic unclamping. The primary outcome is
myocardial damage measured by postoperative 72-h area under the curve of
high-sensitivity cardiac troponin I. Discussion(s): The ProCCard
study will be the first multicenter randomized controlled trial aiming to
assess the role of a bundle of care combining several cardioprotective
strategies to reduce myocardial damage in patients undergoing cardiac
surgery with cardiopulmonary bypass. Trial registration:
ClinicalTrials.gov, NCT03230136. Registered on July 26, 2017. Last updated
on April 17, 2019. Copyright © 2019 The Author(s).

<100>
Accession Number
624788881
Title
A multicenter randomized controlled trial of zephyr endobronchial valve
treatment in heterogeneous emphysema (LIBERATE).
Source
American Journal of Respiratory and Critical Care Medicine. 198 (9) (pp
1151-1164), 2018. Date of Publication: 01 Nov 2018.
Author
Slebos D.-J.; Wiese T.
Institution
(Criner) Department of Thoracic Medicine and Surgery, Lewis Katz School of
Medicine, Temple University, 3501 North Broad Street, Philadelphia, PA
19140, United States
(Sue, Wright) St. Joseph's Hospital and Medical Center, Phoenix, AZ,
United States
(Dransfield) University of Alabama, Birmingham UAB Lung Health Center,
Birmingham, AL, United States
(Rivas-Perez, Wiese) Department of Medicine, University of Louisville,
Louisville, KY, United States
(Sciurba) Division of Pulmonary, Allergy and Critical Care Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
(Shah) Royal Brompton Hospital, Imperial College, London, United Kingdom
(Wahidi) Duke University Medical Center, Duke University, Durham, NC,
United States
(De Oliveira) Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
(Morrissey) Division of Pulmonary Critical Care and Sleep Medicine,
University of California, Davis, Sacramento, CA, United States
(Cardoso) Instituto Do Coracao, Hospital das Clinicas, Universidade de Sao
Paulo, Sao Paulo, Brazil
(Hays) University of California, San Francisco, San Francisco, CA, United
States
(Majid) Interventional Pulmonology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Pastis) Medical University of South Carolina, Charleston, SC, United
States
(Kopas) Pulmonary Critical Care and Sleep Medicine Consultants, Houston
Methodist, Houston, TX, United States
(Vollenweider) Orlando Health Pulmonary and Sleep Medicine Group, Orlando
Regional Medical Center, Orlando, FL, United States
(McFadden) Keck School of Medicine, University of Southern California, Los
Angeles, CA, United States
(Machuzak) Center for Major Airway Diseases, Cleveland Clinic Foundation,
Respiratory Institute, Cleveland, OH, United States
(Hsia) Los Angeles Biomedical Research Institute, Harbor-University of
California Los Angeles, Torrance, CA, United States
(Sung) Stanford Hospital and Clinics, Stanford, CA, United States
(Jarad) University Hospital Bristol NHS Foundation Trust, Bristol, United
Kingdom
(Kornaszewska) Department of Cardiothoracic Surgery, University Hospital
of Wales, Cardiff, United Kingdom
(Hazelrigg) Division of Cardiothoracic Surgery, Southern Illinois
University, School of Medicine, Springfield, IL, United States
(Krishna) Palo Alto Medical Foundation, El Camino Hospital, Mountain View,
CA, United States
(Armstrong) QST Consultations Ltd., Allendale, MI, United States
(Shargill) Pulmonx Corporation, Redwood City, CA, United States
(Slebos) Department of Pulmonary Diseases, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Publisher
American Thoracic Society (E-mail: malexander@thoracic.org)
Abstract
Rationale: This is the first multicenter randomized controlled trial to
evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV)
in patients with little to no collateral ventilation out to 12 months.
 Objective(s): To evaluate the effectiveness and safety of Zephyr EBV
in heterogeneous emphysema with little to no collateral ventilation in the
treated lobe. Method(s): Subjects were enrolled with a 2:1
randomization (EBV/standard of care [SoC]) at 24 sites. Primary outcome at
12 months was the DELTAEBV-SoC of subjects with a post-bronchodilator
FEV<inf>1</inf> improvement from baseline of greater than or equal to 15%.
Secondary endpoints included absolute changes in postbronchodilator
FEV<inf>1</inf>, 6-minute-walk distance, and St. George's Respiratory
Questionnaire scores. Measurements and Main Results: A total of 190
subjects (128 EBV and 62 SoC) were randomized. At 12 months, 47.7% EBV and
16.8% SoC subjects had a DELTAFEV<inf>1</inf> greater than or equal to 15%
(P, 0.001). DELTAEBV-SoC at 12 months was statistically and clinically
significant: For FEV<inf>1</inf>, 0.106 L (P,0.001); 6-minute-walk
distance, 139.31 m (P = 0.002); and St. George's Respiratory
Questionnaire, 27.05 points (P = 0.004). Significant DELTAEBV-SoC were
also observed in hyperinflation (residual volume, 2522 ml; P,0.001),
modified Medical Research Council Dyspnea Scale (20.8 points; P,0.001),
and the BODE (body mass index, airflow obstruction, dyspnea, and exercise
capacity) index (21.2 points). Pneumothorax was the most common serious
adverse event in the treatment period (procedure to 45 d), in 34/128
(26.6%) of EBV subjects. Four deaths occurred in the EBV group during this
phase, and one each in the EBV and SoC groups between 46 days and 12
months. Conclusion(s): Zephyr EBV provides clinically meaningful
benefits in lung function, exercise tolerance, dyspnea, and quality of
life out to at least 12 months, with an acceptable safety profile in
patients with little or no collateral ventilation in the target lobe.
Clinical trial registered with www.clinicaltrials.gov (NCT
01796392). Copyright © 2018 by the American Thoracic Society.

<101>
Accession Number
624997287
Title
Nitric oxide decreases acute kidney injury and stage 3 chronic kidney
disease after cardiac surgery.
Source
American Journal of Respiratory and Critical Care Medicine. 198 (10) (pp
1279-1287), 2018. Date of Publication: 15 Nov 2018.
Author
Lei C.; Berra L.; Rezoagli E.; Yu B.; Dong H.; Yu S.; Hou L.; Chen M.;
Chen W.; Wang H.; Zheng Q.; Shen J.; Jin Z.; Chen T.; Zhao R.; Christie
E.; Sabbisetti V.S.; Nordio F.; Bonventre J.V.; Xiong L.; Zapol W.M.
Institution
(Lei, Dong, Hou, Chen, Shen, Xiong) Department of Anesthesiology and
Perioperative Medicine, Xijing Hospital, Fourth Military Medical
University, 127 West Changle Road, Xi'an, Shaanxi 710032, China
(Berra, Rezoagli, Yu, Zapol) Department of Anesthesia, Critical Care and
Pain Medicine, Massachusetts General Hospital, Harvard Medical School,
Boston, MA, United States
(Rezoagli) School of Medicine and Surgery, University of Milan-Bicocca,
Monza, Italy
(Yu, Chen, Wang, Zheng, Jin, Chen, Zhao) Department of Cardiovascular
Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an,
Shaanxi, China
(Christie, Sabbisetti, Bonventre) Division of Renal Medicine, Department
of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Nordio) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United
States
Publisher
American Thoracic Society (E-mail: malexander@thoracic.org)
Abstract
Rationale: No medical intervention has been identified that decreases
acute kidney injury and improves renal outcome at 1 year after cardiac
surgery. Objective(s): To determine whether administration of nitric
oxide reduces the incidence of postoperative acute kidney injury and
improves long-term kidney outcomes after multiple cardiac valve
replacement requiring prolonged cardiopulmonary bypass. Method(s):
Two hundred and forty-four patients undergoing elective, multiple valve
replacement surgery, mostly due to rheumatic fever, were randomized to
receive either nitric oxide (treatment) or nitrogen (control). Nitric
oxide and nitrogen were administered via the gas exchanger during
cardiopulmonary bypass and by inhalation for 24 hours postoperatively.
 Measurements and Main Results: The primary outcome was as follows:
oxidation of ferrous plasma oxyhemoglobin to ferric methemoglobin was
associated with reduced postoperative acute kidney injury from 64%
(control group) to 50% (nitric oxide group) (relative risk [RR], 0.78; 95%
confidence interval [CI], 0.62-0.97; P = 0.014). Secondary outcomes were
as follows: at 90 days, transition to stage 3 chronic kidney disease was
reduced from 33% in the control group to 21% in the treatment group (RR,
0.64; 95% CI, 0.41-0.99; P = 0.024) and at 1 year, from 31% to 18% (RR,
0.59; 95% CI, 0.36-0.96; P = 0.017). Nitric oxide treatment reduced the
overall major adverse kidney events at 30 days (RR, 0.40; 95% CI,
0.18-0.92; P = 0.016), 90 days (RR, 0.40; 95% CI, 0.17-0.92; P = 0.015),
and 1 year (RR, 0.47; 95% CI, 0.20-1.10; P = 0.041). Conclusion(s):
In patients undergoing multiple valve replacement and prolonged
cardiopulmonary bypass, administration of nitric oxide decreased the
incidence of acute kidney injury, transition to stage 3 chronic kidney
disease, and major adverse kidney events at 30 days, 90 days, and 1
year. Copyright © 2018 by the American Thoracic Society.

<102>
Accession Number
622035440
Title
Modeling statin-induced reductions of cardiovascular events in primary
prevention: A VOYAGER meta-analysis.
Source
Cardiology (Switzerland). 140 (1) (pp 30-34), 2018. Date of Publication:
01 Jun 2018.
Author
Karlson B.W.; Nicholls S.J.; Lundman P.; Barter P.J.; Palmer M.K.
Institution
(Karlson) AstraZeneca Gothenburg, Pepparedsleden 1, Molndal SE-43183,
Sweden
(Karlson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, SA, Australia
(Lundman) Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
(Barter) University of New South Wales, Sydney, NSW, Australia
(Palmer) Manchester Metropolitan University, School of Healthcare Science,
Manchester, United Kingdom
Publisher
S. Karger AG
Abstract
Objective: We used individual patient data from the VOYAGER database to
estimate cardiovascular (CV) risk reduction with commonly used
high-intensity statins. Method(s): In patients with known
atherosclerotic CV disease (ASCVD) treated with high-intensity statin
therapy (n = 6,735), the predicted risk reduction was estimated using the
Cholesterol Treatment Trialists' Collaboration meta-analysis, which
determined risk reduction per 38.7 mg/dL statin-mediated reduction in
low-density lipoprotein cholesterol. Result(s): The greatest
reductions in risk were seen in major vascular events (estimated rate
ratios ranged from 0.55 with rosuvastatin [RSV] 40 mg to 0.60 with
atorvastatin [ATV] 40 mg) and coronary heart disease death (estimated rate
ratios ranged from 0.58 with RSV 40 mg to 0.64 with ATV 40 mg).
 Conclusion(s): Our results show that, in individuals without clinical
ASCVD, statin therapy has the potential to reduce the frequency of CV
events. Copyright © 2018 S. Karger AG, Basel. All rights
reserved.

<103>
Accession Number
619713862
Title
The use of del Nido cardioplegia in adult cardiac surgery: A prospective
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (3) (pp 1011-1018),
2018. Date of Publication: March 2018.
Author
Ad N.; Holmes S.D.; Massimiano P.S.; Rongione A.J.; Fornaresio L.M.;
Fitzgerald D.
Institution
(Ad) Department of Cardiovascular and Thoracic Surgery, West Virginia
University, Morgantown, WVa, United States
(Ad, Massimiano, Rongione) Adventist HealthCare, Takoma Park, Md, United
States
(Ad) Inova Fairfax Hospital, Falls Church, Va, United States
(Holmes, Fornaresio) Heart and Vascular Institute, West Virginia
University Medicine, Morgantown, WVa, United States
(Fitzgerald) The Medical University of South Carolina, Charleston, SC,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The del Nido cardioplegia solution has been used extensively
in congenital heart surgery for more than 20 years and more recently for
adults. This randomized controlled trial examined whether expanding this
technique to adult cardiac surgery confers benefits in surgical workflow
and clinical outcome compared with blood-based cardioplegia.
 Method(s): Adult first-time coronary artery bypass grafting (CABG),
valve, or CABG/valve surgery patients requiring cardiopulmonary bypass
(CPB) were randomized to del Nido cardioplegia (n = 48) or whole blood
cardioplegia (n = 41). Primary outcomes assessed myocardial preservation.
Troponin I was measured at baseline, 2 hours after CPB termination, 12 and
24 hours after cardiovascular intensive care unit admission. Alpha was set
at P <.001. Result(s): Preoperative characteristics were similar
between groups, including age, Society of Thoracic Surgeons risk score,
CABG, and valve procedures. There was no significant difference on CPB
time (97 vs 103 minutes; P =.288) or crossclamp time (70 vs 83 minutes; P
=.018). The del Nido group showed higher return to spontaneous rhythm
(97.7% vs 81.6%; P =.023) and fewer patients required inotropic support
(65.1% vs 84.2%; P =.050), but did not reach statistical significance.
Incidence of Society of Thoracic Surgeons-defined morbidity was low, with
no strokes, myocardial infarctions, renal failure, or operative deaths.
For del Nido group patients, troponin levels did not increase as much as
for control patients (P =.040), but statistical significance was not
reached. Conclusion(s): Evidence from this study suggests del Nido
cardioplegia use in routine adult cases may be safe, result in comparable
clinical outcomes, and streamline surgical workflow. The trend for
troponin should be investigated further because it may suggest superior
myocardial protection with the del Nido solution. Copyright ©
2017 The American Association for Thoracic Surgery

<104>
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. Design(s):
Single, blinded, randomized control trial. Setting(s): Teaching
hospital. Participant(s): Twenty-five patients undergoing cardiac
surgery with CPB. Intervention(s): Subjects were randomly assigned
(1:1) to Inspire 8F (Sorin) or Affinity Fusion (Medtronic) oxygenators.
 Measurements and Main Results: The mean arterial blood concentration
in the Inspire 8F (Sorin) group was 59 (standard deviation [SD] 23)
micro g/mL, compared with 53 (SD 17) micro g/mL in the Affinity
Fusion (Medtronic) group with a nonsignificant mean difference of 6 (95%
confidence interval = -11, 22) micro 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). 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. Copyright © 2019

<105>
Accession Number
2002901808
Title
The Thoracic Surgery Social Media Network: Early experience and lessons
learned.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (4) (pp 1127-1136),
2019. Date of Publication: October 2019.
Author
Luc J.G.Y.; Ouzounian M.; Bender E.M.; Blitz A.; Stamp N.L.; Varghese
T.K.; Cooke D.T.; Antonoff M.B.
Institution
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, British Columbia, Canada
(Ouzounian) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
(Bender) Department of Cardiothoracic Surgery, Stanford University, Palo
Alto, Calif, United States
(Blitz) Division of Cardiac Surgery, University of Cincinnati Medical
Center, Cincinnati, OH, United States
(Stamp) Department of Cardiothoracic Surgery & Transplantation, Fiona
Stanley Hospital, Murdoch, Australia
(Varghese) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
(Cooke) Section of General Thoracic Surgery, University of California
Davis Health, Sacramento, Calif, United States
(Antonoff) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson Cancer Center, Houston, Tex, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The Thoracic Surgery Social Media Network (TSSMN) is a social
media collaborative formed in 2015 by The Annals of Thoracic Surgery and
The Journal of Thoracic and Cardiovascular Surgery to bring social media
attention to key publications from both journals and to highlight major
accomplishments in the specialty. Our aim is to describe TSSMN's
preliminary experience and lessons learned. Method(s): Twitter
analytics was used to obtain information regarding the @TSSMN Twitter
handle and #TSSMN hashtag. TweetChat and general hashtag #TSSMN analytics
were measured using Symplur (Symplur LLC, Los Angeles, Calif). A TSSMN
Tweeter App was created, and its use and downloads were analyzed.
 Result(s): Hashtag #TSSMN has a total of 17,181 tweets, 2100 users,
and 32,226,280 impressions, with peaks in tweeting activity corresponding
to TweetChats. Thirteen 1-hour TweetChats drew a total of 489
participants, 5195 total tweets, and 17,297,708 total impressions. The top
demographic category of TweetChat participants included Doctors (47%),
Advocates/Supports (11%), and Unknown (10%), with 3% characterized as
patients. The TSSMN Tweeter iTunes App (Apple, Cupertino, Calif) was
downloaded 3319 times with global representation. A total of 859 articles
were viewed through the App, with 450 articles from The Annals of Thoracic
Surgery and 409 from The Journal of Thoracic and Cardiovascular Surgery.
 Conclusion(s): We demonstrate that TSSMN further enhances the ability
for the journals to connect with their readership and the cardiothoracic
community. Ongoing studies to correlate social media attention with
article reads, article-level metrics, citations, and journal impact factor
are eagerly awaited. Copyright © 2019

<106>
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. 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. 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. Copyright © 2019
Elsevier Inc.

<107>
Accession Number
2002841812
Title
The Eternal Debate With a Consistent Answer: CABG vs PCI.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Farina P.; Gaudino M.F.L.; Taggart D.P.
Institution
(Farina) Department of Cardiothoracic Surgery, Mater Misericordiae
University Hospital, Dublin, Ireland
(Gaudino) Department of Cardiothoracic Surgery, John Radcliffe Hospital,
Oxford, United Kingdom
(Taggart) Department of Cardiothoracic Surgery, Weill Cornell Medical
College, New York, NY, United States
Publisher
W.B. Saunders
Abstract
An ongoing debate exists over the role of percutaneous coronary
intervention and coronary artery bypass grafting for revascularization in
patients with multivessel or left main disease. Despite improvements in
stent technology, bypass surgery still provides the best long-term results
in the majority of patients. The present review focuses on randomized
controlled trials and a meta-analysis published over the last 4
years. Copyright © 2019 Elsevier Inc.

<108>
Accession Number
2002925531
Title
TCT-381 TAVR-Patients at High Risk for Bleeding: Value of LAAO in This
Special Cohort.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B378), 2019. Date of Publication: 1 October
2019.
Author
Woitek F.; Haussig S.; Crusius L.; Mobius-Winkler S.; Sandri M.; Majunke
N.; Borger M.; Thiele H.; Abdel-Wahab M.; Mangner N.; Linke A.
Institution
(Woitek, Haussig, Mangner) Heart Center Dresden, Technical University of
Dresden, Dresden, Germany
(Crusius, Sandri, Majunke) University of Leipzig-Heart Center, Leipzig,
Germany
(Mobius-Winkler) University Jena, Jena, Germany
(Borger) Department of Cardiac Surgery, Leipzig Heart Center, Leipzig,
Germany
(Thiele, Abdel-Wahab) Heart Center Leipzig, University Hospital, Leipzig,
Germany
(Linke) Dresden University Hospital, Heart Center, Dresden, Germany
Publisher
Elsevier USA
Abstract
Background: The frequency of atrial fibrillation increases with advanced
age and comorbidities leading to a high co-incidence of patients receiving
transcatheter aortic valve replacement (TAVR) who are in need of oral
anticoagulation. Left atrial appendage occlusion (LAAO) is an alternative
to oral anticoagulation and may effect outcome in the TAVR cohort. The aim
of this study was to explore possible advantages of interventional LAAO in
TAVR patients. Method(s): Consecutive TAVR patients (n = 3,328) who
received TAVR between 2009 and 2017 were stratified according to the
presence of atrial fibrillation (pre-existing [PEAF] or new-onset [NOAF])
or sinus rhythm (SR) as well as whether they received LAAO at a time point
at the authors' center. NOAF was defined as any documented phase of AF
lasting for at least 30 s during the initial hospitalization phase.
All-cause mortality at 2 years was the primary endpoint. All endpoint
definitions were subject to the VARC-2 definitions. Result(s): SR was
present in 50.8% of the TAVR patients, 49.2% had AF (PEAF 43.0%; NOAF
5.2%). Only 1% of the global patient cohort (n = 29) received LAAO, most
of them shortly after the TAVR procedure (n = 22). LAAO patients had an
intermediate STS-PROM score of 7.6 +/- 1.3%, whereas the score was lower
in the SR group and higher in the AF groups (SR 7.3 +/- 0.9%; PEAF 8.9 +/-
0.3 and NOAF 7.9 +/- 0.6%; p < 0.05 vs. PEAF). There was no significant
difference between the groups with regard to the
CHA<inf>2</inf>DS<inf>2</inf>VASc and HAS-BLED score observed
(CHA<inf>2</inf>DS<inf>2</inf>VASc SR 5.4 +/- 0.04; PEAF 5.5 +/- 0.04;
NOAF 5.2 +/- 0.1, and LAAO 5.5 +/- 0.3; HAS-BLED SR 3.1 +/- 0.02; PEAF 3.1
+/- 0.03; NOAF 3.2 +/- 0.06, and LAAO 3.3 +/- 0.16; p > 0.05). VARC
success rates and safety endpoints as well as 30-day mortality were
comparable among the 4 groups (SR 5.1% vs. PEAF 5.6% vs. NOAF 2.4% vs.
LAAO 0%; p > 0.05) with a tendency to a better outcome for the SR and LAAO
group. At 2 years, mortality was significantly higher in patients with
PEAF compared with in patients with SR, LAAO, and NOAF (SR 16.4% vs. PEAF
25.5% vs. NOAF 18.9% vs. LAAO 18.2%; p < 0.05 vs. PEAF), predominantly
driven by a higher cardiovascular mortality. Conclusion(s): Bleeding
and stroke risk is high in TAVR patients. Patients who received both TAVR
and LAAO face a comparable outcome to patients with SR in this selected
patient cohort. LAAO in TAVR patients may be underutilized and should be
considered more often. Further controlled trials are needed to expand the
LAAO indication for this special patient cohort. Categories: STRUCTURAL:
Valvular Disease: Aortic Copyright © 2019

<109>
Accession Number
2002925530
Title
TCT-424 Systematic Review and Pooled Analysis of New- Versus
Old-Generation Valves for Transcatheter Aortic Valve Replacement in
Bicuspid Aortic Stenosis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B420), 2019. Date of Publication: 1 October
2019.
Author
Butt N.; Khan J.; Rogers T.; Kolm P.; Mussalam A.; Edelman J.; Khalid N.;
Shlofmitz E.; Chen Y.; Iantorno M.; Gajanana D.; Torguson R.; Weintraub
W.; Waksman R.
Institution
(Butt, Khan, Rogers, Kolm, Mussalam, Edelman, Khalid, Shlofmitz, Chen,
Iantorno, Gajanana, Torguson, Weintraub, Waksman) MedStar Washington
Hospital Center, Washington, DC, United States
Publisher
Elsevier USA
Abstract
Background: Clinical trials of transcatheter aortic valve replacement
(TAVR) in aortic stenosis have typically excluded bicuspid aortic valves.
New-generation valves (Sapien 3, Edwards Lifesciences; Evolut R/Pro,
Medtronic; Lotus, Boston) may have improved outcomes compared with those
of their older counterparts (Sapien and Sapien XT, Edwards Lifesciences;
CoreValve, Medtronic). This study compared available data on new- versus
old-generation valves for TAVR in bicuspid aortic valves. Method(s):
A search of the PubMed and Cochrane databases using terms "TAVR,"
"Bicuspid," "TAVI," "Transcatheter aortic valve implantation," and
"Transcatheter aortic valve replacement" yielded 208 results. A large
single study from a 2019 national meeting was also included. Nonrelevant
studies, studies with fewer than 10 patients, and duplicate data were
removed. Nineteen studies met our inclusion criteria (Figure). [Figure
presented] Results: From January 2010 to April 2019, 4,103 patients had
TAVR for bicuspid aortic stenosis, of which 1,020 (24.9%) used
old-generation valves and 3,083 (75.1%) used new-generation valves. Pooled
analysis using VARC-2 outcomes showed that new-generation valves were
associated with decreased mortality (odds ratio [OR]: 0.36; 95% confidence
interval [CI]: 0.27 to 0.48), paravalvular leak (OR: 0.12; 95% CI: 0.06 to
0.23), and permanent pacemaker insertion (OR: 0.49; 95% CI: 0.35 to 0.68)
when compared with old-generation valves. However, no difference in
incidence of stroke or major bleeding was noted. Conclusion(s): Our
pooled analysis suggests new generation valves, compared with
old-generation valves, are safer for TAVR in bicuspid aortic valve
stenosis. However only 2 studies directly compared both generations of
valves, hence a meta-analysis could not be performed. Categories:
ENDOVASCULAR: Aortic Disease and Aortic Intervention Copyright ©
2019

<110>
Accession Number
2002925519
Title
TCT-311 4-Year Clinical Outcomes in High Bleeding Risk Patients After
Surgical or Percutaneous Left Main Coronary Artery Revascularization: The
EXCEL Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B309), 2019. Date of Publication: 1 October
2019.
Author
Claessen B.; Giustino G.; Ben-Yehuda O.; Taggart D.; Kandzari D.; Morice
M.-C.; Mehran R.; Kini A.; Guedeney P.; Kappetein A.P.; Sabik J.; Serruys
P.; Stone G.
Institution
(Claessen) Mount Sinai Hospital, New York, NY, United States
(Giustino, Guedeney) Icahn School of Medicine at Mount Sinai, New York,
NY, United States
(Ben-Yehuda) Cardiovascular Research Foundation, Columbia University
Medical Center, New York, NY, United States
(Taggart) Oxford University, Oxford, United Kingdom
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Morice) CERC, Massy, France
(Mehran) The Zena and Michael A. Wiener Cardiovascular Institute, Mount
Sinai Hospital, New York, NY, United States
(Kini) Mount Sinai Health System, New York, NY, United States
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Sabik) Department of Thoracic and Cardiovascular Surgery, The Cleveland
Clinic Foundation, Cleveland, OH, United States
(Serruys) Imperial College, London, United Kingdom
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center/New York-Presbyterian Hospital, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: There is little data on long-term outcomes in high bleeding
risk (HBR) patients undergoing percutaneous coronary intervention (PCI) or
coronary artery bypass graft (CABG) for left main coronary artery disease.
 Method(s): In the EXCEL trial, 1,905 patients with left main coronary
artery disease and low or intermediate SYNTAX scores were randomized to
PCI with everolimus-eluting stents versus CABG. Patients with >=1 of the
following criteria were considered HBR: age >=75 years; thrombocytopenia
(<100,000/mm3); anemia (hemoglobin <10 g/dl); creatinine
clearance <40 m1/min; and prior stroke. Four-year outcomes in HBR and
non-HBR patients were analyzed. Result(s): In EXCEL, 1,174 patients
(61.6%) were considered HBR according to the aforementioned definition.
HBR patients were older, more often female, less often Caucasian, and more
often had hypertension, diabetes, and chronic obstructive pulmonary
disease. Four-year rates of the primary endpoint (death, myocardial
infarction [MI], or stroke) were significantly higher in HBR versus
non-HBR patients (19.4% vs. 14.9%; p = 0.02), as was Bleeding Academic
Research Consortium (BARC) 3 to 5 bleeding (7.8% vs. 5.0%; p = 0.02).
There were no significant interactions between HBR status and randomized
treatment regarding the primary outcome, BARC 3 to 5 bleeding, or other
endpoints at 4-year follow-up (Table). [Figure presented]
 Conclusion(s): In EXCEL, HBR patients had significantly higher rates
of the primary endpoint and BARC 3 to 5 bleeding at 4-year follow-up.
During follow-up, PCI compared with CABG resulted in lower rates of BARC 3
to 5 bleeding, higher rates of ischemia-driven revascularization, and
similar composite rates of death, MI, or stroke regardless of HBR status.
Categories: CORONARY: Stents: Drug-Eluting Copyright © 2019

<111>
Accession Number
2002925509
Title
TCT-369 Efficacy and Safety of Figure-of-Eight Suture Versus Manual
Pressure for Venous Access Closure: A Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B366), 2019. Date of Publication: 1 October
2019.
Author
Atti V.; Angirekula A.; Turagam M.; Velagapudi P.; Gidda K.; Patel S.;
Mujer M.T.; Patel N.; Rayamajhi S.; Lakkireddy D.
Institution
(Atti, Mujer) Michigan State University, Lansing, MI, United States
(Angirekula) Odessa High School, Odessa, TX, United States
(Turagam) Mount Sinai Hospital, New York, NY, United States
(Velagapudi) University of Nebraska Medical Center, Omaha, NE, United
States
(Gidda) Mercy Health St. Vincent Medical Center, Toledo, OH, United States
(Patel) Health Quest Department of Internal Medicine/Vassar Brothers
Medical Center, Poughkeepsie, NY, United States
(Patel) Icahn School of Medicine, New York, NY, United States
(Rayamajhi) Michigan State University, East Lansing, MI, United States
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Kansas City, MO, United States
Publisher
Elsevier USA
Abstract
Background: Vascular hemostasis after venous access in cardiovascular
procedures remains a challenge. Figure-of-eight (FoE) emerged as an
alternative technique to manual pressure. However, its feasibility and
safety is unknown. Method(s): A comprehensive search in, PubMed, Web
of Science, EBSCO Services, Cochrane Central Register of Controlled
Trials, Google Scholar, and various scientific conference sessions from
inception to December 1, 2018, was performed. A meta-analysis was
performed using random-effects model to calculate risk ratio (RR) and mean
difference with 95% confidence interval (CI). Result(s): Seven
studies were eligible and included 1,978 patients, of whom 982 patients
received the FoE suture whereas 996 received manual pressure. There was no
difference in the risk of access site pseudoaneurysm (RR: 0.48; 95% CI:
0.13 to 1.73; p = 0.26) and fistula (RR: 0.90; 95% CI: 0.22 to 3.75; p =
0.89) between the 2 techniques. Compared with manual pressure, FoE was
associated with lower risk of access site complications (RR: 0.37; 95% CI:
0.24 to 0.58, 0.65; p < 0.0001) including bleeding (RR: 0.30; 95% CI: 0.18
to 0.50; p < 0.00001) and hematoma (RR: 0.41; 95% CI: 0.25 to 0.68, 0.83;
p = 0.0005). Time to hemostasis was significantly lower with FoE than with
manual pressure (mean difference: -21.04 min; 95% CI: -35.66 to -6.42; p =
0.005) (Figures 1.2 to 1.5). [Figure presented] Conclusion(s): The
results of this meta-analysis showed that there was no difference in the
risk of access site pseudoaneurysm and fistula between FoE and manual
pressure. Compared with manual pressure, FoE was associated with lower
risk of access site hematoma and bleeding. These results reiterate the
safety and feasibility of FoE suture for venous access closure.
Categories: ENDOVASCULAR: Complications Copyright © 2019

<112>
Accession Number
2002925462
Title
TCT-820 Systematical Review and Meta-Analysis on the Use of Inotropes and
Vasopressors in Cardiogenic Shock: Time to Close the Gap Between Current
Clinical Practice and Evidence?.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B803), 2019. Date of Publication: 1 October
2019.
Author
Karami M.; Hemradj V.; Ouweneel D.; Vlaar A.; Lagrand W.K.; Henriques
J.P.S.
Institution
(Karami, Ouweneel, Vlaar, Lagrand, Henriques) Amsterdam UMC, University of
Amsterdam, Amsterdam, the Netherlands, Netherlands
(Hemradj) Isala Heart Centre, Zwolle, the Netherlands, Netherlands
Publisher
Elsevier USA
Abstract
Background: Vasopressors and inotropes are routinely used in the treatment
of cardiogenic shock (CS) to improve hemodynamic status and restore organ
perfusion. However, in the absence of solid clinical evidence, it is
unclear whether these drugs represent the best treatment strategy in all
patients with CS. We therefore performed a systematic review and
meta-analysis to investigate the effects of different vasopressors and
inotropes on mortality. Method(s): Medline, Embase, and CENTRAL were
searched from inception to February 2019. We included all studies
(randomized controlled trials [RCTs] and observational studies) that
reported mortality in CS, including patients with acute myocardial
infarction, with at least 1 group receiving vasopressor or inotrope
therapy compared with a control group that was not exposed to the
vasopressor or inotrope. The following drugs were included: epinephrine,
norepinephrine, milrinone, levosimendan, dobutamine, and dopamine.
Exclusion criteria were case reports, correspondence, and studies
reporting only on post-cardiac surgery patients. Result(s): A total
of 7,433 studies were screened, and 14 studies (4 RCTs) were included,
comprising 1,277 patients with CS. Because most studies were
observational, the overall quality of evidence was low. None of the pooled
estimates of the different vasopressors or inotropes showed a difference
in short-term (<90-day) mortality between the therapy and control groups
(Figure; short-term mortality of patients with CS treated with a
vasopressor or inotrope vs. a constructed control group). We found a trend
toward treatment with levosimendan, compared with control (risk ratio:
0.69; 95% confidence interval: 0.47 to 1.00) (Figure). [Figure presented]
 Conclusion(s): In this systematic review and meta-analysis, we found
that none of the vasopressor or inotropic drugs was associated with
differences in mortality in patients with CS. This implies that
comparative studies are necessary to close the knowledge gap between
common clinical practice and current evidence. Categories: CORONARY:
Hemodynamic Support and Cardiogenic Shock Copyright © 2019

<113>
Accession Number
2002925428
Title
TCT-99 Outcomes With Retrograde Versus Antegrade Chronic Total Occlusion
Revascularization.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B99), 2019. Date of Publication: 1 October
2019.
Author
Megaly M.; Ali A.; Saad M.; Omer M.; Xenogiannis I.; Werner G.;
Karmpaliotis D.; Russo J.; Yamane M.; Garbo R.; Ungi I.; Rinfret S.;
Pershad A.; Garcia S.; Sianos G.; Mashayekhi K.; Galassi A.; Burke M.N.;
Brilakis E.
Institution
(Megaly, Omer, Xenogiannis) Minneapolis Heart Institute, Minneapolis, MN,
United States
(Ali) Mercy Hospital and Medical Center, Chicago, IL, United States
(Saad) University of Arkansas for Medical Sciences, Little Rock, AR,
United States
(Werner) Klinikum Darmstadt, Darmstadt, Germany
(Karmpaliotis) Interventional Cardiologist, New York, New York, United
States
(Russo) NewYork-Presbyterian/Columbia University Medical Center, New York,
NY, United States
(Yamane) Saitama Sekishinkai Hospital, Sayama City, Japan
(Garbo) San Giovanni Bosco Hospital, Turin, Italy
(Ungi) University of Szeged, Szeged, Hungary
(Rinfret) McGill University Health Centre (MUHC), Montreal, Quebec, Canada
(Pershad) Banner University Medical Center Phoenix, Phoenix, AZ, United
States
(Garcia) Minneapolis Heart Institute Foundation, Minneapolis, MN, United
States
(Sianos) AHEPA University Hospital, Thessaloniki, Greece
(Mashayekhi) University Heart Center Bad Krozingen, Bad Krozingen, Germany
(Galassi) University of Catania, Catania, Italy
(Burke, Brilakis) Minneapolis Heart Institute, Abbott Northwestern
Hospital, Minneapolis, MN, United States
Publisher
Elsevier USA
Abstract
Background: The retrograde approach has contributed to a substantial
increase in the success rate of chronic total occlusion (CTO) percutaneous
coronary intervention (PCI), but has been associated with higher risk for
complications. Method(s): We conducted a systematic review and
meta-analysis including studies from 2000 to April 2019 comparing the
in-hospital and long-term outcomes with retrograde versus antegrade CTO
PCI. Result(s): A total of 10 observational studies (n = 7,159
patients [7,270 lesions]) met our inclusion criteria (retrograde approach
1,839 patients [1,864 lesions], antegrade approach 5,320 patients [5,406
lesions]). The lesions treated with the retrograde approach were longer
(35.2 +/- 13.6 mm vs. 21.9 +/- 9 mm; p < 0.001) and had higher J-CTO score
(2.9 +/- 1 vs. 1.8 +/- 0.9; p < 0.001) compared with the lesions treated
with the antegrade approach. Both retrograde and antegrade CTO PCI were
associated with similar in-hospital mortality (0.54% vs. 0.23%; odds ratio
[OR]: 1.94; 95% confidence interval [CI]: 0.73 to 5.13; p = 0.18), urgent
revascularization (0.27% vs. 0.42%; OR: 0.87; 95% CI: 0.28 to 2.73; p =
81), and cerebrovascular events (0.51% vs. 0.19%, OR: 2.11; 95% CI: 0.8 to
5.53; p = 0.13). Retrograde CTO PCI was associated with higher risk of
in-hospital myocardial infarction (MI) (3.13% vs. 1.44%; OR: 2.23; 95% CI
: 1.42 to 3.51; p < 0.001), urgent pericardiocentesis (1.14% vs. 0.49%;
OR: 2.09; 95% CI: 1.07 to 4.09; p = 0.003) and contrast-induced
nephropathy (3.65% vs. 1.77%; OR: 1.90; 95% CI: 1.18 to 3.06; p = 0.008)
compared with antegrade CTO PCI. At a mean follow-up duration of 48 +/- 31
months, no difference in long-term mortality (13% vs. 8.8%, OR: 1.79; 95%
CI: 0.84 to 3.81; p = 0.13) was noted between both groups. However,
retrograde CTO PCI was associated with a higher risk of MI (5.6% vs. 2.6%;
OR: 2.07; 95% CI: 1.10 to 3.88; p = 0.02), target vessel revascularization
(32.3% vs. 17.3%; OR: 1.92; 95% CI: 1.49 to 2.46; p < 0.001), and target
lesion revascularization (12.9% vs. 7.2%; OR: 2.08; 95% CI: 1.33 to 3.25;
p = 0.001) compared with antegrade CTO PCI (Figure). [Figure presented]
 Conclusion(s): Compared with antegrade CTO PCI, the retrograde
approach is performed in more complex lesions and is associated with a
higher risk for acute and long-term adverse events. Categories: CORONARY:
Complex and Higher Risk Procedures for Indicated Patients
(CHIP) Copyright © 2019

<114>
Accession Number
2002925334
Title
TCT-723 Transcatheter Versus Surgical Aortic-Valve Replacement in Patients
With Severe Aortic Stenosis: A Systematic Review and Meta-Analysis of
Randomized Controlled Trials.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B710), 2019. Date of Publication: 1 October
2019.
Author
Wang L.; Zhang X.; Xu B.
Institution
(Wang, Xu) Affiliated Drum Tower Hospital, Nanjing University School of
Medicine, Nanjing, China, China
(Zhang) Nanjing University School of Medicine, Nanjing, Jiangsu, China,
China
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as a
promising strategy for treating patients with severe aortic stenosis. We
aimed to compare the safety and efficacy of TAVR with those of surgical
aortic valve replacement (SAVR) and to determine the performance change of
TAVR with time and within several subgroups. Method(s): Randomized
trials were included. Data of 30-day, 1-year, 2-year, and long-term (>=2
years) follow-up were analyzed separately. Result(s): Eight trials
with 7,841 patients were included. Compared with SAVR, TAVR was associated
with a lower rate of all-cause mortality or disabling stroke at 30-day
(odds ratio [OR]: 0.72; p = 0.004), 1-year (OR: 0.83; p = 0.01), and
2-year (OR: 0.86; p = 0.02) but not at long-term (>=2 years) follow-up
(rate ratio [RR]: 1.02; 95% confidence interval [CI]: 0.92 to 1.13; p =
0.67). Notably, 5-year data showed numerically higher incidence in TAVR
(RR: 1.11; 95% CI: 0.97 to 1.27; p = 0.12). The risks associated with TAVR
versus SAVR increased over time, showing a significant interaction (p for
interaction = 0.002), as were those for new-onset atrial fibrillation and
rehospitalization (p for interaction = 0.005 and 0.02 respectively). Other
outcomes are presented in the Figure. TAVR with a transfemoral approach
and new-generation valve was associated with reduction in all-cause
mortality or disabling stroke compared with corresponding comparators
(Figure). [Figure presented] Conclusion(s): Compared with SAVR, TAVR
was associated with a lower risk for all-cause mortality or disabling
stroke within 2 years, but not at long-term follow-up; the risk seems to
increase over time. More data are needed to confirm longer term
performance of TAVR. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2019

<115>
Accession Number
2002925326
Title
TCT-727 Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk
Patients: A Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B713), 2019. Date of Publication: 1 October
2019.
Author
Rogers T.; Sondergaard L.; Zhang C.; Craig P.; Torguson R.; Waksman R.
Institution
(Rogers, Torguson, Waksman) MedStar Washington Hospital Center,
Washington, DC, Denmark
(Sondergaard) Rigshospitalet University Hospital, Copenhagen, Denmark,
Denmark
(Zhang, Craig) MedStar Cardiovascular Research Network, Washington, DC,
Denmark
Publisher
Elsevier USA
Abstract
Background: Much of the benefit of transcatheter aortic valve replacement
(TAVR) versus surgical aortic valve replacement (SAVR) in randomized
trials of patients at low surgical risk with severe aortic stenosis
appeared to be driven by a reduction in rehospitalization. Missing or
unpublished data and different trial designs and statistical methodology
make comparisons between trials for the clinical endpoint of death or
disabling stroke challenging. Method(s): Survival and disabling
stroke data were either directly available or extracted from Kaplan-Meier
plots using software that digitizes graphs into coordinates. This
technique allowed the calculation of variance estimates, necessary to
execute a random-effect model. Accuracy was evaluated by comparing
recreated and original accumulative incidence rates. Within the
normal-normal hierarchical model, a Bayesian random-effect model is more
appropriate than a frequentist model because of the small number of
trials. The treatment effect (TE) was the risk difference (TAVR - SAVR),
and the uniform was set on [-1, 1] as its prior. The shrinkage prior was
used for heterogeneity. Both are proper, noninformative priors.
 Result(s): Figure 1A depicts the posterior marginal distribution of
the TE. A negative TE favors TAVR. The 95% credible interval was -3.8% to
0.4%. The posterior probability of TE <0 was 0.95, compared with 0.5
prior. Figure 1B depicts the forest plot for the combined endpoint of
mortality and disabling stroke. Conclusion(s): This meta-analysis
strongly favors TAVR for the clinical endpoint of death or disabling
stroke, supporting expansion of TAVR to patients at low surgical risk.
Categories: STRUCTURAL: Valvular Disease: Aortic Copyright © 2019

<116>
Accession Number
2002925315
Title
TCT-68 Influence of Final Kissing Balloon Inflation on Long-Term Outcomes
After PCI of Distal Left Main Bifurcation Lesions: Analysis From the EXCEL
Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B68), 2019. Date of Publication: 1 October
2019.
Author
Kini A.; Dangas G.; Baber U.; Vengrenyuk Y.; Kandzari D.; Leon M.; Morice
M.-C.; Serruys P.; Kappetein A.P.; Sabik J.; Dressler O.; Mehran R.;
Sharma S.; Stone G.
Institution
(Kini, Sharma) Mount Sinai Health System, New York, NY, United States
(Dangas, Baber, Mehran) Zena and Michael A. Wiener Cardiovascular
Institute, Mount Sinai Hospital, New York, NY, United States
(Vengrenyuk) Mount Sinai Hospital, New York, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia, Georgia
(Leon) Columbia University Medical Center/NewYork-Presbyterian Hospital,
New York, United States
(Morice) CERC, Massy, France
(Serruys) Imperial College, London, United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Sabik) Department of Thoracic and Cardiovascular Surgery, The Cleveland
Clinic Foundation, Cleveland, OH, United States
(Dressler) Cardiovascular Research Foundation, New York, NY, United States
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center/NewYork-Presbyterian Hospital, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Final kissing balloon inflation (FKBI) after percutaneous
coronary intervention (PCI) of bifurcation lesions has been advocated
based on bench tests and computer simulations; however, the impact of FKBI
on long-term clinical outcomes remains controversial. The study aims to
determine the impact of FKBI on 4-year outcomes after PCI of distal left
main (LM) bifurcation lesions in relation to a 1- or 2-stent strategy.
 Method(s): The EXCEL trial was a multinational randomized study that
compared PCI with everolimus-eluting stents and coronary artery bypass
graft surgery in patients with LM disease. We examined the baseline
characteristics and 4-year clinical outcomes after PCI of a distal LM
bifurcation lesion according to use of FKBI. The primary endpoint was the
composite rate of death, myocardial infarction (MI), or stroke. The major
secondary endpoint was the composite rate of death, MI, stroke or
ischemia-driven revascularization (IDR). Result(s): Among 948
patients randomized to PCI, 759 had distal LM lesions treated, 430 and 329
of which were treated with 1 stent and >=2 stents, respectively. FKBI was
performed in 175 (40.7%) and 235 (71.4%) 1-stent and >=2-stent patients,
respectively. After multivariable adjustment for baseline differences, the
4-year rate of the primary endpoint was similar with versus without FKBI
in both the 1-stent (17.5% vs. 15.9%, respectively; adjusted hazard ratio
[HR]: 1.12; 95% CI: 0.68 to 1.84; p = 0.65) and >=2-stent (19.8% vs. 25.8%
respectively; adjusted HR: 0.65; 95% CI: 0.38 to 1.10; p = 0.11) groups
(Figure 1). Nor were there significant differences in the major secondary
endpoint after FKBI versus no FKBI in the 1-stent and >=2-stent groups:
25.0% vs. 25.9% (adjusted HR: 1.02; 95% CI: 0.68 to 1.53; p = 0.92) and
32.3% vs. 33.2% (adjusted HR: 0.77; 95% CI: 0.49 to 1.22; p = 0.27).
 Conclusion(s): In the EXCEL trial, the performance of FKBI after PCI
of distal LM bifurcation lesions was not associated with improved 4-year
clinical outcomes regardless of whether 1 stent or >=2 stents were
implanted. Randomized trials are warranted to evaluate the utility of
FKBI. Categories: CORONARY: Stents: Drug-Eluting Copyright © 2019

<117>
Accession Number
2002925314
Title
TCT-721 Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement
in Low-Risk Patients: A Meta-Analysis of Randomized Controlled Trials.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B708), 2019. Date of Publication: 1 October
2019.
Author
Koshy A.; Murphy A.; Farouque O.; Horrigan M.; Yudi M.
Institution
(Koshy, Murphy, Farouque, Horrigan, Yudi) Austin Health, Melbourne,
Australia, Australia
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has
revolutionized the treatment of severe aortic stenosis (AS), though its
safety and efficacy in low-risk patients remains to be established.
 Method(s): A systematic review of PubMed, Medline, and Embase
identified 4 randomized controlled trials (RCTs) in patients at low
surgical risk comparing TAVR with surgical aortic valve replacement
(SAVR). A meta-analysis was performed using a random-effects model with a
primary outcome of a composite of all-cause mortality and stroke.
 Result(s): A total of 4 RCTs with 2,836 patients were included in the
final analysis. A total of 1,363 patients were randomized to SAVR and
1,473 to TAVR. The composite of all-cause mortality and stroke was
significantly lower in patients undergoing TAVR compared with SAVR (odds
ratio [OR]: 0.59; 95% confidence interval [CI]: 0.37 to 0.95; p = 0.03;
I2 = 31%). The difference in the primary composite outcome was
driven by a difference in mortality (OR: 0.66; 95% CI: 0.44 to 0.98; p =
0.04; I2 = 0%), without significant differences in stroke (OR:
0.75; 95% CI: 0.45 to 1.26; p = 0.28; I2 = 37%). Patients
undergoing TAVR had a significantly higher risk for permanent pacemaker
implantation (OR: 3.9; 95% CI: 1.8 to 8.4; p < 0.001; I2 = 84%)
and moderate or severe paravalvular leak (OR: 5.0; 95% CI: 1.6 to 15.7; p
= 0.01; I2 = 19%) (Figures A to C). [Figure presented]
 Conclusion(s): In patients with severe AS at low surgical risk, the
rate of the composite of death and stroke was significantly lower with
TAVR than with SAVR. Longer term follow-up with a focus on the impact of
permanent pacemaker implantation, paravalvular leak, and structural valve
deterioration is essential before the use of TAVR can be generalized to
the broader population of patients with AS. Categories: ENDOVASCULAR:
Aortic Disease and Aortic Intervention Copyright © 2019

<118>
Accession Number
2002925292
Title
TCT-73 The Relative Effects of New Pacemakers Versus Left Bundle Branch
Block on Clinical and Echocardiographic Outcomes in the PARTNER Trials.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B73), 2019. Date of Publication: 1 October
2019.
Author
Dizon J.; Nazif T.; Crowley A.; George I.; Kodali S.; Thourani V.; Mack
M.; Leon M.
Institution
(Dizon, Nazif, George, Leon) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Crowley) Cardiovascular Research Foundation, New York, NY, United States
(Kodali) Columbia University Medical Center, New York, NY, United States
(Thourani) MedStar Heart & Vascular Institute, Washington, DC, United
States
(Mack) The Heart Hospital Baylor Plano, Plano, TX, United States
Publisher
Elsevier USA
Abstract
Background: Despite evolving technology, cardiac conduction disturbances
requiring permanent pacing remain a complication of transcatheter aortic
valve replacement (TAVR) in a significant number of patients. The
long-term effect of permanent pacemakers after TAVR has been variable by
previous reports, whereas left bundle branch block (LBBB) has been
associated with poor outcomes. We analyzed the combined data from the
PARTNER randomized trials and registries to assess the effect of new
pacemakers and LBBB on 2-year clinical and echocardiographic outcomes.
 Method(s): This analysis included high- and intermediate-risk
surgical candidates who underwent TAVR in the PARTNER studies, including
PARTNER 1A; PARTNER 2A, nonrandomized continued access protocols, and the
S3 intermediate- and high-risk registries. Patients with baseline LBBB or
pre-existing pacemakers were excluded. The 2-year outcomes for total
mortality, mortality/hospitalization, cardiovascular death, and left
ventricular ejection fraction (LVEF) (using a baseline adjusted analysis
of covariance model) were compared between patients with new pacemakers
(PM), new LBBB, and no pacemaker or LBBB (NL). Result(s): The PM
group (n = 315) had a nonsignificant higher rate of adverse clinical
outcomes compared with the NL group (n = 2,460) at 2 years (p = 0.08 for
mortality/hospitalization and cardiovascular death). PM patients had
significantly lower average LVEF at 2 years compared with NL patients
(54.9% vs. 58.7%; p < 0.001). In contrast, LBBB patients (n = 215) had
poorer LVEF and significantly worsened clinical outcomes across the board
compared with NL patients (p < 0.001 for all). Conclusion(s): Among
intermediate and high-risk patients who underwent TAVR in the PARTNER
studies, permanent pacemaker implantation within 30 days did not have
significantly worsened clinical outcomes, but average LVEF was
significantly worsened at 2 years relative to nonpaced patients. In
contrast, new LBBB was strongly associated with worsened clinical outcomes
and poorer LVEF at 2 years. Whether these results can be explained by a
protective effect of pacing or less deleterious effects on LV function
relative to LBBB will require further study. Categories: STRUCTURAL:
Valvular Disease: Aortic Copyright © 2019

<119>
Accession Number
2002925253
Title
TCT-728 Low-Risk Transcatheter Versus Surgical Aortic Valve Replacement: A
Meta-Analysis of Randomized Controlled Trials.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B714), 2019. Date of Publication: 1 October
2019.
Author
Narayanan M.A.; Kandasamy V.V.; Reddy Y.N.V.; Megaly M.; Baskaran J.;
Pershad A.; Suri R.; Garcia S.
Institution
(Narayanan) University of Minnesota, Minneapolis, Minnesota, United Arab
Emirates
(Kandasamy) University of Louisville, Louisville, Kentucky, United Arab
Emirates
(Reddy) Mayo Clinic, Rochester, Minnesota, United Arab Emirates
(Megaly) Minneapolis Heart Institute, Minneapolis, Minnesota, United Arab
Emirates
(Baskaran) CHI Health Creighton University Medical Center, Omaha,
Nebraska, United Arab Emirates
(Pershad) Banner University Medical Center Phoenix, Phoenix, Arizona,
United Arab Emirates
(Suri) Cleveland Clinic, Abu Dhabi, United Arab Emirates, United Arab
Emirates
(Garcia) Minneapolis Heart Institute at Abbott Northwestern Hospital,
Minneapolis, Minnesota, United Arab Emirates
Publisher
Elsevier USA
Abstract
Background: Current guidelines recommend surgical aortic valve replacement
(SAVR) for patients with severe symptomatic aortic stenosis (AS) and low
surgical risk. A few randomized controlled trial (RCTs) have evaluated
transcatheter aortic valve replacement (TAVR) in patients at low surgical
risk, but equipoise exists related to TAVR valve durability, paravalvular
leak (PVL), and the role of TAVR in younger patients at low surgical risk.
We aimed to perform a meta-analysis including all available RCTs to date
comparing TAVR with SAVR in patients with severe AS and low surgical risk.
 Method(s): Five databases were analyzed from January 2000 to March
2019 for RCTs comparing SAVR with TAVR in low-risk patients with severe
AS. Result(s): Four RCTs of low-risk TAVR patients with 2,887
patients were included. Mean follow-up duration was about 24.1 +/- 24
months. Early mortality was lower with TAVR compared with SAVR (risk ratio
[RR]: 0.44; 95% confidence interval [CI]: 0.20 to 0.95; p = 0.038),
whereas long-term mortality was similar (RR: 0.67; 95% CI: 0.39 to 1.14; p
= 0.141). Both early and long-term stroke rates were similar. TAVR was
associated with lower risk for atrial fibrillation, major bleeding, acute
kidney injury, and rehospitalization but higher rates of pacemaker
implantation and moderate or severe PVL. There was no difference in major
vascular complications, myocardial infarction, endocarditis, aortic valve
gradients, and valve area at follow-up (Figures 1A and 1B). [Figure
presented] Conclusion(s): In low-risk patients with severe AS, TAVR
has a lower early mortality compared with SAVR with no difference in
long-term mortality. Transfemoral TAVR may be an appropriate treatment
option for severe symptomatic AS, irrespective of surgical risk.
Categories: STRUCTURAL: Valvular Disease: Aortic Copyright © 2019

<120>
Accession Number
2002925244
Title
TCT-241 Inadvertent Aortocoronary Arteriovenous Fistula After Coronary
Artery Bypass Surgery: A Systematic Review.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B240), 2019. Date of Publication: 1 October
2019.
Author
Chen K.; Scridon T.; Sabates A.; Midwall J.; Kieval J.; Chait R.
Institution
(Chen, Sabates) University of Miami, Atlantis, FL, United States
(Scridon) Florida State University College of Medicine, Tallahassee, FL,
United States
(Midwall) Boca Raton, Florida, United States
(Kieval) Vero Beach Cardiovascular Associates, Cleveland Clinic Indian
River Hospital, Vero Beach, FL, United States
(Chait) JFK Medical Center/University of Miami, Atlantis, FL, United
States
Publisher
Elsevier USA
Abstract
Background: Inadvertent aortocoronary arteriovenous fistula (ACAVF) is a
rare complication following coronary artery bypass grafting surgery
(CABG). The aim of this study was to investigate the incidence and trend
of management for ACAVF. Method(s): To identify all published cases
of ACAVF following CABG, MEDLINE and EMBASE were searched through June
2018. We defined ACAVF as inadvertent attachment of the grating vessel
onto a cardiac vein instead of targeted coronary artery. A systematic
review was performed to identify the incidence, clinical features, and
management, and related outcomes were analyzed. Result(s): A total of
48 post-CABG ACAVF cases were gathered. Among these patients, the mean age
was 61.8 years and 81.3% were men. Most common presenting symptoms were
chest pain (60.4%) and dyspnea (29.2%). The average onset of symptoms was
3 years; however, 54.2% of patients developed symptoms within the first
year. The majority of cases reported targeted native vessel LAD during
CABG (62.5%). Of these cases, 8 (16.7%) were managed conservatively, 9
(18.8%) chose to undergo surgery including ligation and repeating CABG,
and 27 (56.3%) underwent percutaneous closure. Among these patients, 13
cases (27.1%) were managed with coil embolization, 5 (10.4%) with balloon
embolization, 5 (10.4%) were treated with a covered stent, and 4 (8.3%)
used a vascular plug. There were no reported complications following
treatment in this group (Figure 1). [Figure presented] Conclusion(s):
Inadvertent ACAVF are rare following CABG. Percutaneous closure was
feasible and safe in treating these patients. Categories: STRUCTURAL:
Complications Copyright © 2019

<121>
Accession Number
2002925243
Title
TCT-427 Meta-Analysis Comparing Safety and Outcomes After Transcatheter
Aortic Valve Replacement in Bicuspid Aortic Stenosis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B422), 2019. Date of Publication: 1 October
2019.
Author
Sridhara S.; Gavhane P.; Pandya B.; Kumar A.; Kanwar N.; Rodriguez J.;
Hiriyur Prakash M.P.; Panchal H.
Institution
(Sridhara, Hiriyur Prakash) Banner University Medical Center, Phoenix,
Arizona, Georgia
(Gavhane) Arizona State University, Phoenix, Arizona, Georgia
(Pandya) Staten Island University Hospital, Northwell Health, Staten
Island, New York, Georgia
(Kumar) Emory University School of Medicine, Atlanta, Georgia, Georgia
(Kanwar) NYC Health and Hospitals, New York, New York, Georgia
(Rodriguez, Panchal) Florida Heart Center PA, Fort Pierce, Florida,
Georgia
Publisher
Elsevier USA
Abstract
Background: Patients with bicuspid aortic stenosis (AS) have traditionally
been excluded in randomized clinical trials comparing surgical and
transcatheter aortic valve replacement (TAVR) and outcomes post-TAVR are
limited in scientific publications. Method(s): PubMed, Embase, and
Cochrane Library databases were searched through May 30, 2019, and the
authors identified 13 relevant studies. Random- and fixed-effect models
with heterogeneity statistics were used to assess the odds of 30-day and
long-term mortality and complications post-TAVR Results: In 11,223
patients, the 30-day (odds ratio [OR]: 1.35; 95% confidence interval [CI]:
0.93 to 1.98; p = 0.11) and long-term mortality (OR: 0.92; 95% CI: 0.72 to
1.18; p = 0.51) were similar among patients undergoing TAVR for bicuspid
versus tricuspid AS (Figures 1A and 1B). Major bleeding (OR: 1.11; 95% CI:
0.77 to 1.61; p = 0.56), vascular complications (OR: 1.05; 95% CI: 0.70 to
1.57; p=0.83), stroke (OR: 1.22; 95% CI: 0.75 to 1.99; p = 0.41), and
pacemaker implantation (OR: 1.04; 95% CI: 0.81 to 1.35; p = 0.74) did not
differ significantly among bicuspid versus tricuspid AS. Interestingly,
tricuspid AS patients were more likely to experience paravalvular leak
(OR: 1.53; 95% CI: 1.16 to 2.01; p = 0.003) and conversion to surgery (OR:
2.56; 95% CI: 1.47 to 4.48; p < 0.001), as shown in Figures 1C and 1D.
[Figure presented] Conclusion(s): In a meta-analysis comparing TAVR
in bicuspid versus tricuspid AS, both short- and long-term mortality and
complications were similar with higher odds of paravalvular leak and
conversion to surgery in tricuspid AS patients. Future randomized studies
evaluating these findings are warranted Categories: STRUCTURAL: Valvular
Disease: Aortic Copyright © 2019

<122>
Accession Number
2002925241
Title
TCT-314 Inpatient Versus Outpatient PCI in Patients With Left Main
Disease: Analysis From the EXCEL Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B312), 2019. Date of Publication: 1 October
2019.
Author
Gaba P.; Serruys P.; Karmpaliotis D.; Banning A.; Zhang Z.; Morice M.-C.;
Kandzari D.; Ben-Yehuda O.; Mehran R.; Leon M.; Sabik J.; Kappetein A.P.;
Stone G.
Institution
(Gaba) Columbia University Medical Center, New York, NY, United States
(Serruys) Imperial College, London, United Kingdom
(Karmpaliotis) New York-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Zhang) Cardiovascular Research Foundation, New York, NY, United States
(Morice) CERC, Massy, France
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Ben-Yehuda) Cardiovascular Research Foundation, Columbia University
Medical Center, New York, NY, United States
(Mehran) The Zena and Michael A. Wiener Cardiovascular Institute, Mount
Sinai Hospital, New York, NY, United States
(Leon) Columbia University Medical Center/New York-Presbyterian Hospital,
New York, NY, United States
(Sabik) Department of Thoracic and Cardiovascular Surgery, The Cleveland
Clinic Foundation, Cleveland, OH, United States
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center/New York-Presbyterian Hospital, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Prior studies of patients with noncomplex coronary artery
disease have demonstrated safety of percutaneous coronary intervention
(PCI) performed in the outpatient setting. The angiographic finding of
left main coronary artery disease (LMCAD) usually prompts hospital
admission for rapid revascularization. Whether outpatient PCI in patients
with LMCAD is safe is unknown. Method(s): In the EXCEL trial, 1,905
patients with LMCAD and site-assessed low or intermediate SYNTAX scores
were randomized to PCI versus coronary artery bypass graft. The primary
endpoint was major adverse cardiac events ([MACE], death, stroke, or
myocardial infarction). Outcomes were analyzed according to PCI performed
in the inpatient versus outpatient setting. Result(s): Among the
1,905 patients, 897 underwent PCI as their first procedure, including 97
as outpatients (10.8%) and 800 as inpatients (89.2%). Patients who
underwent outpatient PCI were less likely to have experienced recent
myocardial infarction but were more likely to have presented with stable
angina or silent ischemia. LM Medina and SYNTAX score classifications were
similar between the groups, whereas LM diameter stenosis was lower in the
outpatient PCI group (61.6 +/- 12.4% vs 64.7 +/- 12.3%; p = 0.03). There
were no significant differences in MACE at 30 days and 4 years (Figure A
and B). Multivariable analysis adjusting for baseline covariates also
found no significant differences in MACE at 30 days (hazard ratio [HR]:
0.55; 95% confidence interval [CI]: 0.13 to 2.32; p = 0.42) or 4 years
(HR: 1.03; 95% CI: 0.58 to 1.81; p = 0.92). Similar results were observed
in patients with severe LMCAD (quantitative coronary angiography diameter
stenosis > median) and distal LM bifurcation lesions. [Figure presented]
 Conclusion(s): In the EXCEL trial, outpatient PCI of selected
patients with LMCAD was not associated with an early or late hazard of
MACE. Categories: CORONARY: Stents: Drug-Eluting Copyright © 2019

<123>
Accession Number
2002925238
Title
TCT-240 Quality of Life Between Coronary Artery Bypass Graft Surgery and
Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B239), 2019. Date of Publication: 1 October
2019.
Author
Saqib N.; Pir M.S.; Liaqat M.; Haseeb A.; Boruah P.
Institution
(Saqib, Pir, Liaqat, Haseeb, Boruah) The Wright Center for Graduate
Medical Education, Scranton, PA, United States
Publisher
Elsevier USA
Abstract
Background: Quality of life (QoL) evaluation of health care for
decision-making and operational planning is vital for patient outcome. QoL
among patients undergoing percutaneous coronary intervention (PCI)
compared with coronary artery bypass grafting (CABG) at the 1-year mark is
important tool for decision-making. Method(s): Extensive search on
PubMed and EMBASE was done. Initial search with PCI and CABG yielded 2,336
studies; adding "quality" narrowed to 200. These studies were
independently evaluated by 2 physicians. Four studies comparing QoL in
patients at the 1-year mark after undergoing PCI or CABG using the Seattle
Angina Questionnaire (SAQ) were identified. A total of 9,043 patients
across different centers (5,170 PCI and 3,873 CABG) were identified.
Preferred Reporting Items for Systematic reviews and Meta-Analyses was
used. A study-level analysis was done using Review manager 5.3. As a
guide, an I2 > 30% was considered an indicator of statistical
heterogeneity among the studies. A Mantel-Haenszel Random effects model
was used to calculate the pooled mean for homogeneous endpoints. The
results are reported as mean and 95% confidence intervals (CIs). A p value
<0.05 was considered significant. Result(s): At 1 year, the CABG
group had a significantly higher QoL compared with the PCI group with
average intervention effect (-0.81 [95% CI: -1.09 to -0.60]) shown in the
forest plot (Figure) favoring CABG. In-between study variances represented
by Tau2 were measured at 0.00 and heterogeneity score was 0% with p value
<0.0001. [Figure presented] Conclusion(s): Our meta-analysis is first
to report cumulative QoL benefit with CABG compared with PCI at 1-year
follow-up. Categories: OTHER: Quality, Guidelines and Appropriateness
Criteria Copyright © 2019

<124>
Accession Number
2002925229
Title
TCT-316 Clinical Outcomes After Left Main Coronary Artery
Revascularization by PCI or CABG in Current, Former, and Never Smokers:
Analysis From the EXCEL Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B314), 2019. Date of Publication: 1 October
2019.
Author
Shahim B.; Redfors B.; Chen S.; Morice M.-C.; Taggart D.; Gersh B.; Puskas
J.; Kandzari D.; Merkely B.; Crowley A.; Serruys P.; Kappetein A.P.; Sabik
J.; Ben-Yehuda O.; Stone G.
Institution
(Shahim, Redfors, Chen) Cardiovascular Research Foundation, New York, NY,
United States
(Morice) CERC, Massy, France
(Taggart) Oxford University, Oxford, United Kingdom
(Gersh) Mayo Clinic, Rochester, MN, United States
(Puskas) Mount Sinai, New York, NY, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Merkely) Semmelweis University, Cardiac and Vascular Center, Budapest,
Hungary
(Crowley) Cardiovascular Research Foundation, Queens, New York, NY, United
States
(Serruys) Imperial College, London, United Kingdom
(Kappetein) Medtronic, Mounds View, MN, United States
(Sabik) Department of Thoracic and Cardiovascular Surgery, The Cleveland
Clinic Foundation, Cleveland, OH, United States
(Ben-Yehuda) Cardiovascular Research Foundation, Columbia University
Medical Center, New York, NY, United States
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center/New York-Presbyterian Hospital, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Cigarette smoking is a well-known risk factor for coronary
artery disease; however, the impact of smoking on outcomes after coronary
revascularization is less well understood, especially in patients with
left main coronary artery disease (LMCAD) undergoing coronary artery
bypass graft (CABG) or percutaneous coronary intervention (PCI). This
study sought to assess the association between smoking status and clinical
outcomes at 4 years among patients undergoing LMCAD revascularization in
the contemporary EXCEL trial and to examine whether smoking status
influenced the relative efficacy of PCI versus CABG in these high-risk
patients. Method(s): The EXCEL trial randomized 1,905 patients with
LMCAD and visually assessed low or intermediate anatomical complexity
(SYNTAX score <=32) to PCI with everolimus-eluting stents or CABG.
Patients were categorized according to smoking status (current, former, or
never), and their outcomes at 4 years were examined using multivariable
Cox proportional hazards regression. The primary endpoint was a composite
of death, myocardial infarction, or stroke. Result(s): Among 1,892
patients with known smoking status at baseline, 416 (22%) were current
smokers, 773 (41%) were former smokers, and 703 (37%) were never smokers.
The crude rates of the primary endpoint were 16.0% for never smokers,
17.5% for former smokers (p = 0.44 vs. never smokers), and 21.0% for
smokers (p = 0.047 vs. never smokers). Compared with never smokers, the
adjusted risk of the primary endpoint was higher for current smokers
(adjusted hazard ratio [HR]: 1.61; 95% confidence interval [CI]: 1.15 to
2.26; p = 0.006), but not for former smokers (adjusted HR: 1.05; 95% CI:
0.80 to 1.38; p = 0.71). The relative efficacy of PCI versus CABG for the
4-year primary endpoint was similar irrespective of smoking status
(p<inf>interaction</inf> = 0.85). Conclusion(s): In the EXCEL trial,
current smokers had a higher adjusted 4-year risk of the primary composite
endpoint of death, myocardial infarction, or stroke compared with never
smokers, whereas former smokers were not at increased risk. Active smoking
was a risk factor for LMCAD revascularization irrespective of
revascularization method. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2019

<125>
Accession Number
2002925211
Title
TCT-706 Can Clinical Predictive Models Identify Patients Who Should Not
Receive TAVR?.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B693), 2019. Date of Publication: 1 October
2019.
Author
Wessler B.; Weintraub A.; Udelson J.; Kent D.
Institution
(Wessler, Weintraub, Udelson, Kent) Tufts Medical Center, Boston, MA,
United States
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is routinely
offered to patients with very high predicted risk. Although most patients
benefit from TAVR, a significant minority have persistent symptoms or die
within 1 year of treatment. There is interest in identifying patients for
whom this procedure is futile and should not be offered. Method(s):
We conducted a systematic review to identify TAVR clinical predictive
models (CPMs) published through October 31, 2018, using the Tufts
Predictive Analytics and Comparative Effectiveness CPM Registry
(http://www.pace.tuftsmedicalcenter.org/cpm). For each TAVR CPM we
extracted information on predicted and observed outcome rates for the
highest reported stratum of risk. The 95% confidence interval for observed
event rates was calculated using the exact binomial method. We compared
the highest reported event rates with an often-cited quantitative
definition of futility. Result(s): Sixteen TAVR CPMs representing
62,852 treated patients were published from 2013 to 2018. These CPMs
predict mortality (n = 13) or the composite outcome of mortality or high
symptom burden (n = 3). The highest predicted rates ranged from 11.0% for
in-hospital mortality to 75.1% for the composite of mortality or high
symptom burden 1 year after TAVR. Statistical confidence was lowest for
the highest observed event rates (Figure). No high-risk TAVR group had an
appropriate event rate and adequate statistical power to meet a
quantitative definition of futility. [Figure presented]
 Conclusion(s): In the case of TAVR, currently available CPMs have
insufficient statistical power to identify patients for whom TAVR is
futile. Categories: STRUCTURAL: Valvular Disease: Aortic Copyright
© 2019

<126>
Accession Number
2002925177
Title
TCT-315 White Blood Cell Count and 4-Year Clinical Outcomes After Left
Main Coronary Artery Revascularization: Insights From the EXCEL Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B313), 2019. Date of Publication: 1 October
2019.
Author
Claessen B.; Ben-Yehuda O.; Mehran R.; Dressler O.; Chen S.; Mansour S.;
Noiseux N.; Kappetein A.P.; Sabik J.; Sharma S.; Kini A.; Serruys P.;
Stone G.
Institution
(Claessen) Mount Sinai Hospital, New York, NY, United States
(Ben-Yehuda) Cardiovascular Research Foundation, Columbia University
Medical Center, New York, NY, United States
(Mehran) The Zena and Michael A. Wiener Cardiovascular Institute, Mount
Sinai Hospital, New York, NY, United States
(Dressler, Chen) Cardiovascular Research Foundation, New York, NY, United
States
(Mansour, Noiseux) Centre Hospitalier de l'Universite de Montreal (CHUM),
Montreal, Quebec, Canada
(Kappetein) Medtronic, Mounds View, MN, United States
(Sabik) Department of Thoracic and Cardiovascular Surgery, The Cleveland
Clinic Foundation, Cleveland, OH, United States
(Sharma, Kini) Mount Sinai Health System, New York, NY, United States
(Serruys) Imperial College, London, United Kingdom
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center/New York-Presbyterian Hospital, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Studies have identified an association between elevated white
blood cell (WBC) counts and clinical outcomes after percutaneous coronary
intervention for both acute coronary syndrome and stable coronary artery
disease. The prognostic impact of WBC count in patients undergoing
revascularization for left main coronary artery disease is unknown.
 Method(s): In the EXCEL trial, 1,905 patients with left main coronary
artery disease and low or intermediate SYNTAX scores were randomized to
percutaneous coronary intervention with everolimus-eluting stents versus
coronary artery bypass graft. Patients were grouped in tertiles based on
baseline WBC count. Result(s): Among 1,895 patients with baseline WBC
count available, WBC count in the tertiles was 5.6 +/- 0.8, 7.5 +/- 0.5,
and 10.1 +/- 1.6 x109/l. Patients with a higher baseline WBC
count were younger, more often current smokers, more often had chronic
obstructive pulmonary disease, less often had anemia, and had higher
baseline high-sensitivity C-reactive protein. Rates of the primary
composite endpoint (death, myocardial infarction, or stroke) at 4 years
were similar across WBC tertiles (WBC<inf>low</inf> 17.2%,
WBC<inf>mid</inf> 16.5%, WBC<inf>high</inf> 19.1%; p = 0.43). Individual
components of the primary endpoint, Bleeding Academic Research Consortium
(BARC) 3 to 5 bleeding, stent thrombosis or graft occlusion, and
ischemia-driven revascularization were all similar across WBC tertiles
(Table 1). Results were consistent when analyzed separately in patients
with acute coronary syndrome and stable coronary artery disease. After
multivariable adjustment, WBC count was not an independent predictor of
adverse events. There was no significant interaction between WBC and
treatment with percutaneous coronary intervention versus coronary artery
bypass graft for the primary endpoint (p<inf>interaction</inf> = 0.70).
<inf>Table 1. Three-Year Clinical Outcomes According to WBC Count
Tertiles</inf> [Figure presented] Conclusion(s): In EXCEL, there was
no association between baseline WBC count and 4-year clinical outcomes
after left main revascularization. These results conflict with other
reports regarding the prognostic value of baseline WBC count in other
settings, warranting further study. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2019

<127>
Accession Number
2002925173
Title
TCT-842 Long-Term Incidence of Myocardial Infarction in Patients
Undergoing Percutaneous Coronary Intervention Versus Coronary Artery
Bypass Grafting for Isolated Left Anterior Descending Artery Disease: A
Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B825), 2019. Date of Publication: 1 October
2019.
Author
Prasad M.; Chen S.; Flattery E.; Finn M.; Karmpaliotis D.; Kirtane A.J.;
Moses J.W.
Institution
(Prasad) Columbia University, New York, NY, United States
(Chen) Cardiovascular Research Foundation, New York, NY, United States
(Flattery, Kirtane, Moses) NewYork-Presbyterian Columbia University
Medical Center, New York, NY, United States
(Finn) Columbia University Medical Center, New York, NY, United States
(Karmpaliotis) NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Patients with isolated left anterior descending coronary
artery (LAD) disease may be treated with coronary artery bypass grafting
(CABG) or percutaneous coronary intervention (PCI), but on the basis of
data from patients with diabetes, many have suggested that CABG may reduce
the incidence of long-term myocardial infarction (MI). We aimed to compare
the incidence of MI in patients treated with CABG versus PCI with isolated
LAD disease. Method(s): We performed a comprehensive search of
several databases to identify studies comparing treatment of isolated LAD
disease with PCI versus CABG. The outcome of interest was MI. We excluded
all studies with patients treated for multivessel coronary disease or
studies that did not report the outcome of myocardial infarction after at
least 6 months of follow-up. Result(s): Seventeen studies with 4,752
patients were included in the current meta-analysis (Figure 1). Median
follow-up was 2.5 years (range: 6 months to 10 years). The incidence of MI
on long-term follow-up was similar between the CABG and PCI groups (odds
ratio [OR]: 0.98; 95% confidence interval [CI]: 0.74 to 1.30). A
subanalysis of randomized controlled trials also showed no difference
between the CABG and PCI groups. Additional subanalyses studying patients
with >3 and 5 years of follow-up showed no difference in the occurrence of
long-term MI on follow-up between patients treated with CABG and PCI.
[Figure presented] Conclusion(s): Our meta-analysis suggests that
treatment with CABG may not be protective against occurrence of MI
compared with PCI. Categories: CORONARY: Complex and Higher Risk
Procedures for Indicated Patients (CHIP) Copyright © 2019

<128>
Accession Number
2002925159
Title
TCT-456 Pre-Existing Atrial Fibrillation Is Associated With Increased Risk
of Mid-Term and Long-Term Mortality in Transcatheter Mitral Valve Repair:
Systemic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B451), 2019. Date of Publication: 1 October
2019.
Author
Prasitlumkum N.; Limpruttidham N.; Kittipibul V.; Kewcharoen J.;
Riangwiwat T.; Rattanawong P.
Institution
(Prasitlumkum) Hawaii Internal Medicine Residency Program, Honolulu, HI,
United States
(Limpruttidham, Kewcharoen, Rattanawong) University of Hawaii Internal
Medicine Residency Program, Honolulu, HI, United States
(Kittipibul) Jackson Memorial Hospital Internal Medicine Residency
Program, Miami, FL, United States
(Riangwiwat) Heart Institute, Geisinger Medical Center, Danville, PA,
United States
Publisher
Elsevier USA
Abstract
Background: Atrial fibrillation (AF) is the most common arrhythmia and is
independently associated with significant morbidity and mortality. Recent
studies suggested that AF is potentially linked to higher 1-year and
long-term all-cause mortality in patients undergoing transcatheter mitral
valve repair (TMVR). However, the association was still inconclusive. This
study assessed the correlation between AF and TMVR by performing a
systematic review and meta-analysis of the published reports.
 Method(s): The authors comprehensively searched the databases of
MEDLINE and EMBASE from inception to March 2019. Included studies were
prospective or retrospective cohort studies that compared 1-year and
long-term all-cause mortality among patients undergoing TMVR both with and
without AF. Data from each study were combined using the random-effects,
generic inverse variance method of DerSimonian and Laird to calculate risk
ratios and 95% confidence intervals (CIs). Result(s): Fourteen
studies consisting of 9,501 subjects undergoing TMVR (5,788 with AF and
3,713 without AF) were included in this meta-analysis. The presence of AF
was associated with mid-term all-cause mortality (pooled odd ratio [OR]:
1.40; 95% CI: 1.32 to 1.49; p < 0.001; I2 = 0%). In addition,
the association between AF and long-term all-cause mortality remained
substantial (pooled OR: 1.46; 95% CI: 1.28 to 1.56; p < 0.001;
I2 = 8.2%) (Figure). [Figure presented] Conclusion(s): AF
is associated with an increased risk of both 1-year and long-term
all-cause mortality in patients undergoing TMVR. This study suggests that
AF could be a potential risk factor of mortality among patients undergoing
TMVR. Categories: STRUCTURAL: Valvular Disease: Mitral Copyright
© 2019

<129>
Accession Number
2002925152
Title
TCT-695 Protection Against Cerebral Embolism During Transcatheter Aortic
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B682), 2019. Date of Publication: 1 October
2019.
Author
Sehatbakhsh S.; Kushnir A.; Chait R.; Lovitz L.; Donath E.; Rothenberg M.;
Midwall S.
Institution
(Sehatbakhsh) University of Miami Palm Beach Consortium/JFK Medical
Center, West Palm Beach, FL, United States
(Kushnir) University of Miami Palm Beach Consortium, Atlantis, FL, United
States
(Chait) JFK Medical Center/University of Miami, Atlantis, FL, United
States
(Lovitz, Rothenberg) JFK Medical Center, Atlantis, FL, United States
(Donath) University of Miami School of Medicine/JFK Medical Center, West
Palm Beach, FL, United States
(Midwall) Palm Beach Heart Associates, Delray Beach, FL, United States
Publisher
Elsevier USA
Abstract
Background: Stroke remains a major complication after transcatheter aortic
valve replacement (TAVR) in 2% to 5% of patients. Cerebral embolic
protection devices (CEPDs) have used to avoid this complication. The aim
of this meta-analysis is to assess the potential benefits of the routine
use of CEPDs after TAVR. Method(s): A systematic review and
meta-analysis of studies that tested the efficacy and safety of CEPDs
during TAVR was performed. Trials using any type of CEPD and TAVR vascular
access were included. The primary endpoint was a composite endpoint of
stroke, transient ischemic attack (TIA), and mortality 30 days post-TAVR.
Secondary outcomes were 30-day mortality, stroke or TIA, disabling stroke,
major vascular complications, bleeding, and acute kidney injury (AKI). The
meta-analysis was performed using primarily fixed-effects modeling. The
I2 statistic and forest plots were used to evaluate the extent
of heterogeneity. Causes of heterogeneity were subsequently examined via
subgroup analyses and meta-regression. Result(s): Five studies met
the inclusion criteria. A total of 1,198 patients (47% men, mean age 81.7
years) with severe aortic stenosis who underwent TAVR with (n = 677) or
without (n = 521) CEPD implantation were included. Implanted CEPDs that
were evaluated included the Claret sentinel device and the TriGaurd. For
the primary endpoint, patients who underwent CEPD implantation were 43%
less likely to experience stroke, TIA, or death within 30 days, and this
difference was statistically significant (risk ratio: 0.57; 95% confidence
interval: 0.39 to 0.85; p < 0.01; I2= 39%, tau-squared
heterogeneity p = 0.16). Additionally, for a variety of other secondary
endpoints of interest (including mortality, stroke or TIA, and disabling
stroke) there was a similar statistically significant difference among
those with CEPD implantation versus control subjects (and with minimal
statistical heterogeneity). There was no significant difference between
the 2 groups with regard to major vascular complications, bleeding, and
AKI. Conclusion(s): This meta-analysis confirms favorable effects of
CEPD during TAVR to prevent cerebral vascular accidents. It also appears
that the implantation of CEPDs during TAVR is relatively safe. These
findings can potentially suggest routine use of CEPDs during TAVR in
eligible patients. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2019

<130>
Accession Number
2002925151
Title
TCT-306 Association Between Prediabetes and Clinical Outcomes After Left
Main Coronary Artery Revascularization by PCI or CABG: Analysis From the
EXCEL Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B304), 2019. Date of Publication: 1 October
2019.
Author
Redfors B.; Chen S.; Schampaert E.; Ungi I.; Mansour S.; Sabate M.;
Gershlick A.; Bochenek A.; Karmpaliotis D.; Noiseux N.; Crowley A.;
Ben-Yehuda O.; Stone G.
Institution
(Redfors, Chen, Crowley) Cardiovascular Research Foundation, New York, NY,
United States
(Schampaert) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Ungi) University of Szeged, Szeged, Hungary
(Mansour, Noiseux) Centre Hospitalier de l'Universite de Montreal (CHUM),
Montreal, Quebec, Canada
(Sabate) Hospital Clinic of Barcelona, Barcelona, Spain
(Gershlick) University of Leicester, Leicester, United Kingdom
(Bochenek) First Department of Cardiovascular Surgery, American Heart of
Poland, Bielsko-Biala, Poland
(Karmpaliotis) New York-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
(Ben-Yehuda) Cardiovascular Research Foundation, Columbia University
Medical Center, New York, NY, United States
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center/New York-Presbyterian Hospital, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Diabetes mellitus increases the risk of adverse events after
revascularization in patients with left main coronary artery disease
(LMCAD). Prediabetes often progresses to diabetes and has been associated
with long-term risks; however, whether pre-diabetes itself increases the
risk of adverse events after LMCAD revascularization is unknown.
 Method(s): The EXCEL trial randomized 1,905 patients with LMCAD and
visually assessed low or intermediate SYNTAX scores to percutaneous
coronary intervention with everolimus-eluting stents versus coronary
artery bypass graft. The primary endpoint was the composite of all-cause
death, myocardial infarction, or stroke. Patients were defined as having
either diabetes (glycosylated hemoglobin [HbA<inf>1c</inf>] >=6.5% or a
pre-existing diabetes diagnosis), pre-diabetes (5.7 <= HbA<inf>1c</inf> <
6.5%), or normal glucose metabolism (NGM). Result(s): Baseline
diabetes status and HbA<inf>1c</inf> levels were available in 1,793
(94.1%) randomized patients, of whom 632 (35.2%) had diabetes and 622
(34.7%) had pre-diabetes. The 4-year rate of the primary endpoint was
higher in patients with diabetes compared with pre-diabetes or NGM
(Figure) (adjusted hazard ratio [HR]: 0.74; 95% confidence interval [CI]:
0.56 to 0.98; p = 0.04 for pre-diabetes vs. diabetes; and adjusted HR:
0.91; 95% CI: 0.67 to 1.25; p = 0.57 for pre-diabetes vs. NGM). The
relative efficacy of percutaneous coronary intervention versus coronary
artery bypass graft for the primary endpoint was similar for patients with
diabetes, pre-diabetes, and NGM (p<inf>interaction</inf> = 0.84). [Figure
presented] Conclusion(s): Both pre-diabetes and diabetes were common
among patients undergoing LMCAD revascularization in the EXCEL trial.
Diabetes but not pre-diabetes was associated with an increased risk of
death, stroke, or myocardial infarction within 4 years irrespective of
revascularization method. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2019

<131>
Accession Number
2002925087
Title
Incidence and Predictors of Hemodynamic Deterioration of Transcatheter and
Surgical Bioprosthetic Aortic Valves: Pooled Analysis From the CoreValve
Pivotal Trials.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B6), 2019. Date of Publication: 1 October
2019.
Author
O'Hair D.; Reardon M.; Yakubov S.; Deeb G.M.; Sondergaard L.; Van Mieghem
N.; Popma J.
Institution
(O'Hair) Boulder Heart, Boulder, United States
(Reardon) Houston Methodist DeBakey Heart & Vascular Center, Houston
Texas, United States
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Deeb) University of Michigan Hospitals, Ann Arbor, MI, United States
(Sondergaard) Rigshospitalet University Hospital, Copenhagen, Denmark
(Van Mieghem) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
alternative to surgical aortic valve replacement (SAVR) in patients with
severe, symptomatic aortic stenosis at intermediate or higher surgical
risk for death. Recent data supports the use of TAVR in patients at low
surgical risk and highlights the need to assess hemodynamic durability of
the implanted bioprosthetic valve in patients with longer life-expectancy.
 Method(s): Hemodynamic deterioration was defined as an increase in
mean gradient of >=10 mm Hg from discharge to last available echo OR:
reintervention for stenosis >30 days post-procedure. Effective orifice
area (EOA), mean aortic valve gradient, and Doppler velocity index (DVI)
were determined through 5 years for all patients who underwent TAVR in the
CoreValve US pivotal and continued-access studies and through 2 years in
patients treated in the SURTAVI trial. These hemodynamic endpoints were
compared between patients receiving TAVR and SAVR in the CoreValve
high-risk and SURTAVI randomized trials. Result(s): Baseline
characteristics were similar between patients randomized to TAVR or SAVR.
Mean gradient, EOA, and DVI remained consistent for through 5 years, and
there was no significant difference between transcatheter and surgical
bioprostheses in change from baseline to last available echocardiography.
Hemodynamic deterioration was less common after TAVR than after SAVR (1.4%
vs. 3.5%; p = 0.0001) (Table). An analysis of preprocedural, procedural,
and device-related factors and medication intake associated with
hemodynamic deterioration is in progress and will be available for
presentation in September. [Figure presented] Conclusion(s):
Hemodynamic deterioration was uncommon through 5 years post-procedure for
the CoreValve bioprosthesis and lower than observed for surgical valves.
The final analysis will be updated with the 3-year follow-up for the
SURTAVI trial. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2019

<132>
Accession Number
2002925082
Title
TCT-547 Sham-Controlled Trials of Invasive Cardiovascular Interventions: A
Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B540), 2019. Date of Publication: 1 October
2019.
Author
Lauder L.; Scholz S.; Ewen S.; Wijns W.; Serruys P.; Edelman E.; Capodanno
D.; da Costa B.; Juni P.; Mahfoud F.
Institution
(Lauder, Scholz) Universitatsklinikum des Saarlandes, Homburg, Germany,
Germany
(Ewen, Mahfoud) Universitatsklinikum des Saarlandes, Klinik fur Innere
Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin,
Homburg/Saar, Germany, Germany
(Wijns) The Lambe Institute for Translational Medicine and Curam, National
University of Ireland, Galway, Galway, Ireland, Ireland
(Serruys) Imperial College, London, United Kingdom, United Kingdom
(Edelman) Massachusetts Institute of Technology, Cambridge, Massachusetts,
Italy
(Capodanno) Cardiology Division, University of Catania, Catania, Catania,
Italy, Italy
(da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland, Switzerland
(Juni) University of Toronto, Toronto, Ontario, Canada, Canada
Publisher
Elsevier USA
Abstract
Background: Sham control arms are increasingly called for in trials
investigating invasive interventions, and yet, their benefit has not been
rigorously evaluated. This systematic review and meta-analysis aimed to
analyze the effect of invasive interventions and sham treatment on primary
efficacy and safety endpoints in different cardiovascular conditions.
 Method(s): MEDLINE and Web of Science were searched from inception
through December 31, 2018, for double-blinded, randomized, sham-controlled
trials of invasive interventions in cardiology and cardiovascular surgery.
Guidelines, original articles, and review papers were reviewed in
duplicate for eligibility. Due to the heterogeneity of the studies, effect
size and relative risk were calculated for pre-defined continuous and
binary primary efficacy endpoints, respectively, to compare the efficacy
of active with sham treatment. Result(s): In total, 28 trials
including 3,753 patients were analyzed. Patients underwent invasive
interventions for coronary artery disease (n = 10), hypertension (n = 8),
heart failure (n = 4), vasovagal syncope (n = 3), patent foramen ovale (n
= 2), or dysfunctional dialysis access grafts (n = 1). Only 9 trials (32%)
met all pre-defined primary efficacy endpoints. Effect sizes were
calculated for 10 trials using continuous endpoints, in which active
treatment achieved a moderate and large effect size (0.5 to 0.79 and
>=0.8) in 3 (30%). The sham effect was variable and not related to the
invasiveness of the procedure. The difference in effect size between
active and sham treatment (true treatment effect) was small in 7 of 10
(70%) trials. In 5 of 13 (38%) trials reporting binary efficacy endpoints,
a superiority of active treatment over sham was documented. Overall,
adverse events were rare and occurred equally following active and sham
treatment. Conclusion(s): The true treatment effect of invasive
interventions was small in most studies included in this analysis. This
analysis, therefore, reiterates the need for carefully conducted,
sham-controlled trials to discriminate between true treatment and
nonspecific effects and thus ensure that patients are not exposed to
ineffective procedures. Categories: OTHER: Statistics and Trial
Design Copyright © 2019

<133>
Accession Number
2002925076
Title
Modified Body Mass Index, A Novel Marker of Malnutrition and Clinical
Frailty, is Associated With Outcomes After Transcatheter and Surgical
Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B3), 2019. Date of Publication: 1 October
2019.
Author
Driggin E.; Gupta A.; Alu M.; Liu M.; Chen S.; Kodali S.; Maurer M.;
Thourani V.; Dvir D.; Mack M.; Leon M.; Green P.
Institution
(Driggin, Gupta, Kodali, Maurer, Green) Columbia University Medical
Center, New York, United States
(Alu) Columbia University, New York, NY, United States
(Liu, Chen) Cardiovascular Research Foundation, New York, NY, United
States
(Thourani) MedStar Heart & Vascular Institute, Washington, DC, United
States
(Dvir) University of Washington, Seattle, WA, United States
(Mack) The Heart Hospital Baylor Plano, Plano, TX, United States
(Leon) Columbia University Medical Center/NewYork-Presbyterian Hospital,
New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Frailty is associated with poor outcomes after transcatheter
aortic valve replacement (TAVR). However, routine measurement of frailty
has not penetrated clinical practice. Modified body mass index (mBMI), the
product of body mass index (BMI) and serum albumin, is an easily
measurable potential proxy for frailty that is associated with survival in
elderly cohorts with nonvalvular heart disease. The aim is to investigate
the relationship of mBMI with survival after TAVR and surgical aortic
valve replacement (SAVR). Method(s): We utilized pooled data from the
PARTNER (Placement of Aortic Transcatheter Valves) trial from the
PARNTER1, PARTNER2, and S3 cohorts. We estimated cumulative mortality at 1
year for quartiles of mBMI with the Kaplan-Meier method and compared them
with the log-rank test. We performed Cox proportional hazards modeling to
examine the association of mBMI strata with 1-year mortality adjusting for
baseline clinical characteristics. Result(s): A total of 6,953
patients who underwent TAVR or SAVR (mean age 83 + 7.3 years, 57% male)
were included in the analysis. All-cause 1-year mortality was highest in
the lowest mBMI quartile (Figure). Multivariable Cox proportional hazards
modeling showed mBMI as an independent predictor of all-cause 1-year
mortality with the lowest mBMI quartile as most predictive (hazard ratio:
2.36; 95% confidence interval: 1.88 to 2.96; p < 0.0001). Low mBMI was
also associated with higher rates of major stroke, vascular complication,
and aortic valve reintervention at 1 year. Notably, results did not differ
when stratified by treatment with TAVR versus SAVR. [Figure presented]
 Conclusion(s): Modified BMI is associated with survival at 1 year
after TAVR and SAVR. Categories: ENDOVASCULAR: Aortic Disease and Aortic
Intervention Copyright © 2019

<134>
Accession Number
2002925027
Title
TCT-719 Antithrombotic Strategies After Transcatheter Aortic Valve
Implantation: Insights From a Network Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B706), 2019. Date of Publication: 1 October
2019.
Author
Kuno T.; Takagi H.; Sugiyama T.; Ando T.; Miyashita S.; Valentin N.;
Yuichi S.; Kodaira M.; Numasawa Y.; Kanei Y.; Hayashida K.; Bangalore S.
Institution
(Kuno) Department of Medicine, Mount Sinai Beth Israel, New York, New
York, Japan
(Takagi) Shizuoka Medical Center, Shizuoka, Japan, Japan
(Sugiyama) Diabetes and Metabolism Information Center, Research Institute,
Center for Global Health and Medicine, Tokyo, Japan, Japan
(Ando) Detroit Medical Center, Troy, Michigan, Japan
(Miyashita, Valentin, Kanei) Mount Sinai Beth Israel, New York, New York,
Japan
(Yuichi) Columbia University, New York, New York, Japan
(Kodaira) Department of Cardiology, Japanese Red Cross Ashikaga Hospital,
Ashikaga, Japan, Japan
(Numasawa) Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan, Japan
(Hayashida) Keio University School of Medicine, Tokyo, Japan, Japan
(Bangalore) New York University School of Medicine, New York, NY, United
States
Publisher
Elsevier USA
Abstract
Background: Meta-analyses comparing single-antiplatelet therapy (SAPT)
versus dual-antiplatelet therapy (DAPT) and antiplatelet therapy with or
without oral anticoagulation (OAC) have been conducted to determine the
appropriate post-transcatheter aortic valve replacement (TAVR)
antithrombotic regimen. However, there have been limited direct
comparisons across the different therapeutic strategies. The objective of
this study was to investigate the efficacy and safety of different
antithrombotic strategies in patients undergoing TAVR using a network
meta-analysis. Method(s): MEDLINE and Embase were searched through
December 2018 to investigate the efficacy and safety of different
antithrombotic strategies (SAPT, DAPT, OAC, OAC + SAPT, and OAC + DAPT) in
patients undergoing TAVR. The main outcome measures were all-cause
mortality, major or life-threatening bleeding, and stroke. The minimum
follow-up period was 3 months. Result(s): Our search identified 3
randomized controlled trials and 10 nonrandomized studies, with a total of
20,548 patients who underwent TAVR. There was no significant difference on
mortality among SAPT, DAPT, OAC, and OAC + SAPT, but OAC + DAPT had
significantly higher rates of mortality compared with other antithrombotic
strategies (p < 0.05 for all comparisons, I2 = 0%). P scores
were 89.7% (DAPT), 73.6% (SAPT), 51.4% (OAC+SAPT), 45.2% (OAC), and 0.03%
(OAC + DAPT) on survival. SAPT had significantly lower rates of bleeding
compared with DAPT (odds ratio [OR]: 0.59; 95% confidence interval [CI]:
0.46 to 0.77; p < 0.001), OAC + SAPT (OR: 0.58; 95% CI: 0.34 to 0.99; p =
0.045), and OAC + DAPT (OR: 0.41; 95% CI: 0.18 to 0.93; p = 0.033)
(I2 = 0%). There was no significant difference on stroke among
all antithrombotic strategies. Conclusion(s): Patients who underwent
TAVR had similar all-cause mortality rates among different antithrombotic
strategies, except that DAPT + OAC conferred higher all-cause mortality
risk. Patients on SAPT had significantly lower bleeding risk than those on
DAPT, OAC + SAPT, and OAC + DAPT. Our results suggest that SAPT is the
preferred regimen when there is no indication for DAPT or OAC post-TAVR.
When DAPT or OAC is indicated, DAPT + OAC should be avoided or duration
should be minimized to avoid bleeding events. Categories: STRUCTURAL:
Valvular Disease: Aortic Copyright © 2019

<135>
Accession Number
2002925020
Title
TCT-687 Outcomes in Patients Undergoing Transcatheter Aortic Valve
Replacement With or Without Percutaneous Coronary Intervention: A
Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B674), 2019. Date of Publication: 1 October
2019.
Author
Khan M.; Yamani N.; Deo S.; Lateef N.; Riaz H.; Khan S.; Hassan H.;
Kanaa'n A.; Reed G.; Krishnaswamy A.; Puri C.; Kapadia S.
Institution
(Khan) John H. Stroger Jr. Hospital of Cook County, Chicago, IL, United
States
(Yamani) Rush University, Chicago, IL, United States
(Deo) Case Western Reserve University, Cleveland, OH, United States
(Lateef) Creighton University, Omaha, NE, United States
(Riaz, Kanaa'n, Reed, Krishnaswamy, Kapadia) Cleveland Clinic, Cleveland,
OH, United States
(Khan) West Virginia University, Morgantown, WV, United States
(Hassan) Einstein Healthcare Network, Philadelphia, PA, United States
(Puri) Cleveland Clinic Foundation, Cleveland, OH, United States
Publisher
Elsevier USA
Abstract
Background: Patients undergoing transcatheter aortic valve replacement
(TAVR) routinely undergo coronary angiography prior to the procedure to
define the coronary anatomy and evaluate the extent of coronary artery
disease (CAD). Whether percutaneous coronary intervention (PCI) prior to
or concomitant with TAVR confers any additional clinical benefit remains
unclear. The primary objective of this systematic review was to evaluate
the impact of CAD with or without PCI on hard clinical endpoints in
patients undergoing TAVR Methods: A search of the published research was
performed using MEDLINE, Embase, Google Scholar, and Scopus from inception
of these databases until April 2019. The primary outcome was 30-day
all-cause mortality, and secondary outcomes were stroke, permanent
pacemaker implantation, acute kidney injury (AKI), and 1-year mortality.
The main summary estimate was random-effects odds ratio (OR) with 95%
confidence interval (CIs). Result(s): Ten studies enrolling 4,580
patients (mean age 82.4 years, 52.6% women) were included. Our study found
no difference in effect estimates for 30-day mortality (OR: 1.3; 95% CI:
0.36 to 1.45; p = 0.22; I2 = 37.5%), stroke (OR: 0.7; 95% CI:
0.36 to 1.45; p = 0.36; I2 = 32.8%), permanent pacemaker
implantation (OR: 1.0; 95% CI: 0.61 to 1.70; p = 0.85; I2 =
73%), AKI (OR: 0.7; 95% CI: 0.46 to 1.06; p = 0.08; I2 =
14.4%), and 1-year mortality (OR: 1.2; 95% CI: 0.92 to 1.52; p = 0.18;
I2 = 0.0%) in patients undergoing TAVR with and without PCI
(Figure). [Figure presented] Conclusion(s): Our analysis indicates
that PCI with TAVR in patients with severe aortic stenosis and concomitant
CAD grants no additional clinical advantage in terms of patient-important
clinical outcomes. Categories: ENDOVASCULAR: Aortic Disease and Aortic
Intervention Copyright © 2019

<136>
Accession Number
2002925017
Title
Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement in
Moderate-Risk Patients: A Pooled PARTNER 2 Trial and Registry Study.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B2), 2019. Date of Publication: 1 October
2019.
Author
Chau K.; Chen S.; Crowley A.; Pibarot P.; Hahn R.; Douglas P.; Alu M.;
Finn M.; Kodali S.; Jaber W.; Rodriguez L.L.; Thourani V.; Leon M.
Institution
(Chau, Finn, Kodali) Columbia University Medical Center, New York, United
States
(Chen) CRF, New York, NY, United States
(Crowley) Cardiovascular Research Foundation, Queens, New York, United
States
(Pibarot) Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
(Hahn) New York-Presbyterian Hospital, New York, NY, United States
(Douglas) Duke Clinical Research Institute, Durham, NC, United States
(Alu) Columbia University, New York, NY, United States
(Jaber) Cleveland Clinic, Cleveland, OH, United States
(Rodriguez) Heart and Vascular Institute CC, Cleveland, OH, United States
(Thourani) MedStar Heart & Vascular Institute, Washington, DC, United
States
(Leon) Columbia University Medical Center/NewYork-Presbyterian Hospital,
New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Paravalvular regurgitation (PVR) after transcatheter aortic
valve replacement (TAVR) has been associated with increased mortality. In
this study, we investigated clinical outcomes and transthoracic
echocardiogram (TTE) changes in patients with and without PVR.
 Method(s): A total of 1,974 intermediate-risk patients who received
TAVR in the PARTNER 2 trial and registries were included. Clinical
outcomes at 2 years post-discharge were compared among patients with
varying PVR severity (as determined by the 30-day TTE) using
trial-stratified multivariable Cox proportional hazards models adjusted
for baseline clinical characteristics. TTE changes between 30 days and 1
year post-TAVR were analyzed using analysis of covariance (adjusted for
baseline TTE measurements). Result(s): A total of 1,176 patients had
no/trace PVR, 680 had mild, and 118 had moderate/severe PVR. Compared with
mild/trace/no PVR patients, moderate/severe PVR patients had an increased
risk of all-cause (hazard ratio [HR]: 1.86; 95% confidence interval [CI]:
1.17 to 2.96; p = 0.008) and cardiovascular (CV) death (HR: 2.54; 95%
CI:1.41 to 4.58; p = 0.002). Moderate/severe PVR patients also had an
increased risk of rehospitalization (HR: 2.25; 95% CI: 1.48 to 3.49; p =
0.0002) and reintervention (HR: 8.29; 95% CI: 1.84 to 37.33; p = 0.006).
Moderate/severe PVR was associated with greater increases in left
ventricular (LV) end-diastolic and -systolic dimensions and volumes, LV
mass indexes, and reductions in left ventricular ejection fractions
(LVEFs). Mild PVR was not associated with higher mortality,
rehospitalization, or reintervention rates (Table). [Figure presented]
 Conclusion(s): In this pooled analysis of intermediate-risk TAVR
patients, moderate/severe PVR was associated with worse clinical outcomes
at 2 years, including all-cause and CV death, rehospitalization, and
reintervention. Moderate/severe PVR was also associated with greater
increases in LV dimensions and volumes and lower LVEFs. Such adverse
cardiac remodeling may carry an adverse prognosis. Categories: STRUCTURAL:
Valvular Disease: Aortic Copyright © 2019

<137>
Accession Number
2002924986
Title
TCT-76 Mid-Term Outcomes after Transcatheter Aortic Valve Replacement With
a Mechanically-Expanded Versus Self-Expandable Valve: 3-Year Results From
the REPRISE III Randomized Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B76), 2019. Date of Publication: 1 October
2019.
Author
Rizik D.; Rajagopal V.; Bajwa T.; Southard J.; Yakubov S.; Cutlip D.;
Teirstein P.; Ihlberg L.; Allocco D.; Reardon M.
Institution
(Rizik) HonorHealth Heart Group, Scottsdale, AZ, United States
(Rajagopal) Interventional Cardiologist, Atlanta, Georgia, Georgia
(Bajwa) Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's
Medical Centers, Milwaukee, WI, United States
(Southard) University CA Davis Medical Center, Sacramento, CA, United
States
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, United States
(Teirstein) Scripps Clinic and Research Foundation, La Jolla, CA, United
States
(Ihlberg) Boston Scientific, Marlborough, MA, United States
(Allocco) Boston Scientific Corporation, Maple Grove, MN, United States
(Reardon) Houston Methodist DeBakey Heart & Vascular Center, Houston, TX,
United States
Publisher
Elsevier USA
Abstract
Background: REPRISE III is the first large randomized comparison of 2 TAVR
platforms: the mechanically-expanded Lotus valve (Boston Scientific,
Marlborough, Massachusetts) and self-expanding CoreValve (CV) (Medtronic,
Dublin, Ireland). In aortic stenosis patients with high/extreme surgical
risk, Lotus was noninferior to CV for the primary safety endpoint (30-day
death, stroke, life-threatening/major bleeding, stage 2/3 acute kidney
injury, major vascular complications) and superior for the primary
effectiveness endpoint (1-year death, disabling stroke, and >= moderate
paravalvular leak [PVL]). This analysis sought to determine whether the
clinical benefits were sustained over time by evaluating 3-year outcomes
in REPRISE III. Method(s): REPRISE III randomized patients (2:1) to
receive Lotus or CV for severe, symptomatic aortic stenosis at 55 centers
globally (n = 912; Lotus 607, CV 305). Follow-up will continue through 5
years. Rates are post-randomization in the intent-to-treat population.
 Result(s): At 3 years, the rate of all-cause mortality or disabling
stroke was similar in Lotus- and CV-treated patients (Table). All-cause
and cardiovascular mortality also occurred at similar rates in both
treatment arms. Disabling stroke occurred more frequently in the CV versus
the Lotus cohort at 3 years; more Lotus patients received a new permanent
pacemaker compared with CV. At 3 years, valve areas were larger with CV
compared with Lotus; mean gradient was lower with CV than Lotus (both p <
0.01). More patients had moderate or greater paravalvular leak with CV
(5.3%) than Lotus (0.7%) at 3 years (p < 0.01). Similar improvements in
New York Heart Association functional class and in health status (assessed
by the SF-12 and Kansas City Cardiomyopathy questionnaires) were found
between treatment arms. Additional details will be available at the time
of the presentation. [Figure presented] Conclusion(s): This 3-year
analysis from the REPRISE study demonstrates durability of benefit after
Lotus valve implantation. Patients in both cohorts showed a significant
improvement in functional and health status, which were preserved over 3
years of follow-up. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2019

<138>
Accession Number
2002924971
Title
TCT-193 Sustained Safety and Efficacy of Magmaris Bioabsorbable Scaffold:
A 2-Year Follow-Up Analysis From Pooled Multicenter Italian Experience.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B192), 2019. Date of Publication: 1 October
2019.
Author
Galli S.; Montorsi P.; Troiano S.; Rapetto C.; Pisano F.; Aprigliano G.;
Leoncini M.; Ravagnani P.M.
Institution
(Galli, Montorsi, Troiano, Ravagnani) Department of Clinical Sciences and
Community Health, Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Rapetto) SSD Cardiologia Interventistica Sanremo, Sanremo, Imperia, Italy
(Pisano) Interventional Cardiology, Parini Regional Hospital, Aosta,
Aosta, Italy
(Aprigliano) Istituto Clinico Citta Studi, Milan, Italy, Cassina de'
Pecchi, Milan, Italy
(Leoncini) Sanremo Civil Hospital, Sanremo, Italy
Publisher
Elsevier USA
Abstract
Background: Magnesium bioabsorbable metallic scaffold (Magmaris), with low
thrombogenicity, short scaffolding time, and complete reabsorption at 12
months, is completely different from PLLA-based scaffolds. Method(s):
We evaluate 24-month clinical results in "real world" pooled patients with
lesions suitable for Magmaris scaffold in terms of target vessel failure
(a combination of death, new myocardial infarction [MI], coronary artery
bypass graft, target lesion failure, and target lesion revascularization)
and scaffold thrombosis. The "4Ps" strategy (patient/lesion selection,
pre-dilatation, proper size, and post-dilatation) to implant the scaffold
was strongly recommended. Dual antiplatelet therapy was stopped at 12
months per protocol. Result(s): From 4 Italian centers, we collected
125 patients (130 lesions) with 24 completed follow-up. Clinical
characteristics are: 83.6% men, mean age 60.7 +/- 9.9 years, and diabetes
in 16%. Clinical indication was elective in 76% and ACS in 24% (8%
ST-segment elevation MI). The vessel treated was left anterior descending
in 51%, right coronary artery in 30%, and left circumflex in 19%; most of
the cases in prox-mid segment (63%) due to 3.0- and 3.5-mm available sizes
alone. Lesion type was A to B1 in 52% and B2 to C in 48%, respectively.
Mean scaffold length and diameter was 21.8 +/- 3.9 mm and 3.25 +/- 0.25
mm, respectively. A single scaffold was implanted in 83%, and 17% had
multiple lesions. The 4P strategy was respected in 95%, and imaging
(intravascular ultrasound/optical coherence tomography) was used in 47%.
Procedural success was 99% and clinical success 98%, with 1.5%
periprocedural MI. The 24-month follow-up was completed in all 125
patients. In all, 92.8% of patients were event-free at 24 months, and
major adverse cardiovascular events are in the Table. [Figure presented]
 Conclusion(s): The 2-year follow-up results of this multicenter
series confirm the safety and efficacy shown in previous controlled
trials. Particularly between 12 and 24 months, we observed 2.4% target
lesion revascularization and no scaffold thrombosis. Categories: CORONARY:
Stents: Bioresorbable Vascular Scaffolds Copyright © 2019

<139>
Accession Number
2002924965
Title
TCT-376 Randomized Trial of Conventional Transseptal Needle Versus
Radiofrequency Energy Needle Puncture for Left Atrial Access During
Cryoballoon Ablation (CRYO-LATS Study).
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B373), 2019. Date of Publication: 1 October
2019.
Author
Andrade J.; Champagne J.; Deyell M.; Essebag V.; Morillo C.; Sapp J.;
Theoret-Patrick P.; Wells G.; Verma A.
Institution
(Andrade, Deyell) UBC, Vancouver, British Columbia, Canada
(Champagne) IUPCQ, Quebec City, Quebec, Canada
(Essebag) McGill, Montreal, Quebec, Canada
(Morillo) Libin Cardiovascular Institute of Alberta, Calgary, Alberta,
Canada
(Sapp) Dalhousie, Halifax, Nova Scotia, Canada
(Theoret-Patrick) Ottawa, Ottawa, Ontario, Canada
(Wells) Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Ontario, Canada
Publisher
Elsevier USA
Abstract
Background: Transseptal puncture is a critical step in achieving left
atrial (LA) access for many cardiac procedures. More recently, there has
been an increasing need for LA access using large caliber sheaths, which
presents a unique risk of perforation associated with the initial
advancement into the LA due to the larger diameter and shouldering. This
study sought to investigate the comparative effectiveness of a Baylis
transseptal system (RF needle, TorFlex sheath, and specialized ProTrack
guidewire) compared with a conventional transseptal (conventional sheath,
Brockenbrough needle, and standard guidewire) for transseptal LA access
during cryoballoon ablation procedures, which require the use of a 15-F
guiding sheath. Method(s): In this prospective, single-blinded,
controlled trial, 135 patients with symptomatic paroxysmal atrial
fibrillation undergoing pulmonary vein isolation with the Arctic Front
Cryoballoon system were randomized to transseptal access with the
conventional transseptal versus the Baylis transseptal system. The primary
outcome was time required for transseptal LA access. Secondary outcomes
included failure of the assigned transseptal system and radiation
exposure. Result(s): The median transseptal puncture time was
significantly shorter using the Baylis transseptal system compared with
the conventional transseptal (80 s [interquartile range (IQR): 51 to 131]
vs. 119 s [IQR: 61 to 225]; p = 0.016). Fewer transseptal attempts were
noted with the Baylis transseptal system compared with the conventional
transseptal (1 [range 0 to 3] vs. 1 [range 0 to 6]; p = 0.023). There was
a trend to less radiation exposure with the Baylis transseptal system
compared with the conventional transseptal (27 s [IQR: 12 to 60] vs. 54 s
[IQR: 18 to 96]; p = 0.066). Failure to achieve transseptal LA access with
the assigned system was rarely observed (1 patient in each group).
 Conclusion(s): Use of the Baylis transseptal system resulted in
shorter time to LA access and reduced radiation exposure compared with LA
access using conventional transseptal equipment. Categories: STRUCTURAL:
Electrophysiology Copyright © 2019

<140>
Accession Number
2002924959
Title
TCT-803 Clinical Outcomes After TAVR in Patients With and Without
Peripheral Arterial Disease: Results From the BRAVO-3 Randomized Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B787), 2019. Date of Publication: 1 October
2019.
Author
Zilberszac R.; Chandiramani R.; Hengstenberg C.; Sartori S.; Cao D.;
Chandrasekhar J.; Tchetche D.; Violini R.; Jeger R.; Van Belle E.;
Dumonteil N.; Berg J.T.; Deliargyris E.; Mehran R.; Dangas G.
Institution
(Zilberszac, Hengstenberg) Division of Cardiology, Department of Internal
Medicine II, Medical University of Vienna, Vienna, Austria, Austria
(Chandiramani, Sartori, Cao, Chandrasekhar) Icahn School of Medicine at
Mount Sinai, New York, New York, France
(Tchetche, Dumonteil) Clinique Pasteur, Toulouse, France, France
(Violini) Department of Interventional Cardiology, San Camillo Hospital,
Rome, Italy
(Jeger) University Hospital Basel, University of Basel, Basel,
Switzerland, Switzerland
(Van Belle) Insititut Coeur Poumon-Centre Hospitalier Regional, Lille,
France, France
(Berg) Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, the
Netherlands, Netherlands
(Deliargyris) PLx Pharma, Sparta, NJ, United States
(Mehran, Dangas) The Zena and Michael A. Wiener Cardiovascular Institute,
Mount Sinai Hospital, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Peripheral artery disease (PAD) is common in patients
undergoing transcatheter aortic valve replacement (TAVR) and has been
related to higher risk for adverse events. Whether patients with and
without PAD experience different outcomes according to bivalirudin or
unfractionated heparin (UFH) use during TAVR is unknown. We evaluated
clinical outcomes by the presence of PAD from the BRAVO-3 randomized
trial. Method(s): A total of 802 patients undergoing transfemoral
TAVR were randomized to either bivalirudin or UFH across 31 centers.
Primary endpoints were major bleeding (Bleeding Academic Research
Consortium >=3b), major adverse cardiac events (MACE; a composite of
death, myocardial infarction, or stroke), and net adverse cardiovascular
events (NACE; a composite of major bleeding or MACE) at 30 days.
 Result(s): Of the total cohort, 15% patients had PAD (n = 119; 60
received bivalirudin and 59 UFH). Coronary artery disease and diabetes
were more frequent in patients with PAD, but clinical characteristics and
European System for Cardiac Operative Risk Evaluation score were otherwise
comparable with those in patients without PAD. Vascular complications
occurred more frequently in patients with PAD both in hospital (25.2% vs.
16.7%; p = 0.018) and at 30 days (29.4% vs. 17.3%; p = 0.001) compared
with those without PAD (Figure). In patients with PAD, bivalirudin was
associated with increased risk for vascular complications at 30 days
compared with UFH (38.3% vs. 20.3%; p = 0.03), driven by higher rates of
minor but not major complications. [Figure presented] Conclusion(s):
Patients with PAD undergoing transfemoral TAVR have similar mortality and
NACE rates compared with patients without PAD but do have a higher risk
for vascular complications. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2019

<141>
Accession Number
2002924951
Title
TCT-317 Impact of Coronary Artery Dominance on Prognosis After PCI and
CABG for Unprotected Left Main Disease: Analysis From the EXCEL Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B315), 2019. Date of Publication: 1 October
2019.
Author
Usui E.; Maehara A.; Noguchi M.; Fujimura T.; Gkargkoulas F.; Ali Z.;
Zhang Y.; Kappetein A.P.; Sabik J.; Serruys P.; Mintz G.; Genereux P.;
Stone G.
Institution
(Usui, Maehara, Noguchi, Fujimura, Gkargkoulas, Zhang, Mintz)
Cardiovascular Research Foundation, New York, NY, United States
(Ali) New York-Presbyterian Hospital/Columbia University Medical Center,
New York, NY, United States
(Kappetein) Medtronic, Mounds View, MN, United States
(Sabik) Department of Thoracic and Cardiovascular Surgery, The Cleveland
Clinic Foundation, Cleveland, OH, United States
(Serruys) Imperial College, London, United Kingdom
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center/New York-Presbyterian Hospital, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: The impact of coronary artery dominance on prognosis after
treatment of unprotected left main disease has not been studied.
 Method(s): This study examined the 4-year outcomes among patients
with left-dominance (L-D) versus right or codominance (R/C-D) in the EXCEL
trial in which patients with unprotected left main disease with SYNTAX
scores <=32 were randomized to percutaneous coronary intervention (PCI)
with everolimus-eluting stents versus coronary artery bypass graft (CABG).
After eliminating 82 patients with angiograms insufficient to determine
dominancy, 4-year outcomes (all-cause death, myocardial infarction [MI],
stroke, or ischemia-driven revascularization [IDR] between L-D and R/C-D
was compared in 1,823 patients. Result(s): The prevalence of L-D was
5.8% (106 of 1,823) and was similar in CABG and PCI groups. SYNTAX scores
were similar between the 2 groups, as were most other baseline
characteristics. After multivariable analysis adjusting for small
intergroup differences (Table 1), patients with L-D and R/C-D had similar
4-year rates of the primary composite study endpoint of death, MI, or
stroke, as well as death alone, whether treated with PCI or CABG.
Ischemia-driven target lesion revascularization (ID-TLR) and stroke were
more frequent in patients with L-D compared after PCI, whereas
periprocedural MI was more frequent in patients with L-D after CABG
(Figure). [Figure presented] Conclusion(s): Whereas overall outcomes
after PCI and CABG in EXCEL patients with unprotected left main disease
were favorable in both L-D and R/C-D, L-D was associated with greater
rates of early complications (periprocedural MI after CABG) and late
adverse events (ID-TLR and stroke after PCI). Categories: CORONARY:
Stents: Drug-Eluting Copyright © 2019

<142>
Accession Number
2002924942
Title
TCT-737 Balloon Expandable Versus Self Expanding Transcatheter Aortic
Valve Systems: A Bayesian Network Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B723), 2019. Date of Publication: 1 October
2019.
Author
Osman M.; Ghaffar Y.A.; Saleem M.; Kheiri B.; Osman K.; Munir M.; Alkhouli
M.
Institution
(Osman, Ghaffar, Saleem, Munir) West Virginia University, Morgantown, West
Virginia, Sudan
(Kheiri) Knight Cardiovascular Institute, Oregon Health & Science
University, Portland, Oregon, Sudan
(Osman) Faculty of Medicine, University of Khartoum, Khartoum, Sudan,
Sudan
(Alkhouli) West Virginia University Heart and Vascular Institute,
Morgantown, West Virginia, Sudan
Publisher
Elsevier USA
Abstract
Background: Two transcatheter aortic valve systems are currently in use in
the United States. These are the balloon-expandable SAPIEN valves (BEV)
(Edwards Lifesciences, Irvine, California), and the self-expanding
CoreValve system (SEV) (Medtronic, Minneapolis, Minnesota). In this
analysis, we used the advanced meta-analytic properties of Bayesian
analysis to compare both. Method(s): We conducted a search of PubMed,
Embase, and the Cochrane library from inception through March 30, 2019,
for randomized controlled trials (RCTs) comparing BEV with SEV directly or
BEV with surgical aortic valve replacement (SAVR) or SEV with SAVR. The
primary outcome was all-cause mortality at maximum follow-up. Secondary
outcomes were cardiovascular mortality, stroke, new permanent pacemaker
implantation (PPM), reintervention, heart failure hospitalization, and
moderate to severe paravalvular leak (PVL). Result(s): Eight RCTs
with 8,059 patients were included. There were no difference in all-cause
mortality (odds ratio [OR]: 0.9; 95% confidence interval [CI]: 0.58 to
1.52; I2 = 19.6%), cardiovascular mortality (OR: 0.88; 95% CI:
0.53 to 1.44, I2 = 18.5%), stroke (OR: 0.77; 95% CI: 0.46 to
1.39; I2 = 16.9%), and heart failure hospitalization (OR: 0.83;
95% CI: 0.27 to 2.4; I2 = 62%) between BEV and SEV. Pacemaker
implantation and PVL rates were less in BEV (OR: 0.43; 95% CI: 0.19 to
0.87; I2 = 38.2%) compared with SEV (OR: 0.04; 95% CI: 0.0 to
0.33; I2 = 79%) (Figures A and B). [Figure presented]
 Conclusion(s): Similar outcomes were seen in BEV compared with SEV
with the exception of high rates of PPM implantation and PVL in the SEV
group. There is a need for large RCTs to confirm these findings.
Categories: STRUCTURAL: Valvular Disease: Aortic Copyright © 2019

<143>
Accession Number
2002924934
Title
TCT-711 Prevalence and Clinical Impact of Bioprosthesis Thrombosis After
Transcatheter Aortic Valve Implantation. A Collaborative Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B698), 2019. Date of Publication: 1 October
2019.
Author
Rheude T.; Pellegrini C.; Stortecky S.; Xhepa E.; Alvarez H.; Ammon F.;
Pilgrim T.; Kastrati A.; Cassese S.; Joner M.
Institution
(Rheude, Pellegrini, Alvarez, Kastrati, Joner) Deutsches Herzzentrum
Munchen, Munich, Germany, Germany
(Stortecky, Pilgrim) University Hospital Bern, Bern, Switzerland,
Switzerland
(Xhepa, Cassese) Deutsches Herzzentrum Munchen-Technische Universitat
Munchen, Munich, Germany, Germany
(Ammon) University of Erlangen, Erlangen, Germany, Germany
Publisher
Elsevier USA
Abstract
Background: The prevalence and the clinical impact of bioprosthesis
thrombosis after transcatheter aortic valve replacement (TAVR) remain
unknown, though valve thrombosis (VT) and subclinical leaflet thrombosis
(SLT) have become increasingly recognized. We performed a collaborative
meta-analysis to evaluate the prevalence and clinical impact of SLT and VT
after TAVR. Method(s): We systematically searched electronic
scientific databases for studies reporting on SLT and/or VT following
TAVR. We summarized diagnostic strategies and prevalence of SLT and/or VT
and estimated their effect on the risk for all-cause death and stroke by
using a random-effects meta-analysis. Result(s): Thirteen studies
including a total of 9,923 patients reported on bioprosthesis thrombosis
after TAVR and entered final calculations. The summary crude prevalence of
SLT and VT after TAVI was 14.8% (95% confidence interval [CI]: 9.7% to
20.7%) and 1.1% (95% CI: 0.5% to 1.9%), respectively. All-cause death was
similar among patients with SLT (risk ratio [RR]: 0.77; 95% CI: 0.50 to
1.18; p = 0.22) or VT (RR: 1.29; 95% CI: 0.38 to 4.34; p = 0.68) compared
with those without these complications. The risk for stroke was higher in
patients with VT (RR: 7.51; 95% CI: 2.59 to 21.78; p < 0.001) but not in
those with SLT (RR: 1.62; 95% CI: 0.77 to 3.43; p = 0.20) after TAVR
compared with those patients without these complications. An exploratory
meta-regression analysis found age (p < 0.001), atrial fibrillation (p <
0.001), and left ventricular ejection fraction (p = 0.003) to be
associated with a higher prevalence of bioprosthesis thrombosis.
 Conclusion(s): The prevalence of subclinical leaflet thrombosis and
of valve thrombosis after TAVR is 14.8% and 1.1%, respectively. The
presence of bioprosthesis thrombosis after TAVR does not increase the risk
for all-cause death. VT, but not SLT, is associated with an increased risk
for stroke. Future studies should focus on prevention and treatment of
bioprosthesis thrombosis to further improve clinical outcomes after TAVR.
Categories: STRUCTURAL: Valvular Disease: Aortic Copyright © 2019

<144>
Accession Number
2002924915
Title
TCT-459 Transcatheter Mitral Valve-in-Valve Replacement for Failed
Bioprostheses: A Systematic Review.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B454), 2019. Date of Publication: 1 October
2019.
Author
Hyasat K.; Murdoch D.; Poon K.; Raffel C.
Institution
(Hyasat, Poon, Raffel) The Prince Charles Hospital, Brisbane, Queensland,
Australia, Australia
(Murdoch) Centre for Heart Valve Innovation, St. Paul's and Vancouver
General Hospital, Vancouver, British Columbia, Canada, Canada
Publisher
Elsevier USA
Abstract
Background: Transcatheter mitral valve-in-valve for failed bioprosthetic
valves is an emerging alternative to surgical reoperation in high-risk
patients. This systematic review assessed the early outcomes of mitral
valve-in-valve replacement. Method(s): A comprehensive search
strategy was designed and a thorough computer-based search was performed
using OVID MEDLINE, EMBASE, Google Scholar, and PubMed databases. The
authors included studies utilizing transcatheter mitral valve-in-valve
replacement in failed bioprosthetic valves, mitral ring repairs, and
mitral clips. The 30-day and outcome of all-cause mortality, stroke, major
bleeding, and reintervention was analyzed. Result(s): Seventeen
observational studies were included in the analysis that comprised 558
patients (437 bioprosthetic mitral valves, 110 mitral rings, and 11 mitral
clips). The mean age was 75 years; 39% of patients were male; and 82.3% (n
= 459) had New York Heart Association functional class III or IV symptoms.
The mean Society of Thoracic Surgeons (STS) score was 12.2%. Mean
pre-operative left ventricular ejection fraction was 55.3%. Mitral
regurgitation was the most common mitral valve pathology in failed
bioprostheses occurring in 53.9% (n = 299). Mitral stenosis and mixed
mitral disease comprised 24.9% (n = 139) and 21.5% (n = 120),
respectively. Overall analysis demonstrated a low 30-day all-cause
mortality of 2.5%. The rates of stroke were low at 0.7% (n = 4). Major
bleeding occurred in 6.8% (n = 38). Of the 2.7% (n = 16) who required
reintervention, 0.4% (n = 2) needed surgical replacement and 0.4% (n = 2)
further valve-in-valve procedures. Conclusion(s): Transcatheter
mitral valve-in-valve is a safe and feasible option in patients with
failed mitral valve bioprostheses who are at high surgical risk for
reoperations. Categories: STRUCTURAL: Valvular Disease:
Mitral Copyright © 2019

<145>
Accession Number
2002924909
Title
TCT-699 Preoperative Frailty Parameters as Predictors for Outcomes After
Transcatheter Aortic Valve Implantation: A Systematic Review and
Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B686), 2019. Date of Publication: 1 October
2019.
Author
van Mourik M.S.; Lanting V.; Limpens J.; Piek J.; Baan J.; Henriques
J.P.S.; Vis M.M.
Institution
(van Mourik) Amsterdam UMC, AMC, Amsterdam, the Netherlands, Netherlands
(Lanting, Limpens, Baan, Henriques, Vis) Amsterdam UMC, University of
Amsterdam, Amsterdam, the Netherlands, Netherlands
(Piek) Amsterdam University Medical Centers, Location AMC, Amsterdam, the
Netherlands, Netherlands
Publisher
Elsevier USA
Abstract
Background: Guidelines suggest using frailty characteristics in the workup
for transcatheter aortic valve replacement (TAVR). There are many
frailty-screening tools with different components. The prognostic value of
the individual parameters in frailty is yet unclear. The objective was to
find and pool predictors of 1-year mortality after TAVR. Method(s):
We followed a 2-step approach. First, we searched OVID-Medline for
randomized controlled trials of TAVR to identify frailty parameters used
in these studies. Second, we searched OVID-Medline and OVID-Embase from
inception to April 12, 2018, to find publications on frailty parameters
and predictors of outcomes after TAVR. Papers were included for pooled
analysis if the studied parameters were dichotomized with clear cutoff
values based on common standards or clinical practice and reported
adjusted hazard ratios (HRs) of 1-year mortality after TAVR (Figure).
[Figure presented] Results: We calculated pooled effect estimates of 49
studies on the basis of dichotomized frailty-scores (HR: 2.16; 95%
confidence interval [CI]: 1.57 to 3.00), chronic lung disease (HR: 1.57;
95% CI: 1.45 to 1.70), estimated glomerular filtration rate (eGFR) <30
ml/min (HR: 1.95; 95% CI: 1.68 to 2.29), body mass index (BMI) <20
kg/m2 (HR: 1.49; 95% CI: 1.09 to 2.03), hypoalbuminemia (HR:
1.77; 95% CI: 1.38 to 2.25), anemia (HR: 2.08; 95% CI: 0.93 to 4.66), low
gait speed (HR: 13.33; 95% CI: 1.75 to 101.49), and Katz ADL Index score
of 1 or more deficits in activities of daily living (ADLs) (HR: 5.16; 95%
CI: 0.77 to 34.47). Conclusion(s): We identified multiple frailty
parameters used in TAVR research in this meta-analysis that were
predictive of 1-year mortality. Chronic lung disease, chronic kidney
disease, underweight, hypoalbuminemia, a low frailty score, anemia, low
gait speed, and ADL deficiency were associated with worse 1-year outcomes.
Categories: STRUCTURAL: Valvular Disease: Aortic Copyright © 2019

<146>
Accession Number
2002924885
Title
TCT-730 Key Cardiovascular Outcomes After Balloon Expandable Versus Self
Expandable Transcatheter Aortic Valve Implantation.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B716), 2019. Date of Publication: 1 October
2019.
Author
Riaz H.; Lin C.; Siddiqi T.; Khan S.; Khan M.; Bhatt D.
Institution
(Riaz, Lin) Cleveland Clinic, Cleveland, Ohio, Pakistan
(Siddiqi) Dow Medical College, Karachi, Pakistan, Pakistan
(Khan) West Virginia University, Morgantown, West Virginia, Pakistan
(Khan) John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois,
Pakistan
(Bhatt) Brigham and Women's Hospital, Boston, Massachusetts, Pakistan
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been shown
to be noninferior to surgical aortic valve replacement across a broad
spectrum of pre-procedural risks. However, the relative safety of the
balloon-expandable (BE) versus self-expandable (SE) deployment of TAVR
remains uncertain. Herein, we conduct a meta-analysis to compare the 2
systems with regard to key safety and efficacy endpoints. Method(s):
PubMed (Medline) was searched for all studies that examined outcomes after
transfemoral deployment of either BE or SE systems. All-cause mortality
and stroke at month 12 or completion of study was the pre-specified
primary efficacy endpoint of the study. Safety endpoints of interest
included permanent pacemaker (PPM) implantation, moderate or severe
paravalvular aortic insufficiency (AI), cardiovascular mortality,
myocardial infarction, major bleeding, and vascular complications.
Subgroup analyses were conducted to account for the generation of the
valves, with SAPIEN 3 and Evolut regarded as the new-generation valves and
SAPIEN XT and CoreValve regarded as the older generation valves. Pooled
proportions were used to estimate the aggregate outcomes using a
random-effects model given the significant heterogeneity, and the
estimates are presented as odds ratios with 95% confidence intervals
(CIs). Result(s): A total of 58 studies with 19,774 patients, 22
studies in the SE group (7,060 patients) and 35 studies in the BE group
(12,714 patients), were included in the analysis. Pooled estimates
revealed that the rates of all-cause mortality, cardiovascular mortality,
stroke, and myocardial infarction were similar (p > 0.05 for all). The
rate of PPM implantation was significantly (p for interaction < 0.001)
higher with SE (1,061 of 4,637 [22.8%]; 95% CI: 20.8% to 29.5%) compared
with the BE valves (573 of 5,804 [9.8%]; 95% CI: 5.0% to 11.6%). The rate
of moderate or severe AI was also significantly higher (p < 0.05) with SE
(293 of 2,692 [10.8%]; 95% CI: 4.2% to 16.8%) compared with BE (267 of
5,770 [4.6%]; 95% CI: 1.7% to 5.7%). Temporal trends suggest that for both
BE and SE, the rates of PPM and severe AI have decreased over time.
Subgroup analyses were performed on the basis of patient risk (low,
intermediate, and high) and generation of devices (old vs. newer), and the
findings remained consistent. Conclusion(s): Our meta-analysis of
randomized and observational studies reveals that compared with SE, BE
valves are associated with significantly lower risk for PPM implantation
and moderate to severe AI after deployment of the TAVR valves, while
all-cause, cardiovascular mortality, and stroke were similar. Future
studies should focus on devising strategies that can further reduce the
rate of AI and PPM implantation after TAVR. A randomized comparison
between the new-generation devices may also help providing direct
comparative evidence. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2019

<147>
Accession Number
2002924850
Title
TCT-537 Electrophysiological Complications With Transcatheter Versus
Surgical Aortic Valve Replacement in Low-Risk Patients: Evidence From a
Meta-Analysis of Randomized Controlled Trials.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B530), 2019. Date of Publication: 1 October
2019.
Author
Kundu A.; Sardar P.; Malhotra R.; Qureshi W.; Kakouros N.
Institution
(Kundu, Kakouros) University of Massachusetts Medical School, Worcester,
MA, United States
(Sardar) Brown University, Providence, UT, United States
(Malhotra) UMass Memorial Medical Center, Worcester, MA, United States
(Qureshi) Emory University, Winston-Salem, NC, United States
Publisher
Elsevier USA
Abstract
Background: Electrophysiological complications such as conduction
abnormalities and arrhythmias are frequently encountered during
transcatheter aortic valve replacement (TAVR), which is an established
treatment option in high- and intermediate-risk patients with severe
aortic valve stenosis (AS). However, there is less data regarding the
safety of TAVR in low-risk patients. We performed a meta-analysis to
evaluate the risk of electrophysiological complications with TAVR,
compared with surgical aortic valve replacement (SAVR) in low-risk
patients with severe AS. Method(s): Databases were searched through
May 5, 2019, for randomized controlled trials (RCTs) that compared TAVR
with SAVR for the treatment of low-risk (mean STS-PROM score <4%) patients
with severe AS. The electrophysiological safety outcomes assessed in this
study were new-onset atrial fibrillation and requirement for permanent
pacemaker implantation. Longest available follow-up data was used for both
outcomes. Data from each trial was analyzed using the random effects model
of DerSimonian and Laird to estimate pooled odds ratios (ORs) and
respective 95% confidence intervals (CIs). Result(s): The final
analysis included 2,953 patients from 5 studies. Electrophysiological
complications were among the most common adverse outcomes encountered in
both groups. New-onset atrial fibrillation was observed in a total of 700
(24.3%) patients from 4 RCTs. Compared with SAVR, TAVR was associated with
a much lower risk of developing new-onset atrial fibrillation (10.2% vs.
39.4%; OR: 0.17; 95% CI: 0.14 to 0.21; p < 0.001, I2 = 0%). However, a
total of 346 (11.7%) patients from 5 RCTs required permanent pacemaker
implantation. TAVR was associated with a higher risk of requiring
permanent pacemaker implantation (17.4% vs. 5.6%; OR: 4.25; 95% CI: 1.86
to 9.73; p < 0.001; I2 = 83%) compared with SAVR (Figure). [Figure
presented] Conclusion(s): In comparison with SAVR, TAVR is associated
with a reduced risk of new-onset atrial fibrillation, but a higher risk of
permanent pacemaker implantation in low-risk patients with severe AS.
Categories: STRUCTURAL: Valvular Disease: Aortic Copyright © 2019

<148>
Accession Number
2002924839
Title
TCT-308 Impact of Periprocedural Major Adverse Events After PCI and CABG
on Long-Term Outcomes in Patients With Left Main Disease: The EXCEL Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B306), 2019. Date of Publication: 1 October
2019.
Author
Jain S.; Dressler O.; Serruys P.; Kappetein A.P.; Sabik J.; Leon M.;
Taggart D.; Morice M.-C.; Puskas J.; Kandzari D.; Lembo N.; Brown W.;
Banning A.; Stone G.
Institution
(Jain) New York Presbyterian-Columbia, New York, NY, United States
(Dressler) Cardiovascular Research Foundation, New York, NY, United States
(Serruys) Imperial College, London, United Kingdom
(Kappetein) Medtronic, Mounds View, MN, United States
(Sabik) Department of Thoracic and Cardiovascular Surgery, The Cleveland
Clinic Foundation, Cleveland, OH, United States
(Leon) Columbia University Medical Center/New York-Presbyterian Hospital,
New York, NY, United States
(Taggart) Oxford University, Oxford, United Kingdom
(Morice) CERC, Massy, France
(Puskas) Mount Sinai, New York, NY, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Lembo) Columbia University Medical Center, New York, NY, United States
(Brown) Piedmont Heart Institute CardioThoracic Surgeons, Atlanta, Georgia
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center/New York-Presbyterian Hospital, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: In the EXCEL trial, periprocedural major adverse events (MAE)
were more frequent after coronary artery bypass graft (CABG) versus
percutaneous coronary intervention (PCI) for treatment of left main (LM)
disease. The association between composite and individual MAE after LM
revascularization and long-term survival is unknown. Method(s): In
the EXCEL trial, 1,905 patients with LM disease and visually assessed low
or intermediate SYNTAX scores were randomized to PCI versus CABG.
Pre-specified MAE included MI, stroke, TIMI (Thrombolysis In Myocardial
Infarction) major or minor bleeding, transfusion >=2 units of blood,
unplanned coronary revascularization, unplanned surgery or therapeutic
radiologic procedure, renal failure, intubation for >48 h, sternal wound
dehiscence, post-pericardiotomy syndrome, atrial fibrillation or other
major arrhythmia, and sepsis. Cox proportional hazards regression was
performed to determine whether composite and individual MAE were
independent predictors of death between 30 days and 4 years.
 Result(s): MAE occurred in 104 of 926 patients (11.2%) and 409 of 913
patients (44.8%) who underwent PCI versus CABG and survived to 30 days,
respectively (p < 0.001). Patients with a MAE were older and more likely
to be female, have baseline peripheral vascular disease, anemia, carotid
artery disease, atrial fibrillation, and lower creatinine clearance. Any
MAE was associated with higher rates of mortality between 30 days and 4
years after PCI (21.0% vs. 7.8%; adjusted hazard ratio [HR]: 2.57; 95%
confidence interval [CI]: 1.53 to 4.32) and CABG (9.4% vs. 3.9%; adjusted
HR: 2.57; 95% CI: 1.44 to 4.61) (p<inf>interaction</inf> = 1.00). By
multivariable analysis, periprocedural MI, stroke, blood transfusion, and
any unplanned coronary revascularization were independently associated
with mortality between 30 days and 4 years after both PCI and CABG. Any
unplanned surgery or radiologic procedure, renal failure, wound
dehiscence, intubation for >48 h, atrial fibrillation, and sepsis were
also independently associated with mortality between 30 days and 4 years
after CABG. TIMI bleeding, post-pericardiotomy syndrome, and other major
arrhythmias were unrelated to late mortality after either PCI or CABG.
 Conclusion(s): In the EXCEL trial, periprocedural MAE were strongly
associated with long-term mortality after LM PCI and CABG. Prevention of
periprocedural MAE may improve the long-term prognosis in patients with LM
coronary artery disease undergoing revascularization. Categories:
CORONARY: Complications Copyright © 2019

<149>
Accession Number
2002924835
Title
TCT-734 Transcatheter Compared to Surgical Aortic Valve Replacement in
Patients With Low Surgical Risk: A Meta-Analysis of All Randomized
Controlled Trials.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B720), 2019. Date of Publication: 1 October
2019.
Author
Malik A.; Zaid S.; Ahmad H.; Goldberg J.; Dutta T.; Undemir C.; Cohen M.;
Aronow W.; Lansman S.; Tang G.
Institution
(Malik, Zaid, Ahmad, Goldberg, Lansman) Westchester Medical Center & New
York Medical College, Valhalla, NY, United States
(Dutta, Undemir, Cohen, Aronow) Westchester Medical Center, Valhalla, NY,
United States
(Tang) Mount Sinai Health System, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) for the
treatment symptomatic severe aortic stenosis (AS) is indicated in patients
with intermediate or higher surgical risk. The latest trials have shown
that TAVR and surgical aortic valve replacement (SAVR) perform similarly
at 1 year for the composite outcomes of mortality, stroke, and
rehospitalization. We performed a comprehensive meta-analysis to compare
individual results at 1 year for TAVR compared with SAVR in low-risk
patients. Method(s): PubMed, Embase, and Cochrane Central were
searched systematically for all randomized controlled trials (RCTs) that
reported 1-year comparative outcomes of TAVR and SAVR in patients deemed
to have low surgical risk with Society of Thoracic Surgeons Predicted Risk
of Mortality scores of <4%. Summary effects with 95% confidence intervals
(CIs) for all clinical endpoints were calculated using a random-effects
model using the DerSimonian and Laird estimator. We used the Cochran Q
test to assess heterogeneity between studies and the I2
statistic to quantify the proportion of observed inconsistency across
study results not explained by chance. All analyses were performed using R
software. Result(s): Data from 4 studies and 2,887 randomized
patients were available. TAVR was significantly better than SAVR at 1 year
for the individual outcomes of all-cause mortality (risk ratio [RR]: 0.61;
95% CI: 0.39 to 0.96; p = 0.03; I2 = 0%), cardiovascular
mortality (RR: 0.55; 95% CI: 0.30 to 0.90; p = 0.02; I2 = 0%),
and atrial fibrillation (RR: 0.27; 95% CI: 0.20 to 0.35; p < 0.01;
I2 = 63%), whereas there was a significantly higher risk for
paravalvular risk (RR: 5.70; 95% CI: 1.73 to 18.79; p < 0.01;
I2 = 34%) and a greater number of pacemaker implantations
associated with TAVR compared with SAVR at 1 year (RR: 3.96; 95% CI: 1.65
to 9.54; p < 0.01; I2 = 86%). There was no difference between
TAVR and SAVR for the outcomes of myocardial infarction, stroke, major
vessel complications, and major or life-threatening bleeding (Figure).
[Figure presented] Conclusion(s): The latest randomized trial data
demonstrate that in the short term, TAVR is safe and effective in reducing
all-cause mortality or stroke. Longer follow-up of RCTs is needed to
determine the durability of clinical benefits in TAVR over SAVR in
low-risk patients. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2019

<150>
Accession Number
2002924830
Title
TCT-729 Short-Term Outcomes with Transcatheter vs. Surgical Aortic Valve
Replacement in Low-Risk Patients: A Meta-Analysis of Randomized Controlled
Trials.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B715), 2019. Date of Publication: 1 October
2019.
Author
Kundu A.; Sardar P.; Malhotra R.; Qureshi W.; Kakouros N.
Institution
(Kundu, Kakouros) University of Massachusetts Medical School, Worcester,
Massachusetts, Georgia
(Sardar) Brown University, Providence, Rhode Island, Georgia
(Malhotra) UMass Memorial Medical Center, Worcester, Massachusetts,
Georgia
(Qureshi) Emory University, Atlanta, Georgia, Georgia
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
established treatment option in high- and intermediate-risk patients with
severe aortic valve stenosis (AS). There are fewer data regarding the
efficacy of TAVR in low-risk patients. We performed a meta-analysis to
evaluate the short-term efficacy and safety of TAVR in comparison with
surgical aortic valve replacement (SAVR) in low-risk patients with severe
AS. Method(s): Databases were searched from inception through May 5,
2019, for randomized controlled trials that compared TAVR with SAVR for
the treatment of low-risk (mean Society of Thoracic Surgeons Predicted
Risk of Mortality score <4%) patients with severe AS. The primary outcome
of interest was short-term all-cause mortality. Secondary outcomes
included short-term major bleeding and acute kidney injury (AKI; stage 2
or 3). All outcomes were assessed at 30 days. Data from each trial were
analyzed using the random-effects model of DerSimonian and Laird to
estimate pooled odds ratios (OR) and respective 95% confidence intervals
(CI). Heterogeneity across trials was assessed using Higgins I2
statistics, considering I2 <25% as low and I2 >75%
as high heterogeneity and the Cochran Q statistic (p <= 0.1) as
significant for each outcome. All statistical analysis was performed using
the Cochrane Collaborative software Review Manager version 5.3.5.
 Result(s): The final analysis included a total of 2,953 patients from
5 studies. Compared with SAVR, TAVR was associated with similar short-term
mortality (0.8% vs. 1.4%; OR: 0.51; 95% CI: 0.24 to 1.11; p = 0.09;
I2 = 0%). Randomization to TAVR was associated with a reduced
risk for developing both short-term major bleeding (3.7% vs. 14.6%; OR:
0.27; 95% CI: 0.12 to 0.60; p < 0.001; I2 = 77%), as well as
AKI (0.6% vs. 2.8%; OR: 0.26; 95% CI: 0.13 to 0.52; p < 0.001;
I2 = 0%) (Figure). Significant heterogeneity was observed only
for the outcome of short-term major bleeding, mostly attributable to the
PARTNER 3 trial (residual I2 = 0% on exclusion of PARTNER 3).
[Figure presented] Conclusion(s): Our analysis shows that TAVR has
similar short-term clinical efficacy to SAVR, with a much more favorable
safety profile, in low-risk patients with severe AS. Categories:
STRUCTURAL: Valvular Disease: Aortic Copyright © 2019

<151>
Accession Number
2002924816
Title
TCT-675 Direct Stenting Versus Adjunctive Balloon Angioplasty for
Saphenous Vein Graft Percutaneous Coronary Intervention.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B662), 2019. Date of Publication: 1 October
2019.
Author
Latif F.; Uyeda L.; Edson R.; Holmes D.; Rao S.; Aggarwal K.; Uretsky B.;
Ziada K.; McFalls E.; Irimpen A.; Truong H.T.; Kinlay S.; Papademetriou
V.; Velagaleti R.; Rangan B.; Mavromatis K.; Banerjee S.; Brilakis E.
Institution
(Latif) University of Oklahoma, Edmond, Oklahoma, Georgia
(Uyeda, Edson) VA Cooperative Studies Program, Sunnyvale, California,
Georgia
(Holmes) Mayo Clinic, Rochester, Minnesota, Georgia
(Rao) Duke University Medical Center, Durham, North Carolina, Georgia
(Aggarwal) University of Missouri School of Medicine, Columbia, Missouri,
Georgia
(Uretsky) University of Arkansas for Medical Sciences/Central Arkansas
Veterans Healthcare System, Little Rock, Arkansas, Georgia
(Ziada) Gill Heart & Vascular Institute, University of Kentucky,
Lexington, Kentucky, Georgia
(McFalls) Minneapolis Veterans Affairs Medical Center, Minneapolis,
Georgia
(Irimpen) Tulane University Heart and Vascular Institute, Southeast
Louisiana Veterans Health Care System, New Orleans, Louisiana, Georgia
(Truong) Loma Linda VA Healthcare System, Loma Linda, California, Georgia
(Kinlay) VA Boston Healthcare System, Brigham and Women's Hospital,
Boston, Massachusetts, Georgia
(Papademetriou) Veterans Affairs and GTU Medical Centers, Washington, DC,
Georgia
(Velagaleti) Boston VA Healthcare System, Boston, Georgia
(Rangan, Banerjee) University of Texas Southwestern Medical Center/VA
North Texas Health Care System, Dallas, Texas, Georgia
(Mavromatis) Atlanta VA Medical Center, Decatur, Georgia, Georgia
(Brilakis) Minneapolis Heart Institute, Abbott Northwestern Hospital,
Minneapolis, Minnesota, Georgia
Publisher
Elsevier USA
Abstract
Background: Direct stenting without pre- or post-dilation has been
advocated for saphenous vein graft (SVG) percutaneous coronary
intervention (PCI) to decrease the incidence of periprocedural myocardial
infarction (MI) and target lesion revascularization (TLR). Method(s):
In an analysis of the DIVA (Drug-Eluting Stents vs. Bare Metal Stents in
SVG Angioplasty) randomized controlled trial, patients were stratified
into stent-only and balloon-stent groups. The primary endpoint was
12-month target vessel failure (TVF; a composite of cardiac death, target
vessel MI, or TLR). Secondary endpoints included all-cause death, stent
thrombosis (ST), MI, and TLR. Result(s): Of the 575 patients, 185
patients underwent stent-only PCI. Two groups were similar for most
baseline characteristics. There was no difference in the incidence of TVF
at 12 months (15% vs. 19%; p = 0.19) or during long-term follow-up (median
2.7 years). During long-term follow-up, incidence of definite ST was lower
in the stent-only compared with the balloon-stent group (1% vs. 5%; p =
0.008), as was the composite of definite or probable ST (5% vs. 11%; p =
0.009) and target vessel or indeterminate MI (8% vs. 14%; p = 0.023).
Incidence of other secondary endpoints was similar (Table; TVF and
endpoints with p <= 0.05 shown). Multivariate analysis showed that adding
group identifier (stent only vs. balloon stent) to the proportional hazard
model with selected participant and graft characteristics did not
significantly increase ability to predict TVF during entire follow-up
period, though number of years since coronary artery bypass graft and >1
target SVG lesion were associated with increased TVF during entire
follow-up, while pre-intervention TIMI (Thrombolysis In Myocardial
Infarction) flow grade 3 was protective (Table). [Figure presented]
 Conclusion(s): In patients undergoing PCI of de novo SVG lesions,
there was no difference in TVF at 12-month and long-term follow-up in the
stent-only versus the balloon-stent group, but the incidence of ST was
lower in the stent-only group. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2019

<152>
Accession Number
2002924785
Title
TCT-708 Outcomes of Transcatheter Aortic Valve Replacement in Oncology
Patients With Severe Aortic Stenosis.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B695), 2019. Date of Publication: 1 October
2019.
Author
Murphy A.; Koshy A.; Cameron W.; Horrigan M.; Yeo B.; Farouque O.; Yudi M.
Institution
(Murphy, Koshy, Horrigan, Yeo, Farouque, Yudi) Austin Health, Melbourne,
Australia, Australia
(Cameron) Monash University, Melbourne, Australia, Australia
Publisher
Elsevier USA
Abstract
Background: Current heart team risk assessment using the Society for
Thoracic Surgeons (STS) score incorporates a history of cancer as a
covariate. However, this has not been validated in patients undergoing
transcatheter aortic valve replacement (TAVR). As the survivorship
population increases, it is imperative to establish efficacy and safety in
those with histories of cancer, as they represent a growing proportion of
patients with severe aortic stenosis (AS). Method(s): A systematic
review of PubMed, MEDLINE and Embase was conducted to identify studies
reporting outcomes in patients with histories of malignancy undergoing
TAVR. A meta-analysis was performed using a random-effects model with a
primary outcome of all-cause mortality and cardiac mortality at longest
follow-up. On secondary analyses, we evaluated procedural safety and
efficacy. Result(s): A total of 7 observational studies with 6,323
patients were included in the quantitative analysis. Short-term mortality
and long-term all-cause mortality were not significantly different when
comparing patients with and without histories of cancer (risk ratio [RR]:
0.61; 95% confidence interval [CI]: 0.36 to 1.01; p = 0.06; and RR: 1.24;
95% CI: 0.95 to 1.63; p = 0.11, respectively). No significant differences
in the rates of periprocedural complications, including stroke, bleeding,
paravalvular leak, and pacemaker implantation, were noted (Figure).
[Figure presented] Conclusion(s): In patients with severe AS
undergoing TAVR, a history of cancer was not associated with adverse
short- and long-term survival. On the basis of these findings, TAVR should
be considered in all patients with severe aortic stenosis, irrespective of
their history of malignancy. Categories: ENDOVASCULAR: Aortic Disease and
Aortic Intervention Copyright © 2019

<153>
Accession Number
2002924772
Title
TCT-780 Randomized Comparison of Hemostasis Times Following Transradial
Access With a Kaolin-Based Hemostatic Pad (QuikClot
Radial) vs. Mechanical Compression (TR Band).
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B764), 2019. Date of Publication: 1 October
2019.
Author
Roberts J.; Niu J.; Shah S.; Cianferra E.; Pastor-Cervantes J.
Institution
(Roberts, Niu, Shah, Pastor-Cervantes) Memorial Cardiac and Vascular
Institute, Memorial Regional Hospital, Memorial Healthcare System,
Hollywood, FL, United States
(Cianferra) Office of Human Research, Memorial Healthcare System,
Hollywood, FL, United States
Publisher
Elsevier USA
Abstract
Background: Hemostasis after transradial access is usually achieved with a
mechanical compression device. This study investigated the efficacy of the
QuikClot Radial pad (QCRP) on hemostasis times compared with mechanical
compression with a TR Band. Method(s): Patients undergoing cardiac
procedures using the radial approach were randomly assigned to the
following 3 groups (n = 50 per group): group 1 received 60 min of
mechanical compression with a TR Band inflated with 10 ml of air followed
by gradual weaning over the subsequent 60 min; group 2 was treated with
the QCRP, with 5 min of manual pressure followed by 25 min of light
compression with a Coban bandage; and group 3 was treated with the QCRP,
with 5 min of manual pressure followed by a Tegaderm dressing. Hemostasis
time was defined as the time needed from sheath removal to achieve
complete hemostasis. Radial artery occlusion (RAO) was assessed by the
reverse Barbeau's test 1 h after hemostasis. Result(s): No
differences were observed among the 3 groups in age, clinical
characteristics, total procedural heparin (mean dose 6,723 +/- 193 U), and
end-procedural activated clotting time. A 6-F sheath was used in 94% of
patients. Hemostasis per the method described above was obtained in 88% in
group 1, 92% in group 2, and 72% in group 3 (p = 0.016). Requirement for
recompression was higher in group 3 (28%) compared with group 1 (12%; p =
0.046) and group 2 (8%; p = 0.009). Mean hemostasis time in group 1 was
126 +/- 8 min, compared with 32 +/- 6 and 11 +/- 5 min in groups 2 and 3,
respectively. RAO was documented in 2 patients (4%) in group 1, 1 (2%) in
group 2, and 3 (6%) in group 3 (p = 0.594). Hematoma was documented in 3
patients (6%) in group 1, 3 (6%) in group 2, and 4 (8%) in group 3 (p =
0.898). Conclusion(s): Five minutes of manual pressure with a QCRP
combined with either a Coban bandage or a Tegaderm dressing significantly
shortened hemostasis time versus a TR Band, with a higher incidence of
recompression in the Tegaderm cohort. RAO and access-site complications
were similar in the 3 cohorts. A QCRP combined with a Coban bandage
appears to be a safe and effective hemostasis strategy and shortened
hemostasis by 94 min compared with a TR Band. Categories: OTHER: Vascular
Access: Coronary Copyright © 2019

<154>
Accession Number
629406302
Title
Three-Dimensional Echocardiography for Transcatheter Aortic Valve
Replacement Sizing: A Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. 8 (19) (pp e013463), 2019. Date
of Publication: 01 Oct 2019.
Author
Rong L.Q.; Hameed I.; Salemi A.; Rahouma M.; Khan F.M.; Wijeysundera H.C.;
Angiolillo D.J.; Shore-Lesserson L.; Biondi-Zoccai G.; Girardi L.N.;
Fremes S.E.; Gaudino M.
Institution
(Rong) Department of Anesthesiology Weill Cornell Medicine New York NY
(Hameed, Salemi, Rahouma, Khan, Girardi, Gaudino) Department of
Cardiothoracic Surgery Weill Cornell Medicine New York NY
(Wijeysundera, Fremes) Schulich Heart Centre Sunnybrook Health Science
University of Toronto Canada
(Angiolillo) Division of Cardiology University of Florida College of
Medicine Jacksonville FL
(Shore-Lesserson) Department of Anesthesiology North Shore University
Hospital Manhasset NY
(Biondi-Zoccai) Department of Medico-Surgical Sciences and Biotechnologies
Sapienza University of Rome Latina Italy
(Biondi-Zoccai) Mediterranea Cardiocentro Napoli Italy
Publisher
NLM (Medline)
Abstract
Background Transcatheter aortic valve replacement (TAVR) is the standard
of care for many patients with severe symptomatic aortic stenosis and
relies on accurate sizing of the aortic annulus. It has been suggested
that 3-dimensional transesophageal echocardiography (3D TEE) may be used
instead of multidetector computed tomography (MDCT) for TAVR planning.
This systematic review and meta-analysis compared 3D TEE and MDCT for
pre-TAVR measurements. Methods and Results A systematic literature search
was performed. The primary outcome was the correlation coefficient between
3D TEE- and MDCT-measured annular area. Secondary outcomes were
correlation coefficients for mean annular diameter, annular perimeter, and
left ventricular outflow tract area; interobserver and intraobserver
agreements; mean differences between 3D TEE and MDCT measurements; and
pooled sensitivities, specificities, and receiver operating characteristic
area under curve values of 3D TEE and MDCT for discriminating post-TAVR
paravalvular aortic regurgitation. A random effects model was used.
Meta-regression and leave-one-out analysis for the primary outcome were
performed. Nineteen studies with a total of 1599 patients were included.
Correlations between 3D TEE and MDCT annular area, annular perimeter,
annular diameter, and left ventricular outflow tract area measurements
were strong (0.86 [95% CI, 0.80-0.90]; 0.89 [CI, 0.82-0.93]; 0.80 [CI,
0.70-0.87]; and 0.78 [CI, 0.61-0.88], respectively). Mean differences
between 3D TEE and MDCT between measurements were small and
nonsignificant. Interobserver and intraobserver agreement and
discriminatory abilities for paravalvular aortic regurgitation were good
for both 3D TEE and MDCT. Conclusions For pre-TAVR planning, 3D TEE is
comparable to MDCT. In patients with renal dysfunction, 3D TEE may be
potentially advantageous for TAVR measurements because of the lack of
contrast exposure.

<155>
Accession Number
629403781
Title
Impact of Lung Expansion Therapy Using Positive End-Expiratory Pressure in
Mechanically Ventilated Patients Submitted to Coronary Artery Bypass
Grafting.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2019. Date
of Publication: 23 Sep 2019.
Author
Cordeiro A.L.L.; Carvalho S.; Leite M.C.; Vila-Flor A.; Freitas B.; Sousa
L.; Oliveira Q.; Guimaraes A.R.
Institution
(Cordeiro) Escola Bahiana de Medicina e Saude Publica (Bahiana) Unidade
Academica Brotas Salvador Bahia Brazil Escola Bahiana de Medicina e Saude
Publica (Bahiana) - Unidade Academica Brotas, Salvador, Bahia, Brazil
(Cordeiro) Faculdade Nobre Feira de Santana Bahia Brazil Faculdade Nobre
(FAN), Feira de Santana, Bahia, Brazil
(Carvalho, Leite, Vila-Flor, Freitas, Sousa, Oliveira, Guimaraes)
Instituto Nobre de Cardiologia Feira de Santana Bahia Brazil Instituto
Nobre de Cardiologia (INCARDIO), Feira de Santana, Bahia, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the impact of different levels of positive
end-expiratory pressure (PEEP) on gas exchange in patients undergoing
coronary artery bypass grafting (CABG). METHOD(S): A randomized
clinical trial was conducted with patients undergoing CABG surgery.
Patients were randomized into three groups: Group 10, PEEP of 10 cmH2O;
Group 12, PEEP of 12 cmH2O; and Group 15, PEEP of 15 cmH2O. After the
randomization, all patients underwent gas analysis at three moments: (1)
before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one
hour after extubation. RESULT(S): Sixty-six patients were studied, of
which 61.7% were men, with mean age of 64 +/- 8.9 years. Patients
allocated to Group 15 showed a significant improvement in gas exchange
comparing pre- and post-expansion values (239+/-21 vs. 301+/-19, P<0,001)
and the increase was maintained after extubation (278+/-26). Despite the
use of high levels of PEEP, no significant hemodynamic change was
evidenced. CONCLUSION(S): It is concluded that high levels of PEEP
(15 cmH2O) are beneficial for the improvement of gas exchange in patients
undergoing CABG.

<156>
Accession Number
629402710
Title
Reply, Mannitol in Cardiopulmonary Bypass Prime Solution.
Source
Acta anaesthesiologica Scandinavica. (no pagination), 2019. Date of
Publication: 23 Sep 2019.
Author
Hyllen S.; Ljunggren M.; Skold A.; Dardashti A.
Institution
(Hyllen, Ljunggren, Skold, Dardashti) Skanes University Hospital, Lund-
Cardiothoracic Surgery, Anestesiology and Intensive Care, SE-221 85 Lund,
Lund, Sweden, Lund, 221 85, Sweden
Publisher
NLM (Medline)
Abstract
We are pleased to receive response from Dr. G. Malmqvist and Mr. M.
Appelblad to our article "The use of mannitol in cardiopulmonary bypass
prime solution - Prospective randomized double-blind clinical trial". The
authors of the letter highlight the general effects of the hyperosmolar
prime solution during cardiac surgery. Understanding the pathophysiology
of fluid shifts during cardiopulmonary bypass is of great importance
especially concerning the possible negative effects of treating
hyponatremia. We appreciate this valuable contribution to the
discussion. Copyright © 2019 The Acta Anaesthesiologica
Scandinavica Foundation. Published by John Wiley & Sons Ltd.

<157>
Accession Number
629401663
Title
Perioperative beta-blockers for preventing surgery-related mortality and
morbidity in adults undergoing cardiac surgery.
Source
The Cochrane database of systematic reviews. 9 (pp CD013435), 2019. Date
of Publication: 23 Sep 2019.
Author
Blessberger H.; Lewis S.R.; Pritchard M.W.; Fawcett L.J.; Domanovits H.;
Schlager O.; Wildner B.; Kammler J.; Steinwender C.
Institution
(Blessberger) Department of Cardiology, Med Campus III, Kepler University
Hospital, Medical Faculty of the Johannes Kepler University Linz,
Krankenhausstrase 9, Linz 4020, Austria
Publisher
NLM (Medline)
Abstract
BACKGROUND: Randomized controlled trials (RCTs) have yielded conflicting
results regarding the ability of beta-blockers to influence perioperative
cardiovascular morbidity and mortality. Thus routine prescription of these
drugs in unselected patients remains a controversial issue. A previous
version of this review assessing the effectiveness of perioperative
beta-blockers in cardiac and non-cardiac surgery was last published in
2018. The previous review has now been split into two reviews according to
type of surgery. This is an update and assesses the evidence in cardiac
surgery only. OBJECTIVE(S): To assess the effectiveness of
perioperatively administered beta-blockers for the prevention of
surgery-related mortality and morbidity in adults undergoing cardiac
surgery. SEARCH METHOD(S): We searched CENTRAL, MEDLINE, Embase,
CINAHL, Biosis Previews and Conference Proceedings Citation Index-Science
on 28 June 2019. We searched clinical trials registers and grey
literature, and conducted backward- and forward-citation searching of
relevant articles. SELECTION CRITERIA: We included RCTs and
quasi-randomized studies comparing beta-blockers with a control (placebo
or standard care) administered during the perioperative period to adults
undergoing cardiac surgery. We excluded studies in which all participants
in the standard care control group were given a pharmacological agent that
was not given to participants in the intervention group, studies in which
all participants in the control group were given a beta-blocker, and
studies in which beta-blockers were given with an additional agent (e.g.
magnesium). We excluded studies that did not measure or report review
outcomes. DATA COLLECTION AND ANALYSIS: Two review authors independently
assessed studies for inclusion, extracted data, and assessed risks of
bias. We assessed the certainty of evidence with GRADE. MAIN RESULTS: We
included 63 studies with 7768 participants; six studies were
quasi-randomized and the remaining were RCTs. All participants were
undergoing cardiac surgery, and in most studies, at least some of the
participants were previously taking beta-blockers. Types of beta-blockers
were: propranolol, metoprolol, sotalol, esmolol, landiolol, acebutolol,
timolol, carvedilol, nadolol, and atenolol. In twelve studies,
beta-blockers were titrated according to heart rate or blood pressure.
Duration of administration varied between studies, as did the time at
which drugs were administered; in nine studies this was before surgery, in
20 studies during surgery, and in the remaining studies beta-blockers were
started postoperatively. Overall, we found that most studies did not
report sufficient details for us to adequately assess risk of bias. In
particular, few studies reported methods used to randomize participants to
groups. In some studies, participants in the control group were given
beta-blockers as rescue therapy during the study period, and all studies
in which the control was standard care were at high risk of performance
bias because of the open-label study design. No studies were prospectively
registered with clinical trials registers, which limited the assessment of
reporting bias. We judged 68% studies to be at high risk of bias in at
least one domain.Study authors reported few deaths (7 per 1000 in both the
intervention and control groups), and we found low-certainty evidence that
beta-blockers may make little or no difference to all-cause mortality at
30 days (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.47 to 1.90;
29 studies, 4099 participants). For myocardial infarctions, we found no
evidence of a difference in events (RR 1.05, 95% CI 0.72 to 1.52; 25
studies, 3946 participants; low-certainty evidence). Few study authors
reported cerebrovascular events, and the evidence was uncertain (RR 1.37,
95% CI 0.51 to 3.67; 5 studies, 1471 participants; very low-certainty
evidence). Based on a control risk of 54 per 1000, we found low-certainty
evidence that beta-blockers may reduce episodes of ventricular arrhythmias
by 32 episodes per 1000 (RR 0.40, 95% CI 0.25 to 0.63; 12 studies, 2296
participants). For atrial fibrillation or flutter, there may be 163 fewer
incidences with beta-blockers, based on a control risk of 327 incidences
per 1000 (RR 0.50, 95% CI 0.42 to 0.59; 40 studies, 5650 participants;
low-certainty evidence). However, the evidence for bradycardia and
hypotension was less certain. We found that beta-blockers may make little
or no difference to bradycardia (RR 1.63, 95% CI 0.92 to 2.91; 12 studies,
1640 participants; low-certainty evidence), or hypotension (RR 1.84, 95%
CI 0.89 to 3.80; 10 studies, 1538 participants; low-certainty evidence).We
used GRADE to downgrade the certainty of evidence. Owing to studies at
high risk of bias in at least one domain, we downgraded each outcome for
study limitations. Based on effect size calculations in the previous
review, we found an insufficient number of participants in all outcomes
(except atrial fibrillation) and, for some outcomes, we noted a wide
confidence interval; therefore, we also downgraded outcomes owing to
imprecision. The evidence for atrial fibrillation and length of hospital
stay had a moderate level of statistical heterogeneity which we could not
explain, and we, therefore, downgraded these outcomes for inconsistency.
AUTHORS' CONCLUSION(S): We found no evidence of a difference in early
all-cause mortality, myocardial infarction, cerebrovascular events,
hypotension and bradycardia. However, there may be a reduction in atrial
fibrillation and ventricular arrhythmias when beta-blockers are used. A
larger sample size is likely to increase the certainty of this evidence.
Four studies awaiting classification may alter the conclusions of this
review.

<158>
Accession Number
629401473
Title
Transthyretin Cardiac Amyloidosis and Aortic Stenosis: Connection and
Therapeutic Implications.
Source
Current cardiology reviews. (no pagination), 2019. Date of Publication: 22
Jul 2019.
Author
Penalver J.; Ambrosino M.; Jeon H.D.; Agrawal A.; Kanjanahattakij N.;
Pitteloud M.; Stempel J.; Amanullah A.
Institution
(Penalver, Ambrosino, Jeon, Agrawal, Kanjanahattakij, Pitteloud, Stempel)
Department of Medicine, Einstein Medical Center, Philadelphia. United
States
(Amanullah) Department of Medicine, Cardiovascular Disease, Einstein
Medical Center. United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is growing interest in the observed significant
incidence of transthyretin cardiac amyloidosis in elderly patients with
aortic stenosis. Approximately 16% of patients with severe aortic stenosis
undergoing aortic valve replacement have transthyretin cardiac
amyloidosis. Outcomes after aortic valve replacement appear worse in
patients with concomitant transthyretin cardiac amyloidosis.
 METHOD(S): Publications in PubMed, Cochrane Library, and Embase
databases were systematically searched from January 2012 to September 2018
using the keywords transthyretin, amyloidosis, and aortic stenosis. All
studies published in English that reported the prevalence, association and
outcomes of transthyretin cardiac amyloidosis in patients with aortic
stenosis undergoing were included. RESULTS/CONCLUSION: The relationship
between aortic stenosis and transthyretin cardiac amyloidosis is not well
understood. A few studies have proven successful surgical management when
both conditions coexist. This systematic review suggests that
transthyretin cardiac amyloidosis is common in elderly patients with
aortic stenosis and tend to have high mortality rates after AVR. The
significant incidence of the two diseases occurring simultaneously
warrants further investigation to improve management strategies in the
future. Copyright© Bentham Science Publishers; For any queries,
please email at epub@benthamscience.net.

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