EPICORE Embase Updates: EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
629369791
Title
Perioperative beta-blockers for preventing surgery-related mortality and
morbidity in adults undergoing cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2019 (9) (no pagination), 2019.
Article Number: CD013435. 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, Kammler, Steinwender) Department of Cardiology, Med Campus
III, Kepler University Hospital, Medical Faculty of the Johannes Kepler
University Linz, Linz, Austria
(Lewis, Pritchard, Fawcett) Lancaster Patient Safety Research Unit, Royal
Lancaster Infirmary, Lancaster, United Kingdom
(Domanovits) Department of Emergency Medicine, Vienna General Hospital,
Medical University of Vienna, Vienna, Austria
(Schlager) Department of Internal Medicine II, Division of Angiology,
Vienna General Hospital, Medical University of Vienna, Vienna, Austria
(Wildner) Information Retrieval Office, University Library of the Medical
University of Vienna, Vienna, Austria
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
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. Objectives To assess the effectiveness of perioperatively
administered beta-blockers for the prevention of surgery-related mortality
and morbidity in adults undergoing cardiac surgery. Search methods 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' conclusions 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. Copyright
© 2019 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<2>
Accession Number
2002675388
Title
Late clinical outcomes of unselected patients with diabetic mellitus and
multi-vessel coronary artery disease.
Source
International Journal of Cardiology. 296 (pp 21-25), 2019. Date of
Publication: 1 December 2019.
Author
Ebrahim M.E.B.M.; Dignan R.; Femia G.; Kim S.; Gregory G.; Burgess S.; Hee
L.; Mussap C.; Aty W.; Lo S.; Juergens C.P.; French J.K.
Institution
(Ebrahim, Dignan, Femia, Kim, Burgess, Hee, Mussap, Aty, Lo, Juergens,
French) Departments of Cardiology and Cardiothoracic Surgery, Liverpool
Hospital, South Western Sydney Clinical School, the University of New
South Wales, Sydney, NSW, Australia
(Aty) Departments of Cardiothoracic Surgery, Suez Canal University,
Ismailia, Egypt
(Gregory) University of Sydney, Australia
Publisher
Elsevier Ireland Ltd
Abstract
Background: The Future Revascularization Evaluation in Patients with
Diabetes Mellitus: Optimal Management of Multi-Vessel Disease (FREEDOM)
clinical trial randomized only a proportion of screened patients with
diabetes mellitus (DM) and multi-vessel disease (MVD). Methods and
Results: We determined late rates of death, non-fatal myocardial
infarction (MI) and stroke in all 430 patients with DM who had MVD
identified on angiographic screening for the FREEDOM Trial, which
recruited from June 2006 -March 2010 at Liverpool Hospital, Sydney,
Australia. Mortality at 6 years [median] was 23% among 192
FREEDOM-eligible patients and 26% among 238 FREEDOM-ineligible patients,
of whom 139 [58%] had prior. CABG (mortality 31%). Overall, 196 (45%) had
percutaneous coronary intervention (PCI), 127 (30%) underwent coronary
artery bypass grafting (CABG) (who were 4 years younger; p = 0.003), and
107 (25%) had neither procedure of whom 80 were considered unsuitable for
revascularization. Mortality was 26% post-PCI 16%, post-CABG and 33% among
those who did not undergo revascularization (p = 0.01). On multivariable
analyses, factors associated with late mortality were older age,
hypertension and not undergoing CABG (all p < 0.05). Factors associated
with late MI were presented with an acute coronary syndrome, whereas
patients that underwent treatment with either PCI or CABG had less late MI
(all p < 0.05). Conclusion(s): Among consecutive diabetic patients
with MVD, at a median of 6-years CABG was associated with better survival
and fewer non-fatal MI outcomes compared to PCI. Copyright © 2019
Elsevier B.V.

<3>
Accession Number
2003128156
Title
Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients
With Stable Chest Pain.
Source
Journal of the American College of Cardiology. 74 (16) (pp 2058-2070),
2019. Date of Publication: 22 October 2019.
Author
Adamson P.D.; Williams M.C.; Dweck M.R.; Mills N.L.; Boon N.A.; Daghem M.;
Bing R.; Moss A.J.; Mangion K.; Flather M.; Forbes J.; Hunter A.; Norrie
J.; Shah A.S.V.; Timmis A.D.; van Beek E.J.R.; Ahmadi A.A.; Leipsic J.;
Narula J.; Newby D.E.; Roditi G.; McAllister D.A.; Berry C.
Institution
(Adamson, Williams, Dweck, Mills, Boon, Daghem, Bing, Moss, Hunter, Shah,
Newby) British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Edinburgh, United Kingdom
(Adamson) Christchurch Heart Institute, University of Otago, Christchurch,
New Zealand
(Williams, Dweck, Mills, Daghem, Bing, Moss, Hunter, Shah, van Beek,
Newby) Edinburgh Imaging, Queen's Medical Research Institute University of
Edinburgh, Edinburgh, United Kingdom
(Mangion, Roditi, Berry) Institute of Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Forbes) Health Research Institute, University of Limerick, Limerick,
Ireland
(Norrie) Edinburgh Clinical Trials Unit, University of Edinburgh,
Edinburgh, United Kingdom
(Timmis) William Harvey Research Institute, Queen Mary University of
London, London, United Kingdom
(Ahmadi, Narula) Ichan School of Medicine and Mount Sinai Hospital, Mount
Sinai Heart, New York, NY, United States
(Ahmadi, Leipsic) St. Paul's Hospital, University of British Columbia,
Vancouver, British Columbia, Canada
(McAllister) Institute of Health and Wellbeing, University of Glasgow,
Glasgow, United Kingdom
Publisher
Elsevier USA
Abstract
Background: Within the SCOT-HEART (Scottish COmputed Tomography of the
HEART Trial) trial of patients with stable chest pain, the use of coronary
computed tomography angiography (CTA) reduced the rate of death from
coronary heart disease or nonfatal myocardial infarction (primary
endpoint). Objective(s): This study sought to assess the consistency
and mechanisms of the 5-year reduction in this endpoint. Method(s):
In this open-label trial, 4,146 participants were randomized to standard
care alone or standard care plus coronary CTA. This study explored the
primary endpoint by symptoms, diagnosis, coronary revascularizations, and
preventative therapies. Result(s): Event reductions were consistent
across symptom and risk categories (p = NS for interactions). In patients
who were not diagnosed with angina due to coronary heart disease, coronary
CTA was associated with a lower primary endpoint incidence rate (0.23; 95%
confidence interval [CI]: 0.13 to 0.35 vs. 0.59; 95% CI: 0.42 to 0.80 per
100 patient-years; p < 0.001). In those who had undergone coronary CTA,
rates of coronary revascularization were higher in the first year (hazard
ratio [HR]: 1.21; 95% CI: 1.01 to 1.46; p = 0.042) but lower beyond 1 year
(HR: 0.59; 95% CI: 0.38 to 0.90; p = 0.015). Patients assigned to coronary
CTA had higher rates of preventative therapies throughout follow-up (p <
0.001 for all), with rates highest in those with CT-defined coronary
artery disease. Modeling studies demonstrated the plausibility of the
observed effect size. Conclusion(s): The beneficial effect of
coronary CTA on outcomes is consistent across subgroups with plausible
underlying mechanisms. Coronary CTA improves coronary heart disease
outcomes by enabling better targeting of preventative treatments to those
with coronary artery disease. (Scottish COmputed Tomography of the HEART
Trial [SCOT-HEART]; NCT01149590) Copyright © 2019 The Authors

<4>
Accession Number
2003128155
Title
Efficacy and Safety of Ticagrelor Monotherapy in Patients Undergoing
Multivessel PCI.
Source
Journal of the American College of Cardiology. 74 (16) (pp 2015-2027),
2019. Date of Publication: 22 October 2019.
Author
Takahashi K.; Serruys P.W.; Chichareon P.; Chang C.C.; Tomaniak M.; Modolo
R.; Kogame N.; Magro M.; Chowdhary S.; Eitel I.; Zweiker R.; Ong P.;
Ottesen M.M.; Tijssen J.G.P.; Wykrzykowska J.J.; de Winter R.J.; Garg S.;
Stoll H.-P.; Hamm C.; Steg P.G.; Onuma Y.; Valgimigli M.; Vranckx P.;
Carrie D.; Windecker S.
Institution
(Takahashi, Chichareon, Modolo, Kogame, Tijssen, Wykrzykowska, de Winter)
Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Serruys) International Centre for Circulatory Health, Imperial College
London, London, United Kingdom
(Chichareon) Division of Cardiology, Department of Internal Medicine,
Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
(Chang, Tomaniak, Onuma) Department of Cardiology, Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Tomaniak) First Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Modolo) Department of Internal Medicine, Cardiology Division, University
of Campinas (UNICAMP), Campinas, Brazil
(Magro) TweeSteden Ziekenhuis, Tilburg, Netherlands
(Chowdhary) Manchester University Foundation Trust, Manchester, United
Kingdom
(Eitel) University Heart Center Lubeck, Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine) and German Center for
Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lubeck, Lubeck,
Germany
(Zweiker) Medical University Hospital Graz, Graz, Austria
(Ong) Tan Tock Seng Hospital, Singapore
(Ottesen) Zealand University Hospital, Roskilde, Denmark
(Tijssen, Onuma) Cardialysis B.V., Rotterdam, Netherlands
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
(Stoll) Biosensors Clinical Research, Morges, Switzerland
(Hamm) University of Giessen and Kerckhoff Heart and Thorax Center,
University of Giessen, Bad Nauheim, Germany
(Steg) FACT (French Alliance for Cardiovascular Trials), Universite
Paris-Diderot, Paris, France
(Valgimigli, Windecker) Department of Cardiology, University of Bern,
Inselspital, Bern, Switzerland
(Vranckx) Jessa Ziekenhuis, Faculty of Medicine and Life Sciences at the
Hasselt University, Hasselt, Belgium
(Carrie) Rangueil Hospital, Toulouse, France
Publisher
Elsevier USA
Abstract
Background: Data on optimal antiplatelet treatment regimens in patients
who undergo multivessel percutaneous coronary intervention (PCI) are
sparse. Objective(s): This post hoc study investigated the impact of
an experimental strategy (1-month dual antiplatelet therapy [DAPT]
followed by 23-month ticagrelor monotherapy) versus a reference regimen
(12-month DAPT followed by 12-month aspirin monotherapy) according to
multivessel PCI. Method(s): The GLOBAL LEADERS trial is a
prospective, multicenter, open-label, randomized controlled trial,
allocating all-comer patients in a 1:1 ratio to either the experimental
strategy or the reference regimen. The primary endpoint was the composite
of all-cause death or new Q-wave myocardial infarction at 2 years. The
secondary safety endpoint was Bleeding Academic Research Consortium type 3
or 5 bleeding. Result(s): Among the overall study population
(n=15,845), 3,576 patients (22.4%) having multivessel PCI experienced a
significantly higher risk of ischemic and bleeding events at 2 years,
compared to those having single-vessel PCI. There was an interaction
between the experimental strategy and multivessel PCI on the primary
endpoint (hazard ratio: 0.62; 95% confidence interval: 0.44 to 0.88;
p<inf>interaction</inf> = 0.031). This difference was largely driven by a
lower risk of all-cause mortality. In contrast, the risk of Bleeding
Academic Research Consortium type 3 or 5 bleeding was statistically
similar between the 2 regimens (hazard ratio: 0.92; 95% confidence
interval: 0.61 to 1.39; p<inf>interaction</inf> = 0.754).
 Conclusion(s): Long-term ticagrelor monotherapy following 1-month
DAPT can favorably balance ischemic and bleeding risks in patients with
multivessel PCI. These findings should be interpreted as
hypothesis-generating and need to be replicated in future dedicated
randomized trials. (GLOBAL LEADERS: A Clinical Study Comparing Two Forms
of Anti-platelet Therapy After Stent Implantation;
NCT01813435). Copyright © 2019 American College of Cardiology
Foundation

<5>
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

<6>
Accession Number
2002379732
Title
Peri-procedural thrombocytopenia after aortic bioprosthesis implant: A
systematic review and meta-analysis comparison among conventional,
stentless, rapid-deployment, and transcatheter valves.
Source
International Journal of Cardiology. 296 (pp 43-50), 2019. Date of
Publication: 1 December 2019.
Author
Jiritano F.; Santarpino G.; Serraino G.F.; Ten Cate H.; Matteucci M.; Fina
D.; Mastroroberto P.; Lorusso R.
Institution
(Jiritano, Matteucci, Fina, Lorusso) Cardio-Thoracic Surgery Dept., Heart
& Vascular Centre, Maastricht University Medical Centre, and
Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Jiritano, Serraino, Mastroroberto) Cardiac Surgery Unit, University
"Magna Graecia" of Catanzaro, Catanzaro, Italy
(Santarpino) Citta di Lecce Hospital, GVM Care & Research, Lecce, Italy
(Ten Cate) Laboratory for Clinical Thrombosis and Hemostasis, Department
of Internal Medicine, Cardiovascular Research Institute Maastricht
(CARIM), Maastricht University Medical Center, Maastricht, Netherlands
(Matteucci) Department of Cardiac Surgery, Circolo Hospital, University of
Insubria, Varese, Italy
(Fina) University of Milan, IRCCS San Donato, Milan, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: Thrombocytopenia has been shown to occur soon after surgical
biological aortic valve replacement (AVR), and recently reported also
after transcatheter valve implantation (TAVI). The mechanism underlying
this phenomenon is still unknown, and its clinical impact on the
peri-operative outcome has been poorly investigated. Method(s): A
systematic review and a meta-analysis of all available studies reporting
data about peri-procedural thrombocytopenia on isolated bio-AVR, comparing
rapid-deployment (RDV), stentless (stentless-AVR), and TAVI vs. stented
(stented-AVR) valves, have been performed. Result(s): Fifteen trials
(2.163 patients) were included in the meta-analysis. Perioperative
platelet reduction ranged from 35% to 55% in stented-AVR, from 60% to 77%
in stentless-AVR, from 53% to 60% in RDV, and from to 21% to 72% in TAVI
(apparently, balloon-expandable valves more frequently associated to
thrombocytopenia). Stented-AVR required more red blood cells transfusion
than stentless-AVR (P < 0.0001), whereas no difference has been found
between RDV and stented-AVR. Platelet transfusion rate was very low in all
surgical groups. No difference has been found in RDV and stentless-AVR vs.
stented-AVR, in terms of reoperation for bleeding, and length-of-intensive
care unit or hospital stay. Conclusion(s): Thrombocytopenia-related
major adverse events were mainly reported in TAVI patients, whereas
clinically meaningless in surgical patients. Transient peri-procedural
thrombocytopenia is common after bio-AVR, regardless of prosthesis's type
or implant modality. It should receive appropriate monitoring and focused
investigations. Copyright © 2019 The Authors

<7>
Accession Number
628621846
Title
The Effect of Levosimendan Versus Milrinone on the Occurrence Rate of
Acute Kidney Injury Following Congenital Heart Surgery in Infants: A
Randomized Clinical Trial.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. 20 (10) (pp 947-956), 2019. Date of Publication: 01 Oct
2019.
Author
Thorlacius E.M.; Suominen P.K.; Wahlander H.; Keski-Nisula J.; Vistnes M.;
Ricksten S.-E.; Synnergren M.; Romlin B.S.; Castellheim A.
Institution
(Thorlacius, Ricksten, Romlin, Castellheim) Department of Anesthesiology
and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg
and Queen Silvia Children's Hospital, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Suominen, Keski-Nisula) Department of Anesthesia and Intensive Care,
Children's Hospital, Helsinki University Central Hospital, Helsinki,
Finland
(Wahlander) Department of Pediatric Cardiology, Sahlgrenska Academy,
University of Gothenburg and Queen Silvia Children's Hospital, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Vistnes) Department of Internal Medicine, Diakonhjemmet Hospital and
Institute for Experimental Medical Research, Oslo University Hospital and
University of Oslo, Oslo, Norway
(Synnergren) Department of Pediatric Thoracic Surgery, Queen Silvia
Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
NLM (Medline)
Abstract
OBJECTIVES: It has been shown that, in contrast to other inotropic agents,
levosimendan improves glomerular filtration rate after adult cardiac
surgery. The aim of this study was to investigate the efficacy of
levosimendan, compared with milrinone, in preventing acute kidney
dysfunction in infants after open-heart surgery with cardiopulmonary
bypass. DESIGN: Two-center, double-blinded, prospective, randomized
clinical trial. SETTING: The study was performed in two tertiary pediatric
centers, one in Sweden (Gothenburg) and one in Finland (Helsinki).
PATIENTS: Infants between 1 and 12 months old, diagnosed with Tetralogy of
Fallot, complete atrioventricular septal defect or nonrestrictive
ventricular septal defect, undergoing total corrective cardiac surgery
with cardiopulmonary bypass. INTERVENTIONS: Seventy-two infants were
randomized to receive a perioperative infusion of levosimendan (0.1
micro g/kg/min) or milrinone (0.4 micro g/kg/min). The infusion
was initiated at the start of cardiopulmonary bypass and continued for 26
hours. MEASUREMENTS AND MAIN RESULTS: The primary outcome variable was the
absolute value of serum creatinine data on postoperative day 1. Secondary
outcomes included the following: 1) acute kidney injury according to the
serum creatinine criteria of the Kidney Diseases: Improving Global
Outcomes; 2) acute kidney injury with serum creatinine corrected for fluid
balance; 3) plasma neutrophil gelatinase-associated lipocalin; 4) cystatin
C; 5) urea; 6) lactate; 7) hemodynamic variables; 8) use of diuretics in
the PICU; 9) need of dialysis; 10) length of ventilator therapy; and 11)
length of PICU stays. There was no significant difference in postoperative
serum creatinine between the treatment groups over time (p = 0.65). The
occurrence rate of acute kidney injury within 48 hours was 46.9% in the
levosimendan group and 39.5% in the milrinone group (p = 0.70). There were
no significant differences in other secondary outcome variables between
the groups. CONCLUSION(S): Levosimendan compared with milrinone did
not reduce the occurrence rate of acute kidney injury in infants after
total corrective heart surgery for atrioventricular septal defect,
ventricular septal defect, or Tetralogy of Fallot.

<8>
Accession Number
628113088
Title
Spontaneous Breathing Trial for Prediction of Extubation Success in
Pediatric Patients Following Congenital Heart Surgery: A Randomized
Controlled Trial.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. 20 (10) (pp 940-946), 2019. Date of Publication: 01 Oct
2019.
Author
Ferreira F.V.; Sugo E.K.; Aragon D.C.; Carmona F.; Carlotti A.P.C.P.
Institution
(Ferreira) All authors: Department of Pediatrics, Division of Pediatric
Critical Care, Ribeirao Preto Medical School, University of Sao Paulo,
Ribeirao Preto, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To evaluate the usefulness of a spontaneous breathing trial
for predicting extubation success in pediatric patients in the
postoperative period after cardiac surgery compared with a physician-led
weaning. STUDY DESIGN: Randomized, controlled trial. SETTING: PICU of a
tertiary-care university hospital. PATIENTS: A population of pediatric
patients following cardiac surgery for congenital heart disease.
INTERVENTIONS: Patients on mechanical ventilation for more than 12 hours
after surgery who were considered ready for weaning were randomized to the
spontaneous breathing trial group or the control group. The spontaneous
breathing trial was performed on continuous positive airway pressure with
the pressure support of 10 cmH2O, the positive end-expiratory pressure of
5 cmH2O, and the fraction of inspired oxygen less than or equal to 0.5 for
2 hours. Patients in the control group underwent ventilator weaning
according to clinical judgment. MEASUREMENTS AND MAIN RESULTS: The primary
endpoint was extubation success defined as no need for reintubation within
48 hours after extubation. Secondary outcomes were PICU length of stay,
hospital length of stay, occurrence rate of ventilator-associated
pneumonia, and mortality. One hundred and ten patients with the median age
of 8 months were included in the study: 56 were assigned to the
spontaneous breathing trial group and 54 were assigned to the control
group. Demographic and clinical data and Risk Adjustment for Congenital
Heart Surgery-1 classification were similar in both groups. Patients
undergoing the spontaneous breathing trial had greater extubation success
(83% vs 68%, p = 0.02) and shorter PICU length of stay (median 85 vs
367hr, p < 0.0001) compared with the control group, respectively. There
was no significant difference between groups in hospital length of stay,
occurrence rate of ventilator-associated pneumonia, and mortality.
 CONCLUSION(S): Pediatric patients with congenital heart disease
undergoing the spontaneous breathing trial postoperatively had greater
extubation success and shorter PICU length of stay compared with those
weaned according to clinical judgment.

<9>
Accession Number
627659239
Title
An economic analysis of medical and surgical management of aortopathy
associated with bicuspid aortic valve.
Source
European heart journal. Quality of care & clinical outcomes. 5 (4) (pp
380-387), 2019. Date of Publication: 01 Oct 2019.
Author
Hardikar A.; Marwick T.H.
Institution
(Hardikar, Marwick) Cardiovascular Imaging group, Menzies Institute for
Medical research, 17 Liverpool Street, Hobart, TAS, Australia
(Hardikar) Department of Cardiothoracic Surgery, Royal Hobart Hospital, 48
Liverpool Street, Hobart, TAS, Australia
(Marwick) Imaging Research, Baker Heart and Diabetes Institute, 75
Commercial Road, Melbourne, VIC, Australia
Publisher
NLM (Medline)
Abstract
AIMS: To develop a cost-effectiveness model to address the outcome and
economic implications of different thresholds for surgery in the
management of aortopathy associated with bicuspid aortic valve disease.
METHODS AND RESULTS: A model was created from the perspective of an
Australian healthcare funding agency. The index case was a 65-year-old
with bicuspid aortic valve (BAV) and ascending aorta diameter of 5.0cm.
Health states were defined as: pre-operative with dilated aorta,
post-operative without complications, post-complication, and death. The
mean and variance of risks and transition probabilities were taken from a
local surgical database and local costs and utilities of elective and
urgent thoracic aortic surgery (AoS) with or without aortic valve
replacement, with a sensitivity analysis based on a systematic review.
Scenario analyses were provided for other aortic dimensions. Implications
for survival, quality-adjusted life years (QALYs), and costs were
calculated from healthcare delivery and economic perspectives. After 10
000 simulations for the reference case, the utility of watchful waiting
(WW) exceeded that of elective AoS (13+/-4 vs. 10+/-5 QALY). The net
monetary benefit was A$351 063+/-304 965 with immediate AoS vs. 534
797+/-198 570 with WW surveillance. The most important variables affecting
effectiveness were utility value of survivors, rate of aortic growth, and
probability of acute aortic event during WW. CONCLUSION(S): This
decision-analytic model informed by our practice, as well as a systematic
analysis, shows that AoS in a BAV patient with aorta <5cm diameter is
costlier and less effective than WW. Copyright Published on behalf of
the European Society of Cardiology. All rights reserved. © The
Author(s) 2019. For permissions, please email:
journals.permissions@oup.com.

<10>
Accession Number
629201420
Title
Preoperative high-intensity interval training is effective and safe in
deconditioned patients with lung cancer: A randomized clinical trial.
Source
Journal of rehabilitation medicine. 51 (9) (pp 712-718), 2019. Date of
Publication: 03 Oct 2019.
Author
Bhatia C.; Kayser B.
Institution
(Bhatia) Respiratory Care Service, University Hospitals of Geneva, Geneva
1205, Switzerland
Publisher
NLM (Medline)
Abstract
BACKGROUND: The outcome of surgery in deconditioned patients can be
improved through prehabilitation. This study examined the effect of
prehabilitation in patients diagnosed with lung cancer. METHOD(S):
Candidates for lung cancer resection were assigned to high-intensity
interval training (n=74) or usual care (n=77). Cardiopulmonary exercise
testing and 6-min walk test were performed before and after training.
High-intensity interval training consisted of 2-3-weekly, 2x10-min series
of cycling at peak power, measured with cardiopulmonary exercise testing
prior to training, with a 15-s on-off duty cycle, preceded by a 5-min
warm-up and followed by a 5-min cool-down. Work-rate, heart-rate,
saturation, dyspnoea and leg effort were monitored. RESULT(S):
Waiting time (median 25 days) allowed a median of 8 high-intensity
interval training sessions to be performed. Adherence to mean
high-intensity interval training was 87% (18% standard deviation; SD).
High-intensity interval training power increased (23 watt, 95% confidence
interval (95% CI): 20-26 watt), as did heart rate (14 bpm, 95% CI 11-16
bpm). Resting heart rate (-6 bpm, 95% CI -4 to -7 bpm) and heart rate 1
min post-cool-down decreased (-5 bpm, 95% CI -4 to -7 bpm). Aerobic
capacity increased after high-intensity interval training (14%, 95% CI
3-26%), as did peak power output (median 7%, 95% CI 2-13%), but not after
usual care. Six-min walk test score increased after high-intensity
interval training (median 20%, 95% CI 14-26%), but not after usual care.
 CONCLUSION(S): Short-term high-intensity interval training is
feasible in deconditioned patients and increases cardio-respiratory
fitness and walking capacity.

<11>
Accession Number
2001920368
Title
A Pilot Randomized Controlled Study of Mild Hypercapnia During Cardiac
Surgery With Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (11) (pp 2968-2978),
2019. Date of Publication: November 2019.
Author
Chan M.J.; Lucchetta L.; Cutuli S.; Eyeington C.; Glassford N.J.;
Martensson J.; Angelopoulos P.; Matalanis G.; Weinberg L.; Eastwood G.M.;
Bellomo R.
Institution
(Chan, Lucchetta, Cutuli, Eyeington, Glassford, Martensson, Eastwood,
Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Angelopoulos) Department of Cardiac Perfusion, Austin Hospital,
Melbourne, Australia
(Matalanis) Department of Cardiac Surgery, Austin Hospital, Melbourne,
Australia
(Weinberg) Department of Anaesthesia, Austin Hospital, Melbournez,
Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
(Bellomo) Data Assessment Research Evaluation Centre, University of
Melbourne and Austin Hospital, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objectives: To test whether targeted therapeutic mild hypercapnia (TTMH)
would attenuate cerebral oxygen desaturation detected using near-infrared
spectroscopy during cardiac surgery requiring cardiopulmonary bypass
(CPB). Design(s): Randomized controlled trials. Setting(s):
Operating rooms and intensive care unit of tertiary hospital.
 Participant(s): The study comprised 30 patients undergoing cardiac
surgery with CPB. Intervention(s): Patients were randomly assigned to
receive either standard carbon dioxide management (normocapnia) or TTMH
(target arterial carbon dioxide partial pressure between 50 and 55 mmHg)
throughout the intraoperative period and postoperatively until the onset
of spontaneous ventilation. Measurements and Main Results: Relevant
biochemical and hemodynamic variables were measured, and cerebral tissue
oxygen saturation (SctO<inf>2</inf>) was monitored with near-infrared
spectroscopy. Patients were followed-up with neuropsychological testing.
Patient demographics between groups were compared using the Fisher exact
and Mann-Whitney tests, and SctO<inf>2</inf> between groups was compared
using repeated measures analysis of variance. The median patient age was
67 years (interquartile range [IQR] 62-72 y), and the median EuroSCORE II
was 1.1. The median CPB time was 106 minutes. The mean intraoperative
arterial carbon dioxide partial pressure for each patient was
significantly higher with TTMH (52.1 mmHg [IQR 49.9-53.9 mmHg] v 40.8 mmHg
[IQR 38.7-41.7 mmHg]; p < 0.001) as was pulmonary artery pressure (23.9
mmHg [IQR 22.4-25.3 mmHg] v 18.5 mmHg [IQR 14.8-20.7 mmHg]; p = 0.004).
There was no difference in mean percentage change in SctO<inf>2</inf>
during CPB in the control group for both hemispheres (left: -6.7% v -2.3%;
p = 0.110; right: -7.9% v -1.0%; p = 0.120). Compliance with
neuropsychological test protocols was poor. However, the proportion of
patients with drops in test score >20% was similar between groups in all
tests. Conclusion(s): TTMH did not increase SctO<inf>2</inf>
appreciably during CPB but increased pulmonary artery pressures before and
after CPB. These findings do not support further investigation of TTMH as
a means of improving SctO<inf>2</inf> during and after cardiac surgery
requiring CPB. Copyright © 2019 Elsevier Inc.

<12>
Accession Number
2001741548
Title
Intravenous Iron Versus Placebo in the Management of Postoperative
Functional Iron Deficiency Anemia in Patients Undergoing Cardiac Valvular
Surgery: A Prospective, Single-Blinded, Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (11) (pp 2941-2948),
2019. Date of Publication: November 2019.
Author
Xu H.; Duan Y.; Yuan X.; Wu H.; Sun H.; Ji H.
Institution
(Xu, Duan, Yuan, Wu, Sun) Department of Adult Cardiac Surgery, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Science, Peking Union Medical College, Beijing, China
(Ji) Department of Anesthesiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: To compare the efficacy of intravenous iron versus placebo to
correct postoperative functional iron deficiency anemia in patients
undergoing cardiac valvular surgery. Design(s): A prospective,
single-blinded, randomized controlled study. Setting(s): National
Center for Cardiovascular Diseases and a university hospital.
 Participant(s): The study comprised 150 patients with postoperative
functional iron deficiency anemia after cardiac valvular surgery.
 Intervention(s): The patients were randomly assigned (1:1) to either
the treatment (intravenous iron) group or the control (placebo) group.
 Measurements and Main Results: The hemoglobin and ferritin
concentrations and postoperative adverse events were collected and
compared between the 2 groups. The hemoglobin concentration and the
proportion of patients who had their anemia corrected or achieved
hemoglobin increments of >20 g/L in the intravenous iron group were
significantly higher than that in the placebo group at postoperative day
14 (p = 0.023, p = 0.037, and p = 0.001), whereas there was no statistical
difference at postoperative day 7. The ferritin concentration was
substantially higher at postoperative day 7 and postoperative day 14 in
the intravenous iron group compared with the placebo group (both p <
0.001). There were no significant differences in rates of death, blood
tranfusion, antibiotic upgrade, ventilator time >24 hours, postoperative
hospital stay >10 days, poor wound healing, and perivalvular leakage
between the 2 groups. Conclusion(s): Intravenous iron could
significantly increase the hemoglobin level in patients with postoperative
functional iron deficiency anemia at postoperative day 14. However, there
is no difference in blood transfusion requirements or postoperative
adverse outcomes between the 2 groups. Copyright © 2019 Elsevier
Inc.

<13>
Accession Number
2002931582
Title
Stop The Clot? Towards 'Quality' Venous Thromboembolism Prophylaxis In
Thoracic Surgery.
Source
European Journal of Surgical Oncology. Conference: BASO-The Association
for Cancer Surgery Annual Scientific Meeting. The Law Society, United
Kingdom. 45 (11) (pp 2209), 2019. Date of Publication: November 2019.
Author
Caruana E.; Swallow G.; Duffy J.
Institution
(Caruana, Duffy) Thoracic Surgery, Nottingham University Hospitals,
Nottingham, United Kingdom
(Caruana) NIHR Biomedical Research Centre, Nottingham, United Kingdom
(Swallow) Clinical Haematology, Nottingham University Hospitals,
Nottingham, United Kingdom
Publisher
W.B. Saunders Ltd
Abstract
Background: Venous Thromboembolism (VTE) is uncommon after general
thoracic surgery, but is associated with a persistently-elevated mortality
risk. The National Institute for Health and Care Excellence (NICE)
introduced recommendations for thoracic surgery in their 2018 guidance on
VTE prophylaxis (NG89). These extrapolated from a single systematic
review, with no thoracic-specific literature. We sought to introduce
validated, risk-stratified, evidence-based guidance to reduce VTE
incidence. Method(s): Thoracic surgical patients, and VTE events at
our institution (2014 to 2018) were identified from hospital databases.
Statistical analysis was performed in STATA v16. A national survey of VTE
prophylaxis after thoracic surgery was performed. A review of
thoracic-specific literature was conducted, and local guidelines derived
through internal cross-specialty consultation. Result(s): 18 of 1,203
(1.4%) patients suffered VTE. The Caprini score was positively correlated
with VTE risk (OR 1.38, 95% CI 1.10 to 1.72, p = 0.008). VTE patients had
lower one-year survival (57% vs 88%, p < 0.001). There is significant
geographical variation in VTE prophylaxis after thoracic surgery. Only one
trust reported following NICE guidance. None practiced a risk-stratified
approach, or extended prophylaxis beyond 7 days. Local evidence-based
guidelines for risk-stratified mechanical- and extended course
chemical-VTE prophylaxis were developed, and successfully approved by NICE
for deviation from NG89. Conclusion(s): Our evidence-based approach
improves the 'quality' - defined as the right care, to the right patient,
at the right time - of VTE prophylaxis offered. There is scope for
broadening the reach of this initiative beyond the local
level. Copyright © 2019

<14>
Accession Number
2001133235
Title
Impact of Coronary Artery Chronic Total Occlusion on Arrhythmic and
Mortality Outcomes: A Systematic Review and Meta-Analysis.
Source
JACC: Clinical Electrophysiology. 4 (9) (pp 1214-1223), 2018. Date of
Publication: September 2018.
Author
Chi W.K.; Gong M.; Bazoukis G.; Yan B.P.; Letsas K.P.; Liu T.; Baranchuk
A.; Nombela-Franco L.; Dong M.; Tse G.
Institution
(Chi, Yan, Tse) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, SAR, Hong Kong
(Chi, Tse) Li Ka Shing Institute of Health Sciences, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong, SAR, Hong Kong
(Gong, Liu) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Bazoukis, Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
(Baranchuk) Department of Medicine, Kingston General Hospital, Queen's
University, Kingston, Ontario, Canada
(Nombela-Franco) Cardiology Department, Instituto Cardiovascular, Hospital
Clinico San Carlos, IdISSC, Madrid, Spain
(Dong) Department of Cardiology, Yantai Yuhuangding Hospital Affiliated to
Qingdao University, Yantai, Shandong Province, China
(Tse) Department of Medicine and Therapeutics, Faculty of Medicine, The
Chinese University of Hong Kong, Room 114043, 9/F, Lui Che Woo Clinical
Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong, Hong
Kong
Publisher
Elsevier Inc
Abstract
Objectives: This study aimed to examine the relationship between chronic
coronary artery total occlusion (CTO) status and the occurrence of
ventricular tachycardia (VT)/ventricular fibrillation (VF) or appropriate
implantable cardioverter-defibrillator (ICD) therapy. Background(s):
CTO is a significant problem in patients with ischemic heart disease.
However, the extent to which it predisposes affected individuals to VT/VF
and whether these arrhythmic events could be prevented by
revascularization are unclear. Therefore, a systematic review and
meta-analysis were conducted to examine the relationship between CTO
status and the occurrence of VT/VF or appropriate ICD therapy.
 Method(s): PubMed and Embase databases were searched until November
16, 2017, identifying 137 studies. Result(s): Seventeen studies
involving 54,594 subjects (mean age, 61 +/- 21 years of age, 81% male)
with a mean follow-up of 43 +/- 31 months were included. The presence of
CTO was associated with higher risk of VT/VF or appropriate ICD therapy
(adjusted hazard ratio [aHR]: 1.99; 95% confidence interval (CI): 1.53 to
2.59; p < 0.0001, I2 = 3%) but not in cardiac mortality (aHR:
2.59; 95% CI: 0.64 to 10.59; p = 0.18, I2 = 86%) or in
all-cause mortality (aHR: 1.70; 95% CI: 0.84 to 3.46; p = 0.14;
I2 = 64%). Compared to patients with non-infarct-related CTOs,
those with infarct-related CTOs have a higher risk of VT/VF or appropriate
ICD therapy (aHR: 2.47; 95% CI: 1.76 to 3.46; p < 0.0001; I2 =
14%), cardiac mortality (aHR: 2.73; 95% CI: 1.02 to 7.30; p < 0.05;
I2 = 79%) and higher all-cause mortality (aHR: 1.69; 95% CI:
1.19 to 2.40; p < 0.01; I2 = 40%). Nonrevascularization of CTOs
tended to be associated with an increased risk of all-cause mortality
compared to successful revascularization (unadjusted HR: 1.52; 95% CI:
0.96 to 2.43; p = 0.08; I2 = 76). Conclusion(s): CTOs,
especially infarct-related, are associated with high risk of VT/VF or
appropriate ICD therapy and mortality. ICD implantation could be
beneficial. However, it is not clear that revascularization has an impact
on the outcome of patients with CTOs. Copyright © 2018 American
College of Cardiology Foundation

<15>
Accession Number
2001028524
Title
Intensive versus moderate statin therapy and early graft occlusion after
coronary bypass surgery: The Aggressive Cholesterol Therapy to Inhibit
Vein Graft Events randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (1) (pp 151-161.e1),
2019. Date of Publication: January 2019.
Author
Kulik A.; Abreu A.M.; Boronat V.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Lynn Heart and Vascular Institute, Boca Raton
Regional Hospital, Charles E. Schmidt College of Medicine, Florida
Atlantic University, Boca Raton, Fla, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Statins prevent saphenous vein graft (SVG) disease and improve
outcomes after coronary artery bypass graft surgery. However, the optimal
postoperative statin dose remains unclear. The Aggressive Cholesterol
Therapy to Inhibit Vein Graft Events trial was undertaken to evaluate
whether early postoperative high-dose statin therapy reduces SVG occlusion
compared with conventional moderate-dose therapy. Method(s): In this
pilot, multicenter, double-blind randomized trial, 173 patients who had
coronary artery bypass graft surgery with SVG were randomized to receive
10 mg or 80 mg atorvastatin daily for 1 year. The primary outcome was SVG
occlusion at 1 year. Secondary outcomes were SVG stenosis and major
adverse cardiovascular events. Result(s): During trial enrollment,
patients randomized to 80 mg atorvastatin achieved significantly lower
low-density lipoprotein cholesterol levels (P <.00001). One-year graft
assessment was performed in 145 patients (83.8%). The primary outcome, SVG
occlusion at 1 year, did not significantly differ between the 2 groups
(12.9% vs 11.4% for 10 mg atorvastatin vs 80 mg atorvastatin; P =.85). The
incidence of vein graft stenosis also did not significantly differ between
the groups (P =.54). However, there was a trend toward fewer patients
developing vein graft disease (either occlusion or stenosis) in the 80 mg
atorvastatin group (29.2% vs 19.2%, 10 mg atorvastatin vs 80 mg
atorvastatin; P =.18). Freedom from major adverse cardiovascular events at
1 year was similar between the groups (P =.27). Conclusion(s):
Compared with 10 mg atorvastatin, 80 mg atorvastatin did not significantly
reduce vein graft occlusion 1 year after coronary artery bypass graft
surgery in this pilot trial. Copyright © 2018 The American
Association for Thoracic Surgery

<16>
Accession Number
629454451
Title
Drug Use and Postoperative Mortality following Valve Surgery for Infective
Endocarditis: A Systematic Review and Meta-analysis.
Source
Clinical Infectious Diseases. 69 (7) (pp 1120-1129), 2019. Date of
Publication: 13 Sep 2019.
Author
Hall R.; Shaughnessy M.; Boll G.; Warner K.; Boucher H.W.; Bannuru R.R.;
Wurcel A.G.
Institution
(Hall, Shaughnessy, Boucher) Tufts University School of Medicine, Boston,
MA, United States
(Boll, Warner) Division of Cardiac Surgery, Department of Surgery, Tufts
University School of Medicine, Boston, MA, United States
(Boucher, Wurcel) Division of Geographic Medicine and Infectious Diseases,
Department of Medicine, Tufts University, School of Medicine, Boston, MA
02111, United States
(Bannuru) Center for Treatment Comparison and Integrative Analysis, Tufts
Medical Center, Tufts University School of Medicine, Boston, MA, United
States
(Wurcel) Department of Public Health and Community Medicine, Tufts
University, School of Medicine, Boston, MA, United States
Publisher
Oxford University Press
Abstract
Background: Infective endocarditis (IE) often requires surgical
intervention. An increasingly common cause of IE is injection drug use
(IDU-IE). There is conflicting evidence on whether postoperative mortality
differs between people with IDU-IE and people with IE from etiologies
other than injection drug use (non-IDU-IE). In this manuscript, we compare
short-term postoperative mortality in IDU-IE vs non-IDU-IE through
systematic review and meta-analysis. Method(s): The review was
conducted according to the Cochrane Handbook for Systematic Reviews of
Interventions and the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. Publication databases were queried for key terms
included in articles up to September 2017. Randomized controlled trials,
prospective cohorts, or retrospective cohorts that reported on 30-day
mortality or in-hospital/operative mortality following valve surgery and
that compared outcomes between IDU-IE and non-IDU-IE were included.
 Result(s): Thirteen studies with 1593 patients (n = 341 [21.4%]
IDU-IE) were included in the meta-analysis. IDU-IE patients more
frequently had tricuspid valve infection, Staphylococcus infection, and
heart failure before surgery. Meta-analysis revealed no statistically
significant difference in 30-day postsurgical mortality or in-hospital
mortality between the 2 groups. Conclusion(s): Despite differing
preoperative clinical characteristics, early postoperative mortality does
not differ between IDU-IE and non-IDU-IE patients who undergo valve
surgery. Future research on long-term outcomes following valve replacement
is needed to identify opportunities for improved healthcare delivery with
IDU-IE. Copyright © 2018 Published by Oxford University Press for
the Infectious Diseases Society of America 2018.

<17>
Accession Number
629221562
Title
Corticosteroids and Intravenous Immunoglobulin in Pediatric Myocarditis: A
Meta-Analysis.
Source
Frontiers in Pediatrics. 7 (no pagination), 2019. Article Number: 342.
Date of Publication: 16 Aug 2019.
Author
Li Y.; Yu Y.; Chen S.; Liao Y.; Du J.
Institution
(Li, Yu, Liao, Du) Department of Pediatrics, Peking University First
Hospital, Beijing, China
(Li, Yu) Department of Basic Medical Sciences, Peking University School of
Basic Medical Sciences, Beijing, China
(Chen) Division of Biological Sciences, University of California, San
Diego, La Jolla, CA, United States
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: The efficacy of corticosteroids and intravenous immunoglobulin
(IVIG) in pediatric myocarditis remains controversial. Objective(s):
The authors performed a meta-analysis to assess the therapeutic efficacy
of corticosteroids and IVIG in children with myocarditis. Method(s):
We retrieved the trials on corticosteroids and IVIG therapy, respectively,
in pediatric myocarditis from nine databases up to December 2018.
Statistical analysis was performed using Review Manager 5.3.
 Result(s): Our analysis included 8 studies and 334 pediatric
patients. The data demonstrated that children receiving corticosteroids
showed no significant improvement on left ventricular ejection fraction
(LVEF) from 1 to 8 month-follow-up (MD = 5.17%, 95% CI = -0.26% to 10.60%,
P = 0.06), and no significant improvement in death or heart
transplantation incidence at the end of follow-up (OR = 1.33, 95% CI =
0.27-6.70, P = 0.73). However, children receiving IVIG revealed a
statistically remarkable increase in LVEF at a follow-up over the course
of 6 months to 1 year (MD = 18.91%, 95% CI = 11.74-26.08%, P < 0.00001),
and a decrease in death or heart transplantation at the end of follow-up
(OR = 0.31, 95% CI = 0.12-0.75, P = 0.01). Further comparisons showed that
the mortality and heart transplantation rate of children with myocarditis
treated with IVIG were significantly lower than those with corticosteroid
therapy (t' = 11.336, P < 0.001). Conclusion(s): IVIG might be
beneficial to improve LVEF and survival for myocarditis in children.
However, the present evidence does not support corticosteroids as superior
to conventional therapy in children with myocarditis. Further randomized
controlled trials with a larger sample size are required. ©
Copyright © 2019 Li, Yu, Chen, Liao and Du.

<18>
Accession Number
629427427
Title
Comparison of the sustainability of mitral annular dynamics between two
semi-rigid annuloplasty devices.
Source
European Journal of Cardio-thoracic Surgery. 56 (2) (pp 360-368), 2019.
Date of Publication: 2019.
Author
Bouchez S.; Timmermans F.; Philipsen T.; Francois K.; Bove T.
Institution
(Bouchez) Department of Cardiac Anesthesiology, University Hospital of
Gent, Gent, Belgium
(Timmermans) Department of Cardiology, University Hospital of Gent, Gent,
Belgium
(Philipsen, Francois, Bove) Department of Cardiac Surgery, University
Hospital of Gent, Corneel Heymanslaan 10, Gent 9000, Belgium
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Objectives: The choice of annuloplasty device is fundamental at the time
of mitral valve repair, the goal being to optimally restore the
physiological 3-dimensional (3D) structure and dynamics of the mitral
annulus (MA). This study evaluated MA dynamics after annuloplasty with 2
different semi-rigid devices. Method(s): Thirty-three patients
eligible for mitral valve repair were selected for annuloplasty with the
Physio II ring (Edwards Lifesciences, Irving, CA, USA) (n = 17) or the
Memo 3D ring (LivaNova, Saluggia, Italy) (n = 16). MA dynamics were
assessed with transoesophageal 3D echocardiography intraoperatively and 1
year after repair. Result(s): The postoperative changes in the
anteroposterior diameter {3.7% [standard deviation (SD) 2.7] vs 1.9% [SD
1.3]; P = 0.013} and in the annular height [27.7% (SD 8.7) vs 18.0% (SD
13.9); P = 0.003] were significantly larger with the Memo 3D ring during
the cardiac cycle. The restoration of the saddle shape at baseline was
superior with the Physio II ring, defined by a larger systolic annular
height-to-commissural width ratio [15.1% (SD 2.3) vs 7.1% (SD 2.4); P <
0.001]. These observations of MA dynamics were sustained after 1 year,
shown by a greater anteroposterior extension [5.1% (SD 1.0) vs 1.7% (SD
1.6); P = 0.002] and change in annular height-to-commissural width ratio
[15.7% (SD 12.7) vs 3.1% (SD 3.0); P = 0.020] for the Memo 3D ring. There
were no significant differences in mitral valve function between the 2
devices. Conclusion(s): The MA dynamics after annuloplasty with the
Physio II and Memo 3D rings demonstrated a better systolic 3D restoration
of the saddle shape with the Physio II ring, whereas the saddle-shaped
geometry improved significantly with the Memo 3D ring, as a dynamic
phenomenon. The Memo 3D ring also showed increased anteroposterior annular
mobility and folding dynamics throughout the cardiac cycle. Moreover, the
observed differences in MA dynamics between both devices appeared to be
sustainable 1 year after ring implantation. Copyright © 2019 The
Author(s). All rights reserved.

<19>
Accession Number
2002984444
Title
Meta-Analysis Comparing Outcomes in Patients Undergoing Transcatheter
Aortic Valve Implantation With Versus Without Percutaneous Coronary
Intervention.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Lateef N.; Khan M.S.; Deo S.V.; Yamani N.; Riaz H.; Virk H.U.H.; Khan
S.U.; Hedrick D.P.; Kanaan A.; Reed G.W.; Krishnaswamy A.; Puri R.;
Kapadia S.R.; Kalra A.
Institution
(Lateef) Department of Medicine, Creighton University Medical Center,
Omaha, NE, United States
(Khan, Yamani) Department of Medicine, John H. Stroger, Jr. Hospital of
Cook County, Chicago, IL, United States
(Deo) Department of Cardiovascular Surgery, Louis Stokes Cleveland VA
Medical Center, Cleveland, OH, United States
(Riaz, Hedrick, Kanaan, Reed, Krishnaswamy, Puri, Kapadia, Kalra)
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Virk) Department of Cardiovascular Medicine, Albert Einstein Medical
Center, Philadelphia, PA, United States
(Khan) West Virginia University, Morgantown, WV, United States
(Hedrick, Kanaan, Kalra) Department of Cardiovascular Medicine, Akron
General Medical Center, Cleveland, OH, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients having transcatheter aortic valve implantation (TAVI) routinely
undergo coronary angiography before the procedure to define the coronary
anatomy and to evaluate the extend of coronary artery disease (CAD).
Whether percutaneous coronary intervention (PCI) prior/concomitant with
TAVI confers any additional clinical benefit in patients with CAD remains
unclear. Literature search was performed using Medline, Embase, Google
Scholar, and Scopus from inception of these databases till April 2019.
Included outcomes were 30-day all-cause mortality, stroke, myocardial
infarction (MI), acute kidney injury, and 1-year mortality. The main
summary estimate was random effects odds ratio (OR) with 95% confidence
intervals (CIs). Eleven cohort studies enrolling 5,580 patients (mean age
82.4 years and 52.6% females) were included. Our study found no difference
in effect estimates for 30-day all-cause mortality (OR 1.30 [0.85 to
1.98], p = 0.22, I2 = 37.5%), stroke (OR 0.7 (0.36 to 1.45), p
= 0.36, I2 = 32.8%), MI (OR 2.71 [0.55 to 12.23], p = 0.22,
I2 = 41.3%), acute kidney injury (OR 0.7 [0.46 to 1.06], p =
0.08, I2 = 14.4%) and 1-year all-cause mortality (OR 1.19 [0.92
to 1.52], p = 0.18, I2 = 0.0%) in patients who underwent TAVI
with and without PCI. In conclusion, our analysis indicates that PCI with
TAVI in patients with severe aortic stenosis and concomitant CAD grants no
additional clinical advantage in terms of patient important clinical
outcomes. Further randomized studies are needed to better delineate the
clinical practice for myocardial revascularization in patients receiving
transcatheter therapy for aortic valve disease. Copyright © 2019
Elsevier Inc.

<20>
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.

<21>
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.

<22>
Accession Number
628508211
Title
Inspiratory Muscle Training after Heart Valve Replacement Surgery Improves
Inspiratory Muscle Strength, Lung Function, and Functional Capacity: A
RANDOMIZED CONTROLLED TRIAL.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 39 (5) (pp
E1-E7), 2019. Date of Publication: 01 Sep 2019.
Author
Cargnin C.; Karsten M.; Guaragna J.C.V.D.C.; Dal Lago P.
Institution
(Cargnin, Dal Lago) Programa de Pos-graduacao em Ciencias da Saude,
Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Porto
Alegre, Brazil
(Karsten, Dal Lago) Programa de Pos-graduacao em Ciencias da Reabilitacao,
Porto Alegre, Brazil
(Karsten) Departamento de Fisioterapia, Universidade Do Estado de Santa
Catarina (UDESC), Florianopolis, Brazil
(Karsten) Programa de Pos-graduacao em Fisioterapia (UDESC),
Florianopolis, Brazil
(Guaragna) Faculdade de Medicina, Pontificia Universidade Catolica Do Rio
Grande Do sul (PUCRS), Porto Alegre, Brazil
(Dal Lago) Departamento de Fisioterapia, Universidade Federal de Ciencias
da Saude de Porto Alegre-UFSCPA, Rua Sarmento Leite, 245, Porto Alegre,
Rio Grande do Sul 90050-170, Brazil
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: The aim of this study was to analyze the effects of inspiratory
muscle training (IMT) as a therapeutic strategy after heart valve
replacement surgery (HVRS). Method(s): A double-blind, randomized,
clinical trial that included patients undergoing elective HVRS, without
post-operative complications, were allocated to 2 groups: IMT group
(IMT-G) and IMT placebo group (IMT-PG). The IMT started 3 d after surgery
and was performed twice daily for 4 wk. Lung function, maximum inspiratory
pressure (MIP) as a measure of inspiratory muscle strength, functional
capacity, and quality of life were assessed pre-operatively and at the end
of training. Result(s): The IMT-G recovered pre-operative MIP and
lung function values after 4 wk of training. This group also increased the
distance walked during the 6-min walk test (6MWD). In the IMT-PG, the
values of MIP were below those found pre-operatively, with impairment of
lung function and lower 6MWD in the final evaluation. At the end of IMT,
MIP was correlated with the 6MWD and with the spirometry variables.
 Conclusion(s): IMT performed for 4 wk after HVRS was effective in
restoring the values of inspiratory muscle strength and lung function to
the pre-operative level and increasing the functional capacity assessed by
the 6MWD. Furthermore, an association between lung function and functional
capacity was observed, demonstrating the clinical relevance of the use of
IMT in the rehabilitation process of these patients. Copyright ©
2019 Wolters Kluwer Health, Inc. All rights reserved.

<23>
Accession Number
2003184036
Title
Using a 3D printer in cardiac valve surgery: A systematic review.
Source
Revista da Associacao Medica Brasileira. 65 (6) (pp 818-824), 2019. Date
of Publication: 2019.
Author
Cavalheiro Boll L.F.; Rodrigues G.O.; Rodrigues C.G.; Bertollo F.L.;
Irigoyen M.C.; Goldmeier S.
Institution
(Cavalheiro Boll, Rodrigues, Bertollo, Goldmeier) Institute of Cardiology,
University Foundation of Cardiology, Av. Princesa Isabel, Porto Alegre, RS
370, Brazil
(Rodrigues) College Method of Sao Paulo, Sao Paulo, SP, Brazil
(Irigoyen) School of Medicine of, University of Sao Paulo, SP, Brazil
Publisher
Associacao Medica Brasileira
Abstract
BACKGROUND: The use of the 3D printer in complex cardiac surgery planning.
 OBJECTIVE(S): To analyze the use and benefits of 3D printing in heart
valve surgery through a systematic review of the literature.
 METHOD(S): This systematic review was reported following the
Preferred Reporting Items for Systematic Review and registered in the
Prospero (International Prospective Register of Systematic Reviews)
database under the number CRD42017059034. We used the following databases:
PubMed, EMBASE, Scopus, Web of Science and Lilacs. We included articles
about the keywords "Heart Valves", "Heart Valve Prosthesis Implantation",
"Heart Valve Prosthesis", "Printing, Three-Dimensional", and related entry
terms. Two reviewers independently conducted data extraction and a third
reviewer solved disagreements. All tables used for data extraction are
available at a separate website. We used the Cochrane Collaboration tool
to assess the risk of bias of the studies included. RESULT(S): We
identified 301 articles and 13 case reports and case series that met the
inclusion criteria. Our studies included 34 patients aged from 3 months to
94 years. CONCLUSION(S): Up to the present time, there are no studies
including a considerable number of patients. A 3D-printed model produced
based on the patient enables the surgeon to plan the surgical procedure
and choose the best material, size, format, and thickness to be used. This
planning leads to reduced surgery time, exposure, and consequently, lower
risk of infection. Copyright © 2019 Associacao Medica Brasileira.
All rights reserved.

<24>
Accession Number
629491173
Title
Hyperoxia during cardiopulmonary bypass does not decrease cardiovascular
complications following cardiac surgery: the CARDIOX randomized clinical
trial.
Source
Intensive care medicine. 45 (10) (pp 1413-1421), 2019. Date of
Publication: 01 Oct 2019.
Author
Abou-Arab O.; Huette P.; Martineau L.; Beauvalot C.; Beyls C.; Josse E.;
Touati G.; Bouchot O.; Bouhemad B.; Diouf M.; Lorne E.; Guinot P.-G.
Institution
(Abou-Arab, Huette, Martineau, Beyls, Lorne) Department of Anesthesiology
and Critical Care Medicine, Amiens Picardy University Hospital, Rue du
Professeur Christian Cabrol, Amiens 80054, France
(Abou-Arab) MP3CV, EA7517, CURS, Jules Verne University of Picardy, 80054,
Amiens, France
(Beauvalot, Bouhemad, Guinot) Department of Anesthesiology and Critical
Care Medicine, Dijon University Hospital, Dijon 14033, France
(Josse, Diouf) Department of Clinical Research, Amiens Picardy University
Hospital, Amiens 80054, France
(Touati) Department of Cardiac Surgery, Amiens Picardy University
Hospital, Amiens 80054, France
(Bouchot) Department of Cardiac Surgery, Dijon University Hospital, Dijon
14033, France
Publisher
NLM (Medline)
Abstract
PURPOSE: Data on the benefit or or harmful effects of oxygen level on
ischemic reperfusion injuries in cardiac surgery are insufficient. We
hypothesized that hyperoxia during cardiopulmonary bypass decreases the
incidence of postoperative atrial fibrillation (POAF) and ventricular
fibrillation, and therefore decreases cardiovascular morbidity (CARDIOX
study). METHOD(S): An open-label, randomized clinical trial including
adults undergoing elective cardiac surgery, i.e. cardiopulmonary bypass
(CPB) randomized 1:1 to an intervention group or standard group at two
French University Hospitals from June 2016 to October 2018. The
intervention consisted in delivering of an inspired fraction of oxygen of
one to one during CPB. The standard care consisted in delivering oxygen to
achieve a partial arterial blood pressure less than 150 mmHg. The primary
endpoint was the occurrence of POAF and/or ventricular
tachycardia/ventricular fibrillation (VT/VF) within the 15 days following
cardiac surgery. The secondary endpoint was the occurrence of major
adverse cardiovascular events (MACCE: in-hospital mortality, stroke,
cardiac arrest, acute kidney injury, and mesenteric ischemia).
 RESULT(S): 330 patients were randomly assigned to either the
intervention group (n=161) or the standard group (n=163). Mean PaO2 was
447+/-98 mmHg and 161+/-60 mmHg during CPB, for the intervention and
standard group (p<0.0001) respectively. The incidence of POAF or VT/VF
were similar in the intervention group and the standard group (30% [49 of
161 patients] and 30% [49 of 163 patients], absolute risk reduction 0.4%;
95% CI,-9.6-10.4; p=0.94). MACCE was similar between groups with, an
occurrence of 24% and 21% for the intervention group and the standard
groups (absolute risk reduction 3.4%; 95% CI,-5.7-12.5; p=0.47)
respectively. After adjustment, the primary and secondary endpoints
remained similar for both groups. CONCLUSION(S): Hyperoxia did not
decrease POAF and cardiovascular morbidity following cardiac surgery with
CPB. CLINICALTRIAL. GOV IDENTIFIER: NCT02819739.

<25>
Accession Number
629491163
Title
154 compared to 54 mmol per liter of sodium in intravenous maintenance
fluid therapy for adult patients undergoing major thoracic surgery
(TOPMAST): a single-center randomized controlled double-blind trial.
Source
Intensive care medicine. 45 (10) (pp 1422-1432), 2019. Date of
Publication: 01 Oct 2019.
Author
Van Regenmortel N.; Hendrickx S.; Roelant E.; Baar I.; Dams K.; Van
Vlimmeren K.; Embrecht B.; Wittock A.; Hendriks J.M.; Lauwers P.; Van
Schil P.E.; Van Craenenbroeck A.H.; Verbrugghe W.; Malbrain M.L.N.G.; Van
den Wyngaert T.; Jorens P.G.
Institution
(Van Regenmortel, Baar, Dams, Verbrugghe, Jorens) Department of Intensive
Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem,
2650, Antwerp, Belgium
(Van Regenmortel) Department of Intensive Care Medicine, Ziekenhuis
Netwerk Antwerpen Campus Stuivenberg ,Lange Beeldekensstraat 267, Antwerp
2060, Belgium
(Hendrickx, Van Vlimmeren, Embrecht, Wittock) Department of
Anesthesiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem,
2650, Antwerp, Belgium
(Roelant) Clinical Trial Center (CTC), Clinical Research Center Antwerp,
Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10,
Edegem, 2650, Antwerp, Belgium
(Roelant) StatUa, Center for Statistics, University of Antwerp,
Prinsstraat 13, Antwerp 2000, Belgium
(Hendriks, Lauwers, Van Schil) Department of Thoracic and Vascular
Surgery, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650,
Antwerp, Belgium
(Hendriks, Lauwers, Van Schil, Van Craenenbroeck, Van den Wyngaert,
Jorens) Faculty of Medicine and Health Sciences, University of Antwerp,
Universiteitsplein 1, Antwerp 2610, Belgium
(Van Craenenbroeck) Department of Nephrology, Antwerp University Hospital,
Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
(Malbrain) Department of Intensive Care Medicine, University Hospital
Brussels (UZB), Laarbeeklaan 101, Jette, 1090, Brussels, Belgium
(Malbrain) Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
(VUB), Laarbeeklaan 103, Jette, 1090, Brussels, Belgium
(Van den Wyngaert) Department of Nuclear Medicine, Antwerp University
Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
Publisher
NLM (Medline)
Abstract
PURPOSE: To determine the effects of the sodium content of maintenance
fluid therapy on cumulative fluid balance and electrolyte disorders.
 METHOD(S): We performed a randomized controlled trial of adults
undergoing major thoracic surgery, randomly assigned (1:1) to receive
maintenance fluids containing 154 mmol/L (Na154) or 54 mmol/L (Na54) of
sodium from the start of surgery until their discharge from the ICU, the
occurrence of a serious adverse event or the third postoperative day at
the latest. Investigators, caregivers and patients were blinded to the
treatment. Primary outcome was cumulative fluid balance. Electrolyte
disturbances were assessed as secondary endpoints, different adverse
events and physiological markers as safety and exploratory endpoints.
FINDINGS: We randomly assigned 70 patients; primary outcome data were
available for 33 and 34 patients in the Na54 and Na154 treatment arms,
respectively. Estimated cumulative fluid balance at 72 h was 1369 mL (95%
CI 601-2137) more positive in the Na154 arm (p<0.001), despite comparable
non-study fluid sources. Hyponatremia<135 mmol/L was encountered in four
patients (11.8%) under Na54 compared to none under Na154 (p=0.04), but
there was no significantly more hyponatremia<130 mmol/L (1 versus 0;
p=0.31). There was more hyperchloremia>109 mmol/L under Na154 (24/35
patients, 68.6%) than under Na54 (4/34 patients, 11.8%) (p<0.001). The
treating clinicians discontinued the study due to clinical or radiographic
fluid overload in six patients receiving Na154 compared to one patient
under Na54 (excess risk 14.2%; 95% CI-0.2-30.4%, p=0.05).
 CONCLUSION(S): In adult surgical patients, sodium-rich maintenance
solutions were associated with a more positive cumulative fluid balance
and hyperchloremia; hypotonic fluids were associated with mild and
asymptomatic hyponatremia.

<26>
Accession Number
629490934
Title
Effect of open-lung vs conventional perioperative ventilation strategies
on postoperative pulmonary complications after on-pump cardiac surgery:
the PROVECS randomized clinical trial.
Source
Intensive care medicine. 45 (10) (pp 1401-1412), 2019. Date of
Publication: 01 Oct 2019.
Author
Lagier D.; Fischer F.; Fornier W.; Huynh T.M.; Cholley B.; Guinard B.;
Heger B.; Quintana G.; Villacorta J.; Gaillat F.; Gomert R.; Degirmenci
S.; Colson P.; Lalande M.; Benkouiten S.; Minh T.H.; Pozzi M.; Collart F.;
Latremouille C.; Vidal Melo M.F.; Velly L.J.; Jaber S.; Fellahi J.-L.;
Baumstarck K.; Guidon C.
Institution
(Lagier, Guinard, Quintana, Villacorta, Gaillat, Gomert, Degirmenci,
Velly, Guidon) Departement d'Anesthesie et Reanimation (SAR 2), CHU La
Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
(Lagier) Inra 1260, Aix Marseille Universite, Marseille, France
(Fischer, Heger) Departement d'Anesthesie et Reanimation, Nouvel Hopital
Civil, Hopitaux Universitaires de Strasbourg, Strasbourg, France
(Fornier, Fellahi) Service d'Anesthesie et Reanimation, Hospices Civils de
Lyon, Hopital Louis Pradel, Lyon, France
(Fornier) Centre d'Investigation Clinique de Lyon, INSERM 1407, Lyon,
France
(Huynh, Cholley) Service d'Anesthesie et Reanimation, Hopital Europeen
Georges Pompidou, AP-HP, Paris, France
(Huynh, Cholley, Latremouille) Service de Chirurgie Cardiaque, Hopital
Europeen Georges Pompidou, AP-HP, Paris, France
(Huynh, Cholley, Latremouille) Universite Paris Descartes-Sorbonne
Paris-Cite, Paris, France
(Colson, Lalande) CHU de Montpellier, Departement d'Anesthesie et
Reanimation, Hopital Arnaud de Villeneuve, Montpellier, France
(Colson) IGF, Cnrs, Inserm, Universite de Montpellier, Montpellier, France
(Benkouiten) Direction de la Recherche en Sante de l'Assistance Publique
des Hopitaux de Marseille, Marseille, France
(Minh) Service de Chirurgie Cardiaque, Nouvel Hopital Civil, Strasbourg,
France
(Pozzi) Service de Chirurgie Cardiaque, Hospices Civils de Lyon, Hopital
Louis Pradel, Lyon, France
(Collart) Service de Chirurgie Cardiaque, CHU La Timone, Assistance
Publique des Hopitaux de Marseille, Marseille, France
(Vidal Melo) Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, United
States
(Velly) INT, Aix Marseille Universite, Marseille, France
(Jaber) Departement d'Anesthesie et Reanimation, Hopital Saint-Eloi,
Montpellier, France
(Jaber) UMR CNRS 9214-Inserm U1046, Universite de Montpellier,
Montpellier, France
(Fellahi) IHU OPERA, Inserm 1060, Faculte de Medecine Lyon Est, Universite
Claude Bernard Lyon 1, Lyon, France
(Baumstarck) Centre d'Etudes et de Recherches sur les Services de Sante et
Qualite, Aix-Marseille Universite, Faculte de Medecine, Marseille, France
Publisher
NLM (Medline)
Abstract
PURPOSE: To evaluate whether a perioperative open-lung ventilation
strategy prevents postoperative pulmonary complications after elective
on-pump cardiac surgery. METHOD(S): In a pragmatic, randomized,
multicenter, controlled trial, we assigned patients planned for on-pump
cardiac surgery to either a conventional ventilation strategy with no
ventilation during cardiopulmonary bypass (CPB) and lower perioperative
positive end-expiratory pressure (PEEP) levels (2 cm H2O) or an open-lung
ventilation strategy that included maintaining ventilation during CPB
along with perioperative recruitment maneuvers and higher PEEP levels (8
cm H2O). All study patients were ventilated with low-tidal volumes before
and after CPB (6 to 8 ml/kg of predicted body weight). The primary end
point was a composite of pulmonary complications occurring within the
first 7 postoperative days. RESULT(S): Among 493 randomized patients,
488 completed the study (mean age, 65.7 years; 360 (73.7%) men; 230
(47.1%) underwent isolated valve surgery). Postoperative pulmonary
complications occurred in 133 of 243 patients (54.7%) assigned to
open-lung ventilation and in 145 of 245 patients (59.2%) assigned to
conventional ventilation (p=0.32). Open-lung ventilation did not
significantly reduce the use of high-flow nasal oxygenotherapy (8.6% vs
9.4%; p=0.77), non-invasive ventilation (13.2% vs 15.5%; p=0.46) or new
invasive mechanical ventilation (0.8% vs 2.4%, p=0.28). Mean alive
ICU-free days at postoperative day 7 was 4.4+/-1.3 days in the open-lung
group vs 4.3+/-1.3 days in the conventional group (mean difference,
0.1+/-0.1 day, p=0.51). Extra-pulmonary complications and adverse events
did not significantly differ between groups. CONCLUSION(S): A
perioperative open-lung ventilation including ventilation during CPB does
not reduce the incidence of postoperative pulmonary complications as
compared with usual care. This finding does not support the use of such a
strategy in patients undergoing on-pump cardiac surgery. TRIAL
REGISTRATION: Clinicaltrials.gov Identifier: NCT02866578.
https://clinicaltrials.gov/ct2/show/NCT02866578.

<27>
[Use Link to view the full text]
Accession Number
629490376
Title
Compare the prognosis of Da Vinci robot-assisted thoracic surgery (RATS)
with video-assisted thoracic surgery (VATS) for non-small cell lung
cancer: A Meta-analysis.
Source
Medicine. 98 (39) (pp e17089), 2019. Date of Publication: 01 Sep 2019.
Author
Guo F.; Ma D.; Li S.
Institution
(Guo) Department of Thoracic Surgery, Peking Union Medical College
Hospital, Peking Union Medical College, Chinese Academy of Medical
Sciences, Beijing, China
Publisher
NLM (Medline)
Abstract
To determine if there are advantages to transitioning to Da Vinci robotics
by a surgeon compared to the video-assisted thoracic surgical lobectomy.A
systematic electronic search of online electronic databases: PubMed,
Embase, and Cochrane library updated on December 2017. Publications on
comparison Da Vinci-robot-assisted thoracic surgery (RATS) and
video-assisted thoracic surgery (VATS) for non-small cell lung cancer were
collected. Meta-analysis RevMan 5.3 software (The Cochrane collaboration,
Oxford, UK) was used to analyze the combined pooled HRs using fixed or
random-effects models according to the heterogeneity.Fourteen
retrospective cohort studies were included. No statistical difference was
found between the 2 groups with respect to conversion to open, dissected
lymph nodes number, hospitalization time after surgery, duration of
surgery, drainage volume after surgery, prolonged air leak, and morbidity
(P > .05).Da Vinci-RATS lobectomy is a feasible and safe technique and can
achieve an equivalent surgical efficacy when compared with VATS. There
does not seem to be a significant advantage for an established VATS
lobectomy surgeon to transition to robotics based on clinical outcomes.

<28>
Accession Number
629489480
Title
Transcatheter Mitral Valve Replacement in Patients with Heart Failure and
Secondary Mitral Regurgitation: From COAPT Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2019. Date
of Publication: 19 Sep 2019.
Author
Asch F.M.; Grayburn P.A.; Siegel R.J.; Kar S.; Lim D.S.; Zaroff J.G.;
Mishell J.M.; Whisenant B.; Mack M.J.; Lindenfeld J.; Abraham W.T.; Stone
G.W.; Weissman N.J.
Institution
(Asch, Weissman) MedStar Health Research Institute, DC, WA
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, TX, Dallas, United States
(Siegel, Kar) Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
(Lim) Division of Cardiology, University of Virginia, VA, Charlottesville,
United States
(Zaroff, Mishell) Kaiser Permanente - San Francisco Hospital, San
Francisco, CA
(Whisenant) UT, Intermountain Medical Center, Murray, United States
(Mack) Baylor Scott & White Heart and Vascular Hospital, TX, Plano, United
States
(Lindenfeld) Advanced Heart Failure, Vanderbilt Heart and Vascular
Institute, TN, Nashville, United States
(Abraham) Departments of Medicine, Physiology, and Cell Biology, Division
of Cardiovascular Medicine, and the Davis Heart and Lung Research
Institute, The Ohio State University, Columbus, OH
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York and The Cardiovascular Research
Foundation, NY, NY, Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: In the COAPT trial among patients with heart failure (HF) and
moderate-to-severe (3+) or severe (4+) secondary mitral regurgitation
(SMR), patients treated with the transcatheter mitral valve replacement
(TMVR) had reduced rates of HF hospitalization and mortality compared with
guideline-directed medical therapy (GDMT) alone. OBJECTIVE(S): To
describe the echocardiographic patient qualification process for COAPT,
baseline echocardiographic characteristics, changes over time, and the
interaction between treatment group and echocardiographic parameters on
clinical outcomes. METHOD(S): A novel echocardiographic algorithm was
implemented for grading MR severity during the screening process.
Standardized echocardiograms were obtained at baseline and during regular
follow-up intervals through 2 years, and analyzed by a core laboratory.
 RESULT(S): A total of 614 patients were randomized to TMVR plus
maximally- tolerated GDMT or GDMT alone. Mean baseline left ventricular
ejection fraction (LVEF) was 31.3+/-9.3%, LV end-diastolic volume was
192.7+/-71 ml, and effective regurgitant orifice area was 0.41+/-0.15 cm2.
The beneficial effect of TMVR compared with GDMT alone was consistent in
all echocardiographic subgroups, independent of the severity of LV
dysfunction, LV dilatation, pulmonary hypertension, severity of tricuspid
regurgitation or individual MR characteristics. The LVEF decreased and the
LV volumes progressively increased in both groups during follow-up,
although less after TMVR (P<0.05). CONCLUSION(S): HF patients in the
COAPT trial with 3+ or 4+ SMR, selected using strict echocardiographic
criteria, benefitted from TMVR with reduced 2-year rates of death and HF
hospitalization. Strict application of these echocardiographic criteria
should enable the COAPT results to be translated to clinical
practice. Copyright © 2019. Published by Elsevier Inc.

<29>
Accession Number
2003282526
Title
Weighing Coronary Revascularization Options in Patients With Type 2
Diabetes Mellitus.
Source
Canadian Journal of Diabetes. (no pagination), 2019. Date of Publication:
2019.
Author
Godoy L.C.; Tavares C.A.M.; Farkouh M.E.
Institution
(Godoy, Farkouh) Peter Munk Cardiac Centre, University of Toronto,
Toronto, Ontario, Canada
(Godoy, Farkouh) Heart and Stroke/Richard Lewar Centres of Excellence in
Cardiovascular Research, University of Toronto, Toronto, Ontario, Canada
(Godoy, Tavares) Instituto do Coracao, Faculdade de Medicina, Universidade
de Sao Paulo, Sao Paulo, Brazil
Publisher
Elsevier B.V.
Abstract
Patients with diabetes mellitus (DM) are at increased risk for developing
coronary artery disease. Choosing the optimal revascularization strategy,
such as coronary artery bypass grafting or percutaneous coronary
intervention (PCI), may be difficult in this population. A large body of
evidence suggests that, for patients with DM and stable multivessel
ischemic heart disease, coronary artery bypass grafting is usually
superior to PCI, leading to lower rates of all-cause mortality, myocardial
infarction and repeat revascularization in the long term. In patients with
less complex coronary anatomy (2- or single-vessel disease, especially
without involvement of the proximal left anterior descendent artery), PCI
may be a viable option. Because these anatomic patterns are less frequent
in patients with DM, there is less evidence to guide revascularization in
these cases. Patients with DM and left main disease and those in the acute
coronary syndrome setting are also underrepresented in randomized trials,
and the best revascularization strategy for these patients is not clear.
Once the revascularization procedure is performed, patients should be kept
engaged in controlling the risk factors for progression of cardiovascular
disease. Avoidance of smoking, control of cholesterol, blood pressure and
glycemic levels; regular practice of physical activity of at least
moderate intensity; and a balanced diet are of key importance in the
post-revascularization period. In this study, we review the current
literature in the management of patients with DM and coronary artery
disease undergoing a revascularization procedure. Copyright ©
2019 Canadian Diabetes Association

<30>
Accession Number
2003273825
Title
Single- versus multidose cardioplegia in adult cardiac surgery patients: A
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Gambardella I.; Gaudino M.F.L.; Antoniou G.A.; Rahouma M.; Worku B.;
Tranbaugh R.F.; Nappi F.; Girardi L.N.
Institution
(Gambardella, Gaudino, Rahouma, Worku, Tranbaugh, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian
Medical Center, New York, NY, United States
(Gambardella, Antoniou, Worku, Tranbaugh) Department of Cardiothoracic
Surgery, Weill Cornell Medicine-NewYork Presbyterian Brooklyn Methodist
Hospital, Brooklyn, NY, United States
(Antoniou) Department of Vascular & Endovascular Surgery, The Royal Oldham
Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
(Antoniou) Division of Cardiovascular Sciences, School of Medical
Sciences, University of Manchester, Manchester, United Kingdom
(Nappi) Cardiac Surgery Center, Cardiologique du Nord de Saint-Denis,
Paris, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To compare outcomes of single (intervention group: del Nido
[DN], and histamine-tryptophan-ketoglutarate) versus multidose (control
group) cardioplegia in the adult cardiac surgery patients. Method(s):
Medical search engines were interrogated to identify relevant randomized
controlled trials and propensity-score matched cohorts. Meta-analysis was
conducted for primary (in-hospital/30-day mortality) and secondary
(ischemic and cardiopulmonary bypass [CPB] times, reperfusion
fibrillation, peak of cardiac enzymes, myocardial infarction) endpoints.
Subgroup analyses were conducted for study design and type of
intervention, and meta-regression for primary outcome included type of
surgery and left ventricular ejection fraction as moderators.
 Result(s): Ten randomized controlled trials and 13 propensity-score
matched cohorts were included, reporting on 5516 patients. Estimates are
expressed as (parameter value [OR, odds ratio; MD, mean difference; SMD,
standardized mean difference]/unit of measure [95% confidence interval], P
value). DN reduced ischemic time (MD, -7.18 minutes [-12.52 to -1.84], P <
.01), CPB time (MD, -10.44 minutes [-18.99 to -1.88], P .01), reperfusion
fibrillation (OR, 0.16 [0.05-0.54], P < .01), and cardiac enzymes (SMD
-0.17 [-0.29, 0.05], P < .01) compared with multidose cardioplegia. None
of these beneficial effects were reproduced by
histamine-tryptophan-ketoglutarate, which instead increased CPB time (MD,
2.04 minutes [0.73-3.37], P < .01) and reperfusion fibrillation (OR, 1.80
[1.20-2.70], P < .01). There was no difference in mortality and myocardial
infarction between single and multidose, independently of type of surgery
or left ventricular ejection fraction. Conclusion(s): DN decreases
operative times, reperfusion fibrillation, and surge of cardiac enzymes
compared with multidose cardioplegia. Copyright © 2019 The
American Association for Thoracic Surgery

<31>
Accession Number
2001262560
Title
Blinded outcomes and angina assessment of coronary bioresorbable
scaffolds: 30-day and 1-year results from the ABSORB IV randomised trial.
Source
The Lancet. 392 (10157) (pp 1530-1540), 2018. Date of Publication: 27
October - 2 November 2018.
Author
Stone G.W.; Ellis S.G.; Gori T.; Metzger D.C.; Stein B.; Erickson M.;
Torzewski J.; Williams J.; Lawson W.; Broderick T.M.; Kabour A.; Piegari
G.; Cavendish J.; Bertolet B.; Choi J.W.; Marx S.O.; Genereux P.;
Kereiakes D.J.
Institution
(Stone, Marx) NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
(Stone, Genereux) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Gori) Kardiologie I University Medical Center and Deutsches Zentrum fur
Herz-Kreislaufforschung, Rhein-Main, Mainz, Germany
(Metzger) Ballad Health Systems CVA Heart Institute, Kingsport, TN, United
States
(Stein) Morton Plant Hospital, Clearwater, FL, United States
(Erickson) Royal Perth Hospital, Perth, WA, Australia
(Torzewski) Kliniken Oberallgau, Immenstadt, Germany
(Williams) Presbyterian Hospital, Charlotte, NC, United States
(Lawson) Stony Brook University Medical Center, Stony Brook, NY, United
States
(Broderick, Kereiakes) The Carl and Edyth Lindner Research Center at The
Christ Hospital, Cincinnati, OH, United States
(Kabour) Mercy St Vincent Medical Center, Toledo, OH, United States
(Piegari) St Joseph Medical Center, Wyomissing, PA, United States
(Cavendish) Scripps Memorial Hospital La Jolla, La Jolla, CA, United
States
(Bertolet) North Mississippi Medical Center, Tupelo, MS, United States
(Choi) Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas,
TX, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Previous studies showed more adverse events with coronary
bioresorbable vascular scaffolds (BVS) than with metallic drug-eluting
stents (DES), although in one randomised trial angina was reduced with
BVS. However, these early studies were unmasked, lesions smaller than
intended for the scaffold were frequently enrolled, implantation technique
was suboptimal, and patients with myocardial infarction, in whom BVS might
be well suited, were excluded. Method(s): In the active-controlled,
blinded, multicentre, randomised ABSORB IV trial, patients with stable
coronary artery disease or acute coronary syndromes aged 18 years or older
were recruited from 147 hospitals in five countries (the USA, Germany,
Australia, Singapore, and Canada). Enrolled patients were randomly
assigned (1:1) to receive polymeric everolimus-eluting BVS (Absorb; Abbott
Vascular, Santa Clara, CA, USA) with optimised implantation technique or
cobalt-chromium everolimus-eluting stents (EES; Xience; Abbott Vascular,
Santa Clara, CA, USA). Randomisation was stratified by diabetic status,
whether patients would have been eligible for enrolment in the previous
ABSORB III trial, and site. Patients and clinical assessors were masked to
randomisation. The primary endpoint was target lesion failure (cardiac
death, target vessel myocardial infarction, or ischaemia-driven target
lesion revascularisation) at 30 days, tested for non-inferiority with a
2.9% margin for the risk difference. Analysis was by intention to treat.
The trial is registered with ClinicalTrials.gov, number NCT02173379, and
is closed to accrual. Finding(s): Between Aug 15, 2014, and March 31,
2017, we screened 18 722 patients for eligibility, 2604 of whom were
enrolled. 1296 patients were assigned to BVS, and 1308 patients were
assigned to EES. Follow-up data at 30 days and 1 year, respectively, were
available for 1288 and 1254 patients with BVS and for 1303 and 1272
patients with EES. Biomarker-positive acute coronary syndromes were
present in 622 (24%) of 2602 patients, and, by angiographic core
laboratory analysis, 78 (3%) of 2893 of lesions were in very small
vessels. Target lesion failure at 30 days occurred in 64 (5.0%) patients
assigned to BVS and 48 (3.7%) patients assigned to EES (difference 1.3%,
upper 97.5% confidence limit 2.89; one-sided
p<inf>non-inferiority</inf>=0.0244). Target lesion failure at 1 year
occurred in 98 (7.8%) patients assigned to BVS and 82 (6.4%) patients
assigned to EES (difference 1.4%, upper 97.5% confidence limit 3.4;
one-sided p<inf>non-inferiority</inf>=0.0006). Angina, adjudicated by a
central events committee at 1 year, occurred in 270 (20.3%) patients
assigned to BVS and 274 (20.5%) patients assigned to EES (difference
-0.3%, 95% CI -3.4% to 2.9%; one-sided p<inf>non-inferiority</inf>=0.0008;
two-sided p<inf>superiority</inf>=0.8603). Device thrombosis within 1 year
occurred in nine (0.7%) patients assigned to BVS and four (0.3%) patients
assigned to EES (p=0.1586). Interpretation(s): Polymeric BVS
implanted with optimised technique in an expanded patient population
resulted in non-inferior 30-day and 1-year rates of target lesion failure
and angina compared with metallic DES. Funding(s): Abbott
Vascular. Copyright © 2018 Elsevier Ltd

<32>
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.

<33>
Accession Number
629430560
Title
Impact of preoperative fractional flow reserve on arterial bypass graft
anastomotic function: The IMPAG trial.
Source
European Heart Journal. 40 (29) (pp 2421-2428), 2019. Date of Publication:
August 2019.
Author
Glineur D.; Grau J.B.; Etienne P.-Y.; Benedetto U.; Fortier J.H.;
Papadatos S.; Laruelle C.; Pieters D.; El Khoury E.; Blouard P.;
Timmermans P.; Ruel M.; Chong A.-Y.; So D.; Chan V.; Rubens F.; Gaudino
M.F.
Institution
(Glineur, Grau, Fortier, Ruel, Chan, Rubens) Division of Cardiac Surgery,
University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7,
Canada
(Etienne, Papadatos) Division of Cardiovascular and Thoracic Surgery,
Cliniques St Luc Bouge, Bouge, Belgium
(Benedetto, Gaudino) Department of Cardiothoracic Surgery, New York
Presbyterian-Weill Cornell Medicine, New York, NY, United States
(Laruelle, Pieters, El Khoury, Blouard, Timmermans) Division of
Cardiology, Cliniques St Luc Bouge, Bouge, Belgium
(Chong, So) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, Canada
Publisher
Oxford University Press
Abstract
Aims: Visual estimation is the most commonly used method to evaluate the
degree of coronary artery stenosis prior to coronary artery bypass
grafting. In interventional cardiology, the use of fractional flow reserve
(FFR) to guide revascularization decisions has become routine. We
investigated whether the preoperative FFR measurement of coronary lesions
is associated with anastomosis function 6 months after surgical
revascularization using a multiarterial grafting strategy. Methods
and Results: In this prospective double-blind study, 67 patients were
enrolled from two institutions in Europe and Canada. From these patients,
199 coronary lesions were assessed visually and with FFR at the time of
the preoperative angiogram. All patients received coronary
revascularization using multiple arterial grafts. A post-operative 6-month
angiogram was performed to assess anastomosis functionality using a
described angiographic method. The primary outcome was the association
between preoperative FFR values and anastomosis function 6 months after
surgery. Preoperative FFR was significantly associated with 6-months
anastomotic function for all conduits and for all targets (P < 0.001). An
FFR value of <=0.78 was associated with an anastomotic occlusion rate of
3%. Conclusion(s): We found a significant association between the
preoperative FFR measurement of the target vessel and the anastomotic
functionality at 6 months, with a cut-off of 0.78. Integration of FFR
measurement into the preoperative diagnostic workup before multiarterial
coronary surgical revascularization leads to improved anastomotic graft
function. Clinical Trials. gov Identifier: NCT02527044. Copyright
© The Author(s) 2019.

<34>
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.

<35>
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.

<36>
Accession Number
629167410
Title
Pharmacological interventions for the treatment of delirium in critically
ill adults.
Source
Cochrane Database of Systematic Reviews. 2019 (9) (no pagination), 2019.
Article Number: CD011749. Date of Publication: 03 Sep 2019.
Author
Burry L.; Hutton B.; Williamson D.R.; Mehta S.; Adhikari N.K.J.; Cheng W.;
Wes Ely E.; Egerod I.; Fergusson D.A.; Rose L.
Institution
(Burry) Department of Pharmacy, Mount Sinai Hospital, Leslie Dan Faculty
of Pharmacy, University of Toronto, Toronto, Canada
(Hutton, Cheng) Knowledge Synthesis Group, Ottawa Hospital Research
Institute, Ottawa, Canada
(Williamson) Faculty of Pharmacy / Department of Pharmacy, Universite de
Montreal / Hopital du Sacre-Coeur de Montreal, Montreal, Canada
(Mehta) Interdepartmental Division of Critical Care Medicine, Mount Sinai
Hospital, University of Toronto, Toronto, Canada
(Adhikari) Interdepartmental Division of Critical Care Medicine,
University of Toronto, Toronto, Canada
(Adhikari) Department of Critical Care Medicine, Sunnybrook Health
Sciences Centre, Toronto, Canada
(Wes Ely) Center for Health Services Research, Vanderbilt University
School of Medicine, Nashville, TN, United States
(Egerod) Intensive Care Unit 4131, Rigshospitalet, University of
Copenhagen, Copenhagen O, Denmark
(Fergusson) Ottawa Hospital Research Institute, Ottawa, Canada
(Rose) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre and Sunnybrook Research Institute, Toronto, Canada
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background Although delirium is typically an acute reversible cognitive
impairment, its presence is associated with devastating impact on both
short- term and long-term outcomes for critically ill patients. Advances
in our understanding of the negative impact of delirium on patient
outcomes have prompted trials evaluating multiple pharmacological
interventions. However, considerable uncertainty surrounds the relative
benefits and safety of available pharmacological interventions for this
population. Objectives Primary objective 1. To assess the effects of
pharmacological interventions for treatment of delirium on duration of
delirium in critically ill adults with confirmed or documented high risk
of delirium Secondary objectives To assess the following: 1. effects of
pharmacological interventions on delirium-free and coma-free days; days
with coma; delirium relapse; duration of me- chanical ventilation;
intensive care unit (ICU) and hospital length of stay; mortality; and
long-term outcomes (e.g. cognitive; discharge disposition; health-related
quality of life); and 2. the safety of such treatments for critically ill
adult patients. Search methods We searched the following databases from
their inception date to 21 March 2019: Ovid MEDLINE, Ovid MEDLINE In-
Process & Other Non-Indexed Citations, Embase Classic+Embase, and PsycINFO
using the Ovid platform. We also searched the Cochrane Library on Wiley,
the International Prospective Register of Systematic Reviews (PROSPERO) (
http://www.crd.york.ac.uk/ PROSPERO/), the Cumulative Index to Nursing and
Allied Health Literature (CINAHL), and Web of Science. We performed a grey
literature search of relevant databases and websites using the resources
listed in Grey Matters developed by the Canadian Agency for Drugs and
Technologies in Health (CADTH). We also searched trial registries and
abstracts from annual scientific critical care and delirium society
meetings. Selection criteria We sought randomized controlled trials
(RCTs), including quasi-RCTs, of any pharmacological (drug) for treatment
of delirium in critically ill adults. The drug intervention was to be
compared to another active drug treatment, placebo, or a
non-pharmacological intervention (e.g. mobilization). We did not apply any
restrictions in terms of drug class, dose, route of administration, or
duration of delirium or drug exposure. We defined critically ill patients
as those treated in an ICU of any specialty (e.g. burn, cardiac, medical,
surgical, trauma) or high-dependency unit. Data collection and analysis
Two review authors independently identified studies from the search
results; four review authors (in pairs) performed data extraction and
assessed risk of bias independently. We performed data synthesis through
pairwise meta-analysis and network meta-analysis (NMA). Our hypothetical
network structure was designed to be analysed at the drug class level and
illustrated a network diagram of 'nodes' (i.e. drug classes) and 'edges'
(i.e. comparisons between different drug classes from existing trials),
thus describing a treatment network of all possible comparisons between
drug classes. We assessed the quality of the body of evidence according to
GRADE, as very low, low, moderate, or high. Main results We screened 7674
citations, from which 14 trials with 1844 participants met our inclusion
criteria. Ten RCTs were placebo-controlled, and four reported comparisons
of different drugs. Drugs examined in these trials were the following:
antipsychotics (n = 10), alpha2 agonists (n = 3; all dexmedetomidine),
statins (n = 2), opioids (n = 1; morphine), serotonin antagonists (n = 1;
ondansetron), and cholinesterase (CHE) inhibitors (n = 1; rivastigmine).
Only one of these trials consistently used non-pharmacological
interventions that are known to improve patient outcomes in both
intervention and control groups. Eleven studies (n = 1153 participants)
contributed to analysis of the primary outcome. Results of the NMA showed
that the intervention with the smallest ratio of means (RoM) (i.e. most
preferred) compared with placebo was the alpha2 agonist dexmedetomidine
(0.58; 95% credible interval (CrI) 0.26 to 1.27; surface under the
cumulative ranking curve (SUCRA) 0.895; moderate-quality evidence). In
order of descending SUCRA values (best to worst), the next best
interventions were atypical antipsychotics (RoM 0.80, 95% CrI 0.50 to
1.11; SUCRA 0.738; moderate-quality evidence), opioids (RoM 0.88, 95% CrI
0.37 to 2.01; SUCRA 0.578; very-low quality evidence), and typical
antipsychotics (RoM 0.96, 95% CrI 0.64 to1.36; SUCRA 0.468; high-quality
evidence). The NMAs of multiple secondary outcomes revealed that only the
alpha<inf>2</inf> agonist dexmedetomidine was associated with a shorter
duration of mechanical ventilation (RoM 0.55, 95% CrI 0.34 to 0.89;
moderate-quality evidence), and the CHE inhibitor rivastigmine was
associated with a longer ICU stay (RoM 2.19, 95% CrI 1.47 to 3.27;
moderate-quality evidence). Adverse events often were not reported in
these trials or, when reported, were rare; pair-wise analysis of QTc
prolongation in seven studies did not show significant differences between
antipsychotics, ondansetron, dexmedetomidine, and placebo. Authors'
conclusions We identified trials of varying quality that examined six
different drug classes for treatment of delirium in critically ill adults.
We found evidence that the alpha2 agonist dexmedetomidine may shorten
delirium duration, although this small effect (compared with placebo) was
seen in pairwise analyses based on a single study and was not seen in the
NMA results. Alpha2 agonists also ranked best for duration of mechanical
ventilation and length of ICU stay, whereas the CHE inhibitor rivastigmine
was associated with longer ICU stay. We found no evidence of a difference
between placebo and any drug in terms of delirium-free and coma-free days,
days with coma, physical restraint use, length of stay, long-term
cognitive outcomes, or mortality. No studies reported delirium relapse,
resolution of symptoms, or quality of life. The ten ongoing studies and
the six studies awaiting classification that we identified, once published
and assessed, may alter the conclusions of the review. Copyright
© 2019 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<37>
Accession Number
2000882198
Title
The effects of recruitment maneuver during noninvasive ventilation after
coronary bypass grafting: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (6) (pp 2170-2177.e1),
2018. Date of Publication: December 2018.
Author
Miura M.C.; Ribeiro de Carvalho C.R.; Yamada da Silveira L.T.; de Moraes
Regenga M.; Petri Damiani L.; Fu C.
Institution
(Miura, de Moraes Regenga) Hospital do Coracao, Sao Paulo-SP, Brazil
(Miura) Department of Physiotherapy, Communication Science & Disorders,
Occupational Therapy, Medical School of the University of Sao Paulo, Sao
Paulo, Brazil
(Miura, Yamada da Silveira, Fu) Cardio-Pulmonary Department-Respiratory
ICU, Pulmonary Division, Heart Institute, Hospital das Clinicas da FMUSP,
University of Sao Paulo, Sao Paulo, Brazil
(Ribeiro de Carvalho) University Hospital, Universidade de Sao Paulo, Sao
Paulo, Brazil
(Petri Damiani) HCor Research Institute, Hospital do Coracao, Sao Paulo,
Brazil
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Pulmonary impairment is a common complication after coronary
artery bypass graft procedure and may be prevented or treated by
noninvasive ventilation. Recruitment maneuvers include sustained airway
pressure with high levels of positive end-expiratory pressure in patients
with hypoxemia, favoring homogeneous pulmonary ventilation and
oxygenation. This study aimed to evaluate whether noninvasive ventilation
with recruitment maneuver could safely improve oxygenation in patients
with atelectasis and hypoxemia who underwent a coronary artery bypass
grafting procedure. Method(s): Thirty-four patients admitted to our
intensive care unit undergoing mechanical ventilation after surgery, with
ratio of arterial oxygen partial pressure to fraction of inspired oxygen <
300 and radiologic atelectasis score >=2, were included. The control group
consisted of 16 randomized patients and the recruitment group consisted of
18 patients. After extubation, noninvasive ventilation was applied for 30
minutes 3 times a day with positive end-expiratory pressure of 8 cm
H<inf>2</inf>O. The recruitment group received recruitment maneuver with
positive end-expiratory pressure of 15 cm H<inf>2</inf>O and 20 cm
H<inf>2</inf>O for 2 minutes each during noninvasive ventilation. We
analyzed the arterial oxygen partial pressure in room air, radiologic
atelectasis score, hemodynamic stability, and adverse events from
extubation until discharge. Result(s): Arterial oxygen partial
pressure increased 12.6% +/- 6.8% in the control group and 23.3% +/- 8.5%
in the recruitment group (P <.001). The radiologic atelectasis score was
completely improved for 94.4% of the recruitment group with no adverse
events, whereas 87.5% of the control group presented some atelectasis (P
<.001). Conclusion(s): Noninvasive ventilation with recruitment
maneuvers is safe, improves oxygenation, and reduces atelectasis in
patients undergoing coronary artery bypass. Copyright © 2018 The
American Association for Thoracic Surgery

<38>
Accession Number
2001001361
Title
What are the clinical, quality-of-life, and cost consequences of 30years
of excellent vs. poor glycemic control in type 1 diabetes?.
Source
Journal of Diabetes and its Complications. 32 (10) (pp 911-915), 2018.
Date of Publication: October 2018.
Author
Herman W.H.; Braffett B.H.; Kuo S.; Lee J.M.; Brandle M.; Jacobson A.M.;
Prosser L.A.; Lachin J.M.
Institution
(Herman) Departments of Internal Medicine and Epidemiology, University of
Michigan, Ann Arbor, MI, United States
(Braffett, Lachin) The Biostatistics Center, George Washington University,
Washington, DC, United States
(Kuo) Department of Internal Medicine, University of Michigan, Ann Arbor,
MI, United States
(Lee) Pediatric Endocrinology, Child Health Evaluation and Research Unit,
University of Michigan, Ann Arbor, MI, United States
(Brandle) Division of Endocrinology and Diabetes, Kantonsspital St.
Gallen, Sankt Gallen, SG, Switzerland
(Jacobson) Winthrop-University Hospital, Mineola, NY, United States
(Prosser) Department of Pediatrics, University of Michigan, Ann Arbor, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: The Diabetes Control and Complications Trial (DCCT)
demonstrated that intensive therapy for type 1 diabetes delayed the
development of microvascular and neuropathic complications compared to
conventional therapy. At the end of DCCT, all participants were trained in
intensive therapy, care was transferred to community providers, and the
difference in HbA1c between treatment groups narrowed and disappeared. Our
objective was to describe the outcomes and the quality-of-life and costs
associated with those outcomes in participants who maintained excellent
vs. poor glycemic control over 30 years. Research design and methods: We
assessed the incidence of retinopathy, nephropathy, neuropathy,
cardiovascular disease, acute metabolic complications, death,
quality-of-life, and costs in the tertile of DCCT intensive therapy
participants who achieved a mean updated HbA1c of <7.2% (55 mmol/mol) and
the tertile of DCCT conventional therapy participants (n = 240) who
achieved a mean updated HbA1c of >8.8% (73 mmol/mol) over 30 years.
 Result(s): Thirty years of excellent vs. poor glycemic control
substantially reduced the incidence of retinopathy requiring laser therapy
(5% vs. 45%), end-stage renal disease (0% vs. 5%), clinical neuropathy
(15% vs. 50%), myocardial infarction (3% vs. 5%), stroke (0.4% vs. 2%),
and death (6% vs. 20%). It also resulted in a gain of ~1.62
quality-adjusted life-years and averted ~$90,900 in costs of complications
per participant. Conclusion(s): Thirty years of excellent vs. poor
glycemic control for T1DM can substantially reduce the incidence of
complications, comorbidities, and death, improve quality-of-life, and
reduce costs. These estimates represent the benefits that may be achieved
with excellent glycemic control. Copyright © 2018 Elsevier Inc.

<39>
[Use Link to view the full text]
Accession Number
627082476
Title
Association of blood pressure measurements with peripheral artery disease
events reanalysis of the ALLHAT data.
Source
Circulation. 138 (17) (pp 1805-1814), 2018. Date of Publication: 2018.
Author
Itoga N.K.; Tawfik D.S.; Lee C.K.; Maruyama S.; Leeper N.J.; Chang T.I.
Institution
(Itoga, Lee, Leeper) Division of Vascular Surgery, Department of Surgery,
Stanford University School of Medicine, CA, United States
(Tawfik, Maruyama) Department of Health Research and Policy, Stanford
University School of Medicine, CA, United States
(Tawfik) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, Stanford University School of Medicine, CA, United States
(Chang) Division of Nephrology, Department of Medicine, Stanford
University School of Medicine, 777 Welch Road, Suite DE, Room D100, Palo
Alto, CA 94305, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Current guidelines recommend treating hypertension in patients
with peripheral artery disease (PAD) to reduce the risk of cardiac events
and stroke, but the effect of reducing blood pressure on lower extremity
PAD events is largely unknown. We investigated the association of blood
pressure with lower extremity PAD events using data from the ALLHAT trial
(Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial). METHOD(S): ALLHAT investigated the effect of different
antihypertensive medication classes (chlorthalidone, amlodipine,
lisinopril, or doxazosin) on cardiovascular events. With the use of these
data, the primary outcome in our analysis was time to first lower
extremity PAD event, defined as PAD-related hospitalization, procedures,
medical treatment, or PAD-related death. Given the availability of
longitudinal standardized blood pressure measurements, we analyzed
systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse
pressure as time-varying categorical variables (reference categories
120-129 mm Hg for SBP, 70-79 mm Hg for DBP, and 45-54 mm Hg for pulse
pressure) in separate models. We used extended Cox regression with death
as a competing risk to calculate the association of each blood pressure
component with PAD events, and report the results as subdistribution
hazard ratios and 95% CIs. RESULT(S): The present analysis included
33 357 patients with an average age of 67.4 years, 53.1% men, 59.7% white
race, and 36.2% with diabetes mellitus. The median baseline blood pressure
was 146/84 mm Hg. Participants were followed for a median of 4.3
(interquartile range, 3.6-5.3) years, during which time 1489 (4.5%) had a
lower extremity PAD event, and 4148 (12.4%) died. In models adjusted for
demographic and clinical characteristics, SBP <120 mm Hg was associated
with a 26% (CI, 5%-52%; P=0.015) higher hazard and SBP>=160 mm Hg was
associated with a 21% (CI, 0%-48%; P=0.050) higher hazard for a PAD event,
in comparison with SBP 120 to 129 mm Hg. In contrast, lower, but not
higher, DBP was associated with a higher hazard of PAD events: for DBP <60
mm Hg (hazard ratio, 1.72; CI, 1.38-2.16). Pulse pressure had a U-shaped
association with PAD events. CONCLUSION(S): In this reanalysis of
data from ALLHAT, we found a higher rate of lower extremity PAD events
with higher and lower SBP and pulse pressure and with lower DBP. Given the
recent revised blood pressure guidelines advocating lower SBP targets for
overall cardiovascular risk reduction, further refinement of optimal blood
pressure targets specific to PAD is needed. Copyright © 2018
American Heart Association, Inc.

<40>
Accession Number
2000774397
Title
Goal-directed perfusion to reduce acute kidney injury: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (5) (pp 1918-1927.e2),
2018. Date of Publication: November 2018.
Author
Ranucci M.; Johnson I.; Willcox T.; Baker R.A.; Boer C.; Baumann A.;
Justison G.A.; de Somer F.; Exton P.; Agarwal S.; Parke R.; Newland R.F.;
Haumann R.G.; Buchwald D.; Weitzel N.; Venkateswaran R.; Ambrogi F.;
Pistuddi V.
Institution
(Ranucci, Pistuddi) Department of Cardiothoracic and Vascular Anesthesia
and Intensive Care Unit, Istituto di Ricovero e Cura a Carattere
Scientifico, Policlinico San Donato, San Donato Milanese, Milan, Italy
(Johnson, Agarwal) Department of Perfusion, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Johnson, Agarwal) Department of Anesthesia, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Willcox, Parke) Green Lane Cardiothoracic Unit and Cardiothoracic and
Vascular Intensive Care, Auckland City Hospital, Auckland, New Zealand
(Willcox, Parke) Department of Anaesthesiology, Faculty of Medical and
Health Sciences, University of Auckland, Auckland, New Zealand
(Baker, Newland) Cardiac Research and Perfusion, Cardiac and Thoracic
Surgical Unit, Flinders Medical Centre and Flinders University, Adelaide,
South Australia, Australia
(Boer, Haumann) Department of Anesthesiology, Institute for Cardiovascular
Research, VU University Medical Center, Amsterdam, Netherlands
(Boer, Haumann) Department of Cardiothoracic Surgery, Institute for
Cardiovascular Research, VU University Medical Center, Amsterdam,
Netherlands
(Baumann, Buchwald) Department of Anaesthesiology, Intensive Care,
Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil,
Ruhr University, Bochum, Germany
(Baumann, Buchwald) Department of Cardiac and Thoracic Surgery, BG
University Hospital Bergmannsheil, Ruhr University, Bochum, Germany
(Justison, Weitzel) Department of Perfusion, University of Colorado
Denver, Aurora, Colo, United States
(Justison, Weitzel) Department of Anesthesiology, University of Colorado
Denver, Aurora, Colo, United States
(de Somer) Heart Centre, University Hospital Ghent, Ghent, Belgium
(Exton, Venkateswaran) Department of Cardiothoracic Surgery, University
Hospital of South Manchester National Health Service Foundation Trust,
Manchester, United Kingdom
(Ambrogi) Department of Clinical Sciences and Community Health, University
of Milan, and IRCCS Policlinico San Donato, Milan, Italy
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To determine whether a goal-directed perfusion (GDP) strategy
aimed at maintaining oxygen delivery (DO<inf>2</inf>) at >=280
mL.min-1.m-2 reduces the incidence of acute kidney
injury (AKI). Method(s): This multicenter randomized trial enrolled a
total of 350 patients undergoing cardiac surgery in 9 institutions.
Patients were randomized to receive either GDP or conventional perfusion.
A total of 326 patients completed the study and were analyzed. Patients in
the treatment arm were treated with a GDP strategy during cardiopulmonary
bypass (CPB) aimed to maintain DO<inf>2</inf> at >=280
mL.min-1.m-2. The perfusion strategy for patients in
the control arm was factored on body surface area and temperature. The
primary endpoint was the rate of AKI. Secondary endpoints were intensive
care unit length of stay, major morbidity, red blood cell transfusions,
and operative mortality. Result(s): Acute Kidney Injury Network
(AKIN) stage 1 was reduced in patients treated with GDP (relative risk
[RR], 0.45; 95% confidence interval [CI], 0.25-0.83; P =.01). AKIN stage
2-3 did not differ between the 2 study arms (RR, 1.66; 95% CI, 0.46-6.0; P
=.528). There were no significant differences in secondary outcomes. In a
prespecified analysis of patients with a CPB time between 1 and 3 hours,
the differences in favor of the treatment arm were more pronounced, with
an RR for AKI of 0.49 (95% CI, 0.27-0.89; P =.017). Conclusion(s): A
GDP strategy is effective in reducing AKIN stage 1 AKI. Further studies
are needed to define perfusion interventions that may reduce more severe
levels of renal injury (AKIN stage 2 or 3). Copyright © 2018 The
American Association for Thoracic Surgery

<41>
[Use Link to view the full text]
Accession Number
627081522
Title
Safety and efficacy of intracoronary infusion of allogeneic human cardiac
stem cells in patients with st-segment elevation myocardial infarction and
left ventricular dysfunction a multicenter randomized, double-blind, and
placebo-controlled clinical trial.
Source
Circulation Research. 123 (5) (pp 579-589), 2018. Date of Publication:
2018.
Author
Fernandez-Aviles F.; Sanz-Ruiz R.; Bogaert J.; Plasencia A.C.; Gilaberte
I.; Belmans A.; Fernandez-Santos M.E.; Charron D.; Mulet M.; Yotti R.;
Palacios I.; Luque M.; Sadaba R.; Roman J.A.S.; Larman M.; Sanchez P.L.;
Sanchis J.; Jimenez M.F.; Claus P.; Al-Daccak R.; Lombardo E.; Abad J.L.;
Delarosa O.; Corcostegui L.; Bermejo J.; Janssens S.
Institution
(Sanz-Ruiz, Bogaert, Plasencia, Fernandez-Santos, Yotti, Bermejo)
Instituto de Investigacion Sanitaria Gregorio Maranon, Universidad
Complutense, Hospital General Universitario Gregorio Maranon, Madrid,
Spain
(Fernandez-Aviles, Sanz-Ruiz, Bogaert, Plasencia, Fernandez-Santos, Yotti,
Roman, Sanchez, Jimenez, Bermejo, Janssens) Instituto de Salud Carlos III,
CIBERCV, Madrid, Spain
(Bogaert, Belmans, Claus, Bermejo, Janssens) Department of Cardiovascular
Medicine, University Hospitals, Herestraat 49, Leuven B-3000, Belgium
(Gilaberte, Mulet, Palacios, Luque, Lombardo, Abad, Delarosa, Corcostegui)
Coretherapix S.L.U., Tigenix Group Madrid, Spain
(Charron, Al-Daccak) Hopital Saint-Louis, HLA et Medicine (HLA-MED),
Paris, France
(Sadaba) Department of Cardiac Surgery, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Roman) Department of Cardiology, Instituto de Ciencias del Corazon
(ICICOR), Valladolid, Spain
(Larman) Department of Cardiology, Policlinia Guipuzcoa, San Sebastian,
Spain
(Sanchez) Department of Cardiology, Hospital Clinico Universitario,
Salamanca, Spain
(Sanchis) Department of Cardiology, Hospital Clinico Universitario,
Valencia, Spain
(Jimenez) Department of Cardiology, UGC Corazon Hospital Clinico Virgen de
la Victoria, IBIMA, UMA, Spain
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rationale: Allogeneic cardiac stem cells (AlloCSC-01) have shown
protective, immunoregulatory, and regenerative properties with a robust
safety profile in large animal models of heart disease. Objective(s):
To investigate the safety and feasibility of early administration of
AlloCSC-01 in patients with STsegment- elevation myocardial infarction.
 Methods and Results: CAREMI (Safety and Efficacy of Intracoronary
Infusion of Allogeneic Human Cardiac Stem Cells in Patients With STEMI and
Left Ventricular Dysfunction) was a phase I/II multicenter, randomized,
double-blind, placebo-controlled trial in patients with
ST-segment-elevation myocardial infarction, left ventricular ejection
fraction <=45%, and infarct size >=25% of left ventricular mass by cardiac
magnetic resonance, who were randomized (2:1) to receive AlloCSC-01 or
placebo through the intracoronary route at days 5 to 7. The primary end
point was safety and included all-cause death and major adverse cardiac
events at 30 days (all-cause death, reinfarction, hospitalization because
of heart failure, sustained ventricular tachycardia, ventricular
fibrillation, and stroke). Secondary safety end points included major
adverse cardiac events at 6 and 12 months, adverse events, and immunologic
surveillance. Secondary exploratory efficacy end points were changes in
infarct size (percentage of left ventricular mass) and indices of
ventricular remodeling by magnetic resonance at 12 months. Forty-nine
patients were included (92% male, 55+/-11 years), 33 randomized to
AlloCSC-01 and 16 to placebo. No deaths or major adverse cardiac events
were reported at 12 months. One severe adverse events in each group was
considered possibly related to study treatment (allergic dermatitis and
rash). AlloCSC-01 elicited low levels of donor-specific antibodies in 2
patients. No immune-related adverse events were found, and no differences
between groups were observed in magnetic resonance-based efficacy
parameters at 12 months. The estimated treatment effect of AlloCSC-01 on
the absolute change from baseline in infarct size was -2.3% (95%
confidence interval, -6.5% to 1.9%). Conclusion(s): AlloCSC-01 can be
safely administered in ST-segment-elevation myocardial infarction patients
with left ventricular dysfunction early after revascularization. Low
immunogenicity and absence of immune-mediated events will facilitate
adequately powered studies to demonstrate their clinical efficacy in this
setting. Copyright © 2018 American Heart Association, Inc.

<42>
[Use Link to view the full text]
Accession Number
627081477
Title
Liraglutide reduces cardiovascular events and mortality in type 2 diabetes
mellitus independently of baseline low-density lipoprotein cholesterol
levels and statin use results from the LEADER trial.
Source
Circulation. 138 (15) (pp 1605-1607), 2018. Date of Publication: 2018.
Author
Verma S.; Leiter L.A.; David Mazer C.; Bain S.C.; Buse J.; Marso S.; Nauck
M.; Zinman B.; Bosch-Traberg H.; Rasmussen S.; Michelsen M.M.; Bhatt D.L.
Institution
(Verma) Division of Cardiac Surgery, St. Michael's Hospital, University of
Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON M5B 1W8, Canada
(Leiter) Division of Endocrinology and Metabolism, St. Michael's Hospital,
University of Toronto, Ontario, Canada
(David Mazer) Department of Anasthesia, St. Michael's Hospital, University
of Toronto, Ontario, Canada
(Bain) Institute of Life Science, Swansea University, United Kingdom
(Buse) University of North Carolina, School of Medicine, Chapel Hill, NC,
United States
(Marso) HCA Midwest Health Heart and Vascular Institute, Kansas City, MO,
United States
(Nauck) Diabetes Center Bochum-Hattingen, St. Josef-Hospital,
Ruhr-University Bochum, Germany
(Zinman) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
University of Toronto, ON, Canada
(Bosch-Traberg, Rasmussen, Michelsen) Novo Nordisk A/S, Soborg, Denmark
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<43>
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.

<44>
Accession Number
629465258
Title
Effects of Different Rehabilitation Protocols in Inpatient Cardiac
Rehabilitation after Coronary Artery Bypass Graft Surgery: A RANDOMIZED
CLINICAL TRIAL.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. (no pagination),
2019. Date of Publication: 2019.
Author
Zanini M.; Nery R.M.; De Lima J.B.; Buhler R.P.; Da Silveira A.D.; Stein
R.
Institution
(Zanini, Nery, De Lima, Buhler, Da Silveira, Stein) Federal University of
Rio Grande Do sul, Rio Grande do Sul, Brazil
(Zanini, Da Silveira, Stein) Exercise Cardiology Research Group, Hospital
de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: Patients undergoing coronary artery bypass graft (CABG) surgery
typically experience loss of cardiopulmonary capacity in the
post-operative period. The purpose of this study was to evaluate the
effects of different rehabilitation protocols used in inpatient cardiac
rehabilitation on functional capacity and pulmonary function in patient
status post-CABG surgery. Method(s): This was a single-blind
randomized controlled trial. The primary endpoint of functional capacity
and secondary endpoints of lung capacity and respiratory muscle function
were assessed in patients scheduled to undergo CABG. After surgery, 40
patients were randomly assigned across 1 of 4 inpatient cardiac
rehabilitation groups: G1, inspiratory muscle training, active upper limb
and lower limb exercise training, and early ambulation; G2, same protocol
as G1 without inspiratory muscle training; G3, inspiratory muscle training
alone; and G4, control. All groups received chest physical therapy and
expiratory positive airway pressure. Patients were reassessed on
post-operative day 6 and post-discharge day 30 (including cardiopulmonary
exercise testing). Result(s): The 6-min walk distance on
post-operative day 6 was significantly higher in groups that included
exercise training (G1 and G2), remaining higher at 30 d post-discharge (P
<.001 between groups). Peak oxygen uptake on day 30 was also higher in G1
and G2 (P =.005). All groups achieved similar recovery of lung function.
 Conclusion(s): Protocols G1 and G2, which included a systematic plan
for early ambulation and upper and lower limb exercise, attenuated fitness
losses while in the hospital and significantly enhanced recovery 1 mo
after CABG. Copyright © 2019 Wolters Kluwer Health, Inc.

<45>
Accession Number
629465135
Title
Effect of Cardiac Rehabilitation on Sexual Satisfaction among Patients
after Coronary Artery Bypass Graft Surgery.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. (no pagination),
2019. Date of Publication: 2019.
Author
Rakhshan M.; Toufigh A.; Dehghani A.; Yaktatalab S.
Institution
(Rakhshan, Toufigh, Dehghani, Yaktatalab) Shiraz University of Medical
Sciences, Community Based Psychiatric Care Research Center, Shiraz
71936-13119, Iran, Islamic Republic of
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: After coronary artery bypass graft (CABG) surgery, many patients
experience diminished sexual function and satisfaction. The present study
aimed to investigate the effect of outpatient cardiac rehabilitation (OCR)
on the level of sexual satisfaction among post-CABG patients.
 Method(s): A clinical trial was performed at the Al-Zahra Hospital,
Shiraz, Iran, from July 2017 to January 2018. Based on the inclusion
criteria, 104 post-CABG patients were recruited into the study. The
participants were randomly assigned to the intervention (OCR) group (n =
52) or the usual care group (n = 52). The intervention group received 20
sessions of OCR, whereas the usual care group received the routine
hospital care and education. Data were collected using the Index of Sexual
Satisfaction and a demographic data sheet. The data were analyzed using
the SPSS software, v23.0 (IBM) and the independent sample t test,
paired-samples t test, and chi2 test. Result(s): There was
no statistically significant difference in the mean pre-intervention score
for sexual satisfaction between the groups. However, a statistically
significant difference in the mean post-intervention score for sexual
satisfaction was observed between the groups (P <.001). The difference in
the mean pre- and post-intervention scores for sexual satisfaction in the
intervention group was statistically significant (P <.001), whereas there
was no significant difference in the usual care group. Conclusion(s):
Post-CABG patients who completed the OCR program experienced an increased
level of sexual satisfaction. It is, therefore, recommended to include an
OCR program as part of the patient treatment and aftercare following CABG
surgery. Copyright © 2019 Wolters Kluwer Health, Inc.

<46>
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)

<47>
Accession Number
2000989446
Title
Mini-Stern Trial: A randomized trial comparing mini-sternotomy to full
median sternotomy for aortic valve replacement.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (6) (pp
2124-2132.e31), 2018. Date of Publication: December 2018.
Author
Nair S.K.; Sudarshan C.D.; Thorpe B.S.; Singh J.; Pillay T.; Catarino P.;
Valchanov K.; Codispoti M.; Dunning J.; Abu-Omar Y.; Moorjani N.; Matthews
C.; Freeman C.J.; Fox-Rushby J.A.; Sharples L.D.
Institution
(Nair, Sudarshan, Catarino, Valchanov, Codispoti, Dunning, Abu-Omar,
Moorjani, Matthews, Freeman) Department of Cardiothoracic Surgery,
Papworth Hospital, Cambridge, United Kingdom
(Nair, Pillay) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Thorpe) Leeds Institute of Clinical Trials Research, University of Leeds,
Leeds, United Kingdom
(Singh, Fox-Rushby) Health Economics Research Group, Brunel University
London, London, United Kingdom
(Sharples) London School of Hygiene and Tropical Medicine, Keppel Street,
London, United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Aortic valve replacement (AVR) can be performed either through
full median sternotomy (FS) or upper mini-sternotomy (MS). The Mini-Stern
trial aimed to establish whether MS leads to quicker postoperative
recovery and shorter hospital stay after first-time isolated AVR.
 Method(s): This pragmatic, open-label, parallel randomized controlled
trial (RCT) compared MS with FS for first-time isolated AVR in 2 United
Kingdom National Health Service hospitals. Primary endpoints were duration
of postoperative hospital stay and the time to fitness for discharge from
hospital after AVR, analyzed in the intent-to-treat population.
 Result(s): In this RCT, 222 patients were recruited and randomized (n
= 118 in the MS group; n = 104 in the FS group). Compared with the FS
group, the MS group had a longer hospital length of stay (mean, 9.5 days
vs 8.6 days) and took longer to achieve fitness for discharge home (mean,
8.5 days vs 7.5 days). Adjusting for valve type, sex, and surgeon, hazard
ratios (HRs) from Cox models did not show a statistically significant
effect of MS (relative to FS) on either hospital stay (HR, 0.874; 95%
confidence interval [CI], 0.668-1.143; P =.3246) or time to fitness for
discharge (HR, 0.907; 95% CI, 0.688-1.197; P value =.4914). During a mean
follow-up of 760 days (745 days for the MS group and 777 days for the FS
group), 12 patients (10%) in the MS group and 7 patients (7%) in the FS
group died (HR, 1.871; 95% CI, 0.723-4.844; P =.1966). Average extra cost
for MS was 1714 during the first 12 months after AVR. Conclusion(s):
Compared with FS for AVR, MS did not result in shorter hospital stay,
faster recovery, or improved survival and was not cost-effective. The MS
approach is not superior to FS for performing AVR. Copyright ©
2018 The American Association for Thoracic Surgery

<48>
Accession Number
629475512
Title
Pain rebound in day surgery: How can we avoid it?.
Source
Regional Anesthesia and Pain Medicine. Conference: 38th Annual European
Society of Regional Anesthesia Congress, ESRA 2019. Spain. 44 (10
Supplement 1) (pp A8-A10), 2019. Date of Publication: October 2019.
Author
Bruhn J.
Institution
(Bruhn) Radboud UMC, Anesthesiology, Nijmegen, Netherlands
Publisher
BMJ Publishing Group
Abstract
Pain after ambulatory surgery is an important problem in daily clinical
anesthesia. It is one of the major reasons for readmission. Therefore
steps should be taken to minimize pain after ambulatory surgery. Combining
paracetamol with a NSAID is considered standard practice. Often an opioid
is added. Whereas earlier mostly tramadol was chosen, patients often
complained about dizziness and nausea. Now there is a trend towards
oxycodon. A high oral bioavailability makes it a good choice as a tablet
with a long acting and a fast acting version to choose of or to combine.
This easy application is also a disadvantage with the potential for
inappropriate use also if described postoperatively. This approach of
combining paracetamol with a NSAID and a (weak) opioid is in accordance
with the WHO pain ladder. But unfortunately it does not solve all problems
of postoperative pain management after ambulatory surgery. In the
following, additional options will be described including regional
anesthesia, methadone, enhanced intraoperative multimodal regimens en
enhanced postoperative multimodal regimens. It is important to realise
that one of the main problems is that we are not yet able to reliably
identify the patients with severe postoperative pain after ambulatory
surgery. That makes it more difficult to decide when to go for the
enhanced options (and when not). Regional anesthesia One point of interest
is the prolongation of peripheral nerve blocks in the ambulatory settings.
Addition of substances like dexamethasone or dexmedetomidine have been
described to prolong peripheral nerve blocks. Recently, choosing a
liposomal local anesthetic like liposomal bupivacaine became also an
option. Whereas a single shot technique with additives or with liposomal
bupivacaine is technically the easier option, some centers are working
with catheter techniques also in the ambulatory setting. Elastomeric
disposable pumps, removal of the catheter by the patients themselves and
easy trouble shooting for example via smart apps are important parts of
this approach. When no pure regional anesthesia approach is chosen or
available for a specific surgery, the addition of a regional technique for
improved postoperative analgesia should always be considered. The
infiltration of the incision site with local anesthetics is nearly always
possible. For the ambulatory setting often a very distal technique like
posterior tibial nerve block for foot surgery or a block of the distal
upper limb nerves, i. e. median, radial, ulnar or musculocutaneous nerve
are advantageous and easily learned and performed with ultrasound
guidance. Recently described thoracic wall blocks like PECs block II or
serratus plane block and abdominal wall blocks like quadratus lumborum
block are a welcome addition for ambulatory surgery. The erector spinae
block is a relative simple option (nearly) without the risk of
pneumothorax and can be chosen as a substitute for the traditional
paravertebral block for thoracic wall surgery when the processus
transversus at level Th3/Th4 is targeted or for abdominal surgery when the
processus transversus at level Th7/Th8 is targeted. Historic books about
regional anesthesia like 'Regional Anesthesia (Victor Pauchet's
Technique)' by B. Sherwood- Dunn, 1920, are incredible sources of
inspiration for the dedicated regional anesthesiologist searching for the
re-invention of regional techniques for ambulatory surgery. Methadone
Methadone is a synthetic opioid with unique properties as it combines a
very long-acting pharmacology with acting not only on opioid receptors but
also on NMDA receptors (like e.g. ketamine or magnesium). Whereas it is a
standard part of the care for drug addictives and for chronic pain
patients and it is less known for perioperative analgesia. Due to its long
acting properties, a single bolus at induction is often sufficient.
Problems like cumulation and respiratory depression as described with
repetitive administrations are less a problem (or no problem) with a
single bolus at induction of anesthesia. Whereas a single bolus at
induction of 0,2 mg/kg has been suggested, for ambulatory surgery often a
smaller bolus like 0,1 - 0,15 mg/kg is sufficient. Komen at al. published
the following study very recently in Anesth Analg (2019; 128:802-810):
'Intraoperative methadone in same-day ambulatory surgery: A randomized,
doubleblinded, dose-finding pilot study.' They concluded: 'In sameday
discharge surgery, this pilot study identified a single intraoperative
dose of methadone (0,15 mg/kg ideal body weight), which decreased
intraoperative and postoperative opioid requirements and postoperative
pain, compared with conventional intermittent short-duration opioids, with
similar side effects.' Interestingly they found also a very long-lasting
effect: in the 30 days after discharge patients who received methadone
0,15 mg/kg had less pain at rest and used fewer opioid pills than
controls. Enhanced intraoperative multimodal regimen Gabapentinoids,
dexamethasone, ketamine and magnesium are seen as common parts of an
enhanced intraoperative multimodal regimen. For ambulatory surgery, some
anesthesiologists are relatively reluctant concerning gabapentinoids as
dizziness and sedation are common (unwanted) side effects which are
especially unwanted in ambulatory patients. Dexamethasone has been
described to prolong peripheral nerve blocks (not only if applied
perineurally but also if applied intravenously) and reduce pain scores
after spinal anesthesia. As multimodal analgetic component a dose of 0,1
mg/kg has been recommended. Therefore, for this purpose a standard dose of
4 or 5 mg dexamethasone as used for PONV prophylaxis is not sufficient.
Due to its action on the NMDA receptor, ketamine is traditionally part of
many multimodal analgetic regimens. Discussions remain about the optimal
dose. The actual 2018 Cochrane review 'Perioperative intravenous ketamine
for acute postoperative pain in adults' states: 'No analysis by dose was
possible.' In contrast, a previous version of this Cochrane review stated:
'Interestingly there seemed to be no increased morphine-sparing effect on
increasing the ketamine dose above an estimated dose of 30 mg/24 hours.'
Therefore a reasonable dosing in ambulatory patients may be to limit the
ketamine dose to 30 mg racemic ketamine or 15 mg esketamine. As there are
doubts in the literature about the effectivity of a single bolus ketamine,
some anesthesiologists split this amount of ketamine in two parts, giving
one part at induction and one part e.g. 30 minutes after incision.
Interestingly, for depressive patients this ketamine dose has been shown
to have a mood enhancing effect. Magnesium iv has been less often used in
the past. But there is evidence for its analgetic properties as magnesium
is also acting on the NMDA receptor. Commonly a dosing scheme with a bolus
of 40-50 mg/kg (given over about 15 minutes) followed by a continuous
infusion has been used. Avoiding hypomagnesemia which is often present
after surgery seems to be correlated with lower postoperative pain.
Therefore in ambulatory surgery simplified dosing schemes with a single
bolus of 2g magnesium administered in the infusion drip chamber may be
sufficient. For abdominal surgery infusion scheme of lidocaine iv has been
described for better postoperative analgesia. This can be used for many
laparoscopic surgeries which are done as ambulatory surgery. 1,5 mg/kg
slow bolus lidocaine iv followed by 1,5 mg/kg/h seems to be a reasonable
dosing scheme. Esmolol as a short acting beta blocker has been described
to lower postoperative pain scores. Whereas it is possible to perform
opioid free ambulatory anesthesia with esmolol, mostly esmolol is combined
with low-dose opioids for more stable anesthesia. Whereas the above named
components are easily introduced in clinical practice, the use and dosing
of esmolol demand a bit more attention and experience of the
anesthesiologist. Enhanced postoperative multimodal regimens Interestingly
most of the above named concepts are tailored to intraoperative not to
postoperative use. This connects to the above stated sentences: 'It is
important to realise that one of the main problems is that we are not yet
able to reliably identify the patients with severe postoperative pain
after ambulatory surgery. That makes it more difficult to decide when to
go for the enhanced options (and when not).' For example, when the
ambulatory patients awake with severe postoperative pain, it is too late
for intraoperative use of esmolol of lidocaine iv (and iv application of
ketamine (psychomimetic effects) or magnesium (local pain or global
feeling of body heat) are not always appreciated by the patients).
Interestingly, recent studies have shown a significant analgetic effect of
dexamethasone repeated on day 1 (or even day 1 and 2) postoperatively.
Therefore it may be an option to discharge the patient with a 20 mg
(taking in account the lesser oral bioavailability) tablet of dexamethason
to be taken if severe postoperative pain appears to be present at home.
Recently, there also arose an increasing interest in antioxidative
substances, like vitamine C, as a postoperative analgetic additives, which
can also be easily administered orally at home (eg. in a single dose of 2
g).

<49>
Accession Number
629475484
Title
What's new about paraspinal techniques?.
Source
Regional Anesthesia and Pain Medicine. Conference: 38th Annual European
Society of Regional Anesthesia Congress, ESRA 2019. Spain. 44 (10
Supplement 1) (pp A58-A60), 2019. Date of Publication: October 2019.
Author
Raft J.
Institution
(Raft) Institut De Cancerologie De Lorraine, Anesthesiology, Nancy, France
Publisher
BMJ Publishing Group
Abstract
Thoracic epidural analgesia (TEA) and paravertebral block (PVB) were still
the gold standards for postoperative analgesia after thoracic and
abdominal surgeries. Techniques of TEA and PVB changed to become safer
with less failures thanks to ultrasounds. the increased of ultrasound use,
permitted the anesthesiologists to explore the paraspinal anatomy. Since a
couple of years, appeared new paraspinal techniques. It involves
injections into the musculofascial plane. All these interfascial plane
blocks have shown promise as an alternative to neuraxial blockade for a
variety of surgeries with good effects. In addition, these blocks have a
reduced risk of direct spinal cord injury, epidural hematoma, and central
infection. the site of injection is distant from neuraxis and pleura.
These new paraspinal blocks become more and more popular because they are
easy to perform. This short review will explore all these new paraspinal
techniques. Between the transverse process and the paravertebral space,
the costovertebral ligament do not performed a closed border. Costache and
al. aimed to place the needle tip at the midpoint between the transverse
process and pleura.1 on cadavers, the presence of methylene blue dye in
the paravertebral space was examined because of the presence of a gap
between the medial and lateral portions of the costovertebral ligament.
Case reports confirmed the analgesic effect of this injection. the name of
this regional analgesia is the mid-point transverse process to pleura
(MTP) block. the injection posterior to the costovertebral ligament will
result in solution passing through gaps and fenestrations, and reaching
the nerve root in the paravertebral space. So pleural displacement may not
always be necessary for paravertebral spread, as evident with other
paraspinal blocks: the retrolaminar (RLB), the erector spinae plane (ESP)
and the paraspinal blocks. the injectate distribution from these
paraspinal blocks to the paravertebral space is volume dependent,
suggesting that high volumes would be required to achieve effective
regional anesthesia and analgesia that would be consistent with PVB.2
Thoracic paravertebral block has complications: epidural spread (2.1%),
Horner's syndrome (1.8%), vascular puncture (0.5%), convulsions (0.2%) and
pneumothorax (0.1%).3 These paraspinal blocks seem to be safer because of
the placement of the needle tip within a few millimetres or centimeters of
the pleura and the intervertebral foramen. The retrolaminar block is the
most posterior and medial block. the injection of local anesthetic is
performing just behind the lamina. the indication of this block has to be
specified. a retrolaminar block has been reported to be an effective
analgesic method for breast cancer surgery: 15 ml of 0.5% ropivacaine for
each lamina of the T2 and T4 vertebrae versus placebo reduce pain score
immediatly after surgery4 or 20mL of 0.375% levobupivacaine at T4 lamina
and a continuous infusion with 4 ml/h of 0.25% levobupivacaine for 72h.5
the other surgeries reported for this block were at the thoracic level or
on vertebra: thoracic lobectomy,6 transapical transcatheter aortic valve
implantation,7 and acute lumbar trauma.8 However, the use of a bilateral
retrolaminar block for lumbar vertebral surgery has been successfully
reported in 2017.9 Lumbar laminoplasty of L2 to L4 with a bilateral
retrolaminar block performed with 0.375% levobupivacaine (20 mL injected
into each side, 40 mL total) injected into the bilateral dorsal space of
the fourth thoracic spinous process. No additional analgesics were
administered during the perioperative period. This study suggests that a
retrolaminar block can block the posterior rami of the lumbar nerves. a
bilateral retrolaminar block was an effective analgesic for lumbar
vertebral surgery.9 Bilateral block seems to be necessary despite
unilateral surgery because of the existence of cross over innervation near
the midline.10 Currently, the most popular paraspinal block is the ESP
block. More than 242 case reports were actually published.11 Forero M et
al described this novel technique in 2016.12 the ultrasound-guided ESP
block is a recently developed procedure for providing extensive truncal
analgesia.12 the procedure is relatively easier to perform and
noninvasive, compared to thoracic paravertebral block and thoracic
epidural analgesia. the patient is placed in a sitting position and
ultrasound is used to identify the chosen transverse process by counting
down from the first rib. the transducer is placed in a longitudinal
parasagittal orientation to identify the tip of the transverse process
deep to the overlying muscles. a needle is inserted in plane to the US
beam in a caudal-to-cranial direction to place the needle tip between the
posterior fascia of the erector spinae muscle and the chosen transverse
process. This is verified by hydrodissection with 0.5-1 mL of normal
saline and visualization of linear fluid spread deep to the erector spinae
muscle following which local anesthesics can be injected. the ESP block is
a recently described, easy and reliable superficial block that targets the
posterior part of the transverse process and the erector spinae muscle.12
the ESP block seems to be a simple alternative to the conventional
paravertebral and neuraxial blocks. the easily identifiable landmarks make
this block a good novel regional anesthetic technique. a catheter can be
insert easily in this interfascial space. ESP was described and used for
several adult and pediatric indications: thoracic neuropathic pain,12
analgesia for thoracic surgery,13 14 analgesia for rib fractures,15
vertebra surgery,16 17 breast surgery,18-20 analgesia for chronic shoulder
pain,21 major open abdominal surgery (open radical cystoprostatectomy with
ureter and neobladder reconstruction),22 bariatric surgery,23 laparoscopic
ventral hernia repair24 and hip analgesia: total hip arthroplasty.25 More
laterally of the paravertebral space, a paraspinal block can be
performed.26 the injection of local anesthetics is perform between the
extrathoracic fascia and paraspinal muscles near the T3/T4 spinous
process. the needle advanced craniocaudally towards the lower ribs to
provide maximal diffusion. 26 Paraspinal block do not have lots of
evaluation but this block could be comparable as a lateral ESP block. More
lateraly on the body, limit between a para-spinal and a thoracic block,
the rhomboid intercostal block can be performed by an injection between
the rhomboid major and intercostal muscles at the T6-7 level.27 At last,
an injection of local anesthetic in the fascial plane between the
multifidus and longissimus muscles of the thoracolumbar spine can be
performed: the thoraco-lumbar interfascial plane (TLIP) block.28 For
memory, erector spinae muscules are composed from median to lateral by 3
parts: multifidus, longissimus thoracis, and iliocostalis. the dorsal
ramus emerges at junction between superior articular process and
transverse process and splits into 3 branches (medial, intermediate, and
lateral). TLIP block targets the sensory component of the dorsal rami of
the thoracolumbar nerves. TLIP is reported for the treatment of
postoperative pain after spine surgery. Some modified technique can be
described with an other injection between the longissimus and iliocostalis
muscles.29 An injection superficial to the posterior thoracolumbar fascia
(investing the paraspinal muscles) will probably ensure subcutaneous
blockade. Randomized controlled trials are needed to valid the
indications. At the cervical level, different para-spinous blocks are
described. They are performed for cervical spinal surgery because of
blocking the dorsal rami of the cervical spinal nerves. the
inter-semispinal plane (ISP) block involves injection of local anesthetic
into the fascial plane between the semispinalis cervicis and semispinalis
capitis muscles.30 the multifidus cervicis plane (MCP) is the fascial
plane block between the multifidus cervicis and semispinalis cervicis
muscles.31 the cervical interfascial plane (CIP) block need an anesthetic
injection between the multifidus and longissimus muscles.32 In conclusion,
it is well kown that TEA and PVB are technically challenging procedures
and are associated with a significant failure rate. In contrast, the
para-spinal blocks are novel alternatives. They are simpler and safer to
perform. But there is a paucity of controlled clinical trials, yet an
abundance of case reports. Randomized controlled trials are needed to
valid all these good experiences described in case reports. ESP still
actually the most described para-spinal block.

<50>
Accession Number
629475392
Title
Interest of preoperative parasternal blockin patients undergoing coronary
artery bypass surgery.
Source
Regional Anesthesia and Pain Medicine. Conference: 38th Annual European
Society of Regional Anesthesia Congress, ESRA 2019. Spain. 44 (10
Supplement 1) (pp A109-A110), 2019. Date of Publication: October 2019.
Author
Bloc S.; Naudin C.; Merzoug M.; Gibert H.; Law Koune J.D.; Burg Y.;
Leclerc D.; Vuitton A.S.; Waldmann T.; Grinda J.M.; Vistarini N.; Aubert
S.; Squara P.
Institution
(Bloc, Gibert, Law Koune, Burg, Leclerc, Vuitton) CMC Ambroise Pare,
Anaesthesiology Department, Neuilly-sur-Seine, France
(Naudin, Merzoug) CMC Ambroise Pare, Clinical Research Department,
Neuilly-sur-Seine, France
(Waldmann, Grinda, Vistarini, Aubert) CMC Ambroise Pare, Cardiac Surgery
Department, Neuilly-sur-Seine, France
(Squara) CMC Ambroise Pare, Critical Care Medicine Department,
Neuilly-sur-Seine, France
Publisher
BMJ Publishing Group
Abstract
Background and aims Sternotomy for coronary artery bypass surgery is
associated with episodes of hypertension and tachycardia despite adequate
level of anaesthesia, thus increasing the risk of myocardial ischemia.
This study was designed to assess the effect of preoperative parasternal
block (PSB) on anaesthetic agents consumption required to maintain
hemodynamic stability during sternotomy. Methods After approval of the
Ethics Committee and written informed consent, 20 patients were enrolled
in this prospective, randomized, double-blind study. Aneasthesia was
induced with Propofol and Remifentanil using target-controlled infusion,
guided by the patient state index (PSI25-50) and the hemodynamic response:
blood pressure (BP) and heart rate (HR). Block was performed under
ultrasound with 60 ml of 0.25% Ropivacaine (Group PSB) or normal saline
(Group CTL), divided into 4 injections (2 per side of the sternum),
between the pectoralis major and intercostal muscles. Maximal dose of
Remifentanil and Propofol used to maintain the hemodynamic stability
during sternotomy were measured. Halogenated anaesthetic requirement was
noted. BP, HR, and PSI were measured every minute until 5 minutes after
the retractor placement. Mann-Whitney test was used to analyze
quantitative variables and Fisher's-exact test for categorical variables.
Results Demographic data are presented in table 1. PSB significantly
reduced consumption of anaesthetic agents during sternotomy, including the
use of halogens and maintained PSI in higher values (table 2). No
difference was observed regarding postoperative complications. Conclusions
Preoperative PSB prevents hemodynamic instability during sternotomy,
without increasing anaesthetic agent consumption. It allows a better
stability of anaesthesia depth. Its impact on postoperative pain should be
assessed. (Table Presented).

<51>
Accession Number
629475354
Title
Dexmedetomidine: Its role in the perioperative setting.
Source
Regional Anesthesia and Pain Medicine. Conference: 38th Annual European
Society of Regional Anesthesia Congress, ESRA 2019. Spain. 44 (10
Supplement 1) (pp A66-A68), 2019. Date of Publication: October 2019.
Author
Moka E.; Theodoraki K.; Siafaka I.; Vadalouca A.
Institution
(Moka) Creta InterClinic Hospital, Anaesthesiology Department, Heraklion,
Crete, Greece
(Theodoraki, Siafaka, Vadalouca) Aretaieion University Hospital, A'
Anaesthesiology Clinic, Pain Relief and Palliative Care Centre, Athens,
Greece
Publisher
BMJ Publishing Group
Abstract
Many nociceptive, inflammatory, and neuropathic pathways contribute to
perioperative pain. Although opioids have long been a mainstay for
perioperative analgesia, other non-opioid molecules, including
dexmedetomidine, have been increasingly used as part of a multimodal
analgesic plan to provide improved postoperative pain control, while
minimizing opioidrelated side effects. Dexmedetomidine (DEX) is an alpha-2
adrenergic receptor agonist that can be directly applied to the peripheral
nervous system, causing a dose-dependent inhibition of C- and Aafibers.
Alpha-2 adrenergic receptors act on the locus ceruleus area, inhibiting
nociceptive neurotransmission, through the posterior horn of the spinal
cord. Alpha-2 adrenergic receptors also act on the presynaptic membrane,
inhibiting the release of norepinephrine, which in turn induces
hyperpolarization and inhibits the pain signals to the brain. Moreover,
DEX promotes the release of acetylcholine from spinal interneurons; the
resulting increased synthesis and release of nitric oxide could be
involved in the regulation of analgesia. as such, DEX could be effectively
applied for preoperative, intraoperative, and postoperative analgesia (iv,
spinal canal, and nerve blocks). While there have not been any large-scale
clinical trials conducted, the current body of evidence suggests that DEX
is suitable for use as an adjuvant analgesic at all perioperative stages,
keeping in mind its potential adverse effects, such as hypotension and
bradycardia, which must be taken into consideration by clinicians.
Preoperative Dexmedetomidine Utilization Dexmedetomidine can be
administered intravenously, intramuscularly, orally, buccally, and
intranasally, in the preoperative setting. Buccal and intranasal
administration have a high bioavailability and are more easily tolerated
by patients due to noninvasiveness, making it an excellent choice for
preoperative premedication in children. Intranasal DEX 1 mg/kg and 0.2
mg/kg midazolam, approximately 45-60 min before the induction of pediatric
tonsillectomy and complete dental rehabilitation, resulted in the same
sedation, with DEX markedly reducing the required dosage of postoperative
analgesia drugs, suggesting that its preoperative administration reduces
early postoperative pain in children and has a relatively prolonged
duration as an adjuvant analgesic. In paediatric population, intranasal
DEX (2 mg/kg) during myringotomy and pressure-equalizing tube placement
reduced the need for additional analgesics, as well as perioperative pain
levels. However, increasing the intranasal dose of DEX to 2 mg/kg led to a
prolonged postoperative recovery time. Thus, the dose of intranasal DEX
should not be more than 2 mg/kg during short procedures in children.
Intraoperative Dexmedetomidine: Intravenous Administration High doses of
opioids (eg remifentanil) may induce hyperalgesia, which presents as a
decreased mechanical hyperalgesia threshold, enhanced pain intensity, a
shorter time to first postoperative analgesic requirement, and greater
opioid consumption. An initial intravenous dose of DEX (1.0 mg/kg) in 10
min, followed by a continuous infusion of up to 0.7 mg/kg/h approximately
15 min before the induction of general anesthesia, may be a novel and
effective treatment option for preventing or attenuating opioid-induced
hyperalgesia. Some studies results reported that DEX led to a decreased
requirement for opioid analgesics and inhaled anesthetics, and lessened
the incidence of severe cardiovascular changes during traumatic phases of
surgeries. In thoracic surgery, patients given DEX at a loading dose of 1
mg/kg for 10 min, followed by continuous infusion at 0.5 mg/kg/h until 30
min before the end of surgery, exhibited reduced resting and coughing
numerical rating scale scores and a sufentanil-sparing effect during the
first 24 h. Premedication with a single intravenous dose of 0.5 mg/kg DEX
decreased the intraoperative propofol and postoperative analgesic
requirements, and increased the postoperative satisfaction and Ramsay
sedation scale scores considerably in patients undergoing direct
laryngoscopic biopsy under total intravenous anesthesia. Additionally, it
has been found that sensory block duration was prolonged by at least 34%,
motor block duration was prolonged by at least 17%, and time to first
analgesic request was increased by at least 53% when intravenous DEX was
administered with spinal anesthesia. Further, its use was associated with
a 3.7-fold increase in transient reversible bradycardia. Intravenous
dexmedetomidine with a single-injection interscalene brachial plexus block
for outpatient shoulder surgery reduced the pain and opioid consumption
for up to 8 h postoperatively, without prolonging motor blockade, possibly
being related to the central sedative and analgesic effects, and
sensitization of the nervous system produced by the excited alpha-2
adrenergic receptor. DEX can be an effective baseline anaesthetic adjuvant
for patients undergoing locoregional anesthesia for a broad range of
surgical procedures, providing better patient satisfaction, lower opioid
requirements, and less respiratory depression than placebo rescued with
midazolam and fentanyl. Further, common adverse events associated with
DEX, such as bradycardia and hypotension, are predominately mild to
moderate in severity. Intraoperative Dexmedetomidine Administration:
Progress of Spinal Analgesia Patients, undergoing lower limb vascular
surgery under lumbar epidural anesthesia (15 mL of levobupivacaine with
0.5 mg/kg DEX) exhibited a longer time to twosegment regression and total
regression, compared to patients who received levobupivacaine and racemic
bupivacaine alone. Nevertheless, DEX caused significant bradycardia, that
required treatment. Epidural administration of 15 mL of 0.5% isobaric
bupivacaine with 1 mg/kg DEX provided superior early onset of analgesia,
superior intraoperative analgesia, stable cardio-respiratory parameters,
prolonged postoperative analgesia, and increased patient comfort, compared
to 15 mL of 0.5% isobaric bupivacaine with 2 mg/kg clonidine in patients
undergoing lower limb orthopedic surgery. Intrathecal administration of 15
mg of 0.5% isobaric bupivacaine with 5 mg of DEX provided earlier onset of
sensory and motor block with longer duration of analgesia and haemodynamic
stability, compared to bupivacaine alone, in patients undergoing
infraumbilical surgeries. In paediatric population, 1 mg/kg DEX, as an
adjuvant to 1 mL/kg of 0.25% bupivacaine in caudal analgesia in patients,
aged 2-10 years, undergoing infraumbilical surgeries, resulted in an
increased duration of caudal analgesia and improved hemodynamic stability
without an increase in adverse effects. Intraoperative Dexmedetomidine
Administration: Progress of Peripheral Nerve Block Analgesia A randomized,
paired, triple- blind trial in 21 healthy volunteers who received
bilateral saphenous nerve blocks with 20 mL of 0.5% ropivacaine and 1 mL
of 100 mg/ml DEX in one thigh, and 20 mL of 0.5% ropivacaine and 1 mL of
saline in the contralateral thigh showed that DEX prolonged the saphenous
nerve block by a peripheral mechanism, but not necessarily to a clinically
relevant extent. In another prospective, randomized, controlled,
double-blind, crossover trial, 14 healthy volunteers received an
ultrasound-guided tibial nerve block with a 10 mL solution containing 0.5%
ropivacaine with 1 mg/kg DEX. the addition of DEX prolonged the duration
of sensory blockade, without affecting onset time. Forty-five patients
undergoing arthroscopic knee surgery received ultrasound-guided femoral
nerve block with 25 mL of 0.5% bupivacaine combined with 25 mg, 50 mg, or
75 mg of DEX before the induction of general aneasthesia. the addition of
50 mg and 75 mg of DEX reduced the onset time, extended the duration of
block, prolonged the time to the first postoperative request for rescue
analgesia, and reduced postoperative morphine requirements. the 75 mg dose
had the best analgesic profile, but was associated with an increased risk
of hypotension. a study using DEX 100 mg as an adjuvant to 0.5%
bupivacaine in ultrasound-guided combined femoral-sciatic nerve block in
30 patients undergoing below-knee surgery found a prolonged duration of
analgesia. However, these patients also experienced significant
bradycardia. In another study of 31 patients undergoing elective shoulder
surgery under general anaesthesia with an interscalene block, adding 150
mg DEX to 0.5% ropivacaine increased the duration of the nerve block and
improved postoperative pain. However, DEX dexreased heart rate, without
influencing the blood pressure. a 79- year-old man with multiple cerebral
infarcts, congestive heart failure, atrial flutter, and syncope was
treated with an above-knee amputation under lumbar plexus and sciatic
nerve block with the addition of 1 mg DEX to 0.33% ropivacaine. Complete
nerve block was maintained for the full duration of the surgery, and
analgesia was maintained for 26 h with haemodynamic stability and moderate
sedation.

<52>
Accession Number
629475235
Title
Ketamine for pain: Complications and best practice.
Source
Regional Anesthesia and Pain Medicine. Conference: 38th Annual European
Society of Regional Anesthesia Congress, ESRA 2019. Spain. 44 (10
Supplement 1) (pp A52-A53), 2019. Date of Publication: October 2019.
Author
Saricaoglu F.
Institution
(Saricaoglu) Hacettepe University, Department of Anesthesiology and
Reanimation, Ankara, Turkey
Publisher
BMJ Publishing Group
Abstract
Ketamine is an anaesthetic drug discovered in the 1960s, it is known to
produce a dissociative state with sedation, amnesia, and analgesia.
Currently, ketamine is being actively studied for potential use in acute
and chronic pain conditions. The principle pharmacological action of
ketamine is NMDA receptor antagonism. Given the role of NMDA receptor in
nociceptive signaling, it is reasonable to postulate that ketamine
possesses analgesic properties. Acute pain procedures Most studies
evaluating ketamine in an acute pain setting have focused on the
perioperative environment and a few other specific painful disease states,
such as sickle cell pain crises. For patients outside the perioperative
setting, evidence is limited to mostly case reports. the evidence suggests
that most patients who benefit from ketamine in the acute pain setting
fall into several categories. the first group of patients is those who are
undergoing painful surgery, after which the expected postoperative pain
rating is considered to be in the severe range. Examples of surgical
procedures in which the benefits seem to be the greatest include upper
abdominal surgery and thoracic surgery; orthopedic limb, spine,
intra-abdominal, and lower abdominal procedures also appear to be painful
enough to warrant consideration of ketamine. Opioid-tolerant and
opioid-dependent patients are frequently cited as groups that should
receive ketamine, primarily because it makes conceptual sense given the
role of the NMDA receptor in hyperalgesia and opioid tolerance. Evidence
for ketamine in acute painful exacerbations of chronic diseases such as
sickle cell disease and nonoperative trauma (eg, rib fractures) is limited
to mostly case reports and small case series. Studies have shown that
perioperative ketamine use for more than 24 h has a modest but
statistically significant reduction in the incidence of persistent
post-surgical pain at 3 months after operation. Such beneficial effects
were observed at 6 months but not 12 months after surgery. Nonparenteral
ketamine, especially intranasal ketamine (IN) that got the FDA approval
very recently, is likely to continue to increase in use for acute
exacerbations of chronic pain conditions. Chronic pain procedures For
spinal cord injury pain, there is weak evidence supporting ketamine
infusions (0.42 mg/kg per hour to 0.4 mg/kg ranging from 17 minutes to 5
hours for 7 consecutive days) for short-term improvements in pain. For
CRPS, there is moderate evidence supporting ketamine infusions (22 mg/h
for 4 days or 0.35 mg/kg per hour over 4 hours daily for 10 days) to
provide improvements in pain for up to 12 weeks. For mixed neuropathic
pain, PLP, PHN, fibromyalgia, cancer pain, ischemic pain, migraine
headache, and low-back pain, there was weak or no evidence supporting
ketamine infusions for immediate improvements in pain. Excluding CRPS,
there was no evidence supporting ketamine infusions for intermediate or
long-term improvements in pain. Ketamine is often considered in management
of these refractory cancer pain, although current evidence is insufficient
to allow any conclusion on its effectiveness.S mall randomized controlled
trials (RCTs) were able to show that addition of ketamine improves the
effectiveness of morphine. There are also case reports showing effective
analgesia in refractory cancer-related neuropathic pain using intrathecal
ketamine infusions, even though the safety profile and potential
neurotoxicity is not clear. Adverse effects and pathophysiology
Cardiovascular and Pulmonary Effects: Reviews have noted that ketamine has
both a negative inotropic effect and simultaneous indirect sympathetic
nervous system stimulation, which is due to systemic release of
catecholamines, vagal nerve inhibition, inhibition of norepinephrine
reuptake at peripheral nerves, and other mechanisms. In the pulmonary
system, ketamine causes bronchodilation that appears to be due to
circulating catecholamines. Pharyngeal and laryngeal reflexes are mostly
preserved, as is respiratory function, and there are increased secretions.
Spinal Cord Effects: Several studies in animals suggest that ketamine may
cause pathological changes when given intrathecally. Currently, the use of
intrathecal ketamine is listed as a sixth-line adjuvant to be used in
conjunction with other neuraxial analgesics in individuals with refractory
cancer or other terminal chronic pain conditions. Psychomimetic Adverse
Effects: Reviews and meta-analyses of perioperative ketamine have come to
different conclusions regarding ketamine's adverse psychomimetic effects
including hallucinations, visual disturbances, unpleasant dreams, and
dysphoria, when it is used in subanesthetic doses. Hepatic, Genitourinary,
and Gastrointestinal Effects: There are few studies that directly address
the issues of hepatotoxicity and cystitis with subanesthetic ketamine use.
Data must be extrapolated from animal studies and studies in ketamine
abusers. In humans, the incidence of hepatotoxicity and cystitis may be
increased with higher doses and repeated exposure, although liver enzyme
levels return to normal after discontinuation of the drug.
Ketamine-induced cystitis has been documented primarily in abusers of
ketamine. It typically presents as painful hematuria, dysuria, frequency,
and postmicturition pain. Treatment begins with cessation of ketamine use
and may also consist of mucosal protective agents such as hyaluronic acid
or anticholinergic drugs. More severe disease may require surgical
intervention. From a clinical practice perspective, oral ketamine has
significant abuse potential and a high street value. For these reasons, in
patients with a history of abuse or who are at high risk of abuse, the
risks of prescribing it chronically in a community-based setting should be
weighed against the potential benefits, and proper surveillance, similar
to what is done for patients on chronic opioid therapy, should be used.
More research should also be conducted regarding the long-term effects of
ketamine. The use of ketamine has skyrocketed for chronic pain and
depression, but many questions remain unanswered. In conclusion, despite
its drawbacks, ketamine remains a powerful and inexpensive tool for
practitioners who manage acute pain. We believe its use will continue to
expand as more institutions treat increasingly challenging patients in the
perioperative period as well as those with painful disease exacerbations
while trying to combat the opioid epidemic. More research is needed to
refine selection criteria for the treatment of acute pain and possible
prevention of chronic pain, to determine the ideal dosing and treatment
regimen to include coadministration of ketamine with opioids and
adjuvants, and to better understand the long-term risks of ketamine in
patients who receive serial treatments for frequent acute pain
exacerbations.

<53>
Accession Number
629475222
Title
Ultrasound-guided bilateral erector spinae plane block versus intrathecal
morphine for analgesia in living donors for liver transplantation: A
randomized non-inferiority trial.
Source
Regional Anesthesia and Pain Medicine. Conference: 38th Annual European
Society of Regional Anesthesia Congress, ESRA 2019. Spain. 44 (10
Supplement 1) (pp A122), 2019. Date of Publication: October 2019.
Author
Kang R.A.; Choi D.H.; Ko J.S.; Park S.J.; Kim J.S.; Han Bum J.
Institution
(Kang, Choi, Ko, Park) Samsung Medical Center, Anesthesiology and Pain
Medicine, Seoul, South Korea
(Kim, Han Bum) Ajou University School of Medicine, Anesthesiology and Pain
Medicine, Suwon, South Korea
Publisher
BMJ Publishing Group
Abstract
Background and aims Preoperative intrathecal morphine (ITM) is an
effective analgesic method for living liver donors after open hepatectomy,
but there is several complications. the erector spinae plane (ESP) block
has been reported to provide adequate postoperative analgesia in both
thoracic and abdominal surgeries. We compared the postoperative analgesic
efficacy of ESP block to ITM after laparoscopic living donor right
hemihepatectomy. Methods 54 living donors scheduled for laparoscopic right
hemihepatectomy were randomly assigned to one of two groups: an ESP group
(n=27) and an ITM group (n=27). Donors in the ESP group received
preoperative ultrasoundguided bilateral ESP blocks at the level of T8
transverse process with an injection of local anesthetic (20 ml of 0.5%
ropivacaine with 1:200,000 epinephrine for each side). Donors in the ITM
group received an intrathecal injection of morphine sulfate (400 mg)
preoperatively. the primary outcome was the degree of analgesia assessed
by 11-point numeric rating scale pain scores at 24 hours after surgery.
the predetermined noninferiority limit was 1. Results The mean pain score
at 24 hours postoperatively was 2.5+/-1.0 for ESP group and 1.3+/-1.1 for
ITM group. the mean treatment difference (ESP-ITM) in pain score at 24
hours was 1.22 (95% CI: 0.66 to 1.79), and the upper limit of the 95% CI
(1.79) was higher than the pre-specified non-inferiority margin (d=1),
indicating ESP was inferior to ITM. Conclusions Ultrasound-guided
bilateral ESP block may provide adequate postoperative pain control after
living liver donor hepatectomy, but it showed comparably less analgesic
efficacy than that of ITM during the first 24 hours.

<54>
Accession Number
629475167
Title
Comparison of ultrasound-guided erector spinae plane block and thoracic
paravertebral block for postoperative analgesia after video-assisted
thoracic surgery: A prospective randomized noninferiority trial.
Source
Regional Anesthesia and Pain Medicine. Conference: 38th Annual European
Society of Regional Anesthesia Congress, ESRA 2019. Spain. 44 (10
Supplement 1) (pp A129), 2019. Date of Publication: October 2019.
Author
Taketa Y.; Fujitani T.
Institution
(Taketa, Fujitani) Ehime Prefectural Central Hospital, Department of
Anesthesiology and Critical Care, Matsuyama, Japan
Publisher
BMJ Publishing Group
Abstract
Background and aims The anesthetic characteristics of ultrasound-guided
erector spinae plane block (ESPB) remain unclear. We conducted a study to
clarify the analgesic efficacy of ESPB compared to that of thoracic
paravertebral block (TPVB) for postoperative analgesia in video-assisted
thoracic surgery (VATS). Methods This study was a prospective randomized
non-inferiority trial approved by the Institutional Review Board of Ehime
Prefectural Central Hospital (No. 29-84, 02/03/2018). 88 patients
scheduled for VATS were randomly allocated to either an ESPB or a TPVB
group. Patients in both groups received continuous infusion of 0.2%
levobupivacaine (8 mL/ hour) after 20 mL of 0.2% levobupivacaine bolus
injection. the primary outcome was postoperative numerical pain rating
score (NRS) at rest 24 hours postoperatively, with a maximum acceptable
difference (non-inferiority margin) between the groups in as 0.5. We also
evaluated NRS during movement, amount of rescue fentanyl used, and the
number of anesthetized dermatomes. Results 81 patients completed the
study. NRS at rest was significantly lower in the TPVB group at 1, 2, and
24 hours postoperatively (respective p values = 0.018, 0.008, and 0.030).
There were no significant differences in NRS during movement. the median
difference in NRS at rest 24 hours postoperatively was 1 (range 0-1),
which failed to demonstrate non-inferiority. the number of anesthetized
dermatomes at parasternal regions was significantly greater in the TPVB
group (p < 0.0001). There were no statistically significant differences in
rescue fentanyl use. Conclusions This study suggests that the analgesic
effect of ESPB for VATS was not equivalent compared to TPVB 24 hours
postoperatively.

<55>
Accession Number
629468965
Title
The feasibility, safety and impact of a prehabilitation program for
patients undergoing cystectomy.
Source
Journal of Urology. Conference: American Urological Association Annual
Meeting, AUA 2019. United States. 201 (4 Supplement 1) (pp e926-e927),
2019. Date of Publication: April 2019.
Author
Kaye D.R.; Thelen-Perry S.; Schafer C.; Qin Y.; Reger H.I.; Parker C.;
Kaffenberg S.; Herrel L.; Morgan T.; Weizer A.; Hafez K.; Montgomery J.S.
Institution
(Kaye, Thelen-Perry, Schafer, Qin, Reger, Parker, Kaffenberg, Herrel,
Morgan, Weizer, Hafez, Montgomery) Ann ArborMIUnited States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION AND OBJECTIVES: Cystectomy patients are often elderly and
frail. As a result, they experience high complications rates, frequent
readmissions, poor quality of life (QOL) and require substantial medical
resources. Strategies to improve outcomes and expand patient eligibility
for cystectomy are lacking. Herein, we prospectively evaluate the
feasibility, safety and impact of a prehabilitation program for patients
undergoing cystectomy for bladder cancer. METHOD(S): This phase I/II
study accrued patients >60 years old from 03/2013-10/2017 with
biopsy-proven bladder cancer, Karnofsky performance score >70 and a
sedentary baseline lifestyle. All subjects were prescribed a 4 week (3
sessions per week) supervised, escalating pre-operative strength and
cardiovascular exercise training program. Primary outcomes were
feasibility and safety; secondary outcomes included changes in functional
fitness, patient-reported QOL, peri-operative complications and
readmissions. RESULT(S): Fifty-four patients enrolled in the program,
completing 85.7% (SD 20.7%) of the prescribed exercise sessions. There
were no adverse events. Functional fitness and patient-reported QOL
improved post-intervention, with sustained improvements in general and
mental health 90-days post-surgery (Table 1, Figure 1). The 90-day
complication rate was 43%; the readmission rate was 20% which is not
statistically decreased when compared to our historic cohort (29%,
p=0.14). CONCLUSION(S): Prehabilitation prior to cystectomy is
feasible, safe, and results in marked improvements in patient strength and
sustained improvements in patient-reported QOL from baseline. There was an
encouraging trend toward decreased readmissions but this did not reach
statistical significance. Efforts to further evaluate the impact of
prehabilitation in this population in an expanded and randomized fashion
are warranted.

<56>
Accession Number
629472081
Title
Safety and efficacy of a self-expanding versus a balloon-expandable
bioprosthesis for transcatheter aortic valve replacement in patients with
symptomatic severe aortic stenosis: a randomised non-inferiority trial.
Source
Lancet (London, England). (no pagination), 2019. Date of Publication: 26
Sep 2019.
Author
Lanz J.; Kim W.-K.; Walther T.; Burgdorf C.; Mollmann H.; Linke A.;
Redwood S.; Thilo C.; Hilker M.; Joner M.; Thiele H.; Conzelmann L.;
Conradi L.; Kerber S.; Schymik G.; Prendergast B.; Husser O.; Stortecky
S.; Heg D.; Juni P.; Windecker S.; Pilgrim T.
Institution
(Lanz, Stortecky, Windecker, Pilgrim) Department of Cardiology,
Inselspital, Bern University Hospital, Bern, Switzerland
(Kim) Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad
Nauheim, Germany
(Walther) Department of Cardiac, Thoracic and Thoracic Vascular Surgery,
University Hospital Frankfurt, Frankfurt, Germany
(Burgdorf) Heart and Vascular Centre, Bad Bevensen, Germany
(Mollmann, Husser) Department of Internal Medicine I,
St-Johannes-Hospital, Dortmund, Germany
(Linke) Department of Internal Medicine and Cardiology, Heart Centre
Dresden, Technische Universitat Dresden, Dresden, Germany
(Redwood, Prendergast) Department of Cardiology, St Thomas' Hospital,
London, United Kingdom
(Thilo) Department of Cardiology, Klinikum Augsburg, Augsburg, Germany
(Hilker) Department of Cardiothoracic Surgery, University Medical Centre,
Regensburg, Germany
(Joner) German Heart Centre, Technical University of Munich, Munich,
Germany
(Thiele) Heart Centre Leipzig, Leipzig, Germany
(Conzelmann) Department of Cardiac Surgery, Helios Klinik, Karlsruhe,
Germany
(Conradi) Department of Cardiovascular Surgery, University Heart Centre
Hamburg, Hamburg, Germany
(Kerber) Department of Cardiology, Cardiovascular Centre Bad Neustadt,
Germany
(Schymik) Department of Cardiology, Stadtisches Klinikum Karlsruhe,
Germany
(Heg) Clinical Trials Unit, University of Bern, Bern, Switzerland
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, Department of Medicine and Institute of Health
Policy, Management, Evaluation, University of Toronto, ON, Toronto, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is the preferred
treatment option for older patients with symptomatic severe aortic
stenosis. Differences in the properties of available TAVR systems can
affect clinical outcomes. Among patients undergoing TAVR, we compared the
self-expanding ACURATE neo TAVR system with the balloon-expandable SAPIEN
3 TAVR system with regard to early safety and efficacy. METHOD(S): In
this randomised non-inferiority trial, patients (aged >=75 years)
undergoing transfemoral TAVR for treatment of symptomatic severe aortic
stenosis, and who were deemed to be at increased surgical risk, were
recruited at 20 tertiary heart valve centres in Germany, the Netherlands,
Switzerland, and the UK. Participants were randomly assigned (1:1) to
receive treatment with the ACURATE neo or the SAPIEN 3 with a
computer-based randomly permuted block scheme, stratified by study centre
and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM)
category. The primary composite safety and efficacy endpoint comprised
all-cause death, any stroke, life-threatening or disabling bleeding, major
vascular complications, coronary artery obstruction requiring
intervention, acute kidney injury (stage 2 or 3), rehospitalisation for
valve-related symptoms or congestive heart failure, valve-related
dysfunction requiring repeat procedure, moderate or severe prosthetic
valve regurgitation, or prosthetic valve stenosis within 30 days of the
procedure. Endpoint assessors were masked to treatment allocation.
Non-inferiority of ACURATE neo compared with SAPIEN 3 was assessed in the
intention-to-treat population on the basis of a risk-difference margin of
7.7% for the primary composite endpoint, with a one-sided alpha of 0.05.
This trial is registered with ClinicalTrials.gov (number NCT03011346) and
is ongoing but not recruiting. FINDINGS: Between Feb 8, 2017, and Feb 2,
2019, up to 5132 patients were screened and 739 (mean age 82.8 years [SD
4.1]; median STS-PROM score 3.5% [IQR 2.6-5.0]) were enrolled. 30-day
follow-up was available for 367 (99%) of 372 patients allocated to the
ACURATE neo group, and 364 (99%) of 367 allocated to the SAPIEN 3 group.
Within 30 days, the primary endpoint occurred in 87 (24%) patients in the
ACURATE neo and in 60 (16%) in the SAPIEN 3 group; thus, non-inferiority
of the ACURATE neo was not met (absolute risk difference 7.1% [upper 95%
confidence limit 12.0%], p=0.42). Secondary analysis of the primary
endpoint suggested superiority of the SAPIEN 3 device over the ACURATE neo
device (95% CI for risk difference -1.3 to -12.9, p=0.0156). The ACURATE
neo and SAPIEN 3 groups did not differ in incidence of all-cause death
(nine patients [2%] vs three [1%]) and stroke (seven [2%] vs 11 [3%]);
whereas acute kidney injury (11 [3%] vs three [1%]) and moderate or severe
prosthetic aortic regurgitation (34 [9%] vs ten [3%]) were more common in
the ACURATE neo group. INTERPRETATION: TAVR with the self-expanding
ACURATE neo did not meet non-inferiority compared to the
balloon-expandable SAPIEN 3 device in terms of early safety and clinical
efficacy outcomes. An early composite safety and efficacy endpoint was
useful in discriminating the performance of different TAVR systems.
FUNDING: Boston Scientific (USA). Copyright © 2019 Elsevier Ltd.
All rights reserved.

<57>
Accession Number
629471278
Title
Prevention of Early Postoperative Decline: A Randomized, Controlled
Feasibility Trial of Perioperative Cognitive Training.
Source
Anesthesia and analgesia. (no pagination), 2019. Date of Publication: 27
Sep 2019.
Author
O'Gara B.P.; Mueller A.; Gasangwa D.V.I.; Patxot M.; Shaefi S.; Khabbaz
K.; Banner-Goodspeed V.; Pascal-Leone A.; Marcantonio E.R.; Subramaniam B.
Institution
(O'Gara, Mueller, Gasangwa, Patxot, Shaefi, Banner-Goodspeed, Subramaniam)
From the Department of Anesthesia, Critical Care and Pain Medicine
(Khabbaz) Department of Surgery, Division of Cardiac Surgery
(Pascal-Leone) Department of Neurology, Division of Cognitive Neurology,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
(Pascal-Leone) Neurorehabilitation, Universitat Autonoma Barcelona,
Bellaterra, Spain
(Marcantonio) Department of Medicine, Division of General Medicine and
Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative delirium and postoperative cognitive dysfunction
(POCD) are common after cardiac surgery and contribute to an increased
risk of postoperative complications, longer length of stay, and increased
hospital mortality. Cognitive training (CT) may be able to durably improve
cognitive reserve in areas deficient in delirium and POCD and, therefore,
may potentially reduce the risk of these conditions. We sought to
determine the feasibility and potential efficacy of a perioperative CT
program to reduce the incidence of postoperative delirium and POCD in
older cardiac surgery patients. METHOD(S): Randomized controlled
trial at a single tertiary care center. Participants included 45 older
adults age 60-90 undergoing cardiac surgery at least 10 days from
enrollment. Participants were randomly assigned in a 1:1 fashion to either
perioperative CT via a mobile device or a usual care control. The primary
outcome of feasibility was evaluated by enrollment patterns and adherence
to protocol. Secondary outcomes of postoperative delirium and POCD were
assessed using the Confusion Assessment Method and the Montreal Cognitive
Assessment, respectively. Patient satisfaction was assessed via a
postoperative survey. RESULT(S): Sixty-five percent of eligible
patients were enrolled. Median (interquartile range [IQR]) adherence (as a
percentage of prescribed minutes played) was 39% (20%-68%), 6% (0%-37%),
and 19% (0%-56%) for the preoperative, immediate postoperative, and
postdischarge periods, respectively. Median (IQR) training times were 245
(136-536), 18 (0-40), and 122 (0-281) minutes for each period,
respectively. The incidence of postoperative delirium (CT group 5/20 [25%]
versus control 3/20 [15%]; P = .69) and POCD (CT group 53% versus control
37%; P = .33) was not significantly different between groups for either
outcome in this limited sample. CT participants reported a high level of
agreement (on a scale of 0-100) with statements that the program was easy
to use (median [IQR], 87 [75-97]) and enjoyable (85 [79-91]). CT
participants agreed significantly more than controls that their memory
(median [IQR], 75 [54-82] vs 51 [49-54]; P = .01) and thinking ability
(median [IQR], 78 [64-83] vs 50 [41-68]; P = .01) improved as a result of
their participation in the study. CONCLUSION(S): A CT program
designed for use in the preoperative period is an attractive target for
future investigations of cognitive prehabilitation in older cardiac
surgery patients. Changes in the functionality of the program and
enrichment techniques may improve adherence in future trials. Further
investigation is necessary to determine the potential efficacy of
cognitive prehabilitation to reduce the risk of postoperative delirium and
POCD.

<58>
Accession Number
629466849
Title
Ramelteon for Prevention of Postoperative Delirium: A Randomized
Controlled Trial in Patients Undergoing Elective Pulmonary
Thromboendarterectomy.
Source
Critical care medicine. (no pagination), 2019. Date of Publication: 17 Sep
2019.
Author
Jaiswal S.J.; Vyas A.D.; Heisel A.J.; Ackula H.; Aggarwal A.; Kim N.H.;
Kerr K.M.; Madani M.; Pretorius V.; Auger W.R.; Fernandes T.M.; Malhotra
A.; Owens R.L.
Institution
(Jaiswal, Aggarwal) Scripps Research Translational Institute, La Jolla,
CA, Italy
(Jaiswal, Heisel) Division of Hospital Medicine, Scripps Clinic/Scripps
Green Hospital, La Jolla, CA, Italy
(Vyas, Ackula, Kim, Kerr, Auger, Fernandes, Malhotra, Owens) Division of
Pulmonary, Critical Care and Sleep Medicine, University of California San
Diego School of Medicine, La Jolla, CA, Italy
(Madani, Pretorius) Division of Cardiovascular and Thoracic Surgery,
University of California San Diego School of Medicine, La Jolla, CA, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To assess the efficacy of ramelteon in preventing delirium, an
acute neuropsychiatric condition associated with increased morbidity and
mortality, in the perioperative, ICU setting. DESIGN: Parallel-arm,
randomized, double-blinded, placebo-controlled trial. SETTING: Academic
medical center in La Jolla, California. PATIENTS: Patients greater than or
equal to 18 years undergoing elective pulmonary thromboendarterectomy.
INTERVENTIONS: Ramelteon 8 mg or matching placebo starting the night prior
to surgery and for a maximum of six nights while in the ICU. MEASUREMENTS
AND MAIN RESULTS: Incident delirium was measured twice daily using the
Confusion Assessment Method-ICU. The safety outcome was coma-free days
assessed by the Richmond Agitation-Sedation Scale. One-hundred twenty
participants were enrolled and analysis completed in 117. Delirium
occurred in 22 of 58 patients allocated to placebo versus 19 of 59
allocated to ramelteon (relative risk, 0.8; 95% CI, 0.5-1.4; p = 0.516).
Delirium duration, as assessed by the number of delirium-free days was
also similar in both groups (placebo median 2 d [interquartile range, 2-3
d] vs ramelteon 3 d [2-5 d]; p = 0.181). Coma-free days was also similar
between groups (placebo median 2 d [interquartile range, 1-3 d] vs
ramelteon 3 d [2-4 d]; p = 0.210). We found no difference in ICU length of
stay (median 4 d [interquartile range, 3-5 d] vs 4 d [3-6 d]; p = 0.349),
or in-hospital mortality (four vs three deaths; relative risk ratio, 0.7;
95% CI, 0.2-3.2; p = 0.717), all placebo versus ramelteon, respectively.
 CONCLUSION(S): Ramelteon 8 mg did not prevent postoperative delirium
in patients admitted for elective cardiac surgery.

<59>
Accession Number
2002067777
Title
A systematic review and meta-analysis of supplemental education in
patients treated with oral anticoagulation.
Source
Blood Advances. 3 (10) (pp 1638-1646), 2019. Date of Publication: 28 May
2019.
Author
Paquette M.; Witt D.M.; Holbrook A.; Skov J.; Ansell J.; Schunemann H.J.;
Wiercioch W.; Nieuwlaat R.
Institution
(Paquette, Schunemann, Wiercioch, Nieuwlaat) Department of Health Research
Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
(Paquette) Department of Medicine, Boehringer Ingelheim, Ltd, Burlington,
ON, Canada
(Witt) Department of Pharmacotherapy, University of Utah College of
Pharmacy, Salt Lake City, UT, United States
(Holbrook) Division of Clinical Pharmacology and Toxicology, McMaster
University, Hamilton, ON, Canada
(Holbrook, Schunemann) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Skov) Unit for Health Promotion Research, Department of Public Health,
University of Southern Denmark, Esbjerg, Denmark
(Ansell) Zucker School of Medicine, Hofstra Northwell, Hempstead, NY,
United States
Publisher
American Society of Hematology (E-mail: publishing@hematology.org)
Abstract
Oral anticoagulants (OACs) are indicated for treatment and prevention of
thromboembolic diseases. Supplemental patient education (education) has
been proposed to improve outcomes, and this systematic review assesses the
effect of education on mortality, thromboembolic events (TEEs) including
venous thromboembolism (VTE), and bleeding in patients taking OACs.
Randomized controlled trials were included, and 2 authors independently
screened articles and assessed risk of bias. In 9 trials (controls, n 5
720; intervention group patients, n 5 646), 4 assessed critical outcomes
of mortality, TEEs (VTE, stroke, and systemic embolism), and bleeding to
estimate absolute risk ratios. When comparing education with usual care,
in 1000 patients, there may be 12 fewer deaths (95% confidence interval
[CI], 19 fewer to 154 more) and 16 fewer bleeding events (95% CI, 34 fewer
to 135 more), but this evidence is uncertain; the evidence also suggests 6
fewer VTEs (95% CI, 10 fewer to 16 more) and 8 fewer TEEs (95% CI, 16
fewer to 18 more). The mean difference in time in therapeutic range may be
2.4% higher in the education group compared with usual care (95% CI, 2.79%
lower to 7.58% higher). We also found very low certainty of evidence for a
large increase in knowledge scores (standardized mean difference, 0.84
standard deviation units higher; 95% CI, 0.51-1.16). Overall, the
certainty of evidence was low to very low because of serious risk of bias
and serious imprecision. Additional sufficiently powered trials or
different approaches to education are required to better assess
supplemental education effects on outcomes in patients taking
OACs. Copyright © 2019 by The American Society of Hematology

<60>
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

<61>
Accession Number
2001645346
Title
Complementary role of cardiac computed tomography angiography in the
diagnosis of prosthetic aortic valve endocarditis and septic coronary
embolism - A case report.
Source
Journal of Radiology Case Reports. 13 (2) (pp 9-14), 2019. Date of
Publication: February 2019.
Author
van den Boogert T.; Claessen B.; Robbers-Visser D.; Henriques J.; Planken
R.N.
Institution
(van den Boogert, Claessen, Robbers-Visser, Henriques) Department of
Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
(Planken) Department of Radiology and nuclear medicine, Amsterdam UMC,
University of Amsterdam, Amsterdam, Netherlands
Publisher
EduRad (P.O. Box 1570 Lincoln, California 95648, United States)
Abstract
A 73-year old man presented with a posterolateral ST-elevated myocardial
infarction 9 months after biological aortic valve replacement for aortic
valve stenosis. Invasive coronary angiography showed a filling defect
across the left main coronary artery bifurcation extending into the left
anterior descending artery and the ramus circumflex. Transthoracic
echocardiography revealed a thickened prosthesis leaflet with signs of
slight stenosis. Cardiac computed tomography angiography showed a mass on
the left coronary cusp of the valve prosthesis, suggestive for vegetation
or thrombus. The scan also revealed central luminal filling defects,
indicative for thrombus or septic emboli. Blood cultures proved positive
for Propionibacterium acnes, therefore the patient was treated for
prosthetic valve endocarditis. Computed tomography angiography offers high
diagnostic accuracy for detecting infective endocarditis and renders
complementary information about valvular anatomy, coronary artery disease
and the extension of infections. Copyright © 2019, EduRad. All
rights reserved.

<62>
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.

<63>
Accession Number
626552432
Title
Early nasal high-flow versus Venturi mask oxygen therapy after lung
resection: A randomized trial.
Source
Critical Care. 23 (1) (no pagination), 2019. Article Number: 68. Date of
Publication: 28 Feb 2019.
Author
Pennisi M.A.; Bello G.; Congedo M.T.; Montini L.; Nachira D.; Ferretti
G.M.; Meacci E.; Gualtieri E.; De Pascale G.; Grieco D.L.; Margaritora S.;
Antonelli M.
Institution
(Pennisi, Bello, Montini, Gualtieri, De Pascale, Grieco, Antonelli)
Dipartimento Delle Scienze dell'Emergenza, Anestesiologiche e della
Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e
Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli
IRCCS, Rome, Italy
(Pennisi, Bello, Montini, Gualtieri, De Pascale, Grieco, Antonelli)
Istituto di Anestesia e Rianimazione, Universita Cattolica Del Sacro
Cuore, Rome, Italy
(Congedo, Nachira, Ferretti, Meacci, Margaritora) Dipartimento Delle
Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione
Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
(Congedo, Nachira, Ferretti, Meacci, Margaritora) Istituto di Patologia
Speciale Chirurgica, Universita Cattolica Del Sacro Cuore, Rome, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Data on high-flow nasal oxygen after thoracic surgery are
limited and confined to the comparison with low-flow oxygen. Different
from low-flow oxygen, Venturi masks provide higher gas flow at a
predetermined fraction of inspired oxygen (FiO<inf>2</inf>). We conducted
a randomized trial to determine whether preemptive high-flow nasal oxygen
reduces the incidence of postoperative hypoxemia after lung resection, as
compared to Venturi mask oxygen therapy. Method(s): In this
single-center, randomized trial conducted in a teaching hospital in Italy,
consecutive adult patients undergoing thoracotomic lung resection, who
were not on long-term oxygen therapy, were randomly assigned to receive
high-flow nasal or Venturi mask oxygen after extubation continuously for
two postoperative days. The primary outcome was the incidence of
postoperative hypoxemia (i.e., ratio of the partial pressure of arterial
oxygen to FiO<inf>2</inf> (PaO<inf>2</inf>/FiO<inf>2</inf>) lower than 300
mmHg) within four postoperative days. Result(s): Between September
2015 and April 2018, 96 patients were enrolled; 95 patients were analyzed
(47 in high-flow group and 48 in Venturi mask group). In both groups, 38
patients (81% in the high-flow group and 79% in the Venturi mask group)
developed postoperative hypoxemia, with an unadjusted odds ratio (OR) for
the high-flow group of 1.11 [95% confidence interval (CI) 0.41-3] (p =
0.84). No inter-group differences were found in the degree of dyspnea nor
in the proportion of patients needing oxygen therapy after treatment
discontinuation (OR 1.34 [95% CI 0.60-3]), experiencing pulmonary
complications (OR 1.29 [95% CI 0.51-3.25]) or requiring ventilatory
support (OR 0.67 [95% CI 0.11-4.18]). Post hoc analyses revealed that
PaO<inf>2</inf>/FiO<inf>2</inf> during the study was not different between
groups (p = 0.92), but patients receiving high-flow nasal oxygen had lower
arterial pressure of carbon dioxide, with a mean inter-group difference of
2 mmHg [95% CI 0.5-3.4] (p = 0.009), and were burdened by a lower risk of
postoperative hypercapnia (adjusted OR 0.18 [95% CI 0.06-0.54], p =
0.002). Conclusion(s): When compared to Venturi mask after
thoracotomic lung resection, preemptive high-flow nasal oxygen did not
reduce the incidence of postoperative hypoxemia nor improved other
analyzed outcomes. Further adequately powered investigations in this
setting are warranted to establish whether high-flow nasal oxygen may
yield clinical benefit on carbon dioxide clearance. Copyright ©
2019 The Author(s).

<64>
Accession Number
624898850
Title
Is goal-directed fluid therapy based on dynamic variables alone sufficient
to improve clinical outcomes among patients undergoing surgery? A
meta-analysis.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 298. Date of
Publication: 14 Nov 2018.
Author
Deng Q.-W.; Tan W.-C.; Zhao B.-C.; Wen S.-H.; Shen J.-T.; Xu M.
Institution
(Deng, Wen, Shen, Xu) Department of Anesthesiology, First Affiliated
Hospital, Sun Yat-sen University, No.58, Zhongshan 2nd Road, Guangzhou
510080, China
(Tan) Department of Endoscopy, Sun Yat-sen University Cancer Center, No.
651, Dongfeng East Road, Guangzhou 510060, China
(Zhao) Department of Anesthesiology, Nanfang Hospital, Southern Medical
University, No. 1838, Guangzhou Avenue North, Guangzhou 510515, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Whether goal-directed fluid therapy based on dynamic
predictors of fluid responsiveness (GDFTdyn) alone improves clinical
outcomes in comparison with standard fluid therapy among patients
undergoing surgery remains unclear. Method(s): PubMed, EMBASE, the
Cochrane Library and ClinicalTrials.gov were searched for relevant
studies. Studies comparing the effects of GDFTdyn with that of standard
fluid therapy on clinical outcomes among adult patients undergoing surgery
were considered eligible. Two analyses were performed separately: GDFTdyn
alone versus standard fluid therapy and GDFTdyn with other optimization
goals versus standard fluid therapy. The primary outcomes were short-term
mortality and overall morbidity, while the secondary outcomes were serum
lactate concentration, organ-specific morbidity, and length of stay in the
intensive care unit (ICU) and in hospital. Result(s): We included 37
studies with 2910 patients. Although GDFTdyn alone lowered serum lactate
concentration (mean difference (MD) - 0.21 mmol/L, 95% confidence interval
(CI) (- 0.39, - 0.03), P = 0.02), no significant difference was found
between groups in short-term mortality (odds ratio (OR) 0.85, 95% CI
(0.32, 2.24), P = 0.74), overall morbidity (OR 1.03, 95% CI (0.31, 3.37),
P = 0.97), organ-specific morbidity, or length of stay in the ICU and in
hospital. Analysis of trials involving the combination of GDFTdyn and
other optimization goals (mainly cardiac output (CO) or cardiac index
(CIx)) showed a significant reduction in short-term mortality (OR 0.45,
95% CI (0.24, 0.85), P = 0.01), overall morbidity (OR 0.41, 95% CI (0.28,
0.58), P < 0.00001), serum lactate concentration (MD - 0.60 mmol/L, 95% CI
(- 1.04, - 0.15), P = 0.009), cardiopulmonary complications (cardiac
arrhythmia (OR 0.58, 95% CI (0.37, 0.92), P = 0.02), myocardial infarction
(OR 0.35, 95% CI (0.16, 0.76), P = 0.008), heart failure/cardiovascular
dysfunction (OR 0.31, 95% CI (0.14, 0.67), P = 0.003), acute lung
injury/acute respiratory distress syndrome (OR 0.13, 95% CI (0.02, 0.74),
P = 0.02), pneumonia (OR 0.4, 95% CI (0.24, 0.65), P = 0.0002)), length of
stay in the ICU (MD - 0.77 days, 95% CI (- 1.07, - 0.46), P < 0.00001) and
in hospital (MD - 1.18 days, 95% CI (- 1.90, - 0.46), P = 0.001).
 Conclusion(s): It was not the optimization of fluid responsiveness by
GDFTdyn alone but rather the optimization of tissue and organ perfusion by
GDFTdyn and other optimization goals that benefited patients undergoing
surgery. Patients managed with the combination of GDFTdyn and CO/CI goals
might derive most benefit. Copyright © 2018 The Author(s).

<65>
Accession Number
624898842
Title
Systematic review of incretin therapy during peri-operative and intensive
care.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 299. Date of
Publication: 14 Nov 2018.
Author
Hulst A.H.; Plummer M.P.; Hollmann M.W.; Devries J.H.; Preckel B.; Deane
A.M.; Hermanides J.
Institution
(Hulst, Hollmann, Preckel, Hermanides) Department of Anaesthesiology,
Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Postbus 22660,
Amsterdam 1105 AZ, Netherlands
(Plummer, Deane) Intensive Care Unit, Royal Melbourne Hospital, 300
Grattan Street, Parkville, VIC 3050, Australia
(Devries) Department of Endocrinology, Amsterdam UMC, University of
Amsterdam, Meibergdreef 9, Postbus 22660, Amsterdam 1105 AZ, Netherlands
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Glucagon-like peptide 1 (GLP-1) and glucose-dependent
insulinotropic peptide (GIP) are incretin hormones. By lowering blood
glucose in a glucose-dependent manner, incretin-based therapies represent
a novel and promising intervention to treat hyperglycaemia in hospital
settings. We performed a systematic review of the literature for all
current applications of incretin-based therapies in the peri-operative and
critical care settings. Method(s): We searched MEDLINE, the Cochrane
Library, and Embase databases for all randomised controlled trials using
exogenous GLP-1, GLP-1 receptor agonists, exogenous GIP and dipeptidyl
peptidase IV inhibitors in the setting of adult peri-operative care or
intensive care. We defined no comparator treatment. Outcomes of interest
included blood glucose, frequency of hypoglycaemia and insulin
administration. Result(s): Of the 1190 articles identified during the
initial literature search, 38 fulfilled criteria for full-text review, and
19 single-centre studies were subsequently included in the qualitative
review. Of the 18 studies reporting glycaemic control, improvement was
reported in 15, defined as lower glucose concentrations in 12 and as
reduced insulin administration (with similar glucose concentrations) in 3.
Owing to heterogeneity, meta-analysis was possible only for the outcome of
hypoglycaemia. This revealed an incidence of 7.4% in those receiving
incretin-based therapies and 6.8% in comparator groups (P = 0.94).
 Conclusion(s): In small, single-centre studies, incretin-based
therapies lowered blood glucose and reduced insulin administration without
increasing the incidence of hypoglycaemia. Trial registration: PROSPERO,
CRD42017071926. Copyright © 2018 The Author(s).

<66>
Accession Number
629460826
Title
Transcatheter aortic valve replacement versus surgery for symptomatic
severe aortic stenosis: A reconstructed individual patient data
meta-analysis.
Source
Catheterization and cardiovascular interventions : official journal of the
Society for Cardiac Angiography & Interventions. (no pagination), 2019.
Date of Publication: 30 Sep 2019.
Author
Dowling C.; Kondapally Seshasai S.R.; Firoozi S.; Brecker S.J.
Institution
(Dowling, Kondapally Seshasai, Firoozi, Brecker) Cardiology Clinical
Academic Group, University of London and St. George's University Hospitals
NHS Foundation Trust, St. George's, London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We wished to undertake a reconstructed individual patient data
meta-analysis of randomized clinical trials comparing transcatheter aortic
valve replacement (TAVR) and surgery for patients with severe symptomatic
aortic stenosis. BACKGROUND: TAVR and surgery are both well-established
methods for treating patients with symptomatic severe aortic stenosis who
are at low, intermediate, and high risk for surgery. METHOD(S): Data
were identified by searches of Medline, Embase, CENTRAL and
ClinicalTrials.gov for all randomized clinical trials, which compared TAVR
and surgery that had published at least 1 year of follow-up. Individual
patient data were reconstructed from Kaplan-Meier curves. RESULT(S):
A total of 7,770 patients from seven randomized clinical trials were
included in this meta-analysis. At 1 year, TAVR was associated with a
lower risk of death from any cause (hazard ratio [HR], 0.85, 95%
confidence interval [CI], 0.73-0.98; p = .03), disabling stroke (HR, 0.71;
95% CI, 0.54-0.93; p = .01) and the composite end point of death or
disabling stroke (HR, 0.79; 95% CI, 0.67-0.92; p = .002). Significant
interactions were found for access suitability, with TAVR associated with
a lower risk of these end points in patients suitable for transfemoral
access. TAVR was associated with a lower risk of periprocedural events,
whereas the risk of late events was similar between TAVR and surgery.
 CONCLUSION(S): At 1 year, TAVR was associated with a lower risk of
death, disabling stroke and the composite end point, when compared with
surgery. These associations were strongest within the subgroup of patients
in whom transfemoral access was feasible. Copyright © 2019 Wiley
Periodicals, Inc.

<67>
Accession Number
629459934
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement in low-risk patients: a propensity score-matched analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 30 Sep 2019.
Author
Schaefer A.; Schofer N.; Gossling A.; Seiffert M.; Schirmer J.; Deuschl
F.; Schneeberger Y.; Voigtlander L.; Detter C.; Schaefer U.; Blankenberg
S.; Reichenspurner H.; Conradi L.; Westermann D.
Institution
(Schaefer, Schirmer, Schneeberger, Detter, Reichenspurner, Conradi)
Department of Cardiovascular Surgery, University Heart Center Hamburg,
Hamburg, Germany
(Schofer, Gosling, Seiffert, Deuschl, Voigtlander, Schaefer, Blankenberg,
Westermann) Department of General and Interventional Cardiology,
University Heart Center Hamburg, Hamburg, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of the study was to determine the differences in
outcomes of surgical aortic valve replacement (SAVR) and transcatheter
aortic valve implantation (TAVI) in low-risk patients. METHOD(S): All
patients with a logistic EuroSCORE II <4% who underwent transfemoral TAVI
between 2008 and 2016 (n=955) or SAVR between 2009 and 2014 (n=886) at our
centre were included. One hundred and nine patients per group were
available for propensity score matching. RESULT(S): Mortality during
the 30-day follow-up showed no differences (SAVR vs TAVI: 1.1% vs 1.8%,
P=1.0) but the rates of permanent pacemaker implantation (0.0 vs 14.8%,
P<0.001) and paravalvular leakage >= moderate (0.0 vs 7.0%, P=0.017) were
higher in TAVI patients. No difference was found regarding postoperative
effective orifice area and transvalvular pressure gradients. Although, the
1-year survival was similar between both groups; 3- and 5-year survival
was significantly inferior in the TAVI patient cohort. CONCLUSION(S):
TAVI yielded similar short-term outcomes compared with SAVR despite higher
rates of permanent pacemaker implantation and paravalvular leakage >=
moderate, but inferior long-term survival. Poorer long-term outcomes of
the TAVI patient cohort were attributable to a more comorbid TAVI
population. This emphasizes the need for long-term results from randomized
controlled trials before TAVI can be broadly expanded to younger low-risk
patients. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<68>
Accession Number
629459895
Title
Ticagrelor-based antiplatelet regimens in patients treated with coronary
artery bypass grafting: a meta-analysis of randomized controlled trials.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 30 Sep 2019.
Author
von Scheidt M.; Bongiovanni D.; Tebbe U.; Nowak B.; Stritzke J.; Zhao Q.;
Zhu Y.; Kastrati A.; Cassese S.; Schunkert H.
Institution
(von Scheidt, Kastrati, Cassese, Schunkert) Klinik fur Herz- und
Kreislauferkrankungen, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(von Scheidt, Bongiovanni, Kastrati, Schunkert) DZHK (German Center for
Cardiovascular Research), partner site Munich Heart Alliance, Munich,
Germany
(Bongiovanni) Medical Department I, Cardiology, Klinikum rechts der Isar,
Technical University, Munich, Germany
(Tebbe) Department of Cardiology, Angiology, Intensive Care Medicine,
District Hospital Lippe-Detmold, Detmold, Germany
(Nowak) CCB, Cardiovascular Center Bethanien, Frankfurt, Germany
(Stritzke) ListGermany
(Zhao, Zhu) Ruijin Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The optimal antiplatelet strategy in patients undergoing CABG
remains unclear. This is the first meta-analysis investigating the
clinical outcomes associated with ticagrelor-based antiplatelet regimens
in patients receiving CABG. METHOD(S): Relevant scientific databases
were searched for studies investigating antiplatelet regimens after CABG
from inception until April 1, 2019. Studies which randomly assigned CABG
patients to either ticagrelor-based or control antiplatelet regimens were
eligible. The primary outcome of this analysis was all-cause death. The
main secondary outcome was MI. Other outcomes of interest were cardiac
death, major adverse cardiac events, stroke and bleeding. This study is
registered with PROSPERO, number CRD42019122192. RESULT(S): Five
trials comprising 3996 patients (2002 assigned to ticagrelor-based and
1994 to control antiplatelet regimens) were eligible for quantitative
synthesis. The median follow-up was 12months. Control antiplatelet
regimens consisted of either aspirin or clopidogrel or both. As compared
to control, ticagrelor-based regimens reduced the risk of all-cause death
[0.61 (0.43-0.87); P=0.007], cardiac death [0.58 (0.39-0.86); P=0.007] and
major adverse cardiac events [0.79 (0.63-0.98); P=0.03], without
difference in the risk of MI [0.76 (0.50-1.18); P=0.22], stroke [0.99
(0.56-1.78); P=0.98] or bleeding [1.04 (0.95-1.14); P=0.41]. There was a
treatment effect modification for the primary outcome associated with
trials enrolling predominantly patients with acute coronary syndrome (P
for interaction=0.038). CONCLUSION(S): In patients receiving CABG,
ticagrelor-based regimens reduce mortality and major adverse cardiac
events without excess bleeding risk as compared with aspirin monotherapy
or the combination of aspirin and clopidogrel. The benefit of
ticagrelor-based regimens is more relevant in those studies enrolling
predominantly patients with acute coronary syndrome. These findings
require further confirmation in randomized trials focused on this subset
of patients and powered for clinical outcomes. 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
2003128337
Title
Relation of Lipid-Lowering Therapy to Need for Aortic Valve Replacement in
Patients With Asymptomatic Mild to Moderate Aortic Stenosis.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Greve A.M.; Bang C.N.; Boman K.; Egstrup K.; Kesaniemi Y.A.; Ray S.;
Pedersen T.R.; Wachtell K.
Institution
(Greve) Department of Clinical Biochemistry, Rigshospitalet, Copenhagen,
Denmark
(Bang) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Boman) Department of Medicine, Institution of Public Health and Clinical
Medicine, Umea University, Skellefta, Sweden
(Egstrup) Medicinsk Afdeling, OUH Svendborg Sygehus, Denmark
(Kesaniemi) Department of Medicine, Institute of Clinical Medicine,
University of Oulu and Clinical Research Center, Oulu University Hospital,
Oulu, Finland
(Ray) Manchester Academic Health Sciences Center, University Hospitals of
South Manchester, Manchester, United Kingdom
(Pedersen) Center for Preventive medicine, Oslo University Hospital,
Ulleval and University of Oslo, Oslo, Norway
(Wachtell) Department of Cardiology, Oslo University Hospital, Oslo,
Norway
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
In this study, we aimed to determine if pretreatment low-density
lipoprotein (LDL) levels and aortic stenosis (AS) severity alter the
efficacy of lipid-lowering therapy on reducing aortic valve replacement
(AVR). We used 1,687 patients with asymptomatic mild-to-moderate AS, who
were randomly assigned (1:1) to 40/10 mg simvastatin/ezetimibe combination
versus. placebo in the simvastatin and ezetimibe in aortic stenosis (SEAS)
trial. Pretreatment LDL levels (>4 mmol/L) and peak aortic jet velocity (3
m/s) were used to partition study participants into 4 groups, which were
followed for a primary endpoint of AVR. Cox regression with tests for
interaction was used to study the effect of randomized treatment in each
subgroup. During a median follow-up of 4.3 years (IQR 4.2 to 4.7 years;
total 7,396 patient-years of follow-up), 478 (28%) patients underwent AVR
and 146 (9%) died. A significant risk dependency was detected between
simvastatin/ezetimibe combination, LDL levels and mild versus moderate AS
on rates of AVR (p = 0.01 for interaction). In stratified analyses,
randomized treatment, therefore, reduced the rate of AVR in patients with
LDL levels >4 mmol and mild AS at baseline (HR 0.4; 95% CI: 0.2 to 0.9).
There was no detectable effect of randomized treatment on the need for AVR
in the 3 other participants subgroups. We conclude, that in a secondary
analysis from a prospective randomized clinical trial, treatment with
simvastatin/ezetimibe combination reduced the need for AVR in a subset of
patients with mild AS and high pretreatment LDL levels (Unique identifier
on clinicaltrials.gov: NCT00092677). Copyright © 2019 Elsevier
Inc.

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