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

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<1>
Accession Number
2002113612
Title
A systematic review and meta-analysis of bivalirudin application in
peripheral endovascular procedures.
Source
Journal of Vascular Surgery. 70 (1) (pp 274-284.e5), 2019. Date of
Publication: July 2019.
Author
Hu Y.; Liu A.Y.; Zhang L.; Wu X.; Shi S.; Elmore J.R.; Zhang X.
Institution
(Hu) Biomedical & Translational Informatics, Geisinger Medical Center,
Danville, Penn, United States
(Liu) Department of Cell and Systems Biology, University of Toronto,
Toronto, Ontario, Canada
(Zhang, Wu, Zhang) Division of Anesthesiology, Geisinger Medical Center,
Danville, Penn, United States
(Shi) Gillings School of Global Public Health, University of North
Carolina-Chapel Hill, Chapel Hill, NC, United States
(Elmore) Department of Vascular Surgery, Geisinger Medical Center,
Danville, Penn, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The direct thrombin inhibitor bivalirudin (BIV) was shown to be
superior to unfractionated heparin (UFH) in percutaneous coronary
interventions for reducing procedural blood loss. The aim of this study
was to compare outcome profiles of BIV and UFH in peripheral endovascular
procedures (PEPs) by synthesizing the currently available data.
 Method(s): Following the PRISMA statement, we conducted a
comprehensive literature search using Medline, Cochrane CENTRAL, PubMed,
EMBASE, CINAHL Google scholar, and clinicaltrials.gov. We recruited
randomized, controlled trials and well-conducted observational studies
that compared UFH and BIV in PEPs requiring anticoagulation, excluding
endovascular cardiac procedures and coronary interventions. Random-effects
meta-analyses were conducted to compare the outcome profiles of these two
agents. Result(s): Thirteen articles containing 17 studies involving
a total of 21,057 patients were enrolled. Of these, 2 were randomized
controlled trials, 2 were prospective cohort studies, and 10 were
retrospective studies. There were no significant differences between BIV
and UFH in terms of procedural success rates, major and minor
perioperative bleeding, transfusion, perioperative transient ischemic
attack, or hemorrhagic strokes. However, compared with UFH, BIV had
significantly lower odds ratios (OR) of perioperative mortality (OR, 0.58;
95% confidence interval [CI], 0.40-0.86), major adverse cardiovascular
events (OR, 0.65; 95% CI, 0.51-0.83), net adverse clinical events (OR,
0.75; 95% CI, 0.63-0.88), perioperative myocardial infarction (OR, 0.73;
95% CI, 0.55-0.98), major vascular complications (OR, 0.59; 95% CI,
0.39-0.91), and minor vascular complications (OR, 0.58; 95% CI,
0.40-0.84). Conclusion(s): Compared with UFH, PEPs using BIV had
comparable procedural success rates and odds of perioperative transient
ischemic attack and hemorrhagic stroke. However, procedures with BIV had a
lower but nonsignificant odds of perioperative bleeding and transfusion.
Depending on the procedures conducted, the patients who received BIV will
have reduced or comparable odds of perioperative mortality, myocardial
infarction, major adverse cardiovascular events, net adverse clinical
events, and major and minor vascular complications. Therefore, BIV may be
chosen solely as an alternative procedural anticoagulant to UFH for
PEPs. Copyright © 2019 The Authors

<2>
Accession Number
2002699138
Title
Terminal QRS distortion in ST elevation myocardial infarction as a
prediction of mortality: Systematic review and meta-analysis.
Source
Acta Cardiologica Sinica. 35 (5) (pp 445-458), 2019. Date of Publication:
2019.
Author
Prasitlumkum N.; Sirinvaravong N.; Limpruttidham N.; Rattanawong P.; Tom
E.; Kanitsoraphan C.; Chongsathidkiet P.; Boondarikpornpant T.
Institution
(Prasitlumkum, Limpruttidham, Rattanawong, Tom) University of Hawaii,
Honolulu, HI, United States
(Sirinvaravong) Department of Medicine, Einstein Medical Center,
Philadelphia, PA, United States
(Kanitsoraphan) Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
(Rattanawong, Chongsathidkiet) Faculty of Medicine Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand
(Chongsathidkiet) Department of Pathology, Duke University Medical Center,
Durham, NC, United States
(Boondarikpornpant) Department of Medicine, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand
Publisher
Republic of China Society of Cardiology (E-mail: acs@tsoc.org.tw)
Abstract
Background: Terminal QRS distortion reflects advanced stage and large
myocardial infarction predisposing the heart to adverse outcomes. Recent
studies suggest that terminal QRS distortion is associated with morbidity
and mortality in ST elevation myocardial infarction (STEMI). However, a
systematic review and meta-analysis of the literature have not been done.
 Objective(s):We assessed the association between terminal QRS
distortion in patients with STEMI andmortality by a systematic review of
the literature and a meta-analysis. Method(s): We comprehensively
searched the databases of MEDLINE and EMBASE from inception to September
2017. Included studies were published prospective or retrospective cohort
studies that compared all-cause mortality in subjects with STEMI with QRS
distortion versus those without QRS distortion. Data fromeach studywere
combined using the random-effects, generic inverse variance method of
DerSimonian and Laird to calculate risk ratios and 95% confidence
intervals. Result(s): Fifteen studies from January 1993 to May 2015
were included in this meta-analysis involving 7,479 subjects with STEMI
(2,906 QRS distortion and 4,573 non-QRS distortion). QRS distortion was
associated with increased mortality (pooled risk ratio = 1.81, 95%
confidence interval: 1.37-2.40, p < 0.000, I2 = 41.6%). Considering the
introduction of clopidogrel in 2004, we performed subgroup analyses before
and after 2004, and the associated with higher mortality was still present
(before 2004, RR 1.75, 95% CI 1.08-2.82, p = 0.022, I2 = 66.1%; after
2004, RR 1.96, 95% CI 1.44-2.65, p < 0.001, I2 = 0%). Conclusion(s):
Terminal QRS distortion increased all-cause mortality by 81%. Our study
suggests that terminal QRS distortion is an important tool to assess the
risk in patients with STEMI. Copyright © 2019, Republic of China
Society of Cardiology. All rights reserved.

<3>
Accession Number
2002618415
Title
Effects of vitamin c on organ function in cardiac surgery patients: A
systematic review and meta-analysis.
Source
Nutrients. 11 (9) (no pagination), 2019. Article Number: 2103. Date of
Publication: September 2019.
Author
Hill A.; Clasen K.C.; Wendt S.; Majoros A.G.; Stoppe C.; Adhikari N.K.J.;
Heyland D.K.; Benstoem C.
Institution
(Hill, Clasen, Majoros, Stoppe, Benstoem) Department of Intensive Care
Medicine, Medical Faculty RWTH Aachen, Aachen D-52074, Germany
(Hill, Clasen, Wendt) Department of Anesthesiology, Medical Faculty RWTH
Aachen, Aachen D-52074, Germany
(Hill, Clasen, Wendt, Stoppe, Benstoem) CARE-Cardiovascular Critical Care
and Anesthesia Evaluation and Research, Aachen D-52074, Germany
(Majoros) Medical Student of the Medical Faculty RWTH Aachen University,
Aachen D-52074, Germany
(Adhikari) Department of Critical Care Medicine, Sunnybrook Health
Sciences Centre, Interdepartmental Division of Critical Care Medicine,
University of Toronto, Toronto, ON M4N 3M5, Canada
(Heyland) Clinical Evaluation Research Unit, Kingston General Hospital,
Kingston, CA K7L 2V7, Canada
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Background: Cardiac surgery is associated with oxidative stress and
systemic inflammation, which both contribute to postoperative organ
dysfunction. Vitamin C is a pleiotropic, antioxidant, and potentially
organ-protective micronutrient. Past clinical trials and meta-analyses
have focused predominantly on occurrence of postoperative atrial
fibrillation. Therefore, we investigated the influence of perioperative
vitamin C administration on clinically relevant parameters closer related
to the patient's recovery, especially organ function, and overall outcomes
after cardiac surgery. Method(s): Randomized controlled trials (RCTs)
comparing perioperative vitamin C administration versus placebo or
standard of care in adult patients undergoing cardiac surgery were
identified through systematic searches in Pubmed, EMBASE, and CENTRAL on
23 November 2018. Published and unpublished data were included. Assessed
outcomes include organ function after cardiac surgery, adverse events,
in-hospital mortality, intensive care unit, and hospital length-of-stay.
Data was pooled only when appropriate. Result(s): A total of 19 RCTs
with 2008 patients were included in this meta-analysis. Vitamin C
significantly decreased the incidence of atrial fibrillation (p = 0.008),
ventilation time (p < 0.00001), ICU length-of-stay (p = 0.004), and
hospital length-of-stay (p < 0.0001). However, on average, vitamin C had
no significant effects on in-hospital mortality (p = 0.76), or on the
incidence of stroke (p = 0.82). High statistical heterogeneity was
observed in most analyses. Conclusion(s): Vitamin C impacts
clinically and economically important outcomes, such as ICU and hospital
length-of-stay, duration of mechanical ventilation and lowers the
incidence of atrial fibrillation. Due to missing reports on organ
dysfunction, this meta-analysis cannot answer the question, if vitamin C
can improve single- or multiorgan function after cardiac
surgery. Copyright © 2019 by the authors. Licensee MDPI, Basel,
Switzerland.

<4>
Accession Number
2002659831
Title
Systemic oxygen delivery during one-lung ventilation: Comparison between
propofol and sevoflurane anaesthesia in a randomised controlled trial.
Source
Journal of Clinical Medicine. 8 (9) (no pagination), 2019. Article Number:
1438. Date of Publication: September 2019.
Author
Hahm T.S.; Jeong H.; Ahn H.J.
Institution
(Hahm, Jeong, Ahn) Department of Anaesthesiology and Pain Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
06351, South Korea
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Systemic oxygen delivery (DO<inf>2</inf>) is a more comprehensive marker
of patient status than arterial oxygen saturation (SaO<inf>2</inf>), and
DO<inf>2</inf> in the range of 330-500 mL min-1 is reportedly
adequate during anaesthesia. We measured DO<inf>2</inf> during one-lung
ventilation (OLV) for thoracic surgery-where the risk of pulmonary shunt
is significant, and hypoxia occurs frequently-and compared sevoflurane and
propofol, the two most commonly used anaesthetics in terms of
DO<inf>2</inf>. Sevoflurane impairs hypoxic pulmonary vasoconstriction.
Thus, our hypothesis was that propofol-based anaesthesia would show a
higher DO<inf>2</inf> value than sevoflurane-based anaesthesia. This was a
double-blinded randomised controlled trial conducted at a university
hospital from 2017 to 2018. The study population consisted of patients
scheduled for lobectomy under OLV (N = 120). Sevoflurane or propofol was
titrated to a bispectral index of 40-50. Haemodynamic variables were
measured during two-lung ventilation (TLV) and OLV at 15 and 45 min (OLV15
and OLV45, respectively) using oesophageal Doppler monitoring. The mean
DO<inf>2</inf> (mL min-1) was not different between the
sevoflurane and propofol anaesthesia groups (TLV: 680 vs. 706; OLV15: 685
vs. 703; OLV45: 759 vs. 782, respectively). SaO<inf>2</inf> was not
correlated with DO<inf>2</inf> (r = 0.09, p = 0.100). Patients with
SaO<inf>2</inf> < 94% showed adequate DO<inf>2</inf> (641 +/- 203 mL
min-1), and patients with high SaO<inf>2</inf> (> 97%) showed
inadequate DO<inf>2</inf> (14% of measurements < 500 mL min-1).
In conclusion, DO<inf>2</inf> did not significantly differ between
sevoflurane and propofol. SaO<inf>2</inf> was not correlated with
DO<inf>2</inf> and was not informative regarding whether the patients were
receiving an adequate oxygen supply. DO<inf>2</inf> may provide additional
information on patient status, which may be especially important when
patients show a low SaO<inf>2</inf>. Copyright © 2019 by the
authors. Licensee MDPI, Basel, Switzerland.

<5>
Accession Number
2002644324
Title
Comparison of dexmedetomidine or sufentanil combined with ropivacaine for
epidural analgesia after thoracotomy: A randomized controlled study.
Source
Journal of Pain Research. 12 (pp 2673-2678), 2019. Date of Publication:
2019.
Author
Yan M.J.; Wang T.; Wu X.M.; Zhang W.
Institution
(Yan) Department of Anesthesiology, Chun'an First People's Hospital,
Hangzhou 310000, China
(Yan, Wu) Department of Anesthesiology, Zhejiang Provincial People's
Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310000,
China
(Wang) Second Clinical College, Zhejiang Chinese Medical University,
Hangzhou 310000, China
(Zhang) Department of Anesthesiology, Affiliated Women and Children's
Hospital of Jiaxing University, Jiaxing 314000, China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Thoracotomy is frequently accompanied with moderate-to-severe
postoperative pain, and excellent pain management is important for early
rehabilitation. The purpose of this study is to investigate the effects of
dexmedetomidine combined with ropivacaine for epidural analgesia after
thoracotomy. Method(s): One hundred and thirty patients undergoing
elective lung lobectomy were enrolled in the double-blind study and
randomly divided into two groups. Group A received 0.5 micro g/mL of
dexmedetomidine plus 0.1% ropivacaine for postoperative analgesia, and
group B (control group) received 0.5 micro g/mL of sufentanil plus
0.1% ropivacaine for postoperative analgesia. Hemodynamic parameters were
monitored. Pain intensity at rest was assessed using a visual analog scale
(VAS) at 2, 4, 6, 8, 12, 24, and 48 hrs postoperatively. Ramsay sedation
score (RSS), analgesic consumption, postoperative respiratory depression,
nausea and vomiting, pruritus, and bradycardia were recorded.
 Result(s): The VAS values at rest during the postoperative 6-48 hrs
were lower in group A than those in group B (P<0.05), and the RSS values
were higher in group A during the postoperative 4-48 hrs compared to group
B (P<0.05). Side effects were similar between the groups (P>0.05).
 Conclusion(s): Dexmedetomidine combined with ropivacaine may provide
better postoperative analgesia and sedative effect in patients undergoing
thoracic surgery with fewer side effects. It is superior to sufentanil in
analgesic effect during postoperative analgesia after
thoracotomy. Copyright © 2019 Yan et al.

<6>
Accession Number
628958029
Title
Quality of life in patients with advanced heart failure and an implanted
left ventricular assist device: an umbrella review protocol.
Source
JBI database of systematic reviews and implementation reports. 17 (10) (pp
2115-2121), 2019. Date of Publication: 01 Oct 2019.
Author
Abrams D.; McNair M.
Institution
(Abrams, McNair) School of Nursing, University of Mississippi Medical
Center, Jackson, United States
(Abrams, McNair) Mississippi Centre for Evidence Based Practice: a Joanna
Briggs Institute Centre of Excellence
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This review aims to evaluate the effectiveness of implanted
left ventricular assist devices on quality of life in patients with
advanced heart failure. INTRODUCTION: Approximately 500,000 patients
worldwide are diagnosed with advanced heart failure. The preferred
treatment for patients who remain symptomatic after standard medical
treatment is heart transplantation. However, due to the shortage of donor
organs, left ventricular assist devices are increasingly used as an
alternative. This umbrella review is necessary to advise clinicians so
they may provide patients and families with clear information on standard
medical treatment, implanted left ventricular assist devices and heart
transplantation. INCLUSION CRITERIA: This umbrella review will consider
research syntheses that include patients 16 years or over with advanced
heart failure and an implanted left ventricular assist device. The primary
outcome is quality of life, and secondary outcomes include patient
survival rates and the New York Heart Association functional
classification changes. METHOD(S): An initial search of PubMed and
CINAHL has been undertaken to identify articles and create a search
strategy. Retrieved articles will be screened against the inclusion
criteria. Included studies will be critically appraised for methodological
quality according to JBI umbrella review methodology, and data will be
extracted using the standardized JBI data extraction tool. The results
will be presented in a Summary of Evidence, and a GRADE Summary of
Findings will be produced for grading the quality of the evidence.

<7>
Accession Number
2002374072
Title
Cost-effectiveness comparison of routine transfusion with restrictive and
liberal transfusion strategies for surgical patients in China.
Source
Vox Sanguinis. 114 (7) (pp 721-739), 2019. Date of Publication: 01 Oct
2019.
Author
Yu X.; Wang Z.; Huang Y.; Xin S.; Sun H.; Zhang X.; Wang Y.; Han W.; Xue
F.; Wang L.; Hu Y.; Xu M.; Li L.; He J.; Jiang J.
Institution
(Yu, Wang, Huang, Xu) Peking Union Medical College Hospital, Chinese
Academy of Medical Sciences, Beijing, China
(Wang, Han, Xue, Wang, Hu, Jiang) Department of Epidemiology and
Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of
Medical Sciences & Peking Union Medical College, Beijing, China
(Xin, Zhang, Li) First Hospital of China Medical University, Shenyang,
China
(Sun, Wang, He) Xiangya Hospital, Central South University, Changsha,
China
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objectives: A health industry standard recommending
restrictive transfusion is to be in effect in China in April 2019. We aim
to explore its potential economic and clinical impacts among surgical
patients. Material(s) and Method(s): A decision tree model was
applied to compare cost-effectiveness of current routine transfusion in
China, a restrictive (transfusion at Hb < 8 g/dl or ischaemic symptoms)
and a liberal (transfusion at Hb < 10 g/dl) strategy. Parameters were
estimated from empirical data of 25 227 surgical inpatients aged >=30
years in a multicenter study and supplemented by meta-analysis when
necessary. Results are shown for cardio-cerebral-vascular (CCV) surgery
and non-CCV (orthopaedics, general, thoracic) surgery separately.
 Result(s): Per 10 000 patients in routine, restrictive, liberal
transfusion scenarios, total spending (transfusion and length of stay
related) was 7.67, 7.58 and 9.39 million CNY (1 CNY x 0.157 = 1 US dollar)
for CCV surgery and 6.35, 6.70 and 8.09 million CNY for non-CCV surgery;
infectious and severe complications numbered 354, 290, and 290 (CCV) and
315, 286, and 330 (non-CCV), respectively. Acceptability curves showed
high probabilities for restrictive strategy to be cost-effective across a
wide range of willingness-to-pay values. Such findings were mostly
consistent in sensitivity and subgroup analyses except for patients with
cardiac problems. Conclusion(s): We showed strong rationale,
succeeding previous findings only in cardiac or joint procedures, to
comply with the new standard as restrictive transfusion has high potential
to save blood, secure safety, and is cost-effective for a wide spectrum of
surgical patients. Experiences should be further summarized to pave the
way towards individualized transfusion. Copyright © 2019
International Society of Blood Transfusion

<8>
Accession Number
629352949
Title
Sternal wound closure in the current era: the need of a tailored approach.
Source
General thoracic and cardiovascular surgery. 67 (11) (pp 907-916), 2019.
Date of Publication: 01 Nov 2019.
Author
Nenna A.; Nappi F.; Dougal J.; Satriano U.; Chello C.; Mastroianni C.;
Lusini M.; Chello M.; Spadaccio C.
Institution
(Nenna, Satriano, Mastroianni, Lusini, Chello) Department of
Cardiovascular Surgery, Universita Campus Bio-Medico Di Roma, Via Alvaro
del Portillo 200, Rome 00128, Italy
(Nappi) Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis,
Paris, France
(Dougal, Spadaccio) Cardiac Surgery, Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Chello) Dermatology, University of Rome "La Sapienza", Rome, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Median sternotomy remains the most common access to perform
cardiac surgery procedures. However, the experience of the operating
surgeon remains a crucial factor during sternal closure to avoid potential
complications related to poor sternal healing, such as mediastinitis.
Considering the lack of major randomized controlled trials and the
heterogeneity of the current literature, this narrative review aims to
summarize the different techniques and approaches to sternal closure with
the aim to investigate their reflections into clinical outcomes and to
inform the choice on the most effective closure method after median
sternotomy. METHOD(S): A literature search through PubMed, Embase,
EBSCO, Cochrane database of systematic reviews, and Web of Science from
its inception up to April 2019 using the following search keywords in
various combinations: sternal, sternotomy, mediastinitis, deep sternal
wound infection, cardiac surgery, closure. RESULT(S): Single wire
fixation methods, at present, seems the most useful method to perform
sternal closure in routine patients, although patients with a fragile
sternum might benefit more from a figure-of-eight technique. In high-risk
patients (e.g. chronic pulmonary disease, obesity, bilateral internal
mammary artery harvesting, diabetes, off-midline sternotomy), rigid plate
fixation is currently the most effective method, if available;
alternatively, weave techniques could be used. CONCLUSION(S): The
choice among the sternal closure techniques should be mainly inspired and
tailored on the patient's characteristics, and correct judgement and
experience play a pivotal role. A decisional algorithm has been proposed
as an attempt to overcome the absence of specific guidelines and to guide
the operative approach. This operative approach might be used also in
non-cardiac procedure in which median sternotomy is required, such as in
case of thoracic surgery.

<9>
Accession Number
2003415380
Title
The Role of Bariatric Surgery in Patients with Obesity and Advanced Heart
Failure as a Bridge to Heart Transplantation: A Systematic Review and
Meta-Analysis.
Source
Surgery for Obesity and Related Diseases. Conference: The 36th ASMBS
Annual Meeting. United States. 15 (10 Supplement) (pp S47), 2019. Date of
Publication: October 2019.
Author
Doumouras A.; Lee Y.; Anvari S.; Wong J.; Gmora S.; Anvari M.; Hong D.
Institution
(Doumouras, Wong, Hong) McMaster University, Hamilton
(Lee, Anvari) McMaster University School of Medicine, Hamilton
(Gmora) McMaster University, Hamilton, ON, Canada
(Anvari) McMaster University, Hamilton, AZ, United States
Publisher
Elsevier Inc.
Abstract
Background: Class 3 obesity or greater (BMI >35 kg/m2) is a
relative contraindication for heart transplant due to its perioperative
risk and mortality. Bariatric surgery has been explored as a potential
bridging procedure to transplant by facilitating weight loss and improving
cardiac function. The aim of this systematic review and meta-analysis is
to investigate the role of bariatric surgery on improving transplant
candidacy in patients with ESHF. Method(s): MEDLINE, EMBASE, CENTRAL,
and PubMed databases were searched up to February 2019 for studies that
performed bariatric surgery on patients with severe obesity and ESHF. Key
outcomes included rate of patients listed for heart transplantation after
bariatric surgery, rate of patients subsequently receiving transplant,
change in BMI after bariatric surgery, 30-day complications. Pooled
estimates were calculated using the random effects meta-analysis of
proportions. MINORS tool was used to assess quality of evidence.
 Result(s): 10 studies with 92 patients were included. Mean (SD)
preoperative BMI was 45.1 (5.1) kg/m2 and BMI after surgery was
33.8 (4.0) kg/m2 with absolute BMI loss of 25.1%. After
bariatric surgery, 69% (95%CI, 48%-88%) of patients with ESHF were listed
for transplantation. Time to bariatric surgery to receiving heart
transplant was 12 (13-20.5) months. Of the listed patients, 67% (95%CI,
45-86%) successfully received a heart transplant. The rate of 30-day
bariatric surgery-related complications was 18% (95%CI 6%-33%) and rate of
30-day mortality after bariatric surgery was 0%. Conclusion(s):
Bariatric surgery can facilitate sustained weight loss in obese patients
with ESHF, thus improving heart transplant candidacy and
transplantation. Copyright © 2019

<10>
Accession Number
2003407477
Title
EP1.15-10 Survival Impact of Non-Surgical Treatment in Thymic Epithelial
Tumours: A Retrospective Study.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S1055-S1056), 2019. Date
of Publication: October 2019.
Author
Ridai S.; Benchakroun N.; Bouchbika Z.; Jouhadi H.; Tawfik N.; Sahraoui
S.; Benider A.
Institution
(Ridai, Benchakroun, Bouchbika, Jouhadi, Tawfik, Sahraoui, Benider)
Radiation Oncology, CHU Ibn Rochd, Casablanca, Morocco
Publisher
Elsevier Inc.
Abstract
Background: The management of thymic epithelial tumours, although poorly
defined due to their rarity, remains multidisciplinary in order to offer
patients multimodal treatment with surgery as the therapeutic pillar. Our
main objective is to highlight the impact of non-surgical treatments on
the overall survival and the progression free survival of patients treated
for these tumours at the Mohamed VI center. Method(s): We carried out
a monocentric, descriptive and retrospective study using databases from
the oncology, the thoracic surgery and anatomopathology departments of the
Ibn Rochd University Hospital in Casablanca. We identified all patients
with thymoma or thymic carcinoma whose histological diagnosis was made on
a biopsy or a surgical excision piece between July 2006 and February 2016
After exclusions, 42 patients were identified and we used a farm sheet to
specify for each patient, epidemiological data, data related to
histological type, Masaoka-Koga staging and progress under treatment
(complete or partial response, stabilization or progression) For our
analysis, we used Microsoft Office, Excel 2007 and Kaplan Meier Software
to assess overall ans progression free survival. Result(s): 42 cases
of thymic epithelial tumours were reported between 2006 and 2016 with
apredominance of type B1 in patients aged between 25 and 77 years. The
radiological assessment carried out before treament showed that 9.5% of
the diseases were metastatic from the outset, while the others had an
intra - thoracic locoregional extension Half of the patients were
resectable from the outset, wich made it possible to perform primary
surgery leading to carcinological resection with generally simple
post-operative outcomes. In our series, CAP D1 = D21 chemotherapy was the
preferred regimen to be indicated as a pre operative treatment to reduce
the size of the tumor and increase its resectivity rate in 11 patients
(26,2% of cases). This chemotherapy was indicated as adjuvant treatment in
06 cases of incomplete resection (14,3% of cases) Two patients (4,8% of
cases) received first chemotherapy followed by exclusive radiation therapy
at 66 Gy while more than 25% received a post-operative radiation therapy
at variable doses ranging from 50-54Gy for R0 tumours or microscopic
disease to 60-70Gy for macroscopic disease. The overall and progression
free survivals at 22 months were 94,6% and 68,4% respectively. The
prognostic factors are, in univariate analysis, the performans status, the
histological type, the Masaoka-Koga stage and the quality of surgical
resection. The multivariate analysis could not be performed due to a lack
of statistical power, due to the small number of patients and the
retrospective nature of the study. Conclusion(s): The thymic
epithelial tumours treatment is a real challenge given the absence of
randomized prospective studies on this subject Surgery remains the
mainstay of management but neo-adjuvant and or adjuvant treatments can be
considered in case of poor prognostic factors in order to reduce the risk
of recurrence or death from the disease. Keywords: Adjuvant, neoadjuvant,
thymic epithelial tumors Copyright © 2019

<11>
Accession Number
2003407009
Title
OA13.02 Video-Assisted Thoracoscopic Surgery vs. Thoracotomy for Non-Small
Cell Lung Cancer: Survival Outcome of a Randomized Trial.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S240), 2019. Date of
Publication: October 2019.
Author
Situ D.; Long H.; Tan Q.; Luo Q.; Wang Z.; Jiang G.; Rong T.
Institution
(Situ, Long, Rong) Lung Cancer Research Institute, Sun Yat-Sen University,
Guangzhou, China
(Tan) Thoracic Surgery, Daping Hospital of the Third Military Medical
University, Chongqing, China
(Luo) Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong
University, Shanghai, China
(Wang) Thoracic Surgery, Shenzhen People's Hospital, Jinan University,
Shenzhen, China
(Jiang) Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University,
Shanghai, China
Publisher
Elsevier Inc.
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) has been widely
used in the treatment of early-stage non-small cell lung cancer (NSCLC).
However, there has not been a robust randomized control trial (RCT) to
confirm the non-inferiority of VATS to open lobectomy in term of oncologic
efficacy. Therefore, a large multicenter RCT in China was designed and
initiated to verify the role of VATS. Method(s): A phase 3 RCT was
undertaken at five thoracic surgery tertiary centers in China. Patients
aged 18-75 years old who were diagnosed of clinically early-stage NSCLCs
were randomized in a 1:1 ratio into VATS and thoracotomy groups. Radical
lobectomy plus hilar and mediastinal lymph node dissection was the
standard surgical intervention. The primary end-point of study was 5-year
overall survival (OS). The secondary end-points including 5-year
disease-free survival (DFS) and cancer relapse rates would also be
reported here. Analysis was by intention to treat. This study is
registered with the, number NCT01102517. Result(s): A total of 508
patients were recruited between January 2008 and March 2014. The final
follow-up for 5-year survival analysis was completed in March 2019. And
432 patients were eligible for analysis (222 cases in VATS group and 210
cases in thoracotomy group). The cancer relapse (recurrence and
metastasis) rates were 39.2% in VATS group and 36.7% in thoracotomy group
respectively (P=0.621). Patients who received VATS lobectomies had a
similar 5-year DFS to those who underwent open surgery (58% versus 62%,
P=0.686). Finally, the 5-year OS rates were of no significant difference
between VATS and thoracotomy groups (74% versus 71%, P=0.497). [Figure
presented] Conclusion(s): The non-inferiority of VATS to thoracotomy
lobectomy was confirmed in our RCT in terms of oncologic efficacy for
clinically early-stage NSCLCs. Keywords: Non-Small Cell Lung Cancer,
Survival, Thoracoscopic Surgery Copyright © 2019

<12>
Accession Number
2003406691
Title
P2.16-42 The Use of a Smartphone Application Improves Postoperative
Outcomes in Patients Undergoing Lung Cancer Resection.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S882), 2019. Date of
Publication: October 2019.
Author
Olivero C.F.; Collado L.M.; Sarceda J.J.; Martin E.F.; Santacruz C.C.;
Gastardi J.; Martinez A.G.; Manzanal P.A.; Capa P.S.; Tardido M.M.; Alen
V.; Hernando-Trancho F.
Institution
(Olivero) Thoracic Surgery, Hospital Universitari Arnau de Vilanova,
Lleida, Spain
(Collado) Thoracic Surgery, Hospital Arnau Vilanova, Lleida, Spain
(Sarceda, Martin, Gastardi, Martinez, Alen, Hernando-Trancho) Thoracic
Surgery Department, Hospital Clinico San Carlos, Madrid, Spain
(Santacruz) General Surgery, Hospital Arnau Vilanova, Lleida, Spain
(Manzanal, Capa, Tardido) Deparment of Physical Medicine and
Rehabilitation, Hospital Clinico San Carlos, Madrid, Spain
Publisher
Elsevier Inc.
Abstract
Background: For early stages of lung cancer, complete surgical resection
with curative intent for patients who are surgical candidates remains the
most effective treatment. However, thoracic surgery procedures are related
to postoperative pulmonary complications which increase the morbidity and
mortality. Preoperative pulmonary rehabilitation programs improve
postoperative outcomes. This study aims to evaluate the role of a
smartphone application to improve pulmonary rehabilitation in a group
patients scheduled for lung cancer resection. Method(s): A Smartphone
application containing peri-operative medical advice (stop smoking, mouth
health, early mobilization and pain control) and ten chest physical
exercises (aerobic exercise, inspiratory muscle strength and secretion
mobilization technique) was created. This prospective and no randomized
study was developed between January 2017 and December 2018. All patients
scheduled for surgery were asked to participate. A group of 68 patients
used and interacted with the software before and after the surgery. The
control group (114 patients) received classical information and education
by the Department of Physical Medicine and Rehabilitation.
Clinical-pathological variables, incidence of postoperative pulmonary
complications, duration of chest drainage, length of hospital stay and 30
days mortality rate were recorded and analyzed. Result(s):
Postoperative pulmonary complications were developed 17.6% in the
intervention group and 33.3% in the control group (P=0.02). The length of
hospital stay was shorter in the intervention group (median 3+/-4.09d vs.
5+/-6.87d P=0.001). No differences were found in duration of chest
drainage or 30 day mortality compared with control group.
 Conclusion(s): This new technological resource created by thoracic
surgeons demonstrates that preoperative rehabilitation program and patient
education improve postoperative outcomes in patients undergoing lung
cancer resection, decreasing the incidence of postoperative pulmonary
complications and length of hospital stay. Keywords: Chest Physical
Therapy, Postoperative Pulmonary Complications, Smartphone
Application Copyright © 2019

<13>
Accession Number
2003406416
Title
P2.16-02 Randomising Patients into Trials of Thoracic Cancer Surgery: An
Analysis of Patient and Cancer Team Behaviour in Practice.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S865), 2019. Date of
Publication: October 2019.
Author
Treasure T.; Macbeth F.; Baum M.; Shackcloth M.; Edwards J.; Batchelor T.
Institution
(Treasure) Clinical Operational Research Unit, University College London,
London, United Kingdom
(Macbeth) Cardiff University, Cardiff, United Kingdom
(Baum) University College London, London, United Kingdom
(Shackcloth) Thoracic Surgery, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Edwards) Northern General Hospital, Sheffield, United Kingdom
(Batchelor) Bristol Hospitals NHS Trusts, Bristol, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) is a
multicentre trial funded by Cancer Research UK. In Stage 1 participants
were invited to consent for further evaluation within the PulMiCC protocol
and if eligible were offered randomisation (Stage 2) to lung
metastasectomy or continued active monitoring. Noting a decreasing rate of
randomisation during 2016, the Data Monitoring Committee recommended that
the reasons should be investigated. Method(s): The three most
actively recruiting centres were approached and asked to provide reasons
for patients in Stage 1 not being randomised and to provide data according
to the fields in the first column of the table. We sought to discover who
made the decision to not randomise and to establish what clinical
management was then followed. If participants were deemed ineligible we
asked for the reason. Result(s): Of 155 patient participants
consented into Stage 1 of the trial, and after full information and
counselling during the period of assessment, 41 elected to make their own
decision. The split to have or not have metastasectomy was 22:19. When the
clinicians made the decision 77/78 (99%) patients had metastasectomy. Full
data are given in the table. Ten patients had other pathology, nine lung
cancer and one carcinoid. The protocol placed no constraint on the number
of metastases but one unit set its own limits at 2-4 deeming patients
outside as not eligible for randomisation but as suitable for
metastasectomy. [Figure presented] Conclusion(s): At trial closure,
of 512 patients in Stage 1, 82% were not randomised resulting in an
inconclusive result despite the efforts of many doctors and scientists and
the participation of a large number of patients. In the sample of 155
drawn from the three most active centres, 78 patients deemed eligible had
the decision made for them by the clinical team and of the 18 deemed
ineligible, half of the reasons were not aligned with the written
protocol. That means at least 56% of the patients were lost to
randomisation by clinicians' decisions.The 41 patients who elected to make
their own decision, to have or not have metastasectomy, did so in numbers
which better reflected equipoise. The difficulty faced by clinicians in
declaring uncertainty is well recognised. In PulMiCC this resulted in
exclusion of many patients who had given their informed consent. Learning
from this and similar experiences, later UK trials of thoracic oncology
(MARS-2, VIOLETS) have recruited well after specific training in the
QuinteT method for randomisation into surgical trials. Keywords:
Oligometastasectomy, Surgical oncology, Randomised trials Copyright
© 2019

<14>
Accession Number
2003405450
Title
MS07.01 Preoperative Optimazition: Reducing Surgery Complications Through
Tobacco Cessation.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S163-S164), 2019. Date
of Publication: October 2019.
Author
Harpole D.
Institution
(Harpole) Department of Surgery, Duke University, Durham, NC, United
States
Publisher
Elsevier Inc.
Abstract
Optimizing Outcomes after Pulmonary Resections with Smoking Cessation Data
on increased risk of complications after major thoracic surgery for
current smokers has been documented for several decades, suggesting that
smoking cessation for even a few weeks may significantly reduce this risk
based on early return of muco-ciliary clearance of respiratory secretions
and decreased risk of atelectasis and pneumonia. Moreover, the awareness
of potential lung cancer mortality on patients is a potent "teachable
moment" for a smoking intervention. However, the literature is anything
but definitive on: 1. Method of smoking cessation / counseling (including
pharmacological and non-pharmacological adjuncts) 2. Length of time
required for maximal risk reduction 3. Durability of cessation after
surgery This presentation will review the strongest trials in the
literature, as well as recent data on a concerted risk reduction programs
of Enhanced Recovery from surgery (ERAS) that include smoking cessation.
References: Stokes SM, Wakeam E, Antonoff MB, Backhus LM, Meguid RA,
Ordell D, Varghese TK. Optimizing health before elective thoracic surgery:
systematic review of modifiable risk factors. J Thorac Dis 11: S537-554;
2109 Sardari NP, Weyler J, Colpaert C. Prognostic value of smoking status
in operated NSCLC. Lung Cancer 47:351-9; 2005 Mills E, Eyawo O, Lockhart
I. Smoking cessation reduces perioperative complications: A systematic
review and meta-analysis. Am J Med 124:144-8; 2011 Kozower BD, Lau CL,
Philllips JV. Thoracic surgeon-directed tobacco cessation intervention.
Ann Thorac Surg 89:926-30, 2010 Thomasen T, Abrishami A, Yang Y.
Interventions for perioperative smoking cessation. Cochrane Database Syst
review 3:CD002299; 2014 Lugg ST, Tikka T, Agostini PJ, Kerr A, Kalkat MS
et al. Smoking and timing of cessation on postoperative complications
after curative-intent lung cancer surgery. J Cardiothorac Surg 12:52-60;
2017 Rodriguez M, Gomez-Hernandez MT, Novoa N, Jimenez MF, Aranda JL.
Refraining from smoking shortly before lobectomy has no influence on the
risk of pulmonary complications. Eur J Cardiothorac Surg 51:498-503; 2017
Zaman M, Bilal H, Mahmood S, Tang A. Does getting smokers to stop smoking
before lung resections reduce their risk? Interact Cardiovasc Thorac Surg.
14:320-323; 2012 Gemine RE, Ghosal R, Collier G, Parry D, Campbell I,
Davies G, Lewis KE. Longitudinal study to assess impact of smoking at
diagnosis and quitting on 1-year survival for people with NSCLC. Lung
Cancer 129:1-7; 2019 Keywords: lung cancer surgery, Smoking cessation
program, perioperative risk Copyright © 2019

<15>
Accession Number
629634839
Title
Music Interventions in Percutaneous Coronary Procedures: A Meta-Analysis.
Source
Clinical nursing research. (pp 1054773819883171), 2019. Date of
Publication: 18 Oct 2019.
Author
Su S.-F.; Yeh W.-T.
Institution
(Su) Department of Nursing, National Taichung University of Science and
Technology, Taichung City, Taiwan (Republic of China)
(Yeh) Department of Nursing, Taichung Veterans General Hospital, Taichung
City, Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
To clarify the effectiveness of music intervention for improving the
well-being of patients undergoing coronary procedures for coronary heart
disease, we conducted full-text searches of various databases (MEDLINE,
Cochrane Library, CINAHL, ProQuest, and Airiti Library; 1966-2019) to
identify randomized controlled trials and quasi-experimental studies of
music intervention in recipients of angiography or percutaneous coronary
intervention. Outcome measures included anxiety, discomfort, pain, heart
rate, and blood pressure. The Cochrane methodology, Jadad Quality Score,
and ROBINS-I were employed to evaluate evidence from 10 studies. Music
intervention reduced anxiety (effect size: Z = 2.15, p = .03; six studies)
and discomfort of lying (Z = 2.40, p = .02; two studies), but did not
affect pain (Z = 0.94; two studies), heart rate (Z = 0.94; five studies),
or blood pressure (systolic, Z = 1.27; diastolic, Z = 1.32; four studies)
(all p > .05). The heterogeneity among studies was high. Large-scale,
transcultural, high-quality trials are warranted to confirm the benefit of
music intervention in patients undergoing coronary procedures.

<16>
Accession Number
629634825
Title
Is serum total bilirubin a predictor of prognosis in arteriosclerotic
cardiovascular disease? A meta-analysis.
Source
Medicine. 98 (42) (pp e17544), 2019. Date of Publication: 01 Oct 2019.
Author
Lan Y.; Liu H.; Liu J.; Zhao H.; Wang H.
Institution
(Lan) Vascular Medicine Center, Peking University Shougang Hospital,
Beijing, China
Publisher
NLM (Medline)
Abstract
The protective role of serum total bilirubin, a widely recognized
antioxidant, has been approved by numerous updating studies. However,
regarding the effect of high serum total bilirubin level (STBL) in
arteriosclerotic cardiovascular disease (ASCVD) are conflicting in
different sources of data. We, therefore, performed this meta-analysis to
evaluate the influence of STBL on risk of ASCVD.Four databases were used
to identify the literature with a date of search of January, 2019.
Finally, a total of 20 studies had been adopted. ASCVD was defined as
acute coronary syndrome, stable angina, coronary revascularization,
atherosclerotic stroke or transient ischemic attack, and peripheral
arterial disease (PAD). All relevant data were collected from studies
meeting the inclusion criteria.A total of 20 published studies (323,891
cases) met the inclusion criteria. The meta-analysis revealed that, in
studies excluding heterogeneity, STBL was significantly positively related
to in-hospital cardiovascular mortality (odds ratio [OR] 2.82, 95%
confidence interval [CI] 1.83-4.36, Z = 4.69, P < .001) and major adverse
cardiac events (OR 1.88, 95% CI 1.414-2.491, Z = 4.36, P < .001), also
negatively associated with prognosis of acute myocardial infarction,
pooled hazard ratio (HR) = 0.804 (95% CI 0.700-0.923, Z = 3.08, P = .002).
The correlation similarity was also reflected in terms of patients with
stroke (HR 0.78, 95% CI 0.70-0.88, Z = 4.24, P = .003). Combined analysis
revealed that lower STBL was significantly associated with PAD, pooled OR
= 0.91 (95% CI 0.85-0.98, Z = 2.39, P = .017). In general analysis, a
conclusion can be drawn, that higher STBL was significantly negative
correlated with cardiovascular disease, pooled HR = 0.83 (95% CI
0.73-0.94, Z = 3.02, P = .003).Higher STBL significantly improved the
prognosis of ASCVD; furthermore, STBL was an important factor in the
long-term prognosis of vascular-related disease prevention and can be used
as a predictor in vascular-related disease risk prediction.

<17>
Accession Number
629646393
Title
Transcatheter aortic valve replacement versus surgical aortic valve
replacement in low-surgical-risk patients: An updated meta-analysis.
Source
Catheterization and cardiovascular interventions : official journal of the
Society for Cardiac Angiography & Interventions. (no pagination), 2019.
Date of Publication: 21 Oct 2019.
Author
Goel S.; Pasam R.T.; Wats K.; Patel J.; Chava S.; Gotesman J.; Malik B.A.;
Frankel R.; Shani J.; Gidwani U.
Institution
(Goel, Pasam, Wats, Patel, Chava, Gotesman, Malik, Frankel, Shani)
Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, United
States
(Gidwani) Department of Cardiology, Icahn School of Medicine at Mount
Sinai, NY
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The purpose of this meta-analysis is to compare the safety and
efficacy of transcatheter aortic-valve replacement (TAVR) to surgical
aortic valve replacement (SAVR) in low-surgical-risk patients. BACKGROUND:
TAVR is proven to be safe and effective in patients with high- and
intermediate-risk aortic stenosis. However, there is limited data on the
safety and efficacy of TAVR in patients with low surgical risk.
 METHOD(S): We conducted an electronic database search of all
published data for studies that compared TAVR to SAVR in low-surgical-risk
patients (mean society for thoracic surgery [STS] score <4% and/or
logistic EuroScore <10%) and reported on subsequent all-cause mortality,
cardiac mortality, stroke rates, and other outcomes of interest. Event
rates were compared with a forest plot of odds ratio using a
random-effects model assuming interstudy heterogeneity. RESULT(S): A
total of seven studies (n = 6,293 patients; TAVR = 2,912; and SAVR =
3,381) were included in the final analysis. There was no significant
difference between TAVR and SAVR in terms of all-cause mortality (OR 0.82;
95% CI 0.50-1.36, I2 =51%), cardiac mortality (OR 0.57; 95% CI 0.32-1.02,
I2 =0%), new pacemaker implantation (OR = 3.11; 95% CI 0.58-16.60, I2 =
89%), moderate/severe paravalvular leak (PVL; OR 3.50; 95% CI 0.64-19.10,
I2 = 54%) and rate of stroke (OR 0.63; 95% CI 0.34-1.15, I2 =39%) at
1-year follow-up. TAVR was found to have a significantly lower incidence
of atrial fibrillation (AF; OR 0.15, 95% CI 0.10-0.24, I2 =38%) as
compared to SAVR. CONCLUSION(S): The results of our meta-analysis
demonstrate similar rates of all-cause mortality, cardiac mortality, and
stroke at 1-year follow-up in patients undergoing TAVR and SAVR. TAVR is
associated with a lower incidence of AF relative to SAVR. However, there
was a significantly higher incidence of PVL with TAVR compared to
SAVR. Copyright © 2019 Wiley Periodicals, Inc.

<18>
Accession Number
629646149
Title
Impact of diabetes mellitus on short term vascular complications after
TAVR: Results from the BRAVO-3 randomized trial.
Source
International journal of cardiology. (no pagination), 2019. Date of
Publication: 11 Oct 2019.
Author
Goel R.; Power D.; Tchetche D.; Chandiramani R.; Guedeney P.; Claessen
B.E.; Sartori S.; Cao D.; Meneveau N.; Tron C.; Dumonteil N.; Widder J.D.;
Hengstenberg C.; Ferrari M.; Violini R.; Stella P.R.; Jeger R.;
Anthopoulos P.; Deliargyris E.N.; Mehran R.; Dangas G.D.
Institution
(Goel, Power, Chandiramani, Claessen, Sartori, Cao, Mehran, Dangas) The
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York City, NY, United States
(Tchetche, Dumonteil) Groupe CardioVasculaire Interventionnel, Clinique
Pasteur, Toulouse, France
(Guedeney) Sorbonne Universite, ACTION Study Group, Institut de
Cardiologie, Pitie Salpetriere Hospital (AP-HP), Paris 1166, France
(Meneveau) Department of Cardiology, EA3920, University Hospital Jean
Minjoz, 25000, Besancon, France
(Tron) Division of Cardiology, CHU de Rouen, Rouen, France
(Widder) Department of Cardiology and Angiology, Hannover Medical School,
Hannover, Germany
(Hengstenberg) Department of Internal Medicine II, Division of Cardiology,
Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090,
Austria
(Ferrari) Helios Dr. Horst Schmidt Kliniken Wiesbaden, Germany
(Violini) Interventional Cardiology Unit, San Camillo Hospital, Via
Circonvallazione Gianicolense, Rome, Italy
(Stella) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Jeger) Department of Cardiology, University Hospital Basel, University of
Basel, Switzerland
(Anthopoulos) Arena Pharmaceuticals Inc., Zug, Switzerland
(Deliargyris) SpartaUnited States
Publisher
NLM (Medline)
Abstract
AIMS: The impact of diabetes mellitus (DM) on clinical outcomes after
transcatheter aortic valve replacement (TAVR) remains unclear. The aim of
this study was to investigate the impact of DM on short-term clinical
outcomes after TAVR in a large randomized trial population. METHODS AND
RESULTS: BRAVO-3 trial randomized 802 patients undergoing trans-femoral
TAVR to procedural anticoagulation with bivalirudin or unfractionated
heparin. The study population was divided according to the presence of DM,
and further stratified according to the use of insulin. Net adverse
cardiovascular outcomes (NACE - death, myocardial infarction (MI), stroke
or major bleeding by Bleeding Academic Research Consortium (BARC) type 3b
or above) was the primary outcome in-hospital and at 30-days. Of the total
802 randomized patients, 239 (30%) had DM at baseline, with 87 (36%) being
treated with insulin. At 30-days, DM patients experienced numerically
higher rates of net adverse cardiovascular events (16.3% vs. 14.4%,
p=0.48) and acute kidney injury (19.7% vs. 15.1%, p=0.11), while non-DM
(NDM) patients had numerically higher rates of cerebrovascular accidents
(3.6% vs. 1.7%, p=0.22). After multivariable adjustment, DM patients had
higher odds of vascular complications at 30-days (OR 1.57, p=0.03) and
life-threatening bleeding both in-hospital (OR 1.50, p=0.046) and at
30-days (OR 1.50, p=0.03) with the excess overall risk primarily
attributed to the higher rates observed among non-insulin dependent DM
patients. CONCLUSION(S): Patients with DM had higher adjusted odds of
vascular and bleeding complications up to 30-days post-TAVR. Overall,
there was no significant association between DM and early mortality
following TAVR. Copyright © 2019 Elsevier B.V. All rights
reserved.

<19>
Accession Number
629646020
Title
The challenge of non-adherence to early rehabilitation after coronary
artery bypass surgery: Secondary results from the SheppHeartCABG trial.
Source
European journal of cardiovascular nursing : journal of the Working Group
on Cardiovascular Nursing of the European Society of Cardiology. (pp
1474515119883454), 2019. Date of Publication: 19 Oct 2019.
Author
Hojskov I.E.; Thygesen L.C.; Moons P.; Egerod I.; Olsen P.S.; Berg S.K.
Institution
(Hojskov, Olsen, Berg) Heart Centre, University of Copenhagen, Denmark
(Hojskov) Department of Nursing and Nutrition Education. The Faculty of
Health Sciences, University College, Copenhagen, Denmark
(Thygesen) National Institute of Public Health, University of Southern
Denmark, Denmark
(Moons) Department of Public Health and Primary Care, University of
Leuven, Belgium
(Moons) Department of Pediatrics and Child Health, University of Cape
Town, South Africa
(Egerod) Department of Intensive Care Unit, Rigshospitalet, University of
Copenhagen, Denmark
Publisher
NLM (Medline)
Abstract
BACKGROUND: Attending and maintaining a cardiac rehabilitation programme
is a challenge. AIMS: The purpose of this study was to explore
associations between non-adherence to early coronary artery bypass graft
rehabilitation and sociodemographic and clinical baseline data.
 METHOD(S): Coronary artery bypass graft patients were randomised 1:1
to either four weeks of comprehensive early rehabilitation or usual care.
Outcomes were assessed at three time-points points: baseline, discharge
and four weeks post-coronary artery bypass graft. Differences in
sociodemographic and clinical baseline data in adherent versus
non-adherent patients were tested using the Pearson chi2 test for
categorical variables. To test associations between non-adherence to
exercise training and sociodemographic and clinical baseline data,
multivariate logistic regression was used to estimate the odds ratio for
in-hospital training and post-discharge training adjusted for age, sex and
left ventricular ejection fraction. RESULT(S): Non-adherence to
in-hospital versus post-discharge exercise training was 31% (n=48) versus
53% (n=81). Female non-adherence was 20% versus 70%. Non-adherence to
in-hospital versus post-discharge mindfulness was 87% versus 70%. Male
non-adherence to mindfulness was 85% versus 70%. Non-adherence to
psycho-educational consultations was 3%, most of whom were men. Patients
with university level education were more adherent to in-hospital exercise
training than patients with lower educational level (odds ratio=3.14 (95%
confidence interval; 1.16-8.51), p=0.02). Diabetic patients were more
non-adherent to exercise training after discharge (3.74 (1.54-9.08),
p=0.004) as were overweight patients (0.37 (0.17-0.80), p=0.01).
 CONCLUSION(S): This study demonstrated wide acceptance of
psycho-educational consultations in post-coronary artery bypass graft
patients. Adherence to physical rehabilitation was low especially after
discharge from hospital and the opportunity to attend a mindfulness
programme was not used.

<20>
Accession Number
629645492
Title
Sex-mismatch influence on survival after heart transplantation. A
systematic review and meta-analysis of observational studies.
Source
Clinical transplantation. (pp e13737), 2019. Date of Publication: 20 Oct
2019.
Author
Ayesta A.; Urrutia G.; Madrid E.; Vernooij R.W.M.; Vicent L.;
Martinez-Selles M.
Institution
(Ayesta) Servicio de cardiologia. Hospital Universitario Central de
Asturias. Oviedo. Asturias, Spain
(Urrutia) Institut d'Investigacio Biomedica Sant Pau (IIB Sant Pau),
Barcelona, Spain
(Urrutia) CIBER Epidemiologia y Salud Publica (CIBERESP), Spain
(Urrutia, Madrid, Vernooij) Centro Iberoamericano Cochrane. Barcelona,
Spain
(Madrid) Centro de Investigacion Biomedica. Facultad de Medicina,
Universidad de Valparaiso, Chile
(Madrid) Centro Interdisciplinar para Estudios de la Salud, Facultad de
Medicina Universidad de Valparaiso, Chile
(Vicent, Martinez-Selles) Servicio de Cardiologia. Hospital Universitario
Gregorio Maranon, Instituto de Investigacion Sanitaria Gregorio Maranon
(IiSGM), Spain
(Vicent, Martinez-Selles) Universidad Complutense de Madrid. Madrid, Spain
(Martinez-Selles) Universidad Europea de Madrid. Madrid, Spain
Publisher
NLM (Medline)
Abstract
INTRODUCTION AND OBJECTIVES: Heart transplantation (HT) is the treatment
for patients with end-stage heart disease. Despite contradictory reports,
survival seems to be worse when donor/recipient sex is mismatched. This
systematic review and meta-analysis aim to synthesize the evidence on the
effect of donor/recipient sex-mismatch after HT. METHOD(S): We
searched PubMed and EMBASE until November 2017. Comparative cohort and
registry studies were included. Published articles were systematically
selected and, when possible, pooled in a meta-analysis. The primary
endpoint was one-year mortality. RESULT(S): After retrieving 556
articles, ten studies (76,175 patients) were included in the quantitative
meta-analysis. Significant differences were found in one-year survival
between sex-matched and mismatched recipients (odds ratio (OR) 1.30, 95%
confidence interval (CI) 1.25-1.35, p < 0.001). In female recipients, we
found that sex mismatch was not a risk factor for one-year mortality (OR=
0.93, 95% CI = 0.85-1.00, p = 0.06). However, in male recipients, we found
that it was a risk factor for one-year mortality (OR= 1.38, 95% CI =
1.31-1.44, p < 0.001). CONCLUSION(S): Sex-mismatch increases one-year
mortality after HT in male recipients. Its influence in long-term survival
should be further explored with high-quality studies. Copyright ©
2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

<21>
Accession Number
629644590
Title
Prophylactic Noninvasive Ventilation Versus Conventional Care in Patients
After Cardiac Surgery.
Source
The Journal of surgical research. (no pagination), 2019. Date of
Publication: 16 Oct 2019.
Author
Liu Q.; Shan M.; Liu J.; Cui L.; Lan C.
Institution
(Liu, Shan, Lan) Department of Respiratory Mechanics Lab, First Affiliated
Hospital of Zhengzhou University, Zhengzhou, Henan, China
(Liu) Department of Thoracic Surgery, First Affiliated Hospital of
Zhengzhou University, Zhengzhou, Henan, China
(Cui) Department of Preventive Medicine, Epidemiology and Health
Statistics School of Public Health, Zhengzhou University, Zhengzhou,
Henan, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac surgery can be accompanied by postoperative
complications, which are associated with increased postoperative morbidity
and mortality. Therefore, it is necessary to investigate the effect of
prophylactic noninvasive ventilation (NIV) after extubation versus
conventional pulmonary care on complications after cardiac surgery.
MATERIALS AND METHODS: An electronic search of PubMed, Cochrane Library,
Ovid, and EMBASE was conducted to find randomized controlled trials which
compared the effect of prophylactic NIV with controlled strategies on
complications and which were published before April 2018. RESULT(S):
Ten studies (1011 patients) were included in the final analysis. The
atelectasis rate was 32.6% in the prophylactic-NIV group, which was lower
than that in the control group (48.71%). Prophylactic NIV could lower the
rate of atelectasis, reintubation, and other respiratory complications
(pleural effusion, pneumonia, and hypoxia) (odds ratio = 0.43, 0.33, and
0.45; 95% confidence interval: 0.21-0.88, 0. 13-0.84, 0.27-0.75; P = 0.02,
0.02, and 0.002, respectively). The effect on cardiac and distal organ
complications (P = 0.07) and hospital mortality (P = 0.62) might be
limited. CONCLUSION(S): Prophylactic NIV is associated with a lower
rate of postoperative pulmonary complications. The effect on the other
complications and hospital mortality might be limited. Further evidence
with randomized controlled trials can discern the benefits. Copyright
© 2019 The Authors. Published by Elsevier Inc. All rights reserved.

<22>
Accession Number
629644262
Title
NT-Pro BNP Predicts Myocardial Injury Post-Vascular Surgery and is Reduced
with CoQ10: A Randomized Double-Blind Trial.
Source
Annals of vascular surgery. (no pagination), 2019. Date of Publication: 17
Oct 2019.
Author
Carlson S.; Khan A.; Johnson D.K.; Hocum-Stone L.; Kelly R.F.; Gravely
A.A.; Mbai M.; Green D.L.; Santilli S.; Garcia S.; Adabag S.; McFalls E.O.
Institution
(Carlson, Hocum-Stone, Mbai, Adabag) Division of Cardiology, Minneapolis
VA Medical Center, Minneapolis, MN; University of Minnesota. Minneapolis,
MN
(Khan) University of Minnesota. Minneapolis, MN
(Johnson) Division of Cardiology, Minneapolis VA Medical Center, MN,
Minneapolis, United States
(Kelly) Division of Cardiothoracic Surgery, University of Minnesota, MN,
Minneapolis, United States
(Gravely) Minneapolis VA Medical Center. Department of Research
Statistical Center
(Green, Santilli) Division of Vascular Surgery, Minneapolis VA Medical
Center
(Garcia) Minneapolis Heart Institute. Minneapolis, MN
(McFalls) Division of Cardiology, Minneapolis VA Medical Center,
Minneapolis, MN; University of Minnesota. Minneapolis, MN. Electronic
address: mcfal001@umn.edu
Publisher
NLM (Medline)
Abstract
BACKGROUND: NT-Pro BNP levels provide incremental value in perioperative
risk assessment prior to major non-cardiac surgery. Whether they can be
pharmacologically modified in patients prior to an elective vascular
operation is uncertain. METHOD(S): A double-blind randomized
controlled trial was implemented at a single institution. Patients were
screened during their preoperative vascular clinic appointment and
randomly assigned to CoQ10 (400 mg per day) versus Placebo for 3 days
prior to surgery. Biomarkers including NT-Pro BNP, troponin I and
C-reactive protein were obtained prior to and following surgery for up to
48 hours. The primary end-point was postoperative NT-Pro BNP levels and
secondary end-point measures included myocardial injury, defined by an
elevated cardiac troponin level and length of stay. RESULT(S): One
hundred and twenty-three patients were randomized to receive either CoQ10
(N=62) versus Placebo (N=61) for 3 days before vascular surgery.
Preoperative cardiac risks included ischemic heart disease (N=52), CHF
(N=12), stroke (N=23) and diabetes mellitus (N=48) and the planned
vascular procedures were infra-inguinal (N=78), carotid (N=36), and
intraabdominal (N=9). There were no intergroup differences in these
clinical variables. NT-Pro BNP levels (median; IQs) in the CoQ10 and
Placebo groups were 179 (75-347) and 217 (109-585) pg/ml respectively
(P=0.08) preoperatively and 397 (211-686) and 591 (288-1433) pg/ml
respectively (P=0.01) at 24 hours following surgery. Patients with an
elevated NT-Pro BNP had a higher incidence of myocardial injury, (58%
versus 20%; P<0.01) and a longer hospital stay (4.4+/-3.8 versus 2.8+/-3.2
days; P<0.02) compared with individuals without an elevated NT-Pro BNP
level. CONCLUSION(S): NT-Pro BNP levels predict adverse events
post-vascular surgery and are lowered in those patients assigned to
preoperative administration of CoQ10. Copyright © 2019. Published
by Elsevier Inc.

<23>
Accession Number
629637892
Title
"Synchronous versus Staged Carotid Endarterectomy (CEA) and Coronary
Artery Bypass Graft (CABG) for Patients with Concomitant Severe Coronary
and Carotid Artery Stenosis: a Systematic Review and Meta-analysis".
Source
Annals of vascular surgery. (no pagination), 2019. Date of Publication: 16
Oct 2019.
Author
Tzoumas A.; Giannopoulos S.; Texakalidis P.; Charisis N.; Machinis T.;
Koullias G.J.
Institution
(Tzoumas) Medical School Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Giannopoulos) 251 HAF and VA Hospital, Athens, Greece
(Texakalidis) Department of Neurosurgery, Emory University School of
Medicine, Atlanta, United States
(Charisis) Department of Surgery, Division of Surgical Oncology, Stony
Brook University Hospital, Stony Brook, NY, United States
(Machinis) Department of Neurosurgery, Virginia Commonwealth University,
Richmond, VA, United States
(Koullias) Division of Vascular and Endovascular Surgery, Department of
Surgery, Stony Brook University Hospital, Stony Brook, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Due to the systemic nature of atherosclerosis, arteries at
different sites are commonly simultaneously affected. As a result, severe
Coronary Artery Disease (CAD) requiring Coronary Artery Bypass Graft
(CABG) frequently coexists with significant carotid stenosis that warrants
revascularization. OBJECTIVE(S): To compare simultaneous carotid
endarterectomy (CEA) and CABG vs. staged CEA and CABG for patients with
concomitant CAD and carotid artery stenosis in terms of peri-operative
outcomes. METHOD(S): This study was performed according to the PRISMA
guidelines. A meta-analysis was conducted with the use of a random effects
model. The I-square statistic was used to assess for heterogeneity.
 RESULT(S): Eleven studies comprising 44,895 patients were included in
this meta-analysis (21,710 in the synchronous group and 23,185 patients in
the staged group). The synchronous CEA and CABG group had a statistically
significant lower risk for myocardial infarction(MI)
(OR:0.15;95%CI:0.04-0.61;I2=0%) and higher risk for stroke
(OR:1.51;95%CI:1.34-1.71;I2=0%) and death
(OR:1.33;95%CI:1.01-1.75;I2=47.8%). Transient ischemic attacks (TIA)
(OR:1.27;95%CI:1.00-1.61;I2=0.0%), postoperative bleeding
(OR:0.82;95%CI:0.22-3.05;I2=0.0%) and pulmonary complications
(OR:1.52;95%CI:0.24-9.60;I2=67.5%) were similar between the two groups.
 CONCLUSION(S): Patients in the simultaneous CEA and CABG group had a
significantly higher risk of 30-day mortality and stroke and lower risk
for MI as compared to staged CEA and CABG group. The rates of TIA,
postoperative bleeding and pulmonary complications were similar between
the two groups. Future randomized trials or prospective cohorts are needed
to validate our results. Copyright © 2019 Elsevier Inc. All
rights reserved.

<24>
Accession Number
629636988
Title
Pericardial effusion under nivolumab: case-reports and review of the
literature.
Source
Journal for immunotherapy of cancer. 7 (1) (pp 266), 2019. Date of
Publication: 18 Oct 2019.
Author
Anastasia S.; Audrey M.-L.; Jennifer A.; Constance T.; Mariana M.;
Francois G.; Stephane O.; Laurence W.
Institution
(Anastasia, Laurence) Immunologie Clinique, AP/HP, Hopital Europeen
Georges Pompidou, Paris, France
(Anastasia, Audrey, Mariana, Francois, Stephane, Laurence) Universite
Paris Descartes, Sorbonne Paris-Cite, Paris, France
(Audrey) Anatomopathologie, AP/HP, Hopital Cochin, Paris, France
(Jennifer, Francois) Oncologie medicale, AP/HP, Hopital Cochin, Paris,
France
(Constance, Stephane) Oncologie medicale, AP/HP, Hopital Europeen Georges
Pompidou, Paris, France
(Mariana) Unite fonctionnelle de Cardio-oncologie et Prevention, AP/HP,
Hopital Europeen Georges Pompidou, Paris, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Nivolumab, a programmed death-1 (PD-1) inhibitor, is an immune
checkpoint inhibitor particularly used in the treatment of malignant
melanoma, non-small cell lung cancer and renal cell carcinoma.
Immune-related adverse events are frequent under immunotherapies.
Cardiotoxic side effects, initially thought to be rare, are more often
encountered paralleling the expanding use of immune checkpoint blockade.
Among them, pericardial effusion and tamponade deserve attention as they
may present with unusual symptomatology. CASE PRESENTATION: We report
three cases of pericardial effusion under nivolumab for lung
adenocarcinoma. Two cases of early and late-onset pericardial effusion
were symptomatic with tamponade and one case occurred without any
symptoms. Pericardiocentesis with pericardial biopsy was performed in
symptomatic pericardial effusion followed by the administration of a
corticotherapy. Pericardial biopsies showed infiltration of T-lymphocytes,
mostly CD4+. Nivolumab was stopped in two cases and resumed for one
patient. Pericardial effusion evolved positively in all cases with or
without treatment. CONCLUSION(S): We review the literature on
pericardial effusion under nivolumab to further discuss the hallmarks of
pericardial effusion under nivolumab and the management of nivolumab
therapy in this situation. In conclusion, pericardial effusion as an
immune-related adverse event under nivolumab appears less rare than
initially thought and may require particular attention.

<25>
Accession Number
629559386
Title
Early-Term Outcomes of Off-Pump versus On-Pump Beating-Heart Coronary
Artery Bypass Surgery.
Source
Thoracic and Cardiovascular Surgeon. 67 (7) (pp 546-553), 2019. Date of
Publication: 2019.
Author
Velioglu Y.; Isik M.
Institution
(Velioglu) Department of Cardiovascular Surgery, Faculty of Medicine,
Abant Izzet Baysal University, Bolu 14280, Turkey
(Isik) Department of Cardiovascular Surgery, Meram Faculty of Medicine,
Necmettin Erbakan University, Konya, Turkey
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background The current study analyzed and compared early-term outcomes of
off-pump versus on-pump beating heart coronary artery bypass surgery.
Methods a From January 2011 to January 2018, a total of 736 patients
underwent isolated first-time elective beating-heart coronary artery
bypass surgery without the use of aortic cross-clamping and cardioplegic
arrest at our institution, and they were included in this study. Data of
patients were collected and retrospectively analyzed. Patients were
divided into two groups according to the use of cardiopulmonary bypass
during the operation, as off-pump group (n = 399) and on-pump
beating-heart group (n = 337). Both groups were compared with each other
in terms of preoperative, intraoperative, and postoperative data. Results
a Groups were statistically similar with regard to baseline clinical
characteristics and demographics. When compared with off-pump group,
on-pump beating-heart group had a greater number of distal bypass, longer
length of hospital stay, and lower postoperative hematocrit level, and
received more blood product transfusion. No statistically significant
differences were detected between the groups with respect to mortality and
postoperative complications except for atrial fibrillation. Atrial
fibrillation was significantly frequent in on-pump beating-heart group.
Conclusion a Our study suggested that off-pump and on-pump beating-heart
coronary artery bypass procedures had similar early mortality and major
complication rates except for atrial fibrillation. However, it seemed that
off-pump procedure was superior to on-pump beating-heart procedure with
regard to length of hospital stay, blood product transfusion, and atrial
fibrillation development. Further prospective randomized studies with
larger patient series are needed to support our research and attain more
accurate data. Copyright © 2019 Georg Thieme Verlag KG Stuttgart
New York.

<26>
Accession Number
629559369
Title
Is There a Place for Thoracoscopic Enucleation of Esophageal
Gastrointestinal Stromal Tumors?.
Source
Thoracic and Cardiovascular Surgeon. 67 (7) (pp 585-588), 2019. Date of
Publication: 2019.
Author
Cohen C.; Pop D.; Icard P.; Berthet J.-P.; Venissac N.; Mouroux J.
Institution
(Cohen, Pop, Icard, Berthet, Venissac, Mouroux) Department of Thoracic
Surgery, Centre Hospitalier Universitaire de Nice, 30 Voie Romaine, Nice
Cedex 1 06001, France
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Esophageal gastrointestinal stromal tumors (E-GISTs) represent
less than 1% of all GISTs. The rarity of this lesion precludes the
realization of randomized studies, and its treatment remains a matter of
debate. We aimed to evaluate the feasibility of enucleation by
video-assisted thoracic surgery (VATS) for low- to intermediate-risk
E-GIST. Methods We performed a retrospective review of patients treated by
enucleation through VATS between January 2004 and January 2014 and
reviewed the literature. Results We included five patients (four men and
one woman). Mean age was 53 years (range: 49-79). Three patients were
diagnosed because of dysphagia and two others incidentally. The diagnosis
was made by immunostaining demonstrating CD117 expression on tumor cells.
The mitotic index of all E-GISTs was low (<= 5 per 50 high-power field).
Median postoperative follow-up was 5.5 years, and there was no recurrence.
Conclusion Thoracoscopic enucleation of E-GIST seems to represent a
valuable option as the postoperative morbidity/mortality is low and the
oncological outcome is good for low-to-intermediate grade of malignity
tumors. This is a retrospective study focused on minimally invasive
treatment of E-GIST. We evaluated the feasibility of VATS enucleation of
low-to-medium grade of malignity E-GIST. Copyright © 2019 Georg
Thieme Verlag KG Stuttgart New York.

<27>
Accession Number
2002908819
Title
In-Hospital Physiotherapy and Physical Recovery 3 Months After Lung Cancer
Surgery: A Randomized Controlled Trial.
Source
Integrative Cancer Therapies. 18 (no pagination), 2019. Date of
Publication: 2019.
Author
Jonsson M.; Ahlsson A.; Hurtig-Wennlof A.; Vidlund M.; Cao Y.; Westerdahl
E.
Institution
(Jonsson, Hurtig-Wennlof, Vidlund, Cao, Westerdahl) Orebro University,
Orebro, Sweden
(Ahlsson) Karolinska University Hospital, Stockholm, Sweden
(Cao) Karolinska Institutet, Stockholm, Sweden
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background. Lung cancer is the most frequently diagnosed cancer and one of
the leading causes of cancer deaths. Surgery is the primary approach for
curative treatment. Postoperative complications are common, and
physiotherapy is often routinely provided for their prevention and
treatment, even though the evidence is limited. The aim of this study was
to examine the effect of in-hospital physiotherapy on postoperative
physical capacity, physical activity, and lung function among patients
undergoing lung cancer surgery. Methods. A total of 107 patients
undergoing elective thoracic surgery were included in a single-blinded
randomized controlled trial, and randomized to a study group, receiving
in-hospital physiotherapy treatment, or a control group, not receiving
in-hospital physiotherapy treatment. The patients were assessed
preoperatively and 3 months after surgery. The in-hospital physiotherapy
treatment consisted of early mobilization, ambulation, breathing
exercises, and thoracic range of motion exercises. Physical capacity was
assessed with the 6-minute walk test. Level of physical activity was
objectively assessed with an accelerometer and subjectively assessed with
the International Physical Activity Questionnaire Modified for the
Elderly. Results. Physical capacity for the whole sample was significantly
decreased 3 months postoperatively compared with preoperative values (P
=.047). There were no statistically significant differences between the
groups regarding physical capacity, physical activity, spirometric values,
or dyspnea. However, patients in the study group increased their level of
self-reported physical activity from preoperatively to 3 months
postoperatively, while the patients in the control group did not.
Conclusions. No difference in physical capacity, physical activity, or
lung function was found 3 months postoperatively in lung cancer surgery
patients receiving in-hospital physiotherapy compared with control
patients. Copyright © The Author(s) 2019.

<28>
Accession Number
629644099
Title
Prevention of Stroke in Atrial Fibrillation after Coronary Stenting:
Systematic Review and Network Meta-Analysis.
Source
Stroke. 50 (8) (pp 2125-2132), 2019. Date of Publication: 01 Aug 2019.
Author
Knijnik L.; Rivera M.; Blumer V.; Cardoso R.; Fernandes A.; Fernandes G.;
Ferreira T.; Romano J.G.; Lambrakos L.K.; Cohen M.G.
Institution
(Knijnik, Fernandes, Fernandes, Ferreira) Department of Internal Medicine,
University of Miami Miller, School of Medicine, 1611 NW 12th Ave, Miami,
FL 33136, United States
(Lambrakos, Cohen) Cardiovascular Division, Department of Medicine,
University of Miami Miller, School of Medicine, FL, United States
(Romano) Department of Neurology, University of Miami Miller, School of
Medicine, FL, United States
(Rivera) Cardiovascular Division, Washington University, School of
Medicine, St. Louis, MO, United States
(Blumer) Cardiovascular Division, Duke University Hospital, Durham, NC,
United States
(Cardoso) Division of Cardiology, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose-The optimal antithrombotic strategy to balance
thromboembolic and bleeding events, especially acute stroke, for patients
with atrial fibrillation following coronary stenting remains a matter of
debate. We conducted a network meta-analysis to identify the
antithrombotic regimen associated with the lowest rate of bleeding and
thromboembolic events in atrial fibrillation after coronary stenting.
Methods-PubMed, Scopus, and Cochrane Central were searched for randomized
controlled trials and observational studies of patients with atrial
fibrillation after coronary stenting. The outcomes of interest were
stroke, myocardial infarction, major adverse cardiac events, mortality,
and major bleeding. A network meta-analysis was performed comparing the
available antithrombotic regimens in the literature. Results-Three
randomized and 15 observational studies were included, with a total of 23
478 participants. Median follow-up was 2 years. Network meta-analysis
demonstrated that Vitamin K antagonist plus single antiplatelet therapy or
direct-acting oral anticoagulant plus single antiplatelet therapy were the
most effective regimens in preventing stroke. Direct-acting oral
anticoagulant regimens were associated with lower major bleeding rates
than Vitamin K antagonist regimens. Regimens with dual antiplatelet
therapy were associated with lower rates of myocardial infarction. Vitamin
K antagonist plus dual antiplatelet therapy was associated with a lower
mortality and low-dose direct-acting oral anticoagulants with decreased
major cardiovascular adverse events. Conclusions-Direct-acting oral
anticoagulant regimens were associated with less major bleeding and major
cardiovascular adverse events, but Vitamin K antagonists were associated
with decreased mortality and stroke. These results suggest that the
decision of antithrombotic therapy in patients with atrial fibrillation
after percutaneous coronary intervention needs to be
individualized. Copyright © 2019 American Heart Association, Inc.

<29>
Accession Number
2003424845
Title
Ticagrelor Alone Versus Dual Antiplatelet Therapy From 1 Month After
Drug-Eluting Coronary Stenting.
Source
Journal of the American College of Cardiology. 74 (18) (pp 2223-2234),
2019. Date of Publication: 5 November 2019.
Author
Franzone A.; McFadden E.; Leonardi S.; Piccolo R.; Vranckx P.; Serruys
P.W.; Benit E.; Liebetrau C.; Janssens L.; Ferrario M.; Zurakowski A.;
Diletti R.; Dominici M.; Huber K.; Slagboom T.; Buszman P.; Bolognese L.;
Tumscitz C.; Bryniarski K.; Aminian A.; Vrolix M.; Petrov I.; Garg S.;
Naber C.; Prokopczuk J.; Hamm C.; Steg P.G.; Heg D.; Juni P.; Windecker
S.; Valgimigli M.
Institution
(Franzone, Piccolo) Department of Advanced Biomedical Sciences, Federico
II University of Naples, Naples, Italy
(McFadden) Cardialysis Core Laboratories and Clinical Trial Management,
Rotterdam, Netherlands
(McFadden) Department of Cardiology, Cork University Hospital, Cork,
Ireland
(Leonardi, Ferrario) University of Pavia and Fondazione IRCCS Policlinico
S. Matteo, Pavia, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Belgium
(Serruys) Department of Cardiology, Imperial College of London, London,
United Kingdom
(Benit) Department of Cardiology, Jessa Hospital, Hasselt, Belgium
(Liebetrau, Hamm) Department of Cardiology, Kerckhoff Heart and Thorax
Center, Bad Nauheim, Germany
(Liebetrau, Hamm) German Center for Cardiovascular Research (DZHK),
partner site RheinMain, Frankfurt am Main, Germany
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Zurakowski) Department of Interventional Cardiology, American Heart of
Poland SA, Chrzanow, Poland
(Diletti) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Dominici) S. Maria University-Hospital, Terni, Italy
(Huber) 3rd Medical Department, Cardiology, Wilhelminenhospital, and
Sigmund Freud University Medical School, Vienna, Austria
(Slagboom) Onze Lieve Vrouwe Gasthuis Amsterdam, Amsterdam, Netherlands
(Buszman) Center for Cardiovascular Research and Development, American
Heart of Poland, Sanatoryjna 1, Ustron, Poland
(Buszman) Department of Epidemiology and Statistics, Medical University of
Silesia, Poniatowskiego 15, Katowice, Poland
(Bolognese) Azienda Toscana Usl Sudest, Arezzo, Italy
(Tumscitz) Cardiology Unit Sant'Anna Hospital, Ferrara, Italy
(Bryniarski) Jagiellonian University Medical College, The John Paul II
Hospital, Krakow, Poland
(Aminian) Department of Cardiology, Centre Hospitalier Universitaire de
Charleroi, Charleroi, Belgium
(Vrolix) Ziekenhuis Oost Limburg, Genk, Belgium
(Petrov) Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
(Garg) East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
(Naber) Contilia Heart and Vascular Centre, Stadtspital Triemli, Zurich,
Switzerland
(Prokopczuk) Polsko-Amerykanskie Kliniki Serca Kozle, Kozle, Poland
(Steg) Hopital Bichat, AP-HP, Universite Paris-Diderot, Paris, France
(Heg) Institute of Social and Preventive Medicine and 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, University of Toronto,
Toronto, Ontario, Canada
(Windecker, Valgimigli) Department of Cardiology, Inselspital, University
of Bern, Bern, Switzerland
Publisher
Elsevier USA
Abstract
Background: The GLOBAL LEADERS (GLOBAL LEADERS: A Clinical Study Comparing
Two Forms of Anti-platelet Therapy After Stent Implantation) study
randomly assigned 15,991 patients undergoing percutaneous coronary
intervention to 1-month dual antiplatelet therapy (DAPT) followed by
23-month ticagrelor monotherapy or conventional 12-month DAPT followed by
12-month aspirin. Apart from Q-wave myocardial infarction (MI), all study
endpoints were analyzed as investigator reported. Objective(s): This
was a pre-specified ancillary study assessing whether experimental therapy
is noninferior, and if met, superior, to conventional treatment for the
coprimary efficacy endpoint of all-cause death, nonfatal MI, nonfatal
stroke, or urgent target vessel revascularization and superior in
preventing BARC 3 (Bleeding Academic Research Consortium) or 5 bleeding
(coprimary safety endpoint) at 2 years with a 0.025 significance level to
preserve nominal 5% alpha error. Method(s): An independent clinical
event committee adjudicated investigator-reported and eventually
unreported events of 7,585 patients from the 20 top-enrolling
participating sites. Result(s): The 2-year coprimary efficacy
endpoint occurred in 271 (7.14%) and in 319 (8.41%) patients in the
experimental and conventional groups, respectively (rate ratio [RR]: 0.85;
95% confidence interval [CI]: 0.72 to 0.99), fulfilling noninferiority (p
noninferiority <0.001), but not superiority (p superiority = 0.0465). The
rates of BARC 3 or 5 bleeding did not differ (RR: 1.00; 95% CI: 0.75 to
1.33; p = 0.986). A time-dependent treatment effect was observed with the
experimental strategy being associated with a lower risk of MI (RR: 0.54;
95% CI: 0.33 to 0.88; p interaction = 0.062) and definite stent thrombosis
(RR: 0.14; 95% CI: 0.03 to 0.63; p interaction = 0.007) after 1-year
post-percutaneous coronary intervention. Conclusion(s): Ticagrelor
monotherapy after 1-month DAPT was noninferior, but not superior, to
conventional treatment in the prevention of ischemic events, and it did
not decrease major bleeding risk as compared with conventional treatment.
(GLOBAL LEADERS Adjudication Sub-Study [GLASSY];
NCT03231059). Copyright © 2019 American College of Cardiology
Foundation

<30>
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

<31>
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

<32>
[Use Link to view the full text]
Accession Number
627462438
Title
Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute
Myocardial Infarction: Long-Term 6-Year Outcome of the Randomized
IABP-SHOCK II Trial.
Source
Circulation. 139 (3) (pp 395-403), 2019. Date of Publication: 15 Jan 2019.
Author
Thiele H.; Zeymer U.; Thelemann N.; Neumann F.-J.; Hausleiter J.;
Abdel-Wahab M.; Meyer-Saraei R.; Fuernau G.; Eitel I.; Hambrecht R.; Bohm
M.; Werdan K.; Felix S.B.; Hennersdorf M.; Schneider S.; Ouarrak T.; Desch
S.; De Waha-Thiele S.
Institution
(Thiele, Abdel-Wahab, Desch) Department of Internal Medicine/Cardiology,
Heart Center Leipzig, University of Leipzig, Strumpellstrase 39, Leipzig
04289, Germany
(Thiele, Abdel-Wahab, Desch) Leipzig Heart Institute, Germany
(Zeymer, Schneider, Ouarrak) Klinikum Ludwigshafen, Institut fur
Herzinfarktforschung, Germany
(Thelemann, Meyer-Saraei, Fuernau, Eitel, De Waha-Thiele) University Heart
Center, Luebeck, Germany
(Neumann) Heart Center Bad Krozingen, University of Freiburg, Germany
(Hausleiter) Klinikum der Ludwig-Maximilians, Universitat Munchen, Germany
(Abdel-Wahab) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Fuernau, Eitel, Desch, De Waha-Thiele) German Center for Cardiovascular
Research, Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany
(Hambrecht) Klinikum Links der Weser, Bremen, Germany
(Bohm) University Clinic of Saarland, Homburg/Saar, Germany
(Werdan) Department of Internal Medicine/Cardiology, Martin-Luther
University Halle-Wittenberg, Germany
(Felix) University Medicine Greifswald, Germany
(Hennersdorf) Department of Internal Medicine/Cardiology, SLK Kliniken
Heilbronn, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The role of intraaortic balloon counterpulsation (IABP) in
cardiogenic shock is still a subject of intense debate despite the neutral
results of the IABP-SHOCK II trial (Intraaortic Balloon Pump in
Cardiogenic Shock II) with subsequent downgrading in international
guidelines. So far, randomized data on the impact of IABP on long-term
clinical outcomes in patients with cardiogenic shock complicating acute
myocardial infarction are lacking. Furthermore, only limited evidence is
available on general long-term outcomes of patients with cardiogenic shock
treated by contemporary practice. Method(s): The IABP-SHOCK II trial
is a multicenter, randomized, open-label trial. Between 2009 and 2012, 600
patients with cardiogenic shock complicating acute myocardial infarction
undergoing early revascularization were randomized to IABP versus control.
 Result(s): Long-term follow-up was performed 6.2 years (interquartile
range 5.6-6.7) after initial randomization. Follow-up was completed for
591 of 600 patients (98.5%). Mortality was not different between the IABP
and the control group (66.3% versus 67.0%; relative risk, 0.99; 95% CI,
0.88-1.11; P=0.98). There were also no differences in recurrent myocardial
infarction, stroke, repeat revascularization, or rehospitalization for
cardiac reasons (all P>0.05). Survivors' quality of life as assessed by
the EuroQol 5D questionnaire and the New York Heart Association class did
not differ between groups. Conclusion(s): IABP has no effect on
all-cause mortality at 6-year long-term follow-up. Mortality is still very
high, with two thirds of patients with cardiogenic shock dying despite
contemporary treatment with revascularization therapy. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov/. Unique identifier:
NCT00491036. Copyright © 2018 American Heart Association, Inc.

<33>
Accession Number
625958818
Title
In HF with secondary mitral regurgitation, transcatheter mitral valve
repair reduced HF hospitalizations at 2 years.
Source
Annals of Internal Medicine. 170 (2) (pp JC7-JC8), 2019. Date of
Publication: 15 Jan 2019.
Author
Donato A.; Elgin E.
Institution
(Donato, Elgin) Tower Health System, West Reading, PA, United States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<34>
Accession Number
625958779
Title
A wearable cardioverter-defibrillator did not reduce arrhythmic death in
MI with reduced ejection fraction.
Source
Annals of Internal Medicine. 170 (2) (pp JC5), 2019. Date of Publication:
15 Jan 2019.
Author
Sullivan K.; Van Spall H.G.C.
Institution
(Sullivan, Van Spall) McMaster University, Hamilton, ON, Canada
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<35>
[Use Link to view the full text]
Accession Number
629493849
Title
Standard median sternotomy, right minithoracotomy, totally thoracoscopic
surgery, percutaneous closure, and transthoracic closure for atrial septal
defects in children: A protocol for a network meta-analysis.
Source
Medicine (United States). 98 (38) (no pagination), 2019. Article Number:
e17270. Date of Publication: 01 Sep 2019.
Author
Yi K.; Guo X.; You T.; Wang Y.; Ding F.; Hou X.; Zhou L.
Institution
(Yi, You, Ding, Hou) Department of Cardiovascular Surgery, Gansu
Provincial Hospital, No. 204, Dong gang West Road, Chengguan District,
Lanzhou City, Gansu Province, China
(Yi, You, Ding, Hou) International Congenital Heart Disease Diagnosis and
Treatment Reginal Center, Lanzhou, China
(Guo) First Clinical Medical College, Lanzhou University, Lanzhou, China
(Wang) Department of Endocrinology, Gansu Provincial Hospital, Lanzhou,
China
(Zhou) Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Atrial septal defect (ASD) is one of the most common congenital
heart diseases, with an average of 1.64 per 1000 newborns with the ASD.
Empirical studies suggest that surgery should be performed early in the
presence of right atrium and or right ventricular enlargement, even for
asymptomatic patients. Many surgical procedures can be used to treat ASD.
But which method is the best choice remains unclear. This study aims to
compare the efficacy and safety of standard median sternotomy, right
minithoracotomy, totally thoracoscopic surgery, percutaneous closure,
transcutaneous by echocardiography, and transcutaneous by radiotherapy for
ASDs in children using Bayesian network meta-analysis (NMA).
 Method(s):We will perform a comprehensive literature search using
PubMed, EMBASE.com, the Cochrane Library, Web of Science, and Chinese
Biomedical Literature Database to identify relevant studies from inception
to April 2019. Randomized controlled trials, prospective or retrospective
cohort studies that reported the efficacy and safety of surgical
procedures for the treatment of atrial septal defects will be included.
Risk of bias of the included randomized controlled trials and prospective
or retrospective cohort studies will be evaluated according to the
Cochrane Handbook 5.1.0 and the risk of bias in non-randomized studies of
interventions, respectively. A Bayesian NMA will be performed using R
3.4.1. Result(s):The results of this NMA will be submitted to a
peer-reviewed journal for publication. Conclusion(s):This NMA will
summarize the direct and indirect evidence to assess the efficacy and
safety of different surgical procedures for the treatment of ASDs.Ethics
and dissemination:Ethics approval and patient consent are not required as
this study is a network meta-analysis based on published trials.PROSPERO
registration number:CRD42019130902. Copyright © 2019 the
Author(s). Published by Wolters Kluwer Health, Inc.

<36>
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.

<37>
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.

<38>
Accession Number
2002496856
Title
Nicorandil prior to primary percutaneous coronary intervention improves
clinical outcomes in patients with acute myocardial infarction: A
meta-analysis of randomized controlled trials [letter].
Source
Drug Design, Development and Therapy. 13 (pp 2825-2826), 2019. Date of
Publication: 2019.
Author
Li J.; Zhang L.; Lu A.
Institution
(Li, Zhang, Lu) Department of Cardiology, The Second Clinical Medical
College of Jinan University, Shenzhen People's Hospital, Shenzhen 518020,
China
(Lu) Department of Cardiology, The Second Clinical Medical College of
Jinan University, Shenzhen People's Hospital, No.1017 Dongmen North Road,
Shenzhen 518020, China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)

<39>
Accession Number
629595543
Title
Forced diuresis with matched hydration during transcatheter aortic valve
implantation for Reducing Acute Kidney Injury: A randomized,
sham-controlled study (REDUCE-AKI).
Source
European Heart Journal. 40 (38) (pp 3169-3178), 2019. Date of Publication:
07 Oct 2019.
Author
Arbel Y.; Ben-Assa E.; Puzhevsky D.; Litmanowicz B.; Galli N.; Chorin E.;
Halkin A.; Sadeh B.; Konigstein M.; Bassat O.K.-B.; Steinvil A.; Bazan S.;
Banai S.; Finkelstein A.
Institution
(Arbel, Ben-Assa, Puzhevsky, Litmanowicz, Galli, Chorin, Halkin, Sadeh,
Konigstein, Steinvil, Bazan, Banai, Finkelstein) Department of Cardiology,
Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine,
Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
(Bassat) Department of Nephrology, Tel-Aviv Medical Center Affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st,
Tel-Aviv, Israel
Publisher
Oxford University Press
Abstract
Aims: Acute kidney injury (AKI) is a common complication following
transcatheter aortic valve implantation (TAVI) and is associated with
increased risk for short- and long-term mortality. In patients undergoing
percutaneous coronary intervention (PCI), forced diuresis with matched
hydration has been shown to reduce the incidence of AKI by ~50%. The aim
of the present study was to evaluate whether forced diuresis with matched
intravenous hydration reduces AKI in patients undergoing TAVI.
 Methods and Results: Reducing Acute Kidney Injury (REDUCE-AKI) was a
single-centre, prospective, randomized, double-blind sham-controlled
clinical trial, designed to examine the effect of an automated matched
saline infusion with urine output for the prevention of AKI in patients
undergoing TAVI. A total of 136 TAVI patients were randomized, 68 in each
group. Mean age was 83.9 +/- 5 years and 41.2% were males. There were no
differences in baseline characteristics between the two groups. The rate
of AKI was not statistically different between the groups (25% in the
active group vs. 19.1% in the sham group, P = 0.408). There was a
significant increase in long-term mortality in the active group (27.9% vs.
13. 2% HR 3.744, 95% CI 1.51-9.28; P = 0.004). The study was terminated
prematurely by the Data Safety Monitoring Board for futility and a
possible signal of harm. Conclusion(s): Unlike in PCI, forced
diuresis with matched hydration does not prevent AKI in patients
undergoing TAVI, and might be associated with increased long-term
mortality. Future studies should focus on understanding the mechanisms
behind these findings. Clinicaltrials.gov registration: NCT01866800, 30
April 2013. Copyright © 2019 Published on behalf of the European
Society of Cardiology. All rights reserved.

<40>
Accession Number
629595265
Title
The final meta-analysis?.
Source
European Heart Journal. 40 (38) (pp 3154-3155), 2019. Date of Publication:
07 Oct 2019.
Author
Webb J.G.; Landes U.
Institution
(Webb, Landes) Department of Cardiology, St. Paul's Hospital, Centre for
Heart Valve Innovation, University of British Columbia, 1081 Burrard
Street, Vancouver, BC V6Z 1Y6, Canada
Publisher
Oxford University Press

<41>
Accession Number
629594997
Title
Transcatheter aortic valve implantation vs. surgical aortic valve
replacement for treatment of symptomatic severe aortic stenosis: An
updated meta-analysis.
Source
European Heart Journal. 40 (38) (pp 3143-3153), 2019. Date of Publication:
07 Oct 2019.
Author
Siontis G.C.M.; Overtchouk P.; Cahill T.J.; Modine T.; Prendergast B.;
Praz F.; Pilgrim T.; Petrinic T.; Nikolakopoulou A.; Salanti G.;
Sondergaard L.; Verma S.; Juni P.; Windecker S.
Institution
(Siontis, Overtchouk, Praz, Pilgrim, Windecker) Department of Cardiology,
Bern University Hospital, Inselspital, University of Bern, Bern,
Switzerland
(Cahill) Department of Cardiology, Oxford Heart Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Modine) Institut Coeur-Poumon, Service de Chirurgie Cardiovasculaire,
Hopital Cardiologique, CHRU de Lille, 2 Av Oscar Lambret, Lille, France
(Prendergast) Department of Cardiology, St Thomas' Hospital, Westminster
Bridge Rd, London, United Kingdom
(Petrinic) Cairns Library, Oxford University Hospitals NHS Foundation
Trust, Oxford, United Kingdom
(Nikolakopoulou, Salanti) Institute of Social and Preventive Medicine
(ISPM), University of Bern, Mittelstrasse 43, Bern, Switzerland
(Sondergaard) Department of Cardiology, Heart Center, Rigshospitalet,
Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Juni) Department of Medicine, Institute of Health Policy, Management and
Evaluation, Applied Health Research Centre, Li Ka Shing Knowledge
Institute, St Michael's Hospital, University of Toronto, 30 Bond Street,
Toronto, ON, Canada
Publisher
Oxford University Press
Abstract
Aims: Owing to new evidence from randomized controlled trials (RCTs) in
low-risk patients with severe aortic stenosis, we compared the collective
safety and efficacy of transcatheter aortic valve implantation (TAVI) vs.
surgical aortic valve replacement (SAVR) across the entire spectrum of
surgical risk patients. Methods and Results: The meta-analysis is
registered with PROSPERO (CRD42016037273). We identified RCTs comparing
TAVI with SAVR in patients with severe aortic stenosis reporting at
different follow-up periods. We extracted trial, patient, intervention,
and outcome characteristics following predefined criteria. The primary
outcome was all-cause mortality up to 2 years for the main analysis. Seven
trials that randomly assigned 8020 participants to TAVI (4014 patients)
and SAVR (4006 patients) were included. The combined mean STS score in the
TAVI arm was 9.4%, 5.1%, and 2.0% for high-, intermediate-, and low
surgical risk trials, respectively. Transcatheter aortic valve
implantation was associated with a significant reduction of all-cause
mortality compared to SAVR {hazard ratio [HR] 0.88 [95% confidence
interval (CI) 0.78-0.99], P = 0.030}; an effect that was consistent across
the entire spectrum of surgical risk (P-for-interaction = 0.410) and
irrespective of type of transcatheter heart valve (THV) system
(P-for-interaction = 0.674). Transcatheter aortic valve implantation
resulted in lower risk of strokes [HR 0.81 (95% CI 0.68-0.98), P = 0.028].
Surgical aortic valve replacement was associated with a lower risk of
major vascular complications [HR 1.99 (95% CI 1.34-2.93), P = 0.001] and
permanent pacemaker implantations [HR 2.27 (95% CI 1.47-3.64), P < 0.001]
compared to TAVI. Conclusion(s): Compared with SAVR, TAVI is
associated with reduction in all-cause mortality and stroke up to 2 years
irrespective of baseline surgical risk and type of THV
system. Copyright © 2019 Published on behalf of the European
Society of Cardiology. All rights reserved.

<42>
Accession Number
628287464
Title
Video Technologies for Recording Open Surgery: A Systematic Review.
Source
Surgical Innovation. 26 (5) (pp 599-612), 2019. Date of Publication: 01
Oct 2019.
Author
Saun T.J.; Zuo K.J.; Grantcharov T.P.
Institution
(Saun, Grantcharov) St Michael's Hospital, Toronto, ON, Canada
(Saun, Zuo) University of Toronto, ON, Canada
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Video recording of surgical procedures is an important tool for surgical
education, performance enhancement, and error analysis. Technology for
video recording open surgery, however, is limited. The objective of this
article is to provide an overview of the available literature regarding
the various technologies used for intraoperative video recording of open
surgery. A systematic review was conducted in accordance with the
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA)
guidelines using the MEDLINE, Cochrane Central, and EMBASE databases. Two
authors independently screened the titles and abstracts of the retrieved
articles, and those that satisfied the defined inclusion criteria were
selected for a full-text review. A total of 2275 publications were
initially identified, and 110 were included in the final review. The
included articles were categorized based on type of article, surgical
subspecialty, type and positioning of camera, and limitations identified
with their use. The most common article type was primary-technical (29%),
and the dominant specialties were general surgery (22%) and plastic
surgery (18%). The most commonly cited camera used was the GoPro (30%)
positioned in a head-mount configuration (60%). Commonly cited limitations
included poor video quality, inadequate battery life, light overexposure,
obstruction by surgical team members, and excessive motion. Open surgery
remains the mainstay of many surgical specialties today, and technological
innovation is absolutely critical to fulfill the unmet need for better
video capture of open surgery. The findings of this article will be
valuable for guiding future development of novel technology for this
purpose. Copyright © The Author(s) 2019.

<43>
Accession Number
629360619
Title
Renal insufficiency and severe coronary artery disease: Should coronary
artery bypass grafting, off-pump coronary artery bypass grafting or
percutaneous coronary intervention be performed?.
Source
Current Opinion in Cardiology. 34 (6) (pp 645-649), 2019. Date of
Publication: 01 Nov 2019.
Author
Hayatsu Y.; Ruel M.; Sun L.Y.
Institution
(Hayatsu, Ruel) Division of Cardiac Surgery, University of Ottawa Heart
Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
(Sun) Division of Cardiac Anesthesiology, University of Ottawa Heart
Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
(Sun) School of Epidemiology and Public Health, University of Ottawa, ON,
Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of reviewChronic kidney disease (CKD) is an important determinant
of long-term survival. However, the optimal revascularization strategy for
patients with CKD is still controversial. Herein we review the impact of
different treatment modalities on the outcomes of patients with CKD.Recent
findingsCABG could confer better long-term outcomes than PCI in patients
with CKD, irrespective of CKD severity. CABG as compared with PCI may be
associated with improved long-term survival albeit higher short-term risk.
Off-pump as compared with on-pump CABG may be associated with better
short-term outcomes but no demonstrable long-term benefit. In CKD patients
who are treated with PCI, the use of drug-eluting stents may be associated
with better intermediate-term outcomes than bare metal stents.SummaryThere
is insufficient evidence to inform the optimal revascularization strategy
for patients with CKD and severe coronary artery disease. CABG as compared
with PCI confers greater long-term benefit but higher upfront risk. A
multidisciplinary, team-based evaluation based on individual patient
comorbidity, frailty and anatomical disease burden, is recommended when
making treatment decisions. Copyright © 2019 Wolters Kluwer
Health, Inc. All rights reserved.

<44>
Accession Number
629595761
Title
Aortic growth rates are not increased in Turner syndrome - A prospective
CMR study.
Source
European Heart Journal Cardiovascular Imaging. 20 (10) (pp 1164-1170),
2019. Date of Publication: 01 Oct 2019.
Author
Mortensen K.H.; Wen J.; Erlandsen M.; Trolle C.; Ringgaard S.; Gutmark
E.J.; Gutmark-Little I.; Andersen N.H.; Gravholt C.H.
Institution
(Mortensen, Wen, Trolle, Gravholt) Department of Endocrinology and
Internal Medicine, Medical Research Laboratories, Aarhus University
Hospital, Aarhus 8200 N, Denmark
(Mortensen) Cardiorespiratory Unit, Great Ormond Street Hospital for
Children NHS Foundation Trust, London WC1N 3JH, United Kingdom
(Erlandsen) Section for Biostatistics, Department of Public Health, Aarhus
University, Aarhus 8000 C, Denmark
(Ringgaard) MR Research Centre, Aarhus University Hospital, Aarhus 8200 N,
Denmark
(Gutmark) Department of Aerospace Engineering and Engineering Mechanics,
CEAS, University of Cincinnati, Cincinnati, OH 45221, United States
(Gutmark-Little) Division of Endocrinology, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH 45229, United States
(Andersen) Department of Cardiology, Aalborg University Hospital, Aalborg
9000, Denmark
(Gravholt) Department of Molecular Medicine, Aarhus University Hospital,
Aarhus 8200 N, Denmark
Publisher
Oxford University Press
Abstract
Background: Aortic disease is a key determinant of outcomes in Turner
syndrome (TS). The present study characterized aortic growth rates and
outcomes over nearly a decade in adult women with TS. Methods and
Results: Prospective observational study assessing aortic diameters twice
with cardiovascular magnetic resonance imaging in women with TS [N = 91;
mean follow-up 8.8 +/- 3.3 (range 1.6-12.6) years] and healthy age-matched
female controls [N = 37; mean follow-up 6.7 +/- 0.5 (range 5.9-8.1)
years]. Follow-up also included aortic outcomes and mortality,
antihypertensive treatment and ambulatory blood pressure. Aortic growth
rates were similar or smaller in TS, but the variation was larger. The
proximal aorta in TS grew by 0.20 +/- 0.26 (mid-ascending) to 0.32 +/-
0.36 (sinuses) mm/year. This compared to 0.26 +/- 0.14 (mid-ascending) and
0.32 +/- 0.17 (sinuses) mm/year in the controls. During 799 years at risk,
7 suffered an aortic outcome (1 aortic death, 2 aortic dissections, 2
aortic interventions, 2 surgical aortic listings) with further 2 aortic
valve replacements. At baseline, two women were excluded. One died during
subacute aortic surgery (severe dilatation) and one had a previously
undetected type A dissection. The combined aortic outcome rate was 1126
per 100 000 observation years. The aortic and all-cause mortality rates
were 1 per 799 years (125 deaths per 100 000 observation years) and 9 per
799 years (1126 deaths per 100 000 observation years). Aortic growth
patterns were particularly perturbed in bicuspid aortic valves (BAV) and
aortic coarctation (CoA). Conclusion(s): Aortic growth rates in TS
are not increased. BAVs and CoA are major factors that impact aortic
growth. Aortic outcomes remain a concern. Copyright © The
Author(s) 2019.

<45>
[Use Link to view the full text]
Accession Number
624892939
Title
A randomized, triple-blind trial of cardiac shock-wave therapy on exercise
tolerance and symptoms in patients with stable angina pectoris.
Source
Coronary Artery Disease. 29 (7) (pp 579-586), 2018. Date of Publication:
01 Nov 2018.
Author
Shkolnik E.; Burneikaite G.; Jakutis G.; Scherbak M.; Zuoziene G.;
Petrauskiene B.; Trush E.; Vasyuk Y.; Laucevicius A.; Celutkiene J.
Institution
(Shkolnik, Scherbak, Trush, Vasyuk) Moscow State University of Medicine
and Dentistry, Moscow, Russian Federation
(Shkolnik) Yale-New Haven Health Bridgeport Hospital, Bridgeport,
Connecticut, United States
(Burneikaite, Jakutis, Zuoziene, Petrauskiene, Celutkiene) Clinic of
Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of
Medicine, Vilnius University, Palangos Street 1/10-3, Vilnius 01117,
Lithuania
(Burneikaite, Zuoziene, Petrauskiene, Celutkiene) Vilnius University
Hospital, Santaros Klinikos, Centre of Cardiology and Angiology, Lithuania
(Laucevicius) Centre of Innovative Medicine, Vilnius, Lithuania
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Despite major advances in managing coronary artery disease and
continuous research on alternative techniques to enhance myocardial
perfusion and reduce symptoms, coronary artery disease is still one of the
leading causes of adult disability worldwide. Cardiac shockwave therapy
(CSWT) has shown promising results in the amelioration of myocardial
ischemia in experimental studies; however, clinical results are limited to
single-center, mostly uncontrolled and underpowered trials. The current
study aimed to evaluate whether CSWT can improve exercise tolerance and
relieve angina symptoms in addition to optimal medical treatment in
patients with stable angina. Participants and methods A prospective,
randomized, triple blind, sham-procedure-controlled study was carried out.
The primary endpoint was total exercise duration in the modified Bruce
treadmill test at the 6-month follow-up. The secondary endpoints were
changes in ST-segment depression during the treadmill test, angina
symptoms during the treadmill test, number of angina attacks per week,
number of sublingual nitroglycerin consumption per week, Canadian
Cardiovascular Society angina functional class, and the Seattle Angina
Questionnaire score at the 6-month follow-up. Patients were randomized at
a 1 : 1 ratio to optimal medical plus cardiac shock-wave therapy
(OMT+CSWT) and optimal medical therapy with sham procedure (OMT+placebo)
groups. Results The mean exercise time improved in both study arms - CSWT
and placebo treatment - at the 3- and 6-month follow-up, without a
significant difference between groups. The magnitude and frequency of peak
exercise ST-segment depression reduced significantly in the CSWT+OMT group
compared with the OMT+placebo group at the 6-month follow-up (51.4 vs.
90.6%, P=0.001). Percentage of angina-free patients increased
progressively in both groups throughout the study. The Seattle Angina
Questionnaire scores improved significantly in both arms for four of five
domains at the 3- and the 6-month follow-up. Numerically, although
insignificant, the decrease in the number of angina episodes was more
prominent in the OMT+CSWTgroup compared with the OMT+placebo group.
Conclusion The total exercise duration in the modified Bruce treadmill
test at the 6-month follow-up did not differ significantly in patients
treated with CSWT compared with optimal medical therapy alone. In
addition, CSWT exerted a neutral effect on the quality of life and level
of angina. Copyright © 2018 Wolters Kluwer Health, Inc. All
rights reserved.

<46>
Accession Number
2003355967
Title
Preoperative Anemia and Outcomes in Cardiovascular Surgery: Systematic
Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Padmanabhan H.; Siau K.; Curtis J.; Ng A.; Menon S.; Luckraz H.; Brookes
M.J.
Institution
(Padmanabhan, Siau, Menon, Brookes) Department of Gastroenterology, Heart
& Lung Centre, Wolverhampton, United Kingdom
(Curtis) Shrewsbury Health Library, Royal Shrewsbury Hospital, Shrewsbury,
United Kingdom
(Ng) Department of Cardiothoracic Anaesthesiology, Heart & Lung Centre,
Wolverhampton, United Kingdom
(Luckraz) Cardiothoracic Surgery Department, Heart Centre, American
Hospital Dubai, Oud Metha, Dubai, United Arab Emirates
Publisher
Elsevier USA
Abstract
Background: Preoperative anemia is common in patients scheduled for
cardiac surgery. However, its effect on postoperative outcomes remains
controversial. This meta-analysis aimed to clarify the impact of anemia on
outcomes after cardiac surgery. Method(s): A literature search was
conducted on MEDLINE, Embase, Cochrane, and Web of Science databases. The
primary outcome was 30-day postoperative or in-hospital mortality.
Secondary outcomes included acute kidney injury, stroke, blood
transfusion, and infection. A meta-analytic model was used to determine
the differences in the above postoperative outcomes between anemic and
nonanemic patients. Result(s): Of 1103 studies screened, 22 met the
inclusion criteria. Of 114,277 patients, 23,624 (20.6%) were anemic.
Anemia was associated with increased mortality (odds ratio [OR], 2.74; 95%
confidence interval [CI], 2.32-3.24; I2 = 69.6%; P <.001),
acute kidney injury (OR, 3.13; 95% CI, 2.37-4.12; I2 = 71.1%; P
<.001), stroke (OR, 1.46; 95% CI, 1.24-1.72; I2 = 21.6%; P
<.001), and infection (OR, 2.65; 95% CI, 1.98-3.55; I2 = 46.7%;
P <.001). More anemic patients were transfused than nonanemic patients
(33.3% vs 11.9%, respectively). No statistically significant association
was found between mortality and blood transfusion (OR, 1.35; 95% CI,
0.92-1.98; I2 = 83.7%; P =.12), but we were not able to compare
mortality with or without transfusion in those who were or were not
anemic. Conclusion(s): Preoperative anemia is associated with adverse
outcomes after cardiac surgery. These findings support the addition of
preoperative anemia to future risk prediction models and as a target for
risk modification. Copyright © 2019

<47>
Accession Number
2003346849
Title
Perioperative adverse events attributed to alpha2-adrenoceptor agonists in
patients not at risk of cardiovascular events: systematic review and
meta-analysis.
Source
British Journal of Anaesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Demiri M.; Antunes T.; Fletcher D.; Martinez V.
Institution
(Demiri, Antunes, Fletcher, Martinez) Service d'anesthesie, Hopital
Raymond-Poincare de Garches, Assistance Publique Hopitaux de Paris, Paris,
France
(Fletcher, Martinez) Institut National de la Sante et de la Recherche
Medicale, U-987, hopital Ambroise Pare F-92100, France
(Fletcher, Martinez) Universite Versailles Saint-Quentin, Versailles
F-78035, France
Publisher
Elsevier Ltd
Abstract
Background: Several systematic reviews have reported the benefits of
perioperative alpha2-adrenoceptor agonist use for various conditions, but
safety evidence is poorly documented. Method(s): We performed a
systematic review focusing on adverse events. We searched the MEDLINE,
Embase, LILACS, Cochrane, and Clinical Trials Register databases for RCTs
comparing the effects of alpha2-adrenoceptor agonists and placebo during
non-cardiovascular surgery under general anaesthesia, for any indication,
in patients not at risk of cardiovascular events. The primary outcome was
the incidence of severe adverse events during or after alpha2-adrenoceptor
agonist administration. The secondary endpoints were other adverse events.
A meta-analysis was carried out on the combined data. Evidence quality was
rated by the Grading of Recommendations Assessment, Development and
Evaluation method. Result(s): We included 56 studies (4868 patients).
Our review, based on moderate-quality evidence, revealed that hypotension
occurred frequently during the preoperative and postoperative periods, for
both clonidine and dexmedetomidine. Bradycardia was reported only with
dexmedetomidine. In contrast, dexmedetomidine seemed to protect against
intraoperative hypertension and tachycardia. Subgroup analysis suggested
that the risk of hypotension and bradycardia persisted after cessation of
treatment. Interestingly, intraoperative hypotension and postoperative
bradycardia were not observed with a bolus dosage of dexmedetomidine less
than 0.5 mug kg-1 or with continuous administration alone.
 Conclusion(s): The pooled data for the incidence of adverse events
associated with the use of alpha2-adrenoceptor agonists in various
perioperative contexts provided high-confidence evidence for a risk of
hypotension and bradycardia, and protective effects against hypertension
and tachycardia. Protocol Registration: CRD42017071583. Copyright
© 2019

<48>
Accession Number
2003409935
Title
The REDUCE FMR Trial: A Randomized Sham-Controlled Study of Percutaneous
Mitral Annuloplasty in Functional Mitral Regurgitation.
Source
JACC: Heart Failure. 7 (11) (pp 945-955), 2019. Date of Publication:
November 2019.
Author
Witte K.K.; Lipiecki J.; Siminiak T.; Meredith I.T.; Malkin C.J.; Goldberg
S.L.; Stark M.A.; von Bardeleben R.S.; Cremer P.C.; Jaber W.A.; Celermajer
D.S.; Kaye D.M.; Sievert H.
Institution
(Witte, Malkin) Leeds Institute for Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom
(Lipiecki) Clinique Pole Sanioyte Republique, Clermont Ferrand, France
(Siminiak) Poznan University of Medical Sciences, HCP Medical Center,
Poznan, Poland
(Meredith) Faculty of Medicine, Nursing and Health Sciences, Monash
University, Melbourne, Australia
(Goldberg) Tyler Heart Institute at Community Hospital of the Monterey
Peninsula, Monterey, CA, United States
(Goldberg, Stark) Cardiac Dimensions, Kirkland, WA, United States
(von Bardeleben) Department of Cardiology, University Medical Centre
Mainz, Mainz, Germany
(Cremer, Jaber) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Celermajer) Faculty of Medicine and Health, University of Sydney, New
South Wales, Australia
(Kaye) Department of Cardiology, Alfred Hospital, Melbourne, Victoria,
Australia
(Sievert) CardioVascular Center Sankt Katherinen, Frankfurt, Germany
(Sievert) Anglia Ruskin University, Chelmsford, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to evaluate the effects of the Carillon
device on mitral regurgitation severity and left ventricular remodeling.
 Background(s): Functional mitral regurgitation (FMR) complicates
heart failure with reduced ejection fraction and is associated with a poor
prognosis. Method(s): In this blinded, randomized, proof-of-concept,
sham-controlled trial, 120 patients receiving optimal heart failure
medical therapy were assigned to a coronary sinus-based mitral annular
reduction approach for FMR or sham. The pre-specified primary endpoint was
change in mitral regurgitant volume at 12 months, measured by quantitative
echocardiography according to an intention-to-treat analysis.
 Result(s): Patients (69.8 +/- 9.5 years of age) were randomized to
either the treatment (n = 87) or the sham-controlled (n = 33) arm. There
were no significant differences in baseline characteristics between the
groups. In the treatment group, 73 of 87 (84%) had the device implanted.
The primary endpoint was met, with a statistically significant reduction
in mitral regurgitant volume in the treatment group compared to the
control group (decrease of 7.1 ml/beat [95% confidence interval [CI]:
-11.7 to -2.5] vs. an increase of 3.3 ml/beat [95% CI: -6.0 to 12.6],
respectively; p = 0.049). Additionally, there was a significant reduction
in left ventricular volumes in patients receiving the device versus those
in the control group (left ventricular end-diastolic volume decrease of
10.4 ml [95% CI: -18.5 to -2.4] vs. an increase of 6.5 ml [95% CI: -5.1 to
18.2]; p = 0.03 and left ventricular end-systolic volume decrease of 6.2
ml [95% CI: -12.8 to 0.4] vs. an increase of 6.1 ml [95% CI: -1.42 to
13.6]; p = 0.04). Conclusion(s): The Carillon device significantly
reduced mitral regurgitant volume and left ventricular volumes in
symptomatic patients with functional mitral regurgitation receiving
optimal medical therapy. (Carillon Mitral Contour System for Reducing
Functional Mitral Regurgitation [REDUCE FMR]; NCT02325830) Copyright
© 2019 The Authors

<49>
Accession Number
628848549
Title
Dilated cardiomyopathy: from epidemiologic to genetic phenotypes: A
translational review of current literature.
Source
Journal of Internal Medicine. 286 (4) (pp 362-372), 2019. Date of
Publication: 01 Oct 2019.
Author
Reichart D.; Magnussen C.; Zeller T.; Blankenberg S.
Institution
(Reichart, Magnussen, Zeller, Blankenberg) University Heart Center
Hamburg, Hamburg, Germany
Publisher
Blackwell Publishing Ltd
Abstract
Dilated cardiomyopathy (DCM) is characterized by left ventricular
dilatation and, consecutively, contractile dysfunction. The causes of DCM
are heterogeneous. DCM often results from myocarditis, exposure to
alcohol, drugs or other toxins and metabolic or endocrine disturbances. In
about 35% of patients, genetic mutations can be identified that usually
involve genes responsible for cytoskeletal, sarcomere and nuclear envelope
proteins. Due to its heterogeneity, a detailed diagnostic work-up is
necessary to identify the specific underlying cause and exclude other
conditions with phenotype overlap. Patients with DCM show typical systolic
heart failure symptoms, but, with progress of the disease, diastolic
dysfunction is present as well. Depending on the underlying pathology, DCM
patients also become apparent through arrhythmias, thromboembolic events
or cardiogenic shock. Disease progression and prognosis are mostly driven
by disease severity and reverse remodelling within the heart. The worst
prognosis is seen in patients with lowest ejection fractions or severe
diastolic dysfunction, leading to terminal heart failure with subsequent
need for left ventricular assist device implantation or heart
transplantation. Guideline-based heart failure medication and device
therapy reduces the frequency of heart failure hospitalizations and
improves survival. Copyright © 2019 The Association for the
Publication of the Journal of Internal Medicine

<50>
[Use Link to view the full text]
Accession Number
629606899
Title
Effects of bronchial blockers on one-lung ventilation in general
anesthesia: A randomized controlled trail.
Source
Medicine (United States). 98 (41) (no pagination), 2019. Article Number:
e17387. Date of Publication: 01 Oct 2019.
Author
Zheng M.; Niu Z.; Chen P.; Feng D.; Wang L.; Nie Y.; Wang B.; Zhang Z.;
Shan S.; Kapritsou M.
Institution
(Zheng, Niu, Chen, Feng, Wang, Nie, Wang, Zhang, Shan) Department of
Anesthesiology, Cangzhou Central Hospital, No.16 Xinhua West Road,
Cangzhou, Hebei Province 061001, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Double-lumen bronchial tubes (DLBT) and bronchial blockers
(BB) are commonly used in the anesthesia for clinical thoracic surgery.
But there are few systematic clinical comparisons between them. In this
study, the effects of BB and DLBT on one-lung ventilation (OLV) are
studied. Method(s): The 200 patients with thoracic tuberculosis
undergoing thoracic surgery, were randomly assigned to group A (DLBT) and
group B (BB). Intubation time, hemodynamic changes (mean arterial pressure
[MAP], heart rate [HR]), and arterial blood gas indicators (arterial
partial pressure of carbon dioxide [PaCO<inf>2</inf>], arterial partial
pressure of oxygen [PaO<inf>2</inf>], airway plateau pressure [Pplat], and
airway peak pressure [Ppeak]) at 4 time points were recorded.
Complications such as hoarseness, pulmonary infection, pharyngalgia, and
surgical success rate were also evaluated postoperatively. Result(s):
Intubation times were shorter in group B. Both MAP and HR in group A were
significantly higher 1minute after intubation than before, but also higher
than those in group B. PaO<inf>2</inf> levels were lower in both groups
during (OLV) than immediately after anesthesia and after two-lung
ventilation (TLV), with PaO<inf>2</inf> being lower after 60minutes of OLV
than after 20minutes of OLV. Furthermore, at both points during OLV,
PaO<inf>2</inf> was lower in group A than in group B. No significant
differences in PaCO<inf>2</inf> were found between the 2 groups. Ppeak and
Pplat were increased in both groups during OLV, with both being higher in
group A than in group B. The incidence of postoperative hoarseness,
pulmonary infection, and pharyngalgia were lower in group B. There was no
significant difference in the success rate of operation between the 2
groups. Conclusion(s): Compare with using DLBT, implementation of BB
in general anesthesia has less impact on hemodynamics, PaO<inf>2</inf> and
airway pressures, and achieves lower incidence of postoperative
complication. Copyright © 2019 the Author(s). Published by
Wolters Kluwer Health, Inc.

<51>
Accession Number
628019094
Title
Sex-mismatched red blood cell transfusions and mortality: A systematic
review and meta-analysis.
Source
Vox Sanguinis. 114 (5) (pp 505-516), 2019. Date of Publication: July 2019.
Author
Zeller M.P.; Rochwerg B.; Jamula E.; Li N.; Hillis C.; Acker J.P.;
Runciman R.J.R.; Lane S.J.; Ahmed N.; Arnold D.M.; Heddle N.M.
Institution
(Zeller, Jamula, Li, Hillis, Runciman, Lane, Ahmed, Arnold, Heddle)
McMaster Centre for Transfusion Research, McMaster University, Hamilton,
ON, Canada
(Zeller) Canadian Blood Services, Medical Office, Hamilton, ON, Canada
(Zeller, Arnold, Heddle) Division of Hematology and Thromboembolism,
Department of Medicine, McMaster University, Hamilton, ON, Canada
(Rochwerg) Division of Critical Care, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Rochwerg) Department of Health Research Methods, Evidence & Impact,
McMaster University, Hamilton, ON, Canada
(Hillis) Department of Oncology, McMaster University, Hamilton, ON, Canada
(Acker) Department of Laboratory Medicine and Pathology, University of
Alberta, Edmonton, AB, Canada
(Acker) Centre for Innovation, Canadian Blood Services, Edmonton, AB,
Canada
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objectives: Selection of a compatible red blood cell (RBC)
unit does not include matching for donor sex. This systematic review and
meta-analysis aims to summarize the evidence examining the impact of
sex-mismatched RBC transfusion on recipient mortality. Material(s)
and Method(s): Ovid MEDLINE, Ovid EMBASE, CINAHL, PubMed, Web of Science
and the Cochrane Database of Systematic Reviews were searched from
inception up to 23 November 2018. Randomized controlled trials and
observational studies were included in the search. Eligible studies
reported on the impact of sex-matched compared to sex-mismatched RBC
transfusion on recipient mortality. Two investigators independently
extracted data and assessed study quality. A three-level meta-analytic
model was applied to emphasize the unknown dependence among the effect
sizes. Result(s): Five retrospective observational studies (n = 86
737) were included; no RCTs were found. Sex-mismatched RBC transfusions
were associated with a higher risk of death compared with sex-matched
transfusions (pooled hazard ratio [HR]: 1.13; 95% confidence interval
[CI]: 1.02-1.24). In the subgroup of cardiovascular surgery (n = 57 712),
there was no significant increase in mortality with sex-mismatched
transfusions (pooled HR: 1.08; 95% CI: 0.95-1.22). The data were prone to
confounding, selection bias and reporting bias. Certainty of the evidence
was very low. Conclusion(s): Sex-mismatched RBC transfusions were
associated with an increased risk of death in this pooled analysis.
However, the certainty of the evidence was very low from observational
studies. The need to match donor and recipient sex for transfusions
requires further investigation because of the potential widespread
impact. Copyright © 2019 International Society of Blood
Transfusion

<52>
Accession Number
2002712331
Title
Safety and efficacy of biatrial vs left atrial surgical ablation during
concomitant cardiac surgery: A meta-analysis of clinical studies with a
focus on the causes of pacemaker implantation.
Source
Journal of Cardiovascular Electrophysiology. 30 (10) (pp 2150-2163), 2019.
Date of Publication: 01 Oct 2019.
Author
Cappabianca G.; Ferrarese S.; Tutino C.; Corazzari C.; Matteucci M.;
Mantovani V.; Musazzi A.; De Ponti R.; Beghi C.
Institution
(Cappabianca, Ferrarese, Tutino, Corazzari, Matteucci, Mantovani, Musazzi,
De Ponti, Beghi) Department of Heart and Vessels, Ospedale di Circolo,
University of Insubria, Varese, Italy
(Cappabianca, Ferrarese, Tutino, Corazzari, Matteucci, Mantovani, Musazzi,
De Ponti, Beghi) Cardiac Surgery Research Center, University of Insubria,
Varese, Italy
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: The latest STS guidelines recommend concomitant atrial
fibrillation (AF) ablation not only during mitral surgery (Class IA) but
also during other-than-mitral cardiac surgery procedures (Class IB) in
patients with preoperative AF. Conventional Cox-Maze III/IV procedures are
performed on both atria (BA), but several studies reported excellent
results with left atrial only (LA) ablations: the scope of this study is
to compare the safety and efficacy of BA vs LA approach. Methods and
Results: Pubmed, Scopus, and WOS were searched from inception to November
2018: 28 studies including 7065 patients and comparing the performance of
BA vs LA approaches were identified: of these, 16 (57.1%) enrolled
exclusively patients with non-paroxysmal AF forms, 10 (35.7%) focused on
mitral surgery as main procedure, and 16 (57.1%) regarded patients
undergone Cox-Maze with radiofrequency. The 6- and 12-months prevalence of
sinus rhythm were higher in the BA group (OR, 1.37, CI, 1.09-1.73, P =.008
and OR, 1.37, CI, 0.99-1.88, P =.05 respectively). Permanent pacemaker
(PPM) implantation (OR, 1.85, CI, 1.38-2.49, P <.0001) and reopening for
bleeding (OR, 1.70, CI, 1.05-2.75, P =.03) were higher in the BA group.
Among patients undergone PPM implantation, BA group had a significantly
higher risk of sinoatrial node dysfunction (OR, 3.01, CI, 1.49-6.07, P
=.002). Conclusion(s): Concomitant BA ablation appears superior to LA
ablation in terms of efficacy but is associated with a higher risk of
bleeding and of PPM implantation, more frequently due to sinoatrial node
dysfunction. LA approach should be preferable in patients with a higher
risk of bleeding or with perioperative risk factors for PPM
implantation. Copyright © 2019 Wiley Periodicals, Inc.

<53>
[Use Link to view the full text]
Accession Number
625621581
Title
Fish Oil and Perioperative Bleeding.
Source
Circulation. Cardiovascular quality and outcomes. 11 (11) (pp e004584),
2018. Date of Publication: 01 Nov 2018.
Author
Akintoye E.; Sethi P.; Harris W.S.; Thompson P.A.; Marchioli R.; Tavazzi
L.; Latini R.; Pretorius M.; Brown N.J.; Libby P.; Mozaffarian D.
Institution
(Akintoye) Division of Cardiovascular Medicine, University of Iowa
Hospitals and Clinics (E.A.)
(Sethi, Harris, Thompson) Department of Internal Medicine, Sanford School
of Medicine, University of South Dakota
(Harris) OmegaQuant, LLC, Sioux Falls
(Marchioli) Cardiovascular Renal Metabolic Therapeutic Area, Medical
Strategy and Science, Therapeutic Science and Strategy Unit, Milan, United
States
(Tavazzi) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
(Latini) Department of Cardiovascular Research, IRCCS Istituto di Ricerche
Farmacologiche "Mario Negri", Milan, United States
(Pretorius) Division of Cardiothoracic Anesthesiology, Department of
Anesthesiology, Vanderbilt University Medical Center, Nashville, United
States
(Brown) Department of Pharmacology (N.B.) and Department of Medicine
(N.B.), Vanderbilt University School of Medicine, TN, Nashville, United
States
(Libby) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston
(Mozaffarian) Friedman School of Nutrition Science and Policy, Tufts
University, Boston
Publisher
NLM (Medline)
Abstract
Background Fish oil is among the most common natural supplements for
treatment of hypertriglyceridemia or prevention of cardiovascular disease.
However, concerns about theoretical bleeding risk have led to
recommendations that patients should stop taking fish oil before surgery
or delay in elective procedures for patients taking fish oil by some
health care professionals. Methods and Results We tested the effect of
fish oil supplementation on perioperative bleeding in a multinational,
placebo-controlled trial involving 1516 patients who were randomized to
perioperative fish oil (eicosapentaenoic acid+docosahexaenoic acid; 8-10 g
for 2-5 days preoperatively, and then 2 g/d postoperatively) or placebo.
Primary outcome was major perioperative bleeding as defined by the
Bleeding Academic Research Consortium. Secondary outcomes include
perioperative bleeding per thrombolysis in myocardial infarction and
International Society on Thrombosis and Hemostasis definitions, chest tube
output, and total units of blood transfused. Participants' mean (SD) age
was 63 (13) years, and planned surgery included coronary artery bypass
graft (52%) and valve surgery (50%). The primary outcome occurred in 92
patients (6.1%). Compared with placebo, risk of Bleeding Academic Research
Consortium bleeding was not higher in the fish oil group: odds ratio,
0.81; 95% CI, 0.53-1.24; absolute risk difference, 1.1% lower (95% CI,
-3.0% to 1.8%). Similar findings were seen for secondary bleeding
definitions. The total units of blood transfused were significantly lower
in the fish oil group compared with placebo (mean, 1.61 versus 1.92;
P<0.001). Evaluating achieved plasma phospholipid omega-3 polyunsaturated
fatty acids levels with supplementation (on the morning of surgery),
higher levels were associated with lower risk of Bleeding Academic
Research Consortium bleeding, with substantially lower risk in the third
(odds ratio, 0.30 [95% CI, 0.11-0.78]) and fourth (0.36 [95% CI,
0.15-0.87]) quartiles, compared with the lowest quartile. Conclusions Fish
oil supplementation did not increase perioperative bleeding and reduced
the number of blood transfusions. Higher achieved n-3-PUFA levels were
associated with lower risk of bleeding. These novel findings support the
need for reconsideration of current recommendations to stop fish oil or
delay procedures before cardiac surgery. Clinical Trial Registration URL:
https://www.clinicaltrials.gov . Unique identifier: NCT00970489.

<54>
Accession Number
629410197
Title
Comparison of the expression of cluster of differentiation (CD)39 and CD73
between propofol- and sevoflurane-based anaesthesia during open heart
surgery.
Source
Scientific reports. 8 (1) (pp 10197), 2018. Date of Publication: 05 Jul
2018.
Author
Oh C.-S.; Kim K.; Kang W.-S.; Woo N.-S.; Kang P.-S.; Kim J.-S.; Kim H.-R.;
Lee S.-H.; Kim S.-H.
Institution
(Oh, Kim, Kang, Woo, Kim) Department of Anaesthesiology and Pain Medicine,
Konkuk University Medical Centre, Konkuk University School of Medicine,
Seoul, South Korea
(Kang) Department of Anaesthesiology and Pain Medicine, Konyang University
Hospital, Konyang University College of Medicine, Daejeon, South Korea
(Kim) Department of Thoracic and Cardiovascular Surgery, Konkuk University
Medical Centre, Konkuk University School of Medicine, Seoul, South Korea
(Kim) Department of Anatomy and Cell Biology, Seoul National University
College of Medicine, Seoul, South Korea
(Lee) Department of Microbiology, Konkuk University School of Medicine,
Seoul, South Korea
(Lee, Kim) Department of Medicine, Institute of Biomedical Science and
Technology, Konkuk University School of Medicine, Seoul, South Korea
(Kim) Department of Infection and Immunology, Konkuk University School of
Medicine, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
High expression of cluster of differentiation (CD)39 and CD73 has
cardio-protective effects. We hypothesised that the expression of CD39 and
CD73 would differ between propofol- and volatile anaesthetic-based
anaesthesia in patients undergoing open heart surgery (OHS). The objective
of this prospective randomized trial was to compare the changes in CD39
and CD73 levels in CD4+ T cells between propofol- and sevoflurane-based
anaesthesia during OHS. The study randomly allocated 156 patients
undergoing OHS to a propofol or sevoflurane group. Blood was obtained
preoperatively and up to 48hours after weaning from cardiopulmonary bypass
(CPB). The expression levels of CD39 and CD73 in circulating CD4+ T cells,
serum cytokines and other laboratory parameters were analysed. The primary
outcome was the expression of CD39 and CD73 on CD4+ T cells. Demographic
data and perioperative haemodynamic changes did not show significant
differences between the two groups. The expression of CD39 and CD73 in the
sevoflurane group was significantly lower than in the propofol group
(P<0.001). Other laboratory findings including cardiac enzymes and
cytokine levels, did not show significant intergroup differences. Propofol
attenuated the decrease in CD39 and CD73 in circulating CD4+ T cells
compared to sevoflurane-based anaesthesia during OHS.

<55>
Accession Number
625565910
Title
Costs and benefits of Papacarie in pediatric dentistry: a randomized
clinical trial.
Source
Scientific reports. 8 (1) (pp 17908), 2018. Date of Publication: 17 Dec
2018.
Author
Bottega F.; Bussadori S.K.; Battisti I.D.E.; Vieira E.P.; Pompeo T.S.;
Winkelmann E.R.
Institution
(Bottega, Vieira, Pompeo) RS, Regional University of the Northwestern of
Rio Grande do Sul (UNIJUI), Ijui, Brazil
(Bussadori) Rehabilitation Sciences and Biophotonics Applied to Heath
Science, University of Nove of Julho (UNINOVE), Sao Paulo, Brazil
(Battisti) Federal University of Fronteira Sul (UFFS), RS, Cerro Largo,
Brazil
(Winkelmann) RS, Regional University of the Northwestern of Rio Grande do
Sul (UNIJUI), Ijui, Brazil
Publisher
NLM (Medline)
Abstract
Papacarie gel is an agent that eliminates the need for local anesthesia
and reduces the need for using a drill. However, there is no information
regarding the cost per procedure. Therefore we analyzed the cost, per
procedure, of Papacarie gel compared to the traditional method (drilling),
and performed a comparison between these methods of carious tissue
removal. A randomized clinical trial was performed with 24 children with
an average age of 5.9 years old. Of these children, 12 were boys and 12
were girls, which resulted in a total of 46 restorations. Patients were
separated into: Papacarie group (caries removal with the
chemical-mechanical method - Papacarie gel) and Drill group (caries
removal with the traditional method - drilling). Values of the materials
used in the procedures, heart rate (before, 5minutes during, and after
dental treatment), and the total consultation duration were recorded. A
level of significance of 5% was adopted. Papacarie had a lower cost per
procedure ($ 0.91) when compared to the traditional method ($ 1.58).
Papacarie provided a cost reduction of 42% compared to the traditional
method. Using local anesthesia ($ 2.17), the cost reduction increased to
58%. In the procedure using drill+Papacarie ($ 1.37), the cost reduction
was 33%. Heart rate, consultation duration, and number of restorations
were not statistically different. Papacarie shows an excellent cost
benefit for minimally invasive removal of carious tissue and is a feasible
alternative for public health care.

<56>
[Use Link to view the full text]
Accession Number
52164508
Title
Review of randomized clinical trials of donor management and organ
preservation in deceased donors: Opportunities and issues.
Source
Transplantation. 94 (5) (pp 425-441), 2012. Date of Publication: 15 Sep
2012.
Author
Dikdan G.S.; Mora-Esteves C.; Koneru B.
Institution
(Dikdan, Mora-Esteves, Koneru) Department of Surgerys, UMDNJ-New Jersey
Medical Schools, Medical Science Bldg, 185 South Orange Ave, Newark, NJ
07103, United States
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Given the static number of deceased donors, improvements in donor
management and organ preservation to increase the number and quality of
organs transplanted per donor are more pressing. Because controlled trials
provide the best evidence, we conducted a review of English-language
literature of trials in donor management and organ preservation to provide
a compendium and to promote additional discussion and studies.Eighty-seven
reports were retrieved: 13 on hemodynamic and fluid management, 7 on
immunosuppressants, 12 on preconditioning, 34 on preservation fluids, and
21 on pulsatile perfusion. Sixteen studies are ongoing. Although hormonal
therapy is used widely, additional studies are needed to determine the
benefit of thyroid hormone and insulin replacement and to optimize steroid
regimens. Dopamine's success in reducing kidney delayed graft function
highlights the opportunity for additional preconditioning trials of remote
ischemia, gases, opioids, and others. More rapid progress requires
addressing unique barriers in consent and research approval, legal
constraints precluding research in cardiac death donors, and streamlining
collaboration of multiple stakeholders. With little interest from
industry, federal funding needs to be increased.While the University of
Wisconsin solution still reigns supreme, several promising preservative
solutions and additives with not only biophysical but also pharmacological
effects are on the cusp of phase 1 to 2 trials. After nearly three decades
of uncertainty, the recent success of a European trial has reenergized the
topic not only of machine preservation of the kidney but also of other
organs evident by trials in progress. However, the costs of such technical
innovations merit the burden of rigorous proof from controlled trials.
Copyright © 2012 Lippincott Williams &Wilkins.

<57>
Accession Number
50984447
Title
Percutaneous mitral valve interventions: Overview of new approaches.
Source
Current Cardiology Reports. 12 (5) (pp 404-412), 2010. Date of
Publication: September 2010.
Author
Goldberg S.L.; Feldman T.
Institution
(Goldberg) University of Washington Medical Center, Seattle, WA, United
States
(Goldberg) Cardiac Dimensions, Inc., Kirkland, WA, United States
(Feldman) Evanston Hospital, Evanston, IL, United States
Publisher
Current Medicine Group LLC (400 Market St, Ste 700 Philadelphia PA 19106,
United States)
Abstract
The percutaneous management of valvular heart disease has recently been
receiving a great deal of interest as an area of great potential.
Innovative technologies are now being developed to treat mitral
regurgitation. Although there are established surgical techniques for
treating organic mitral regurgitation, the surgical management of
functional mitral regurgitation remains controversial, and such patients
have a poor prognosis. Therefore, a percutaneous treatment for functional
mitral regurgitation holds great clinical potential. Having a nonsurgical
approach available may be attractive to patients with organic mitral valve
regurgitation as well. Several approaches and devices have been designed
to treat specifically functional mitral regurgitation, and some of these
have been applied to humans in early-stage evaluations. The MitraClip
device (Abbott Laboratories, Abbott Park, IL) has been used to treat both
functional and degenerative mitral valve regurgitation and has been
compared to surgery in the EVEREST II (Endovascular Valve Edge-to-Edge
Repair Study II) randomized trial. Although the field of percutaneous
management of mitral regurgitation is at an early stage, it has been
demonstrated that percutaneous approaches can reduce mitral regurgitation,
suggesting there is a great deal of potential for clinical benefit to
patients with mitral regurgitation. © 2010 Springer Science+Business
Media, LLC.

<58>
Accession Number
2003407861
Title
PL02.06 In Hospital Clinical Efficacy, Safety and Oncologic Outcomes from
VIOLET: A UK Multi-Centre RCT of VATS Versus Open Lobectomy for Lung
Cancer.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S6), 2019. Date of
Publication: October 2019.
Author
Lim E.; Batchelor T.; Dunning J.; Shackcloth M.; Anikin V.; Naidu B.;
Belcher E.; Loubani M.; Zamvar V.; Brush T.; Dabner L.; Harris R.;
Phillips D.; Beard C.; Mckeon H.; Paramasivan S.; Elliott D.; Rojas A.R.;
Stokes E.; Wordsworth S.; Blazeby J.; Rogers C.; Trialists T.V.
Institution
(Lim, Trialists) Royal Brompton Hospital, London, United Kingdom
(Batchelor) Bristol Hospitals NHS Trusts, Bristol, United Kingdom
(Dunning) The James Cook University Hospital, Bw, United Kingdom
(Shackcloth) Thoracic Surgery, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Anikin) Thoracic Surgery, Royal Brompton & Harefield NHS Foundation
Trust, London, United Kingdom
(Naidu) University Hospitals Birmingham, Ss, United Kingdom
(Belcher) John Radcliffe Hospital, Du, United Kingdom
(Loubani) Hull and East Yorkshire Hospitals NHS Trust, Jq, United Kingdom
(Zamvar) Royal Infirmary Edinburgh, Sa, United Kingdom
(Brush, Dabner, Harris, Phillips, Beard, Mckeon, Paramasivan, Elliott,
Rojas, Blazeby, Rogers) Clinical Trials and Evaluation Unit Bristol, Hw,
United Kingdom
(Stokes, Wordsworth) Nuffield Department of Population Health, Lf, United
Kingdom
Publisher
Elsevier Inc.
Abstract
Background: VATS is currently the most popular form of access for lung
cancer resection in the UK. However, there is limited comparative
information from high quality randomised controlled trials and no
information on early oncologic outcomes for quality assurance for a
minimal access approach. VIOLET is the largest randomised trial conducted
to date to compare clinical efficacy, safety and oncologic outcomes of
VATS versus open surgery for lung cancer. Method(s): VIOLET is a
parallel group randomised trial conducted across 9 UK thoracic surgery
centres. Participants with known or suspected primary lung cancer were
randomised in a 1:1 ratio to VATS (one to four ports) or open lobectomy.
Randomisation was stratified by surgeon. Patients within clinical stage
cT1-3, N0-1 and M0 using TNM 8 with disease suitable for VATS or open
surgery were eligible to join the trial. We report on early outcomes in
the period from randomisation to hospital discharge after surgery.
 Result(s): From Jul 2015 to Feb 2019, 2,109 patients were screened to
randomise 503 participants to VATS (n=247) or open (n=256) lobectomy. The
mean age (SD) was 69 (8.8) years and 249 (49.5%) were male. Baseline
clinical T category was cT1 333 (67.3%), cT2 125 (25.2%), cT3 37 (7.5%)
with cN0 466 (94%) and cN1 30 (6%). Lobectomy was undertaken in 221
(89.5%) patients randomised to VATS and 232 (90.6%) patients randomised to
open surgery. The in-hospital mortality rate was 1.4% (7/502) and the
conversion rate from VATS to open was 5.7% (14/246) with the main reasons
listed as pleural adhesions (n=4) and bleeding (n=4). There were no
differences in R0 resection; which was 98.8% (218/223) in the VATS group
and 97.4% (228/234) in the open group; P=0.839 or in nodal upstaging from
cN0/1 to pN2 disease which was observed in 6.2% (15/244) of the VATS group
and 4.8% (12/252) of the open group; P=0.503. The median (visual analogue)
pain score was 4 (interquartile range, IQR 2 to 5) in both groups on day
one with 3 (1 to 5) in the VATS group and 4 (2 to 5) in the open group on
day two. A significant reduction of overall in-hospital complications was
observed in patients receiving VATS at 32.8% (81/247) compared to open
44.3% (113/255) surgery; P=0.008 without any difference in serious adverse
events between the two groups, which was 8.1% (20/247) for VATS and 7.8%
(20/255) for open surgery; P=0.897. Patients randomised to VATS had a
shorter median (IQR) length of stay of 4 (3 to 7) versus 5 (3 to 8) days
compared to patients randomised to open surgery, P=0.008.
 Conclusion(s): In early stage lung cancer, VATS lobectomy is
associated with significantly lower in-hospital complications and shorter
length of stay compared to open lobectomy. This was achieved without any
compromise to early oncologic outcomes (pathologic complete resection and
upstaging of mediastinal lymph nodes) nor any difference in serious
adverse events in the early post-operative period. Keywords: VATS,
Thoracic surgery, Early lung cancer Copyright © 2019

<59>
Accession Number
2003407246
Title
GR01.05 Site of Oligometastases.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S82), 2019. Date of
Publication: October 2019.
Author
Van Schil P.
Institution
(Van Schil) Thoracic and Vascular Surgery, Antwerp University Hospital,
Belgium, Belgium
Publisher
Elsevier Inc.
Abstract
The concept of oligometastatic disease representing patients with only a
few or "oligo"metastases, is a relatively new entity in thoracic oncology
and surgery [1-2]. Most probably, an intermediate state exists between
patients with locoregional disease without distant metastases and those
with multiple metastatic involvement in one or more distant organs. The
International Association for the Study of Lung Cancer (IASLC) adopted
this concept and in the 8th Tumor-Node-Metastasis (TNM) edition
a new category was introduced representing those patients with a single
metastasis in a single distant organ, currently M1b involvement [3]. These
patients belong to stage IVA, as well as patients with contralateral
malignant nodules. In contrast, multiple metastases in a single or
multiple distant organs are currently described as M1c disease, and they
are grouped together in the new stage IVB category. In the IASLC database
patients with clinical stage IVA disease had a median survival time (MST)
and 5-year survival rate of 11.5 months and 10%, respectively, in contrast
to 6.0 months and 0% for patients with stage IVB disease [4]. No consensus
exists on the precise definition of oligometastatic disease. For this
reason, the European Organisation of Research and Treatment of Cancer
(EORTC) created a task force to propose a definition of synchronous
oligometastatic disease based on consensus by thoracic oncology experts
[5]. A maximum of 5 metastases and 3 organs is proposed. Diffuse serosal
metastases (meningeal, pericardial, pleural, mesenteric) as well as bone
marrow involvement are not accepted as specific site as these cannot be
treated with radical intent. Is the specific organ involved important in
management and prognosis of these patients? Patients with contralateral
lung nodules, brain, bone and adrenal metastases are mostly reported in
literature as these organs are quite accessible for local ablative
treatment by surgical excision or stereotactic radiotherapy. For patients
with bilateral / contralateral tumor nodules introduced in the IASLC
prospective database by the electronic data capture (EDC) system, MST was
12 months, quite similar to patients with ipsilateral pleural/pericardial
effusion. Although the numbers were quite small, for those patients with a
single adrenal metastasis introduced by EDC, MST was 6.5 months, for a
single bone metastasis 12.6 months, and for a single brain metastasis 12.1
months [3]. These survival times were significantly better than those for
patients with multiple lesions at a single site. In general, most survival
data are from retrospective series with an inherent selection or
publication bias. For this reason, the EORTC decided not to consider the
specific organ involved but this may change when more prospective data
become available. Are there any predictive factors for survival in
patients with oligometastatic disease? In an individual patient data
meta-analysis of 757 patients with 1-5 synchronous or metachronous
metastases from non-small cell lung cancer (NSCLC), predictive factors
were synchronous versus metachronous metastases, N stage and
adenocarcinoma histology [6]. Surgery was the most frequently used
treatment, as well for the primary tumor as for the metastatic
involvement. Low-risk patients had metachronous metastases, the
intermediate risk group presented with synchronous metastases and N0
disease, and the high-risk group with synchronous disease and thoracic
lymph node involvement. So, adequate lymph node staging should be
performed in every patient [7]. May combined modality therapy including
locoregional ablative treatment by stereotactic radiotherapy or surgery
improve prognosis in patients with oligometastatic disease? A recent
landmark trial investigated the role of local ablative therapy in patients
with stage IV NSCLC with three or fewer metastases remaining after
first-line systemic therapy [8]. In this multicentre, controlled phase II
study 49 patients were randomized between local consolidative therapy
group consisting of surgery, radiotherapy or a combination with the aim of
ablating all residual disease, and maintenance treatment which was chosen
from a predefined list of regimens approved by the Food and Drug
Administration (FDA). Primary endpoint was progression-free survival.
Secondary outcomes were overall survival, safety and tolerability, time to
progression of previous metastatic lesions, time to appearance of new
metastatic lesions, and quality of life. Most frequent metastatic sites
were brain, bone, adrenal gland, pleura and metastatic lung lesions.
Significantly longer progression-free and overall survival rates were
noted in the local consolidative therapy group than in the maintenance
treatment group. Time to the appearance of a new lesion was longer among
patients in the local consolidative therapy group than among patients in
the treatment group. Survival after progression was also longer in the
local consolidative group [8]. Regarding specific management of
oligometastatic disease related to the site of involvement, the European
Society of Medical Oncology (ESMO) recently published clinical practice
guidelines for metastatic NSCLC including oligometastatic disease [9]. In
the presence of a solitary metastatic site on imaging studies, efforts
should be made to obtain a cytological or histological confirmation of
stage IV disease. Stage IV patients with one to three synchronous
metastases at diagnosis may experience long-term disease-free survival
following systemic therapy and local consolidative therapy (high-dose
radiotherapy or surgery). Because of the limited evidence, these patients
should be discussed within a multidisciplinary tumor (MDT) board and
inclusion in clinical trials is preferred. Although operative risk is low
and long-term survival may be achieved, current evidence for surgery in
oligometastatic disease is limited, and the relative contribution of
surgery versus radiotherapy as local treatment modality has not been
established yet. Solitary lesions in the contralateral lung should, in
most cases, be considered as synchronous secondary primary tumors and, if
possible, treated with curative-intent therapy [9]. Finally, even salvage
surgery may be considered in highly selected patients with oligometastatic
disease to improve long-term outcome [10]. References: 1. Pfannschmidt J.
Lung Cancer. 2010;69:251-8 2. Shields' General Thoracic Surgery, 8th
edition 2019, pp. 1289-90 3. Eberhardt WE. J Thorac Oncol. 2015;10:1515-22
4. Goldstraw P. J Thorac Oncol 2016; 11:39-51 5. Dingemans AM. IASLC
19th WCLC 2018; abstract MA25.02 6. Ashworth AB. Clin Lung
Cancer 2014;15:346-55 7. Fernandez R. J Thorac Dis 2019;
11(Suppl.7):S969-S975 8. Gomez DR. J Clin Oncol 2019 May 8; 9. Planchard
D. Ann Oncol 2018; 29(Suppl. 4):iv192-iv237 10. Duchateau N. Ann Thorac
Surg 2017;103:e409-e11. Copyright © 2019

<60>
Accession Number
2003407223
Title
CS01.04 NSCLC OMD is Defined by a Fixed Maximum Number of Metastases, Not
Technical Reasons of Local Treatment.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S79), 2019. Date of
Publication: October 2019.
Author
Wright G.
Institution
(Wright) Division of Cancer Surgery, Peter Maccallum Cancer Centre,
Melbourne, VIC, Australia
Publisher
Elsevier Inc.
Abstract
Other than a select group of patients with solitary brain metastases and
cT1-2a N0 resectable primary cancers, the idea of aggressively ablating
metastatic non-small cell lung cancer (NSCLC) has always been considered
unconventional. The resectable solitary cerebral metastasis has
traditionally yielded better results than any other M1b disease, and this
has been put down to careful selection and perhaps a different biology in
these rare cases. It wasn't until the publication of a large individual
patient data meta analysis in 20141 that more general treatment
of OMD could be benchmarked and taken seriously enough to consider
clinical trials. This confirmed that in select populations, long-term
survival was achievable by surgical or radio-ablation of a small number of
metastases. Only 1.9% of the series had more than 3 metastases and only 3%
of the series had multi-organ disease. A main finding of multivariate
analysis was that those with any nodal disease (effectively another
metastatic site) did poorly. The definition of the oligometastatic disease
state (OMD) has always been elusive. In principle, it is defined as M1a-c
disease with low metastatic burden (usually up to three or five lesions)
and limited organ involvement (usually up to two sites). It is considered
an intermediate condition between truly localized disease and widely
metastatic disease. The reporting bias of 1-3 metastases seen in so many
published treatment series is tacit acknowledgement that OMD only
encompasses three or fewer metastases, and probably to just a single
organ. Our own IALSC TNM staging system recognizes this in our M1
sub-stages. Unlike oligo-metastatic colorectal carcinoma, sarcoma or renal
cell carcinoma, which have reproducibly achieved long term survival after
pulmonary metastasectomy (and/or hepatic metastasectomy) for several
decades, the pace of disease and apparent inevitability of shortened
lifespan in a patient with metastatic NSCLC has led to self-regulation of
this practice for our tumour specialty. The relatively poorer average
cardio-pulmonary fitness of patients with lung cancer and the maxim of
'first do no harm' largely tempered any enthusiasm. As surgery has become
increasingly less invasive/morbid, and therapies such as stereotactic
ablative body radiotherapy (SABR) and radiofrequency ablation have become
more readily available, the temptation is to expand indications for
intervention well beyond their evidence base and/or cost-benefit ratio.
The last 5 years has seen a proliferation of publications of
eyebrow-raising SABR series outside of any clinical trial protocols. This
is a slippery slope that surgeons have been accused of sliding down in
pulmonary metastasectomy for colorectal carcinoma2. We must not
let our enhanced ability to inflict therapy dictate whether or not a
condition is appropriate to treat. The definition of OMD cannot be
stretched arbitrarily to match our technological capabilities or we will
waste huge resources and inevitably cause some harm by way of futile
overtreatment. The 'breakthrough' SABR-COMET trial3 has
invigorated discussion and enthusiasm for treating NSCLC oligometastatic
disease on the basis that overall survival was superior with ablation of
OMD (41 months) compared to the control group treated with palliative
measures (28 months). This enthusiasm does need to be tempered by a few
salient observations. Firstly, this was a phase 2 trial of mixed
histologies with 66 recruits in the treatment arm and 33 in the control
arm. In all, only 18 enrolled patients had NSCLC, with 12 in the treatment
arm. It is indeterminate from the paper how well these particular NSCLC
patients performed and the confidence intervals would be wide. The
follow-up tail becomes decidedly 'bushy' after 1 year due to censorship.
There were three treatment-related deaths and four other serious adverse
effects not seen in the control arm. The control rate was less optimistic
than in Rusthoven's phase 1 trial4, with 75% having no
progression in targeted lesions (compared to 49% in the control arm). The
most telling information supporting the <=3 metastasis OMD hypothesis is
the number of metastases and number of organs involved in the recruited
SABR-COMET patients. Only 7 recruits had more than 3 metastases, with 5 of
these receiving SABR. It is not clear if ANY of these had NSCLC, but these
are not dissimilar numbers to the aforementioned NSCLC meta
analysis1. Historically, there is far more data on survival
after metastasectomy for series excluding NSCLC. Only 1% of pulmonary
metastasectomies in the International Registry of Lung
Metastases5 had NSCLC and some may have been second primaries.
Whilst 26% of cases had >=4 metastases resected, this was largely confined
to sarcoma and germ cell tumours, where aggressive resection and
re-resection is considered standard of care. Their survival was still
inferior to patients with either solitary or 2-3 metastases. This is
despite the likelihood that patients with >=4 metastases are
"hyper-selected", based on survival characteristics such as performance
status, younger age, excellent fitness, anatomical location and favourable
observed tumour behaviour. This creates a false impression that this group
is receiving not dissimilar survival benefit as the cohort with ablation
of 1-3 metastases. OMD as a hypothesis is very reasonable and deserves to
be tested. Diluting the potential benefits by expanding that definition to
match our technological wizardry is not. Clinical trial resources would be
better mobilized to further study surgical and/or SABR metastasectomy in
lung cancer with <=3 metastases in a single organ before expanding
umbrella trials to >=4 metastases. References 1. Ashworth, A. B. et al. An
individual patient data metaanalysis of outcomes and prognostic factors
after treatment of oligometastatic non-small-cell lung cancer. Clin Lung
Cancer 15, 346-355 (2014). 2. Treasure, T., Internullo, E. & Utley, M.
Resection of pulmonary metastases: a growth industry. Cancer Imaging 8,
121-124 (2008). 3. Palma, D. A. et al. Stereotactic ablative radiotherapy
for comprehensive treatment of oligometastatic tumors (SABR-COMET): Study
protocol for a randomized phase II trial. BMC Cancer 12, 8 (2012). 4.
Rusthoven, K. E. et al. Multi-institutional phase I/II trial of
stereotactic body radiation therapy for lung metastases. J. Clin. Oncol.
27, 1579-1584 (2009). 5. Pastorino, U. et al. Long-term results of lung
metastasectomy: prognostic analyses based on 5206 cases. The Journal of
Thoracic and Cardiovascular Surgery 113, 37-49 (1997). Keywords:
metastasectomy, oligometastasis, Stereotactic Copyright © 2019

<61>
Accession Number
2003406942
Title
MS11.04 Surgical Resection of SCLC - Not so Obsolete Any Longer.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S177-S178), 2019. Date
of Publication: October 2019.
Author
Lyons G.
Institution
(Lyons) Thoracic Surgery, Buenos Aires British Hospital, Argentina,
Argentina
Publisher
Elsevier Inc.
Abstract
More than 2 million new lung cancer cases were detected worldwide in 2018,
and small cell lung cancer (SCLC) represents about 13-15 % of all lung
cancers. Although surgery was initially regarded as the treatment of
choice for all types of lung cancer, it was abandoned for SCLC almost 30
years ago after the results of the Medical Research Council (MRC)
randomized trial conducted by Fox et al. in 1973, which showed poor mean
survival for the surgical group when compared to the RT group (6.5 months
vs. 10 months, P = 0.04). (1) These results led to the abandonment of
surgery as a standard treatment in favor of chemotherapy. Two subsequent
meta-analyses revealed that the addition of thoracic radiation to systemic
chemotherapy improved survival, and that has become the standard of care.
(2) After the introduction of TNM classification, investigators proposed
that surgery was postulated to be indicated in limited-SCLC, particularly
stage T1, N0, with 5-year survival rates of as high as 52.6% for stage 1
disease. (3) Further, surgical resection after induction chemoradiotherapy
demonstrated a control of local relapse in almost 100% of the patients and
5- and 10-year survival rates for patients with stage IIB to IIA were 39%
and 35%, respectively, for all patients (resected or not) and 44% and 41%
for patients treated with a trimodality approach including adjuvant
surgery. (4) Another argument for surgical resection is that the final
histology of SCLC might reveal a component of NSCLC in 11-25% cases. (5)
In a recent series of Wakeam et al. including 2,089 patients with SCLC
undergoing surgery who were matched 1:1 to those undergoing NST, surgery
was associated with longer survival for stage I (median overall survival
[OS] 38.6 months vs. 22.9 months), for stage II (median OS 23.4 months vs.
20.7 months), and stage IIIA (median OS 21.7 vs. 16.0 months. In analyses
by T and N stage, longer OS was observed in resected patients with stage
T3/T4 N0 (median OS 33.0 vs. 16.8 months, p=0.008) and node positivity
(N1+ 24.4 vs. 18.3 months p=0.03; N2+ 20.1 vs. 14.6 months p=0.007). (6) A
recent meta-analysis that included a total of 41,483 patients concluded
that surgical resection was associated with superior OS in stage I (HR =
0.56, 95% CI: 0.49-0.64, p< 0.001), stage II (HR = 0.75, 95% CI:
0.57-0.99, P = 0.04), and stage III diseases (HR = 0.70, 95% CI:
0.56-0.88, P = 0.002). (11) Unlike stage I disease, there is no consensus
for surgery in stage II and stage IIIA SCLC. Surgical resection is
concordant with NCCN and ASCO guidelines; however, evidence shows that in
the vast majority of T1 and T2 N0M0 patients, surgery is not offered in
the absence of any documented contraindication. Rostadt et al., in a
series of 2,442 patients with SCLC, found out that 26% were stages IA and
IB and thus candidates for surgical resection, while only 38 patients
(1.5%) underwent surgical therapy. (8) CT screening identifies SCLC at an
earlier stage - with better survival - than usual care and offers the hope
that more SCLC patients may become long-term survivors. Austin et al.
carried out a multinational study of baseline and annual repeat CT
screenings of 48,037 volunteers at risk for lung cancer. (9) They found 48
SCLC cases, 92% of which were asymptomatic at diagnosis. Clinical stage
was IA in 16 patients (33%), II in 5 (11%), III in 20 (42%), and IV in 7
(15%). Estimated cure rates were 36% overall and 54% for the clinical
stage I cases. Conclusion(s): Surgical resection is indicated in SCLC
in stages I and IIA after precise staging including mediastinoscopy.
Patients should receive systemic therapy after resection and mediastinal
radiation therapy in cases with nodal metastases. Surgical resection in
stages I and IIA SCLC is concordant with NCCN and ASCO guidelines;
however, surgery is offered only in one-third of the patients in the
absence of any documented contraindication. CT screening identifies SCLC
at an earlier stage and offers the hope that more SCLC patients may be
candidates for surgical resection and become long-term survivors. Selected
cases in stages IIB and IIIA may be candidates for surgery as part of the
multidisciplinary treatment. References: 1) Fox W, Scadding JG. Medical
Research Council comparative trial of surgery and radiotherapy for primary
treatment of small-celled or oat-celled carcinoma of bronchus. Ten-year
follow-up. Lancet. 1973; 2: 63-5.) 2) Pignon JP, Arriagada R, Ihde DC, et
al. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N
Engl J Med. 1999;341:476-484. Warde P, Payne D. Does thoracic irradiation
improve survival and local control in limited-stage small-cell carcinoma
of the lung? A meta-analysis. J Clin Oncol. 1992;10:890-895.) 3) Schreiber
D, Rineer J, Weedon J, Vongtama D, Wortham A, Kim A, et al. Survival
outcomes with theuse of surgery in limited-stage small cell lung cancer:
should its role be re-evaluated? Cancer. 2010;116: 1350-57. 4) Eberhardt
W, Korfee S. New approaches for small-cell lung cancer: Local treatments.
Cancer Control 2003;10:289-96. 5) Asamura H, Kameya T, Matsuno Y, Noguchi
M, Tada H, Ishikawa Y, et al. Neuroendocrine neoplasms of the lung: A
prognostic spectrum. J Clin Oncol 2006;24:70-6.) 6) Wakeam E, Acuna SA,
Leighl NB, Giuliani ME, Finlayson SRG, Varghese TK, et al. Surgery Versus
Chemotherapy and Radiotherapy For Early and Locally Advanced Small Cell
Lung Cancer: A Propensity-Matched Analysis of Survival. Lung Cancer. 2017;
109: 78-88. 7) Liu T, Chen Z, Dang J, Li G (2018) The role of surgery in
stage I to III small cell lung cancer: A systematic review and
meta-analysis. PLoS ONE 13(12): e0210001. 8) Hans Rostadt, Anne Naalsundb,
Randi Jacobsena, Trond Eirik Stranda, Helge Scottc, Erik Heyerdahl Stromc,
Jarle Norsteina. Should more patients have been offered surgical therapy?
European Journal of Cardio-thoracic Surgery 26 (2004) 782-786) 9) Austin
JH, Yip R, D'Souza BM, Yankelevitz DF, Henschke CI, International Early
Lung Cancer Action Program Investigators. Small-cell carcinoma of the lung
detected by CT screening: stage distribution and curability. Lung Cancer.
2012 76(3): 339-43.) Keywords: surgery, small cell lung
cancer Copyright © 2019

<62>
Accession Number
2003406482
Title
IBS10.01 Surgerical Treatment of Tracheal Tumours.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S99-S100), 2019. Date of
Publication: October 2019.
Author
Klepetko W.
Institution
(Klepetko) Thoracic Surgery, Medical University Vienna, Vienna, Austria
Publisher
Elsevier Inc.
Abstract
Tracheal tumors are relatively rare and account only for <1% of all
malignant diseases.1 The most common types of primary tracheal
tumors are squamous cell carcinoma and adenoid cystic carcinoma, which
represent together two thirds of all primary tracheal tumors.2
Additionally, patients with secondary tracheal tumors might benefit from
resection of the tumor including the trachea. Surgical procedures
involving the trachea require a meticulous pre-operative planning,
advanced surgical techniques and infrastructural prerequisites. Therefore,
surgical resections of tracheal tumors are highly elective procedures at
specialized centers. The preoperative work-up includes the histological
verification of the tumor via bronchoscopy, which is usually combined with
the determination of the estimated extend of resection. Moreover,
radiologic imaging, preferably PET-CT, completes the tumor staging.
Patients with locally advanced and initially unresectable tracheal tumors
might be candidates for neoadjuvant therapy. Usually, neoadjuvant
treatment consisting of sole chemotherapy is preferred, as radiation
therapy may negatively impact the anastomotic healing. If the patient
received induction therapy, the radiological imaging as well as the
bronchoscopic evaluation has to be repeated after completion of the
induction therapy to confirm the response to the therapy and to plan the
surgical procedure. The most common approaches for tracheal resection
include cervicotomy, partial or complete sternofissure, and posterolateral
thoracotomy. The optimal surgical approach has to be chosen according the
location and extent of the tumor. During surgery, special care should be
taken to preserve the lateral blood supply of the trachea, to protect the
recurrent nerves and to avoid excessive tension on the anastomosis.
Inadequate surgical technique increases the risk for anastomotic
insufficiency, which is a potentially life-threatening complication. In
the literature, anastomotic complications (i.e. partial or complete
dehiscence, granuloma or re-stenosis) occur in approximately 9% cases
after tracheal surgery. The risk for anastomotic complications increases
with the length of resection, diabetes mellitus and previous
treatments.3 As the airway in tracheal surgery has to be shared
with the anesthesiologist, an appropriate ventilation strategy during
induction of anesthesia, surgical preparation and at the end of the
surgical procedure has to be defined. Although the double-lumen tube is
routinely used in thoracic surgery, it has only a negligible role in
airway surgery. The preferably used devices in airway surgery are the
laryngeal mask, single-lumen endotracheal tube, high-frequency jet
ventilation catheters and cross-table ventilation using a sterile
endotracheal tube. Moreover, extracorporal membranoxygenation (ECMO)
support is a valid option for selected, complex resections. It provides
the advantage to operate on the patient without any airway device in the
surgical field. A veno-venous ECMO is sufficient to fully substitute
respiration. However, cardiorespiratory support by a veno-arterial ECMO
configuration might be a valid option in some patients. In summary, the
ventilation strategy is dependent on the location of the location,
availability of devices, experience of the team and personal preferences.
Therefore, planning the ventilation strategy is crucial for a successful
surgical procedure. Similar to the surgical treatment of other solid
malignancies, the major aim of tracheal surgery is the radical resection
of the tumor including all loco-regional lymph nodes. The adenoid-cystic
carcinoma represents an exemption from this rule. Due to its low-malignant
tumor biology and the susceptibility to radiotherapy, even incomplete
resection is acceptable in this tumor entity. As the adenoid-cystic
carcinoma is characterized by a longitudinal, submucosal growth pattern
(Figure 1), there might be a discrepancy between the resection length
needed to obtain a complete resection and the technical possibility to
perform a tension-free anastomosis. An incomplete resection combined with
an adjuvant radiation therapy is therefore a valid treatment option in
patients with adenoid-cystic carcinoma. Radiotherapy can be initiated as
bronchoscopy confirms complete healing of the anastomosis approximately
6-8 weeks after surgery. Although the treatment of patients with tracheal
tumors is demanding, an excellent perioperative and long-term outcome of
patients with tracheal tumors can be achieved. In experienced hands, the
peri-operative mortality after tracheal resection is <1%.4
Moreover, surgery in multimodality treatment concept provides a very good
long-term overall survival, which is especially true for adenoid- cystic
carcinoma in which a 5-year overall survival up to 91% can be
achieved.5 In summary, the surgical treatment of tracheal
tumors is technically demanding and should therefore be performed at
high-volume centers. Within the heterogeneity of tracheal tumors, the
adenoid-cystic carcinoma represents a unique tumor entity. Embedded in a
multimodal treatment concept, excellent long-term outcome can be achieved
despite incomplete surgical resection. After careful planning by a
multidisciplinary team, even extended tracheal resections for malignant
disease can be performed safely with a very low morbidity and mortality.
[Figure presented] 1. Grillo HC. Surgery of the trachea and bronchi.
Hamilton, Ont.; Lewiston, NY: BC Decker; 2004. 2. Mallick S, Benson R,
Giridhar P, Rajan Singh A, Rath GK. Demography, patterns of care and
survival outcomes in patients with malignant tumors of trachea: A
systematic review and individual patient data analysis of 733 patients.
Lung Cancer. 2019;132:87-93. 3. Wright CD, Grillo HC, Wain JC, et al.
Anastomotic complications after tracheal resection: prognostic factors and
management. The Journal of thoracic and cardiovascular surgery.
2004;128(5):731-739. 4. Auchincloss HG, Wright CD. Complications after
tracheal resection and reconstruction: prevention and treatment. J Thorac
Dis. 2016;8(Suppl 2):S160-167. 5. Urdaneta AI, Yu JB, Wilson LD.
Population based cancer registry analysis of primary tracheal carcinoma.
Am J Clin Oncol. 2011;34(1):32-37. Copyright © 2019

<63>
Accession Number
2003406120
Title
ES16.01 Proton Therapy.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S53), 2019. Date of
Publication: October 2019.
Author
Faivre-Finn C.
Institution
(Faivre-Finn) Department of Radiotherapy Related Research, The
Christie-University of Manchester, Manchester, United Kingdom
Publisher
Elsevier Inc.
Abstract
Proton therapy is an attractive option for the treatment of lung cancer
patients due to the physical properties of proton beams. Proton therapy
allows a focused delivery of radiation at the Bragg peak, with very steep
decline of the radiation dose beyond the target volume. These properties
offer the possibility to 1) reduce toxicity by reducing the integral dose
and the dose to adjacent normal tissues and 2) escalate the dose to the
target in some patients. In this talk, I will summarise briefly the
physics/radiobiology of protons and the need for adaptation. I will also
discuss the rationale for the use of protons in patients with lung cancer,
including reduction in integral dose, cardiac toxicity and reduction in
haematological toxicity. The clinical trial evidence supporting the use of
protons will be presented in early stage and locally advanced non-small
cell lung cancer as well as in small-cell lung cancer. Finally I will
discuss future research directions, including preclinical and drug-proton
combination research, ongoing clinical trials, the model based-approach
and the need for biomarkers. References: Liao Z, Lee JJ, Komaki R, eat l.
Bayesian Adaptive Randomization Trial of Passive Scattering Proton Therapy
and Intensity-Modulated Photon Radiotherapy for Locally Advanced
Non-Small-Cell Lung Cancer. J Clin Oncol. 2018;36(18):1813-1822 Chang JY,
Jabbour SK, De Ruysscher D, et al; International Particle Therapy
Co-operative Group Thoracic Subcommittee.Consensus Statement on Proton
Therapy in Early-Stage and Locally Advanced Non-Small Cell Lung Cancer.
Int J Radiat Oncol Biol Phys. 2016;95(1):505-16. Vyfhuis MAL, Onyeuku N,
Diwanji T, Mossahebi S, Amin NP, Badiyan SN, Mohindra P, Simone CB 2nd.
Advances in proton therapy in lung cancer. Ther Adv Respir Dis. 2018
Jan-Dec;12:1753466618783878 C, Pawelke J, Seidlitz A, Peitzsch C, et al;
"Radiobiology of Proton Therapy": Results of an international expert
workshop.Luhr A, von Neubeck Radiother Oncol. 2018; 128(1):56-67 Jin,
J.Y., et al., Higher Radiation Dose to Immune System is Correlated With
Poorer Survival in Patients With Stage III Non-small Cell Lung Cancer: A
Secondary Study of a Phase 3 Cooperative Group Trial (NRG Oncology RTOG
0617). International Journal of Radiation Oncology Biology Physics, 2017.
99(2): p. S151-S152. Joseph, N., et al., Post-treatment lymphocytopaenia,
integral body dose and overall survival in lung cancer patients treated
with radical radiotherapy. Radiotherapy and Oncology, 2019. 135: p.
115-119. Durante, M., D.J. Brenner, and S.C. Formenti, Does Heavy Ion
Therapy Work Through the Immune System? Int J Radiat Oncol Biol Phys,
2016. 96(5): p. 934-936. Lee, H.J., Jr., J. Zeng, and R. Rengan, Proton
beam therapy and immunotherapy: an emerging partnership for immune
activation in non-small cell lung cancer. Translational lung cancer
research, 2018. 7(2): p. 180-188. Dess, R.T., et al., Cardiac Events After
Radiation Therapy: Combined Analysis of Prospective Multicenter Trials for
Locally Advanced Non-Small-Cell Lung Cancer. J Clin Oncol, 2017. 35(13):
p. 1395-1402. McWilliam, A., et al., Radiation dose to heart base linked
with poorer survival in lung cancer patients. Eur J Cancer, 2017. 85: p.
106-113. Schulz-Ertner, D. and H. Tsujii, Particle radiation therapy using
proton and heavier ion beams. J Clin Oncol, 2007. 25(8): p. 953-64.
Gameiro, S.R., et al., Tumor Cells Surviving Exposure to Proton or Photon
Radiation Share a Common Immunogenic Modulation Signature, Rendering Them
More Sensitive to T Cell-Mediated Killing. Int J Radiat Oncol Biol Phys,
2016. 95(1): p. 120-30. Copyright © 2019

<64>
Accession Number
2003406064
Title
IBS07.01 Enhanced Recovery for Thoracic Surgery.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S96), 2019. Date of
Publication: October 2019.
Author
Kerr A.
Institution
(Kerr) Thoracic Surgery Research, University Hospitals Birmingham,
Birmingham, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Enhanced Recovery After Surgery (ERAS) also known as "fast
track surgery", was pioneered back in the 1990s by Henrik Kehlet in
colorectal surgery. It has developed as a multimodal evidenced based
approach which has been designed and tested to enable patients to recover
more quickly after major surgery thus reducing the length of hospital stay
and the associated costs, Its aim is to minimise the physical and
psychological stress response to surgery and has been proven effective in
many different areas, by delivering multiple interventions throughout the
entire patient journey from referral to discharge and beyond. Over the
years the evidence modified this approach and now ERAS programmes are
growing in popularity and are becoming more established across a range of
surgical specialities, but there is still a little way to go in thoracic
surgery to build evidence and recommendations on the elements of the ERAS
programme. Method(s): The main principles for ERAS programmes are; to
enable the patients to be as healthy as possible before surgical
treatment, receive the best possible care during their operation and have
the best possible care while recovering (picture 1). There are as many as
45 enhanced recovery items throughout the entire pathway. The ideal start
to the ERAS pathway is to optimise the pre-operative health which should
commence when the referral from primary care is made. Interventions for
smoking cessation and managing pre-existing comorbidities such as diabetes
and hypertension are key elements in getting the patients in the best
possible condition for surgery. Other pre surgery interventions are
prehabilitation, nutritional screening, and patient information to manage
expectations and discharge planning. Key recommendations for the admission
on the day of surgery are to give patients pre surgery carbohydrate
loading drinks and minimise their fasting period. In terms of
intraoperative items, minimally invasive surgery, less opioid use,
avoidance of urine catheters and fluid management are recommended
elements. In the post-operative and follow-up phase, early oral hydration
and nutrition to enable the removal of intravenous therapy, early
mobilisation within 24 hours, early chest drain removal to facilitate
discharge with a recommendation for telephone follow-up if applicable;
these recommendations are becoming more common in thoracic surgery.
 Result(s): In specialties such as colorectal, gastric and liver
surgery the ERAS pathways are well established with good supporting
evidence demonstrating a reduction in hospital length of stay,
postoperative complication rates and cost reductions. Recommendations and
guidance in thoracic surgery ERAS programmes has been published by the
Enhanced Recovery after Surgery Society and the European Society for
Thoracic Surgery (1). Some recommendations are based on high quality
evidence; however in some cases thoracic surgery specific evidence is
simply not available to support the recommendations therefore evidence
from other surgical specialities has been extrapolated to thoracic
surgery. The key recommendations include: pre surgery smoking cessation -
a known risk factor for developing post-operative pulmonary complications
(however there is a strong debate around smoking cessation timing prior to
surgery); malnutrition increases risk of complications therefore
nutritional screening is highly recommended as well as minimising
starvation; the use of carbohydrate loading the evidence is low but the
recommendation is strong due to proven reduction in insulin resistance in
the context of general surgery. Patient education has been shown to reduce
anxiety and improve expectations for both patients and carers. It is not
clear if patients with good lung function and exercise capacity benefit
from Prehabilitation but the evidence for the high risk group is strong,
thus is highly recommended. There also is a strong recommendation for
avoiding sedatives and the use of regional/non-opiate analgesia for pain
relief, adequate control of nausea and vomiting, video-assisted approach
when possible with early removal of chest drains. The guidance
recommendation is high for dedicated pre-op counselling, prehabilitation,
carbohydrate loading, use of regional anaesthetic techniques and short
acting anaesthetic agents, dexamethasone to prevent post of nausea and
pain, use of digital drainage with no external suction and early
mobilisation after surgery but the evidence level is low. The impact of
ERAS on the long term outcomes is another aspect that is yet to be
determined. As the recommendation grade for most of the elements is
strong, the use of a systematic perioperative care pathway has the
potential to improve outcomes after surgery. Conclusion(s): These
guidelines outline recommendations for the perioperative management of
patients undergoing lung surgery based on the best available evidence.
However there are barriers to implement many aspects of the ERAS programme
due to lack of evidence, so there is still a need for large-scale,
multicenter randomised trials to test aspects of the pathway. (1)
Guidelines for enhanced recovery after lung surgery: recommendations of
the Enhanced Recovery After Surgery (ERAS) Society and the European
Society of Thoracic Surgeons (ESTS) [Figure presented] Keywords: Enhanced
recovery, Thoracic surgery Copyright © 2019

<65>
Accession Number
2003405737
Title
MS16.05 Optimal Treatment Selection for Screen-Detected Lung Cancers.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S188-S189), 2019. Date
of Publication: October 2019.
Author
Ikeda N.
Institution
(Ikeda) Department of Surgery, Tokyo Medical University, Tokyo, Japan
Publisher
Elsevier Inc.
Abstract
In recent years, the number of early stage lung cancers, especially cases
showing ground-glass opacity (GGO) has enormously increased mainly due to
frequent use of chest CT in routine practice or screening purpose. The
surgical approach has enormously changed to pursue both curability and
minimal inavasiveness for such early disease. Increased number of VATS
lobectomy and sublobar resection for selected patients is the
international trend.Conventional bronchoscopic examination for screening
detected tiny cancers shows low diagnostic rate therefore the combination
of virtual bronchoscopic navigation (VBN) and EBUS guide-sheath has been
employed. A total of 40000 lung cancers were resected in Japan in 2015 and
70% of surgeries were performed by video-assisted1). Although
there are a few randomized controlled trial, the evidence of VATS
lobectomy is supported many propensity-matched studies, several high
quality meta-analyses as well as outcome studies2).
Segmentectomy has been performed intentionally mainly for lung cancer 2cm
or less in diameter. Several comparative studies between lobectomy and
segmentectomy for tumors <2cm showed no significant difference in
survival3). Recently, segmentectomy is selected based on the
size, location as well as the consolidation size in the primary lesion in
preoperative high resolution CT (HRCT). The proportion of consolidation
diameter to tumor diameter (C/T ratio) correlates with biological
malignancy and the establishment of robust image criteria predicting
non-invasive cancer is desirable to find candidates for segmentectomy. The
Japan Clinical Oncology Group (JCOG) conducted a prospective cohort study
to recognize the relationship between HRCT finding and pathological
non-invasiveness (no lymph node metastasis or vessel invasion) in clicical
stage IA cancer (JCOG0201)4). This study revealed that
adenocarcinoma <2.0 cm with <0.25 consolidation to the maximum tumor
diameter showed pathological non-invasiveness in 98.7% and this criterion
could be used to as radiological non-invasive adenocarcinoma5).
Based on the result of JCOG0201, two prospective studies were performed
and finished recruitment, phase II trial of wide wedge resection for
radiological non-invasive adenocarcinoma (tumor diameter 2cm or less and
consolidation ratio<0.25) (JCOG0804) and randomised phase III trial for
radiological invasive adenocarcinoma (tumor diameter 2cm or less and
consolidation ratio>0.25) to evaluate non-inferiority in OS of
segmentectomy compared to lobectomy (JCOG0802)6). The
indication of segmentectomy will be demonstrated by the results of these
studies. Although C/T ratio in the maximum plane of the tumor has been
applied clinically as an index of malignancy, objective measurement is
sometimes difficult due to the irregular shape of objectives. It should be
more accurate to analyze the ratio of the consolidation part volume to
whole tumor volume quantitatively by creating 3D-CT image. In our analysis
of 252 cases of stage I lung cancer, the solid part volume of the tumor
had a statistically significant correlation with prognosis7).
In addition, PET-CT has been routinely used for the management of lung
cancer and another approach to evaluate the biological aggressiveness. The
standardized uptake value (SUV) of the main tumor is recognized to be as a
predictor of the clinicopathological characteristics. Our data showed that
more accurate prognosis of stage IA adenocarcinoma could be predicted by
the combination of SUVmax and solid part volume of the primary
tumor8). Since CT reflects the histologic grade of the tumor
and SUVmax reflects the intratumoral metabolism, the combined use of these
may be expected to evaluate nature of lung cancer more precisely than each
alone.The information on the grade of malignancy obtained from
preoperative images is useful for selecting appropriate treatment. In the
near future, radiomics can analyze the radiologic images and extract
important pathological and genomic information non-invasively before
treatment. Advances in imaging and quantitative analysis will be powerful
support to select interventions of screening detected lung cancer.
References 1) Committee for Scientific Affairs The Japanese Association
for Thoracic Surgery, Thoracic and cardiovascular surgery in Japan during
2015 : Annual report by the Japanese Association for Thoracic Surgery. Gen
Thorac Cardiovasc Surg.2018;66:581-615. 2) Ikeda N Updates on minimally
inavasive surgery in non-small cell lung cancer. Curr. Treat. In Oncol.
2019;20:16 (DOI 10.1007/s11864-019-0614-9) 3) Okada M, Koike T,
Higashiyama M, et al. Radical sublobar resection for small-sized non-small
cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;
132: 769-775 4) Suzuki K, Koike T, Asakawa T, et al.: A prospective
radiological study of thin-section computed tomography to predict
pathological noninvasiveness in peripheral clinical IA lung cancer (Japan
Clinical Oncology Group 0201). J Thorac Oncol 2011;6:751-756 5) Asamura H,
Hishida T, Suzuki K, et al. Radiographically determined noninvasive
adenocarcinoma of the lung: Survival outcomes of Japan Clinical Oncology
Group 0201 J Thorac Cardiovasc Surg 2013;146:24-30 6) Nakamura K, Saji H,
Nakajima R, et.al. A Phase III Randomized Trial of Lobectomy Versus
Limited Resection for Small-sized Peripheral Non-small Cell Lung Cancer
(JCOG0802/WJOG4607L) Jpn J Clin Oncol 2010;40:271-274 7) Shimada Y,
Furumoto H, Imai K, et al. Prognostic value of tumor solid-part size and
solid-part volume in parients with clinical stage I non-small cell lung
cancer. J Thorac Dis 2018;10:6491-6500 8) Furumoto H, Shimada Y, Imai K,
et al. Prognostic impact of the integration of volumetric quantification
of the solid part of the tumor on 3DCT and FDG-PET imaging in clinical
stage IA adenocarcinoma of the lung. Lung Cancer 2018;121:91-96 Keywords:
VATS, segmentectomy, PET-CT Copyright © 2019

<66>
Accession Number
2003405717
Title
ES15.03 Managing Sleep Difficulties and Cancer.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S52), 2019. Date of
Publication: October 2019.
Author
Ftanou M.
Institution
(Ftanou) Peter Maccallum Cancer Centre, Melbourne, ACT, Australia
Publisher
Elsevier Inc.
Abstract
This paper discusses evidence-based interventions for managing sleep
difficulties in people with cancer. Insomnia is a common sleep problem in
people with cancer. Insomnia refers to the difficulty of falling asleep,
staying asleep and early morning awakenings. It causes distress or
impairment in important areas of functioning, such as relationships and
employment. It is estimated that between 30-60% of cancer survivors
experience significant sleep disturbances that can persist for up to five
years post treatment. Aside from greatly impacting on quality of life,
poor sleep is associated with anxiety, depression, concentration and
memory difficulties, higher rates of pain, increased use of sedatives and
poorer work performance [1-3]. People with lung cancer are at an increased
risk of experiencing sleep difficulties because of their generally older
age, compromised respiratory function, increased disease burden and the
impact of treatments [4]. Sleep difficulties also have economic and social
impacts on the broader community, due to increased health system costs,
productivity losses and wellbeing costs [5]. Cognitive Behaviour Therapy
(CBT) is considered to be the first-line treatment for insomnia [6]. CBT
targets dysfunctional attitudes, beliefs and habits that interfere with
sleep. CBT for insomnia commences with a comprehensive assessment about
the nature and duration of sleep complaints, the impact on daytime
functioning, compensatory behaviours, the person's beliefs about sleep and
any other biopsychosocial factors that might be impacting on sleep. Common
screening tools used to assess the impact of sleep difficulties include
the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS) and
the Pittsburgh Insomnia Rating Scale (PIRS). These tools are
self-reporting and easy to administer. CBT for insomnia is a
multi-component intervention and includes psychoeducation, sleep hygiene,
stimulus control, sleep restriction, relaxation, cognitive strategies and
relapse prevention strategies. It is usually delivered between four to
eight session modules. CBT is effective in improving sleep disturbance,
fatigue, pain and quality of life. The effects of CBT are durable, with
benefits lasting up to three years post-treatment [7, 8]. CBT is suitable
for most adults with insomnia, however, it works best with people who are
motivated and have the cognitive capacity to learn and adopt CBT
strategies. CBT can be effectively provided in group settings,
individually, via telephone, video or online methods. Over three quarters
of patients achieve remission or significant reduction of sleep
disturbance after CBT treatment [9]. CBT has been found to be more
effective than mindfulness, massage, exercise and acupuncture
intervention. CBT has been found to be as effective as pharmacological
intervention in the short-term and more beneficial than medication in the
longer term. CBT is also more cost-effective than pharmacological or
non-treatment of sleep difficulties [10]. Despite the benefits of CBT,
access for people with cancer is limited due to lack specialist
availability, cost and awareness of the benefit of CBT. To improve access
to evidence-based interventions for people with cancer, stepped-care
approaches (where face-to-face CBT is reserved for the most complex cases
while less burdensome and less costly self-managed interventions are
available for less complex cases) could help translate evidence into
clinical practice. Conclusion(s): Sleep difficulties are highly
prevalent in people with cancer, however, access to evidenced-based
interventions are limited. Embedding evidence based-screening and CBT into
routine care is essential to improving quality of life and care for people
with cancer. Savard, J., Simard, S., Blanchet, J., Ivers, H. & Morin, C.M.
Prevalence, clinical characteristics, and risk factors for insomnia in the
context of breast cancer. Sleep 24, 583-590 (2001). Davidson, J.R.,
MacLean, A.W., Brundage, M.D. & Schulze, K. Sleep disturbance in cancer
patients. Social science & medicine (1982) 54, 1309-1321 (2002). Howell,
Doris, et al. "A Pan-Canadian practice guideline: prevention, screening,
assessment, and treatment of sleep disturbances in adults with cancer."
Supportive Care in Cancer21.10 (2013): 2695-2706. Halle, Ingrid Helene, et
al. "Trajectory of sleep disturbances in patients undergoing lung cancer
surgery: a prospective study." Interactive cardiovascular and thoracic
surgery 25.2 (2017): 285-291. Deloitte Access Economics. Re-awakening
Australia: the economic cost of sleep disorders in Australia C, Australia:
Deloitte Access Economics, 2011. Re-awakening Australia: the economic cost
of sleep disorders in Australia, 2010.Canberra, Australia; 2011. Morin CM,
Benca R. Chronic insomnia. Lancet (London, England).
2012;379(9821):1129-41 Arico D, Raggi A, Ferri R. Cognitive Behavioral
Therapy for Insomnia in Breast Cancer Survivors: A Review of the
Literature. Frontiers in psychology. 2016;7:1162. Blom, K., Jernelov, S.,
Ruck, C., Lindefors, N., & Kaldo, V. (2016). Three-Year follow-up of
insomnia and hypnotics after controlled internet treatment for insomnia.
Sleep, 39(6), 1, 1267-1274. Fiorentino L, McQuaid JR, Liu L, Natarajan L,
He F, Cornejo M, et al. Individual cognitive behavioral therapy for
insomnia in breast cancer survivors: a randomized controlled crossover
pilot study. Nature and science of sleep. 2009;2010:1-8. Reynolds S, R. M.
The Cost of Insomnia and the Benefit of Increased Access to Evidence-Based
Treatment. Sleep Medicine Clinics,. 2017;12(1):39-46. Keywords: Sleep,
Insomnia, Cognitive Behaviour Therapy Copyright © 2019

<67>
Accession Number
629630790
Title
Hydroxocobalamin: A novel rescue treatment for post-cardiac
surgeryrefractory vasoplegia?.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. United States. 47 (1
Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Huang E.; Omran M.B.; Patel V.; Newsome A.; Bora V.
Institution
(Huang) AugustaGAUnited States
(Omran) Garyounis University, Libyan Arab Jamahiriya
(Patel) Georgia Regents University, Augusta, GA, United States
(Newsome) Augusta University Medical Center, Augusta, GA, United States
(Bora) Augusta University, Augusta, GA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Cardio-pulmonary bypass (CPB) present a significant
physiologic stress and post CPB period can be complicated by shock
pathophysiology. Vasoplegic shock is a type of distributive shock which
occurs in 5-45% of cases post CPB, it can lead to decreased end organ
perfusion, progressing to multi-organ failure, prolonged hospital stays
and death. Standard management includes fluids, catecholamine and
noncatecholamine vasopressors, and stress-dose steroids. A subset of
vasoplegic shock is refractory to standard therapies possibly due to
nitric oxide (NO) mediated vasodilation. Traditionally, methylene blue has
been used as rescue drug, however, there is some recent evidence for the
usefulness of hydroxycobalamin (HCB) in vasoplegia due to its effect as NO
scavenger. Method(s): This is single center retrospective study
between Nov 2017 -May 2018, analyzing adult cardiac surgery patients who
received HCB for refractory vasoplegia. The primary outcome was change in
mean arterial pressure (MAP) and vasopressor requirements post HCB
administration at 1,2,6,12 and 24 hrs. Result(s): A total of eight
patients received HCB for cardiac vasoplegia and five had complete data
for inclusion in the study. The median (range) time to HCB administration
was 16 (1-19) hours from end of surgical procedure. The median MAP prior
to HCB administration was 60 (43-73) mmHg with a median systemic vascular
resistance (SVR) of 646 (441-880) dyn?s?cm-5and a median dose of 0.20
(0.15-0.28) mcg/kg/min of norepinephrine equivalent (NEE). One hour after
HCB administration, the median MAP increased by 22% with two of the five
patients experiencing a decrease in NEE. By six hours after
administration, the median MAP was 75 (71-79) mmHg and median NEE was 0.05
(0.01-0.15) mcg/kg/min. At 24 hours after administration the median MAP
was 82 (70-89) mmHg, the median NEE was 0.03 (0-0.30) mcg/kg/min with two
patient off of all vasopressors. No adverse events were associated with
HCB administration and all patients survived to hospital discharge.
 Conclusion(s): In patients with cardiac surgery associated
vasoplegia, hydroxocobalamin may be associated with increasing MAP while
decreasing the need for vasoactive therapies. Prospective randomized
studies are warranted to further elucidate the effectiveness of HCB in
catecholamine refractory vasoplegia.

<68>
[Use Link to view the full text]
Accession Number
629630782
Title
Outcomes in patients with postoperative vasoplegia receiving angiotensin
ii for vasodilatory shock.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. United States. 47 (1
Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Friedman B.; Mackey C.; Panwar R.; Evans A.; Altaweel L.; Handisides D.;
Chavez A.; Klijian A.
Institution
(Friedman) Joseph M. Still Burn Center, Augusta, GA, United States
(Mackey) Riverside Pulmonary Association, Columbus, OH, United States
(Panwar) John Hunter Hospital, NSW, Australia
(Evans) Morristown Medical Center, Morristown, NJ, United States
(Altaweel) Inova Medical Group, Falls Church, VA, United States
(Handisides, Chavez) La Jolla Pharmaceutical Company, San Diego, CA,
United States
(Klijian) Sharp and Scripps, San Diego, CA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Vasoplegia is a common cause of distributive shock
and may lead to catecholamine-resistant hypotension. Persistent
hypotension due to vasoplegia can be a major risk factor for death among
patients following cardiac surgery. In this study, we analyzed the effect
of angiotensin II (Ang II) on mean arterial pressure (MAP) in patients
with vasoplegia. Method(s):ATHOS-3 was a randomized,
placebo-controlled, double- blind study of patients with severe
vasodilatory shock. Patients with persistent vasodilatory shock despite
fluid resuscitation and more than 0.2 mug/kg/min norepinephrine equivalent
dose of standard of care vasopressors were randomized to receive either
intravenous Ang II or placebo. Standard of care vasopressors were to be
held constant for 3 hours while Ang II or placebo were titrated. During
the second part of the study, catecholamine sparing was assessed by
attempting to reduce reliance on standard of care vasopressors. Using
methods from the ATHOS-3 trial we performed a subgroup analysis of
patients who had vasoplegia following cardiac surgery. Result(s): A
total of 19 (5.9%) of the 321 treated patients had vasoplegia (9 on
placebo and 10 on Ang II). The MAP response, defined as an increase from
baseline of at least 10 mm Hg or an increase to at least 75 mm Hg, was
achieved by 0% (95% CI: 0.0- 33.6) of patients in the placebo group and
90% (95% CI: 55.5- 99.7) in the Ang II group. Odds ratio stratified by
baseline randomization stratification (APACHE II Score and baseline MAP)
was 17.9 (95% CI: 2.26-141), p=0.0008. For patients with vasoplegia, the
28-day mortality was not significantly different between the placebo (11%)
and Ang II groups (10%). Conclusion(s): Ang II is effective in
improving MAP in patients with post-operative vasoplegia and
catecholamine-resistant shock. More studies are warranted in this patient
population.

<69>
[Use Link to view the full text]
Accession Number
629630101
Title
Use of factor concentrates for the management of perioperative bleeding in
cardiac surgery.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. United States. 47 (1
Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Phillips J.; Nasef R.; Kablaoui F.; Cherfan A.
Institution
(Phillips, Nasef, Kablaoui, Cherfan) Cleveland Clinic Abu Dhabi, Abu
Dhabi, United Arab Emirates
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: European perioperative bleeding guidelines Rinka1,
Justin Tawil2 recommend coagulation factor concentrates, guided by
pointof-care viscoelastic assays, to reduce blood loss and transfusion
associated costs in complex cardiovascular surgery. However, use for this
indication remains off-label due to lack of high quality evidence.
Furthermore, a recent randomized controlled trial showed a higher
incidence of mortality, stroke, and myocardial infarction in cardiac
surgery patients with fibrinogen concentrate compared to placebo. The
objective of this study was to evaluate the appropriate use and safety of
factor concentrates in cardiac surgery at our institution, Cleveland
Clinic Abu Dhabi. Method(s): A retrospective chart review was
conducted for adult patients undergoing cardiovascular surgery who
received fibrinogen concentrate (FC) and/or prothrombin complex
concentrate (PCC) for perioperative bleeding between August 1, 2015 and
April 30, 2017. Patients were followed until hospital discharge. The
following data were collected: FC dose, PCC dose, use of
thromboelastography (TEG), blood product requirements, adverse
thromboembolic events, and in-hospital mortality. Result(s): A total
of 43 patients received FC, of whom 23 patients (53%) also received PCC
and 1 patient (2%) received recombinant factor VIIa. The median initial
dose of FC was 28 mg/kg (1.5 g) and the median initial dose of PCC was 25
units/kg (2000 units). The FC dose was repeated in 12 patients (28%).
Among the 23 PCC recipients, 3 patients received a repeated dose (13%).
PRBCs were administered to 38 patients (88%), FFP to 20 patients (47%),
and cryoprecipitate to 5 patients (12%) (median amount 4 units, 3 units,
and 1 unit, respectively). TEG was used to guide factor concentrate use in
47% of patients. Three patients (7%) developed thromboembolic adverse
events, all of whom received both FC and PCC. One patient that developed a
stroke received FC, PCC, and recombinant factor VIIa. Seven patients (16%)
died during hospital admission. Conclusion(s): The majority of
patients were prescribed factor concentrates without TEG guided results as
recommended by guidelines. To optimize the use, ensure patient safety, and
reduce costs, a TEG-based algorithm to guide treatment has been
implemented. Our study is limited by retrospective design and a
cause-effect relationship of thrombotic events cannot be confirmed.
Randomized controlled trials are needed to better define the role of these
agents and their safety.

<70>
[Use Link to view the full text]
Accession Number
629629876
Title
The effect of rudeness on challenging diagnostic error: A randomized
controlled simulation trial.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. United States. 47 (1
Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Avesar M.; Erez A.; Essakow J.; Young C.; Cooper B.; Klein M.; Akan D.;
Chang T.; Rake A.
Institution
(Avesar, Essakow, Young, Klein, Akan, Chang, Rake) Children's Hospital Los
Angeles, Los Angeles, CA, United States
(Erez, Cooper) Univeristy of Florida, Gainesville, FL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Exposing resident teams to rude behavior worsens
diagnostic accuracy by inhibiting collaborative processes. The effect of
rude behavior on diagnostic cognition is less studied at the individual
code-team leader level and among experienced providers. We hypothesize
that a rude physicianto- physician hand-off will inhibit Pediatric
Critical Care Medicine (PCCM) physicians from overcoming diagnostic error,
compared to a hand-off in a neutral, professional environment.
 Method(s): This was a simulation-based randomized control study among
physicians in a tertiary care pediatric ICU. Pediatric resident, PCCM
fellow, and PCCM attending physicians participated in one high-fidelity
simulation where all clinical information was standardized using
progressive reveal by confederate ancillary staff. The scenario was a
post-operative cardiac tamponade that began with a hand-off by an
operative team member who included an incorrect diagnosis of sepsis. The
hand-off was randomized to neutral vs rude (condescending tone with
dismissive non-medical commentary). Primary outcome was whether or not the
hand-off diagnostic error was challenged; secondary question was whether
or not experience level affected this relationship. Data were analyzed
using Fisher's Exact Test. Result(s): In total, there were 35
simulations (13 resident, 12 fellow, and 10 attending). Among residents, 6
of 7 (86%) did not challenge the diagnostic error in the rude group
compared to 4 of 6 (67%) in the neutral group. Among fellows, 1 of 6 (17%)
did not challenge the diagnostic error in either group. Among attendings,
1 of 4 (25%) did not challenge the diagnostic error in the rude group
compared to 1 of 6 (17%) in the neutral group. Overall, 47% of physicians
with a rude hand-off did not challenge the diagnosis compared to 33% with
a neutral hand-off (p = 0.4). Level of experience was associated with
challenging diagnosis; 23% of residents, 83% of fellows, and 80% of
attendings challenged regardless of their exposure to rudeness (p =
0.003). Conclusion(s): Experience level had a far more significant
effect than exposure to rudeness on whether or not PCCM physicians
challenged diagnostic error. Unlike resident team focused studies, we did
not find an effect of rudeness on diagnosis. This could be because novice
trainees are more vulnerable to rudeness, or perhaps because rudeness has
more of an effect on teams than individuals. More research should explore
how experienced providers challenge diagnostic error.

<71>
[Use Link to view the full text]
Accession Number
629629760
Title
Content analysis of bowel protocols in North American intensive care
units.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. United States. 47 (1
Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Dionne J.; Zytaruk N.; Smith O.; Rose L.; Alam N.; Campisi J.; Cook D.
Institution
(Dionne, Cook) McMaster University, Hamilton, ON, Canada
(Zytaruk) Saint Joseph's Healthcare, Hamilton, ON, Canada
(Smith) St. Michael's Hospital, Toronto, ON, Canada
(Rose) University of Toronto, Toronto, ON, Canada
(Alam) Centre Universitaire De Sante McGill et IR-CUSM, Montreal, Canada
(Alam) McGill University Health Centr, Montreal, Canada
(Campisi) McGill University, Montreal, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Alterations in bowel habit are common in the ICU, and
bowel protocols are gaining popularity. Our objective was to characterize
bowel protocols created in North American ICUs participating in a
randomized trial of probiotics to prevent ICU-acquired infections.
 Method(s): We performed content analysis of 31 bowel protocols
identified from 49 ICUs, analyzed for: 1) initiation criteria, 2)
medications incorporated, 3) medication escalation approaches, 4)
discontinuation criteria, and 5) stool assessment methods. Result(s):
Of 49 ICUs, 30 (61.2%) had at a bowel protocol; 27 (90%) were stand-alone
documents and 4 (13.3%) were embedded in admission orders. Separate
protocols existed for patients with spinal cord injury (5 sites), patients
receiving opioids (4 sites), and for surgical, cardiac and medical ICUs (3
sites). The most common laxative classification was stimulant laxatives
including senna (n=26 protocols, 86.7%) and bisacodyl (n=23, 76.6%),
followed by glycerin (n=15, 50%), docusate sodium (n=14, 46.7%),
polyethylene glycol 3350 (PEG-3350) (n=13, 43.3%), sodium phosphate (n=13,
43.3%), sodium citrate (n=13, 43.3%,), and lactulose (n=8, 26.7%). Mineral
oil (n=3, 10%) and milk of magnesia (n=5, 16.7%) were uncommon. Most bowel
protocols (n=16, 53%) were initiated by nurses based on initiation
criteria. These criteria included no bowel movement for 24-72 hours (n=9,
30%), opioid use (n=4, 13.3%), ICU admission (n=3, 13.3%), "at risk for
constipation" without definition (n=2, 6.7%), no stool on digital rectal
exam (DRE) (n=2, 6.7%), and enteral nutrition initiation (n=1, 3.3%); the
remainder had no initiation criteria. Criteria for laxative escalation
included time from last bowel movement (n=18, 60%), opioid use (n=4,
13.3%), or no stool on DRE (n=3, 13.3%), while remaining protocols did not
specify when to change drug dosing or class. While 13 bowel protocols
included diarrhea as a discontinuation criterion, only 2 incorporated
stool assessment charts to track bowel movements. Conclusion(s):
Bowel protocols have variable and sometimes unspecified initiation,
escalation and discontinuation criteria, and incorporate different classes
of laxatives. Uncertainty about optimal bowel management strategies is
reflected in these institutional guides.

<72>
[Use Link to view the full text]
Accession Number
629629713
Title
Effects of corticosteroids on endothelial dysfunction in cardiac surgery
patients.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. United States. 47 (1
Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Halenarova K.
Institution
(Halenarova) Erasme, ULB, Brussels, Belgium
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Endothelium plays a key role in multiple
physiological and pathophysiological processes and its dysfunction in
different clinical situations is associated with worse outcome. Cardiac
surgery with cardiopulmonary bypass represents an important endothelial
insult leading to alterations of its functions. The objectives of the
present study were to investigate cardiopulmonary bypass-induced
endothelial dysfunction on three different levels: macrocirculatory, as
assessed by flow mediated vasodilation; microcirculatory, as assessed by
NIRS during a vascular occlusion test; and biological, as assessed by a
core glycocalyx protein Syndecan-1 analysis. Our hypothesis was that a
single high dose corticosteroid administration at the induction of
anesthesia in cardiac surgery patients would have a potentially protective
effect on endothelial cell function. Method(s): In this prospective,
randomized, double-blinded trial, we used three different methods (flow
mediated dilation FMD, near-infrared spectroscopy NIRS, performed both
during vascular occlusion test (VOT), and biological analysis of a marker
of endothelial degradation Syndecan-1, to assess cardiopulmonary (CPB)
induced endothelial dysfunction. We included 40 patients, randomized in
two groups, methylprednisolone (MP, n=20) and placebo (P, n=20).
Hemodynamic, macro- and microcirculatory variables were obtained before
the surgery, on admission to the intensive care unit after the surgery and
on postoperative day 1; blood samples were obtained also at anesthesia
induction and on postoperative day 2. Data were analyzed using
Mann-Whitney and Fisher's exact test. Results are presented as median
(25th to 75th percentile). Result(s): Results issued from the
preliminary analysis of first 16 patients (methylprednisolone MP=10,
placebo P=6) showed that endothelial function was altered with
cardiopulmonary bypass in both groups, as shown by decreased recovery StO2
slope during VOT immediately after CPB; this was significantly attenuated
in methylprednisolone group: StO2 asc = 1,14 %/s (0,75 - 1,4) compared to
StO2 asc = 0,08 %/s (0,5 - 0,94) in placebo group, P=0,042). FMD% showed
less consistent results in these patients. In both groups, the micro- and
macrocirculatory alterations improved with time, more rapidly in
methylprednisolone group than with placebo. Conclusion(s):
Endothelial function is altered immediately after CBP, likely to a lesser
extent when prophylactic methylprednisolone is administered.

<73>
[Use Link to view the full text]
Accession Number
629629162
Title
Can artificial intelligence help to predict ventilation days? A systematic
review.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. United States. 47 (1
Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Spiegel R.; Stocker S.; Opic P.; Semmlack S.; Tisljar K.; Sutter R.
Institution
(Spiegel) BG Unfallklinik Tuebingen (Critical Care), Basel University
Hospital (Internal Medicine), Tuebingen, Germany
(Stocker) Intensive Care Unit, Bern University Hospital, Bern, Switzerland
(Opic, Semmlack, Tisljar, Sutter) Medical Intensive Care Units, Basel
University Hospital, Basel, Switzerland
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Artificial intelligence (AI) plays a burgeoning role
in assisting intensive care unit (ICU) personnel. Here we analyze the
question whether recent advances in AI can help to predict ventilation
days. If the need for prolonged mechanical ventilation is predictable, the
ICU could plan resources and, depending on the individual patient,
organize tracheostomy. Method(s): We conducted a systematic review in
PubMed including all articles until 22 July 2018. MeSH Terms/Fields were
"artificial intelligence", "ventilation" and "days". This resulted in a
total of 42 articles. We subsequently included the MeSH Terms/Fields
"prolonged ventilation", which yielded another 25 articles. Among articles
applying AI approaches, we identified a total of 21000 cases. All
predictions/validations by AI approaches were based on retrospective data.
The prediction was expressed as "area under the receiver operating curve"
(AUC). The articles diverged in terms of their endpoints, e.g.
"ventilation > 24 hours" following a coronary artery bypass surgery
depending on preoperative risk profile or "ventilation > 7 days" depending
on six different illness severity scores when entering the ICU. AI
approaches included a classifier with the gradient-boosted decision trees
algorithm, an artificial neural network and multivariate logistic
regression. Result(s): Depending on database size, we weighed the
AUCs. This resulted in an average AUC. Overall, the AI approaches had an
AUC of 0.84. Consequently, they answered the question in terms of expected
mechanical ventilation relatively precise (for preoperative risk profile
they indicated if postoperative ventilation was > 24 hours, for newly
admitted ICU patients they indicated if ventilation was expected to be > 7
days). Conclusion(s): Limitations are that predictions/validations
were only based on retrospective data. In addition, several different AI
approaches were chosen. Before these AI approaches can be applied in an
ICU to guide decisions, they first need to be cross-validated in
prospective studies involving different ICUs. This calls for comparative
studies between different AI approaches in prospective, multicenter
trials. Based on the current approaches, it is still impossible to judge
how long weaning will take in individual cases and whether to prepare the
patient for tracheostomy.

<74>
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Accession Number
629629144
Title
The effect of dexmedetomidine versus propofol on the incidence of
postoperative atrial fibrillation.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. United States. 47 (1
Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Thompson B.; Righi A.; Lahora J.
Institution
(Thompson, Righi, Lahora) Cleveland Clinic Akron General, Akron, OH,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Post-operative atrial fibrillation (POAF) is a known
complication of cardiac surgery. Following cardiac surgery, many patients
will return to the intensive care unit mechanically ventilated requiring
sedation. Dexmedetomidine, a selective alpha-2 agonist, is a sedative
medication with favorable cardiac effects including decreases in
tachycardia. Only one randomized controlled trial to date, conducted by
Liu, et al., has evaluated the use of dexmedetomidine versus propofol on
the incidence of POAF in an elective coronary artery bypass graft (CABG)
patient population. This study found that dexmedetomidine decreased the
incidence of POAF following cardiac surgery compared to propofol. The
primary objective of this study was to determine the incidence of POAF
after elective and urgent cardiac surgery in patients who received
dexmedetomidine versus those who received propofol. Method(s): This
is a retrospective cohort study of adult patients without pre-existing
atrial fibrillation that underwent an urgent or elective cardiac surgery
(CABG, valve procedure, or combined CABG and valve procedure) at the study
institution between January 2011 and August 2017 who received
dexmedetomidine or propofol after surgery. Data collection included
demographics, the use of rate control medications or anticoagulation prior
to admission, comorbid conditions, type of cardiac surgery, and if the
surgery was urgent or elective. Documentation in the electronic health
record was used to determine if patients developed POAF, to determine if
patients required treatment for POAF at hospital discharge, and to
determine hospital length of stay (LOS). Result(s): One hundred and
ninety-nine patients were included in the final analysis (100
dexmedetomidine versus 99 propofol). The use of prophylactic amiodarone
was significantly higher in the propofol group. POAF occurred in 32
patients who received dexmedetomidine and 21 patients who received
propofol (p=0.085). There were no statistically significant differences in
LOS or the need for treatment of POAF at hospital discharge.
 Conclusion(s): Dexmedetomidine was not associated with a decreased
incidence of POAF in this patient population. The significant difference
in the use of prophylactic amiodarone between the two groups and the
inclusion of multiple surgical procedures may have affected rates of POAF.
Additional research is needed to determine the effect of dexmedetomidine
in this patient population.

<75>
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Accession Number
629628522
Title
Effect of 4-factor pcc reversal protocol in LVAD patients undergoing heart
transplantation.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. United States. 47 (1
Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Wong M.-C.; Mak H.; Ferreira R.
Institution
(Wong) Pharm D BCPS, Seattle, WA, United States
(Wong, Mak, Ferreira) University of Washington Medical Center, Seattle,
WA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Patients with left ventricular assist devices (LVADs)
undergoing heart transplantation (HT) are at higher bleeding risk due to
chronic anticoagulation therapy with warfarin. The use of 4-factor
prothrombin complex concentrate (4F-PCC) provides rapid reversal of
international normalized ratio (INR). Various studies have suggested that
4F-PCC may be associated with a reduction in blood product transfusions
(BPT). The aim of the study is to evaluate outcomes associated with
implementation of a hemostasis protocol using 4F-PCC during HT. The
hemostasis protocol also included administration of fresh frozen plasma
(FFP) 10-15ml/kg if INR >2 in the operating room. Method(s): This is
a single-center, retrospective study to compare outcomes among LVAD
patients undergoing HT between the pre-protocol group without 4F-PCC
(n=29) and post-protocol group with 4F-PCC (n=27). The primary outcome was
the use of intra-and 24-hour post-operative BPT. Secondary outcomes were
drug and BPT costs, thrombotic complications, length of hospital stay and
mortality rate. Continuous variables were analyzed using Mann-Whitney U
test and categorical variables were analyzed with Fisher exact test with p
values <0.05 being statistically significant. Result(s): The combined
intra-and post-operative BPT was significantly lower in the post-protocol
group compared to the preprotocol group (22 [17-27] vs 15 [10-23],
p=0.01). Specifically, utilization of FFP in the post-protocol group was 5
units fewer than the pre-protocol group (12 [8-15] vs 7 [5-10], p<0.008).
There was also a trend of less red blood cells used in the postprotocol
group by 1 unit (p=0.065). There was no difference in cardiopulmonary
bypass time and chest tube output within 24 hours post-operatively between
pre-and post-protocol groups. Thrombotic complications (17% vs 22%),
length of hospital stay (16 vs 17 days), and in-hospital mortality (7% vs
0%) were not statistically different between pre-and post-protocol groups.
The protocol did not appear to reduce cost, but instead may increase
average cost by $3421 per patient. Conclusion(s): The implementation
of a hemostasis protocol primarily reduced FFP transfusion among patients
with LVADs undergoing HT. Due to the lack of benefit in clinical outcomes
and cost-effectiveness, a randomized control trial is warranted before
utilizing 4F-PCC routinely.

<76>
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Accession Number
629628328
Title
Thyroid hormone replacement in children after cardiac surgery: Does it
change clinical outcomes?.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. United States. 47 (1
Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Loomba R.; Flores S.; Checchia P.; Graham E.; Bronicki R.
Institution
(Loomba) Children's Hospital of Wisconsin, United States
(Flores) Missouri CityTXUnited States
(Checchia) Texas Children's Hospital, Houston, TX, United States
(Graham) Medical University of South Carolina, Charleston, SC, United
States
(Bronicki) Baylor College of Medicine, Houston, TX, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Thyroid hormone has been administered perioperatively
as an optimizing agent to offset its relative reduction after the
initiation of cardiopulmonary bypass (CPB) and deep hypothermic
circulatory arrest (DHCA) in children with congenital heart disease.
However, it remains unclear whether its use is associated with improved
outcomes. We performed a meta-analysis of studies investigating the
association of thyroid hormone administration and clinical outcomes.
 Method(s): A systematic review was conducted describing postoperative
characteristics of children who underwent cardiac surgery and were
enrolled in a study in which the child was either enrolled to receive
thyroid hormone or placebo. A meta-analysis was then conducted to
determine the effects of postoperative thyroid hormone replacement on
characteristics of the postoperative course in children who underwent
cardiac surgery. The following outcomes were included: mechanical
ventilation duration, ICU stay, postoperative hospital stay, inotrope
score, cardiac index at 24 hours postoperatively, and inpatient mortality.
 Result(s): A total of 9 studies with 711 patients were included in
the final analyses. All included studies were prospective and randomized
to either thyroid hormone or placebo. There was variation in thyroid
hormone dosing, ranging from 0.4g/kg up to 5g/kg over a 24-hour period.
There was variation with the duration of therapy, ranging from a single
dose after cessation of CPB to continued thyroid hormone for the duration
of the ICU stay. There was a statistically significant difference in
inotrope score between the two groups. The mean difference in inotrope
score between the two groups was found to be-1.249 (95% confidence
interval-1.570 to-0.929, p<0.001) with inotrope score being significantly
lower in the thyroid group. There was no statistically significant
difference in duration of mechanical ventilation, duration of ICU stay,
duration of hospital stay, cardiac index and mortality between the two
groups. Conclusion(s): Routine thyroid hormone replacement with
approximately 1-5g/kg administered over 24 hours does not significantly
alter postoperative characteristics in children having undergone cardiac
surgery. No change was seen in duration of mechanical ventilation, ICU
stay, or postoperative hospital stay. A significant difference was found
in respect to inotrope score which was lower in those having received
thyroid hormone replacement, the small absolute difference between groups
make this clinically insignificant.

<77>
Accession Number
629615086
Title
Liraglutide for perioperative management of hyperglycaemia in cardiac
surgery patients (GLOBE): A multicentre, prospective, superiority
randomised trial.
Source
Diabetes. Conference: 79th Scientific Sessions of the American Diabetes
Association, ADA 2019. United States. 68 (Supplement 1) (no pagination),
2019. Date of Publication: June 2019.
Author
Hulst A.H.; Preckel B.; Hollmann M.W.; Devries J.H.; Hermanides J.
Institution
(Hulst, Preckel, Hollmann, Devries, Hermanides) AmsterdamNetherlands
Publisher
American Diabetes Association Inc.
Abstract
Background: Most cardiac surgery patients develop perioperative
hyperglycaemia requiring intravenous insulin therapy. This is
labour-intensive and carries a risk of hypoglycaemia. We hypothesised that
preoperative administration of the GLP-1 receptor agonist liraglutide
would reduce the number of patients requiring insulin during cardiac
surgery. Method(s): In this randomised, blinded, placebo-controlled,
parallel-group, balanced (1:1), superiority, multicentre randomised trial,
adult patients undergoing cardiac surgery in four Dutch tertiary hospitals
were randomised to receive 0 6 mg subcutaneous liraglutide on the evening
before surgery and 1 2 mg after induction of anaesthesia, or matching
placebo. Blood glucose was measured hourly and controlled using an
insulin-bolus-algorithm. The primary outcome was insulin administration
for blood glucose above 8 0 mmol/L in the operating theatre. Research
pharmacists used centralised, stratified, variable-block, randomisation
software. Patients, care providers, and study personnel were blinded to
treatment allocation. Finding(s): Between June 2017 and August 2018,
278 patients were randomised to liraglutide (139) or placebo (139). All
patients receiving at least one study drug injection were included in the
intention-to-treat analyses (liraglutide: 129, placebo: 132). In the
liraglutide group, 55 patients (43%) required additional insulin compared
to 80 patients (61%) in the placebo group, absolute difference: 18% (95%
CI 5 9-30 0, p=0 003). Dose and number of insulin injections and mean
blood glucose were all significantly lower in the liraglutide group. We
observed no difference in the incidence of hypoglycaemia, nausea and
vomiting, mortality, or postoperative complications.
 Interpretation(s): Preoperative liraglutide reduces insulin
requirements while improving peri-operative glycaemic control during
cardiac surgery.

<78>
Accession Number
629613694
Title
Sitagliptin for the prevention and treatment of perioperative
hyperglycemia in diabetic patients undergoing cardiac surgery.
Source
Diabetes. Conference: 79th Scientific Sessions of the American Diabetes
Association, ADA 2019. United States. 68 (Supplement 1) (no pagination),
2019. Date of Publication: June 2019.
Author
Cardona S.; Tsegka K.G.; Jacobs S.; Albury B.S.; Galindo R.J.; Migdal A.;
Halkos M.E.; Keeling W.B.; Miller J.S.; Macheers S.K.; Guyton R.A.;
Vellanki P.; Davis G.; Fayfman M.; Peng L.; Pasquel F.J.; Umpierrez G.E.
Institution
(Cardona, Tsegka, Jacobs, Albury, Galindo, Migdal, Halkos, Keeling,
Miller, Macheers, Guyton, Vellanki, Davis, Fayfman, Peng, Pasquel,
Umpierrez) 1Atlanta, GA, Decatur, GA
Publisher
American Diabetes Association Inc.
Abstract
Perioperative hyperglycemia (BG >180 mg/dl) is reported in more than 80%
of patients with T2D after cardiac surgery and is associated with high
morbidity and mortality. Continuous insulin infusion (CII), the
recommended for treatment of perioperative hyperglycemia is labor
intensive and is associated with hypoglycemia risk. Because, treatment
with DPP-4is has been shown to improve glucose control without
hypoglycemia in general surgery patients, we conducted a double-blinded
randomized trial to test the hypothesis that sitagliptin could prevent and
treat hyperglycemia after CABG. A total of 202 patients with T2D were
randomized to sitagliptin (n=101) or placebo (n=101) once daily, starting
the day prior to surgery and continued in the ICU and after transition to
regular wards. We observed no differences in BG prior to or during
surgery, ICU stay or after transition to floor between groups. There were
no differences in the number of patients requiring insulin therapy in the
ICU or in regular floors, frequency of hypoglycemia or in hospital
complications. Sitagliptin was associated with lower SQ insulin
requirements without increased risk of hyper-or hypoglycemia compared to
placebo after transition to regular floor. Conclusion(s): Sitagliptin
cannot be recommended for the prevention or treatment of perioperative
hyperglycemia in patients with T2D undergoing cardiac surgery.

<79>
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Accession Number
629629446
Title
Personalized Versus Protocolized Fluid Management Using Noninvasive
Hemodynamic Monitoring (Clearsight System) in Patients Undergoing
Moderate-Risk Abdominal Surgery.
Source
Anesthesia and Analgesia. 129 (1) (pp E8-E12), 2019. Date of Publication:
01 Jul 2019.
Author
Joosten A.; Raj Lawrence S.; Colesnicenco A.; Coeckelenbergh S.; Vincent
J.L.; Van Der Linden P.; Cannesson M.; Rinehart J.
Institution
(Joosten, Raj Lawrence, Colesnicenco, Coeckelenbergh) Department of
Anesthesiology, Cliniques Universitaires de Bruxelles (CUB) Erasme,
Universite Libre de Bruxelles, Hospital Erasme, 808 Rt de Lennik, Brussels
1070, Belgium
(Vincent) Department of Intensive Care, CUB Erasme, Universite Libre de
Bruxelles, Brussels, Belgium
(Van Der Linden) Department of Anesthesiology, Centre
Hospitalo-Universitaire (CHU) Brugmann, Universite Libre de Bruxelles,
Brussels, Belgium
(Cannesson) Department of Anesthesiology and Perioperative Medicine,
University of California Los Angeles, David Geffen School of Medicine, Los
Angeles, CA, United States
(Rinehart) Department of Anesthesiology and Perioperative Care, University
of California Irvine, Orange, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Advances in noninvasive hemodynamic monitoring systems allow delivery of
goal-directed fluid therapy and could therefore be used in less-invasive
surgical procedures. In this randomized controlled trial, we compared
closed-loop-assisted goal-directed fluid therapy using a noninvasive
cardiac output (Clearsight system) monitor (personalized approach) to a
protocolized fluid therapy approach in 40 patients undergoing
moderate-risk laparoscopic abdominal surgery. Cardiac output and stroke
volume variations were not significantly different in both groups and
remained within predefined target values >90% of the study time.
Personalized fluid therapy does not seem to offer any hemodynamic
advantage over a protocolized approach in this population. Copyright
© 2018 International Anesthesia Research Society.

<80>
Accession Number
2002691194
Title
A single dose of tramadol in continuous wound analgesia with
levobupivacaine does not reduce post-sternotomy pain: A randomized
controlled trial.
Source
Journal of Pain Research. 12 (pp 2733-2741), 2019. Date of Publication:
2019.
Author
Bethenod F.; Ellouze O.; Berthoud V.; Missaoui A.; Cransac A.; Aho S.;
Bouchot O.; Girard C.; Guinot P.G.; Bouhemad B.
Institution
(Bethenod, Ellouze, Berthoud, Missaoui, Girard, Guinot, Bouhemad) Service
d'Anesthesie Reanimation, Unite d'Anesthesie Reanimation Cardio
Vasculaire, Centre Hospitalier Universitaire de Dijon, Dijon, France
(Cransac) Pharmacie Centrale, Centre Hospitalier Universitaire de Dijon,
Dijon, France
(Aho) Service d'Epidemiologie et d'Hygiene Hospitalieres, Centre
Hospitalier Universitaire de Dijon, Dijon, France
(Bouchot) Service De Chirurgie Cardiaque, Vasculaire Et Thoracique, Centre
Hospitalier Universitaire De Dijon, Dijon, France
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Medial sternotomy is commonly used in cardiac surgery,
although it results in intense post-operative pain. The placement of a
sternal wound catheter for the administration of local anesthetic
represents an effective technique. An initial bolus of tramadol in the
sternal wound catheter could potentiate the effect of the local anesthetic
and decrease both the post-operative pain and the morphine consumption.
 Patients and Methods: We conducted a prospective, randomized,
double-blind study at the University Hospital Center, Dijon, France.
Patients requiring scheduled or non-extreme emergency surgery for valve
disease, aorta disease, atrial myxoma, or coronary artery bypass graft via
sternotomy were included. A sternal wound catheter was inserted at the end
of the surgery. The patients were randomized to receive either a 2 mg/kg
bolus of tramadol (n=80) or a placebo (n=80) in the wound catheter. The
bolus administration was followed by a continuous infusion of 1.25%
levobupivacaine for the first 48 hrs following surgery. The patients'
morphine consumption during the first 48 hrs after extubation was
recorded. The other investigated variables were the patients' rescue
analgesia, arterial blood gasses, and length of stay in the intensive care
unit and in hospital, as well as the incidence of chronic pain at the
four-month follow-up point. Result(s): The morphine consumption was
found to be comparable in the two groups (38 mg vs 32 mg, p=0.102). No
effect was found in terms of the arterial blood gasses, lengths of stay,
or incidence of chronic pain. Conclusion(s): The addition of tramadol
to the local anesthetic delivered via a wound catheter following
sternotomy did not reduce the patients' post-operative morphine
consumption. Copyright © 2019 Bethenod et al.

<81>
Accession Number
629631617
Title
Predicting mortality with cardiac troponins: recent insights from
meta-analyses.
Source
Diagnosis (Berlin, Germany). (no pagination), 2019. Date of Publication:
17 Oct 2019.
Author
Lippi G.; Cervellin G.; Sanchis-Gomar F.
Institution
(Lippi) Section of Clinical Biochemistry, University of Verona, Piazzale
LA Scuro, Verona 37134, Italy
(Cervellin) Emergency Department, University Hospital of Parma, Parma,
Italy
(Sanchis-Gomar) Department of Physiology, Faculty of Medicine, University
of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
Publisher
NLM (Medline)
Abstract
The introduction of cardiac troponin (cTn) testing in clinical practice
has been one of the most important breakthroughs that have occurred in the
recent history of laboratory medicine. Although it is now uncontestable
that cTn values are essential for diagnosing acute coronary syndrome
(ACS), solid evidence is also emerging that assessment of either cardiac
troponin I (cTnI) or T (cTnT) may provide valuable prognostic information
in the general healthy population, as well as in patients with a vast
array of cardiac and extra-cardiac diseases. We have hence performed a
critical review of the scientific literature for identifying meta-analyses
which have investigated the potential contribution of cTns in predicting
the risk of death in health and disease. According to the articles
identified with our research, we can conclude that increased cTn values
may be considered independent risk factors for all-cause mortality in the
general population, as well as in patients with ACS, in those undergoing
revascularization procedures, or with stable coronary artery disease
(CAD), heart failure (HF) and atrial fibrillation (AF). Measurement of cTn
may then be helpful for stratifying the mortality risk in non-cardiac
hospitalized patients, in those with critical illness or sepsis, syncope,
stroke, acute aortic dissection, pulmonary diseases, brain injury, renal
failure, vascular and non-cardiac surgery. Although this evidence has
notable clinical implications, the cost-effectiveness of population
screening with high-sensitivity (hs) cTn immunoassays has not been proven
so far.

<82>
[Use Link to view the full text]
Accession Number
629626178
Title
Five-Year Clinical and Echocardiographic Outcomes from the NOTION
Randomized Clinical Trial in Patients at Lower Surgical Risk.
Source
Circulation. 139 (24) (pp 2714-2723), 2019. Date of Publication: 11 Jun
2019.
Author
Thyregod H.G.H.; Ihlemann N.; Jorgensen T.H.; Nissen H.; Kjeldsen B.J.;
Petursson P.; Chang Y.; Franzen O.W.; Engstrom T.; Clemmensen P.; Hansen
P.B.; Andersen L.W.; Steinbruuchel D.A.; Olsen P.S.; Sondergaard L.
Institution
(Thyregod, Steinbruuchel, Olsen) Department of Cardiothoracic
Surgerys,Heart Centre, Rigshospitalet, Copenhagen University Hospital,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Ihlemann, Jorgensen, Franzen, Engstrom, Sondergaard) Department of
Cardiology, Heart Centre, Rigshospitalet, Copenhagen University Hospital,
Denmark
(Hansen, Andersen) Department of Cardiac Anesthesia, Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Denmark
(Nissen) Department of Cardiology, Odense University Hospital, Denmark
(Kjeldsen) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Denmark
(Petursson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Chang) Coronary and Structural Heart Disease Clinical Department,
Medtronic Plc, Mounds View, MN, United States
(Clemmensen) Department of General and Interventional Cardiology,
University Heart Center Hamburg Eppendorf, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The NOTION trial (Nordic Aortic Valve Intervention) was
designed to compare transcatheter aortic valve replacement (TAVR) with
surgical aortic valve replacement (SAVR) in patients >=70 years old with
isolated severe aortic valve stenosis. Clinical and echocardiographic
outcomes are presented after 5 years. Method(s): Patients were
enrolled at 3 Nordic centers and randomized 1:1 to TAVR using the
self-expanding CoreValve prosthesis (n=145) or SAVR using any stented
bioprostheses (n=135). The primary composite outcome was the rate of
all-cause mortality, stroke, or myocardial infarction at 1 year defined
according to Valve Academic Research Consortium-2 criteria.
 Result(s): Baseline characteristics were similar. The mean age was
79.1+/-4.8 years and mean Society of Thoracic Surgeons Predicted Risk of
Mortality score was 3.0%+/-1.7%. After 5 years, there were no differences
between TAVR and SAVR in the composite outcome (Kaplan-Meier estimates
38.0% versus 36.3%, log-rank test P=0.86) or any of its components. TAVR
patients had larger prosthetic valve area (1.7 cm2 versus 1.2
cm2, P<0.001) with a lower mean transprosthetic gradient (8.2
mm Hg versus 13.7 mm Hg, P<0.001), both unchanged over time. More TAVR
patients had moderate/severe total aortic regurgitation (8.2% versus 0.0%,
P<0.001) and a new pacemaker (43.7% versus 8.7%, P<0.001). Four patients
had prosthetic reintervention and no difference was found for functional
outcomes. Conclusion(s): These are currently the longest follow-up
data comparing TAVR and SAVR in lower risk patients, demonstrating no
statistical difference for major clinical outcomes 5 years after TAVR with
a self-expanding prosthesis compared to SAVR. Higher rates of prosthetic
regurgitation and pacemaker implantation were seen after TAVR. Clinical
Trial Registration: URL: Https://clinicaltrials.gov. Unique identifier:
NCT01057173. Copyright © 2019 Lippincott Williams and Wilkins.
All rights reserved.

<83>
[Use Link to view the full text]
Accession Number
629624061
Title
Type 2 Diabetes and Hypertension: A Study on Bidirectional Causality.
Source
Circulation Research. 124 (6) (pp 930-937), 2019. Date of Publication: 15
Mar 2019.
Author
Sun D.; Zhou T.; Heianza Y.; Li X.; Fan M.; Fonseca V.A.; Qi L.
Institution
(Sun, Zhou, Heianza, Li, Qi) Department of Epidemiology, School of Public
Health and Tropical Medicine, Tulane University, 1440 Canal St, Suite
1724, New Orleans, LA 70112, United States
(Zhou) Department of Public Health Laboratory Sciences, West China School
of Public Health, Sichuan University, Chengdu, Sichuan Province, China
(Fan) Department of Epidemiology and Biostatistics, School of Public
Health, Peking University Health Science Center, Beijing, China
(Fonseca) Section of Endocrinology and Metabolism, Tulane University
School of Medicine, New Orleans, LA, United States
(Qi) Department of Nutrition, Harvard T.H. Chan School of Public Health,
Boston, MA, United States
(Qi) Channing Division of Network Medicine, Department of Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United
States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rationale: In observational studies, type 2 diabetes mellitus (T2D) has
been associated with an increased risk of hypertension, and vice versa;
however, the causality between these conditions remains to be determined.
 Objective(s): This population-based prospective cohort study sought
to investigate the bidirectional causal relations of T2D with
hypertension, systolic and diastolic blood pressure (BP) using Mendelian
randomization (MR) analysis. Methods and Results: After exclusion of
participants free of a history of heart failure, cardiovascular disease,
cardiac procedures, and non-T2D diabetes mellitus, a total of 318 664
unrelated individuals with qualified genotyping data of European descent
aged 37 to 73 from UK Biobank were included. The genetically instrumented
T2D and hypertension were constructed using 134 and 233 single nucleotide
polymorphisms, respectively. Seven complementary MR methods were applied,
including inverse-variance weighted method, 2 median-based methods (simple
and weighted), MR-Egger, MR-robust adjusted profile scores, MR-Pleiotropy
Residual Sum and Outlier, and multivariate MR. The genetically
instrumented T2D was associated with risk of hypertension (odds ratio,
1.07 [95% CI, 1.04-1.10], P=3.4x10-7), whereas the genetically
determined hypertension showed no relationship with T2D (odds ratio, 0.96
[0.88-1.04], P=0.34). Our MR estimates from T2D to BP showed that the
genetically instrumented T2D was associated with a 0.67 mm Hg higher
systolic BP (95% CI, 0.41-0.93, P=5.75x10-7) but not with a
higher diastolic BP. There was no clear evidence showing a causal effect
of elevated systolic BP or diastolic BP on T2D risk. Positive pleiotropic
bias was indicated in the hypertension->T2D relation (odds ratio, of
MR-Egger intercept 1.010 [1.004-1.016], P=0.001) but not from T2D to
hypertension (1.001 [0.998-1.004], P=0.556). Conclusion(s): T2D may
causally affect hypertension, whereas the relationship from hypertension
to T2D is unlikely to be causal. These findings suggest the importance of
keeping an optimal glycemic profile in general populations, and BP
screening and monitoring, especially systolic BP, in patients with
T2D. Copyright © 2019 American Heart Association, Inc.

<84>
Accession Number
629624035
Title
Cost-utility analysis of minimally invasive surgery for lung cancer: A
randomized controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 56 (4) (pp 754-761), 2019.
Date of Publication: 01 Oct 2019.
Author
Bendixen M.; Kronborg C.; Jorgensen O.D.; Andersen C.; Licht P.B.
Institution
(Bendixen, Jorgensen, Licht) Department of Cardiothoracic and Vascular
Surgery, Odense University Hospital, Odense, Denmark
(Kronborg) Centre of Health Economic Research, University of Southern
Denmark, Odense, Denmark
(Andersen) Department of Thoracic Anaesthesiology, Odense University
Hospital, Odense, Denmark
(Licht) Odense Patient Data Explorative Network (OPEN), University of
Southern Denmark, Odense, Denmark
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Minimally invasive video-assisted thoracic surgery (VATS) was
first introduced in the early 1990s. For decades, numerous non-randomized
studies demonstrated advantages of VATS over thoracotomy with lower
morbidity and shorter hospital stay, but only recently did a randomized
trial document that VATS results in lower pain scores and better quality
of life. Opposing arguments for VATS have always been increased costs and
concerns about oncological adequacy. In this paper, we aim to investigate
the cost-effectiveness of VATS. METHOD(S): The study was designed as
a cost-utility analysis of the first 12 months following surgery and was
performed together with a clinical randomized controlled trial of VATS
versus thoracotomy for lobectomy of stage 1 lung cancer during a 6-year
period (2008-2014). All health-related expenses were retrieved from a
national database (Statistics Denmark) including hospital readmissions,
outpatient clinic visits, prescription medication costs, consultations
with general practitioners, specialists, physiotherapists, psychologists
and chiropractors. RESULT(S): One hundred and three VATS patients and
103 thoracotomy patients were randomized. Mean costs per patient operated
by VATS were 103 108 Danish Kroner (Dkr) (13 818) and 134 945 Dkr (18 085)
by thoracotomy, making the costs for VATS 31 837 Dkr (4267) lower than
thoracotomy (P < 0.001). The difference in quality-adjusted life years
gained over 52 weeks of follow-up was 0.021 (P = 0.048, 95% confidence
interval-0.04 to-0.00015) in favour of VATS. The median duration of the
surgical procedure was shorter after thoracotomy (79 vs 100 min; P <
0.001). The mean length of hospitalization was shorter following VATS (4.8
vs 6.7 days; P = 0.027). The use of other resources was not significantly
different between groups. The costs of resources were lower in the VATS
group. This difference was primarily due to reduced costs of readmissions
(VATS 29 247 Dkr vs thoracotomy 51 734 Dkr; P < 0.001) and costs of
outpatient visits (VATS 51 412 Dkr vs thoracotomy 61 575 Dkr; P = 0.012).
 CONCLUSION(S): VATS is a cost-effective alternative to thoracotomy
following lobectomy for stage 1 lung cancer. Economical outcomes as
measured by quality-adjusted life years were significantly better and
overall costs were lower for VATS. Clinical Trial Registration Number:
NCT01278888. Copyright © 2019 The Author(s).

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Accession Number
629624013
Title
Metabolic Surgery for Hypertension in Patients with Obesity.
Source
Circulation Research. 124 (7) (pp 1009-1024), 2019. Date of Publication:
29 Mar 2019.
Author
Pareek M.; Bhatt D.L.; Schiavon C.A.; Schauer P.R.
Institution
(Pareek, Bhatt) Brigham and Women's Hospital Heart and Vascular Center,
Harvard Medical School, Boston, MA, United States
(Pareek) Department of Cardiology, Nephrology, and Endocrinology, North
Zealand Hospital, Hillerod, Denmark
(Schiavon) Research Institute, Heart Hospital, Sao Paulo, Brazil
(Schauer) Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid
Ave, Cleveland, OH 44195, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The global prevalence of overweight and obesity has risen substantially
over the past 4 decades and is accompanied by an increasing burden of
cardiovascular risk factors such as hypertension. Metabolic surgery is the
most effective method to treat obesity and may further improve associated
conditions. Although most research has been directed toward the glycemic
effects of weight loss surgery, there has been a growing interest in
exploring its potential blood pressure-reducing properties. Systematic
reviews and meta-analyses based primarily on observational data have
suggested that metabolic surgery may aid in controlling hypertension. Only
one randomized controlled trial specifically addressing this concept has
been conducted, though supportive of the findings from observational
studies. We review contemporary procedures for weight loss and their
effects on cardiometabolic risk, particularly hypertension. In addition,
we describe potential pathophysiological mechanisms and the effects of
metabolic surgery on cardiovascular events and mortality. Copyright
© 2019 American Heart Association, Inc.

<86>
Accession Number
629623922
Title
Improving coronary artery bypass grafting: A systematic review and
meta-analysis on the impact of adopting transit-time flow measurement.
Source
European Journal of Cardio-thoracic Surgery. 56 (4) (pp 654-663), 2019.
Date of Publication: 01 Oct 2019.
Author
Thuijs D.J.F.M.; Bekker M.W.A.; Taggart D.P.; Pieter Kappetein A.; Kieser
T.M.; Wendt D.; Di Giammarco G.; Trachiotis G.D.; Puskas J.D.; Head S.J.
Institution
(Thuijs, Bekker, Pieter Kappetein, Head) Department of Cardiothoracic
Surgery, Erasmus MC, University Medical Centre, Dr. Molewaterplein 40, GD
Rotterdam 3015, Netherlands
(Taggart) Department of Cardiovascular Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, United Kingdom
(Kieser) Division of Cardiac Surgery, Department of Cardiac Sciences,
Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary,
Canada
(Wendt) Department of Thoracic and Cardiovascular Surgery, West German
Heart and Vascular Centre, University of Duisburg-Essen, Duisburg, Germany
(Di Giammarco) Department of Cardiac Surgery, Universita degli Studi "g.
d'Annunzio" Chieti-Pescara, Chieti, Italy
(Trachiotis) Department of Cardiothoracic Surgery, Veterans Affairs
Medical Centre, Washington, DC, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Saint Luke's,
New York, NY, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)

<87>
Accession Number
629623906
Title
Transthoracic clamp versus endoaortic balloon occlusion in minimally
invasive mitral valve surgery: A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 56 (4) (pp 643-653), 2019.
Date of Publication: 01 Oct 2019.
Author
Rival P.M.; Moore T.H.M.; McAleenan A.; Hamilton H.; Du Toit Z.; Akowuah
E.; Angelini G.D.; Vohra H.A.
Institution
(Rival, Hamilton, Du Toit) University of Bristol Medical School, Senate
House, Tyndall Ave, Bristol BS8 1TH, United Kingdom
(Moore) Natl. Inst. for Hlth. Research Collaboration for Leadership in
Applied Health Research and Care West, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
(McAleenan) Population Health Sciences, Bristol Medical School, University
of Bristol, Bristol, United Kingdom
(Akowuah) Department of Cardiac Surgery, James Cook Hospital,
Middlesbrough, United Kingdom
(Angelini, Vohra) Department of Cardiac Surgery, Bristol Heart Institute,
Bristol, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)

<88>
Accession Number
629550063
Title
Antithrombotic treatment after coronary artery bypass graft surgery:
Systematic review and network meta-analysis.
Source
The BMJ. 367 (no pagination), 2019. Article Number: l5476. Date of
Publication: 2019.
Author
Solo K.; Lavi S.; Kabali C.; Levine G.N.; Kulik A.; John-Baptiste A.A.;
Fremes S.E.; Martin J.; Eikelboom J.W.; Ruel M.; Huitema A.A.; Choudhury
T.; Bhatt D.L.; Tzemos N.; Mamas M.A.; Bagur R.
Institution
(Solo, John-Baptiste, Martin, Bagur) Department of Epidemiology and
Biostatistics, Schulich School of Medicine and Dentistry, Western
University, London, ON, Canada
(Solo) Cochrane Canada Center, MacGRADE Center, Department of Health
Research Methods, Evidence and Impact, McMaster University, Hamilton, ON,
Canada
(Lavi, Huitema, Choudhury, Tzemos, Bagur) London Health Sciences Centre,
Division of Cardiology, Department of Medicine, Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
(Kabali) Epidemiology Division, Dalla Lana School of Public Health,
University of Toronto, Toronto, ON, Canada
(Levine) Department of Medicine, Baylor College of Medicine, Houston, TX,
United States
(Kulik) Lynn Heart and Vascular Institute, Boca Raton Regional Hospital,
Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca
Raton, FL, United States
(John-Baptiste, Martin) Department of Anesthesia and Perioperative
Medicine and Centre for Medical Evidence, Decision Integrity and Clinical
Impact (MEDICI), Western University, London, ON, Canada
(John-Baptiste) Interfaculty Program in Public Health, Western University,
London, ON, Canada
(Fremes) Schulich Heart Centre, Sunnybrook Health Science, University of
Toronto, Toronto, ON, Canada
(Fremes) Institute of Health Policy Management and Evaluation, Dalla Lana
School of Public Health, University of Toronto, ON, Canada
(Eikelboom) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, Hamilton, ON, Canada
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Bhatt) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United
States
(Mamas, Bagur) Keele Cardiovascular Research Group, Institute for Applied
Clinical Science, Centre for Prognosis Research, Institute of Primary Care
and Health Sciences, Keele University, Stoke on Trent, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To assess the effects of different oral antithrombotic drugs
that prevent saphenous vein graft failure in patients undergoing coronary
artery bypass graft surgery. Design Systematic review and network
meta-analysis. Data sources Medline, Embase, Web of Science, CINAHL, and
the Cochrane Library from inception to 25 January 2019. Eligibility
criteria for selecting studies Randomised controlled trials of
participants (aged >=18) who received oral antithrombotic drugs
(antiplatelets or anticoagulants) to prevent saphenous vein graft failure
after coronary artery bypass graft surgery. Main outcome measures The
primary efficacy endpoint was saphenous vein graft failure and the primary
safety endpoint was major bleeding. Secondary endpoints were myocardial
infarction and death. Results This review identified 3266 citations, and
21 articles that related to 20 randomised controlled trials were included
in the network meta-analysis. These 20 trials comprised 4803 participants
and investigated nine different interventions (eight active and one
placebo). Moderate certainty evidence supports the use of dual
antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50,
95% confidence interval 0.31 to 0.79, number needed to treat 10) or
aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein
graft failure when compared with aspirin monotherapy. The study found no
strong evidence of differences in major bleeding, myocardial infarction,
and death among different antithrombotic therapies. The possibility of
intransitivity could not be ruled out; however, between-trial
heterogeneity and incoherence were low in all included analyses.
Sensitivity analysis using per graft data did not change the effect
estimates. Conclusions The results of this network meta-analysis suggest
an important absolute benefit of adding ticagrelor or clopidogrel to
aspirin to prevent saphenous vein graft failure after coronary artery
bypass graft surgery. Dual antiplatelet therapy after surgery should be
tailored to the patient by balancing the safety and efficacy profile of
the drug intervention against important patient outcomes. Study
registration PROSPERO registration number CRD42017065678. Copyright
© Published by the BMJ Publishing Group Limited. For permission to
use (where not already granted under a licence) please go to.

<89>
Accession Number
2003221676
Title
The use of mannitol in cardiopulmonary bypass prime solution-Prospective
randomized double-blind clinical trial.
Source
Acta Anaesthesiologica Scandinavica. 63 (10) (pp 1298-1305), 2019. Date of
Publication: 01 Nov 2019.
Author
Ljunggren M.; Skold A.; Dardashti A.; Hyllen S.
Institution
(Ljunggren, Skold, Dardashti, Hyllen) Department of Cardiothoracic
Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund,
Sweden
(Dardashti, Hyllen) Department of Clinical Sciences, Cardiothoracic
Surgery, Lund University, Lund, Sweden
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: The optimal prime solution for the cardiopulmonary bypass
(CPB) circuit in adult cardiac surgery has not yet been defined. Mannitol
is widely used in the priming solution for CPB despite the fact that there
is no clear consensus on the role of mannitol in cardiac surgery. The aim
of this study was to investigate the effect of mannitol in the CPB prime
solution. Method(s): This prospective, randomized, double-blind study
included 40 patients with normal cardiac and renal functions, who
underwent coronary artery bypass grafting. One group received a prime
based on Ringer's acetate (n = 20), and the other a prime consisting of
Ringer's acetate with 200 mL mannitol (n = 20). Changes in osmolality,
acid-base status, electrolytes, and renal-related parameters were
monitored. Result(s): No significant differences were found in
osmolality between the Ringer's acetate group and the mannitol group at
any time. The mannitol group showed a pronounced decrease in sodium, from
138.7 +/- 2.8 mmol/L at anaesthesia onset, to 133.9 +/- 2.6 mmol/L after
the start of CPB (P <.001). No differences were seen in the renal
parameters between the groups, apart from a short-term effect of mannitol
on peroperative urine production (P =.003). Conclusion(s): We
observed no effects on osmolality of a prime solution containing mannitol
compared to Ringer's acetate-based prime in patients with normal cardiac
and renal function. The use of mannitol in the prime resulted in a
short-term, significant decrease in sodium level. Copyright ©
2019 The Authors. Acta Anaesthesiologica Scandinavica published by John
Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica
Foundation

<90>
Accession Number
2002768022
Title
Health-related quality of life for patients with cardiovascular disease
after a coronary artery bypass graft: A systematic review.
Source
Indian Journal of Public Health Research and Development. 10 (8) (pp
2606-2610), 2019. Date of Publication: August 2019.
Author
Sukartini T.; Arifin H.; Rohmah U.N.; Ramadhani D.R.
Institution
(Sukartini, Arifin, Rohmah, Ramadhani) Faculty of Nursing, Universitas
Airlangga, Surabaya, Indonesia
Publisher
Indian Journal of Public Health Research and Development (Aster-06/603,
Supertech Emerald Court, Sector - 93 A, Expressway, NOIDA, UTTAR PRADESH
201 304, India)
Abstract
CABG can affect health-related quality of life (HRQoL) and it can take a
long time to improve. The following question was raised: 'How long does it
take for the HRQoL of patients with a Coronary Artery Bypass Graft (CBAG)
to increase?' The aim was to analyze the recent scientific production of
HRQoL in cardiovascular patients with CABG. The PRISMA approach was used
and we examined articles from Scopus, EBSCO and ProQuest that were
published between 2014 - 2018. We used "health related quality of life",
restricted our search to "coronary artery bypass graft" and used "after"
in the title, keywords and abstract connected by the Boolean operator
"AND". SF-36 was used to assess the HRQoL and it increased within six
months after CABG. This was influenced by self-control, obesity, age,
gender, emotions and personality. Improving the patient's quality of life
is key for the nurses to control so then the heart surgery patients become
prosperous and thus reduce their morbidity and mortality. Copyright
© 2019, Indian Journal of Public Health Research and Development. All
rights reserved.

<91>
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Accession Number
629629001
Title
Perioperative/Postoperative Atrial Fibrillation and Risk of Subsequent
Stroke and/or Mortality: A Meta-Analysis.
Source
Stroke. 50 (6) (pp 1364-1371), 2019. Date of Publication: 2019.
Author
Lin M.-H.; Kamel H.; Singer D.E.; Wu Y.-L.; Lee M.; Ovbiagele B.
Institution
(Lin, Lee) Department of Neurology, Chang Gung University College of
Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan (Republic of China)
(Kamel) Department of Neurology, Weill Cornell Medical College, New York,
United States
(Singer) Division of General Internal Medicine, Massachusetts General
Hospital and Harvard Medical School, Boston, United States
(Wu) Institute of Population Health Sciences, National Health Research
Institutes, Miaoli County, Taiwan (Republic of China)
(Ovbiagele) Department of Neurology, University of California, San
Francisco, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose-Although believed to be transient and
self-limiting, new-onset perioperative/postoperative atrial fibrillation
(POAF) might be a risk factor for stroke and mortality. We conducted a
systematic review and meta-analysis to qualitatively and quantitatively
evaluate the relationship of POAF with early and late risks of mortality
and stroke. Methods-We searched Pubmed, EMBASE, and Cochrane Library (1966
through March 2018) to identify cohort studies that reported stroke and
mortality associated with POAF. We computed a random-effects estimate
based on the Mantel-Haenszel method. Odds ratios with 95% CI were used as
a measure of the association between POAF and early (in-hospital or within
30 days of surgery) stroke and mortality, while hazard ratios (HR) were
used for long-term outcomes. Results-Our analysis included 35 studies with
2 458 010 patients. Pooling the results from the random-effects model
showed that POAF was associated with increased risks of early stroke (odds
ratio, 1.62; 95% CI, 1.47-1.80), early mortality (odds ratios, 1.44; 95%
CI, 1.11-1.88), long-term stroke (HR, 1.37; 95% CI, 1.07-1.77), and
long-term mortality (HR, 1.37; 95% CI, 1.27-1.49). Analyses focusing on
high-quality studies obtained similar results. In subgroup analyses, POAF
was more strongly associated with stroke in patients undergoing noncardiac
surgery (HR, 2.00; 95% CI, 1.70-2.35) than in patients undergoing cardiac
surgery (HR, 1.20; 95% CI, 1.07-1.34). Conclusions-New-onset POAF is
associated with an increased risk of stroke and mortality, both in the
short-term and long-term. The best strategy to reduce stroke risk among
these patients needs to be determined. Copyright © 2019 American
Heart Association, Inc.

<92>
[Use Link to view the full text]
Accession Number
629628403
Title
Impact of 2 Distinct Levels of Mean Arterial Pressure on Near-Infrared
Spectroscopy during Cardiac Surgery: Secondary Outcome from a Randomized
Clinical Trial.
Source
Anesthesia and Analgesia. 128 (6) (pp 1081-1088), 2019. Date of
Publication: 01 Jun 2019.
Author
Holmgaard F.; Vedel A.G.; Lange T.; Nilsson J.C.; Ravn H.B.
Institution
(Holmgaard, Vedel, Nilsson, Ravn) Department of Cardiothoracic
Anesthesiology, Heart Centre, Rigshospitalet, University of Copenhagen,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Lange) Section of Biostatistics, University of Copenhagen, Copenhagen,
Denmark
(Lange) Center for Statistical Science, Peking University, Beijing, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Near-infrared spectroscopy (NIRS) is used worldwide to monitor
regional cerebral oxygenation (rScO<inf>2</inf>) during cardiopulmonary
bypass (CPB). Intervention protocols meant to mitigate cerebral
desaturation advocate to increase mean arterial pressure (MAP) when
cerebral desaturation occurs. However, the isolated effect of MAP on
rScO<inf>2</inf> is uncertain. The aim of the present study was in a
randomized, blinded design to elucidate the effect of 2 distinct levels of
MAP on rScO<inf>2</inf> values during CPB. We hypothesized that a higher
MAP would be reflected in higher rScO<inf>2</inf> values, lower frequency
of patients with desaturation, and a less pronounced cerebral desaturation
load. METHOD(S): This is a substudy of the Perfusion Pressure
Cerebral Infarct trial, in which we investigated the impact of MAP levels
during CPB on ischemic brain injury after cardiac surgery. Deviation in
rScO<inf>2</inf> was a predefined outcome in the Perfusion Pressure
Cerebral Infarct trial. Patients were randomized to low MAP (LMAP; 40-50
mm Hg) or high MAP (HMAP; 70-80 mm Hg) during CPB. CPB pump flow was fixed
at 2.4 L/min/m2, and MAP levels were targeted using
norepinephrine. Intraoperatively, NIRS monitoring was performed in a
blinded fashion, with sensors placed on the left and right side of the
patient's forehead. NIRS recordings were extracted for offline analysis as
the mean value of left and right signal during prespecified periods. Mean
rScO<inf>2</inf> during CPB was defined as the primary outcome in the
present study. RESULT(S): The average MAP level during CPB was 67 mm
Hg +/- SD 5.0 in the HMAP group (n = 88) and 45 mm Hg +/- SD 4.4 in the
LMAP group (n = 88). Mean rScO<inf>2</inf> was significantly lower in the
HMAP group during CPB (mean difference, 3.5; 95% confidence interval,
0.9-6.1; P =.010). There was no difference in rScO<inf>2</inf> values at
specified time points during the intraoperative period between the 2
groups. Significantly more patients experienced desaturation below 10% and
20% relative to rScO<inf>2</inf> baseline in the HMAP group (P =.013 and P
=.009, respectively), and the cerebral desaturation load below 10%
relative to rScO<inf>2</inf> baseline was more pronounced in the HMAP
group (P =.042). CONCLUSION(S): In a randomized blinded study, we
observed that a higher MAP induced by vasopressors, with a fixed CPB pump
flow, leads to lower mean rScO<inf>2</inf> and more frequent and
pronounced cerebral desaturation during CPB. The mechanism behind these
observations is not clear. We cannot exclude extracranial contamination of
the NIRS signal as a possible explanation. However, we cannot recommend
increasing MAP by vasoconstrictors during cerebral desaturation because
this is not supported by the findings of the present study. Copyright
© 2019 International Anesthesia Research Society.

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[Use Link to view the full text]
Accession Number
629627691
Title
Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac
Surgery: A Randomized Controlled Trial.
Source
Anesthesiology. 130 (6) (pp 958-970), 2019. Date of Publication: 01 Jun
2019.
Author
Klinger R.Y.; Cooter M.; Bisanar T.; Terrando N.; Berger M.; Podgoreanu
M.V.; Stafford-Smith M.; Newman M.F.; Mathew J.P.; Blumenthal J.A.;
Karhausen J.A.; Kertai M.D.; Krishnamoorthy V.; Li Y.-J.; Swaminathan M.;
Warner D.S.; Funk B.L.; Brassard R.; Toulgoat-Dubois Y.; Waweru P.; Babyak
M.A.; Browndyke J.N.; Welsh-Bohmer K.A.; Sketch M.H.; Bennett E.R.;
Graffagnino C.; Laskowitz D.T.; Strittmatter W.J.; Collins K.; Smigla G.;
Shearer I.; D'Amico T.A.; Daneshmand M.A.; Gaca J.G.; Glower D.D.; Haney
J.; Harpole D.; Hartwig M.G.; Hughes G.C.; Klapper J.A.; Lin S.S.; Lodge
A.J.; Milano C.A.; Plichta R.P.; Schroeder J.N.; Smith P.K.; Tong B.C.
Institution
(Klinger, Cooter, Bisanar, Terrando, Berger, Podgoreanu, Stafford-Smith,
Mathew) Department of Anesthesiology, Duke University Medical Center, Box
3094, Durham, NC 27710, United States
(Newman) Department of Anesthesiology, University of Kentucky School of
Medicine, Lexington, KY, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Editor's Perspective What We Already Know about This Topic Preclinical and
clinical studies suggest that lidocaine might be neuroprotective, which
could benefit surgical patients at risk of neurologic compromise What This
Article Tells Us That Is New This multicenter trial of intravenous
lidocaine administered during and after cardiac surgery did not show an
effect on cognition at 6 weeks postoperatively Background: Cognitive
decline after cardiac surgery occurs frequently and persists in a
significant proportion of patients. Preclinical studies and human trials
suggest that intravenous lidocaine may confer protection in the setting of
neurologic injury. It was hypothesized that lidocaine administration would
reduce cognitive decline after cardiac surgery compared to placebo.
 Method(s): After institutional review board approval, 478 patients
undergoing cardiac surgery were enrolled into this multicenter,
prospective, randomized, double-blinded, placebo-controlled, parallel
group trial. Subjects were randomized to lidocaine 1 mg/kg bolus after the
induction of anesthesia followed by a continuous infusion (48 mug .
kg-1 . min-1 for the first hour, 24 mug .
kg-1 . min-1 for the second hour, and 10 mug .
kg-1 . min-1 for the next 46 h) or saline with
identical volume and rate changes to preserve blinding. Cognitive function
was assessed preoperatively and at 6 weeks and 1 yr postoperatively using
a standard neurocognitive test battery. The primary outcome was change in
cognitive function between baseline and 6 weeks postoperatively, adjusting
for age, years of education, baseline cognition, race, and procedure type.
 Result(s): Among the 420 allocated subjects who returned for 6-week
follow-up (lidocaine: N = 211; placebo: N = 209), there was no difference
in the continuous cognitive score change (adjusted mean difference [95%
CI], 0.02 (-0.05, 0.08); P = 0.626). Cognitive deficit (greater than 1 SD
decline in at least one cognitive domain) at 6 weeks occurred in 41% (87
of 211) in the lidocaine group versus 40% (83 of 209) in the placebo group
(adjusted odds ratio [95% CI], 0.94 [0.63, 1.41]; P = 0.766). There were
no differences in any quality of life outcomes between treatment groups.
At the 1-yr follow-up, there continued to be no difference in cognitive
score change, cognitive deficit, or quality of life. Conclusion(s):
Intravenous lidocaine administered during and after cardiac surgery did
not reduce postoperative cognitive decline at 6 weeks. Copyright
© 2019 the American Society of Anesthesiologists, Inc.

<94>
Accession Number
2001243295
Title
Rationale and design of the randomized prospective ATLAS study: Avoid
Transvenous Leads in Appropriate Subjects.
Source
American Heart Journal. 207 (pp 1-9), 2019. Date of Publication: January
2019.
Author
Mondesert B.; Bashir J.; Philippon F.; Dubuc M.; Amit G.; Exner D.; Joza
J.; Birnie D.H.; Lane C.; Tsang B.; Korley V.; Spears D.; Ling A.; Djuric
A.; Crystal E.; Hruczkowski T.; Roux J.-F.; Carroll S.; Essebag V.; Krahn
A.D.; Healey J.S.
Institution
(Mondesert, Dubuc) Department of Medicine, Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada
(Bashir, Krahn) University of British Columbia, Vancouver, British
Columbia, Canada
(Philippon) Institut Universitaire de cardiologie et de pneumologie de
Quebec, Laval University, Quebec City, Quebec, Canada
(Amit, Ling, Djuric, Carroll, Healey) Population Health Research
Institute, McMaster University, Hamilton, Ontario, Canada
(Exner) Libin Cardiovascular Institute of Alberta, Calgary, Alberta,
Canada
(Joza, Essebag) McGill University Health Centre, Montreal, Quebec, Canada
(Birnie) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
(Lane) Royal Jubilee Hospital, Victoria, British Columbia, Canada
(Tsang) Southlake Regional Health Centre, Newmarket, Ontario, Canada
(Korley) Division of Cardiology, Department of Medicine, St Michael's
Hospital, University of Toronto, Toronto, Ontario, Canada
(Spears) Peter Munk Cardiac Center Toronto General Hospital, University
Health Network, Toronto, Canada
(Crystal) Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, Ontario, Canada
(Hruczkowski) Department of Medicine, Division of Cardiology, University
of Alberta, Edmonton, Canada
(Roux) Cardiology Service, Medicine department, Medicine and Health
sciences university, Sherbrooke university, Sherbrooke, Quebec, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The defibrillator lead is the weakest part of the transvenous
(TV) implantable cardioverter defibrillation (ICD) system and a frequent
cause of morbidity. Lead dislodgement, cardiac perforation,
insertion-related trauma including pneumothorax and vascular injury, are
common early complications of TV-ICD implantation. Venous occlusion,
tricuspid valve dysfunction, lead fracture and lead insulation failure are
additional, later complications. The introduction of a totally
sub-cutaneous ICD (S-ICD) may reduce these lead-related issues, patient
morbidity, hospitalizations and costs. However, such benefits compared to
the TV-ICD have not been demonstrated in a randomized trial.
 Design(s): ATLAS (Avoid Transvenous Leads in Appropriate Subjects) is
a multi-centered, randomized, open-label, parallel group trial. Patients
younger than 60 years are eligible. If older than 60 years, patients are
eligible if they have an inherited heart rhythm disease, or risk factors
for ICD-related complication, such as hemodialysis, a history of ICD or
pacemaker infection, heart valve replacement, or severe pulmonary disease.
This study will determine if using an S-ICD compared to a TV-ICD reduces a
primary composite outcome of perioperative complications including
pulmonary or pericardial perforation, lead dislodgement or dysfunction,
tricuspid regurgitation and ipsilateral venous thrombosis. Five hundred
patients will be enrolled from 14 Canadian hospitals, and data collected
to both early- (at 6 months) and mid-term complications (at 24 months) as
well as mortality and ICD shock efficacy. The ATLAS randomized trial is
comparing early- and mid-term vascular and lead-related complications
among S-ICD versus TV-ICD recipients who are younger or at higher risk of
ICD-related complications. Copyright © 2018 Elsevier Inc.

<95>
Accession Number
627121574
Title
Clinical outcomes of paediatric patients supported by the Berlin Heart
EXCOR: a systematic review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (5) (pp 830-839),
2019. Date of Publication: 01 Nov 2019.
Author
Rohde S.; Antonides C.F.J.; Dalinghaus M.; Muslem R.; Bogers A.J.J.C.
Institution
(Rohde, Antonides, Muslem, Bogers) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Dalinghaus) Department of Paediatric Cardiology, Erasmus University
Medical Centre, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
Ventricular assist devices (VADs) are widely accepted as therapy to bridge
children to heart transplantation. We provide a systematic review of the
current state of clinical outcomes in children after paediatric VAD
support by the Berlin Heart EXCOR (BH EXCOR) device. A systematic
literature search was performed in April 2018. Studies reporting clinical
outcomes in at least 15 children supported by a BH EXCOR VAD were
included. Additionally, we focused on outcomes in small children and
compared outcomes of children supported by a left ventricular assist
device (LVAD) versus children supported by a biventricular assist device
(BiVAD). Eighteen publications fulfilled the inclusion criteria and were
included in this systematic review. Mortality rates ranged from 6.3%
[confidence interval (CI) 0.0-18.1%] to 38.9% (2.8-75.0%) while
transplantation rates ranged from 37.0% (CI 18.8-55.2%) to 72.5% (CI
63.9-81.2%) and successful weaning rates from 0.0% to 20.7% (CI
6.0-35.5%). In children under 1 year of age, mortality rates ranged from
20.0% to 55.5% and transplantation rates ranged from 0.0% to 62.5%. BiVAD
support seemed to result in worse clinical outcomes than LVAD support.
Incidence of stroke ranged from 5.0% to 47.0% in all children supported
with the BH EXCOR. Although a high incidence of adverse events such as
stroke and pump thrombosis is reported, VAD support should be considered
in children with end-stage heart failure awaiting heart transplantation.
Further research is warranted, especially on optimal timing of device
implantation and anticoagulation regimens. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<96>
Accession Number
627179088
Title
Sutured and sutureless repair of postinfarction left ventricular free-wall
rupture: a systematic review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (5) (pp 840-848),
2019. Date of Publication: 01 Nov 2019.
Author
Matteucci M.; Fina D.; Jiritano F.; Blankesteijn W.M.; Raffa G.M.;
Kowalewski M.; Beghi C.; Lorusso R.
Institution
(Matteucci, Fina, Jiritano, Lorusso) Department of Cardiothoracic Surgery,
Heart and Vascular Centre, Maastricht University Medical Centre,
Maastricht, Netherlands
(Matteucci, Beghi) Department of Cardiac Surgery, Circolo Hospital,
University of Insubria, Varese, Italy
(Fina) Department of Cardiology, University of Milan, IRCCS Policlinico
San Donato, Milan, Italy
(Jiritano) Department of Cardiac Surgery, University Magna Graecia of
Catanzaro, Catanzaro, Italy
(Blankesteijn) Department of Pharmacology and Toxicology, Cardiovascular
Research Institute Maastricht, Maastricht University, Maastricht,
Netherlands
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, Palermo, Italy
(Kowalewski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
(Lorusso) Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
Publisher
NLM (Medline)
Abstract
Postinfarction left ventricular free-wall rupture is a potentially
catastrophic event. Emergency surgical intervention is almost invariably
required, but the most appropriate surgical procedure remains
controversial. A systematic review, from 1993 onwards, of all available
reports in the literature about patients undergoing sutured or sutureless
repair of postinfarction left ventricular free-wall rupture was performed.
Twenty-five studies were selected, with a total of 209 patients analysed.
Sutured repair was used in 55.5% of cases, and sutureless repair in the
remaining cases. Postoperative in-hospital mortality was 13.8% in the
sutured group, while it was 14% in the sutureless group. A trend towards a
higher rate of in-hospital rerupture was observed in the sutureless
technique. The most common cause of in-hospital mortality (44%) was low
cardiac output syndrome. In conclusion, sutured and sutureless repair for
postinfarction left ventricular free-wall rupture showed comparable
in-hospital mortality. However, because of the limited number of patients
and the variability of surgical strategies in each reported series,
further studies are required to provide more consistent data and lines of
evidence. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<97>
Accession Number
2003405645
Title
MA16.05 Wearable Technology for Preconditioning Before Thoracic Surgery: A
Feasibility Study.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S314), 2019. Date of
Publication: October 2019.
Author
Patel Y.; Hylton D.; Rok M.; Beauchamp M.; Wald J.; Mbuagbaw L.; Finley
C.; Agzarian J.; Shargall Y.; Fahim C.; Hanna W.
Institution
(Patel, Hylton, Rok, Finley, Agzarian, Shargall, Fahim, Hanna) Division of
Thoracic Surgery, Mcmaster University, Hamilton, ON, Canada
(Beauchamp) Rehabilitation Science, Mcmaster University, Hamilton, ON,
Canada
(Wald) Respirology, Mcmaster University /St. Joseph's Healthcare Hamilton,
Hamilton, ON, Canada
(Mbuagbaw) Clinical Epidemiology & Biostatistics, Mcmaster University /St.
Joseph's Healthcare Hamilton, Hamilton, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Preconditioning before surgery can lower complication rates,
but there are significant barriers to its adoption in the lung cancer
population, which is characteristically older, suffers multiple
comorbidities, and is averse to exercise. In an effort to overcome these
barriers, we designed Move For Surgery (MFS), a home-based, preoperative
preconditioning program which involves aerobic exercise using wearable
technology and deep breathing exercises. We aimed to test the feasibility
of MFS in preparation for a randomized controlled clinical trial.
 Method(s): In this prospective feasibility study, patients undergoing
resection for NSCLC were preoperatively enrolled and provided with a
wearable activity tracker (Fitbit) and a booklet describing various
aerobic exercises, deep breathing exercises, and nutritional and smoking
cessation tips. The daily step count, sleep cycle, and calories burned
were synced and tracked remotely. Daily step goals were set by increasing
the participants' baseline step count by 600 steps each week until the day
of surgery. Participants were encouraged and motivated to reach their
daily step goal by daily automatic reminders through the Fitbit.
Participants completed the EQ-5D-5L health-related quality of life
instrument at baseline and on the day of surgery. Data is presented as
mean +/- SD and median (range). Continuous variables were compared using
Student's t-test, and categorical variables were compared using Chi-square
or Fischer's exact test, with a level of significance p<0.05.
 Result(s): Of the 40 patients screened, 62.5% (25/40) were eligible
and enrolled. Of the 15 not eligible, 80% (12/15) did not have a
smartphone. Participants (n=25) were enrolled from 11/2017 to 07/2018.
Median age was 62 (33-82) and 72% (18/25) were women. The mean predicted
FEV1 and DLCO were 88.9% +/- 23.4% and 74.9% +/- 19.8% respectively.
Participants spent a median of 25 days (8-55) on trial, and wore their
Fitbits 90.0% +/- 25.2% of the time. The mean baseline daily step count
for this cohort was 7,586 +/- 4,082, and the participants were able to
achieve the daily step goal in 40.8% +/- 30.0% of the time. Participants
with higher baseline step counts (>=6,000/day) were more likely to achieve
the daily step goals (52.2% vs 20.5%; p=0.0083). Significant improvement
was seen in the overall health component of the EQ-5D-5L from before the
intervention (76.4 +/- 15.45) to after the intervention (80.4 +/- 14.57;
p=0.03). Overall, 96.0% (24/25) of the participants completed the
recommended deep breathing exercises, 100% (25/25) recommended MFS for
future patients, and 96.0% (24/25) stated they will buy their own Fitbits
and continue this lifestyle post-surgery. Conclusion(s): A
preoperative preconditioning trial with wearable technology prior to lung
cancer resection is feasible based on encouraging enrollment rates, use of
the device, and goal achievement, but it is only applicable to
participants with smart devices. MFS motivates patients to undergo
preconditioning before lung cancer resection and to continue with a
healthy lifestyle after surgery. A revision of the daily step goal is
required to improve compliance. A randomized trial is in progress to
determine the impact of MFS on postoperative outcomes in the thoracic
surgery population. Keywords: Preconditioning, Wearable Technology,
Thoracic surgery Copyright © 2019

<98>
Accession Number
2003405517
Title
MS06.05 Transcervical Lymphadenectomies.
Source
Journal of Thoracic Oncology. Conference: IASLC 2019 World Conference on
Lung Cancer (WCLC). Spain. 14 (10 Supplement) (pp S162-S163), 2019. Date
of Publication: October 2019.
Author
Zielinski M.
Institution
(Zielinski) Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
Publisher
Elsevier Inc.
Abstract
Introduction: The aim of his study is to analyze the issue of
transcervical lympadenectomies for Non-Small-Cell Lung Cancer performed by
the techniques of Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA)
and Transcervical Extended Mediastinal Lymphadenectomy (TEMLA). Methods
The Pubmed search was performed and there were 27 articles found on VAMLA
and 33 articles on TEMLA. After further analysis there were 13 original
article on VAMLA and 18 original articles on TEMLA. In the current paper
all proven and possible advantages of transcervical lymphadenectomies
represented by VAMLA and TEMLA are described. Results The proven
advantages of VAMLA and TEMLA: 1. Superior diagnostic value in discovery
of the metastatic mediastinal nodes for staging and restaging of NSCLC. 2.
bilateral mediastinal lymphadenectomy, more extensive than the techniques
of lymphadenectomy used during standard thoracotomy or Video-Assisted
Thoracic Surgery (VATS) approaches. Possible advantages include: 1.
Improved selection of patients for pulmonary resection for NSCLC 2.
Combination of VAMLA/TEMLA with VATS pulmonary resection, 3. Combination
of VAMLA/TEMLA with esophegeal resection, 4. Combination of TEMLA and
Stereotactic Radiotherapy (SBRT) for advanced NSCLC 5. The use of TEMLA
for preoperative staging of mesothelioma, 6. Combination of TEMLA and
pulmonary lobectomy through a sole transcevical approach 7. Resection of
various metastatic tumors, including thyroid cancer and metastatic
mediastinal nodes. 8. Possible impact of VAMLA/TEMLA on improvement of
survival for NSCLC patients, which is the most important issue. In case of
VAMLA superior survival of patients operated on with the use pulmonary
resection with VAMLA in comparison to the pulmonary resection with
addition of standard mediastinoscopy. In case of TEMLA no reports on
survival has been published, yet Disadvantages of VAMLA/TEMLA include 1.
Possible complications, especially the left recurrent nerve palsy 2.
Possible delay or elimination of some patients from pulmonary resection
due to postoperative complication in case of negative result of
VAMLA/TEMLA 3. Scar in the neck (cosmetic) 4. Demanding surgical technique
Conclusions 1. Bilateral transcervical lymphadenectomies representd by
VAMLA and TEMLA are more extensive than the techniques of lymphadenectomy
used during standard thoracotomy or Video-Assisted Thoracic Surgery (VATS)
approaches and superior to the other techniques of staging and restaging
of NSCLC in regard to the diagnostic value. 2. There are several other
possible advantages of TEMLA/VAMLA for the treatment of NSCLC, esophageal
cancer, mediastinal tumors and malignant mesothelioma. 3. Possible impact
of VAMLA/TEMLA on survival of NSCLC has not been proven, yet. References
Hurtgen M, Friedel G, Toomes H et al: Radical video-assisted
mediastinoscopic lymphadenectomy (VAMLA) - technique and first results.
Eur J Cardiothorac Surg 2002;21:348-51 Zielinski M, Szlubowski A,
Kolodziej M, Orzechowski S, Laczynska E, Pankowski J, Jakubiak M, Obrochta
A. Comparison of endobronchial ultrasound and/or endoesophageal ultrasound
with transcervical extended mediastinal lymphadenectomy for staging and
restaging of non-small-cell lung cancer. J Thorac Oncol. 2013
May;8(5):630-6. Zielinski M, Hauer J, Hauer L, Pankowski J, Nabialek T,
Szlubowski A. Staging algorithm for diffuse malignant pleural
mesothelioma. Interact Cardiovasc Thorac Surg. 2010;10:185-9 Zielinski M,
Pankowski J, Hauer L et al: The right upper lobe pulmonary resection
performed through the transcervical approach. Eur J Cardiothorac Surg.
2007;32:766-769 Singh AK, Hennon M, Ma SJ, Demmy TL, Picone A, Dexter EU,
Nwogu C, Attwood K, Tan W, Hermann GM, Fung-Kee-Fung S, Malhotra HK,
Yendamuri S, Gomez-Suescun JA. A pilot study of stereotactic body
radiation therapy (SBRT) after surgery for stage III non-small cell lung
cancer. BMC Cancer. 2018 Nov 29;18(1):1183. Turna A, Demirkaya A, Ozkul S,
Oz B, Gurses A, Kaynak K. Video-assisted mediastinoscopic lymphadenectomy
is associated with better survival than mediastinoscopy in patients with
resected non-small cell lung cancer. J Thorac Cardiovasc Surg. 2013
Oct;146(4):774-80. Epub 2013 Jun 15. Li X, Wang W, Zhou Y, Yang D, Wu J,
Zhang B, Wu Z, Tang J. Efficacy comparison of transcervical video-assisted
mediastinoscopic lymphadenectomy combined with left transthoracic
esophagectomy versus right transthoracic esophagectomy for esophageal
cancer treatment. World J Surg Oncol. 2018 Feb 9;16(1):25. Call S, Obiols
C, Rami-Porta R, Trujilo-Reyes JC, Iglesias M, Saumench R,
Gonzalez-Pont G, Serra-Mitjans M, Belda-Sanchis J. Video-Assisted
Mediastinoscopic Lymphadenectomy for Staging Non-Small Cell Lung Cancer.
Ann Thorac Surg. 2016 Apr;101(4):1326-33. Epub 2016 Jan 21.Kim HJ, Kim YH,
Choi SH, Kim HR, Kim DK, Park SI. Video-assisted mediastinoscopic
lymphadenectomy combined with minimally invasive pulmonary resection for
left-sided lung cancer: feasibility and clinical impacts on surgical
outcomes+. Eur J Cardiothorac Surg. 2016 Jan;49(1):308-13. Epub 2015 Mar
11 Zielinski M. Transcervical Resection of the Mediastinal Tumors. In
Zielinski M, Rami-Porta R (eds). Transcervical Approach in Thoracic
Surgery. Springer 2014, pages 141-148. Copyright © 2019

<99>
Accession Number
629610368
Title
Successful post-procedure intervention in a tertiary care setting with
high rate of surgical site infection among patients with coronary artery
bypass graft.
Source
Antimicrobial Resistance and Infection Control. Conference: 5th
International Conference on Prevention and Infection Control, ICPIC 2019.
Switzerland. 8 (Supplement 1) (no pagination), 2019. Date of Publication:
2019.
Author
Slim O.; Alshamrani M.; Abukhzam B.; Abdulebdeh S.; Abagguey D.; El-Saed
A.; Balkhy H.
Institution
(Slim, Alshamrani, Abukhzam, Abagguey, El-Saed) Infection Prevention and
Control, King Abulaziz Medical City, Riyadh, Saudi Arabia
(Abdulebdeh) Cardiac Department, King Abulaziz Medical City, Riyadh, Saudi
Arabia
(Balkhy) Antimicrobial Resistance, World Health Organization, Genva,
Switzerland
Publisher
BioMed Central Ltd.
Abstract
Introduction: The rate of surgical site infection (SSI) among our patients
who underwent coronary artery bypass graft (CABG) has been consistently
higher than reported by the US National Healthcare Safety Network (NHSN).
Post-discharge personal hygiene has been raised as a possible contributing
factor. Objective(s): The objective was to examine the impact of
using post-procedure antiseptic body shower on infection and mortality in
CABG patients. Method(s): Interventional study was conducted among
all patients who underwent CABG at king Abulaziz Medical City, Riyadh,
Saudi Arabia between October 2018 and March 2019. The intervention was
educational sessions focusing on appropriate usage of chlorhexidine
gluconate 4% antiseptic body shower during hospital stay and 7 days
post-discharge. The outcome was the development of superficial SSI
according to NHSN criteria. This was assessed from outpatient records,
emergency visits, and a phone call. Additionally, the phone call was used
to confirm the compliance with the intervention. Result(s): Out of
111 patients included in the current study, 87 (78.4%) were compliant with
the post-procedure antiseptic body shower and 13 (11.7%) developed
superficial SSI. Compared with non-compliant patients, patients who were
compliant with the intervention had markedly low SSI rate (2.3% vs. 45.8%,
p<0.001) and no mortality (0.0% vs. 8.3%, p=0.045). The difference in SSI
remained significant after adjustment for the risk index categories in
both groups (p<0.001). Additionally, total and post-procedure length of
hospital stay were shorter among compliant patients compared with
non-compliant patients (17.8+/-8.4 vs.31.1+/-30.3 days, p< 0.001 and
11.5+/-6.6 vs. 24.1+/-29.2 days, p<0.001, respectively).
 Conclusion(s): The current findings indicate that the use of
chlorhexidine gluconate 4% antiseptic body shower was very effective in
reducing the risk of infection, mortality, and length of stay.
Additionally, the findings highlight the importance of patient education
and personal hygiene. The findings still need to be confirmed in large
randomized studies.

<100>
Accession Number
629610182
Title
Influence of antimicrobial stewardship in the adequacy of antimicrobial
prescription - A cross-sectional survey.
Source
Antimicrobial Resistance and Infection Control. Conference: 5th
International Conference on Prevention and Infection Control, ICPIC 2019.
Switzerland. 8 (Supplement 1) (no pagination), 2019. Date of Publication:
2019.
Author
Silva-Pinto A.; Duro R.; Rocha-Pereira N.; Andrade P.; Mourato-Torres J.;
Lima-Alves C.
Institution
(Silva-Pinto, Duro, Rocha-Pereira, Andrade, Mourato-Torres, Lima-Alves)
Infection Control and Antimicrobial Stewardship Unit, CENTRO HOSPITALAR
UNIVERSITARIO SAO JOAO, Porto, Portugal
Publisher
BioMed Central Ltd.
Abstract
Introduction: Antimicrobial stewardship is a multimodal strategy to
optimize adequacy of antimicrobial prescription, crucial in the approach
to decrease antimicrobial resistance. Objective(s): To assess the
adequacy of antimicrobial prescription in a university hospital and to
compare the adequacy in departments with or without antimicrobial
stewardship interventions. Method(s): We performed a cross-sectional
study based on the point prevalence survey rules from WHO. One third of
the patients in each department were randomly selected. After selection,
we classified the adequacy of each antimicrobial prescribed (considering
necessity of treatment, spectrum, dose, administration route and duration
of therapy), according to local recommendations and, in its absence,
national/international guidelines. We compared antimicrobial prescription
adequacy in departments with specific ongoing antimicrobial stewardship
interventions (Cardiothoracic Surgery, Haematology, Orthopaedics, Plastic
Surgery, Urology, Vascular Surgery) and those without such interventions.
 Result(s): On the day of the study, 898 patients were hospitalized.
We randomly included 316 (35%). Of those, 119 had at least one
antimicrobial prescription (37,7%), corresponding to 172 antimicrobials
(33 (19,2%) were prescribed as prophylaxis and 139 (80,8%) as treatment).
Table 1 depicts some variables of interest. We considered antimicrobial
prescription as adequate in 107 patients (62,2%). Comparing departments
with and without antimicrobial stewardship interventions, we noticed a
statistically significant difference: 76,6% vs. 56,8% (p=0,021; Chi
Squared test). Conclusion(s): Antimicrobial stewardship is a
multimodal strategy with a positive impact in the adequacy of
antimicrobial prescriptions.

<101>
Accession Number
629609852
Title
Abstracts from the 5th International Conference on Prevention and
Infection Control, ICPIC 2019.
Source
Antimicrobial Resistance and Infection Control. Conference: 5th
International Conference on Prevention and Infection Control, ICPIC 2019.
Switzerland. 8 (Supplement 1) (no pagination), 2019. Date of Publication:
2019.
Author
Anonymous
Publisher
BioMed Central Ltd.
Abstract
The proceedings contain 553 papers. The topics discussed include: the
effect of postoperative continuation of antibiotic prophylaxis on the
incidence of surgical site infection: a systematic review and
meta-analysis; impact of climate factors on surgical site infection rates.
data from 17 years of surveillance in Germany; reducing staphylococcus
aureus surgical site infections using an anti-staphylococcal bundle in New
Zealand; management and outbreak investigation of serratia marcescens
neurosurgical site infections associated with a contaminated shaving razor
used for preoperative scalp shaving; impact of a bundle intervention to
reduce surgical site infection after craniotomy: a before-after
prospective study; barriers and facilitators to implementing a bundled
intervention to prevent S. aureus surgical site infections (SSI) among
cardiac and orthopedic surgery patients: why did it work better for
orthopedic surgeries?; and motion detection and artificial intelligence in
the automatic documentation of key figures for hand hygiene compliance.

<102>
Accession Number
2002668556
Title
Effects of an orientation tour on preoperative anxiety in candidates for
coronary artery bypass grafting: A randomized clinical trial.
Source
ARYA Atherosclerosis. 15 (4) (pp 154-160), 2019. Date of Publication:
2019.
Author
Niknejad R.; Mirmohammad-Sadeghi M.; Akbari M.; Ghadami A.
Institution
(Niknejad) School of Nursing and Midwifery, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Mirmohammad-Sadeghi) Isfahan Cardiovascular Research Center,
Cardiovascular Research Institute, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Akbari) Cardiac Rehabilitation Research Center, Cardiovascular Research
Institute AND Nursing and Midwifery Care Research Center, School of
Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan,
Iran, Islamic Republic of
(Ghadami) Nursing and Midwifery Care Research Center AND Department of
Operating Room, School of Nursing and Midwifery, Isfahan University of
Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Candidates for cardiac surgery usually suffer from
preoperative anxiety. Although there are various anxiety reduction
techniques, it is unclear which one is the most effective. Therefore, the
present study was conducted to explore the effects of an orientation tour
on preoperative anxiety in candidates for coronary artery bypass grafting
(CABG). METHOD(S): In this randomized clinical trial study, 70
patients who were candidate for CABG were recruited from February 2016 to
May 2017. They were randomly assigned to two groups of 35. The
intervention group members were taken on an orientation tour and the
control group received routine care. Data were collected using the
State-Trait Anxiety Inventory (STAI). RESULT(S): The statistical
tests revealed that there was no significant difference between the
intervention group (42.43 +/- 13.24) and the control group (45.11 +/-
10.19) with respect to the preintervention state anxiety level (P =
0.340); however, before surgery, the state anxiety level was significantly
lower in the intervention group (34.83 +/- 11.15) than in the control
group (47.69 +/- 11.30) (P < 0.001). Moreover, the independent t-test
showed that there was no significant difference between the intervention
(43.71 +/- 12.04) and control (45.03 +/- 8.76) groups with respect to the
pre-intervention trait anxiety level (P = 0.600). Nevertheless, before
surgery, the trait anxiety level was significantly lower in the
intervention group (35.40 +/- 10.24) than in the control group (46.91 +/-
9.51) (P < 0.001). CONCLUSION(S): The preoperative orientation tour
had a positive impact on the anxiety level in the candidates for CABG.
Hence, the tour can be used as a remarkably effective technique for
reducing anxiety. Copyright © 2019, Isfahan University of Medical
Sciences(IUMS). All rights reserved.

<103>
Accession Number
629602755
Title
What are the options for cardiac standstill during aneurysm surgery? A
systematic review.
Source
Neurosurgical review. (no pagination), 2019. Date of Publication: 15 Oct
2019.
Author
Meling T.R.; Lave A.
Institution
(Meling, Lave) Department of Clinical Neurosciences, Division of
Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
(Meling) Faculty of Medicine, University of Geneva, Geneva, Switzerland
(Meling) Service de Neurochirurgie, Hopitaux Universitaires de Geneve,
Geneva 1205, Switzerland
Publisher
NLM (Medline)
Abstract
To perform a systematic review of the techniques for transient circulatory
arrest during intracerebral aneurysm surgery according to the PRISMA
guidelines. Search of PubMed and Google Scholar using the following:
("heart arrest" OR "cardiac standstill"[All Fields]) AND ("intracranial
aneurysm" OR "intracranial"[All Fields] AND "aneurysm"[All Fields]). A
total of 41 original articles were retrieved, of which 17 were excluded
(review articles, editorials and single-case reports). A total of 24
separate articles published between 1984 and 2018 were included in the
final analysis, where the majority of patients harbored anterior
circulation giant or large aneurysms. Adenosine-induced cardiac arrest
gave a short, temporary asystole. The method had benefits in aneurysm with
a broad neck, a thin wall, in specific localizations with narrow surgical
corridors or in case of intraoperative rupture. Rapid ventricular pacing
(RVP) allows a longer and more easily controlled hypotension. Its use is
largely limited to elective cases. Deep hypothermic circulatory arrest
required a complex infrastructure, and fatal procedure complications lead
to a 11.5-30% 30-day mortality rate, limiting its application to giant or
complex aneurysm of the basilar artery or to residual posterior
circulation aneurysm after endovascular treatment. Adenosine and RVP are
both effective options to facilitate clipping of complex aneurysms.
However, their use in patient with ischemic heart disease and cardiac
arrhythmias should be avoided, and their safety in the context of
subarachnoid hemorrhage is yet to be determined. Today, deep hypothermic
circulatory arrest is almost obsolete due to endovascular alternatives.

<104>
Accession Number
629602537
Title
Study protocol for VIdeo assisted thoracoscopic lobectomy versus
conventional Open LobEcTomy for lung cancer, a UK multicentre randomised
controlled trial with an internal pilot (the VIOLET study).
Source
BMJ open. 9 (10) (pp e029507), 2019. Date of Publication: 14 Oct 2019.
Author
Lim E.; Batchelor T.; Shackcloth M.; Dunning J.; McGonigle N.; Brush T.;
Dabner L.; Harris R.; Mckeon H.E.; Paramasivan S.; Elliott D.; Stokes
E.A.; Wordsworth S.; Blazeby J.; Rogers C.A.
Institution
(Lim) Academic Division of Thoracic Surgery, Royal Brompton and Harefield
NHS foundation Trust, London, United Kingdom
(Batchelor) Thoracic Surgery, University Hospitals Bristol NHS Foundation
Trust, Bristol Royal Infirmary, Bristol, United Kingdom
(Shackcloth) Department of Thoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Dunning) Department of Thoracic Surgery, James Cook University Hospital,
Middlesbrough, United Kingdom
(McGonigle) Department of Thoracic Surgery, Royal Brompton and Harefield,
Harefield Hospital, London, United Kingdom
(Brush, Dabner, Harris, Mckeon, Rogers) Clinical Trials and Evaluation
Unit, Bristol Trials Centre, Bristol Medical School, University of
Bristol, Bristol, United Kingdom
(Paramasivan, Elliott, Blazeby) Population Health Sciences, Bristol
Medical School, University of Bristol, Bristol, United Kingdom
(Stokes, Wordsworth) Health Economics Research Centre, Nuffield Department
of Population Health, University of Oxford, Oxford, United Kingdom
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Lung cancer is a leading cause of cancer deaths worldwide
and surgery remains the main treatment for early stage disease. Prior to
the introduction of video-assisted thoracoscopic surgery (VATS), lung
resection for cancer was undertaken through an open thoracotomy. To date,
the evidence base supporting the different surgical approaches is based on
non-randomised studies, small randomised trials and is focused mainly on
short-term in-hospital outcomes. METHODS AND ANALYSIS: The VIdeo assisted
thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer
study is a UK multicentre parallel group randomised controlled trial (RCT)
with blinding of outcome assessors and participants (to hospital
discharge) comparing the effectiveness, cost-effectiveness and
acceptability of VATS lobectomy versus open lobectomy for treatment of
lung cancer. We will test the hypothesis that VATS lobectomy is superior
to open lobectomy with respect to self-reported physical function 5weeks
after randomisation (approximately 1month after surgery). Secondary
outcomes include assessment of efficacy (hospital stay, pain, proportion
and time to uptake of chemotherapy), measures of safety (adverse health
events), oncological outcomes (proportion of patients upstaged to
pathologic N2 (pN2) disease and disease-free survival), overall survival
and health related quality of life to 1year. The QuinteT Recruitment
Intervention is integrated into the trial to optimise recruitment. ETHICS
AND DISSEMINATION: This trial has been approved by the UK (Dulwich)
National Research Ethics Service Committee London. Findings will be
written-up as methodology papers for conference presentation, and
publication in peer-reviewed journals. Many aspects of the feasibility
work will inform surgical RCTs in general and these will be reported at
methodology meetings. We will also link with lung cancer clinical studies
groups. The patient and public involvement group that works with the
Respiratory Biomedical Research Unit at the Brompton Hospital will help
identify how we can best publicise the findings. TRIAL REGISTRATION
NUMBER: ISRCTN13472721. Copyright © Author(s) (or their
employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

<105>
Accession Number
629601825
Title
Characterizing Patient-Centered Postoperative Recovery After Adult Cardiac
Surgery: A Systematic Review.
Source
Journal of the American Heart Association. 8 (21) (pp e013546), 2019. Date
of Publication: 05 Nov 2019.
Author
Mori M.; Angraal S.; Chaudhry S.I.; Suter L.G.; Geirsson A.; Wallach J.D.;
Krumholz H.M.
Institution
(Mori, Geirsson) Section of Cardiac Surgery Yale School of Medicine New
Haven CT
(Mori, Angraal, Suter, Geirsson, Krumholz) Center for Outcomes Research
and Evaluation Yale-New Haven Hospital New Haven CT
(Chaudhry) Section of General Internal Medicine Department of Medicine
Yale School of Medicine New Haven CT
(Suter) Section of Rheumatology Department of Medicine Yale School of
Medicine New Haven CT
(Suter) Section of Rheumatology Department of Medicine VA Medical Center
West Haven CT
(Wallach) Department of Environmental Health Sciences Yale School of
Public Health New Haven CT
(Wallach) Collaboration for Research Integrity and Transparency (CRIT)
Yale School of Medicine New Haven CT
(Krumholz) Section of Cardiovascular Medicine Department of Internal
Medicine Yale School of Medicine New Haven CT
(Krumholz) Department of Health Policy and Management Yale School of
Public Health New Haven CT
Publisher
NLM (Medline)
Abstract
Background Improving postoperative recovery is important, with a national
focus on postacute care, but the volume and quality of evidence in this
area are not well characterized. We conducted a systematic review to
characterize studies on postoperative recovery after adult cardiac surgery
using patient-reported outcome measures. Methods and Results From MEDLINE
and Web of Science, studies were included if they prospectively assessed
postoperative recovery on adult patients undergoing cardiac surgery using
patient-reported outcome measures. Six recovery domains were defined by
prior literature: nociceptive symptoms, mental health, physical function,
activities of daily living, sleep, and cognitive function. Of the 3432
studies, 105 articles met the inclusion criteria. The studies were small
(median sample size, 119), and mostly conducted in single-center settings
(n=81; 77%). Study participants were predominantly men (71%) and white
(88%). Coronary artery bypass graft was included in 93% (n=98). Studies
commonly selected for elective cases (n=56; 53%) and patients with less
comorbidity (n=67; 64%). Median follow-up duration was 91 (interquartile
range, 42-182) days. Studies most commonly assessed 1 domain (n=42; 40%).
The studies also varied in the instruments used and differed in their
reporting approach. Studies commonly excluded patients who died during the
follow-up period (n=48; 46%), and 45% (n=47) did not specify how those
patients were analyzed. Conclusions Studies of postoperative
patient-reported outcome measures are low in volume, most often single
site without external validation, varied in their approach to missing
data, and narrow in the domains and diversity of patients. The evidence
base for postoperative patient-reported outcome measures needs to be
strengthened.

<106>
Accession Number
629599921
Title
Protocol for a multicentre randomised controlled trial evaluating the
effects of moderate hypothermia versus normothermia on mortality in
patients with refractory cardiogenic shock rescued by venoarterial
extracorporeal membrane oxygenation (VA-ECMO) (HYPO-ECMO study).
Source
BMJ open. 9 (10) (pp e031697), 2019. Date of Publication: 14 Oct 2019.
Author
Jacquot A.; Lepage X.; Merckle L.; Girerd N.; Levy B.
Institution
(Jacquot) Medical Intensive Care Unit, Institut Lorrain du Coeur et des
Vaisseaux, CHRU Nancy-Hopitaux de Brabois, Vandoeuvre-les-Nancy, Nancy,
France
(Lepage, Merckle) Centre d'Investigation Clinique 1433, module
Plurithematique, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu,
CHRU Nancy - Hopitaux de Brabois, Vandoeuvre-les-Nancy, France
(Girerd) INSERM, Centre d'Investigation Clinique 1433, Institut Lorrain du
Coeur et des Vaisseaux, Hopitaux de Brabois, Vandoeuvre-les-Nancy, Inserm
1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN
Network, Universite de Lorraine ,CHRU de NancyVandoeuvre les Nancy, France
(Levy) Groupe Choc, equipe 2, Inserm U1116, Vandoeuvre les Nancy, France
(Levy) University de Lorraine, Nancy 54000, France
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Venoarterial extracorporeal membrane oxygenation (VA-ECMO)
is widely used to support the most severe forms of cardiogenic shock (CS).
Nevertheless, despite extracorporeal membrane oxygenation (ECMO) use,
mortality still remains high (50%). Moderate hypothermia (MH)
(33degreeC-34degreeC) may improve cardiac performance and decrease
ischaemia-reperfusion injuries. The use of MH during VA-ECMO is strongly
supported by experimental and preliminary clinical data. METHODS AND
ANALYSIS: The Hypothermia-Extracorporeal Membrane Oxygenation (HYPO-ECMO)
study is a multicentre, prospective, controlled randomised trial between
an MH group (33degreeC<=TdegreeC<=34degreeC) and normothermia group
(36degreeC<=TdegreeC<=37degreeC). The primary endpoint is all-cause
mortality at day 30 following randomisation. The study will also assess as
secondary endpoints the effects of targeted temperature management
strategies on (1) mortality rate at different time points, (2) organ
failure and supportive treatment use and (3) safety. All intubated adults
with refractory CS supported with VA-ECMO will be screened. Exclusion
criteria are patients having undergone cardiac surgery for heart
transplantation or left or biventricular assist device implantation, acute
poisoning with cardiotoxic drugs, pregnancy, uncontrolled bleeding and
refractory cardiac arrest.Three-hundred and thirty-four patients will be
randomised and followed up to 6 months to detect a 15% difference in
mortality. Data analysis will be intention to treat. The differences
between the two study groups in the risk of all-cause mortality at day 30
following randomisation will be studied using logistic regression analysis
adjusted for postcardiotomy setting, prior cardiac arrest, prior
myocardial infarction, age, vasopressor dose, Sepsis-related Organ Failure
Assessment (SOFA) score and lactate at randomisation. ETHICS AND
DISSEMINATION: Ethics approval has been granted by the Comite de
Protection des Personnes Est III Ethics Committee. The trial has been
approved by the French Health Authorities (Agence Nationale de la Securite
du Medicament et des Produits de Sante). Dissemination of results will be
performed via journal articles and presentations at national and
international conferences. Since this study is also the first step in the
constitution of an 'ECMO Trials Group', its results will also be
disseminated by the aforementioned group. TRIAL REGISTRATION NUMBER:
NCT02754193. Copyright © Author(s) (or their employer(s)) 2019.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<107>
Accession Number
629622130
Title
Effect of low-dose dexamethasone on extra vascular lung water in patients
following on-pump elective primary coronary artery bypass graft surgery.
Source
Annals of cardiac anaesthesia. 22 (4) (pp 372-378), 2019. Date of
Publication: 01 Oct 2019.
Author
Maddali M.M.; Waje N.D.; Arora N.R.; Panchatcharam S.M.
Institution
(Maddali, Waje, Arora) Department of Cardiac Anesthesia, National Heart
Center, Royal Hospital, Muscat, Oman
(Panchatcharam) Department of Studies and Research, Oman Medical Specialty
Board, Muscat, Oman
Publisher
NLM (Medline)
Abstract
Background: The primary objective was to compare the effect of a low-dose
dexamethasone as against a saline placebo on extravascular lung water
index (EVLWI) in patients undergoing elective primary coronary artery
bypass surgery. The secondary endpoints were to assess the effect of
dexamethasone on other volumetric parameters (pulmonary vascular
permeability index, global end diastolic volume index, and intrathoracic
blood volume index), Vasoactive Inotrope Scores, hemodynamic parameters
and serum osmolality in both groups. Settings and Design: Prospective
observational study performed at a single tertiary cardiac care center.
 Material(s) and Method(s): Twenty patients were randomized to receive
either dexamethasone (steroid group, n = 10) or placebo (nonsteroid group,
n = 10) twice before the institution of cardiopulmonary bypass (CPB).
EVLWI and other volumetric parameters were obtained with the help of
VolumeViewTM Combo Kit connected to EV 1000 clinical platform at
predetermined intervals. Hemodynamic parameters, vasoactive-inotropic
Scores, hematocrit values were recorded at the predetermined time
intervals. Baseline and 1st postoperative day serum osmolality values were
also obtained. Result(s): The two groups were evenly matched in terms
of demographic and CPB data. Intra- and inter-group comparison of the
baseline EVLWI including other volumetric and hemodynamic parameters with
those recorded at subsequent intervals revealed no statistical difference
and was similar. Generalized estimating equation model was obtained to
compare the changes between the groups over the entire study period which
showed that on an average the changes between the steroid and nonsteroid
group in terms of all volumetric parameters were not statistically
significant. Conclusion(s): There were no beneficial effects of
low-dose dexamethasone on EVLWI or other volumetric parameters in patients
subjected to on-pump primary coronary bypass surgery. Hemodynamic
parameters were also not affected. Probably, the advanced hemodynamic
monitoring aided in optimal fluid management in the nonsteroidal group
impacting EVLW accumulation.

<108>
Accession Number
629621735
Title
Comparative evaluation of hemodynamic responses and ease of intubation
with airtraq video laryngoscope versus macintosh laryngoscope in patients
with ischemic heart disease.
Source
Annals of cardiac anaesthesia. 22 (4) (pp 365-371), 2019. Date of
Publication: 01 Oct 2019.
Author
Varsha A.V.; George G.; Pillai R.; Sahajanandan R.
Institution
(Varsha) Department of Cardiothoracic Surgery, Christian Medical College
and Hospital, Vellore, Tamil Nadu, India
(George, Pillai, Sahajanandan) Department of Anaesthesia, Christian
Medical College and Hospital, Vellore, Tamil Nadu, India
Publisher
NLM (Medline)
Abstract
Introduction: Hemodynamic responses during laryngoscopy can potentially
precipitate ischemia in patients with coronary artery disease. There are
conflicting reports regarding the hemodynamic stress responses between the
conventional Macintosh and video laryngoscopes. There is a paucity of
studies regarding the same in cardiac surgical patients. Material(s)
and Method(s): A prospective, randomized control study to compare the
hemodynamic responses and ease of intubation using Airtraq video
laryngoscope and Macintosh laryngoscope in patients with ischemic heart
disease. Result(s): Seventy patients were randomized into two groups.
Baseline variables including age, weight, Mallampati score, and
comorbidities were comparable between the two groups. There was
statistically significant elevation in mean heart rate in the Macintosh
group at 2nd-min (P = 0.02) and 3rd-min (P = 0.05) postintubation.
Similarly, there was a significant increase in mean arterial pressure at
2nd (P = 0.06), 3rd (P = 0.03), and 4th (P = 0.03) in the Macintosh group.
The time for laryngoscopy and Intubation Difficulty Scale was
significantly better in the Airtraq group (P = 0.001 and 0.001). However,
the median time to intubation was longer in the Airtraq group (13 s vs. 11
s, P = 0.05). Laryngoscopy view was better with Airtraq even in patients
with Mallampati score 3 (ten patients). The incidence of trauma was same
in both the groups. Conclusion(s): Airtraq provides the better
hemodynamic stability and ease of intubation and may be considered
superior to conventional Macintosh laryngoscope for intubation in patients
with ischemic heart disease.

<109>
Accession Number
629621481
Title
The comparison of dexmedetomidine, esmolol, and combination of
dexmedetomidine with esmolol for attenuation of sympathomimetic response
to laryngoscopy and intubation in patients undergoing coronary artery
bypass grafting.
Source
Annals of cardiac anaesthesia. 22 (4) (pp 353-357), 2019. Date of
Publication: 01 Oct 2019.
Author
Singh D.; Jagannath S.; Priye S.; Mudassar A.S.
Institution
(Singh, Jagannath, Priye, Mudassar) Department of Anaesthesiology, Vydehi
Institute of Medical Sciences, Bengaluru, Karnataka, India
Publisher
NLM (Medline)
Abstract
Background: The aim of this study was to compare the effects of
dexmedetomidine, esmolol, and combination of both on control of
sympathetic response to laryngoscopy and tracheal intubation in coronary
artery disease patients. Material(s) and Method(s): A prospective,
randomized, double-blinded clinical study included 90 patients scheduled
for elective coronary artery bypass surgery. Patients were randomly
allocated into three groups of 30 each: dexmedetomidine group (Group D) 1
mug/kg, esmolol group (Group E) 2 mg/kg, and group dexmedetomidine with
esmolol (Group DE) 0.5 mug/kg of dexmedetomidine with 1 mg/kg of esmolol.
Each drug was diluted with 0.9% normal saline to 20 ml volume and infused
in 10 min before induction of anesthesia. Hemodynamic changes (heart rate
[HR], arterial blood pressure, and pulmonary artery pressure) were
compared at various time intervals as follows-baseline, after study drug,
after induction, and 1, 3, and 5 min after intubation. Statistical
analysis included analysis of variance, Chi-square, and Fisher's exact
test. Result(s): In Group DE, there was no significant increase in HR
at all-time intervals, and the HR was stable compared to Group D and Group
E. Blood pressure values were comparable in all groups except in Group E
at 5 min. The pulmonary arterial pressures were statistically less in DE
group except at 3 and 5 min. Conclusion(s): The combination of
dexmedetomidine and esmolol group has beneficial effect on HR and
pulmonary arterial pressures but has no additional advantage with respect
to arterial blood pressure when compared with dexmedetomidine and esmolol
groups in patients undergoing elective coronary artery bypass grafting.

<110>
Accession Number
629620776
Title
Impact of non-respect of SYNTAX score II recommendation for surgery in
patients with left main coronary artery disease treated by percutaneous
coronary intervention: an EXCEL substudy.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 16 Oct 2019.
Author
Modolo R.; Chichareon P.; van Klaveren D.; Dressler O.; Zhang Y.; Sabik
J.F.; Onuma Y.; Kappetein A.P.; Stone G.W.; Serruys P.W.
Institution
(Modolo, Chichareon) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Modolo) Cardiology Division, Department of Internal Medicine, University
of Campinas (UNICAMP), Campinas, Brazil
(Chichareon) Division of Cardiology, Department of Internal Medicine,
Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
(van Klaveren) Department of Biomedical Data Sciences, Leiden University
Medical Center, Leiden, Netherlands
(Dressler, Zhang, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, NY, NY, United States
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
USA
(Onuma) Department of Cardiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Onuma) Cardialysis Clinical Trials Management and Core Laboratories,
Rotterdam, Netherlands
(Kappetein) Medtronic, Maastricht, Netherlands
(Stone) New York-Presbyterian Hospital, Columbia University Medical
Center, NY, NY, United States
(Serruys) Imperial College London, London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The SYNTAX score II (SSII) was developed from the SYNTAX trial
to predict the 4-year all-cause mortality after left main or multivessel
disease revascularization and to facilitate the decision-making process.
The SSII provides the following treatment recommendations: (i) coronary
artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)
(equipoise risk), (ii) CABG preferred (excessive risk for PCI) or (iii)
PCI preferred (excessive risk for CABG). We sought to externally validate
SSII and to investigate the impact of not abiding by the SSII
recommendations in the randomized EXCEL trial of PCI versus CABG for left
main disease. METHOD(S): The calibration plot of predicted versus
observed 4-year mortality was constructed from individual values of SSII
in EXCEL. To assess overestimation versus underestimation of predicted
mortality risk, an optimal fit regression line with slope and intercept
was determined. Prospective treatment recommendations based on SSII were
compared with actual treatments and all-cause mortality at 4years.
 RESULT(S): SSII variables were available from EXCEL trial in
1807/1905 (95%) patients. For the entire cohort, discrimination was
possibly helpful (C statistic=0.670). SSII-predicted all-cause mortality
at 4years overestimated the observed mortality, particularly in the
highest-risk percentiles, as confirmed by the fit regression line
[intercept 2.37 (1.51-3.24), P=0.003; slope 0.67 (0.61-0.74), P<0.001].
When the SSII-recommended treatment was CABG, randomized EXCEL patients
treated with PCI had a trend towards higher mortality compared with those
treated with CABG (14.1% vs 5.3%, P=0.07) in the as-treat population. In
the intention-to-treat population, patients randomized to PCI had higher
mortality compared with those randomized to CABG (15.1% vs 4.1%, P=0.02),
when SSII recommended CABG. CONCLUSION(S): In the EXCEL trial of
patients with left main disease, the SSII-predicted 4-year mortality
overestimated the 4-year observed mortality with a possibly helpful
discrimination. Non-compliance with SSII CABG treatment recommendations
(i.e. randomized to PCI) was associated with higher 4-year all-cause
mortality. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<111>
Accession Number
629620492
Title
Pragmatic randomised clinical trial of proton versus photon therapy for
patients with non-metastatic breast cancer: the Radiotherapy Comparative
Effectiveness (RadComp) Consortium trial protocol.
Source
BMJ open. 9 (10) (pp e025556), 2019. Date of Publication: 15 Oct 2019.
Author
Bekelman J.E.; Lu H.; Pugh S.; Baker K.; Berg C.D.; de Gonzalez A.B.;
Braunstein L.Z.; Bosch W.; Chauhan C.; Ellenberg S.; Fang L.C.; Freedman
G.M.; Hahn E.A.; Haffty B.G.; Khan A.J.; Jimenez R.B.; Kesslering C.; Ky
B.; Lee C.; Lu H.-M.; Mishra M.V.; Mullins C.D.; Mutter R.W.; Nagda S.;
Pankuch M.; Powell S.N.; Prior F.W.; Schupak K.; Taghian A.G.; Wilkinson
J.B.; MacDonald S.M.; Cahlon O.
Institution
(Bekelman, Lu, Freedman, Nagda) Department of Radiation Oncology,
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,
United States
(Pugh) American College of Radiology, Philadelphia, PA, United States
(Baker, Mishra) Department of Radiation Oncology, University of Maryland
School of Medicine, Baltimore, MD, United States
(Berg, de Gonzalez, Lee) Division of Cancer Epidemiology and Genetics,
National Cancer Institute, National Institutes of Health, Bethesda, MD,
United States
(Braunstein, Khan, Powell, Schupak, Cahlon) Department of Radiation
Oncology, Memorial Sloan Kettering Cancer Center, New York city, NY,
United States
(Bosch) Department of Radiation Oncology, Washington University in St.
Louis, St. Louis, MO, United States
(Chauhan) Mayo Clinic Minnesota, Rochester, MN, United States
(Ellenberg) Department of Biostatistics, Epidemiology and Informatics,
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,
United States
(Fang) Department of Radiation Oncology, University of Washington School
of Medicine, Seattle, WA, United States
(Hahn) Department of Medical Social Sciences, Northwestern University,
Evanston, IL, United States
(Haffty) Department of Radiation Oncology, Rutgers Cancer Institute of New
Jersey, New Brunswick, New Jersey, USA
(Jimenez, Lu, Taghian, MacDonald) Department of Radiation Oncology,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Kesslering, Pankuch) Northwestern Medicine Chicago Proton Center,
Warrenville, IL, United States
(Ky) Cardio-Oncology Program, Division of Cardiovascular Medicine,
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,
United States
(Mullins) University of Maryland School of Pharmacy, Baltimore, MD, United
States
(Mutter) Department of Radiation Oncology, Mayo Clinic, Rochester, MN,
United States
(Prior) Department of Biomedical Informatics, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Wilkinson) Provision Proton Therapy Center, Knoxville, TN, United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: A broad range of stakeholders have called for randomised
evidence on the potential clinical benefits and harms of proton therapy, a
type of radiation therapy, for patients with breast cancer. Radiation
therapy is an important component of curative treatment, reducing cancer
recurrence and extending survival. Compared with photon therapy, the
international treatment standard, proton therapy reduces incidental
radiation to the heart. Our overall objective is to evaluate whether the
differences between proton and photon therapy cardiac radiation dose
distributions lead to meaningful reductions in cardiac morbidity and
mortality after treatment for breast cancer. METHOD(S): We are
conducting a large scale, multicentre pragmatic randomised clinical trial
for patients with breast cancer who will be followed longitudinally for
cardiovascular morbidity and mortality, health-related quality of life and
cancer control outcomes. A total of 1278 patients with non-metastatic
breast cancer will be randomly allocated to receive either photon or
proton therapy. The primary outcomes are major cardiovascular events,
defined as myocardial infarction, coronary revascularisation,
cardiovascular death or hospitalisation for unstable angina, heart
failure, valvular disease, arrhythmia or pericardial disease. Secondary
endpoints are urgent or unanticipated outpatient or emergency room visits
for heart failure, arrhythmia, valvular disease or pericardial disease.
The Radiotherapy Comparative Effectiveness (RadComp) Clinical Events
Centre will conduct centralised, blinded adjudication of primary outcome
events. ETHICS AND DISSEMINATION: The RadComp trial has been approved by
the institutional review boards of all participating sites. Recruitment
began in February 2016. Current version of the protocol is A3, dated 08
November 2018. Dissemination plans include presentations at scientific
conferences, scientific publications, stakeholder engagement efforts and
presentation to the public via lay media outlets. TRIAL REGISTRATION
NUMBER: NCT02603341. Copyright © Author(s) (or their employer(s))
2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<112>
Accession Number
2002761003
Title
The incidence of perioperative stroke: Estimate using state and national
databases and systematic review.
Source
Journal of Stroke. 21 (3) (pp 290-301), 2019. Date of Publication:
September 2019.
Author
Al-Hader R.; Al-Robaidi K.; Jovin T.; Jadhav A.; Wechsler L.R.; Thirumala
P.D.
Institution
(Al-Hader, Al-Robaidi, Thirumala) Department of Neurological Surgery,
University of Pittsburgh, Pittsburgh, PA, United States
(Al-Hader, Al-Robaidi, Jovin, Jadhav, Wechsler, Thirumala) University of
Pittsburgh School of Medicine, Pittsburgh, PA, United States
(Jovin, Jadhav, Wechsler, Thirumala) Department of Neurology, University
of Pittsburgh, Pittsburgh, PA, United States
Publisher
Korean Stroke Society (E-mail: stroke@stroke.or.kr)
Abstract
Background and Purpose Perioperative stroke remains a devastating
complication after surgical procedures, due to hemodynamic and
inflammatory changes that increase the risk of strokes within 30 days
following surgery. We aimed to assess the incidence of perioperative
strokes in patients undergoing various surgical procedures and reach a
national estimate. Methods A retrospective cohort study was conducted
using California State Inpatient Databases, State Emergency Department
Databases, State Ambulatory Surgery and Services Databases, and the
National Inpatient Sample (NIS) during the period 2008 to 2011 from the
Healthcare Cost and Utilization Project. A systematic review was conducted
using PubMed, Embase, and Web of Science databases to obtain published
articles that reported the incidence of perioperative stroke in various
surgical procedures. Results Analysis of 3,694,410 surgical encounters
from the state of California (mean+/-standard deviation age: 52.4+/-21.1
years) yielded an overall rate of perioperative stroke of 0.32%
(n=11,759). The incidence of perioperative strokes was highest following
neurological (1.25%), vascular (1.07%), and cardiac (0.98%) surgeries. The
NIS database contained a total of 48,672,974 weighted hospitalizations and
yielded a rate of perioperative stroke of 0.42% (n=204,549). The
systematic review completed yielded 187 articles, which had an overall
sample size of 184,922 and an incidence of perioperative stroke ranging
from 0% to 13.86%. It is estimated that in any given year, there would be
approximately 40,000 to 55,000 (0.33% to 0.46%) perioperative strokes
nationally. Conclusions Our findings support further strategies to
identify and stratify patients undergoing surgical procedures with a high
incidence of perioperative strokes to improve patient counseling and a
future potential treatment plan. Copyright © 2019 Korean Stroke
Society.

<113>
Accession Number
2002518247
Title
The effect of speed of normal saline injection on optic nerve sheath
diameter in thoracic epidural anesthesia.
Source
Pain Physician. 22 (4) (pp E325-E332), 2019. Date of Publication:
July-August 2019.
Author
Hong J.H.; Jung S.W.; Park J.H.
Institution
(Hong, Park) Department of Anesthesiology and Pain Medicine, Keimyung
University, DongSan Hospital, Daegu, South Korea
(Jung) Department of Psychiatry, Keimyung University DongSan Hospital,
Daegu, South Korea
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Intracranial pressure (ICP) is affected after epidural saline
solution or local anesthetic injection. Both ICP and epidural pressures
have been shown to reach peak pressure just after epidural injection and
begin decline thereafter. Measuring the optic nerve sheath diameter (ONSD)
through ultrasonography is one of the noninvasive methods used for ICP
assessment. Objective(s): The purpose of this study was to
investigate the effect of the speed of epidural saline injection on the
ONSD under awake conditions. Study Design: Prospective randomized
trial. Setting(s): An interventional pain management practice in
South Korea. Method(s): This study included 40 patients receiving
thoracic epidural catheterization for pain management after upper
abdominal or thoracic surgery. Following successful epidural space
confirmation, patients were randomized to receive epidural saline infusion
with a speed of either 1 mL/second (slow speed, A group) or 3 mL/second
(rapid speed, B group), respectively. For the measurement of ONSD,
transorbital sonography was performed and ONSD was measured at 3 mm
posterior to the optic nerve head. Result(s): The A and B groups
showed significant increases in ONSD according to time. Post hoc analysis
of this result revealed that ONSD at T10 and T30 were significantly
increased from baseline values (T0) (*P < 0.05 vs. T0; +P < 0.001 vs. T0).
The mean values at any of the time points anddegree of changes (T1-T0,
T10-T0, and T30-T0) in ONSD between groups A and B did not show any
significance. Limitation(s): We could not confirm the time of
normalization of ONSD after the end of epidural injection of normal
saline. Conclusion(s): Thoracic epidural injection of 10 mL of normal
saline solution resulted in a significant increase of ONSD compared to
baseline, however, the speed of injection did not affect the increase of
ONSD. Copyright © 2019 Pain Physician. All rights reserved.

<114>
Accession Number
2002720708
Title
Levosimendan versus milrinone in the management of impaired left
ventricular function in patients undergoing coronary artery bypass graft
surgery.
Source
Open Anesthesiology Journal. 13 (1) (pp 59-67), 2019. Date of Publication:
2019.
Author
Amin S.W.; Abd-Elgalil S.M.; Mohamed S.A.; Ahmed M.M.; Hamawy T.Y.; Fathi
L.M.
Institution
(Abd-Elgalil, Mohamed, Ahmed, Hamawy) Department of Anesthesia and ICU,
Ain Shams University, Cairo, Egypt
(Amin, Fathi) Military Medical Academy, Cairo, Egypt
Publisher
Bentham Science Publishers (P.O. Box 294, Bussum 1400 AG, Netherlands)
Abstract
Background: Patients undergoing cardiac surgery are at risk of
postcardiotomy myocardial dysfunction. This condition causes delayed
recovery, organ failure, prolonged intensive care unit and hospital stays,
and an increased risk of mortality; these patients often require inotropic
agent support. Levosimendan is a calcium sensitizer with a unique
mechanism of action, binding to cardiac troponin C and enhancing
myofilament responsiveness to calcium, increasing myocardial contraction
without increasing myocardial oxygen consumption. Phosphodiesterase III
inhibitors such as milrinone provide an alternative means of inotropic
support by increasing the concentration of cyclic AMP and intracellular
calcium. They also have vasodilatory effects. Objective(s): The aim
of this study was the comparison between levosimendan versus milrinone
regarding their effects on the hemodynamics, need for additional
mechanical (intra aortic balloon pump) or pharmacological support to the
heart, weaning from mechanical ventilation and duration of intensive care
unit stay for patients after Off-Pump Coronary Artery Bypass Graft
(OPCABG) surgery suffering from impaired left ventricular function
(preoperative ejection fraction = 40%). Method(s): 60 patients
between 40 and 70 years of both sexes with impaired left ventricular
function (ejection fraction = 40%), New York Heart Association (NYHA III &
IV), undergoing elective Off-Pump Coronary Artery Bypass Graft (OPCABG)
surgery were selected for this study. After induction of anesthesia,
patients were randomly assigned to one of two equal groups each containing
30 patients: Group L (Levosimendan group) included patients who received
levosimendan 0.1- 0.2 micro g/kg/min. Started immediately with the
induction of anesthesia. Group M (Milrinone group) included patients who
received milrinone 0.4-0.6 micro g/kg/min. Started immediately with
the induction of anesthesia. In both groups, norepinephrine was titrated
(8 mg norepinephrine in 50 ml saline) to keep mean arterial pressure MAP =
70 mmHg. Hemodynamic findings included Preoperative and post ICU discharge
ejection fraction, systemic and pulmonary artery pressures, systemic and
pulmonary vascular resistance, cardiac output and stroke volume. Also
laboratory findings included Serum lactate and Troponin I., in addition,
to post operative findings were: Need for intra aortic balloon pump, time
of weaning from the ventilator, days of ICU stay and appearance of drug
allergy compared in both groups. Result(s): There was a significant
increase in the ejection fraction in both groups that was greater in the
levosimendan group. The decrease in pulmonary pressure in the levosimendan
group was more significant than milrinone group. There was a gradual
decrease in pulmonary and systemic vascular resistance in both groups with
a more significant decrease in the levosimendan group. There was a gradual
increase in cardiac output and stroke volume in both groups that was
greater in the levosimendan group. Serum lactate gradually decreased in
both groups with an insignificant difference; there was an increase in
serum troponin I level in both groups which was more significant in the
milrinone group. Weaning from mechanical ventilation and length of ICU
stay was shown to be significantly shorter in time in the levosimendan
group. Conclusion(s): Both levosimendan and milrinone caused a
significant increase in cardiac output, stroke volume and ejection
fraction, with a decrease in pulmonary and systemic vascular resistance.
These effects improved cardiac performance by decreasing afterload and
increasing cardiac inotropism. It was noticed that these effects were more
significant with levosimendan than milrinone. Also, there was a decrease
in ICU stay, mechanical ventilation timing and hospital stay with
levosimendan than milrinone which decreased the costs of treatment for the
patients. Copyright © 2019 Amin et al.

<115>
Accession Number
2002699140
Title
Predictors of postoperative atrial fibrillation after beating-heart
coronary artery bypass surgery: Is cardiopulmonary bypass a risk factor?.
Source
Acta Cardiologica Sinica. 35 (5) (pp 468-475), 2019. Date of Publication:
2019.
Author
Velioglu Y.; Yuksel A.
Institution
(Velioglu, Yuksel) Department of Cardiovascular Surgery, Abant Izzet
Baysal University Faculty of Medicine, Bolu, Turkey
Publisher
Republic of China Society of Cardiology (E-mail: acs@tsoc.org.tw)
Abstract
Backgrouand: To determine the risk factors and postoperative outcomes of
new-onset atrial fibrillation (AF) following beating-heart coronary artery
bypass grafting (CABG) surgery. Method(s): A total of 458 patients
who underwent beating-heart CABG without the use of aortic cross clamping
and cardioplegic arrest between January 2011 and January 2015 were
included in the study, and they were divided into two groups according to
the development of new-onset AF as the AF group (n = 143) and non-AF group
(n = 315). Both groups were compared in terms of preoperative clinical
features and perioperative data, and the risk factors and postoperative
outcomes of AF following beating-heart CABG were determined.
 Result(s): The incidence of postoperative AF was 31.2%. Patients in
the AF group were significantly older (68.08 +/- 7.76 vs. 61.76 +/- 9.83
years, p <= 0.001) and had significantly higher use of cardiopulmonary
bypass during surgery (69.2% vs. 43.2%, p <= 0.001) than the patients in
the non-AF group. The patients with AF also had statistically
significantly longer lengths of intensive care unit and hospital stay than
those without AF (43.79 +/- 32.39 vs. 30.49 +/- 33.31 hours, p <= 0.001,
and 8.20 +/- 4.37 vs. 5.77 +/- 2.16 days, p <= 0.001, respectively).
 Conclusion(s): Our study revealed that age and the use of
cardiopulmonary bypass during surgerywere independent predictors of AF
following beating-heart CABG. In addition, postoperative AFwas associated
with prolonged intensive care unit and hospital stay. Further prospective
randomized studies with larger patient series are required to support our
research and attain more accurate data. Copyright © 2019,
Republic of China Society of Cardiology. All rights reserved.

<116>
Accession Number
2002688898
Title
Clinical outcomes of transcatheter vs surgical aortic valve replacement in
patients with chronic liver disease: A systematic review and metaanalysis.
Source
Ochsner Journal. 19 (3) (pp 241-247), 2019. Date of Publication: September
2019.
Author
Ndunda P.; Srinivasan S.; Vindhyal M.; Muutu T.; Vukas R.; Fanari Z.
Institution
(Ndunda, Srinivasan, Vindhyal, Muutu, Fanari) Department of Internal
Medicine, University of Kansas, School of Medicine-Wichita, Wichita, KS,
United States
(Vukas) A. R. Dykes Library, Research & Learning, University of Kansas
Medical Center, Kansas City, KS, United States
(Fanari) Heartland Cardiology/Wesley Medical Center, University of Kansas,
School of Medicine-Wichita, Wichita, KS, United States
Publisher
Ochsner Clinic (E-mail: kmcfadden@ochsner.org)
Abstract
Background: Chronic liver disease increases cardiac surgical risk, with
30-day mortality ranging from 9% to 52% in patients with Child-Pugh class
A and C, respectively. Data comparing the outcomes of transcatheter aortic
valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in
patients with liver disease are limited. Method(s): We searched
PubMed, Cochrane Library, Web of Science, and Google Scholar for relevant
studies and assessed risk of bias using the Risk of Bias in Non-Randomized
Studies - of Interventions (ROBINS-I) Cochrane Collaboration tool.
 Result(s): Five observational studies with 359 TAVR and 1,872 SAVR
patients were included in the analysis. Overall, patients undergoing TAVR
had a statistically insignificant lower rate of in-hospital mortality
(7.2% vs 18.1%; odds ratio [OR] 0.67; 95% confidence interval [CI] 0.25,
1.82; I2=61%) than patients receiving SAVR. In propensity
score-matched cohorts, patients undergoing TAVR had lower rates of
in-hospital mortality (7.3% vs 13.2%; OR 0.51; 95% CI 0.27, 0.98;
I2=13%), blood transfusion (27.4% vs 51.1%; OR 0.36; 95% CI
0.21, 0.60; I2=31%), and hospital length of stay (10.9 vs 15.7
days; mean difference -6.32; 95% CI -10.28, -2.36; I2=83%) than
patients having SAVR. No significant differences between the 2
interventionswere detected in the proportion of patients discharged home
(65.3% vs 53.9%; OR 1.3; 95% CI 0.56, 3.05; I2=67%), acute
kidney injury (10.4% vs 17.1%; OR 0.55; 95% CI 0.29, 1.07; I2=
0%), or mean cost of hospitalization ($250,386 vs $257,464; standardized
mean difference -0.07; 95% CI -0.29, 0.14; I2=0%).
 Conclusion(s): In patients with chronic liver disease, TAVR may be
associated with lower rates of in-hospital mortality, blood transfusion,
and hospital length of stay compared with SAVR. Copyright ©
Academic Division of Ochsner Clinic Foundation.

<117>
Accession Number
2002688530
Title
Acute effects of aerobic exercise on the blood pressure of patients after
coronary artery bypass grafting.
Source
American Journal of Cardiovascular Disease. 9 (4) (pp 28-33), 2019.
Article Number: AJCD0096591. Date of Publication: 2019.
Author
Furtado Almeida F.J.; Gambassi B.B.; Sauaia B.A.; Furtado Almeida A.E.A.;
Ribeiro D.A.F.; de Sousa P.R.; Chaves L.F.C.; da Silva Sousa T.M.; da
Silva Nina V.J.
Institution
(Furtado Almeida, da Silva Nina) Universidade Federal do Maranhao, Sao
Luis, MA, Brazil
(Furtado Almeida, Gambassi, Sauaia, Furtado Almeida, Ribeiro, de Sousa,
Chaves, da Silva Sousa) Departamento de Educacao Fisica, Universidade
Ceuma, Sao Luis, MA, Brazil
(Furtado Almeida) Departamento de Educacao Fisica, Universidade Estadual
do Maranhao, Sao Luis, MA, Brazil
(da Silva Nina) Hospital Universitario da Universidade Federal do Maranhao
(HUUFMA), Sao Luis, MA, Brazil
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Background: Coronary artery bypass grafting a frequent surgical procedure
to treat coronary heart disease, uses the patient's own veins or arteries
to bypass narrowed areas and restore blood flow to heart muscle. Cardiac
rehabilitation follows this procedure and includes psychological and
nutritional support along with the regular practice of physical exercises.
 Objective(s): The aim of this study was to investigate the acute
effects of the aerobic exercise on the blood pressure of patients after
coronary artery bypass grafting. Method(s): After 30 days of surgical
procedure, 14 patients were assigned to the aerobic exercise group
(exercise on the cycle ergometer for 35 minutes), while 8 patients were
assigned to the control group (absolute rest for 35 minutes). Blood
pressure was measured by a digital automatic device before and after 24
hours of the experiment in both groups. Result(s): Systolic (P =
0.639) and diastolic (P = 0.103) blood pressures were similar between CG
and AEG at baseline. Regarding intragroup differences, no significant
changes were observed after 24 hours for SBP in the CG (P = 0.999) and AEG
(P = 0.244). On the other hand, significant changes were found for DBP
after 24 hours for the CG (P = 0.007) and AEG (P = 0.015). When CG and AEG
were compared after 24 hours, no significant differences were found for
SBP (P = 0.999) and DBP (P = 0.054). Conclusion(s): We found
decreased diastolic blood pressure in the aerobic exercise group when the
results for pre-training and post-training were compared. However, to
support our findings further research is needed, preferably using
randomized controlled trials. Copyright © 2019, E-Century
Publishing Corporation. All rights reserved.

<118>
Accession Number
2002679107
Title
Randomized placebo controlled open labelled comparison of efficacy of
diclofenac transdermal patch in post operative pain.
Source
Research Journal of Pharmacy and Technology. 12 (3) (pp 1119-1121), 2019.
Date of Publication: March 2019.
Author
Salunke N.; Kumar M.K.; Yogesh; Tabassum M.; Pravallika P.; Sampoorna M.;
Rao P.
Institution
(Salunke, Kumar) Durgabai Deshmukh Hospital, 1-9-27, Osmania University
Rd, Vidya Nagar, Adikmet, Hyderabad, Telangana, India
(Yogesh) Bharath School of Pharmacy, Mangalpally, Ibrahimpatnam,
Telangana, India
(Tabassum, Pravallika, Sampoorna, Rao) Department of Pharmacy, Bharath
School of Pharmacy, Mangalpally, Ibrahimpatnam, Telangana, India
Publisher
Research Journal of Pharmacy and Technology (E-mail: info@rjptonline.org )
Abstract
Postoperative incisional pain is a common form of acute pain. Recent
studies demonstrate that about 50-70% of patients experience moderate to
severe pain after surgery. Reasons for this quandary are distinct
mechanisms of incisional nociception compared to other pain conditions or
lack of an in depth knowledge about the pathophysiology and
neuropharmacology of postoperative pain. Acute postoperative pain is
followed by chronic pain in 10-50% of individuals which can be severe in
about 2-10% of patients undergoing common operations such as groin hernia
repair, breast and thoracic surgery, leg amputation, and coronary artery
bypass surgery. Therefore, persistent postsurgical pain represents a
major, largely unrecognised clinical problem. Iatrogenic neuropathic pain
is probably the most important cause of long-term postsurgical pain.
Consequently, surgical techniques that avoid nerve damage should be
applied whenever possible. Major surgical operations are still followed by
pain, organ dysfunction and prolonged convalescence. It has been assumed
that sufficient pain relief will improve the surgical outcome with reduced
morbidity, need for hospitalization and convalescence. It has been
realized that several other factors in perioperative management are
important in the control of postoperative recovery and rehabilitation, and
that these factors must be considered and revised in order to achieve the
advantageous effects of pain relief on outcome. Among the most commonly
used pain-relieving techniques [patient-controlled analgesia (PCA) with
opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and epidural
analgesic techniques], there is evidence that the epidural local
anaesthetic or local anaesthetic-opioid techniques are the most effective
on providing dynamic pain relief after major surgical procedures. The goal
of postoperative pain management is to relieve the pain while keeping side
effects to a minimum. This can be best accomplished with a multimodal
approach. Minimally invasive surgery and enhanced recovery protocols have
addressed pain management in terms of these goals. Copyright ©
RJPT All right reserved.

<119>
Accession Number
2002631521
Title
Single-arm meta-analysis of Argentine studies reporting in-hospital
mortality after aortic valve replacement in low and intermediate risk
patients.
Source
Revista Argentina de Cardiologia. 87 (4) (pp 271-280), 2019. Date of
Publication: August 2019.
Author
Borracci R.A.; Navia D.O.; Kotowicz V.; Machain A.; Higa C.C.
Institution
(Borracci) Servicios de Cirugia Cardiovascular del, Hospital Aleman de
Buenos Aires, Argentina
(Navia) Servicios de Cirugia Cardiovascular del, Instituto Cardiovascular
de Buenos Aires, Argentina
(Kotowicz) Servicios de Cirugia Cardiovascular del, Hospital Italiano de
Buenos Aires, Argentina
(Machain) Servicios de Cirugia Cardiovascular del, Hospital Britanico de
Buenos Aires, Argentina
(Higa) Servicio de Cardiologia del Hospital Aleman de Buenos Aires,
Argentina
Publisher
Sociedad Argentina de Cardiologia (E-mail: info@sac.org.ar)
Abstract
Background: Current evidence favors surgical valve replacement to treat
symptomatic aortic disease, except in elderly patients at increased risk
for surgery, in whom transcatheter aortic valve implantation (TAVI) may be
eligible. Objective(s): Considering that the use of TAVI has been
proposed to be extended to other groups at lower risk, the purpose of this
study was to perform a single-arm meta-analysis of local studies reporting
in-hospital mortality after surgical aortic valve replacement in low and
intermediate risk patients in Argentina, as a benchmark for comparing with
local TAVI outcomes. Method(s): A systematic review search strategy
was performed using controlled trials and observational studies identified
in MEDLINE, Embase, SCOPUS, and the Cochrane library to March 2019.
 Result(s): Among 80 studies identified through the search, 4
observational articles reported in-hospital mortality and postoperative
complications after aortic valve replacement, divided into intermediate
and/or low risk patients according to the STS score or the EuroSCORE II.
In 1,192 patients, in-hospital mortality was 3.1%. Weighted pooled
estimates were: Postoperative stroke1.3%, myocardial infarction 0.4%, need
for definite pacemaker 2.7%, mediastinitis 1.4%, and reoperation for
bleeding 2.6%. Conclusion(s): The proven efficacy of TAVI in
high-risk patients is leading to the expansion of its indications toward
lower-risk cases; but this shift should be supported by meaningful
evidence of its benefit over surgical valve replacement. This single-arm
metaanalysis of Argentine studies presents in-hospital mortality and
postoperative complications after aortic valve replacement in low and
intermediate risk patients. The updated information on local results of
surgery could serve as a benchmark for comparing with TAVI performance in
our setting. Copyright © 2019, Sociedad Argentina de Cardiologia.
All rights reserved.

<120>
Accession Number
629616837
Title
Prophylactic implantable cardioverter-defibrillator in the very elderly.
Source
Europace. 21 (7) (pp 1063-1069), 2019. Date of Publication: 01 Jul 2019.
Author
Zakine C.; Garcia R.; Narayanan K.; Gandjbakhch E.; Algalarrondo V.;
Lellouche N.; Perier M.-C.; Fauchier L.; Gras D.; Bordachar P.; Piot O.;
Babuty D.; Sadoul N.; Defaye P.; Deharo J.-C.; Klug D.; Leclercq C.;
Extramiana F.; Boveda S.; Marijon E.
Institution
(Zakine, Narayanan, Perier, Marijon) Paris Cardiovascular Research Center,
Paris, France
(Garcia) University Hospital of Poitiers, Poitiers, France
(Narayanan) Maxcure Hospitals, Hyderabad, India
(Gandjbakhch) La Pitie Salpetriere Hospital, Paris, France
(Algalarrondo) Antoine-Beclere Hospital, Paris, France
(Lellouche) Henri Mondor Hospital, Paris, France
(Perier, Marijon) European Georges Pompidou Hospital, Cardiology
Department, Paris, France
(Fauchier, Babuty) Tours University Hospital, Tours, France
(Gras) Hopital Prive du Confluent, Nantes, France
(Bordachar) University Hospital Od Bordeaux, Bordeaux, France
(Piot) Centre Cardiologique du Nord, Saint Denis, France
(Sadoul) Nancy University Hospital, Nancy, France
(Defaye) University Hospital of Grenoble, Grenoble, France
(Deharo) La Timone University Hospital, Marseille, France
(Klug) Lille University Hospital, Lille, France
(Leclercq) Rennes University Hospital, Universite de Rennes, CIC-IT,
Rennes, France
(Extramiana) Bichat-Claude-Bernard Hospital, Paris, France
(Boveda) Clinique Pasteur, Toulouse, France
(Marijon) Paris Descartes University, Paris, France
Publisher
Oxford University Press
Abstract
Aims: Current guidelines do not propose any age cut-off for the primary
prevention implantable cardioverter-defibrillator (ICD). However, the
risk/benefit balance in the very elderly population has not been well
studied. Methods and Results: In a multicentre French study assessing
patients implanted with an ICD for primary prevention, outcomes among
patients aged >=80 years were compared with <80 years old controls matched
for sex and underlying heart disease (ischaemic and dilated
cardiomyopathy). A total of 300 ICD recipients were enrolled in this
specific analysis, including 150 patients >=80 years (mean age 81.9 +/-
2.0 years; 86.7% males) and 150 controls (mean age 61.8 +/- 10.8 years).
Among older patients, 92 (75.6%) had no more than one associated
comorbidity. Most subjects in the elderly group got an ICD as part of a
cardiac resynchronization therapy procedure (74% vs. 46%, P < 0.0001).
After a mean follow-up of 3.0 +/- 2 years, 53 patients (35%) in the
elderly group died, including 38.2% from non cardiovascular causes of
death. Similar proportion of patients received >=1 appropriate therapy
(19.4% vs. 21.6%; P = 0.65) in the elderly group and controls,
respectively. There was a trend towards more early perioperative events (P
= 0.10) in the elderly, with no significant increase in late complications
(P = 0.73). Conclusion(s): Primary prevention ICD recipients >=80
years in the real world had relatively low associated comorbidity. Rates
of appropriate therapies and device-related complications were similar,
compared with younger subjects. Nevertheless, the inherent limitations in
interpreting observational data on this particular competing risk
situation call for randomized controlled trials to provide definitive
answers. Meanwhile, a careful multidisciplinary evaluation is needed to
guide patient selection for ICD implantation in the elderly
population. Copyright © 2019 Published on behalf of the European
Society of Cardiology. All rights reserved.

<121>
Accession Number
629608105
Title
Non-intubated video-assisted thoracoscopic surgery vs. Intubated
video-assisted thoracoscopic surgery for thoracic disease: A systematic
review and meta-analysis of 1,684 cases.
Source
Journal of Thoracic Disease. 11 (8) (pp 3556-3568), 2019. Date of
Publication: 2019.
Author
Zhang K.; Chen H.-G.; Wu W.-B.; Li X.-J.; Wu Y.-H.; Xu J.-N.; Jia Y.-B.;
Zhang J.
Institution
(Zhang, Chen, Wu, Li, Wu, Xu, Jia, Zhang) Department of Thoracic Surgery,
Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630,
China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Non-intubated video-assisted thoracoscopic surgery (NIVATS)
has been increasingly used in lobectomy, bullectomy, wedge resection, lung
volume reduction, sympathectomy and talc pleurodesis, which may reduce
postoperative complications. However, the benefits of non-intubated and
intubated methods of VATS remain controversial. Method(s): We
comprehensively searched PubMed, Web of Science, Embase and the Cochrane
Library, and performed a systematic review to assess the two techniques.
Random and fixed-effects meta-analytical models were used based on the low
between-study heterogeneity. Study quality, publication bias, and
heterogeneity were assessed. Result(s): Compared to intubated
methods, NIVATS had a lower postoperative complications rate [odds ratio
(OR): 0.63; 95% confidence interval (CI), 0.46-0.86; P<0.01], shorter
global in-operating time [weighted mean difference (WMD): -35.96 min; 95%
CI, -48.00 to -23.91; P<0.01], shorter hospital stay (WMD: -1.35 days; 95%
CI, -1.72 to -0.98; P<0.01), shorter anesthesia time (WMD: -7.29 min; 95%
CI, -13.30 to -1.29; P<0.01), shorter chest-tube placement time (WMD:
-1.04 days; 95% CI, -1.75 to -0.33; P<0.01), less chest pain (WMD: -1.31;
95% CI, -2.45 to -0.17; P<0.05) and lower perioperative mortality rate
(OR: 0.13; 95% CI, 0.02-0.99; P=0.05). Conclusion(s): NIVATS is a
safe, efficient and feasible technique for thoracic surgery and may be a
better alternative procedure owing to its advantage in reducing
postoperative complications rate, hospital stay, and chest
pain. Copyright © Journal of Thoracic Disease. All rights
reserved.

<122>
Accession Number
2002507302
Title
Visceral bed involvement in thromboangiitis obliterans: A systematic
review.
Source
Vascular Health and Risk Management. 15 (pp 317-353), 2019. Date of
Publication: 2019.
Author
Fakour F.; Fazeli B.
Institution
(Fakour) Immunology and Microbiology Department, Mashhad Azad University
of Medical Sceinces, Mashhad, Iran, Islamic Republic of
(Fazeli) Immunology Research Center, Inflammation and Inflammatory
Diseases Division, Immunology Department, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Fazeli) Vascular Independent Research and Education, European Foundation,
Department of Angiology, L. Sacco Hospital, Milan, Italy
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
One of the challenges of thromboangiitis obliterans (TAO) management is in
the patients whose other vascular beds are involved and it remains a
challenge to know whether to pursue invasive procedures or to continue
medical treatment for such TAO patients. The aim of this review was to
investigate reports of the involvement of the visceral vessels in TAO and
the related clinical manifestations, management approaches and outcomes.
According to our systematic review, the frequency of published articles,
the organs most commonly involved were the gastrointestinal tract, the
heart, the central nervous system, the eye, the kidneys, the urogenital
system, the mucocutaneous zones, joints, lymphohematopoietic system and
the ear. Notably, reports of the involvement of almost all organs have
been made in relation to TAO. There were several reports of TAO
presentation in other organs before disease diagnosis, in which the
involvement of the extremities presented after visceral involvement. The
characteristics of the visceral arteries looked like the arteries of the
extremities according to angiography or aortography. Also, in autopsies of
TAO patients, the vascular involvement of multiple organs has been noted.
Moreover, systemic medical treatment could lead to the recovery of the
patient from the onset of visceral TAO. This study reveals that TAO may be
a systemic disease and patients should be aware of the possible
involvement of other organs along with the attendant warning signs. Also,
early systemic medical treatment of such patients may lead to better
outcomes and reduce the overall mortality rate. Copyright © 2019
Fakour and Fazeli.

<123>
Accession Number
2002867702
Title
Modified Single-Patch versus Two-Patch Repair for Atrioventricular Septal
Defect: A Systematic Review and Meta-Analysis.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 10 (5) (pp
616-623), 2019. Date of Publication: 01 Sep 2019.
Author
Loomba R.S.; Flores S.; Villarreal E.G.; Bronicki R.A.; Anderson R.H.
Institution
(Loomba) Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn,
IL, United States
(Flores, Villarreal, Bronicki) Critical Care and Cardiology, Pediatrics,
Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Anderson) Institute of Genetics, Newcastle University, Newcastle Upon
Tyne, United Kingdom
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: We performed a meta-analysis of studies to determine whether
the modified single-patch technique offers benefits when compared to the
two-patch repair. The postoperative outcomes examined in this study were
cardiopulmonary bypass time, cross-clamp time, duration of mechanical
ventilation, intensive care unit length of stay, total hospital length of
stay, need for reoperation, need for reoperation for left ventricular
outflow tract obstruction or left atrioventricular valve regurgitation,
need for pacemaker implantation, and mortality during follow-up.
 Method(s): A review was conducted to identify studies comparing a
modified single-patch repair versus two-patch repair. A fixed-effects
model was utilized for end points with low heterogeneity and a
random-effects model for end points with significant heterogeneity.
Meta-regression was also performed to determine the influence of other
factors on the variables of interest. Result(s): A total of 964
unique manuscripts were screened, with 10 being included in the final
analyses. There were a total of 724 patients, with 353 (49%) having
undergone repair utilizing a modified single-patch repair. Mean age at
repair for modified single-patch repair and two-patch repair was 8.81 and
9.03 months, respectively. Significant differences were noted in
cardiopulmonary bypass time and cross-clamp time with mean difference of
-28.53 and -22.69 minutes, respectively. In comparison to the two-patch
repair, both times were decreased in modified single-patch repair. No
significant difference was noted in any other variables.
 Conclusion(s): Modified single-patch repair for atrioventricular
septal defects requires less cardiopulmonary bypass and cross-clamp time
but does not significantly impact the examined postoperative
outcomes. Copyright © The Author(s) 2019.

<124>
Accession Number
626985735
Title
Treat stroke to target trial design: First trial comparing two LDL targets
in patients with atherothrombotic strokes.
Source
European Stroke Journal. 4 (3) (pp 271-280), 2019. Date of Publication: 01
Sep 2019.
Author
Amarenco P.; Kim J.S.; Labreuche J.; Giroud M.; Lee B.-C.; Mahagne M.-H.;
Nighoghossian N.; Simon T.; Steg P.G.; Touboul P.-J.; Vicaut E.; Yelles
N.; Bruckert E.
Institution
(Amarenco, Touboul) Assistance Publique-Hopitaux de Paris (APHP),
Department of Neurology and Stroke Center, Bichat Hospital, INSERM
LVTS-U1148, DHU FIRE, Universite Paris-Diderot, Sorbonne-Paris Cite,
Paris, France
(Kim) Department of Neurology, Asan Medical Center, Seoul, South Korea
(Labreuche) Universite Lille, CHU Lille, EA 2694 - Sante publique:
epidemiologie et qualite des soins, Lille F-59000, France
(Giroud) Department of Neurology, INSERM, Universite Bourgogne, Dijon,
France
(Lee) Department of Neurology, Hallym University Sacred Heart Hospital,
Anyang, South Korea
(Mahagne) Stroke Unit, Pasteur hospital, Nice, France
(Nighoghossian) Hospices Civils de Lyon, Department of Neurology and
Stroke center, Lyon University, Lyon, France
(Simon) APHP, Department of Clinical Pharmacology and Clinical Research
Platform of East of Paris (CRC-CRB-URC), Saint Antoine University
Hospital, Paris, France
(Steg) APHP, Department of Cardiology, INSERM LVTS-U1148, DHU FIRE,
Universite Paris-Diderot, Sorbonne-Paris Cite, Hopital Bichat, Paris,
France
(Vicaut) APHP, Department of Biostatistics, Universite Paris-Diderot,
Sorbonne-Paris Cite, Fernand Widal hospital, Paris, France
(Yelles) APHP, Centre de Pharmaco-epidemiologie de l'AP-HP (CEPHEPI),
Hopital Pitie-Salpetriere, Paris, France
(Bruckert) APHP, Pitie-Salpetriere University Hospital, Pierre and Marie
Curie University, Sorbonne-Paris Cite, Paris, France
(Simon) Sorbonne University, France
(Steg) NHLI Imperial College, ICMS Royal Brompton Hospital London, United
Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: In patients with non-cardio-embolic stroke, atorvastatin 80
mg/day reduced the relative risk of recurrent stroke by 16%, and a post
hoc analysis showed that achieving an LDL-c of less than 70 mg/dL reduced
the relative risk by 28% as compared to an on-treatment LDL of 100 mg/dL
or more. Current guidelines from the French drug agency recommend treating
with a statin after an ischaemic stroke to a target of less than 100
mg/dL, but no study directly tested LDL-c targets. The Treat Stroke to
Target (TST) trial will compare the efficacy of achieving an LDL-c of less
than 70 mg/dL versus an achieved LDL-c of 100 +/- 10 mg/dL for secondary
prevention in patients with recent ischaemic stroke of atherosclerotic
origin. Main hypothesis: An achieved on-treatment LDL-c of less than 70
mg/dL will reduce by 25% the risk of recurrent ischaemic stroke,
myocardial infarction, urgent coronary or carotid revascularisation
following new symptoms requiring hospitalisation, and vascular death
compared with on-treatment LDL-c of 100 +/- 10 mg/dL. Design(s):
Patients are randomised to either LDL-c levels, and the investigator who
is not blinded can use the lipid-lowering agent of his/her choice
available on the market (including statins and ezetimibe), in order to
achieve the assigned LDL-c level. To be eligible for enrolment, patients
have a recent ischaemic stroke or TIA of atherosclerotic origin with at
least one arterial stenosis of a cerebral artery, enrolled between acute
phase of the qualifying stroke (once the neurological deficit is
stabilised) and three months. The initial planned sample size of 3760
participants followed three years was amended to allow follow-up of all
enrolled patients until 385 primary efficacy outcome events have occurred,
and no later than 31 December 2019. Patients will be recruited in 76 sites
in two countries (France and South Korea) between March 2010 and December
2018 (last included patient followed up to one year). Safety outcomes will
include haemorrhagic strokes and new onset diabetes. All primary endpoints
will be adjudicated by an endpoint committee, blinded to the assigned
LDL-c level. Two sub-studies assess (1) the relative effect of assigned
LDL-c levels on occurrence of new atherosclerotic plaque as detected by
carotid ultrasound during follow-up, using M'ATH software for
repositioning and (2) the genetic and biomarker drivers of recurrent
primary endpoints according to assigned LDL-c lowering arm, in
atherosclerotic strokes. Summary: The TST trial is evaluating the
benefits of achieving an LDL-c less than 70 mg/dL for secondary stroke
prevention in ischaemic stroke patients of atherosclerotic origin. Main
results are anticipated in 2020 or earlier (ClinicalTrials.gov
NCT01252875). Copyright © European Stroke Organisation 2019.

<125>
Accession Number
2003185128
Title
Effectiveness of the new generation transcatheter aortic valve in the real
life studies. Review and meta-analysis.
Source
European Review for Medical and Pharmacological Sciences. 23 (18) (pp
8018-8027), 2019. Date of Publication: 2019.
Author
Acconcia M.C.; Caretta Q.; Monzo L.; Tanzilli G.; Sili Scavalli A.; Sergi
D.; Di Luozzo M.; Marchei M.; Chiocchi M.; Romeo F.; Gaudio C.
Institution
(Acconcia, Monzo, Tanzilli, Gaudio) Department of Cardiovascular Disease,
Sapienza University of Rome, Rome, Italy
(Caretta) Department of Experimental and Clinical Medicine, University of
Florence, Florence, Italy
(Sili Scavalli) Department of Internal Medicine, Sapienza University of
Rome, Rome, Italy
(Sergi, Di Luozzo, Marchei, Romeo) Department of Cardiovascular Disease,
Tor Vergata University of Rome, Rome, Italy
(Chiocchi) Department of Diagnostic Imaging, Molecular Imaging,
Interventional Radiology and Radiotherapy, Tor Vergata University of Rome,
Rome, Italy
Publisher
Verduci Editore s.r.l (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: The aim of the meta-analysis was to assess post-procedural
outcome of the new generation of transcatheter aortic valve implantation
(TAVI) devices, focusing on thetransfemoral and balloon-expandable SAPIEN
3 (Edwards Lifesciences Inc., Irvine, CA, USA), the self-expanding
CoreValveTM Evolut series R and PRO (R/PRO)TM (Medtronic Inc.,
Minneapolis, MN, USA) and ACURATE neoTM transcatheter aortic valve
(Symetis SA, a Boston Scientific company, Ecublens, Switzerland).
MATERIALS AND METHODS: All observational studies were retrieved through
PubMed computerized database from January 2014 until June 30th,
2019. The risk difference (RD) with the 95% confidence interval (CI) was
used to assess the effectiveness of the intervention under comparison. The
primary end point was 30-day mortality. Safety end points included: (i)
stroke, (ii) moderate/severe paravalvular leak, and (iii) the need for new
permanent pacemaker implantation. RESULT(S): Meta-analysis
demonstrated no significant differences as regards to either 30-day
mortality or stroke for all the groups of prostheses under comparison.
ACURATE neo was associated with significantly less new permanent pacemaker
implantation compared to SAPIEN 3 (RD: -0.06; 95% CI -0.08 to -0.03;
p<0.0001; l2=0%) or to EVOLUT R/PRO (RD: -0.06; 95% CI -0.09 to
-0.02; p=0.0009; l2=0%). A significant reduction of new
permanent pacemaker need was observed in the group of patients implanted
with SAPIEN 3 compared to EVOLUT R/PRO (RD: -0.07; 95% CI -0.09 to -0.04;
p<0.00001; l2=7%). The occurrence of moderate/severe leak was
significantly increased in the group of patients implanted with ACURATE
neo vs. SAPIEN 3 (RD: 0.04; 95% CI 0.02 to 0.05; p<0.00001;
l2=0%). No significant differences were found between ACURATE
neo vs. EVOLUT R/PRO (RD: -0.01; 95% CI -0.04 to 0.02; p=0.69;
l2=0%) and between SAPIEN 3 vs. EVOLUT R/PRO (RD: -0.01; 95% CI
-0.04 to 0.01; p=0.28; l2=73%). CONCLUSION(S): The results
of the meta-analysis show that: (1) ACURATE neo was associated with
significantly less new permanent pacemaker implantation than SAPIEN 3 and
EVOLUT R/PRO; (2) SAPIEN 3 had significantly lower occurrence of
moderate/severe valvular leak than ACURATE neo. Copyright © 2019
Verduci Editore s.r.l. All rights reserved.

<126>
Accession Number
2001302089
Title
A Randomized Controlled Trial of Liposomal Bupivacaine Parasternal
Intercostal Block for Sternotomy.
Source
Annals of Thoracic Surgery. 107 (1) (pp 128-134), 2019. Date of
Publication: January 2019.
Author
Lee C.Y.; Robinson D.A.; Johnson C.A.; Zhang Y.; Wong J.; Joshi D.J.; Wu
T.-T.; Knight P.A.
Institution
(Lee, Robinson, Johnson, Wong, Joshi, Knight) Division of Cardiac Surgery,
Department of Surgery, University of Rochester Medical Center, Rochester,
NY, United States
(Zhang, Wu) Department of Biostatistics and Computational Biology,
University of Rochester, Rochester, NY, United States
Publisher
Elsevier USA
Abstract
Background: Optimal pain control continues to be a concern in cardiac
surgery. Current strategies for postoperative pain management often yield
suboptimal results. The superiority of Exparel (Pacira Pharmaceuticals,
Inc, Parsippany, NJ) in providing postoperative pain control and opioid
sparing is equivocal. This prospective, randomized, double-blind study
examines the efficacy of Exparel as a novel single-dose application
parasternal nerve block in postoperative pain control and opioid sparing.
 Method(s): This single-surgeon study included 79 patients undergoing
median sternotomy for coronary revascularization. Study participants were
randomized to either the drug or a control arm. Each participant received
Exparel or normal saline placebo administered as a parasternal nerve
block. Postoperative pain was rated according to the nonverbal pain scale
or numeric rating scale. Total amount of narcotic pain medication used and
patients' pain scores within the first 72 hours postoperatively were
compared. Secondary outcomes compared the intensive care unit length of
stay, hospital length of stay, time to extubation, time to return of bowel
function, and time to return to work or daily activities. Result(s):
The primary endpoint of pain levels between the two groups demonstrated no
significant difference when analyzing the individual time points
postoperatively. However, overall pain levels were significantly lower in
the study drug group (p = 0.04). There was no significant difference in
the amount of analgesics required postoperatively or in secondary
endpoints between the groups. Conclusion(s): Exparel does not provide
an opioid-sparing benefit or any secondary outcome benefit compared with
placebo. Exparel may be associated with a marginal decrease in
postoperative pain levels. (Parasternal Nerve Bock in Cardiac Patients;
NCT01826851.) Copyright © 2019 The Society of Thoracic Surgeons

<127>
Accession Number
2001341456
Title
Arterial Switch Operation: Operative Approach and Outcomes.
Source
Annals of Thoracic Surgery. 107 (1) (pp 302-310), 2019. Date of
Publication: January 2019.
Author
Fricke T.A.; Konstantinov I.E.
Institution
(Fricke, Konstantinov) Department of Cardiac Surgery, Royal Children's
Hospital, Melbourne, Australia
(Fricke, Konstantinov) Department of Pediatrics, University of Melbourne,
Melbourne, Australia
(Fricke, Konstantinov) Murdoch Children's Research Institute, Melbourne,
Australia
(Konstantinov) Melbourne Children's Centre for Cardiovascular Genomics and
Regenerative Medicine, Melbourne, Australia
Publisher
Elsevier USA
Abstract
The arterial switch operation has excellent early outcomes. Although the
majority of patients are growing into healthy adults, a small subset
require reoperation for pulmonary stenosis as well as neoaortic root
dilatation and neoaortic valve regurgitation, especially as follow-up
increases. Challenging subgroups include patients with anomalous coronary
anatomy, concomitant aortic arch obstruction, Taussig-Bing anomaly,
ventricular septal defect, and low operative weight, and patients with an
intact interventricular septum who present late. Copyright © 2019
The Society of Thoracic Surgeons

<128>
[Use Link to view the full text]
Accession Number
622140427
Title
No neurocognitive advantage for immediate antiretroviral treatment in
adults with greater than 500 CD4+ T-cell counts.
Source
AIDS. 32 (8) (pp 985-997), 2018. Date of Publication: 15 May 2018.
Author
Wright E.J.; Grund B.; Robertson K.R.; Cysique L.; Brew B.J.; Collins
G.L.; Poehlman-Roediger M.; Vjecha M.J.; Penalva De Oliveira A.C.;
Standridge B.; Carey C.; Avihingsanon A.; Florence E.; Lundgren J.D.;
Arenas-Pinto A.; Mueller N.J.; Winston A.; Nsubuga M.S.; Lal L.; Price
R.W.
Institution
(Wright) Department of Infectious Diseases Alfred Health, Monash
University, Burnet Institute, Peter Doherty Institute for Infection and
Immunity, Melbourne, VIC, Australia
(Grund) School of Statistics, University of Minnesota, Minneapolis, MN,
United States
(Robertson) Department of Neurology, University of North Carolina, NC,
United States
(Cysique) Neurosciences Research Australia, St. Vincent's Hospital Sydney,
Applied Medical Research Centre, Australia
(Brew) Neurosciences Program, Peter Duncan Neurosciences Unit, St
Vincent's Centre for Applied Medical Research, University of New South
Wales, Sydney, Australia
(Collins, Poehlman-Roediger) Division of Biostatistics, School of Public
Health, University of Minnesota, Minneapolis, MN, United States
(Vjecha) Institute for Clinical Research, Inc, Washington, DC, United
States
(Penalva De Oliveira) Instituto Emilio Ribas, Sao Paulo, Brazil
(Standridge) Veterans Affairs Medical Center, Washington, DC, United
States
(Carey) Kirby Institute, University of New South Wales, Sydney, Australia
(Avihingsanon) HIV-NAT Thai Red Cross AIDS Research Centre and Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand
(Florence) Department of Clinical Sciences, Institute of Tropical
Medicine, Antwerp, Belgium
(Lundgren) CHIP, Department of Infectious Diseases, Rigshospitalet,
University of Copenhagen, Denmark
(Arenas-Pinto) MRC Clinical Trials Unit at UCL, Institute of Clinical
Trials and Methodology, University College London, London, United Kingdom
(Mueller) Division of Infectious Diseases and Hospital Epidemiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland
(Winston) Division of Infectious Diseases, Department of Medicine,
Imperial College London, London, United Kingdom
(Nsubuga) People in Need Agency (PINA), Uganda
(Lal) Burnet Institute, Melbourne, Australia
(Price) Department of Neurology, University of California San Francisco,
San Francisco, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: To compare the effect of immediate versus deferred
antiretroviral treatment (ART) on neuropsychological test performance in
treatment-naive HIV-positive adults with more than 500 CD4 + cells/mul.
 Design(s): Randomized trial. Method(s): The START parent study
randomized participants to commence immediate versus deferred ART until
CD4 + less than 350 cells/mul. The START Neurology substudy used eight
neuropsychological tests, at baseline, months 4, 8, 12 and annually, to
compare groups for changes in test performance. Test results were
internally standardized to z-scores. The primary outcome was the average
of the eight test z-scores (QNPZ-8). Mean changes in QNPZ-8 from baseline
were compared by intent-to-treat using longitudinal mixed models. Changes
from baseline to specific time points were compared using ANCOVA models.
 Result(s): The 592 participants had a median age of 34 years; median
baseline CD4 + count was 629 cells/mul; the mean follow-up was 3.4 years.
ART was used for 94 and 32% of accrued person-years in the immediate and
deferred groups, respectively. There was no difference between the
immediate and deferred ART groups in QNPZ-8 change through follow-up
[-0.018 (95% CI -0.062 to 0.027, P = 0.44)], or at any visit. However,
QNPZ-8 scores increased in both arms during the first year, by 0.22 and
0.24, respectively (P < 0.001 for increase from baseline).
 Conclusion(s): We observed substantial improvement in neurocognitive
test performance during the first year in both study arms, underlining the
importance of using a control group in studies assessing neurocognitive
performance over time. Immediate ART neither benefitted nor harmed
neurocognitive performance in individuals with CD4 + cell counts above 500
cells/mul. Copyright © 2018 Wolters Kluwer Health, Inc. All
rights reserved.

<129>
Accession Number
2001226742
Title
Bibliometric Analysis of the Top 100 Most Cited Articles in the First 50
Years of Heart Transplantation.
Source
American Journal of Cardiology. 123 (1) (pp 175-186), 2019. Date of
Publication: 1 January 2019.
Author
Kolkailah A.A.; Fugar S.; Vondee N.; Hirji S.A.; Okoh A.K.; Ayoub A.;
Al-Ogaili A.; Paz Rios L.H.; Kumar S.K.; Camacho M.T.; Rich J.D.; Golzar
Y.
Institution
(Kolkailah, Ayoub, Al-Ogaili, Paz Rios) Department of Medicine, John H.
Stroger, Jr. Hospital of Cook County, Chicago, IL, United States
(Fugar) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
(Vondee) Department of Medicine, St. Vincent Charity Medical Center,
Cleveland, OH, United States
(Hirji) Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Okoh, Camacho) Cardiology and Cardiac Surgery Research Unit, Newark Beth
Israel Medical Center, Newark, NJ, United States
(Kumar) Division of Advanced Heart Failure and Transplant Cardiology,
Tampa General Hospital, Tampa, FL, United States
(Rich) Division of Advanced Heart Failure and Transplant Cardiology,
Northwestern Memorial Hospital, Chicago, IL, United States
(Golzar) Division of Cardiology, John H. Stroger, Jr. Hospital of Cook
County, Chicago, IL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The world celebrates over 50 years since the first human-to-human heart
transplant. Bibliometric analysis is a statistical concept that has
recently evolved, enabling scientists to study citation patterns and
identify characteristics of highly cited scholarly work in different
fields. Although it has been widely utilized, such analyses have not been
conducted to date on heart transplant literature. We sought to assess the
characteristics of the top 100 most referenced citations in the field of
heart transplantation. We searched the Scopus database (www.scopus.com) to
identify all articles relating to heart transplantation. The articles were
arranged in descending order from most cited to least cited and selected
articles were scrutinized for data extraction. One hundred articles were
included in the final list. Of the total 40,660 citations identified,
3,210 (8.0%) were self-citations, which impacted the final rank order. The
articles were published in 25 different journals between 1960 and 2013.
The most productive 5-year time period was between 2000 and 2005, when 24
of the 100 most cited publications were produced. There was no correlation
between the journals' impact factors and the number of articles produced
per journal. The presence and type of funding were not associated with the
number of citations. Over 85% of first and senior investigators were men.
In conclusion, our study highlights key features of the most highly cited
scientific literature on heart transplantation and provides insights into
trends of published work in this field. Additionally, this work may serve
as a useful guide to researchers and funding bodies by highlighting the
most prolific areas of cardiac transplant research to date. Copyright
© 2018

<130>
Accession Number
2001335190
Title
Patient-Reported Outcomes in Cardiothoracic Surgery.
Source
Annals of Thoracic Surgery. 107 (1) (pp 294-301), 2019. Date of
Publication: January 2019.
Author
Subramanian M.; Kozower B.D.; Brown L.M.; Khullar O.V.; Fernandez F.G.
Institution
(Subramanian, Kozower) Division of Cardiothoracic Surgery, Washington
University School of Medicine, St. Louis, MO, United States
(Brown) Division of Cardiothoracic Surgery, University of California Davis
Health, Davis, CA, United States
(Khullar, Fernandez) Section of Cardiothoracic Surgery, Emory University
School of Medicine, Atlanta, Georgia
Publisher
Elsevier USA
Abstract
Background: Current studies in cardiothoracic clinical research frequently
fail to use end points that are most meaningful to patients, including
measures associated with quality of life. Patient-reported outcomes (PROs)
represent an underused but important component of high-quality
patient-centered care. Our objective was to highlight important principles
of PRO measurement, describe current use in cardiothoracic operations, and
discuss the potential for and challenges associated with integration of
PROs into large clinical databases. Method(s): We performed a
literature review by using the PubMed/EMBASE databases. Clinical articles
that focused on the use of PROs in cardiothoracic surgical outcomes
measurement or clinical research were included in this review.
 Result(s): PROs measure the outcomes that matter most to patients and
facilitate the delivery of patient-centered care. When effectively used,
PRO measures have provided detailed and nuanced quality-of-life data for
comparative effectiveness research. However, further steps are needed to
better integrate PROs into routine clinical care. Conclusion(s):
Incorporation of PROs into routine clinical practice is essential for
delivering high-quality patient-centered care. Future integration of PROs
into prospectively collected registries and databases, including that The
Society of Thoracic Surgeons National Database, has the potential to
enrich comparative effectiveness research in cardiothoracic
surgery. Copyright © 2019 The Society of Thoracic Surgeons

<131>
Accession Number
2003356979
Title
TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) IN ARGENTINA: META-ANALYSIS
OF REAL-LIFE DATA.
Source
Value in Health Regional Issues. Conference: ISPOR Latin America 2019:
Data and Value in Healthcare: 2020 and Beyond. Colombia. 19 (Supplement)
(pp S25-S26), 2019. Date of Publication: October 2019.
Author
Carosella L.; Brescacin C.; Pissinis J.; Giorgi M.; Boissonnet C.
Institution
(Carosella, Brescacin, Pissinis) CEMIC, Buenos Aires, Argentina
(Giorgi) Instituto Universitario CEMIC, buenos aires, B, Argentina
(Boissonnet) Insituto Universitario CEMIC, buenos aires, B, Argentina
Publisher
Elsevier Inc.
Abstract
Objectives: TAVR is a validated technology for patients with severe
symptomatic aortic stenosis that has been available in South America since
2008. Reports on the clinical outcomes of this procedure in a real-life
setting in Argentina are scarce. We conducted a meta-analysis of
observational data including non-clinical variables. Method(s): a
systematic review of published papers and abstracts (presented in regional
and national scientific sessions) of unicentric TAVR cohorts from
Argentina between 2008 to 2018 was conducted. Two independent researcher
teams extract data, discrepancies were solved by consensus. All outcomes
were assessed during hospitalization and at 30 days. We ran random-effects
models by means of R package "meta" (Schwarzer, 2007), estimating
heterogeneity with Cochrane's Q and I2 statistics.
 Result(s): Twelve cohorts pooling 774 patients were included in the
meta-analysis. The most frequently implanted device was CoreValve.
Procedure success was 97% (95CI 91.25%-99%; I2 0%) as reported
by the authors. In-hospital complications were: moderate or severe aortic
regurgitation 21.1% (95CI 12.6%-33.2%; I2 54.5%), mortality
6.1% (95CI 4.3%-8.5%; I2 0%), stroke 4.5% (95CI 2.5%-7.8%;
I2 0%), permanent pacemaker implantation 20.9% (95CI
13.2%-31.8%; I2 79.2%). At 30-days mortality was 9.7% (95CI
6.9%-13.4%; I2 22.7%). Meta-regression with center-level
variables revealed that 30-day mortality was higher in public funded
hospitals but was not related to geographic location, number of beds,
residence programs or university affiliation. Conclusion(s): this is
the first meta-analysis about TAVR performance in a real-life setting in
Argentina. Overall results are better than those reported for the region
but worse than those reported for Europe or USA. Copyright © 2019

<132>
Accession Number
2003356812
Title
COST-EFFECTIVENESS ANALYSIS OF THREE-DIMENSIONAL TRANSESOPHAGEAL
ECHOCARDIOGRAPHY VERSUS TWO-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAM FOR
THE EVALUATION OF PATIENTS WITH MITRAL REGURGITATION WITH INDICATION OF
SURGICAL TREATMENT.
Source
Value in Health Regional Issues. Conference: ISPOR Latin America 2019:
Data and Value in Healthcare: 2020 and Beyond. Colombia. 19 (Supplement)
(pp S47-S48), 2019. Date of Publication: October 2019.
Author
dos Santos W.M.; Holanda P.; Miglioranza M.H.; Le Bihan D.; Rosim M.P.;
Okumura L.; Vieira M.; de Resende M.V.C.; Oliveira W.P.; Nunes C.G.O.;
Pedro G.O.; Nita M.E.; Riveros B.; Lucchetta R.C.
Institution
(dos Santos, Holanda, Rosim, Okumura, Pedro, Nita, Lucchetta)
MAPESolutions, Sao Paulo, Brazil
(Miglioranza) University Foundation of Cardiology, Porto Alegre, Brazil
(Le Bihan) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Vieira) Instituto do Coracao, Sao Paulo, Brazil
(de Resende) Hospital Samaritano, Sao Paulo, Brazil
(Oliveira) Camara Federal dos Deputados, Brasilia, Brazil
(Nunes) CDI - Centro de Diagnostico por Imagem, Goiania, Brazil
(Riveros) MAPESolutions, Curitiba, Brazil
Publisher
Elsevier Inc.
Abstract
Objectives: To perform the cost-effectiveness analysis of
three-dimensional transesophageal echocardiography (3DTEE) in comparison
to two-dimensional transesophageal echocardiography (2DTEE) for the
anatomic-functional evaluation and surgical planning of severe mitral
regurgitation. Method(s): a complete economic study was based on a
systematic review of 3DTEE and 2DTEE accuracy and private health system
costs of two different surgical interventions: mitral valve plasty and
mitral valve replacement. The prevalence of common postoperative
complications was also predicted for elective procedures: atrial
fibrillation (8.6%); acute myocardial infarction (1.4%); thrombosis
(3.5%); bleeding (1.5%); endocarditis (6.3%). The decision tree method was
adopted as a data analysis model. The Bayes' theorem was used based on
sensitivity and specificity measurements. The costs, considering
literature and professional tables, were: 3DTEE = US$ 349; 2DTEE = US$
204; diagnostic evaluation = US$ 597; surgical procedure = US$ 3,643;
surgical treatment = US$ 374. Result(s): The deterministic analysis
of the diagnostic test shows that 3DTEE (non-dominated) is superior to
2DTEE (absolutely dominated). The 3DTEE presents a cost reduction of US$
1,147 and incremental effectiveness (true identification) of 22% when
compared to 2DTEE. The multivariate probabilistic sensitivity analysis
showed that after 100,000 iterations, the diagnosis based on the 3DTEE
becomes the first choice regardless of the willingness to pay threshold.
 Conclusion(s): 3DTEE was cost-effective compared to 2DTEE. Thus,
3DTEE is a potential device to promote health compared to 2DTEE for
surgical planning of severe mitral regurgitation. Copyright ©
2019

<133>
Accession Number
2003356622
Title
BUDGET IMPACT ANALYSIS OF TRICLOSAN-COATED SUTURES FOR SURGICAL SITE
INFECTION PREVENTION IN COLOMBIA.
Source
Value in Health Regional Issues. Conference: ISPOR Latin America 2019:
Data and Value in Healthcare: 2020 and Beyond. Colombia. 19 (Supplement)
(pp S79), 2019. Date of Publication: October 2019.
Author
Patino A.F.; Sanchez D.; Heins E.
Institution
(Patino) Johnson & Johnson Medical Devices - Northern Cluster LATAM,
Bogota, CUN, Colombia
(Sanchez) Johnson & Johnson Medical, Mexico City, Mexico
(Heins) Johnson & Johnson Medical Colombia, Bogota, Colombia
Publisher
Elsevier Inc.
Abstract
Objectives: Treatment of surgical site infections (SSI) may require a
large amount of resources for health institutions and the healthcare
system in general. Organizations such as WHO, CDC, among others, recommend
the use of triclosan-coated sutures as an alternative that reduces the
risk of SSI. The objective of this study is to evaluate the budget impact
of applying triclosan-coated sutures in selected surgical procedures under
two perspectives: hospital and third payer. Method(s): A budget
impact model was developed with a time horizon of one year, taking a
hypothetical cohort of patients undergoing abdominal wall closure (WC),
colorectal surgery (CS), joint replacement (JR) and coronary artery bypass
graft (CABG), where the volume of procedures was estimated internally. The
SSI risk reduction rate due to the use of triclosan-coated sutures comes
from published meta-analysis, SSI rates associated with each procedure and
costs of treatment for SSI were taken from published evidence, the cost of
traditional sutures and the cost of triclosan-coated sutures was included
into the model. Result(s): The adoption of triclosan-coated sutures
provide savings in each of the analyzed procedures equivalent to
31,608,000 COP for WC, 20,904,000 COP for CS, 22,512,000 COP for JR and
29,652,000 COP for CABG. Total savings from the adoption of
triclosan-coated sutures is 22.7%. Sensitivity analysis is consistent with
these results. Conclusion(s): Adopting triclosan-coated sutures can
generate significant savings for hospitals, payers and for the Colombian
healthcare system, through the prevention of cases of SSI. Copyright
© 2019

<134>
Accession Number
2003356349
Title
General Anesthesia Versus Locoregional Anesthesia for Carotid
Endarterectomy: A Systematic Review.
Source
Journal of Vascular Surgery. Conference: VEITH symposium. United States.
70 (5 Supplement) (pp e190), 2019. Date of Publication: November 2019.
Author
Ma W.; Lurie F.
Institution
(Ma) The First Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
(Ma, Lurie) Jobst Vascular Institute, Toledo, OH, United States
Publisher
Mosby Inc.
Abstract
Objective: The objective of this study was to determine whether performing
carotid endarterectomy (CEA) under locoregional anesthesia reduces the
risk of perioperative complications as well as mortality compared with
general anesthesia and to investigate an optimal anesthetic technique
generally accepted by patients and surgeons for the vascular anesthetists.
 Method(s): We searched the PubMed, MEDLINE, and Embase databases and
Index to Scientific and Technical Proceedings. We also hand searched
relevant journals and searched the reference lists of articles identified.
The predefined inclusion criterion is randomized trials comparing
different anesthetic techniques in CEA. Four review authors independently
assessed trial quality and extracted data. Pooled odds ratios and
corresponding 95% confidence interval for the perioperative outcomes were
calculated, including stroke, cardiac complications, mortality, operative
time, length of stay, conversion to another technique, shunted arteries,
and respiratory distress. Result(s): We included 16 randomized trials
involving 5543 operations, of which 3526 were from the single largest
trial (General Anesthesia vs Local Anesthesia [GALA] trial). In comparing
the locoregional group with the general group, there was no statistically
significant difference in the incidence of stroke and cardiac
complications. General anesthesia was associated with more shunts used in
operations with a statistically significant difference. The average length
of stay was significantly shorter in patients of the locoregional group.
Neither the GALA trial nor the pooled analysis was adequately powered to
reliably detect an effect on mortality. Conclusion(s): The results
from this review show insufficient evidence to determine which anesthesia
technique is preferable in regard to major complications and mortality
after CEA. It suggests that vascular surgeons and anesthetists perform
ideal anesthetic technique according to the clinical situation and their
own preferences where applicable. Copyright © 2019

<135>
Accession Number
2003356312
Title
Black-Blood Venous Imaging With Phase Contrast: A Contrast-Free
Cardiovascular Magnetic Resonance Approach for the Diagnosis of
May-Thurner Syndrome.
Source
Journal of Vascular Surgery. Conference: VEITH symposium. United States.
70 (5 Supplement) (pp e184), 2019. Date of Publication: November 2019.
Author
Cheng Z.; Wang H.; Yin L.; Yan J.; Huang F.; Han T.
Institution
(Cheng, Wang, Yin, Yan, Huang, Han) Fujian Provincial Hospital, Fuzhou,
Fujian Province, China
Publisher
Mosby Inc.
Abstract
Objective: May-Thurner syndrome (MTS) is a venous compression syndrome in
which the left common iliac vein is compressed between the lower lumbar
spine and the right common iliac artery. The objective of this study was
to determine whether black-blood venous imaging (BBVI) technique can
diagnose May-Thurner syndrome. Method(s): This is a prospective,
single-center study. All patients were admitted to the cardiovascular
surgery division for MTS and screened for study eligibility; 46 patients
received BBVI with phase contrast (BBVI + PC), computed tomography
venography (CTV), and digital subtraction angiography (DSA). Two blinded
readers assessed the randomized BBVI + PC images from all participants and
made independent decisions about the presence or absence of iliac vein
compression. Images obtained by CTV and DSA were also randomized and
assessed by the two readers. Using the consensus diagnosis of DSA as the
reference, the sensitivity, specificity, positive and negative predictive
values, and accuracy of BBVI + PC and CTV as well as their diagnostic
agreement with DSA were calculated. In addition, diagnostic confidence and
inter-reader diagnostic agreement were evaluated for all three techniques.
 Result(s): BBVI + PC with optimized parameters effectively allowed
visualization of iliac venous compression directly. High sensitivity
(92.4% vs 88.6%), specificity(99.0% vs 96.7%), positive predictive values
(96.5% vs 89.8%), negative predictive values (98.7% vs 93.3%), and
accuracy (98.2% vs 97.6%) were obtained by BBVI + PC in comparison with
CTV. Good diagnostic confidence and excellent diagnostic and inter-reader
agreements were achieved by BBVI + PC, which were superior to CTV in
detecting MTS. Conclusion(s): BBVI + PC allows direct visualization
of iliac venous compression and has the potential to be a reliable
diagnostic method without the use of contrast agent. Copyright ©
2019

<136>
[Use Link to view the full text]
Accession Number
629594482
Title
Multiarterial coronary artery bypass grafting: Is the radial artery
fulfilling the unkept promise of the right internal thoracic artery?.
Source
Current Opinion in Cardiology. 34 (6) (pp 628-636), 2019. Date of
Publication: 01 Nov 2019.
Author
Affronti A.; Ruel M.; Gaudino M.F.L.
Institution
(Affronti, Ruel) Division of Cardiac Surgery, University of Ottawa Heart
Institute, 40 Ruskin Street, Ottawa K1Y 4W7, Canada
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York City, NY, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of reviewThe debate on the second best conduit for CABG is still
intense. In this review, we discuss the role of the radial artery and the
right internal thoracic artery (RITA) compared with saphenous vein grafts
(SVG).Recent findingsThe recent RADIAL STUDY has been the first evidence
based on randomized trials of a clinical benefit using a second arterial
graft in CABG.On the other hand, the definitive 10-year results of the ART
trial failed to show a clinical advantage associated with the use of
bilateral internal thoracic artery (BITA). A thorough and contextualized
analysis of this and other studies, however, may offer a different
perspective.SummaryArterial conduits in CABG have shown better patency
rates than SVG. Whether this leads to better clinical outcomes is still
debated. In this setting, the radial artery and the RITA seem to offer a
similar advantage, although with different indications and
contraindications. Copyright © 2019 Wolters Kluwer Health, Inc.
All rights reserved.

<137>
Accession Number
2003343071
Title
Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow
Reserve-Guided Revascularization Strategy.
Source
JACC: Cardiovascular Interventions. 12 (20) (pp 2035-2046), 2019. Date of
Publication: 28 October 2019.
Author
Kim C.H.; Koo B.-K.; Dehbi H.-M.; Lee J.M.; Doh J.-H.; Nam C.-W.; Shin
E.-S.; Cook C.M.; Al-Lamee R.; Petraco R.; Sen S.; Malik I.S.; Nijjer
S.S.; Mejia-Renteria H.; Alegria-Barrero E.; Alghamdi A.; Altman J.;
Baptista S.B.; Bhindi R.; Bojara W.; Brugaletta S.; Silva P.C.; Di Mario
C.; Erglis A.; Gerber R.T.; Going O.; Harle T.; Hellig F.; Indolfi C.;
Janssens L.; Jeremias A.; Kharbanda R.K.; Khashaba A.; Kikuta Y.;
Krackhardt F.; Laine M.; Lehman S.J.; Matsuo H.; Meuwissen M.; Niccoli G.;
Piek J.J.; Ribichini F.; Samady H.; Sapontis J.; Seto A.H.; Sezer M.;
Sharp A.S.P.; Singh J.; Takashima H.; Talwar S.; Tanaka N.; Tang K.; Van
Belle E.; van Royen N.; Vinhas H.; Vrints C.J.; Walters D.; Yokoi H.;
Samuels B.; Buller C.; Patel M.R.; Serruys P.W.; Escaned J.; Davies J.E.
Institution
(Kim) Division of Cardiology, Department of Internal Medicine, VHS Medical
Center, Seoul, South Korea
(Koo) Division of Cardiology, Department of Internal Medicine, Seoul
National University Hospital, Seoul National University, Seoul, South
Korea
(Koo) Institute on Aging, Seoul National University, Seoul, South Korea
(Dehbi) Cancer Research UK and University College London Cancer Trials
Centre, University College London, London, United Kingdom
(Lee) Division of Cardiology, Department of Internal Medicine, Heart
Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, South Korea
(Doh) Department of Medicine, Inje University Ilsan Paik Hospital,
Daehwa-dong, South Korea
(Nam) Department of Medicine, Keimyung University Dongsan Medical Center,
Daegu, South Korea
(Shin) Division of Cardiology, Department of Internal Medicine, Ulsan
Medical Center, Ulsan Hospital, Ulsan, South Korea
(Cook, Al-Lamee, Petraco, Sen, Malik, Nijjer, Serruys, Davies) Hammersmith
Hospital, Imperial College London, London, United Kingdom
(Mejia-Renteria, Escaned) Hospital Clinico San Carlos, Instituto de
Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid,
Madrid, Spain
(Alegria-Barrero) Hospital Universitario de Torrejon, Universidad
Francisco de Vitoria, Madrid, Spain
(Alghamdi) King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi
Arabia
(Altman) Colorado Heart and Vascular, Lakewood, CO, United States
(Baptista) Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
(Bhindi) Royal North Shore Hospital, Sydney, Australia
(Bojara) Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz,
Germany
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
(Silva) Hospital Santa Maria, Lisbon, Portugal
(Di Mario) Royal Brompton Hospital, Imperial College London, London,
United Kingdom
(Di Mario) University of Florence, Florence, Italy
(Erglis) Pauls Stradins Clinical University Hospital, Riga, Latvia
(Gerber) Conquest Hospital, St Leonards-on-Sea, United Kingdom
(Going) Sana Klinikum Lichtenberg, Lichtenberg, Germany
(Harle) Klinikum Oldenburg, European Medical School, Carl von Ossietzky
University, Oldenburg, Germany
(Hellig) Sunninghill Hospital, Johannesburg, South Africa
(Indolfi) University Magna Graecia, Catanzaro, Italy
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Jeremias) Stony Brook University Medical Center, New York, NY, United
States
(Kharbanda) John Radcliffe Hospital, Oxford University Hospitals
Foundation Trust, Oxford, United Kingdom
(Khashaba) Ain Shams University, Cairo, Egypt
(Kikuta) Fukuyama Cardiovascular Hospital, Fukuyama, Japan
(Krackhardt) Charite Campus Virchow Klinikum, Universitaetsmedizin,
Berlin, Germany
(Laine) Helsinki University Hospital, Helsinki, Finland
(Lehman) Flinders University, Adelaide, Australia
(Matsuo) Gifu Heart Center, Gifu, Japan
(Meuwissen) Amphia Hospital, Breda, Netherlands
(Niccoli) Catholic University of the Sacred Heart, Rome, Italy
(Piek) AMC Heart Center, Academic Medical Center, Amsterdam, Netherlands
(Ribichini) University Hospital Verona, Verona, Italy
(Samady) Emory University, Atlanta, Georgia
(Sapontis) MonashHeart, Monash University, Melbourne, Australia
(Seto) Veterans Affairs Long Beach Healthcare System, Long Beach, CA,
United States
(Sezer) Istanbul University, Istanbul Faculty of Medicine, Istanbul,
Turkey
(Sharp) Royal Devon and Exeter Hospital, University of Exeter, Exeter,
United Kingdom
(Singh) Washington University School of Medicine in St. Louis, St. Louis,
MO, United States
(Takashima) Aichi Medical University Hospital, Aichi, Japan
(Talwar) Royal Bournemouth General Hospital, Bournemouth, United Kingdom
(Tanaka) Tokyo Medical University, Tokyo, Japan
(Tang) Essex Cardiothoracic Centre, Basildon, United Kingdom
(Tang) Anglia Ruskin University, Chelmsford, United Kingdom
(Van Belle) Institut Coeur Poumon, Lille University Hospital, Lille,
France
(Van Belle) UMR INSERM 1011, Centre Hospitalier Universitaire de Lille et
de Institut Pasteur de Lille, Universite de Lille, Lille, France
(van Royen) VU University Medical Center, Amsterdam, Netherlands
(Vinhas) Hospital Garcia de Horta, Lisbon, Portugal
(Vrints) Antwerp University Hospital, Antwerp, Belgium
(Walters) Prince Charles Hospital, Brisbane, Australia
(Yokoi) Fukuoka Sannou Hospital, Fukuoka, Japan
(Samuels) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Buller) St. Michaels Hospital, Toronto, Canada
(Patel) Duke University, Durham, Norh Carolina, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to evaluate sex differences in procedural
characteristics and clinical outcomes of instantaneous wave-free ratio
(iFR)- and fractional flow reserve (FFR)-guided revascularization
strategies. Background(s): An iFR-guided strategy has shown a lower
revascularization rate than an FFR-guided strategy, without differences in
clinical outcomes. Method(s): This is a post hoc analysis of the
DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to
guide Revascularization) study, in which 601 women and 1,891 men were
randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year
major adverse cardiac events (MACE), a composite of all-cause death,
nonfatal myocardial infarction, or unplanned revascularization.
 Result(s): Among the entire population, women had a lower number of
functionally significant lesions per patient (0.31 +/- 0.51 vs. 0.43 +/-
0.59; p < 0.001) and less frequently underwent revascularization than men
(42.1% vs. 53.1%; p < 0.001). There was no difference in mean iFR value
according to sex (0.91 +/- 0.09 vs. 0.91 +/- 0.10; p = 0.442). However,
the mean FFR value was lower in men than in women (0.83 +/- 0.09 vs. 0.85
+/- 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a
higher rate of revascularization than an iFR-guided strategy (57.1% vs.
49.3%; p = 0.001), but this difference was not observed in women (41.4%
vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR-
and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard
ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men
(6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66
to 1.46; p = 0.919). Conclusion(s): An FFR-guided strategy was
associated with a higher rate of revascularization than iFR-guided
strategy in men, but not in women. However, iFR- and FFR-guided strategies
showed comparable clinical outcomes, regardless of sex. (Functional Lesion
Assessment of Intermediate Stenosis to guide Revascularization
[DEFINE-FLAIR]; NCT02053038) Copyright © 2019 American College of
Cardiology Foundation

<138>
Accession Number
2002889106
Title
The Effect of CYP2C19 and Nongenetic Factors on Clopidogrel Responsiveness
in the MENA Region: A Systematic Review.
Source
Clinical and Applied Thrombosis/Hemostasis. 25 (no pagination), 2019. Date
of Publication: 2019.
Author
Ali Z.; Elewa H.
Institution
(Ali, Elewa) College of Pharmacy, Qatar University, Doha, Qatar
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Clopidogrel is the cornerstone antiplatelet used in the treatment and
prevention of thrombotic events. Some studies examined the effect of
CYP2C19 polymorphism and nongenetic factors on clopidogrel response in the
Middle East and North Africa (MENA) region. However, the consistency among
these studies is yet unknown. This study aims to estimate the prevalence
of CYP2C19 genetic variants in MENA region and to evaluate the effect of
these variants as well as the nongenetic factors on clopidogrel
responsiveness. A systematic literature search was performed to identify
relevant articles. Only observational studies were included. A total of 20
studies in 8 different populations were included. The CYP2C19*2 variant is
the most prevalent loss-of-function (LOF) allele in the MENA region
(1.7%-35%). The frequency of CYP2C19*17 ranged from 5.3% to 26.9%. Of the
9 studies, 6 found an association between carriers of at least 1 LOF
allele and clopidogrel resistance. Older age, high body mass index,
females, and the use of calcium channel blockers were associated with
clopidogrel resistance as well. Association between the CYP2C19*2 allele
and clopidogrel resistance is common among MENA populations. Future
studies should focus on having larger sample sizes to detect other minor
variant alleles and their effect on bleeding and cardiovascular
outcomes. Copyright © The Author(s) 2019.

<139>
Accession Number
2003319010
Title
Long-term health-related quality of life of adult patients treated with
extracorporeal membrane oxygenation (ECMO): An integrative review.
Source
Heart and Lung. 48 (6) (pp 538-552), 2019. Date of Publication: November -
December 2019.
Author
Knudson K.A.; Gustafson C.M.; Sadler L.S.; Whittemore R.; Redeker N.S.;
Andrews L.K.; Mangi A.; Funk M.
Institution
(Knudson, Sadler, Whittemore, Redeker, Andrews, Funk) Yale School of
Nursing, 400 West Campus Drive, Orange, CT 06477, United States
(Gustafson) Nell Hodgson Woodruff School of Nursing, Emory University,
1520 Clifton Rd NE, Atlanta, GA 30322, United States
(Mangi) Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Extracorporeal membrane oxygenation (ECMO), a rescue treatment
for patients with severe pulmonary and/or cardiac dysfunction, is
increasingly being used worldwide. A better understanding of long-term
health-related quality of life (HRQOL) is needed. Objective(s): To
synthesize research on long-term (at least 6 months post-ECMO) HRQOL of
adults treated with ECMO. Method(s): In this integrative review, we
searched 3 electronic databases and did a hand search of relevant journals
for articles published 2000-2019, according to the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
 Result(s): Thirty-one studies, representing 913 patients treated with
ECMO, were included. Long-term HRQOL was slightly better for patients
treated with veno-venous ECMO than veno-arterial ECMO, and mental health
outcomes tended to be better than physical ones. Survivors frequently
experienced physical complications, functional limitations, anxiety,
depression, and post-traumatic stress symptoms, although improvements were
observed over time. Conclusion(s): Early identification and
management of physical and mental health problems may improve HRQOL
outcomes. Copyright © 2019 Elsevier Inc.

<140>
Accession Number
624838456
Title
CT coronary angiography does not reduce mortality or myocardial infarction
in low-risk patients with acute chest pain.
Source
BMJ Evidence-Based Medicine. 24 (5) (pp E5), 2019. Date of Publication: 01
Oct 2019.
Author
Adamson P.D.; Than M.P.
Institution
(Adamson) BHF Centre for Cardiovascular Research, University of Edinburgh,
Edinburgh EH164SB, United Kingdom
(Adamson) Christchurch Heart Institute, University of Otago, Christchurch,
New Zealand
(Than) Emergency Department, Christchurch Hospital, Christchurch, New
Zealand
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)

<141>
Accession Number
2003346867
Title
Noninvasive Mapping of Premature Ventricular Contractions by Merging
Magnetocardiography and Computed Tomography.
Source
JACC: Clinical Electrophysiology. 5 (10) (pp 1144-1157), 2019. Date of
Publication: October 2019.
Author
Aita S.; Ogata K.; Yoshida K.; Inaba T.; Kosuge H.; Machino T.; Tsumagari
Y.; Hattori A.; Ito Y.; Komatsu Y.; Sekihara K.; Horigome H.; Aonuma K.;
Nogami A.; Kandori A.; Ieda M.
Institution
(Aita, Yoshida, Inaba, Kosuge, Machino, Tsumagari, Hattori, Ito, Komatsu,
Aonuma, Nogami, Ieda) Department of Cardiology, University of Tsukuba,
Tsukuba, Japan
(Ogata, Kandori) Research and Development Group, Hitachi Ltd., Kokubunji,
Japan
(Yoshida) Department of Cardiology, Ibaraki Prefectural Central Hospital,
Kasama, Japan
(Kosuge) Tsukuba Advanced Imaging Center, Tsukuba, Japan
(Sekihara) Signal Analysis Inc., Hachioji, Japan
(Horigome) Department of Pediatrics, University of Tsukuba, Tsukuba, Japan
Publisher
Elsevier Inc
Abstract
Objectives: This study aimed to develop a novel premature ventricular
contraction (PVC) mapping method to predict PVC origins in whole
ventricles by merging a magnetocardiography (MCG) image with a cardiac
computed tomography (CT) image. Background(s): MCG can noninvasively
discriminate PVCs originating from the aortic sinus cusp from those
originating from the right ventricular outflow tract. Method(s): This
study was composed of 22 candidates referred for catheter ablation of
idiopathic PVCs. MCG and CT were performed the same day before ablation.
Estimated origins by MCG-CT imaging using the recursive null steering
spatial filter algorithm were compared with origins determined by
electroanatomic mapping (CARTO, Biosense Webster, Inc., Diamond Bar,
California) during the ablation procedure. Radiopaque acrylic markers for
the CT scan and coil markers generating a weak magnetic field during MCG
measurements were used as reference markers to merge the 2 images
3-dimensionally. Result(s): PVC origins were determined by
endocardial and epicardial mapping and ablation results in 18 (86%)
patients (right ventricular outflow tract in 10 patients, aortic sinus
cusp in 2 patients, interventricular septum in 1 patient, near His bundle
in 1 patient, right ventricular free wall in 1 patient, and left
ventricular free wall in 3 patients). Estimated origins by MCG-CT imaging
matched the origins determined during the procedure in 94% (17 of 18) of
patients, whereas the electrocardiography algorithms were accurate in only
56% (10 of 18). Discrimination of an epicardium versus an endocardium or
right- versus left-sided septum was successful in 3 of 4 patients (75%).
 Conclusion(s): The diagnostic accuracy of noninvasive MCG-CT mapping
was high enough to allow clinical use to predict the site of PVC origins
in the whole ventricles. Copyright © 2019 The Authors

<142>
[Use Link to view the full text]
Accession Number
627432677
Title
Survival, Quality of Life, and Functional Status Following Prolonged ICU
Stay in Cardiac Surgical Patients: A Systematic Review.
Source
Critical Care Medicine. 47 (1) (pp E52-E63), 2019. Date of Publication: 01
Jan 2019.
Author
Trivedi V.; Bleeker H.; Kantor N.; Visintini S.; McIsaac D.I.; McDonald B.
Institution
(Trivedi, McIsaac, McDonald) Department of Anesthesiology and Pain
Medicine, University of Ottawa, Ottawa, ON, Canada
(Trivedi, Bleeker, Kantor, McIsaac, McDonald) Faculty of Medicine,
University of Ottawa, Ottawa, ON, Canada
(Trivedi, Visintini, McDonald) Division of Cardiac Anesthesiology,
University of Ottawa Heart Institute, Ottawa, ON, Canada
(McIsaac) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(McIsaac) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Compared with noncardiac critical illness, critically ill
postoperative cardiac surgical patients have different underlying
pathophysiologies, are exposed to different processes of care, and thus
may experience different outcome trajectories. Our objective was to
systematically review the outcomes of cardiac surgical patients requiring
prolonged intensive care with respect to survival, residential status,
functional recovery, and quality of life in both hospital and long-term
follow-up. Data Sources: MEDLINE, Embase, CINAHL, Web of Science, and
Dissertations and Theses Global up to July 21, 2017. Study Selection:
Studies were included if they assessed hospital or long-term survival
and/or patient-centered outcomes in adult patients with prolonged ICU
stays following major cardiac surgery. After screening 10,159 citations,
114 articles were reviewed in full; a final 34 articles met criteria for
data extraction. Data Extraction: Two reviewers independently
extracted data and assessed risk of bias using the National Institutes of
Health Quality Assessment Tool for Observational Studies. Extracted data
included the used definition of prolonged ICU stay, number and
characteristics of prolonged ICU stay patients, and any comparator short
stay group, length of follow-up, hospital and long-term survival,
residential status, patient-centered outcome measure used, and relevant
score. Data Synthesis: The definition of prolonged ICU stay varied
from 2 days to greater than 14 days. Twenty-eight studies observed greater
in-hospital mortality among all levels of prolonged ICU stay. Twenty-five
studies observed greater long-term mortality among all levels of prolonged
ICU stay. Multiple tools were used to assess patient-centered outcomes.
Long-term health-related quality of life and function was equivalent or
worse with prolonged ICU stay. Conclusion(s): We found consistent
evidence that patients with increases in ICU length of stay beyond 48
hours have significantly increasing risk of hospital and long-term
mortality. The significant heterogeneity in exposure and outcome
definitions leave us unable to precisely quantify the risk of prolonged
ICU stay on mortality and patient-centered outcomes. Copyright ©
2018 by the Society of Critical Care Medicine and Wolters Kluwer Health,
Inc. All Rights Reserved.

<143>
Accession Number
627827955
Title
Exclusion criteria and adverse events in perioperative trials of
tranexamic acid in cardiac surgery: a systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. 66 (10) (pp 1240-1250), 2019. Date of
Publication: 15 Oct 2019.
Author
Khair S.; Perelman I.; Yates J.; Taylor J.; Lampron J.; Tinmouth A.;
Saidenberg E.
Institution
(Khair, Perelman, Yates, Taylor, Lampron, Tinmouth, Saidenberg) Faculty of
Medicine, University of Ottawa, Ottawa, Canada
(Perelman, Lampron, Tinmouth, Saidenberg) Clinical Epidemiology, Ottawa
Hospital Research Institute, Ottawa, Canada
(Lampron, Tinmouth, Saidenberg) Ottawa Hospital, 501 Smyth Rd, Ottawa, ON
K1H 8L6, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Tranexamic acid (TXA) reduces perioperative blood loss and
transfusion requirement following cardiac surgery. Nevertheless, TXA
remains underutilized because of concerns regarding development of adverse
events. We conducted a systematic review to determine which patients are
commonly excluded from TXA cardiac surgery clinical trials to determine if
there are patient groups lacking safety data on TXA. Method(s): The
databases Medline, EMBASE, and the Cochrane Central Register of Controlled
Trials were searched until September 2017. Eligible studies were
randomized-controlled trials (RCTs) administering systemic TXA
perioperatively to patients undergoing any cardiac surgery. Our primary
outcome was the exclusion criteria for each RCT, and the secondary
endpoint was TXA safety. A descriptive synthesis was performed to analyze
the exclusion criteria. TXA safety was assessed with meta-analysis.
Principal findings: Seventy eligible RCTs were included. The most common
reasons for excluding patients from TXA cardiac surgery trials were major
hepatic, renal, or cardiac comorbidities (76% of studies). Meta-analysis
showed that TXA did not increase the risk of adverse events compared with
placebo or no intervention (risk ratio, 0.97; 95% confidence interval,
0.88 to 1.07), including thrombosis and seizure. Conclusion(s): We
found that systemic TXA is safe to use in cardiac surgery. Certain patient
groups are frequently excluded from TXA cardiac surgery trials, and may
consequently have limited efficacy and safety data on TXA. Further
research in these patient groups may be needed; nevertheless, for many
patient populations there are sufficient data to inform evidence-based
guidelines for TXA use in cardiac surgery. Trial registration: PROSPERO
(CRD42017060971); registered 4 April, 2017. Copyright © 2019,
Canadian Anesthesiologists' Society.

<144>
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.

<145>
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.

<146>
Accession Number
624533182
Title
Anaemia and mortality in patients with transcatheter aortic valve
replacement: a systematic review and meta-analysis.
Source
Acta Cardiologica. 74 (5) (pp 386-392), 2019. Date of Publication: 03 Sep
2019.
Author
Kanjanahattakij N.; Rattanawong P.; Krishnamoorthy P.; Sirinvaravong N.;
Chongsathidkiet P.; Lapumnuaypol K.; George J.C.; Witzke C.; Figueredo
V.M.
Institution
(Kanjanahattakij, Sirinvaravong, Lapumnuaypol) Department of Medicine,
Einstein Medical Center, Philadelphia, PA, United States
(Rattanawong) University of Hawaii Internal Medicine Residency Program,
Honolulu, HI, United States
(Krishnamoorthy, George, Witzke, Figueredo) Division of Cardiology,
Department of Medicine, Einstein Medical Center, Philadelphia, PA, United
States
(Chongsathidkiet) Department of Pathology, Duke University Medical Center,
Durham, NC, United States
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Objective: This study was done to determine the relationship between
pre-procedural anaemia and mortality post transcatheter aortic valve
replacement (TAVR). Introduction: TAVR is now a treatment option for
patients with severe aortic stenosis (AS) with high surgical risk. Anaemia
is a common comorbidity in the TAVR population. Small studies have
suggested that anaemia is associated with worse short-term and long-term
mortality in patients who underwent TAVR. However, there are no
meta-analyses to further assess this association. Method(s): Studies
were systematically searched from electronic databases (EMBASE and
MEDLINE). Inclusion criteria were adult population with aortic stenosis
who underwent TAVR, and number of patients with pre-procedural anaemia
reported. Outcomes were short-term mortality or long-term mortality.
Pooled effect size was calculated with a random-effect model, weighted for
the inverse of variance. Heterogeneity was assessed with I2.
 Result(s): Six studies were included in the final analysis. Of these,
pooled analysis of four studies examining association between anaemia and
30-day mortality did not show a statistically significant relationship. A
pooled analysis of four studies examining the association of anaemia and
long-term mortality after TAVR showed pooled adjusted risk ratio (RR) of
1.43, 95% CI 1.22-1.67 with low heterogeneity (I2 = 33%).
Subgroup analysis after exclusion of one smaller study showed that the
association remained significant (RR 1.41, 95% CI 1.27-1.56) with
decreased heterogeneity (I2 = 0%). Conclusion(s): This
systematic review and meta-analysis found an association between
pre-procedural anaemia and increased long-term but not short-term
mortality after TAVR. Further study of the pathophysiology underlying this
association is needed. Copyright © 2018, © 2018 Belgian
Society of Cardiology.

<147>
[Use Link to view the full text]
Accession Number
625733541
Title
Regional Analgesia Added to General Anesthesia Compared With General
Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: A
Systematic Review and Meta-analysis of Randomized Clinical Trials.
Source
Anesthesia and analgesia. 128 (1) (pp 130-136), 2019. Date of Publication:
01 Jan 2019.
Author
Monahan A.; Guay J.; Hajduk J.; Suresh S.
Institution
(Monahan, Hajduk, Suresh) From the Department of Pediatric Anesthesiology,
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, Mexico
(Guay) Department of Anesthesio logy and Critical Care, Faculty of
Medicine, Laval University, Quebec City, QC, Canada
(Guay) Department of Anesthesiology, Faculty of Medicine, QC, Canada
(Guay) Teaching and Research Unit, Health Sciences, University of Quebec
in Abitibi-Temiscamingue, QC, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this systematic review was to compare the effects
of regional analgesic (RA) techniques with systemic analgesia on
postoperative pain, nausea and vomiting, resources utilization,
reoperation, death, and complications of the analgesic techniques in
children undergoing cardiac surgery. METHOD(S): A search was done in
May 2018 in PubMed, Embase, and the Cochrane Central Register of
Controlled Trials for randomized controlled trials comparing RA techniques
with systemic analgesia. Risks of bias of included trials were judged with
the Cochrane tool. Data were analyzed with fixed- (I(2) < 25%) or
random-effects models (I(2) >= 25%). The quality of evidence was graded
according to the Grading of Recommendations Assessment, Development, and
Evaluation working group scale. RESULT(S): We included 14 randomized
controlled trials with 605 participants (312 to RA and 293 to the
comparator). RA reduces pain up to 24 hours after surgery. At 6-8 hours
after surgery, the standardized mean difference was -0.81 (95% confidence
interval [CI], -1.22 to -0.40; low-quality evidence). We did not find a
difference for nausea and vomiting (risk ratio [RR], 0.89; 95% CI,
0.61-1.31; very low-quality evidence), duration of tracheal intubation
(standardized mean difference, -0.18; 95% CI, -0.40 to 0.05; low-quality
evidence), intensive care unit length of stay (mean difference, -0.10
hours; 95% CI, -1.31 to 1.12 hours; low-quality evidence), hospital length
of stay (mean difference, -0.02 days; 95% CI, -1.16 to 1.12 days;
low-quality evidence), reoperation (RR, 0.76; 95% CI, 0.17-3.28;
low-quality evidence), death (RR, 0.50; 95% CI, 0.05-4.94; low-quality
evidence), and respiratory depression (RR, 2.06; 95% CI, 0.20-21.68; very
low-quality evidence). No trial reported signs of local anesthetic
toxicity or lasting neurological or infectious complications related to
the RA techniques. One trial reported 1 transient ipsilateral episode of
diaphragmatic paralysis with intrapleural analgesia that resolved with
cessation of local anesthetic administration. CONCLUSION(S): Compared
to systemic analgesia, RA techniques reduce postoperative pain up to 24
hours in children undergoing cardiac surgery. Currently, there is no
evidence that RA for pediatric cardiac surgery has any impact on major
morbidity and mortality. These results should be interpreted cautiously
because they represent a meta-analysis of small and heterogeneous studies.
Further studies are needed.

<148>
Accession Number
627842795
Title
Female-to-Male Transgender Chest Contouring: A Systematic Review of
Outcomes and Knowledge Gaps.
Source
Annals of plastic surgery. 83 (5) (pp 589-593), 2019. Date of Publication:
01 Nov 2019.
Author
Cohen W.A.; Shah N.R.; Iwanicki M.; Therattil P.J.; Keith J.D.
Institution
(Cohen) From the Division of Plastic and Reconstructive Surgery, Rutgers
New Jersey Medical School, Newark, United States
Publisher
NLM (Medline)
Abstract
PURPOSE: The number of gender affirmation surgeries performed in the
United States is increasing. Frequently, chest contouring is the first
surgery for female-to-male transgender patients; it fosters assimilation
into the new gender role with a desired sense of masculinity. Creating an
aesthetic male chest requires adjustment of breast tissue volume, proper
nipple-areolar complex placement, and abolishment of the inframammary
fold. Although much has been published on various techniques and outcomes,
there is no consensus on how to approach transmale top surgery. We have
reviewed the most up-to-date literature and in so doing have uncovered
significant knowledge gaps. METHOD(S): An electronic literature
review was performed. PubMed search keywords included combinations of
"female-to-male," "transgender surgery," "chest contour," and
"nipple-areolar complex." Articles were included if the patients were
transgender female to male. RESULT(S): Our literature search yielded
67 unique articles, 22 of which met our inclusion criteria. A total of
2447 unique patients were analyzed. The articles discussed aspects of
chest surgery in female-to-male transsexuals including mastectomy and
nipple aesthetics. Relevant data trends were extracted and subsequently
investigated. DISCUSSION: Female-to-male transgender patients often
undergo chest contouring as their initial gender affirmation surgery. As
the surgical treatment of gender dysphoria continues to grow, it is
imperative for plastic surgeons to understand the surgical options and
associated outcomes for transmasculine top surgery. Future research is
needed to improve patient selection, surgical decision making, and
patient-reported outcomes for different chest contouring techniques. In
addition, there is a significant knowledge gap for the ideal
nipple-areolar complex shape, size, and location.

<149>
Accession Number
629590598
Title
Systematic Review and Meta-Analysis of Interventional Emergency Treatment
of Decompensated Severe Aortic Stenosis.
Source
The Journal of invasive cardiology. (no pagination), 2019. Date of
Publication: 15 Oct 2019.
Author
Wernly B.; Jirak P.; Lichtenauer M.; Veulemans V.; Zeus T.; Piayda K.;
Hoppe U.C.; Lauten A.; Frerker C.; Jung C.
Institution
(Jung) University Hospital Dusseldorf, Department of Medicine, Division of
Cardiology, Pulmonary Diseases and Vascular Medicine, Germany
Publisher
NLM (Medline)
Abstract
AIMS: Patients in cardiogenic shock (CS) due to decompensated aortic
stenosis (AS) evidence poor prognosis. Both emergency transcatheter aortic
valve replacement (eTAVR) and emergency balloon aortic valvuloplasty
(eBAV) have been reported in CS patients. We aimed to summarize and
compare available studies on eBAV and eTAVR in patients suffering from CS
due to decompensated AS with regard to safety and efficacy. METHODS AND
RESULTS: Study-level data were analyzed. Heterogeneity was assessed using
the I2 statistic. Pooled proportions, ie, event rates, were calculated and
obtained using a random-effects model (DerSimonian and Laird). Eight
studies were found suitable for the final analysis, including 311
patients. Primary endpoint was mortality at 30 days. For eBAV (n = 238),
30-day mortality rate was 46.2% (95% confidence interval [CI],
30.3%-62.5%; I2=74%), major bleeding rate was 10% (95% CI, 5.4%-15.7%;
I2=13%), and stroke rate was 0.7% (95% CI, 0.0%-2.7%; I2=0%). Aortic
regurgitation (AR) >=II was present in 8.6% (95% CI, 0.4%-23.5%; I2=86%).
For eTAVR (n = 73), 30-day mortality rate was 22.6% (95% CI, 12.0%-35.2%;
I2=26%), major bleeding rate was 5.8% (95% CI, 0.5%-14.7%; I2=0%), and
stroke rate was 5.8% (95% CI, 0.5%-14.7%; I2=0%). AR >=II was present in
4% (95% CI, 0.0%-12.1%; I2=0%). CONCLUSION(S): Mortality in CS
patients due to decompensated severe AS is high, regardless of
interventional treatment strategy. Both eBAV and eTAVR seem feasible. As
eTAVR is associated with better initial improvements in hemodynamics and
simultaneously avoids sequential interventions, it might be favorable to
eBAV in select patients. If eTAVR is not available, eBAV might serve as a
"bridge" to elective TAVR.

<150>
Accession Number
629590208
Title
Rectal Diclofenac administration for prevention of post-Endoscopic
Retrograde Cholangio-Pancreatography (ERCP) acute pancreatitis. Randomized
prospective study.
Source
La Clinica terapeutica. 170 (5) (pp e332-e336), 2019. Date of Publication:
01 Sep 2019.
Author
Geraci G.; Palumbo V.D.; D'Orazio B.; Maffongelli A.; Fazzotta S.; Lo
Monte A.I.
Institution
(Geraci, Palumbo, D'Orazio, Maffongelli, Fazzotta, Lo Monte) University
Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and
Thoracic Surgery, Palermo, Italy
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Post-Endoscopic Retrograde Cholangio-Pancreatography
pancreatitis (PEP) is a relevant (1-4%) complication of biliopancreatic
operative endoscopy. Rectal nonsteroidal anti-inflammatory drugs
(specifically, 100 mg of diclofenac) have shown promising prophylactic
activity in PEP. The aim of our prospective study is to report whether
prophylactic oral versus rectal suppository versus intramuscular
diclofenac versus placebo are able to reduce the incidence and the
severity of ERCP-induced pancreatitis. MATERIALS AND METHODS: In this
randomized, double-blinded, prospective study, 100 patients (49 male, 51
female), similar with regard to indication for ERCP, were enrolled between
January 2016 and November 2017 to undergo ERCP in the Section of General
and Thoracic Surgery of University Hospital of Palermo. They were
randomized into five groups, respectively 20 patients with placebo by
mouth; 20 patients with 50 mg diclofenac sodium enteric-coated capsules by
mouth; 20 with 100 mg rectal suppository diclofenac, 20 with 75 mg/3 ml
intramuscular diclofenac sodium, 20 with 75 mg/3 ml intramuscular
diclofenac sodium and 20 with 75 mg/3 ml intravenous diclofenac. All drugs
were administered 30 to 90 minutes before ERCP. All clinical data were
collected one day before and 2, 12 and 24 hour after ERCP. RESULT(S):
Data were prospectively collected and to demonstrate the preventive effect
of rectal diclofenac on PEP, a two-by-two table and chi-square test with
Yates correction were used: the incidence of PEP was significantly lower
(p < 0.001) in the rectal diclofenac group respect to other groups and, in
the same way, the incidence of post-ERCP pain was significantly lower in
the rectal diclofenac group than in the other groups (p = 0.001) and
patients discharge was consequently earlier (p < 0.01).
 CONCLUSION(S): 100 mg dose rectal diclofenac administered 30-60
minutes before ERCP can effectively prevent PEP.

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