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<1>
Accession Number
2001676494
Title
In-hospital physiotherapy improves physical activity level after lung
cancer surgery: a randomized controlled trial.
Source
Physiotherapy (United Kingdom). 105 (4) (pp 434-441), 2019. Date of
Publication: December 2019.
Author
Jonsson M.; Hurtig-Wennlof A.; Ahlsson A.; Vidlund M.; Cao Y.; Westerdahl
E.
Institution
(Jonsson, Westerdahl) Department of Physiotherapy, Faculty of Medicine and
Health, Orebro University, Orebro SE-70182, Sweden
(Hurtig-Wennlof) School of Health Sciences, Department of Medical
Diagnostics, Faculty of Medicine and Health, Orebro University, Orebro
SE-70182, Sweden
(Ahlsson) Cardiovascular Division, Karolinska University Hospital,
Stockholm SE-17176, Sweden
(Vidlund) Department of Vascular and Cardiothoracic Surgery, Faculty of
Medicine and Health, Orebro University, Orebro SE-70182, Sweden
(Cao) Unit of Biostatistics, Institute of Environmental Medicine,
Karolinska Institutet, Stockholm SE-17177, Sweden
(Cao) Clinical Epidemiology and Biostatistics, School of Medical Sciences,
Orebro University, Orebro SE-70182, Sweden
Publisher
Elsevier Ltd
Abstract
Objectives: Patients undergoing lung cancer surgery are routinely offered
physiotherapy. Despite its routine use, effects on postoperative physical
recovery have yet not been demonstrated. The aim of this study was to
investigate whether physiotherapy could improve postoperative in-hospital
physical activity level and physical capacity. Design(s):
Single-blind randomized controlled trial. Setting(s): Thoracic
surgery department at a University Hospital. Participant(s): Patients
undergoing elective thoracic surgery (n = 94) for confirmed or suspected
lung cancer were assessed during hospital stay. Intervention(s):
Daily physiotherapy, consisting of mobilization, ambulation, shoulder
exercises and breathing exercises. The control group received no
physiotherapy treatment. Outcome(s): In-hospital physical activity
assessed with the Actigraph GT3X+ accelerometer, six-minute walk test,
spirometry and dyspnea scores. Result(s): The treatment group reached
significantly more accelerometer counts (2010 (1508) vs 1629 (1146), mean
difference 495 [95% CI 44 to 1109]), and steps per hour (49 (47) vs 37
(34), mean difference 14 [95% CI 3 to 30]), compared to the control group,
during the first three postoperative days. No significant differences in
six-minute walk test (percent of preoperative 71% vs 79%, P = 0.13),
spirometry (FEV1 percent of preoperative 69% vs 69%, P = 0.83) or dyspnoea
(M-MRC 2 vs 2, P = 0.74) between the groups were found.
 Conclusion(s): Patients receiving in-hospital physiotherapy showed
increased level of physical activity during the first days after lung
cancer surgery, compared to an untreated control group. However, no
effects on the six-minute walk test or spirometric values were found. The
clinical importance of an increased physical activity level during the
early postoperative period needs to be further evaluated. Clinical Trial
Registration number: NCT01961700. Copyright © 2018 The Authors

<2>
Accession Number
629785128
Title
Bronchial blocker versus double-lumen endobronchial tube in minimally
invasive cardiac surgery.
Source
BMC Pulmonary Medicine. 19 (1) (no pagination), 2019. Article Number: 207.
Date of Publication: 09 Nov 2019.
Author
Zhang C.; Yue J.; Li M.; Jiang W.; Pan Y.; Song Z.; Shi C.; Fan W.; Pan Z.
Institution
(Zhang, Yue, Li, Jiang, Song, Shi, Pan) Department of Anesthesiology,
Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan
District, Changchun,Jilin province 130041, China
(Pan) Yanbian University, Yanbian,Jilin province 130000, China
(Fan) Department of Intensive Care Unit, Second Hospital of Jilin
University, Changchun,Jilin province 130041, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: To compare the therapeutic value of a bronchial blocker (BB)
with a double-lumen tube (DLT) in minimally invasive cardiac surgery
(MICS). Method(s): Sixty patients who underwent MICS were randomized
to use either a DLT (Group D, n = 30) or a BB (Group B, n = 29; one failed
was omitted). The following data were collected: Time of intubation and
tube localization; incidence of tube displacement; postoperative sore
throat and hoarseness; time of cardiopulmonary bypass; maintenance time
for SpO<inf>2</inf> < 90% (PaCO<inf>2</inf> < 60 mmHg); mean arterial
pressure and heart rate; SpO<inf>2</inf>, PaO<inf>2</inf>,
PaCO<inf>2</inf>, EtCO<inf>2</inf>, mean airway pressure, and airway peak
pressure; surgeons' satisfaction with anesthesia; and short-term
complications. Result(s): The times of intubation and tube
localization were significantly longer in Group B than in Group D (P <
0.05). Patients in Group B exhibited significantly lower incidence of tube
displacement, postoperative sore throat, and hoarseness when compared with
patients in Group D (P < 0.05). Mean arterial pressure and heart rate were
significantly lower in Group B than in Group D after tracheal intubation
(P < 0.05). The mean airway pressure and airway peak pressure were
significantly lower in Group B than in Group D after one-lung ventilation
(P < 0.05). SpO<inf>2</inf> and PaO<inf>2</inf> in Group B were
significantly higher than in group D after cardiopulmonary bypass (P <
0.05). No short-term postoperative complications were observed in patients
of Groups B and D during 3 month follow-up. Conclusion(s): BB can be
a potential alternative to the conventional DLT for lung isolation in
MICS. Trial registration: ChiCTR1900024250, July 2, 2019. Copyright
© 2019 The Author(s).

<3>
Accession Number
627895167
Title
Is systematic lymph node dissection mandatory or is sampling adequate in
patients with stage I non-small-cell lung cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 550-554),
2019. Date of Publication: 2019.
Author
Mitsos S.; Panagiotopoulos N.; Patrini D.; George R.S.
Institution
(Mitsos, Panagiotopoulos, Patrini, George) Thoracic Surgery Department,
University College London Hospitals, NHS Foundation Trust, London, United
Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: Is systematic lymph node
dissection (SLND) mandatory or is sampling adequate in stage I
non-small-cell lung cancer (NSCLC)? Two hundred and eleven papers were
identified, of which 12 papers represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and the results of
these papers are tabulated. There are 7 retrospective cohort reviews, 3
meta-analyses and 2 randomized controlled clinical trials (RCTs) to answer
the clinical question. Four of the 7 retrospective studies demonstrated
that the total number of resected lymph nodes and the number of lymph node
stations sampled affected the accuracy of staging in patients with
early-stage NSCLC and had an impact on overall survival and disease-free
survival. Two RCTs, 1 meta-analysis and 1 cohort study revealed no
significant benefit in overall survival and disease-free survival in
patients undergoing SLND. One meta-analysis, which contained only 1 RCT,
revealed significantly better 3- and 5-year survival with SLND. One
further metaanalysis revealed improved survival with SLND in cohort
studies but no significant difference in the 4 RCTs included. Two further
studies identified specific subgroups of patients in whom LN sampling
could be justified and SLND avoided. We conclude that there is no
significant difference in the recurrence rate when performing either SLND
or LN sampling in patients with stage I NSCLC. While retrospective cohort
studies implied survival benefit with SLND, this was not borne out in RCTs
and meta-analyses. However, there may be a potential survival benefit for
patients who are upstaged by SLND identifying mediastinal nodal
involvement. Copyright © 2018 The Author.

<4>
Accession Number
623220176
Title
The HEART Pathway Randomized Controlled Trial One-year Outcomes.
Source
Academic Emergency Medicine. 26 (1) (pp 41-50), 2019. Date of Publication:
January 2019.
Author
Stopyra J.P.; Riley R.F.; Hiestand B.C.; Russell G.B.; Hoekstra J.W.;
Lefebvre C.W.; Nicks B.A.; Cline D.M.; Askew K.L.; Elliott S.B.;
Herrington D.M.; Burke G.L.; Miller C.D.; Mahler S.A.
Institution
(Stopyra, Hiestand, Hoekstra, Lefebvre, Nicks, Cline, Askew, Elliott,
Miller, Mahler) Department of Emergency Medicine, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Russell, Herrington) Department of Biostatistical Sciences, Wake Forest
School of Medicine, Winston-Salem, NC, United States
(Burke) Department of Internal Medicine, Division of Cardiology, Wake
Forest School of Medicine, Winston-Salem, NC, United States
(Burke) Public Health Sciences, Wake Forest School of Medicine,
Winston-Salem, NC, United States
(Mahler) Departments of Implementation Science and Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United
States
(Riley) The Christ Hospital Heart and Vascular Center and Lindner Center
for Research and Education, Cincinnati, OH, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The objective was to determine the impact of the HEART Pathway
on health care utilization and safety outcomes at 1 year in patients with
acute chest pain. Method(s): Adult emergency department (ED) patients
with chest pain (N = 282) were randomized to the HEART Pathway or usual
care. In the HEART Pathway arm, ED providers used the HEART score and
troponin measures (0 and 3 hours) to risk stratify patients. Usual care
was based on American College of Cardiology/American Heart Association
guidelines. Major adverse cardiac events (MACE-cardiac death, myocardial
infarction [MI], or coronary revascularization), objective testing (stress
testing or coronary angiography), and cardiac hospitalizations and ED
visits were assessed at 1 year. Randomization arm outcomes were compared
using Fisher's exact tests. Result(s): A total of 282 patients were
enrolled, with 141 randomized to each arm. MACE at 1 year occurred in
10.6% (30/282): 9.9% in the HEART Pathway arm (14/141; 10 MIs, four
revascularizations without MI) versus 11.3% in usual care (16/141; one
cardiac death, 13 MIs, two revascularizations without MI; p = 0.85). Among
low-risk HEART Pathway patients, 0% (0/66) had MACE, with a negative
predictive value (NPV) of 100% (95% confidence interval = 93%-100%).
Objective testing through 1 year occurred in 63.1% (89/141) of HEART
Pathway patients compared to 71.6% (101/141) in usual care (p = 0.16).
Nonindex cardiac-related hospitalizations and ED visits occurred in 14.9%
(21/141) and 21.3% (30/141) of patients in the HEART Pathway versus 10.6%
(15/141) and 16.3% (23/141) in usual care (p = 0.37, p = 0.36).
 Conclusion(s): The HEART Pathway had a 100% NPV for 1-year safety
outcomes (MACE) without increasing downstream hospitalizations or ED
visits. Reduction in 1-year objective testing was not
significant. Copyright © 2018 by the Society for Academic
Emergency Medicine

<5>
Accession Number
624844334
Title
Clinical efficacy of different side branch protection techniques on
patients receiving coronary intervention and prognostic analysis.
Source
European Review for Medical and Pharmacological Sciences. 22 (20) (pp
6977-6982), 2018. Date of Publication: 2018.
Author
Lai J.-X.; Mo Z.-Q.; Song A.-J.; Tan W.-F.
Institution
(Lai, Mo, Song, Tan) Department of Cardiovascular Medicine, Jiangmen
Central Hospital, Jiangmen, China
Publisher
Verduci Editore s.r.l (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: To investigate and analyze the clinical efficacy of different
side branch protection techniques on patients receiving coronary
intervention and the patient's prognosis. PATIENTS AND METHODS: A
total of 80 patients with coronary heart disease treated in Jiangmen
Central Hospital from January 2014 to January 2017 were collected.
According to different side branch protection strategies selected during
operation, they were divided into jailed wire technique (JWT) group
(n=20), jailed balloon technique (JBT) group (n=20), balloon-stent kissing
technique (BSKT) group (n=20), and BSKT+RW group (n=20). The relevant
operation parameters and the prevalence of adverse reactions at 1 month
and 6 months after operation were compared among the four groups.
 RESULT(S): The success rate of operation and relevant operation
parameters in BSKT+RW group were slightly superior to those in other three
groups, but there were no significant differences among the four groups
(p>0.05). Besides, the prevalence rates of adverse reactions at 1 month
and 6 months after the operation had no significant differences among the
four groups, but they were slightly lower in BSKT+RW group than those in
the other three groups. CONCLUSION(S): There are no significant
differences in the clinical efficacy and postoperative recovery of
patients receiving coronary intervention among the four kinds of different
side branch protection techniques. However, BSKT+RW is slightly superior
to the other three treatment methods, which, therefore, is a preferred
choice if the patient's economic conditions permit. Copyright ©
2018 Verduci Editore s.r.l. All rights reserved.

<6>
Accession Number
628544334
Title
Chinese Patients With Heart Valve Replacement Do Not Benefit From Warfarin
Pharmacogenetic Testing on Anticoagulation Outcomes.
Source
Therapeutic drug monitoring. 41 (6) (pp 748-754), 2019. Date of
Publication: 01 Dec 2019.
Author
Hao Y.; Yang J.; Zheng X.; Hu Y.; Yan X.; Zhang L.
Institution
(Hao, Yang, Yan, Zhang) Department of Clinical Laboratory, Wuhan Asia
Heart Hospital, Wuhan University
(Zheng, Hu) Laboratory of Molecular Cardiology, Wuhan Asia Heart Hospital,
Wuhan University, Wuhan, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Genotype-guided warfarin dosing has been shown in some
randomized trials to improve anticoagulation outcomes in individuals of
European ancestry; yet, its utility in Chinese patients with heart valve
replacement remains unresolved. METHOD(S): A total of 2264 patients
who underwent heart valve replacement at Wuhan Asia Heart Hospital were
enrolled in this study. Patients were randomly divided into 2 groups,
namely, a genotype-guided and a traditional clinically guided warfarin
dosing group. In the genotype-guided group (n = 1134), genotyping for
CYP2C9 and VKORC1 (-1639 G->A) was performed using TaqMan genotyping
assay. Warfarin doses were predicted with the International Warfarin
Pharmacogenetics Consortium algorithm. Patients in the control group (n =
1130) were clinically guided. The primary outcome was to compare the
incidence of adverse events (major bleeding and thrombotic) during a
90-day follow-up period between 2 groups. Secondary objectives were to
describe effects of the pharmacogenetic intervention on the first
therapeutic-target-achieving time, the stable maintenance dose, and the
hospitalization days. RESULT(S): A total of 2245 patients were
included in the analysis. Forty-nine events occurred during follow-up.
Genotype-guided dosing strategy did not result in a reduction in major
bleeding (0.26% versus 0.63%; hazard ratio, 0.44; 95% confidence interval,
0.13-1.53; P = 0.20) and thrombotic events (0.89% versus 1.61%; hazard
ratio, 0.56; 95% confidence interval, 0.27-1.17; P = 0.12) compared with
clinical dosing group. Compared with traditional dosing, patients in the
genotype-guided group reached their therapeutic international normalized
ratio in a shorter time (3.8 +/- 2.0 versus 4.4 +/- 2.0 days, P < 0.001).
There was no difference in hospitalization days (P = 0.28).
 CONCLUSION(S): Warfarin pharmacogenetic testing according to the
International Warfarin Pharmacogenetics Consortium algorithm cannot
improve anticoagulation outcomes in Chinese patients with heart valve
replacement.

<7>
Accession Number
2003476963
Title
Current state of leadless pacemakers: state of the art review.
Source
Expert Review of Cardiovascular Therapy. 17 (10) (pp 699-706), 2019. Date
of Publication: 03 Oct 2019.
Author
Afzal M.R.; Shah N.; Daoud G.; Houmsse M.
Institution
(Afzal, Daoud, Houmsse) Division of Cardiovascular Medicine, Wexner
Medical Center at the Ohio State University Medical Center, Columbus, OH,
United States
(Shah) Department of internal Medicine, St. Mary Mercy Hospital, Livonia,
MI, United States
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Leadless pacemakers (LPs) are the latest advancement in the
field of pacing. Experience from pivotal trials and post-marketing studies
has proven the feasibility and safety of these devices. The LPs obviate
the need of pulse generator pocket and leads, which translates into lower
incidence of lead related complications and pocket related infections.
This review will summarize the existing literature on the LPs,
specifically indications; implant procedure, unique situations and long-
term follow up. Areas covered: This review will summarize the results of
published pivotal trials. Several multicenter studies where LP was used in
the unique situations such as during concomitant AV node ablation and
across bioprosthetic valve will also be discussed. An extensive search
using PUBMED was performed to identify the relevant articles. Expert
commentary: The use of LPs is expanding and the published results a
preferential use of such devices for patients who need single ventricle
pacing. Additionally, the use of these devices in several unique
situations such as patients with inferior vena cava filters, bioprosthetic
tricuspid valves and concomitant atrio-ventricular nodal (AV) ablation has
also been shown to be safe. Copyright © 2019, © 2019 Informa
UK Limited, trading as Taylor & Francis Group.

<8>
Accession Number
2002016463
Title
Cardiopulmonary Bypass Priming with Hydroxyethyl Starch 6% 130/0.4 or
Sodium Chloride 0.9%: A Preliminary Double-Blind Randomized Controlled
Study in Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (12) (pp 3534-3535),
2019. Date of Publication: December 2019.
Author
Schweizer R.; Lameche M.; Coelembier C.; Portran P.; Fornier W.; Colombet
B.; Grinberg D.; Pozzi M.; Jacquet-Lagreze M.; Fellahi J.-L.
Institution
(Schweizer, Lameche, Coelembier, Portran, Fornier, Jacquet-Lagreze,
Fellahi) Service d'Anesthesie-Reanimation, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon, France
(Colombet) Service de Pharmacie Hospitaliere, Hopital Louis Pradel,
Hospices Civils de Lyon, Lyon, France
(Grinberg, Pozzi) Service de Chirurgie Cardiaque, Vasculaire et
Thoracique, Hopital Louis Pradel, Hospices Civils de Lyon, Lyon, France
(Fellahi) IHU OPERA Cardioprotection, Universite Claude Bernard Lyon 1,
Lyon, France
Publisher
W.B. Saunders

<9>
Accession Number
2003547838
Title
Keeping up to date: a current review of wearable cardioverter
defibrillator use.
Source
Acta Cardiologica. (no pagination), 2019. Date of Publication: 2019.
Author
Ashraf S.; Ilyas S.; Siddiqui F.; Ando T.; Shokr M.; Panaich S.;
Briasoulis A.; Afonso L.; Khan M.
Institution
(Ashraf, Siddiqui, Ando, Shokr, Panaich, Briasoulis, Afonso, Khan)
Division of Cardiology, Detroit Medical Center/Wayne State University,
Detroit, MI, United States
(Ilyas) Department of Medicine, The Warren Alpert Medical School of Brown
University, Providence, RI, United States
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
The introduction of wearable cardioverter defibrillators (WCD) provides a
novel means of protection in select patients at high risk for sudden
cardiac death. The WCD can safely record and terminate life-threatening
arrhythmias. In this review, we explore the data behind indications for
WCD use and discuss its limitations. We searched PubMed, Google Scholar
and Cochrane Central Register of controlled trials for relevant studies.
The VEST trial, the first randomised controlled trial on WCD use, did not
show statistical significance in utility of the WCD in post-myocardial
infarction patients with low ejection fraction. While the use of WCD in
this select patient population showed no benefit, the findings of the
trial merit closer inspection. Various other indications of WCD use still
exist and others require exploration. Select subsets of patients who stand
to benefit for other indications include severely decreased left
ventricular function post-revascularization with high arrhythmic burden,
severe non-ischaemic cardiomyopathy, patients awaiting heart transplant
and patients who have had their implantable cardioverter device
temporarily removed. The role of the WCD is also being explored in
children, peripartum cardiomyopathy, haemodialysis patients, and in
syncope secondary to high-risk arrhythmias. Copyright © 2019,
© 2019 Belgian Society of Cardiology.

<10>
Accession Number
628967248
Title
Clinical observation of modified gastric tube in middle and lower thoracic
esophageal carcinoma surgery.
Source
Journal of cardiothoracic surgery. 14 (1) (pp 146), 2019. Date of
Publication: 30 Jul 2019.
Author
Liu B.; Wang W.; Liang T.
Institution
(Liu, Wang, Liang) Department of Thoracic Surgery, First Affiliated
Hospital of Anhui University of Chinese Medicine, No.117 Meishan Road,
Hefei, Anhui 230031, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: A clinical case-control study was conducted to analyze the
short-term efficacy of modified gastric tube in surgery for middle (mid)-
and lower- thoracic esophageal carcinoma compared with the conventional
gastric tube and its effect on postoperative pulmonary function.
 METHOD(S): A total of 70 patients with mid- and lower-thoracic
esophageal cancer who underwent esophagectomy between October 2012 and
September 2018 in our hospital were recruited in the study. They were
randomly divided into a modified gastric tube group (n=35) and a
conventional gastric tube group (n=35). The operation time, intraoperative
blood loss, number of intraoperative lymph node dissection,
gastrointestinal decompression time and postoperative hospital stay were
recorded. The operation results and complications were recorded, and the
pulmonary function was recorded at 3days before surgery and 6weeks after
surgery. RESULT(S): The operation time in the modified gastric tube
group was significantly lower than that in the gastric tube group
(P<0.05). There were no anastomotic leakage or death occurred in the
modified gastric tube group. There was 1 case of anastomotic leakage in
the conventional gastric tube group. The pulmonary function in both groups
was improved at 6weeks after surgery, but there was no significant
difference between both groups (P>0.05). CONCLUSION(S): Modified
gastric tube has a good clinical application value compared with gastric
tube for patients with mid- and lower-thoracic esophageal cancer. It is
easy and safe, and can shorten the operation time without aggravation of
pulmonary function after surgery.

<11>
Accession Number
629871956
Title
Risk prediction models for survival after heart transplantation: A
systematic review.
Source
American journal of transplantation : official journal of the American
Society of Transplantation and the American Society of Transplant
Surgeons. (no pagination), 2019. Date of Publication: 15 Nov 2019.
Author
Aleksova N.; Alba A.C.; Molinero V.M.; Connolly K.; Orchanian-Cheff A.;
Badiwala M.; Ross H.J.; Duero Posada J.G.
Institution
(Aleksova, Alba, Molinero, Badiwala, Ross, Duero Posada) Peter Munk
Cardiac Centre, Toronto General Hospital-University Health Network,
Toronto, Canada
(Connolly) Hamilton Health Sciences, Hamilton, Canada
(Orchanian-Cheff) Library and Information Services, University Health
Network, Toronto, Canada
Publisher
NLM (Medline)
Abstract
Risk prediction scores have been developed to predict survival following
heart transplantation (HT). Our objective was to systematically review the
model characteristics and performance for all available scores that
predict survival after HT. Ovid Medline and Epub Ahead of Print and
In-Process & Other Non-Indexed Citations, Ovid Embase, Cochrane Database
of Systematic Reviews, and Cochrane Central Register of Controlled
Clinical Trials were searched to December 2018. Eligible articles reported
a score to predict mortality following HT. Of the 5392 studies screened,
21 studies were included that derived and/or validated 16 scores. Seven
(44%) scores were validated in external cohorts and 8 (50%) assessed model
performance. Overall model discrimination ranged from poor to moderate
(C-statistic/AUROC 0.54-0.77). The IMPACT score was the most widely
validated, was well calibrated in two large registries, and was best at
discriminating 3-month survival (C-statistic 0.76). Most scores did not
perform particularly well in any cohort in which they were assessed. This
review shows that there is insufficient data to recommend the use of one
model over the others for prediction of post-HT outcomes. Copyright
© 2019 The American Society of Transplantation and the American
Society of Transplant Surgeons.

<12>
Accession Number
629870732
Title
In vivo comparison of the optiflow and EZ glide aortic dispersion
cannulas.
Source
Journal of cardiac surgery. (no pagination), 2019. Date of Publication: 15
Nov 2019.
Author
Gennari M.; Rossi F.; Polvani G.; Bertera A.; Riva G.; Fave A.D.; Rassiga
C.; Agrifoglio M.
Institution
(Gennari, Rossi, Polvani, Bertera, Riva, Agrifoglio) Department of
Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
(Polvani, Agrifoglio) Department of Cardiovascular Sciences and Community
Health, University of Milan, Italy
(Fave) Department of Pathophysiology and Transplantation, University of
Milan, Italy
(Rassiga) Neurology Unit, ASST Santi Paolo e Carlo, Presidio San Paolo,
Milan, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Morbidity associated with coronary artery bypass grafts and
embolization during aortic cannulation is strongly related to patient
characteristics/comorbidities, arterial cannulation site used and the
shape of arterial cannulae tips. The desired features of an arterial
cannula should be to mitigate the morbid effects of these cannulas and to
focus on achieving higher blood flows with lower cannula pressures (CPs).
MATERIALS AND METHODS: To evaluate the in vivo performance of two aortic
dispersion flow cannulas: the Optiflow (Sorin Group, Italy) and EZ Glide
(Edwards Lifesciences). They were evaluated for CPs, pump-flow rates
(FRs), and plasma-free hemoglobin (Hb) over a 12-month period. Data were
collected in a prospective, randomized (1:1), nonblinded, monocentric
study with a cohort of 30 patients (optiflow group N=15; EZ Glide group
N=15). RESULT(S): The optiflow cannula was found to have decreasing
CPs as the pump FRs were increased (112.3+/-10.9 vs 131.1+/-11.4mmHg;
P<.001). Results indicated no significant differences between groups for
increases in plasma free Hb (P=.41) and total microembolic signals counts
during the period of cardiac surgery (P=.63). CONCLUSION(S): Both
optiflow and EZ Glide dispersion flow arterial cannulas performed well,
but the optiflow cannula demonstrated an ability to increase pump FRs with
lower arterial line and CPs than the EZ Glide cannula. This implies an
ability to improve peripheral perfusion while reducing cannula shear
stress and the risk of endothelial damage, thereby having the potential to
reduce the risk of atherosclerotic plaque dislodgement. Copyright
© 2019 Wiley Periodicals, Inc.

<13>
Accession Number
629870448
Title
Intraoperative graft flow profiles in coronary artery bypass surgery: A
meta-analysis.
Source
Journal of cardiac surgery. (no pagination), 2019. Date of Publication: 15
Nov 2019.
Author
Silva M.; Rong L.Q.; Naik A.; Rahouma M.; Hameed I.; Robinson B.; Ruan Y.;
Jiang Y.; Abed A.W.; Girardi L.N.; Gaudino M.
Institution
(Silva, Naik, Rahouma, Hameed, Robinson, Ruan, Jiang, Abed, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, NY
(Silva) Department of Cardiothoracic Surgery, Hospital Santa Marta -
CHULC, Lisbon, Portugal
(Rong) Department of Anesthesiology, Weill Cornell Medicine, NY
Publisher
NLM (Medline)
Abstract
BACKGROUND: Conduits used in coronary artery bypass artery grafting (CABG)
have different properties and flow profiles. We compared intraoperative
mean graft flow (MGF) between arterial and venous conduits, off-pump CABG
(OPCABG) and on-pump CABG (ONCABG) procedures, skeletonized and pedicled
internal mammary artery (IMA) grafts, and pulsatility index (PI) between
OPCABG and ONCABG, in pairwise meta-analyses. METHOD(S): Following a
systematic literature search, all studies comparing MGF in arterial and
venous grafts, were included. The primary endpoint was comparison of
pooled MGF between arterial and venous grafts. Secondary endpoints were
comparisons of pooled MGF in OPCABG vs ONCABG, anastomosed skeletonized vs
pedicled IMA grafts, free skeletonized vs pedicled IMA grafts and PI in
OPCABG versus ONCABG. RESULT(S): A total of 25 studies with 4443
patients were included. Compared with venous grafts, arterial grafts had
lower MGF (standardized mean difference [SMD], -0.28; 95% confidence
interval [CI, -0.34; -0.22]; P<.001). OPCABG was associated with
significantly lower MGF compared to ONCABG (SMD, -0.29; 95%CI, -0.50;
-0.08]; P=.01). No differences were found in MGF between skeletonized vs
pedicled IMA after anastomosis (SMD, 0.32; 95%CI [-0.08; 0.71]; P=.11) or
in free flow (SMD, 0.76; 95%CI [-0.14; 1.65]; P=.10). No difference was
found in PI between OPCABG and ONCABG. At meta-regression, age was
associated with higher MGF, while OPCABG was associated with lower MGF.
 CONCLUSION(S): Intraoperative flow of venous conduits is higher than
that of arterial grafts. Compared to OPCABG surgery, graft flow is higher
in ONCABG. In skeletonized and pedicled IMA conduits, no difference in
flow profiles was found. Copyright © 2019 Wiley Periodicals, Inc.

<14>
Accession Number
629869224
Title
Patient blood management (PBM) in pregnancy and childbirth: literature
review and expert opinion.
Source
Archives of gynecology and obstetrics. (no pagination), 2019. Date of
Publication: 14 Nov 2019.
Author
Surbek D.; Vial Y.; Girard T.; Breymann C.; Bencaiova G.A.; Baud D.;
Hornung R.; Taleghani B.M.; Hosli I.
Institution
(Surbek) Department of Obstetrics and Gynaecology, Bern University
Hospital, Insel Hospital, University of Bern, Bern 3010, Switzerland
(Vial, Baud) Service of Obstetrics, Department Woman-Mother-Child,
University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne,
Switzerland
(Girard) Department of Anaesthesiology, University Hospital Basel, Basel,
Switzerland
(Breymann) Obstetric Research-Feto Maternal Haematology Unit, University
Hospital Zurich, Zurich, Switzerland
(Bencaiova, Hosli) Clinic of Obstetrics and Gynaecology, University
Hospital Basel, Basel, Switzerland
(Hornung) Department of Obstetrics and Gynaecology, St. Gallen Cantonal
Hospital, St. Gallen, Switzerland
(Taleghani) Department of Haematology, Inselspital, University and
University Hospital Bern, Bern, Switzerland
Publisher
NLM (Medline)
Abstract
PURPOSE: Patient blood management [PBM] has been acknowledged and
successfully introduced in a wide range of medical specialities, where
blood transfusions are an important issue, including anaesthesiology,
orthopaedic surgery, cardiac surgery, or traumatology. Although pregnancy
and obstetrics have been recognized as a major field of potential
haemorrhage and necessity of blood transfusions, there is still little
awareness among obstetricians regarding the importance of PBM in this
area. This review, therefore, summarizes the importance of PBM in
obstetrics and the current evidence on this topic. METHOD(S): We
review the current literature and summarize the current evidence of PBM in
pregnant women and postpartum with a focus on postpartum haemorrhage (PPH)
using PubMed as literature source. The literature was reviewed and
analysed and conclusions were made by the Swiss PBM in obstetrics working
group of experts in a consensus meeting. RESULT(S): PBM comprises a
series of measures to maintain an adequate haemoglobin level, improve
haemostasis and reduce bleeding, aiming to improve patient outcomes.
Despite the fact that the WHO has recommended PBM early 2010, the majority
of hospitals are in need of guidelines to apply PBM in daily practice. PBM
demonstrated a reduction in morbidity, mortality, and costs for patients
undergoing surgery or medical interventions with a high bleeding
potential. All pregnant women have a significant risk for PPH. Risk
factors do exist; however, 60% of women who experience PPH do not have a
pre-existing risk factor. Patient blood management in obstetrics must,
therefore, not only be focused on women with identified risk factor for
PPH, but on all pregnant women. Due to the risk of PPH, which is inherent
to every pregnancy, PBM is of particular importance in obstetrics.
Although so far, there is no clear guideline how to implement PBM in
obstetrics, there are some simple, effective measures to reduce anaemia
and the necessity of transfusions in women giving birth and thereby
improving clinical outcome and avoiding complications. CONCLUSION(S):
PBM in obstetrics is based on three main pillars: diagnostic and/or
therapeutic interventions during pregnancy, during delivery and in the
postpartum phase. These three main pillars should be kept in mind by all
professionals taking care of pregnant women, including obstetricians,
general practitioners, midwifes, and anaesthesiologists, to improve
pregnancy outcome and optimize resources.

<15>
Accession Number
629869137
Title
The relationship between vitamin D and risk of atrial fibrillation: a
dose-response analysis of observational studies.
Source
Nutrition journal. 18 (1) (pp 73), 2019. Date of Publication: 14 Nov 2019.
Author
Liu X.; Wang W.; Tan Z.; Zhu X.; Liu M.; Wan R.; Hong K.
Institution
(Liu, Wang, Tan, Zhu, Liu, Wan, Hong) Cardiovascular Department, Second
Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006,
China
(Hong) Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The relationship between serum vitamin D and atrial
fibrillation (AF) or postoperative atrial fibrillation (POAF) in patients
undergoing coronary artery bypass graft (CABG) is still debated. It is
also unclear whether there is a dose-response relationship between
circulating vitamin D and the risk of AF or POAF. METHOD(S): The
Cochrane Library, PubMed, and Embase databases were searched for relevant
studies. We used a "one-stage approach" with a restricted cubic spline
model to summarize the dose-specific relationships between serum vitamin D
and AF. Relative risk (RR) was used to measure the effects in this
meta-analysis. RESULT(S): In total, 13 studies were included with a
total of 6519 cases of AF among 74,885 participants. Vitamin D deficiency
(<20ng/ml) was associated with increased risks of AF (RR: 1.23, 95% CI:
1.05-1.43). In the dose-response analysis, the summary RR for a 10ng/ml
increased in vitamin D was 0.88 (95% CI: 0.78-0.98) and there was no
evidence of a non-linear association, Pnon-linearity=0.86. In the age
subgroup, high vitamin D (per 10ng/ml increase) reduced the risk of AF in
the older group (>65years) (RR=0.68, 95% CI=0.52-0.89) but not among young
individuals (<65years) (RR=0.87, 95% CI=0.72-1.06). In addition, a strong
association was found between a 10ng/ml increased in vitamin D and POAF
incident in the patient after CABG (RR: 0.44, 95% CI: 0.24-0.82).
 CONCLUSION(S): Our dose-response meta-analysis suggested serum
vitamin D deficiency was associated with an increased risk of AF in the
general population and POAF in patients after CABG. Further studies are
needed to explore the age difference in the association between serum
vitamin D level and the risk of AF and whether vitamin D supplements will
prevent AF. TRIAL REGISTRATION: This study has been registered with
PROSPERO (International prospective register of systematic
reviews)-registration number-CRD42019119258.

<16>
Accession Number
2003538705
Title
Remote ischemic preconditioning and its role in the prevention of new
onset atrial fibrillation post-cardiac surgery. A meta-analysis of
randomized control trials.
Source
Journal of Arrhythmia. (no pagination), 2019. Date of Publication: 2019.
Author
Kumar A.; Singh H.; Shariff M.
Institution
(Kumar, Shariff) Department of Critical Care Medicine, St John's Medical
College Hospital, Bangalore, India
(Singh) Internist, Michigan Primary Care Partners, Rapids, MI, United
States
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Background: The denouement of remote ischemic preconditioning on new onset
atrial fibrillation (NOAF) post-cardiac surgery is not well-established.
An updated meta-analysis of randomized control trials was performed by
comparing remote ischemic preconditioning with controls and the outcome of
interest was NOAF. Method(s): The systemic review was performed in
accordance with the PRISMA (Preferred reporting items for systemic review)
and AHA (American Heart Association) guidelines. PubMed database was
searched to include relevant randomized control trials from inception to
July 2019. We used Mantel-Haenzsel method with random error model to
calculate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity
was assessed using the I2 test> 50% or chi2 P <.05.
Publication bias was visually assessed using a funnel plot.
 Result(s): Twelve randomized control trials were included in the
final analysis. Remote ischemic preconditioning did not alter the risk of
NOAF post-cardiac surgery [RR: 0.95, CI: 0.83-1.09, P =.48, I2
= 37%, chi2 P =.09]. Conclusion(s): In conclusion, the
present meta-analysis failed to provide any evidence for the beneficial
effect of remote ischemic preconditioning in the prevention of
NOAF. Copyright © 2019 The Authors. Journal of Arrhythmia
published by John Wiley & Sons Australia, Ltd on behalf of the Japanese
Heart Rhythm Society.

<17>
Accession Number
627895115
Title
Does the 'non-intubated' anaesthetic technique offer any advantage for
patients undergoing pulmonary lobectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 555-558),
2019. Date of Publication: 2019.
Author
Ali J.M.; Volpi S.; Kaul P.; Aresu G.
Institution
(Ali, Volpi, Kaul, Aresu) Department of Cardiothoracic Surgery, Royal
Papworth Hospital, Cambridge, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was: Do patients undergoing
pulmonary lobectomy using the non-intubated anaesthetic technique have
superior clinical outcomes? Altogether, 324 papers were found using the
reported search, of which 5 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. The nonintubated anaesthetic technique can be safely
used in patients undergoing video-assisted thoracic surgery lobectomy. Low
conversion rates to intubation are reported, and conversion has been
safely managed with no associated morbidity or mortality reported. The
technique has not been shown to impact on the incidence of postoperative
complications. However, studies consistently demonstrate improved
postoperative outcomes in terms of recovery from anaesthesia permitting
earlier oral intake and mobilization which is associated with a reduced
length of hospital stay. Copyright © The Author(s) 2018.

<18>
Accession Number
627895110
Title
Randomized evaluation of fibrinogen versus placebo in complex
cardiovascular surgery: Post hoc analysis and interpretation of phase III
results.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 566-574),
2019. Date of Publication: 2019.
Author
Rahe-Meyer N.; Levy J.H.; Mazer C.D.; Schramko A.; Klein A.A.; Brat R.;
Okita Y.; Ueda Y.; Schmidt D.S.; Gill R.
Institution
(Rahe-Meyer) Department of Anaesthesiology and Critical Care, Franziskus
Hospital, Bielefeld, Germany
(Levy) Department of Anesthesiology and Critical Care, Duke University
School of Medicine, Durham, NC, United States
(Mazer) Department of Anesthesia, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Schramko) Department of Anesthesiology, Intensive Care and Pain Medicine,
Helsinki University Hospital, Helsinki, Finland
(Klein) Department of Anaesthesia and Intensive Care, Papworth Hospital,
Cambridge, United Kingdom
(Brat) Department of Cardiac Surgery, Faculty of Medicine, University of
Ostrava, Ostrava, Czechia
(Okita) Department of Cardiovascular Surgery, Kobe University Hospital,
Kobe, Japan
(Ueda) Department of Cardiac Surgery, Nagoya University Graduate School of
Medicine, Nagoya, Japan
(Schmidt) CSL Behring, Marburg, Germany
(Gill) Department of Anaesthesia, University Hospital of Southampton,
Southampton, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: In a multicentre, randomized-controlled, phase III trial in
complex cardiovascular surgery (Randomized Evaluation of Fibrinogen vs
Placebo in Complex Cardiovascular Surgery: REPLACE), single-dose human
fibrinogen concentrate (FCH) was associated with the transfusion of
increased allogeneic blood products (ABPs) versus placebo. Post hoc
analyses were performed to identify possible reasons for this result.
 Method(s): We stratified REPLACE results by adherence to the
transfusion algorithm, pretreatment fibrinogen level (<=2 g/l vs >2 g/l)
and whether patients were among the first 3 treated at their centre.
 Result(s): Patients whose treatment was adherent with the transfusion
algorithm [FCH, n = 47 (60.3%); placebo, n = 57 (77.0%); P = 0.036]
received smaller quantities of ABPs than those with non-adherent treatment
(P < 0.001). Among treatment-adherent patients with pretreatment plasma
fibrinogen <=2 g/l, greater reduction in 5-min bleeding mass was seen with
FCH versus placebo (median -22.5 g vs -15.5 g; P = 0.071). Considering
patients with the above conditions and not among the first 3 treated at
their centre (FCH, n = 15; placebo, n = 22), FCH was associated with
trends towards reduced transfusion of ABPs (median 2.0 vs 4.0 units; P =
0.573) and greater reduction in 5-min bleeding mass (median -21.0 g vs
-9.5 g; P = 0.173). Differences from a preceding single-centre phase II
study with positive outcomes included more patients with pretreatment
fibrinogen >2 g/l and fewer patients undergoing thoracoabdominal aortic
aneurysm repair. Conclusion(s): None of the patient stratifications
provided a clear explanation for the lack of efficacy seen for FCH in the
REPLACE trial versus the positive phase II outcomes. However, together,
the 3 factors demonstrated trends favouring FCH. Less familiarity with the
protocol and procedures and unavoidable differences in the study
populations may explain the differences seen between the phase II study
and REPLACE. Copyright © The Author(s) 2018.

<19>
Accession Number
628354743
Title
The use of GLP-1 receptor agonists in hospitalised patients: An untapped
potential.
Source
Diabetes/Metabolism Research and Reviews. 35 (8) (no pagination), 2019.
Article Number: e3191. Date of Publication: 01 Nov 2019.
Author
Mustafa O.G.; Whyte M.B.
Institution
(Mustafa, Whyte) Department of Diabetes, King's College Hospital NHS
Foundation Trust, London, United Kingdom
(Whyte) Department of Clinical and Experimental Medicine, University of
Surrey, Guildford, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
In the outpatient setting, glucagon-like peptide-1 (GLP-1) receptor
agonists have proved to be highly efficacious drugs that provide glycaemic
control with a low risk of hypoglycaemia. These characteristics make GLP-1
receptor agonists attractive agents to treat dysglycaemia in perioperative
or high-dependency hospital settings, where glycaemic variability and
hyperglycaemia are associated with poor prognosis. GLP-1 also has a direct
action on the myocardium and vasculature-which may be advantageous in the
immediate aftermath of a vascular insult. This is a narrative review of
the work in this area. The aim was to determine the populations of
hospitalised patients being evaluated and the clinical and mechanistic
end-points tested, with the institution of GLP-1 therapy in hospital. We
searched the PubMed, Embase, and Google scholar databases, combining the
term "glucagon-like peptide 1" OR "GLP-1" OR "incretin" OR "liraglutide"
OR "exenatide" OR "lixisenatide" OR "dulaglutide" OR "albiglutide" AND
"inpatient" OR "hospital" OR "perioperative" OR "postoperative" OR
"surgery" OR "myocardial infarction" OR "stroke" OR "cerebrovascular
disease" OR "transient ischaemic attack" OR "ICU" OR "critical care" OR
"critical illness" OR "CCU" OR "coronary care unit." Pilot studies were
reported in the fields of acute stroke, cardiac resuscitation, coronary
care, and perioperative care that showed advantages for GLP-1 therapy,
with normalisation of glucose, lower glucose variability, and lower risk
of hypoglycaemia. Animal and human studies have reported improvements in
myocardial performance when given acutely after vascular insult or
surgery, but these have yet to be translated into randomised clinical
trials. Copyright © 2019 The Authors. Diabetes/Metabolism
Research and Reviews Published by John Wiley & Sons Ltd

<20>
Accession Number
629765236
Title
Cost-effectiveness of point-of-care viscoelastic haemostatic assays in the
management of bleeding during cardiac surgery: Protocol for a prospective
multicentre pragmatic study with stepped-wedge cluster randomised
controlled design and 1-year follow-up (the IMOTEC study).
Source
BMJ Open. 9 (11) (no pagination), 2019. Article Number: e029751. Date of
Publication: 01 Nov 2019.
Author
Rigal J.-C.; Boissier E.; Lakhal K.; Riche V.-P.; Durand-Zaleski I.; Rozec
B.
Institution
(Rigal, Lakhal, Rozec) Anesthesie et reanimation chirurgicale, Hopital
Guillaume et Rene Laennec, Centre Hospitalier Universitaire de Nantes,
Nantes Universite, Nantes, France
(Boissier) Laboratoire d'hematologie, Hopital Guillaume et Rene Laennec,
Centre Hospitalier Universitaire de Nantes, Nantes Universite, Nantes,
France
(Riche) Direction de la recherche, Centre Hospitalier Universitaire de
Nantes, Nantes Universite, Nantes, France
(Durand-Zaleski) URCECo Ile de France, Groupe hospitalier A.Chenevier,
Henri Mondor, AP-HP, Paris, France
(Durand-Zaleski) AP-HP Public Health, Henri Mondor Hospital,
ECEVE-UMR1123, INSERM and UPEC, Paris, France
(Rozec) L'institut du thorax, INSERM, CNRS, Nantes Universite, Nantes,
France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction During cardiac surgery-associated bleeding, the early
detection of coagulopathy is crucial. However, owing to time constraints
or lack of suitable laboratory tests, transfusion of haemostatic products
is often inappropriately triggered, either too late (exposing to prolonged
bleeding and thus to avoidable administration of blood products) or
blindly to the coagulation status (exposing to unnecessary haemostatic
products administration in patients with no coagulopathy). Undue
exposition to transfusion risks and additional healthcare costs may arise.
With the perspective of secondary care-related costs, the IMOTEC study
(Interet MedicO-economique de la Thrombo-Elastographie, dans le management
transfusionnel des hemorragies peri-operatoires de chirurgies Cardiaques
sous circulation extracorporelle) aims at assessing the cost-effectiveness
of a point-of-care viscoelastic haemostatic assay (VHA: RoTem or
TEG)-guided management of bleeding. Among several outcome measures,
particular emphasis will be put on quality of life with a 1-year
follow-up. Methods and analysis This is a multicentre, prospective,
pragmatic study with stepped-wedge cluster randomised controlled design.
Over a 36-month period (24 months of enrolment and 12 months of
follow-up), 1000 adult patients undergoing cardiac surgery with
cardiopulmonary bypass will be included if a periprocedural significant
bleeding occurs. The primary outcome is the cost-effectiveness of a
VHA-guided algorithm over a 1-year follow-up, including patients' quality
of life. Secondary outcomes are the cost-effectiveness of the VHA-guided
algorithm with regard to the rate of surgical reexploration and 1-year
mortality, its cost per-patient, its effectiveness with regard to
haemorrhagic, infectious, renal, neurological, cardiac, circulatory,
thrombotic, embolic complications, transfusion requirements, mechanical
ventilation free-days, duration of intensive care unit and in-hospital
stay and mortality. Ethics and dissemination The study was registered at
Clinicaltrials.gov and was approved by the Committee for the Protection of
Persons of Nantes University Hospital, The French Advisory Board on
Medical Research Data Processing and the French Personal Data Protection
Authority. A publication of the results in a peer-reviewed journal is
planned. Copyright © Author(s) (or their employer(s)) 2019.

<21>
Accession Number
2003235175
Title
Omega-3 polyunsaturated fatty acids and stroke burden.
Source
International Journal of Molecular Sciences. 20 (22) (no pagination),
2019. Article Number: 5549. Date of Publication: 02 Nov 2019.
Author
Ueno Y.; Miyamoto N.; Yamashiro K.; Tanaka R.; Hattori N.
Institution
(Ueno, Miyamoto, Yamashiro, Hattori) Department of Neurology, Juntendo
University, Faculty of Medicine, Tokyo 113-8421, Japan
(Tanaka) Stroke Center and Division of Neurology, Department of Medicine,
Jichi Medical University, Tochigi 329-0498, Japan
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Stroke is a major leading cause of death and disability worldwide. N-3
polyunsaturated fatty acids (PUFAs) including eicosapentaenoic acid and
docosahexaenoic acid have potent anti-inflammatory effects, reduce
platelet aggregation, and regress atherosclerotic plaques. Since the
discovery that the Greenland Eskimo population, whose diet is high in
marine n-3 PUFAs, have a lower incidence of coronary heart disease than
Western populations, numerous epidemiological studies to explore the
associations of dietary intakes of fish and n-3 PUFAs with cardiovascular
diseases, and large-scale clinical trials to identify the benefits of
treatment with n-3 PUFAs have been conducted. In most of these studies the
incidence and mortality of stroke were also evaluated mainly as secondary
endpoints. Thus, a systematic literature review regarding the association
of dietary intake of n-3 PUFAs with stroke in the epidemiological studies
and the treatment effects of n-3 PUFAs in the clinical trials was
conducted. Moreover, recent experimental studies were also reviewed to
explore the molecular mechanisms of the neuroprotective effects of n-3
PUFAs after stroke. Copyright © 2019 by the authors. Licensee
MDPI, Basel, Switzerland.

<22>
Accession Number
620617939
Title
Meta-analysis of sutureless technology versus standard aortic valve
replacement and transcatheter aortic valve replacement.
Source
European Journal of Cardio-thoracic Surgery. 53 (2) (pp 463-471), 2018.
Article Number: ezx307. Date of Publication: 01 Feb 2018.
Author
Qureshi S.H.; Boulemden A.; Szafranek A.; Vohra H.
Institution
(Qureshi, Boulemden, Szafranek) Department of Cardiac Surgery, Trent
Cardiac Centre, Nottingham University Hospital, City Campus, Nottingham,
United Kingdom
(Vohra) Department of Cardiac Surgery, Bristol Heart Institute, Bristol
Royal Infirmary, Bristol, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Aortic valve replacement (AVR) using sutureless technology is
a feasible alternative in surgical patients. Comparative evidence against
established strategies such as conventional AVR and transcatheter AVR is
lacking, limiting the assessment of safety and efficacy. METHOD(S):
Medline search for available evidence was undertaken. The outcomes
analysed were 30-day mortality, risk for stroke, myocardial infarction,
renal failure, paravalvular leak and need for permanent pacemaker. Odds
ratios were pooled using fixed- and randomeffect models. A trial
sequential analysis was undertaken to assess the statistical reliability
of cumulative evidence. RESULT(S): Twelve studies of moderate
methodological quality were included. Sutureless AVR was associated with
at least 30% reduction in 30-day mortality versus transcatheter AVR [odds
ratio (95% confidence interval) 0.40 (0.25, 0.62); P < 0.001] primarily in
the low- and intermediate-risk population and a similar reduction in the
risk for paravalvular leak [0.13 (0.09, 0.17); P < 0.001]. There was no
reduction in the risk for 30-day mortality versus conventional AVR [1.03
(0.56, 1.88); P = 0.93]. There was evidence in favour of conventional AVR
with at least 50% risk reduction in pacemaker implantation against
sutureless technology. There was absence of either benefit or harm
vis-a-vis risk for renal injury or stroke due to lack of required
information size. CONCLUSION(S): Current evidence suggests risk
reduction in 30-day mortality with sutureless AVR versus transcatheter AVR
but is inconclusive versus standard AVR in matched patients. Robust
randomized evidence is lacking to lend support to any potential
recommendation. Copyright © The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<23>
Accession Number
2001764620
Title
Is the era of bilateral internal thoracic artery grafting coming for
diabetic patients? An updated meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (6) (pp 1559-1570.e2),
2019. Date of Publication: December 2019.
Author
Zhou P.; Zhu P.; Nie Z.; Zheng S.
Institution
(Zhou, Zhu, Zheng) Department of Cardiovascular Surgery, Nanfang Hospital,
Southern Medical University, Guangzhou, Guangdong, China
(Nie) Department of Epidemiology, Guangdong Cardiovascular Institute,
Guangdong Provincial Key Laboratory of South China Structural Heart
Disease, Guangdong General Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Because of an increased risk of sternal wound complications,
the use of bilateral internal thoracic artery grafting in diabetic
patients remains controversial. The objective of the present meta-analysis
is to compare the safety and efficacy of single internal thoracic artery
and bilateral internal thoracic artery grafting in the diabetic
population. Method(s): Four electronic databases, including PubMed,
the Cochrane Library, Embase, and ISI Web of Knowledge, were
comprehensively searched. Prospective randomized trials or observational
studies comparing single internal thoracic artery and bilateral internal
thoracic artery were considered eligible for the current study.
 Result(s): A literature search yielded 1 randomized controlled trial
and 17 observational studies (129,871 diabetic patients: 124,233 single
internal thoracic arteries and 5638 bilateral internal thoracic arteries).
Pooled analysis demonstrated overall incidence of deep sternal wound
infection in the bilateral internal thoracic artery grafting group was
significantly higher than in the single internal thoracic artery grafting
group (3.26% for bilateral internal thoracic artery vs 1.70% for single
internal thoracic artery). No significant difference was found between
both groups in terms of risk of deep sternal wound infection when the
skeletonized harvesting technique was adopted. Furthermore, in-hospital
mortality was comparable between both groups (2.80% for bilateral internal
thoracic artery vs 2.36% for single internal thoracic artery). However,
compared with single internal thoracic artery grafting, bilateral internal
thoracic artery grafting could confer a lower risk for long-term overall
mortality (hazard ratio, 1.41; 95% confidence interval, 1.18-1.67; P
<.001; I2 = 63%) and cardiac mortality (hazard ratio, 3.15; 95%
confidence interval, 2.23-4.46; P <.001; I2 = 0%).
 Conclusion(s): Compared with single internal thoracic artery
grafting, bilateral internal thoracic artery grafting is associated with
enhanced long-term survival among diabetic patients. Skeletonization of
bilateral internal thoracic artery is not associated with an increased
risk of deep sternal wound infection. Therefore, surgeons should be
encouraged to adopt bilateral internal thoracic artery grafting in a
skeletonized manner more routinely in diabetic patients. Copyright
© 2019 The American Association for Thoracic Surgery

<24>
Accession Number
2002077425
Title
Could Short-Term Perioperative High-Dose Atorvastatin Offer Antiarrhythmic
and Cardio-Protective Effects in Rheumatic Valve Replacement Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (12) (pp 3340-3347),
2019. Date of Publication: December 2019.
Author
Allah E.A.; Kamel E.Z.; Osman H.M.; Abd-Elshafy S.K.; Nabil F.; Elmelegy
T.T.H.; Elkhayat H.; Ibrahim A.S.; Minshawy A.A.
Institution
(Allah, Kamel, Osman, Abd-Elshafy, Nabil, Ibrahim) Faculty of Medicine,
Assiut University, Assiut, Egypt
(Elmelegy) Clinical pathology department, Faculty of Medicine, Assiut
University, Assiut, Egypt
(Elkhayat, Minshawy) Cardiothoracic Surgery department, Faculty of
Medicine, Assiut, Egypt
Publisher
W.B. Saunders
Abstract
Objectives: To evaluate the role of prophylactic high-dose atorvastatin
for prevention of postoperative atrial fibrillation (POAF), inflammatory
response attenuation, and myocardial protection after valve replacement
cardiac surgery. Design(s): Randomized controlled trial.
 Setting(s): Assiut University Hospitals. Participant(s):
Sixty-four adult patients undergoing cardiac valve replacement surgery.
 Intervention(s): The participants were equally divided into 2 groups.
Group S received 80 mg of atorvastatin (oral tablets), 12 and 2 hours
preoperatively, and on the 2nd, 3rd, 4th, and 5th postoperative days.
Control group C received placebo at the same time periods. Measurements:
The incidence of POAF, postoperative white blood cell count, serum
C-reactive protein, interleukin 6, and troponin I. Main Result(s):
Group S patients showed a lower incidence of POAF compared with the
placebo group (p = 0.031). The white blood cell count showed significant
reductions in group S compared with group C on the second, third, fourth,
and fifth postoperative days. The C-reactive protein level showed
significant reductions on the third, fourth, and fifth postoperative days
in group S compared with group C (p = 0.001, 0.001, and 0.001,
respectively). The serum level of interleukin 6 showed a significant
reduction on the fifth postoperative day in group S compared with group C
(p = 0.001). There was no significant difference between the 2 groups
regarding the troponin I level and inotropic score. Conclusion(s):
Prophylactic use of high dose atorvastatin can decrease the incidence of
POAF and attenuate the inflammatory process in adult patients undergoing
isolated rheumatic cardiac valve replacement surgery. Copyright ©
2019 Elsevier Inc.

<25>
Accession Number
2002398580
Title
Addition of low-dose liraglutide to insulin therapy is useful for
glycaemic control during the peri-operative period: effect of
glucagon-like peptide-1 receptor agonist therapy on glycaemic control in
patients undergoing cardiac surgery (GLOLIA study).
Source
Diabetic Medicine. 36 (12) (pp 1621-1628), 2019. Date of Publication: 01
Dec 2019.
Author
Makino H.; Tanaka A.; Asakura K.; Koezuka R.; Tochiya M.; Ohata Y.;
Tamanaha T.; Son C.; Shimabara Y.; Fujita T.; Miyamoto Y.; Kobayashi J.;
Hosoda K.
Institution
(Makino, Tanaka, Koezuka, Tochiya, Ohata, Tamanaha, Son, Hosoda)
Department of Endocrinology and Metabolism, National Cerebral and
Cardiovascular Centre, Suita, Osaka, Japan
(Asakura) Department of, Data Science, National Cerebral and
Cardiovascular Centre, Suita, Osaka, Japan
(Shimabara, Fujita, Kobayashi) Department of, Adult Cardiac Surgery,
National Cerebral and Cardiovascular Centre, Suita, Osaka, Japan
(Miyamoto) Department of, Preventive Cardiology, National Cerebral and
Cardiovascular Centre, Suita, Osaka, Japan
Publisher
Blackwell Publishing Ltd
Abstract
Aim: To test the hypothesis that the addition of a glucagon-like peptide-1
receptor agonist that can decrease glucose levels without increasing the
hypoglycaemia risk will achieve appropriate glycaemic control during the
peri-operative period. Method(s): We studied 70 people with Type 2
diabetes who underwent elective cardiac surgery. Participants were
randomized to either an insulin-alone or an insulin plus liraglutide 0.6
mg/day group. We evaluated average M values, which indicated the proximity
index of the target glucose level from day 1 to day 10. Result(s):
The average M value in the liraglutide plus insulin group was
significantly lower than that in the insulin-alone group (liraglutide plus
insulin 5.8 vs insulin-alone 12.3; P < 0.001). The frequency of insulin
dose modification in the liraglutide plus insulin group was significantly
lower than that in the insulin-alone group (odds ratio 0.19, 95% CI
0.08-0.49; P < 0.001). The frequency of hypoglycaemia in the liraglutide
plus insulin group tended to be lower than that in the insulin-alone group
(odds ratio 0.57, 95% CI 0.15-2.23; P = 0.21). Conclusion(s): The
results of this study showed that the addition of low-dose liraglutide to
insulin achieved lower M values than insulin alone, suggesting that the
addition of low-dose liraglutide may achieve better glycaemic control
during the peri-operative period. (Clinical trials registry no.: UMIN
000008003). Copyright © 2019 Diabetes UK

<26>
Accession Number
2001926871
Title
Patient Blood Management for Neonates and Children Undergoing Cardiac
Surgery: 2019 NATA Guidelines.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (12) (pp 3249-3263),
2019. Date of Publication: December 2019.
Author
Faraoni D.; Meier J.; New H.V.; Van der Linden P.J.; Hunt B.J.
Institution
(Faraoni) Division of Cardiac Anesthesia, Department of Anesthesia and
Pain Medicine, The Hospital for Sick Children, University of Toronto,
Toronto, Canada
(Meier) Clinic of Anesthesiology and Critical Care Medicine, Kepler
University Clinic, Johannes Kepler University Linz, Linz, Austria
(New) NHS Blood and Transplant/Imperial College London, London, United
Kingdom
(Van der Linden) Department of Anesthesiology, Centre Hospital
Universitaire Brugmann, Hopital Universitaire Des Enfants Reine Fabiola,
Universite Libre de Bruxelles, Brussels, Belgium
(Hunt) Thrombosis & Haemophilia Centre, St Thomas' Hospital, London,
United Kingdom
Publisher
W.B. Saunders
Abstract
Pediatric cardiac surgery is associated with a substantial risk of
bleeding, frequently requiring the administration of allogeneic blood
products. Efforts to optimize preoperative hemoglobin, limit blood
sampling, improve hemostasis, reduce bleeding, correct coagulopathy, and
incorporate blood sparing techniques (including restrictive transfusion
practices) are key elements of patient blood management (PBM) programs,
and should be applied to the pediatric cardiac surgical population as
across other disciplines. Many guidelines for implementation of PBM in
adults undergoing cardiac surgery are available, but evidence regarding
the implementation of PBM in children is limited to systematic reviews and
specific guidelines for the pediatric cardiac population are missing. The
objective of the task force from the Network for the Advancement of
Patient Blood Management, Haemostasis and Thrombosis (NATA,
www.nataonline.com) is to provide evidence-based recommendations regarding
anemia management and blood transfusion practices in the perioperative
care of neonates and children undergoing cardiac surgery, and to highlight
potential areas where additional research is urgently
required. Copyright © 2019 Elsevier Inc.

<27>
Accession Number
629725159
Title
Prevalence and Impact of Treatment Crossover in Cardiac Surgery Randomized
Trials: A Meta-Epidemiologic Study.
Source
Journal of the American Heart Association. 8 (21) (pp e013711), 2019. Date
of Publication: 05 Nov 2019.
Author
Gaudino M.; Fremes S.E.; Ruel M.; Di Franco A.; Di Mauro M.; Chikwe J.;
Frati G.; Girardi L.N.; Taggart D.P.; Biondi-Zoccai G.
Institution
(Gaudino, Di Franco, Girardi) Department of Cardiothoracic Surgery Weill
Cornell Medicine New York NY
(Fremes) Schulich Heart Centre Division of Cardiac Surgery Department of
Surgery Sunnybrook Health Sciences Centre University of Toronto Ontario
Canada
(Ruel) University of Ottawa Heart Institute University of Ottawa Ontario
Canada
(Di Mauro) Heart Department SS Annunziata Hospital Chieti Italy
(Chikwe) Department of Cardiothoracic Surgery Stony Brook School of
Medicine New York NY
(Chikwe) Department of Cardiothoracic Surgery Mount Sinai Hospital New
York NY
(Frati, Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies Sapienza University of Rome Latina Italy
(Frati) Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.)
Neuromed Pozzilli Italy
(Taggart) Nuffield Department of Surgical Sciences University of Oxford
United Kingdom
(Biondi-Zoccai) Mediterranea Cardiocentro Napoli Italy
Publisher
NLM (Medline)
Abstract
Background Crossover dilutes treatment effect and reduces statistical
power of intention-to-treat analysis. We examined incidence and impact on
cardiac surgery randomized controlled trial (RCT) outcomes of crossover
from experimental to control interventions, or vice versa. Methods and
Results MEDLINE, EMBASE, and Cochrane Library were searched, and RCTs
(>=100 patients) comparing >=2 adult cardiac surgical interventions were
included. Crossover from the initial treatment assignment and relative
risks (RRs) for each trial's primary end point and mortality at longest
available follow-up were extracted. All RRs were calculated as >1 favored
control group and <1 favored experimental arm. Primary outcome was the
effect estimate for primary end point of each RCT, and secondary outcome
was all-cause mortality; both were appraised as RR at the longest
follow-up available. Sixty articles reporting on 47 RCTs (25 440 patients)
were identified. Median crossover rate from experimental to control group
was 7.0% (first quartile, 2.0%; third quartile, 9.7%), whereas from
control to experimental group, the rate was 1.3% (first quartile, 0%;
third quartile, 3.6%). RRs for primary end point and mortality were higher
in RCTs with higher crossover rate from experimental to control group (RR,
1.01 [95% CI, 0.94-1.07] versus RR, 0.80 [95% CI, 0.66-0.97] and RR, 1.02
[95% CI, 0.95-1.11] versus RR, 0.94 [95% CI, 0.82-1.07], respectively).
Crossover from control to experimental group did not alter effect
estimates for primary end point or mortality (RR, 0.82 [95% CI, 0.63-1.05]
versus RR, 0.95 [95% CI, 0.86-1.04] and RR, 0.88 [95% CI, 0.73-1.07]
versus RR, 1.02 [95% CI, 0.95-1.09], respectively). Conclusions Crossover
from experimental to control group is associated with outcomes of cardiac
surgery RCTs. Crossover should be minimized at designing stage and
carefully appraised after study completion.

<28>
Accession Number
629860125
Title
Upper vena cava syndrome on port catheter: About a case report and review
of literature.
Source
Cardiovascular Journal of Africa. Conference: 20th PanAfrican Course on
Interventional Cardiology, PAFCIC 2019. Tunisia. 30 (Supplement 1) (pp
137), 2019. Date of Publication: September 2019.
Author
Tarek S.; Mouna B.; Khadija S.; Chiraz L.; Ouerghi S.; Mestiri T.; Amine
J.; Adel M.
Institution
(Tarek, Mouna, Khadija, Chiraz, Amine, Adel) Department of Thoracic and
Cardiovascular Surgery, A.Mami Hospital, Ariana, Tunisia
(Ouerghi, Mestiri) Department of Anesthesiology, A. Mami Hospital, Ariana,
Tunisia
Publisher
Clinics Cardive Publishing (PTY)Ltd
Abstract
Introduction: The superior vena cava syndrome includes all the symptoms
resulting from an obstruction of venous return through the superior vena
cava. It is a rare entity that its iatrogenic origin is growing in the
last few years owing to the increasing use of intravascular devices. We
will look into the case of a 35 year old female hospitalized in our
cardiac surgery department with extended thromboses of a port catheter to
discuss the therapeutic options of this rare entity. Case presentation: We
report the case of a 35-year-old woman with a history of breast tumor
treated with neo-adjuvant chemotherapy via a right sub-clavicular venous
catheter port followed by a lumpectomy. She was admitted to our department
with an upper vena cava syndrome caused by a thrombosis extended from the
catheter of the superior vena cava to the right atrium. She was treated by
a thrombectomy under cardiopulmonary bypass. Conclusion(s): Upper
vena cava syndrome secondary to a port catheter thrombosis is a severe
complication in patients with neoplasm. The therapeutic strategy is based
on a multidisciplinary team decision and the surgical treatment remains
mandatory.

<29>
Accession Number
629862455
Title
Transcatheter Aortic Valve Replacement Influence on Coronary Hemodynamics:
A Quantitative Meta-Analysis and Proposed Decision-Making Algorithm.
Source
The Journal of invasive cardiology. (no pagination), 2019. Date of
Publication: 15 Nov 2019.
Author
Kotronias R.A.; Scarsini R.; Rajasundaram S.; De Maria G.L.; Ciofani J.L.;
Ribichini F.; Kharbanda R.K.; Banning A.P.
Institution
(Banning) Oxford Heart Centre, John Radcliffe Hospital, Headley Way,
Oxford, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: As transcatheter aortic valve replacement (TAVR) expands to
younger and lower-risk severe aortic stenosis patients, appropriate
coronary artery disease treatment is key to reducing long-term adverse
cardiovascular outcomes. Recently, studies have been exploring the role of
coronary-physiology guided revascularization strategies. Our aim was to
investigate whether TAVR influences coronary physiology measurements using
quantitative meta-analytic methods. METHOD(S): We performed a Medline
and Embase search for studies evaluating coronary physiology indices
before and after TAVR. Double independent screening and extractions of
baseline, procedural, angiographic, and echocardiographic data were
performed. Risk of bias was assessed using the ACROBAT-NRSI tool. Pooled
mean difference estimates of coronary hemodynamic indices before and after
TAVR were derived using random-effects models with the inverse variance
method (RevMan, Review Manager, version 5.3.5; Nordic Cochrane Centre).
 RESULT(S): Five studies evaluating 250 coronary vessels in 169 severe
aortic stenosis patients were quantitatively synthesized. Coronary flow
reserve did not change immediately after TAVR in non-diseased vessels (n =
3; mean difference, 0.11; 95% confidence interval [CI], -0.10-0.32; P=.29;
I2=0%; P=.68). Importantly, fractional flow reserve also did not vary
significantly following TAVR in both non-diseased (n = 3; mean difference,
-0.01; 95% CI, -0.04-0.03; P=.75; I2=41; P=.19) and diseased coronaries (n
= 3; mean difference, -0.01; 95% CI, -0.03-0.01; P=.49; I2=0%; P=.46).
Similarly, instantaneous wave-free ratio remained stable following TAVR (n
= 2; mean difference, 0.00; 95% CI, -0.02-0.02; P>.99; I2=0; P>.99.
 CONCLUSION(S): Pooled coronary physiology measurements before and
after TAVR are similar, but data on variation within individual lesions
are limited.

<30>
Accession Number
629861921
Title
Dexmedetomidine Reduces Atrial Fibrillation After Adult Cardiac Surgery: A
Meta-Analysis of Randomized Controlled Trials.
Source
American journal of cardiovascular drugs : drugs, devices, and other
interventions. (no pagination), 2019. Date of Publication: 14 Nov 2019.
Author
Liu Y.; Zhang L.; Wang S.; Lu F.; Zhen J.; Chen W.
Institution
(Liu, Wang, Lu, Zhen) Department of Intensive Care Unit, Beijing Shijitan
Hospital, Capital Medical University, No. 10 ,Tieyi Road, Beijing 100038,
China
(Zhang) Department of anesthesiology, Beijing Daxing Maternal and Child
Care Hospital, Beijing, China
(Chen) Department of Intensive Care Unit, Beijing Shijitan Hospital,
Capital Medical University, No. 10 ,Tieyi Road, Beijing 100038, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Dexmedetomidine has been shown to have antiarrhythmic effects
by exhibiting sympatholytic properties and activating the vagus nerve in
preclinical studies. Results from clinical trials of dexmedetomidine on
atrial fibrillation (AF) following adult cardiac surgery are
controversial. MATERIALS AND METHODS: We searched EMBASE, PubMed and
Cochrane CENTRAL databases for randomized controlled trials (RCTs)
comparing the antiarrhythmic effect of dexmedetomidine versus placebo or
other anesthetic drugs in adult patients undergoing cardiac surgery. The
primary outcome was the incidence of AF. The secondary outcomes were
ventricular arrhythmias [ventricular fibrillation (VF), ventricular
tachycardia (VT)], mechanical ventilation (MV) duration, intensive care
unit (ICU) length of stay, and hospital length of stay, and all-cause
mortality. RESULT(S): Thirteen trials with a total of 1684 study
patients were selected. Compared with controls, dexmedetomidine
significantly reduced the incidence of postoperative AF [odds ratio (OR)
0.75; 95% confidence interval (CI) 0.58-0.97; P = 0.03] and VT (OR 0.23;
95% CI 0.11-0.48; P < 0.0001). No significant difference for the incidence
of VF existed (OR 0.80; 95% CI 0.21-3.03; P = 0.74). There was no
significant difference between groups in MV duration [weighted mean
difference (WMD) -0.10; 95% CI -0.42 to 0.21; P = 0.52], postoperative ICU
stay (WMD -0.49; 95% CI -2.64 to 1.66; P = 0.65), hospital stay (WMD
-0.01; 95% CI -0.16 to 0.13; P = 0.88) and mortality (OR 0.59; 95% CI
0.15-2.37; P = 0.46). CONCLUSION(S): Perioperative administration of
dexmedetomidine in adult patients undergoing cardiac surgery reduced the
incidence of postoperative AF and VT. But there was no significant
difference in incidence of VF, MV duration, ICU stay, hospital stay and
mortality.

<31>
Accession Number
629848070
Title
Does tranexamic acid improve intra-operative visualisation in endoscopic
ear surgery? A double-blind, randomised, controlled trial.
Source
The Journal of laryngology and otology. (pp 1-5), 2019. Date of
Publication: 13 Nov 2019.
Author
Das A.; Mitra S.; Ghosh D.; Kumar S.; Sengupta A.
Institution
(Das, Mitra, Ghosh, Kumar, Sengupta) Department of Otorhinolaryngology and
Head Neck Surgery, Institute of Post-Graduate Medical Education and
Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To assess the effect of tranexamic acid on intra-operative
bleeding and surgical field visualisation. METHOD(S): Fifty patients
undergoing various endoscopic ear surgical procedures, including
endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy,
endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly
assigned to: a study group that received tranexamic acid or a control
group which received normal saline. The intra-operative bleeding and
operative field visualisation was graded using the Das and Mitra
endoscopic ear surgery bleeding and field visibility score, which was
separately analysed for the external auditory canal and the middle ear.
 RESULT(S): The Das and Mitra score was better (p < 0.05) in the group
that received tranexamic acid as a haemostat when working in the external
auditory canal; with respect to the middle ear, no statistically
significant difference was found between the two agents. Mean values for
mean arterial pressure, heart rate and surgical time were comparable in
both groups, with no statistically significant differences.
 CONCLUSION(S): Tranexamic acid appears to be an effective haemostat
in endoscopic ear surgery, thus improving surgical field visualisation,
especially during manipulation of the external auditory canal soft
tissues.

<32>
Accession Number
629848015
Title
Physiological Versus Angiographic Guidance for Myocardial
Revascularization in Patients Undergoing Transcatheter Aortic Valve
Implantation.
Source
Journal of the American Heart Association. 8 (22) (pp e012618), 2019. Date
of Publication: 19 Nov 2019.
Author
Lunardi M.; Scarsini R.; Venturi G.; Pesarini G.; Pighi M.; Gratta A.;
Gottin L.; Barbierato M.; Caprioglio F.; Piccoli A.; Ferrero V.; Ribichini
F.
Institution
(Lunardi, Scarsini, Venturi, Pesarini, Pighi, Gratta, Piccoli, Ferrero,
Ribichini) Division of Cardiology Department of Medicine University of
Verona Italy
(Gottin) Division of Anaesthesiology Department of Surgery University of
Verona Italy
(Barbierato, Caprioglio) Division of Cardiology Ospedale di Mestre Venezia
Italy
Publisher
NLM (Medline)
Abstract
Background Management of coronary artery disease in patients undergoing
transcatheter aortic valve implantation is uncertain. Fractional flow
reserve (FFR) has never been clinically validated in aortic stenosis. The
study aim was to analyze the clinical outcome of FFR-guided
revascularization in patients undergoing transcatheter aortic valve
implantation. Methods and Results Patients with severe aortic stenosis and
coronary artery disease at coronary angiography were included in this
retrospective analysis and divided in 2 groups: angiography guided
(122/216; 56.5%) versus FFR-guided revascularization (94/216; 43.5%).
Patients were clinically followed up and evaluated for the occurrence of
major adverse cardiac and cerebrovascular events at 2-year follow-up. Most
lesions in the FFR group resulted negative according to the conventional
0.80 cutoff value (111/142; 78.2%) and were deferred. The FFR-guided group
showed a better major adverse cardiac and cerebrovascular event-free
survival compared with the angio-guided group (92.6% versus 82.0%; hazard
ratio, 0.4; 95% CI, 0.2-1.0; P=0.035). Patients with deferred lesions
based on FFR presented better outcome compared with patients who underwent
angio-guided percutaneous coronary intervention (91.4% versus 68.1%;
hazard ratio, 0.3; 95% CI, 0.1-0.6; P=0.001). Conclusions FFR guidance was
associated with favorable outcome in this observational study in patients
undergoing transcatheter aortic valve implantation. Randomized trials are
needed to investigate the long-term effects of FFR-guided
revascularization against angiographic guidance alone in patients with
aortic stenosis.

<33>
Accession Number
2003605233
Title
Characterizing Patient-Centered Postoperative Recovery After Adult Cardiac
Surgery: A Systematic Review.
Source
Journal of the American Heart Association. 8 (21) (no pagination), 2019.
Article Number: e013546. 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, United States
(Mori, Angraal, Suter, Geirsson, Krumholz) Center for Outcomes Research
and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States
(Chaudhry) Section of General Internal Medicine, Department of Medicine,
Yale School of Medicine, New Haven, CT, United States
(Suter) Section of Rheumatology, Department of Medicine, Yale School of
Medicine, New Haven, CT, United States
(Suter) Section of Rheumatology, Department of Medicine, VA Medical
Center, West Haven, CT, United States
(Wallach) Department of Environmental Health Sciences, Yale School of
Public Health, New Haven, CT, United States
(Wallach) Collaboration for Research Integrity and Transparency (CRIT),
Yale School of Medicine, New Haven, CT, United States
(Krumholz) Section of Cardiovascular Medicine, Department of Internal
Medicine, Yale School of Medicine, New Haven, CT, United States
(Krumholz) Department of Health Policy and Management, Yale School of
Public Health, New Haven, CT, United States
Publisher
American Heart Association Inc.
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. Conclusion(s): 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. Copyright © 2019 The Authors. Published on
behalf of the American Heart Association, Inc., by Wiley.

<34>
Accession Number
2003605205
Title
Predictors of Late Mortality in D-Transposition of the Great Arteries
After Atrial Switch Repair: Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. 8 (21) (no pagination), 2019.
Article Number: e012932. Date of Publication: 05 Nov 2019.
Author
Venkatesh P.; Evans A.T.; Maw A.M.; Pashun R.A.; Patel A.; Kim L.; Feldman
D.; Minutello R.; Wong S.C.; Stribling J.C.; LaPar D.; Holzer R.; Ginns
J.; Bacha E.; Singh H.S.
Institution
(Venkatesh, Pashun, Patel, Kim, Feldman, Minutello, Wong, LaPar, Holzer,
Ginns, Bacha, Singh) Division of Cardiology, Departments of Medicine and
Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital,
Cornell Center for Adult Congenital Heart Disease, NY, United States
(Evans, Maw) Division of Hospital Medicine, Weill Cornell Medicine, New
York Presbyterian Hospital, NY, United States
(Stribling) Weill Cornell Medicine, Samuel J. Wood Library, Myra Mahon
Patient Resource Center, NY, United States
Publisher
American Heart Association Inc.
Abstract
Background: Existing data on predictors of late mortality and prevention
of sudden cardiac death after atrial switch repair surgery for
D-transposition of the great arteries (D-TGA) are heterogeneous and
limited by statistical power. Methods and Results: We conducted a
systematic review and meta-analysis of 29 observational studies,
comprising 5035 patients, that reported mortality after atrial switch
repair with a minimum follow-up of 10 years. We also examined 4 additional
studies comprising 105 patients who reported rates of implantable
cardioverter-defibrillator therapy in this population. Average survival
dropped to 65% at 40 years after atrial switch repair, with sudden cardiac
death accounting for 45% of all reported deaths. Mortality was
significantly lower in cohorts that were more recent and operated on
younger patients. Patient-level risk factors for late mortality were
history of supraventricular tachycardia (odds ratio [OR] 3.8, 95% CI
1.4-10.7), Mustard procedure compared with Senning (OR 2.9, 95% CI
1.9-4.5) and complex D-TGA compared with simple D-TGA (OR 4.4, 95% CI
2.2-8.8). Significant risk factors for sudden cardiac death were history
of supraventricular tachycardia (OR 4.7, 95% CI 2.2-9.8), Mustard
procedure (OR 2.2, 95% CI 1.1-4.1), and complex D-TGA (OR 5.7, 95% CI
1.8-18.0). Out of a total 124 implantable cardioverter-defibrillator
discharges over 330 patient-years in patients with implantable
cardioverter-defibrillators for primary prevention, only 8% were
appropriate. Conclusion(s): Patient-level risk of both mortality and
sudden cardiac death after atrial switch repair are significantly
increased by history of supraventricular tachycardia, Mustard procedure,
and complex D-TGA. This knowledge may help refine current selection
practices for primary prevention implantable cardioverter-defibrillator
implantation, given disproportionately high rates of inappropriate
discharges. Copyright © 2019 The Authors. Published on behalf of
the American Heart Association, Inc., by Wiley.

<35>
Accession Number
2003605196
Title
Pacemaker Implantation and Dependency After Transcatheter Aortic Valve
Replacement in the REPRISE III Trial.
Source
Journal of the American Heart Association. 8 (21) (no pagination), 2019.
Article Number: e012594. Date of Publication: 05 Nov 2019.
Author
Meduri C.U.; Kereiakes D.J.; Rajagopal V.; Makkar R.R.; O'Hair D.; Linke
A.; Waksman R.; Babliaros V.; Stoler R.C.; Mishkel G.J.; Rizik D.G.; Iyer
V.S.; Schindler J.; Allocco D.J.; Meredith I.T.; Feldman T.E.; Reardon
M.J.
Institution
(Meduri, Rajagopal) Piedmont Heart Institute, Atlanta, GA, United States
(Kereiakes) The Christ Hospital Heart and Vascular Center, The Lindner
Research Center, Cincinnati, OH, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(O'Hair) Aurora St. Luke's Medical Center, Milwaukee, WI, United States
(Linke) Dresden University Hospital, Heart Center Dresden, Germany
(Waksman) Washington Hospital Center, Washington, DC, United States
(Babliaros) Emory University Hospital, Emory University, Atlanta, GA,
United States
(Stoler) Baylor Heart & Vascular Hospital, Dallas, TX, United States
(Mishkel) St. John's Hospital, Springfield, IL, United States
(Rizik) HonorHealth and the Scottsdale-Lincoln Health Network, Scottsdale,
AZ, United States
(Iyer) University at Buffalo/Gates Vascular Institute, Buffalo, NY, United
States
(Schindler) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Allocco, Meredith) Boston Scientific Corp, Marlborough, MA, United States
(Feldman) Edwards Lifesciences, Irvine, CA, United States
(Feldman) Northshore University Health System, Evanston Hospital,
Evanston, IL, United States
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
Publisher
American Heart Association Inc.
Abstract
Background: As transcatheter aortic valve replacement expands to younger
and/or lower risk patients, the long-term consequences of permanent
pacemaker implantation are a concern. Pacemaker dependency and impact have
not been methodically assessed in transcatheter aortic valve replacement
trials. We report the incidence and predictors of pacemaker implantation
and pacemaker dependency after transcatheter aortic valve replacement with
the Lotus valve. Methods and Results: A total of 912 patients with
high/extreme surgical risk and symptomatic aortic stenosis were randomized
2:1 (Lotus:CoreValve) in REPRISE III (The Repositionable Percutaneous
Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve
System-Randomized Clinical Evaluation) trial. Systematic assessment of
pacemaker dependency was pre-specified in the trial design. Pacemaker
implantation within 30 days was more frequent with Lotus than CoreValve.
By multivariable analysis, predictors of pacemaker implantation included
baseline right bundle branch block and depth of implantation; diabetes
mellitus was also a predictor with Lotus. No association between new
pacemaker implantation and clinical outcomes was found. Pacemaker
dependency was dynamic (30 days: 43%; 1 year: 50%) and not consistent for
individual patients over time. Predictors of pacemaker dependency at 30
days included baseline right bundle branch block, female sex, and depth of
implantation. No differences in mortality or stroke were found between
patients who were pacemaker dependent or not at 30 days. Rehospitalization
was higher in patients who were not pacemaker dependent versus patients
without a pacemaker or those who were dependent. Conclusion(s):
Pacemaker implantation was not associated with adverse clinical outcomes.
Most patients with a new pacemaker at 30 days were not dependent at 1
year. Mortality and stroke were similar between patients with or without
pacemaker dependency and patients without a pacemaker. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov/. Unique identifier
NCT02202434. Copyright © 2019 The Authors. Published on behalf of
the American Heart Association, Inc., by Wiley.

<36>
Accession Number
2003605117
Title
Use and Outcomes Associated With Perioperative Amiodarone in Cardiac
Surgery.
Source
Journal of the American Heart Association. 8 (15) (no pagination), 2019.
Article Number: e009892. Date of Publication: 06 Aug 2019.
Author
Atreya A.R.; Priya A.; Pack Q.R.; Pekow P.S.; Stefan M.; Lagu T.; Lotfi
A.S.; Lindenauer P.K.
Institution
(Atreya) Section of Electrophysiology, Samuel and Jean Frankel
Cardiovascular Center, University of Michigan, Ann Arbor, United States
(Priya, Pack, Pekow, Stefan, Lagu, Lindenauer) Institute for Healthcare
Delivery and Population Science, University of Massachusetts Medical
School-Baystate, Springfield, MA, United States
(Pack, Stefan, Lagu, Lotfi, Lindenauer) Department of Medicine, University
of Massachusetts Medical School-Baystate, Springfield, MA, United States
(Pack, Lotfi) Division of Cardiology, University of Massachusetts Medical
School-Baystate, Springfield, MA, United States
(Priya, Pekow) School of Public Health and Health Sciences, University of
Massachusetts, Amherst, MA, United States
(Lindenauer) Department of Quantitative and Population Health Sciences,
University of Massachusetts Medical School, Worcester, MA, United Kingdom
Publisher
American Heart Association Inc.
Abstract
Background: In randomized controlled trials, perioperative administration
of amiodarone has been shown to reduce the incidence of postoperative
atrial arrhythmias and length of stay (LOS) among patients undergoing
coronary bypass surgery. However, little is known about the use or
effectiveness of perioperative amiodarone in routine clinical practice.
 Methods and Results: We studied patients >=18 years old without a
previous history of atrial or ventricular arrhythmias who underwent
elective coronary bypass surgery between 2013 and 2014 within a network of
235 US hospitals. Perioperative amiodarone was defined as receipt of
amiodarone either on the day of or the day preceding surgery. We used
covariate-adjusted modeling and instrumental variable methods to examine
the association between receipt of amiodarone and the development of
atrial arrhythmias, in-hospital mortality, readmission, LOS, and cost. Of
12 758 patients, 2195 (17.2%) received perioperative amiodarone, 3330
(26.1%) developed atrial arrhythmias postoperatively, and the average LOS
was 6.4 days (+/-2.6 days). Instrumental variable analysis showed that
receipt of perioperative amiodarone was associated with lower risk of
atrial arrhythmias (risk difference -11 percentage points, 95% CI -19 to
-4 percentage points; P=0.002) and a shorter LOS (-0.7 day, 95% CI -1.39
to -0.01 days; P=0.048). There was no association between receipt of
perioperative amiodarone and in-hospital mortality, cost, or readmission.
 Conclusion(s): Among patients undergoing coronary bypass surgery
without previous arrhythmias, perioperative amiodarone is associated with
a lower risk of atrial arrhythmias and shorter LOS. These findings are
consistent with previous randomized trials and lend support to current
guideline recommendations. Copyright © 2019 The Authors.
Published on behalf of the American Heart Association, Inc., by Wiley.

<37>
Accession Number
2003235762
Title
The use of modern telemedicine technologies in an innovative optimal
cardiac rehabilitation program for patients after myocardial
revascularization: Concept and design of restore, a randomized clinical
trial.
Source
Cardiology Journal. 26 (5) (pp 594-603), 2019. Date of Publication: 06 Nov
2019.
Author
Milewski K.; Malecki A.; Orszulik-Baron D.; Kachel M.; Hirnle P.; Orczyk
M.; Dunal R.; Mikolajowski G.; Janas A.; Nowak Z.; Kozak K.; Roskiewicz
W.; Nierwinska K.; Izworski A.; Rybicki A.; Buszman P.P.; Piotrowicz R.;
Buszman P.E.
Institution
(Milewski, Orszulik-Baron, Kachel, Hirnle, Orczyk, Janas, Buszman,
Buszman) Center for Cardiovascular Research and Development, American
Heart of Poland, Katowice, Poland
(Milewski, Malecki, Orczyk, Mikolajowski, Nowak, Nierwinska) The Jerzy
Kukuczka Academy of Physical Education, Katowice, Poland
(Buszman, Buszman) Andrzej Frycz Modrzewski KrakowUniversity, Faculty of
Medicine and Health Sciences, Krakow, Poland
(Dunal) Silvermedia, Krakow, Poland
(Kozak) Universitatsklinikum Carl Gustav Carus, Dresden, Germany
(Roskiewicz) Fraunhofer-Gesellschaft zur Forderung der Angewandten
Forschung e.V, Munchen, Germany
(Izworski) AGH University of Science and Technology, Krakow, Poland
(Rybicki) Uzdrowisko Ustron Health Resort, Poland
(Piotrowicz) Head of Department of Cardiac Rehabilitation and Noninvasive
Electrocardiology, National Institute of Cardiology, Warsaw, Poland
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Despite proven efficacy of cardiac rehabilitation (CR) in reducing the
all-cause mortality in patients after myocardial revascularization, the
penetration of CR, due to patient-related factors and referral rates
remains limited. To improve the outcomes, home-based tele-rehabilitation
(TR) has been proposed recently. In theory TR enhances the effects of
standard CR procedures due to implementation of an intelligent monitoring
system designed to ensure optimal training through on-demand transmission
of vital signs, aimed at motivating the patients through daily schedule
reminders, setting daily goals and creating a platform for mutual
feedback. Several meta-analyses assessing various studies comparing these
two methods (CR and TR) have proven that they are at least equally
effective, with some of the research showing superiority of TR. Although
there was a small sample size, lack of long-term follow-up, reporting
effects of TR itself, no integration with tools designed for coaching,
motivating and promoting a healthy lifestyle constitutes an important
limitation. The latter carries a hopeful prognosis for improvement when
utilizing a broad-spectrum approach, especially with use of dedicated
technological solutions exploiting the fact of a large and yet rapidly
increasing penetration of smartphones, mobile PCs and tablets in the
population. The above-mentioned findings worked as the basis and rationale
for commencing the RESTORE project aimed at developing and delivering
state-of-the-art, comprehensive TR for patients after myocardial
revascularization and evaluating its molecular aspect in view of how it
influences the atherosclerosis progression attenuation. This paper
presents the current state and rationale behind the project based on
up-to-date TR efficacy data. Copyright © 2019 Via Medica.

<38>
Accession Number
629808150
Title
Experiences of informal caregivers after cardiac surgery: A systematic
integrated review of qualitative and quantitative studies.
Source
BMJ Open. 9 (11) (no pagination), 2019. Article Number: e032751. Date of
Publication: 01 Nov 2019.
Author
Bjornnes A.K.; Moons P.; Parry M.; Halvorsen S.; Tonnessen T.; Lie I.
Institution
(Bjornnes) Department of Nursing and Health Promotion, Oslo Metropolitan
University, Oslo, Norway
(Moons) KU Leuven Department of Public Health and Primary Care, KU
Leuven-University, Leuven, Belgium
(Moons) Institute of Health and Care Sciences, University of Gothenburg,
Gothenburg, Sweden
(Parry) Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
Toronto, ON, Canada
(Halvorsen) Department of Cardiology, Division of Medicine, Oslo
University Hospital Ulleval, Oslo, Norway
(Halvorsen, Tonnessen) Institute of Clinical Medicine, Faculty of
Medicine, University of Oslo, Oslo, Norway
(Tonnessen, Lie) Department of Cardiothoracic Surgery, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital Ullevaal,
Oslo, Norway
(Lie) Center for Patient-centered Heart and Lung Research, Department of
Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases,
Oslo University Hospital, Oslo, Norway
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To provide a comprehensive synthesis of informal caregivers'
experiences of caring for a significant other following discharge from
cardiac surgery. Design Systematic integrated review without
meta-analysis. Data sources A bibliographic search for publications
indexed in six databases (Cochrane Library, CINAHL, MEDLINE, EMBASE, AMED
and PsycINFO), including a scan of grey literature sources (GreyNet
International, Google Scholar, Web of Science, WorldCat and the Clinical
Trials Registry) was conducted in October 2018. Eligibility criteria for
selecting studies Studies were included if they described views and
perspectives of informal caregivers of cardiac surgery patients
(non-intervention studies (qualitative and quantitative)), and the
effectiveness of interventions to evaluate support programme for informal
caregivers of cardiac surgery patients (intervention studies). Results Of
the 4912 articles identified in searches, 42 primary research studies were
included in a narrative synthesis with 5292 participants, including 3231
(62%) caregivers of whom 2557 (79%) were women. The median sample size
across studies was 96 (range 6-734). Three major themes emerged from the
qualitative study data: (1) caregiver information needs; (2) caregiver
work challenges and (3) caregivers adaption to recovery. Across the
observational studies (n=22), similar themes were found. The trend across
seven intervention studies focused on caregiver information needs related
to patient disease management and symptom monitoring, and support for
caregivers to reduce symptoms of emotional distress. Conclusion Informal
caregivers want to assist in the care of their significant others after
hospital discharge postcardiac surgery. However, caregivers feel insecure
and overwhelmed and they lack clear/concise discharge information and
follow-up support during the early at-home recovery period. The burden of
caregiving has been recognised and reported since the early 1990s, but
there remains a limited number of studies that assesses the effectiveness
of caregiver interventions. PROSPERO registration number
CRD42018096590. 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.

<39>
Accession Number
628797177
Title
Postoperative administration of tranexamic acid as approach to reduce
blood loss after open-heart surgery.
Source
Kardiovaskulare Medizin. Conference: Joint Annual Meeting 2019 of the
Swiss Society of Cardiology and the Swiss Society of Cardiac Surgery,
SSC-SSCS 2019. Switzerland. 22 (3) (no pagination), 2019. Date of
Publication: 2019.
Author
Meissner F.; Ploetze K.; Waldow T.
Institution
(Meissner, Ploetze, Waldow) Department of Cardiac Surgery, University
Heart Center Dresden, Dresden, Germany
(Meissner) Department of Cardiac Surgery, University Hospital Basel,
Basel, Switzerland
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Introduction: The administration of tranexamic acid (TXA) reduces blood
loss and transfusion requirements among patients undergoing open-heart
surgery. In contrast to its use before and during cardiopulmonary bypass,
the administration of TXA following open-heart surgery is scarcely
investigated. Furthermore, there are concerns about an increased risk of
thromboembolic events like my-ocardial infarction, stroke and acute kidney
injury. Method(s): In a retrospective cohort study at the University
Heart Center Dresden, patients who underwent elective or urgent on-pump
open-heart surgery and received regularly 1 g TXA before cardiopulmonary
bypass were included. Patients with postoperative administration of 1 g
TXA were compared to patients without. Primary endpoint was the
postoperative blood loss within 24 hours. Secondary endpoints included
transfusion requirements, reoperations, hospital mortality and adverse
events. Result(s): Among 2.179 patients undergoing open-heart surgery
at the University Heart Center Dresden between July 1, 2013 and October
31, 2014, 92 or 4.2% received TXA postoperatively. The logistic regression
revealed a highly significant correlation between postoperative blood loss
and use of TXA (p <0.00001). After coarsened exact and nearest neighbor
matching with replacement, 71 patients with postoperative administration
of TXA were compared to 71 without (n = 142). On the one hand,
postop-erative administration of TXA did not result in decreased blood
loss (MD 146.7 ml; p = 0.064), less red blood cell transfusions (RR 0.98
[0.77-1.24]; p >0.99) or lower risk for reoperation (RR 0.70 [0.38-1.27];
p = 0.325). On the other hand, there was no evidence of an increased risk
for thromboembolic complications like myocardial infarction (RR 1.00
[0.21-4.79]; p = 1.000), stroke (RR 1.00 [0.14-6.90]; p = 1.000), acute
kidney injury requiring dialysis (RR 1.00 [0.26-3.84]; p = 1.000) or
higher hospital mortality (RR 1.00 [0.26-3.84]; p = 1.000).
 Conclusion(s): The postoperative administration of TXA did neither
reduce blood loss nor transfusion requirements nor the rate of
reoperations. The use of TXA was shown to be safe in terms of
thromboembolic events and hospital mortality. It is recommended to carry
out a randomized controlled trial investigating the postoperative
administration of TXA. Unless there is no evidence, the postoperative use
of TXA should be restricted to patients with massive blood loss and signs
of hyperfibrinolysis only.

<40>
Accession Number
628796825
Title
10 versus 20 minutes treatment of human pericardium with glutaraldehyde in
OZAKI procedure.
Source
Kardiovaskulare Medizin. Conference: Joint Annual Meeting 2019 of the
Swiss Society of Cardiology and the Swiss Society of Cardiac Surgery,
SSC-SSCS 2019. Switzerland. 22 (3) (no pagination), 2019. Date of
Publication: 2019.
Author
Isu G.; Koechlin L.; Borisov V.; Eckstein F.S.; Marsano A.; Reuthebuch O.
Institution
(Isu) Department of Surgery and Biomedicine, University Hospital Basel,
Switzerland
(Koechlin, Borisov, Eckstein, Reuthebuch) Department of Surgery, Unispital
Basel, Basel, Switzerland
(Marsano) Department of Surgery and Biomedicine, Unispital Basel, Basel,
Switzerland
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Background: The aortic valve replacement/neocuspidiza-tion using
autologous pericardium (OZAKI technique) has gained popularity within the
last years. Before using the autologous pericardium to reconstruct the
valve, it is treated with glutaraldehyde (GA) for 10 minutes according the
Ozaki's original publication. However, it is unclear, if longer
intraoperative GA treatment (20 minutes) would enhance the pericardium
mechanical stability and strength. Method(s): After OZAKI valve
replacement, leftover pericardium in 6 patients (3 males and 3 females)
was bisected directly postoperatively and one half was treated for another
10 minutes (20 minutes in total). Strip samples of 25 x 5 mm2
were cut with randomized orientations to average the high tissue
anisotropy and used to evaluate the differences in strength and stability
performing standard uniaxial tensile tests (MTS Synergy). For each
specimen, thickness profiles were reconstructed and measured by in-house
developed image processing algorithms (Mat-lab 2017b, Mathworks) necessary
to calculate the resistant cross-section defined as the section at the
minimum thickness (width x minimum thickness). Thus, stress-strain curves
were elaborated and ultimate tensile strength (UTS), ultimate tensile
strain (uts) and collagen elastic modulus were calculated as engineering
stress at the minimum resistant cross-section. Two-tailed t-test was
performed to compare the two different experimental groups.
 Result(s): Uniaxial stretching generated elongations at rupture of 25
+/- 7% vs. 22 +/- 5% (10 vs. 20 min, p=0.05) corresponding to UTS values
reaching 5.16 +/- 2 and 6.54 +/- 3 MPa (p=0.59), respectively. The high
standard deviation values resulted from the highly anisotropy of the
tissue, which was averaged by randomizing sample orientation and from
gender differences (6.17 vs. 8.62 MPa, for males and 4.22 vs. 4.62 MPa for
females). Interestingly, the elastic modulus E representing the stiffness
properties of the collagen fibres showed similar values after treating the
pericardium for 10 or 20 mins with E values between 31.80 +/- 15.05 and
37.35 +/- 15.78 MPa (p=0.25,10 and 20 min, respectively).
 Conclusion(s): With this study we showed that doubling of fixation
time did not result in significantly different outcomes compared to the
operative procedure in regard to pericardium mechanical stability
quantified in terms of elastic modulus and ultimate tensile strength and
strain.

<41>
Accession Number
627649474
Title
Outcomes of percutaneous coronary interventions in cardiac transplantation
patients: A meta-analysis of 21 studies with 1031 patients.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 19 (10
Supplement 2) (pp e8), 2018. Date of Publication: 01 Oct 2018.
Author
Vadala P.; D'Ascenzo F.; Hammad S.; Omede P.; Montefusco A.; Barbero C.;
Conrotto F.; Moretti C.; Marra W.G.; Pidello S.; Rinaldi M.; Boffini M.;
Tobis J.; Benza R.; Tarantini G.; D'Amico M.
Institution
(Vadala, D'Ascenzo, Hammad, Omede, Montefusco, Barbero, Conrotto, Moretti,
Marra, Pidello, Rinaldi, Boffini, D'Amico) Division of Cardiology,
Department of Internal Medicine, Citta della Salute e della Scienza,
Torino, Italy
(Tobis) Division of Cardiology, UCLA Medical Center, Los Angeles, United
States
(Benza) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, United States
(Tarantini) Department of Cardiac, Thoracic, and Vascular Sciences,
University of Padova Medical Center, Padova, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction. Outcomes of patients with orthotopic heart transplantation
(OHT) undergoing percutaneous coronary intervention (PCI) remain to be
defined, especially according to kind of stent and to use of intracoronary
imaging. Methods. All studies evaluating the impact of PCI on OHT patients
were included. MACE, a composite and mutually exclusive end point of all
cause death, target lesion revascularization (TLR) and stent thrombosis
(ST) was the primary end point, while its components along with
cardiovascular death were the secondary ones Meta-regression analysis was
used to assess the impact of coronary stent medications (everolimus and
sirolimus), of IVUS, and of anti-reject drugs on TLR. Results. 21 studies
with 1031 patients were included, with a median time from OHT of 7.1 years
(6.5-8.7). Elective angiographic control was the most frequent indication
(65% of patients): multivessel disease was reported in 38.8% (28.9-39.0),
IVUS was used in 57% (29-80) and drug eluting stents (DES) were implanted
in 62.2% (53.5-10). After 1.3 years, MACE occurred in 39.4% of patients
(20.82-57.98), mainly driven by TLR (11.78% [5.57-17-98] for patients with
DES and 34.23% [22.21-46.25] for BMS), while ST occurred in 2.03%
[0.57-2.30]. At meta-regression, IVUS reduced TLR (-0.035:-0.045:-0.021),
while the type of antiproliferative drug coating the stents or the
adjunctive immunosuppressant therapy did not impact subsequent
revascularization. Conclusion. Patients with OHT undergoing PCI are at
high risk of recurrent revascularization, which are reduced by use of
intracoronary imaging and DES. Although DES is preferable to BMS in
preventing restenosis in OHT lesions, the type of antiproliferative drug
in the DES did not impact TLR. Further studies are needed to evaluate the
effectiveness of adjuvant immunosuppressant therapy.

<42>
Accession Number
2003128337
Title
Relation of Lipid-Lowering Therapy to Need for Aortic Valve Replacement in
Patients With Asymptomatic Mild to Moderate Aortic Stenosis.
Source
American Journal of Cardiology. 124 (11) (pp 1736-1740), 2019. Date of
Publication: 1 December 2019.
Author
Greve A.M.; Bang C.N.; Boman K.; Egstrup K.; Kesaniemi Y.A.; Ray S.;
Pedersen T.R.; Wachtell K.
Institution
(Greve) Department of Clinical Biochemistry, Rigshospitalet, Copenhagen,
Denmark
(Bang) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Boman) Department of Medicine, Institution of Public Health and Clinical
Medicine, Umea University, Skellefta, Sweden
(Egstrup) Medicinsk Afdeling, OUH Svendborg Sygehus, Denmark
(Kesaniemi) Department of Medicine, Institute of Clinical Medicine,
University of Oulu and Clinical Research Center, Oulu University Hospital,
Oulu, Finland
(Ray) Manchester Academic Health Sciences Center, University Hospitals of
South Manchester, Manchester, United Kingdom
(Pedersen) Center for Preventive medicine, Oslo University Hospital,
Ulleval and University of Oslo, Oslo, Norway
(Wachtell) Department of Cardiology, Oslo University Hospital, Oslo,
Norway
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
In this study, we aimed to determine if pretreatment low-density
lipoprotein (LDL) levels and aortic stenosis (AS) severity alter the
efficacy of lipid-lowering therapy on reducing aortic valve replacement
(AVR). We used 1,687 patients with asymptomatic mild-to-moderate AS, who
were randomly assigned (1:1) to 40/10 mg simvastatin/ezetimibe combination
versus. placebo in the simvastatin and ezetimibe in aortic stenosis (SEAS)
trial. Pretreatment LDL levels (>4 mmol/L) and peak aortic jet velocity (3
m/s) were used to partition study participants into 4 groups, which were
followed for a primary endpoint of AVR. Cox regression with tests for
interaction was used to study the effect of randomized treatment in each
subgroup. During a median follow-up of 4.3 years (IQR 4.2 to 4.7 years;
total 7,396 patient-years of follow-up), 478 (28%) patients underwent AVR
and 146 (9%) died. A significant risk dependency was detected between
simvastatin/ezetimibe combination, LDL levels and mild versus moderate AS
on rates of AVR (p = 0.01 for interaction). In stratified analyses,
randomized treatment, therefore, reduced the rate of AVR in patients with
LDL levels >4 mmol and mild AS at baseline (HR 0.4; 95% CI: 0.2 to 0.9).
There was no detectable effect of randomized treatment on the need for AVR
in the 3 other participants subgroups. We conclude, that in a secondary
analysis from a prospective randomized clinical trial, treatment with
simvastatin/ezetimibe combination reduced the need for AVR in a subset of
patients with mild AS and high pretreatment LDL levels (Unique identifier
on clinicaltrials.gov: NCT00092677). Copyright © 2019 Elsevier
Inc.

<43>
Accession Number
2002984444
Title
Meta-Analysis Comparing Outcomes in Patients Undergoing Transcatheter
Aortic Valve Implantation With Versus Without Percutaneous Coronary
Intervention.
Source
American Journal of Cardiology. 124 (11) (pp 1757-1764), 2019. Date of
Publication: 1 December 2019.
Author
Lateef N.; Khan M.S.; Deo S.V.; Yamani N.; Riaz H.; Virk H.U.H.; Khan
S.U.; Hedrick D.P.; Kanaan A.; Reed G.W.; Krishnaswamy A.; Puri R.;
Kapadia S.R.; Kalra A.
Institution
(Lateef) Department of Medicine, Creighton University Medical Center,
Omaha, NE, United States
(Khan, Yamani) Department of Medicine, John H. Stroger, Jr. Hospital of
Cook County, Chicago, IL, United States
(Deo) Department of Cardiovascular Surgery, Louis Stokes Cleveland VA
Medical Center, Cleveland, OH, United States
(Riaz, Hedrick, Kanaan, Reed, Krishnaswamy, Puri, Kapadia, Kalra)
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Virk) Department of Cardiovascular Medicine, Albert Einstein Medical
Center, Philadelphia, PA, United States
(Khan) West Virginia University, Morgantown, WV, United States
(Hedrick, Kanaan, Kalra) Department of Cardiovascular Medicine, Akron
General Medical Center, Cleveland, OH, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients having transcatheter aortic valve implantation (TAVI) routinely
undergo coronary angiography before the procedure to define the coronary
anatomy and to evaluate the extend of coronary artery disease (CAD).
Whether percutaneous coronary intervention (PCI) prior/concomitant with
TAVI confers any additional clinical benefit in patients with CAD remains
unclear. Literature search was performed using Medline, Embase, Google
Scholar, and Scopus from inception of these databases till April 2019.
Included outcomes were 30-day all-cause mortality, stroke, myocardial
infarction (MI), acute kidney injury, and 1-year mortality. The main
summary estimate was random effects odds ratio (OR) with 95% confidence
intervals (CIs). Eleven cohort studies enrolling 5,580 patients (mean age
82.4 years and 52.6% females) were included. Our study found no difference
in effect estimates for 30-day all-cause mortality (OR 1.30 [0.85 to
1.98], p = 0.22, I2 = 37.5%), stroke (OR 0.7 (0.36 to 1.45), p
= 0.36, I2 = 32.8%), MI (OR 2.71 [0.55 to 12.23], p = 0.22,
I2 = 41.3%), acute kidney injury (OR 0.7 [0.46 to 1.06], p =
0.08, I2 = 14.4%) and 1-year all-cause mortality (OR 1.19 [0.92
to 1.52], p = 0.18, I2 = 0.0%) in patients who underwent TAVI
with and without PCI. In conclusion, our analysis indicates that PCI with
TAVI in patients with severe aortic stenosis and concomitant CAD grants no
additional clinical advantage in terms of patient important clinical
outcomes. Further randomized studies are needed to better delineate the
clinical practice for myocardial revascularization in patients receiving
transcatheter therapy for aortic valve disease. Copyright © 2019
Elsevier Inc.

<44>
Accession Number
2002721645
Title
Effect of increasing age on percutaneous coronary intervention vs coronary
artery bypass grafting in older adults with unprotected left main coronary
artery disease: A meta-analysis and meta-regression.
Source
Clinical Cardiology. 42 (11) (pp 1071-1078), 2019. Date of Publication: 01
Nov 2019.
Author
Khan M.R.; Kayani W.T.; Ahmad W.; Manan M.; Hira R.S.; Hamzeh I.; Jneid
H.; Virani S.S.; Kleiman N.; Lakkis N.; Alam M.
Institution
(Khan) Division of Cardiology, McLaren-Flint/Michigan State University,
Flint, MI, United States
(Kayani, Hamzeh, Jneid, Virani, Lakkis, Alam) Section of Cardiology,
Department of Internal Medicine, Baylor College of Medicine, Houston, TX,
United States
(Ahmad) Department of Internal Medicine, Nishtar Medical University,
Multan, Pakistan
(Manan) Department of Internal Medicine, King Edward Medical University,
Lahore, Pakistan
(Hira) Division of Cardiology, University of Washington, Seattle, WA,
United States
(Jneid, Virani) Section of Cardiology, Michael E. DeBakey Veterans Affairs
Medical Center, Houston, TX, United States
(Kleiman) Houston Methodist DeBakey Heart and Vascular Center, Houston
Methodist Hospital, Houston, TX, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Older adults (>=70-year-old) are under-represented in the
published data pertaining to unprotected left main coronary artery disease
(ULMCAD). Hypothesis: Percutaneous coronary intervention (PCI) might be
comparable to coronary artery bypass grafting (CABG) for revascularization
of ULMCAD. Method(s): We compared PCI versus CABG in older adults
with ULMCAD with an aggregate data meta-analyses (4880 patients) of
clinical outcomes [all-cause mortality, myocardial infarction (MI), repeat
revascularization, stroke and major adverse cardiac and cerebrovascular
events(MACCE)] at 30 days, 12-24 months & >=36 months in patients with
mean age >=70 years and ULMCAD. A meta-regression analysis evaluated the
effect of age on mortality after PCI. Odds ratios (OR) and 95% confidence
intervals (CI) were estimated using random-effects model. Result(s):
All-cause mortality between PCI and CABG was comparable at 30-days
(OR0.77, 95% CI 0.42- 1.41) and 12-24-months (OR 1.22, 95% CI 0.78-1.93).
PCI was associated with a markedly lower rate of stroke at 30-day
follow-up in octogenarians (OR 0.14, 95% CI 0.02-0.76) but an overall
higher rate of repeat revascularization. At >=36-months, MACCE (OR
1.26,95% CI 0.99-1.60) and all-cause mortality (OR 1.39, 95% CI 1.00-1.93)
showed a trend favoring CABG but did not reach statistical significance.
On meta-regression, PCI was associated with a higher mortality with
advancing age (coefficient=0.1033, p=0.042). Conclusion(s): PCI was
associated with a markedly lower rate of early stroke in octogenarians as
compared to CABG. All-cause mortality was comparable between the two arms
with a trend favoring CABG at >=36-months.PCI was however associated with
increasing mortality with advancing age as compared to CABG. Copyright
© 2019 The Authors. Clinical Cardiology published by Wiley
Periodicals, Inc.

<45>
Accession Number
629762931
Title
Thrombelastometry guided blood-component therapy after cardiac surgery: A
randomized study.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 201.
Date of Publication: 06 Nov 2019.
Author
Haensig M.; Kempfert J.; Kempfert P.-M.; Girdauskas E.; Borger M.A.;
Lehmann S.
Institution
(Haensig) Department of Vascular Surgery, Cardiovascular Center,
University of Leipzig, Liebigstr 20, Leipzig 04103, Germany
(Kempfert, Kempfert) Department of Cardiothoracic and Vascular Surgery,
German Heart Center Berlin, Berlin, Germany
(Girdauskas) Department of Cardiac and Cardiovascular Surgery, University
Heart Center Hamburg, Hamburg, Germany
(Borger, Lehmann) Clinic of Cardiac Surgery, Heart Center, University of
Leipzig, Leipzig, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Significant bleeding is a well known complication after
cardiac surgical procedures and is associated with worse outcome.
Thrombelastometry (ROTEM) allows point-of-care testing of the coagulation
status but only limited data is available yet. The aim was to evaluate the
ROTEM-guided blood component therapy in a randomized trial.
 Method(s): In case of significant postoperative bleeding (> 200 ml/h)
following elective isolated or combined cardiac surgical procedures
(including 14% re-do procedures and 4% requiring circulatory arrest)
patients were randomized to either a 4-chamber ROTEM-guided
blood-component transfusion protocol or received treatment guided by an
algorithm based on standard coagulation testing (control). One hundred
four patients (mean age: 67.2 +/- 10.4 years, mean log. EuroSCORE 7.0 +/-
8.8%) met the inclusion criteria. Mean CPB-time was 112.1 +/- 55.1 min.,
mean cross-clamp time 72.5 +/- 39.9 min. Result(s): Baseline
demographics were comparable in both groups. Overall there was no
significant difference in transfusion requirements regarding red blood
cells, platelets, plasma, fibrinogen or pooled factors and the
re-thoracotomy rate was comparable (ROTEM: 29% vs. control: 25%). However,
there was a trend towards less 24-h drainage loss visible in the
ROTEM-group (ROTEM: 1599.1 +/- 834.3 ml vs. control: 1867.4 +/- 827.4 ml;
p = 0.066). In the subgroup of patients with long CPB-times (> 115 min.; n
= 55) known to exhibit an increased risk for diffuse coagulopathy
ROTEM-guided treatment resulted in a significantly lower 24-h drainage
loss (ROTEM: 1538.2 +/- 806.4 ml vs. control: 2056.8 +/- 974.5 ml; p =
0.032) and reduced 5-year mortality (ROTEM: 0% vs. control: 15%; p =
0.03). Conclusion(s): In case of postoperative bleeding following
cardiac surgical procedures a treatment algorithm based on "point-of-care"
4-chamber ROTEM seems to be at least as effective as standard therapy. In
patients with long CPB-times ROTEM-guided treatment may result in less
bleeding, a marked reduction in costs and long-term mortality. Trial
registration: German Clinical Trials Register, TRN: DRKS00017367, date of
registration: 05.06.2019, 'retrospectively registered'. Copyright
© 2019 The Author(s).

<46>
Accession Number
628143983
Title
Cost-effectiveness of coronary artery bypass graft and percutaneous
coronary intervention compared to medical therapy in patients with
coronary artery disease: a systematic review.
Source
Heart Failure Reviews. 24 (6) (pp 967-975), 2019. Date of Publication: 01
Nov 2019.
Author
Gholami S.S.; Azar F.E.F.; Rezapour A.; Tajdini M.
Institution
(Gholami) Department of Health Economics, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Azar, Rezapour) Health Management and Economics Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Tajdini) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Coronary artery disease (CAD) has significant social and economic
implications. It is necessary to create tools to identify the most
cost-effectiveness treatments, which can assist clinicians in their
therapeutic decisions so that the maximum possible benefit is reached with
the lowest possible cost. Effectiveness must be measured by final
treatment goals in which the most effective interventions are those with
the lowest costs. This study is aimed to systematically review and compare
the studies conducted on the cost-effectiveness of the three coronary
artery disease treatment strategies (medical treatment, percutaneous
coronary intervention, and coronary artery bypass graft). In this
systematic review, the databases NHS Economic Evaluation Database, Embase,
MEDLINE, Science Direct, and Scopus were searched for studies on the
cost-effectiveness of coronary artery bypass graft (CABG) and percutaneous
coronary intervention (PCI) compared to medical therapy (MT) in patients
with coronary artery disease between 1 January 2004 to 30 September 2018.
The quality appraisal of the included studies was examined using the
Consolidated Health Economics Evaluation Reporting Standards (CHEERS)
statement. Out of 186 unique retrievals, 8 studies were included. The
results showed that the all studies clearly stated the time horizon of the
study and included direct medical costs in their analysis. In addition, in
most of the studies, quality-adjusted life years (QALY) were the main
outcome used for measuring the effectiveness. The studies reported various
ranges of the incremental cost-effectiveness ratio (ICER); accordingly,
the highest ratio was observed in the USA ($212,800) for PCI v MT and the
lowest ratio was observed in Brazil ($4403) for CABG v MT. Although the
results of the studies were different in terms of a number of aspects,
such as the viewpoint of the study, the study horizons, and the costs of
expenditure items, they reached similar results. Based on the result of
the present study, it seems that each three treatment strategies for CAD
yielded improvements in QALY. Copyright © 2019, Springer
Science+Business Media, LLC, part of Springer Nature.

<47>
Accession Number
626347713
Title
A prescription support-tool for chronic management of oral antithrombotic
combinations in adults based on a systematic review of international
guidelines.
Source
PLoS ONE. 14 (2) (no pagination), 2019. Article Number: e0211695. Date of
Publication: February 2019.
Author
Zerah L.; Bun R.-S.; Guillo S.; Collet J.-P.; Bonnet-Zamponi D.; Tubach F.
Institution
(Zerah, Bun, Guillo, Bonnet-Zamponi, Tubach) Sorbonne Universite, INSERM,
Institut Pierre Louis d'Epidemiologie et de Sante Publique, AP-HP, Hopital
Pitie-Salpetriere, Departement Biostatistique Sante Publique et
Information Medicale, Unite de Recherche Clinique, PSL-CFX, Centre de
Pharmacoepidemiologie (Cephepi), Paris, France
(Collet) Sorbonne Universite, INSERM, AP-HP, Hopital Pitie-Salpetriere,
Departement de Cardiologie, Paris, France
(Bonnet-Zamponi) Observatoire du Medicament des Dispositifs Medicaux et de
l'Innovation Therapeutique Ile de France (OMEDIT), Paris, France
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Oral antithrombotic (AT) drugs, which include antiplatelet and
anticoagulant therapies, are widely implicated in serious preventable
bleeding events. Avoiding inappropriate oral AT combinations is a major
concern. Numerous practical guidelines have been released; a document to
enhance prescriptions of oral AT combinations for adults would be of great
help. Objective To synthesize guidelines on the prescription of oral AT
combinations in adults and to create a prescription support-tool for
clinicians about chronic management ( one month) of oral AT combinations.
Methods A systematic review of guidelines published between January 2012
and April 2017, in English or in French, from Trip database, Guideline
International Network and PubMed, dealing with the prescription of oral
ATs in adults was conducted. In-hospital management of ATs, bridging
therapy and switches of ATs were not considered. Some specific topics
requiring specialized follow-up (cancer, auto-immune disease, haemophilia,
HIV, paediatrics and pregnancy) were excluded. Last update was made in
November 2018. Results A total of 885 guidelines were identified and 70
met the eligibility criteria. A prescription support-tool summarizing
medical conditions requiring chronic management of oral AT combinations in
adults with drug types, dosage and duration, on a double-sided page, was
provided and tested by an external committee of physicians. The lack of
specific guidelines for old people (age 75 years and older) is questioned
considering the specific vulnerability of this age group to serious
bleedings. Conclusions Recommendations on prescriptions about chronic
management of oral AT combinations in adults were mainly consensual but
dispersed in numerous guidelines according to the medical indication. We
provide a prescription support-tool for clinicians. Further studies are
needed to assess the impact of this tool on appropriate prescribing and
the prevention of serious adverse drug events. Copyright © 2019
Zerah et al. This is an open access article distributed under the terms of
the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.

<48>
Accession Number
623266566
Title
Transcatheter valve-in-valve versus redo surgical aortic valve replacement
for the treatment of degenerated bioprosthetic aortic valve: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (7) (pp 1404-1411),
2018. Date of Publication: 01 Dec 2018.
Author
Tam D.Y.; Vo T.X.; Wijeysundera H.C.; Dvir D.; Friedrich J.O.; Fremes S.E.
Institution
(Tam, Fremes) Division of Cardiac Surgery, Department of Surgery, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, Canada
(Tam, Wijeysundera, Fremes) Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, Canada
(Vo) Division of Cardiac Surgery, Department of Surgery, University of
Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
(Wijeysundera) Division of Cardiology, Department of Medicine, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, Canada
(Dvir) Division of Cardiology Department of Medicine, University of
Washington Medical Centre, Seattle, WA, United States
(Friedrich) Critical Care and Medicine Departments, St. Michael's Hospital
University of Toronto, Toronto, Canada
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To determine the safety and efficacy of valve-in-valve
transcatheter aortic valve replacement (ViV) versus redo surgical aortic
valve replacement (SAVR) for the treatment of previously failed aortic
bioprostheses. Background(s): Valve-in-valve has emerged as a
treatment option for patients with a failed aortic bioprosthesis. Evidence
for safety and efficacy remains limited to small studies. Method(s):
Medline and Embase were searched to 2017 for studies that directly
compared ViV to redo SAVR. A random effects meta-analysis was performed.
 Result(s): Four unadjusted (n = 298) and two propensity-matched (n =
200) observational studies were included. Valve-in-valve patients were
2.85-years older (P = 0.03) and were 23% higher in predicted mortality
risk (ratio of means: 1.23, 95% confidence interval (95%CI): 1.02-1.48).
There was no difference in peri-operative mortality (4.4% vs. 5.7%, P =
0.83;I2 = 0%) or late mortality, reported at median one year
follow-up (incident rate ratio (IRR) 0.93, 95%CI: 0.74-1.16, P = 0.51,
I2 = 0%) between ViV and redo SAVR. The incidence of permanent
pacemaker implantation (8.3% vs 14.6%; P = 0.05;I2 = 0%) and
dialysis (3.2% vs. 10.3%; P = 0.03; I2 = 0%) were lower in ViV.
There was a reduction in the incidence of severe patient-prosthesis
mismatch (3.3% vs 13.5%; P = 0.03; I2 = 0%) and mild or greater
paravalvular leak (5.5% vs 21.1%; P = 0.03; I2 = 37%) in the
redo SAVR group compared to ViV. Conclusion(s): Despite higher
predicted surgical risk of ViV patients, there was no difference in
mortality but less permanent pacemaker implantation and dialysis compared
to redo SAVR. Choice of treatment must be individualized for both
anatomical and patient risk factors; in high risk patients with favorable
previous prosthesis size, valve-in-valve may be preferred. Copyright
© 2018 Wiley Periodicals, Inc.

<49>
Accession Number
2001387632
Title
Trans-Catheter Aortic Valve Replacement and Surgical Aortic Valve
Replacement Outcomes in Patients with Dialysis: Systematic Review and
Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 20 (10) (pp 852-857), 2019.
Date of Publication: October 2019.
Author
Vindhyal M.R.; Ndunda P.; Khayyat S.; Boppana V.S.; Fanari Z.
Institution
(Vindhyal, Ndunda, Khayyat, Boppana, Fanari) Internal Medicine, University
of Kansas School of Medicine - Wichita, 1010 N Kansas, Wichita, KS 67214,
United States
(Boppana, Fanari) Cardiology, Heartland Cardiology/Wesley Medical Center,
550 N Hillside, Wichita, KS 67214, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Dialysis is associated with higher rate of aortic valve
calcification and higher cardiovascular mortality. Transcatheter aortic
valve replacement (TAVR) is an established alternative for surgical aortic
valve replacement (SAVR) in patients with higher and intermediate
co-morbidities including dialysis. Method(s): Two independent
investigators systematically searched Medline, Cochrane, and Web of
Science. The ROBINS-I tool was used to analyze and assess the bias from
the selected studies. Result(s): The search resulted in 4
observational studies with a total of 966 patients. TAVR in dialysis
patients was associated with no significant difference in in-hospital
mortality [8.1% vs 10.3%; OR (95% CI) 0.74 (0.35, 1.60), I2 = 50%, P =
0.45], risk-of-strokes at 30 days [2% vs 4.4%; OR (95% CI) 0.49 (0.22,
1.09), I2 = 0%, P = 0.08], vascular complications [12.7% vs 13.2%; OR (95%
CI) 0.96 (0.55, 1.67), I2 = 0%, P = 0.89], need of blood transfusion
[43.1% vs 66.4%; OR (95% CI) 0.27 (0.05, 1.39), I2 = 89%, P = 0.12], or
bleeding risk [5.6% vs 6.8%; OR (95% CI) 0.91 (0.18, 4.64), I2 = 5%, P =
0.91] when compared to SAVR. TAVR was associated with significantly
shorter length of stay [8.5 days vs 14.2 days; mean difference (95% CI)
-5.89 (-9.13, -2.64), I2 = 76%, P < 0.0001] and higher pacemaker
implantation [11.4% vs 6.8%; OR (95% CI) 1.74 (1.07, 2.81), I2 = 5%, P =
0.02]. Conclusion(s): TAVR outcomes were comparable to SAVR but had a
significantly shorter length of stay and a higher pacemaker implantation
rate in dialysis patients. Copyright © 2018 Elsevier Inc.

<50>
Accession Number
2003238021
Title
Intraoperative blood pressure variability predicts postoperative mortality
in non-cardiac surgery-A prospective observational cohort study.
Source
International Journal of Environmental Research and Public Health. 16 (22)
(no pagination), 2019. Article Number: 4380. Date of Publication: 02 Nov
2019.
Author
Wiorek A.; Krzych L.J.
Institution
(Wiorek, Krzych) Department of Anaesthesiology and Intensive Care, School
of Medicine in Katowice, Medical University of Silesia, 14 Medykow Street,
Katowice 40-752, Poland
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Little is known about the clinical importance of blood pressure
variability (BPV) during anesthesia in non-cardiac surgery. We sought to
investigate the impact of intraoperative BPV on postoperative mortality in
non-cardiac surgery subjects, taking into account patient-and
procedure-related variables. This prospective observational study covered
835 randomly selected patients who underwent gastrointestinal (n = 221),
gynecological (n = 368) and neurosurgical (n = 246) procedures. Patient's
and procedure's risks were assessed according to the validated tools and
guidelines. Blood pressure (systolic, SBP, and diastolic, DBP) was
recorded in five-minute intervals during anesthesia. Mean arterial
pressure (MAP) was assessed. Individual coefficients of variation (Cv)
were calculated. Postoperative 30-day mortality was considered the
outcome. Median SBP_Cv was 11.2% (IQR 8.4-14.6), DBP_Cv was 12.7% (IQR
9.8-16.3) and MAP_Cv was 10.96% (IQR 8.26-13.86). Mortality was 2%. High
SBP_Cv (i.e., >=11.9%) was associated with increased mortality by 4.5
times (OR = 4.55; 95% CI 1.48-13.93; p = 0.008). High DBP_Cv (i.e.,
>=22.4%) was associated with increased mortality by nearly 10 times (OR =
9.73; 95% CI 3.26-28.99; p < 0.001). High MAP_Cv (i.e., >=13.6%) was
associated with increased mortality by 3.5 times (OR = 3.44; 95% CI
1.34-8.83; p = 0.01). In logistic regression, it was confirmed that the
outcome was dependent on both SBPV and DBPV, after adjustment for
perioperative variables, with AUCSBP_Cv = 0.884 (95% CI 0.859-0.906; p <
0.001) and AUCDBP_Cv = 0.897 (95% CI 0.873-0.918; p < 0.001). Therefore,
intraoperative BPV may be considered a prognostic factor for the
postoperative mortality in non-cardiac surgery, and DBPV seems more
accurate in outcome prediction than SBPV. Copyright © 2019 by the
authors. Licensee MDPI, Basel, Switzerland.

<51>
Accession Number
2003645386
Title
No Concluding Evidence on Optimal Activated Clotting Time for Non-cardiac
Arterial Procedures.
Source
European Journal of Vascular and Endovascular Surgery. (no pagination),
2019. Date of Publication: 2019.
Author
Doganer O.; Wiersema A.M.; Scholtes V.; Blankensteijn J.D.; Yeung K.K.;
Jongkind V.
Institution
(Doganer, Wiersema, Jongkind) Department of Vascular Surgery, Dijklander
Ziekenhuis, Hoorn, Netherlands
(Doganer, Wiersema, Scholtes, Blankensteijn, Yeung, Jongkind) Department
of Vascular Surgery, Amsterdam University Medical Centres (Amsterdam UMC)
Location VU Medical Centre (VUMC), Amsterdam, Netherlands
Publisher
W.B. Saunders Ltd
Abstract
Objectives: Heparin has a non-predictable effect in the individual
patient. The activated clotting time (ACT) is used to measure the level of
anticoagulation after administration of heparin. To date, appropriate
heparin dose protocols and corresponding therapeutic ACT values have not
been established in non-cardiac arterial procedures (NCAP). The aim of
this review was to study the use of ACT monitoring during NCAP, and
whether an optimal ACT could be determined based on the fewest arterial
thrombo-embolic complications (ATEC) and bleeding complications.
 Method(s): This systematic review was performed in accordance with
the PRISMA Guidelines. A systematic search was conducted in MEDLINE,
EMBASE, and the Cochrane database. Any associations were evaluated between
peri-procedural ACT levels and ATEC and bleeding complications detected
during the same admission as the primary procedure or during 30 day follow
up. Also, heparin dose protocols, peri-procedural target ACTs, different
ACT devices, protamine use and pre-, peri-, and post-procedural
anticoagulation therapy were evaluated. Result(s): In total, 21
studies with 3982 patients were included, on both open and endovascular
NCAP. Four studies were primarily designed to correlate peak
peri-procedural ACT with clinical outcomes; however, the definitions of
the results and the clinical outcomes were too heterogeneous for analysis.
There was major variability in all studied aspects of ACT measurement,
heparin and protamine use, and in the type of procedures in the included
studies. Overall methodological quality of the included studies was poor.
No randomised controlled trials were found. Studies were at a high risk of
bias. Conclusion(s): This systematic review demonstrates a lack of
data and no consensus in the literature concerning the optimal ACT, and
the possible association with haemorrhagic complications and ATEC during
NCAP. Copyright © 2019 European Society for Vascular Surgery

<52>
Accession Number
629847864
Title
Effect of Using Triclosan-Impregnated Polyglactin Suture to Prevent
Infection of Saphenectomy Wounds in CABG: A Prospective, Double-Blind,
Randomized Clinical Trial.
Source
Brazilian journal of cardiovascular surgery. 34 (5) (pp 588-595), 2019.
Date of Publication: 01 Dec 2019.
Author
Santos P.S.; Santos M.; Colafranceschi A.S.; Pragana A.N.S.; Correia M.G.;
Simoes H.H.; Rocha F.A.; Soggia M.E.V.; Santos A.P.M.S.; Coutinho A.A.;
Figueira M.S.; Tura B.R.
Institution
(Santos, Colafranceschi, Pragana, Simoes, Rocha, Soggia, Santos, Figueira)
Instituto Nacional de Cardiologia Department of Cardiovascular Surgery Rio
de Janeiro RJ Brazil Department of Cardiovascular Surgery, Instituto
Nacional de Cardiologia (INC), RJ, Rio de Janeiro, Brazil
(Santos, Coutinho) Instituto Nacional de Cardiologia Nucleo de Avaliacao
de Tecnologia em Saude Rio de Janeiro RJ Brazil Nucleo de Avaliacao de
Tecnologia em Saude (NATS), Instituto Nacional de Cardiologia (INC), RJ,
Rio de Janeiro, Brazil
(Correia, Tura) Instituto Nacional de Cardiologia Department of
Biostatistics and Bioinformatics Rio de Janeiro RJ Brazil Department of
Biostatistics and Bioinformatics, Instituto Nacional de Cardiologia (INC),
RJ, Rio de Janeiro, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the efficacy of triclosan-coated suture for the
reduction of infection in saphenectomy wounds of patients undergoing
coronary artery bypass graft (CABG) surgery. METHOD(S): A total of
508 patients who underwent saphenectomy in CABG surgery were included in a
prospective, randomized, double-blind trial from February/2011 to
June/2014. Patients were randomized into the triclosan-coated suture group
(n= 251) and the conventional non-antibiotic suture group (n=257).
Demographic (gender and age), clinical (body mass index, diabetes, and use
of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp
times) variables and those related to the saphenectomy wound (pain,
dehiscence, erythema, infection, necrosis, and hyperthermia) were measured
and analyzed. RESULT(S): Of the 508 patients who underwent
saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three
(6.5%) patients presented infection: 13 (5.3%) with triclosan and 20
(7.9%) with conventional suture (P=0.281). Among diabetic patients
(n=204), triclosan suture was used in 45.1% with four cases of infection;
conventional suture was used in 54.9% of them, with 11 cases of infection.
Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in
9.9% of patients with triclosan-coated suture and in 17.9% with
conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of
patients with triclosan-coated suture and in 5.4% of those with
conventional suture (P=0.028). CONCLUSION(S): Triclosan-coated suture
shows lower infection rate in saphenectomy of patients undergoing CABG,
although the differences were not statistically significant. Pain and
wound hyperthermia were less frequent in patients with triclosan-coated
sutures compared with conventional sutures.

<53>
Accession Number
629847588
Title
The Effect of High-Dose Vitamin C on Biochemical Markers of Myocardial
Injury in Coronary Artery Bypass Surgery.
Source
Brazilian journal of cardiovascular surgery. 34 (5) (pp 517-524), 2019.
Date of Publication: 01 Dec 2019.
Author
Emadi N.; Nemati M.H.; Ghorbani M.; Allahyari E.
Institution
(Emadi) Shiraz University of Medical Sciences Blood Circulation Technology
Shiraz Iran Blood Circulation Technology, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Nemati) Shiraz University of Medical Sciences Department of Heart Surgery
Shiraz Iran Department of Heart Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Ghorbani) Shiraz University of Medical Sciences Anesthesiology Research
Center Shiraz Iran Anesthesiology Research Center, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Ghorbani) Torbat Heydarieh University of Medical Sciences Department of
Public Health Torbat Heydarieh Iran Department of Public Health, Torbat
Heydarieh University of Medical Sciences, Iran, Islamic Republic of
(Allahyari) Shiraz University of Medical Sciences Department of
Anesthesiology Shiraz Iran Department of Anesthesiology, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the effect of high-dose vitamin C on cardiac
reperfusion injury and plasma levels of creatine kinase-muscle/brain
(CK-MB), troponin I, and lactate dehydrogenase (LDH) in patients
undergoing coronary artery bypass grafting (CABG). METHOD(S): This is
a double-blind randomized clinical trial study. Fifty patients (50-80
years old) who had CABG surgery were selected. The intervention group
received 5 g of intravenous vitamin C before anesthesia induction and 5 g
of vitamin C in cardioplegic solution. The control group received the same
amount of placebo (normal saline). Arterial blood samples were taken to
determine the serum levels of CK-MB, troponin I, and LDH enzymes. Left
ventricular ejection fraction was measured and hemodynamic parameters were
recorded at intervals. RESULT(S): High doses of vitamin C in the
treatment group led to improvement of ventricular function (ejection
fraction [EF]) and low Intensive Care Unit (ICU) stay. The cardiac enzymes
level in the vitamin C group was lower than in the control group. These
changes were not significant between the groups in different time
intervals (anesthesia induction, end of bypass, 6 h after surgery, and 24
h after surgery) for CK-MB, LDH, and troponin I. Hemodynamic parameters,
hematocrit, potassium, urinary output, blood transfusion, arrhythmia, and
inotropic support showed no significant difference between the groups.
 CONCLUSION(S): Vitamin C has significantly improved the patients'
ventricular function (EF) 72 h after surgery and reduced the length of ICU
stay. No significant changes in cardiac biomarkers, including CK-MB,
troponin I, and LDH, were seen over time in each group. IRCT CODE:
IRCT2016053019470N33.

<54>
Accession Number
2003797151
Title
The effect of carotid chemoreceptor inhibition on exercise tolerance in
chronic obstructive pulmonary disease: A randomized-controlled crossover
trial.
Source
Respiratory Medicine. 160 (no pagination), 2019. Article Number: 105815.
Date of Publication: November - December 2019.
Author
Phillips D.B.; Collins S.E.; Bryan T.L.; Wong E.Y.L.; McMurtry M.S.;
Bhutani M.; Stickland M.K.
Institution
(Phillips, Collins, Bryan, Wong, Bhutani, Stickland) Division of Pulmonary
Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada
(Phillips) Faculty of Kinesiology, Sport, and Recreation, University of
Alberta, Canada
(Collins) Faculty of Rehabilitation Medicine, University of Alberta,
Canada
(McMurtry) Division of Cardiology, Faculty of Medicine and Dentistry,
University of Alberta, Canada
(Stickland) G.F. MacDonald Centre for Lung Health, Covenant Health,
Edmonton, Alberta, Canada
Publisher
W.B. Saunders Ltd
Abstract
Background: Patients with chronic obstructive pulmonary disease (COPD)
have an exaggerated ventilatory response to exercise, contributing to
exertional dyspnea and exercise intolerance. We recently demonstrated
enhanced activity and sensitivity of the carotid chemoreceptor (CC) in
COPD which may alter ventilatory and cardiovascular regulation and
negatively affect exercise tolerance. We sought to determine whether CC
inhibition improves ventilatory and cardiovascular regulation, dyspnea and
exercise tolerance in COPD. Method(s): Twelve mild-moderate COPD
patients (FEV<inf>1</inf> 83 +/- 15 %predicted) and twelve age- and
sex-matched healthy controls completed two time-to-symptom limitation
(T<inf>LIM</inf>) constant load exercise tests at 75% peak power output
with either intravenous saline or low-dose dopamine (2
mug.kg-1.min-1, order randomized) to inhibit the CC.
Ventilatory responses were evaluated using expired gas data and dyspnea
was evaluated using a modified Borg scale. Inspiratory capacity maneuvers
were performed to determine operating lung volumes. Cardiac output was
estimated using impedance cardiography and vascular conductance was
calculated as cardiac output/mean arterial pressure (MAP). Result(s):
At a standardized exercise time of 4-min and at T<inf>LIM</inf>;
ventilation, operating volumes and dyspnea were unaffected by dopamine in
COPD patients and controls. In COPD, dopamine decreased MAP and increased
vascular conductance at all time points. In controls, dopamine increased
vascular conductance at T<inf>LIM</inf>, while MAP was unaffected.
 Conclusion(s): There was no change in time to exhaustion in either
group with dopamine. These data suggest that the CC plays a role in
cardiovascular regulation during exercise in COPD; however, ventilation,
dyspnea and exercise tolerance were unaffected by CC inhibition in COPD
patients. Copyright © 2019 Elsevier Ltd

<55>
Accession Number
2003780181
Title
The effect of the CYP2C19*2 allele on cardiovascular outcomes in patients
with coronary artery stenting: A prospective study.
Source
Archives of Medical Science. 15 (4) (pp 837-844), 2019. Date of
Publication: 2019.
Author
Yang D.; Peng C.; Liao Z.; Wang X.; Guo W.; Li J.
Institution
(Yang, Peng, Liao, Wang, Guo) Department of Cardiology, Shenzhen Sun
Yat-sen Cardiovascular Hospital, Shenzen, China
(Li) Department of Cardiology, Second Clinical Medical College of Jinan
University, No.1017 Dongmen North Road, Shenzen 518000, China
Publisher
Termedia Publishing House Ltd. (Kleeberqa St.2, Poznan 61-615, Poland)
Abstract
Introduction: The aim of the study was to evaluate the effects of
cytochrome P450 2C19*2 (CYP2C19*2) on ischemic and bleeding events in the
Chinese Han population. Material(s) and Method(s): Patients after
coronary artery stenting were enrolled for genotyping CYP2C19*2. Platelet
reactivity 4 weeks after stent implantation was compared between different
genotype groups. Ischemic and bleeding events were compared after 6
months' follow-up. Result(s): A total of 255 patients were enrolled
and 57.7% and 42.3% of patients presented with stable angina and acute
coronary syndrome, respectively. The prevalence of homozygous (AA) and
heterozygous (GA) CYP2C19*2 variants was 3.5% and 24.7% respectively, and
the prevalence of wild type (GG) was 71.8%. Compared to GG and GA genotype
groups, the absolute platelet activity reduction was significantly lower
in AA genotype (GG 43.6 +/-7.8%, GA 31.9 +/-6.5%, and AA 24.8 +/-5.3%, p <
0.01 for trend). After 6 months' follow-up, 3.3%, 4.8% and 11.1% of
patients experienced ischemic events in GG, GA and AA genotype groups,
respectively (p = 0.003 for trend). After adjusting for traditional risk
factors, AA genotype was significantly associated with ischemic events,
with hazard ratio 1.19 and 95% confidence interval 1.08-1.30 (p = 0.013).
Also, 2.2%, 1.6% and 0% of patients experienced bleeding events in GG, GA
and AA genotype groups (p = 0.153 for trend). No independent association
of CYP2C19*2 genotype and bleeding events was observed.
 Conclusion(s): Genotyping of CYP2C19*2 may be useful to guide
antiplatelet treatment in the Chinese Han population. Randomized
controlled trials are warranted to investigate whether genotype-guided
antiplatelet treatment could reduce ischemic events. Copyright ©
2018 Termedia & Banach

<56>
Accession Number
2003779699
Title
Mid-term and long-term outcomes of endoscopic versus open vein harvesting
for coronary artery bypass: A systematic review and meta-analysis.
Source
International Journal of Surgery. 72 (pp 167-173), 2019. Date of
Publication: December 2019.
Author
Li G.; Zhang Y.; Wu Z.; Liu Z.; Zheng J.
Institution
(Li, Wu, Zheng) Department of Cardiovascular Surgery, Sun Yat-sen Memorial
Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
(Zhang) Department of Pathology, The Second Affiliated Hospital of
Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of
Chinese Medicine, Guangzhou, Guangdong 510120, China
(Liu) Department of Hepatobiliary Surgery, Second Affiliated Hospital of
Guangzhou Medical University, Guangzhou, Guangdong 510260, China
Publisher
Elsevier Ltd
Abstract
Background: Two prevalent harvesting techniques are routinely utilized in
coronary artery bypass grafting (CABG): endoscopic vein harvesting (EVH)
and open vein harvesting (OVH). Our purpose is to compare mid-term and
long-term outcomes between these two techniques for CABG. Method(s):
After the acquisition of evidence, available studies assessing both
harvesting techniques with follow-up precondition (a minimum of one year)
were identified. The primary outcome was all-cause mortality. Secondary
outcomes of interest included the number of intra-operative graft
injuries, leg-wound complications, in-hospital mortality, major adverse
cardiac events (MACE) and graft patency. Result(s): Twenty-two
studies including 27911 patients were identified. The incidences of
all-cause mortality, in-hospital death, and MACE were similar between EVH
and OVH. EVH was associated with more graft injuries (weighted mean
difference (WMD) 0.73; 95% confidence interval (CI) 0.18-1.28; P = 0.009),
lower mid-term graft patency (odds ratio (OR) 0.80; 95% CI 0.70-0.91; P =
0.0005), and decreased long-term graft patency (OR 0.15, 95% CI 0.04-0.61;
P = 0.008) as compared with OVH. Fewer leg-wound complications were
observed in endoscopic harvesting as compared to conventional technique
(OR 0.19, 95% CI 0.12-0.30; P < 0.001). Data from subgroup analysis
suggested study period as a key factor affecting the outcomes for graft
patency. Conclusion(s): The risks for all-cause mortality,
in-hospital death, and MACE are similar between EVH and OVH. EVH increases
conduit injuries and lowers mid-long term graft patency rates, however,
study period, with growing surgical expertise, may be associated with
better outcomes. Copyright © 2019 IJS Publishing Group Ltd

<57>
Accession Number
2003572044
Title
Sex-mismatch influence on survival after heart transplantation: A
systematic review and meta-analysis of observational studies.
Source
Clinical Transplantation. (no pagination), 2019. Article Number: e13737.
Date of Publication: 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, Spain
(Urrutia) Institut d'Investigacio Biomedica Sant Pau (IIB Sant Pau),
Barcelona, Spain
(Urrutia) CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
(Urrutia, Madrid, Vernooij) Centro Iberoamericano Cochrane, Barcelona,
Spain
(Madrid) Centro de Investigacion Biomedica, Facultad de Medicina,
Universidad de Valparaiso, Valparaiso, Chile
(Madrid) Centro Interdisciplinar para Estudios de la Salud, Facultad de
Medicina, Universidad de Valparaiso, Valparaiso, Chile
(Vicent, Martinez-Selles) Servicio de Cardiologia, Hospital Universitario
Gregorio Maranon, Instituto de Investigacion Sanitaria Gregorio Maranon
(IiSGM), CIBERCV, Madrid, Spain
(Vicent, Martinez-Selles) Universidad Complutense de Madrid, Madrid, Spain
(Martinez-Selles) Universidad Europea de Madrid, Madrid, Spain
Publisher
Blackwell Publishing Ltd
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 aims 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 <.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 =.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 <.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

<58>
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.

<59>
Accession Number
2002580755
Title
The protective effects of L-carnitine on myocardial ischaemia-reperfusion
injury in patients with rheumatic valvular heart disease undergoing CPB
surgery are associated with the suppression of NF-kappaB pathway and the
activation of Nrf2 pathway.
Source
Clinical and Experimental Pharmacology and Physiology. 46 (11) (pp
1001-1012), 2019. Date of Publication: 01 Nov 2019.
Author
Li M.; Xu S.; Geng Y.; Sun L.; Wang R.; Yan Y.; Wang H.; Li Y.; Yi Q.;
Zhang Y.; Hao J.; Deng C.; Li W.; Xue L.
Institution
(Li, Xu, Yan, Wang, Li, Yi, Zhang, Hao, Deng) Department of Cardiovascular
Surgery, The First Affiliated Hospital of Medical College of Xi'an
Jiaotong University, Xi'an, China
(Geng, Li, Xue) Department of Laboratory, The Second Affiliated Hospital
of Medical College of Xi'an Jiaotong University, Xi'an, China
(Sun) Department of Ultrasound, The Second Affiliated Hospital of Medical
College of Xi'an Jiaotong University, Xi'an, China
(Wang) Department of Geriatrics Neurology, The Second Affiliated Hospital
of Medical College of Xi'an Jiaotong University, Xi'an, China
Publisher
Blackwell Publishing
Abstract
Myocardial ischaemia-reperfusion injury (MIRI) is a main pathophysiologic
change following CPB surgery. L-carnitine, a natural amino acid, is able
to transport fatty acids for generating energy and has a protective effect
on MIRI. We aim to investigate the protective effect of L-carnitine on
MIRI in patients with rheumatic valvular heart disease (RVHD) performed
CPB surgical operation and the underlying mechanism. In this study,
patients were randomized to three groups. L-carnitine was added to the
crystalloid cardioplegic solution for experimental group 1 (6 g/L) and
experimental group 2 (12 g/L), whereas no L-carnitine was used in the
control group. Our results showed that L-carnitine significantly
attenuated myocardial injury after surgery in these patients. L-carnitine
decreased serum markers of myocardial injury including CK-MB, cTnI,
hs-cTnT and IMA. L-carnitine increased left ventricular ejection fraction
(LVEF) but reduced wall motion score index (WMSI) after operation.
L-carnitine also inhibited myeloperoxidase (MPO) activity and inflammatory
cytokines in the myocardium of patients after unclamping the aorta.
Additionally, L-carnitine increased levels of superoxide dismutase (SOD)
and catalase (CAT) while decreased levels of malondialdehyde (MDA) and
protein carbonyl content in the myocardium of patients after unclamping
the aorta. Moreover, L-carnitine suppressed the activation of nuclear
factor kappa B (NF-kappaB) and activated nuclear factor erythroid
2-related factor 2 (Nrf2). There was also no significant difference in
these indices between two experimental groups after unclamping the aorta.
Taken together, L-carnitine had a protective effect against CPB-induced
MIRI in patients with RVHD, which might be related to its modulation of
NF-kappaB and Nrf2 activities. Copyright © 2019 John Wiley & Sons
Australia, Ltd

<60>
Accession Number
628374630
Title
Outcomes of Vocal Fold Motion Impairment and Dysphagia after Pediatric
Cardiothoracic Surgery: A Systematic Review.
Source
Otolaryngology - Head and Neck Surgery (United States). 161 (5) (pp
754-763), 2019. Date of Publication: 01 Nov 2019.
Author
Orzell S.; Joseph R.; Ongkasuwan J.; Bedwell J.; Shin J.; Raol N.
Institution
(Orzell) Department of Otolaryngology, SUNY Upstate Medical Center,
Syracuse, NY, United States
(Joseph) School of Medicine, Emory University, Atlanta, GA, United States
(Ongkasuwan, Bedwell) Department of Otolaryngology, Baylor College of
Medicine, Houston, TX, United States
(Shin) Department of Otolaryngology, Harvard Medical School, Boston, MA,
United States
(Raol) Department of Otolaryngology-Head and Neck Surgery, School of
Medicine, Emory University, Atlanta, GA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: The objective of this study was to systematically review the
literature regarding vocal fold motion impairment (VFMI), respiratory
outcomes, and swallowing outcomes in children following congenital heart
surgery (CHS). Data Sources: PubMed, Embase, Medline, and CINAHL
databases. Review Methods: Data sources were searched from inception to
November 30, 2018. Studies that described recovery of VFMI and swallowing
function following CHS were included, and a qualitative analysis was
performed. Result(s): A total of 1371 studies were identified, of
which 8 met inclusion criteria for VFMI and 5 met inclusion criteria for
swallowing outcomes. Studies including patients who underwent isolate
patent ductus arteriosus ligation were excluded. VFMI was present in 8% to
59% of subjects, and rates of recovery ranged from 9% to 96% at 6 months
to 6 years of follow-up. Inability to maintain an oral diet occurred in
14% to 100% of subjects with VFMI and 11% to 61% without VFMI following
surgery. Tolerance of an oral diet without tube feeding was present in 66%
to 75% of subjects with VFMI and 88% to 100% without VFMI at 24 days to
3.2 years of follow-up. Limited data suggest that time to extubation is
longer in VFMI subjects, but overall hospital length of stay and mortality
may not be affected by VFMI status. Conclusion(s): Data evaluating
dysphagia and VFMI after CHS are limited. Most studies suggest significant
improvement in swallowing function, while rate of recovery of VFMI is
variable. Future prospective studies with standardized screening and
follow-up are needed to better elucidate outcomes to help develop
algorithms for identification and management of VFMI after
CHS. Copyright © American Academy of Otolaryngology-Head and Neck
Surgery Foundation 2019.

<61>
Accession Number
2003671059
Title
The effect of low-dose colchicine in patients with stable coronary artery
disease: The LoDoCo2 trial rationale, design, and baseline
characteristics.
Source
American Heart Journal. 218 (pp 46-56), 2019. Date of Publication:
December 2019.
Author
Nidorf S.M.; Fiolet A.T.L.; Eikelboom J.W.; Schut A.; Opstal T.S.J.; Bax
W.A.; Budgeon C.A.; Tijssen J.G.P.; Mosterd A.; Cornel J.H.; Thompson P.L.
Institution
(Nidorf) GenesisCare Western Australia, Perth, Australia
(Nidorf, Thompson) Heart Research Institute of Western Australia, Perth,
Australia
(Fiolet, Schut, Opstal, Bax, Mosterd, Cornel) Dutch Network for
Cardiovascular Research (WCN), Utrecht, Netherlands
(Fiolet) The Netherlands Heart Institute, Utrecht, Netherlands
(Fiolet) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Eikelboom) Department of Medicine, McMaster University, Hamilton,
Ontario, Canada
(Opstal, Cornel) Department of Cardiology, Northwest Clinics, Alkmaar,
Netherlands
(Bax) Department of Internal Medicine, Northwest Clinics, Alkmaar,
Netherlands
(Budgeon) Department of Cardiovascular Sciences, University of Leicester,
and the NIHR Leicester Cardiovascular Biomedical Research Unit Glenfield
Hospital, Leicester, United Kingdom
(Budgeon) Centre for Applied Statistics, University of Western Australia,
Perth, Australia
(Tijssen) Department of Cardiology, Amsterdam UMC, Amsterdam, Netherlands
(Mosterd) Department of Cardiology, Meander Medical Center, Amersfoort,
Netherlands
(Cornel) Department of Cardiology, Radboud University Medical Center,
Netherlands
(Thompson) Sir Charles Gairdner Hospital, Perth, Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Because patients with stable coronary artery disease are at continued risk
of major atherosclerotic events despite effective secondary prevention
strategies, there is a need to continue to develop additional safe,
effective and well-tolerated therapies for secondary prevention of
cardiovascular disease. Rationale and Design: The LoDoCo (Low Dose
Colchicine) pilot trial showed that the anti-inflammatory drug colchicine
0.5 mg once daily appears safe and effective for secondary prevention of
cardiovascular disease. Colchicine's low cost and long-term safety suggest
that if its efficacy can be confirmed in a rigorous trial, repurposing it
for secondary prevention of cardiovascular disease would have the
potential to impact the global burden of cardiovascular disease. LoDoCo2
is an investigator-initiated, international, multicentre, double-blind,
event driven trial in which 5522 patients with stable coronary artery
disease tolerant to colchicine during a 30-day run-in phase have been
randomized to colchicine 0.5 mg daily or matching placebo on a background
of optimal medical therapy. The study will have 90% power to detect a 30%
reduction in the composite primary endpoint: cardiovascular death,
myocardial infarction, ischemic stroke and ischemia-driven coronary
revascularization. Adverse events potentially related to the use of
colchicine will also be collected, including late gastrointestinal
intolerance, neuropathy, myopathy, myositis, and neutropenia.
 Conclusion(s): The LoDoCo2 Trial will provide information on the
efficacy and safety of low-dose colchicine for secondary prevention in
patients with stable coronary artery disease. Copyright © 2019
Elsevier Inc.

<62>
Accession Number
2003701920
Title
Efficacy and Safety of Stents in ST-Segment Elevation Myocardial
Infarction.
Source
Journal of the American College of Cardiology. 74 (21) (pp 2572-2584),
2019. Date of Publication: 26 November 2019.
Author
Chichareon P.; Modolo R.; Collet C.; Tenekecioglu E.; Vink M.A.; Oh P.C.;
Ahn J.-M.; Musto C.; Diaz de la Llera L.S.; Cho Y.-S.; Violini R.; Park
S.-J.; Suryapranata H.; Piek J.J.; de Winter R.J.; Wykrzykowska J.J.;
Spaulding C.; Kang W.C.; Slagboom T.; Hofma S.H.; Wijnbergen I.F.; Di
Lorenzo E.; Pijls N.H.; Raber L.; Brugaletta S.; Sabate M.; Stoll H.-P.;
Stone G.W.; Windecker S.; Onuma Y.; Serruys P.W.
Institution
(Chichareon, Modolo, Collet, Piek, de Winter, Wykrzykowska) Heart Center,
Department of Clinical and Experimental Cardiology, Amsterdam
Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
(Chichareon) Cardiology Unit, Department of Internal Medicine, Faculty of
Medicine, Prince of Songkla University, Songkhla, Thailand
(Modolo) Department of Internal Medicine, Cardiology Division, University
of Campinas (UNICAMP), Campinas, Brazil
(Collet, Onuma) Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(Tenekecioglu) Erasmus Medical Center, Rotterdam, Netherlands
(Vink, Slagboom) OLVG Hospital, Amsterdam, Netherlands
(Oh, Kang) Department of Cardiology, Gachon University Gil Medical Center,
Incheon, South Korea
(Ahn, Park) Department of Cardiology, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, South Korea
(Musto, Violini) Interventional Cardiology Unit-San Camillo Hospital,
Rome, Italy
(Diaz de la Llera) Unidad de Hemodinamica y Cardiologia Intervencionista,
Hospital Universitario Virgen del Rocio, Seville, Spain
(Cho) Seoul National University Bundang Hospital, Seongnam, South Korea
(Suryapranata) Department of Cardiology, Radboud University Medical
Center, Nijmegen, Netherlands
(Spaulding) Cardiology Department, European Hospital Georges
Pompidou-Assistance Publique Hopitaux de Paris, Sudden Death Expert
Center, INSERM U 970, PARCC, Paris Descartes University, Paris, France
(Hofma) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Wijnbergen, Pijls) Department of Cardiology, Catharina Hospital
Eindhoven, Eindhoven, Netherlands
(Di Lorenzo) Cardiology Department, G. Moscati Hospital, Avellino, Italy
(Raber, Windecker) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Brugaletta, Sabate) Hospital Clinic, Institut Clinic Cardiovascular,
Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS),
University of Barcelona, Barcelona, Spain
(Stoll) Biosensors Clinical Research, Morges, Switzerland
(Stone) New York Presbyterian Hospital, Columbia University Medical Center
and the Cardiovascular Research Foundation, New York, NY, United States
(Onuma) Cardialysis Clinical Trials Management and Core Laboratories,
Rotterdam, Netherlands
(Serruys) Department of Cardiology, Imperial College of London, London,
United Kingdom
Publisher
Elsevier USA
Abstract
Background: To date, no specific drug-eluting stent (DES) has fully proven
its superiority over others in patients with ST-segment elevation
myocardial infarction (STEMI) undergoing percutaneous coronary
intervention. Objective(s): The purpose of this study was to compare
the safety and efficacy of coronary artery stents in STEMI patients in a
patient-level network meta-analysis. Method(s): Eligible studies were
dedicated randomized controlled trials comparing different stents in STEMI
patients undergoing percutaneous coronary intervention with at least 12
months of clinical follow-up. Of 19 studies identified from the published
data, individual patient data were collected in 15 studies with 10,979
patients representing 87.7% of patients in the overall network of
evidence. The primary endpoint was the composite of cardiac death,
reinfarction, or target lesion revascularization. Result(s): Overall,
8,487 (77.3%) of 10,979 STEMI patients were male and the mean age was 60.7
years. At a median follow-up of 3 years, compared with bare-metal stents
(BMS), patients treated with paclitaxel-, sirolimus-, everolimus-, or
biolimus-eluting stents had a significantly lower risk of the primary
endpoint (adjusted hazard ratios [HRs]: 0.74 [95% confidence interval
(CI): 0.63 to 0.88], 0.65 [95% CI: 0.49 to 0.85], 0.70 [95% CI: 0.53 to
0.91], and 0.66 [95% CI: 0.49 to 0.88], respectively). The risk of primary
endpoint was not different between patients treated with BMS and
zotarolimus-eluting stents (adjusted HR: 0.83 [95% CI: 0.51 to 1.38]).
Among patients treated with DES, no significant difference in the risk of
the primary outcome was demonstrated. Treatment with second-generation DES
was associated with significantly lower risk of definite or probable stent
thrombosis compared with BMS (adjusted HR: 0.61 [95% CI: 0.42 to 0.89])
and first-generation DES (adjusted HR: 0.56 [95% CI: 0.36 to 0.88]).
 Conclusion(s): In STEMI patients, DES were superior to BMS with
respect to long-term efficacy. No difference in long-term efficacy and
safety was observed among specific DES. Second-generation were superior to
first-generation DES in reducing stent thrombosis. (Clinical Outcomes
After Primary Percutaneous Coronary Intervention [PCI] Using Contemporary
Drug-Eluting Stent [DES]: Evidence From the Individual Patient Data
Network Meta-Analysis; CRD42018104053) Copyright © 2019 American
College of Cardiology Foundation

<63>
Accession Number
629724255
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) (no pagination), 2019. Article Number: e031697. Date of
Publication: 01 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, Universite de
Lorraine, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux,
Hopitaux de Brabois, Vandoeuvre-les-Nancy, France
(Girerd) Inserm 1116, INI-CRCT, Cardiovascular and Renal Clinical
Trialists, F-CRIN Network, Vandoeuvre les Nancy, France
(Levy) Groupe Choc Equipe 2, Inserm U1116, Vandoeuvre les Nancy, France
(Levy) University de Lorraine, Nancy 54000, France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
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 a ECMO Trials Group', its results will also be disseminated by the
aforementioned group. Trial registration number NCT
02754193. Copyright © 2019 Author(s).

<64>
Accession Number
2003236887
Title
Impact of spinal and general anesthesia on HS-troponin in geriatric
patients.
Source
Turk Geriatri Dergisi. 22 (2) (pp 191-196), 2019. Date of Publication:
2019.
Author
Mansuroglu C.
Institution
(Mansuroglu) Ankara Numune Research and Education Hospital, Cardiology
Department, Ankara, Turkey
Publisher
Geriatrics Society
Abstract
Introduction: We compared the myocardial injury risk of selective spinal
anesthesia and general anesthesia with using peri operative plasma high
sensitive- cardiac troponins in geriatric noncardiac surgery patients.
 Material(s) and Method(s): We planned the study as prospective,
randomized and double blinded. The study group was consisted of American
Society of Anesthesiologist score I- II over 65 years old 46 preoperative
non- cardiac surgery patients which randomly separated into the general or
selective spinal anesthesia groups. Demographic characteristics of the
groups were nearly the same. Anesthesia was performed via injection of
bupivacaine 5 mg in Lumbar 4-5 intervertebral space in selective spinal
anesthesia group, and propofol and remifentanil for anesthesia induction
and then desflurane inhalation with laryngeal mask for anesthesia
maintenance in general anesthesia group. Patients' 12 lead
electrocardiograms and high sensitive- troponins were taken on the day of
operation and postoperative day 1, 2 and 3. Result(s): In this study
any cardiac complication was observed and high sensitive- Troponin T
levels were at the normal range of mean of 13.90+/-4, 24 ng/(95% CI,
8.90-18.20; p=0.43). High sensitive-Troponin T was slightly increased the
near significant of a mean19.34+/- 3.2 ng/L(95% CI, 15.43- 23.52; p= 0.05)
in spinal anesthesia group than general anesthesia on postoperative third
day. Conclusion(s): Any distinct difference in myocardial injury was
not observed between low risk non cardiac operations in the elderly with
selective spinal anesthesia and with general anesthesia methods in our
study. However, the third day increase in high sensitive-Troponin in
selective spinal anesthesia group needs larger studies with longer follow-
up in moderate to high risk patients in clinical practice
usage. Copyright © 2019, Geriatrics Society. All rights reserved.

<65>
Accession Number
2003688083
Title
Radial versus femoral approach in women undergoing coronary angiography: A
meta-analysis of randomized controlled trials.
Source
Journal of Invasive Cardiology. 31 (11) (pp 335-340), 2019. Date of
Publication: 2019.
Author
Al Halabi S.A.; Burke L.; Hussain F.; Lopez J.; Mathew V.; Bernat I.;
Shroff A.
Institution
(Al Halabi, Burke, Lopez, Mathew) Division of Cardiology, Loyola
University Chicago Stritch School of Medicine, Maywood, IL, United States
(Hussain) Department of Internal Medicine, Loyola University Chicago
Stritch School of Medicine, Maywood, IL, United States
(Bernat) Department of Cardiology, University Hospital Pilsen, Pilsen,
Czechia
(Shroff) Division of Cardiology, University of Illinois, Chicago, IL,
United States
(Shroff) Division of Cardiology, Department of Medicine University,
Illinois Hospital and Health Sciences System, 740 West Taylor Street,
Chicago, IL 60612, United States
Publisher
HMP Communications
Abstract
Objectives. We sought to compare outcomes with radial vs femoral approach
in female patients undergoing coronary angiography. Background. Women
undergoing cardiac procedures have increased risk of bleeding and vascular
complications, but are under-represented in randomized clinical trials
(RCTs) involving coronary angiography. Methods. We performed a
meta-analysis of RCTs comparing outcomes in women undergoing angiography
with radial vs femoral approaches. The primary outcome was non-coronary
artery bypass graft (CABG) related bleeding at 30 days. Secondary outcomes
included major adverse cardiovascular or cerebrovascular events (MACCE; a
composite of death, stroke or myocardial infarction), vascular
complications, procedure duration, and access-site crossover. Results.
Four studies (n = 6041 female patients) met the inclusion criteria. In
female patients undergoing coronary angiography, radial access decreased
non-CABG related bleeding (odds ratio [OR], 0.56; 95% confidence interval
[CI], 0.44-0.72; P<.001), MACCE (OR, 0.73; 95% CI, 0.58-0.93; P=.01),
vascular complications (OR, 0.49; 95% CI, 0.32-0.75; P<.001) with no
significant difference in procedure time (mean difference, 0.04; 95% CI,
-0.97 to 0.89; P=.93). There was an increase in access-site crossover
using the radial approach (OR, 2.86; 95% CI, 2.24-3.63; P<.001). Patients
undergoing radial approach were more likely to prefer radial access for
the next procedure (OR, 6.96; 95% CI, 5.70-8.50; P<.001). Conclusions. In
female patients undergoing coronary angiography or intervention, the
radial approach is associated with decreased bleeding, MACCE, and vascular
complications. These data suggest that radial access should be the
preferred approach for women. Copyright © 2019 HMP
Communications. All rights reserved.

<66>
Accession Number
2003688077
Title
Plaque sealing with drug-eluting stents versus medical therapy for
treating intermediate non-obstructive saphenous vein graft lesions: A
pooled analysis of the VELETI and VELETI II trials.
Source
Journal of Invasive Cardiology. 31 (11) (pp E308-E315), 2019. Date of
Publication: 2019.
Author
Maes F.; Jolly S.S.; Cairns J.; Delarochelliere R.; Cote M.; Dzavik V.;
Rodes-Cabau J.
Institution
(Maes, Delarochelliere, Cote, Rodes-Cabau) Quebec Heart and Lung
Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, QC G1V 4G5,
Canada
(Jolly) Population Health Research Institute, Hamilton Health Sciences,
McMaster University, Hamilton, ON, Canada
(Cairns) Vancouver General Hospital, Vancouver, BC, Canada
(Dzavik) Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON,
Canada
Publisher
HMP Communications
Abstract
Background. The presence of intermediate "non-obstructive" saphenous vein
graft (SVG) lesions is a strong predictor of cardiac events. We wanted to
assess the efficacy of sealing these SVG lesions with drug-eluting stent
(DES) implantation for reducing major adverse cardiac event (MACE) rate.
Methods. The present analysis is based on the pooled data from the VELETI
and VELETI II randomized trials. Patients with at least 1 intermediate SVG
lesion (30%-60% diameter stenosis) were randomized to DES implantation
(SVG-DES) or medical treatment (SVG-MT). The primary outcome was the first
occurrence of MACE, defined as the composite of cardiac death, myocardial
infarction, or coronary revascularization related to the target SVG.
Results. A total of 182 patients were included (mean age, 70 +/- 9 years),
with 90 and 92 patients allocated to the SVG-DES and SVG-MT groups,
respectively. After a mean follow-up of 4 +/- 1 years, patients in the
SVG-MT group exhibited a higher rate of MACE related to the target SVG
(23.9% vs 17.8% in the SVG-DES group; P=.04) and MACE related to the
target SVG lesion (21.7% vs 12.2% in the SVG-DES group; P<.01). In the
multivariable analysis, a higher total cholesterol value at baseline
(P=.04) was the only independent predictor of SVG disease progression
leading to clinical events. Conclusions. In patients with prior coronary
artery bypass grafting and intermediate non-obstructive SVG lesions,
plaque sealing with DES reduced the incidence of MACE related to SVG
disease progression. A higher cholesterol level was the main predictor of
SVG disease progression leading to clinical events in these
patients. Copyright © 2019 HMP Communications. All rights
reserved.

<67>
Accession Number
2003686103
Title
Qing-Xin-Jie-Yu Granule for patients with stable coronary artery disease
(QUEST Trial): A multicenter, double-blinded, randomized trial.
Source
Complementary Therapies in Medicine. 47 (no pagination), 2019. Article
Number: 102209. Date of Publication: December 2019.
Author
Li J.; Gao Z.; Zhang L.; Li S.; Yang Q.; Shang Q.; Gao X.; Qu H.; Gao J.;
Shi L.; Liu Y.; Du J.; Xu H.; Shi D.
Institution
(Li, Zhang) Department of Cardiology, Dongzhimen Hospital, The First
Affiliated Hospital of Beijing University of Chinese Medicine, Beijing,
China
(Li, Gao, Li, Yang, Shang, Qu, Gao, Liu, Du, Xu, Shi) Cardiovascular
Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical
Sciences, Beijing, China
(Gao) Internal Medicine Division, Tieying Hospital of Fengtai District,
Beijing, China
(Shi) Department of Cardiovasology, Beijing Chinese Medicine Hospital,
Capital Medical University, Beijing, China
Publisher
Churchill Livingstone
Abstract
Background and aim: Despite optimal secondary preventive treatment,
patients with stable coronary artery disease (SCAD) remain at high risk of
cardiovascular events. This multicenter, double-blinded, randomized trial
sought to determine whether the addition of Qing-Xin-Jie-Yu Granule
(QXJYG), a traditional Chinese medicine prescription, to standard therapy
would further reduce risk of cardiovascular events in patients with SCAD.
 Method(s): A total of 1500 patients with documented SCAD were
randomly assigned in a 1:1 ratio to QXJYG or placebo for 6 months, and
followed up for another 6 months. The primary outcome was a composite of
cardiovascular death, nonfatal myocardial infarction (MI) and coronary
revascularization. Near the end of the trial, but before unblinding, a
commonly used composite 'hard' endpoint composed of cardiovascular death,
nonfatal myocardial infarction and ischemic stroke was additionally
analyzed. Result(s): During a median follow-up of 12 months, no
significant difference of the primary outcome between the two groups was
observed (1.59% vs. 1.62%; hazard ratio, 0.41; 95% CI, 0.13-1.28).
However, absolute risk of the composite 'hard' endpoint was reduced by
0.99% (0.31% vs. 1.30%; hazard ratio, 0.06; 95%CI, 0.01 to 0.53). No
difference of adverse events between the two groups was observed.
 Conclusion(s): In patients with SCAD, the addition of QXJYG to
standard therapy was associated with reduced risk of nonfatal MI and the
composite 'hard' endpoint of cardiovascular death, nonfatal MI and stroke.
(http://www.chictr.org.cn/showproj.aspx?proj=5200,
ChiCTR-TRC-13004370). Copyright © 2019 Elsevier Ltd

<68>
Accession Number
2001445897
Title
Transcatheter versus surgical aortic valve replacement in low-risk
surgical patients: A meta-analysis of randomized clinical trials.
Source
Cardiovascular Revascularization Medicine. 20 (10) (pp 838-842), 2019.
Date of Publication: October 2019.
Author
Kheiri B.; Osman M.; Abubakar H.; Subahi A.; Chahine A.; Ahmed S.; Bachuwa
G.; Alkotob M.L.; Hassan M.; Bhatt D.L.
Institution
(Kheiri, Chahine, Ahmed, Bachuwa) Department of Internal Medicine, Hurley
Medical Center, Michigan State University, Flint, MI, United States
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, WV, United States
(Abubakar, Subahi) Department of Internal Medicine, Wayne State
University, Detroit, MI, United States
(Alkotob, Hassan) Division of Cardiology, Hurley Medical Center, Michigan
State University, Flint, MI, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a valid
option for patients with high or intermediate surgical risk. However,
clinical outcomes of TAVR in low-risk patients are lacking. Our aim was to
evaluate the efficacy and safety of TAVR versus surgical aortic valve
replacement (SAVR) in low-surgical-risk patients. Method(s):
Electronic database review was conducted for all randomized clinical
trials (RCTs) that compared TAVR versus SAVR in low-risk patients. We
calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a
random-effects model. Result(s): We included 3 RCTs totaling 604
patients (310 TAVR and 294 SAVR). Our results showed no significant
difference in mortality between TAVR compared with SAVR (RR = 0.71; 95% CI
= 0.22-2.30; P = 0.56), however, there was a significantly increased risk
of pacemaker implantation (RR = 7.28; 95% CI = 3.94-13.42; P < 0.01) and
moderate/severe paravalvular leakage (PVL) (RR = 6.74; 95% CI =
1.31-34.65; P = 0.02) with TAVR. Nevertheless, TAVR demonstrated a
significantly reduced risk of post-procedural bleeding (RR = 0.40; 95% CI
= 0.30-0.54; P < 0.01) and new-onset atrial fibrillation (RR = 0.36; 95%
CI = 0.27-0.47; P < 0.01). Other clinical outcomes were not significantly
different between the groups and included cardiovascular mortality,
stroke, transient ischemic attack, and myocardial infarction.
 Conclusion(s): Among low-risk patients, TAVR offered comparable
efficacy outcomes and fewer bleeding events compared with SAVR. There were
increased risks of pacemaker implantation and PVL associated with TAVR,
though lower atrial fibrillation risks. Copyright © 2018 Elsevier
Inc.

<69>
Accession Number
2002055719
Title
Current Readings on Outcomes After Off-Pump Coronary Artery Bypass
Grafting.
Source
Seminars in Thoracic and Cardiovascular Surgery. 31 (4) (pp 726-733),
2019. Date of Publication: Winter 2019.
Author
Patel V.; Unai S.; Gaudino M.; Bakaeen F.
Institution
(Patel, Unai, Bakaeen) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
Publisher
W.B. Saunders
Abstract
Off-pump coronary artery bypass grafting (CABG) gained popularity in the
1990s through early 2000s as surgeons sought to mitigate the purported
adverse effects of cardiopulmonary bypass and reduce the risk of
neurologic events from aortic manipulation. Since then, results of several
large randomized controlled trials and meta-analyses have failed to
demonstrate an advantage of off-pump CABG over traditional on-pump CABG
and have even raised concerns about potential suboptimal outcomes. The
modern debate about off- vs on-pump CABG centers around long-term
outcomes, the role of surgeon experience, identification of specific
patient populations for which off-pump CABG is most appropriate, and
identification of novel techniques and technologies to improve long-term
outcomes. We review the key findings of 5 contemporary papers that address
these issues and provide a current perspective on the status of off-pump
CABG. Copyright © 2019 Elsevier Inc.

<70>
Accession Number
2002683140
Title
Network meta-analysis of new-generation valves for transcatheter aortic
valve implantation.
Source
Heart and Vessels. 34 (12) (pp 1984-1992), 2019. Date of Publication: 01
Dec 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, 762-1 Nagasawa, Sunto-gun, Shizuoka, Shimizu-cho 411-8611,
Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
To comprehensively compare and rank new-generation valves (NGVs) for
transcatheter aortic valve implantation, we performed a network
meta-analysis (NMA) of all eligible comparative studies. MEDLINE and
EMBASE were searched through September 2018. We included all studies
comparing 4 NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3) and an early
generation valve (CoreValve) as the reference transcatheter heart valve
(THV) each other and reporting at least one of postprocedural incidence of
all-cause death, >= moderate aortic regurgitation (AR), and new permanent
pacemaker implantation (PMI). To compare different THVs, a random-effects
restricted-maximum-likelihood NMA based on a frequentist framework for
indirect and mixed comparisons was used. Using surface under the
cumulative ranking curve (SUCRA), the relative ranking probability of each
THV was estimated and the hierarchy of competing THVs was obtained. We
identified 29 eligible studies enrolling a total of 17,817 patients. In
accordance with the estimated SUCRA probability, SAPIEN 3 was the best
effective for a reduction in death (80.6%) and the second best for
decreased >= moderate AR (74.4%) and PMI (74.1%) compared with the other
THVs. Lotus was ranked the best for a reduction in >= moderate AR
(94.5%;), whereas the worst for decreased PMI (1.2%) and the second worst
for a reduction in mortality (38.6%). ACURATE was the best for decreased
PMI (99.2%) and the second best for a reduction in mortality (77.9%). As a
whole, SAPIEN 3 may be the best effective NGV among the 4 examined NGVs
(ACURATE, Evolut R, Lotus, and SAPIEN 3). Copyright © 2019,
Springer Japan KK, part of Springer Nature.

<71>
Accession Number
2003559615
Title
Update on stem cell technologies in congenital heart disease.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Brown M.A.; Rajamarthandan S.; Francis B.; O'Leary-Kelly M.K.; Sinha P.
Institution
(Brown, Rajamarthandan, Francis, O'Leary-Kelly) School of Medicine,
Georgetown University, Washington, DC, United States
(Sinha) Department of Cardiac Surgery, Children's National Medical Center,
Washington, DC, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Congenital heart disease (CHD) continues to be among the most
common birth defects, affecting an estimated 40 000 births annually in the
United States. The most common complication of CHD is heart failure. With
improved medical management and surgical outcomes, survival for complex
congenital heart defects has dramatically improved, but consequentially
there are more adults with CHD than children with CHD. Due to longer-term
sequelae of CHD, surgical and medical treatment previously thought to be
curative is now realized at best to be palliative, and there is a
considerable burden of CHD-related heart failure. Stem cell therapy as an
adjunct to current surgical and medical strategies is being explored in an
effort to ameliorate CHD-related heart failure. This review aims to
explore the current literature with regard to stem cell therapy for CHD as
well as ongoing trials. Method(s): A MEDLINE (Ovid), MEDLINE
(Pubmed), and clinicaltrials.gov search were performed using the medical
subject headings congenital heart defects combined with hematopoietic stem
cells, stem cell transplantation, mesenchymal stem cells (MSC), cell- or
tissue-based therapy, or MSC transplantation. Articles must have been
published after 2010. Result(s): Twenty three articles and 9 ongoing
trials met all inclusion criteria. Conclusion(s): Areas of interest
include myocardiocyte regeneration, tissue graft development to minimize
reoperations, and methods of stem cell delivery. While several small
trials are showing promise, it is too soon to make definitive statements
about the future of stem cell therapies in this field. Copyright
© 2019 Wiley Periodicals, Inc.

<72>
Accession Number
2002219762
Title
Hemoadsorption to Reduce Plasma-Free Hemoglobin During Cardiac Surgery:
Results of REFRESH I Pilot Study.
Source
Seminars in Thoracic and Cardiovascular Surgery. 31 (4) (pp 783-793),
2019. Date of Publication: Winter 2019.
Author
Gleason T.G.; Argenziano M.; Bavaria J.E.; Kane L.C.; Coselli J.S.;
Engelman R.M.; Tanaka K.A.; Awad A.; Sekela M.E.; Zwischenberger J.B.
Institution
(Gleason) University of Pittsburgh Medical Center, Department of
Cardiothoracic Surgery, Pittsburgh, PA, United States
(Argenziano) Columbia University Medical Center-New York Presbyterian
Hospital, Department of Surgery, New York, NY, United States
(Bavaria) Hospital of the University of Pennsylvania, Department of
Surgery, Philadelphia, PA, United States
(Kane) Texas Children's Hospital, Department of Surgery, Houston, TX,
United States
(Coselli) Texas Heart Institute, Department of Surgery, Houston, TX,
United States
(Engelman) Baystate Medical Center, Department of Surgery, Springfield,
MA, United States
(Tanaka) University of Maryland School of Medicine, Department of
Anesthesiology, Baltimore, MD, United States
(Awad) Cooper University Hospital, Camden, NJ, United States
(Sekela, Zwischenberger) University of Kentucky College of Medicine,
Department of Surgery, Lexington, KY, United States
Publisher
W.B. Saunders
Abstract
Generation of plasma-free hemoglobin (pfHb) and activated complement
during complex cardiac surgery contributes to end-organ dysfunction. This
prospective, multicenter REFRESH I (REduction in FREe Hemoglobin)
randomized controlled trial evaluated the safety and feasibility of
CytoSorb hemoadsorption therapy to reduce these factors during prolonged
cardiopulmonary bypass (CPB). Eligible patients underwent elective,
nonemergent complex cardiac surgery with expected CPB duration >=3 hours.
Exclusions included single procedures including primary coronary artery
bypass graft, single valves, transplant, and left ventricular assist
device extraction. TREATMENT used 2 parallel 300 mL CytoSorb
hemoadsorption cartridges in a side circuit during CPB. CONTROL was
standard of care. Of 52 enrolled patients, 46 underwent surgery (Safety
group, n = 23 vs Control, n = 23), and 38 were evaluated for pfHb
reduction (EFFICACY group, n = 18 vs CONTROL, n = 20). Type and number of
serious adverse events (44 vs 43 CONTROL) were similar, as was 30-day
mortality. Transient reduction in platelets during CPB was observed in
both groups, especially TREATMENT, but returned to pretreatment levels
after CPB without bleeding. Peak pfHb was positively correlated with CPB
length (P = 0.01) but the high variability of pfHb, due to the broad
surgical procedure mix, prevented detection of changes in pfHb in the
overall EFFICACY population. However, the valve replacement surgery
subgroup (8 vs 10 CONTROL) had the highest peak pfHb levels, and TREATMENT
demonstrated significant pfHb reductions vs CONTROL (P <= 0.05) in CPB >=3
hours. In the EFFICACY group, C3a and C5a were significantly reduced by
treatment throughout surgery. Intraoperative hemoadsorption with CytoSorb
was safe and feasible in this randomized, controlled pilot study during
complex cardiac surgery. Treatment with CytoSorb resulted in significant
reductions in pfHb during valve replacement surgery and reductions in C3a
and C5a in the overall EFFICACY group. Future studies will target complex
cardiac surgery patients with prolonged CPB to assess hemoadsorption
effect on end-organ dysfunction and outcomes. Copyright © 2019

<73>
Accession Number
629829957
Title
Beneficial effect of left atrial appendage closure during cardiac surgery:
a meta-analysis of 280 585 patients.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 11 Nov 2019.
Author
Martin Gutierrez E.; Castano M.; Gualis J.; Martinez-Comendador J.M.;
Maiorano P.; Castillo L.; Laguna G.
Institution
(Martin Gutierrez, Castano, Gualis, Maiorano, Castillo, Laguna) Servicio
de Cirugia Cardiaca, Hospital Universitario de Leon - CAULE, Leon, Spain
(Martinez-Comendador) Servicio de Cirugia Cardiaca, Complexo Hospitalario
Universitario A Coruna (CHUAC), A Coruna, Spain
Publisher
NLM (Medline)
Abstract
In non-rheumatic atrial fibrillation (AF), left atrial appendage (LAA) is
thought to be the source of embolism in 90% of the strokes. Thus, as
recent clinical trials have shown the non-inferiority of percutaneous LAA
closure (LAAc) in comparison to medical treatment, and despite a IIb
recommendation in the latest guidelines for concomitant surgical LAAc, we
sought to investigate the beneficial effect of LAAc in the surgical
population. A meta-analysis model was performed comparing studies
including any cardiac surgery with or without concomitant surgical LAAc
reporting stoke/embolic events and/or mortality, from inception to January
2019. Twenty-two studies (280 585 patients) were included in the model.
Stroke/embolic events both in the perioperative period [relative risk (RR)
0.66, 95% confidence interval (CI) 0.53-0.82; P = 0.0001] and during
follow-up of >2 years (RR 0.67, 95% CI 0.51-0.89; P < 0.005) were
significantly reduced in patients who underwent surgical LAAc (RR 0.71,
95% CI 0.58-0.87; P = 0.001). Regarding the rate of preoperative AF, LAAc
showed protective effect against stroke/embolic events in studies with
>70% preoperative AF (RR 0.64, 95% CI 0.53-0.77; P<0.00001) but no benefit
in the studies with <30% of preoperative AF (RR 0.77, 95% CI 0.46-1.28;
P=0.31). Postoperative mortality was also significantly lower in surgical
patients with LAAc at the mid- and long-term follow-up. (RR 0.72, 95% CI
0.67-0.78; P<0.00001; I2=0%). Based on these findings, concomitant
surgical LAAc is associated with lower rates of embolic events and stroke
in the postoperative period in patients with preoperative AF and also
improves postoperative mortality in the mid- and long-term
follow-up. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<74>
Accession Number
629828496
Title
Impact of patient blood management guidelines on blood transfusions and
patient outcomes during cardiac surgery.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination), 2019.
Date of Publication: 07 Oct 2019.
Author
Irving A.H.; Harris A.; Petrie D.; Higgins A.; Smith J.; McQuilten Z.K.
Institution
(Irving, Harris, Petrie) Centre for Health Economics, Monash University,
Melbourne, Australia
(Higgins) Australian and New Zealand Intensive Care Research Centre,
School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia
(Smith) Department of Surgery, School of Clinical Sciences at Monash
Health, Monash University, Melbourne, Australia; Department of
Cardiothoracic Surgery, Monash Health, Melbourne, Australia
(McQuilten) Australian and New Zealand Intensive Care Research Centre,
School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia; Department of Haematology, Monash Health, Melbourne,
Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVE: In March 2012, Australia's National Blood Authority published
national patient blood-management guidelines for perioperative care
developed by a systematic review and clinical expert opinion. This study
assesses how blood transfusions and patient outcomes in cardiac surgery
changed after the guidelines were published. METHOD(S): Blood
transfusions and patient outcomes in cardiac surgery were compared before
and after implementation of the guidelines using an interrupted time
series analysis. The evaluation included red blood cells, platelets,
cryoprecipitate, fresh-frozen plasma, 30-day mortality, 30-day
readmissions, and hospital and intensive care length of stay. Patient
characteristics were controlled for along with hospital characteristics
using fixed effects. Different responses across institutional settings
were assessed with an expanded difference-in-differences model.
 RESULT(S): After the guidelines were published, our model found a
significant reduction in red blood cell, platelet, and fresh-frozen plasma
transfusions. There was also a significant reduction in hospital length of
stay but no significant impact on cryoprecipitate, 30-day mortality,
30-day readmissions, or intensive care unit length of stay. The subgroup
analyses found no differences with regards to institutional settings.
 CONCLUSION(S): Following the publication of the guidelines, there was
a measurable reduction in perioperative blood transfusions in cardiac
surgery with an associated reduction in hospital length of stay but no
detectable differences in other patient outcomes. Copyright ©
2019 The American Association for Thoracic Surgery. Published by Elsevier
Inc. All rights reserved.

<75>
Accession Number
2003235793
Title
A randomised single-centre trial of inhaled liposomal cyclosporine for
bronchiolitis obliterans syndrome post-lung transplantation.
Source
ERJ Open Research. 5 (4) (no pagination), 2019. Article Number:
00167-2019. Date of Publication: October 2019.
Author
Iacono A.; Wijesinha M.; Rajagopal K.; Murdock N.; Timofte I.; Griffith
B.; Terrin M.
Institution
(Iacono, Murdock, Timofte) Shock, Trauma and Transplantation and Dept of
Medicine, University of Maryland, Baltimore, MD, United States
(Wijesinha, Terrin) Dept of Epidemiology, University of Maryland,
Baltimore, MD, United States
(Rajagopal) Memorial Hermann Hospital Texas Medical Center, Houston, TX,
United States
(Griffith) Dept of Cardiothoracic Surgery, University of Maryland,
Baltimore, MD, United States
Publisher
European Respiratory Society (E-mail: info@ersnet.org)
Abstract
No proven treatments exist for bronchiolitis obliterans syndrome (BOS)
following lung transplantation. Inhaled liposomal cyclosporine (L-CsA) may
prevent BOS progression. Method(s): A 48-week phase IIb randomised
clinical trial was conducted in 21 lung transplant patients with BOS
assigned to either L-CsA with standard-of-care (SOC) oral
immunosuppression (L-CsA group) or SOC (SOC-alone group). Efficacy
end-points were BOS progression-free survival (defined as absence of >=20%
decline in forced expiratory volume in 1 s (FEV1) from randomisation,
re-transplantation or death) and BOS grade change. Result(s): BOS
progression-free survival was 82% for L-CsA versus 50% for SOC-alone
(p=0.1) and BOS grade worsened in 18% for L-CsA versus 60% for SOC-alone
(p=0.05). Mean changes in deltaFEV<inf>1</inf> and forced vital capacity,
respectively, stabilised with L-CsA: +0.005 (95% CI -0.004-+0.013) and
-0.005 (95% CI -0.015-+0.006) L.month-1, but worsened with
SOC-alone: -0.023 (95% CI -0.033--0.013) and -0.026 (95% CI -0.039--0.014)
L.month-1 (p<0.0001 and p=0.009). Median survival (4.1 versus
2.9 years; p=0.03) and infection rate (45% versus 60%; p=0.7) improved
with L-CsA versus SOC-alone; creatinine and tacrolimus levels were
similar. Conclusion(s): L-CsA was well tolerated and stabilised lung
function in lung transplant recipients affected by BOS without systemic
toxicity, providing a basis for a global phase III trial using
L-CsA. Copyright © ERS 2019.

<76>
Accession Number
629724095
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) (no pagination), 2019. Article Number: e029507. Date of
Publication: 01 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, Bristol Royal Infirmary, University
Hospitals Bristol, NHS Foundation Trust, 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
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
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 5 weeks
after randomisation (approximately 1 month 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 1 year. 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.

<77>
Accession Number
629723817
Title
Recurrence Risk in Patients with Cryptogenic Stroke, Patent Foramen Ovale,
and Thrombophilia: A Systematic Review and Meta-Analysis.
Source
Thrombosis and Haemostasis. 119 (11) (pp 1839-1848), 2019. Date of
Publication: 2019.
Author
Hviid C.V.B.; Simonsen C.Z.; Hvas A.-M.
Institution
(Hviid, Hvas) Thrombosis and Hemostasis Research Unit, Department of
Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens
Boulevard 99, Aarhus N 8200, Denmark
(Simonsen) Department of Neurology, Aarhus University Hospital, Aarhus,
Denmark
(Hvas) Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Objective ?A patent foramen ovale (PFO) is frequently associated with
cryptogenic stroke in the young. Endovascular closure is superior to
antithrombotic treatment in prevention of recurrence, but in the presence
of a concomitant thrombophilia, the best preventive strategy is unknown.
This review investigates if thrombophilia increases the risk of recurrence
in patients with cryptogenic stroke and PFO and attempts to evaluate the
best antithrombotic strategy after PFO closure in these patients. Methods
?Medline, Embase, and Web of Science were searched until April 2018. Study
quality was assessed by the National Heart, Lung and Blood Institute
Quality assessment tool. Odds ratio (OR) and hazard ratio for recurrence
were pooled in a random effect model stratified by secondary preventive
strategy. Results ?Eleven studies were included. Inherited or acquired
thrombophilia was associated with an increased risk of recurrence (OR =
2.41, 95% confidence interval [CI]: 1.44-4.06). Looking only at patients
treated with PFO closure, the risk of recurrence just lost significance
(OR = 2.07, 95% CI: 0.95-4.48). The antithrombotic treatment after PFO
closure was heterogeneous and recurrent events occurred in patients with
both inherited and acquired thrombophilia treated by antiplatelet as well
as anticoagulant therapy. Conclusion ?Thrombophilia is associated with an
increased risk of recurrence in patients with PFO and cryptogenic stroke,
which may persist after PFO closure. This suggests a need for
antithrombotic therapy after PFO closure. Study heterogeneity precludes
strong conclusions on antithrombotic treatment, but life-long antiplatelet
therapy to patients without preexisting indication for anticoagulant
therapy seems reasonable. Copyright © 2019 Georg Thieme Verlag KG
Stuttgart . New York.

<78>
Accession Number
629715604
Title
Coronary artery bypass surgery plus medical therapy versus medical therapy
alone for ischaemic heart disease: A protocol for a systematic review with
meta-analysis and trial sequential analysis.
Source
Systematic Reviews. 8 (1) (no pagination), 2019. Article Number: 246. Date
of Publication: 28 Oct 2019.
Author
Lorenzen U.S.; Buggeskov K.B.; Nielsen E.E.; Sethi N.J.; Carranza C.L.;
Gluud C.; Jakobsen J.C.
Institution
(Lorenzen) Department of Vascular Surgery, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Buggeskov) Department of Thoracic Anaesthesiology, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
(Nielsen, Sethi) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Department 7812, Rigshospitalet, Copenhagen University Hospital,
Copenhagen, Denmark
(Carranza) Department of Cardiothoracic Surgery, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
(Gluud, Jakobsen) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Department 7812, Rigshospitalet, Copenhagen University Hospital,
Copenhagen, Denmark
(Jakobsen) Department of Cardiology, Holbaek Hospital, Holbaek, Denmark
(Jakobsen) Department of Regional Health Research, Faculty of Health
Sciences, University of Southern Denmark, Odense, Denmark
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Despite increasing survival, cardiovascular disease remains
the primary cause of death worldwide with an estimated 7.4 million annual
deaths. The main symptom of ischaemic heart disease is chest pain (angina
pectoris) most often caused by blockage of a coronary artery. The aim of
coronary artery bypass surgery is revascularisation achieved by surgically
grafting harvested arteries or veins distal to the coronary lesion
restoring blood flow to the heart muscle. Older evidence suggested a clear
survival benefit of coronary artery bypass graft surgery, but more recent
trials yield less clear evidence. We want to assess the benefits and harms
of coronary artery bypass surgery combined with different medical
therapies versus medical therapy alone in patients with ischaemic heart
disease. Method(s): This protocol for a systematic review follows the
recommendations of Cochrane and the eight-step assessment procedure
suggested by Jakobsen and colleagues. We plan to include all randomised
clinical trials assessing coronary artery bypass surgery combined with
different medical therapies versus medical therapy alone in patients with
ischaemic heart disease. We plan to search the Cochrane Central Register
of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, Science Citation
Index Expanded on Web of Science, and BIOSIS to identify relevant trials.
Any eligible trial will be assessed as high risk or low risk of bias, and
our conclusions will primarily be based on trials at low risk of bias. The
analyses of the extracted data will be performed using Review Manager 5,
STATA 16 and trial sequential analysis. For both our primary and secondary
outcomes, we will create a 'Summary of Findings' table and use GRADE to
assess the certainty of the evidence. Discussion(s): Coronary artery
bypass surgery is invasive and can cause death, which is why its use must
be thoroughly studied to determine if it yields a large enough long-term
benefit for the thousands of patients receiving it every year. Systematic
review registration: PROSPERO ID 131924. Copyright © 2019 The
Author(s).

<79>
Accession Number
629715603
Title
Protocol for a systematic review and network meta-analysis of the
management of new onset atrial fibrillation in critically unwell adult
patients.
Source
Systematic Reviews. 8 (1) (no pagination), 2019. Article Number: 242. Date
of Publication: 28 Oct 2019.
Author
Johnston B.W.; Hill R.; Duarte R.; Chean C.S.; McAuley D.F.; Blackwood B.;
Pace N.; Welters I.D.
Institution
(Johnston, Hill, Duarte, Chean, Welters) University of Liverpool, Royal
Liverpool and Broadgreen University Hospitals, Liverpool Health Partners,
Liverpool, United Kingdom
(McAuley, Blackwood) Wellcome-Wolfson Institute of Experimental Medicine,
Queen's University Belfast, Belfast, United Kingdom
(Pace) University of Utah, Salt Lake City, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: New onset atrial fibrillation is the most commonly encountered
arrhythmia in critically unwell patients with a reported incidence of 4%
to 29%. The occurrence of new onset atrial fibrillation may precipitate
acute heart failure and lead to thromboembolic complications as well as
being associated with increased in-hospital and in intensive care unit
(ICU) mortality. Despite being common, much of our current knowledge
regarding the treatment of new onset atrial fibrillation comes from
patients with chronic atrial fibrillation or post cardiac surgery. It is
unclear if management strategies in these patient cohorts can be applied
to new onset atrial fibrillation in the general ICU. This protocol for a
systematic review and network meta-analysis aims to address this
uncertainty and define what is the most effective management strategy for
the treatment of new onset atrial fibrillation (NOAF) in acutely unwell
adult patients. Method(s): In this systematic review and network
meta-analysis, we plan to search electronic databases (Cochrane Central
Register of Controlled Trials [CENTRAL], MEDLINE, EMBASE, Science Citation
Index Expanded on Web of Science and relevant trial registries) for
relevant randomised and non-randomised trials. Citations will be reviewed
by title, abstract and full text by two independent reviewers and
disagreement resolved by discussion and a third independent reviewer, if
necessary. The Cochrane Risk of Bias tool will be used to assess risk of
bias in randomised trials and the Risk of Bias in Nonrandomised Studies of
Interventions (ROBINS-I) tool will be used for non-randomised studies.
Statistical analysis will be carried out using R package meta and netmeta.
We will first conduct a pairwise meta-analysis. If conditions for indirect
comparison are satisfied and suitable data are available, we will conduct
network meta-analysis using frequentist methodology. Treatments will be
ranked according to efficacy with associated P-scores. We will assess the
quality of the evidence in the pairwise using GRADE methodology and
network meta-analysis comparisons in the CINeMA module in R package meta.
 Discussion(s): Our review will be the first to assess direct and
indirect evidence to assess the efficacy and rank the treatments available
for new onset atrial fibrillation in critically unwell patients. Our
review findings will be applicable to the care of people in a range of
acute settings including, ICU, the emergency department and acute medical
units. Systematic review registration: PROSPERO registry number:
CRD42019121739. Copyright © 2019 The Author(s).

<80>
Accession Number
2001598863
Title
Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting
in Unprotected Left Main Coronary Artery Stenosis.
Source
American Journal of the Medical Sciences. 357 (3) (pp 230-241), 2019. Date
of Publication: March 2019.
Author
Wang Z.; Zhan B.; Bao H.; Huang X.; Wu Y.; Liang Q.; Zhang W.; Jiang L.;
Cheng X.
Institution
(Wang, Zhan, Bao, Huang, Wu, Jiang, Cheng) Department of Cardiovascular
Medicine, Second Affiliated Hospital of Nanchang University, Nanchang,
Jiangxi, China
(Liang) Jiangxi Key Laboratory of Molecular Medicine, Second Affiliated
Hospital of Nanchang University, Nanchang, Jiangxi, China
(Zhang) Department of Pharmacy, Second Affiliated Hospital of Nanchang
University, Nanchang, Jiangxi, China
Publisher
Elsevier B.V.
Abstract
Background: The present study performed a meta-analysis of randomized and
prospective trials to compare the outcomes of percutaneous coronary
intervention (PCI) with stents versus coronary artery bypass graft surgery
(CABG) for unprotected left main coronary artery (UPLM) stenosis.
 Method(s): The Cochrane Library, PubMed and EMBASE databases were
systematically searched until July 2017. The Newcastle-Ottawa scale was
used for quality assessment. Result(s): A total of 19 studies with
16,900 participants were included. Pooled analysis showed no significant
differences in all-cause mortality (odds ratio [OR] 0.94; 95% CI
0.74-1.20) and cardiac death (OR 1.04; 95% CI 0.74-1.47). However,
subgroup analysis showed that PCI was associated with a low all-cause
mortality rate at 30-day follow up (OR 0.48; 95% CI 0.26-0.89). The stroke
rate in PCI was lower in short-term follow up (OR 0.45; 95% CI 0.23-0.88)
and long-term follow up (OR 0.36; 95% CI 0.27-0.47). On the other hand,
PCI was associated with higher risk of myocardial infarction (OR 1.59; 95%
CI 1.34-1.88), repeat revascularization (OR 2.47; 95% CI 1.80-3.37) and
target vessel revascularization (OR 2.10; 95% CI 1.72-2.57) compared to
CABG in the pooled analysis. Conclusion(s): The current evidence
suggests that the risk of stroke was significantly reduced in PCI compared
to that in CABG. Therefore, PCI is the preferred treatment for patients
with a high risk of stroke. Additionally, in short-term follow up, PCI was
reported to be safe and effective for UPLM patients compared to CABG.
However, CABG caused fewer complications long term. Copyright ©
2019 Southern Society for Clinical Investigation

<81>
Accession Number
623487752
Title
Mitochondrial and contractile function of human right atrial tissue in
response to remote ischemic conditioning.
Source
Journal of the American Heart Association. 7 (15) (no pagination), 2018.
Article Number: e009540. Date of Publication: 01 Aug 2018.
Author
Kleinbongard P.; Gedik N.; Kirca M.; Stoian L.; Frey U.; Zandi A.;
Thielmann M.; Jakob H.; Peters J.; Kamler M.; Heusch G.
Institution
(Kleinbongard, Gedik, Kirca, Stoian, Heusch) Institut fur
Pathophysiologie, Westdeutsches Herz- und Gefaszentrum,
Universitatsklinikum Essen, Germany
(Frey, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Germany
(Zandi, Kamler) Klinik fur Herzchirurgie Essen-Huttrop, Westdeutsches
Herz- und Gefaszentrum, Universitatsklinikum Essen, Germany
(Thielmann, Jakob) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Westdeutsches Herz- und Gefaszentrum, Universitatsklinikum Essen, Germany
Publisher
American Heart Association Inc.
Abstract
Background-Remote ischemic preconditioning (RIPC) by repeated brief cycles
of limb ischemia/reperfusion attenuates myocardial ischemia/reperfusion
injury. We aimed to identify a functional parameter reflecting the
RIPC-induced protection in human. Therefore, we measured mitochondrial
function in right atrial tissue and contractile function of isolated right
atrial trabeculae before and during hypoxia/reoxygenation from patients
undergoing coronary artery bypass grafting with RIPC or placebo,
respectively. Methods and Results-One hundred thirty-seven patients under
isoflurane anesthesia underwent RIPC (3x5 minutes blood pressure cuff
inflation on the left upper arm/5 minutes deflation, n=67) or placebo
(cuff uninflated, n=70), and right atrial appendages were harvested before
ischemic cardioplegic arrest. Myocardial protection by RIPC was assessed
from serum troponin I/T concentrations over 72 hours after surgery. Atrial
tissue was obtained for isolation of mitochondria (RIPC/placebo: n=10/10).
Trabeculae were dissected for contractile function measurements at
baseline and after hypoxia/reoxygenation (60 min/30 min) and for western
blot analysis after hypoxia/reoxygenation (RIPC/placebo, n=57/60).
Associated with cardioprotection by RIPC (26% decrease in the area under
the curve of troponin I/T), mitochondrial adenosine diphosphate-stimulated
complex I respiration (+10%), adenosine triphosphate production (+46%),
and calcium retention capacity (+37%) were greater, whereas reactive
oxygen species production (-24%) was less with RIPC than placebo.
Contractile function was improved by RIPC (baseline, +7%; reoxygenation,
+24%). Expression and phosphorylation of proteins, which have previously
been associated with cardioprotection, were not different between RIPC and
placebo. Conclusions-Cardioprotection by RIPC goes along with improved
mitochondrial and contractile function of human right atrial
tissue. Copyright © 2018 The Authors.

<82>
Accession Number
624784122
Title
Comparison of angiotensin-converting enzyme inhibitor and angiotensin
receptor blocker management strategies before cardiac surgery: A pilot
randomized controlled registry trial.
Source
Journal of the American Heart Association. 7 (20) (no pagination), 2018.
Article Number: 009917. Date of Publication: 01 Oct 2018.
Author
van Diepen S.; Norris C.M.; Zheng Y.; Nagendran J.; Graham M.M.; Ortega
D.G.; Townsend D.R.; Ezekowitz J.A.; Bagshaw S.M.
Institution
(van Diepen, Norris, Ortega, Townsend, Bagshaw) Department of Critical
Care Medicine, Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
(van Diepen, Graham, Ezekowitz) Division of Cardiology, Department of
Medicine, University of Alberta, Edmonton, AB, Canada
(van Diepen, Zheng, Ezekowitz) Canadian VIGOUR Center, University of
Alberta, Edmonton, AB, Canada
(Norris) Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
(Norris, Nagendran) Division of Cardiac Surgery, University of Alberta
Hospital, Edmonton, AB, Canada
(van Diepen, Graham, Ezekowitz) C2 Cardiology Walter MacKenzie Center,
University of Alberta Hospital, 8440-112 St, Edmonton, AB T6G 2B7, Canada
Publisher
American Heart Association Inc.
Abstract
Background--Postoperative clinical outcomes associated with the
preoperative continuation or discontinuation of angiotensin-converting
enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) before
cardiac surgery remain unclear. Methods and Results--In a single-center,
open-label, randomized, registry-based clinical trial, patients undergoing
nonemergent cardiac surgery were assigned to ACEI/ARB continuation or
discontinuation 2 days before surgery. Among the 584 patients screened,
261 met study criteria and 126 (48.3%) patients were enrolled. In
total,121 patients (96% adherence; 60 to continuation and 61 to ACEI/ARB
discontinuation) underwent surgery and completed the study protocol, and
follow-up was 100% complete. Postoperative intravenous vasopressor use
(78.3% versus 75.4%, P=0.703), vasodilator use (71.7% versus 80.3%,
P=0.265), vasoplegic shock (31.7% versus 27.9%, P=0.648), median duration
of vasopressor (10 versus 5 hours, P=0.494), and vasodilator requirements
(10 versus 9 hours, P=0.469) were not significantly different between the
continuation and discontinuation arms. No differences were observed in the
incidence of acute kidney injury (1.7% versus 1.6%, P=0.991), stroke (no
events, mortality (1.7% versus 1.6%, P=0.991), median duration of
mechanical ventilation (6 versus 6 hours, P=0.680), and median intensive
care unit length of stay (43 versus 27 hours, P=0.420) between the
treatment arms. Conclusions--A randomized study evaluating the routine
continuation or discontinuation of ACEIs or ARBs before cardiac surgery
was feasible, and treatment assignment was not associated with differences
in postoperative physiological or clinical outcomes. These preliminary
findings suggest that preoperative ACEI/ARB management strategies did not
affect the postoperative course of patients undergoing cardiac
surgery. Copyright © 2018 The Authors.

<83>
[Use Link to view the full text]
Accession Number
627081693
Title
Effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 16 (12) (pp
2304-2329), 2018. Date of Publication: 2018.
Author
Mares M.A.; McNally S.; Fernandez R.S.
Institution
(Mares, McNally) School of Nursing and Midwifery, Western Sydney
University, Parramatta, Australia
(Mares) Centre for Applied Nursing Research, Liverpool, Australia
(Mares, McNally) New S. Wales Centre for Evidence Based Health Care: A
Joanna Briggs Institute Centre of Excellence, Liverpool, Australia
(Mares) Ingham Institute for Applied Medical Research, Liverpool,
Australia
(Fernandez) School of Nursing, University of Wollongong, Wollongong,
Australia
(Fernandez) Centre for Research in Nursing and Health, St George Hospital,
Kogarah, Australia
(Fernandez) Centre for Evidence Based Initiatives in Health Care: A Joanna
Briggs Institute Centre of Excellence, Australia
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Review objective: The objective of this review was to investigate the
effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery on patients' health-related quality
of life and hospital readmission. Introduction: Coronary heart disease is
a major cause of death and disability worldwide, putting a great strain on
healthcare resources. For the past two decades, population-wide primary
prevention and individual healthcare approaches have resulted in a
dramatic decline in overall cardiac mortality. Over the intervening years,
surgical techniques in cardiology have also improved substantially. As a
result, long-term outcomes in patients treated with coronary artery bypass
graft surgery have established the treatment's effectiveness and survival
benefit. Furthermore, participating in cardiac rehabilitation following
coronary artery bypass graft surgery has also demonstrated a significant
decrease in all-cause cardiac mortality in these patients. Inclusion
criteria: This review included studies with participants aged 18 years and
over, post coronary artery bypass graft surgery that evaluated nurse-led
cardiac rehabilitation (CR) programs compared with usual care or other
forms of CR. The outcomes of interest were the health-related quality of
life and hospital readmissions following coronary artery bypass graft
surgery and measured using validated scales. Randomized controlled trials
reported in English between 2000 to June 2017 were considered for
inclusion. Method(s): The search strategy aimed to find both
published and unpublished studies using a three-step search strategy. An
initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a
search for unpublished studies including Dissertation Abstracts
International, ProQuest Dissertations and Theses, Google Scholar, MedNar
and ClinicalTrials.gov. Papers selected for retrieval were assessed by two
independent reviewers for methodological validity prior to inclusion in
the review using the standardized critical appraisal tools from the Joanna
Briggs Institute System for the Unified Management, Assessment and Review
of Information (JBI SUMARI). Quantitative data was extracted from papers
included in the review using the standardized data extraction tool from
JBI-SUMARI. No meta-analysis was undertaken due to heterogeneity of the
outcome measures. All results were subject to double data entry. Effect
sizes expressed as risk ratio (for categorical data) and weighted mean
differences (for continuous data) and their 95% confidence intervals were
calculated for analysis. Result(s): Three trials involving 329
patients were included in the final review. The trials that investigated
the effect of home based cardiac rehabilitation programs compared to usual
care at six weeks, three months and six months follow-up demonstrated no
statistically significant difference in health-related quality of life at
any of the follow-up periods. However, one study demonstrated
significantly higher scores related to health-related quality of life
among those who received nurse-led home based cardiac rehabilitation
(154.93+/-4.6) compared to those who received usual care (134.20+/-8.2) at
two months follow-up. No trials were identified that compared the
effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery on readmissions to hospital.
 Conclusion(s): There is not enough evidence to support or discourage
nurse-led cardiac rehabilitation programs on health-related quality of
life in patients following coronary artery bypass graft surgery. However,
the sparse data available suggests improvements in health-related quality
of life at two months follow-up among those who received a nurse-led
program. Further large-scale multicenter trials with standardized
methodology are needed to determine the effect of nurse-led cardiac
rehabilitation programs on health-related quality of life and rates of
readmission to hospital following coronary artery bypass graft
surgery. Copyright © 2018 THE JOANNA BRIGGS INSTITUTE.

<84>
Accession Number
629773283
Title
The Radial Artery for Coronary Bypass Grafting: The Fifth Decade.
Source
Surgical technology international. 35 (pp 253-264), 2019. Date of
Publication: 04 Oct 2019.
Author
Nappi F.; Singh S.S.A.; Timofeeva I.; Gentile F.; Acar C.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Singh) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, University of Glasgow Institute of Cardiovascular and Medical
Sciences, Glasgow, United Kingdom
(Timofeeva) Department of Imaging, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Gentile) Cardiovascular Disease Diagnostic Medical Center, Naples, Italy
(Acar) Department of Cardiac Surgery, La Pitie Salpetriere Hospital,
Paris, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: In 1989, we reported the use of the radial artery as a second
target conduit for coronary artery bypass grafting. However, underpowered
randomized trials have reported differences in clinical outcomes between
the radial artery and other grafts. As we approach 50 years of experience
with radial artery grafting, we reviewed the literature to determine the
second-best target vessel for coronary operations. METHOD(S): An
electronic review of the literature with an emphasis on randomized
controlled trials, propensity-matched observational series, and
meta-analyses identified a large population of patients who received
arterial conduit and saphenous vein grafts. RESULT(S): The radial
artery has been proven to be reliable as a second target conduit for
coronary artery bypass grafting, with outcomes and patency rates superior
to those for saphenous vein graft. It has also been proven to be both safe
and effective as a third conduit in the territory of the right coronary
artery. A paucity of evidence with few comparable series limits the use of
the gastroepiploic artery. CONCLUSION(S): In its fifth decade of use,
we can definitively conclude that the aorto-to-coronary radial bypass
graft is the conduit of choice for coronary operations after the left
internal thoracic artery to the left anterior descending artery.

<85>
Accession Number
2003548633
Title
Clinical outcomes of mitral valve intervention in patients with mitral
annular calcification: A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Ribeiro R.V.P.; Yanagawa B.; Legare J.-F.; Hassan A.; Ouzounian M.; Verma
S.; Friedrich J.O.
Institution
(Ribeiro, Yanagawa, Verma) Division of Cardiovascular Surgery, Department
of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Ribeiro, Ouzounian) Division of Cardiovascular Surgery, Department of
Surgery, Peter Munk Cardiac Centre, University Health Network, University
of Toronto, Toronto, ON, Canada
(Legare, Hassan) Division of Cardiovascular Surgery, New Brunswick Heart
Centre, Dalhousie University, Saint John, NB, Canada
(Friedrich) Critical Care and Medicine Department, Li Ka Shing Knowledge
Institute, St. Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Friedrich) Interdepartmental Division of Critical Care, Department of
Medicine, University of Toronto, Toronto, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Mitral valve (MV) disease with mitral annular calcification
(MAC) poses a surgical challenge and the clinical outcomes of MV surgery
as well as transcatheter mitral valve replacement (TMVR) remain relatively
unexplored. We performed a systematic review and meta-analysis to assess
the effects of MAC on clinical outcomes following MV surgery and TMVR.
 Method(s): We searched MEDLINE and EMBASE databases until February
2019 for studies comparing clinical outcomes of MV surgery or TMVR in
patients with and without MAC. Data were extracted by two independent
investigators. Outcomes were perioperative and midterm complications and
mortality. Result(s): Seven observational studies enrolling 2902
patients were included. MAC patients were older, more likely to be female
with greater chronic lung disease and kidney failure. Perioperative
mortality was similar between patients with and without MAC undergoing MV
surgery (risk ratio [RR], 1.15; 95% confidence interval [CI], 0.50-2.65; P
=.74). MAC was associated with a higher risk of bleeding, permanent
pacemaker implantation, and periprosthetic leak. Midterm mortality was
greater in MAC patients undergoing MV surgery (incident rate ratio [IRR],
1.32; 95% CI, 1.05-1.67; P =.02). MAC patients undergoing TMVR had higher
perioperative (RR, 4.65; 95% CI, 2.93-7.38; P <.01) and 1-year (RR, 5.44;
95% CI, 3.49-8.49; P <.01) mortality, decreased procedural success,
greater left ventricular outflow tract obstruction and need for conversion
to surgery when compared with patients undergoing TMVR for dysfunction of
a bioprosthetic valve or annuloplasty ring. Conclusion(s): MV
procedures in patients with MAC are associated with higher mortality and
morbidity. This is largely driven by the high-risk patient profile
associated with MAC. TMVR holds promise but has important limitations and
should be reserved for select patients. Copyright © 2019 Wiley
Periodicals, Inc.

<86>
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. 123 (6) (pp 795-807), 2019. Date of
Publication: December 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): Pooled data for the incidence of adverse events
associated with use of alpha2-adrenoceptor agonists in various
perioperative contexts provide high-confidence evidence for a risk of
hypotension and bradycardia, and protective effects against hypertension
and tachycardia. Protocol Registration: CRD42017071583. Copyright
© 2019

<87>
Accession Number
629395564
Title
Standard restrictive sternal precautions and modified sternal precautions
had similar effects in people after cardiac surgery via median sternotomy
('SMART' Trial): a randomised trial.
Source
Journal of physiotherapy. 64 (2) (pp 97-106), 2018. Date of Publication:
01 Apr 2018.
Author
Katijjahbe M.A.; Granger C.L.; Denehy L.; Royse A.; Royse C.; Bates R.;
Logie S.; Nur Ayub M.A.; Clarke S.; El-Ansary D.
Institution
(Katijjahbe) Department of Physiotherapy, The University of Melbourne,
Australia; Department of Physiotherapy, Hospital Canselor Tunku Mukhriz,
University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
(Granger) Department of Physiotherapy, The University of Melbourne,
Australia; Physiotherapy Department, Royal Melbourne Hospital, Australia
(Denehy) Department of Physiotherapy, University of Melbourne, Australia
(Royse) Department of Surgery, The University of Melbourne, Australia;
Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Australia
(Royse) Department of Surgery, The University of Melbourne, Australia;
Department of Anaesthesia, Royal Melbourne Hospital, Australia
(Bates) Physiotherapy Department, Royal Melbourne Hospital, Australia
(Logie) Physiotherapy Department, Melbourne Private Hospital, Australia
(Nur Ayub) Heart and Lung Centre, University Kebangsaan Malaysia Medical
Centre, Kuala Lumpur, Malaysia
(Clarke) Statistical Consulting Centre, School of Mathematics and
Statistics, University of Melbourne, Australia
(El-Ansary) Department of Physiotherapy, The University of Melbourne,
Australia; Department of Surgery, The University of Melbourne, Australia;
Department of Health Professions, Swinburne University, Melbourne,
Australia
Publisher
NLM (Medline)
Abstract
QUESTION: In people who have undergone cardiac surgery via median
sternotomy, does modifying usual sternal precautions to make them less
restrictive improve physical function, pain, kinesiophobia and
health-related quality of life? DESIGN: Two-centre, randomised, controlled
trial with concealed allocation, blinded assessors and intention-to-treat
analysis. PARTICIPANTS: Seventy-two adults who had undergone cardiac
surgery via a median sternotomy were included. INTERVENTION: Participants
were randomly allocated to one of two groups at 4 (SD 1) days after
surgery. The control group received the usual advice to restrict their
upper limb use for 4 to 6 weeks (ie, restrictive sternal precautions). The
experimental group received advice to use pain and discomfort as the safe
limits for their upper limb use during daily activities (ie, less
restrictive precautions) for the same period. Both groups received
postoperative individualised education in hospital and via weekly
telephone calls for 6 weeks. OUTCOME MEASURES: The primary outcome was
physical function assessed by the Short Physical Performance Battery.
Secondary outcomes included upper limb function, pain, kinesophobia, and
health-related quality of life. Outcomes were measured before hospital
discharge and at 4 and 12 weeks postoperatively. Adherence to sternal
precautions was recorded. RESULT(S): There were no statistically
significant differences in physical function between the groups at 4 weeks
(MD 1.0, 95% CI -0.2 to 2.3) and 12 weeks (MD 0.4, 95% CI -0.9 to 1.6)
postoperatively. There were no statistically significant between-group
differences in secondary outcomes. CONCLUSION(S): Modified (ie, less
restrictive) sternal precautions for people following cardiac surgery had
similar effects on physical recovery, pain and health-related quality of
life as usual restrictive sternal precautions. Similar outcomes can be
anticipated regardless of whether people following cardiac surgery are
managed with traditional or modified sternal precautions. TRIAL
REGISTRATION: Australian and New Zealand Clinical Trials Registry
ANZCTRN12615000968572. [Katijjahbe MA, Granger CL, Denehy L, Royse A,
Royse C, Bates R, Logie S, Nur Ayub MA, Clarke S, El-Ansary D (2018)
Standard restrictive sternal precautions and modified sternal precautions
had similar effects in people after cardiac surgery via median sternotomy
('SMART' Trial): a randomised trial. Journal of Physiotherapy 64:
97-106]. Crown Copyright © 2018. Published by Elsevier B.V. All
rights reserved.

<88>
Accession Number
629819338
Title
Stent Thrombosis in Patients with Atrial Fibrillation Undergoing Coronary
Stenting in the AUGUSTUS Trial.
Source
Circulation. (no pagination), 2019. Date of Publication: 11 Nov 2019.
Author
Lopes R.D.; Leonardi S.; Wojdyla D.M.; Vora A.N.; Thomas L.; Storey R.F.;
Vinereanu D.; Granger C.B.; Goodman S.G.; Aronson R.; Windecker S.; Thiele
H.; Valgimigli M.; Mehran R.; Alexander J.H.
Institution
(Lopes, Wojdyla, Thomas, Granger, Alexander) Duke Clinical Research
Institute, Duke University School of Medicine, Durham
(Leonardi) University of Pavia and Fondazione IRCCS Policlinico S. Matteo,
Pavia, Italy
(Vora) UPMC Pinnacle
(Storey) University of Sheffield, Sheffield, United Kingdom
(Vinereanu) University of Medicine and Pharmacy Carol Davila, University
and Emergency Hospital of Bucharest, Romania
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton, and
Terrence Donnelly Heart Centre, St. Michael's Hospital, University of
Toronto, Toronto, Canada
(Aronson) Bristol-Myers Squibb, Lawrenceville, United States
(Windecker, Valgimigli) Bern University Hospital, Inselspital, University
of Bern, Switzerland
(Thiele) Heart Center Leipzig at University of Leipzig, Department of
Internal Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, Cardiovascular Research Foundation, NY, NY,
Sweden
Publisher
NLM (Medline)
Abstract
We describe the incidence, timing, and characteristics of stent thrombosis
and its consequences in patients with atrial fibrillation (AF) in the
AUGUSTUS trial1 who received a coronary stent during their qualifying
admission (acute coronary syndrome [ACS] or elective percutaneous coronary
intervention [PCI]) and the randomized treatment effects of low-dose
aspirin (compared with placebo) and apixaban (compared with vitamin K
antagonist [VKA]) on the risk of stent thrombosis. We included patients
who received a stent during their qualifying admission. We excluded
patients with medically-managed ACS (n=1097) or an unknown qualifying
index event (n=19). The protocol was approved by appropriate ethics
committees; patients provided written informed consent prior to
participation.

<89>
Accession Number
629818908
Title
REDUCE-IT USA: Results from the 3,146 Patients Randomized in the United
States.
Source
Circulation. (no pagination), 2019. Date of Publication: 11 Nov 2019.
Author
Bhatt D.L.; Miller M.; Brinton E.A.; Jacobson T.A.; Steg P.G.; Ketchum
S.B.; Doyle R.T.; Juliano R.A.; Jiao L.; Granowitz C.; Tardif J.-C.;
Olshansky B.; Chung M.K.; Gibson C.M.; Giugliano R.P.; Budoff M.J.;
Ballantyne C.M.
Institution
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, MA, Boston
(Miller) Department of Medicine, University of Maryland School of
Medicine, MD, Baltimore, United States
(Brinton) Utah Lipid Center, UT, Salt Lake City, United States
(Jacobson) Lipid Clinic and Cardiovascular Risk Reduction Program,
Department of Medicine, Emory University School of Medicine, Atlanta,
United States
(Steg) French Alliance for Cardiovascular Trials, Hopital Bichat, Paris,
France; Assistance Publique-Hopitaux de Paris, Universite de Paris, INSERM
Unite 1148, Paris, France
(Ketchum, Doyle, Juliano, Jiao, Granowitz) Amarin Pharma, Inc.,
Bridgewater, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Olshansky) University of Iowa, IA
(Chung) Cleveland Clinic, Cleveland, OH
(Gibson) Beth Israel Deaconess Hospital, Boston, MA; Baim Clinical
Research Institute, Boston, MA
(Giugliano) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, MA, Boston
(Budoff) Los Angeles Biomedical Research Institute at Harbor UCLA Medical
Center, Torrance, CA
(Ballantyne) Department of Medicine, Baylor College of Medicine, TX,
Houston
Publisher
NLM (Medline)
Abstract
Background: Some trials have found patients from the United States of
America (USA) derive less benefit than patients enrolled outside the USA.
This prespecified subgroup analysis of Reduction of Cardiovascular Events
with Icosapent Ethyl - Intervention Trial (REDUCE-IT) was conducted to
determine the degree of benefit of icosapent ethyl in the USA.
 Method(s): REDUCE-IT randomized 8,179 statin-treated patients with
qualifying triglycerides >=135 and <500 mg/dL and low-density lipoprotein
(LDL)-cholesterol >40 and <=100 mg/dL and a history of atherosclerosis or
diabetes to icosapent ethyl 4 grams/day or placebo. The primary endpoint
was cardiovascular death, non-fatal myocardial infarction, non-fatal
stroke, coronary revascularization, or hospitalization for unstable
angina. The key secondary endpoint was cardiovascular death, non-fatal
myocardial infarction, or non-fatal stroke. A prespecified hierarchy
examined individual and composite endpoints. Result(s): A total of
3,146 USA patients (38.5% of the trial) were randomized and followed for a
median of 4.9 years; 32.3% were women, 9.7% Hispanic. The primary endpoint
occurred in 24.7% of placebo versus 18.2% of icosapent ethyl patients
[hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.59-0.80,
p=0.000001]; the key secondary endpoint occurred in 16.6% versus 12.1% (HR
0.69, 95% CI 0.57-0.83, p=0.00008). All prespecified hierarchy endpoints
were meaningfully and significantly reduced, including cardiovascular
death (6.7% to 4.7%, HR 0.66, 95% CI 0.49-0.90, p=0.007), myocardial
infarction (8.8% to 6.7%, HR 0.72, 95% CI 0.56-0.93, p=0.01), stroke (4.1%
to 2.6%, HR 0.63, 95% CI 0.43-0.93, p=0.02), and all-cause mortality (9.8%
to 7.2%, HR 0.70, 95% CI 0.55-0.90, p=0.004); for all-cause mortality for
the USA versus non-USA patients, pinteraction=0.02. Safety and
tolerability findings were consistent with the full study cohort.
 Conclusion(s): While the non-USA subgroup showed significant
reductions in the primary and key secondary endpoints, the USA subgroup
demonstrated particularly robust risk reductions across a variety of
composite and individual endpoints, including all-cause mortality.
Clinical Trial Registration: URL: https://clinicaltrials.gov Unique
Identifier: NCT01492361.

<90>
Accession Number
629818824
Title
Del Nido cardioplegia in isolated adult coronary artery bypass surgery.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination), 2019.
Date of Publication: 24 Sep 2019.
Author
Timek T.A.; Beute T.; Robinson J.A.; Zalizadeh D.; Mater R.; Parker J.L.;
Lypka M.; Willekes C.L.
Institution
(Timek, Willekes) Division of Cardiothoracic Surgery, Spectrum Health,
Grand Rapids, Mich; Michigan State University College of Human Medicine,
Grand Rapids, Mich
(Beute, Robinson, Zalizadeh, Mater) Michigan State University College of
Human Medicine, Grand Rapids, Mich
(Parker, Lypka) Office of Research, Spectrum Health, Grand Rapids, Mich
Publisher
NLM (Medline)
Abstract
BACKGROUND: Del Nido cardioplegia (DC) offers prolonged single-dose
myocardial protection in pediatric cardiac surgery. We set out to evaluate
the efficacy of DC in adult patients undergoing isolated coronary artery
bypass grafting (CABG). METHOD(S): From January 2014 to October 2017,
851 consecutive isolated CABG surgeries were performed by 2 study surgeons
at our center with blood cardioplegia (BC, n = 350), used from January
2012 to April 2014, and DC (n = 501), used from May 2014 to October 2017.
Propensity matching was used to yield 325 well-matched pairs. Clinical
data were extracted from our local Society of Thoracic Surgeons database
and mortality data from the Michigan State Social Security Death Index.
 RESULT(S): Single-dose administration was used in 83% (417/501) of
patients receiving DC. In propensity-matched groups, postoperative median
troponin T levels (0.28 [0.16-0.59] ng/mL vs 0.46 [0.27-0.81] ng/mL; P <
.01) were lower for patients receiving DC, and no difference in ejection
fraction on postoperative echocardiography was observed (54 +/- 12% and 53
+/- 13% for BC and DC, respectively; P = .36). Perioperative outcomes were
similar except for greater rate of atrial fibrillation (33% vs 23%; P =
.01) in the DC group. Subgroup analyses revealed equivalent myocardial
protection and clinical outcomes in patients with age >=75 years, left
ventricular ejection fraction <=35%, left main disease, or Society of
Thoracic Surgeons score >=2.5%. Four-year survival did not differ between
patients undergoing BC or DC. CONCLUSION(S): The current study
revealed noninferior myocardial protection and clinical outcomes with DC
versus BC in both routine and greater-risk patients undergoing isolated
CABG. DC demonstrated the feasibility of single-dose administration for
isolated CABG surgery. Larger randomized studies are needed to further
explore the safety and efficacy of DC in adult cardiac surgery with longer
crossclamp times. Copyright © 2019 The American Association for
Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

<91>
Accession Number
629818363
Title
Does Race Influence Decision Making for Advanced Heart Failure Therapies?.
Source
Journal of the American Heart Association. 8 (22) (pp e013592), 2019. Date
of Publication: 19 Nov 2019.
Author
Breathett K.; Yee E.; Pool N.; Hebdon M.; Crist J.D.; Knapp S.; Larsen A.;
Solola S.; Luy L.; Herrera-Theut K.; Zabala L.; Stone J.; McEwen M.M.;
Calhoun E.; Sweitzer N.K.
Institution
(Breathett, Sweitzer) Division of Cardiovascular Medicine Department of
Medicine Sarver Heart Center University of Arizona Tucson AZ
(Yee, Larsen) Sarver Heart Center, Clinical Research Office University of
Arizona Tucson AZ
(Pool, Hebdon, Crist, McEwen) College of Nursing University of Arizona
Tucson AZ
(Knapp) Statistics Consulting Lab Bio5 Institute University of Arizona
Tucson AZ
(Solola) Department of Medicine University of Arizona Tucson AZ
(Luy) University of Rochester Rochester New York U.S
(Herrera-Theut, Zabala) University of Arizona Medical School Tucson AZ
(Stone) Department of Psychology University of Arizona Tucson AZ
(Calhoun) Center for Population Health Sciences University of Arizona
Tucson AZ
Publisher
NLM (Medline)
Abstract
Background Race influences medical decision making, but its impact on
advanced heart failure therapy allocation is unknown. We sought to
determine whether patient race influences allocation of advanced heart
failure therapies. Methods and Results Members of a national heart failure
organization were randomized to clinical vignettes that varied by patient
race (black or white man) and were blinded to study objectives.
Participants (N=422) completed Likert scale surveys rating factors for
advanced therapy allocation and think-aloud interviews (n=44). Survey
results were analyzed by least absolute shrinkage and selection operator
and multivariable regression to identify factors influencing advanced
therapy allocation, including interactions with vignette race and
participant demographics. Interviews were analyzed using grounded theory.
Surveys revealed no differences in overall racial ratings for advanced
therapies. Least absolute shrinkage and selection operator regression
selected no interactions between vignette race and clinical factors as
important in allocation. However, interactions between participants aged
>=40 years and black vignette negatively influenced heart transplant
allocation modestly (-0.58; 95% CI, -1.15 to -0.0002), with adherence and
social history the most influential factors. Interviews revealed
sequential decision making: forming overall impression, identifying
urgency, evaluating prior care appropriateness, anticipating challenges,
and evaluating trust while making recommendations. Race influenced each
step: avoiding discussing race, believing photographs may contribute to
racial bias, believing the black man was sicker compared with the white
man, developing greater concern for trust and adherence with the black
man, and ultimately offering the white man transplantation and the black
man ventricular assist device implantation. Conclusions Black race
modestly influenced decision making for heart transplant, particularly
during conversations. Because advanced therapy selection meetings are
conversations rather than surveys, allocation may be vulnerable to racial
bias.

<92>
Accession Number
629817956
Title
Deep Venous Thrombosis and Pulmonary Embolism in Cardiac Surgical
Patients.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 07 Nov 2019.
Author
Khoury H.; Lyons R.; Sanaiha Y.; Rudasill S.; Shemin R.J.; Benharash P.
Institution
(Khoury, Rudasill) Cardiovascular Outcomes Research Laboratories
(CORELAB), University of California Los Angeles, Los Angeles, CA
(Lyons, Shemin) Division of Cardiac Surgery, University of California Los
Angeles, Los Angeles, CA
(Sanaiha, Benharash) Cardiovascular Outcomes Research Laboratories
(CORELAB), University of California Los Angeles, Los Angeles, CA; Division
of Cardiac Surgery, University of California Los Angeles, Los Angeles, CA
Publisher
NLM (Medline)
Abstract
BACKGROUND: Deep venous thrombosis and pulmonary embolism are
life-threatening complications following surgery, warranting prophylaxis.
However, prophylaxis is not uniformly practiced among cardiac surgical
patients. This study aimed to characterize the national incidence,
mortality, and costs associated with thromboembolism following cardiac
surgery. METHOD(S): The 2005-2015 National Inpatient Sample was used
to identify all adult patients undergoing coronary artery bypass grafting
or valve surgery. International Classification of Disease codes were used
to identify patients with deep venous thrombosis and pulmonary embolism.
 RESULT(S): Of approximately 3 million patients undergoing cardiac
surgery, 1.62% developed deep venous thrombosis and 0.38% pulmonary
embolism. Those with deep venous thrombosis and pulmonary embolism were
more commonly female (33.2% and 36.2 vs. 31.2%, P<0.001), older (68.1 and
66.0% vs. 65.7 years, P<0.001), and had a higher Elixhauser comorbidity
index (4.0 and 4.7 vs. 3.7, P<0.001). Deep venous thrombosis and pulmonary
embolism were associated with increased mortality (4.95% and 14.8% vs.
2.67%, P<0.001). After adjustment for baseline differences, deep venous
thrombosis was associated with an incremental increase in cost of $12,308,
while pulmonary embolism was associated with $13,879 cost increase
following cardiac surgery. Pulmonary embolism was an independent predictor
of mortality (Adjusted Odds Ratio, 3.39; 95% Confidence Interval
2.74-4.18). CONCLUSION(S): The mortality and financial burden related
to thromboembolism in cardiac surgery are significant. Prophylaxis may be
indicated in cardiac surgery patients to improve quality of care and
reduce healthcare costs. Future controlled randomized trials investigating
the benefit of thromboembolism prophylaxis in cardiac surgery are
warranted. Copyright © 2019. Published by Elsevier Inc.

<93>
Accession Number
629824866
Title
Effect of Home-Based Cardiac Rehabilitation in a Lower-Middle Income
Country: RESULTS FROM A CONTROLLED TRIAL.
Source
Journal of cardiopulmonary rehabilitation and prevention. (no pagination),
2019. Date of Publication: 08 Nov 2019.
Author
Joshi V.L.; Moniruzzaman M.; Karim R.; Uddin J.; Siraj M.; Rashid M.A.;
Rossau H.K.; Taylor R.S.; Zwisler A.-D.
Institution
(Uddin) Physiotherapy Unit, Department of Cardiac Surgery (Mr Jamal
Uddin), Department of Cardiac Surgery (Drs Siraj and Jalal Uddin), and
Department of Cardiology (Drs Rashid and Karim) Ibrahim Cardiac Hospital &
Research Institute, Shagbag, Dhaka, Bangladesh; Danish Knowledge Centre
for Rehabilitation and Palliative Care (REHPA), Odense University Hospital
and University of Southern Denmark, Copenhagen, Denmark (Messrs Jamal
Uddin and Joshi, Ms Rossau, and Drs Taylor and Zwisler); Department of
Noncommunicable Disease, Bangladesh University of Health Sciences (BUHS),
Dhaka, Bangladesh (Mr Moniruzzaman and Dr Jalal Uddin); Institute of
Health Research, University of Exeter Medical School, Exeter, United
Kingdom (Dr Taylor); and Institute of Health and Well Being, University of
Glasgow, Glasgow, United Kingdom (Dr Taylor)
Publisher
NLM (Medline)
Abstract
PURPOSE: Cardiovascular disease is the leading cause of mortality and
morbidity in lower-middle income countries (LMICs), including Bangladesh.
Cardiac rehabilitation (CR) as part of secondary prevention of
cardiovascular disease has been shown to reduce mortality and morbidity
and improve quality of life and exercise capacity. However, to date, very
few controlled trials of CR have been conducted in LMICs. METHOD(S):
A quasi-randomized controlled trial comparing home-based CR plus usual
care with usual care alone was undertaken with patients following coronary
artery bypass graft surgery. Participants in the CR group received an
in-hospital CR class and were introduced to a locally developed
educational booklet with details of a home-based exercise program and then
received monthly telephone calls for 12 mo. Primary outcomes were coronary
heart disease (CHD) risk factors, health-related quality of life (HRQOL),
and mental well-being. Maximal oxygen uptake as a measure of exercise
capacity was a secondary outcome. RESULT(S): In total, 142 of 148
eligible participants took part in the trial (96%); 71 in each group. At
12-mo follow-up, 61 patients (86%) in the CR group and 40 (56%) in the
usual care group provided complete outcome data. Greater reductions in CHD
risk factors and improvements in HRQOL, mental well-being, and exercise
capacity were seen for the CR group compared with the usual care group.
 CONCLUSION(S): In the context of a single-center LMIC setting, this
study demonstrated the feasibility of home-based CR programs and offers a
model of service delivery that could be replicated on a larger scale.

<94>
Accession Number
629823364
Title
Intraoperative Ketamine for Analgesia Post-Coronary Artery Bypass Surgery:
A Randomized, Controlled, Double-Blind Clinical Trial.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2019.
Date of Publication: 11 Oct 2019.
Author
Cameron M.; Tam K.; Al Wahaibi K.; Charghi R.; Beique F.
Institution
(Cameron, Charghi, Beique) Department of Anesthesia, Jewish General
Hospital, Montreal, Quebec, Canada; Department of Anesthesia, McGill
University, Montreal, Quebec, Canada
(Tam) Department of Anesthesia, Jewish General Hospital, Montreal, QC,
Canada
(Al Wahaibi) Department of Anesthesia, McGill University, Montreal, QC,
Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To determine whether the administration of ketamine during
coronary artery bypass grafting (CABG) surgery leads to a reduction in the
quantity of opioids required over the first 48 hours after surgery.
DESIGN: Randomized, controlled, double-blind clinical trial. SETTING:
Single university academic center. PARTICIPANTS: Patients undergoing CABG
surgery with a normal left ventricular ejection fraction. INTERVENTIONS:
Ketamine administered intravenously as a bolus dose of 0.5 mg/kg before
skin incision, followed by an infusion of 0.5 mg/kg/h until the end of
surgery. MEASUREMENTS AND MAIN RESULTS: One hundred eighty-three patients
were screened, and 80 patients were randomized. Baseline characteristics
were similar between the 2 groups. The intervention group received 53.6 mg
(95% confidence interval [CI] 47.1-60.1 mg) of morphine equivalents in the
first 48 hours after surgery, whereas the placebo group received 55.7 mg
(95% CI 48.4-63.1 mg) over the same time period (p=0.66). No significant
difference was noted in morphine equivalents over the first 6, 12, or 24
hours postoperatively or in maximum, minimum, or average pain scores on
postoperative days 1 or 2. CONCLUSION(S): The administration of
ketamine during CABG surgery did not result in reduced opioid consumption
or pain scores postoperatively. Copyright © 2019 Elsevier Inc.
All rights reserved.

<95>
Accession Number
2003239223
Title
Atrial fibrillation post coronary artery graft surgery: A review of
literature.
Source
International Journal of General Medicine. 12 (pp 415-420), 2019. Date of
Publication: 2019.
Author
Jannati M.
Institution
(Jannati) Cardiovascular Surgery Ward, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Atrial fibrillation (AF) is a failure that is observed in heart disease
and is also known to be the most common heart rhythm disturbance post
coronary artery bypass surgery. Although AF is considered a transient
problem, it is usually accompanied with a variety of complications and
morbidity for patients and may result in death. In the present study,
pre-and post-operative considerable factors which may increase the risk
and mortality of AF, and possible treatments have been concisely
reviewed. Copyright © 2019 Jannati.

<96>
Accession Number
629783613
Title
Five-year outcomes after PCI or CABG for left main coronary disease.
Source
New England Journal of Medicine. 381 (19) (pp 1820-1830), 2019. Date of
Publication: 07 Nov 2019.
Author
Stone G.W.; Pieter Kappetein A.; Sabik J.F.; Pocock S.J.; Morice M.-C.;
Puskas J.; Kandzari D.E.; Karmpaliotis D.; Morris Brown W.; Lembo N.J.;
Banning A.; Merkely B.; Horkay F.; Boonstra P.W.; Van Boven A.J.; Ungi I.;
Bogats G.; Mansour S.; Noiseux N.; Sabate M.; Pomar J.; Hickey M.;
Gershlick A.; Buszman P.E.; Bochenek A.; Schampaert E.; Page P.; Modolo
R.; Gregson J.; Simonton C.A.; Mehran R.; Kosmidou I.; Genereux P.;
Crowley A.; Dressler O.; Serruys P.W.
Institution
(Stone, Karmpaliotis, Morris Brown, Lembo, Modolo, Kosmidou, Genereux,
Crowley, Dressler) Cardiovascular Research Foundation, 1700 Broadway, 8th
Fl., New York, NY 10019, United States
(Stone, Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, United States
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, United
States
(Karmpaliotis, Lembo, Kosmidou) New York-Presbyterian Hospital, Columbia
University Medical Center, New York, United States
(Pieter Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Van Boven, Buszman) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Modolo) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Sabik) University Hospitals Cleveland Medical Center, Cleveland, United
Kingdom
(Pocock, Gregson) London School of Hygiene and Tropical Medicine, United
Kingdom
(Serruys) InternationalCentre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Hickey, Gershlick) University Hospitals of Leicester, NHS Trust,
Leicester, United Kingdom
(Morice) Hopital Prive Jacques Cartier, Ramsay Generale de Sante, Massy,
France
(Kandzari, Morris Brown) Piedmont Heart Institute, Atlanta, United States
(Merkely, Horkay) Semmelweis University, Budapest, Hungary
(Ungi, Bogats) University of Szeged, Szeged, Hungary
(Mansour, Noiseux) Centre Hospitalier, L'Universite de Montreal, Canada
(Schampaert, Page, Genereux) Hopital du Sacre-Coeur de Montreal, Canada
(Sabate, Pomar) Hospital Clinic, Barcelona, Spain
(Buszman, Bochenek) Medical University of Silesia, Katowice, Poland
(Buszman, Bochenek) American Heart of Poland, Ustron, Poland
(Modolo) University of Campinas, Campinas, Brazil
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Long-term outcomes after percutaneous coronary intervention
(PCI) with contemporary drug-eluting stents, as compared with
coronary-artery bypass grafting (CABG), in patients with left main
coronary artery disease are not clearly established. METHODS We randomly
assigned 1905 patients with left main coronary artery disease of low or
intermediate anatomical complexity (according to assessment at the
participating centers) to undergo either PCI with fluoropolymer-based
cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or
CABG (CABG group, 957 patients). The primary outcome was a composite of
death, stroke, or myocardial infarction. RESULTS At 5 years, a primary
outcome event had occurred in 22.0% of the patients in the PCI group and
in 19.2% of the patients in the CABG group (difference, 2.8 percentage
points; 95% confidence interval [CI], -0.9 to 6.5; P=0.13). Death from any
cause occurred more frequently in the PCI group than in the CABG group (in
13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI, 0.2 to 6.1). In
the PCI and CABG groups, the incidences of definite cardiovascular death
(5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI,
-1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4
percentage points; 95% CI, -1.3 to 4.2) were not significantly different.
All cerebrovascular events were less frequent after PCI than after CABG
(3.3% vs. 5.2%; difference, -1.9 percentage points; 95% CI, -3.8 to 0),
although the incidence of stroke was not significantly different between
the two groups (2.9% and 3.7%; difference, -0.8 percentage points; 95% CI,
-2.4 to 0.9). Ischemia-driven revascularization was more frequent after
PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points;
95% CI, 3.7 to 10.0). CONCLUSIONS In patients with left main coronary
artery disease of low or intermediate anatomical complexity, there was no
significant difference between PCI and CABG with respect to the rate of
the composite outcome of death, stroke, or myocardial infarction at
5years.(FundedbyAbbottVascular;EXCELClinicalTrials.govnumber,NCT01205776).
 Copyright © 2019 Massachusetts Medical Society.

<97>
Accession Number
629780693
Title
Long term surgical outcomes for infective endocarditis in people who
inject drugs: A systematic review and meta-analysis.
Source
BMC Infectious Diseases. 19 (1) (no pagination), 2019. Article Number:
918. Date of Publication: 08 Nov 2019.
Author
Goodman-Meza D.; Weiss R.E.; Gamboa S.; Gallegos A.; Bui A.A.T.; Goetz
M.B.; Shoptaw S.; Landovitz R.J.
Institution
(Goodman-Meza, Goetz, Landovitz) Division of Infectious Diseases, David
Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS),
Los Angeles, CA 90095-1688, United States
(Goodman-Meza, Goetz) Infectious Diseases, VA Greater Los Angeles
Healthcare System, Los Angeles, CA, United States
(Weiss) Department of Biostatistics, Fielding School of Public Health,
UCLA, Los Angeles, CA, United States
(Gamboa, Gallegos) Universidad Autonoma de Baja California, United States
(Bui) Medical Imaging Informatics (MII) Group, Department of Radiological
Sciences, UCLA, Los Angeles, CA, United States
(Shoptaw) Department of Family Medicine, David Geffen School of Medicine
at UCLA, Los Angeles, CA, United States
(Landovitz) UCLA Center for Clinical AIDS Research and Education, David
Geffen School of Medicine, Los Angeles, CA, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In recent years, the number of infective endocarditis (IE)
cases associated with injection drug use has increased. Clinical
guidelines suggest deferring surgery for IE in people who inject drugs
(PWID) due to a concern for worse outcomes in comparison to non-injectors
(non-PWID). We performed a systematic review and meta-analysis of
long-term outcomes in PWID who underwent cardiac surgery and compared
these outcomes to non-PWID. Method(s): We systematically searched for
studies reported between 1965 and 2018. We used an algorithm to estimate
individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined
it with published individual patient data (IPD) to analyze long-term
outcomes after cardiac surgery for IE in PWID. Our primary outcome was
survival. Secondary outcomes were reoperation and mortality at 30-days,
one-, five-, and 10-years. Random effects Cox regression was used for
estimating survival. Result(s): We included 27 studies in the
systematic review and 19 provided data (KM or IPD) for the meta-analysis.
PWID were younger and more likely to have S. aureus than non-PWID.
Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and
56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID.
PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05-2.05) and more
than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25-4.50) than
non-PWID. Conclusion(s): PWID had shorter survival that non-PWID.
Implementing evidence-based interventions and testing new modalities are
urgently needed to improve outcomes in PWID after cardiac
surgery. Copyright © 2019 The Author(s).

<98>
Accession Number
2003536590
Title
Safety and Efficacy of Enoxaparin in Pregnancy: A Systematic Review and
Meta-Analysis.
Source
Advances in Therapy. (no pagination), 2019. Date of Publication: 2019.
Author
Jacobson B.; Rambiritch V.; Paek D.; Sayre T.; Naidoo P.; Shan J.;
Leisegang R.
Institution
(Jacobson) Department of Haematology and Molecular Medicine, University of
Witwatersrand, 1 Jan Smuts Ave, Johannesburg, South Africa
(Rambiritch) Department of Pharmacology, University of KwaZulu-Natal,
University Rd, Westville, South Africa
(Paek, Sayre) Doctor Evidence, 301 Arizona Ave, Santa Monica, CA, United
States
(Naidoo) Sanofi Affiliate, Medical, 2 Bond St, Grand Central, Midrand,
South Africa
(Naidoo) Department of Health Informatics, School of Health Professions,
Rutgers, State University of New Jersey, 57 US Highway 1, New Brunswick,
NJ, United States
(Shan) Sanofi Global, Medical, 54-56 Rue la Boetie, Paris, France
(Leisegang) Department of Pharmaceutical Biosciences, Uppsala University,
Uppsala 752 36, Sweden
(Leisegang) FAMCRU, The Department of Paediatrics & Child Health,
Stellenbosch University, Tygerberg, Cape Town, South Africa
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: International guidelines support the use of low molecular
weight heparins for the treatment of thromboembolism and
thromboprophylaxis during pregnancy. However, evidence of the benefit and
harm associated with specific low molecular weight heparins such as
enoxaparin is dated. No current systematic review and meta-analysis
describing the safety and efficacy of enoxaparin for thromboembolism and
thromboprophylaxis during pregnancy exists. Method(s): PubMed,
Embase, and Cochrane databases were searched on August 17, 2018 for
clinical trials or observational studies in pregnant women receiving
enoxaparin; patients with a prosthetic heart valve were excluded. Risk
ratios (RR) with 95% confidence intervals (CI) were calculated using a
random effects model, and heterogeneity was measured using the
I2 statistic. Result(s): Of the 485 records identified in
the search, 24 studies published clinical trials, and observational
studies were found dating back to 2000. Only one observational cohort and
one randomized control trial focused on the use of enoxaparin for
thromboprophylaxis and therefore efficacy was not assessed; the other
studies included women with recurrent pregnancy loss (15 studies), history
of placental vascular complications (five studies), and recurrent in vitro
fertilization failure (two studies) and were therefore analyzed in terms
of safety only. Bleeding events were non-significantly more often reported
for enoxaparin compared to untreated controls (RR 1.35 [0.88-2.07]) but
less often reported for enoxaparin versus aspirin (RR 0.93 [0.62-1.39]);
thromboembolic events, thrombocytopenia, and teratogenicity were rarely
reported events; in patients with a history of recurrent pregnancy loss,
encouragingly the rates of pregnancy loss were significantly lower for
enoxaparin compared to untreated controls (RR 0.58 [0.34-0.96]) and
enoxaparin + aspirin versus aspirin alone (RR 0.42 [0.32-0.56]) as well as
observably lower for enoxaparin versus aspirin alone (RR 0.39
[0.15-1.01]), though significant heterogeneity was observed (I2
> 60). Conclusion(s): Literature on the efficacy and safety of
enoxaparin for thromboembolism and thromboprophylaxis remains scanty, and
therefore efficacy was not assessed; in terms of safety, when including
other indications for enoxaparin in pregnancy, we found that enoxaparin
was associated with significantly lower complications than aspirin. Given
differences in study design and study heterogeneity, pregnancy loss
results should be interpreted with caution. Moreover, reports of
thromboembolic events, thrombocytopenia, and congenital malformations were
rare. Funding(s): Sanofi. Copyright © 2019, The Author(s).

<99>
Accession Number
2003531868
Title
Anti-inflammatory drugs in the prevention of post-operative atrial
fibrillation: a literature review.
Source
Inflammopharmacology. (no pagination), 2019. Date of Publication: 2019.
Author
Nomani H.; Mohammadpour A.H.; Moallem S.M.H.; Sahebkar A.
Institution
(Nomani) School of Pharmacy, Mashhad University of Medical Sciences,
Mashhad, Iran, Islamic Republic of
(Mohammadpour) Department of Clinical Pharmacy, School of Pharmacy,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Mohammadpour) Pharmaceutical Research Center, Pharmaceutical Technology
Institute, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Moallem) School of Medicine, Mashhad University of Medical Sciences,
Mashhad, Iran, Islamic Republic of
(Sahebkar) Halal Research Center of IRI, FDA, Tehran, Iran, Islamic
Republic of
(Sahebkar) Neurogenic Inflammation Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Sahebkar) Biotechnology Research Center, Pharmaceutical Technology
Institute, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
Publisher
Birkhauser Verlag AG
Abstract
Atrial fibrillation (AF) is a serious and common complication following
heart surgery. Cardiac surgery triggers inflammation in the heart and
makes it susceptible to the incidence of AF. Therefore, anti-inflammatory
drugs may reduce the rate of AF incidence in the post-surgery conditions.
Immunosuppressant agents, steroidal anti-inflammatory drugs
(corticosteroids), non-aspirin non-steroid anti-inflammatory drugs
(NSAIDs), colchicine and omega-3 unsaturated fatty acids (n-3 UFA) are
drugs with well-known anti-inflammatory properties. The efficacy, safety
and other aspects of using these drugs in the prevention of post-operative
AF (POAF) have been reviewed here. Studies evaluating the efficacy of
colchicine have shown that it could be effective in the prevention of
POAF. However, there is a need for additional studies to find a colchicine
regimen with optimal efficacy and higher tolerability. The use of
corticosteroids may also be of value based on the most of meta-analyses.
In the case of n-3 polyunsaturated fatty acids and NSAIDs, current data
fail to support their efficacy in POAF prevention. Moreover, perioperative
administration of NSAIDs may be associated with some severe safety
considerations. Immunosuppressant agents have not been used for the
prevention of POAF. Further studies are needed to find the most effective
strategy for POAF prevention with the least safety considerations and the
highest health benefits. Copyright © 2019, Springer Nature
Switzerland AG.

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