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

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<1>
Accession Number
613544518
Title
Everolimus-eluting Stents or bypass surgery for left main coronary artery
disease.
Source
New England Journal of Medicine. 375 (23) (pp 2223-2235), 2016. Date of
Publication: 08 Dec 2016.
Author
Stone G.W.; Sabik J.F.; Serruys P.W.; Simonton C.A.; Genereux P.; Puskas
J.; Kandzari D.E.; Morice M.-C.; Lembo N.; Brown W.M.; Taggart D.P.;
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.; Bochenek A.; Schampaert E.; Page P.; Dressler
O.; Kosmidou I.; Mehran R.; Pocock S.J.; Kappetein A.P.
Institution
(Stone) New York Presbyterian Hospital, Columbia University Medical
Center, New York, United States
(Stone, Genereux, Dressler, Kosmidou, Mehran) Cardiovascular Research
Foundation, New York, United States
(Puskas, Mehran) Mount Sinai Medical Center, New York, United States
(Sabik) Cleveland Clinic Foundation, Cleveland, United States
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Taggart, Banning) Oxford University Hospitals, Oxford, United Kingdom
(Hickey, Gershlick) University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Genereux, Schampaert, Page) Hopital du Sacre-Coeur de Montreal, Montreal,
Canada
(Mansour, Noiseux) Centre Hospitalier de L'Universite de Montreal, Hopital
Hotel-Dieu de Montreal, Montreal, Canada
(Kandzari, Lembo, Brown) Piedmont Hospital, Atlanta, United States
(Morice) Ramsay Generale de Sante, Hopital Prive Jacques Cartier, Massy,
France
(Merkely, Horkay) Semmelweis University, Budapest, Hungary
(Ungi, Bogats) University of Szeged, Szeged, Hungary
(Boonstra, Van Boven) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Sabate, Pomar) Hospital Clinic, Barcelona, Spain
(Buszman, Bochenek) Medical University of Silesia, Katowice, Poland
(Buszman, Bochenek) American Heart of Poland, Ustron, Poland
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Patients with obstructive left main coronary artery disease are
usually treated with coronary-artery bypass grafting (CABG). Randomized
trials have suggested that drug-eluting stents may be an acceptable
alternative to CABG in selected patients with left main coronary disease.
METHODS We randomly assigned 1905 eligible patients with left main
coronary artery disease of low or intermediate anatomical complexity to
undergo either percutaneous coronary intervention (PCI) with
fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group,
948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was
assessed at the sites and defined by a Synergy between Percutaneous
Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32
or lower (the SYNTAX score reflects a comprehensive angiographic
assessment of the coronary vasculature, with 0 as the lowest score and
higher scores [no upper limit] indicating more complex coronary anatomy).
The primary end point was the rate of a composite of death from any cause,
stroke, or myocardial infarction at 3 years, and the trial was powered for
noninferiority testing of the primary end point (noninferiority margin,
4.2 percentage points). Major secondary end points included the rate of a
composite of death from any cause, stroke, or myocardial infarction at 30
days and the rate of a composite of death, stroke, myocardial infarction,
or ischemia-driven revascularization at 3 years. Event rates were based on
Kaplan-Meier estimates in time-to-first-event analyses. RESULTS At 3
years, a primary end-point event had occurred in 15.4% of the patients in
the PCI group and in 14.7% of the patients in the CABG group (difference,
0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage
points; P = 0.02 for noninferiority; hazard ratio, 1.00; 95% confidence
interval, 0.79 to 1.26; P = 0.98 for superiority). The secondary end-point
event of death, stroke, or myocardial infarction at 30 days occurred in
4.9% of the patients in the PCI group and in 7.9% in the CABG group
(P<0.001 for noninferiority, P = 0.008 for superiority). The secondary
end-point event of death, stroke, myocardial infarction, or
ischemia-driven revascularization at 3 years occurred in 23.1% of the
patients in the PCI group and in 19.1% in the CABG group (P = 0.01 for
noninferiority, P = 0.10 for superiority). CONCLUSIONS In patients with
left main coronary artery disease and low or intermediate SYNTAX scores by
site assessment, PCI with everolimus-eluting stents was noninferior to
CABG with respect to the rate of the composite end point of death, stroke,
or myocardial infarction at 3 years. Copyright © 2016
Massachusetts Medical Society.

<2>
Accession Number
2003234645
Title
Percutaneous occlusion of left atrial appendage: Growing clinical
experience and lack of multicenter randomized clinical trials.
Source
Arquivos Brasileiros de Cardiologia. 113 (4) (pp 722-724), 2019. Date of
Publication: October 2019.
Author
Pisani C.F.; Scanavacca M.
Institution
(Pisani, Scanavacca) Unidade Clinica de Arritmia do Instituto do Coracao
(InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade
de Sao Paulo (HC-FMUSP), Sao Paulo, SP, Brazil
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)

<3>
Accession Number
625806118
Title
Additional filtering of blood from a cell salvage device is not likely to
show important additional benefits in outcome in cardiac surgery.
Source
Transfusion. 59 (3) (pp 989-994), 2019. Date of Publication: March 2019.
Author
de Vries A.J.; Vermeijden W.J.; van Pelt L.J.; van den Heuvel E.R.; van
Oeveren W.
Institution
(de Vries) Department of Anesthesiology, University Medical Center
Groningen, Groningen, Netherlands
(Vermeijden) Department of Critical Care, Medisch Spectrum Twente,
Enschede, Netherlands
(van Pelt) Department of Laboratory Medicine, University Medical Center
Groningen, Groningen, Netherlands
(van den Heuvel) Department of Mathematics & Computer Science, Eindhoven
University of Technology, Eindhoven, Netherlands
(van Oeveren) Haemoscan b.v, Groningen, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Several authors and manufacturers of cell salvage devices
recommend additional filtering of processed blood before transfusion.
There is no evidence to support this practice. Therefore, we compared the
clinical outcome and biochemical effects of cell salvage with or without
additional filtering. STUDY DESIGN AND METHODS: The patients, scheduled
for coronary artery bypass grafting, valve replacement, or combined
procedures were part of our randomized multicenter factorial study of cell
salvage and filter use on transfusion requirements (ISRCTN 58333401). They
were randomized to intraoperative cell salvage or cell salvage plus
additional WBC depletion filter. We compared the occurrence of major
adverse events (combined death/stroke/myocardial infarction) as primary
outcome and minor adverse events (renal function disturbances, infections,
delirium), ventilation time, and length of stay in the intensive care unit
and hospital. We also measured biochemical markers of organ injury and
inflammation. RESULT(S): One hundred eighty-nine patients had cell
salvage, and 175 patients had cell salvage plus filter and completed the
study. Demographic data, surgical procedures, and amount of salvaged blood
were not different between the groups. There was no difference in the
primary outcome with a risk of 6.3% (95% confidence interval [CI],
3.34-11.25) in the cell salvage plus filter group versus 5.8% (95% CI,
3.09-10.45) in the cell salvage group, a relative risk of 1.08 (95% CI,
0.48- 2.43]. There were no differences in minor adverse events and
biochemical markers between the groups. CONCLUSION(S): The routine
use of an additional filter for transfusion of salvaged blood is unlikely
to show important additional benefits. Copyright © 2019 AABB

<4>
Accession Number
2002941859
Title
Prognostic effect of troponin elevation in patients undergoing carotid
endarterectomy with regional anesthesia - A prospective study.
Source
International Journal of Surgery. 71 (pp 66-71), 2019. Date of
Publication: November 2019.
Author
Pereira-Macedo J.; Rocha-Neves J.P.; Dias-Neto M.F.; Andrade J.P.V.
Institution
(Pereira-Macedo, Rocha-Neves, Dias-Neto) Department of Angiology and
Vascular Surgery, Centro Hospitalar Universitario de Sao Joao, Porto,
Portugal
(Rocha-Neves, Andrade) Department of Biomedicine - Unity of Anatomy,
Faculdade de Medicina da Universidade Do Porto, Portugal
(Rocha-Neves, Dias-Neto) Department of Surgery and Physiology, Faculdade
de Medicina da Universidade Do Porto, Portugal
Publisher
Elsevier Ltd
Abstract
Background: Myocardial injury after noncardiac surgery (MINS) occurs in
15% of patients undergoing carotid endarterectomy (CEA) with general
anesthesia. Short and long-term risk of myocardial infarction (MI) and
stroke have been strongly associated with the presence of MINS, with an
associated mortality rate superior to 10% in the first year. Due to the
absence of studies concerning CEA with regional anesthesia (RA), the
present study aimed to evaluate the incidence of MINS in patients with RA
and its prognostic value on cardiovascular events or death.
 Material(s) and Method(s): From January 2009 to January 2018, 156
patients from a Portuguese tertiary care medical center who underwent CEA
under RA were retrieved from a prospectively gathered database. Troponin I
or high-sensitive troponin I values were systematically measured in the
postoperative period and studied as a binary outcome in a logistic
regression model. Survival analysis was used to study the impact of MINS
in time-dependent clinical outcomes such as stroke and MI. Result(s):
The incidence of MINS after CEA was 15.3%. Multivariate analysis confirmed
that chronic heart failure was strongly associated with MINS (OR: 4.458,
95% CI: 1689-11.708, P < 0.001). A previously diagnosed MINS was
associated with the long-term risk of MI and major adverse cardiovascular
events (MACE) with hazard ratios (HR) of 3.318 (95% CI: 0.97-13.928,
Breslow: P = 0.025) and 1.955 (95% CI: 1.01-4.132, Breslow: P = 0.046),
respectively. Conclusion(s): MINS is a long-term predictor of MI and
MACE. Troponin assessment after CEA should be routinely monitored in
patients with a cardiovascular risk superior to 5%. Further studies
concerning prophylaxis and management of MINS should be carried on,
focusing on the effect of anesthetic procedure in postoperative troponin
elevation. Copyright © 2019 IJS Publishing Group Ltd

<5>
Accession Number
623691250
Title
The cortisol stress response induced by surgery: A systematic review and
meta-analysis.
Source
Clinical Endocrinology. 89 (5) (pp 554-567), 2018. Date of Publication:
November 2018.
Author
Prete A.; Yan Q.; Al-Tarrah K.; Akturk H.K.; Prokop L.J.; Alahdab F.;
Foster M.A.; Lord J.M.; Karavitaki N.; Wass J.A.; Murad M.H.; Arlt W.;
Bancos I.
Institution
(Prete, Karavitaki, Arlt) Institute of Metabolism and Systems Research,
University of Birmingham, Birmingham, United Kingdom
(Prete, Karavitaki, Arlt) Centre for Endocrinology, Diabetes and
Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
(Yan) Department of Surgery, Mayo Clinic, Rochester, MN, United States
(Al-Tarrah, Foster, Lord) Institute of Inflammation and Ageing, University
of Birmingham, Birmingham, United Kingdom
(Akturk) Barbara Davis Center for Diabetes, University of Colorado School
of Medicine, Aurora, CO, United States
(Prokop) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
(Alahdab, Murad) Evidence-based Practice Center, Mayo Clinic, Rochester,
MN, United States
(Foster) NIHR Surgical Reconstruction and Microbiology Research Centre,
Queen Elizabeth Hospital Birmingham & Royal Centre for Defence Medicine,
Birmingham, United Kingdom
(Wass) Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill
Hospital, Oxford, United Kingdom
(Bancos) Division of Endocrinology, Metabolism and Nutrition, Department
of Internal Medicine, Mayo Clinic, Rochester, MN, United States
Publisher
Blackwell Publishing Ltd
Abstract
Objective: Surgery is a stressor that can be categorized by duration and
severity and induces a systemic stress response that includes increased
adrenal cortisol production. However, the precise impact of surgical
stress on the cortisol response remains to be defined. Design(s): We
performed a systematic review and meta-analysis to assess the cortisol
stress response induced by surgery and to stratify this response according
to different parameters. Method(s): We conducted a comprehensive
search in several databases from 1990 to 2016. Pairs of reviewers
independently selected studies, extracted data and evaluated the risk of
bias. Cortisol concentrations were standardized, pooled in meta-analysis
and plotted over time. Result(s): We included 71 studies reporting
peri-operative serum cortisol measurements in 2953 patients. The cortisol
response differed substantially between moderately/highly invasive and
minimally invasive surgical procedures. Minimally invasive procedures did
not show a peri-operative cortisol peak, whereas more invasive surgeries
caused a cortisol surge that was more pronounced in older subjects, women
and patients undergoing open surgery and general anaesthesia. The duration
of the procedure and the use of etomidate for induction of anaesthesia did
not affect the cortisol response. Conclusion(s): The peri-operative
cortisol stress response is dynamic and influenced by patient-specific,
surgical and anaesthetic features. However, the available evidence is
derived from highly heterogeneous studies, with only two of 71 studies
measuring cortisol by mass spectrometry, which currently prevents a
precise and reproducible definition of this response. Copyright ©
2018 John Wiley & Sons Ltd.

<6>
Accession Number
629740125
Title
Anti-inflammatory drugs in the prevention of post-operative atrial
fibrillation: a literature review.
Source
Inflammopharmacology. (no pagination), 2019. Date of Publication: 31 Oct
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
NLM (Medline)
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.

<7>
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

<8>
Accession Number
629739325
Title
Safety and Efficacy of Enoxaparin in Pregnancy: A Systematic Review and
Meta-Analysis.
Source
Advances in therapy. (no pagination), 2019. Date of Publication: 31 Oct
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, USA
(Naidoo) Sanofi Affiliate, Medical, 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, NB, United
States
(Shan) Sanofi Global, Medical, Paris, France
(Leisegang) Department of Pharmaceutical Biosciences, Uppsala University,
Uppsala 752 36, Sweden
(Leisegang) FAMCRU, Department of Paediatrics & Child Health, Stellenbosch
University, Tygerberg, Cape Town, South Africa
Publisher
NLM (Medline)
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.Sanofi.

<9>
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.

<10>
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.

<11>
Accession Number
2003531594
Title
Ultrafiltration in Pediatric Cardiac Surgery Review.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 10 (6) (pp
778-788), 2019. Date of Publication: 01 Nov 2019.
Author
Bierer J.; Stanzel R.; Henderson M.; Sett S.; Horne D.
Institution
(Bierer, Sett, Horne) Division of Cardiac Surgery, Department of Surgery,
Dalhousie University, Halifax, NS, Canada
(Stanzel, Henderson) Department of Clinical Perfusion, Nova Scotia Health
Authority, Halifax, NS, Canada
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: The use of cardiopulmonary bypass in pediatric cardiac
surgery is associated with significant inflammation, fluid overload, and
end-organ dysfunction yielding morbidity and mortality. For decades,
various intraoperative ultrafiltration techniques such as conventional
ultrafiltration, modified ultrafiltration (MUF), zero-balance
ultrafiltration (ZBUF), and combination techniques (ZBUF-MUF) have been
used to mitigate these toxicities and promote improved postoperative
outcomes. However, there is currently no consensus on the ultrafiltration
technique or strategy that yields the most benefit for infants and
children undergoing open heart surgery. Method(s): A
librarian-conducted PubMed literature search from 1990 to 2018 yielded 90
clinical studies or publications on the various forms of ultrafiltration
and the impact on physiologic markers and clinical outcomes. All
publications were reviewed, summarized, and conclusions synthesized. The
data sets were not combined for systematic or meta-analysis due to
significant heterogeneity in study protocols and patient populations.
 Result(s): Modified ultrafiltration significantly promotes improved
myocardial function, reduction in fluid overload, and reduced bleeding and
transfusion complications. Furthermore, ZBUF has shown a consistent
reduction in inflammatory cytokines and improved pulmonary function and
compliance. There is conflicting evidence that MUF, ZBUF, and ZBUF-MUF
culminate in reduced ventilation time and intensive care unit stay.
 Conclusion(s): Various modes of ultrafiltration have been shown to be
associated with improved physiologic function or clinical outcomes in
pediatric cardiac surgery. There are some inconsistent trial results that
can be explained by heterogeneity in ultrafiltration, clinical staff
preferences, and institution protocols. Ultrafiltration has some essential
benefit as it is ubiquitously used at pediatric heart centers; however,
the optimal protocol could be yet identified. Copyright © The
Author(s) 2019.

<12>
Accession Number
628496814
Title
Impact of pretransplant recipient body mass index on post heart transplant
mortality: A systematic review and meta-analysis.
Source
Clinical transplantation. 32 (8) (pp e13348), 2018. Date of Publication:
01 Aug 2018.
Author
Foroutan F.; Doumouras B.S.; Ross H.; Alba A.C.
Institution
(Foroutan, Doumouras, Ross, Alba) Heart Failure/Transplant Program,
Toronto General Hospital, University Health Network, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
The ISHLT's 2016 Guidelines on the selection of heart transplant (HT)
candidates recommends weight loss prior to listing for persons with body
mass (BMI) index greater than 35 kg/m2 . We conducted a systematic review
to assess the impact of BMI on all-cause mortality. We searched to
identify eligible observational studies that followed HT recipients. We
used the GRADE system to quantify absolute effects and quality of
evidence, and meta-analyzed survival curves to assess post-transplant
mortality across BMI categories. We found a significantly increased risk
of mortality in patients with BMI > 30 kg/m2 across all age categories,
independently of transplant era and study source (BMI 30-34.9: HR 1.10,
95% CI 1.04-1.17; BMI >= 35: HR 1.24, 95% CI 1.12-1.38). We also found an
increased risk of death in underweight (BMI < 18.5 kg/m2 ) candidates over
39 years of age (Age 40-65: HR 1.24, 95% CI 1.02-1.53; Age > 65: HR 1.70,
95% 1.13-2.57). We found obesity and underweight BMI to be associated with
mortality post-HT. The similar and overlapping increased risk of mortality
in patients with BMI 30-34.9 and BMI >= 35 does not support the recently
updated ISHLT guidelines. Future evidence in the form of randomized
controlled trials is required to assess effectiveness of interventions
targeting obesity-related comorbidities and weight
management. Copyright © 2018 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd.

<13>
Accession Number
629804510
Title
2019 Irish Cardiac Society Scientific Meeting and AGM.
Source
Heart. Conference: 2019 Irish Cardiac Society Scientific Meeting and AGM.
Ireland. 105 (Supplement 7) (no pagination), 2019. Date of Publication:
October 2019.
Author
Anonymous
Publisher
BMJ Publishing Group
Abstract
The proceedings contain 64 papers. The topics discussed include:
predictors and impact of pacemaker implantation following TAVI; the
Northern Irish dataset; the low dose colchicine after myocardial
infarction (LoDoCo-MI) study: a pilot randomized placebo controlled trial
of colchicine following myocardial infarction; characterization of the
structural and electrical impact of an atrial septal defect; pace and
ablate for poorly controlled AF - how does it affect heart failure
metrics?; pulmonary vein isolation- evaluating outcomes in the shift from
radiofrequency to established cryoballoon ablation; peak troponin T in
STEMI: a predictor of all-cause mortality and left ventricular Function;
cardiac implantable electronic device complications in a real-world
setting; rapid ambulatory physiologist-led discharge facilitating (RAPID)
monitoring is a safe and efficient alternative to inpatient telemetry; the
use of half concentration saline is superior for the catheter ablation of
typical atrial flutter; and conscious sedation for transcatheter aortic
valve implantation: is the anesthetist required?.

<14>
Accession Number
629806344
Title
Is there a predictive value of haemoglobin A1c for outcomes after cardiac
surgery?.
Source
Anatolian Journal of Cardiology. Conference: 35th Turkish Cardiology
Congress. Turkey. 22 (Supplement 1) (pp 65), 2019. Date of Publication:
October 2019.
Author
Ozturk S.; Kayacioglu I.; Sensoz Y.; Ozcelik S.
Institution
(Ozturk, Kayacioglu, Sensoz, Ozcelik) Department of Cardiovascular
Surgery, Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and
Research Hospital, Istanbul, Turkey
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: In recent years, the relationship between the
biomarkers and outcomes of operations is an increasing study area in
cardiac surgery. Therefore, we aimed to investigate the role of
haemoglobin A1c for the outcomes of cardiac surgery in adults.
 Method(s): Literature review was carried out in PubMed electronic
database without any limitations of date. Included studies were that
recorded the preoperative levels of haemoglobin A1c and postoperative
complications developed after cardiac surgery. We used only English as
article language. Results of the studies were evaluated based on either
random or fixed effect model in accordance with the presence of
heterogeneity (I2>25%). Result(s): A total of 1325 articles were
found upon a database screening. After the article titles and abstracts
were analysed, 11 articles were included in the meta-analysis that cover
14059 patients and comply with inclusion criteria. The results pointed out
that there was a relationship between preoperative haemoglobin A1c levels
and postoperative renal failure (OD: 0.61, 95% CI: 0.46-0.798 and
p<0.001), mediastinitis (OD: 0.33, 95% CI: 0.23-0.47 and p<0.001).
Otherwise, no relationship were observed between haemoglobin A1c and
postoperative atrial fibrillation, myocardial infarction, stroke,
pneumonia, cardiac tamponade, reoperations, gastrointestinal complications
and low cardiac output syndrome (p<0.05). Heterogeneity was observed for
postoperative atrial fibrillation and renal failure (I2 >25%).
 Conclusion(s): We concluded that preoperative haemoglobin A1c levels
were associated with developed of postoperative renal failure and
mediastinitis after cardiac surgery. However, there was a need larger
trials to prevent the heterogeneity of results for atrial fibrillation and
renal failure.

<15>
Accession Number
629806135
Title
Comparison of different anticoagulation regimens regarding maternal and
fetal outcomes in pregnant patients with mechanical prosthetic heart
valves: ANATOLIA-PREG trial.
Source
Anatolian Journal of Cardiology. Conference: 35th Turkish Cardiology
Congress. Turkey. 22 (Supplement 1) (pp 36), 2019. Date of Publication:
October 2019.
Author
Guner A.; Kalcik M.; Yesin M.; Bayam E.; Kalkan S.; Gursoy M.O.; Gunduz
S.; Karakoyun S.; Ozkan M.
Institution
(Guner, Bayam, Kalkan, Gunduz, Ozkan) Department of Cardiology, Kartal
Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
(Kalcik) Department of Cardiology, Hitit University, Faculty of Medicine,
Corum, Turkey
(Yesin, Karakoyun) Department of Cardiology, Kafkas University, Faculty of
Medicine, Kars, Turkey
(Gursoy) Department of Cardiology, Izmir Ataturk Training and Research
Hospital, Izmir, Turkey
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: Mechanical heart valves (MHVs) are highly
thrombogenic, and pregnancy-induced procoagulant status increases the risk
of MHV thrombosis up to 10%. Despite numerous research, the optimal
anticoagulation therapy during pregnancy remains a controversial issue in
the field of obstetrics and cardiology. The proposed regimens include,
unfractionated heparin (UFH), low molecular weight heparin (LMWH) and
vitamin K antagonists (VKAs). Each of these regimens can be used either
alone for throughout pregnancy or in combination with one regimen in the
first trimester and another in the remaining part of pregnancy, however
the potential maternal and fetal side effects associated with these
regimens pose challenges. The aim of this retrospective study was to
estimate the risk of adverse maternal and fetal outcomes among different
anticoagulation regimens in patients with MHVs during pregnancy. Finally,
based on our findings, we aimed to outline certain recommendations that
offer the most optimal feto-maternal outcome Methods: Anticoagulant
treatment was analyzed retrospectively for pregnant women with MHVs who
were admitted or referred to our clinic between January 1996 and May 2018
in our hospital after the first trimester or after the pregnancy was
terminated. A total of 91 patients, with a total of 132 pregnancies, were
enrolled. According to anticoagulation treatment, six main groups each
with different regimens were identified. Result(s): Sixty two (46.9%)
of 132 pregnancies resulted in fetal loss; 50 (37.8%) abortus, 12 (9%)
intrauterin death occurred. Warfarin fetotoxicity was detected in a total
of 10 children (7.5%). Two of them were patent foramen ovale (1.5%), 2
were hydrocephalus (1.5%), 1 was coarctation of aorta (0.75%), 1 was
deafness (0.75%), 1 was microcephaly (0.75%), 1 was esophageal atresia
(0.75%), 1 was laryngomalacia (0.75%) and 1 was intrauterine growth
retardation (0.75%). Fourty five valve thromboses developed during
pregnancy or the postpartum period including 26 (19.6%) large
non-obstructive thrombus and 19 (14.3%) obstructive thrombus. Of these 45
patients, 26 were treated with fibrinolytic therapy (19.6%), 6 with
surgery (4.5%), and 13 with UFH (%9.8). Cerebrovascular events developed
in 14 patients; 7 of them were ischemic stroke (5.3%), 1 was hemorrhagic
stroke (0.75%), and 6 were TIA (4.5%). Coronary-systemic emboli developed
in 3 patients. Two of them were coronary embolism (1.5%), 1 of them were
peripheral artery embolism (0.75%). Bleeding occurred in 19 patients
(14.3%) during delivery. One maternal mortality was recorded.
 Conclusion(s): Although there is no consensus on the most suitable
anticoagulant regimen during pregnancy, low-dose warfarin may be
appropriate for patients with effective INR monitoring with low-dose
warfarin with effective maternal protection and acceptable fetal outcome.
There is a need for prospective randomized studies and large patient
registry databases for optimal anticoagulation therapy.

<16>
Accession Number
629805917
Title
Efficiency of thyroid function test on prediction of postoperative atrial
fibrillation after cardiac surgery.
Source
Anatolian Journal of Cardiology. Conference: 35th Turkish Cardiology
Congress. Turkey. 22 (Supplement 1) (pp 92), 2019. Date of Publication:
October 2019.
Author
Ozturk S.; Kayacioglu I.; Sensoz Y.; Ozdemir K.
Institution
(Ozturk, Kayacioglu, Sensoz, Ozdemir) Department of Cardiovascular
Surgery, Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and
Research Hospital, Istanbul, Turkey
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: Postoperative atrial fibrillation due to cardiac
surgery is an important complication that increases mortality and
morbidity. Therefore, prediction of atrial fibrillation before surgery may
increase the survey and decrease cost based on morbidity. In this review
we aimed to analyze the efficiency of thyroid function tests (thyroid
stimulating hormone, thyroxine and tri-iodothyronine) on prediction of
postoperative atrial fibrillation. Method(s): Literature review was
carried out in PubMed, Science direct and Ovid electronic database. No
date limitations was applied. The trials, in which the preoperative levels
of thyroid stimulating hormone, thyroxine and tri-iodothyronine in cardiac
surgery patients were recorded, included. Only the articles in English
language were reviewed. Results were evaluated with fix or random effect
models according to the presence of heterogeneity (I2> 25%).
 Result(s): We obtained 547 articles after screening of database.
After checking over the titles and abstracts 5 trials were included that
cover 380 patients and comply with inclusion criteria. According to
results of analysis, there was no significant relationship between
postoperative atrial fibrillation and thyroid stimulating hormone
(SMD:-0.36, 95%CI -1.01-0.29 and p=0.27), and also thyroxine (SMD: -0.005
95% CI -0.29-0.28 and p=0.97). However, tri-iodothyronine (SMD: 1.05,95%CI
0.032-2.08 and p=0.04) was correlated with development of atrial
fibrillation. Hetergeneity was observed in three parameters (I2; TSH:
87.22%, T3: 93.08% and T4: 29.91%). Conclusion(s): We concluded that
preoperative levels of tri-iodothyronine was an effective parameter for
predicting postoperative atrial fibrillation after cardiac surgery, but
there was a need larger trials for eliminating heterogeneity.

<17>
Accession Number
2003685707
Title
AFTER RAFT: LONG TERM OUTCOMES OF CARDIAC RESYNCHRONIZATION THERAPY.
Source
Heart Rhythm. Conference: Heart Rhythm 2019. United Arab Emirates. 16 (6)
(pp 967), 2019. Date of Publication: June 2019.
Author
Sivakumaran S.T.; Kimber S.K.M.; Tsuyuki R.; Pan B.; Jones A.P.; Cujec B.;
McAlister F.; Patterson I.; Becher H.
Institution
(Sivakumaran, Kimber, Tsuyuki, Pan, Jones, Cujec, McAlister, Patterson,
Becher) University of Alberta, Edmonton, AB, Canada
Publisher
Elsevier B.V.
Abstract
Introduction: The Resynchronization-Defibrillation in Ambulatory Heart
Failure Trial (RAFT NCT00251251), compared ICD versus ICD-CRT in patients
with NYHA II or III heart failure, ejection fraction <= 30 percent and QRS
duration >= 120 msec or paced QRS >= 200 msec, on optimal medical therapy.
This study demonstrated a reduction in heart failure hospitalization and
mortality with ICD-CRT. However, the mean follow up was only 3.3 years.
The longer term efficacy of CRT remains unknown. Method(s): Patients
enrolled in the RAFT study at a single center were followed on a long term
basis. Patients with an ICD alone at the conclusion of RAFT were offered
crossover to ICD-CRT. Patients continued follow-up in the device clinic
and heart failure clinic every six months. Device procedures and outcomes
were tracked. The primary outcome was time to heart failure
hospitalization, death, cardiac transplant or ventricular assist device
(VAD) by original randomization. The secondary outcome was death, cardiac
transplant or VAD by long term therapy received. Applications: Of 111
patients randomized, 88 were male and 23 were female. Sixty-eight patients
had an ischemic cardiomyopathy and 43 patients had a dilated
cardiomyopathy. The indication for device therapy was primary prevention
in 88 patients and secondary prevention in 23 patients. Heart failure
symptoms were NYHA Class II for 75 patients and NYHA Class III for 36
patients and mean ejection fraction was 21.5+/-5.5%. Fifty-seven patients
were randomized to ICD-CRT and 54 patients to ICD. Patients were followed
for a mean of 7.9+/-4.3 years with complete follow-up available on 110
patients (99%). Of patients randomized to ICD-CRT, 54 received CRT, while
32 patients randomized to ICD alone, crossed-over to ICD-CRT. The median
time to the primary endpoint was 7.7 (4.3-10.2) years for ICD-CRT patients
versus 4.2 (2.7-8) years for ICD patients (p=0.17). Median time to death,
cardiac transplant or VAD for the 86 patients who ultimately received
CRT-ICD was 9.5 (7.8-10.4) years versus 3.3 (1.9-3.7) years for those 24
patients receiving ICD alone (p < 0.0001). Next Steps/Future: This is the
first long-term report of patients recruited for the RAFT trial. The
results suggest that the effect of CRT is both powerful and enduring.
[Figure Presented] Copyright © 2019

<18>
Accession Number
2003685699
Title
FIVE-YEAR OUTCOMES IN CARDIAC SURGERY PATIENTS WITH ATRIAL FIBRILLATION
UNDERGOING CONCOMITANT SURGICAL ABLATION VERSUS NO ABLATION. THE LONG-TERM
FOLLOW-UP OF THE PRAGUE-12 STUDY.
Source
Heart Rhythm. Conference: Heart Rhythm 2019. United Arab Emirates. 16 (6)
(pp 972), 2019. Date of Publication: June 2019.
Author
Osmancik P.; Budera P.; Talavera D.; Hlavicka J.; Herman D.; Holy J.;
Cervinka P.; Smid J.; Opatrny J.; Hanak P.; Hatala R.; Widimsky P.
Publisher
Elsevier B.V.
Abstract
Introduction: Previous randomized trials have shown the efficacy of the
MAZE procedure in terms of maintaining sinus rhythm, but without an effect
on clinical outcomes. However, most of these studies were small with short
follow-ups, generally not exceeding 1 year. The aim of this study was to
assess clinical outcomes of the MAZE procedure after 5 years of follow-up.
 Method(s): The PRAGUE-12 study was a prospective, randomized
multicenter clinical trial assessing cardiac surgery with left atrial
ablation for AF vs. cardiac surgery alone. Patients with AF who were also
indicated for cardiac surgery (coronary artery disease (CAD), valve
surgery) were enrolled and randomized to group SA (surgical ablation) or
Co (control, no ablation). All patients were followed for 5 years. The
primary endpoint was a composite of cardiovascular (CV) death, stroke,
hospitalization for heart failure (HFH) or severe bleeding. Secondary
endpoints included all parts of the primary endpoint and recurrence of AF.
Applications: Originally, 224 patients were enrolled, with 207 patients
ultimately analyzed (group SA=108, group Co=99 patients). Both groups were
similar relative to important clinical characteristics except for CAD,
which was more common in the Co group (SA: 55 pts. (50.9%) vs. Co 64 pts.
(64.6%), p<0.05). Kaplan-Meier survival curves showed a higher incidence
of the primary endpoint in the Co group (p=0.02, Figure). However, in the
Cox regression model and after adjusting for all covariables, the
difference between groups was not significant (hazard ratio (HR) 0.69,
[0.46-1.02], p=0.063). The incidence of CV death, bleedimg or HFH was
nonsignificantly reduced in the SA group. The incidence of stroke and AF
recurrences were significantly reduced in the SA group, and remained
significant even after adjustment for all covariables incl. CAD (stroke:
HR 0.31, [0.12-0.92], p=0.019, AF recurrences: HR 0.44, [0.31-0.62],
p<0.001). Next Steps/Future: Concomitant SA of AF is associated with a
greater likelihood of maintaining sinus rhythm and a decreased risk of
stroke. Additional long-term follow-up is needed to see the broader
benefits of AF ablation. [Figure Presented] Copyright © 2019

<19>
Accession Number
629805659
Title
Left ventricular non-compaction (LVNC): A Rare Cardiomyopathy. Evaluation
of large series in literature and treatment approaches.
Source
Anatolian Journal of Cardiology. Conference: 34th Turkish Cardiology
Congress. Turkey. 20 (Supplement 1) (pp 29), 2018. Date of Publication:
October 2018.
Author
Sahan E.
Institution
(Sahan) Department of Cardiology, Ataturk Chest Diseases and Thoracic
Surgery Training and Research Hospital, Ankara, Turkey
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: Left ventricular non-compaction (LVNC) is a rare
congenital cardiomyopathy, especially with LV dysfunction, characterized
by prominent trabeculations and deep recesses that communicate with the
ventricular cavity. LVNC can remain asymptomatic in many years. The most
common clinical situations are symptoms heart failure(HF), systemic
embolism, and ventricular arrhythmia. The frequency of the diagnosis of
LVNC has been increased but still little is known among physicians. The
purpose of this article is to improve the current knowledge of this rare
cardiomyopathy. Method(s): Over 1000 both articles and case reports
were reviewed in the PubMed database by searching the keywords
"ventricular noncompaction", "left ventricular noncompaction",
"ventricular noncompaction cardiomyopathy", "left ventricular
noncompaction cardiomyopathy" and "isolated left ventricular
noncompaction". 812 patients' data from 14 articles were included.
 Result(s): The age of diagnosis was between 1 week to 93 years. Mean
age was 45,5 years. 480 patients(63,5%) were male and 276 patients (36.5%)
were female. The most common clinical condition was HF Ventricular
arrhythmias, chest pain, cerebrovascular events,syncope and systemic
emboli are other clinical conditions. Thromboembolic events are more
common in elderly patients. The most common ECG fndings are non-specifc
ST/T wave abnormalities and LBBB. Also ventricular tachycardias were
reported. Preexcitation syndrome was more frequently in young patients.
Thromboembolic events are common in patients with atrial fbrillation(AF).
15 patients have undergone heart transplantation. Mortality occurred in
142 patients (22.9%), which was due to: HF in 50 patients; sudden cardiac
death in 24 patients; other causes included cerebrovascular events,
pulmonary embolism, undefned causes in 53 patients. Conclusion(s):
LNVC is a rare congenital cardiomyopathy can cause LV dysfunction.
Hospitalization for HF was the leading cause of morbidity. LVNC patients
with HF should be treated with optimal medical treatment. ICDs with or
without CRT should be considered for progresive HF. Heart transplantation
is another treatment option for progressive HF Anticoagulant therapy
should be used primarily for AF, LVEF <=30% or thromboembolism. Predictors
of mortality in LVNC patients are HF, ventricular arrhythmias, LV systolic
dysfunction and AF For all frst-degree relatives, family screening by
echocardiography is recommended. Early diagnosis and treatment may prevent
sudden cardiac deaths (with ICDs).

<20>
Accession Number
629805587
Title
Incidence of bifurcation coronary lesion as a culprit lesion in patients
with acute myocardial infartion and short and long term outcomes of
treatment strategy.
Source
Anatolian Journal of Cardiology. Conference: 34th Turkish Cardiology
Congress. Turkey. 20 (Supplement 1) (pp 115-116), 2018. Date of
Publication: October 2018.
Author
Harbalioglu H.
Institution
(Harbalioglu) Department of Cardiology, Ataturk State Hospital, Duzce,
Turkey
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: Several studies of single and double stent techniques
in patients with bifurcation lesions have been reported. However, studies
of patients with acute coronary syndrome (ACS) and bifurcation lesions are
stil insuffcient. In the present study, we assessed the short and long
term outcomes of single and double stent techniques of bifurcation lesions
in patients with ACS. Method(s): In our study, 2992 patients with ACS
who underwent percutaneous coronary intervention (PCI) were enrolled
retrospectively. Of 2992 patients, 385 patient with myocardial
infarcion(MI) had bifurcation lesions. The Synergy between PCI with
TAXUSTM and Cardiac Surgery (SYNTAX) score, pre-PCI Thrombolysis in
Myocardial Infarction (TIMI) fow, post-PCI TIMI fow, duration of
procedure, angiographic features, post-PCI side branch loss, 1- and
12-month mortality rates were noted. Result(s): 169 (43.9%) patient
had ST segment elevation MI, whereas 216 (56.1%) patient had non-ST
segment elevation MI. 355 (92.2%) patient underwent single stent and 30
(7.8%) patient underwent double stent technique. Side branch loss was
found in 11.2% of patients of the single stent and in 3.3% of patients of
the double stent group. Compared to single stent group, duration of
angiography and procedure in double stent group were signifcantly longer.
The rates of 1-month mortality in single and double stent group were 4.2%
and 3.3%, respectively. On the other hand, 1- year mortality rates were
11.5% and 13.3%, respectively. Conclusion(s): Side branch loss, short
and long term mortality rates were similar in both single and double stent
groups. However, related to this subject multicenter and large randomizied
controlled trials are needed.

<21>
Accession Number
629805723
Title
Is the bolus intravenous administration of sodium bicarbonate immediately
before contrast exposure more preventive strategy at contrast induced
nephropathy in patient with also moderate-severe renal insuffciency.
Source
Anatolian Journal of Cardiology. Conference: 34th Turkish Cardiology
Congress. Turkey. 20 (Supplement 1) (pp 119), 2018. Date of Publication:
October 2018.
Author
Ozgul N.; Guneri S.; Kakar H.; Alpaslan E.; Baris N.
Institution
(Ozgul, Guneri, Kakar, Alpaslan, Baris) Department of Cardiology, Dokuz
Eylul University Faculty of Medicine, Izmir, Turkey
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: Contrast induced nephropathy (CIN) causes the third
most frequently hospital acquired acute renal failure. Some randomized
controlled multicenter trials have recently shown that among patients at
high risk for renal complications who were undergoing angiographic
prosedure, there was no superiority between some protection strategies for
the prevention of death,need for dialysis even from prevention of CIN. But
some other studies showed the preventive effect of hydration and/or
bicarbonate. So there are some controversies in this era. Also the effect
of bolus administration of sodium bicarbonate is not well known. We aimed
to compare the effect of a single-bolus iv administration of sodium
bicarbonate immediately before contrast exposure in addition to hydration
with sodium chloride alone to prevent CIN in patient with moderate and
severe renal insuffciency. Method(s): 200 patients (70.5% men,mean
age 72.03+/-10.78 years) with moderate to severe renal insuffciency who
were undergoing angiograpic prosedure [coroner angiography, percutaneous
coronary intervention, per-iferic angiography or transcatheter aortic
valve implantation] were included in this study. Data were scanned
retrospectively and were assigned to the following 2 groups. The sodium
bicarbonate group (Group A, n=100) was defned as the patients who received
standard hydration (SH) with sodyum chloride plus a single bolus iv
administration of sodium bicarbonate (20 meq) immediately before contrast
exposure and Group B (n=100) defned as SH with sodium chloride alone. SH
defned as the patients who received sodium chloride infusion 12 hours
before the contrast exposure and contiued to receive 12 hours after the
prosedure. Serum creatinine and the glomerular fltration rate (eGFR) were
evaluated before as well as 24 and 48 hours after contrast media
injection. The primary end point was development of CIN (defned as an
increase >25% or >0.5 mg/dl in serum creatinine within 2 days after the
procedure) and acute renal failure recuiring dialysis because of the
contrast exposure. The secondary end point was MACE (cardiovascular death,
serebrovasculer event or myocardial infarction)or hospitalization with
cardiovasculer events for the long term follow-up. Result(s): There
were no signifcant differences between the 2 groups in clinical,procedural
and biochemical characteristics.The incidence of CIN was signifcantly
lower in Group A than in group B (9.0% vs 20.0%, p=0.026) but the
incedence of dialysis because of the contrast exposure is not signifcant
in 2 groups. There were no signifcant differences between 2 groups in
secondary end points (39.0% vs 35.2%, p=0.58) Conclusion(s): Our
study suggests that single-bolus iv administration of sodium bicarbonate
in addition to SH immediately before contrast exposure is more effectively
to prevent CIN than SH alone in patients with moderate-severe renal
insuffciency undergoing an angiographic procedure.

<22>
Accession Number
629806310
Title
Incidence and predictors of permanent pacemaker after transcathater aortic
valve implantion (TAVI) with Edwards Sapien XT device in patients with
severe aortic stenosis due to bicuspid aortic valve.
Source
Anatolian Journal of Cardiology. Conference: 34th Turkish Cardiology
Congress. Turkey. 20 (Supplement 1) (pp 19), 2018. Date of Publication:
October 2018.
Author
Suygun H.; Kasapkara H.A.; Ayhan H.; Bastug S.; Aslan A.N.; Erdogan M.;
Karaduman B.D.; Guzel H.C.; Celik M.C.; Bozkurt E.
Institution
(Suygun, Kasapkara, Ayhan, Bozkurt) Department of Cardiology, Yildirim
Beyazit University Faculty of Medicine, Ankara, Turkey
(Bastug, Aslan, Erdogan, Karaduman, Guzel, Celik) Department of
Cardiology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: Transcatheter aortic valve implantation (TAVI) is
being increasingly performed in patients with bicuspid aortic valve (BAV)
stenosis. Cardiac conduction disturbances requiring permanent pacemaker
(PPM) are a frequent complication of TAVI. However, there is a lack of
data on PPM predictors after TAVI in patients with BAV stenosis. The aim
of this study was to assess the incidence and the predictors of
postoperative PPM requirement in BAV patients undergoing TAVI with Edwards
Sapien XT. Method(s): Sixty two patients who were diagnosed as BAV
stenosis by multislice computed tomography (MSCT) and transthoracic
echocardiography (TTE) from 416 patients who underwent TAVI with Edwards
Sa-pien XT device due to symptomatic severe aortic stenosis were included
retrospectively in Ankara Yildirim Beyazit University, Department of
Cardiology between November 2012 and January 2018. Preprocedural clinical,
anatomic, electrocardiography (ECG), MSCT measurements and procedural
features of the patients were evaluated by univariate analysis for
predictors of PPM implantation. All variables that are signifcant for PPM
implantation in univariate analysis (p<0.05) were entered into a
multivariate logistic regression analysis model. Result(s): Post-TAVI
PPM implantation was performed in 8 patients, with an incidence of 12.9%.
All patients who underwent PPM implantation were found to have bicuspid
type 1 right coronary cusp-left coronary cusp (L-R) fusion. In univariate
analyze, it was observed that the large diameter of the aortic annulus
measured by TTE before treatment had a tendency to implant the PPM but did
not reach statistical signifcance (p=0.07). For univariate analysis of
post-TAVI PPM implantation; preprosedural right bundle brunch block (RBBB)
(p<0.0001), shortness of membranous septum in MSCT (p<0.0001), long aortic
annulus-left main coronary artery (LMCA) distance (p=0.04) were determined
statistically signifcant. When these variables were tested in multivariate
logistic regression analysis, the preprocedural RBBB (p<0.0001) and the
short length of the membranous septum (p=0.03) were determined
statistically signifcant. In multivariate logistic regression analysis, a
statistically signifcant trend was observed in the increase of aortic
annulus-LMCA distance (p=0.08). Conclusion(s): The presence of RBBB
and the short length of membranous septum before the procedure were found
to be independent risk factors for post-TAVI PPM implantation in patients
with BAV treated with Edwards Sapien XT. The type 1 (L-R) patients in the
bicuspid patient group were may be at risk for PPM implantation after
TAVI. Large anulus diameter and increased anulus-LMCA distance might be
risk factors for post-TAVI PPM implantation in patients with BAV stenosis.
Further prospective randomized studies with avaible number of patients
size are required to evaluate predictors of PPM after TAVI in BAV.

<23>
Accession Number
629806205
Title
Periprocedural intermittent contralateral arm ischemia facilitates radial
artery puncture.
Source
Anatolian Journal of Cardiology. Conference: 34th Turkish Cardiology
Congress. Turkey. 20 (Supplement 1) (pp 15), 2018. Date of Publication:
October 2018.
Author
Korkmaz A.; Unal S.; Guray U.
Institution
(Korkmaz, Guray) Department of Cardiology, Ankara Numune Training and
Research Hospital, Ankara, Turkey
(Unal) Department of Cardiology, Ankara Turkiye Yuksek Ihtisas Training
and Research Hospital, Ankara, Turkey
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: Transradial access (TRA) is widely used for both
diagnostic and interventional cardiac procedures. Intermittent arm
ischemia before percutaneous coronary intervention induces remote ischemic
preconditioning and attenuates myocardial injury in patients with
myocardial infarction. Several studies have shown that intermittent arm
ischemia increases coronary fow and is related to autonomic nerve system.
In this study we sought to investigate whether periprocedural intermittent
arm ischemia facilitates radial artery puncture. Method(s): Patients
(n=80) undergoing planned coronary interventions using TRA were
prospectively randomized to intermittent contralateral arm ischemia (n=40)
group and control (40) group. Radial artery diameters were measured by
ultrasonography. The study endpoint aimed to determine whether the
intermittent arm ischemia would improve radial artery access, number of
punctures and successful cannulation. Result(s): Baseline demographic
and clinical characteristics were similar in two groups. There were also
no signifcant differences regarding radial artery diameters before
intervention between groups (2.21 mm [2.0-2.70] for intermittent
contralateral arm ischemia group and 2.40 mm [2.09-2.68] for controls,
p=0.301). However, the radial artery puncture success ratio was higher in
the intermittent contralateral arm ischemia group as compared to the
control group (p=0.025). In multivariable logistic regression analysis
intermittent contralateral arm ischemia was found to be signifcantly
associated with radial artery puncture success (HR: 8.261, 95% CI:
1.427-47.823, p=0.018). Conclusion(s): Periprocedural intermittent
contralateral arm ischemia facilitates radial artery puncture in patients
undergoing transradial cardiac catheterization.

<24>
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.

<25>
Accession Number
629801197
Title
Targeting high-sensitivity C-reactive protein levels in acute coronary
syndrome patients undergoing contemporary lipid-lowering therapy: a
sub-analysis of the HIJ-PROPER trial.
Source
Journal of cardiology. (no pagination), 2019. Date of Publication: 04 Nov
2019.
Author
Kawada-Watanabe E.; Yamaguchi J.; Sekiguchi H.; Arashi H.; Ogawa H.;
Hagiwara N.
Institution
(Kawada-Watanabe, Yamaguchi, Sekiguchi, Arashi, Ogawa, Hagiwara)
Department of Cardiology, Heart Institute of Japan, Tokyo Women's Medical
University, Tokyo, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: The effects of high-sensitivity C-reactive protein (hs-CRP)
levels on clinical outcomes in chronic-phase acute coronary syndrome (ACS)
patients undergoing aggressive lipid-lowering therapy remain unclear. We
examined the effects of hs-CRP levels on the prognosis of ACS patients who
underwent aggressive lipid-lowering therapy and determined treatment
targets for hs-CRP value. METHOD(S): This post-hoc sub-analysis of a
prospective randomized control trial (HIJ-PROPER) included 1734 ACS
patients with dyslipidemia, who were divided into hs-CRP quartiles after 3
months of treatment. Primary endpoints were combined all-cause death,
non-fatal myocardial infarction, non-fatal stroke, unstable angina, and
ischemia-driven coronary revascularization. Secondary endpoint was
all-cause death. RESULT(S): The median follow-up period was 3.7
years. Overall, 1415 patients were evaluated retrospectively. No
significant among-group differences were noted in low-density lipoprotein
cholesterol (LDL-C) levels over time (p=0.44). Kaplan-Meier analyses
revealed that the incidence of the primary and secondary endpoints was
significantly higher in the highest hs-CRP group than in the other groups
[hazard ratio (HR)=1.52, 95% confidence interval (CI)=1.16-2.00, p<0.01;
HR=5.30, 95% CI=2.47-11.32, p<0.01, respectively]. The cut-off hs-CRP
level to predict all-cause death was 0.74mg/L (receiver operating
characteristic curve: sensitivity: 68%, specificity: 62%). Multivariate
analyses revealed that hs-CRP >=0.74mg/Lat 3 months was correlated with an
increased risk of all-cause death (adjusted HR=3.68, 95% CI=2.22-6.10,
p<0.01). CONCLUSION(S): Elevated hs-CRP levels independently
predicted a worse prognosis, regardless of LDL-C levels, suggesting that
interventions against elevated inflammatory responses plus intensive
lipid-lowering therapy and coronary revascularization are encouraging
options for secondary prevention in ACS patients. TRIAL REGISTRATION: This
trial is registered with the UMIN Clinical Trials Registry number
UMIN000002742. Trial name: Proper level of lipid lowering with
pitavastatin and ezetimibe in acute coronary syndrome (HIJ-PROPER) URL:
https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr-view.cgi?recptno=R000003334
. Copyright © 2019. Published by Elsevier Ltd.

<26>
Accession Number
629801139
Title
No Concluding Evidence on Optimal Activated Clotting Time for Non-cardiac
Arterial Procedures.
Source
European journal of vascular and endovascular surgery : the official
journal of the European Society for Vascular Surgery. (no pagination),
2019. Date of Publication: 04 Nov 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, the Netherlands; Department of Vascular Surgery,
Amsterdam University Medical Centres (Amsterdam UMC) Location VU Medical
Centre (VUMC), Amsterdam, the Netherlands
(Scholtes, Blankensteijn, Yeung) Department of Vascular Surgery, Amsterdam
University Medical Centres (Amsterdam UMC) Location VU Medical Centre
(VUMC), Amsterdam, Netherlands
Publisher
NLM (Medline)
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.
Published by Elsevier B.V. All rights reserved.

<27>
Accession Number
629800599
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) (pp 918), 2019. 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) Division of Infectious Diseases, David Geffen School of
Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA,
90095-1688, USA. dgoodman@mednet.ucla.edu
(Goodman-Meza) Infectious Diseases, VA Greater Los Angeles Healthcare
System, Los Angeles, CA, USA. dgoodman@mednet.ucla.edu
(Weiss) Department of Biostatistics, Fielding School of Public Health,
UCLA, Los Angeles, CA, USA
(Gamboa, Gallegos) Universidad Autonoma de Baja California, Tijuana,
United States
(Bui) Medical Imaging Informatics (MII) Group, Department of Radiological
Sciences, UCLA, Los Angeles, CA, USA
(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, USA
(Goetz) Infectious Diseases, VA Greater Los Angeles Healthcare System, Los
Angeles, CA, USA
(Shoptaw) Department of Family Medicine, David Geffen School of Medicine
at UCLA, Los Angeles, CA, USA
(Landovitz) UCLA Center for Clinical AIDS Research & Education, David
Geffen School of Medicine, Los Angeles, CA, USA
Publisher
NLM (Medline)
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.

<28>
Accession Number
629799127
Title
Are segmentectomy and lobectomy comparable in terms of curative intent for
early stage non-small cell lung cancer?.
Source
General thoracic and cardiovascular surgery. (no pagination), 2019. Date
of Publication: 06 Nov 2019.
Author
Mimae T.; Okada M.
Institution
(Mimae, Okada) Department of Surgical Oncology, Hiroshima University,
1-2-3 Kasumi ,Minami-ku, Hiroshima 734-8551, Japan
Publisher
NLM (Medline)
Abstract
In 1995, Ginsberg et al. compared lobectomy with limited resection
including segmentectomy and wide-wedge resection for stage I lung cancer
in a randomized controlled trial and found that limited resection should
not be applied to otherwise healthy patients with clinical stage IA lung
cancer who can tolerate lobectomy. However, recent advances in diagnostic
technology have improved the precision of detecting early-stage and small
lung cancers. Therefore, whether radical segmentectomy, anatomical
segmentectomy with hilar and mediastinal lymph node dissection (that is
more valuable than wedge resection in terms of oncological aspects) and
lobectomy are comparable in terms of curative intent for patients with
early-stage non-small cell lung cancer (NSCLC) remains controversial. The
role of segmentectomy differs according to tumor or patient
characteristics. High resolution computed tomography findings of tumor
size, location, and the presence or ratio of a ground glass opacity (GGO)
component and the maximum of standardized uptake value on
fluorine-18-2-deoxy-D-glucose positron emission tomography are important
for selecting surgical procedures because the malignant potential of even
early-stage NSCLC is variable. The ongoing JCOG0802/WJOG4607L, JCOG1211,
and CALGB140503 trials will disclose the influence of segmentectomy for
patients with early-staged NSCLCs that are small peripheral tumors based
on preoperative high-resolution computed tomography findings about
preserved pulmonary function and long-term prognosis. Segmentectomy is a
key surgical procedure that general thoracic surgeons will need to master
considering that it can be converted to lobectomy if the surgical margin
is insufficient or lymph node metastasis is intraoperatively confirmed.

<29>
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.

<30>
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).

<31>
Accession Number
2003460303
Title
Diagnostic Value of Advanced Imaging Modalities for the Detection and
Differentiation of Prosthetic Valve Obstruction: A Systematic Review and
Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 12 (11P1) (pp 2182-2192), 2019. Date of
Publication: November 2019.
Author
Kim J.Y.; Suh Y.J.; Han K.; Kim Y.J.; Choi B.W.
Institution
(Kim) Department of Radiology, Dongsan Medical Center, Keimyung University
College of Medicine, Daegu, Korea, South Korea
(Suh, Han, Kim, Choi) Department of Radiology, Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of
Medicine, Seoul, Korea, South Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This meta-analysis investigated the diagnostic values of
transthoracic echocardiography (TTE), 2-dimensional (2D) and 3-dimensional
(3D) transesophageal echocardiography (TEE), and multidetector-row
computed tomography (MDCT) in patients with suspected mechanical
prosthetic valve obstruction (PVO) for detecting subprosthetic mass and
differentiating its causes. Background(s): Diagnostic values of
advanced imaging modalities, such as MDCT and TEE, for the detection and
differentiation of PVO have not been investigated. Method(s): PubMed
and EMBASE were systematically searched for studies that evaluated PVO
using imaging modalities. The modified Quality Assessment of Diagnostic
Accuracy Studies-2 tool was used to evaluate study quality. Pooled
sensitivity of each modality for PVO detection and pooled diagnostic
accuracy of TEE and MDCT for differentiating the causes of PVO were
analyzed. Study heterogeneity was also assessed. Result(s): Seventeen
studies (229 patients) that used at least 1 index tool among TTE, TEE, or
MDCT were included. For detecting a subprosthetic mass that caused PVO, 3D
TEE and MDCT showed a higher sensitivity of 81% (95% confidence interval
[CI]: 40% to 95%) and 88% (95% CI: 81% to 93%), respectively, compared
with TTE (20%; 95% CI: 7% to 47%) and 2D TEE (68%; 95% CI: 46% to 84%).
Pooled sensitivity and specificity for diagnosing thrombus as a cause of
PVO was 75% (95% CI: 54% to 88%) and 75% (95% CI: 40% to 93%),
respectively, for TEE and 45% (95% CI: 16% to 77%) and 90% (95% CI: 77% to
96%), respectively, for MDCT. Pooled sensitivity for diagnosing pannus as
a cause of PVO was 62% (95% CI: 46% to 76%) for TEE and 85% (95% CI: 70%
to 93%) for MDCT. Conclusion(s): This meta-analysis suggested that
MDCT and 3D TEE have higher sensitivity than do TTE and 2D TEE, and can be
reliable imaging modalities for detecting a subprosthetic mass that causes
PVO. Moreover, MDCT can more accurately differentiate the cause of PVO
than does TEE. Copyright © 2019 American College of Cardiology
Foundation

<32>
Accession Number
624234772
Title
Effects of comprehensive cardiac rehabilitation on functional capacity in
a middle-income country: a randomised controlled trial.
Source
Heart. 105 (5) (pp 406-413), 2019. Date of Publication: 01 Mar 2019.
Author
Da Silva Chaves G.S.; De Melo Ghisi G.L.; Grace S.L.; Oh P.; Ribeiro A.L.;
Britto R.R.
Institution
(Da Silva Chaves, Britto) Physical Therapy Department, Federal University
of Minas Gerais, Belo Horizonte 31270-901, Brazil
(De Melo Ghisi, Grace, Oh) Cardiovascular Prevention and Rehabilitation
Program, University Health Network, University of Toronto, Toronto, ON,
Canada
(De Melo Ghisi, Grace) School of Kinesiology and Health Science, Faculty
of Health, York University, Toronto, ON, Canada
(Ribeiro) Hospital das Clinicas, Division of Cardiology and Cardiovascular
Surgery, School of Medicine, Universidade Federal de Minas Gerais, Minas
Gerais, Brazil
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Despite the growing epidemic of cardiovascular diseases in
middle-income countries, there is insufficient evidence about cardiac
rehabilitation (CR) in these countries. Thus, the effects of comprehensive
CR on functional capacity and risk factors were investigated in Brazil, to
test the hypothesis that it results in better outcomes than exercise-only
or no CR. Methods Single-blinded, randomised controlled trial with three
parallel arms: comprehensive CR (exercise+education) versus exercise-only
CR versus wait-list control. Eligible coronary patients were randomised in
blocks of four with 1:1:1 concealed allocation. Participants randomised to
exercise-only CR received 36 exercise classes; comprehensive CR group also
received 24 educational sessions. The primary outcome was incremental
shuttle walk test (ISWT) distance; secondary outcomes were cardiovascular
risk factors. All outcomes were assessed at baseline and 6 months later.
Analysis of covariance was performed on the basis of intention-to-treat
(ITT) and per-protocol. Results 115 (88.5%) patients were randomised; 93
(80.9%) were retained. There were improvements in ISWT distance from
pretest to post-test with comprehensive (from 358.4+/-132.6 to
464.8+/-121.6 m; mean change=106.4; p<0.001) and exercise-only (from
391.5+/-118.8 to 488.1+/-106.3 m; mean change=96.5, p<0.001) CR, with
significantly greater functional capacity with comprehensive CR versus
control (ITT: mean difference=75.6+/-30.7 m, 95% CI 1.4 to 150.2). There
were also reductions in systolic blood pressure with comprehensive CR
(ITT: reduction of 6.2+/-17.8 mm Hg, p=0.04). There were no significant
differences for other outcomes. Conclusion Results showed clinically
significant improvements in functional capacity and blood pressure with
CR, and significantly greater functional capacity with comprehensive CR
compared with usual care. Trial registration number NCT02575976;
Results. Copyright © 2019 Author(s) (or their employer(s)).
Re-use permitted under CC BY-NC.

<33>
Accession Number
2003583472
Title
Safety and efficacy of a self-expanding versus a balloon-expandable
bioprosthesis for transcatheter aortic valve replacement in patients with
symptomatic severe aortic stenosis: a randomised non-inferiority trial.
Source
The Lancet. 394 (10209) (pp 1619-1628), 2019. Date of Publication: 2 - 8
November 2019.
Author
Lanz J.; Kim W.-K.; Walther T.; Burgdorf C.; Mollmann H.; Linke A.;
Redwood S.; Thilo C.; Hilker M.; Joner M.; Thiele H.; Conzelmann L.;
Conradi L.; Kerber S.; Schymik G.; Prendergast B.; Husser O.; Stortecky
S.; Heg D.; Juni P.; Windecker S.; Pilgrim T.
Institution
(Lanz, Stortecky, Windecker, Pilgrim) Department of Cardiology,
Inselspital, Bern University Hospital, Bern, Switzerland
(Kim) Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad
Nauheim, Germany
(Walther) Department of Cardiac, Thoracic and Thoracic Vascular Surgery,
University Hospital Frankfurt, Frankfurt, Germany
(Burgdorf) Heart and Vascular Centre, Bad Bevensen, Germany
(Mollmann, Husser) Department of Internal Medicine I,
St-Johannes-Hospital, Dortmund, Germany
(Linke) Department of Internal Medicine and Cardiology, Heart Centre
Dresden, Technische Universitat Dresden, Dresden, Germany
(Redwood, Prendergast) Department of Cardiology, St Thomas' Hospital,
London, United Kingdom
(Thilo) Department of Cardiology, Klinikum Augsburg, Augsburg, Germany
(Hilker) Department of Cardiothoracic Surgery, University Medical Centre,
Regensburg, Germany
(Joner) German Heart Centre, Technical University of Munich, Munich,
Germany
(Thiele) Heart Centre Leipzig, Leipzig, Germany
(Conzelmann) Department of Cardiac Surgery, Helios Klinik, Karlsruhe,
Germany
(Conradi) Department of Cardiovascular Surgery, University Heart Centre
Hamburg, Hamburg, Germany
(Kerber) Department of Cardiology, Cardiovascular Centre Bad Neustadt, Bad
Neustadt, Germany
(Schymik) Department of Cardiology, Stadtisches Klinikum Karlsruhe,
Karslruhe, Germany
(Heg) Clinical Trials Unit, University of Bern, Bern, Switzerland
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, Department of Medicine and Institute of Health
Policy, Management, and Evaluation, University of Toronto, Toronto, ON,
Canada
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is the preferred
treatment option for older patients with symptomatic severe aortic
stenosis. Differences in the properties of available TAVR systems can
affect clinical outcomes. Among patients undergoing TAVR, we compared the
self-expanding ACURATE neo TAVR system with the balloon-expandable SAPIEN
3 TAVR system with regard to early safety and efficacy. Method(s): In
this randomised non-inferiority trial, patients (aged >=75 years)
undergoing transfemoral TAVR for treatment of symptomatic severe aortic
stenosis, and who were deemed to be at increased surgical risk, were
recruited at 20 tertiary heart valve centres in Germany, the Netherlands,
Switzerland, and the UK. Participants were randomly assigned (1:1) to
receive treatment with the ACURATE neo or the SAPIEN 3 with a
computer-based randomly permuted block scheme, stratified by study centre
and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM)
category. The primary composite safety and efficacy endpoint comprised
all-cause death, any stroke, life-threatening or disabling bleeding, major
vascular complications, coronary artery obstruction requiring
intervention, acute kidney injury (stage 2 or 3), rehospitalisation for
valve-related symptoms or congestive heart failure, valve-related
dysfunction requiring repeat procedure, moderate or severe prosthetic
valve regurgitation, or prosthetic valve stenosis within 30 days of the
procedure. Endpoint assessors were masked to treatment allocation.
Non-inferiority of ACURATE neo compared with SAPIEN 3 was assessed in the
intention-to-treat population on the basis of a risk-difference margin of
7.7% for the primary composite endpoint, with a one-sided alpha of 0.05.
This trial is registered with ClinicalTrials.gov (number NCT03011346) and
is ongoing but not recruiting. Finding(s): Between Feb 8, 2017, and
Feb 2, 2019, up to 5132 patients were screened and 739 (mean age 82.8
years [SD 4.1]; median STS-PROM score 3.5% [IQR 2.6-5.0]) were enrolled.
30-day follow-up was available for 367 (99%) of 372 patients allocated to
the ACURATE neo group, and 364 (99%) of 367 allocated to the SAPIEN 3
group. Within 30 days, the primary endpoint occurred in 87 (24%) patients
in the ACURATE neo and in 60 (16%) in the SAPIEN 3 group; thus,
non-inferiority of the ACURATE neo was not met (absolute risk difference
7.1% [upper 95% confidence limit 12.0%], p=0.42). Secondary analysis of
the primary endpoint suggested superiority of the SAPIEN 3 device over the
ACURATE neo device (95% CI for risk difference -1.3 to -12.9, p=0.0156).
The ACURATE neo and SAPIEN 3 groups did not differ in incidence of
all-cause death (nine patients [2%] vs three [1%]) and stroke (seven [2%]
vs 11 [3%]); whereas acute kidney injury (11 [3%] vs three [1%]) and
moderate or severe prosthetic aortic regurgitation (34 [9%] vs ten [3%])
were more common in the ACURATE neo group. Interpretation(s): TAVR
with the self-expanding ACURATE neo did not meet non-inferiority compared
to the balloon-expandable SAPIEN 3 device in terms of early safety and
clinical efficacy outcomes. An early composite safety and efficacy
endpoint was useful in discriminating the performance of different TAVR
systems. Funding(s): Boston Scientific (USA). Copyright ©
2019 Elsevier Ltd

<34>
Accession Number
2001537578
Title
Uniportal Lung Cancer Surgery: State of the Evidence.
Source
Annals of Thoracic Surgery. 107 (3) (pp 962-972), 2019. Date of
Publication: March 2019.
Author
Sihoe A.D.L.
Institution
(Sihoe) Department of Surgery, Li Ka Shing Faculty of Medicine, The
University of Hong Kong, Hong Kong, Hong Kong
(Sihoe) Division of Thoracic Surgery, The University of Hong Kong Shenzhen
Hospital, Shenzhen, China
(Sihoe) Department of Thoracic Surgery, Tongji University Shanghai
Pulmonary Hospital, Shanghai, China
Publisher
Elsevier USA
Abstract
Background: Uniportal video-assisted thoracic surgery (VATS) has generated
much attention in recent years, but questions remain regarding the
adequacy of evidence to support its use in lung cancer surgery. This
review aims to explore what the currently published literature suggests
the role of the uniportal approach may be and to critically appraise that
literature. Method(s): A systematic review was conducted using the
Ovid Medline database to identify articles related to uniportal VATS.
Articles were selected for review on the basis of ability to provide
original clinical data on the role of uniportal VATS for lung cancer
surgery. Result(s): The literature search revealed that only some
publications on uniportal VATS provided original clinical data. Twenty-two
articles were selected for review, including 9 case series and 13
comparative studies. No concerns about the safety of the uniportal VATS
were noted. Some but not all comparative studies provided data suggesting
that uniportal VATS may hold advantages over multiportal VATS in some
simple clinical outcomes (such as reduced lengths of stay and
postoperative pain). However, the quantity and quality of evidence thus
far are limited. Conclusion(s): It remains premature to declare
superiority for uniportal VATS in lung cancer surgery. A higher level of
evidence is needed, especially in investigating objective benefits and
treatment efficacy of the single-incision approach. Copyright ©
2019 The Society of Thoracic Surgeons

<35>
Accession Number
2001481642
Title
Handoffs From the Operating Room to the Intensive Care Unit After
Cardiothoracic Surgery: From The Society of Thoracic Surgeons Workforce on
Critical Care.
Source
Annals of Thoracic Surgery. 107 (2) (pp 619-630), 2019. Date of
Publication: February 2019.
Author
Chatterjee S.; Shake J.G.; Arora R.C.; Engelman D.T.; Firstenberg M.S.;
Geller C.M.; Hirose H.; Lonchyna V.A.; Lytle F.T.; Milewski R.K.C.;
Moosdorf R.G.H.; Rabin J.; Sanjanwala R.; Galati M.; Whitman G.J.
Institution
(Chatterjee) Division of General and Cardiothoracic Surgery, Michael E.
DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX,
United States
(Chatterjee) Department of Cardiovascular Surgery, Texas Heart Institute,
Houston, TX, United States
(Shake) Department of Surgery, University of Mississippi School of
Medicine, Jackson, MS, United States
(Arora, Sanjanwala) Department of Surgery, St. Boniface Hospital,
University of Manitoba, Winnipeg, Canada
(Engelman) Department of Surgery, Baystate Medical Center, Springfield,
MA, United States
(Firstenberg) Division of Cardiothoracic Surgery, Department of Surgery,
The Medical Center of Aurora, Aurora, CO, United States
(Geller) Division of Cardiothoracic Surgery, Department of Surgery,
Crozer-Keystone Health System, Drexel University College of Medicine,
Upland, PA, United States
(Hirose) Division of Cardiothoracic Surgery, Department of Surgery, Thomas
Jefferson University, Philadelphia, PA, United States
(Lonchyna) Section of Cardiac and Thoracic Surgery, Department of Surgery,
University of Chicago School of Medicine, Chicago, IL, United States
(Lytle) Division of Critical Care Medicine, Department of Anesthesiology,
Case Western Reserve University, Cleveland, OH, United States
(Milewski) Department of Surgery, University of Pennsylvania School of
Medicine, Philadelphia, PA, United States
(Moosdorf) Department for Cardiovascular Surgery, Phillips University
Marburg, Marburg, Germany
(Rabin) R. Adams Cowley Shock Trauma Center, University of Maryland School
of Medicine, Baltimore, MD, United States
(Galati) Texas Medical Center Library, Houston, TX, United States
(Whitman) Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
Publisher
Elsevier USA

<36>
Accession Number
2003397064
Title
Reducing blood loss in pediatric craniosynostosis surgery by use of
tranexamic acid.
Source
Neurochirurgie. 65 (5) (pp 302-309), 2019. Date of Publication: November
2019.
Author
Eustache G.; Riffaud L.
Institution
(Eustache) Rennes University, CHU of Rennes, Department of Anesthesiology,
Rennes 35000, France
(Riffaud) Rennes University, CHU of Rennes, Department of Neurosurgery,
Rennes 35000, France
(Riffaud) INSERM MediCIS, Unit U1099 LTSI, Rennes 1 University, Rennes,
35000, France
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction: Craniosysnostosis surgical corrections are routine
procedures in the pediatric neurosurgical field. However, these procedures
result in significant blood loss. Tranexamic acid (TXA) is an
antifibrinolytic drug, which has demonstrated a significant reduction in
perioperative blood loss in many pediatric surgical procedures such as
cardiac surgery and scoliosis surgery. We conducted a systematic review to
evaluate protocols of TXA use in pediatric craniosynostosis procedures and
its effect on intraoperative blood loss and transfusions. Material(s)
and Method(s): A comprehensive literature review of the National Library
of Medicine (PubMed) database was performed to identify relevant studies.
We included any clinical study reporting on blood loss or blood
transfusion for pediatric craniosynostosis surgery with intraoperative use
of tranexamic acid, with the following limits: publication date from
inception to May 2019; reports in English. Result(s): Thirteen
studies were eligible for our review. Of the 13 studies, 4 were
prospective, randomised, double-blind controlled trials, 9 were
retrospective studies, tailored as a "before-after" studies, comparing
blood loss and transfusion without/with TXA. TXA significantly decreases
the number and volume of packed red blood cell transfusions and the rate
of transfusion in children undergoing craniosynostosis surgery.
Significantly fewer fresh frozen plasma transfusions were required in the
TXA groups in 2 randomised studies. Length of stay in hospital was
significantly lower with the use of TXA in three studies. Advantages of
TXA administration also include an excellent patient tolerance of side
effects, ease of administration and low cost. Conclusion(s): TXA
significantly reduces blood loss and the need for transfusions in children
undergoing craniosynostosis surgery. TXA administration should be a
routine part of strategy to reduce blood loss and limit transfusions in
these procedures. Copyright © 2019 Elsevier Masson SAS

<37>
Accession Number
2003460299
Title
Meta-Analysis of the Prognostic Role of Late Gadolinium Enhancement and
Global Systolic Impairment in Left Ventricular Noncompaction.
Source
JACC: Cardiovascular Imaging. 12 (11P1) (pp 2141-2151), 2019. Date of
Publication: November 2019.
Author
Grigoratos C.; Barison A.; Ivanov A.; Andreini D.; Amzulescu M.-S.;
Mazurkiewicz L.; De Luca A.; Grzybowski J.; Masci P.G.; Marczak M.;
Heitner J.F.; Schwitter J.; Gerber B.L.; Emdin M.; Aquaro G.D.
Institution
(Grigoratos, Barison, De Luca, Emdin, Aquaro) Fondazione Gabriele
Monasterio CNR/Regione Toscana, Pisa, Italy
(Grigoratos, Emdin) Institute of Life Sciences, Scuola Superiore
Sant'Anna, Pisa, Italy
(Ivanov, Heitner) Department of Cardiology, New York Methodist Hospital,
Brooklyn, NY, United States
(Andreini) Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Andreini) Department of Clinical Sciences and Community Health,
Cardiovascular Section, University of Milan, Milan, Italy
(Amzulescu, Gerber) Division of Cardiology, Department of Cardiovascular
Diseases Cliniques St. Luc and Pole de Recherche Cardiovasculaire,
Institut de Recherche Experimentale et Clinique, Universite Catholique de
Louvain, Brussels, Belgium
(Mazurkiewicz, Grzybowski) Department of Cardiomyopathies, Institute of
Cardiology, Warsaw, Poland
(Mazurkiewicz, Marczak) CMR Unit, Institute of Cardiology, Warsaw, Poland
(Masci, Schwitter) Division of Cardiology and CMR-Center, University
Hospital Lausanne, Lausanne, Switzerland
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The objective of this meta-analysis was to assess the
predictive value of late gadolinium enhancement (LGE) and global systolic
impairment for future major adverse cardiovascular events in left
ventricular noncompaction (LVNC). Background(s): The prognosis of
patients with LVNC, with and without left ventricular dysfunction and LGE,
is still unclear. Method(s): A systematic review of published
research and a meta-analysis reporting a combined endpoint of hard
(cardiac death, sudden cardiac death, appropriate defibrillator firing,
resuscitated cardiac arrest, cardiac transplantation, assist device
implantation) and minor (heart failure hospitalization and thromboembolic
events) events was performed. Result(s): Four studies with 574
patients with LVNC and 677 with no LVNC and an average follow-up duration
of 5.2 years were analyzed. In patients with LVNC, LGE was associated with
the combined endpoint (pooled odds ratio: 4.9; 95% confidence interval:
1.63 to 14.6; p = 0.005) and cardiac death (pooled odds ratio: 9.8; 95%
confidence interval: 2.44 to 39.5; p < 0.001). Preserved left ventricular
systolic function was found in 183 patients with LVNC: 25 with positive
LGE and 158 with negative LGE. In LVNC with preserved ejection fraction,
positive LGE was associated with hard cardiac events (odds ratio: 6.1; 95%
confidence interval: 2.1 to 17.5; p < 0.001). No hard cardiac events were
recorded in patients with LVNC, preserved ejection fraction, and negative
LGE. Conclusion(s): Patients with LVNC but without LGE have a better
prognosis than those with LGE. When LGE is negative and global systolic
function is preserved, no hard cardiac events are to be expected.
Currently available criteria allow diagnosis of LVNC, but to further
define the presence and prognostic significance of the disease, LGE and/or
global systolic impairment must be considered for better risk
stratification. Copyright © 2019 American College of Cardiology
Foundation

<38>
Accession Number
624935237
Title
Volatile anesthetics versus propofol in the cardiac surgical setting of
remote ischemic preconditioning: A secondary analysis of a Cochrane
Systematic Review.
Source
Minerva Anestesiologica. 84 (11) (pp 1298-1306), 2018. Date of
Publication: November 2018.
Author
Benstoem C.; Goetzenich A.; Autschbach R.; Marx G.; Stoppe C.; Breuer T.
Institution
(Benstoem, Marx, Stoppe, Breuer) Department of Intensive Care Medicine and
Intermediate Care, Medical Faculty, RWTH Aachen University, Pauwelsstr.
30, Aachen D-52074, Germany
(Goetzenich, Autschbach) Department of Thoracic and Cardiovascular
Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: So far, the concept of remote ischemic preconditioning
(RIPC) failed its translation from experimental to clinical studies. In
addition to our Cochrane Systematic Review, we systematically assessed the
use of the intravenous anesthetic propofol, as a potential confounding
factor. EVIDENCEACQUISITION: We searched CENTRAL, MEDLINE, Embase and Web
of Science. We included randomized controlled trials comparing RIPCwith no
RIPCin adult patients scheduled for coronary artery bypass graft surgery
(with or without valve surgery) receiving either exclusively propofol or
exclusively volatile anesthetics. Two authors independently assessed
methodological quality and extracted data. We report odds ratios (ORs)
with 95% confidence intervals as our summary statistics are based on
random-effects models. EVIDENCESYNTHESIS: We included 14 studies involving
4060 participants. We found no difference in treatment effect between the
propofol and volatile anesthetic groups when RIPCor no RIPCis applied on a
composite endpoint (all-cause mortality, non-fatal myocardial infarction
and/or any new stroke), all-cause mortality, non-fatal myocardial
infarction, stroke, or length of stay on ICU. On cardiac markers, RIPCdid
show a treatment effect on cardiac troponin T measured as AUC 72 hours
(SMD -0.80, CI -1.34, -0.25) in the propofol group. However, these
findings have to be interpreted with great caution, to date only a very
limited number of patients received volatile anesthetics in RIPCtrials
(minimum N.=15, maximum N.=232). CONCLUSION(S): Present data do not
permit a final assessment regarding the role of volatile or intravenous
anesthetics as a possible confounding factor in RIPCtrials. Copyright
© 2018 EDIZIONIMINERVAMEDICA.

<39>
Accession Number
624935128
Title
Effects of inhalation and intravenous anesthesia on intraoperative
cardiopulmonary function and postoperative complications in patients
undergoing thoracic surgery.
Source
Minerva Anestesiologica. 84 (11) (pp 1287-1297), 2018. Date of
Publication: November 2018.
Author
Pang Q.-Y.; An R.; Liu H.-L.
Institution
(Pang, An, Liu) Department of Anesthesiology, Chongqing Cancer Hospital
and Institute, 181 Hanyu Lu, Shapingba district, Chongqing 400030, China
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: There is a high incidence of postoperative cardiopulmonary
complications after thoracic surgery with one lung ventilation (OLV), the
effect of general anesthetics on intraoperative cardiopulmonary function
and postoperative complications is still unclear. EVIDENCEACQUISITION: We
searched the EMBASE, PubMed, Cochrane Library, Springer, Wiley, CNKI, VIP
and Wanfang databases for randomized controlled trials (RCTs) in which
inhalation anesthesia and intravenous anesthesia were compared;
intraoperative cardiopulmonary function and postoperative complications
were assessed in patients undergoing thoracic surgery with intraoperative
one-lung ventilation (OLV). EVIDENCESYNTHESIS: Twenty-three RCTs with a
total of 1349 patients were included. Compared with intravenous
anesthesia, inhalation anesthesia significantly increased pulmonary shunt
fraction (Qs/Qt) (mean: 5.72, 95% CI: 3.93 to 7.51, P<0.0001), and
improved Cardiac Index (CI) (mean difference [MD]: 0.19, 95% CI: 0.10 to
0.28, P<0.0001), but decreased Oxygenation Index (OI) during OLV
intraoperatively (MD: -27.37, 95% CI: -43.92 to -10.82, P=0.001).
Inhalation anesthesia could reduce postoperative pulmonary complications
(RR: 0.47, 95% CI: 0.33 to 0.66, P<0.0001), but did not reduce
postoperative cardiac adverse events (P>0.05). CONCLUSION(S):
Inhalation anesthesia can preserve intraoperative cardiac function and
reduce postoperative pulmonary complications in patients undergoing
thoracic surgery with OLV; although it decreases intraoperative pulmonary
function, inhalation anesthesia may be superior to intravenous anesthesia
in thoracic surgery. Publication bias existed in some included studies,
and the sample size was not large enough in CIand cardiac adverse
events. Copyright © 2018 EDIZIONIMINERVAMEDICA.

<40>
Accession Number
624287429
Title
Perioperative hyperglycemia and neurocognitive outcome after surgery: A
systematic review.
Source
Minerva Anestesiologica. 84 (10) (pp 1178-1188), 2018. Date of
Publication: October 2018.
Author
Hermanides J.; Qeva E.; Preckel B.; Bilotta F.
Institution
(Qeva, Bilotta) Department of Anesthesiology, Critical Care and Pain,
Sapienza University of Rome, Rome, Italy
(Hermanides, Preckel) Department of Anesthesiology, Academic Medical
Centre, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
introDUction: Preliminary evidence suggest a possible relationship between
perioperative hyperglycemia, postoperative delirium (PoD) or cognitive
dysfunction (PocD). We aim to present the available clinical evidence
related to chronic (i.e. diabetes mellitus) or acute perioperative
hyperglycemia as risk factors for PoD/PocD. eviDence acQUisition: a
literature search of eMBase (via ovid, 1974-present) online medical
database and MeDline (via PubMed or ovid, 1946-present) was performed. all
types of clinical studies including randomized controlled trials,
prospective, as well as retrospective cohort studies were screened.
clinical studies that reported original information on the relationship
between diabetes mellitus (DM) and/or acute perioperative abnormal glucose
levels and PoD or PocD were selected. reviews and editorials (i.e.
articles not presenting original preclinical or clinical research) were
excluded and case-reports were not considered for analysis. eviDence
sYntHesis: our search resulted in 2356 papers for screening, from which we
selected 29 studies that met our inclusion criteria. DM was investigated
in 24 observational papers, acute perioperative hyperglycemia in six
observational studies and two randomized controlled trials examined the
effect of perioperative glucose lowering on PoD/PocD. Diabetes was
associated with PoD or PocD in 18/24 observational studies and 6/6 of the
included observational studies found that perioperative hyperglycemia was
associated with PoD/PocD, independent of diabetes. the two randomized
controlled trials had a different trial design and reported conflicting
results. conclUsions: according to the available evidence, DM and acute
perioperative hyperglycemia may be associated with an increased risk for
PoD/PocD. these conclusions are based mostly on observational studies and
deserve more and dedicated research. this systematic review may direct the
design of future studies. Copyright © 2018 Edizioni Minerva
Medica.

<41>
Accession Number
2001926721
Title
Comparison of early and midterm outcomes after transsubclavian/axillary
versus transfemoral, transapical, or transaortic transcatheter aortic
valve implantation.
Source
Heart and Lung. 48 (6) (pp 519-529), 2019. Date of Publication: November -
December 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, Shimizu-cho, Sunto-gun, Shizuoka 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
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Outcomes after transsubclavian/transaxillary
(TSc/TAx)-transcatheter aortic valve implantation (TAVI) have been
unclear. Objective(s): To compare outcomes after TSc/TAx-TAVI versus
transfemoral (TF)-TAVI, transapical (TAp)-TAVI, or transaortic (TAo)-TAVI,
we performed meta-analysis of currently available studies. Method(s):
Studies considered for inclusion met the following criteria: the study
population was patients undergoing TAVI; patients were assigned to
TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least one of
postprocedural early (30-day or in-hospital) or late (including early)
outcomes was reported. An odds or hazard ratio of each early or late
outcome with its 95% confidence interval for TSc/TAx-TAVI versus the other
approach was extracted from each individual study and combined in the
random-effects model. Result(s): Our search identified 15 eligible
reports from 12 studies including 10,528 patients. Pooled analysis of
early all-cause mortality demonstrated a statistically significant
reduction after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.003) or
TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation
demonstrated a statistically significant increase after TSc/TAx-TAVI
compared with TAp-TAVI (P = 0.0001) or TAo-TAVI (P < 0.00001). Pooled
analysis of midterm all-cause mortality demonstrated a statistically
significant increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007).
 Conclusion(s): Early all-cause mortality was lower after TSc/TAx-TAVI
than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent
after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm all-cause
mortality was higher after TSc/TAx-TAVI than TF-TAVI. Copyright ©
2019 Elsevier Inc.

<42>
Accession Number
2002683140
Title
Network meta-analysis of new-generation valves for transcatheter aortic
valve implantation.
Source
Heart and Vessels. (no pagination), 2019. Date of Publication: 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, Shimizu-cho, Sunto-gun, Shizuoka 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.

<43>
Accession Number
629450934
Title
Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease.
Source
The New England journal of medicine. 381 (19) (pp 1820-1830), 2019. Date
of Publication: 07 Nov 2019.
Author
Stone G.W.; Kappetein A.P.; Sabik J.F.; Pocock S.J.; Morice M.-C.; Puskas
J.; Kandzari D.E.; Karmpaliotis D.; Brown W.M.; Lembo N.J.; Banning A.;
Merkely B.; Horkay F.; Boonstra P.W.; van Boven A.J.; Ungi I.; Bogats G.;
Mansour S.; Noiseux N.; Sabate M.; Pomar J.; Hickey M.; Gershlick A.;
Buszman P.E.; Bochenek A.; Schampaert E.; Page P.; Modolo R.; Gregson J.;
Simonton C.A.; Mehran R.; Kosmidou I.; Genereux P.; Crowley A.; Dressler
O.; Serruys P.W.
Institution
(Stone, Kappetein, Sabik, Pocock, Morice, Puskas, Kandzari, Karmpaliotis,
Brown, Lembo, Banning, Merkely, Horkay, Boonstra, van Boven, Ungi, Bogats,
Mansour, Noiseux, Sabate, Pomar, Hickey, Gershlick, Buszman, Bochenek,
Schampaert, Page, Modolo, Gregson, Simonton, Mehran, Kosmidou, Genereux,
Crowley, Dressler, Serruys) From the Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.,
R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L.,
R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint
Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia
University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus
Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden
(P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam,
Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals
Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene
and Tropical Medicine (S.J.P., J.G.) and the International Centre for
Circulatory Health, National Heart and Lung Institute, Imperial College
London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and
University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all
in the United Kingdom; Hopital Prive Jacques Cartier, Ramsay Generale de
Sante, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K.,
W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University
of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de
l'Universite de Montreal (S.M., N.N.) and Hopital du Sacre-Coeur de
Montreal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S.,
J. Pomar); Medical University of Silesia, Katowice, and American Heart of
Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of
Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA
(C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ (P.G.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Long-term outcomes after percutaneous coronary intervention
(PCI) with contemporary drug-eluting stents, as compared with
coronary-artery bypass grafting (CABG), in patients with left main
coronary artery disease are not clearly established. METHOD(S): We
randomly assigned 1905 patients with left main coronary artery disease of
low or intermediate anatomical complexity (according to assessment at the
participating centers) to undergo either PCI with fluoropolymer-based
cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or
CABG (CABG group, 957 patients). The primary outcome was a composite of
death, stroke, or myocardial infarction. RESULT(S): At 5 years, a
primary outcome event had occurred in 22.0% of the patients in the PCI
group and in 19.2% of the patients in the CABG group (difference, 2.8
percentage points; 95% confidence interval [CI], -0.9 to 6.5; P=0.13).
Death from any cause occurred more frequently in the PCI group than in the
CABG group (in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI,
0.2 to 6.1). In the PCI and CABG groups, the incidences of definite
cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5
percentage points; 95% CI, -1.4 to 2.5) and myocardial infarction (10.6%
and 9.1%; difference, 1.4 percentage points; 95% CI, -1.3 to 4.2) were not
significantly different. All cerebrovascular events were less frequent
after PCI than after CABG (3.3% vs. 5.2%; difference, -1.9 percentage
points; 95% CI, -3.8 to 0), although the incidence of stroke was not
significantly different between the two groups (2.9% and 3.7%; difference,
-0.8 percentage points; 95% CI, -2.4 to 0.9). Ischemia-driven
revascularization was more frequent after PCI than after CABG (16.9% vs.
10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0).
 CONCLUSION(S): In patients with left main coronary artery disease of
low or intermediate anatomical complexity, there was no significant
difference between PCI and CABG with respect to the rate of the composite
outcome of death, stroke, or myocardial infarction at 5 years. (Funded by
Abbott Vascular; EXCEL ClinicalTrials.gov number,
NCT01205776.). Copyright © 2019 Massachusetts Medical Society.

<44>
Accession Number
2003523983
Title
The impact of deep sternal wound infections treated by negative pressure
on early, 1 year and late mortality: A longitudinal case-control study.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Drossos G.; Ampatzidou F.; Baddour A.; Madesis A.; Karaiskos T.
Institution
(Drossos, Baddour, Madesis, Karaiskos) Cardiothoracic Surgery Department,
G. Papanikolaou General Hospital, Thessaloniki, Greece
(Ampatzidou) Cardiothoracic Intensive Care Unit, G. Papanikolaou General
Hospital, Thessaloniki, Greece
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background/Aim: Deep sternal wound infection (DSWI) after cardiac surgery,
is a rare complication that can be fatal. Due to a lack of available data,
we compared early in-hospital, 1-year and long-term mortality in patients
with DSWI. Method(s): Patients undergoing any type of cardiac
surgery, in the Cardiothoracic Surgery Department of G. Papanikolaou
Hospital, between May 2012 and December 2016, were investigated. All
patients who developed DWSI postoperatively, treated with negative
pressure wound therapy (NPWT), were included in the group of cases. A
random population from the rest of the patients was selected in a 1:2
ratio, representing controls. Result(s): From a total of 2104
patients, 80 patients (3.8%) developed DSWI (cases group), whereas 180
patients were randomly selected as controls. Early (within 30 days)
mortality was significantly higher in the DSWI group compared with
controls (15% vs 3.9%, respectively; P =.002). Similarly, more deaths
occurred in the cases group compared with controls during the follow-up
(ie, 19 vs 12, respectively; P <.001); the majority of deaths (84.2%)
occurred within the first year. Long-term survival did not differ between
the two study groups during follow-up (median duration = 1072 vs 1022 days
for cases and controls, respectively). Conclusion(s): DSWI
significantly increased early and 1-year mortality in poststernotomy
patients treated with NPWT compared with those not developing this
complication. However, long-term survival was similar between the two
study groups, thus highlighting the beneficial effect of NPWT in terms of
clinical outcomes in patients with DWSI. Copyright © 2019 Wiley
Periodicals, Inc.

<45>
Accession Number
2003464602
Title
Anesthesia for renal transplantation in patients with dilated
cardiomyopathy: a retrospective study of 31 cases.
Source
Brazilian Journal of Anesthesiology. 69 (5) (pp 477-483), 2019. Date of
Publication: September - October 2019.
Author
Goyal V.K.; Gupta P.; Baj B.
Institution
(Goyal, Gupta, Baj) Mahatma Gandhi Medical College and Hospital,
Department of Anaesthesiology, Critical Care and Pain Management, Jaipur,
India
Publisher
Elsevier Editora Ltda
Abstract
Background and objectives: Dilated cardiomyopathy is a state of
progressive enlargement of cardiac chambers mainly left ventricle which
leads to decreased cardiac output and ultimately cardiac failure. Although
it has multifactorial etiology, it is quite common in patients with end
stage renal disease who require renal transplant surgery for their cure.
Both conditions go side by side and anesthetic management of such cases
poses real challenge to anesthesiologist. Strict monitoring and control of
cardiac physiology is of utmost importance besides meticulous fluid
management, thus preserving renal blood flow on one hand and preventing
cardiac failure on other hand. This is the basis of achieving good outcome
of the renal transplant surgery. Method(s): This is a retrospective
observational study done by analysing electronic database of 31 patients
with dilated cardiomyopathy who underwent renal transplant surgery. Data
was studied in terms of demographics, duration of renal disease,
comorbidities mainly hypertension, cardiac echo graphic findings including
ejection fraction, medications and post-operative outcome. Result(s):
Most common perioperative complication in this patient population was
hypotension (51.61%) followed by pulmonary complications postoperative
mechanical ventilation (12.9%) and pulmonary edema (6.45%). High incidence
of hypotension may be a causative factor to increased rate of delayed
graft functioning (12.9%) and acute tubular necrosis (2.23%) in these
patients. Conclusion(s): Strict monitoring and control of hemodynamic
parameters as well as meticulous fluid therapy is the cornerstone in
improving outcome in patients with dilated cardiomyopathy undergoing renal
transplant surgery. Copyright © 2019

<46>
Accession Number
2003474279
Title
Transfusion-related immunomodulation: gamma irradiation alters the effects
of leukoreduction on alloimmunization.
Source
Transfusion. (no pagination), 2019. Date of Publication: 2019.
Author
Nelson K.A.; Aldea G.S.; Warner P.; Latchman Y.; Gunasekera D.; Tamir A.;
Gernsheimer T.; Bolgiano D.; Slichter S.J.
Institution
(Nelson, Warner, Latchman, Gunasekera, Tamir, Gernsheimer, Bolgiano,
Slichter) Bloodworks Northwest, Seattle, WA, United States
(Aldea) Department of Surgery, Division of Cardiothoracic Surgery,
University of Washington, Seattle, WA, United States
(Latchman) Silverback Therapeutics, Seattle, WA, United States
(Gunasekera) Uniformed Services University of Health Sciences, Bethesda,
MD, United States
(Gernsheimer, Slichter) Division of Hematology, University of Washington
School of Medicine, Seattle, WA, United States
(Gernsheimer, Slichter) Seattle Cancer Care Alliance, Seattle, WA, United
States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Adverse events following blood transfusion include
allosensitization and generalized immunosuppression, collectively referred
to as transfusion-related immune modulation. We evaluated the
immunological effects of red blood cell (RBC) and platelet transfusions on
alloantibody responses and on immunoregulatory cells in
nonimmunosuppressed patients undergoing cardiovascular surgery. STUDY
DESIGN AND METHODS: Patients were randomized to receive standard
unmodified (STD), leukoreduced (LR), or leukoreduced and gamma-irradiated
(LRgamma) RBCs. Patients received only apheresis platelets that were
in-process LR and were gamma-irradiated for the third arm. Nontransfused
patients served as controls for the effects of surgery itself on
immunologic changes. Antibodies to HLA were assessed with use of
solid-phase assays. The effects of transfusion on adaptive and innate
immunity were evaluated by assessing T regulatory cells (Tregs) and
invariant natural killer T (iNKT) cells. RESULT(S): LR of blood
products reduced the development of human leukocyte antigen (HLA)
alloantibodies, but only in patients without preexisting HLA antibodies.
However, if LR blood products were gamma-irradiated, HLA antibody
production was not reduced. Compared to nontransfused patients, recipients
of STD or LR transfusions showed a significant increase in
CD4+CD25hi T cells expressing FoxP3 or CTLA4 and also of iNKT
cells producing interleukin-4. In contrast, recipients of LRgamma blood
products showed markedly lower increases in all three cellular assays.
 CONCLUSION(S): LR decreased HLA alloantibody production in naive
recipients, but did not reduce the immunosuppressive effects of
transfusion. LRgamma reduced immunosuppression and was not associated with
decreased HLA alloantibody production. Copyright © 2019 AABB

<47>
[Use Link to view the full text]
Accession Number
627633464
Title
Does Lifestyle Exercise After a Cardiac Event Improve Metabolic Syndrome
Profile in Older Adults?.
Source
The Journal of cardiovascular nursing. 33 (3) (pp E1-E9), 2018. Date of
Publication: 01 May 2018.
Author
Wright K.D.; Moore-Schiltz L.; Sattar A.; Josephson R.; Moore S.M.
Institution
(Wright) Kathy D. Wright, PhD, RN, GCNS-BC, PMHCNS-BC Assistant Professor,
Chief Diversity Officer College of Nursing, Discovery Theme Traumatic
Brain, The Ohio State University, Columbus, Ohio. Laura Moore-Schiltz,
PhD, RDN, LD Consultant, Moore-Schiltz Consulting. Abdus Sattar, PhD
Associate Professor of Biostatistics, Department of Epidemiology and
Biostatistics, School of Medicine, Case Western Reserve University,
Cleveland, Ohio. Richard Josephson, MD, FACC, FAHA, FACP, FAACVPR
Professor of Medicine, School of Medicine, Case Western Reserve
University, and Director of Cardiac Intensive Care and of Cardiovascular
and Pulmonary Rehabilitation, Division of Cardiovascular Medicine,
Harrington Heart & Vascular Institute, University Hospitals Health System,
Cleveland, Ohio. Shirley M. Moore, PhD, RN, FAAN Edward J. and Louise
Mellen Professor of Nursing, Associate Dean for Research, and Director of
SMART Center, Frances Payne Bolton School of Nursing, Case Western Reserve
University, Cleveland, Ohio. The authors have no conflicts of interest to
disclose
Publisher
NLM (Medline)
Abstract
BACKGROUND: Exercise is a common recommendation to reduce the risk factors
of metabolic syndrome, yet there are limited data on the influence of
lifestyle exercise after cardiac events on metabolic syndrome factors.
 OBJECTIVE(S): The purpose of this study was to determine whether
lifestyle exercise improves metabolic syndrome profile in older adults
after a cardiac event. METHOD(S): Participants were from a
post-cardiac-event lifestyle exercise study. Five metabolic syndrome
factors were assessed: waist circumference, triglycerides, high-density
lipids, glucose, and systolic and diastolic blood pressure. Objective
measures of exercise were obtained from heart rate monitors over a year.
Logistic regression was used to determine whether participants who engaged
in the minimum recommendation of 130 hours of exercise or greater during
the 12-month period improved their metabolic syndrome profile by improving
at least 1 metabolic syndrome factor. RESULT(S): In the sample of 116
participants (74% men; average age, 67.5 years), 43% exercised at the
recommended amount (>=130 h/y) and 28% (n = 33) improved their metabolic
syndrome profile. After controlling for confounding factors of age,
gender, race, diabetes, functional ability, and employment, subjects who
exercised at least 130 hours a year were 3.6 times more likely to improve
at least 1 metabolic syndrome factor (95% confidence interval,
1.24-10.49). Of the 28% who improved their metabolic syndrome profile, 72%
increased their high-density lipoprotein and 60.6% reduced their waist
circumference and glucose. CONCLUSION(S): After a cardiac event,
older patients who engage in lifestyle exercise at the recommended amount
have improvement in their metabolic syndrome profile.

<48>
Accession Number
629798174
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: 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) Jerzy
Kukuczka Academy of Physical Education, Katowice, Poland
(Dunal) KrakowPoland
(Kozak) Universitatsklinikum Carl Gustav Carus Dresden
(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
(Buszman, Buszman) rzej Frycz Modrzewski Krakow University, Faculty of
Medicine and Health Sciences, Krakow, Poland
(Piotrowicz) Head of Department of Cardiac Rehabilitation and Noninvasive
Electrocardiology, National Institute of Cardiology, Warsaw, Poland
Publisher
NLM (Medline)
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.

<49>
Accession Number
629797915
Title
Five-Year Outcomes in Patients With Diabetes Mellitus Treated With
Biodegradable Polymer Sirolimus-Eluting Stents Versus Durable Polymer
Everolimus-Eluting Stents.
Source
Journal of the American Heart Association. 8 (22) (pp e013607), 2019. Date
of Publication: 19 Nov 2019.
Author
Iglesias J.F.; Heg D.; Roffi M.; Tuller D.; Lanz J.; Rigamonti F.; Muller
O.; Moarof I.; Cook S.; Weilenmann D.; Kaiser C.; Cuculi F.; Valgimigli
M.; Juni P.; Windecker S.; Pilgrim T.
Institution
(Iglesias, Roffi, Rigamonti) Division of Cardiology Geneva University
Hospitals Geneva Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials Unit
Bern University Hospital Bern Switzerland
(Tuller) Department of Cardiology Triemlispital Zurich Switzerland
(Lanz, Valgimigli, Windecker, Pilgrim) Department of Cardiology Bern
University Hospital Bern Switzerland
(Muller) Department of Cardiology Lausanne University Hospital Lausanne
Switzerland
(Moarof) Department of Cardiology Kantonsspital Aarau Switzerland
(Cook) Department of Cardiology University and Hospital Fribourg
Switzerland
(Weilenmann) Department of Cardiology Kantonsspital St Gallen Switzerland
(Kaiser) Department of Cardiology Basel University Hospital Basel
Switzerland
(Cuculi) Department of Cardiology Kantonsspital Luzern Switzerland
(Juni) Department of Medicine and Institute of Health Policy, Management
and Evaluation Applied Health Research Centre Li Ka Shing Knowledge
Institute of St Michael's Hospital University of Toronto Canada
Publisher
NLM (Medline)
Abstract
Background The choice of optimal drug-eluting stent therapy for patients
with diabetes mellitus (DM) undergoing percutaneous coronary intervention
remains uncertain. We aimed to assess the long-term clinical outcomes
after percutaneous coronary intervention with biodegradable polymer
sirolimus-eluting stents (BP-SES) versus durable polymer
everolimus-eluting stents (DP-EES) in patients with DM. Methods and
Results In a prespecified subgroup analysis of the BIOSCIENCE (Ultrathin
Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer
Everolimus-Eluting Stent for Percutaneous Coronary Revascularization)
trial (NCT01443104), patients randomly assigned to ultrathin-strut BP-SES
or thin-strut DP-EES were stratified according to diabetic status. The
primary end point was target lesion failure, a composite of cardiac death,
target vessel myocardial infarction, and clinically indicated target
lesion revascularization, at 5 years. Among 2119 patients, 486 (22.9%)
presented with DM. Compared with individuals without DM, patients with DM
were older and had a greater baseline cardiac risk profile. In patients
with DM, target lesion failure at 5 years occurred in 74 patients
(cumulative incidence, 31.0%) treated with BP-SES and 57 patients (25.8%)
treated with DP-EES (risk ratio, 1.23; 95% CI, 0.87-1.73 [P=0.24]). In
individuals without DM, target lesion failure at 5 years occurred in 124
patients (16.8%) treated with BP-SES and 132 patients (16.8%) treated with
DP-EES (risk ratio, 0.98; 95% CI, 0.77-1.26 [P=0.90; P for
interaction=0.31]). Cumulative 5-year incidence rates of cardiac death,
target vessel myocardial infarction, clinically indicated target lesion
revascularization, and definite stent thrombosis were similar among
patients with DM treated with BP-SES or DP-EES. There was no interaction
between diabetic status and treatment effect of BP-SES versus DP-EES.
Conclusions In a prespecified subgroup analysis of the BIOSCIENCE trial,
we found no difference in clinical outcomes throughout 5 years between
patients with DM treated with ultrathin-strut BP-SES or thin-strut DP-EES.
Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique
identifier: NCT01443104.

<50>
Accession Number
2003678336
Title
Update in Cardiac Sarcoidosis.
Source
Annals of the American Thoracic Society. 16 (11) (pp 1341-1350), 2019.
Date of Publication: 2019.
Author
Neto M.L.R.; Jellis C.L.; Joyce E.; Callahan T.D.; Hachamovitch R.; Culver
D.A.
Institution
(Neto, Culver) Department of Pulmonary and Critical Care Medicine,
Cleveland Clinic, Pulmonary, 9500 Euclid Avenue, A90, Cleveland, OH 44195,
United States
(Jellis, Callahan, Hachamovitch) Department of Cardiovascular Medicine,
Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, United
States
(Joyce) Department of Cardiology, Mater Misericordiae University Hospital,
Dublin, Ireland
Publisher
American Thoracic Society (E-mail: malexander@thoracic.org)
Abstract
Increasing awareness of cardiac manifestations of sarcoidosis and the
widespread availability of advanced imaging tests have led to a tidal wave
of interest in a condition that was once considered rare. In this Focused
Review, we explore important clinical questions that may confront
specialists faced with possible cardiac involvement. In the absence of an
ideal reference standard, three main sets of clinical criteria exist: The
Japanese Ministry of Health and Welfare, the Heart Rhythm Society, and the
World Association for Sarcoidosis and Other Granulomatous Disorders
criteria. Once cardiac sarcoidosis is suspected, clinicians should be
familiar with the prevalence of the disease in different clinical
scenarios. Before obtaining advanced cardiac imaging, electrocardiogram,
ambulatory electrocardiogram, echocardiogram, and B-type natriuretic
peptide may be useful. The available therapies for cardiac sarcoidosis
include immunosuppression, antiarrhythmic medications, heart failure
medications, device therapy, ablation therapy, and heart transplantation.
Contemporary data suggest that long-term survival in cardiac sarcoidosis
is better than previously believed. There is no randomized controlled
trial demonstrating benefits of screening, but screening is recommended
based on observational data. Copyright © 2019 by the American
Thoracic Society.

<51>
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.

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

<53>
Accession Number
2002865874
Title
Comparison of hemodynamic factors predicting prognosis in heart failure: A
systematic review.
Source
Journal of Clinical Medicine. 8 (10) (no pagination), 2019. Article
Number: 1757. Date of Publication: October 2019.
Author
Aalders M.; Kok W.
Institution
(Aalders, Kok) Department of Clinical and Experimental Cardiology,
Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105AZ,
Netherlands
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Objectives: We systematically reviewed the literature to address the
question of which of the three hemodynamic factors predicts prognosis best
in heart failure patients when directly compared to each other: cardiac
output, preload or afterload. Method(s): Prognostic studies in heart
failure (HF) were searched that included at least two of the three
hemodynamic variables: (1) cardiac output or cardiac index (CI), (2)
preload represented by pulmonary capillary wedge pressure (PCWP) and (3)
afterload simplified to systolic blood pressure (SBP). Critical appraisal
was done according to the QUIPS format for prognostic studies. The main
endpoint was all-cause mortality, which could be combined with other
endpoints. We report the number of studies in which CI, PCWP and SBP
remained significant prognostic predictors in multivariate analysis. We
also assessed whether hemodynamic predictors of prognosis varied in four
different HF-populations. Result(s): Included were 18 studies
containing a multivariate analysis. PCWP was an independent predictor of
prognosis in 10 of 18 studies, SBP in 3 of 14 studies and CI in none of 18
studies. Results were not specific for any of the HF-populations.
 Conclusion(s): A higher PCWP and lower SBP are independent predictors
of poor prognosis in HF. In spite of the frequently used concept behind
HF, this review demonstrates that CI is not an independent predictor of
prognosis in HF. Copyright © 2019 by the authors. Licensee MDPI,
Basel, Switzerland.

<54>
Accession Number
2003451981
Title
Efficacy and safety of tacrolimus in de novo pediatric transplant
recipients randomized to receive immediate- or prolonged-release
tacrolimus.
Source
Clinical Transplantation. 33 (10) (no pagination), 2019. Article Number:
e13698. Date of Publication: 01 Oct 2019.
Author
Vondrak K.; Parisi F.; Dhawan A.; Grenda R.; Webb N.J.A.; Marks S.D.;
Debray D.; Holt R.C.L.; Lachaux A.; Kelly D.; Kazeem G.; Undre N.
Institution
(Vondrak) University Hospital Motol, Prague, Czechia
(Parisi) Ospedale Pediatrico Bambino Gesu, Rome, Italy
(Dhawan) King's College Hospital, London, United Kingdom
(Grenda) The Children's Memorial Health Institute, Warsaw, Poland
(Webb) Manchester University Foundation Trust, Manchester, United Kingdom
(Marks) Great Ormond Street Hospital for Children, NHS Foundation Trust,
London, United Kingdom
(Debray) APHP-Hopital Universitaire Necker, Paris, France
(Holt) Alder Hey Children's Hospital, Liverpool, United Kingdom
(Lachaux) Universite Lyon 1 et Hospices Civils de Lyon, Lyon, France
(Kelly) Birmingham Women's & Children's Hospital, Birmingham, United
Kingdom
(Kazeem, Undre) Astellas Pharma Europe Ltd, Chertsey, United Kingdom
(Kazeem) BENKAZ Consulting Ltd, Cambridge, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Background and aims: This multicenter trial compared immediate-release
tacrolimus (IR-T) vs prolonged-release tacrolimus (PR-T) in de novo
kidney, liver, and heart transplant recipients aged <16 years. Each
formulation had similar pharmacokinetic (PK) profiles. Follow-up efficacy
and safety results are reported herein. Material(s) and Method(s):
Patients, randomized 1:1, received once-daily, PR-T or twice-daily, IR-T
within 4 days of surgery. After a 4-week PK assessment, patients continued
randomized treatment for 48 additional weeks. At Year 1, efficacy
assessments included the number of clinical acute rejections,
biopsy-confirmed acute rejection (BCAR) episodes (including severity),
patient and graft survival, and efficacy failure (composite of death,
graft loss, BCAR, or unknown outcome). Adverse events were assessed
throughout. Result(s): The study included 44 children. At Year 1,
mean +/- standard deviation tacrolimus trough levels were 6.6 +/- 2.2 and
5.4 +/- 1.6 ng/mL, and there were 2 and 7 acute rejection episodes in the
PR-T and IR-T groups, respectively. No cases of graft loss or death were
reported during the study. The overall efficacy failure rate was 18.2%
(PR-T n = 1; IR-T n = 7). Conclusion(s): In pediatric de novo solid
organ recipients, the low incidence of BCAR and low efficacy failure rate
suggest that PR-T-based immunosuppression is effective and well tolerated
to 1-year post-transplantation. Copyright © 2019 The Authors.
Clinical Transplantation published by John Wiley & Sons Ltd

<55>
Accession Number
2001243140
Title
Meta-Analysis of Impact of Anemia and Hemoglobin Level on Survival After
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 123 (2) (pp 306-314), 2019. Date of
Publication: 15 January 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To establish evidence whether baseline anemia and decreases in baseline
hemoglobin levels affect survival after transcatheter aortic valve
implantation (TAVI), we performed a meta-analysis of available studies.
Studies considered for inclusion met the following criteria: the design
was a comparative study of patients with baseline anemia versus those
without baseline anemia or a cohort study investigating baseline anemia
(as a dichotomous variable) or baseline hemoglobin levels (as a continuous
variable) as one of prognostic factors of mortality; the study population
was patients who underwent TAVI; and main outcomes included early (30-day
or in-hospital) or late (including early) all-cause mortality.
Study-specific estimates were combined in the random-effects model. Our
search identified 15 eligible studies including a total of 11,657 TAVI
patients. Pooled analysis demonstrated that baseline anemia was associated
with a statistically significant increase in early (p = 0.003) and midterm
mortality (p < 0.0001) and that incremental decreases in baseline
hemoglobin levels were associated with a statistically significant
increase in midterm mortality (p < 0.00001). Pooled analysis of only
adjusted estimates indicated that anemia was independently associated with
a statistically significant increase in early (p = 0.02) and midterm
mortality (p < 0.0001) and that incremental decreases in baseline
hemoglobin levels were independently associated with a statistically
significant increase in midterm mortality (p < 0.00001). In conclusion,
baseline anemia and lower baseline hemoglobin levels may be associated
with increased early and midterm mortality after TAVI. Copyright
© 2018 Elsevier Inc.

<56>
Accession Number
2001306417
Title
Meta-Analysis Comparing Mitral Valve Repair Versus Replacement for
Degenerative Mitral Regurgitation Across All Ages.
Source
American Journal of Cardiology. 123 (3) (pp 446-453), 2019. Date of
Publication: 1 February 2019.
Author
Jung J.C.; Jang M.-J.; Hwang H.Y.
Institution
(Jung, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Although current guidelines recommend mitral valve repair (MVr) over
mitral valve replacement (MVR) for patients with mitral regurgitation
(MR), it is unclear if it should be also recommended in elderly patients
with limited life expectancy. This study was conducted to compare the
results of MVr with those of MVR to determine the optimal treatment option
for patients with degenerative MR, particularly according to the patient's
age. A literature search of 5 electronic databases was performed. The
primary outcome was all-cause mortality. The secondary outcomes included
early mortality and freedom from reoperation. A metaregression analysis
and subgroup analysis were performed according to the mean age of the
study population. Twelve retrospective studies (2,950 and 1,252 patients
in the MVr and MVR groups, respectively) were selected. Pooled analyses
demonstrated that the risk of all-cause mortality was significantly higher
in the MVR group than in the MVr group both in all studies and in studies
presenting adjusted results (hazard ratio[95% confidence interval] =
1.57[1.39 to 1.77] and 1.53[1.34 to 1.74], respectively). This benefit was
similar across all ages when the metaregression analysis and the subgroup
analysis were performed (p = 0.879 and 0.123, respectively). Early
mortality and risk of reoperation were also higher in the MVR group than
in the MVr group (risk ratio[95% confidence interval] = 4.51[3.12 to 6.51]
and hazard ratio[95% confidence interval] = 1.47[1.09 to 1.98],
respectively). In conclusion, this study indicates that MVr is beneficial
compared with MVR in patients with degenerative MR regardless of patients'
age in terms of all-cause mortality. Copyright © 2018 Elsevier
Ltd

<57>
Accession Number
2001260983
Title
Meta-analysis Comparing Culprit Vessel Only Versus Multivessel
Percutaneous Coronary Intervention in Patients With Acute Myocardial
Infarction and Cardiogenic Shock.
Source
American Journal of Cardiology. 123 (2) (pp 218-226), 2019. Date of
Publication: 15 January 2019.
Author
Khan M.S.; Siddiqi T.J.; Usman M.S.; Riaz H.; Khan A.R.; Murad M.H.; Kalra
A.; Figueredo V.M.; Bhatt D.L.
Institution
(Khan) Department of Internal Medicine, John H. Stroger Jr. Hospital of
Cook County, Chicago, IL, United States
(Siddiqi, Usman) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Riaz) Department of Cardiology, Cleveland Clinic, Cleveland, OH, United
States
(Khan) Department of Cardiology, University of Louisville, Louisville,
Kentucky, United Kingdom
(Murad) Evidence-Based Practice Center, Mayo Clinic, Rochester, NY, United
States
(Kalra) Harrington Heart & Vascular Institute, University Hospitals
Cleveland Medical Center, Division of Cardiovascular Medicine, Department
of Medicine, Case Western Reserve University School of Medicine,
Cleveland, OH, United States
(Figueredo) Department of Cardiology, Institute for Heart & Vascular
Health, Einstein Medical Center, Philadelphia, PA, United States
(Figueredo) Department of Medicine, Sidney Kimmel College of Medicine,
Thomas Jefferson University, Philadelphia, PA, United States
(Bhatt) Department of Cardiology, Brigham and Women's Hospital Heart &
Vascular Center, Harvard Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cardiogenic shock (CS) after a myocardial infarction continues to be
associated with high mortality. Whether percutaneous coronary intervention
(PCI) of noninfarct coronary arteries (multivessel intervention [MVI])
improves outcomes in CS after acute myocardial infarction (AMI) remains
controversial. MEDLINE, Cochrane CENTRAL, and Scopus databases were
searched for original studies comparing MVI with culprit-vessel
intervention (CVI) in AMI patients with multivessel disease and CS. Risk
ratios (RRs) and 95% confidence intervals were calculated and pooled using
a random effects model. Thirteen studies, consisting of 7,906 patients
(n<inf>MVI</inf> = 1,937; n<inf>CVI</inf> = 5,969), were included in this
meta-analysis. Overall, the MVI and CVI groups did not differ
significantly in the risk of short-term mortality (RR: 1.06 [0.91, 1.23];
p = 0.45; I2 = 75.82%), long-term mortality (RR: 0.93 [0.78,
1.11]; p = 0.37; I2 = 67.92%), reinfarction (RR: 1.16 [0.75,
1.79]; p = 0.50; I2 = 0%), revascularization (RR: 0.84 [0.48,
1.47]; p = 0.54; I2 = 83.01%), bleeding (RR: 1.15 [0.96, 1.38];
p = 0.09, I2 = 0%), or stroke (RR: 1.29 [0.86, 1.94]; p = 0.80,
I2 = 0%). However, significantly increased risk of renal
failure was seen in the MVI group (RR: 1.35 [1.10, 1.66]; p = 0.004;
I2 = 0%). On subgroup analysis, it was seen that results from
retrospective studies showed higher short-term mortality in the MVI group
in comparison with prospective studies (p = 0.003). The certainty in
estimates is low due to the largely observational nature of the evidence.
In conclusion, MVI provides no additional reduction in short- or long-term
mortality in AMI patients with multivessel disease and CS. Additionally,
the risk of renal failure may be higher with the use of MVI. Copyright
© 2018

<58>
Accession Number
623428402
Title
A review of combination antimicrobial therapy for enterococcus faecalis
bloodstream infections and infective endocarditis.
Source
Clinical Infectious Diseases. 67 (2) (pp 303-309), 2018. Date of
Publication: 02 Jul 2018.
Author
Beganovic M.; Luther M.K.; Rice L.B.; Arias C.A.; Rybak M.J.; Laplante
K.L.
Institution
(Beganovic, Luther, Laplante) College of Pharmacy, University of Rhode
Island, 7 Greenhouse Rd, Ste 295A, Kingston, RI 02881, United States
(Beganovic, Luther, Laplante) Infectious Diseases Research Program,
Providence Veterans Affairs Medical Center, Providence, RI, United States
(Luther, Laplante) Center of Innovation in Long-Term Services and
Supports, Providence Veterans Affairs Medical Center, Providence, RI,
United States
(Rice) Rhode Island Hospital, Providence, Rhode Island, Providence, RI,
United States
(Rice, Laplante) Warren Alpert Medical School of Brown University,
Division of Infectious Diseases, Providence, RI, United States
(Arias) Center for Antimicrobial Resistance and Microbial Genomics,
Division of Infectious Diseases, Department of Internal Medicine,
Department of Microbiology and Molecular Genetics, University of Texas
Health Science Center at Houston (UTHealth), McGovern Medical School,
Bogota, Colombia
(Arias) Center for Infectious Diseases, UTHealth School of Public Health,
Bogota, Colombia
(Arias) Molecular Genetics and Antimicrobial Resistance Unit,
International Center for Microbial Genomics, Universidad El Bosque,
Bogota, Colombia
(Rybak) Anti-Infective Research Laboratory, Department of Pharmacy
Practice, Eugene Applebaum College of Pharmacy and Health Sciences,
Michigan, United States
(Rybak) Department of Medicine, Division of Infectious Diseases, School of
Medicine, Wayne State University, Michigan, United States
(Rybak) Department of Pharmacy Services, Detroit Receiving Hospital,
Michigan, United States
Publisher
Oxford University Press
Abstract
Enterococci, one of the most common causes of hospital-associated
infections, are responsible for substantial morbidity and mortality.
Enterococcus faecalis, the more common and virulent species, causes
serious high-inoculum infections, namely infective endocarditis, that are
associated with cardiac surgery and mortality rates that remained
unchanged for the last 30 years. The best cures for these infections are
observed with combination antibiotic therapy; however, optimal treatment
has not been fully elucidated. It is the purpose of this review to
highlight treatment options and their limitations, and provide direction
for future investigative efforts to aid in the treatment of these severe
infections. While ampicillin plus ceftriaxone has emerged as a preferred
treatment option, mortality rates continue to be high, and from a safety
standpoint, ceftriaxone, unlike other cephalosporins, promotes
colonization with vancomycin resistant-enterococci due to high biliary
concentrations. More research is needed to improve patient outcomes from
this high-mortality disease. Copyright © Published by Oxford
University Press for the Infectious Diseases Society of America 2018.

<59>
Accession Number
629684841
Title
Intra-pleural fibrinolytic therapy versus placebo, or a different
fibrinolytic agent, in the treatment of adult parapneumonic effusions and
empyema.
Source
Cochrane Database of Systematic Reviews. 2019 (10) (no pagination), 2019.
Article Number: CD002312. Date of Publication: 30 Oct 2019.
Author
Altmann E.S.; Crossingham I.; Wilson S.; Davies H.R.
Institution
(Altmann) Department of General Medicine, John Hunter Hospital, New
Lambton Heights, Australia
(Crossingham, Wilson) East Lancashire Hospitals NHS Trust, Blackburn,
United Kingdom
(Davies) Respiratory and Sleep Services, Southern Adelaide Local Health
Network (SALHN), Bedford Park, Australia
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background Pleural infection, including parapneumonic effusions and
thoracic empyema, may complicate lower respiratory tract infections.
Standard treatment of these collections in adults involves antibiotic
therapy, effective drainage of infected fluid and surgical intervention if
conservative management fails. Intrapleural fibrinolytic agents such as
streptokinase and alteplase have been hypothesised to improve fluid
drainage in complicated parapneumonic effusions and empyema and therefore
improve treatment outcomes and prevent the need for thoracic surgical
intervention. Intrapleural fibrinolytic agents have been used in
combination with DNase, but this is beyond the scope of this review.
Objectives To assess the benefits and harms of adding intrapleural
fibrinolytic therapy to standard conservative therapy (intercostal
catheter drainage and antibiotic therapy) in the treatment of complicated
parapneumonic effusions and empyema. Search methods We searched the
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and
Embase, ClinicalTrials.gov and the World Health Organization (WHO) trials
portal. We contacted trial authors for further information and requested
details regarding the possibility of unpublished trials. The most recent
search was conducted on 28 August 2019. Selection criteria Parallel-group
randomised controlled trials (RCTs) in adult patients with post-pneumonic
empyema or complicated parapneumonic effusions (excluding tuberculous
effusions) who had not had prior surgical intervention or trauma comparing
an intrapleural fibrinolytic agent (streptokinase, alteplase or urokinase)
versus placebo or a comparison of two fibrinolytic agents. Data collection
and analysis Two review authors independently extracted data. We contacted
study authors for further information. We used odds ratios (OR) for
dichotomous data and reported 95% confidence intervals (CIs). We used
Cochrane's standard methodological procedures of meta-analysis. We applied
the GRADE approach to summarise results and to assess the overall
certainty of evidence. Main results We included in this review a total of
12 RCTs. Ten studies assessed fibrinolytic agents versus placebo (993
participants); one study compared streptokinase with urokinase (50
participants); and one compared alteplase versus urokinase (99
participants). The primary outcomes were death, requirement for surgical
intervention, overall treatment failure and serious adverse effects. All
studies were in the inpatient setting. Outcomes were measured at varying
time points from hospital discharge to three months. Seven trials were at
low or unclear risk of bias and two at high risk of bias due to inadequate
randomisation and inappropriate study design respectively. We found no
evidence of difference in overall mortality with fibrinolytic versus
placebo (OR 1.16, 95% CI 0.71 to 1.91; 8 studies, 867 participants; I2 =
0%; moderate certainty of evidence). We found evidence of a reduction in
surgical intervention with fibrinolysis in the same studies (OR 0.37, 95%
CI 0.21 to 0.68; 8 studies, 897 participants; I2 = 51%; low certainty of
evidence); and overall treatment failure (OR 0.16, 95% CI 0.05 to 0.58; 7
studies, 769 participants; I2 = 88%; very low certainty of evidence, with
evidence of significant heterogeneity). We found no clear evidence of an
increase in adverse effects with intrapleural fibrinolysis, although this
cannot be excluded (OR 1.28, 95% CI 0.36 to 4.57; low certainty of
evidence). In a sensitivity analysis, the reduction in referrals for
surgery and overall treatment failure with fibrinolysis disappeared when
the analysis was confined to studies at low or unclear risk of bias. In a
moderate-risk population (baseline 14% risk of death, 20% risk of surgery,
27% risk of treatment failure), intra-pleural fibrinolysis leads to 19
more deaths (36 fewer to 59 more), 115 fewer surgical interventions (150
fewer to 55 fewer) and 214 fewer overall treatment failures (252 fewer to
93 fewer) per 1000 people. A single study of streptokinase versus
urokinase found no clear difference between the treatments for requirement
for surgery (OR 1.00, 95% CI 0.13 to 7.72; 50 participants; low-certainty
evidence). A single study of alteplase versus urokinase showed no clear
difference in requirement for surgery (OR alteplase versus urokinase 0.46,
95% CI 0.04 to 5.24) but an increased rate of adverse effects, primarily
bleeding, with alteplase (OR 5.61, 95% CI 1.16 to 27.11; 99 participants;
low-certainty evidence). This translated into 154 (6 to 499 more) serious
adverse events with alteplase compared with urokinase per 1000 people
treated. Authors' conclusions In patients with complicated infective
pleural effusion or empyema, intrapleural fibrinolytic therapy was
associated with a reduction in the requirement for surgical intervention
and overall treatment failure but with no evidence of change in mortality.
Discordance between the negative largest trial of this therapy and other
studies is of concern, however, as is an absence of significant effect
when analysing low risk of bias trials only. The reasons for this
difference are uncertain but may include publication bias. Intrapleural
fibrinolytics may increase the rate of serious adverse events, but the
evidence is insufficient to confirm or exclude this
possibility. Copyright © 2019 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<60>
Accession Number
2002344172
Title
Adherence to lifestyle changes after coronary artery bypass graft: Outcome
of preoperative peer education.
Source
Patient Education and Counseling. 102 (12) (pp 2231-2237), 2019. Date of
Publication: December 2019.
Author
Golaghaie F.; Esmaeili-Kalantari S.; Sarzaeem M.; Rafiei F.
Institution
(Golaghaie) Department of Community Health Nursing, Arak University of
Medical Sciences, Arak, Iran, Islamic Republic of
(Esmaeili-Kalantari) Student Research Committee, Arak University of
Medical Sciences, Arak, Iran, Islamic Republic of
(Sarzaeem) Department of Cardiovascular Surgery, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Rafiei) Department of Biostatistics & Epidemiology, School of health,
Scientific Research Center, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Publisher
Elsevier Ireland Ltd
Abstract
Objective: This study was done to investigate the effect of preoperative
peer education on patients' adherence to medication and lifestyle changes
after Coronary Artery Bypass Graft (CABG). Method(s): In this
randomized clinical trial, the peers of CABG patients conducted
preoperative educational sessions at the ward in groups of 4-5 (n = 36)
while the control group (n = 34) received routine education by a nurse.
Adherence of both groups to medication and recommendations for lifestyle
modification including physical activity, smoking, and diet was measured
one and two months after discharge. Result(s): A multivariate
analysis of co-variance showed the significant effect of peer education on
adherence (F = 32.586, p < 0.001; eta2 = 0.671). Univariate
ANCOVA revealed a significant difference in adherence to diet between the
two groups (F = 62.316, p = 0 0.0001; eta2 = 0.482). Based on
the repeated measures ANOVA, peer education significantly improved the
CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total
adherence (F = 9.911, p = 0.002) compared to the control group.
 Conclusion(s): Preoperative peer education had a significant effect
on improving CABG patients' adherence to lifestyle changes after hospital
discharge. Practice implication: Peer education can be used as an
effective method to improve the CABG patients ' adherence to lifestyle
changes. Copyright © 2019 Elsevier B.V.

<61>
Accession Number
2003272732
Title
BARI 2D: A Reanalysis Focusing on Cardiovascular Events.
Source
Mayo Clinic Proceedings. 94 (11) (pp 2249-2262), 2019. Date of
Publication: November 2019.
Author
Genuth S.M.; Vlachos H.; Brooks M.M.; Bantle J.P.; Chaitman B.R.; Green
J.; Kelsey S.F.; King S.B.; McBane R.; Sako E.Y.; Schneider D.J.; Steffes
M.; Frye R.L.
Institution
(Genuth) Division of Clinical and Molecular Endocrinology, Department of
Medicine, Case Western Reserve University, Cleveland, OH, United States
(Vlachos, Brooks, Kelsey) Epidemiology Data Center, University of
Pittsburgh, PA, United States
(Bantle, Steffes) Department of Medicine, University of Minnesota,
Minneapolis, United States
(Bantle, Steffes) Department of Laboratory Medicine and Pathology,
University of Minnesota, Minneapolis, United States
(Chaitman) Division of Cardiology, Department of Medicine, St. Louis
University, MO, United States
(Green) Division of Endocrinology, Department of Medicine, Duke University
Medical Center, Durham, NC, United States
(King) Emory University School of Medicine, Atlanta, GA, United States
(McBane, Frye) Mayo Clinic, Rochester, MN, United States
(Sako) Department of Cardiothoracic Surgery, University of Texas Health
Science Center at San Antonio, United States
(Schneider) Department of Medicine, University of Vermont Medical Center,
Burlington, United States
Publisher
Elsevier Ltd
Abstract
Objective: To reanalyze the Bypass Angioplasty Revascularization
Investigation 2 Diabetes trial using a new composite cardiovascular
disease (CVD) outcome to determine how best to treat patients with type 2
diabetes mellitus and stable coronary artery disease. Patients and
Methods: From January 1, 2001, to November 30, 2008, 2368 patients with
type 2 diabetes mellitus and angiographically proven coronary artery
disease were randomly assigned to insulin-sensitizing (IS) or
insulin-providing (IP) therapy and simultaneously to coronary
revascularization (REV) or no or delayed REV (intensive medical therapy
[MED]), with all patients receiving intensive medical treatment. The
outcome of this analysis was a composite of 8 CVD events. Result(s):
Four-year Kaplan-Meier rates for the composite CVD outcome were 35.8% (95%
CI, 33.1%-38.5%) with IS therapy and 41.6% (95% CI, 38.7%-44.5%) with IP
therapy (P=.004). Much of this difference was associated with lower
in-trial levels of fibrinogen, C-reactive protein, and hemoglobin
A<inf>1c</inf> with IS therapy. Four-year composite CVD rates were 32.7%
(95% CI, 30.0%-35.4%) with REV and 44.7% (95% CI, 41.8%-47.6%) with MED
(P<.001). A beneficial effect of IS vs IP therapy was present with REV
(27.7%; 95% CI, 24.0%-31.4% vs 37.5%; 95% CI, 33.6%-41.4%; P<.001), but
not with MED (43.6%; 95% CI, 39.5%-47.7% vs 45.7%; 95% CI, 41.6%-49.8%;
P=.37) (homogeneity, P=.05). This interaction between IS therapy and REV
was limited to participants preselected for coronary artery bypass
grafting (CABG). The lowest composite CVD rates occurred in patients
preselected for CABG and assigned to IS therapy and REV (17.3%; 95% CI,
11.8%-22.8%). Conclusion(s): In the Bypass Angioplasty
Revascularization Investigation 2 Diabetes trial, the IS treatment
strategy and the REV treatment strategy each reduces cardiovascular
events. The combination of IS drugs and CABG results in the lowest risk of
subsequent CVD events. Trial Registration: clinicaltrials.gov Identifier:
NCT00006305 Copyright © 2019 Mayo Foundation for Medical
Education and Research

<62>
Accession Number
2003618443
Title
Reducing delirium and cognitive dysfunction after off-pump coronary
bypass: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Szwed K.; Pawliszak W.; Szwed M.; Tomaszewska M.; Anisimowicz L.;
Borkowska A.
Institution
(Szwed, Szwed, Tomaszewska, Borkowska) Department of Clinical
Neuropsychology, Collegium Medium, Nicolaus Copernicus University,
Bydgoszcz, Poland
(Pawliszak, Anisimowicz) Department of Cardiac Surgery, Collegium Medium,
Nicolaus Copernicus University, Bydgoszcz, Poland
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Neuropsychiatric complications of surgical coronary
revascularization are inconspicuous but frequent and clinically relevant.
So far, attempts to reduce their occurrence, such as the introduction of
off-pump coronary artery bypass (OPCAB) grafting method, have not brought
the desired results. The aim of this trial was to determine whether using
any of the 2 selected modifications of OPCAB could decrease the incidence
of these undesired sequelae. Method(s): In this single-center,
assessor- and patient-blinded, superiority, randomized controlled trial,
192 patients scheduled for elective isolated OPCAB were randomized to 3
parallel arms. The control arm underwent "conventional" OPCAB with vein
grafts. The first study arm underwent anaortic OPCAB (ANA) with total
arterial revascularization. The second study arm underwent OPCAB with vein
grafts using carbon dioxide surgical field flooding (CO<inf>2</inf>FF).
Outcomes included the incidence of postoperative delirium (PD) and early
postoperative cognitive dysfunction (ePOCD). Result(s): The incidence
of PD was 35.9% in the control (OPCAB) arm, 32.8% in the CO<inf>2</inf>FF
arm, and 12.5% in the ANA arm (chi2 [2, N = 191] = 10.17; P =
.006). Post hoc tests revealed that the incidence of PD in the ANA arm
differed from that in the OPCAB arm (odds ratio [OR], 0.26; 95% confidence
interval [CI], 0.09-0.68; P = .002). The incidence of ePOCD was 34.4% in
the OPCAB arm, 28.1% in the CO<inf>2</inf>FF arm, and 9.5% in the ANA arm
(chi2 [2, N = 191] = 11.58; P = .003). Post hoc tests revealed
that the incidence of ePOCD differed between the ANA and OPCAB arms (OR,
0.20; 95% CI, 0.06-0.58; P < .001). Conclusion(s): Performing ANA
significantly decreases the incidence of PD and ePOCD compared with
"conventional" OPCAB with vein grafts, whereas CO<inf>2</inf>FF is
inconsequential in this regard. These results, which probably reflect
decreased delivery of embolic load to the brain in ANA, may have practical
applicability in daily practice to improve clinical
outcomes. Copyright © 2019 The American Association for Thoracic
Surgery

<63>
Accession Number
2003570830
Title
Low-risk transcatheter versus surgical aortic valve replacement - An
updated meta-analysis of randomized controlled trials.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Anantha-Narayanan M.; Kandasamy V.V.; Reddy Y.N.; Megaly M.; Baskaran J.;
Pershad A.; Suri R.M.; Garcia S.
Institution
(Anantha-Narayanan) University of Minnesota Medical Center, United States
(Kandasamy) University of Louisville Medical Center, United States
(Reddy) Mayo Clinic, United States
(Megaly, Garcia) Minneapolis Heart Institute, United States
(Baskaran) CHI Health Creighton University Medical Center, United States
(Pershad) University of Arizona, Banner, United States
(Suri) Cleveland Clinic, Abu Dhabi, United Arab Emirates
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: To perform a meta-analysis including all available randomized
controlled trials (RCTs) to date comparing transcatheter aortic valve
replacement (TAVR) to surgical aortic valve replacement (SAVR) in patients
with severe aortic stenosis (AS) and low surgical risk.
 Background(s): Current guidelines recommend SAVR for patients with
severe symptomatic AS and low surgical risk. A few RCTs have evaluated
TAVR in low surgical risk patients but equipoise exists related to TAVR
valve durability, paravalvular leak (PVL) and role of TAVR in younger, low
surgical risk patients. Method(s): Five databases were analyzed from
January-2000 to March-2019 for RCTs comparing SAVR to TAVR in low-risk
severe AS patients. Result(s): Four RCTs on low-risk TAVR patients
with 2887 patients were included. Mean follow-up was ~24.1 +/- 24 months.
Early mortality was lower with TAVR compared to SAVR (RR: 0.44, 95% CI:
0.20-0.95, P = 0.038) whereas long-term mortality was similar (RR: 0.67,
95% CI: 0.39-1.14, P = 0.141). Both early and long-term stroke rates were
similar. TAVR was associated with lower risk of atrial fibrillation, major
bleeding, acute kidney injury (AKI) and rehospitalization, but higher
rates of permanent pacemaker implantation (PPM) and moderate or severe
PVL. There was no difference in major vascular complications, myocardial
infarction, endocarditis, aortic valve gradients and valve area at
follow-up. Conclusion(s): In low-risk patients with severe AS, TAVR
has a lower early mortality compared to SAVR with no difference in
long-term mortality. Although complication rates varied between TAVR and
SAVR, our study findings suggest that transfemoral-TAVR is an appropriate
treatment option for severe symptomatic AS in patients with low surgical
risk. Copyright © 2019 Elsevier Inc.

<64>
Accession Number
2003522319
Title
Interatrial septum dissection and atrial wall hematoma following
transseptal puncture: A systematic review of the literature.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Meier D.; Antiochos P.; Herrera-Siklody C.; Eeckhout E.; Delabays A.;
Tzimas G.; Fournier S.; Pascale P.; Muller O.; Monney P.
Institution
(Meier, Antiochos, Herrera-Siklody, Eeckhout, Delabays, Tzimas, Fournier,
Pascale, Muller, Monney) Division of Cardiology, University Hospital of
Lausanne (CHUV), Lausanne, Switzerland
(Fournier) Division of Cardiology, Department of Advanced Biomedical
Sciences, University of Naples Federico II, Italy
(Pascale, Muller, Monney) Faculty of Biology and Medicine, Lausanne
University, Lausanne, Switzerland
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Interatrial septum (IAS) dissection due to transseptal
puncture (TSP) is a rare, underreported complication of the procedure.
Data on the mechanism, diagnosis, and management of this complication are
lacking. Method(s): We conducted a systematic review of all reported
cases of IAS dissection with or without associated LA hematoma due to TSP,
by thoroughly searching MEDLINE and EMBASE through May 2019.
 Result(s): After screening of n = 882 studies, eight studies with a
total of 19 patients addressed the complication of IAS dissection and/or
LA hematoma secondary to TSP. Median age was 63 years with a 1:1 male to
female ratio. Ablation of atrial fibrillation was the most frequently
reported procedure (84%). Diagnosis was established using fluoroscopy with
contrast injection (58%), TEE (32%) or intracardiac echocardiography (5%).
The mechanism identified involved puncture of the septum secundum portion
of the IAS, leading to transient needle passage into the extracardiac
space. In the majority of patients, the hematoma remained localized in the
IAS and management was conservative with progressive resolution of the
hematoma during follow-up (95%). Two patients (11%) required further
intervention by either pericardiocentesis or surgical drainage due to
hemodynamic instability. Conclusion(s): IAS dissection with or
without hematoma after TSP remains an underdiagnosed entity. The main
mechanism involves lesion to the septum secundum portion of the IAS,
resulting in needle passage into the extracardiac space and local
bleeding. Although conservative management may be sufficient in the
majority of cases, interventional cardiologists should be familiar with
this complication and its diagnosis. Copyright © 2019 Wiley
Periodicals, Inc.

<65>
Accession Number
2003517936
Title
Transcatheter aortic valve replacement versus surgical aortic valve
replacement in low-surgical-risk patients: An updated meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Goel S.; Pasam R.T.; Wats K.; Patel J.; Chava S.; Gotesman J.; Malik B.A.;
Frankel R.; Shani J.; Gidwani U.
Institution
(Goel, Pasam, Wats, Patel, Chava, Gotesman, Malik, Frankel, Shani)
Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, United
States
(Gidwani) Department of Cardiology, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The purpose of this meta-analysis is to compare the safety and
efficacy of transcatheter aortic-valve replacement (TAVR) to surgical
aortic valve replacement (SAVR) in low-surgical-risk patients.
 Background(s): TAVR is proven to be safe and effective in patients
with high- and intermediate-risk aortic stenosis. However, there is
limited data on the safety and efficacy of TAVR in patients with low
surgical risk. Method(s): We conducted an electronic database search
of all published data for studies that compared TAVR to SAVR in
low-surgical-risk patients (mean society for thoracic surgery [STS] score
<4% and/or logistic EuroScore <10%) and reported on subsequent all-cause
mortality, cardiac mortality, stroke rates, and other outcomes of
interest. Event rates were compared with a forest plot of odds ratio using
a random-effects model assuming interstudy heterogeneity. Result(s):
A total of seven studies (n = 6,293 patients; TAVR = 2,912; and SAVR =
3,381) were included in the final analysis. There was no significant
difference between TAVR and SAVR in terms of all-cause mortality (OR 0.82;
95% CI 0.50-1.36, I2 = 51%), cardiac mortality (OR 0.57; 95% CI
0.32-1.02, I2 = 0%), new pacemaker implantation (OR = 3.11; 95%
CI 0.58-16.60, I2 = 89%), moderate/severe paravalvular leak
(PVL; OR 3.50; 95% CI 0.64-19.10, I2 = 54%) and rate of stroke
(OR 0.63; 95% CI 0.34-1.15, I2 = 39%) at 1-year follow-up. TAVR
was found to have a significantly lower incidence of atrial fibrillation
(AF; OR 0.15, 95% CI 0.10-0.24, I2 = 38%) as compared to SAVR.
 Conclusion(s): The results of our meta-analysis demonstrate similar
rates of all-cause mortality, cardiac mortality, and stroke at 1-year
follow-up in patients undergoing TAVR and SAVR. TAVR is associated with a
lower incidence of AF relative to SAVR. However, there was a significantly
higher incidence of PVL with TAVR compared to SAVR. Copyright ©
2019 Wiley Periodicals, Inc.

<66>
Accession Number
2003514857
Title
Prevalence and patterns of cognitive impairment in acute coronary syndrome
patients: A systematic review.
Source
European Journal of Preventive Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Zhao E.; Lowres N.; Woolaston A.; Naismith S.L.; Gallagher R.
Institution
(Zhao, Lowres, Naismith, Gallagher) Charles Perkins Centre, University of
Sydney, Australia
(Zhao, Woolaston) Sydney Nursing School, University of Sydney, Australia
(Lowres, Gallagher) Stroke Prevention, Heart Research Institute, Sydney,
Australia
(Naismith) Healthy Brain Ageing Program, Brain and Mind Centre, University
of Sydney, Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Minimising risk factors through secondary prevention behaviour
is challenging for patients following an acute coronary syndrome.
Cognitive impairment can potentially make these changes more difficult.
However, cognitive impairment prevalence in acute coronary syndrome
patients is poorly understood. Design(s): This study was based on a
systematic review. Method(s): A systematic review was conducted of
PubMed, Medline, PsycINFO and Cochrane databases up to March 2019, to
identify studies reporting the prevalence of cognitive impairment in acute
coronary syndrome patients. Predefined inclusion criteria were specified,
including use of a validated cognitive impairment screening tool. Studies
were excluded if patients had diagnosed dementia or coronary artery bypass
graft surgery. Strengthening The Reporting of Observational Studies in
Epidemiology and Cochrane Risk of Bias tools were used to assess quality.
 Result(s): From 747 potential studies, nine were included. The total
sample size was 6457 (range 53-2174), mean age range was 51.3-77.4 years,
and range of proportions of males was 57-100%. Reported cognitive
impairment prevalence rates varied substantially (9-85%) with no clear
pattern over time. From the two studies which examined domains, verbal
fluency, memory and language were affected the most. Meta-analysis could
not be undertaken due to diverse screening tools (n = 9), cut-off scores
and screening timepoints. Conclusion(s): Cognitive impairment in
acute coronary syndrome patients is currently poorly described, and likely
affects a substantial number of acute coronary syndrome patients who
remain undetected and have the potential to develop to dementia in the
future. As domains are most affected, this could impact understanding and
retention of health education. Research is needed to accurately determine
the prevalence of cognitive impairment in acute coronary syndrome patients
and create suitable standardised measures and thresholds. Copyright
© The European Society of Cardiology 2019.

<67>
Accession Number
2003509274
Title
The Healthy Heart-Mind Trial: Randomized Controlled Trial of Melatonin for
Prevention of Delirium.
Source
Journal of the American Geriatrics Society. (no pagination), 2019. Date of
Publication: 2019.
Author
Ford A.H.; Flicker L.; Kelly R.; Patel H.; Passage J.; Wibrow B.; Anstey
M.; Edwards M.; Almeida O.P.
Institution
(Ford, Flicker, Kelly, Patel, Wibrow, Anstey, Almeida) Medical School,
University of Western Australia, Perth, WA, Australia
(Ford, Flicker) WA Centre for Health & Ageing, University of Western
Australia, Perth, WA, Australia
(Passage) School of Medicine, University of Notre Dame and Department of
Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA,
Australia
(Wibrow, Anstey) Intensive Care Unit, Sir Charles Gairdner Hospital,
Perth, WA, Australia
(Edwards) Department of Cardiothoracic Surgery, Fiona Stanley Hospital,
Perth, WA, Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
OBJECTIVES: Delirium is a serious medical condition with increased
incidence in at-risk surgical populations. We sought to determine if
melatonin use reduces the incidence of delirium in individuals undergoing
major cardiac surgery. DESIGN: Randomized double-blind placebo-controlled
clinical trial (two arms, 1:1 allocation, parallel design). SETTING: The
trial took place in two metropolitan hospitals (public tertiary and
private) in Perth, Western Australia. PARTICIPANTS: We recruited 210
adults aged 50 years or older who were due to undergo coronary artery
bypass grafting or valve replacement surgery. INTERVENTION: Participants
were randomly assigned (1:1) to 7 days of treatment with melatonin 3 mg at
night or matching placebo, starting 2 days before the surgery.
MEASUREMENTS: The primary outcome of interest was incident delirium within
7 days of surgery as assessed via daily clinical assessment that included
the Confusion Assessment Method. Secondary outcomes of interest included
duration and severity of delirium, length of hospital stay, cognitive
function, and mood and anxiety symptoms at discharge and 3 months after
the surgery. RESULT(S): The groups were well balanced for demographic
and clinical parameters. Forty-two participants developed delirium, but it
was evenly distributed between the groups (melatonin 21/98, 21.4%; placebo
21/104, 20.2%; adjusted odds ratio [OR] =.78; 95% confidence interval [CI]
=.35-1.75). The median duration of delirium was 3 (interquartile range
[IQR] = 2-4) and 2 (IQR = 1-3) days for people treated with melatonin and
placebo, respectively (z = -1.03; P =.304). A similar proportion of
participants experienced severe episodes of delirium in each group
(melatonin 9/21, 42.9% vs placebo 6/21, 28.6%; chi2 =.93; P
=.334; adjusted OR = 1.98; 95% CI =.40-9.78). The groups did not differ in
terms of length of stay, mood, anxiety, and cognitive performance.
 CONCLUSION(S): The findings of this randomized double-blind
placebo-controlled trial do not support the prophylactic use of melatonin
to prevent delirium after major cardiac surgery. Copyright © 2019
The American Geriatrics Society

<68>
Accession Number
2003482061
Title
Levosimendan or milrinone for right ventricular inotropic treatment?-A
secondary analysis of a randomized trial.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2019. Date of
Publication: 2019.
Author
Fredholm M.; Jorgensen K.; Houltz E.; Ricksten S.-E.
Institution
(Fredholm, Jorgensen, Houltz, Ricksten) Department of Anesthesiology and
Intensive Care Medicine at the Sahlgrenska Academy, University of
Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: The aim of the present study was to compare the effects of
milrinone and levosimendan on right ventricular (RV) inotropy and
lusitropy in patients after aortic valve replacement (AVR) for aortic
stenosis, a procedure in which an abnormal postoperative RV function may
be seen. Method(s): In a prospective, blinded trial, 31 patients were
randomized to receive either milrinone (0.4 and 0.8 micro g/kg/min, n
= 16) or levosimendan (0.1 and 0.2 micro g/kg/min, n = 15) after AVR
for aortic stenosis. RV performance, afterload (pulmonary arterial
elastance), RV strain, systolic (SR-S) and early diastolic (SR-E) strain
rate were measured by pulmonary artery thermodilution catheterization and
transoesophageal two-dimensional speckle tracking echocardiography. To
circumvent the indirect effects of inodilator-induced hemodynamic changes
on RV systolic and diastolic deformation, pulmonary arterial elastance,
central venous pressure and heart rate were maintained constant by atrial
pacing, plasma volume expansion with colloids and phenylephrine-induced
vasoconstriction during treatment with the inotropes. Result(s): A
dose-dependent increase in stroke volume index and cardiac index by
approximately 20% were seen with both agents at the highest doses, with no
difference between groups (P =.792 and 0.744, respectively). In both
groups, RV strain and SR-S dose-dependently increased by 20% and 15%-19%,
respectively, at the highest doses (P =.742 and 0.259, respectively) with
no difference between groups. SR-E improved by both agents 20%-24% at the
highest dose with no difference between groups (P =.714).
 Conclusion(s): The direct RV inotropic and lusitropic effects of
levosimendan and milrinone were comparable at clinically relevant infusion
rates. Copyright © 2019 The Acta Anaesthesiologica Scandinavica
Foundation. Published by John Wiley & Sons Ltd

<69>
Accession Number
2003464820
Title
Cardiovascular outcomes with transcatheter vs. surgical aortic valve
replacement in low-risk patients: An updated meta-analysis of randomized
controlled trials.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Kundu A.; Sardar P.; Malhotra R.; Qureshi W.T.; Kakouros N.
Institution
(Kundu, Malhotra, Qureshi, Kakouros) Division of Cardiovascular Medicine,
University of Massachusetts Medical School, Worcester, MA, United States
(Sardar) Division of Cardiology, Brown University, Rhode Island Hospital,
Providence, RI, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: TAVR is an established treatment option in high and
intermediate-risk patients with severe AS. There is less data regarding
the efficacy of TAVR in low-risk patients. This meta-analysis evaluated
efficacy and safety outcomes of transcatheter aortic valve replacement
(TAVR) in comparison to surgical aortic valve replacement (SAVR) in
low-risk patients with severe aortic stenosis (AS). Method(s):
Databases were searched for randomized controlled trials (RCTs) that
compared TAVR with SAVR for the treatment of low-risk patients with severe
AS. We calculated pooled odds ratios (ORs) and 95% confidence intervals
(CIs) using the random-effects model. Result(s): The final analysis
included 2953 patients from 5 studies. Compared to SAVR, TAVR was
associated with similar mid-term mortality [OR 0.67; 95% CI 0.37-1.21; p =
0.18], as well as similar short-term mortality [OR 0.51; 95% CI 0.24-1.11;
p = 0.09]. Randomization to TAVR was associated with a reduced risk of
developing acute kidney injury [OR 0.26; 95% CI 0.13-0.52; p < 0.001],
short-term major bleeding [OR 0.27; 95% CI 0.12-0.60; p < 0.001] and
new-onset atrial fibrillation [OR 0.17; 95% CI 0.14-0.21; p < 0.001].
However, TAVR was associated with a higher risk of requiring permanent
pacemaker implantation [OR 4.25; 95% CI 1.86-9.73; p < 0.001]. There was
no significant difference in the risk of myocardial infarction, stroke,
endocarditis or aortic valve re-intervention between the two groups.
 Conclusion(s): Our meta-analysis showed that TAVR has similar
clinical efficacy to SAVR, with a more favorable safety profile, in
patients with severe AS who are at low-surgical risk. Copyright ©
2019 Elsevier Inc.

<70>
Accession Number
2003450587
Title
Trials Focusing on Prevention and Treatment of Delirium After Cardiac
Surgery: A systematic Review of Randomized Evidence.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Pieri M.; De Simone A.; Rose S.; De Domenico P.; Lembo R.; Denaro G.;
Landoni G.; Monaco F.
Institution
(Pieri, De Domenico, Lembo, Denaro, Landoni, Monaco) Department of
Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(De Simone) Department of Neonatal Intensive Care Unit, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Rose) Department of Neurology Rehabilitation, IRCCS San Raffaele
Scientific Institute, Milan, Italy
Publisher
W.B. Saunders
Abstract
Background: Delirium after cardiac surgery is associated with adverse
outcomes, including prolonged hospital stay, prolonged intensive care unit
stay, and increased mortality. Effective preventive interventions and
treatments still are largely unknown. Aim(s): This systematic review
aimed to gather and summarize the existing evidence from randomized trials
concerning interventions studied in the prevention or treatment of
delirium in adult patients undergoing cardiac surgery. Method(s): A
systematic review of the literature using a key word strategy and Boolean
operators was performed. PubMed and the Cochrane and Scopus databases were
searched for pertinent studies until July 2018 (no inception limit).
 Result(s): Of 2,556 articles identified, 56 studies met the inclusion
criteria and were included in the review-39 addressed pharmacologic
strategies and 17 nonpharmacologic interventions. Interestingly, 51 (91%)
trials focused on delirium prevention and only 5 (9%) on delirium
treatment. Most of the analyzed studies were recent double-blind,
single-center trials conducted in Europe or North America, with a low risk
of bias. Overall, 38 different interventions were identified: 15 (26%)
interventions were performed before surgery, 20 (36%) in the operating
room, and 21 (38%) after surgery. The most frequently analyzed strategies
were the administration of dexmedetomidine, ketamine, antipsychotics,
glucocorticoids, propofol, opioids, volatile anesthetics, local
anesthetics, and remote ischemic preconditioning. The analyzed strategies
were extremely heterogenous, and dexmedetomidine was the most promising
measure able to prevent the development of postoperative delirium.
 Conclusion(s): In the present systematic review of 56 randomized
controlled trials that examined 38 interventions, the authors found that
dexmedetomidine was the most frequently studied agent and that it might
reduce the occurrence of delirium after cardiac surgery. Copyright
© 2019 Elsevier Inc.

<71>
Accession Number
2003443964
Title
A randomized control trial comparing prophylactic dexmedetomidine versus
clonidine on rates and duration of delirium in older adult patients
undergoing coronary artery bypass grafting.
Source
Journal of Clinical Anesthesia. (no pagination), 2019. Article Number:
109622. Date of Publication: 2019.
Author
Shokri H.; Ali I.
Institution
(Shokri, Ali) Ain Shams University, Cairo, Egypt
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: Postoperative delirium occurs in 20-50% of elderly
patients undergoing cardiac surgery and increases morbidity and mortality.
We investigated whether prophylactic dexmedetomidine could reduce delirium
incidence in elderly patients after coronary artery bypass grafting
(CABG), compared with clonidine. Design(s): Prospective observational
trial. Setting(s): Academic university hospital. Participant(s):
Patients (60-70 years old) who underwent CABG and received either
dexmedetomidine or clonidine infusion postoperatively.
 Intervention(s): Patients were randomly allocated to dexmedetomidine
or clonidine groups. In the dexmedetomidine group, patients received an
initial infusion of 0.7-1.2 mug/kg/h; sedation and analgesia were
evaluated after 45-60 min. If the Richmond assessment sedation score
(RASS) increased from +1 to +4, the infusion rate was increased by 0.1-0.2
mug/kg/h every 30 min, up to 1-1.4 mug/kg body-weight/h. Dexmedetomidine
infusion was not discontinued pre-extubation; thereafter, infusion was
reduced by 0.1 mug/kg/h until 0.2 mug/kg/h. The maximum infusion duration
was 72 h. In the clonidine group, patients received an initial infusion of
0.5 mug/kg, followed by 1-2 mug/kg/h, if the RASS changed from +1 to +4.
This was continued throughout mechanical ventilation. Measurements:
Patients were followed up to 5 days post-surgery. Delirium incidence,
extubation time, lengths of intensive care unit (ICU) and hospital stay,
need for inotropic support or vasopressors, mean arterial blood pressure
and heart rate, hospital mortality rate, total postoperative morphine
dose, number of patients receiving haloperidol, and adverse events were
recorded. Main Result(s): Two-hundred-and-eighty-six patients
(dexmedetomidine, 144; clonidine, 142) were studied. Dexmedetomidine was
associated with lower risk and duration of delirium, shorter mechanical
ventilation duration and ICU stay, lower mortality rate, and lower
morphine consumption than the clonidine group. Dexmedetomidine
significantly decreased heart rates after ICU admission.
 Conclusion(s): Postoperative infusion of dexmedetomidine provides a
feasible option for postoperative control of delirium after CABG in adult
patients. Copyright © 2019 Elsevier Inc.

<72>
Accession Number
629465258
Title
Effects of Different Rehabilitation Protocols in Inpatient Cardiac
Rehabilitation after Coronary Artery Bypass Graft Surgery: A RANDOMIZED
CLINICAL TRIAL.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. (no pagination),
2019. Date of Publication: 2019.
Author
Zanini M.; Nery R.M.; De Lima J.B.; Buhler R.P.; Da Silveira A.D.; Stein
R.
Institution
(Zanini, Nery, De Lima, Buhler, Da Silveira, Stein) Federal University of
Rio Grande Do sul, Rio Grande do Sul, Brazil
(Zanini, Da Silveira, Stein) Exercise Cardiology Research Group, Hospital
de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: Patients undergoing coronary artery bypass graft (CABG) surgery
typically experience loss of cardiopulmonary capacity in the
post-operative period. The purpose of this study was to evaluate the
effects of different rehabilitation protocols used in inpatient cardiac
rehabilitation on functional capacity and pulmonary function in patient
status post-CABG surgery. Method(s): This was a single-blind
randomized controlled trial. The primary endpoint of functional capacity
and secondary endpoints of lung capacity and respiratory muscle function
were assessed in patients scheduled to undergo CABG. After surgery, 40
patients were randomly assigned across 1 of 4 inpatient cardiac
rehabilitation groups: G1, inspiratory muscle training, active upper limb
and lower limb exercise training, and early ambulation; G2, same protocol
as G1 without inspiratory muscle training; G3, inspiratory muscle training
alone; and G4, control. All groups received chest physical therapy and
expiratory positive airway pressure. Patients were reassessed on
post-operative day 6 and post-discharge day 30 (including cardiopulmonary
exercise testing). Result(s): The 6-min walk distance on
post-operative day 6 was significantly higher in groups that included
exercise training (G1 and G2), remaining higher at 30 d post-discharge (P
<.001 between groups). Peak oxygen uptake on day 30 was also higher in G1
and G2 (P =.005). All groups achieved similar recovery of lung function.
 Conclusion(s): Protocols G1 and G2, which included a systematic plan
for early ambulation and upper and lower limb exercise, attenuated fitness
losses while in the hospital and significantly enhanced recovery 1 mo
after CABG. Copyright © 2019 Wolters Kluwer Health, Inc.

<73>
Accession Number
629465135
Title
Effect of Cardiac Rehabilitation on Sexual Satisfaction among Patients
after Coronary Artery Bypass Graft Surgery.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. (no pagination),
2019. Date of Publication: 2019.
Author
Rakhshan M.; Toufigh A.; Dehghani A.; Yaktatalab S.
Institution
(Rakhshan, Toufigh, Dehghani, Yaktatalab) Shiraz University of Medical
Sciences, Community Based Psychiatric Care Research Center, Shiraz
71936-13119, Iran, Islamic Republic of
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: After coronary artery bypass graft (CABG) surgery, many patients
experience diminished sexual function and satisfaction. The present study
aimed to investigate the effect of outpatient cardiac rehabilitation (OCR)
on the level of sexual satisfaction among post-CABG patients.
 Method(s): A clinical trial was performed at the Al-Zahra Hospital,
Shiraz, Iran, from July 2017 to January 2018. Based on the inclusion
criteria, 104 post-CABG patients were recruited into the study. The
participants were randomly assigned to the intervention (OCR) group (n =
52) or the usual care group (n = 52). The intervention group received 20
sessions of OCR, whereas the usual care group received the routine
hospital care and education. Data were collected using the Index of Sexual
Satisfaction and a demographic data sheet. The data were analyzed using
the SPSS software, v23.0 (IBM) and the independent sample t test,
paired-samples t test, and chi2 test. Result(s): There was
no statistically significant difference in the mean pre-intervention score
for sexual satisfaction between the groups. However, a statistically
significant difference in the mean post-intervention score for sexual
satisfaction was observed between the groups (P <.001). The difference in
the mean pre- and post-intervention scores for sexual satisfaction in the
intervention group was statistically significant (P <.001), whereas there
was no significant difference in the usual care group. Conclusion(s):
Post-CABG patients who completed the OCR program experienced an increased
level of sexual satisfaction. It is, therefore, recommended to include an
OCR program as part of the patient treatment and aftercare following CABG
surgery. Copyright © 2019 Wolters Kluwer Health, Inc.

<74>
Accession Number
2002380213
Title
Defining the learning curve of robotic thoracic surgery: what does it
take?.
Source
Surgical Endoscopy. 33 (12) (pp 3880-3888), 2019. Date of Publication: 01
Dec 2019.
Author
Power A.D.; D'Souza D.M.; Moffatt-Bruce S.D.; Merritt R.E.; Kneuertz P.J.
Institution
(Power, D'Souza, Moffatt-Bruce, Merritt, Kneuertz) Division of Thoracic
Surgery, Department of Surgery, The Ohio State University Wexner Medical
Center, 410 West 10th Avenue; N846a Doan Hall, Columbus, OH 43210, United
States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Controversy exists as to what constitutes a learning curve to
achieve competency, and how the initial learning period of robotic
thoracic surgery should be approached. Method(s): We conducted a
systematic review of the literature published prior to December 2018 using
PubMed/MEDLINE for studies of surgeons adopting the robotic approach for
anatomic lung resection or thymectomy. Changes in operating room time and
outcomes based on number of cases performed, type of procedure, and
existing proficiency with video-assisted thoracoscopic surgery (VATS) were
examined. Result(s): Twelve observational studies were analyzed,
including nine studies on robotic lung resection and three studies on
thymectomy. All studies showed a reduction in operative time with an
increasing number of cases performed. A steep learning curve was described
for thymectomy, with a decrease in operating room time in the first 15
cases and a plateau after 15-20 cases. For anatomic lung resection, the
number of cases to achieve a plateau in operative time ranged between
15-20 cases and 40-60 cases. All but two studies had at least some VATS
experience. Six studies reported on experience of over one hundred cases
and showed continued gradual improvements in operating room time.
 Conclusion(s): The learning curve for robotic thoracic surgery
appears to be rapid with most studies indicating the steepest improvement
in operating time occurring in the initial 15-20 cases for thymectomy and
20-40 cases for anatomic lung resection. Existing data can guide a
standardized robotic curriculum for rapid adaptation, and aid
credentialing and quality monitoring for robotic thoracic surgery
programs. Copyright © 2019, Springer Science+Business Media, LLC,
part of Springer Nature.

<75>
Accession Number
629225006
Title
Pacemaker Implantation Associated Myocardial Micro-Damage: A Randomised
Comparison between Active and Passive Fixation Leads.
Source
Scientific reports. 8 (1) (pp 4870), 2018. Date of Publication: 20 Mar
2018.
Author
Blazek P.; Ferri-Certic J.; Vrazic H.; Lennerz C.; Grebmer C.; Kaitani K.;
Karch M.; Starcevic B.; Semmler V.; Kolb C.
Institution
(Blazek) Deutsches Herzzentrum Munchen, Klinik fur Herz- und
Kreislauferkrankungen, Abteilung fur Elektrophysiologie, Fakultat fur
Medizin der Technischen Universitat Munchen, Munich, Germany
(Ferri-Certic) Dubrovnik General Hospital, Dept. of Cardiology, Dubrovnik,
Croatia
(Vrazic, Starcevic) University Hospital Dubrava, Division of Cardiology,
Department of Internal Medicine, Zagreb, Croatia
(Lennerz, Grebmer, Semmler, Kolb) Deutsches Herzzentrum Munchen, Klinik
fur Herz- und Kreislauferkrankungen, Abteilung fur Elektrophysiologie,
Fakultat fur Medizin der Technischen Universitat Munchen, Munich, Germany
(Lennerz) DZHK (German Centre for Cardiovascular Research), partner site
Munich Heart Alliance, Munich, Germany
(Kaitani) Tenri Hospital, Dept. of Cardiology, Tenri, Japan
(Karch) Klinikverbund Kempten-Oberallgau, Abteilung fur Kardiologie,
Kempten, Germany
Publisher
NLM (Medline)
Abstract
Fixation of the pacemaker leads during pacemaker implantation leads to an
increase of cardiac Troponin T (cTnT) that can be interpreted as a sign of
minimal myocardial damage. This trial evaluates whether the mechanism type
of lead fixation influences the magnitude of cTnT release. Patients having
a de-novo cardiac pacemaker implantation or a lead revision were centrally
randomized to receive either a ventricular lead with an active (screw) or
passive (tine) fixation mechanism. High-sensitive Troponin T (hsTnT) was
determined on the day of the procedure beforehand and on the following
day. 326 Patients (median age (IQR) 75.0 (69.0-80.0) years, 64% male) from
six international centers were randomized to receive ventricular leads
with an active (n=166) or passive (n=160) fixation mechanism. Median (IQR)
hsTnT levels increased by 0.009 (0.004-0.021) ng/ml in the group receiving
screw-in ventricular leads and by 0.008 (0.003-0.030) ng/ml in the group
receiving tined ventricular leads (n.s.). In conclusion pacemaker
implantations are followed by a release of hsTnT. The choice between
active or passive fixation ventricular leads does not have a significant
influence on the extent of myocardial injury and the magnitude of hsTnT
release.

<76>
[Use Link to view the full text]
Accession Number
629782679
Title
Response by Vedel et al to Letters Regarding Article, "high-Target Versus
Low-Target Blood Pressure Management during Cardiopulmonary Bypass to
Prevent Cerebral Injury in Cardiac Surgery Patients: A Randomized
Controlled Trial".
Source
Circulation. 138 (21) (pp 2447-2448), 2018. Date of Publication: 20 Nov
2018.
Author
Vedel A.G.; Rasmussen L.S.; Holmgaard F.; Nilsson J.C.
Institution
(Vedel, Holmgaard, Nilsson) Department of Cardiothoracic Anesthesia, Heart
Center, Rigshospitalet, University of Copenhagen, Denmark
(Vedel, Rasmussen) Department of Anesthesia, Center of Head and
Orthopedics, Rigshospitalet, University of Copenhagen, Denmark
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<77>
[Use Link to view the full text]
Accession Number
629782677
Title
Letter by Ge and Kong Regarding Article, "high-Target Versus Low-Target
Blood Pressure Management during Cardiopulmonary Bypass to Prevent
Cerebral Injury in Cardiac Surgery Patients: A Randomized Controlled
Trial".
Source
Circulation. 138 (21) (pp 2445-2446), 2018. Date of Publication: 20 Nov
2018.
Author
Ge H.-W.; Kong F.-J.
Institution
(Ge, Kong) Department of Urology, Affiliated Hangzhou First People's
Hospital, Zhejiang University School of Medicine, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<78>
[Use Link to view the full text]
Accession Number
629782675
Title
Letter by Jha Regarding Article, "high-Target Versus Low-Target Blood
Pressure Management during Cardiopulmonary Bypass to Prevent Cerebral
Injury in Cardiac Surgery Patients: A Randomized Controlled Trial".
Source
Circulation. 138 (21) (pp 2443-2444), 2018. Date of Publication: 20 Nov
2018.
Author
Jha A.K.
Institution
(Jha) Department of Anesthesiology and Critical Care, Jawaharlal Institute
of Postgraduate Medical Education and Research, Puducherry, India
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<79>
[Use Link to view the full text]
Accession Number
629782673
Title
Letter by Lema Regarding Article, "high-Target Versus Low-Target Blood
Pressure Management during Cardiopulmonary Bypass to Prevent Cerebral
Injury in Cardiac Surgery Patients: A Randomized Controlled Trial".
Source
Circulation. 138 (21) (pp 2442), 2018. Date of Publication: 20 Nov 2018.
Author
Lema G.
Institution
(Lema) Pontificia Universidad Catolica de Chile, Santiago, Chile
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<80>
Accession Number
629773283
Title
The Radial Artery for Coronary Bypass Grafting: The Fifth Decade.
Source
Surgical technology international. 35 (no pagination), 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.

<81>
Accession Number
629768985
Title
PREVENTION OF CEREBROVASCULAR MICRO-EMBOLIZATION DURING AORTA-CORONARY
BYPASS UNDER CONDITIONS OF ARTIFICIAL BLOOD CIRCULATION.
Source
Georgian medical news. (294) (pp 83-87), 2019. Date of Publication: 01 Sep
2019.
Author
Radiushin D.; Loskutov O.
Institution
(Radiushin, Loskutov) Shupyk National Medical Academy of Posgraduate
Education, Department of Anaesthesiology and Intensive Care, Kyiv; Odessa
Regional Clinical Hospital, Ukraine
Publisher
NLM (Medline)
Abstract
The aim of the research was to investigate the relationship between
cerebral microembolization and the development of postoperative cognitive
impairment in patients after coronary artery bypass grafting with and
without prophylactic administration of nitroglycerin at the end of
artificial blood circulation. The study included 72 patients (43 male and
29 female) who had ACBPS using an ABCA. The patients were randomized into
two clinical groups. The number of patients in the control group was 34
patients, in the study group - 38 patients. The study of the cognitive
sphere was performed using a battery of clinical tests that included MSA
and MMSE scales, Trail-making test, Grooved Pageboard, fine hands-motor
test, 10 words test by AR Luria, Wexler's test, Schultz tables. The
assessment was carried out on a day before the intervention and on the
fifth day after the surgical intervention. It was shown that by all
patients undergoing aorto-coronary bypass syrgery microembolization within
the cerebral blood flow had been determined. The vast majority of
microemboli is formed at the beginning of artificial blood circulation, at
the moment of clamping aorta, as well as during the restoration of
effective cardiac activity. Intraoperative microembolization of cerebral
blood flow in excess of 750 microemboli leads to clinically significant
deterioration of the brain functions in the early postoperative period.
When used as a peripheral vasodilator, nitroglycerin, at a dose of 8-10
mug/kg*min in high (120-130%) volume perfusion rate, decreases the number
of microemboluses in the basin of SMA by 2.4%.

<82>
Accession Number
629767816
Title
Keeping up to date: a current review of wearable cardioverter
defibrillator use.
Source
Acta cardiologica. (pp 1-10), 2019. Date of Publication: 05 Nov 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, MI,
Detroit, United States
(Ilyas) Department of Medicine, The Warren Alpert Medical School of Brown
University, Providence, RI, USA
Publisher
NLM (Medline)
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.

<83>
Accession Number
629766840
Title
The Impact of Left Ventricular Assist Device Infections on Postcardiac
Transplant Outcomes: A Systematic Review and Meta-Analysis.
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992). 65
(8) (pp 827-836), 2019. Date of Publication: 01 Nov 2019.
Author
Chahal D.; Sepehry A.A.; Nazzari H.; Wright A.J.; Toma M.
Institution
(Chahal) From the Postgraduate Medicine Program, University of British
Columbia, Vancouver, BC, Canada
(Sepehry) Division of Neurology, University of British Columbia,
Vancouver, BC, Canada
(Nazzari, Toma) Division of Cardiology, University of British Columbia,
Vancouver, BC, Canada
(Wright) Division of Infectious Diseases, University of British Columbia,
Vancouver, BC, Canada
Publisher
NLM (Medline)
Abstract
Left ventricular assist devices (LVADs) are associated with numerous
short- and long-term complications, including infection. The impact LVAD
infections have on clinical outcomes after transplantation is not well
established. We sought to determine whether the presence of infection
while on LVAD support negatively influences outcomes after cardiac
transplantation. We searched electronic databases and bibliographies for
full text studies that identified LVAD infections during support and also
reported on posttransplant outcomes. A meta-analysis of posttransplant
survival was conducted using a random effects model. Of 2,373 records, 13
bridge to transplant (BTT) cohort studies were selected (n = 6,631, 82%
male, mean age 50.7+/-2.7 years). A total of 6,067 records (91.5%)
received transplant. There were 3,718 (56.1%) continuous-flow LVADs
(CF-LVADs), 1,752 (26.4%) pulsatile LVADs, and 1,161 (17.5%) unknown type
records. A total of 2,586 records (39.0%) developed LVAD infections.
Patients with LVAD infections were younger (50.5+/-1.5 vs. 51.3+/-1.5, p =
0.02), had higher body mass indeices (BMIs) (28.4+/-0.7 vs. 26.8+/-0.4, p
< 0.01), and longer LVAD support times (347.0+/-157.6 days vs.
180.2+/-106.0 days, p < 0.01). Meta-analysis demonstrated increased
posttransplant mortality in those patients who had an LVAD infection
(hazard ratio [HR] 1.30, 95% CI: 1.16-1.46, p < 0.001). Subgroup
meta-analyses by continuous-flow and pulsatile device type demonstrated
significant increased risk of death for both types of devices (HR 1.47,
95% CI: 1.22-1.76, p < 0.001 and 1.71, 95% CI: 1.19-2.45, p = 0.004,
respectively). Patients who develop LVAD infections are younger, have
higher BMIs and longer LVAD support times. Our data suggests that
LVAD-related infections result in a 30% increase in postcardiac
transplantation mortality. Strategies to prevent LVAD infections should be
implemented to improve posttransplant outcomes in this high-risk
population.

<84>
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).

<85>
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.

<86>
Accession Number
629717540
Title
Protocol for a multi-centered, stepped wedge, cluster randomized
controlled trial of the de-adoption of oral chlorhexidine prophylaxis and
implementation of an oral care bundle for mechanically ventilated
critically ill patients: The CHORAL study.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 603. Date of
Publication: 24 Oct 2019.
Author
Dale C.M.; Rose L.; Carbone S.; Smith O.M.; Burry L.; Fan E.; Amaral
A.C.K.-B.; McCredie V.A.; Pinto R.; Quinonez C.R.; Sutherland S.; Scales
D.C.; Cuthbertson B.H.
Institution
(Dale, Rose, Carbone, Smith) Lawrence S. Bloomberg Faculty of Nursing,
University of Toronto, Toronto, Canada
(Dale) Trauma Emergency and Critical Care, Sunnybrook Health Sciences
Centre, Toronto, Canada
(Dale, Rose, Amaral, Scales, Cuthbertson) Sunnybrook Research Institute,
Toronto, Canada
(Rose, Amaral, Pinto, Scales, Cuthbertson) Department of Critical Care
Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
(Rose) Florence Nightingale Faculty of Nursing, Midwifery and Palliative
Care, King's College, London, United Kingdom
(Smith) Department of Critical Care, St. Michael's Hospital, Toronto,
Canada
(Smith) Li Ka Shing Knowledge Institute, Toronto, Canada
(Burry) Department of Pharmacy, Mount Sinai Hospital, Toronto, Canada
(Burry) Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto,
Canada
(Burry, Fan, Amaral, McCredie, Scales, Cuthbertson) Interdepartmental
Division of Critical Care Medicine, University of Toronto, Toronto, Canada
(Fan, McCredie) Department of Medicine, University Health Network,
Toronto, Canada
(Quinonez) Faculty of Dentistry, University of Toronto, Toronto, Canada
(Sutherland) Department of Dentistry, Sunnybrook Health Sciences Centre,
Toronto, Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Routine application of chlorhexidine oral rinse is recommended
to reduce risk of ventilator-associated pneumonia (VAP) in mechanically
ventilated patients. Recent reappraisal of the evidence from two
meta-analyses suggests chlorhexidine may cause excess mortality in
non-cardiac surgery patients and does not reduce VAP. Mechanisms for
possible excess mortality are unclear. The CHORAL study will evaluate the
impact of de-adopting chlorhexidine and implementing an oral care bundle
(excluding chlorhexidine) on mortality, infection-related
ventilator-associated complications (IVACs), and oral health status.
 Method(s): The CHORAL study is a stepped wedge, cluster randomized
controlled trial in six academic intensive care units (ICUs) in Toronto,
Canada. Clusters (ICU) will be randomly allocated to six sequential steps
over a 14-month period to de-adopt oral chlorhexidine and implement a
standardized oral care bundle (oral assessment, tooth brushing,
moisturization, and secretion removal). On study commencement, all
clusters begin with a control period in which the standard of care is oral
chlorhexidine. Clusters then begin crossover from control to intervention
every 2 months according to the randomization schedule. Participants
include all mechanically ventilated adults eligible to receive the
standardized oral care bundle. The primary outcome is ICU mortality;
secondary outcomes are IVACs and oral health status. We will determine
demographics, antibiotic usage, mortality, and IVAC rates from a validated
local ICU clinical registry. With six clusters and 50 ventilated patients
on average each month per cluster, we estimate that 4200 patients provide
80% power after accounting for intracluster correlation to detect an
absolute reduction in mortality of 5.5%. We will analyze our primary
outcome of mortality using a generalized linear mixed model adjusting for
time to account for secular trends. We will conduct a process evaluation
to determine intervention fidelity and to inform interpretation of the
trial results. Discussion(s): The CHORAL study will inform
understanding of the effectiveness of de-adoption of oral chlorhexidine
and implementation of a standardized oral care bundle for decreasing ICU
mortality and IVAC rates while improving oral health status. Our process
evaluation will inform clinicians and decision makers about intervention
delivery to support future de-adoption if justified by trial
results. Copyright © 2019 The Author(s).

<87>
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).

<88>
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).

<89>
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

<90>
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.

<91>
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.

<92>
Accession Number
2003234252
Title
The effect of hypertension and/or diabetes on blood pressure and heart
rate changes in patients undergoing oral surgeries.
Source
Eastern Journal of Medicine. 24 (4) (pp 441-450), 2019. Date of
Publication: 2019.
Author
Cigerim L.; Kaplan V.
Institution
(Cigerim, Kaplan) Van Yuzuncu Yil University, Faculty of Dentistry,
Department of Oral and Maxillofacial Surgery, Van, Turkey
Publisher
Yuzuncu Yil Universitesi Tip Fakultesi (Eastern Journal of Medicine, Van
65100, Turkey)
Abstract
The aim of this study was to evaluate the effect of hypertension and/or
diabetes on systolic blood pressure (SBP), diastolic blood pressure (DBP)
and heart rate (HR) changes of individuals during oral surgeries. This
randomized observational study was conducted on patients undergone oral
surgical procedures. The individuals were divided into 3 systemic disease
groups. The group 1 consisted of only individuals with hypertension, the
group 2 included individuals with hypertension and diabetes, and the group
3 consisted of only individuals with diabetes. Initial and final SBP, DBP
and HR measurements according to age, gender and body mass index (BMI)
between groups were analy zed statistically. The statistical significance
level was set at p<0.05. Of the 414 patients aged 18-82 years included in
the study, 38.2% were male and 61.8% were female. Outcomes of 271 patients
undergone surgical procedures; the DBP change of the patients in the group
3 were significantly lower than that of those in the group 1 (p<0.01). The
HR change of the patients in the group 1 was significantly higher than
that of the patients in the groups 2 and 3 (p<0.05). The increase in the
SBP of the patients in the group 2 was higher than that of the patients in
the group 3 in patients under the age of 50 years (p<0.05). In the
literature, there was no study that evaluated the change in blood pressure
and heart rate during surgery in diabetic patients. Hypertension,
diabetes, individual factors like BMI and age were effective in SBP, DBP
and HR changes. Copyright © 2019, Yuzuncu Yil Universitesi Tip
Fakultesi. All rights reserved.

<93>
Accession Number
2003557397
Title
Impact of Aortic Atherosclerosis Burden on Outcomes of Surgical Aortic
Valve Replacement.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Iribarne A.; Pan S.; McCullough J.N.; Mathew J.P.; Hung J.; Zeng X.;
Voisine P.; O'Gara P.T.; Sledz N.M.; Gelijns A.C.; Taddei-Peters W.C.;
Messe S.R.; Moskowitz A.J.; Thourani V.H.; Argenziano M.; Groh M.A.;
Giustino G.; Overbey J.R.; DiMaio J.M.; Smith P.K.
Institution
(Iribarne, McCullough) Section of Cardiac Surgery, Dartmouth-Hitchcock
Medical Center, New Hampshire, Lebanon
(Pan, Sledz, Gelijns, Moskowitz, Giustino, Overbey) Department of
Population Health Science & Policy, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Mathew) Division of Cardiothoracic Anesthesiology, Duke University
Medical Center, Durham, NC, United States
(Hung, Zeng) Division of Cardiology, Massachusetts General Hospital,
Boston, MA, United States
(Voisine) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Quebec, Quebec, Canada
(O'Gara) Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
MA, United States
(Taddei-Peters) Division of Cardiovascular Sciences, National Heart, Lung,
and Blood Institute, Bethesda, MD, United States
(Messe) Department of Neurology, Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, United States
(Thourani) Department of Cardiac Surgery, MedStar Heart and Vascular
Institute, Washington, DC, United States
(Argenziano) Division of Cardiothoracic Surgery, Department of Surgery,
New York-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Groh) Cardiovascular and Thoracic Surgery, Mission Health and Hospitals,
Asheville, NC, United States
(DiMaio) Department of Cardiothoracic Surgery, The Heart Hospital Baylor
Plano, Baylor Scott & White Health, Plano, TX, United States
(Smith) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke University Medical Center, Durham, NC, United States
Publisher
Elsevier USA
Abstract
Background: Epiaortic ultrasound detects and localizes ascending aortic
atherosclerosis. In this analysis we investigated the association between
epiaortic ultrasound-based atheroma grade during surgical aortic valve
replacement (SAVR) and perioperative adverse outcomes. Method(s):
SAVR patients in a randomized trial of 2 embolic protection devices
underwent a protocol-defined 5-view epiaortic ultrasound read at a core
laboratory. Aortic atherosclerosis was quantified with the Katz atheroma
grade, and patients were categorized as mild (grade I-II) or
moderate/severe (grade III-V). Multivariable logistic regression was used
to estimate associations between atheroma grade and adverse outcomes,
including death, clinically apparent stroke, cerebral infarction on
diffusion-weighted magnetic resonance imaging, delirium, and acute kidney
injury (AKI) by 7 and 30 days. Result(s): Precannulation epiaortic
ultrasound data were available for 326 of 383 randomized patients (85.1%).
Of these, 106 (32.5%) had moderate/severe Katz atheroma grade at any
segment of the ascending aorta. Although differences in the composite of
death, stroke, or cerebral infarction on diffusion-weighted magnetic
resonance imaging by 7 days were not statistically significant,
moderate/severe atheroma grade was associated with a greater risk of AKI
by 7 days (adjusted odds ratio, 2.63; 95% confidence interval, 1.24-5.58;
P = .01). At 30 days, patients with moderate/severe atheroma grade had a
greater risk of death, stroke, or AKI (adjusted odds ratio, 1.97; 95%
confidence interval, 1.04-3.71; P = .04). Conclusion(s):
Moderate/severe aortic atherosclerosis was associated with an increased
risk of adverse events after SAVR. Epiaortic ultrasound may serve as a
useful adjunct for identifying patients who may benefit from strategies to
reduce atheroembolic complications during SAVR. Copyright © 2019

<94>
Accession Number
2003545210
Title
Transcatheter versus surgical aortic valve replacement in low surgical
risk patients: A meta-analysis of randomized-controlled trials and
propensity-matched studies.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Rawasia W.F.; Usman M.S.; Mujeeb F.A.; Zafar M.; Khan S.U.; Alkhouli M.
Institution
(Rawasia, Khan, Alkhouli) West Virginia University, Heart and Vascular
Institute, Morgantown, WV, United States
(Usman, Mujeeb, Zafar) Dow University of Health Sciences, Karachi,
Pakistan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: We performed a meta-analysis of randomized trials (RCT) and
propensity-matched (PSM) studies comparing transcatheter aortic valve
implantation (TAVI) with surgical aortic valve replacement (SAVR) in low
surgical risk patients. Method(s): Published studies including
low-risk patients who underwent TAVI (n = 9068) or SAVR (n = 17,388) were
included. Outcomes of interest were short-term (30-day) and mid-term
(1-year) mortality and major complications. Result(s): Short-term
mortality was lower with TAVI vs. SAVR (1.8% vs. 2.8%, RR = 0.67,
[0.56-0.80]). TAVI was associated with lower risk of atrial fibrillation
(7.4% vs. 36.5%, RR = 0.21, [0.14-0.31]), and kidney injury (5.3% vs. 9%,
RR = 0.45, [0.26-0.80]), but had higher incidence of vascular
complications (5.5% vs. 1.4%, RR = 4.88 [1.47-16.18]), and permanent
pacemaker implantation (14.9% vs. 3.4%, RR = 4.94 [3.03-8.08]). Stroke
rates were similar between both interventions (1.7% vs. 2.2%, RR = 0.80
[0.54-1.18]). Mid-term all-cause mortality was similar in the pooled
analysis for TAVI vs. SAVR (8.6% vs. 8.4%, RR = 0.90 [0.66-1.24]), but was
lower with TAVI in RCTs (2.1% vs. 3.5%, RR = 0.61 [0.39-0.95]).
Cardiovascular mortality was lower with TAVI (1.6% vs. 2.9%, RR = 0.55
[0.33-0.90]), but stroke (3% vs. 4.2%, RR = 0.69, [0.45-1.06]) and valve
re-interventions rates (0.8% vs. 0.6%, RR = 1.28 [0.52-3.17]) were similar
between both strategies. Conclusion(s): TAVI in low surgical risk
patients is associated with lower short-term morbidity and mortality
compared with SAVR. Copyright © 2019 Elsevier Inc.

<95>
Accession Number
2003528911
Title
Radiation Exposure During Transcatheter Valve Replacement: What Cardiac
Surgeons Need to Know.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Aquino A.; Khiabani A.J.; Henn M.C.; Zajarias A.; Melby S.J.; Sintek M.;
Lasala J.; Kachroo P.; Novak E.; Maniar H.S.
Institution
(Aquino, Zajarias, Sintek, Lasala, Novak) Cardiovascular Division,
Department of Medicine, Washington University School of Medicine,
Barnes-Jewish Hospital, St Louis, MO, United States
(Khiabani, Henn, Melby, Kachroo, Maniar) Division of Cardiothoracic
Surgery, Department of Surgery, Washington University School of Medicine,
Barnes-Jewish Hospital, St Louis, MO, United States
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) and
transcatheter mitral valve replacement expose operators to radiation.
These procedures differ primarily in whether they are performed via a
transfemoral (TF) or an alternative access (AA) approach. This study
compared operator radiation exposure during transcatheter valve
implantation when performed via a TF vs an AA approach, when performed in
a catheterization lab vs a hybrid operating room (OR), and investigated
the potential benefit of disposable shielding. Method(s): Dosimeters
were worn during TAVR-TF (n = 50) and TAVR-AA (n = 31) procedures by
operators. All TAVR-AA procedures were performed in a hybrid OR and TF
procedures were performed in either catheterization labs (n = 16) or a
hybrid OR (n = 34). Disposable radiation shielding pads (RADPAD; Worldwide
Innovations and Technologies, Inc, Kansas City) or a placebo were added in
a randomized, blinded fashion. Result(s): Team radiation exposure was
higher after TAVR-AA vs TAVR-TF (median 15.1 mRad [interquartile range:
IQR 8.6, 32.4] vs 5.5 mRad [IQR 2.4, 9.8], P < .001). TAVR-TF procedures
required the same amount of fluoroscopy time regardless of where they were
performed (20.3 +/- 7.4 min in hybrid OR vs 19.0 +/- 6.4 min in
catheterization lab, P = .55). However, radiation exposure for TAVR-TF
remained higher when performed in a hybrid OR (median 9.0 mRad [IQR 4.5,
11.9] vs 2.2 mRad [IQR 1.3, 2.8], P < .001). Radiation exposure was
greatest for TAVR-AA (median 15.1 mRad [IQR 8.6, 32.4]). The use of RADPAD
did not decrease radiation exposure (median 9.0 mRad [IQR 4.5, 14.7] vs
9.4 mRad [IQR 2.8, 19.5], P = .82). Conclusion(s): Procedures
performed in the hybrid OR were associated with higher operator radiation
exposure. In comparison with the TF approach, AA cases had the highest
levels of operator radiation. This is particularly important in cases of
transcatheter mitral valve replacement that can only be done via an AA
approach. The use of disposable radiation shielding in this series did not
attenuate operator radiation exposure. Radiation shielding within hybrid
ORs should be scrutinized in an effort to remain on par with that found
within catheterization labs. Copyright © 2019 The Society of
Thoracic Surgeons

<96>
Accession Number
2003509560
Title
Antithrombotic strategies after transcatheter aortic valve implantation:
Insights from a network meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Kuno T.; Takagi H.; Sugiyama T.; Ando T.; Miyashita S.; Valentin N.;
Shimada Y.J.; Kodaira M.; Numasawa Y.; Kanei Y.; Hayashida K.; Bangalore
S.
Institution
(Kuno, Miyashita, Valentin) Department of Medicine, Icahn School of
Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United
States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Sugiyama) Diabetes and Metabolism Information Center, Research Institute,
Center for Global Health and Medicine, Tokyo, Japan
(Sugiyama) Department of Health Services Research, Faculty of Medicine,
University of Tsukuba, Tsukuba, Japan
(Sugiyama) Department of Public Health/Health Policy, Graduate School of
Medicine, The University of Tokyo, Tokyo, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
(Shimada) Division of Cardiology, Department of Medicine, Columbia
University Medical Center, New York, NY, United States
(Kodaira, Numasawa) Department of Cardiology, Japanese Red Cross Ashikaga
Hospital, Ashikaga, Japan
(Kanei) Department of Cardiology, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
(Bangalore) New York University School of Medicine, New York, NY, United
States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We aimed to investigate the efficacy and safety of different
antithrombotic strategies in patients undergoing transcatheter aortic
valve implantation (TAVI) using network meta-analyses. Background(s):
Meta-analyses comparing single antiplatelet therapy (SAPT) vs. dual
antiplatelet therapy (DAPT), +/- oral anticoagulant (OAC) was conducted to
determine the appropriate post TAVI antithrombotic regimen. However, there
was limited direct comparisons across the different therapeutic
strategies. Method(s): MEDLINE and EMBASE were searched through
December 2018 to investigate the efficacy and safety of different
antithrombotic strategies (SAPT, DAPT, OAC, OAC + SAPT, and OAC + DAPT) in
patients undergoing TAVI. The main outcome were all-cause mortality, major
or life-threatening bleeding events, and stroke. Result(s): Our
search identified 3 randomized controlled trials and 10 nonrandomized
studies, a total of 20,548 patients who underwent TAVI. All OACs were
vitamin K antagonists. There was no significant difference on mortality
except that OAC + DAPT had significantly higher rates of mortality
compared with others (p <.05, I2 = 0%). SAPT had significantly
lower rates of bleeding compared with DAPT, OAC+SAPT, and OAC+DAPT (hazard
ratio [HR]: 0.59 [0.46-0.77], p <.001, HR: 0.58 [0.34-0.99], p =.045, HR:
0.41 [0.18-0.93], p =.033, respectively, I2 = 0%). There was no
significant difference on stroke among all antithrombotic strategies.
 Conclusion(s): Patients who underwent TAVI had similar all-cause
mortality rates among different antithrombotic strategies except OAC+DAPT.
Patients on SAPT had significantly lower bleeding risk than those on DAPT,
OAC + SAPT, and OAC + DAPT. Our results suggest SAPT is the preferred
regimen when there is no indication for DAPT or OAC. When DAPT or OAC is
indicated, DAPT + OAC should be avoided. Copyright © 2019 Wiley
Periodicals, Inc.

<97>
Accession Number
2003629330
Title
Review of the evidence in survival studies of patients with a biological
valve replacement.
Source
Revista Colombiana de Cardiologia. (no pagination), 2019. Date of
Publication: 2019.
Author
Castaneda-Porras O.
Institution
(Castaneda-Porras) Segura, Moron & Castaneda Asesores en Salud Ltda.
(SMC-AS) Unidad de Investigaciones, Bogota, Colombia
Publisher
Elsevier B.V.
Abstract
Introduction: The modifications in the structural / functional features of
replacement valves have led to an increase the survival curves of the
patients. This can be seen in the reduction in morbidity and mortality
rates after the surgical intervention of the cardiac valves, as well as
the substantial changes in the cost-effectivity and cost-benefit ratio of
these procedures. Objective(s): To determine the survival of patients
over 60 years of age with a biological valve replacement. Material(s)
and Method(s): A review of follow-up published studies that evaluated the
survival of patients subjected to a valve replacement. A search was made
of the scientific articles registered in the PubMed databases, using the
selected descriptors as Key words: Heart Valve Prosthesis, Bioprosthesis,
Survival, in the references management program-EndNote. The strength of
the scientific evidence in each of the selected articles was assessed
using the McMaster scale for quantitative studies. Result(s): A total
of 12 references were found and 5 (41.7%) were discarded, and 7 (58.3%)
had an overall "strong" score with the McMaster scale. The mean follow-up
time was 13.7 years, and the male ratio was 1:0.8. The mean age of the
patients was 67.2 (range: 60.0-78.5) years. The mean survival rate at 10
years was 65%. Conclusion(s): A higher survival was observed between
the patients fitted with a mechanical versus a biological valve. However,
the literature has established the use of a biological replacement valve
as a reasonable option in patients over 60 years of age. It is also
recognised that more studies are needed that can corroborate the
findings. Copyright © 2019 Sociedad Colombiana de Cardiologia y
Cirugia Cardiovascular

<98>
Accession Number
2002730908
Title
Efficacy of Tafamidis in Transthyretin Amyloid Cardiomyopathy in the
ATTR-ACT Trial.
Source
Heart and Lung. Conference: 2019 AAHFN Annual Meeting. JW Marriott, United
States. 48 (5) (pp 470), 2019. Date of Publication: September/October
2019.
Author
Anonymous
Publisher
Mosby Inc.
Abstract
Background: Transthyretin cardiomyopathy (ATTR-CM) is an underdiagnosed,
fatal disease caused by the deposition of transthyretin amyloid fibrils in
the heart leading to heart failure (HF). It can be hereditary due to
mutations in the TTR gene (ATTRm) or acquired (wild-type [ATTRwt]).
Tafamidis is a selective transthyretin stabilizer which prevents tetramer
dissociation and amyloidogenesis. The Tafamidis in Transthyretin
Cardiomyopathy Clinical Trial (ATTR-ACT) was an international,
multicenter, double-blind, placebo-controlled, randomized trial of
Tafamidis in patients with ATTR-CM. Objective(s): Given the limited
number of patients with ATTR-CM, a novel study design was utilized to
enable rigorous testing of the efficacy of tafamidis on hard
cardiovascular (CV) endpoints in a study of relatively modest size
compared with traditional CV trials. The primary results of this trial
were further supported through the application of pre-specified
sensitivity analyses. Method(s): Patients with ATTR-CM were
randomized (2:1:2) to tafamidis (80 mg or 20 mg of tafamidis meglumine),
or placebo (orally, once daily), for 30 months. Enrollment was stratified
by NYHA class and genotype. The primary efficacy analysis was a
hierarchical combination of all-cause mortality and frequency of
CV-related hospitalizations comparing the pooled tafamidis groups (20 mg
and 80 mg) vs. the placebo group using the Finkelstein-Schoenfeld (F-S)
method. The primary efficacy analysis result was examined using a series
of sensitivity analyses. Key secondary endpoints were change from baseline
to Month 30 in the six-minute walk test distance and the Kansas City
Cardiomyopathy Questionnaire (KCCQ) overall score. Safety assessments
included adverse events, vital signs, and clinical laboratory tests.
 Result(s): A total of 441 patients were randomized (tafamidis=264,
placebo=177). Tafamidis was associated with a significant reduction in the
hierarchical combination of all-cause mortality and CVrelated
hospitalizations (P<0.001). Tafamidis also significantly reduced the
decline in both the six-minute walk distance (by 75.68 m [standard error,
9.24]; P<0.001]),and KCCQ overall score (by 13.65 [2.13]; P<0.001) as
compared with placebo. Sensitivity analyses consistently confirmed the
efficacy of tafamidis in patients with ATTR-CM: there was a 30% reduction
in risk of all-cause mortality (heart transplant and implantation of a
cardiac mechanical assist device treated as death) with tafamidis compared
with placebo (P=0.0259); and when heart transplant and implantation of a
cardiac mechanical assist device were not treated as death, there was a
33% reduction in risk of all-cause mortality with tafamidis compared with
placebo (P=0.018). Tafamidis was safe and well tolerated in this
population. Conclusion(s): ATTR-ACT, the largest randomized
controlled trial in ATTR-CM, showed that tafamidis is the first treatment
to improve survival and quality of life in ATTR-CM. Significant and
clinically meaningful improvements were observed in functional capacity as
measured by the six-minute walk distance and quality of life by KCCQ
overall score. Sensitivity analyses confirmed the robustness of these
results. Tafamidis was safe and well tolerated. The primary trial results,
along with the sensitivity analyses described here, provide strong
rationale for the use of tafamidis as first-line therapy in
ATTR-CM. Copyright © 2019

<99>
Accession Number
629759976
Title
Defining protocol deviations in a pragmatic non-inferiority trial of
potassium control after Coronary Artery Bypass Grafting.
Source
Trials. Conference: 5th International Clinical Trials Methodology
Conference, ICTMC 2019. United Kingdom. 20 (Supplement 1) (no pagination),
2019. Date of Publication: October 2019.
Author
Allen E.; Elbourne D.; Sturgess J.; Evans R.; Canter R.; Dodd M.; O'Brien
B.
Institution
(Allen, Elbourne, Sturgess, Evans, Canter, Dodd) Lshtm, London, United
Kingdom
(O'Brien) St Bartholomew's Hospital and Barts Heart Centre, London, United
Kingdom
Publisher
BioMed Central Ltd.
Abstract
Introduction: : Intention to treat (ITT) analysis is the analytic method
of choice for superiority trials as it adheres to the randomisation
process and is conservative. However, the ITT analysis may not be
conservative for non-inferiority trials as including non-compliers may
bias towards equivalence. Whilst a per-protocol (PP) analysis, is more
likely to identify differences it can also bias results. Therefore, the
recommended approach for non-inferiority trials is to carry out both an
ITT and PP analysis. A clear definition of compliance with the
intervention is therefore needed. The Tight K trial is a randomised
non-inferiority trial investigating the impact of maintaining serum
potassium <=3.6mEq/L vs <=4.5mEq/L on the incidence of new onset atrial
fibrillation after isolated elective Coronary Artery Bypass Grafting. A
pilot trial was carried out. Defining compliance with the potassium
protocols in each arm is crucial for the analysis of the trial; however,
is not straightforward. Whilst the protocols specify maintaining levels of
potassium, supplementation generally occurs when a patient falls below the
level required. Therefore, compliance cannot be based on all, or even most
measurements being above the required thresholds. Additionally, patients'
potassium levels vary differently by patient, with greater variability
observed in some. Method(s): Here we use data from the pilot trial to
explore possible definitions of compliance using statistical process
control. Timing of Potential Results: Initial Control Charts suggest that
they could help define algorithms to identify patients who have not
complied with their assigned protocol. Work is ongoing and results will be
available by October 2109. Potential Relevance &Impact: Many medical
protocols are administered in the belief that they will have the desired
effect with little evidence that they do. There is currently no accepted
way of assessing protocol deviations in these situations such and the
proposed approach shows promise.

<100>
Accession Number
629759295
Title
Using data from routine sources in the development of an objective measure
of early outcome after surgery.
Source
Trials. Conference: 5th International Clinical Trials Methodology
Conference, ICTMC 2019. United Kingdom. 20 (Supplement 1) (no pagination),
2019. Date of Publication: October 2019.
Author
Maishman R.; Gibbison B.; Reeves B.; Rogers C.
Institution
(Maishman, Reeves, Rogers) Clinical Trials and Evaluation Unit, Bristol
Trials Centre, University of Bristol, Bristol, United Kingdom
(Gibbison) Department of Cardiac Anaesthesia and Intensive Care, Bristol
Heart Institute/University Hospitals Bristol NHS FT, Bristol, United
Kingdom
Publisher
BioMed Central Ltd.
Abstract
Introduction: In trials in surgery, post-operative length of hospital stay
(LoS) is often used as a proxy for early outcome. However, blinding of
surgeons is typically not possible, which leads to potential for bias, as
the surgeon decides when a patient is ready for discharge. This has led us
to investigate how routinely collected clinical measures during the first
24 hours and complications that occur throughout the post-operative stay
could be used to develop a more objective measure of early outcome.
 Method(s): Measurements routinely collected during the first 24 hours
after surgery have been extracted from hospital electronic records and
combined with trial data for a cohort of patients who have previously
participated in a cardiac surgery RCT. Relationships between six
measurements (summarised over the first 24 hours) and LoS have been
investigated to identify early indicators of poor outcome. The six
measures were chosen in discussion with clinician colleagues. Provisional
results: A total of 808 patients who had participated in one of 7 trials
were included. Initial univariable and multivariable analyses suggest
higher arterial mean blood pressure and higher minimum haemoglobin were
significantly associated with shorter LoS, while higher maximum lactate
and maximum potassium were associated with longer LoS. Heart rate and
temperature were not associated with LoS. Effect estimates were attenuated
for all measurements in the multivariate analysis. We will also describe
the association between these measures and complications and how these are
being combined, alongside patient and clinician "ratings" of complication
severity, to develop of an objective measure of early outcome. Potential
relevance and impact: Supplementing clinical trial data with routinely
collected measurements provides more detailed information on early outcome
at minimal additional cost. The methodology to develop this measure is
applicable in other clinical areas.

<101>
Accession Number
2003490166
Title
Open access efforts begin to bloom: ESC Heart Failure gets full attention
and first impact factor.
Source
ESC Heart Failure. 6 (5) (pp 903-908), 2019. Date of Publication: 01 Oct
2019.
Author
Anker S.D.; von Haehling S.; Papp Z.
Institution
(Anker) Division of Cardiology and Metabolism, Department of Cardiology,
Charite, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin D-13353,
Germany
(Anker) Berlin-Brandenburg Center for Regenerative Therapies (BCRT),
Berlin, Germany
(Anker) German Centre for Cardiovascular Research (DZHK), Berlin, Germany
(von Haehling) Department of Cardiology and Pneumology, Heart Center
Gottingen, University of Gottingen Medical Center,
Georg-August-University, Gottingen, Germany
(von Haehling) German Centre for Cardiovascular Medicine (DZHK),
Gottingen, Germany
(Papp) Division of Clinical Physiology, Department of Cardiology, Faculty
of Medicine, University of Debrecen, Debrecen, Hungary
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
In 2014, the Heart Failure Association (HFA) of the European Society of
Cardiology (ESC) founded the first open access journal focusing on heart
failure, called ESC Heart Failure (ESC-HF). In the first 5 years, in
ESC-HF we published more than 450 articles. Through ESC-HF, the HFA gives
room for heart failure research output from around the world. A transfer
process from the European Journal of Heart Failure to ESC-HF has also been
installed. As a consequence, in 2018 ESC-HF received 289 submissions, and
published 148 items (acceptance rate 51%). The journal is listed in Scopus
since 2014 and on the PubMed website since 2015. In 2019, we received our
first impact factor from ISI Web of Knowledge / Thomson-Reuters, which is
3.407 for 2018. This report reviews which papers get best cited. Not
surprisingly, many of the best cited papers are reviews and facts &
numbers mini reviews, but original research is also well
cited. Copyright © 2019 The Authors. ESC Heart Failure published
by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

<102>
[Use Link to view the full text]
Accession Number
629689102
Title
Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent
Persistent Pain after Cardiac Surgery.
Source
Anesthesiology. 131 (1) (pp 119-131), 2019. Date of Publication: 01 Jul
2019.
Author
Anwar S.; Cooper J.; Rahman J.; Sharma C.; Langford R.
Institution
(Anwar) Department of Perioperative Medicine, Barts Heart Centre, London,
United Kingdom
(Anwar, Cooper) National Institutes of Health Research Biomedical Research
Centre at Barts, London, United Kingdom
(Rahman, Sharma, Langford) Pain and Anaesthesia Research Centre, St.
Bartholomew's Hospital, London, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Editor's Perspective What We Already Know about This Topic Cardiac surgery
is associated with a significant rate of chronic postoperative pain Few
proven strategies exist to reduce chronic postoperative pain What This
Article Tells Us That Is New The administration of pregabalin (14 days)
with or without ketamine (2 days) postoperatively reduced the prevalence
of pain at 3 and 6 months Side effects from pregabalin and ketamine
administration were generally mild Background: Persistent postsurgical
pain is common and affects quality of life. The hypothesis was that use of
pregabalin and ketamine would prevent persistent pain after cardiac
surgery. Method(s): This randomized, double-blind, placebo-controlled
trial was undertaken at two cardiac surgery centers in the United Kingdom.
Adults without chronic pain and undergoing any elective cardiac surgery
patients via sternotomy were randomly assigned to receive either usual
care, pregabalin (150 mg preoperatively and twice daily for 14
postoperative days) alone, or pregabalin in combination with a 48-h
postoperative infusion of intravenous ketamine at 0.1 mg . kg-1
. h-1. The primary endpoints were prevalence of clinically
significant pain at 3 and 6 months after surgery, defined as a pain score
on the numeric rating scale of 4 or higher (out of 10) after a functional
assessment of three maximal coughs. The secondary outcomes included acute
pain, opioid use, and safety measures, as well as long-term neuropathic
pain, analgesic requirement, and quality of life. Result(s): In
total, 150 patients were randomized, with 17 withdrawals from treatment
and 2 losses to follow-up but with data analyzed for all participants on
an intention-to-treat basis. The prevalence of pain was lower at 3
postoperative months for pregabalin alone (6% [3 of 50]) and in
combination with ketamine (2% [1 of 50]) compared to the control group
(34% [17 of 50]; odds ratio = 0.126 [0.022 to 0.5], P = 0.0008; and 0.041
[0.0009 to 0.28], P < 0.0001, respectively) and at 6 months for pregabalin
alone (6% [3 of 50]) and in combination with ketamine 0% (0 of 5) compared
to the control group (28% [14 of 50]; odds ratio = 0.167 [0.029 to 0.7], P
= 0.006; and 0.000 [0 to 0.24], P < 0.0001). Diplopia was more common in
both active arms. Conclusion(s): Preoperative administration of 150
mg of pregabalin and postoperative continuation twice daily for 14 days
significantly lowered the prevalence of persistent pain after cardiac
surgery. Copyright © 2019, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc.

<103>
[Use Link to view the full text]
Accession Number
629702202
Title
Ultrasound-Guided Femoral Arterial Cannulation in Neonates Undergoing
Cardiac Surgery or Catheterization: Comparison of 0.014-Inch Floppy Versus
0.019-Inch Straight Guidewire.
Source
Pediatric Critical Care Medicine. 20 (7) (pp 608-613), 2019. Date of
Publication: 01 Jul 2019.
Author
Polat T.B.
Institution
(Polat) Department of Pediatric Cardiology, Altinbas University, School of
Medicine, Istanbul, Turkey
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Percutaneous femoral artery cannulation can be technically
challenging in small infants. Design(s): We designed a prospective
randomized trial to compare the use of two different guidewires for
femoral arterial cannulation in neonates undergoing cardiac surgery or
catheterization. Setting(s): Cardiac ICU in a university hospital.
 Patient(s): One-hundred twenty-four children were enrolled in this
prospective study, with 64 being randomized to the 0.019-inch straight
guidewire group and 60 to the 0.014-inch floppy guidewire group.
 Intervention(s): Femoral artery cannulation. Measurements and
Main Results: The study period was limited to 10 minutes at the first site
of arterial puncture. The time to complete cannulation, number of
successful cannulation on first attempt, number of attempts, and number of
successful cannulations were compared. The number of successful
cannulations and successful cannulations on first attempt were higher in
0.014-inch floppy guidewire group (p = 0.001; p = 0.002, respectively).
The time to complete cannulation was significantly shorter, and the number
of attempts was lower in 0.014-inch floppy guidewire group (p = 0.001).
Among the neonates less than 2000g, the number of attempts and time to
complete cannulation were significantly lower (p < 0.001), and number of
successful cannulation on first attempt and number of successful
cannulations were significantly higher (p < 0.028; p < 0.001,
respectively) in the 0.014-inch floppy guidewire Conclusion(s): Using
0.014-inch floppy guidewire for femoral arterial cannulation in
particularly very small neonates provides significant improvement in first
attempt success, number of successful cannulations, number of attempts,
time to complete cannulation. Copyright © 2019 by the Society of
Critical Care Medicine and the World Federation of Pediatric Intensive and
Critical Care Societies.

<104>
Accession Number
2003583431
Title
Meta-analysis of Randomized Controlled Trials Assessing the Impact of
Proprotein Convertase Subtilisin/Kexin Type 9 Antibodies on Mortality and
Cardiovascular Outcomes.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
AlTurki A.; Marafi M.; Dawas A.; Dube M.-P.; Vieira L.; Sherman M.H.;
Gregoire J.; Thanassoulis G.; Tardif J.-C.; Huynh T.
Institution
(AlTurki, Dawas, Thanassoulis, Huynh) Division of Cardiology, McGill
University Health Center, Montreal, Quebec, Canada
(Marafi, Vieira) Department of Neurology, Montreal Neurological Institute,
Montreal, Quebec, Canada
(Dube, Gregoire, Tardif) Montreal Heart Institute, Universite de Montreal,
Montreal, Quebec, Canada
(Sherman) Division of Endocrinology, McGill University Health Center,
Montreal, Quebec, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition by
monoclonal antibodies has been shown to reduce low density lipoprotein
(LDL-C) but its effects on cardiovascular (CV) outcomes have not been
fully described. The aim of this study is to assess the impact of PCSK9
inhibition on mortality and CV outcomes by pooling data from all available
randomized clinical trials (RCT) of PCSK9 inhibitors. We conducted a
comprehensive search of electronic databases, up to December 1, 2018, for
all RCTs comparing PCSK9 inhibition to placebo or ezetimibe in patients
with hypercholesterolemia or coronary artery disease receiving maximally
tolerated statin for primary or secondary prevention of mortality and
cardiovascular outcomes. We used random-effects meta-analyses to summarize
the studies. We retained 23 RCTs having included 88,041 patients in
primary and secondary prevention. The follow-up ranged from 6 to 36
months. PCSK9 inhibition was not significantly associated with reductions
in total mortality (odds ratio [OR] 0.91, 95% confidence interval [CI] 078
to 1.06; p = 0.22) and CV mortality (OR 0.95, 95% CI 0.84 to 1.07; p =
0.37). In contrast, PCSK9 inhibition was associated with reductions in
myocardial infarction (OR 0.80, 95% CI 0.71 to 0.91; p <0.0001), stroke
(OR 0.75, 95% CI 0.65 to 0.85; p <0.0001), and coronary revascularization
(OR 0.82, 95% CI 0.77 to 0.88; p <0.0001). In conclusion, PCSK9 inhibition
was associated with reductions in myocardial infarction, stroke, and
coronary revascularization. Future analyses may identify high-risk
patients who may benefit more from these agents and longer follow-up of
current or new trials may show a mortality benefit. Copyright ©
2019 Elsevier Inc.

<105>
Accession Number
2003508562
Title
The challenge of non-adherence to early rehabilitation after coronary
artery bypass surgery: Secondary results from the SheppHeartCABG trial.
Source
European Journal of Cardiovascular Nursing. (no pagination), 2019. Date of
Publication: 2019.
Author
Hojskov I.E.; Thygesen L.C.; Moons P.; Egerod I.; Olsen P.S.; Berg S.K.
Institution
(Hojskov, Olsen, Berg) The Heart Centre, University of Copenhagen, Denmark
(Hojskov) Department of Nursing and Nutrition Education, The Faculty of
Health Sciences, University College, Copenhagen, Denmark
(Thygesen) National Institute of Public Health, University of Southern
Denmark, Denmark
(Moons) Department of Public Health and Primary Care, University of
Leuven, Belgium
(Moons) Department of Pediatrics and Child Health, University of Cape
Town, South Africa
(Egerod) Department of Intensive Care Unit, Rigshospitalet, University of
Copenhagen, Denmark
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Attending and maintaining a cardiac rehabilitation programme
is a challenge. Aim(s): The purpose of this study was to explore
associations between non-adherence to early coronary artery bypass graft
rehabilitation and sociodemographic and clinical baseline data.
 Method(s): Coronary artery bypass graft patients were randomised 1:1
to either four weeks of comprehensive early rehabilitation or usual care.
Outcomes were assessed at three time-points points: baseline, discharge
and four weeks post-coronary artery bypass graft. Differences in
sociodemographic and clinical baseline data in adherent versus
non-adherent patients were tested using the Pearson chi2 test
for categorical variables. To test associations between non-adherence to
exercise training and sociodemographic and clinical baseline data,
multivariate logistic regression was used to estimate the odds ratio for
in-hospital training and post-discharge training adjusted for age, sex and
left ventricular ejection fraction. Result(s): Non-adherence to
in-hospital versus post-discharge exercise training was 31% (n=48) versus
53% (n=81). Female non-adherence was 20% versus 70%. Non-adherence to
in-hospital versus post-discharge mindfulness was 87% versus 70%. Male
non-adherence to mindfulness was 85% versus 70%. Non-adherence to
psycho-educational consultations was 3%, most of whom were men. Patients
with university level education were more adherent to in-hospital exercise
training than patients with lower educational level (odds ratio=3.14 (95%
confidence interval; 1.16-8.51), p=0.02). Diabetic patients were more
non-adherent to exercise training after discharge (3.74 (1.54-9.08),
p=0.004) as were overweight patients (0.37 (0.17-0.80), p=0.01).
 Conclusion(s): This study demonstrated wide acceptance of
psycho-educational consultations in post-coronary artery bypass graft
patients. Adherence to physical rehabilitation was low especially after
discharge from hospital and the opportunity to attend a mindfulness
programme was not used. Copyright © The European Society of
Cardiology 2019.

<106>
Accession Number
2003507920
Title
Transcatheter aortic valve replacement versus surgery for symptomatic
severe aortic stenosis: A reconstructed individual patient data
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Dowling C.; Kondapally Seshasai S.R.; Firoozi S.; Brecker S.J.
Institution
(Dowling, Kondapally Seshasai, Firoozi, Brecker) Cardiology Clinical
Academic Group, St. George's, University of London and St. George's
University Hospitals NHS Foundation Trust, London, United Kingdom
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We wished to undertake a reconstructed individual patient data
meta-analysis of randomized clinical trials comparing transcatheter aortic
valve replacement (TAVR) and surgery for patients with severe symptomatic
aortic stenosis. Background(s): TAVR and surgery are both
well-established methods for treating patients with symptomatic severe
aortic stenosis who are at low, intermediate, and high risk for surgery.
 Method(s): Data were identified by searches of Medline, Embase,
CENTRAL and ClinicalTrials.gov for all randomized clinical trials, which
compared TAVR and surgery that had published at least 1 year of follow-up.
Individual patient data were reconstructed from Kaplan-Meier curves.
 Result(s): A total of 7,770 patients from seven randomized clinical
trials were included in this meta-analysis. At 1 year, TAVR was associated
with a lower risk of death from any cause (hazard ratio [HR], 0.85, 95%
confidence interval [CI], 0.73-0.98; p =.03), disabling stroke (HR, 0.71;
95% CI, 0.54-0.93; p =.01) and the composite end point of death or
disabling stroke (HR, 0.79; 95% CI, 0.67-0.92; p =.002). Significant
interactions were found for access suitability, with TAVR associated with
a lower risk of these end points in patients suitable for transfemoral
access. TAVR was associated with a lower risk of periprocedural events,
whereas the risk of late events was similar between TAVR and surgery.
 Conclusion(s): At 1 year, TAVR was associated with a lower risk of
death, disabling stroke and the composite end point, when compared with
surgery. These associations were strongest within the subgroup of patients
in whom transfemoral access was feasible. Copyright © 2019 Wiley
Periodicals, Inc.

<107>
Accession Number
2003506980
Title
The Prediction Model of Warfarin Individual Maintenance Dose for Patients
Undergoing Heart Valve Replacement, Based on the Back Propagation Neural
Network.
Source
Clinical Drug Investigation. (no pagination), 2019. Date of Publication:
2019.
Author
Li Q.; Wang J.; Tao H.; Zhou Q.; Fu B.; Qin W.Z.; Li D.; Hou J.L.; Chen
J.; Zhang W.-H.
Institution
(Li, Chen) Department of Evidence-Based Medicine and Clinical
Epidemiology, West China Hospital, Sichuan University, Guo Xue Xiang 37#,
Chengdu, Sichuan 610041, China
(Wang) Department of Career Development Division, The Fourth Affiliated
Hospital of Anhui Medical University, Hefei, China
(Tao) Department of Hematology, West China Hospital, Sichuan University,
Chengdu, China
(Zhou) Department of Nutrition, The Second Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Chen) Department of Anesthesiology, China Mianyang Central Hospital,
Mianyang, China
(Fu) Department of Cardiovascular Surgery, Tianjin Central Hospital,
Tianjin, China
(Qin) Department of Social Medicine and Health Management, Shandong
University, Jinan, China
(Li, Hou) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, Chengdu, China
(Zhang) Department of Research Laboratory for Human Reproduction, Faculty
of Medicine and School of Public Health, Universite Libre de Bruxelles
(ULB), Brussels, Belgium
(Zhang) International Centre for Reproductive Health (ICRH), Department of
Public Health and Primary Care, Ghent University, Ghent, Belgium
Publisher
Springer International Publishing
Abstract
Background and Objective: Because of the narrow therapeutic window and
huge inter-individual variation, the individual precision on anticoagulant
therapy of warfarin is challenging. In our study, we aimed to construct a
Back Propagation Neural Network (BPNN) model to predict the individual
warfarin maintenance dose among Chinese patients who have undergone heart
valve replacement, and validate its prediction accuracy. Method(s):
In this study, we analyzed 13,639 eligible patients extracted from the
Chinese Low Intensity Anticoagulant Therapy after Heart Valve Replacement
database, which collected data on patients using warfarin after heart
valve replacement from 15 centers all over China. Ten percent of patients
who were finally enrolled in the database were used as the external
validation, while the remaining were randomly divided into the training
and internal validation groups at a ratio of 3:1. Input variables were
selected by univariate analysis of the general linear model; 2.0, the mean
value of the international normalized ratio (INR) range 1.5-2.5, was used
as the mandatory variable. The BPNN model and the multiple linear
regression (MLR) model were constructed by the training group and
validated through comparisons of the mean absolute error (MAE), mean
squared error (MSE), root mean squared error (RMSE), and ideal predicted
percentage. Result(s): Finally, 10 input variables were selected and
a three-layer BPNN model was constructed. In the BPNN model, the value of
MAE (0.688 mg/day and 0.740 mg/day in internal and external validation,
respectively), MSE (0.580 mg/day and 0.599 mg/day in internal and external
validation, respectively), and RMSE (0.761 mg/day and 0.774 mg/day in
internal and external validation, respectively) were achieved. Ideal
predicted percentages were high in both internal (63.0%) and external
validation (59.7%), respectively. Compared with the MLR model, the BPNN
model showed a higher ideal prediction percentage in the external
validation group (59.7% vs. 56.6%), and showed the best prediction
accuracy in the intermediate-dose subgroup (internal validation group:
85.2%; external validation group: 84.7%) and a high predicted percentage
in the high-dose subgroup (internal validation group: 36.2%; external
validation group: 39.8%), but poor performance in the low-dose subgroup
(internal validation group: 0%; external validation group: 0.3%).
Meanwhile, the BPNN model showed better ideal prediction percentage in the
high-dose group than the MLR model (internal validation: 36.2% vs. 31.6%;
external validation: 42.8% vs. 37.8%). Conclusion(s): The BPNN model
shows promise for predicting the warfarin maintenance dose after heart
valve replacement. Copyright © 2019, Springer Nature Switzerland
AG.

<108>
Accession Number
629744540
Title
Bypassing the blues: Insomnia in the depressed post-CABG population.
Source
Annals of clinical psychiatry : official journal of the American Academy
of Clinical Psychiatrists. 31 (4) (pp e2-e10), 2019. Date of Publication:
01 Nov 2019.
Author
Waterman L.A.; Belnap B.H.; Gebara M.A.; Huang Y.; Abebe K.Z.; Rollman
B.L.; Karp J.F.
Institution
(Karp) Western Psychiatric Institute and Clinic, Pittsburgh, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Recovery from coronary artery bypass graft (CABG) surgery
often is complicated by depression and insomnia, resulting in poorer
health-related quality of life and clinical outcomes. We explored the
relationships among depression, insomnia, quality of life, and the impact
of a collaborative care strategy on reducing insomnia in patients after
CABG surgery. METHOD(S): Patients with a Patient Health Questionnaire
score >=10 were randomized to nurse-delivered collaborative care for
depression (n = 150) or their physician's usual care (n = 152). A
convenience sample of patients without depression (n = 151) served as the
control group. Using the Hamilton Depression Rating Scale sleep questions,
we created an "insomnia index." RESULTS: At baseline, 63% of participants
who were depressed vs 12% of those who were not depressed reported
insomnia. Compared with usual care, fewer collaborative care participants
reported insomnia at 8 months, and they tended to have a lower insomnia
score (insomnia index change score -0.95 and -1.47, respectively; P = .05)
with no timeby- randomization interaction, Cohen's d = 0.22 (95%
confidence interval, -0.001 to 0.43). Participants with baseline insomnia
reported greater improvements in mental health-related quality of life
(Medical Outcomes Survey 36-item Short Form Mental Component Summary
score; -3.32, P = .02), but insomnia was not a significant moderator of
the effect of collaborative care. CONCLUSION(S): This is the first
study to examine the long-term impact on insomnia among post-CABG patients
treated for depression. Future collaborative care studies could consider
including a therapeutic focus for insomnia.

<109>
Accession Number
629738553
Title
Neuro-oncological features of spinal meningiomas: systematic review.
Source
Neuro-Chirurgie. (no pagination), 2019. Date of Publication: 28 Oct 2019.
Author
Pereira B.J.A.; de Almeida A.N.; Paiva W.S.; de Aguiar P.H.P.; Teixeira
M.J.; Marie S.K.N.
Institution
(Pereira) Departamento de Neurologia da Faculdade de Medicina da
Universidade de Sao Paulo-SP, Brazil
(de Almeida) Divisao de Neurocirurgia Funcional IPQ. Hospital das Clinicas
da Universidade de Sao Paulo-SP, Brazil
(Paiva, de Aguiar, Teixeira, Marie) Departamento de Neurologia da
Faculdade de Medicina da Universidade de Sao Paulo-SP, Brazil
Publisher
NLM (Medline)
Abstract
PURPOSE: Review the published data on spinal meningioma (SM) to create a
more comprehensive picture of its natural history. METHOD(S): A
review of the published SM literature was carried out through a Medline
search up to December 2018. The search using the keyword "spinal
meningiomas" returned 248 papers and the parameters analyzed in our
present study were examined in those publications. Papers without a
detailed description of clinical findings, neuroimaging confirmation of
the spinal tumor, minimum follow-up of 5 years, or a clear description of
the clinical findings were excluded. RESULT(S): In the 24 manuscripts
reviewed, 1811 (1450 females/ 361 males) patients with SM were analyzed.
The thoracic spine (1181 - 64.6%) and cervical spine (394 - 22.7%) were
the more prevalent levels. The psammomatous (27.8%) and meningothelial
variants (25.2%) were the most prevalent histopathological subtypes. Gross
total resection (Simpson I and II) was achieved in 94.5% of cases and
subtotal resection (Simpson III or more) in 5.5%. The tumor recurrence
rate was 4.4%, and the mortality rate related to surgery or disease
progression was 3%. CONCLUSION(S): WHO grade I predominance was
observed among spinal meningiomas, analogous to intracranial meningiomas.
SMs predominated in the thoracic spine. Surgery with gross total resection
was achieved in the vast majority of cases, resulting in low recurrence
and mortality rates. Copyright © 2019 Elsevier Masson SAS. All
rights reserved.

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