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

Total documents retrieved: 85

Results Generated From:
Embase <1980 to 2019 Week 48>
Embase (updates since 2019-11-22)

<1>
Accession Number
2002834883
Title
Effects of anesthetic depth on postoperative cognitive dysfunction (pocd)
in non-cardiac surgical patients: A meta-analysis.
Source
International Journal of Clinical and Experimental Medicine. 12 (9) (pp
11169-11177), 2019. Date of Publication: 2019.
Author
An R.; Pang Q.; Liu H.
Institution
(An, Pang, Liu) Department of Anesthesiology, Chongqing University Cancer
Hospital, Chongqing, China
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
The current study aimed to summarize related published articles concerning
the depth of anesthesia and postoperative cognitive dysfunction (POCD) in
non-cardiac surgical patients. Moreover, this study aimed to investigate
the effects of the depth of anesthesia on short- or long-term POCD.
 Method(s): Medline, Embase, Ovid, Cochrane Library, Google Scholar,
CNKI, and Wan-fang databases were searched. Researchers focused on the
effects of the depth of anesthesia on POCD and on postoperative S100-beta
protein levels. Result(s): A total of 2,625 patients from 20
randomized controlled trials (RCTs) were enrolled. The current
meta-analysis shows that deep anesthesia significantly decreased incidence
of POCD, compared with light anesthesia, on day 1 [OR, 0.31; 95% CI (0.24,
0.40), P < 0.00001, from 3 to 5 days [OR, 0.35; 95% CI (0.24, 0.52), P <
0.00001], day 7 [OR, 0.45; 95% CI (0.27, 0.74), P=0.002], and from 1 to 3
months [OR, 0.66; 95% CI (0.45,0.99), P=0.04] after surgery. Serum
S100-beta protein levels in patients that received deep anesthesia were
much lower than those in patients receiving light anesthesia [MD, -270.29;
95% CI (-295.81, -244.77), P < 0.00001] on postoperative day 1.
 Conclusion(s): Deep anesthesia can significantly reduce incidence
rates of short- or long-term POCD. Serum S100-beta protein levels on
postoperative day 1 could be reduced with deep anesthesia. Copyright
© 2019, E-Century Publishing Corporation. All rights reserved.

<2>
Accession Number
627035261
Title
Clinical outcomes of percutaneous mitral valve repair with MitraClip for
the management of functional mitral regurgitation.
Source
Catheterization and Cardiovascular Interventions. 94 (6) (pp 820-826),
2019. Date of Publication: 15 Nov 2019.
Author
Marmagkiolis K.; Hakeem A.; Ebersole D.G.; Iliescu C.; Ates I.;
Cilingiroglu M.
Institution
(Marmagkiolis) Pepin Heart Institute, Florida Hospital Tampa, Tampa, FL,
United States
(Hakeem) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Ebersole) Watson Clinic LLP, Lakeland, FL, United States
(Iliescu) Division of Cardiology, Department of Medicine, MD Anderson
Cancer Center, University of Texas at Houston, Houston, TX, United States
(Ates, Cilingiroglu) School of Medicine, Bahcesehir University, Istanbul,
Turkey
(Cilingiroglu) Arkansas Heart Hospital, Little Rock, AR, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To evaluate the safety and efficacy of percutaneous mitral
valve repair for the management of functional mitral insufficiency.
 Background(s): Severe FMR is present in 25-30% of patients with heart
failure and is an independent predictor of mortality and hospitalizations
in patients with both ischemic and nonischemic cardiomyopathy. MitraClip
therapy has been approved for high surgical risk patients with primary
mitral regurgitation. Recent studies including two randomized trials have
yielded conflicting results in terms of its clinical efficacy and outcomes
for FMR. A quantitative evaluation and synthesis of this information are
essential in elucidating the role of MitraClip repair for FMR.
 Method(s): We performed a literature search using PubMed, EMBASE, and
Cochrane Central Register of Controlled Trials from September 2008 to
September 2018. Studies comparing percutaneous mitral valve repair using
the MitraClip device against conservative therapy for the management of
functional mitral regurgitation were included. Result(s): Seven
studies with 1,174 patients in MitraClip group and 1,015 patients in
medical therapy group met inclusion criteria. The 12-month mortality in
the MitraClip group was 18.4% compared with 25.9% in the medical therapy
group (odds ratio [OR]: 0.65 [0.50, 0.86]; p <.002). The rate of
readmission at 12 months was 29.9% in the MitraClip group compared with
54.1% in the medical therapy group (OR: 040 [0.32-0.49]; p <.0001. The
prognostic efficacy of MitraClip repair appears to be more substantial
over longer follow-up period over medical therapy alone.
 Conclusion(s): Based on the results of this meta-analysis,
percutaneous mitral valve repair with MitraClip appears to be superior to
medical therapy for symptomatic moderate-to-severe functional mitral
insufficiency. Further clinical research is needed to identify the ideal
patient subgroups who receive maximum benefit with the MitraClip
therapy. Copyright © 2019 Wiley Periodicals, Inc.

<3>
Accession Number
2002344100
Title
In Search of the Ideal Valve: Optimizing Genetic Modifications to Prevent
Bioprosthetic Degeneration.
Source
Annals of Thoracic Surgery. 108 (2) (pp 624-635), 2019. Date of
Publication: August 2019.
Author
Smood B.; Hara H.; Cleveland D.C.; Cooper D.K.C.
Institution
(Smood, Hara, Cooper) Xenotransplantation Program, Department of Surgery,
University of Alabama at Birmingham, Birmingham, AL, United States
(Cleveland) Division of Pediatric Cardiovascular Surgery, University of
Alabama at Birmingham, Birmingham, AL, United States
Publisher
Elsevier USA
Abstract
Background: Bioprosthetic heart valves undergo structural degeneration and
calcification. Similarities exist in the histopathologic features of
explanted bioprosthetic valves and rejected pig tissues and organs after
xenotransplantation into nonhuman primates. The development of more
durable bioprosthetic valves, namely from genetically modified pigs, could
negate the need for the insertion of mechanical prostheses in children and
young adults with the requirement for life-long anticoagulation and might
avoid the need for reoperation in elderly patients. Method(s): We
reviewed the literature (MedlinePlus, PubMed, Google Scholar) through
September 1, 2018, under four key terms: (1) bioprosthetic heart valves,
(2) xenograft antigens, (3) immunologic responses to bioprosthetic valves,
and (4) genetic modification of xenografts. Result(s): Advances in
tissue and organ xenotransplantation have elucidated important immunologic
barriers that provide innovative approaches to prevent structural
degeneration of bioprosthetic heart valves. The current evidence suggests
that bioprosthetic valves derived from genetically modified pigs lacking
xenogeneic antigens (namely Gal, Neu5Gc, and Sda), termed triple-knockout
pigs, would function considerably longer than current wild-type
(genetically unmodified) porcine valves in human recipients.
 Conclusion(s): Preclinical and clinical studies to determine the
safety and efficacy of triple-knockout porcine bioprosthetic valves will
likely establish that they are more resistant to human immune responses
and thus less susceptible to structural degeneration. Copyright ©
2019 The Society of Thoracic Surgeons

<4>
Accession Number
628001740
Title
A high-efficiency MUF method benefits postoperative hemodynamic stability
and oxygen delivery in neonates with transposition of great arteries.
Source
Journal of Cardiac Surgery. 34 (6) (pp 468-473), 2019. Date of
Publication: June 2019.
Author
Shen J.; Wang W.; Zhang W.; Jiang L.; Yang Y.Y.
Institution
(Shen, Wang, Zhang, Jiang, Yang) Department of Cardiothoracic Surgery,
School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To minimize the postoperative hemodynamic changes in neonates
with transposition of great arteries (TGA) by modifying the circuit and
efficiency of traditional modified ultrafiltration (MUF). Method(s):
Ninety-one patients (<5 kg) underwent arterial switch operations, which
were randomized to a traditional MUF (tMUF) group (N = 38) or a modified
MUF (mMUF) group (N = 53). MUF of both the groups lasted for 8 to 12
minutes, during which the near-infrared spectroscopy was used to monitor
cerebral tissue oxygenation parameters. Result(s): The cerebral
oxygenation was significantly improved after MUF in both groups. The
tissue hemoglobin concentration index (THI) was proportional to the total
cerebral hemoglobin during MUF. The ascending velocity of THI was faster
in the mMUF group. The mean change range in the mMUF group was 0.90 +/-
0.44 mM/cm, while that in the tMUF group was 0.51 +/- 0.35 mM/cm (P =
0.028). Quantitative changes in the cerebral concentration of oxygenated
hemoglobin increased faster in the mMUF group, in which a nadir of low
efficacy MUF was not observed. The rising velocity of the tissue
oxygenation index was faster in the mMUF group. All mMUF cases had stable
hemodynamics during MUF. The tMUF was aborted in two patients because of
unstable hemodynamics. At the end of MUF, hematocrit was significantly
greater in the mMUF group than in the tMUF group (40.33 +/- 5.43% vs 34.41
+/- 5.11%; P < 0.01). Conclusion(s): The mMUF circuit is more
miniaturized and less prime, which leads to more efficient
ultrafiltration. It benefits postoperative hemodynamic stability and
oxygen delivery in neonates with TGA. Copyright © 2019 Wiley
Periodicals, Inc.

<5>
Accession Number
628001512
Title
The role of ministernotomy in aortic valve surgery-A prospective
randomized study.
Source
Journal of Cardiac Surgery. 34 (6) (pp 435-439), 2019. Date of
Publication: June 2019.
Author
Vukovic P.M.; Milojevic P.; Stojanovic I.; Micovic S.; Zivkovic I.; Peric
M.; Milicic M.; Milacic P.; Milojevic M.; Bojic M.
Institution
(Vukovic, Milojevic, Stojanovic, Micovic, Zivkovic, Peric, Milicic,
Milacic, Milojevic, Bojic) Department of Cardiac Surgery, Dedinje
Cardiovascular Institute, Belgrade, Serbia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aims: The purpose of this prospective randomized study was
to compare the early and midterm outcomes of aortic valve replacement
(AVR) through upper ministernotomy with conventional AVR through median
sternotomy. Method(s): One hundred patients undergoing elective AVR
were randomized into two groups: the M group (upper ministernotomy group,
n = 50) and the C group (conventional sternotomy group, n = 50). The
operative data, major adverse outcomes, and postoperative variables were
compared between the two groups of patients. A cross-sectional follow-up
was performed 24.9 +/- 5.8 months after surgery. Result(s): The
aortic cross-clamp time and cardiopulmonary bypass time were significantly
longer in the M group. Similar incidences of major cardiac, neurologic and
renal complications were recorded in both groups. Two patients (4%) in the
C group developed wound infections. The length of ICU stay was similar in
both groups. The patients in the M group had a shorter hospital stay
compared with the patients in the C group (7.6 +/- 2 days vs 9.3 +/- 4.8
days; P = 0.022). Follow-up revealed that the time period needed to reach
full recovery was significantly shorter in the ministernotomy group (1.7
+/- 1.2 months vs 2.8 +/- 1.6 months; P = 0.001). Morbidity and mortality
data did not differ between the two groups. Conclusion(s): There was
no difference in the major outcomes between the patients who underwent
upper ministernotomy and those who underwent full sternotomy. The benefits
of the minimally invasive approach were the shorter hospital stay and
significantly faster recovery of patients after discharge from the
hospital. Copyright © 2019 Wiley Periodicals, Inc.

<6>
Accession Number
2001481092
Title
Alirocumab Reduces Total Nonfatal Cardiovascular and Fatal Events: The
ODYSSEY OUTCOMES Trial.
Source
Journal of the American College of Cardiology. 73 (4) (pp 387-396), 2019.
Date of Publication: 5 February 2019.
Author
Szarek M.; White H.D.; Schwartz G.G.; Alings M.; Bhatt D.L.; Bittner V.A.;
Chiang C.-E.; Diaz R.; Edelberg J.M.; Goodman S.G.; Hanotin C.; Harrington
R.A.; Jukema J.W.; Kimura T.; Kiss R.G.; Lecorps G.; Mahaffey K.W.;
Moryusef A.; Pordy R.; Roe M.T.; Tricoci P.; Xavier D.; Zeiher A.M.; Steg
P.G.
Institution
(Szarek) State University of New York, Downstate School of Public Health,
Brooklyn, NY, United States
(White) University of Auckland and Green Lane Cardiovascular Services
Auckland City Hospital, Auckland, New Zealand
(Schwartz) Division of Cardiology, University of Colorado School of
Medicine, Aurora, CO, United States
(Alings) Amphia Ziekenhuis Molengracht, Breda, Netherlands
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Bittner) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
(Chiang) General Clinical Research Center, Taipei Veterans General
Hospital and National Yang-Ming University, Taipei, Taiwan (Republic of
China)
(Diaz) Estudios Cardiologicos Latinoamerica, Instituto Cardiovascular de
Rosario, Rosario, Argentina
(Edelberg, Moryusef) Sanofi, Bridgewater, NJ, United States
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton,
Alberta, St. Michael's Hospital, University of Toronto, Toronto, Ontario,
Canada
(Hanotin, Lecorps) Sanofi, Paris, France
(Harrington, Mahaffey) Stanford Center for Clinical Research, Department
of Medicine, Stanford University, Stanford, CA, United States
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Kimura) Kyoto University Graduate School of Medicine, Kyoto-shi, Kyoto,
Japan
(Kiss) Magyar Honvedseg Egeszsegugyi Kozpont, Budapest, Hungary
(Pordy) Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
(Roe) Division of Cardiology, Department of Medicine, Duke University
School of Medicine, Durham, NC, United States
(Roe, Tricoci) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Xavier) Department of Pharmacology and Division of Clinical Research, St.
John's Medical College and Research Institute, Bangalore, India
(Zeiher) Department of Medicine III, Goethe University, Frankfurt am Main,
Germany
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris and
Paris Diderot University, Sorbonne Paris Cite FACT (French Alliance for
Cardiovascular Trials), INSERM U1148, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
Publisher
Elsevier USA
Abstract
Background: The ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes
After an Acute Coronary Syndrome During Treatment With Alirocumab) trial
compared alirocumab with placebo, added to high-intensity or
maximum-tolerated statin treatment, after acute coronary syndrome (ACS) in
18,924 patients. Alirocumab reduced the first occurrence of the primary
composite endpoint and was associated with fewer all-cause deaths.
 Objective(s): This pre-specified analysis determined the extent to
which alirocumab reduced total (first and subsequent) nonfatal
cardiovascular events and all-cause deaths in ODYSSEY OUTCOMES.
 Method(s): Hazard functions for total nonfatal cardiovascular events
(myocardial infarction, stroke, ischemia-driven coronary
revascularization, and hospitalization for unstable angina or heart
failure) and death were jointly estimated, linked by a shared frailty
accounting for patient risk heterogeneity and correlated within-patient
nonfatal events. An association parameter also quantified the strength of
the linkage between risk of nonfatal events and death. The model provides
accurate relative estimates of nonfatal event risk if nonfatal events are
associated with increased risk for death. Result(s): With 3,064 first
and 5,425 total events, 190 fewer first and 385 fewer total nonfatal
cardiovascular events or deaths were observed with alirocumab compared
with placebo. Alirocumab reduced total nonfatal cardiovascular events
(hazard ratio: 0.87; 95% confidence interval: 0.82 to 0.93) and death
(hazard ratio: 0.83; 95% confidence interval: 0.71 to 0.97) in the
presence of a strong association between nonfatal and fatal event risk.
 Conclusion(s): In patients with ACS, the total number of nonfatal
cardiovascular events and deaths prevented with alirocumab was twice the
number of first events prevented. Consequently, total event reduction is a
more comprehensive metric to capture the totality of alirocumab clinical
efficacy after ACS. Copyright © 2019 The Authors

<7>
Accession Number
627110359
Title
Aortic valve repair or replacement in patients with aortic regurgitation:
A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 34 (6) (pp 377-384), 2019. Date of
Publication: June 2019.
Author
Wong C.H.M.; Chan J.S.K.; Sanli D.; Rahimli R.; Harky A.
Institution
(Wong, Chan) Faculty of Medicine, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong
(Sanli) Gundogmus National Town Hospital, Antalya, Turkey
(Rahimli) Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
(Harky) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To systematically compare clinical outcomes between aortic
valve repair and replacement in patients with aortic regurgitation.
 Method(s): A comprehensive literature search was undertaken among the
four major databases (PubMed, Embase, Scopus, and Ovid) to identify all
published data comparing clinical outcomes of aortic valve repair vs
replacement. Database searched from inception to November 2018.
 Result(s): A total of 1071 patients were analyzed in eight articles.
Mean age was similar in both groups of patients (47.2 +/- 12.8 vs 48.3 +/-
12.7 years, P = 0.83, aortic valve repair and replacement, respectively).
The preoperative left ventricular ejection fraction was better in the
repair group (56.7% +/- 4.8 vs 53.3% +/- 4.2, P = 0.005). The rate of
moderate-to-severe regurgitation and bicuspid aortic valve were similar in
both cohorts (81% vs 78%, P = 0.90% and 58% vs 55%, P = 0.46). In-hospital
and 1-year mortality was lower in repair cohort, although not reaching
statistical significance (1.3% vs 3.6%, P = 0.12; 5.9% vs 9.3%, P = 0.77).
Reoperation rate was higher in repair patients at 1 year (8.8% vs 3.7%, P
= 0.03). Conclusion(s): Aortic valve repair offers comparable
perioperative outcomes to aortic valve replacement in aortic regurgitation
patients at the expense of higher late reintervention rate. Larger trials
with long-term follow-up are required to confirm the long-term benefits of
aortic valve repair. Copyright © 2019 Wiley Periodicals, Inc.

<8>
Accession Number
623736830
Title
Unequal intra-group variance in trajectory classification.
Source
Statistics in Medicine. 37 (28) (pp 4155-4166), 2018. Date of Publication:
10 Dec 2018.
Author
Klich A.; Ecochard R.; Subtil F.
Institution
(Klich, Ecochard, Subtil) Service de Biostatistique-Bioinformatique, Pole
Sante Publique, Hospices Civils de Lyon, Lyon, France
(Klich, Ecochard, Subtil) Universite de Lyon, Universite Lyon 1, CNRS,
Laboratoire de Biometrie et Biologie Evolutive UMR 5558, Villeurbanne,
France
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Classifying patients into groups according to longitudinal series of
measurements (ie, trajectory classification) has become frequent in
clinical research. Most classification models suppose an equal intra-group
variance across groups. This assumption is sometimes inappropriate because
measurements in diseased subjects are often more heterogeneous than in
healthy ones. We developed a new classification model for trajectories
that uses unequal intra-group variance across groups and evaluated its
impact on classification using simulations and a clinical study. The
classification and typical trajectories were estimated using the
classification Expectation Maximization (EM) algorithm to maximize the
classification likelihood, the log-likelihood being profiled during the
Maximization (M) step of the algorithm. The simulations showed that
assuming equal intra-group variance resulted in a high misclassification
rate (up to 50%) when the real intra-group variances were different. This
rate was greatly reduced by allowing intra-group variances to be
different. Similar classification was obtained when the real intra-group
variances were equal, except when the total sample size and the number of
repeated measurements were small. In a randomized trial that compared the
effect of low vs standard cyclosporine A dose on creatinine levels after
cardiac transplantation, the classification model with unequal intra-group
variance led to more meaningful groups than with equal intra-group
variance and showed distinct benefits of low dose. In conclusion, we
recommend the use of a classification model for trajectories that allows
for unequal intra-group variance across groups except when the number of
repeated measurements and total sample size are small. Copyright
© 2018 John Wiley & Sons, Ltd.

<9>
Accession Number
619963102
Title
Comprehensive Cardiac CT With Myocardial Perfusion Imaging Versus
Functional Testing in Suspected Coronary Artery Disease: The Multicenter,
Randomized CRESCENT-II Trial.
Source
JACC: Cardiovascular Imaging. 11 (11) (pp 1625-1636), 2018. Date of
Publication: November 2018.
Author
Lubbers M.; Coenen A.; Kofflard M.; Bruning T.; Kietselaer B.; Galema T.;
Kock M.; Niezen A.; Das M.; van Gent M.; van den Bos E.-J.; van Woerkens
L.; Musters P.; Kooij S.; Nous F.; Budde R.; Hunink M.; Nieman K.
Institution
(Lubbers, Coenen, Galema, Musters, Nieman) Department of Cardiology,
Erasmus University Medical Center, Rotterdam, Netherlands
(Lubbers, Coenen, Nous, Budde, Hunink, Nieman) Department of Radiology,
Erasmus University Medical Center, Rotterdam, Netherlands
(Kofflard, van Gent, van den Bos, van Woerkens) Department of Cardiology,
Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands
(Bruning) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Kietselaer) Department of Cardiology, Maastricht University Medical
Center, Maastricht, Netherlands
(Kock, Kooij) Department of Radiology, Albert Schweitzer Ziekenhuis,
Dordrecht, Netherlands
(Niezen) Department of Radiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Das) Department of Radiology, Maastricht University Medical Center,
Maastricht, Netherlands
(Nieman) Stanford Cardiovascular Institute, Stanford University, Palo
Alto, CA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to assess the effectiveness, efficiency, and
safety of a tiered, comprehensive cardiac computed tomography (CT)
protocol in comparison with functional testing. Background(s):
Although CT angiography accurately rules out coronary artery disease
(CAD), incorporation of CT myocardial perfusion imaging as part of a
tiered diagnostic approach could improve the clinical value and efficiency
of cardiac CT in the diagnostic work-up of patients with angina pectoris.
 Method(s): Between July 2013 and November 2015, 268 patients (mean
age 58 years; 49% female) with stable angina (mean pre-test probability
54%) were prospectively randomized between cardiac CT and standard
guideline-directed functional testing (95% exercise electrocardiography).
The tiered cardiac CT protocol included a calcium scan, followed by CT
angiography if calcium was detected. Patients with >=50% stenosis on CT
angiography underwent CT myocardial perfusion imaging. Result(s): By
6 months, the primary endpoint, the rate of invasive coronary angiograms
without a European Society of Cardiology class I indication for
revascularization, was lower in the CT group than in the functional
testing group (2 of 130 [1.5%] vs. 10 of 138 [7.2%]; p = 0.035), whereas
the proportion of invasive angiograms with a revascularization indication
was higher (88% vs. 50%; p = 0.017). The median duration until the final
diagnosis was 0 (0 of 0) days in the CT group and 0 (0 of 17) in the
functional testing group (p < 0.001). Overall, 13% of patients randomized
to CT required further testing, compared with 37% in the functional
testing group (p < 0.001). The adverse event rate was similar (3% vs. 3%;
p = 1.000), although the median cumulative radiation dose was higher for
the CT group (3.1 mSv [interquartile range: 1.6 to 7.8] vs. 0 mSv
[interquartile range: 0.0 to 7.1]; p < 0.001). Conclusion(s): In
patients with suspected stable CAD, a tiered cardiac CT protocol with
dynamic perfusion imaging offers a fast and efficient alternative to
functional testing. (Comprehensive Cardiac CT Versus Exercise Testing in
Suspected Coronary Artery Disease 2 [CRESCENT2];
NCT02291484) Copyright © 2018 American College of Cardiology
Foundation

<10>
Accession Number
619963099
Title
Value of Myocardial Perfusion Assessment With Coronary Computed Tomography
Angiography in Patients With Recent Acute-Onset Chest Pain.
Source
JACC: Cardiovascular Imaging. 11 (11) (pp 1611-1621), 2018. Date of
Publication: November 2018.
Author
Sorgaard M.H.; Linde J.J.; Kuhl J.T.; Kelbaek H.; Hove J.D.; Fornitz G.G.;
Jorgensen T.B.S.; Heitmann M.; Kragelund C.; Hansen T.F.; Abdulla J.;
Engstrom T.; Jensen J.S.; Wiegandt Y.T.; Hofsten D.E.; Kober L.V.; Kofoed
K.F.
Institution
(Sorgaard, Linde, Engstrom, Wiegandt, Hofsten, Kober, Kofoed) Department
of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Kuhl, Heitmann) Department of Cardiology, Bispebjerg Hospital, University
of Copenhagen, Copenhagen, Denmark
(Kelbaek) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
(Hove) Department of Cardiology, Hvidovre Hospital, University of
Copenhagen, Copenhagen, Denmark
(Fornitz, Jorgensen) Department of Cardiology, Amager Hospital,
Copenhagen, University of Copenhagen, Copenhagen, Denmark
(Kragelund) Department of Cardiology, Herlev Hospital, University of
Copenhagen, Copenhagen, Denmark
(Hansen, Jensen) Department of Cardiology, Gentofte Hospital, University
of Copenhagen, Copenhagen, Denmark
(Abdulla) Department of Medicine, Division of Cardiology, Glostrup
Hospital, University of Copenhagen, Copenhagen, Denmark
(Kofoed) Department of Radiology, The Diagnostic Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors sought to perform a randomized controlled trial to
evaluate the clinical efficacy of combined examination with coronary
computed tomography angiography (CTA) and computed tomography perfusion
imaging (CTP) compared to coronary CTA alone. Background(s): Stress
myocardial CTP may increase diagnostic specificity when added to coronary
CTA in patients suspected of having ischemic heart disease.
 Method(s): Patients recently hospitalized for acute-onset chest pain,
who had acute coronary syndrome had been ruled out by normal
electrocardiograms, normal troponin levels, and relief of symptoms, and
who had a clinical indication for outpatient noninvasive testing, were
screened for inclusion in the CATCH-2 (CArdiac cT in the treatment of
acute CHest pain 2) trial (NCT02014311). Patients were randomized 1:1 to
examination with coronary CTA or coronary CTA+CTP. The primary endpoint
was the frequency of coronary revascularization among patients referred
for invasive coronary angiography (ICA) based on index computed tomography
evaluation. Secondary endpoints were invasive procedural complications at
index-related ICA, post-index cardiac death, hospital admittance because
of recurrence of chest pain, unstable angina pectoris, or acute myocardial
infarction, ICA, and revascularization. Result(s): Among 300 patients
allocated to the coronary CTA+CTP group, 41 (14%) were referred for ICA
compared with 89 (30%) allocated to coronary CTA (p < 0.0001). The primary
endpoint occurred in 50% of coronary CTA+CTP patients versus 48% of
invasively examined patients (p = 0.85). The total number of
revascularizations was significantly lower in the coronary CTA+CTP group
compared to the coronary CTA group (n = 20 [7%] vs. n = 42 [14%]; p =
0.0045). At median follow-up of 1.5 years, the occurrence of secondary
endpoints was similar in the 2 groups. Conclusion(s): A
post-discharge diagnostic strategy of coronary CTA+CTP safely reduces the
need for invasive examination and treatment in patients suspected of
having ischemic heart disease. (CArdiac cT in the treatment of acute CHest
pain 2-Myocardial CT Perfusion [CATCH2]; NCT02014311) Copyright ©
2018 American College of Cardiology Foundation

<11>
Accession Number
623683616
Title
Off-pump coronary artery bypass grafting: 30 years of debate.
Source
Journal of the American Heart Association. 7 (16) (no pagination), 2018.
Article Number: e009934. Date of Publication: 01 Aug 2018.
Author
Gaudino M.; Angelini G.D.; Antoniades C.; Bakaeen F.; Benedetto U.;
Calafiore A.M.; Franco A.D.; Mauro M.D.; Fremes S.E.; Girardi L.N.;
Glineur D.; Grau J.; He G.-W.; Patrono C.; Puskas J.D.; Ruel M.; Schwann
T.A.; Tam D.Y.; Tatoulis J.; Tranbaugh R.; Vallely M.; Zenati M.A.; Mack
M.; Taggart D.P.
Institution
(Gaudino, Franco, Girardi, Tranbaugh) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Angelini, Benedetto) Bristol Heart Institute, University of Bristol,
United Kingdom
(Antoniades, Taggart) University of Oxford, United Kingdom
(Bakaeen) Cleveland Clinic, Cleveland, OH, United States
(Calafiore) Cardiac Surgery, Pope John Paul II Foundation, Campobasso,
Italy
(Mauro) Cardiovascular Disease Institute, University of L'Aquila, Italy
(Fremes, Tam) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Canada
(Glineur, Grau) Division of Cardiac Surgery, Ottawa Heart Institute,
Ottawa, Canada
(He) TEDA International Cardiovascular Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Tianjin, China
(Patrono) Department of Pharmacology, Catholic University School of
Medicine, Rome, Italy
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York City, NY, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, Canada
(Schwann) University of Toledo College of Medicine, Toledo, OH, United
States
(Tatoulis) Department of Surgery, University of Melbourne, Parkville,
Australia
(Vallely) Sydney Medical School, The University of Sydney, Australia
(Zenati) Harvard Medical School, Boston, MA, United States
(Mack) The Heart Hospital Baylor Plano, Plano, TX, United States
Publisher
American Heart Association Inc.

<12>
Accession Number
619490713
Title
The ratio of circulating regulatory cluster of differentiation 4 T cells
to endothelial progenitor cells predicts clinically significant acute
rejection after heart transplantation.
Source
Journal of Heart and Lung Transplantation. 37 (4) (pp 496-502), 2018. Date
of Publication: April 2018.
Author
Choi D.-H.; Chmura S.A.; Ramachandran V.; Dionis-Petersen K.Y.; Kobayashi
Y.; Nishi T.; Luikart H.; Dimbil S.; Kobashigawa J.; Khush K.; Lewis D.B.;
Fearon W.F.
Institution
(Choi, Kobayashi, Nishi, Luikart, Khush, Fearon) Division of
Cardiovascular Medicine, Stanford University Medical Center, Stanford,
California, United States
(Choi) Department of Internal Medicine, Chosun University School of
Medicine, Gwangju, South Korea
(Chmura, Ramachandran, Dionis-Petersen, Lewis) Division of Allergy,
Immunology, and Rheumatology, Department of Pediatrics, Stanford
University School of Medicine, Stanford, California, United States
(Dimbil, Kobashigawa) Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, California, United States
Publisher
Elsevier USA
Abstract
Background: The aim of this study was to determine the value of the ratio
of the percentage of circulating regulatory cluster of differentiation 4 T
cells (%Tregs) to the percentage of endothelial progenitor cells (%EPCs;
Treg/EPC ratio) for predicting clinically significant acute rejection.
 Method(s): Peripheral blood %Tregs and %EPCs were quantified in 91
cardiac transplant recipients using flow cytometry at a mean of 42 +/- 13
days after transplant. The primary end point was clinically significant
acute rejection, defined as an event that led to an acute augmentation of
immunosuppression in conjunction with an International Society for Heart
and Lung Transplantation grade >= 2R in a right ventricular endomyocardial
biopsy specimen or non-cellular rejection (specimen-negative rejection)
with hemodynamic compromise (decrease in left ventricular ejection
fraction by > 25%). Result(s): Significant rejection occurred in 27
recipients (29.7%) during a median of 49.4 months (interquartile range,
37.0-62.0 months). The mean %Tregs and %EPCs were not significantly
different between those with and without an episode of significant
rejection, but the mean Treg/EPC ratio was significantly lower in
recipients with significant rejection (44.9 vs 106.7, p = 0.001). Receiver
operating characteristic curve analysis showed an area under the curve
value for significant rejection for a Treg/EPC ratio of 0.712. The best
cutoff value of the Treg/EPC ratio that distinguished between those with
or without significant rejection was <= 18 by receiver operating
characteristic curve analysis. Kaplan-Meier analysis revealed that
patients with a Treg/EPC ratio of <= 18 had a significantly higher rate of
rejection than those with a Treg/EPC ratio > 18 (61.5% vs 16.9%, log-rank
p < 0.0001). A low Treg/EPC ratio was an independent predictor of
significant rejection. Conclusion(s): A low Treg/EPC ratio measured
soon after heart transplantation is an independent predictor of acute
rejection. The Treg/EPC ratio has potential as an early biomarker after
heart transplantation for predicting acute rejection. Copyright ©
2018

<13>
Accession Number
2000856609
Title
Prospective Comparison of FFR Derived From Coronary CT Angiography With
SPECT Perfusion Imaging in Stable Coronary Artery Disease: The ReASSESS
Study.
Source
JACC: Cardiovascular Imaging. 11 (11) (pp 1640-1650), 2018. Date of
Publication: November 2018.
Author
Sand N.P.R.; Veien K.T.; Nielsen S.S.; Norgaard B.L.; Larsen P.; Johansen
A.; Hess S.; Deibjerg L.; Husain M.; Junker A.; Thomsen K.K.; Rohold A.;
Jensen L.O.
Institution
(Sand, Deibjerg, Husain, Thomsen, Rohold) Department of Cardiology,
Hospital of Southwest Denmark, Esbjerg, Denmark
(Sand) Institute of Regional Health Research, University of Southern
Denmark, Odense, Denmark
(Veien, Junker, Jensen) Department of Cardiology, Odense University
Hospital, Odense, Denmark
(Nielsen) Department of Nuclear Medicine, Aalborg University Hospital,
Aalborg, Denmark
(Norgaard) Department of Cardiology, Aarhus University Hospital, Skejby,
Aarhus, Denmark
(Larsen) Department of Epidemiology, Biostatistics and Bioinformatics,
University of Southern Denmark, Odense, Denmark
(Johansen) Department of Nuclear Medicine, Odense University Hospital,
Odense, Denmark
(Hess) Department of Radiology and Nuclear Medicine, Hospital of Southwest
Denmark, Esbjerg, Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to compare the per-patient diagnostic
performance of coronary computed tomography angiography (CTA)-derived
fractional flow reserve (FFR<inf>CT</inf>) with that of single-photon
emission computed tomography (SPECT), using a fractional flow reserve
(FFR) value of <=0.80 as the reference for diagnosing at least 1
hemodynamically significant stenosis in a head-to-head comparison of
patients with intermediate coronary stenosis as determined by coronary
CTA. Background(s): No previous study has prospectively compared the
diagnostic performance of FFR<inf>CT</inf> and myocardial perfusion
imaging by SPECT in symptomatic patients with intermediate range coronary
artery disease (CAD). Method(s): This study was conducted at a
single-center as a prospective study in patients with stable angina
pectoris (N = 143). FFR<inf>CT</inf> and SPECT analyses were performed by
core laboratories and were blinded for the personnel responsible for
downstream patient management. FFR<inf>CT</inf> <=0.80 distally in at
least 1 coronary artery with a diameter >=2 mm classified patients as
having ischemia. Ischemia by SPECT was encountered if a reversible
perfusion defect (summed difference score >=2) or transitory ischemic
dilation of the left ventricle (ratio >1.19) were found. Result(s):
The per-patient diagnostic performance for identifying ischemia (95%
confidence interval [CI]), FFR<inf>CT</inf> versus SPECT, were sensitivity
of 91% (95% CI: 81% to 97%) versus 41% (95% CI: 29% to 55%; p < 0.001);
specificity of 55% (95% CI: 44% to 66%) versus 86% (95% CI: 77% to 93%; p
< 0.001); negative predictive value of 90% (95% CI: 82% to 98%) versus 68%
(95% CI: 59% to 77%; p = 0.001); positive predictive value of 58% (95% CI:
48% to 68%) versus 67% (95% CI: 51% to 82%; p = NS); and accuracy of 70%
(95% CI: 62% to 77%) versus 68% (95% CI: 60% to 75%; p = NS) respectively.
 Conclusion(s): In patients with stable chest pain and CAD as
determined by coronary CTA, the overall diagnostic accuracy levels of
FFR<inf>CT</inf> and SPECT were identical in assessing hemodynamically
significant stenosis. However, FFR<inf>CT</inf> demonstrated a
significantly higher diagnostic sensitivity than SPECT. Copyright
© 2018 The Authors

<14>
Accession Number
2001054350
Title
Comparison of International Guidelines for Assessment of Suspected Stable
Angina: Insights From the PROMISE and SCOT-HEART.
Source
JACC: Cardiovascular Imaging. 11 (9) (pp 1301-1310), 2018. Date of
Publication: September 2018.
Author
Adamson P.D.; Newby D.E.; Hill C.L.; Coles A.; Douglas P.S.; Fordyce C.B.
Institution
(Adamson, Newby) British Heart Foundation Centre for Cardiovascular
Science, University of Edinburgh, Edinburgh, United Kingdom
(Hill, Coles, Douglas) Duke Clinical Research Institute, Duke University
School of Medicine, Durham, North Carolina, United States
(Fordyce) Division of Cardiology, University of British Columbia,
Vancouver, British Columbia, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to compare the performance of major
guidelines for the assessment of stable chest pain including risk-based
(American College of Cardiology/American Heart Association and European
Society of Cardiology) and symptom-focused (National Institute for Health
and Care Excellence) strategies. Background(s): Although noninvasive
testing is not recommended in low-risk individuals with stable chest pain,
guidelines recommend differing approaches to defining low-risk patients.
 Method(s): Patient-level data were obtained from the PROMISE
(Prospective Multicenter Imaging Study for Evaluation of Chest Pain) and
SCOT-HEART (Scottish Computed Tomography of the Heart) trials. Pre-test
probability was determined and patients dichotomized into low-risk and
intermediate-high-risk groups according to each guideline's definitions.
The primary endpoint was obstructive coronary artery disease on coronary
computed tomography angiography. Secondary endpoints were coronary
revascularization at 90 days and cardiovascular death or nonfatal
myocardial infarction up to 3 years. Result(s): In total, 13,773
patients were included of whom 6,160 had coronary computed tomography
angiography. The proportions of patients identified as low risk by the
American College of Cardiology/American Heart Association, European
Society of Cardiology, and National Institute for Health and Care
Excellence guidelines, respectively, were 2.5%, 2.5%, and 10.0% within
PROMISE, and 14.0%, 19.8%, and 38.4% within SCOT-HEART. All guidelines
identified lower rates of obstructive coronary artery disease in low-
versus intermediate-high-risk patients with a negative predictive value of
>=0.90. Compared with low-risk groups, all intermediate-high-risk groups
had greater risks of coronary revascularization (odds ratio [OR]: 2.2 to
24.1) and clinical outcomes (OR: 1.84 to 5.8). Conclusion(s):
Compared with risk-based guidelines, symptom-focused assessment identifies
a larger group of low-risk chest pain patients potentially deriving
limited benefit from noninvasive testing. (Scottish Computed Tomography of
the Heart Trial [SCOT-HEART]; NCT01149590; Prospective Multicenter Imaging
Study for Evaluation of Chest Pain [PROMISE]; NCT01174550) Copyright
© 2018 The Authors

<15>
Accession Number
629893607
Title
Tafamidis: A First-in-Class Transthyretin Stabilizer for Transthyretin
Amyloid Cardiomyopathy.
Source
The Annals of pharmacotherapy. (pp 1060028019888489), 2019. Date of
Publication: 18 Nov 2019.
Author
Park J.; Egolum U.; Parker S.; Andrews E.; Ombengi D.; Ling H.
Institution
(Park, Ling) Philadelphia College of Osteopathic Medicine, Suwanee, United
States
(Egolum) Heart Center of Northeast Georgia Medical Center, Gainesville,
United States
(Parker, Andrews) Hampton University, VA, Hampton, United States
(Ombengi) Medical College of Wisconsin, WI, Milwaukee, United States
Publisher
NLM (Medline)
Abstract
Objective: To review the pharmacology, efficacy, and safety of the
selective transthyretin inhibitor tafamidis for transthyretin amyloid
cardiomyopathy (ATTR-CM). Data Sources: A PubMed (1966 to October
2019) and ClinicalTrials. gov search was conducted using the keywords
tafamidis, Fx-1006A, Vyndaqel, and Vyndamax. Additional articles were
identified from references. Study Selection and Data Extraction: We
included English-language clinical studies evaluating the pharmacology,
efficacy, or safety of tafamidis in humans for ATTR-CM. Data
Synthesis: Tafamidis binds to the thyroxine-binding sites of the
transthyretin tetramer and inhibits its dissociation into monomers, which
is the rate-limiting step in the amyloidogenic process. Treatment with
tafamidis was significantly associated with a significant reduction in
mortality, lowered cardiovascular-related hospitalizations, less
functional decline, and improved transthyretin stabilization compared with
placebo. Additionally, tafamidis was found to have fewer adverse events,
with no difference found compared with placebo. Relevance to Patient Care
and Clinical Practice: Historically, symptomatic management for ATTR-CM
was the only option, and the treatment of the underlying disease was
limited to liver or heart transplantation. Tafamidis is the first
medication approved for the treatment of ATTR-CM and the only medication
that showed a reduction in all-cause mortality and cardiovascular-related
hospitalizations in patients with amyloidosis. However, the role of
tafamidis in patients with the New York Heart Association class III/IV
heart failure or mutated transthyretin remains unclear.
 Conclusion(s): Tafamidis is an effective and safe oral medication for
the treatment of the cardiomyopathy of transthyretin-mediated amyloidosis
in adults to reduce cardiovascular mortality and cardiovascular-related
hospitalization.

<16>
Accession Number
629883996
Title
Effectiveness of Incentive Spirometry on Inspiratory Muscle Strength After
Coronary Artery Bypass Graft Surgery.
Source
Heart, lung & circulation. (no pagination), 2019. Date of Publication: 24
Oct 2019.
Author
Manapunsopee S.; Thanakiatpinyo T.; Wongkornrat W.; Chuaychoo B.;
Thirapatarapong W.
Institution
(Manapunsopee, Thanakiatpinyo) Department of Rehabilitation Medicine,
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
(Wongkornrat) Cardiothoracic Division, Department of Surgery, Faculty of
Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Chuaychoo) Division of Respiratory Diseases and Tuberculosis, Department
of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
(Thirapatarapong) Department of Rehabilitation Medicine, Faculty of
Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although the use of incentive spirometry with a deep breathing
exercise (DBE) is widely used in clinical practice in patients who have
undergone coronary artery bypass graft (CABG) surgery, the effect of this
combination therapy has not been conclusively elucidated. The aim of this
study was to investigate the effect of postoperative combined incentive
spirometry and DBE versus DBE alone on inspiratory muscle strength
following CABG. METHOD(S): This randomised clinical trial was
conducted in patients scheduled to undergo CABG surgery at Siriraj
Hospital, Bangkok Thailand. The study group received incentive spirometry
and DBE, and the control group received DBE only. Maximal inspiratory
pressure (MIP) before surgery and at day 4 after surgery was assessed by a
respiratory pressure metre. Secondary outcomes, including postoperative
pulmonary complication and duration of postoperative hospitalisation, were
obtained from the medical records. RESULT(S): Ninety (90) patients
were included, with 47 and 43 patients assigned to the study and control
groups, respectively. In both groups, there was a significant reduction in
MIP from preoperative baseline to postoperative day 4; however, the MIP in
the incentive spirometry group had a significantly smaller reduction in
MIP compared with the control group (33.0+/-23.2% vs 47.2+/-20.1%,
respectively; p=0.006, 95% confidence interval, 3.9-23.3). There was no
difference between groups regarding secondary outcomes.
 CONCLUSION(S): Patients in the study group had significantly better
recovery of inspiratory muscle strength on day 4 post-CABG than patients
in the control group. There was no significant difference between groups
for either postoperative pulmonary complications or length of hospital
stay. Copyright © 2019 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights
reserved.

<17>
Accession Number
629883525
Title
Usefulness of Discharge Resting Heart Rate to Predict Adverse
Cardiovascular Outcomes in Patients With Left Main Coronary Artery Disease
Revascularized With Percutaneous Coronary Intervention vs Coronary Artery
Bypass Grafting (from the EXCEL Trial).
Source
The American journal of cardiology. (no pagination), 2019. Date of
Publication: 26 Oct 2019.
Author
Kosmidou I.; Crowley A.; Macedo L.; Ben-Yehuda O.; Gersh B.J.; Boonstra
P.W.; Kappetein A.P.; Serruys P.W.; Sabik J.F.; Stone G.W.
Institution
(Kosmidou, Ben-Yehuda) Clinical Trials Center, Cardiovascular Research
Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, New York
(Crowley, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, NY
(Macedo) NewYork-Presbyterian Hospital/Columbia University Medical Center,
NY
(Gersh) Department of Cardiovascular Medicine, Mayo Clinic College of
Medicine, Rochester, MN
(Boonstra) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
Publisher
NLM (Medline)
Abstract
The prognostic impact of resting heart rate (RHR) following
revascularization with percutaneous coronary intervention (PCI) or
coronary artery bypass grafting (CABG) in patients with left main coronary
artery disease (LMCAD) is unknown. We aimed to assess the effect of RHR at
discharge on 3-year cardiovascular outcomes following PCI and CABG for
LMCAD. In the EXCEL trial, 1,905 patients with LMCAD were randomized to
PCI with everolimus-eluting stents versus CABG. RHR was measured at
discharge following the index hospitalization. The principal outcome
measure was the composite endpoint of death, myocardial infarction (MI) or
stroke at 3 years. Among 1,303 patients in sinus rhythm with available
ECGs, the median (IQR) discharge RHR was 72 (62to 81) bpm. Median
discharge RHR was higher after CABG versus PCI (78 [IQR 70 to 86] versus
65 [IQR 59 to 74] bpm, p <0.0001). At 3 years, 107 patients (8.2%) had a
primary composite endpoint event including 61 patients (4.7%) who died. By
multivariable analysis, discharge RHR assessed as a continuous variable
(per 5 bpm) was an independent predictor at 3 years of the primary
composite endpoint of death, MI, or stroke (hazard ratio [HR] 1.15, 95%
confidence interval [CI] 1.06 to 1.25, p=0.0006); the secondary composite
endpoint of death, MI, stroke, or ischemia-driven revascularization at 3
years (HR 1.12, 95% CI 1.05 to 1.19, p=0.0007); all-cause mortality (HR
1.18, 95% CI 1.07 to 1.31, p=0.002); and cardiovascular death (HR 1.16,
95% CI 1.00 to 1.33, p=0.046). No significant interactions were present
between RHR and treatment with PCI versus CABG for the primary (pint=0.20)
or secondary (pint=0.47) composite endpoints. In patients with LMCAD
undergoing revascularization, an increased RHR at discharge was associated
with a higher risk for adverse cardiovascular outcomes at 3 years,
irrespective of treatment modality. Copyright © 2019 Elsevier
Inc. All rights reserved.

<18>
Accession Number
629883180
Title
Aorto-cardiac fistula etiology, presentation, and management: A systematic
review.
Source
Heart & lung : the journal of critical care. (no pagination), 2019. Date
of Publication: 15 Nov 2019.
Author
Foster T.J.; Amin A.H.; Busu T.; Patel K.; Farjo P.; Hallak A.A.; Ali N.;
Alkhouli M.
Institution
(Foster, Busu, Patel, Farjo) Division of Cardiovascular Disease, West
Virginia University, 1 Medical Drive, Morgantown, United States
(Amin) Section of Cardiology, Carilion Clinic, Virginia Tech-Carilion
School of Medicine, 2 Riverside Circle, Roanoke, United States
(Hallak) West Virginia University Health Science Center, 1 Medical Drive,
Morgantown, United States
(Ali) Department of Pediatrics, Carilion Clinic, Virginia Tech-Carilion
School of Medicine, 2 Riverside Circle, Roanoke, United States
(Alkhouli) Division of Cardiovascular Disease, West Virginia University, 1
Medical Drive, Morgantown, WV 26505, USA; Department of Cardiovascular
Diseases, Mayo Clinic School of Medicine, Rochester, MN
Publisher
NLM (Medline)
Abstract
BACKGROUND: Aorto-cardiac fistulae are a rare but increasingly reported
entity, and data are scarce. METHOD(S): The authors performed a
systematic review of ACFs to characterize the underlying etiology,
clinical presentation, and compare outcomes of treatment strategies.
 RESULT(S): 3,733 publications were identified in the search. Of
those, 292 studies including 300 patients were included. Etiology of ACFs
was 38% iatrogenic, 25% infectious, 14% traumatic, and 15% due to other
causes. Most patients (74%) presented with heart failure. Common locations
were aortic-right atrium (37%), and aortic-pulmonary artery (25%). The
majority of patients (71%) were treated surgically, while 13% were treated
percutaneously, and 16% were treated conservatively. Patients who were
managed conservatively had a higher mortality than those treated with
invasive closure (53% vs. 12% vs. 3%, p = <0.00001). CONCLUSION(S):
This systematic review sheds light on this highly morbid condition. Once
recognized, fistula closure appears to be superior to conservative
management. Copyright © 2019 Elsevier Inc. All rights reserved.

<19>
Accession Number
629217733
Title
Minimal access versus sternotomy for complex mitral valve repair: A
meta-analysis.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 31 Aug 2019.
Author
Moscarelli M.; Fattouch K.; Gaudino M.; Nasso G.; Paparella D.; Punjabi
P.; Athanasiou T.; Benedetto U.; Angelini G.D.; Santarpino G.; Speziale G.
Institution
(Moscarelli, Fattouch, Nasso, Paparella, Santarpino, Speziale) GVM Care &
Research, Department of Cardiovascular Surgery, Italy
(Gaudino) Department of Cardio-Thoracic Surgery Weill Cornell Medicine New
York City, NY, United States
(Punjabi, Athanasiou) Imperial College of London, Hammersmith Hospital,
London, United Kingdom
(Benedetto, Angelini) Bristol Heart Institute, University of Bristol,
United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is high demand for minimally invasive mitral valve
repair; however, it is unclear whether the minimally invasive approach
provides the same performance of conventional sternotomy in a context of
complex mitral valve disease. Here, we compared outcomes of minimally
invasive and sternotomy procedures for bileaflet and Barlow's mitral valve
disease. METHOD(S): We performed a pooled meta-analysis of studies
reporting early and late follow-up of mitral valve repair for complex
mitral valve regurgitation (MR). The primary outcome was moderate MR
recurrence and need for re-operation. Secondary outcomes included:
operation time, reopening for bleeding, associated tricuspid procedures,
failed repair, and in-hospital mortality. Incidence rates (IRs) were
calculated for long-term follow-up. Effect estimates were calculated as
IRs with 95% confidence intervals. When Kaplan-Meier curves were
available, event rates were estimated from the curves with Plot Digitizer
software; otherwise, reported event rates were used to calculate IRs.
 RESULT(S): Eighteen studies including 1905 patients (654 minimally
invasive and 1251 sternotomy) with a mean follow-up of 51.6 months (range,
14-138 months) were meta-analyzed with a random model. There were no
significant between-group differences in moderate MR recurrence and
re-operation (minimally invasive vs. sternotomy, 1.7%, [1.0-2.9%] vs. 1.3%
[0.9-1.8%], p = 0.22). Patients in the minimally invasive group were
exposed to significantly longer cross clamp and cardiopulmonary bypass
times (p < 0.01); however, there were no additional between-group
differences in secondary outcomes. CONCLUSION(S): This is the first
meta-analysis to demonstrate that minimally invasive and sternotomy
approaches produce comparable results for complex mitral valve
repair. Copyright © 2019. Published by Elsevier Inc.

<20>
Accession Number
629818824
Title
Del Nido cardioplegia in isolated adult coronary artery bypass surgery.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination), 2019.
Date of Publication: 24 Sep 2019.
Author
Timek T.A.; Beute T.; Robinson J.A.; Zalizadeh D.; Mater R.; Parker J.L.;
Lypka M.; Willekes C.L.
Institution
(Timek, Willekes) Division of Cardiothoracic Surgery, Spectrum Health,
Grand Rapids, Mich; Michigan State University College of Human Medicine,
Grand Rapids, Mich
(Beute, Robinson, Zalizadeh, Mater) Michigan State University College of
Human Medicine, Grand Rapids, Mich
(Parker, Lypka) Office of Research, Spectrum Health, Grand Rapids, Mich
Publisher
NLM (Medline)
Abstract
BACKGROUND: Del Nido cardioplegia (DC) offers prolonged single-dose
myocardial protection in pediatric cardiac surgery. We set out to evaluate
the efficacy of DC in adult patients undergoing isolated coronary artery
bypass grafting (CABG). METHOD(S): From January 2014 to October 2017,
851 consecutive isolated CABG surgeries were performed by 2 study surgeons
at our center with blood cardioplegia (BC, n = 350), used from January
2012 to April 2014, and DC (n = 501), used from May 2014 to October 2017.
Propensity matching was used to yield 325 well-matched pairs. Clinical
data were extracted from our local Society of Thoracic Surgeons database
and mortality data from the Michigan State Social Security Death Index.
 RESULT(S): Single-dose administration was used in 83% (417/501) of
patients receiving DC. In propensity-matched groups, postoperative median
troponin T levels (0.28 [0.16-0.59] ng/mL vs 0.46 [0.27-0.81] ng/mL; P <
.01) were lower for patients receiving DC, and no difference in ejection
fraction on postoperative echocardiography was observed (54 +/- 12% and 53
+/- 13% for BC and DC, respectively; P = .36). Perioperative outcomes were
similar except for greater rate of atrial fibrillation (33% vs 23%; P =
.01) in the DC group. Subgroup analyses revealed equivalent myocardial
protection and clinical outcomes in patients with age >=75 years, left
ventricular ejection fraction <=35%, left main disease, or Society of
Thoracic Surgeons score >=2.5%. Four-year survival did not differ between
patients undergoing BC or DC. CONCLUSION(S): The current study
revealed noninferior myocardial protection and clinical outcomes with DC
versus BC in both routine and greater-risk patients undergoing isolated
CABG. DC demonstrated the feasibility of single-dose administration for
isolated CABG surgery. Larger randomized studies are needed to further
explore the safety and efficacy of DC in adult cardiac surgery with longer
crossclamp times. Copyright © 2019 The American Association for
Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

<21>
Accession Number
629869224
Title
Patient blood management (PBM) in pregnancy and childbirth: literature
review and expert opinion.
Source
Archives of gynecology and obstetrics. (no pagination), 2019. Date of
Publication: 14 Nov 2019.
Author
Surbek D.; Vial Y.; Girard T.; Breymann C.; Bencaiova G.A.; Baud D.;
Hornung R.; Taleghani B.M.; Hosli I.
Institution
(Surbek) Department of Obstetrics and Gynaecology, Bern University
Hospital, Insel Hospital, University of Bern, Bern 3010, Switzerland
(Vial, Baud) Service of Obstetrics, Department Woman-Mother-Child,
University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne,
Switzerland
(Girard) Department of Anaesthesiology, University Hospital Basel, Basel,
Switzerland
(Breymann) Obstetric Research-Feto Maternal Haematology Unit, University
Hospital Zurich, Zurich, Switzerland
(Bencaiova, Hosli) Clinic of Obstetrics and Gynaecology, University
Hospital Basel, Basel, Switzerland
(Hornung) Department of Obstetrics and Gynaecology, St. Gallen Cantonal
Hospital, St. Gallen, Switzerland
(Taleghani) Department of Haematology, Inselspital, University and
University Hospital Bern, Bern, Switzerland
Publisher
NLM (Medline)
Abstract
PURPOSE: Patient blood management [PBM] has been acknowledged and
successfully introduced in a wide range of medical specialities, where
blood transfusions are an important issue, including anaesthesiology,
orthopaedic surgery, cardiac surgery, or traumatology. Although pregnancy
and obstetrics have been recognized as a major field of potential
haemorrhage and necessity of blood transfusions, there is still little
awareness among obstetricians regarding the importance of PBM in this
area. This review, therefore, summarizes the importance of PBM in
obstetrics and the current evidence on this topic. METHOD(S): We
review the current literature and summarize the current evidence of PBM in
pregnant women and postpartum with a focus on postpartum haemorrhage (PPH)
using PubMed as literature source. The literature was reviewed and
analysed and conclusions were made by the Swiss PBM in obstetrics working
group of experts in a consensus meeting. RESULT(S): PBM comprises a
series of measures to maintain an adequate haemoglobin level, improve
haemostasis and reduce bleeding, aiming to improve patient outcomes.
Despite the fact that the WHO has recommended PBM early 2010, the majority
of hospitals are in need of guidelines to apply PBM in daily practice. PBM
demonstrated a reduction in morbidity, mortality, and costs for patients
undergoing surgery or medical interventions with a high bleeding
potential. All pregnant women have a significant risk for PPH. Risk
factors do exist; however, 60% of women who experience PPH do not have a
pre-existing risk factor. Patient blood management in obstetrics must,
therefore, not only be focused on women with identified risk factor for
PPH, but on all pregnant women. Due to the risk of PPH, which is inherent
to every pregnancy, PBM is of particular importance in obstetrics.
Although so far, there is no clear guideline how to implement PBM in
obstetrics, there are some simple, effective measures to reduce anaemia
and the necessity of transfusions in women giving birth and thereby
improving clinical outcome and avoiding complications. CONCLUSION(S):
PBM in obstetrics is based on three main pillars: diagnostic and/or
therapeutic interventions during pregnancy, during delivery and in the
postpartum phase. These three main pillars should be kept in mind by all
professionals taking care of pregnant women, including obstetricians,
general practitioners, midwifes, and anaesthesiologists, to improve
pregnancy outcome and optimize resources.

<22>
Accession Number
625025656
Title
The Effect of Interactive Therapeutic Play Education Program on Anxiety
Levels of Children Undergoing Cardiac Surgery and Their Mothers.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. 33 (6) (pp 781-789), 2018. Date of
Publication: 01 Dec 2018.
Author
Coskunturk A.E.; Gozen D.
Publisher
NLM (Medline)
Abstract
PURPOSE: This study was conducted to determine the effect of Interactive
Therapeutic Play Education Program applied in preparing pediatric cardiac
patients for surgery on the postoperative anxiety levels of such children
and their mothers. DESIGN: This was a randomized controlled experimental
trial. METHOD(S): The study was conducted on children aged 6 to 12
years, who underwent surgery for congenital heart disease, and their
mothers (N = 43). FINDINGS: Anxiety levels of the children and their
mothers were similar in the preoperative period, whereas postoperative
anxiety levels were lower in the experimental group than in the control
group (P < .05). CONCLUSION(S): As a result of this study it was
determined that education provided using therapeutic play to preoperative
patients aged 6 to 12 years to undergo surgery reduced the anxiety levels
of children and their mothers in the postoperative period. Copyright
© 2017 American Society of PeriAnesthesia Nurses. Published by
Elsevier Inc. All rights reserved.

<23>
Accession Number
2003851436
Title
Timing of Staged Nonculprit Artery Revascularization in Patients With
ST-Segment Elevation Myocardial Infarction: COMPLETE Trial.
Source
Journal of the American College of Cardiology. 74 (22) (pp 2713-2723),
2019. Date of Publication: 3 December 2019.
Author
Wood D.A.; Cairns J.A.; Wang J.; Mehran R.; Storey R.F.; Nguyen H.; Meeks
B.; Kunadian V.; Tanguay J.-F.; Kim H.-H.; Cheema A.; Deghani P.;
Natarajan M.K.; Jolly S.S.; Amerena J.; Keltai M.; James S.; Hlinomaz O.;
Niemela K.; AlHabib K.; Lewis B.S.; Nguyen M.; Sarma J.; Dzavik V.; Della
Siega A.; Mehta S.R.
Institution
(Wood, Cairns) Centre for Cardiovascular Innovation, St. Paul's and
Vancouver General Hospitals, University of British Columbia, Vancouver,
British Columbia, Canada
(Wang, Nguyen, Meeks, Natarajan, Jolly, Mehta) Population Health Research
Institute, McMaster University and Hamilton Health Sciences, Hamilton,
Ontario, Canada
(Mehran) The Zena A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Kunadian) Institute of Cellular Medicine, Faculty of Medical Sciences,
Newcastle University and Cardiothoracic Centre, Freeman Hospital,
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne,
United Kingdom
(Tanguay) Montreal Heart Institute and Universite de Montreal, Montreal,
Quebec, Canada
(Kim) St Mary's General Hospital, Kitchener, Ontario, Canada
(Cheema) St. Michael's Hospital, Toronto, Ontario, Canada
(Deghani) Prairie Vascular Research Network, University of Saskatchewan,
Regina, Saskatchewan, Canada
(Amerena) Kardinia House, Geelong, Victoria, Australia
(Keltai) Hungarian Institute of Cardiology, Budapest, Hungary
(James) Uppsala Clinical Research Centre and Department of Medical
Sciences, Uppsala, Sweden
(Hlinomaz) University Hospital St Anne, Brno, Czechia
(Niemela) Heart Centre, Tampere University Hospital, Tampere, Finland
(AlHabib) Department of Cardiac Services, King Fahad Cardiac Center, Saudi
Arabia
(Lewis) Cardiovascular Clinical Research Institute, Lady Davis Carmel
Medical Center, Haifa, Israel
(Nguyen) Division of Cardiology, Centre Hospitalier, Universitaire de
Sherbrooke, Quebec, Quebec, Canada
(Sarma) North West Heart Centre, Wythenshawe Hospital, Manchester, United
Kingdom
(Dzavik) Peter Munk Cardiac Centre, University Health Network, Toronto,
Ontario, Canada
(Della Siega) Department of Cardiac Services, Victoria Heart Institute
Foundation, Victoria, British Columbia, Canada
Publisher
Elsevier USA
Abstract
Background: The COMPLETE (Complete vs Culprit-only Revascularization to
Treat Multi-vessel Disease After Early PCI for STEMI) trial demonstrated
that staged nonculprit lesion percutaneous coronary intervention (PCI)
reduced major cardiovascular (CV) events in patients with ST-segment
elevation myocardial infarction (STEMI) and multivessel coronary artery
disease (CAD). Objective(s): The purpose of this study was to
determine the effect of nonculprit-lesion PCI timing on major CV outcomes
and also the time course of the benefit of complete revascularization.
 Method(s): Following culprit-lesion PCI, 4,041 patients with STEMI
and multivessel CAD were randomized to staged nonculprit-lesion PCI or
culprit-lesion only PCI. Randomization was stratified according to
investigator-planned timing of nonculprit-lesion PCI: during or after the
index hospitalization. The first coprimary outcome was the composite of CV
death or myocardial infarction (MI). In pre-specified analyses, hazard
ratios (HRs) were calculated for each time stratum. Landmark analyses of
the entire population were performed within 45 days and after 45 days.
 Result(s): For nonculprit-lesion PCI planned during the index
hospitalization (actual time: median 1 day), CV death or MI was reduced
with complete revascularization compared with culprit-lesion only PCI (HR:
0.77; 95% confidence interval [CI]: 0.59 to 1.00). For nonculprit lesion
PCI planned to occur after hospital discharge (actual time: median 23
days), CV death or MI was also reduced with complete revascularization
(HR: 0.69; 95% CI: 0.49 to 0.97; interaction p = 0.62). Landmark analyses
demonstrated an HR of 0.86 (95% CI: 0.59 to 1.24) during the first 45 days
and 0.69 (95% CI: 0.54 to 0.89) from 45 days to the end of follow-up for
intended nonculprit lesion PCI versus culprit lesion only PCI.
 Conclusion(s): Among STEMI patients with multivessel disease, the
benefit of complete revascularization over culprit-lesion only PCI was
consistent irrespective of the investigator-determined timing of
nonculprit-lesion intervention. The benefit of complete revascularization
on hard clinical outcomes emerged mainly over the long term. Copyright
© 2019 American College of Cardiology Foundation

<24>
Accession Number
2003605182
Title
Prevalence and Impact of Treatment Crossover in Cardiac Surgery Randomized
Trials: A Meta-Epidemiologic Study.
Source
Journal of the American Heart Association. 8 (21) (no pagination), 2019.
Article Number: e013711. Date of Publication: 05 Nov 2019.
Author
Gaudino M.; Fremes S.E.; Ruel M.; Di Franco A.; Di Mauro M.; Chikwe J.;
Frati G.; Girardi L.N.; Taggart D.P.; Biondi-Zoccai G.
Institution
(Gaudino, Di Franco, Girardi) Department of Cardiothoracic Surgery, Weill
Cornell Medicine, New York, NY, United States
(Fremes) Schulich Heart Centre, Division of Cardiac Surgery, Department of
Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON,
Canada
(Ruel) University of Ottawa Heart Institute, University of Ottawa, ON,
Canada
(Di Mauro) Heart Department, SS Annunziata Hospital, Chieti, Italy
(Chikwe) Department of Cardiothoracic Surgery, Stony Brook School of
Medicine, New York, NY, United States
(Chikwe) Department of Cardiothoracic Surgery, Mount Sinai Hospital, New
York, NY, United States
(Frati, Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Frati) Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.)
Neuromed, Pozzilli, Italy
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
United Kingdom
(Biondi-Zoccai) Mediterranea Cardiocentro, Napoli, Italy
Publisher
American Heart Association Inc.
Abstract
Background: Crossover dilutes treatment effect and reduces statistical
power of intention-to-treat analysis. We examined incidence and impact on
cardiac surgery randomized controlled trial (RCT) outcomes of crossover
from experimental to control interventions, or vice versa. Methods
and Results: MEDLINE, EMBASE, and Cochrane Library were searched, and RCTs
(>=100 patients) comparing >=2 adult cardiac surgical interventions were
included. Crossover from the initial treatment assignment and relative
risks (RRs) for each trial's primary end point and mortality at longest
available follow-up were extracted. All RRs were calculated as >1 favored
control group and <1 favored experimental arm. Primary outcome was the
effect estimate for primary end point of each RCT, and secondary outcome
was all-cause mortality; both were appraised as RR at the longest
follow-up available. Sixty articles reporting on 47 RCTs (25 440 patients)
were identified. Median crossover rate from experimental to control group
was 7.0% (first quartile, 2.0%; third quartile, 9.7%), whereas from
control to experimental group, the rate was 1.3% (first quartile, 0%;
third quartile, 3.6%). RRs for primary end point and mortality were higher
in RCTs with higher crossover rate from experimental to control group (RR,
1.01 [95% CI, 0.94-1.07] versus RR, 0.80 [95% CI, 0.66-0.97] and RR, 1.02
[95% CI, 0.95-1.11] versus RR, 0.94 [95% CI, 0.82-1.07], respectively).
Crossover from control to experimental group did not alter effect
estimates for primary end point or mortality (RR, 0.82 [95% CI, 0.63-1.05]
versus RR, 0.95 [95% CI, 0.86-1.04] and RR, 0.88 [95% CI, 0.73-1.07]
versus RR, 1.02 [95% CI, 0.95-1.09], respectively). Conclusion(s):
Crossover from experimental to control group is associated with outcomes
of cardiac surgery RCTs. Crossover should be minimized at designing stage
and carefully appraised after study completion. Copyright © 2019
The Authors. Published on behalf of the American Heart Association, Inc.,
by Wiley.

<25>
Accession Number
629882397
Title
Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis.
Source
The New England journal of medicine. 382 (2) (no pagination), 2020. Date
of Publication: 09 Jan 2020.
Author
Kang D.-H.; Park S.-J.; Lee S.-A.; Lee S.; Kim D.-H.; Kim H.-K.; Yun
S.-C.; Hong G.-R.; Song J.-M.; Chung C.-H.; Song J.-K.; Lee J.-W.; Park
S.-W.
Institution
(Kang, Park, Lee, Lee, Kim, Kim, Yun, Hong, Song, Chung, Song, Lee, Park)
From the Division of Cardiology (D.-H. Kang, S.L., J.-K.S.) and the
Departments of Cardiothoracic Surgery (C.-H.C., J.-W.L.) and Biostatistics
(S.-C.Y.), Asan Medical Center, College of Medicine, University of Ulsan,
Samsung Medical Center, Sungkyunkwan University School of Medicine
(S.-J.P., Division of Cardiology, Severance Hospital (G.-R.H.), the
Cardiovascular Center, Seoul National University Hospital (H.-K.K.) - all
in Seoul, S.-A.L, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: The timing and indications for surgical intervention in
asymptomatic patients with severe aortic stenosis remain controversial.
 METHOD(S): In a multicenter trial, we randomly assigned 145
asymptomatic patients with very severe aortic stenosis (defined as an
aortic-valve area of <=0.75 cm2 with either an aortic jet velocity of
>=4.5 m per second or a mean transaortic gradient of >=50 mm Hg) to early
surgery or to conservative care according to the recommendations of
current guidelines. The primary end point was a composite of death during
or within 30 days after surgery (often called operative mortality) or
death from cardiovascular causes during the entire follow-up period. The
major secondary end point was death from any cause during follow-up.
 RESULT(S): In the early-surgery group, 69 of 73 patients (95%)
underwent surgery within 2 months after randomization, and there was no
operative mortality. In an intention-to-treat analysis, a primary
end-point event occurred in 1 patient in the early-surgery group (1%) and
in 11 of 72 patients in the conservative-care group (15%) (hazard ratio,
0.09; 95% confidence interval [CI], 0.01 to 0.67; P=0.003). Death from any
cause occurred in 5 patients in the early-surgery group (7%) and in 15
patients in the conservative-care group (21%) (hazard ratio, 0.33; 95% CI,
0.12 to 0.90). In the conservative-care group, the cumulative incidence of
sudden death was 4% at 4 years and 14% at 8 years. CONCLUSION(S):
Among asymptomatic patients with very severe aortic stenosis, the
incidence of the composite of operative mortality or death from
cardiovascular causes during the follow-up period was significantly lower
among those who underwent early aortic-valve replacement surgery than
among those who received conservative care. (Funded by the Korean
Institute of Medicine; RECOVERY ClinicalTrials.gov number,
NCT01161732.). Copyright © 2019 Massachusetts Medical Society.

<26>
[Use Link to view the full text]
Accession Number
629916774
Title
Methylprednisolone Does Not Reduce Acute Postoperative Pain After Cardiac
Surgery: Subanalysis of a Randomized Clinical Trial.
Source
Anesthesia and analgesia. 129 (6) (pp 1468-1473), 2019. Date of
Publication: 01 Dec 2019.
Author
Turan A.; Cohen B.; Whitlock R.P.; Essber H.; Niazi A.; Makarova N.;
Saasouh W.; Alfirevic A.; Marciniak D.; Sessler D.I.
Institution
(Turan, Cohen, Essber, Niazi, Sessler) From the Departments of Outcomes
Research
(Turan) General Anesthesia, Cleveland Clinic, Cleveland, OH, United States
(Cohen) Division of Anesthesia, Critical Care and Pain Management,
Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University,
Israel
(Whitlock) Population Health Research Institute, Hamilton Health Sciences
and McMaster University, Hamilton, Ontario, Canada
(Alfirevic, Marciniak) Department of Cardiothoracic Anesthesia Cleveland
Clinic, Cleveland, OH, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pain after cardiac surgery is largely treated with opioids,
but their poor safety profile makes nonopioid medications attractive as
part of multimodal pathways. Anti-inflammatory drugs reduce acute
postoperative pain, but the role of steroids in reducing acute
poststernotomy pain is unclear. We evaluated the association between the
intraoperative administration of methylprednisolone and postoperative
analgesia, defined as a composite of pain scores and opioid consumption,
during the initial 24 hours after cardiac surgery. METHOD(S): We
conducted a post hoc retrospective analysis of a large clinical trial in
which adults having cardiac surgery were randomized 1:1 to receive 2
intraoperative doses of 250 mg IV methylprednisolone or placebo. Pain
scores and opioid consumption were collected during the initial 24 hours
after surgery. Methylprednisolone was considered to be associated with
better pain control than placebo if proven noninferior (not worse) on both
pain scores (defined a priori with delta of 1 point) and opioid
consumption (delta of 20%) and superior to placebo in at least 1 of the 2
outcomes. This test was repeated in the opposite direction (testing
whether placebo is better than methylprednisolone on postoperative pain
management). RESULT(S): Of 251 eligible patients, 127 received
methylprednisolone and 124 received placebo. Methylprednisolone was
noninferior to placebo on pain with difference in mean (CI) pain scores of
-0.25 (-0.71 to 0.21); P < .001. However, methylprednisolone was not
noninferior to placebo on opioid consumption (ratio of geometric means
[CI]: 1.11 [0.64-1.91]; P = .37). Because methylprednisolone was not
noninferior to placebo on both outcomes, we did not proceed to superiority
testing based on the a priori stopping rules. Similar results were found
when testing the opposite direction. CONCLUSION(S): In this post hoc
analysis, we could not identify a beneficial analgesic effect after
cardiac surgery associated with methylprednisolone administration. There
are currently no data to suggest that methylprednisolone has significant
analgesic benefit in adults having cardiac surgery.

<27>
Accession Number
629913121
Title
Association of Genetically Predicted Lipid Levels With the Extent of
Coronary Atherosclerosis in Icelandic Adults.
Source
JAMA cardiology. (no pagination), 2019. Date of Publication: 20 Nov 2019.
Author
Bjornsson E.; Thorleifsson G.; Helgadottir A.; Gudnason T.; Gudbjartsson
T.; Andersen K.; Gretarsdottir S.; Olafsson I.; Tragante V.; Olafsson OH.;
Jonsdottir B.; Eyjolfsson G.I.; Sigurdardottir O.; Thorgeirsson G.;
Gudbjartsson D.F.; Thorsteinsdottir U.; Holm H.; Stefansson K.
Institution
(Bjornsson, Thorleifsson, Helgadottir, Gretarsdottir, Tragante, Olafsson,
Thorgeirsson, Gubjartsson, Thorsteinsdottir, Holm, Stefansson) deCODE
genetics/Amgen Inc, Reykjavik, Iceland
(Bjornsson, Gubjartsson, Andersen, Olafsson, Thorgeirsson,
Thorsteinsdottir, Stefansson) Faculty of Medicine, University of Iceland,
Reykjavik, Iceland
(Bjornsson, Gunason, Andersen, Thorgeirsson) Division of Cardiology,
Landspitali-The National University Hospital of Iceland, Reykjavik,
Iceland
(Gubjartsson) Division of Cardiothoracic Surgery, Landspitali-The National
University Hospital of Iceland, Reykjavik, Iceland
(Olafsson) Department of Clinical Biochemistry, Landspitali-The National
University Hospital of Iceland, Reykjavik, Iceland
(Tragante) Division of Heart & Lungs, Department of Cardiology, University
Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
(Jonsdottir) ReykjavikIceland
(Eyjolfsson) Laboratory in Mjodd, Reykjavik, Iceland
(Sigurardottir) Department of Clinical Biochemistry, Akureyri Hospital,
Akureyri, Iceland
(Gubjartsson) School of Engineering and Natural Sciences, University of
Iceland, Reykjavik, Iceland
Publisher
NLM (Medline)
Abstract
Importance: Genetic studies have evaluated the influence of blood lipid
levels on the risk of coronary artery disease (CAD), but less is known
about how they are associated with the extent of coronary atherosclerosis.
 Objective(s): To estimate the contributions of genetically predicted
blood lipid levels on the extent of coronary atherosclerosis. Design,
Setting, and Participant(s): This genetic study included Icelandic adults
who had undergone coronary angiography or assessment of coronary artery
calcium using cardiac computed tomography. The study incorporates data
collected from January 1987 to December 2017 in Iceland in the Swedish
Coronary Angiography and Angioplasty Registry and 2 registries of
individuals who had undergone percutaneous coronary interventions and
coronary artery bypass grafting. For each participant, genetic scores were
calculated for levels of non-high-density lipoprotein cholesterol
(non-HDL-C), low-density lipoprotein cholesterol (LDL-C), high-density
lipoprotein cholesterol (HDL-C), and triglycerides, based on reported
effect sizes of 345 independent, lipid-associated variants. The genetic
scores' predictive ability for lipid levels was assessed in more than
87000 Icelandic adults. A mendelian randomization approach was used to
estimate the contribution of each lipid trait. Exposures: Genetic scores
for levels of non-HDL-C, LDL-C, HDL-C, and triglycerides. Main
Outcomes and Measures: The extent of angiographic CAD and coronary artery
calcium quantity. Result(s): A total of 12460 adults (mean [SD] age,
65.1 [10.7] years; 8383 men [67.3%]) underwent coronary angiography, and
4837 had coronary artery calcium assessed by computed tomography. A
genetically predicted increase in non-HDL-C levels by 1 SD (38 mg/dL [to
convert to millimoles per liter, multiply by 0.0259]) was associated with
greater odds of obstructive CAD (odds ratio [OR], 1.83 [95% CI,
1.63-2.07]; P=2.8x10-23). Among patients with obstructive CAD, there were
significant associations with multivessel disease (OR, 1.26 [95% CI,
1.11-1.44]; P=4.1x10-4) and 3-vessel disease (OR, 1.47 [95% CI,
1.26-1.72]; P=9.2x10-7). There were also significant associations with the
presence of coronary artery calcium (OR, 2.04 [95% CI, 1.70-2.44];
P=5.3x10-15) and loge-transformed coronary artery calcium (effect, 0.70
[95% CI, 0.53-0.87]; P=1.0x10-15). Genetically predicted levels of
non-HDL-C remained associated with obstructive CAD and coronary artery
calcium extent even after accounting for the association with LDL-C.
Genetically predicted levels of HDL-C and triglycerides were associated
individually with the extent of coronary atherosclerosis, but not after
accounting for the association with non-HDL cholesterol. Conclusions
and Relevance: In this study, genetically predicted levels of non-HDL-C
were associated with the extent of coronary atherosclerosis as estimated
by 2 different methods. The association was stronger than for genetically
predicted levels of LDL-C. These findings further support the notion that
non-HDL-C may be a better marker of the overall burden of atherogenic
lipoproteins than LDL-C.

<28>
Accession Number
629884523
Title
Atherosclerotic cardiovascular disease in women with endometriosis: a
systematic review of risk factors and prospects for early surveillance.
Source
Reproductive biomedicine online. (no pagination), 2019. Date of
Publication: 08 Jun 2019.
Author
Tan J.; Taskin O.; Iews M.; Lee A.J.; Kan A.; Rowe T.; Bedaiwy M.A.
Institution
(Tan, Taskin, Kan, Rowe, Bedaiwy) Department of Obstetrics & Gynaecology,
University of British Columbia, Vancouver British Columbia, Canada
(Iews) Department of Obstetrics & Gynaecology, The University of British
Columbia, Vancouver British Columbia, Canada; Department of Obstetrics and
Gynecology, South Valley University, Luxor, Egypt
(Lee) Department of Cardiovascular Surgery, University of British
Columbia, Vancouver British Columbia, Canada
Publisher
NLM (Medline)
Abstract
Endometriosis and atherosclerotic cardiovascular disease (ASCVD) share
similar pathogenic mechanisms. Hence, this systematic review evaluates the
association between endometriosis and lifetime ASCVD risk including
co-prevalence with dyslipidaemia, atherosclerosis and non-invasive markers
of endothelial dysfunction. The electronic databases Embase, PubMed,
MEDLINE, Cochrane Register of Trials and ClinicalTrials.gov were
systematically searched for relevant articles. Two prospective cohort
studies demonstrated an increased lifetime ASCVD risk after controlling
for demographic and lifestyle confounders in women with endometriosis, as
measured by higher incidence of myocardial infarction (relative risk [RR]
1.52), angiography-confirmed angina (RR 1.91), or requiring coronary
artery bypass graft surgery (RR 1.35). Among 10 studies that included 407
patients with surgically proven endometriosis and 557 controls, RR of
developing hypercholesterolemia and hypertension were 1.25 and 1.14,
respectively, while higher serum lipoprotein a and lower paraoxonase 1
levels were found in women with endometriosis that was negatively
correlated with stage of disease (r=-0.74, P < 0.0001). Hence, currently
available evidence suggests that women with endometriosis are at higher
lifetime risk of developing ASCVD than women without endometriosis.
However, robust causal evidence is still lacking and future studies are
needed to determine whether women with endometriosis represent a high-risk
population for lifelong ASCVD risk. Copyright © 2019 Reproductive
Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

<29>
Accession Number
629884279
Title
Balloon-Expandable versus Self-Expanding Transcatheter Aortic Valve
Replacement: A Propensity-Matched Comparison from The France-TAVI
Registry.
Source
Circulation. (no pagination), 2019. Date of Publication: 16 Nov 2019.
Author
Van Belle E.; Vincent F.; Labreuche J.; Auffret V.; Debry N.; Lefevre T.;
Eltchaninoff H.; Manigold T.; Gilard M.; Verhoye J.-P.; Himbert D.; Koning
R.; Collet J.-P.; Leprince P.; Teiger E.; Duhamel A.; Cosenza A.; Schurtz
G.; Porouchani S.; Lattuca B.; Robin E.; Coisne A.; Modine T.; Richardson
M.; Joly P.; Rioufol G.; Ghostine S.; Bar O.; Amabile N.; Champagnac D.;
Ohlmann P.; Meneveau N.; Lhermusier T.; Leroux L.; Leclercq F.; Gandet T.;
Pinaud F.; Cuisset T.; Motreff P.; Souteyrand G.; Iung B.; Folliguet T.;
Commeau P.; Cayla G.; Bayet G.; Darremont O.; Spaulding C.; Le Breton H.;
Delhaye C.
Institution
(Van Belle, Vincent, Debry, Cosenza, Schurtz, Porouchani, Robin, Coisne,
Modine, Richardson, Delhaye) CHU de Lille, Departement de cardiologie,
Universite de Lille, Inserm U1011, Institut Pasteur de Lille, EGID, Lille,
France
(Labreuche, Duhamel) Univ. Lille, Department of biostatistics, EA 2694 -
Sante publique : epidemiologie et qualite des soins, CHU Lille, Lille
F-59000, France
(Auffret, Verhoye, Le Breton) CHU Pontchaillou, Service de Cardiologie et
Maladies Vasculaires, CIC-IT 804, Universite de Rennes 1, Laboratoire de
traitement du signal et de l'image, Inserm U1099, 35000 Rennes, France
(Lefevre) Institut cardiovasculaire Paris-Sud, Massy, France
(Eltchaninoff) service de cardiologie, Rouen, France
(Manigold) CHU Guillaume et Rene Laennec, Institut du Thorax, Service de
cardiologie, Nantes, France
(Gilard) CHU La Cavale Blanche, Departement de Cardiologie, Optimisation
des Regulations Physiologiques, UFR Sciences et Techniques, EA4324, Brest
29200, France
(Himbert, Iung) AP-HP, hopital Bichat, departement de cardiologie,
universite Paris-Diderot, Paris, France
(Koning) Clinique Saint-Hilaire, service de cardiologie, Rouen, France
(Collet, Leprince) AP-HP, CHU La Pitie-Salpetriere, service de
cardiologie, Paris, France
(Teiger) Hopital Henri-Mondor Assistance Publique Hopitaux de Paris,
departement de cardiologie, 94000 Creteil, France
(Lattuca, Cayla) CHU Nimes, Cardiologie, Universite Montpellier, Nimes,
France
(Joly) Hopital Saint-Joseph, Federation de cardiologie, Marseille 13000,
France
(Rioufol) Division de cardiologie, Centre d'Investigation Clinique de Lyon
(CIC), Bron 69677, France
(Ghostine) Centre Marie Lannelongue, Departement de cardiologie, Le
Plessis Robinson, France
(Bar) Clinique Saint Gatien, service de cardiologie, Tours, France
(Amabile) Institut Mutualiste Montsouris, departement de cardiologie,
Paris, France
(Champagnac) Clinique du Tonkin, service de cardiologie, Villeurbanne,
France
(Ohlmann) Nouvel hopital civil, departement de cardiologie, Universite de
Strasbourg, CHU de Strasbourg, Strasbourg, France
(Meneveau) CHU Besancon, Cardiologie, EA3920, Hopital Jean Minjoz,
Besancon, France
(Lhermusier) Departement de cardiologie, Inserm U1048, I2MC, CHU de
ToulouseUniversite de Toulouse 3, Toulouse, France
(Leroux) Hopital cardiologique du Haut-Leveque, departement de cardiologie
interventionnelle, Universite de Bordeaux, Pessac, France
(Leclercq, Gandet) Service de cardiologie, CHU Arnaud de Villeneuve,
Montpellier, France
(Pinaud) CHU d'Angers, Service de Chirurgie cardiaque, CNRS UMR 6214,
INSERM 1083, France
(Cuisset) CHU La Timone Assistance publique hopitaux de Marseille,
departement de cardiologie, Inserm UMR1062, INRA UMR 1260, Universite
d'Aix-Marseille, Marseille, France
(Motreff, Souteyrand) CHU Gabriel Montpied, departement de cardiologie,
ISIT, CNRS (UMR-6284), Clermont-Ferrand, Universite d'Auvergne, France
(Folliguet) Service de chirurgie cardiovasculaire, CHU de
NancyVandoeuvre-les-Nancy, France
(Commeau) Polyclinique les Fleurs, Cardiologie, Ollioules, France
(Bayet) Hopital prive Clairval, service de cardiologie, Marseille 13273,
France
(Darremont) Clinique Saint Augustin, Service de cardiologie, Bordeaux
33000, France
(Spaulding) Hopital Europeen Georges Pompidou, Paris 75015, France
Publisher
NLM (Medline)
Abstract
Background: No randomized study powered to compare balloon-expandable (BE)
with self-expanding (SE) transcatheter heart valve (THV) on individual
endpoints after transcatheter aortic valve replacement (TAVR) has been
conducted to date. Method(s): From January 2013 to December 2015, the
FRANCE-TAVI nationwide registry included 12,141 patients undergoing BE-THV
(Edwards, n=8038) or SE-THV (Medtronic, n=4103) for native aortic stenosis
(AS). Long-term mortality status was available in all patients (median 20
months, IQR:14-30). Patients treated with BE-THV (n=3910) were
successfully matched 1:1 with 3910 patients treated with SE-THV by using
propensity-score (25 clinical, anatomical and procedural variables) and by
date of the procedure (within 3 months). The first co-primary outcome was
the occurrence of paravalvular regurgitation (PVR){greater than or equal
to}moderate and/or in-hospital mortality. The 2nd co-primary outcome was
2-year all-cause mortality. Result(s): In matched-propensity
analyses, the incidence of the 1st co-primary outcome was higher with
SE-THV (19.8%) compared with BE-THV(11.9%; RR=1.68; 95%CI:1.46-1.91;
p<0.0001). Each component of the outcome was also higher in SE-THV
patients: PVR{greater than or equal to}moderate (15.5% vs. 8.3%; RR=1.90;
95% CI:1.63-2.22; p<0.0001) and in-hospital mortality (5.6% vs 4.2%,
RR=1.34; 95%CI:1.07-1.66; p=0.01). During follow-up, all-cause mortality
occurred in 899 patients treated with SE-THV (2-year mortality was 29.8%)
and in 801 patients treated with BE-THV (2-year mortality 26.6%; HR=1.17;
95% CI:1.06-1.29; p=0.003). Similar results were found using inverse
probability of treatment weighting using propensity score analysis.
 Conclusion(s): The present study suggests that use of SE-THV was
associated with a higher risk of PVR and higher in-hospital and 2-year
mortality as compared with BE-THV. These data strongly support the need
for a randomized trial sufficiently powered to compare head-to-head the
latest generation of SE and BE-THV.(Registry of Aortic Valve Bioprostheses
Established by Catheter [FRANCE-TAVI]; NCT01777828) Clinical Trial
Registration: URL: https://clinicaltrials.gov Unique identifier:
NCT01777828.

<30>
Accession Number
629883653
Title
Long-term survival after xenograft versus homograft aortic root
replacement: Results from a prospective randomized trial.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination), 2019.
Date of Publication: 04 Oct 2019.
Author
Melina G.; De Robertis F.; Gaer J.A.; Angeloni E.; El-Hamamsy I.; Bahrami
T.; Pepper J.R.; Takkenberg J.J.M.; Yacoub M.H.
Institution
(Melina) Royal Brompton and Harefield NHS Foundation Trust, London, United
Kingdom; Department of Cardiac Surgery, Ospedale Sant'Andrea, "Sapienza"
Universita di Roma, Rome, Italy
(De Robertis, Gaer, Bahrami, Pepper) Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
(Angeloni) Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome,
Italy
(El-Hamamsy) Division of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada
(Takkenberg) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Yacoub) Imperial College, London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The study objective was to investigate the long-term survival
of patients undergoing xenograft versus homograft full root aortic valve
replacement. METHOD(S): A total of 166 patients requiring aortic
valve surgery were randomized to undergo the Freestyle (Medtronic Inc,
Minneapolis, Minn) bioprosthesis (N = 90) or a homograft (N = 76) full
root aortic valve replacement between 1997 and 2005 in a single
institution. Six patients randomly assigned to the homograft crossed over
to the Freestyle bioprosthesis because of the unavailability of suitably
sized homografts. All surgeons were required to adhere to the standard
surgical technique for homograft root implantation previously described.
Follow-up was 98.5% complete. RESULT(S): The mean age of the study
population was 65 +/- 8 years. Coronary artery bypass grafting was
associated with root aortic valve replacement in 76 of 166 patients (46%,
P = not significant between groups), and overall hospital mortality was
4.8% (8/166, P = not significant between groups). Median follow-up was
13.8 years (range, 0-21.8 years; 2033 patient-years). The Kaplan-Meier
survival analysis showed that there was no significant difference in
overall survival between the 2 arms at 5, 10, and 15 years. Twenty-year
survival was 28.3% +/- 5% for the Freestyle group versus 25.1% +/- 5.7%
for the homograft group (P = .90), which was comparable to the age- and
sex-matched UK general population. The freedom from aortic valve
reoperation at 20 years was comparable for the Freestyle group versus the
homograft group (67.9% +/- 8.8% vs 67.2% +/- 10.3%, respectively; P =
.74). CONCLUSION(S): This is the first study to investigate the
long-term survival of xenograft versus homograft full root aortic valve
replacement from a prospective randomized trial. The observed 20-year
overall survival and freedom from aortic valve reoperation serve as a
benchmark for future studies on interventions for aortic valve disease in
the elderly. Copyright © 2019 The American Association for
Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

<31>
Accession Number
629882593
Title
Efficacy of Precise Foot Massage Therapy on Pain and Anxiety Following
Cardiac Surgery: Pilot Study.
Source
Pain management nursing : official journal of the American Society of Pain
Management Nurses. (no pagination), 2019. Date of Publication: 13 Nov
2019.
Author
Alameri R.; Dean G.; Castner J.; Volpe E.; Elghoneimy Y.; Jungquist C.
Institution
(Alameri) Department of Fundamental Nursing, College Nursing, Imam
Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
(Dean, Castner, Volpe, Jungquist) School of Nursing, State University of
New York, Buffalo, NY, United States
(Elghoneimy) College of Medicine, Imam Abdulrahman Bin Faisal University,
Dammam, Saudi Arabia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pain is the most pervasive distressing symptom following
cardiac surgery. Forty percent of postoperative cardiac patients report
inadequate pain management. Undertreated acute pain results in increased
anxiety, delayed wound healing, and increased chance of persistent chronic
pain. Foot massage is a safe, visible complementary approach to manage
acute pain following surgery. AIM: The aim of this study is to evaluate
the efficacy of integrating foot massage therapy for managing postcardiac
pain. METHOD(S): A randomized placebo controlled single blinded trial
comparing foot massage to placebo was conducted at a large hospital in
Saudi Arabia. Thirty-one patients who had undergone cardiac surgery (16 in
experimental and 15 in placebo group) participated in the study.
Ten-minute foot massage was delivered to the experimental group by a nurse
researcher, twice during one day, within 30 minutes after receiving an
opioid pain medication. RESULT(S): The findings of this study
indicate that foot massage significantly (p < .05) decreases pain
intensity and anxiety in patients who have undergone cardiac surgery
compared with a placebo control group. CONCLUSION(S): Providing
non-pharmacologic interventions for pain is the responsibility of the
nursing staff. Foot massage is within the scope of nursing practice and is
a safe and effective manner of improving patient care. Foot massage in
conjunction with pharmacological interventions is effective in improving
pain and anxiety. Future studies should consider focusing on frequency,
dose, feasibility, acceptability, and participants'
satisfaction. Copyright © 2019 American Society for Pain
Management Nursing. Published by Elsevier Inc. All rights reserved.

<32>
Accession Number
629882231
Title
Reduced Leaflet Motion after Transcatheter Aortic-Valve Replacement.
Source
The New England journal of medicine. (no pagination), 2019. Date of
Publication: 16 Nov 2019.
Author
De Backer O.; Dangas G.D.; Jilaihawi H.; Leipsic J.A.; Terkelsen C.J.;
Makkar R.; Kini A.S.; Veien K.T.; Abdel-Wahab M.; Kim W.-K.; Balan P.; Van
Mieghem N.; Mathiassen O.N.; Jeger R.V.; Arnold M.; Mehran R.; Guimaraes
A.H.C.; Norgaard B.L.; Kofoed K.F.; Blanke P.; Windecker S.; Sondergaard
L.
Institution
(De Backer, Dangas, Jilaihawi, Leipsic, Terkelsen, Makkar, Kini, Veien,
Abdel-Wahab, Kim, Balan, Van Mieghem, Mathiassen, Jeger, Arnold, Mehran,
Guimaraes, Norgaard, Kofoed, Blanke, Windecker, Sondergaard) From the
Heart Center, Rigshospitalet, Copenhagen University Hospital, University
of Copenhagen, Copenhagen (O.D.B., K.F.K., L.S.); the Zena and Michael A.
Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai
Hospital (G.D.D., A.S.K., R. Mehran), and NYU Langone Health (H.J.) - both
in New York; National and Kapodistrian University of Athens, Athens
(G.D.D.); the Department of Medical Imaging, St. Paul's Hospital,
University of British Columbia, Vancouver, Canada (J.A.L., P. Blanke); the
Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T.,
O.N.M., B.L.N.), and the Department of Cardiology, Odense University
Hospital, Odense (K.T.V.) - both in Denmark; Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles (R. Makkar); the Department of
Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg (M.A.-W.),
Heart Center Leipzig, University of Leipzig, Leipzig (M.A.-W.), Kerckhoff
Heart Center, Department of Cardiology and Cardiac Surgery, Bad Nauheim
(W.-K.K.), and Kardiologie und Angiologie, Universitatsklinikum Erlangen,
Erlangen (M.A.) - all in Germany; the Department of Internal Medicine,
University of Texas Health Science Center, Houston (P. Balan);
Thoraxcentrum, Erasmus Medisch Centrum (N.V.M.), European Cardiovascular
Research Institute (A.H.C.G.), and Cardialysis, Academic Research
Organization (A.H.C.G.) - all in Rotterdam, the Netherlands; and the
Department of Cardiology, Basel University Hospital, University of Basel,
Basel (R.V.J.), and the Department of Cardiology, Inselspital, Bern
University Hospital, University of Bern, Bern (S.W.) - both in Switzerland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Subclinical leaflet thickening and reduced leaflet motion of
bioprosthetic aortic valves have been documented by four-dimensional
computed tomography (CT). Whether anticoagulation can reduce these
phenomena after transcatheter aortic-valve replacement (TAVR) is not
known. METHOD(S): In a substudy of a large randomized trial, we
randomly assigned patients who had undergone successful TAVR and who did
not have an indication for long-term anticoagulation to a
rivaroxaban-based antithrombotic strategy (rivaroxaban [10 mg] plus
aspirin [75 to 100 mg] once daily) or an antiplatelet-based strategy
(clopidogrel [75 mg] plus aspirin [75 to 100 mg] once daily). Patients
underwent evaluation by four-dimensional CT at a mean (+/-SD) of 90+/-15
days after randomization. The primary end point was the percentage of
patients with at least one prosthetic valve leaflet with grade 3 or higher
motion reduction (i.e., involving >50% of the leaflet). Leaflet thickening
was also assessed. RESULT(S): A total of 231 patients were enrolled.
At least one prosthetic valve leaflet with grade 3 or higher motion
reduction was found in 2 of 97 patients (2.1%) who had scans that could be
evaluated in the rivaroxaban group, as compared with 11 of 101 (10.9%) in
the antiplatelet group (difference, -8.8 percentage points; 95% confidence
interval [CI], -16.5 to -1.9; P=0.01). Thickening of at least one leaflet
was observed in 12 of 97 patients (12.4%) in the rivaroxaban group and in
33 of 102 (32.4%) in the antiplatelet group (difference, -20.0 percentage
points; 95% CI, -30.9 to -8.5). In the main trial, the risk of death or
thromboembolic events and the risk of life-threatening, disabling, or
major bleeding were higher with rivaroxaban (hazard ratios of 1.35 and
1.50, respectively). CONCLUSION(S): In a substudy of a trial
involving patients without an indication for long-term anticoagulation who
had undergone successful TAVR, a rivaroxaban-based antithrombotic strategy
was more effective than an antiplatelet-based strategy in preventing
subclinical leaflet-motion abnormalities. However, in the main trial, the
rivaroxaban-based strategy was associated with a higher risk of death or
thromboembolic complications and a higher risk of bleeding than the
antiplatelet-based strategy. (Funded by Bayer; GALILEO-4D
ClinicalTrials.gov number, NCT02833948.). Copyright © 2019
Massachusetts Medical Society.

<33>
Accession Number
629882032
Title
A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve
Replacement.
Source
The New England journal of medicine. (no pagination), 2019. Date of
Publication: 16 Nov 2019.
Author
Dangas G.D.; Tijssen J.G.P.; Wohrle J.; Sondergaard L.; Gilard M.;
Mollmann H.; Makkar R.R.; Herrmann H.C.; Giustino G.; Baldus S.; De Backer
O.; Guimaraes A.H.C.; Gullestad L.; Kini A.; von Lewinski D.; Mack M.;
Moreno R.; Schafer U.; Seeger J.; Tchetche D.; Thomitzek K.; Valgimigli
M.; Vranckx P.; Welsh R.C.; Wildgoose P.; Volkl A.A.; Zazula A.; van
Amsterdam R.G.M.; Mehran R.; Windecker S.
Institution
(Dangas, Tijssen, Wohrle, Sondergaard, Gilard, Mollmann, Makkar, Herrmann,
Giustino, Baldus, De Backer, Guimaraes, Gullestad, Kini, von Lewinski,
Mack, Moreno, Schafer, Seeger, Tchetche, Thomitzek, Valgimigli, Vranckx,
Welsh, Wildgoose, Volkl, Zazula, van Amsterdam, Mehran, Windecker) From
the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York (G.D.D., G.G., A.K., R. Mehran);
National and Kapodistrian University of Athens, Athens (G.D.D.); Amsterdam
University Medical Centers-University of Amsterdam, Amsterdam (J.G.P.T.),
and Cardialysis, Academic Research Organization, Rotterdam (J.G.P.T.,
A.H.C.G., R.G.M.A.) - both in the Netherlands; the Department of Internal
Medicine II, University of Ulm, Ulm (J.W., J.S.), the Department of
Internal Medicine I, St. Johannes Hospital Dortmund, Dortmund (H.M.), the
Department of Internal Medicine III, Heart Center, University Hospital of
Cologne, Cologne (S.B.), the Department of General and Interventional
Cardiology, University Hospital Hamburg-Eppendorf, Hamburg (U.S.), and
Bayer, Berlin (K.T.) - all in Germany; the Heart Center, Rigshospitalet,
University of Copenhagen, Copenhagen (L.S., O.D.B.); La Cavale Blanche
University Hospital, Cardiology Department, Brest (M.G.), and Clinique
Pasteur, Toulouse (D.T.) - both in France; Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles (R.R.M.); the University of
Pennsylvania, Philadelphia (H.C.H.); the Department of Cardiology, Oslo
University Hospital Rikshospitalet, and the Institute of Clinical
Medicine, University of Oslo - all in Oslo (L.G.); the Department of
Cardiology, Medical University of Graz, Graz, Austria (D.L.); Baylor Scott
and White Health, Temple, TX (M.M.); the Department of Cardiology,
University Hospital of La Paz, Hospital La Paz Institute for Health
Research, Madrid (R. Moreno); the Department of Cardiology, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland (M.V.,
S.W.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Whether the direct factor Xa inhibitor rivaroxaban can prevent
thromboembolic events after transcatheter aortic-valve replacement (TAVR)
is unclear. METHOD(S): We randomly assigned 1644 patients without an
established indication for oral anticoagulation after successful TAVR to
receive rivaroxaban at a dose of 10 mg daily (with aspirin at a dose of 75
to 100 mg daily for the first 3 months) (rivaroxaban group) or aspirin at
a dose of 75 to 100 mg daily (with clopidogrel at a dose of 75 mg daily
for the first 3 months) (antiplatelet group). The primary efficacy outcome
was the composite of death or thromboembolic events. The primary safety
outcome was major, disabling, or life-threatening bleeding. The trial was
terminated prematurely by the data and safety monitoring board because of
safety concerns. RESULT(S): After a median of 17 months, death or a
first thromboembolic event (intention-to-treat analysis) had occurred in
105 patients in the rivaroxaban group and in 78 patients in the
antiplatelet group (incidence rates, 9.8 and 7.2 per 100 person-years,
respectively; hazard ratio with rivaroxaban, 1.35; 95% confidence interval
[CI], 1.01 to 1.81; P=0.04). Major, disabling, or life-threatening
bleeding (intention-to-treat analysis) had occurred in 46 and 31 patients,
respectively (4.3 and 2.8 per 100 person-years; hazard ratio, 1.50; 95%
CI, 0.95 to 2.37; P=0.08). A total of 64 deaths occurred in the
rivaroxaban group and 38 in the antiplatelet group (5.8 and 3.4 per 100
person-years, respectively; hazard ratio, 1.69; 95% CI, 1.13 to 2.53).
 CONCLUSION(S): In patients without an established indication for oral
anticoagulation after successful TAVR, a treatment strategy including
rivaroxaban at a dose of 10 mg daily was associated with a higher risk of
death or thromboembolic complications and a higher risk of bleeding than
an antiplatelet-based strategy. (Funded by Bayer and Janssen
Pharmaceuticals; GALILEO ClinicalTrials.gov number,
NCT02556203.). Copyright © 2019 Massachusetts Medical Society.

<34>
Accession Number
629878841
Title
Postoperative Pain and Analgesic Requirements in the First Year after
Intraoperative Methadone for Complex Spine and Cardiac Surgery.
Source
Anesthesiology. (no pagination), 2019. Date of Publication: 07 Nov 2019.
Author
Murphy G.S.; Avram M.J.; Greenberg S.B.; Shear T.D.; Deshur M.A.;
Dickerson D.; Bilimoria S.; Benson J.; Maher C.E.; Trenk G.J.; Teister
K.J.; Szokol J.W.
Institution
(Murphy) From the Department of Anesthesiology, NorthShore University
HealthSystem, University of Chicago Pritzker School of Medicine, Evanston,
Illinois (G.S.M., S.B.G., T.D.S., M.A.D., D.D., S.B., J.B., C.E.M.,
G.J.T., K.J.T., J.W.S.) the Department of Anesthesiology, Northwestern
University Feinberg School of Medicine, Chicago, Illinois (M.J.A.)
Publisher
NLM (Medline)
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: The intraoperative administration
of methadone is effective in reducing postoperative painPreventative
analgesic interventions may provide protection against the development of
persistent postoperative pain WHAT THIS ARTICLE TELLS US THAT IS NEW:
Using data from two previously completed trials, it was observed that a
single intraoperative dose of methadone was associated with fewer episodes
of pain during the first month after cardiac surgery and the first 3
months after spinal surgeryFewer spine surgery patients who received
methadone intraoperatively were receiving opioids 3 months after surgery,
suggesting a possible reduction in chronic opioid use BACKGROUND::
Methadone is a long-acting opioid that has been reported to reduce
postoperative pain scores and analgesic requirements and may attenuate
development of chronic postsurgical pain. The aim of this secondary
analysis of two previous trials was to follow up with patients who had
received a single intraoperative dose of either methadone or traditional
opioids for complex spine or cardiac surgical procedures. METHOD(S):
Preplanned analyses of long-term outcomes were conducted for spinal
surgery patients randomized to receive 0.2 mg/kg methadone at the start of
surgery or 2 mg hydromorphone at surgical closure, and for cardiac surgery
patients randomized to receive 0.3 mg/kg methadone or 12 mug/kg fentanyl
intraoperatively. A pain questionnaire assessing the weekly frequency (the
primary outcome) and intensity of pain was mailed to subjects 1, 3, 6, and
12 months after surgery. Ordinal data were compared with the Mann-Whitney
U test, and nominal data were compared using the chi-square test or Fisher
exact probability test. The criterion for rejection of the null hypothesis
was P < 0.01. RESULT(S): Three months after surgery, patients
randomized to receive methadone for spine procedures reported the weekly
frequency of chronic pain was less (median score 0 on a 0 to 4 scale [less
than once a week] vs. 3 [daily] in the hydromorphone group, P = 0.004).
Patients randomized to receive methadone for cardiac surgery reported the
frequency of postsurgical pain was less at 1 month (median score 0) than
it was in patients randomized to receive fentanyl (median score 2 [twice
per week], P = 0.004). CONCLUSION(S): Analgesic benefits of a single
dose of intraoperative methadone were observed during the first 3 months
after spinal surgery (but not at 6 and 12 months), and during the first
month after cardiac surgery, when the intensity and frequency of pain were
the greatest.

<35>
Accession Number
629893603
Title
Preservation of renal function in cardiac surgery patients with low
cardiac output syndrome: levosimendan vs beta agonists.
Source
BMC anesthesiology. 19 (1) (pp 212), 2019. Date of Publication: 17 Nov
2019.
Author
Guerrero Orriach J.L.; Navarro Arce I.; Hernandez Rodriguez P.; Raigon
Ponferrada A.; Malo Manso A.; Ramirez Aliaga M.; Ramirez Fernandez A.;
Escalona Belmonte J.J.; Bellido Estevez I.; Gomez Luque A.; Barrera
Serrano R.; Toledo Medina C.S.; Rubio Navarro M.; Cruz Manas J.
Institution
(Guerrero Orriach) Institute of Biomedical Research in Malaga [IBIMA],
Malaga, Spain
(Guerrero Orriach) Department of Anaesthesiology, Virgen de la Victoria
University Hospital, University Campus Teatinos, Malaga C.P. 29010, Spain
(Guerrero Orriach) Department of Pharmacology and Pediatrics, School of
Medicine, University of Malaga, Malaga, Spain
(Navarro Arce, Hernandez Rodriguez, Raigon Ponferrada, Malo Manso, Ramirez
Aliaga, Ramirez Fernandez, Escalona Belmonte, Gomez Luque, Barrera
Serrano, Toledo Medina, Rubio Navarro, Cruz Manas) Department of
Anaesthesiology, Virgen de la Victoria University Hospital, University
Campus Teatinos, Malaga C.P. 29010, Spain
(Raigon Ponferrada, Malo Manso, Ramirez Aliaga, Ramirez Fernandez,
Escalona Belmonte, Bellido Estevez, Gomez Luque, Rubio Navarro, Cruz
Manas) Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain
(Bellido Estevez, Gomez Luque) Department of Pharmacology and Pediatrics,
School of Medicine, University of Malaga, Malaga, Spain
Publisher
NLM (Medline)
Abstract
BACKGROUND: Some studies have been performed to assess the effects of
levosimendan on cardiac function when administered to cardiac surgery
patients with low cardiac output syndrome (LCOS) in the immediate
postoperative period. Levosimendan is an inotropic agent for the treatment
of low cardiac output syndrome that seems to have a protective effect on
renal function. METHOD(S): It is a quasi-experimental study. A total
of 100 patients with LCOS received either beta-agonists or levosimendan.
We assessed the incidence of postoperative kidney failure in cardiac
surgery patients. In patients who had kidney failure at diagnosis of LCOS,
we examined whether differences existed in the evolution of kidney failure
based on the treatment administered for LCOS. The parameters measured
included haemodynamics, oxygen supply, and renal function as assessed by
the AKI scale. ANOVA, Student's t-test and Wilcoxon or Friedman tests were
used. RESULT(S): Up to 30% of cardiac surgery patients had kidney
failure at diagnosis of LCOS. Kidney failure at discharge from the ICU was
more frequent in patients who received beta-agonist drugs as compared to
those who received levosimendan (p<0.05). CONCLUSION(S): The
incidence of kidney failure decreased with the postoperative
administration of levosimendan to cardiac surgery patients with LCOS, as
compared to beta-agonists. TRIAL REGISTRATION: Current Controlled Trials
ISRCTN 46058317. Date of registration: 7/10/2019. Retrospectively
registered.

<36>
Accession Number
2003626188
Title
Myocardial Involvement in Patients With Histologically Diagnosed Cardiac
Sarcoidosis: A Systematic Review and Meta-Analysis of Gross Pathological
Images From Autopsy or Cardiac Transplantation Cases.
Source
Journal of the American Heart Association. 8 (10) (no pagination), 2019.
Article Number: e011253. Date of Publication: 21 May 2019.
Author
Okasha O.; Kazmirczak F.; Chen K.-H.A.; Farzaneh-Far A.; Shenoy C.
Institution
(Okasha, Kazmirczak, Chen, Shenoy) Cardiovascular Division, Department of
Medicine, University of Minnesota Medical School, Minneapolis, MN, United
States
(Farzaneh-Far) Section of Cardiology, Department of Medicine, University
of Illinois at Chicago, Chicago, IL, United States
Publisher
American Heart Association Inc.
Abstract
Background: In patients with suspected cardiac sarcoidosis, late
gadolinium enhancement on cardiovascular magnetic resonance imaging and/or
18F-fluorodeoxyglucose uptake on positron emission tomography
are often used to reach a clinical diagnosis of cardiac sarcoidosis. On
the basis of data from the imaging literature of clinical cardiac
sarcoidosis, no specific features of myocardial involvement are regarded
as pathognomonic for cardiac sarcoidosis. Thus, a diagnosis of cardiac
sarcoidosis is challenging to make. There has been no systematic analysis
of histologically diagnosed cardiac sarcoidosis for patterns of myocardial
involvement. We hypothesized that certain patterns of myocardial
involvement are more frequent in histologically diagnosed cardiac
sarcoidosis. Methods and Results: We performed a systematic review
and meta-analysis of gross pathological images from the published
literature of patients with histologically diagnosed cardiac sarcoidosis
who underwent autopsy or cardiac transplantation. Thirty-three eligible
articles provided images of 49 unique hearts. Analysis of these hearts
revealed certain features of myocardial involvement in >90% of cases: left
ventricular (LV) subepicardial, LV multifocal, septal, and right
ventricular free wall involvement. In contrast, other patterns were seen
in 0% to 6% of cases: absence of gross LV myocardial involvement, isolated
LV midmyocardial involvement, isolated LV subendocardial involvement,
isolated LV transmural involvement, absence of septal involvement, or
isolated involvement of only one LV level. Conclusion(s): In this
systematic review and meta-analysis of histologically diagnosed cardiac
sarcoidosis, we identified certain features of myocardial involvement that
occurred frequently and others that occurred rarely or never. These
patterns could aid the interpretation of cardiovascular magnetic resonance
imaging and positron emission tomography imaging and improve the diagnosis
and the prognostication of patients with suspected cardiac
sarcoidosis. Copyright © 2019 The Authors. Published on behalf of
the American Heart Association, Inc., by Wiley.

<37>
Accession Number
2003247141
Title
Neutrophil gelatinase-associated lipocalin as a marker of postoperative
acute kidney injury following cardiac surgery in patients with
preoperative kidney impairment.
Source
Cardiovascular and Hematological Disorders - Drug Targets. 19 (3) (pp
239-248), 2019. Date of Publication: 2019.
Author
Tidbury N.; Browning N.; Shaw M.; Morgan M.; Kemp I.; Matata B.
Institution
(Tidbury, Browning, Shaw, Morgan, Kemp, Matata) Liverpool Heart & Chest
Hospital NHS Foundation Trust, United Kingdom
(Matata) Department of Clinical Infection, Microbiology and Immunology,
University of Liverpool, Liverpool L14 3PE, United Kingdom
Publisher
Bentham Science Publishers (P.O. Box 294, Bussum 1400 AG, Netherlands)
Abstract
Introduction: Acute kidney injury (AKI) is a serious complication of
cardiac surgery. The current 'gold standard' for determining AKI is change
in serum creatinine and urine output, however, this change occurs
relatively late after the actual injury occurs. Identification of new
biomarkers that detect early AKI is required. Recently, new biomarkers,
such as the NephroCheck Test and AKIRisk have also been tested and found
to be good indicators of AKI. Neutrophil gelatinase-associated lipocalin
(NGAL) has shown promise in paediatric patients but has displayed varied
results in adult populations, particularly post cardiac surgery. The aim
of this study was to assess the value of urinary NGAL as a biomarker of
AKI in patients with pre-existing renal impairment (eGFR >15ml/min to
eGFR<60ml/min). Method(s): A post-hoc analysis of urinary NGAL
concentrations from 125 patients with pre-existing kidney impairment, who
participated in a randomised trial of haemofiltration during cardiac
surgery, was undertaken. Urinary NGAL was measured using ELISA at
baseline, post-operatively and 24 and 48 hours after surgery, and serum
creatinine was measured pre and postoperatively and then at 24, 48, 72 and
96 hours as routine patient care. NGAL concentrations were compared in
patients with and without AKI determined by changes in serum creatinine
concentrations. A Kaplan-Meier plot compared survival for patients with or
without AKI and a Cox proportional hazards analysis was performed to
identify factors with the greatest influence on survival. Result(s):
Following surgery, 43% of patients developed AKI (based on KDIGO
definition). Baseline urinary NGAL was not found to be significantly
different between patients that did and did not develop AKI. Urinary NGAL
concentration was increased in all patients following surgery, regardless
of whether they developed AKI and was also significant between groups at
24 (p=0.003) and 48 hours (p<0.0001). Urinary NGAL concentrations at 48
hours correlated with serum creatinine concentrations at 48 hours
(r=0.477, p<0.0001), 72 hours (r=0.488, p<0.0001) and 96 hours (r=0.463,
p<0.0001). Urinary NGAL at 48 hours after surgery strongly predicted AKI
(AUC=0.76; P=0.0001). A Kaplan-Meier plot showed that patients with
postoperative AKI had a significantly lower 7-year survival compared with
those without AKI. Postoperative urinary NGAL at 48 hours >156ng/mL also
strongly predicted 7-year survival. However, additive EuroSCORE, age,
current smoking and post-operative antibiotics usage were distinctly
significantly more predictive of 7-year survival as compared with
postoperative urinary NGAL at 48 hours >156ng/mL. Conclusion(s): Our
study demonstrated that postoperative urinary NGAL levels at 48 hours
postsurgery strongly predicts the onset or severity of postoperative AKI
based on KDIGO classification in patients with preoperative kidney
impairment and were also strongly related to 7-year
survival. Copyright © 2019 Bentham Science Publishers.

<38>
Accession Number
629849790
Title
The relationship between vitamin D and risk of atrial fibrillation: A
dose-response analysis of observational studies.
Source
Nutrition Journal. 18 (1) (no pagination), 2019. Article Number: 73. Date
of Publication: 14 Nov 2019.
Author
Liu X.; Wang W.; Tan Z.; Zhu X.; Liu M.; Wan R.; Hong K.
Institution
(Liu, Wang, Tan, Zhu, Liu, Wan, Hong) Cardiovascular Department, Second
Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006,
China
(Hong) Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi,
China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The relationship between serum vitamin D and atrial
fibrillation (AF) or postoperative atrial fibrillation (POAF) in patients
undergoing coronary artery bypass graft (CABG) is still debated. It is
also unclear whether there is a dose-response relationship between
circulating vitamin D and the risk of AF or POAF. Method(s): The
Cochrane Library, PubMed, and Embase databases were searched for relevant
studies. We used a "one-stage approach" with a restricted cubic spline
model to summarize the dose-specific relationships between serum vitamin D
and AF. Relative risk (RR) was used to measure the effects in this
meta-analysis. Result(s): In total, 13 studies were included with a
total of 6519 cases of AF among 74,885 participants. Vitamin D deficiency
(< 20 ng/ml) was associated with increased risks of AF (RR: 1.23, 95% CI:
1.05-1.43). In the dose-response analysis, the summary RR for a 10 ng/ml
increased in vitamin D was 0.88 (95% CI: 0.78-0.98) and there was no
evidence of a non-linear association, P<inf>non-linearity</inf> = 0.86. In
the age subgroup, high vitamin D (per 10 ng/ml increase) reduced the risk
of AF in the older group (> 65 years) (RR = 0.68, 95% CI = 0.52-0.89) but
not among young individuals (< 65 years) (RR = 0.87, 95% CI = 0.72-1.06).
In addition, a strong association was found between a 10 ng/ml increased
in vitamin D and POAF incident in the patient after CABG (RR: 0.44, 95%
CI: 0.24-0.82). Conclusion(s): Our dose-response meta-analysis
suggested serum vitamin D deficiency was associated with an increased risk
of AF in the general population and POAF in patients after CABG. Further
studies are needed to explore the age difference in the association
between serum vitamin D level and the risk of AF and whether vitamin D
supplements will prevent AF. Trial registration: This study has been
registered with PROSPERO (International prospective register of systematic
reviews)-registration number- CRD42019119258. Copyright © 2019
The Author(s).

<39>
Accession Number
629922575
Title
Impact of one-week preoperative physical training on clinical outcomes of
surgical lung cancer patients with limited lung function: A randomized
trial.
Source
Annals of Translational Medicine. 7 (20) (no pagination), 2019. Article
Number: 544. Date of Publication: 2019.
Author
Lai Y.; Wang X.; Zhou K.; Su J.; Che G.
Institution
(Lai, Wang, Zhou, Che) Department of Thoracic Surgery, West China
Hospital, Sichuan University, Chengdu 610041, China
(Wang) Department of Thoracic Surgery, Cancer Hospital and Institute,
Sichuan Cancer Center, School of Medicine, University of Electronic
Science and Technology of China, Chengdu 610000, China
(Su) Rehabilitation Department, West China Hospital, Sichuan University,
Chengdu 610041, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: To investigate the influence of preoperative physical training
combining aerobic and breathing exercises on surgical lung cancer patients
with impaired lung function. Method(s): A total of 68 patients with
predicted postoperative FEV1% <60% were equally and randomly assigned into
one-week physical training combining aerobic and breathing exercises
(intervened group: IG) or routine preoperative preparation (control group:
CG). Then, 6-min walking distance (6-MWD), in-hospital length of stay
(LOS), and other clinical variables were included and recorded.
 Result(s): An increase of 22.6+/-27.0 m of 6-MWD was observed in IG,
compared to 2.7+/-27.6 m in CG (between-group difference: 19.9 m, 95% CI:
6.7 to 33.2, P=0.004), but no difference was found in lung function. The
emotional function of EORTC-QLQ-30 was significantly improved in IG after
the training regimen, compared to CG. Meanwhile, the intervened patients
(IG) had significantly lower postoperative pulmonary complication (PPC)
rate (11.8%, 4/34 vs. 35.3%, 12/34, P=0.022), shorter postoperative LOS
[median: 5.0 interquartile (4.0-7.0) vs. 8.0 (7.0-10.0) days, P<0.001] and
lower costs, including total cost [48,588.7 (44,999.1-52,693.3) vs.
52,445.3 (49,002.9-61,994.0) , P=0.016], material cost [23,350.8
(18,300.6-26,421.9) vs. 25,730.0 (21,328.7-29,250.2) , P=0.048] and drug
cost [7,230.0 (6,661.9-8,347.4) vs. 11,388.6 (7,963.0-16,314.3) ,
P<0.001]. Conclusion(s): The preoperative physical training combining
aerobic and breathing exercises can improve exercise capacity, decrease
the occurrence of PPCs, and shorten LOS with lower in-hospital cost; it
thus shows potential to be an effective preparation strategy for surgical
lung cancer patients with limited lung function. Copyright ©
Annals of Translational Medicine. All rights reserved.

<40>
[Use Link to view the full text]
Accession Number
629892947
Title
Effect of baseline left ventricular ejection fraction on 2-year outcomes
after transcatheter aortic valve replacement: Analysis of the PARTNER 2
Trials.
Source
Circulation: Heart Failure. 12 (8) (no pagination), 2019. Article Number:
e005809. Date of Publication: 01 Aug 2019.
Author
Furer A.; Chen S.; Redfors B.; Elmariah S.; Pibarot P.; Herrmann H.C.;
Hahn R.T.; Kodali S.; Thourani V.H.; Douglas P.S.; Alu M.C.; Fearon W.F.;
Passeri J.; Malaisrie S.C.; Crowley A.; McAndrew T.; Genereux P.;
Ben-Yehuda O.; Leon M.B.; Burkhoff D.
Institution
(Furer, Chen, Redfors, Alu, Crowley, McAndrew, Ben-Yehuda, Leon, Burkhoff)
Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY
10019, United States
(Redfors) Sahlgrenska University Hospital, Goteborg, Sweden
(Elmariah, Passeri) Department of Cardiology, Massachusetts General
Hospital, Boston, United States
(Pibarot) Department of Medicine, Quebec Heart and Lung Institute Laval
University, Canada
(Herrmann) Department of Medicine, University of Pennsylvania,
Philadelphia, United States
(Hahn, Kodali) Department of Medicine, Columbia University Medical Center,
New York, NY, United States
(Thourani) MedStar Heart and Vascular Institute, Georgetown University
School of Medicine, Washington, DC, United States
(Douglas) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Fearon) Department of Medicine (Cardiovascular Medicine), Stanford
University, CA, United States
(Malaisrie) Division of Cardiac Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center, NJ,
United States
(Furer) IDF Medical Corps Headquarters, Israel
(Furer) School of Military Medicine, Hadassah Medical Center, Jerusalem,
Israel
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Impaired left ventricular function is associated with worse
prognosis among patients with aortic stenosis treated medically or with
surgical aortic valve replacement. It is unclear whether reduced left
ventricular ejection fraction (LVEF) is an independent predictor of
adverse outcomes after transcatheter aortic valve replacement.
 Methods and Results: Patients who underwent transcatheter aortic
valve replacement in the PARTNER 2 trials (Placement of Aortic
Transcatheter Valves) and registries were stratified according to presence
of reduced LVEF (<50%) at baseline, and 2-year risk of cardiovascular
mortality was compared using Kaplan-Meier methods and multivariable Cox
proportional hazards regression. Of 2991 patients, 839 (28%) had reduced
LVEF. These patients were younger, more often males, and were more likely
to have comorbidities, such as coronary disease, diabetes mellitus, and
renal insufficiency. Compared with patients with normal LVEF, patients
with low LVEF had higher crude rates of 2-year cardiovascular mortality
(19.8% versus 12.0%, P<0.0001) and all-cause mortality (27.4% versus
19.2%, P<0.0001). Mean aortic valve gradient was not associated with
clinical outcomes other than heart failure hospitalizations (hazard ratio
[HR], 0.99; CI, 0.99-1.00; P=0.03). After multivariable adjustment,
patients with reduced versus normal LVEF had significantly higher adjusted
risk of cardiovascular death (adjusted HR, 1.42, 95% CI, 1.11-1.81;
P=0.005), but not all-cause death (adjusted HR, 1.20; 95% CI, 0.99-1.47;
P=0.07). When LVEF was treated as continuous variable, it was associated
with increased 2-year risk of both cardiovascular mortality (adjusted HR
per 10% decrease in LVEF, 1.16; 95% CI, 1.07-1.27; P=0.0006) and all-cause
mortality (adjusted HR, 1.09; 95% CI, 1.01-1.16; P=0.02).
 Conclusion(s): In this patient-level pooled analysis of PARTNER 2
patients who underwent transcatheter aortic valve replacement, baseline
LVEF was an independent predictor of 2-year cardiovascular mortality.
Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique
identifiers: NCT01314313, NCT02184442, NCT03222128, and
NCT02184441. Copyright © 2019 Lippincott Williams and Wilkins.
All rights reserved.

<41>
[Use Link to view the full text]
Accession Number
629886338
Title
Ripple-AT Study: A Multicenter and Randomized Study Comparing 3D Mapping
Techniques During Atrial Tachycardia Ablations.
Source
Circulation: Arrhythmia and Electrophysiology. 12 (8) (no pagination),
2019. Article Number: 007394. Date of Publication: 01 Aug 2019.
Author
Luther V.; Agarwal S.; Chow A.; Koa-Wing M.; Cortez-Dias N.; Carpinteiro
L.; De Sousa J.; Balasubramaniam R.; Farwell D.; Jamil-Copley S.;
Srinivasan N.; Abbas H.; Mason J.; Jones N.; Katritsis G.; Lim P.B.;
Peters N.S.; Qureshi N.; Whinnett Z.; Linton N.W.F.; Kanagaratnam P.
Institution
(Luther, Koa-Wing, Mason, Katritsis, Lim, Peters, Qureshi, Whinnett,
Linton, Kanagaratnam) Department of Cardiology, Mary Stanford Wing, St
Marys Hospital, Imperial College Healthcare NHS Trust, London W2 1NY,
United Kingdom
(Agarwal, Mason) Papworth Hospital, Cambridge, United Kingdom
(Chow, Srinivasan, Abbas) Barts Heart Centre, London, United Kingdom
(Cortez-Dias, Carpinteiro, De Sousa) Hospital de Santa Maria, Lisbon,
Portugal
(Balasubramaniam, Jones) Royal Bournemouth and Christchurch Hospital,
United Kingdom
(Farwell) Essex Cardiothoracic Centre, Basildon, United Kingdom
(Jamil-Copley) Nottingham University Hospital, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Ripple mapping (RM) is an alternative approach to activation
mapping of atrial tachycardia (AT) that avoids electrogram annotation. We
tested whether RM is superior to conventional annotation based local
activation time (LAT) mapping for AT diagnosis in a randomized and
multicenter study. Method(s): Patients with AT were randomized to
either RM or LAT mapping using the CARTO3v4 CONFIDENSE system. Operators
determined the diagnosis using the assigned 3D mapping arm alone, before
being permitted a single confirmatory entrainment manuever if needed. A
planned ablation lesion set was defined. The primary end point was AT
termination with delivery of the planned ablation lesion set. The
inability to terminate AT with this first lesion set, the use of more than
one entrainment manuever, or the need to crossover to the other mapping
arm was defined as failure to achieve the primary end point.
 Result(s): One hundred five patients from 7 centers were recruited
with 22 patients excluded due to premature AT termination, noninducibility
or left atrial appendage thrombus. Eighty-three patients (pts; RM=42,
LAT=41) completed mapping and ablation within the 2 groups of similar
characteristics (RM versus LAT: prior ablation or cardiac surgery n=35
[83%] versus n=35 [85%], P=0.80). The primary end point occurred in 38/42
pts (90%) in the RM group and 29/41pts (71%) in the LAT group (P=0.045).
This was achieved without any entrainment in 31/42 pts (74%) with RM and
18/41 pts (44%) with LAT (P=0.01). Of those patients who failed to achieve
the primary end point, AT termination was achieved in 9/12 pts (75%) in
the LAT group following crossover to RM with entrainment, but 0/4 pts (0%)
in the RM group crossing over to LAT mapping with entrainment (P=0.04).
 Conclusion(s): RM is superior to LAT mapping on the CARTO3v4
CONFIDENSE system in guiding ablation to terminate AT with the first
lesion set and with reduced entrainment to assist diagnosis. Clinical
Trials Registration: https://www.clinicaltrials.gov. Unique identifier:
NCT02451995. Copyright © 2019 American Heart Association, Inc.

<42>
Accession Number
2003863613
Title
Health Status After Transcatheter Versus Surgical Aortic Valve Replacement
in Low-Risk Patients With Aortic Stenosis.
Source
Journal of the American College of Cardiology. 74 (23) (pp 2833-2842),
2019. Date of Publication: 10 December 2019.
Author
Baron S.J.; Magnuson E.A.; Lu M.; Wang K.; Chinnakondepalli K.; Mack M.;
Thourani V.H.; Kodali S.; Makkar R.; Herrmann H.C.; Kapadia S.; Babaliaros
V.; Williams M.R.; Kereiakes D.; Zajarias A.; Alu M.C.; Webb J.G.; Smith
C.R.; Leon M.B.; Cohen D.J.
Institution
(Baron) Lahey Hospital and Medical Center, Burlington, MA, United States
(Baron, Magnuson, Wang, Chinnakondepalli) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City, Kansas City, MO, United
States
(Lu) Edwards LifeSciences, Irvine, CA, United States
(Mack) Baylor Scott and White Healthcare, Plano, TX, United States
(Thourani) Marcus Heart and Vascular Center, Piedmont Heart Institute,
Atlanta, Georgia
(Kodali, Alu, Smith, Leon) Columbia University Medical Center, New York,
NY, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Herrmann) Hospital of University of Pennsylvania, Philadelphia, PA,
United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Babaliaros) Emory University School of Medicine, Atlanta, Georgia
(Williams) New York University Langone Medical Center, New York, NY,
United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Zajarias) Washington University School of Medicine, Barnes-Jewish
Hospital, St. Louis, MO, United States
(Webb) St. Paul's Hospital, University of British Columbia, Vancouver,
British Columbia, Canada
(Cohen) University of Missouri-Kansas City, Kansas City, MO, United States
Publisher
Elsevier USA
Abstract
Background: In patients with severe aortic stenosis (AS) at low surgical
risk, treatment with transcatheter aortic valve replacement (TAVR) results
in lower rates of death, stroke, and rehospitalization at 1 year compared
with surgical aortic valve replacement; however, the effect of treatment
strategy on health status is unknown. Objective(s): This study sought
to compare health status outcomes of TAVR versus surgery in low-risk
patients with severe AS. Method(s): Between March 2016 and October
2017, 1,000 low-risk patients with AS were randomized to transfemoral TAVR
using a balloon-expandable valve or surgery in the PARTNER 3 (Placement of
Aortic Transcatheter Valves) trial. Health status was assessed at baseline
and 1, 6, and 12 months using the KCCQ (Kansas City Cardiomyopathy
Questionnaire), SF-36 (Short Form-36 Health Survey), and EQ-5D (EuroQoL).
The primary endpoint was change in KCCQ-OS (KCCQ Overall Summary) score
over time. Longitudinal growth curve modeling was used to compare changes
in health status between treatment groups over time. Result(s): At 1
month, TAVR was associated with better health status than surgery (mean
difference in KCCQ-OS 16.0 points; p < 0.001). At 6 and 12 months, health
status remained better with TAVR, although the effect was reduced (mean
difference in KCCQ-OS 2.6 and 1.8 points respectively; p < 0.04 for both).
The proportion of patients with an excellent outcome (alive with KCCQ-OS
>=75 and no significant decline from baseline) was greater with TAVR than
surgery at 6 months (90.3% vs. 85.3%; p = 0.03) and 12 months (87.3% vs.
82.8%; p = 0.07). Conclusion(s): Among low-risk patients with severe
AS, TAVR was associated with meaningful early and late health status
benefits compared with surgery. Copyright © 2019 American College
of Cardiology Foundation

<43>
Accession Number
2003880319
Title
Combined Coronary Artery Bypass Surgery With Bone Marrow Stem Cell
Transplantation: Are We There Yet?.
Source
Annals of Thoracic Surgery. 108 (6) (pp 1913-1921), 2019. Date of
Publication: December 2019.
Author
Ayyat K.S.; Argawi A.; Mende M.; Steinhoff G.; Borger M.A.; Deebis A.M.;
McCurry K.R.; Garbade J.
Institution
(Ayyat, McCurry) Department of Thoracic and Cardiovascular Surgery, Heart
and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, United
States
(Ayyat, McCurry) Department of Inflammation and Immunity, Lerner Research
Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
(Ayyat, Deebis) Department of Cardiothoracic Surgery, Zagazig University,
Zagazig, Egypt
(Argawi, Borger, Garbade) Department of Cardiac Surgery, Heart Center
University, Medicine Leipzig, Leipzig, Germany
(Mende) Coordination Centre for Clinical Trials, University of Leipzig,
Leipzig, Germany
(Steinhoff) Department of Cardiac Surgery, Reference and Translation
Center for Cardiac Stem Cell Therapy, University Medicine Rostock,
Rostock, Germany
Publisher
Elsevier USA
Abstract
Background: Although the safety and feasibility of combined coronary
artery bypass grafting (CABG) and bone marrow stem cell (BMSC)
transplantation have been proven, the efficacy of this approach remains
controversial. Therefore, we conducted an updated meta-analysis of
randomized controlled trials to evaluate the efficacy of this procedure.
 Method(s): Electronic databases were systematically searched for
randomized trials comparing 4-month to 6-month follow-up outcomes in
patients who underwent isolated CABG (CABG group) and patients who
received BMSC transplantation with CABG (BMSC group). A random-effects
meta-analysis was conducted across eligible studies. Meta-regression and
subgroup analyses were utilized to identify sources of data heterogeneity.
 Result(s): Thirteen trials were eligible, with a total number of 292
patients in the BMSC group and 247 patients in the CABG group. Compared
with the CABG group, the BMSC group showed significant improvement of
follow-up left ventricular ejection fraction (n = 539, 4.8%; 95%
confidence interval [CI], 2.3%-7.3%; P = .001). The analyzed data showed
significant heterogeneity (I2 = 74.2%, P < .001). The reduction
in scar size (n = 120; -2.2 mL; 95% CI, -18.2 mL to 13.7 mL; P = .44) and
the improvement in the 6-minute walk test (n = 212; 41 m; 95% CI, -13 m to
95 m; P = .10) did not reach statistical significance. No significant
correlation was found between the number of the injected BMSCs or the
method of injection and the change in ejection fraction.
 Conclusion(s): The present evidence suggests that combined CABG and
BMSC transplantation is associated with improvement of left ventricular
ejection fraction. However, the heterogeneity in the data suggests
variations in patient response to this therapy. Further studies are
required to understand these variations. Copyright © 2019 The
Society of Thoracic Surgeons

<44>
Accession Number
2003880288
Title
The Choice of Treatment in Ischemic Mitral Regurgitation With Reduced Left
Ventricular Function.
Source
Annals of Thoracic Surgery. 108 (6) (pp 1901-1912), 2019. Date of
Publication: December 2019.
Author
Nappi F.; Avtaar Singh S.S.; Padala M.; Attias D.; Nejjari M.; Mihos C.G.;
Benedetto U.; Michler R.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Avtaar Singh) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Padala) Structural Heart Research & Innovation, Laboratory, Carlyle
Fraser Heart Center, Division of Cardiothoracic Surgery, Emory University,
Atlanta, Georgia
(Attias) Department of Cardiology, Centre Cardiologique du Nord,
Saint-Denis, France
(Nejjari) Department of Cardiology, Interventional Cardiology Centre
Cardiologique du Nord, Saint-Denis, France
(Mihos) Echocardiography Laboratory, Division of Cardiology, Columbia
University, Mount Sinai Heart Institute, Miami Beach, FL, United States
(Benedetto) Department of Cardiothoracic Surgery, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Michler) Department of Surgery and Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York,
NY, United States
Publisher
Elsevier USA
Abstract
Background: Ischemic mitral regurgitation is a condition characterized by
mitral insufficiency secondary to an ischemic left ventricle. Primarily,
the pathology is the result of perturbation of normal regional left
ventricular geometry combined with adverse remodeling. We present a
comprehensive review of contemporary surgical, medical, and percutaneous
treatment options for ischemic mitral regurgitation, rigorously examined
by current guidelines and literature. Method(s): We conducted a
literature search of the PubMed database, Embase, and the Cochrane Library
(through November 2018) for studies reporting perioperative or late
mortality and echocardiographic outcomes after surgical and nonsurgical
intervention for ischemic mitral regurgitation. Result(s): Treatment
of this condition is challenging and often requires a multimodality
approach. These patients usually have multiple comorbidities that may
preclude surgery as a viable option. A multidisciplinary team discussion
is crucial in optimizing outcomes. There are several options for treatment
and management of ischemic mitral regurgitation with differing benefits
and risks. Guideline-directed medical therapy for heart failure is the
treatment choice for moderate and severe ischemic mitral regurgitation,
with consideration of coronary revascularization, mitral valve surgery,
cardiac resynchronization therapy, or a combination of these, in
appropriate candidates. The use of transcatheter mitral valve therapy is
considered appropriate in high-risk patients with severe ischemic mitral
regurgitation, heart failure, and reduced left ventricular ejection
fraction, especially in those with hemodynamic instability.
 Conclusion(s): The role of mitral valve surgery and transcatheter
mitral valve therapy continues to evolve. Copyright © 2019 The
Society of Thoracic Surgeons

<45>
Accession Number
2003247973
Title
What is the role of preoperative breathing exercises in reducing
postoperative atelectasis after cabg?.
Source
Reviews on Recent Clinical Trials. 14 (4) (pp 275-279), 2019. Date of
Publication: 2019.
Author
Moradian S.T.; Heydari A.A.; Mahmoudi H.
Institution
(Moradian) Atherosclerosis Research Center, Baqiyatallah University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Heydari, Mahmoudi) Trauma Research Center and faculty of Nursing,
Baqiyatallah University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Bentham Science Publishers (P.O. Box 294, Bussum 1400 AG, Netherlands)
Abstract
Background: Atelectasis and hypoxemia are frequently reported after
coronary artery bypass graft surgery (CABG). Some studies confirm the
benefits of breathing exercises on pulmonary complications, but the
efficacy of preoperative breathing exercises in patients undergoing CABG
is controversial. In this study, the effect of preoperative breathing
exercises on the incidence of atelectasis and hypoxemia in patients
candidate for CABG was examined. Method(s): In a single-blinded
randomized clinical trial, 100 patients who were undergoing coronary
artery bypass graft surgery were randomly allocated into two groups of
experimental and control, each consisted of 50 patients. Before the
operation, experimental group patients were enrolled in a protocol
including deep breathing, cough and incentive spirometer. In the control
group, hospital routine physiotherapy was implemented. All the patients
received the hospital routine physiotherapy once a day for 2 to 3 minutes
in the first four days postoperatively. Arterial blood gases and
atelectasis were compared between groups. Result(s): There was no
significant difference between groups in terms of atelectasis and
hypoxemia (p<inf>Value></inf>0.05). Conclusion(s): Preoperative
breathing exercise does not reduce pulmonary complications in patients
undergoing CABG. Copyright © 2019 Bentham Science Publishers.

<46>
Accession Number
2003247648
Title
Investigating the effect of fibrinogen injection on bleeding in coronary
artery bypass surgery: A clinical trial.
Source
Anesthesiology and Pain Medicine. 9 (4) (no pagination), 2019. Article
Number: e92165. Date of Publication: August 2019.
Author
Zadeh F.J.; Janatmakan F.; Soltanzadeh M.; Zamankhani M.
Institution
(Zadeh, Janatmakan, Soltanzadeh, Zamankhani) Department of Anesthesia,
Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur
University of Medical Sciences, Ahvaz, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: editor@anesthpain.com)
Abstract
Background: Prevention and optimal treatment of postoperative bleeding are
of great clinical importance in various types of surgeries including
coronary artery bypass graft (CABG). Reducing the amount of bleeding will
reduce the complications subsequent to blood transfusion. The positive
effects of coagulation factors, especially fibrinogen, after
cardiovascular bypass could have beneficial effects due to reduced
bleeding and less need for blood transfusion. However, different studies
have reported controversial findings. Objective(s): The present study
aimed to evaluate the effect of prophylactic administration of fibrinogen
on blood loss in patients undergoing CABG surgery to achieve more accurate
clinical outcomes. Method(s): This was a double-blind randomized
clinical trial conducted on 36 patients hospitalized in Ahvaz Imam
Khomeini Hospital for coronary artery bypass graft. Patients were
randomized to receive either fibrinogen concentrate (n = 18) or placebo (n
= 18). Hemoglobin, hematocrit, international normalized ratio, prothrombin
time, partial thromboplastin time, and fibrinogen were checked
preoperatively. The transfusion of allogeneic blood components and the
volume of blood loss were recorded and compared between the groups.
 Result(s): Prophylactic fibrinogen injection reduced the need for
blood transfusion, blood products, and postoperative hypotension in the
fibrinogen group when compared to the control group (P <= 0.005). There
was a significant difference between the two groups in terms of the amount
of bleeding during operation (P <= 0.005). Conclusion(s): Fibrinogen
plays a key role in preventing and stopping the bleeding. Accordingly,
fibrinogen decreases bleeding and the need for paced cell in patients in
CABG. Given the adverse outcomes of bleeding and coagulopathy in patients
undergoing surgery, we conclude that the use of fibrinogen could be
beneficial as a prophylactic in hemorrhagic surgery. Copyright ©
2019, Author(s).

<47>
[Use Link to view the full text]
Accession Number
629881881
Title
Long-Term Effect of Ultrathin-Strut Versus Thin-Strut Drug-Eluting Stents
in Patients with Small Vessel Coronary Artery Disease Undergoing
Percutaneous Coronary Intervention: A Subgroup Analysis of the BIOSCIENCE
Randomized Trial.
Source
Circulation: Cardiovascular Interventions. 12 (8) (no pagination), 2019.
Article Number: e008024. Date of Publication: 01 Aug 2019.
Author
Iglesias J.F.; Heg D.; Roffi M.; Tuller D.; Noble S.; Muller O.; Moarof
I.; Cook S.; Weilenmann D.; Kaiser C.; Cuculi F.; Haner J.; Juni P.;
Windecker S.; Pilgrim T.
Institution
(Iglesias, Roffi, Noble) Division of Cardiology, Geneva University
Hospitals, Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, Bern University Hospital, Switzerland
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Muller) Department of Cardiology, Lausanne University Hospital,
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, Switzerland
(Cuculi) Department of Cardiology, Kantonsspital Luzern, Switzerland
(Haner, Windecker, Pilgrim) Department of Cardiology, University of Bern,
Bern University Hospital, Freiburgstrasse 18, Bern 3010, Switzerland
(Juni) Applied Health Research Centre, Department of Medicine and
Institute of Health Policy, University of Toronto, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Randomized trials evaluating the Orsiro biodegradable polymer
sirolimus-eluting stent (BP-SES; 60 and 80 mum strut thickness for stent
diameters <=3 and >3 mm, respectively) did not stratify according to
vessel size and failed to specify the impact of ultrathin-strut thickness
on long-Term clinical outcomes compared with durable polymer
everolimus-eluting stents (DP-EES). We sought to assess the long-Term
effect of ultrathin-strut (60 mum) BP-SES versus thin-strut (81 mum)
DP-EES on long-Term outcomes in patients undergoing percutaneous coronary
revascularization for small vessel disease. Method(s): In a subgroup
analysis of the randomized, multicenter, noninferiority BIOSCIENCE trial,
patients with stable coronary artery disease or acute coronary syndrome
randomly assigned to treatment with BP-SES or DP-EES were stratified
according to vessel size (<=3 mm versus >3 mm) as a surrogate to compare
patients treated with ultrathin-strut versus thin-strut drug-eluting
stent. The primary end point was target lesion failure, a composite of
cardiac death, target vessel myocardial infarction, and clinically
indicated target lesion revascularization, within 5 years. Result(s):
Among 2109 patients, 1234 (59%) were treated for small vessel disease. At
5 years, target lesion failure occurred in 124 patients (cumulative
incidence, 22.3%) treated with ultrathin-strut BP-SES and 109 patients
(18.3%) treated with thin-strut DP-EES (rate ratio, 1.22; 95% CI,
0.94-1.58; P=0.13). Cumulative incidences of cardiac death, target vessel
myocardial infarction, and clinically indicated target lesion
revascularization and definite stent thrombosis at 5 years were similar in
patients treated with ultrathin-strut BP-SES and thin-strut DP-EES. After
adjustment for potential confounders, there was no significant interaction
between vessel size and treatment effect of BP-SES versus DP-EES.
 Conclusion(s): We found no significant difference in clinical
outcomes throughout 5 years between patients with small vessel disease
treated with ultrathin-strut BP-SES versus thin-strut DP-EES. Clinical
Trial Registration: URL: https://www.clinicaltrials.gov. Unique
identifier: NCT01443104. Copyright © 2019 American Heart
Association, Inc.

<48>
Accession Number
629881809
Title
Invasive Versus Medical Management in Patients with Prior Coronary Artery
Bypass Surgery with a Non-ST Segment Elevation Acute Coronary Syndrome: A
Pilot Randomized Controlled Trial.
Source
Circulation: Cardiovascular Interventions. 12 (8) (no pagination), 2019.
Article Number: e007830. Date of Publication: 01 Aug 2019.
Author
Lee M.M.Y.; Petrie M.C.; Rocchiccioli P.; Simpson J.; Jackson C.E.;
Corcoran D.S.; Mangion K.; Brown A.; Cialdella P.; Sidik N.P.; McEntegart
M.B.; Shaukat A.; Rae A.P.; Hood S.H.M.; Peat E.E.; Findlay I.N.; Murphy
C.L.; Cormack A.J.; Bukov N.B.; Balachandran K.P.; Oldroyd K.G.; Ford I.;
Wu O.; McConnachie A.; Barry S.J.E.; Berry C.
Institution
(Lee, Petrie, Rocchiccioli, Simpson, Jackson, Corcoran, Mangion,
Cialdella, Sidik, McEntegart, Shaukat, Rae, Hood, Peat, Oldroyd, Berry)
Department of Cardiology, West of Scotland Heart and Lung Centre, Golden
Jubilee National Hospital, Glasgow, United Kingdom
(Brown) British Heart Foundation Glasgow Cardiovascular Research Centre,
Institute of Cardiovascular and Medical Sciences, University of Glasgow,
United Kingdom
(Ford, McConnachie) Robertson Centre for Biostatistics, University of
Glasgow, United Kingdom
(Wu) Health Economics and Health Technology Assessment, University of
Glasgow, United Kingdom
(Findlay) Department of Cardiology, Western Infirmary, Glasgow, United
Kingdom
(Findlay, Murphy, Cormack) Department of Cardiology, Royal Alexandra
Hospital, Paisley, United Kingdom
(Murphy) Department of Cardiology, Glasgow Royal Infirmary, United Kingdom
(Bukov, Balachandran) Department of Cardiology, Royal Blackburn Hospital,
United Kingdom
(Barry) Department of Mathematics and Statistics, University of
Strathclyde, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The benefits of routine invasive management in patients with
prior coronary artery bypass grafts presenting with non-ST elevation acute
coronary syndromes are uncertain because these patients were excluded from
pivotal trials. Method(s): In a multicenter trial, non-ST elevation
acute coronary syndromes patients with prior coronary artery bypass graft
were prospectively screened in 4 acute hospitals. Medically stabilized
patients were randomized to invasive management (invasive group) or
noninvasive management (medical group). The primary outcome was adherence
with the randomized strategy by 30 days. A blinded, independent Clinical
Event Committee adjudicated predefined composite outcomes for efficacy
(all-cause mortality, rehospitalization for refractory ischemia/angina,
myocardial infarction, hospitalization because of heart failure) and
safety (major bleeding, stroke, procedure-related myocardial infarction,
and worsening renal function). Result(s): Two hundred seventeen
patients were screened and 60 (mean+/-SD age, 71+/-9 years, 72% male) were
randomized (invasive group, n=31; medical group, n=29). One-Third (n=10)
of the participants in the invasive group initially received percutaneous
coronary intervention. In the medical group, 1 participant crossed over to
invasive management on day 30 but percutaneous coronary intervention was
not performed. During 2-years' follow-up (median [interquartile range],
744 [570-853] days), the composite outcome for efficacy occurred in 13
(42%) subjects in the invasive group and 13 (45%) subjects in the medical
group. The composite safety outcome occurred in 8 (26%) subjects in the
invasive group and 9 (31%) subjects in the medical group. An efficacy or
safety outcome occurred in 17 (55%) subjects in the invasive group and 16
(55%) subjects in the medical group. Health status (EuroQol 5 Dimensions)
and angina class in each group were similar at 12 months.
 Conclusion(s): More than half of the population experienced a serious
adverse event. An initial noninvasive management strategy is feasible. A
substantive health outcomes trial of invasive versus noninvasive
management in non-ST elevation acute coronary syndromes patients with
prior coronary artery bypass grafts appears warranted. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT01895751. Copyright © 2019 American Heart Association, Inc.

<49>
Accession Number
2003957020
Title
Acute myocardial infarction following penetrating thoracic trauma: A case
report and review of literature.
Source
International Journal of Surgery Case Reports. 65 (pp 358-360), 2019. Date
of Publication: 2019.
Author
Bhuller S.B.; Hasan S.R.; Weaver J.; Lieser M.
Institution
(Bhuller, Weaver) Department of Surgery, Sky Ridge Medical Center, 10101
RidgeGate Parkway, Lone Tree, CO 80124, United States
(Hasan) Department of Internal Medicine, Oak Hill Hospital, 11375 Cortez
Blvd, Brooksville, FL 34613, United States
(Lieser) Department of Trauma Surgery, Research Medical Center, 2316 E
Meyer Blvd, Kansas City, MO 64132, United States
Publisher
Elsevier Ltd
Abstract
Introduction: Acute myocardial infarction (AMI) as a result of penetrating
thoracic trauma (PTT) is rare; however, there have been a few reports of
AMI from gunshot wounds. Presentation of case: A patient without a history
of coronary artery disease (CAD) presented with stab wounds to the left
chest and underwent a left anterior thoracotomy, left lung wedge
resection, negative pericardial window, and negative exploratory
laparotomy. Shortly after leaving the operating room (OR) in a stable
condition, the patient experienced a STEMI. An acute thrombus in the
proximal left anterior descending (LAD) artery was identified.
 Discussion(s): AMI as a result of trauma, both blunt and penetrating,
is extremely rare. There have been more reports of AMI secondary to blunt
trauma, but it is much less common to find reports in literature of AMI
from PTT. Conclusion(s): AMI as a result of penetrating trauma is
rare, but can occur secondary to an acute thrombus, even in the absence of
a direct cardiac injury. MI should be a consideration in patients with
penetrating trauma to the chest, regardless of the intensity of the
trauma. At minimum, a 12-lead electrocardiogram (ECG) and a baseline
troponin should be obtained at initial evaluation and post-operatively, if
surgically managed. If ECG demonstrates findings concerning for MI, it
should be followed with an echocardiogram and/or cardiac angiogram to
further help guide management, with an early cardiology
consultation. Copyright © 2019

<50>
Accession Number
2003642921
Title
"The heart supporters": systematic review for ventricle assist devices in
congenital heart surgery.
Source
Heart Failure Reviews. (no pagination), 2019. Date of Publication: 2019.
Author
Comentale G.; Giordano R.; Pilato E.; D'Amore A.; Romano R.; Simeone S.;
Browning R.; Palma G.; Iannelli G.
Institution
(Comentale, Giordano, Pilato, D'Amore, Simeone, Palma, Iannelli) Division
of Cardiac Surgery, University of Napoli "Federico II", Sergio Pansini
ndegree5, Napoli 80131, Italy
(Romano) Division of Pediatrics, University of Napoli "Federico II",
Sergio Pansini ndegree5, Napoli 80131, Italy
(Browning) Division of Cardiovascular Perfusion, The Royal Brompton,
London, United Kingdom
Publisher
Springer
Abstract
Ventricular assist device (VAD) implantation is a widely used procedure in
children with cardiac failure refractory to medical therapy as a long-term
bridge to recovery or transplant. This strategy has proved to be of an
enormous advantage in the cure of these children. The aim of this review
is to evaluate the current strategies used for clinical monitoring of
paediatric patients with a VAD, focusing on the management of several
aspects such as anticoagulant and antiplatelet therapy, haemorrhagic and
thrombotic complications, as well as the effects that VADs have on the
exposure, effectiveness and the safety of drugs. The sources used for this
research are MEDLINE, PubMed and Cochrane Library. The use of key words
such as "paediatric ventricular assist device", "clinical management",
"anticoagulant therapy" and "infections" retrieved 146 papers. With the
application of the inclusion criteria, 42 articles have been selected, but
following further analysis, only 21 were eligible. The post-implant
process is still complicated due to the lack of guidelines regarding
clinical management and for the frequent occurrence of adverse events
including bleeding, infection and thromboembolic episodes. From these
findings, we can highlight the importance of establishing a suitable
antithrombotic therapy, as well as ensuring that the prevention and
treatment of infection are paramount during the management of these
patients. The clinical management of VAD paediatric children is complex
and challenging. At the moment, there are no guidelines regarding
strategies to adopt, but from the analysed surveys, it has been possible
to highlight a relative coherence between adopted therapies in different
centres worldwide. Copyright © 2019, Springer Science+Business
Media, LLC, part of Springer Nature.

<51>
Accession Number
2003639900
Title
What is the safety and efficacy of the use of automated fastener in heart
valve surgery?.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Salmasi M.Y.; Chien L.; Hartley P.; Al-Balah A.; Lall K.; Oo A.; Casula
R.; Athanasiou T.
Institution
(Salmasi, Athanasiou) Department of Surgery and Cancer, Imperial College
London, London, United Kingdom
(Chien, Hartley, Al-Balah) Department of Medical Sciences, Faculty of
Medicine, Imperial College London, London, United Kingdom
(Lall, Oo) Barts Health Centre, Barts Health Trust, London, United Kingdom
(Casula) Department of Cardiac Surgery, Hammersmith Hospital, London,
United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Cor-Knot automated fastener has been used as an adjunct in
heart valve surgery to eliminate the need for manual tying during valve
implantation. Although reduced operative time and facilitation for
minimally invasive surgery are clear benefits, whether their use
translates to improved patient outcome remains debatable. This study aims
to review the safety and efficacy of automated fasteners in heart valve
surgeries. Method(s): Specific searches were conducted via online
medical databases (Pubmed, Embase, Ovid) between 1950 and June 2019.
Longitudinal studies were included that provided operative parameters.
 Result(s): The initial literature search identified 3773 articles,
but only eight met the inclusion criteria and were used for analysis: four
studies related to aortic valve replacement (AVR), four related to mitral
valve (MV) intervention (total n = 810). The meta-analysis revealed the
significantly shorter aortic cross-clamp time in the Cor-knot group
compared to manual tying, both in AVR and MV surgeries (P <.05).
Cardiopulmonary bypass time was significantly shorter in the Cor-knot
group when analyzing studies in MV surgery (weighted mean difference
[WMD]: 110.0; 95% confidence interval: 12.3-207.7; P =.027) The use of
Cor-Knot did not increase the risk of permanent pacemaker implantation,
paravalvular leak, and 30-day mortality. The majority of studies reported
no change in the length of intensive unit care and total hospital stay.
 Conclusion(s): We confirmed that the majority of existing literatures
indicated the safety and intraoperative efficacy with automated fastener
application. Nevertheless, there is currently no evidence to support
automated fastened sutures can translate its intraoperative advantages to
improved patient outcome. Copyright © 2019 Wiley Periodicals,
Inc.

<52>
Accession Number
2003639606
Title
Percutaneous repair or medical treatment for secondary mitral
regurgitation: outcomes at 2 years.
Source
European Journal of Heart Failure. (no pagination), 2019. Date of
Publication: 2019.
Author
Armoiry X.; Boutitie F.; Mewton N.; Messika-Zeitoun D.; Saint Etienne C.;
Samson G.; Maucort-Boulch D.; Obadia J.F.; Obadia J.-F.; Barthelet M.;
Grinberg D.; Rioufol G.; Thibault H.; Thivolet S.; Furber A.; Benard T.;
Debrux J.-L.; Pinaud F.; Rouleau F.; Chocron S.; Chopard R.; Meneveau N.;
Schiele F.; Gilard M.; Boschat J.; Castellant P.; Jobic Y.; Le Ven F.;
Romain D.; Beygui F.; Sabatier R.; Saloux E.; Motreff P.; Clerfond G.;
Azarnoush K.; Lusson J.R.; Vorilhon C.; Teiger E.; Champagne S.; Couetil
J.-P.; Damy T.; Dubois-Rande J.-L.; Ernande L.; Guendouz S.; Lim P.; Monin
J.-L.; Nguyen A.; Ternacle J.; Zerbib C.; Bertrand B.; Bouvaist H.;
Saunier C.; Vaislic C.; Khelifa R.C.; Favereau X.; Hilpert L.; Maribas P.;
Azmoun A.; Angel J.-Y.; Baruteau A.; Brenot P.; Deleuze P.; Garcon P.;
Raoux F.; Slama M.; Van Belle E.; Prat A.; Coisne A.; Duvapentiah A.;
Juthier F.; Modine T.; Polge A.-S.; Richardson M.; Rousse N.; Spillemaeker
H.; Sudre A.; Vincent F.; Vincentelli A.; Jeu A.; Ketelers R.; Bonnet
J.-L.; Bonnet G.; Habib G.; Pankert M.; Salaun E.; Collart F.; Houel R.;
Bille J.; Commeau P.; Joly P.; Michel N.; Philip E.; Collet F.; Armero S.;
Bayet G.; Giacomoni M.-P.; Maximovitch A.; Lefevre T.; Cormier B.; Romano
M.; Leclercq F.; Albat B.; Cade S.; Cransac F.; Macia J.-C.; Piot C.;
Francois F.; Pons M.; Raczka F.; Sportouch C.; Juilliere Y.; Folliguet T.;
Huttin O.; Popovic B.; Selton-Suty C.; Venner C.; Guerin P.; Baron O.;
Letocart V.; Letourneau T.; Piriou N.; Trochu J.-N.; Belliard O.; Allouch
P.; Bensouda C.; Janower S.; Makowski S.; Pasquier D.; Pilliere R.;
Rosencher J.; Moceri P.; Vahanian A.; Brochet E.; Himbert D.; Iung B.;
Nataf P.; Spaulding C.; Achouh P.; Jouan J.; Karam N.; Mirabel M.; Puscas
T.; Riant E.; Suen P.W.; Caussin C.; Berrebi A.; Diakov C.; Philippe F.;
Veugeois A.; Collet J.P.; Choussat R.; Isnard R.; Montalescot G.; Leroux
L.; Coste P.; Dijos M.; Labrousse L.; Lafitte S.; Picard F.; Raud-Raynier
P.; Degrand B.; Bedossa M.; Corbineau H.; Donal E.; Leurent G.;
Eltchaninoff H.; Bauer F.; Tron C.; Nejjari M.; Attias D.; Gerbay A.;
Pierrard R.; Fuzellier J.-F.; Drogoul L.; Elebeze J.-P.; Lopez S.;
Mariottini C.; Meyer P.; Mihoubi A.; Tapia M.; Teboul J.; Ohlmann P.;
Goette-Dimarco P.; Kretz J.-G.; Mommerot A.; Morel O.; Petit-Eisenmann H.;
Samet A.; Trinh A.; Carrie D.; Gautier M.; Badie Y.L.; Lhermusier T.;
Marcheix B.; Tchetche D.; Abouliatim I.; Bonfils L.; Dumonteil N.; Farah
B.; Fondard O.; Pathak A.; Etienne C.S.; Bernard A.; Dion F.; Loardi C.;
Quilliet L.; Seemann A.; Antoine C.; Arnoult M.A.; Meurisse Y.; Wautot F.;
Champagnac D.; Dementhon J.; Doisy V.; Frieh J.-P.; Garrier O.; Jamal F.;
Lamartine S.; Leroux P.-Y.; Lienhart Y.; Staat P.; Zouaghi O.
Institution
(Iung, Messika-Zeitoun, Brochet, Himbert) Universite de Paris and INSERM
1148, Paris, France
(Iung, Vahanian) APHP, Hopital Bichat, DHU FIRE, Paris, France
(Armoiry) Pharmacy Department and Laboratoire MATEIS, Hospices Civils de
Lyon and Claude Bernard University, Lyon, France
(Boutitie, Maucort-Boulch) Lyon, France; Universite Lyon 1, Villeurbanne,
France; CNRS, UMR5558, Laboratoire de Biometrie et Biologie Evolutive,
Equipe Biostatistique-Sante, Service de Biostatistique - Bioinformatique,
Pole Sante Publique, Hospices Civils de Lyon, Villeurbanne, France
(Mewton, Samson) Hopital Cardiovasculaire Louis Pradel, Clinical
Investigation Center & Heart Failure Department, INSERM 1407, Hospices
Civils de Lyon and Claude Bernard University, Lyon, France
(Trochu, Guerin, Piriou) CHU Nantes, INSERM, Nantes Universite, Clinique
Cardiologique et des Maladies Vasculaires, CIC 1413, Institut du Thorax,
Nantes, France
(Lefevre, Cormier) Institut Jacques Cartier, Massy, France
(Messika-Zeitoun) Division of Cardiology, University of Ottawa Heart
Institute, Ottawa, Canada
(Thibault, Thivolet) Hopital Cardiovasculaire Louis Pradel, Service des
Explorations Fonctionnelles Cardiovasculaires, Hospices Civils de Lyon and
Claude Bernard University, Lyon, France
(Leurent, Donal) CHU Rennes, Hopital Pontchaillou, Rennes, France
(Bonnet, Habib) APHM, Hopital de la Timone, Marseille, France
(Piot) Clinique du Millenaire, Montpellier, France
(Rouleau) CHU Angers, Angers, France
(Carrie) CHU Toulouse, Hopital Rangueil, Toulouse, France
(Nejjari) Centre Cardiologique du Nord, Saint-Denis, France
(Ohlmann) Hopitaux Universitaires de Strasbourg, Nouvel Hopital Civil,
Strasbourg, France
(Saint Etienne) CHRU de Tours, Hopital Trousseau, Tours, France
(Leroux) CHU Bordeaux, Hopital Haut-Leveque, Pessac, France
(Gilard) CHRU Brest, Hopital de La Cavale Blanche, Brest, France
(Rioufol) Hopital Cardiovasculaire Louis Pradel, Service d'Hemodynamique
et Cardiologie Interventionnelle, Hospices Civils de Lyon and Claude
Bernard University, Lyon, France
(Obadia) Hopital Cardiovasculaire Louis Pradel, Chirurgie
Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon
and Claude Bernard University, Lyon, France
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Aims: The MITRA-FR trial showed that among symptomatic patients with
severe secondary mitral regurgitation, percutaneous repair did not reduce
the risk of death or hospitalization for heart failure at 12 months
compared with guideline-directed medical treatment alone. We report the
24-month outcome from this trial. Methods and Results: At 37 centres,
we randomly assigned 304 symptomatic heart failure patients with severe
secondary mitral regurgitation (effective regurgitant orifice area >20
mm2 or regurgitant volume >30 mL), and left ventricular
ejection fraction between 15% and 40% to undergo percutaneous valve repair
plus medical treatment (intervention group, n = 152) or medical treatment
alone (control group, n = 152). The primary efficacy outcome was the
composite of all-cause death and unplanned hospitalization for heart
failure at 12 months. At 24 months, all-cause death and unplanned
hospitalization for heart failure occurred in 63.8% of patients (97/152)
in the intervention group and 67.1% (102/152) in the control group [hazard
ratio (HR) 1.01, 95% confidence interval (CI) 0.77-1.34]. All-cause.
mortality occurred in 34.9% of patients (53/152) in the intervention group
and 34.2% (52/152) in the control group (HR 1.02, 95% CI 0.70-1.50).
Unplanned hospitalization for heart failure occurred in 55.9% of patients
(85/152) in the intervention group and 61.8% (94/152) in the control group
(HR 0.97, 95% CI 0.72-1.30). Conclusion(s): In patients with severe
secondary mitral regurgitation, percutaneous repair added to medical
treatment did not significantly reduce the risk of death or
hospitalization for heart failure at 2 years compared with medical
treatment alone. Copyright © 2019 The Authors. European Journal
of Heart Failure © 2019 European Society of Cardiology

<53>
Accession Number
2003637598
Title
Dexmedetomidine Reduces Atrial Fibrillation After Adult Cardiac Surgery: A
Meta-Analysis of Randomized Controlled Trials.
Source
American Journal of Cardiovascular Drugs. (no pagination), 2019. Date of
Publication: 2019.
Author
Liu Y.; Zhang L.; Wang S.; Lu F.; Zhen J.; Chen W.
Institution
(Liu, Wang, Lu, Zhen, Chen) Department of Intensive Care Unit, Beijing
Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian
District, Beijing 100038, China
(Zhang) Department of anesthesiology, Beijing Daxing Maternal and Child
Care Hospital, Beijing, China
Publisher
Adis
Abstract
Background: Dexmedetomidine has been shown to have antiarrhythmic effects
by exhibiting sympatholytic properties and activating the vagus nerve in
preclinical studies. Results from clinical trials of dexmedetomidine on
atrial fibrillation (AF) following adult cardiac surgery are
controversial. Material(s) and Method(s): We searched EMBASE, PubMed
and Cochrane CENTRAL databases for randomized controlled trials (RCTs)
comparing the antiarrhythmic effect of dexmedetomidine versus placebo or
other anesthetic drugs in adult patients undergoing cardiac surgery. The
primary outcome was the incidence of AF. The secondary outcomes were
ventricular arrhythmias [ventricular fibrillation (VF), ventricular
tachycardia (VT)], mechanical ventilation (MV) duration, intensive care
unit (ICU) length of stay, and hospital length of stay, and all-cause
mortality. Result(s): Thirteen trials with a total of 1684 study
patients were selected. Compared with controls, dexmedetomidine
significantly reduced the incidence of postoperative AF [odds ratio (OR)
0.75; 95% confidence interval (CI) 0.58-0.97; P = 0.03] and VT (OR 0.23;
95% CI 0.11-0.48; P < 0.0001). No significant difference for the incidence
of VF existed (OR 0.80; 95% CI 0.21-3.03; P = 0.74). There was no
significant difference between groups in MV duration [weighted mean
difference (WMD) - 0.10; 95% CI - 0.42 to 0.21; P = 0.52], postoperative
ICU stay (WMD - 0.49; 95% CI - 2.64 to 1.66; P = 0.65), hospital stay (WMD
- 0.01; 95% CI - 0.16 to 0.13; P = 0.88) and mortality (OR 0.59; 95% CI
0.15-2.37; P = 0.46). Conclusion(s): Perioperative administration of
dexmedetomidine in adult patients undergoing cardiac surgery reduced the
incidence of postoperative AF and VT. But there was no significant
difference in incidence of VF, MV duration, ICU stay, hospital stay and
mortality. Copyright © 2019, Springer Nature Switzerland AG.

<54>
Accession Number
2003620547
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: 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
Springer Tokyo (E-mail: orders@springer.jp)
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. Copyright © 2019, The Japanese Association for
Thoracic Surgery.

<55>
Accession Number
629881543
Title
Occurence of First and Recurrent Major Adverse Cardiovascular Events with
Liraglutide Treatment among Patients with Type 2 Diabetes and High Risk of
Cardiovascular Events: A Post Hoc Analysis of a Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Verma S.; Bain S.C.; Buse J.B.; Idorn T.; Rasmussen So.; Orsted D.D.;
Nauck M.A.
Institution
(Verma) Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St
Michael's Hospital, University of Toronto, 30 Bond St, Bond Wing, Toronto,
Toronto, ON M5B 1W8, Canada
(Bain) Diabetes Research Unit Cymru, Swansea University Medical School,
Swansea, United Kingdom
(Buse) Department of Medicine, University of North Carolina, School of
Medicine at Chapel Hill, Chapel Hill, United States
(Idorn, Rasmussen, Orsted) Novo Nordisk A/S, Soborg, Denmark
(Nauck) Diabetes Center Bochum-Hattingen, St Josef Hospital
(Ruhr-Universitat Bochum), Bochum, Germany
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: After the occurrence of nonfatal cardiovascular events,
recurrent events are highly likely. Most cardiovascular outcomes trials
analyze first events only; extending analyses to first and recurrent
(total) events can provide clinically meaningful information.
 Objective(s): To investigate whether liraglutide is associated with
reduced first and recurrent total major adverse cardiovascular events
(MACE) compared with placebo among patients with type 2 diabetes and high
risk of cardiovascular events. Design, Setting, and Participant(s):
This post hoc analysis of the Liraglutide Effect and Action in Diabetes:
Evaluation of Cardiovascular Outcome Results (LEADER) randomized,
double-blind, clinical trial included data from patients with type 2
diabetes who had established or were at high risk for cardiovascular
disease at 410 sites in 32 countries from August 2010, to December 2015.
Data analysis was performed from August 15, 2016, to July 5, 2019.
 Intervention(s): Patients were randomized 1:1 to receive liraglutide
(up to 1.8 mg per day) or placebo, both with standard care, for 3.5 to 5.0
years. Main Outcomes and Measures: Assessed outcomes were MACE
(cardiovascular death, nonfatal myocardial infarction, and nonfatal
stroke), expanded MACE (primary MACE plus coronary revascularization and
hospitalization for heart failure or unstable angina pectoris), and the
individual end points. Result(s): The 9340 LEADER trial participants
(6003 [64.3%] male; mean [SD] age, 64.3 [7.2] years) experienced 1605
total MACE (1302 first and 303 recurrent events; median follow-up, 3.8
years [range, 0-5.2 years]). Patients who experienced any MACE were older
(1 MACE: mean [SD] age, 65.6 [8.0] years; >1 MACE: 65.7 [7.9] years) and
had diabetes for longer duration (1 MACE: mean [SD] duration, 13.4 [8.3]
years; >1 MACE: 14.4 [8.7] years) compared with patients without MACE
(mean [SD] age, 64.1 [7.1] years; mean [SD] duration, 12.7 [7.9] years).
Fewer first and recurrent MACE occurred in the liraglutide group (n =
4668; 608 first and 127 recurrent events) than in the placebo group (n =
4672; 694 first and 176 recurrent events). Liraglutide was associated with
a 15.7% relative risk reduction in total MACE (hazard ratio [HR], 0.84;
95% CI, 0.76-0.93) and a 13.4% reduction in total expanded MACE (HR, 0.87;
95% CI, 0.81-0.93) compared with placebo. For most individual
cardiovascular end points, liraglutide was associated with lower risk vs
placebo. Conclusions and Relevance: These results suggest that
liraglutide treatment is associated with reduced total MACE compared with
placebo among patients with type 2 diabetes and high risk of
cardiovascular events. This analysis supports the findings of an absolute
benefit of liraglutide treatment with respect to the overall burden of
cardiovascular events in this high-risk patient population. Trial
Registration: ClinicalTrials.gov identifier: NCT01179048. Copyright
© 2019 American Medical Association. All rights reserved.

<56>
Accession Number
629868988
Title
Comparison of ultrasound-guided erector spinae plane block and thoracic
paravertebral block for postoperative analgesia after video-assisted
thoracic surgery: A randomized controlled non-inferiority clinical trial.
Source
Regional Anesthesia and Pain Medicine. (no pagination), 2019. Article
Number: 100827. Date of Publication: 2019.
Author
Taketa Y.; Irisawa Y.; Fujitani T.
Institution
(Taketa, Irisawa, Fujitani) Department of Anesthesiology and Critical
Care, Ehime Prefectural Central Hospital, Matsuyama 790-0024, Japan
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background and objectives: The anesthetic characteristics of
ultrasound-guided erector spinae plane block (ESPB) remain unclear. We
compared the analgesic efficacies of ESPB and thoracic paravertebral block
(TPVB) for analgesia after video-assisted thoracic surgery (VATS).
 Method(s): In this prospective randomized non-inferiority trial, 88
patients undergoing VATS randomly received ESPB or TPVB. All patients
received continuous infusion of 0.2% levobupivacaine (8 mL/hour) after
injection of a 20 mL 0.2% levobupivacaine bolus. The primary outcome was
median differences between the groups in postoperative numerical rating
scale (NRS) scores at rest, 24 hours postoperatively. Result(s):
Eighty-one patients completed the study. The median difference in NRS
scores at rest 24 hours postoperatively was 1 (range 0-1), demonstrating
the non-inferiority of ESPB to TPVB. NRS scores at rest were significantly
lower in the TPVB group at 1, 2 and 24 hours postoperatively (p=0.02, 0.01
and 0.006, respectively). NRS scores on movement were similar. More
dermatomes in parasternal regions were anaesthetized in the TPVB group
(p<0.0001). Total plasma levobupivacaine concentrations were significantly
lower in the ESPB group within 20 hours postoperatively (p=0.036).
 Conclusion(s): The analgesic effect of ESPB after VATS was
non-inferior to that of TPVB 24 hours postoperatively. Trial registration
number: UMIN000030658. Copyright © American Society of Regional
Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and
permissions. Published by BMJ.

<57>
Accession Number
2002634003
Title
Postoperative Adjuvant Chemotherapy or Chemoradiation versus Surgery alone
for Thoracic Pathological Node Positive Esophageal Cancer: A Propensity
Score-Matched Analysis (APEC Study 2).
Source
International Journal of Radiation Oncology Biology Physics. Conference:
The American Society for Radiation Oncology 61st Annual Meeting. United
States. 105 (1 Supplement) (pp S129), 2019. Date of Publication: 1
September 2019.
Author
Wang Q.; Li T.; Han Y.; Li Q.; Peng L.; Xie T.; Fang Q.; Yang X.; Zhuang
X.; Dai W.; Jiang Y.; Wang Y.; Lv J.; Wu L.; Cao B.; Lang J.
Institution
(Wang, Li, Wang, Lv, Wu, Cao, Lang) Department of Radiation Oncology,
Sichuan Cancer Hospital& Institution, Sichuan Cancer Center, School of
Medicine, University of Electronic Science and Technology of China,
Chengdu, China
(Han, Li, Peng, Xie, Fang, Yang, Zhuang, Dai, Jiang) Thoracic Surgery
Department, Sichuan Cancer hospital institute/Sichuan Cancer Center/School
of Medicine, University of Electronic Science and Technology of China,
Chengdu, China
Publisher
Elsevier Inc.
Abstract
Purpose/Objective(s): No completed randomized controlled trial has
compared long-term survival outcomes of patients receiving postoperative
adjuvant chemotherapy (POCT group) and chemoradiation therapy (POCRT
group) compare with surgery alone (S group) directly for Pathological node
positive Thoracic Esophageal Squamous cell cancer (N+ TESCC).
Materials/Methods: Patients with N+ TESCC receiving either adjuvant
chemotherapy or chemoradiation after esophagectomy were identified at
Sichuan Cancer Hospital from January 2009 to December 2017. Univariate
analysis compared patient, tumor, and postoperative outcome
characteristics. Kaplan-Meier analysis was performed to compare overall
survival (OS) and disease free survival (DFS) by adjuvant therapy type.
Propensity score matching was used to create patient groups that were
balanced across several covariates (n= 281 in each group). Finally, a Cox
proportional hazards model was fitted to identify variables associated
with increased mortality hazard. Result(s): From 2009 to 2017, a
total of 1490 of N+ TESCC patients received operation whereas 283(19.0%)
received POCRT, 563 (37.8%) received POCT, 644(43.2%) received Surgery
alone. Patients who received POCRT and POCT were more likely to achieve a
longer 5-year OS (38.8% and 30.0% versus 27.3%, p = 0.005) and DFS (36.4%
and 27.5% versus 25.2%, p = 0.089). These data were confirmed in the
matched samples (5-year OS, 38.1% and 30.9 % versus 20.5% [p = 0.006];
DFS, 35.9% and 28.2% versus 19.6% [p = 0.017]). Multivariate Cox analyses
in the matched samples revealed that postoperative POCRT and POCT were
independently associated with longer OS (hazard ratio = 0.878, 95%
confidence interval: 0.818 - 0.942, p < 0.001) and longer DFS (hazard
ratio = 0.931, 95% confidence interval: 0.869-0.997, p = 0.042 ) than
resection alone. Subgroup analysis found: for N1-2 patients, POCRT and
POCT have longer 5-year OS (p=0.001) and DFS (p=0.034) than S group. For
N3 patients, postoperative adjuvant therapy cannot prolong the OS and DFS
than resection alone. Conclusion(s): Postoperative adjuvant
chemoradiation therapy and chemotherapy are strongly associated with
improved OS and DFS in patients with N positive TESCC. A multicenter,
randomized phase III clinical trial is warranted to confirm these
findings. Copyright © 2019

<58>
Accession Number
2002629167
Title
Pterins as diagnostic markers of mechanical and impact-induced trauma: A
systematic review.
Source
Journal of Clinical Medicine. 8 (9) (no pagination), 2019. Article Number:
1383. Date of Publication: September 2019.
Author
Lindsay A.; Baxter-Parker G.; Gieseg S.P.
Institution
(Lindsay) Institution for Physical Activity and Nutrition (IPAN), School
of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
(Baxter-Parker, Gieseg) School of Biological Sciences, University of
Canterbury, Christchurch 8140, New Zealand
(Gieseg) Department of Radiology, University of Otago Christchurch, PO Box
4345, Christchurch 8011, New Zealand
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
We performed a systematic review of the literature to evaluate pterins as
biomarkers of mechanical and impact-induced trauma. MEDLINE and Scopus
were searched in March 2019. We included in vivo human studies that
measured a pterin in response to mechanical or impact-induced trauma with
no underlying prior disease or complication. We included 40 studies with a
total of 3829 subjects. Seventy-seven percent of studies measured a
significant increase in a pterin, primarily neopterin or total neopterin
(neopterin + 7,8-dihydroneopterin). Fifty-one percent of studies measured
an increase within 24 h or trauma, while 46% measured increases beyond 48
h. Pterins also showed promise as predictors of post-trauma complications
such as sepsis, multi-organ failure and mortality. Exercise-induced trauma
and traumatic brain injury caused an immediate increase in neopterin or
total neopterin, while patients of multiple trauma had elevated pterin
levels that remained above baseline for several days. Pterin concentration
changes in response to surgery were variable with patients undergoing
cardiac surgery having immediate and sustained pterin increases, while
hysterectomy, liver resection or hysterectomy showed no change. This
review provides systematic evidence that pterins, in particular neopterin
and total neopterin, increase in response to multiple forms of mechanical
or impact-induced trauma. Copyright © 2019 by the authors.
Licensee MDPI, Basel, Switzerland.

<59>
Accession Number
2002219762
Title
Hemoadsorption to Reduce Plasma-Free Hemoglobin During Cardiac Surgery:
Results of REFRESH I Pilot Study.
Source
Seminars in Thoracic and Cardiovascular Surgery. 31 (4) (pp 783-793),
2019. Date of Publication: Winter 2019.
Author
Gleason T.G.; Argenziano M.; Bavaria J.E.; Kane L.C.; Coselli J.S.;
Engelman R.M.; Tanaka K.A.; Awad A.; Sekela M.E.; Zwischenberger J.B.
Institution
(Gleason) University of Pittsburgh Medical Center, Department of
Cardiothoracic Surgery, Pittsburgh, PA, United States
(Argenziano) Columbia University Medical Center-New York Presbyterian
Hospital, Department of Surgery, New York, NY, United States
(Bavaria) Hospital of the University of Pennsylvania, Department of
Surgery, Philadelphia, PA, United States
(Kane) Texas Children's Hospital, Department of Surgery, Houston, TX,
United States
(Coselli) Texas Heart Institute, Department of Surgery, Houston, TX,
United States
(Engelman) Baystate Medical Center, Department of Surgery, Springfield,
MA, United States
(Tanaka) University of Maryland School of Medicine, Department of
Anesthesiology, Baltimore, MD, United States
(Awad) Cooper University Hospital, Camden, NJ, United States
(Sekela, Zwischenberger) University of Kentucky College of Medicine,
Department of Surgery, Lexington, KY, United States
Publisher
W.B. Saunders
Abstract
Generation of plasma-free hemoglobin (pfHb) and activated complement
during complex cardiac surgery contributes to end-organ dysfunction. This
prospective, multicenter REFRESH I (REduction in FREe Hemoglobin)
randomized controlled trial evaluated the safety and feasibility of
CytoSorb hemoadsorption therapy to reduce these factors during prolonged
cardiopulmonary bypass (CPB). Eligible patients underwent elective,
nonemergent complex cardiac surgery with expected CPB duration >=3 hours.
Exclusions included single procedures including primary coronary artery
bypass graft, single valves, transplant, and left ventricular assist
device extraction. TREATMENT used 2 parallel 300 mL CytoSorb
hemoadsorption cartridges in a side circuit during CPB. CONTROL was
standard of care. Of 52 enrolled patients, 46 underwent surgery (Safety
group, n = 23 vs Control, n = 23), and 38 were evaluated for pfHb
reduction (EFFICACY group, n = 18 vs CONTROL, n = 20). Type and number of
serious adverse events (44 vs 43 CONTROL) were similar, as was 30-day
mortality. Transient reduction in platelets during CPB was observed in
both groups, especially TREATMENT, but returned to pretreatment levels
after CPB without bleeding. Peak pfHb was positively correlated with CPB
length (P = 0.01) but the high variability of pfHb, due to the broad
surgical procedure mix, prevented detection of changes in pfHb in the
overall EFFICACY population. However, the valve replacement surgery
subgroup (8 vs 10 CONTROL) had the highest peak pfHb levels, and TREATMENT
demonstrated significant pfHb reductions vs CONTROL (P <= 0.05) in CPB >=3
hours. In the EFFICACY group, C3a and C5a were significantly reduced by
treatment throughout surgery. Intraoperative hemoadsorption with CytoSorb
was safe and feasible in this randomized, controlled pilot study during
complex cardiac surgery. Treatment with CytoSorb resulted in significant
reductions in pfHb during valve replacement surgery and reductions in C3a
and C5a in the overall EFFICACY group. Future studies will target complex
cardiac surgery patients with prolonged CPB to assess hemoadsorption
effect on end-organ dysfunction and outcomes. Copyright © 2019

<60>
Accession Number
2002077425
Title
Could Short-Term Perioperative High-Dose Atorvastatin Offer Antiarrhythmic
and Cardio-Protective Effects in Rheumatic Valve Replacement Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (12) (pp 3340-3347),
2019. Date of Publication: December 2019.
Author
Allah E.A.; Kamel E.Z.; Osman H.M.; Abd-Elshafy S.K.; Nabil F.; Elmelegy
T.T.H.; Elkhayat H.; Ibrahim A.S.; Minshawy A.A.
Institution
(Allah, Kamel, Osman, Abd-Elshafy, Nabil, Ibrahim) Faculty of Medicine,
Assiut University, Assiut, Egypt
(Elmelegy) Clinical pathology department, Faculty of Medicine, Assiut
University, Assiut, Egypt
(Elkhayat, Minshawy) Cardiothoracic Surgery department, Faculty of
Medicine, Assiut, Egypt
Publisher
W.B. Saunders
Abstract
Objectives: To evaluate the role of prophylactic high-dose atorvastatin
for prevention of postoperative atrial fibrillation (POAF), inflammatory
response attenuation, and myocardial protection after valve replacement
cardiac surgery. Design(s): Randomized controlled trial.
 Setting(s): Assiut University Hospitals. Participant(s):
Sixty-four adult patients undergoing cardiac valve replacement surgery.
 Intervention(s): The participants were equally divided into 2 groups.
Group S received 80 mg of atorvastatin (oral tablets), 12 and 2 hours
preoperatively, and on the 2nd, 3rd, 4th, and 5th postoperative days.
Control group C received placebo at the same time periods. Measurements:
The incidence of POAF, postoperative white blood cell count, serum
C-reactive protein, interleukin 6, and troponin I. Main Result(s):
Group S patients showed a lower incidence of POAF compared with the
placebo group (p = 0.031). The white blood cell count showed significant
reductions in group S compared with group C on the second, third, fourth,
and fifth postoperative days. The C-reactive protein level showed
significant reductions on the third, fourth, and fifth postoperative days
in group S compared with group C (p = 0.001, 0.001, and 0.001,
respectively). The serum level of interleukin 6 showed a significant
reduction on the fifth postoperative day in group S compared with group C
(p = 0.001). There was no significant difference between the 2 groups
regarding the troponin I level and inotropic score. Conclusion(s):
Prophylactic use of high dose atorvastatin can decrease the incidence of
POAF and attenuate the inflammatory process in adult patients undergoing
isolated rheumatic cardiac valve replacement surgery. Copyright ©
2019 Elsevier Inc.

<61>
Accession Number
2003355967
Title
Preoperative Anemia and Outcomes in Cardiovascular Surgery: Systematic
Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 108 (6) (pp 1840-1848), 2019. Date of
Publication: December 2019.
Author
Padmanabhan H.; Siau K.; Curtis J.; Ng A.; Menon S.; Luckraz H.; Brookes
M.J.
Institution
(Padmanabhan, Siau, Menon, Brookes) Department of Gastroenterology, Heart
& Lung Centre, Wolverhampton, United Kingdom
(Curtis) Shrewsbury Health Library, Royal Shrewsbury Hospital, Shrewsbury,
United Kingdom
(Ng) Department of Cardiothoracic Anaesthesiology, Heart & Lung Centre,
Wolverhampton, United Kingdom
(Luckraz) Cardiothoracic Surgery Department, Heart Centre, American
Hospital Dubai, Oud Metha, Dubai, United Arab Emirates
Publisher
Elsevier USA
Abstract
Background: Preoperative anemia is common in patients scheduled for
cardiac surgery. However, its effect on postoperative outcomes remains
controversial. This meta-analysis aimed to clarify the impact of anemia on
outcomes after cardiac surgery. Method(s): A literature search was
conducted on MEDLINE, Embase, Cochrane, and Web of Science databases. The
primary outcome was 30-day postoperative or in-hospital mortality.
Secondary outcomes included acute kidney injury, stroke, blood
transfusion, and infection. A meta-analytic model was used to determine
the differences in the above postoperative outcomes between anemic and
nonanemic patients. Result(s): Of 1103 studies screened, 22 met the
inclusion criteria. Of 114,277 patients, 23,624 (20.6%) were anemic.
Anemia was associated with increased mortality (odds ratio [OR], 2.74; 95%
confidence interval [CI], 2.32-3.24; I2 = 69.6%; P < .001),
acute kidney injury (OR, 3.13; 95% CI, 2.37-4.12; I2 = 71.1%; P
< .001), stroke (OR, 1.46; 95% CI, 1.24-1.72; I2 = 21.6%; P <
.001), and infection (OR, 2.65; 95% CI, 1.98-3.55; I2 = 46.7%;
P < .001). More anemic patients were transfused than nonanemic patients
(33.3% vs 11.9%, respectively). No statistically significant association
was found between mortality and blood transfusion (OR, 1.35; 95% CI,
0.92-1.98; I2 = 83.7%; P = .12), but we were not able to
compare mortality with or without transfusion in those who were or were
not anemic. Conclusion(s): Preoperative anemia is associated with
adverse outcomes after cardiac surgery. These findings support the
addition of preoperative anemia to future risk prediction models and as a
target for risk modification. Copyright © 2019 The Society of
Thoracic Surgeons

<62>
Accession Number
2001441112
Title
Polyether ether ketone (PEEK) and its 3D printed implants applications in
medical field: An overview.
Source
Clinical Epidemiology and Global Health. 7 (4) (pp 571-577), 2019. Date of
Publication: December 2019.
Author
Haleem A.; Javaid M.
Institution
(Haleem, Javaid) Department of Mechanical Engineering, Jamia Millia
Islamia, New Delhi, India
Publisher
Elsevier B.V.
Abstract
Background: Extensively studied research articles on Polyether ether
ketone (PEEK) in "medical" and "PEEK 3D printing in the medical field" to
identify a direction of the development and identify critical applications
in medicine. Material(s) and Method(s): This is a literature-based
study of research articles listed in Scopus. A literature review &
bibliometric analysis is done to achieve the research objective.
 Result(s): Searching keywords as "PEEK" "medical" through Scopus
identified 426 research articles and searching "PEEK" "medical" "3D
printing" identified ten articles. This study identifies that PEEK is a
suitable material that helps innovation and helps to solve different
surgical and medical problems. Analysis of the Scopus data depicts an
increasing trend in the medical field, especially the application of this
material. Much research is done on PEEK in medical, but there is very less
work reported on PEEK 3D printing in medical. 3D PEEK implants are
preferred in medical for requirements of extensive customisation. This
technology caters well to the manufacturing of prosthetics, artificial
bone, heart & its parts and other human parts. Finally, twelve important
applications areas are identified in medical. Conclusion(s): PEEK has
somewhat bone like properties. This material can be well used in 3D
printing technologies to help fulfil various challenges of the medical. In
medical, PEEK materials foresee different surgical application as it can
replace titanium and ceramic implants. The need is to explore the use of
PEEK in different surgeries of orthopaedic, spine, maxilla-facial, cranial
and others 3D printing manufactures complex design implants as per
requirement of a patient with an exact match. This material is also
applicable for cardiac surgery like manufacturing of heart valve
prostheses and leaflet heart valves. PEEK material is hard, lightweight,
stiff and is a robust polymer while having satisfactory wear properties
that help implants with an extended life. In dentistry, PEEK implants have
also the potential for use in tooth replacement. It seems somewhat
cost-effective to fulfil innovative medical requirements with comparable
wear and mechanical strength. Copyright © 2019 INDIACLEN

<63>
Accession Number
2001745066
Title
Intraoperative intercostal nerve cryoablation During the Nuss procedure
reduces length of stay and opioid requirement: A randomized clinical
trial.
Source
Journal of Pediatric Surgery. 54 (11) (pp 2250-2256), 2019. Date of
Publication: November 2019.
Author
Graves C.E.; Moyer J.; Zobel M.J.; Mora R.; Smith D.; O'Day M.; Padilla
B.E.
Institution
(Graves, Moyer, Zobel, Mora, Smith, O'Day, Padilla) Division of Pediatric
Surgery, Department of Surgery, University of California, San Francisco,
United States
Publisher
W.B. Saunders
Abstract
Purpose: Minimally-invasive repair of pectus excavatum by the Nuss
procedure is associated with significant postoperative pain, prolonged
hospital stay, and high opiate requirement. We hypothesized that
intercostal nerve cryoablation during the Nuss procedure reduces hospital
length of stay (LOS) compared to thoracic epidural analgesia.
 Design(s): This randomized clinical trial evaluated 20 consecutive
patients undergoing the Nuss procedure for pectus excavatum between May
2016 and March 2018. Patients were randomized evenly via closed-envelope
method to receive either cryoanalgesia or thoracic epidural analgesia.
Patients and physicians were blinded to study arm until immediately
preoperatively. Setting(s): Single institution, UCSF-Benioff
Children's Hospital. Participant(s): 20 consecutive patients were
recruited from those scheduled for the Nuss procedure. Exclusion criteria
were age < 13 years, chest wall anomaly other than pectus excavatum,
previous repair or other thoracic surgery, and chronic use of pain
medications. Main Outcomes and Measures: Primary outcome was
postoperative LOS. Secondary outcomes included total operative time,
total/daily opioid requirement, inpatient/outpatient pain score, and
complications. Primary outcome data were analyzed by the Mann-Whitney
U-test for nonparametric continuous variables. Other continuous variables
were analyzed by two-tailed t-test, while categorical data were compared
via Chi-squared test, with alpha = 0.05 for significance. Result(s):
20 patients were randomized to receive either cryoablation (n = 10) or
thoracic epidural (n = 10). Mean operating room time was 46.5 min longer
in the cryoanalgesia group (p = 0.0001). Median LOS decreased by 2 days in
patients undergoing cryoablation, to 3 days from 5 days (Mann-Whitney U, p
= 0.0001). Cryoablation patients required significantly less inpatient
opioid analgesia with a mean decrease of 416 mg oral morphine equivalent
per patient (p = 0.0001), requiring 52%-82% fewer milligrams on
postoperative days 1-3 (p < 0.01 each day). There was no difference in
mean pain score between the groups at any point postoperatively, up to one
year, and no increased incidence of neuropathic pain in the cryoablation
group. No complications were noted in the cryoablation group; among
patients with epidurals, one patient experienced a symptomatic
pneumothorax and another had urinary retention. Conclusions and relevance:
Intercostal nerve cryoablation during the Nuss procedure decreases
hospital length of stay and opiate requirement versus thoracic epidural
analgesia, while offering equivalent pain control. Type of Study:
Treatment study. Level of Evidence: Level I. Copyright ©
2019 Elsevier Inc.

<64>
Accession Number
2003433121
Title
Meta-analysis Evaluating the Safety and Efficacy of Transcarotid
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 124 (12) (pp 1940-1946), 2019. Date of
Publication: 15 December 2019.
Author
Usman M.S.; Rawasia W.F.; Siddiqi T.J.; Mujeeb F.A.; Nadeem S.; Alkhouli
M.
Institution
(Usman, Siddiqi, Mujeeb, Nadeem) Dow University of Health Sciences,
Karachi, Pakistan
(Rawasia) River Region Cardiology Associates, Montgomery, AL, United
States
(Alkhouli) Mayo Clinic School of Medicine - Mayo Clinic, Rochester, MN,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We performed a systemic review and meta-analysis of studies evaluating
transcarotid vascular access for transcatheter aortic valve implantation
(TAVI). Published studies evaluating transcarotid vascular access for TAVI
were included in this analysis. Outcomes of interest included 30-day
mortality, stroke/transient ischemic attack (TIA), new pacemaker
implantation, acute kidney injury (AKI), major vascular complication,
major bleeding, and myocardial infarction. Pooled estimate for 30-day
mortality was 5.3% (95% confidence interval [CI] 4.0% to 6.8%;
I2 = 4%), stroke/TIA was 3.4% (95% CI 2.4% to 4.6%;
I2 = 0%), new pacemaker implantation was 15.3% (95% CI 10.8% to
19.7%; I2 = 72%), AKI was 3.4% (95% CI 1.3% to 6.5%;
I2 = 58%), major vascular complication was 2.4% (95% CI 1.1% to
3.7%; I2 = 46%), major bleeding was 4.3% (95% CI 2.8% to 6.1%;
I2 = 11%), and myocardial infarction was 1.1% (95% CI 0.4% to
2.0%; I2 = 0%). Metaregression was carried out to study the
association of effect size with the continuous study-level covariates that
included average age, proportion of males, and mean STS score. In this
regard, mean STS score showed association with major vascular
complications (coefficient: 0.008; p = 0.049). Cumulative meta-analysis
carried out showed that there was temporal trend of decreasing incidence
of stroke/TIA, major vascular complications, and AKI for transcarotid
TAVI. In conclusion, transcarotid access for TAVI is a reasonable choice
in patients requiring alternate access to transfemoral
route. Copyright © 2019 Elsevier Inc.

<65>
Accession Number
629725262
Title
The serratus plane block for postoperative analgesia in breast and
thoracic surgery: A systematic review and meta-analysis.
Source
Regional Anesthesia and Pain Medicine. 44 (12) (pp 1066-1074), 2019. Date
of Publication: 01 Dec 2019.
Author
Chong M.; Berbenetz N.; Kumar K.; Lin C.
Institution
(Chong, Kumar, Lin) Department of Anesthesia and Perioperative Medicine,
Western University, London, ON N6A 3K7, Canada
(Berbenetz) Department of Medicine, Queen's University, Kingston, ON,
Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background and objectives The serratus plane block (SPB) is a novel chest
wall interfascial plane block. Its analgesic efficacy compared with
non-block care and paravertebral block (PVB) is unestablished. Methods We
conducted a random-effects meta-analysis of randomized controlled trials
(RCTs) recruiting adult surgical patients that compared a SPB to non-block
care or PVB for postoperative analgesia. Visual analog scale pain scores
were the primary outcome. Database sources were Medline, Embase, the
Cochrane Library, and Google Scholar searched up to July 29, 2019 without
language restriction. Risk of bias was assessed using Cochrane
methodology. Results Nineteen RCTs that comprised 1260 patients were
included. Six trials involved thoracic surgery patients and 13 studied
breast surgery patients. SPB reduced pain scores 0 hour postoperatively
(-1.62 cm; 99% CI-2.43 to-0.81; p<0.001; I 2 =92%), at 2-4 hours (-1.29
cm; 99% CI-2.08 to-0.49; p<0.001; I 2 =92%), at 6 hours (-1.69 cm; 99%
CI-3.19 to-0.20; p=0.004; I 2 =99%), and up to 24 hours compared with
non-block care. SPB also prolonged the time to first analgesic request
(193.2 min; 95% CI 7.2 to 379.2 min; p=0.04; I 2 =99%), reduced 24-hour
postoperative opioid consumption (-11.27 mg of IV morphine
equivalent;-17.36 to-5.18 mg; p<0.001), and reduced postoperative nausea
and vomiting (RR 0.51; 95% CI 0.38 to 0.68; p<0.001; I 2 =12%). In
contrast, no meaningful differences were detected in any of the outcomes
for the SPB versus PVB data. Conclusions SPB reduced postoperative pain
scores (Grading of Recommendations Assessment, Development, and Evaluation
rating: low; due to heterogeneity and deficiencies in blinding) in breast
and thoracic surgery patients compared with non-block care. Based on five
trials only, SPB was not appreciably different from PVB. Copyright
© American Society of Regional Anesthesia & Pain Medicine 2019. No
commercial re-use. See rights and permissions. Published by BMJ.

<66>
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. 124 (12) (pp 1869-1875), 2019. Date of
Publication: 15 December 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.

<67>
Accession Number
2001546788
Title
Effect of pranayama on anxiety and pain among patients undergoing cardiac
surgery: A non-randomized controlled trial.
Source
Clinical Epidemiology and Global Health. 7 (4) (pp 606-610), 2019. Date of
Publication: December 2019.
Author
Chandrababu R.; Kurup S.B.; Ravishankar N.; Ramesh J.
Institution
(Chandrababu) Manipal College of Nursing, Manipal Academy of Higher
Education, Manipal, Karnataka 576104, India
(Kurup) Sri Ramachandra College of Nursing, Sri Ramachandra Institute of
Higher Education and Research, Porur, Chennai 600116, India
(Ravishankar) Department of Statistics, Prasanna School of Public Health,
Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
(Ramesh) Udupi College of Nursing, Shree Krishna Educational Trust,
Manipal, Karnataka 576104, India
Publisher
Elsevier B.V.
Abstract
Background: Major cardiac surgery could be physically and mentally
stressful. Anxiety and pain are commonly experienced by patients while
undergoing cardiac surgery. Yoga is recognized as the most beneficial
complementary and alternative therapy. Objective(s): To assess the
effect of alternate nostril breathing exercises (pranayama) on anxiety and
pain among patients undergoing cardiac surgery. Method(s): A
non-randomized controlled trial was adopted as study design and involved
48 patients undergoing cardiac surgery. The experimental group (n = 24)
received pranayama study intervention while the control group (n = 24)
received routine care of the hospital. Outcomes were state anxiety and
pain, measured with the state anxiety inventory and a visual analogue
scale respectively. Data were analyzed by SPSS version 20.0. Repeated
measures ANOVA was used to test the effect of the intervention.
 Result(s): Study results showed that patients in the experimental
group experienced a significant decrease in anxiety (p < 0.05) than the
control group. There was a decrease in pain scores but was not
statistically significant across different time point measurements at p <
0.05 between the groups. Conclusion(s): These findings support the
use of pranayama for decreasing anxiety among patients undergoing cardiac
surgery. However, there is a need for randomized controlled trials with
higher sample size to confirm this results. Future trials also should
focus on the estimation of relevant biomarkers such as endorphins to
understand the scientific rationale. Copyright © 2019 INDIACLEN

<68>
Accession Number
629909786
Title
Risk prediction of acute kidney injury after cardiac surgery in a
high-risk South Asian population: Data from a single center.
Source
Indian Journal of Nephrology. Conference: 50th Annual Conference of Indian
Society of Nephrology, ISNCON 2019. India. 29 (7 Supplement 1) (pp S27),
2019. Date of Publication: November 2019.
Author
Gharge A.; Nayak S.; Shenoy P.
Institution
(Gharge) Department of General Medicine and Nephrology, Nitte University,
Mangalore, Karnataka, India
(Nayak, Shenoy) Nephrology, K. S. Hegde Medical Academy, Nitte University,
Mangalore, Karnataka, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is a frequent
postoperative complication associated with an increased risk of mortality,
morbidity, and hospital costs. Preoperative risk scores such as the
Cleveland Clinic Scoring Tool (CCST) have been validated in Western
population group to identify patients at higher risk of AKI and may
facilitate preventive strategies. However, the scoring tool has not been
validated systematically in a South Asian cohort. AIM OF THE STUDY: To
evaluate the applicability of the CCST in prediction of AKI after open
cardiac surgery in a South Indian tertiary care center. METHOD(S):
This was a retrospective study on all patients who underwent elective open
cardiac surgery over 7 years from January 2012 to December 2018 at a
single center, and relevant details were extracted from a comprehensive
chart review. The primary outcome was AKI as defined by the Kidney Disease
Improving Global Outcomes criteria. Patients were risk stratified as per
the CCST to assess for prediction of AKI into low-risk (0-2);
intermediate-risk (3-5); and high-risk (>6) groups. RESULT(S): A
total of 490 patients underwent open cardiac surgery, with a mean age of
52.27 +/- 12.03 years. Overall incidence of AKI was 11.6%. Mean age, sex,
body mass index, preoperative serum creatinine, diabetes mellitus, chronic
obstructive pulmonary disease, and cardiopulmonary bypass time were not
statistically different in patients who developed AKI versus those who did
not have AKI postoperatively. The mean CCST scores were 1.6 in those
without AKI; 1.8 in Stage 1 AKI; 3.0 in Stage 2 AKI; and 4.3 in Stage 3
AKI. Higher risk scores predicted greater risk of AKI. A total of 108
patients (22%) were on angiotensinconverting enzyme
(ACE)/angiotensinreceptor blockers (ARBs); 135 patients (27.5%) received
betablockers; 119 (24.2%) received diuretics; while 193 (39.3%) had
received preoperative statins. Comparison of drug use between the two
groups revealed that preoperative use of ACEI/ARB was associated with
highest risk of AKI (P = 0.006). Mortality rate was also high at 26.3% in
those with AKI compared to 1.8% in non-AKI group (P = 0.04).
 CONCLUSION(S): The modified CCST was valid in risk identification of
patients with severe stage of AKI but did not have strong discrimination
for early AKI stages. Preoperative statin use did not protect against AKI;
however, preoperative ARB/ACEI use was significantly associated with
occurrence of postoperative AKI.

<69>
Accession Number
629909757
Title
Estimation of cause of death due to kidney disease and need for
standardization of cause of death certification.
Source
Indian Journal of Nephrology. Conference: 50th Annual Conference of Indian
Society of Nephrology, ISNCON 2019. India. 29 (7 Supplement 1) (pp
S91-S92), 2019. Date of Publication: November 2019.
Author
Gupta A.K.; Singh N.P.
Institution
(Gupta, Singh) Department of Nephrology, Max Super Speciality Hospital,
Vaishali, Ghaziabad; Uttar Pradesh, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
BACKGROUND: Estimation of disease burden in a population provides a basis
for setting up priorities in health programs. In developing countries,
where four-fifth of the world's deaths occur, ascertaining mortality due
to kidney failure is difficult due to insufficient coverage of vital
registration and low reliability of the cause of death (COD) in the death
certificate. Since precise, reliable, and up-to-date, statistics about
causes of death were not available. AIM OF THE STUDY: To estimate the
contribution of acute kidney injury (AKI) in ascertaining COD among
deceased patients. METHOD(S): This was a preliminary pilot study and
there was no existing literature available that ascertains the cause of
death due to kidney disease. The COD derived from 150 deceased patients
death certificates were verified with hospital records of the deceased
patient to find out the actual cause of death. The priority was given to
death occurred from the wards having high risk of mortality due to kidney
disease such as intensive care unit, cardiac care unit, surgery unit,
pulmonology, gastroenterology unit, oncology, and general medicine unit.
Death record files of 150 randomly selected deceased patients were
analyzed to find out the cause of death vis-a-vis hospital patient
records. Patient's death summary and death certificates were analyzed
along with death files. RESULT(S): Of 150 deceased, 85 were male with
a mean age of 64.18 +/- 15.4 years. 66% of deaths occurred among
individuals aged 60 years and above. COD was selected from a restricted
list derived from the ICD-10. The causes selected for inclusion in the
list comprises from death certificate/summary (there was multiple COD in
individual patient). As per record of death summary/certificate, disease
of kidney (acute kidney injury [AKI], acute on chronic kidney disease
[CKD], glomerulonephritis [GN], and nephropathy) accounted for 78 (52%).
In contrast, the number of cases of kidney disease reported as per
analysis of death records was found in 126 (84%) deceased patients. As per
record from death certificate and summary, COD due to kidney disease was
found in 60 (40%) and 52 (34.7%), respectively. In contrast, on analysis
of death records, COD due to kidney disease was found in 97(64.6%) cases.
All patients those who had COD due to CKD had elevated creatinine, anuric,
sepsis, septic shock, and MODS and more than three-fourth had history of
anemia. CONCLUSION(S): In comparison to death certificate/summary,
there were higher numbers of COD cases due to kidney disease (AKI, acute
on CKD, GN, and nephropathy) on analysis of death records. In view of the
growing importance of CKD, setting up of pointers for ascertaining
mortality due to kidney disease should be advocated.

<70>
Accession Number
629016316
Title
The role of paravertebral blocks in ambulatory surgery: Review of the
literature.
Source
Acta Clinica Croatica. 58 (Supplement 1) (pp 43-47), 2019. Date of
Publication: 2019.
Author
Zupcic M.; Dedic D.; Zupcic S.G.; Duzel V.; Simurina T.; Sakic L.;
Grubjesic I.; Sutic I.; Korusic A.
Institution
(Zupcic, Grubjesic) Clinical Hospital Centre Rijeka, Clinic of
Anesthesiology and Intensive Care Medicine, Rijeka, Croatia
(Zupcic, Zupcic, Sutic) University of Rijeka, Faculty of Medicine,
Department of Physiology and Immunology, Rijeka, Croatia
(Zupcic, Simurina, Korusic) J. J. Strossmayer University, Faculty of
Medicine, Osijek, Croatia
(Dedic, Korusic) Clinical Hospital Dubrava, Clinic of Anaesthesiology,
Reanimatology and Intensive Care Medicine, Zagreb, Croatia
(Zupcic) Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka,
Croatia
(Duzel) Barking, Havering and Redbridge University Hospitals NHS Trust,
Department of Anaesthesia, London, United Kingdom
(Simurina) General Hospital Zadar, Department of Anesthesiology and
Intensive Care Medicine, Zadar, Croatia
(Simurina) Department of Health Studies, University of Zadar, Zadar,
Croatia
(Sakic) Department of Anaesthesiology, Reanimatology and Intensive
Medicine, University Hospital "Sveti Duh", Zagreb, Croatia
(Sutic) University of Rijeka, Faculty of Medicine, Department of Family
medicine, Rijeka, Croatia
Publisher
Klinicka Bolnica Sestre Milosrdnice
Abstract
Ambulatory surgery often involves surgical procedures on the thorax,
abdomen and limbs, which can be associated with substantial postoperative
pain. The aim of this narrative review is to provide an analysis of the
effectiveness of paravertebral block (PVB) alone or in combination with
general anaesthesia, in this setting, with an emphasis on satisfactory
postoperative analgesia in comparison to other modalities. We have
conducted a search of current medical literature written in English
through PubMed, Google Scholar and Ovid Medline. Peer-reviewed
professional articles, review articles, retrospective and prospective
studies, case reports and case series were systematically searched for
during the time period between November 2003 and February 2019. The
literature used for the purpose of creating this review showed that
utilisation of paravertebral block either alone or in combination with
general anaesthesia, has a positive effect on satisfactory analgesia in
ambulatory surgery. With a multimodal analgesic approach of PVB and other
techniques of anaesthesia and analgesia there is a reduction in
postoperative opioid consumption, fewer side effects, lower pain scores,
decreased mortality, earlier mobilisation of patients and reduced hospital
stay. Copyright © 2019, Klinicka Bolnica Sestre Milosrdnice. All
rights reserved.

<71>
Accession Number
2003797151
Title
The effect of carotid chemoreceptor inhibition on exercise tolerance in
chronic obstructive pulmonary disease: A randomized-controlled crossover
trial.
Source
Respiratory Medicine. 160 (no pagination), 2019. Article Number: 105815.
Date of Publication: November - December 2019.
Author
Phillips D.B.; Collins S.E.; Bryan T.L.; Wong E.Y.L.; McMurtry M.S.;
Bhutani M.; Stickland M.K.
Institution
(Phillips, Collins, Bryan, Wong, Bhutani, Stickland) Division of Pulmonary
Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada
(Phillips) Faculty of Kinesiology, Sport, and Recreation, University of
Alberta, Canada
(Collins) Faculty of Rehabilitation Medicine, University of Alberta,
Canada
(McMurtry) Division of Cardiology, Faculty of Medicine and Dentistry,
University of Alberta, Canada
(Stickland) G.F. MacDonald Centre for Lung Health, Covenant Health,
Edmonton, Alberta, Canada
Publisher
W.B. Saunders Ltd
Abstract
Background: Patients with chronic obstructive pulmonary disease (COPD)
have an exaggerated ventilatory response to exercise, contributing to
exertional dyspnea and exercise intolerance. We recently demonstrated
enhanced activity and sensitivity of the carotid chemoreceptor (CC) in
COPD which may alter ventilatory and cardiovascular regulation and
negatively affect exercise tolerance. We sought to determine whether CC
inhibition improves ventilatory and cardiovascular regulation, dyspnea and
exercise tolerance in COPD. Method(s): Twelve mild-moderate COPD
patients (FEV<inf>1</inf> 83 +/- 15 %predicted) and twelve age- and
sex-matched healthy controls completed two time-to-symptom limitation
(T<inf>LIM</inf>) constant load exercise tests at 75% peak power output
with either intravenous saline or low-dose dopamine (2
mug.kg-1.min-1, order randomized) to inhibit the CC.
Ventilatory responses were evaluated using expired gas data and dyspnea
was evaluated using a modified Borg scale. Inspiratory capacity maneuvers
were performed to determine operating lung volumes. Cardiac output was
estimated using impedance cardiography and vascular conductance was
calculated as cardiac output/mean arterial pressure (MAP). Result(s):
At a standardized exercise time of 4-min and at T<inf>LIM</inf>;
ventilation, operating volumes and dyspnea were unaffected by dopamine in
COPD patients and controls. In COPD, dopamine decreased MAP and increased
vascular conductance at all time points. In controls, dopamine increased
vascular conductance at T<inf>LIM</inf>, while MAP was unaffected.
 Conclusion(s): There was no change in time to exhaustion in either
group with dopamine. These data suggest that the CC plays a role in
cardiovascular regulation during exercise in COPD; however, ventilation,
dyspnea and exercise tolerance were unaffected by CC inhibition in COPD
patients. Copyright © 2019 Elsevier Ltd

<72>
Accession Number
2001645104
Title
Best practice in psychological activities in cardiovascular prevention and
rehabilitation: Position Paper.
Source
Monaldi Archives for Chest Disease. 88 (2) (pp 47-83), 2018. Date of
Publication: 2018.
Author
Sommaruga M.; Angelino E.; Porta P.D.; Abatello M.; Baiardo G.; Balestroni
G.; Bettinardi O.; Callus E.; Ciraci C.; Omodeo O.; Rizza C.; Michielin
P.; Ambrosetti M.; Griffo R.; Pedretti R.F.E.; Pierobon A.
Institution
(Sommaruga) Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS,
Via Camaldoli 64, Milan 20138, Italy
(Angelino) Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS,
Turin, Italy
(Porta) FERB Onlus Rehabilitation Center of Cernusco sul Naviglio, Milan,
Italy
(Abatello) Unit of Cardiology, University Health Agency, Trieste, Italy
(Baiardo) Cardiovascular Institute of Camogli, Genova, Italy
(Balestroni) Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS,
Veruno, Italy
(Bettinardi) Department of Mental Health and Addictive Behavior, Local
Health Authority, Piacenza, Italy
(Callus) Clinical Psychology Service, Polyclinic San Donato IRCCS, San
Donato Milanese, Milan, Italy
(Ciraci) Cardiovascular Prevention and Rehabilitation Unit, Don Carlo
Gnocchi Foundation, Parma, Italy
(Omodeo) Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS,
Pavia, Italy
(Rizza) Gruppo Multimedica Spa-IRCCS, Milan, Italy
(Michielin) Department of Psychology, University of Padua, Italy
(Ambrosetti) Cardiovascular Rehabilitation Unit, Le Terrazze Clinic,
Cunardo, Italy
(Griffo) Research and Educational Centre GICR-IACPR, Genoa, Italy
(Pedretti) Department of Cardiology, Istituti Clinici Scientifici Maugeri
IRCCS, Pavia, Italy
(Pierobon) Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS,
Montescano, Italy
Publisher
PAGEPress Publications (E-mail: emanuela.fusinato@pagepress.org)
Abstract
Recent guidelines on cardiovascular disease prevention suggest multimodal
behavioral interventions for psychosocial risk factors and referral for
psychotherapy in the case of clinically significant symptoms of depression
and anxiety overall. Accordingly, psychologists of the Italian Association
for Cardiovascular Prevention, Rehabilitation and Epidemiology
(GICR-IACPR) have reviewed the key components of psychological activities
in cardiovascular prevention and rehabilitation (CPR). The aim of this
study was to elaborate a position paper on the Non com best practice in
routine psychological activities in CPR based on efficacy, effectiveness
and sustainability. The steps followed were: i) a review of the latest
international guidelines and position papers; ii) analysis of the
evidence-based literature; iii) a qualitative analysis of the
psychological services operating in some reference Italian cardiac
rehabilitation facilities; iv) classification of the psychological
activities in CPR as low or high intensity based on the NICE Guidelines on
psychological interventions on anxiety and depression. We confirm the
existence of an association between depression, anxiety, social factors,
stress, personality and illness onset/outcome and coronary heart disease.
Evidence for an association between depression, social factors and disease
outcome emerges particularly for chronic heart failure. Some positive
psychological variables (e.g., optimism) are associated to illness
outcome. Evidence is reported on the impact of psychological activities on
'new' conditions which are now indicated for cardiac rehabilitation:
pulmonary hypertension, grown-up congenital heart, end-stage heart
failure, implantable cardioverter-defribrillator and mechanical
ventricular assist devices, frail and oldest-old patients, and end-of-life
care. We also report evidence related to caregivers. The Panel divided
evidence-based psychological interventions into: i) low intensity
(counseling, psycho-education, self-care, self-management, telemedicine,
self-help); or ii) high intensity (individual, couples and/or family and
group psychotherapy, such as stress management). The results show that
psychotherapy is consisting of cognitive-behavioral therapy (mainly),
interpersonal therapy, and short term psycho-dinamic therapy. The current
data further refine the working tools available for psychological
activities in CPR, giving clear directions about the choice of
interventions, which should be evidence-based and have at least a minimum
standard. This document provides a comprehensive update on new knowledge
and new paths for psychologists working in the CPR
settings. ©Copyright M. Sommaruga et al., 2018 Tipografia PI-ME
Editrice, Italy

<73>
Accession Number
2003605196
Title
Pacemaker Implantation and Dependency After Transcatheter Aortic Valve
Replacement in the REPRISE III Trial.
Source
Journal of the American Heart Association. 8 (21) (no pagination), 2019.
Article Number: e012594. Date of Publication: 05 Nov 2019.
Author
Meduri C.U.; Kereiakes D.J.; Rajagopal V.; Makkar R.R.; O'Hair D.; Linke
A.; Waksman R.; Babliaros V.; Stoler R.C.; Mishkel G.J.; Rizik D.G.; Iyer
V.S.; Schindler J.; Allocco D.J.; Meredith I.T.; Feldman T.E.; Reardon
M.J.
Institution
(Meduri, Rajagopal) Piedmont Heart Institute, Atlanta, GA, United States
(Kereiakes) The Christ Hospital Heart and Vascular Center, The Lindner
Research Center, Cincinnati, OH, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(O'Hair) Aurora St. Luke's Medical Center, Milwaukee, WI, United States
(Linke) Dresden University Hospital, Heart Center Dresden, Germany
(Waksman) Washington Hospital Center, Washington, DC, United States
(Babliaros) Emory University Hospital, Emory University, Atlanta, GA,
United States
(Stoler) Baylor Heart & Vascular Hospital, Dallas, TX, United States
(Mishkel) St. John's Hospital, Springfield, IL, United States
(Rizik) HonorHealth and the Scottsdale-Lincoln Health Network, Scottsdale,
AZ, United States
(Iyer) University at Buffalo/Gates Vascular Institute, Buffalo, NY, United
States
(Schindler) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Allocco, Meredith) Boston Scientific Corp, Marlborough, MA, United States
(Feldman) Edwards Lifesciences, Irvine, CA, United States
(Feldman) Northshore University Health System, Evanston Hospital,
Evanston, IL, United States
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
Publisher
American Heart Association Inc.
Abstract
Background: As transcatheter aortic valve replacement expands to younger
and/or lower risk patients, the long-term consequences of permanent
pacemaker implantation are a concern. Pacemaker dependency and impact have
not been methodically assessed in transcatheter aortic valve replacement
trials. We report the incidence and predictors of pacemaker implantation
and pacemaker dependency after transcatheter aortic valve replacement with
the Lotus valve. Methods and Results: A total of 912 patients with
high/extreme surgical risk and symptomatic aortic stenosis were randomized
2:1 (Lotus:CoreValve) in REPRISE III (The Repositionable Percutaneous
Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve
System-Randomized Clinical Evaluation) trial. Systematic assessment of
pacemaker dependency was pre-specified in the trial design. Pacemaker
implantation within 30 days was more frequent with Lotus than CoreValve.
By multivariable analysis, predictors of pacemaker implantation included
baseline right bundle branch block and depth of implantation; diabetes
mellitus was also a predictor with Lotus. No association between new
pacemaker implantation and clinical outcomes was found. Pacemaker
dependency was dynamic (30 days: 43%; 1 year: 50%) and not consistent for
individual patients over time. Predictors of pacemaker dependency at 30
days included baseline right bundle branch block, female sex, and depth of
implantation. No differences in mortality or stroke were found between
patients who were pacemaker dependent or not at 30 days. Rehospitalization
was higher in patients who were not pacemaker dependent versus patients
without a pacemaker or those who were dependent. Conclusion(s):
Pacemaker implantation was not associated with adverse clinical outcomes.
Most patients with a new pacemaker at 30 days were not dependent at 1
year. Mortality and stroke were similar between patients with or without
pacemaker dependency and patients without a pacemaker. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov/. Unique identifier
NCT02202434. Copyright © 2019 The Authors. Published on behalf of
the American Heart Association, Inc., by Wiley.

<74>
Accession Number
629780693
Title
Long term surgical outcomes for infective endocarditis in people who
inject drugs: A systematic review and meta-analysis.
Source
BMC Infectious Diseases. 19 (1) (no pagination), 2019. Article Number:
918. Date of Publication: 08 Nov 2019.
Author
Goodman-Meza D.; Weiss R.E.; Gamboa S.; Gallegos A.; Bui A.A.T.; Goetz
M.B.; Shoptaw S.; Landovitz R.J.
Institution
(Goodman-Meza, Goetz, Landovitz) Division of Infectious Diseases, David
Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS),
Los Angeles, CA 90095-1688, United States
(Goodman-Meza, Goetz) Infectious Diseases, VA Greater Los Angeles
Healthcare System, Los Angeles, CA, United States
(Weiss) Department of Biostatistics, Fielding School of Public Health,
UCLA, Los Angeles, CA, United States
(Gamboa, Gallegos) Universidad Autonoma de Baja California, United States
(Bui) Medical Imaging Informatics (MII) Group, Department of Radiological
Sciences, UCLA, Los Angeles, CA, United States
(Shoptaw) Department of Family Medicine, David Geffen School of Medicine
at UCLA, Los Angeles, CA, United States
(Landovitz) UCLA Center for Clinical AIDS Research and Education, David
Geffen School of Medicine, Los Angeles, CA, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In recent years, the number of infective endocarditis (IE)
cases associated with injection drug use has increased. Clinical
guidelines suggest deferring surgery for IE in people who inject drugs
(PWID) due to a concern for worse outcomes in comparison to non-injectors
(non-PWID). We performed a systematic review and meta-analysis of
long-term outcomes in PWID who underwent cardiac surgery and compared
these outcomes to non-PWID. Method(s): We systematically searched for
studies reported between 1965 and 2018. We used an algorithm to estimate
individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined
it with published individual patient data (IPD) to analyze long-term
outcomes after cardiac surgery for IE in PWID. Our primary outcome was
survival. Secondary outcomes were reoperation and mortality at 30-days,
one-, five-, and 10-years. Random effects Cox regression was used for
estimating survival. Result(s): We included 27 studies in the
systematic review and 19 provided data (KM or IPD) for the meta-analysis.
PWID were younger and more likely to have S. aureus than non-PWID.
Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and
56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID.
PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05-2.05) and more
than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25-4.50) than
non-PWID. Conclusion(s): PWID had shorter survival that non-PWID.
Implementing evidence-based interventions and testing new modalities are
urgently needed to improve outcomes in PWID after cardiac
surgery. Copyright © 2019 The Author(s).

<75>
[Use Link to view the full text]
Accession Number
627390086
Title
Open-Label Randomized Trial Comparing Oral Anticoagulation With and
Without Single Antiplatelet Therapy in Patients With Atrial Fibrillation
and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent
Implantation: OAC-ALONE Study.
Source
Circulation. 139 (5) (pp 604-616), 2019. Date of Publication: 29 Jan 2019.
Author
Matsumura-Nakano Y.; Shizuta S.; Komasa A.; Morimoto T.; Masuda H.; Shiomi
H.; Goto K.; Nakai K.; Ogawa H.; Kobori A.; Kono Y.; Kaitani K.; Suwa S.;
Aoyama T.; Takahashi M.; Sasaki Y.; Onishi Y.; Mano T.; Matsuda M.;
Motooka M.; Tomita H.; Inoko M.; Wakeyama T.; Hagiwara N.; Tanabe K.; Akao
M.; Miyauchi K.; Yajima J.; Hanaoka K.; Morino Y.; Ando K.; Furukawa Y.;
Nakagawa Y.; Nakao K.; Kozuma K.; Kadota K.; Kimura K.; Kawai K.; Ueno T.;
Okumura K.; Kimura T.
Institution
(Matsumura-Nakano, Shizuta, Komasa, Shiomi, Sasaki, Okumura, Kimura)
Department of Cardiovascular Medicine, Kyoto University Graduate School of
Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Nishinomiya, Japan
(Masuda, Ando) Department of Cardiology, Kokura Memorial Hospital,
Kitakyushu, Japan
(Goto) Department of Cardiology, Saitama Medical University International
Medical Center, Japan
(Nakai) Department of Cardiovascular Medicine, Uji Tokushukai Medical
Center, Japan
(Ogawa, Akao) Department of Cardiology, National Hospital Organization
Kyoto Medical Center, Japan
(Kobori, Furukawa) Department of Cardiovascular Medicine, Kobe City
Medical Center General Hospital, Japan
(Kono) Kono Clinic, Kyoto, Japan
(Kaitani) Department of Cardiovascular Medicine, Japanese Red Cross Otsu
Hospital, Japan
(Suwa) Department of Cardiology, Juntendo University Shizuoka Hospital,
Izunokuni, Japan
(Aoyama) Division of Cardiology, Shimada Municipal Hospital, Japan
(Takahashi) Department of Cardiology, Shimabara Hospital, Kyoto, Japan
(Onishi) Department of Cardiology, Hiratsuka Kyosai Hospital, Japan
(Mano) Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
(Matsuda) Division of Cardiology, Kishiwada City Hospital, Japan
(Motooka) Division of Cardiology, Shizuoka General Hospital, Japan
(Tomita) Department of Cardiology, Hirosaki University Graduate School of
Medicine, Japan
(Inoko) Cardiovascular Center, Tazuke Kofukai Medical Research Institute,
Kitano Hospital, Osaka, Japan
(Wakeyama) Division of Cardiology, Tokuyama Central Hospital, Shunan,
Japan
(Hagiwara) Department of Cardiology, Heart Institute of Japan, Tokyo
Women's Medical University, Japan
(Tanabe) Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Miyauchi) Department of Cardiovascular Medicine, Juntendo University
Hospital, Tokyo, Japan
(Yajima) Department of Cardiovascular Medicine, Cardiovascular Institute,
Tokyo, Japan
(Hanaoka) Hanaoka Seishu Memorial Cardiovascular Clinic, Sapporo, Japan
(Morino) Department of Cardiology, Iwate Medical University, Morioka,
Japan
(Nakagawa) Department of Cardiology, Tenri Hospital, Japan
(Nakao) Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular
Center, Japan
(Kozuma) Department of Cardiology, Teikyo University Hospital, Tokyo,
Japan
(Kadota) Department of Cardiology, Kurashiki Central Hospital, Japan
(Kimura) Division of Cardiology, Yokohama City University Medical Center,
Japan
(Kawai) Department of Cardiovascular Medicine, Chikamori Hospital, Kochi,
Japan
(Ueno) Division of Cardiovascular Medicine, Kurume University Hospital,
Japan
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Despite recommendations in the guidelines and consensus
documents, there has been no randomized controlled trial evaluating oral
anticoagulation (OAC) alone without antiplatelet therapy (APT) in patients
with atrial fibrillation and stable coronary artery disease beyond 1 year
after coronary stenting. Method(s): This study was a prospective,
multicenter, open-label, noninferiority trial comparing OAC alone to
combined OAC and single APT among patients with atrial fibrillation beyond
1 year after stenting in a 1:1 randomization fashion. The primary end
point was a composite of all-cause death, myocardial infarction, stroke,
or systemic embolism. The major secondary end point was a composite of the
primary end point or major bleeding according to the International Society
on Thrombosis and Haemostasis classification. Although the trial was
designed to enroll 2000 patients during 12 months, enrollment was
prematurely terminated after enrolling 696 patients in 38 months.
 Result(s): Mean age was 75.0+/-7.6 years, and 85.2% of patients were
men. OAC was warfarin in 75.2% and direct oral anticoagulants in 24.8% of
patients. The mean CHADS2 score was 2.5+/-1.2. During a median
follow-up interval of 2.5 years, the primary end point occurred in 54
patients (15.7%) in the OAC-alone group and in 47 patients (13.6%) in the
combined OAC and APT group (hazard ratio, 1.16; 95% CI, 0.79-1.72; P=0.20
for noninferiority, P=0.45 for superiority). The major secondary end point
occurred in 67 patients (19.5%) in the OAC-alone group and in 67 patients
(19.4%) in the combined OAC and APT group (hazard ratio, 0.99; 95% CI,
0.71-1.39; P=0.016 for noninferiority, P=0.96 for superiority). Myocardial
infarction occurred in 8 (2.3%) and 4 (1.2%) patients, whereas stroke or
systemic embolism occurred in 13 (3.8%) and 19 (5.5%) patients,
respectively. Major bleeding occurred in 27 (7.8%) and 36 (10.4%)
patients, respectively. Conclusion(s): This randomized trial did not
establish noninferiority of OAC alone to combined OAC and APT in patients
with atrial fibrillation and stable coronary artery disease beyond 1 year
after stenting. Because patient enrollment was prematurely terminated, the
study was underpowered and inconclusive. Future larger studies are
required to establish the optimal antithrombotic regimen in this
population. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT01962545. Copyright © 2019 American Heart Association, Inc.

<76>
Accession Number
627898630
Title
Do patients who require re-exploration for bleeding have inferior outcomes
following cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 613-618),
2019. Date of Publication: 2019.
Author
Ali J.M.; Wallwork K.; Moorjani N.
Institution
(Ali, Wallwork, Moorjani) Department of Cardiothoracic Surgery, Royal
Papworth Hospital, Cambridge CB23 3RE, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: Do patients who require
return to theatre (RTT) for bleeding have inferior outcomes following
cardiac surgery? Altogether, 598 papers were found using the reported
search, of which 8 represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. In summary, patients who bleed following cardiac surgery
and then RTT have increased mortality and experience greater morbidity,
including neurological, respiratory and renal complications, which result
in increased length of intensive care unit stay and hospital stay. It is
not easy to dissect the relative contribution of the blood loss and
consequent haemodynamic instability, the RTT and the increased blood
product consumption to the inferior outcomes observed, as there is
evidence that each is important. However, several studies have
demonstrated RTT to be an independent predictor of morbidity and
mortality, even when controlling for amount of transfusion. Patients who
bleed and RTT beyond 12 h postoperatively appear to have the poorest
outcomes, suggesting that the decision to RTT should not be delayed if
there are concerns over significant bleeding, to ensure the best patient
outcomes. Copyright © 2018 The Author(s).

<77>
[Use Link to view the full text]
Accession Number
627370738
Title
Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction:
Randomized SHOCK-COOL Trial.
Source
Circulation. 139 (4) (pp 448-457), 2019. Date of Publication: 22 Jan 2019.
Author
Fuernau G.; Beck J.; Desch S.; Eitel I.; Jung C.; Erbs S.; Mangner N.;
Lurz P.; Fengler K.; Jobs A.; Vonthein R.; De Waha-Thiele S.; Sandri M.;
Schuler G.; Thiele H.
Institution
(Fuernau, Desch, Jobs, De Waha-Thiele) Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine), University Heart Center
Luebeck, University Hospital Schleswig-Holstein, University of Luebeck,
Germany
(Vonthein) Institute of Medical Biometry and Statistics and Center for
Clinical Trials, University of Luebeck, Germany
(Eitel) German Center for Cardiovascular Research, Deutsches Zentrum fur
Herz-Kreislauf-Forschung DZHK, Partner Site Hamburg/Kiel/Lubeck, Luebeck,
Germany
(Beck, Erbs, Mangner, Lurz, Fengler, Sandri, Schuler, Thiele) Department
of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital,
Germany
(Jung) Medical Faculty, Division of Cardiology, Pulmonology and Vascular
Medicine, University Hospital Dusseldorf, Heinrich-Heine-University
Dusseldorf, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Experimental trials suggest improved outcome by mild therapeutic
hypothermia for cardiogenic shock after acute myocardial infarction. The
objective of this study was to investigate the hemodynamic effects of mild
therapeutic hypothermia in patients with cardiogenic shock complicating
acute myocardial infarction. Method(s): Patients (n=40) with
cardiogenic shock undergoing primary percutaneous coronary intervention
without classic indications for mild therapeutic hypothermia underwent
randomization in a 1:1 fashion to mild therapeutic hypothermia for 24
hours or control. The primary end point was cardiac power index at 24
hours; secondary end points included other hemodynamic parameters and
serial measurements of arterial lactate. Result(s): No relevant
differences were observed for the primary end point of cardiac power index
at 24 hours (mild therapeutic hypothermia versus control: 0.41
[interquartile range, 0.31-0.52] versus 0.36 [interquartile range,
0.31-0.48] W/m2; P=0.50; median difference, -0.025
W/m2; 95% CI, -0.12 to 0.06). Similarly, all other hemodynamic
measurements were not statistically different. Arterial lactate levels at
6, 8, and 10 hours were significantly higher in patients in the mild
therapeutic hypothermia group with a slower decline (P for
interaction=0.03). There were no differences in 30-day mortality (60%
versus 50%; hazard ratio, 1.27; 95% CI, 0.55-2.94; P=0.55).
 Conclusion(s): In this randomized trial, mild therapeutic hypothermia
failed to show a substantial beneficial effect on cardiac power index at
24 hours in patients with cardiogenic shock after acute myocardial
infarction. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT01890317. Copyright © 2018 American Heart Association, Inc.

<78>
Accession Number
622801072
Title
Closure, anticoagulation, or antiplatelet therapy for cryptogenic stroke
with patent foramen ovale: Systematic review of randomized trials,
sequential meta-analysis, and new insights from the CLOSE study.
Source
Journal of the American Heart Association. 7 (12) (no pagination), 2018.
Article Number: e008356. Date of Publication: 01 Jun 2018.
Author
Chatellier G.; Mas J.-L.; Turc G.; Domigo V.; Guiraud V.; Touze E.; Calvet
D.; Varenne O.; Menacer S.; Sroussi M.; Nana A.; Cabanes L.; Guillon B.;
Schunck A.; Herisson F.; De Gaalon S.; Sevin M.; Langlard J.-M.; Piriou
N.; Jaafar P.; Massardier E.; d'Here B.; Stepowski D.; Bauer F.; Hosseini
H.; Teiger E.; Duval A.-M.; Lim P.; Mechtouff L.; Nighoghossian N.; Derex
L.; Cho T.; Rossi R.; Rioufol G.; Derumeaux G.; Thibaut H.; Barthelet M.;
Thivolet S.; Arquizan C.; Mourand I.; Sportouch C.; Cade S.; Cransac F.;
Giroud M.; Bejot Y.; Eicher J.-C.; L'Huillier I.; Vuillier F.; Moulin T.;
Meneveau N.; Chopard R.; Descotes-Genon V.; Detante O.; Garambois K.;
Bertrand B.; Saunier C.; Mazighi M.; Juliard E.J.-M.; Brochet E.; Guidoux
C.; Meseguer D.; Cabrejo L.; Lavallee P.; Amarenco P.; Messika-Zeitoun;
Lepage L.; Bugnicourt J.-M.; Canaple S.; Lamy C.; Godefroy O.; Leborgne
L.; Guillaumont M.-P.; Trojette F.; Malaquin D.; Vaduva C.; Couvreur G.;
Golfier V.; Plurien F.; Taldir G.; Lucas C.; Cordonnier C.; Henon H.;
Dumont F.; Dequatre-Ponchelle N.; Leys D.; Godart F.; Richardson M.; Polge
A.-S.; Montaigne D.; Coisne A.; Sibon I.; Rouanet F.; Renou P.; Thambo
J.-B.; Reant P.; Laffite S.; Roudaut R.; Garnier P.; Comtet C.; Delsart
D.; Ferrier A.; Bourgois N.; Clavelou P.; Rouhart F.; Timsit S.; Le Cadet
E.; Tirel A.; Mocquard Y.; Guerin P.; Jobic Y.; Le Ven F.; Pouliquen
M.-C.; Milandre L.; Robinet-Borgomano E.; Laksiri N.; Rey C.; Fraisse A.;
Habib G.; Chalvignac V.; Thuny F.; Sablot D.; Runavot G.; Piot C.; Targosz
F.; Chopat P.; Sultan P.; Lacour C.; Richard S.; Ducrocq X.; Marcon F.;
Selton-Suty M.C.; Huttin O.; Bruandet M.; Zuber M.; Tamazyan R.; Antakly
Y.; Garcon P.; Serfaty J.; Favrole P.; Dubois-Rande J.-L.; Hammoudi N.;
Pinel J.-F.; Schleich J.-M.; Donal E.; Lelong B.; Chabanne C.; Viader F.;
Apoil M.; Cogez J.; Labombarda F.; Saloux E.; Reiner P.; Buffon F.; Baudet
M.; Logeart D.; Lefebvre C.; Bataille M.; Godard F.; Biausque F.; Lefetz
Y.; Clement-Dupont M.; Weimar C.; Zegarac V.; Schmitz T.; Plicht B.;
Eissmann M.; Mahabadi A.; Obadia M.; Aubry P.; Iglesias Benyounes N.;
Macian F.; Lusson J.-R.; Darodes N.; Tanguy B.; Mohty D.; Vuillemet F.;
Onea R.; Greciano S.; Roth O.; Neau J.-P.; Quillet L.; Christiaens L.;
Saudeau D.; Patat F.; Singer O.; Fichtlscherer S.; Pico F.; Juliard J.-M.;
Charbonnel C.
Institution
(Turc, Calvet, Mas) Department of Neurology, Hopital Sainte-Anne, Paris,
France
(Turc, Calvet, Sroussi, Chatellier, Mas) Universite Paris Descartes,
Sorbonne Paris Cite, Paris, France
(Turc, Calvet, Mas) INSERM U894, Paris, France
(Turc, Calvet, Mas) DHU Neurovasc, Paris, France
(Guerin) Department of Cardiology, INSERM UMR 915, Institut du Thorax,
Nantes, France
(Guerin) Institut du Thorax, Centre Hospitalier Universitaire de Nantes,
Nantes, France
(Sroussi) Department of Cardiology, Cochin Hospital, India
(Chatellier) Epidemiology and Clinical Research Unit, Georges Pompidou
European Hospital, France
(Chatellier) APHP, Paris, France
(Chatellier) INSERM CIC 1418, Paris, France
(Mas, Turc, Domigo, Guiraud, Touze, Calvet, Lamy, Teiger, Juliard,
Dubois-Rande, Aubry, Varenne, Menacer, Sroussi, Nana, Cabanes) Hopital
Sainte-Anne, Paris, France
(Guillon, Schunck, Herisson, De Gaalon, Sevin, Guerin, Langlard, Piriou,
Jaafar) Hopital Laennec, Nantes, France
(Massardier, Juliard, Aubry, d'Here, Stepowski, Bauer) CHU Rouen, France
(Hosseini, Dubois-Rande, Teiger, Duval, Lim) Hopital Henri Mondor,
Creteil, France
(Mechtouff, Nighoghossian, Derex, Cho, Rossi, Rioufol, Derumeaux, Thibaut,
Barthelet, Thivolet) CHU Pierre Wertheimer, Lyon, France
(Arquizan, Mourand, Piot, Sportouch, Cade, Cransac) Hopital Gui de
Chauliac, Montpellier, France
(Giroud, Bejot, Eicher, Eicher, L'Huillier) CHU Dijon, France
(Vuillier, Moulin, Meneveau, Chopard, Descotes-Genon) CHU Jean Minjoz,
Besancon, France
(Detante, Garambois, Bertrand, Saunier) CHU Grenoble-Alpes, France
(Mazighi, Guidoux, Juliard, Aubry, Brochet, Guidoux, Meseguer, Cabrejo,
Lavallee, Amarenco, Messika-Zeitoun, Lepage) Hopital Bichat, Paris, France
(Bugnicourt, Canaple, Lamy, Godefroy, Rey, Leborgne, Guillaumont,
Trojette, Malaquin) CHU Nord, Amiens, France
(Vaduva, Couvreur, Golfier, Schleich, Plurien, Taldir) Hopital Yves Le
Foll, St-Brieuc, France
(Lucas, Cordonnier, Henon, Dumont, Dequatre-Ponchelle, Leys, Godart, Rey,
Richardson, Polge, Montaigne, Coisne) CHU Salengro, Lille, France
(Sibon, Rouanet, Renou, Thambo, Reant, Laffite, Roudaut) CHU Bordeaux,
France
(Garnier, Lusson, Comtet, Delsart) Hopital Nord, St-Etienne, France
(Ferrier, Bourgois, Clavelou, Lusson, Lusson) CHU Montpied,
Clermont-Ferrand, France
(Rouhart, Timsit, Le Cadet, Tirel, Mocquard, Guerin, Jobic, Le Ven,
Pouliquen) CHU La Cavale Blanche, Brest, France
(Milandre, Robinet-Borgomano, Laksiri, Rey, Fraisse, Habib, Chalvignac,
Thuny) CHU La Timone, Marseille, France
(Sablot, Runavot, Piot, Targosz, Chopat, Sultan) CH Perpignan, France
(Lacour, Richard, Ducrocq, Marcon, Selton-Suty, Huttin) CHU Nancy, France
(Bruandet, Zuber, Tamazyan, Juliard, Aubry, Antakly, Garcon, Serfaty)
Hopital Saint-Joseph, Paris, France
(Favrole, Dubois-Rande, Hammoudi) Hopital Tenon, Paris, France
(Pinel, Schleich, Donal, Lelong, Chabanne) Hopital Pontchaillou, Rennes,
France
(Viader, Apoil, Cogez, Juliard, Labombarda, Saloux) CHU Caen, France
(Reiner, Buffon, Juliard, Baudet, Logeart) Hopital Lariboisiere, Paris,
France
(Lefebvre, Bataille, Godard, Biausque, Lefetz, Clement-Dupont) CH Lens,
France
(Weimar, Zegarac, Schmitz, Plicht, Eissmann, Mahabadi) Essen University
Hospital, Essen, Germany
(Obadia, Juliard, Aubry, Iglesias Benyounes) Fondation Hopital Rothschild,
Paris, France
(Macian, Lusson, Darodes, Tanguy, Mohty) CHU Limoges, France
(Vuillemet, Onea, Greciano, Roth) Hopitaux Civils de Colmar, France
(Neau, Quillet, Christiaens) CHU Poitiers et CHRU Tours, France
(Saudeau, Patat) CHU Bretonneau, Tours, France
(Singer, Fichtlscherer) Goethe University Hospital, Frankfurt, Germany
(Pico, Juliard, Charbonnel) CH Mignot, Versailles, France
Publisher
American Heart Association Inc.
Abstract
Background--We conducted a systematic review and meta-analysis of
randomized controlled trials (RCTs) comparing patent foramen ovale (PFO)
closure, anticoagulation, and antiplatelet therapy to prevent stroke
recurrence in patients with PFO-associated cryptogenic stroke. Methods and
Results--We searched Medline, Cochrane Library, and EMBASE through March
2018. The primary outcome was stroke recurrence. Pooled incidences, hazard
ratios, and risk ratios (RRs) were calculated in random-effects
meta-analyses. PFO closure was associated with a lower risk of recurrent
stroke compared with antithrombotic therapy (antiplatelet therapy or
anticoagulation: 3560 patients from 6 RCTs; RR=0.36, 95% CI: 0.17-0.79;
I2=59%). The effect of PFO closure on stroke recurrence was
larger in patients with atrial septal aneurysm or large shunt (RR=0.27,
95% CI, 0.11-0.70; I2=42%) compared with patients without these
anatomical features (RR=0.80, 95% CI, 0.43-1.47; I2=12%). Major
complications occurred in 2.40% (95% CI, 1.03-4.25; I2=77%) of
procedures. New-onset atrial fibrillation was more frequent in patients
randomized to PFO closure versus antithrombotic therapy (RR=4.33, 95% CI,
2.37-7.89; I2=14%). One RCT compared PFO closure versus
anticoagulation (353 patients; hazard ratio=0.14, 95% CI, 0.00-1.45) and 2
RCTs compared PFO closure versus antiplatelet therapy (1137 patients;
hazard ratio=0.18, 95% CI, 0.05-0.63; I2=12%). Three RCTs
compared anticoagulation versus antiplatelet therapy, with none showing a
significant difference. Conclusions--PFO closure is superior to
antithrombotic therapy to prevent stroke recurrence after cryptogenic
stroke. The annual absolute risk reduction of stroke was low, but it has
to be tempered by a substantial time at risk (at least 5 years) in young
and middle-aged patients. PFO closure was associated with an increased
risk of atrial fibrillation. Copyright © 2018 The Authors.

<79>
Accession Number
623986311
Title
Efficacy of Different Types of Exercise-Based Cardiac Rehabilitation on
Coronary Heart Disease: a Network Meta-analysis.
Source
Journal of General Internal Medicine. 33 (12) (pp 2201-2209), 2018. Date
of Publication: 01 Dec 2018.
Author
Xia T.-L.; Huang F.-Y.; Peng Y.; Huang B.-T.; Pu X.-B.; Yang Y.; Chai H.;
Chen M.
Institution
(Xia, Huang, Peng, Huang, Pu, Yang, Chai, Chen) Department of Cardiology,
West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041,
China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Exercise-based cardiac rehabilitation (CR) has been recognized
as an essential component of the treatment for coronary heart disease
(CHD). Determining the efficacy of modern alternative treatment methods is
the key to developing exercise-based CR programs. Method(s): Studies
published through June 6, 2016, were identified using MEDLINE, EMBASE, and
the Cochrane Library. English-language articles regarding the efficacy of
different modes of CR in patients with CHD were included in this analysis.
Two investigators independently reviewed abstracts and full-text articles
and extracted data from the studies. According to the categories described
by prior Cochrane reviews, exercise-based CR was classified into
center-based CR, home-based CR, tele-based CR, and combined CR for this
analysis. Outcomes included all-cause mortality, cardiovascular death,
recurrent fatal and/or nonfatal myocardial infarction, recurrent cardiac
artery bypass grafting, recurrent percutaneous coronary intervention
(PCI), and hospital readmissions. Result(s): Sixty randomized
clinical trials (n = 19,411) were included in the analysis. Network
meta-analysis (NMA) demonstrated that only center-based CR significantly
reduced all-cause mortality (center-based: RR = 0.76 [95% CI 0.64-0.90], p
= 0.002) compared to usual care. Other modes of CR were not significantly
different from usual care with regard to their ability to reduce
mortality. Treatment ranking indicated that combined CR exhibited the
highest probability (86.9%) of being the most effective mode, but this
finding was not statistically significant due to the small sample size
(combined: RR = 0.50 [95% CI 0.20-1.27], p = 0.146). Conclusion(s):
Current evidence suggests that center-based CR is acceptable for patients
with CHD. As home- and tele-based CR can save time, money, effort, and
resources and may be preferred by patients, their efficacy should be
investigated further in subsequent studies. Copyright © 2018,
Society of General Internal Medicine.

<80>
Accession Number
629377425
Title
The RADial artery International ALliance (RADIAL) extended follow-up
study: rationale and study protocol.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (6) (pp 1025-1030),
2019. Date of Publication: 01 Dec 2019.
Author
Gaudino M.; Benedetto U.; Fremes S.; Ballman K.; Biondi-Zoccai G.;
Sedrakyan A.; Nasso G.; Raman J.; Buxton B.; Hayward P.A.; Moat N.;
Collins P.; Webb C.; Peric M.; Petrovic I.; Yoo K.J.; Hameed I.; Di Franco
A.; Moscarelli M.; Speziale G.; Girardi L.N.; Hare D.L.; Taggart D.P.
Institution
(Gaudino, Hameed, Di Franco, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, NY, NY, United States
(Benedetto) Department of Cardiac Surgery, Bristol Heart Institute,
Bristol, United Kingdom
(Fremes) Department of Surgery, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, Canada
(Ballman, Sedrakyan) Department of Healthcare Policy and Research, Weill
Cornell Medicine, NY, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) NaplesItaly
(Nasso, Moscarelli, Speziale) Anthea Hospital, Bari, Italy
(Raman, Hare) Austin Hospital, Melbourne, VIC, Australia
(Buxton, Hayward, Hare) Department of Surgery, University of Melbourne,
Melbourne, VIC, Australia
(Moat, Collins, Webb) NHLI, Imperial College London, Royal Brompton and
Harefield NHS Foundation Trust, London, United Kingdom
(Peric, Petrovic) Dedinje Cardiovascular Institute and Belgrade University
School of Medicine, Belgrade, Serbia
(Yoo) Yonsei University College of Medicine, Seoul, South Korea
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
Oxford, United Kingdom
Publisher
NLM (Medline)
Abstract
It is generally accepted that radial artery (RA) grafts have better
mid-term patency rate compared to saphenous vein grafts. However, the
clinical correlates of the improved patency rate are still debated.
Observational studies have suggested increased survival and event-free
survival for patients who receive an RA rather than a saphenous vein, but
they are open to bias and confounders. The only evidence based on
randomized data is a pooled meta-analysis of 6 randomized controlled trial
comparing the RA and the saphenous vein published by the RADial artery
International Alliance (RADIAL). In the RADIAL database, improved freedom
from follow-up cardiac events (death, myocardial infarction and repeat
revascularization) was found at 5-year follow-up in the RA arm. The most
important limitation of the RADIAL analysis is that most of the included
trials had an angiographic follow-up in the first 5 years and it is
unclear whether the rate of repeat revascularization (the main driver of
the composite outcome) was clinically indicated due to per-protocol
angiographies. Here, we present the protocol for the long-term analysis of
the RADIAL database. By extending the follow-up beyond the 5th
postoperative year (all trials except 1 did not have angiographic
follow-up beyond 5 years), we aim to provide data on the role of RA in
coronary artery bypass surgery with respect to long-term
outcomes. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<81>
Accession Number
629459934
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement in low-risk patients: a propensity score-matched analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (6) (pp 1131-1139),
2019. Date of Publication: 01 Dec 2019.
Author
Schaefer A.; Schofer N.; Gossling A.; Seiffert M.; Schirmer J.; Deuschl
F.; Schneeberger Y.; Voigtlander L.; Detter C.; Schaefer U.; Blankenberg
S.; Reichenspurner H.; Conradi L.; Westermann D.
Institution
(Schaefer, Schirmer, Schneeberger, Detter, Reichenspurner, Conradi)
Department of Cardiovascular Surgery, University Heart Center Hamburg,
Hamburg, Germany
(Schofer, Gosling, Seiffert, Deuschl, Voigtlander, Schaefer, Blankenberg,
Westermann) Department of General and Interventional Cardiology,
University Heart Center Hamburg, Hamburg, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of the study was to determine the differences in
outcomes of surgical aortic valve replacement (SAVR) and transcatheter
aortic valve implantation (TAVI) in low-risk patients. METHOD(S): All
patients with a logistic EuroSCORE II <4% who underwent transfemoral TAVI
between 2008 and 2016 (n=955) or SAVR between 2009 and 2014 (n=886) at our
centre were included. One hundred and nine patients per group were
available for propensity score matching. RESULT(S): Mortality during
the 30-day follow-up showed no differences (SAVR vs TAVI: 1.1% vs 1.8%,
P=1.0) but the rates of permanent pacemaker implantation (0.0 vs 14.8%,
P<0.001) and paravalvular leakage >= moderate (0.0 vs 7.0%, P=0.017) were
higher in TAVI patients. No difference was found regarding postoperative
effective orifice area and transvalvular pressure gradients. Although, the
1-year survival was similar between both groups; 3- and 5-year survival
was significantly inferior in the TAVI patient cohort. CONCLUSION(S):
TAVI yielded similar short-term outcomes compared with SAVR despite higher
rates of permanent pacemaker implantation and paravalvular leakage >=
moderate, but inferior long-term survival. Poorer long-term outcomes of
the TAVI patient cohort were attributable to a more comorbid TAVI
population. This emphasizes the need for long-term results from randomized
controlled trials before TAVI can be broadly expanded to younger low-risk
patients. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<82>
Accession Number
2001387632
Title
Trans-Catheter Aortic Valve Replacement and Surgical Aortic Valve
Replacement Outcomes in Patients with Dialysis: Systematic Review and
Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 20 (10) (pp 852-857), 2019.
Date of Publication: October 2019.
Author
Vindhyal M.R.; Ndunda P.; Khayyat S.; Boppana V.S.; Fanari Z.
Institution
(Vindhyal, Ndunda, Khayyat, Boppana, Fanari) Internal Medicine, University
of Kansas School of Medicine - Wichita, 1010 N Kansas, Wichita, KS 67214,
United States
(Boppana, Fanari) Cardiology, Heartland Cardiology/Wesley Medical Center,
550 N Hillside, Wichita, KS 67214, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Dialysis is associated with higher rate of aortic valve
calcification and higher cardiovascular mortality. Transcatheter aortic
valve replacement (TAVR) is an established alternative for surgical aortic
valve replacement (SAVR) in patients with higher and intermediate
co-morbidities including dialysis. Method(s): Two independent
investigators systematically searched Medline, Cochrane, and Web of
Science. The ROBINS-I tool was used to analyze and assess the bias from
the selected studies. Result(s): The search resulted in 4
observational studies with a total of 966 patients. TAVR in dialysis
patients was associated with no significant difference in in-hospital
mortality [8.1% vs 10.3%; OR (95% CI) 0.74 (0.35, 1.60), I2 = 50%, P =
0.45], risk-of-strokes at 30 days [2% vs 4.4%; OR (95% CI) 0.49 (0.22,
1.09), I2 = 0%, P = 0.08], vascular complications [12.7% vs 13.2%; OR (95%
CI) 0.96 (0.55, 1.67), I2 = 0%, P = 0.89], need of blood transfusion
[43.1% vs 66.4%; OR (95% CI) 0.27 (0.05, 1.39), I2 = 89%, P = 0.12], or
bleeding risk [5.6% vs 6.8%; OR (95% CI) 0.91 (0.18, 4.64), I2 = 5%, P =
0.91] when compared to SAVR. TAVR was associated with significantly
shorter length of stay [8.5 days vs 14.2 days; mean difference (95% CI)
-5.89 (-9.13, -2.64), I2 = 76%, P < 0.0001] and higher pacemaker
implantation [11.4% vs 6.8%; OR (95% CI) 1.74 (1.07, 2.81), I2 = 5%, P =
0.02]. Conclusion(s): TAVR outcomes were comparable to SAVR but had a
significantly shorter length of stay and a higher pacemaker implantation
rate in dialysis patients. Copyright © 2018 Elsevier Inc.

<83>
[Use Link to view the full text]
Accession Number
629466849
Title
Ramelteon for Prevention of Postoperative Delirium: A Randomized
Controlled Trial in Patients Undergoing Elective Pulmonary
Thromboendarterectomy.
Source
Critical care medicine. 47 (12) (pp 1751-1758), 2019. Date of Publication:
01 Dec 2019.
Author
Jaiswal S.J.; Vyas A.D.; Heisel A.J.; Ackula H.; Aggarwal A.; Kim N.H.;
Kerr K.M.; Madani M.; Pretorius V.; Auger W.R.; Fernandes T.M.; Malhotra
A.; Owens R.L.
Institution
(Jaiswal, Aggarwal) Scripps Research Translational Institute, La Jolla,
CA, Italy
(Jaiswal, Heisel) Division of Hospital Medicine, Scripps Clinic/Scripps
Green Hospital, La Jolla, CA, Italy
(Vyas, Ackula, Kim, Kerr, Auger, Fernandes, Malhotra, Owens) Division of
Pulmonary, Critical Care and Sleep Medicine, University of California San
Diego School of Medicine, La Jolla, CA, Italy
(Madani, Pretorius) Division of Cardiovascular and Thoracic Surgery,
University of California San Diego School of Medicine, La Jolla, CA, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To assess the efficacy of ramelteon in preventing delirium, an
acute neuropsychiatric condition associated with increased morbidity and
mortality, in the perioperative, ICU setting. DESIGN: Parallel-arm,
randomized, double-blinded, placebo-controlled trial. SETTING: Academic
medical center in La Jolla, California. PATIENTS: Patients greater than or
equal to 18 years undergoing elective pulmonary thromboendarterectomy.
INTERVENTIONS: Ramelteon 8mg or matching placebo starting the night prior
to surgery and for a maximum of six nights while in the ICU. MEASUREMENTS
AND MAIN RESULTS: Incident delirium was measured twice daily using the
Confusion Assessment Method-ICU. The safety outcome was coma-free days
assessed by the Richmond Agitation-Sedation Scale. One-hundred twenty
participants were enrolled and analysis completed in 117. Delirium
occurred in 22 of 58 patients allocated to placebo versus 19 of 59
allocated to ramelteon (relative risk, 0.8; 95% CI, 0.5-1.4; p = 0.516).
Delirium duration, as assessed by the number of delirium-free days was
also similar in both groups (placebo median 2 d [interquartile range, 2-3
d] vs ramelteon 3 d [2-5 d]; p = 0.181). Coma-free days was also similar
between groups (placebo median 2 d [interquartile range, 1-3 d] vs
ramelteon 3 d [2-4 d]; p = 0.210). We found no difference in ICU length of
stay (median 4 d [interquartile range, 3-5 d] vs 4 d [3-6 d]; p = 0.349),
or in-hospital mortality (four vs three deaths; relative risk ratio, 0.7;
95% CI, 0.2-3.2; p = 0.717), all placebo versus ramelteon, respectively.
 CONCLUSION(S): Ramelteon 8mg did not prevent postoperative delirium
in patients admitted for elective cardiac surgery.

<84>
Accession Number
2002625742
Title
Early Aortic Valve Replacement versus Watchful Waiting in Asymptomatic
Severe Aortic Stenosis: A Study-Level Meta-Analysis.
Source
Structural Heart. 3 (6) (pp 483-490), 2019. Date of Publication: 02 Nov
2019.
Author
Sa M.P.B.O.; Cavalcanti L.R.P.; Escorel Neto A.C.A.; Perazzo A.M.;
Simonato M.; Clavel M.-A.; Pibarot P.; Lima R.C.
Institution
(Sa, Cavalcanti, Escorel Neto, Perazzo, Lima) Division of Cardiovascular
Surgery of Pronto Socorro Cardiologico de Pernambuco-PROCAPE, Recife,
Brazil
(Sa, Cavalcanti, Escorel Neto, Perazzo, Lima) University of
Pernambuco-UPE, Recife, Brazil
(Sa, Lima) Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Instituite-FCM/ICB,
Recife, Brazil
(Simonato) Escola Paulista de Medicina-UNIFESP, Sao Paulo, Brazil
(Clavel, Pibarot) Institut Universitaire de Cardiologie et de Pneumologie
du Quebec, QC, Canada
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: The management of patients with asymptomatic, severe aortic
stenosis (AS) is controversial. We performed a meta-analysis to examine
the impact on outcomes of early aortic valve replacement (AVR) in patients
with severe asymptomatic AS versus a watchful-waiting (WW) approach.
 Method(s): Databases were searched for studies published until April
2019. Main outcome of interest was death during follow-up. Result(s):
The search yielded 1,889 studies for inclusion. Of these, seven articles
were analyzed and their data extracted. The total number of patients
included was 3,839. The overall HR (95% CI) for death showed a
statistically significant difference between the groups, with lower risk
in the "early AVR" group (random effect model: HR 0.280; 95% CI
0.159-0.494, P < 0.001). There was evidence of significant statistical
heterogeneity of treatment effect among the studies for death. Funnel plot
analysis disclosed no asymmetry around the axis for the outcome of
interest, which means that we have low risk of publication bias related to
this outcome. Sensitivity analysis showed that none of the studies had a
particular impact on the results. The meta-regression coefficients for the
modulating factors age, male sex, presence of hypertension and presence of
diabetes were significant for mortality, showing that the early
intervention becomes even more protective in comparison with the
conservative approach when we take these factors into consideration.
 Conclusion(s): Early AVR seems to be a better approach than WW in the
treatment of asymptomatic patients with severe AS, but we would still
advocate a case-by-case decision-making process. Copyright ©
2019, © 2019 Cardiovascular Research Foundation.

<85>
Accession Number
629881499
Title
Transcatheter versus surgical aortic valve replacement in low-risk
surgical patients: A meta-analysis of randomized clinical trials.
Source
Cardiovascular revascularization medicine : including molecular
interventions. 20 (10) (pp 838-842), 2019. Date of Publication: 01 Oct
2019.
Author
Kheiri B.; Osman M.; Abubakar H.; Subahi A.; Chahine A.; Ahmed S.; Bachuwa
G.; Alkotob M.L.; Hassan M.; Bhatt D.L.
Institution
(Kheiri, Chahine, Ahmed, Bachuwa) Department of Internal Medicine, Hurley
Medical Center, Michigan State University, MI, Flint, United States
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, United States
(Abubakar, Subahi) Department of Internal Medicine, Wayne State
University, MI, Detroit, United States
(Alkotob, Hassan) Division of Cardiology, Hurley Medical Center, Michigan
State University, MI, Flint, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, MA, Boston, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a valid
option for patients with high or intermediate surgical risk. However,
clinical outcomes of TAVR in low-risk patients are lacking. Our aim was to
evaluate the efficacy and safety of TAVR versus surgical aortic valve
replacement (SAVR) in low-surgical-risk patients. METHOD(S):
Electronic database review was conducted for all randomized clinical
trials (RCTs) that compared TAVR versus SAVR in low-risk patients. We
calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a
random-effects model. RESULT(S): We included 3 RCTs totaling 604
patients (310 TAVR and 294 SAVR). Our results showed no significant
difference in mortality between TAVR compared with SAVR (RR=0.71; 95%
CI=0.22-2.30; P=0.56), however, there was a significantly increased risk
of pacemaker implantation (RR=7.28; 95% CI=3.94-13.42; P<0.01) and
moderate/severe paravalvular leakage (PVL) (RR=6.74; 95% CI=1.31-34.65;
P=0.02) with TAVR. Nevertheless, TAVR demonstrated a significantly reduced
risk of post-procedural bleeding (RR=0.40; 95% CI=0.30-0.54; P<0.01) and
new-onset atrial fibrillation (RR=0.36; 95% CI=0.27-0.47; P<0.01). Other
clinical outcomes were not significantly different between the groups and
included cardiovascular mortality, stroke, transient ischemic attack, and
myocardial infarction. CONCLUSION(S): Among low-risk patients, TAVR
offered comparable efficacy outcomes and fewer bleeding events compared
with SAVR. There were increased risks of pacemaker implantation and PVL
associated with TAVR, though lower atrial fibrillation
risks. Copyright © 2018 Elsevier Inc. All rights reserved.

EPICORE Embase Updates

Wednesday, December 4, 2019

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

No comments:

Post a Comment

Followers

Blog Archive

About Me