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<1>
Accession Number
629660258
Title
Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood Component
Transfusion after Cardiac Surgery: The FIBRES Randomized Clinical Trial.
Source
JAMA - Journal of the American Medical Association. 322 (20) (pp
1966-1976), 2019. Date of Publication: 26 Nov 2019.
Author
Callum J.; Farkouh M.E.; Scales D.C.; Heddle N.M.; Crowther M.; Rao V.;
Hucke H.-P.; Carroll J.; Grewal D.; Brar S.; Bussieres J.; Grocott H.;
Harle C.; Pavenski K.; Rochon A.; Saha T.; Shepherd L.; Syed S.; Tran D.;
Wong D.; Zeller M.; Karkouti K.
Institution
(Callum) Department of Laboratory Medicine and Molecular Diagnostics,
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Callum) Laboratory Medicine Program, University Health Network, Toronto,
ON, Canada
(Callum) Department of Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, ON, Canada
(Farkouh, Rao, Carroll, Grewal, Karkouti) Peter Munk Cardiac Centre,
University Health Network, Toronto, ON, Canada
(Farkouh) Heart and Stroke Richard Lewar Centre, University of Toronto,
Toronto, ON, Canada
(Scales, Karkouti) Interdepartmental Division of Critical Care, Department
of Medicine, University of Toronto, Toronto, ON, Canada
(Scales) Sunnybrook Research Institute, Department of Critical Care
Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Heddle) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Heddle, Crowther) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Rao) University Health Network, Division of Cardiovascular Surgery,
Toronto General Hospital, Toronto, ON, Canada
(Rao, Carroll, Grewal) University of Toronto, Toronto, ON, Canada
(Hucke) Department of Biostatistics, ERGOMED CDS GmbH, Cologne, Germany
(Carroll, Grewal, Karkouti) Department of Anesthesia and Pain Management,
Sinai Health System, Women's College Hospital, University Health Network,
Toronto, ON, Canada
(Brar) Department of Anesthesiology, Pharmacology and Therapeutics,
University of British Columbia, Vancouver, Canada
(Brar) Royal Columbian Hospital, Vancouver, BC, Canada
(Bussieres) Anesthesiology Department, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Universite Laval, Quebec City,
QC, Canada
(Grocott) Department of Anesthesiology, Perioperative and Pain Medicine,
and Surgery, University of Manitoba, Winnipeg, Canada
(Harle) Department of Anesthesia and Perioperative Medicine, Western
University, London, ON, Canada
(Pavenski) St Michael's Hospital, Division of Transfusion Medicine,
Department of Laboratory Medicine and Pathobiology, University of Toronto,
Toronto, ON, Canada
(Rochon) Department of Anesthesiology, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada
(Saha) Department of Anesthesiology and Perioperative Medicine, Kingston
General Hospital, Queen's University, Kingston, ON, Canada
(Shepherd) Department of Pathology and Molecular Medicine, Kingston Health
Science Center, Queen's University, Kingston, ON, Canada
(Syed) Department of Anesthesiology, Hamilton Health Sciences Corporation,
McMaster University, Hamilton, ON, Canada
(Tran) University of Ottawa Heart Institute, Division of Cardiac
Anesthesiology and Critical Care, Department of Anesthesia and Pain
Medicine, University of Ottawa, School of Epidemiology and Public Health,
Ottawa, ON, Canada
(Wong) Cardiac Surgery, Royal Columbian Hospital, University of British
Columbia, Vancouver, Canada
(Zeller) McMaster Centre for Transfusion Research, Department of Medicine,
McMaster University, Hamilton, ON, Canada
(Karkouti) Department of Anesthesia, Institute of Health Policy,
Management, and Evaluation, University of Toronto, Toronto, ON, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Excessive bleeding is a common complication of cardiac
surgery. An important cause of bleeding is acquired hypofibrinogenemia
(fibrinogen level <1.5-2.0 g/L), for which guidelines recommend fibrinogen
replacement with cryoprecipitate or fibrinogen concentrate. The 2 products
have important differences, but comparative clinical data are lacking.
<br/>Objective(s): To determine if fibrinogen concentrate is noninferior
to cryoprecipitate for treatment of bleeding related to hypofibrinogenemia
after cardiac surgery. <br/>Design, Setting, and Participant(s):
Randomized clinical trial at 11 Canadian hospitals enrolling adult
patients experiencing clinically significant bleeding and
hypofibrinogenemia after cardiac surgery (from February 10, 2017, to
November 1, 2018). Final 28-day follow-up visit was completed on November
28, 2018. <br/>Intervention(s): Fibrinogen concentrate (4 g; n = 415) or
cryoprecipitate (10 units; n = 412) for each ordered dose within 24 hours
after cardiopulmonary bypass. <br/>Main Outcomes and Measures: Primary
outcome was blood components (red blood cells, platelets, plasma)
administered during 24 hours post bypass. A 2-sample, 1-sided test for the
ratio of the mean number of units was conducted to evaluate noninferiority
(threshold for noninferiority ratio, <1.2). <br/>Result(s): Of 827
randomized patients, 735 (372 fibrinogen concentrate, 363 cryoprecipitate)
were treated and included in the primary analysis (median age, 64
[interquartile range, 53-72] years; 30% women; 72% underwent complex
operations; 95% moderate to severe bleeding; and pretreatment fibrinogen
level, 1.6 [interquartile range, 1.3-1.9] g/L). The trial met the a priori
stopping criterion for noninferiority at the interim analysis after 827 of
planned 1200 patients were randomized. Mean 24-hour postbypass allogeneic
transfusions were 16.3 (95% CI, 14.9 to 17.8) units in the fibrinogen
concentrate group and 17.0 (95% CI, 15.6 to 18.6) units in the
cryoprecipitate group (ratio, 0.96 [1-sided 97.5% CI, - to 1.09; P <.001
for noninferiority] [2-sided 95% CI, 0.84 to 1.09; P =.50 for
superiority]). Thromboembolic events occurred in 26 patients (7.0%) in the
fibrinogen concentrate group and 35 patients (9.6%) in the cryoprecipitate
group. <br/>Conclusions and Relevance: In patients undergoing cardiac
surgery who develop clinically significant bleeding and hypofibrinogenemia
after cardiopulmonary bypass, fibrinogen concentrate is noninferior to
cryoprecipitate with regard to number of blood components transfused in a
24-hour period post bypass. Use of fibrinogen concentrate may be
considered for management of bleeding in patients with acquired
hypofibrinogenemia in cardiac surgery. Trial Registration:
ClinicalTrials.gov Identifier: NCT03037424.<br/>Copyright &#xa9; 2019
American Medical Association. All rights reserved.

<2>
Accession Number
626868998
Title
Long-term impact of diabetes in patients with ST-segment elevation
myocardial infarction: Insights from the EXAMINATION randomized trial.
Source
Catheterization and Cardiovascular Interventions. 94 (7) (pp 917-925),
2019. Date of Publication: 01 Dec 2019.
Author
Jimenez-Quevedo P.; Brugaletta S.; Cequier A.; Iniguez A.; Serra A.;
Mainar V.; Campo G.; Tespili M.; Nombela-Franco L.; del Trigo M.; Gonzalo
N.; Escaned J.; Salinas P.; Nunez-Gil I.; Fernandez-Perez C.;
Fernandez-Ortiz A.; Macaya C.; Serruys P.W.; Sabate Tenas M.
Institution
(Jimenez-Quevedo, Nombela-Franco, del Trigo, Gonzalo, Escaned, Salinas,
Nunez-Gil, Fernandez-Perez, Fernandez-Ortiz, Macaya) Interventional
Cardiology Department, Clinico San Carlos University Hospital, IdISSC,
Madrid, Spain
(Brugaletta, Sabate Tenas) Interventional Cardiology Department,
University Hospital Clinic, Institut d'Investigacions Biomediques August
Pi i Sunyer (IDIBAPS), Barcelona, Spain
(Cequier) Interventional Cardiology Department, University Hospital of
Bellvitge, Barcelona, Spain
(Iniguez) Interventional Cardiology Department, Hospital do Meixoeiro,
Vigo, Spain
(Serra) Interventional Cardiology Department, University Hospital of Sant
Pau, Barcelona, Spain
(Mainar) Interventional Cardiology Department, Hospital General of
Alicante, Alicante, Spain
(Campo) Interventional Cardiology Department, University Hospital Ferrara,
Ferrara, Italy
(Tespili) Interventional Cardiology Department, University Hospital
Bolognini Seriate, Bergamo, Italy
(Serruys) Interventional Cardiology Department, International Centre of
Circulatory Health, Imperial College London, London, United Kingdom
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Long-term outcomes of diabetic patients suffering from
ST-segment elevation myocardial infarction (STEMI) and treated with
second-generation drug-eluting stent have been scarcely evaluated. The aim
of this posthoc subanalysis of the EXAMINATION trial was to compare 5-year
outcomes according to the presence of diabetes mellitus. <br/>Method(s):
From a total of 1,497 patients included in the trial, 258 were diabetics
(n = 137, received everolimus-eluting stent (EES) and n = 121 bare-metal
stent (BMS); whereas 1,239 were nondiabetics (n = 613 treated with EES and
n = 626 with BMS). Patient-oriented combined endpoint (POCE) defined as
all-cause death, any MI or any revascularization, and other clinical
parameters were collected up to 5-years. All results were adjusted for
various potential confounders. <br/>Result(s): At 5-years, patients with
diabetes showed similar rates of POCE between diabetics treated with EES
and those treated with BMS (32.8% vs. 32.2%; p = 0.88). However, rates of
TLR were significantly lower in the EES group (4.4% vs. 9.9%; HR 0.52
(0.29-0.94); P = 0.03). In non-diabetics, the use of EES was associated
with a significant improvement in all-clinical parameters except for MI
rate: POCE: [10.0% vs. 12.6%; HR 0.78(0.62-0.98); P = 0.038], all cause
death: [7.0% vs. 12.1%; HR 0.62(0.42-0.90); P = 0.014], and [TLR: 4.2 vs.
6.7; HR 0.60 (0.37-0.98); P = 0.04]. Overall, diabetics showed higher rate
of POCE at 5-years (32.6% vs. 21.5% in nondiabetics HR1.45[1.03-2.04];p =
0.03) driven by increased rates of MI and the need for revascularization
that occurred in coronary segments remote from target lesions [2.7% vs.
1.1%; HR: 2.27 (1.12-5.23); P = 0.02 and 14% vs. 6.2%; HR: 2.11
(1.38-3.22); P = 0.001, respectively]. <br/>Conclusion(s): Diabetics had
worse clinical outcomes than nondiabetics after STEMI mainly due to
atherosclerosis progression. At 5-years, the treatment with EES did not
reduce the rate of POCE in diabetics but reduced the need for
revascularization compared with BMS.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<3>
Accession Number
2003779699
Title
Mid-term and long-term outcomes of endoscopic versus open vein harvesting
for coronary artery bypass: A systematic review and meta-analysis.
Source
International Journal of Surgery. 72 (pp 167-173), 2019. Date of
Publication: December 2019.
Author
Li G.; Zhang Y.; Wu Z.; Liu Z.; Zheng J.
Institution
(Li, Wu, Zheng) Department of Cardiovascular Surgery, Sun Yat-sen Memorial
Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
(Zhang) Department of Pathology, The Second Affiliated Hospital of
Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of
Chinese Medicine, Guangzhou, Guangdong 510120, China
(Liu) Department of Hepatobiliary Surgery, Second Affiliated Hospital of
Guangzhou Medical University, Guangzhou, Guangdong 510260, China
Publisher
Elsevier Ltd
Abstract
Background: Two prevalent harvesting techniques are routinely utilized in
coronary artery bypass grafting (CABG): endoscopic vein harvesting (EVH)
and open vein harvesting (OVH). Our purpose is to compare mid-term and
long-term outcomes between these two techniques for CABG. <br/>Method(s):
After the acquisition of evidence, available studies assessing both
harvesting techniques with follow-up precondition (a minimum of one year)
were identified. The primary outcome was all-cause mortality. Secondary
outcomes of interest included the number of intra-operative graft
injuries, leg-wound complications, in-hospital mortality, major adverse
cardiac events (MACE) and graft patency. <br/>Result(s): Twenty-two
studies including 27911 patients were identified. The incidences of
all-cause mortality, in-hospital death, and MACE were similar between EVH
and OVH. EVH was associated with more graft injuries (weighted mean
difference (WMD) 0.73; 95% confidence interval (CI) 0.18-1.28; P = 0.009),
lower mid-term graft patency (odds ratio (OR) 0.80; 95% CI 0.70-0.91; P =
0.0005), and decreased long-term graft patency (OR 0.15, 95% CI 0.04-0.61;
P = 0.008) as compared with OVH. Fewer leg-wound complications were
observed in endoscopic harvesting as compared to conventional technique
(OR 0.19, 95% CI 0.12-0.30; P < 0.001). Data from subgroup analysis
suggested study period as a key factor affecting the outcomes for graft
patency. <br/>Conclusion(s): The risks for all-cause mortality,
in-hospital death, and MACE are similar between EVH and OVH. EVH increases
conduit injuries and lowers mid-long term graft patency rates, however,
study period, with growing surgical expertise, may be associated with
better outcomes.<br/>Copyright &#xa9; 2019 IJS Publishing Group Ltd

<4>
Accession Number
2003260110
Title
Effect of the aortic root infusion of sufentanil on ischemia-reperfusion
injury in patients undergoing coronary artery bypass grafting: A
randomized clinical trial.
Source
Journal of Tehran University Heart Center. 14 (4) (pp 177-182), 2019. Date
of Publication: 2019.
Author
Bagher Khosravi M.; Kahrom M.; Tahari M.; Alizadeh K.; Soltani G.; Ghanad
M.A.
Institution
(Bagher Khosravi) Department of Anesthesia, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Kahrom) Department of Cardiovascular Surgery, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Tahari) Division of Cardiac Perfusion, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Alizadeh, Soltani, Ghanad) Department of Anesthesia, School of Medicine,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Tehran Heart Center (E-mail: abbasi.hesam@gmail.com)
Abstract
Background: Ischemic postconditioning is a novel strategy for attaining
cardioprotection. Remarkable evidence from various in vitro and in vivo
animal and human studies have shown significant opioid-induced
cardioprotection against myocardial ischemia/reperfusion (I/R) injury. The
purpose of this study was to assess the cardioprotective effect of
sufentanil against I/R injury after on-pump coronary artery bypass
grafting (CABG). <br/>Method(s): Between June 2016 and July 2017, 80
consecutive patients with triple-vessel disease undergoing on-pump CABG
were enrolled in this prospective randomized study. The patients assigned
to the sufentanil group received a single dose of sufentanil (0.2
micro&#32;g/kg diluted with 50 cc of saline) 5 minutes before the removal
of the aorta cross-clamp, with the sufentanil injected via a cardioplegia
needle into the aortic root. In the control group, the same volume of
normal saline was injected as a placebo. Cardiac enzymes, the inotrope
score, and the outcome data were compared between the 2 groups.
<br/>Result(s): The mean age of the patients was 60.48+/-7.50 years
(range=41-69 y), and men comprised 65.0% of the study population. The
levels of CK-MB and cardiac troponin I were significantly lower in the
sufentanil group (P<0.001). The amount of inotrope use (P<0.001), the
incidence of atrial fibrillation (P=0.014), electrical shock (P=0.007),
and the mechanical ventilation time (P<0.001) decreased in the sufentanil
group compared with the control group. However, the use of intra-aortic
balloon pumps (P=0.247) and the ICU length of stay (P=0.867) were not
significantly different between the 2 groups. <br/>Conclusion(s): The
injection of a single dose of sufentanil into the aortic root prior to
aorta cross-clamp removal diminished cardiac injury during on-pump CABG in
our patients.<br/>Copyright &#xa9; 2019, Tehran Heart Center. All rights
reserved.

<5>
Accession Number
2003779728
Title
Atherosclerotic cardiovascular disease in women with endometriosis: a
systematic review of risk factors and prospects for early surveillance.
Source
Reproductive BioMedicine Online. 39 (6) (pp 1007-1016), 2019. Date of
Publication: December 2019.
Author
Tan J.; Taskin O.; Iews M.; Lee A.J.; Kan A.; Rowe T.; Bedaiwy M.A.
Institution
(Tan, Taskin, Iews, Kan, Rowe, Bedaiwy) Department of Obstetrics &
Gynaecology, The University of British Columbia, Vancouver, British
Columbia, Canada
(Iews) Department of Obstetrics and Gynecology, South Valley University,
Luxor, Egypt
(Lee) Department of Cardiovascular Surgery, The University of British
Columbia, Vancouver, British Columbia, Canada
Publisher
Elsevier Ltd
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.<br/>Copyright &#xa9; 2019 Reproductive
Healthcare Ltd.

<6>
Accession Number
630049669
Title
The effect of remote ischaemic preconditioning on myocardial injury in
emergency hip fracture surgery (PIXIE trial): Phase II randomised clinical
trial.
Source
The BMJ. 367 (no pagination), 2019. Article Number: l6395. Date of
Publication: 04 Dec 2019.
Author
Ekeloef S.; Homilius M.; Stilling M.; Ekeloef P.; Koyuncu S.; Munster
A.-M.B.; Meyhoff C.S.; Gundel O.; Holst-Knudsen J.; Mathiesen O.; Gogenur
I.
Institution
(Ekeloef, Gogenur) Center for Surgical Science, Department of Surgery,
Zealand University Hospital, Lykkebaekvej 1, Koege DK-4600, Denmark
(Homilius, Stilling) Department of Orthopaedic Surgery, University Clinic
for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro,
Denmark
(Stilling) Department of Clinical Medicine, Aarhus University, Aarhus,
Denmark
(Ekeloef) Department of Anaesthesiology, Regional Hospital West Jutland,
Holstebro, Denmark
(Koyuncu, Holst-Knudsen, Mathiesen) Centre for Anaesthesiological
Research, Department of Anaesthesiology, Zealand University Hospital,
Koege, Denmark
(Munster) Department of Clinical Biochemistry, Regional Hospital West
Jutland, Holstebro, Denmark
(Munster) Unit for Thrombosis Research, Department of Clinical
Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
(Meyhoff, Gundel) Department of Anaesthesia and Intensive Care, Bispebjerg
and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Gundel) Department of Anaesthesiology, Herlev and Gentofte Hospital,
University of Copenhagen, Herlev, Denmark
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To investigate whether remote ischaemic preconditioning (RIPC)
prevents myocardial injury in patients undergoing hip fracture surgery.
Design Phase II, multicentre, randomised, observer blinded, clinical
trial. Setting Three Danish university hospitals, 2015-17. Participants
648 patients with cardiovascular risk factors undergoing hip fracture
surgery. 286 patients were assigned to RIPC and 287 were assigned to
standard practice (control group). Intervention The RIPC procedure was
initiated before surgery with a tourniquet applied to the upper arm and
consisted of four cycles of forearm ischaemia for five minutes followed by
reperfusion for five minutes. Main outcome measures The original primary
outcome was myocardial injury within four days of surgery, defined as a
peak plasma cardiac troponin I concentration of 45 ng/L or more caused by
ischaemia. The revised primary outcome was myocardial injury within four
days of surgery, defined as a peak plasma cardiac troponin I concentration
of 45 ng/L or more or high sensitive troponin I greater than 24 ng/L (the
primary outcome was changed owing to availability of testing). Secondary
outcomes were peak plasma troponin I and total troponin I release during
the first four days after surgery (cardiac and high sensitive troponin I),
perioperative myocardial infarction, major adverse cardiovascular events,
and all cause mortality within 30 days of surgery, length of postoperative
stay, and length of stay in the intensive care unit. Several planned
secondary outcomes will be reported elsewhere. Results 573 of the 648
randomised patients were included in the intention-to-treat analysis (mean
age 79 (SD 10) years; 399 (70%) women). The primary outcome occurred in 25
of 168 (15%) patients in the RIPC group and 45 of 158 (28%) in the control
group (odds ratio 0.44, 95% confidence interval 0.25 to 0.76; P=0.003).
The revised primary outcome occurred in 57 of 286 patients (20%) in the
RIPC group and 90 of 287 (31%) in the control group (0.55, 0.37 to 0.80;
P=0.002). Myocardial infarction occurred in 10 patients (3%) in the RIPC
group and 21 patients (7%) in the control group (0.46, 0.21 to 0.99;
P=0.04). Statistical power was insufficient to draw firm conclusions on
differences between groups for the other clinical secondary outcomes
(major adverse cardiovascular events, 30 day all cause mortality, length
of postoperative stay, and length of stay in the intensive care unit).
Conclusions RIPC reduced the risk of myocardial injury and infarction
after emergency hip fracture surgery. It cannot be concluded that RIPC
overall prevents major adverse cardiovascular events after surgery. The
findings support larger scale clinical trials to assess longer term
clinical outcomes and mortality. Trial registration ClinicalTrials.gov
NCT02344797.<br/>Copyright &#xa9; Published by the BMJ Publishing Group
Limited. For permission to use (where not already granted under a licence)
please go to.

<7>
Accession Number
630042336
Title
Microvascular Alterations During Cardiac Surgery Using a Heparin or
Phosphorylcholine-Coated Circuit.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2019.
Date of Publication: 17 Oct 2019.
Author
Dekker N.A.M.; Veerhoek D.; van Leeuwen A.L.I.; Vonk A.B.A.; van den Brom
C.E.; Boer C.
Institution
(Dekker) Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit
Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands;
Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam,
Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Department
of Cardio-thoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam,
Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
(Veerhoek, Vonk) Department of Cardio-thoracic Surgery, Vrije Universiteit
Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
(van Leeuwen, van den Brom) Department of Physiology, Amsterdam UMC, Vrije
Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The
Netherlands; Department of Cardio-thoracic Surgery, Amsterdam UMC, Vrije
Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The
Netherlands
(Boer) Department of Anesthesiology, Vrije Universiteit Amsterdam,
Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Heparin biocompatible coating frequently is used to reduce
inflammation and blood coagulation during cardiopulmonary bypass (CPB) in
cardiac surgery. Whether heparin coating is protective or damaging to the
vascular endothelium is unclear. The authors investigated whether
heparin-coated (HC) circuits are associated with better preservation of
microcirculatory perfusion and glycocalyx dimensions compared with
nonheparin phosphorylcholine-coated (PC) circuits. DESIGN: Prospective,
randomized blinded study. SETTING: Tertiary university hospital.
PARTICIPANTS: A total of 26 adults undergoing elective coronary artery
bypass graft surgery with CPB. INTERVENTIONS: PC (n = 13) versus HC
circuits (n = 13). MEASUREMENTS AND MAIN RESULTS: Sublingual
microcirculatory perfusion was measured before, during, and after CPB
using sidestream dark field imaging and analyzed for perfused vessel
density and perfused boundary region, an inverse parameter for glycocalyx
dimensions. Onset of CPB was associated with an increase in perfused
boundary region in the PC group that continued until the third
postoperative day (2.0 +/- 0.2 to 2.5 +/- 0.2 micro&#32;m; p=0.018). This
was paralleled by increased plasma syndecan-1 levels in the PC group.
Contrastingly, both parameters remained unaltered in the HC group compared
with baseline levels. CPB decreased perfused vessel density in both groups
(CPB v pre-CPB: PC: 17 +/- 2 to 13 +/- 2 mm/mm2, p=0.006; HC: 16 +/- 2 to
11 +/- 2 mm/mm2, p=0.003) and remained equally altered in the first 3
postoperative days. <br/>CONCLUSION(S): The use of an HC circuit is
associated with better preservation of the endothelial glycocalyx compared
with PC circuits, whereas microcirculatory perfusion was disturbed equally
in both groups. Hence, CPB-induced microcirculatory perfusion disturbances
seem to be coating independent.<br/>Copyright &#xa9; 2019 The Authors.
Published by Elsevier Inc. All rights reserved.

<8>
Accession Number
2004128690
Title
Thoracic Endovascular Aortic Repair (TEVAR) in a Case of Grade 3 Blunt
Aortic Injury with an Aberrant Vertebral Artery Origin.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 32nd Annual Meeting 2018. Spain. 58
(6 Supplement 2) (pp e381-e382), 2019. Date of Publication: December 2019.
Author
Baig M.A.A.; Al Fozan A.; Guzman T.; Basahai I.A.; Osman I.S.
Institution
(Baig, Al Fozan, Guzman, Osman) Vascular & Endovascular Surgery, King Saud
Medical City, Riyadh, Saudi Arabia
(Basahai) Interventional Radiology Department, King Saud Medical City,
Riyadh, Saudi Arabia
Publisher
W.B. Saunders Ltd
Abstract
Introduction - A 22-year-old male presented to our hospital with a history
of an unrestrained high-speed motor vehicle accident. On presentation he
was hemodynamically stable with a right humerus fracture and facial
injuries. Trauma CT protocol revealed a grade-3 aortic tear of the
descending thoracic aorta with an anomalous origin of left vertebral
artery (VA) distal to the left subclavian artery. At a multidisciplinary
team meeting it was noted that the left VA was dominant and the right VA
was stenosed in part of its course. CT angiography suggested that the
direct re-implantation of left vertebral artery onto the left carotid
artery was not possible due to the unusually short cervical portion of the
pre-foraminal VA due to its early entry into foramen transversarium of C7
instead of C6. It was therefore decided to proceed with left carotid to
left vertebral artery and left carotico-subclavian artery bypass prior to
TEVAR of the descending aorta. Methods - Using a transverse left cervical
approach the left VA was dissected out as it ascended towards the foramen
transversarium of C7. Using the great saphenous vein an interposition
graft was raised between the left common carotid and left VA using 7/0
prolene. Intraoperative Doppler assessment confirmed satisfactory flow. An
ipsilateral carotico-subclavian bypass was then performed with Dacron
graft using 6/0 prolene. TEVAR was then performed with a 26 mm x100 mm
C-Tag stent. Results - CT angiography on the 2nd postoperative day
confirmed patency of both carotico-vertebral and carotico-subclavian
grafts and satisfactory placement of the TEVAR stent. The patient was
noted to have a left Horner's syndrome but otherwise made an uneventful
recovery. He was discharged on the 3rd postoperative day. At follow up one
month later he remained well with no complications and complete resolution
of Horner's syndrome. [Formula presented] Conclusion - Patients with
traumatic Aortic tears undergoing emergency TEVAR and in whom a proximal
landing zone will seal the origin of an aberrant dominant left vertebral
artery arising from aortic arch (proximal or distal to the LSA) should
have vertebral artery revascularization prior to deployment of the TEVAR.
References 1. Clancy TV, Gary Maxwell J, Covington DL, Brinker CC,
Blackman D. A statewide analysis of level I and II trauma centers for
patients with major injuries. J Trauma 2001; 51:346-51. 2. Richens D,
Field M, Neale M, and Oakley C. The mechanism of injury in blunt traumatic
rupture of the aorta. Eur J Cardiothoracic Surg 2002;21:288-93.Debakey ME,
Henly WS, Cooley DA, et al. Surgical management of dissecting aneurysms of
the aorta. J Thoracic Cardiovasc Surg 1965;49:130-49 3. Lee WA, Matsumura
JS, Mitchell RS, Farber MA, Greenberg RK, Azizzadeh A et al. Endovascular
repair of traumatic thoracic aortic injury: Clinical practice guidelines
of the Society for Vascular Surgery. Journal of Vascular Surgery. 2011
Jan; 53(1):187-192. Available from, DOI: 4. Yuan SM; Aberrant origin of
vertebral artery and its clinical implications. Braz J Cardiovasc Surg
31(1):52-59(2016) 5. Lacout A, Khalil A, Figl A, Liloku R, Marcy PY.
Vertebral arteria lusoria: a life-threatening condition for oesophageal
surgery. Surg Radiol Anat. 2012; 34(4):381-3. 6. Uchino A, Saito N,
Takahashi M, Okada Y, Kozawa E, Nishi N, et al. Variations in the origin
of the vertebral artery and its level of entry into the transverse foramen
diagnosed by CT angiography; Neuroradiology. 2013;55(5):585-94 7.
Rangel-Castilla, L., Kalani, M.Y., Cronk, K., Zabramski, J.M., Russin,
J.J., Spetzler, R.F. Vertebral artery transposition for revascularization
of the posterior circulation: a critical assessment of temporary and
permanent complications and outcomes. J Neurosurg. 2015;122:671-677 8.
Bartel T, Eggebrecht H, Muller S, et al. Comparison of diagnostic and
therapeutic value of transesophageal echocardiography, intravascular
ultrasonic imaging, and intraluminal phased-array imaging in aortic
dissection with tear in the descending thoracic aorta (type B). Am J
Cardiol 2007; 99: 270-274 9. Matsumura JS, Lee WA, Mitchell RS, et al. The
Society for Vascular Surgery Practice Guidelines: management of the left
subclavian artery with thoracic endovascular aortic repair. J Vasc Surg.
2009;50:1155-1158 10. Rizvi AZ, Murad MH, Fairman RM, Erwin PJ, Montori
VM. The effect of left subclavian artery coverage on morbidity and
mortality in patients undergoing endovascular thoracic aortic
interventions: a systematic review and meta-analysis. J Vasc Surg 2009;
50:1159-69. 11. Azizzadeh A, Keyhani K, Miller CC III, Coogan SM, Safi HJ,
Estrera AL. Blunt traumatic aortic injury: initial experience with
endovascular repair. J Vasc Surg 2009;49:1403-8 12. V. Riambau et al
Clinical Practice Guidelines of the European Society for Vascular Surgery
(ESVS). Eur J Vasc Endovasc Surg (2017) 53, 4-52. 13. TEVAR: Endovascular
Repair of the Thoracic Aorta; David A. Nation, MD Grace J. Wang, MD; Semin
Intervent Radiol. 2015 Sep; 32(3): 265-271. 14. Demetriades D. Blunt
thoracic aortic injuries: crossing the rubicon. J Am Coll Surg.
2011;214(3):247Y259. 15. Nabil Saouti Vikash Hindori William J. Morshuis
Robin H. Heijmen; Left subclavian artery revascularization as part of
thoracic stent grafting. European Journal of Cardio-Thoracic Surgery,
Volume 47, Issue 1, 1 January 2015, Pages 120-125 <br/>Copyright &#xa9;
2019

<9>
Accession Number
2004128660
Title
Vascular Access Surgery can be Safely Performed in an Ambulatory Setting.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 32nd Annual Meeting 2018. Spain. 58
(6 Supplement 2) (pp e465), 2019. Date of Publication: December 2019.
Author
Mestres G.; Yugueros X.; Blanco C.; Fontsere N.; Fierro A.; Derosa T.M.;
Riambau V.
Institution
(Mestres, Yugueros, Blanco, Fierro, Derosa, Riambau) Vascular Surgery
Division, Cardiovascular Institute, Vascular Access Unit, Spain
(Fontsere) Nephrology Department, Vascular Access Unit, Hospital Clinic,
University of Barcelona, Barcelona, Spain
Publisher
W.B. Saunders Ltd
Abstract
Insitution(s): ¹Vascular Surgery Division, Cardiovascular
Institute. Vascular Access Unit, ²Nephrology Department.
Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona,
Spain Introduction: Vascular access surgery can be technically
high-demanding, but most procedures can be safely performed in an
ambulatory setting, decreasing costs and improving efficiency, but the
evidence is weak. The objective of this study is to demonstrate the safety
and effectiveness of performing vascular access surgery in an ambulatory
setting. <br/>Method(s): An historical prospective review including all
vascular access open surgeries (vascular access creations and repairs,
excluding catheters or endovascular repairs of previous accesses)
performed by our Vascular Access Unit during the last 5 years (January
2013 to December 2017) was performed. Patient comorbidities, surgery
details, hospital admission condition, and one-month follow-up patency and
complications (significant infection, bleeding, readmission and
reintervention) were reviewed. Comparisons between ambulatory condition
and complications during follow-up were analyzed. <br/>Result(s): In the
last 5 years, 1414 vascular access surgeries were performed (67.8% access
creations and 32.2% previous access repairs; mean age 66.6 years, 64.7%
males, 66.4% in the left side) in 1012 patients. Most surgeries were
performed under local anesthesia (59.2%) or axillary plexus block (38.4%),
and mainly in an ambulatory setting, without hospital night stay (90.9%).
2.5% were emergent and 9.1% urgent surgeries. During first postoperative
month follow-up, 22 cases (1.6%) needed readmission or reintervention
(only 9 [0.6%] during first week); significant infection occurred in 14
(1.0%, but only 2 needed readmission and vascular access removal) and 13
cases (0.9%) showed important hematoma or bleeding (only 6 [0.4%] needing
reintervention). Secondary patency of new vascular access creations was
94.1% at one month. Ambulatory setting was not related to a higher rate of
readmissions, reinterventions, bleeding or infection (P>0.05 for all
comparisons). <br/>Conclusion(s): Arteriovenous access surgery can be
safely performed in an ambulatory setting, in spite of complex cases,
comorbidities, or the increasing use of axillary plexus blocks. Surgical
results and access patency are good, and complications needing readmission
remain very low, not related to the ambulatory condition. References 1.
Sawant A, Mills PK, Dhingra H. Increased length of stay and costs
associated with inpatient management of vascular access failures. Semin
Dial. 2013;26:106-10. 2. Al-Jaishi AA, Liu AR, Lok CE, Zhang JC, Moist LM.
Complications of the arteriovenous fistula: a systematic review. J Am Soc
Nephrol. 2017;28(6):1839-50. 3. Almasri J, Alsawas M, Mainou M, Mustafa RA
et al. Outcomes of vascular access for hemodialysis: A systematic review
and meta-analysis. J Vasc Surg 2016;64:236-43 4. Lin PH, Yang KH,
Kollmeyer KR, Uceda PV et al. Treatment outcomes and lessons learned from
5134 cases of outpatient office-based endovascular procedures in a
vascular surgical practice. Vascular. 2017; 25(2): 115-122. 5. Dobson A,
El-Gamil AM, Shimer MT, DaVanzo JE et al. Clinical and Economic Value of
Performing Dialysis Vascular Access Procedures in a Freestanding
Office-Based Center as Compared with the Hospital Outpatient Department
among Medicare ESRD Beneficiaries. Semin Dial 2013; 26(5): 624-32.
<br/>Copyright &#xa9; 2019

<10>
Accession Number
2004128658
Title
Effect of Remote Ischemic Preconditioning on the Incidence of Contrast
Induced Nephropathy in Patients Undergoing EVAR (Rip-EVAR Study).
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 32nd Annual Meeting 2018. Spain. 58
(6 Supplement 2) (pp e307-e308), 2019. Date of Publication: December 2019.
Author
Castillo D.G.; San Norberto Garcia E.M.; Estevez Fernandez I.T.; Ibanez
Marana M.A.; Fidalgo Domingos L.A.; Puerta C.V.
Institution
(Castillo, San Norberto Garcia, Estevez Fernandez, Ibanez Marana, Fidalgo
Domingos, Puerta) Angiology and Vascular Surgery, Hospital Clinico
Universitario, Valladolid, Spain
Publisher
W.B. Saunders Ltd
Abstract
Introduction - Contrast induced nephropathy (CIN) is a major inconvenience
when using iodinated contrast media (ICM) and associates significantly
increased morbimortality and costs of hospitalization[1]. Remote ischemic
preconditioning (RIP) is a non-invasive tissular protection technique
believed to decrease renal insult produced by ICM[2,3]. The primary
outcome of this study is to evaluate the impact of RIP on the incidence of
CIN in patients undergoing EVAR. Methods - Patients undergoing elective
EVAR were recruited prior to receiving ICM and randomized into the
control/RIP groups. Biochemical parameters determined renal function
before and after surgery in immediate (24-72 hours) and at 30 days'
follow-up. Results - Of the 49 patients included in the study, 98% were
male. Mean age was 73 years (range 56-87). Diabetes (22,4%) and chronic
renal failure (30,6%) was present prior to administration of ICM. RIP was
applied in 44,9% of the patients. 18,4% developed CIN despite renal
protection strategies. RIP did not influence outcome in terms of incidence
of CIN, seric creatinine, urea or estimated glomerular filtration (eFG) in
immediate postoperative period. However, when >=50ml of ICM were used, the
group of RIP patients showed a statistically significant improvement in
seric creatinine (1.02+/-0.3mg/dl vs 1.61+/-0.6mg/dl; p=0,027), urea
(43.1+/-14.9mg/dl vs 69.25+/-30.8mg/dl; p=0,007) and eFG
(74.23+/-18.3ml/min/1.73m2 vs 48.74+/-22.1ml/min/1.73m2; p=0,026) at 30
days follow-up. <br/>Conclusion(s): In short-term follow-up, RIP seems to
be an effective way of alleviating effects of ICM on the renal parenchyma
in EVAR procedures in which more than 50ml of ICM are used. Larger studies
should be conducted in order to consolidate these results. Of the 49
patients included in the study, 98% were male. Mean age was 73 years
(range 56-87). Diabetes (22,4%) and chronic renal failure (30,6%) was
present prior to administration of ICM. RIP was applied in 44,9% of the
patients. 18,4% developed CIN despite renal protection strategies. RIP did
not influence outcome in terms of incidence of CIN, seric creatinine, urea
or estimated glomerular filtration (eFG) in immediate postoperative
period. However, when >50ml of ICM were used, the group of RIP patients
showed a statistically significant improvement in seric creatinine
(1.02+/-.3mg/dl vs 1.61+/-.6mg/dl; p=0,027), urea (43.1+/-14.9mg/dl vs
69.25+/-30.8mg/dl; p=0,007) and eFG (74.23+/-18.3ml/min/1.73m2 vs
48.74+/-22.1ml/min/1.73m2; p=0,026) at 30 days follow-up. Conclusion - In
short-term follow-up, RIP seems to be an effective way of alleviating
effects of ICM on the renal parenchyma in EVAR procedures in which more
than 50ml of ICM are used. Larger studies should be conducted in order to
consolidate these results. References 1. Tsai TT, Patel UD, Chang TI,
Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary Incidence,
Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing
Percutaneous Coronary Interventions. JACC: Cardiovascular Interventions.
Elsevier Inc; 2014 Jan 1;7(1):1-9. 2. Zarbock A, Schmidt C, Van Aken H,
Wempe C, Martens S, Zahn PK, et al. Effect of Remote Ischemic
Preconditioning on Kidney Injury Among High-Risk Patients Undergoing
Cardiac Surgery. JAMA. 2015 Jun 2;313(21):2133-9. 3. Ali ZA, Callaghan CJ,
Lim E, Ali AA, Reza Nouraei SA, Akthar AM, et al. Remote Ischemic
Preconditioning Reduces Myocardial and Renal Injury After Elective
Abdominal Aortic Aneurysm Repair: A Randomized Controlled Trial.
Circulation. 2007 Sep 11;116(11_suppl):I-98-I-105. <br/>Copyright &#xa9;
2019

<11>
Accession Number
2004128600
Title
Open Thoracic and Thoracoabdominal Aortic Repair After Prior Endovascular
Therapy.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 32nd Annual Meeting 2018. Spain. 58
(6 Supplement 2) (pp e286-e287), 2019. Date of Publication: December 2019.
Author
Keschenau P.R.; Ketting S.; Mees B.; Barbati M.E.; Grommes J.; Gombert A.;
Schurink G.W.; Kotelis D.; Jacobs M.J.
Institution
(Keschenau, Barbati, Grommes, Gombert, Kotelis, Jacobs) European Vascular
Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany
(Ketting, Mees, Schurink, Jacobs) European Vascular Center
Aachen-Maastricht, University Hospital Maastricht, Maastricht, Netherlands
Publisher
W.B. Saunders Ltd
Abstract
Introduction - As endovascular techniques have evolved, the indications
for endovascular therapy of aortic disease have expanded to more complex
pathologies and to all aortic segments (1). However, the rising number of
endovascularly treated patients entails an increase in the number of
required secondary reinterventions, especially in the mid- and long-term
(2-4). Despite the ongoing improvement of endovascular modalities to treat
different kinds of failures and complications following endovascular
treatment (5), not all of them can be managed by endovascular means. There
are still a relevant number of patients who require secondary open surgery
or conversion. When the thoracic aorta is involved, this means thoracic
aortic (TAA) or even extensive thoracoabdominal aortic (TAAA) surgery with
or without simultaneous repair of the ascending aorta and the aortic arch
(6, 7). The aim of this study was to present current results of open TAA
and TAAA repair as secondary procedure after previous endovascular aortic
therapy. Methods - From 2006 to July 2017 45 open thoracic aortic (TAA) or
thoracoabdominal aortic (TAAA) operations were performed on 44 patients
(median age 58[15-80] years) as secondary surgery after previous
endovascular therapy comprising TEVAR (n=38;86%), EVAR (n=3;7%),
fenestrated EVAR (n=1;2%) and TEVAR plus EVAR (n=1;2%). 11 patients(25%)
had had previous open aortic surgery at the secondary surgery site.
Indications for TAA(A) repair were type I endoleak (n=10;23%),
post-dissection aneurysm progression due to persisting false lumen
perfusion (n=8;18%), proximal/distal disease progression (n=16;36%),
device fracture/dislocation (n=4;9%), infection (n=5;11%) and initial
endograft misplacement (n=1;2%). The operations included descending
thoracic aortic repair (n=13, 29%), TAAA type I (n=4;9%), type II
(n=5;11%), type III (n=13;29%), type IV (n=7;16%) and type V repair
(n=3;7%) with simultaneous arch repair in 18%(n=8). Median time to
secondary surgery was 36(2-168) months. Median follow-up was 39(3-118)
months. Results - In-hospital mortality was 20%(n=9) due to intraoperative
aneurysm rupture, pneumonia-induced sepsis, hemorrhagic cerebellar
infarction, mesenteric ischemia, bronchoesophageal fistula and multiorgan
failure (1/9,respectively) as well as hemorrhage (3/9). Estimated survival
was 73% at one year and 71% overall. The most frequent complications were
pneumonia (n=19;43%), bleeding requiring revision (n=11;25%) and sepsis
(n=14;32%). Transient dialysis was required in 32%(n=14), permanent
dialysis in 6%(n=2). Permanent spinal cord deficit (paraparesis) occurred
in 6%(n=2). Estimated freedom from aortic reintervention was 86%. [Formula
presented] Conclusion - Open TAA(A) repair as secondary procedure after
previous endovascular aortic therapy is an important treatment option even
in the endovascular era. It represents a durable treatment that can
produce respectable outcomes. Yet the perioperative morbidity and
mortality are relevant and a specialized team and infrastructure are
mandatory in these complex procedures. Therefore, centralization is
required. References 1. Hongku K, Dias NV, Sonesson B, Resch TA. Total
aortic endovascular repair. J Cardiovasc Surg (Torino).
2016;57(6):784-805. 2. Hellgren T, Wanhainen A, Steuer J, Mani K. Outcome
of endovascular repair for intact and ruptured thoracic aortic aneurysms.
J Vasc Surg. 2017:1-8. 3. Patel R, Sweeting MJ, Powell JT, Greenhalgh RM,
for the EVAR trial investigators. Endovascular versus open repair of
abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular
aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial.
Lancet 2016;388:2366-74. 4. Verzini F, Loschi D, De Rango P, Ferrer C,
Simonte G, Coscarella C, Pogany G, Cao P. Current results of total
endovascular repair of thoracoabdominal aortic aneurysms. J Cardiovasc
Surg (Torino). 2014;55(1):9-19. 5. Resch T. Failure modes and secondary
endovascular interventions after endovascular aortic repair. J Cardiovasc
Surg (Torino). 2017;58(2):218-77. 6. Canaud L, Alric P, Gandet T, Albat B,
Marty-Ane C, Berthet J. Surgical conversion after thoracic endovascular
aortic repair. J Thorac Cardiovasc Surg 2011;142:1027-31. 7. Langer S,
Mommertz G, Koeppel TA, Schurink GW, Autschbach R, Jacobs MJ. Surgical
correction of failed thoracic endovascular aortic repair. J Vasc Surg.
2008;47(6):1195-202. <br/>Copyright &#xa9; 2019

<12>
Accession Number
2004128560
Title
Synchronous Bilateral Carotid Endarterectomies (SBCEAs): Why Not?.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 32nd Annual Meeting 2018. Spain. 58
(6 Supplement 2) (pp e486-e487), 2019. Date of Publication: December 2019.
Author
Chaudhuri A.; Abdellatif M.; Kommer M.
Institution
(Chaudhuri, Abdellatif, Kommer) BMK Vascular Centre, Bedford Hospital NHS
Trust, Bedford, United Kingdom
Publisher
W.B. Saunders Ltd
Abstract
Introduction: Controversy exists about management of patients presenting
with bilateral significant carotid artery stenoses. The vast majority will
be either entirely asymptomatic or symptomatic on one side only, with
bilateral symptoms being quite rare (1). Though the concept of synchronous
bilateral carotid endarterectomy (SBCEA) is not new (2-4), recently
published European Society for Vascular Surgery guidelines recommend
staged CEAs as first line of management for fear of bilateral recurrent
laryngeal or hypoglossal nerve injuries (5). Bilateral CAS is also
favoured over bilateral synchronous CEAs if bilateral revascularization is
considered essential. <br/>Method(s): The authors report 14 cases of
bilateral (synchronous & asynchronous) carotid endarterectomies undertaken
at recommended treatment threshold (70-99% if asymptomatic & 50-99% if
symptomatic) treated in a single centre between December 2010 & February
2018. Patients were grouped according to timing of procedures: (group 1,
SBCEAs, n=9), (group 2, staged BCEAs, n=5 patients i.e. 10 procedures). A
review of each case is presented detailing: patient demographics, disease
severity, initial presentations, surgical technique & postoperative
complications. A comparison was done between the 2 groups to assess rate
of complications (stroke & nerve injury), postoperative length of stay
(LOS), 30 day mortality, operative time per side & cost. Statistical
analyses have not been undertaken given the small sample sizes.
<br/>Result(s): Out of the 9 patients in group 1 (mean age 72.7 years; 6
males, 3 females); 4 patients were asymptomatic, 4 had unilateral symptoms
& 1 presented with bilateral amaurosis fugax. A clear discussion was had
with all patients regarding the fact that SBCEAs are performed in low
numbers in order to guide informed consent. In 5 patients general
anaesthesia (GA) was used while local anaesthesia (LA) was used in 4
patients of whom only one patient was converted to GA. Mean operative time
was 165 minutes. Shunting was used on both sides (n=5), single side (n=2)
or not at all (n=2); bilateral neck wounds were closed at the end of the
operation. Postoperative complications encountered in two patients
(hoarseness n=1; dysphagia n=1). Mean post-operative LOS was 2.9 days.
Over the same period 5 patients also underwent asynchronous bilateral CEA.
4 procedures were performed for totally asymptomatic lesions (70-99%)
while 6 were done for symptomatic stenosis (50-99%). In 4 instances GA was
used while LA was used in the remaining 6. Mean operative time was 102
minutes. Shunting was used 4 times. Postoperative periods were uneventful
in all patients. Average post-operative LOS was 1 day. In both groups, all
operations were undertaken by a single operator (AC), bovine pericardial
patches were used in 100% of cases. None of the patients developed
hypoglossal nerve palsy; stroke and 30-day mortality was 0%. The
approximate cost of a staged procedure was calculated at 2786(3287) for
both sides vs. 1943(2293) for a one-stage approach. This equates to a
saving of 84,300 (99,459) per hundred patients requiring bilateral CEA.
[Formula presented] <br/>Conclusion(s): Synchronous bilateral CEAs can be
a safe & feasible approach in selected patients as indicated in this small
series, and echoes those by other authors. A multi-centre randomised
controlled trial is recommended to fully assess the benefits &
complications of this intervention; nevertheless, in reality, we cannot
see this happen as most surgeons will be unwilling to undertake the
procedure. References 1. Kumar ID, Singh S, Williams G, Train J. Bilateral
one-stage carotid endarterectomy-Is there an indication? Eur J Vasc
Endovasc Surg. 2001;21(6):575-6. 2. Dimakakos PB. Bilateral carotid
endarterectomy. Eur J Vasc Endovasc Surg. 2001;22(5):477. 3. Chang BB,
Darling RC, 3rd, Shah DM, Paty PS, Leather RP. Carotid endarterectomy can
be safely performed with acceptable mortality and morbidity in patients
requiring coronary artery bypass grafts. Am J Surg. 1994;168(2):94-6. 4.
Darling RC, 3rd, Kubaska S, Shah DM, Paty PS, Chang BB, Lloyd WE, et al.
Bilateral carotid endarterectomy during the same hospital admission.
Cardiovasc Surg. 1996;4(6):759-62. 5. Writing Group: Naylor AR, Ricco JB,
de Borst GJ, Debus S, de Haro J, et al. Editor's Choice - Management of
Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical
Practice Guidelines of the European Society for Vascular Surgery (ESVS).
Eur J Vasc Endovasc Surg. 2018;55(1):3-81. <br/>Copyright &#xa9; 2019

<13>
Accession Number
2003904259
Title
Act Guided Heparin Administration in Elective Open Abdominal Aortic
Aneurysm Repair: Results of A Pilot Study.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 33rd Annual Meeting 2019. Germany.
58 (6 Supplement 3) (pp e654), 2019. Date of Publication: December 2019.
Author
Doganer O.; Wiersema A.; Pierie M.; Blankensteijn J.; Yeung K.K.; Jongkind
V.
Institution
(Doganer, Wiersema, Jongkind) Dijklander Ziekenhuis, Vascular Surgery,
Hoorn, Netherlands
(Doganer, Wiersema, Blankensteijn, Yeung, Jongkind) Amsterdam UMC, VU
University Medical Center, Vascular Surgery, Amsterdam, Netherlands
(Pierie) Isala Zwolle, Vascular Surgery, Zwolle, Netherlands
Publisher
W.B. Saunders Ltd
Abstract
Introduction: Almost all vascular surgeons use a bolus of 5 000 IU of
unfractionated heparin (UFH). However, its dose-response and elimination
curves are non-linear, and display a high inter-patient variability. The
activated clotting time (ACT) is an established method to measure the
level of anticoagulation. The purpose of this study was to evaluate the
rate of arterial thrombo-embolic complications (ATEC) and bleeding
complications in patients undergoing elective open abdominal aortic
aneurysm repair (AAA), in which a bolus of 5 000 IU of UFH was compared to
an ACT guided additional UFH dose protocol. <br/>Method(s): All
consecutive patients that underwent primary elective open AAA repair were
included from a multicentre (1 academic and 2 peripheral hospitals)
prospective study on ACT guided heparinization (MANCO: Measuring the ACT
during non-cardiac arterial procedures, Clin. Trials.gov NCT 03426293).
ACT measurements were performed as a bedside point-of-care test. During
the first part of the study patients received a bolus of 5 000 IU. During
the second part of the study patients received an initial bolus of 5 000
IU or 100 IU/kg and additional UFH dosages were administered, with a
target ACT of 200 - 250 sec. The primary study endpoints were ATEC (graft
thrombosis, embolism, myocardial infarction, transient ischemic attack,
minor and major stroke, pulmonary embolism, bowel ischemia) detected
during the procedure or during 30 day follow-up or during the same
admission of the primary procedure, bleeding complications and mortality
during 30 day follow-up. The secondary study endpoints were all other
complications, the level of periprocedural anticoagulation as measured by
the ACT and the additional and total UFH dosages administered.
<br/>Result(s): 46 primary elective open AAA procedures were included, 18
patients in the standard dose group and 28 patients in the additional dose
group. In the standard dose group 28% of patients reached an ACT of 200
sec. compared to 100% in the additional dose group. In the additional dose
group the mean total periprocedural UFH dose administered was 9874 +/-
2909 IU. ATEC occurred in 27.8% of patients in the standard dose group
versus 14.3% in the additional dose group (P= 0.26). Bleeding
complications did not increase in the additional dose group (38.9 versus
35.7%, P= 0.83). In both groups no patient died during 30 day follow-up.
<br/>Conclusion(s): A standard dose of 5000 IU UFH leads to inadequate
levels of heparinisation. Higher dosing of UFH aimed at an ACT of 200 sec.
is safe, does not lead to increased bleeding, and potentially leads to a
reduction in ATEC. A randomized controlled trial is needed to provide
evidence on potential reduction in thrombo-embolic complications.
Disclosure: Grant of Medtronic to perform the ACT
measurements.<br/>Copyright &#xa9; 2019

<14>
Accession Number
2003904169
Title
Preoperative Cardiac Stress Testing in Patients Undergoing Vascular
Surgery: Preliminary Results of a Systematic Review.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 33rd Annual Meeting 2019. Germany.
58 (6 Supplement 3) (pp e616-e617), 2019. Date of Publication: December
2019.
Author
Nduwayo S.; Houghton J.; Nickinson A.; Pepper C.; McMahon G.; Bown M.;
McCann G.P.; Sayers R.
Institution
(Nduwayo, Houghton, Nickinson, McMahon, Bown, McCann, Sayers) University
of Leicester, Cardiovascular Sciences, Leicester, United Kingdom
(Nduwayo, Houghton, Nickinson, McMahon, Bown, Sayers) University Hospitals
of Leicester NHS Trust, Leicester Vascular Institute, Leicester, United
Kingdom
(Pepper) University Hospital of Leicester NHS Trust, Library Services,
Leicester, United Kingdom
Publisher
W.B. Saunders Ltd
Abstract
Introduction: Coronary artery disease (CAD) is a major cause of
perioperative morbidity and mortality in patients undergoing vascular
surgery. Several tests have been used to assess risk of postoperative
cardiac complications. In this systematic review we compared the
prognostic accuracy of preoperative cardiac stress tests in predicting
postoperative cardiac events in patients undergoing vascular surgery.
<br/>Method(s): A study protocol was designed in accordance with PRISMA
(Preferred Reporting Items for Systematic reviews and Meta-Analyses) and
registered with the International Prospective Register of Systematic
Reviews (CRD42019117846). A search of Medline, Embase, Scopus, CINAHL and
the Cochrane library databases was conducted to identify studies
correlating postoperative cardiac events of patients undergoing vascular
surgery to preoperative cardiac stress tests between 1998 and 2018. For
the purpose of this review, only pharmacological stressing agents were
included. Quality was assessed using the Newcastle-Ottawa scores (NOS).
Sensitivity and specificity of each test was calculated from published
results. Summary receiver operator characteristic (SROC) curve and forest
plots were used to compare different tests. <br/>Result(s): A total of 17
studies (3182 patients) were included. The mean age was 67+/-3 years and
82% were male. Twelve studies (71%) were prospective and 13 (76%) had a
Newcastle-Ottawa scale score 37. Seven studies used stress
echocardiography (SE), 8 myocardial perfusion imaging (MPI) and 2 studies
compared SE and MPI. With regards to predicting postoperative cardiac
events, MPI and SE had a sensitivity of 70% (95% confidence interval [CI]
44% to 83%) and 49% (95% CI 32% to 70%) respectively whilst specificity
was 60% (95% CI 45% to 79%) and 85% (95% CI 74% to 87%) respectively.
<br/>Conclusion(s): Overall prognostic accuracy of cardiac stress tests
for postoperative cardiac events after vascular surgery remains modest.
Further research is required in vascular surgery patients using newer
techniques and modalities that have been shown to have higher diagnostic
accuracy of predicting CAD. Disclosure: Nothing to disclose<br/>Copyright
&#xa9; 2019

<15>
Accession Number
630050250
Title
Should we continue to routinely revascularize patients during valve
surgery in optimal medical therapy era?.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2237), 2019. Date of
Publication: October 2019.
Author
Dias Ferreira Reis J.P.; Strong C.; Roque D.; Morais L.; Mendonca T.;
Modas P.D.; Farto E Abreu P.; Almeida M.; Cacela D.; Morais C.; Mendes M.;
Cruz Ferreira R.; Bravo Baptista S.; Raposo L.; Ramos R.
Institution
(Dias Ferreira Reis, Morais, Mendonca, Modas, Cacela, Cruz Ferreira,
Ramos) Hospital De Santa Marta, Lisbon, Portugal
(Strong, Almeida, Mendes, Raposo) Hospital De Santa Cruz, Cardiology,
Lisbon, Portugal
(Roque, Farto E Abreu, Morais, Bravo Baptista) Hospital Prof Fernando Da
Fonseca EPE, Cardiology, Amadora, Portugal
Publisher
Oxford University Press
Abstract
Background: Optimal management of stable obstructive coronary artery
disease (CAD) in patients (pts) undergoing heart valve surgery remains
controversial. The aim of the present study is to evaluate the effective
prognostic role of CABG in pts undergoing valve surgery who had
concomitant CAD. <br/>Method(s): We conducted a retrospective multicenter
survival analysis using multivariable Cox models and Kaplan-Meier curves
of consecutive pts undergoing valve surgery with or without concomitant
CABG between January 2015 and February 2017. <br/>Result(s): From 1196
consecutive pts undergoing valvular surgery in 3 portuguese centers, 257
(21.5%) were found to have obstructive CAD (55.6% male, mean age 74+/-8
y.o., mean follow-up time 16+/-8 months, aortic valve disease 78.8%). No
coronary revascularization (R) was attempted in 177 pts, complete R was
achieved in 40 and R was anatomically incomplete in the remaining 40 pts.
Age (75 vs 77.3 y.o.; p=0.202), multivessel disease (46.3% vs 53.8%,
p=0.270), aortic valve disease (91.0% vs 92.5%, p=0.683), left ventricular
ejection fraction <40% (11.8% vs 19.4%, p=0.272) were comparable between
nonrevascularized and revascularized pts; SYNTAX score was low and also
similar in both groups (7+/-12 vs 7+/-5, p=0.856). Left main disease (8.5%
vs 17.5%, p=0.034) and EUROSCORE IIrisk score (2.3+/-2 vs 3.2+/-2,
p=0.011) was higher for those with any revascularization.
Non-revascularized pts had significantly lower all-cause mortality at
follow up than those with any R (10.2% vs 21.2%, p=0.016). However, both
in-hospital (4% vs 7.5%, p=0.230) and cardiovascular mortality (6.9% vs
7.1%, p=1.00) were similar. In a multivariate analysis, independent
predictors for all-cause mortality were: any surgical R (HR 4.52, CI95%
2.09-9.78), baseline atrial fibrillation (HR 2.51, CI95% 1.07-5.90), left
main disease (HR 3.153, CI95% 1.26-7.90) and peripheral artery disease (HR
2.95, CI95% 1.036-8.421). All-cause mortality for pts with obstructive CAD
was higher than in pts with no CAD (13.6% vs 6.2, p<0.001). Interestingly,
however, after multivariable adjustment, complete R was not found to be
protective as compared to no R (HR 0.79, IC 0.31-2.06, p=0.633)
<br/>Conclusion(s): Significant CAD is associated with worse outcomes in
pts undergoing valve surgery. In this study, standard
angiographically-guided R was not associated with improved results.
Randomized controlled trials are needed to further assess risk
stratification and the role of coronary R of stable CAD in this setting.
(Figure Presented).

<16>
Accession Number
630050133
Title
Optimal medical therapy improves survival in patients with ischaemic
cardiomyopathy: An analysis of the STICH trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2190), 2019. Date of
Publication: October 2019.
Author
Wolfe N.; Mitchell J.D.; Brown D.L.
Institution
(Wolfe, Mitchell, Brown) Washington University, School of Medicine,
Cardiovascular Division, St. Louis, United States
Publisher
Oxford University Press
Abstract
Background: Prior studies have demonstrated underuse of optimal medical
therapy (OMT) in patients with coronary artery disease (CAD) after
revascularization. However, there are limited studies assessing compliance
with OMT on long-term survival in patients with CAD and no studies
evaluating the impact of OMT in patients with severe CAD and reduced left
ventricular (LV) function. The Surgical Treatment for Ischaemic Heart
Failure (STICH) Trial was a randomized clinical trial that compared
coronary-artery bypass grafting (CABG) with medical therapy versus medical
therapy alone in the treatment of ischemic cardiomyopathy.
<br/>Purpose(s): This study sought to determine compliance with OMT over
time and the impact of OMT compliance on survival in patients with or
without revascularization. <br/>Method(s): STICH was a multicenter,
randomized clinical trial of patients with an LV ejection fraction of 35%
or less and CAD amenable to CABG who were randomized to CABG plus medical
therapy (N=610) or medical therapy alone (N=602). A medication history was
obtained at hospital discharge or 30 days after enrollment, 1 year, 5
years, and 10 years. OMT was defined as the combination of at least 1
antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting
enzyme inhibitor/angiotensin receptor blocker. The primary outcome was
all-cause mortality. Comparison of mortality between the OMT and non-OMT
groups was performed using multivariate Cox regression modeling with OMT
as a time-dependent covariate. <br/>Result(s): Of the 1212 patients
randomized, at a median follow-up of 9.8 years, all-cause mortality was
58.9% in the CABG group and 66.1% in the medical therapy group. In the
CABG arm, 63.6% of patients were on OMT throughout the study period
compared to 66.5% of patients in the medical therapy arm (p=0.3). Those on
OMT were younger (59.6 vs. 61.4 years, p<0.001); were more often in NYHA
class I-II (67.4% vs. 56%, p<0.001); and lower rates of atrial
fibrillation (9.4% vs. 18.1%, p<0.001), current smoking (18.6% vs. 24.5%,
p=0.015), and depression (4.8% vs. 8.8%, p=0.005). Those on OMT had higher
rates of hyperlipidemia (63.8% vs. 54.4%, p=0.001) and prior myocardial
infarction (79.4% vs. 73.1%, p=0.01). There was no difference in sex,
diabetes, and hypertension between those on OMT and non-OMT. In
multivariate survival analysis, OMT was associated with a significant
reduction in mortality (adjusted hazard ratio, 0.69; 95% confidence
interval, 0.58-0.81; p<0.001). The treatment effect with OMT (31% relative
reduction in mortality over 10 years) was numerically greater than the
treatment effect of CABG (24% relative reduction in mortality with CABG
versus medical therapy alone). <br/>Conclusion(s): OMT improves long-term
survival in patients with ischaemic cardiomyopathy regardless of
revascularization status. Strategies to improve OMT use and adherence in
this population is needed to maximize survival.

<17>
Accession Number
630050046
Title
Mortality of surgical redo aortic valve replacement versus transcatheter
aortic valve-in-valve implantation in patients with degenerated aortic
bioprosthesis: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2438), 2019. Date of
Publication: October 2019.
Author
Sanchez Recalde A.; Pardo A.; Salido Tahoces L.; Mestre J.L.; Hernandez
Antolin R.; Sanmartin M.; Zamorano J.L.
Institution
(Sanchez Recalde, Pardo, Salido Tahoces, Mestre, Hernandez Antolin,
Sanmartin, Zamorano) University Hospital Ramon y Cajal De Madrid, Madrid,
Spain
Publisher
Oxford University Press
Abstract
Background: Transcatheter valve-in-valve (tVIV) implantation for
degenerated aortic bioprosthesis has become an alternative to surgical
aortic valve replacement (sAVR) in the past few years. However, some
concerns have been raised regarding to the long-term safety and efficacy
of tVIV. The objective was to compare the clinical and echocardiographic
outcomes of tVIV implantation with redo cAVR. <br/>Method(s): After an
extensive search of PubMed we included 7 observational studies (3 used
propensity score matching) comparing tVIV versus sAVR in 762 patients The
primary endpoint was all-cause mortality determined from the longest
available survival data. Other outcomes of interest were stroke, permanent
pacemaker implantation, paravalvular leak, hospital stay and postoperative
aortic valve gradient. The review was conducted according to the MOOSE
recomendations. Der Simonian and Laird random effects model was used to
estimate summary measures and their 95% CI. <br/>Result(s): Patients in
the tVIV group were significantly older (78 vs 73 y.o.) and had a higher
baseline risk compared to those in the re-sAVR group (Euroscore 19.7 vs
14.3). There was no statistical difference in procedural or 30-day
mortality 5.4% vs 5.3% in tVIV and sAVR, respectively (RR 0.98, 95% CI
0.54-1.80; p=0.96], and long-term mortality (from 6 month to 5 years)
18.7% versus 16.5% (RR 1.13, 95% CI 0.80-1.60; P=0.50). The risk of stroke
was similar (1.5% in tVIV vs 2.4% in sAVR, p=0.47). tVIV was associated
with a significantly lower rate of permanent pacemaker implantations 6.9%
vs 12.1% (RR 0.58, 95% CI 0.36-0.94; P=0.03) and shorter hospital length
stay (7 days vs 12 days, p=0.02). However, echocardiographic postoperative
aortic valve gradients were lower in sAVR group than in tVIV (RR 1.83, 95%
CI 0.75-2.91, p<0.001). <br/>Conclusion(s): This meta-analysis suggests
that patients with aortic degenerated bioprosthesis treated with tVIV have
similar 30-day and long-term mortality with lower need of permanent
pacemaker and length stay than sAVR. Thus tVIV is a valid alternative to
standard surgical treatment. (Table Presented) .

<18>
Accession Number
630048842
Title
Pulmonary artery ablation during open mitral valve surgery for pulmonary
artery hypertension: A prospective randomized study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2279), 2019. Date of
Publication: October 2019.
Author
Bogachev-Prokophiev A.V.; Zalesov A.; Afanasyev A.V.; Sharifulin R.M.;
Ovcharov M.A.; Karaskov A.M.
Institution
(Bogachev-Prokophiev, Zalesov, Afanasyev, Sharifulin, Ovcharov, Karaskov)
Meshalkin National Medical Research Center, Novosibirsk, Russian
Federation
Publisher
Oxford University Press
Abstract
Purpose: Recent investigations of pulmonary artery (PA) ablation into the
treatment of idiopathic pulmonary artery hypertension (PAH) have suggested
improvement of functional capacity, and hemodynamics. We investigated the
impact of PA ablation in patients with PAH due to left heart disease (Dana
Point, 2008) scheduled for open-heart mitral valve surgery.
<br/>Method(s): Fifty patients aged 52+/-10 with mitral valve disease
complicated severe PAH (mean PAP >40mm Hg) were randomly assigned to
mitral valve surgery with or without PA ablation procedure. Eligible
criteria: positive reactive test with nitric oxide inhalation (decrease of
mean PAP more than 10 mm Hg without decrease of cardiac output). There
were no between group differences in preoperative characteristics.
Surgical procedure: After bypass is establishedthe fibrous fold of
pericardiumand the ligamentum arteriosum are dissected out, and the
branches of the right and left pulmonary artery are mobilized well out
into the hilum of the lungs bilaterally. PA ablation was performed
epicardially at the bifurcation of the main PA, and 10 mm distal to the
right and left PA's using AtriCure Isolatormultifunctional pen. Serial
assessment of echocardiography, right heart catheterization (catheter
Swan-Ganz), and 6-min walk test (6MWT) were performed during hospital
stay. The primary endpoints were the change of meanpulmonary artery
pressure (PAP)and 6MWT. The secondary endpoints were hospital mortality,
freedom from PADN-related complication: PA perforation, PA dissection, and
PA thrombosis (MDCT assessment). <br/>Result(s): There were no early
deaths. No procedure-related complications were observed. On first day
after surgery patients from ablation group showed significant reduction of
mean PAP (from 50.6+/-5.3to 34.6+/-9.9 mm Hg, p<0.001), and significant
improvement of 6MWT at discharge (from 229+/-34 m to 475+/-21 m, p<0.001).
On first day after surgery patients from control group also showed
significant reduction of mean PAP (from 51.3+/-6.3to 47.2+/-8.5 mm Hg,
p=0.011), and significant improvement of 6MWT at discharge (from 249+/-32
m to 335+/-18 m, p<0.001). Nevertheless, there was significant between
group difference in mean PAP on first day after surgery (34.6+/-9.9 mm Hg,
vs 47.2+/-8.5 mm Hg, p=0.005). Moreover there was significant differences
in 6MWT at discharge (475+/-21 m vs 335+/-18 m, p=0.002) with benefit to
ablation group. <br/>Conclusion(s): We report for the first time the
effect and superiority of PA ablation on functional capacity and
hemodynamics in patients with mitral valve disease complicated PAH.
Epicardial PA ablation for the treatment PAH can be effectively and safely
performed during open heart surgery. (Figure Presented).

<19>
Accession Number
630048518
Title
The left atrial appendage closure by surgery-2 randomized trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2329), 2019. Date of
Publication: October 2019.
Author
Dominguez H.; Madsen C.V.; Irmukhamedov A.; Carranza C.L.; Rafiq S.;
Rodriguez-Lecoq R.; Torrents A.; Moya-Mitjans A.; Sharma V.; Kruuse C.R.;
Nilsson B.; Dixen U.; Sajadieh A.; Greve A.M.; Park-Hansen J.
Institution
(Dominguez, Madsen, Sajadieh, Park-Hansen) Bispebjerg and Frederiksberg
Hospital, Frederiksberg, Denmark
(Irmukhamedov) Odense University Hospital, Department of Heart, Lung and
Vascular Surgery, Odense, Denmark
(Carranza, Rafiq, Greve) Rigshospitalet, Copenhagen University Hospital,
Copenhagen, Denmark
(Rodriguez-Lecoq, Torrents, Moya-Mitjans) University Hospital Vall
d'Hebron, Barcelona, Spain
(Sharma) University of Utah, Division of Cardiothoracic Surgery, Salt Lake
City, United States
(Kruuse) Herlev Hospital, Neurology, Herlev, Denmark
(Nilsson, Dixen) Hvidovre Hospital, Copenhagen University Hospital,
Cardiology, Hvidovre, Denmark
Publisher
Oxford University Press
Abstract
Background: Since the left atrium appendage (LAA) is the predilection site
for clot formation in patients with atrial fibrillation (AF), closure of
the LAA during surgery (LAACS) is often performed but not yet demonstrated
to protect against stroke. The recent LAACS trial found that LAA closure
protected from strokes and silent brain damages on a moderate (n=187)
number of patients. However, results based solely on strokes and cerebral
transitory ischemic attacks (TIA) was not significant (18% events in the
control group compared to 6% in patients where LAA was closed (p=0.07).
Furthermore, incomplete closure of the LAA is of concern, with an
increased relative risk for stroke (10-25%). <br/>Purpose(s): Determine if
LAA closure added to planned open heart surgery protects against
post-operative major stroke and minor stroke. <br/>Method(s): Adults
scheduled for open-heart surgery who sign informed consent will be
included regardless of known AF, provided LAA closure is not previously
planned. LAACS-2 is an open, parallel, international multi-center study
where patients will be randomized to closure of the LAA (with clip or
staple), in addition to planned open-heart surgery. The LAA will remain
open in the control group. Randomization will be stratified according to
ongoing or expected use of anti-coagulant medication following surgery and
classified as coronary artery bypass surgery (CABG) alone, mitral valve
surgery or other. The primary endpoint is stroke or TIA occurring over at
least two years following surgery. Secondary endpoints are: Total
mortality and a combination of stroke, TIA or image of recent cerebral
infarction in clinical settings demonstrated post-operatively, until the
end follow-up. Occurrence of AF during follow-up will be assessed with
prolonged (up to several weeks) monitoring with a three-lead compact
sensor. Studies on percutaneous coronary intervention and CABG, estimate a
3.7% pooled incidence of stroke in the first three years following
coronary by-pass operations. Using these estimates and those from the
previous LAACS study (3.2% strokes on patients with closed LAA vs 11.3% in
the control group, p=0.07), we estimate that LAA closure can be
demonstrated to protect from strokes, with a significance level of 0.05
and a 90% power, including 1200-1400 patients in an event-driven study.
Expecting a cross-over of 10-20%, we plan to enroll 2000 adults. According
to the a priori power-calculations, the LAACS-2 trial is powered: 1) to
determine if randomization to closure of the LAA in conjunction with
planned openheart surgery, protects patients from post-operative clinical
strokes; and 2) if there is an increased thrombogenic effect of incomplete
closure or excessive pouch, since such harm can be identified by including
between 359 and 1455 patients. <br/>Perspective(s): If the LAACS procedure
in conjunction with planned openheart surgery protects against future
stroke it should be included in future guidelines.

<20>
Accession Number
630047098
Title
RAAS inhibition improves event-free survival in cardiac transplant
recipients: Results of the prospective cohort study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 3916), 2019. Date of
Publication: October 2019.
Author
Shevchenko A.; Gautier S.; Shevchenko O.; Kachanova J.; Kwan V.
Institution
(Shevchenko, Shevchenko) Russian State Medical University, Cardiology CME
Cathedra, Moscow, Russian Federation
(Gautier, Kachanova, Kwan) Institute of Transplantology and Artificial
Organs, Moscow, Russian Federation
Publisher
Oxford University Press
Abstract
Background: Despite known achievements, long-term survival of heart
transplant (HT) recipients still needs to be improved. The
Renin-Angiotensin-Aldosterone System (RAAS) hyper-activation could be the
result of heart denervation and immune suppressive therapy in these
patients. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin
receptor blockers (ARB) have been shown to be beneficial in patients with
hypertension, heart failure (HF) and diabetic nephropathy.
<br/>Purpose(s): The study was aimed to assess the effects of ACEI and ARB
on the prognosis and cardiac transplant remodelling in HT recipients.
<br/>Method(s): Four hundred ninety-six critical HF patients had cardiac
transplant surgery between January 2012 and December 2016 in Shu-makov
National Research Centre of Transplantology, and Artificial Organs
(Moscow, Russian Federation) which accounted to 57.9% of all heart
transplantations (HTx) performed in the country during that period. All
patients >18 years old who survived 30 days after the operation without
known contraindications for ACEI or ARB were sequentially included in the
study. A non-randomised controlled trial study design was used. Study
endpoints included death from any cause and re-transplantation due to the
irreversible cardiac transplant failure. <br/>Result(s): 385 HT recipients
(mean age 46.3+/-2.3 years, 51 females and 334 males) enrolled in the
study. Thirty days after the HTx, a RAAS inhibitor was assigned to 141
recipients. Patients receiving ACEI or ARB had significantly better
event-free survival than the control group (log-rank p=0.045) during the
follow-up for 1856.5+/-68.3 days. Unadjusted analysis revealed other
factors related to the risk of death or irreversible HT failure: recipient
age <37 years old, donor age>44 years old, aortic cross-clamping time >117
min, peri-operational ECMO>3 days of duration, acute renal failure
requiring dialysis during first 30 days after the operation, right atrium
size, mitral regurgitation 2+, tricuspid regurgitation 1+, donor's heart
posterior wall thickness (PWT) >12mm, and left ventricle (LV)
end-diastolic dimension (EDD). When adjusted to the RAAS inhibitors use,
only the donor's age and early renal failure remained significant. LV EDD
did not change over time in both groups, whereas LV PWT in the control
group significantly increased from 12.3+/-0.3 to 13.5+/-0.5 mm (p<0.05).
<br/>Conclusion(s): Heart transplant recipients who received RAAS
inhibitors had better survival and less LV hypertrophy progression that
could reflect the beneficial effects of ACEI and ARB after heart
transplantation.

<21>
Accession Number
630046999
Title
Pregnancy outcomes in women with cardiothoracic transplants: A systematic
review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 3915), 2019. Date of
Publication: October 2019.
Author
Dong S.; D'Souza R.; Acuna S.; Zaffar N.; Bhagra C.; Silversides C.; Ross
H.
Institution
(Dong) University of Toronto, Department of Medicine, Toronto, Canada
(D'Souza, Zaffar) Mount Sinai Hospital of the University Health Network,
Obstetrics and Gynaecology, Toronto, Canada
(Acuna) University of Toronto, Institute of Health Policy Management and
Evaluation, Toronto, Canada
(Bhagra, Silversides) Mount Sinai Hospital of the University Health
Network, Toronto, Canada
(Ross) Toronto General Hospital, Peter Munk Cardiac Centre, Toronto,
Canada
Publisher
Oxford University Press
Abstract
Background: Increasing numbers of women with heart-lung transplants (HLT)
are now planning and continuing with pregnancies. The risks of pregnancies
in these women have not been systematically assessed. <br/>Method(s): A
search strategy was designed for MEDLINE, EMBASE, and Cochrane Central
from inception to January 2018 to identify studies reporting outcomes in
three or more pregnancies following HLT. Pooled incidence of maternal
outcomes and fetal and neonatal outcomes were calculated using
random-effects meta-analysis and reported per 100 pregnancies with 95%
confidence intervals (CI). Risk-of-bias was determined using the Joanna
Briggs Checklist for Case Series. Subgroup analysis was conducted based on
transplanted organ. <br/>Result(s): A total of 3658 records were
identified, 172 full texts reviewed, and 12 studies included. The included
studies reported on 385 pregnancies in 272 transplant recipients. Maternal
complications included mortality during pregnancy [0.5% (0, 1.1%)],
mortality during the specified follow-up period [15.4% (10,4, 20.3%)],
graft rejection during pregnancy [7.4% (4.2, 10.5%)], preeclampsia [12.3%
(7.2%, 17.5%)], gestational diabetes [6.4% (2.6, 10.1%)], and caesarean
deliveries [41.4% (33.4, 48.7%)]. As many as 78.4% (69.8, 86.9%)
pregnancies resulted in live births. Of the remainder, 13.6% (6.3, 20.9%)
resulted in miscarriages (fetal loss under 20 weeks of gestation), 2%
(0.3, 3.7%) resulted in stillbirths (fetal loss after 20 weeks of
gestation), and 6.8% (4.3, 9.3%) in pregnancy terminations for various
reasons. Of those born live, 3.4% (1.3, 5.6%) succumbed in the neonatal
period. Over half the pregnancies [51.2% (31, 71.3%)] resulted in preterm
deliveries (<37 weeks of gestation). There were subgroup-specific
variations in the prevalence of complications. For example, lung
transplant recipients were less likely than heart transplant recipients to
have pregnancies complicated by preeclampsia [8.3% (3.0, 13.6%) vs. 17.8%
(10.8, 24.8%)] suffer maternal mortality during the follow up period
[41.4% (23.4, 59.3%) vs. 10.8% (5.9, 15.8%)]. Studies had a moderate
risk-of-bias. <br/>Conclusion(s): Although large proportions of
pregnancies in women with HLT result in live births and few maternal
deaths occur during pregnancy, these women are at increased risk for
preeclampsia, preterm birth, perinatal mortality and maternal mortality
following childbirth. Subgroup-specific variations should be taken into
account while counselling HLT recipients contemplating pregnancies.

<22>
Accession Number
630046403
Title
Impact of idiopathic thrombocytopenic purpura on clinical outcomes in
patients with acute myocardial infarction.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2208), 2019. Date of
Publication: October 2019.
Author
Chehab O.; Pahuja M.; Adegbala O.; Akintoye E.; Ramia P.; Morsi R.;
Alrojolah L.; Mishra T.; Shokr M.; Kanj A.; Abdallah N.; Tabaja H.; Afonso
L.; Abidov A.
Institution
(Chehab, Pahuja, Adegbala, Akintoye, Mishra, Shokr, Kanj, Abdallah,
Tabaja, Afonso, Abidov) Wayne State University, Detroit, United States
(Ramia, Alrojolah) American University of Beirut AUB, Beirut, Lebanon
(Morsi) Harvard Medical School, Boston, United States
Publisher
Oxford University Press
Abstract
Background: There is scarce evidence reflecting the clinical outcomes in
patients with Idiopathic Thrombocytopenic Purpura (ITP) and Acute
Myocardial Infarction (AMI). The ITP patient population is at higher risk
of bleeding complications due to low platelet counts and difficulty in
managing their antiplatelet and anticoagulation therapy. In our study, we
sought to assess clinical outcomes of ITP patients admitted with AMI using
the US national inpatient sample (NIS) database. <br/>Purpose(s): To
determine difference in in-hospital mortality, clinical complications, and
length of stay (LOS) in AMI patients with and without ITP. <br/>Method(s):
We identified adults aged >=18 years hospitalized from 2005 to 2014 with
AMI as their primary diagnosis utilizing ICD-9 codes 410.0 to 410.92.
Patients with ITP were identified using ICD-9 code 287.31. The primary
outcome was in-hospital mortality. Secondary outcomes included coronary
revascularization procedures (PCI and CABG), and in-hospital complications
including bleeding (intracranial, epistaxis, GI, and GU bleeding,
hematoma, and bleeding requiring transfusion), cardiac complications,
transfusions, acute ischemic stroke (AIS), and LOS. A propensity-matched
cohort accounting for demographic characteristics, comorbidities, and
cardiovascular risk factors, was created to compare these outcomes.
Patients with secondary causes of ITP such as HIV, pregnancy, sepsis, SLE,
malignancy were excluded. <br/>Result(s): A total of 1108034 AMI
admissions, of which 1002 with ITP, were identified. In the unmatched
group, patients with ITP were older, and had more comorbidities (diabetes
mellitus; hypothyroidism; atrial fibrillation; previous history of
cardiovascular, peripheral, and end stage renal disease; all p<0.05). In
the AMI population, 851 ITP and 851 non-ITP admissions were
propensity-matched. Figure 1 illustrates the primary and secondary
outcomes of the study among the propensity-matched study groups. Although
there was no difference in short-term mortality between the ITP and
non-ITP patients with AMI, patients with ITP were less likely to undergo
coronary revascularization possibly because of thrombocytopenia. Patients
with ITP had significantly more bleeding complications and transfusions.
We observed in our study that patients with ITP had a significantly longer
LOS compared to non-ITP patients (6.1 vs 5.4 days, with a mean ratio of
1.14 (95% CI: 1.05,1.23)). <br/>Conclusion(s): In the large population of
patients included in the NIS database, patients with ITP admitted with
AMI, have a significantly higher rate of bleeding complications, undergo
less PCI and have a longer LOS compared to AMI patients without ITP. There
are no current guidelines by ACC/AHA/ESC regarding management of patients
with AMI and thrombocytopenia. These results warrant further investigation
through randomized controlled trials including patients with
thrombocytopenia to assess long term outcomes and to define optimal
management in this population. (Figure Presented).

<23>
Accession Number
2004165198
Title
Left Ventricular Rapid Pacing Via the Valve Delivery Guidewire in
Transcatheter Aortic Valve Replacement.
Source
JACC: Cardiovascular Interventions. 12 (24) (pp 2449-2459), 2019. Date of
Publication: 23 December 2019.
Author
Faurie B.; Souteyrand G.; Staat P.; Godin M.; Caussin C.; Van Belle E.;
Mangin L.; Meyer P.; Dumonteil N.; Abdellaoui M.; Monsegu J.;
Durand-Zaleski I.; Lefevre T.
Institution
(Faurie, Abdellaoui, Monsegu) Institut Cardiovasculaire, Groupe
Hospitalier Mutualiste de Grenoble, Grenoble, France
(Faurie, Staat, Abdellaoui, Monsegu) Cardiology Department, Medipole HP
Lyon-Villeurbane, Villeurbane, France
(Souteyrand) Cardiology Department, Centre Hospitalier Universitaire
Gabriel-Montpied, Clermont-Ferrand, France
(Godin) Cardiology Department, clinique Saint Hilaire, Rouen, France
(Caussin) Cardiology Department, Institut Mutualiste Montsouris, Paris,
France
(Van Belle) Departement de cardiologie, Institut Coeur Poumon, Centre
Hospitalier Universitaire de Lille, Lille, France
(Mangin) Cardiology Department, Centre Hospitalier Annecy Genevois,
Epagny, France
(Meyer) Cardiology Department, Institut Arnault Tzanck,
Saint-Laurent-du-Var, France
(Dumonteil) Cardiology Department, clinique Pasteur, Toulouse, France
(Durand-Zaleski) Cardiology Department, URC-Eco Ile de France, hopital de
l'Hotel Dieu, Assistance Publique-Hopitaux de Paris, Paris, France
(Lefevre) Institut Cardiovasculaire Paris Sud, Hopital Prive Jacques
Cartier, Massy, France
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study investigated whether left ventricular (LV)
stimulation via a guidewire-reduced procedure duration while maintaining
efficacy and safety compared with standard right ventricular (RV)
stimulation. <br/>Background(s): Rapid ventricular pacing is necessary to
ensure cardiac standstill during transcatheter aortic valve replacement
(TAVR). <br/>Method(s): This is a prospective, multicenter,
single-blinded, superiority, randomized controlled trial. Patients
undergoing transfemoral TAVR with a SAPIEN valve (Edwards Lifesciences,
Irvine, California) were allocated to LV or RV stimulation. The primary
endpoint was procedure duration. Secondary endpoints included efficacy,
safety, and cost at 30 days. <br/>Result(s): Between May 2017 and May
2018, 307 patients were randomized, but 4 were excluded because they did
not receive the intended treatment: 303 patients were analyzed in the LV
(n = 151) or RV (n = 152) stimulation groups. Mean procedure duration was
significantly shorter in the LV stimulation group (48.4 +/- 16.9 min vs.
55.6 +/- 26.9 min; p = 0.0013), with a difference of -0.12 (95% confidence
interval: -0.20 to -0.05) in the log-transformed procedure duration (p =
0.0012). Effective stimulation was similar in the LV and RV stimulation
groups: 124 (84.9%) versus 128 (87.1%) (p = 0.60). Safety of stimulation
was also similar in the LV and RV stimulation groups: procedural success
occurred in 151 (100%) versus 151 (99.3%) patients (p = 0.99); 30-day
MACE-TAVR (major adverse cardiovascular event-transcatheter aortic valve
replacement) occurred in 21 (13.9%) versus 26 (17.1%) patients (p = 0.44);
fluoroscopy time (min) was lower in the LV stimulation group (13.48 +/-
5.98 vs. 14.60 +/- 5.59; p = 0.02), as was cost (18,807 +/- 1,318 vs.
19,437 +/- 2,318; p = 0.001). <br/>Conclusion(s): Compared with RV
stimulation, LV stimulation during TAVR was associated with significantly
reduced procedure duration, fluoroscopy time, and cost, with similar
efficacy and safety. (Direct Left Ventricular Rapid Pacing Via the Valve
Delivery Guide-wire in TAVR [EASY TAVI]; NCT02781896)<br/>Copyright &#xa9;
2019 American College of Cardiology Foundation

<24>
Accession Number
2003793145
Title
Preventing spasm of the radial artery conduit during coronary artery
bypass grafting: Nicardipine versus verapamil.
Source
Journal of Cardiac Surgery. 34 (12) (pp 1505-1510), 2019. Date of
Publication: 01 Dec 2019.
Author
Ozdemir H.I.; van Dijk C.H.B.; Ozdemir A.B.; van Straten B.H.M.;
Haanschoten M.; Soliman-Hamad M.A.
Institution
(Ozdemir, van Dijk, van Straten, Soliman-Hamad) Department of
Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
(Ozdemir) Department of Engineering Technology, KU Leuven, Belgium
(Haanschoten) Department of Anesthesiology, Catharina Hospital, Eindhoven,
Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and aim of the study: In vitro studies have shown a reduction
in radial artery spasm with the use of calcium antagonists. The purpose of
this study was to evaluate the efficacy of topical treatment of the radial
artery conduit using either verapamil or nicardipine before the
anastomoses. <br/>Method(s): This prospective randomized study included
131 patients, who underwent coronary artery bypass grafting surgery with
the use of the radial artery as a conduit. In 65 patients, the harvested
radial artery was topically treated with verapamil and in 66 patients with
nicardipine. After harvesting the radial artery, the direct flow through
the conduit was measured in vitro before 5-minute incubation in
nicardipine or verapamil and measured again after incubation. The flow
before and after incubation was compared. Postincubation flow was also
compared in the two groups. After performing the anastomosis, the flow
through the radial artery was measured in vivo. <br/>Result(s): The mean
flow after NaCl incubation was 19.93 +/- 12.66 mL/min and after incubation
in the Ca+ channel blocker 47.16 +/- 14.58 mL/min (P <.001). No
significant difference in postincubation free flow was found between
verapamil (46.29 +/- 15.43 mL/min) and nicardipine (48.01 +/- 13.77
mL/min; P =.503). <br/>Conclusion(s): Topical treatment with Ca+ channel
blockers reduces radial artery spasm and significantly increases the free
flow through the radial artery conduit. Nicardipine is a safe and
effective alternative of verapamil in preventing spasm of radial artery
conduit.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<25>
Accession Number
628321562
Title
Mammalian target of rapamycin (mTOR) inhibitors and skin cancer risk in
nonrenal solid organ transplant recipients: systematic review and
meta-analysis.
Source
International Journal of Dermatology. 59 (1) (pp 91-98), 2020. Date of
Publication: 01 Jan 2020.
Author
Phan K.; Moloney F.J.; Hogarty D.T.; Lenane P.; McColl D.; Yazdabadi A.
Institution
(Phan) Department of Dermatology, Liverpool Hospital, Liverpool, Sydney,
Australia
(Moloney, Lenane) Department of Dermatology, Mater Misericordiae
University Hospital, University College Dublin, Dublin, Ireland
(Hogarty) Medical School, Monash University, Melbourne, VIC, Australia
(McColl, Yazdabadi) Department of Dermatology, Northern Health, Melbourne,
VIC, Australia
(Yazdabadi) Department of Dermatology, Eastern Health, Melbourne, VIC,
Australia
(Yazdabadi) Department of Dermatology, Alfred Health, Melbourne, VIC,
Australia
(Yazdabadi) Department of Dermatology, Deakin University, Melbourne, VIC,
Australia
(Yazdabadi) Department of Dermatology, Melbourne University, Melbourne,
VIC, Australia
Publisher
Blackwell Publishing Ltd
Abstract
Background: Solid organ transplant recipients have an increased risk of
malignancy compared with the general population. Mammalian target of
rapamycin (mTOR) inhibitors have been used as immunosuppressants in
transplant recipients. There remains a lack of evidence of this treatment
in nonrenal solid organ transplantation. We aimed to perform a systematic
review and meta-analysis to assess the effects of mTOR inhibitors on
secondary nonmelanoma skin cancer (NMSC) malignancies in nonrenal
transplant recipients. <br/>Method(s): A systematic review and
meta-analysis was performed according to Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies
for the present systematic review and meta-analysis included those in
which patient cohorts underwent heart, liver, lung, and pancreas (i.e.
nonrenal solid organ) transplantation, with treatment group being those
treated with an mTOR inhibitor such as sirolimus or everolimus, and
control group being placebo, or alternative non-mTOR inhibitor treatment
such as calcineurin inhibitors or as per standard treatment protocol.
<br/>Result(s): From the six included studies, we found no significant
difference in the odds of either primary or secondary NMSC (OR 0.73, 95%
CI 0.41-1.29, P = 0.28). Pooled analysis of patients with secondary NMSC
demonstrated a trend toward significant benefit with mTOR inhibitor
treatment (OR 0.61, 95% CI 0.37-1.02, P = 0.06) but no protective effect
for primary NMSC (OR 0.53, 95% CI 0.03-9.96, P = 0.67).
<br/>Conclusion(s): Our results suggest that in nonrenal transplant
recipients, mTOR inhibitors may have a protective effect against secondary
NMSC but not primary NMSC posttransplantation. Extrapolating the findings
of reduced NMSC in renal transplant populations to nonrenal transplant
cases should be cautioned.<br/>Copyright &#xa9; 2019 The International
Society of Dermatology

<26>
Accession Number
2004041865
Title
Ten-Year Outcomes of Sirolimus-Eluting Versus Zotarolimus-Eluting Coronary
Stents in Patients With Versus Without Diabetes Mellitus (SORT OUT III).
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Olesen K.K.W.; Pareek M.; Madsen M.; Jensen L.O.; Christiansen E.H.;
Thuesen L.; Lassen J.F.; Kristensen S.D.; Botker H.E.; Maeng M.
Institution
(Olesen, Pareek, Christiansen, Kristensen, Botker, Maeng) Department of
Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Olesen, Madsen) Department of Clinical Epidemiology, Aarhus University
Hospital, Aarhus, Denmark
(Jensen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Thuesen, Lassen) Department of Cardiology, Aalborg Hospital, Aalborg,
Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We compared 10-year clinical outcomes in diabetes and nondiabetes patients
treated with Endeavor zotarolimus-eluting (ZES) or Cypher
sirolimus-eluting coronary stents (SES). A total of 1,162 patients were
randomized to ZES (169 with diabetes) and 1,170 patients were randomized
to SES (168 with diabetes). Patients were further stratified by diabetes
status at the time of inclusion. A subgroup of patients with diabetes (n =
88) underwent angiographic re-evaluation 10 months after stent
implantation. End points included a combined end point of death or
myocardial infarction, and the individual end points of death, myocardial
infarction, and revascularization. In patients with diabetes, we found no
difference in the combined end point (odds ratio [OR] 0.81, 95% confidence
interval [CI] 0.53 to 1.24), death (OR 0.80, 95% CI 0.51 to 1.25), or in
MI (OR 1.07, 95% CI 0.60 to 1.91). However, diabetics with ZES more
frequently underwent coronary revascularization compared with SES patients
(OR 1.93, 95% CI 1.05 to 3.66). In patients without diabetes, ZES and SES
had similar 10-year rates of all end points (death: OR 1.13, 95% CI 0.93
to 1.39; MI: OR 0.80, 95% CI 0.61 to 1.05; revascularization: OR 0.81, 95%
CI 0.61 to 1.09). Landmark analysis from 5 to 10 years showed no
difference in outcomes between SES and ZES in either subgroup. In
conclusion, at 10 years, SES and ZES performed similarly in patients with
and without diabetes. Although coronary revascularization was more
prevalent in diabetes patients with ZES, this may, in part, have been
related to the angiographic follow-up that was offered to a subgroup of
diabetes patients.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<27>
Accession Number
630063879
Title
Aortic valve replacement with pulmonary hypertension: Meta-analysis of
70676 patients.
Source
Journal of cardiac surgery. 34 (12) (pp 1617-1625), 2019. Date of
Publication: 01 Dec 2019.
Author
Rocha R.V.; Friedrich J.O.; Hong K.; Lee J.; Cheema A.; Bagai A.; Verma
S.; Yanagawa B.
Institution
(Rocha, Hong, Lee, Verma, Yanagawa) Divisions of Cardiac Surgery,
University of Toronto, Toronto, ON, Canada
(Friedrich) Critical Care and Medicine, University of Toronto, Toronto,
ON, Canada
(Cheema, Bagai) Cardiology St Michael's Hospital, University of Toronto,
Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND AND AIM OF THE STUDY: We compared early and late outcomes of
surgical aortic valve replacement (SAVR) in patients with aortic stenosis
(AS) and pulmonary hypertension (PHT). <br/>METHOD(S): We searched MEDLINE
and EMBASE databases until July 2018 for studies comparing patients with
AS and none, mild-moderate, or severe PHT undergoing SAVR. Random-effects
meta-analysis was performed. <br/>RESULT(S): There were 12 observational
studies with 70676 patients with median follow-up 4.0 years (interquartile
range, 2.6-4 years). Compared to patients with no PHT, patients with any
PHT undergoing SAVR were older (mean difference [MD], 2.31 years; 95%
confidence interval [CI], 1.38-3.23 years; P<.01), with greater
comorbidities and reduced ejection fraction (MD, -4.36; 95%CI, -5.94 to
-2.78; P<.01). Patients with any PHT had higher unadjusted (5.2% vs 2.4%;
risk ratio [RR], 2.27; 95%CI, 2.04-2.53; P<.01) and adjusted (RR, 1.65;
95%CI, 1.28-2.14; P<.01) in-hospital mortality compared with no PHT.
Severe (RR, 3.53; 95%CI, 1.46-8.54; P< .01) and mild-moderate PHT (RR,
2.13; 95%CI, 1.28-3.55; P< .01) were associated with higher unadjusted
in-hospital mortality compared with no PHT. Any PHT was associated with a
higher unadjusted risk of stroke (RR, 1.64; 95%CI, 1.42-1.90; P<.01),
acute kidney injury (RR, 2.02; 95%CI, 1.50-2.72; P<.01), prolonged
ventilation (RR, 1.62; 95%CI, 1.04-2.52; P=.03), and longer hospital stay
(MD, 1.76 days; 95%CI, 0.57-2.95; P<.01). Severe (HR, 2.44; 95%CI,
1.60-3.72; P<.01) but not mild-moderate PHT (HR, 2.25; 95%CI, 0.91-5.59;
P=.08) was associated with higher adjusted long-term mortality compared
with no PHT. <br/>CONCLUSION(S): Patients with severe AS and severe PHT
had a significant increase in operative mortality and more than double the
risk of long-term mortality following SAVR compared with patients with no
PHT. Such patients may benefit from a less invasive transcatheter aortic
valve intervention.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<28>
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. 34 (12) (pp 1598-1607), 2019. Date of
Publication: 01 Dec 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. <br/>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.
<br/>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.
<br/>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.<br/>Copyright &#xa9; 2019 Wiley Periodicals,
Inc.

<29>
Accession Number
2002367508
Title
Pediatric Heart Transplantation: Transitioning to Adult Care (TRANSIT):
Feasibility of a Pilot Randomized Controlled Trial.
Source
Journal of Cardiac Failure. 25 (12) (pp 948-958), 2019. Date of
Publication: December 2019.
Author
Grady K.L.; Andrei A.-C.; Shankel T.; Chinnock R.; Miyamoto S.D.;
Ambardekar A.V.; Anderson A.; Addonizio L.; Latif F.; Lefkowitz D.;
Goldberg L.R.; Hollander S.A.; Pham M.; Van't Hof K.; Weissberg-Benchell
J.; Yancy C.; Liu M.; Melody N.; Pahl E.
Institution
(Grady, Andrei, Liu) Department of Surgery, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
(Shankel, Chinnock) Department of Medicine, Loma Linda University
Children's Hospital, Loma Linda, CA, United States
(Miyamoto) Department of Medicine, Children's Hospital Colorado, Aurora,
CO, United States
(Ambardekar) Department of Medicine, University of Colorado, Aurora, CO,
United States
(Anderson, Yancy) Department of Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL, United States
(Addonizio, Latif) Department of Medicine, Columbia University Medical
Center, New York, NY, United States
(Lefkowitz) Department of Psychiatry, The Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Goldberg) Department of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Hollander, Pham) Department of Medicine, Stanford University, Palo Alto,
CA, United States
(Van't Hof, Pahl) Department of Medicine, Ann & Robert H. Lurie Children's
Hospital of Chicago, Chicago, IL, United States
(Weissberg-Benchell) Department of Psychiatry, Ann & Robert H. Lurie
Children's Hospital of Chicago, Chicago, IL, United States
(Melody) Pharmacy Department, Northwestern Memorial Hospital, Chicago, IL,
United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: Young-adult heart transplant recipients transferring to adult
care are at risk for poor health outcomes. We conducted a pilot randomized
controlled trial to determine the feasibility of and to test a transition
intervention for young adults who underwent heart transplantation as
children and then transferred to adult care. <br/>Method(s): Participants
were randomized to the transition intervention (4 months long, focused on
heart-transplant knowledge, self-care, self-advocacy, and social support)
or usual care. Self-report questionnaires and medical records data were
collected at baseline and 3 and 6 months after the initial adult clinic
visit. Longitudinal analyses comparing outcomes over time were performed
using generalized estimating equations and linear mixed models.
<br/>Result(s): Transfer to adult care was successful and feasible (ie,
excellent participation rates). The average patient standard deviation of
mean tacrolimus levels was similar over time in both study arms and < 2.5,
indicating adequate adherence. There were no between-group or within-group
differences in percentage of tacrolimus bioassays within target range (>
50%). Average overall adherence to treatment was similarly good in both
groups. Rates of appointment keeping through 6 months after transfer
declined over time in both groups. <br/>Conclusion(s): The feasibility of
the study was demonstrated. Our transition intervention did not improve
outcomes.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<30>
Accession Number
630039051
Title
Epiaortic Ultrasound for Assessment of Intraluminal Atheroma; Insights
from the REGROUP Trial.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2019.
Date of Publication: 09 Nov 2019.
Author
Shapeton A.D.; Leissner K.B.; Zorca S.M.; Amirfarzan H.; Stock E.M.;
Biswas K.; Haime M.; Srinivasa V.; Quin J.A.; Zenati M.A.
Institution
(Shapeton, Leissner, Zorca, Amirfarzan, Stock, Biswas) Cooperative Studies
Program Coordinating Center, Office of Research and Development,
Department of Veterans Affairs, MD, Perry Point
(Haime, Quin, Zenati) Division of Cardiac Surgery, Veterans Affairs Boston
Healthcare System and Harvard Medical School, MA, Boston
(Srinivasa) Department of Anesthesia, Critical Care and Pain Medicine,
Veterans Affairs Boston Healthcare System and Harvard Medical School, MA,
Boston
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To assess the use of epiaortic ultrasound in contemporary
cardiac surgery, as well as its impact on surgical cannulation strategy
and cerebrovascular events. DESIGN: Epiaortic ultrasound data was
prospectively collected in the Randomized Endovein Graft Prospective
(REGROUP) trial (VA Cooperative Studies Program #588, ClinicalTrials.gov,
NCT01850082), which randomized 1,150 coronary artery bypass graft patients
between 2014 and 2017 to endoscopic or open-vein graft harvest. SETTING:
Sixteen cardiac surgery programs within the Veterans Affairs Healthcare
System with expertise at performing endoscopic vein-graft harvesting.
PARTICIPANTS: Veterans Affairs patients, greater than 18 years of age,
undergoing elective or urgent coronary artery bypass grafting with
cardiopulmonary bypass and cardioplegic arrest with at least one planned
saphenous vein graft were eligible for enrollment. INTERVENTIONS:
Epiaortic ultrasound was performed by the surgeon using a high frequency
(>7 MHz) ultrasound transducer. Two-dimensional images of the ascending
aorta in multiple planes were acquired before aortic cannulation and
cross-clamping. MEASUREMENTS AND MAIN RESULTS: Epiaortic ultrasound was
performed in 34.1% (269 of 790) of patients in REGROUP. Among these
patients, simple intraluminal atheroma was observed in 21.9% (59 269), and
complex intraluminal atheroma comprised 2.2% (6 of 269). The aortic
cannulation or cross-clamp strategy was modified based on these findings
in 7.1% of cases (19 of 269). There was no difference in stroke between
patients who underwent epiaortic ultrasound and those who did not (1.9% v
1.2% p=0.523). <br/>CONCLUSION(S): Despite current guidelines recommending
routine use of epiaortic ultrasound (IIa/B) to reduce the risk of stroke
in cardiac surgery, in this contemporary trial, use remains infrequent,
with significant site-to-site variability.<br/>Copyright Published by
Elsevier Inc.

<31>
Accession Number
630064115
Title
Positive airway pressure therapy for the treatment of central sleep apnoea
associated with heart failure.
Source
The Cochrane database of systematic reviews. 12 (pp CD012803), 2019. Date
of Publication: 04 Dec 2019.
Author
Yamamoto S.; Yamaga T.; Nishie K.; Nagata C.; Mori R.
Institution
(Yamamoto) Shinshu University Hospital, Department of Rehabilitation,
3-1-1 Asahi, Matsumoto, Nagano, Japan
(Yamaga) Health Science University, Department of Occupational Therapy,
Japan
(Nishie) Iida Municipal Hospital, Department of Respiratory Medicine,
Iida, Nagano, Japan
(Nagata) National Center for Child Health and Development, Department of
Education for Clinical Research, 2-10-1 Okura ,Setagaya-ku, Tokyo
157-8535, Japan
(Mori) National Center for Child Health and Development, Department of
Health Policy, 2-10-1 Okura ,Setagaya-ku, Tokyo 157-0074, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Ischaemic heart disease including heart failure is the most
common cause of death in the world, and the incidence of the condition is
rapidly increasing. Heart failure is characterised by symptoms such as
fatigue and breathlessness during light activity, as well as disordered
breathing during sleep. In particular, sleep disordered breathing (SDB),
including central sleep apnoea (CSA) and obstructive sleep apnoea (OSA),
is highly prevalent in people with chronic heart failure. A previous
meta-analysis demonstrated that positive airway pressure (PAP) therapy
dramatically increased the survival rate of people with heart failure who
had CSA, and thus could contribute to improving the prognosis of these
individuals. However, recent trials found that adaptive servo-ventilation
(ASV) including PAP therapy had a higher risk of all-cause mortality and
cardiovascular mortality. A meta-analysis that included recent trials was
therefore needed. <br/>OBJECTIVE(S): To assess the effects of positive
airway pressure therapy for people with heart failure who experience
central sleep apnoea. <br/>SEARCH METHOD(S): We searched the Cochrane
Central Register of Controlled Trials (CENTRAL) in the Cochrane Library,
MEDLINE, Embase, and Web of Science Core Collection on 7 February 2019
with no limitations on date, language, or publication status. We also
searched two clinical trials registers in July 2019 and checked the
reference lists of primary studies. SELECTION CRITERIA: We excluded
cross-over trials and included individually randomised controlled trials,
reported as full-texts, those published as abstract only, and unpublished
data. DATA COLLECTION AND ANALYSIS: Two review authors independently
extracted outcome data from the included studies. We double-checked that
data had been entered correctly by comparing the data presented in the
systematic review with study reports. We analysed dichotomous data as risk
ratios (RRs) with 95% confidence intervals (CIs) and continuous data as
mean difference (MD) or standardised mean difference (SMD) with 95% CIs.
Furthermore, we performed subgroup analysis in the ASV group or continuous
PAP group separately. We used GRADEpro GDT software to assess the quality
of evidence as it relates to those studies that contribute data to the
meta-analyses for the prespecified outcomes. MAIN RESULTS: We included 16
randomised controlled trials involving a total of 2125 participants. The
trials evaluated PAP therapy consisting of ASV or continuous PAP therapy
for 1 to 31 months. Many trials included participants with heart failure
with reduced ejection fraction. Only one trial included participants with
heart failure with preserved ejection fraction. We are uncertain about the
effects of PAP therapy on all-cause mortality (RR 0.81, 95% CI 0.54 to
1.21; participants = 1804; studies = 6; I2 = 47%; very low-quality
evidence). We found moderate-quality evidence of no difference between PAP
therapy and usual care on cardiac-related mortality (RR 0.97, 95% CI 0.77
to 1.24; participants = 1775; studies = 5; I2 = 11%). We found low-quality
evidence of no difference between PAP therapy and usual care on all-cause
rehospitalisation (RR 0.95, 95% CI 0.70 to 1.30; participants = 1533;
studies = 5; I2 = 40%) and cardiac-related rehospitalisation (RR 0.97, 95%
CI 0.70 to 1.35; participants = 1533; studies = 5; I2 = 40%). In contrast,
PAP therapy showed some indication of an improvement in quality of life
scores assessed by all measurements (SMD -0.32, 95% CI -0.67 to 0.04;
participants = 1617; studies = 6; I2 = 76%; low-quality evidence) and by
the Minnesota Living with Heart Failure Questionnaire (MD -0.51, 95% CI
-0.78 to -0.24; participants = 1458; studies = 4; I2 = 0%; low-quality
evidence) compared with usual care. Death due to pneumonia (N = 1, 3% of
PAP group); cardiac arrest (N = 18, 3% of PAP group); heart
transplantation (N = 8, 1% of PAP group); cardiac worsening (N = 3, 9% of
PAP group); deep vein thrombosis/pulmonary embolism (N = 1, 3% of PAP
group); and foot ulcer (N = 1, 3% of PAP group) occurred in the PAP
therapy group, whereas cardiac arrest (N = 16, 2% of usual care group);
heart transplantation (N = 12, 2% of usual care group); cardiac worsening
(N = 5, 14% of usual care group); and duodenal ulcer (N = 1, 3% of usual
care group) occurred in the usual care group across three trials. AUTHORS'
<br/>CONCLUSION(S): The effect of PAP therapy on all-cause mortality was
uncertain. In addition, although we found evidence that PAP therapy did
not reduce the risk of cardiac-related mortality and rehospitalisation,
there was some indication of an improvement in quality of life for heart
failure patients with CSA. Furthermore, the evidence was insufficient to
determine whether adverse events were more common with PAP than with usual
care. These findings were limited by low- or very low-quality evidence.
PAP therapy may be worth considering for individuals with heart failure to
improve quality of life.<br/>Copyright &#xa9; 2019 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<32>
Accession Number
630063244
Title
American Society of Hematology 2019 guidelines for management of venous
thromboembolism: prevention of venous thromboembolism in surgical
hospitalized patients.
Source
Blood advances. 3 (23) (pp 3898-3944), 2019. Date of Publication: 10 Dec
2019.
Author
Anderson D.R.; Morgano G.P.; Bennett C.; Dentali F.; Francis C.W.; Garcia
D.A.; Kahn S.R.; Rahman M.; Rajasekhar A.; Rogers F.B.; Smythe M.A.;
Tikkinen K.A.O.; Yates A.J.; Baldeh T.; Balduzzi S.; Brozek J.L.;
Ikobaltzeta I.E.; Johal H.; Neumann I.; Wiercioch W.; Yepes-Nunez J.J.;
Schunemann H.J.; Dahm P.
Institution
(Anderson) Department of Medicine, Dalhousie University, Halifax, Canada
(Morgano, Baldeh, Brozek, Ikobaltzeta, Wiercioch, Schunemann) Department
of Health Research Methods, McMaster University, ON, Hamilton, Canada
(Bennett) LA, Shreveport, United States
(Dentali) Department of Medicine and Surgery, Insubria University, Varese,
Italy
(Francis) Wilmot Cancer Center, University of Rochester Medical Center,
Rochester, NY
(Garcia) Division of Hematology, Department of Medicine, University of
Washington Medical Center, University of Washington School of Medicine,
Seattle, WA
(Kahn) Department of Medicine, McGill University and Lady Davis Institute,
QC, Montreal, Canada
(Rahman) Lillian S. Wells Department of Neurosurgery and
(Rajasekhar) Division of Hematology and Oncology, Department of Medicine,
University of Florida, FL, Gainesville, United States
(Rogers) Trauma and Acute Care Surgery, Penn Medicine Lancaster General
Health, Lancaster
(Smythe) Department of Pharmaceutical Services, Beaumont Hospital, Royal
Oak, MI
(Smythe) Department of Pharmacy Practice, Wayne State University, MI,
Detroit, United States
(Tikkinen) Department of Urology and
(Tikkinen) Department of Public Health, University of Helsinki and
Helsinki University Hospital, Helsinki, Finland
(Yates) Department of Orthopedic Surgery, University of Pittsburgh Medical
Center, Pittsburgh, United States
(Balduzzi) Department of Diagnostic, Clinical, Public Health Medicine,
University of Modena and Reggio Emilia, Modena, Italy
(Brozek, Schunemann) Department of Medicine and
(Johal) Center for Evidence-Based Orthopaedics, Division of Orthopaedic
Surgery, McMaster University, ON, Hamilton, Canada
(Neumann) Department of Internal Medicine, School of Medicine, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Yepes-Nunez) School of Medicine, Universidad de los Andes, Bogota,
Colombia
(Dahm) Urology Section, Minneapolis VA Health Care System, Minneapolis,
MN; and
(Dahm) Department of Urology, University of Minnesota, MN, Minneapolis,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Venous thromboembolism (VTE) is a common source of
perioperative morbidity and mortality. <br/>OBJECTIVE(S): These
evidence-based guidelines from the American Society of Hematology (ASH)
intend to support decision making about preventing VTE in patients
undergoing surgery. <br/>METHOD(S): ASH formed a multidisciplinary
guideline panel balanced to minimize bias from conflicts of interest. The
McMaster University GRADE Centre supported the guideline-development
process, including performing systematic reviews. The Grading of
Recommendations Assessment, Development and Evaluation (GRADE) approach
was used to assess evidence and make recommendations, which were subject
to public comment. <br/>RESULT(S): The panel agreed on 30 recommendations,
including for major surgery in general (n = 8), orthopedic surgery (n =
7), major general surgery (n = 3), major neurosurgical procedures (n = 2),
urological surgery (n = 4), cardiac surgery and major vascular surgery (n
= 2), major trauma (n = 2), and major gynecological surgery (n = 2).
<br/>CONCLUSION(S): For patients undergoing major surgery in general, the
panel made conditional recommendations for mechanical prophylaxis over no
prophylaxis, for pneumatic compression prophylaxis over graduated
compression stockings, and against inferior vena cava filters. In patients
undergoing total hip or total knee arthroplasty, conditional
recommendations included using either aspirin or anticoagulants, as well
as for a direct oral anticoagulant over low-molecular-weight heparin
(LMWH). For major general surgery, the panel suggested pharmacological
prophylaxis over no prophylaxis, using LMWH or unfractionated heparin. For
major neurosurgery, transurethral resection of the prostate, or radical
prostatectomy, the panel suggested against pharmacological prophylaxis.
For major trauma surgery or major gynecological surgery, the panel
suggested pharmacological prophylaxis over no prophylaxis.

<33>
Accession Number
2003815061
Title
Causes and predictors of readmission after transcatheter aortic valve
implantation: A meta-analysis and systematic review.
Source
Herz. (no pagination), 2019. Date of Publication: 2019.
Author
Li Y.-M.; Mei F.-Y.; Yao Y.-J.; Tsauo J.-Y.; Peng Y.; Chen M.
Institution
(Li, Tsauo, Peng, Chen) Department of Cardiology, West China Hospital,
Sichuan University, 37 Guoxue Street, Chengdu 610041, China
(Mei) Zhejiang Provincial People's Hospital, Hangzhou, China
(Yao) West China School of Medicine, Sichuan University, Chengdu, China
Publisher
Springer Medizin (E-mail: kundenservice@springermedizin.de)
Abstract
Background: Since readmission rate is an important clinical index to
determine the quality of inpatient care and hospital performance, the aim
of this study was to explain the causes and predictors of readmission
following transcatheter aortic valve implantation (TAVI) at short-term and
mid-term follow-up. <br/>Methods and Results: A systematic review and
meta-analysis of all published articles from Embase, Pubmed/MEDLINE, and
Ovid was carried out. In all, 10 studies including 52,702 patients were
identified. The pooled estimate for the overall event rate was 0.15, and
cardiovascular causes were the main reason for 30-day readmission (0.42,
95% confidence interval [CI]: 0.39-0.45). In addition, the pooled
incidence of 1-year readmission was 0.31, and cardiovascular events were
still the main cause (0.41, 95% CI: 0.33-0.48). Patients with major and
life-threatening bleeding, new permanent pacemaker implantation, and
clinical heart failure were associated with a high risk for early
readmission after TAVI. Moreover, an advanced (>=3) New York Heart
Association classification, acute kidney injury, paravalvular leak, mitral
regurgitation (>= moderate), and major bleeding predicted unfavorable
outcome to 1-year readmission. Female gender and transfemoral TAVI was
associated with a lower risk for unplanned rehospitalization.
<br/>Conclusion(s): This meta-analysis found cardiovascular factors to be
the main causes for both 30-day and 1-year rehospitalization. Heart
failure represented the most common cardiovascular event at both
short-term and mid-term follow-up. Several baseline characteristics and
procedure-related factors were deemed unfavorable predictors of
readmission. Importantly, transfemoral access and female gender were
associated with a lower risk of readmission.<br/>Copyright &#xa9; 2019,
Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

<34>
Accession Number
2003791079
Title
Left internal mammary artery side branch intervention in the management of
coronary steal syndrome following coronary artery bypass grafting.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Mangels D.; Penny W.; Reeves R.
Institution
(Mangels, Reeves) Department of Cardiovascular Medicine, University of
California, San Diego, CA, United States
(Penny) Division of Cardiovascular Medicine, VA Medical Center, University
of California, San Diego, CA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The objective of this qualitative review is to summarize the
pathophysiological and clinical data behind the clinical entity of left
internal mammary artery (LIMA) side branch coronary steal as well as the
potential diagnostic and therapeutic modalities available.
<br/>Background(s): The presence of persistent unligated LIMA side
branches following coronary artery bypass grafting has previously been
associated with stable angina and acute coronary syndromes. However,
despite numerous attempts to objectively demonstrate a coronary steal
phenomenon, the pathophysiology of LIMA side branch flow diversion remains
elusive and the clinical utility of intervention is not well elucidated.
<br/>Method(s): A review of literature and available data including case
reports, case series, and investigational studies was performed.
<br/>Result(s): Therapeutic closure of LIMA side branches has been
reported in at least 44 patients and in at least 31 publications since
1990 and is associated with an 87.5% rate of freedom from angina amongst
technically successful initial interventions. In all patients with pre-
and post- stress testing, intervention was associated with an improvement
and/or resolution of previously observed reversible ischemia.
<br/>Conclusion(s): LIMA side branch coronary steal should remain an
ongoing consideration in symptomatic patients with large unligated side
branches onangiography, particularly when there is clear evidence of
reversible ischemiaon perfusion imaging.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<35>
Accession Number
2003751963
Title
Thoracic endovascular aortic repair versus open chest surgical repair for
patients with type B aortic dissection: a systematic review and
meta-analysis.
Source
Annals of Medicine. 51 (7-8) (pp 360-370), 2019. Date of Publication: 17
Nov 2019.
Author
Liu J.; Xia J.; Yan G.; Zhang Y.; Ge J.; Cao L.
Institution
(Liu, Zhang, Ge) Department of Cardiothoracic Surgery, Suining Central
Hospital, Suining, Sichuan, China
(Xia) Department of Pathology, Suining Central Hospital, Suining, Sichuan,
China
(Yan) Department of Radiology, Suining Central Hospital, Suining, Sichuan,
China
(Cao) Department of Intensive Care Unit, Suining Central Hospital,
Suining, Sichuan, China
Publisher
Taylor and Francis Ltd
Abstract
Aim: This meta-analysis study aimed to compare the efficacy and safety of
TEVAR versus OCSR for TBAD patients. <br/>Method(s): We systematically
searched PubMed, EmBase, and the Cochrane library to identify studies
compared the effectiveness of TEVAR and OCSR in TBAD patients from the
inception up to July 2019. The summary results were calculated using a
random-effects model. <br/>Result(s): The electronic search identified
1,894 studies, and 18 studies with 9,664 TBAD patients were included. We
noted patients received TEVAR were associated with a reduced risk of
in-hospital mortality, acute renal failure, respiratory failure, and
bleeding as compared with OCSR, whereas no significant differences between
groups for the risk of stroke, myocardial infarction, paraplegia,
mesenteric ischaemia/infarction, reinterventions, sepsis, and spinal cord
ischaemia. <br/>Conclusion(s): The findings of this meta-analysis study
suggested that TEVAR resulted in more short-term survival benefits.
Moreover, the reduced risk of acute renal failure, respiratory failure and
bleeding was detected in TEVAR group. The treatment effects of TEVAR
versus OCSR on specific complications should be further verified by a
study with high-level of evidence.Key message Comprehensive collected
studies investigated the treatment effectiveness between TEVAR and OCSR
for TBAD patients TEVAR resulted in more survival benefits, in addition to
lower risk of acute renal failure, respiratory failure and bleeding The
results of stratified analyses according to patients' characteristics were
conducted.<br/>Copyright &#xa9; 2019, &#xa9; 2019 Informa UK Limited,
trading as Taylor & Francis Group.

<36>
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. <br/>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. <br/>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]. <br/>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.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<37>
Accession Number
629969000
Title
Safety and efficacy of tranexamic acid in paediatric cardiac surgery:
Study protocol for a double-blind randomised controlled trial.
Source
BMJ Open. 9 (11) (no pagination), 2019. Article Number: e032642. Date of
Publication: 01 Nov 2019.
Author
Zhang Y.; Jia Y.; Shi J.; Yuan S.; Wang R.; Zhang Z.; Wang X.; Liu J.; Ran
J.; Zhao Y.; Hua Z.; Yan J.; Li S.; Zheng Z.; Hu S.; Wang Y.; Yan F.
Institution
(Zhang, Jia, Shi, Yuan, Wang, Zhang, Yan) Anaesthesiology, Fuwai Hospital,
National Centre for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Wang) Paediatric Intensive Care Unit, Fuwai Hospital, National Centre for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Liu) Cardiopulmonary Bypass, Fuwai Hospital, National Centre for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Ran, Zhao, Hua, Yan, Li, Zheng, Hu) Cardiovascular Surgery, Fuwai
Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
(Wang) Medical Research and Biometrics Centre, Anaesthesiology, National
Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction An initial retrospective study suggested that tranexamic acid
(TXA) administration increased the incidence of seizures in paediatric
patients undergoing cardiac surgery. However, the efficacy of TXA in
paediatric cardiac surgery remains unclear owing to the small sample sizes
of the studies. Therefore, this study will investigate the efficacy and
safety of TXA in paediatric patients undergoing cardiac surgery. We
hypothesised that TXA may increase the incidence of postoperative seizures
with no effect on postoperative allogeneic transfusion in paediatric
patients undergoing cardiac surgery. The pragmatic study will provide
important implications for paediatric cardiac surgery. Methods and
analysis This will be a single-centre prospective, double-blind randomised
controlled trial. The plan is to enrol in the study 2090 paediatric
patients aged 31 days to 7 years who will be undergoing cardiac surgery
with cardiopulmonary bypass (CPB). All eligible participants will be
randomly assigned to either the TXA or placebo group by using a Web-based
randomisation service in a 1:1 ratio. The primary safety end point will be
postoperative seizures until hospital discharge, and the primary efficacy
end point will be the volume of allogeneic red blood cell transfusion
after termination of CPB. All patients will be followed up for 1 year
postdischarge. All data will be analysed in accordance with the
intention-to-treat principle. Ethics and dissemination This study was
approved by the institutional review board of Fuwai Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College (No
20191195). Written informed consent will be obtained from the
parents/legal guardian of each patient because all participants will be
<18 years of age. The results of the trial will be published in an
international peer-reviewed journal. Trial registration number Chinese
Clinical Trial Register (ChiCTR1900024131).<br/>Copyright &#xa9; Author(s)
(or their employer(s)) 2019. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<38>
Accession Number
2003365574
Title
Safety and efficacy of self-expandable Evolut R vs. balloon-expandable
Sapien 3 valves for transcatheter aortic valve implantation: A systematic
review and meta-analysis.
Source
Experimental and Therapeutic Medicine. 18 (5) (pp 3893-3904), 2019. Date
of Publication: 2019.
Author
He C.; Xiao L.; Liu J.
Institution
(He) Department of Cardiovascular Medicine, Hanchuan People's Hospital,
Hanchuan, Hubei 431600, China
(Xiao) Department of Haematology, Hanchuan Hospital of Traditional Chinese
Medicine, Hanchuan, Hubei 431600, China
(Liu) Department of Critical Care Medicine, Hanchuan People's Hospital, Te
1 People's Avenue, Hanchuan, Hubei 431600, China
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
The aim of this study was to systematically search literature and conduct
a meta-analysis comparing the clinical efficacy and safety of Evolut R and
Sapien 3 valves for transcatheter aortic valve implantation (TAVI). The
PubMed, Biomed Central, Scopus, Cochrane library and Google scholar
databases were searched for articles published up to June, 2019. A total
of 5 studies were included. In total, 795 patients underwent TAVI with
Evolut R, while 665 patients received the Sapien 3 valve in the included
studies. Overall device success with Evolut R was 95.7% and with Sapien 3
was 94.2%. Pooled data indicated no significant differences between the 2
valves (OR, 1.12; 95% CI, 0.66-1.89; P=0.68; I² =0%). No
significant differences were observed in the incidence of none to mild
paravalvular leakage between the 2 groups (OR, 1.71; 95% CI, 0.83-3.54;
P=0.14; I 2 =0%). Both mean [random; mean difference (MD) = -3.96; 95% CI,
-4.61 to -3.31; P<0.00001, I² =0%] and peak (random; MD =
-6.85; 95% CI, -8.22 to -5.48; P<0.00001, I² =0%) aortic valve
gradients were significantly lower with Evolut R. No significant
differences were observed in the 30-day mortality (OR, 1.32; 95% CI,
0.45-3.87; P=0.62; I² =0%) or 30-day stroke outcomes (OR, 0.76;
95% CI, 0.32-1.81; P=0.54; I² =0%) between the 2 devices. On
the whole, the findings of this study indicate that Evolut R and Sapien 3
valves may be comparable in terms of device success and short-term
complications. The differences between the 2 devices for post-operative
moderate to severe paravalvular leak and permanent pacemaker implantation
remain unclear. There is thus a need for a large multi-center randomized
controlled trial to provide stronger evidence on this
subject.<br/>Copyright &#xa9; 2019 Spandidos Publications. All rights
reserved.

<39>
Accession Number
2003244488
Title
Application of remote ischemic preconditioning in patients undergoing
chemotherapy with anthracyclines.
Source
Current Enzyme Inhibition. 15 (2) (pp 114-119), 2019. Date of Publication:
2019.
Author
Zatta S.M.; Murad N.; Alves B.C.A.; Azzalis L.A.; Junqueira V.B.C.; Rocha
R.O.; Bacci M.R.; Feder D.; Chagas A.C.P.; Adami F.; Fonseca F.L.A.
Institution
(Zatta, Rocha) Servico de Oncologia, Hospital Santa Marcelina, Sao Paulo,
SP, Brazil
(Murad, Alves, Bacci, Feder, Chagas, Adami, Fonseca) Centro Universitario
Saude ABC, Faculdade de Medicina do ABC, Santo Andre, SP, Brazil
(Azzalis, Junqueira, Fonseca) Departamento de Ciencias Farmaceuticas,
Universidade Federal de Sao Paulo, Diadema, SP, Brazil
Publisher
Bentham Science Publishers (P.O. Box 294, Bussum 1400 AG, Netherlands)
Abstract
Background: The most active agents for the treatment of breast cancer are
the anthracyclines whose clinical usefulness is limited by cumulative
dose-dependent cardiotoxicity, which results in congestive heart failure
among other limiting factors. With all the attempts to minimize
chemotherapeutic cardiotoxicity, remote ischemic preconditioning (RIPC)
has been considered as a potent endogenous mechanism capable of inhibiting
inflammatory responses. <br/>Objective(s): This study aimed to verify if
RIPC may be effective as prophylaxis to prevent anthracycline-induced
cardiotoxicity in oncological patients. <br/>Method(s): The
preconditioning method was based on four to five-minute cycles of a blood
pressure cuff insufflation around the upper arm (either left or right)
from 200 mmHg to 250 mmHg, inducing ischemic intervals interspersed with 5
minutes of reperfusion. <br/>Result(s): In this work, echocardiogram
results showed a ventricular mass variation that can get worse during
chemotherapeutic treatment; however, in patients who had been undergoing
RIPC sessions over a period of 6 months, it was observed that this change
did not occur. The parameters for troponin T levels were considered; they
were higher in patients who were not undergoing RIPC in relation to those
who were. When both cases were compared, it was possible to infer that
there was a clinically significant improvement for those who went through
the procedure. <br/>Conclusion(s): Thus, through the analysis of this
study, it is possible to conclude that RIPC is a lowcost, non-invasive
procedure which brings cardiac protection for patients undergoing
chemotherapy with anthracyclines, providing support in the treatment of
cancer.<br/>Copyright &#xa9; 2019 Bentham Science Publishers.

<40>
Accession Number
629403781
Title
Impact of Lung Expansion Therapy Using Positive End-Expiratory Pressure in
Mechanically Ventilated Patients Submitted to Coronary Artery Bypass
Grafting.
Source
Brazilian journal of cardiovascular surgery. 34 (6) (pp 699-703), 2020.
Date of Publication: 01 Jan 2020.
Author
Cordeiro A.L.L.; Carvalho S.; Leite M.C.; Vila-Flor A.; Freitas B.; Sousa
L.; Oliveira Q.; Guimaraes A.R.
Institution
(Cordeiro) Escola Bahiana de Medicina e Saude Publica (Bahiana) Unidade
Academica Brotas Salvador Bahia Brazil Escola Bahiana de Medicina e Saude
Publica (Bahiana) - Unidade Academica Brotas, Salvador, Bahia, Brazil
(Cordeiro) Faculdade Nobre Feira de Santana Bahia Brazil Faculdade Nobre
(FAN), Feira de Santana, Bahia, Brazil
(Carvalho, Leite, Vila-Flor, Freitas, Sousa, Oliveira, Guimaraes)
Instituto Nobre de Cardiologia Feira de Santana Bahia Brazil Instituto
Nobre de Cardiologia (INCARDIO), Feira de Santana, Bahia, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the impact of different levels of positive
end-expiratory pressure (PEEP) on gas exchange in patients undergoing
coronary artery bypass grafting (CABG). <br/>METHOD(S): A randomized
clinical trial was conducted with patients undergoing CABG surgery.
Patients were randomized into three groups: Group 10, PEEP of 10 cmH2O;
Group 12, PEEP of 12 cmH2O; and Group 15, PEEP of 15 cmH2O. After the
randomization, all patients underwent gas analysis at three moments: (1)
before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one
hour after extubation. <br/>RESULT(S): Sixty-six patients were studied, of
which 61.7% were men, with mean age of 64 +/- 8.9 years. Patients
allocated to Group 15 showed a significant improvement in gas exchange
comparing pre- and post-expansion values (239+/-21 vs. 301+/-19, P<0,001)
and the increase was maintained after extubation (278+/-26). Despite the
use of high levels of PEEP, no significant hemodynamic change was
evidenced. <br/>CONCLUSION(S): It is concluded that high levels of PEEP
(15 cmH2O) are beneficial for the improvement of gas exchange in patients
undergoing CABG.

<41>
Accession Number
628520090
Title
Neuroprotective Effect of Low Mean Arterial Pressure on Postoperative
Cognitive Deficit Attenuated by Prolonged Coronary Artery Bypass Time: A
Meta-Analysis.
Source
Brazilian journal of cardiovascular surgery. 34 (6) (pp 739-748), 2020.
Date of Publication: 01 Jan 2020.
Author
Kiabi F.H.; Soleimani A.; Habibi M.R.
Institution
(Kiabi, Soleimani, Habibi) Mazandaran University of Medical Sciences
Faculty of Medicine Department of Anesthesiology Sari Iran Department of
Anesthesiology, Faculty of Medicine, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The true influence of the low mean arterial pressure (low
MAP) during coronary artery bypass grafting (CABG) on the development of
postoperative cognitive deficit (POCD) remains controversial. We aimed to
perform a meta-analysis and meta-regression to determine the effect of low
MAP on POCD, as well as moderator variables between low MAP and POCD.
<br/>METHOD(S): The Web of Science, PubMed database, Scopus and the
Cochrane Library database (up to June 2018) were searched and retrieved
articles systematically reviewed. Only randomized controlled trials (RCTs)
comparing maintenance of low MAP (<80 mmHg) and high MAP (>80 mmHg) during
cardiopulmonary bypass (CPB) were included in our final review.
Statistical analysis of the risk ratio (RR) and corresponding 95%
confidence interval (CI) was used to report the overall effect. The
overall effect and meta-regression analysis were done using
Mantel-Haenszel risk ratio (MHRR) and the corresponding 95% confidence
interval (CI). <br/>RESULT(S): A total of 731 patients in three RCTs were
included in this study. POCD occurred in 6.4% of all cases. Maintenance of
low MAP did not reduce the occurrence of POCD (MHRR 1.012 [95% CI
0.277-3.688]; Z=0.018; P=0.986; I2=66%). Shorter CPB time reduced the
occurrence of POCD regardless of group assignment (MH log risk ratio
-0.519 [95% CI -0.949 - -0.089]; Z= -2.367; P=0.017). <br/>CONCLUSION(S):
POCD is a common event among CABG patients. The neuroprotective effect of
low MAP on POCD was attenuated by the prolonged CPB time.

<42>
Accession Number
630043933
Title
National Lipid Association Scientific Statement on the use of icosapent
ethyl in statin-treated patients with elevated triglycerides and high or
very-high ASCVD risk.
Source
Journal of clinical lipidology. (no pagination), 2019. Date of
Publication: 02 Nov 2019.
Author
Orringer C.E.; Jacobson T.A.; Maki K.C.
Institution
(Orringer) Miller School of Medicine, Cardiovascular Division, University
of Miami, FL, Miami, United States
(Jacobson) Department of Medicine, Emory University, Atlanta, United
States
(Maki) School of Public Health, Department of Applied Health Science,
Indiana University, Bloomington, IN, USA; Midwest Biomedical Research,
Center for Metabolic and Cardiovascular Health, Addison, IL, USA
Publisher
NLM (Medline)
Abstract
Representatives from the National Lipid Association (NLA) participated in
the development of the 2018 American Heart Association/American College of
Cardiology/Multisociety Guideline on the Management of Blood Cholesterol,
which reaffirmed that lifestyle changes and statin treatment are
therapeutic cornerstones for atherosclerotic cardiovascular disease
(ASCVD) risk reduction. It also updated prior recommendations to
incorporate newer data demonstrating ASCVD risk reduction with ezetimibe
and proprotein convertase subtilisin kexin type 9 inhibitors as adjuncts
to statin therapy for patients at high and very-high ASCVD risk. The 2018
Guideline was finalized shortly before full results were available from a
randomized, placebo-controlled cardiovascular outcomes trial [Reduction of
Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT)]
that examined the effects of icosapent ethyl (IPE) 4 g/d on major adverse
cardiovascular events in selected high- or very high-risk, statin-treated
patients with elevated triglycerides. The primary outcome variable of
first major adverse cardiovascular event (cardiovascular death, myocardial
infarction, stroke, coronary revascularization and hospitalization for
unstable angina) was reduced by 25% (95% confidence interval 17%-32%, P <
.001). REDUCE-IT served as the primary basis for the NLA's review of
evidence for the use of IPE for ASCVD risk reduction. Based on this
review, the NLA position is that for patients aged >=45 years with
clinical ASCVD, or aged >=50 years with diabetes mellitus requiring
medication plus >=1 additional risk factor, with fasting triglycerides 135
to 499 mg/dL on high-intensity or maximally tolerated statin therapy
(+/-ezetimibe), treatment with IPE is recommended for ASCVD risk reduction
(evidence rating: class I; evidence level: B-R).<br/>Copyright &#xa9; 2019
National Lipid Association. Published by Elsevier Inc. All rights
reserved.

<43>
Accession Number
2003962886
Title
Meta-Analysis of Transcatheter Aortic Valve Implantation Versus Surgical
Aortic Valve Replacement in Patients With Low Surgical Risk.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Vipparthy S.C.; Ravi V.; Avula S.; Kambhatla S.; Mahmood M.; Kabour A.;
Ali S.S.; Barzallo M.; Mungee S.
Institution
(Vipparthy, Barzallo, Mungee) OSF St. Francis Medical Center, UICOMP,
Peoria, IL, United States
(Ravi) Rush University Medical Center, Chicago, IL, United States
(Avula, Mahmood, Kabour, Ali) Mercy St Vincent Medical Center, Toledo, OH,
United States
(Kambhatla) John H Stroger Jr. Hospital of Cook County, Chicago, IL,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) is the current standard of
care for patients with severe aortic stenosis who are at high risk for
surgery. However, several recent studies have demonstrated the comparable
safety and efficacy of TAVI in low-risk patients as well. We sought to
pool the existing data to further assert its comparability. MEDLINE,
Cochrane, and Embase databases were evaluated for relevant articles
published from January 2005 to June 2019. Studies comparing outcomes of
TAVI versus surgical aortic valve replacement in patients who are at low
risk for surgery were included. Twelve studies (5 randomized controlled
trials and 7 observational studies) totaling 27,956 patients were
included. Follow-up ranged from 3 months to 5 years. Short-term all-cause
mortality, short-term, and 1-year cardiac mortality were significantly
lower in the TAVI group. One-year all-cause mortality, short-term, and
1-year stroke and myocardial infarction were similar in both groups. Rate
of acute kidney injury and new-onset atrial fibrillation were lower in the
TAVI group, whereas permanent pacemaker implantation and major vascular
complications were higher in the TAVI group. Subgroup analysis of
randomized controlled trials showed significantly lower 1-year all-cause
mortality in the TAVI group. In conclusion, in severe aortic stenosis
patients at low surgical risk, TAVI when compared with surgical aortic
valve replacement, demonstrated a lower rate of short-term all-cause
mortality, short-term, and 1-year cardiac mortality and similar in terms
of 1-year all-cause mortality. TAVI is emerging as a safe and efficacious
alternative for low surgical risk patients.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<44>
Accession Number
2003906335
Title
Social Media Improves Cardiothoracic Surgery Literature Dissemination:
Results of a Randomized Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Luc J.G.Y.; Archer M.A.; Arora R.C.; Bender E.M.; Blitz A.; Cooke D.T.;
Hlci T.N.; Kidane B.; Ouzounian M.; Varghese T.K.; Antonoff M.B.
Institution
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, Canada
(Archer) Department of Thoracic Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Arora) Section of Cardiac Surgery, Department of Surgery, Max Rady
College of Medicine, University of Manitoba, St Boniface Hospital,
Winnipeg, Canada
(Bender) Department of Cardiothoracic Surgery, Stanford University, Palo
Alto, CA, United States
(Blitz) Division of Cardiac Surgery, University of Cincinnati Medical
Center, Cincinnati, OH, United States
(Cooke) Section of General Thoracic Surgery, UC Davis Health, Sacramento,
CA, United States
(Hlci) Department of Cardiothoracic Surgery, Morriston Hospital, Swansea
Bay University Health Board, Swansea, United Kingdom
(Kidane) Section of Thoracic Surgery, Department of Surgery, University of
Manitoba, Winnipeg, Canada
(Ouzounian) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University of Toronto, Toronto, Canada
(Varghese) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
(Antonoff) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson Cancer Center, Houston, TX, United States
Publisher
Elsevier USA
Abstract
Background: The Thoracic Surgery Social Media Network (TSSMN) represents a
collaborative effort of leading journals in cardiothoracic surgery to
highlight publications via social media, specifically Twitter. We
conducted a prospective randomized trial to determine the effect of
scheduled tweeting on nontraditional bibliometrics of dissemination.
<br/>Method(s): A total of 112 representative original articles
(2017-2018) were selected and randomized 1:1 to an intervention group to
be tweeted via TSSMN or a control (non-tweeted) group. Four articles per
day were tweeted by TSSMN delegates for 14 days. Primary endpoints
included change in article-level metrics (Altmetric) score pre-tweet and
post-tweet compared with the control group. Secondary endpoints included
change in Twitter analytics day 1 post-tweet and day 7 post-tweet for each
article compared with baseline. <br/>Result(s): Tweeting via TSSMN
significantly improved article Altmetric scores (pre-tweet 1 vs post-tweet
8; P <.001), Mendeley reads (pre-tweet 1 vs post-tweet 3; P <.001), and
Twitter impressions (day 1 post-tweet 1599 vs day 7 post-tweet 2296; P
<.001). Subgroup analysis demonstrates that incorporating photos into the
tweets trended toward increased link clicks to the full-text article (P
=.08) whereas tweeting at 1 pm Eastern Standard Time and 9 pm Eastern
Standard Time generated the highest and lowest audience reach (P =.022),
respectively. Articles published in adult cardiac surgery achieved the
highest change in Altmetric score (P =.028) and Mendeley reads (P =.028),
and were more likely to be retweeted (P =.042) than were those published
on education, general thoracic surgery, and congenital surgery.
<br/>Conclusion(s): Social media highlights of scholarly literature via
TSSMN Twitter activity improves article Altmetric scores, Mendeley reads,
and Twitter analytics, with dissemination to a greater
audience.<br/>Copyright &#xa9; 2019

<45>
Accession Number
2004060171
Title
The effect of inhalation aromatherapy in patients undergoing cardiac
surgery: A systematic review and meta-analysis of randomized controlled
trials.
Source
Complementary Therapies in Medicine. 48 (no pagination), 2020. Article
Number: 102256. Date of Publication: January 2020.
Author
Abdelhakim A.M.; Hussein A.S.; Doheim M.F.; Sayed A.K.
Institution
(Abdelhakim) Kasr Alainy, Faculty of Medicine, Cairo University, 395
portsaid street, Bab el-kalq, Cairo, Egypt
(Hussein) Faculty of Medicine, Al-Azhar University, Cairo, Egypt
(Doheim) Faculty of Medicine, Alexandria University, Alexandria, Egypt
(Sayed) Faculty of Medicine, Minia University, Minia, Egypt
Publisher
Churchill Livingstone
Abstract
Objective: The goal of this study was to synthesize evidence regarding the
efficacy of inhalation aromatherapy in patients undergoing cardiac
surgery. <br/>Method(s): We conducted an electronic search of four
authentic databases. Randomized controlled trials (RCTs), which compared
inhalation aromatherapy versus control in patients undergoing cardiac
surgery, were included. Data were extracted from eligible studies and
pooled in a meta-analysis model. We sought to evaluate anxiety, pain,
stress, and vital signs including heart rate, systolic and diastolic blood
pressure. <br/>Result(s): Nine RCTs were included in this study with a
total of 656 patients. Our analysis showed inhalation aromatherapy was
significantly effective in reducing anxiety (MD= -3.11, 95 % CI [-5.26,
-0.96], p = 0.005), and pain (MD= -0.83, 95 % CI [-1.59, -0.07], p = 0.03)
in patients undergoing cardiac surgery. Additionally, inhalation
aromatherapy significantly reduced heart rate compared to control group
(MD= -5.49, 95 % CI [-9.07, -1.81], p = 0.003). However, no significant
differences were found between both groups in mental stress, systolic and
diastolic blood pressure. <br/>Conclusion(s): Inhalation aromatherapy
administration especially with lavender can significantly reduce anxiety,
pain, and heart rate in patients performed cardiac surgery. However, it is
not associated with significant differences in systolic and diastolic
blood pressure. Further studies are needed to confirm our
results.<br/>Copyright &#xa9; 2019 Elsevier Ltd

<46>
Accession Number
2003629330
Title
Review of the evidence in survival studies of patients with a biological
valve replacement.
Source
Revista Colombiana de Cardiologia. 26 (6) (pp 328-337), 2019. Date of
Publication: November - December 2019.
Author
Castaneda-Porras O.
Institution
(Castaneda-Porras) Segura, Moron & Castaneda Asesores en Salud Ltda.
(SMC-AS) Unidad de Investigaciones, Bogota, Colombia
Publisher
Elsevier B.V.
Abstract
Introduction: The modifications in the structural / functional features of
replacement valves have led to an increase the survival curves of the
patients. This can be seen in the reduction in morbidity and mortality
rates after the surgical intervention of the cardiac valves, as well as
the substantial changes in the cost-effectivity and cost-benefit ratio of
these procedures. <br/>Objective(s): To determine the survival of patients
over 60 years of age with a biological valve replacement. <br/>Material(s)
and Method(s): A review of follow-up published studies that evaluated the
survival of patients subjected to a valve replacement. A search was made
of the scientific articles registered in the PubMed databases, using the
selected descriptors as Key words: Heart Valve Prosthesis, Bioprosthesis,
Survival, in the references management program-EndNote. The strength of
the scientific evidence in each of the selected articles was assessed
using the McMaster scale for quantitative studies. <br/>Result(s): A total
of 12 references were found and 5 (41.7%) were discarded, and 7 (58.3%)
had an overall "strong" score with the McMaster scale. The mean follow-up
time was 13.7 years, and the male ratio was 1:0.8. The mean age of the
patients was 67.2 (range: 60.0-78.5) years. The mean survival rate at 10
years was 65%. <br/>Conclusion(s): A higher survival was observed between
the patients fitted with a mechanical versus a biological valve. However,
the literature has established the use of a biological replacement valve
as a reasonable option in patients over 60 years of age. It is also
recognised that more studies are needed that can corroborate the
findings.<br/>Copyright &#xa9; 2019 Sociedad Colombiana de Cardiologia y
Cirugia Cardiovascular

<47>
Accession Number
629976095
Title
Influence of volatile anesthesia versus total intravenous anesthesia on
chronic postsurgical pain after cardiac surgery using the Initiative on
Methods, Measurement, and Pain Assessment in Clinical Trials criteria:
study protocol for a prospective randomized controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 645. Date of
Publication: 27 Nov 2019.
Author
Zheng J.-Q.; Hua Y.-S.; Ren S.-F.; Yu H.
Institution
(Yu, Zheng, Hua, Yu) Department of Anesthesiology, West China Hospital,
Sichuan University and The Research Units of West China (2018RU012),
Chinese Academy of Medical Sciences, Chengdu 610041, China
(Ren) Department of Cardiovascular surgery, West China Hospital, Sichuan
University and The Research Units of West China (2018RU012), Chinese
Academy of Medical Sciences, Chengdu 610041, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Many patients develop chronic postsurgical pain (CPSP) after
cardiac surgery, which interferes with their sleep, mood, and quality of
life. Studies have suggested that propofol improves postoperative
analgesia compared with volatile anesthetics, but its preventive effect on
CPSP following cardiac surgery is still unknown. This study compares the
incidence of CPSP following cardiac surgery for those receiving volatile
anesthesia and those receiving propofol-based total intravenous anesthesia
(TIVA) using criteria recommended by the Initiative on Methods,
Measurement, and Pain Assessment in Clinical Trials (IMMPACT).
Methods/design: This is a prospective randomized controlled trial. In
total, 500 adults undergoing cardiac surgery will be randomly allocated to
the volatile or the TIVA group. The volatile group will receive
sevoflurane or desflurane during surgery as general anesthesia. The TIVA
group will receive propofol-based intravenous agents and no volatile
agents during surgery. The primary outcomes will be the frequency of CPSP
at 3 months, 6 months, and 1 year after surgery. In this case, CPSP is
sternal or thoracic pain. It is defined as either (1) numerical rating
scale (NRS) > 0 or (2) meeting all six IMMPACT criteria for CPSP. The
IMMPACT criteria are validated pain instruments. <br/>Discussion(s): To
our knowledge, this is the first prospective randomized controlled trial
to investigate the prevention of CPSP following cardiac surgery for
patients receiving volatile anesthesia compared to those receiving
propofol-based TIVA using validated pain instruments in accordance with
the IMMPACT recommendations. This study will provide important information
on which of these two anesthetic regimens is better for preventing CPSP
after cardiac surgery. Trial registration: Chictr.org.cn,
ChiCTR1900020747. Registered on 16 January 2019.<br/>Copyright &#xa9; 2019
The Author(s).

<48>
Accession Number
2004057772
Title
Ramucirumab plus erlotinib in patients with untreated, EGFR-mutated,
advanced non-small-cell lung cancer (RELAY): a randomised, double-blind,
placebo-controlled, phase 3 trial.
Source
The Lancet Oncology. 20 (12) (pp 1655-1669), 2019. Date of Publication:
December 2019.
Author
Nakagawa K.; Garon E.B.; Seto T.; Nishio M.; Ponce Aix S.; Paz-Ares L.;
Chiu C.-H.; Park K.; Novello S.; Nadal E.; Imamura F.; Yoh K.; Shih J.-Y.;
Au K.H.; Moro-Sibilot D.; Enatsu S.; Zimmermann A.; Frimodt-Moller B.;
Visseren-Grul C.; Reck M.; Chu Q.; Cortot A.; Pujol J.-L.; Fabre E.;
Lamour C.; Bischoff H.; Kollmeier J.; Kimmich M.; Engel-Riedel W.;
Hammerschmidt S.; Schutte W.; Syrigos K.; Ho J.C.M.; Au K.-H.; Ardizzoni
A.; Pasello G.; Gregorc V.; Del Conte A.; Galetta D.; Takahashi T.;
Kumagai T.; Hotta K.; Goto Y.; Hosomi Y.; Sakai H.; Takiguchi Y.; Kim
Y.H.; Kurata T.; Yamaguchi H.; Daga H.; Okamoto I.; Satouchi M.; Ikeda S.;
Kasahara K.; Atagi S.; Azuma K.; Aoe K.; Horio Y.; Yamamoto N.; Tanaka H.;
Watanabe S.; Nogami N.; Ozaki T.; Koyama R.; Hirashima T.; Kaneda H.;
Tomii K.; Fujita Y.; Seike M.; Nishimura N.; Kato T.; Ichiki M.; Saka H.;
Hirano K.; Nakahara Y.; Sugawara S.; Kim S.-W.; Min Y.J.; Lee H.W.; Kang
J.-H.; An H.J.; Lee K.H.; Kim J.-S.; Lee G.-W.; Lee S.Y.; Alexandru A.;
Udrea A.A.; Juan-Vidal O.; Nadal-Alforja E.; Gil-Bazo I.; Ponce-Aix S.;
Rubio-Viqueira B.; Alonso Garcia M.; Felip Font E.; Fuentes Pradera J.;
Coves Sarto J.; Lin M.-C.; Su W.-C.; Hsia T.-C.; Chang G.-C.; Wei Y.-F.;
Su J.; Cicin I.; Goksel T.; Harputluoglu H.; Ozyilkan O.; Henning I.;
Popat S.; Hatcher O.; Mileham K.; Acoba J.; Garon E.; Jung G.; Raj M.;
Martin W.; Dakhil S.
Institution
(Nakagawa) Department of Medical Oncology, Kindai University Faculty of
Medicine, Osaka, Japan
(Garon) David Geffen School of Medicine at University of California Los
Angeles, Translational Research in Oncology US Network, Los Angeles, CA,
United States
(Seto) National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
(Nishio) Department of Thoracic Medical Oncology, The Cancer Institute
Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
(Ponce Aix, Paz-Ares) Hospital Universitario 12 de Octubre, H12O-CNIO Lung
Cancer Clinical Research Unit, Universidad Complutense and Ciberonc,
Madrid, Spain
(Chiu) Department of Chest Medicine, Taipei Veterans General Hospital,
Taipei, Taiwan (Republic of China)
(Park) Samsung Medical Center, Division of Hematology and Oncology,
Sungkyunkwan University School of Medicine, Seoul, South Korea
(Novello) Department of Oncology, University of Turin, Azienda
ospedaliero-universitaria San Luigi, Orbassano, Italy
(Nadal) Department of Medical Oncology, Catalan Institute of Oncology, and
Clinical Research in Solid Tumors group, Oncobell, l'Institut
d'Investigacio Biomedica de Bellvitge, L'Hospitalet, Barcelona, Spain
(Imamura) Osaka International Cancer Institute, Osaka, Japan
(Yoh) National Cancer Center Hospital East, Kashiwa, Japan
(Shih) Department of Internal Medicine, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Au) Queen Elizabeth Hospital, Kowloon, Hong Kong
(Moro-Sibilot) Grenoble University Hospital, Grenoble, France
(Enatsu) Eli Lilly Japan KK Kobe, Kobe, Japan
(Zimmermann) Eli Lilly and Company, Indianapolis, IN, United States
(Frimodt-Moller) Eli Lilly and Company, Copenhagen, Denmark
(Visseren-Grul) Lilly Oncology, Utrecht, Netherlands
(Reck) LungenClinic, Airway Research Center North, German Center for Lung
Research, Grosshansdorf, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Dual blockade of the EGFR and VEGF pathways in EGFR-mutated
metastatic non-small-cell lung cancer (NSCLC) is supported by preclinical
and clinical data, yet the approach is not widely implemented. RELAY
assessed erlotinib, an EGFR tyrosine kinase inhibitor (TKI) standard of
care, plus ramucirumab, a human IgG1 VEGFR2 antagonist, or placebo in
patients with untreated EGFR-mutated metastatic NSCLC. <br/>Method(s):
This is a worldwide, double-blind, phase 3 trial done in 100 hospitals,
clinics, and medical centres in 13 countries. Eligible patients were aged
18 years or older (20 years or older in Japan and Taiwan) at the time of
study entry, had stage IV NSCLC, with an EGFR exon 19 deletion (ex19del)
or exon 21 substitution (Leu858Arg) mutation, an Eastern Cooperative
Oncology Group performance status of 0 or 1, and no CNS metastases. We
randomly assigned eligible patients in a 1:1 ratio to receive oral
erlotinib (150 mg/day) plus either intravenous ramucirumab (10 mg/kg) or
matching placebo once every 2 weeks. Randomisation was done by an
interactive web response system with a computer-generated sequence and
stratified by sex, geographical region, EGFR mutation type, and EGFR
testing method. The primary endpoint was investigator-assessed
progression-free survival in the intention-to-treat population. Safety was
assessed in all patients who received at least one dose of study
treatment. This trial is registered at ClinicalTrials.gov, NCT02411448,
and is ongoing for long-term survival follow-up. <br/>Finding(s): Between
Jan 28, 2016, and Feb 1, 2018, 449 eligible patients were enrolled and
randomly assigned to treatment with ramucirumab plus erlotinib (n=224) or
placebo plus erlotinib (n=225). Median duration of follow-up was 20.7
months (IQR 15.8-27.2). At the time of primary analysis, progression-free
survival was significantly longer in the ramucirumab plus erlotinib group
(19.4 months [95% CI 15.4-21.6]) than in the placebo plus erlotinib group
(12.4 months [11.0-13.5]), with a stratified hazard ratio of 0.59 (95% CI
0.46-0.76; p<0.0001). Grade 3-4 treatment-emergent adverse events were
reported in 159 (72%) of 221 patients in the ramucirumab plus erlotinib
group versus 121 (54%) of 225 in the placebo plus erlotinib group. The
most common grade 3-4 treatment-emergent adverse events in the ramucirumab
plus erlotinib group were hypertension (52 [24%]; grade 3 only) and
dermatitis acneiform (33 [15%]), and in the placebo plus erlotinib group
were dermatitis acneiform (20 [9%]) and increased alanine aminotransferase
(17 [8%]). Treatment-emergent serious adverse events were reported in 65
(29%) of 221 patients in the ramucirumab plus erlotinib group and 47 (21%)
of 225 in the placebo plus erlotinib group. The most common serious
adverse events of any grade in the ramucirumab plus erlotinib group were
pneumonia (seven [3%]) and cellulitis and pneumothorax (four [2%], each);
the most common in the placebo plus erlotinib group were pyrexia (four
[2%]) and pneumothorax (three [1%]). One on-study treatment-related death
due to an adverse event occurred (haemothorax after a thoracic drainage
procedure for a pleural empyema) in the ramucirumab plus erlotinib group.
<br/>Interpretation(s): Ramucirumab plus erlotinib demonstrated superior
progression-free survival compared with placebo plus erlotinib in patients
with untreated EGFR-mutated metastatic NSCLC. Safety was consistent with
the safety profiles of the individual compounds in advanced lung cancer.
The RELAY regimen is a viable new treatment option for the initial
treatment of EGFR-mutated metastatic NSCLC. <br/>Funding(s): Eli
Lilly.<br/>Copyright &#xa9; 2019 Elsevier Ltd

<49>
Accession Number
628325494
Title
Outcomes of Chronic Total Occlusions in Coronary Arteries According to
Three Therapeutic Strategies: A Meta-analysis with 6985 Patients from 8
Published Observational Studies.
Source
Brazilian journal of cardiovascular surgery. 34 (6) (pp 645-652), 2020.
Date of Publication: 01 Jan 2020.
Author
Zheng Y.-Y.; Gao Y.; Chen Y.; Wu T.-T.; Ma Y.-T.; Zhang J.-Y.; Xie X.
Institution
(Zheng, Zhang) Zhengzhou University First Affiliated Hospital Department
of Cardiology Zhengzhou People's Republic of China Department of
Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
(Gao) Xinjiang Medical University First Affiliated Hospital Department of
Cadre Ward Urumqi Xinjiang People's Republic of China Department of Cadre
Ward, First Affiliated Hospital of Xinjiang Medical University, Urumqi,
Xinjiang, China
(Chen, Wu, Ma, Xie) Xinjiang Medical University First Affiliated Hospital
Heart Center Urumqi Xinjiang People's Republic of China Heart Center,
First Affiliated Hospital of Xinjiang Medical University, Urumqi,
Xinjiang, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To perform a systematic review and meta-analysis of studies
comparing coronary artery bypass grafting (CABG), percutaneous coronary
intervention (PCI), and medical treatment (MT) in patients with chronic
total occlusions (CTOs). <br/>METHOD(S): We identified eligible
observational studies published in the China National Knowledge
Infrastructure database, PubMed, Excerpta Medica database, Google Scholar,
Cochrane Library, Web of Science, and "Clinical trials" registration from
1999 to October 2018. Main outcome measures were all-cause mortality,
cardiac death, major adverse cardiac events (MACEs), and myocardial
infarction (MI). <br/>RESULT(S): There were eight observational studies
including 6985 patients. Patients' mean age was 64.4 years. Mean follow-up
time was 4.3 years. Comparing with MT (2958 patients), PCI (3157 patients)
presented decreased all-cause mortality (odd ratio [OR]: 0.46, 95%
confidence interval [CI]: 0.36-0.60; P<0.001), cardiac death (OR: 0.40,
95% CI: 0.31-0.52; P<0.001), MACE (OR: 0.55, 95% CI: 0.43-0.71; P<0.001),
and MI (OR: 0.40, 95% CI: 0.26-0.62; P<0.001). Comparing with MT, CABG
(613 patients) presented lower all-cause mortality (OR: 0.50, 95% CI:
0.36-0.69; P<0.001) and MACE (OR: 0.50, 95% CI: 0.26-0.96; P=0.04), but
not lower MI (OR: 0.23, 95% CI: 0.03-1.54; P=0.13) and cardiac death (OR:
0.83, 95% CI: 0.51-1.35). Comparing with CABG, PCI did not present
decreased risk for those outcomes. <br/>CONCLUSION(S): PCI or CABG was
associated with better clinical outcome in patients with CTO than MT. PCI
is not better than CABG in decreasing mortality, MI, cardiac death, and
MACE in coronary CTO patients.

<50>
Accession Number
629847864
Title
Effect of Using Triclosan-Impregnated Polyglactin Suture to Prevent
Infection of Saphenectomy Wounds in CABG: A Prospective, Double-Blind,
Randomized Clinical Trial.
Source
Brazilian journal of cardiovascular surgery. 34 (5) (pp 588-595), 2019.
Date of Publication: 01 Dec 2019.
Author
Santos P.S.; Santos M.; Colafranceschi A.S.; Pragana A.N.S.; Correia M.G.;
Simoes H.H.; Rocha F.A.; Soggia M.E.V.; Santos A.P.M.S.; Coutinho A.A.;
Figueira M.S.; Tura B.R.
Institution
(Santos, Colafranceschi, Pragana, Simoes, Rocha, Soggia, Santos, Figueira)
Instituto Nacional de Cardiologia Department of Cardiovascular Surgery Rio
de Janeiro RJ Brazil Department of Cardiovascular Surgery, Instituto
Nacional de Cardiologia (INC), RJ, Rio de Janeiro, Brazil
(Santos, Coutinho) Instituto Nacional de Cardiologia Nucleo de Avaliacao
de Tecnologia em Saude Rio de Janeiro RJ Brazil Nucleo de Avaliacao de
Tecnologia em Saude (NATS), Instituto Nacional de Cardiologia (INC), RJ,
Rio de Janeiro, Brazil
(Correia, Tura) Instituto Nacional de Cardiologia Department of
Biostatistics and Bioinformatics Rio de Janeiro RJ Brazil Department of
Biostatistics and Bioinformatics, Instituto Nacional de Cardiologia (INC),
RJ, Rio de Janeiro, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the efficacy of triclosan-coated suture for the
reduction of infection in saphenectomy wounds of patients undergoing
coronary artery bypass graft (CABG) surgery. <br/>METHOD(S): A total of
508 patients who underwent saphenectomy in CABG surgery were included in a
prospective, randomized, double-blind trial from February/2011 to
June/2014. Patients were randomized into the triclosan-coated suture group
(n= 251) and the conventional non-antibiotic suture group (n=257).
Demographic (gender and age), clinical (body mass index, diabetes, and use
of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp
times) variables and those related to the saphenectomy wound (pain,
dehiscence, erythema, infection, necrosis, and hyperthermia) were measured
and analyzed. <br/>RESULT(S): Of the 508 patients who underwent
saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three
(6.5%) patients presented infection: 13 (5.3%) with triclosan and 20
(7.9%) with conventional suture (P=0.281). Among diabetic patients
(n=204), triclosan suture was used in 45.1% with four cases of infection;
conventional suture was used in 54.9% of them, with 11 cases of infection.
Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in
9.9% of patients with triclosan-coated suture and in 17.9% with
conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of
patients with triclosan-coated suture and in 5.4% of those with
conventional suture (P=0.028). <br/>CONCLUSION(S): Triclosan-coated suture
shows lower infection rate in saphenectomy of patients undergoing CABG,
although the differences were not statistically significant. Pain and
wound hyperthermia were less frequent in patients with triclosan-coated
sutures compared with conventional sutures.

<51>
Accession Number
629847588
Title
The Effect of High-Dose Vitamin C on Biochemical Markers of Myocardial
Injury in Coronary Artery Bypass Surgery.
Source
Brazilian journal of cardiovascular surgery. 34 (5) (pp 517-524), 2019.
Date of Publication: 01 Dec 2019.
Author
Emadi N.; Nemati M.H.; Ghorbani M.; Allahyari E.
Institution
(Emadi) Shiraz University of Medical Sciences Blood Circulation Technology
Shiraz Iran Blood Circulation Technology, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Nemati) Shiraz University of Medical Sciences Department of Heart Surgery
Shiraz Iran Department of Heart Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Ghorbani) Shiraz University of Medical Sciences Anesthesiology Research
Center Shiraz Iran Anesthesiology Research Center, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Ghorbani) Torbat Heydarieh University of Medical Sciences Department of
Public Health Torbat Heydarieh Iran Department of Public Health, Torbat
Heydarieh University of Medical Sciences, Iran, Islamic Republic of
(Allahyari) Shiraz University of Medical Sciences Department of
Anesthesiology Shiraz Iran Department of Anesthesiology, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the effect of high-dose vitamin C on cardiac
reperfusion injury and plasma levels of creatine kinase-muscle/brain
(CK-MB), troponin I, and lactate dehydrogenase (LDH) in patients
undergoing coronary artery bypass grafting (CABG). <br/>METHOD(S): This is
a double-blind randomized clinical trial study. Fifty patients (50-80
years old) who had CABG surgery were selected. The intervention group
received 5 g of intravenous vitamin C before anesthesia induction and 5 g
of vitamin C in cardioplegic solution. The control group received the same
amount of placebo (normal saline). Arterial blood samples were taken to
determine the serum levels of CK-MB, troponin I, and LDH enzymes. Left
ventricular ejection fraction was measured and hemodynamic parameters were
recorded at intervals. <br/>RESULT(S): High doses of vitamin C in the
treatment group led to improvement of ventricular function (ejection
fraction [EF]) and low Intensive Care Unit (ICU) stay. The cardiac enzymes
level in the vitamin C group was lower than in the control group. These
changes were not significant between the groups in different time
intervals (anesthesia induction, end of bypass, 6 h after surgery, and 24
h after surgery) for CK-MB, LDH, and troponin I. Hemodynamic parameters,
hematocrit, potassium, urinary output, blood transfusion, arrhythmia, and
inotropic support showed no significant difference between the groups.
<br/>CONCLUSION(S): Vitamin C has significantly improved the patients'
ventricular function (EF) 72 h after surgery and reduced the length of ICU
stay. No significant changes in cardiac biomarkers, including CK-MB,
troponin I, and LDH, were seen over time in each group. IRCT CODE:
IRCT2016053019470N33.

<52>
Accession Number
629992071
Title
Immunosuppressive Treatment for Myocarditis in the Pediatric Population: A
Meta-Analysis.
Source
Frontiers in Pediatrics. 7 (no pagination), 2019. Article Number: 430.
Date of Publication: 15 Nov 2019.
Author
He B.; Li X.; Li D.
Institution
(He, Li, Li) Department of Pediatrics, Renmin Hospital of Wuhan
University, Wuhan, China
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
The use of immunosuppressants in the treatment of myocarditis in children
remains controversial. The aim of this meta-analysis is to summarize the
current empirical evidence for immunosuppressive treatment for myocarditis
in the pediatric population. We searched PubMed, MEDLINE, and Embase for
articles to identify studies analyzing the efficiency of immunosuppressive
treatment in the pediatric population. Pooled estimates were generated
using fixed- or random-effect models. Heterogeneity within studies was
assessed using Cochran's Q and I² statistics. Funnel plots and
Begg's rank correlation method were constructed to evaluate publication
bias. Sensitivity analyses were also conducted to evaluate the potential
sources of heterogeneity. After a detailed screening of 159 studies, six
separate studies were identified, with 181 patients in the
immunosuppressive treatment group, and 199 in the conventional treatment
group. The immunosuppressive treatment group showed a significant
improvement in left ventricular ejection fraction (LVEF) [mean difference
1.10; 95% CI: 0.41, 1.79] and significantly decreased left ventricular
end-diastolic dimension (LVEDD) [mean difference -0.77 mm, 95% CI: -1.35
to -0.20 mm] when compared to the conventional treatment group.
Furthermore, the risk of death and heart transplant in conventional
treatment was significantly higher than in the immunosuppressive treatment
group [relative risk (RR): 4.74; 95% CI: 2.69, 8.35]. No significant
heterogeneity across the studies was observed. There was no evidence of
publication bias when assessed by Begg's test. <br/>Conclusion(s): There
may be a possible benefit, in the short term, to the addition of
immunosuppressive therapy in the management of myocarditis in the
pediatric population. However, further prospective investigation is
warranted to validate this finding.<br/>&#xa9; Copyright &#xa9; 2019 He,
Li and Li.

<53>
Accession Number
2004001712
Title
Adjuvant Radiation Therapy for Thoracic Soft Tissue Sarcomas: A
Population-Based Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Rehmani S.S.; Raad W.; Weber J.; Lazarev S.; Ayub A.; Al-Ayoubi A.M.;
Bhora F.Y.
Institution
(Rehmani, Raad, Weber, Ayub, Al-Ayoubi, Bhora) Department of Thoracic
Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health
System, New York, NY, United States
(Weber, Bhora) Department of Thoracic Surgery, Health Quest, Poughkeepsie,
NY, United States
(Lazarev) Department of Radiation Oncology, Icahn School of Medicine at
Mount Sinai, Mount Sinai Health System, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: The role of adjuvant radiation therapy (RT) in the management
of thoracic soft tissue sarcomas (STSs) remains unclear. We aimed to study
the characteristics of patients with thoracic STS who received RT after
surgical resection and investigate the impact of RT on survival outcomes.
<br/>Method(s): We queried National Cancer Database to identify patients
with surgically resected thoracic STS from 2004 to 2012. Factors
associated with receiving adjuvant RT were identified. Analyses were
performed to identify prognostic factors and compare overall survival (OS)
in both unmatched and propensity score-matched cohorts. <br/>Result(s):
Overall, 1215 patients were identified, of whom 557 (45.8%) received
adjuvant RT. Tumor grade (odds ratio [OR], 2.87; 95% confidence interval
[CI], 2.18-3.77), tumor size (OR, 1.82; 95% CI, 1.36-2.42), and tumor
margins (OR, 1.97; 95% CI, 1.43-2.72) were found to be significant
predictors of receiving RT. Mean OS of patients receiving RT in the
unmatched cohort was 91 months vs 88 months for patients who did not (P =
.556). When adjusted for all variables, adjuvant RT was found to be
associated with improved survival (hazard ratio, 0.79; 95% CI, 0.61-0.96).
Survival analysis of the matched cohort also demonstrated improved
survival with adjuvant RT (120 months vs 100 months; P = .02). Subgroup
analysis in both the unmatched and matched cohorts showed patients with
high-grade tumors more likely to benefit from adjuvant RT.
<br/>Conclusion(s): This population-based analysis is the largest dataset
of primary thoracic STSs to date and suggests significant survival benefit
associated with adjuvant RT. The improvement in OS was more notable in
patients with high-grade tumors. Randomized prospective studies are
warranted to further understand the benefit of RT in this
group.<br/>Copyright &#xa9; 2019 The Society of Thoracic Surgeons

<54>
Accession Number
2003969691
Title
CHA<inf>2</inf>DS<inf>2</inf>-VASc Score for Identifying Patients at High
Risk of Postoperative Atrial Fibrillation After Cardiac Surgery: A
Meta-analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Chen Y.-L.; Zeng M.; Liu Y.; Xu Y.; Bai Y.; Cao L.; Ling Z.; Fan J.; Yin
Y.
Institution
(Chen, Zeng, Xu, Cao, Ling, Fan, Yin) Department of Cardiology, the 2nd
Affiliated Hospital of Chongqing Medical University, Chongqing, China
(Liu) Biostatistics & Bioinformatics Shared Resource at Winship Cancer
Institute, Emory University, Atlanta, Georgia
(Liu) Department of Biostatistics & Bioinformatics, Rollins School of
Public Health, Emory University, Atlanta, Georgia
(Bai) Department of Respiratory and Critical Care Medicine, the 1st
Affiliated Hospital of Chongqing Medical University, Chongqing, China
(Fan) Department of Biomedical Engineering and Pediatrics, Emory
University, Atlanta, Georgia
Publisher
Elsevier USA
Abstract
Background: Postoperative atrial fibrillation (POAF) is a common
complication after cardiac surgery, resulting in an increased risk of
morbidity and longer hospital stay. Pharmacologic prophylaxis has been
recommended to improve the outcome in patients at high risk of developing
POAF after cardiac surgery. Several studies have applied the
CHA<inf>2</inf>DS<inf>2</inf>-VASc (Congestive heart failure, Hypertension
Age [>=65 = 1 point, >=75 = 2 points], Diabetes, and Stroke/transient
ischemic attack (2 points)-vascular disease [peripheral arterial disease,
previous myocardial infarction, aortic atheroma]) score in the risk
stratification of POAF but yielded contradicting results. This study aims
to determine the association between CHA<inf>2</inf>DS<inf>2</inf>-VASc
score and POAF and further to explore its discriminative ability for the
prediction of POAF. <br/>Method(s): We systematically searched the
Medline, Embase, Cochrane library, and other data sources with key terms
"CHA<inf>2</inf>DS<inf>2</inf>-VASc," "atrial fibrillation," and "cardiac
surgery." Studies designed for CHA<inf>2</inf>DS<inf>2</inf>-VASc score in
stratifying the risks of POAF in patients undergoing cardiac surgery were
included. Statistical analyses were performed with R 3.5.1 and STATA 13.0.
<br/>Result(s): Seven hundred twenty-one studies were identified, of which
12 studies with 18,086 patients were finally included in our analysis. The
CHA<inf>2</inf>DS<inf>2</inf>-VASc score was found to be an independent
predictor of POAF after cardiac surgery (odds ratio, 1.46; 95% confidence
interval [CI], 1.25-1.72) and exhibited a relatively strong specificity
(0.70; 95% CI, 0.61-0.78) and sensitivity (0.72; 95% CI, 0.54-0.85) for
predicting POAF. The bivariate model-based pooled area under the receiver
operating curve was estimated to be 0.76 (95% CI, 0.72-0.79).
<br/>Conclusion(s): The CHA<inf>2</inf>DS<inf>2</inf>-VASc score has
relatively good performance in predicting POAF after cardiac surgery and
may help identify the patients at high risk of POAF.<br/>Copyright &#xa9;
2019

<55>
Accession Number
2003948772
Title
Meta-Analysis Comparing Results of Transcatheter Versus Surgical
Aortic-Valve Replacement in Patients With Severe Aortic Stenosis.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Zhang X.; Wang T.; Lan R.; Dai Q.; Kang L.; Wang L.; Wang Y.; Xu W.; Xu B.
Institution
(Zhang, Lan, Dai, Kang, Wang, Xu, Xu) Department of Cardiology, Affiliated
Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
(Wang, Wang) Centre for translational Medicine, Nanjing University School
of Medicine, Nanjing, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic-valve replacement (TAVR) has emerged as a promising
strategy for treating patients with severe aortic stenosis. We aimed to
compare TAVR with surgical aortic-valve replacement (SAVR) and determine
the performance of TAVR over time and within several subgroups. We
included 8 randomized trials comparing TAVR versus SAVR. Compared with
SAVR, TAVR was associated with a lower rate of all-cause mortality or
disabling stroke at 30-day (odds ratio [OR], 0.72; p = 0.004), 1-year (OR,
0.83; p = 0.01), and 2-year (OR, 0.86; p = 0.02), but not at long-term
follow-up (rate ratio [RR], 1.02 [confidence interval 0.92 to 1.13]; p =
0.67). Notably, 5-year data showed numerically higher incidence in TAVR
(RR, 1.11 [confidence interval 0.97 to 1.27]; p = 0.12). The risks
associated with TAVR versus SAVR increased over time, showing a
significant interaction (p for interaction = 0.01), as were for new-onset
atrial fibrillation and rehospitalization. Incidences of major bleeding,
new-onset fibrillation, and acute kidney injury were lower in TAVR,
whereas transient ischemic attack, major vascular complications, permanent
pacemaker implantation, reintervention, and paravalvular leak were lower
in SAVR. Incidences for all-cause and cardiovascular mortality, myocardial
infarction, and stroke were not statistically different. TAVR with
transfemoral approach and new-generation valve was associated with
reduction in all-cause mortality or disabling stroke compared with
corresponding comparators. In conclusion, TAVR was associated with a lower
risk for all-cause mortality or disabling stroke within 2 years, but not
at long-term follow-up compared with SAVR; the risks seems to increase
over time. More data are needed to determine longer-term performance of
TAVR.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<56>
Accession Number
373203852
Title
Effects of propofol and midazolam infusions on serum lipid and glucose
levels in hyperlipidemic patients undergoing coronary artery bypass
surgery.
Source
Turkiye Klinikleri Journal of Medical Sciences. 34 (2) (pp 267-272), 2014.
Date of Publication: 2014.
Author
Acarturk H.; Oztekin I.; Oztek S.D.; Issever H.; Canik S.
Institution
(Acarturk, Canik) Department of Anesthesiology and Reanimation, Siyami
Ersek Heart Surgery Hospital, Istanbul, Turkey
(Oztekin) Department of Anesthesiology and Reanimation, Trakya University,
Edirne, Turkey
(Oztek) Department of Surgical Nursing, Istanbul University Florence
Nightingale Highschool of Nursing, Turkey
(Issever) Department of Public Health, Istanbul University, Istanbul,
Turkey
Publisher
Turkiye Klinikleri
Abstract
Objective: Propofol has been accused for increasing plasma lipid levels
during continuous infusion due to its lipid content. We aimed to show the
effect and the risk of propofol infusion on plasma lipid and glucose
levels in patients with hyperlipidemia undergoing coronary artery bypass
graft surgery (CABG), and to compare them with a midazolam used control
group. <br/>Material(s) and Method(s): In this randomized controlled
study, 15 patients in the propofol group had anesthesia induction with
intravenous propofol 1%, 2 mg/kg, fentanyl 10-15 mcg/kg, pancuronium 0.1
mg/kg, and the anesthesia was maintained with 1% 2-5 mg/kg/h propofol
infusion, fentanyl 5-10 mcg/kg/hr, and an hourly pancuronium dose of 0.03
mg/kg The anesthetia management of 15 patients in midazolam group included
induction with midazolam 0.1 mg/kg, fentanyl 10-15 mcg/kg, pancuronium 0.1
mg/kg, and infusion of midazolam 0.05-0.07 mg/kg/hr, fentanyl 5-10
mcg/kg/hr, and an hourly pancuronium dose of 0.03 mg/kg Plasma lipid
[total cholesterol (CHL), triglyceride (TRG), high density lipoprotein
(HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL)]
and glucose concentrations were measured in both groups perioperatively,
at seven different time points until 72 hours after the operation.
<br/>Result(s): The decreases of TRG and HDL levels were statistically
significant in the midazolam group. There were no significant differences
for the decreases in CHL, LDL and VLDL levels between the groups. In both
groups, plasma glucose levels increased significantly, independent from
the propofol and midazolam infusions. <br/>Conclusion(s): We observed that
propofol and midazolam anesthesia used in patients with hyperlipidemia
undergoing to CABG did not have any effect on plasma lipid or glucose
levels. &#xa9; 2014 by Turkiye Klinikleri.

<57>
Accession Number
368463986
Title
Effects of epidural bupivacaine on the doses of propofol, alfentanil,
vecuronium, and neuromuscular block: A prospective randomized,
single-blind clinical study.
Source
Turkiye Klinikleri Journal of Medical Sciences. 33 (2) (pp 306-313), 2013.
Date of Publication: 2013.
Author
Karlilar B.; Tunc M.; Gunal Sazak H.; Telatar A.; Savkilioglu E.;
Karabulut E.
Institution
(Karlilar) Clinic of Anesthesiology and Reanimation, Umut Surgical Medical
Center, Mersin, Turkey
(Tunc, Gunal Sazak, Savkilioglu) Anesthesiology and Reanimation, Ataturk
Pulmonary Diseases and Surgery Training and Research Hospital, Ankara,
Turkey
(Telatar) Anesthesiology and Reanimation, Sinop State Hospital, Sinop,
Turkey
(Karabulut) Department of biostatistics, Hacettepe University, Faculty of
Medicine, Ankara, Turkey
Publisher
Turkiye Klinikleri
Abstract
Objective: This study was planned to ascertain the effects of epidural
bupivacaine on the doses of propofol, alfentanil and vecuronium used for
the maintenance for general anesthesia in patients receiving thoracic
epidural anesthesia (TEA) combined with total intravenous anesthesia
(TIVA) in thoracic surgery. In addition, the impacts of TEA on duration,
intensity, reversal and the characteristics of residual block related to
vecuronium-induced neuromuscular blockade was investigated.
<br/>Material(s) and Method(s): Thirty patients scheduled for thoracic
surgery were randomly assigned into two groups. Group 1 received TIVA
combined with TEA, whereas Group 2 obtained TIVA solely. Epidural
bupivacaine (0.375%) was given 6 mL/h following 1.5 mL/segment bupivacaine
(0.5%) bolus in Group 1. General anesthesia was provided with propofol,
alfentanil and vecuronium in both groups. Propofol dose was adjusted to
maintain bispectral index (BIS) value between 45 and 60, whereas
alfentanil dose was titrated according to the hemodynamic parameters.
Following neuromuscular monitoring and stabilization of response to the
neuromuscular stimulus, 0.1 mg/kg vecuronium was injected intravenously in
5 seconds. The responses to train of four (TOF) stimulation (TOF1 and
TOF2), posttetanic count (PTC), and TOF rate (TOFR) values were recorded.
The neuromuscular blockade was reversed after closure of surgical incision
and the fourth response to TOF during recovery. The residual block was
assessed in surgical intensive care unit for 30 minutes. <br/>Result(s):
Alfentanil amount used in the maintenance was significantly less in Group
1 compared to Group 2 (p<0.05), whereas there was no difference between
the groups for propofol and vecuronium doses (p>0.05). There was no
statistically significant difference between the groups with respect to
the onset time of vecuronium, TOF1 time following induction, and duration
of the clinical effects of vecuronium used for induction and maintenance
(p>0.05). <br/>Conclusion(s): It was demonstrated that epidural
bupivacaine decreased the requirement of alfentanil without alterations in
propofol and vecuronium doses in patients undergoing thoracic surgery in
our study. We also suggest that in the present dose, epidural bupivacaine
has no effect on duration, intensity, reversal or the characteristics of
residual block related to vecuronium-induced neuromuscular blockade.
&#xa9; 2013 by Turkiye Klinikleri.

<58>
Accession Number
369142732
Title
The efficacy of vitamin E in the prevention of lung ischemia-reperfusion
injury after cardiopulmonary bypass in open heart surgery.
Source
Turkiye Klinikleri Journal of Medical Sciences. 33 (3) (pp 777-784), 2013.
Date of Publication: 2013.
Author
Acipayam M.; Sunar H.; Canbaz S.; Huseyinova G.; Erbas H.; Erten O.; Duran
E.
Institution
(Acipayam) Department of Cardiovascular Surgery, Mustafa Kemal University,
Hatay, Turkey
(Sunar) Clinic of Cardiovascular Surgery, Kartal Kosuyolu Yuksek Ihtisas
Training and Research Hospital, Istanbul, Turkey
(Canbaz, Duran) Department of Cardiovascular Surgery, Trakya University,
Edirne, Turkey
(Huseyinova) Department of Pathology, Trakya University, Edirne, Turkey
(Erbas) Department of Biochemistry, Trakya University, Edirne, Turkey
(Erten) Clinic of Biochemistry, Uzunkopru State Hospital, Trabzon, Turkey
Publisher
Turkiye Klinikleri
Abstract
Objective: The purpose of the study was to investigate the effects of
vitamin E in the protection of the lung from potential
ischemia-reperfusion injury during elective coronary artery bypass graft
surgery. <br/>Material(s) and Method(s): This controlled randomized
single-center study included patients who underwent elective coronary
bypass grafting (CABG) operation. Forty-nine patients were randomly
divided into 2 groups. Water soluble Vitamin E (100 mg) in tepid saline
(n=25) or tepid saline alone (n=24) was administered via the jugular vein
before the aortic cross clamping. Serum total antioxidant capacity (TAC)
levels and serum malonedialdehyde levels (MDA) were measured. Pulmonary
biopsies were obtained before the aortic cross clamping and 60 minutes
after removing the cross clamp. Biopsies were examined histopathologically
under electron microscopy. <br/>Result(s): Serum MDA levels at T1 (15
minutes after removal of the cross clamp) and T2 (30 minutes after removal
of the cross clamp) were higher in the control group compared to the
Vitamin group. Serum TAC levels at T1, T2 and T3 (60 minutes after removal
of the cross clamp) were higher in the Vitamin E group compared to the
control group. Histopathologic injury grade was lower in the Vitamin E
group than in the control group. <br/>Conclusion(s): Vitamin E was found
to be protective against reperfusion induced oxidative injury in the early
operative period. &#xa9; 2013 by Turkiye Klinikleri.

<59>
Accession Number
364076944
Title
A Comparison of preprandial mixed insulin given three times daily and
basal-bolus insulin therapy started postoperatively on patients having
coronary artery bypass graft surgery.
Source
Marmara Medical Journal. 25 (1) (pp 16-19), 2012. Date of Publication:
2012.
Author
Yazici D.; Tas S.; Emir H.; Sunar H.
Institution
(Yazici) Sub-department of Endocrinology and Metabolism, Department of
Internal Medicine, School of Medicine, Marmara University, Istanbul,
Turkey
(Tas, Sunar) Cardiac and Vascular Surgery Clinic, Kartal Kosuyolu
Education and Research Hospital, Istanbul, Turkey
(Emir) Diabetes Education Nurse, Kartal Education and Research Hospital,
Istanbul, Turkey
Publisher
Marmara University
Abstract
Objective: Insulin therapy initiated after coronary artery bypass graft
(CABG) surgery has decreased long-term mortality. The aim was to compare
the effectiveness of prandial premixed therapy (PPT) using insulin thrice
daily and basal-bolus therapy (BBT) on patients having CABG surgery.
<br/>Patients and Methods: Thirty-four patients having CABG surgery were
included. Fasting blood glucose (FBG), postprandial blood glucose (PPBG),
hemoglobin A1c (HbA1c) and hemoglobin levels were determined
preoperatively and at the first week postoperatively when the patients
were randomized to either PPT or BBT. Initial measurements were repeated
at the end of three months. <br/>Result(s): Seventeen patients (F/M:9/8;
61.5+/-8.5 years) were assigned on a random basis to the mixed insulin arm
and 17 patients (F/M:10/7; 57.4+/-9.2 years) to the basal-bolus arm. FBG,
PPBG and HbA1c levels of both groups (7.6+/-0.8 % vs 6.7+/-0.5 % in the
BBT and 7.3+/-0.7 % vs 7.3+/-1.0 % in the PPT group) at the end of the 3
months were not different than at the time of randomization. The
percentage of patients reaching HbA1c levels below 6.0%, 6.5% and 7.0%
were higher in the BBT group compared to the PPT group.
<br/>Conclusion(s): For patients who had undergone CABG surgery, BBT
provided more patients with HbA1c levels below the target than did PPT.
&#xa9; Marmara Medical Journal, Published by Galenos Publishing.

<60>
Accession Number
50313684
Title
Comparison of the Sirolimus-Eluting Versus Paclitaxel-Eluting Coronary
Stent in Patients With Diabetes Mellitus: The Diabetes and Drug-Eluting
Stent (DiabeDES) Randomized Angiography Trial.
Source
American Journal of Cardiology. 103 (3) (pp 345-349), 2009. Date of
Publication: 01 Feb 2009.
Author
Maeng M.; Jensen L.O.; Galloe A.M.; Thayssen P.; Christiansen E.H.; Hansen
K.N.; Helqvist S.; Botker H.E.; Lassen J.F.; Thuesen L.
Institution
(Maeng, Christiansen, Botker, Lassen, Thuesen) Department of Cardiology,
Aarhus University Hospital, Skejby Hospital, Aarhus, Denmark
(Jensen, Thayssen, Hansen) Department of Cardiology, Odense University
Hospital, Odense, Denmark
(Galloe) Department of Cardiology, Gentofte Hospital, University of
Copenhagen, Gentofte, Denmark
(Helqvist) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
Publisher
Elsevier Inc.
Abstract
The aim of the present study was to evaluate angiographic late luminal
loss after the implantation of sirolimus-eluting Cypher stents and
paclitaxel-eluting Taxus stents in patients with diabetes. The study was a
Danish multicenter, open-label, randomized trial. One hundred fifty-three
patients with diabetes with coronary artery disease were randomized to
Cypher (n = 76) or Taxus (n = 77) stent implantation. All patients were
followed for 8 months. The primary end point was 8-month angiographic
in-stent late luminal loss. This primary end point was reduced in the
Cypher group compared with the Taxus group (0.23 +/- 0.54 vs 0.44 +/- 0.52
mm, p = 0.025). Angiographic in-segment restenosis at 8-month follow-up, a
secondary end point, was present in 16 patients (Cypher, n = 6; Taxus, n =
10; p = 0.24). Target lesion revascularization was performed in 5 patients
(6.5%) and 9 patients (11.8%) in the Cypher and Taxus groups, respectively
(p = 0.25). Definite stent thrombosis was observed in 2 patients (in the
Taxus group), no patients had probable stent thrombosis, and 1 patient in
each group had possible stent thrombosis. Major adverse cardiac events
(cardiac death, myocardial infarction, definite stent thrombosis, or
target lesion revascularization) were observed in 17 patients (Cypher, n =
6; Taxus, n = 11; p = 0.19). In conclusion, angiographic in-stent late
luminal loss is significantly reduced in patients with diabetes by use of
the sirolimus-eluting Cypher stent compared with the paclitaxel-eluting
Taxus stent. &#xa9; 2009 Elsevier Inc. All rights reserved.

<61>
Accession Number
2003489238
Title
Association of intra-operative hypotension with acute kidney injury,
myocardial injury and mortality in non-cardiac surgery: A meta-analysis.
Source
International Journal of Clinical Practice. 73 (10) (no pagination), 2019.
Article Number: e13394. Date of Publication: 01 Oct 2019.
Author
An R.; Pang Q.-Y.; Liu H.-L.
Institution
(An, Pang, Liu) Department of Anesthesiology, Chongqing University Cancer
Hospital/Chongqing Cancer Institute/Chongqing Cancer Center, Chongqing
City 400030, China
Publisher
Blackwell Publishing Ltd
Abstract
Background: Intra-operative hypotension might induce poor postoperative
outcomes in non-cardiac surgery, and the relationship between the level or
duration of Intra-operative hypotension (IOH) and postoperative adverse
events is still unclear. In this study, we performed a meta-analysis to
determine how IOH could affect acute kidney injury (AKI), myocardial
injury and mortality in non-cardiac surgery. <br/>Method(s): We searched
PubMed (Medline), Embase, Springer, The Cochrane Library, Ovid and Google
Scholar, and retrieved the related clinical trials on intra-operative
hypotension and prognosis in non-cardiac surgery. <br/>Result(s): Fifteen
observational studies were included. The meta-analysis showed that in
non-cardiac surgery, intra-operative hypotension (mean arterial pressure
[MAP]) <60 mm Hg for more than 1 minute was associated with an increased
risk of postoperative acute kidney injury(AKI) [1-5 minutes: odds ratio
(OR) = 1.13, 95% CI (1.04, 1.23), I² = 0, P =.003; 5-10
minutes: OR = 1.18, 95% CI (1.07, 1.31), I² = 0, P =.001; >10
minutes: OR = 1.35, 95% CI (1.1, 1.67), I² = 52.6%, P =.004]
and myocardial injury [1-5 minutes: OR = 1.16, 95% CI (1.01, 1.33),
I² = 30.6%, P =.04; 5-10 minutes: OR = 1.34, 95% CI (1.01,
1.77), I² = 70.4%, P =.046; >10 minutes: OR = 1.43, 95% CI
(1.18, 1.72), I² = 39.4%, P <.0001]. Intra-operative
hypotension (MAP < 60 mm Hg) for 1-5 minutes was not associated with
postoperative 30-day mortality [OR = 1.15, 95% CI (0.95, 1.4),
I² = 0, P =.154], but intra-operative hypotension (MAP < 60 mm
Hg) for more than 5 min was associated with an increased risk of
postoperative 30-day mortality [OR = 1.11, 95% CI (1.06, 1.17),
I² = 51.9%, P <.0001]. <br/>Conclusion(s): Intra-operative
hypotension was associated with an increased risk of postoperative AKI,
myocardial injury and 30-day mortality in non-cardiac surgery.
Intra-operative MAP < 60 mm Hg more than 1 minute should be
avoided.<br/>Copyright &#xa9; 2019 John Wiley & Sons Ltd

<62>
Accession Number
625288499
Title
Effects of a prolonged intervention of breathing exercises after cardiac
surgery - a randomised controlled trial.
Source
European Journal of Physiotherapy. 21 (4) (pp 233-239), 2019. Date of
Publication: 02 Oct 2019.
Author
Carlsson M.; Berthelsen O.; Fagevik Olsen M.
Institution
(Carlsson, Berthelsen, Fagevik Olsen) Department of Physical Therapy,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Carlsson, Fagevik Olsen) Department of Physiotherapy, Institute of
Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
Publisher
Taylor and Francis Ltd
Abstract
Objectives: To evaluate the effect of a prolonged intervention of
breathing exercises with Inspiratory Resistance Positive Expiratory
Pressure for one month after open cardiac surgery concerning lung
function, respiratory movements and postoperative pulmonary complications.
<br/>Method(s): A randomised controlled trial comparing the effect of
home-based breathing exercise after discharge from the hospital or stop at
discharge. Eighty patients were randomly assigned to an intervention group
or control group. Forced vital capacity, forced expiratory volume in the
first second, peak expiratory flow, respratory movements and saturation
were measured at discharge and after the intervention. At follow-up
self-reported pulmonary complications were also recorded. <br/>Result(s):
A significant increase in forced vital capacity (p =.04) was found in the
intervention group compared with the control group, and there were a
tendency towards significant differences also in forced expiratory volume
in the first second and saturation (p =.06). Respiratory movements
increased significantly after one month but there were no significant
differences between groups. None of the patients reported being treated
for pneumonia. <br/>Conclusion(s): A prolonged intervention of breathing
exercise for one month after open cardiac surgery significantly increases
forced vital capacity and may accelerate recovery after cardiac surgery.
Clinical registration number: FoU in Sweden no 76141.<br/>Copyright &#xa9;
2018, &#xa9; 2018 Informa UK Limited, trading as Taylor & Francis Group.

<63>
Accession Number
2003783543
Title
Distal transradial access for cardiac catheterization: A systematic
scoping review.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Coomes E.A.; Haghbayan H.; Cheema A.N.
Institution
(Coomes) Department of Medicine, University of Toronto, Toronto, ON,
Canada
(Haghbayan) Division of Cardiology, London Health Sciences Centre, Western
University, London, ON, Canada
(Haghbayan) Department of Social and Preventive Medicine, Universite
Laval, QC, Canada
(Cheema) Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto,
ON, Canada
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: Systematically review the literature for cardiac
catheterization and coronary angiography via distal transradial access
(dTRA) and its outcomes. <br/>Background(s): dTRA, via anatomical
snuffbox, may have several advantages over conventional transradial access
(cTRA) for percutaneous cardiac procedures, including easier left-sided
access for aorto-coronary grafts, future proximal radial artery
preservation, and patient and operator comfort. However, its procedural
characteristics and safety profile remain unclear. <br/>Method(s): Ovid
MEDLINE and EMBASE were searched from inception to September 2018. Two
authors independently performed two-stage selection and data extraction.
Reports assessing the dTRA approach for cardiac intervention in adults
reporting any outcomes were eligible. Descriptive summary statistics were
calculated from pooled data. <br/>Result(s): A total of 19 publications
comprising 4,212 participants undergoing dTRA were included. Mean age was
63.8 years, and 23.0% were female. dTRA was primarily undertaken for
assessment of stable coronary artery disease (87.6%), with 41.7% for
diagnostic procedures and 46.9% undergoing percutaneous coronary
intervention. The overall success rate for undertaking the dTRA approach
was 95.4% (69-100%). Complications occurred in 2.4% of cases, of which the
leading complications were bleeding/hematoma (18.2%). Complication rates
did not significantly differ between dTRA and cTRA. The occurrence of
radial artery occlusion in patients undergoing dTRA was low (1.7%).
<br/>Conclusion(s): Observational data demonstrate that dTRA is a safe and
feasible method for percutaneous cardiac procedures, with high rates of
procedural success and low rates of complication. As data comparing dTRA
with cTRA remain limited, future high-quality randomized comparative
studies are required.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.