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

<2>
Accession Number
2003557185
Title
The utility of traditional Chinese medicine (Shenmai) in the cardiac
rehabilitation after coronary artery bypass grafting: A single-center
randomized clinical trial.
Source
Complementary Therapies in Medicine. 47 (no pagination), 2019. Article
Number: 102203. Date of Publication: December 2019.
Author
Zhang C.; Zheng Y.; Chen T.; Wang S.; Xu M.
Institution
(Zhang, Wang, Xu) Department of Cardiovascular Surgery, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
(Zheng) The University of Pittsburgh School of Nursing, Pittsburgh, PA,
United States
(Chen) Department of Clinical Sciences, Liverpool School of Tropical
Medicines, Pembroke Pl, Liverpool L3 5QA, United Kingdom
Publisher
Churchill Livingstone
Abstract
Objective: examine the efficacy and safety of Shenmai to the cardiac
rehabilitation in patients received coronary artery bypass grafting.
 Design(s): a single-center randomized, single blind clinical trial.
 Setting(s): Department of Cardiovascular Surgery, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China. Subjects: Patients
with coronary artery disease who received coronary artery bypass grafting
in our center were studied. They must be competent to complete the
6-minute walking test without any assistance and without any severe
comorbidity. Intervention(s): in Shemmai group, the participants were
treated with Shenmai injection (100 ml/day) right after the surgery to
discharge for 9.28 +/- 3.75 days and then capsule (3.6 g/day) sequentially
for 30 days in addition to the cardiac rehabilitation. In control group,
only cardiac rehabilitation was conducted. Main measures: the 6-Minute
Walking Test was measured at three time points: one day before operation,
on the day of discharge and 30 days follow up. Result(s): The sample
(n = 166) was predominately male (84%), with mean age was 61.12 +/- 9.13
years. There was no significant difference between groups in baseline
characteristics and the procedural characteristics. There was one death in
control group and one stroke in Shenmai group right after the surgery.
Overall, there was group (p =.005) and time effect (p <.001) on the
6-minute walking distance. Participants in the Shenmai group walked longer
distance in meters compared with control group on the day of discharge
(314.54 +/- 64.14 vs. 271.29 +/- 76.82, P <.001), while no significant
differences before operation (399.72 +/- 93.19 vs. 403.67 +/- 91.99, p
=.78) and on 30-day follow up (436.54 +/- 67.64 vs. 421.64 +/- 83.53, p
=.21). Conclusion(s): Shenmai improves the exercise tolerance in the
early stage of the cardiac rehabilitation for patients received coronary
artery bypass grafting. Copyright © 2019 Elsevier Ltd

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

<4>
Accession Number
628374481
Title
Prognostic factors of mortality after surgery in infective endocarditis:
systematic review and meta-analysis.
Source
Infection. 47 (6) (pp 879-895), 2019. Date of Publication: 01 Dec 2019.
Author
Varela Barca L.; Navas Elorza E.; Fernandez-Hidalgo N.; Moya Mur J.L.;
Muriel Garcia A.; Fernandez-Felix B.M.; Miguelena Hycka J.; Rodriguez-Roda
J.; Lopez-Menendez J.
Institution
(Varela Barca, Miguelena Hycka, Rodriguez-Roda, Lopez-Menendez) Department
of Cardiovascular Surgery, University Hospital Ramon y Cajal, Ctra.
Colmenar Viejo, km. 9.100, Madrid 28034, Spain
(Navas Elorza) Department of Infectology, University Hospital Ramon y
Cajal, Madrid, Spain
(Fernandez-Hidalgo) Department of Infectious Diseases, University Hospital
Vall d'Hebron, Barcelona, Spain
(Moya Mur) Department of Cardiology, University Hospital Ramon y Cajal,
Madrid, Spain
(Muriel Garcia, Fernandez-Felix) Clinical Biostatistics Unit, Hospital
Ramon y Cajal (IRYCIS), Madrid, Spain
(Fernandez-Felix) CIBER Epidemiology and Public Health (CIBERESP), Madrid,
Spain
Publisher
Springer
Abstract
Purpose: There is a lack of consensus about which endocarditis-specific
preoperative characteristics have an actual impact over postoperative
mortality. Our objective was the identification and quantification of
these factors. Method(s): We performed a systematic review of all the
studies which reported factors related to in-hospital mortality after
surgery for acute infective endocarditis, conducted according to PRISMA
recommendations. A search string was constructed and applied on three
different databases. Two investigators independently reviewed the
retrieved references. Quality assessment was performed for identification
of potential biases. All the variables that were included in at least two
validated risk scores were meta-analyzed independently, and the pooled
estimates were expressed as odds ratios (OR) with their confidence
intervals (CI). Result(s): The final sample consisted on 16 studies,
comprising a total of 7484 patients. The overall pooled OR were
statistically significant (p < 0.05) for: age (OR 1.03, 95% CI 1.00-1.05),
female sex (OR 1.56, 95% CI 1.35-1.81), urgent or emergency surgery (OR
2.39 95% CI 1.91-3.00), previous cardiac surgery (OR 2.19, 95% CI
1.84-2.61), NYHA >= III (OR 1.84, 95% CI 1.33-2.55), cardiogenic shock (OR
4.15, 95% CI 3.06-5.64), prosthetic valve (OR 1.98, 95% CI 1.68-2.33),
multivalvular affection (OR 1.35, 95% CI 1.01-1.82), renal failure (OR
2.57, 95% CI 2.15-3.06), paravalvular abscess (OR 2.39, 95% CI 1.77-3.22)
and S. aureus infection (OR 2.27, 95% CI 1.89-2.73). Conclusion(s):
After a systematic review, we identified 11 preoperative factors related
to an increased postoperative mortality. The meta-analysis of each of
these factors showed a significant association with an increased
in-hospital mortality after surgery for active infective endocarditis.
Graphic abstract: Graph summary of the Pooled Odds Ratios of the 11
preoperative factors analyzed after the systematic review and
meta-analysis.[Figure not available: see fulltext.]. Copyright ©
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<5>
Accession Number
2002822517
Title
Endovascular Treatment versus Medical Therapy for Hypertensive Patients
with Renal Artery Stenosis: An Updated Systematic Review.
Source
Annals of Vascular Surgery. 61 (pp 445-454), 2019. Date of Publication:
November 2019.
Author
Piaggio D.; Bracale U.; Pecchia L.; Di Taranto M.D.; Sodo M.; Bracale U.M.
Institution
(Piaggio, Pecchia) Department of Engineering, University of Warwick,
Coventry, United Kingdom
(Bracale) Department of Gastroenterology, Endocrinology and Endoscopic
Surgery, University of Naples Federico II, Naples, Italy
(Di Taranto) Department of Molecular Medicine and Medical Biotechnology,
University of Naples Federico II, Naples, Italy
(Sodo) General Surgery Unit, Department of Public Health, University of
Naples Federico II, Naples, Italy
(Bracale) Vascular and Endovascular Surgery Unit, Department of Public
Health, University of Naples Federico II, Naples, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The benefit of balloon angioplasty, with or without stenting, for the
treatment of patients with renal artery stenosis remains controversial. A
number of randomized controlled trials have attempted to determine its
efficacy but the matter remains unclear. A 2014 Cochrane review, which
combined data from 8 trials, showed homogeneity among the trials with no
significant benefit shown. This systematic review replicates the same
research methods and meta-analysis while expanding it to include papers
between 2014 and 2018. One of the trials included in the previous review
published results in the interim. Additionally, 2 ongoing trials
identified in the 2014 review are yet to publish any result. Meta-analysis
of the reports showed no heterogeneity between trials and no significant
improvement shown by balloon angioplasty, with or without stenting, versus
medical therapy. Further studies are recommended in order to assess the
benefits of balloon angioplasty for patients with more severe renal artery
stenosis. Copyright © 2019 Elsevier Inc.

<6>
Accession Number
628862252
Title
A Systematic Review and Meta-Analysis of del Nido Versus Conventional
Cardioplegia in Adult Cardiac Surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 14 (5) (pp 385-393), 2019. Date of Publication: 01 Oct 2019.
Author
An K.R.; Rahman I.A.; Tam D.Y.; Ad N.; Verma S.; Fremes S.E.; Latter D.A.;
Yanagawa B.
Institution
(An, Rahman, Tam, Verma, Latter, Yanagawa) Division of Cardiac Surgery, Li
Ka Shing Knowledge Institute, St Michael's Hospital, University of
Toronto, ON, Canada
(Ad) Division of Cardiac Surgery, University of Maryland School of
Medicine, Baltimore, United States
(Fremes) Division of Cardiac Surgery, Department of Surgery, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto,
ON, Canada
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: Del Nido cardioplegia (DC) has been used extensively in
pediatric cardiac surgery but the efficacy and safety in adults remains
uncertain. Our objective was to perform a systematic review and
meta-analysis comparing DC and blood cardioplegia (BC) in our primary
endpoint of 30-day or in-hospital mortality as well as other efficacy and
safety endpoints. Method(s): Both MEDLINE and EMBASE were searched
from 1996 to 2017 for studies comparing DC and BC. Data were extracted by
2 independent investigators and aggregated in a random effects model.
 Result(s): One randomized controlled trial (n = 89), 7 adjusted (n =
1,104), and 5 unadjusted observational studies (n = 717) were included.
There was no difference in in-hospital mortality between DC and BC
(relative risk:0.67, 95% confidence interval [CI]: 0.22, 2.07; P = 0.49).
DC reduced cardioplegia volume requirements (mean difference [MD]:-1.1 L,
95% CI, -1.6, -0.6; P < 0.0001), aortic cross-clamp time (MD: -8 minutes,
95% CI, -12, -3; P = 0.0004), and cardiopulmonary bypass (CPB) times (MD:
-8 minutes, 95% CI, -14, -3; P = 0.03). DC reduced troponin release
(standardized MD: -0.3, 95% CI, -0.5, -0.1; P = 0.001). In-hospital
outcomes of stroke, atrial fibrillation, acute kidney injury/dialysis, low
cardiac output state, blood transfusion, reoperation rate, postoperative
left ventricular EF, intensive care unit length of stay (LOS), and
in-hospital LOS were comparable between groups. Conclusion(s): DC is
a safe alternative to BC in routine adult cardiac surgery. Its use is
associated with reduction in CPB and aortic cross-clamp times and may
potentially offer improved myocardial protection. Copyright © The
Author(s) 2019.

<7>
Accession Number
2003796907
Title
Prevalence of Ascending Thoracic Aortic Ectasies and Aneurysms Based Upon
Absolute and Individual Predicted Normal Aortic Size. A Substudy from the
Population-Based Randomized Dancavas Trial.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 31st Annual Meeting 2017. France. 58
(6 Supplement 1) (pp e72-e73), 2019. Date of Publication: December 2019.
Author
Obel L.M.; Diederichsen A.C.; Steffensen F.H.; Frost L.; Lambrechtsen J.;
Busk M.; Urbonaviciene G.; Egstrup K.; Bovling A.S.; Lindholt J.S.
Institution
(Obel, Diederichsen) Department of Cardiology, Odense University Hospital,
Elitary Research Centre CIMA, Odense, Denmark
(Steffensen, Busk) Department of Cardiology, Vejle Hospital, Vejle,
Denmark
(Frost, Urbonaviciene) Department of Cardiology, Diagnostic Centre,
Regional Hospital Silkeborg, Silkeborg, Denmark
(Lambrechtsen, Egstrup) Department of Cardiology, Odense University
Hospital, Svendborg, Denmark
(Bovling, Lindholt) Department of Cardiothoracic and Vascular Surgery,
Odense University Hospital, Elitary Research Centre CIMA, Odense, Denmark
Publisher
W.B. Saunders Ltd
Abstract
Introduction - During the planning of a large screening trial, a lack of a
clear definition of ascending thoracic aortic aneurysms (aTAA) in various
relevant guidelines was exposed. Normally, an aneurysm is defined as a
diameter at least 50% greater than the normal size of the artery, while a
25-49% increase is considered to be ectatic. (1) The healthy aorta is
usually considered not to exceed 40 mm in diameter. (2) The objectives of
this study were: To report the prevalence of aTAA and ectasies based upon
a uniform size cut-off point at 40 mm. To develop a prediction formula
that provides an individual reference value for the normal ascending
aortic size rather than a uniform cut-off value. To report the prevalence
of aTAA and ectasies based upon the individual predicted normal size.
Methods - Men and women aged 65-74 were randomized 1:2 without exclusion
criteria to participate in the Danish Cardiovascular Screening Trial,
DANCAVAS (n>10,000). (3) Participants had their weight and height measured
and underwent electrocardiography-gated noncontrast cardiac CT-scans. The
anterior-posterior ascending aortic size was measured at the initial
circular level above the sinotubular junction. Through multivariate linear
regression analysis based on age, gender and body surface area (BSA), a
formula that predicts the normal diameter of the ascending aorta was
developed. By dividing the observed diameter with the predicted diameter,
a size index was created. An index <1.25 was set to be normal, an index
>=1.25-1.49 as an ectatic aorta, and >=1.50 to be an aneurysm. Results -
The study population consists currently of 8354 participants (7613 male,
741 female) with an average of 69 years +/-3 years. The overall average
diameter of the ascending aorta was 37+/-4 mm (38 +/-4 vs. 34 +/-4 mm for
male and female, respectively, p<0.001). Age and BSA correlated
significantly with ascending aortic size (r=0.09 and r=0.31, respectively,
p<0.001). The prevalence of aTAA and ectasies based upon an absolute size
cut-off point at 40 mm was 24.3%, but only 4.1% based upon an index
>=1.25. Using this as the golden standard, the sensitivity and specificity
of using 40 mm as cut point for aTAA and ectasies were 100% and 79%,
respectively. The negative and positive predicted values were 100% and
16.7%, respectively. The prevalence of aTAA was 0.17% based upon an index
>=1.5. Using this as the golden standard, the sensitivity and specificity
of using 40 mm as cut point for aTAA was 100% and 76%, respectively. The
negative and positive predicted values were 100% and 0.7%, respectively.
(See image) Conclusion - Using individual reference value of aTAA and
ectasies, realistic prevalence were exposed. Using an absolute size
criterion of +40 mm, high sensitivities and specificities are possible,
but with 6-145 times as many false positives than true positives. Besides
causing over-diagnosing with psychological costs, it impairs cost
effectiveness of screening and surveillance programs. References 1.
Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC.
Suggested standards for reporting on arterial aneurysms. Subcommittee on
Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting
Standards, Society for Vascular Surgery and North American Chapter,
International Society for Cardiovascular Surgery. Journal of vascular
surgery. 1991;13(3):452-8. 2. Erbel R, Aboyans V, Boileau C, Bossone E, Di
Bartolomeo R, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis
and treatment of aortic diseases. Eur Heart J. 2014;35(41):2873-U93. 3.
Diederichsen AC, Rasmussen LM, Sogaard R, Lambrechtsen J, Steffensen FH,
Frost L, et al. The Danish Cardiovascular Screening Trial (DANCAVAS):
study protocol for a randomized controlled trial. Trials. 2015;16:554.
[Formula presented] Copyright © 2019

<8>
Accession Number
2003796853
Title
Radiation Dosage for Percutaneous PAD Treatment is Different in
Cardiovascular Disciplines: Results from an Eleven Year Population Based
Registry in the Metropolitan Area of Hamburg.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 31st Annual Meeting 2017. France. 58
(6 Supplement 1) (pp e41-e42), 2019. Date of Publication: December 2019.
Author
Behrendt C.-A.; Riess H.C.; Heidemann F.; Debus E.S.
Institution
(Behrendt, Ries, Heidemann, Debus) Department of Vascular Medicine,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Publisher
W.B. Saunders Ltd
Abstract
Introduction - The worldwide prevalence of peripheral artery disease (PAD)
has evolved to an intervention as the primary treatment option and
therefore radiation is used with escalating incidence. Dose area product
(DAP) correlates well with the total energy imparted to the patient during
fluoroscopic interventions. This study aims to determine whether there are
any associations among stage of disease, gender, age, and expertise on the
radiation dose in single endovascular treatments of PAD. Methods - This
study was a prospective, mandatory, population based cross-sectional
registry design. In total, 24,000 invasive percutaneous endovascular
treatments of PAD conducted in the metropolitan area of Hamburg (Germany)
were consecutively collected between January 2004 and December 2015. DAP
was analysed by discipline conducting the procedure, Fontaine
classification, patient gender, and age. Results - Statistically
significant differences in median DAP values were found. The lowest median
DAP values were observed in surgical centres (7.1 vs. 18.0 Gy*cm2, p<.001)
and in endovascular revascularisations (ER) following multidisciplinary
consultation (11.6 vs. 23.4 Gy*cm2, p<.001). Considering the treatment of
intermittent claudication, men had statistically significantly higher DAP
values compared with women. Furthermore, lower median DAP values were
observed in higher age groups, with lowest dosages in octogenarians.
[Formula presented] Conclusion - This is the first large population based
study on DAP during ER for PAD. Several significant differences in median
DAP values were observed, although patient stratification was comparable.
Pre-operative therapy strategy planning can lead to lower DAP values,
emphasising the importance of further vascular research and quality
improvement projects targeting this topic. To date, available evidence is
limited and therefore there is no accepted range of DAP levels. However,
the ever increasing use of fluoroscopic interventions means that further
investigation into radiation exposure to patients and healthcare
professionals is required in order to keep DAP levels low. References 1.
Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al.
Comparison of global estimates of prevalence and risk factors for
peripheral artery disease in 2000 and 2010: a systematic review and
analysis. Lancet. 2013;382(9901):1329-40. 2. Malyar N, Furstenberg T,
Wellmann J, Meyborg M, Luders F, Gebauer K, et al. Recent trends in
morbidity and in-hospital outcomes of in-patients with peripheral arterial
disease: a nationwide population-based analysis. European heart journal.
2013;34(34):2706-14. 3. DeStatis SB. Krankenhausdiagnosestatistik URL:
https://www.gbe-bund.de/: Statistisches Bundesamt DeStatis; 2014
[Gesundheitsberichterstattung des Bundes]. 4. Wagner LK, Eifel PJ, Geise
RA. Potential biological effects following high X-ray dose interventional
procedures. Journal of vascular and interventional radiology : JVIR.
1994;5(1):71-84. 5. The 2007 Recommendations of the International
Commission on Radiological Protection. ICRP publication 103. Ann ICRP.
2007;37(2-4):1-332. 6. Carlsson C. Determination of Integral Absorbed Dose
from Exposure Measurements. Acta Radiol Ther Phys Biol. 1963;1:433-58. 7.
Carlsson GA, Carlsson CA. Quantities and concepts used in radiation
dosimetry. The International Journal of Applied Radiation and Isotopes.
1982;33(11):953-65. 8. Wise KN, Sandborg M, Persliden J, Carlsson GA.
Sensitivity of coefficients for converting entrance surface dose and
kerma-area product to effective dose and energy imparted to the patient.
Physics in medicine and biology. 1999;44(8):1937-54. 9. Spira D, Kirchner
S, Blumenstock G, Herz K, Ketelsen D, Wiskirchen J, et al. Therapeutic
angiographic procedures: differences in dose area product between analog
image intensifier and digital flat panel detector. Acta radiologica.
2016;57(5):587-94. 10. Kocinaj D, Cioppa A, Ambrosini G, Tesorio T,
Salemme L, Sorropago G, et al. Radiation dose exposure during cardiac and
peripheral arteries catheterisation. International journal of cardiology.
2006;113(2):283-4. 11. Behrendt CA, Heidemann F, Haustein K, Grundmann RT,
Debus ES. Perkutane endovaskulare Therapie der infrainguinalen PAVK.
Gefasschirurgie. 2016:1-11. 12. Simpson EL, Michaels JA, Thomas SM,
Cantrell AJ. Systematic review and meta-analysis of additional
technologies to enhance angioplasty for infrainguinal peripheral arterial
occlusive disease. Br J Surg. 2013;100(9):1128-37. 13. Pancholy SB, Joshi
P, Shah S, Rao SV, Bertrand OF, Patel TM. Effect of Vascular Access Site
Choice on Radiation Exposure During Coronary Angiography: The REVERE Trial
(Randomized Evaluation of Vascular Entry Site and Radiation Exposure).
JACC Cardiovascular interventions. 2015;8(9):1189-96. 14. Meijer WT, Hoes
AW, Rutgers D, Bots ML, Hofman A, Grobbee DE. Peripheral arterial disease
in the elderly: The Rotterdam Study. Arterioscler Thromb Vasc Biol.
1998;18(2):185-92. 15. Murabito JM, Evans JC, Nieto K, Larson MG, Levy D,
Wilson PW. Prevalence and clinical correlates of peripheral arterial
disease in the Framingham Offspring Study. American heart journal.
2002;143(6):961-5. 16. Hansson B, Karambatsakidou A. Relationships Between
Entrance Skin Dose, Effective Dose and Dose Area Product for Patients in
Diagnostic and Interventional Cardiac Procedures. Radiation protection
dosimetry. 2000;90(1-2):141-4. 17. Berrington de Gonzalez A, Darby S. Risk
of cancer from diagnostic X-rays: estimates for the UK and 14 other
countries. Lancet. 2004;363(9406):345-51. 18. Kullo IJ, Rooke TW. CLINICAL
PRACTICE. Peripheral Artery Disease. N Engl J Med. 2016;374(9):861-71. 19.
Ebrahimi R, Uberoi A, Treadwell M, Sadrzadeh Rafie AH. Effect of Low-Frame
Invasive Coronary Angiography on Radiation and Image Quality. The American
journal of cardiology. 2016;118(2):195-7. Copyright © 2019

<9>
Accession Number
2003796801
Title
Left Subclavian Artery Revascularization for Thoracic Aortic
Stentgrafting: Single Center Experience in 101 Patients.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 31st Annual Meeting 2017. France. 58
(6 Supplement 1) (pp e76-e77), 2019. Date of Publication: December 2019.
Author
Van Der Weijde E.; Saouti N.; Bakker O.J.; Heijmen R.H.
Institution
(Van Der Weijde, Saouti, Heijmen) Cardiothoracic surgery, St Antonius
Hospital, Nieuwegein, Netherlands
(Bakker) Vascular & Endovascular Surgery, University Medical Centre
Utrecht, Utrecht, Netherlands
Publisher
W.B. Saunders Ltd
Abstract
Introduction - Endovascular treatment of thoracic aortic pathology (TEVAR)
requires a landing zone of at least 20mm in length, necessitating coverage
of the left subclavian artery (LSA) in approximately 40% of the
patients.1 Coverage of the LSA may increase the risk of
ischaemic stroke, spinal cord ischaemia (SCI) and/or left arm
claudication. Besides some endovascular options to preserve LSA flow, in
the majority of cases the LSA is surgically revascularized by either a
carotid-to-subclavian bypass graft or subclavian-carotid transposition. A
relatively safe option, which has been shown to decrease the risk of
stroke compared to LSA coverage without revascularization.2,3
Conflicting data and opinions exist in literature on the (additional) risk
of surgical LSA revascularization (requiring temporary occlusion of the
left common carotid artery (LCCA) for the anastomosis).4,5,6 In
this study, we retrospectively analysed the indications, as well as the
operative results of LSA revascularization in 97 patients, in our single
centre TEVAR experience. Methods - Between 2000 and 2017, a total of 101
consecutive patients underwent surgical revascularization of the LSA prior
to, concomitant, or following TEVAR. Data were retrospective collected.
Revascularization was performed through a small supraclavicular incision
and consisted of a transposition or bypass graft, using perioperative
transcranial Doppler. Data regarding the indication for LSA
revascularization, procedural details and early and late postoperative
results were analysed. Results - A total of 64 carotid-subclavian bypass
grafts and 33 subclavian-carotid transpositions were performed in the
context of TEVAR. The majority was performed prior to stentgrafting,
indicated to reduce the risk of stroke (n=58, incomplete Willis' circle,
dominant left vertebral artery (LVA) and/or exclusion of an arteria
lusoria), to reduce the risk of SCI (n=18, in case of previous aortic
repair, and/or stenting the entire descending aorta) or to reduce the risk
of left arm malperfusion (n=8, small or absent LVA or LVA originating from
the aortic arch). In two patients there was a patent left internal mammary
artery to coronary artery bypass graft. In fourteen patients LSA
revascularization was performed secondary to the stentgraft procedure,
either immediately due to acute left arm malperfusion (n=2) or during
follow-up due to invalidating left arm claudication (n=12). There was no
in-hospital mortality, two ischaemic strokes (2%) were noted and one
patient experienced permanent SCI (1%). Both strokes were considered to be
related to the stentgraft procedure rather than the preceding LSA bypass.
Additional complications observed were sympathetic chain nerve palsy
(Horner's syndrome) (n=6), phrenic nerve palsy (n=5), recurrent nerve
palsy (n=4), chyle leakage requiring diet or re-exploration (n=6). In one
patient, the LSA bypass occluded during follow-up requiring a redo
surgical bypass. [Formula presented] Conclusion - Selective surgical
revascularization of the left subclavian artery in case of LSA coverage in
TEVAR may be indicated to lower the risk of stroke, spinal cord ischaemia,
and left arm malperfusion. The procedure can be performed safely when
using perioperative monitoring and result in a low risk of stroke and
peripheral nerve injury. References 1) Kotelis D, Geisbusch P, Hinz U,
Hyhlik-Durr A, von Tengg-Kobligk H, Allenberg JR, Bockler D. Short and
midterm results after left subclavian artery coverage during endovascular
repair of the thoracic aorta. J Vasc Surg. 2009 Dec;50(6):1285-1292. 2)
Patterson BO, Holt PJ, Nienaber C, Fairman RM, Heijmen RH, Thompson MM.
Management of the left subclavian artery and neurologic complications
after thoracic endovascular aortic repair. J Vasc Surg 2014;60:1491-1497.
3) Saouti N, Hindori V, Morshuis WJ, et al. Left subclavian artery
revascularization as part of thoracic stent grafting. Eur J Cardiothorac
Surg. 2015 Jan;47(1):120-125; discussion 125. 4) Maldonado TS, Dexter D,
Rockman CB, Veith FJ, Garg K, Arko F, Bertoni H, Ellozy S, Jordan W, Woo
E. Left subclavian artery coverage during thoracic endovascular aortic
aneurysm repair does not mandate revascularization. J Vasc Surg. 2013
Jan;57(1):116-124. 5) Cooper DG, Walsh SR, Sadat U, Noorani A, Hayes PD,
Boyle JR. Neurological complications after left subclavian artery coverage
during thoracic endovascular aortic repair: a systematic review and
meta-analysis. J Vasc Surg. 2009 Jun;49(6):1594-1601. 6) Contrella BN,
Sabri SS, Tracci MC, Stone JR, Kern JA, Upchurch GR, Matsumoto AH, Angle
JF. Outcomes of Coverage of the Left Subclavian Artery during Endovascular
Repair of the Thoracic Aorta. J Vasc Interv Radiol. 2015
Nov;26(11):1609-1614. Copyright © 2019

<10>
Accession Number
2003796694
Title
Conservative Treatment of Thrombosed Type Acute Aortic Dissection
Involving the Ascending Aorta Successfully Leads to Remodeling.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 31st Annual Meeting 2017. France. 58
(6 Supplement 1) (pp e129-e130), 2019. Date of Publication: December 2019.
Author
Bromfield-Jansen E.; Jongkind V.; Lelij R.; Wisselink W.
Institution
(Bromfield-Jansen, Jongkind, Wisselink) Surgery, Vrije Universiteit
Medical Center, Amsterdam, Netherlands
(Lelij) Radiology, Vrije Universiteit Medical Center, Amsterdam,
Netherlands
Publisher
W.B. Saunders Ltd
Abstract
Introduction - The preferred treatment for non-thrombosed acute aortic
dissection of the ascending aorta is surgical intervention [1-3]. For
thrombosed type dissection of the ascending aorta best treatment remains
debatable. Studies from Asia have recently shown medical treatment to be a
reasonable alternative for this specific subgroup [4-8]. Absence of an
intimal tear is thought to be important for a safe conservative treatment
strategy. In this case report we present a patient with acute aortic
dissection Stanford type A with an entry tear and thrombosis of the false
lumen of the ascending aorta who was managed with conservative treatment.
Methods - A 69-year-old white female was referred to our center with acute
onset of upper abdominal and back pain. She was hemodynamically stable
with no signs of shock. The patient had multiple peripheral vascular
bypasses in the year before admission and an aortic tube graft seven years
earlier for an infrarenal inflammatory aneurysm. Computer tomography
angiography (CTA) showed a circular intramural hematoma (maximum diameter
5mm) from the aortic root to the proximal descending aorta where a
penetrating atherosclerotic ulceration was visible 7 cm from the origin of
the left subclavian artery with asymmetric intramural hematoma blood pools
in the descending aorta. There was no sign of pleural effusion,
pericardial effusion, or organ ischemia. The echocardiogram showed good
left ventricular function without aortic valve regurgitation and a
moderately dilated ascending aorta to 4.2 cm with a thickened wall. The
combination of an entry tear distal from the left subclavian artery and
intramural hematoma of the ascending aorta provided a treatment dilemma,
since it is difficult to treat both lesions using a single approach. The
upper abdominal and back pain had subsided at presentation to our center
and the patient was clinically stable; therefore we opted for a
conservative approach with close observation. The patient was admitted to
the intensive care unit and antihypertensive therapy aimed at maximum
systolic pressure of 100 mmHg was initiated, with re-evaluation multiple
times every shift. Follow up CTAs were performed on days 2, 3, 10, 14, 21
and 28. During her hospital stay, the patient occasionally experienced
mild pain, which responded well to medication. With systolic blood
pressures of 130mmHg, on day 10 the intramural hematoma (IMH) in the
ascending aorta had grown to 10mm. With tighter blood pressure control the
IMH decreased and no further progression in hematoma thickness or aortic
diameter was observed on subsequent CTA scans. Progression of the
intramural blood pools in the descending aorta was treated conservatively.
Follow up 4 weeks after discharge (day 59) showed remodeling of the
ascending aorta with persistent blood pools in the descending aorta and
only minimal further dilatation. Results - CT-angiogram on day 10 (left)
vs day 59 (right) showing resolution of the intramural hematoma and
remodeling of the ascending aorta. [Formula presented] Conclusion -
Dissection involving the ascending aorta is a life-threatening condition
for which operative treatment is recommended in most cases. In thrombosed
dissection, conservative therapy with close observation and willingness to
convert to immediate surgery may be considered. This approach can lead to
complete remodeling of the ascending aorta. References 1. Mussa, F.,
Horton, J., Moridzadeah R. et al. Acute aortic dissection and intramural
hematoma: a systematic review. JAMA. 2016;316(7):754-763. 2. Attia, R.,
Young, C., Fallouh, H. et al. In patients with acute aortic intramural
haematoma is open surgical repair superior to conservative management?
Interactive CardioVascular and Thoracic Surgery 9 (2009) 868-871. 3. Ando,
T., Kobayashi, T., Endo, H. et al. Surgical treatment or conservative
therapy for Stanford type A acute aortic dissection with a thrombosed
false lumen. Ann Vas Dis Vol. 5, No. 4; 2012; 428-434. 4. Kitai, T., Kaji,
S., Yamamuro, A. et al. Clinical outcomes of medical therapy and timely
operation in initially diagnosed type A aortic intramural hematoma: a 20
year experience. Circulation. 2009;120[suppl 1]:S292-S298. 5. Sawaki, S.,
Hirate, Y., Ashida, S. et al. Clinical outcomes of medical treatment of
acute type A intramural hematoma. Asian CardioVasc Thorac Ann
2010;18:354-9. 6. Choi, Y., Son, J., Lee, S. et al. Treatment patterns and
their outcomes of acute aortic intramural hematoma in real world:
multicenter registry for aortic intramural hematoma. BMC Cardiovascular
Disorders 2014, 14:103. 7. Kan, C., Chang, R. and Chang, J. Optimal
initial treatment and clinical outcome of type A aortic intramural
hematoma: a clinical review. European Journal of Cardio-thoracic Surgery
33 (2008) 1002-1006. 8. Uzuka, T., Ito, T., Hagiwara, T. et al. A
treatment strategy for early thrombosed Stanford type A acute aortic
dissection. Gen Thorac Cardiovasc Surg (2013) 61:84-88. Copyright
© 2019

<11>
Accession Number
2003796659
Title
Relative Aortic Size and its Consequences of a Population-Based Prevalence
of Abdominal Aortic Aneurysms - A Substudy from the Randomized Dancavas
Trial.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 31st Annual Meeting 2017. France. 58
(6 Supplement 1) (pp e145), 2019. Date of Publication: December 2019.
Author
Bovling A.S.; Diederichsen A.; Steffensen F.H.; Lambrechtsen J.; Frost L.;
Busk M.; Urbonaviciene G.; Egstrup K.; Obel L.M.; Lindholt J.S.
Institution
(Bovling, Lindholt) Cardiothoracic and Vascular Surgery, Denmark
(Diederichsen, Obel) Department of Cardiology, University Hospital of
Odense, Odense C, Denmark
(Steffensen, Busk) Department of Cardiology, Vejle Hospital, Vejle,
Denmark
(Lambrechtsen, Egstrup) Department of Cardiology, Svendborg, University
Hospital of Odense, Svendborg, Denmark
(Frost, Urbonaviciene) Department of Cardiology, Diagnostic Center,
Regional Hospital Silkeborg, Silkeborg, Denmark
Publisher
W.B. Saunders Ltd
Abstract
Introduction - Absolute cut-off measurement of the abdominal aorta
anterior-posterior (AP) diameter is used for clinical decision making
regarding abdominal aorta aneurysm (AAA) regardless of body size. (1)
Purpose - To predict the individual normal aortic diameter based upon age
and body surface area (BSA), and then describe the consequences in those
detected positive, with either an ectatic aorta, AAA or an AAA where
surgery was advised, or negative by screening. (2, 3) Methods - Men aged
65-74 were randomized 1:2 to screening or being control in the ongoing
DANCAVAS trial (4). In 7 612 males, mean age 69.5 years (+/- 2.6 years), a
non-contrast-enhanced CT scan (nCT) was performed and information
regarding weight and height was collected. Through multivariate linear
regression analysis based on age, BSA and non-aneurysmal aortas
(nCT-diameter < 25mm), the predicted normal aortic diameter was
calculated. By dividing the observed diameter with the predicted diameter
an index, relative to age and size were created, the relative size index
(RSI). An index <1.25 was set to be normal, an index >1.25 and <1.50 set
to an ectatic aorta, an index 31.50 set to an AAA (4) and an index 32.75
as limit for advised surgery as the absolute cut point is 55 mm, and mean
size is 20 mm (55/20=2.75). Results - Mean aortic AP was 20.8 mm
(+/-5.2mm). The prevalence of ectatic aortas is 5.7% and 6.4% (p= 0.0701)
for CT and RSI, respectively. Regarding AAA, the prevalence is 4.3% and
4.6% (p= 0.3694) for CT and RSI, respectively. Finally regarding when
surgery is advised in the group of AAAs greater than 30mm, the prevalence
is 7.1% and 8.3% (p= 0.5658) for CT and RSI, respectively. Age and BSA
both correlated significantly with the aortic AP diameter, r= 0.064 and r=
0.22, respectively, p< 0.001. Equation - CT Predicted infrarenal AP aorta
diameter = 9.70 + age * 0.048 + BSA * 3.18 When the RSI>1.25 is used as
golden standard, the sensitivity and specificity of the absolute
measurements are 89.0% and 99.7%, respectively. The positive predicted
value (PPV) and negative predicted value (NPV) are 97.6% and 98.7%,
respectively. Using the RSI>1.50 as golden standard for AAA's, the
sensitivity and specificity of the absolute clinical cut-off value of
30mm, is 92.8% and 99.9%, respectively. The PPV and NPV is 99.1% and
99.7%, respectively. Finally, when using the RSI>2.75 as the golden
standard for when surgery is advised, and when only AAA greater than 30mm
are evaluated, the sensitivity and specificity of the absolute clinical
cut-off value of 55mm is 81.5% and 99.7%, respectively. The PPV and NPV is
95.6% and 98.4%, respectively. Conclusion - It doesn't seem to have a
great influence on either the diagnosis of AAA's, if the patient is
evaluated regarding absolute measurements or RSI. The greatest impact of
using RSI, if any, seems to be regarding when to advise surgery, even
though it's not significant. References 1. Erbel R, Aboyans V, Boileau C,
Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the
diagnosis and treatment of aortic diseases: Document covering acute and
chronic aortic diseases of the thoracic and abdominal aorta of the adult.
The Task Force for the Diagnosis and Treatment of Aortic Diseases of the
European Society of Cardiology (ESC). European heart journal.
2014;35(41):2873-926. 2. Lin FY, Devereux RB, Roman MJ, Meng J, Jow VM,
Jacobs A, et al. Assessment of the thoracic aorta by multidetector
computed tomography: age- and sex-specific reference values in adults
without evident cardiovascular disease. Journal of cardiovascular computed
tomography. 2008;2(5):298-308. 3. Wolak A, Gransar H, Thomson LE, Friedman
JD, Hachamovitch R, Gutstein A, et al. Aortic size assessment by
noncontrast cardiac computed tomography: normal limits by age, gender, and
body surface area. JACC Cardiovascular imaging. 2008;1(2):200-9. 4.
Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC.
Suggested standards for reporting on arterial aneurysms. Subcommittee on
Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting
Standards, Society for Vascular Surgery and North American Chapter,
International Society for Cardiovascular Surgery. Journal of vascular
surgery. 1991;13(3):452-8. Copyright © 2019

<12>
Accession Number
630015768
Title
Meta-Analysis of Transcatheter Aortic Valve Implantation Versus Surgical
Aortic Valve Replacement in Patients With Low Surgical Risk.
Source
The American journal of cardiology. (no pagination), 2019. Date of
Publication: 08 Nov 2019.
Author
Vipparthy S.C.; Ravi V.; Avula S.; Kambhatla S.; Mahmood M.; Kabour A.;
Ali S.S.; Barzallo M.; Mungee S.
Institution
(Vipparthy) OSF St. Francis Medical Center, Peoria, IL, United States
(Ravi) Rush University Medical Center, Chicago, IL, Mexico
(Avula, Mahmood, Kabour, Ali) Mercy St Vincent Medical Center, Toledo,
Ohio
(Kambhatla) John H Stroger Jr. Hospital of Cook County, Chicago, IL,
Mexico
(Barzallo, Mungee) OSF St. Francis Medical Center, Peoria, IL, United
States
Publisher
NLM (Medline)
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. Copyright © 2019
Elsevier Inc. All rights reserved.

<13>
Accession Number
630012192
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 : official journal of the
Society for Cardiac Angiography & Interventions. (no pagination), 2019.
Date of Publication: 29 Nov 2019.
Author
Mangels D.; Penny W.; Reeves R.
Institution
(Mangels, Reeves) Department of Cardiovascular Medicine, University of
California, San Diego, CA, Mexico
(Penny) Division of Cardiovascular Medicine, VA Medical Center, University
of California, San Diego, CA, Mexico
Publisher
NLM (Medline)
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. BACKGROUND: 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. METHOD(S): A review
of literature and available data including case reports, case series, and
investigational studies was performed. 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. 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. Copyright ©
2019 Wiley Periodicals, Inc.

<14>
Accession Number
630010829
Title
Meta-Analysis Comparing Results of Transcatheter Versus Surgical
Aortic-Valve Replacement in Patients With Severe Aortic Stenosis.
Source
The American journal of cardiology. (no pagination), 2019. Date of
Publication: 07 Nov 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) 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
(Xu) Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing
University School of Medicine, Nanjing, China
Publisher
NLM (Medline)
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. Copyright © 2019 Elsevier Inc. All rights reserved.

<15>
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. 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. 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. 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%).
 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. Copyright © 2019 Wiley Periodicals, Inc.

<16>
Accession Number
2002159992
Title
Left lateral intercostal region versus subxiphoid position for pleural
drain during elective coronary artery bypass graft surgery: Randomized
clinical trial.
Source
Sao Paulo Medical Journal. 137 (1) (pp 66-74), 2019. Date of Publication:
January-February 2019.
Author
Simon S.; Coronel C.; de Almeida A.S.; Marcadenti A.
Institution
(Simon) Instituto de Cardiologia, Fundacao Universitaria de Cardiologia
(IC/FUC), Porto Alegre, RS, Brazil
(Simon) Cardiology and Cardiac Surgery Services, Hospital Nossa Senhora da
Conceicao Hospital (HNSC), Porto Alegre, RS, Brazil
(Coronel) Instituto de CardiologiaFundacao, Universitaria de Cardiologia
(IC/ FUC), Porto Alegre, RS, Brazil
(Coronel) La Salle University (Unilasalle Canoas), Canoas, RS, Brazil
(de Almeida) Hospital Nossa Senhora da Conceicao Hospital (HNSC), Porto
Alegre, RS, Brazil
(Marcadenti) Instituto de Cardiologia, Fundacao Universitaria de
Cardiologia (IC/ FUC), Porto Alegre, RS, Brazil
(Marcadenti) Universidade Federal de Ciencias da Saude de Porto Alegre
(UFCSPA), Porto Alegre, RS, Brazil
(Marcadenti) Instituto de Pesquisa do Hospital do Coracao (HCor), Sao
Paulo, SP, Brazil
Publisher
Associacao Paulista de Medicina (E-mail: revistas@apm.org.br)
Abstract
BACKGROUND: The pleural drain insertion site after coronary artery bypass
graft (CABG) surgery may alter lung function, especially respiratory
muscle strength. The main objective of this study was to compare the
effectiveness and safety of use of the left lateral intercostal region
versus the subxiphoid position for pleural drainage during elective CABG
surgery using extracorporeal circulation (ECC). DESIGN AND SETTING:
Randomized trial conducted in a tertiary-level hospital in Porto Alegre,
Brazil. METHOD(S): 48 patients were assigned to group 1 (pleural
drain in the left lateral intercostal region) or group 2 (pleural drain in
the subxiphoid position). Respiratory muscle strength was measured in
terms of maximal inspiratory pressure (MIP) and maximal expiratory
pressure (MEP), in cmH2O, by means of manovacuometry preoperatively, 24
and 72 hours after drain removal and before discharge from hospital. Pain
and dyspnea scales, presence of infections, pleural effusion and
atelectasis, duration of drain use, drainage volumes and surgical
reinterventions were also evaluated. RESULT(S): After adjustments,
there were no significant differences between the groups at the end of the
study (before discharge), in predicted percentages either for MIP (delta
group 1: -17.21% versus delta group 2: -22.26%; P = 0.09) or for MEP
(delta group 1: -9.38% versus delta group 2: -13.13%; P = 0.17). There
were no differences between the groups in relation to other outcomes.
 CONCLUSION(S): There was no difference in maximal respiratory
pressures in relation to the pleural drain insertion site among patients
who underwent CABG surgery using ECC. TRIAL REGISTRATION: ReBEc
V1111.1159.4447. Copyright © 2019 by Associacao Paulista de
Medicina.

<17>
Accession Number
2002984801
Title
Meta-analysis Comparing Multivessel Versus Culprit Coronary Arterial
Revascularization for Patients With Non-ST-Segment Elevation Acute
Coronary Syndromes.
Source
American Journal of Cardiology. 124 (10) (pp 1501-1511), 2019. Date of
Publication: 15 November 2019.
Author
Siebert V.R.; Borgaonkar S.; Jia X.; Nguyen H.L.; Birnbaum Y.; Lakkis
N.M.; Alam M.
Institution
(Siebert, Nguyen) Department of Medicine, Baylor College of Medicine,
Houston, TX, United States
(Borgaonkar, Jia, Birnbaum, Lakkis, Alam) Department of Medicine, Section
of Cardiology, Baylor College of Medicine, Houston, TX, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We present a systematic review and meta-analysis comparing efficacy and
safety outcomes between single procedure multivessel revascularization
(MVR) and culprit vessel only revascularization in patients presenting
with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). NSTE-ACS
is the most common form of acute coronary syndrome (ACS), and multivessel
disease is common. There is no consensus on the most efficacious single
procedure revascularization strategy for patients undergoing percutaneous
coronary intervention not meeting coronary artery bypass grafting
criteria. Studies in PubMed and EMBASE databases were systematically
reviewed, and 15 studies met criteria for inclusion in the meta-analysis.
Baseline characteristics between the groups were similar. A random effects
model was used to calculate odds ratios (OR) with 95% confidence intervals
(CI). Heterogeneity of studies was assessed using Cochrane's Q and Higgins
I2 tests. For short-term outcomes, patients who underwent MVR
had higher rates of major adverse cardiac events (OR 1.14; 95% CI 1.01 to
1.29; p = 0.03); and stroke (OR 1.94; 95% CI 1.01 to 3.72; p = 0.05), but
lower rates of urgent or emergent coronary artery bypass grafting (OR
0.35; 95% CI 0.29 to 0.43; p <0.00001). In the long-term, MVR patients had
less frequent major adverse cardiac events (OR 0.76; 95% CI 0.61-0.93; p =
0.009), all-cause death (OR 0.83; 95% CI 0.71 to 0.97; p = 0.03), and
repeat revascularization, (OR 0.62; 95% CI 0.42 to 0.90; p = 0.01). MVR
following NSTE-ACS was associated with higher short-term risk, but
long-term benefit. In conclusion, these results support the use of single
procedure multivessel revascularization for NSTE-ACS patients who are
suitable candidates at the time of percutaneous coronary
intervention. Copyright © 2019 Elsevier Inc.

<18>
Accession Number
2003253536
Title
Comparison effect of tranexamic acid (TA) and tranexamic acid combined
with vitamin C (TXC) on drainage volume and atrial fibrillation arrhythmia
in patients undergoing cardiac bypass surgery: Randomized clinical trial.
Source
Anesthesiology and Pain Medicine. 9 (5) (no pagination), 2019. Article
Number: e96096. Date of Publication: 2019.
Author
Ghorbaninezhad K.; Bakhsha F.; Yousefi Z.; Halakou S.; Mehrbakhsh Z.
Institution
(Ghorbaninezhad) Department of Anesthesia, Golestan University of Medical
Sciences, Gorgan, Iran, Islamic Republic of
(Bakhsha, Yousefi, Halakou) Department of Paramedical School, Golestan
University of Medical Sciences, Gorgan, Iran, Islamic Republic of
(Mehrbakhsh) Department of Biostatistics, Faculty of Healt, Golestan
University of Medical Sciences, Gorgan, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: editor@anesthpain.com)
Abstract
Background: Tranexamic acid and vitamin C are potent antifibrinolytic and
oxidative stress agents that reduce blood loss and transfusion blood in
cardiopulmonary bypass (CPB). Objective(s): The aim of this study was
to evaluate the efficacy of tranexamic acid (TA) and tranexamic acid
combined with vitamin C (TXC) on drainage volume (blood loss) and atrial
fibrillation (AF) in patients undergoing cardiac bypass surgery in Gorgan,
Shafa hospital, Iran. Method(s): This study is a double-blind
randomized clinical trial. A sample size of 120 candidates of cardiac
bypass surgery were included in this prospective study. Patients were
randomly assigned to treatments in two groups. In both groups, 50 mg/kg
tranexamic acid was administered intravenously directly before sternotomy:
group A (N = 58) patients received tranexamic acid (TA) only and group B
(N = 62) tranexamic acid with vitamin C (TXC) half an hour before surgery
and 2 g vitamin C with 100 mL 0.9% saline were injected. Subsequently,
during 4 days after surgery, 1000 mg of vitamin C and 100 cc 0.9% saline
was infused every day. Intraoperative and postoperative blood loss (volume
of blood in the drain) and atrial fibrillation complications were recorded
for 24 hours after the operation. Result(s): The patients who
received vitamin C had less bleeding during operation and in the early
hours post-operation. Patients in (TA) group had mean drainage of 34.41
milliliter more than patients in (TXC) group (P < 0.001). Chi-square test
showed that arrhythmia (AF) condition was the same in the two groups
during 14 times of study (four times during operation and ten times up to
24 hours after the operation), and AF arrhythmia in the two groups was
less than 5%. Conclusion(s): In this study tranexamic acid with
vitamin C have a positive effect on the amount of drainage (blood loss)
and there was no significant difference in the incidence of AF between two
groups. Copyright © 2019, Author(s).

<19>
Accession Number
622265424
Title
Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: A
meta-analysis of randomized controlled trials.
Source
European Heart Journal. 39 (18) (pp 1638-1649), 2018. Date of Publication:
07 May 2018.
Author
Ahmad Y.; Howard J.P.; Arnold A.; Shin M.S.; Cook C.; Petraco R.; Demir
O.; Williams L.; Iglesias J.F.; Sutaria N.; Malik I.; Davies J.; Mayet J.;
Francis D.; Sen S.
Institution
(Ahmad, Howard, Arnold, Shin, Cook, Petraco, Demir, Williams, Iglesias,
Sutaria, Malik, Davies, Mayet, Francis, Sen) National Heart and Lung
Institute, Hammersmith Hospital, Imperial College London W12 0HS, United
Kingdom
Publisher
Oxford University Press
Abstract
Aims The efficacy of patent foramen ovale (PFO) closure for cryptogenic
stroke has been controversial. We undertook a meta-analysis of randomized
controlled trials (RCTs) comparing device closure with medical therapy to
prevent recurrent stroke for patients with PFO. Methods and results We
systematically identified all RCTs comparing device closure to medical
therapy for cryptogenic stroke in patients with PFO. The primary efficacy
endpoint was recurrent stroke, analysed on an intention-to-treat basis.
The primary safety endpoint was new onset atrial fibrillation (AF). Five
studies (3440 patients) were included. In all, 1829 patients were
randomized to device closure and 1611 to medical therapy. Across all
patients, PFO closure was superior to medical therapy for prevention of
stroke [hazard ratio (HR) 0.32, 95% confidence interval (95% CI)
0.13-0.82; P = 0.018, I 2 = 73.4%]. The risk of AF was significantly
increased with device closure [risk ratio (RR) 4.68, 95% CI 2.19-10.00,
P<0.001, heterogeneity I 2 = 27.5%)]. In patients with large shunts, PFO
closure was associated with a significant reduction in stroke (HR 0.33,
95% CI 0.16-0.72; P = 0.005), whilst there was no significant reduction in
stroke in patients with a small shunt (HR 0.90, 95% CI 0.50-1.60; P =
0.712). There was no effect from the presence or absence of an atrial
septal aneurysm on outcomes (P = 0.994). Conclusion In selected patients
with cryptogenic stroke, PFO closure is superior to medical therapy for
the prevention of further stroke: this is particularly true for patients
with moderate-to-large shunts. Guidelines should be updated to reflect
this. Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<20>
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. 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. Copyright © 2019
The Author(s).

<21>
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). Copyright © Author(s)
(or their employer(s)) 2019. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<22>
Accession Number
629929869
Title
Preservation of renal function in cardiac surgery patients with low
cardiac output syndrome: Levosimendan vs beta agonists.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 212.
Date of Publication: 17 Nov 2019.
Author
Guerrero Orriach J.L.; Navarro Arce I.; Hernandez Rodriguez P.; Raigon
Ponferrada A.; Malo Manso A.; Ramirez Aliaga M.; Ramirez Fernandez A.;
Escalona Belmonte J.J.; Bellido Estevez I.; Gomez Luque A.; Barrera
Serrano R.; Toledo Medina C.S.; Rubio Navarro M.; Cruz Manas J.
Institution
(Guerrero Orriach, Raigon Ponferrada, Malo Manso, Ramirez Aliaga, Ramirez
Fernandez, Escalona Belmonte, Bellido Estevez, Gomez Luque, Rubio Navarro,
Cruz Manas) Institute of Biomedical Research in Malaga (IBIMA), Malaga,
Spain
(Guerrero Orriach, Navarro Arce, Hernandez Rodriguez, Raigon Ponferrada,
Malo Manso, Ramirez Aliaga, Ramirez Fernandez, Escalona Belmonte, Gomez
Luque, Barrera Serrano, Toledo Medina, Rubio Navarro, Cruz Manas)
Department of Anaesthesiology, Virgen de la Victoria University Hospital,
University Campus Teatinos, Malaga C.P. 29010, Spain
(Guerrero Orriach, Bellido Estevez, Gomez Luque) Department of
Pharmacology and Pediatrics, School of Medicine, University of Malaga,
Malaga, Spain
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Some studies have been performed to assess the effects of
levosimendan on cardiac function when administered to cardiac surgery
patients with low cardiac output syndrome (LCOS) in the immediate
postoperative period. Levosimendan is an inotropic agent for the treatment
of low cardiac output syndrome that seems to have a protective effect on
renal function. Method(s): It is a quasi-experimental study. A total
of 100 patients with LCOS received either beta-agonists or levosimendan.
We assessed the incidence of postoperative kidney failure in cardiac
surgery patients. In patients who had kidney failure at diagnosis of LCOS,
we examined whether differences existed in the evolution of kidney failure
based on the treatment administered for LCOS. The parameters measured
included haemodynamics, oxygen supply, and renal function as assessed by
the AKI scale. ANOVA, Student's t-test and Wilcoxon or Friedman tests were
used. Result(s): Up to 30% of cardiac surgery patients had kidney
failure at diagnosis of LCOS. Kidney failure at discharge from the ICU was
more frequent in patients who received beta-agonist drugs as compared to
those who received levosimendan (p < 0.05). Conclusion(s): The
incidence of kidney failure decreased with the postoperative
administration of levosimendan to cardiac surgery patients with LCOS, as
compared to beta-agonists. Trial registration: Current Controlled Trials
ISRCTN 46058317. Date of registration: 7/10/2019. Retrospectively
registered. Copyright © 2019 The Author(s).

<23>
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. Objective(s): To determine the survival of patients
over 60 years of age with a biological valve replacement. Material(s)
and Method(s): A review of follow-up published studies that evaluated the
survival of patients subjected to a valve replacement. A search was made
of the scientific articles registered in the PubMed databases, using the
selected descriptors as Key words: Heart Valve Prosthesis, Bioprosthesis,
Survival, in the references management program-EndNote. The strength of
the scientific evidence in each of the selected articles was assessed
using the McMaster scale for quantitative studies. Result(s): A total
of 12 references were found and 5 (41.7%) were discarded, and 7 (58.3%)
had an overall "strong" score with the McMaster scale. The mean follow-up
time was 13.7 years, and the male ratio was 1:0.8. The mean age of the
patients was 67.2 (range: 60.0-78.5) years. The mean survival rate at 10
years was 65%. Conclusion(s): A higher survival was observed between
the patients fitted with a mechanical versus a biological valve. However,
the literature has established the use of a biological replacement valve
as a reasonable option in patients over 60 years of age. It is also
recognised that more studies are needed that can corroborate the
findings. Copyright © 2019 Sociedad Colombiana de Cardiologia y
Cirugia Cardiovascular

<24>
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. 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. 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.
 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. Funding(s): Eli
Lilly. Copyright © 2019 Elsevier Ltd

<25>
Accession Number
629229443
Title
Antiplatelet strategy after transcatheter aortic valve replacement: an
updated meta-analysis.
Source
The Journal of cardiovascular surgery. 60 (5) (pp 624-632), 2019. Date of
Publication: 01 Oct 2019.
Author
Ma X.; Xu Z.; Li J.; Zhao D.; Kong X.; Ma J.; Ma H.; Yun Y.; Sun L.; Zhang
Y.; Wei D.; Jiao Q.; Zou C.; Wang Z.
Institution
(Ma) Department of Cardiovascular Surgery, Shandong Provincial Hospital
affiliated to Shandong First Medical University, Jinan, China
(Ma) Department of Cardiovascular Surgery, Shandong Provincial Hospital
affiliated to Shandong University, Jinan, China
(Xu, Li, Zhao, Sun, Wei, Zou, Wang) Department of Cardiovascular Surgery,
Shandong Provincial Hospital affiliated to Shandong First Medical
University, Jinan, China
(Xu, Li, Zhao, Sun, Wei, Zou, Wang) Department of Cardiovascular Surgery,
Shandong Provincial Hospital affiliated to Shandong University, Jinan,
China
(Kong) Department of Vascular Surgery, Shandong Provincial Hospital
affiliated to Shandong University, Jinan, China
(Ma) Department of Pathology, Shandong Provincial Hospital affiliated to
Shandong University, Jinan, China
(Ma) Qingdao University Medical College, Qingdao University, Qingdao,
China
(Yun) Department of Neurology, Qilu Hospital of Shandong University,
Jinan, China
(Zhang) Emergency Center, Shandong Provincial Hospital affiliated to
Shandong University, Jinan, China
(Jiao) Department of Anesthesiology, Shandong Provincial Hospital
affiliated to Shandong University, Jinan, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Recently transcatheter aortic valve replacement (TAVR) has
emerged as a feasible alternative for traditional surgical aortic valve
replacement (SAVR) in patients with intermediate to high risk. There is
currently no clear consensus regarding the optimal antiplatelet strategy
after TAVR. The primary objective of this updated meta-analyses was to
compare the outcomes of dual antiplatelet therapy (DAPT) versus single
antiplatelet therapy (SAPT) following TAVR. EVIDENCE ACQUISITION: A
meta-analysis of eligible studies of patients undergoing TAVR which
reported our outcomes of postoperative DAPT in comparison with SAPT, was
carried out. The outcomes included the all-cause mortality, stroke,
major/life-threatening bleeding, myocardial infarction and a composite
endpoint of mortality, stroke, bleeding and myocardial infarction.
EVIDENCE SYNTHESIS: Three randomized controlled trials (RCTs, N.=421) and
5 observational studies (N.=6683) were included in this updated
meta-analysis. All-cause mortality was comparable between the two groups
(OR 1.13 [95% CI: 0.70-1.81], P=0.619). Besides, DAPT resulted in an
augmented risk of major/life-threatening bleeding (OR 2.45 [95% CI:
1.08-5.59], P=0.032). No statistically significant difference was found
between the two groups in the rates of stroke (OR 0.83 [95% CI:
0.62-1.10], P=0.212) and myocardial infarction (OR 1.17 [95% CI:
0.47-2.91], P=0.728). And DAPT led to an increased rate of the composite
endpoint (OR 2.39 [95% CI: 1.63-3.50], P<0.0001). CONCLUSIONS: The updated
meta-analysis presents the evidence that post-TAVR DAPT increases bleeding
events, with no benefit in survival and ischemic events, in comparison
with SAPT. Nevertheless, it is currently difficult to evaluate by a
meta-analysis the effectiveness of DAPT versus SAPT to prevent the valve
thrombosis resulting in leaflet dysfunction, due to a limited number of
existing publications. Additional RCTs are needed to determine the optimal
antiplatelet strategy after TAVR.

<26>
Accession Number
630003328
Title
Prophylactic plasma transfusion for patients without inherited bleeding
disorders or anticoagulant use undergoing non-cardiac surgery or invasive
procedures.
Source
The Cochrane database of systematic reviews. 11 (pp CD012745), 2019. Date
of Publication: 28 Nov 2019.
Author
Huber J.; Stanworth S.J.; Doree C.; Fortin P.M.; Trivella M.; Brunskill
S.J.; Hopewell S.; Wilkinson K.L.; Estcourt L.J.
Institution
(Huber) University Hospital Southampton NHS Foundation Trust, Shackleton
Department of Anaesthesia, Tremona Road, Hampshire, Southampton So16 6YD,
United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust and
University of Oxford, National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, John Radcliffe Hospital, Headley Way
,Headington, Oxford OX3 9BQ, United Kingdom
(Doree, Brunskill) NHS Blood and Transplant, Systematic Review Initiative,
John Radcliffe Hospital, Oxford OX3 9BQ, United Kingdom
(Fortin) 5639 Gowland Rd., Sechelt, Canada
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Hopewell) University of Oxford, Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research
Centre, Windmill Road, Oxford, Oxfordshire, UK, OX3 7LD
(Wilkinson) Southampton University NHS Hospital, Paediatric and Adult
Cardiothoracic Anaesthesia, Tremona Road, Southampton SO16 6YD, United
Kingdom
(Estcourt) NHS Blood and Transplant, Haematology/Transfusion Medicine,
John Radcliffe Hospital, Level 2Headington, Oxford OX3 9BQ, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: In the absence of bleeding, plasma is commonly transfused to
people prophylactically to prevent bleeding. In this context, it is
transfused before operative or invasive procedures (such as liver biopsy
or chest drainage tube insertion) in those considered at increased risk of
bleeding, typically defined by abnormalities of laboratory tests of
coagulation. As plasma contains procoagulant factors, plasma transfusion
may reduce perioperative bleeding risk. This outcome has clinical
importance given that perioperative bleeding and blood transfusion have
been associated with increased morbidity and mortality. Plasma is
expensive, and some countries have experienced issues with blood product
shortages, donor pool reliability, and incomplete screening for
transmissible infections. Thus, although the benefit of prophylactic
plasma transfusion has not been well established, plasma transfusion does
carry potentially life-threatening risks. OBJECTIVE(S): To determine
the clinical effectiveness and safety of prophylactic plasma transfusion
for people with coagulation test abnormalities (in the absence of
inherited bleeding disorders or use of anticoagulant medication) requiring
non-cardiac surgery or invasive procedures. SEARCH METHOD(S): We
searched for randomised controlled trials (RCTs), without language or
publication status restrictions in: Cochrane Central Register of
Controlled Trials (CENTRAL; 2017 Issue 7); Ovid MEDLINE (from 1946); Ovid
Embase (from 1974); Cumulative Index to Nursing and Allied Health
Literature (CINAHL; EBSCOHost) (from 1937); PubMed (e-publications and
in-process citations ahead of print only); Transfusion Evidence Library
(from 1950); Latin American Caribbean Health Sciences Literature (LILACS)
(from 1982); Web of Science: Conference Proceedings Citation Index-Science
(CPCI-S) (Thomson Reuters, from 1990); ClinicalTrials.gov; and World
Health Organization (WHO) International Clinical Trials Registry Search
Platform (ICTRP) to 28 January 2019. SELECTION CRITERIA: We included RCTs
comparing: prophylactic plasma transfusion to placebo, intravenous fluid,
or no intervention; prophylactic plasma transfusion to alternative
pro-haemostatic agents; or different haemostatic thresholds for
prophylactic plasma transfusion. We included participants of any age, and
we excluded trials incorporating individuals with previous active
bleeding, with inherited bleeding disorders, or taking anticoagulant
medication before enrolment. DATA COLLECTION AND ANALYSIS: We used
standard methodological procedures expected by Cochrane. MAIN RESULTS: We
included five trials in this review, all were conducted in high-income
countries. Three additional trials are ongoing. One trial compared fresh
frozen plasma (FFP) transfusion with no transfusion given. One trial
compared FFP or platelet transfusion or both with neither FFP nor platelet
transfusion given. One trial compared FFP transfusion with administration
of alternative pro-haemostatic agents (factors II, IX, and X followed by
VII). One trial compared the use of different transfusion triggers using
the international normalised ratio measurement. One trial compared the use
of a thromboelastographic-guided transfusion trigger using standard
laboratory measurements of coagulation. Four trials enrolled only adults,
whereas the fifth trial did not specify participant age. Four trials
included only minor procedures that could be performed by the bedside.
Only one trial included some participants undergoing major surgical
operations. Two trials included only participants in intensive care. Two
trials included only participants with liver disease. Three trials did not
recruit sufficient participants to meet their pre-calculated sample size.
Overall, the quality of evidence was low to very low across different
outcomes according to GRADE methodology, due to risk of bias,
indirectness, and imprecision. One trial was stopped after recruiting two
participants, therefore this review's findings are based on the remaining
four trials (234 participants). When plasma transfusion was compared with
no transfusion given, we are very uncertain whether there was a difference
in 30-day mortality (1 trial comparing FFP or platelet transfusion or both
with neither FFP nor platelet transfusion, 72 participants; risk ratio
(RR) 0.38, 95% confidence interval (CI) 0.13 to 1.10; very low-quality
evidence). We are very uncertain whether there was a difference in major
bleeding within 24 hours (1 trial comparing FFP transfusion vs no
transfusion, 76 participants; RR 0.33, 95% CI 0.01 to 7.93; very
low-quality evidence; 1 trial comparing FFP or platelet transfusion or
both with neither FFP nor platelet transfusion, 72 participants; RR 1.59,
95% CI 0.28 to 8.93; very low-quality evidence). We are very uncertain
whether there was a difference in the number of blood product transfusions
per person (1 trial, 76 participants; study authors reported no
difference; very low-quality evidence) or in the number of people
requiring transfusion (1 trial comparing FFP or platelet transfusion or
both with neither FFP nor platelet transfusion, 72 participants; study
authors reported no blood transfusion given; very low-quality evidence) or
in the risk of transfusion-related adverse events (acute lung injury) (1
trial, 76 participants; study authors reported no difference; very
low-quality evidence). When plasma transfusion was compared with other
pro-haemostatic agents, we are very uncertain whether there was a
difference in major bleeding (1 trial; 21 participants; no events; very
low-quality evidence) or in transfusion-related adverse events (febrile or
allergic reactions) (1 trial, 21 participants; RR 9.82, 95% CI 0.59 to
162.24; very low-quality evidence). When different triggers for FFP
transfusion were compared, the number of people requiring transfusion may
have been reduced (for overall blood products) when a
thromboelastographic-guided transfusion trigger was compared with standard
laboratory tests (1 trial, 60 participants; RR 0.18, 95% CI 0.08 to 0.39;
low-quality evidence). We are very uncertain whether there was a
difference in major bleeding (1 trial, 60 participants; RR 0.33, 95% CI
0.01 to 7.87; very low-quality evidence) or in transfusion-related adverse
events (allergic reactions) (1 trial; 60 participants; RR 0.33, 95% CI
0.01 to 7.87; very low-quality evidence). Only one trial reported 30-day
mortality. No trials reported procedure-related harmful events (excluding
bleeding) or quality of life. AUTHORS' CONCLUSION(S): Review findings
show uncertainty for the utility and safety of prophylactic FFP use. This
is due to predominantly very low-quality evidence that is available for
its use over a range of clinically important outcomes, together with lack
of confidence in the wider applicability of study findings, given the
paucity or absence of study data in settings such as major body cavity
surgery, extensive soft tissue surgery, orthopaedic surgery, or
neurosurgery. Therefore, from the limited RCT evidence, we can neither
support nor oppose the use of prophylactic FFP in clinical
practice. Copyright © 2019 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<27>
Accession Number
630003099
Title
Outcomes with retrograde versus antegrade chronic total occlusion
revascularization.
Source
Catheterization and cardiovascular interventions : official journal of the
Society for Cardiac Angiography & Interventions. (no pagination), 2019.
Date of Publication: 28 Nov 2019.
Author
Megaly M.; Ali A.; Saad M.; Omer M.; Xenogiannis I.; Werner G.S.;
Karmpaliotis D.; Russo J.J.; Yamane M.; Garbo R.; Gagnor A.; Ungi I.;
Rinfret S.; Pershad A.; Wojcik J.; Garcia S.; Mashayekhi K.; Sianos G.;
Galassi A.R.; Burke M.N.; Brilakis E.S.
Institution
(Megaly, Omer, Xenogiannis, Garcia, Burke, Brilakis) Minneapolis Heart
Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States
(Megaly, Omer) Department of Cardiovascular Medicine, Hennepin Healthcare,
Minneapolis, MN, United States
(Ali) Department of Medicine, Mercy Hospital and Medical Center, Chicago,
IL, Mexico
(Saad) Division of Cardiovascular Medicine, Warren Alpert School of
Medicine at Brown University, Providence, RI, United States
(Saad) Department of Cardiovascular Medicine, Ain Shams University
Hospitals, Cairo, Egypt
(Werner) Klinikum Darmstadt GmbH, Medizinische Klinik I (Cardiology and
Intensive Care), Darmstadt, Germany
(Karmpaliotis, Russo) Department of Cardiology, Columbia University, NY
(Yamane) Department of Cardiology, Sayama Hospital, Saitama, Japan
(Garbo) Department of Invasive Cardiology, San Giovanni Bosco Hospital,
Turin, Italy
(Gagnor) Department of Invasive Cardiology, Maria Vittoria Hospital,
Turin, Italy
(Ungi) Division of Invasive Cardiology, University of Szeged, Second
Department of Internal Medicine and Cardiology Center, Szeged, Hungary
(Rinfret) Division of Interventional Cardiology, McGill University Health
Centre, Montreal, Canada
(Pershad) Division of Cardiology, Banner-University Medical Center,
Phoenix, AZ, United States
(Wojcik) Department of Cardiology, Hospital of Invasive Cardiology
IKARDIA, Poland
(Mashayekhi) Division of Cardiology and Angiology II, University Heart
Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Sianos) First Department of Cardiology, AHEPA University Hospital,
Thessaloniki, Greece
(Galassi) Department of Clinical and Experimental Medicine,
Catheterization Laboratory and Cardiovascular Interventional Unit,
Cannizzaro Hospital, University of Catania, Catania, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of the study was to evaluate the outcomes of
retrograde versus antegrade approach in chronic total occlusion (CTO)
percutaneous coronary intervention (PCI). BACKGROUND: The retrograde
approach has increased the success rate of CTO PCI but has been associated
with a higher risk for complications. METHOD(S): We conducted a
meta-analysis of studies published between 2000 and August 2019 comparing
the in-hospital and long-term outcomes with retrograde versus antegrade
CTO PCI. RESULT(S): Twelve observational studies (10,240 patients)
met our inclusion criteria (retrograde approach 2,789 patients, antegrade
approach 7,451 patients). Lesions treated with the retrograde approach had
higher J-CTO score (2.8 vs. 1.9, p<.001). Retrograde CTO PCI was
associated with a lower success rate (80.9% vs. 87.4%, p<.001). Both
approaches had similar in-hospital mortality, urgent revascularization,
and cerebrovascular events. Retrograde CTO PCI was associated with higher
risk of in-hospital myocardial infarction (MI; odds ratio [OR] 2.37, 95%
confidence intervals [CI] 1.7, 3.32, p<.001), urgent pericardiocentesis
(OR 2.53, 95% CI 1.41-4.51, p = .002), and contrast-induced nephropathy
(OR 2.12, 95% CI 1.47-3.08; p<.001). During a mean follow-up of
48+/-31months retrograde crossing had similar mortality (OR 1.79, 95% CI
0.84-3.81, p = .13), but a higher incidence of MI (OR 2.07, 95% CI
1.1-3.88, p = .02), target vessel revascularization (OR 1.92, 95% CI
1.49-2.46, p<.001), and target lesion revascularization (OR 2.08, 95% CI
1.33-3.28, p = .001). CONCLUSION(S): Compared with antegrade CTO PCI,
retrograde CTO PCI is performed in more complex lesions and is associated
with a higher risk for acute and long-term adverse events. Copyright
© 2019 Wiley Periodicals, Inc.

<28>
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. 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. 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. 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. Copyright © 2019 Elsevier Ltd

<29>
Accession Number
629596918
Title
Pragmatic randomised clinical trial of proton versus photon therapy for
patients with non-metastatic breast cancer: The Radiotherapy Comparative
Effectiveness (RadComp) Consortium trial protocol.
Source
BMJ Open. 9 (10) (no pagination), 2019. Article Number: e025556. Date of
Publication: 01 Oct 2019.
Author
Bekelman J.E.; Lu H.; Pugh S.; Baker K.; Berg C.D.; De Gonzalez A.B.;
Braunstein L.Z.; Bosch W.; Chauhan C.; Ellenberg S.; Fang L.C.; Freedman
G.M.; Hahn E.A.; Haffty B.G.; Khan A.J.; Jimenez R.B.; Kesslering C.; Ky
B.; Lee C.; Lu H.-M.; Mishra M.V.; Mullins C.D.; Mutter R.W.; Nagda S.;
Pankuch M.; Powell S.N.; Prior F.W.; Schupak K.; Taghian A.G.; Wilkinson
J.B.; Macdonald S.M.; Cahlon O.
Institution
(Bekelman, Lu, Freedman, Nagda) Department of Radiation Oncology,
University of Pennsylvania Perelman, School of Medicine, Philadelphia, PA,
United States
(Pugh) American College of Radiology, Philadelphia, PA, United States
(Baker, Mishra) Department of Radiation Oncology, University of Maryland,
School of Medicine, Baltimore, MD, United States
(Berg, De Gonzalez, Lee) Division of Cancer Epidemiology and Genetics,
National Cancer Institute, National Institutes of Health, Bethesda, MD,
United States
(Braunstein, Khan, Powell, Schupak, Cahlon) Department of Radiation
Oncology, Memorial Sloan Kettering Cancer Center, New York city, NY,
United States
(Bosch) Department of Radiation Oncology, Washington University in St.
Louis, St. Louis, MO, United States
(Chauhan) Mayo Clinic Minnesota, Rochester, MI, United States
(Ellenberg) Department of Biostatistics Epidemiology and Informatics,
University of Pennsylvania Perelman, School of Medicine, Philadelphia, PA,
United States
(Fang) Department of Radiation Oncology, University of Washington, School
of Medicine, Seattle, WA, United States
(Hahn) Department of Medical Social Sciences, Northwestern University,
Evanston, IL, United States
(Haffty) Department of Radiation Oncology, Rutgers Cancer Institute of New
Jersey, New Brunswick, NJ, United States
(Jimenez, Lu, Taghian, Macdonald) Department of Radiation Oncology,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Kesslering, Pankuch) Northwestern Medicine Chicago Proton Center,
Warrenville, IL, United States
(Ky) Cardio-Oncology Program, Division of Cardiovascular Medicine,
University of Pennsylvania Perelman, School of Medicine, Philadelphia, PA,
United States
(Mullins) PHSR, University of Maryland, School of Pharmacy, Baltimore, MD,
United States
(Mutter) Department of Radiation Oncology, Mayo Clinic, Rochester, MN,
United States
(Prior) Department of Biomedical Informatics, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Wilkinson) Provision Proton Therapy Center, Knoxville, TN, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction A broad range of stakeholders have called for randomised
evidence on the potential clinical benefits and harms of proton therapy, a
type of radiation therapy, for patients with breast cancer. Radiation
therapy is an important component of curative treatment, reducing cancer
recurrence and extending survival. Compared with photon therapy, the
international treatment standard, proton therapy reduces incidental
radiation to the heart. Our overall objective is to evaluate whether the
differences between proton and photon therapy cardiac radiation dose
distributions lead to meaningful reductions in cardiac morbidity and
mortality after treatment for breast cancer. Methods We are conducting a
large scale, multicentre pragmatic randomised clinical trial for patients
with breast cancer who will be followed longitudinally for cardiovascular
morbidity and mortality, health-related quality of life and cancer control
outcomes. A total of 1278 patients with non-metastatic breast cancer will
be randomly allocated to receive either photon or proton therapy. The
primary outcomes are major cardiovascular events, defined as myocardial
infarction, coronary revascularisation, cardiovascular death or
hospitalisation for unstable angina, heart failure, valvular disease,
arrhythmia or pericardial disease. Secondary endpoints are urgent or
unanticipated outpatient or emergency room visits for heart failure,
arrhythmia, valvular disease or pericardial disease. The Radiotherapy
Comparative Effectiveness (RadComp) Clinical Events Centre will conduct
centralised, blinded adjudication of primary outcome events. Ethics and
dissemination The RadComp trial has been approved by the institutional
review boards of all participating sites. Recruitment began in February
2016. Current version of the protocol is A3, dated 08 November 2018.
Dissemination plans include presentations at scientific conferences,
scientific publications, stakeholder engagement efforts and presentation
to the public via lay media outlets. Trial registration number
NCT02603341. Copyright © Author(s) (or their employer(s)) 2019.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<30>
Accession Number
2002212409
Title
Perioperative dexmedetomidine reduces delirium in elderly patients after
non-cardiac surgery: a systematic review and meta-analysis of
randomized-controlled trials.
Source
Canadian Journal of Anesthesia. 66 (12) (pp 1489-1500), 2019. Date of
Publication: 01 Dec 2019.
Author
Pan H.; Liu C.; Ma X.; Xu Y.; Zhang M.; Wang Y.
Institution
(Pan, Liu, Ma, Xu, Zhang, Wang) Department of Anesthesiology, Shandong
Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu
Road, Jinan 250021, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Delirium is a frequent postoperative complication in elderly
patients after non-cardiac surgery. We performed this updated
meta-analysis to ascertain more precisely the efficacy of dexmedetomidine
(DEX) on the incidence of postoperative delirium (POD) in elderly patients
after non-cardiac surgery. Method(s): We searched PubMed, EMBASE, the
Cochrane Library, Web of Science, and the Cumulative Index of Nursing and
Allied Health Literature (CINAHL) from inception until February 24, 2019.
In this meta-analysis, we included randomized-controlled trials comparing
the effect of DEX vs normal saline (NS) or other anesthetic drugs on POD
incidence in elderly (either >= 60 or >= 65 yr old) patients undergoing
non-cardiac surgery. We performed subgroup analyses of the DEX dosing
strategy (starting time, dose, and duration of administration, with or
without loading dose) and the strategy of various control drugs. A
random-effects model was used for all analyses. Result(s): We
included 11 studies involving 2,890 patients in our meta-analysis. The
pooled results of these studies revealed that DEX significantly reduced
the incidence of POD (relative risk [RR], 0.47; 95% confidence interval
[CI], 0.38 to 0.58; P < 0.001) compared with the control group. Meanwhile,
the incidences of hypotension (RR, 1.20; 95% CI, 1.04 to 1.39; P = 0.01)
and bradycardia (RR, 1.33; 95% CI, 1.08 to 1.63; P = 0.007) were increased
in the DEX group. Subgroup analyses revealed a decrease in POD incidence
when DEX was administered intraoperatively (RR, 0.43; 95% CI, 0.33 to
0.57; P < 0.001) and postoperatively (RR, 0.38; 95% CI, 0.27 to 0.54; P <
0.001) with a loading dose (RR, 0.49; 95% CI, 0.36 to 0.69; P < 0.001)
compared with NS (RR, 0.49; 95% CI, 0.37 to 0.64; P < 0.001) and other
anesthetic drugs (RR, 0.40; 95% CI, 0.26 to 0.60; P < 0.001). There were
significant differences in the time to extubation (standardized mean
difference, -0.60; 95% CI, -1.17 to -0.03; P = 0.04) and the length of
hospital stay (mean difference, -0.50 days; 95% CI, -0.97 to -0.03; P =
0.04). The amount of data for the duration of mechanical ventilation and
length of intensive care unit stay were insufficient to perform a
meta-analysis. Conclusion(s): Perioperative dexmedetomidine reduces
the incidence of POD in elderly patients after non-cardiac surgery, but
this comes at the cost of an increased incidence of hypotension and
bradycardia. Copyright © 2019, Canadian Anesthesiologists'
Society.

<31>
Accession Number
2002656690
Title
A meta-analysis of impact of mitral stenosis on outcomes after
transcatheter aortic valve implantation.
Source
Journal of Cardiac Surgery. 34 (11) (pp 1256-1263), 2019. Date of
Publication: 01 Nov 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To determine whether concomitant mitral stenosis (MS) impairs
outcomes after transcatheter aortic valve implantation (TAVI) in patients
with severe aortic stenosis (AS), we performed a meta-analysis of
currently available evidence. Method(s): To identify all
observational comparative studies of outcomes after TAVI for AS in
patients with MS vs patients with no-MS, we searched databases (MEDLINE
and EMBASE) using web-based search engines (PubMed and OVID). Studies
meeting the following criteria were included; the design was an
observational study; the study population was patients undergoing TAVI for
AS; outcomes in patients with MS were compared with those in patients with
no-MS. Study-specific estimates were then pooled using inverse
variance-weighted averages of logarithmic odds and hazard ratios in the
random-effects model. Result(s): We identified six eligible studies
including 111 621 patients undergoing TAVI. In pooled analyses,
postprocedural incidence of >= moderate paravalvular aortic regurgitation
(PAR) (P =.02), early all-cause mortality (P =.008), early incidence of
myocardial infarction (MI) (P =.01), and midterm all-cause mortality (P
=.03) after TAVI were significantly higher in patients with MS than in
patients with no-MS. There were no significant differences in early
incidence of stroke, major bleeding, acute kidney injury, and new
permanent pacemaker implantation after TAVI between patients with MS and
patients with no-MS. When the study for mitral annular calcification was
excluded in the pooled analyses, no results except for MI were
substantially altered but the significance for early incidence of MI
disappeared (P =.10). Conclusion(s): Postprocedural incidence of >=
moderate PAR, early all-cause mortality, early incidence of MI, and
midterm all-cause mortality after TAVI are higher in patients with MS than
in patients with no-MS. Copyright © 2019 Wiley Periodicals, Inc.

<32>
Accession Number
625678747
Title
Sex-related response to bivalirudin and unfractionated heparin in patients
with acute myocardial infarction undergoing percutaneous coronary
intervention: A subgroup analysis of the VALIDATE-SWEDEHEART trial.
Source
European Heart Journal: Acute Cardiovascular Care. 8 (6) (pp 502-509),
2019. Date of Publication: 01 Sep 2019.
Author
Venetsanos D.; Sederholm Lawesson S.; Frobert O.; Omerovic E.; Henareh L.;
Robertsson L.; Linder R.; Gotberg M.; James S.; Alfredsson J.; Erlinge D.;
Swahn E.
Institution
(Venetsanos, Sederholm Lawesson, Alfredsson, Swahn) Department of
Cardiology and Department of Medical and Health Sciences, Linkoping
University, Linkoping, Sweden
(Frobert) Department of Cardiology, Orebro University, Sweden
(Omerovic) Department of Cardiology, Sahlgrenska University Hospital,
Sweden
(Henareh) Department of Medicine, Karolinska Institute, Sweden
(Robertsson) Department of Cardiology, Sodra Alvsborgs Sjukhus, Sweden
(Linder) Department of Cardiology, Danderyd Hospital, Sweden
(Gotberg, Erlinge) Department of Cardiology, Skane University Hospital,
Sweden
(James) Department of Medical Sciences, Uppsala University, Sweden
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aims: Our aim was to study the impact of sex on anticoagulant treatment
outcomes during percutaneous coronary intervention in acute myocardial
infarction patients. Method(s): This study was a prespecified
analysis of the Bivalirudin versus Heparin in ST-Segment and Non
ST-Segment Elevation Myocardial Infarction in Patients on Modern
Antiplatelet Therapy in the Swedish Web System for Enhancement and
Development of Evidence-based Care in Heart Disease Evaluated according to
Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART) trial, in which
patients with myocardial infarction were randomised to bivalirudin or
unfractionated heparin during percutaneous coronary intervention. The
primary outcome was the composite of death, myocardial infarction or major
bleeding at 180 days. Result(s): There was a lower risk of the
primary outcome in women assigned to bivalirudin than to unfractionated
heparin (13.6% vs 17.1%, hazard ratio 0.78, 95% confidence interval
(0.60-1.00)) with no significant difference in men (11.8% vs 11.2%, hazard
ratio 1.06 (0.89-1.26), p for interaction 0.05). The observed difference
was primarily due to lower risk of major bleeding (Bleeding Academic
Research Consortium definition 2, 3 or 5) associated with bivalirudin in
women (8.9% vs 11.8%, hazard ratio 0.74 (0.54-1.01)) but not in men (8.5%
vs 7.3%, hazard ratio 1.16 (0.94-1.43) in men, p for interaction 0.02).
Conversely, no significant difference in the risk of Bleeding Academic
Research Consortium 3 or 5 bleeding, associated with bivalirudin, was
found in women 4.5% vs 5.4% (hazard ratio 0.84 (0.54-1.31)) or men 2.9% vs
2.1% (hazard ratio 1.36 (0.93-1.99)). Bleeding Academic Research
Consortium 2 bleeding occurred significantly less often in women assigned
to bivalirudin than to unfractionated heparin. The risk of death or
myocardial infarction did not significantly differ between randomised
treatments in men or women. Conclusion(s): In women, bivalirudin was
associated with a lower risk of adverse outcomes, compared to
unfractionated heparin, primarily due to a significant reduction in
Bleeding Academic Research Consortium 2 bleeds. Copyright © The
European Society of Cardiology 2018.

<33>
Accession Number
2003397064
Title
Reducing blood loss in pediatric craniosynostosis surgery by use of
tranexamic acid.
Source
Neurochirurgie. 65 (5) (pp 302-309), 2019. Date of Publication: November
2019.
Author
Eustache G.; Riffaud L.
Institution
(Eustache) Rennes University, CHU of Rennes, Department of Anesthesiology,
Rennes 35000, France
(Riffaud) Rennes University, CHU of Rennes, Department of Neurosurgery,
Rennes 35000, France
(Riffaud) INSERM MediCIS, Unit U1099 LTSI, Rennes 1 University, Rennes,
35000, France
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction: Craniosysnostosis surgical corrections are routine
procedures in the pediatric neurosurgical field. However, these procedures
result in significant blood loss. Tranexamic acid (TXA) is an
antifibrinolytic drug, which has demonstrated a significant reduction in
perioperative blood loss in many pediatric surgical procedures such as
cardiac surgery and scoliosis surgery. We conducted a systematic review to
evaluate protocols of TXA use in pediatric craniosynostosis procedures and
its effect on intraoperative blood loss and transfusions. Material(s)
and Method(s): A comprehensive literature review of the National Library
of Medicine (PubMed) database was performed to identify relevant studies.
We included any clinical study reporting on blood loss or blood
transfusion for pediatric craniosynostosis surgery with intraoperative use
of tranexamic acid, with the following limits: publication date from
inception to May 2019; reports in English. Result(s): Thirteen
studies were eligible for our review. Of the 13 studies, 4 were
prospective, randomised, double-blind controlled trials, 9 were
retrospective studies, tailored as a "before-after" studies, comparing
blood loss and transfusion without/with TXA. TXA significantly decreases
the number and volume of packed red blood cell transfusions and the rate
of transfusion in children undergoing craniosynostosis surgery.
Significantly fewer fresh frozen plasma transfusions were required in the
TXA groups in 2 randomised studies. Length of stay in hospital was
significantly lower with the use of TXA in three studies. Advantages of
TXA administration also include an excellent patient tolerance of side
effects, ease of administration and low cost. Conclusion(s): TXA
significantly reduces blood loss and the need for transfusions in children
undergoing craniosynostosis surgery. TXA administration should be a
routine part of strategy to reduce blood loss and limit transfusions in
these procedures. Copyright © 2019 Elsevier Masson SAS

<34>
Accession Number
628273723
Title
Can venous cannula design influence venous return and negative pressure
with a minimally invasive extracorporeal circulation?.
Source
International Journal of Artificial Organs. 42 (12) (pp 704-710), 2019.
Date of Publication: 01 Dec 2019.
Author
Bennett M.J.; Hodgkiss S.; Lloyd C.T.; Webb G.
Institution
(Bennett) Cardiothoracic Anaesthesia, University Hospitals Plymouth NHS
Trust, Plymouth, United Kingdom
(Hodgkiss, Webb) Clinical Perfusion, University Hospitals Plymouth NHS
Trust, Plymouth, United Kingdom
(Lloyd) Cardiothoracic Surgery, University Hospitals Plymouth NHS Trust,
Plymouth, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Recent advances to make cardiopulmonary bypass more
physiological include the use of kinetic-assisted venous drainage but
without a venous reservoir. Despite manipulation of intravascular volume
and patient positioning, arterial flow is frequently reduced. Negative
venous line pressures can be generated, which may elicit gaseous
microemboli. We investigated the influence of venous cannula design on
venous return and negative venous line pressures. Method(s): In a
single-centre, single-surgeon, prospective, randomized, double-blind
trial, 48 patients undergoing isolated coronary artery, aortic valve or
combined coronary artery and aortic valve surgery, with a minimally
invasive circuit, were randomized to a conventional two-stage (2S) or
three-stage venous cannula (3S), or to a three-stage venous cannula with
additional 'fenestrated' ridges (F3S). Blood flow, venous line pressures
and gaseous microemboli number and size were measured. Result(s): The
pump flow achieved was the same between groups, but in each case fell
below the target range of 2.2-2.4 L min-1 m-2. The
three-stage cannula recorded significantly lower negative pressure than
the other cannulae. The total count and volume of gaseous emboli detected
with the F3S cannulae was very high in some cases, with wide
heterogeneity. Discussion(s): The low negative pressures recorded
with three-stage cannula, despite having a larger drainage orifice area,
suggest that negative pressure may be more influenced by lumen diameter
and vena cava collapse rather than drainage hole size. The additional
fenestrations resulted in flow characteristics and negative pressures
similar to the larger two-stage cannula but are associated with generation
of gaseous microemboli. Copyright © The Author(s) 2019.

<35>
Accession Number
2002641242
Title
Clinical outcomes of automated anastomotic devices: A metanalysis.
Source
Journal of Cardiac Surgery. 34 (11) (pp 1297-1304), 2019. Date of
Publication: 01 Nov 2019.
Author
Micali L.R.; Matteucci F.; Parise O.; Tetta C.; Moula A.I.; de Jong M.;
Londero F.; Gelsomino S.
Institution
(Micali, Matteucci, Parise, Tetta, Moula, de Jong, Londero, Gelsomino)
Cardiothoracic Department, Maastricht University Hospital, Maastricht,
Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aims: We investigated neurological events, graft patency,
major adverse cardiovascular events (MACEs), and mortality at 1 year
following coronary artery bypass grafting (CABG) surgery using automated
proximal anastomotic devices (APADs) and compared the overall rates with
the current literature. Method(s): A systematic review of all
available reports of APADs use in the literature was conducted. Cumulative
incidence and 95% confidence interval (CI) were the main statistical
indexes. Nine observational studies encompassing a total of 718 patients
were included at the end of the selection process. Result(s): The
cumulative event rate of neurological complications was 4.8% (lower-upper
limits: 2.8-8.0, P <.001; I2 = 72.907%, P =.002; Egger's test:
intercept = -2.47, P = 0.16; Begg and Mazumdar test: tau = -0.20, p =
0.57). Graft patency was 90.5% (80.4 to 95.7, P <.001; I2 =
76.823%, P =.005; Egger's test: intercept = -3.04, P =.10; Begg and
Mazumdar test: tau = -0.67, P =.17). Furthermore, the overall incidence of
MACEs was 3.7% (1.3-10.4, P <.001; I2 = 51.556%, P =.103;
Egger's test: intercept = -1.98, P = <.11; Begg and Mazumdar test: tau =
-0.67, P =.17). Finally, mortality within 1 year was 5% (3.5-7, P <.001;
I2 = 29.675%, P =.202; Egger's test: intercept = -0.91, P =.62;
Begg and Mazumdar test: tau = -0.04, P =.88). Conclusion(s): APADs do
not seem to be correlated with a reduction of either neurological events
or mortality. By contrast, these tools showed satisfactory one-year graft
patency and a low incidence of MACEs. Further research on this topic is
warranted. Copyright © 2019 The Authors. Journal of Cardiac
Surgery published by Wiley Periodicals, Inc.

<36>
Accession Number
2001265017
Title
A Randomized Trial to Assess Regional Left Ventricular Function After
Stent Implantation in Chronic Total Occlusion: The REVASC Trial.
Source
JACC: Cardiovascular Interventions. 11 (19) (pp 1982-1991), 2018. Date of
Publication: 8 October 2018.
Author
Mashayekhi K.; Nuhrenberg T.G.; Toma A.; Gick M.; Ferenc M.; Hochholzer
W.; Comberg T.; Rothe J.; Valina C.M.; Loffelhardt N.; Ayoub M.; Zhao M.;
Bremicker J.; Jander N.; Minners J.; Ruile P.; Behnes M.; Akin I.;
Schaufele T.; Neumann F.-J.; Buttner H.J.
Institution
(Mashayekhi, Nuhrenberg, Toma, Gick, Ferenc, Hochholzer, Comberg, Rothe,
Valina, Loffelhardt, Ayoub, Zhao, Bremicker, Jander, Minners, Ruile,
Neumann, Buttner) Department of Cardiology and Angiology II, University
Heart Center Freiburg * Bad Krozingen, Bad Krozingen, Germany
(Behnes, Akin) First Department of Medicine, University Medical Centre
Mannheim, Germany
(Behnes, Akin) DZHK (German Centre for Cardiovascular Research), partner
site Heidelberg/Mannheim, Mannheim, Germany
(Schaufele) Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart,
Germany
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to investigate whether percutaneous
coronary intervention (PCI) of chronic total occlusions (CTOs) improves
left ventricular function. Background(s): The benefit of PCI in CTOs
is still controversial. Method(s): Patients with CTOs who were
candidates for PCI were eligible for the study and were randomized to PCI
or no PCI of CTO. Relevant coexisting non-CTO lesions were treated as
indicated. Patients underwent cardiac magnetic resonance imaging at
baseline and at 6 months. The primary endpoint was the change in segmental
wall thickening (SWT) in the CTO territory. Secondary endpoints were
improvement of regional wall motion and changes in left ventricular
volumes and ejection fraction. Furthermore, major adverse coronary events
after 12 months were assessed. Result(s): The CTO PCI group comprised
101 patients and the no CTO PCI group 104 patients. The change in SWT did
not differ between the CTO PCI (4.1% [interquartile range: 14.6 to 19.3])
and no CTO PCI (6.0% [interquartile range: 8.6 to 6.0]) groups (p = 0.57).
Similar results were obtained for other indexes of regional and global
left ventricular function. Subgroup analysis revealed that only in
patients without major non-CTO lesions (basal SYNTAX [Synergy Between
Percutaneous Coronary Intervention With Taxus and Cardiac Surgery] score
<=13) CTO PCI was associated with larger improvement in SWT than no CTO
PCI (p for interaction = 0.002). Driven by repeat intervention, major
adverse coronary event rates at 12 months were significantly lower in the
CTO PCI group (16.3% vs. 5.9%; p = 0.02). Conclusion(s): No benefit
was seen for CTO PCI in terms of the primary endpoint, SWT, or other
indexes of left ventricular function. CTO PCI resulted in clinical benefit
over no CTO PCI, as evidenced by reduced major adverse coronary event
rates at 12 months. Copyright © 2018 American College of
Cardiology Foundation

<37>
Accession Number
2001368229
Title
Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass
Grafting in Patients With Prior Cerebrovascular Disease: Results From the
EXCEL Trial.
Source
JACC: Cardiovascular Interventions. 11 (24) (pp 2441-2450), 2018. Date of
Publication: 24 December 2018.
Author
Diamond J.; Madhavan M.V.; Sabik J.F.; Serruys P.W.; Kappetein A.P.; Leon
M.B.; Taggart D.P.; Berland J.; Morice M.-C.; Gersh B.J.; Kandzari D.E.;
Dressler O.; Stone G.W.
Institution
(Diamond, Madhavan, Leon, Stone) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Leon, Dressler, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Taggart) John Radcliffe Hospital, Oxford, United Kingdom
(Berland) Clinique Saint Hilaire, Rouen, France
(Morice) Ramsay Generale de Sante - Institut Cardiovasculaire Paris Sud,
Massy, France
(Gersh) Mayo Clinic College of Medicine, Rochester, MN, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to determine whether high-risk
patients with left main coronary artery disease (LMCAD) and prior
cerebrovascular disease (CEVD) preferentially benefit from
revascularization by percutaneous coronary intervention (PCI) compared
with coronary artery bypass grafting (CABG). Background(s): Patients
with known CEVD requiring revascularization are often referred to PCI
rather than CABG. There is a paucity of data regarding the impact of CEVD
in patients with LMCAD undergoing revascularization. Method(s): In
the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization) trial, patients with LMCAD
and low or intermediate SYNTAX (Synergy Between PCI with Taxus and Cardiac
Surgery) scores were randomized to PCI with everolimus-eluting stents
versus CABG. The effects of prior CEVD, defined as prior stroke, transient
ischemic attack, or carotid artery disease, on 30-day and 3-year event
rates were assessed. Result(s): Prior CEVD was present in 233 of
1,898 patients (12.3%). These patients were older and had higher rates of
comorbidities, including hypertension, diabetes, peripheral vascular
disease, anemia, chronic kidney disease, and prior PCI, compared with
those without prior CEVD. Patients with prior CEVD had higher rates of
stroke at 30 days (2.2% vs. 0.8%; p = 0.05) and 3 years (6.4% vs. 2.2%; p
= 0.0003) and higher 3-year rates of the primary endpoint of all-cause
death, stroke, or myocardial infarction (25.0% vs. 13.6%; p < 0.0001). The
relative effects of PCI versus CABG on the 30-day and 3-year rates of
stroke (p<inf>interaction</inf> = 0.65 and 0.16, respectively) and the
3-year rates of the primary composite endpoint (p<inf>interaction</inf> =
0.14) were consistent in patients with and those without prior CEVD.
 Conclusion(s): Patients with LMCAD and prior CEVD compared with those
without CEVD have higher rates of stroke and reduced event-free survival
after revascularization. Data from the EXCEL trial do not a priori support
a preferential role of PCI over CABG in patients with known
CEVD. Copyright © 2018 American College of Cardiology Foundation

<38>
Accession Number
624786043
Title
Single versus dual antiplatelet therapy after transcatheter aortic valve
implantation: A systematic review and meta-analysis.
Source
Cardiology (Switzerland). 141 (1) (pp 52-65), 2018. Date of Publication:
01 Nov 2018.
Author
Hu X.; Yang F.-Y.; Wang Y.; Zhang Y.; Chen M.
Institution
(Hu, Yang, Wang, Zhang) West China School of Medicine, West China
Hospital, Sichuan University, Chengdu, China
(Chen) Department of Cardiology, West China Hospital, Sichuan University,
37 Guoxue Street, Chengdu 610041, China
Publisher
S. Karger AG
Abstract
Objectives: Although dual antiplatelet therapy (DAPT) with aspirin and
clopidogrel is currently recommended in patients after transcatheter
aortic valve implantation (TAVI), this practice is not supported by
sufficient evidence. This study was performed to compare DAPT to single
antiplatelet therapy (SAPT). Method(s): An electronic search was
completed of PubMed, Embase, Ovid Medline, Web of Science, and Cochrane
Central Register of Controlled Trials. Studies comparing DAPT versus SAPT
in patients undergoing TAVI were included. Result(s): Seven studies
incorporating 1,445 patients were eligible for the present meta-analysis.
There were no significant differences on 30-day all-cause mortality (OR
1.19, 95% CI 0.63-2.25, p = 0.593), 6-month all-cause mortality (OR 1.11,
95% CI 0.49-2.53, p = 0.796), or 1-year all-cause mortality (OR 1.19, 95%
CI 0.63- 2.25, p = 0.593). DAPT was associated with an increased risk for
30-day (OR 2.91, 95% CI 1.85-4.58, p < 0.01), 6-month (OR 2.54, 95% CI
1.26-5.10, p < 0.001), and 1-year major and lethal bleeding (OR 2.65, 95%
CI 1.04-6.77, p = 0.041) based on 896, 337, and 583 patients,
respectively, compared to SAPT. Conclusion(s): Compared to SAPT, DAPT
was not shown to be superior in reducing thrombotic events, but presented
an increased risk of major/life-threatening bleeding. More randomized
controlled trials are needed to provide further evidence. Copyright
© 2018 S. Karger AG, Basel.

<39>
Accession Number
623952028
Title
The prevalence of computed tomography-defined leaflet thrombosis in intra-
versus supra-annular transcatheter aortic valve prostheses.
Source
Catheterization and Cardiovascular Interventions. 92 (7) (pp 1414-1416),
2018. Date of Publication: 01 Dec 2018.
Author
Rashid H.N.; Nasis A.; Gooley R.P.; Cameron J.D.; Brown A.J.
Institution
(Rashid, Nasis, Gooley, Cameron, Brown) Monash Cardiovascular Research
Centre, MonashHEART, Monash Health, and Monash University, Clayton, VIC,
Australia
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Introduction: Leaflet thrombosis (LT) defined by computed tomography (CT)
following transcatheter aortic valve replacement (TAVR) has been shown to
increase cerebrovascular events. The neo-sinus plays an important role in
the development of LT. Intra-annular valves (IAV) have a larger neo-sinus
when compared to supra-annular valves (SAV), and has been associated with
larger thrombus burden. The prevalence of LT with IAV and SAV in a larger,
diverse cohort is unknown. Method(s): We performed a systematic
review to assess the prevalence of LT in IAV versus SAV TAVR prostheses.
Inclusion criteria were (1) reported CT-defined LT following TAVR, (2)
comparison between LT and non-LT cohort, (3) separate registry/database,
and (4) fully published status. A total of 2,013 citations were reviewed
and 7 studies were included. Result(s): Overall, 1,644 patients were
included from 7 observational studies and the prevalence of LT following
TAVR was 12.8%. The Portico valve system (IAV) had the highest prevalence
of LT with 35.2%, followed by Symetis Acurate Neo (SAV) at 15.4% and the
Lotus valve system (IAV) at 14.5%. LT occurred more frequently in IAV than
SAV (13.5% vs. 7%, P = 0.02). Subanalysis of IAV versus SAV with the
exclusion of the Portico valve was performed to ensure results were not
influenced by this valve system and revealed IAV still had higher rates of
LT (12.1% vs. 7%, P = 0.05). Conclusion(s): In summary, IAV
prostheses appear to be associated with higher rates of LT when compared
with SAV. Copyright © 2018 Wiley Periodicals, Inc.

<40>
Accession Number
2001325769
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Prior Cardiac Surgery in the Randomized PARTNER 2A Trial.
Source
JACC: Cardiovascular Interventions. 11 (21) (pp 2207-2216), 2018. Date of
Publication: 12 November 2018.
Author
Chen S.; Redfors B.; Ben-Yehuda O.; Crowley A.; Greason K.L.; Alu M.C.;
Finn M.T.; Vahl T.P.; Nazif T.; Thourani V.H.; Suri R.M.; Svensson L.;
Webb J.G.; Kodali S.K.; Leon M.B.
Institution
(Chen, Redfors, Ben-Yehuda, Crowley, Leon) Cardiovascular Research
Foundation, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Greason) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
MN, United States
(Alu, Finn, Vahl, Nazif, Kodali, Leon) Columbia University Medical
Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Thourani) Medstar Heart & Vascular Institute, Washington, District of
Columbia, United States
(Suri, Svensson) Cleveland Clinic, Cleveland, OH, United States
(Webb) St. Paul's Hospital, University of British Columbia, Vancouver,
British Columbia, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to further evaluate clinical
outcomes in patients with and without PCS. Background(s): Prior
cardiac surgery (PCS) is associated with increased surgical risk and
post-operative complications following surgical aortic valve replacement
(SAVR), but whether this risk is similar in transcatheter aortic valve
replacement (TAVR) is unclear. Method(s): In the PARTNER 2A
(Placement of Aortic Transcatheter Valve) trial, 2,032 patients with
severe aortic stenosis at intermediate surgical risk were randomized to
TAVR with the SAPIEN XT valve or SAVR. Adverse clinical outcomes at 30
days and 2 years were compared using Kaplan-Meier event rates and
multivariate Cox proportional hazards regression models. The primary
endpoint of the PARTNER 2 trial was all-cause death and disabling stroke.
 Result(s): Five hundred nine patients (25.1%) had PCS, mostly (98.2%)
coronary artery bypass grafting. There were no significant differences
between TAVR and SAVR in patients with or without PCS in the rates of the
primary endpoint at 30 days or 2 years. Nevertheless, an interaction was
observed between PCS and treatment arm; whereas no-PCS patients treated
with TAVR had higher rates of 30-day major vascular complications than
patients treated with SAVR (adjusted hazard ratio: 2.66; 95% confidence
interval: 1.68 to 4.22), the opposite was true for patients with PCS
(adjusted hazard ratio: 0.27; 95% confidence interval: 0.11 to 0.66)
(p<inf>interaction</inf> <0.0001). A similar interaction was observed for
life-threatening or disabling bleeding. Conclusion(s): In the PARTNER
2A trial of intermediate-risk patients with severe aortic stenosis
undergoing SAVR versus TAVR, the relative risk for 2-year adverse clinical
outcomes was similar between TAVR and SAVR in patients with or without
PCS. Copyright © 2018 American College of Cardiology Foundation

<41>
Accession Number
2004017767
Title
Echocardiographic Outcomes After Transcatheter Leaflet Approximation in
Patients With Secondary Mitral Regurgitation: The COAPT Trial.
Source
Journal of the American College of Cardiology. 74 (24) (pp 2969-2979),
2019. Date of Publication: 17 December 2019.
Author
Asch F.M.; Grayburn P.A.; Siegel R.J.; Kar S.; Lim D.S.; Zaroff J.G.;
Mishell J.M.; Whisenant B.; Mack M.J.; Lindenfeld J.; Abraham W.T.; Stone
G.W.; Weissman N.J.
Institution
(Asch, Weissman) Cardiovascular Core Laboratories, MedStar Health Research
Institute, Washington, DC, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(Siegel, Kar) Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United
States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Zaroff, Mishell) Kaiser Permanente-San Francisco Hospital, San Francisco,
CA, United States
(Whisenant) Intermountain Medical Center, Murray, UT, United States
(Mack) Baylor Scott & White Heart and Vascular Hospital, Plano, TX, United
States
(Lindenfeld) Advanced Heart Failure, Vanderbilt Heart and Vascular
Institute, Nashville, TN, United States
(Abraham) Departments of Medicine, Physiology, and Cell Biology, Division
of Cardiovascular Medicine, and the Davis Heart and Lung Research
Institute, The Ohio State University, Columbus, OH, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Stone) The Cardiovascular Research Foundation, New York, NY, United
States
Publisher
Elsevier USA
Abstract
Background: In the COAPT (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients with Functional
Mitral Regurgitation) trial among patients with heart failure (HF) and
moderate-to-severe (3+) or severe (4+) secondary mitral regurgitation,
patients treated with transcatheter mitral valve repair (TMVr) through
leaflet approximation had reduced rates of HF hospitalization and
mortality compared with guideline-directed medical therapy (GDMT) alone.
 Objective(s): The purpose of this study was to describe the
echocardiographic patient qualification process for the COAPT trial,
baseline echocardiographic characteristics, changes over time, and the
interaction between treatment group and echocardiographic parameters on
clinical outcomes. Method(s): A novel echocardiographic algorithm was
implemented for grading mitral regurgitation severity during the screening
process. Standardized echocardiograms were obtained at baseline and during
regular follow-up intervals through 2 years, and were analyzed by a core
laboratory. Result(s): A total of 614 patients were randomized to
TMVr plus maximally tolerated GDMT or GDMT alone. Mean baseline left
ventricular (LV) ejection fraction was 31.3 +/- 9.3%, LV end-diastolic
volume was 192.7 +/- 71 ml, and effective regurgitant orifice area was
0.41 +/- 0.15 cm2. The beneficial effect of TMVr compared with
GDMT alone was consistent in all echocardiographic subgroups, independent
of the severity of LV dysfunction, LV dilatation, pulmonary hypertension,
severity of tricuspid regurgitation, or individual mitral regurgitation
characteristics. The LV ejection fraction decreased and the LV volumes
progressively increased in both groups during follow-up, although less
after TMVr (p < 0.05). Conclusion(s): HF patients in the COAPT trial
with 3+ or 4+ secondary mitral regurgitation, selected using strict
echocardiographic criteria, benefitted from TMVr with reduced 2-year rates
of death and HF hospitalization. Strict application of these
echocardiographic criteria should enable the COAPT results to be
translated to clinical practice. (Cardiovascular Outcomes Assessment of
the MitraClip Percutaneous Therapy for Heart Failure Patients With
Functional Mitral Regurgitation [The COAPT Trial] [COAPT];
NCT01626079) Copyright © 2019 The Authors

<42>
Accession Number
629980000
Title
Effect of lidocaine cream analgesia for chest drain tube removal after
video-assisted thoracoscopic surgery for lung cancer: A randomized
clinical trial.
Source
Regional Anesthesia and Pain Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Watanabe S.-N.; Imai K.; Kimura T.; Saito Y.; Takashima S.; Matsuzaki I.;
Kurihara N.; Atari M.; Matsuo T.; Iwai H.; Sato Y.; Motoyama S.; Nomura
K.; Nishikawa T.; Minamiya Y.
Institution
(Watanabe, Imai, Saito, Takashima, Matsuzaki, Kurihara, Atari, Matsuo,
Iwai, Sato, Motoyama, Minamiya) Thoracic Surgery, Akita University
Graduate School of Medicine, School of Medicine, Akita 010-8543, Japan
(Kimura, Nishikawa) Anesthesia and Intensive Care Medicine, Akita
University Graduate School of Medicine, School of Medicine, Akita, Japan
(Nomura) Public Health, Akita University Graduate School of Medicine,
School of Medicine, Akita, Japan
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background and objectives: Pain management makes an important contribution
to good respiratory care and early recovery after thoracic surgery.
Although the development of video-assisted thoracoscopic surgery (VATS)
has led to improved patient outcomes, chest tube removal could be
distressful experience for many patients. The aim of this trial was to
test whether the addition of lidocaine cream would have a signii cant
impact on the pain treatment during chest tube removal from patients who
had undergone VATS for lung cancer. Method(s): This clinical trial
was a double-blind randomized study. Forty patients with histologically
confirmed lung cancer amenable to lobectomy/segmentectomy were enrolled.
All patients had standard perioperative care. Patients were randomly
assigned to receive either epidural anesthesia plus placebo cream
(placebo, Group P) or epidural anesthesia plus 7% lidocaine cream
cutaneously around the chest tube insertion site and on the skin over the
tube's course 20 min (Group L) before chest drain removal. Result(s):
Visual analog scale (VAS) scores were higher in Group P (median 5, IQR,
3.25-8) than in Group L (median 2, IQR, 1-3). Pain intensities measured
using a PainVision system were also higher in Group P (median 296.7, IQR,
216.9-563.5) than Group L (median 41.2, IQR, 11.8-97.0). VAS scores and
the pain intensity associated with chest drain removal were significantly
lower in Group L than Group P (p=0.0002 vs p<0.0001). Conclusion(s):
Analgesia using lidocaine cream is a very simple way to reduce the pain of
chest tube removal after VATS. Copyright © American Society of
Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights
and permissions. Published by BMJ.

<43>
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.
 Objective(s): To determine if fibrinogen concentrate is noninferior
to cryoprecipitate for treatment of bleeding related to hypofibrinogenemia
after cardiac surgery. 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. Intervention(s): Fibrinogen concentrate (4 g; n = 415) or
cryoprecipitate (10 units; n = 412) for each ordered dose within 24 hours
after cardiopulmonary bypass. 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). 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. 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. Copyright © 2019
American Medical Association. All rights reserved.

<44>
Accession Number
627607461
Title
Meta-Analysis Comparing Renal Outcomes after Transcatheter versus Surgical
Aortic Valve Replacement.
Source
Journal of Interventional Cardiology. 2019 (no pagination), 2019. Article
Number: 3537256. Date of Publication: 2019.
Author
Shah K.; Chaker Z.; Busu T.; Shah R.; Osman M.; Alqahtani F.; Alkhouli M.
Institution
(Shah, Shah, Osman, Alqahtani, Alkhouli) Division of Cardiology, West
Virginia School of Medicine, Morgantown, WV, United States
(Chaker, Busu) Department of Medicine, West Virginia School of Medicine,
Morgantown, WV, United States
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Acute kidney injury (AKI) is a common complication of aortic
valve replacement. However, comparative on the incidence of (AKI)
following transcatheter (TAVR) versus surgical valve replacement (SAVR) is
sparse. Methods. We performed a meta-analysis of the randomized controlled
trials (RCT) and propensity-matched observational studies comparing (A)
incidence of AKI and (B) incidence of dialysis-requiring AKI at 30 days
after TAVR and SAVR. Results. Twenty-six studies (20 propensity-matched
studies; 6 RCTs) including 19,954 patients were analyzed. The incidence of
AKI was lower after TAVR than after SAVR (7.1% vs. 12.1%, OR 0.52; 95%CI,
0.39-0.68; p<0.001, I2=57%), but the incidence of
dialysis-requiring AKI was similar (2.8% vs. 4.1%, OR 0.78; 95%CI,
0.49-1.25; p=0.31, I2=70%). Similar results were observed in a
sensitivity analysis including RCTs only for both AKI ([5 RCTs; 5,418
patients], 2.0% vs. 5.0%, OR 0.39; 95%CI, 0.28-0.53; p<0.001,
I2=0%), and dialysis-requiring AKI ([2 RCTs; 769 patients];
2.9% vs. 2.6%, OR 1.1; 95%CI, 0.47-2.58; p=0.83, I2=0%).
However, in studies including low-intermediate risk patients only, TAVR
was associated with lower incidence of AKI ([10 studies; 6,510 patients],
7.6% vs. 12.4%, OR 0.55, 95%CI 0.39-0.77, p<0.001, I2=57%), and
dialysis-requiring AKI, ([10 studies; 12,034 patients], 2.0% vs. 3.6%, OR
0.57, 95%CI 0.38-0.85, p=0.005, I2=23%). Conclusions. TAVR is
associated with better renal outcomes at 30 days in comparison with SAVR,
especially in patients at low-intermediate surgical risk. Further studies
are needed to assess the impact of AKI on long-term outcomes of patients
undergoing TAVR and SAVR. Copyright © 2019 Kuldeep Shah et al.

<45>
Accession Number
627607460
Title
Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in
Patients with Functional Mitral Regurgitation: A Systematic Review and
Meta-Analysis.
Source
Journal of Interventional Cardiology. 2019 (no pagination), 2019. Article
Number: 2753146. Date of Publication: 2019.
Author
Lodhi M.U.; Usman M.S.; Siddiqi T.J.; Khan M.S.; Khan M.A.A.; Khan S.U.;
Syed I.A.; Rahim M.; Naidu S.S.; Doukky R.; Alkhouli M.
Institution
(Lodhi, Syed) Department of Internal Medicine, Raleigh General Hospital,
West Virginia University, WV, United States
(Usman, Siddiqi, Khan) Department of Internal Medicine, Civil Hospital,
Dow University, Karachi, Pakistan
(Khan, Doukky) Department of Internal Medicine, John H Stroger Jr.
Hospital of Cook County, Chicago, IL, United States
(Khan, Rahim) Department of Internal Medicine, West Virginia University,
WV, United States
(Naidu) Division of Cardiology, Westchester Medical Center, Valhalla, NY,
United States
(Doukky) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
(Alkhouli) Division of Cardiology, West Virginia University, Morgantown,
WV, United States
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objectives. To compare percutaneous mitral valve repair (PMVR) with
optimal medical therapy (OMT) in patients with heart failure (HF) and
severe functional mitral regurgitation (FMR). Background. Many patients
with HF and FMR are not suitable for surgical valve replacement and remain
symptomatic despite maximal OMT. PMVR has recently emerged as an
alternative solution. Methods. We performed a systematic review and a
meta-analysis to address this question. Cochrane CENTRAL, MEDLINE, and
Scopus were searched for randomized (RCT) and nonrandomized studies
comparing PMVR with OMT in patients with HF and FMR. Primary endpoint was
all-cause midterm mortality (at 1 and 2 years). Secondary endpoints were
30-day mortality and cardiovascular mortality and HF hospitalizations, at
maximum follow-up. Studies including mixed cohort of degenerative and
functional MR were allowed initially but were excluded in a secondary
sensitivity analysis for each of the study's end points. This
meta-analysis was performed following the publication of two RCTs
(MITRA-FR and COAPT). Results. Eight studies (six observational, two RCTs)
comprising 3,009 patients were included in the meta-analysis. In
comparison with OMT, PMVR significantly reduced 1-year mortality (RR: 0.70
[0.56, 0.87]; p=0.002; I2=47.6%), 2-year mortality (RR: 0.63
[0.55, 0.73]; p<0.001; I2=0%), and cardiovascular mortality
(RR: 0.32 [0.23, 0.44]; p<0.001; I2=0%). No significant
difference between PMVR+OMT and OMT was noted in HF hospitalization (HR:
0.69 [0.40, 1.20]; p=0.19; I2=85%) and 30-day mortality (RR:
1.13 [0.68, 1.87]; p=0.16; I2=0%). Conclusions. In comparison
with OMT, PMVR significantly reduces 1-year mortality, 2-year mortality,
and cardiovascular mortality in patients with HF and severe
MR. Copyright © 2019 Muhammad Uzair Lodhi et al.

<46>
Accession Number
627250473
Title
One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve
Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A
Meta-Analysis and Meta-Regression.
Source
Journal of Interventional Cardiology. 2019 (no pagination), 2019. Article
Number: 8947204. Date of Publication: 2019.
Author
Quintana R.A.; Monlezun D.J.; Dasilva-Deabreu A.; Sandhu U.G.; Okwan-Duodu
D.; Ramirez J.; Denktas A.E.; Jneid H.; Paniagua D.
Institution
(Quintana, Okwan-Duodu) Division of Cardiology, Department of Medicine,
Emory University School of Medicine, Atlanta, GA, United States
(Monlezun) Division of Cardiology, Department of Medicine, University of
Texas MD Anderson Cancer Center, Houston, TX, United States
(Dasilva-Deabreu) Division of Cardiology, John Ochsner Heart and Vascular
Institute, New Orleans, LA, United States
(Sandhu) Division of Cardiology, Department of Medicine, University of
California San Francisco-Fresno, Fresno, CA, United States
(Ramirez) Department of Pediatrics, Affiliated with Weil Cornell College
of Medicine, Lincoln Medical and Mental Health Center, Bronx, NY, United
States
(Denktas, Jneid, Paniagua) Division of Cardiology, Department of Medicine,
Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston,
TX, United States
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objective. To assess 1-year mortality after transcatheter aortic valve
replacement (TAVR) in patients with bicuspid aortic stenosis (AS).
Background. Clinical trials have proven the beneficial effect of TAVR on
mortality in patients with tricuspid AS. Individuals with bicuspid AS were
excluded from these trials. Methods. A meta-analysis using literature
search from the Cochrane, PubMed, ClinicalTrials, SCOPUS, and EMBASE
databases was conducted to determine the effect of TAVR on 1-year
mortality in patients with bicuspid AS. Short-term outcomes that could
potentially impact one-year mortality were analyzed. Results. After
evaluating 380 potential articles, 5 observational studies were selected.
A total of 3890 patients treated with TAVR were included: 721 had bicuspid
and 3,169 had tricuspid AS. No statistically significant difference
between the baseline characteristics of the two groups of patients was
seen outside of mean aortic gradient. Our primary endpoint of one-year
all-cause mortality revealed 85 deaths in 719 patients (11.82%) with
bicuspid AS compared to 467 deaths in 3100 patients (15.06%) with
tricuspid AS, with no difference between both groups [relative risk (RR)
1.03; 95% CI 0.70-1.51]. Patients with bicuspid AS were associated with a
decrease in device success (RR 0.62; 95% CI 0.45-0.84) and an increase in
moderate-to-severe prosthetic valve regurgitation (RR 1.55; 95% CI
1.07-2.22) after TAVR compared to patients with tricuspid AS. The effect
of meta-regression coefficients on one-year all-cause mortality was not
statistically significant for any patient baseline characteristics.
Conclusion. When comparing TAVR procedure in tricuspid AS versus bicuspid
AS, there was no difference noted in one-year all-cause
mortality. Copyright © 2019 Raymundo A. Quintana et al.

<47>
Accession Number
627248090
Title
Clinical Outcomes of Transcatheter Aortic Valve Replacement in
Nonagenarians: A Systematic Review and Meta-Analysis.
Source
Journal of Interventional Cardiology. 2019 (no pagination), 2019. Article
Number: 5819232. Date of Publication: 2019.
Author
Liu Y.; Du Y.; Fu M.; Ma Y.; Wang D.; Zhang J.; Liu W.; Zhao Y.; Zhou Y.
Institution
(Liu, Du, Fu, Ma, Wang, Zhang, Liu, Zhao, Zhou) Department of Cardiology,
12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing
Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory
of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center
for Coronary Heart Disease, Beijing 100029, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objectives. To compare the incidence of mortality and complications
between nonagenarians and younger patients undergoing transcatheter aortic
valve replacement (TAVR). Background. TAVR has become an alternative
treatment for nonagenarian patients with severe aortic stenosis. Previous
studies have reported conflicting results regarding the clinical outcomes
between nonagenarians and younger patients who underwent TAVR. Methods. We
searched PubMed, EMBASE, and Cochrane Library databases with predefined
criteria from the inception dates to July 8, 2018. The primary clinical
endpoint was 30-day and 1-year all-cause mortalities. Secondary outcomes
were considered the rates of stroke, myocardial infarction, any bleeding,
any acute kidney injury, any vascular complications, new pacemaker
implantation, and conversion to surgical aortic valve replacement.
Results. A total of 5 eligible studies with 25,371 patients were included
in this meta-analysis. Compared with younger patients who underwent TAVR,
nonagenarians had a significantly higher mean Society of Thoracic Surgeons
score (STS score) (MD, 2.80; 95%CI: 2.58, 3.30; P<0.00001) and logistic
European System for Cardiac Operative Risk Evaluation (logistic EuroSCORE)
(MD, 2.72; 95%CI: 1.01, 4.43; P=0.002). Nonagenarians were associated with
significantly higher 30-day mortality (6.2% vs. 3.7%; OR, 1.73; 95%CI:
1.49, 2.00) and 1-year mortality (15.5% vs. 11.8%; OR, 1.39; 95%CI: 1.26,
1.53), without significant statistical heterogeneity. Nonagenarians were
associated with significantly increased rates of major or life-threatening
bleeding, vascular complications and stroke of 20%, 35%, and 32%,
respectively. There were no significant differences in the rate of
myocardial infarction, stage 2 or 3 acute kidney injury, new pacemaker
implantation, or conversion to surgical aortic valve replacement.
Conclusions. Nonagenarians showed worse clinical outcomes than younger
patients after TAVR, while the incidence of mortality was acceptable. TAVR
remains an option for nonagenarian patients with severe aortic stenosis
and should be comprehensively evaluated by the heart valve
team. Copyright © 2019 Yan Liu et al.

<48>
Accession Number
2004021580
Title
STEREOTACTIC BODY RADIOTHERAPY FOR OLIGOMETASTATIC CANCER: A RAPID REVIEW
OF THE CLINICAL EFFECTIVENESS AND COST-EFFECTIVENESS.
Source
Radiotherapy and Oncology. Conference: CARO 2019: Annual Scientific
Meeting. United States. 139 (Supplement 1) (pp S99), 2019. Date of
Publication: October 2019.
Author
Sutherland J.; Lachance C.; Campbell K.; Cooper-Jones B.
Institution
(Lachance, Campbell) Canadian Agency for Drugs and Technologies in Health,
Ottawa, ON, Canada
(Cooper-Jones) Canadian Agency for Drugs and Technologies in Health,
Vancouver, BC, Canada
(Sutherland) Canadian Agency for Drugs and Technologies in Health,
Winnipeg, MB, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Purpose: The National Cancer Institute defines oligometastasis as a "type
of metastasis in which cancer cells from the original (primary) tumour
travel through the body and form a small number of new tumours (metastatic
tumours) in one or two other parts of the body." One potential treatment
for patients with oligometastatic cancer is stereotactic body radiotherapy
(SBRT, also known as stereotactic ablative radiotherapy).
 Objective(s): To summarize the evidence regarding the clinical
effectiveness and cost-effectiveness of SBRT for patients with
oligometastatic cancer. Material(s) and Method(s): A limited
literature search was conducted of three academic databases and the grey
literature, and titles and abstracts of the retrieved publications were
reviewed. Full-text publications were evaluated for final article
selection according to predetermined selection criteria (population,
intervention, comparator, outcomes, and study designs). Studies that did
not directly describe the target population as patients with
oligometastatic cancer were excluded. Result(s): The literature
search of the academic databases identified 798 citations, with one
additional article identified from the grey literature. After screening
the abstracts, 79 were deemed potentially relevant, and four met the
criteria for inclusion in this review - three retrospective cohort studies
that compared SBRT to usual care for patients with adrenal metastatic
tumours or pulmonary (lung) oligometastases, and one economic evaluation.
Overall, the clinical evidence was of limited quality. One cohort study
found local control for adrenal metastasis in patients with
oligometastasis was most effective with real-time tumour-tracking
radiotherapy (RTRT) versus SBRT, although there were more adverse events
with RTRT. The other two cohort studies considered patients with pulmonary
metastases (comparing SBRT to pulmonary metastasectomy) and did not find
any significant differences in the outcomes investigated (overall survival
rates, progression-free survival, freedom from failure of local strategy,
and freedom from local progression). The economic evaluation assessed the
cost-effectiveness of initial management strategies including SBRT for
pulmonary oligometastases in patients with melanoma, non-small cell lung
cancer (NSCLC; three types), and colon cancer. For melanoma and NSCLC
adenocarcinoma, SBRT was the most cost-effective; for the other NSCLC
subtypes examined, systemic therapy was more cost-effective; and, for
colon cancer, video-assisted thoracic surgery (VATS) wedge resection was
more cost-effective. However, it is unclear whether these findings can be
applied to a Canadian setting. Conclusion(s): Given the limited
availability and low quality of evidence, the effectiveness and use of
stereotactic body radiotherapy for oligometastatic cancer remains
uncertain. Copyright © 2019 Elsevier Ireland Ltd

<49>
Accession Number
629992767
Title
Levosimendan Reduces Mortality and Low Cardiac Output Syndrome in Cardiac
Surgery.
Source
The Thoracic and cardiovascular surgeon. (no pagination), 2019. Date of
Publication: 26 Nov 2019.
Author
Weber C.; Esser M.; Eghbalzadeh K.; Sabashnikov A.; Djordjevic I.; Maier
J.; Merkle J.; Choi Y.-H.; Madershahian N.; Liakopoulos O.; Deppe A.C.;
Wahlers T.C.W.
Institution
(Weber, Esser, Eghbalzadeh, Sabashnikov, Djordjevic, Maier, Merkle, Choi,
Madershahian, Liakopoulos, Deppe, Wahlers) Department of Cardiothoracic
Surgery, University of Cologne, Cologne, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: There has been conflicting evidence concerning the effect of
levosimendan on clinical outcomes in patients undergoing cardiac surgery.
Therefore, we performed a systematic review and conducted this
meta-analysis to provide evidence for/against the administration of
levosimendan in cardiac surgery patients. METHOD(S): We performed a
meta-analysis from literature search in PubMed, EMBASE, and Cochrane
Library. Only randomized controlled trials comparing the administration of
levosimendan in cardiac surgery patients with a control group (other
inotrope, standard therapy/placebo, or an intra-aortic balloon pump) were
included. In addition, at least one clinical outcome had to be mentioned:
mortality, myocardial infarction, low cardiac output syndrome (LCOS),
acute kidney injury, renal replacement therapy, atrial fibrillation,
prolonged inotropic support, length of intensive care unit, and hospital
stay. The pooled treatment effects (odds ratio [OR], 95% confidence
intervals [CI]) were assessed using a fixed or random effects model.
 RESULT(S): The literature search retrieved 27 randomized, controlled
trials involving a total of 3,198 patients. Levosimendan led to a
significant reduction in mortality (OR: 0.67; 95% CI: 0.49-0.91;
p=0.0087). Furthermore, the incidence of LCOS (OR: 0.56, 95% CI:
0.42-0.75; p<0.0001), acute kidney injury (OR: 0.63; 95% CI: 0.46-0.86;
p=0.0039), and renal replacement therapy (OR: 0.70; 95% CI: 0.50-0.98;
p=0.0332) was significantly decreased in the levosimendan group.
 CONCLUSION(S): Our meta-analysis suggests beneficial effects for the
prophylactic use of levosimendan in patients with severely impaired left
ventricular function undergoing cardiac surgery. The administration of
levosimendan was associated with a reduced mortality, less LCOS, and
restored adequate organ perfusion reflected in less acute kidney
injury. Copyright Georg Thieme Verlag KG Stuttgart . New York.

<50>
Accession Number
629927672
Title
Commentary on the Nordic-Baltic bifurcation study IV (randomised
comparison of provisional side branch stenting versus a two-stent strategy
for treatment of true coronary bifurcation lesions involving a large side
branch).
Source
Open Heart. 6 (2) (no pagination), 2019. Article Number: e001168. Date of
Publication: 01 Nov 2019.
Author
Alasnag M.; Bharadwaj A.; Al-Shaibi K.
Institution
(Alasnag, Al-Shaibi) Cardiology, King Fahd Armed Forces Hospital, Jeddah
23311, Saudi Arabia
(Bharadwaj) Cardiology, Loma Linda University, Loma Linda, CA, United
States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)

<51>
Accession Number
2001546788
Title
Effect of pranayama on anxiety and pain among patients undergoing cardiac
surgery: A non-randomized controlled trial.
Source
Clinical Epidemiology and Global Health. 7 (4) (pp 606-610), 2019. Date of
Publication: December 2019.
Author
Chandrababu R.; Kurup S.B.; Ravishankar N.; Ramesh J.
Institution
(Chandrababu) Manipal College of Nursing, Manipal Academy of Higher
Education, Manipal, Karnataka 576104, India
(Kurup) Sri Ramachandra College of Nursing, Sri Ramachandra Institute of
Higher Education and Research, Porur, Chennai 600116, India
(Ravishankar) Department of Statistics, Prasanna School of Public Health,
Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
(Ramesh) Udupi College of Nursing, Shree Krishna Educational Trust,
Manipal, Karnataka 576104, India
Publisher
Elsevier B.V.
Abstract
Background: Major cardiac surgery could be physically and mentally
stressful. Anxiety and pain are commonly experienced by patients while
undergoing cardiac surgery. Yoga is recognized as the most beneficial
complementary and alternative therapy. Objective(s): To assess the
effect of alternate nostril breathing exercises (pranayama) on anxiety and
pain among patients undergoing cardiac surgery. Method(s): A
non-randomized controlled trial was adopted as study design and involved
48 patients undergoing cardiac surgery. The experimental group (n = 24)
received pranayama study intervention while the control group (n = 24)
received routine care of the hospital. Outcomes were state anxiety and
pain, measured with the state anxiety inventory and a visual analogue
scale respectively. Data were analyzed by SPSS version 20.0. Repeated
measures ANOVA was used to test the effect of the intervention.
 Result(s): Study results showed that patients in the experimental
group experienced a significant decrease in anxiety (p < 0.05) than the
control group. There was a decrease in pain scores but was not
statistically significant across different time point measurements at p <
0.05 between the groups. Conclusion(s): These findings support the
use of pranayama for decreasing anxiety among patients undergoing cardiac
surgery. However, there is a need for randomized controlled trials with
higher sample size to confirm this results. Future trials also should
focus on the estimation of relevant biomarkers such as endorphins to
understand the scientific rationale. Copyright © 2019 INDIACLEN

<52>
Accession Number
629725262
Title
The serratus plane block for postoperative analgesia in breast and
thoracic surgery: A systematic review and meta-analysis.
Source
Regional Anesthesia and Pain Medicine. 44 (12) (pp 1066-1074), 2019. Date
of Publication: 01 Dec 2019.
Author
Chong M.; Berbenetz N.; Kumar K.; Lin C.
Institution
(Chong, Kumar, Lin) Department of Anesthesia and Perioperative Medicine,
Western University, London, ON N6A 3K7, Canada
(Berbenetz) Department of Medicine, Queen's University, Kingston, ON,
Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background and objectives The serratus plane block (SPB) is a novel chest
wall interfascial plane block. Its analgesic efficacy compared with
non-block care and paravertebral block (PVB) is unestablished. Methods We
conducted a random-effects meta-analysis of randomized controlled trials
(RCTs) recruiting adult surgical patients that compared a SPB to non-block
care or PVB for postoperative analgesia. Visual analog scale pain scores
were the primary outcome. Database sources were Medline, Embase, the
Cochrane Library, and Google Scholar searched up to July 29, 2019 without
language restriction. Risk of bias was assessed using Cochrane
methodology. Results Nineteen RCTs that comprised 1260 patients were
included. Six trials involved thoracic surgery patients and 13 studied
breast surgery patients. SPB reduced pain scores 0 hour postoperatively
(-1.62 cm; 99% CI-2.43 to-0.81; p<0.001; I 2 =92%), at 2-4 hours (-1.29
cm; 99% CI-2.08 to-0.49; p<0.001; I 2 =92%), at 6 hours (-1.69 cm; 99%
CI-3.19 to-0.20; p=0.004; I 2 =99%), and up to 24 hours compared with
non-block care. SPB also prolonged the time to first analgesic request
(193.2 min; 95% CI 7.2 to 379.2 min; p=0.04; I 2 =99%), reduced 24-hour
postoperative opioid consumption (-11.27 mg of IV morphine
equivalent;-17.36 to-5.18 mg; p<0.001), and reduced postoperative nausea
and vomiting (RR 0.51; 95% CI 0.38 to 0.68; p<0.001; I 2 =12%). In
contrast, no meaningful differences were detected in any of the outcomes
for the SPB versus PVB data. Conclusions SPB reduced postoperative pain
scores (Grading of Recommendations Assessment, Development, and Evaluation
rating: low; due to heterogeneity and deficiencies in blinding) in breast
and thoracic surgery patients compared with non-block care. Based on five
trials only, SPB was not appreciably different from PVB. Copyright
© American Society of Regional Anesthesia & Pain Medicine 2019. No
commercial re-use. See rights and permissions. Published by BMJ.

<53>
Accession Number
624513084
Title
Effect of Cricoid Pressure Compared with a Sham Procedure in the Rapid
Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial.
Source
JAMA Surgery. 154 (1) (pp 9-17), 2019. Date of Publication: January 2019.
Author
Birenbaum A.; Hajage D.; Roche S.; Ntouba A.; Eurin M.; Cuvillon P.; Rohn
A.; Compere V.; Benhamou D.; Biais M.; Menut R.; Benachi S.; Lenfant F.;
Riou B.
Institution
(Birenbaum, Roche) Department of Anesthesiology and Critical Care, Hopital
Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Paris, France
(Hajage) Sorbonne Universite, Department of Biostatistics Public Health
and Medical Information, Hopital Pitie-Salpetriere, Assistance
Publique-Hopitaux de Paris, Paris, France
(Ntouba) Universite Jules Verne, Department of Anesthesiology and Critical
Care, CHI Amiens-Picardie, Amiens, France
(Eurin) Department of Anesthesiology and Critical Care, Hopital Beaujon,
Assistance Publique-Hopitaux de Paris, Clichy, France
(Cuvillon) Universite de Montpellier, Department of Anesthesiology and
Critical Care, Hopital Caremeau, Nimes, France
(Rohn) Department of Anesthesiology and Critical Care, Centre Hospitalier
Universitaire Regional de Lille, Lille, France
(Compere) Universite de Haute-Normandie, Department of Anesthesiology and
Critical Care, Hopital, Rouen, France
(Benhamou) Universite Paris-Sud, Department of Anesthesiology and Critical
Care, Hopital Bicetre, Assistance Publique-Hopitaux de Paris, Le
Kremlin-Bicetre, France
(Biais) Universite Victor Segalen, Department of Anesthesiology and
Critical Care, Hopital Pellegrin, Bordeaux, France
(Menut) Universite Toulouse 3-Paul Sabatier, Department of Anesthesiology
and Intensive Care, University Hospital of Toulouse, Toulouse, France
(Benachi) Department of Anesthesiology and Critical Care, Hopital
Avicenne, Assistance Publique-Hopitaux de Paris, Bobigny, France
(Lenfant) Department of Anesthesiology, Centre Hospitalier Simone Veil,
Cannes, France
(Riou) Sorbonne Universite, UMR Inserm, Institut Hospitalo-universitaire
ICAN, Department of Emergency Medicine and Surgery, Hopital
Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Paris, France
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The use of cricoid pressure (Sellick maneuver) during rapid
sequence induction (RSI) of anesthesia remains controversial in the
absence of a large randomized trial. Objective(s): To test the
hypothesis that the incidence of pulmonary aspiration is not increased
when cricoid pressure is not performed. Design, Setting, and
Participant(s): Randomized, double-blind, noninferiority trial conducted
in 10 academic centers. Patients undergoing anesthesia with RSI were
enrolled from February 2014 until February 2017 and followed up for 28
days or until hospital discharge (last follow-up, February 8, 2017).
 Intervention(s): Patients were assigned to a cricoid pressure
(Sellick group) or a sham procedure group. Main Outcomes and
Measures: Primary end point was the incidence of pulmonary aspiration (at
the glottis level during laryngoscopy or by tracheal aspiration after
intubation). It was hypothesized that the sham procedure would not be
inferior to the cricoid pressure. The secondary end points were related to
pulmonary aspiration, difficult tracheal intubation, and traumatic
complications owing to the tracheal intubation or cricoid pressure.
 Result(s): Of 3472 patients randomized, mean (SD) age was 51 (19)
years and 1777 (51%) were men. The primary end point, pulmonary
aspiration, occurred in 10 patients (0.6%) in the Sellick group and in 9
patients (0.5%) in the sham group. The upper limit of the 1-sided 95% CI
of relative risk was 2.00, exceeding 1.50, failing to demonstrate
noninferiority (P =.14). The risk difference was -0.06% (2-sided 95% CI,
-0.57 to 0.42) in the intent-to-treat population and -0.06% (2-sided 95%
CI, -0.56 to 0.43) in the per protocol population. Secondary end points
were not significantly different among the 2 groups (pneumonia, length of
stay, and mortality), although the comparison of the Cormack and Lehane
grade (Grades 3 and 4, 10% vs 5%; P <.001) and the longer intubation time
(Intubation time >30 seconds, 47% vs 40%; P <.001) suggest an increased
difficulty of tracheal intubation in the Sellick group. Conclusions
and Relevance: This large randomized clinical trial performed in patients
undergoing anesthesia with RSI failed to demonstrate the noninferiority of
the sham procedure in preventing pulmonary aspiration. Further studies are
required in pregnant women and outside the operating room. Trial
Registration: ClinicalTrials.gov Identifier: NCT02080754. Copyright
© 2018 American Medical Association. All rights reserved.

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

<55>
Accession Number
2002255546
Title
Comparison of 3 blind brachial plexus block techniques during maintenance
of anesthesia and postoperative pain scores in dogs undergoing surgical
procedures of the thoracic limb.
Source
Canadian Journal of Veterinary Research. 83 (3) (pp 197-205), 2019. Date
of Publication: July 2019.
Author
Skelding A.; Valverde A.; Aguilera R.; Moens N.M.; Sinclair M.; Thomason
J.J.
Institution
(Skelding, Valverde, Aguilera, Moens, Sinclair) Department of Clinical
Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G
2W1, Canada
(Thomason) Department of Biomedical Sciences, Ontario Veterinary College,
University of Guelph, Guelph, ON N1G 2W1, Canada
Publisher
Canadian Veterinary Medical Association (339 Booth Street, Ottawa ONT K1R
7K1, Canada)
Abstract
The degree of analgesia provided by blind techniques for brachial plexus
blocks (BPBs) has not been compared in clinical cases undergoing surgery
of the thoracic limb. The objective of this study was to evaluate the
anesthetic conditions and postoperative analgesia resulting from 3
different BPB local anesthetic techniques in canine patients undergoing
such surgery. Twenty-four client-owned dogs received a standardized
premedication/induction protocol (hydromorphone and
acepromazine/propofol), maintained with isoflurane in oxygen using
mechanical ventilation, in a prospective, randomized, blinded clinical
trial. Before surgery, dogs received 1 of 3 anatomical BPB techniques:
traditional, perpendicular, or axillary, with 0.2 mL/kg body weight (BW)
of bupivacaine 0.5%. Cardiorespiratory variables and isoflurane end-tidal
concentrations were recorded throughout anesthesia. Scores for anesthetic
maintenance (0-best to 4-responsive), recovery quality (0-not responsive
to 3-responsive), and Glasgow pain scale were recorded for up to 24 h
postoperatively. All dogs recovered uneventfully from anesthesia and no
differences in the measured variables or scores were noted among groups,
during and after anesthesia. When thoracic limb amputations in each of the
3 groups (n = 9; 4 in traditional, 3 in perpendicular, 2 in axillary) were
compared to the other surgical procedures (n = 15); however, scores for
anesthetic maintenance were higher [0 (0 to 1) versus 0 (0 to 0); median
(interquartile range)], recovery [1 (0 to 2) versus 0 (0 to 0)], and pain
[2.4 (2.4 to 3.0) versus 1.6 (1.4 to 2.2)] in the first 3 h
post-extubation. Surgery times were also longer with amputations [115 min
(100 to 138 min) versus 50 min (41 to 90 min)]. The 3 BPB techniques
provided similar anesthesia and postoperative pain scores. Despite higher
pain scores in thoracic limb amputations than in less invasive surgeries,
the BPB appeared to provide significant comfort. Copyright ©
2019, Canadian Veterinary Medical Association. All rights reserved.

<56>
Accession Number
2002019573
Title
Individualized decision aid for diverse women with lupus nephritis
(IDEA-WON): A randomized controlled trial.
Source
PLoS Medicine. 16 (5) (no pagination), 2019. Article Number: e1002800.
Date of Publication: May 2019.
Author
Singh J.A.; Fraenkel L.; Green C.; Alarcon G.S.; Barton J.L.; Saag K.G.;
Hanrahan L.M.; Raymond S.C.; Kimberly R.P.; Leong A.L.; Reyes E.; Street
R.L.; Suarez-Almazor M.E.; Eakin G.S.; Marrow L.; Morgan C.J.; Caro B.;
Sloan J.A.; Jandali B.; Garcia S.R.; Grossman J.; Winthrop K.L.; Trupin
L.; Dall'era M.; Meara A.; Rizvi T.; Chatham W.W.; Yazdany J.
Institution
(Singh, Green, Alarcon, Saag, Kimberly, Morgan, Chatham) University of
Alabama at Birmingham, Birmingham, AL, United States
(Singh) Birmingham VA Medical Center, Birmingham, AL, United States
(Fraenkel) Yale University, New Haven, CT, United States
(Barton, Winthrop) Oregon Health Science University, Portland, OR, United
States
(Barton) VA Portland Health Care System, Portland, OR, United States
(Hanrahan, Raymond) Lupus Foundation of America, Washington, DC, United
States
(Leong) Healthy Motivation, Inc., Los Angeles, CA, United States
(Reyes) Elyse Reyes Consulting, Los Angeles, CA, United States
(Street) Texas A&M University, College Station, TX, United States
(Suarez-Almazor) University of Texas MD Anderson Cancer Center, Houston,
TX, United States
(Eakin, Marrow) Arthritis Foundation, Atlanta, GA, United States
(Caro) Georgia State University, Atlanta, GA, United States
(Sloan) Mayo Clinic School of Medicine, Rochester, MN, United States
(Jandali, Garcia, Rizvi) Baylor College of Medicine, Houston, TX, United
States
(Grossman) University of California, Los Angeles (UCLA), Los Angeles, CA,
United States
(Trupin, Dall'era, Yazdany) University of California at San Francisco
(UCSF), San Francisco, CA, United States
(Meara) Ohio State University, Columbus, OH, United States
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Treatment decision-making regarding immunosuppressive therapy
is challenging for individuals with lupus. We assessed the effectiveness
of a decision aid for immunosuppressive therapy in lupus nephritis.
Methods and findings In a United States multicenter, open-label,
randomized controlled trial (RCT), adult women with lupus nephritis,
mostly from racial/ethnic minority backgrounds with low socioeconomic
status (SES), seen in in-or outpatient settings, were randomized to an
individualized, culturally tailored, computerized decision aid versus
American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using
computer-generated randomization. We hypothesized that the co-primary
outcomes of decisional conflict and informed choice regarding
immunosuppressive medications would improve more in the decision aid
group. Of 301 randomized women, 298 were analyzed; 47% were
African-American, 26% Hispanic, and 15% white. Mean age (standard
deviation [SD]) was 37 (12) years, 57% had annual income of < $40,000, and
36% had a high school education or less. Compared with the provision of
the ACR lupus pamphlet (n = 147), participants randomized to the decision
aid (n = 151) had (1) a clinically meaningful and statistically
significant reduction in decisional conflict, 21.8 (stan-dard error [SE],
2.5) versus 12.7 (SE, 2.0; p = 0.005) and (2) no difference in informed
choice in the main analysis, 41% versus 31% (p = 0.08), but clinically
meaningful and statistically significant difference in sensitivity
analysis (net values for immunosuppressives positive [in favor] versus
negative [against]), 50% versus 35% (p = 0.006). Unresolved decisional
conflict was lower in the decision aid versus pamphlet groups, 22% versus
44% (p < 0.001). Significantly more patients in the decision aid versus
pamphlet group rated information to be excellent for understanding lupus
nephritis (49% versus 33%), risk factors (43% versus 27%), medication
options (50% versus 33%; p <= 0.003 for all); and the ease of use of
materials was higher in the decision aid versus pamphlet groups (51%
versus 38%; p = 0.006). Key study limitations were the exclusion of men,
short follow-up, and the lack of clinical outcomes, including medication
adherence. Conclusions An individualized decision aid was more effective
than usual care in reducing decisional conflict for choice of
immunosuppressive medications in women with lupus nephritis. Trial
registration Clinicaltrials.gov, NCT02319525. Copyright © 2019,
Public Library of Science. All rights reserved.

<57>
Accession Number
625444719
Title
Continued vs. interrupted direct oral anticoagulants at the time of device
surgery, in patients with moderate to high risk of arterial
thrombo-embolic events (BRUISE CONTROL-2).
Source
European Heart Journal. 39 (44) (pp 3973-3979), 2018. Date of Publication:
21 Nov 2018.
Author
Birnie D.H.; Healey J.S.; Wells G.A.; Ayala-Paredes F.; Coutu B.; Sumner
G.L.; Becker G.; Verma A.; Philippon F.; Kalfon E.; Eikelboom J.; Sandhu
R.K.; Nery P.B.; Lellouche N.; Connolly S.J.; Sapp J.; Essebag V.
Institution
(Birnie, Wells, Nery) Department of Medicine, University of Ottawa,
University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON K1Y 4W7,
Canada
(Healey, Eikelboom, Connolly) Hamilton Health Sciences, Population Health
Research Institute, McMaster University, 237 Barton St. East, Hamilton, ON
L8L 2X2, Canada
(Ayala-Paredes) Hopital Fleurimont, Universite de Sherbrooke, 3001 12e Ave
Nord, Sherbrooke, QC J1H 5N4, Canada
(Coutu) Centre Hospitalier de l'Universite de Montreal, Hopital
Hotel-Dieu, 850 St-Denis St., Montreal, QC H2X 0A9, Canada
(Sumner) Libin Cardiovascular Institute, Foothills Medical Centre,
University of Calgary, 1403 29th St. NW, Calgary, AB T2N 2T9, Canada
(Becker, Essebag) Hopital du Sacre-Coeur de Montreal, 5400 boul Gouin
Ouest, Montreal, QC H4J 1C5, Canada
(Verma) Southlake Regional Health Center, 581 Davis Dr, Newmarket, ON L3Y
2P9, Canada
(Philippon) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Laval University, 2725 chemin, Ste-Foy, QC G1V 4G5, Canada
(Kalfon) Galilee Medical Center, 1 Ben Tzvi Blvd, Nahariya 22100, Israel
(Sandhu) University of Alberta, 8440 112 St, Edmonton, AB T6G 2B7, Canada
(Lellouche) Service de Cardiologie, Hopital Henri Mondor, APHP, Creteil,
France
(Sapp) QEII Health Sciences Centre, Dalhousie University, Halifax, NS,
Canada
(Essebag) McGill University Health Center, McGill University, Hopital
Sacre-Coeur de Montreal, Montreal, QC, Canada
Publisher
Oxford University Press
Abstract
Aims Guidelines recommend warfarin continuation rather than heparin
bridging for pacemaker and defibrillator surgery, after the BRUISE CONTROL
trial demonstrated an 80% reduction in device pocket haematoma with this
approach. However, direct oral anticoagulants (DOACs) are now used to
treat the majority of patients with atrial fibrillation. We sought to
understand the best strategy to manage the DOACs at the time of device
surgery and specifically hypothesized that performing device surgery
without DOAC interruption would result in a reduced haematoma rate.
Methods and results We randomly assigned patients with atrial fibrillation
and CHA2DS2-VASc score 2, to continued vs. interrupted DOAC (dabigatran,
rivaroxaban, or apixaban). The primary outcome was blindly evaluated,
clinically significant device pocket haematoma: resulting in re-operation,
interruption of anticoagulation, or prolonging hospital stay. In the
continued arm, the median time between pre- and post-operative DOAC doses
was 12 h; in the interrupted arm the median time was 72 h. Clinically
significant haematoma occurred in of 7 of 328 (2.1%; 95% CI 0.94.3)
patients in the continued DOAC arm and 7 of 334 (2.1%; 95% CI 0.94.3)
patients in the interrupted DOAC arm (P = 0.97). Complications were
uncommon, and included one stroke and one symptomatic pericardial effusion
in each arm. Conclusions These results suggest that, dependent on the
clinical scenario, either management strategy (continued DOAC or
interrupted DOAC) might be reasonable, at least for patients similar to
those enrolled in our trial. Copyright © 2018 Oxford University
Press.

<58>
Accession Number
2002132642
Title
Prognostic value of coronary artery calcium score in symptomatic
individuals: A meta-analysis of 34,000 subjects.
Source
International Journal of Cardiology. 299 (pp 56-62), 2020. Date of
Publication: 15 January 2020.
Author
Lo-Kioeng-Shioe M.S.; Rijlaarsdam-Hermsen D.; van Domburg R.T.; Hadamitzky
M.; Lima J.A.C.; Hoeks S.E.; Deckers J.W.
Institution
(Lo-Kioeng-Shioe, Rijlaarsdam-Hermsen, van Domburg, Hoeks, Deckers)
Department of Cardiology, Erasmus MC, University Medical Center,
Rotterdam, Netherlands
(Rijlaarsdam-Hermsen) Medical Center Haaglanden Bronovo, The Hague,
Netherlands
(Hadamitzky) Institut fur Radiologie und Nuklearmedizin, Hospital at the
Technische Universitat Munchen, Munich, Germany
(Lima) Department of Cardiology, Johns Hopkins Hospital and School of
Medicine, Baltimore, MD, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Coronary artery calcium (CAC) scanning has evolved into an
important subclinical prediction method for cardiovascular diseases in
asymptomatic subjects. However, the prognostic implication of CAC scanning
in symptomatic individuals is less clear. Objective(s): To assess the
prognostic utility of CAC in predicting risk of major adverse cardiac
events (MACE) in stable patients with suspected CAD. Method(s): We
did a systematic electronic literature search for studies presenting
original data in CAC score, and reporting cardiovascular events in stable,
symptomatic patients as primary outcome. Primary outcome of the
meta-analysis was the occurrence of MACE, a composite of late coronary
revascularization, hospitalization for unstable angina or heart failure,
nonfatal myocardial infarction, and cardiac death or all-cause mortality.
Using random effects models, we pooled relative risk ratios of CAC for
MACE, and adjusted hazard ratios (HR) of the associations between
different CAC strata (CAC 0-100,100-400, and >= 400, versus CAC = 0) and
incident MACE. Result(s): We included 19 observational studies (n =
34,041). In total, 1601 events were analyzed, of which 158 in patients
with CAC = 0. The pooled relative risk ratio was 5.71 (95%-CI: 3.98;8.19)
for subjects with CAC > 0. The pooled estimate of adjusted HRs
demonstrated increasing, positive associations, with the strongest
association for CAC > 400 (HR: 4.88; 95%-CI: 2.44;9.27).
 Conclusion(s): This meta-analysis demonstrated that increased levels
of CAC are strongly and independently associated with increased risk for
MACE in stable, symptomatic patients with suspected CAD, showing
increasing risk with greater CAC scores. Application of CAC scanning as a
prediction method could be useful for a considerable number of such
patients. Copyright © 2019

<59>
Accession Number
629281605
Title
Does transatrial-transpulmonary approach improve outcomes compared with
transventricular approach in non-neonatal patients undergoing tetralogy of
Fallot repair?.
Source
Interactive cardiovascular and thoracic surgery. 29 (6) (pp 960-966),
2019. Date of Publication: 01 Dec 2019.
Author
Ye X.T.; Buratto E.; Konstantinov I.E.; d'Udekem Y.
Institution
(Ye, Buratto, Konstantinov, d'Udekem) Cardiac Surgery Unit, Royal
Children's Hospital, Melbourne, VIC, Australia
(Ye, Buratto, Konstantinov, d'Udekem) Department of Paediatrics,
University of Melbourne, Melbourne, VIC, Australia
(Ye, Buratto, Konstantinov, d'Udekem) Murdoch Children's Research
Institute, Melbourne, VIC, Australia
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether the
transatrial-transpulmonary approach to tetralogy of Fallot repair in
non-neonatal patients provides superior outcomes compared with the
transventricular approach. Altogether, 175 papers were found using the
reported search, of which 11 represented the best evidence to answer the
clinical question. Two randomized controlled trials (RCTs) and 3
observational studies showed that the transatrial approach resulted in
better preservation of right ventricular (RV) function, whereas 4
observational studies showed no significant difference. Three
observational studies showed better attenuation of RV dilatation, whereas
3 showed no difference. One RCT and 2 observational studies showed lower
incidence of postoperative ventricular arrhythmias, while 1 RCT and 4
observational studies showed no difference. Two observational studies
demonstrated greater freedom from reoperation, 1 RCT and 2 observational
studies showed no difference, while 1 retrospective study observed a
higher incidence of residual RV outflow tract obstruction and lower
freedom from reoperation in infants. Two observational studies reported
lower risk of requiring pulmonary valve replacement, whereas 2 reported no
difference. Three observational studies reported superior exercise
capacity, while 1 reported no difference. No difference in long-term
survival was demonstrated. The results presented suggest that transatrial
repair of tetralogy of Fallot confers superior or equivalent outcomes in
terms of preservation of RV function and volume, ventricular arrhythmias,
need for pulmonary valve replacement, and exercise capacity compared with
transventricular repair. However, the incidence of residual RV outflow
tract obstruction may be higher in infants undergoing transatrial
repair. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<60>
Accession Number
2002354633
Title
Integrin s1 polymorphisms and bleeding risk after coronary artery
stenting.
Source
Molecular Biology Reports. 46 (6) (pp 5695-5702), 2019. Date of
Publication: 01 Dec 2019.
Author
Thienel M.; Lusebrink E.; Kastrati A.; Dannenberg L.; Polzin A.; Schulz
C.; Massberg S.; Petzold T.
Institution
(Thienel, Lusebrink, Schulz, Massberg, Petzold) Medizinische Klinik und
Poliklinik I, Klinikum der Universitat Munchen, Marchioninistrase 15,
Munich 81377, Germany
(Kastrati) Klinik fur Herz- und Kreislauferkrankungen, Deutsches
Herzzentrum Munchen, Munich, Germany
(Thienel, Lusebrink, Kastrati, Schulz, Massberg, Petzold) DZHK (German
Centre for Cardiovascular Research), partner site Munich Heart Alliance,
Munich, Germany
(Dannenberg, Polzin) Klinik fur Kardiologie, Pneumologie und Angiologie,
Universitatsklinikum Dusseldorf, Dusseldorf, Germany
(Dannenberg, Polzin) CARID (Cardiovascular Research Institute Dusseldorf),
Dusseldorf, Germany
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
Bleeding complications following percutaneous coronary intervention
associate with increased mortality. However, the underlying molecular
mechanisms are insufficiently understood. Platelet recruitment and
activation at sites of vascular injury depends on the function of integrin
adhesion receptors. Besides GPIIbIIIa as the most abundant integrin
receptor, platelets relevantly express s1 integrins. Experimental evidence
from in vivo studies suggests a significant role of s1 integrins in
primary haemostasis. However, little is known about the clinical impact of
genetic alterations of the beta1 subunit, which might contribute to
bleeding complications in patients. In this study, we performed DNA
sequencing of patients suffering from bleeding complications after
coronary artery stenting according to TIMI or BARC classification. We
isolated DNA samples from 741 patients out of a cohort from 14,160
patients recruited in seven randomized clinical trials between June 2000
and May 2011. Subsequently, Sanger sequencing was performed covering the
beta1 integrin cytoplasmic activation domain (exon16) and its non-coding
upstream region. Out of 764 patients suffering from bleeding
complications, 741 DNA samples were successfully sequenced. Genotype
variation was detected for SNP rs2153875 located within the non-coding
upstream region with following allele frequency in study population: CC
(7.3%), CA (35%) and AA (57.8%), which is similar to a general population
cohort. Further, genotype variation in SNP rs2153875 do not associate with
the frequency of TIMI or BARC classified access or non-access site
bleedings. Genotype variations of the beta1 integrin activation domain do
not associate with bleeding risk after PCI. Copyright © 2019,
Springer Nature B.V.

<61>
Accession Number
629965257
Title
Association of Genetically Predicted Lipid Levels with the Extent of
Coronary Atherosclerosis in Icelandic Adults.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Bjornsson E.; Thorleifsson G.; Helgadottir A.; Gudnason T.; Gudbjartsson
T.; Andersen K.; Gretarsdottir S.; Olafsson I.; Tragante V.; Olafsson
O.H.; Jonsdottir B.; Eyjolfsson G.I.; Sigurdardottir O.; Thorgeirsson G.;
Gudbjartsson D.F.; Thorsteinsdottir U.; Holm H.; Stefansson K.
Institution
(Bjornsson, Thorleifsson, Helgadottir, Gretarsdottir, Tragante, Olafsson,
Thorgeirsson, Gubjartsson, Thorsteinsdottir, Holm, Stefansson) DeCODE
Genetics/Amgen Inc, Sturlugata 8, Reykjavik 101, Iceland
(Bjornsson, Gubjartsson, Andersen, Olafsson, Thorgeirsson,
Thorsteinsdottir, Stefansson) Faculty of Medicine, University of Iceland,
Reykjavik, Iceland
(Bjornsson, Gunason, Andersen, Thorgeirsson) Division of Cardiology,
Landspitali-The National University Hospital of Iceland, Reykjavik,
Iceland
(Gubjartsson) Division of Cardiothoracic Surgery, Landspitali-The National
University Hospital of Iceland, Reykjavik, Iceland
(Olafsson) Department of Clinical Biochemistry, Landspitali-The National
University Hospital of Iceland, Reykjavik, Iceland
(Tragante) Division of Heart and Lungs, Department of Cardiology,
University Medical Center Utrecht, Utrecht University, Utrecht,
Netherlands
(Jonsdottir) Rontgen Domus, Reykjavik, Iceland
(Eyjolfsson) Laboratory in Mjodd, Reykjavik, Iceland
(Sigurardottir) Department of Clinical Biochemistry, Akureyri Hospital,
Akureyri, Iceland
(Gubjartsson) School of Engineering and Natural Sciences, University of
Iceland, Reykjavik, Iceland
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Genetic studies have evaluated the influence of blood lipid
levels on the risk of coronary artery disease (CAD), but less is known
about how they are associated with the extent of coronary atherosclerosis.
 Objective(s): To estimate the contributions of genetically predicted
blood lipid levels on the extent of coronary atherosclerosis. Design,
Setting, and Participant(s): This genetic study included Icelandic adults
who had undergone coronary angiography or assessment of coronary artery
calcium using cardiac computed tomography. The study incorporates data
collected from January 1987 to December 2017 in Iceland in the Swedish
Coronary Angiography and Angioplasty Registry and 2 registries of
individuals who had undergone percutaneous coronary interventions and
coronary artery bypass grafting. For each participant, genetic scores were
calculated for levels of non-high-density lipoprotein cholesterol
(non-HDL-C), low-density lipoprotein cholesterol (LDL-C), high-density
lipoprotein cholesterol (HDL-C), and triglycerides, based on reported
effect sizes of 345 independent, lipid-associated variants. The genetic
scores' predictive ability for lipid levels was assessed in more than
87000 Icelandic adults. A mendelian randomization approach was used to
estimate the contribution of each lipid trait. Exposures: Genetic scores
for levels of non-HDL-C, LDL-C, HDL-C, and triglycerides. Main
Outcomes and Measures: The extent of angiographic CAD and coronary artery
calcium quantity. Result(s): A total of 12460 adults (mean [SD] age,
65.1 [10.7] years; 8383 men [67.3%]) underwent coronary angiography, and
4837 had coronary artery calcium assessed by computed tomography. A
genetically predicted increase in non-HDL-C levels by 1 SD (38 mg/dL [to
convert to millimoles per liter, multiply by 0.0259]) was associated with
greater odds of obstructive CAD (odds ratio [OR], 1.83 [95% CI,
1.63-2.07]; P = 2.8 x 10-23). Among patients with obstructive
CAD, there were significant associations with multivessel disease (OR,
1.26 [95% CI, 1.11-1.44]; P = 4.1 x 10-4) and 3-vessel disease
(OR, 1.47 [95% CI, 1.26-1.72]; P = 9.2 x 10-7). There were also
significant associations with the presence of coronary artery calcium (OR,
2.04 [95% CI, 1.70-2.44]; P = 5.3 x 10-15) and
log<inf>e</inf>-transformed coronary artery calcium (effect, 0.70 [95% CI,
0.53-0.87]; P = 1.0 x 10-15). Genetically predicted levels of
non-HDL-C remained associated with obstructive CAD and coronary artery
calcium extent even after accounting for the association with LDL-C.
Genetically predicted levels of HDL-C and triglycerides were associated
individually with the extent of coronary atherosclerosis, but not after
accounting for the association with non-HDL cholesterol. Conclusions
and Relevance: In this study, genetically predicted levels of non-HDL-C
were associated with the extent of coronary atherosclerosis as estimated
by 2 different methods. The association was stronger than for genetically
predicted levels of LDL-C. These findings further support the notion that
non-HDL-C may be a better marker of the overall burden of atherogenic
lipoproteins than LDL-C. Copyright © 2019 American Medical
Association. All rights reserved.

<62>
Accession Number
629962610
Title
Avoidance of Vagal Response During Circumferential Pulmonary Vein
Isolation: Effect of Initiating Isolation From Right Anterior Ganglionated
Plexi.
Source
Circulation. Arrhythmia and electrophysiology. 12 (12) (pp e007811), 2019.
Date of Publication: 01 Dec 2019.
Author
Hu F.; Zheng L.; Liu S.; Shen L.; Liang E.; Ding L.; Wu L.; Chen G.; Fan
X.; Yao Y.
Institution
(Hu, Zheng, Liu, Shen, Liang, Ding, Wu, Chen, Fan, Yao) Cardiac Arrhythmia
Center, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Circumferential pulmonary vein isolation (CPVI) often cause
unavoidable vagal reflexes during procedure due to the coincidental
modification of ganglionated plexus which are located on pulmonary vein
(PV) antrum. The right anterior ganglionated plexi (RAGP) which located at
superoanterior area of right superior PV antrum is an essential station to
regulate the cardiac autonomic nerve activities and is easily
coincidentally ablated during CPVI. The aim of this study is to assess the
effect of RAGP ablation on vagal response (VR) during CPVI.
 METHOD(S): A total of 80 patients with paroxysmal atrial fibrillation
who underwent the first time CPVI were prospectively enrolled and randomly
assigned to 2 groups: group A (n=40), CPVI started with right PVs at RAGP
site; group B (n=40): CPVI started with left PVs first, and the last
ablation site is RAGP. Electrophysiological parameters include basal cycle
length, A-H interval, H-V interval, sinus node recovery time, and
atrioventricular node Wenckebach point were recorded before and after CPVI
procedure. RESULT(S): During CPVI, the positive VR were only observed
on 1 patient in group A and 25 patients in group B (P<0.001). A total of
21 patients with positive VR in group B needed for temporary ventricular
pacing during procedure, while the only patient with positive VR in group
A did not need for temporary ventricular pacing (P<0.001). Compared with
baseline, basal cycle length, sinus node recovery time, and
atrioventricular node Wenckebach point were decreased significantly after
CPVI procedure in both groups (all P<0.05) and without differences between
2 groups. CONCLUSION(S): Circumferential PV isolation initiated from
RAGP could effectively inhibit VR occurrence and significantly increase
heart rate during procedure.

<63>
Accession Number
629962381
Title
Left ventricular size predicts clinical benefit after percutaneous mitral
valve repair for secondary mitral regurgitation: A systematic review and
meta-regression analysis.
Source
Cardiovascular revascularization medicine : including molecular
interventions. (no pagination), 2019. Date of Publication: 15 Nov 2019.
Author
Zimarino M.; Ricci F.; Capodanno D.; De Innocentiis C.; Verrengia E.;
Swaans M.J.; Lombardi C.; Brouwer J.; Gallina S.; Grasso C.; De Caterina
R.; Tamburino C.
Institution
(Zimarino, De Innocentiis, Verrengia, Gallina) Institute of Cardiology "G.
d'Annunzio" University, Chieti, Italy
(Ricci) Institute for Advanced Biomedical Technologies, Department of
Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University,
Chieti, Italy; Department of Clinical Sciences, Lund University, Clinical
Research Center, Skane University Hospital, Malmo 205-02, Sweden
(Capodanno, Grasso, Tamburino) Division of Cardiology, Ferrarotto
Hospital, University of Catania, Catania, Italy
(Swaans, Brouwer) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Lombardi) Cardiology, Department of Medical and Surgical Specialties,
University of Brescia, Italy
(De Caterina) Institute of Cardiology, University of Pisa, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: The benefit of percutaneous mitral valve repair (PMVR) in
patients with secondary MR is still debated. We aimed to compare the
outcome of PMVR with optimal medical therapy (OMT) versus OMT alone in
patients with secondary mitral regurgitation (MR) and to assess the role
of potential effect modifiers. METHOD(S): We performed a systematic
review and meta-analysis of 2 randomized clinical trials (RCT) and 7
non-randomized observational studies (nROS). Hazard ratios (HR) and 95%
confidence intervals (CI) were pooled through inverse variance
random-effects model to compute the summary effect size for all-cause
death, cardiovascular death and cardiac-related hospitalization. Subgroup
and meta-regression analysis were also performed. RESULT(S): An
overall population of 3118 individuals (67% men; mean age, 73years) was
included: 1775 PMVR+OMT and 1343 OMT patients, with mean follow-up of
24+/-15months. PMVR+OMT was associated with a lower risk of all-cause
death (HR: 0.77; 95% CI: 0.68-0.87), cardiovascular death (HR: 0.55; 95%
CI: 0.34-0.89) and cardiac-related hospitalization (HR:0.77; 95% CI:
0.64-0.92). Meta-regression analysis showed that larger left ventricular
end-diastolic volume index (LVEDVI) portends higher risk of all-cause
death, cardiovascular death and cardiac-related hospitalization after PMVR
(p<0.001 for all). CONCLUSION(S): This study-level meta-analysis
shows that PMVR+OMT is associated with reduced all-cause death,
cardiovascular death and cardiac-related hospitalization when compared
with OMT alone in secondary MR. LVEDVI is a predictive marker of efficacy,
as patients with smaller LVEDVI have been shown to derive the largest
benefit from PMVR. Copyright © 2019 Elsevier Inc. All rights
reserved.

<64>
Accession Number
629962088
Title
Echocardiographic outcomes from seven randomized trials of transcatheter
versus surgical aortic valve replacement.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). (no pagination),
2019. Date of Publication: 20 Nov 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center
(Ando) Division of Interventional Cardiology, Department of Cardiology,
Presbyterian Hospital/Columbia University Medical Center, NY, United
States
Publisher
NLM (Medline)
Abstract
AIMS: We performed meta-analyses of echocardiographic outcomes, including
postprocedural aortic valve area (AVA), aortic valve mean pressure
gradient (MPG), and paravalvular aortic regurgitation (PAR), exclusively
from all currently available randomized controlled trials (RCTs) of
transcatheter aortic valve implantation (TAVI) versus surgical aortic
valve replacement (SAVR). METHOD(S): To identify all RCTs providing
echocardiographic outcomes (AVA, MPG, and PAR) up to 2 years after TAVI
versus SAVR, PubMed and ClinicalTrials.gov were searched through June
2019. Mean differences in AVA (and MPG) between the TAVI and SAVR groups
and odds (or hazard) ratios of at least moderate PAR for TAVI versus SAVR
were pooled using the random-effects meta-analysis. RESULT(S): We
identified seven eligible RCTs. At 30 days (P = 0.004), 1 year (P =
0.006), and 2 years (P = 0.03), AVA was significantly larger after TAVI
than after SAVR. After TAVI than after SAVR, MPG was significantly lower
at 30 days (P = 0.03) and 2 years (P = 0.01), and nonsignificantly lower
at 1 year (P = 0.06). At 30 days (P < 0.00001), 1 year (P < 0.00001), and
2 years (P < 0.00001), incidence of at least moderate PAR was
significantly greater after TAVI than after SAVR. CONCLUSION(S): On
the basis of the present meta-analyses of all the seven currently
available RCTs, AVA is larger, MPG is lower, and incidence of at least
moderate PAR is greater 30 days, 1 and 2 years after TAVI than after SAVR.

<65>
Accession Number
2003740664
Title
Intra-aortic balloon pump does not influence cerebral hemodynamics and
neurological outcomes in high-risk cardiac patients undergoing cardiac
surgery: an analysis of the IABCS trial.
Source
Annals of Intensive Care. 9 (1) (no pagination), 2019. Article Number:
130. Date of Publication: 01 Dec 2019.
Author
Caldas J.R.; Panerai R.B.; Bor-Seng-Shu E.; Ferreira G.S.R.; Camara L.;
Passos R.H.; Salinet A.M.; Azevedo D.S.; de-Lima-Oliveira M.; Galas
F.R.B.G.; Fukushima J.T.; Nogueira R.; Taccone F.S.; Landoni G.; Almeida
J.P.; Robinson T.G.; Hajjar L.A.
Institution
(Caldas, Camara, Galas, Fukushima, Almeida) Department of Anesthesia,
University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
(Caldas) Universidade de Salvador, UNIFACS, Salvador, Bahia, Brazil
(Panerai, Robinson) Department of Cardiovascular Sciences, University of
Leicester, Leicester, United Kingdom
(Panerai, Robinson) NIHR Leicester Biomedical Research Centre, Leicester,
United Kingdom
(Bor-Seng-Shu, Salinet, Azevedo, de-Lima-Oliveira, Nogueira) Department of
Neurosurgery, Hospital das Clinicas, University of Sao Paulo, Sao Paulo,
Brazil
(Ferreira, Hajjar) Department of Cardiopneumology, Universidade de Sao
Paulo, Sao Paulo, Brazil
(Caldas, Passos) Critical Care Unit Hospital Sao Rafael Salvador,
Salvador, Brazil
(Taccone) Department of Intensive Care, Hopital Erasme, Brussels, Belgium
(Landoni) Department of Anaesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute and Vita-Salute San Raffaele University of Milan,
Milan, Italy
(Hajjar) Surgical Intensive Care, Heart Institute, University of Sao
Paulo, Av. Dr. Ene'as de Carvalho Aguiar 44, Sao Paulo 05403-000, Brazil
(Caldas) Escola Bahiana de Medicina e Saude Pubica, Salvador, Brazil
Publisher
Springer
Abstract
Background: The intra-aortic balloon pump (IABP) is often used in
high-risk patients undergoing cardiac surgery to improve coronary
perfusion and decrease afterload. The effects of the IABP on cerebral
hemodynamics are unknown. We therefore assessed the effect of the IABP on
cerebral hemodynamics and on neurological complications in patients
undergoing cardiac surgery who were randomized to receive or not receive
preoperative IABP in the 'Intra-aortic Balloon Counterpulsation in
Patients Undergoing Cardiac Surgery' (IABCS) trial. Method(s): This
is a prospectively planned analysis of the previously published IABCS
trial. Patients undergoing elective coronary artery bypass surgery with
ventricular ejection fraction <= 40% or EuroSCORE >= 6 received
preoperative IABP (n = 90) or no IABP (n = 91). Cerebral blood flow
velocity (CBFV) of the middle cerebral artery through transcranial Doppler
and blood pressure through Finometer or intra-arterial line were recorded
preoperatively (T1) and 24 h (T2) and 7 days after surgery (T3) in
patients with preoperative IABP (n = 34) and without IABP (n = 33).
Cerebral autoregulation was assessed by the autoregulation index that was
estimated from the CBFV response to a step change in blood pressure
derived by transfer function analysis. Delirium, stroke and cognitive
decline 6 months after surgery were recorded. Result(s): There were
no differences between the IABP and control patients in the autoregulation
index (T1: 5.5 +/- 1.9 vs. 5.7 +/- 1.7; T2: 4.0 +/- 1.9 vs. 4.1 +/- 1.6;
T3: 5.7 +/- 2.0 vs. 5.7 +/- 1.6, p = 0.97) or CBFV (T1: 57.3 +/- 19.4 vs.
59.3 +/- 11.8; T2: 74.0 +/- 21.6 vs. 74.7 +/- 17.5; T3: 71.1 +/- 21.3 vs.
68.1 +/- 15.1 cm/s; p = 0.952) at all time points. Groups were not
different regarding postoperative rates of delirium (26.5% vs. 24.2%, p =
0.83), stroke (3.0% vs. 2.9%, p = 1.00) or cognitive decline through
analysis of the Mini-Mental State Examination (16.7% vs. 40.7%; p = 0.07)
and Montreal Cognitive Assessment (79.16% vs. 81.5%; p = 1.00).
 Conclusion(s): The preoperative use of the IABP in high-risk patients
undergoing cardiac surgery did not affect cerebral hemodynamics and was
not associated with a higher incidence of neurological complications.
Trial registrationhttp://www.clinicaltrials.gov
(NCT02143544). Copyright © 2019, The Author(s).

<66>
Accession Number
2003250472
Title
Antithrombotic therapy for percutaneous cardiovascular interventions: From
coronary artery disease to structural heart interventions.
Source
Journal of Clinical Medicine. 8 (11) (no pagination), 2019. Article
Number: 2016. Date of Publication: November 2019.
Author
Caracciolo A.; Mazzone P.; Laterra G.; Garcia-Ruiz V.; Polimeni A.;
Galasso S.; Saporito F.; Carerj S.; D'ascenzo F.; Marquis-Gravel G.;
Giustino G.; Costa F.
Institution
(Caracciolo, Mazzone, Laterra, Galasso, Saporito, Carerj, Costa)
Department of Clinical and Experimental Medicine, Policlinic "G. Martino",
University of Messina, Messina 98100, Italy
(Garcia-Ruiz) UGC del Corazon, Servicio de Cardiologia, Hospital Clinico
Universitario Virgen de la Victoria, Malaga 29010, Spain
(Polimeni) Division of Cardiology, Department of Medical and Surgical
Sciences, Magna Graecia University, Catanzaro 88100, Italy
(D'ascenzo) Division of Cardiology, Department of Medical Sciences, Citta
della Salute e della Scienza, University of Turin, Turin 10124, Italy
(Marquis-Gravel) Duke Clinical Research Institute, Durham, NC 27708,
United States
(Marquis-Gravel) Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
(Giustino) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY 10029-6574, United States
(Giustino) Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, New York, NY 10029-6574, United States
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Percutaneous cardiovascular interventions have changed dramatically in
recent years, and the impetus given by the rapid implementation of novel
techniques and devices have been mirrored by a refinement of
antithrombotic strategies for secondary prevention, which have been
supported by a significant burden of evidence from clinical studies. In
the current manuscript, we aim to provide a comprehensive, yet pragmatic,
revision of the current available evidence regarding antithrombotic
strategies in the domain of percutaneous cardiovascular interventions. We
revise the evidence regarding antithrombotic therapy for secondary
prevention in coronary artery disease and stent implantation, the complex
interrelation between antiplatelet and anticoagulant therapy in patients
undergoing percutaneous coronary intervention with concomitant atrial
fibrillation, and finally focus on the novel developments in the secondary
prevention after structural heart disease intervention. A special focus on
treatment individualization is included to emphasize risk and benefits of
each therapeutic strategy. Copyright © 2019 by the authors.
Licensee MDPI, Basel, Switzerland.

<67>
Accession Number
2003249234
Title
Association between obsessive-compulsive symptoms and long-term cardiac
outcomes in patients with acute coronary syndrome: Effects of depression
comorbidity and treatment.
Source
Psychiatry Investigation. 16 (11) (pp 843-851), 2019. Date of Publication:
November 2019.
Author
Lee H.-J.; Kim J.-W.; Kang H.-J.; Kim S.-W.; Shin I.-S.; Hong Y.-J.; Ahn
Y.-K.; Jeong M.-H.; Yoon J.-S.; Kim J.-M.
Institution
(Lee, Kim, Kang, Kim, Shin, Yoon, Kim) Department of Psychiatry, Chonnam
National University Medical School, Gwangju, South Korea
(Hong, Ahn, Jeong) Department of Cardiology, Chonnam National University
Medical School, Gwangju, South Korea
Publisher
Korean Neuropsychiatric Association (RN 522, G-five Central Plaza 1685-8,
Seocho-Dong, Seocho-Gu, Seoul 137-882, South Korea)
Abstract
Objective The role of obsessive-compulsive symptoms (OCS) in patients with
acute coronary syndrome (ACS) is not well elucidated. This study
investigated the association between OCS and the long-term prognosis of
ACS in tandem with depression comorbidity and treatment. Methods A
cross-sectional baseline study and a nested 24-week double-blind
escitalopram-placebo controlled trial were carried out between May 2007
and March 2013, and then a 5-12-year follow-up for major adverse cardiac
events (MACE) was conducted. A total of 1, 152 patients with ACS were
stratified by baseline depression comorbidity and treatment allocation
into four groups: no depression (706 patients), depression and taking
escitalopram (149 patients), depression and taking a placebo (151
patients), and depression and receiving medical care as usual (CAU; 146
patients). OCS were evaluated using the Symptom Checklist-90-Revised
Obsessive-Compulsive symptom domain. During the follow-up, Kaplan-Meier
event rates for MACE outcomes were calculated, and hazard ratios were
estimated using Cox regression models after adjusting for a range of
covariates. Results A higher OCS score at baseline was associated with a
worse ACS prognosis after adjusting for relevant covariates and across
MACE outcomes. This association varied according to the depression
comorbidity. The association was significant in patients without
depression and depressive patients receiving placebos and CAU, but not in
depressive patients on escitalopram. Conclusion Evaluating OCS and
depression is recommended during the early phase of ACS. Treatment for OCS
may improve the long-term cardiac outcomes of patients with
ACS. Copyright © 2019 Korean Neuropsychiatric Association.

<68>
Accession Number
2003247648
Title
Investigating the effect of fibrinogen injection on bleeding in coronary
artery bypass surgery: A clinical trial.
Source
Anesthesiology and Pain Medicine. 9 (4) (no pagination), 2019. Article
Number: e92165. Date of Publication: August 2019.
Author
Zadeh F.J.; Janatmakan F.; Soltanzadeh M.; Zamankhani M.
Institution
(Zadeh, Janatmakan, Soltanzadeh, Zamankhani) Department of Anesthesia,
Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur
University of Medical Sciences, Ahvaz, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: editor@anesthpain.com)
Abstract
Background: Prevention and optimal treatment of postoperative bleeding are
of great clinical importance in various types of surgeries including
coronary artery bypass graft (CABG). Reducing the amount of bleeding will
reduce the complications subsequent to blood transfusion. The positive
effects of coagulation factors, especially fibrinogen, after
cardiovascular bypass could have beneficial effects due to reduced
bleeding and less need for blood transfusion. However, different studies
have reported controversial findings. Objective(s): The present study
aimed to evaluate the effect of prophylactic administration of fibrinogen
on blood loss in patients undergoing CABG surgery to achieve more accurate
clinical outcomes. Method(s): This was a double-blind randomized
clinical trial conducted on 36 patients hospitalized in Ahvaz Imam
Khomeini Hospital for coronary artery bypass graft. Patients were
randomized to receive either fibrinogen concentrate (n = 18) or placebo (n
= 18). Hemoglobin, hematocrit, international normalized ratio, prothrombin
time, partial thromboplastin time, and fibrinogen were checked
preoperatively. The transfusion of allogeneic blood components and the
volume of blood loss were recorded and compared between the groups.
 Result(s): Prophylactic fibrinogen injection reduced the need for
blood transfusion, blood products, and postoperative hypotension in the
fibrinogen group when compared to the control group (P <= 0.005). There
was a significant difference between the two groups in terms of the amount
of bleeding during operation (P <= 0.005). Conclusion(s): Fibrinogen
plays a key role in preventing and stopping the bleeding. Accordingly,
fibrinogen decreases bleeding and the need for paced cell in patients in
CABG. Given the adverse outcomes of bleeding and coagulopathy in patients
undergoing surgery, we conclude that the use of fibrinogen could be
beneficial as a prophylactic in hemorrhagic surgery. Copyright ©
2019, Author(s).

<69>
Accession Number
2003433121
Title
Meta-analysis Evaluating the Safety and Efficacy of Transcarotid
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 124 (12) (pp 1940-1946), 2019. Date of
Publication: 15 December 2019.
Author
Usman M.S.; Rawasia W.F.; Siddiqi T.J.; Mujeeb F.A.; Nadeem S.; Alkhouli
M.
Institution
(Usman, Siddiqi, Mujeeb, Nadeem) Dow University of Health Sciences,
Karachi, Pakistan
(Rawasia) River Region Cardiology Associates, Montgomery, AL, United
States
(Alkhouli) Mayo Clinic School of Medicine - Mayo Clinic, Rochester, MN,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We performed a systemic review and meta-analysis of studies evaluating
transcarotid vascular access for transcatheter aortic valve implantation
(TAVI). Published studies evaluating transcarotid vascular access for TAVI
were included in this analysis. Outcomes of interest included 30-day
mortality, stroke/transient ischemic attack (TIA), new pacemaker
implantation, acute kidney injury (AKI), major vascular complication,
major bleeding, and myocardial infarction. Pooled estimate for 30-day
mortality was 5.3% (95% confidence interval [CI] 4.0% to 6.8%;
I2 = 4%), stroke/TIA was 3.4% (95% CI 2.4% to 4.6%;
I2 = 0%), new pacemaker implantation was 15.3% (95% CI 10.8% to
19.7%; I2 = 72%), AKI was 3.4% (95% CI 1.3% to 6.5%;
I2 = 58%), major vascular complication was 2.4% (95% CI 1.1% to
3.7%; I2 = 46%), major bleeding was 4.3% (95% CI 2.8% to 6.1%;
I2 = 11%), and myocardial infarction was 1.1% (95% CI 0.4% to
2.0%; I2 = 0%). Metaregression was carried out to study the
association of effect size with the continuous study-level covariates that
included average age, proportion of males, and mean STS score. In this
regard, mean STS score showed association with major vascular
complications (coefficient: 0.008; p = 0.049). Cumulative meta-analysis
carried out showed that there was temporal trend of decreasing incidence
of stroke/TIA, major vascular complications, and AKI for transcarotid
TAVI. In conclusion, transcarotid access for TAVI is a reasonable choice
in patients requiring alternate access to transfemoral
route. Copyright © 2019 Elsevier Inc.

<70>
Accession Number
2003583431
Title
Meta-analysis of Randomized Controlled Trials Assessing the Impact of
Proprotein Convertase Subtilisin/Kexin Type 9 Antibodies on Mortality and
Cardiovascular Outcomes.
Source
American Journal of Cardiology. 124 (12) (pp 1869-1875), 2019. Date of
Publication: 15 December 2019.
Author
AlTurki A.; Marafi M.; Dawas A.; Dube M.-P.; Vieira L.; Sherman M.H.;
Gregoire J.; Thanassoulis G.; Tardif J.-C.; Huynh T.
Institution
(AlTurki, Dawas, Thanassoulis, Huynh) Division of Cardiology, McGill
University Health Center, Montreal, Quebec, Canada
(Marafi, Vieira) Department of Neurology, Montreal Neurological Institute,
Montreal, Quebec, Canada
(Dube, Gregoire, Tardif) Montreal Heart Institute, Universite de Montreal,
Montreal, Quebec, Canada
(Sherman) Division of Endocrinology, McGill University Health Center,
Montreal, Quebec, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition by
monoclonal antibodies has been shown to reduce low density lipoprotein
(LDL-C) but its effects on cardiovascular (CV) outcomes have not been
fully described. The aim of this study is to assess the impact of PCSK9
inhibition on mortality and CV outcomes by pooling data from all available
randomized clinical trials (RCT) of PCSK9 inhibitors. We conducted a
comprehensive search of electronic databases, up to December 1, 2018, for
all RCTs comparing PCSK9 inhibition to placebo or ezetimibe in patients
with hypercholesterolemia or coronary artery disease receiving maximally
tolerated statin for primary or secondary prevention of mortality and
cardiovascular outcomes. We used random-effects meta-analyses to summarize
the studies. We retained 23 RCTs having included 88,041 patients in
primary and secondary prevention. The follow-up ranged from 6 to 36
months. PCSK9 inhibition was not significantly associated with reductions
in total mortality (odds ratio [OR] 0.91, 95% confidence interval [CI] 078
to 1.06; p = 0.22) and CV mortality (OR 0.95, 95% CI 0.84 to 1.07; p =
0.37). In contrast, PCSK9 inhibition was associated with reductions in
myocardial infarction (OR 0.80, 95% CI 0.71 to 0.91; p <0.0001), stroke
(OR 0.75, 95% CI 0.65 to 0.85; p <0.0001), and coronary revascularization
(OR 0.82, 95% CI 0.77 to 0.88; p <0.0001). In conclusion, PCSK9 inhibition
was associated with reductions in myocardial infarction, stroke, and
coronary revascularization. Future analyses may identify high-risk
patients who may benefit more from these agents and longer follow-up of
current or new trials may show a mortality benefit. Copyright ©
2019 Elsevier Inc.

<71>
Accession Number
629783613
Title
Five-year outcomes after PCI or CABG for left main coronary disease.
Source
New England Journal of Medicine. 381 (19) (pp 1820-1830), 2019. Date of
Publication: 07 Nov 2019.
Author
Stone G.W.; Pieter Kappetein A.; Sabik J.F.; Pocock S.J.; Morice M.-C.;
Puskas J.; Kandzari D.E.; Karmpaliotis D.; Morris Brown W.; Lembo N.J.;
Banning A.; Merkely B.; Horkay F.; Boonstra P.W.; Van Boven A.J.; Ungi I.;
Bogats G.; Mansour S.; Noiseux N.; Sabate M.; Pomar J.; Hickey M.;
Gershlick A.; Buszman P.E.; Bochenek A.; Schampaert E.; Page P.; Modolo
R.; Gregson J.; Simonton C.A.; Mehran R.; Kosmidou I.; Genereux P.;
Crowley A.; Dressler O.; Serruys P.W.
Institution
(Stone, Karmpaliotis, Morris Brown, Lembo, Modolo, Kosmidou, Genereux,
Crowley, Dressler) Cardiovascular Research Foundation, 1700 Broadway, 8th
Fl., New York, NY 10019, United States
(Stone, Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, United States
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, United
States
(Karmpaliotis, Lembo, Kosmidou) New York-Presbyterian Hospital, Columbia
University Medical Center, New York, United States
(Pieter Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Van Boven, Buszman) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Modolo) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Sabik) University Hospitals Cleveland Medical Center, Cleveland, United
Kingdom
(Pocock, Gregson) London School of Hygiene and Tropical Medicine, United
Kingdom
(Serruys) InternationalCentre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Hickey, Gershlick) University Hospitals of Leicester, NHS Trust,
Leicester, United Kingdom
(Morice) Hopital Prive Jacques Cartier, Ramsay Generale de Sante, Massy,
France
(Kandzari, Morris Brown) Piedmont Heart Institute, Atlanta, United States
(Merkely, Horkay) Semmelweis University, Budapest, Hungary
(Ungi, Bogats) University of Szeged, Szeged, Hungary
(Mansour, Noiseux) Centre Hospitalier, L'Universite de Montreal, Canada
(Schampaert, Page, Genereux) Hopital du Sacre-Coeur de Montreal, Canada
(Sabate, Pomar) Hospital Clinic, Barcelona, Spain
(Buszman, Bochenek) Medical University of Silesia, Katowice, Poland
(Buszman, Bochenek) American Heart of Poland, Ustron, Poland
(Modolo) University of Campinas, Campinas, Brazil
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Long-term outcomes after percutaneous coronary intervention
(PCI) with contemporary drug-eluting stents, as compared with
coronary-artery bypass grafting (CABG), in patients with left main
coronary artery disease are not clearly established. METHODS We randomly
assigned 1905 patients with left main coronary artery disease of low or
intermediate anatomical complexity (according to assessment at the
participating centers) to undergo either PCI with fluoropolymer-based
cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or
CABG (CABG group, 957 patients). The primary outcome was a composite of
death, stroke, or myocardial infarction. RESULTS At 5 years, a primary
outcome event had occurred in 22.0% of the patients in the PCI group and
in 19.2% of the patients in the CABG group (difference, 2.8 percentage
points; 95% confidence interval [CI], -0.9 to 6.5; P=0.13). Death from any
cause occurred more frequently in the PCI group than in the CABG group (in
13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI, 0.2 to 6.1). In
the PCI and CABG groups, the incidences of definite cardiovascular death
(5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI,
-1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4
percentage points; 95% CI, -1.3 to 4.2) were not significantly different.
All cerebrovascular events were less frequent after PCI than after CABG
(3.3% vs. 5.2%; difference, -1.9 percentage points; 95% CI, -3.8 to 0),
although the incidence of stroke was not significantly different between
the two groups (2.9% and 3.7%; difference, -0.8 percentage points; 95% CI,
-2.4 to 0.9). Ischemia-driven revascularization was more frequent after
PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points;
95% CI, 3.7 to 10.0). CONCLUSIONS In patients with left main coronary
artery disease of low or intermediate anatomical complexity, there was no
significant difference between PCI and CABG with respect to the rate of
the composite outcome of death, stroke, or myocardial infarction at
5years.(FundedbyAbbottVascular;EXCELClinicalTrials.govnumber,NCT01205776).
 Copyright © 2019 Massachusetts Medical Society.

<72>
Accession Number
621176178
Title
Comparison of single versus dual antiplatelet therapy after TAVR: A
systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (4) (pp 783-791),
2018. Date of Publication: 01 Oct 2018.
Author
Raheja H.; Garg A.; Goel S.; Banerjee K.; Hollander G.; Shani J.; Mick S.;
White J.; Krishnaswamy A.; Kapadia S.
Institution
(Raheja, Banerjee, Mick, White, Krishnaswamy, Kapadia) Department of
Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland,
OH, United States
(Garg) Department of Cardiology, Newark Beth Israel Medical Center,
Newark, NJ, United States
(Goel, Hollander, Shani) Department of Cardiology, Maimonides Medical
Center, Brooklyn, NY, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We aim to evaluate the efficacy of dual versus single
anti-platelet therapy (SAPT) after TAVR through a systematic review and
meta-analysis of published research. Background(s): Dual antiplatelet
therapy (DAPT) with aspirin and clopidogrel is a commonly practiced
strategy after transcatheter aortic valve replacement (TAVR). However,
there is lack of sufficient evidence supporting this approach.
 Method(s): We searched PubMed, EMBASE, the Cochrane Central Register
of Controlled trials, and the clinical trial registry maintained at
clinicaltrials.gov for randomized control trials (RCT) and observational
studies comparing DAPT with SAPT post TAVR. Event rates were compared
using a forest plot of relative risk with 95% confidence intervals using a
random-effects model assuming inter-study heterogeneity. Result(s): A
total of six studies (3 RCTs and 3 observational studies, n = 840) were
included in the final analysis. Compared to SAPT, DAPT was associated with
increased risk of significant bleeding (life threatening and major) [RR =
2.52 (95% CI 1.62-3.92, P < 0.0001)] with the number needed to harm for
major or life-threatening bleeding calculated to be 10.4. There was no
significant difference in the incidence of stroke [RR = 1.06 (95% CI,
0.43-2.60, P = 0.90)], spontaneous myocardial infarction [RR = 2.08 (95%
CI, 0.56-7.70, P = 0.27)] and all-cause mortality [RR = 1.18 (95% CI,
0.68-2.05, P = 0.56] in the DAPT and SAPT groups. Conclusion(s): In
this small meta-analysis of DAPT versus SAPT after TAVR, DAPT did not
prevent stroke, myocardial infarction or death while the risk of bleeding
was higher. Results from ongoing trials are awaited to determine the best
anti-thrombotic approach after TAVR. Copyright © 2018 Wiley
Periodicals, Inc.

<73>
Accession Number
622093305
Title
Sex disparities in acute myocardial infarction care and outcomes.
Source
Catheterization and Cardiovascular Interventions. 92 (5) (pp E341-E347),
2018. Date of Publication: 01 Nov 2018.
Author
Gul B.; Kozuma K.; Haimi I.; Zhao W.; Simonton C.; Ying S.-W.; Buda A.;
Mehta S.; Baumbach A.; Lansky A.
Institution
(Gul, Haimi, Buda, Baumbach, Lansky) Division of Cardiovascular Medicine,
Department of Internal Medicine, Yale School of Medicine, New Haven, CT,
United States
(Kozuma) Division of Cardiovascular Medicine, Teikyo University, Tokyo,
Japan
(Zhao, Simonton, Ying) Abbott Vascular, Santa Clara, CA, United States
(Mehta) Lumen Global and LATIN, Miami, FL, United States
(Baumbach, Lansky) Department of Cardiology, St Bartholomew's Hospital,
London, United Kingdom
(Baumbach, Lansky) William Harvey Research Institute and Queen Mary
University of London, London, United Kingdom
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Aim: We investigated sex-based and regional outcomes after contemporary
percutaneous coronary intervention (PCI) with the Xience V stent in
patients with acute myocardial infarction (AMI). Methods and Results:
This patient level pooled analysis includes three multi-center,
prospective post-market registries performed in the US, Japan, and China.
A total of 1,938 patients treated with Xience V stents in the setting of
AMI were enrolled. Compared to men, women had higher major adverse cardiac
events (MACE) (14.1% vs. 9.8% P < 0.01, RR 1.4, 95% CI 1.1-1.4) and
all-cause mortality (10% vs. 6.2% P < 0.01, RR 1.61, 95% CI 1.14-2.27) at
one year, without any significant difference in device specific outcomes
of target vessel failure (TVF). US patients compared to the patients from
China and Japan had increased MACE (female: 18% vs. 7.1%, P = 0.0012,
male: 15.7% vs. 4.1%, P < 0.0001). Multivariable analysis demonstrated
that major bleeding was the strongest predictor of MACE (OR 10.51, 95%CI
4.01-27.50, P < 0.0001), MI (OR 4.26, 95%CI 1.37-13.29, P = 0.012), and
all-cause death (OR 5.3, 95%CI 2.32-12.13, P < 0.0001).
 Conclusion(s): Women with AMI who underwent PCI with XIENCE DES have
higher all-cause mortality at one year in compared to men. Region based
outcomes demonstrated increased MACE among US patients compared to the
patients from China and Japan. After adjusting for differences in
demographics, major bleeding, rather than female sex, predicted the higher
observed all-cause mortality. Copyright © 2018 Wiley Periodicals,
Inc.

<74>
Accession Number
622003862
Title
Improved stent expansion with prolonged compared with short balloon
inflation: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (5) (pp 873-880),
2018. Date of Publication: 01 Nov 2018.
Author
Saad M.; Bavineni M.; Uretsky B.F.; Vallurupalli S.
Institution
(Saad, Uretsky, Vallurupalli) Division of Cardiology, University of
Arkansas for Medical Sciences, Little Rock, AR, United States
(Saad) Division of Cardiovascular Medicine, Ain Shams University, Cairo,
Egypt, United States
(Bavineni) Division of Hospital Medicine, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Uretsky, Vallurupalli) Division of Cardiology, Central Arkansas Veterans
Healthcare System, Little Rock, AR, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Despite evidence from individual studies suggesting that
prolonged inflation improves coronary stent expansion, relatively shorter
inflation times are commonly employed in clinical practice.
 Method(s): We performed an electronic search of PubMed, Web of
Science, Cochrane, and CINAHL databases to retrieve outcome studies
comparing prolonged versus short inflation times during stent deployment.
Outcomes studied included minimal stent diameter (MSD) and minimal stent
area (MSA). Standardized mean difference (SMD) was used to estimate the
effect sizes for these continuous variables. Result(s): Seven studies
with a total of 341 patients (415 lesions; mean age 67.6 years; 82% male)
were included. Drug-eluting stents were used in 89 +/- 15% of coronary
lesions. Prolonged stent inflation was associated with increased minimal
stent diameter (2.93 +/- 0.34 mm vs. 2.72 +/- 0.28 mm; SMD = 0.42; 95% CI
0.25-0.59; P < 0.001) and minimal stent area (5.99 +/- 1.21 mm2
vs. 5.17 +/- 0.87 mm2; SMD = 0.46; 95% CI 0.19-0.73; P = 0.001)
compared with shorter duration stent inflation. This difference remained
significant in sensitivity analyses that excluded studies with very
prolonged inflation duration or multiple stent balloon inflations.
 Conclusion(s): Despite differences in duration and methodology,
prolonged stent inflation is associated with improved expansion compared
with shorter duration. The effect of this optimization recommends
randomized trials to determine whether long-term outcomes can be improved
by this simple technical modification. Copyright © 2018 Wiley
Periodicals, Inc.

<75>
Accession Number
2003731409
Title
Prospective, multicenter, randomized, controlled trial evaluating the
performance of a novel combination powder vs hemostatic matrix in
cardiothoracic operations.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Dang N.C.; Ardehali A.; Bruckner B.A.; Parrino P.E.; Gillen D.L.; Hoffman
R.W.; Spotnitz R.; Cavoores S.; Shorn I.J.; Manson R.J.; Spotnitz W.D.
Institution
(Dang) Department of Surgery, Kaiser Moanalua Medical Center, Honolulu,
HI, United States
(Ardehali) Department of Surgery, University of California at Los Angeles,
Los Angeles, CA, United States
(Bruckner) Methodist DeBakey Heart and Vascular Center, Houston Methodist
Hospital, Houston, TX, United States
(Parrino) Thoracic and Cardiovascular Surgery Section, Ochsner Medical
Center, New Orleans, LA, United States
(Gillen) Department of Statistics, University of California, Irvine, CA,
United States
(Hoffman, Spotnitz, Cavoores, Shorn, Manson, Spotnitz) Biom'up SA, Lyon,
France
(Manson) Department of Surgery, Duke University, Durham, NC, United States
(Manson) Department of Mechanical Engineering and Materials Science, Duke
University, Durham, NC, United States
(Spotnitz) Department of Surgery, University of Virginia, Charlottesville,
VA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Aim: This trial compared the hemostatic performance of a novel combination
powder (CP) to a control hemostatic matrix (HM) in cardiothoracic
operations. Method(s): Patients meeting eligibility criteria were
enrolled after providing informed consent. Subjects were randomized
intraoperatively to receive CP (HEMOBLAST Bellows; Biom'up, France) or HM
(FLOSEAL Hemostatic Matrix; Baxter Healthcare Corporation, Hayward, CA).
Bleeding was assessed using a clinically validated, quantitative bleeding
severity scale. The primary endpoint was total time to hemostasis (TTTH),
from the start of device preparation, as an indicator of when a surgeon
asks for a surgical hemostat until hemostasis was achieved. TTTH at 3
minutes was utilized for the primary analysis, while TTTH at 5 minutes was
considered as a secondary endpoint. Result(s): A total of 105
subjects were enrolled across four institutions. The primary efficacy
endpoint for the superiority of CP relative to HM for success at achieving
hemostasis within 3 minutes was met, with 64.2% of the CP group achieving
hemostasis compared with 9.6% of the HM group, a difference of 54.54%
(37.4%-71.6%; P <.001 for superiority). The secondary efficacy endpoint
was also met, with 92.5% of the CP group achieving hemostasis at 5 minutes
versus 44.2% in the HM group, a difference of 48.2% (31.1%-65.4%; P <.001
for noninferiority). There were no device-related adverse events.
 Conclusion(s): In this multicenter, randomized, controlled trial,
comparison of CP to HM revealed CP superiority and noninferiority for TTTH
at 3 and 5 minutes, respectively. Copyright © 2019 The Authors.
Journal of Cardiac Surgery published by Wiley Periodicals, Inc.

<76>
Accession Number
2003355967
Title
Preoperative Anemia and Outcomes in Cardiovascular Surgery: Systematic
Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 108 (6) (pp 1840-1848), 2019. Date of
Publication: December 2019.
Author
Padmanabhan H.; Siau K.; Curtis J.; Ng A.; Menon S.; Luckraz H.; Brookes
M.J.
Institution
(Padmanabhan, Siau, Menon, Brookes) Department of Gastroenterology, Heart
& Lung Centre, Wolverhampton, United Kingdom
(Curtis) Shrewsbury Health Library, Royal Shrewsbury Hospital, Shrewsbury,
United Kingdom
(Ng) Department of Cardiothoracic Anaesthesiology, Heart & Lung Centre,
Wolverhampton, United Kingdom
(Luckraz) Cardiothoracic Surgery Department, Heart Centre, American
Hospital Dubai, Oud Metha, Dubai, United Arab Emirates
Publisher
Elsevier USA
Abstract
Background: Preoperative anemia is common in patients scheduled for
cardiac surgery. However, its effect on postoperative outcomes remains
controversial. This meta-analysis aimed to clarify the impact of anemia on
outcomes after cardiac surgery. Method(s): A literature search was
conducted on MEDLINE, Embase, Cochrane, and Web of Science databases. The
primary outcome was 30-day postoperative or in-hospital mortality.
Secondary outcomes included acute kidney injury, stroke, blood
transfusion, and infection. A meta-analytic model was used to determine
the differences in the above postoperative outcomes between anemic and
nonanemic patients. Result(s): Of 1103 studies screened, 22 met the
inclusion criteria. Of 114,277 patients, 23,624 (20.6%) were anemic.
Anemia was associated with increased mortality (odds ratio [OR], 2.74; 95%
confidence interval [CI], 2.32-3.24; I2 = 69.6%; P < .001),
acute kidney injury (OR, 3.13; 95% CI, 2.37-4.12; I2 = 71.1%; P
< .001), stroke (OR, 1.46; 95% CI, 1.24-1.72; I2 = 21.6%; P <
.001), and infection (OR, 2.65; 95% CI, 1.98-3.55; I2 = 46.7%;
P < .001). More anemic patients were transfused than nonanemic patients
(33.3% vs 11.9%, respectively). No statistically significant association
was found between mortality and blood transfusion (OR, 1.35; 95% CI,
0.92-1.98; I2 = 83.7%; P = .12), but we were not able to
compare mortality with or without transfusion in those who were or were
not anemic. Conclusion(s): Preoperative anemia is associated with
adverse outcomes after cardiac surgery. These findings support the
addition of preoperative anemia to future risk prediction models and as a
target for risk modification. Copyright © 2019 The Society of
Thoracic Surgeons

<77>
Accession Number
629928786
Title
Meta-analysis of impact of troponins on mortality after transcatheter
aortic valve implantation.
Source
The Journal of cardiovascular surgery. (no pagination), 2019. Date of
Publication: 18 Nov 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Takagi) Department of Cardiovascular Surgery, Kitasato University School
of Medicine, Sagamihara, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, NY,
NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, MI, Detroit,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: To determine whether troponin (Tn) can predict mortality after
transcatheter aortic valve implantation (TAVI), we performed a
meta-analysis of currently available studies investigating impact of
baseline and postprocedural Tn. METHOD(S): MEDLINE and EMBASE were
searched through April 2019 using PubMed and OVID. Studies considered for
inclusion met the following criteria: the study investigating impact of
baseline and postprocedural Tn on mortality; the study population was
patients undergoing TAVI; outcomes included early (30-day or
in-hospital)/late (including early) mortality. For each study, data
regarding early/late mortality in both high and low (defined in each
study) level of baseline/postprocedural Tn groups were used to generate
odds ratios (ORs) and 95% confidence intervals (CIs), or reported ORs and
hazard ratios (HRs) with 95% CIs were directly extracted. Study-specific
estimates were combined using inverse variance-weighted averages of
logarithmic ORs/HRs in the random-effects model. RESULT(S): We
identified 19 eligible studies including a total of 7555 patients
undergoing TAVI. Pooled analyses demonstrated associations of high levels
of baseline Tn with statistically significant increases in both 30-day (P
= 0.002) and midterm mortality (P < 0.00001), no correlation of high
postprocedural Tn with 30-day mortality (P = 0.13), and an association of
high postprocedural Tn with a statistically significant increase in
midterm mortality (P = 0.002). High levels of baseline/postprocedural TnT
predicted statistically significant increases in both 30-day (P = 0.002/<
0.0001) and midterm mortality (P < 0.00001/0.0003). CONCLUSION(S):
Both baseline and postprocedural Tn, especially TnT, may predict mortality
after TAVI for AS.

<78>
Accession Number
2003880319
Title
Combined Coronary Artery Bypass Surgery With Bone Marrow Stem Cell
Transplantation: Are We There Yet?.
Source
Annals of Thoracic Surgery. 108 (6) (pp 1913-1921), 2019. Date of
Publication: December 2019.
Author
Ayyat K.S.; Argawi A.; Mende M.; Steinhoff G.; Borger M.A.; Deebis A.M.;
McCurry K.R.; Garbade J.
Institution
(Ayyat, McCurry) Department of Thoracic and Cardiovascular Surgery, Heart
and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, United
States
(Ayyat, McCurry) Department of Inflammation and Immunity, Lerner Research
Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
(Ayyat, Deebis) Department of Cardiothoracic Surgery, Zagazig University,
Zagazig, Egypt
(Argawi, Borger, Garbade) Department of Cardiac Surgery, Heart Center
University, Medicine Leipzig, Leipzig, Germany
(Mende) Coordination Centre for Clinical Trials, University of Leipzig,
Leipzig, Germany
(Steinhoff) Department of Cardiac Surgery, Reference and Translation
Center for Cardiac Stem Cell Therapy, University Medicine Rostock,
Rostock, Germany
Publisher
Elsevier USA
Abstract
Background: Although the safety and feasibility of combined coronary
artery bypass grafting (CABG) and bone marrow stem cell (BMSC)
transplantation have been proven, the efficacy of this approach remains
controversial. Therefore, we conducted an updated meta-analysis of
randomized controlled trials to evaluate the efficacy of this procedure.
 Method(s): Electronic databases were systematically searched for
randomized trials comparing 4-month to 6-month follow-up outcomes in
patients who underwent isolated CABG (CABG group) and patients who
received BMSC transplantation with CABG (BMSC group). A random-effects
meta-analysis was conducted across eligible studies. Meta-regression and
subgroup analyses were utilized to identify sources of data heterogeneity.
 Result(s): Thirteen trials were eligible, with a total number of 292
patients in the BMSC group and 247 patients in the CABG group. Compared
with the CABG group, the BMSC group showed significant improvement of
follow-up left ventricular ejection fraction (n = 539, 4.8%; 95%
confidence interval [CI], 2.3%-7.3%; P = .001). The analyzed data showed
significant heterogeneity (I2 = 74.2%, P < .001). The reduction
in scar size (n = 120; -2.2 mL; 95% CI, -18.2 mL to 13.7 mL; P = .44) and
the improvement in the 6-minute walk test (n = 212; 41 m; 95% CI, -13 m to
95 m; P = .10) did not reach statistical significance. No significant
correlation was found between the number of the injected BMSCs or the
method of injection and the change in ejection fraction.
 Conclusion(s): The present evidence suggests that combined CABG and
BMSC transplantation is associated with improvement of left ventricular
ejection fraction. However, the heterogeneity in the data suggests
variations in patient response to this therapy. Further studies are
required to understand these variations. Copyright © 2019 The
Society of Thoracic Surgeons

<79>
Accession Number
2003880288
Title
The Choice of Treatment in Ischemic Mitral Regurgitation With Reduced Left
Ventricular Function.
Source
Annals of Thoracic Surgery. 108 (6) (pp 1901-1912), 2019. Date of
Publication: December 2019.
Author
Nappi F.; Avtaar Singh S.S.; Padala M.; Attias D.; Nejjari M.; Mihos C.G.;
Benedetto U.; Michler R.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Avtaar Singh) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Padala) Structural Heart Research & Innovation, Laboratory, Carlyle
Fraser Heart Center, Division of Cardiothoracic Surgery, Emory University,
Atlanta, Georgia
(Attias) Department of Cardiology, Centre Cardiologique du Nord,
Saint-Denis, France
(Nejjari) Department of Cardiology, Interventional Cardiology Centre
Cardiologique du Nord, Saint-Denis, France
(Mihos) Echocardiography Laboratory, Division of Cardiology, Columbia
University, Mount Sinai Heart Institute, Miami Beach, FL, United States
(Benedetto) Department of Cardiothoracic Surgery, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Michler) Department of Surgery and Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York,
NY, United States
Publisher
Elsevier USA
Abstract
Background: Ischemic mitral regurgitation is a condition characterized by
mitral insufficiency secondary to an ischemic left ventricle. Primarily,
the pathology is the result of perturbation of normal regional left
ventricular geometry combined with adverse remodeling. We present a
comprehensive review of contemporary surgical, medical, and percutaneous
treatment options for ischemic mitral regurgitation, rigorously examined
by current guidelines and literature. Method(s): We conducted a
literature search of the PubMed database, Embase, and the Cochrane Library
(through November 2018) for studies reporting perioperative or late
mortality and echocardiographic outcomes after surgical and nonsurgical
intervention for ischemic mitral regurgitation. Result(s): Treatment
of this condition is challenging and often requires a multimodality
approach. These patients usually have multiple comorbidities that may
preclude surgery as a viable option. A multidisciplinary team discussion
is crucial in optimizing outcomes. There are several options for treatment
and management of ischemic mitral regurgitation with differing benefits
and risks. Guideline-directed medical therapy for heart failure is the
treatment choice for moderate and severe ischemic mitral regurgitation,
with consideration of coronary revascularization, mitral valve surgery,
cardiac resynchronization therapy, or a combination of these, in
appropriate candidates. The use of transcatheter mitral valve therapy is
considered appropriate in high-risk patients with severe ischemic mitral
regurgitation, heart failure, and reduced left ventricular ejection
fraction, especially in those with hemodynamic instability.
 Conclusion(s): The role of mitral valve surgery and transcatheter
mitral valve therapy continues to evolve. Copyright © 2019 The
Society of Thoracic Surgeons

<80>
Accession Number
629938461
Title
Retinal blood flow measurements by doppler optical coherence tomography
flowmeter can reflect condition of aortic stenosis.
Source
Investigative Ophthalmology and Visual Science. Conference: 2019 Annual
Meeting Association for Research in Vision and Ophthalmology, ARVO 2019.
Canada. 60 (9) (no pagination), 2019. Date of Publication: July 2019.
Author
Song Y.; Yoshioka T.; Takahashi K.; Tani T.; Akiba M.; Sakai J.; Nakamura
S.; Minamide K.; Ishiko S.; Yanagi Y.; Yoshida A.
Institution
(Song, Yoshioka, Takahashi, Tani, Ishiko, Yanagi, Yoshida) Asahikawa
Medical University, New York, NY, United States
(Song, Yanagi) Singapore Eye Research Institute, Singapore
(Akiba, Sakai, Nakamura, Minamide) Topcon Corporation, Japan
Publisher
Association for Research in Vision and Ophthalmology Inc.
Abstract
Purpose : Though early detection of aortic stenosis (AS) can improve the
survival rate, conventional methods such as stethoscope and
echocardiography, the gold standard of evaluating condition of AS, are
subjective and technique-sensitive. We developed Doppler optical coherence
tomography flowmeter (DOCT flowmeter: IOVS 2016, IOVS 2017, PLoS ONE 2018)
which can easily, accurately and non-invasively measure retinal blood flow
(RBF) within 3 seconds. We also reported that DOCT flowmeter showed the
abnormal velocity waveform of retinal blood flow (RBF) in a patient with
aortic regurgitation. The purpose of the study was to investigate the
relationship between parameters of DOCT flowmeter and echocardiography in
patients with AS. Methods : Eleven eyes of 11 subjects who visited the
cardiovascular surgery clinic in Asahikawa Medical University hospital and
was diagnosed with AS, and 20 eyes of 20 agematched healthy subjects
(control) were chosen in this study. The superotemporal artery in randomly
selected one eye was used for measuring RBF using DOCT flowmeter. The
upstroke time (UT) of the RBF velocity waveforms, an index representing a
rising feature value of RBF velocity waveforms, was calculated. The peak
velocity (PV) was measured by echocardiography, then the correlation
coefficient between UT and PV was calculated. In addition, in 9 out of 11
AS patients, RBF was measured before and after the aortic valve
replacement surgery to check if UT was improved after the surgery.
Pearson's correlation coefficient was used to assess the relationships
between UT and PV. Paired t test was employed to compare UTs between
before and after the surgery for AS. P values less than 0.05 were
considered statistically significant. Results : UT in AS patients (0.22
+/- 0.017 sec) was longer than that in control (0.14 +/- 0.022 sec) (P <
0.001). There was a very high correlation between UT and PV (R = 0.91) (P
< 0.001). After the surgery for AS, UT was significantly improved (pre-op,
0.22 +/- 0.019 sec; post-op, 0.14 +/- 0.019 sec) (p < 0.001). Conclusions
: Current study strongly suggests that DOCT is equivalent to conventional
echography in detecting blood flow changes occurring in AS patients. Since
DOCT flowmeter can non-invasively acquire the RBF velocity waveforms
within 3 seconds, this modality is a useful and convenient screening test
that can potentially replace the conventional echography.

<81>
Accession Number
2003253092
Title
Comparison the effect of active cyclic breathing technique and routine
chest physiotherapy on pain and respiratory parameters after coronary
artery graft surgery: A randomized clinical trial.
Source
Anesthesiology and Pain Medicine. 9 (5) (no pagination), 2019. Article
Number: e94654. Date of Publication: 2019.
Author
Derakhtanjani A.S.; Jaberi A.A.; Haydari S.; Bonabi T.N.
Institution
(Derakhtanjani) Department of Medical Surgical Nursing, School of Nursing
and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran,
Islamic Republic of
(Jaberi) Department of Psychiatric and Mental Health Nursing, School of
Nursing and Midwifery, Rafsanjan University of Medical Sciences,
Rafsanjan, Iran, Islamic Republic of
(Jaberi, Bonabi) Social Determinants of Health Research Center, Rafsanjan
University of Medical Sciences, Rafsanjan, Iran, Islamic Republic of
(Haydari) Department of Fundamental Nursing, Geriatric Care Research
Center, School of Nursing and Midwifery, Rafsanjan University of Medical
Sciences, Rafsanjan, Iran, Islamic Republic of
(Bonabi) Department of Community Health Nursing, School of Nursing and
Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran,
Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: editor@anesthpain.com)
Abstract
Background: There are limited reports available on preferred chest
physiotherapy methods in patients with coronary artery graft (CABG)
surgery. Objective(s): The aim of this study was to compare the
effect of active cyclic breathing technique (ACBT) and routine chest
physiotherapy on pain and respiratory parameters in patients undergoing
CABG surgery. Method(s): This randomized clinical trial was carried
out from July to November 2018. Seventy patients were selected randomly
after CABG according to inclusion criteria and then assigned in two groups
(35 in ACBT and 35 in routine physiotherapy) by random minimization
method. The arterial blood gas levels, pain, heart rate, and respiratory
rate were measured for both groups before and after the intervention on
two consecutive days after surgery. Data were analyzed by SPSS software
V.22, at a significance level of 0.05. Result(s): The two groups were
similar in terms of demographic variables. In within group comparison in
the physiotherapy group, the level of PaO<inf>2</inf>, HR, RR, and pain
increased significantly on both days (P = 0.001), SaO<inf>2</inf> on the
first day (P = 0.005) and second day (P = 0.001), and PaCO<inf>2</inf> on
the first day (P = 0.02). In ACBT group, the level of SaO<inf>2</inf>, HR,
RR, and pain increased significantly on both days (P = 0.001),
HCO<inf>3</inf> on the first day (P = 0.021), and PaO<inf>2</inf> on the
second day (P = 0.001) post intervention. In between group comparison, on
the first day, the level of PH (P = 0.034), and on the second day
HCO<inf>3</inf> (P = 0.032) decreased, while RR (P = 0.011) increased
significantly in the physiotherapy group, at post-intervention phase.
 Conclusion(s): ACBT and routine physiotherapy had similar effects on
arterial oxygenation, HR, and pain perception following CABG surgery. The
physiotherapy on the second day increased the RR to an abnormal
range. Copyright © 2019, Author(s).

<82>
Accession Number
629954915
Title
A Systematic Review for Variables to Be Collected in a Transplant Database
for Improving Risk Prediction.
Source
Transplantation. 103 (12) (pp 2591-2601), 2019. Date of Publication: 01
Dec 2019.
Author
Almasri J.; Tello M.; Benkhadra R.; Morrow A.S.; Hasan B.; Farah W.;
Alvarez Villalobos N.; Mohammed K.; Allen J.-S.P.; Prokop L.J.; Wang Z.;
Kasiske B.L.; Israni A.K.; Murad M.H.
Institution
(Almasri, Tello, Benkhadra, Morrow, Hasan, Farah, Alvarez Villalobos,
Mohammed, Allen, Wang, Murad) Evidence-Based Practice Research Program,
Mayo Clinic, MN
(Almasri, Tello, Benkhadra, Morrow, Hasan, Farah, Alvarez Villalobos,
Mohammed, Allen, Wang, Murad) Robert D. and Patricia E. Kern Center for
the Science of Health Care Delivery, Mayo Clinic, MN
(Prokop) Mayo Clinic Libraries, Mayo Clinic, MN, Rochester
(Kasiske) Scientific Registry of Transplant Recipients, Minneapolis
Medical Research Foundation, MN, Minneapolis, United States
(Kasiske) Department of Medicine, Hennepin Healthcare, University of
Minnesota, MN, Minneapolis, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: This systematic review was commissioned to identify new
variables associated with transplant outcomes that are not currently
collected by the Organ Procurement and Transplantation Network (OPTN).
 METHOD(S): We identified 81 unique studies including 1193410 patients
with median follow-up of 36 months posttransplant, reporting 108 unique
risk factors. RESULT(S): Most risk factors (104) were recipient
related; few (4) were donor related. Most risk factors were judged to be
practical and feasible to routinely collect. Relative association measures
were small to moderate for most risk factors (ranging between 1.0 and
2.0). The strongest relative association measure for a heart transplant
outcome with a risk factor was 8.6 (recipient with the previous Fontan
operation), for a kidney transplant 2.8 (sickle cell nephropathy as
primary cause of end-stage renal disease), for a liver transplant 14.3
(recipient serum ferritin >500 micro g/L), and for a lung transplant
6.3 (Burkholderia cepacia complex infection for 1 y or less). OPTN may
consider some of these 108 variables for future collection to enhance
transplant research and clinical care. CONCLUSION(S): Evidence-based
approaches can be used to determine variables collected in databases and
registries. Several candidate variables have been identified for OPTN.

<83>
Accession Number
2003795670
Title
Synchronous versus Staged Carotid Endarterectomy and Coronary Artery
Bypass Graft for Patients with Concomitant Severe Coronary and Carotid
Artery Stenosis: A Systematic Review and Meta-analysis.
Source
Annals of Vascular Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Tzoumas A.; Giannopoulos S.; Texakalidis P.; Charisis N.; Machinis T.;
Koullias G.J.
Institution
(Tzoumas) Department of Internal Medicine, Medical School Aristotle
University of Thessaloniki, Thessaloniki, Greece
(Giannopoulos) Department of Surgery, 251 HAF and VA Hospital, Athens,
Greece
(Texakalidis) Department of Neurosurgery, Emory University School of
Medicine, Atlanta, GA, United States
(Charisis) Division of Surgical Oncology, Department of Surgery, Stony
Brook University Hospital, Stony Brook, NY, United States
(Machinis) Department of Neurosurgery, Virginia Commonwealth University,
Richmond, VA, United States
(Koullias) Division of Vascular and Endovascular Surgery, Department of
Surgery, Stony Brook University Hospital, Stony Brook, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Due to the systemic nature of atherosclerosis, arteries at
different sites are commonly simultaneously affected. As a result, severe
coronary artery disease (CAD) requiring coronary artery bypass grafting
(CABG) frequently coexists with significant carotid stenosis that warrants
revascularization. To compare simultaneous carotid endarterectomy (CEA)
and CABG versus staged CEA and CABG for patients with concomitant CAD and
carotid artery stenosis in terms of perioperative outcomes.
 Method(s): This study was performed according to the Preferred
Reporting Items for Systematic reviews and Meta-Analyses guidelines. A
meta-analysis was conducted with the use of a random effects model. The
I2 statistic was used to assess for heterogeneity.
 Result(s): Eleven studies comprising 44,895 patients were included in
this meta-analysis (21,710 in the synchronous group and 23,185 patients in
the staged group). The synchronous CEA and CABG group had a statistically
significant lower risk for myocardial infarction (MI) (odds ratio [OR]
0.15, 95% CI 0.04-0.61, I2 = 0%) and higher risk for stroke (OR
1.51, 95% CI 1.34-1.71, I2 = 0%) and death (OR 1.33, 95% CI
1.01-1.75, I2 = 47.8%). Transient ischemic attacks (TIAs) (OR
1.27, 95% CI 1.00-1.61, I2 = 0.0%), postoperative bleeding (OR
0.82, 95% CI 0.22-3.05, I2 = 0.0%), and pulmonary complications
(OR 1.52, 95% CI 0.24-9.60, I2 = 67.5%) were similar between
the 2 groups. Conclusion(s): Patients in the simultaneous CEA and
CABG group had a significantly higher risk of 30-day mortality and stroke
and lower risk for MI as compared to staged CEA and CABG group. The rates
of TIA, postoperative bleeding, and pulmonary complications were similar
between the 2 groups. Future randomized trials or prospective cohorts are
needed to validate our results. Copyright © 2019 Elsevier Inc.

<84>
Accession Number
2003638940
Title
Intraoperative graft flow profiles in coronary artery bypass surgery: A
meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Silva M.; Rong L.Q.; Naik A.; Rahouma M.; Hameed I.; Robinson B.; Ruan Y.;
Jiang Y.; Abed A.W.; Girardi L.N.; Gaudino M.
Institution
(Silva, Naik, Rahouma, Hameed, Robinson, Ruan, Jiang, Abed, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York, NY, United States
(Rong) Department of Anesthesiology, Weill Cornell Medicine, New York, NY,
United States
(Silva) Department of Cardiothoracic Surgery, Hospital Santa Marta -
CHULC, Lisbon, Portugal
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Conduits used in coronary artery bypass artery grafting (CABG)
have different properties and flow profiles. We compared intraoperative
mean graft flow (MGF) between arterial and venous conduits, off-pump CABG
(OPCABG) and on-pump CABG (ONCABG) procedures, skeletonized and pedicled
internal mammary artery (IMA) grafts, and pulsatility index (PI) between
OPCABG and ONCABG, in pairwise meta-analyses. Method(s): Following a
systematic literature search, all studies comparing MGF in arterial and
venous grafts, were included. The primary endpoint was comparison of
pooled MGF between arterial and venous grafts. Secondary endpoints were
comparisons of pooled MGF in OPCABG vs ONCABG, anastomosed skeletonized vs
pedicled IMA grafts, free skeletonized vs pedicled IMA grafts and PI in
OPCABG versus ONCABG. Result(s): A total of 25 studies with 4443
patients were included. Compared with venous grafts, arterial grafts had
lower MGF (standardized mean difference [SMD], -0.28; 95% confidence
interval [CI, -0.34; -0.22]; P <.001). OPCABG was associated with
significantly lower MGF compared to ONCABG (SMD, -0.29; 95%CI, -0.50;
-0.08]; P =.01). No differences were found in MGF between skeletonized vs
pedicled IMA after anastomosis (SMD, 0.32; 95%CI [-0.08; 0.71]; P =.11) or
in free flow (SMD, 0.76; 95%CI [-0.14; 1.65]; P =.10). No difference was
found in PI between OPCABG and ONCABG. At meta-regression, age was
associated with higher MGF, while OPCABG was associated with lower MGF.
 Conclusion(s): Intraoperative flow of venous conduits is higher than
that of arterial grafts. Compared to OPCABG surgery, graft flow is higher
in ONCABG. In skeletonized and pedicled IMA conduits, no difference in
flow profiles was found. Copyright © 2019 Wiley Periodicals, Inc.

<85>
Accession Number
2003701920
Title
Efficacy and Safety of Stents in ST-Segment Elevation Myocardial
Infarction.
Source
Journal of the American College of Cardiology. 74 (21) (pp 2572-2584),
2019. Date of Publication: 26 November 2019.
Author
Chichareon P.; Modolo R.; Collet C.; Tenekecioglu E.; Vink M.A.; Oh P.C.;
Ahn J.-M.; Musto C.; Diaz de la Llera L.S.; Cho Y.-S.; Violini R.; Park
S.-J.; Suryapranata H.; Piek J.J.; de Winter R.J.; Wykrzykowska J.J.;
Spaulding C.; Kang W.C.; Slagboom T.; Hofma S.H.; Wijnbergen I.F.; Di
Lorenzo E.; Pijls N.H.; Raber L.; Brugaletta S.; Sabate M.; Stoll H.-P.;
Stone G.W.; Windecker S.; Onuma Y.; Serruys P.W.
Institution
(Chichareon, Modolo, Collet, Piek, de Winter, Wykrzykowska) Heart Center,
Department of Clinical and Experimental Cardiology, Amsterdam
Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
(Chichareon) Cardiology Unit, Department of Internal Medicine, Faculty of
Medicine, Prince of Songkla University, Songkhla, Thailand
(Modolo) Department of Internal Medicine, Cardiology Division, University
of Campinas (UNICAMP), Campinas, Brazil
(Collet, Onuma) Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(Tenekecioglu) Erasmus Medical Center, Rotterdam, Netherlands
(Vink, Slagboom) OLVG Hospital, Amsterdam, Netherlands
(Oh, Kang) Department of Cardiology, Gachon University Gil Medical Center,
Incheon, South Korea
(Ahn, Park) Department of Cardiology, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, South Korea
(Musto, Violini) Interventional Cardiology Unit-San Camillo Hospital,
Rome, Italy
(Diaz de la Llera) Unidad de Hemodinamica y Cardiologia Intervencionista,
Hospital Universitario Virgen del Rocio, Seville, Spain
(Cho) Seoul National University Bundang Hospital, Seongnam, South Korea
(Suryapranata) Department of Cardiology, Radboud University Medical
Center, Nijmegen, Netherlands
(Spaulding) Cardiology Department, European Hospital Georges
Pompidou-Assistance Publique Hopitaux de Paris, Sudden Death Expert
Center, INSERM U 970, PARCC, Paris Descartes University, Paris, France
(Hofma) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Wijnbergen, Pijls) Department of Cardiology, Catharina Hospital
Eindhoven, Eindhoven, Netherlands
(Di Lorenzo) Cardiology Department, G. Moscati Hospital, Avellino, Italy
(Raber, Windecker) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Brugaletta, Sabate) Hospital Clinic, Institut Clinic Cardiovascular,
Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS),
University of Barcelona, Barcelona, Spain
(Stoll) Biosensors Clinical Research, Morges, Switzerland
(Stone) New York Presbyterian Hospital, Columbia University Medical Center
and the Cardiovascular Research Foundation, New York, NY, United States
(Onuma) Cardialysis Clinical Trials Management and Core Laboratories,
Rotterdam, Netherlands
(Serruys) Department of Cardiology, Imperial College of London, London,
United Kingdom
Publisher
Elsevier USA
Abstract
Background: To date, no specific drug-eluting stent (DES) has fully proven
its superiority over others in patients with ST-segment elevation
myocardial infarction (STEMI) undergoing percutaneous coronary
intervention. Objective(s): The purpose of this study was to compare
the safety and efficacy of coronary artery stents in STEMI patients in a
patient-level network meta-analysis. Method(s): Eligible studies were
dedicated randomized controlled trials comparing different stents in STEMI
patients undergoing percutaneous coronary intervention with at least 12
months of clinical follow-up. Of 19 studies identified from the published
data, individual patient data were collected in 15 studies with 10,979
patients representing 87.7% of patients in the overall network of
evidence. The primary endpoint was the composite of cardiac death,
reinfarction, or target lesion revascularization. Result(s): Overall,
8,487 (77.3%) of 10,979 STEMI patients were male and the mean age was 60.7
years. At a median follow-up of 3 years, compared with bare-metal stents
(BMS), patients treated with paclitaxel-, sirolimus-, everolimus-, or
biolimus-eluting stents had a significantly lower risk of the primary
endpoint (adjusted hazard ratios [HRs]: 0.74 [95% confidence interval
(CI): 0.63 to 0.88], 0.65 [95% CI: 0.49 to 0.85], 0.70 [95% CI: 0.53 to
0.91], and 0.66 [95% CI: 0.49 to 0.88], respectively). The risk of primary
endpoint was not different between patients treated with BMS and
zotarolimus-eluting stents (adjusted HR: 0.83 [95% CI: 0.51 to 1.38]).
Among patients treated with DES, no significant difference in the risk of
the primary outcome was demonstrated. Treatment with second-generation DES
was associated with significantly lower risk of definite or probable stent
thrombosis compared with BMS (adjusted HR: 0.61 [95% CI: 0.42 to 0.89])
and first-generation DES (adjusted HR: 0.56 [95% CI: 0.36 to 0.88]).
 Conclusion(s): In STEMI patients, DES were superior to BMS with
respect to long-term efficacy. No difference in long-term efficacy and
safety was observed among specific DES. Second-generation were superior to
first-generation DES in reducing stent thrombosis. (Clinical Outcomes
After Primary Percutaneous Coronary Intervention [PCI] Using Contemporary
Drug-Eluting Stent [DES]: Evidence From the Individual Patient Data
Network Meta-Analysis; CRD42018104053) Copyright © 2019 American
College of Cardiology Foundation

<86>
Accession Number
2001481102
Title
Impact of Chronic Kidney Disease on Outcomes of Myocardial
Revascularization in Patients With Diabetes.
Source
Journal of the American College of Cardiology. 73 (4) (pp 400-411), 2019.
Date of Publication: 5 February 2019.
Author
Farkouh M.E.; Sidhu M.S.; Brooks M.M.; Vlachos H.; Boden W.E.; Frye R.L.;
Hartigan P.; Siami F.S.; Bittner V.A.; Chaitman B.R.; Mancini G.B.J.;
Fuster V.
Institution
(Farkouh) Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Ontario, Canada
(Sidhu) Albany Medical College, Albany, NY, United States
(Brooks, Vlachos) University of Pittsburgh, Pittsburgh, PA, United States
(Boden) Boston University and VA New England Health Care System, Boston,
MA, United States
(Frye) Mayo Clinic, Rochester, MN, United States
(Hartigan) Yale University and VA West Haven, West Haven, CT, United
States
(Siami) New England Research Institutes, Watertown, MA, United States
(Bittner) University of Alabama at Birmingham, Birmingham, AL, United
States
(Chaitman) St. Louis University, St. Louis, MO, United States
(Mancini) University of British Columbia, Vancouver, British Columbia,
Canada
(Fuster) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Fuster) Centro Nacional de Investigaciones Cardiovasculares, Madrid,
Spain
Publisher
Elsevier USA
Abstract
Background: The optimal coronary revascularization strategy in patients
with stable ischemic heart disease (SIHD) who have type 2 diabetes (T2DM)
and chronic kidney disease (CKD) remains unclear. Objective(s): This
patient-level pooled analysis sought to compare outcomes of 3 large,
federally-funded randomized trials in SIHD patients with T2DM and CKD
(COURAGE [Clinical Outcomes Utilizing Revascularization and Aggressive
Drug Evaluation], BARI 2D [Bypass Angioplasty Revascularization
Investigation 2 Diabetes], and FREEDOM [Future Revascularization
Evaluation in Patients with Diabetes Mellitus: Optimal Management of
Multi-vessel Disease]). Method(s): The primary endpoint was the
composite of major adverse cardiovascular or cerebrovascular events
(MACCE) including all-cause death, myocardial infarction (MI), or stroke
adjusted for trial and randomization strategy. Result(s): Of the
4,953 patients with available estimated glomerular filtration rate (eGFR)
at baseline, 1,058 had CKD (21.4%). CKD patients were more likely to be
older, be female, and have a history of heart failure. CKD subjects were
more likely to experience a MACCE (adjusted hazard ratio [HR]: 1.48; 95%
confidence interval [CI]: 1.28 to 1.71; p = 0.0001) during a median
4.5-year follow-up. Both mild (eGFR 45 to 60 ml/min/1.73 m2)
and moderate to severe (eGFR <45 ml/min/1.73 m2) CKD predicted
MACCE (adjusted HRs: 1.25 and 2.26, respectively). For patients without
CKD, coronary artery bypass graft (CABG) surgery combined with optimal
medical therapy (OMT) was associated with lower MACCE rates compared with
percutaneous coronary intervention (PCI) + OMT (adjusted HR: 0.69; 95% CI:
0.55 to 0.86; p = 0.001). For the comparison of CABG + OMT versus PCI +
OMT in the CKD group, there was only a statistically significant
difference in subsequent revascularization rates (HR: 0.25; 95% CI: 0.15
to 0.41; p = 0.0001) but not in MACCE rates. Conclusion(s): Among
SIHD patients with T2DM and no CKD, CABG + OMT significantly reduced MACCE
compared with PCI + OMT. In subjects with CKD, there was a nonsignificant
trend toward a better MACCE outcome with CABG and a significant reduction
in subsequent revascularization. Copyright © 2019 American
College of Cardiology Foundation

<87>
Accession Number
628001382
Title
Low-frequency ventilation during cardiopulmonary bypass for lung
protection: A randomized controlled trial.
Source
Journal of Cardiac Surgery. 34 (6) (pp 385-399), 2019. Date of
Publication: June 2019.
Author
Fiorentino F.; Jaaly E.A.; Durham A.L.; Adcock I.M.; Lockwood G.; Rogers
C.; Ascione R.; Reeves B.C.; Angelini G.D.
Institution
(Fiorentino, Lockwood) Department of Surgery & Cancer, Imperial College
London, London, United Kingdom
(Jaaly, Rogers, Ascione, Reeves, Angelini) Department of Cardiac Surgery,
Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary,
Bristol, United Kingdom
(Durham, Adcock) Department of Cardiac Surgery, National Heart & Lung
Institute, Imperial College London, London, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: Pulmonary dysfunction is a common complication in patients
undergoing heart surgery. Current clinical practice does not include any
specific strategy for lung protection. To compare the anti-inflammatory
effects of low-frequency ventilation (LFV), as measured by nuclear factor
kappa-light-chain-enhancer of activated B cells (NF-kappaB) p65 pathway
activation, for the entire cardiopulmonary bypass (CPB) vs both lungs left
collapsed in patients undergoing coronary artery bypass grafting (CABG).
 Method(s): Two groups parallel randomized controlled trial. The
primary outcome was inflammation measured by NF-kappaB p65 activation in
pre- and post-CPB lung biopsies. Secondary outcomes were additional
inflammatory markers in both biopsy tissue and blood. Result(s):
Thirty-seven patients were randomly allocated to LFV (18) and to both
lungs left collapsed (19). The mean concentration of NF-kappaB p65 in the
biopsies before chest closure (adjusted for pre-CPB concentration) was
higher in the LFV group compared to both lungs left collapsed group but
this was not significant (0.102, 95% confidence interval, -0.022 to 0.226,
P = 0.104). There were no significant differences between groups in the
other inflammatory markers measured in tissue and blood.
 Conclusion(s): In patients undergoing elective CABG, the use of LFV
during CPB when compared to both lungs left collapsed does not seem to
reduce inflammation in lung biopsies and blood. Copyright © 2019
Wiley Periodicals, Inc.

<88>
Accession Number
2001382906
Title
Systematic preoperative CT scan is associated with reduced risk of stroke
in minimally invasive mitral valve surgery: A meta-analysis.
Source
International Journal of Cardiology. 278 (pp 300-306), 2019. Date of
Publication: 1 March 2019.
Author
Leonard J.R.; Henry M.; Rahouma M.; Khan F.M.; Wingo M.; Hameed I.; Di
Franco A.; Guy T.S.; Girardi L.N.; Gaudino M.
Institution
(Leonard, Henry, Rahouma, Khan, Wingo, Hameed, Di Franco, Guy, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York City, NY, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Minimally invasive mitral valve surgery (MIMVS) is performed
with increasing frequency. However, patients undergoing MIMVS might be at
increased risk of perioperative stroke, mainly due to retrograde aortic
embolization during femoral cardio-pulmonary bypass. Pre-operative
computed tomography (CT) screening allows visualization of the aorta and
femoro-iliac vessels and individualization of the surgical approach. In
this meta-analysis, we aim to determine if systematic pre-operative CT
screening is associated with decreased incidence of post-operative stroke
and other complications following MIMVS. Method(s): A comprehensive
review was performed in PubMed (inception-May 2018). Eligible studies
included those which reported on MIMVS (mini-thoracotomy, port access or
robotic approach) with retrograde arterial perfusion. Studies were
separated into two subgroups: systematic pre-operative CT screening
(CT-group) and no CT screening (Non-CT). Pooled event rates (PER) for
operative mortality, post-operative stroke, perioperative myocardial
infarction (MI), and new onset renal failure requiring dialysis were
estimated and inter-group comparisons were performed. Result(s): Data
from 57 studies (13,731 patients) were analyzed (19 CT-group, 38 Non-CT).
PER for post-operative stroke was 2.0% with a statistically significant
difference between the groups (CT-group: 1.5% versus Non-CT: 2.2%, P =
0.03). PER for new dialysis was 1.9%, significantly lower in the CT-group
(0.8% versus 2.3% in the Non-CT group, P = 0.02). PER for operative
mortality was 1.4% with a trend towards better outcomes in the CT-group
(0.8% versus 1.6% in the Non-CT group, P = 0.05). Conclusion(s):
Systematic pre-operative CT screening is associated with lower risk of
post-operative stroke and need for dialysis and a trend toward lower
operative mortality after MIMVS. Copyright © 2018 Elsevier B.V.

<89>
[Use Link to view the full text]
Accession Number
629886338
Title
Ripple-AT Study: A Multicenter and Randomized Study Comparing 3D Mapping
Techniques During Atrial Tachycardia Ablations.
Source
Circulation: Arrhythmia and Electrophysiology. 12 (8) (no pagination),
2019. Article Number: 007394. Date of Publication: 01 Aug 2019.
Author
Luther V.; Agarwal S.; Chow A.; Koa-Wing M.; Cortez-Dias N.; Carpinteiro
L.; De Sousa J.; Balasubramaniam R.; Farwell D.; Jamil-Copley S.;
Srinivasan N.; Abbas H.; Mason J.; Jones N.; Katritsis G.; Lim P.B.;
Peters N.S.; Qureshi N.; Whinnett Z.; Linton N.W.F.; Kanagaratnam P.
Institution
(Luther, Koa-Wing, Mason, Katritsis, Lim, Peters, Qureshi, Whinnett,
Linton, Kanagaratnam) Department of Cardiology, Mary Stanford Wing, St
Marys Hospital, Imperial College Healthcare NHS Trust, London W2 1NY,
United Kingdom
(Agarwal, Mason) Papworth Hospital, Cambridge, United Kingdom
(Chow, Srinivasan, Abbas) Barts Heart Centre, London, United Kingdom
(Cortez-Dias, Carpinteiro, De Sousa) Hospital de Santa Maria, Lisbon,
Portugal
(Balasubramaniam, Jones) Royal Bournemouth and Christchurch Hospital,
United Kingdom
(Farwell) Essex Cardiothoracic Centre, Basildon, United Kingdom
(Jamil-Copley) Nottingham University Hospital, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Ripple mapping (RM) is an alternative approach to activation
mapping of atrial tachycardia (AT) that avoids electrogram annotation. We
tested whether RM is superior to conventional annotation based local
activation time (LAT) mapping for AT diagnosis in a randomized and
multicenter study. Method(s): Patients with AT were randomized to
either RM or LAT mapping using the CARTO3v4 CONFIDENSE system. Operators
determined the diagnosis using the assigned 3D mapping arm alone, before
being permitted a single confirmatory entrainment manuever if needed. A
planned ablation lesion set was defined. The primary end point was AT
termination with delivery of the planned ablation lesion set. The
inability to terminate AT with this first lesion set, the use of more than
one entrainment manuever, or the need to crossover to the other mapping
arm was defined as failure to achieve the primary end point.
 Result(s): One hundred five patients from 7 centers were recruited
with 22 patients excluded due to premature AT termination, noninducibility
or left atrial appendage thrombus. Eighty-three patients (pts; RM=42,
LAT=41) completed mapping and ablation within the 2 groups of similar
characteristics (RM versus LAT: prior ablation or cardiac surgery n=35
[83%] versus n=35 [85%], P=0.80). The primary end point occurred in 38/42
pts (90%) in the RM group and 29/41pts (71%) in the LAT group (P=0.045).
This was achieved without any entrainment in 31/42 pts (74%) with RM and
18/41 pts (44%) with LAT (P=0.01). Of those patients who failed to achieve
the primary end point, AT termination was achieved in 9/12 pts (75%) in
the LAT group following crossover to RM with entrainment, but 0/4 pts (0%)
in the RM group crossing over to LAT mapping with entrainment (P=0.04).
 Conclusion(s): RM is superior to LAT mapping on the CARTO3v4
CONFIDENSE system in guiding ablation to terminate AT with the first
lesion set and with reduced entrainment to assist diagnosis. Clinical
Trials Registration: https://www.clinicaltrials.gov. Unique identifier:
NCT02451995. Copyright © 2019 American Heart Association, Inc.

<90>
[Use Link to view the full text]
Accession Number
629886330
Title
Comparison Between Contact Force Monitoring and Unipolar Signal
Modification as a Guide for Catheter Ablation of Atrial Fibrillation:
Prospective Multi-Center Randomized Study.
Source
Circulation: Arrhythmia and Electrophysiology. 12 (8) (no pagination),
2019. Article Number: 007311. Date of Publication: 01 Aug 2019.
Author
Ejima K.; Kato K.; Okada A.; Wakisaka O.; Kimura R.; Ishizawa M.; Imai T.;
Toyama Y.; Shoda M.; Hagiwara N.
Institution
(Ejima, Shoda, Hagiwara) Department of Cardiology, Tokyo Women's Medical
University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162, Japan
(Kato) Department of Cardiology, Tokyo Metropolitan Tama Medical Center,
Japan
(Okada) Department of Cardiology, Shinshu University, Matsumoto, Japan
(Wakisaka) Department of Cardiology, Oita Medical Center, Japan
(Kimura) Department of Arrhythmia, Kanazawa Cardiovascular Hospital, Japan
(Ishizawa) Department of Cardiology, Kagawa University, Takamatsu, Japan
(Imai) Department of Cardiology, Suwa Central Hospital, Chino, Japan
(Toyama) Department of Cardiology, Takamatsu Red Cross Hospital, Japan
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Both contact force monitoring (CFM) and unipolar signal
modification (USM) are guides for ablation, which improve the efficacy of
pulmonary vein isolation of atrial fibrillation. We sought to compare the
outcomes of atrial fibrillation ablation guided by CFM or USM.
 Method(s): A total of 136 patients with paroxysmal atrial
fibrillation underwent a circumferential pulmonary vein isolation using CF
sensing ablation catheters and were randomly assigned to undergo catheter
ablation guided by either CFM (CFM-guided group: n=70) or USM (USM-guided
group: n=66). In the USM-guided group, each radiofrequency application
lasted until the development of completely positive unipolar electrograms.
In the CFM-guided group, a CF of 20 g (range, 10-30 g) and minimum
force-time integral of 400 g were the targets for each radiofrequency
application. The primary end point was freedom from any atrial
tachyarrhythmia recurrence without antiarrhythmic drugs at 12-months of
follow-up. Result(s): The cumulative freedom from recurrences at
12-months was 85% in the USM-guided group and 70% in the CFM-guided group
(P=0.031). The incidence of time-dependent and ATP-provoked early
electrical reconnections between the left atrium and PVs, procedural time,
fluoroscopic time, and average force-time integral, did not significantly
differ between the 2 groups. The radiofrequency time for the pulmonary
vein isolation was shorter in the USM-guided group than CFM-guided group
but was not statistically significant (P=0.077). Conclusion(s): USM
was superior to CFM as an end point for radiofrequency energy deliveries
during the pulmonary vein isolation in patients with paroxysmal atrial
fibrillation in terms of the 12-month recurrence-free rate. Clinical Trial
Registration: URL: https://www.umin.ac.jp/ctr/index.htm. Unique
identifier: UMIN000021127. Copyright © 2019 American Heart
Association, Inc.

<91>
Accession Number
2002625742
Title
Early Aortic Valve Replacement versus Watchful Waiting in Asymptomatic
Severe Aortic Stenosis: A Study-Level Meta-Analysis.
Source
Structural Heart. 3 (6) (pp 483-490), 2019. Date of Publication: 02 Nov
2019.
Author
Sa M.P.B.O.; Cavalcanti L.R.P.; Escorel Neto A.C.A.; Perazzo A.M.;
Simonato M.; Clavel M.-A.; Pibarot P.; Lima R.C.
Institution
(Sa, Cavalcanti, Escorel Neto, Perazzo, Lima) Division of Cardiovascular
Surgery of Pronto Socorro Cardiologico de Pernambuco-PROCAPE, Recife,
Brazil
(Sa, Cavalcanti, Escorel Neto, Perazzo, Lima) University of
Pernambuco-UPE, Recife, Brazil
(Sa, Lima) Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Instituite-FCM/ICB,
Recife, Brazil
(Simonato) Escola Paulista de Medicina-UNIFESP, Sao Paulo, Brazil
(Clavel, Pibarot) Institut Universitaire de Cardiologie et de Pneumologie
du Quebec, QC, Canada
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: The management of patients with asymptomatic, severe aortic
stenosis (AS) is controversial. We performed a meta-analysis to examine
the impact on outcomes of early aortic valve replacement (AVR) in patients
with severe asymptomatic AS versus a watchful-waiting (WW) approach.
 Method(s): Databases were searched for studies published until April
2019. Main outcome of interest was death during follow-up. Result(s):
The search yielded 1,889 studies for inclusion. Of these, seven articles
were analyzed and their data extracted. The total number of patients
included was 3,839. The overall HR (95% CI) for death showed a
statistically significant difference between the groups, with lower risk
in the "early AVR" group (random effect model: HR 0.280; 95% CI
0.159-0.494, P < 0.001). There was evidence of significant statistical
heterogeneity of treatment effect among the studies for death. Funnel plot
analysis disclosed no asymmetry around the axis for the outcome of
interest, which means that we have low risk of publication bias related to
this outcome. Sensitivity analysis showed that none of the studies had a
particular impact on the results. The meta-regression coefficients for the
modulating factors age, male sex, presence of hypertension and presence of
diabetes were significant for mortality, showing that the early
intervention becomes even more protective in comparison with the
conservative approach when we take these factors into consideration.
 Conclusion(s): Early AVR seems to be a better approach than WW in the
treatment of asymptomatic patients with severe AS, but we would still
advocate a case-by-case decision-making process. Copyright ©
2019, © 2019 Cardiovascular Research Foundation.

<92>
Accession Number
2002679775
Title
Fresh frozen plasma and platelet concentrate storage duration not
associated with in hospital mortality risk.
Source
Vox Sanguinis. 114 (8) (pp 835-841), 2019. Date of Publication: 01 Nov
2019.
Author
Ng M.S.Y.; Hay K.; Choy J.; Middelburg R.A.; Tung J.-P.; Fraser J.F.
Institution
(Ng, Tung, Fraser) Critical Care Research Group, The Prince Charles
Hospital, Chermside, QLD, Australia
(Ng, Choy, Tung, Fraser) Faculty of Medicine, Oral Health Centre,
University of Queensland, Herston, QLD, Australia
(Ng, Tung) Research and Development, Australian Red Cross Blood Service,
Kelvin Grove, QLD, Australia
(Hay) QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
(Choy) Royal Brisbane & Women's Hospital, Herston, QLD, Australia
(Middelburg) Centre for Clinical Transfusion Research, Sanquin Research,
Leiden, Netherlands
(Middelburg) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objectives: To date, the effects of FFP and PC storage
duration on mortality have only been studied in a few studies in limited
patient subpopulations. The aim of the current study was to determine
whether FFP and PC storage duration is associated with increased in
hospital mortality risk across cardiac surgery, acute medicine, ICU and
orthopaedic surgery patients. Material(s) and Method(s): Two-stage
individual patient data meta-analyses were performed to determine the
effects of FFP and PC storage duration on in hospital mortality. Preset
random effects models were used to determine pooled unadjusted and
adjusted (adjusted for age, gender and units of product transfused) effect
estimates. Result(s): The FFP storage duration analysis included 3625
patients across four studies. No significant association was observed
between duration of storage and in hospital mortality in unadjusted
analysis, but after adjusting for patient age, gender and units of product
a small increased risk of in hospital mortality was observed for each
additional month of storage (OR: 1.05, 95% CI: 1.01-1.08). This effect was
no longer statistically significant when donor ABO blood group was
incorporated into the random effects model on post hoc analyses. A total
of 547 patients across five studies were incorporated in the PC storage
duration analysis. No association was observed between PC storage duration
and odds of in hospital morality (adjusted OR: 0.94, 95% CI: 0.79-1.11).
 Conclusion(s): There is insufficient evidence to support shortening
FFP or PC shelf life based on in hospital mortality. Copyright ©
2019 International Society of Blood Transfusion

<93>
Accession Number
629768985
Title
PREVENTION OF CEREBROVASCULAR MICRO-EMBOLIZATION DURING AORTA-CORONARY
BYPASS UNDER CONDITIONS OF ARTIFICIAL BLOOD CIRCULATION.
Source
Georgian medical news. (294) (pp 83-87), 2019. Date of Publication: 01 Sep
2019.
Author
Radiushin D.; Loskutov O.
Institution
(Radiushin, Loskutov) Shupyk National Medical Academy of Posgraduate
Education, Department of Anaesthesiology and Intensive Care, Kyiv; Odessa
Regional Clinical Hospital, Ukraine
Publisher
NLM (Medline)
Abstract
The aim of the research was to investigate the relationship between
cerebral microembolization and the development of postoperative cognitive
impairment in patients after coronary artery bypass grafting with and
without prophylactic administration of nitroglycerin at the end of
artificial blood circulation. The study included 72 patients (43 male and
29 female) who had ACBPS using an ABCA. The patients were randomized into
two clinical groups. The number of patients in the control group was 34
patients, in the study group - 38 patients. The study of the cognitive
sphere was performed using a battery of clinical tests that included MSA
and MMSE scales, Trail-making test, Grooved Pageboard, fine hands-motor
test, 10 words test by AR Luria, Wexler's test, Schultz tables. The
assessment was carried out on a day before the intervention and on the
fifth day after the surgical intervention. It was shown that by all
patients undergoing aorto-coronary bypass syrgery microembolization within
the cerebral blood flow had been determined. The vast majority of
microemboli is formed at the beginning of artificial blood circulation, at
the moment of clamping aorta, as well as during the restoration of
effective cardiac activity. Intraoperative microembolization of cerebral
blood flow in excess of 750 microemboli leads to clinically significant
deterioration of the brain functions in the early postoperative period.
When used as a peripheral vasodilator, nitroglycerin, at a dose of 8-10
mug/kg*min in high (120-130%) volume perfusion rate, decreases the number
of microemboluses in the basin of SMA by 2.4%.

<94>
Accession Number
2003813919
Title
Aminoglycosides for infective endocarditis: time to say goodbye?.
Source
Clinical Microbiology and Infection. (no pagination), 2019. Date of
Publication: 2019.
Author
Lebeaux D.; Fernandez-Hidalgo N.; Pilmis B.; Tattevin P.; Mainardi J.-L.
Institution
(Lebeaux, Mainardi) Service de Microbiologie, Unite Mobile
d'Infectiologie, AP-HP, Hopital Europeen Georges Pompidou, Centre
Universite de Paris, Universite de Paris, Paris, France
(Fernandez-Hidalgo) Servei de Malalties Infeccioses, Hospital Universitari
Vall d'Hebron, Universitat Autonoma de Barcelona. Barcelona, Spain
(Fernandez-Hidalgo) Spanish Network for Research in Infectious Diseases
(REIPI), Instituto de Salud Carlos III, Madrid, Spain
(Pilmis) Service de Microbiologie et Plateforme de dosage des
Anti-infectieux, Equipe Mobile de Microbiologie Clinique, Groupe
Hospitalier Paris Saint-Joseph, Paris, France
(Tattevin) Infectious Diseases and Intensive Care Unit, Pontchaillou
University Hospital, Rennes, France
Publisher
Elsevier B.V.
Abstract
BACKGROUND: Based on experimental studies showing synergism with
beta-lactams and glycopeptides, aminoglycosides have long been considered
essential in the treatment of infective endocarditis (IE). However, their
use is associated with a high risk of renal failure, especially in elderly
patients. AIMS: The aim of this narrative review was to summarize the
evidence to support reducing or even avoiding the use of aminoglycosides
for the treatment of IE. We also analysed data supporting the use of
aminoglycosides in specific subgroup of IE patients. SOURCES: PubMed
database was searched up to July 2019 to identify relevant studies.
CONTENTS: Recent European Guidelines reduced the use of aminoglycosides in
IE, no longer recommended in Staphylococcus aureus native-valve IE, and
shortened to 2 weeks for IE related to Enterococcus faecalis and
streptococci with penicillin MIC >0.125 mug/mL. In addition, an
alternative regimen without aminoglycosides (ampicillin or amoxicillin
plus ceftriaxone) is proposed for E. faecalis. Observational studies
suggested that gentamicin would not be necessary in the case of
staphylococcal prosthetic valve IE as long as rifampicin is maintained.
Recent clinical studies showed that for streptococcal IE, gentamicin could
be restricted to isolates with penicillin MIC >0.5 mug/mL. For the
empirical and definitive treatment of E. faecalis IE, amoxicillin or
ampicillin plus ceftriaxone may be considered, irrespective of high-level
of aminoglycoside resistance. IMPLICATIONS: In a scenario of progressive
increase in the age and frailty of IE patients, the use of aminoglycosides
can be reduced or avoided in ~90% cases. This should result in reduced
incidence of renal failure, an important prognostic factor in
IE. Copyright © 2019 European Society of Clinical Microbiology
and Infectious Diseases

<95>
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. (no pagination), 2019. Date of
Publication: 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. Copyright © 2019 Reproductive
Healthcare Ltd.

<96>
Accession Number
2003779290
Title
Long-term survival after xenograft versus homograft aortic root
replacement: Results from a prospective randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Melina G.; De Robertis F.; Gaer J.A.; Angeloni E.; El-Hamamsy I.; Bahrami
T.; Pepper J.R.; Takkenberg J.J.M.; Yacoub M.H.
Institution
(Melina, De Robertis, Gaer, Bahrami, Pepper) Royal Brompton and Harefield
NHS Foundation Trust, London, United Kingdom
(Melina, Angeloni) Department of Cardiac Surgery, Ospedale Sant'Andrea,
"Sapienza" Universita di Roma, Rome, Italy
(El-Hamamsy) Division of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada
(Takkenberg) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Yacoub) Imperial College, London, United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to investigate the long-term survival
of patients undergoing xenograft versus homograft full root aortic valve
replacement. Method(s): A total of 166 patients requiring aortic
valve surgery were randomized to undergo the Freestyle (Medtronic Inc,
Minneapolis, Minn) bioprosthesis (N = 90) or a homograft (N = 76) full
root aortic valve replacement between 1997 and 2005 in a single
institution. Six patients randomly assigned to the homograft crossed over
to the Freestyle bioprosthesis because of the unavailability of suitably
sized homografts. All surgeons were required to adhere to the standard
surgical technique for homograft root implantation previously described.
Follow-up was 98.5% complete. Result(s): The mean age of the study
population was 65 +/- 8 years. Coronary artery bypass grafting was
associated with root aortic valve replacement in 76 of 166 patients (46%,
P = not significant between groups), and overall hospital mortality was
4.8% (8/166, P = not significant between groups). Median follow-up was
13.8 years (range, 0-21.8 years; 2033 patient-years). The Kaplan-Meier
survival analysis showed that there was no significant difference in
overall survival between the 2 arms at 5, 10, and 15 years. Twenty-year
survival was 28.3% +/- 5% for the Freestyle group versus 25.1% +/- 5.7%
for the homograft group (P = .90), which was comparable to the age- and
sex-matched UK general population. The freedom from aortic valve
reoperation at 20 years was comparable for the Freestyle group versus the
homograft group (67.9% +/- 8.8% vs 67.2% +/- 10.3%, respectively; P =
.74). Conclusion(s): This is the first study to investigate the
long-term survival of xenograft versus homograft full root aortic valve
replacement from a prospective randomized trial. The observed 20-year
overall survival and freedom from aortic valve reoperation serve as a
benchmark for future studies on interventions for aortic valve disease in
the elderly. Copyright © 2019 The American Association for
Thoracic Surgery

<97>
Accession Number
2003720783
Title
The effects of a comprehensive rehabilitation and intensive education
program on anxiety, depression, quality of life, and major adverse cardiac
and cerebrovascular events in unprotected left main coronary artery
disease patients who underwent coronary artery bypass grafting.
Source
Irish Journal of Medical Science. (no pagination), 2019. Date of
Publication: 2019.
Author
Ma L.; Deng L.; Yu H.
Institution
(Ma, Deng, Yu) Department of Cardiovascular Surgery, The First Affiliated
Hospital of Harbin Medical University, 23 Youzheng Street, Harbin,
Heilongjiang 150001, China
Publisher
Springer
Abstract
Objective: This study aimed to explore the effect of a comprehensive
rehabilitation and intensive education (CRIE) program on anxiety,
depression, quality of life (QoL), and major adverse cardiac and
cerebrovascular events (MACCE) risk in unprotected left main coronary
artery disease (ULMCAD) patients who underwent coronary artery bypass
grafting (CABG). Method(s): In total, 300 ULMCAD patients who
underwent CABG were randomly assigned to the CRIE group or usual care (UC)
group in a 1:1 ratio. During a 12-month intervention, anxiety and
depression were evaluated by Hospital Anxiety and Depression Scale (HADS),
QoL was evaluated by 12-Item Short-Form Health Survey (SF-12), on
discharge day from hospital (M0), and at 3 months after the discharge
(M3), M6, and M12. All patients were further followed up until occurrence
of MACCE or for an additional 24 months, and MACCE accumulating occurrence
rate was calculated. Result(s): At M12, HADS-anxiety score and
anxiety prevalence (17.3% vs. 29.3%) were decreased in the CRIE group than
those in the UC group, meanwhile HADS-depression score and depression
prevalence (15.3% vs. 24.7%) were also reduced in the CRIE group than
those in the UC group. For QoL, SF-12 Physical Component Summary (PCS)
score at M6/M12, and SF-12 PCS score change (M12 - M0) were increased in
the CRIE group than those in the UC group; meanwhile, SF-12 Mental
Component Summary (MCS) score at M12 and SF-12 PCS score change (M12 - M0)
were increased in the CRIE group than those in the UC group as well.
Besides, MACCE accumulating occurrence rate was numerically lower in the
CRIE group compared with that in the UC group but without statistical
significance. Conclusion(s): CRIE is an effective approach in
improving anxiety, depression, and QoL in ULMCAD patients who underwent
CABG. Copyright © 2019, Royal Academy of Medicine in Ireland.

<98>
Accession Number
2003701251
Title
Impact of patient blood management guidelines on blood transfusions and
patient outcomes during cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Irving A.H.; Harris A.; Petrie D.; Higgins A.; Smith J.; McQuilten Z.K.
Institution
(Irving, Harris, Petrie) Centre for Health Economics, Monash University,
Melbourne, Australia
(Higgins, McQuilten) Australian and New Zealand Intensive Care Research
Centre, School of Public Health and Preventive Medicine, Monash
University, Melbourne, Australia
(Smith) Department of Surgery, School of Clinical Sciences at Monash
Health, Monash University, Melbourne, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Melbourne,
Australia
(McQuilten) Department of Haematology, Monash Health, Melbourne, Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: In March 2012, Australia's National Blood Authority published
national patient blood-management guidelines for perioperative care
developed by a systematic review and clinical expert opinion. This study
assesses how blood transfusions and patient outcomes in cardiac surgery
changed after the guidelines were published. Method(s): Blood
transfusions and patient outcomes in cardiac surgery were compared before
and after implementation of the guidelines using an interrupted time
series analysis. The evaluation included red blood cells, platelets,
cryoprecipitate, fresh-frozen plasma, 30-day mortality, 30-day
readmissions, and hospital and intensive care length of stay. Patient
characteristics were controlled for along with hospital characteristics
using fixed effects. Different responses across institutional settings
were assessed with an expanded difference-in-differences model.
 Result(s): After the guidelines were published, our model found a
significant reduction in red blood cell, platelet, and fresh-frozen plasma
transfusions. There was also a significant reduction in hospital length of
stay but no significant impact on cryoprecipitate, 30-day mortality,
30-day readmissions, or intensive care unit length of stay. The subgroup
analyses found no differences with regards to institutional settings.
 Conclusion(s): Following the publication of the guidelines, there was
a measurable reduction in perioperative blood transfusions in cardiac
surgery with an associated reduction in hospital length of stay but no
detectable differences in other patient outcomes. Copyright ©
2019 The American Association for Thoracic Surgery

<99>
Accession Number
2003681781
Title
Intraoperative Ketamine for Analgesia Post-Coronary Artery Bypass Surgery:
A Randomized, Controlled, Double-Blind Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Cameron M.; Tam K.; Al Wahaibi K.; Charghi R.; Beique F.
Institution
(Cameron, Tam, Charghi, Beique) Department of Anesthesiology, Jewish
General Hospital, Montreal, Quebec, Canada
(Cameron, Al Wahaibi, Charghi, Beique) Department of Anesthesia, McGill
University, Montreal, Quebec, Canada
Publisher
W.B. Saunders
Abstract
Objectives: To determine whether the administration of ketamine during
coronary artery bypass grafting (CABG) surgery leads to a reduction in the
quantity of opioids required over the first 48 hours after surgery.
 Design(s): Randomized, controlled, double-blind clinical trial.
 Setting(s): Single university academic center. Participant(s):
Patients undergoing CABG surgery with a normal left ventricular ejection
fraction. Intervention(s): Ketamine administered intravenously as a
bolus dose of 0.5 mg/kg before skin incision, followed by an infusion of
0.5 mg/kg/h until the end of surgery. Measurements and Main Results:
One hundred eighty-three patients were screened, and 80 patients were
randomized. Baseline characteristics were similar between the 2 groups.
The intervention group received 53.6 mg (95% confidence interval [CI]
47.1-60.1 mg) of morphine equivalents in the first 48 hours after surgery,
whereas the placebo group received 55.7 mg (95% CI 48.4-63.1 mg) over the
same time period (p = 0.66). No significant difference was noted in
morphine equivalents over the first 6, 12, or 24 hours postoperatively or
in maximum, minimum, or average pain scores on postoperative days 1 or 2.
 Conclusion(s): The administration of ketamine during CABG surgery did
not result in reduced opioid consumption or pain scores
postoperatively. Copyright © 2019 Elsevier Inc.

<100>
Accession Number
2003657138
Title
Targeting high-sensitivity C-reactive protein levels in acute coronary
syndrome patients undergoing contemporary lipid-lowering therapy: a
sub-analysis of the HIJ-PROPER trial.
Source
Journal of Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Kawada-Watanabe E.; Yamaguchi J.; Sekiguchi H.; Arashi H.; Ogawa H.;
Hagiwara N.
Institution
(Kawada-Watanabe, Yamaguchi, Sekiguchi, Arashi, Ogawa, Hagiwara)
Department of Cardiology, The Heart Institute of Japan, Tokyo Women's
Medical University, Tokyo, Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: The effects of high-sensitivity C-reactive protein (hs-CRP)
levels on clinical outcomes in chronic-phase acute coronary syndrome (ACS)
patients undergoing aggressive lipid-lowering therapy remain unclear. We
examined the effects of hs-CRP levels on the prognosis of ACS patients who
underwent aggressive lipid-lowering therapy and determined treatment
targets for hs-CRP value. Method(s): This post-hoc sub-analysis of a
prospective randomized control trial (HIJ-PROPER) included 1734 ACS
patients with dyslipidemia, who were divided into hs-CRP quartiles after 3
months of treatment. Primary endpoints were combined all-cause death,
non-fatal myocardial infarction, non-fatal stroke, unstable angina, and
ischemia-driven coronary revascularization. Secondary endpoint was
all-cause death. Result(s): The median follow-up period was 3.7
years. Overall, 1415 patients were evaluated retrospectively. No
significant among-group differences were noted in low-density lipoprotein
cholesterol (LDL-C) levels over time (p = 0.44). Kaplan-Meier analyses
revealed that the incidence of the primary and secondary endpoints was
significantly higher in the highest hs-CRP group than in the other groups
[hazard ratio (HR) = 1.52, 95% confidence interval (CI) = 1.16-2.00, p <
0.01; HR = 5.30, 95% CI = 2.47-11.32, p < 0.01, respectively]. The cut-off
hs-CRP level to predict all-cause death was 0.74 mg/L (receiver operating
characteristic curve: sensitivity: 68%, specificity: 62%). Multivariate
analyses revealed that hs-CRP >=0.74 mg/L at 3 months was correlated with
an increased risk of all-cause death (adjusted HR = 3.68, 95% CI =
2.22-6.10, p < 0.01). Conclusion(s): Elevated hs-CRP levels
independently predicted a worse prognosis, regardless of LDL-C levels,
suggesting that interventions against elevated inflammatory responses plus
intensive lipid-lowering therapy and coronary revascularization are
encouraging options for secondary prevention in ACS patients. Trial
registration: This trial is registered with the UMIN Clinical Trials
Registry number UMIN000002742. Trial name: Proper level of lipid lowering
with pitavastatin and ezetimibe in acute coronary syndrome (HIJ-PROPER)
URL:
https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr-view.cgi?recptno=R000003334
 Copyright © 2019

<101>
Accession Number
629938781
Title
Internal perivenous compression-a Swiss invention.
Source
Vasa - European Journal of Vascular Medicine. Conference: 20. Unionstagung
der Schweizerischen Gesellschaften fur Gefasskrankheiten Gemeinsam mit der
Schweizerischen Gesellschaft fur Ultraschall in der Medizin Sektion
Gefasse und 20e Congres de l'Union des Societes Suisses des Maladies
Vasculaires en collaboration avec la Societe Suisse d'Ultrasons en
Medecine Section Vaisseaux. Switzerland. 48 (Supplement 103) (pp 24),
2019. Date of Publication: November 2019.
Author
Ragg J.C.; Kreis S.; Despa O.
Institution
(Ragg, Kreis, Despa) ZurichSwitzerland
Publisher
Hogrefe Verlag GmbH and Co. KG
Abstract
Objective: Therapy of venous insufficiency, formerly consisting mainly of
surgery and textile compression, today includes also endovenous thermal
ablation, sclerofoam, vein gluing, stenting, and various venotonic or
anti-inflammatory medications. As insufficiency usually goes along with
vein dilatation, the idea to adjust dilated veins or valve zones by
perivenous biocompatible gel injection was established by a Swiss work
group in 2013, a potentially comfortable, fully vein saving, non-chemical
method. Besides lots of known medical bulking agents like dextranomer,
cellulose derivatives, poly acrylate polyalcohol copolymer,
polytetrafluoroethylene, polydimethylsiloxane, calcium hydroxyapatite and
even acrylates, the best choice for use in phlebology seemed to be
cross-linked hyaluronan according to the huge experience with its
biocompatibility. There are currently three options under evaluation: 1)
Percutaneous valvuloplasty (PVP), aiming at restoration of local valve
function; 2) focal venoplasty (FVP), aiming at diameter reduction to
modify hemodynamics, and 3) segmental venoplasty (SVP) to reduce diameters
as an adjunct to endoluminal procedures. Method(s): PVP was studied
in 25 patients (17 f, 8 m, 25-54 y., GSM valves, diameter 7.0-12.0 mm),
using a 24 mg/l prototype hyaluronan. FVP was evaluated in 19 patients (13
f, 6 m, 26-69 y.) for reflux reduction in GSV, SSV or sidebranch
insufficiency (also 24 mg/l). SVP was investigated in 40 cases (23 f, 17
m, 41-72 yrs.) with GSV or SSV insufficiency, adjunctive to Biomatrix
sclerofoam (Venartis), using another, less viscous and less durable
hyaluronan (16 mg/l). For this collective, target segments were split and
randomized to hyaluronan vs. NaCl 0,09 %. Until presentation, another 30
cases will be added to the studies, including also hyaluronan-dextranomer
mixtures for longer persistance. Result(s): PVP established
orthograde flow in 24/25 cases (96.0 %). With FVP, 16/19 cases were
successful (83.3 %) in obtaining alternate (n=9) or orthograde flow (n=7),
correlating well with clinical improvement. In both applications, medical
benefit was unchanged at 6 months FU. With SVP, technical success (> 50 %
lumen reduction) was obtained in all cases (40/40). In all hyaluronan
compressed segments, there was no postinterventional pain or discomfort
(FU 8 weeks), compared to 36/40 cases (90 %) after standard procedures.
All hyaluronan applications were without adverse reactions.
 Conclusion(s): PVP is effective and safe to restore valve function,
best suitable for early stages of pressure-induced valve decompensation.
FVP for hemodynamic purposes showed feasibility, effectivity and safety,
while clear indications need further studies. The main current value is to
replace former more invasive techniques like CHIVA or ASVAL. SVP
adjunctive to endovenous ablation significantly improves post-treatment
comfort. The choice of hyaluronan at this time instead of more permanent
material is justified by the excellent safety results. PVP and FVP will
require maintenance injections in few year's intervals, it may not mean
healing venous insufficiency, but significantly slows down course of the
disease. Finally, a revisiting mode will allow to develop more
individually tailored solutions, including all other means of prevention
(motion, stockings, medication) instead of failing with the atttempt of
"once and forever" actions.

<102>
Accession Number
629927233
Title
Liraglutide for perioperative management of hyperglycemia in cardiac
surgery patients: a multicenter randomized superiority trial.
Source
Diabetes, obesity & metabolism. (no pagination), 2019. Date of
Publication: 20 Nov 2019.
Author
Hulst A.H.; Visscher M.J.; Godfried M.B.; Thiel B.; Gerritse B.M.; Scohy
T.V.; Bouwman R.A.; Willemsen M.G.A.; Hollmann M.W.; Preckel B.; DeVries
J.H.; Hermanides J.
Institution
(Hulst, Visscher, Hollmann, Preckel, Hermanides) Department of
Anesthesiology, University of Amsterdam, AZ, Meibergdreef 9 ,Postbus
22660, Amsterdam, Netherlands
(Hulst, Godfried, Thiel) Department of Anesthesiology, OLVG, AC,
Oosterpark 9, Amsterdam, Netherlands
(Hulst, Gerritse, Scohy) Department of Anesthesiology, Amphia, CK,
Molengracht 21, Breda, Netherlands
(Bouwman, Willemsen) Department of Anesthesiology, Catharina Hospitals, EJ
Eindhoven, Michelangelolaan 2, Netherlands
(DeVries) Department of Endocrinology, University of Amsterdam, AZ,
Meibergdreef 9 ,Postbus 22660, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
AIMS: Most cardiac surgery patients, with or without diabetes, develop
perioperative hyperglycemia, for which intravenous insulin is the only
therapeutic option. This is labor-intensive and carries a risk of
hypoglycemia. We hypothesized that preoperative administration of the
glucagon-like peptide-1 receptor agonist liraglutide reduces the number of
patients requiring insulin for glycemic control during cardiac surgery.
MATERIALS AND METHODS: In this randomised, blinded, placebo-controlled,
parallel-group, balanced (1:1), multicentre randomised, superiority trial,
adult patients undergoing cardiac surgery in four Dutch tertiary hospitals
were randomised to receive 0.6 mg subcutaneous liraglutide on the evening
before surgery and 1.2 mg after induction of anaesthesia or matching
placebo. Blood glucose was measured hourly and controlled using an
insulin-bolus-algorithm. The primary outcome was insulin administration
for blood glucose above 8.0mmol/L in the operating theatre. Research
pharmacists used centralised, stratified, variable-block, randomisation
software. Patients, care providers, and study personnel were blinded to
treatment allocation. RESULT(S): Between June 2017 and August 2018,
278 patients were randomised to liraglutide (139) or placebo (139). All
patients receiving at least one study drug injection were included in the
intention-to-treat analyses (129 in the liraglutide group, 132 in the
placebo group). In the liraglutide group 55 (43%) patients required
additional insulin compared to 80 (61%) patients in the placebo group,
absolute difference: 18% (95% CI 5.9-30.0, p=0.003). Dose and number of
insulin injections and mean blood glucose were all significantly lower in
the liraglutide group. We observed no difference in the incidence of
hypoglycaemia, nausea and vomiting, mortality, or postoperative
complications. CONCLUSION(S): Preoperative liraglutide, compared to
placebo, reduces insulin requirements while improving perioperative
glycemic control during cardiac surgery. REGISTRATION: trialregister.nl
Identifier: NTR6323 FUNDING: Novo Nordisk This article is protected by
copyright. All rights reserved.

<103>
Accession Number
629945922
Title
Disagreement Between Randomized and Observational Evidence on the Use of
Bilateral Internal Thoracic Artery Grafting: A Meta-Analytic Approach.
Source
Journal of the American Heart Association. 8 (23) (pp e014638), 2019. Date
of Publication: 03 Dec 2019.
Author
Gaudino M.; Rahouma M.; Hameed I.; Khan F.M.; Taggart D.P.; Flather M.;
Biondi-Zoccai G.; Fremes S.E.
Institution
(Gaudino, Rahouma, Hameed, Khan) Department of Cardiothoracic Surgery
Weill Cornell Medicine New York City NY
(Taggart) Nuffield Department of Surgical Sciences University of Oxford
United Kingdom
(Flather) University of East Anglia Norwich United Kingdom
(Biondi-Zoccai) Department of Medico-Surgical Sciences and Biotechnologies
Sapienza University of Rome Latina Italy
(Biondi-Zoccai) Mediterranea Cardiocentro Napoli Italy
(Fremes) Schulich Heart Centre Division of Cardiac Surgery Department of
Surgery Sunnybrook Health Sciences Centre University of Toronto Ontario
Canada
Publisher
NLM (Medline)
Abstract
Background The ART (Arterial Revascularization Trial) showed no difference
in survival at 10 years between patients assigned to the single versus
bilateral internal thoracic artery grafting strategies. This finding is in
contrast with the results of most observational studies, where the use of
2 internal thoracic arteries has been associated with improved survival.
Methods and Results We selected propensity-matched studies from the most
comprehensive observational meta-analysis on the long-term outcomes of
patients receiving 1 versus 2 internal thoracic arteries. Individual
participant survival data from each study and the ART were reconstructed
using an iterative algorithm that was applied to solve the Kaplan-Meier
equations. The reconstructed individual participant survival data were
aggregated to obtain combined survival curves and Cox regression hazard
ratios with 95% CIs. Individual participant survival data were obtained
from 14 matched observational studies (24 123 patients) and the ART. The
10-year survival of the control group of ART was significantly higher than
that of the matched observational studies (hazard ratio, 0.86; 95% CI,
0.80-0.93). The 10-year survival of the experimental group of ART was
significantly lower than that of the bilateral internal thoracic artery
group of the observational studies (hazard ratio, 1.11; 95% CI,
1.03-1.20). Conclusions Both the improved outcome of the control arm and
the lower beneficial effect of the intervention had played a role in the
difference between observational evidence and ART.

<104>
Accession Number
2003792693
Title
Aorto-cardiac fistula etiology, presentation, and management: A systematic
review.
Source
Heart and Lung. (no pagination), 2019. Date of Publication: 2019.
Author
Foster T.J.; Amin A.H.; Busu T.; Patel K.; Farjo P.; Hallak A.A.; Ali N.;
Alkhouli M.
Institution
(Foster, Busu, Patel, Farjo, Alkhouli) Division of Cardiovascular Disease,
West Virginia University, 1 Medical Drive, Morgantown, WV 26505, United
States
(Amin) Section of Cardiology, Carilion Clinic, Carilion Clinic, Virginia
Tech-Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016,
United States
(Hallak) West Virginia University Health Science Center, 1 Medical Drive,
Morgantown, WV 26505, United States
(Ali) Department of Pediatrics, Carilion Clinic, Virginia Tech-Carilion
School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, United States
(Alkhouli) Department of Cardiovascular Diseases, Mayo Clinic School of
Medicine, Rochester, MN, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Aorto-cardiac fistulae are a rare but increasingly reported
entity, and data are scarce. Method(s): The authors performed a
systematic review of ACFs to characterize the underlying etiology,
clinical presentation, and compare outcomes of treatment strategies.
 Result(s): 3,733 publications were identified in the search. Of
those, 292 studies including 300 patients were included. Etiology of ACFs
was 38% iatrogenic, 25% infectious, 14% traumatic, and 15% due to other
causes. Most patients (74%) presented with heart failure. Common locations
were aortic-right atrium (37%), and aortic-pulmonary artery (25%). The
majority of patients (71%) were treated surgically, while 13% were treated
percutaneously, and 16% were treated conservatively. Patients who were
managed conservatively had a higher mortality than those treated with
invasive closure (53% vs. 12% vs. 3%, p = <0.00001). Conclusion(s):
This systematic review sheds light on this highly morbid condition. Once
recognized, fistula closure appears to be superior to conservative
management. Copyright © 2019 Elsevier Inc.

<105>
Accession Number
2003792554
Title
Usefulness of Discharge Resting Heart Rate to Predict Adverse
Cardiovascular Outcomes in Patients With Left Main Coronary Artery Disease
Revascularized With Percutaneous Coronary Intervention vs Coronary Artery
Bypass Grafting (from the EXCEL Trial).
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Kosmidou I.; Crowley A.; Macedo L.; Ben-Yehuda O.; Gersh B.J.; Boonstra
P.W.; Kappetein A.P.; Serruys P.W.; Sabik J.F.; Stone G.W.
Institution
(Kosmidou, Crowley, Ben-Yehuda, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Kosmidou, Macedo, Ben-Yehuda) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Gersh) Department of Cardiovascular Medicine, Mayo Clinic College of
Medicine, Rochester, MN, United States
(Boonstra) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The prognostic impact of resting heart rate (RHR) following
revascularization with percutaneous coronary intervention (PCI) or
coronary artery bypass grafting (CABG) in patients with left main coronary
artery disease (LMCAD) is unknown. We aimed to assess the effect of RHR at
discharge on 3-year cardiovascular outcomes following PCI and CABG for
LMCAD. In the EXCEL trial, 1,905 patients with LMCAD were randomized to
PCI with everolimus-eluting stents versus CABG. RHR was measured at
discharge following the index hospitalization. The principal outcome
measure was the composite endpoint of death, myocardial infarction (MI) or
stroke at 3 years. Among 1,303 patients in sinus rhythm with available
ECGs, the median (IQR) discharge RHR was 72 (62to 81) bpm. Median
discharge RHR was higher after CABG versus PCI (78 [IQR 70 to 86] versus
65 [IQR 59 to 74] bpm, p <0.0001). At 3 years, 107 patients (8.2%) had a
primary composite endpoint event including 61 patients (4.7%) who died. By
multivariable analysis, discharge RHR assessed as a continuous variable
(per 5 bpm) was an independent predictor at 3 years of the primary
composite endpoint of death, MI, or stroke (hazard ratio [HR] 1.15, 95%
confidence interval [CI] 1.06 to 1.25, p = 0.0006); the secondary
composite endpoint of death, MI, stroke, or ischemia-driven
revascularization at 3 years (HR 1.12, 95% CI 1.05 to 1.19, p = 0.0007);
all-cause mortality (HR 1.18, 95% CI 1.07 to 1.31, p = 0.002); and
cardiovascular death (HR 1.16, 95% CI 1.00 to 1.33, p = 0.046). No
significant interactions were present between RHR and treatment with PCI
versus CABG for the primary (p<inf>int</inf> = 0.20) or secondary
(p<inf>int</inf> = 0.47) composite endpoints. In patients with LMCAD
undergoing revascularization, an increased RHR at discharge was associated
with a higher risk for adverse cardiovascular outcomes at 3 years,
irrespective of treatment modality. Copyright © 2019 Elsevier
Inc.

<106>
Accession Number
2003779007
Title
Effectiveness of Incentive Spirometry on Inspiratory Muscle Strength After
Coronary Artery Bypass Graft Surgery.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Manapunsopee S.; Thanakiatpinyo T.; Wongkornrat W.; Chuaychoo B.;
Thirapatarapong W.
Institution
(Manapunsopee, Thanakiatpinyo, Thirapatarapong) Department of
Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol
University, Bangkok, Thailand
(Wongkornrat) Cardiothoracic Division, Department of Surgery, Faculty of
Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Chuaychoo) Division of Respiratory Diseases and Tuberculosis, Department
of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Publisher
Elsevier Ltd
Abstract
Background: Although the use of incentive spirometry with a deep breathing
exercise (DBE) is widely used in clinical practice in patients who have
undergone coronary artery bypass graft (CABG) surgery, the effect of this
combination therapy has not been conclusively elucidated. The aim of this
study was to investigate the effect of postoperative combined incentive
spirometry and DBE versus DBE alone on inspiratory muscle strength
following CABG. Method(s): This randomised clinical trial was
conducted in patients scheduled to undergo CABG surgery at Siriraj
Hospital, Bangkok Thailand. The study group received incentive spirometry
and DBE, and the control group received DBE only. Maximal inspiratory
pressure (MIP) before surgery and at day 4 after surgery was assessed by a
respiratory pressure metre. Secondary outcomes, including postoperative
pulmonary complication and duration of postoperative hospitalisation, were
obtained from the medical records. Result(s): Ninety (90) patients
were included, with 47 and 43 patients assigned to the study and control
groups, respectively. In both groups, there was a significant reduction in
MIP from preoperative baseline to postoperative day 4; however, the MIP in
the incentive spirometry group had a significantly smaller reduction in
MIP compared with the control group (33.0+/-23.2% vs 47.2+/-20.1%,
respectively; p=0.006, 95% confidence interval, 3.9-23.3). There was no
difference between groups regarding secondary outcomes.
 Conclusion(s): Patients in the study group had significantly better
recovery of inspiratory muscle strength on day 4 post-CABG than patients
in the control group. There was no significant difference between groups
for either postoperative pulmonary complications or length of hospital
stay. Copyright © 2019 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<107>
Accession Number
2003720455
Title
Tafamidis: A First-in-Class Transthyretin Stabilizer for Transthyretin
Amyloid Cardiomyopathy.
Source
Annals of Pharmacotherapy. (no pagination), 2019. Date of Publication:
2019.
Author
Park J.; Egolum U.; Parker S.; Andrews E.; Ombengi D.; Ling H.
Institution
(Park, Ling) Philadelphia College of Osteopathic Medicine, Suwanee, GA,
United States
(Egolum) The Heart Center of Northeast Georgia Medical Center,
Gainesville, GA, United States
(Parker, Andrews) Hampton University, Hampton, VA, United States
(Ombengi) Medical College of Wisconsin, Milwaukee, WI, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: To review the pharmacology, efficacy, and safety of the
selective transthyretin inhibitor tafamidis for transthyretin amyloid
cardiomyopathy (ATTR-CM). Data Sources: A PubMed (1966 to October
2019) and ClinicalTrials. gov search was conducted using the keywords
tafamidis, Fx-1006A, Vyndaqel, and Vyndamax. Additional articles were
identified from references. Study Selection and Data Extraction: We
included English-language clinical studies evaluating the pharmacology,
efficacy, or safety of tafamidis in humans for ATTR-CM. Data
Synthesis: Tafamidis binds to the thyroxine-binding sites of the
transthyretin tetramer and inhibits its dissociation into monomers, which
is the rate-limiting step in the amyloidogenic process. Treatment with
tafamidis was significantly associated with a significant reduction in
mortality, lowered cardiovascular-related hospitalizations, less
functional decline, and improved transthyretin stabilization compared with
placebo. Additionally, tafamidis was found to have fewer adverse events,
with no difference found compared with placebo. Relevance to Patient Care
and Clinical Practice: Historically, symptomatic management for ATTR-CM
was the only option, and the treatment of the underlying disease was
limited to liver or heart transplantation. Tafamidis is the first
medication approved for the treatment of ATTR-CM and the only medication
that showed a reduction in all-cause mortality and cardiovascular-related
hospitalizations in patients with amyloidosis. However, the role of
tafamidis in patients with the New York Heart Association class III/IV
heart failure or mutated transthyretin remains unclear.
 Conclusion(s): Tafamidis is an effective and safe oral medication for
the treatment of the cardiomyopathy of transthyretin-mediated amyloidosis
in adults to reduce cardiovascular mortality and cardiovascular-related
hospitalization. Copyright © The Author(s) 2019.

<108>
Accession Number
2003716133
Title
Patient blood management (PBM) in pregnancy and childbirth: literature
review and expert opinion.
Source
Archives of Gynecology and Obstetrics. (no pagination), 2019. Date of
Publication: 2019.
Author
Surbek D.; Vial Y.; Girard T.; Breymann C.; Bencaiova G.A.; Baud D.;
Hornung R.; Taleghani B.M.; Hosli I.
Institution
(Surbek) Department of Obstetrics and Gynaecology, Bern University
Hospital, Insel Hospital, University of Bern, Friedbuhlstrasse 19, Bern
3010, Switzerland
(Bencaiova, Hosli) Clinic of Obstetrics and Gynaecology, University
Hospital Basel, Basel, Switzerland
(Vial, Baud) Service of Obstetrics, Department Woman-Mother-Child,
University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne,
Switzerland
(Girard) Department of Anaesthesiology, University Hospital Basel, Basel,
Switzerland
(Breymann) Obstetric Research-Feto Maternal Haematology Unit, University
Hospital Zurich, Zurich, Switzerland
(Hornung) Department of Obstetrics and Gynaecology, St. Gallen Cantonal
Hospital, St. Gallen, Switzerland
(Taleghani) Department of Haematology, Inselspital, University and
University Hospital Bern, Bern, Switzerland
Publisher
Springer
Abstract
Purpose: Patient blood management [PBM] has been acknowledged and
successfully introduced in a wide range of medical specialities, where
blood transfusions are an important issue, including anaesthesiology,
orthopaedic surgery, cardiac surgery, or traumatology. Although pregnancy
and obstetrics have been recognized as a major field of potential
haemorrhage and necessity of blood transfusions, there is still little
awareness among obstetricians regarding the importance of PBM in this
area. This review, therefore, summarizes the importance of PBM in
obstetrics and the current evidence on this topic. Method(s): We
review the current literature and summarize the current evidence of PBM in
pregnant women and postpartum with a focus on postpartum haemorrhage (PPH)
using PubMed as literature source. The literature was reviewed and
analysed and conclusions were made by the Swiss PBM in obstetrics working
group of experts in a consensus meeting. Result(s): PBM comprises a
series of measures to maintain an adequate haemoglobin level, improve
haemostasis and reduce bleeding, aiming to improve patient outcomes.
Despite the fact that the WHO has recommended PBM early 2010, the majority
of hospitals are in need of guidelines to apply PBM in daily practice. PBM
demonstrated a reduction in morbidity, mortality, and costs for patients
undergoing surgery or medical interventions with a high bleeding
potential. All pregnant women have a significant risk for PPH. Risk
factors do exist; however, 60% of women who experience PPH do not have a
pre-existing risk factor. Patient blood management in obstetrics must,
therefore, not only be focused on women with identified risk factor for
PPH, but on all pregnant women. Due to the risk of PPH, which is inherent
to every pregnancy, PBM is of particular importance in obstetrics.
Although so far, there is no clear guideline how to implement PBM in
obstetrics, there are some simple, effective measures to reduce anaemia
and the necessity of transfusions in women giving birth and thereby
improving clinical outcome and avoiding complications. Conclusion(s):
PBM in obstetrics is based on three main pillars: diagnostic and/or
therapeutic interventions during pregnancy, during delivery and in the
postpartum phase. These three main pillars should be kept in mind by all
professionals taking care of pregnant women, including obstetricians,
general practitioners, midwifes, and anaesthesiologists, to improve
pregnancy outcome and optimize resources. Copyright © 2019, The
Author(s).

<109>
Accession Number
2003691344
Title
Minimal Access Vs Sternotomy for Complex Mitral Valve Repair: A
Meta-Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Moscarelli M.; Fattouch K.; Gaudino M.; Nasso G.; Paparella D.; Punjabi
P.; Athanasiou T.; Benedetto U.; Angelini G.D.; Santarpino G.; Speziale G.
Institution
(Moscarelli) Imperial College NHLI, and Cardiothoracic and Vascular
Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA,
Italy
(Fattouch, Nasso, Speziale) Cardiothoracic and Vascular Department, Maria
Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Paparella) Santa Maria Hospital, GVM Care & Research, Department of
Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
(Punjabi, Athanasiou) Imperial College of London, Hammersmith Hospital,
London, United Kingdom
(Benedetto, Angelini) Bristol Heart Institute, University of Bristol,
Bristol, United Kingdom
(Santarpino) GVM Care and Research, Department of Cardiovascular Surgery,
Bari, Italy
Publisher
Elsevier USA
Abstract
Background: There is high demand for minimally invasive mitral valve
repair; however, it is unclear whether the minimally invasive approach
provides the same performance as conventional sternotomy in a context of
complex mitral valve disease. Here, we compared outcomes of minimally
invasive and sternotomy procedures for bileaflet and Barlow's mitral valve
disease. Method(s): We performed a pooled meta-analysis of studies
reporting early and late follow-up of mitral valve repair for complex
mitral valve regurgitation. The primary outcome was moderate mitral valve
regurgitation recurrence and need for reoperation. Secondary outcomes
included operation time, reopening for bleeding, associated tricuspid
procedures, failed repair, and inhospital mortality. Incidence rates were
calculated for long-term follow-up. Effect estimates were calculated as
incidence rates with 95% confidence intervals. When Kaplan-Meier curves
were available, event rates were estimated from the curves with Plot
Digitizer software; otherwise, reported event rates were used to calculate
incidence rates. Result(s): Eighteen studies including 1905 patients
(654 minimally invasive and 1251 sternotomy) with a mean follow-up of 51.6
months (range, 14 to 138) were meta-analyzed with a random model. There
were no significant between-group differences in moderate mitral valve
regurgitation recurrence and reoperation (minimally invasive vs
sternotomy, 1.7% [95% confidence interval, 1.0% to 2.9%] vs 1.3% [95%
confidence interval, 0.9% to 1.8%], P = .22). Patients in the minimally
invasive group were exposed to significantly longer cross-clamp and
cardiopulmonary bypass times (P < .01); however, there were no additional
between-group differences in secondary outcomes. Conclusion(s): This
meta-analysis has demonstrated that minimally invasive and sternotomy
approaches produce comparable results for complex mitral valve
repair. Copyright © 2019

<110>
Accession Number
2003674213
Title
Del Nido cardioplegia in isolated adult coronary artery bypass surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Timek T.A.; Beute T.; Robinson J.A.; Zalizadeh D.; Mater R.; Parker J.L.;
Lypka M.; Willekes C.L.
Institution
(Timek, Willekes) Division of Cardiothoracic Surgery, Spectrum Health,
Grand Rapids, Mich, United States
(Timek, Beute, Robinson, Zalizadeh, Mater, Willekes) Michigan State
University College of Human Medicine, Grand Rapids, Mich, United States
(Parker, Lypka) Office of Research, Spectrum Health, Grand Rapids, Mich,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Del Nido cardioplegia (DC) offers prolonged single-dose
myocardial protection in pediatric cardiac surgery. We set out to evaluate
the efficacy of DC in adult patients undergoing isolated coronary artery
bypass grafting (CABG). Method(s): From January 2014 to October 2017,
851 consecutive isolated CABG surgeries were performed by 2 study surgeons
at our center with blood cardioplegia (BC, n = 350), used from January
2012 to April 2014, and DC (n = 501), used from May 2014 to October 2017.
Propensity matching was used to yield 325 well-matched pairs. Clinical
data were extracted from our local Society of Thoracic Surgeons database
and mortality data from the Michigan State Social Security Death Index.
 Result(s): Single-dose administration was used in 83% (417/501) of
patients receiving DC. In propensity-matched groups, postoperative median
troponin T levels (0.28 [0.16-0.59] ng/mL vs 0.46 [0.27-0.81] ng/mL; P <
.01) were lower for patients receiving DC, and no difference in ejection
fraction on postoperative echocardiography was observed (54 +/- 12% and 53
+/- 13% for BC and DC, respectively; P = .36). Perioperative outcomes were
similar except for greater rate of atrial fibrillation (33% vs 23%; P =
.01) in the DC group. Subgroup analyses revealed equivalent myocardial
protection and clinical outcomes in patients with age >=75 years, left
ventricular ejection fraction <=35%, left main disease, or Society of
Thoracic Surgeons score >=2.5%. Four-year survival did not differ between
patients undergoing BC or DC. Conclusion(s): The current study
revealed noninferior myocardial protection and clinical outcomes with DC
versus BC in both routine and greater-risk patients undergoing isolated
CABG. DC demonstrated the feasibility of single-dose administration for
isolated CABG surgery. Larger randomized studies are needed to further
explore the safety and efficacy of DC in adult cardiac surgery with longer
crossclamp times. Copyright © 2019 The American Association for
Thoracic Surgery

<111>
Accession Number
2003781942
Title
Aortic valve myxoma. Systematic review and a new case report.
Source
Cirugia Cardiovascular. (no pagination), 2019. Date of Publication: 2019.
Author
Espinosa-Queb N.N.; Luna-Sanchez J.A.; Revilla-Casaos H.;
Dominguez-Rodriguez J.A.; Lara-Valdes A.J.; Tarelo-Saucedo J.M.
Institution
(Espinosa-Queb, Luna-Sanchez, Revilla-Casaos, Dominguez-Rodriguez,
Lara-Valdes, Tarelo-Saucedo) Servicio de Cirugia Cardio-Toracica, Hospital
regional General Ignacio Zaragoza, ISSSTE, Ciudad de Mexico, Mexico
Publisher
Elsevier Doyma
Abstract
Introduction and objectives: Primary cardiac tumors are very rare
(0.0017-0.23%); myxomas being the most frequent (80%). Its location is
mainly the left atrium and very rarely on the valves (<1%). There are few
cases reported on its aortic valve location, therefore we report a new
case to which a primary resection of aortic valve myxoma, but which
subsequently required valve replacement. The objective of this article is
to perform a systematic review of aortic valve myxoma reported.
 Method(s): The information found in the search engines PubMed and
Google Scholar was collected, using the words: myxoma valve, cardiac
myxoma, heart myxoma, and aortic valve myxoma. Result(s): We found 14
reports of aortic valve myxoma published until August 2019. Therefore, by
adding ours, we analyzed the information of 15 cases in total.
 Conclusion(s): The aortic valve myxoma is very rare, it occurs most
frequently in children under 20 years and over 50 years, the male sex is
the most affected. It is a solitary tumor with a diameter less than 1.5 cm
and early and total resection with preservation of the native valve should
be of choice, however, valvular replacement should be
assessed. Copyright © 2019 Sociedad Espanola de Cirugia
Toracica-Cardiovascular

<112>
Accession Number
2003725188
Title
Temporal Trends in Mortality after Transcatheter Aortic Valve Replacement:
A Systematic Review and Meta-Regression Analysis.
Source
Structural Heart. (no pagination), 2019. Date of Publication: 2019.
Author
Mattke S.; Schneider S.; Orr P.; Lakdawalla D.; Goldman D.
Institution
(Mattke, Orr) Center for Improving Chronic Illness Care, University of
Southern California, Los Angeles, CA, United States
(Schneider) Center for Self-Report Science, University of Southern
California, Los Angeles, CA, United States
(Lakdawalla, Goldman) Leonard D. Schaeffer Center for Health Policy &
Economics, University of Southern California, Los Angeles, CA, United
States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: We estimated trends for mortality after transcatheter aortic
valve replacement (TAVR) using meta-analytic techniques. Mortality rates
after TAVR have reportedly declined as the procedure became more
routinized and device technology improved. Confirming this finding with a
systematic assessment of the evidence could have substantial implications
for the choice between TAVR and surgical valve replacements.
 Method(s): We conducted a systematic literature review up to June 20,
2018 and extracted data on 30-day and 1-year mortality rates, surgical
risk, device type, study design, and the proportion of procedures that
used a transapical approach. We used meta-regression to test whether
risk-adjusted 30-day and 1-year mortality rates declined over time.
 Result(s): We identified 145 studies and 179 subsamples, once results
for separately reported subgroups were broken out. Of these, 160
subsamples (89%) representing 137 studies and 91,652 patients contained
information on 30-day mortality, and 93 subsamples (52%) representing 84
studies and 40,765 patients information on 1-year mortality. The adjusted
30-day mortality rate after TAVR fell from 10.48% (95% CI 7.97-11.65%) in
2007 to 2.27% (95% CI 1.14-4.49%) in 2016, corresponding to a relative
decrease of 78% over 10 years. The adjusted mortality rate within 1 year
after TAVR was 30.24% (95% CI 24.53-36.65%) in 2007 and fell to 11.35%
(95% CI 8.32-15.31%) in 2014, corresponding to a relative decrease of 63%
over 8 years. Conclusion(s): The results suggest that near-term
survival after TAVR has improved substantially within the short period
after the procedure was introduced and support the increasing utilization
of TAVR. Copyright © 2019, © 2019 Cardiovascular Research
Foundation.

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