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<1>
Accession Number
2004352926
Title
Comparison of Coronary Artery Bypass Grafting and Drug-Eluting Stents in
Patients with Left Main Coronary Artery Disease and Chronic Kidney
Disease: A Systematic Review and Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 20 (12) (pp 1184-1189), 2019.
Date of Publication: December 2019.
Author
Barbarawi M.; Zayed Y.; Hamid K.; Kheiri B.; Barbarawi O.; Sundus S.;
Rashdan L.; Alabdouh A.; Chahine A.; Bachuwa G.; Alkotob M.L.
Institution
(Barbarawi, Zayed, Hamid, Kheiri, Sundus, Rashdan, Chahine, Bachuwa)
Department of Internal Medicine, Hurley Medical Center/Michigan State
University, Flint, MI 48503, United States
(Barbarawi) Department of Internal Medicine, Mutah University, Al-Karak,
Jordan
(Alabdouh) Department of Internal Medicine, Saint Agnes Hospital,
Baltimore, MD 21229, United States
(Alkotob) Division of Cardiology, Hurley Medical Center/Michigan State
University, Flint, MI 48503, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Treatment of left main coronary artery disease (LMCAD) in
patients with chronic kidney disease (CKD) with either percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG)
remains controversial. Therefore, we performed a meta-analysis to evaluate
the optimal choice of therapy when treating LMCAD in patients with CKD.
<br/>Method(s): We performed an electronic database search of Pubmed,
Embase, and Cochrane Library for all studies that compared PCI with CABG
when treating LMCAD in the setting of CKD. Major adverse cardiac and
cerebrovascular events (MACCE) were the primary outcome. Secondary
outcomes included myocardial infarction (MI), cerebrovascular events,
all-cause mortality, and repeat revascularization. <br/>Result(s): Our
analysis included 5 studies (2 randomized controlled trial and 3
retrospective) representing a total of 1212 patients. Mean follow up was
3.4 +/- 1.3 years. Our study demonstrated a significant reduction in MACCE
for patients treated with CABG compared with PCI (odd ratio [OR] 0.72; 95%
confidence interval [CI] 0.55-0.95, P = 0.02, I² = 0%). We also
found a significant reduction in both MI (OR 0.55; 95% CI 0.34-0.87; P =
0.01; I² = 0%) and repeat revascularization (OR 0.22; 95% CI
0.10-0.51; P < 0.001, I² = 63%) in the CABG group. However,
CABG was associated with increased risks of cerebrovascular disease events
compared with PCI (OR 2.04; 95% CI 1.02-4.08; P = 0.04, I² =
0%). <br/>Conclusion(s): In patients with CKD requiring LMCAD
intervention, CABG is associated with a lower risk of MACCE, MI, and
repeat revascularization, however it was associated with an increased risk
of cerebrovascular accidents when compared to patients who received PCI
therapy. Further RCTs with sufficient power are required to confirm these
findings.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<2>
Accession Number
2004307180
Title
Effects of intensive lipid-lowering therapy on mortality after coronary
bypass surgery: A meta-analysis of 7 randomised trials.
Source
Atherosclerosis. 293 (pp 75-78), 2020. Date of Publication: January 2020.
Author
Alkhalil M.
Institution
(Alkhalil) Cardiology Department, Royal Victoria Hospital, Belfast, United
Kingdom
(Alkhalil) Cardiology Department, Toronto General Hospital, 200 Elizabeth
Street, Toronto M5G 2C4, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: The recent reported analysis from the ODYSSEY
OUTCOMES trial showed that patients with previous coronary bypass graft
surgery (CABG) had enhanced clinical benefits in response to intensive
low-density lipoprotein-cholesterol (LDL-c). Nonetheless, the impact on
cardiovascular and all-cause mortality was difficult to ascertain given
the relatively small number. <br/>Method(s): We conducted a meta-analysis
investigating the role of more versus less intensive lipid-lowering
treatment, taking into consideration the difference in studies duration
when reporting treatment effect. <br/>Result(s): A significant 14%
reduction in deaths from any cause [RR 0.86 (95% CI, 0.74 to 0.99)] and
25% reduction in cardiovascular mortality [RR 0.75, (95% CI, 0.65 to
0.86)] were associated with intensive LDL-c reduction in patients post
CABG. Importantly, this reduction was apparent in patients who were stable
or developed an acute coronary syndrome following CABG.
<br/>Conclusion(s): Patients with previous CABG incurred reduction in
all-cause mortality and particularly cardiovascular mortality in response
to intensive LDL-c reduction. Patient's clinical presentation following
CABG did not modulate the associated benefits with intensive LDL-c
reduction. Characterising atherosclerotic disease may help identify other
high-risk groups who may benefit maximally from additional lipid-lowering
therapies.<br/>Copyright &#xa9; 2019 Elsevier B.V.

<3>
Accession Number
629824866
Title
Effect of Home-Based Cardiac Rehabilitation in a Lower-Middle Income
Country: RESULTS FROM A CONTROLLED TRIAL.
Source
Journal of cardiopulmonary rehabilitation and prevention. 40 (1) (pp
29-34), 2020. Date of Publication: 01 Jan 2020.
Author
Joshi V.L.; Moniruzzaman M.; Karim R.; Uddin J.; Siraj M.; Rashid M.A.;
Rossau H.K.; Taylor R.S.; Zwisler A.-D.
Institution
(Uddin) Physiotherapy Unit, Department of Cardiac Surgery (Mr Jamal
Uddin), Department of Cardiac Surgery (Drs Siraj and Jalal Uddin), and
Department of Cardiology (Drs Rashid and Karim) Ibrahim Cardiac Hospital &
Research Institute, Shagbag, Dhaka, Bangladesh; Danish Knowledge Centre
for Rehabilitation and Palliative Care (REHPA), Odense University Hospital
and University of Southern Denmark, Copenhagen, Denmark (Messrs Jamal
Uddin and Joshi, Ms Rossau, and Drs Taylor and Zwisler); Department of
Noncommunicable Disease, Bangladesh University of Health Sciences (BUHS),
Dhaka, Bangladesh (Mr Moniruzzaman and Dr Jalal Uddin); Institute of
Health Research, University of Exeter Medical School, Exeter, United
Kingdom (Dr Taylor); and Institute of Health and Well Being, University of
Glasgow, Glasgow, United Kingdom (Dr Taylor)
Publisher
NLM (Medline)
Abstract
PURPOSE: Cardiovascular disease is the leading cause of mortality and
morbidity in lower-middle income countries (LMICs), including Bangladesh.
Cardiac rehabilitation (CR) as part of secondary prevention of
cardiovascular disease has been shown to reduce mortality and morbidity
and improve quality of life and exercise capacity. However, to date, very
few controlled trials of CR have been conducted in LMICs. <br/>METHOD(S):
A quasi-randomized controlled trial comparing home-based CR plus usual
care with usual care alone was undertaken with patients following coronary
artery bypass graft surgery. Participants in the CR group received an
in-hospital CR class and were introduced to a locally developed
educational booklet with details of a home-based exercise program and then
received monthly telephone calls for 12 mo. Primary outcomes were coronary
heart disease (CHD) risk factors, health-related quality of life (HRQOL),
and mental well-being. Maximal oxygen uptake as a measure of exercise
capacity was a secondary outcome. <br/>RESULT(S): In total, 142 of 148
eligible participants took part in the trial (96%); 71 in each group. At
12-mo follow-up, 61 patients (86%) in the CR group and 40 (56%) in the
usual care group provided complete outcome data. Greater reductions in CHD
risk factors and improvements in HRQOL, mental well-being, and exercise
capacity were seen for the CR group compared with the usual care group.
<br/>CONCLUSION(S): In the context of a single-center LMIC setting, this
study demonstrated the feasibility of home-based CR programs and offers a
model of service delivery that could be replicated on a larger scale.

<4>
Accession Number
2003572044
Title
Sex-mismatch influence on survival after heart transplantation: A
systematic review and meta-analysis of observational studies.
Source
Clinical Transplantation. 33 (12) (no pagination), 2019. Article Number:
e13737. Date of Publication: 01 Dec 2019.
Author
Ayesta A.; Urrutia G.; Madrid E.; Vernooij R.W.M.; Vicent L.;
Martinez-Selles M.
Institution
(Ayesta) Servicio de cardiologia, Hospital Universitario Central de
Asturias, Oviedo, Spain
(Urrutia) Institut d'Investigacio Biomedica Sant Pau (IIB Sant Pau),
Barcelona, Spain
(Urrutia) CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
(Urrutia, Madrid, Vernooij) Centro Iberoamericano Cochrane, Barcelona,
Spain
(Madrid) Centro de Investigacion Biomedica, Facultad de Medicina,
Universidad de Valparaiso, Valparaiso, Chile
(Madrid) Centro Interdisciplinar para Estudios de la Salud, Facultad de
Medicina, Universidad de Valparaiso, Valparaiso, Chile
(Vicent, Martinez-Selles) Servicio de Cardiologia, Hospital Universitario
Gregorio Maranon, Instituto de Investigacion Sanitaria Gregorio Maranon
(IiSGM), CIBERCV, Madrid, Spain
(Vicent, Martinez-Selles) Universidad Complutense de Madrid, Madrid, Spain
(Martinez-Selles) Universidad Europea de Madrid, Madrid, Spain
Publisher
Blackwell Publishing Ltd
Abstract
Introduction and objectives: Heart transplantation (HT) is the treatment
for patients with end-stage heart disease. Despite contradictory reports,
survival seems to be worse when donor/recipient sex is mismatched. This
systematic review and meta-analysis aims to synthesize the evidence on the
effect of donor/recipient sex mismatch after HT. <br/>Method(s): We
searched PubMed and EMBASE until November 2017. Comparative cohort and
registry studies were included. Published articles were systematically
selected and, when possible, pooled in a meta-analysis. The primary
endpoint was one-year mortality. <br/>Result(s): After retrieving 556
articles, ten studies (76 175 patients) were included in the quantitative
meta-analysis. Significant differences were found in one-year survival
between sex-matched and mismatched recipients (odds ratio (OR) 1.30, 95%
confidence interval (CI) 1.25-1.35, P <.001). In female recipients, we
found that sex mismatch was not a risk factor for one-year mortality (OR =
0.93, 95% CI = 0.85-1.00, P =.06). However, in male recipients, we found
that it was a risk factor for one-year mortality (OR = 1.38, 95% CI =
1.31-1.44, P <.001). <br/>Conclusion(s): Sex mismatch increases one-year
mortality after HT in male recipients. Its influence in long-term survival
should be further explored with high-quality studies.<br/>Copyright &#xa9;
2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<5>
Accession Number
2004309270
Title
Cost-effectiveness of routine transoesophageal echocardiography during
cardiac surgery: a discrete-event simulation study.
Source
British Journal of Anaesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Dieleman J.M.; Myles P.S.; Bulfone L.; Younie S.; van Zaane B.; McGiffin
D.; Moodie M.; Gao L.
Institution
(Dieleman) Department of Anaesthesia, Westmead Hospital, Sydney, Australia
(Dieleman, Myles) Department of Anaesthesia and Perioperative Medicine,
Monash University, Melbourne, Australia
(Bulfone, Younie, Moodie, Gao) Deakin Health Economics, Institute for
Health Transformation, Faculty of Health, Deakin University, Melbourne,
Australia
(van Zaane) Department of Anesthesiology, University Medical Center
Utrecht, Utrecht, Netherlands
(McGiffin) Department of Cardiothoracic Surgery, The Alfred Hospital,
Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: The aim of this study was to simulate and compare the
healthcare and economic outcomes associated with routine use of
intraoperative transoesophageal echocardiography (TOE) in patients
undergoing cardiac surgery with those associated with a scenario where TOE
is not routinely used. <br/>Method(s): The impact of TOE on surgical
decision-making was estimated through a systematic literature review.
Individual short-term morbidity and mortality estimates were generated by
application of the Society of Thoracic Surgeons risk calculator. Long-term
event rates, unit costs, and utility weights were sourced from published
literature and expert opinion. A discrete-event simulation model was then
constructed to simulate both the in-hospital and post-discharge outcomes
for patients undergoing cardiac surgery. Robustness of the base case
results was examined through deterministic and probabilistic sensitivity
analyses. An incremental cost-effectiveness ratio of 30 000 per
quality-adjusted life-year gained was assumed to represent acceptable
cost-effectiveness. <br/>Result(s): Routine use of intraoperative TOE was
associated with lower costs and higher benefits per patient, which
indicates that use of TOE is a dominant strategy. The intervention
resulted in the avoidance of 299 cardiac complications, 20 strokes, and 11
all-cause deaths per 10 000 patients. Routine intraoperative TOE was
associated with an increased occurrence of bleeding owing to more valvular
surgery and subsequent long-term anticoagulation. <br/>Conclusion(s):
Routine intraoperative TOE is a cost-effective procedure for patients
undergoing cardiac surgery, leading to lower overall costs. It was
associated with a decrease in long-term complications including stroke,
cardiac complications, and death, although there was a slight increase in
extracranial bleeding events.<br/>Copyright &#xa9; 2019 British Journal of
Anaesthesia

<6>
Accession Number
628783614
Title
A Double-Blind Randomized Controlled Trial to Determine the Preventive
Effect of Hangekobokuto on Aspiration Pneumonia in Patients Undergoing
Cardiovascular Surgery.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 25 (6) (pp
318-325), 2019. Date of Publication: 20 Dec 2019.
Author
Kawago K.; Nishibe T.; Shindo S.; Inoue H.; Motohashi S.; Akasaka J.;
Ogino H.
Institution
(Kawago, Shindo, Inoue, Motohashi, Akasaka) Department of Cardiovascular
Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji,
Tokyo, Japan
(Kawago, Nishibe, Ogino) Department of Cardiovascular Surgery, Tokyo
Medical University, Tokyo, Japan
Publisher
NLM (Medline)
Abstract
PURPOSE: This study aimed to assess whether hangekobokuto (HKT) can
prevent aspiration pneumonia in patients undergoing cardiovascular
surgery. <br/>METHOD(S): We performed a single-center, double-blinded,
randomized, placebo-controlled study of HKT in patients undergoing
cardiovascular surgery. JPS HKT extract granule (JPS-16) was used as HKT.
The primary endpoint was defined as the prevention of postoperative
aspiration pneumonia. The secondary endpoints included complete recovery
from swallowing and coughing disorders. <br/>RESULT(S): Between August
2014 and August 2015, a total of 34 patients were registered in this
study. The rate of subjects with postoperative aspiration pneumonia was
significantly lower in the HKT group than in the placebo group (p =
0.017). In high-risk patients for aspiration pneumonia, the rate was
significantly lower in the HKT group than in the placebo group (p =
0.015). The rate of subjects with swallowing disorders tended to be lower
in the HKT group than in the placebo group (p = 0.091), and in high-risk
patients, the rate was significantly lower in the HKT group than in the
placebo group (p = 0.038). <br/>CONCLUSION(S): HKT can prevent aspiration
pneumonia in patients undergoing cardiovascular surgery. In high-risk
patients for aspiration pneumonia, HKT can prevent aspiration pneumonia
and improve swallowing disorders.

<7>
Accession Number
628751700
Title
The Relationship between the Use of Cold and Isothermic Blood Cardioplegia
Solution for Myocardial Protection during Cardiopulmonary Bypass and the
Ischemia-Reperfusion Injury.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 25 (6) (pp
296-303), 2019. Date of Publication: 20 Dec 2019.
Author
Sacli H.; Kara I.; Diler M.S.; Percin B.; Turan A.I.; Kirali K.
Institution
(Sacli, Kara, Kirali) Faculty of Medicine, Department of Cardiovascular
Surgery, Sakarya University, Turkey
(Diler, Percin, Turan) Department of Cardiovascular Surgery, Sakarya
University Education and Research Hospital, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: In this study, we aimed to assess myocardial protection and
ischemia-reperfusion injury in patients undergoing open heart surgery with
isothermic blood cardioplegia (IBC) or hypothermic blood cardioplegia
(HBC). MATERIALS AND METHODS: A total of 48 patients who underwent
isolated coronary artery bypass grafting or isolated mitral valve surgery
between March 2017 and October 2017 were evaluated as randomized
prospective study. Study groups (HBC: Group 1, IBC: Group 2) were compared
in terms of interleukin 6 (IL-6), IL-8, IL-10, and complement factor 3a
(C3a) levels, metabolic parameters, creatine kinase-muscle/brain (CK-MB)
and high-sensitivity Troponin I (hsTn-I), and clinical outcomes.
<br/>RESULT(S): Comparison of the markers of ischemia-reperfusion injury
showed significantly higher levels of the proinflammatory cytokine IL-6 in
the early postoperative period as well as IL-8, in Group 2 (p <0.001),
whereas the anti-inflammatory cytokine IL-10 was significantly higher
during the X1 time period (p = 0.11) in Group 2, and subsequently it was
higher in Group 1. Using myocardial temperature probes, the target
myocardial temperatures were measured in the patients undergoing open
heart surgery with different routes of cardioplegia, and significant
differences were noted (p = 0.000). <br/>CONCLUSION(S): HBC for open heart
surgery is associated with less myocardial injury and intraoperative and
postoperative morbidity, indicating superior myocardial protection versus
IBC.

<8>
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Accession Number
2004292338
Title
Peripheral versus central extracorporeal membrane oxygenation for
postcardiotomy shock: Multicenter registry, systematic review, and
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Mariscalco G.; Salsano A.; Fiore A.; Dalen M.; Ruggieri V.G.; Saeed D.;
Jonsson K.; Gatti G.; Zipfel S.; Dell'Aquila A.M.; Perrotti A.; Loforte
A.; Livi U.; Pol M.; Spadaccio C.; Pettinari M.; Ragnarsson S.; Alkhamees
K.; El-Dean Z.; Bounader K.; Biancari F.; Dashey S.; Yusuff H.; Porter R.;
Sampson C.; Harvey C.; Settembre N.; Fux T.; Amr G.; Lichtenberg A.;
Jeppsson A.; Gabrielli M.; Reichart D.; Welp H.; Chocron S.; Fiorentino
M.; Lechiancole A.; Netuka I.; De Keyzer D.; Strauven M.; Palve K.
Institution
(Mariscalco, El-Dean) Department of Cardiac Surgery, Glenfield Hospital,
University Hospitals of Leicester, Leicester, United Kingdom
(Salsano) Division of Cardiac Surgery, Department of Integrated Surgical
and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
(Fiore) Department of Cardiothoracic Surgery, Henri Mondor University
Hospital, AP-HP, Paris-Est University, Creteil, France
(Dalen) Department of Molecular Medicine and Surgery, Department of
Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital,
Stockholm, Sweden
(Ruggieri) Division of Cardiothoracic and Vascular Surgery, Robert Debre
University Hospital, Reims, France
(Saeed) Cardiovascular Surgery, University Hospital of Dusseldorf,
Dusseldorf, Germany
(Jonsson) Department of Cardiac Surgery, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Zipfel) Hamburg University Heart Center, Hamburg, Germany
(Dell'Aquila) Department of Cardiothoracic Surgery, Munster University
Hospital, Munster, Germany
(Perrotti) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Loforte) Department of Cardiothoracic, Transplantation and Vascular
Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
(Livi) Cardiothoracic Department, University Hospital of Udine, Udine,
Italy
(Pol) Institute of Clinical and Experimental Medicine, Prague, Czechia
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Pettinari) Department of Cardiovascular Surgery, Ziekenhuis
Oost-Limburgl, Genk, Belgium
(Ragnarsson) Department of Cardiothoracic Surgery, University of Lund,
Lund, Sweden
(Alkhamees) Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
(Bounader) Division of Cardiothoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
(Biancari) Heart Center, Turku University Hospital and University of
Turku, Turku, Finland
(Biancari) Department of Surgery, University of Oulu, Oulu, Finland
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: We hypothesized that cannulation strategy in venoarterial
extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in
the perioperative survival of patients affected by postcardiotomy shock.
<br/>Method(s): Between January 2010 and March 2018, 781 adult patients
receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers
were retrieved from the Postcardiotomy Veno-arterial Extracorporeal
Membrane Oxygenation study registry. A parallel systematic review and
meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through
December 2018 was also accomplished. <br/>Result(s): Central and
peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536
(68.6%) patients, respectively. Main indications for the institution
VA-ECMO were failure to wean from cardiopulmonary bypass (38%) and heart
failure following cardiopulmonary bypass weaning (48%). The doubly robust
analysis after inverse probability treatment weighting by propensity score
demonstrated that central VA-ECMO was associated with greater hospital
mortality (odds ratio 1.54; 95% confidence interval, 1.09-2.18),
reoperation for bleeding/tamponade (odds ratio, 1.96; 95% confidence
interval, 1.37-2.81), and transfusion of more than 9 RBC units (odds
ratio, 2.42; 95% confidence interval, 1.59-3.67). The systematic review
provided a total of 2491 individuals with postcardiotomy shock treated
with VA-ECMO. Pooled prevalence of in-hospital/30-day mortality in overall
patient population was 66.6% (95% confidence interval, 64.7-68.4%), and
pooled unadjusted risk ratio analysis confirmed that patients undergoing
peripheral VA-ECMO had a lower in-hospital/30-day mortality than patients
undergoing central cannulation (risk ratio, 0.92; 95% confidence interval,
0.87-0.98). Adjustments for important confounders did not alter our
results. <br/>Conclusion(s): In patients with postcardiotomy shock treated
with VA-ECMO, central cannulation was associated with greater in-hospital
mortality than peripheral cannulation.<br/>Copyright &#xa9; 2019 The
American Association for Thoracic Surgery

<9>
Accession Number
2001386254
Title
Motivational interviewing to support LDL-C therapeutic goals and
lipid-lowering therapy compliance in patients with acute coronary
syndromes (IDEAL-LDL) study: rationale and design.
Source
Hellenic Journal of Cardiology. 60 (4) (pp 249-253), 2019. Date of
Publication: July - August 2019.
Author
Boulmpou A.; Kartas A.; Farmakis I.; Zafeiropoulos S.; Nevras V.;
Papadimitriou I.; Tampaki A.; Vlachou A.; Lillis L.; Koutsakis A.;
Karvounis H.; Giannakoulas G.
Institution
(Boulmpou, Kartas, Farmakis, Zafeiropoulos, Nevras, Papadimitriou,
Tampaki, Vlachou, Lillis, Koutsakis, Karvounis, Giannakoulas) Department
of Cardiology, AHEPA University Hospital, Aristotle University of
Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
Publisher
Hellenic Cardiological Society
Abstract
Background: Achieving low-density lipoprotein cholesterol (LDL-C) target
levels after an acute coronary syndrome (ACS) is of paramount importance,
and is often burdened by undertreatment and medication or lifestyle
non-adherence issues. <br/>Objective(s): We examined the effect of a
patient-centered, physician-led motivational intervention following ACS on
relevant secondary prevention aspects. Methods-design: The IDEAL-LDL is a
single-center, randomized controlled clinical trial, conducted among
patients hospitalized due to an ACS. Following discharge, all patients
undergo a baseline assessment of lipid profile. Patients in the
intervention group receive an in-person educational session and an
informative leaflet, and also undergo two phone-based, motivational
interviewing sessions at 1 and 6 months. These interventions emphasize on
LDL-C goals, adherence to lipid-lowering medication, and healthy
dietary-lifestyle habits, and are not provided to patients in the control
group, who receive usual care. At 12 months after each patient's
discharge, an in-person interview and lipid profile reassessment are
performed. The primary outcomes are the assessment of LDL-C goal
achievement (<70 mg/dL or >50% reduction from baseline levels) from
baseline to 1 year and changes in medication adherence. Secondary outcomes
relate to the incidence of the composite outcome of cardiovascular death,
nonfatal myocardial infarction/stroke, need for myocardial
revascularization, and recurrent hospitalization during the follow-up
period. <br/>Discussion(s): This paper describes the protocol, design, and
rationale for key methodology for an ongoing clinical trial featuring a
simple and feasible intervention. Similar adherence efficacy trials have
not led to sufficient improvements, and there remains a gap regarding how
adherence interventions should be implemented into clinical
care.<br/>Copyright &#xa9; 2018 Hellenic Society of Cardiology

<10>
Accession Number
628898043
Title
Effect of Autotransfusion Using Intraoperative Predonated Autologous Blood
on Coagulopathy during Thoracic Aortic Surgery: A Randomized Controlled
Trial.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 25 (6) (pp
311-317), 2019. Date of Publication: 20 Dec 2019.
Author
Suzuki R.; Mikamo A.; Matsuno Y.; Fujita A.; Kurazumi H.; Yamashita A.;
Hamano K.
Institution
(Suzuki, Mikamo, Matsuno, Fujita, Kurazumi, Hamano) Department of Surgery
and Clinical Science, Division of Cardiac Surgery, Yamaguchi University
Graduate School of Medicine, Ube, Yamaguchi, Japan
(Yamashita) Department of Anesthesiology, Yamaguchi University Graduate
School of Medicine, Ube, Yamaguchi, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intraoperative predonated autologous blood transfusion is
thought to replenish platelets and coagulation factors and ameliorate
coagulopathy. This study aimed to evaluate whether intraoperative
predonated autotransfusion improves coagulopathy during thoracic aortic
surgery. <br/>METHOD(S): Patients who underwent thoracic aortic surgery
were randomized into two groups as follows: those who received
intraoperative predonated blood (group A: n = 31) and those who did not
receive (group N: n = 22). In group A, autologous blood was retransfused
immediately after cessation of cardiopulmonary bypass (c-CPB).
<br/>RESULT(S): The mean intraoperative allogenic blood or blood product
transfusion requirements were significantly lesser in group A than in
group N (packed red blood cells [RBCs]: 6.3 +/- 5.1 vs. 9.1 +/- 4.3 units,
p = 0.04; fresh frozen plasma [FFP]: 3.0 +/- 4.1 vs. 6.1 +/- 5.7 units, p
= 0.03). After c-CPB, hemoglobin (Hb) level, platelet count, and
coagulopathy became significantly worse than those at the start of surgery
in both the groups. However, the values significantly improved 30 min
after c-CPB only in group A. Renal function was significantly worse in
group N. <br/>CONCLUSION(S): Intraoperative predonated autotransfusion
significantly improved coagulopathy, with reduced allogeneic blood
transfusion volume during thoracic aortic surgery. Furthermore, reduction
of allogeneic blood transfusion may reduce the adverse effects on renal
function.

<11>
Accession Number
2004367821
Title
Intraoperative Optimization of Both Depth of Anesthesia and Cerebral
Oxygenation in Elderly Patients Undergoing Coronary Artery Bypass Graft
Surgery-A Randomized Controlled Pilot Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Kunst G.; Gauge N.; Salaunkey K.; Spazzapan M.; Amoako D.; Ferreira N.;
Green D.W.; Ballard C.
Institution
(Kunst, Salaunkey, Amoako, Ferreira, Green) Department of Anaesthetics and
Pain Medicine, King's College Hospital NHS Foundation Trust, London,
United Kingdom
(Kunst, Spazzapan) School of Cardiovascular Medicine and Sciences, King's
College London British Heart Foundation Centre of Excellence, Faculty of
Life Sciences and Medicine, London, United Kingdom
(Gauge, Ferreira, Ballard) Wolfson Centre for Age-Related Diseases,
Institute of Psychiatry, Psychology and Neuroscience, Kings College
London, London, United Kingdom
(Salaunkey) Royal Papworth Hospital, Cambridge, United Kingdom
(Ballard) University of Exeter Medical School, Exeter, United Kingdom
Publisher
W.B. Saunders
Abstract
Objectives: Does intraoperative optimization of both depth of anesthesia
and regional cerebral tissue oxygenation (rScO<inf>2</inf>) in elderly
patients reduce postoperative cognitive decline (primary outcome) or
delirium (secondary outcome)? Design: Prospective randomized controlled
single blind trial. <br/>Setting(s): A single major urban teaching and
university hospital and tertiary referral center. <br/>Participant(s):
Patients, 65 years of age and older, undergoing elective coronary artery
bypass graft surgery on cardiopulmonary bypass. <br/>Intervention(s):
Intraoperative depth of anesthesia bispectral index (BIS) values were
targeted at 50 +/- 10. Regional cerebral tissue desaturations of more than
15% of the pre-induction value, or below 50%, were avoided.
<br/>Measurements and Main Results: Eighty-two patients were included, and
mean depth of anesthesia values using BIS were significantly higher during
surgery in the intervention group with 40.6 (7.3) versus 35.4 (6.7) in the
control group, mean (standard deviation), p = 0.004. The cognitive
function was similar between the treatment and control groups at 6 weeks
postoperatively with a Mini Mental State Examination (MMSE) of 27 (26,29)
in the intervention group and an MMSE of 29 (27,29) in the control group,
median (interquartile range), with p = 0.12. The authors observed a
reduction in the incidence of delirium, occurring in 2.4% (n = 1) of
patients in the intervention group and in 20% (n = 8) in the control group
(p = 0.01). <br/>Conclusion(s): This pilot trial demonstrates that
noninvasive target-controlled depth of anesthesia monitoring is feasible.
Cognitive function at 6 weeks showed no difference between the treatment
and control groups; however, postoperative delirium was reduced in the
intervention group.<br/>Copyright &#xa9; 2019 The Authors

<12>
Accession Number
2004261542
Title
The Prevalence and Treatment of Erectile Dysfunction in Male Solid Organ
Transplant Recipients.
Source
Sexual Medicine Reviews. (no pagination), 2019. Date of Publication: 2019.
Author
Payne K.; Popat S.; Lipshultz L.I.; Thirumavalavan N.
Institution
(Payne) Baylor College of Medicine, Houston, TX, United States
(Popat, Lipshultz) Scott Department of Urology, Baylor College of
Medicine, Houston, TX, United States
(Thirumavalavan) Urology Institute, University Hospitals/Case Western
Reserve University School of Medicine, Cleveland, OH, United States
Publisher
Elsevier B.V.
Abstract
Introduction: Erectile dysfunction (ED) is a prevalent and
under-recognized complaint among male solid organ transplant recipients.
Most research on this topic has focused on kidney transplant recipients
alone. In this review, we integrate current research on ED across all
types of solid organ transplant recipients and assess the success of
current methods of ED treatment in transplant populations. <br/>Aim(s): To
review the current literature addressing the prevalence and treatment of
ED in the male solid organ transplant population. <br/>Method(s): A
literature search was conducted using PubMed to identify relevant studies.
Search terms included "organ transplant" and "erectile dysfunction."
Titles and abstracts were reviewed for relevance. References from
identified articles were also searched and included, if appropriate.
<br/>Main Outcome Measure(s): Review of peer-reviewed literature.
<br/>Result(s): The prevalence of ED among transplant recipients is higher
than that in the general population: 39.8-86.2% in liver transplant
recipients, 54-66% in renal transplant recipients, 71-78% in heart
transplant recipients, and 79% in simultaneous pancreas-kidney transplant
recipients. Phosphodiesterase-5 inhibitors have up to 80% efficacy in
treating ED in kidney transplant recipients. Intracavernosal injections
have been used with success rates of 60-70% in cardiac and renal
transplant recipients. Penile prostheses have also been shown to be safe
and effective across transplant types. A low incidence of infection has
been reported in several case series, although there is concern for an
increased rate of mechanical complications in pelvic organ transplant
recipients. Accordingly, placement of a two-piece or malleable prosthesis
or ectopic reservoir placement with a three-piece inflatable prosthesis is
suggested in this population. <br/>Conclusion(s): ED is highly prevalent
among male solid organ transplant recipients and should be routinely
screened in this population. Current modalities of ED treatment used in
the general population are safe and effective in solid organ transplant
recipients, although success rates are often lower than those in the
general population. Payne K, Popat S, Lipshultz LI, et al. The Prevalence
and Treatment of Erectile Dysfunction in Male Solid Organ Transplant
Recipients. Sex Med Rev 2019;XX:XXX-XXX.<br/>Copyright &#xa9; 2019
International Society for Sexual Medicine

<13>
Accession Number
630399757
Title
Epidemiology and management of primary spontaneous pneumothorax: a
systematic review.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 20 Dec 2019.
Author
Mendogni P.; Vannucci J.; Ghisalberti M.; Anile M.; Aramini B.; Congedo
M.T.; Nosotti M.; Bertolaccini L.; D'Ambrosio A.E.; De Vico A.; Guerrera
F.; Imbriglio G.; Pardolesi A.; Schiavon M.; Russo E.
Institution
(Mendogni, Nosotti) Thoracic Surgery and Lung Transplant Unit, Foundation
IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
(Vannucci, Anile) Department of Thoracic Surgery, Umberto I Hospital,
University of Rome Sapienza, Rome, Italy
(Ghisalberti) Thoracic Surgery Unit, University Hospital of Siena, Siena,
Italy
(Aramini) Division of Thoracic Surgery, Department of Medical and Surgical
Sciences for Children & Adults, University Hospital of Modena and Reggio
Emilia, Modena, Italy
(Congedo) Division of Thoracic Surgery, Catholic University of Sacred
Heart, Rome, Italy
(Bertolaccini) Division of Thoracic Surgery, IEO, European Institute of
Oncology IRCCS, Milan, Italy
(D'Ambrosio) Thoracic Surgery Unit, Catania, Italy
(De Vico) Thoracic Surgery Unit, Brescia, Italy
(Guerrera) Department of Thoracic Surgery, University of Torino, Torino,
Italy
(Imbriglio) Thoracic Surgery Unit, Vito Fazzi Hospital, Lecce, Italy
(Pardolesi) Unit of Thoracic Surgery, Foundation IRCCS National Cancer
Institute of Milan, Milan, Italy
(Schiavon) Thoracic Surgery Unit, Department of Cardiac, Thoracic,
Vascular Sciences and Public Health, University of Padova, Padova, Italy
(Russo) Division of Thoracic Surgery and Lung Transplantation, Department
for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic
Transplantation, Palermo, Italy
Publisher
NLM (Medline)
Abstract
CLINICAL TRIAL REGISTRATION NUMBER: International Prospective Register of
Systematic Reviews (PROSPERO): CRD42018084247.<br/>Copyright &#xa9; The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<14>
Accession Number
2003936389
Title
Hyperoxia and antioxidants during major non-cardiac surgery and risk of
cardiovascular events: Protocol for a 2 x 2 factorial randomised clinical
trial.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2019. Date of
Publication: 2019.
Author
Petersen C.; Loft F.C.; Aasvang E.K.; Vester-Andersen M.; Rasmussen L.S.;
Wetterslev J.; Jorgensen L.N.; Christensen R.; Meyhoff C.S.
Institution
(Petersen, Loft, Meyhoff) Department of Anaesthesia and Intensive Care,
Bispebjerg and Frederiksberg Hospital, University of Copenhagen,
Copenhagen, Denmark
(Petersen, Loft, Meyhoff) Copenhagen Center for Translational Research,
Bispebjerg and Frederiksberg, Copenhagen University Hospital, Copenhagen,
Denmark
(Aasvang, Rasmussen, Meyhoff) Department of Clinical Medicine, University
of Copenhagen, Copenhagen, Denmark
(Aasvang) Department of Anaesthesia, Centre for Cancer and Organ Diseases,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Vester-Andersen) Herlev Anaesthesia Critical and Emergency Care Science
Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital
Herlev-Gentofte, Herlev, Denmark
(Rasmussen) Department of Anaesthesia, Center of Head and Orthopaedics,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Wetterslev) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Department 7812, Copenhagen University Hospital, Rigshospitalet,
Copenhagen, Denmark
(Jorgensen) Digestive Disease Center, Bispebjerg and Frederiksberg
Hospital, University of Copenhagen, Copenhagen, Denmark
(Christensen) Musculoskeletal Statistics Unit, The Parker Institute,
Bispebjerg and Frederiksberg Hospital, University of Copenhagen,
Copenhagen, Denmark
(Christensen) Research Unit of Rheumatology, Department of Clinical
Research, University of Southern Denmark, Odense University Hospital,
Odense, Denmark
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Myocardial injury after non-cardiac surgery occurs in a high
number of patients, resulting in increased mortality in the post-operative
period. The use of high inspiratory oxygen concentrations may cause
hyperoxia, which is associated with impairment of coronary blood flow.
Furthermore, the surgical stress response increases reactive oxygen
species, which is involved in several perioperative complications
including myocardial injury and death. Avoidance of hyperoxia and
substitution of reactive oxygen species scavengers may be beneficial. Our
primary objective is to examine the effect of oxygen and added
antioxidants for prevention of myocardial injury assessed by area under
the curve for troponin measurements during the first three post-operative
days. <br/>Method(s): The VIXIE trial (VitamIn and oXygen Interventions
and cardiovascular Events) is an investigator-initiated, blinded, 2 x 2
factorial multicentre clinical trial. We include 600 patients with
cardiovascular risk factors undergoing major non-cardiac surgery.
Participants are randomised to an inspiratory oxygen fraction of 0.80 or
0.30 during and for 2 hours after surgery and either an intravenous bolus
of vitamin C and an infusion of N-acetylcysteine or matching placebo of
both. The primary outcome is the area under the curve for high-sensitive
cardiac troponin release during the first three post-operative days as a
marker of the extent of myocardial injury. Secondary outcomes are
mortality, non-fatal myocardial infarction and non-fatal serious adverse
events within 30 days. <br/>Perspective(s): The current trial will provide
further evidence for clinicians on optimal administration of perioperative
oxygen in surgical patients with cardiovascular risks and the clinical
effects of two common antioxidants.<br/>Copyright &#xa9; 2019 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<15>
[Use Link to view the full text]
Accession Number
630375820
Title
Dexmedetomidine's Relationship to Delirium in Patients Undergoing Cardiac
Surgery: A Systematic Review.
Source
Critical Care Nursing Quarterly. 43 (1) (pp 28-38), 2020. Date of
Publication: 01 Jan 2020.
Author
Halpin E.; Inch H.; O'Neill M.
Institution
(Halpin, Inch, O'Neill) Surgical Critical Care Unit, University of
Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
This systematic review aims to determine the relationship between
postoperative delirium and the use of dexmedetomidine in comparison with
commonly used sedatives/analgesics in the postoperative cardiac surgery
patient. A systematic literature search of PubMed plus, CINAHL, Scopus,
and Ovid, and limited to the English language in the last 10 years, was
performed. Randomized controlled trials, observational and retrospective
studies, and meta-analyses with at least 1 delirium assessment tool were
included. The search found 196 potential articles; however, only 12 met
the criteria outlined. The systematic review revealed a decrease in
postoperative delirium for patients receiving dexmedetomidine in all
studies. Seven studies demonstrated statistically significant reductions
in postoperative delirium with dexmedetomidine compared with other
sedatives/analgesics. One study also revealed reduction of delirium with
dexmedetomidine as compared with normal saline. Two studies showed a
delayed time to delirium onset in patients receiving dexmedetomidine
versus propofol or morphine. The 2 meta-analyses found that all included
studies had a statistically significant reduction in postoperative
delirium when using dexmedetomidine. Postoperative use of dexmedetomidine
in cardiac surgery patients may reduce the incidence of postoperative
delirium.<br/>Copyright &#xa9; 2020 Wolters Kluwer Health, Inc. All rights
reserved.

<16>
Accession Number
2004365113
Title
Pericardial tamponade as a complication of invasive cardiac procedures: A
review of the literature.
Source
Postepy w Kardiologii Interwencyjnej. 15 (4) (pp 394-403), 2019. Date of
Publication: 2019.
Author
Adamczyk M.; Wasilewski J.; Niedziela J.; Rozentryt P.; Gasior M.
Institution
(Adamczyk, Wasilewski, Niedziela, Rozentryt, Gasior) 3rd Department of
Cardiology, Medical University of Silesia, Silesian Centre for Heart
Diseases, 9 Sklodowskiej St, Zabrze 41-800, Poland
Publisher
Termedia Publishing House Ltd. (Kleeberqa St.2, Poznan 61-615, Poland)
Abstract
Cardiac tamponade (CT) is a rare but often life-threatening complication
after invasive cardiac procedures. Some procedures favor CT. Furthermore,
the incidence depends on patients' comorbidities, sex and age and
operators' skills. In this paper we review studies and meta-analyses
concerning the rate of iatrogenic CT. We define the risk factors of CT and
show concise characteristics for each invasive cardiac procedure
separately. According to our analysis CT occurs especially after
procedures requiring transseptal puncture or perioperative
anticoagulation. The overall rate of CT after such procedures varies among
published studies from 0.089% to 4.8%. For this purpose we searched the
PubMed database for clinical studies published up to December 2018. We
included only those studies in which a defined minimum of procedures were
performed (1000 for atrial fibrillation ablation, 6000 for percutaneous
coronary intervention, 900 for permanent heart rhythm devices, 90 for left
atrial appendage closure, 300 for transcatheter aortic valve implantation
and percutaneous mitral valve repair with the Mitra-Clip system). The
search was structured around the key words and variants of these terms. In
addition, secondary source documents were identified by manual review of
reference lists, review articles and guidelines. The search was limited to
humans and adults (18+ years).<br/>Copyright &#xa9; 2019 Termedia
Publishing House Ltd.. All rights reserved.

<17>
Accession Number
2001493266
Title
Mycotic Coronary Aneurysms.
Source
Heart Lung and Circulation. 29 (1) (pp 128-136), 2020. Date of
Publication: January 2020.
Author
Baker D.W.; Whitehead N.J.; Barlow M.
Institution
(Baker, Whitehead, Barlow) John Hunter Hospital, Newcastle, NSW, Australia
Publisher
Elsevier Ltd
Abstract
Background: Mycotic coronary aneurysms (MCA) are rare but often lead to
significant morbidity and mortality. Evidence on the topic is limited to
case reports and small case series. A systematic review was performed to
improve understanding of this challenging diagnosis. A case report
prompting this review is also included. <br/>Method(s): Relevant articles
were identified by searching databases Medline and Google Scholar for
terms 'mycotic coronary aneurysm'. Manual searching from article
references identified further case reports. <br/>Result(s): Ninety-seven
(97) published cases of MCA were identified between 1812 and 2017; 80
cases since the introduction of percutaneous coronary intervention (PCI)
with stents in 1986. The most common associations were PCI (40.0%) and
infective endocarditis (IE) (40.0%). Complications including aneurysm
rupture (28.9%), pericardial effusion (37.3%) and myocardial infarction
(39.8%) were frequent. Short-term mortality was high at 42.6%. The most
common treatment was surgical resection of the aneurysm with bypass
grafting. <br/>Conclusion(s): We present a case and the largest systematic
review to date of this rare diagnosis, identifying 97 published case
reports. Clinical scenarios in which to consider MCA include febrile
illness after recent PCI, febrile illness (particularly infective
endocarditis) with evidence of coronary ischaemia, and purulent
pericarditis. Given the high rate of complications and mortality,
immediate surgical referral is recommended.<br/>Copyright &#xa9; 2018

<18>
Accession Number
2004284068
Title
Intensive LDL cholesterol-lowering treatment beyond current
recommendations for the prevention of major vascular events: a systematic
review and meta-analysis of randomised trials including 327 037
participants.
Source
The Lancet Diabetes and Endocrinology. 8 (1) (pp 36-49), 2020. Date of
Publication: January 2020.
Author
Wang N.; Fulcher J.; Abeysuriya N.; Park L.; Kumar S.; Di Tanna G.L.;
Wilcox I.; Keech A.; Rodgers A.; Lal S.
Institution
(Fulcher, Keech) NHMRC Clinical Trials Centre, University of Sydney,
Sydney, NSW, Australia
(Wang, Park, Wilcox, Keech, Lal) University of Sydney, Sydney, NSW,
Australia
(Wang, Fulcher, Wilcox, Keech, Lal) Department of Cardiology, Royal Prince
Alfred Hospital, Sydney, NSW, Australia
(Abeysuriya) Princess Alexandra Hospital, Brisbane, QLD, Australia
(Wang, Di Tanna, Rodgers) The George Institute, Sydney, NSW, Australia
(Kumar) Royal North Shore Hospital, Sydney, NSW, Australia
(Fulcher, Wilcox, Lal) Central Sydney Cardiology, Sydney, NSW, Australia
(Wang, Rodgers) University of New South Wales, Sydney, NSW, Australia
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The benefits of LDL cholesterol-lowering treatment for the
prevention of atherosclerotic cardiovascular disease are well established.
However, the extent to which these effects differ by baseline LDL
cholesterol, atherosclerotic cardiovascular disease risk, and the presence
of comorbidities remains uncertain. <br/>Method(s): We did a systematic
literature search (MEDLINE, Embase, and the Cochrane Central Register of
Controlled Trials, from inception up to June 15, 2019) for randomised
controlled trials of statins, ezetimibe, and proprotein convertase
subtilisin/kexin type 9 inhibitors with at least 1000 patient-years of
follow-up. Random-effects meta-analysis and meta-regressions were done to
assess for risk of major vascular events (a composite of cardiovascular
mortality, non-fatal myocardial infarction, non-fatal ischaemic stroke, or
coronary revascularisation) per 1 mmol/L (38.7 mg/dL) reduction in LDL
cholesterol concentrations. <br/>Finding(s): 327 037 patients from 52
studies were included in the meta-analysis. Each 1 mmol/L reduction in LDL
cholesterol was associated with a 19% relative risk (RR) reduction for
major vascular events (RR 0.81 [95% CI 0.78-0.84]; p<0.0001). Similar
reductions (per 1 mmol/L reduction in LDL cholesterol) were found in
trials with participants with LDL cholesterol 2.60 mmol/L or lower,
2.61-3.40 mmol/L, 3.41-4.10 mmol/L, and more than 4.1 mmol/L (p=0.232 for
interaction); and in a subgroup of patients who all had a baseline LDL
cholesterol less than 2.07 mmol/L (80 mg/dL; RR 0.83 [95% CI 0.75-0.92];
p=0.001). We found greater RR reductions in patients at lower 10-year
atherosclerotic cardiovascular disease risk (change in RR per 10% lower
10-year atherosclerotic cardiovascular disease 0.97 [95% CI 0.95-0.98];
p<0.0001) and in patients at younger age across a mean age of 50-75 years
(change in RR per 10 years younger age 0.92 [0.83-0.97]; p=0.015). We
found no difference in RR reduction for participants with or without
diabetes (p=0.878 for interaction) and chronic kidney disease (p=0.934 for
interaction). <br/>Interpretation(s): For each 1 mmol/L LDL cholesterol
lowering, the risk reduction of major vascular events is independent of
the starting LDL cholesterol or the presence of diabetes or chronic kidney
disease. Patients at lower cardiovascular risk and younger age might have
a similar relative reduction in risk with LDL-cholesterol lowering
therapies and future studies should investigate the potential benefits of
earlier intervention. <br/>Funding(s): None.<br/>Copyright &#xa9; 2020
Elsevier Ltd

<19>
Accession Number
2004258207
Title
Pharmacological interventions to reduce edema following cardiopulmonary
bypass: A systematic review and meta-analysis.
Source
Journal of Critical Care. 56 (pp 63-72), 2020. Date of Publication: April
2020.
Author
Dekker N.A.M.; van Leeuwen A.L.I.; van de Ven P.M.; de Vries R.; Hordijk
P.L.; Boer C.; van den Brom C.E.
Institution
(Dekker, van Leeuwen, Boer, van den Brom) Department of Anesthesiology,
Experimental Laboratory for VItal Signs, Amsterdam UMC, Vrije
Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
(Dekker, van Leeuwen, Hordijk, van den Brom) Department of Physiology,
Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences,
Amsterdam, Netherlands
(van de Ven) Department of Epidemiology and Biostatistics, Amsterdam UMC,
Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam,
Netherlands
(de Vries) Medical Library, Vrije Universiteit, Amsterdam, Netherlands
Publisher
W.B. Saunders
Abstract
Purpose: To compare the effectiveness of different types of
pharmacological agents to reduce organ specific edema following
cardiopulmonary bypass (CPB). <br/>Method(s): Pubmed, Embase.com and
Cochrane were searched for studies administrating a pharmacological agent
before CPB. Primary outcome was postoperative edema. <br/>Result(s):
Forty-four studies (clinical n = 6, preclinical n = 38) fulfilled
eligibility criteria. Steroids were used in most clinical studies (n = 5,
83%) and reduced postoperative edema in 4 studies, however heterogeneity
precluded meta-analysis. In preclinical studies, a total of 31 different
drugs were tested of which 20 (65%) reduced edema in at least one organ.
Particularly neutrophil inhibitors, and modulators of coagulation or
endothelial barrier reduced pulmonary edema (SMD -2.77 [-3.93, -1.61];
-1.29 [-2.12, -0.46], -2.33 [-4.69, 0.03], respectively) compared to no
treatment. Reducing renal (SMD -0.91 [CI -1.65 to -0.18]), intestinal (SMD
-1.98 [CI -3.92 to -0.04]) or myocardial (SMD -1.95 [CI -3.91 to -0.01])
edema following CPB required specific modulators of endothelial barrier.
<br/>Conclusion(s): Overall, neutrophil inhibitors and direct modulators
of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced
edema following CPB, in particular pulmonary edema. Future research should
focus on a combination of these strategies to reduce edema and assess the
effect on organ function and outcome following CPB.<br/>Copyright &#xa9;
2019 The Authors

<20>
Accession Number
2004165198
Title
Left Ventricular Rapid Pacing Via the Valve Delivery Guidewire in
Transcatheter Aortic Valve Replacement.
Source
JACC: Cardiovascular Interventions. 12 (24) (pp 2449-2459), 2019. Date of
Publication: 23 December 2019.
Author
Faurie B.; Souteyrand G.; Staat P.; Godin M.; Caussin C.; Van Belle E.;
Mangin L.; Meyer P.; Dumonteil N.; Abdellaoui M.; Monsegu J.;
Durand-Zaleski I.; Lefevre T.
Institution
(Faurie, Abdellaoui, Monsegu) Institut Cardiovasculaire, Groupe
Hospitalier Mutualiste de Grenoble, Grenoble, France
(Faurie, Staat, Abdellaoui, Monsegu) Cardiology Department, Medipole HP
Lyon-Villeurbane, Villeurbane, France
(Souteyrand) Cardiology Department, Centre Hospitalier Universitaire
Gabriel-Montpied, Clermont-Ferrand, France
(Godin) Cardiology Department, clinique Saint Hilaire, Rouen, France
(Caussin) Cardiology Department, Institut Mutualiste Montsouris, Paris,
France
(Van Belle) Departement de cardiologie, Institut Coeur Poumon, Centre
Hospitalier Universitaire de Lille, Lille, France
(Mangin) Cardiology Department, Centre Hospitalier Annecy Genevois,
Epagny, France
(Meyer) Cardiology Department, Institut Arnault Tzanck,
Saint-Laurent-du-Var, France
(Dumonteil) Cardiology Department, clinique Pasteur, Toulouse, France
(Durand-Zaleski) Cardiology Department, URC-Eco Ile de France, hopital de
l'Hotel Dieu, Assistance Publique-Hopitaux de Paris, Paris, France
(Lefevre) Institut Cardiovasculaire Paris Sud, Hopital Prive Jacques
Cartier, Massy, France
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study investigated whether left ventricular (LV)
stimulation via a guidewire-reduced procedure duration while maintaining
efficacy and safety compared with standard right ventricular (RV)
stimulation. <br/>Background(s): Rapid ventricular pacing is necessary to
ensure cardiac standstill during transcatheter aortic valve replacement
(TAVR). <br/>Method(s): This is a prospective, multicenter,
single-blinded, superiority, randomized controlled trial. Patients
undergoing transfemoral TAVR with a SAPIEN valve (Edwards Lifesciences,
Irvine, California) were allocated to LV or RV stimulation. The primary
endpoint was procedure duration. Secondary endpoints included efficacy,
safety, and cost at 30 days. <br/>Result(s): Between May 2017 and May
2018, 307 patients were randomized, but 4 were excluded because they did
not receive the intended treatment: 303 patients were analyzed in the LV
(n = 151) or RV (n = 152) stimulation groups. Mean procedure duration was
significantly shorter in the LV stimulation group (48.4 +/- 16.9 min vs.
55.6 +/- 26.9 min; p = 0.0013), with a difference of -0.12 (95% confidence
interval: -0.20 to -0.05) in the log-transformed procedure duration (p =
0.0012). Effective stimulation was similar in the LV and RV stimulation
groups: 124 (84.9%) versus 128 (87.1%) (p = 0.60). Safety of stimulation
was also similar in the LV and RV stimulation groups: procedural success
occurred in 151 (100%) versus 151 (99.3%) patients (p = 0.99); 30-day
MACE-TAVR (major adverse cardiovascular event-transcatheter aortic valve
replacement) occurred in 21 (13.9%) versus 26 (17.1%) patients (p = 0.44);
fluoroscopy time (min) was lower in the LV stimulation group (13.48 +/-
5.98 vs. 14.60 +/- 5.59; p = 0.02), as was cost (18,807 +/- 1,318 vs.
19,437 +/- 2,318; p = 0.001). <br/>Conclusion(s): Compared with RV
stimulation, LV stimulation during TAVR was associated with significantly
reduced procedure duration, fluoroscopy time, and cost, with similar
efficacy and safety. (Direct Left Ventricular Rapid Pacing Via the Valve
Delivery Guide-wire in TAVR [EASY TAVI]; NCT02781896)<br/>Copyright &#xa9;
2019 American College of Cardiology Foundation

<21>
Accession Number
2004379971
Title
"To endoscopize or not to endoscopize, that is the question" about vein
harvesting techniques for coronary surgery. A commentary on "mid-term and
long-term outcomes of endoscopic versus open vein harvesting for coronary
artery bypass: A systematic review and meta-analysis".
Source
International Journal of Surgery. 74 (pp 3-4), 2020. Date of Publication:
February 2020.
Author
Bonacchi M.
Institution
(Bonacchi) F.U. University Cardiac Surgery, Experimental and Clinical
Medicine Department, University of Florence, Firenze, Italy
Publisher
Elsevier Ltd

<22>
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. 45 (1) (pp 16-21), 2020. Date of
Publication: 01 Jan 2020.
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 significant
impact on the pain treatment during chest tube removal from patients who
had undergone VATS for lung cancer. Methods 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. Results 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 Analgesia
using lidocaine cream is a very simple way to reduce the pain of chest
tube removal after VATS. Trial registration number
UMIN000013824.<br/>Copyright &#xa9; American Society of Regional
Anesthesia & Pain Medicine 2020. No commercial re-use. See rights and
permissions. Published by BMJ.

<23>
Accession Number
629868988
Title
Comparison of ultrasound-guided erector spinae plane block and thoracic
paravertebral block for postoperative analgesia after video-assisted
thoracic surgery: a randomized controlled non-inferiority clinical trial.
Source
Regional Anesthesia and Pain Medicine. 45 (1) (pp 10-15), 2020. Date of
Publication: 01 Jan 2020.
Author
Taketa Y.; Irisawa Y.; Fujitani T.
Institution
(Taketa, Irisawa, Fujitani) Department of Anesthesiology and Critical
Care, Ehime Prefectural Central Hospital, Matsuyama 790-0024, Japan
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background and objectives The anesthetic characteristics of
ultrasound-guided erector spinae plane block (ESPB) remain unclear. We
compared the analgesic efficacies of ESPB and thoracic paravertebral block
(TPVB) for analgesia after video-assisted thoracic surgery (VATS). Method
In this prospective randomized non-inferiority trial, 88 patients
undergoing VATS randomly received ESPB or TPVB. All patients received
continuous infusion of 0.2% levobupivacaine (8 mL/hour) after injection of
a 20 mL 0.2% levobupivacaine bolus. The primary outcome was median
differences between the groups in postoperative numerical rating scale
(NRS) scores at rest, 24 hours postoperatively. Results Eighty-one
patients completed the study. The median difference in NRS scores at rest
24 hours postoperatively was 1 (range 0-1), demonstrating the
non-inferiority of ESPB to TPVB. NRS scores at rest were significantly
lower in the TPVB group at 1, 2 and 24 hours postoperatively (p=0.02, 0.01
and 0.006, respectively). NRS scores on movement were similar. More
dermatomes in parasternal regions were anaesthetized in the TPVB group
(p<0.0001). Total plasma levobupivacaine concentrations were significantly
lower in the ESPB group within 20 hours postoperatively (p=0.036).
Conclusions The analgesic effect of ESPB after VATS was non-inferior to
that of TPVB 24 hours postoperatively. Trial registration number
UMIN000030658.<br/>Copyright &#xa9; American Society of Regional
Anesthesia & Pain Medicine 2020. No commercial re-use. See rights and
permissions. Published by BMJ.

<24>
Accession Number
630091958
Title
Perioperative restrictive versus goal-directed fluid therapy for adults
undergoing major non-cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2019 (12) (no pagination), 2019.
Article Number: CD012767. Date of Publication: 12 Dec 2019.
Author
Wrzosek A.; Jakowicka-Wordliczek J.; Zajaczkowska R.; Serednicki W.T.;
Jankowski M.; Bala M.M.; Swierz M.J.; Polak M.; Wordliczek J.
Institution
(Wrzosek, Zajaczkowska, Serednicki, Wordliczek) Jagiellonian University
Medical College, Department of Interdisciplinary Intensive Care, Krakow,
Poland
(Wrzosek) University Hospital, Department of Anaethesiology and Intensive
Care, Krakow, Poland
(Jakowicka-Wordliczek, Jankowski) University Hospital, Department of
Anaesthesiology and Intensive Care, Krakow, Poland
(Jankowski) Jagiellonian University Medical College, Department of
Internal Medicine; Systematic Reviews Unit, Krakow, Poland
(Bala) Jagiellonian University Medical College, Chair of Epidemiology and
Preventive Medicine, Department of Hygiene and Dietetics; Systematic
Reviews Unit, Kopernika 7, Krakow 31-034, Poland
(Swierz) Jagiellonian University Medical College, Department of Hygiene
and Dietetics; Systematic Reviews Unit, Krakow, Poland
(Polak) Jagiellonian University Medical College, Department of
Epidemiology and Population Studies in the Institute of Public Health,
Krakow, Poland
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Perioperative fluid management is a crucial element of
perioperative care and has been studied extensively recently; however,
'the right amount' remains uncertain. One concept in perioperative fluid
handling is goal-directed fluid therapy (GDFT), wherein fluid
administration targets various continuously measured haemodynamic
variables with the aim of optimizing oxygen delivery. Another recently
raised concept is that perioperative restrictive fluid therapy (RFT) may
be beneficial and at least as effective as GDFT, with lower cost and less
resource utilization. <br/>Objective(s): To investigate whether RFT may be
more beneficial than GDFT for adults undergoing major non-cardiac surgery.
<br/>Search Method(s): We searched the following electronic databases on
11 October 2019: Cochrane Central Register of Controlled Trials, in the
Cochrane Libary; MEDLINE; and Embase. Additionally, we performed a
targeted search in Google Scholar and searched trial registries (World
Health Organization (WHO) International Clinical Trials Registry Platform
(ICTRP) and ClinicalTrials.gov) for ongoing and unpublished trials. We
scanned the reference lists and citations of included trials and any
relevant systematic reviews identified. <br/>Selection Criteria: We
included randomized controlled trials (RCTs) comparing perioperative RFT
versus GDFT for adults (aged = 18 years) undergoing major non-cardiac
surgery. <br/>Data Collection and Analysis: Two review authors
independently screened references for eligibility, extracted data, and
assessed risk of bias. We resolved discrepancies by discussion and
consulted a third review author if necessary. When necessary, we contacted
trial authors to request additional information. We presented pooled
estimates for dichotomous outcomes as risk ratios (RRs) with 95%
confidence intervals (CIs), and for continuous outcomes as mean
differences (MDs) with standard deviations (SDs). We used Review Manager 5
software to perform the meta-analyses. We used a fixed-effect model if we
considered heterogeneity as not important; otherwise, we used a
random-effects model. We used Poisson regression models to compare the
average number of complications per person. <br/>Main Result(s): From 6396
citations, we included six studies with a total of 562 participants. Five
studies were performed in participants undergoing abdominal surgery
(including one study in participants undergoing cytoreductive abdominal
surgery with hyperthermic intraperitoneal chemotherapy (HIPEC)), and one
study was performed in participants undergoing orthopaedic surgery. In all
studies, surgeries were elective. In five studies, crystalloids were used
for basal infusion and colloids for boluses, and in one study, colloid was
used for both basal infusion and boluses. Five studies reported the ASA
(American Society of Anesthesiologists) status of participants. Most
participants were ASA II (60.4%), 22.7% were ASA I, and only 16.9% were
ASA III. No study participants were ASA IV. For the GDFT group,
oesophageal doppler monitoring was used in three studies, uncalibrated
invasive arterial pressure analysis systems in two studies, and a
non-invasive arterial pressure monitoring system in one study. In all
studies, GDFT optimization was conducted only intraoperatively. Only one
study was at low risk of bias in all domains. The other five studies were
at unclear or high risk of bias in one to three domains. RFT may have no
effect on the rate of major complications compared to GDFT, but the
evidence is very uncertain (RR 1.61, 95% CI 0.78 to 3.34; 484
participants; 5 studies; very low-certainty evidence). RFT may increase
the risk of all-cause mortality compared to GDFT, but the evidence on this
is also very uncertain (RD 0.03, 95% CI 0.00 to 0.06; 544 participants; 6
studies; very low-certainty evidence). In a post-hoc analysis using a Peto
odds ratio (OR) or a Poisson regression model, the odds of all-cause
mortality were 4.81 times greater with the use of RFT compared to GDFT,
but the evidence again is very uncertain (Peto OR 4.81, 95% CI 1.38 to
16.84; 544 participants; 6 studies; very low-certainty evidence).
Nevertheless, sensitivity analysis shows that exclusion of a study in
which the final volume of fluid received intraoperatively was higher in
the RFT group than in the GDFT group revealed no differences in mortality.
Based on analysis of secondary outcomes, such as length of hospital stay
(464 participants; 5 studies; very low-certainty evidence),
surgery-related complications (364 participants; 4 studies; very
low-certainty evidence), non-surgery-related complications (74
participants; 1 study; very low-certainty evidence), renal failure (410
participants; 4 studies; very low-certainty evidence), and quality of
surgical recovery (74 participants; 1 study; very low-certainty evidence),
GDFT may have no effect on the risk of these outcomes compared to RFT, but
the evidence is very uncertain. Included studies provided no data on
administration of vasopressors or inotropes to correct haemodynamic
instability nor on cost of treatment. Authors' conclusions: Based on very
low-certainty evidence, we are uncertain whether RFT is inferior to GDFT
in selected populations of adults undergoing major non-cardiac surgery.
The evidence is based mainly on data from studies on abdominal surgery in
a low-risk population. The evidence does not address higher-risk
populations or other surgery types. Larger, higher-quality RCTs including
a wider spectrum of surgery types and a wider spectrum of patient groups,
including high-risk populations, are needed to determine effects of the
intervention.<br/>Copyright &#xa9; 2019 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<25>
Accession Number
630088723
Title
New warfarin anticoagulation management model after heart valve surgery:
Rationale and design of a prospective, multicentre, randomised trial to
compare an internet-based warfarin anticoagulation management model with
the traditional warfarin management model.
Source
BMJ Open. 9 (12) (no pagination), 2019. Article Number: e032949. Date of
Publication: 05 Dec 2019.
Author
Zhu Z.; Meng X.; Han J.; Li Y.; Liu K.; Shen J.; Qin Y.; Zhang H.
Institution
(Zhu, Li, Meng, Han, Li, Liu, Shen, Qin, Zhang) Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Warfarin is an effective anticoagulant and the only oral
anticoagulant available for patients with mechanical heart valves. The
prothrombin time and the associated international normalised ratio (INR)
are routinely tested to monitor the response to anticoagulation therapy in
patients. Patients who undergo mechanical heart valve replacement need
lifelong anticoagulation therapy, and their INR is regularly measured to
adjust the anticoagulation strength and the dose of anticoagulation drugs.
Appropriate warfarin anticoagulation management can reduce patient
complications, such as bleeding and thrombosis, and improve the long-term
survival rate. We propose modern internet technology as a platform to
build a warfarin anticoagulation follow-up system after valve replacement
surgery. This system will provide doctors and patients with more
standardised and safer follow-up methods as well as a method to further
reduce the risk of warfarin anticoagulation-related complications and
improve its therapeutic effects. Methods and analysis A prospective,
multicentre, randomised, controlled trial will be conducted. A total of
700 patients who require long-term warfarin anticoagulation monitoring
after heart valve replacement will be enrolled and randomly divided at a
1:1 ratio into a traditional outpatient anticoagulation management group
and a group undergoing a new method of management based on the internet
technology with follow-up for 1 year. Differences in the percentage of
time in the therapeutic range (TTR), drug dose adjustments,
bleeding/thrombosis and other related complications will be observed. The
primary endpoint is the difference in the TTR between the two groups. The
purpose of this study is to explore a safer and more effective mode of
doctor-patient interaction and communication in the internet era. As of 13
July 2019, 534 patients had been enrolled. Ethics and dissemination This
study protocol was approved by the Ethics Committee of Beijing Anzhen
Hospital, Capital Medical University. The results will be published in a
peer-reviewed medical journal. Trial registration number
ChiCTR1800016204.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<26>
Accession Number
2003655458
Title
Efficacy and safety of PCSK9 monoclonal antibodies.
Source
Expert Opinion on Drug Safety. 18 (12) (pp 1191-1201), 2019. Date of
Publication: 02 Dec 2019.
Author
Iqbal Z.; Dhage S.; Mohamad J.B.; Abdel-Razik A.; Donn R.; Malik R.; Ho
J.H.; Liu Y.; Adam S.; Isa B.; Stefanutti C.; Soran H.
Institution
(Iqbal, Dhage, Abdel-Razik, Ho, Adam, Soran) Cardiovascular Trials Unit,
The Old St Mary's Hospital, Central Manchester University Hospitals,
Manchester, United Kingdom
(Mohamad) College of Medicine, University of Duhok, Dahuk, Iraq
(Donn, Liu) Cardiovascular Research Group, School of Medical Sciences,
University of Manchester, Manchester, United Kingdom
(Malik) Department of Medicine, Weill Cornell Medical College, Doha, Qatar
(Isa) Department of Endocrinology and Diabetes, Wythenshawe Hospital,
Manchester, United Kingdom
(Stefanutti) Department of Molecular Medicine, Sapienza' University of
Rome, Rome, Italy
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Proprotein convertase subtilisin/kexin type 9 (PCSK9)
inhibitors are novel drugs that have been developed since the discovery of
the PCSK9 protein in 2003. In addition to background statin treatment,
they reduce low-density lipoprotein cholesterol (LDL-C) to unprecedented
levels and have shown encouraging results in improving cardiovascular
events. Concerns regarding the safety of PCSK9 inhibitors and very low
LDL-C have somewhat been allayed after several longer-term prospective
studies. Areas covered: A comprehensive literature search was carried out
including article searches in electronic databases (EMBASE, PUBMED, OVID)
and reference lists of relevant articles. This review examines novel
research concerning PCSK9 monoclonal antibodies and cardiovascular
outcomes with a special focus on their safety and tolerability. The safety
of very low LDL-C concentrations and the link between LDL-C lowering and
diabetes is also discussed. Expert opinion: PCSK9 monoclonal antibodies
when added to background statin therapy, lowers LDL-C to previously
unattainable levels. This is safe with little undesirable effects and
impacts positively on cardiovascular disease. Current guidance limits
their use to primary prevention. Cost effectiveness should be taken into
consideration before allowing a wider use of this new class of cholesterol
lowering therapy and more data on their long-term safety is
welcome.<br/>Copyright &#xa9; 2019, &#xa9; 2019 Informa UK Limited,
trading as Taylor & Francis Group.

<27>
Accession Number
2003353364
Title
Near-infrared spectroscopy monitoring in cardiac and noncardiac surgery:
Pairwise and network meta-analyses.
Source
Journal of Clinical Medicine. 8 (12) (no pagination), 2019. Article
Number: 2208. Date of Publication: December 2019.
Author
Ortega-Loubon C.; Herrera-Gomez F.; Bernuy-Guevara C.; Jorge-Monjas P.;
Ochoa-Sangrador C.; Bustamante-Munguira J.; Tamayo E.; Alvarez F.J.
Institution
(Ortega-Loubon, Bustamante-Munguira) Department of Cardiac Surgery,
University Clinical Hospital of Valladolid, Ramon y Cajal Ave. 3,
Valladolid 47003, Spain
(Ortega-Loubon, Herrera-Gomez, Jorge-Monjas, Tamayo, Alvarez) BioCritic.
Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal
Ave. 7, Valladolid 47005, Spain
(Herrera-Gomez, Bernuy-Guevara, Alvarez) Pharmacological Big Data
Laboratory, Department of Pharmacology and Therapeutics, University of
Valladolid, Ramon y Cajal Ave. 7, Valladolid 47005, Spain
(Herrera-Gomez) Department of Anatomy and Radiology, Faculty of Medicine,
University of Valladolid, Ramon y Cajal Ave. 7, Valladolid 47005, Spain
(Jorge-Monjas, Tamayo) Department of Anaesthesiology, University Clinical
Hospital of Valladolid, Ramon y Cajal Ave. 3, Valladolid 47003, Spain
(Jorge-Monjas, Tamayo) Department of Surgery, Faculty of Medicine,
University of Valladolid, Ramon y Cajal Ave. 7, Valladolid 47005, Spain
(Ochoa-Sangrador) Clinical Epidemiology Support Office, Sanidad Castilla y
Leon, Requejo Ave. 35, Zamora 49022, Spain
(Alvarez) Ethics Committee of Drug Research-East Valladolid, University
Clinical Hospital of Valladolid, Ramon y Cajal Ave. 3, Valladolid 47003,
Spain
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Goal-directed therapy based on brain-oxygen saturation (bSo<inf>2</inf>)
is controversial and hotly debated. While meta-analyses of aggregated data
have shown no clinical benefit for brain near-infrared spectroscopy
(NIRS)-based interventions after cardiac surgery, no network meta-analyses
involving both major cardiac and noncardiac procedures have yet been
undertaken. Randomized controlled trials involving NIRS monitoring in both
major cardiac and noncardiac surgery were included. Aggregate-level data
summary estimates of critical outcomes (postoperative cognitive decline
(POCD)/postoperative delirium (POD), acute kidney injury, cardiovascular
events, bleeding/need for transfusion, and postoperative mortality) were
obtained. NIRS was only associated with protection against POCD/POD in
cardiac surgery patients (pooled odds ratio (OR)/95% confidence interval
(CI)/I²/number of studies (n): 0.34/0.14-0.85/75%/7), although
a favorable effect was observed in the analysis, including both cardiac
and noncardiac procedures. However, the benefit of the use of NIRS
monitoring was undetectable in Bayesian network meta-analysis, although
maintaining bSo<inf>2</inf> > 80% of the baseline appeared to have the
most pronounced impact. Evidence was imprecise regarding acute kidney
injury, cardiovascular events, bleeding/need for transfusion, and
postoperative mortality. There is evidence that brain NIRS-based
algorithms are effective in preventing POCD/POD in cardiac surgery, but
not in major noncardiac surgery. However, the specific target
bSo<inf>2</inf> threshold has yet to be determined.<br/>Copyright &#xa9;
2019 by the authors. Licensee MDPI, Basel, Switzerland.

<28>
Accession Number
630284346
Title
Relationship between acute hypercarbia and hyperkalaemia during surgery.
Source
World Journal of Clinical Cases. 7 (22) (pp 3711-3717), 2019. Date of
Publication: 2019.
Author
Weinberg L.; Russell A.; Mackley L.; Dunnachie C.; Meyerov J.; Tan C.; Li
M.; Hu R.; Karalapillai D.
Institution
(Weinberg, Dunnachie, Tan, Li, Hu) Department of Anaesthesia, Austin
Health, Melbourne, VLC 3084, Australia
(Russell, Mackley, Karalapillai) Department of Intensive Care, Austin
Health, Melbourne, VIC 3084, Australia
(Meyerov) Melbourne Medical School, University of Melbourne, Melbourne,
VIC 3010, Australia
Publisher
Baishideng Publishing Group Co (7901 Stoneridge Drive, Suite 501,
Pleasanton, California 94588, United States. E-mail: bpg@baishideng.com)
Abstract
BACKGROUND The relationship between hyperkalaemia and metabolic acidosis
is well described in the critical care setting; however, the relationship
between acute respiratory acidosis and plasma potassium concentration is
less well understood. In a controlled model of increasing levels of
hypercarbia, we tested the hypothesis of whether increasing levels of
hypercarbia are associated with changes in plasma potassium
concentrations. AIM To determine whether increasing levels of hypercarbia
are associated with changes in plasma potassium concentrations. METHODS We
performed a post-hoc study examining changes in serum potassium in 24
patients who received increased levels of hypercarbia during cardiac
surgery. Arterial blood gases and plasma concentrations of potassium were
measured at baseline, 3 min prior to, and then every 3 min for 15 min
during the intervention of hypercarbia. The primary endpoint was the
absolute change in serum K+ at 15 min compared to the baseline K+ value.
The following secondary endpoints were evaluated: (1) The association
between CO<inf>2</inf> and serum K+ concentration; and (2) The correlation
between plasma pH and serum K+ concentrations. RESULTS During the
intervention, PaCO<inf>2</inf> increased from 43.6 mmHg (95%CI: 40.1 to
47.1) at pre-intervention to 83.9 mmHg (95%CI: 78.0 to 89.8) at 15 min
after intervention; P < 0.0001. The mean (SD) serum potassium increased
from 4.16 (0.35) mmol/L at baseline to 4.28 (0.33) mmol/L at 15 min
(effect size 0.09 mol/L; P = 0.22). There was no significant correlation
between PaCO<inf>2</inf> and potassium (Pearson's coefficient 0.06; 95%CI:
-0.09 to 0.21) or between pH and potassium (Pearson's coefficient -0.07;
95%CI: -0.22 to 0.09). CONCLUSION Acute hypercarbia and subsequent
respiratory acidaemia were not associated with hyperkalaemia in patients
undergoing major surgery.<br/>Copyright &#xa9; The Author(s) 2019.

<29>
Accession Number
630276908
Title
Efficacy and safety of subcutaneous fellow's stitch using "fisherman's
knot" technique to achieve large caliber (> 10 french) venous hemostasis.
Source
Cardiology Research. 10 (5) (pp 303-308), 2019. Date of Publication: 01
Oct 2019.
Author
Kumar P.; Aggarwaal P.; Sinha S.K.; Pandey U.; Razi M.; Sharma A.K.;
Thakur R.; Varma C.M.; Krishna V.
Institution
(Kumar) Department of Cardiology, Rajendra Institute of Medical Science,
Ranchi, Jharkhand, India
(Aggarwaal, Sinha, Pandey, Razi, Sharma, Thakur, Varma, Krishna)
Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical
College, Kanpur, Uttar Pradesh 208002, India
Publisher
Elmer Press (E-mail: production@elmerpress.com)
Abstract
Background: Among patients undergoing intervention involving venous
access, various techniques have been implemented to achieve hemostasis in
order to reduce local access site complications, to decrease length of
stay and to facilitate early ambulation. We aimed to assess the efficacy
and safety of fellow's stitch using "fisherman's knot" (figure of Z (FoZ)
technique when compared with conventional manual compression for immediate
closure of large venous sheath (> 10 French (Fr). <br/>Method(s): Between
November 2012 and March 2019, 949 patients underwent various interventions
which involved venous access requiring hemostasis. All the patients were
anticoagulated with heparin during the procedure. In a sequential
allocation, fellow's stitch using "fisherman's knot" (group I: n = 384)
and conventional manual compression (group II: n = 365) were used in
achieving hemostasis at right/left femoral venous access site following
sheath removal (> 12 Fr). A 0-Vicryl suture was used to make one deep
stitch just distal to entry of sheath and one superficial stitch just
proximal to entry site, thereby creating an FoZ. A fisherman's knot was
then tied, and knot was pushed down while sheath was removed. In cases
where immediate hemostasis was not achieved, it was compressed for 2 min
to achieve it. <br/>Result(s): The mean age of 949 patients was 13.1 +/-
8.2 years where male (n = 574; 65%) outnumbered female (n = 375; 35%). In
group I, hemostasis was achieved immediately after tying the knot in 343
(89.3%) patients, while within <= 2 min of light pressure in 41 (10.7%)
patients. Five (1.3%) patients had failure of stitch as suture snapped
during knotting, and hemostasis was achieved by manual compression as per
protocol in group I. The median time to hemostasis (1.1 vs. 14.3 min, P <
0.001), ambulation (3.3 vs. 18.9 h, P < 0.01) and hospital stay (24.6 vs.
36.8 h, P < 0.001) was significantly shorter in group I compared to group
II. The minor vascular access site complications in form of hematoma (n =
6 (1.6%) vs. n = 1 (0.2%); P < 0.001), and thrombosis at femoral vein (n =
4 (1.1%) vs. n = 0 (0%); P < 0.001) were significantly higher in group II
when compared to group I. The differences regarding re-bleeding and
formation of arterio-venous fistula between both the groups were
statistically insignificant. <br/>Conclusion(s): The fellow's stitch using
"fisherman's knot" or "FoZ" suture is a simple, efficacious and safe
technique to achieve an immediate hemostasis after removal of larger
venous sheath (> 10 Fr).<br/>Copyright &#xa9; The authors.

<30>
Accession Number
630236741
Title
The RADial artery International ALliance (RADIAL) extended follow-up
study: Rationale and study protocol.
Source
European Journal of Cardio-thoracic Surgery. 56 (6) (pp 1025-1030), 2019.
Date of Publication: 01 Dec 2019.
Author
Gaudino M.; Benedetto U.; Fremes S.; Ballman K.; Biondi-Zoccai G.;
Sedrakyan A.; Nasso G.; Raman J.; Buxton B.; Hayward P.A.; Moat N.;
Collins P.; Webb C.; Peric M.; Petrovic I.; Yoo K.J.; Hameed I.; Di Franco
A.; Moscarelli M.; Speziale G.; Girardi L.N.; Hare D.L.; Taggart D.P.
Institution
(Gaudino, Hameed, Di Franco, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, United
States
(Benedetto) Department of Cardiac Surgery, Bristol Heart Institute,
Bristol, United Kingdom
(Fremes) Department of Surgery, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, Canada
(Ballman, Sedrakyan) Department of Healthcare Policy and Research, Weill
Cornell Medicine, New York, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Naples, Italy
(Nasso, Moscarelli, Speziale) Anthea Hospital, Bari, Italy
(Raman, Hare) Austin Hospital, Melbourne, VIC, Australia
(Buxton, Hayward, Hare) Department of Surgery, University of Melbourne,
Melbourne, VIC, Australia
(Moat, Collins, Webb) NHLI, Imperial College London, Royal Brompton and
Harefield NHS Foundation Trust, London, United Kingdom
(Peric, Petrovic) Dedinje Cardiovascular Institute, Belgrade University
School of Medicine, Belgrade, Serbia
(Yoo) Yonsei University College of Medicine, Seoul, South Korea
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
Oxford, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
It is generally accepted that radial artery (RA) grafts have better
mid-term patency rate compared to saphenous vein grafts. However, the
clinical correlates of the improved patency rate are still debated.
Observational studies have suggested increased survival and event-free
survival for patients who receive an RA rather than a saphenous vein, but
they are open to bias and confounders. The only evidence based on
randomized data is a pooled meta-analysis of 6 randomized controlled trial
comparing the RA and the saphenous vein published by the RADial artery
International Alliance (RADIAL). In the RADIAL database, improved freedom
from follow-up cardiac events (death, myocardial infarction and repeat
revascularization) was found at 5-year follow-up in the RA arm. The most
important limitation of the RADIAL analysis is that most of the included
trials had an angiographic follow-up in the first 5 years and it is
unclear whether the rate of repeat revascularization (the main driver of
the composite outcome) was clinically indicated due to per-protocol
angiographies. Here, we present the protocol for the long-term analysis of
the RADIAL database. By extending the follow-up beyond the 5th
postoperative year (all trials except 1 did not have angiographic
follow-up beyond 5 years), we aim to provide data on the role of RA in
coronary artery bypass surgery with respect to long-term
outcomes.<br/>Copyright &#xa9; 2019 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<31>
Accession Number
2002985927
Title
Transcatheter aortic valve replacement for bicuspid aortic valve stenosis
with first- and new-generation bioprostheses: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 298 (pp 76-82), 2020. Date of
Publication: 1 January 2020.
Author
Ueshima D.; Fovino L.N.; Brener S.J.; Fabris T.; Scotti A.; Barioli A.;
Giacoppo D.; Pavei A.; Fraccaro C.; Napodano M.; Tarantini G.
Institution
(Ueshima, Fovino, Fabris, Scotti, Barioli, Giacoppo, Pavei, Fraccaro,
Napodano, Tarantini) Department of Cardiac, Thoracic, Vascular Sciences
and Public Health, University of Padua Medical School, Padua, Italy
(Brener) Department of Medicine, Cardiac Catheterization Laboratory, New
York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United
States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Subjects with bicuspid aortic valve (BAV) have been excluded
from transcatheter aortic valve replacement (TAVR) randomized trials.
<br/>Method(s): With this meta-analysis of observational studies we first
compared TAVR outcomes of BAV vs. tricuspid aortic valve (TAV) patients,
stratifying the results by device generation. Then, we looked for
differences between balloon-expandable (BE) and self-expandable (SE)
bioprostheses in BAV patients. Primary outcome was 30-day mortality.
Secondary outcomes were 30-day stroke, moderate-severe paravalvular
leakage, new pacemaker implantation, vascular complications and 1-year
mortality. <br/>Result(s): Thirteen studies (11,032 patients, 7291 TAV and
3741 BAV) and seven studies (706 patients, 367 treated with BE, 339 with
SE valve) met inclusion criteria. Thirty-day (OR = 1.13; 95% CI 0.88-1.46,
p = 0.33) and 1-year mortality (OR = 1.02; 95% CI 0.77-1.37, p = 0.87)
were similar between patients receiving TAVR for BAV or TAV. Subjects
treated for BAV were at higher risk of conversion to conventional surgery
(OR = 2.35; 95% CI 1.30-4.23, p = 0.005), implantation of a second valve
(OR = 2.06; 95% CI 1.31-3.25; p = 0.002), moderate/severe paravalvular
leakage (PVL) (OR = 1.67; 95% CI 1.29-2.17; p = 0.0001) and device failure
(OR = 1.26; 95% CI 1.02-1.56; p = 0.04). Rates of adverse events decreased
significantly with the use of new-generation devices, but outcome
differences remained consistent. BAV patients treated with BE vs. SE
valves had similar 30-day and 1-year mortality, stroke and moderate-severe
PVL. Balloon-expandable valves were associated with lower rates of a
second valve and new pacemaker implantation but carried higher risk of
annular rupture. <br/>Conclusion(s): BAV patients treated with TAVR had
similar 30-day and 1-year mortality as well as stroke and new pacemaker
implantation rates compared to TAV subjects, but carried higher risk of
moderate/severe PVL, conversion to surgery and device failure. Event rates
significantly decreased with the use of new-generation devices, but TAVR
still showed better procedural results in TAV compared to
BAV.<br/>Copyright &#xa9; 2019

<32>
Accession Number
2004416017
Title
An Invited Commentary on "Does saphenous vein graft failure even matter?
Commentary on: Mid-term and long-term outcomes of endoscopic versus open
vein harvesting for coronary artery bypass: A systematic review and
meta-analysis" (Int J Surg 2019;72:167-173).
Source
International Journal of Surgery. 74 (pp 25-26), 2020. Date of
Publication: February 2020.
Author
Naik A.; Hameed I.; Gaudino M.
Institution
(Naik, Hameed, Gaudino) Department of Cardiothoracic Surgery, Weill
Cornell Medicine, New York, NY, United States
Publisher
Elsevier Ltd

<33>
Accession Number
2004268545
Title
Rationale and design of the STeroids to REduce Systemic inflammation after
infant heart Surgery (STRESS) trial.
Source
American Heart Journal. 220 (pp 192-202), 2020. Date of Publication:
February 2020.
Author
Hill K.D.; Baldwin H.S.; Bichel D.P.; Butts R.J.; Chamberlain R.C.; Ellis
A.M.; Graham E.M.; Hickerson J.; Hornik C.P.; Jacobs J.P.; Jacobs M.L.;
Jaquiss R.D.; Kannankeril P.J.; O'Brien S.M.; Torok R.; Turek J.W.; Li
J.S.
Institution
(Hill, Chamberlain, Hornik, Torok, Turek, Li) Duke University Pediatric
and Congenital Heart Center, Durham, NC, United States
(Hill, Ellis, Hickerson, Hornik, O'Brien, Li) Duke Clinical Research
Institute, Durham, NC, United States
(Baldwin, Bichel, Kannankeril) Vanderbilt University Medical Center,
Nashville, TN, United States
(Butts, Jaquiss) University of Texas Southwestern, Dallas, TX, United
States
(Graham) Medical University of South Carolina, Charleston, SC, United
States
(Jacobs, Jacobs) Johns Hopkins University School of Medicine, Baltimore,
MD, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
For decades, physicians have administered corticosteroids in the
perioperative period to infants undergoing heart surgery with
cardiopulmonary bypass (CPB) to reduce the postoperative systemic
inflammatory response to CPB. Some question this practice because steroid
efficacy has not been conclusively demonstrated and because some studies
indicate that steroids could have harmful effects. STRESS is a randomized,
placebo-controlled, double-blind, multicenter trial designed to evaluate
safety and efficacy of perioperative steroids in infants (age < 1 year)
undergoing heart surgery with CPB. Participants (planned enrollment =
1,200) are randomized 1:1 to methylprednisolone (30 mg/kg) administered
into the CPB pump prime versus placebo. The trial is nested within the
existing infrastructure of the Society of Thoracic Surgeons Congenital
Heart Surgery Database. The primary outcome is a global rank score of
mortality, major morbidities, and hospital length of stay with components
ranked commensurate with their clinical severity. Secondary outcomes
include several measures of major postoperative morbidity, postoperative
hospital length of stay, and steroid-related safety outcomes including
prevalence of hyperglycemia and postoperative infectious complications.
STRESS will be one of the largest trials ever conducted in children with
heart disease and will answer a decades-old question related to safety and
efficacy of perioperative steroids in infants undergoing heart surgery
with CPB. The pragmatic "trial within a registry" design may provide a
mechanism for conducting low-cost, high-efficiency trials in a
heretofore-understudied patient population.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<34>
Accession Number
2003447321
Title
Effect of two different colloid priming strategies in infants weighing
less than 5 kg undergoing on-pump cardiac surgeries.
Source
Artificial Organs. 44 (1) (pp 58-66), 2020. Date of Publication: 01 Jan
2020.
Author
Zhou C.; Tong Y.; Feng Z.; Cui Y.; Zhao M.; Hu J.; Liu K.; Zhao J.; Liu J.
Institution
(Zhou, Tong, Feng, Cui, Zhao, Hu, Liu, Zhao, Liu) State Key Laboratory of
Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Our aim was to explore the effect of two different priming strategies
(artificial colloid only vs. artificial colloid combined with human serum
albumin) on the prognosis of children weighing less than 5 kg undergoing
on-pump congenital heart disease (CHD) surgery. A total of 65 children
weighing less than 5 kg who underwent on-pump CHD surgery in our hospital
from September 2016 to December 2017 were enrolled in this study. The
children were randomly divided into two groups: artificial colloid priming
group (AC group, n = 33) and artificial colloid combined albumin priming
group (ACA group, n = 32). The primary clinical endpoint was the peri-CPB
colloid osmotic pressure (COP). Secondary clinical endpoints included
perioperative blood product and hemostatic drug consumption, postoperative
renal function, coagulation function, postoperative renal function, and
postoperative recovery parameters. COP values were not significant in the
priming system as well as peri-CPB time points between the two groups (P
>.05). Platelet consumption in the AC group was significantly lower than
that in the ACA group (P <.05). There were no significant differences in
the use of other blood products and hemostatic drugs as well as
perioperative coagulation parameters between the two groups (P >.05).
Postoperative length of stay in the AC group was significantly lower than
that in the ACA group (P <.05). There were no significant differences in
mortality, postoperative mechanical ventilation time, ICU time, and
perioperative adverse events (including postoperative AKI) occurrences
between the two groups (P >.05). In the on-pump cardiac surgeries of
patients weighing less than 5 kg, total colloidal priming would not affect
peri-CPB COP values, postoperative coagulation function, and blood
products consumption. Total artificial colloidal priming strategy is
feasible in low-weight patients.<br/>Copyright &#xa9; 2019 International
Center for Artificial Organs and Transplantation and Wiley Periodicals,
Inc.

<35>
Accession Number
2001492497
Title
Off- vs. On-Pump Coronary Artery Bypass Grafting Long-Term Survival is
Driven by Incompleteness of Revascularisation.
Source
Heart Lung and Circulation. 29 (1) (pp 149-155), 2020. Date of
Publication: January 2020.
Author
Thakur U.; Nerlekar N.; Muthalaly R.G.; Comella A.; Wong N.C.; Cameron
J.D.; Harper R.W.; Smith J.A.; Brown A.J.
Institution
(Thakur, Nerlekar, Muthalaly, Comella, Wong, Cameron, Harper, Smith,
Brown) Monash Cardiovascular Research Centre, Monash University and
MonashHeart, Monash Health, Melbourne, Vic, Australia
(Thakur, Muthalaly, Comella, Wong, Harper, Smith) Department of Surgery
(School of Clinical Sciences at Monash Health], Monash University,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: Off-pump coronary artery bypass grafting (CABG) negates the
requirement for extracorporeal circulation used with the traditional
on-pump approach. However, off-pump CABG is technically more challenging
and may theoretically lead to less complete revascularisation. Recent data
suggests a prognostic benefit for traditional on-pump CABG, but the
mechanism for this remains unclear. We hypothesised that the inferior
outcomes with off-pump CABG could be driven by the need for repeat
revascularisation, with this benefit only becoming clear at long-term
follow-up. We therefore evaluated short, medium and long-term outcomes of
patients undergoing revascularisation with on vs. off-pump CABG.
<br/>Method(s): Electronic databases were searched to identify suitable
randomised controlled trials enrolling >=100 patients in each arm.
Clinical outcomes were extracted at 30-days, 12-months or >4 years. The
primary outcome was long-term all-cause death, while secondary outcomes
included 30-day, 12-month and >4-year cardiac death, stroke, myocardial
infarction or revascularisation. <br/>Result(s): Thirteen (13) studies
comprising 13,234 patients were included. Off-pump CABG was associated
with an increased risk of all-cause death (Odds Ratio [OR] 1.18, 95%
confidence interval [CI] 1.02-1.32, p = 0.01) and repeat bypass surgery
(OR 2.57, 95%CI 1.23-5.39, p = 0.01) at long-term follow-up. A
significant, increased requirement for revascularisation in off-pump was
seen at 12-month follow-up (OR 1.59, 95%CI 1.09-2.33, p = 0.02). No
differences were noted between groups at 30-days, 12-months and >4 years
for myocardial infarction or stroke. <br/>Conclusion(s): Off-pump CABG is
associated with significantly higher rates of all-cause mortality rate at
long-term follow-up. These outcomes demonstrate a temporal relationship
that may be driven by a greater requirement for repeat revascularisation
at 1- and 5-year follow-up. Study registration: CRD42018102019
(PROSPERO).<br/>Copyright &#xa9; 2018 Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<36>
Accession Number
630243693
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement for severe aortic stenosis in people with low surgical risk.
Source
Cochrane Database of Systematic Reviews. 2019 (12) (no pagination), 2019.
Article Number: CD013319. Date of Publication: 20 Dec 2019.
Author
Kolkailah A.A.; Doukky R.; Pelletier M.P.; Volgman A.S.; Kaneko T.; Nabhan
A.F.
Institution
(Kolkailah) Cook County Health, Department of Medicine, Chicago, IL,
United States
(Doukky) Cook County Health, Division of Cardiology, Chicago, IL, United
States
(Pelletier) University Hospitals, Case Western Reserve University,
Division of Cardiac Surgery, Cleveland, OH, United States
(Volgman) Rush University Medical Center, Division of Cardiology, Chicago,
IL, United States
(Kaneko) Brigham and Women's Hospital, Harvard Medical School, Division of
Cardiac Surgery, Boston, MA, United States
(Nabhan) Ain Shams University, Department of Obstetrics and Gynaecology,
Faculty of Medicine, 16 Ali Fahmi Kamel Street, Heliopolis, Cairo 11351,
Egypt
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Severe aortic valve stenosis (AS) is a major cause of
morbidity and mortality worldwide. The definitive management for severe AS
is aortic valve replacement (AVR). The choice of transcatheter approach
versus open-heart surgery for AVR in people with severe AS and low
surgical risk remains a matter of debate. <br/>Objective(s): To assess the
benefits and harms of transcatheter aortic valve implantation (TAVI)
compared to surgical aortic valve replacement (SAVR) in people with severe
AS and low surgical risk. <br/>Search Method(s): We searched the following
databases for randomised controlled trials (RCTs) on 29 April 2019:
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase,
and Web of Science Core Collection. We also searched ClinicalTrials.gov
and the World Health Organization International Clinical Trials Registry
Platform. We searched all databases from inception to present and imposed
no restriction on language or date of publication. <br/>Selection
Criteria: We included RCTs that compared TAVI and SAVR in adults (18 years
of age or older) with severe AS and low surgical risk. <br/>Data
Collection and Analysis: We used the standard methodological procedures
expected by Cochrane. Two authors independently screened titles and
abstracts for inclusion, performed data extraction, and assessed risk of
bias in the studies included. We analysed dichotomous data using the risk
ratio (RR) and continuous data using the mean difference (MD), with
respective 95% confidence intervals (CI). We assessed the certainty of
evidence for each outcome using the GRADE approach. Our outcomes of
interest were assessed in the short term (i.e. during hospitalisation and
up to 30 days of follow-up). Primary outcomes were all-cause mortality,
stroke, and rehospitalisation. Secondary outcomes were myocardial
infarction (MI), cardiac death, length of hospital stay (LOS), permanent
pacemaker (PPM) implantation, new-onset atrial fibrillation, acute kidney
injury (AKI), and any bleeding. <br/>Main Result(s): We identified four
studies (13 reports), with 2818 participants, and one ongoing study.
Overall certainty of evidence ranged from high to very low. There is
probably little or no difference between TAVI and SAVR for the following
short-term outcomes: all-cause mortality (RR 0.69, 95% CI 0.33 to 1.44;
SAVR 11 deaths per 1000, TAVI 8 deaths per 1000 (95% CI 4 to 16); 2818
participants; 4 studies; moderate-certainty evidence); stroke (RR 0.73,
95% CI 0.42 to 1.25; SAVR 21 strokes per 1000, TAVI 16 strokes per 1000
(95% CI 9 to 27); 2818 participants; 4 studies; moderate-certainty
evidence); MI (RR 0.82, 95% CI 0.42 to 1.58; SAVR 14 MI per 1000, TAVI 11
MI per 1000 (95% CI 6 to 21); 2748 participants; 3 studies;
moderate-certainty evidence); and cardiac death (RR 0.71, 95% CI 0.32 to
1.56; SAVR 10 cardiac deaths per 1000, TAVI 7 cardiac deaths per 1000 (95%
CI 3 to 16); 2818 participants; 4 studies; moderate-certainty evidence).
TAVI may reduce the risk of short-term rehospitalisation, although the
confidence interval also includes the possibility of no difference in risk
between groups (RR 0.64, 95% CI 0.39 to 1.06; SAVR 30 cases per 1000, TAVI
19 cases per 1000 (95% CI 12 to 32); 2468 participants; 2 studies;
low-certainty evidence). TAVI, compared with SAVR, probably increases the
risk of PPM implantation (RR 3.65, 95% CI 1.50 to 8.87; SAVR 47 per 1000,
TAVI 170 cases per 1000 (95% CI 70 to 413); number needed to treat for an
additional harmful outcome (NNTH) = 7; 2683 participants; 3 studies;
moderate-certainty evidence). We are uncertain whether TAVI, compared with
SAVR, affects the LOS in days, although it appears to be associated with
shorter LOS. TAVI, compared with SAVR, reduces the risk of atrial
fibrillation (RR 0.21, 95% CI 0.15 to 0.30; 2683 participants; 3 studies),
AKI (RR 0.30, 95% CI 0.16 to 0.58; 2753 participants; 4 studies), and
bleeding (RR 0.31, 95% CI 0.16 to 0.62; 2753 participants; 4 studies) (all
high-certainty evidence). Authors' conclusions: Our meta-analysis
indicates that, in the short term, TAVI probably has little or no
mortality difference compared to SAVR for severe AS in individuals with
low surgical risk. Similarly, there is probably little or no difference in
risk of stroke, MI, and cardiac death between the two approaches. TAVI may
reduce the risk of rehospitalisation, but we are uncertain about the
effects on LOS. TAVI reduces the risk of atrial fibrillation, AKI, and
bleeding. However, this benefit is offset by the increased risk of PPM
implantation. Long-term follow-up data are needed to further assess and
validate these outcomes, especially durability, in the low surgical risk
population.<br/>Copyright &#xa9; 2019 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<37>
Accession Number
630355617
Title
Comparison of ultrasound-guided retrolaminar block with epidural analgesia
on postoperative analgesia in patients undergoing video-assisted thoracic
surgery.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
2019 International Conference of the American Thoracic Society , ATS 2019.
United States. 199 (9) (no pagination), 2019. Date of Publication: May
2019.
Author
Fujimura N.; Nobukuni K.; Hatta M.; Obuchi T.; Yoshino J.
Institution
(Fujimura, Nobukuni, Hatta, Yoshino) Anesthesiology, St. Mary's Hospital,
Kurume, Japan
(Obuchi) Thoracic Surgery, St. Mary's Hospital, Kurume, Japan
Publisher
American Thoracic Society
Abstract
Introduction: Postoperative pain after open thoracotomy is severe and
associated with postoperative pulmonary complications. Thoracic epidural
analgesia (TEA) has been used for reducing post postoperative pain after
open thoracotomy. TEA provides better postoperative pain relief and
protect pulmonary complications after open thoracotomy. However, TEA
carries the risk of severe complications such as epidural abscess and
spinal hematoma. Recently Videoassisted thoracic surgery (VATS) has been
widely performed with its advantages of reduced morbidity with early
recovery. From the fact that VATS is associated with less postoperative
pain compared with open thoracotomy, the roll of TEA for the postoperative
analgesia after VATS is still controversial. Ultrasound-guided
retrolaminar analgesia (RLB) is a new thoracic truncal block. RLB was
considered a safe maneuver compared to TEA. However the effects of RLB on
postoperative pain after VATS is not elucidated. Thus the purpose of this
study is to compare RLB with TEA on postoperative analgesia undergoing
VATS. <br/>Method(s): Thirty nine healthy patients (ASA 1-2) undergoing
VATS for pneumothorax were enrolled in the present study. Patients were
randomly divided into two groups; The first group of patients with TEA
(group EPI; n=20) and the second group of patients with ultrasound-guided
RLB (group RLB; n=19) for postoperative pain relief. All patients received
general anesthesia under a standard protocol. In the EPI group, an
epidural catheter was inserted at Th4-7 interspace before general
anesthesia. Postoperative analgesia was induced with single shot
administration of 0.375% ropivacaine (3- 6ml) followed by continuous
administration of 0.2% ropivacaine (3-6ml/h). In the RLB group, a catheter
was inserted at Th3-7 retrolaminar space under general anesthesia
postoperatively. Postoperative analgesia was induced with single shot
administration of mixture of 0.75% ropivacaine (10ml) plus 1% lidocaine
with 1:100,000 epinephrine (10ml) followed by continuous administration of
0.2% ropivacaine (8-12ml/h). All patients received a multimodal pain
management strategy consisting of scheduled administration of NsAIDs.
Postoperative pain were assessed using Numerical Rating Scale (NRS) score
at just after operation, 6 and 12h after operation, and postoperative days
(POD) 1and 2. ANOVA was used for statistical analysis. <br/>Result(s):
There were no significant differences between the NRS scores between two
groups. <br/>Conclusion(s): Ultrasound-guided RLB can provide comparable
pain relief to TEA after VATS.

<38>
Accession Number
630354912
Title
Recruitment maneuver during non-invasive ventilation in coronary artery
bypass grafting patients: Effect on cost of oxygen supplementation.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
2019 International Conference of the American Thoracic Society , ATS 2019.
United States. 199 (9) (no pagination), 2019. Date of Publication: May
2019.
Author
Fu C.
Institution
(Fu) Physical Therapy, Communication Sciences and Disorders, and
Occupational Therapy, SAO PAULO UNIVERSITY, Sao Paulo, Brazil
Publisher
American Thoracic Society
Abstract
Introduction: Atelectasis and hypoxemia are the major pulmonary
complications in the early period after coronary artery bypass grafting
(CABG) and may cause necessity of oxygen supplementation and, thus,
increase health care cost. Noninvasive ventilation (NIV) has been used in
postoperative care for prevention and treatment of pulmonary
complications. The aim of this study was to compare the cost of
supplementary oxygen at the ward in post CABG patients who used NIV
associated with recruitment maneuver at the intensive care unit (ICU) and
patients who used conventional NIV at the ICU. <br/>Method(s): 34 patients
after CABG, with PaO2/FiO2 ratio < 300 and radiological atelectasis score
>= 2 were included. Exclusion criteria: use of vasoconstrictor drugs in
increasing doses or mean arterial blood pressure <65 mmHg; tracheostomy,
pre-existing lung disease with Global Initiative for Chronic Obstructive
Lung Disease (GOLD) classification > 2; contraindication to the use of
NIV; refuse of RM by the surgeon in charge. Patients were randomized: 16
to the control group (CG) and 18 to the recruitment group (RG). After
extubation NIV was applied for 30 minutes three times a day, according to
ICU routine, with PEEP=8 cm H2O. RG was submitted to recruitment maneuver
with PEEP=15 cm H2O and 20 cm H2O for 2 minutes each during NIV. We
compared the estimated mean cost related to oxygen supplementation at the
ward of the two groups. <br/>Result(s): Patients' baseline characteristics
were not different between groups. Mean age was 63.8 +/- 9.3 for CG versus
68.7 +/- 8.5 for RG (p=0.113). There were 87.5% of male patients in CG and
77.8% in RG (p=0.660). Length of MV was 9.5 +/- 3.9 hours for CG versus
7.1 +/- 3.4 hours for RG (p=0.064). Mean length of stay (LOS) at ward was
6.7 +/- 3.7 days for CG and 6.1 +/- 3.9 for RG (p=0.661). Mean hospital
LOS was 9.3 +/- 3.9 for CG and 8.5 +/- 4.8 for RG (p=0.594). Estimated
cost for oxygen supplementation was US$ 258.5 [226.2 - 290.8] in CG and
US$ 0 [0 - 0] for RG (p<0.001). <br/>Conclusion(s): Patients who were
submitted to NIV associated with recruitment maneuver after CABG presented
lower cost related to supplementary oxygen at the ward.

<39>
Accession Number
630354843
Title
A rare case of hydropneumothorax and necrotizing pneumonia by clostridium
perfringens.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
2019 International Conference of the American Thoracic Society , ATS 2019.
United States. 199 (9) (no pagination), 2019. Date of Publication: May
2019.
Author
Dudiki N.; Summers S.; Maxfield M.; Leslie R.
Institution
(Dudiki, Summers, Maxfield, Leslie) Pulmonary and Critical Care Medicine,
University of Massachusetts Medical School, Worcester, MA, United States
Publisher
American Thoracic Society
Abstract
Introduction: Primary Clostridial pleuro-pulmonary infections are rare in
the absence of predisposing risk factors. We describe a case of empyema,
pneumothorax and necrotizing pneumonia caused by Clostridium perfringens
secondary to pulmonary infarction following an acute pulmonary embolism.
Literature search from Pubmed did not show similar cases of Clostridial
infections due to acute pulmonary embolism.Case: A 43-year-old male with a
recent history of femur fracture presented with right pleuritic chest pain
and shortness of breath. CT PE protocol confirmed right sided pulmonary
emboli extending to the right main pulmonary artery, segmental and
sub-segmental branches and associated right lower lobe infarction. He was
started on anticoagulation and was admitted due to high clot burden. 50
hours after presentation, the patient developed markedly worsening dyspnea
and tachycardia. Exam suggested a right pneumothorax, CXR confirmed this
with associated worsening infiltrate and large pleural effusion. The
patient underwent chest tube placement, draining brown, foul smelling
fluid. Pleural fluid cultures grew Clostridium perfringens, Hemophilus
influenzae, Streptococcus anginosus and Fusobacterium necrophorum. Patient
was started on intravenous Vancomycin and Piperacillin-Tazobactam. CT
chest with angiography was obtained given the concern for devitalized lung
tissue due to the organisms identified. This showed decreased arterial and
venous opacification of the right lower lobe concerning for lung necrosis
and empyema. After multi-disciplinary colloquy with Thoracic surgery,
Infectious diseases, Pulmonary and Radiology, a decision was made against
surgical resection of the lung acutely given the marked clinical
improvement, lack of systemic infectious signs and a higher risk of
broncho-pleural fistula. The patient was discharged on oral
Amoxicillin-Clavulanate and chest tube drainage with close outpatient
follow up. A week after discharge, he was seen by outpatient Thoracic
surgery who noted increased chest tube drainage and a new air leak with CT
chest showing necrotic right lower lobe and broncho-pleural fistulae.
Subsequently, the patient underwent open thoracotomy with right middle and
lower lobectomy with virtuous clinical recovery. <br/>Discussion(s):
Pleuropulmonary infections caused by Clostridium perfringens are
exceedingly rare. Few cases have been reported, typically in the presence
of risk factors like aspiration, chest trauma, cirrhosis and lung cancer.
We believe that the Clostridial empyema and pneumothorax occurred
following lung infarction due to pulmonary embolism. The case highlights
the importance of adequate source control in addition to appropriate
antibiotics to achieve an overall favorable outcome.

<40>
Accession Number
630354811
Title
Systematic review of intravenous acetaminophen after cardiac surgery.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
2019 International Conference of the American Thoracic Society , ATS 2019.
United States. 199 (9) (no pagination), 2019. Date of Publication: May
2019.
Author
Malesker M.A.; Hilleman D.E.; Morrow L.E.
Institution
(Malesker, Hilleman) Pharmacy Practice, Creighton University, Omaha, NE,
United States
(Morrow) Creighton Univ, Omaha, NE, United States
Publisher
American Thoracic Society
Abstract
Rationale. The analgesic indication for intravenous acetaminophen (IVA) is
broad with no specific recommendations concerning which patients would
most likely benefit. Furthermore, the safety and efficacy in vulnerable
critical care subpopulations is not well delineated. The objective of this
systematic review was to evaluate the effectiveness of IVA after cardiac
surgery via median sternotomy. Methods. A search of PubMed and CINAHL
Complete using the terms paracetamol, propacetamol, acetaminophen, cardiac
surgery, coronary artery bypass graft, and heart valve surgery was
conducted from inception of the databases through September 6, 2018.
Relevant manuscripts were reviewed and evaluated using established quality
criteria (Jadad, et al., Lohr, et al.). The primary outcomes to be
evaluated were pain scores, opioid consumption, and opioid-related adverse
reactions. Results. Twelve trials met criteria and were reviewed: two
studies were subsequently excluded due to inability to determine relevant
outcomes. The remaining 10 trials included 3 active-control studies and 7
placebo-control studies. All studies included small numbers of subjects
with a combined total of 354 patients receiving IVA. All 10 studies
reported pain scores, 9 reported opioid consumption, and 7 reported
opioid-related adverse reactions. Only 2 studies reported patient
satisfaction and none of the studies reported hospital length of stay.
Collectively, these studies suggest that IVA has superior analgesic
effects compared to placebo and active comparator. However, IVA did not
demonstrate greater analgesic efficacy when compared to oral or rectal
acetaminophen. IVA appears to be opioid sparing and may be associated with
fewer opioid-related adverse effects. Conclusions. The available clinical
trial data concerning the use of IVA after cardiac surgery is lacking and
limits meaningful definitive conclusions. Published randomized, controlled
trials are few in number and uniformly include small numbers of patients.
Although the majority of studies demonstrated superior pain control
compared to active- or placebo-controls, fewer studies reported reductions
in opioid consumption and opioid-related adverse reactions.

<41>
Accession Number
630353818
Title
All that is transudative is not benign.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
2019 International Conference of the American Thoracic Society , ATS 2019.
United States. 199 (9) (no pagination), 2019. Date of Publication: May
2019.
Author
Phillips N.; Kakol M.; Sheehan E.
Institution
(Phillips) Internal Medicine, UNM, Albuquerque, NM, United States
(Kakol, Sheehan) UNM, Albuquerque, NM, United States
Publisher
American Thoracic Society
Abstract
Case 1. An elderly female with a medical history significant for coronary
artery disease, atrial fibrillation on warfarin, chronic kidney disease
and a history of heart failure presented with ongoing complaints of
chronic dyspnea and associated fatigue. No family history of lung cancer.
No smoking history or affiliated exposure to environmental risk factors.
Brain natriuretic peptide on admission 4,836 (normal <450). CT-contrast of
the thorax depicted patchy consolidation throughout the lungs with
peripheral peri-bronchial nodules, and moderate right sided pleural
effusion most consistent with an infectious process. She underwent
thoracentesis and was found to have a benign transudative effusion.
Cytology later returned positive for lung adenocarcinoma. Case 2. An
elderly female with a medical history of metastatic breast cancer admitted
for acute hypoxemic respiratory failure to the Medical Intensive Care
Unit. CT thorax depicted new moderate size pericardial effusion, bilateral
pleural effusions and worsening of left upper lobe metastatic disease
compatible with carcinomatosis. Patient underwent pericardiocentesis that
was positive for metastatic carcinoma. Later, Pulmonary was consulted for
a therapeutic thoracentesis consistent with transudative effusion.
Cytology later returned positive for carcinoma consistent with breast
primary. <br/>Discussion(s): Transudates are the result of forces of
hydrostatic or oncotic imbalances, and often stem from common diseases
such as heart failure or cirrhosis. In general if it is a transudate, it
is less likely to be malignant, this is often the case, but not always. In
cancer, development of transudative effusions from post-obstructive
atelectasis or cachexia with low plasma oncotic pressures may also
develop. Similarly, increased systemic venous pressure from superior vena
cava syndrome or extensive pleura visceral involvement may trap the lung,
or paraneoplastic pulmonary embolisms may arise, also causing transudates.
Straying again from Light's classic criteria, another article published in
Chest, one author found that in a retrospective meta-analysis that
"malignant pleural effusions may be transudates in 1 to 10% of patients".
It is likely better to think of things that often cause an exudative
effusion, but may cause a transudative one. The list is long, but even the
often used clinical resource UptoDate remarked that 3 to 10 percent of
effusions from malignancies may be transudative, "possibly due to early
lymphatic obstruction, obstructive atelectasis, or concomitant disease".
Other case reports exist of this uncommon but present phenomenon. This
further exhibits the need to using clinical judgement when evaluating
transudative pleural effusions, particularly if malignancy is suspected.
(Table Presented) .

<42>
Accession Number
630351586
Title
Effective treatment of obstructive sleep apnea with CPAP reduces major
adverse cerebrocardiovascular outcomes: A systematic review and
meta-analysis of per-protocol use of CPAP in randomized controlled trials.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
2019 International Conference of the American Thoracic Society , ATS 2019.
United States. 199 (9) (no pagination), 2019. Date of Publication: May
2019.
Author
Javaheri S.; Martinez-Garcia M.; Campos-Rodriguez F.; Muriel A.; Peker Y.
Institution
(Javaheri) Division of Pulmonary and Sleep Medicine, Bethesda North
Hospital, Cincinnati, OH, United States
(Martinez-Garcia) Pneumology Service, University and Polytechnic la Fe
Hospital, Valencia, Spain
(Campos-Rodriguez) Respiratory Department, Hospital de Valme, Sevilla,
Spain
(Muriel) Clinical Biostatistics Unit Ramon y Cajal Hospital, Alcala
University, Madrid, Spain
(Peker) Pulmonary Medicine, Koc University, Istanbul, Turkey
Publisher
American Thoracic Society
Abstract
IMPORTANCE: Obstructive sleep apnea (OSA) is associated with increased
risk for major adverse cerebrovascular and cardiovascular events (MACCEs).
Continuous positive airway pressure (CPAP) effectively treats OSA, but
treatment with CPAP may not necessarily prevent incident downstream
consequences. <br/>OBJECTIVE(S): Because adherence to CPAP is the most
critical factor, which could be associated with improved outcomes, we
assessed association of adequate use of CPAP vs usual care for MACCEs.
DATA SOURCES AND STUDY SELECTION: MEDLINE, EMBASE, and the Cochrane
Library were searched from inception date to March 2017 for randomized
clinical trials (RCTs) that reported both adequate use of CPAP, defined
per protocol as at least 4 hours a night, and MACCEs during a follow-up
period of at least 12 months. DATA EXTRACTION AND SYNTHESIS: Two authors
independently extracted data using standardized forms. Summary relative
risks (RRs), risk differences (RDs) and 95% confidence intervals (CI)s
were obtained using random-effects meta-analysis.MAIN OUTCOMES: The MACCEs
included composite of acute myocardial infarction (AMI), stroke, and
cerebrovascular or cardiovascular death. <br/>RESULT(S): The analyses
included data from 5 eligible RCTs with 1141 participants in the control
group, and 943 who used CPAP>= 4 hours per night. Per protocol use of
CPAP, compared with usual care, significantly improved MACCEs (RR 0.68
[95% CI, 0.50 to 0.92]; P=0.01, and RD -0.05 [95% CI, -0.09 to -0.003],
P=0.001). CPAP use also significantly decreased the composite first
cerebrovascular and cardiovascular event (encompassing fatal or non-fatal
stroke + transient ischemic attack [TIA] + fatal and non-fatal AMI +
angina + revascularization procedures) (RR, 0.78 [95% CI, 0.63 to 0.98];
P=0.03, and RD -0.03 [95% CI, -0.06 to -0.004], P=0.025), and
cerebrovascular composite outcome (cerebrovascular death + stroke +TIA)
(RR, 0.59 [95% CI, 0.39 to 0.89]; P=0.01, and RD -0.05 [95% CI -0.04 to
0.01], P=0.001). However, CPAP therapy did not improve the cardiac
composite outcome of AMI + angina + revascularization procedures +cardiac
death (RR, 1.11 [95% CI, 0.89 to 1.38]; P=0.37, and RD 0.02 [95% -0.02 to
0.04], P=0.32).CONCLUSIONS AND RELEVANCE: These findings strongly suggest
that effective use of CPAP, compared with no CPAP, reduces risk for MACCEs
in OSA, especially cerebrovascular composite outcomes. Physicians taking
care of adults with OSA should address the critical importance of CPAP
adherence on cerebrovascular and cardiovascular outcomes.

<43>
Accession Number
630350363
Title
Nitric oxide administration during cardiopulmonary bypass reduces the
incidence of cardiac surgery-associated acute kidney injury: Prospective
randomized study.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
2019 International Conference of the American Thoracic Society , ATS 2019.
United States. 199 (9) (no pagination), 2019. Date of Publication: May
2019.
Author
Anfinogenova Y.J.; Kamenshchikov N.O.; Podoksenov Y.K.; Kozlov B.N.;
Svirko Y.S.; Popov S.V.; Evtushenko V.V.; Lugovsky V.A.; Shipulin V.M.
Institution
(Anfinogenova, Kamenshchikov, Podoksenov, Kozlov, Svirko, Popov,
Evtushenko, Lugovsky, Shipulin) Cardiology Research Institute, Tomsk NRMC,
Tomsk, Russian Federation
Publisher
American Thoracic Society
Abstract
RATIONALE: Acute kidney injury (AKI) is a serious complication of cardiac
surgery with cardiopulmonary bypass (CPB). The effects of nitric oxide
(NO) supply to cardiopulmonary bypass (CPB) circuit during cardiac surgery
and cardiac surgery-associated AKI (CSA-AKI) rates were studied in adult
patients. <br/>METHOD(S): Prospective randomized study was conducted in
the Department of Cardiovascular Surgery, Cardiology Research Institute,
Tomsk NRMC (Russia). A total of 96 patients were included in the study.
Patients underwent cardiac surgery with normothermic non-pulsating CPB.
Patients were blindly randomized based on computergenerated permuted block
randomization sequence to NO-treatment group and control group. In
NO-treatment group, additional NO supply line was connected to gas-air
mixture supply circuit under aseptic conditions. NO-treatment group
received 40-ppm NO introduced through the membrane oxygenator during the
entire CPB period. Control group received sham treatment. <br/>RESULT(S):
CSA-AKI rate, diuresis during CPB, urinary neutrophil
gelatinase-associated lipocalin (uNGAL) levels 4 h after surgery, free
hemoglobin concentrations during intraoperative period, plasma
concentrations of NO metabolites (nitrite (NO<inf>2</inf>) and nitrate
(NO<inf>3</inf>)), total concentration of NO metabolites (NOx, uM/mL) as
well as plasma concentrations of proinflammatory mediators (tumor necrosis
factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, and IL- 8) and
anti-inflammatory mediators (IL-1 receptor antagonist (IL-1RA) and IL-4)
during the intraoperative period were assessed. NO-treatment was
associated with a significant decrease in CSA-AKI rate: 10 (20.8%) in
NO-treatment group versus 20 (41.6%) in control group (p = 0.023).
NO-treatment was also significantly associated with an increase in
diuresis (2.6 [2.1; 5.08] mL/kg/h) during CPB compared to control (1.7
[0.80; 2.50] mL/kg/h, p = 0.0002). uNGAL levels 4 h after surgery were
1.12 [0.75; 5.8] ng/mL in NO-treatment group versus 4.62 [2.02; 34.55]
ng/mL in control group (p = 0.005). Free hemoglobin concentrations
significantly increased at the end of CPB period and at the end of surgery
in both groups without significant intergroup differences. In NO-treatment
group, concentrations of NO metabolites significantly increased at 5 min
postclamping, 5 min after declamping, and at the end of surgery (p =
0.0073; p = 0.00014; p = 0.028). Concentrations of proinflammatory and
anti-inflammatory mediators did not significantly differ between groups
during the intraoperative period. <br/>CONCLUSION(S): Administration of NO
to cardiac surgery patients during CPB through the extracorporeal
circulation circuit was associated with a significant decrease in the
CSA-AKI rate. Proposed approach was well controlled and safe.

<44>
Accession Number
630350146
Title
Treatment of central sleep Apnea: A systematic review.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
2019 International Conference of the American Thoracic Society , ATS 2019.
United States. 199 (9) (no pagination), 2019. Date of Publication: May
2019.
Author
Eshraghi M.; Caruso A.; Pereira H.A.; Akers K.; Salloum A.; Sankari A.;
Badr M.S.
Institution
(Eshraghi, Caruso, Pereira, Salloum, Sankari, Badr) John D. Dingell VAMC
and Wayne State University, Detroit, MI, United States
(Akers) Wayne State University, Detroit, MI, United States
Publisher
American Thoracic Society
Abstract
Objective: To systematically review and evaluate the outcomes of treatment
in Central Sleep Apnea (CSA) including sleep parameters, sleep severity
indexes, oxygen saturation, quality of life, and heart-related parameters.
<br/>Background(s): Central sleep apnea (CSA) is a disorder characterized
by the repeated and consistent absence in both airflow and ventilatory
effort. Treatment of CSA has proven inconsistent due to its diverse
presentation and oftentimes idiopathic nature. While there are many
modalities to manage the different manifestations of CSA, there has yet to
be a review to compare the efficacy of different treatment types.
<br/>Method(s): A systematic search was conducted for articles reporting
primary data on treatment in central sleep apnea of PUBMED, MEDLINE,
EMBASE, CINAHAL, SCOPUS, WEB OF SCIENCE, and Cochrane electronic databases
on February 12, 2018. Inclusion criteria were studies with a clearly
defined population (human adult), a minimum number of patients >=3,
treatment in central sleep apnea, and report outcomes. Various outcomes
including apnea-hypopnea index (AHI), central apnea index (CAI), sleep
parameters, oxygen saturation (SpO2), sleep arousals, cardiovascular
outcomes, morality/survival outcomes, quality of life,
admission/re-admission rates, and lengths of stay were collected.
Significant outcomes were recorded along with their pvalues.
<br/>Result(s): The initial search strategy identified 8968 titles and
abstracts after removal of duplicates; 875 full text articles were
reviewed in detail, and 151 articles were included in the final analysis.
Of the included articles, 34% of the studies (n=51) utilized adaptive
servoventilation (ASV) as a treatment modality, 30% (n=45) studied the
effects of CPAP, 15% (n=23) analyzed nocturnal O2 and/or CO2 treatments,
and 14% (n=21) investigated the effects of various pharmacological
treatments (i.e., Acetazolamide, Beta-Blockers, Carvedilol, Temazepam,
Theophylline, Triazolam). Acetazolamide was the most frequently studied
agent (43% of pharmacological studies, n=9). Other infrequently reported
treatments were cardiac surgery, cardiac resynchronization therapy, and
acclimatization which comprised 23% (n=34) of the included studies. The
most commonly reported outcome was AHI (85%, n=129). Other reported
outcomes were SpO2 data, sleep parameters (sleep efficiency and total
sleep time), arousal indices, and CAI. Very few articles included data
regarding mortality and/or survival (2%, n=3), admission/re-admission (1%,
n=1) and lengths of stay (1%, n=1) as outcomes. <br/>Conclusion(s): Our
systematic review revealed that ASV and acetazolamide were the most
commonly studied positive-pressure and pharmacologic therapy respectively.
Long-term outcome data are rather limited. Thus, a comprehensive analysis
of all treatment types to assess their long-term outcomes is needed.

<45>
Accession Number
630349527
Title
Therapeutic hypothermia in intensive care unit: Meta-analysis.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
2019 International Conference of the American Thoracic Society , ATS 2019.
United States. 199 (9) (no pagination), 2019. Date of Publication: May
2019.
Author
Alqalyoobi S.; Sarkeshik A.A.; Boctor N.; Hoerger J.; Klimberg N.;
Bartolome B.G.; Stewart S.L.; Albertson T.E.
Institution
(Alqalyoobi) Pulmonary and Critical Care Division, University of
California, Davis Medical Center, Sacramento, CA, United States
(Sarkeshik) Division of Cardiothoracic Surgery, University of California,
Davis Medical Center, Sacramento, CA, United States
(Boctor, Hoerger, Klimberg, Bartolome) Department of Internal Medicine,
University of California, Davis Medical Center, Sacramento, CA, United
States
(Stewart) Division of Biostatistics, University of California, Davis
School of Medicine, Sacramento, CA, United States
(Albertson) Internal Medicine, University of California, Davis School of
Medicine, Sacramento, CA, United States
Publisher
American Thoracic Society
Abstract
Rationale: Therapeutic Hypothermia (TH) is defined as designed reduction
of the human body's core temperature to 32degreeC-35degreeC for a duration
of 24-48 hours. TH has been studied extensively in many diseases related
to critical care illness. The term post-resuscitation disease and
reperfusion injury was first used to describe a cascade of destructive
processes that affect the injured brain during the minutes to hours after
an episode of ischemia or trauma. The major effect of TH is thought to be
the attenuation of the secondary injury mechanisms that are induced by
underlying insult. In this meta-analysis, the effect of TH on mortality
across different indications in medical, neurological and cardiac critical
care medicine is assessed. <br/>Method(s): Electronic databases Embase,
Ovid MEDLINE, TRIP and CINAHL databases were searched for related topics
between 1940 and October, 2018. Search terms that were used "hypothermia,"
"therapeutic hypothermia," "cooling," "induced hypothermia," and
"hypothermia" with the Boolean operators (AND, OR, NOT or AND NOT).
Studies were limited to adults and randomized controlled trials. Outcome
data for mortality in all the included studies was extracted. Pooled risk
ratios (RRs) were calculated with 95% confidence intervals using random
effects models for dichotomous outcomes. <br/>Result(s): Of 2451 articles
identified, 84 studies met eligibility criteria. When all disease
categories were combined, no significant reduction in mortality rates was
found in patients treated with TH compared to controls (RR, 1.00; 95% CI,
0.95-1.04; p = 0.9). No significant reduction in mortality rates was
noticed in traumatic brain injury patients treated with TH (RR, 0.88; 95%
CI, 0.73-1.07; p = 0.2), adult stroke patients treated with TH (RR, 1.28;
95% CI, 0.81-2.03; p = 0.29), patients who had out of hospital cardiac
arrest treated with TH (RR, 0.98; 95% CI, 0.93-1.04; p = 0.57), adult
patients who underwent Cardiac Pulmonary bypass surgery treated with TH
intra-operatively (RR, 1.39; 95% CI, 0.95-2.03; p = 0.09), or in patients
with other critical care diseases who were treated with TH (RR, 1.14; 95%
CI, 0.97-1.35; p = 0.11) (Figure). <br/>Conclusion(s): Our meta-analysis
suggests that after decades of extensive research, therapeutic hypothermia
has yet to show a beneficial effect on mortality across different critical
care diseases. (Figure Presented).

<46>
Accession Number
630349191
Title
A thymoma with massive pleural effusions and cardiac tamponade.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
2019 International Conference of the American Thoracic Society , ATS 2019.
United States. 199 (9) (no pagination), 2019. Date of Publication: May
2019.
Author
Khan A.; Faisaluddin M.; Jain A.; Khetpal N.; Russin M.
Institution
(Khan, Jain, Khetpal) Internal Medicine, Florida Hospital Medical Center,
Orlando, FL, United States
(Faisaluddin) Internal Medicine, Deccan College of Medical Sciences,
Hyderabad, India
(Russin) Internal Medicine, Univeristy of Central Florida, Orlando, FL,
United States
Publisher
American Thoracic Society
Abstract
Introduction: Thymomas are the most common neoplasms found in the anterior
mediastinum and account for one quarter of all mediastinal tumours. Most
patients with a thymoma are asymptomatic, and one third present with
symptoms related to local spread of the tumor. However, a spontaneous
hemorrhagic pericardial effusion and cardiac tamponade is an unexpected
clinical feature occuring in less than 20% of patients. Case Presentation:
A 47 year old woman presented with shortness of breath, bilateral leg
swelling and abdominal distention. She was tachycardic, and had muffled
heart sounds with pulsus paradoxus. A chest CT revealed findings
suggestive of metastatic disease to the pleural cavity with bulky pleural
tumor deposits. An echocardiogram showed signs of cardiac tamponade, and
an emergent pericardial window was performed providing symptomatic relief.
Pathologic analysis of the pleural mass and pleural fluid collected during
the cardiothoracic intervention, suggested an invasive thymoma type B2,
which was deemed unresectable due to perivascular encasement.
<br/>Discussion(s): Thymomas account for approximately 20-25% of all
mediastinal masses in people of all ages. One third to one half of the
patients with a thymoma are asymptomatic, and 33% of patients present with
symptoms related to the local spread like chest pain, dyspnea, and
superior vena cava syndrome. However, a hemorrhagic pericardial tamponade
is an uncommon initial manifestation. Our patient had not only presented
with cardiac tamponade, but also with bilateral pleural effusions and
nodular pleural based lesions. In a review of literature, only 7 similar
cases have been reported, asserting the rarity of this presentation. This
case was classified as Type B2 (increased number of single or clustered
polygonal or dendritic epithelial cells intermingled with abundant
immature T cells) according to the WHO classification, and stage IV A
(Pleural or pericardial dissemination) according to the Masaoka staging
system. Surgical resection remains the mainstay of treatment for early
stage tumors which are localized. For stage IV A tumors, surgery is
considered only if metastases can be resected. In cases which are
inoperable, treatment with systemic chemotherapy (cyclophosphamide,
doxorubicin and cisplatin), radiation, or chemoradiotherapy needs to be
initiated. <br/>Conclusion(s): A thymoma can present as an anterior
mediastinal mass with extension to the pleura and pericardium, causing a
catastrophic cardiac tamponade. Surgical options are limited in such
cases, and chemoradiotherapy is indicated for further management after
stabilization of the patient's hemodynamic status.

<47>
Accession Number
2003930760
Title
Transcatheter versus surgical aortic valve replacement in low-risk
patients: a meta-analysis of randomized trials.
Source
Clinical Research in Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Hofer F.; Hengstenberg C.; Goliasch G.; Grygier M.; Mascherbauer J.;
Siller-Matula J.M.
Institution
(Hofer, Hengstenberg, Goliasch, Mascherbauer, Siller-Matula) Division of
Cardiology, Department of Internal Medicine II, Medical University of
Vienna, Vienna, Austria
(Grygier) 1st Department of Cardiology, Poznan University of Medical
Sciences, Poznan, Poland
(Siller-Matula) Department of Experimental and Clinical Pharmacology,
Centre for Preclinical Research and Technology (CEPT), Medical University
of Warsaw, Warsaw, Poland
Publisher
Springer
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as a
treatment option for severe aortic stenosis in patients at intermediate or
high surgical risk. However, until recently there was insufficient
evidence regarding the outcomes of TAVR compared to surgical aortic valve
replacement (SAVR) for patients at low risk. <br/>Method(s): We conducted
a meta-analysis and systematic review of all randomized trials comparing
the efficacy and safety of TAVR versus SAVR in patients at low surgical
risk. Risk ratios (RR) and 95% confidence intervals (CIs) were calculated,
using fixed- or random-effects model. <br/>Result(s): Four trials were
eligible for analysis and comprised a total of 2887 patients (1497
allocated to TAVR and 1390 allocated to SAVR group). TAVR was associated
with a 39% relative risk reduction (RRR) of major adverse cardiac events
(MACE) (absolute risk reduction ARR of 3.7%; RR 0.61; 95% CI 0.47-0.79);
39% RRR of overall mortality (ARR of 1.4%; RR 0.61; 95% CI 0.39-0.96) and
45% RRR of cardiovascular mortality (ARR of 1.3%; RR 0.55; 95% CI
0.33-0.90), 69% RRR of life threatening or disabling bleeding (ARR of
7.0%; RR 0.31; 95% CI 0.22-0.44), 73% RRR of new-onset atrial fibrillation
(ARR of 29%; RR 0.27; 95% CI 0.20-0.35) and 73% RRR of acute kidney injury
(ARR of 2.1%; RR 0.27; 95% CI 0.14-0.56) as compared with SAVR. In
contrast, TAVR was associated with a 4.7-fold increased risk of new
pacemaker (PM) implantation (RR 4.72; 95% CI 1.83-12.15), which was driven
by use of self-expanding valves. <br/>Conclusion(s): TAVR in low-risk
patients is superior to SAVR for the majority of outcomes. Graphical
abstract: [Figure not available: see fulltext.].<br/>Copyright &#xa9;
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<48>
Accession Number
630361971
Title
Discharge Education Intervention to Reduce Anxiety and Depression in
Cardiac Surgery Patients: A Randomized Controlled Study.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. (no pagination), 2019. Date of
Publication: 16 Dec 2019.
Author
Yaman Aktas Y.; Gok Ugur H.; Orak O.S.
Institution
(Yaman Aktas) Department of Surgical Nursing, Faculty of Health Sciences,
Giresun University, Giresun, Turkey
(Gok Ugur) Department of Public Health Nursing, Faculty of Health
Sciences, Ordu University, Ordu, Turkey
(Orak) Department of Psychiatric Nursing, Faculty of Health Sciences,
Ondokuz Mayis University, Samsun, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: This study aimed to determine possible effects of a discharge
education intervention on anxiety and depression among cardiac surgery
patients in a private hospital in the city of Ordu, Turkey. DESIGN: A
randomized controlled trial. <br/>METHOD(S): Thirty-three patients were
placed in standard care group and 33 into standard care plus discharge
education group. Patients in the discharge education group were provided
an individual training from the first day of the hospital admission until
the day of the discharge. The standard care group received usual discharge
instructions. FINDINGS: The Hospital Anxiety and Depression Scale-anxiety
subscale scores were not significantly different between patients in the
discharge and standard care groups (group: F = 1.58; P > .05). There was a
significant difference for depression, indicating that the discharge
education group had significantly lower depression than the standard care
group (group: F = 19.23; P < .01). <br/>CONCLUSION(S): Our findings
supported that the discharge education intervention reduced depression in
cardiac surgery patients.<br/>Copyright &#xa9; 2019 American Society of
PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

<49>
Accession Number
630287718
Title
Clinical outcome comparison of percutaneous coronary intervention and
bypass surgery in diabetic patients with coronary artery disease: A
meta-analysis of randomized controlled trials and observational studies.
Source
Diabetology and Metabolic Syndrome. 11 (1) (no pagination), 2019. Article
Number: 110. Date of Publication: 19 Dec 2019.
Author
Zhai C.; Cong H.; Hou K.; Hu Y.; Zhang J.; Zhang Y.
Institution
(Zhai, Cong, Hou) School of Medicine, NanKai University, Weijin Road No.
94, Nankai District, Tianjin 300071, China
(Zhai, Cong, Hou, Hu, Zhang, Zhang) Department of Cardiology, Tianjin
Chest Hospital, Taierzhuang South Road No. 291, Jinnan District, Tianjin
300350, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The optimal revascularization technique in diabetic patients
with complex coronary artery disease (CAD), including left main CAD and
multivessel coronary disease (MVD), remains controversial. The current
study aimed to compare adverse clinical endpoints of coronary artery
bypass graft (CABG) and percutaneous coronary intervention (PCI) in
patients with diabetes mellitus (DM). <br/>Method(s): Relevant studies
were found from MEDLINE, OVID, Science Direct, Embase and the Cochrane
Central database from January 2010 to April 2019. Risk ratio (RR) with 95%
confidence interval (CI) was used to express the pooled effect on
discontinuous variables. Outcomes evaluated were all-cause mortality,
major adverse cardiac/cerebrovascular events (MACCE), cardiac death,
myocardial infarction, stroke, and repeat revascularization.
<br/>Result(s): Sixteen studies were included (18,224 patients). PCI was
associated with the increase risk for MACCE (RR 1.59, 95% CI 1.38-1.85),
cardiac death (RR 1.76, 95% CI 1.11-2.80), MI (RR 1.98, 95% CI 1.53-2.57),
repeat revascularization (RR 2.61, 95% CI 2.08-3.29). The risks for
all-cause mortality (RR 1.23, 95% CI 1.00-1.52) and stroke (RR 0.71, 95%
CI 0.48-1.03) were similar between two strategies. Stratified analysis
based on studies design and duration of follow-up showed largely similar
findings with the overall analyses, except for a significant increased
risk of all-cause mortality (RR 1.32, 95% CI 1.04-1.67) in long-term
group, and CABG was associated with a higher stroke rate compared to PCI,
which are results that were found in RCTs (RR 0.47, 95% CI 0.28-0.79) and
mid-term groups (RR 0.39, 95% CI 0.23-0.66). <br/>Conclusion(s): CABG was
superior to PCI for diabetic patients with complex CAD (including left
main CAD and/or MVD), but might be associated with a higher risk of stroke
mid-term follow-up. Number of Protocol registration PROSPERO CRD
42019138505.<br/>Copyright &#xa9; 2019 The Author(s).

<50>
Accession Number
630285985
Title
Prognostic value of adiponectin level in patients with coronary artery
disease: A systematic review and meta-analysis.
Source
Lipids in Health and Disease. 18 (1) (no pagination), 2019. Article
Number: 227. Date of Publication: 23 Dec 2019.
Author
Yang L.; Li B.; Zhao Y.; Zhang Z.
Institution
(Yang, Li, Zhao, Zhang) Department of General Medicine, Lanzhou University
Second Hospital, No. 82 Cuiyingmen, Lanzhou, Gansu Province 730030, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Conflicting results on the prognostic value of blood
adiponectin level in patients with coronary artery disease (CAD) have been
reported. This meta-analysis aimed to investigate the prognostic value of
elevated adiponectin level in CAD patients. <br/>Method(s): A
comprehensive literature search was conducted in PubMed and Embase
databases up to May 10, 2019. Studies evaluating the association between
adiponectin level and major adverse cardiovascular events (death, stroke,
acute coronary syndrome or coronary revascularisation), cardiovascular
mortality, and all-cause mortality in CAD patients were included. Pooled
multivariable adjusted risk ratios (RR) and 95% confidence intervals (CI)
was calculated for the highest vs the lowest category of adiponectin
level. <br/>Result(s): Twelve studies including 10,974 CAD patients were
included. Elevated adiponectin level was independently associated with
higher risk of cardiovascular (RR 1.93; 95% CI 1.55-2.42; p < 0.001) and
all-cause mortality (RR 1.96; 95% CI 1.64-2.34; p < 0.001) in CAD
patients. However, CAD patients with higher adiponectin level did not
significantly increase major cardiovascular events risk (RR 1.12; 95% CI
0.86-1.45; p = 0.407) after adjustment for potential confounders.
<br/>Conclusion(s): This meta-analysis indicates that elevated adiponectin
level is an independent predictor of cardiovascular and all-cause
mortality in CAD patients. Measurement of blood adiponectin level has
potential to identify CAD patients who have high risk of
death.<br/>Copyright &#xa9; 2019 The Author(s).

<51>
Accession Number
630285059
Title
Multicenter randomized study on the comparison between electronic and
traditional chest drainage systems.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 730. Date of
Publication: 16 Dec 2019.
Author
Marulli G.; Comacchio G.M.; Nosotti M.; Rosso L.; Mendogni P.; Natale G.;
Andriolo L.; Imbriglio G.; Larocca V.; Brascia D.; Rea F.
Institution
(Marulli, Brascia) Thoracic Surgery Unit, Department of Organ
Transplantation and Emergency, University Hospital of Bari, Piazza Giulio
Cesare 11, Bari 70124, Italy
(Comacchio, Natale, Rea) Thoracic Surgery Unit, Department of Cardiologic,
Thoracic and Vascular Sciences, University Hospital of Padova, Padova,
Italy
(Nosotti, Rosso, Mendogni) Thoracic Surgery Unit, Fondazione IRCCS Ca'
Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
(Andriolo, Imbriglio, Larocca) Thoracic Surgery Unit, V Fazzi Hospital,
Lecce, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In patients submitted to major pulmonary resection, the
postoperative length of stay is mainly influenced by the duration of air
leaks and chest tube removal. The measurement of air leaks largely relies
on traditional chest drainage systems which are prone to subjective
interpretation. Difficulty in differentiating between active air leaks and
bubbles due to a pleural space effect may also lead to tentative drain
clamping and prolonged time for chest drain removal. New digital systems
allow continuous monitoring of air leaks, identifying subtle leakage that
may be not visible during daily patient evaluation. Moreover, an objective
assessment of air leaks may lead to a reduced interobserver variability
and to an optimized timing for chest tube removal. <br/>Method(s): This
study is a prospective randomized, interventional, multicenter trial
designed to compare an electronic chest drainage system (DrentechTM Palm
Evo) with a traditional system (DrentechTM Compact) in a cohort of
patients undergoing pulmonary lobectomy through a standard three-port
video-assisted thoracic surgery approach for both benign and malignant
disease. The study will enroll 382 patients in three Italian centers. The
duration of chest drainage and the length of hospital stay will be
evaluated in the two groups. Moreover, the study will evaluate whether the
use of a digital chest system compared with a traditional system reduces
the interobserver variability. Finally, it will evaluate whether the
digital drain system may help in distinguishing an active air leak from a
pleural space effect, by the digital assessment of intrapleural
differential pressure, and in identifying potential predictors of
prolonged air leaks. <br/>Discussion(s): To date, few studies have been
performed to evaluate the clinical impact of digital drainage systems. The
proposed prospective randomized trial will provide new knowledge to this
research area by investigating and comparing the difference between
digital and traditional chest drain systems. In particular, the objectives
of this project are to evaluate the feasibility and usefulness of digital
chest drainages and to provide new tools to identify patients at higher
risk of developing prolonged air leaks. Trial registration:
ClinicalTrials.gov, NCT03536130. Retrospectively registered on 24 May
2018.<br/>Copyright &#xa9; 2019 The Author(s).

<52>
Accession Number
2003929359
Title
Impact of established cardiovascular disease on outcomes in the randomized
global leaders trial.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Garg S.; Chichareon P.; Kogame N.; Takahashi K.; Modolo R.; Chang C.-C.;
Tomaniak M.; Fath-Ordoubadi F.; Anderson R.; Oldroyd K.G.; Stables R.H.;
Kukreja N.; Chowdhary S.; Galasko G.; Hoole S.; Zaman A.; Hamm C.W.; Steg
P.G.; Juni P.; Valgimigli M.; Windecker S.; Onuma Y.; Serruys P.W.
Institution
(Garg) Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust,
Blackburn, United Kingdom
(Chichareon, Kogame, Takahashi, Modolo) Department of Clinical and
Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC,
University of Amsterdam, Heart Center, 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
(Chang, Tomaniak) Erasmus Medical Center, Thoraxcenter, Rotterdam,
Netherlands
(Tomaniak) First Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Fath-Ordoubadi) Manchester Heart Centre, Manchester Royal Infirmary,
Manchester University Foundation Trust, Manchester, United Kingdom
(Anderson) Department of Cardiology, University Hospital of Wales,
Cardiff, United Kingdom
(Oldroyd) West of Scotland Heart and Lung Centre, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Stables) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
(Kukreja) Department of Cardiology, East and North Hertfordshire NHS
Trust, Hertfordshire, United Kingdom
(Chowdhary) Wythenshawe Hospital, Manchester University Foundation Trust,
Manchester, United Kingdom
(Galasko) Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS
Foundation Trust, Blackpool, United Kingdom
(Hoole) Department of Interventional Cardiology, Royal Papworth Hospital,
Cambridge, United Kingdom
(Zaman) Department of Cardiology, Freeman Hospital and Institute of
Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United
Kingdom
(Hamm) Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim,
Germany
(Steg) FACT, French Alliance for Cardiovascular Trials; Hopital Bichat,
AP-HP; Universite Paris-Diderot; and INSERM U-1148, Paris, France
(Steg) Royal Brompton Hospital, Imperial College, London, United Kingdom
(Juni) Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto,
Canada
(Valgimigli, Windecker) Department of Cardiology, Bern University
Hospital, Bern, Switzerland
(Onuma, Serruys) Department of Cardiology, National University of Ireland
Galway, Galway, Ireland
(Serruys) NHLI, Imperial College London, London, United Kingdom
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To investigate the impact of different anti-platelet strategies
on outcomes after percutaneous coronary intervention (PCI) in patients
with established cardiovascular disease (CVD). <br/>Method(s): GLOBAL
LEADERS was a randomized, superiority, all-comers trial comparing
one-month dual anti-platelet therapy (DAPT) with ticagrelor and aspirin
followed by 23-month ticagrelor monotherapy (experimental treatment) with
standard 12-month DAPT followed by 12-month aspirin monotherapy (reference
treatment) in patients treated with a biolimus A9-eluting stent.
Established CVD was defined as >=1 prior myocardial infarction, PCI,
coronary artery bypass operation, stroke, or established peripheral
vascular disease. The primary endpoint was a composite of all-cause death
or new Q-wave MI at 2-years. The secondary safety endpoint was BARC 3 or 5
bleeding. Exploratory secondary endpoints were the patient-orientated
composite endpoint and net adverse clinical events. <br/>Result(s): Among
the 15,761 patients in this cohort were 6,693 patients (42.5%) with
established CVD. Compared to those without established CVD, these patients
had significantly higher rates of the primary (5.1 vs. 3.3%,
HR1.59[1.36-1.86], p <.001) and secondary composite endpoints with no
significant differences in bleeding. There was a nonsignificant reduction
in the primary endpoint in patients with established CVD receiving the
experimental treatment (4.6 vs. 5.6%, HR0.82[0.66-1.02], p =.07). When
comparing patients without CVD to those with one or three territories of
CVD, the hazard ratio for the primary endpoint increased in unadjusted and
adjusted models. <br/>Conclusion(s): The poorer outcomes in patients with
established CVD are not mitigated by prolonged monotherapy with a potent
P2Y12 inhibitor suggesting a greater need to focus on modifiable risk
factors.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<53>
Accession Number
2003927538
Title
Outcomes of patients who undergo percutaneous coronary intervention with
covered stents for coronary perforation: A systematic review and pooled
analysis of data.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Nagaraja V.; Schwarz K.; Moss S.; Kwok C.S.; Gunning M.
Institution
(Nagaraja) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Schwarz) Cardiology Department, Worcestershire Royal Hospital, Worcester,
United Kingdom
(Moss) Orange Base Hospital, Orange, NSW, Australia
(Kwok) School of Primary, Community and Social Care, Keele University,
Stoke-on-Trent, United Kingdom
(Kwok, Gunning) Royal Stoke University Hospital, Stoke-on-Trent, United
Kingdom
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This review aims to evaluate the adverse outcomes for patients
after treatment with covered stents. <br/>Background(s): Coronary
perforation is a potentially fatal complication of percutaneous coronary
revascularization which may be treated using covered stents. Studies have
evaluated long-term outcomes among patients who received these devices,
but hitherto no literature review has taken place. <br/>Method(s): We
conducted a systematic review of adverse outcomes for patients after
treatment with covered stents. Data from studies were pooled and outcomes
were compared according to stent type. <br/>Result(s): A total of 29
studies were analyzed with data from 725 patients who received covered
stents. The proportion of patients with chronic total occlusions, vein
graft percutaneous coronary intervention (PCI), intracoronary imaging and
rotational atherectomy were 16.9, 11.5, 9.2, and 6.6%, respectively. The
stents used were primarily polytetrafluoroethylene (PTFE) (70%) and
Papyrus (20.6%). Mortality, major adverse cardiovascular events,
pericardiocentesis/tamponade and emergency surgery were 17.2, 35.3, 27.1,
and 5.3%, respectively. Stratified analysis by use of PTFE, Papyrus and
pericardial stents, suggested no difference in mortality (p =.323), or
target lesion revascularization (p =.484). Stent thrombosis,
pericardiocentesis/tamponade and emergency coronary artery bypass surgery
(CABG) occurred more frequently in patients with PTFE stent use (p =.011,
p =.005, p =.012, respectively). In-stent restenosis was more common with
pericardial stent use (<.001, pooled analysis for first- and
second-generation pericardial stents). <br/>Conclusion(s): Cases of
coronary perforation which require implantation of a covered stent are
associated with a high rate of adverse outcomes. The use of PTFE covered
stents appears to be associated with more stent thrombosis,
pericardiocentesis/tamponade, and emergency CABG when compared to Papyrus
or pericardial stents.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<54>
Accession Number
2004290778
Title
Prevalence of active tuberculosis infection in transplant recipients: A
systematic review and meta-analysis.
Source
Microbial Pathogenesis. 139 (no pagination), 2020. Article Number: 103894.
Date of Publication: February 2020.
Author
Mamishi S.; Pourakbari B.; Moradzadeh M.; van Leeuwen W.B.; Mahmoudi S.
Institution
(Mamishi, Pourakbari, Moradzadeh, Mahmoudi) Pediatric Infectious Disease
Research Center, Tehran University of Medical Science, Tehran, Iran,
Islamic Republic of
(Mamishi) Department of Infectious Diseases, Pediatrics Center of
Excellence, Children's Medical Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(van Leeuwen) Department of Innovative Molecular Diagnostics, University
of Applied Sciences Leiden, Leiden, Netherlands
Publisher
Academic Press
Abstract
Introduction: Tuberculosis (TB) is considered as a serious complication of
organ transplant; therefore, the detection and appropriate treatment of
active TB infection is highly recommended for the reduction of mortality
in the future. The aim of this review was to conduct a systematic review
and meta-analysis assessing the prevalence of active TB infection in
transplant recipients (TRs). <br/>Material(s) and Method(s): Electronic
databases, including MEDLINE (via PubMed), SCOPUS and Web of Science were
searched up to December 24, 2017. The prevalence of active TB was
estimated using the random effects meta-analysis. Heterogeneity was
evaluated by subgroup analysis. Data were analyzed by STATA version 14.
<br/>Result(s): The pooled prevalence of post-transplant active TB was
estimated 3% [95% CI: 2-3]. The pooled prevalence of active TB in
different transplant forms was as follows: renal,3% [95% CI: 2-4]; stem
cell transplant (SCT), 1% [95% CI: 0-3]; lung, 4% [95% CI: 2-6]; heart, 3%
[95% CI: 2-4]; liver, 1% [95% CI: 1], and hematopoietic stem cell
transplant (HSCT), 2% [95% CI: 1-3]. The prevalence of different clinical
presentations of TB was as follows: pulmonary TB (59%; 95% CI: 54-65),
extra pulmonary TB (27%; 95% CI: 21-33), disseminated TB (15%; 95% CI:
12-19) and miliary TB (8%; 95% CI: 4-13). The pooled prevalence of
different diagnostic tests was as follows: chest X-ray, 57% [95% CI,
46-67]; culture, 56% [95% CI, 45-68]; smear, 49% [95% CI, 40-58]; PCR, 43%
[95% CI, 40-58]; histology, 26% [95% CI, 20-32], and tuberculin skin test,
19% [95% CI, 10-28]. <br/>Conclusion(s): A high suspicion level for TB,
the early diagnosis and the prompt initiation of therapy could increase
the survival rates among SOT patients. Overall, renal and lung TRs appear
to have a higher predisposition for acquiring TB than other type of
recipients. Monitoring of the high-risk recipients, prompt diagnosis, and
appropriate treatment are required to manage TB infection among TRs
especially in endemic areas.<br/>Copyright &#xa9; 2019 Elsevier Ltd

<55>
Accession Number
2002659429
Title
Viscoelastic Blood Tests Use in Adult Cardiac Surgery: Meta-Analysis,
Meta-Regression, and Trial Sequential Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (1) (pp 119-127),
2020. Date of Publication: January 2020.
Author
Meco M.; Montisci A.; Giustiniano E.; Greco M.; Pappalardo F.; Mammana L.;
Panisi P.; Roscitano C.; Cirri S.; Donatelli F.; Albano G.
Institution
(Meco, Panisi, Roscitano, Albano) Anesthesia and Intensive Care
Department, Humanitas Gavazzeni Clinic, Bergamo, Italy
(Montisci, Cirri) Department of Anesthesia and Intensive Care,
Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milano, Italy
(Montisci, Donatelli) Cardiac Surgery, University of Milan, Milano, Italy
(Giustiniano, Greco) Department of Anesthesia and Intensive Care, IRCCS
Humanitas Clinical and Research Center, Rozzano, Italy
(Pappalardo) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute and Vita-Salute San Raffaele University,
Milano, Italy
(Mammana, Donatelli) Department of Cardiac Surgery, Cardiothoracic Center,
Istituto Clinico Sant'Ambrogio, Milano, Italy
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative hemorrhage in cardiac surgery is a significant
cause of morbidity and mortality. Standard laboratory tests fail as
predictors for bleeding in the surgical setting. The use of viscoelastic
(VE) hemostatic assays thromboelastography (TEG) and rotational
thromboelastometry (ROTEM) could be an advantage in patients undergoing
cardiac surgery. The objective of this meta-analysis was to analyze the
effects (benefits and harms) of VE-guided transfusion practice in cardiac
surgery patients. <br/>Design(s): A meta-analysis of randomized trials.
<br/>Setting(s): For this study, PubMed, EMBASE, Scopus, and the Cochrane
Collaboration database were searched, and only randomized controlled
trials were included. A systematic review and meta-analysis were performed
in accordance with the standards set forth by the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses statement, using a
random-effects model. <br/>Participant(s): The study comprised adult
cardiac surgery patients. <br/>Intervention(s): VE-hemostatic assays
transfusion algorithm compared with transfusion algorithms based on
clinicians' discretion. <br/>Measurements and Main Results: Seven
comparative randomized controlled trials were considered, including a
total of 1,035 patients (522 patients in whom a TEG- or ROTEM-based
transfusion algorithm was used). In patients treated according to
VE-guided algorithms, red blood cell (odds ratio 0.61; 95% confidence
interval [CI]: 0.37-0.99; p: 0.04; I²: 66%) and fresh frozen
plasma transfusions (risk difference 0.22; 95% CI: 0.11-0.33; p < 0.0001;
I²: 79%) use was reduced; platelets transfusion was not reduced
(odds ratio 0.61; 95% CI: 0.32-1.15; p: 0.12; I² 74%).
<br/>Conclusion(s): This study demonstrated that the use of VE assays in
cardiac surgical patients is effective in reducing allogenic blood
products exposure, postoperative bleeding at 12 and 24 hours after
surgery, and the need for redo surgery unrelated to surgical
bleeding.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<56>
Accession Number
2002645121
Title
Meta-analysis of propensity matched studies of robotic versus conventional
mitral valve surgery.
Source
Journal of Cardiology. 75 (2) (pp 177-181), 2020. Date of Publication:
February 2020.
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
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: To compare early outcomes after robotic versus conventional
mitral valve surgery (R-MVS versus C-MVS), we performed a meta-analysis of
currently available propensity score matched (PSM) studies.
<br/>Method(s): To identify all PSM studies of R-MVS versus C-MVS, PubMed
and Web of Science were searched thorough November 2018 using the terms of
robotic or robot, mitral, and propensity. Inclusion criteria were PSM
studies of isolated R-MVS versus C-MVS. Odds ratios of dichotomous data
and mean differences for continuous data were generated for each study and
combined in a meta-analysis using the random-effects model.
<br/>Result(s): We identified 7 PSM studies of R-MVS versus C-MVS
enrolling a total of 3764 patients. Pooled analyses demonstrated
significantly longer cardiopulmonary bypass (CPB) (p < 0.00001) and
cross-clamp time (p = 0.004) in R-MVS than C-MVS. However, intensive care
unit (ICU) (p = 0.0005) and hospital stay (p < 0.0001) was significantly
shorter; and incidence of red blood cell (RBC) transfusion (p = 0.03),
prolonged ventilation (p = 0.048), and atrial fibrillation (AF) (p = 0.01)
was significantly less frequent after R-MVS than C-MVS. There was no
significant difference in incidence of reoperation for bleeding and valve
dysfunction, >=moderate mitral regurgitation, renal failure, dialysis,
pneumonia, stroke, cardiac arrest, and all-cause death (p = 0.27) between
R-MVS and C-MVS. <br/>Conclusion(s): ICU/hospital stay was shorter and RBC
transfusion/prolonged ventilation/AF was less frequent after R-MVS than
C-MVS despite longer CPB and cross-clamp time in R-MVS than C-MVS. The
other early outcomes including all-cause mortality were similarly frequent
after R-MVS and C-MVS.<br/>Copyright &#xa9; 2019 Japanese College of
Cardiology

<57>
Accession Number
2002142929
Title
High-Flow Therapy by Nasal Cannulae Versus High-Flow Face Mask in Severe
Hypoxemia After Cardiac Surgery: A Single-Center Randomized Controlled
Study-The HEART FLOW Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (1) (pp 157-165),
2020. Date of Publication: January 2020.
Author
Vourc'h M.; Nicolet J.; Volteau C.; Caubert L.; Chabbert C.; Lepoivre T.;
Senage T.; Roussel J.-C.; Rozec B.
Institution
(Vourc'h, Nicolet, Caubert, Chabbert, Lepoivre, Rozec) Intensive Care Unit
of Cardiothoracic Surgery, Department of Anesthesia and Critical Care,
Hopital Laennec, University Hospital of Nantes, Nantes, France
(Volteau) Department of Methodology and Biostatistics, Department of
Research Promotion, University Hospital of Nantes, Nantes, France
(Senage, Roussel) Cardiovascular and Thoracic Surgery Unit, Hopital
Laennec, University Hospital of Nantes, Nantes, France
Publisher
W.B. Saunders
Abstract
Objective: To determine whether high-flow oxygen therapy by nasal cannulae
(HFNC) is more effective than a high-flow face mask (HFFM) in severe
hypoxemia. <br/>Design(s): Randomized, single-center, open-labeled,
controlled trial. <br/>Setting(s): University Hospital of Nantes, France.
<br/>Participant(s): Cardiac surgery patients presenting oxygen saturation
<96% with Venturi mask 50%. <br/>Intervention(s): Oxygenation by HFNC (45
L/min, F<inf>I</inf>O<inf>2</inf> 100%) or Hudson RCI non-rebreather face
mask with a reservoir bag (15 L/min). <br/>Measurements and Main Results:
The co-primary outcomes were the
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio at 1 and 24 hours. In the
intent-to-treat analysis (90 patients), the mean (standard deviation)
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratios were: after 1 hour,
113.4 (50.2) in HFFM versus 137.8 (57.0) in HFNC (mean difference 24.4, CI
97.5% [2.9-45.9], p = 0.03), and after 24 hours, 106.9 (62.6) in HFFM
versus 129.9 (54.0) in HFNC (mean difference 23.0, CI 97.5% [1.5-44.6], p
= 0.04). After adjustment on baseline
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2,</inf> this difference persisted at
24 hours (p = 0.04). For secondary outcomes, the
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio after 6 hours was 108.7
(47.9) in HFFM versus 136.0 (45.2) in HFNC (p = 0.01), without difference
after 48 hours (p = 0.95). Refractory hypoxemia requiring noninvasive
ventilation occurred in 13 (28%) patients in HFNC versus 24 (56%) patients
in HFFM (p = 0.007). The HFNC improved satisfaction (p = 0.0002) and
reduced mucus dryness (p = 0.003) compared with HFFM. <br/>Conclusion(s):
In patients with severe hypoxemia after cardiac surgery,
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> at 1 and 24 hours were higher
and the use of noninvasive ventilation was reduced in HFNC compared with
HFFM.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<58>
Accession Number
2002972431
Title
Synchronous Carotid Endarterectomy and Coronary Artery Bypass Graft versus
Staged Carotid Artery Stenting and Coronary Artery Bypass Graft for
Patients with Concomitant Severe Coronary and Carotid Stenosis: A
Systematic Review and Meta-analysis.
Source
Annals of Vascular Surgery. 62 (pp 463-473.e4), 2020. Date of Publication:
January 2020.
Author
Texakalidis P.; Charisis N.; Jonnalagadda A.K.; Chaitidis N.; Giannopoulos
S.; Kaskoutis C.; Machinis T.; Koullias G.J.
Institution
(Giannopoulos) Department of Vascular 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
(Jonnalagadda) Division of Cardiology, MedStar Washington Hospital Center,
Washington, DC, United States
(Chaitidis, Kaskoutis) Department of Internal Medicine, 401 General Army
Hospital, Athens, Greece
(Giannopoulos) School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
(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: Owing to the systemic nature of atherosclerosis, medium and
large arteries at different sites are commonly simultaneously affected. As
a result, severe coronary artery disease (CAD) requiring coronary artery
bypass graft (CABG) frequently coexists with significant carotid stenosis
that warrants revascularization. The aim of this study was to compare
synchronous carotid endarterectomy (CEA) and CABG vs. staged carotid
artery stenting (CAS) and CABG for patients with concomitant CAD and
carotid artery stenosis in terms of perioperative (30-day) outcomes.
<br/>Method(s): This study was performed according to the Preferred
Reporting Items for Systematic reviews and Meta-Analyses guidelines.
Eligible studies were identified through a search of PubMed, Scopus, and
Cochrane until July 2018. A meta-analysis was conducted with the use of a
random-effects model. The I-square statistic was used to assess
heterogeneity. <br/>Result(s): Five studies comprising 16,712 patients
were included in this meta-analysis. Perioperative stroke (odds ratio
[OR]: 0.84; 95% confidence interval [CI]: 0.43-1.64; I² =
39.1%), transient ischemic attack (TIA; OR: 0.32; 95% CI: 0.04-2.67;
I² = 27.6%), and myocardial infarction (MI) rates (OR: 0.56;
95% CI: 0.08-3.85; I² = 68.9%) were similar between the two
groups. However, patients who underwent simultaneous CEA and CABG were at
a statistically significant higher risk for perioperative mortality (OR:
1.80; 95% CI: 1.05-3.06; I² = 0.0%). <br/>Conclusion(s): The
current meta-analysis did not detect statistically significant differences
in the rates of perioperative stroke, TIA, and MI between the groups.
However, patients in the simultaneous CEA and CABG group had a
significantly higher risk of 30-day mortality. Future randomized trials or
prospective cohorts are needed to validate our results.<br/>Copyright
&#xa9; 2019 Elsevier Inc.

<59>
Accession Number
630154879
Title
Does general anesthesia affect neurodevelopment in infants and children?.
Source
The BMJ. 367 (no pagination), 2019. Article Number: l6459. Date of
Publication: 2019.
Author
McCann M.E.; Soriano S.G.
Institution
(McCann, Soriano) Department of Anesthesia, Harvard Medical School,
Boston, MA, United States
(McCann, Soriano) Department of Anesthesiology, Critical Care and Pain
Medicine, Boston Children's Hospital, Boston, MA, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
General anesthesia has been unequivocally linked to abnormal development
of the central nervous system, leading to neurocognitive impairments in
laboratory models. In vitro and in vivo studies have consistently shown
that exposure to GABA agonists (eg, volatile anesthetics, midazolam, and
propofol) or NMDA antagonists (eg, ketamine, isoflurane, and nitrous
oxide) produces dose dependent and developmental age dependent effects on
various neuronal transmission systems. Exposure to these drugs increases
neuronal cell death in juvenile animals including rats, mice, and
non-human primates. The possibility of anesthetic induced neurotoxicity
occurring in children has led to concerns about the safety of pediatric
anesthesia. A spectrum of behavioral changes has been documented after
general anesthetic exposure in young children, including emergence
delirium, which may be evidence of toxicity. Most clinical studies are
retrospective; specifics about medications or monitoring are unavailable
and many of the outcomes may not be sensitive to detect small
neurocognitive deficits. Some of these retrospective studies have shown an
association between anesthesia exposure at a young age and neurocognitive
deficits, but others have not. Practitioners and families should be
reassured that although general anesthetics have the potential to induce
neurotoxicity, very little clinical evidence exists to support
this.<br/>Copyright &#xa9; Published by the BMJ Publishing Group Limited.
For permission to use (where not already granted under a licence) please
go to.

<60>
Accession Number
630070931
Title
A pragmatic pilot phase II randomised controlled trial of prothrombin
complex concentrates (PCC) versus fresh frozen plasma (FFP) in adult
patients who are undergoing heart surgery (PROPHESY).
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 684. Date of
Publication: 09 Dec 2019.
Author
Green L.; Roberts N.; Cooper J.; Field J.; Gill R.; Klein A.; Agarwal S.;
Stanworth S.; Johnston A.; Monk V.; O'Brien B.
Institution
(Green) Blizard Institute, Queen Mary University of London, NHS Blood and
Transplant and Barts Health NHS Trust, 4 Newark Street, London E1 2AT,
United Kingdom
(Roberts, O'Brien) St Bartholomew's Hospital, West Smithfield, London EC1A
7BE, United Kingdom
(Cooper, Field, Monk) Barts Cardiovascular Clinical Trials Unit (CVCTU),
William Harvey Research Institute, Heart Centre, Barts and the London
School of Medicine, Queen Mary University of London, Charterhouse Square,
London EC1M 6BQ, United Kingdom
(Gill) Southampton General Hospital, Tremona Road, Southampton SO16 6YD,
United Kingdom
(Klein) Papworth Hospitals NHS Foundation Trust, Papworth Everard,
Cambridge CB23 3RE, United Kingdom
(Agarwal) Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL,
United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust, Headley Way,
Oxford OX3 9BQ, United Kingdom
(Johnston) William Harvey Research Institute, Heart Centre, Barts and the
London School of Medicine, Queen Mary University of London, Charterhouse
Square, London EC1M 6BQ, United Kingdom
(O'Brien) Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH,
United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Fresh frozen plasma (FFP) is the accepted standard treatment
for clotting factor replacement in bleeding patients during or immediately
after cardiac surgery. In the United Kingdom prothrombin complex
concentrate (PCC) is not licensed in this setting, although it is being
used in Europe because it has a higher concentration of clotting factor
levels, and it can be administered rapidly and in small volume, resulting
in less volume overload during cardiac surgery. <br/>Method(s): PROPHESY
is a pragmatic, single-centre, open-label, randomised, controlled pilot
trial that will assess whether it is feasible to perform a large trial in
the future that will compare PCC versus FFP in patients who are bleeding
(not on warfarin) and who require blood transfusion. Over a 15-month
period, 50 patients will be randomised to PCC versus FFP if they develop
active bleeding within 24 h of cardiac surgery and for whom the clinician
has decided to administer FFP for treatment of bleeding. Standard
laboratory and point-of-care assessments will be performed as per routine
practice, and additional research blood samples will be taken at three
time points to assess haemostasis. Subjects will be assessed daily up to
hospital discharge or 30 days or death (whichever occurs first) and will
be seen in follow-up for 90 days after surgery to assess for
thromboembolic complications and hospital re-admission since discharge.
Quality-of-life assessment will be performed pre-surgery and at 90 days
post-surgery. We will also perform qualitative research with clinical
experts and patients to explore the understanding of and experience with
the interventions, as well as adherence to study procedures and protocol.
<br/>Discussion(s): There have been no randomised controlled trials that
have compared the safety and efficacy of FFP versus PCC in cardiac surgery
patients who are bleeding. This pilot study will assess if individual
components of a large trial are deliverable to assess the safety and
efficacy of the two blood products in the future.<br/>Copyright &#xa9;
2019 The Author(s).

<61>
Accession Number
2004095171
Title
Improved Analgesic Effect of Paravertebral Blocks before and after
Video-Assisted Thoracic Surgery: A Prospective, Double-Blinded, Randomized
Controlled Trial.
Source
Pain Research and Management. 2019 (no pagination), 2019. Article Number:
9158653. Date of Publication: 2019.
Author
Chu L.; Zhang X.; Lu Y.; Xie G.; Song S.; Fang X.; Cheng B.
Institution
(Chu, Zhang, Xie, Song, Fang, Cheng) Department of Anesthesiology, First
Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun
Road 79, Hangzhou 31003, China
(Zhang) Department of Anesthesiology, Hangzhou Red Cross Hospital, East
Road 208, Hangzhou 31003, China
(Lu) Department of Anesthesiology, Jiaxing First Hospital, South Zhonghuan
Road 1882, Jiaxing 314000, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Despite being less invasive, patients who underwent video-assisted
thoracic surgery (VATS) suffered considerable postoperative pain.
Paravertebral block (PVB) was proven to provide effective analgesia in
patients with VATS; however, there is no difference in pain relief between
preoperative PVB and postoperative PVB. This study was aimed to
investigate the analgesic efficacy of combination of preoperative and
postoperative PVB on the same patient undergoing VATS. In this
prospective, double-blinded, randomized controlled trial, 44 patients
undergoing VATS were enrolled, and they received patient-controlled
intravenous analgesia (PCIA) with sufentanil plus preoperative PVB (Group
A, n = 15) or postoperative PVB (Group B, n = 15), or combination of
preoperative and postoperative PVB (Group C, n = 14). The primary outcome
was sufentanil consumption and PCIA press times in the first 24 hours
postoperatively. Also, data of postoperative use of PCIA and visual
analogue scale (VAS) were collected. In the first 24 hours
postoperatively, median sufentanil consumption in Group C was 0 (0-34.75)
mug, which was much less than that in Group A (45.00 (33.00-47.00) mug,
p=0.005) and Group B (36 (20.00-50.00) mug, p=0.023). Patients in Group C
pressed less times of PCIA (0 (0-0) times) than patients in Group A (2
(1-6) times, p<0.001) and Group B (2 (1-3) times, p=0.009). Kaplan-Meier
analysis showed patients with combination of preoperative and
postoperative PVB had a higher PCIA-free rate than patients with either
technique alone (p=0.003). The VAS among the three groups was comparable
postoperatively. The combination of both preoperative and postoperative
PVB provides better analgesic efficacy during the early postoperative
period and may be an alternative option for pain control after VATS. This
trial is registered with ChiCTR1800017102.<br/>Copyright &#xa9; 2019 Lihua
Chu et al.

<62>
Accession Number
629680938
Title
Cost-effectiveness analysis of anemia treatment among\chronic kidney
disease patients at kien giang general hospital.
Source
Eurasian Journal of Analytical Chemistry. 13 (3) (pp 262-270), 2018. Date
of Publication: 2018.
Author
Nguyen T.D.; Luong X.P.T.; Dinh T.T.; Nguyen H.T.; Le N.Q.
Institution
(Nguyen) Department of Pharmaceutics and Biopharmaceutics (PB), Faculty of
Pharmacy, University of Medicine Pham Ngoc Thach, Ho Chi Minh City 70000,
Vietnam
(Luong) Department of Pharmacy Administration, Faculty of Pharmacy,
University of Medicine and Pharmacy, Ho Chi Minh City 70000, Vietnam
(Dinh) Department of Pharmacy, Kien Giang General Hospital, Kien Giang
91000, Vietnam
(Nguyen) Faculty of Pharmacy, Buon Ma Thuot University, Dak Lak 63000,
Vietnam
(Le) Department of Pharmaceutical Industry, Faculty of Pharmacy,
University of Medicine and Pharmacy, 41 Dinh Tien Hoang Street, Ben Nghe
Ward, District 1, Ho Chi Minh City 70000, Vietnam
Publisher
Society for Innovative Research
Abstract
Background: Anemia due to chronic kidney disease (CKD) is a dangerous
complication that causes a burden on the patients and society. However, it
can be treated with erythropoietin (EPO). There is a lack of studies
evaluating the cost-effectiveness of EPO in Vietnam in treating anemic
complications, leading to difficulties in decision-making in terms of
prescriptions. <br/>Objective(s): This studied was undertaken to explore
the incremental cost-effectiveness ratio (ICER) of EPO in maintaining
different Hb levels when treating anemia in hemodialysis patients due to
end-stage CKD at Kien Giang General Hospital, Vietnam, in 2017.
<br/>Method(s): Cost-effectiveness analysis (CEA) was performed based on
the decision tree and Markov models. The cost and quality-of-life data was
collected via face-to-face interviews using the KDQOL-SF questionnaire.
The probability coefficients of the model were sought systemically from
the randomised clinical trials. <br/>Result(s): The ICERs indicated that
there were no interventions that were cost-effective in relation to gross
domestic product (GDP) of Vietnam. However, patients with the target Hb
level of >10-11 g/dL were inferred to receive the most benefit from the
treatment, as indicated by the corresponding lowest ICER.
<br/>Conclusion(s): The findings of this study should be proposed to
policy decision makers to set up guidelines for appropriate and
cost-effective use of EPO in hospitals in Vietnam.<br/>Copyright &#xa9;
2018 Society for Innovative Research. All rights reserved.

<63>
Accession Number
629962088
Title
Echocardiographic outcomes from seven randomized trials of transcatheter
versus surgical aortic valve replacement.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 21 (1) (pp 58-64),
2020. Date of Publication: 01 Jan 2020.
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). <br/>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. <br/>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. <br/>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.

<64>
Accession Number
629385587
Title
Complex interaction of obesity, intentional weight loss and heart failure:
A systematic review and meta-analysis.
Source
Heart. 106 (1) (pp 58-68), 2020. Date of Publication: 01 Jan 2020.
Author
Mahajan R.; Stokes M.; Elliott A.; Munawar D.A.; Khokhar K.B.;
Thiyagarajah A.; Hendriks J.; Linz D.; Gallagher C.; Kaye D.; Lau D.;
Sanders P.
Institution
(Mahajan, Stokes, Elliott, Munawar, Khokhar, Thiyagarajah, Hendriks, Linz,
Gallagher, Lau, Sanders) Centre for Heart Rhythm Disorders, University of
Adelaide, Adelaide, SA, Australia
(Mahajan) Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale,
SA, Australia
(Stokes, Elliott, Munawar, Khokhar, Thiyagarajah, Hendriks, Linz,
Gallagher, Lau, Sanders) Department of Cardiology, Royal Adelaide
Hospital, Adelaide, SA, Australia
(Kaye) Department of Cardiology, Alfred Hospital, Melbourne, VIC,
Australia
(Kaye) Heart Research, Baker IDI Heart and Diabetes Institute, Melbourne,
VIC, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The aim of the meta-analysis was to determine the association of
obesity and heart failure (HF) and the cardiac impact of intentional
weight loss following bariatric surgery on cardiac structure and
myocardial function in obese subjects. Methods MEDLINE, Embase and Web of
Science were searched up to 3 April 2018. Studies reporting association
and prognostic impact of obesity in HF and the impact of intentional
weight loss following bariatric surgery on cardiac structure and
myocardial function in obesity were included in the meta-analysis. Results
4959 citations were reviewed. After exclusions, 29 studies were analysed.
A 'J curve' relationship was observed between body mass index (BMI) and
risk of HF with maximum risk in the morbidly obese (1.73 (95% CI 1.30 to
2.31), p<0.001, n=11). Although 'obesity paradox' was observed for
all-cause mortality, the overweight group was associated with lower
cardiovascular (CV) mortality (OR=0.86 (95% CI 0.79 to 0.94), n=11) with
no significant differences across other BMI groups. Intentional weight
loss induced by bariatric surgery in obese patients (n=9) without
established HF, atrial fibrillation or known coronary artery disease, was
associated with a reduction in left ventricular mass index (p<0.0001),
improvement in left ventricular diastolic function (p<=0.0001) and a
reduction in left atrial size (p=0.02). Conclusions Despite the increased
risk of HF with obesity, an 'obesity paradox' is observed for all-cause
mortality. However, the nadir for CV mortality is observed in the
overweight group. Importantly, intentional weight loss was associated with
improvement in indices of cardiac structure and myocardial function in
obese patients. Trial registration number APP 74412.<br/>Copyright &#xa9;
Author(s) (or their employer(s)) 2020. No commercial re-use. See rights
and permissions. Published by BMJ.

<65>
Accession Number
629881543
Title
Occurence of First and Recurrent Major Adverse Cardiovascular Events with
Liraglutide Treatment among Patients with Type 2 Diabetes and High Risk of
Cardiovascular Events: A Post Hoc Analysis of a Randomized Clinical Trial.
Source
JAMA Cardiology. 4 (12) (pp 1214-1220), 2019. Date of Publication:
December 2019.
Author
Verma S.; Bain S.C.; Buse J.B.; Idorn T.; Rasmussen So.; Orsted D.D.;
Nauck M.A.
Institution
(Verma) Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St
Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON M5B
1W8, Canada
(Bain) Diabetes Research Unit Cymru, Swansea University Medical School,
Swansea, United Kingdom
(Buse) Department of Medicine, University of North Carolina School of
Medicine at Chapel Hill, Chapel Hill, United States
(Idorn, Rasmussen, Orsted) Novo Nordisk A/S, Soborg, Denmark
(Nauck) Diabetes Center Bochum-Hattingen, St Josef Hospital,
Ruhr-Universitat Bochum, Bochum, Germany
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: After the occurrence of nonfatal cardiovascular events,
recurrent events are highly likely. Most cardiovascular outcomes trials
analyze first events only; extending analyses to first and recurrent
(total) events can provide clinically meaningful information.
<br/>Objective(s): To investigate whether liraglutide is associated with
reduced first and recurrent total major adverse cardiovascular events
(MACE) compared with placebo among patients with type 2 diabetes and high
risk of cardiovascular events. <br/>Design, Setting, and Participant(s):
This post hoc analysis of the Liraglutide Effect and Action in Diabetes:
Evaluation of Cardiovascular Outcome Results (LEADER) randomized,
double-blind, clinical trial included data from patients with type 2
diabetes who had established or were at high risk for cardiovascular
disease at 410 sites in 32 countries from August 2010, to December 2015.
Data analysis was performed from August 15, 2016, to July 5, 2019.
<br/>Intervention(s): Patients were randomized 1:1 to receive liraglutide
(up to 1.8 mg per day) or placebo, both with standard care, for 3.5 to 5.0
years. <br/>Main Outcomes and Measures: Assessed outcomes were MACE
(cardiovascular death, nonfatal myocardial infarction, and nonfatal
stroke), expanded MACE (primary MACE plus coronary revascularization and
hospitalization for heart failure or unstable angina pectoris), and the
individual end points. <br/>Result(s): The 9340 LEADER trial participants
(6003 [64.3%] male; mean [SD] age, 64.3 [7.2] years) experienced 1605
total MACE (1302 first and 303 recurrent events; median follow-up, 3.8
years [range, 0-5.2 years]). Patients who experienced any MACE were older
(1 MACE: mean [SD] age, 65.6 [8.0] years; >1 MACE: 65.7 [7.9] years) and
had diabetes for longer duration (1 MACE: mean [SD] duration, 13.4 [8.3]
years; >1 MACE: 14.4 [8.7] years) compared with patients without MACE
(mean [SD] age, 64.1 [7.1] years; mean [SD] duration, 12.7 [7.9] years).
Fewer first and recurrent MACE occurred in the liraglutide group (n =
4668; 608 first and 127 recurrent events) than in the placebo group (n =
4672; 694 first and 176 recurrent events). Liraglutide was associated with
a 15.7% relative risk reduction in total MACE (hazard ratio [HR], 0.84;
95% CI, 0.76-0.93) and a 13.4% reduction in total expanded MACE (HR, 0.87;
95% CI, 0.81-0.93) compared with placebo. For most individual
cardiovascular end points, liraglutide was associated with lower risk vs
placebo. <br/>Conclusions and Relevance: These results suggest that
liraglutide treatment is associated with reduced total MACE compared with
placebo among patients with type 2 diabetes and high risk of
cardiovascular events. This analysis supports the findings of an absolute
benefit of liraglutide treatment with respect to the overall burden of
cardiovascular events in this high-risk patient population.<br/>Copyright
&#xa9; 2019 American Medical Association. All rights reserved.

<66>
Accession Number
2003895247
Title
Toward a robust tool for pharmacokinetic-based personalization of
treatment with tacrolimus in solid organ transplantation: A model-based
meta-analysis approach.
Source
British Journal of Clinical Pharmacology. (no pagination), 2019. Date of
Publication: 2019.
Author
Nanga T.M.; Doan T.T.P.; Marquet P.; Musuamba F.T.
Institution
(Nanga, Doan, Marquet) INSERM UMR 1248, Universite de Limoges, FHU
support, Limoges Cedex 87025, France
(Musuamba) Federal Agency for Medicines and Health Products, Brussels,
Belgium
(Musuamba) Faculte des sciences pharmaceutiques, Universite de Lubumbashi,
Lubumbashi, Democratic Republic Congo
Publisher
Blackwell Publishing Ltd
Abstract
Aims: The objective of this study is to develop a generic model for
tacrolimus pharmacokinetics modelling using a meta-analysis approach, that
could serve as a first step towards a prediction tool to inform
pharmacokinetics-based optimal dosing of tacrolimus in different
populations and indications. <br/>Method(s): A systematic literature
review was performed and a meta-model developed with NONMEM software using
a top-down approach. Historical (previously published) data were used for
model development and qualification. In-house individual rich and sparse
tacrolimus blood concentration profiles from adult and paediatric kidney,
liver, lung and heart transplant patients were used for model validation.
Model validation was based on successful numerical convergence, adequate
precision in parameter estimation, acceptable goodness of fit with respect
to measured blood concentrations with no indication of bias, and
acceptable performance of visual predictive checks. External validation
was performed by fitting the model to independent data from 3 external
cohorts and remaining previously published studies. <br/>Result(s): A
total of 76 models were found relevant for meta-model building from the
literature and the related parameters recorded. The meta-model developed
using patient level data was structurally a 2-compartment model with
first-order absorption, absorption lag time and first-time varying
elimination. Population values for clearance, intercompartmental
clearance, central and peripheral volume were 22.5 L/h, 24.2 L/h, 246.2 L
and 109.9 L, respectively. The absorption first-order rate and the lag
time were fixed to 3.37/h and 0.33 hours, respectively. Transplanted organ
and time after transplantation were found to influence drug apparent
clearance whereas body weight influenced both the apparent volume of
distribution and the apparent clearance. The model displayed good results
as regards the internal and external validation. <br/>Conclusion(s): A
meta-model was successfully developed for tacrolimus in solid organ
transplantation that can be used as a basis for the prediction of
concentrations in different groups of patients, and eventually for
effective dose individualization in different subgroups of the
population.<br/>Copyright &#xa9; 2019 The British Pharmacological Society

<67>
Accession Number
628417462
Title
Clinical guidelines for perioperative hemodynamic management of non
cardiac surgical adult patients.
Source
Minerva anestesiologica. 85 (12) (pp 1315-1333), 2019. Date of
Publication: 01 Dec 2019.
Author
Brienza N.; Biancofiore G.; Cavaliere F.; Corcione A.; De Gasperi A.; De
Rosa R.C.; Fumagalli R.; Giglio M.T.; Locatelli A.; Lorini F.L.; Romagnoli
S.; Scolletta S.; Tritapepe L.
Institution
(Brienza) Unit of Anesthesia and Resuscitation, Department of Emergencies
and Organ Transplantations, Aldo Moro University, Bari, Italy
(Biancofiore) Operative Unit of Anesthesia and Transplant Resuscitation,
University of Pisa, Pisa, Italy
(Cavaliere) Unit of Cardiac Anesthesia and Cardiosurgical Intensive
Therapy, A. Gemelli University Polyclinic, Sacred Heart Catholic
University, Rome, Italy
(Corcione, De Rosa) Operative Unit of Anesthesia and Intensive
Postoperative Therapy, Department of Critical Area, Colli-Monaldi
Hospital, Naples, Italy
(De Gasperi) Operative Unit of Anesthesia and Resuscitation II, Niguarda
Ca' Granda Hospital, Milan, Italy
(Fumagalli) Operative Unit of Anesthesia and Resuscitation I, Milano
Bicocca University, Niguarda Ca' Granda Hospital, Milan, Italy
(Giglio) Unit of Anesthesia and Resuscitation, Department of Emergencies
and Organ Transplantations, Aldo Moro University, Bari, Italy
(Locatelli) Service of Anesthesia and Cardiovascular Intensive Therapy,
Department of Emergency and Critical Area, Santa Croce e Carle Hospital,
Cuneo, Italy
(Lorini) Department of Emergency, Papa Giovanni XXIII Hospital, Bergamo,
Italy
(Romagnoli) Department of Anesthesia and Resuscitation, University of
Florence, Careggi University Hospital, Florence, Italy
(Scolletta) Unit of Resuscitation and Critical Medicine, Department of
Medicine, Surgery and Neurosciences, University Hospital of Siena, Siena,
Italy
(Tritapepe) Operative Unit of Anesthesia and Intensive Therapy in
Cardiosurgery, Department of Emergency and Admission, Umberto I
Policlinic, Sapienza University, Rome, Italy
Publisher
NLM (Medline)
Abstract
Perioperative hemodynamic management, through monitoring and intervention
on physiological parameters to improve cardiac output and oxygen delivery
(goal-directed therapy, GDT), may improve outcome. However, an Italian
survey has revealed that hemodynamic protocols are applied by only 29.1%
of anesthesiologists. Aim of this paper is to provide clinical guidelines
for a rationale use of perioperative hemodynamic management in non cardiac
surgical adult patients, oriented for Italy and updated with most recent
studies. Guidelines were elaborated according to NICE (National Institute
for Health and Care Excellence) and GRADE system (Grading of
Recommendations of Assessment Development and Evaluations). Key questions
were formulated according to PICO system (Population, Intervention,
Comparators, Outcome). Guidelines and systematic reviews were identified
on main research databases and strategy was updated to June 2018. There is
not enough good quality evidence to support the adoption of a GDT protocol
in order to reduce mortality, although it may be useful in high risk
patients. Perioperative GDT protocol to guide fluid therapy is recommended
to reduce morbidity. Continuous monitoring of arterial pressure may help
to identify short periods of hemodynamic instability and hypotension.
Fluid strategy should aim to a near zero balance in normovolemic patients
at the beginning of surgery, and a slight positive fluid balance may be
allowed to protect renal function. Drugs such as inotropes,
vasocostrictors, and vasodilatator should be used only when fluids alone
are not sufficient to optimize hemodynamics. Perioperative GDT protocols
are associated with a reduction in costs, although no economic study has
been performed in Italy.

<68>
Accession Number
628051208
Title
Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for
Acute and Chronic Pain Prevention.
Source
Pain physician. 22 (3) (pp 271-280), 2019. Date of Publication: 01 May
2019.
Author
Abd-Elshafy S.K.; Abdallal F.; Kamel E.Z.; Edwar H.; Allah E.A.; Maghraby
H.H.M.; Sayed J.A.; Ali M.S.; Elkhayat H.; Mahran G.S.K.
Institution
(Abd-Elshafy) Department of Anesthesia, Intensive Care, Pain Management,
South Egypt Cancer Institute, Assiut University
(Abdallal, Edwar, Allah, Maghraby, Sayed, Ali) Department of Anesthesia,
Faculty of Medicine, Assiut University, Egypt
(Kamel) Assiut University, Egypt
(Elkhayat) Cardiothoracic surgery, Assiut University, Faculty of Medicine,
Egypt
(Mahran) Department of Critical Care and Emergency Nursing, Faculty of
Nursing, Assiut University, Egypt
Publisher
NLM (Medline)
Abstract
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is considered as
one of the minimally invasive surgeries. Early postoperative pain
alleviation is very important to avoid complications, at the same time,
proper early pain control is an established fact to decrease the incidence
of chronic pain. <br/>OBJECTIVE(S): To evaluate the efficacy of thoracic
paravertebral block (PVB) by a bupivacaine/ dexmedetomidine mixture on
acute and chronic post-thoracoscopic surgery pain in patients undergoing
VATS. STUDY DESIGN: A randomized prospective double-blinded trial.
SETTING: Assiut University Hospitals, Orman Cardiology Hospital.
<br/>METHOD(S): Sixty adult patients underwent elective VATS surgery under
general anesthesia randomly allocated into 2 groups; Group I received
thoracic PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and Group II
received PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and
dexmedetomidine (1 mcg/kg). Postoperative pain (at rest, with cough, and
with movement) was assessed through a visual analog scale (VAS) every 30
minutes in the first 2 hours, then at the second, fourth, eighth, and 24th
hours. Time to first analgesia request and consumption of intravenous
rescue analgesia (ketorolac tromethamine 30 mg/dose) was recorded.
Follow-up of the patients regarding the incidence of chronic
post-thoracoscopic pain by the end of the third and sixth months after the
procedure was reviewed through the Leeds Assessment of Neuropathic
Symptoms and Signs (LANSS) pain scale. <br/>RESULT(S): VAS score was
significantly lower in Group II during the early postoperative 90 minute
records. Pain with cough and with movement persisted to be significantly
lower in Group II up to the second postoperative hour. Time to first
analgesia requirement was significantly longer in Group II in comparison
to Group (P < 0.001). There was less ketorolac consumption in Group II
than in Group I (P = 0.002). At the third month, Group II showed
significantly lower incidence of LANSS pain scale than Group I (P = 0.04).
LIMITATIONS: There was the heterogeneity of surgical procedures in the
patients. <br/>CONCLUSION(S): Dexmedetomidine as an adjuvant to
bupivacaine PVB offers better pain relief during the early postoperative
hours, and it carries a favorable effect on chronic postoperative
pain.Clinical trial registry number: NCT03632161. KEY WORDS:
Dexmedetomidine, paravertebral block, video-assisted thoracoscopic
surgery, postoperative pain, chronic pain.

<69>
Accession Number
629354251
Title
Levosimendan in patients with left ventricular dysfunction undergoing
cardiac surgery: a meta-analysis and trial sequential analysis of
randomized trials.
Source
Scientific reports. 8 (1) (pp 7775), 2018. Date of Publication: 17 May
2018.
Author
Xing Z.; Tang L.; Chen P.; Huang J.; Peng X.; Hu X.
Institution
(Xing, Tang, Chen, Huang, Peng, Hu) Department of Cardiovascular Medicine,
Second Xiangya Hospital, Central South University, Changsha, Hunan 410011,
China
Publisher
NLM (Medline)
Abstract
Patients with left ventricular dysfunction (LVD) undergoing cardiac
surgery have a high mortality rate. Levosimendan, a calcium sensitizer,
improves myocardial contractility without increasing myocardial oxygen
demand. It is not clear whether levosimendan can reduce mortality in
cardiac surgery patients with LVD. The PubMed, Embase, and Cochrane
Central databases were searched to identify randomized trials comparing
levosimendan with conventional treatment in cardiac surgery patients with
LVD. We derived pooled risk ratios (RRs) with random effects models. The
primary endpoint was perioperative mortality. Secondary endpoints were
renal replacement treatment, atrial fibrillation, myocardial infarction,
ventricular arrhythmia, and hypotension. Fifteen studies enrolling 2606
patients were included. Levosimendan reduced the incidence of
perioperative mortality (RR: 0.64, 95%CI: 0.45-0.91) and renal replacement
treatment (RR:0.71, 95%CI:0.52-0.95). However, sensitivity analysis,
subgroup analysis and Trial Sequential Analysis (TSA) indicated that more
evidence was needed. Furthermore, levosimendan did not reduce the
incidence of atrial fibrillation (RR:0.82, 95%CI:0.64-1.07), myocardial
infarction (RR:0.56, 95%CI:0.26-1.23), or ventricular arrhythmia (RR:0.74,
95%CI:0.49-1.11), but it increased the incidence of hypotension
(RR:1.11,95%CI:1.00-1.23). There was not enough high-quality evidence to
either support or contraindicate the use of levosimendan in cardiac
surgery patients with LVD.

<70>
Accession Number
609632251
Title
Pharmacist intervention in pain management following heart surgery.
Source
European Journal of Hospital Pharmacy. 22 (5) (pp 306-308), 2015. Date of
Publication: September 2015.
Author
Decelis D.A.; Adami M.Z.; Galea J.; Attard-Pizzuto M.; Inglott A.S.;
Azzopardi L.M.
Institution
(Decelis, Adami, Attard-Pizzuto, Inglott, Azzopardi) Department of
Pharmacy, Faculty of Medicine and Surgery, University of Malta, Joselove,
Triq il-Merill, Mosta MST4611, Malta
(Galea) Department of Surgery, Faculty of Medicine and Surgery, University
of Malta, Msida, Malta
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: Pain is a common symptom in cardiac surgery patients. This
study aimed to investigate the influence of pharmacist intervention to
ease postoperative pain in cardiac surgery patients. Methodology: Patients
undergoing heart surgery were randomised to control or intervention. The
intervention group was given systematic verbal information and, at
discharge, a pharmaceutical care plan. Pain score and diary assessment
were compared up to 6 weeks after the surgery. <br/>Result(s): 100
patients participated. Mean Pain Score was lower in the intervention group
from week 1 to 6 (p<0.05). Compliance with analgesic was higher in the
intervention group. <br/>Conclusion(s): The intervention improved
compliance and decreased pain score, illustrating the positive effect the
pharmacist had on these patients.

<71>
Accession Number
630316765
Title
Characteristics and financial impact of potentially inappropriate platelet
transfusion in the inpatient hospital setting.
Source
Blood. Conference: 61st Annual Meeting of the American Society of
Hematology, ASH 2019. United States. 134 (Supplement 1) (no pagination),
2019. Date of Publication: November 2019.
Author
Mou E.; Murphy C.; Hom J.; Shieh L.; Shah N.
Publisher
American Society of Hematology
Abstract
Introduction Platelets are transfused prophylactically to prevent
hemorrhage in a variety of patient populations. However, guidelines
indicate that prophylactic platelet transfusions in patients with platelet
counts above 50k/uL are usually not indicated, with notable exceptions
including those undergoing neurological or cardiac bypass surgery. Common
minor procedures such as paracentesis, central line placement, and lumbar
puncture have been safely performed at platelet counts below 50k/uL.
Despite this evidence, our institution incurred approximately 10 million
dollars (USD) in direct platelet costs in 2017, with nearly 40% of
platelet transfusions are occurring when the patient's platelet count
exceeded 50k/uL. Given the significant financial impact of, and potential
adverse effects associated with inappropriate platelet transfusion, we
implemented a best practice advisory (BPA) in our electronic medical
record (EMR) in order to better characterize patterns of platelet
transfusion orders in patients with platelet counts >50k/uL. Methods An
EMR-embedded BPA was activated in the inpatient hospital setting of a
large, tertiary care academic medical center on May 1, 2019, and triggered
whenever a platelet transfusion order was placed on an admitted patient
whose most recent documented platelet count was >50k/ul. To inform the
comparative impact of BPA alerts on provider behavior, alerts were
randomized at the patient level to trigger either in standard or silent
fashion. For standard alerts, the BPA appeared on-screen, informing the
provider that their platelet transfusion order was potentially
inappropriate and citing supportive evidence. Providers had the option of
following or overriding the alert (Figure 1). In case of alert override, a
pre-specified or free text justification was requested. Pre-specified
options included upcoming neurosurgery, cardiac bypass surgery, known
qualitative platelet defects, or patients taking antiplatelet drugs.
Charge data were based on charges for platelet transfusion orders as
listed in the hospital charge master. Results From May 1, 2019 to July 30,
2019, the alert fired 181 times (Figure 2). Alerts were silently triggered
in 64 (35%) cases. Of the 117 active alerts, 23 (20%) were followed and 94
(80%) were overridden. The most common reasons for alert override included
prophylactic transfusions ahead of non-cardiac and non-neurosurgical
operations (18%), upcoming cardiac bypass surgery (18%), qualitative
platelet defects (12%), active central nervous system (CNS) bleeding
(12%), and active non-CNS bleeding (7%). The estimated cost savings
associated with followed alerts was $18,170 USD. Discussion Our BPA was
effective in reducing instances of platelet transfusion orders by 20% over
a threemonth period, translating to an estimated annual savings of nearly
$70,000 USD in hospital charges. Conversely, the 80% alert override rate
indicates that platelet transfusion in patients with platelet counts
>50k/uL remains common, occurring in a variety of contexts. Potentially
appropriate reasons for platelet transfusions included orders in the
setting of cardiovascular bypass surgery, active CNS bleeding, or
qualitative platelet defects, representing circumstances in which platelet
thresholds are often set higher than 50k/uL. Alternatively, 25% of alert
overrides occurred in potentially inappropriate contexts, including
patients undergoing non-cardiovascular/non-neurosurgical procedures and
patients with non-CNS active bleeding, settings where routinely targeting
a platelet threshold >50k/uL is not supported by evidence. As a result of
our study's randomized design, future directions include comparative
analyses between patient care encounters in which alerts were silently
versus visibly triggered, allowing for rigorous determination as to
whether providers' interaction with our BPA influences subsequent rates of
potentially inappropriate platelet utilization as compared to a control
group. Overall, our findings show that platelets are frequently ordered in
potentially inappropriate settings, and that reducing these orders imparts
significant financial savings. These results provide an impetus for
interventions directed at educating providers on appropriate platelet
ordering practices, in order to further reduce unnecessary expenditures
and optimize patient care.

<72>
Accession Number
630316535
Title
Maximum 24-hour platelet count fall rate as a predictor of hit.
Source
Blood. Conference: 61st Annual Meeting of the American Society of
Hematology, ASH 2019. United States. 134 (Supplement 1) (no pagination),
2019. Date of Publication: November 2019.
Author
Lefler D.S.; Cuker A.; Pishko A.M.
Publisher
American Society of Hematology
Abstract
Background: Heparin-induced thrombocytopenia (HIT) is a high-stakes
diagnosis. A delay in initiation of appropriate therapy is associated with
a 6.1% daily incidence of thrombosis, amputation, and death (Greinacher et
al, Blood 2000). However, misdiagnosis exposes patients without HIT to
alternative anticoagulants and their attendant risk of major bleeding.
Although a meta-analysis showed that the negative predictive value (NPV)
of a low-probability 4Ts score is 99.8%, the positive predictive value
(PPV) of the 4Ts score is limited. This is particularly true among
individuals with an intermediate-probability score, in whom the PPV is
only 14% (Cuker et al. Blood 2012). It has been observed that
immune-mediated causes of thrombocytopenia result in a more precipitous
fall in the platelet count than other common causes of hospital-acquired
thrombocytopenia (e.g. infection, disseminated intravascular coagulation,
drug-induced myelosuppression). Nevertheless, the pace of platelet count
fall is not currently captured in the 4Ts score or other clinical
prediction models for HIT. We hypothesized that rapidity of the platelet
count fall could help to discriminate HIT status among patients with an
intermediate probability 4Ts score. <br/>Method(s): In a cohort of 292
patients with suspected HIT and prospectively calculated 4Ts scores, we
identified patients with an intermediate 4Ts score (4 or 5). Patients were
classified as HIT-positive or HIT-negative by an independent panel of HIT
experts as previously described (Pishko et al. Blood Advances 2018). We
compared the frequency of scores in each of the 4Ts score categories
between HIT-positive and-HIT negative patients using Chi-square analysis.
For each day from hospital admission to day of HIT laboratory testing, we
extracted the first measured platelet count, exposure to heparin, and
platelet transfusions. We also extracted the dates of the following events
of interest, as they may be associated with an immediate fall in platelet
count: cardiovascular surgery, initiation of extracorporeal membrane
oxygenation, intra-aortic balloon pump placement, Impella device
placement, and left ventricular assist device implantation. Two reviewers
reviewed the platelet count and clinical data for each patient to
determine the day on which the platelet count began to decline, excluding
platelet count falls 24 hours following one of the aforementioned events
of interest. From this date, we calculated the change in platelet count
per each 24-hour timeframe, expressed as a percentage of the previous
day's platelet count. For each subject, we identified the maximum
percentage decrease in platelet count in a 24-hour period
(Fall<inf>max</inf>). We then compared the Fall<inf>max</inf> between
HIT-positive and HIT-negative subjects using the Wilcoxon-rank sum test.
We assessed the operating characteristics of Fall<inf>max</inf> for the
diagnosis of HIT at different cut-offs. We selected a cut-off that
maximized specificity of the metric while maintaining a sensitivity of
>=95%. <br/>Result(s): Among 292 patients, 158 (54.1%) had a 4Ts score of
4 or 5. Twenty-two (13.9%) were HITpositive and 136 (86.1%) were
HIT-negative. Patient characteristics are listed in table 1. No single
item in the 4Ts score exhibited a significant relationship with HIT
diagnosis (table 2). The median Fall<inf>max</inf> was 49.6% (IQR
42.3-58.9) in HIT-positive patients and 38.5% (IQR 27.8-50.4) in
HIT-negative patients (p=0.009). At a Fall<inf>max</inf> cut off of >=
30%, the sensitivity and specificity of this measure for the diagnosis of
HIT was 95.5% (95% CI 77.2%-99.9%) and 29.4% (95% CI 21.9%-37.8%),
respectively (table 3). 29.4% (40/136) of the HIT-negative patients had a
Fall<inf>max</inf> below this cut-off versus only 2.4% (1/22) HIT-positive
patients. <br/>Conclusion(s): The maximum percentage decrease in platelet
count within 24-hours (Fall<inf>max</inf>) was significantly higher in
HIT-positive versus HIT-negative patients. A Fall<inf>max</inf> >= 30% may
be a useful metric to discriminate HIT positivity among patients with an
intermediate 4Ts score. In this cohort, nearly 30% of HIT negative
patients did not meet this cut-off and thus may have been spared
alternative anticoagulant exposure. The rapidity of platelet count fall
holds promise as a marker for improving the PPV of the 4Ts score, though
it requires further evaluation and external validation. (Table Presented).

<73>
Accession Number
630316469
Title
2018 evidence base of patient blood management - Recommendations from the
first international consensus conference, Frankfurt/Main, Germany.
Source
Blood. Conference: 61st Annual Meeting of the American Society of
Hematology, ASH 2019. United States. 134 (Supplement 1) (no pagination),
2019. Date of Publication: November 2019.
Author
Mueller M.M.; Van Remoortel H.; Meybohm P.; Aranko K.; Murphy M.; Carson
J.L.; Seifried E.
Publisher
American Society of Hematology
Abstract
Introduction: The analysis of published clinical trial results is
essential for the evidence base of patient blood management (PBM). In
addition, an evidence-based way of developing guidelines and
recommendation is indispensable for high quality patient-centred
hemotherapy. The international Consensus Conference (ICC) was set up in
order to develop evidence-based clinical and research recommendations for
preoperative anemia, red blood cell (RBC) transfusion thresholds in adult
patients and implementation of PBM programmes. <br/>Method(s): An
international scientific committee (SC) defined 17
population-intervention-comparison-outcome (PICO) questions for the three
topics preoperative anemia, red blood cell (RBC) transfusion S thresholds
in adult patients and implementation of PBM. From these 17 PICO questions,
literature search was conducted in four biomedical databases. Several
meta-analyses, forest plots, the GRADE methodology (= grading of
recommendations, assessment, development and evaluation), GRADEpro, the
open source online database for GRADE as well as the Evidence-to-Decision
(EtD) framework were used in order to keep the development of
recommendations as evidence-based and transparent as possible. Three
expert panels (EP) consisting of clinicians, scientists, nurses, patient
representatives and methodologists were established and used the methods
described above in order to develop recommendations driven by published
evidence. <br/>Result(s): Out of more than 17,500 literature citations,
data from 145 studies (63 randomised trials including more than 23,000
patients (pts.) & 82 observational studies including more than 4 million
pts.) was incorporated into the final analysis. The expert panel for
preoperative anemia developed 4 clinical and 3 research recommendations. A
strong recommendation advocates for early detection and management of
preoperative anemia before major elective surgery. For RBC transfusion
thresholds, 4 clinical and 6 research recommendations came out of the
process. Two strong clinical recommendations for PBC transfusion
thresholds advocate a hemoglobin level (hb) of < 7 g/dL for critical ill,
but clinical stable adult intensive care patients independent of septic
shock and < 7.5 g/dL for adults undergoing cardiac surgery. For
implementation of PBM programmes, 2 clinical and 3 research
recommendations were defined. Research recommendations define open fields
in PBM and try to initiate additional studies in order to answer still
open questions. <br/>Conclusion(s): This is the first ICC for PBM defining
the evidence base for three clinically important hemotherapy topics. The
relative paucity of strong evidence in current PBM literature underscores
the ongoing struggle to a.) find internationally accepted definitions e.g.
for anemia and b.) execute internationally planned meaningful multicentre
trials in the still open fields of PBM. The clinical recommendations found
here however should be considered and accepted in clinical practice.

<74>
Accession Number
2004352546
Title
Impact of Stroke Volume Index and Left Ventricular Ejection Fraction on
Mortality After Aortic Valve Replacement.
Source
Mayo Clinic Proceedings. 95 (1) (pp 69-76), 2020. Date of Publication:
January 2020.
Author
Ito S.; Nkomo V.T.; Orsinelli D.A.; Lin G.; Cavalcante J.; Popma J.J.;
Adams D.H.; Checuti S.J.; Deeb G.M.; Boulware M.; Huang J.; Little S.H.;
Cohen S.A.; Reardon M.J.; Oh J.K.
Institution
(Ito, Nkomo, Lin, Oh) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
(Orsinelli) Department of Cardiology, Ohio State University Wexner Medical
Center, Columbus, United States
(Cavalcante) Minneapolis Heart Institute, MN, United States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Adams) Department of Cardiothoracic Surgery, Mount Sinai Medical Center,
New York, NY, United States
(Checuti, Deeb) Department of Cardiac Surgery and Interventional
Cardiology, University of Michigan Hospitals, Ann Arbor, United States
(Boulware, Huang, Cohen) Department of Clinical Research and Statistical
Services, Medtronic, Minneapolis, MN, United States
(Little, Reardon) Department of Cardiology and Cardiothoracic Surgery,
Houston Methodist Debakey Heart and Vascular Center, TX, United States
(Cohen) Division of Cardiovascular Medicine, Perelman School of Medicine,
Philadelphia, PA, United States
Publisher
Elsevier Ltd
Abstract
Objective: To assess the impact of stroke volume index (SVI) and left
ventricular ejection fraction (LVEF) on prognosis in patients with severe
aortic stenosis, comparing those undergoing transcatheter aortic valve
replacement (TAVR) and those with surgical AVR (SAVR). <br/>Patients and
Methods: A total of 742 patients from the CoreValve US Pivotal High-Risk
Trial randomized to TAVR (n=389) or SAVR (n=353) from February 2011 to
September 2012 were stratified by an SVI of 35 mL/m² and LVEF
of 50% for comparing all-cause mortality at 1 year. <br/>Result(s): The
prevalence of an SVI of less than 35 mL/m² in patients who
underwent TAVR and SAVR was 35.8% (125 of 349) and 31.3% (96 of 307),
respectively; LVEF of less than 50% was present in 18.1% (63 of 348) and
19.6% (60 of 306), respectively. Among patients with an SVI of less than
35 mL/m², 1-year mortality was similar between patients with
TAVR and SAVR (16.3% vs 22.2%; P=.25). However, in those with an SVI of 35
mL/m² or greater, 1-year mortality was lower in those with TAVR
than SAVR (10.3% vs 17.3%; P=.03). In patients with an LVEF of less than
50%, mortality was not affected by AVR approach (P>.05). In patients with
an LVEF of 50% or higher, TAVR was associated with lower mortality than
SAVR when SVI was preserved (9.8% vs 18.6%; P=.01). Mortality was not
affected by SVI within the same AVR approach when LVEF was 50% or higher.
<br/>Conclusion(s): In patients with severe aortic stenosis at high risk,
there is a significant interaction between AVR approach and the status of
SVI and LVEF. When LVEF or SVI was reduced, prognosis was similar
regardless of AVR approach. In those with preserved LVEF or SVI, TAVR was
associated with a better prognosis than SAVR. Trial Registration:
clinicaltrials.gov Identifier: NCT01240902<br/>Copyright &#xa9; 2019 Mayo
Foundation for Medical Education and Research

<75>
Accession Number
2004368705
Title
Efficacy and safety of transcarotid transcatheter aortic valve
replacement: A systematic review.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Bob-Manuel T.; Almusawi H.; Rezan T.; Khaira H.; Akingbola A.; Nasir A.;
Soto J.T.; Jenkins J.; Ibebuogu U.N.
Institution
(Bob-Manuel, Rezan, Khaira, Akingbola, Nasir, Soto, Jenkins) John Ochsner
Heart and Vascular Center, New Orleans, LA, United States
(Almusawi) Department of Hospital Medicine, Leonard J Charbert Medical
Center, Houma, LA, United States
(Ibebuogu) Division of Cardiology, University of Tennessee Health Science
Center, Memphis, TN, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: In patients who are not suitable for traditional access routes
for transcatheter aortic valve replacement (TAVR) due to severe peripheral
vascular disease (PVD) or prohibitive surgical risk, carotid artery (CA)
access is an emerging route for TAVR. This study represents the most up to
date on outcomes of carotid access TAVR. <br/>Method(s): A systematic
review was conducted as per the Preferred Reporting Instructions for
Systematic Reviews and Meta-analysis (PRISMA). We performed a thorough
electronic search through Pubmed, SCOPUS and Embase databases. Statistical
analyses were performed using SPSS version 24 (IBM Corporation, Armonk,
New York, USA). <br/>Result(s): A total of 15 non-randomized studies were
included in this systematic review comprising of patients that received
TAVR via 4 vascular access sites, transcarotid (TC) (N = 1035),
transfemoral (TF) (N = 1116), transapical (TAP) (N = 307), transaortic
(TAO) (N = 176) and transaxillary (TAX) (N = 90). In the Transcarotid
cases, device success was achieved in 95.6% of patients (n = 748). The
30-day and 1-yr mortality was 4.2% and 10.5% respectively. 15.3% of
patients required new pacemaker implantation. In-hospital stroke or TIA
occurred in 4% of cases. 30-day stroke or TIA occurred in 5% of cases.
There were no hemorrhagic strokes. 30-day Mortality was significantly
higher in the Transaortic group (12.1%) compared to the Transcarotid group
(2.6%) [RR = 2.93 95% CI = 1.15-7.58; p = 0.027]. There were no
differences in outcomes between the Transcarotid group and the Transapical
or Transaxillary groups. <br/>Conclusion(s): The most contemporary data on
Carotid access TAVR shows impressive device success, low rates of stroke
and pacemaker implantation and an acceptable 30-day and 1-year mortality.
30-day mortality was significantly lower in TC compared to TAO
patients.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<76>
Accession Number
2004352172
Title
The prognostic implication of perioperative cardiac enzyme elevation in
patients with fractured neck of femur: A systematic review and
meta-analysis.
Source
Injury. (no pagination), 2019. Date of Publication: 2019.
Author
Lowe M.J.; Lightfoot N.J.
Institution
(Lowe) Department of Anaesthesia, Auckland City Hospital, Auckland, New
Zealand
(Lightfoot) Department of Anaesthesia and Pain Medicine, Middlemore
Hospital, Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Background:: Neck of Femur (NOF) fractures are a common injury in comorbid
elderly patients which are associated with increased rates of morbidity
and mortality following fracture. Because of their injury, patients can
experience reductions in quality of life and independent living leading to
transfer to nursing home or dependent levels of care. Numerous factors are
associated with either complications or reductions in survival following
fractured NOF. From the VISION cohort there is evidence that troponin
elevation in the post-operative period following a diverse range of
non-cardiac surgical procedures may lead to an increased risk of mortality
in the absence of classical ischaemic or cardiac symptoms. The aim of this
systematic review and meta-analysis is to validate the utility of
perioperative troponin elevation as a prognostic indicator for mortality
and cardiac morbidity in those with fractured NOF. <br/>Method(s):: The
PRISMA guidelines for the conduct of meta-analyses were followed. An
electronic search was conducted of the EMBASE, MEDLINE (Ovid) and Biosis
databases. Studies were included for analysis if they stratified outcomes
by perioperative troponin elevation in surgically managed fractured NOF
and reported sufficient data on troponin elevation and mortality following
surgery. Primary and secondary outcomes assessed were all-cause
post-operative mortality and a composite measure of cardiac complications
(myocardial infarction, cardiac failure and arrhythmia) respectively.
<br/>Result(s):: Eleven studies met inclusion criteria giving a total of
1363 patients. Overall, 497 patients (36.5%) experienced an elevation in
troponin levels following surgery. Perioperative troponin elevation was
significantly associated with all-cause mortality (OR 2.6; 95% CI 1.5 -
4.6; p <0.001) and cardiac complications (OR 7.4; 95% CI 3.5 - 15.8; p
<0.001). Patient factors significantly associated with troponin elevation
included pre-existing coronary artery disease, cardiac failure,
hypertension, previous stroke and previous myocardial infarction.
<br/>Conclusion(s):: Perioperative troponin elevation is significantly
associated with increased mortality and post-operative cardiac
complications following fractured NOF and may be a useful prognostic
indicator in these patients. Future research should further stratify
patients by the magnitude of troponin elevation and further refine the
risk factors.<br/>Copyright &#xa9; 2019

<77>
Accession Number
630345265
Title
A single-dose of stellate ganglion block for the prevention of
postoperative dysrhythmias in patients undergoing thoracoscopic surgery
for cancer: A prospective randomised controlled double-blind trial.
Source
European journal of anaesthesiology. (no pagination), 2019. Date of
Publication: 12 Dec 2019.
Author
Wu C.-N.; Wu X.-H.; Yu D.-N.; Ma W.-H.; Shen C.-H.; Cao Y.
Institution
(Wu) From the Department of Anaesthesiology, First Affiliated Hospital of
Guangzhou University of Chinese Medicine, Guangzhou (C-NW, W-HM),
Department of Anesthesiology, Peking University Shenzhen Hospital,
Shenzhen (W-HW), Department of Anesthesiology, Guangdong Provincial
People's Hospital (D-NY), Department of Thoracic Surgery, First Affiliated
Hospital of Guangzhou University of Chinese Medicine (C-HS) and Department
of Cardiovascular Pharmacology, School of Pharmacological Science,
Southern Medical University, Guangzhou, China (YC)
Publisher
NLM (Medline)
Abstract
BACKGROUND: New-onset arrhythmias and sleep disturbances are frequently
observed during the postoperative period in patients undergoing thoracic
surgery. <br/>OBJECTIVE(S): We evaluated the effectiveness of a
single-dose stellate ganglion block (SGB) to prevent the occurrence of
arrhythmias in patients undergoing thoracic surgery for cancer. DESIGN:
Randomised controlled double-blind study. SETTING: Single university
hospital. PATIENTS: Ninety patients with lung cancer or oesophagal cancer
scheduled for elective video-assisted thoracoscopic surgery were randomly
randomised into one of two equal groups (the SGB group and control group,
n = 40 each). INTERVENTIONS: Patients received a single dose of 5 ml of
0.5% ropivacaine during ultrasound-guided SGB before induction of general
anaesthesia in the SGB group. MAIN OUTCOME MEASURES: Holter ECG was
continuously monitored during the first 48 postoperative hours, and sleep
state was monitored during the first two postoperative nights.
<br/>RESULT(S): The incidences of postoperative supraventricular
tachycardias were lower in the SGB group compared with the control group
during the first 48 postoperative hours; 11.6 (5/43) vs. 31.8% (14/44),
respectively, P = 0.023 (odds ratio 0.28, 95% confidence interval 0.09 to
0.87). The SGB also prolonged the total sleep time and increased the sleep
efficiency during the first two postoperative nights. The duration of
stage N2 sleep was longer in the SGB group compared with the control group
[28 (interquartile range, 14 to 58) to 94 (interquartile range, 69 to 113)
min, P = 0.016] on the first postoperative night. There were no
differences in the duration of stage N1 and N3 sleep (P = 0.180, 0.086,
respectively) on the first postoperative night, and the duration of stage
N1, N2 and N3 sleep (P = 0.194, 0.057, 0.405, respectively) on the second
postoperative night between the groups. <br/>CONCLUSION(S): A
pre-operative SGB effectively prevented the occurrence of postoperative
supraventricular tachycardias and improves the objective sleep quality in
patients undergoing thoracic surgery for cancer. TRIAL REGISTRATION
NUMBER: ChiCTR-1900023064.

<78>
Accession Number
630331701
Title
Does tranexamic acid improve intra-operative visualisation in endoscopic
ear surgery? A double-blind, randomised, controlled trial.
Source
Journal of Laryngology and Otology. 133 (12) (pp 1033-1037), 2019. Date of
Publication: 2019.
Author
Das A.; Mitra S.; Ghosh D.; Kumar S.; Sengupta A.
Institution
(Das, Mitra, Ghosh, Kumar, Sengupta) Department of Otorhinolaryngology and
Head Neck Surgery, Institute of Post-Graduate Medical Education and
Research, Seth Sukhlal Karnani Memorial Hospital, 244 AJC Bose Road,
Kolkata 700020, India
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objective To assess the effect of tranexamic acid on intra-operative
bleeding and surgical field visualisation.Methods Fifty patients
undergoing various endoscopic ear surgical procedures, including
endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy,
endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly
assigned to: a study group that received tranexamic acid or a control
group which received normal saline. The intra-operative bleeding and
operative field visualisation was graded using the Das and Mitra
endoscopic ear surgery bleeding and field visibility score, which was
separately analysed for the external auditory canal and the middle
ear.Results The Das and Mitra score was better (p < 0.05) in the group
that received tranexamic acid as a haemostat when working in the external
auditory canal; with respect to the middle ear, no statistically
significant difference was found between the two agents. Mean values for
mean arterial pressure, heart rate and surgical time were comparable in
both groups, with no statistically significant differences.Conclusion
Tranexamic acid appears to be an effective haemostat in endoscopic ear
surgery, thus improving surgical field visualisation, especially during
manipulation of the external auditory canal soft tissues.<br/>&#xa9;
Copyright JLO (1984) Limited, 2019.

<79>
Accession Number
630337640
Title
Pre-operative sildenafil for patients with pulmonary hypertension
undergoing mitral valve surgery: A systematic review and meta-analysis.
Source
Cardiology Research. 10 (6) (pp 369-377), 2019. Date of Publication: 2019.
Author
Villanueva D.L.E.; Agustin R.D.; Llanes E.J.
Institution
(Villanueva, Agustin, Llanes) Division of Cardiovascular Medicine,
University of the Philippines, Philippine General Hospital, Taft Avenue,
Manila 1000, Philippines
Publisher
Elmer Press (E-mail: production@elmerpress.com)
Abstract
Background: Pulmonary hypertension is a usual complication of
long-standing mitral valve disease. Perioperative pulmonary hypertension
is a risk factor for right ventricular failure and is an important cause
of morbidity and mortality in patients with pulmonary hypertension
undergoing mitral valve surgery. Phosphodiesterase-5 inhibitors
particularly sildenafil citrate have proven clinical benefit for pulmonary
arterial hypertension but have shown discordant results in group 2
pulmonary hypertension patients. We sought to determine the effect of
pre-operative sildenafil on the intra-operative hemodynamic parameters of
these patients. <br/>Method(s): Studies were included if they satisfied
the following criteria: 1) Randomized controlled trials; 2) Adult patients
with pulmonary hypertension scheduled for elective mitral valve surgery;
and 3) Reported data on changes in pre-, intra-, and post-operative
hemodynamic parameters. Using PUBMED, Clinical Key, Science Direct, and
Cochrane databases, a search for eligible studies was conducted from
September 1 to December 31, 2018. The quality of each study was evaluated
using the Cochrane Risk of Bias Tool. The primary outcome of interest is
on the effect of pre-operative sildenafil on the improvement of
intra-operative hemodynamic parameters such as systolic pulmonary artery
pressure (sPAP), mean pulmonary arterial pressure, mean arterial pressure,
pulmonary and systemic vascular resistances. We also investigated its
effect on the post-operative mortality, length of cardiopulmonary bypass
time, ventilation time, and inotrope support requirement. Review Manager
5.3 was utilized to perform analysis of random effects for continuous
outcomes. <br/>Result(s): We identified three studies involving 153
patients with pulmonary hypertension undergoing mitral valve surgery,
showing that among those who received pre-operative sildenafil there is a
significant decrease in intra-operative systolic pulmonary arterial
pressure (mean difference -11.19 (95% confidence interval (CI), -20.23 to
-2.15), P < 0.05) and post-operative sPAP (mean difference -13.67 (95% CI,
- 19.56 to - 7.78), P < 0.05) without significantly affecting the mean
arterial pressure (mean difference 1.94 (95% CI, -5.49 to 9.37), P <
0.05). The systemic and pulmonary vascular resistances were not affected
as well. <br/>Conclusion(s): Administration of pre-operative sildenafil to
patients with pulmonary hypertension undergoing mitral valve surgery
decreases intra-operative and post-operative systolic pulmonary arterial
pressure without significantly affecting other systemic hemodynamic
parameters.<br/>Copyright &#xa9; The authors.

<80>
Accession Number
2004322340
Title
Remote Ischaemic Preconditioning Attenuates Cardiac Biomarkers During
Vascular Surgery: A Randomised Clinical Trial.
Source
European Journal of Vascular and Endovascular Surgery. (no pagination),
2019. Date of Publication: 2019.
Author
Kepler T.; Kuusik K.; Lepner U.; Starkopf J.; Zilmer M.; Eha J.; Vahi M.;
Kals J.
Institution
(Kepler, Lepner, Kals) Department of Surgery, Institute of Clinical
Medicine, University of Tartu, Tartu, Estonia
(Kepler, Kuusik, Zilmer, Kals) Department of Biochemistry, Institute of
Biomedicine and Translational Medicine, Centre of Excellence for Genomics
and Translational Medicine, University of Tartu, Tartu, Estonia
(Kuusik, Eha) Department of Cardiology, Institute of Clinical Medicine,
University of Tartu, Tartu, Estonia
(Lepner, Starkopf, Eha, Kals) Tartu University Hospital, Tartu, Estonia
(Starkopf) Department of Anaesthesiology and Intensive Care, Institute of
Clinical Medicine, University of Tartu, Tartu, Estonia
(Vahi) Institute of Mathematics and Statistics, University of Tartu,
Tartu, Estonia
Publisher
W.B. Saunders Ltd
Abstract
Objective: The main aim of this study was to evaluate the effect of remote
ischaemic preconditioning (RIPC) on preventing the leakage of cardiac
damage biomarkers in patients undergoing vascular surgery. <br/>Method(s):
This is a randomised, sham-controlled, double-blinded, single-centre
study. Patients undergoing open abdominal aortic aneurysm repair, surgical
lower limb revascularisation surgery or carotid endarterectomy were
recruited non-consecutively. The RIPC protocol consisting of 4 cycles of 5
minutes of ischaemia, followed by 5 minutes of reperfusion, was applied. A
RIPC or a sham procedure was performed noninvasively along with
preparation for anaesthesia. High sensitivity troponin T level was
measured preoperatively and 2, 8 and 24 hours after surgery and pro b-type
natriuretic peptide was measured preoperatively and 24 hours after
surgery. <br/>Result(s): There was significantly higher leakage of high
sensitivity troponin T (peak change median 2 ng/L, IQR 0.9-6.2 ng/L vs 0.6
ng/L, IQR 0.7-2.1 ng/L, p = .0002) and pro b-type natriuretic peptide
(change median 144 pg/mL, IQR 17-318 pg/mL vs 51 pg/mL, IQR 12-196 pg/mL,
p = .02) in the sham group compared to the RIPC group. <br/>Conclusion(s):
RIPC reduces the leakage of high sensitivity troponin T and pro b-type
natriuretic peptide. Therefore, it may offer cardioprotection in patients
undergoing non-cardiac vascular surgery. The clinical significance of RIPC
has to be evaluated in larger studies excluding the factors known to
influence its effect.<br/>Copyright &#xa9; 2019 European Society for
Vascular Surgery

<81>
Accession Number
2003891890
Title
Risk prediction models for survival after heart transplantation: A
systematic review.
Source
American Journal of Transplantation. (no pagination), 2019. Date of
Publication: 2019.
Author
Aleksova N.; Alba A.C.; Molinero V.M.; Connolly K.; Orchanian-Cheff A.;
Badiwala M.; Ross H.J.; Duero Posada J.G.
Institution
(Aleksova, Alba, Molinero, Badiwala, Ross, Duero Posada) Peter Munk
Cardiac Centre, Toronto General Hospital-University Health Network,
Toronto, Canada
(Connolly) Hamilton Health Sciences, Hamilton, Canada
(Orchanian-Cheff) Library and Information Services, University Health
Network, Toronto, Canada
Publisher
Blackwell Publishing Ltd
Abstract
Risk prediction scores have been developed to predict survival following
heart transplantation (HT). Our objective was to systematically review the
model characteristics and performance for all available scores that
predict survival after HT. Ovid Medline and Epub Ahead of Print and
In-Process & Other Non-Indexed Citations, Ovid Embase, Cochrane Database
of Systematic Reviews, and Cochrane Central Register of Controlled
Clinical Trials were searched to December 2018. Eligible articles reported
a score to predict mortality following HT. Of the 5392 studies screened,
21 studies were included that derived and/or validated 16 scores. Seven
(44%) scores were validated in external cohorts and 8 (50%) assessed model
performance. Overall model discrimination ranged from poor to moderate
(C-statistic/area under the receiver operating characteristics 0.54-0.77).
The IMPACT score was the most widely validated, was well calibrated in two
large registries, and was best at discriminating 3-month survival
(C-statistic 0.76). Most scores did not perform particularly well in any
cohort in which they were assessed. This review shows that there are
insufficient data to recommend the use of one model over the others for
prediction of post-HT outcomes.<br/>Copyright &#xa9; 2019 The American
Society of Transplantation and the American Society of Transplant Surgeons

<82>
Accession Number
2004217606
Title
Pregnancy outcomes in women with cardiothoracic transplants: A Systematic
review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2019. Date of
Publication: 2019.
Author
Acuna S.; Zaffar N.; Dong S.; Ross H.; D'Souza R.
Institution
(Acuna, D'Souza) Institute of Health Policy, Management & Evaluation,
University of Toronto, Toronto, Ontario, Canada
(Zaffar, Dong, D'Souza) Division of Maternal-Fetal Medicine, Department of
Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto,
Toronto, Ontario, Canada
(Dong) Faculty of Medicine, University of Toronto, Toronto, Ontario,
Canada
(Ross) Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada
(D'Souza) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
Toronto, Ontario, Canada
Publisher
Elsevier USA
Abstract
Increasing numbers of women with thoracic transplants are planning and
continuing pregnancies. However, pregnancy outcomes and risks to the
mother and baby have not been systematically assessed. MEDLINE, EMBASE,
and Cochrane Central were searched from their inception to January 2018,
to identify studies reporting outcomes on 3 or more pregnancies following
thoracic transplants. Pooled incidences were calculated using a
random-effect meta-analysis. Risk-of-bias was assessed using the Joanna
Briggs Checklist for case series. Subgroup analysis was conducted based on
the organ transplanted. Of the 3,658 records identified, 12 studies were
included that reported on 385 pregnancies in 272 thoracic transplant
recipients. Maternal complications included mortality (pooled incidence
0.5% [95% confidence intervals 0, 1.1%] during pregnancy and 15.4% [10.4,
20.3%] during follow-up, which ranged between 3 and 7 years), graft
rejection (7.4% [4.2, 10.5%]), hypertensive disorders of pregnancy [26.6%
[13.7, 39.6%]), and cesarean deliveries (41.4% [33.4, 48.7%]). Maternal
mortality was more common in recipients of lung vs heart transplants
(41.4% [23.4, 59.3] vs 10.8% [5.9, 15.8]), respectively. Although 78.4%
(69.8, 86.9%) of the pregnancies resulted in live births, 51.2% (31,
71.3%) were born preterm and neonatal deaths occurred in 3.4% (1.3, 5.6%).
Congenital anomalies affected 4.3% (1.8, 6.8%) of the newborns. Although
few maternal deaths occurred during pregnancy, in keeping with median
survival data, delayed mortality for thoracic transplant recipients
remains high. Despite the high numbers of live births, these pregnancies
continue to be at risk for hypertensive disorders, graft rejection,
preterm birth, and neonatal mortality. Prospectively gathered data from
international registries should supplement these findings to better inform
clinical counseling and practice.<br/>Copyright &#xa9; 2019 International
Society for Heart and Lung Transplantation

<83>
Accession Number
2004207266
Title
Honorary authorship in cardiothoracic surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Noruzi A.; Takkenberg J.J.M.; Kayapa B.; Verhemel A.; Gadjradj P.S.
Institution
(Noruzi, Takkenberg) Department of Cardiothoracic Surgery, Erasmus Medical
Centre, Rotterdam, Netherlands
(Kayapa, Verhemel, Gadjradj) Department of Neurosurgery, Leiden University
Medical Centre, Leiden, Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Honorary authorship (HA) refers to enlisted authors who did
not make sufficient contributions to a paper according to the guidelines,
as defined by the International Committee of Medical Journal Editors
(ICMJE). This study assessed the proportion of, and factors associated
with, HA in cardiothoracic surgical literature in 2017. <br/>Method(s):
Five cardiothoracic surgery journals were selected based on their impact
factors in 2017 for evaluation of HA. Articles were included in the
analysis if there was more than 1 listed author and if there was an
available E-mail address of the corresponding author. All corresponding
authors received an invitation to fill out our survey regarding their
paper in 2017. <br/>Result(s): In total, 1511 authors opened the
invitation, resulting in a total of 590 respondents (28.9%); 77.1% of all
authors were aware of the ICMJE guidelines and 47.0% were aware of the
general issue of HA. A total of 367 (62.7%) authors stated that at least
one of the coauthors had performed solely nonauthorship tasks, whereas 148
(25.3%) authors stated that they believed that their article contained at
least one honorary author. Having a senior member who was automatically
included on all submitted manuscripts and not being aware of the general
issue of HA were associated with significantly greater odds of having HA.
<br/>Conclusion(s): Our results show that, despite the high awareness of
the ICMJE guidelines, there is a large discrepancy in perceived HA and
guideline-based HA. The authors plead for a better understanding and
implementation of the guidelines in a more transparent authorship
system.<br/>Copyright &#xa9; 2019 The American Association for Thoracic
Surgery

<84>
Accession Number
2004192412
Title
Effect of atrial pacing on post-operative atrial fibrillation following
coronary artery bypass grafting: Pairwise and network meta-analyses.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Ruan Y.; Robinson N.B.; Naik A.; Silva M.; Hameed I.; Rahouma M.; Oakley
C.; Di Franco A.; Zamvar V.; Girardi L.N.; Gaudino M.
Institution
(Ruan, Robinson, Naik, Silva, Hameed, Rahouma, Oakley, Di Franco, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Cornell Medicine, New York,
NY, United States
(Zamvar) Department of Cardiothoracic Surgery, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom
(Ruan) Department of Cardiovascular Surgery, Renmin Hospital of Wuhan
University, Wuhan, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: To determine the effect of atrial pacing on the rate of
post-operative atrial fibrillation (POAF) following coronary artery bypass
grafting. <br/>Method(s): After a systematic literature search, randomized
clinical trials (RCTs) comparing any combination of no pacing (NP),
bi-atrial (BiA) pacing, left-atrial (LA) pacing and right-atrial (RA)
pacing were included. Pairwise and network meta-analyses were performed
using the generic inverse variance method. The primary outcome was POAF
incidence. Secondary outcomes were postoperative bleeding, infection, and
operative mortality. Leave-one-out and meta-regression were done.
<br/>Result(s): Fourteen RCTs were included with a total of 1727 patients.
Compared with NP, any form of atrial pacing was significantly associated
with lower incidence of POAF (odds ratio [OR]: 0.49; 95% confidence
interval [CI]: 0.35-0.69). BiA pacing was associated with the larger risk
reduction (OR: 0.36; 95% CI: 0.20-0.64 vs. 0.59; 95% CI: 0.34-1.02 for LA
and 0.64; 95% CI: 0.38-1.07 for RA). Secondary outcomes were similar
between the no pacing and pacing groups. On meta-regression, age and the
use of continuous monitoring were associated with lower reduction of the
incidence of POAF. In the network meta-analysis, BiA pacing ranked the
best strategy for the prevention of POAF (OR: 0.34; 95% CI: 0.21-0.55).
<br/>Conclusion(s): Compared to other pacing modalities, BiA pacing is
associated with lower rates of POAF following CABG.<br/>Copyright &#xa9;
2019 Elsevier B.V.

<85>
Accession Number
2001693973
Title
Bacterial infiltration in structural heart valve disease.
Source
Journal of Thoracic and Cardiovascular Surgery. 159 (1) (pp 116-124.e4),
2020. Date of Publication: January 2020.
Author
Oberbach A.; Friedrich M.; Lehmann S.; Schlichting N.; Kullnick Y.; Graber
S.; Buschmann T.; Hagl C.; Bagaev E.; Gruhle M.; Albert M.; Luehr M.;
Pichlmaier M.; Rodloff A.C.; Reiche K.; Kraft T.; Horn F.
Institution
(Oberbach, Hagl, Bagaev) Department of Cardiac Surgery,
Ludwig-Maximilians-University, Munich, Germany
(Oberbach, Friedrich, Lehmann, Schlichting, Kullnick, Buschmann)
Department of Diagnostics, Fraunhofer Institute for Cell Therapy and
Immunology, Leipzig, Germany
(Oberbach) Division of Gastroenterology and Hepatology, Department of
Medicine, The Johns Hopkins Medical Institutions, Baltimore, Md, United
States
(Friedrich) Institute of Clinical Immunology, University of Leipzig,
Leipzig, Germany
(Lehmann) Department of Internal Medicine, University of Leipzig, Leipzig,
Germany
(Schlichting) Department of Visceral, Transplantation, Thoracic and
Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
(Graber) Institute for Medical Microbiology and Epidemiology of Infectious
Diseases, Leipzig University Hospital, Leipzig, Germany
(Hagl) Munich Heart Alliance, Partner Site German Center for
Cardiovascular Disease (DZHK), Munich, Germany
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The pathology of structural valvular heart disease (sVHD)
ranges from basic diseases of rheumatologic origin to chronic degenerative
remodeling processes after acute bacterial infections. Molecular genetic
methods allow detection of the complete microbial spectrum in heart valve
tissues independent of microbiological cultivation. In particular,
whole-metagenome analysis is a sensitive and highly specific analytical
method that allows a deeper insight into the pathogenicity of the
diseases. In the present study we assessed the pathogen spectrum in heart
valve tissue from 25 sVHD patients using molecular and microbiological
methods. <br/>Method(s): Twenty-five sVHD patients were selected randomly
from an observational cohort study (March 2016 to January 2017). The
explanted native heart valves were examined using microbiological methods
and immunohistological structural analysis. In addition, the bacterial
metagenome of the heart valve tissue was determined using next-generation
sequencing. <br/>Result(s): The use of sonication as a pretreatment of
valve tissue from 4 sVHD patients permitted successful detection of
Clostridium difficile, Enterococcus faecalis, Staphylococcus
saccharolyticus, and Staphylococcus haemolyticus using microbial
cultivation. Histological staining revealed intramural localization.
Metagenome analysis identified a higher rate of bacterial infiltration in
52% of cases. The pathogen spectrum included both gram-positive and
gram-negative bacteria. <br/>Conclusion(s): Microbiological and molecular
biological studies are necessary to detect the spectrum of bacteria in a
calcified heart valve. Metagenome analysis is a valid method to gain new
insight into the polymicrobial pathophysiology of sVHD. Our results
suggest that an undetected proportion of sVHD might be triggered by
chronic inflammation or influenced by secondary bacterial
infiltration.<br/>Copyright &#xa9; 2019 The American Association for
Thoracic Surgery

<86>
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.

<87>
Accession Number
628024479
Title
Pharmacological Prophylaxis of Atrial Fibrillation After Surgical
Myocardial Revascularization.
Source
Medical archives (Sarajevo, Bosnia and Herzegovina). 73 (1) (pp 19-22),
2019. Date of Publication: 01 Feb 2019.
Author
Osmanovic E.; Ostojic M.; Avdic S.; Djedovic S.; Delic A.; Kadric N.;
Terzic A.; Avdic-Salihovic A.
Institution
(Osmanovic, Avdic, Djedovic, Kadric, Terzic, Avdic-Salihovic) Heart Center
BH Tuzla, Tuzla, Bosnia and Herzegovina
(Ostojic) School of Medicine University of Belgrade, Serbia
(Delic) SarajevoBosnia and Herzegovina
Publisher
NLM (Medline)
Abstract
Introduction: Postoperative Atrial Fibrillation (POAF) is associated with
a higher rate of postoperative complications and mortality, as well as
with longer hospitalization and increased treatment costs. We have
designed and performed a randomized, trial of pharmacological prophylaxis
in which the event of interest is POAF. <br/>Aim(s): The aim of this study
is to reduce the risk of postoperative, complications associated with this
arrhythmia. <br/>Method(s): We included 240 stable patients with a
coronary heart disease, who were referred to elective surgical
revascularization of the myocardium. The patients were assigned into three
groups of 80 patients each: group A (BB, beta blocker, comparator), group
B (BB+ Amiodarone) and group C (BB + Rosuvastatin). The goal was to
establish whether intervention by combination therapy was more useful than
a comparator. <br/>Result(s): An event of interest (POAF) has occurred in
66 of the total 240 patients. Number of new POAF cases is the lowest in
Group B, 14 (17.5%) compared to 25 (31.25%) new cases in the comparator
group, and 27 new cases (33.75%) in group C. Absolute risk reduction was
13.75%, =14% less POAF in group B compared to comparator. Relative risk
reduction was 56% (RR 0.56, p = 0.04). Number Needed to Treat was 7.27. In
group C, 33.75% of patients developed POAF. Absolute risk was
insignificantly higher in group C (2.5%, NS) compared to the comparator
.The number needed to harm was high, 40. <br/>Conclusion(s): The results
of our research show that prophylaxis of POAF with combined therapy BB +
Amiodarone was the most efficient one.

<88>
Accession Number
628714816
Title
The neutrophil to lymphocyte ratio in heart failure: a comprehensive
review.
Source
Romanian journal of internal medicine = Revue roumaine de medecine
interne. 57 (4) (pp 296-314), 2019. Date of Publication: 01 Dec 2019.
Author
Delcea C.; Buzea C.A.; Dan G.A.
Institution
(Delcea, Buzea, Dan) Carol Davila University of Medicine and Pharmacy,
Bucharest, Romania
(Delcea, Buzea, Dan) Cardiology Department, Colentina Clinical Hospital,
Bucharest, Romania
(Delcea, Dan) CDPC Cardiology Laboratory, Colentina Clinical Hospital,
Bucharest, Romania
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Heart failure (HF) and systemic inflammation are
interdependent processes that continuously potentiate each other. Distinct
pathophysiological pathways are activated, resulting in increased
neutrophil count and reduced lymphocyte numbers, making the neutrophil to
lymphocyte ratio (NLR) a potential indirect marker of severity. We
conducted this comprehensive review to characterize the role of NLR in HF.
<br/>METHOD(S): We searched the PubMed (MEDLINE) database using the key
words "neutrophil", "lymphocyte", "heart failure", "cardiomyopathy",
"implantable cardioverter defibrillator", "cardiac resynchronization
therapy" and "heart transplant". <br/>RESULT(S): We identified 241
publications. 31 were selected for this review, including 12,107 patients.
NLR was correlated to HF severity expressed by clinical, biological, and
imaging parameters, as well as to short and long-term prognosis. Most
studies reported its survival predictive value. Elevated NLR (>2.1-7.6)
was an independent predictor of in-hospital mortality [adjusted HR 1.13
(95% CI 1.01-1.27) - 2.8 (95% CI 1.43-5.53)] as well as long-term
all-cause mortality [adjusted HR 1.43 (95% CI 1.1-1.85) - 2.403 (95% CI
1.076-5.704)]. Higher NLR levels also predicted poor functional capacity
[NLR > 2.26/2.74, HR 3.93 (95% CI 1.02-15.12) / 3.085 (95% CI 1.52-6.26)],
hospital readmissions [NLR > 2.9/7.6, HR 1.46 (95% CI 1.10-1.93) / 3.46
(95% CI 2.11-5.68)] cardiac resynchronization therapy efficacy [NLR >
3.45/unit increase, HR 12.22 (95% CI 2.16-69.05) / 1.51 (95% CI
1.01-2.24)] and appropriate implantable cardioverter defibrillator shocks
(NLR > 2.93), as well as mortality after left ventricular assist device
implantation [NLR > 4.4 / quartiles, HR 1.67 (95% CI 1.03-2.70) / 1.22
(95% CI 1.01-1.47)] or heart transplant (NLR > 2.41, HR 3.403 (95% CI
1.04-11.14)]. <br/>CONCLUSION(S): Increased NLR in HF patients can be a
valuable auxiliary biomarker of severity, and most of all, of poor
prognosis.

<89>
Accession Number
629726971
Title
Comparison of ProGlide vs. Prostar in patients undergoing transcatheter
aortic valve implantation.
Source
Minerva cardioangiologica. 67 (6) (pp 443-449), 2019. Date of Publication:
01 Dec 2019.
Author
Giordano A.; Corcione N.; Ferraro P.; Morello A.; Conte S.; Testa L.;
Iadanza A.; Sardella G.; Mancone M.; Berti S.; Petronio A.S.; Romagnoli
E.; Pepe M.; Frati G.; Biondi-Zoccai G.
Institution
(Giordano, Corcione, Morello) Unit of Cardiovascular Interventional
Medicine, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
(Ferraro, Conte) Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe
Vesuviano, Naples, Italy
(Testa) Department of Cardiology, San Donato Polyclinic IRCCS, San Donato
Milanese, Milan, Italy
(Iadanza) Unit of Hemodynamics, Department of Cardiac, Thoracic and
Vascular Sciences, Santa Maria alle Scotte Polyclinic, Siena, Italy
(Sardella, Mancone) Department of Cardiovascular, Respiratory, Anaesthetic
and Geriatric Sciences, Umberto I Polyclinic, Sapienza University, Rome,
Italy
(Berti) G. Monasterio C.N.R. Foundation, Ospedale del Cuore, Massa, Italy
(Petronio) Department of Cardiology, University Hospital of Pisa, Pisa,
Italy
(Romagnoli) Institute of Cardiology, A. Gemelli University Polyclinic,
IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
(Pepe) Division of Cardiology, Department of Emergency and Organ
Transplantation, University of Bari, Bari, Italy
(Frati) Department of Medico-Surgical Sciences and Biotechnologies,
Sapienza University, Rome, Italy
(Frati) IRCCS NEUROMED, Isernia, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) NaplesItaly
Publisher
NLM (Medline)
Abstract
BACKGROUND: Expanding indications to transcatheter aortic valve
implantation (TAVI) warrant meticolous vascular management and
minimization of access site complications. Two leading vascular closure
devices (VCD) are currently used for TAVI, ProGlide vs. Prostar, but their
comparative effectiveness and safety are debated. We aimed at comparing
acute and 1-month outcomes of patients undergoing TAVI using as VCD either
ProGlide (Perclose) or Prostar (XL). <br/>METHOD(S): The prospective
RISPEVA database was queried for baseline, procedural, and outcome details
of patients undergoing TAVI and in whom either ProGlide or Prostar had
been used as VCD. Outcomes of interest were death, vascular complication,
and bleeding, distinguishing specific subtypes. Outcomes were adjudicated
according to current Valve Academic Research Consortium definitions.
<br/>RESULT(S): A total of 1987 subjects were included, 913 (46.0%)
receiving ProGlide, and 1074 receiving Prostar (54.0%). Several baseline
and procedural differences were evident, including surgical risk,
concomitant coronary artery disease, sheath size, use of predilation, and
chosen TAVI device (all P<0.05). Periprocedurally, despite similar rates
of device success (P=0.262), Prostar was associated with a lower risk of
vascular stenosis (P=0.005), but a higher rate of device malfunction
(P=0.028). Unadjusted analysis for 1-month outcomes suggested higher rates
of major adverse events, any bleeding, major bleeding, and renal failure
in patients receiving Prostar (all P<0.05). However, propensity
score-adjusted analysis did not confirm any significant differences,
suggesting that confounding factors mostly drove unadjusted differences.
<br/>CONCLUSION(S): Use of ProGlide and Prostar as VCD of choice for TAVI
appears similarly safe and effective, despite some potential benefits
associated with ProGlide. Further randomized trials are warranted to
confirm or disprove these findings.

<90>
Accession Number
629447639
Title
The incidence and prognostic implications of worsening right ventricular
function after surgical or transcatheter aortic valve replacement:
insights from PARTNER IIA.
Source
European heart journal. 39 (28) (pp 2659-2667), 2018. Date of Publication:
21 Jul 2018.
Author
Cremer P.C.; Zhang Y.; Alu M.; Rodriguez L.L.; Lindman B.R.; Zajarias A.;
Hahn R.T.; Lerakis S.; Malaisrie S.C.; Douglas P.S.; Pibarot P.; Svensson
L.G.; Leon M.B.; Jaber W.A.
Institution
(Cremer, Rodriguez, Jaber) Department of Cardiovascular Imaging, Heart and
Vascular Institute, Cleveland Clinic, 9500 Euclid Ave: DeskJ1-5,
Cleveland, OH, USA
(Zhang, Leon) Cardiovascular Research Foundation, NY, NY, United States
(Alu, Hahn, Leon) Columbia University Medical Center, NY, NY, United
States
(Lindman) Vanderbilt University Medical Center, TN, Nashville, United
States
(Zajarias) Washington University School of Medicine, St. Louis, MO, USA
(Lerakis) Emory University, Atlanta, United States
(Malaisrie) Northwestern University, Chicago, United States
(Douglas) Duke University Medical Center and Duke Clinical Research
Institute, Durham, United States
(Pibarot) Department of Medicine, Universite Laval, QC, Canada
(Svensson) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
Publisher
NLM (Medline)
Abstract
Aims: In patients randomized to transcatheter or surgical aortic valve
replacement (TAVR, SAVR), we sought to determine whether SAVR is
associated with worsening right ventricular (RV) function and whether RV
deterioration is associated with mortality. <br/>Methods and Results: In
1376 patients from PARTNERIIA with paired baseline and 30-day core lab
echocardiograms, worsening RV function was defined as decline by at least
one grade from baseline to 30days. Our primary outcome was all-cause
mortality from 30days to 2years. Among 744 patients with TAVR, 62 (8.3%)
had worsening RV function, compared with 156 of 632 patients with SAVR
(24.7%) (P<0.0001). In a multivariable model, SAVR [odds ratio (OR) 4.05,
95% confidence interval (CI) 2.55-6.44], a dilated RV (OR 2.38, 95% CI
1.37-4.14), and more than mild tricuspid regurgitation (TR) (OR 2.58, 95%
CI 1.25-5.33) were associated with worsening RV function. There were 169
deaths, and patients with worsening RV function had higher all-cause
mortality [hazard ratio (HR) 1.98, 95% CI 1.40-2.79]. This association
remained robust after adjusting for clinical and echocardiographic
variables. Among patients with worsening RV function, there was no
mortality difference between TAVR and SAVR (HR 1.16, 95% CI 0.61-2.18).
The development of moderate or severe RV dysfunction from baseline normal
RV function conferred the worst prognosis (HR 2.87, 95% CI 1.40-5.89).
<br/>Conclusion(s): After aortic valve replacement, worsening RV function
is more common in patients with baseline RV dilation, more than mild TR,
and in patients treated with SAVR. Worsening RV function and the magnitude
of deterioration have important prognostic implications.

<91>
Accession Number
629447588
Title
Annual number of candidates for transcatheter aortic valve implantation
per country: current estimates and future projections.
Source
European heart journal. 39 (28) (pp 2635-2642), 2018. Date of Publication:
21 Jul 2018.
Author
Durko A.P.; Osnabrugge R.L.; Van Mieghem N.M.; Milojevic M.; Mylotte D.;
Nkomo V.T.; Pieter Kappetein A.
Institution
(Durko, Osnabrugge, Milojevic, Pieter Kappetein) Department of
Cardio-Thoracic Surgery, Erasmus University Medical Center, Netherlands
(Van Mieghem) Department of Interventional Cardiology, Erasmus University
Medical Center, Netherlands
(Mylotte) Galway University Hospital, Newcastle Rd, Galway, Ireland
(Nkomo) Division of Cardiovascular Diseases, Mayo Clinic, 1216 2nd St SW
Rochester, MN, United States
Publisher
NLM (Medline)
Abstract
Aims: The number of transcatheter aortic valve implantation (TAVI)
procedures is rapidly increasing. This has a major impact on health care
resource planning. However, the annual numbers of TAVI candidates per
country are unknown. The aim of this study was to estimate current and
future number of annual TAVI candidates in 27 European countries, the USA
and Canada. <br/>Methods and Results: Systematic literature searches and
meta-analyses were performed on aortic stenosis (AS) epidemiology and
decision-making in severe symptomatic AS. The incidence rate of severe AS
was determined. Findings were combined with population statistics and
integrated into a model employing Monte Carlo simulations to predict the
annual number of TAVI candidates. Various future scenarios and sensitivity
analyses were explored. Data from 37 studies (n=26402) informed the model.
The calculated incidence rate of severe AS was 4.4/year [95% confidence
interval (95% CI) 3.0-6.1] in patients>=65years. AS-related symptoms were
present in 68.3% (95% CI 60.8-75.9%) of patients with severe AS. Despite
having severe symptomatic AS, 41.6% (95% CI 36.9-46.3%) did not undergo
surgical aortic valve replacement. Of the non-operated patients, 61.7%
(95% CI 42.0-81.7%) received TAVI. The model predicted 114757 (95% CI
69380-172799) European and 58556 (95% CI 35631-87738) Northern-American
TAVI candidates annually. <br/>Conclusion(s): Currently, approximately
180000 patients can be considered potential TAVI candidates in the
European Union and in Northern-America annually. This number might
increase up to 270000 if indications for TAVI expand to low-risk patients.
These findings have major implications for health care resource planning
in the 29 individual countries.

<92>
Accession Number
630305610
Title
Predictive model of in-hospital mortality in left-sided infective
endocarditis.
Source
Revista espanola de cardiologia (English ed.). (no pagination), 2019. Date
of Publication: 14 Dec 2019.
Author
Garcia-Granja P.E.; Lopez J.; Vilacosta I.; Sarria C.; Dominguez F.;
Ladron R.; Olmos C.; Saez C.; Vilches S.; Garcia-Arribas D.; Cobo-Marcos
M.; Ramos A.; Maroto L.; Gomez I.; Carrasco M.; Garcia-Pavia P.; San Roman
J.A.
Institution
(Garcia-Granja) Servicio de Cardiologia, Instituto de Ciencias del Corazon
(ICICOR), Hospital Clinico Universitario Valladolid, Valladolid, Spain;
CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Electronic address: pabloelpidio88@gmail.com
(Lopez, San Roman) Servicio de Cardiologia, Instituto de Ciencias del
Corazon (ICICOR), Hospital Clinico Universitario Valladolid, Valladolid,
Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
(Vilacosta, Olmos, Garcia-Arribas) Servicio de Cardiologia, Instituto
Cardiovascular, Hospital Clinico San Carlos, Instituto de Investigacion
Sanitaria del Hospital Clinico San Carlos (IdSSC), Madrid, Spain
(Sarria, Saez) Servicio de Medicina Interna, Hospital Universitario La
Princesa, Madrid, Spain
(Dominguez, Cobo-Marcos) CIBER de Enfermedades Cardiovasculares (CIBERCV),
Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatias Familiares,
Servicio de Cardiologia, Hospital Universitario Puerta de Hierro,
Majadahonda, Madrid, Spain
(Ladron, Gomez, Carrasco) Servicio de Cardiologia, Instituto de Ciencias
del Corazon (ICICOR), Hospital Clinico Universitario Valladolid,
Valladolid, Spain
(Vilches) Unidad de Insuficiencia Cardiaca y Cardiopatias Familiares,
Servicio de Cardiologia, Hospital Universitario Puerta de Hierro,
Majadahonda, Madrid, Spain
(Ramos) Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna,
Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
(Maroto) Servicio de Cirugia Cardiaca, Instituto Cardiovascular, Hospital
Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital
Clinico San Carlos (IdSSC), Madrid, Spain
(Garcia-Pavia) CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid,
Spain; Unidad de Insuficiencia Cardiaca y Cardiopatias Familiares,
Servicio de Cardiologia, Hospital Universitario Puerta de Hierro,
Majadahonda, Madrid, Spain; Universidad Francisco de Vitoria (UFV),
Pozuelo de Alarcon, Madrid, Spain
Publisher
NLM (Medline)
Abstract
INTRODUCTION AND OBJECTIVES: Infective endocarditis (IE) is a complex
disease with high in-hospital mortality. Prognostic assessment is
essential to select the most appropriate therapeutic approach; however,
international IE guidelines do not provide objective assessment of the
individual risk in each patient. We aimed to design a predictive model of
in-hospital mortality in left-sided IE combining the prognostic variables
proposed by the European guidelines. <br/>METHOD(S): Two prospective
cohorts of consecutive patients with left-sided IE were used. Cohort 1
(n=1002) was randomized in a 2:1 ratio to obtain 2 samples: an adjustment
sample to derive the model (n=688), and a validation sample for internal
validation (n=314). Cohort 2 (n=133) was used for external validation.
<br/>RESULT(S): The model included age, prosthetic valve IE,
comorbidities, heart failure, renal failure, septic shock, Staphylococcus
aureus, fungi, periannular complications, ventricular dysfunction, and
vegetations as independent predictors of in-hospital mortality. The model
showed good discrimination (area under the ROC curve=0.855; 95%CI,
0.825-0.885) and calibration (P value in Hosmer-Lemeshow test=0.409),
which were ratified in the internal (area under the ROC curve=0.823;
95%CI, 0.774-0.873) and external validations (area under the ROC
curve=0.753; 95%CI, 0.659-0.847). For the internal validation sample
(observed mortality: 29.9%) the model predicted an in-hospital mortality
of 30.7% (95%CI, 27.7-33.7), and for the external validation cohort
(observed mortality: 27.1%) the value was 26.4% (95%CI, 22.2-30.5).
<br/>CONCLUSION(S): A predictive model of in-hospital mortality in
left-sided IE based on the prognostic variables proposed by the European
Society of Cardiology IE guidelines has high discriminatory
ability.<br/>Copyright &#xa9; 2019 Sociedad Espanola de Cardiologia.
Published by Elsevier Espana, S.L.U. All rights reserved.

<93>
Accession Number
630302380
Title
Comparison of intensive insulin therapy and conventional glucose
management in patients undergoing coronary artery bypass grafting.
Source
Journal of Anaesthesiology Clinical Pharmacology. 35 (4) (pp 493-497),
2019. Date of Publication: October-December 2019.
Author
Mohod V.; Ganeriwal V.; Bhange J.
Institution
(Mohod, Ganeriwal, Bhange) Department of Anaesthesiology and Critical
Care, Grant Medical College and Sir JJ Group of Hospital, 4/31, Swastik
Building, J J Hospital Campus, Byculla, Mumbai, Maharashtra, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Hyperglycemia during cardiac surgery is a risk factor for postoperative
outcomes. Because incidence of diabetes mellitus is increasing in Indian
population, we tried to evaluate the western protocol for strict control
of blood sugar perioperatively. The main aim of the study was to evaluate
glycemic control during coronary artery bypass grafting and to determine
whether intensive insulin therapy (IIT) is better than the conventional
one. <br/>Material(s) and Method(s): A prospective randomized comparative
study was conducted to evaluate IIT and conventional management of glucose
in 40 patients undergoing on-pump coronary artery bypass grafting.
Outcomes measured were incidence of hyperglycemia or hypoglycemia,
incidence of hypokalemia, prolonged intubation, wound infections, strokes,
acute renal failure, new onset arrhythmias, length of stay in ICU and
hospital, cardiac arrest and mortality. The statistical analysis was done
by using Chi-square test, and paired and unpaired t test. <br/>Result(s):
The diabetic patients had significantly higher mean blood sugar and
insulin requirement. The incidence of hyperglycemia was significantly
higher in conventional management of blood sugar (P = 0.001), whereas
hypoglycemia (P = 0.047) and hypokalemia (P = 0.020) were significantly
higher in IIT. There were no significant difference in the incidence of
prolonged intubation, wound infection, length of ICU and hospital stay,
strokes, acute renal failure, new onset arrhythmias, cardiac arrest, and
mortality. <br/>Conclusion(s): The IIT did not improve the morbidity and
mortality in our patients undergoing coronary artery bypass
grafting.<br/>Copyright &#xa9; 2019 Journal of Anaesthesiology Clinical
Pharmacology <br/> Published by Wolters Kluwer - Medknow.

<94>
Accession Number
2003914641
Title
Vascular Complications after Transfemoral Transcatheter Aortic Valve
Implantation: A Systematic Review and Meta-Analysis.
Source
Structural Heart. (no pagination), 2019. Date of Publication: 2019.
Author
Rahhab Z.; Ramdat Misier K.; El Faquir N.; Kroon H.; Ziviello F.; Kardys
I.; Daemen J.; De Jaegere P.; Reardon M.J.; Popma J.; Van Mieghem N.M.
Institution
(Rahhab, Ramdat Misier, El Faquir, Kroon, Ziviello, Kardys, Daemen, De
Jaegere, Van Mieghem) Department of Cardiology, Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Reardon) Department of Cardiovascular Surgery, Houston Methodist
Hospital, Houston, TX, United States
(Popma) Department of Cardiology, Beth Israel Deaconess Medical Center,
Harvard University, Boston, MA, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Vascular complications (VCs) after transcatheter aortic valve
implantation (TAVI) are associated with impaired outcome. We performed a
meta-analysis to determine in-hospital/30-day major VCs rate after
transfemoral-TAVI adjudicated by an independent clinical-event-committee,
and to compare the major VCs rate with regard to consecutive generations
of balloon-expandable and self-expanding platforms, device profile,
experience and patient risk-profile. <br/>Method(s): A systematic,
computerized search with predefined criteria was performed in PubMed,
Embase and Cochrane on March 27, 2018. The overall pooled proportion of VC
was calculated using a random-effects model. Subgroups were examined based
on sheath size, STS-score and start-date of inclusion (early (< January
2012); late-phase (>= January 2012) studies). <br/>Result(s): A total of
24 studies with 14308 patients were included. The pooled major VCs rate
was 7.71% and was lower in low-profile vs. high-profile device studies
(5.51% vs. 8.46%, p = 0.0015). Major VCs rate decreased significantly with
transition to newer generation balloon-expandable valves ((Sapien vs.
Sapien XT (15.18% vs. 8.48%, p < 0.00001); Sapien XT vs. Sapien 3 (8.48%
vs. 4.48%, p = 0.005)) and there was a tendency towards fewer major VCs in
EvolutR vs. CoreValve (5.98% vs. 7.97%, p = 0.094). Major VC rate was
lower in late-phase vs. early-phase studies (5.82% vs. 7.84%, p = 0.048)
and a tendency towards a lower rate was seen in intermediate vs. high-risk
studies (7.09% vs. 9.62%, p = 0.059). <br/>Conclusion(s): The pooled rate
of independently adjudicated major VCs after transfemoral-TAVI was 7.71%.
Experience and device profile are associated with fewer major
VCs.<br/>Copyright &#xa9; 2019, &#xa9; 2019 The Author(s). Published with
license by Taylor & Francis Group, LLC.