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

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<1>
Accession Number
631908587
Title
Comparisons of perventricular device closure, conventional surgical
repair, and transcatheter device closure in patients with perimembranous
ventricular septal defects: a network meta-analysis.
Source
BMC surgery. 20 (1) (pp 115), 2020. Date of Publication: 26 May 2020.
Author
Li D.; Zhou X.; Li M.; An Q.
Institution
(Li) Department of Cardiovascular Surgery, West China Hospital, Sichuan
University, No. 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China
(Zhou) Evidence-based Medicine Research Center, School of Basic Medical
Sciences, Jiangxi University of Traditional Chinese Medicine, Nanchang,
Jiangxi, China
(Li) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
(An) Department of Cardiovascular Surgery, West China Hospital, Sichuan
University, No. 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Treatments for perimembranous ventricular septal defects
(pmVSD) mainly include conventional surgical repair (CSR), transcatheter
device closure (TDC), and perventricular device closure (PDC). We aimed to
perform a network meta-analysis to compare the three approaches in
patients with pmVSD. METHOD(S): We searched for comparative studies
on device closure and conventional repair for pmVSD to April 2020. A
network meta-analysis was performed under the frequentist frame with risk
ratio and 95% confidence interval. The main outcome was the procedural
success rate. Additional outcomes were postoperative complications,
including residual shunt, intra-cardiac conduction block, valvular
insufficiency, incision infection, and pericardial effusion.
 RESULT(S): Twenty-four studies of 8113 patients were included in the
comparisons. The pooled estimates of success rate favored the CSR compared
with the PDC. No significant differences of success rate were found in the
TDC versus CSR and the PDC versus TDC. The pooled estimates of incidences
of the residual shunt, new tricuspid regurgitation, incision infection,
and pericardial effusion favored the PDC compared with the CSR. There were
no significant differences between the PDC and TDC approaches in all
outcomes except new aortic regurgitation. CONCLUSION(S): The PDC
technique not only reduces the risk of significant complications compared
with the CSR, but also produces not inferior results compared with the TDC
in selected pmVSD patients. PROSPERO REGISTRATION NUMBER: CRD42019125257.

<2>
Accession Number
2005875740
Title
Microplegia in cardiac surgery: Systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 35 (10) (pp 2737-2746), 2020. Date of
Publication: 01 Oct 2020.
Author
Owen C.M.; Asopa S.; Smart N.A.; King N.
Institution
(Owen, King) School of Biomedical Sciences, Faculty of Health, University
of Plymouth, Plymouth, United Kingdom
(Asopa) South West Cardiothoracic Centre, University Hospitals Plymouth,
Plymouth, United Kingdom
(Smart) Exercise Physiology, School of Science and Technology, University
of New England, Armidale, Australia
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Background: Consensus on the optimum choice of cardioplegia remains
elusive. One possibility that has been suggested to have beneficial
properties is microplegia, a cardioplegia of reduced crystalloid volume.
The aim of this meta-analysis is to comprehensively investigate
microplegia against a range of clinical outcomes. Method(s): To
identify potential studies, systematic searches were carried out in four
databases (eg, Pubmed, EMBASE). The search strategy included the key
concepts of "microplegia" OR "mini-cardioplegia" OR "miniplegia" AND
"cardiac surgery." This was followed by a meta-analysis investigating:
mortality, crystalloid volume; cardiopulmonary bypass time; cross-clamp
time; intra-aortic balloon pump use; spontaneous heartbeat recovery;
inotropic support; low cardiac output syndrome; myocardial infarction;
acute renal failure; atrial fibrillation, reoperation for bleeding;
creatine kinase myocardial band (CK-MB); intensive care unit (ICU) time
and hospital stay. Result(s): Eleven studies comprising 5798
participants were analyzed. Microplegia used a lower volume of
crystalloids and led to a higher spontaneous return of heartbeat, odds
ratio (OR) 4.271 (95% confidence intervals [CIs]: 1.935, 9.423;
I2 = 76.57%; P <.001) and a lower requirement for inotropic
support, OR: 0.665 (95% CI: 0.47, 0.941; I2 = 3.53%; P =.021).
Microplegia was also associated with a lower CK-MB release, mean
difference (MD) -6.448 ng/mL (95% CI: -9.386, -3.511; I2 = 0%;
P <.001) and a shorter ICU stay, MD: -0.411 days (95% CI: -0.812, -0.009;
I2 = 17.65%; P =.045). All other comparisons were
nonsignificant. Conclusion(s): Microplegia has similar effects to
other types of cardioplegia and is beneficial with regard to spontaneous
return of heartbeat, inotropic support, ICU stay, and CK-MB
release. Copyright © 2020 The Authors. Journal of Cardiac Surgery
published by Wiley Periodicals LLC

<3>
Accession Number
2005393914
Title
The efficacy and safety of CYP2C19 genotype-guided antiplatelet therapy
compared with conventional antiplatelet therapy in patients with acute
coronary syndrome or undergoing percutaneous coronary intervention: A
meta-analysis of randomized controlled trials.
Source
Platelets. 31 (8) (pp 971-980), 2020. Date of Publication: 16 Nov 2020.
Author
Lyu S.-Q.; Yang Y.-M.; Zhu J.; Wang J.; Wu S.; Zhang H.; Shao X.-H.; Ren
J.-M.
Institution
(Lyu, Yang, Zhu, Wang, Wu, Zhang, Shao, Ren) Chinese Academy of Medical
Sciences and Peking Union Medical College, Emergency and Critical Care
Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital,
National Center for Cardiovascular Diseases, Beijing, China
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Cytochrome P450 (CYP) 2C19 genotype is closely associated with the
metabolism and efficacy of clopidogrel, thereby having an important impact
on clinical outcomes of patients with acute coronary syndrome (ACS) or
undergoing percutaneous coronary intervention (PCI). This study aimed to
evaluate the efficacy and safety of CYP2C19 genotype-guided antiplatelet
therapy in patients with ACS or undergoing PCI. PubMed, EMBASE, the
Cochrane Library and clinicaltrials.gov were searched to identify
randomized controlled trials (RCTs) comparing CYP2C19 genotype-guided
antiplatelet therapy with conventional therapy in patients with ACS or
undergoing PCI. Eight RCTs involving 6708 patients were included in this
meta-analysis. CYP2C19 genotype-guided antiplatelet therapy was slightly
superior to the conventional antiplatelet therapy in reducing the risk of
MACE [RR(95%CI): 0.71(0.51-0.98), p = .04]. Meanwhile, the genotype-guided
therapy group had significantly lower incidence of myocardial infarction
[RR(95%CI): 0.56(0.40-0.78), p < .01], but similar risk of all-cause
mortality, cardiovascular mortality, stent thrombosis, urgent
revascularization and stroke compared to the conventional therapy group.
Incidences of major/minor bleeding and major bleeding were comparable
between the two groups. In patients with ACS or undergoing PCI, CYP2C19
genotype-guided antiplatelet therapy displayed benefit over conventional
antiplatelet therapy in reducing the risk of MACE and myocardial
infarction, without increasing bleeding risk. Further RCTs are needed to
provide more evidences for CYP2C19 genotype-guided antiplatelet
therapy. Copyright © 2020 Taylor & Francis Group, LLC.

<4>
Accession Number
632573558
Title
The effect of problem-based learning after coronary heart disease - A
randomised study in primary health care (COR-PRIM).
Source
BMC Cardiovascular Disorders. 20 (1) (no pagination), 2020. Article
Number: 370. Date of Publication: 14 Aug 2020.
Author
Kohler A.K.; Jaarsma T.; Tingstrom P.; Nilsson S.
Institution
(Kohler, Jaarsma, Tingstrom, Nilsson) Department of Health, Medicine and
Caring Sciences, Linkoping University, Linkoping SE-581 83, Sweden
(Nilsson) Primary Health Care Centre in Vikbolandet, Vikbolandet 610 24,
Sweden
Publisher
BioMed Central Ltd (United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: Cardiac rehabilitation is effective after coronary heart
disease (CHD). However, risk factors remain, and patients report fear for
recurrence during recovery. Problem-based learning is a pedagogical
method, where patients work self-directed in small groups with problem
solving of real-life situations to manage CHD risk factors and self-care.
We aimed to demonstrate the better effectiveness of problem-based learning
over home-sent patient information for evaluating long-term effects of
patient empowerment and self-care in patients with CHD. Hypothesis tested:
One year of problem-based learning improves patients' empowerment- and
self-efficacy, to change self-care compared to 1 year of standardised
home-sent patient information after CHD. Method(s): Patients (N =
157) from rural and urban areas in Sweden between 2011 and 2015 (78% male;
age. 68 +/- 8.5 years) with CHD verified by percutaneous coronary
intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and
CABG+PCI or myocardial infarction (29.9%) were randomly assigned to
problem-based learning (experimental group; n = 79) or home-sent patient
information (controls; n = 78). The problem-based learning intervention
consisted of patient education in primary care by nurses tutoring groups
of 6-9 patients on 13 occasions over 1 year. Controls received home-sent
patient information on 11 occasions during the study year. Result(s):
At one-year follow-up, the primary outcome, patient empowerment, did not
significantly differ between the experimental group and controls. We found
no significant differences between the groups regarding the secondary
outcomes e.g. self-efficacy, although we found significant differences for
body mass index (BMI) [- 0.17 (SD 1.5) vs. 0.50 (SD 1.6), P = 0.033], body
weight [- 0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85), P = 0.026] and HDL
cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P = 0.038] favouring
the experimental group compared to controls. Conclusion(s): The
problem-based learning- and the home-sent patient information
interventions had similar results regarding patient empowerment,
self-efficacy, and well-being. However, problem-based learning exhibited
significant effects on weight loss, BMI, and HDL cholesterol levels,
indicating that this intervention positively affected risk factors
compared to the home-sent patient information. Trial registration:
NCT01462799 (February 2020). Copyright © 2020 The Author(s).

<5>
Accession Number
629175204
Title
The Effect of Continuous Ventilation on Thiol-Disulphide Homeostasis and
Albumin-Adjusted Ischemia-Modified Albumin During Cardiopulmonary Bypass.
Source
Brazilian journal of cardiovascular surgery. 34 (4) (pp 436-443), 2019.
Date of Publication: 27 Aug 2019.
Author
Ozgunay S.E.; Ozsin K.K.; Ustundag Y.; Karasu D.; Ozyaprak B.; Balci B.;
Erel O.; Yavuz S.
Institution
(Ozgunay, Karasu, Ozyaprak) University of Health Sciences Bursa Yuksek
Ihtisas Training and Research Hospital Department of Anesthesiology Bursa
Turkey Department of Anesthesiology, University of Health Sciences, Bursa
Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
(Ozsin, Balci, Yavuz) University of Health Sciences Bursa Yuksek Ihtisas
Training and Research Hospital Department of Cardiovascular Surgery Bursa
Turkey Department of Cardiovascular Surgery, University of Health
Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa,
Turkey
(Ustundag) University of Health Sciences Bursa Yuksek Ihtisas Training and
Research Hospital Department of Medical Biochemistry Bursa Turkey
Department of Medical Biochemistry, University of Health Sciences, Bursa
Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
(Erel) University of Health Sciences Ankara Diskapi Yildirim Beyazit
Research and Education Hospital Department of Medical Biochemistry Ankara
Turkey Department of Medical Biochemistry, University of Health Sciences,
Ankara Diskapi Yildirim Beyazit Research and Education Hospital, Ankara,
Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To investigate the effect of continuous lung ventilation with
low tidal volume on oxidation parameters, such as thiol/disulphide
homeostasis and albumin-adjusted ischemia-modified albumin (AAIMA), during
cardiopulmonary bypass (CBP) in coronary artery bypass grafting (CABG).
 METHOD(S): Seventy-four patients who underwent elective CABG with CPB
were included in the study. Blood samples were taken in the preoperative
period, 10 minutes after CPB, and six and 24 hours postoperatively.
Patients were assigned to the continuous ventilation group (Group 1, n=37)
and the non-ventilated group (Group 2, n=37). The clinical
characteristics, thiol/disulphide homeostasis, ischemia-modified albumin
(IMA), and AAIMA levels of the patients were compared. RESULT(S): A
significant difference was found between the groups regarding native
thiol, total thiol, and IMA levels at the postoperative 24th hour
(P=0.030, P=0.031, and P=0.004, respectively). There was no difference
between the groups in terms of AAIMA. AAIMA levels returned to
preoperative levels in Groups 1 and 2, at the 6th and 24th postoperative
hours, respectively. Length of hospital stay was significantly shorter in
Group 1 (P<0.001) than in Group 2. CONCLUSION(S): Continuous
ventilation during CPB caused an increase in native and total thiol
levels, an earlier return of AAIMA levels, and shorter hospital stay.
Continuous ventilation may reduce the negative effects of CPB on
myocardium (Table 2, Figure 1, and Reference 31).

<6>
Accession Number
629174979
Title
Coronary Artery Bypass Graft Surgery Improves Survival Without Increasing
the Risk of Stroke in Patients with Ischemic Heart Failure in Comparison
to Percutaneous Coronary Intervention: A Meta-Analysis With 54,173
Patients.
Source
Brazilian journal of cardiovascular surgery. 34 (4) (pp 396-405), 2019.
Date of Publication: 27 Aug 2019.
Author
Sa M.P.B.O.; Perazzo AM.; Saragiotto F.A.S.; Cavalcanti L.R.P.; Almeida
A.C.E.; Campos J.C.S.; Braga P.G.B.; Rayol S.D.C.; Diniz R.G.S.; Sa
F.B.C.A.; Lima R.C.
Institution
(Sa, Perazzo, Saragiotto, Cavalcanti, Almeida, Campos, Braga, Rayol,
Diniz, Sa, Lima) Pronto Socorro Cardiologico de Pernambuco - PROCAPE
Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of
Cardiovascular Surgery, Pronto Socorro Cardiologico de Pernambuco -
PROCAPE, Recife, Pernambuco, Brazil
(Sa, Perazzo, Saragiotto, Cavalcanti, Almeida, Campos, Braga, Rayol,
Diniz, Sa, Lima) University of Pernambuco - UPE Recife Pernambuco Brazil
University of Pernambuco - UPE, Recife, Pernambuco, Brazil
(Sa, Lima) Faculty of Medical Sciences and Biological Sciences Institute -
FCM/ICB Nucleus of Postgraduate and Research in Health Sciences Recife
Pernambuco Brazil Nucleus of Postgraduate and Research in Health Sciences,
Faculty of Medical Sciences and Biological Sciences Institute - FCM/ICB,
Recife, Pernambuco, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate whether there is any difference on the results of
patients treated with coronary artery bypass grafting (CABG) or
percutaneous coronary intervention (PCI) in the setting of ischemic heart
failure (HF). METHOD(S): Databases (MEDLINE, Embase, Cochrane
Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific
Electronic Library Online [SciELO], Literatura Latino-americana e do
Caribe em Ciencias da Saude [LILACS], and Google Scholar) were searched
for studies published until February 2019. Main outcomes of interest were
mortality, myocardial infarction, repeat revascularization, and stroke.
 RESULT(S): The search yielded 5,775 studies for inclusion. Of these,
20 articles were analyzed, and their data were extracted. The total number
of patients included was 54,173, and those underwent CABG (N=29,075) or
PCI (N=25098). The hazard ratios (HRs) for mortality (HR 0.763; 95%
confidence interval [CI] 0.678-0.859; P<0.001), myocardial infarction (HR
0.481; 95% CI 0.365-0.633; P<0.001), and repeat revascularization (HR
0.321; 95% CI 0.241-0.428; P<0.001) were lower in the CABG group than in
the PCI group. The HR for stroke showed no statistically significant
difference between the groups (random effect model: HR 0.879; 95% CI
0.625-1.237; P=0.459). CONCLUSION(S): This meta-analysis found that
CABG surgery remains the best option for patients with ischemic HF,
without increase in the risk of stroke.

<7>
Accession Number
629157895
Title
Effect of dental treatment before cardiac valve surgery: Systematic review
and meta-analysis.
Source
Journal of the American Dental Association (1939). 150 (9) (pp 739-747),
2019. Date of Publication: 01 Sep 2019.
Author
Lockhart P.B.; DeLong H.R.; Lipman R.D.; Abt E.; Baddour L.M.; Colvin M.;
Miller C.S.; Sollecito T.; O'Brien K.; Estrich C.G.; Araujo M.W.B.;
Carrasco-Labra A.
Publisher
NLM (Medline)
Abstract
BACKGROUND: The purpose of this systematic review was to determine the
potential effect of dental treatment before cardiac valve surgery (CVS) or
left ventricular assist device (LVAD) implantation on morbidity and
mortality. TYPES OF STUDIES REVIEWED: The authors included relevant
studies from MEDLINE, Embase, and the Cochrane Central Register of
Controlled Trials, including randomized controlled trials and cohort
studies, published from 1998 through 2019 and involving adults who
received dental treatment before CVS or LVAD implantation. The authors
assessed bias by using the Newcastle-Ottawa Quality Assessment Scale and
evidence certainty by using the Grading of Recommendations Assessment,
Development and Evaluation approach. The authors used a meta-analysis with
a random-effects model to estimate dichotomous and continuous outcomes,
expressed as relative risk (RR) and weighted mean difference.
 RESULT(S): Six studies met the inclusion criteria for CVS but none
for LVAD implantation. Very low certainty in the evidence suggested
uncertainty as to whether health outcomes for patients undergoing dental
treatment before CVS differed from those who did not. Postsurgical
outcomes included all-cause mortality (RR, 1.00; 95% confidence interval
[CI], 0.53 to 1.91), infective endocarditis (RR, 1.30; 95% CI, 0.51 to
3.35), postsurgical infection (RR, 1.01; 95% CI, 0.76 to 1.33), and length
of stay in the hospital (weighted mean difference, 2.9; 95% CI, -2.3 to
8.1). CONCLUSIONS AND PRACTICAL IMPLICATIONS: From the available evidence,
it is unclear whether postoperative outcomes differ in patients receiving
dental treatment before CVS compared with outcomes in those who do not.
Dentists and medical care professionals should collaborate on an
appropriate course of action for each patient, weighing any potentially
relevant care considerations. Copyright © 2019 American Dental
Association. Published by Elsevier Inc. All rights reserved.

<8>
Accession Number
624872227
Title
The effect of remote ischemic preconditioning on the incidence of acute
kidney injury in patients undergoing coronary artery bypass graft surgery:
A randomized controlled trial.
Source
Iranian Journal of Medical Sciences. 43 (6) (pp 587-595), 2018. Date of
Publication: November 2018.
Author
Bagheri S.; Shahbazi S.; Shafa M.; Borhani-Haghighi A.; Kiani M.; Sagheb
M.M.
Institution
(Bagheri, Kiani, Sagheb) Shiraz Nephro-Urology Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Shahbazi) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Shafa) Department of Cardiac Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Borhani-Haghighi) Clinical Neurology Research Center, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Shriaz University of Medical Sciences (E-mail: info@gmj.ir)
Abstract
Background: Remote ischemic preconditioning (RIPC) protects other organs
from subsequent lethal ischemic injury, but uncertainty remains. We
investigated if RIPC could prevent acute kidney injury (AKI) in patients
undergoing coronary artery bypass graft (CABG) surgery. Method(s):
This parallel-group, double-blind, randomized, controlled trial was done
on adults undergoing elective or urgent on-pump CABG surgery from 2013 to
2017 in Shiraz, Iran. Patients were allocated to RIPC or control groups
through permuted blocking. The patients in the RIPC group received three
cycles of 5 min ischemia and 5 min reperfusion in the upper arm after
induction of anesthesia. We placed an uninflated cuff on the arm for 30
min in the control group. The study primary endpoint was an incidence of
AKI. Secondary endpoints included short-term clinical outcomes. We
compared categorical and continuous variables using Pearson
chi2 and unpaired t tests, respectively. P<0.05 was considered
significant. Result(s): Of the 180 patients randomized to RIPC (n=90)
and control (n=90) groups, 87 patients in the RIPC and 90 patients in the
control group were included in the analysis. There was no significant
difference in the incidence of AKI between the groups (38 patients [43.7%]
in the RIPC group and 41 patients [45.6%] in the control group; relative
risk, 0.96; 95% confidence interval, 0.69 to 1.33; P=0.80). No significant
differences were seen regarding secondary endpoints such as postoperative
liver function, atrial fibrillation, and inpatient mortality.
 Conclusion(s): RIPC did not reduce the incidence of AKI, neither did
it improve short-term clinical outcomes in patients undergoing on-pump
CABG surgery. Copyright © 2018, Shiraz University of Medical
Sciences. All rights reserved.

<9>
Accession Number
620401046
Title
Systematic detection of polyvascular disease combined with aggressive
secondary prevention in patients presenting with severe coronary artery
disease: The randomized AMERICA Study.
Source
International Journal of Cardiology. 254 (pp 36-42), 2018. Date of
Publication: 01 Mar 2018.
Author
Collet J.-P.; Cayla G.; Ennezat P.-V.; Leclercq F.; Cuisset T.; Elhadad
S.; Henry P.; Belle L.; Cohen A.; Silvain J.; Barthelemy O.; Beygui F.;
Diallo A.; Vicaut E.; Montalescot G.
Institution
(Collet, Silvain, Barthelemy, Montalescot) Sorbonne Universite Paris 6,
ACTION Study Group, Institut de Cardiologie Hopital Pitie-Salpetriere
(APHP), INSERM UMRS, Paris 1166, France
(Cayla) ACTION Study Group, Cardiologie, CHU Caremeau, Universite de
Montpellier, Nimes, France
(Ennezat) Cardiologie, Pole Thorax et Vaisseaux, CHU La Tronche, Grenoble,
France
(Leclercq) Cardiologie, Hopital Arnaud de Villeneuve-CHU Montpellier,
France
(Cuisset) Department of Cardiology, CHU Timone and Aix-Marseille Univ,
INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis,
Faculty of Medicine, Marseille F-13385, France
(Elhadad) Cardiologie, CH de Lagny-Marne la Vallee, Jossigny, France
(Henry) Cardiologie, CHU Lariboisiere (APHP), Paris, France
(Belle) Cardiologie, Centre Hospitalier d'Annecy, France
(Cohen) Cardiologie, CHU Saint-Antoine (APHP), Paris, France
(Beygui) Cardiologie, Hopital de la Cote de Nacre, Caen, France
(Diallo, Vicaut) ACTION Study Group, Unite de Recherche Clinique-Hopital
Lariboisiere (APHP), France and Universite Denis Diderot, Paris, France
Publisher
Elsevier Ireland Ltd
Abstract
Background: The prevalence and associated-risk of asymptomatic multisite
artery disease (MSAD) in high risk coronary patients are unknown. Whether
systematic identification and aggressive management of asymptomatic MSAD
is clinically relevant in high risk coronary patients has not been
evaluated. Method(s): We randomly assigned 521 high risk coronary
patients defined by the presence of three-vessel coronary disease (n =
304) or recent acute coronary syndrome beyond the age of 75 years (n =
215) to either a strategy of systematic detection of asymptomatic MSAD
combined with an aggressive secondary prevention (n = 263) or to a more
conventional strategy based on treatment of coronary artery disease only
with standard of care (n = 258). The primary end point was the time to
first occurrence of death, any organ failure or ischemic event leading to
re-hospitalization through two years of follow-up. Result(s): The
pro-active strategy identified asymptomatic MSAD in 21.7% of patients with
few revascularizations (3.6%); the pro-active pharmacological secondary
prevention was obtained in > 85% of patients and life-style changes in <
60% of patients. At 2-year follow-up, the primary end point occurred in
44.9% of patients in the pro-active group and 43.0% of patients in the
conventional group (HR 1.03; 95% confidence interval [CI], 0.80 to 1.34].
The rate of major bleeding did not differ significantly between groups
(4.6% vs 5.0%; HR, 0.97; 95% CI, 0.40 to 1.91). Conclusion(s): In
high risk coronary patients, there is no apparent benefit of a systematic
detection of asymptomatic extra-coronary atherothrombotic disease and
intensified treatment over a 2-year follow-up period. (Funded by the
Academic Allies in Cardiovascular Trials Initiatives and Organized
Networks and Institut de l'Atherothrombose; AMERICA ClinicalTrials.gov
number, NCT00445835). Copyright © 2017 Elsevier Ireland Ltd

<10>
Accession Number
620031659
Title
Meta-Analysis of Culprit-Only Versus Multivessel Percutaneous Coronary
Intervention in Patients With ST-Segment Elevation Myocardial Infarction
and Multivessel Coronary Disease.
Source
American Journal of Cardiology. 121 (5) (pp 529-536), 2018. Date of
Publication: 01 Mar 2018.
Author
Bangalore S.; Toklu B.; Stone G.W.
Institution
(Bangalore) Division of Cardiology, New York University School of
Medicine, New York, New York, United States
(Toklu) Division of Cardiology, Mt. Sinai Beth Israel Medical Center, New
York, New York, United States
(Stone) New York Presbyterian Hospital, Columbia University Medical Center
and the Cardiovascular Research Foundation, New York, New York, United
States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Recently, several randomized controlled trials (RCT) in patients with
ST-segment elevation myocardial infarction (STEMI) and multivessel disease
(MVD) have compared a strategy of routine multivessel percutaneous
coronary intervention (PCI) performed either as a single procedure or as
staged procedures to culprit-only PCI. All of these trials have been
underpowered for clinical end points. We searched PubMed, Embase, and
Cochrane Central Register of Controlled Trials for RCT comparing
multivessel PCI with culprit-only PCI in patients with STEMI and MVD. The
primary efficacy outcome was the composite rate of death or MI. Other
efficacy outcomes included death, MI, and repeat revascularization. Safety
outcomes were contrast-associated acute kidney injury, stroke, and major
bleeding. Pairwise direct comparison and mixed-treatment comparison
network meta-analyses were performed. Eleven trials that enrolled 3,150
patients with a total of 5,296 patient-years of follow-up were included.
In direct comparison meta-analysis, single-procedure multivessel PCI was
associated with a reduction in the risk of death or MI (rate ratio [RR] =
0.52; 95% confidence interval [CI] 0.37 to 0.73; p <0.001), due to less
death (RR = 0.64; 95% CI 0.40 to 1.02; p = 0.06) and MI (RR = 0.42; 95% CI
0.25 to 0.69; p <0.0001) compared with culprit-only PCI. No heterogeneity
(I2 = 0) was present between studies. In contrast, staged
multivessel PCI did not significantly reduce death or MI compared with
culprit-only PCI. Both multivessel PCI strategies reduced the risk of
repeat revascularization without significant differences in safety
outcomes. Results were consistent in the mixed-treatment comparison
meta-analysis. In conclusion, the present meta-analysis suggests that
single-procedure multivessel PCI may be the preferred strategy in patients
with STEMI and MVD. Copyright © 2017 Elsevier Inc.

<11>
Accession Number
616777963
Title
Heated humidified high-flow nasal cannula oxygen after thoracic surgery -
A randomized prospective clinical pilot trial.
Source
Journal of Critical Care. 40 (pp 225-228), 2017. Date of Publication: 01
Aug 2017.
Author
Brainard J.; Scott B.K.; Sullivan B.L.; Fernandez-Bustamante A.; Piccoli
J.R.; Gebbink M.G.; Bartels K.
Institution
(Brainard, Scott, Sullivan, Fernandez-Bustamante, Bartels) Department of
Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th
Avenue, Leprino Office Building, 7th Floor, MS B-113, Aurora, CO 80045,
United States
(Piccoli, Gebbink) Department of Respiratory Care, University of Colorado
Hospital, 12605 East 16th Avenue, MS F-764, Aurora, CO 80045, United
States
Publisher
W.B. Saunders
Abstract
Background Thoracic surgery patients are at high-risk for adverse
pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen
(HHFNC O<inf>2</inf>) may decrease such events. We hypothesized that
patients randomized to prophylactic HHFNC O<inf>2</inf> would develop
fewer pulmonary complications compared to conventional O<inf>2</inf>
therapy. Methods and patients Fifty-one patients were randomized to HHFNC
O<inf>2</inf> vs. conventional O<inf>2</inf>. The primary outcome was a
composite of postoperative pulmonary complications. Secondary outcomes
included oxygenation and length of stay. Continuous variables were
compared with t-test or Mann-Whitney-U test, categorical variables with
Fisher's Exact test. Results There were no differences in postoperative
pulmonary complications based on intention to treat [two in HHFNC
O<inf>2</inf> (n = 25), two in control (n = 26), p = 0.680], and after
exclusion of patients who discontinued HHFNC O<inf>2</inf> early [one in
HHFNC O<inf>2</inf> (n = 18), two in control (n = 26), p = 0.638].
Discomfort from HHFNC O<inf>2</inf> occurred in 11/25 (44%); 7/25 (28%)
discontinued treatment. Conclusions Pulmonary complications were rare
after thoracic surgery. Although HHFNC O<inf>2</inf> did not convey
significant benefits, these results need to be interpreted with caution,
as our study was likely underpowered to detect a reduction in pulmonary
complications. High rates of patient-reported discomfort with HHFNC
O<inf>2</inf> need to be considered in clinical practice and future
trials. Copyright © 2017 Elsevier Inc.

<12>
Accession Number
616633961
Title
Transcathether aortic valve implantation with the new repositionable
self-expandable Evolut R versus CoreValve system: A case-matched
comparison.
Source
International Journal of Cardiology. 243 (pp 126-131), 2017. Date of
Publication: 15 Sep 2017.
Author
Giannini C.; De Carlo M.; Tamburino C.; Ettori F.; Latib A.M.; Bedogni F.;
Bruschi G.; Presbitero P.; Poli A.; Fabbiocchi F.; Violini R.; Trani C.;
Giudice P.; Barbanti M.; Adamo M.; Colombo P.; Benincasa S.; Agnifili M.;
Petronio A.S.
Institution
(Giannini, De Carlo, Petronio) Azienda Ospedaliero-Universitaria Pisana,
Pisa, Italy
(Tamburino, Barbanti) Ferrarotto Hospital, University of Catania, Catania,
Italy
(Ettori, Adamo) Ospedali Civili, Brescia, Italy
(Latib, Benincasa) Scientific Institute S. Raffaele, Milan, Italy
(Bedogni, Agnifili) Policlinico San Donato, San Donato, Italy
(Bruschi, Colombo) "De Gasperis" Cardio Center ASST Niguarda Metropolitan
Hospital, Milan, Italy
(Presbitero) Clinical Institute Humanitas, Rozzano, Milan, Italy
(Poli) Ospedale Civile, Legnano, Italy
(Fabbiocchi) Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Violini) San Camillo Forlanini Hospital, Rome, Italy
(Trani) Institute of Cardiology, Catholic University of Sacred Heart,
Rome, Italy
(Giudice) Giovanni Di Dio e Ruggi D'Aragona University Hospital, Salerno,
Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite promising results following transcatheter aortic valve
implantation (TAVI), several relevant challenges still remain. To overcome
these issues, new generation devices have been developed. The purpose of
the present study was to determine whether TAVI with the new
self-expanding repositionable Evolut R offers potential benefits compared
to the preceding CoreValve, using propensity matching. Methods Between
June 2007 and November 2015, 2148 consecutive patients undergoing TAVI
either CoreValve (n = 1846) or Evolut R (n = 302) were prospectively
included in the Italian TAVI ClinicalService project. For the purpose of
our analysis 211 patients treated with the Evolut R were matched to 211
patients treated with the CoreValve. An independent core laboratory
reviewed all angiographic procedural data and an independent clinical
events committee adjudicated all events. Results Patients treated with
Evolut R experienced higher 1-year overall survival (log rank test p =
0.045) and a significantly lower incidence of major vascular access
complications, bleeding events and acute kidney injury compared to
patients treated with the CoreValve. Recapture manoeuvres to optimize
valve deployment were performed 44 times, allowing a less implantation
depth for the Evolut R. As a consequence, the rate of more than mild
paravalvular leak and new permanent pacemaker was lower in patients
receiving the Evolut R. Conclusion In this matched comparison of high
surgical risk patients undergoing TAVI, the use of Evolut R was associated
with a significant survival benefit at 1 year compared with the CoreValve.
This was driven by lower incidence of periprocedural complications and
higher rates of correct anatomic positioning. Copyright © 2017
Elsevier B.V.

<13>
Accession Number
616544711
Title
Higher success rate with transcranial electrical stimulation of
motor-evoked potentials using constant-voltage stimulation compared with
constant-current stimulation in patients undergoing spinal surgery.
Source
Spine Journal. 17 (10) (pp 1472-1479), 2017. Date of Publication: October
2017.
Author
Shigematsu H.; Kawaguchi M.; Hayashi H.; Takatani T.; Iwata E.; Tanaka M.;
Okuda A.; Morimoto Y.; Masuda K.; Tanaka Y.
Institution
(Shigematsu, Iwata, Tanaka, Okuda, Morimoto, Masuda, Tanaka) Department of
Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara
City, Nara 6348522, Japan
(Kawaguchi, Hayashi, Tanaka) Department of Anesthesiology, Nara Medical
University, 840 Shijo-cho, Kashihara City, Nara 6348522, Japan
(Takatani) Division of Central Clinical Laboratory, Nara Medical
University, 840 Shijo-cho, Kashihara City, Nara 6348522, Japan
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background Context During spine surgery, the spinal cord is
electrophysiologically monitored via transcranial electrical stimulation
of motor-evoked potentials (TES-MEPs) to prevent injury. Transcranial
electrical stimulation of motor-evoked potential involves the use of
either constant-current or constant-voltage stimulation; however, there
are few comparative data available regarding their ability to adequately
elicit compound motor action potentials. We hypothesized that the success
rates of TES-MEP recordings would be similar between constant-current and
constant-voltage stimulations in patients undergoing spine surgery.
Purpose The objective of this study was to compare the success rates of
TES-MEP recordings between constant-current and constant-voltage
stimulation. Study Design This is a prospective, within-subject study.
Patient Sample Data from 100 patients undergoing spinal surgery at the
cervical, thoracic, or lumbar level were analyzed. Outcome Measures The
success rates of the TES-MEP recordings from each muscle were examined.
Materials and Methods Transcranial electrical stimulation with
constant-current and constant-voltage stimulations at the C3 and C4
electrode positions (international "10-20" system) was applied to each
patient. Compound muscle action potentials were bilaterally recorded from
the abductor pollicis brevis (APB), deltoid (Del), abductor hallucis (AH),
tibialis anterior (TA), gastrocnemius (GC), and quadriceps (Quad) muscles.
Results The success rates of the TES-MEP recordings from the right Del,
right APB, bilateral Quad, right TA, right GC, and bilateral AH muscles
were significantly higher using constant-voltage stimulation than those
using constant-current stimulation. The overall success rates with
constant-voltage and constant-current stimulations were 86.3% and 68.8%,
respectively (risk ratio 1.25 [95% confidence interval: 1.20-1.31]).
Conclusions The success rates of TES-MEP recordings were higher using
constant-voltage stimulation compared with constant-current stimulation in
patients undergoing spinal surgery. Copyright © 2017 Elsevier
Inc.

<14>
Accession Number
615615840
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention with drug-eluting stents for left main coronary artery
disease: A meta-analysis of randomized trials.
Source
International Journal of Cardiology. 241 (pp 142-148), 2017. Date of
Publication: 15 Aug 2017.
Author
Putzu A.; Gallo M.; Martino E.A.; Ferrari E.; Pedrazzini G.; Moccetti T.;
Cassina T.
Institution
(Putzu, Cassina) Department of Cardiovascular Anesthesia and Intensive
Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
(Gallo, Ferrari) Department of Cardiac Surgery, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
(Martino) Department of Anesthesia and Intensive Care, San Gerardo
Hospital, Via Pergolesi 33, Monza, Italy
(Pedrazzini, Moccetti) Department of Cardiology, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite several clinical studies, efficacy of coronary artery
bypass grafting (CABG) surgery versus percutaneous coronary intervention
(PCI) in patients with left main (LM) disease remains controversial. The
objective of this meta-analysis of randomized trials was to evaluate the
clinical outcome of CABG versus PCI with drug-eluting stents in LM
coronary disease. Methods We systematically searched online databases up
to March 2017 for randomized trials comparing CABG to PCI with
drug-eluting stents. We calculated odds ratios (ORs) and 95% confidence
intervals (CIs). Results We included data from 5 randomized trials and
4595 patients. At 30 days, CABG was associated with higher stroke (OR 2.54
[95% CI, 1.02-6.31]) and periprocedural myocardial infarction (OR 1.45
[95% CI, 1.00-2.10]), with no other significant differences compared to
PCI. At 1 year, CABG reduced repeat revascularization (OR 0.56 [95% CI,
0.40-0.77]), but increased stroke (OR 5.11 [95% CI, 1.62-16.12]). At 3-5
years, CABG reduced repeat revascularization (OR 0.55 [95% CI, 0.45-0.67])
and non-periprocedural myocardial infarction (OR 0.45 [95% CI,
0.29-0.70]), without significant differences on other outcomes.
Conclusions From the present updated meta-analysis of available studies on
LM coronary disease treatment, there were no differences in mortality,
myocardial infarction, and stroke rate at 3-5 years follow-up after CABG
or PCI, but CABG decreased the rate of repeat revascularization and
non-periprocedural infarction. However, at short-term follow-up, CABG
showed higher rate of stroke and periprocedural myocardial infarction, but
these effects attenuated over time. These findings merit further
investigation at longer follow-up. Copyright © 2017 Elsevier B.V.

<15>
Accession Number
617760216
Title
Cangrelor Versus Clopidogrel on a Background of Unfractionated Heparin
(from CHAMPION PHOENIX).
Source
American Journal of Cardiology. 120 (7) (pp 1043-1048), 2017. Date of
Publication: 01 Oct 2017.
Author
Vaduganathan M.; Harrington R.A.; Stone G.W.; Steg P.G.; Gibson C.M.; Hamm
C.W.; Price M.J.; Deliargyris E.N.; Prats J.; Mahaffey K.W.; White H.D.;
Bhatt D.L.
Institution
(Vaduganathan, Bhatt) Brigham and Women's Hospital Heart & Vascular Center
and Harvard Medical School, Boston, Massachusetts, United States
(Harrington, Mahaffey) Stanford University Medical School, Stanford,
California, United States
(Stone) Columbia University Medical Center and the Cardiovascular Research
Foundation, New York City, New York, United States
(Steg) FACT (French Alliance for Cardiovascular clinical Trials), DHU
FIRE, INSERM Unite 1148, Universite Paris-Diderot, Paris, France
(Steg) Hopital Bichat, Assistance-Publique-Hopitaux de Paris, Paris,
France
(Steg) NHLI, Imperial College, Royal Brompton Hospital, London, United
Kingdom
(Gibson) Beth Israel Deaconess Medical Center, Division of Cardiology,
Boston, Massachusetts, United States
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Price) Scripps Clinic and Scripps Translational Science Institute, La
Jolla, California, United States
(Deliargyris) Science and Strategy Consulting Group, Basking Ridge, New
Jersey, United States
(Prats) The Medicines Company, Parsippany, New Jersey, United States
(White) Green Lane Cardiovascular Service, Auckland, New Zealand
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Cangrelor is approved for use during percutaneous coronary intervention
(PCI) and is administered with different parenteral anticoagulants. We
examined the efficacy and safety of cangrelor in the subgroup of patients
who received unfractionated heparin (UFH) during PCI in the modified
intention-to-treat population of the randomized CHAMPION PHOENIX trial
(cangrelor vs clopidogrel; n = 10,939). The primary efficacy end point was
the composite of death, myocardial infarction, ischemia-driven
revascularization, or stent thrombosis (ST) at 48 hours. The key secondary
efficacy end point was ST. UFH was used in 69.2% (7,569/10,939) of
patients. In the UFH subgroup, cangrelor reduced the primary composite
efficacy end point at 48 hours compared with clopidogrel (4.8% vs 5.9%;
odds ratio [OR] 0.80 [0.65 to 0.98]; p = 0.03). Cangrelor consistently
reduced ST at 2 hours (0.7% vs 1.3%; OR 0.56 [0.35 to 0.90]; p = 0.01) and
48 hours (0.9% vs 1.4%; OR 0.70 [0.45 to 1.07]; p = 0.10). There was no
difference in GUSTO (Global Use of Strategies to Open Occluded Coronary
Arteries)-defined severe or life-threatening bleeding (0.1% vs 0.1%; OR
1.24 [0.33 to 4.61]; p = 0.75) or blood transfusion requirement at 48
hours (0.4% vs 0.2%; OR 1.87 [0.83 to 4.21]; p = 0.12). In conclusion,
cangrelor reduces early ischemic periprocedural complications without
increasing severe bleeding compared with clopidogrel in patients
undergoing PCI with UFH. Copyright © 2017 Elsevier Inc.

<16>
Accession Number
614518952
Title
Effects of low-dose atrial natriuretic peptide infusion on cardiac
surgery-associated acute kidney injury: A multicenter randomized
controlled trial.
Source
Journal of Critical Care. 38 (pp 253-258), 2017. Date of Publication: 01
Apr 2017.
Author
Mitaka C.; Ohnuma T.; Murayama T.; Kunimoto F.; Nagashima M.; Takei T.;
Iguchi N.; Tomita M.
Institution
(Mitaka) Department of Anesthesiology, Tokyo Medical and Dental University
Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
(Mitaka) Department of Anesthesiology and Pain Medicine, Juntendo
University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Ohnuma, Murayama) Intensive Care Unit, Department of Anesthesiology,
Saitama Medical Center, Jichi Medical University, 1-847 Amanuma,
Ohmiya-ku, Saitama 330-8503, Japan
(Kunimoto) Intensive Care Unit, Gunma University Hospital, 3-39-15 Shouwa,
Maebashi, Gunma 371-8511, Japan
(Nagashima, Takei) Intensive Care Unit, Yokohama City Minato Red Cross
Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama, Kanagawa 231-8682,
Japan
(Iguchi) Intensive Care Unit, Osaka University Hospital, 2-15 Yamadaoka,
Suita, Osaka 565-0871, Japan
(Tomita) Clinical Research Center, Tokyo Medical and Dental University
Hospital of Medicine 1-5-45 Yushima, Tokyo 113-8519, Japan
Publisher
W.B. Saunders
Abstract
Purpose To evaluate the effects of atrial natriuretic peptide (ANP) on
renal function and medical costs in patients with acute kidney injury
(AKI) associated with cardiac surgery. Materials and methods The Japanese
trial for AKI in Post-cardiovascular surgery patients by ANP (JAPAN) was a
prospective, multicenter, randomized, double-blind, placebo-controlled
study conducted in 11 hospitals in Japan. Acute kidney injury was defined
as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours.
The patients were randomly assigned to receive ANP (0.02 mug
kg-1 min-1) or placebo. The primary end point was a
change in renal function. The secondary end points were a need for renal
replacement therapy, the lengths of intensive care unit and hospital
stays, and medical costs incurred over the 90-day follow-up. Results Of
the 77 randomized patients, 37 were in the ANP group and 40 were in the
placebo group. Although ANP significantly (P =.018) increased urine
output, it did not significantly improve renal function compared with
placebo. There were no significant differences between the groups in the
renal replacement therapy rate, the lengths of the intensive care unit and
hospital stays, or medical costs. Conclusion Atrial natriuretic peptide
infusion did not show a renoprotective effect or cost-saving effect in the
treatment of cardiac surgery-associated AKI. Copyright © 2016 The
Authors

<17>
Accession Number
614075888
Title
Use of noninvasive and invasive mechanical ventilation in cardiogenic
shock: A prospective multicenter study.
Source
International Journal of Cardiology. 230 (pp 191-197), 2017. Date of
Publication: 01 Mar 2017.
Author
Hongisto M.; Lassus J.; Tarvasmaki T.; Tolppanen H.; Lindholm M.G.;
Banaszewski M.; Parissis J.; Spinar J.; Silva-Cardoso J.; Carubelli V.; Di
Somma S.; Masip J.; Harjola V.-P.; Kober L.; Mebazaa A.; Metra M.; Sionis
A.; Koniari K.; Voumvourakis A.; Karavidas A.; Sans-Rosello J.; Vila M.;
Duran-Cambra A.; Bulgari B.; Lazzarini V.; Parenica J.; Stipal R.; Ludka
O.; Palsuva M.; Ganovska E.; Kubena P.; Hassager C.; Backlund T.; Jurkko
R.; Jarvinen K.; Nieminen T.; Pulkki K.; Soininen L.; Sund R.; Tierala I.;
Tolonen J.; Varpula M.; Korva T.; Pietila M.; Pitkala A.; Marino R.; Sousa
A.; Sousa C.; Paiva M.; Rangel I.; Almeida R.; Pinho T.; Julia Maciel M.;
Stepinska J.; Skrobisz A.; Goral P.
Institution
(Hongisto, Tarvasmaki, Harjola) Emergency Medicine, University of
Helsinki, Department of Emergency Care, Helsinki University Hospital,
Helsinki, Finland
(Lassus, Tolppanen) Helsinki University Hospital, Heart and Lung Center,
Division of Cardiology, Helsinki, Finland
(Sionis) Intensive Cardiac Care Unit, Cardiology Department, Hospital de
la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant
Pau) Barcelona, Spain
(Lindholm) Rigshospitalet, Copenhagen University Hospital, Intensive
Cardiac Care Unit, Copenhagen, Denmark
(Banaszewski) Institute of Cardiology, Intensive Cardiac Therapy Clinic,
Warsaw, Poland
(Parissis) Attikon University Hospital, Heart Failure Clinic and Secondary
Cardiology Department, Athens, Greece
(Spinar) University Hospital Brno, Department of Internal Medicine and
Cardiology, Brno, Czechia
(Silva-Cardoso) University of Porto, CINTESIS, Department of Cardiology,
Porto Medical School, Sao Joao Hospital Center, Porto, Portugal
(Carubelli) Division of Cardiology, Department of Medical and Surgical
Specialties, Radiological Sciences, and Public Health, University and
Civil Hospital of Brescia, Italy
(Di Somma) Department of Medical Sciences and Translational Medicine,
University of Rome Sapienza, Emergency Medicine Sant'Andrea Hospital,
Rome, Italy
(Masip) University of Barcelona, Hospital Sant Joan Despi Moises Broggi,
Critical Care Department, Consorci Sanitari Integral, Barcelona, Spain
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite scarce data, invasive mechanical ventilation (MV) is
widely recommended over non-invasive ventilation (NIV) for ventilatory
support in cardiogenic shock (CS). We assessed the real-life use of
different ventilation strategies in CS and their influence on outcome
focusing on the use of NIV and MV. Methods 219 CS patients were
categorized by the maximum intensity of ventilatory support they needed
during the first 24 h into MV (n = 137; 63%), NIV (n = 26; 12%), and
supplementary oxygen (n = 56; 26%) groups. We compared the clinical
characteristics and 90-day outcome between the MV and the NIV groups.
Results Mean age was 67 years, 74% were men. The MV and NIV groups did not
differ in age, medical history, etiology of CS,
PaO<inf>2</inf>/FiO<inf>2</inf> ratio, baseline hemodynamics or LVEF. MV
patients predominantly presented with hypoperfusion, with more severe
metabolic acidosis, higher lactate levels and greater need for vasoactive
drugs, whereas NIV patients tended to be more often congestive. 90-day
outcome was significantly worse in the MV group (50% vs. 27%), but after
propensity score adjustment, mortality was equal in both groups.
Confusion, prior CABG, ACS etiology, higher lactate level, and lower
baseline PaO<inf>2</inf> were independent predictors of mortality, whereas
ventilation strategy did not have any influence on outcome. Conclusions
Although MV is generally recommended mode of ventilatory support in CS, a
fair number of patients were successfully treated with NIV. Moreover,
ventilation strategy was not associated with outcome. Thus, NIV seems a
safe option for properly chosen CS patients. Copyright © 2016
Elsevier Ireland Ltd

<18>
Accession Number
618418792
Title
Meta-Analysis Comparing >=10-Year Mortality of Off-Pump Versus On-Pump
Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. 120 (11) (pp 1933-1938), 2017. Date of
Publication: 01 Dec 2017.
Author
Takagi H.; Ando T.; Mitta S.
Institution
(Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit,
Michigan, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Off-pump coronary artery bypass grafting (CABG) is suggested to be
associated with an increase in long-term (>=5-year) all-cause mortality.
To determine whether off-pump CABG is associated with an increase in very
long-term (>=10-year) all-cause mortality, we performed a meta-analysis of
propensity-score matched observational comparative studies of off-pump
versus on-pump CABG. MEDLINE and EMBASE were searched through May 2017. A
hazard ratio of follow-up (including early) all-cause mortality for
off-pump versus on-pump CABG was extracted from each individual study.
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic hazard ratios in the random-effects model. Of 164
potentially relevant studies, our search identified 16 propensity-score
matched observational comparative studies of off-pump versus on-pump CABG
with >=10-year follow-up enrolling a total of 82,316 patients. A pooled
analysis of all the 16 studies demonstrated that off-pump CABG was
significantly associated with an increase in all-cause mortality (hazard
ratio 1.07, 95% confidence interval 1.03 to 1.12, p for effect = 0.0008; p
for heterogeneity = 0.30, I2 = 12%). In a sensitivity analysis,
exclusion of any single hazard ratio from the analysis (leave-one-out
meta-analysis) did not substantively alter the overall result. There was
no evidence of a significant publication bias. In conclusion, off-pump
CABG is associated with an increase in very long-term (>=10 years)
all-cause mortality compared with on-pump CABG. Copyright © 2017
Elsevier Inc.

<19>
Accession Number
613116790
Title
Clinical value of post-percutaneous coronary intervention fractional flow
reserve value: A systematic review and meta-analysis.
Source
American Heart Journal. 183 (pp 1-9), 2017. Date of Publication: 01 Jan
2017.
Author
Rimac G.; Fearon W.F.; De Bruyne B.; Ikeno F.; Matsuo H.; Piroth Z.;
Costerousse O.; Bertrand O.F.
Institution
(Rimac, Costerousse, Bertrand) Cardiology Department, Quebec Heart-Lung
Institute, Quebec, Quebec, Canada
(Fearon, Ikeno) Stanford University Medical Center, Stanford, CA, United
States
(De Bruyne) Cardiovascular Center Aalst OLV Clinic, Aalst, Belgium
(Matsuo) Department of Cardiovascular Medicine, Gifu Heart Center, Gifu,
Japan
(Piroth) Hungarian Institute of Cardiology, Budapest, Hungary
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Background Fractional flow reserve (FFR) prior to percutaneous coronary
intervention (PCI) is useful to guide treatment. Whether post-PCI FFR
assessment might have clinical impact is controversial. The aim of this
study is to evaluate the range of post-PCI FFR values and analyze the
relationship between post-PCI FFR and clinical outcomes. Methods We
systematically searched the PubMed, EMBASE, and Cochrane Library databases
with cross-referencing of articles reporting post-PCI FFR and correlating
post-PCI FFR values and clinical outcomes. The outcomes of interest were
the immediate post-PCI FFR values and the correlations between post-PCI
FFR and the incidence of repeat intervention and major adverse cardiac
events (MACE). Results From 1995 to 2015, a total of 105 studies (n =
7470) were included, with 46 studies reporting post-PCI FFR and 59 studies
evaluating relationship between post-PCI and clinical outcomes up to 30
months after PCI. Overall, post-PCI FFR values demonstrated a normal
distribution with a mean value of 0.90 +/- 0.04. There was a positive
correlation between the percentage of stent use and post-PCI FFR (P <
.0001). Meta-regression analysis indicated that higher post-PCI FFR values
were associated with reduced rates of repeat intervention (P < .0001) and
MACE (P = .0013). A post-PCI FFR >=0.90 was associated with significantly
lower risk of repeat PCI (odds ratio 0.43, 95% CI 0.34-0.56, P < .0001)
and MACE (odds ratio 0.71, 95% CI 0.59-0.85, P = .0003). Conclusions FFR
measurement after PCI was associated with prognostic significance. Further
investigation is required to assess the role of post-PCI FFR and validate
cutoff values in contemporary clinical practice. Copyright © 2016

<20>
Accession Number
618216921
Title
Effects of person-centred care after an event of acute coronary syndrome:
Two-year follow-up of a randomised controlled trial.
Source
International Journal of Cardiology. 249 (pp 42-47), 2017. Date of
Publication: 15 Dec 2017.
Author
Fors A.; Swedberg K.; Ulin K.; Wolf A.; Ekman I.
Institution
(Fors, Ulin, Wolf, Ekman) Institute of Health and Care Sciences,
Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden, Box 457,
Gothenburg 405 30, Sweden
(Fors, Swedberg, Ulin, Wolf, Ekman) Centre for Person-Centred Care (GPCC),
University of Gothenburg, Gothenburg, Sweden
(Fors) Narhalsan Research and Development Primary Health Care, Region
Vastra Gotaland, Sweden
(Swedberg) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Swedberg) National Heart and Lung Institute, Imperial College, London,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Aim To assess the long-term effect of person-centred care (PCC) in
patients with acute coronary syndrome (ACS). Method Patients with ACS were
randomly assigned to treatment as usual (control group) or an added PCC
intervention for six months. The primary endpoint was a composite score of
changes in general self-efficacy >= five units, return to work or to a
prior activity level and re-hospitalisation or death. Results The
composite score improved in the PCC intervention group (n = 94) at a
two-year follow-up compared with the control group (n = 105) (18.1%, n =
17 vs. 10.5%, n = 11; P = 0.127). In the per-protocol analysis (n = 183)
the improvement was significant in favour of the PCC intervention (n = 78)
compared with usual care (n = 105) (21.8%, n = 17 vs. 10.5%, n = 11; P =
0.039). This effect was driven by the finding that more patients in the
PCC group improved their general self-efficacy score >= 5 units (32.2%, n
= 19 vs. 17.3%, n = 14; P = 0.046). The composite score improvement was
significantly higher in the PCC intervention group without post-secondary
education (n = 33) in comparison with corresponding patients in the
control group (n = 50) (30.3%, n = 10 vs. 10.0%, n = 5; P = 0.024).
Conclusion Implementation of PCC results in sustained improvements in
health outcome in patients with ACS. PCC can be incorporated into
conventional cardiac prevention programmes to improve equity in uptake and
patient health outcomes. Trial registration Swedish registry,
Researchweb.org, ID NR 65791. Copyright © 2017 The Authors

<21>
Accession Number
619051523
Title
Association between QRS duration on prehospital ECG and mortality in
patients with suspected STEMI.
Source
International Journal of Cardiology. 249 (pp 55-60), 2017. Date of
Publication: 15 Dec 2017.
Author
Hansen R.; Frydland M.; Moller-Helgestad O.K.; Lindholm M.G.; Jensen L.O.;
Holmvang L.; Ravn H.B.; Kjaergaard J.; Hassager C.; Moller J.E.
Institution
(Hansen, Moller-Helgestad, Jensen, Holmvang, Moller) Department of
Cardiology, Odense University Hospital, Sdr Boulevard 29, Odense C
DK-5000, Denmark
(Frydland, Lindholm, Ravn, Kjaergaard, Hassager) The Heart Center,
Copenhagen University Hospital Rigshospitalet, Blegdamsvej, Copenhagen
DK-2100, Denmark
Publisher
Elsevier Ireland Ltd
Abstract
Background QRS duration has previously shown association with mortality in
patients with acute myocardial infarction treated with thrombolytics, less
is known in patients with suspected ST segment elevation myocardial
infarction (STEMI) when assessing QRS duration on prehospital ECG. Thus,
the objective was to investigate the prognostic effect of QRS duration on
prehospital ECG and presence of classic left and right bundle branch block
(LBBB/RBBB) for all-cause mortality in patients with suspected STEMI.
Method In total 2105 consecutive patients (mean age 64 +/- 13 years, 72%
men) with suspected STEMI were prospectively included. QRS duration was
registered from automated QRS measurement on prehospital ECG and patients
were divided according to quartiles of QRS duration (< 89 ms, 89-98 ms,
99-111 ms and > 111 ms). Primary endpoint was all-cause 30-day mortality.
Predictors of all-cause mortality were assessed using Cox proportional
hazards analysis. Results Among all patients median QRS duration was 98 ms
(IQR 88-112 ms). RBBB-morphology was seen in 126 patients (6.0%) and LBBB
in 88 patients (4.2%), 80% were treated with percutaneous coronary
intervention and the final diagnosis was STEMI in 1777 patients (84%).
Thirty-day mortality was 7.6% in patients with suspected STEMI. In
multivariable analysis, QRS duration > 111 ms (hazard ratio (HR) 3.08; 95%
confidence interval (CI): 1.71-5.57, p = 0.0002), LBBB - morphology (HR
3.0; 95% CI: 1.38-6.53, p = 0.006) and RBBB (HR 3.68; 95% CI: 1.95-6.95, p
< 0.0001) were associated with 30 day all-cause mortality. Conclusion In
patients with suspected STEMI, QRS prolongation, LBBB, and RBBB on
prehospital ECG are associated with increased risk of death. Copyright
© 2017 Elsevier B.V.

<22>
Accession Number
614025709
Title
Efficacy and safety of sedation with dexmedetomidine in critical care
patients: A meta-analysis of randomized controlled trials.
Source
Anaesthesia Critical Care and Pain Medicine. 35 (1) (pp 7-15), 2016. Date
of Publication: 01 Feb 2016.
Author
Constantin J.-M.; Momon A.; Mantz J.; Payen J.-F.; De Jonghe B.; Perbet
S.; Cayot S.; Chanques G.; Perreira B.
Institution
(Constantin, Momon, Perbet, Cayot) Perioperative Department, University
Hospital of Clermont-Ferrand, Clermont-Ferrand 63000, France
(Perreira) Biostatistics Unit, Department of Clinical Research and
Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand
63000, France
(Mantz) Department of Anaesthesiology and Critical Care Medicine, Hopital
Europeen Georges-Pompidou, Universite Paris-Descartes Sorbonne Paris Cite,
Paris 75908, France
(Payen) Department of Anaesthesia and Critical Care, Michallon Hospital,
boulevard de la Chantourne, Grenoble 38000, France
(Payen) Joseph-Fourier University, Grenoble Institute of Neurosciences,
chemin Fortune-Ferrini, Grenoble 38042, France
(De Jonghe) Reanimation Medico-Chirurgicale, Centre Hospitalier de
Poissy-St-Germain, Poissy 78300, France
(Chanques) Intensive Care and Anaesthesiology Department, University of
Montpellier Saint-Eloi Hospital, Montpellier 34000, France
Publisher
Elsevier Masson s.r.l.
Abstract
Introduction Dexmedetomidine may help physicians target a low level of
sedation. Unfortunately, the impact of dexmedetomidine on major endpoints
remains unclear in intensive care unit (ICU). Material and methods To
evaluate the association between dexmedetomidine use with efficacy and
safety outcomes, two reviewers independently identified randomized
controlled trials comparing dexmedetomidine with other sedative agents in
non-post-cardiac surgery critically ill patients in the PubMed and
Cochrane databases. Random effects models were considered if heterogeneity
was detected using the DerSimonian and Laird estimation method.
Statistical heterogeneity between results was assessed by examining forest
plots, confidence intervals (CI) and by using the I2 statistic.
The risk of bias was assessed using the risk of bias tool. Results This
meta-analysis included 1994 patients from 16 randomized controlled trials.
Comparators were lorazepam, midazolam and propofol. Dexmedetomidine was
associated with a reduction in ICU length of stays (WMD = -0.304; 95% CI
[-0.477, -0.132]; P = 0.001), mechanical ventilation duration (WMD =
-0.313, 95% CI [-0.523, -0.104]; P = 0.003) and delirium incidence (RR =
0.812, 95% CI [0.680, 0.968]; P = 0.020). Dexmedetomidine is also
associated with an increase in the incidence of bradycardia (RR = 1.947,
95% CI [1.387, 2.733]; P = 0.001) and hypotension (RR = 1.264; 95% CI
[1.013, 1.576]; P = 0.038). Conclusions and relevance In this first
meta-analysis including only randomized controlled trials related to ICU
patients, dexmedetomidine was associated with a 48 h reduction in ICU
length of stay, mechanical ventilation duration and delirium occurrence
despite a significant heterogeneity among studies. Dexmedetomidine was
also associated with an increase in bradycardia and
hypotension. Copyright © 2015 Societe francaise d'anesthesie et
de reanimation (Sfar)

<23>
Accession Number
608882726
Title
Extracorporeal resuscitation for refractory out-of-hospital cardiac arrest
in adults: A systematic review of international practices and outcomes.
Source
Resuscitation. 101 (pp 12-20), 2016. Date of Publication: April 01, 2016.
Author
Ortega-Deballon I.; Hornby L.; Shemie S.D.; Bhanji F.; Guadagno E.
Institution
(Ortega-Deballon) Canadian National Transplant Research Program, Canada
(Ortega-Deballon) Research Institute McGill University Health Centre,
Montreal, Canada
(Ortega-Deballon) Centre de Prelevement d'Organes, Laboratoire de
Simulation, Hopital du Sacre-Coeur, Montreal, Canada
(Ortega-Deballon) Faculty of Medicine and Health Sciences, Universidad de
Alcala de Henares, Madrid, Spain
(Ortega-Deballon) Helicopter Emergency Medical Service (SUMMA 112),
Madrid, Spain
(Hornby) DePPaRT Study, Pediatric Critical Care, Children's Hospital of
Eastern Ontario Research Institute, Ottawa, Canada
(Hornby, Shemie) Deceased Donation, Canadian Blood Services, Ottawa,
Canada
(Shemie, Bhanji) Division of Critical Care, Montreal Children's Hospital,
McGill University Health Centre, Montreal, Canada
(Shemie, Bhanji) McGill University, Montreal, Canada
(Bhanji) Royal College of Physicians and Surgeons of Canada, Canada
(Guadagno) Medical Library, McConnell Resource Centre, McGill University
Health Centre, Montreal, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Aim: Extracorporeal resuscitation during cardiopulmonary resuscitation
(ECPR) deploys rapid cardiopulmonary bypass to sustain oxygenated
circulation until the return of spontaneous circulation (ROSC). The
purpose of this systematic review is to address the defining elements and
outcomes (quality survival and organ donation) of currently active
protocols for ECPR in refractory out-of-hospital cardiac arrest (OHCA) of
cardiac origin in adult patients. The results may inform policy and
practices for ECPR and help clarify the corrresponding intersection with
deceased organ donation. Method(s): We searched Medline, Embase,
Cochrane and seven other electronic databases from 2005 to 2015, with no
language restrictions. Internal validity and the quality of the studies
reporting outcomes and guidelines were assessed. The review was included
in the international prospective register of systematic reviews (Prospero,
CRD42014015259). Result(s): One guideline and 20 outcome studies were
analyzed. Half of the studies were prospective observational studies
assessed to be of fair to good methodological quality. The remainder were
retrospective cohorts, case series, and case studies. Ages ranged from 16
to 75 years and initial shockable cardiac rhythms, witnessed events, and a
reversible primary cause of cardiac arrest were considered favorable
prognostic factors. CPR duration and time to hospital cannulation varied
considerably. Coronary revascularization, hemodynamic interventions and
targeted temperature management neuroprotection were variable. A total of
833 patients receiving this ECPR approach had an overall reported survival
rate of 22%, including 13% with good neurological recovery. Additionally,
88 potential and 17 actual deceased organ donors were identified among the
non-survivor population in 8 out of 20 included studies. Study
heterogeneity precluded a meta-analysis preventing any meaningful
comparison between protocols, interventions and outcomes.
 Conclusion(s): ECPR is feasible for refractory OHCA of cardiac origin
in adult patients. It may enable neurologically good survival in selected
patients, who practically have no other alternative in order to save their
lives with quality of life, and contribute to organ donation in those who
die. Large, prospective studies are required to clarify patient selection,
modifiable outcome variables, risk-benefit and
cost-effectiveness. Copyright © 2016 Elsevier Ireland Ltd.

<24>
Accession Number
608761473
Title
Novel Approaches in Primary Cardiovascular Disease Prevention: The HOPE-3
Trial Rationale, Design, and Participants' Baseline Characteristics.
Source
Canadian Journal of Cardiology. 32 (3) (pp 311-318), 2016. Date of
Publication: 01 Mar 2016.
Author
Lonn E.; Bosch J.; Pogue J.; Avezum A.; Chazova I.; Dans A.; Diaz R.;
Fodor G.J.; Held C.; Jansky P.; Keltai M.; Keltai K.; Kunti K.; Kim J.-H.;
Leiter L.; Lewis B.; Liu L.; Lopez-Jaramillo P.; Pais P.; Parkhomenko A.;
Peters R.J.G.; Piegas L.S.; Reid C.M.; Sliwa K.; Toff W.D.; Varigos J.;
Xavier D.; Yusoff K.; Zhu J.; Dagenais G.; Yusuf S.
Institution
(Lonn, Yusuf) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Lonn, Bosch, Pogue, Yusuf) Population Health Research Institute, Hamilton
Health Sciences and McMaster University, Hamilton, ON, Canada
(Avezum) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Chazova) Russian Cardiology Research Complex, Moscow, Russian Federation
(Dans) College of Medicine of the University of the Philippines, Manula,
Philippines
(Diaz) Fundacion ECLA, Rosario, Argentina
(Fodor) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Held) Department of Medical Sciences, Uppsala University, Uppsala, Sweden
(Jansky) University Hospital Motol, Prague, Czechia
(Keltai, Keltai) Hungarian Institute of Cardiology, Semmelweis University,
Budapest, Hungary
(Kunti) Diabetes Research Centre, University of Leicester, Leicester,
United Kingdom
(Kim) St. Paul's Hospital, The Catholic University of Korea, Seoul, South
Korea
(Leiter) Li Ka Shing Knowledge Institute and Keenan Research Centre for
Biomedical Science, St. Michael's Hospital, University of Toronto,
Toronto, ON, Canada
(Lewis) Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport
School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
(Liu) Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China
(Lopez-Jaramillo) Fundacion Oftalmolgica de Santander (FOSCAL) and
Instituto Masira, Medical School, Universidad de Santander, Bucaramanga,
Colombia
(Pais, Xavier) Division of Clinical Research and Training, St. John's
Research Institute, Bangalore, India
(Parkhomenko) Ukranian Strazhesko Institute of Cardiology, Kiev, Ukraine
(Peters) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Piegas) Hospital do Coracao, Sao Paulo, Brazil
(Reid, Varigos) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Sliwa) Hatter Institute for Cardiovascular Research in Africa, Department
of Medicine, University of Cape Town and Soweto Cardiovascular Research
Group, Johannesburg, South Africa
(Toff) Department of Cardiovascular Sciences, University of Leicester and
Leicester NIHR Biomedical Research Unit in Cardiovascular Disease,
Glenfield Hospital, Leicester, United Kingdom
(Yusoff) Universiti Teknologi MARA, Selangor, Malaysia
(Zhu) Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing, China
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Universite Laval, QC, Canada
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Cholesterol and blood pressure (BP) can be effectively and
safely lowered with statin drugs and BP-lowering drugs, reducing major
cardiovascular (CV) events by 20%-30% within 5 years in high-risk
individuals. However, there are limited data in lower-risk populations.
The Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial is evaluating
whether cholesterol lowering with a statin drug, BP lowering with low
doses of 2 antihypertensive agents, and their combination safely reduce
major CV events in individuals at intermediate risk who have had no
previous vascular events and have average cholesterol and BP levels.
 Method(s): A total of 12,705 women 65 years or older and men 55 years
or older with at least 1 CV risk factor, no known CV disease, and without
any clear indication or contraindication to the study drugs were
randomized to rosuvastatin 10 mg/d or placebo and to
candesartan/hydrochlorothiazide 16/12.5 mg/d or placebo (2 x 2 factorial
design) and will be followed for a mean of 5.8 years. The coprimary study
outcomes are the composite of CV death, nonfatal myocardial infarction
(MI), and nonfatal stroke and the composite of CV death, nonfatal MI,
nonfatal stroke, resuscitated cardiac arrest, heart failure, and arterial
revascularization. Result(s): Participants were recruited from 21
countries in North America, South America, Europe, Asia, and Australia.
Mean age at randomization was 66 years and 46% were women.
 Conclusion(s): The HOPE-3 trial will provide new information on
cholesterol and BP lowering in intermediate-risk populations with average
cholesterol and BP levels and is expected to inform approaches to primary
prevention worldwide (HOPE-3 ClinicalTrials.gov
NCT00468923). Copyright © 2016 Canadian Cardiovascular Society.

<25>
Accession Number
608106073
Title
Ultra low-dose chest ct with iterative reconstructions as an alternative
to conventional chest x-ray prior to heart surgery (CRICKET study):
Rationale and design of a multicenter randomized trial.
Source
Journal of Cardiovascular Computed Tomography. 10 (3) (pp 242-245), 2016.
Date of Publication: 01 Jun 2016.
Author
den Harder A.M.; de Heer L.M.; Maurovich-Horvat P.; Merkely B.; de Jong
P.A.; Das M.; de Wit G.A.; Leiner T.; Budde R.P.J.
Institution
(den Harder, de Jong, Leiner) Department of Radiology, University Medical
Center, P.O. Box 85000, Utrecht 3508GA, Netherlands
(de Heer) Department of Cardiothoracic Surgery, University Medical Center,
P.O. Box 85000, Utrecht 3508GA, Netherlands
(Maurovich-Horvat, Merkely) MTA-SE Cardiovascular Imaging Research Group,
Heart and Vascular Center, Semmelweis University, 68 Varosmajor ut,
Budapest 1122, Hungary
(Das) Department of Radiology, Maastricht University Medical Center, P.O.
Box 5800, Maastricht 6202 AZ, Netherlands
(Das) CARIM School for Cardiovascular Diseases, Maastricht University
Medical Center, P.O. Box 5800, Maastricht 6202AZ, Netherlands
(de Wit) Department of Epidemiology, Julius Center for Health Sciences and
Primary Care, P.O. Box 85000, Utrecht 3508GA, Netherlands
(de Wit) National Institute of Public Health and the Environment, P.O. Box
1, Bilthoven 3720 BA, Netherlands
(Budde) Department of Radiology, Erasmus Medical Center, P.O. Box 2040,
Rotterdam 3000CA, Netherlands
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background Stroke after cardiac surgery is a severe complication with a
persistently high incidence of 1.4 - 9.7%. Postoperative strokes are
mainly embolic and can be provoked by manipulation and clamping of the
aorta during cardiac surgery, resulting in the mobilization of
atherothrombotic material and calcifications from the aortic wall.
Computed tomography (CT) can offer preoperative visualization of aortic
calcifications with low radiation exposure. We hypothesize that
preoperative knowledge regarding the location and extent of aortic
calcifications can be used to optimize surgical strategy and decrease
postoperative stroke rate. Methods/design The CRICKET study (ultra
low-dose chest CT with iterative reconstructions as an alternative to
conventional chest x-ray prior to heart surgery) is a prospective
multicenter randomized clinical trial to evaluate whether non-contrast
chest CT before cardiac surgery can decrease postoperative stroke rate by
optimizing surgical strategy. Patients scheduled to undergo cardiac
surgery aged 18 years and older are eligible for inclusion. Exclusion
criteria are pregnancy, a chest/cardiac CT in the past three months,
emergency surgery, concomitant or prior participation in a study with
ionizing radiation and unwillingness to be informed about incidental
findings. Subjects (n = 1.724) are randomized between routine care,
including a chest x-ray, or routine care with an additional low dose chest
CT. The primary objective is to investigate whether the postoperative
in-hospital stroke rate is reduced in the CT arm compared to the routine
care arm of the randomized trial. The secondary outcome measures are
altered surgical approach based on CT findings and
cost-effectiveness. Copyright © 2016 Society of Cardiovascular
Computed Tomography

<26>
Accession Number
611177110
Title
Cardioprotective effect of extended remote ischemic preconditioning in
patients undergoing coronary artery bypass grafting: A randomized clinical
trial.
Source
Iranian Journal of Medical Sciences. 41 (4) (pp 265-274), 2016. Date of
Publication: July 2016.
Author
Karami A.; Khosravi M.B.; Shafa M.; Azemati S.; Khademi S.; Akhlagh S.H.;
Maghsodi B.
Institution
(Karami, Khosravi, Azemati, Khademi, Akhlagh, Maghsodi) Shiraz
Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Shafa) Department of Cardiac Surgery, Faghihi Hospital, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Shriaz University of Medical Sciences (E-mail: info@gmj.ir)
Abstract
Background: The cardioprotective effect of ischemic preconditioning has
been known for many years. Since the temporary ischemia in the heart may
cause lethal cardiac effects, the idea of creating ischemia in organs far
from the heart such as limbs was raised as remote ischemic preconditioning
(RIPC). We hypothesized that the extension of RIPC has more
cardioprotective effect in patients undergoing coronary artery bypass
graft (CABG) surgeries. Method(s): In this triple-blind randomized
clinical trial study, 96 patients were randomly divided into 3 groups and
two blood pressure cuffs were placed on both upper and lower extremities.
In group A, only upper extremity cuff and in group B upper limb and lower
limb cuff was inflated intermittently and group C was the control group.
RIPC was induced with three 5-min cycles of cuff inflation about 100 mmHg
over the initial systolic blood pressure before starting cardiopulmonary
bypass. The primary endpoints were troponin I and creatine
phosphokinasemyoglobin isoenzyme (CK-MB). Result(s): Six hours after
the termination of CPB, there was a peak release of the troponin I level
in all groups (group A=4.90 ng/ml, group B=4.40 ng/ml, and group C=4.50
ng/ml). There was a rise in plasma CK-MB in all groups postoperatively and
there were not any significant differences in troponin I and CK-MB release
between the three groups. Conclusion(s): RIPC induced by upper and
lower limb ischemia does not reduce postoperative myocardial enzyme
elevation in adult patients undergoing CABG. Copyright © 2016,
Shiraz University of Medical Sciences. All rights reserved.

<27>
Accession Number
601020272
Title
Impact of thrombus burden on outcomes after standard versus mesh-covered
stents in acute myocardial infarction (from the MGuard for Acute ST
Elevation Reperfusion Trial).
Source
American Journal of Cardiology. 115 (2) (pp 161-166), 2015. Date of
Publication: 15 Jan 2015.
Author
Costa R.A.; Abizaid A.; Lotan C.; Dudek D.; Silber S.; Dizon J.M.; Maehara
A.; Dressler O.; Brener S.J.; Stone G.W.
Institution
(Costa, Abizaid) Department of Invasive Cardiology, Institute Dante
Pazzanese of Cardiology, Sao Paulo, Brazil
(Costa, Abizaid) Cardiovascular Research Center, Sao Paulo, Brazil
(Lotan) Hadassah Medical Center, Jerusalem, Israel
(Dudek) Department of Interventional Cardiology, Jagiellonian University
Medical College, Krakow, Poland
(Silber) Heart Center at the Isar, Munich, Germany
(Dizon, Maehara, Dressler, Brener, Stone) Cardiovascular Research
Foundation, New York, NY, United States
(Brener) New York Methodist Hospital, Brooklyn, NY, United States
(Stone) New York Presbyterian Hospital, Columbia University Medical
Center, New York, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Large thrombus burden negatively affects the results of percutaneous
coronary intervention (PCI) for acute ST-segment elevation myocardial
infarction (STEMI). We investigated the impact of thrombus burden in
patients with STEMI undergoing primary PCI with the mesh-covered MGuard
stent (InspireMD Ltd., Tel Aviv, Israel) versus a control bare-metal or
drug-eluting stent. In 433 patients with STEMI randomized to the MGuard
stent versus a control stent, angiographically visible thrombus was
identified in 383 patients (88.5%), with median thrombus area 30.15
mm2 (22.70, 41.93). Lesions with large thrombus (area > median)
were treated with more frequent use of manual aspiration (80.8% vs 65.8%,
p = 0.0009) and longer (22.1 +/- 5.9 vs 19.4 +/- 5.4 mm, p <0.0001) and
larger (3.46 +/- 0.40 vs 3.29 +/- 0.36 mm, p <0.0001) stents. PCI of
lesions with large thrombus burden had more thrombotic complications
(30.6% vs 15.9%, p = 0.0007) and reduced angiographic success (80.3% vs
91.1%, p = 0.003). In large thrombus lesions, the MGuard stent was more
effective than control stents in achieving Thrombolysis In Myocardial
Infarction-3 flow (87.9% vs 74.5%, p = 0.02) and tended to result in less
slow flow or no reflow (8.8% vs 17.6%, p = 0.07). ST-segment resolution
was improved with the MGuard, and clinical outcomes were favorable in both
stent groups, regardless of thrombus burden. In conclusion, reperfusion
success is reduced after primary PCI in lesions with large thrombus
burden, an outcome that may be modified by the MGuard stent. Copyright
© 2015 Elsevier Inc.

<28>
Accession Number
601878046
Title
Incidence and impact of totally occluded culprit coronary arteries in
patients presenting with non-ST-segment elevation myocardial infarction.
Source
American Journal of Cardiology. 115 (4) (pp 428-433), 2015. Date of
Publication: 15 Feb 2015.
Author
Warren J.; Mehran R.; Yu J.; Xu K.; Bertrand M.E.; Cox D.A.; Lincoff A.M.;
Manoukian S.V.; Ohman E.M.; Pocock S.J.; White H.D.; Stone G.W.
Institution
(Warren, Mehran, Yu) Icahn School of Medicine at Mount Sinai, New York,
NY, United States
(Mehran, Xu, Stone) Cardiovascular Research Foundation, New York, NY,
United States
(Bertrand) Hopital Cardiologique, Lille, France
(Cox) Lehigh Valley Health Network, Allentown, PA, United States
(Lincoff) Cleveland Clinic Lerner College of Medicine, Case Western
Reserve University, Cleveland, OH, United States
(Manoukian) Sarah Cannon Research Institute, Nashville, TN, United States
(Ohman) Duke University Medical Center, Durham, NC, United States
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(White) Department of Medicine, University of Auckland, Auckland, New
Zealand
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Stone) NewYork-Presbyterian/Columbia University Medical Center, New York,
NY, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
The accuracy of the 12-lead electrocardiogram in detecting coronary artery
occlusion is limited. We sought to determine the incidence, distribution,
and outcomes of patients who have total occlusion of the culprit artery
but present with non-ST-segment elevation myocardial infarction (NSTEMI).
The randomized Acute Catheterization and Urgent Intervention Triage
Strategy trial enrolled 13,819 patients presenting with non-ST-segment
elevation acute coronary syndromes who underwent an early invasive
strategy. The present study includes 1,319 patients with baseline
biomarker elevation (NSTEMI) and no history of coronary artery bypass
graft who underwent percutaneous coronary intervention of a single culprit
vessel. We compared the baseline characteristics and outcomes according to
whether the culprit vessel was occluded (baseline Thrombolysis In
Myocardial Infarction [TIMI] 0 to 1) or patent (TIMI 2 to 3 flow) by
angiographic core laboratory assessment. TIMI 0 to 1 flow in the culprit
artery was present in 262 of 1,319 (19.9%) patients. The incidence of
coronary occlusion was 28.4%, 19.3%, and 12.6% in patients with NSTEMI
because of right coronary, left circumflex, and left anterior descending
artery disease, respectively. Patients with an occluded culprit artery
were more commonly men and had ST-segment deviation >=1 mm. One-year
outcomes, including death (3.5% vs 3.0%, p = 0.68) and myocardial
infarction (8.4% vs 9.6%, p = 0.47), did not differ significantly between
patients with versus without occluded culprit arteries, respectively. In
conclusion, the present study demonstrates that the culprit artery is
totally occluded in approximately 1 in 5 patients presenting with NSTEMI
and single-vessel disease; however, the presence of total occlusion in
NSTEMI was not associated with an incremental hazard of death or
reinfarction at 1 year. Copyright © 2015 Elsevier Inc. All rights
reserved.

<29>
Accession Number
601695893
Title
Hemodynamic outcomes of transcatheter aortic valve replacement and medical
management in severe, inoperable aortic stenosis: A longitudinal
echocardiographic study of cohort B of the PARTNER trial.
Source
Journal of the American Society of Echocardiography. 28 (2) (pp
210-217.e9), 2015. Date of Publication: 01 Feb 2015.
Author
Douglas P.S.; Hahn R.T.; Pibarot P.; Weissman N.J.; Stewart W.J.; Xu K.;
Wang Z.; Lerakis S.; Siegel R.; Thompson C.; Gopal D.; Keane M.G.;
Svensson L.G.; Tuzcu E.M.; Smith C.R.; Leon M.B.
Institution
(Douglas) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Hahn, Smith, Leon) Columbia University Medical Center, New York
Presbyterian Hospital, New York, NY, United States
(Pibarot) Department of Medicine, Laval University, Quebec, QC, Canada
(Weissman) Medstar Health Research Institute, Georgetown University School
of Medicine, Washington, DC, United States
(Stewart, Svensson, Tuzcu) Cleveland Clinic Foundation, Cleveland, OH,
United States
(Xu) Cardiovascular Research Foundation, New York, NY, United States
(Wang) Medstar Washington Hospital Center, Washington, DC, United States
(Lerakis) Emory University School of Medicine, Atlanta, GA, United States
(Siegel) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Thompson) St Paul's Hospital, Vancouver, BC, Canada
(Gopal) Heart Hospital Baylor, Scott and White Health, Plano, TX, United
States
(Keane) Temple Heart and Vascular Center, Philadelphia, PA, United States
(Douglas) Duke Clinical Research Institute, 7022 North Pavilion DUMC, PO
Box 17969, Durham, NC 27715, United States
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Background: Inoperable aortic stenosis may be treated with either
transcatheter aortic valve replacement (TAVR) or medical management (MM)
with or without balloon aortic valvuloplasty (BAV). The aim of this study
was to compare the long-term echocardiographic findings among TAVR, MM,
and BAV in patients with severe, inoperable aortic stenosis.
 Method(s): A total of 358 inoperable patients in the Placement of
Aortic Transcatheter Valves trial were randomized to MM or TAVR.
Echocardiograms obtained at baseline, 30 days, and 1, 2, and 3 years were
analyzed by a central core laboratory. Result(s): At baseline, TAVR
and MM were similar, with more frequent Society of Thoracic Surgeons score
> 10 (51.7% vs 65.0%, P =.03) and larger end-systolic volumes (54.5 +/-
29.3 vs 69.1 +/- 48.0 mL, P =.03) in MM. By 30 days after TAVR, mean
aortic valve gradient had decreased (from 43.8 +/- 14.7 to 10.0 +/- 4.3 mm
Hg, P <.001), ejection fraction had increased (from 53.2 +/- 12.4% to 56.7
+/- 10.0%, P <.001), and left ventricular (LV) mass index had decreased
(from 144.7 +/- 36.1 to 140.0 +/- 37.9 gm/m2, P <.05). After 1
year, aortic valve gradients and area were unchanged, while LV mass index
had decreased by another 16 gm/m2 (to 124 gm/m2). By
30 days after BAV, mean aortic valve gradient had decreased from 43.4 +/-
15.0 to 31.9 +/- 11.1 mm Hg, while ejection fraction and LV mass index
were unchanged; gradient reverted to baseline at 1 year. No changes in
gradients or mass were seen in MM patients. Conclusion(s): TAVR
results in immediate and sustained relief in pressure overload and
improved LV systolic function, with continued regression of hypertrophy
over 3 years. Poor clinical results with BAV are explained by the modest
and transient reductions in pressure overload with BAV, which were not
accompanied by improved LV function or remodeling. TAVR is the preferred
treatment in eligible inoperable patients. Copyright © 2015
Published by Elsevier Inc.

<30>
Accession Number
603511431
Title
Early invasive strategy in high-risk acute coronary syndrome without
ST-segment elevation. The Sisca randomized trial.
Source
International Journal of Cardiology. 182 (pp 414-418), 2015. Date of
Publication: 01 Mar 2015.
Author
Reuter P.-G.; Rouchy C.; Cattan S.; Benamer H.; Jullien T.; Beruben A.;
Montely J.-M.; Assez N.; Raphael V.; Hennequin B.; Boccara A.; Javaud N.;
Soulat L.; Adnet F.; Lapostolle F.
Institution
(Reuter, Adnet, Lapostolle) Service des Urgences et Service d'Aide
Medicale Urgente, Centre Hospitalier Universitaire Avicenne, Assistance
Publique-Hopitaux de Paris, 125 rue de Stalingrad, Bobigny Cedex 93009,
France
(Reuter, Adnet, Lapostolle) Universite Paris 13, Sorbonne Paris Cite,
Bobigny EA 3509, France
(Rouchy, Soulat) Service des Urgences et Service d'Aide Medicale Urgente,
Centre Hospitalier de Chateauroux, 216 Avenue de Verdun, Chateauroux
36000, France
(Cattan) Departement de Cardiologie, Groupe Hospitalier Intercommunal le
Raincy-Montfermeil, 10 Rue du General Leclerc, Montfermeil 93370, France
(Benamer) Departement de Cardiologie, Clinique la Roseraie, 120 Avenue de
la Republique, Aubervilliers 93300, France
(Jullien) Departement de Cardiologie, Centre Cardiologique du Nord, 36 Rue
des Moulins Gemeaux, Saint-Denis 93200, France
(Beruben) Service Mobile d'Urgence et de Reanimation, Groupe Hospitalier
Intercommunal le Raincy-Montfermeil, 10 Rue du General Leclerc,
Montfermeil 93370, France
(Montely) Departement de Cardiologie, Centre Hospitalier Intercommunal
Robert Ballanger, Boulevard Robert Ballanger, Aulnay-sous-Bois 93600,
France
(Assez) Service d'Aide Medicale Urgente du Nord Pole de l'Urgence, Centre
Hospitalier Regional Universitaire de Lille, 5 avenue Oscar-Lambret, Lille
Cedex 59037, France
(Raphael) Service Mobile d'Urgence et de Reanimation, Centre Hospitalier
Intercommunal Robert Ballanger, Boulevard Robert Ballanger,
Aulnay-sous-Bois 93600, France
(Hennequin) Service Mobile d'Urgence et de Reanimation, Centre Hospitalier
de Saint-Denis, 2 Rue du Docteur Delafontaine, Saint-Denis 93200, France
(Boccara) Departement de Cardiologie, Centre Hospitalier Intercommunal
Andre Gregoire, 56 Boulevard de la Boissiere, Montreuil 93100, France
(Javaud) Service des Urgences, Centre Hospitalier Universitaire Jean
Verdier, Assistance Publique-Hopitaux de Paris, Avenue du 14 Juillet,
Bondy 93140, France
Publisher
Elsevier Ireland Ltd
Abstract
Background The optimal therapeutic strategy for patients with high-risk
acute coronary syndrome without ST-segment elevation (NSTE-ACS) remains
unclear. Objective Our aim was to compare the effectiveness of an early
invasive strategy and a delayed invasive strategy in the management of
high-risk NSTE-ACS patients. Methods This randomized clinical trial in a
primarily pre-hospital setting enrolled patients with chest pain,
electrocardiographic criteria for an NSTE-ACS, and at least one criterion
of severity (ESC criterion or TIMI score > 5). Patients were randomized to
either an early invasive strategy (tirofiban infusion and coronary
angiography within 6 h) or delayed invasive strategy (as per guidelines
and physician discretion; coronary angiography within 6 h was not
advised). The primary endpoint was the cumulative incidence of deaths,
myocardial infarctions, or urgent revascularizations at 30 days of
follow-up. Secondary endpoints were failure of delayed management, length
of hospital stay and long-term mortality. Results Between January 2007 and
February 2010, 170 patients were enrolled. The cumulative incidence of
adverse outcomes was significantly lower for early invasive than delayed
management (2% [95% CI 0-9] vs. 24% [95% CI 16-35], p < 10- 4).
Delayed management failed in 24% of cases. The length of hospital stay was
significantly shorter in patients undergoing angioplasty or treated with
tirofiban within 6 h (p = 0.0003). Long-term mortality was 16% in both
arms after a median follow-up of 4.1 years. Conclusion An early invasive
strategy reduced major adverse cardiac events in patients with high-risk
NSTE-ACS. Early angiography or tirofiban (GP IIb/IIIa inhibitor) infusion
proved necessary in a quarter of patients assigned to delayed
management. Copyright © 2014 Elsevier Ireland Ltd. All rights
reserved.

<31>
Accession Number
602988031
Title
Meta-analysis of clinical outcomes of patients who underwent percutaneous
coronary interventions for chronic total occlusions.
Source
American Journal of Cardiology. 115 (10) (pp 1367-1375), 2015. Date of
Publication: 15 May 2015.
Author
Christakopoulos G.E.; Christopoulos G.; Carlino M.; Jeroudi O.M.; Roesle
M.; Rangan B.V.; Abdullah S.; Grodin J.; Kumbhani D.J.; Vo M.; Luna M.;
Alaswad K.; Karmpaliotis D.; Rinfret S.; Garcia S.; Banerjee S.; Brilakis
E.S.
Institution
(Christakopoulos, Christopoulos, Jeroudi, Roesle, Rangan, Abdullah,
Grodin, Kumbhani, Luna, Banerjee, Brilakis) Department of Cardiovascular
Diseases, VA North Texas Healthcare System, UT Southwestern Medical
Center, Dallas, TX, United States
(Carlino) Department of Cardiovascular Diseases, San Raffaele Scientific
Institute, Milan, Italy
(Vo) Department of Cardiovascular Diseases, University of Manitoba, MT,
Canada
(Alaswad) Department of Cardiovascular Diseases, Henry Ford Hospital,
Detroit, MI, United States
(Karmpaliotis) Department of Cardiovascular Diseases, Columbia University,
New York, NY, United States
(Rinfret) Department of Cardiovascular Diseases, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Laval University, Quebec City,
QC, Canada
(Garcia) Department of Cardiovascular Diseases, Minneapolis VA Healthcare
System, University of Minnesota, Minneapolis, MN, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Successful percutaneous coronary intervention (PCI) for chronic total
occlusions (CTOs) has been associated with clinical benefit. There are no
randomized controlled trials on long-term clinical outcomes after CTO PCI,
limiting the available evidence to observational cohort studies. We sought
to perform a weighted meta-analysis of the long-term outcomes of
successful versus failed CTO PCI. A total of 25 studies, published from
1990 to 2014, with 28,486 patients (29,315 CTO PCI procedures) were
included. We analyzed data on mortality, subsequent coronary artery bypass
grafting (CABG), myocardial infarction, major adverse cardiac events,
angina pectoris, stroke, and target vessel revascularization using
random-effects models. Procedural success was 71% (range 51% to 87%).
During a weighted mean follow-up of 3.11 years, compared with
unsuccessful, successful CTO PCI was associated with lower mortality (odds
ratio [OR] 0.52, 95% confidence interval [CI] 0.43 to 0.63), less residual
angina (OR 0.38, 95% CI 0.24 to 0.60), lower risk for stroke (OR 0.72, 95%
CI 0.60 to 0.88), less need for subsequent coronary artery bypass grafting
(OR 0.18, 95% CI 0.14 to 0.22), and lower risk for major adverse cardiac
events (0.59, 95% CI 0.44 to 0.79). There was no difference in the
incidence of target vessel revascularization (OR 0.66, 95% CI 0.36 to
1.23) or myocardial infarction (OR 0.73, 95% CI 0.52 to 1.03). Outcomes
were similar in patients who underwent balloon angioplasty only or
stenting with bare metal or drug-eluting stents. Compared with failed
procedures, successful CTO PCIs are associated with a lower risk of death,
stroke, and coronary artery bypass grafting and less recurrent angina
pectoris. Copyright © 2015 Elsevier Inc. All rights reserved.

<32>
Accession Number
600485884
Title
Management of multivessel coronary disease in STEMI patients: A systematic
review and meta-analysis.
Source
International Journal of Cardiology. 179 (pp 552-557), 2015. Date of
Publication: 20 Jan 2015.
Author
Moretti C.; D'Ascenzo F.; Quadri G.; Omede P.; Montefusco A.; Taha S.;
Cerrato E.; Colaci C.; Chen S.-L.; Biondi-Zoccai G.; Gaita F.
Institution
(Moretti, D'Ascenzo, Quadri, Omede, Montefusco, Taha, Cerrato, Colaci,
Gaita) Division of Cardiology, Department of Internal Medicine, University
of Turin, Italy
(Chen) Nanjing Medical University, Nanjing, China
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, Rome,
Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background Appropriate management for patients with multivessel coronary
disease presenting with ST segment Elevation Myocardial Infarction (STEMI)
remains to be defined. Methods and results Medline and Cochrane Library
were searched for randomized controlled trials (RCTs) or observational
studies adjusted with multivariate analysis, reporting about STEMI
patients with multivessel coronary disease treated with either a culprit
only or complete revascularization strategy, excluding patients in
cardiogenic shock. Prespecified analysis was performed according to the
strategy of complete revascularization, either during the same procedure
of primary percutaneous coronary intervention (PCI) or during the index
hospitalization. MACE (a composite and mutually exclusive end point of
death or myocardial infarction or revascularization) at follow-up of at
least one year was the primary end point. 9 studies with 4686 patients
compared culprit only versus complete PCI performed during the primary
PCI. Rates of MACE did not differ at 90 days (OR 0.70 [0.38, 1.27],
I2 = 0%) or at 1 year (1-2.5) (OR 0.70 [0.47, 1.03],
I2 = 0%). No significant difference was found for the
components of the primary outcome, apart from a reduction in repeated
revascularization for patients undergoing complete PCI during the STEMI
procedure (OR 0.62 [0.39, 0.98], I2 = 0%). 6 studies (1 RCT)
with 5855 patients compared culprit only lesions versus complete PCI
performed during index hospitalization. 90 day risk of MACE did not differ
nor 1 year (1-2.5) MACE (OR 0.86 [0.62, 1.08], I2 = 0%), with a
similar reduction in repeated revascularization (0.60 [0.40, 0.90],
I2 = 0%). Conclusions Complete revascularization performed
during primary PCI or index hospitalizations for patients presenting with
STEMI appears safe at short term follow-up and offers a reduction in
repeated revascularization at one year. Copyright © 2014 Elsevier
Ireland Ltd. All rights reserved.

<33>
Accession Number
604986262
Title
A 2-year follow-up of a randomized multicenter study comparing a
paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in small
coronary vessels the BELLO study.
Source
International Journal of Cardiology. 184 (1) (pp 17-21), 2015. Date of
Publication: 2015.
Author
Naganuma T.; Latib A.; Sgueglia G.A.; Menozzi A.; Castriota F.; Micari A.;
Cremonesi A.; De Felice F.; Marchese A.; Tespili M.; Presbitero P.;
Panoulas V.F.; Buffoli F.; Tamburino C.; Varbella F.; Colombo A.
Institution
(Naganuma, Latib, Colombo) EMO-GVM Centro Cuore Columbus, Interventional
Cardiology Unit, 48 Via M. Buonarroti, Milan 20145, Italy
(Naganuma, Latib, Colombo) Interventional Cardiology Unit, San Raffaele
Scientific Institute, Milan, Italy
(Castriota) GVM Care and Research, Interventional Cardiology Unit, Citta
di Lecce Hospital, Lecce, Italy
(Micari) GVM Care and Research, Interventional Cardiology Unit, Maria
Eleonora Hospital, Palermo, Italy
(Cremonesi) GVM Care and Research, Interventional Cardiology Unit, Maria
Cecilia Hospital, Cotignola, Italy
(De Felice) Interventional Cardiology Unit, Ospedale San Camillo, Rome,
Italy
(Marchese) GVM Care and Research, Interventional Cardiology Unit, Anthea
Hospital, Bari, Italy
(Tespili) Interventional Cardiology Unit, Ospedale Bolognini, Seriate,
Bergamo, Italy
(Presbitero) Istituto Clinico Humanitas, Interventional Cardiology Unit,
Rozzano, Milan, Italy
(Sgueglia) Interventional Cardiology Unit, Ospedale Santa Maria Goretti,
Latina, Italy
(Buffoli) Interventional Cardiology Unit, Ospedale di Mantova, Mantova,
Italy
(Panoulas, Tamburino) Division of Cardiology, University of Catania,
Ferrarotto Hospital, Catania, Italy
(Varbella) Interventional Cardiology Unit, Ospedale di Rivoli, Torino,
Italy
(Menozzi) Cardiology Department, Interventional Cardiology Unit, Ospedale
di Parma, Parma, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background/objectives: A prospective, multi-center, randomized trial,
BELLO (Balloon Elution and Late Loss Optimization), showed that the
primary endpoint of in-stent (in-balloon) late loss was significantly less
with drug-eluting balloons (DEB) as compared with paclitaxel-eluting
stents (PES). At 6 months, DEB and PES were associated with similar rates
of angiographic restenosis, target lesion revascularization (TLR), and
major adverse cardiac events (MACE) defined as death, myocardial
infarction and target vessel revascularization. The aim of this study was
to report 2-year clinical outcomes after treatment of de novo small vessel
disease with DEB as compared with PES. Method(s): A total of 182
patients were enrolled and randomized to treatment with DEB (n=90) in 94
lesions or PES (n= 92) in 98 lesions. The study endpoint was the incidence
of MACE at 2-year follow-up. Result(s): Two-year follow-up was
achieved in almost all cases (97.8% in DEB group vs. 98.9% in PES group).
There was a trend towards a lower incidence of MACE in the DEB group as
compared with the PES group (14.8% vs. 25.3%; p= 0.08). TLR rates in the
DEB group were acceptable at 6 months, 1 year and 2 years and did not
differ significantly from the PES group (4.4% vs. 7.6%, p =0.37; 6.7% vs.
12.1%, p =0.23; 6.8% vs. 12.1%, p =0.25, respectively).
 Conclusion(s): Our results suggest that treatment of small vessel
disease with a paclitaxel DEB is associated with a trend for improved
clinical outcomes as compared with PES up to 2 years. Late catch-up
phenomenon requiring repeat intervention after treatment with DEB was not
evident in this study. Copyright © 2015 Elsevier Ireland Ltd. All
rights reserved.

<34>
Accession Number
604625390
Title
Rationale and design of the Cyclosporine to ImpRove Clinical oUtcome in
ST-elevation myocardial infarction patients (the CIRCUS trial).
Source
American Heart Journal. 169 (6) (pp 758-766.e6), 2015. Date of
Publication: 01 Jun 2015.
Author
Mewton N.; Cung T.T.; Morel O.; Cayla G.; Bonnefoy-Cudraz E.; Rioufol G.;
Angoulvant D.; Guerin P.; Elbaz M.; Delarche N.; Coste P.; Vanzetto G.;
Metge M.; Aupetit J.-F.; Jouve B.; Motreff P.; Tron C.; Labeque J.-N.;
Steg P.G.; Cottin Y.; Range G.; Clerc J.; Coussement P.; Prunier F.;
Moulin F.; Roth O.; Belle L.; Dubois P.; Barragan P.; Gilard M.; Piot C.;
Colin P.; Morice M.-C.; Monassier J.-P.; Ider O.; Dubois-Rande J.L.P.;
Unterseeh T.; Lebreton H.; Beard T.; Blanchard D.; Grollier G.; Malquarti
V.; Staat P.; Sudre A.; Hansson M.J.; Elmer E.; Boussaha I.; Jossan C.;
Torner A.; Claeys M.; Garcia-Dorado D.; Ovize M.
Institution
(Mewton, Boussaha, Jossan, Ovize) Hopital Cadiovasculaire Louis Pradel,
Clinical Investigation Center, Hospices Civils de Lyon, 28, Avenue Doyen
Lepine, BRON Cedex 69677, France
(Cung) Centre Hospitalier Universitaire Arnaud de Villeneuve, Montpellier,
France
(Morel) Hopitaux Universitaires de Strasbourg, NHC, Strasbourg, France
(Cayla) Centre Hospitalier Universitaire de Nimes, Nimes, France
(Bonnefoy-Cudraz, Rioufol) Centre Hospitalier Universitaire, Hopital
Cardiovasculaire Louis Pradel, Lyon, France
(Angoulvant) Centre Hospitalier Universitaire de Tours, Tours, France
(Guerin) Hopital Guillaume et Rene Laennec, Nantes, France
(Elbaz) Centre Hospitalier Universitaire de Rangueil, Toulouse, France
(Delarche) Centre Hospitalier de Pau, Pau, France
(Coste) Hopital Haut Leveque, Bordeaux, France
(Vanzetto) Hopital A. Michallon, Centre Hospitalier Universitaire,
Grenoble, France
(Metge) Hopital Henri Duffau, Avignon, France
(Aupetit) Centre Hospitalier St Luc St Joseph, Lyon, France
(Jouve) Centre Hospitalier du Pays d'Aix, Aix en provence, France
(Motreff) Centre Hospitalier Universitaire, Hopital Gabriel Montpied,
Clermont Ferrand, France
(Tron) Hopital Charles Nicolle, Rouen, France
(Labeque) Clinique de la Fourcade, Bayonne, France
(Steg) APHP, Hopital Bichat, Paris, France
(Cottin) Hopital du Bocage, Dijon, France
(Range) Centre Hospitalier General, Chartres, France
(Clerc) Centre Hospitalier de Compiegne, Compiegne, France
(Coussement) Algemeen Ziekenhuis Sint Jan, Brugge, Belgium
(Prunier) Centre Hospitalier Universitaire, Angers, France
(Moulin) Centre Hospitalier Universitaire de Nancy Brabois, Nancy, France
(Roth) Centre Hospitalier Universitaire de Mulhouse, Mulhouse, France
(Belle) Centre Hospitalier d'Annecy, Annecy, France
(Dubois) Centre Hospitalier Henri Mondor, Creteil, France
(Barragan) Polyclinique des Fleurs, Ollioules, France
(Gilard) Hopital de la Cavale Blanche, Brest, France
(Piot) Clinique du Millenaire, Montpellier, France
(Colin) Clinique Esquirol, Agen, France
(Morice) Institut Jacques Cartier, Massy, France
(Monassier, Ider) Clinique du Diaconat, Mulhouse, France
(Dubois-Rande) Centre Hospitalier Universitaire Charleroi, Charleroi,
Belgium
(Unterseeh) Hopital Claude Galien, Quincy sous senat, France
(Lebreton) Hopital Pontchaillou, Rennes, France
(Beard) Clinique de l'Ormeau - CCV des Pyrenees, Tarbes, France
(Blanchard) Clinique Saint-Gatien, Tours, France
(Grollier) Centre Hospitalier Regional et Universitaire, Hopital de la
Cote de Nacre, Caen, France
(Malquarti) Clinique de la Sauvegarde, Lyon, France
(Staat) Clinique du Tonkin, Lyon, France
(Sudre) Centre Hospitalier Regional et Universitaire, Hopital
Cardiologique Calmette, Lille, France
(Hansson, Elmer) Department of Physiology, Lund University, Lund, Sweden
(Torner) Scandinavian Development Services, Danderyd, Sweden
(Claeys) University Hospital Antwerp, Edegem, Belgium
(Garcia-Dorado) Hospital Universitari Vall D 'Hebron, Barcelona, Spain
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Background Both acute myocardial ischemia and reperfusion contribute to
cardiomyocyte death in ST-elevation myocardial infarction (STEMI). The
final infarct size is the principal determinant of subsequent clinical
outcome in STEMI patients. In a proof-of-concept phase II trial, the
administration of cyclosporine prior to primary percutaneous coronary
intervention (PPCI) has been associated with a reduction of infarct size
in STEMI patients. Methods CIRCUS is an international, prospective,
multicenter, randomized, double-blinded, placebo-controlled trial. The
study is designed to compare the efficacy and safety of cyclosporine
versus placebo, in addition to revascularization by PPCI, in patients
presenting with acute anterior myocardial infarction within 12 hours of
symptoms onset and initial TIMI flow <=1 in the culprit left anterior
descending coronary artery. Patients are randomized in a 1:1 fashion to
2.5 mg/kg intravenous infusion of cyclosporine or matching placebo
performed in the minutes preceding PCI. The primary efficacy end point of
CIRCUS is a composite of 1-year all-cause mortality, rehospitalization for
heart failure or heart failure worsening during initial hospitalization,
and left ventricular adverse remodeling as determined by sequential
transthoracic echochardiography. Secondary outcomes will be tested using a
hierarchical sequence of left ventricular (LV) ejection fraction and
absolute measurements of LV volumes. The composite of death and
rehospitalization for heart failure or heart failure worsening during
initial hospitalization will be further assessed at three years after the
initial infarction. Results Recruitment lasted from April 2011 to February
2014. The CIRCUS trial has recruited 975 patients with acute anterior
myocardial infarction. The 12-months results are expected to be available
in 2015. Conclusions The CIRCUS trial is testing the hypothesis that
cyclosporine in addition to early revascularization with PPCI compared to
placebo in patients with acute anterior myocardial infarction reduces the
incidence of death, heart failure and adverse LV remodeling at one-year
follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.

<35>
Accession Number
600599267
Title
Performance of technology-driven simulators for medical students - A
systematic review.
Source
Journal of Surgical Research. 192 (2) (pp 531-543), 2014. Date of
Publication: 01 Dec 2014.
Author
Michael M.; Abboudi H.; Ker J.; Khan M.S.; Dasgupta P.; Ahmed K.
Institution
(Michael, Khan, Dasgupta, Ahmed) MRC Centre for Transplantation, NIHR
Biomedical Research Centre, King's College London, London, United Kingdom
(Michael, Khan, Dasgupta, Ahmed) Department of Urology, Guy's Hospital,
London, United Kingdom
(Abboudi) Department of Urology, Royal Sussex County Hospital, Brighton,
United Kingdom
(Ker) Clinical Skills Centre, Ninewells Hospital and Medical School, Level
6, Dundee, United Kingdom
Publisher
Academic Press Inc. (E-mail: apjcs@harcourtbrace.com)
Abstract
Background: Simulation-based education has evolved as a key training tool
in high-risk industries such as aviation and the military. In parallel
with these industries, the benefits of incorporating specialty-oriented
simulation training within medical schools are vast. Adoption of
simulators into medical school education programs has shown great promise
and has the potential to revolutionize modern undergraduate education.
 Material(s) and Method(s): An English literature search was carried
out using MEDLINE, EMBASE, and psychINFO databases to identify all
randomized controlled studies pertaining to "technology-driven" simulators
used in undergraduate medical education. A validity framework
incorporating the "framework for technology enhanced learning" report by
the Department of Health, United Kingdom, was used to evaluate the
capabilities of each technology-driven simulator. Information was
collected regarding the simulator type, characteristics, and brand name.
Where possible, we extracted information from the studies on the
simulators' performance with respect to validity status, reliability,
feasibility, education impact, acceptability, and cost effectiveness.
 Result(s): We identified 19 studies, analyzing simulators for medical
students across a variety of procedure-based specialities including;
cardiovascular (n = 2), endoscopy (n = 3), laparoscopic surgery ( n = 8),
vascular access ( n = 2), ophthalmology ( n = 1), obstetrics and
gynecology (n = 1), anesthesia (n = 1), and pediatrics ( n = 1).
Incorporation of simulators has so far been on an institutional level; no
national or international trends have yet emerged. Conclusion(s):
Simulators are capable of providing a highly educational and realistic
experience for the medical students within a variety of
speciality-oriented teaching sessions. Further research is needed to
establish how best to incorporate simulators into a more primary stage of
medical education; preclinical and clinical undergraduate
medicine. Copyright © 2014 Elsevier Inc. All rights reserved.

<36>
Accession Number
601067629
Title
Appropriate Revascularization in Stable Angina: Lessons From the BARI 2D
Trial.
Source
Canadian Journal of Cardiology. 30 (12) (pp 1595-1601), 2014. Date of
Publication: 01 Dec 2014.
Author
Krone R.J.; Althouse A.D.; Tamis-Holland J.; Venkitachalam L.; Campos A.;
Forker A.; Jacobs A.K.; Ocampo S.; Steiner G.; Fuentes F.; Pena Sing I.R.;
Brooks M.M.
Institution
(Althouse, Brooks) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Tamis-Holland) Mount Sinai Saint Luke's Hospital, New York, NA, United
States
(Venkitachalam) Department of Biomedical and Health Informatics,
University of Missouri-Kansas City, Kansas City, MO, United States
(Campos, Ocampo) Department of Cardiology, Hospital de Especialidades,
Centro Medico La Raza, IMSS, MEX City, Mexico
(Forker) Mid America Heart Institute, University of Missouri-Kansas City,
Kansas City, MO, United States
(Jacobs) Boston University and Boston Medical Center, Boston, MA, United
States
(Steiner) The University of Toronto, Toronto, ON, Canada
(Fuentes) Division of Cardiology, The University of Texas Health Science
Center at Houston, Houston, TX, United States
(Pena Sing) Heart and Vascular Catheterization Laboratories, Nanticoke
Memorial Hospital, Seaford, DE, United States
(Pena Sing) New York University, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: The 2012 Guidelines for Diagnosis and Management of Patients
with Stable Ischemic Heart Disease recommend intensive antianginal and
risk factor treatment (optimal medical management [OMT]) before
considering revascularization to relieve symptoms. The Bypass Angioplasty
Revascularization Investigation 2 Diabetes (BARI 2D) trial randomized
patients with ischemic heart disease and anatomy suitable to
revascularization to (1) initial OMT with revascularization if needed or
(2) initial revascularization plus OMT and found no difference in major
cardiovascular events. Ultimately, however, 37.9% of the OMT group was
revascularized during the 5-year follow-up period. Method(s): Data
from the 1192 patients randomized to OMT were analyzed to identify
subgroups in which the incidence of revascularization was so high that
direct revascularization without a trial period could be justified.
Multivariate logistic analysis, Cox regression models of baseline data,
and a landmark analysis of participants who did not undergo
revascularization at 6 months were constructed. Result(s): The models
that used only data available at the time of study entry had limited
predictive value for revascularization by 6 months or by 5 years; however,
the model incorporating severity of angina during the first 6 months could
better predict revascularization (C statistic= 0.789). Conclusion(s):
With the possible exception of patients with severe angina and proximal
left anterior descending artery disease, this analysis supports the
recommendation of the 2012 guidelines for a trial of OMT before
revascularization. Patients could not be identified at the time of
catheterization, but a short period of close follow-up during OMT
identified the nearly 40% of patients who underwent
revascularization. Copyright © 2014 Canadian Cardiovascular
Society.

<37>
Accession Number
53209900
Title
Twelve-month cost-effectiveness of telephone-delivered collaborative care
for treating depression following CABG surgery: A randomized controlled
trial.
Source
General Hospital Psychiatry. 36 (5) (pp 453-459), 2014. Date of
Publication: September 2014.
Author
Donohue J.M.; Belnap B.H.; Men A.; He F.; Roberts M.S.; Schulberg H.C.;
Reynolds C.F.; Rollman B.L.
Institution
(Donohue, Men, Roberts) Department of Health Policy and Management,
University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA,
United States
(Belnap, Roberts, Rollman) Division of General Internal Medicine, Center
for Research on Health Care, University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States
(He, Reynolds) Department of Psychiatry, University of Pittsburgh School
of Medicine, Pittsburgh, PA, United States
(Schulberg) Department of Psychiatry, Weill Cornell Medical College, White
Plains, NY, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Objective: To determine the 12-month cost-effectiveness of a collaborative
care (CC) program for treating depression following coronary artery bypass
graft (CABG) surgery versus physicians' usual care (UC). Method(s):
We obtained 12 continuous months of Medicare and private medical insurance
claims data on 189 patients who screened positive for depression following
CABG surgery, met criteria for depression when reassessed by telephone 2
weeks following hospitalization (nine-item Patient Health Questionnaire >=
10) and were randomized to either an 8-month centralized, nurse-provided
and telephone-delivered CC intervention for depression or to their
physicians' UC. Result(s): At 12 months following randomization, CC
patients had $2068 lower but statistically similar estimated median costs
compared to UC (P= .30) and a variety of sensitivity analyses produced no
significant changes. The incremental cost-effectiveness ratio of CC was
-$9889 (-$11,940 to -$7838) per additional quality-adjusted life-year
(QALY), and there was 90% probability it would be cost-effective at the
willingness to pay threshold of $20,000 per additional QALY. A
bootstrapped cost-effectiveness plane also demonstrated a 68% probability
of CC "dominating" UC (more QALYs at lower cost). Conclusion(s):
Centralized, nurse-provided and telephone-delivered CC for post-CABG
depression is a quality-improving and cost-effective treatment that meets
generally accepted criteria for high-value care. © 2014 Elsevier Inc.

<38>
Accession Number
373112377
Title
Coronary computed tomography as a cost-effective test strategy for
coronary artery disease assessment - A systematic review.
Source
Atherosclerosis. 234 (2) (pp 426-435), 2014. Date of Publication: June
2014.
Author
Zeb I.; Abbas N.; Nasir K.; Budoff M.J.
Institution
(Zeb, Abbas) Bronx-Lebanon Hospital Center, 1650 Grand Concourse, Bronx,
NY, United States
(Nasir) Center for Prevention and Wellness Research, Baptist Health
Medical Group, Miami Beach, FL, United States
(Nasir) Department of Epidemiology, Robert Stempel College of Public
Health, Florida International University, Miami, FL, United States
(Nasir) Department of Medicine, Herbert Wertheim College of Medicine,
Florida International University, Miami, FL, United States
(Nasir) The Johns Hopkins Ciccarone Center for the Prevention of Heart
Disease, Baltimore, MD, United States
(Budoff) Los Angeles Biomedical Research Institute at Harbor-UCLA Medical
Center, Torrance, CA 90502, United States
Publisher
Elsevier Ireland Ltd
Abstract
Cardiovascular imaging imparts a huge burden on healthcare spending.
Coronary CT angiography (CCTA) may provide a cost effective means of
diagnosing coronary artery disease (CAD) and reducing downstream cost of
testing. We performed a systematic search of literature for randomized
controlled trials or prospective or retrospective non-randomized
comparative studies or case series, decision analytic models and
technology reports in which some or all of the patients underwent CCTA and
looking at the cost effectiveness, comparative effectiveness and
downstream test utilization associated with the use of CCTA. We found 42
articles matching our criteria. CCTA either as first line or as a layering
test may represent a cost effective strategy for initial evaluation of
patients with CAD prevalence of 10%-50% in both near-term and long-term
diagnostic periods. For CAD prevalence >=70%, ICA as initial test may
represent cost effective strategy for diagnosis of stable chest pain. CCTA
may represent cost-effective strategy when performed as a layering test to
equivocal initial stress imaging before performing ICA. Use of CCTA is
cost- and time-effective strategy for evaluation of low risk (<30% CAD
prevalence) acute chest pain patients in emergency department and can be
used for safe exclusion of acute coronary syndrome (ACS). Use of coronary
calcium score as an initial test may require further evidence to be deemed
cost-effective strategy. CCTA may represent a cost effective and may be
associated with less downstream testing for diagnosis of stable chest pain
patients in low to intermediate risk patients whereas for low risk acute
chest pain patients, use of CCTA is associated with expedited patient
management, less cost and safe exclusion of ACS. © 2014 Elsevier
Ireland Ltd.

<39>
Accession Number
52911580
Title
Meta-analysis comparing carvedilol versus metoprolol for the prevention of
postoperative atrial fibrillation following coronary artery bypass
grafting.
Source
American Journal of Cardiology. 113 (3) (pp 565-569), 2014. Date of
Publication: 01 Feb 2014.
Author
Dinicolantonio J.J.; Beavers C.J.; Menezes A.R.; Lavie C.J.; O'Keefe J.H.;
Meier P.; Vorobcsuk A.; Aradi D.; Komocsi A.; Chatterjee S.; D'Ascenzo F.;
Gasparini M.; Brugts J.; Biondi-Zoccai G.
Institution
(Dinicolantonio) Department of Preventive Cardiology, Saint Luke's
Hospital, University of Missouri-Kansas City, Kansas City, MO, United
States
(Beavers) Department of Pharmacy, Centennial Medical Center, Nashville,
TN, United States
(Menezes, Lavie) Department of Cardiovascular Diseases, Ochsner Clinical
School, University of Queensland School of Medicine, New Orleans, LA,
United States
(Lavie) Department of Preventive Medicine, Pennington Biomedical Research
Center, Baton Rouge, LA, United States
(O'Keefe) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Meier) Heart Hospital, University College London Hospitals UCLH, London,
United Kingdom
(Vorobcsuk, Aradi, Komocsi) Department of Interventional Cardiology, Heart
Centre, University of Pecs, Hungary
(Chatterjee) Cardiovascular Diseases, St. Luke's - Roosevelt Hospital
Center, Division of Cardiology, New York, NY, United States
(D'Ascenzo) Division of Cardiology, Department of Internal Medicine, Citta
della Salute e della Scienza, San Giovanni battista, Turin, Italy
(Gasparini) Department of Mathematical Sciences, Politecnico di Torino,
Rotterdam, Netherlands
(Brugts) Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam,
Netherlands
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Aradi) Department of Cardiology, Heart Center, Balatonfured, Hungary
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
A systematic review and meta-analysis was performed to evaluate the
effects of carvedilol versus metoprolol on the incidence of postoperative
atrial fibrillation in patients undergoing coronary artery bypass grafting
in randomized controlled trials. Ovid MEDLINE, PubMed, CENTRAL, and
Excepta Medica (EMBASE) were searched up to March 2013 for suitable
randomized controlled trials. Data were pooled using random-effects model
for pairwise analyses. A total of 4 trials with 601 patients were included
in this analysis. Pairwise analyses showed that compared with metoprolol,
carvedilol significantly reduced the incidence of postoperative atrial
fibrillation (odds ratio 0.50, 95% confidence interval 0.32 to 0.80). In
conclusion, compared with metoprolol, carvedilol significantly reduces the
incidence of postoperative atrial fibrillation in patients undergoing
coronary artery bypass grafting. © 2014 Elsevier Inc. All rights
reserved.

<40>
Accession Number
53240972
Title
Increased mortality after transcatheter aortic valve implantation (TAVI)
in patients with severe aortic stenosis and low ejection fraction: A
meta-analysis of 6898 patients.
Source
International Journal of Cardiology. 176 (1) (pp 32-39), 2014. Date of
Publication: September 2014.
Author
Sannino A.; Gargiulo G.; Schiattarella G.G.; Brevetti L.; Perrino C.;
Stabile E.; Losi M.A.; Toscano E.; Giugliano G.; Scudiero F.; Chiacchio
E.; Trimarco B.; Esposito G.
Institution
(Sannino, Gargiulo, Schiattarella, Brevetti, Perrino, Stabile, Losi,
Toscano, Giugliano, Scudiero, Chiacchio, Trimarco, Esposito) Division of
Cardiology, Department of Advanced Biomedical Sciences, Federico II
University of Naples, Via Pansini 5, 80131 Naples, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background There is conflicting evidence regarding the safety and efficacy
of transcatheter aortic valve implantation (TAVI) procedures in patients
with severe aortic stenosis and low left ventricular ejection fraction
(EF). The primary aim of this study was to determine the impact of TAVI on
short- and long-term mortality in patients with low EF (EF < 50%); the
secondary aim was to analyze the impact of TAVI procedure on EF recovery
in the same setting of patients. Methods and results Twenty-six studies
enrolling 6898 patients with severe aortic stenosis undergoing TAVI
procedure were included in the meta-analysis and analyzed for 30-day,
6-month and 1-year all-cause and cardiovascular mortality; a further
meta-analysis was also performed in patients with low EF to assess EF
changes post TAVI. In low EF patients, both all-cause and cardiovascular
short- and long-term mortality were significantly higher when compared to
patients with normal EF (30-day-all-cause mortality: 0.13; 95% confidence
interval [CI]: 0.01 to 0.25, I2 = 49.65, Q = 21.85;
1-year-all-cause mortality: 0.25; 95% [CI]: 0.16 to 0.34, I2 =
25.57, Q = 16.12; 30-day-cardiovascular mortality: 0.03; 95% [CI]: - 0.31
to 0.36, I2 = 66.84, Q = 6.03; 1-year-cardiovascular mortality:
0.29; 95% [CI]: 0.12 to 0.45, I2 = 0.00, Q = 1.88).
Nevertheless, in low EF patients TAVI was associated with a significant
recovery of EF, which started at discharge and proceeded up to
1-year-follow-up. Conclusions Patients with low EF severe aortic stenosis
have higher mortality following TAVI compared to normal EF patients,
despite a significant and sustained improvement in EF. © 2014
Elsevier Ireland Ltd. All rights reserved.

<41>
Accession Number
53272308
Title
Meta-analysis of mortality outcomes and mitral regurgitation evolution in
4,839 patients having transcatheter aortic valve implantation for severe
aortic stenosis.
Source
American Journal of Cardiology. 114 (6) (pp 875-882), 2014. Date of
Publication: 15 September 2014.
Author
Sannino A.; Losi M.A.; Schiattarella G.G.; Gargiulo G.; Perrino C.;
Stabile E.; Toscano E.; Giugliano G.; Brevetti L.; Franzone A.; Cirillo
P.; Imbriaco M.; Trimarco B.; Esposito G.
Institution
(Sannino, Losi, Schiattarella, Gargiulo, Perrino, Stabile, Toscano,
Giugliano, Brevetti, Franzone, Cirillo, Imbriaco, Trimarco, Esposito)
Division of Cardiology, Department of Advanced Biomedical Sciences,
Federico II University, Naples, Italy
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective alternative
therapy in selected patients with severe aortic stenosis. The role and
effects of coexistent moderate to severe mitral regurgitation (msMR) in
patients who undergo TAVI remain unclear. Thirteen studies enrolling 4,839
patients who underwent TAVI, including patients with msMR, were considered
in a meta-analysis and analyzed for all-cause-mortality; a further
metaanalysis was performed to assess mitral regurgitation (MR) evolution
after TAVI. In patients with msMR, all-cause-mortality after TAVI was
significantly increased at 30-day (effect size [ES] L0.18, 95% confidence
interval [CI] L0.31 to L0.04, I2 [ 46.51, Q [ 7.48), 1-year (ES L0.22, 95%
CI L0.36 to L0.08, I2 [ 56.20, Q [ 11.41), and 2-year (ES L0.15, 95% CI
L0.27 to L0.02, I2 [ 0.00, Q [ 2.64) follow-up compared with patients with
absent or mild MR, independent of baseline left ventricular ejection
fraction. Interestingly, the impact of msMR on outcomes was statistically
stronger when the CoreValve system was used. TAVI was also associated with
an improvement in MR entity at 3- and 6-month follow-up (overall ES L0.19,
95% CI L0.37 to L0.01, I2 [ 61.52, Q [ 10.39). In conclusion, the presence
of preoperative msMR in patients with severe, symptomatic aortic stenosis
who undergo TAVI negatively affects outcomes after TAVI. In addition, in
the same group of patients, a trend toward a reduction in MR severity was
observed. Whether the decrease in MR severity affects mortality after TAVI
remains to be defined. Copyright © 2014 Elsevier Inc. All rights
reserved.

<42>
Accession Number
600209771
Title
Mapping and ablation of autonomic ganglia in prevention of postoperative
atrial fibrillation in coronary surgery: Maappafs atrial fibrillation
randomized controlled pilot study.
Source
Canadian Journal of Cardiology. 30 (10) (pp 1202-1207), 2014. Date of
Publication: 01 Oct 2014.
Author
Al-Atassi T.; Toeg H.; Malas T.; Lam B.-K.
Institution
(Al-Atassi, Toeg, Malas, Lam) Division of Cardiac Surgery, University of
Ottawa Heart Institute, Ottawa, ON, Canada
Publisher
Pulsus Group Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Postoperative atrial fibrillation (POAF) remains common after
coronary artery bypass grafting (CABG). Limited efforts to intervene on
cardiac autonomic ganglionic plexi (AGP) during surgery show mixed
results. In this pilot study, we evaluated the safety and feasibility of
map-guided ablation of AGPs during isolated CABG in the prevention of
POAF. Method(s): In this pilot study, patients undergoing isolated
CABG were randomized into an intervention group (mapping and ablation of
AGP [AGP+] group), and a control group (no mapping and ablation [AGP-]
group). Using high-frequency stimulation, active AGPs were identified and
ablated intraoperatively using radiofrequency. Continuous rhythm
monitoring, serum electrolytes, postoperative medications, and
postoperative complications were recorded until discharge. Result(s):
Randomization of 47 patients (24 AGP+ and 23 AGP-) resulted in similar
baseline characteristics, past medical history, and preoperative
medication use. The intervention added a median of 14 minutes to the
operative time. The incidence of POAF, mean time inPOAF, and median length
of stay in hospital were: AGP+ 21% vs AGP- 30%; AGP+ 298 minutes vs AGP-
514 minutes; AGP+ 5 days vs AGP- 6 days; respectively). Postoperative
complications, medication use, and daily serum electrolyte profiles were
similar in both groups. Conclusion(s): This pilot study demonstrated
the safety and feasibility of mapping and ablation of AGP during CABG with
minimal added operative time. Results further suggest a potentially
clinically significant effect on POAF. A multicentre trial is
warranted. Copyright © 2014 Canadian Cardiovascular Society.

<43>
Accession Number
52829688
Title
Use of IVUS guided coronary stenting with drug eluting stent: A systematic
review and meta-analysis of randomized controlled clinical trials and high
quality observational studies.
Source
International Journal of Cardiology. 170 (1) (pp 54-63), 2013. Date of
Publication: 05 Dec 2013.
Author
Klersy C.; Ferlini M.; Raisaro A.; Scotti V.; Balduini A.; Curti M.;
Bramucci E.; De Silvestri A.
Institution
(Klersy, De Silvestri) Service of Biometry and Statistics, IRCCS
Fondazione Policlinico San Matteo, 27100 Pavia, Italy
(Ferlini, Raisaro, Bramucci) Department of Cardiology, IRCCS Fondazione
Policlinico San Matteo, Pavia, Italy
(Scotti, Balduini, Curti) Center for Scientific Documentation, IRCCS
Fondazione Policlinico San Matteo, Pavia, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background/objectives Long term safety of DES, particularly regarding
thrombosis is of concern. The hypothesized underlying mechanisms (stent
underexpansion, malapposition) could be prevented by IVUS guidance. Aim of
this meta-analysis of randomized controlled clinical trials (RCT) and high
quality observational cohort studies (HQ-OBS) is to quantify the potential
clinical benefit of intravascular ultrasound (IVUS) guidance in
drug-eluting stents (DES) implantation. Methods We performed an extensive
literature search for full-text articles published in 2003-2013. The
primary outcome was the rate of major adverse cardiac events (MACE) in RCT
and HQ-OBS; secondary outcomes were death, myocardial infarction (MI),
revascularization, thrombosis and post-procedural minimum lumen diameter
(MLD). Fixed/random effect relative risks (RRs) or standardized mean
difference (SMD) and 95% confidence interval (95% CI) were computed for
the meta-analysis. Results Thirty-four articles were retrieved from 268
found; of these 3 were RCT and 9 were HQ-OBS; 18,707 patients were
enrolled, 1037 in RCT and 17,670 in OBS. Median follow-up was 20 months.
IVUS guidance was associated with a significantly lower rate of MACE (RR =
0.80, 95% CI 0.71-0.89, p < 0.001), death (RR = 0.60, 95% CI 0.48-0.74, p
< 0.001), MI (RR = 0.59, 95% CI 0.44-0.80, p = 0.001) and thrombosis (RR =
0.50, 95% CI 0.32-0.80, p = 0.007) and larger MLD (SMD = 0.15, 95% CI 0.03
to 0.27, p = 0.014), but not of revascularization (RR = 0.95, 95% CI
0.82-1.09, p = 0.75). Conclusions In this meta-analysis, IVUS guidance in
DES implantation appears to reduce MACE, mortality and MI, possibly by
reducing thrombosis rather than restenosis rate. Patients at high risk for
thrombosis might be identified as the best candidate for IVUS guidance.
© 2013 Elsevier Ireland Ltd.

<44>
Accession Number
2006079472
Title
Effects of intraoperative dexmedetomidine on the incidence of acute kidney
injury in pediatric cardiac surgery patients: A randomized controlled
trial.
Source
Paediatric Anaesthesia. 30 (10) (pp 1132-1138), 2020. Date of Publication:
01 Oct 2020.
Author
Kim E.-H.; Lee J.-H.; Kim H.-S.; Jang Y.-E.; Ji S.-H.; Kim W.-H.; Kwak
J.G.; Kim J.-T.
Institution
(Kim, Lee, Kim, Jang, Ji, Kim) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University
College of Medicine, Seoul, South Korea
(Kim, Kwak) Department of Cardiothoracic Surgery, Seoul National
University Hospital, Seoul National University College of Medicine, Seoul,
South Korea
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Background: Perioperative dexmedetomidine use has been reported to reduce
the incidence of postoperative acute kidney injury after adult cardiac
surgery. However, large-scale randomized controlled trials evaluating the
effect of dexmedetomidine use on acute kidney injury in pediatric patients
are lacking. Aim(s): We investigated whether intraoperative
dexmedetomidine could reduce the incidence of acute kidney injury in
pediatric cardiac surgery patients. Method(s): In total, 141
pediatric patients were randomly assigned to dexmedetomidine or control
groups. After anesthetic induction, patients in the dexmedetomidine group
were administered 1 micro g/kg of dexmedetomidine over 10 minutes and
an additional 0.5 micro g/kg/h of dexmedetomidine during surgery.
Additionally, 1 micro g/kg of dexmedetomidine was infused immediately
after cardiopulmonary bypass was initiated. The incidence of acute kidney
injury was defined following Kidney Disease Improving Global Outcomes
guidelines. Result(s): The final analysis included 139 patients. The
incidence of acute kidney injury did not differ between dexmedetomidine
and control groups (16.9% vs 23.5%; odds ratio 0.661; 95% CI 0.285 to
1.525; P =.33). Similarly, neither the incidence of abnormal postoperative
estimated glomerular filtration rate values (P =.96) nor the incidence of
arrhythmia, mechanical ventilation duration, length of stay in the
intensive care unit, and hospitalization differed between the two groups.
 Conclusion(s): Intraoperative dexmedetomidine did not reduce acute
kidney injury incidence in pediatric cardiac surgery
patients. Copyright © 2020 John Wiley & Sons Ltd

<45>
Accession Number
2005643928
Title
FFR-guided versus coronary angiogram-guided CABG: A review and
meta-analysis of prospective randomized controlled trials.
Source
Journal of Cardiac Surgery. 35 (10) (pp 2785-2793), 2020. Date of
Publication: 01 Oct 2020.
Author
Timbadia D.; Ler A.; Sazzad F.; Alexiou C.; Kofidis T.
Institution
(Timbadia) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore
(Timbadia, Ler, Sazzad, Kofidis) Department of Cardiac Thoracic and
Vascular Surgery, National University Heart Centre, Singapore
(Ler) School of Medicine, National University of Ireland, Galway, Ireland
(Sazzad, Kofidis) Department of Surgery, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
(Sazzad, Kofidis) Cardiovascular Research Institute, National University
of Singapore, Singapore
(Alexiou) Department of Cardiac Surgery, Interbalkan European Medical
Centre, Thessaloniki, Greece
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Background: Fractional flow reserve (FFR) is a well-established method for
the evaluation of coronary artery stenosis before percutaneous coronary
intervention. However, whether FFR assessment should be routinely used
before coronary artery bypass graft surgery (CABG) remains unclear. A
meta-analysis of prospectively randomized controlled trials (PRCTs) was
carried out to compare the outcomes of FFR-guided CABG vs coronary
angiography (CAG)-guided CABG. Method(s): The meta-analysis adhered
to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. Two PRCTs (the FARGO and GRAFFITI trials) were found and
included reporting data on 269 patients with 6 and 12 month follow-up.
Primary endpoints were rates of overall death, MACCE, target vessel
revascularization, and spontaneous myocardial infarction (MI). Secondary
endpoints were overall graft patency and patency of arterial and venous
grafts. Result(s): There were no significant differences between the
FFR-guided and CAG-guided groups in the rates of overall death, MACCE,
target vessel revascularization, spontaneous MI and graft patency.
Meta-analysis of FARGO and GRAFFITI PRCTs showed that FFR-guided CABG and
CAG-guided CABG produced similar clinical outcomes with similar graft
patency rates up to a year postoperatively. Conclusion(s): Currently
available PRCTs showes no sufficient evidence to support the use FFR in
CABG. Copyright © 2020 Wiley Periodicals LLC

<46>
Accession Number
2005609370
Title
Mitral valve surgery combined with on-pump versus off-pump myocardial
revascularization: A prospective randomized analysis with midterm
follow-up.
Source
Journal of Cardiac Surgery. 35 (10) (pp 2649-2656), 2020. Date of
Publication: 01 Oct 2020.
Author
Zavolozhin A.; Shonbin A.; Bystrov D.; Enginoev S.
Institution
(Zavolozhin, Shonbin) Department of Surgery, Arkhangelsk State Medical
University, Arkhangelsk, Russian Federation
(Zavolozhin, Enginoev) Department of Cardiac Surgery, FSBI Federal Centre
for Cardiovascular Surgery of the Ministry of Health of the Russian
Federation, Astrakhan, Russian Federation
(Shonbin, Bystrov) Department of Cardiac Surgery, City Hospital No 1,
Arkhangelsk, Russian Federation
(Enginoev) Department of Cardiac Surgery, Astrakhan State Medical
University, Astrakhan, Russian Federation
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Background: The aim of the study was to compare results off-pump coronary
artery bypass (OPCAB) combined mitral valve reconstruction (MVR) with
standard on-pump approach. Method(s): From January 2014 to December
2017, a total of 53 patients received a combined myocardial
revascularization and MVR for multivessel coronary artery disease (CAD)
complicated by severe ischemic mitral regurgitation (IMR). All the
subjects were divided into two groups: group I: 27 patients, received
OPCAB + MVR, and group II (control group): 26 patients with on-pump
myocardial revascularization (ONCAB) + MVR. Result(s): The aortic
cross-clamp (ACC) and cardio-pulmonary bypass (CPB) times were longer in
group II, 47.0 (44.0; 55.0) vs 94.5 (89.75; 105.5) minutes, P <.05 and
70.0 (63.0; 77.0) vs 138.5 (127.0; 157.5) minutes, P <.05, respectively.
Evaluation of major clinical events showed that the implementation of the
off-pump stage of myocardial revascularization in patients with severe IMR
did not lead to significant changes in the mortality and postoperative
complications. Furthermore, its use did not affect the volume of blood
loss and need for blood transfusion, the duration of mechanical
ventilation, the need for inotropic therapy, as well as the duration of
the patient's resuscitation and the total duration of hospitalization,
with the one exception: the troponin-T level increase in the OPCAB + MVR
group was less than in the ONCAB + MVR group. Conclusion(s): OPCAB
combined MVR in patients with CAD and severe IMR can be performed with
shorter CPB and ACC times, and lower troponin-T level after surgery,
without reducing the risk of surgical complications. Copyright ©
2020 Wiley Periodicals LLC

<47>
Accession Number
632930532
Title
Transcatheter versus surgical aortic valve replacement in patients with
cardiac surgery: Meta-analysis and systematic review of the literature.
Source
Journal of Cardiovascular Development and Disease. 7 (3) (no pagination),
2020. Article Number: 36. Date of Publication: September 2020.
Author
Latif A.; Lateef N.; Ahsan M.J.; Kapoor V.; Usman R.M.; Cooper S.;
Andukuri V.; Mirza M.; Ashfaq M.Z.; Khouzam R.
Institution
(Latif, Lateef, Ahsan, Kapoor, Cooper, Andukuri, Mirza, Ashfaq) Department
of Internal Medicine, Creighton University, Omaha, NE 68124, United States
(Usman) Department of Internal Medicine, University of Tennessee, Memphis,
TN 38152, United States
(Khouzam) Department of Cardiology, University of Tennessee, Memphis, TN
38152, United States
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
The number of patients with severe aortic stenosis (AS) and a history of
prior cardiac surgery has increased. Prior cardiac surgery increases the
risk of adverse outcomes in patients undergoing aortic valve replacement.
To evaluate the impact of prior cardiac surgery on clinical endpoints in
patients undergoing transcatheter aortic valve replacement (TAVR) versus
surgical aortic valve replacement (SAVR), we performed a literature search
using PubMed, Embase, Google Scholar, and Scopus databases. The clinical
endpoints included in our study were 30-day mortality, 1-2-year mortality,
acute kidney injury (AKI), bleeding, stroke, procedural time, and duration
of hospital stay. Seven studies, which included a total of 8221 patients,
were selected. Our study found that TAVR was associated with a lower
incidence of stroke and bleeding complications. There was no significant
difference in terms of AKI, 30-day all-cause mortality, and 1-2-year
all-cause mortality between the two groups. The average procedure time and
duration of hospital stay were 170 min less (p <= 0.01) and 3.6 days
shorter (p < 0.01) in patients with TAVR, respectively. In patients with
prior coronary artery bypass graft and severe AS, both TAVR and SAVR are
reasonable options. However, TAVR may be associated with a lower incidence
of complications like stroke and perioperative bleeding, in addition to a
shorter length of stay. Copyright © 2020 by the authors.

<48>
Accession Number
632381656
Title
Levosimendan Reduces Mortality and Low Cardiac Output Syndrome in Cardiac
Surgery.
Source
Thoracic and Cardiovascular Surgeon. 68 (5) (pp 400-408), 2020. Date of
Publication: 01 Aug 2020.
Author
Weber C.; Esser M.; Eghbalzadeh K.; Sabashnikov A.; Djordjevic I.; Maier
J.; Merkle J.; Choi Y.-H.; Madershahian N.; Liakopoulos O.; Deppe A.C.;
Wahlers T.C.W.
Institution
(Weber, Esser, Eghbalzadeh, Sabashnikov, Djordjevic, Maier, Merkle, Choi,
Madershahian, Liakopoulos, Deppe, Wahlers) Department of Cardiothoracic
Surgery, University of Cologne, Kerpener Street 62, Cologne 50937, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background There has been conflicting evidence concerning the effect of
levosimendan on clinical outcomes in patients undergoing cardiac surgery.
Therefore, we performed a systematic review and conducted this
meta-analysis to provide evidence for/against the administration of
levosimendan in cardiac surgery patients. Methods We performed a
meta-analysis from literature search in PubMed, EMBASE, and Cochrane
Library. Only randomized controlled trials comparing the administration of
levosimendan in cardiac surgery patients with a control group (other
inotrope, standard therapy/placebo, or an intra-aortic balloon pump) were
included. In addition, at least one clinical outcome had to be mentioned:
Mortality, myocardial infarction, low cardiac output syndrome (LCOS),
acute kidney injury, renal replacement therapy, atrial fibrillation,
prolonged inotropic support, length of intensive care unit, and hospital
stay. The pooled treatment effects (odds ratio [OR], 95% confidence
intervals [CI]) were assessed using a fixed or random effects model.
Results The literature search retrieved 27 randomized, controlled trials
involving a total of 3,198 patients. Levosimendan led to a significant
reduction in mortality (OR: 0.67; 95% CI: 0.49-0.91; p = 0.0087).
Furthermore, the incidence of LCOS (OR: 0.56, 95% CI: 0.42-0.75; p <
0.0001), acute kidney injury (OR: 0.63; 95% CI: 0.46-0.86; p = 0.0039),
and renal replacement therapy (OR: 0.70; 95% CI: 0.50-0.98; p = 0.0332)
was significantly decreased in the levosimendan group. Conclusion Our
meta-analysis suggests beneficial effects for the prophylactic use of
levosimendan in patients with severely impaired left ventricular function
undergoing cardiac surgery. The administration of levosimendan was
associated with a reduced mortality, less LCOS, and restored adequate
organ perfusion reflected in less acute kidney injury. Copyright
© 2020 Georg Thieme Verlag. All rights reserved.

<49>
Accession Number
632381648
Title
Bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain
Control Post-Cardiac Surgery: A Randomized Controlled Trial.
Source
Thoracic and Cardiovascular Surgeon. 68 (5) (pp 409-415), 2020. Date of
Publication: 01 Aug 2020.
Author
El Shora H.A.; El Beleehy A.A.; Abdelwahab A.A.; Ali G.A.; Omran T.E.;
Hassan E.A.; Arafat A.A.
Institution
(El Shora, El Beleehy) Anesthesia and Surgical ICU Department, Faculty of
Medicine-Tanta University, Tanta, Gharbeya, Egypt
(Abdelwahab, Omran, Hassan, Arafat) Department of Cardiothoracic Surgery,
Faculty of Medicine-Tanta University, Al-Giesh Street, Tanta, Gharbeya
31529, Egypt
(Ali) Department of Cardiothoracic Surgery, Faculty of Medicine-Zagazig
University, Zagazig, Sharkia, Egypt
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Adequate pain control after cardiac surgery is essential.
Paravertebral block is a simple technique and avoids the potential
complications of epidural catheters. The objective of this study is to
compare the effect of ultrasound-guided bilateral thoracic paravertebral
block with thoracic epidural block on pain control after cardiac surgery.
Materials and Methods Between March 2016 and 2017, 145 patients who had
cardiac surgery through median sternotomy were randomized by stratified
blocked randomization into two groups. Group I (n = 70 patients) had
bilateral ultrasound-guided thoracic paravertebral block and Group II (n =
75 patients) had thoracic epidural analgesia. The primary end point was
the postoperative visual analogue scale (VAS). The duration of mechanical
ventilation, intensive care unit (ICU), and hospital stay were the
secondary end points. The study design is a randomized parallel
superiority clinical trial. Results Both groups had similar preoperative
and operative characteristics. No significant difference in VAS measured
immediately after endotracheal extubation then after 12, 24, and 48 hours
between groups (p = 0.45). Pain score significantly declined with the
repeated measures (p < 0.001) and the decline was not related to the
treatment group. Postoperative pain was significantly related to diabetes
mellitus (p = 0.039). Six patients in group I (8.5%) required an
additional dose of morphine versus three patients (4%) in group II (p =
0.30). Patients in group I had significantly shorter ICU stay (p = 0.005)
and lower incidence of urinary retention (p = 0.04) and vomiting (p =
0.018). No difference was found in operative complications between groups.
Conclusion This randomized parallel controlled trial demonstrates that
ultrasound-guided paravertebral block is safe and effective method for
relieving post-cardiac surgery sternotomy pain compared with thoracic
epidural analgesia but not superior to it. Copyright © 2020 Georg
Thieme Verlag. All rights reserved.

<50>
Accession Number
632340241
Title
Performance at stair-climbing test is associated with postoperative
complications after lung resection: A systematic review and meta-analysis.
Source
Thorax. 75 (9) (pp 791-797), 2020. Date of Publication: 01 Sep 2020.
Author
Boujibar F.; Gillibert A.; Gravier F.E.; Gillot T.; Bonnevie T.; Cuvelier
A.; Baste J.-M.
Institution
(Boujibar, Baste) Department of General and Thoracic Surgery, Chu Rouen,
Rouen, France
(Boujibar, Baste) Normandie University Unirouen, Inserm U1096, Rouen,
France
(Gillibert) Biostatistics Unit, Chu Rouen, Rouen, Normandie, France
(Gravier, Bonnevie) Adir Association, Bois Guillaume, France
(Gravier, Bonnevie, Cuvelier) Normandie University, Unirouen Upres Ea
3830, Rouen University Hospital, Haute Normandie Research and Biomedical
Innovation, Rouen, France
(Gillot) Cetaps Ea 3832, Mont Saint Aignan, France
(Gillot) Erfps, Chu Rouen, Rouen, France
(Cuvelier) Pulmonary and Respiratory Intensive Care Department, Chu Rouen,
Rouen, Normandie, France
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
Background Thoracic surgery is the optimal treatment for early-stage lung
cancer, but there is a high risk of postoperative morbidity. Therefore, it
is necessary to evaluate patients' preoperative general condition and
cardiorespiratory capacity to determine the risk of postoperative
complications. The objective of this study was to assess whether the
stair-climbing test could be used in the preoperative evaluation of lung
resection patients to predict postoperative morbidity following thoracic
surgery. Methods We performed a systematic review and a meta-analysis on
the association between stair-climbing test result and morbidity/mortality
after thoracic surgery. We analysed all articles published until May 2020
in the following databases: Pubmed/Medline, Pedro, The Cochrane library,
Embase and CINAHL. The risk of bias was assessed using the Quality in
Prognosis Studies tool. This meta-analysis is registered as PROSPERO
CRD42019121348. Results 13 articles were included in the systematic review
for a total of 2038 patients and 6 in the meta-analysis. There were
multiple test evaluation criteria: rise time, height, desaturation and
heart rate change. For the meta-analysis, we were able to pool data on the
height of rise at a variable threshold: risk ratio 2.34 (95% CI 1.59 to
3.43) with I2=53% (p=0.06). The threshold for occurrence of complications
was estimated at a 10 m climb. Conclusions Our results indicate that the
stair-climbing test could be used as a first-line functional screening
test to predict postoperative morbidity following thoracic surgery and
that patients with a poor test result (<10 m) should be referred to formal
cardiopulmonary exercise testing. Copyright ©

<51>
Accession Number
2005711157
Title
Infective Endocarditis After Transcatheter Versus Surgical Aortic Valve
Replacement: A Meta-Analysis.
Source
Angiology. 71 (10) (pp 955-965), 2020. Date of Publication: 01 Nov 2020.
Author
Wang J.; Wang X.; Hou F.; Yuan W.; Dong R.; Wang L.; Shen H.; Zhou Y.
Institution
(Wang, Dong) Department of Cardiac Surgery, Beijing Anzhen Hospital
Capital Medical University, Beijing, China
(Wang, Yuan) Center for Cardiac Intensive Care, Beijing Anzhen Hospital
Capital Medical University, Beijing, China
(Wang, Shen, Zhou) Department of Cardiology, Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
(Wang) Department of General Surgery, Chinese PLA general hospital,
Beijing, China
(Hou) Department of Cardiology, Qingdao Municipal Hospital, Qingdao, China
(Wang) Department of Epidemiology, Beijing Anzhen Hospital, Beijing
Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical
University, Beijing, China
Publisher
SAGE Publications Inc. ( United States. E-mail: claims@sagepub.com)
Abstract
We determined the incidence, clinical characteristics, and risk factors of
post-transcatheter aortic valve replacement (TAVR)-associated infective
endocarditis (IE). We compared the incidence of IE after TAVR versus after
surgical aortic valve replacement (SAVR). The incidence rate of IE 1-year
post-TAVR was 0.9% (95% confidence interval [CI]: 0.8-1.0). Transcatheter
aortic valve replacement was associated with significantly reduced IE
incidence (incidence rate ratio: 0.69, 95% CI: 0.52-0.92, P =.011)
compared with SAVR. In patients with TAVR IE, the pooled in-hospital
mortality was 37.8% (95% CI: 32.4-43.3, I2 = 54.9%). Pooled
adjusted hazard ratio (HR) revealed that peri-procedural peripheral artery
disease (HR: 4.02, 95% CI: 2.28-7.10, P '.0001), moderate or severe
residual aortic regurgitation (HR: 2.34, 95% CI: 1.53-3.59, P '.0001),
orotracheal intubation (HR: 2.13, 95% CI: 1.19-3.82, P =.011), and male
gender (HR: 1.70, 95% CI: 1.47-1.97, P '.0001) were risk factors for
post-TAVR IE. Post-TAVR IE is a life-threatening complication often
resulting in in-hospital mortality. The current evidence-based
meta-analysis to identify risk factors may lead to the development of
effective preventive and therapeutic strategies for post-TAVR IE to
ultimately improve patient outcomes. Copyright © The Author(s)
2020.

<52>
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. ( Netherlands)
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. Aim(s): To
review the current literature addressing the prevalence and treatment of
ED in the male solid organ transplant population. 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.
 Main Outcome Measure(s): Review of peer-reviewed literature.
 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. 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. Copyright © 2019
International Society for Sexual Medicine

<53>
Accession Number
630129452
Title
Pulmonary Valve Replacement for Pulmonary Regurgitation in Adults With
Tetralogy of Fallot: A Meta-analysis-A Report for the Writing Committee of
the 2019 Update of the Canadian Cardiovascular Society Guidelines for the
Management of Adults With Congenital Heart Disease.
Source
The Canadian journal of cardiology. 35 (12) (pp 1772-1783), 2019. Date of
Publication: 01 Dec 2019.
Author
Mongeon F.-P.; Ben Ali W.; Khairy P.; Bouhout I.; Therrien J.; Wald R.M.;
Dallaire F.; Bernier P.-L.; Poirier N.; Dore A.; Silversides C.; Marelli
A.
Institution
(Mongeon, Khairy, Dore) Adult Congenital Heart Center, Department of
Specialized Medicine, Montreal Heart Institute, Universite de Montreal,
Montreal, Quebec, Canada
(Ben Ali, Bouhout) Department of surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada
(Therrien) Jewish General Hospital, McGill University, Montreal, Quebec,
Canada
(Wald, Silversides) Peter Munk Cardiac Centre, University Health Network,
Toronto, ON, Canada
(Dallaire) Division of Pediatric and Fetal Cardiology, Centre Hospitalier
Universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Quebec,
Canada
(Bernier) Department of surgery, McGill University Health Center, McGill
University, Montreal, Quebec, Canada
(Poirier) Department of surgery, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec, Canada; Department of surgery,
CHU-Sainte-Justine, Universite de Montreal, Montreal, Quebec, Canada
(Marelli) McGill Adult Unit for Congenital Heart Disease (MAUDE Unit),
McGill University, Montreal, Quebec, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is no systematic evidence review of the long-term
results of surgical pulmonary valve replacement (PVR) dedicated to adults
with repaired tetralogy of Fallot (rTOF) and pulmonary regurgitation.
 METHOD(S): Our primary objective was to determine whether PVR reduced
long-term mortality in adults with rTOF compared with conservative
therapy. Secondary objectives were to determine the postoperative
incidence rate of death, the changes in functional capacity and in right
ventricular (RV) volumes and ejection fraction after PVR, and the
postoperative incidence rate of sustained ventricular arrhythmias. A
systematic search of multiple databases for studies was conducted without
limits. RESULT(S): No eligible randomized controlled trial or cohort
study compared outcomes of PVR and conservative therapy in adults with
rTOF. We selected 10 cohort studies (total 657 patients) reporting
secondary outcomes. After PVR, the pooled incidence rate of death was 1%
per year (95% confidence interval [CI] 0-1% per year) and the pooled
incidence rate of sustained ventricular arrhythmias was 1% per year (95%
CI 1%-2% per year). PVR improved symptoms (odds ratio for postoperative
New York Heart Association functional class > II 0.08, 95% CI 0.03-0.24).
Indexed RV end-diastolic (-61.29 mL/m2, -43.64 to -78.94 mL/m2) and
end-systolic (-37.20 mL/m2, -25.58 to -48.82 mL/m2) volumes decreased
after PVR, but RV ejection fraction did not change (0.19%, -2.36% to
2.74%). The effect of PVR on RV volumes remained constant regardless of
functional status. CONCLUSION(S): Studies comparing PVR and
conservative therapy exclusively in adults with rTOF are lacking. After
PVR, the incidence rates of death and ventricular tachycardia are both 1
per 100 patient-years. Pooled analyses demonstrated an improved functional
status and a reduction in RV volumes. Copyright © 2019 Canadian
Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

<54>
Accession Number
53286371
Title
Response to the comment letter about adjustment.
Source
International Journal of Cardiology. 176 (3) (pp 1365-1366), 2014. Date of
Publication: 20 Oct 2014.
Author
Zhuang X.; Wang W.; Lu D.
Institution
(Zhuang, Wang, Lu) Department of Cardiovascular and Thoracic Surgery,
Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Publisher
Elsevier Ireland Ltd

<55>
Accession Number
2007511813
Title
The effect of pulsatile blood flow during proximal graft in facilitation
weaning from cardiopulmonary bypass pump in coronary artery bypass graft
surgery.
Source
Chirurgia (Turin). 33 (4) (pp 193-196), 2020. Date of Publication: August
2020.
Author
Amouzegarzavareh S.M.; Lak M.
Institution
(Amouzegarzavareh) Atrosclrose Research Center, Baqiyatallah University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Lak) Trauma Research Center, Baqiyatallah University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Even short time pulsatile flow can decrease the need for
inotrope support and facilitate weaning from cardiopulmonary bypass. Thus
clinical study was designed to investigate the effect of pulsatile flow
during proximal graft in order to reduce the need for inotrope support
during weaning from cardiopulmonary bypass (CPB) pump in coronary artery
bypass graft (CABG) surgery METHODS: In this randomized clinical trial
study 74 patients who underwent CABG surgery were randomly divided into
two groups of a) pulsatile flow and b) non-pulsatile flow. Continuous
blood flow was transferred to pulsatile blood flow during proximal graft
by using cardiac contraction RESULTS: Our results clearly showed that
using pulsatile flow significantly reduces the need for inotrope support.
 CONCLUSION(S): It is suggested that pulsatile flow be induced by use
of cardiac contraction during proximal graft in CABG surgery in the same
way as our method which is mentioned in the body of the
paper. Copyright © 2020 Edizioni Minerva Medica. All rights
reserved.

<56>
Accession Number
632959737
Title
Perioperative gabapentin in pediatric thoracic surgery
patients-randomized, placebo-controlled, phase 4 trial.
Source
Pain Medicine (United States). 21 (8) (pp 1562-1571), 2020. Date of
Publication: 2020.
Author
Tomaszek L.; Fenikowski D.; Maciejewski P.; Komotajtys H.; Gawron D.
Institution
(Tomaszek, Fenikowski, Maciejewski, Komotajtys, Gawron) Department of
Thoracic Surgery, Institute of Tuberculosis and Lung Diseases, Rabka-Zdroj
Branch, Rabka-Zdroj, Poland
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
Objective. To determine whether the use of perioperative gabapentin
reduces postoperative pain and anxiety, decreases ropivacaine consumption
and side effects, and improves patient satisfaction. Design. Randomized,
placebo-controlled, phase 4 trial. Blinding. Participants, care providers,
investigators, data analysts. Setting. Department of Thoracic Surgery of
the Institute of Tuberculosis and Lung Disease, Rabka Zdroj Branch,
Poland. Subjects. Forty patients undergoing the Ravitch procedure.
Methods. Patients aged nine to 17 years were randomized into a gabapentin
(preoperative 15 mg/kg, treatment) or placebo group. Postoperative
analgesia included gabapentin (7.5 mg/kg) or placebo two times per day for
three days, epidural ropivacaine fentanyl, paracetamol, nonsteroidal
anti-inflammatory drugs, and metamizol as a "rescue drug." Pain, anxiety,
analgesic consumption, side effects, and patient satisfaction were
recorded. Results. There was no statistically significant difference in
median pain scores (numerical rating scale < 1/10) or incidence of adverse
side effects between the gabapentin group (N 1/4 20) and the placebo group
(N 1/4 20). Postoperative anxiety scores were significantly lower than
before surgery in the gabapentin group (6 [4-8] vs 7 [6-8.5], P < 0.01)
and remained unchanged in the placebo group (6 [5-6.5] vs 6 [5-7], P 1/4
0.07). Gabapentin-treated patients received a lower number of doses of
ondansetron when compared with the placebo group (6 [5-6] vs 7 [6-9], P
1/4 0.02). A significant negative association was found between patient
satisfaction and postoperative state anxiety in the gabapentin group (R
1/4 -0.51, P 1/4 0.02). Conclusions. Perioperative administration of
gabapentin resulted in a decrease of postoperative anxiety in pediatric
patients undergoing the Ravitch procedure. Copyright © 2019
American Academy of Pain Medicine. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com

<57>
Accession Number
2007049939
Title
Cardiopulmonary bypass and internal thoracic artery: Can roller or
centrifugal pumps change vascular reactivity of the graft? The IPITA
study: A randomized controlled clinical trial.
Source
PLoS ONE. 15 (7 July) (no pagination), 2020. Article Number: e0235604.
Date of Publication: July 2020.
Author
Fouquet O.; Van Dang S.; Baudry A.; Meisnerowski P.; Robert P.; Pinaud
F.R.; Binuani P.; Chretien J.-M.; Henrion D.; Baufreton C.; Loufrani L.
Institution
(Fouquet, Van Dang, Baudry, Meisnerowski, Pinaud, Binuani, Baufreton)
Department of Thoracic and Cardiovascular Surgery, University Hospital,
Angers, France
(Fouquet, Van Dang, Baudry, Meisnerowski, Robert, Pinaud, Binuani,
Henrion, Baufreton, Loufrani) Mitovasc Institute Cnrs Umr 6214, University
of Angers, INSERM U1083, Angers, France
(Chretien) Clinical Research Department, University Hospital, Angers,
France
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Cardiopulmonary bypass (CPB) induces a systemic inflammatory
response (SIRS) and affects the organ vascular bed. Experimentally, the
lack of pulsatility alters myogenic tone of resistance arteries and
increases the parietal inflammatory response. The purpose of this study
was to compare the vascular reactivity of the internal thoracic arteries
(ITAs) due to the inflammatory response between patients undergoing
coronary artery bypass grafting (CABG) under CPB with a roller pump or
with a centrifugal pump. Methods Eighty elective male patients undergoing
CABG were selected using one or two internal thoracic arteries under CPB
with a roller pump (RP group) or centrifugal pump (CFP group). ITA samples
were collected before starting CPB (Time 1) and before the last coronary
anastomosis during aortic cross clamping (Time 2). The primary endpoint
was the endotheliumdependent relaxation of ITAs investigated using
wire-myography. The secondary endpoint was the parietal inflammatory
response of arteries defined by the measurements of superoxide levels,
leukocytes and lymphocytes rate and gene expression of inflammatory
proteins using. Terminal complement complex activation (SC5b-9) and
neutrophil activation (elastase) analysis were performed on arterial blood
at the same times. Results Exposure time of ITAs to the pump flow was
respectively 43.3 minutes in the RP group and 45.7 minutes in the CFP
group. Acetylcholine-dependent relaxation was conserved in the two groups
whatever the time. Gene expression of C3 and C4a in the artery wall
decreased from Time 1 to Time 2. No oxidative stress was observed in the
graft. There was no difference between the groups concerning the
leukocytes and lymphocytes rate. SC5b-9 and elastase increased between
Time 1 and Time 2. Conclusion Endothelium-dependent relaxation of the
internal thoracic arteries was preserved during CPB whatever the type of
pump used. The inflammatory response observed in the blood was not found
in the graft wall within this time frame. Copyright © 2020
Fouquet et al.

<58>
Accession Number
2006822771
Title
Ventricular Arrhythmias in Cardiac Amyloidosis: A Review of Current
Literature.
Source
Clinical Medicine Insights: Cardiology. 14 (no pagination), 2020. Date of
Publication: 2020.
Author
Khanna S.; Lo P.; Cho K.; Subbiah R.
Institution
(Khanna, Lo, Cho, Subbiah) Department of Cardiology, St Vincent's
Hospital, Darlinghurst, NSW, Australia
(Subbiah) University of New South Wales, Kensington, Sydney, NSW,
Australia
(Subbiah) Victor Chang Cardiac Research Institute, Darlinghurst, NSW,
Australia
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Cardiac Amyloidosis is an infiltrative cardiomyopathy which occurs
secondary to deposition of mis-folded protein in the myocardium, with the
two most common subtypes being AL amyloidosis and TTR amyloidosis. The
pathogenesis of the disease is multifaceted and involves a variety of
mechanisms including an inflammatory response cascade, oxidative stress
and subsequent separation of myocyte fibrils. Cardiac Amyloidosis
frequently results in congestive cardiac failure and arrhythmias, from a
disruption in cardiac substrate with subsequent electro-mechanical
remodelling. Disease progression is usually demonstrated by development of
progressive pump failure, which may be seen with a high arrhythmic burden,
usually portending a poor prognosis. There is a paucity of literature on
the clinical implications of ventricular arrhythmias in the context of
cardiac amyloidosis. The important diagnostic investigations for these
patients include transthoracic echocardiography, cardiac magnetic
resonance imaging and an electrophysiology study. Whilst there are no
robust management guidelines, studies have indicated benefits from
contemporary pharmacological therapy and case-by-case catheter ablation.
There are novel directed therapies available for TTR amyloidosis that have
shown to improve overall survival. The role of ICD therapy in cardiac
amyloidosis is controversial, with benefits seen predominantly in early
phases of the disease process. The only definitive surgical therapy
includes heart transplantation, but is largely indicated for progressive
decompensated heart failure (Figure 1). Further large-scale studies are
required to better outline management paradigms for treating ventricular
arrhythmias in cardiac amyloidosis. Copyright © The Author(s)
2020.

<59>
Accession Number
2005155426
Title
Comparing the myocardial protection of custodiol alone and in combination
with modified del nido in patients undergoing cardiac surgery; a
double-blind randomized clinical trial.
Source
International Cardiovascular Research Journal. 14 (3) (pp 95-101), 2020.
Article Number: e104728. Date of Publication: September 2020.
Author
Reihanifard N.; Nemati M.H.; Akhlagh S.H.; Abadi A.M.K.H.
Institution
(Reihanifard) Shiraz University of Medical Sciences, Shiraz, IR, Iran,
Islamic Republic of
(Nemati) Department of Surgery, Section of Cardiac Surgery, Shiraz
University of Medical Sciences, Shiraz, IR, Iran, Islamic Republic of
(Akhlagh) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Sciences, Shiraz, IR, Iran, Islamic Republic of
(Abadi) Clinical Research Development Center of Nemazee Hospital, Shiraz
University of Medical Sciences, Shiraz, IR, Iran, Islamic Republic of
Publisher
Iranian Cardiovascular Research Journal (E-mail: editor@icrj.ir)
Abstract
Background: Coronary Artery Bypass Grafting (CABG) has been considered as
the complete treatment of Ischemic Heart Disease (IHD). Cardioplegic
(extracellular and intracellular) solutions have been suggested to reduce
the cross-clamping duration. It was hypothesized that the combination of
the two intra-and extra-cellular solutions, namely Del Nido (DN) and
custodiol, could result in beneficiary clinical and economic outcomes.
 Objective(s): The present study aimed to compare the myocardial
protection of custodiol alone and in combination with modified DN in
patients undergoing cardiac surgery. Method(s): This prospective,
double-blind, clinical trial was conducted on 50 patients undergoing redo
CABG surgery. Aortic clamping was performed using custodiol (20 cc/kg) in
group A. In group B, custodiol 1000 cc was combined with 15 cc/kg cold DN
and was injected using the antigrade method. The two groups were compared
regarding the levels of Creatinine Kinase-MB (CK-MB) and troponin at the
time of anesthesia induction and two hours and 48 hours after the surgery,
intraoperative and postoperative variables, and 48-hour mortality rate.
 Result(s): The results showed similar CK-MB levels in the two groups
at the induction time (P = 0.12). However, a significant difference was
observed between the two groups in this regard two hours (P = 0.018) and
48 hours after the surgery (P = 0.021). Within-group comparisons revealed
significant changes in CK-MB and troponin levels in both groups, with a
steep increase from induction until two hours after the surgery and a
decrease from two hours until 48 hours after the surgery (P < 0.001). The
results indicated no significant difference between the two groups
regarding CK-MB and troponin levels, frequency of intraoperative and
postoperative dysrhythmia, need for intraoperative defibrillation,
ischemic time, and 48-hour mortality rate (P > 0.05). However, the costs
were two-folds higher in group A than in group B (P < 0.001).
 Conclusion(s): The present study findings showed that the selected
solution was appropriate in terms of clinical aspects for the patients
undergoing CABG surgery with long surgical duration or low Ejection
Fraction (EF) and reduced the costs to half. Considering the significant
difference in the CK-MB level and the lower troponin level in the combined
group (not statistically significant), further studies are required to
confirm the clinical priority of the combined solution. Copyright
© 2020, Iranian Cardiovascular Research Journal. All rights reserved.

<60>
Accession Number
2007875663
Title
Ultrasound-Guided Erector Spinae Plane Block and Thoracic Paravertebral
Block for Postoperative Analgesia Management following Video-Assisted
Thoracic Surgery: A Prospective, Randomized, Controlled Study.
Source
Anestezi Dergisi. 28 (3) (pp 170-178), 2020. Date of Publication: 2020.
Author
Ciftci B.; Ekinci M.; Celik E.C.; Tukac I.C.; Golboyu B.E.; Gunluoglu
M.Z.; Atalay Y.O.
Institution
(Ciftci) Medipol Mega Universite Hastanesi Anesteziyoloji ve Reanimasyon
Klinigi, Istanbul, Turkey
(Ekinci, Tukac, Atalay) Istanbul Medipol Universitesi, Tip Fakultesi,
Anesteziyoloji ve Reanimasyon Ana Bilim Dali, Istanbul, Turkey
(Celik) Erzurum Ataturk Universitesi Arastirma Hastanesi, Anesteziyoloji
ve Reanimasyon Ana Bilim Dali, Erzurum, Turkey
(Golboyu) Anesteziyoloji ve Reanimasyon Bilim Dali, Manisa, Turkey
(Gunluoglu) Istanbul Medipol Universitesi Tip Fakultesi, Gogus Cerrahisi
Ana Bilim Dali, Istanbul, Turkey
Publisher
Anestezi Dergisi (E-mail: arud@arss.org)
Abstract
Objective: Evaluation of the effectiveness of ultrasound (US)-guided
erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB)
compared to no intervention control group for postoperative pain
management in video assisted thoracic surgery (VATS) patients.
 Method(s): Three groups - Group ESPB, Group TPVB and the control
group (n=30 per group) were included in this prospective, randomized,
controlled study. The US-guided blocks were performed preoperatively in
the ESPB and TPVB groups. Intravenous patient-controlled postoperative
analgesia via fentanyl was administered in all of the patients. The
patients were evaluated using visual analogue scale (VAS) scores, opioid
consumption, and adverse events. Result(s): At all time intervals
fentanyl consumption and VAS scores were significantly lower both in ESPB
and TPVB groups compared to the control group (p<0.001). Block procedure
time was significantly lower and success of one time puncture was higher
in Group ESPB as compared with that in Group TPVB (p<0.001).
 Conclusion(s): ESPB and TPVB provide more effective analgesia
compared to control group in patients who underwent video-assisted
thoracic surgery. ESPB had a shorter procedural time and higher success of
single-shot technique compared to TPVB. © Copyright
Anesthesiology and Reanimation Specialists' Society.

<61>
Accession Number
2007902495
Title
Safety of Enalapril in Infants: Data from the Pediatric Heart Network
Infant Single Ventricle Trial.
Source
Journal of Pediatrics. (no pagination), 2020. Date of Publication: 2020.
Author
Mathur K.; Hsu D.T.; Lamour J.M.; Aydin S.I.
Institution
(Mathur, Hsu, Lamour, Aydin) Division of Pediatric Cardiology, Children's
Hospital at Montefiore/Albert Einstein College of Medicine, New York, NY,
United States
(Aydin) Division of Pediatric Critical Care, Children's Hospital at
Montefiore/Albert Einstein College of Medicine, New York, NY, United
States
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Objective: To assess the safety profile of angiotensin-converting enzyme
inhibitor therapy in infants with single ventricle. Study design: The
Pediatric Heart Network conducted a double-blind trial involving infants
with single ventricle physiology randomized to receive enalapril or
placebo and followed to 14 months of age. Data including demographics,
drug administration, hemodynamic monitoring, laboratory measurements,
adverse events, and survival were extracted from the public use data set
and compared between the placebo and enalapril-treated groups.
 Result(s): The Infant Single Ventricle trial randomized 230 patients,
with 115 patients in each group. Initial enalapril dose was 0.10 mg/kg/d
and median maximal dose was 0.38 mg/kg/d. There was no significant
difference in change in blood pressure at study drug initiation or when
resuming study drug after Glenn surgery. The incidence of hyperkalemia and
neutropenia did not differ between groups. Renal dysfunction occurred in
3% of the enalapril group and none of the placebo patients, which was not
statistically significant. There was a high frequency of serious adverse
events in both groups. There was no difference in the frequency of heart
transplant or death between groups. Conclusion(s): Enalapril did not
have sustained hemodynamic effects at initiation or up-titration of drug.
Creatinine and potassium were not different between groups, although renal
dysfunction occurred more often in the patients on enalapril. Although
efficacy of enalapril in neonates with single ventricle has not been
demonstrated, the safety profile of angiotensin-converting enzyme
inhibitors appears to be low risk in infants and children with significant
heart disease. Copyright © 2020 Elsevier Inc.

<62>
Accession Number
2006858932
Title
The venous thromboembolism prophylaxis in patients receiving thoracic
surgery: A systematic review.
Source
Asia-Pacific Journal of Clinical Oncology. (no pagination), 2020. Date of
Publication: 2020.
Author
Wang Q.; Ding J.; Yang R.
Institution
(Wang, Ding, Yang) Department of Thoracic Surgery, The Affiliated Brain
Hospital of Nanjing Medical University (South Branch, Nanjing Chest
Hospital), Nanjing, China
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Objectives: Venous thromboembolism (VTE) is a significant and preventable
cause of mortality and morbidity in thoracic surgery. It usually deep
venous thromboembolism (DVT) and pulmonary thromboembolism (PE). We
conducted this article to perform a systematic review on prophylaxis of
perioperative VTE in patients undergoing thoracic surgery especially lung
surgery and esophageal surgery and to identify potential areas for future
research. Method(s): The systematic review we conducted included
studies of patients undergoing thoracic surgery especially lung surgery
and esophageal surgery. Result(s): The study identified 2621
references. Finally, 22 trials with a total of 9072 patients were
included. Only six studies declared that they continued a follow-up after
the discharge of the patients. (range: 1-3 months); three studies reported
on major bleeding events as an outcome measure, and the incidence varied
from 0.8% to 1.6%. Total 346 VTEs occurred, and the overall mean risk of
VTE was estimated at 3.8% (range: 0.77-27%). Conclusion(s): The
evidence for using thromboprophylaxis in thoracic surgery is limited and
controversial, predominantly based on clinical consensus. Future research
is needed to focus on identifying risk of VTE and providing sufficient
evidence with high quality to support clinical strategies concerning the
prophylaxis for VTE. Copyright © 2020 John Wiley & Sons
Australia, Ltd

<63>
Accession Number
2001916898
Title
CHANGES IN THE LIVER TESTS AFTER BARIATRIC SURGERY IN PATIENTS WITH
CIRRHOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Gastroenterology. Conference: Digestive Disease Week, DDW 2019. United
States. 156 (6 Supplement 1) (pp S-1298-S-1299), 2019. Date of
Publication: 2019.
Author
Rassameehiran S.; Tetangco E.P.; Tan G.; Bhagatwala J.; Kendrick K.; Hudgi
A.; Sridhar S.
Publisher
W.B. Saunders
Abstract
Background: Obesity has a strong association with metabolic syndrome,
non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease.
Bariatric surgery has been shown to improve obesity related comorbidities
including the liver histology in NASH patients, however, rapid weight loss
also has been shown to be a risk factor for fatty liver disease. Studies
on bariatrics surgery in patients with cirrhosis are limited. We conducted
a systematic review and meta-analysis of the published literature to
better understand the short-term effects of bariatrics surgery in
cirrhotic patients. Method(s): We searched EMBASE and MEDLINE from
the database inception to Nov 20, 2018. We used the following text words:
"bariatric surgery" and "cirrhosis" as search terms for the published
studies that assessed the short-term effects of bariatric surgery on the
liver tests in patients with cirrhosis. We excluded studies with less than
10 patients and studies which did not provide the liver tests results
within 3 years following post-surgery. Statistical analysis was conducted
with Review Manager (RevMan Version 5.3). The Chi2 test and I2 statistic
was used to address heterogeneity among the studies. The results of
studies were pooled, and an overall odds ratio (OR) with 95% confidence
intervals (CIs) was obtained using generic inverse variance weighting and
a random-effects method. Result(s): Four observational studies met
our inclusion criteria. 82 subjects cases were included in our analysis.
Characteristics of the studies are shown in Table 1. The results of the
study are shown in Figure 1. There was a statistically significant
decrease in the AST, ALT and albumin after bariatric surgery without
significant changes in the MELD scores or bilirubin. Pooled mean
difference in the ALT was -16.19 IU/L (95%CI = -29.66, -2.72). Pooled mean
difference in the AST was -13.68 IU/L (95%CI = -25.20, -2.17). Pooled mean
difference in the albumin was -0.19 g/dL (95%CI = - 0.35, -0.04). No
significant heterogeneity was present among the included studies.
 Conclusion(s): Our study demonstrated that the short-term effects of
bariatric surgery was is not associated with worsening the liver enzymes
or MELD scores in compensated cirrhotic patients. Slight A modest decrease
in albumin may be related to decreased calories intake and malnutrition
post following bariatric surgery and should be monitored closely. Further
prospective studies are warranted to assess the long-term effects of
bariatric surgery in cirrhotic patients. [Table Presented] [Table
Presented] Copyright © 2019 European Association for the Study of
the Liver. All rights reserved.

<64>
Accession Number
2007179300
Title
Meta-analysis Comparing Transradial Versus Transfemoral Secondary Access
in Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 131 (pp 74-81), 2020. Date of Publication:
15 September 2020.
Author
Jhand A.; Apala D.R.; Dhawan R.; Katta N.; Aronow H.D.; Daniels M.J.;
Porter T.R.; Altin E.; Goldsweig A.M.
Institution
(Jhand, Dhawan, Katta, Porter, Goldsweig) Division of Cardiovascular
Medicine, University of Nebraska Medical Center, Omaha, NE, United States
(Apala) Department of Internal Medicine, Creighton University School of
Medicine, Omaha, NE, United States
(Aronow) Warren Alpert Medical School, Brown University, Lifespan
Cardiovascular Institute, Providence, RI, United States
(Daniels) Manchester Heart Centre, Manchester Royal Infirmary, Manchester
University NHS Foundation Trust, Manchester, United Kingdom
(Altin) Division of Cardiovascular Medicine, Yale University School of
Medicine, New Haven, CT, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Up to a quarter of vascular complications during transcatheter aortic
valve implantation (TAVI) result from secondary access via the femoral
artery (FA). The radial artery (RA) is increasingly used as an alternative
to the FA for secondary access in TAVI. Limited data exist on the outcomes
of RA secondary access versus FA secondary access. We therefore conducted
a systematic review and meta-analysis comparing secondary access sites.
PubMed, EMBASE, Scopus, Cochrane library and CINAHL were searched
systematically for studies comparing RA and FA as secondary access sites
for TAVI. Primary outcomes of interest were vascular complications and
major bleeding. Secondary outcomes included all-cause mortality, stroke
and myocardial infarction (MI). Risk ratio (RR), standardized mean
difference and corresponding 95% confidence intervals (CI) were calculated
using a random effects model. Six observational studies comprising 6,373
patients (RA: 1,514, FA: 4,859) met inclusion criteria. Secondary access
was utilized for aortography during valve deployment and to manage primary
access site complications. Procedural characteristics were similar in both
groups. RA was associated with a lower risk of major bleeding (RR: 0.51,
95% CI: 0.40 to 0.64, p <0.00001). No statistically significant difference
was observed in the incidence of overall vascular complications, however,
the risk of major vascular complications was lower with RA (RR: 0.45, 95%
CI: 0.32 to 0.63, p <0.00001). The incidence of stroke and all-cause
mortality was lower in RA, whereas no difference was observed in the risk
of MI. In conclusion, our meta-analysis suggests that RA secondary access
is associated with better outcomes for TAVI than FA. Copyright ©
2020 Elsevier Inc.

<65>
Accession Number
2007138006
Title
Supra annular sizing for TAVR in bicuspid aortic valve stenosis: A
meta-analysis.
Source
Indian Heart Journal. 72 (4) (pp 309-311), 2020. Date of Publication: July
- August 2020.
Author
Kumar A.; Doshi R.; Shariff M.; Adalja D.; Vallabhajosyula S.
Institution
(Kumar, Shariff) Department of Critical Care Medicine, St John's Medical
College Hospital, Bangalore, India
(Doshi) Department of Internal Medicine, University of Nevada Reno School
of Medicine, Reno, NV, United States
(Adalja) Department of Medicine, Gotri Medical Education and Research
Center, Vadodara, Gujrat, India
(Vallabhajosyula) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Publisher
Elsevier B.V. (Netherlands)

<66>
Accession Number
2005875739
Title
Telemedicine in cardiovascular surgery during COVID-19 pandemic: A
systematic review and our experience.
Source
Journal of Cardiac Surgery. 35 (10) (pp 2773-2784), 2020. Date of
Publication: 01 Oct 2020.
Author
Ajibade A.; Younas H.; Pullan M.; Harky A.
Institution
(Ajibade) Birmingham Medical School, University of Birmingham, Birmingham,
United Kingdom
(Younas) St George's Medical School, University of London, London, United
Kingdom
(Pullan, Harky) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Life Sciences,
University of Liverpool, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Objective: The SAR-COV-2 pandemic has had an unprecedented effect on the
UK's healthcare systems. To reduce spread of the virus, elective
treatments and surgeries have been postponed or canceled. There has been a
rise in the use of telemedicine (TM) as an alternative way to carry
outpatient consultations. This systematic review aims to evaluate the
extent to which TM may be able to support cardiac and vascular surgery
patients in the COVID-19 era. Method(s): We looked into how TM can
support the management of patients via triaging, preoperative, and
postoperative care. Evaluations targeted the clinical effectiveness of
common TM methods and the feasibility of applying those methods in the UK
during this pandemic. Result(s): Several studies have published their
evidence on the benefit of TM and its benefit during COVID-19, the data
related to cardiovascular surgery and how this will impact future practice
of this speciality is emerging and yet larger studies with appropriate
timing of outcomes to be published. Conclusion(s): Overall, the use
of virtual consultations and remote monitoring is feasible and best placed
to support these patients via triaging and postoperative monitoring.
However, TM can be limited by the need of sophisticated technological
requirement and patients' educational and know-how computer literacy
level. Copyright © 2020 The Authors. Journal of Cardiac Surgery
published by Wiley Periodicals LLC

<67>
Accession Number
2005788323
Title
Cholesterol lowering with EVOLocumab to prevent cardiac allograft
Vasculopathy in De-novo heart transplant recipients: Design of the
randomized controlled EVOLVD trial.
Source
Clinical Transplantation. 34 (9) (no pagination), 2020. Article Number:
e13984. Date of Publication: 01 Sep 2020.
Author
Broch K.; Gude E.; Karason K.; Dellgren G.; Radegran G.; Gjesdal G.;
Gustafsson F.; Eiskjaer H.; Lommi J.; Pentikainen M.; Lemstrom K.B.;
Andreassen A.K.; Gullestad L.
Institution
(Broch, Gude, Andreassen, Gullestad) Department of Cardiology, Oslo
University Hospital, Rikshospitalet, Oslo, Norway
(Karason, Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Radegran, Gjesdal) The Clinic for Heart Failure and Valvular Disease,
Skane University Hospital, Lund, Sweden
(Radegran) Lund University, Lund, Sweden
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Lommi, Pentikainen, Lemstrom) Helsinki University Hospital Heart and Lung
Center, Helsinki, Finland
(Lemstrom) University of Helsinki, Helsinki, Finland
(Gullestad) KG Jebsen Center for Cardiac Research, University of Oslo,
Norway and Center for Heart Failure Research, Oslo University Hospital,
Norway
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Background: Cardiac allograft vasculopathy (CAV) is characterized by
diffuse thickening of the arterial intima. Statins reduce the incidence of
CAV, but despite the use of statins, CAV remains one of the leading causes
of long-term death after heart transplant. Inhibitors of proprotein
convertase subtilisin-kexin type 9 (PCSK9) substantially reduce
cholesterol levels but have not been tested in heart transplant
recipients. Method(s): The Cholesterol lowering with EVOLocumab to
prevent cardiac allograft Vasculopathy in De-novo heart transplant
recipients (EVOLVD) trial (ClinicalTrials.gov Identifier: NCT03734211) is
a randomized, double-blind trial designed to test the effect of the PCSK9
inhibitor evolocumab on coronary intima thickness in heart transplant
recipients. Adults who have received a cardiac transplant within the past
4-8 weeks are eligible. Exclusion criteria include an estimated glomerular
filtration rate ' 20 mL/min/1.73 m2, renal replacement therapy,
or contraindications to coronary angiography with intravascular
ultrasound. 130 patients will be randomized (1:1) to 12-month treatment
with evolocumab or matching placebo. The primary endpoint is the coronary
artery intima thickness as measured by intravascular ultrasound.
 Conclusion(s): The EVOLVD trial is a randomized clinical trial
designed to show whether treatment with the PCSK9 inhibitor evolocumab can
ameliorate CAV over the first year after heart transplant. Copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<68>
Accession Number
2005619474
Title
Mitral leaflet separation index for mitral valve assessment during balloon
mitral valvuloplasty.
Source
Echocardiography. 37 (8) (pp 1159-1163), 2020. Date of Publication: 01 Aug
2020.
Author
Kinsara A.J.; Awadallah A.M.; AlZaki M.; Goda H.; C. Nanda N.
Institution
(Kinsara, Awadallah) Ministry of National Guard-Health Affairs, King
Abdullah International Medical Research Center, King Saud Bin Abdulaziz
University for Health Sciences, COM-WR, Jeddah, Saudi Arabia
(AlZaki, Goda) Faculty of Medicine, Zagazig University, Zagazig, Egypt
(C. Nanda) Cardiology Division, Department of Medicine, University of
Alabama at Birmingham, Birmingham, AL, United States
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Objective: The objective of the study was to evaluate the accuracy of the
mitral leaflet separation index (MLSI) in selected patients with mitral
stenosis, before and after percutaneous balloon mitral valvuloplasty
(PBMV), compared to conventional methods with transthoracic
echocardiography [TTE]. Method(s): A prospective study was conducted
in 30 patients, ages 20-60 years, with severe symptomatic mitral stenosis
(MS) who had PBMV in the Cardiology Department, Zagazig University and
National Heart Institute. A mean of three to five measurements of MLSI was
taken in diastole in the parasternal long-axis and apical four-chamber
views. The MLSI was re-measured 24-48 hours after PBMV. We calculated the
correlation of the MLSI, pre and post BMV, with two-dimensional (2D) MV
planimetry and pressure half-time (PHT) methods to assess MVA.
 Result(s): There was a positive, highly significant correlation
between pre PBMV 2D planimetry and MLSI (r =.665, P-value <.001) as well
as post PBMV 2D planimetry and MLSI (r =.410, P-value =.025). A positive
highly significant correlation was also noted between pre PBMV PHT and
MLSI (r =.678, P-value <.001) and between post PBMV PHT and MLSI (r =.706,
P-value <.001). Conclusion(s): Mitral leaflet separation index is an
easy and reliable measurement for the assessment of mitral stenosis before
and after PBMV. Copyright © 2020 Wiley Periodicals LLC

<69>
Accession Number
2007931132
Title
Effect of acute normovolemic hemodilution on coronary artery bypass
grafting: A systematic review and meta-analysis of 22 randomized trials.
Source
International Journal of Surgery. 83 (pp 131-139), 2020. Date of
Publication: November 2020.
Author
Li S.; Liu Y.; Zhu Y.
Institution
(Li) Department of Anesthesiology, Jingzhou Central Hospital, Jingzhou
434020, China
(Liu, Zhu) Department of Anesthesia, Chongqing Emergency Medical Center
(Chongqing University Central Hospital), Chongqing 400014, China
Publisher
Elsevier Ltd
Abstract
Background: Efficacy of minimal acute normovolemic hemodilution (ANH) in
avoiding homologous blood transfusion during cardiovascular surgery
remains controversial. Postoperative bleeding and transfusion remain a
source of morbidity and cost after open heart operations. To better
understand the role of acute normovolemic hemodilution (ANH) in coronary
artery bypass grafting (CABG), we compared ANH with standard
intraoperative care in a systematic review including a standard pairwise
meta-analysis of randomized controlled trials (RCTs). Method(s): We
searched the Cochrane Library, PubMed, EMBASE, Web of Science and Chinese
National Knowledge Infrastructure (CNKI) up to April 1, 2020. The primary
outcome was to assess the incidence of ANH-related number of allogeneic
red blood cell units (ARBCu) transfused. Secondary outcomes included the
rate of allogeneic blood transfusion and estimated total blood loss.
 Result(s): A total of 22 RCTs including 1688 patients were identified
for the present meta-analysis. Of these studies, 19 were about CABG with
on-pump and three with off-pump. Our pooled result indicated that patients
received ANH experienced fewer ARBCu transfusions, with a standardized
mean difference (SMD) of -0.60 (95%CI -0.96 to -0.24; P = 0.001). The rate
of allogeneic blood transfusion in ANH group was significant reduced when
compared with controls, with a relative risk (RR) of 0.65 (95%CI 0.52 to
0.82; P = 0.0002). In addition, less postoperative estimated total blood
loss was present, with a SMD of -0.53 (95%CI -0.88 to -0.17; P = 0.004).
 Conclusion(s): The present meta-analysis indicated that ANH could
reduce the number of ARBCu transfused in the CABG surgery setting. In
addition, ANH could also reduce the rate of ARBCu transfusion and
estimated total blood loss for CABG patients. Copyright © 2020
IJS Publishing Group Ltd

<70>
Accession Number
2006801919
Title
Costs of surgical ablation of atrial fibrillation in Ontario, Canada from
2006 to 2017.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Chow J.Y.; McClure G.; Belley-Cote E.P.; McIntyre W.F.; Singal R.K.;
Whitlock R.P.
Institution
(Chow, Belley-Cote, McIntyre) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(McClure) Division of Vascular Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, McIntyre, Whitlock) Population Health Research Institute,
Hamilton, ON, Canada
(Singal) CVT Associates, Vancouver Island Health Authority, Victoria, BC,
Canada
(Whitlock) Division of Cardiac Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Background: International guidelines currently recommend concomitant
surgical ablation of atrial fibrillation (AF) in patients with AF
undergoing cardiac surgery. However, a systematic review and meta-analysis
of 23 randomized controlled trials (RCTs) showed no significant difference
in mortality or stroke in patients who underwent surgical AF ablation
compared with those who did not (moderate-quality evidence).
 Method(s): We estimated the Ontario-wide costs of surgical AF
ablation between 2006 and 2017 using data from a systematic review and
meta-analysis of RCTs, estimates of case volumes from Ontario Health
Insurance Plan fee codes, the ongoing left atrial appendage occlusion
study III trial (NCT01561651), institutional costs from large academic
centers in Ontario, as well as professional fees based on the Ontario fee
schedule. Device costs were obtained from Canadian industry data with
expert input. Result(s): We estimated the average extra cost of
surgical AF ablation at $4,287 CAD (95% CI $4,113-4,619) per patient.
Procedural costs (equipment costs and physician remuneration) comprise
82.2% of this, while smaller portions relate to the increased need for
pacemaker (3.9%) and additional hospital length of stay (13.9%).
Approximately 2,391 patients underwent surgical AF ablation between 2006
and 2017, corresponding to an estimated $10.2 million in incremental cost
during that time span. Conclusion(s): Ontario taxpayers spend
significant financial resources on surgical ablation of AF, a procedure
lacking high-quality evidence demonstrating benefit in reducing mortality
or stroke. Further large prospective studies examining clinically
important outcomes are needed to justify its routine use in patient care
and to guide allocation of healthcare funds. Copyright © 2020
Wiley Periodicals LLC

<71>
Accession Number
2006799525
Title
Management of the aortic root in type A aortic dissection: A valve sparing
approach.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Mohamed Ahmed E.; Chen E.P.
Institution
(Mohamed Ahmed, Chen) Division of Cardiothoracic Surgery, Department of
Surgery, Emory School of Medicine, Atlanta, GA, United States
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Background: Type A acute aortic dissection (TAAAD) is rapidly fatal
without emergency repair. Surgical outcomes have improved over the years
with improvements in technique and postoperative care. Classically,
supracomissural aortic replacement has been the standard of care. However,
reintervention rates, particularly on the aortic root in certain groups of
patients, shifted the focus towards improving long-term results of
surgical repair. With regard to the aortic root, root replacement has been
the gold standard. However, the surgical community realized that valve
replacement in itself is a disease, and valve sparing aortic root
replacement (VSRR) took center stage in the care of these patients.
 Method(s): We searched the Pubmed and EMBASE databases for articles
related to VSRR and composite valve conduit (CVC) root replacement, and
the long-term results of these techniques in TAAAD. Result(s):
Supracomissural repair is limited by reintervention, and CVC results are
affected by complications related to the prosthetic valve. Conversely,
VSRR is associated with good short-term outcomes, improvement in quality
of life, and it is durable. Conclusion(s): VSRR is a sound technique
in TAAAD in experienced hands. Copyright © 2020 Wiley Periodicals
LLC

<72>
Accession Number
2005739612
Title
Effectiveness of prothrombin complex concentrate for the treatment of
bleeding: A systematic review and meta-analysis.
Source
Journal of Thrombosis and Haemostasis. 18 (10) (pp 2457-2467), 2020. Date
of Publication: 01 Oct 2020.
Author
van den Brink D.P.; Wirtz M.R.; Neto A.S.; Schochl H.; Viersen V.;
Binnekade J.; Juffermans N.P.
Institution
(van den Brink, Wirtz, Neto, Binnekade, Juffermans) Department of
Intensive Care Medicine, Amsterdam UMC, Amsterdam, Netherlands
(van den Brink, Wirtz, Juffermans) Laboratory of Experimental Intensive
Care and Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands
(Wirtz) Department of Trauma Surgery, Amsterdam UMC, Amsterdam,
Netherlands
(Neto) Department of Critical Care Medicine, Hospital Israelita Albert
Einstein, Salphao Paulo, Brazil
(Schochl) Department of Anesthesiology and Intensive Care Medicine, AUVA
Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus
Medical University, Salzburg, Austria
(Schochl) Institute for Experimental and Clinical Traumatology, AUVA
Research Centre, Vienna, Austria
(Viersen) Department of Anesthesiology, Amsterdam UMC, Amsterdam,
Netherlands
(Juffermans) Department of Intensive Care Medicine, OLVG Hospital,
Amsterdam, Netherlands
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Prothrombin complex concentrate (PCC) is increasingly being used as a
treatment for major bleeding in patients who are not taking
anticoagulants. The aim of this systematic review and meta-analysis is to
evaluate the effectiveness of PCC administration for the treatment of
bleeding in patients not taking anticoagulants. Studies investigating the
effectivity of PCC to treat bleeding in adult patients and providing data
on either mortality or blood loss were eligible. Data were pooled using
Mantel-Haenszel random effects meta-analysis or inverse variance random
effects meta-analysis. From 4668 identified studies, 17 observational
studies were included. In all patient groups combined, PCC administration
was not associated with mortality (odds ratio = 0.83; 95% confidence
interval [CI], 0.66-1.06; P =.13; I2 = 0%). However, in trauma
patients, PCC administration, in addition to fresh frozen plasma, was
associated with reduced mortality (odds ratio = 0.64; CI, 0.46-0.88; P
=.007; I2 = 0%). PCC administration was associated with a
reduction in blood loss in cardiac surgery patients (mean difference:
-384; CI, -640 to -128, P =.003, I2 = 81%) and a decreased need
for red blood cell transfusions when compared with standard care across a
wide range of bleeding patients not taking anticoagulants (mean
difference: -1.80; CI, -3.22 to -0.38; P =.01; I2 = 92%). In
conclusion, PCC administration was not associated with reduced mortality
in the whole cohort but did reduce mortality in trauma patients. In
bleeding patients, PCC reduced the need for red blood cell transfusions
when compared with treatment strategies not involving PCC. In bleeding
cardiac surgery patients, PCC administration reduced blood
loss. Copyright © 2020 The Authors. Journal of Thrombosis and
Haemostasis published by Wiley Periodicals LLC on behalf of International
Society on Thrombosis and Haemostasis

<73>
Accession Number
2004200028
Title
Retrograde autologous priming to reduce allogeneic blood transfusion
requirements: a systematic review.
Source
Perfusion (United Kingdom). 35 (7) (pp 574-586), 2020. Date of
Publication: 01 Oct 2020.
Author
Vranken N.P.A.; Babar Z.U.D.; Montoya J.A.; Weerwind P.W.
Institution
(Vranken, Babar, Weerwind) Department of Cardiothoracic Surgery,
Maastricht University Medical Center, Maastricht, Netherlands
(Vranken, Weerwind) Cardiovascular Research Institute Maastricht,
Maastricht University Medical Center, Maastricht, Netherlands
(Montoya) Perfusion Sciences Program, Department of Pharmacology, The
University of Arizona, Tucson, AZ, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Efforts have been made to minimize transfusion of packed red
blood cells in patients undergoing cardiac surgery with cardiopulmonary
bypass. One method concerns retrograde autologous priming. Although the
technique has been used for decades, results remain contradictory in terms
of transfusion requirements. Objective(s): This systematic literature
review aimed to summarize the evidence for the efficacy of retrograde
autologous priming in terms of decreasing perioperative packed red blood
cell requirements in adults. Method(s): Two researchers independently
searched PubMed for articles published in the past 10 years. The modified
Cochrane collaboration Risk of Bias Tool and the Research Triangle
Institute Item Bank were used to assess bias. Result(s): Eight
studies were included, of which two randomized and six observational
studies. Five studies, including one randomized study, report a
significant decrease in packed red blood cell use in the retrograde
autologous priming group compared to no retrograde autologous priming
used. All studies are flawed by at least a high risk bias of bias score on
one item of the bias assessment. Conclusion(s): Although most studies
reported significantly fewer packed red blood cell transfusions in the
retrograde autologous priming group, it is important to note that
relatively few articles are available which are flawed by several types of
bias. Prospective, randomized multi-center trials are warranted to
conclude decisively on the benefits of retrograde autologous
priming. Copyright © The Author(s) 2020.

<74>
Accession Number
2007714142
Title
Benznidazole as Prophylaxis for Chagas Disease Infection Reactivation in
Heart Transplant Patients: A Case Series in Brazil.
Source
Tropical Medicine and Infectious Disease. 5 (3) (no pagination), 2020.
Article Number: 132. Date of Publication: September 2020.
Author
Neto J.M.R.; Finger M.A.; dos Santos C.C.
Institution
(Neto, Finger, dos Santos) Instituto Dante Pazzanese de Cardiologia, Av
Dante Pazzanese 500, Sao Paulo CEP 04012-909, Brazil
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
Background-Patients with Chagas cardiomyopathy (CC) have high mortality,
and CC is a common indication for heart transplantation (HTx) in endemic
countries. Chagas disease reactivation (CDR) is common after
transplantation and is likely to cause adverse outcomes unless detected
and treated appropriately. This study reviews our experiences with HTx
among patients with CC, and the use of benznidazole (BZ) before
transplantation. Methods-During the 18-year period from 1996 through 2014,
70 of 353 patients who underwent HTx (19.8%) had CC, and 53 patients met
the inclusion criteria. The effectiveness of prophylactic treatment with
BZ (dose of 5 mg/kg/day, two times per day, for at least four weeks and
for a maximum of eight weeks) was determined based on the observed
reduction in the incidence of CDR during the post-HTx period.
Results-Prophylactic therapy was administered to 18/53 patients (34.0%).
During the follow-up period, the incidence rate of CDR in our study was
34.0% (18/53). Based on logistic regression analysis, only prophylaxis (OR
= 0.12; CI 0.02-0.76; p = 0.025) was considered to protect against CDR.
Conclusion-Our study suggests that the use of BZ may reduce the incidence
of CDR in patients undergoing HTx and warrants further investigation in a
prospective, randomized trial. Copyright © 2020 by the authors.

<75>
Accession Number
632980412
Title
Effect of ticagrelor with or without aspirin on vein graft outcome 1 year
after on-pump and off-pump coronary artery bypass grafting.
Source
Journal of Thoracic Disease. 12 (9) (pp 4915-4923), 2020. Date of
Publication: 01 Sep 2020.
Author
Zhu Y.; Xue Q.; Zhang M.; Hu J.; Liu H.; Wang R.; Wang X.; Han L.; Zhao Q.
Institution
(Zhu, Zhao) Department of Cardiovascular Surgery, Ruijin Hospital
Shanghai, Jiao Tong University School of Medicine, Shanghai, China
(Xue, Han) Department of Cardiovascular Surgery, Changhai Hospital of
Shanghai, Shanghai, China
(Zhang) Department of Cancer Control and Prevention, Shanghai Municipal
Center for Disease Control and Prevention, Shanghai, China
(Hu) Department of Cardiovascular Surgery, Fuwai Central China
Cardiovascular Hospital, Zhengzhou, China
(Liu) Department of Cardiothoracic Surgery, Xinhua Hospital Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Wang) Department of Cardiovascular Surgery, Nanjing First Hospital,
Nanjing, China
(Wang) Department of Cardiovascular Surgery, Jiangsu Province Hospital,
Nanjing, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: In the present post hoc analysis of the DACAB trial, we
evaluated the effects of ticagrelor with or without aspirin on 1-year vein
graft outcomes after coronary artery bypass grafting (CABG) with and
without cardiopulmonary bypass (CPB) (on-pump and off-pump).
 Method(s): The DACAB trial was a multicenter, randomized, open-label,
parallel control study enrolling 500 patients with 1,460 vein grafts
undergoing CABG. For current post-hoc study, all patients in the DACAB
study were included in the analysis to compare the effects of different
antiplatelet regimens under on/off pump. Patients were randomly assigned
to 1 of 3 antiplatelet treatment regimens (ticagrelor plus aspirin, T + A;
ticagrelor alone, T; or aspirin alone, A) within 24 hours after CABG, and
were stratified into on-pump and off-pump subgroups. The primary outcome
was 1-year vein graft patency rate. Result(s): Totally 121 patients
underwent on-pump CABG (39 with 121 vein grafts in T + A, 36 with 101 vein
grafts in T, and 46 with 137 vein grafts in A) and 379 patients underwent
off-pump CABG (129 with 336 vein grafts in T + A, 130 with 387 vein grafts
in T, and 120 with 348 vein grafts in A). Compared with A, T + A showed a
higher 1-year vein graft patency rate in both on-pump (adjusted OR for
non-patency =0.62, 95% CI: 0.16-2.45) and off-pump (adjusted OR for
non-patency =0.35, 95% CI: 0.20-0.62) subgroups, P interaction =0.647;
whereas T did not in either on-pump (adjusted OR for non-patency = 0.92,
95% CI: 0.31-2.76) or off-pump (adjusted OR for non-patency =0.58, 95% CI:
0.34-1.00) subgroups, P interaction =0.430. Conclusion(s): In the
DACAB trial, for patients underwent either on-pump or off-pump CABG,
ticagrelor plus aspirin showed consistent benefit for achieving 1-year
vein graft patency, with particular benefit being seen in the off-pump.
 Copyright © Journal of Thoracic Disease. All rights reserved.

<76>
Accession Number
632980346
Title
Interleukin-6 in patients with cardiac myxoma.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30 (8) (pp
849-852), 2020. Date of Publication: 01 Aug 2020.
Author
Yuan S.-M.; Lin H.-Z.
Institution
(Yuan) Department of Cardiothoracic Surgery, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Putian, Fujian Province,
China
(Lin) Department of Clinical Laboratory, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Putian, Fujian Province,
China
Publisher
College of Physicians and Surgeons Pakistan
Abstract
The relationships between interleukin (IL)-6 and cardiac myxoma remain to
be clarified. This article systematically reviewed the IL-6 properties in
cardiac myxoma patients based on retrieval of pertinent literature
published between 1998 and 2018. Significant differences were found in
circulating IL-6 values between preoperation and 1 and 6 months after
operation. Preoperative circulating IL-6 correlated significantly with
tumour volume (r=0.8552, p=0.003), while there were no significant
correlations with maximal tumour dimension (r=0.2443, p=0.190). No
correlation was found between circulating IL-6 at 1 and 6 months after
tumour resection with either tumour volume or with maximal tumour
dimension. The positive rate of immunostaining of IL-6 in cardiac myxoma
tissues was 93.3%. Overproduction of IL-6 is responsible for the
inflammatory presentations, constitutional symptoms, and recurrence and
distal embolisation of cardiac myxoma. Cardiac myxoma could be a cellular
source of IL-6 release. Cardiac myxoma resection is an absolute choice of
eliminating IL-6 production in these patients. Copyright © 2020
College of Physicians and Surgeons Pakistan. All rights reserved.

<77>
Accession Number
632980316
Title
Pregnancy outcome in women with mechanical prosthetic heart valvesat their
first trimester of pregnancy treated with unfractionated heparin (UFH) or
enoxaparin: A randomized clinical trial.
Source
Journal of Cardiovascular and Thoracic Research. 12 (3) (pp 209-213),
2020. Date of Publication: 2020.
Author
Movahedi M.; Motamedi M.; Sajjadieh A.; Bahrami P.; Saeedi M.
Institution
(Movahedi, Motamedi) Department of Obstetrics and Gynecology, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Sajjadieh, Bahrami) Department of Internal Medicine, Isfahan University
of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Saeedi) Department of Cardiac Surgery, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Saeedi) Department of General Medicine, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Tabriz University of Medical Sciences (E-mail: bioimpacts@gmail.com)
Abstract
Introduction: Pregnancy increases the risks of thromboembolism for the
mother and fetus in patients with mechanical heart valves. The results of
some studies have indicated that low molecular weight heparin (LMWH), in
comparison with unfractionated heparin (UFH), leads to a lower incidence
rate of thrombocytopenia and a decrease in bleeding. Method(s): The
present randomized clinical trial involved 31 pregnant women with
mechanical heart valves at their first trimester (0-14 weeks) of
pregnancy. To perform the study, the patients were divided into two
groups, i.e. group A (LMWH group-16 patients) and group B (UFH group-15
patients). The birth weight, mode of delivery, and gestational age at
birth as well as the maternal and fetal complications were compared
between the two groups. Result(s): The mean age of mothers in the UFH
and LMWH groups was 32.67+/-9.11 and 31.50+/-5.81 years, respectively (P
value > 0.05). Although the rate of maternal and fetal complications was
higher in the UFH group as compared with the LMWH group, the observed
difference was not significant (P value > 0.05). Conclusion(s): LMWH
can be regarded as a safer therapy for both the mother and fetus due to
its lower number of refill prescriptions and fewer changes in the blood
level. Copyright © 2020 The Author (s).

<78>
Accession Number
2006822740
Title
Learning From Controversy: Contemporary Surgical Management of Aortic
Valve Endocarditis.
Source
Clinical Medicine Insights: Cardiology. 14 (no pagination), 2020. Date of
Publication: 2020.
Author
Nappi F.; Avtaar Singh S.S.; Timofeeva I.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Avtaar Singh) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Avtaar Singh) Institute of Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow, United Kingdom
(Timofeeva) Department of Imaging, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Aortic valve replacement is the commonest cardiac surgical operation
performed worldwide for infective endocarditis (IE). Long-term durability
and avoidance of infection relapse are goals of the procedure. However, no
detailed guidelines on prosthesis selection and surgical strategies guided
by the comprehensive evaluation of the extension of the infection and its
microbiological characteristics, clinical profile of the patient, and risk
of infection recurrence are currently available. Conventional mechanical
or stented xenografts are the preferred choice for localized aortic
infection. However, in cases of complex IE with the involvement of the
root or the aortomitral continuity, the use of homograft is suggested
according to the surgeon and center experience. Homograft use should be
counterbalanced against the risk of structural degeneration. Prosthetic
bioroot or prosthetic valved conduit (mechanical and bioprosthetic) are
also potentially suitable alternatives. Further development of
preservation techniques enabling longer durability of allogenic
substitutes is required. We evaluate the current evidence for the use of
valve substitutes in aortic valve endocarditis and propose an
evidence-based algorithm to guide the choice of therapy. We performed a
systemic review to clarify the contemporary surgical management of aortic
valve endocarditis. Copyright © The Author(s) 2020.

<79>
Accession Number
2005150192
Title
Does quicker mean better? Comparison of rapid deployment versus
conventional aortic valve replacement a meta-analysis.
Source
International Heart Journal. 61 (5) (pp 951-960), 2020. Date of
Publication: 2020.
Author
Lu Y.; Wang J.; Chen Z.; Wei J.; Li F.; Cai Z.
Institution
(Lu, Wang, Cai) Department of Cardiology, The Second Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, China
(Chen) Department of Clinical Epidemiology and Biostatistics, Second
Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou,
China
(Wei) Children's Hospital, Zhejiang University School of Medicine,
Hangzhou, China
(Li) Department of Cardiovascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
Publisher
International Heart Journal Association (E-mail: jhj-office@umin.ac.jp)
Abstract
The aim of this meta-analysis was to compare the clinical outcomes in
patients who underwent rapid deployment aortic valve replacement (RDAVR)
and conventional bio prosthetic aortic valve replacement (CAVR). We
performed a literature search by August 2018. The primary outcomes were
hospital and 1-year mortal-ity, and the secondary endpoints included the
aortic cross-clamp (ACC), cardiopulmonary bypass (CPB) time, and
postoperative and valve-related complications. Two randomized controlled
trials and 13 propensity score-matched studies were included. There was no
difference between RDAVR and CAVR in hospital mortality (2.5% versus 2.1%;
risk ratio (RR) 1.16 [95% confidence interval (CI) 0.80-1.68]) or 1-year
mortality (2.9% versus 4.1%; RR 0.69 [95% CI 0.34-1.34]). RDAVR
significantly reduced the ACC time ((mean difference (MD) -24.33 [95% CI
-28.35 to -20.32]) and CPB time (MD -21.51 [95% CI -22.83 to -20.20]). The
pooled analysis showed that RDAVR doubled the occurrence of permanent
pacemaker implantation (8.6% versus 4.3%; RR 2.05 [95% CI 1.62-2.60]).
Meanwhile, the blood transfusion amount (MD -1.54 [95% CI -2.22 to -0.86])
and postoperative atrial fibrillation (POAF) occurrence (RR 0.83 [95% CI
0.69-0.99]) was reduced. The difference of paravalvular leakage frequency
between RDAVR and CAVR was marginal (RR 1.77 [95% CI 1.00-3.17]; P =
0.05). Furthermore, RDAVR was related to larger valves (MD 0.70 cm [95% CI
0.33-1.07]) and lower mean pressure gradients (MD -1.93 mmHg [95% CI -3.58
to -0.28]). The hospital and 1-year survival rates between RDAVR and CAVR
are comparable. RDAVR reduces POAF occurrence and blood transfusion but is
associated with a higher occurrence of pacemaker
implantation. Copyright © International Heart Journal
Association.

<80>
Accession Number
2006857515
Title
Comparison of transhiatal esophagectomy using a mediastinoscope with
transhiatal esophagectomy by the classic method.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2020. Date of
Publication: 2020.
Author
Rezaei R.; Masuom S.H.F.; Soroush N.; Zehi V.
Institution
(Rezaei, Masuom, Soroush) Endoscopic and Minimally Invasive Surgery
Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,
Islamic Republic of
(Zehi) General Surgery, Torbat-e- Heydariyeh University of Medical
Sciences, Torbat-e-Heydariyeh, Iran, Islamic Republic of
Publisher
SAGE Publications Inc. ( United States. E-mail: claims@sagepub.com)
Abstract
Background: This study aimed to evaluate the results of transhiatal
esophagectomy using a mediastinoscope in comparison with conventional
transhiatal esophagectomy. Method(s): Sixty-two esophageal cancer
patients who were referred to our thoracic surgery clinic between April
2015 and March 2017, and met the inclusion criteria, were randomly divided
into two groups of 31 each. In the first group, patients were operated on
by conventional transhiatal esophagectomy. In the second group, only
release of the thoracic esophagus through a neck incision (mediastinal
esophagolysis) was performed using a mediastinoscope. The other surgical
procedures were similar to those in the first group. Result(s): The
mean age of the patients was almost the same in both groups (57.7 years in
the first group versus 56.7 years in the second group). There was no
significant difference in sex ratio. The mean volume of blood loss during
the operation, mean operative time, and intensive care unit stay as well
as cardiopulmonary complications and early postoperative complications
were lower in the group that had esophagectomy using a mediastinoscope,
and the number of resected mediastinal lymph nodes was greater.
 Conclusion(s): Based on the results of this study, it can be expected
that use of a video mediastinoscope for esophagolysis of the thoracic
esophagus in a transhiatal esophagectomy procedure is safe and it will
reduce the morbidity and mortality in these patients. Copyright ©
The Author(s) 2020.

<81>
Accession Number
2006834454
Title
Symptom-orientated oral hygiene for children after heart transplantation:
Effectiveness of a standardized prophylactic program.
Source
Pediatric Transplantation. (no pagination), 2020. Date of Publication:
2020.
Author
Schulz-Weidner N.; Bulski J.C.; Siahi-Benlarbi R.; Bauer J.; Logeswaran
T.; Jux C.; Wetzel W.-E.; Kramer N.
Institution
(Schulz-Weidner, Bulski, Siahi-Benlarbi, Wetzel, Kramer) Department of
Pediatric Dentistry, Medical Centre of Odontology, Justus Liebig
University, Giessen, Germany
(Bauer, Logeswaran, Jux) Pediatric Heart Centre, Justus Liebig University,
Giessen, Germany
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Children with CHD, especially heart-transplanted patients, are predisposed
to have caries lesions, gingivitis and other oral findings like gingival
hyperplasia. The aim of the study was the implementation of a specific
oral hygiene program in these patients and its effect on the improvement
of oral health, especially gingival overgrowth. For this, we used a newly
developed systematic GHI to evaluate and describe this gingival
alteration. Thirty-three children, aged 6 to 15 years with cardiac
transplants (9 girls, 24 boys), were examined and introduced into a
specific oral hygiene program. Each child showed evidence of gingival
hyperplasia. They were randomly divided into three groups with the
following oral care measurements: Group ZZ tooth brushing, Group ZZS tooth
brushing and mouth rinsing, Group ZZSS tooth brushing, mouth rinsing and
the use of an additional single and sulcus toothbrush. A significant
decline of all oral health parameters could be proven in all groups.
Gingival hyperplasia (GHI) improved as well as plaque accumulation (QHI).
The children who used in addition to toothbrushing rinsing solutions
and/or additional miniature toothbrushes showed better parameters of the
gingival hygiene indexes from the baseline examination until the end of
the study. The results show that any infant with cardiac transplant has to
be introduced into an individualized oral hygiene program underlining the
need of comprehensive dental care in cooperation with pediatric
cardiology. Copyright © 2020 John Wiley Periodicals LLC

<82>
Accession Number
2007327685
Title
Percutaneous coronary intervention provided better long term results than
optimal medical therapy alone in patients with chronic total occlusion: A
meta-analysis.
Source
Indian Heart Journal. 72 (4) (pp 225-231), 2020. Date of Publication: July
- August 2020.
Author
Khanra D.; Mishra V.; Jain B.; Soni S.; Bahurupi Y.; Duggal B.; Rathore
S.; Guha S.; Agarwal S.; Aggarwal P.; Sinha S.; Himanshu K.
Institution
(Khanra) New Cross Hospital, Royal Wolverhampton NHS Trust, United Kingdom
(Mishra) Department of Cardiology, Super-Speciality Hospital, NSCB Medical
College, Jabalpur, MP, India
(Jain, Bahurupi, Duggal) All India Institute of Medical Sciences (AIIMS),
Rishikesh, India
(Soni) Department of Cardiology, All India Institution of Medical Sciences
(AIIMS), Rishikesh, India
(Rathore) Frimley Health NHS Foundation Trust, Camberley, Surrey, United
Kingdom
(Guha) Cardiology, Medical College Kolkata, West Bengal, India
(Agarwal) Sunderland Royal Hospital, Kayll Road, United Kingdom
(Aggarwal) Department of Cardiology, ABVIMS and Dr. RML Hospital, New
Delhi, India
(Sinha, Himanshu) Department of Cardiology, LPS Institution of Cardiology,
Kanpur, Uttar Pradesh, India
Publisher
Elsevier B.V. (Netherlands)
Abstract
Aims: Studies comparing the outcome of percutaneous coronary intervention
(PCI) along with optimal medical therapy (OMT) versus OMT alone in
treatment of chronic total occlusion (CTO) are limited by observational
design, variable follow-up period, diverse clinical outcomes, high
drop-out and cross-over rates. This study aims to conduct a meta-analysis
of published data of observational as well as randomized studies comparing
long term outcomes of PCI+OMT versus OMT alone. Methods and Results:
PubMed, Embase and Cochrane databases were systematically reviewed. 15
studies meeting criteria were included in the meta-analysis. The
New-castle Ottawa scale was used to appraise the overall quality of the
studies. Random-effects model with inverse variance method was undertaken.
Major adverse cardiovascular events (MACE) which comprises of cardiac
death, myocardial infarction, stroke, and un-planned revascularization
were significantly lower in the PCI+OMT group (RR:0.76; 95% CI:0.61 to
0.95; P=<0.00001; I2 = 85%). All-cause mortality and cardiac
death were significantly lower in the PCI+OMT group (P=<0.00001 in both).
Myocardial infarction and stroke rates were lower in the PCI+OMT group,
however they did not reach statistical significance (P = 0.24, P = 0.15
respectively). Unplanned revascularizations (of any vessel) were also
similar in both the groups (P = 0.78, I2 = 88%).
 Conclusion(s): PCI of CTO is rewarded with better long term outcome,
in terms of MACE, all-cause mortality and cardiac death with similar rates
of un-planned revascularization. In this largest meta-analysis consisting
of 15 studies, comparing 6093 patients in PCI group and 4943 patients in
OMT group, it has been found that, PCI of CTO has a better long term
outcome in terms of MACE, cardiac death and all causes of mortality with
similar unplanned revascularization. Higher age, TVD, CKD independently
contribute to higher MACE in CTO patients undergoing PCI in multivariate
logistic meta-regression analysis. Copyright © 2020 Cardiological
Society of India

<83>
Accession Number
2004959878
Title
Effect of cardiac rehabilitation on hope among cardiac patients after
coronary artery bypass graft surgery.
Source
Risk Management and Healthcare Policy. 13 (pp 1319-1326), 2020. Date of
Publication: 2020.
Author
Rakhshan M.; Toufigh A.; Dehghani-Firouzabadi A.; Yektatalab S.
Institution
(Rakhshan, Yektatalab) Nursing Department, School of Nursing and
Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
(Toufigh) Student Research Commitee, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Dehghani-Firouzabadi) Medical School, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Dove Medical Press Ltd (E-mail: angela@dovepress.com)
Abstract
Purpose: Following coronary artery bypass graft (CABG) surgery, some
patients experience psycho-mental problems such as hopelessness. The Phase
2 cardiac rehabilitation (CR) program is an important element of the
secondary prevention program in treating patients with cardiovascular
disease (CVD). The present study aimed to determine the effect of the
Phase 2 CR program on the level of hope in cardiac patients after CABG
surgery. Patients and Methods: A clinical trial was conducted from
July 2017 to late January 2018 at the Heart Surgery Centre, Al-Zahra
Hospital, Shiraz, Iran. The target population was patients who sought CR
therapy after CABG surgery. A total of 104 cardiac patients were recruited
and equally divided into control and intervention groups. The intervention
group received 20 sessions of Phase 2 CR program combined with education
and counselling during 8 weeks. The control group only received routine
observations and education. The data were collected pre-and
post-intervention using a demographic form and the Miller Hope Scale
(MHS). Descriptive statistics were expressed as percentages, frequency
distribu-tion, mean and standard deviation. Paired t-test and independent
t-test were used for statistical inference. Data were analyzed using the
SPSS statistical software (version 23.0) and P values <0.05 were
considered statistically significant. Result(s): There was no
significant difference in the mean score of hope between the control and
intervention groups before the intervention. However, a significant
difference between the groups was observed post-intervention (P<0.001).
The results showed a significant difference in the mean score of hope
between pre-intervention (182.36+/-23.07) and post-intervention
(216.94+/-23.05) in the intervention group (P<0.001), whereas the
difference in the control group was not significant (P=0.095). The
measured post-intervention effect size was high (1.05).
 Conclusion(s): The Phase 2 CR program combined with education and
counseling increased hope in CVD patients after CABG
surgery. Copyright © 2020 Rakhshan et al.

<84>
Accession Number
2004266718
Title
Long-term outcome after thrombus aspiration in non-ST-elevation myocardial
infarction: results from the TATORT-NSTEMI trial: Thrombus aspiration in
acute myocardial infarction.
Source
Clinical Research in Cardiology. 109 (10) (pp 1223-1231), 2020. Date of
Publication: 01 Oct 2020.
Author
Feistritzer H.-J.; Meyer-Saraei R.; Lober C.; Bohm M.; Scheller B.; Lauer
B.; Geisler T.; Gawaz M.; Bruch L.; Klein N.; Zeymer U.; Eitel I.; Jobs
A.; Freund A.; Desch S.; de Waha-Thiele S.; Thiele H.
Institution
(Feistritzer, Jobs, Freund, Desch, Thiele) Department of Internal
Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and
Leipzig Heart Institute, Strumpellstr. 39, Leipzig 04289, Germany
(Meyer-Saraei, Eitel, de Waha-Thiele) Department of Cardiology, Angiology
and Intensive Care Medicine, University Heart Center Lubeck, University
Hospital Schleswig-Holstein, Lubeck, Germany
(Lober, Zeymer) Institut fur Herzinfarktforschung GmbH, IHF, Ludwigshafen,
Germany
(Bohm, Scheller) Department of Internal Medicine III, University of
Saarland, Homburg, Germany
(Lauer) Department of Cardiology, University Hospital Jena, Jena, Germany
(Geisler, Gawaz) Department of Cardiology/Cardiovascular Medicine,
University of Tubingen, Tubingen, Germany
(Bruch) Department of Internal Medicine, Unfallkrankenhaus Berlin, Berlin,
Germany
(Klein) Klinik fur Kardiologie und Internistische Intensivmedizin,
Klinikum St. Georg, Leipzig, Germany
(Zeymer) Klinik fur Innere Medizin/Kardiologie, Klinikum Ludwigshafen,
Ludwigshafen, Germany
Publisher
Springer Science and Business Media Deutschland GmbH (E-mail:
info@springer-sbm.com)
Abstract
Aims: To investigate the long-term prognostic value of aspiration
thrombectomy in conjunction with primary percutaneous coronary
intervention (PCI) compared to conventional PCI in patients with
non-ST-elevation myocardial infarction (NSTEMI). Method(s): In the
randomized TATORT-NSTEMI (Thrombus aspiration in thrombus containing
culprit lesions in non-ST-elevation myocardial infarction) trial, NSTEMI
patients with thrombus containing culprit lesions were randomized to
either PCI with aspiration thrombectomy or conventional PCI. The endpoint
was a combination of all-cause death, reinfarction and new congestive
heart failure. Result(s): From 440 patients initially randomized,
outcome data were available in 432 (98.2%) patients at a median follow-up
of 4.9 (interquartile range [IQR] 4.4-5.0) years. Thrombectomy was
associated with a significant reduction of the combined endpoint compared
to conventional PCI (19.9% vs. 30.7%, p = 0.01). This finding was
primarily driven by a reduced rate of reinfarction with thrombectomy (3.4%
vs. 10.3%, p = 0.01). Thrombectomy was still independently associated with
the combined endpoint after multivariable adjustment (hazard ratio [HR]
0.47, 95% confidence interval [CI] 0.30-0.76, p = 0.002). Findings were
consistent across all analyzed subgroups (p values for interaction all '
0.05). Conclusion(s): In NSTEMI, thrombus aspiration is associated
with favorable clinical outcome during long-term follow-up. Clinical trial
registration: NCT01612312. Copyright © 2020, Springer-Verlag GmbH
Germany, part of Springer Nature.

<85>
Accession Number
632609660
Title
Inotropes for the prevention of low cardiac output syndrome and mortality
for paediatric patients undergoing surgery for congenital heart disease: a
network meta-analysis.
Source
Cochrane Database of Systematic Reviews. 2020 (8) (no pagination), 2020.
Article Number: CD013707. Date of Publication: 19 Aug 2020.
Author
Burkhardt B.E.U.; Hummel J.; Rucker G.; Stiller B.
Institution
(Burkhardt) Department of Cardiology, Kinderspital Zurich, Zurich,
Switzerland
(Hummel, Stiller) Department of Congenital Heart Defects and Pediatric
Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
(Rucker) Institute of Medical Biometry and Statistics, Faculty of Medicine
and Medical Center - University of Freiburg, Freiburg, Germany
Publisher
John Wiley and Sons Ltd (E-mail: cs-journals@wiley.co.uk)
Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The
objectives are as follows:. To compare in a network meta-analysis the
efficacy and safety of different prophylactic medications either against
no treatment, or placebo, or against each other (as mono- or combination
prophylaxis) for the prevention of low cardiac output syndrome and
mortality for paediatric patients undergoing surgery for congenital heart
disease. To generate a clinically useful ranking of prophylactic
medications (mono- and combination prophylaxis) according to efficacy and
safety. Copyright © 2020 The Cochrane Collaboration. Published by
John Wiley & Sons, Ltd.

<86>
Accession Number
2005543468
Title
Sleeve Gastrectomy in Patients with Continuous-Flow Left Ventricular
Assist Devices: a Systematic Review and Meta-Analysis.
Source
Obesity Surgery. 30 (11) (pp 4437-4445), 2020. Date of Publication: 01 Nov
2020.
Author
Challapalli J.; Maynes E.J.; O'Malley T.J.; Cross D.E.; Weber M.P.; Choi
J.H.; Aggarwal R.; Boyle A.J.; Whellan D.J.; Entwistle J.W.; Massey H.T.;
Morris R.J.; Tchantchaleishvili V.
Institution
(Challapalli) Drexel University College of Medicine, Philadelphia, PA,
United States
(Maynes, O'Malley, Cross, Weber, Choi, Entwistle, Massey, Morris,
Tchantchaleishvili) Division of Cardiac Surgery, Department of Surgery,
Thomas Jefferson University, Philadelphia, PA, United States
(Aggarwal) Division of Minimally Invasive, Metabolic, and Bariatric
Surgery, Thomas Jefferson University, Philadelphia, PA, United States
(Boyle, Whellan) Division of Cardiology, Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
Springer
Abstract
Purpose: A body mass index (BMI) ' 35 kg/m2 is a relative
contraindication to heart transplantation in patients with end-stage heart
failure. Bariatric surgery can be considered either concomitantly with
continuous-flow left ventricular assist device (CF-LVAD) placement, or
staged after CF-LVAD has been placed. We sought to evaluate the outcomes
of these approaches. Material(s) and Method(s): An electronic search
was performed to identify all relevant studies. After assessment for
inclusion and exclusion criteria, eight studies were pooled for systematic
review and metaanalysis. Result(s): Overall, of 59 patients, 22 (37%)
underwent simultaneous sleeve gastrectomy with CF-LVAD implantation while
37 (63%) underwent staged sleeve gastrectomy after CF-LVAD. The mean age
of patients was 46 years (95% CI: 39-53) with 40% females. Mean BMI at
most recent follow-up (33.4 kg/m2, 95% CI: 30.2-36.6) was
significantly lower compared with mean preoperative BMI (46.7
kg/m2, 95% CI: 42.9-50.6) (p ' 0.01). There was no significant
difference in total incidence of postoperative complications
(simultaneous, 16% (95% CI: 1-87%) versus staged, 23% (95% CI: 7-53%)) or
in overall survival (simultaneous, 93% (95% CI: 72-99%) versus staged, 79%
(95% CI: 60-90%), p = 0.17) for average follow-up time of 12.7 months.
Bariatric surgery resulted in 66% of patients (95% CI: 51-79) to be listed
for heart transplantation, including 33% (95% CI: 22-47) who were
transplanted. Conclusion(s): Both simultaneous and staged bariatric
surgeries with CF-LVAD placement have comparable outcomes and
significantly reduce BMI. This can allow previously ineligible patients to
undergo heart transplantation. Copyright © 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<87>
Accession Number
632376315
Title
Effects of inhaled nitric oxide on haemodynamics and gas exchange in
children after having undergone cardiac surgery utilising cardiopulmonary
bypass.
Source
Cardiology in the Young. 30 (8) (pp 1151-1156), 2020. Date of Publication:
2020.
Author
Villarreal E.G.; Aiello S.; Evey L.W.; Flores S.; Loomba R.S.
Institution
(Villarreal, Evey, Flores) Texas Children's Hospital, Baylor School of
Medicine, Houston, TX, United States
(Villarreal) Tecnologico de Monterrey, Escuela de Medicina y Ciencias de
la Salud, Monterrey, Nuevo Leon, Mexico
(Aiello, Loomba) Chicago Medical School, Rosalind Franklin University of
Medicine and Science, North Chicago, IL, United States
(Loomba) Advocate Children's Hospital, Oak Lawn, IL, United States
Publisher
Cambridge University Press (E-mail: journals_subscriptions@cup.cam.ac.uk)
Abstract
Introduction: For CHD patients undergoing corrective surgery utilising
cardiopulmonary bypass, post-operative inhaled nitric oxide has been
administered to alleviate pulmonary hypertension. We performed a
systematic review and meta-analyses to determine the effect of inhaled
nitric oxide on haemodynamics, gas exchange, and hospitalisation
characteristics in children immediately after cardiopulmonary
bypass.Materials and methods: A systematic review of the literature was
performed to identify full-text manuscripts in English. PubMed, EMBASE,
and the Cochrane databases were queried. Once manuscripts were identified
for inclusion, a list of all the endpoints in each manuscript was created.
Endpoints with data present from two or more studies were then kept for
pooled analyses. All endpoints included were continuous variables and so
mean and standard deviation were utilised as the effect data for
comparison. Result(s): A total of eight studies were deemed
appropriate for inclusion. There were significant differences with
decreases in mean pulmonary artery pressure of -6.82 mmHg, left atrial
pressure of -1.16 mmHg, arteriovenous oxygen difference of -1.63, arterial
carbon dioxide concentration of -2.41 mmHg, mechanical ventilation
duration of -8.56 hours, and length of cardiac ICU stay duration of -0.91
days. All significant variables achieved p < 0.001. Conclusion(s):
Inhaled nitric oxide in children immediately after cardiopulmonary bypass
decreases mean pulmonary artery pressure significantly and decreases the
arterial carbon dioxide concentration significantly without significantly
altering other haemodynamic parameters. This results in a statistically
shorter duration of mechanical ventilation and cardiac ICU length of stay
without altering overall hospital length of stay. Copyright ©
2020 Cambridge University Press. All rights reserved.

<88>
Accession Number
628732836
Title
Acupressure on Anxiety and Sleep Quality After Cardiac Surgery: A
Randomized Controlled Trial.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. 34 (6) (pp 1222-1231), 2019. Date of
Publication: 01 Dec 2019.
Author
Aygin D.; Sen S.
Publisher
NLM (Medline)
Abstract
PURPOSE: To determine the effect of acupressure on anxiety and sleep
quality after cardiac surgery. DESIGN: A randomized pre-post test control
group design. METHOD(S): Patients after cardiac surgery were divided
into two groups: the intervention group (n = 50), who received acupressure
on four different acupoints plus standard care, and the control group (n =
50), who received only standard care. Patients were admitted to the
surgical clinic from the intensive care unit after 3 or 4 days of surgery.
The levels of anxiety and sleep quality were evaluated during three
postoperative days starting from their first day in the surgical clinic.
FINDINGS: Among the patients in the intervention group, the usage of
acupressure decreased the level of anxiety and increased the sleep quality
significantly compared with the control group (P < .05).
 CONCLUSION(S): Our findings showed that acupressure decreased the
level of anxiety and improved the sleep quality in the surgical clinic
after cardiac surgery. Copyright © 2019 American Society of
PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

<89>
Accession Number
628768410
Title
Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after
Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients.
Source
Brazilian journal of cardiovascular surgery. 34 (3) (pp 318-326), 2019.
Date of Publication: 01 Jun 2019.
Author
Sa M.P.B.O.; Cavalcanti L.R.P.; Sarargiotto F.A.S.; Perazzo AM.; Rayol
S.D.C.; Diniz R.G.S.; Sa F.B.C.A.; Menezes A.M.; Lima R.C.
Institution
(Sa, Cavalcanti, Sarargiotto, Perazzo, Rayol, Diniz, Sa, Menezes, Lima)
Pronto-Socorro Cardiologico Universitario de Pernambuco Division of
Cardiovascular Surgery Recife PE Brazil Division of Cardiovascular Surgery
of Pronto-Socorro Cardiologico Universitario de Pernambuco (PROCAPE),
Recife, PE, Brazil
(Sa, Lima) Instituto de Ciencias Biologicas Faculdade de Ciencias Medicas
Nucleus of Postgraduate Studies and Research in Health Sciences Recife PE
Brazil Nucleus of Postgraduate Studies and Research in Health Sciences at
Faculdade de Ciencias Medicas and Instituto de Ciencias Biologicas
(FCM/ICB), Recife, PE, Brazil
(Cavalcanti, Sarargiotto, Perazzo, Rayol, Diniz, Sa, Menezes) Universidade
de Pernambuco Recife PE Brazil Universidade de Pernambuco (UPE), Recife,
PE, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study sought to evaluate the impact of prosthesis-patient
mismatch (PPM) on the risk of early-term mortality after transcatheter
aortic valve implantation (TAVI). METHOD(S): Databases (Medical
Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica
dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR],
ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin
American and Caribbean Literature on Health Sciences [LILACS], and Google
Scholar) were searched for studies published until February 2019. PPM
after TAVI was defined as moderate if the indexed effective orifice area
(iEOA) was between 0.85 cm2/m2 and 0.65 cm2/m2 and as severe if iEOA <=
0.65 cm2/m2. RESULT(S): The search yielded 1,092 studies for
inclusion. Of these, 18 articles were analyzed, and their data extracted.
The total number of patients included who underwent TAVI was 71,106. The
incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without
PPM). One-year mortality was not increased in patients with any PPM (odds
ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P=0.338)
neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029,
P=0.423). Severe PPM was separately associated with high risk (OR 1.109,
95% CI 1.041-1.181, P=0.001). CONCLUSION(S): The presence of severe
PPM after TAVI increased early-term mortality. Although moderate PPM
seemed harmless, the findings of this study cannot not rule out the
possibility of it being detrimental, since there are other registries that
did not address this issue yet.

<90>
Accession Number
628768315
Title
An Easy and Reliable Way to Prevent Electrocardiographic Deteriorations of
Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: Preoperative
Anxiolytic Treatment.
Source
Brazilian journal of cardiovascular surgery. 34 (3) (pp 311-317), 2019.
Date of Publication: 01 Jun 2019.
Author
Demirhan A.; Velioglu Y.; Yoldas H.; Karagoz I.; Cosgun M.; Caliskan D.;
Yildiz I.; Bilgi M.; Erdem K.
Institution
(Demirhan, Yoldas, Karagoz, Caliskan, Yildiz, Bilgi) Abant Izzet Baysal
University Medical School Department of Anesthesiology and Reanimation
Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet
Baysal University Medical School, Bolu, Turkey
(Velioglu, Erdem) Abant Izzet Baysal University Medical School Bolu Turkey
Department of Cardiovascular Surgery, Abant Izzet Baysal University
Medical School, Bolu, Turkey
(Cosgun) Abant Izzet Baysal University Medical School Department of
Cardiology Bolu Turkey Department of Cardiology, Abant Izzet Baysal
University Medical School, Bolu, Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To investigate the effects of preoperative anxiety relieving on
electrophysiological changes in patients undergoing off-pump coronary
artery bypass surgery. METHOD(S): A total of 61 patients at ASA III
risk group in the age range of 18-65 years were enrolled in the present
study. Patients were randomly divided into two groups. Group S (Sedation
group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the
operation. Group C (control group) was not administered with any
anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck
Anxiety Inventory (BAI) were used to evaluate the level of anxiety.
Electrocardiography (ECG), pulse oximeter and standard monitoring were
performed for each patient. QT and P dispersions in each derivation of all
ECGs were calculated. RESULT(S): Preoperative STAI-I scores were
significantly lower in sedation group compared to the controls. Mean
values of QT dispersion measured before induction, at the 1st minute of
induction, 30th second of intubation and 4th minute of intubation in
sedation group were significantly reduced compared to controls (P=0.024;
P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion
measured before induction, at the 3rd minute of induction, 30th second of
intubation and 4th minute of intubation in sedation group were
significantly reduced compared to controls (P=0.001; P=0.020; P=0.023;
P=0.005, respectively). CONCLUSION(S): Elevated anxiety levels in
patients undergoing coronary bypass surgery have a negative effect through
prolonged QT and P-wave dispersion times. Anxiolytic treatment before
surgery may be useful to prevent ventricular and atrial arrhythmias and
associated complications through decreasing the QT and P-wave dispersion
duration.

<91>
Accession Number
2001101081
Title
TCT-71 Predictors, incidence and outcomes of patients undergoing
transcatheter aortic valve implantation complicated by stroke - From the
CENTER-Collaboration.
Source
Journal of the American College of Cardiology. Conference: Thirtieth
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. United States. 72 (13 Supplement) (pp B31), 2018. Date of
Publication: 25 September 2018.
Author
Vlastra W.; Jimenez-Quevedo P.; Tchetche D.; Chandrasekhar J.; Brito F.;
Barbanti M.; Kornowski R.; Latib A.; D'Onofrio A.; Ribichini F.; Baan J.;
Tijssen J.; Hernandez J.D.L.T.; Dumonteil N.; Leite R.; Sartori S.;
D'Errigo P.; Fraccaro C.; Lunardi M.; Orvin K.; Pagnesi M.; Hernandez R.;
Modine T.; Mehran R.; Piek J.; Delewi R.
Institution
(Vlastra, Baan) Academic Medical Center, Amsterdam, Netherlands
(Jimenez-Quevedo) Hospital Universitario Clinico San Carlos, Madrid, Spain
(Tchetche, Dumonteil) Clinique Pasteur, Toulouse, France
(Chandrasekhar, Sartori) Icahn School of Medicine at Mount Sinai, New
York, New York, United States
(Brito) Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
(Barbanti) Division of Cardiology - CAST - AOU Policlinico Vittorio
Emanuele - University of Catania, Italy, Catania, Catania, Italy
(Kornowski, Orvin) Rabin Medical Center, Petach Tikva, Israel
(Latib, Pagnesi) Interventional Cardiology Division,
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute,
Milan, Milan, Italy
(D'Onofrio) Azienda Ospedaliera Universita di Padova, Padova, Padua, Italy
(Ribichini) University of Verona, Verona, Verona, Italy
(Tijssen) AMC, Naarden, Netherlands
(Hernandez) Hospital Universitario Marques de Valdecilla, Santander, Spain
(Leite) Boston Scientific, Sao Paulo, Sao Paulo, Brazil
(D'Errigo) Istituto Superiore di Sanita, Rome, Rome, Italy
(Fraccaro) Division of Cardiology, Department of Cardiac, Thoracic and
Vascular Sciences, University of Padova, Padova, Padua, Italy
(Lunardi) Division of Cardiology, Department of Medicine, University of
Verona, Verona, Verona, Italy
(Hernandez) Hospital Ramon y Cajal, Madrid, Spain
(Modine) Lille University Hospital, Lille, France
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai
Hospital, NY, NY, United States
(Piek) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Delewi) Academical Medical Center, Amsterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Stroke is one of the most devastating complications of
transcatheter aortic valve implantation (TAVI). The aim of this study was
to identify the incidence and predictors of stroke after TAVI and evaluate
the short-term outcomes of patients with stroke. Method(s): The
CENTER-trial is an international collaboration consisting of 3 national
registries and 7 prospective clinical trials. A total of 12,381 patients
undergoing transfemoral TAVI with either an Edwards SAPIEN valve or a
Medtronic CoreValve between 2007 and 2018 were included in the current
patient pooled analyses. The primary endpoint was the incidence of stroke
at 30 days, as defined by the Valve Academic Research Consortium (VARC).
Furthermore, impact of stroke on mortality was assessed and multivariate
logistic regression analyses were performed to identify baseline variables
predictive of stroke. Result(s): In the current patient cohort a
total of 261 patients (2.4%) experienced stroke in the first month after
TAVI. The median patient age of the total population was 83 years (78-86
years) and 58% were women. The median logistic EuroSCORE was 14.4%
(9.0-23.0%). Univariate predictors of stroke were age, lower body mass
index, low GFR and previous cerebrovascular events (stroke or TIA).
However, in multivariate analysis only previous cerebrovascular events
remained a predictor of stroke after TAVI (OR 2.1, 95%CI 1.4-3.3,
P=0.001). Stroke occurring within the first 30 days after TAVI was
associated with a six-fold increase of 30-day mortality rates (OR 6.0,
95%CI 4.4-8.1, p<0.001). Moreover, patients with stroke more frequently
had documented new-onset atrial fibrillation (16% vs 3%, p<0.001) and
major or life-threatening bleedings (12% vs 7%, p=0.002) at 30 day
follow-up. Finally, stroke rates did not differ between those performed in
the early years of TAVI (2007-2012) compared to the more recent years of
TAVI (2012-2018, both 2.4%, p=1.0). Conclusion(s): In this large
global patient level pooled analysis, the incidence of stroke after
transfemoral TAVI was 2.4% and did not differ between early or late years
of TAVI. The occurrence of stroke after TAVI is associated with a
strikingly six-fold increase of 30-day mortality rates, additionally
patients with stroke more frequently had new-onset atrial fibrillation and
major or life-threatening bleeding. Prior cerebrovascular events
independently predict the occurrence of stroke after TAVI. AtTCT 2018we
will provide an in depth analyses of these outcomes and how we can use
these data in daily clinical practice. Categories: STRUCTURAL: Valvular
Disease: Aortic Copyright © 2018

<92>
Accession Number
2001101064
Title
TCT-322 Agreement between coronary CTA and conventional angiography on the
SYNTAX score tertiles stratified by anatomical complexity in the SYNTAX
III Revolution trial.
Source
Journal of the American College of Cardiology. Conference: Thirtieth
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. United States. 72 (13 Supplement) (pp B132), 2018. Date
of Publication: 25 September 2018.
Author
Collet C.; Andreini D.; Teichgraber U.; Doenst T.; Sigusch H.H.;
Alibegovic J.; Manka R.; Plass A.; Ouda A.; Belsack D.; Czapla J.; Lochy
S.; Schoors D.; Onuma Y.; Serruys P.; Bartorelli A.
Institution
(Collet) AMC, Amsterdam, Netherlands
(Andreini, Bartorelli) Centro Cardiologico Monzino, Milan, Italy
(Teichgraber, Doenst) Jena University, Jena, Germany
(Sigusch) HBK Zwickau, Zwickau, Germany
(Alibegovic) SarajevoBosnia and Herzegovina
(Manka) Unknown, Zurich, Switzerland
(Plass) University Hospital Zurich, Zurich, Switzerland
(Ouda) University of Zurich, Zurich, Switzerland
(Belsack, Czapla) UZ Brussel, Brussel, Belgium
(Lochy) UZ Brussel, Jette, Belgium
(Schoors) UZ Brussels, Jette, Belgium
(Onuma) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Serruys) Imperial College, Rotterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: The SYNTAX III Revolution trial reported a high level of
agreement on treatment recommendation (i.e. CABG or PCI) between heart
teams assessing the coronary anatomy either with coronary computed
tomography angiography (CCTA) or conventional angiography plus clinical
information; this occurred despite a moderate degree of correlation in the
anatomical SYNTAX score. We sought to determine the impact of anatomical
complexity on the agreement between CCTA and conventional angiography
regarding the anatomical SYNTAX score risk tertiles. Method(s):
SYNTAX III was a multicentre, international study that included patients
with left main or three-vessel coronary artery disease (CAD). All
anatomical SYNTAX scores were allowed for inclusion. Two heart teams were
randomized to either assess the epicardial coronary disease with CCTA or
conventional angiography accounting for patient's clinical information.
For this analysis, patients were stratified according the anatomical
SYNTAX scores tertiles derived from conventional angiography evaluation
(i.e. <23, 23-32, >32) The mean difference in the anatomical SYNTAX score
between CCTA and conventional angiography was assessed using the
Bland-Altman method. Result(s): Overall, 222 patients with analysable
CCTA and conventional angiography were included. The mean anatomical
SYNTAX score derived from CCTA was 33.9+/-13.0 and 30.3+/-12.2 from
conventional angiography (p<0.001). The overall agreement on the
anatomical SYNTAX score tertiles between diagnostic modalities was fair
(Kappa coefficient 0.33, 95% CI 0.23 to 0.42). The mean difference between
CCTA and conventional angiography in the low, intermediate and high SYNTAX
score tertiles were 9.48 (Limits of agreement (LOA) -7.6, 26.5; n=62), 3.8
(LOA -13.4, 21.1; n=75) and -0.9 (LOA -26.6, 24.8; n=85), ANOVA
p-value<0.001. Conclusion(s): The agreement between CCTA and
conventional angiography on the anatomical SYNTAX score was influenced by
anatomical complexity. The mean difference between CCTA- and
angiography-derived SYNTAX Score was higher in the low risk tertile
compared to the intermediate and high tertiles; however, with wide limits
of agreement. Categories: CORONARY: Coronary Artery Surgery Copyright
© 2018

<93>
Accession Number
2001100811
Title
TCT-171 Time Course of The Survival Advantage of Transcatheter Over
Surgical Aortic Valve Replacement: Interplay between Sex and Patient Risk
Profile.
Source
Journal of the American College of Cardiology. Conference: Thirtieth
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. United States. 72 (13 Supplement) (pp B73), 2018. Date of
Publication: 25 September 2018.
Author
Ueshima D.; Masiero G.; Schiavo A.; Abdelhaleem Badawy M.R.; Brener S.;
Tarantini G.
Institution
(Ueshima) Department of Cardiac, Thoracic and Vascular Sciences,
University of Padua Medical School, Padua, Italy, Padova, Padua, Italy
(Masiero) USC Cardiologia, Ospedale Santa Croce e Carle Cuneo, Cuneo,
Cuneo, Italy
(Schiavo, Tarantini) Department of Cardiac, Thoracic and Vascular
Sciences, University of Padua Medical School, Padua, Italy, Padua, Padua,
Italy
(Abdelhaleem Badawy) Cardiology Department, Minia, Egypt
(Brener) New York Methodist Hospital, Brooklyn, New York, United States
Publisher
Elsevier Inc.
Abstract
Background: Women have been reported to have better survival than men
undergoing transcatheter aortic valve replacement (TAVR). However, scant
data on the sex-based survival benefit of TAVR over surgical aortic valve
replacement (SAVR) are available. We sought to explore the time course of
survival advantage of TAVR over SAVR as function of the patients' risk and
sex. Method(s): A systematic review of studies reporting clinical
outcomes of men and women undergoing TAVR or SAVR was performed. Studies
were divided into 2 groups according to average patient's risk score and
the interplay of surgical risk and sex on outcomes were analyzed.
 Result(s): Eight studies involving 6,596 women and 7,204 male
patients were extracted. Unlike males, female patients had survival
advantage from TAVR over SAVR that became substantial at 1 year from index
procedure and persisted at 2-year of follow-up. Moreover, this sex based
TAVR survival advantage was mainly observed in higher surgical risk
patients. Men showed a significantly lower rate of residual paravalvular
leak after SAVR. [Formula presented] Conclusion(s): Female patients
had a selective mortality benefit from TAVR compared to SAVR. This
sex-based TAVR benefit was mainly observed in high surgical risk patients
beyond 1 year from procedure. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2018

<94>
Accession Number
2001100667
Title
TCT-362 Checking the reality of the SYNTAX III Revolution trial:
Comparison of the virtual heart team decision with the treatment executed.
Source
Journal of the American College of Cardiology. Conference: Thirtieth
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. United States. 72 (13 Supplement) (pp B147), 2018. Date
of Publication: 25 September 2018.
Author
Sonck J.; Andreini D.; Bartorelli A.; Folliguet T.; Diamantis I.; Faber
G.; Kaufmann P.; De Mey J.; La Meir M.; Tanaka K.; Belsack D.; Onuma Y.;
Serruys P.
Institution
(Sonck, De Mey) UZ Brussel, Brussels, Belgium
(Andreini, Bartorelli) Centro Cardiologico Monzino, Milan, Italy
(Folliguet) Institut Mutualiste Montsouris, Paris, France
(Diamantis, Faber) Jena University, Jena, Germany
(Kaufmann) Department of Nuclear Medicine, University Hospital, Zurich,
Switzerland and University of Zurich, Zurich, Switzerland
(La Meir, Belsack) UZ Brussel, Brussel, Belgium
(Tanaka) New York, New YorkUnited States
(Onuma) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Serruys) Imperial College, Rotterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: The results of SYNTAX III Revolution trial suggests that
clinical decision making is feasible using coronary computed tomography
angiography (CCTA) in patients with multivessel disease. However, the
primary endpoint of the trial was based on a virtual decision not bound
with the treatment executed. We sought to investigate the agreement
between the decision based either on CCTA or conventional angiography with
the treatment executed. Method(s): SYNTAX III was a multicentre,
international study that included patients with left main or three-vessel
coronary artery disease (CAD). The heart team was randomized to either
assess the epicardial coronary disease with CCTA or conventional
angiography accounting for patient's clinical information. For the present
analysis, the agreement between the decisions based on conventional
angiography alone and CCTA alone were compared with the treatment
executed. Result(s): Overall, 222 patients with analysable CCTA and
conventional angiography were included in this analysis. Concordance
between the virtual decision and the treatment executed was observed in
71% patients with CCTA and 78% using conventional angiography. The
concordance between vessels intended to be treated in the virtual decision
and vessels treated was observed on 73% and 76% of patients with
conventional angiography and CCTA, respectively. Conclusion(s): In
the SYNTAX III Revolution trial, agreement between the virtual decision
and the treatment executed was observed in more than 70% of patients with
both CCTA and conventional angiography. This result supports the potential
feasibility of clinical decision making based solely on coronary computed
tomography angiography. Categories: CORONARY: Coronary Artery
Surgery Copyright © 2018

<95>
Accession Number
2001100563
Title
The CENTER-Collaboration: Outcomes in patients undergoing transfemoral
transcatheter aortic valve implantation with balloon-expandable valves
versus self-expandable valves.
Source
Journal of the American College of Cardiology. Conference: Thirtieth
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. United States. 72 (13 Supplement) (pp B3), 2018. Date of
Publication: 25 September 2018.
Author
Vlastra W.; Chandrasekhar J.; Munoz-Garcia A.; Tchetche D.; Brito F.;
Barbanti M.; Kornowski R.; Latib A.; D'Onofrio A.; Ribichini F.; Baan J.;
Tijssen J.; Trillo R.; Dumonteil N.; Abizaid A.; Sartori S.; D'Errigo P.;
Fraccaro C.; Lunardi M.; Orvin K.; Pagnesi M.; Del Valle R.; Modine T.;
Mehran R.; Piek J.; Delewi R.
Institution
(Vlastra, Baan) Academic Medical Center, Amsterdam, Netherlands
(Chandrasekhar, Sartori) Icahn School of Medicine at Mount Sinai, New
York, New York, United States
(Munoz-Garcia) Hospital Universitario Clinico Virgen de la Victoria,
Malaga, Spain
(Tchetche, Dumonteil) Clinique Pasteur, Toulouse, France
(Brito) Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
(Barbanti) Division of Cardiology - CAST - AOU Policlinico Vittorio
Emanuele - University of Catania, Italy, Catania, Catania, Italy
(Kornowski, Orvin) Rabin Medical Center, Petach Tikva, Israel
(Latib, Pagnesi) Interventional Cardiology Division,
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute,
Milan, Italy
(D'Onofrio) Azienda Ospedaliera Universita di Padova, Padova, Padua, Italy
(Ribichini) University of Verona, Verona, Verona, Italy
(Tijssen) AMC, Naarden, Netherlands
(Trillo) HCU Santiago de Compostela, Santiago de Compostela, Spain
(Abizaid) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Sao Paulo,
Brazil
(D'Errigo) Istituto Superiore di Sanita, Rome, Rome, Italy
(Fraccaro) Division of Cardiology, Department of Cardiac, Thoracic and
Vascular Sciences, University of Padova, Padova, Padua, Italy
(Lunardi) Division of Cardiology, Department of Medicine, University of
Verona, Verona, Verona, Italy
(Del Valle) Hospital Universitario Central de Asturias, Oviedo, Spain
(Modine) Lille University Hospital, Lille, France
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai
Hospital, New York, New York, United States
(Piek) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Delewi) Academical Medical Center, Amsterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Balloon-expandable Edwards SAPIEN valves (ESV) and
self-expandable Medtronic CoreValves (MCV) are the two most commonly used
devices during transcatheter aortic valve implantation (TAVI). However,
data comparing clinical outcomes in patients treated with ES versus MCV
are limited by the number of patients. We conducted a global patient level
pooled analysis to compare short-term outcomes in patients undergoing
transfemoral TAVI with ESV versus MCV. Method(s): The CENTER-trial is
an international collaboration consisting of 3 national registries and 7
prospective clinical trials or registries encompassing 6 countries. In the
current patient level pooled analysis a total of 12,381 patients
undergoing transfemoral TAVI with either an ESV or a MCV between 2007 and
2018 were included. Primary outcomes were mortality and stroke at 30 days.
Secondary outcomes were permanent pacemaker implantation, myocardial
infarction, new onset atrial fibrillation and major or life-threatening
bleeding. Result(s): A total of 12,381 patients underwent TAVI with
either ESV (n=6,239) or MCV (n=6,142). The median patient age was 83 years
(78-86 years) and 58% were women. The median logistic EuroSCORE was 14.4%
(9.0-23.0%). There were no significant differences in baseline
characteristics between the two valve groups. At 30 days there were no
differences in mortality (ESV, 5.6% vs MCV, 5.9%, p=0.50) and stroke rates
(ESV, 2.2% vs MCV, 2.6%, p=0.17). On the contrary, pacemaker implantation
occurred 2.5-fold more frequently in patients undergoing TAVI with MCV
compared to ESV (ESV, 8.7% vs MCV, 21.9% p<0.001). There was also a
tendency for a higher rate of documented new-onset atrial fibrillation in
patients treated with MCV (ESV, 2.9% vs MCV, 4.8%, p=0.06). In contrast,
in-hospital major or life-threatening bleeding occurred more frequently in
patients treated with ESV (ESV 6.7% vs MCV 5.3%, p=0.002). The rate of
myocardial infarction was not different among the two valve types (ESV,
0.7% vs MCV, 0.9%, p=0.15). Conclusion(s): In the current patient
level pooled analyses of >12,000 patients undergoing transfemoral TAVI
globally, short-term mortality, stroke and myocardial infarction rates did
not differ between ESV and MCV. Use of the MCV was associated to higher
rates of pacemaker implantation and new-onset atrial fibrillation, whereas
use of the ESV was associated to higher bleeding rates. Adjusted outcomes
will be presented at TCT 2018. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2018

<96>
Accession Number
2001100458
Title
TCT-10 Physiological Versus Angiographic Guidance for Myocardial
Revascularization in Patients Undergoing Transcatheter Aortic Valve
Implantation.
Source
Journal of the American College of Cardiology. Conference: Thirtieth
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. United States. 72 (13 Supplement) (pp B4-B5), 2018. Date
of Publication: 25 September 2018.
Author
Lunardi M.; Scarsini R.; Venturi G.; Pesarini G.; Gratta A.; Piccoli A.;
Ferrero V.; Ribichini F.
Institution
(Lunardi, Venturi, Gratta, Piccoli, Ferrero, Ribichini) University of
Verona, Verona, Italy
(Scarsini) Oxford University Hospitals, Oxford, United Kingdom
(Pesarini) Univeristy of Verona, Verona, Italy
Publisher
Elsevier Inc.
Abstract
Background: Management of coronary artery disease (CAD) in patients
undergoing trans-catheter aortic valve implantation (TAVI) is uncertain.
Fractional flow reserve (FFR) has never been validated in aortic stenosis
(AS). Safety of deferring negative FFR coronary lesions in AS is not
established. The study aim was to investigate FFR-guided revascularization
in TAVI patients, with focus on clinical outcome of deferred patients (FFR
negative:>0.80). Method(s): Patients with severe AS (413) underwent
coronary angiography during workup for TAVI between March 2010 and
November 2017. Patients with significant CAD (coronary narrowing >50% in
the proximal segment of the main coronary branches), were included in this
retrospective analysis and divided in two groups: angiographically-guided
(109/192, 56.8%) vs FFR-guided revascularization (83/192, 43.2%), and
followed for 24 months. Result(s): Most lesions in the FFR group
resulted negative (96/125, 77%) and were deferred. Less patients were
treated with PCI in the FFR-guided group (23% vs 32%) with a significantly
better MACCE-free survival compared with the angio-guided group (94% vs
83.5%,p=0.024). A similar effect was observed in deferred patients against
those who underwent angio-guided treatment (96.9% vs 71.4%,p<0.001). When
the clinical outcome of deferred patients with FFR values between
0.75-0.85 was compared with those with FFR>0.85, no significant difference
was observed (MACCE-free 94.1% vs 95.3%,p=0.83). [Formula presented]
 Conclusion(s): FFR-guided revascularization in patients undergoing
TAVI is safe (94% MACCE-free survival at 24-months). Prospective
randomized trials are needed to better investigate the long-term effects
of FFR-guided revascularization against angiographic guidance alone in
patients with AS. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2018

<97>
Accession Number
2000666369
Title
TCTAP A-115 Cerebral Protection During Transcatheter Aortic Valve
Implantation: An Updated Systematic Review and Meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 23rd
Cardiovascular Summit Transcatheter Cardiovascular Therapeutics Asia
Pacific (TCTAP). France. 71 (16 Supplement) (pp S62-S63), 2018. Date of
Publication: 24 April 2018.
Author
Testa L.; Latib A.; Colombo A.; Bedogni F.
Institution
(Testa, Bedogni) IRCCS Policlinico San Donato, Italy
(Latib) San Raffaele Scientific Institute, Italy
(Colombo) EMO GVM Centro Cuore Columbus, San Raffaele Hospital, Italy
Publisher
Elsevier Inc.
Abstract
Background: In the last decade, transcatheter aortic valve implantation
(TAVI) triggered a paradigm shift in the treatment of patients with severe
symptomatic aortic stenosis. Nonetheless, along with groundbreaking
efficacy results, data concerning the risk of cerebrovascular
complications have been consistently reported in studies using either
diffusion-weighted magnetic resonance imaging (DW-MRI) or high-intensity
transient signals as assessed by transcranial Doppler. As conceivable,
embolic protection devices (EPDs) have been ideated and introduced with
the aim of reducing suchan inherent risk but they have been tested in
relatively small populations, providing inconclusive results. We thus
aimed at summarizing, by means of a meta-analytic approach, the available
evidence concerning the safety and efficacy profile of current EPDs in the
setting of TAVI. Method(s): EMBASE, PubMed, Web of Science Core
Collection, and the Cochrane Library were searched up to May 2017. The
search terms used were transcatheter aortic valve implantation ORTAVI OR
transcatheter aortic valve replacement OR TAVR AND embolic protection
device. No language restriction was applied. Abstracts and unpublished
studies presented in conferences were excluded. Single-arm studies that
evaluated the feasibility of performing TAVI with EPD were also excluded.
We included studies that evaluated 1 or more of the following outcomes:
EPD delivery success, stroke, death, new-silent ischemic lesions as
assessed by DW-MRI, neuro-cognitive function as assessed by Mini-Mental
State Examination, Montreal Cognitive Assessment, Center for
Epidemiological Studies Depression Scale, or National Institutes of Health
Stroke Scale. End points were calculated at 30 days and in accordance with
Valve Academic Research Consortium-2 definition. [Formula presented]
Results: Seven studies have been included, totaling 725 patients [15-21].
Five studies were randomized controlled trials [17-21], the remaining two
were registries [15, 16]. The mean age was 81.7 years, and 50.2% were
female. Atrial fibrillation was present at baseline in 30.6% of the
patients. A previous stroke was diagnosed in 94 patients (12.9%). See the
Tables for more details. The EPD delivery success rate was reported in all
studies and was achieved in 94.5% of patients, ranging from 64% to 100%.
All-cause mortality occurred in 1.9% of the patients treated with the use
of an EPD; 2.8% in patients without. The incidence of stroke was 4.8% in
patients treated with the use of EPD and 6% in patients without the use of
EPD. Clinical Outcomes: The use of EPD was not associated with significant
differences in terms of 30-day mortality [OR 0.57 (0.19, 1.66), p=0.3] or
stroke [OR 0.67 (0.35-1.29), p=0.23], without significant differences
between RCTs and registries. No differences were detected according to the
study design. DW-MRI assessment: The overall incidence of new lesions was
88%: 86% in patients with the use of EPD and 91% in patients without EPD.
The total volume of lesions was 88 to 466 mm3 in patients with EPD and 168
to 800 mm3 in patients without EPD. The meta-analysis showed no
differences in terms of the number of new lesions: [standardized mean
difference-0.19; (-0.71 to 0.34); p=0.49]. On the other hand, the use of
EPD was associated with a significantly smaller volume per lesion
[standardized mean difference, -0.52; (-0.85 to -0.20); p=0.002] and
smaller total volume of lesions [standardized mean difference, -0.23
(-0.42 to -0.03), p=0.02]. In registry studies, the use of EPD seemed
detrimental with respect to the number of new lesions. The analysis
according to the type of valve showed that the beneficial effect of the
EPD is mainly driven by the benefit in patients treated with a
self-expanding valve. [Formula presented] [Formula presented]
 Conclusion(s): The use of EPD is not associated with a reduced rate
of stroke, mortality and new ischemic cerebral lesions. The use of EPD
during TAVI is associated with smaller volume of ischemic lesions and
smaller total volume of ischemic lesions. Copyright © 2018

<98>
Accession Number
2000616056
Title
Outcomes Following Mitraclip in Advanced Heart Failure Patients: A
Meta-Analysis.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 38th Annual
Meeting and Scientific Sessions. France. 37 (4 Supplement) (pp S201),
2018. Date of Publication: April 2018.
Author
Belkin M.N.; Nnanabu J.; Mehta P.P.; Feldman T.; Penicka M.; Giannini C.;
Fiorelli F.; Braun D.; Swaans M.; Heyden J.V.; Claeys M.; Orban M.;
Kalantari S.; Raikhelkar J.; Sarswat N.; Kim G.; Sayer G.; Uriel N.
Institution
(Belkin, Nnanabu, Mehta) Internal Medicine Residency Program, Department
of Medicine, University of Chicago, Chicago, IL
(Feldman) Cardiology, NorthShore University Health System, Evanston, IL
(Penicka) Cardiology, OLV Clinic, Aalst, Belgium
(Giannini, Fiorelli) Cardiology, Aziena Ospedaliero Universitaria Pisana,
Pisa, Italy
(Braun) Cardiology, Klinikum der Universitat Munchen, Munich, Germany
(Swaans, Heyden) Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Claeys) Cardiology, University Hospital Antwerp, Edegem, Belgium
(Orban) Cardiology, Ludwig-Maximilians-Universitat Munchen, Munich,
Germany
(Kalantari, Raikhelkar, Sarswat, Kim, Sayer, Uriel) Cardiology, University
of Chicago, Chicago, IL
Publisher
Elsevier Inc.
Abstract
Purpose: Mitral regurgitation (MR) is associated with increased mortality
in heart failure patients. Mitraclip has shown similar mortality, but less
morbidity, in comparison with surgical repair, and it is indicated in
patients at high surgical risk. Further analysis has suggested worse
outcomes in patients with advanced heart failure. This study aims to
assess outcomes following Mitraclip placement in patients with advanced
heart failure (either EF <= 35% and/or NYHA class IV symptoms).
 Method(s): The Ovid Medline, Cochrane, and Scopus databases (through
12/2016) were searched. Randomized controlled trials, prospective, and
retrospective studies of Mitraclip use in patients with mortality outcomes
at 12-month follow-up were included. Result(s): Of 595 studies
identified, 25 were included, of which 10, evaluating 1,042 patients,
provided additional essential data, 13 did not respond, and 2 denied our
request. Average age was 72.5 years, 28.9% were female, and 69% had
functional MR. A significant increase in mortality was noted in patients
with EF <= 35% compared to those with EF > 35%. Mortality rates were 19.8%
and 12.8%, respectively, and RR 1.53 (95% CI 1.08-2.17, p=0.02). Patients
with NYHA IV symptoms at the start of the study had a significant increase
in mortality, with a rate of 33.7% vs 13.6% for NYHA I-III, and RR 2.08
(95% CI 1.58-2.73, p<0.00001). In 5 studies with data comparing those with
EF <= 35% and NYHA IV symptoms to those with EF > 35% and NYHA I-III
symptoms, mortality rates were significantly increased in the former
group, 28.6% vs 7.2%, respectively, and RR 4.05 (95% CI 1.90-8.62,
p=0.003). Conclusion(s): Mitraclip implantation in patients with
advanced heart failure was associated with significantly increased rates
of mortality at 12-month follow-up, with one in three NYHA class IV
patients undergoing Mitraclip dead within one year. This meta-analysis
calls for evaluation of advanced heart failure options (i.e. left
ventricular assist device or heart transplant) as an alternative to
Mitraclip. [Formula presented] Copyright © 2018

<99>
Accession Number
2007585288
Title
MS 07.05 ESTS Registration for Neuroendocrine Tumors.
Source
Journal of Thoracic Oncology. Conference: IASLC 18th World Conference on
Lung Cancer. Japan. 12 (11 Supplement 2) (pp S1685-S1686), 2017. Date of
Publication: November 2017.
Author
Filosso P.L.; Guerrera F.; Lyberis P.
Institution
(Filosso, Guerrera, Lyberis) Sugical Sciences, University of Torino Italy,
Torino, IT, United Kingdom
Publisher
Elsevier Inc.
Abstract
Lung Neuroendocrine Tumors (NETs) are rare neoplasms derived from the
neuroendocrine cells of the bronchopulmonary epithelium. They represent
about 25% of all the neuroendocrine tumors, and no more than 2%-3% of all
the primary tumors of the lung. Their incidence has recently increased by
approximately 6% per year, probably due to the improved awareness as well
as for the diffusion of lung cancer screening programs worldwide. NETs'
incidence now ranges from 0.2 to 2 per 100,000 individuals per year in the
United States. Their rarity, along with the lack of randomized clinical
trials, make lung NETs' global management still questioned, especially in
case of advanced diseases, and only few clinical recommendations currently
exist. In 2012, during the Annual Meeting in Essen (Germany), the European
Society for Thoracic Surgeons (ESTS) created a new Working Group (WG)
specifically dedicated to the Lung NETs. The Steering Committees was
composed by the following Thoracic Surgeons: Pier Luigi Filosso (Torino,
Italy-Chair), Pascal Alexandre Thomas (Marseille, France), Mariano
Garcia-Yuste (Valladolid, Spain), Eric Lim (London, UK), Federico Venuta
(Rome, Italy), Alessandro Brunelli and Konstantinos Papagiannopoulos
(Leeds, UK), Hisao Asamura (Tokyo, Japan). The aim of this WG was to
create a group of physicians expert on Lung NETs in order to improve
scientific knowledge on such rare neoplasms, and disseminate it among the
scientific community. A specific database was rapidly designed, to
retrospectively collect data of patients operated for lung NETs, and it
was sent to all the ESTS Members who expressed their interest to this
project. Moreover, a survey concerning lung NETs'clinical management was
prepared and its results were recently published (Future Oncol.
2016;12:1985-1999). Up to now, 2040 operated NETs patients have been
collected amongst 17 high-volume International Thoracic Surgery
Institution worldwide. This retrospective database was used for several
studies about lung NETs clinical behavior and outcome. In particular, the
outcome and prognostic factors of two aggressive lung NETs: atypical
carcinoids (ACs) and large-cell neuroendocrine carcinomas (LCNCs) were the
object of the first publication (Eur.J.Cardiothorac Surg. 2015;48:55-64).
For ACs, age (P<0.001), tumor size (P=.015) and sub-lobar resections
(P=0.005) were independent negative prognostic factors; for LCNCs, only
pTNM stage III tumors (P=0.016) negatively affected outcome in the
multivariate analysis. Local recurrences and distant metastases were
statistically more frequent in LCNCs (P=0.02), as expected. A prognostic
model of survival for typical carcinoids (TCs) was the matter of the
second publication (Eur.J.Cardiothorac Surg. 2015;48:441-447): an analysis
of 1109 TC patients was performed. A prediction model for mortality,
evaluating age, gender, previous malignancies, peripheral tumor location,
TNM stage and ECOG PS was elaborated, and the final model showed a good
discrimination ability with a C-statistic equal to 0.836 (bootstrap
optimism-corrected 0.806). Moreover, this model has been recently
validated by Cattoni and Coll. The treatment of biologically
aggressive/advanced lung NETs was recently investigated in a paper
published by the Journal of Thoracic Disease (J.Thorac. Dis.
2015;7:S163-S171). Surgery, whenever feasible, remains the mainstay of
treatment, and chemo/radiotherapy should be reserved to progressive
diseases. In case of resected N1-N2 carcinoids, a "watch and see" policy
and a close clinical/radiological follow-up is also recommended. Surgery
alone is not sufficient to treat high-grade NETs (e.g.: LCNC): adjuvant CT
is suggested even in early stages. Platinum-Etoposide regimen demonstrated
to be the most effective; Irinotecan and other biological drugs are also
regarded to be very promising. The management of advanced lung NETs should
be tailored by multidisciplinary teams including Medical and Radiation
Oncologists, Surgeons, Pathologists, Pulmonologists, Endocrinologists,
Interventional Radiologists; patients' prognosis is mainly dependent on
tumor grade and its anatomical extent. Large-cell neuroendocrine carcinoma
(LCNC) is a rare tumor characterized by an aggressive biological behavior
and poor prognosis; its optimal treatment is still under debate. Some
recent reports indicate that adjuvant chemotherapy (CT) may have a
beneficial effect on survival. Data from 400 patients with resected LCNC
were analyzed. The 3- and 5-year survival rates were 54.1% and 45%,
respectively. With the multivariable model, increasing age, ECOG >=2 and
advanced TNM stage were indicators of poor prognosis. Weak evidence of a
higher overall survival in patients receiving adjuvant CT (adjusted hazard
ratio 0.73; 95% confidence interval: 0.56-0.96, P = 0.022) was also
observed (Eur.J.Cardio-Thorac.Surg. 2017;52:339-345). In Stage I TCs
(SITCs) non-anatomical resections (wedge) are sometimes advocated because
of their indolent behavior. An analysis on effect of surgical procedure on
SITC patients' survival was therefore done (Eur.J.Cardiothorac.Surg. 2017
submitted paper). Eight-hundred seventy-six SITC patients (569
females,65%) were included in this study; the 5-year OS rate was 94.3%
(95%CI:92.2 -95.9). At univariable analysis, wedge resection resulted to
be associated with a poor prognosis (5-year OS 82%,95%CI:0.71-0.89,P<.001)
compared to other anatomical resections. At multivariable score-adjusted
analysis, wedge resection confirmed to be an independent predictor of poor
prognosis (HR2.17,95%CI: 1.19-3.96,P=.012). Since 2106, a lung NETs
prospective database is active through the official ESTS European
Database, and up to now, more than 150 new cases have been collected.
Through this new platform, very easy to be used, we are confident to
collect, in few years, more data especially on possible tumor recurrences
and their treatment, as well as on the role of emerging biological drugs
used in the adjuvant setting in advanced diseases. An active participation
of Medical/Radiation Oncologists to this scientific project would be also
desirable. The active role of the most important Scientific Societies
could strongly support the success of this scientific project. Keywords:
Surgery, registry, Lung neuroendocrine tumors Copyright © 2017

<100>
Accession Number
2007585281
Title
OA 16.02 Risk of Recurrence in Stage I Adenocarcinoma of the Lung: A
Multi-Institutional Study on Interaction with Type of Surgery and Type of
Nodal Staging.
Source
Journal of Thoracic Oncology. Conference: IASLC 18th World Conference on
Lung Cancer. Japan. 12 (11 Supplement 2) (pp S1788), 2017. Date of
Publication: November 2017.
Author
Guerrera F.; Lococo F.; Evangelista A.; Rena O.; Ampollini L.; Vannucci
J.; Ventura L.; Marchese V.; Paci M.; Filosso P.L.; Oliaro A.; Casadio C.;
Puma F.; Ardissone F.; Ruffini E.
Institution
(Guerrera, Marchese, Filosso, Oliaro, Ruffini) Thoracic Surgery,
University of Torino, Torino/IT
(Lococo, Paci) Unit of Thoracic Surgery, IRCCS_Arcispedale Santa Maria
Nuova, Reggio Emilia/IT
(Evangelista) Unit of Cancer Epidemiology and Cpo Piedmont, CittA Della
Salute E Della Scienza University Hospital, Torino/IT
(Rena, Casadio) Amedeo Avogadro' University of Eastern Piedmont, Novara/IT
(Ampollini) Department of Surgical Sciences, Thoracic Surgery, University
Hospital of Parma, Parma/IT
(Vannucci, Puma) University of Perugia, Perugia/IT
(Ventura) Thoracic Surgery, University Hospital of Parma, Parma/IT
(Ardissone) Oncology, University of Torino, Torino/IT
Publisher
Elsevier Inc.
Abstract
Background: In last years, an increasing interest emerges on the role of
sub-lobar resection and lobe-specific lymph node dissection in the
treatment of early stage lung cancer. The aim of our study was to define
impact on Cumulative incidence of recurrence (CIR) of type of surgical
resection and type of nodal staging. Furthermore, we evaluated the effect
of interactions between the different kinds of procedure. Method(s):
An analysis of 969 consecutive stage I pulmonary adenocarcinoma patients,
operated in six Thoracic Surgery Institutions between 2001 and 2013, was
conducted. Type of surgical resection included lobectomy and sub-lobar
resection; pneumonectomy and bilobectomy were excluded from the analysis.
Nodal staging procedures were classified in nodal sampling (NS),
lobe-specific lymph node dissection (LS-ND) and systematic lymph node
dissection (SND). Multivariable-adjusted comparisons for CIR was performed
using Fine and Grey model, taking into account death by any cause as
competing event. Test of interaction between type of surgical resection
and type of nodal staging was carried out and results presented in a
stratified way. Missing data were multiple-imputed, combined estimates
were obtained from 5 imputed datasets. Result(s): Median follow-up
was 63 months. Eight-hundred forty-six (87%) patients were submitted to
lobectomy, while 123(13%) to sub-lobar resection. Four-hundred fifty-five
(47%) patients received SND, 98(10%) LS-ND and 416(43%) NS. Two-hundred
forty-seven (26%) patients developed a local/distant recurrence with a
5-year CIR of 24%. Multivariable-adjusted comparisons showed an
independent negative effect of sub-lobar resection(HR
1.52;95%CI:1.07-2.17), LS-ND(HR 1.74;95%CI:1.16-2.6) and NS(HR
1.49;95%CI:1.12-1.98) on CIR(Table). Test of interaction showed an
homogeneity of results among subgroups. Conclusion(s): In our series,
lobectomy and systematic lymph node dissection confirmed to be the optimal
strategy to achieve a favorable prognosis in stage I adenocarcinoma of the
lung. The real value of sub-lobar resection and less aggressive nodal
staging should be assessed by randomized clinical trial before being
integrated in clinical practice. Keywords: NSCLC, Surgery, recurrence
[Formula presented] [Formula presented] [Formula presented] Copyright
© 2017

<101>
Accession Number
2007639873
Title
TCT-664 Comparison of General versus Local Anesthesia in Patients
Undergoing Transcatheter Aortic Valve Replacement (TAVR): A Meta-analysis.
Source
Journal of the American College of Cardiology. Conference: Twenty-Eighth
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 68 (18 Supplement) (pp B269), 2016. Date of Publication: 1
November 2016.
Author
Villablanca P.; Makkiya M.; Nikolic K.; Wang K.; Lesniak-Sobelga A.;
Augoustides J.; Maldonato Y.; Ramakrishna H.
Institution
(Villablanca) Montefiore Medical Center, New York, NY, United States
(Makkiya) montefiore, Bronx, NY, United States
(Nikolic) Mayo Clinic Arizona
(Wang) St. Luke's Mid America Institute
(Lesniak-Sobelga) Department of Cardiac And Vascular Diseases, John Paul
II Hospital, Krakow, Poland
(Augoustides) Interventional Cardiology Unit, University of Palermo, Italy
(Maldonato) Bristol Heart Institute
(Ramakrishna) Mayo Clinic, Phoenix, AZ, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter Aortic Valve Replacement (TAVR) is typically
performed under general anesthesia with endotracheal intubation (GA).
There is growing data in the literature however, that this procedure can
be safely performed under local anesthesia (LA). Method(s): We
performed a comprehensive search of EMBASE, PUBMED, and Web of Science
databases. Odds ratios (OR), difference of the mean (DM) and 95%
confidence intervals (CI) were computed using the Mantel-Haenszel method.
Fixed-effect model was used; if heterogeneity (I2)>40, effects were
obtained using a random model. Sensitivity and cumulative analysis was
performed for each outcome. Result(s): A total of 18 studies and 19
255 patients were included in meta-analysis. The use of GA for TAVR was
associated with an increased overall 30- day mortality (RR 1.35, Cl
1.07-1.70), length of stay (DM 2.33, CI 1.28-3.38), ICU stay (DM 8.98, CI
1.47-16.50), procedural time (DM 24.46, CI 16.52-32.41), use of
vasopressors/inotropes (RR 1.95, CI 1.58-2.40), vascular complications (RR
1.41, CI 1.05-1.89) and post procedural intubation (RR 32.71, CI
18.18-58.88). TAVR with GA showed a lower incidence of paravalvular leak
(RR 0.8, CI 0.66-0.80). No difference was observed between GA and LA for
stroke (RR 1.15, Cl 0.91-1.45), cardiovascular mortality (RR 1.32, Cl
0.83-2.10), permanent pacemaker implantation (RR 1.32, Cl
0.83-2.10),vascular complications (RR 1.11, Cl 0.84-1.46),major bleeding
(RR 1.09, Cl 0.70-1.68), acute kidney injury (RR1.07, CL 0.69-1.65),
myocardial infarction (RR 0.72, Cl 0.39-1.33), procedural success (RR
1.01, CL 0.96-1.06),conduction abnormalities (RR 0.83,Cl
0.64-1.07),annular rupture (RR 0.73, Cl 0.27-1.99) and fluoroscopy time
(DM 1.77, Cl - 0.06-3.61). Conclusion(s): Our meta- analysis suggests
that the use of LA in patients undergoing TAVR is associated with
decreased mortality, shorter hospital stay, reduced vascular complications
and procedural time. Further large randomized trials are needed to confirm
our findings. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2016

<102>
Accession Number
2007639576
Title
TCT-222 Clinical Outcomes of Dual Antiplatelet Therapy after Coronary
Stenting in Patients with Chronic Kidney Disease: Patient-level
Meta-analysis of 4 Randomized Clinical Trials.
Source
Journal of the American College of Cardiology. Conference: Twenty-Eighth
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 68 (18 Supplement) (pp B90-B91), 2016. Date of Publication: 1
November 2016.
Author
Hwang D.; Lee J.M.; Rhee T.-M.; Park J.; Woo (KW) Park K.; Hong M.-K.;
Jang Y.; Valgimigli M.; Colombo A.; Gilard M.; Palmerini T.; Stone G.; Kim
H.-S.
Institution
(Hwang) Seoul National University Hospital
(Lee, Rhee, Park, Woo (KW) Park, Kim) Seoul National University Hospital,
Seoul, South Korea
(Hong) Yonsei University College of Medicine, Seoul, South Korea
(Jang) Unknown
(Valgimigli) Thoraxcenter, Bern, Switzerland
(Colombo) San Raffaele Scientific Institute, Milan, Italy
(Gilard) Brest University, Brest, France
(Palmerini) Policlinico S. Orsola, Bologna, Italy
(Stone) Columbia University Medical Center/NewYork-Presbyterian Hospital,
New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Dual antiplatelet therapy (DAPT) for 6 months to 12 months is
recommended after coronary stenting with drug-eluting stent (DES).
However, DAPT in patients with chronic kidney disease (CKD) has not been
thoroughly investigated. Method(s): Patient-level pooled analysis was
performed with 5,843 patients from 4 randomized controlled trials (RESET,
PRODIGY, ITALIC, and SECURITY), which evaluated DAPT in patients who
underwent coronary stenting with DES. The 1-year clinical outcomes were
compared between short-term DAPT group (<=6-month) and long-term DAPT
group (>6-month), stratified by the presence of CKD. Patient-oriented
composite outcome (POCO, a composite of all cause death, any myocardial
infarction [MI], stroke and TIMI major bleeding) was the primary endpoint.
 Result(s): Among the total patients, 816 patients had CKD (eGFR by
CKD-EPI <60ml/min/m2), while 5,027 patients had normal renal function.
Most patients (88.9%) were treated by 2nd generation DES. In the CKD
population, the rates of POCO at 1 year were 8.0% in the short-term DAPT
group and 9.0% in the long-term DAPT group (HR 1.22, 95% CI 0.75-1.99,
p=0.430). In the non-CKD population, this rate was lower and did not
differ significantly by DAPT duration (2.7% vs. 3.2%, HR 1.15, CI
0.82-1.60, p=0.416). The incidence of thrombotic events (any MI and and
definite/probable stent thrombosis) did not differ between short-term and
long-term DAPT in either CKD or non-CKD population. TIMI major bleeding,
however, were more frequent in the long-term than the short-term DAPT
group, which did not reach the statistical significance in smaller CKD
population (1.3% vs. 0.3%, HR 5.05, CI 0.59-43.2, p=0.139) but reached
significance in larger non-CKD population (1.8% vs. 0.3%, HR 2.80, CI
1.19-6.63, p=0.019). Conclusion(s): Duration of DAPT after coronary
stenting with 2nd generation DES did not affect POCO and thrombotic events
in CKD population as well as in non-CKD one. But long-term DAPT may
increase the incidence of TIMI major bleeding, which reached statistical
significance in the larger non-CKD population while did not in the smaller
CKD one. Categories: CORONARY: Pharmacology/Pharmacotherapy Copyright
© 2016

<103>
Accession Number
2007640043
Title
TCT-683 A Meta-analysis and Meta-regression of Long-Term Outcomes of
Transcatheter versus Surgical Aortic Valve Replacement for Severe Aortic
Stenosis.
Source
Journal of the American College of Cardiology. Conference: Twenty-Eighth
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 68 (18 Supplement) (pp B276-B277), 2016. Date of Publication: 1
November 2016.
Author
Villablanca P.; Makkiya M.; Mathew V.; Thourani V.; Rodes-Cabau J.;
Bangalore S.; Vlismas P.; Briceno D.; Slovut D.; Taub C.; McCarthy P.;
Augoustides J.; Ramakrishna H.
Institution
(Villablanca) Montefiore Medical Center, New York, NY, United States
(Makkiya) montefiore, Bronx, NY, United States
(Mathew) Mayo Clinic, Rochester, MN, United States
(Thourani) Emory University Hospital Midtown, Atlanta, GA, United States
(Rodes-Cabau) Quebec Heart and Lung Institute/Laval University, Quebec,
QC, Canada
(Bangalore) New York University School of Medicine, New York, NY, United
States
(Vlismas) Sunnybrook Health Sciences Centre
(Briceno) Montefiore Medical Center/Albert Einstein College of Medicine,
Bronx, NY, United States
(Slovut) Montefiore Medical Center, New Rochelle, NY, United States
(Taub) Department of Cardiology, Montefiore Medical Center/Albert Einstein
College of Medicine, Bronx, NY, United States
(McCarthy) Northwestern University
(Augoustides) Interventional Cardiology Unit, University of Palermo, Italy
(Ramakrishna) Mayo Clinic, Phoenix, AZ, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as
an alternative to surgical aortic-valve replacement (SAVR) for patients
with severe symptomatic aortic stenosis (AS) who are at high operative
risk. We sought to determine the long-term (>=1 year follow-up) safety and
efficacy TAVR compared with SAVR in patients with severe AS.
 Method(s): We conducted electronic datebase search. Primary endpoint
was all cause mortality. Secondary endpoints included myocardial
infarction (MI), stroke, major bleeding, vascular complications, aortic
regurgitation (AR), acute kidney injury (AKI) and permanent pacemaker
implantation (PPM). Mantel-Haenszel (MH) method for odds ratios (OR) and
95% confidence intervals (CI) were computed. Fixed-effect model was used;
if heterogeneity (I2)>25, effects were obtained using a random model.
 Result(s): 4 RCTs (n= 3,806) and 33 cohorts (n= 40,441) enrolled a
total of 44,247 patients met the inclusion criteria. The mean duration
follow-up was 21.4 months. No difference was found in long-term all-cause
mortality (Risk ratios (RR), 1.06; 95% confidence interval (Cl)
0.91-1.22). There was a significant difference favoring TAVR in the
incidence of stroke (RR, 0.82; 95% Cl 0.71-0.94), atrial fibrillation (RR,
0.43; 95% Cl 0.33-0.54), acute kidney injury (RR, 0.70; 95% Cl 0.53-0.92),
and major bleeding (RR, 0.57; 95% Cl 0.40-0.81). TAVR had significant
higher incidence of vascular complications (RR, 2.90; 95% Cl 1.87-4.49),
aortic regurgitation (RR, 7.00; 95% Cl 5.27-9.30), and pacemaker
implantation (PPM) (RR, 2.02; 95% Cl 1.51-2.68). TAVR demonstrated
significantly lower stroke risk compared to SAVR in high-risk patients
(RR, 1.49; 95% Cl 1.06-2.10); no differences in PPM implantation was
observed in intermediate-risk patients (RR, 1.68; 95% Cl 0.94-3.00). In a
meta-regression analysis, the effect of TAVR baseline clinical features
did not affect the long-term all-cause mortality outcome.
 Conclusion(s): Our meta-analysis showed that TAVR is as effective as
SAVR in high-risk patients with AS for the endpoint of long-term survival;
each intervention confers its own significant complications. There is
early evidence that TAVR may be superior to SAVR in intermediate-risk
patients. Categories: STRUCTURAL: Valvular Disease: Aortic Copyright
© 2016

<104>
Accession Number
2007934155
Title
Dexmedetomidine Improves Lung Function by Promoting Inflammation
Resolution in Patients Undergoing Totally Thoracoscopic Cardiac Surgery.
Source
Oxidative Medicine and Cellular Longevity. 2020 (no pagination), 2020.
Article Number: 8638301. Date of Publication: 2020.
Author
Cui J.; Gao M.; Huang H.; Huang X.; Zeng Q.
Institution
(Cui, Gao, Huang, Zeng) Department of Anesthesiology, Cardiovascular
Institute of Guangdong Province, Guangdong Provincial People's Hospital,
Guangzhou, Guangdong 510030, China
(Cui, Gao, Huang, Zeng) Department of Anesthesiology, Guangdong Provincial
People's Hospital Zhuhai Hospital, Zhuhai Golden Bay Center Hospital,
Zhuhai, Guangdong 519000, China
(Huang) Department of Clinical Laboratory, Guangdong Provincial People's
Hospital Zhuhai Hospital, Zhuhai Golden Bay Center Hospital, Zhuhai,
Guangdong 519000, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objective. Totally thoracoscopic cardiac surgery under cardiopulmonary
bypass combined with one-lung ventilation has been identified as the trend
in cardiac surgery. The aim of this study was to examine the effects of
the selective alpha2 adrenergic receptor agonist dexmedetomidine on the
pulmonary function of patients who underwent mitral valve surgery using
the totally thoracoscopic technique. Methods. Fifty-seven patients who
underwent thoracoscopic mitral valve surgery between July 2019 and
December 2019 were selected. The patients were randomly divided into the
control (Con) group (n=28) and the dexmedetomidine (DEX) group (n=29)
using the random number table method. Arterial blood gas analyses were
performed, and the oxygenation (PaO2/FiO2) and respiratory indexes
(P(A-a)O/PaO2) were calculated 5 min after tracheal intubation (T1), 2 h
after operation (T2), 6 h after operation (T3), and 24 h after operation
(T4). Moreover, the serum cytokines interleukin-6 (IL-6), tumor necrosis
factor-alpha (TNF-alpha), and intercellular adhesion molecule-1 (ICAM-1)
were detected using the enzyme-linked immunosorbent method at all time
points. Chest radiography was performed 24 h after surgery. Peripheral
blood samples were collected before and after the operation for a complete
hemogram. Additionally, the procalcitonin concentration was measured and
recorded when the patients were transported to the intensive care unit
(ICU). The postoperative extubation time, length of ICU stay, and
pulmonary infection rate were also recorded. Results. Inflammatory
reaction after surgery was evident. However, the inflammatory cytokines
IL-6, TNF-alpha, and ICAM-1 in the DEX group were lower than those in the
Con group after surgery (T2 to T4; P<0.05). Neutrophil counts and
procalcitonin concentration were higher in the Con group than in the DEX
group (P<0.05). In addition, in the DEX group, pulmonary exudation on
chest radiography was lower, and pulmonary function, as shown by an
increase in oxidation index and decrease in the respiratory index,
improved after surgery (P<0.05). Moreover, the duration of mechanical
ventilation in the Con group was 3.4 h longer than that in the DEX group.
Conclusion. Dexmedetomidine has a protective effect on pulmonary function
in patients undergoing mitral valve surgery using a totally video-assisted
thoracoscopic technique, which may be related to a reduction in the
concentration of inflammatory cytokines in the early perioperative
period. Copyright © 2020 Junji Cui et al.

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