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<1>
Accession Number
630274945
Title
Decreasing postoperative cognitive deficits after heart surgery: protocol
for a randomized controlled trial on cognitive training.
Source
Trials. 20 (1) (pp 733), 2019. Date of Publication: 16 Dec 2019.
Author
Butz M.; El Shazly J.; Sammer G.; Tschernatsch M.; Kastaun S.; Yenigun M.;
Braun T.; Kaps M.; Boning A.; Puvogel U.; Bachmann G.; Mengden T.;
Schonburg M.; Gerriets T.; Juenemann M.
Institution
(Butz, El Shazly, Yenigun, Braun, Kaps, Juenemann) Department of
Neurology, Heart and Brain Research Group, University Hospital Giessen and
Marburg, Klinikstrase 33, Giessen 35385, Germany
(Butz, El Shazly, Yenigun, Braun, Schonburg, Gerriets, Juenemann)
Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center,
Benekestrase 2-8, Bad Nauheim 61231, Germany
(Sammer) Cognitive Neuroscience at the Centre of Psychiatry, University
Giessen, Klinikstrase 36, Giessen 35385, Germany
(Tschernatsch, Gerriets) Department of Neurology, Community Hospital
Friedberg, Friedberg 61169, Germany
(Kastaun) Institute of General Practice, Addiction Research and Clinical
Epidemiology Unit, Medical Faculty of the Heinrich-Heine University
Dusseldorf, Werdener Strase 4Dusseldorf 40227, Germany
(Boning, Puvogel) Department of Cardiovascular Surgery, University
Hospital Giessen and Marburg, Rudolf-Buchheim-Strase 7, Giessen 35385,
Germany
(Bachmann) Department of Radiology, Kerckhoff Heart and Thorax Center,
Benekestrase 2-8, Bad Nauheim 61231, Germany
(Mengden) Department of Rehabilitation, Kerckhoff Heart and Thorax Center,
Bad Nauheim 61231, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: The occurrence of postoperative cognitive deficits, especially
after heart surgery, has been demonstrated in several studies. These
deficits can clearly be noticed by the patients and by their close
relatives in daily life. Furthermore, postoperative cognitive deficits can
decrease quality of life in social functioning and earning capacity. The
aim of this study is to investigate whether early postoperative cognitive
training can reduce subjective and objective postoperative cognitive
deficits. <br/>METHOD(S): The proposed study is a multicenter, two-arm,
randomized controlled trial involving 144 elderly patients undergoing
elective heart-valve surgery with extracorporeal circulation. Patients
will be assigned to either a training group or a control group. The
intervention involves paper-and-pencil-based cognitive training, which is
conducted for 36min over a period of 18days. The training starts about
1week after surgery and is carried out during the hospitalized
rehabilitation phase. The control group will not receive cognitive
training or a placebo intervention. A detailed assessment of psychological
functions and health-related quality of life prior to surgery at discharge
from rehabilitation and 3 and 12months after discharge will be performed.
The primary outcome of this trial is the training effect on objective
cognitive functions at discharge from rehabilitation. Secondary outcomes
are the training effect on objective and subjective cognitive functions (3
and 12months after discharge), depression, health-related quality of life,
and the impact of perioperative cerebral ischemia on the training effect.
Perioperative cerebral ischemia will be measured with postoperative
magnetic resonance imaging including diffusion-weighted sequences.
DISCUSSION: Should it be shown that our cognitive training can improve
postoperative cognitive deficits and quality of life, one possibility
could be to integrate this intervention into early rehabilitation.
Furthermore, we hope that the investigation of perioperative ischemia by
diffusion-weighted magnetic resonance imaging will improve our
understanding of neurobiological factors influencing the course of
postoperative cognitive plasticity. TRIAL REGISTRATION: German Clinical
Trials Register (DRKS), DRKS00015512. Retrospectively registered on 21
September 2018.

<2>
Accession Number
630274868
Title
Multicenter randomized study on the comparison between electronic and
traditional chest drainage systems.
Source
Trials. 20 (1) (pp 730), 2019. Date of Publication: 16 Dec 2019.
Author
Marulli G.; Comacchio G.M.; Nosotti M.; Rosso L.; Mendogni P.; Natale G.;
Andriolo L.; Imbriglio G.; Larocca V.; Brascia D.; Rea F.
Institution
(Marulli, Brascia) Thoracic Surgery Unit, Department of Organ
Transplantation and Emergency, University Hospital of Bari, Piazza Giulio
Cesare ,11, Bari 70124, Italy
(Comacchio, Natale, Rea) Thoracic Surgery Unit, Department of Cardiologic,
Thoracic and Vascular Sciences, University Hospital of Padova, Padova,
Italy
(Nosotti, Rosso, Mendogni) Thoracic Surgery Unit, Fondazione IRCCS Ca'
Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
(Andriolo, Imbriglio, Larocca) Thoracic Surgery Unit, 'V Fazzi' Hospital,
Lecce, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: In patients submitted to major pulmonary resection, the
postoperative length of stay is mainly influenced by the duration of air
leaks and chest tube removal. The measurement of air leaks largely relies
on traditional chest drainage systems which are prone to subjective
interpretation. Difficulty in differentiating between active air leaks and
bubbles due to a pleural space effect may also lead to tentative drain
clamping and prolonged time for chest drain removal. New digital systems
allow continuous monitoring of air leaks, identifying subtle leakage that
may be not visible during daily patient evaluation. Moreover, an objective
assessment of air leaks may lead to a reduced interobserver variability
and to an optimized timing for chest tube removal. <br/>METHOD(S): This
study is a prospective randomized, interventional, multicenter trial
designed to compare an electronic chest drainage system (DrentechTM Palm
Evo) with a traditional system (DrentechTM Compact) in a cohort of
patients undergoing pulmonary lobectomy through a standard three-port
video-assisted thoracic surgery approach for both benign and malignant
disease. The study will enroll 382 patients in three Italian centers. The
duration of chest drainage and the length of hospital stay will be
evaluated in the two groups. Moreover, the study will evaluate whether the
use of a digital chest system compared with a traditional system reduces
the interobserver variability. Finally, it will evaluate whether the
digital drain system may help in distinguishing an active air leak from a
pleural space effect, by the digital assessment of intrapleural
differential pressure, and in identifying potential predictors of
prolonged air leaks. DISCUSSION: To date, few studies have been performed
to evaluate the clinical impact of digital drainage systems. The proposed
prospective randomized trial will provide new knowledge to this research
area by investigating and comparing the difference between digital and
traditional chest drain systems. In particular, the objectives of this
project are to evaluate the feasibility and usefulness of digital chest
drainages and to provide new tools to identify patients at higher risk of
developing prolonged air leaks. TRIAL REGISTRATION: ClinicalTrials.gov,
NCT03536130. Retrospectively registered on 24 May 2018.

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

<4>
Accession Number
2004351409
Title
Performance of Prognostic Risk Scores in Heart Failure Patients: Do Sex
Differences Exist?.
Source
Canadian Journal of Cardiology. 36 (1) (pp 45-53), 2020. Date of
Publication: January 2020.
Author
Vishram-Nielsen J.K.K.; Foroutan F.; Ross H.J.; Gustafsson F.; Alba A.C.
Institution
(Vishram-Nielsen, Foroutan, Ross, Alba) Heart Failure and Transplant
Program, Peter Munk Cardiac Centre, University Health Network, Toronto,
Ontario, Canada
(Vishram-Nielsen, Gustafsson) Department of Cardiology, Rigshospitalet,
University Hospital of Copenhagen, Copenhagen, Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Sex differences in the performance of prognostic risk scores
in heart failure (HF) patients have not previously been investigated. We
examined the performance of 2 commonly used scores in predicting mortality
and a composite end point consisting of ventricular assist device, heart
transplantation, or mortality in women vs men with HF. <br/>Method(s):
This was a retrospective study of 1,136 (25% women) consecutive ambulatory
adult HF patients with reduced left ventricular ejection fraction (<= 40%)
followed at a single institution from 2000 to 2012. Discrimination,
calibration, and absolute risk reclassification of the Seattle Heart
Failure Model (SHFM) and the Meta-Analysis Global Group in Chronic Heart
Failure (MAGGIC) score to predict 1- and 3-year outcomes were compared
between women and men. <br/>Result(s): At 1- and 3-year follow-ups, 116
(22% women) and 231 (21% women) patients died, respectively. Survival was
equal between sexes (P = 0.41). The SHFM and the MAGGIC score showed
similar discriminatory capacity in women (c-statistics 0.84, 95% CI
0.77-0.92, and 0.74, 95% CI 0.64-0.83) and men (c-statistics 0.74, 95% CI
0.69-0.79, and 0.70, 95% CI 0.64-0.75). There was no difference in the
predicted and observed 1-year mortality by the scores in both sexes.
Compared with the SHFM, the MAGGIC score better reclassified 10% (95% CI
7%-14%) of women and 18% (95% CI 15%-20%) of men. At 3-year follow-up,
similar results were seen for discrimination, whereas both scores
overestimated mortality with more marked overestimation in women. The
results were reproducible for the composite end point, with improved
calibration at 3-year follow-up in both scores. <br/>Conclusion(s): Our
findings support the use of the MAGGIC score in both women and men owing
to better risk classification.<br/>Copyright &#xa9; 2019 Canadian
Cardiovascular Society

<5>
Accession Number
2003353364
Title
Near-infrared spectroscopy monitoring in cardiac and noncardiac surgery:
Pairwise and network meta-analyses.
Source
Journal of Clinical Medicine. 8 (12) (no pagination), 2019. Article
Number: 2208. Date of Publication: December 2019.
Author
Ortega-Loubon C.; Herrera-Gomez F.; Bernuy-Guevara C.; Jorge-Monjas P.;
Ochoa-Sangrador C.; Bustamante-Munguira J.; Tamayo E.; Alvarez F.J.
Institution
(Ortega-Loubon, Bustamante-Munguira) Department of Cardiac Surgery,
University Clinical Hospital of Valladolid, Ramon y Cajal Ave. 3,
Valladolid 47003, Spain
(Ortega-Loubon, Herrera-Gomez, Jorge-Monjas, Tamayo, Alvarez) BioCritic.
Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal
Ave. 7, Valladolid 47005, Spain
(Herrera-Gomez, Bernuy-Guevara, Alvarez) Pharmacological Big Data
Laboratory, Department of Pharmacology and Therapeutics, University of
Valladolid, Ramon y Cajal Ave. 7, Valladolid 47005, Spain
(Herrera-Gomez) Department of Anatomy and Radiology, Faculty of Medicine,
University of Valladolid, Ramon y Cajal Ave. 7, Valladolid 47005, Spain
(Jorge-Monjas, Tamayo) Department of Anaesthesiology, University Clinical
Hospital of Valladolid, Ramon y Cajal Ave. 3, Valladolid 47003, Spain
(Jorge-Monjas, Tamayo) Department of Surgery, Faculty of Medicine,
University of Valladolid, Ramon y Cajal Ave. 7, Valladolid 47005, Spain
(Ochoa-Sangrador) Clinical Epidemiology Support Office, Sanidad Castilla y
Leon, Requejo Ave. 35, Zamora 49022, Spain
(Alvarez) Ethics Committee of Drug Research-East Valladolid, University
Clinical Hospital of Valladolid, Ramon y Cajal Ave. 3, Valladolid 47003,
Spain
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Goal-directed therapy based on brain-oxygen saturation (bSo<inf>2</inf>)
is controversial and hotly debated. While meta-analyses of aggregated data
have shown no clinical benefit for brain near-infrared spectroscopy
(NIRS)-based interventions after cardiac surgery, no network meta-analyses
involving both major cardiac and noncardiac procedures have yet been
undertaken. Randomized controlled trials involving NIRS monitoring in both
major cardiac and noncardiac surgery were included. Aggregate-level data
summary estimates of critical outcomes (postoperative cognitive decline
(POCD)/postoperative delirium (POD), acute kidney injury, cardiovascular
events, bleeding/need for transfusion, and postoperative mortality) were
obtained. NIRS was only associated with protection against POCD/POD in
cardiac surgery patients (pooled odds ratio (OR)/95% confidence interval
(CI)/I²/number of studies (n): 0.34/0.14-0.85/75%/7), although
a favorable effect was observed in the analysis, including both cardiac
and noncardiac procedures. However, the benefit of the use of NIRS
monitoring was undetectable in Bayesian network meta-analysis, although
maintaining bSo<inf>2</inf> > 80% of the baseline appeared to have the
most pronounced impact. Evidence was imprecise regarding acute kidney
injury, cardiovascular events, bleeding/need for transfusion, and
postoperative mortality. There is evidence that brain NIRS-based
algorithms are effective in preventing POCD/POD in cardiac surgery, but
not in major noncardiac surgery. However, the specific target
bSo<inf>2</inf> threshold has yet to be determined.<br/>Copyright &#xa9;
2019 by the authors. Licensee MDPI, Basel, Switzerland.

<6>
Accession Number
2004352926
Title
Comparison of Coronary Artery Bypass Grafting and Drug-Eluting Stents in
Patients with Left Main Coronary Artery Disease and Chronic Kidney
Disease: A Systematic Review and Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 20 (12) (pp 1184-1189), 2019.
Date of Publication: December 2019.
Author
Barbarawi M.; Zayed Y.; Hamid K.; Kheiri B.; Barbarawi O.; Sundus S.;
Rashdan L.; Alabdouh A.; Chahine A.; Bachuwa G.; Alkotob M.L.
Institution
(Barbarawi, Zayed, Hamid, Kheiri, Sundus, Rashdan, Chahine, Bachuwa)
Department of Internal Medicine, Hurley Medical Center/Michigan State
University, Flint, MI 48503, United States
(Barbarawi) Department of Internal Medicine, Mutah University, Al-Karak,
Jordan
(Alabdouh) Department of Internal Medicine, Saint Agnes Hospital,
Baltimore, MD 21229, United States
(Alkotob) Division of Cardiology, Hurley Medical Center/Michigan State
University, Flint, MI 48503, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Treatment of left main coronary artery disease (LMCAD) in
patients with chronic kidney disease (CKD) with either percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG)
remains controversial. Therefore, we performed a meta-analysis to evaluate
the optimal choice of therapy when treating LMCAD in patients with CKD.
<br/>Method(s): We performed an electronic database search of Pubmed,
Embase, and Cochrane Library for all studies that compared PCI with CABG
when treating LMCAD in the setting of CKD. Major adverse cardiac and
cerebrovascular events (MACCE) were the primary outcome. Secondary
outcomes included myocardial infarction (MI), cerebrovascular events,
all-cause mortality, and repeat revascularization. <br/>Result(s): Our
analysis included 5 studies (2 randomized controlled trial and 3
retrospective) representing a total of 1212 patients. Mean follow up was
3.4 +/- 1.3 years. Our study demonstrated a significant reduction in MACCE
for patients treated with CABG compared with PCI (odd ratio [OR] 0.72; 95%
confidence interval [CI] 0.55-0.95, P = 0.02, I² = 0%). We also
found a significant reduction in both MI (OR 0.55; 95% CI 0.34-0.87; P =
0.01; I² = 0%) and repeat revascularization (OR 0.22; 95% CI
0.10-0.51; P < 0.001, I² = 63%) in the CABG group. However,
CABG was associated with increased risks of cerebrovascular disease events
compared with PCI (OR 2.04; 95% CI 1.02-4.08; P = 0.04, I² =
0%). <br/>Conclusion(s): In patients with CKD requiring LMCAD
intervention, CABG is associated with a lower risk of MACCE, MI, and
repeat revascularization, however it was associated with an increased risk
of cerebrovascular accidents when compared to patients who received PCI
therapy. Further RCTs with sufficient power are required to confirm these
findings.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<7>
Accession Number
2003909432
Title
Liraglutide for perioperative management of hyperglycaemia in cardiac
surgery patients: a multicentre randomized superiority trial.
Source
Diabetes, Obesity and Metabolism. (no pagination), 2019. Date of
Publication: 2019.
Author
Hulst A.H.; Visscher M.J.; Godfried M.B.; Thiel B.; Gerritse B.M.; Scohy
T.V.; Bouwman R.A.; Willemsen M.G.A.; Hollmann M.W.; Preckel B.; DeVries
J.H.; Hermanides J.
Institution
(Hulst, Visscher, Hollmann, Preckel, Hermanides) Department of
Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam,
Netherlands
(Hulst, Godfried, Thiel) Department of Anesthesiology, OLVG, Amsterdam,
Netherlands
(Hulst, Gerritse, Scohy) Department of Anesthesiology, Amphia Hospital,
Breda, Netherlands
(Bouwman, Willemsen) Department of Anesthesiology, Catharina Hospitals,
Eindhoven, Netherlands
(DeVries) Department of Endocrinology, Amsterdam UMC, University of
Amsterdam, Amsterdam, Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
Aims: Most cardiac surgery patients, with or without diabetes, develop
perioperative hyperglycaemia, for which intravenous insulin is the only
therapeutic option. This is labour-intensive and carries a risk of
hypoglycaemia. We hypothesized that preoperative administration of the
glucagon-like peptide-1 receptor agonist liraglutide reduces the number of
patients requiring insulin for glycaemic control during cardiac surgery.
<br/>Material(s) and Method(s): In this randomized, blinded,
placebo-controlled, parallel-group, balanced (1:1), multicentre
randomized, superiority trial, adult patients undergoing cardiac surgery
in four Dutch tertiary hospitals were randomized to receive 0.6 mg
subcutaneous liraglutide on the evening before surgery and 1.2 mg after
induction of anaesthesia or matching placebo. Blood glucose was measured
hourly and controlled using an insulin-bolus algorithm. The primary
outcome was insulin administration for blood glucose >8.0 mmol/L in the
operating theatre. Research pharmacists used centralized, stratified,
variable-block, randomization software. Patients, care providers and study
personnel were blinded to treatment allocation. <br/>Result(s): Between
June 2017 and August 2018, 278 patients were randomized to liraglutide
(139) or placebo (139). All patients receiving at least one study drug
injection were included in the intention-to-treat analyses (129 in the
liraglutide group, 132 in the placebo group). In the liraglutide group, 55
(43%) patients required additional insulin compared with 80 (61%) in the
placebo group and absolute difference 18% (95% confidence interval
5.9-30.0, P = 0.003). Dose and number of insulin injections and mean blood
glucose were all significantly lower in the liraglutide group. We observed
no difference in the incidence of hypoglycaemia, nausea and vomiting,
mortality or postoperative complications. <br/>Conclusion(s): Preoperative
liraglutide, compared with placebo, reduces insulin requirements while
improving perioperative glycaemic control during cardiac
surgery.<br/>Copyright &#xa9; 2019 The Authors. Diabetes, Obesity and
Metabolism published by John Wiley & Sons Ltd.

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

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

<10>
Accession Number
630237390
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement in low-risk patients: A propensity score-matched analysis.
Source
European Journal of Cardio-thoracic Surgery. 56 (6) (pp 1131-1139), 2019.
Date of Publication: 01 Dec 2019.
Author
Schaefer A.; Schofer N.; Gossling A.; Seiffert M.; Schirmer J.; Deuschl
F.; Schneeberger Y.; Voigtlander L.; Detter C.; Schaefer U.; Blankenberg
S.; Reichenspurner H.; Conradi L.; Westermann D.
Institution
(Schaefer, Schirmer, Schneeberger, Detter, Reichenspurner, Conradi)
Department of Cardiovascular Surgery, University Heart Center Hamburg,
Martinistrasse 52, Hamburg 20246, Germany
(Schofer, Gosling, Seiffert, Deuschl, Voigtlander, Schaefer, Blankenberg,
Westermann) Department of General and Interventional Cardiology,
University Heart Center Hamburg, Hamburg, Germany
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The aim of the study was to determine the differences in
outcomes of surgical aortic valve replacement (SAVR) and transcatheter
aortic valve implantation (TAVI) in low-risk patients. <br/>METHOD(S): All
patients with a logistic EuroSCORE II <4% who underwent transfemoral TAVI
between 2008 and 2016 (n = 955) or SAVR between 2009 and 2014 (n = 886) at
our centre were included. One hundred and nine patients per group were
available for propensity score matching. <br/>RESULT(S): Mortality during
the 30-day follow-up showed no differences (SAVR vs TAVI: 1.1% vs 1.8%, P
= 1.0) but the rates of permanent pacemaker implantation (0.0 vs 14.8%, P
< 0.001) and paravalvular leakage >= moderate (0.0 vs 7.0%, P = 0.017)
were higher in TAVI patients. No difference was found regarding
postoperative effective orifice area and transvalvular pressure gradients.
Although, the 1-year survival was similar between both groups; 3- and
5-year survival was significantly inferior in the TAVI patient cohort.
<br/>CONCLUSION(S): TAVI yielded similar short-term outcomes compared with
SAVR despite higher rates of permanent pacemaker implantation and
paravalvular leakage >= moderate, but inferior long-term survival. Poorer
long-term outcomes of the TAVI patient cohort were attributable to a more
comorbid TAVI population. This emphasizes the need for long-term results
from randomized controlled trials before TAVI can be broadly expanded to
younger low-risk patients.<br/>Copyright &#xa9; 2019 The Author(s).
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<11>
Accession Number
630236741
Title
The RADial artery International ALliance (RADIAL) extended follow-up
study: Rationale and study protocol.
Source
European Journal of Cardio-thoracic Surgery. 56 (6) (pp 1025-1030), 2019.
Date of Publication: 01 Dec 2019.
Author
Gaudino M.; Benedetto U.; Fremes S.; Ballman K.; Biondi-Zoccai G.;
Sedrakyan A.; Nasso G.; Raman J.; Buxton B.; Hayward P.A.; Moat N.;
Collins P.; Webb C.; Peric M.; Petrovic I.; Yoo K.J.; Hameed I.; Di Franco
A.; Moscarelli M.; Speziale G.; Girardi L.N.; Hare D.L.; Taggart D.P.
Institution
(Gaudino, Hameed, Di Franco, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, United
States
(Benedetto) Department of Cardiac Surgery, Bristol Heart Institute,
Bristol, United Kingdom
(Fremes) Department of Surgery, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, Canada
(Ballman, Sedrakyan) Department of Healthcare Policy and Research, Weill
Cornell Medicine, New York, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Naples, Italy
(Nasso, Moscarelli, Speziale) Anthea Hospital, Bari, Italy
(Raman, Hare) Austin Hospital, Melbourne, VIC, Australia
(Buxton, Hayward, Hare) Department of Surgery, University of Melbourne,
Melbourne, VIC, Australia
(Moat, Collins, Webb) NHLI, Imperial College London, Royal Brompton and
Harefield NHS Foundation Trust, London, United Kingdom
(Peric, Petrovic) Dedinje Cardiovascular Institute, Belgrade University
School of Medicine, Belgrade, Serbia
(Yoo) Yonsei University College of Medicine, Seoul, South Korea
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
Oxford, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
It is generally accepted that radial artery (RA) grafts have better
mid-term patency rate compared to saphenous vein grafts. However, the
clinical correlates of the improved patency rate are still debated.
Observational studies have suggested increased survival and event-free
survival for patients who receive an RA rather than a saphenous vein, but
they are open to bias and confounders. The only evidence based on
randomized data is a pooled meta-analysis of 6 randomized controlled trial
comparing the RA and the saphenous vein published by the RADial artery
International Alliance (RADIAL). In the RADIAL database, improved freedom
from follow-up cardiac events (death, myocardial infarction and repeat
revascularization) was found at 5-year follow-up in the RA arm. The most
important limitation of the RADIAL analysis is that most of the included
trials had an angiographic follow-up in the first 5 years and it is
unclear whether the rate of repeat revascularization (the main driver of
the composite outcome) was clinically indicated due to per-protocol
angiographies. Here, we present the protocol for the long-term analysis of
the RADIAL database. By extending the follow-up beyond the 5th
postoperative year (all trials except 1 did not have angiographic
follow-up beyond 5 years), we aim to provide data on the role of RA in
coronary artery bypass surgery with respect to long-term
outcomes.<br/>Copyright &#xa9; 2019 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<12>
Accession Number
2003272161
Title
Comparison of double sleeve lobectomy by uniportal video-assisted thoracic
surgery (Vats) and thoracotomy for nsclc treatment.
Source
Cancer Management and Research. 11 (pp 10167-10174), 2019. Date of
Publication: 2019.
Author
Wu L.; Wang H.; Cai H.; Fan J.; Jiang G.; He Y.; Jiang L.
Institution
(Wu, Cai, Fan, Jiang, Jiang) Department of Surgery, Shanghai Pulmonary
Hospital, Tongji University Medical School Cancer Institute, Tongji
University School of Medicine, Shanghai 200433, China
(Wang) Medical School, Tongji University, Shanghai 200433, China
(He) Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji
University Medical School Cancer Institute, Tongji University School of
Medicine, Shanghai 200433, China
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Background: With the development of the surgical technique and experience
of surgeons, uniportal VATS has been used in double sleeve lobectomy to
treat non-small cell lung cancer (NSCLC). This retrospective study aims to
evaluate the efficacy and safety of uniportal VATS in NSCLC treatment.
<br/>Method(s): We reviewed 42 NSCLC patients who underwent double sleeve
lobectomy in Shanghai Pulmonary Hospital from June 2015 to November 2017.
21 patients received double sleeve lobectomy through uniportal VATS and 21
through conventional thoracotomy with large incision. <br/>Result(s): The
characteristics of patients were similar between the two groups. The
operation time was longer in the uniportal VATS group (p=0.021) and the
drainage on postoperation day 1 was significantly less in the uniportal
VATS group (p=0.004). Patients reported a lower postoperative pain level
in the uniportal VATS group than in the thoracotomy group (p=0.002). No
statistically significant difference showed in other aspects.
<br/>Conclusion(s): Uniportal VATS double sleeve lobectomy for NSCLC
treatment is safe and effective. Lower postoperative pain level was found
in the uniportal VATS group. Its complication rate and postoperation
survival were similar to the conventional thoracotomy approach with large
incision. But a large randomized clinical trial is still necessary for
further investigation.<br/>Copyright &#xa9; 2019 Wu et al.

<13>
Accession Number
2003857232
Title
A systematic review of the cost-effectiveness of heart valve replacement
with a mechanical versus biological prosthesis in patients with heart
valvular disease.
Source
Heart Failure Reviews. (no pagination), 2019. Date of Publication: 2019.
Author
Azari S.; Rezapour A.; Omidi N.; Alipour V.; Tajdini M.; Sadeghian S.;
Bragazzi N.L.
Institution
(Azari, Rezapour, Alipour) Department of Health Economics, School of
Health Management and Information Sciences, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Omidi, Tajdini, Sadeghian) Department of Cardiology, Tehran Heart Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bragazzi) Laboratory for industrial and applied mathematics (LIAM),
Department of mathematics and statistics, York university, Toronto, Canada
Publisher
Springer
Abstract
Heart valve disease (HVD) affects 2.5% of the US population and one
million individuals aged 65 years and older in the UK. Given its burden,
the aim of the present review was to assess the cost-effectiveness of
heart valve replacement with mechanical versus biological prosthesis in
HVD patients. We performed a systematic search in various electronic
databases from January 1990 to June 2019. Five out of 542 articles were
entered into the study, from which 2 papers were subsequently excluded not
meeting the minimum number of items of the CHEERS checklist.
Quality-Adjusted Life Year, Life Years Gained, and the Incremental
Cost-Effectiveness Ratio (ICER) regarding the type of replaced heart valve
were extracted and reported. Studies were conducted in three different
countries (Iran, France, and USA). ICER ranged from $1253 in Iran to
54,634 in France. Survival rate of mitral mechanical versus biological
valves at 10 and 20 years was 72.9% versus 76.0% and 51% versus 30%,
respectively. Survival rate at 20 years in patients undergoing atrial
valve replacement was 20%. Ten- and 20-year death rates for biological
valves were higher with respect to mechanical prosthesis (15.5% versus
8.4% at 10 years), with this difference becoming more relevant at 20 years
(36.9% versus 13.9%). Due to higher ICER, mortality rate, and lower
success rates in the long term for biological prostheses compared to
mechanical ones, these appear to be more suitable for older patients (aged
>= 70 years).<br/>Copyright &#xa9; 2019, Springer Science+Business Media,
LLC, part of Springer Nature.

<14>
Accession Number
2002662559
Title
Heart rate recovery and morbidity after noncardiac surgery: Planned
secondary analysis of two prospective, multi-centre, blinded observational
studies.
Source
PLoS ONE. 14 (8) (no pagination), 2019. Article Number: e0221277. Date of
Publication: 2019.
Author
Ackland G.L.; Abbott T.E.F.; Minto G.; Clark M.; Owen T.; Prabhu P.; May
S.M.; Reynolds J.A.; Cuthbertson B.H.; Wijesundera D.; Pearse R.M.
Institution
(Ackland, Abbott, May, Reynolds, Pearse) William Harvey Research
Institute, Queen Mary University of London, London, United Kingdom
(Minto) Department of Anaesthesia, Derriford Hospital, Plymouth Hospitals
NHS Trust, Peninsula Schools of Medicine and Dentistry, Plymouth
University, Plymouth, United Kingdom
(Clark) Department of Anaesthesia, Royal Bournemouth Hospital,
Bournemouth, United Kingdom
(Owen) Department of Anaesthesia, Royal Preston Hospital, Lancashire
Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
(Prabhu) Department of Anaesthesia, Royal Surrey County Hospital,
Guildford, United Kingdom
(Cuthbertson, Wijesundera) Department of Critical Care Medicine,
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Cuthbertson, Wijesundera) Department of Anesthesia, University of
Toronto, Toronto, ON, Canada
(Wijesundera) Li Ka Shing Knowledge Institute, St. Michael's Hospital,
Toronto, ON, Canada
(Wijesundera) Department of Anesthesia and Pain Management, Toronto
General Hospital, Toronto, ON, Canada
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Impaired cardiac vagal function, quantified preoperatively as
slower heart rate recovery (HRR) after exercise, is independently
associated with perioperative myocardial injury. Parasympathetic (vagal)
dysfunction may also promote (extra-cardiac) multi-organ dysfunction,
although perioperative data are lacking. Assuming that cardiac vagal
activity, and therefore heart rate recovery response, is a marker of
brainstem parasympathetic dysfunction, we hypothesized that impaired HRR
would be associated with a higher incidence of morbidity after noncardiac
surgery. Methods In two prospective, blinded, observational cohort
studies, we established the definition of impaired vagal function in terms
of the HRR threshold that is associated with perioperative myocardial
injury (HRR 12 beats min^-1 (bpm), 60 seconds after cessation of
cardiopulmonary exercise testing. The primary outcome of this secondary
analysis was all-cause morbidity three and five days after surgery,
defined using the Post-Operative Morbidity Survey. Secondary outcomes of
this analysis were type of morbidity and time to become morbidity-free.
Logistic regression and Cox regression tested for the association between
HRR and morbidity. Results are presented as odds/hazard ratios [OR or HR;
(95% confidence intervals). Results 882/1941 (45.4%) patients had
HRR12bpm. All-cause morbidity within 5 days of surgery was more common in
585/822 (71.2%) patients with HRR12bpm, compared to 718/1119 (64.2%)
patients with HRR>12bpm (OR:1.38 (1.14-1.67); p = 0.001). HRR12bpm was
associated with more frequent episodes of pulmonary (OR:1.31 (1.05-1.62);p
= 0.02)), infective (OR:1.38 (1.10-1.72); p = 0.006), renal (OR:1.91
(1.30-2.79); p = 0.02)), cardiovascular (OR:1.39 (1.15-1.69); p<0.001)),
neurological (OR:1.73 (1.11-2.70); p = 0.02)) and pain morbidity (OR:1.38
(1.14-1.68); p = 0.001) within 5 days of surgery. Conclusions Multi-organ
dysfunction is more common in surgical patients with cardiac vagal
dysfunction, defined as HRR 12 bpm after preoperative cardiopulmonary
exercise testing.<br/>Copyright &#xa9; 2019 Ackland et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<15>
Accession Number
2003829835
Title
Identification of Time-Dependent Risks of Hemodynamic States After Stage 1
Norwood Palliation.
Source
Annals of Thoracic Surgery. 109 (1) (pp 155-162), 2020. Date of
Publication: January 2020.
Author
Hoffman G.M.; Scott J.P.; Ghanayem N.S.; Stuth E.A.; Mitchell M.E.; Woods
R.K.; Hraska V.; Niebler R.A.; Bertrandt R.A.; Mussatto K.A.; Tweddell
J.S.
Institution
(Hoffman, Scott, Ghanayem, Stuth, Mitchell, Woods, Hraska, Niebler,
Bertrandt, Mussatto, Tweddell) Herma Heart Institute, Children's Hospital
of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
(Hoffman, Scott, Ghanayem, Stuth, Mitchell, Woods, Hraska, Niebler,
Bertrandt, Mussatto, Tweddell) Cincinnati Children's Medical Center,
Cincinnati, OH, United States
(Hoffman, Scott, Ghanayem, Stuth, Mitchell, Woods, Hraska, Niebler,
Bertrandt, Mussatto, Tweddell) Texas Children's Hospital, Houston, TX,
United States
Publisher
Elsevier USA
Abstract
Background: Mortality after stage 1 palliation of hypoplastic left heart
syndrome remains significant. Hemodynamic changes result from interaction
of cardiac output (CO) and systemic vascular resistance (SVR). We sought
to identify time-dependent changes in postoperative hemodynamic states and
their associations with mortality. <br/>Method(s): Perioperative data were
prospectively collected in an institutional review board-approved
database. Hemodynamic state was classified as high CO, high SVR, low SVR,
and low CO using bivariate analysis of mean arterial pressure and somatic
regional near-infrared spectroscopic oximetry saturation. State
classifications over 48 postoperative hours were modelled using
multinomial logistic regressions for association with mortality.
<br/>Result(s): Data from 9614 of 10,272 hours in 214 patients were
analyzed. Operative survival was 91%. The predominant state was high CO
(46% time). Low CO state without extracorporeal membrane oxygenation
(ECMO) was found in 52% of patients for 9.7% time. ECMO was employed in 24
(11.2%) patients for 10.4% time. State stability was 33%, with high SVR
the least stable (17%) and high CO the most stable (53%). Transition from
high CO increased in hours 1 to 12, mainly to low SVR. Transition to low
CO was 18.4%, increasing in hours 1 to 12, mainly from high SVR. The
transition risk to ECMO was 0.32%, and 0.74% during hours 1 to 12, only
from low CO. Both low CO and ECMO had increased mortality risk.
<br/>Conclusion(s): Bivariate classification defines hemodynamic states
with distinct physiologic, transition, and mortality risk profiles. High
SVR state was unstable. Transition to ECMO occurred only from low CO,
while the low SVR and high CO states were safest.<br/>Copyright &#xa9;
2020 The Society of Thoracic Surgeons

<16>
Accession Number
2004217458
Title
Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting.
Source
Annals of Thoracic Surgery. 109 (1) (pp 294-301), 2020. Date of
Publication: January 2020.
Author
Biancari F.; Santini F.; Tauriainen T.; Bancone C.; Ruggieri V.G.;
Perrotti A.; Gherli R.; Demal T.; Dalen M.; Santarpino G.; Rubino A.S.;
Nardella S.; Nicolini F.; Zanobini M.; De Feo M.; Onorati F.; Mariscalco
G.; Gatti G.
Institution
(Biancari) Heart Center, Turku University Hospital and Department of
Surgery, University of Turku, Turku, Finland
(Biancari, Tauriainen) Department of Surgery, University of Oulu, Oulu,
Finland
(Santini) Division of Cardiac Surgery, University of Genoa, Genoa, Italy
(Bancone, Rubino) Department of Cardiothoracic Sciences, University of
Campania "Luigi Vanvitelli,", Naples, Italy
(Ruggieri, De Feo) Division of Cardiothoracic and Vascular Surgery, Robert
Debre University Hospital, Reims, France
(Perrotti) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Gherli) Cardiac Surgery Unit, Department of Cardiovascular Sciences, S.
Camillo-Forlanini Hospital, Rome, Italy
(Demal) Hamburg University Heart Center, Hamburg, Germany
(Dalen) Department of Molecular Medicine and Surgery and Department of
Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital,
Stockholm;, Sweden
(Santarpino) Cardiovascular Center, Paracelsus Medical University,
Nuremberg, Germany
(Santarpino) Citta di Lecce Hospital, GVM Care & Research, Lecce, Italy
(Nardella) Department of Cardiac Surgery, St Anna Hospital, Catanzaro,
Italy
(Nicolini) Division of Cardiac Surgery, University of Parma, Parma, Italy
(Zanobini) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
(Onorati) Division of Cardiovascular Surgery, Verona University Hospital,
Verona, Italy
(Mariscalco) Department of Cardiovascular Sciences, Clinical Sciences
Wing, Glenfield Hospital, University of Leicester, Leicester, United
Kingdom
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
Publisher
Elsevier USA
Abstract
Background: Epiaortic ultrasonography (EAU) is a valid imaging method to
detect atherosclerotic changes of the ascending aorta and to guide
surgical strategies for the prevention of cerebral embolism in patients
undergoing isolated coronary artery bypass grafting (CABG). However, its
use is not widespread. <br/>Method(s): The impact of EAU on the outcome
after isolated CABG was investigated in patients from the European
Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry. A
systematic review and meta-analysis of the literature was performed to
substantiate the findings of this observational study. <br/>Result(s): EAU
was performed intraoperatively in 673 of 7241 patients (9.3%) from the
E-CABG registry. In the overall series, the rates of stroke without and
with aortic manipulation were 0.3% and 1.3%, respectively (P = .003). In
660 propensity score-matched pairs, EAU was associated with significantly
lower risk of stroke (0.6% vs 2.6%, P = .007). A literature search yielded
5 studies fulfilling the inclusion criteria. These studies, along with the
present one, included 11,496 patients, of whom 3026 (25.7%) underwent
intraoperative EAU. Their rate of postoperative stroke was significantly
lower than in patients not investigated with EAU (pooled rate, 0.6% vs
1.9%; risk ratio, 0.40; 95% confidence interval, 0.24-0.66; I²
= 0%). On the basis of these pooled rates, the number needed to treat to
prevent 1 stroke is 76.9. <br/>Conclusion(s): Avoiding aortic manipulation
is associated with the lowest risk of stroke in patients undergoing CABG.
When manipulation of the ascending aorta is planned, EAU is effective in
guiding the surgical strategy to reduce the risk for embolic stroke in
these patients.<br/>Copyright &#xa9; 2020 The Society of Thoracic Surgeons

<17>
Accession Number
2004189943
Title
Rivaroxaban in patients with mechanical heart valves: A pilot study.
Source
Thrombosis Research. 186 (pp 1-6), 2020. Date of Publication: February
2020.
Author
Roost E.; Weber A.; Alberio L.; Englberger L.; Reineke D.; Keller D.;
Nagler M.; Carrel T.
Institution
(Roost, Weber, Englberger, Reineke, Keller, Carrel) Department of
Cardiothoracic Surgery, Inselspital, Bern University Hospital, University
of Bern, Bern CH-3010, Switzerland
(Alberio) Division of Haematology and Central Haematology Laboratory,
Lausanne University Hospital (CHUV) Lausanne, Switzerland
(Alberio) Faculty of Biology and Medicine, University of Lausanne (UNIL),
Lausanne, Switzerland
(Nagler) University Institute of Clinical Chemistry, Inselspital, Bern
University Hospital, University of Bern, Berne CH-3010, Switzerland
Publisher
Elsevier Ltd
Abstract
Background: Patients with mechanical heart valves are still not eligible
for treatment with direct oral anticoagulants (DOAC). We aimed to conduct
a proof-of-principle study investigating the anti-Xa inhibitor rivaroxaban
as antithrombotic treatment in patients with recent mechanical aortic
valve replacement. <br/>Material(s) and Method(s): Low-risk patients
scheduled for elective mechanical aortic valve replacement were treated
with rivaroxaban 20 mg once daily (OD) in a prospective cohort study,
started on day 3 postoperatively and given for 6 months. The study was
registered at ClinicalTrials.gov (#NCT02128841). <br/>Result(s): Ten
patients were included (median age, 48; range 39 to 60). Indication was
aortic valve stenosis in 6 patients, aortic root aneurysm with severe
aortic valve regurgitation in 3 patients, and mixed stenosis/regurgitation
in 1 patient. Neither thromboembolic nor bleeding events were observed,
and no patient died. Absence of valve thrombosis was demonstrated in all
patients. On day 7, median D-dimers were 2723 mug/L (inter-quartile range
[IQR] 1672, 5695 mug/L), median TAT levels were 4.5 mug/L (IQR 4.1, 5.6
mug/L); and median peak thrombin generation was 150 nM (IQR 91, 183). On
day 90, median D-dimers were 426 mug/L (IQR 278, 569), median TAT levels
were 2.7 mug/L (IQR 2.2, 3.1), and median peak thrombin generation were 66
nM (IQR 62, 87). <br/>Conclusion(s): Rivaroxaban 20 mg OD was safe and
effective in a pilot study of 10 low risk patients with mechanical aortic
heart valve. Our results justify larger studies investigating the
application of anti-Xa inhibitors in patients with mechanical heart
valves.<br/>Copyright &#xa9; 2019

<18>
Accession Number
2003479561
Title
Perioperative care of children with sickle cell disease: A systematic
review and clinical recommendations.
Source
American Journal of Hematology. 95 (1) (pp 78-96), 2020. Date of
Publication: 01 Jan 2020.
Author
Schyrr F.; Dolci M.; Nydegger M.; Canellini G.; Andreu-Ullrich H.; Joseph
J.-M.; Diezi M.; Cachat F.; Rizzi M.; Renella R.
Institution
(Schyrr, Diezi, Rizzi, Renella) Pediatric Hematology-Oncology Unit,
Division of Pediatrics, Department "Woman-Mother-Child", Lausanne
University Hospital and Lausanne University, Lausanne, Switzerland
(Dolci, Nydegger) Division of Anesthesia, Department of Surgery, Lausanne
University Hospital and Lausanne University, Lausanne, Switzerland
(Canellini, Andreu-Ullrich) Transfusion Medicine Unit, Department of
Laboratory Medicine, Lausanne University Hospital and Lausanne University,
Lausanne, Switzerland
(Joseph) Division of Pediatric Surgery, Department "Woman-Mother-Child",
Lausanne University Hospital and Lausanne University, Lausanne,
Switzerland
(Cachat) Pediatric Nephrology Unit, Division of Pediatrics, Department
"Woman-Mother-Child", Lausanne University Hospital and Lausanne
University, Lausanne, Switzerland
Publisher
Wiley-Liss Inc. (E-mail: info@wiley.com)
Abstract
Children with sickle cell disease (SCD) require specific perioperative
care, and clinical practice in this area remains poorly defined. We aimed
to conduct a systematic, PRISMA-based review of the literature, available
clinical guidelines and practice recommendations. We also aimed to extract
any valuable information for the "best of available-evidence"-based
prevention of perioperative adverse events in children with SCD, and
highlight the most urgent priorities in clinical research. As data
sources, US National Library of Medicine, Medline, National Guideline
Clearinghouse, International Guideline Network, TRIP databases were
searched for any content until January 2019. We also included
institutional, consortia and expert group guidelines. Included were
reports/guidelines in English, French, German, and Italian. Excluded were
reports on obstetrical and fetal management. We identified 202
reports/guidelines fulfilling the criteria outlined above. A majority
focused on visceral, cardiovascular and orthopedic surgery procedures, and
only five were multicenter randomized controlled trials and two
prospective randomized studies. After grading of the quality of the
evidence, the extracted data was summarized into clinical recommendations
for daily practice. Additionally, we designed a risk-grading algorithm to
identify contexts likely to be associated with adverse outcomes. In
conclusion, we provide a systematic PRISMA-based review of the existing
literature and ancillary practice and delineate a set of clinical
recommendations and priorities for research.<br/>Copyright &#xa9; 2019
Wiley Periodicals, Inc.

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

<20>
Accession Number
2001493266
Title
Mycotic Coronary Aneurysms.
Source
Heart Lung and Circulation. 29 (1) (pp 128-136), 2020. Date of
Publication: January 2020.
Author
Baker D.W.; Whitehead N.J.; Barlow M.
Institution
(Baker, Whitehead, Barlow) John Hunter Hospital, Newcastle, NSW, Australia
Publisher
Elsevier Ltd
Abstract
Background: Mycotic coronary aneurysms (MCA) are rare but often lead to
significant morbidity and mortality. Evidence on the topic is limited to
case reports and small case series. A systematic review was performed to
improve understanding of this challenging diagnosis. A case report
prompting this review is also included. <br/>Method(s): Relevant articles
were identified by searching databases Medline and Google Scholar for
terms 'mycotic coronary aneurysm'. Manual searching from article
references identified further case reports. <br/>Result(s): Ninety-seven
(97) published cases of MCA were identified between 1812 and 2017; 80
cases since the introduction of percutaneous coronary intervention (PCI)
with stents in 1986. The most common associations were PCI (40.0%) and
infective endocarditis (IE) (40.0%). Complications including aneurysm
rupture (28.9%), pericardial effusion (37.3%) and myocardial infarction
(39.8%) were frequent. Short-term mortality was high at 42.6%. The most
common treatment was surgical resection of the aneurysm with bypass
grafting. <br/>Conclusion(s): We present a case and the largest systematic
review to date of this rare diagnosis, identifying 97 published case
reports. Clinical scenarios in which to consider MCA include febrile
illness after recent PCI, febrile illness (particularly infective
endocarditis) with evidence of coronary ischaemia, and purulent
pericarditis. Given the high rate of complications and mortality,
immediate surgical referral is recommended.<br/>Copyright &#xa9; 2018

<21>
Accession Number
2004072638
Title
Topical vancomycin for neurosurgery wound prophylaxis: An interim report
of a randomized clinical trial on drug safety in a diverse neurosurgical
population.
Source
Journal of Neurosurgery. 131 (6) (pp 1966-1973), 2019. Date of
Publication: 2019.
Author
Radwanski R.E.; Christophe B.R.; Pucci J.U.; Martinez M.A.; Rothbaum M.;
Bagiella E.; Lowy F.D.; Knopman J.; Connolly E.S.
Institution
(Radwanski, Christophe, Pucci, Martinez, Lowy, Connolly) Department of
Neurological Surgery, Columbia University Medical Center, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Radwanski, Rothbaum, Knopman) Department of Neurological Surgery, Weill
Cornell Medical Center, Icahn School of Medicine at Mount Sinai, New York,
NY, United States
(Bagiella) Center of Biostatistics, Department of Population Health
Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY,
United States
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE Postoperative surgical site infections (SSIs) in neurosurgical
patients carry a significant risk of increased morbidity and mortality.
With SSIs accounting for approximately 20% of nosocomial infections and
costing approximately $1.6 billion USD annually, there is a need for
additional prophylaxis to improve current standards of care. Topical
vancomycin is increasingly utilized in instrumented spinal and
cardiothoracic procedures, where it has been shown to reduce the risk of
SSIs. A randomized controlled trial assessing its efficacy in the general
neurosurgical population is currently underway. Here, the authors report
their initial impressions of topical vancomycin safety among patients
enrolled during the 1st year of the trial. METHODS This prospective,
multicenter, patient-blinded, randomized controlled trial will enroll 2632
patients over 5 years. Here, the authors report the incidence of adverse
events, the degree of systemic vancomycin absorption in treated patients,
and pattern changes of antibiotic-resistant profiles of Staphylococcus
aureus flora among patients enrolled during the 1st year. RESULTS The
topical vancomycin treatment group comprised 257 patients (514 total
enrolled patients), of whom 2 exhibited weakly positive serum levels of
vancomycin (> 3.0 mg/dl). S. aureus was detected preoperatively in the
anterior nares of 35 (18.1%) patients and the skin near the surgical site
of 9 (4.7%). Colonization in the nares remained for many patients (71.4%)
through postoperative day 30. The authors found a significant association
between preoperative S. aureus colonization and postoperative
colonization. Seven methicillin-resistant isolates were detected among 6
different patients. Two isolates were detected preoperatively, and 5 were
de novo postoperative colonization. No adverse responses to treatment have
been reported to date. CONCLUSIONS The authors' data indicate that the use
of topical vancomycin is safe with no significant adverse effects and
minimal systemic absorption, and no development of vancomycin-resistant
microorganisms.<br/>Copyright &#xa9; AANS 2019

<22>
Accession Number
2003392884
Title
Impact of diabetes mellitus on short term vascular complications after
TAVR: Results from the BRAVO-3 randomized trial.
Source
International Journal of Cardiology. 297 (pp 22-29), 2019. Date of
Publication: 15 December 2019.
Author
Goel R.; Power D.; Tchetche D.; Chandiramani R.; Guedeney P.; Claessen
B.E.; Sartori S.; Cao D.; Meneveau N.; Tron C.; Dumonteil N.; Widder J.D.;
Hengstenberg C.; Ferrari M.; Violini R.; Stella P.R.; Jeger R.;
Anthopoulos P.; Deliargyris E.N.; Mehran R.; Dangas G.D.
Institution
(Goel, Power, Chandiramani, Claessen, Sartori, Cao, Mehran, Dangas) The
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York City, NY, United States
(Tchetche, Dumonteil) Groupe CardioVasculaire Interventionnel, Clinique
Pasteur, Toulouse, France
(Guedeney) Sorbonne Universite, ACTION Study Group, Institut de
Cardiologie, Pitie Salpetriere Hospital (AP-HP), UMR_S, Paris 1166, France
(Meneveau) Department of Cardiology, University Hospital Jean Minjoz,
EA3920, Besancon 25000, France
(Tron) Division of Cardiology, CHU de Rouen, Rouen, France
(Widder) Department of Cardiology and Angiology, Hannover Medical School,
Hannover, Germany
(Hengstenberg) Department of Internal Medicine II, Division of Cardiology,
Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090,
Austria
(Ferrari) Helios Dr. Horst Schmidt Kliniken Wiesbaden, Germany
(Violini) Interventional Cardiology Unit, San Camillo Hospital, Via
Circonvallazione Gianicolense, Rome, Italy
(Stella) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Jeger) Department of Cardiology, University Hospital Basel, University of
Basel, Switzerland
(Anthopoulos) Arena Pharmaceuticals Inc., Canton of Zug, Zug, Switzerland
(Deliargyris) PLx Pharma Inc., Sparta, NJ, United States
Publisher
Elsevier Ireland Ltd
Abstract
Aims: The impact of diabetes mellitus (DM) on clinical outcomes after
transcatheter aortic valve replacement (TAVR) remains unclear. The aim of
this study was to investigate the impact of DM on short-term clinical
outcomes after TAVR in a large randomized trial population. <br/>Methods
and Results: BRAVO-3 trial randomized 802 patients undergoing
trans-femoral TAVR to procedural anticoagulation with bivalirudin or
unfractionated heparin. The study population was divided according to the
presence of DM, and further stratified according to the use of insulin.
Net adverse cardiovascular outcomes (NACE - death, myocardial infarction
(MI), stroke or major bleeding by Bleeding Academic Research Consortium
(BARC) type 3b or above) was the primary outcome in-hospital and at
30-days. Of the total 802 randomized patients, 239 (30%) had DM at
baseline, with 87 (36%) being treated with insulin. At 30-days, DM
patients experienced numerically higher rates of net adverse
cardiovascular events (16.3% vs. 14.4%, p = 0.48) and acute kidney injury
(19.7% vs. 15.1%, p = 0.11), while non-DM (NDM) patients had numerically
higher rates of cerebrovascular accidents (3.6% vs. 1.7%, p = 0.22). After
multivariable adjustment, DM patients had higher odds of vascular
complications at 30-days (OR 1.57, p = 0.03) and life-threatening bleeding
both in-hospital (OR 1.50, p = 0.046) and at 30-days (OR 1.50, p = 0.03)
with the excess overall risk primarily attributed to the higher rates
observed among non-insulin dependent DM patients. <br/>Conclusion(s):
Patients with DM had higher adjusted odds of vascular and bleeding
complications up to 30-days post-TAVR. Overall, there was no significant
association between DM and early mortality following TAVR.<br/>Copyright
&#xa9; 2019 Elsevier B.V.

<23>
Accession Number
2004264976
Title
PCV109 COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS FOR THE MINIMALLY
INVASIVE SUTURELESS AORTIC VALVE REPLACEMENT IN PATIENTS WITH AORTIC
STENOSIS IN POLAND.
Source
Value in Health. Conference: ISPOR Europe 2019. Denmark. 22 (Supplement 3)
(pp S561-S562), 2019. Date of Publication: November 2019.
Author
Lipka I.; Niewada M.; Jakubczyk M.; Chirita-Parker O.
Institution
(Lipka, Niewada, Jakubczyk) HealthQuest, Warsaw, Poland
(Chirita-Parker) LivaNova, London, United Kingdom
Publisher
Elsevier Ltd
Abstract
Objectives: Various treatments are available for patients with aortic
stenosis; the choice should account for patient individual characteristics
but also cost and effectiveness. We performed a cost-effectiveness
analysis (CEA) of minimally invasive sutureless aortic valve replacement
(MIS-SU-AVR) vs conventional surgical AVR (cSAVR) and transcatheter aortic
valve implantation (TAVI) and budget impact analysis (BIA) of MIS-SU-AVR
reimbursement from public payer perspective in Poland. <br/>Method(s):
Separate CEA models were developed for cSAVR and TAVI comparisons. The
former was based on the previously published link between cardiopulmonary
bypass time and the risk of death and the expected survival. The
parameters of other events (hospitalization length or pacemaker
implantation) were based on a systematic review. In the latter comparison,
we developed a partitioned survival model. The model was based on the
survival data from published literature, extrapolated to 10 years (results
were based on the restricted mean survival time). In BIA, the number of
patients was based on data on MIS-SU-AVR in other countries. The patients
using MIS-SU-AVR in the new scenario recruit from cSAVR or TAVI; the
proportion was based on current diagnosis-related groups statistics. The
cost of the procedure was based on current cSAVR cost, adjusting for the
device cost; other costs were based of the National Health Fund data.
<br/>Result(s): In the CEA, MIS-SU-AVR offers clinical benefits vs cSAVR
and TAVI (0.1 and 1.1 life years gained, respectively) and is cost saving
vs TAVI (hence, dominant). The incremental cost effectiveness ratio vs
cSAVR amounts to 32,544 EUR (below the official threshold). In the BIA,
there would be 102, 182, 429, and 560 MIS-SU-AVR patients in consecutive
years. Introducing MIS-SU-AVR would result in net savings ('000s EUR): 73,
131, 305, and 403, respectively. <br/>Conclusion(s): MIS-SU-AVR is
cost-effective vs cSAVR and TAVI and its reimbursement would result in net
savings in Poland.<br/>Copyright &#xa9; 2019

<24>
Accession Number
2000715217
Title
The Effects of an Open-Lung Approach During One-Lung Ventilation on
Postoperative Pulmonary Complications and Driving Pressure: A Descriptive,
Multicenter National Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2665-2672),
2018. Date of Publication: 01 Dec 2018.
Author
Belda J.; Ferrando C.; Garutti I.; Pozo N.; Soro M.; Suarez-Sipmann F.;
Tusman G.; Unzueta C.; Villar J.; Bermejo S.; Callejo A.; Coves S.;
Gallego-Ligorit L.; Granell M.; Jimenez M.J.; Lluch A.; Martinez J.A.; de
la Matta M.; Planas A.; Aguirre P.; Rodriguez A.; Sastre J.A.; Arocas B.;
Barcena E.; Belmonte L.; Carbonell J.; Carrizo J.; Charco P.; Cuervo J.;
Del Rio E.; Florea R.; Gutierrez A.; Jurado A.; Lascorz L.; Navarro J.M.;
Martinez S.; Monleon B.; Parra M.J.; Perez S.; Sancho L.; Serralta F.;
Villena A.; Cruz P.; de la Gala F.; Olmedilla L.; Pineiro P.;
Sanchez-Pedrosa G.; Alday E.; Munoz M.; Ramasco F.; Diaz R.; Parera A.;
Cabrera S.; Guerra E.; Morales L.; Gallart L.; Perez A.; Calderon A.;
Guerrero M.; Kadaoui S.-D.; Levstek M.; Real M.I.; Pintor J.; Barrado P.;
Cotera I.; Izquierdo B.; Lacosta L.; Molinos I.; Rubio B.; Puertolas M.;
Sanjuan-Villareal A.; Valles-Torres J.; Tres E.; Viguera L.; Biosca E.;
Broseta A.; Hernandez J.; Morales J.; Navarro-Ripoll R.; Femenia X.;
Minguez L.; Lopez A.; Esteve I.; Llacer E.; Blanco L.; Ceresuela R.;
Orallo M.A.; Pereira D.; Prieto M.P.; Otero T.
Institution
(Belda, Ferrando) Hospital Clinico de Valencia, Valencia, Spain
(Ferrando) CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos
III, Madrid, Spain
(Garutti) Hospital Gregorio Maranon de Madrid, Madrid, Spain
(Belda, Ferrando, Pozo, Soro) Hospital Clinico de Valencia, Valencia,
Spain
(Ferrando, Suarez-Sipmann, Villar) CIBER de Enfermedades Respiratorias,
Instituto de Salud Carlos III, Madrid, Spain
(Garutti) Hospital Gregorio Maranon de Madrid, Madrid, Spain
(Suarez-Sipmann, Planas) La Princesa de Madrid, Madrid, Spain
(Tusman) Hospital Privado Mar de Plata, La Plata, Argentina
(Unzueta) Hospital San Pau i Santa Creu de Barcelona, Barcelona, Spain
(Villar, Rodriguez) Hospital Dr. Negrin de Las Palmas, Las Palmas, Spain
(Bermejo) Hospital Parc de Salut Mar de Barcelona, Barcelona, Spain
(Callejo) Hospital 12 de Octubre de Madrid, Madrid, Spain
(Coves) Hospital de Vinalopo de Elche, Alicante, Spain
(Gallego-Ligorit) Hospital Miguel Servet de Zaragoza, Zaragoza, Spain
(Granell) Hospital Consorcio General de Valencia, Valencia, Spain
(Jimenez) Hospital Clinic de Barcelona, Barcelona, Spain
(Lluch) Hospital La Fe de Valencia, Valencia, Spain
(Martinez) Hospital Mutua de Terrassa, Terrassa, Spain
(de la Matta) Hospital Virgen del Rocio de Sevilla, Sevilla, Spain
(Aguirre) Hospital Alvaro Cunqueiro de Vigo, Vigo, Spain
(Sastre) Hospital Clinico de Salamanca, Salamanca, Spain
(Ferrando, Arocas, Barcena, Belmonte, Carbonell, Carrizo, Charco, Cuervo,
Del Rio, Florea, Gutierrez, Jurado, Lascorz, Navarro, Martinez, Monleon,
Parra, Perez, Sancho, Serralta, Villena) Hospital Clinico de Valencia,
Spain
(Cruz, de la Gala, Olmedilla, Pineiro, Sanchez-Pedrosa) Hospital Gregorio
Maranon de Madrid, Spain
(Alday, Munoz, Ramasco) Hospital La Princesa de Madrid, Spain
(Diaz, Parera) Hospital Sant Pau i Santa Creu de Barcelona, Spain
(Cabrera, Guerra, Morales) Hospital Dr. Negrin de Las Palmas, Spain
(Gallart, Perez) Hospital Parc de Salut Mar de Barcelona, Spain
(Calderon, Guerrero, Kadaoui, Levstek, Real) Hospital 12 de Octubre de
Madrid, Spain
(Pintor) Hospital de Vinalopo de Elche, Spain
(Barrado, Cotera, Izquierdo, Lacosta, Molinos, Rubio, Puertolas,
Sanjuan-Villareal, Valles-Torres, Tres, Viguera) Hospital Miguel Servet de
Zaragoza, Spain
(Biosca, Broseta, Hernandez, Morales) Hospital Consorcio General de
Valencia, Spain
(Navarro-Ripoll) Hospital Clinic de Barcelona, Spain
(Femenia, Minguez, Lopez) Hospital La Fe de Valencia, Spain
(Esteve, Llacer) Hospital Mutua de Terrassa, Spain
(Blanco, Ceresuela, Orallo, Pereira, Prieto, Otero) Hospital Alvaro
Cunqueiro de Vigo, Spain
Publisher
W.B. Saunders
Abstract
Objective: Thoracic surgical procedures are associated with an increased
risk of postoperative pulmonary complications (PPCs), which seem to be
related directly to intraoperative driving pressure. The authors conducted
this study to describe the incidence of PPCs in patients in whom an
individualized open-lung approach was applied during one-lung ventilation.
<br/>Design(s): This was a prospective, multicenter, national descriptive
study. <br/>Setting(s): Thoracic surgery patients undergoing one-lung
ventilation. <br/>Participant(s): Eligible participants were included
consecutively from October 1, 2016, to September 30, 2017. A total of 690
patients were included. <br/>Intervention(s): An individualized open-lung
approach that consisted of an alveolar recruitment maneuver followed by a
positive end-expiratory pressure adjusted to best respiratory system
compliance was performed in all patients. <br/>Measurements and Main
Results: Preoperative and intraoperative data were recorded; the primary
outcome was a description of the incidence of PPCs in these patients
during the first 7 postoperative days. The patients were mainly male, and
half of them had a high risk of PPCs (ARISCAT score exceeding 44). Eleven
percent of participants developed a PPC within the first postoperative
week. The mean open lung positive end-expiratory pressure was 8 +/- 3
cmH<inf>2</inf>O. When compared with pre-open lung approach values, the
open-lung approach significantly decreased the driving pressure (14 +/- 4
cmH<inf>2</inf>O v 11 +/- 3 cmH<inf>2</inf>O; p < 0.001) and increased
dynamic compliance (30 +/- 10 mL/cmH<inf>2</inf>O v 43 +/-15
mL/cmH<inf>2</inf>O; p < 0.001). <br/>Conclusion(s): The low incidence of
PPCs in patients who underwent an open-lung approach during one-lung
ventilation compared with that reported for other thoracic surgery series
and the decrease in the driving pressure in these patients justify an
additional randomized controlled trial to compare the open-lung approach
with the standard protective strategy of low tidal volume and low positive
end-expiratory pressure.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<25>
Accession Number
618278324
Title
Accounting for single center effects in systematic reviews cannot be
overlooked.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 241. Date of
Publication: 15 Sep 2017.
Author
Besen B.A.M.P.; Park M.; Nassar A.P.
Institution
(Besen, Park, Nassar) Hospital das Clinicas, University of Sao Paulo
Medical School, Medical Intensive Care Unit, Medical Emergencies
Discipline, Sao Paulo, Brazil
(Besen) Hospital da Luz, Intensive Care Unit, Sao Paulo, Brazil
(Nassar) A.C. Camargo Cancer Center, Intensive Care Unit, Sao Paulo,
Brazil
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)

<26>
Accession Number
618838054
Title
Effect of ischemic postconditioning during primary percutaneous coronary
intervention for patients with ST-segment elevation myocardial infarction:
A randomized clinical trial.
Source
JAMA Cardiology. 2 (5) (pp 490-497), 2017. Date of Publication: May 2017.
Author
Engstrom T.; Kelbaek H.; Helqvist S.; Hofsten D.E.; Klovgaard L.;
Clemmensen P.; Holmvang L.; Jorgensen E.; Pedersen F.; Saunamaki K.;
Ravkilde J.; Tilsted H.-H.; Villadsen A.; Aaroe J.; Jensen S.E.; Raungaard
B.; Botker H.E.; Terkelsen C.J.; Maeng M.; Kaltoft A.; Krusell L.R.;
Jensen L.O.; Veien K.T.; Kofoed K.F.; Torp-Pedersen C.; Kyhl K.;
Nepper-Christensen L.; Treiman M.; Vejlstrup N.; Ahtarovski K.; Lonborg
J.; Kober L.; Thygesen K.; Jeppesen J.; Galloe A.; Jensen G.B.; Gislasson
G.; Erlinge D.
Institution
(Engstrom, Helqvist, Hofsten, Klovgaard, Clemmensen, Holmvang, Jorgensen,
Pedersen, Saunamaki, Tilsted, Kofoed, Kyhl, Nepper-Christensen, Vejlstrup,
Ahtarovski, Lonborg, Kober) Department of Cardiology, Rigshospitalet,
University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
(Kelbaek, Galloe) Department of Cardiology, Roskilde Hospital, Roskilde,
Denmark
(Ravkilde, Villadsen, Aaroe, Jensen, Raungaard) Department of Cardiology,
Aalborg University Hospital, Aalborg, Denmark
(Botker, Terkelsen, Maeng, Kaltoft, Krusell) Department of Cardiology,
Skejby University Hospital, Skejby, Denmark
(Jensen, Veien) Department of Cardiology, Odense University Hospital,
Odense, Denmark
(Torp-Pedersen) Department of Clinical Epidemiology, Aalborg University
Hospital, Aalborg, Denmark
(Treiman) Department of Biomedical Sciences, Faculty of Health Sciences,
University of Copenhagen, Copenhagen, Denmark
(Thygesen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Jeppesen) Department of Medicine, Copenhagen University Hospital
Glostrup, Copenhagen, Denmark
(Jensen) Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark
(Gislasson) Department of Cardiology, Gentofte Hospital, Cohenhagen,
Denmark
(Erlinge) Department of Cardiology, Lund University, Lund, Sweden
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Ischemic postconditioning of the heart during primary
percutaneous coronary intervention (PCI) induced by repetitive
interruptions of blood flow to the ischemic myocardial region immediately
after reopening of the infarct-related arterymay limit myocardial damage.
<br/>Objective(s): To determine whether ischemic postconditioning can
improve the clinical outcomes in patients with ST-segment
elevationmyocardial infarction (STEMI). <br/>Design, Setting, and
Participant(s): In this multicenter, randomized clinical trial, patients
with onset of symptoms within 12 hours, STEMI, and thrombolysis
inmyocardial infarction (TIMI) grade 0-1 flow in the infarct-related
artery at arrival were randomized to conventional PCI or postconditioning.
Inclusion began on March 21, 2011, through February 2, 2014, and follow-up
was completed on February 2, 2016. Analysis was based on intention to
treat. <br/>Intervention(s): Patients were randomly allocated 1:1 to
conventional primary PCI, including stent implantation, or
postconditioning performed as 4 repeated 30-second balloon occlusions
followed by 30 seconds of reperfusion immediately after opening of the
infarct-related artery and before stent implantation. Main Outcome and
Measures: A combination of all-cause death and hospitalization for heart
failure. <br/>Result(s): During the inclusion period, 1234 patients (975
men [79.0%] and 259 women [21.0%]; mean [SD] age, 62 [11] years) underwent
randomization in the trial. Median follow-up was 38 months (interquartile
range, 24-58 months). The primary outcome occurred in 69 patients (11.2%)
who underwent conventional primary PCI and in 65 (10.5%) who underwent
postconditioning (hazard ratio, 0.93; 95%CI, 0.66-1.30; P = .66). The
hazard ratios were 0.75 (95%CI, 0.49-1.14; P = .18) for all-cause death
and 0.99 (95%CI, 0.60-1.64; P = .96) for heart failure. <br/>Conclusions
and Relevance: Routine ischemic postconditioning during primary PCI failed
to reduce the composite outcome of death from any cause and
hospitalization for heart failure in patients with STEMI and TIMI grade
0-1 flow at arrival.<br/>Copyright &#xa9; 2017 American Medical
Association. All rights reserved.

<27>
Accession Number
618837823
Title
Mortality following cardiovascular and bleeding events occurring beyond 1
year after coronary stenting: A secondary analysis of the Dual
Antiplatelet Therapy (DAPT) Study.
Source
JAMA Cardiology. 2 (5) (pp 478-487), 2017. Date of Publication: May 2017.
Author
Secemsky E.A.; Yeh R.W.; Kereiakes D.J.; Cutlip D.E.; Cohen D.J.; Steg
P.G.; Cannon C.P.; Apruzzese P.K.; D'Agostino R.B.; Massaro J.M.; Mauri
L.; Kaplan A.; Ahmed A.; Ahmed A.-H.; Albirini A.; Moreyra A.; Rabinowitz
A.; Shroff A.; Moak A.; Jacobs A.; Kabour A.; Gupta A.; Irimpen A.;
Rosenthal A.; Taussig A.; Ferraro A.; Chhabra A.; Pucillo A.; Spaedy A.;
White A.; Pratsos A.; Shakir A.; Ghitis A.; Agarwal A.; Chawla A.; Tang
A.; Barker B.; Bertolet B.; Uretsky B.; Erickson B.; Rama B.; McLaurin B.;
Dearing B.; Negus B.; Price B.; Brott B.; Bhambi B.; Bowers B.; Watt B.;
Donohue B.; Hassel C.D.; Croft C.; Lambert C.; O'Shaughnessy C.; Shoultz
C.; Kim C.; Caputo C.; Nielson C.; Scott C.; Wolfe C.; McKenzie C.;
Brachfeld C.; Thieling C.; Fisher D.; Simon D.; Churchill D.; Dobies D.;
Eich D.; Goldberg D.; Griffin D.; Henderson D.; Kandzari D.; Lee D.; Lewis
D.; Mego D.; Paniagua D.; Rizik D.; Roberts D.; Safley D.; Abbott D.; Shaw
D.; Temizer D.; Canaday D.; Myears D.; Westerhausen D.; Ebersole D.; Netz
D.; Baldwin D.; Letts D.; Harlamert E.; Kosinski E.; Portnay E.; Mahmud
E.; Korban E.; Hockstad E.; Rivera E.; Shawl F.; Shamoon F.; Kiernan F.;
Aycock G.R.; Schaer G.; Kunz G.; Kichura G.; Myers G.; Pilcher G.; Tadros
G.; Kaddissi G.I.; Ramadurai G.; Eaton G.; Elsner G.; Mishkel G.; Simonian
G.; Piegari G.; Chen H.; Liberman H.; Aronow H.; Tamboli H.P.; Dotani I.;
Marin J.; Fleischhauer J.F.; Hopkins J.; Leggett J.; Mills J.; Phillips
J.; Revenaugh J.; Mann J.T.; Wilson J.; Pattanayak J.; Aji J.; Strain J.;
Patel J.; Carr J.; Moses J.; Chen J.-C.; Williams J.; Greenberg J.; Cohn
J.; Douglas J.; Gordon J.; Griffin J.; Hawkins J.; Katopodis J.; Lopez J.;
Marshall J.; Wang J.; Waltman J.; Saucedo J.; Galichia J.; McClure M.;
Kozina J.; Stella J.; Tuma J.; Kieval J.; Giri K.; Ramanathan K.; Allen
K.; Atassi K.; Baran K.; Khaw K.; Clayton K.; Croce K.; Skelding K.; Patel
K.; Garratt K.; Harjai K.; Chandrasekhar K.; Kalapatapu K.; Lin L.; Dean
L.; Barr L.; MacDonald L.; Cannon L.; Satler L.; Gruberg L.; Tami L.;
Bikkina M.; Shah M.; Atieh M.; Chauhan M.; Litt M.; Unterman M.; Lechin
M.; Zughaib M.; Fisch M.; Grabarczyk M.; Greenberg M.; Lurie M.;
Rothenberg M.; Stewart M.; Purvis M.; Hook M.; Leesar M.; Buchbinder M.;
Weiss M.; Guerrero M.; Abu-Fadel M.; Ball M.; Chang M.; Cunningham M.; Del
Core M.; Jones M.; Kelberman M.; Lim M.; Ragosta M.; Rinaldi M.; Rosenberg
M.; Savage M.; Tamberella M.; Kellett M.; Vidovich M.; Effat M.; Mirza
M.A.; Khan M.; Dib N.; Laufer N.; Kleiman N.; Farhat N.; Amjadi N.;
Schechtmann N.; Bladuell N.; Quintana O.; Gigliotti O.; Best P.; Flaherty
P.; Hall P.; Gordon P.; Gurbel P.; Ho P.; Luetmer P.; Mahoney P.; Mullen
P.; Teirstein P.; Tolerico P.; Ramanathan P.; Kerwin P.; Lee P.V.; Kraft
P.; Wyman R.M.; Gonzalez R.; Kamineni R.; Dave R.; Sharma R.; Prashad R.;
Aycock R.; Quesada R.; Goodroe R.; Magorien R.; Randolph R.; Bach R.;
Kettelkamp R.; Paulus R.; Waters R.; Zelman R.; Ganim R.; Bashir R.;
Applegate R.; Feldman R.; Frankel R.; Hibbard R.; Jobe R.; Jumper R.;
Maholic R.; Siegel R.; Smith R.; Stoler R.; Watson R.; Wheatley R.; Gammon
R.; Hill R.; Sundrani R.; Caputo R.; Jenkins R.; Stella R.; Germanwala S.;
Hadeed S.; Ledford S.; Dube S.; Gupta S.; Davis S.; Martin S.; Waxman S.;
Dixon S.; Naidu S.; Potluri S.; Cook S.; Crowley S.; Kirkland S.; McIntyre
S.; Thew S.; Lin S.; Marshalko S.; Guidera S.; Hearne S.; Karas S.;
Manoukian S.; Rowe S.; Yakubov S.; Pollock S.; Banerjee S.; Allaqaband S.;
Choi S.; Mulukutla S.; Papadakos S.; Bajwa T.; Addo T.; Schreiber T.;
Haldis T.; Mathew T.; McGarry T.; Nygaard T.; Pow T.; Larkin T.; Caulfield
T.; Stys T.; Lee T.; Mansouri V.; Srinivas V.; Gupta V.; Marquardt W.;
Ballard W.; Bachinsky W.; Colyer W.; Dillon W.; Felten W.; French W.;
Kuehl W.; Nicholas W.; Nicholson W.; Phillips W.; Khatib Y.; Al-Saghir Y.;
Hawa Z.; Masud Z.; Jafar Z.; Muller D.; Meredith I.; Rankin J.; Worthley
M.; Jepson N.; Thompson P.; Hendriks R.; Whitbourn R.; Duffy S.; Stasek
J.; Novobilsky K.; Naplava R.; Coufal Z.; Vaquette B.; Bressollette E.;
Teiger E.; Coste P.; Rihani R.; Darius H.; Bergmann M.W.; Radke P.;
Sebastian P.; Strasser R.; Hoffmann S.; Behrens S.; Moebius-Winkler S.;
Rutsch W.; Lupkovics G.; Horvath I.; Kancz S.; Forster T.; Koszegi Z.;
Devlin G.; Hart H.; Elliott J.; Ormiston J.; Abernathy M.; Fisher N.; Kay
P.; Harding S.; Jaffe W.; Hoffmann A.; Sosnowski C.; Trebacz J.; Buszman
P.; Dobrzycki S.; Kornacewicz-Jach Z.; Iancu A.C.; Ginghina C.D.; Matei
C.; Dobreanu D.; Bolohan F.R.; Dorobantu M.; Jacques A.; Jain A.; Bakhai
A.; Gershlick A.; Adamson D.; Newby D.; Felmeden D.; Purcell I.; Edmond
J.; Irving J.; De Belder M.; Pitt M.; Kelly P.; O'Kane P.; Clifford P.;
Suresh V.
Institution
(Secemsky) Division of Cardiology, Massachusetts General Hospital, Boston,
MA, United States
(Secemsky, Yeh, Cutlip, Cannon, Mauri) Harvard Medical School, Boston, MA,
United States
(Secemsky, Mauri) Center for Clinical Biometrics, Department of Medicine,
Brigham and Women's Hospital, Boston, MA, United States
(Secemsky, Yeh) Smith Center for Outcomes Research in Cardiology, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Secemsky, Yeh, Cutlip, Cannon, Apruzzese, D'Agostino, Massaro, Mauri)
Baim Institute for Clinical Research, Boston, MA, United States
(Yeh, Cutlip) Division of Cardiology, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Kereiakes) Lindner Center for Research and Education, Cincinnati, OH,
United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Cohen) University of Missouri-Kansas City, School of Medicine, Kansas
City, MO, United States
(Steg) Universite Paris-Diderot, Institut National de la Sante et de la
Recherche Medicale U-1148, Hopital Bichat, Paris, France
(Steg) Departement Hospitalo-Universitaire Fibrosis, Inflammation, and
Remodeling, Assistance Publique, Hopitaux de Paris, Paris, France
(Steg) National Heart and Lung Institute, Institute of Cardiovascular
Medicine and Science, Royal Brompton Hospital, Imperial College, London,
United Kingdom
(Cannon, Mauri) Division of Cardiology, Brigham and Women's Hospital, 75
Francis St, Boston, MA 02115, United States
(D'Agostino, Massaro) Boston University School of Public Health, Boston,
MA, United States
(Kaplan) Dartmouth Hitchcock Medical Center, United States
(Ahmed, Ahmed) Altru Health System, United States
(Albirini) Genesis HealthCare System, United States
(Moreyra) University of Medicine and Dentistry of New Jersey, United
States
(Rabinowitz) South Texas Cardiovascular, United States
(Shroff) Jesse Brown VA Medical Center, United States
(Moak) Penn Presbyterian Medical Center, United States
(Jacobs) Boston Medical Center, United States
(Kabour) Mercy St Vincent's Medical Center, United States
(Gupta) North Mississippi Medical Center, United States
(Irimpen) Tulane Medical Center, United States
(Rosenthal) Bayfront Medical Center, United States
(Taussig, Kim) Florida Hospital, United States
(Ferraro) Sacred Heart Medical Center, United States
(Chhabra) Cardiovascular Research, United States
(Pucillo, Kalapatapu) Westchester Medical Center, United States
(Spaedy) Missouri Heart Center, United States
(White) NEA Baptist Clinic, United States
(Pratsos) Bryn Mawr Hospital, United States
(Shakir) Midwest Regional Medical Center, United States
(Ghitis) Diagnostic Cardiology Associates, United States
(Agarwal, Strain) Valley Hospital, United States
(Jain) California Cardiovascular Consultants Medical Associates, United
States
(Chawla) Iowa Heart Center, United States
(Tang) Chambersburg Hospital, United States
(Barker, Siegel) Arizona Regional Medical Center, United States
(Bertolet) Cardiology Associates Research, United States
(Uretsky) Arkansas VA Medical Center, United States
(Erickson) Central Minnesota Heart Center, St Cloud Hospital, United
States
(Rama) Frederick C. Smith Clinic, United States
(McLaurin) AnMed Health, United States
(Dearing) Thomas Hospital, United States
(Negus, Ledford) Chattanooga Heart Institute, United States
(Price, Paulus) King's Daughters Medical Center, United States
(Brott) University of Alabama at Birmingham, United States
(Bhambi) Bakersfield Heart, United States
(Bowers) Cardiopulmonary Research Science and Technology Institute, United
States
(Watt) North Central Heart Institute, United States
(Donohue) University of Pittsburgh Medical Center, Shadyside Hospital,
United States
(Hassel, Litt) Jacksonville Heart Center, United States
(Croft) Holmes Regional Medical Center, United States
(Lambert) Pepin Heart Hospital, United States
(O'Shaughnessy, Farhat) North Ohio Heart Center, United States
(Shoultz) Providence Health Center, United States
(Suresh) Derriford Hospital, United States
(Caputo) North Florida Regional Medical Center, United States
(Nielson) Medical University of South Carolina Hospital, United States
(Scott) University of Tennessee Medical Center, United States
(Wolfe) Providence St Peter Hospital, United States
(McKenzie) St John's Mercy Cardio Research, United States
(Brachfeld) Promise Regional Medical Center, United States
(Thieling) Hattiesburg Clinic PA, United States
(Fisher) UMASS Memorial Medical Center, United States
(Lee) Bay Regional Medical Center, United States
(Simon, Cunningham) University Hospitals Case Medical Center, United
States
(Churchill) Washington Regional Medical Center, United States
(Dobies) Genesys Regional Medical Center, United States
(Eich, Mahoney) Sentara Norfolk General Hospital, United States
(Goldberg) New England Heart Institute, United States
(Griffin, Temizer) Good Samaritan Hospital, United States
(Henderson) Cardiology Research Associates, United States
(Kandzari, Ballard) Piedmont Heart Institute, United States
(Lee) Bakersfield Memorial Hospital, United States
(Lewis) South Central Wisconsin Heart, United States
(Mego, Flaherty) Little Rock Cardiology Clinic, United States
(Paniagua) Michael E. DeBakey VA Medical Center, United States
(Rizik) Scottsdale Health Care, United States
(Roberts) Sacramento Heart and Vascular Institute, United States
(Safley) St Luke's Hospital, United States
(Abbott) Rhode Island Hospital, United States
(Shaw) Christus St Frances Cabrini Hospital, United States
(Clifford) Wycombe General Hospital, United States
(Canaday) Inland Cardiology Associates, United States
(Myears, Hawkins) St John's Medical Research Institute, United States
(Westerhausen) Midwest Cardiovascular Research and Education Foundation,
United States
(Ebersole) Watson Clinic Center for Research, United States
(Netz) Nebraska Heart Institute, United States
(Baldwin) Tulane University Medical School, United States
(Letts, Tamberella) Carolina Heart Specialists, United States
(Harlamert, Fisch) Clarian North Medical Center, United States
(Kosinski) Connecticut Clinical Research, United States
(Portnay, Jumper) Cardiology Associates of Fairfield County, United States
(Mahmud) UCSD Medical Center, United States
(Korban) Jackson-Madison County General Hospital, United States
(Hockstad) Kansas City Heart Foundation, United States
(Rivera) Amarillo Heart Group, United States
(Shawl) Washington Adventist Hospital, United States
(Shamoon) St Michael's Medical Center, United States
(Kiernan) Hartford Hospital, United States
(Aycock, Fleischhauer, Stewart, Aycock) Cardiology Consultants, United
States
(Schaer) Rush University Medical Center, United States
(Kunz) New Mexico Heart Institute PA, United States
(Kichura) St John's Mercy Cardiovascular Research, United States
(Myers) Redmond Regional Medical Center, United States
(Pilcher) St Vincent's Healthcare, United States
(Tadros) North Memorial Medical Center, United States
(Kaddissi, Khaw) Our Lady of Lourdes Medical Center, United States
(Ramadurai) Heartland Cardiovascular Center, United States
(Eaton) Medcentral Health System, United States
(Elsner, McClure, Ball) Care Group, United States
(Mishkel) St John's Hospital, United States
(Simonian) Hackensack University Medical Center, United States
(Piegari) Berks Cardiologists, United States
(Chen) Heart Center PC, United States
(Liberman) Emory University Hospital Midtown, United States
(Aronow) Michigan Heart and Vascular Institute, United States
(Tamboli) Bay Area Cardiology Associates, United States
(Dotani) McFarland Clinic PC, United States
(Marin) St Joseph's Hospital, United States
(O'Kane) Bournemouth Hospital, United States
(Hopkins) Christiana Hospital, United States
(Leggett) Over Lake Hospital Medical Center, United States
(Mills) Duke Raleigh Hospital, United States
(Phillips) Palmetto Richland Memorial Hospital, United States
(Revenaugh) J. L. Sorenson Heart and Lung, United States
(Mann, Hook, Jobe) Wake Heart Research Institute, United States
(Wilson) Texas Heart Institute, United States
(Pattanayak, Kuehl) Asheville Cardiology Associates, United States
(Aji) Cooper University Hospital, United States
(Kelly) Basildon University Hospital, United States
(Patel) Hamilton Cardiology Associates, United States
(Carr) East Texas Medical Center, United States
(Moses) Columbia Presbyterian Hospital, United States
(Chen) Straub Clinic and Hospital, United States
(Williams) Mid Carolina Cardiology, United States
(Greenberg, Crowley) Aurora Denver Cardiology Associates, United States
(Cohn) Ingham Regional Medical Center, United States
(Douglas) Emory University Hospital, United States
(Gordon) Sharp Memorial Hospital, United States
(Griffin) Alegent Health Research Center, United States
(Griffin) Cardiovascular Associates, United States
(Pitt) Heartland Hospital, United States
(Katopodis) Tallahassee Research Institute, United States
(Lopez) Loyola University Medical Center, United States
(Marshall) Northeast Georgia Medical Center, United States
(Wang) Union Memorial Hospital, United States
(Waltman, Caputo, Lin) St Joseph Hospital, United States
(Saucedo, Abu-Fadel) University of Oklahoma Health Science Center, United
States
(Galichia) Galichia Heart Hospital, United States
(McClure) Mid-Michigan Heart and Vascular Center, United States
(Kozina, Chang, Marquardt) Mercy General Hospital, United States
(Stella, Stella) Heart Care Research Foundation, United States
(Tuma) Black Hills Cardiovascular Research, United States
(Kieval, Rothenberg) Palm Beach Heart Research Institute, United States
(Giri) Cardiovascular Associates of Delaware Valley, United States
(Ramanathan, Ramanathan) Northwest Ohio Cardiology Consultants, United
States
(Allen) Presbyterian Heart Group, United States
(Atassi) Northwest Indiana Cardiovascular Physicians PC, United States
(Baran) St Paul Heart Clinic, United States
(De Belder) James Cook Hospital, United States
(Clayton) Munson Medical Center, United States
(Croce) Brigham and Women's Hospital, United States
(Skelding) Geisinger Medical Center, United States
(Patel) St Joseph Mercy Oakland, United States
(Garratt, Papadakos) Lenox Hill Hospital, United States
(Harjai) Donald Guthrie Foundation, United States
(Chandrasekhar) Winter Haven Hospital, United States
(Irving) Ninewells Hospital and MS, United States
(Lin) Morton Plant Hospital, United States
(Dean) University of Washington, United States
(Barr, Kerwin) Midwest Heart Foundation, United States
(MacDonald) Swedish Medical Center, United States
(Cannon) Cardiac and Vascular Research Center of North Michigan, United
States
(Satler) Washington Hospital Center, United States
(Gruberg) Stony Brook University Medical Center, United States
(Tami) Memorial Regional Hospital, United States
(Bikkina) St Joseph's Regional Medical Center, United States
(Shah) Shah Associates, United States
(Atieh) Pinehurst Medical Clinic, United States
(Chauhan) Cardiovascular Specialists of Texas, United States
(Edmond) Weston General Hospital, United States
(Unterman) St Joseph's Hospital Atlanta, United States
(Lechin) College Station Medical Center, United States
(Zughaib, Hall) Providence Hospital, United States
(Purcell) Freeman Hospital, United States
(Grabarczyk) Greenville Memorial Hospital, United States
(Greenberg) Moses Hospital, United States
(Lurie, Wyman) Torrance Memorial Medical Center, United States
(Felmeden) Torbay Hospital, United States
(Newby) Royal Infirmary of Edinburgh, United States
(Purvis) Medical Center of the Rockies, United States
(Adamson) Coventry and Warwickshire UH, United States
(Leesar, Effat) University of Cincinnati, United States
(Buchbinder) Foundation for Cardiovascular Medicine, United States
(Weiss) Jersey Shore University Medical Center, United States
(Guerrero) Henry Ford Hospital, United States
(Gershlick) Glenfield Hospital, United States
(Bakhai) Barnet Hospital, United States
(Jain) London Chest Hospital, United States
(Jacques) St Peter's Hospital, United Kingdom
(Del Core) Cardiac Center of Creighton University Medical Center, United
States
(Jones) Central Baptist Hospital, United States
(Kelberman) St Elizabeth Medical Center, United States
(Lim) St Louis University, United States
(Ragosta) University of Virginia, United States
(Rinaldi) Carolinas Medical Center, United States
(Rosenberg) Advocate Good Shepherd Hospital, United States
(Savage) Thomas Jefferson University Hospital, United States
(Dorobantu) Spitalul Clinic de Urgenta Bucuresti, Romania
(Bolohan) Centrul Clinic de Urgenta de Boli Cardi, Romania
(Kellett) Maine Medical Center, United States
(Vidovich) University of Illinois Hospital, United States
(Dobreanu) Institutul de Boli Cardiovasculare si, Romania
(Mirza) Carilion Medical Center, United States
(Khan) North Dallas Research Associates, United States
(Dib) Mercy Gilbert Medical Center, United States
(Laufer) Heart and Vascular Center of Arizona, United States
(Kleiman) Methodist Hospital, United States
(Matei) Institutul de Urgentapentru Boli Cardiovas, Romania
(Amjadi) Texas Heart and Vascular, United States
(Schechtmann, Karas) MIMA Century Research Associates, United States
(Bladuell) WellStar Kennestone Hospital, United States
(Quintana) Hospital at Renaissance, United States
(Gigliotti) Seton Heart Institute, United States
(Best) Mayo Clinic, United States
(Ginghina) Inst. Urgenta Boli Cardiovasculare, Romania
(Iancu) Institutul Inimii Niculae Stancioiu Cluj-Napoca, Romania
(Gordon) Miriam Hospital, United States
(Gurbel) Sinai Center for Thrombosis Research, United States
(Ho) Kaiser Foundation Hospitals, United States
(Luetmer) Aspirus Heart and Vascular Institute, United States
(Kornacewicz-Jach) SPSK nr 2 Pomor. AM Szczecin, Poland
(Mullen) Memorial Hospital at Gulfport, United States
(Teirstein) Scripps Green Hospital, United States
(Tolerico, Nicholson) York Hospital, United Kingdom
(Dobrzycki) Uniwer. Szpital Klin. Bialystok, Poland
(Buszman) Polsko-Amerykanskie Kliniki Serca, Poland
(Lee) Northeast Cardiology Associates, United States
(Kraft) Beaumont Hospital Troy, United States
(Trebacz) NZOZ Centr. Med. Beluga-Med, Poland
(Gonzalez) Scott and White Health Care Round Rock, United States
(Kamineni) Salem Hospital, United States
(Dave) Spirit Physician Services, United States
(Sharma) St Anthony Central Hospital, United States
(Prashad) Ocala Research Institute, United States
(Sosnowski) Instytut Kardiologii Kardynala Wyszynskiego, Poland
(Quesada) Baptist Hospital, India
(Goodroe) Grand Strand Regional Medical Center, United States
(Magorien) Ohio State University Medical Center, United States
(Randolph) Winchester Medical Center, United States
(Bach) Washington University School of Medicine, St Louis, MO, United
States
(Kettelkamp) Cardiologists LC, United States
(Hoffmann) Wielospecj. Szpital Miejskiim, Poland
(Waters) St Joseph's Medical Center, United States
(Zelman) Cape Cod Research Institute, United States
(Ganim) Kingwood Medical Center, United States
(Bashir) Temple University, United States
(Applegate) Wake Forest University, United States
(Feldman) MediQuest Munroe Regional Medical Center, United States
(Frankel) Maimonides Medical Center, United States
(Hibbard) Bryan LGH Medical Center, United States
(Jaffe) Ascot Integrated Hospital, United States
(Harding) Wellington Hospital, United Kingdom
(Maholic) Hamot Medical Center, United States
(Kay) Middlemore Hospital, United States
(Smith) Tyler Cardiovascular Consultants, United States
(Stoler) Baylor Heart and Vascular Hospital, United States
(Watson) Abington Medical Specialist, United States
(Wheatley) Centennial Heart, United States
(Gammon) Austin Heart Research, United States
(Hill) St Bernard's Medical Center, United States
(Sundrani) Cardiovascular Consultants, United States
(Fisher) Nelson Hospital, United States
(Jenkins) Kootenai Medical Center, United States
(Abernathy) Wakefield Hospital, United States
(Germanwala) Longview Regional Medical Center, United States
(Hadeed) Conemaugh Valley Memorial Hospital, United States
(Ormiston) Mercy Angiography, United States
(Dube) Indiana Heart Hospital, United States
(Gupta) Oregon Health and Science University, United States
(Davis) Baptist Health Medical Center, United States
(Martin) Covenant Medical Center, United States
(Waxman) Lahey Clinic Medical Center, United States
(Dixon) William Beaumont Hospital, United States
(Naidu) Winthrop University Hospital, United States
(Potluri) Heart Hospital Baylor Plano, United States
(Cook) Novant Clinical Research Institute, United States
(Cook) Sacred Heart General Hospital, United States
(Elliott) Christchurch Hospital, United States
(Kirkland) Forsyth Medical Center, United States
(McIntyre) Martin Memorial Health Systems, United States
(Thew) Heart Clinics Northwest PS, United States
(Hart) North Shore Hospital, United States
(Marshalko) Bridgeport Hospital, United States
(Guidera) Doylestown Hospital, United States
(Hearne) Delmarva Heart Research Foundation, United States
(Devlin) Waikato Hospital, New Zealand
(Manoukian) Sarah Cannon Research Institute, United States
(Rowe) Cox Medical Centers, United States
(Yakubov) Ohio Health Research Institute, United States
(Pollock) Rockingham Memorial Hospital, United States
(Banerjee) VA North Texas Health Care Center, United States
(Allaqaband, Bajwa) Sinai Medical Center, United States
(Choi) California Pacific Medical Center Research, United States
(Mulukutla) University of Pittsburgh Medical Center, United States
(Koszegi) Josa Andras Oktato Korhaz Nonprofit Kft, Hungary
(Forster) Szegedi Tudomanyegyetem SZ-GY, Hungary
(Addo) University of Texas Southwestern Medical Center, United States
(Schreiber) DMC Harper University Hospital, United States
(Haldis) MeritCare Hospital Pharmacy, United States
(Mathew) Slocum Dickson Medical Group, United States
(McGarry) Oklahoma Foundation for Cardiovascular Research, United States
(Nygaard) Cardiovascular Group, United States
(Pow) Great Lakes Heart and Vascular Institute, United States
(Larkin) Midwest Heart Specialists, United States
(Caulfield) Providence St Vincent Medical Center, United States
(Stys) Sanford Research, United States
(Lee) Stanford Medical Center, United States
(Mansouri) St Thomas Hospital, United States
(Srinivas) Weiler Hospital, United States
(Gupta) Borgess Research Institute, United States
(Kancz) Gottsegen Gyorgy Orszagos Kardiologiai Intezet, Hungary
(Horvath) Pecsi Tudomanyegyetem Klinikai Kozpont, Hungary
(Bachinsky) Pinnacle Health, United States
(Colyer) University of Toledo Medical Center, United States
(Dillon) Louisville Cardiology Medical, United States
(Felten) Mid-Michigan Medical Center, United States
(French) LA Biomed Research Institute, United States
(Lupkovics) Zala Megyei Korhaz, Hungary
(Nicholas) Freeman West Hospital, United States
(Rutsch) Helios Klinikum Emil von Behring, Germany
(Phillips) Central Maine Medical Center, United States
(Khatib, Al-Saghir) 1st Coast Cardiovascular Institute, United States
(Moebius-Winkler) Herzzentrum Leipzig GmbH, Germany
(Hawa) North Kansas City Hospital, United States
(Masud) Kaleida Health, United States
(Jafar) Hudson Valley Heart Center, United States
(Muller) St Vincent's Hospital Sydney, Australia
(Meredith) Monash Heart Southern Health, Australia
(Rankin) Royal Perth Hospital, Australia
(Worthley) Royal Adelaide Hospital, Australia
(Jepson) Prince of Wales Eastern Heart, Australia
(Thompson) Sir Charles Gardiner Hospital, Australia
(Hendriks) Fremantle Hospital, Australia
(Whitbourn) St Vincent's Hospital Melbourne, Australia
(Duffy) Alfred Hospital, Australia
(Stasek) FN Hradec Kralove, Czechia
(Novobilsky) Mestska nemocnice Ostrava, Czechia
(Naplava) Centrum pro choroby srdce, Czechia
(Coufal) KNTB a.s., Czechia
(Vaquette) Hopital Saint Louis, France
(Bressollette) Nouvelle Clinique Nantaise, France
(Teiger) CHU Henri Mondor, France
(Coste) Groupe Hospitalier Sud, France
(Rihani) Hopital Saint Philibert, France
(Darius) Vivantes-Klinikum Neukoelln, Germany
(Bergmann) Asklepios Klinik St Georg, Germany
(Radke) UK-SH, Germany
(Sebastian) Elbe-Kliniken Stade GmbH, Germany
(Strasser) Universitaetsklinikum Dresden, Germany
(Hoffmann) Vivantes Klin. Friedrichshain, Germany
(Behrens) VivantesHumboldt Klinikum, Germany
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Early cardiovascular and bleeding events after coronary
stenting are associated with high risk of morbidity and mortality.
<br/>Objective(s): To assess the prognosis of cardiovascular and bleeding
events occurring beyond 1 year after coronary stenting. <br/>Design,
Setting, and Participant(s): This secondary analysis is derived from data
from the Dual Antiplatelet Therapy (DAPT) Study, a multi center trial
involving 220 US and in ternational clinical sites from 11 countries. The
study dateswere August 2009 to May 2014. Individuals who underwent
coronary stenting and completed 12 months of thienopyridine plus aspirin
therapy without ischemic or bleeding events remained on an aspirin regimen
and were randomized to continued thienopyridine therapy vs placebo for 18
additional months. Individuals were then followed up for 3 additional
months while receiving aspirin therapy alone. The analysis began in August
2015. Exposures: Ischemic events (myocardial infarction not related to
stent thrombosis, stent thrombosis, and ischemic stroke) and bleeding
events (Global Utilization of Streptokinase and Tissue Plasminogen
Activator for Occluded Arteries [GUSTO] classification moderate or severe
bleeding). <br/>Main Outcomes and Measures: Ischemic events (myocardial
infarction not related to stent thrombosis, stent thrombosis, and ischemic
stroke) and bleeding events (GUSTO classification moderate or severe
bleeding). Death at 21 months after randomization (33 months after
coronary stenting). <br/>Result(s): Intotal, 25 682 individuals older than
18 years with an indication for coronarystentingwere enrolled, and 11
648(meanage,61.3 years; 25.1%female)were randomized. After randomization,
478 individuals (4.1%) had 502 ischemic events (306 with myocardial
infarction, 113 with stent thrombosis, and 83 with ischemic stroke), and
232 individuals (2.0%) had 235 bleeding events (155 with moderate and 80
with severe bleeding). Among individuals with ischemic events, 52(10.9%)
died. The annualized mortality rate after an ischemic event was 27.2
(95%CI, 20.3-35.7) per 100 person-years. The cumulative incidence of death
after an ischemic event among the total randomized study population was
0.5%(0.3% with myocardial infarction,0.1% with stent thrombosis, and 0.1%
with ischemic stroke). Among individuals with bleeding events, 41 (17.7%)
died. The annualized mortality rate after a bleeding event was 21.5
(95%CI, 15.4-29.1) per 100 person-years. The cumulative incidence of death
after a bleeding event among the total randomized study population was
0.3%(0.1% with moderate and 0.2% with severe bleeding). <br/>Conclusions
and Relevance: In patients treated with dual antiplatelet therapy for at
least 1 year after coronary stenting, ischemic events were more frequent
than bleeding events, and both events were associated with high risk of
mortality.<br/>Copyright &#xa9; 2017 American Medical Association. All
rights reserved.

<28>
Accession Number
619378690
Title
Longitudinal hemodynamics of transcatheter and surgical aortic valves in
the PARTNER Trial.
Source
JAMA Cardiology. 2 (11) (pp 1197-1206), 2017. Date of Publication:
November 2017.
Author
Douglas P.S.; Leon M.B.; Mack M.J.; Svensson L.G.; Webb J.G.; Hahn R.T.;
Pibarot P.; Weissman N.J.; Miller D.C.; Kapadia S.; Herrmann H.C.; Kodali
S.K.; Makkar R.R.; Thourani V.H.; Lerakis S.; Lowry A.M.; Rajeswaran J.;
Finn M.T.; Alu M.C.; Smith C.R.; Blackstone E.H.
Institution
(Douglas, Leon, Hahn) Duke University Medical Center, Durham, NC, United
States
(Leon, Hahn, Kodali, Finn, Alu, Smith) New York Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Svensson, Kapadia, Lowry, Rajeswaran, Blackstone) Cleveland Clinic,
Cleveland, OH, United States
(Webb) St Paul's Hospital, University of British Columbia, Vancouver, BC,
Canada
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Weissman, Miller) MedStar Washington Hospital Center, Washington, DC,
United States
(Miller) Stanford University, Stanford, CA, United States
(Herrmann) University of Pennsylvania Health System, Philadelphia, PA,
United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Thourani, Lerakis) Emory University, Atlanta, GA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Use of transcatheter aortic valve replacement (TAVR) for
severe aortic stenosis is growing rapidly. However, to our knowledge, the
durability of these prostheses is incompletely defined. <br/>OBJECTIVE(S):
To determine the midterm hemodynamic performance of balloon-expandable
transcatheter heart valves. DESIGN, SETTING, AND PARTICIPANTS: In this
study, we analyzed core laboratory-generated data from echocardiograms of
all patients enrolled in the Placement of Aortic Transcatheter Valves
(PARTNER) 1 Trial with successful TAVR or surgical AVR (SAVR) obtained
preimplantation and at 7 days, 1 and 6 months, and 1, 2, 3, 4, and 5 years
postimplantation. Patients from continued access observational studies
were included for comparison. INTERVENTIONS: Successful implantation after
randomization to TAVR vs SAVR (PARTNER 1A; TAVR, n = 321; SAVR, n = 313),
TAVR vs medical treatment (PARTNER 1B; TAVR, n = 165), and continued
access (TAVR, n = 1996). Five-year echocardiogram data were available for
424 patients after TAVR and 49 after SAVR. MAIN OUTCOMES AND MEASURES:
Death or reintervention for aortic valve structural indications, measured
using aortic valve mean gradient, effective orifice area, Doppler velocity
index, and evidence of hemodynamic deterioration by reintervention,
adverse hemodynamics, or transvalvular regurgitation. <br/>RESULT(S): Of
2795 included patients, the mean (SD) age was 84.5 (7.1) years, and 1313
(47.0%) were female. Population hemodynamic trends derived from nonlinear
mixed-effects models showed small early favorable changes in the first few
months post-TAVR, with a decrease of -2.9 mm Hg in aortic valve mean
gradient, an increase of 0.028 in Doppler velocity index, and an increase
of 0.09 cm² in effective orifice area. There was relative
stability at a median follow-up of 3.1 (maximum, 5) years. Moderate/severe
transvalvular regurgitation was noted in 89 patients (3.7%) after TAVR and
increased over time. Patients with SAVR showed no significant changes. In
TAVR, death/reintervention was associated with lower ejection fraction,
stroke volume index, and aortic valve mean gradient up to 3 years, with no
association with Doppler velocity index or valve area. Reintervention
occurred in 20 patients (0.8%) after TAVR and in 1 (0.3%) after SAVR and
became less frequent over time. Reintervention was caused by structural
deterioration of transcatheter heart valves in only 5 patients. Severely
abnormal hemodynamics on echocardiograms were also infrequent and not
associated with excess death or reintervention for either TAVR or SAVR.
CONCLUSIONS AND RELEVANCE: This large, core laboratory-based study of
transcatheter heart valves revealed excellent durability of the
transcatheter heart valves and SAVR. Abnormal findings in individual
patients, suggestive of valve thrombosis or structural deterioration, were
rare in this protocol-driven database and require further investigation.
TRIAL REGISTRATION: clinicaltrials.gov Identifier:
NCT00530894.<br/>Copyright &#xa9; 2017 American Medical Association. All
rights reserved.

<29>
Accession Number
2002503389
Title
The Effect of Steroids in Patients Undergoing Cardiopulmonary Bypass: An
Individual Patient Meta-Analysis of Two Randomized Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (1) (pp 99-105),
2020. Date of Publication: January 2020.
Author
Whitlock R.P.; Dieleman J.M.; Belley-Cote E.; Vincent J.; Zhang M.;
Devereaux P.J.; Kalkman C.J.; van Dijk D.; Yusuf S.
Institution
(Whitlock, Belley-Cote, Vincent, Zhang, Devereaux, Yusuf) Population
Health Research Institute, Hamilton Health Sciences and McMaster
University, Hamilton, Ontario, Canada
(Whitlock) Department of Surgery, McMaster University, Hamilton, Ontario,
Canada
(Whitlock, Devereaux) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, Ontario, Canada
(Belley-Cote, Devereaux, Yusuf) Department of Medicine, McMaster
University, Hamilton, Ontario, Canada
(Dieleman, Kalkman, van Dijk) University Medical Center, Utrecht,
Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Steroids suppress the inflammatory response to cardiopulmonary
bypass, but the impact on death at 30 days, myocardial infarction or
injury, stroke, renal failure, respiratory failure, new atrial
fibrillation, transfusion requirement, infection, and length of intensive
care unit (ICU) and hospital stays are uncertain. <br/>Design(s):
Patient-level data meta-analysis of 2 randomized trials. <br/>Setting(s):
Eighty-eight cardiac surgical centers in 19 countries.
<br/>Participant(s): A total of 11,989 participants, from the Steroids in
Cardiac Surgery trial and the Dexamethasone in Cardiac Surgery study,
undergoing cardiac surgery with the use of cardiopulmonary bypass.
<br/>Intervention(s): Participants were randomly assigned to steroid or
placebo. Measures and Main Results: Outcomes assessed were mortality at 30
days, myocardial infarction or injury, stroke, renal failure, respiratory
failure, new atrial fibrillation, transfusion requirement, infection, and
length of ICU and hospital stays. There was no significant difference in
death at 30 days between the steroid and placebo groups (odds ratio [OR],
0.87; 95% confidence interval [CI], 0.72-1.07). Myocardial infarction did
not differ significantly (OR, 1.17; 95% CI, 0.93-1.47); however,
myocardial injury was higher in the steroid group (OR, 1.25; 95% CI,
1.12-1.40). There were no significant differences for the outcomes of
stroke, renal failure, new atrial fibrillation, or transfusion. Steroids
significantly reduced respiratory failure (OR, 0.83; 95% CI, 0.75-0.99),
infection (OR, 0.80; 95% CI, 0.72-0.89), and length of ICU (p < 0.001) and
hospital stays (p = 0.006). <br/>Conclusion(s): This patient-level
meta-analysis does not support the routine use of steroids in cardiac
surgery. Steroid administration did not decrease the risk of death,
myocardial infarction, stroke, renal failure, new atrial fibrillation, or
transfusion. Steroids increased the risk of myocardial injury in both the
Steroids in Cardiac Surgery and Dexamethasone in Cardiac Surgery trials.
Finally, steroids lowered the risk of respiratory failure and infection,
and reduced length of ICU and hospital stay.<br/>Copyright &#xa9; 2019

<30>
Accession Number
2003792554
Title
Usefulness of Discharge Resting Heart Rate to Predict Adverse
Cardiovascular Outcomes in Patients With Left Main Coronary Artery Disease
Revascularized With Percutaneous Coronary Intervention vs Coronary Artery
Bypass Grafting (from the EXCEL Trial).
Source
American Journal of Cardiology. 125 (2) (pp 169-175), 2020. Date of
Publication: 15 January 2020.
Author
Kosmidou I.; Crowley A.; Macedo L.; Ben-Yehuda O.; Gersh B.J.; Boonstra
P.W.; Kappetein A.P.; Serruys P.W.; Sabik J.F.; Stone G.W.
Institution
(Kosmidou, Crowley, Ben-Yehuda, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Kosmidou, Macedo, Ben-Yehuda) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Gersh) Department of Cardiovascular Medicine, Mayo Clinic College of
Medicine, Rochester, MN, United States
(Boonstra) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The prognostic impact of resting heart rate (RHR) following
revascularization with percutaneous coronary intervention (PCI) or
coronary artery bypass grafting (CABG) in patients with left main coronary
artery disease (LMCAD) is unknown. We aimed to assess the effect of RHR at
discharge on 3-year cardiovascular outcomes following PCI and CABG for
LMCAD. In the EXCEL trial, 1,905 patients with LMCAD were randomized to
PCI with everolimus-eluting stents versus CABG. RHR was measured at
discharge following the index hospitalization. The principal outcome
measure was the composite endpoint of death, myocardial infarction (MI) or
stroke at 3 years. Among 1,303 patients in sinus rhythm with available
ECGs, the median (IQR) discharge RHR was 72 (62to 81) bpm. Median
discharge RHR was higher after CABG versus PCI (78 [IQR 70 to 86] versus
65 [IQR 59 to 74] bpm, p <0.0001). At 3 years, 107 patients (8.2%) had a
primary composite endpoint event including 61 patients (4.7%) who died. By
multivariable analysis, discharge RHR assessed as a continuous variable
(per 5 bpm) was an independent predictor at 3 years of the primary
composite endpoint of death, MI, or stroke (hazard ratio [HR] 1.15, 95%
confidence interval [CI] 1.06 to 1.25, p = 0.0006); the secondary
composite endpoint of death, MI, stroke, or ischemia-driven
revascularization at 3 years (HR 1.12, 95% CI 1.05 to 1.19, p = 0.0007);
all-cause mortality (HR 1.18, 95% CI 1.07 to 1.31, p = 0.002); and
cardiovascular death (HR 1.16, 95% CI 1.00 to 1.33, p = 0.046). No
significant interactions were present between RHR and treatment with PCI
versus CABG for the primary (p<inf>int</inf> = 0.20) or secondary
(p<inf>int</inf> = 0.47) composite endpoints. In patients with LMCAD
undergoing revascularization, an increased RHR at discharge was associated
with a higher risk for adverse cardiovascular outcomes at 3 years,
irrespective of treatment modality.<br/>Copyright &#xa9; 2019 Elsevier
Inc.

<31>
Accession Number
2004236202
Title
Outcome after surgical repair of tetralogy of Fallot: A systematic review
and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 159 (1) (pp 220-236.e8),
2020. Date of Publication: January 2020.
Author
Romeo J.L.R.; Etnel J.R.G.; Takkenberg J.J.M.; Roos-Hesselink J.W.;
Helbing W.A.; van de Woestijne P.; Bogers A.J.J.C.; Mokhles M.M.
Institution
(Romeo, Etnel, Takkenberg, van de Woestijne, Bogers, Mokhles) Department
of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam,
Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Helbing) Division of Pediatric Cardiology, Department of Pediatrics,
Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam,
Netherlands
(Helbing) Division of Pediatric Cardiology, Department of Pediatrics,
Radboud University Medical Center, Amalia Children's Hospital, Nijmegen,
Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Introduction: Tetralogy of Fallot (TOF) is the most common cyanotic
congenital heart disease. Intracardiac correction was pioneered by Walton
Lillehei in 1955 and has since then gone through major developments. The
aim of this study was to provide a systematic literature review of
published results on the long-term outcome of complete surgical correction
of TOF. <br/>Method(s): MEDLINE, PubMed, Embase, Web of Science, Cochrane,
and Google Scholar were systematically searched for literature published
between January 2000 and July 2018. Pooled estimates with a random effects
model after log-transformation were calculated for mortality and
reintervention. Potential heterogeneity was assessed by subgroup analyses
and meta-regression. <br/>Result(s): A total of 143 papers of 137 distinct
cohorts comprising 21,427 patients and total follow-up duration of 147,430
patient-years were included. Overall mean age at correction was 3.7 +/-
5.6 years, but excluding papers exclusively focusing on correction in
adults yielded a mean age of 0.5 +/- 2.5 years at correction. Previous
palliative shunts (107 studies), a transventricular approach (81 studies),
and a transannular patch (124 studies) were used in 16% (range 0%-78%),
39% (range 0%-100%), and 49% (range 0%-100%) of the patients.
respectively. In case a transannular patch was used, monocusp
reconstruction was applied in 15% (range 0%-100%) (49 studies). The most
common genetic abnormality was Down syndrome, with a pooled estimated
prevalence of 4.6% (range 0%-12.3%). The pooled estimates of early and
late mortality were 2.84% (95% confidence interval [CI], 2.34-3.45) and
0.42%/year (95% CI, 0.33-0.54), respectively. The pooled estimate of late
cardiac mortality was 0.26%/year (95% CI, 0.21-0.34). Valve-related
mortality and non-valve-related mortality had pooled estimates of
0.20%/year (95% CI, 0.15-0.26) and 0.17%/year (95% CI, 0.12-0.22),
respectively. The pooled estimate of reintervention was 2.26%/year (95%
CI, 1.86-2.75). <br/>Conclusion(s): TOF can be surgically corrected at a
young age with low perioperative and long-term mortality. Life-long
intensive follow-up and substantial reintervention rates characterize the
clinical course.<br/>Copyright &#xa9; 2019 The American Association for
Thoracic Surgery

<32>
Accession Number
2004229078
Title
Comparing the efficacy of nidepine and cardepine in lowering blood
pressure after cardio-aortic surgery: A randomized, double-blinded
controlled trial.
Source
Journal of the Medical Association of Thailand. 102 (12) (pp 1289-1295),
2019. Date of Publication: 2019.
Author
Ekkarat P.; Sangkhathat S.; Namchaisiri J.
Institution
(Ekkarat) Department of Surgery, Nakhon Pathom Hospital, Nakhon Pathom,
Thailand
(Sangkhathat) Department of Surgery, Faculty of Medicine, Prince of
Songkla University, Hat Yai, Songkhla, Thailand
(Namchaisiri) Department of Surgery, Faculty of Medicine, Chulalongkorn
University, Bangkok 10330, Thailand
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Background: Parenteral nicardipine is an effective calcium channel blocker
for blood pressure control during the post-cardioaortic surgical period.
<br/>Objective(s): To compare two preparations of nicardipine
hydrochloride, Nidepine, and Cardepine, as a single treatment for acute
hypertension after cardioaortic surgery in adult patients.
<br/>Material(s) and Method(s): The study was a prospective randomized
double-blinded controlled trial of 50 post-cardioaortic surgery patients
with a systolic pressure greater than 140 mmHg that were divided into two
groups. The first group received Nidepine at the initial dose of 1 mg per
hour and titrated every 15 minutes until reaching the target blood
pressure, while the other group received Cardepine at the same dose. The
primary outcome was blood pressure reduction at 15 and 30 minutes of
treatment. <br/>Result(s): The blood pressures in both groups were
significantly reduced within 15 minutes with 40% of the cases reaching the
target of systolic pressure lower than 140 mmHg at 30 minutes. Systolic
pressure reduction at 15 minutes in the Nidepine group (7.45% of baseline)
was not significantly different from that of the Cardepine (5.04% of
baseline) group. The mean arterial pressure reductions in both groups
(6.42% and 6.99% of baseline in the Nidepine group and Cardepine groups,
respectively) were comparable. There were no significant differences in
total drug use in 24 hours (16.3 and 23.8 mg, respectively). The average
duration of therapy was 22.8 hours in the Nidepine group, and 25.3 hours
in the Cardepine group. Resumption of medication after cessation of
treatment was required in two cases (8%) in the Nidepine group and three
cases (12%) in the Cardepine group. There were no statistically
significant differences between the groups in overall complication rates.
<br/>Conclusion(s): Nidepine is therapeutically equivalent to Cardepine in
lowering blood pressure in acute hypertension following cardioaortic
surgery.<br/>Copyright &#xa9; JOURNAL OF THE MEDICAL ASSOCIATION OF
THAILAND <br/> 2019.

<33>
Accession Number
2003641008
Title
Right Ventricular Strain to Assess Early Right Heart Failure in the Left
Ventricular Assist Device Candidate.
Source
Current Heart Failure Reports. 16 (6) (pp 212-219), 2019. Date of
Publication: 01 Dec 2019.
Author
Gumus F.; Saricaoglu C.; Inan M.B.; Akar A.R.
Institution
(Gumus, Saricaoglu, Inan, Akar) Department of Cardiovascular Surgery,
Heart Center, Cebeci Hospitals, Ankara University School of Medicine,
Dikimevi, Ankara 06340, Turkey
Publisher
Springer
Abstract
Purpose of Review: Right heart failure (RHF) following left ventricular
assist device implantation (LVAD) remains the primary cause of
postoperative mortality and morbidity, and prediction of RHF is the main
interest of the transplantation community. In this review, we outline the
role and impact of right ventricular strain in the evaluation of the right
ventricle function before LVAD implantation. Recent Findings: Accumulating
data suggest that measurement of right ventricular longitudinal strain
(RVLS) has a critical role in predicting RHF preoperatively and may
improve morbidity and mortality following LVAD implantation. However, the
significant intraobserver, interobserver variability, the lack of
multicenter, prospective studies, and the need for a learning curve remain
the most critical limitations in the clinical practice at present.
<br/>Summary: This review highlighted the importance of right ventricular
strain in the diagnosis of RHF preoperatively and revealed that RVLS might
have a crucial clinical measurement for the selection and management of
LVAD patients in the future with the more extensive multicenter
studies.<br/>Copyright &#xa9; 2019, Springer Science+Business Media, LLC,
part of Springer Nature.

<34>
Accession Number
2002367508
Title
Pediatric Heart Transplantation: Transitioning to Adult Care (TRANSIT):
Feasibility of a Pilot Randomized Controlled Trial.
Source
Journal of Cardiac Failure. 25 (12) (pp 948-958), 2019. Date of
Publication: December 2019.
Author
Grady K.L.; Andrei A.-C.; Shankel T.; Chinnock R.; Miyamoto S.D.;
Ambardekar A.V.; Anderson A.; Addonizio L.; Latif F.; Lefkowitz D.;
Goldberg L.R.; Hollander S.A.; Pham M.; Van't Hof K.; Weissberg-Benchell
J.; Yancy C.; Liu M.; Melody N.; Pahl E.
Institution
(Grady, Andrei, Liu) Department of Surgery, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
(Shankel, Chinnock) Department of Medicine, Loma Linda University
Children's Hospital, Loma Linda, CA, United States
(Miyamoto) Department of Medicine, Children's Hospital Colorado, Aurora,
CO, United States
(Ambardekar) Department of Medicine, University of Colorado, Aurora, CO,
United States
(Anderson, Yancy) Department of Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL, United States
(Addonizio, Latif) Department of Medicine, Columbia University Medical
Center, New York, NY, United States
(Lefkowitz) Department of Psychiatry, The Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Goldberg) Department of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Hollander, Pham) Department of Medicine, Stanford University, Palo Alto,
CA, United States
(Van't Hof, Pahl) Department of Medicine, Ann & Robert H. Lurie Children's
Hospital of Chicago, Chicago, IL, United States
(Weissberg-Benchell) Department of Psychiatry, Ann & Robert H. Lurie
Children's Hospital of Chicago, Chicago, IL, United States
(Melody) Pharmacy Department, Northwestern Memorial Hospital, Chicago, IL,
United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: Young-adult heart transplant recipients transferring to adult
care are at risk for poor health outcomes. We conducted a pilot randomized
controlled trial to determine the feasibility of and to test a transition
intervention for young adults who underwent heart transplantation as
children and then transferred to adult care. <br/>Method(s): Participants
were randomized to the transition intervention (4 months long, focused on
heart-transplant knowledge, self-care, self-advocacy, and social support)
or usual care. Self-report questionnaires and medical records data were
collected at baseline and 3 and 6 months after the initial adult clinic
visit. Longitudinal analyses comparing outcomes over time were performed
using generalized estimating equations and linear mixed models.
<br/>Result(s): Transfer to adult care was successful and feasible (ie,
excellent participation rates). The average patient standard deviation of
mean tacrolimus levels was similar over time in both study arms and < 2.5,
indicating adequate adherence. There were no between-group or within-group
differences in percentage of tacrolimus bioassays within target range (>
50%). Average overall adherence to treatment was similarly good in both
groups. Rates of appointment keeping through 6 months after transfer
declined over time in both groups. <br/>Conclusion(s): The feasibility of
the study was demonstrated. Our transition intervention did not improve
outcomes.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<35>
Accession Number
2004307180
Title
Effects of intensive lipid-lowering therapy on mortality after coronary
bypass surgery: A meta-analysis of 7 randomised trials.
Source
Atherosclerosis. 293 (pp 75-78), 2020. Date of Publication: January 2020.
Author
Alkhalil M.
Institution
(Alkhalil) Cardiology Department, Royal Victoria Hospital, Belfast, United
Kingdom
(Alkhalil) Cardiology Department, Toronto General Hospital, 200 Elizabeth
Street, Toronto M5G 2C4, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: The recent reported analysis from the ODYSSEY
OUTCOMES trial showed that patients with previous coronary bypass graft
surgery (CABG) had enhanced clinical benefits in response to intensive
low-density lipoprotein-cholesterol (LDL-c). Nonetheless, the impact on
cardiovascular and all-cause mortality was difficult to ascertain given
the relatively small number. <br/>Method(s): We conducted a meta-analysis
investigating the role of more versus less intensive lipid-lowering
treatment, taking into consideration the difference in studies duration
when reporting treatment effect. <br/>Result(s): A significant 14%
reduction in deaths from any cause [RR 0.86 (95% CI, 0.74 to 0.99)] and
25% reduction in cardiovascular mortality [RR 0.75, (95% CI, 0.65 to
0.86)] were associated with intensive LDL-c reduction in patients post
CABG. Importantly, this reduction was apparent in patients who were stable
or developed an acute coronary syndrome following CABG.
<br/>Conclusion(s): Patients with previous CABG incurred reduction in
all-cause mortality and particularly cardiovascular mortality in response
to intensive LDL-c reduction. Patient's clinical presentation following
CABG did not modulate the associated benefits with intensive LDL-c
reduction. Characterising atherosclerotic disease may help identify other
high-risk groups who may benefit maximally from additional lipid-lowering
therapies.<br/>Copyright &#xa9; 2019 Elsevier B.V.

<36>
Accession Number
2004304539
Title
Invited commentary on "Mid-term and long term outcomes of endoscopic
versus open vein harvesting for coronary artery bypass: A systematic
review and meta-analysis" (Int J Surg. 2019;72:167-173).
Source
International Journal of Surgery. 73 (pp 94), 2020. Date of Publication:
January 2020.
Author
Baram A.
Institution
(Baram) Cardiovascular and Thoracic Surgery, Department of Surgery, School
of Medicine, Faculty of Medical Sciences, University of Sulaimani,
Francois Mitterrand Street, Kurdistan Region, Sulaymaniyah 46001, Iraq
(Baram) Department of Thoracic and Cardiovascular Surgery, Sulaimani
Teaching Hospital, Francois Mitterrand Street, Kurdistan Region,
Sulaymaniyah 46001, Iraq
Publisher
Elsevier Ltd

<37>
Accession Number
2004255100
Title
Perioperative management of Wilms' tumor with intracardiac extension:
Report of two cases with review of literature.
Source
Journal of the Saudi Heart Association. (no pagination), 2019. Date of
Publication: 2019.
Author
Altwaeel H.; Kabbani M.S.; Al Shammari A.; Al-Namshan M.; Alghamdi A.A.
Institution
(Altwaeel, Kabbani) Section of Pediatric Cardiac Intensive Care,
Department of Cardiac Sciences, King Abdulaziz Medical City, Riyadh, Saudi
Arabia
(Alghamdi) Section of Cardiac Surgery, Department of Cardiac Sciences,
King Abdulaziz Medical City, Riyadh, Saudi Arabia
(Al Shammari) Section of Urology Surgery, Department of Surgery, King
Abdulaziz Medical City, Riyadh, Saudi Arabia
(Al-Namshan) Department of Pediatric Surgery, King Abdullah Specialist
Children Hospital, Riyadh, Saudi Arabia
(Kabbani, Al Shammari, Al-Namshan, Alghamdi) King Saud Bin AbdulAziz
University for Health Sciences, Riyadh, Saudi Arabia
Publisher
Elsevier B.V.
Abstract
Wilms' tumor (WT) is one of the solid tumor that affects children. It
involves the kidney and may extend to the lungs and liver. WT conquers the
adjacent blood vessels such as renal veins and inferior vena cava (IVC);
its extension to IVC and right-sided heart chambers is unusual.
Furthermore, when the tumor extends to heart chambers, its surgical
management becomes challenging and demands multidisciplinary medical and
surgical specialties including pediatric cardiac surgery. In this report,
we discuss the surgical management and perioperative treatment of two
unusual cases of WT with IVC and intracardiac extension.<br/>Copyright
&#xa9; 2019 King Saud University

<38>
Accession Number
2004217606
Title
Pregnancy outcomes in women with cardiothoracic transplants: A Systematic
review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2019. Date of
Publication: 2019.
Author
Acuna S.; Zaffar N.; Dong S.; Ross H.; D'Souza R.
Institution
(Acuna, D'Souza) Institute of Health Policy, Management & Evaluation,
University of Toronto, Toronto, Ontario, Canada
(Zaffar, Dong, D'Souza) Division of Maternal-Fetal Medicine, Department of
Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto,
Toronto, Ontario, Canada
(Dong) Faculty of Medicine, University of Toronto, Toronto, Ontario,
Canada
(Ross) Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada
(D'Souza) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
Toronto, Ontario, Canada
Publisher
Elsevier USA
Abstract
Increasing numbers of women with thoracic transplants are planning and
continuing pregnancies. However, pregnancy outcomes and risks to the
mother and baby have not been systematically assessed. MEDLINE, EMBASE,
and Cochrane Central were searched from their inception to January 2018,
to identify studies reporting outcomes on 3 or more pregnancies following
thoracic transplants. Pooled incidences were calculated using a
random-effect meta-analysis. Risk-of-bias was assessed using the Joanna
Briggs Checklist for case series. Subgroup analysis was conducted based on
the organ transplanted. Of the 3,658 records identified, 12 studies were
included that reported on 385 pregnancies in 272 thoracic transplant
recipients. Maternal complications included mortality (pooled incidence
0.5% [95% confidence intervals 0, 1.1%] during pregnancy and 15.4% [10.4,
20.3%] during follow-up, which ranged between 3 and 7 years), graft
rejection (7.4% [4.2, 10.5%]), hypertensive disorders of pregnancy [26.6%
[13.7, 39.6%]), and cesarean deliveries (41.4% [33.4, 48.7%]). Maternal
mortality was more common in recipients of lung vs heart transplants
(41.4% [23.4, 59.3] vs 10.8% [5.9, 15.8]), respectively. Although 78.4%
(69.8, 86.9%) of the pregnancies resulted in live births, 51.2% (31,
71.3%) were born preterm and neonatal deaths occurred in 3.4% (1.3, 5.6%).
Congenital anomalies affected 4.3% (1.8, 6.8%) of the newborns. Although
few maternal deaths occurred during pregnancy, in keeping with median
survival data, delayed mortality for thoracic transplant recipients
remains high. Despite the high numbers of live births, these pregnancies
continue to be at risk for hypertensive disorders, graft rejection,
preterm birth, and neonatal mortality. Prospectively gathered data from
international registries should supplement these findings to better inform
clinical counseling and practice.<br/>Copyright &#xa9; 2019 International
Society for Heart and Lung Transplantation

<39>
Accession Number
2004191107
Title
Cost-Effectiveness Analysis of Landiolol, an Ultrashort-Acting
Beta-Blocker, for Prevention of Postoperative Atrial Fibrillation for the
Germany Health Care System.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Walter E.; Heringlake M.
Institution
(Walter) IPF Institute for Pharmaeconomic Research, Vienna, Austria
(Heringlake) Department of Anesthesiology and Intensive Care Medicine,
University of Lubeck, Lubeck, Germany
Publisher
W.B. Saunders
Abstract
Objectives: Landiolol is an ultrashort-acting beta-blocker with high
beta-1 receptor affinity and less blood pressure-lowering properties than
other beta-blockers available for intravenous use in Germany. The present
analysis aimed to determine whether perioperative treatment with landiolol
in cardiac surgical patients is cost-effective under the conditions of the
German Diagnosis-Related Groups health cost reimbursement system.
<br/>Design(s): On the basis of clinical outcome data from a meta-analysis
that included 622 patients from 7 randomized controlled trials, a
decision-model was developed to determine the cost-effectiveness of
landiolol versus standard-of-care (SoC). <br/>Setting(s): Hospital
setting. <br/>Participant(s): Hospital patients undergoing a
representative mix of cardiac surgical procedures (MIX-CS) and isolated
coronary artery bypass grafting (CABG). <br/>Intervention(s): Landiolol
versus SoC in prevention of atrial fibrillation immediately after cardiac
surgery. <br/>Measurements and Main Results: The model benefit was
expressed in a reduction of postoperative atrial fibrillation (POAF)
episodes and reduced complications. The model calculated total inpatient
costs over the hospital length of stay. Costs from published sources were
used for the German hospital perspective. SoC was associated with POAF
rates of 36.0% to 39.2% and 24.4% to 30.1% in the MIX-CS and CABG
populations, respectively. Patients with POAF had a higher morbidity and
mortality. Estimated total costs for SoC patients in the MIX-CS and CABG
groups were 28.792 and 25.630 , respectively. Landiolol reduced the
incidence of POAF to 12.6% in the MIX-CS and 12.1% in the CABG groups.
This was associated with a cost reduction of 2.209 and 1.470 .
<br/>Conclusion(s): This analysis suggests that preventing POAF with
landiolol is highly cost-effective. Additional studies are needed to
assess whether a comparable reduction in POAF and associated cost savings
may be achieved using conventional intravenous beta-blockers or
amiodarone.<br/>Copyright &#xa9; 2019 The Authors

<40>
Accession Number
2004046557
Title
The effects of Hegu point ice massage on post-sternotomy pain in patients
undergoing coronary artery bypass grafting: A single-blind, randomized,
clinical trial.
Source
Advances in Integrative Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Taherian T.; Shorofi S.A.; Zeydi A.E.; Charati J.Y.; Pouresmail Z.; Jafari
H.
Institution
(Taherian) School of Nursing and Midwifery, Student Research Committee,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Shorofi, Jafari) Traditional and Complementary Medicine Research Center,
Addiction Institute, Mazandaran University of Medical Sciences, Sari,
Iran, Islamic Republic of
(Shorofi) Adjunct Research Fellow, Flinders University, Adelaide,
Australia
(Zeydi) School of Nursing and Midwifery, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Charati) School of Health Sciences, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Pouresmail) School of Nursing and Midwifery, Shahid Beheshti University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Elsevier Australia
Abstract
Background and purpose: Pain is considered as one of the most common
problems among patients undergoing open heart surgery. We aimed to
evaluate the effects of Hegu point ice massage on the level of pain
experienced after coronary artery bypass grafting <br/>Material(s) and
Method(s): This is a single-blind, randomized, clinical trial, conducted
on 80 patients who were recruited via convenience sampling method. The
sample was randomly divided into two groups. In the experimental group,
ice massage was performed at the Hegu point on the left hand by applying a
medium pressure for 10 min (2 min massage, 15 s rest) in postoperative day
1 and 2. In the control group, glass marbles were applied at the Hegu
point on the left hand with no pressure and massage for 10 min. Pain
intensity was measured in both groups before the intervention and at 30,
60, and 120 min following the intervention. <br/>Result(s): Following the
intervention on the postoperative day 1, the mean pain score for the
experimental and control groups was 2.97 +/- 1.40 and 3.64 +/- 1.56,
respectively. For the experimental and control groups on postoperative day
2, the mean pain score was 2.35 +/- 1.12 versus 3.03 +/- 1.40,
respectively. Following the intervention on postoperative day 1, the mean
pain score was 2.97 +/- 1.40 and 3.64 +/- 1.56 in the experimental and
control groups, respectively. The mean pain score for the experimental
group was 2.35 +/- 1.12 compared with 3.03 +/- 1.40 for the control group
after the intervention on the second postoperative day. Statistically
significant differences were revealed for the mean pain score between the
two groups after the intervention on the first (p = 0.04) and second (p =
0.02) postoperative days. <br/>Conclusion(s): Hegu point ice massage is an
effective method for relieving pain associated with coronary artery bypass
grafting in specific patients.<br/>Copyright &#xa9; 2019 Elsevier Ltd

<41>
Accession Number
2004015858
Title
Epiaortic Ultrasound for Assessment of Intraluminal Atheroma; Insights
from the REGROUP Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Shapeton A.D.; Leissner K.B.; Zorca S.M.; Amirfarzan H.; Stock E.M.;
Biswas K.; Haime M.; Srinivasa V.; Quin J.A.; Zenati M.A.
Institution
(Haime, Quin, Zenati) Division of Cardiac Surgery, Veterans Affairs Boston
Healthcare System and Harvard Medical School, Boston, MA, United States
(Srinivasa) Department of Anesthesia, Critical Care and Pain Medicine,
Veterans Affairs Boston Healthcare System and Harvard Medical School,
Boston, MA, United States
(Shapeton, Leissner, Zorca, Amirfarzan, Stock, Biswas) Cooperative Studies
Program Coordinating Center, Office of Research and Development,
Department of Veterans Affairs, Perry Point, MD, United States
Publisher
W.B. Saunders
Abstract
Objectives: To assess the use of epiaortic ultrasound in contemporary
cardiac surgery, as well as its impact on surgical cannulation strategy
and cerebrovascular events. <br/>Design(s): Epiaortic ultrasound data was
prospectively collected in the Randomized Endovein Graft Prospective
(REGROUP) trial (VA Cooperative Studies Program #588, ClinicalTrials.gov,
NCT01850082), which randomized 1,150 coronary artery bypass graft patients
between 2014 and 2017 to endoscopic or open-vein graft harvest.
<br/>Setting(s): Sixteen cardiac surgery programs within the Veterans
Affairs Healthcare System with expertise at performing endoscopic
vein-graft harvesting. <br/>Participant(s): Veterans Affairs patients,
greater than 18 years of age, undergoing elective or urgent coronary
artery bypass grafting with cardiopulmonary bypass and cardioplegic arrest
with at least one planned saphenous vein graft were eligible for
enrollment. <br/>Intervention(s): Epiaortic ultrasound was performed by
the surgeon using a high frequency (>7 MHz) ultrasound transducer.
Two-dimensional images of the ascending aorta in multiple planes were
acquired before aortic cannulation and cross-clamping. <br/>Measurements
and Main Results: Epiaortic ultrasound was performed in 34.1% (269 of 790)
of patients in REGROUP. Among these patients, simple intraluminal atheroma
was observed in 21.9% (59 269), and complex intraluminal atheroma
comprised 2.2% (6 of 269). The aortic cannulation or cross-clamp strategy
was modified based on these findings in 7.1% of cases (19 of 269). There
was no difference in stroke between patients who underwent epiaortic
ultrasound and those who did not (1.9% v 1.2% p = 0.523).
<br/>Conclusion(s): Despite current guidelines recommending routine use of
epiaortic ultrasound (IIa/B) to reduce the risk of stroke in cardiac
surgery, in this contemporary trial, use remains infrequent, with
significant site-to-site variability.<br/>Copyright &#xa9; 2019

<42>
Accession Number
2004001126
Title
Microvascular Alterations During Cardiac Surgery Using a Heparin or
Phosphorylcholine-Coated Circuit.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Dekker N.A.M.; Veerhoek D.; van Leeuwen A.L.I.; Vonk A.B.A.; van den Brom
C.E.; Boer C.
Institution
(Dekker, Boer) Department of Anesthesiology, Amsterdam UMC, Vrije
Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam,
Netherlands
(Dekker, van Leeuwen, van den Brom) Department of Physiology, Amsterdam
UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences,
Amsterdam, Netherlands
(Dekker, Veerhoek, van Leeuwen, Vonk, van den Brom) Department of
Cardio-thoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam,
Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Heparin biocompatible coating frequently is used to reduce
inflammation and blood coagulation during cardiopulmonary bypass (CPB) in
cardiac surgery. Whether heparin coating is protective or damaging to the
vascular endothelium is unclear. The authors investigated whether
heparin-coated (HC) circuits are associated with better preservation of
microcirculatory perfusion and glycocalyx dimensions compared with
nonheparin phosphorylcholine-coated (PC) circuits. <br/>Design(s):
Prospective, randomized blinded study. <br/>Setting(s): Tertiary
university hospital. <br/>Participant(s): A total of 26 adults undergoing
elective coronary artery bypass graft surgery with CPB.
<br/>Intervention(s): PC (n = 13) versus HC circuits (n = 13).
<br/>Measurements and Main Results: Sublingual microcirculatory perfusion
was measured before, during, and after CPB using sidestream dark field
imaging and analyzed for perfused vessel density and perfused boundary
region, an inverse parameter for glycocalyx dimensions. Onset of CPB was
associated with an increase in perfused boundary region in the PC group
that continued until the third postoperative day (2.0 +/- 0.2 to 2.5 +/-
0.2 micro&#32;m; p = 0.018). This was paralleled by increased plasma
syndecan-1 levels in the PC group. Contrastingly, both parameters remained
unaltered in the HC group compared with baseline levels. CPB decreased
perfused vessel density in both groups (CPB v pre-CPB: PC: 17 +/- 2 to 13
+/- 2 mm/mm², p = 0.006; HC: 16 +/- 2 to 11 +/- 2
mm/mm², p = 0.003) and remained equally altered in the first 3
postoperative days. <br/>Conclusion(s): The use of an HC circuit is
associated with better preservation of the endothelial glycocalyx compared
with PC circuits, whereas microcirculatory perfusion was disturbed equally
in both groups. Hence, CPB-induced microcirculatory perfusion disturbances
seem to be coating independent.<br/>Copyright &#xa9; 2019 The Authors

<43>
Accession Number
2003873591
Title
Left ventricular size predicts clinical benefit after percutaneous mitral
valve repair for secondary mitral regurgitation: A systematic review and
meta-regression analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Zimarino M.; Ricci F.; Capodanno D.; De Innocentiis C.; Verrengia E.;
Swaans M.J.; Lombardi C.; Brouwer J.; Gallina S.; Grasso C.; De Caterina
R.; Tamburino C.
Institution
(Zimarino, De Innocentiis, Verrengia, Gallina) Institute of Cardiology "G.
d'Annunzio" University, Chieti, Italy
(Ricci) Institute for Advanced Biomedical Technologies, Department of
Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University,
Chieti, Italy
(Ricci) Department of Clinical Sciences, Lund University, Clinical
Research Center, Skane University Hospital, Malmo 205-02, Sweden
(Capodanno, Grasso, Tamburino) Division of Cardiology, Ferrarotto
Hospital, University of Catania, Catania, Italy
(Swaans, Brouwer) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Lombardi) Cardiology, Department of Medical and Surgical Specialties,
University of Brescia, Italy
(De Caterina) Institute of Cardiology, University of Pisa, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The benefit of percutaneous mitral valve repair (PMVR) in
patients with secondary MR is still debated. We aimed to compare the
outcome of PMVR with optimal medical therapy (OMT) versus OMT alone in
patients with secondary mitral regurgitation (MR) and to assess the role
of potential effect modifiers. <br/>Method(s): We performed a systematic
review and meta-analysis of 2 randomized clinical trials (RCT) and 7
non-randomized observational studies (nROS). Hazard ratios (HR) and 95%
confidence intervals (CI) were pooled through inverse variance
random-effects model to compute the summary effect size for all-cause
death, cardiovascular death and cardiac-related hospitalization. Subgroup
and meta-regression analysis were also performed. <br/>Result(s): An
overall population of 3118 individuals (67% men; mean age, 73 years) was
included: 1775 PMVR+OMT and 1343 OMT patients, with mean follow-up of 24
+/- 15 months. PMVR+OMT was associated with a lower risk of all-cause
death (HR: 0.77; 95% CI: 0.68-0.87), cardiovascular death (HR: 0.55; 95%
CI: 0.34-0.89) and cardiac-related hospitalization (HR:0.77; 95% CI:
0.64-0.92). Meta-regression analysis showed that larger left ventricular
end-diastolic volume index (LVEDVI) portends higher risk of all-cause
death, cardiovascular death and cardiac-related hospitalization after PMVR
(p < 0.001 for all). <br/>Conclusion(s): This study-level meta-analysis
shows that PMVR+OMT is associated with reduced all-cause death,
cardiovascular death and cardiac-related hospitalization when compared
with OMT alone in secondary MR. LVEDVI is a predictive marker of efficacy,
as patients with smaller LVEDVI have been shown to derive the largest
benefit from PMVR.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<44>
Accession Number
2003545194
Title
A meta-analysis comparing aspirin alone versus dual antiplatelet therapy
for the prevention of venous graft failure following coronary artery
bypass surgery.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Hesterberg K.; Rawal A.; Khan S.; Rashid A.; Jones D.; Siddiqui T.; Khader
T.A.; Nayyar M.; Shah R.
Institution
(Hesterberg, Rawal, Jones, Khader, Nayyar, Shah) Department of Medicine,
University of Tennessee, Memphis, TN, United States
(Khan) Department of Medicine, Aga Khan University, Pakistan
(Rashid) Jackson Clinic, University of Tennessee, Jackson, TN, United
States
(Siddiqui) Department of Medicine, Texas Tech University Health Sciences
Center El Paso, TX, United States
(Shah) Department of Cardiology, Gulf Coast Regional Medical Center,
Panama City, FL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Aspirin (ASA) monotherapy is the current standard of care
after coronary artery bypass grafting (CABG) to prevent saphenous vein
graft (SVG) failure. Several small, randomized clinical trials (RCTs) have
suggested that dual antiplatelet therapy (DAPT) may be more effective at
preventing SVG failure than ASA alone; however, it is unclear whether some
P2Y12 inhibitors are more effective than others for the prevention of SVG
failure. <br/>Method(s): Scientific databases and websites were searched
to find RCTs. Both traditional pairwise meta-analysis using random-effect
model and network meta-analysis using mixed-treatment comparison models
were performed to compare the efficacy of various anti-platelet strategies
for the prevention of SVG failure. <br/>Result(s): Nine RCTs, which
included a total of 1677 patients, were analyzed. Compared to ASA alone,
DAPT decreased the risk of graft failure by 37% (RR: 0.63, 95% CI:
0.47-0.86; p = 0.003). In the moderator analysis, the decreased risk of
graft failure with DAPT was not significantly different in the ASA +
clopidogrel group than in the ASA + ticagrelor group (P-interaction =
0.17). The results of the network meta-analysis were consistent with those
from pairwise analyses. The risk of major bleeding was not statistically
significantly different between DAPT and ASA alone (RR: 1.35, 95% CI:
0.62-2.94; p = 0.45). <br/>Conclusion(s): In post-CABG patients, DAPT
seems to be more effective at preventing graft failure than ASA alone.
This strategy does not seem to significantly increase major bleeding risk.
Clopidogrel- and ticagrelor-based DAPT seem to be equally effective for
this indication.<br/>Copyright &#xa9; 2019

<45>
Accession Number
2003518383
Title
Evaluation of hyperoxia-induced hypercapnia in obese patients after
cardiac surgery: a randomized crossover comparison of conservative and
liberal oxygen administration.
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Denault M.-H.; Ruel C.; Simon M.; Bouchard P.-A.; Simard S.; Lellouche F.
Institution
(Denault, Ruel, Simon, Bouchard, Simard, Lellouche) Institut universitaire
de cardiologie et de pneumologie de Quebec - Universite Laval Research
Center, 2725 Chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
Publisher
Springer
Abstract
Purpose: Recent studies on patients with stable obesity-hypoventilation
syndrome have raised concerns about hyperoxia-induced hypercapnia in this
population. This study aimed to evaluate whether a higher oxygen
saturation target would increase arterial partial pressure of carbon
dioxide (PaCO<inf>2)</inf> in obese patients after coronary artery bypass
grafting surgery (CABG). <br/>Method(s): Obese patients having CABG were
recruited. With a randomized crossover design, we compared two oxygenation
strategies for 30 min each, immediately after extubation: a peripheral
oxygen saturation (SpO<inf>2</inf>) target of >= 95% achieved with manual
oxygen titration (liberal) and a SpO<inf>2</inf> target of 90% achieved
with FreeO<inf>2</inf>, an automated oxygen titration device
(conservative). The main outcome was end-of-period arterial
PaCO<inf>2</inf>. <br/>Result(s): Thirty patients were included. Mean
(standard deviation [SD]) body mass index (BMI) was 34 (3)
kg.m^-2 and mean (SD) baseline partial pressure of carbon
dioxide (PCO<inf>2</inf>) was 40.7 (3.1) mmHg. Mean (SD) end-of-period
PaCO<inf>2</inf> was 42.0 (5.4) mmHg in the conservative period, compared
with 42.6 (4.6) mmHg in the liberal period [mean difference - 0.6 (95%
confidence interval - 2.2 to 0.9) mmHg; P = 0.4]. Adjusted analysis for
age, BMI, narcotics, and preoperative PaCO<inf>2</inf> did not
substantively change the results. Fourteen patients were retainers,
showing an elevation in mean (SD) PaCO<inf>2</inf> in the liberal period
of 3.3 (4.1) mmHg. Eleven patients had the opposite response, with a mean
(SD) end-of-period PaCO<inf>2</inf> decrease of 1.8 (2.2) mmHg in the
liberal period. Five patients had a neutral response. <br/>Conclusion(s):
This study did not show a clinically important increase in
PaCO<inf>2</inf> associated with higher SpO<inf>2</inf> values in this
specific population of obese patients after CABG. Partial pressure of
carbon dioxide increased with liberal oxygen administration in almost half
of the patients, but no predictive factor was identified. Trial
registration: www.clinicaltrials.gov (NCT02917668); registered 25
September, 2016.<br/>Copyright &#xa9; 2019, Canadian Anesthesiologists'
Society.

<46>
Accession Number
2004264757
Title
PCV112 COST UTILITY ANALYSIS OF TICAGRELOR REMOVAL BY CYTOSORB IN PATIENTS
REQUIRING EMERGENT OR URGENT CARDIAC SURGERY IN THE UK.
Source
Value in Health. Conference: ISPOR Europe 2019. Denmark. 22 (Supplement 3)
(pp S562), 2019. Date of Publication: November 2019.
Author
Javanbakht M.; Trevor M.; Rahimi K.; Branagan-Harris M.; Degener F.;
Blanco D.A.; Preissing F.; Scheier J.; Cook S.F.; Mortensen E.
Institution
(Javanbakht, Trevor) Newcastle University, Newcastle upon Tyne, United
Kingdom
(Rahimi) The George Institute for Global Health, University of Oxford, UK,
Oxford, United Kingdom
(Branagan-Harris) Device Access UK Ltd, University of Southampton Science
Park, Southampton, United Kingdom
(Degener, Blanco, Preissing, Scheier) CytoSorbents Corporation, Berlin,
Germany
(Cook) CERobs Consulting LLC, North Carolina, NC, United States
(Mortensen) CytoSorbents Corporation, New Jersey, NJ, United States
Publisher
Elsevier Ltd
Abstract
Objectives: Acute coronary syndrome patients on dual antiplatelet therapy
needing emergent or urgent cardiac surgery are at risk of major bleeding,
which can impair post-operative outcomes. CytoSorb, a blood purification,
adsorbent polymer technology, has been demonstrated to remove ticagrelor
from blood during on-pump cardiac surgery. This study assessed the
cost-utility of intraoperative removal of ticagrelor using CytoSorb versus
usual care among patients requiring emergent or urgent cardiac surgery.
<br/>Method(s): A de novo decision analytic model, based on current
treatment pathways, was developed to estimate the short- and long-term
costs and outcomes. Results from randomised clinical trials and national
standard sources were used to inform the model. Costs were estimated from
the National Health Service (NHS) and Personal Social Services
perspective. Deterministic and probabilistic sensitivity analyses (PSA)
explored the uncertainty surrounding the input parameters. <br/>Result(s):
In emergent cardiac surgery, intraoperative removal of ticagrelor using
CytoSorb is less costly (12,940 versus 16,886) and more effective (0.06201
versus 0.06076 quality-adjusted life years) than cardiac surgery without
physiologic clearance of ticagrelor over a 30-day time horizon. For urgent
cardiac surgery, use of CytoSorb was less costly than any of the three
comparators; delaying surgery for natural washout without adjunctive
therapy, adjunctive therapy with short-acting antiplatelet agents, or
adjunctive therapy with low molecular-weight heparin. Results from the PSA
showed that CytoSorb has a high probability of being cost saving (99% in
emergent cardiac surgery and 53%-77% in urgent cardiac surgery, depending
on the comparators). Cost savings derive from fewer transfusions of blood
products and re-thoracotomies, and shorter stay in hospital/intensive care
unit. Using CytoSorb could save the NHS 3,195 hospital bed days per year.
<br/>Conclusion(s): Implementation of CytoSorb intraoperatively for
patients on ticagrelor undergoing emergent or urgent cardiac surgery is a
cost-saving strategy, yielding improvement in perioperative and
postoperative outcomes and decreased health resource use.<br/>Copyright
&#xa9; 2019

<47>
Accession Number
2004263653
Title
PRO62 SYSTEMATIC LITERATURE REVIEW OF DISEASE BURDEN, COSTS AND MODELS IN
TRANSTHYRETIN AMYLOID CARDIOMYOPATHY (ATTR-CM).
Source
Value in Health. Conference: ISPOR Europe 2019. Denmark. 22 (Supplement 3)
(pp S852), 2019. Date of Publication: November 2019.
Author
Granghaud A.; Famelart V.; Waeckel A.; Geffroy C.; Demarcq O.; Fievez S.;
Diamand F.; Myjak I.; Millier A.
Institution
(Granghaud, Famelart, Waeckel, Geffroy, Demarcq, Fievez) Pfizer SAS,
Paris, France
(Diamand, Millier) Creativ-Ceutical, Paris, France
(Myjak) Creativ-Ceutical, Cracow, Poland
Publisher
Elsevier Ltd
Abstract
Objectives: Transthyretin amyloid cardiomyopathy (ATTR-CM), is a rare,
progressively debilitating fatal disease. The objective was to conduct a
systematic literature review on the ATTR-CM burden in France, focusing on
epidemiology, survival, cost/resource use, quality of life and economic
models. <br/>Method(s): A unique search was performed in Embase/Medline
with only disease keywords, and specific websites were searched manually.
All studies retrieved were then classified among relevant topics.
<br/>Result(s): Overall 23 studies were selected, including six studies
with French-specific results. Four studies presented French
epidemiological data: 1- among patients with ATTR, 13.8% presented a
cardiac and 41.5% presented cardiac/neurological ATTR, 2- among patients
with hypertrophic cardiomyopathy, 5% had a hereditary ATTR-CM, 3- among
patients with amyloidosis, 81.8% presented a cardiac amyloidosis, out of
which 28.8% were hereditary and 11.6% were wild-type, and 4- among
patients with confirmed cardiac amyloidosis, 40.4% presented hereditary
TTR and 28.1% had a wild-type TTR. Four studies presented results relative
to survival: 1- at 1 year, 74% of patients who had a heart transplant for
cardiac amyloidosis were still alive, 2- at 17 months, the rate was 68% in
patients with hereditary ATTR-CM, and 65% in patients with wild-type
ATTR-CM, 3- at 22 months, the rate was 81% in hereditary ATTR patients and
79% in patients with wild-type ATTR, and 4- 60.9% of hereditary ATTR
patients who underwent liver transplantation survived after a median
follow-up of 5.9 years. Only one study provided results related to
resource use, reporting that among 94 patients with ATTR-CM, 21.3%
underwent a liver transplant, while none underwent a heart transplant.
Quality of life data was documented in four non-French studies, and no
economic evaluation was identified. <br/>Conclusion(s): Knowledge around
ATTR-CM is scarce in France; more research is needed to document its
burden, from both an economic and humanistic perspective.<br/>Copyright
&#xa9; 2019