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

<2>
Accession Number
628077900
Title
Differential modulatory effects of Propofol and Sevoflurane anesthesia on
blood monocyte HLA-DR and CD163 expression during and after cardiac
surgery with cardiopulmonary bypass: a preliminary randomized flow
cytometry study.
Source
Perfusion (United Kingdom). 35 (1) (pp 48-56), 2020. Date of Publication:
01 Jan 2020.
Author
Sbrana S.; Nunziata A.; Storti S.; Haxhiademi D.; Mazzone A.; Leone M.;
Solinas M.; Del Sarto P.
Institution
(Sbrana) Flow Cytometry Laboratory, CNR Institute of Clinical Physiology,
Ospedale del Cuore, Massa, Italy
(Nunziata, Haxhiademi, Del Sarto) Department of Anesthesiology and
Intensive Care, Ospedale del Cuore, Fondazione Toscana Gabriele
Monasterio, Massa, Italy
(Storti) Unit of Laboratory Medicine, Ospedale del Cuore, Fondazione
Toscana Gabriele Monasterio, Massa, Italy
(Mazzone) Adult Cardiology Department, Ospedale del Cuore, Fondazione
Toscana Gabriele Monasterio, Massa, Italy
(Leone) Perfusion Unit, Cardiothoracic Department, Ospedale del Cuore,
Fondazione Toscana Gabriele Monasterio, Massa, Italy
(Solinas) Adult Cardiac Surgery Department, Ospedale del Cuore, Fondazione
Toscana Gabriele Monasterio, Massa, Italy
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: The increase of the anti-inflammatory
CD163^highHLA-DR^low blood monocyte subset is one of
the mechanisms dampening inflammation during cardiac surgery with
cardiopulmonary bypass. We evaluated the effect of two different
anesthetic protocols, intravenous Propofol infusion or Sevoflurane-gas
administration, on the perioperative frequency of this subset.
<br/>Method(s): Blood from patients (Propofol = 11, Sevoflurane = 13)
undergoing minimally invasive mitral valve surgery was drawn
preoperatively (T1), before declamping (T2), at 6 (T3), 24 (T4), 48 (T5),
and 72 hours (T6) after declamping. C-reactive protein, haptoglobin, and
lactate dehydrogenase were measured. A hemolytic index, as C-reactive
protein/haptoglobin ratio, was introduced. Monocyte expression of HLA-DR,
CD163, and the CD163^highHLA-DR^low subset fraction
was quantified by flow cytometry. Baseline-referred variations of
plasmatic and cellular data at T2 were normalized for clamping times.
Subsequent time-point variations were normalized for the final
cardiopulmonary bypass times. <br/>Result(s): Variations of hemolytic
index and lactate dehydrogenase were higher with Propofol at T3 (p = 0.004
and p = 0.02, respectively) when compared with Sevoflurane. At T2, the
down-modulation of CD163 was higher with Propofol (p = 0.005). Starting
from T3, the up-regulatory trend of CD163 was basically higher with
Propofol, although not significantly. Propofol induced higher increments
of HLA-DR low fractions, at T2 (p = 0.04) and, to a lesser extent, at T4
(p = 0.06). Starting from T3, the CD163^highHLA-DR^low
subset variations were higher with Propofol, especially at T4 and T6.
<br/>Conclusion(s): Propofol seems to induce a higher postoperative
fraction of the CD163^highHLA-DR^low monocyte subset.
This could represent either a compensatory mechanism dampening the higher
inflammatory condition observed with Propofol at T2 or a consequence of a
higher postoperative Propofol-induced hemolysis.<br/>Copyright &#xa9; The
Author(s) 2019.

<3>
Accession Number
630413591
Title
Double-chambered right ventricle in children.
Source
Journal of the College of Physicians and Surgeons Pakistan. 29 (12) (pp
1193-1198), 2019. Date of Publication: 2019.
Author
Yuan S.-M.
Institution
(Yuan) First Hospital of Putian, Teaching Hospital, Fujian Medical
University, Fujian Province, China
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
A double-chambered right ventricle (DCRV) is a rare congenital heart
defect. The clinical features of DCRV, especially in the pediatric
population, have not been sufficiently elaborated. There are many
unanswered questions regarding the surgical indications, surgical timing,
natural history, and patient outcomes. This article will discuss the
definition, pathophysiology, clinical features and treatment of DCRV. This
systematic review showed a higher prevalence of symptomatic patients among
children with DCRV with signs of right ventricular pressure overload and
associated congenital heart defects. The spatial relation between
ventricular septal defect and the anomalous muscle bundle might be a
determinant of right ventricular obstruction. Symptomatic patients with an
intra-right ventricular pressure gradient of >20 mmHg are indicated for a
surgical repair. DCRV has a favourable postoperative course as no
postoperative death was reported. Mechanisms of right ventricular
obstruction warrant further elucidations based on larger patient
population in the near future.<br/>Copyright &#xa9; 2019 College of
Physicians and Surgeons Pakistan. All rights reserved.

<4>
Accession Number
630362559
Title
Prophylactic use of levosimendan in pediatric patients undergoing cardiac
surgery: A prospective randomized controlled trial.
Source
Critical Care. 23 (1) (no pagination), 2019. Article Number: 428. Date of
Publication: 30 Dec 2019.
Author
Wang A.; Cui C.; Fan Y.; Zi J.; Zhang J.; Wang G.; Wang F.; Wang J.; Tan
Q.
Institution
(Wang, Cui, Zi, Zhang, Wang, Wang, Tan) Intensive Care Unit (ICU),
Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong
University, No. 9677 Jingshi Road, Jinan 250021, China
(Tan) Intensive Care Unit (ICU), Department of Cardiac Surgery, Provincial
Hospital Affiliated to Shandong First Medical University, Jinan 250021,
China
(Fan) Department of Toxicological and Functional Test, Centers for Disease
Control and Prevention of Shandong, Jinan 250014, China
(Wang) Department of Pharmacy, Shandong Provincial Hospital Affiliated to
Shandong University, Jinan 250021, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The administration of levosimendan prophylactically to
patients undergoing cardiac surgery remains a controversial practice, and
few studies have specifically assessed the value of this approach in
pediatric patients. This study therefore sought to explore the safety and
efficacy of prophylactic levosimendan administration to pediatric patients
as a means of preventing low cardiac output syndrome (LCOS) based upon
hemodynamic, biomarker, and pharmacokinetic readouts. <br/>Method(s): This
was a single-center, double-blind, randomized, placebo-controlled trial.
Patients <= 48 months old were enrolled between July 2018 and April 2019
and were randomly assigned to groups that received either placebo or
levosimendan infusions for 48 h post-surgery, along with all other
standard methods of care. LCOS incidence was the primary outcome of this
study. <br/>Result(s): A total of 187 patients were enrolled, of whom 94
and 93 received levosimendan and placebo, respectively. LCOS incidence did
not differ significantly between the levosimendan and placebo groups (10
[10.6%] versus 18 [19.4%] patients, respectively; 95% confidence interval
[CI] 0.19-1.13; p = 0.090) nor did 90-day mortality (3 [3.2%] versus 4
[4.3%] patients, CI 0.14-3.69, p = 0.693), duration of mechanical
ventilation (median, 47.5 h and 39.5 h, respectively; p = 0.532), ICU stay
(median, 114.5 h and 118 h, respectively; p = 0.442), and hospital stay
(median, 20 days and 20 days, respectively; p = 0.806). The incidence of
hypotension and cardiac arrhythmia did not differ significantly between
the groups. Levels of levosimendan fell rapidly without any plateau in
plasma concentrations during infusion. A multiple logistic regression
indicated that randomization to the levosimendan group was a predictor of
LCOS. <br/>Conclusion(s): Prophylactic levosimendan administration was
safe in pediatric patients and had some benefit to postoperative
hemodynamic parameters, but failed to provide significant benefit with
respect to LCOS or 90-day mortality relative to placebo. Trial
registration: Name of the registry: Safety evaluation and therapeutic
effect of levosimendan on the low cardiac output syndrome in patients
after cardiopulmonary bypass. Trial registration number: ChiCTR1800016594.
Date of registration: 11 June 2018. URL of trial registry record:
http://www.chictr.org.cn/index.aspx.<br/>Copyright &#xa9; 2019 The
Author(s).

<5>
Accession Number
2004041865
Title
Ten-Year Outcomes of Sirolimus-Eluting Versus Zotarolimus-Eluting Coronary
Stents in Patients With Versus Without Diabetes Mellitus (SORT OUT III).
Source
American Journal of Cardiology. 125 (3) (pp 349-353), 2020. Date of
Publication: 1 February 2020.
Author
Olesen K.K.W.; Pareek M.; Madsen M.; Jensen L.O.; Christiansen E.H.;
Thuesen L.; Lassen J.F.; Kristensen S.D.; Botker H.E.; Maeng M.
Institution
(Olesen, Pareek, Christiansen, Kristensen, Botker, Maeng) Department of
Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Olesen, Madsen) Department of Clinical Epidemiology, Aarhus University
Hospital, Aarhus, Denmark
(Jensen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Thuesen, Lassen) Department of Cardiology, Aalborg Hospital, Aalborg,
Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We compared 10-year clinical outcomes in diabetes and nondiabetes patients
treated with Endeavor zotarolimus-eluting (ZES) or Cypher
sirolimus-eluting coronary stents (SES). A total of 1,162 patients were
randomized to ZES (169 with diabetes) and 1,170 patients were randomized
to SES (168 with diabetes). Patients were further stratified by diabetes
status at the time of inclusion. A subgroup of patients with diabetes (n =
88) underwent angiographic re-evaluation 10 months after stent
implantation. End points included a combined end point of death or
myocardial infarction, and the individual end points of death, myocardial
infarction, and revascularization. In patients with diabetes, we found no
difference in the combined end point (odds ratio [OR] 0.81, 95% confidence
interval [CI] 0.53 to 1.24), death (OR 0.80, 95% CI 0.51 to 1.25), or in
MI (OR 1.07, 95% CI 0.60 to 1.91). However, diabetics with ZES more
frequently underwent coronary revascularization compared with SES patients
(OR 1.93, 95% CI 1.05 to 3.66). In patients without diabetes, ZES and SES
had similar 10-year rates of all end points (death: OR 1.13, 95% CI 0.93
to 1.39; MI: OR 0.80, 95% CI 0.61 to 1.05; revascularization: OR 0.81, 95%
CI 0.61 to 1.09). Landmark analysis from 5 to 10 years showed no
difference in outcomes between SES and ZES in either subgroup. In
conclusion, at 10 years, SES and ZES performed similarly in patients with
and without diabetes. Although coronary revascularization was more
prevalent in diabetes patients with ZES, this may, in part, have been
related to the angiographic follow-up that was offered to a subgroup of
diabetes patients.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<6>
Accession Number
2003970025
Title
Meta-analysis of alpha-blockade versus no blockade before adrenalectomy
for phaeochromocytoma.
Source
British Journal of Surgery. 107 (2) (pp e102-e108), 2020. Date of
Publication: 01 Jan 2020.
Author
Schimmack S.; Kaiser J.; Probst P.; Kalkum E.; Diener M.K.; Strobel O.
Institution
(Schimmack, Kaiser, Probst, Diener, Strobel) Department of General,
Visceral and Transplantation Surgery, University of Heidelberg,
Heidelberg, Germany
(Kaiser, Probst, Kalkum, Diener) Study Centre of the German Surgical
Society, University of Heidelberg, Heidelberg, Germany
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Preoperative alpha-blockade in phaeochromocytoma surgery is
recommended by all guidelines to prevent intraoperative cardiocirculatory
events. The aim of this meta-analysis was to assess the benefit of such
preoperative treatment compared with no treatment before adrenalectomy for
phaeochromocytoma. <br/>Method(s): A systematic literature search was
undertaken in MEDLINE, Web of Science and CENTRAL without language
restrictions. Randomized and non-randomized comparative studies
investigating preoperative alpha-blockade in phaeochromocytoma surgery
were included. Data on perioperative safety, effectiveness and outcomes
were extracted. Pooled results were calculated as an odds ratio or mean
difference with 95 per cent confidence interval. <br/>Result(s): A total
of four retrospective comparative studies were included investigating 603
patients undergoing phaeochromocytoma surgery. Mortality, cardiovascular
complications, mean maximal intraoperative systolic and diastolic BP, and
mean maximal intraoperative heart rate did not differ between patients
with or without alpha-blockade. The certainty of the evidence was very low
owing to the inferior quality of studies. <br/>Conclusion(s): This
meta-analysis has shown a lack of evidence for preoperative alpha-blockade
in surgery for phaeochromocytoma. RCTs are needed to evaluate whether
preoperative alpha-blockade can be abandoned.<br/>Copyright &#xa9; 2020
BJS Society Ltd Published by John Wiley & Sons Ltd

<7>
Accession Number
2003948772
Title
Meta-Analysis Comparing Results of Transcatheter Versus Surgical
Aortic-Valve Replacement in Patients With Severe Aortic Stenosis.
Source
American Journal of Cardiology. 125 (3) (pp 449-458), 2020. Date of
Publication: 1 February 2020.
Author
Zhang X.; Wang T.; Lan R.; Dai Q.; Kang L.; Wang L.; Wang Y.; Xu W.; Xu B.
Institution
(Zhang, Lan, Dai, Kang, Wang, Xu, Xu) Department of Cardiology, Affiliated
Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
(Wang, Wang) Centre for translational Medicine, Nanjing University School
of Medicine, Nanjing, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic-valve replacement (TAVR) has emerged as a promising
strategy for treating patients with severe aortic stenosis. We aimed to
compare TAVR with surgical aortic-valve replacement (SAVR) and determine
the performance of TAVR over time and within several subgroups. We
included 8 randomized trials comparing TAVR versus SAVR. Compared with
SAVR, TAVR was associated with a lower rate of all-cause mortality or
disabling stroke at 30-day (odds ratio [OR], 0.72; p = 0.004), 1-year (OR,
0.83; p = 0.01), and 2-year (OR, 0.86; p = 0.02), but not at long-term
follow-up (rate ratio [RR], 1.02 [confidence interval 0.92 to 1.13]; p =
0.67). Notably, 5-year data showed numerically higher incidence in TAVR
(RR, 1.11 [confidence interval 0.97 to 1.27]; p = 0.12). The risks
associated with TAVR versus SAVR increased over time, showing a
significant interaction (p for interaction = 0.01), as were for new-onset
atrial fibrillation and rehospitalization. Incidences of major bleeding,
new-onset fibrillation, and acute kidney injury were lower in TAVR,
whereas transient ischemic attack, major vascular complications, permanent
pacemaker implantation, reintervention, and paravalvular leak were lower
in SAVR. Incidences for all-cause and cardiovascular mortality, myocardial
infarction, and stroke were not statistically different. TAVR with
transfemoral approach and new-generation valve was associated with
reduction in all-cause mortality or disabling stroke compared with
corresponding comparators. In conclusion, TAVR was associated with a lower
risk for all-cause mortality or disabling stroke within 2 years, but not
at long-term follow-up compared with SAVR; the risks seems to increase
over time. More data are needed to determine longer-term performance of
TAVR.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<8>
Accession Number
629565892
Title
Serum albumin in patients undergoing transcatheter aortic valve
replacement: A meta-analysis.
Source
Reviews in cardiovascular medicine. 20 (3) (pp 161-169), 2019. Date of
Publication: 30 Sep 2019.
Author
Hsieh W.C.; Aboud A.; Henry B.M.; Omara M.; Lindner J.; Pirk J.
Institution
(Hsieh) First Faculty of Medicine, Charles University, Prague 1200,
Czechia
(Hsieh, Lindner) 22nd Department of Cardiovascular Surgery, First Faculty
of Medicine, Charles University and General University Hospital in Prague,
Prague 1200, Czechia
(Aboud) Department of Cardiac and Thoracic Vascular Surgery, University of
Schleswig-Holstein, Lubeck Campus, Lubeck 23562, Germany
(Henry) Division of Cardiology, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH 45229, United States
(Omara) Department of Thoracic and Cardiovascular Surgery, Research
Institute, Cleveland Clinic, Cleveland, OH 44195, United States
(Pirk) Department of Cardiology and Cardiac Surgery, Institute of Clinical
and Experimental Medicine IKEM, Prague 14021, Czechia
Publisher
NLM (Medline)
Abstract
Transcatheter aortic valve replacement is becoming a more common
therapeutic option for the treatment of aortic stenosis in patients at
high risk for invasive surgery, but detecting which patients will benefit
clinically can be challenging. Hypoalbuminemia is a useful prognostic
marker for chronic inflammation in this population. We carried out a
systematic review and meta-analysis of studies evaluating the prognostic
value of serum albumin level in patients undergoing transcatheter aortic
valve replacement. A literature search of PubMed, Embase, ScienceDirect,
Web of Science, SciELO, BIOSIS, Wanfang, and CNKI databases was conducted.
Articles published between January 2000 and December 2017 reporting on the
prognostic value of low levels of serum albumin in patients undergoing
transcatheter aortic valve replacement were analyzed according to
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. 11 studies including 6456 patients met inclusion criteria for
meta-analysis. A lower serum albumin level was associated with a lower
survival rate at follow-up in patients who underwent transcatheter aortic
valve replacement. A sub-group analysis of eight studies reporting
adjusted hazard ratios indicated that low serum albumin was independently
correlated with increased post-operative mortality. The hazard ratio of
mortality risk associated with each 1 g/dL increment in serum albumin
level was 0.46, suggesting a potential dose-response relationship between
increased serum albumin level and increased survival rate in patients
undergoing transcatheter aortic valve replacement. This meta-analysis
provides strong evidence for the utility of serum albumin as a prognostic
marker in aortic stenosis patients undergoing transcatheter aortic valve
replacement, with low serum albumin levels (2.5-3.5 g/dL) suggesting poor
prognosis.<br/>Copyright &#xa9; 2019 Hsieh et al. Published by IMR press.
All rights reserved.

<9>
Accession Number
2003523983
Title
The impact of deep sternal wound infections treated by negative pressure
on early, 1 year and late mortality: A longitudinal case-control study.
Source
Journal of Cardiac Surgery. 34 (12) (pp 1550-1555), 2019. Date of
Publication: 01 Dec 2019.
Author
Drossos G.; Ampatzidou F.; Baddour A.; Madesis A.; Karaiskos T.
Institution
(Drossos, Baddour, Madesis, Karaiskos) Cardiothoracic Surgery Department,
G. Papanikolaou General Hospital, Thessaloniki, Greece
(Ampatzidou) Cardiothoracic Intensive Care Unit, G. Papanikolaou General
Hospital, Thessaloniki, Greece
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background/Aim: Deep sternal wound infection (DSWI) after cardiac surgery,
is a rare complication that can be fatal. Due to a lack of available data,
we compared early in-hospital, 1-year and long-term mortality in patients
with DSWI. <br/>Method(s): Patients undergoing any type of cardiac
surgery, in the Cardiothoracic Surgery Department of G. Papanikolaou
Hospital, between May 2012 and December 2016, were investigated. All
patients who developed DWSI postoperatively, treated with negative
pressure wound therapy (NPWT), were included in the group of cases. A
random population from the rest of the patients was selected in a 1:2
ratio, representing controls. <br/>Result(s): From a total of 2104
patients, 80 patients (3.8%) developed DSWI (cases group), whereas 180
patients were randomly selected as controls. Early (within 30 days)
mortality was significantly higher in the DSWI group compared with
controls (15% vs 3.9%, respectively; P =.002). Similarly, more deaths
occurred in the cases group compared with controls during the follow-up
(ie, 19 vs 12, respectively; P <.001); the majority of deaths (84.2%)
occurred within the first year. Long-term survival did not differ between
the two study groups during follow-up (median duration = 1072 vs 1022 days
for cases and controls, respectively). <br/>Conclusion(s): DSWI
significantly increased early and 1-year mortality in poststernotomy
patients treated with NPWT compared with those not developing this
complication. However, long-term survival was similar between the two
study groups, thus highlighting the beneficial effect of NPWT in terms of
clinical outcomes in patients with DWSI.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<10>
Accession Number
2004514075
Title
Long-Term Prognosis of Suspected Myocarditis and Cardiomyopathy Associated
with Viral Infection of the Myocardial Tissue: A Meta-Analysis of Cohort
Studies.
Source
Cardiovascular Therapeutics. 2019 (no pagination), 2019. Article Number:
9342792. Date of Publication: 2019.
Author
Chen W.-H.; Guo Y.-S.; Zhang D.-H.; Zhang H.-J.
Institution
(Chen) Graduate Department, Guangdong Medical University, Zhanjiang, China
(Guo, Zhang, Zhang) Cardiovascular Center, Eighth Affiliated Hospital, Sun
Yat-Sen University, Shenzhen, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Aim. Myocarditis and cardiomyopathy impose a substantial economic burden
on society. Many studies have examined the effects of various predictors
on the prognosis of these diseases, such as the left ventricular systolic
function, the New York Heart Association glomerular filtration rate, the
QT interval, and the presence of viruses. In the present study, we
conducted a meta-analysis of cohort studies to investigate the
significance of the presence of viruses in the myocardial tissue on the
prognosis of these diseases. Methods. The Embase, PubMed, and Cochrane
library databases were searched for relevant literature that had been
published between January 1, 1964 and August 14, 2018. The inclusion
criteria were patients over 18 years of age, suspected myocarditis or
dilated cardiomyopathy, accepted myocardial biopsy, and the detection of
virus in the myocardial tissue. Results. In total, 10 studies met the
inclusion criteria. These studies included 1006 patients with suspected
myocarditis or idiopathic heart disease for whom the primary endpoint was
all-cause death, heart transplant, or re-hospitalization due to fatal
arrhythmia and heart failure. There was no significant difference in the
prognosis of virus-positive and virus-negative patients with myocarditis
or dilated cardiomyopathy confirmed by endomyocardial biopsy (EMB) [hazard
ratio (HR) = 1.40, 95% confidence interval (CI) = 0.93-2.12, P=0.11].
However, virus-negative patients had a better prognosis following
nonspecific treatment (HR = 1.40, 95% CI = 1.06-1.86, P=0.02) and right
ventricular biopsy (HR = 2.08, 95% CI = 1.07-4.04, P=0.03). Conclusions.
The presence of a virus did not worsen the long-term prognosis of patients
with suspected myocarditis or dilated cardiomyopathy. However,
virus-positive patients who did not undergo specific treatment or who
underwent right ventricular biopsy did have a worse prognosis. Thus, the
early diagnosis of the presence of viral infection in the myocardium will
improve the prognosis of patients.<br/>Copyright &#xa9; 2019 Wen-Hao Chen
et al.

<11>
Accession Number
630509518
Title
Clinical impact of conduction disturbances in transcatheter aortic valve
replacement recipients: a systematic review and meta-analysis.
Source
European heart journal. (no pagination), 2020. Date of Publication: 03 Jan
2020.
Author
Faroux L.; Chen S.; Muntane-Carol G.; Regueiro A.; Philippon F.;
Sondergaard L.; Jorgensen T.H.; Lopez-Aguilera J.; Kodali S.; Leon M.;
Nazif T.; Rodes-Cabau J.
Institution
(Faroux, Muntane-Carol, Philippon, Rodes-Cabau) Quebec Heart and Lung
Institute, Laval University, 2725 chemin Ste-Foy ,Quebec City, QC G1V4G5,
Canada
(Chen, Kodali, Leon, Nazif) Columbia University Medical Center, New
York-Presbyterian Hospital, 177 Fort Washington Avenue, NY, NY 10032,
United States
(Regueiro) Institut Clinic Cardiovascular, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Carrer de
Villaroel, 170, Barcelona 08036, Spain
(Sondergaard, Jorgensen) Rigshospitalet, University of Copenhagen,
Blegdamsvej 9, Copenhagen 2100, Denmark
(Lopez-Aguilera) Hospital Reina Sofia of Cordoba, Avenida Menendez Pidal,
Cordoba 14004, Spain
Publisher
NLM (Medline)
Abstract
AIMS: The clinical impact of new-onset persistent left bundle branch block
(NOP-LBBB) and permanent pacemaker implantation (PPI) on transcatheter
aortic valve replacement (TAVR) recipients remains controversial. We aimed
to evaluate the impact of (i) periprocedural NOP-LBBB and PPI post-TAVR on
1-year all-cause death, cardiac death, and heart failure hospitalization
and (ii) NOP-LBBB on the need for PPI at 1-year follow-up. METHODS AND
RESULTS: We performed a systematic search from PubMed and EMBASE databases
for studies reporting raw data on 1-year clinical impact of NOP-LBBB or
periprocedural PPI post-TAVR. Data from 30 studies, including 7792
patients (12 studies) and 42 927 patients (21 studies) for the evaluation
of the impact of NOP-LBBB and PPI after TAVR were sourced, respectively.
NOP-LBBB was associated with an increased risk of all-cause death [risk
ratio (RR) 1.32, 95% confidence interval (CI) 1.17-1.49; P<0.001], cardiac
death (RR 1.46, 95% CI 1.20-1.78; P<0.001), heart failure hospitalization
(RR 1.35, 95% CI 1.05-1.72; P=0.02), and PPI (RR 1.89, 95% CI 1.58-2.27;
P<0.001) at 1-year follow-up. Periprocedural PPI after TAVR was associated
with a higher risk of all-cause death (RR 1.17, 95% CI 1.11-1.25; P<0.001)
and heart failure hospitalization (RR 1.18, 95% CI 1.03-1.36; P=0.02).
Permanent pacemaker implantation was not associated with an increased risk
of cardiac death (RR 0.84, 95% CI 0.67-1.05; P=0.13). <br/>CONCLUSION(S):
NOP-LBBB and PPI after TAVR are associated with an increased risk of
all-cause death and heart failure hospitalization at 1-year follow-up.
Periprocedural NOP-LBBB also increased the risk of cardiac death and PPI
within the year following the procedure. Further studies are urgently
warranted to enhance preventive measures and optimize the management of
conduction disturbances post-TAVR.<br/>Copyright Published on behalf of
the European Society of Cardiology. All rights reserved. &#xa9; The
Author(s) 2020. For permissions, please email:
journals.permissions@oup.com.

<12>
Accession Number
630509429
Title
Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial
function, inflammatory parameters, and platelet function in patients with
acute coronary syndrome undergoing coronary artery stenting: a randomized,
blinded, parallel study.
Source
European heart journal. (no pagination), 2020. Date of Publication: 03 Jan
2020.
Author
Schnorbus B.; Daiber A.; Jurk K.; Warnke S.; Koenig J.; Lackner K.J.;
Munzel T.; Gori T.
Institution
(Schnorbus, Daiber, Munzel, Gori) Zentrum fur Kardiologie, Kardiologie I,
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Schnorbus, Jurk) Center for Thrombosis and Hemostasis,
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Daiber, Munzel, Gori) Deutsches Zentrum fur Herz-Kreislauferkrankungen
(DZHK), Standort Rhein-Main, Langenbeckstrase 1, Mainz 55131, Germany
(Warnke) Interdisciplinary Center for Clinical Trials (IZKS),
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Koenig) Institute of Medical Biostatistics, Epidemiology and Informatics,
University Medical Center, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Lackner) Institute of Clinical Chemistry and Laboratory Medicine,
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
Publisher
NLM (Medline)
Abstract
AIMS: In a randomized, parallel, blinded study, we investigate the impact
of clopidogrel, prasugrel, or ticagrelor on peripheral endothelial
function in patients undergoing stenting for an acute coronary syndrome.
METHODS AND RESULTS: The primary endpoint of the study was the change in
endothelium-dependent flow-mediated dilation (FMD) following stenting. A
total of 90 patients (age 62+/-9years, 81 males, 22 diabetics, 49 non-ST
elevation myocardial infarctions) were enrolled. There were no significant
differences among groups in any clinical parameter. Acutely before
stenting, all three drugs improved FMD without differences between groups
(P=0.73). Stenting blunted FMD in the clopidogrel and ticagrelor group
(both P<0.01), but not in the prasugrel group. During follow-up, prasugrel
was superior to clopidogrel [mean difference 2.13, 95% confidence interval
(CI) 0.68-3.58; P=0.0047] and ticagrelor (mean difference 1.57, 95% CI
0.31-2.83; P=0.0155), but this difference was limited to patients who
received the study therapy 2h before stenting. Ticagrelor was not
significantly superior to clopidogrel (mean difference 0.55, 95% CI -0.73
to 1.82; P=0.39). No significant differences were seen among groups for
low-flow-mediated dilation. Plasma interleukin (IL)-6 (P=0.02 and P=0.01,
respectively) and platelet aggregation reactivity in response to adenosine
diphosphate (P=0.002 and P=0.035) were lower in the prasugrel compared to
clopidogrel and ticagrelor group. <br/>CONCLUSION(S): As compared to
ticagrelor and clopidogrel, therapy with prasugrel in patients undergoing
stenting for an acute coronary syndrome is associated with improved
endothelial function, stronger platelet inhibition, and reduced IL-6
levels, all of which may have prognostic implications. This effect was
lost in patients who received the study medication immediately after
stenting. EUDRACT-NO: 2011-005305-73.<br/>Copyright Published on behalf of
the European Society of Cardiology. All rights reserved. &#xa9; The
Author(s) 2020. For permissions, please email:
journals.permissions@oup.com.

<13>
Accession Number
630500309
Title
Complete revascularization reduces cardiovascular death in patients with
ST-segment elevation myocardial infarction and multivessel disease:
systematic review and meta-analysis of randomized clinical trials.
Source
European heart journal. (no pagination), 2019. Date of Publication: 31 Dec
2019.
Author
Pavasini R.; Biscaglia S.; Barbato E.; Tebaldi M.; Dudek D.; Escaned J.;
Casella G.; Santarelli A.; Guiducci V.; Gutierrez-Ibanes E.; Di Pasquale
G.; Politi L.; Saglietto A.; D'Ascenzo F.; Campo G.
Institution
(Pavasini, Biscaglia, Tebaldi, Campo) Cardiovascular Institute, Azienda
Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara 44124,
Italy
(Barbato) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Via Pansini, Naples 80131, Italy
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
ul. Sw Anny 12, Krakow 31-008, Poland
(Dudek, Campo) Maria Cecilia Hospital, GVM Care & Research, Via Corriera
1, Cotignola 48033, Italy
(Escaned) Hospital Clinico San Carlos IDISCC, Complutense University of
Madrid, Calle del Prof Martin Lagos s/n, Madrid 28040, Spain
(Casella, Di Pasquale) U.O.C. Cardiologia, Ospedale Maggiore ,Largo
Nigrisoli 2, Bologna 40133, Italy
(Santarelli) Cardiovascular Department, Infermi Hospital, Viale Luigi
Settembrini 2, Rimini 47923, Italy
(Guiducci) Interventional Cardiology Unit, S. Maria Nuova Hospital, Viale
Risorgimento 80, Italy
(Gutierrez-Ibanes) Servicio de Cardiologia, Hospital General Universitario
Gregorio Maranon, Calle del Dr Esquerdo 46, Madrid 28007, Spain
(Gutierrez-Ibanes) Universidad Carlos III, Calle Madrid 126 Madrid 28903
Spain
(Politi) Cardiologia Interventistica, ASST Rhodense, Rho 20024, Italy
(Saglietto, D'Ascenzo) Division of Cardiology, University of Turin, A.O.U.
Citta della Salute e della ScienzaCorso Bramante 88/90, Turin 10126, Italy
Publisher
NLM (Medline)
Abstract
AIMS: The aim of this work was to investigate the prognostic impact of
revascularization of non-culprit lesions in patients with ST-segment
elevation myocardial infarction (STEMI) and multivessel disease by
performing a meta-analysis of available randomized clinical trials (RCTs).
METHODS AND RESULTS: Data from six RCTs comparing complete vs.
culprit-only revascularization in STEMI patients with multivessel disease
were analysed with random effect generic inverse variance method
meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95%
confidence interval (CI). The primary outcome was cardiovascular death.
Main secondary outcomes of interest were all-cause death, myocardial
infarction (MI), and repeated coronary revascularization. Overall, 6528
patients were included (3139 complete group, 3389 culprit-only group).
After a follow-up ranging between 1 and 3years (median 2years),
cardiovascular death was significantly reduced in the group receiving
complete revascularization (HR 0.62, 95% CI 0.39-0.97, I2 = 29%). The
number needed to treat to prevent one cardiovascular death was 70 (95% CI
36-150). The secondary endpoints MI and revascularization were also
significantly reduced (HR 0.68, 95% CI 0.55-0.84, I2 = 0% and HR 0.29, 95%
CI 0.22-0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI
37-55) for MI and 8 (95% CI 5-13) for revascularization. All-cause death
(HR 0.81, 95% CI 0.56-1.16, I2 = 27%) was not affected by the
revascularization strategy. <br/>CONCLUSION(S): In a selected study
population of STEMI patients with multivessel disease, a complete
revascularization strategy is associated with a reduction in
cardiovascular death. This reduction is concomitant with that of MI and
the need of repeated revascularization.<br/>Copyright Published on behalf
of the European Society of Cardiology. All rights reserved. &#xa9; The
Author(s) 2019. For permissions, please email:
journals.permissions@oup.com.

<14>
[Use Link to view the full text]
Accession Number
630486319
Title
Echocardiographic outcomes from seven randomized trials of transcatheter
versus surgical aortic valve replacement.
Source
Journal of Cardiovascular Medicine. 21 (1) (pp 58-64), 2020. Date of
Publication: 01 Jan 2020.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Nakashima) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center,
United States
(Ando) Division of Interventional Cardiology, Department of Cardiology,
Presbyterian Hospital/Columbia University Medical Center, New York, NY,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims We performed meta-analyses of echocardiographic outcomes, including
postprocedural aortic valve area (AVA), aortic valve mean pressure
gradient (MPG), and paravalvular aortic regurgitation (PAR), exclusively
from all currently available randomized controlled trials (RCTs) of
transcatheter aortic valve implantation (TAVI) versus surgical aortic
valve replacement (SAVR).MethodsTo identify all RCTs providing
echocardiographic outcomes (AVA, MPG, and PAR) up to 2 years after TAVI
versus SAVR, PubMed and ClinicalTrials.gov were searched through June
2019. Mean differences in AVA (and MPG) between the TAVI and SAVR groups
and odds (or hazard) ratios of at least moderate PAR for TAVI versus SAVR
were pooled using the random-effects meta-analysis.ResultsWe identified
seven eligible RCTs. At 30 days (P=0.004), 1 year (P=0.006), and 2 years
(P=0.03), AVA was significantly larger after TAVI than after SAVR. After
TAVI than after SAVR, MPG was significantly lower at 30 days (P=0.03) and
2 years (P=0.01), and nonsignificantly lower at 1 year (P=0.06). At 30
days (P<0.00001), 1 year (P<0.00001), and 2 years (P<0.00001), incidence
of at least moderate PAR was significantly greater after TAVI than after
SAVR.ConclusionOn the basis of the present meta-analyses of all the seven
currently available RCTs, AVA is larger, MPG is lower, and incidence of at
least moderate PAR is greater 30 days, 1 and 2 years after TAVI than after
SAVR.<br/>Copyright &#xa9; 2019 Italian Federation of Cardiology - I.F.C.
All rights reserved.

<15>
[Use Link to view the full text]
Accession Number
630486303
Title
Spontaneous coronary artery dissection managed with a conservative or
revascularization approach: A meta-analysis.
Source
Journal of Cardiovascular Medicine. 21 (1) (pp 42-50), 2020. Date of
Publication: 01 Jan 2020.
Author
Jamil A.; Tajrishi F.Z.; Kahe F.; Najafi H.; Montazerin S.M.; Shojaei F.;
Chitsazan M.; Liu Y.; Chi G.
Institution
(Jamil) OSF Saint Francis Medical Center, Peoria, IL, United States
(Tajrishi) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Kahe, Najafi, Montazerin, Shojaei, Chitsazan, Chi) Division of
Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA, United States
(Chitsazan) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Liu) Baim Institute for Clinical Research, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BackgroundThe optimal treatment approach for spontaneous coronary artery
dissection (SCAD) remains unclear.ObjectivesThe study aims to compare
in-hospital and long-term clinical outcomes of SCAD patients initially
managed with medical therapy (conservative approach) versus percutaneous
coronary intervention or coronary artery bypass grafting
(revascularization approach) based on published data.MethodsWe identified
relevant studies by performing a systematic search in the Ovid MEDLINE and
Embase databases. Studies with N at least 10 that report in-hospital
outcomes [death, myocardial infarction (MI) and revascularization] or
long-term outcomes (death, MI, revascularization, SCAD recurrence, and
heart failure) were included. Risk difference between conservative and
revascularization approach was estimated with the inverse
variance-weighted method in a fixed-effect or random-effect model.ResultsA
total of 22 nonrandomized, observational studies were analyzed (N=1435).
Compared with the initial revascularization approach, the conservative
approach was associated with a comparable risk of in-hospital outcomes
[risk difference: death, -0.61% (95% confidence interval, -2.13-0.91%),
P=0.43; MI, -0.99% (-4.65-2.67%), P=0.60; revascularization, -3.02%
(-8.79-2.75%), P=0.31] and long-term outcomes [death, -0.06%
(-2.33-2.20%), P=0.96; MI, 0.96% (-2.35-4.27%), P=0.57; revascularization,
-3.31% (-7.63-1.02%), P=0.13; SCAD recurrence, 3.75% (-2.05-9.55%),
P=0.21; heart failure, -0.01% (-3.13-3.11%), P=0.99]. There was no
significant heterogeneity across these studies.ConclusionPooled results
suggest that SCAD patients initially managed with a conservative strategy
may have similar in-hospital and long-term outcomes compared with those
who received revascularization in the absence of ongoing ischemia or left
main artery involvement. More data from prospective studies are warranted
to validate these findings.<br/>Copyright &#xa9; 2019 Italian Federation
of Cardiology - I.F.C. All rights reserved.

<16>
Accession Number
630443323
Title
Safety of switching from Vitamin K antagonist to non-Vitamin K antagonist
oral anticoagulant in frail elderly with atrial fibrillation: Rationale
and design of the FRAIL-AF randomised controlled trial.
Source
BMJ Open. 9 (12) (no pagination), 2019. Article Number: e032488. Date of
Publication: 29 Dec 2019.
Author
Joosten L.P.T.; Van Doorn S.; Hoes A.W.; Nierman M.C.; Wiersma N.M.; Koek
H.L.; Hemels M.E.W.; Huisman M.V.; Roes K.C.; Van Den Bor R.M.; Buding
W.F.; Rutten F.H.; Geersing G.-J.
Institution
(Joosten, Van Doorn, Hoes, Roes, Van Den Bor, Rutten, Geersing) Julius
Center for Health Sciences and Primary Care, University Medical Center
Utrecht, Utrecht University, Utrecht, Netherlands
(Nierman) Department of Thrombosis and Anticoagulation, Atalmedial Medical
Diagnostics Centers, Amsterdam, Netherlands
(Wiersma) Department of Thrombosis and Anticoagulation, Diagnostic Center
Saltro, Utrecht, Netherlands
(Koek) Department of Geriatrics, University Medical Center Utrecht,
Utrecht University, Utrecht, Netherlands
(Hemels) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Hemels) Department of Cardiology, Radboud University Medical Center,
Radboud University, Nijmegen, Netherlands
(Huisman) Department of Thrombosis and Hemostasis, Leiden University
Medical Center, Leiden University, Leiden, Netherlands
(Buding) Dutch Organisation for Patients Using Anticoagulant Medication,
CTD Nederland, Leiden, Netherlands
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Clinical guidelines recommend non-vitamin K antagonist oral
anticoagulants (NOACs) over vitamin K antagonists (VKAs) for stroke
prevention in most patients with atrial fibrillation (AF). Frail elderly
were under-represented in the landmark NOAC-trials, leaving a knowledge
gap on the optimal anticoagulant management (VKA or NOAC) in this
increasing population. The aim of the Frail-AF (FRAIL-AF) study is to
assess whether switching from international normalised ratio (INR)-guided
VKA-management to a NOAC-based treatment strategy compared with continuing
VKA-management is safe in frail elderly patients with AF. Methods and
analysis The FRAIL-AF study is a pragmatic, multicentre, open-label,
randomised controlled clinical trial. Frail elderly (age >=75 years plus a
Groningen Frailty Indicator score >=3) who receive VKA-treatment for AF in
the absence of a mechanical heart valve or severe mitral valve stenosis
will be randomised to switch to a NOAC-based treatment strategy or to
continue INR-guided VKA-management. Patients with severe renal impairment
(estimated glomerular filtration rate <30 mL/min/1.73 m 2) will be
excluded from randomisation. Based on existing trial evidence in non-frail
patients, we will aim to explore whether NOAC-treatment is superior to
VKA-therapy in reducing major or clinically relevant non-major bleeding
events. Secondary outcomes include minor bleeding, the composite of
ischaemic and haemorrhagic stroke, health-related quality of life and
cost-effectiveness. The follow-up period for all subjects is 12 months.
Ethics and dissemination The protocol was approved by the Medical Research
Ethics Committee of the University Medical Center Utrecht, the Netherlands
and by the Central Committee on Research Involving Human Subjects, the
Netherlands. All patients are asked written informed consent. Results are
expected in 2022 and will be disseminated through peer-reviewed journals
as well as presentations at national and international conferences. Trial
registration number EudraCT: 2017-000393-11; The Netherlands Trial
Registry: 6721 (FRAIL-AF study).<br/>Copyright &#xa9; &#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.

<17>
Accession Number
630415498
Title
Efficacy and safety of low-dose colchicine after myocardial infarction.
Source
New England Journal of Medicine. 381 (26) (pp 2497-2505), 2019. Date of
Publication: 26 Dec 2019.
Author
Tardif J.-C.; Kouz S.; Waters D.D.; Bertrand O.F.; Diaz R.; Maggioni A.P.;
Pinto F.J.; Ibrahim R.; Gamra H.; Kiwan G.S.; Berry C.; Lopez-Sendon J.;
Ostadal P.; Koenig W.; Angoulvant D.; Gregoire J.C.; Lavoie M.-A.; Dube
M.-P.; Rhainds D.; Provencher M.; Blondeau L.; Orfanos A.; L'Allier P.L.;
Guertin M.-C.; Roubille F.
Institution
(Tardif, Ibrahim, Gregoire, Lavoie, Dube, Rhainds, L'Allier) Montreal
Heart Institute, 5000 Belanger St., Montreal, PQ H1T 1C8, Canada
(Provencher, Blondeau, Orfanos, Guertin) Montreal Health Innovations
Coordinating Center, Montreal, Canada
(Kouz) Centre Hospitalier Regional de Lanaudiere, Joliette, Canada
(Bertrand) Institut de Cardiologie et Pneumologie de Quebec, Quebec City,
Canada
(Waters) San Francisco General Hospital, San Francisco, United States
(Diaz) Estudios Clinicos Latinoamerica, Rosario, Argentina
(Maggioni) Associazione Nazionale Medici Cardiologi Ospedalieri Research
Center, Florence, Italy
(Pinto) Santa Maria University Hospital (Centro Hospitalar Universitario
Lisboa Norte), Centro Academico de Medicina de Lisboa, Centro
Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da
Universidade de Lisboa, Lisbon, Portugal
(Gamra) Fattouma Bourguiba University Hospital, Monastir, Tunisia
(Kiwan) Bellevue Medical Center, Beirut, Lebanon
(Berry) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
(Lopez-Sendon) Hospital Universitario La Paz, Universidad Autonoma de
Madrid, Instituto de Investigacion La Paz, Centro de Investigacion
Biomedica en Red-Enfermedades Cardiovasculares, Madrid, Spain
(Ostadal) Cardiovascular Center, Na Homolce Hospital, Prague, Czechia
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
DZHK (German Center for Cardiovascular Research), Partner site Munich
Heart Alliance, Munich, Institute of Epidemiology and Medical Biometry,
University of Ulm, Ulm, Germany
(Angoulvant) Centre Hospitalier Universitaire (CHU) de Tours, Equipe
d'Accueil 4245 Transplantation Immunite Inflammation Loire Valley
Cardiovascular Collaboration, Tours University, Tours, France
(Roubille) PhyMedExp (Physiologie et Medecine Experimentale du Coeur et
des Muscles), Universite de Montpellier, INSERM, Centre National de la
Recherche Scientifique, Cardiology Department, CHU de Montpellier,
Montpellier, France
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Experimental and clinical evidence supports the role of
inflammation in atherosclerosis and its complications. Colchicine is an
orally administered, potent anti-inflammatory medication that is indicated
for the treatment of gout and pericarditis. <br/>METHOD(S): We performed a
randomized, double-blind trial involving patients recruited within 30 days
after a myocardial infarction. The patients were randomly assigned to
receive either low-dose colchicine (0.5 mg once daily) or placebo. The
primary efficacy end point was a composite of death from cardiovascular
causes, resuscitated cardiac arrest, myocardial infarction, stroke, or
urgent hospitalization for angina leading to coronary revascularization.
The components of the primary end point and safety were also assessed.
<br/>RESULT(S): A total of 4745 patients were enrolled; 2366 patients were
assigned to the colchicine group, and 2379 to the placebo group. Patients
were followed for a median of 22.6 months. The primary end point occurred
in 5.5% of the patients in the colchicine group, as compared with 7.1% of
those in the placebo group (hazard ratio, 0.77; 95% confidence interval
[CI], 0.61 to 0.96; P = 0.02). The hazard ratios were 0.84 (95% CI, 0.46
to 1.52) for death from cardiovascular causes, 0.83 (95% CI, 0.25 to 2.73)
for resuscitated cardiac arrest, 0.91 (95% CI, 0.68 to 1.21) for
myocardial infarction, 0.26 (95% CI, 0.10 to 0.70) for stroke, and 0.50
(95% CI, 0.31 to 0.81) for urgent hospitalization for angina leading to
coronary revascularization. Diarrhea was reported in 9.7% of the patients
in the colchicine group and in 8.9% of those in the placebo group (P =
0.35). Pneumonia was reported as a serious adverse event in 0.9% of the
patients in the colchicine group and in 0.4% of those in the placebo group
(P = 0.03). <br/>CONCLUSION(S): Among patients with a recent myocardial
infarction, colchicine at a dose of 0.5 mg daily led to a significantly
lower risk of ischemic cardiovascular events than placebo.<br/>Copyright
&#xa9; 2019 Massachusetts Medical Society.

<18>
Accession Number
630363553
Title
The OMACS-PIL study: A randomised controlled trial within the OMACS
observational study.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 772. Date of
Publication: 27 Dec 2019.
Author
Culliford L.; Brierley R.; Clout M.; Evans R.; Maishman R.; Phillips D.;
Tabusa H.; Reeves B.; Rogers C.A.
Institution
(Culliford, Brierley, Clout, Evans, Maishman, Phillips, Tabusa, Reeves,
Rogers) Clinical Trials and Evaluation Unit Bristol, Bristol Trials
Centre, Translational Health Sciences, Bristol Medical School, Queens
Building (Zone A), Bristol Royal Infirmary, Bristol BS2 8HW, United
Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: There has been little research to investigate whether the
appearance of paper patient information leaflets (PILs) used to describe
research studies to potential participants influences their decision to
take part. Embedding a study within a trial (SWAT) is an efficient way of
answering this type of methodological question. We included a randomised
SWAT within a large cohort study, Outcome Monitoring after Cardiac Surgery
(OMACS), to address this question. <br/>Method(s): Potential participants
for the OMACS study were randomised to receive one of three PILs, which
were identical in content but with varying formatting and use of colour:
PIL A (enhanced format), PIL B (hybrid format) and PIL C (standard
format). Consent to OMACS was the primary outcome. Consent rates using the
three different PIL formats were collected and compared. Qualitative
feedback on the different formats was obtained from a public and patient
involvement (PPI) group. <br/>Result(s): For the SWAT, 1517 PILs were sent
to potential participants, of whom 640 (42%) consented to take part in
OMACS. PIL B had the highest recruitment rate, with 45% of patients
consenting to participation; 40% and 41% of patients consented to
participation after receiving PILs A and C, respectively. Compared to PIL
C, the consent rate was 4% higher with PIL B (45% versus 41%, 95%
confidence interval (CI) -2% to + 10%, p = 0.16) and 1% lower with PIL A
(40% versus 41%, 95% CI - 7% to + 5%, p = 0.72). <br/>Conclusion(s):
Consent rates were similar for all three PIL formats. PIL B is being used
for the remainder of the host study and will be used to inform the design
of PILs for other research studies, as it was the preferred format of the
PPI group. Trial registration: International Clinical Trials Registry,
ISRCTN90204321. Registered on 21 January 2015.<br/>Copyright &#xa9; 2019
The Author(s).

<19>
Accession Number
2004483427
Title
Minimally invasive CABG or hybrid coronary revascularization for
multivessel coronary diseases: Which is best? A systematic review and
metaanalysis.
Source
Heart Surgery Forum. 22 (6) (pp E494-E502), 2019. Date of Publication: 09
Oct 2019.
Author
Guan Z.; Zhang Z.; Gu K.; Wang H.; Lin J.; Zhou W.; Wan F.
Institution
(Guan, Zhang, Gu, Wang, Lin, Zhou, Wan) Department of Cardiology Surgery,
Peking University Third Hospital, 49 North Garden Rd. Haidian District,
Beijing 100191, China
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Objectives: Minimally invasive coronary revascularization (MICR) involves
minimally invasive direct coronary artery bypass grafting (MIDCAB) and
robotic-assisted coronary artery bypass grafting (RCABG), and hybrid
coronary revascularization (HCR) aims to combine MICR/RCABG on left
anterior descending (LAD) and percutaneous coronary interventions (PCI) on
non-LAD lesions. We performed a systematic review and metaanalysis to
compare clinical outcome after MICR and HCR. <br/>Method(s): A
metaanalysis was carried out through searching PubMed, EMBASE, Web of
Science, and Medline for comparative studies evaluating the primary and
secondary clinical end points. <br/>Result(s): A systematic literature
search identified 8 observational studies that satisfied our inclusion
criteria, including being suitable for metaanalysis; the studies were
between 1990 and 2018 and included 1084 cases of HCR and 2349 cases of
MICR. Metaanalysis of these studies showed that HCR was associated with a
reduced need for ICU LOS (WMD -11.46 hours, 95% CI, -18.76 ~ -4.25, P =
.02), to hospital time (WMD -1.34 hours, 95% CI, -2.42 to 0.26, P < .01),
and blood transfusion (OR 0.43, 95% CI, 0.31-0.59, P < .00001) than MICR.
Comparisons of individual components showed no significant difference in
terms of in-hospital mortality, MACCE, shock, myocardial infarction (MI),
long-term survival, total variable cost, and surgical complications
(including renal failure, chest drainage, bleeding). <br/>Conclusion(s):
HCR was noninferior to MICR in terms of in-hospital mortality, MACCE,
shock, MI, long-term survival, total variable cost, and surgical
complications (including renal failure, chest drainage, bleeding), whereas
HCR was associated with a reduced need for ICU LOS, hospital time, and
blood transfusion than MICR and less infection than MICR. Further
randomized studies are warranted to corroborate these observational
data.<br/>Copyright &#xa9; 2019 Forum Multimedia Publishing, LLC.

<20>
Accession Number
2003963263
Title
Transfusing Platelets During Bypass Rewarming in Neonates Improves
Postoperative Outcomes: A Randomized Controlled Trial.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 11 (1) (pp
71-76), 2020. Date of Publication: 01 Jan 2020.
Author
Gautam N.K.; Pierre J.; Edmonds K.; Pawelek O.; Griffin E.; Xu Z.;
Dodge-Khatami A.; Salazar J.
Institution
(Gautam, Pierre, Edmonds, Pawelek, Griffin, Xu) Department of
Anesthesiology, McGovern Medical School, University of Texas Health
Science Center at Houston, TX, United States
(Dodge-Khatami, Salazar) Division of Pediatric Congenital Heart Surgery,
McGovern Medical School, University of Texas Health Science Center at
Houston, TX, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: In neonates, transfusion of platelets after hemodilution from
cardiopulmonary bypass (CPB) has been standard. We hypothesize that
platelet administration during the rewarming phase before termination of
CPB would reduce coagulopathy, enhance hemostasis, reduce transfusion, and
improve postoperative outcomes after neonatal cardiac surgery.
<br/>Method(s): A prospective, randomized trial was performed in 46
neonates. Controls received platelets only at the end of bypass with other
blood products to assist in hemostasis. The treatment group received 10
mL/kg of platelets during the rewarming phase of bypass after cross-clamp
release. After protamine, transfusion and perioperative management
protocols were identical and constant among groups. <br/>Result(s): Two
neonates in each group were excluded secondary to postoperative need for
extracorporeal support. Controls (n = 21) and treatment patients (n = 21)
were similar in age, weight, case complexity, associated syndromes, single
ventricle status, and CPB times. Compared to controls, the treatment group
required 40% less postbypass blood products (58 +/- 29 vs 103 +/- 80
mL/kg, P =.04), and case completion time after protamine administration
was 28 minutes faster (P =.016). The treatment group required fewer
postoperative mediastinal explorations for bleeding (P =.045) and had a
lower fluid balance (P =.04). The treatment group had shorter mechanical
ventilation (P =.016) and length of intensive care unit times (P =.033).
There were no 30-day mortalities in either group. <br/>Conclusion(s):
Platelet transfusion during the rewarming phase of neonatal cardiac
surgery was associated with reduced bleeding and improved postoperative
outcomes, compared to platelets given after coming off bypass. Further
studies are necessary to understand mechanisms and benefits of this
strategy.<br/>Copyright &#xa9; The Author(s) 2019.

<21>
Accession Number
2003963260
Title
Budesonide for Protein Losing Enteropathy in Patients with Fontan
Circulation: A Systematic Review and Meta-Analysis.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 11 (1) (pp
85-91), 2020. Date of Publication: 01 Jan 2020.
Author
Kewcharoen J.; Mekraksakit P.; Limpruttidham N.; Kanitsoraphan C.;
Charoenpoonsiri N.; Poonsombudlert K.; Pattison R.J.; Rattanawong P.
Institution
(Kewcharoen, Limpruttidham, Kanitsoraphan, Poonsombudlert, Pattison,
Rattanawong) University of Hawaii Internal Medicine Residency Program,
Honolulu, HI, United States
(Mekraksakit) Department of Medicine, Phramongkutklao College of Medicine,
Bangkok, Thailand
(Charoenpoonsiri) Faculty of Medicine, Chulalongkorn University Hospital,
Bangkok, Thailand
(Rattanawong) Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Recent studies have shown that oral budesonide can be used to
improve albumin level in patients with protein-losing enteropathy (PLE)
following Fontan procedure. However, there has never been a systematic
review and meta-analysis to confirm this finding. We performed a
systematic review and meta-analysis to explore the therapeutic effect of
budesonide in patients with PLE post-Fontan procedure. <br/>Method(s): We
searched the databases of MEDLINE and EMBASE from inception to January
2019. Included studies were published studies that evaluate albumin level
before and after budesonide therapy in patients with PLE following Fontan
procedure. Data from each study were combined using the random-effects
model. <br/>Result(s): Five studies with 36 post-Fontan operation patients
with PLE were included. In random-effects model, there was a statistically
significant difference in albumin level between before and after
budesonide treatment (weighted mean difference = 1.28, 95% confidence
interval: 0.76-1.79). No publication bias was observed on a funnel plot
and Egger test with a P value of.676. <br/>Conclusion(s): The results of
this systematic review and meta-analysis show that budesonide can be used
to increase albumin level in patients with PLE following Fontan operation.
Further studies may focus on the impact of outcome of budesonide in this
population.<br/>Copyright &#xa9; The Author(s) 2019.

<22>
Accession Number
2003502820
Title
A systematic review and thematic synthesis exploring how a previous
experience of physical activity influences engagement with cardiac
rehabilitation.
Source
European Journal of Cardiovascular Nursing. 19 (1) (pp 31-43), 2020. Date
of Publication: 01 Jan 2020.
Author
McHale S.; Astin F.; Neubeck L.; Dawkes S.; Hanson C.L.
Institution
(McHale, Neubeck, Dawkes, Hanson) Cardiovascular Health, School of Health
and Social Care, Edinburgh Napier University, United Kingdom
(Astin) Centre for Applied Research in Health, University of Huddersfield,
United Kingdom
(Neubeck) Sydney Nursing School, University of Sydney, Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Exercise-based cardiac rehabilitation is recognised
internationally as an effective therapy to improve quality of life and
reduce the risk of hospital readmission for individuals diagnosed with
acute coronary syndrome. Despite this, half of eligible individuals choose
not to engage and the main reason is lack of interest. Furthermore, prior
to attending, 40% of eligible individuals report meeting physical activity
guidelines. It is unclear whether this influences decisions about
engagement. <br/>Aim(s): The aim of this review is to examine
systematically qualitative evidence describing patients' perceptions and
experiences, and synthesise what is known about how a previous experience
of physical activity in adults diagnosed with acute coronary syndrome
influences engagement with physical activity during cardiac
rehabilitation. <br/>Method(s): A systematic review and thematic synthesis
was conducted of primary qualitative studies to examine peer-reviewed
literature published between1990 and 2017, accessed from database searches
of MEDLINE, CINHAL, PsycINFO and Embase. <br/>Result(s): The initial
search produced 486 studies, and of these 12 relevant studies were
included in this review. Studies included 388 participants from six
countries. For previously active individuals, communication factors,
self-perceptions of an exercise identity and experience of cardiac
rehabilitation influence engagement in physical activity during cardiac
rehabilitation. <br/>Conclusion(s): In adults diagnosed with acute
coronary syndrome, communication post event and during cardiac
rehabilitation is a source of self-appraisal and creates expectations of
cardiac rehabilitation. In addition, perceptions of an exercise identity
and experience of exercise-based cardiac rehabilitation influence
decisions about engagement. To improve uptake and adherence, health
professionals should consider previous physical activity levels and tailor
information to optimise physical activity post event.<br/>Copyright &#xa9;
The European Society of Cardiology 2019.

<23>
Accession Number
2003548633
Title
Clinical outcomes of mitral valve intervention in patients with mitral
annular calcification: A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 35 (1) (pp 66-74), 2020. Date of Publication:
01 Jan 2020.
Author
Ribeiro R.V.P.; Yanagawa B.; Legare J.-F.; Hassan A.; Ouzounian M.; Verma
S.; Friedrich J.O.
Institution
(Ribeiro, Yanagawa, Verma) Division of Cardiovascular Surgery, Department
of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Ribeiro, Ouzounian) Division of Cardiovascular Surgery, Department of
Surgery, Peter Munk Cardiac Centre, University Health Network, University
of Toronto, Toronto, ON, Canada
(Legare, Hassan) Division of Cardiovascular Surgery, New Brunswick Heart
Centre, Dalhousie University, Saint John, NB, Canada
(Friedrich) Critical Care and Medicine Department, Li Ka Shing Knowledge
Institute, St. Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Friedrich) Interdepartmental Division of Critical Care, Department of
Medicine, University of Toronto, Toronto, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Mitral valve (MV) disease with mitral annular calcification
(MAC) poses a surgical challenge and the clinical outcomes of MV surgery
as well as transcatheter mitral valve replacement (TMVR) remain relatively
unexplored. We performed a systematic review and meta-analysis to assess
the effects of MAC on clinical outcomes following MV surgery and TMVR.
<br/>Method(s): We searched MEDLINE and EMBASE databases until February
2019 for studies comparing clinical outcomes of MV surgery or TMVR in
patients with and without MAC. Data were extracted by two independent
investigators. Outcomes were perioperative and midterm complications and
mortality. <br/>Result(s): Seven observational studies enrolling 2902
patients were included. MAC patients were older, more likely to be female
with greater chronic lung disease and kidney failure. Perioperative
mortality was similar between patients with and without MAC undergoing MV
surgery (risk ratio [RR], 1.15; 95% confidence interval [CI], 0.50-2.65; P
=.74). MAC was associated with a higher risk of bleeding, permanent
pacemaker implantation, and periprosthetic leak. Midterm mortality was
greater in MAC patients undergoing MV surgery (incident rate ratio [IRR],
1.32; 95% CI, 1.05-1.67; P =.02). MAC patients undergoing TMVR had higher
perioperative (RR, 4.65; 95% CI, 2.93-7.38; P <.01) and 1-year (RR, 5.44;
95% CI, 3.49-8.49; P <.01) mortality, decreased procedural success,
greater left ventricular outflow tract obstruction and need for conversion
to surgery when compared with patients undergoing TMVR for dysfunction of
a bioprosthetic valve or annuloplasty ring. <br/>Conclusion(s): MV
procedures in patients with MAC are associated with higher mortality and
morbidity. This is largely driven by the high-risk patient profile
associated with MAC. TMVR holds promise but has important limitations and
should be reserved for select patients.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<24>
Accession Number
2002369824
Title
Mediastinitis in the intensive care unit patient: a narrative review.
Source
Clinical Microbiology and Infection. 26 (1) (pp 26-34), 2020. Date of
Publication: January 2020.
Author
Pastene B.; Cassir N.; Tankel J.; Einav S.; Fournier P.-E.; Thomas P.;
Leone M.
Institution
(Pastene, Leone) Aix Marseille Universite, Assistance Publique Hopitaux de
Marseille, Hopital Nord, Department of Anaesthesiology and Intensive Care
Medicine, Marseille, France
(Cassir, Leone) MEPHI, IHU Mediterranee Infection, Aix Marseille
Universite, Marseille, France
(Tankel) Department of General Surgery, Shaare Zedek Medical Centre,
Jerusalem, Israel
(Tankel) Department of Surgery and Cancer, Imperial College Healthcare
Trust, St Mary's Hospital, London, United Kingdom
(Einav) Surgical Intensive Care Unit, Shaare Zedek Medical Centre,
Jerusalem, Israel
(Fournier) VITROME, IHU Mediterranee Infection, Aix Marseille Universite,
Marseille, France
(Thomas) Aix Marseille Universite, Assistance Publique Hopitaux de
Marseille, Hopital Nord, Department of Thoracic Surgery and Oesophageal
Diseases, Marseille, France
Publisher
Elsevier B.V.
Abstract
Background: Mediastinitis is a rare but severe infection, defined as an
inflammation of the connective tissues and structures within the
mediastinum. Due to its proximity to vital structures, mediastinitis
represents a highly morbid pathological process associated with a high
risk of mortality. In most cases mediastinitis requires treatment in the
intensive care unit. <br/>Objective(s): To highlight to the reader the
clinical features of mediastinitis, to attempt to define each clinical
scenario, to describe the responsible pathogens and finally to depict both
the medical and surgical treatments. Sources: We performed a literature
search of the PubMed and Cochrane libraries, limited for articles
published between January 2003 and December 2018, reporting on acute
mediastinitis. Content: The term covers different entities of different
aetiologies including deep sternal wound infection related to sternotomy;
oesophageal perforation or anastomosis leakage; and finally descending
necrotizing mediastinitis, often secondary to oropharyngeal abscess. The
responsible pathogens and therefore subsequent management depends on the
underlying aetiology. Empirical antimicrobial therapy should cover the
suspected microorganisms while surgery and supportive measures should aim
to reduce the inoculum of pathogens by providing adequate drainage and
debridement. Implications: Literature concerning mediastinitis in the
intensive care unit is relatively scarce. We have collated the evidence
and reviewed the different causes and treatment options of acute
mediastinitis with a particular focus on microbiological epidemiology.
Future research in larger cohorts is needed to better understand the
treatment of this difficult disease.<br/>Copyright &#xa9; 2019 European
Society of Clinical Microbiology and Infectious Diseases

<25>
Accession Number
630331701
Title
Does tranexamic acid improve intra-operative visualisation in endoscopic
ear surgery? A double-blind, randomised, controlled trial.
Source
Journal of Laryngology and Otology. 133 (12) (pp 1033-1037), 2019. Date of
Publication: 2019.
Author
Das A.; Mitra S.; Ghosh D.; Kumar S.; Sengupta A.
Institution
(Das, Mitra, Ghosh, Kumar, Sengupta) Department of Otorhinolaryngology and
Head Neck Surgery, Institute of Post-Graduate Medical Education and
Research, Seth Sukhlal Karnani Memorial Hospital, 244 AJC Bose Road,
Kolkata 700020, India
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objective To assess the effect of tranexamic acid on intra-operative
bleeding and surgical field visualisation.Methods Fifty patients
undergoing various endoscopic ear surgical procedures, including
endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy,
endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly
assigned to: a study group that received tranexamic acid or a control
group which received normal saline. The intra-operative bleeding and
operative field visualisation was graded using the Das and Mitra
endoscopic ear surgery bleeding and field visibility score, which was
separately analysed for the external auditory canal and the middle
ear.Results The Das and Mitra score was better (p < 0.05) in the group
that received tranexamic acid as a haemostat when working in the external
auditory canal; with respect to the middle ear, no statistically
significant difference was found between the two agents. Mean values for
mean arterial pressure, heart rate and surgical time were comparable in
both groups, with no statistically significant differences.Conclusion
Tranexamic acid appears to be an effective haemostat in endoscopic ear
surgery, thus improving surgical field visualisation, especially during
manipulation of the external auditory canal soft tissues.<br/>&#xa9;
Copyright JLO (1984) Limited, 2019.

<26>
Accession Number
630304046
Title
Randomised controlled trial to evaluate the influence of mHealth and
eHealth skin cancer prevention education among young organ transplant
recipients: The HIPPOlino intervention study.
Source
BMJ Open. 9 (12) (no pagination), 2019. Article Number: e028842. Date of
Publication: 16 Dec 2019.
Author
Bottcher S.; Buck C.; Zeeb H.; Laschewski G.; Hauer C.; Wagner G.; Sachse
M.M.
Institution
(Bottcher, Buck, Zeeb) Leibniz-Institut fur Praventionsforschung und
Epidemiologie-BIPS, Bremen, Germany
(Zeeb) High-Profile Research Area Health Sciences, University of Bremen,
Bremen, Germany
(Laschewski) Deutscher Wetterdienst, Freiburg, Germany
(Hauer) Bremen Cancer Society, Bremen, Germany
(Wagner, Sachse) Department of Dermatology, Allergology and Phlebology,
Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To determine whether a multicomponent sun protection
intervention programme (mHealth) for young organ transplant recipients
(OTR) leads to a higher increase of preventive knowledge and behavioural
change than an e-learning education programme (eHealth). Design Randomised
controlled trial with one preintervention baseline survey and three
follow-up surveys after 6 weeks, 6 and 12 months. Comparison of two
different intervention schedules with a control group (CG). Setting
Multicomponent sun protection trainings in Germany, the Netherlands and
Austria between June 2013 and September 2015. Participants 137 OTRs (5-22
years of age, 61 females/76 males) participated in the study.
Interventions (A) Intervention group 1 (IG1): personal training with
subsequent forwarding of individual ultraviolet index-dependent sun
protection recommendations via short message service (SMS); (B)
intervention group 2 (IG2): e-learning training without SMS; (C) CG:
regular information letters, online training after 1 year. Outcome
measures Key questions were used to form a knowledge and a behavioural
score. Behavioural strategies and knowledge were quantified through
self-Administered questionnaires. Results Analyses 6 weeks after the
intervention showed a higher knowledge increase in both IG compared with
the CG (IG1 to CG: OR 12.64, 95% CI 4.20 to 38.20; IG2 to CG: OR 2.59, 95%
CI 0.95 to 7.04). Sun protection behaviour improved slightly but not
significantly in both IG (IG1 to CG: OR 2.56, 95% CI 0.93 to 7.00; IG2 to
CG: OR 1.22, 95% CI 0.45 to 3.32). One year after the intervention, no
behavioural changes were observed in either IG compared with the CG. IG1
but not IG2 still scored significantly higher in sun protection knowledge
than the CG 1 year after intervention (IG1 to CG: OR 4.46, 95% CI 1.48 to
13.43; IG2 to CG: OR 1.41, 95% CI 0.51 to 3.93). Conclusions This
multicomponent sun protection programme provides a promising strategy to
increase sun protection knowledge and possibly also protective behaviour
in young OTR. Trial registration number DRKS00011393.<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.

<27>
Accession Number
2001386254
Title
Motivational interviewing to support LDL-C therapeutic goals and
lipid-lowering therapy compliance in patients with acute coronary
syndromes (IDEAL-LDL) study: rationale and design.
Source
Hellenic Journal of Cardiology. 60 (4) (pp 249-253), 2019. Date of
Publication: July - August 2019.
Author
Boulmpou A.; Kartas A.; Farmakis I.; Zafeiropoulos S.; Nevras V.;
Papadimitriou I.; Tampaki A.; Vlachou A.; Lillis L.; Koutsakis A.;
Karvounis H.; Giannakoulas G.
Institution
(Boulmpou, Kartas, Farmakis, Zafeiropoulos, Nevras, Papadimitriou,
Tampaki, Vlachou, Lillis, Koutsakis, Karvounis, Giannakoulas) Department
of Cardiology, AHEPA University Hospital, Aristotle University of
Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
Publisher
Hellenic Cardiological Society
Abstract
Background: Achieving low-density lipoprotein cholesterol (LDL-C) target
levels after an acute coronary syndrome (ACS) is of paramount importance,
and is often burdened by undertreatment and medication or lifestyle
non-adherence issues. <br/>Objective(s): We examined the effect of a
patient-centered, physician-led motivational intervention following ACS on
relevant secondary prevention aspects. Methods-design: The IDEAL-LDL is a
single-center, randomized controlled clinical trial, conducted among
patients hospitalized due to an ACS. Following discharge, all patients
undergo a baseline assessment of lipid profile. Patients in the
intervention group receive an in-person educational session and an
informative leaflet, and also undergo two phone-based, motivational
interviewing sessions at 1 and 6 months. These interventions emphasize on
LDL-C goals, adherence to lipid-lowering medication, and healthy
dietary-lifestyle habits, and are not provided to patients in the control
group, who receive usual care. At 12 months after each patient's
discharge, an in-person interview and lipid profile reassessment are
performed. The primary outcomes are the assessment of LDL-C goal
achievement (<70 mg/dL or >50% reduction from baseline levels) from
baseline to 1 year and changes in medication adherence. Secondary outcomes
relate to the incidence of the composite outcome of cardiovascular death,
nonfatal myocardial infarction/stroke, need for myocardial
revascularization, and recurrent hospitalization during the follow-up
period. <br/>Discussion(s): This paper describes the protocol, design, and
rationale for key methodology for an ongoing clinical trial featuring a
simple and feasible intervention. Similar adherence efficacy trials have
not led to sufficient improvements, and there remains a gap regarding how
adherence interventions should be implemented into clinical
care.<br/>Copyright &#xa9; 2018 Hellenic Society of Cardiology

<28>
Accession Number
2001951616
Title
Hemorrhagic Cardiac Tamponade Associated with Apixaban: A Case Report and
Systematic Review of Literature.
Source
Cardiovascular Revascularization Medicine. 20 (11 Supplement) (pp 15-20),
2019. Date of Publication: November 2019.
Author
Asad Z.U.A.; Ijaz S.H.; Chaudhary A.M.D.; Khan S.U.; Pakala A.
Institution
(Asad, Ijaz, Pakala) University of Oklahoma Health Sciences Center,
Oklahoma City, United States
(Chaudhary) Nishtar Medical College, Multan, Pakistan
(Khan) West Virginia University, Morgantown, WV, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Hemorrhagic cardiac tamponade (HCT) is characterized by rapid
accumulation of blood in the pericardium causing hemodynamic collapse. We
report a case of HCT due to Apixaban use in a patient with renal cell
carcinoma, supplemented with a systematic review of pericardial tamponade
associated with the use of direct oral anticoagulants (DOACs). Case
report: A 62-year-old African American male with a history of metastatic
renal cell carcinoma presented with dyspnea while taking Apixaban. He was
diagnosed with pericardial tamponade and 800 ml of hemorrhagic effusion
was drained. The pericardial fluid analysis was negative for malignancy
and suggestive of HCT. He had a complicated hospital course and died
several days later. <br/>Method(s): We searched MEDLINE, EMBASE and other
sources for published cases of pericardial tamponade associated with
DOACs. Our outcomes of interest included patient characteristics, risk
factors, timing from the start of anticoagulation to tamponade, treatment
and mortality. Simple descriptive statistics using percentages for
categorical variables were used to describe the included cases.
<br/>Result(s): A total of 26 cases were included in the final systematic
review after searching MEDLINE, EMBASE and other sources. The mean age was
70 years (range 43-88) with 19 (73%) males. Twelve cases (46%) were
associated with Rivaroxaban, 9 (37%) with Dabigatran and 5(19%) with
Apixaban. Sixteen cases had elevated INR and 15 had elevated creatinine.
Only 2 patients died but 24 had to undergo pericardiocentesis.
<br/>Conclusion(s): Cardiac tamponade is rarely associated with DOACs and
elderly male patients with renal and coagulation abnormalities appear to
have the highest risk.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<29>
Accession Number
2003419465
Title
FFP transfusion and nosocomial infection in cardiac surgery: A systematic
review.
Source
International Cardiovascular Research Journal. 13 (4) (pp 109-114), 2019.
Article Number: e98088. Date of Publication: December 2019.
Author
Naghipour B.; Ahmadi S.; Faridaalaee G.; Arjmand A.; Soleimani F.
Institution
(Naghipour) Department of Anesthesiology and Critical Care, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Ahmadi) Department of Emergency Medicine, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Faridaalaee) Department of Emergency Medicine, Maragheh University of
Medical Sciences, Maragheh, Iran, Islamic Republic of
(Arjmand) Department of Anesthesiology, Maragheh University of Medical
Sciences, Maragheh, Iran, Islamic Republic of
(Soleimani) Department of Nursing, Maragheh University of Medical
Sciences, Maragheh, Iran, Islamic Republic of
Publisher
Iranian Cardiovascular Research Journal (E-mail: editor@icrj.ir)
Abstract
Context: In some studies, Fresh Frozen Plasma (FFP) transfusion in
severely ill patients was accompanied with an increase in the risk of
nosocomial infection. However, there are no comprehensive data in terms of
FFP transfusion and its relationship with nosocomial infection in heart
surgery. Hence, the present systematic review and meta-analysis aimed to
investigate the relationship between FFP transfusion and nosocomial
infection risk in the patients undergoing cardiac surgery. <br/>Evidence
Acquisition: Study selection: The present study included all the studies,
which probed into nosocomial infection after FFP transfusion in patients
with cardiac surgery. Data sources: Medline, Web of Science, Embase,
Central, and Scopus electronic databases were searched to the end of March
2019. <br/>Result(s): Finally, five articles and three abstracts that
studied nosocomial infection were entered into the present systematic
review. FFP increased the rate of nosocomial infection in cardiac surgery
in one article, but this was not the case in the remaining four articles.
The three abstracts also reported that FFP increased the rate of
nosocomial infection in cardiac surgery. <br/>Conclusion(s): The studies
indicated that the benefit of FFP administration outweighed the probable
risk of infection. Indeed, none of the studies indicated a strong
relationship between FFP transfusion and infection rate after cardiac
surgery.<br/>Copyright &#xa9; 2019, Iranian Cardiovascular Research
Journal. All rights reserved.

<30>
Accession Number
629862455
Title
Transcatheter Aortic Valve Replacement Influence on Coronary Hemodynamics:
A Quantitative Meta-Analysis and Proposed Decision-Making Algorithm.
Source
The Journal of invasive cardiology. 32 (1) (pp 37-40), 2020. Date of
Publication: 01 Jan 2020.
Author
Kotronias R.A.; Scarsini R.; Rajasundaram S.; De Maria G.L.; Ciofani J.L.;
Ribichini F.; Kharbanda R.K.; Banning A.P.
Institution
(Banning) Oxford Heart Centre, John Radcliffe Hospital, Headley Way,
Oxford, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: As transcatheter aortic valve replacement (TAVR) expands to
younger and lower-risk severe aortic stenosis patients, appropriate
coronary artery disease treatment is key to reducing long-term adverse
cardiovascular outcomes. Recently, studies have been exploring the role of
coronary-physiology guided revascularization strategies. Our aim was to
investigate whether TAVR influences coronary physiology measurements using
quantitative meta-analytic methods. <br/>METHOD(S): We performed a Medline
and Embase search for studies evaluating coronary physiology indices
before and after TAVR. Double independent screening and extractions of
baseline, procedural, angiographic, and echocardiographic data were
performed. Risk of bias was assessed using the ACROBAT-NRSI tool. Pooled
mean difference estimates of coronary hemodynamic indices before and after
TAVR were derived using random-effects models with the inverse variance
method (RevMan, Review Manager, version 5.3.5; Nordic Cochrane Centre).
<br/>RESULT(S): Five studies evaluating 250 coronary vessels in 169 severe
aortic stenosis patients were quantitatively synthesized. Coronary flow
reserve did not change immediately after TAVR in non-diseased vessels (n =
3; mean difference, 0.11; 95% confidence interval [CI], -0.10-0.32; P=.29;
I2=0%; P=.68). Importantly, fractional flow reserve also did not vary
significantly following TAVR in both non-diseased (n = 3; mean difference,
-0.01; 95% CI, -0.04-0.03; P=.75; I2=41; P=.19) and diseased coronaries (n
= 3; mean difference, -0.01; 95% CI, -0.03-0.01; P=.49; I2=0%; P=.46).
Similarly, instantaneous wave-free ratio remained stable following TAVR (n
= 2; mean difference, 0.00; 95% CI, -0.02-0.02; P>.99; I2=0; P>.99.
<br/>CONCLUSION(S): Pooled coronary physiology measurements before and
after TAVR are similar, but data on variation within individual lesions
are limited.

<31>
Accession Number
629590598
Title
Systematic Review and Meta-Analysis of Interventional Emergency Treatment
of Decompensated Severe Aortic Stenosis.
Source
The Journal of invasive cardiology. 32 (1) (pp 30-36), 2020. Date of
Publication: 01 Jan 2020.
Author
Wernly B.; Jirak P.; Lichtenauer M.; Veulemans V.; Zeus T.; Piayda K.;
Hoppe U.C.; Lauten A.; Frerker C.; Jung C.
Institution
(Jung) University Hospital Dusseldorf, Department of Medicine, Division of
Cardiology, Pulmonary Diseases and Vascular Medicine, Germany
Publisher
NLM (Medline)
Abstract
AIMS: Patients in cardiogenic shock (CS) due to decompensated aortic
stenosis (AS) evidence poor prognosis. Both emergency transcatheter aortic
valve replacement (eTAVR) and emergency balloon aortic valvuloplasty
(eBAV) have been reported in CS patients. We aimed to summarize and
compare available studies on eBAV and eTAVR in patients suffering from CS
due to decompensated AS with regard to safety and efficacy. METHODS AND
RESULTS: Study-level data were analyzed. Heterogeneity was assessed using
the I2 statistic. Pooled proportions, ie, event rates, were calculated and
obtained using a random-effects model (DerSimonian and Laird). Eight
studies were found suitable for the final analysis, including 311
patients. Primary endpoint was mortality at 30 days. For eBAV (n = 238),
30-day mortality rate was 46.2% (95% confidence interval [CI],
30.3%-62.5%; I2=74%), major bleeding rate was 10% (95% CI, 5.4%-15.7%;
I2=13%), and stroke rate was 0.7% (95% CI, 0.0%-2.7%; I2=0%). Aortic
regurgitation (AR) >=II was present in 8.6% (95% CI, 0.4%-23.5%; I2=86%).
For eTAVR (n = 73), 30-day mortality rate was 22.6% (95% CI, 12.0%-35.2%;
I2=26%), major bleeding rate was 5.8% (95% CI, 0.5%-14.7%; I2=0%), and
stroke rate was 5.8% (95% CI, 0.5%-14.7%; I2=0%). AR >=II was present in
4% (95% CI, 0.0%-12.1%; I2=0%). <br/>CONCLUSION(S): Mortality in CS
patients due to decompensated severe AS is high, regardless of
interventional treatment strategy. Both eBAV and eTAVR seem feasible. As
eTAVR is associated with better initial improvements in hemodynamics and
simultaneously avoids sequential interventions, it might be favorable to
eBAV in select patients. If eTAVR is not available, eBAV might serve as a
"bridge" to elective TAVR.

<32>
Accession Number
2003645386
Title
No Concluding Evidence on Optimal Activated Clotting Time for Non-cardiac
Arterial Procedures.
Source
European Journal of Vascular and Endovascular Surgery. 59 (1) (pp
137-147), 2020. Date of Publication: January 2020.
Author
Doganer O.; Wiersema A.M.; Scholtes V.; Blankensteijn J.D.; Yeung K.K.;
Jongkind V.
Institution
(Doganer, Wiersema, Jongkind) Department of Vascular Surgery, Dijklander
Ziekenhuis, Hoorn, Netherlands
(Doganer, Wiersema, Scholtes, Blankensteijn, Yeung, Jongkind) Department
of Vascular Surgery, Amsterdam University Medical Centres (Amsterdam UMC)
Location VU Medical Centre (VUMC), Amsterdam, Netherlands
Publisher
W.B. Saunders Ltd
Abstract
Objectives: Heparin has a non-predictable effect in the individual
patient. The activated clotting time (ACT) is used to measure the level of
anticoagulation after administration of heparin. To date, appropriate
heparin dose protocols and corresponding therapeutic ACT values have not
been established in non-cardiac arterial procedures (NCAP). The aim of
this review was to study the use of ACT monitoring during NCAP, and
whether an optimal ACT could be determined based on the fewest arterial
thrombo-embolic complications (ATEC) and bleeding complications.
<br/>Method(s): This systematic review was performed in accordance with
the PRISMA Guidelines. A systematic search was conducted in MEDLINE,
EMBASE, and the Cochrane database. Any associations were evaluated between
peri-procedural ACT levels and ATEC and bleeding complications detected
during the same admission as the primary procedure or during 30 day follow
up. Also, heparin dose protocols, peri-procedural target ACTs, different
ACT devices, protamine use and pre-, peri-, and post-procedural
anticoagulation therapy were evaluated. <br/>Result(s): In total, 21
studies with 3982 patients were included, on both open and endovascular
NCAP. Four studies were primarily designed to correlate peak
peri-procedural ACT with clinical outcomes; however, the definitions of
the results and the clinical outcomes were too heterogeneous for analysis.
There was major variability in all studied aspects of ACT measurement,
heparin and protamine use, and in the type of procedures in the included
studies. Overall methodological quality of the included studies was poor.
No randomised controlled trials were found. Studies were at a high risk of
bias. <br/>Conclusion(s): This systematic review demonstrates a lack of
data and no consensus in the literature concerning the optimal ACT, and
the possible association with haemorrhagic complications and ATEC during
NCAP.<br/>Copyright &#xa9; 2019 European Society for Vascular Surgery

<33>
Accession Number
2003967199
Title
Timing of initiation of renal replacement therapy in acute kidney injury:
an updated meta-analysis of randomized controlled trials.
Source
Renal Failure. 42 (1) (pp 77-88), 2020. Date of Publication: 01 Jan 2020.
Author
Zhang L.; Chen D.; Tang X.; Li P.; Zhang Y.; Tao Y.
Institution
(Zhang, Tang, Li, Tao) Department of Nephrology, West China Hospital of
Sichuan University, Chengdu, China
(Chen, Zhang) Department of Nephrology, Jianyang People's Hospital of
Sichuan Provinces, Jianyang, China
Publisher
Taylor and Francis Ltd
Abstract
Purpose: The results from randomized controlled trials (RCTs) concerning
the timing of initiation of renal replacement therapy (RRT) for patients
with acute kidney injury (AKI) are still inconsistent. <br/>Material(s)
and Method(s): We searched for RCTs, as well as relevant references,
focusing on the timing of RRT for AKI patients in the Medline, Embase,
Cochrane Library, Google Scholar and Chinese databases from their
inception to December 2018. <br/>Result(s): We included 18 RCTs from 1997
to 2018 involving 2856 patients. Pooled analyses of all RCTs showed no
significant difference in mortality between early initiation and delayed
initiation of RRT (RR 0.98, 95% CI: 0.89 to 1.08, p =.7) (I² =
2%), and similar results were found in critically ill and
community-acquired AKI patients, as well as in a subgroup of patients with
sepsis and in cardiac surgery recipients. There was also no difference in
the incidence of dialysis independence (RR 0.75, 95% CI: 0.47 to 1.2, p
=.2) (I² = 0). However, an early RRT strategy was associated
with a significantly higher incidence of the need for RRT for AKI patients
(RR 1.24, 95% CI: 1.13 to 1.36, p <.01) (I² = 34%).
<br/>Conclusion(s): As no life-threatening complications occurred, there
was no evidence to show any benefit of an early RRT strategy for
critically ill or community-acquired AKI patients; in contrast, a delayed
strategy might avert the need for RRT.<br/>Copyright &#xa9; 2020, &#xa9;
2020 The Author(s). Published by Informa UK Limited, trading as Taylor &
Francis Group.

<34>
Accession Number
630492408
Title
Current Advances in Biodegradable Synthetic Polymer based Cardiac Patches.
Source
Journal of biomedical materials research. Part A. (no pagination), 2020.
Date of Publication: 02 Jan 2020.
Author
McMahan S.; Taylor A.; Copeland K.M.; Pan Z.; Liao J.; Hong Y.
Institution
(McMahan, Taylor, Copeland, Liao, Hong) Department of Bioengineering,
University of Texas at Arlington, TX, Arlington
(Pan) College of Nursing and Health Innovation, University of Texas at
Arlington, TX, Arlington
Publisher
NLM (Medline)
Abstract
The number of people affected by heart disease such as coronary artery
disease (CAD) and myocardial infarction (MI) increases at an alarming rate
each year. Currently, the methods to treat these diseases are restricted
to lifestyle change, pharmaceuticals, and eventually heart transplant if
the condition is severe enough. While these treatment options are the
standard for caring for patients who suffer from heart disease, limited
regenerative ability of the heart restricts the effectiveness of treatment
and may lead to other heart-related health problems in the future. Because
of the increasing need for more effective therapeutic technologies for
treating diseased heart tissue, cardiac patches are now a large focus for
researchers. The cardiac patches are designed to be integrated into
patient's natural tissue to introduce mechanical support and healing to
the damaged areas. As a promising alternative, synthetic biodegradable
polymer based biomaterials can be easily manipulated to customize material
properties, as well as possess certain desired characteristics for cardiac
patch use. This comprehensive review summarizes recent works on synthetic
biodegradable cardiac patches implanted into infarcted animal models. In
addition, this review describes the basic requirements that should be met
for cardiac patch development, and discusses the inspirations to designing
new biomaterials and technologies for cardiac patches. This article is
protected by copyright. All rights reserved.

<35>
Accession Number
2004434223
Title
Antiplatelet strategy after transcatheter aortic valve replacement: An
updated meta-analysis.
Source
Journal of Cardiovascular Surgery. 60 (5) (pp 624-632), 2019. Date of
Publication: 2019.
Author
Ma X.; Xu Z.; Li J.; Zhao D.; Kong X.; Ma J.; Ma H.; Yun Y.; Sun L.; Zhang
Y.; Wei D.; Jiao Q.; Zou C.; Wang Z.
Institution
(Ma, Xu, Li, Zhao, Sun, Wei, Zou, Wang) Department of Cardiovascular
Surgery, Shandong Provincial Hospital affiliated to Shandong University,
No. 324 Jingwu road, Jinan, Shandong 250021, China
(Ma, Xu, Li, Zhao, Sun, Wei, Zou, Wang) Department of Cardiovascular
Surgery, Shandong Provincial Hospital affiliated to Shandong University,
Jinan, China
(Kong) Department of Vascular Surgery, Shandong Provincial Hospital
affiliated to Shandong University, Jinan, China
(Ma) Department of Pathology, Shandong Provincial Hospital affiliated to
Shandong University, Jinan, China
(Ma) Qingdao University Medical College, Qingdao University, Qingdao,
China
(Yun) Department of Neurology, Qilu Hospital of Shandong University,
Jinan, China
(Zhang) Emergency Center, Shandong Provincial Hospital affiliated to
Shandong University, Jinan, China
(Jiao) Department of Anesthesiology, Shandong Provincial Hospital
affiliated to shandong university, Jinan, China
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Recently transcatheter aortic valve replacement (Tavr) has
emerged as a feasible alternative for traditional surgical aortic valve
replacement (savr) in patients with intermediate to high risk. There is
currently no clear consensus regarding the optimal antiplatelet strategy
after Tavr. The primary objective of this updated meta-analyses was to
compare the outcomes of dual antiplatelet therapy (daPT) versus single
antiplatelet therapy (saPT) following Tavr. <br/>Evidence Acquisition: a
meta-analysis of eligible studies of patients undergoing Tavr which
reported our outcomes of postoperative daPT in comparison with saPT, was
carried out. The outcomes included the all-cause mortality, stroke,
major/life-threatening bleeding, myocardial infarction and a composite
endpoint of mortality, stroke, bleeding and myocardial infarction.
<br/>Evidence Synthesis: Three randomized controlled trials (rCTs, n.=421)
and 5 observational studies (n.=6683) were included in this updated
meta-analysis. all-cause mortality was comparable between the two groups
(or 1.13 [95% Ci: 0.70-1.81], P=0.619). Besides, daPT resulted in an
augmented risk of major/life-threatening bleeding (OR 2.45 [95% CI:
1.08-5.59], P=0.032). No statistically significant difference was found
between the two groups in the rates of stroke (or 0.83 [95% Ci:
0.62-1.10], P=0.212) and myocardial infarction (or 1.17 [95% Ci:
0.47-2.91], P=0.728). and daPT led to an increased rate of the composite
endpoint (or 2.39 [95% Ci: 1.63-3.50], P<0.0001). <br/>CONCLUSION(S): The
updated meta-analysis presents the evidence that post-TAVR DAPT increases
bleeding events, with no benefit in survival and ischemic events, in
comparison with SAPT. Nevertheless, it is currently difficult to evaluate
by a meta-analysis the effectiveness of DAPT versus SAPT to prevent the
valve thrombosis resulting in leaflet dysfunction, due to a limited number
of existing publications. Additional RCTs are needed to determine the
optimal antiplatelet strategy after Tavr.<br/>Copyright &#xa9; 2019
Edizioni Minerva Medica.

<36>
Accession Number
2004477022
Title
An In-hospital Mortality Risk Model for Patients Undergoing Coronary
Artery Bypass Grafting in China.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Hu Z.; Chen S.; Du J.; Gu D.; Wang Y.; Hu S.; Zheng Z.
Institution
(Hu, Chen, Du, Gu, Hu, Zheng) Department of Cardiovascular Surgery, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
(Wang) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Wang) Center for Outcomes Research and Evaluation, Yale New Haven Health,
New Haven, CT, United States
Publisher
Elsevier USA
Abstract
Background: To meet the demand of increasing surgical volume and changing
of patient's risk profiles of coronary artery bypass grafting in China, we
developed a new risk model that predicts in-hospital mortality.
<br/>Method(s): The analysis included patients who underwent coronary
artery bypass grafting between January 2013 and December 2016 at 87
hospitals in the Chinese Cardiac Surgery Registry. Patients in years 2013
to 2015 were randomly divided into training (n = 31,297 [75%]) and test (n
= 10,432 [25%]) samples; 2016 patients (n = 15047) comprised the
validation sample. Demographic and clinical risk factors were identified.
The Harrell C statistic was used to evaluate model discrimination, and the
Hosmer-Lemeshow goodness-of-fit test was used to assess calibration.
<br/>Result(s): The 56,776 patients were a mean age of 61.8 (SD, 8.8)
years, and 24.6% were women. Overall, in-hospital mortality was 2.1%. The
final model included 21 risk factors represented by 16 unique variables.
The model achieved good discrimination, with a C statistic of 0.79 (95%
confidence interval [CI], 0.77-0.80) in the training sample, 0.79 (95% CI,
0.76-0.82) in the test sample, and 0.78 (95% CI, 0.76-0.81) in the
validation sample. Model calibration was good according to the
Hosmer-Lemeshow test (P > .05 in the 3 samples). Compared with the
European System for Cardiac Operative Risk Evaluation 2011 revision
(EuroSCORE II) and the Sino(Chinese) System for Coronary artery bypass
grafting Operative Risk Evaluation (SinoSCORE), the model had better
discrimination and calibration. <br/>Conclusion(s): We developed and
evaluated a model with 16 risk factors that predicted in-hospital
mortality risk after coronary artery bypass grafting in China. This
updated model may help surgeons and hospitals better identify high-risk
patient.<br/>Copyright &#xa9; 2019

<37>
Accession Number
2004374001
Title
1-Year Impact on Medical Practice and Clinical Outcomes of
FFR<inf>CT</inf>: The ADVANCE Registry.
Source
JACC: Cardiovascular Imaging. Part 1. 13 (1) (pp 97-105), 2020. Date of
Publication: January 2020.
Author
Patel M.R.; Norgaard B.L.; Fairbairn T.A.; Nieman K.; Akasaka T.; Berman
D.S.; Raff G.L.; Hurwitz Koweek L.M.; Pontone G.; Kawasaki T.; Sand
N.P.R.; Jensen J.M.; Amano T.; Poon M.; Ovrehus K.A.; Sonck J.; Rabbat
M.G.; Mullen S.; De Bruyne B.; Rogers C.; Matsuo H.; Bax J.J.; Leipsic J.
Institution
(Patel, Hurwitz Koweek) Division of Cardiology, Department of Medicine,
Duke University Medical Center, Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Norgaard, Jensen) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark
(Fairbairn) Department of Cardiology, University of Liverpool, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Nieman) Departments of Cardiovascular Medicine and Radiology, Stanford
University, Stanford, CA, United States
(Akasaka) Department of Cardiovascular Medicine, Wakayama Medical
University, Wakayama, Japan
(Berman) Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai
Heart Institute, Los Angeles, CA, United States
(Raff) Division of Cardiology, Beaumont Academic Heart and Vascular Group,
Royal Oak, MI, United States
(Pontone) Centro Cardiologico Monzino, Milan, Italy
(Kawasaki) Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(Sand, Ovrehus) Cardiac Research Unit, Institute of Regional Health
Research, University Hospital of SouthWest DK, University of Southern
Denmark, Odense, Denmark
(Amano) Department of Cardiology, Aichi Medical University, Aichi, Japan
(Poon) Department of Noninvasive Cardiac Imaging, Northwell Health, New
York, NY, United States
(Sonck) Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(Sonck) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Naples, Italy
(Rabbat) Division of Cardiology, Loyola University Chicago, Chicago, IL,
United States
(Mullen, Rogers) HeartFlow Inc., Redwood City, CA, United States
(De Bruyne) Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis, Aalst,
Belgium
(Matsuo) Department of Cardiovascular Medicine, Gifu Heart Center, Gifu,
Japan
(Bax) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Leipsic) Department of Radiology, Providence Health Care, St. Paul's
Hospital, University of British Columbia, Vancouver, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The 1-year data from the international ADVANCE (Assessing
Diagnostic Value of Non-invasive FFR<inf>CT</inf> in Coronary Care)
Registry of patients undergoing coronary computed tomography angiography
(CTA) was used to evaluate the relationship of fractional flow reserve
derived from coronary CTA (FFR<inf>CT</inf>) with downstream care and
clinical outcomes. <br/>Background(s): Guidelines for management of chest
pain using noninvasive imaging pathways are based on short- to
intermediate-term outcomes. <br/>Method(s): Patients (N = 5,083) evaluated
for clinically suspected coronary artery disease and in whom
atherosclerosis was identified by coronary CTA were prospectively enrolled
at 38 international sites from July 15, 2015, to October 20, 2017.
Demographics, symptom status, coronary CTA and FFR<inf>CT</inf> findings
and resultant site-based treatment plans, and clinical outcomes through 1
year were recorded and adjudicated by a blinded core laboratory. Major
adverse cardiac events (MACE), death, myocardial infarction (MI), and
acute coronary syndrome leading to urgent revascularization were captured.
<br/>Result(s): At 1 year, 449 patients did not have follow-up data.
Revascularization occurred in 1,208 (38.40%) patients with an
FFR<inf>CT</inf> <=0.80 and in 89 (5.60%) with an FFR<inf>CT</inf> >0.80
(relative risk [RR]: 6.87; 95% confidence interval [CI]: 5.59 to 8.45; p <
0.001). MACE occurred in 55 patients, 43 events occurred in patients with
an FFR<inf>CT</inf> <=0.80 and 12 occurred in those with an
FFR<inf>CT</inf> >0.80 (RR: 1.81; 95% CI: 0.96 to 3.43; p = 0.06). Time to
first event (all-cause death or MI) occurred in 38 (1.20%) patients with
an FFR<inf>CT</inf> <=0.80 compared with 10 (0.60%) patients with an
FFR<inf>CT</inf> >0.80 (RR: 1.92; 95% CI: 0.96 to 3.85; p = 0.06). Time to
first event (cardiovascular death or MI) occurred cardiovascular death or
MI occurred more in patients with an FFR<inf>CT</inf> <=0.80 compared with
patients with an FFR<inf>CT</inf> >0.80 (25 [0.80%] vs. 3 [0.20%]; RR:
4.22; 95% CI: 1.28 to 13.95; p = 0.01). <br/>Conclusion(s): The 1-year
outcomes from the ADVANCE FFR<inf>CT</inf> Registry show low rates of
events in all patients, with less revascularization and a trend toward
lower MACE and significantly lower cardiovascular death or MI in patients
with a negative FFR<inf>CT</inf> compared with patients with abnormal
FFR<inf>CT</inf> values. (Assessing Diagnostic Value of Non-invasive FFRCT
in Coronary Wave [ADVANCE]; NCT02499679)<br/>Copyright &#xa9; 2020 The
Authors

<38>
Accession Number
2004371249
Title
Effect of Intravascular Ultrasound-Guided Drug-Eluting Stent Implantation:
5-Year Follow-Up of the IVUS-XPL Randomized Trial.
Source
JACC: Cardiovascular Interventions. 13 (1) (pp 62-71), 2020. Date of
Publication: 13 January 2020.
Author
Hong S.-J.; Mintz G.S.; Ahn C.-M.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Kang
T.-S.; Kang W.-C.; Kim Y.H.; Hur S.-H.; Hong B.-K.; Choi D.; Kwon H.; Jang
Y.; Hong M.-K.
Institution
(Hong, Ahn, Kim, Kim, Ko, Choi, Jang, Hong) Severance Cardiovascular
Hospital, Yonsei University Health System, Seoul, Korea, South Korea
(Mintz) Cardiovascular Research Foundation, New York, NY, United States
(Kang) Dankook University College of Medicine, Cheonan, Korea, South Korea
(Kang) Gil Hospital, Gachon University College of Medicine, Incheon,
Korea, South Korea
(Kim) Kangwon National University School of Medicine, Chuncheon, Korea,
South Korea
(Hur) Keimyung University College of Medicine, Daegu, Korea, South Korea
(Hong, Kwon) Gangnam Severance Hospital, Seoul, Korea, South Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The goal of this study was to evaluate whether the beneficial
effect of use of intravascular ultrasound (IVUS) is sustained for
long-term follow-up. <br/>Background(s): The use of IVUS promoted
favorable 1-year clinical outcome in the IVUS-XPL (Impact of Intravascular
Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long
Lesions) trial. It is not known, however, whether this effect is sustained
for long-term follow-up. <br/>Method(s): The IVUS-XPL trial randomized
1,400 patients with long coronary lesions (implanted stent length >=28 mm)
to receive IVUS-guided (n = 700) or angiography-guided (n = 700)
everolimus-eluting stent implantation. Five-year clinical outcomes were
investigated in patients who completed the original trial. The primary
outcome was the composite of major adverse cardiac events, including
cardiac death, target lesion-related myocardial infarction, or
ischemia-driven target lesion revascularization at 5 years, analyzed by
intention-to-treat. <br/>Result(s): Five-year follow-up was completed in
1,183 patients (85%). Major adverse cardiac events at 5 years occurred in
36 patients (5.6%) receiving IVUS guidance and in 70 patients (10.7%)
receiving angiographic guidance (hazard ratio: 0.50; 95% confidence
interval: 0.34 to 0.75; p = 0.001). The difference was driven mainly by a
lower risk for target lesion revascularization (31 [4.8%] vs. 55 [8.4%];
hazard ratio: 0.54; 95% confidence interval: 0.33 to 0.89; p = 0.007). By
landmark analysis, major adverse cardiac events between 1 and 5 years
occurred in 17 patients (2.8%) receiving IVUS guidance and in 31 patients
(5.2%) receiving angiographic guidance (hazard ratio: 0.53; 95% confidence
interval: 0.29 to 0.95; p = 0.031). <br/>Conclusion(s): Compared with
angiography-guided stent implantation, IVUS-guided stent implantation
resulted in a significantly lower rate of major adverse cardiac events up
to 5 years. Sustained 5-year clinical benefits resulted from both within 1
year and from 1 to 5 years post-implantation. (Impact of Intravascular
Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions
[IVUS-XPL Study]: Retrospective and Prospective Follow-Up Study;
NCT03866486)<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<39>
Accession Number
630065755
Title
Longitudinally Measured Fibrinolysis Factors are Strong Predictors of
Clinical Outcome in Patients with Chronic Heart Failure: The Bio-SHiFT
Study.
Source
Thrombosis and Haemostasis. 119 (12) (pp 1947-1955), 2019. Date of
Publication: 2019.
Author
Van Den Berg V.J.; Bouwens E.; Umans V.A.W.M.; De Maat M.; Manintveld
O.C.; Caliskan K.; Constantinescu A.A.; Mouthaan H.; Cornel J.-H.; Baart
S.; Akkerhuis K.M.; Boersma E.; Kardys I.
Institution
(Van Den Berg, Bouwens, Manintveld, Caliskan, Constantinescu, Baart,
Akkerhuis, Boersma, Kardys) Department of Cardiology, Erasmus MC
University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015
GD, Netherlands
(Van Den Berg, Umans, Cornel) Department of Cardiology, Northwest Clinics,
Alkmaar, Netherlands
(Van Den Berg, Baart) Netherlands Heart Institute, Utrecht, Netherlands
(De Maat) Department of Hematology, Erasmus MC University Medical Center
Rotterdam, Rotterdam, Netherlands
(Mouthaan) Olink Proteomics AB, Uppsala, Sweden
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Objective This article investigates whether longitudinally measured
fibrinolysis factors are associated with cardiac events in patients with
chronic heart failure (CHF). Methods A median of 9 (interquartile range
[IQR] 5-10) serial, tri-monthly blood samples per patient were
prospectively collected in 263 CHF patients during a median follow-up of
2.2 (IQR 1.4-2.5) years. Seventy patients (cases) reached the composite
endpoint of cardiac death, heart failure hospitalization, left ventricular
assist device, or heart transplantation. From all longitudinal samples, we
selected baseline samples in all patients and the last two samples before
the event in cases or the last sample available in event-free patients.
Herein, we measured plasminogen activator inhibitor 1 (PAI-1), tissue-type
plasminogen activator (tPA), urokinase-type plasminogen activator (uPA),
and soluble urokinase plasminogen activator surface receptor (suPAR).
Associations between temporal biomarker patterns during follow-up and the
cardiac event were investigated using a joint model. Results Cases were on
average older and showed higher New York Heart Association class than
those who remained event-free. They also had lower blood pressures, and
were more likely to have diabetes, renal failure, and atrial fibrillation.
Longitudinally measured PAI-1, uPA, and suPAR were independently
associated with adverse cardiac events after correction for clinical
characteristics (hazard ratio [95% confidence interval]) per standard
deviation increase of 2.09 (1.28-3.45) for PAI-1, 1.91 (1.18-3.24) for
uPA, and 3.96 (2.48-6.63) for suPAR. Serial measurements of tPA were not
significantly associated with the event after correction for multiple
testing. Conclusion Longitudinally measured PAI-1, uPA, and suPAR are
strongly associated with adverse cardiac events during the course of CHF.
If future research confirms our results, these fibrinolytic factors may
carry potential for improved, and personalized, heart failure surveillance
and treatment monitoring.<br/>Copyright &#xa9; 2019 Georg Thieme Verlag.
All rights reserved.

<40>
Accession Number
2003955615
Title
Left Atrial Appendage Management: No Better Time Than the Present.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 14 (6) (pp 498-502), 2019. Date of Publication: 01 Dec 2019.
Author
Romano M.A.; Bergquist C.S.
Institution
(Romano, Bergquist) Department of Cardiac Surgery, University of Michigan,
Ann Arbor, MI, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)

<41>
Accession Number
2003823944
Title
New-onset postoperative atrial fibrillation after heart surgery.
Source
Acta Anaesthesiologica Scandinavica. 64 (2) (pp 145-155), 2020. Date of
Publication: 01 Feb 2020.
Author
Gudbjartsson T.; Helgadottir S.; Sigurdsson M.I.; Taha A.; Jeppsson A.;
Christensen T.D.; Riber L.P.S.
Institution
(Gudbjartsson) Department of Cardiothoracic Surgery, Landspitali
University Hospital, Reykjavik, Iceland
(Gudbjartsson, Sigurdsson) Faculty of Medicine, University of Iceland,
Reykjavik, Iceland
(Helgadottir) Department of Cardiothoracic Surgery and Anaesthesia,
Uppsala University Hospital, Uppsala, Sweden
(Sigurdsson) Department of Anaesthesia and Critical Care, Landspitali
University Hospital, Reykjavik, Iceland
(Taha) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Taha, Jeppsson) Department of Molecular and Clinical Medicine, Institute
of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Christensen) Department of Cardiothoracic and Vascular Surgery,
Department of Clinical Medicine, Aarhus University Hospital, Aarhus,
Denmark
(Riber) Department of Cardiothoracic and Vascular Surgery, Department of
Clinical Medicine, Odense University Hospital, University of Southern
Denmark, Odense, Denmark
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: New-onset postoperative atrial fibrillation (poAF) complicates
approximately 20-60% of all cardiac surgical procedures and is associated
with an increased periprocedural mortality and morbitity, prolonged
hospital stay, increased costs, and worse long-term survival.
Unfortunately multiple advances in surgery and perioperative care over the
last two decades have not led to a reduction in the incidence of poAF or
associated complications in the daily clinical practice. <br/>Method(s): A
narrative review of the available literature was performed.
<br/>Result(s): An extensive review of the pathophysiology of poAF
following cardiac surgery, clinical, and procedural risk-factors is
provided, as well as prophylactic measures and treatment.
<br/>Conclusion(s): Multiple strategies to prevent and manage poAF
following heart surgery already exist. Our hope is that this review will
facilitate more rigorous testing of prevention strategies, implementation
of prophylaxis regimens as well as optimal treatment of this common and
serious complication.<br/>Copyright &#xa9; 2019 The Acta Anaesthesiologica
Scandinavica Foundation. Published by John Wiley & Sons Ltd

<42>
Accession Number
2003482061
Title
Levosimendan or milrinone for right ventricular inotropic treatment?-A
secondary analysis of a randomized trial.
Source
Acta Anaesthesiologica Scandinavica. 64 (2) (pp 193-201), 2020. Date of
Publication: 01 Feb 2020.
Author
Fredholm M.; Jorgensen K.; Houltz E.; Ricksten S.-E.
Institution
(Fredholm, Jorgensen, Houltz, Ricksten) Department of Anesthesiology and
Intensive Care Medicine at the Sahlgrenska Academy, University of
Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: The aim of the present study was to compare the effects of
milrinone and levosimendan on right ventricular (RV) inotropy and
lusitropy in patients after aortic valve replacement (AVR) for aortic
stenosis, a procedure in which an abnormal postoperative RV function may
be seen. <br/>Method(s): In a prospective, blinded trial, 31 patients were
randomized to receive either milrinone (0.4 and 0.8 micro&#32;g/kg/min, n
= 16) or levosimendan (0.1 and 0.2 micro&#32;g/kg/min, n = 15) after AVR
for aortic stenosis. RV performance, afterload (pulmonary arterial
elastance), RV strain, systolic (SR-S) and early diastolic (SR-E) strain
rate were measured by pulmonary artery thermodilution catheterization and
transoesophageal two-dimensional speckle tracking echocardiography. To
circumvent the indirect effects of inodilator-induced hemodynamic changes
on RV systolic and diastolic deformation, pulmonary arterial elastance,
central venous pressure and heart rate were maintained constant by atrial
pacing, plasma volume expansion with colloids and phenylephrine-induced
vasoconstriction during treatment with the inotropes. <br/>Result(s): A
dose-dependent increase in stroke volume index and cardiac index by
approximately 20% were seen with both agents at the highest doses, with no
difference between groups (P =.792 and 0.744, respectively). In both
groups, RV strain and SR-S dose-dependently increased by 20% and 15%-19%,
respectively, at the highest doses (P =.742 and 0.259, respectively) with
no difference between groups. SR-E improved by both agents 20%-24% at the
highest dose with no difference between groups (P =.714).
<br/>Conclusion(s): The direct RV inotropic and lusitropic effects of
levosimendan and milrinone were comparable at clinically relevant infusion
rates.<br/>Copyright &#xa9; 2019 The Acta Anaesthesiologica Scandinavica
Foundation. Published by John Wiley & Sons Ltd

<43>
Accession Number
630362582
Title
Effects of perioperative transcutaneous electrical acupoint stimulation on
monocytic HLA-DR expression in patients undergoing coronary artery bypass
grafting with cardiopulmonary bypass: Study protocol for a double-blind
randomized controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 789. Date of
Publication: 30 Dec 2019.
Author
Chen W.-T.; Wei J.-F.; Wang L.; Zhang D.-W.; Tang W.; Yong Y.; Wang J.;
Zhou Y.-L.; Yuan L.; Fu G.-Q.; Wang S.; Song J.-G.
Institution
(Chen, Wang, Tang, Wang, Yong, Wang, Zhou, Yuan, Fu, Song) Anesthesiology
Department, Shuguang Hospital Affiliated to Shanghai University of
Traditional Chinese Medicine, Shanghai, China
(Wei, Zhang, Wang) Guangdong Cardiovascular Institute, Guangdong General
Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong
Province, China
(Wei) Shantou University Medical College, Shantou, Guangdong Province,
China
(Song) Acupuncture and Anesthesia Research Institute, Shuguang Hospital
Affiliated to Shanghai University of Traditional Chinese Medicine,
Shanghai, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiac surgery involving cardiopulmonary bypass (CPB) is
known to be associated with a transient postoperative immunosuppression.
When severe and persistent, this immune dysfunction predisposes patients
to infectious complications, which contributes to a prolonged stay in the
intensive care unit (ICU), and even mortality. Effective prevention and
treatment methods are still lacking. Recent studies revealed that
acupuncture-related techniques, such as electroacupuncture and
transcutaneous electrical acupoint stimulation (TEAS), are able to produce
effective cardioprotection and immunomodulation in adult and pediatric
patients undergoing cardiac surgery with CPB, which leads to enhanced
recovery. However, whether perioperative application of TEAS, a
non-invasive technique, is able to improve immunosuppression of the
patients with post-cardiosurgical conditions is unknown. Thus, as a
preliminary study, the main objective is to evaluate the effects of TEAS
on the postoperative expression of monocytic human leukocyte antigen (-D
related) (mHLA-DR), a standardized "global" biomarker of injury or
sepsis-associated immunosuppression, in patients receiving on-pump
coronary artery bypass grafting (CABG). <br/>Method(s): This study is a
single-center clinical trial. The 88 patients scheduled to receive CABG
under CPB will be randomized into two groups: the group receiving TEAS,
and the group receiving transcutaneous acupoint pseudo-electric
stimulation (Sham TEAS). Expression of mHLA-DR serves as a primary
endpoint, and other laboratory parameters (e.g., interleukin [IL]-6,
IL-10) and clinical outcomes (e.g., postoperative infectious
complications, ICU stay time, and mortality) as the secondary endpoints.
In addition, immune indicators, such as high mobility group box 1 protein
and regulatory T cells will also be measured. <br/>Discussion(s): The
current study is a preliminary monocentric clinical trial with a
non-clinical primary endpoint, expression of mHLA-DR, aiming at
determining whether perioperative application of TEAS has a potential to
reverse CABG-associated immunosuppression. Although the immediate clinical
impact of this study is limited, its results would inform further
large-sample clinical trials using relevant patient-centered clinical
outcomes as primary endpoints. Trial registration: ClinicalTrials.gov,
NCT02933996. Registered on 13 October 2016.<br/>Copyright &#xa9; 2019 The
Author(s).

<44>
Accession Number
630484420
Title
The prophylactic use of fibrinogen concentrate in high-risk cardiac
surgery.
Source
Acta anaesthesiologica Scandinavica. (no pagination), 2019. Date of
Publication: 31 Dec 2019.
Author
Kwapisz M.M.; Kent B.; DiQuinzio C.; LeGare J.-F.; Garnett S.; Swyer W.;
Whynot S.; Mingo H.; Scheffler M.
Institution
(Kwapisz, Kent, DiQuinzio, Garnett, Whynot, Mingo, Scheffler) Department
of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie
University, Queen Elizabeth II Health Sciences Centre, 1796 Summer Street,
Halifax, NS B3H3A7, Canada
(LeGare) Department of Surgery, Division of Cardiac Surgery, New Brunswick
Heart Centre, 400 University Ave, Saint John, New Brunswick, E2L 4L4,
Canada
(Swyer) Department of Surgery, Dalhousie University, Queen Elizabeth II
Health Sciences Centre, Perfusion Services, 1796 Summer Street, Halifax,
NS B3H3A7, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Perioperative blood loss is a major contributor to morbidity
and mortality in cardiac surgery. Plasma fibrinogen levels play an
essential role in hemostasis and deplete quickly during hemorrhage. The
objective of the study was to determine whether prophylactic fibrinogen
concentrate administration lowers overall blood product transfusion
requirements in high-risk cardiac surgery in patients with low fibrinogen
plasma levels. <br/>METHOD(S): The study was performed in a prospective,
randomized and double-blinded design. The investigation included 62
patients undergoing elective, high-risk cardiac surgery. After weaning
from cardiopulmonary bypass and reversal of heparin patients received
either fibrinogen concentrate or placebo. The primary outcome variable was
overall blood product usage 24 h after intervention. <br/>RESULT(S): The
fibrinogen group received numerically fewer total units of blood products
than the placebo group, but the difference was not statistically or
clinically significant (for groups n=27; n=29 and 19 vs 37 units
respectively, p=0.908). The overall transfusion rate in both groups was
significantly lower than the institutional average suggested (fibrinogen
group 26%, placebo group 28%). The fibrinogen group showed significantly
higher fibrinogen levels (2.38 vs 1.83 g/l (end of surgery), p<0.001; 3.33
vs 2.68 g/l (12h after intervention), p=0.003) and improved viscoelastic
coagulation parameters (FIBTEM MCF, 27 vs 23 mm, p=0.022).
<br/>CONCLUSION(S): This randomized, controlled trial demonstrates that
point-of-care guided and prophylactic treatment with fibrinogen
concentrate does not reduce transfusion of blood products in a setting of
unexpectedly low transfusion rate as tested in this cohort, but may
improve coagulation parameters in the setting of high risk cardiac
surgery.<br/>Copyright &#xa9; 2020 The Acta Anaesthesiologica Scandinavica
Foundation. Published by John Wiley & Sons Ltd.

<45>
Accession Number
630483256
Title
Feasibility study of early outpatient review and early cardiac
rehabilitation after cardiac surgery: mixed-methods research design-a
study protocol.
Source
BMJ open. 9 (12) (pp e035787), 2019. Date of Publication: 29 Dec 2019.
Author
Ngaage D.; Mitchell N.; Dean A.; Hirst C.; Akowuah E.; Doherty P.J.;
Fairhurst C.; Flemming K.; Hewitt C.; Hinde S.; Mitchell A.; Nichols S.;
Watson J.
Institution
(Ngaage) Castle Hill Hospital, Hull University Teaching Hospitals NHS
Trust, Hull, United Kingdom
(Mitchell, Dean, Hirst, Fairhurst, Hewitt, Mitchell, Watson) York Trials
Unit, Department of Health Sciences, University of York, York, United
Kingdom
(Akowuah) James Cook Hospital, South Tees Hospitals NHS Foundation Trust,
Middlesbrough, United Kingdom
(Doherty, Flemming) Department of Health Sciences, University of York,
York, United Kingdom
(Hinde) Centre for Health Economics, University of York, York, United
Kingdom
(Nichols) Centre for Sport and Exercise Science, Sheffield Hallam
University - Collegiate Crescent Campus, Sheffield, United Kingdom
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Following cardiac surgery, patients currently attend an
outpatient review 6weeks after hospital discharge, where recovery is
assessed and suitability to commence cardiac rehabilitation (CR) is
determined. CR is then started from 8weeks. Following a median sternotomy,
cardiac surgery patients are required to refrain from upper body
exercises, lifting of heavy objects and other strenuous activities for 12
weeks. A delay in starting CR can prolong the recovery process, increase
dependence on family/carers and can cause frustration. However, current
guidelines for activity and exercise after median sternotomy have been
described as restrictive, anecdotal and increasingly at odds with modern
clinical guidance for CR. This study aims to examine the feasibility of
bringing forward outpatient review and starting CR earlier. METHODS AND
ANALYSES: This is a multicentre, randomised controlled, open feasibility
trial comparing postoperative outpatient review 6 weeks after hospital
discharge, followed by CR commencement from 8 weeks (control arm) versus,
postoperative outpatient review 3 weeks after hospital discharge, followed
by commencement of CR from 4 weeks (intervention arm). The study aims to
recruit 100 eligible patients, aged 18-80 years who have undergone
elective or urgent cardiac surgery involving a full median sternotomy,
over a 7-month period across two centres. Feasibility will be measured by
consent, recruitment, retention rates and attendance at appointments and
CR sessions. Qualitative interviews with trial participants and staff will
explore issues around study processes and acceptability of the
intervention and the findings integrated with the feasibility trial
outcomes to inform the design of a future full-scale randomised controlled
trial. ETHICS AND DISSEMINATION: Ethics approval was granted by East
Midlands-Derby Research Ethics Committee on 10 January 2019. The findings
will be presented at relevant conferences disseminated via peer-reviewed
research publications, and to relevant stakeholders. TRIAL REGISTRATION
NUMBER: ISRCTN80441309.<br/>Copyright &#xa9; Author(s) (or their
employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

<46>
Accession Number
630483301
Title
Levosimendan and systemic vascular resistance in cardiac surgery patients:
a systematic review and meta-analysis.
Source
Scientific reports. 9 (1) (pp 20343), 2019. Date of Publication: 30 Dec
2019.
Author
Terbeck S.; Heinisch P.P.; Lenz A.; Friess J.-O.; Guensch D.; Carrel T.;
Eberle B.; Erdoes G.
Institution
(Terbeck, Friess, Guensch, Eberle, Erdoes) Department of Anesthesiology
and Pain Medicine, Inselspital, Bern University Hospital, University of
Bern, Bern, Switzerland
(Heinisch, Carrel) Department of Cardiovascular Surgery, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Lenz) Clinical Trials Unit, University of Bern, Bern, Switzerland
Publisher
NLM (Medline)
Abstract
Levosimendan is a potent non-adrenergic inodilator agent. The net effect
of hemodynamic changes may result in a hyperdynamic state with low
systemic vascular resistance. We conducted a systematic review and
meta-analysis assessing hemodynamics in cardiac surgery patients treated
with levosimendan. English-language literature was searched systematically
from 2006 until October 2018, including randomized controlled trials and
case-matched or retrospective studies providing at least two sequentially
measured hemodynamic variables in adult patients who underwent cardiac
surgery with cardiopulmonary bypass and were treated with levosimendan in
comparison to alternative drugs or devices. Cardiac index significantly
increased in the levosimendan group by 0.74 (0.24 to 1.23) [standardized
mean difference (95% CI); p=0.003] from baseline to postoperative day
(POD) 1, and by 0.75 (0.25 to 1.25; p=0.003) from baseline to POD 7, when
corrected for the standardized mean difference at baseline by a
multivariate mixed effects meta-analysis model. With this correction for
baseline differences, other hemodynamic variables including systemic
vascular resistance did not significantly differ until POD 1 [-0.17 (-0.64
to 0.30), p=0.48] and POD 7 [-0.13 (-0.61 to 0.34), p=0.58] between the
levosimendan and the comparator group. Levosimendan increases cardiac
index in patients undergoing cardiac surgery. Although levosimendan has
inodilator properties, this meta-analysis finds no clinical evidence that
levosimendan produces vasopressor-resistant vasoplegic syndrome.

<47>
Accession Number
630484464
Title
Can high-intensity interval training improve physical and mental health
outcomes? A meta-review of 33 systematic reviews across the lifespan.
Source
Journal of sports sciences. (pp 1-40), 2019. Date of Publication: 31 Dec
2019.
Author
Martland R.; Mondelli V.; Gaughran F.; Stubbs B.
Institution
(Martland, Gaughran) Department of Psychosis Studies, Institute of
Psychiatry, Psychology and Neuroscience (IoPPN), King's College London,
London, United Kingdom
(Mondelli, Stubbs) Department of Psychological Medicine, Institute of
Psychiatry, Psychology and Neuroscience (IoPPN), King's College London,
London, United Kingdom
(Gaughran, Stubbs) South London and Maudsley NHS Foundation Trust, London,
United Kingdom
Publisher
NLM (Medline)
Abstract
High-intensity-interval-training (HIIT) has been suggested to have
beneficial effects in multiple populations across individual systematic
reviews, although there is a lack of clarity in the totality of the
evidence whether HIIT is effective and safe across different populations
and outcomes. The aim of this meta-review was to establish the benefits,
safety and adherence of HIIT interventions across all populations from
systematic reviews and meta-analyses. Major databases were searched for
systematic reviews (with/without meta-analyses) of randomised &
non-randomised trials that compared HIIT to a control. Thirty-three
systematic reviews (including 25 meta-analyses) were retrieved
encompassing healthy subjects and people with physical health
complications. Evidence suggested HIIT improved cardiorespiratory fitness,
anthropometric measures, blood glucose and glycaemic control, arterial
compliance and vascular function, cardiac function, heart rate, some
inflammatory markers, exercise capacity and muscle mass, versus non-active
controls. Compared to active controls, HIIT improved cardiorespiratory
fitness, some inflammatory markers and muscle structure. Improvements in
anxiety and depression were seen compared to pre-training. Additionally,
no acute injuries were reported, and mean adherence rates surpassed 80% in
most systematic reviews. Thus, HIIT is associated with multiple benefits.
Further large-scale high-quality studies are needed to reaffirm and expand
these findings.Abbreviations: ACSM: American College of Sports Medicine;
BMI: Body Mass Index; BNP: Brain Natriuretic Peptide; BP: Blood Pressure;
CAD: Coronary Artery Disease; CHD: Coronary Heart Disease; COPD: Chronic
Obstructive Pulmonary Disease; CRP: c- reactive Protein; CVD:
Cardiovascular Disease; DBP: Diastolic Blood Pressure; ES: Effect Size;
FAS: Reduced Fatty Acid Synthase; FATP-1: Reduced Fatty Acid Transport
Protein 1; FMD: Flow Mediated Dilation; Hs-CRP: High-sensitivity c-
reactive Protein; HDL: High Density Lipoprotein; HIIT: High-Intensity
Interval Training; HOMA: Homoeostatic Model Assessment; HR: Heart Rate;
HTx: Heart Transplant Recipients; IL-6: Interleukin-6; LDL: Low Density
Lipoprotein; LV: Left Ventricular; LVEF: Left Ventricular Ejection
Fraction; MD: Mean Difference; MetS: Metabolic Syndrome; MPO:
Myeloperoxidase; MICT: Moderate-Intensity Continuous Training; NO: Nitric
Oxide; NRCT: Non-Randomised Controlled Trial; PA: Physical Activity;
PAI-1: Plasminogen-activator-inhibitor-1; QoL: Quality of Life; RCT:
Randomised Controlled Trial; RoB: Risk of Bias; RPP: Rate Pressure
Product; RT: Resistance Training; SBP: Systolic Blood Pressure; SD:
Standardised Difference; SMD: Standardised Mean Difference; TAU:
Treatment-As-Usual; T2DM: Type 2 Diabetes Mellitus; TC: Total Cholesterol;
TG: Triglycerides; TNF-alfa: Tumour Necrosis Factor alpha; UMD:
Unstandardised Mean Difference; WC: Waist Circumference; WHR: Waist-to-Hip
Ratio; WMD: Weighted Mean DifferenceKey points: HIIT may improve
cardiorespiratory fitness, cardiovascular function, anthropometric
variables, exercise capacity, muscular structure and function, and anxiety
and depression severity in healthy individuals and those with physical
health disorders.Additionally, HIIT appears to be safe and does not seem
to be associated with acute injuries or serious cardiovascular events.

<48>
Accession Number
2003969995
Title
Meta-analysis of preoperative high-sensitivity cardiac troponin
measurement in non-cardiac surgical patients at risk of cardiovascular
complications.
Source
British Journal of Surgery. 107 (2) (pp e81-e90), 2020. Date of
Publication: 01 Jan 2020.
Author
Zhao B.-C.; Liu W.-F.; Deng Q.-W.; Zhuang P.-P.; Liu J.; Li C.; Liu K.-X.
Institution
(Zhao, Liu, Zhuang, Liu, Li, Liu) Departments of Anaesthesiology, Nanfang
Hospital, Southern Medical University, Guangzhou, China
(Deng) First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Patients undergoing major non-cardiac surgery are at risk of
cardiovascular complications. Raised levels of high-sensitivity troponin
are frequently detected before operation among these patients. However,
the prognostic value of high-sensitivity troponin in predicting
postoperative outcomes remains unclear. <br/>Method(s): A systematic
search of PubMed, Embase and Science Citation Index Expanded was
undertaken for observational studies published before March 2018 that
reported associations between raised preoperative levels of
high-sensitivity troponin and postoperative major adverse cardiac events
and/or mortality after non-cardiac surgery. Meta-analyses were performed,
where possible, using random-effects models. <br/>Result(s): Seven cohort
studies with a total of 4836 patients were included. A raised preoperative
high-sensitivity troponin level was associated with a higher risk of
short-term major adverse cardiac events (risk ratio (RR) 2.92, 95 per cent
c.i. 1.96 to 4.37; I² = 82.6 per cent), short-term mortality
(RR 5.39, 3.21 to 9.06; I² = 0 per cent) and long-term
mortality (RR 2.90, 1.83 to 4.59, I² = 74.2 per cent). The
addition of preoperative high-sensitivity troponin measurement provided
improvements in cardiovascular risk discrimination (increase in C-index
ranged from 0.058 to 0.109) and classification (quantified by continuous
net reclassification improvement) compared with Lee's Revised Cardiac Risk
Index alone. There was substantial heterogeneity and inadequate risk
stratification analysis in the included studies. <br/>Conclusion(s):
Raised preoperative levels of high-sensitivity troponin appear to
represent a risk for postoperative major adverse cardiac events and
mortality. Further study is required before high-sensitivity troponin can
be used to predict risk stratification in routine clinical
practice.<br/>Copyright &#xa9; 2020 BJS Society Ltd Published by John
Wiley & Sons Ltd

<49>
Accession Number
2004486159
Title
Association of plasma-soluble ST2 and galectin-3 with cardiovascular
events and mortality following cardiac surgery.
Source
American Heart Journal. 220 (pp 253-263), 2020. Date of Publication:
February 2020.
Author
Patel D.M.; Thiessen-Philbrook H.; Brown J.R.; McArthur E.; Moledina D.G.;
Mansour S.G.; Shlipak M.G.; Koyner J.L.; Kavsak P.; Whitlock R.P.; Everett
A.D.; Malenka D.J.; Garg A.X.; Coca S.G.; Parikh C.R.
Institution
(Patel, Moledina, Mansour) Program of Applied Translational Research,
Department of Medicine, Yale University School of Medicine, New Haven, CT,
United States
(Thiessen-Philbrook, Parikh) Division of Nephrology, School of Medicine,
Johns Hopkins University, Baltimore, MD, United States
(Brown, Malenka) Dartmouth Institute for Health Policy and Clinical
Practice, Departments of Biomedical Data Science and Epidemiology, Geisel
School of Medicine, New Hampshire, Lebanon
(McArthur, Garg) Institute for Clinical Evaluative Services, Toronto,
Ontario, Canada
(Moledina, Mansour) Section of Nephrology, Yale University School of
Medicine, New Haven, CT, United States
(Shlipak) Kidney Health Research Collaborative, University of California
San Francisco, San Francisco, CA, United States
(Shlipak) Department of Medicine, San Francisco VA Medical Center and
University of California, San Francisco, CA, United States
(Koyner) Section of Nephrology, Department of Medicine, University of
Chicago, Pritzker School of Medicine, Chicago, IL, United States
(Kavsak) Departments of Pathology and Molecular Medicine, McMaster
University, Hamilton, Ontario, Canada
(Whitlock) Population Health Research Institute and Department of Surgery,
McMaster University, Hamilton, Ontario, Canada
(Everett) Division of Cardiology, Department of Pediatrics, Johns Hopkins
School of Medicine, Baltimore, MD, United States
(Garg) Division of Nephrology, Department of Medicine, Western University,
London, Ontario, Canada
(Coca) Division of Nephrology, Department of Medicine, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Cardiac surgery induces hemodynamic stress on the myocardium,
and this process can be associated with significant post-operative
morbidity and mortality. Soluble suppression of tumorigenicity 2 (sST2)
and galectin-3 (gal-3) are biomarkers of myocardial remodeling and
fibrosis; however, their potential association with post-operative changes
is unknown. <br/>Method(s): We measured peri-operative plasma sST2 and
gal-3 levels in two prospective cohorts (TRIBE-AKI and NNE) of over 1800
patients who underwent cardiac surgery. sST2 and gal-3 levels were
evaluated for association with a composite primary outcome of
cardiovascular event or mortality over median follow-up periods of 3.4 and
6.0 years, respectively, for the two cohorts. Meta-analysis of hazard
ratio estimates from the cohorts was performed using random effects
models. <br/>Result(s): Cohorts demonstrated event rates of 70.2 and 66.8
per 1000 person-years for the primary composite outcome. After adjustment
for clinical covariates, higher post-operative sST2 and gal-3 levels were
significantly associated with cardiovascular event or mortality [pooled
estimate HRs: sST2 1.29 (95% CI 1.16, 1.44); gal-3 1.26 (95% CI 1.09,
1.46)]. These associations were not significantly modified by
pre-operative congestive heart failure or AKI. <br/>Conclusion(s): Higher
post-operative sST2 and gal-3 values were associated with increased
incidence of cardiovascular event or mortality. These two biomarkers
should be further studied for potential clinical utility for patients
undergoing cardiac surgery.<br/>Copyright &#xa9; 2019

<50>
Accession Number
630471759
Title
Baseline left ventricular diastolic dysfunction affects midterm mortality
after transcatheter aortic valve implantation.
Source
Journal of cardiac surgery. (no pagination), 2019. Date of Publication: 30
Dec 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Yokoyama Y.; Ueyama H.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Yokoyama) Department of Surgery, Easton Hospital, Easton, PA
(Ueyama, Kuno) Department of Medicine, Mount Sinai Beth Israel Medical
Center, NY
(Ando) Division of Interventional Cardiology, Department of Cardiology,
New York Presbyterian Hospital/Columbia University Medical Center, NY
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To determine whether preprocedural left ventricular (LV)
diastolic dysfunction impairs midterm mortality after transcatheter aortic
valve implantation (TAVI) for patients with severe aortic stenosis (AS),
we performed a meta-analysis of currently available evidence.
<br/>METHOD(S): We identified all studies investigating impact of
preprocedural severity of LV diastolic dysfunction on midterm (>=1-year)
all-cause mortality after TAVI for patients with AS through a search of
databases (MEDLINE and EMBASE) until September 2019. From each study, we
extracted an adjusted (if unavailable, unadjusted) hazard ratio (HR) of
midterm mortality. We pooled study-specific estimates in the
random-effects model. <br/>RESULT(S): Ten eligible studies with a total of
2380 patients with AS undergoing TAVI were identified. In accordance with
pooled analyses, higher-grade preprocedural LV diastolic dysfunction was
associated with significantly worse midterm all-cause mortality after TAVI
compared to lower-grade dysfunction (HR for grade II vs I, 1.15; P=.002;
HR for grade III vs I, 1.35; P=.001; HR for grade III vs II; 1.16, P=.002;
HR for grade II-III vs I, II-III vs 0-I, or III vs I-II, 1.34; P<.00001
[primary meta-analysis]; HR per grade, 1.16; P=.003). No funnel plot
asymmetry for the primary meta-analysis (for grade II-III vs I, II-III vs
0-I, or III vs I-II) was identified, which probably indicated no
publication bias (P=.381 by the linear-regression test).
<br/>CONCLUSION(S): Higher-grade preprocedural LV diastolic dysfunction
was associated with worse midterm all-cause mortality after TAVI for
patients with AS compared to lower-grade dysfunction.<br/>Copyright &#xa9;
2019 Wiley Periodicals, Inc.

<51>
Accession Number
630465792
Title
Comparative efficacy and safety of antithrombotic therapy for
transcatheter aortic valve replacement: a systematic review and network
meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 28 Dec 2019.
Author
Zhu Y.; Zou Z.; Huang Y.; Zhang L.; Chen H.; Li Y.; Liu C.; Li X.; Xu D.;
Zeng Q.
Institution
(Zhu, Zou, Huang, Zhang, Chen, Li, Li, Xu, Zeng) First Clinical Medical
College, State Key Laboratory of Organ Failure Research, Nanfang Hospital,
Southern Medical University, Guangzhou, China
(Zhu, Huang, Xu, Zeng) Guangzhou Regenerative Medicine and Health
Guangdong Laboratory, Guangzhou, China
(Liu) Department of Cardiology, Guangzhou First People's Hospital, School
of Medicine, South China University of Technology, Guangzhou, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We sought to determine the optimal antithrombotic therapy
after transcatheter aortic valve replacement. <br/>METHOD(S): Related
scientific databases were searched until December 2018. We conducted a
pairwise and a network meta-analysis within a frequentist framework,
measuring 30-day bleeding, stroke and all-cause mortality. The surface
under the cumulative ranking (SUCRA) curve was estimated to rank the
therapies. The Grading of Recommendations Assessment, Development and
Evaluation (GRADE) approach was performed. The protocol was registered
with PROSPERO (CRD42018111163). <br/>RESULT(S): Eight studies comprising
2173 patients were analysed. The risk of 30-day bleeding was higher for
dual antiplatelet therapy (DAPT) than single antiplatelet therapy (SAPT)
[odds ratio (OR) 1.90 (1.10-3.28); P=0.02], whereas there was no
difference in the risk of 30-day stroke [OR 1.27 (0.38-4.20); P=0.69] and
mortality [OR 1.46 (0.67-3.22); P=0.34] between DAPT and SAPT. In the
network meta-analysis, DAPT+oral anticoagulant (OAC) increased the risk of
30-day bleeding compared with SAPT [OR 6.21 (1.74-22.17); P=0.005], DAPT
[OR 3.27 (1.04-10.32); P=0.043], SAPT+OAC [OR 4.87 (2.51-9.45); P<0.001]
and OAC [OR 14.4 (1.3-154.7); P=0.028]. Additionally, patients receiving
DAPT + OAC had the highest risks for 30-day bleeding (SUCRA 1.0%). OAC
seemed to be superior to SAPT and DAPT in terms of 30-day bleeding (SUCRA
OAC: 86.3%, SAPT: 72.3%, DAPT: 32.3%) and stroke (SUCRA 54.2%, 47.4%,
40.5%), but not mortality (SUCRA 69.6%, 74.1%, 43.4%). <br/>CONCLUSION(S):
There is a trend towards less bleeding with the application of SAPT, but
no mortality benefit with the application of DAPT is shown. The comparison
of SAPT, DAPT and OAC shows that OAC may improve the balance between
stroke and bleeding, which can reduce the risk of mortality. In addition,
the application of DAPT+OAC was ranked the worst amongst all treatment
modalities and should be avoided due to an increased risk of bleeding.
CLINICAL TRIAL REGISTRATION NUMBER: PROSPERO (International Prospective
Register of Systematic Reviews, CRD42018111163).<br/>Copyright &#xa9; The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<52>
Accession Number
630481936
Title
Magnetic Resonance-Based Diagnostics for Bleeding Assessment in Neonatal
Cardiac Surgery.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 27 Dec 2019.
Author
Choi P.S.; Ibla J.C.; Marturano J.E.; Lowery T.J.; Emani S.
Institution
(Choi, Emani, Emani) Department of Cardiovascular Surgery, Boston
Children's Hospital, MA, Boston
(Ibla) Department of Anesthesiology, Critical Care, Pain Medicine, Boston
Children's Hospital, MA, Boston
(Marturano, Lowery) T2 Biosystems, MA, Lexington, United States
Publisher
NLM (Medline)
Abstract
PURPOSE: Infants undergoing cardiac surgery are at high risk for
post-surgical bleeding. To date, there are no highly predictive models for
post-surgical bleeding in this population. This study's objective was to
assess the predictive ability of T2 magnetic resonance (T2MR).
DESCRIPTION: T2MR utilizes magnetic resonance to detect clot formation
characteristics on a small blood sample and provides hemostatic parameters
that can assess bleeding risk. EVALUATION: This prospective,
single-institution study enrolled 100 patients less than 12 months old
undergoing cardiac surgery from 4/27/2015 and 9/21/2016. Primary endpoint
was post-surgical bleeding within 24 hours after procedure. T2MR data was
modeled with binary recursive partitioning algorithm with randomized
cross-validation. The tight clot metric produced the highest univariate
discrimination of bleeding (receiver operator curve = 0.64, classification
accuracy = 72%), and along with the platelet function metric, demonstrated
highest relative importance based on Gini index splitting. Multivariate
modeling with cross-validation showed mean receiver operator curve area of
0.74 and classification accuracy of 82%. <br/>CONCLUSION(S): T2MR tight
clot and platelet function metrics were associated with bleeding
events.<br/>Copyright &#xa9; 2019. Published by Elsevier Inc.

<53>
Accession Number
630468197
Title
Reduction of drainage-associated complications in cardiac surgery with a
digital drainage system: A randomized controlled trial.
Source
Journal of Thoracic Disease. 11 (12) (pp 5177-5186), 2019. Date of
Publication: 01 Dec 2019.
Author
Van Linden A.; Hecker F.; Courvoisier D.S.; Arsalan M.; Kohne J.; Brei C.;
Holubec T.; Walther T.
Institution
(Van Linden, Hecker, Arsalan, Holubec, Walther) Department of
Cardiothoracic and Vascular Surgery, Goethe University Hospital,
Theodor-Stern Kai 7, Frankfurt 60590, Germany
(Courvoisier) Faculty of Medicine, University of Geneva, Geneva,
Switzerland
(Kohne) Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim,
Germany
(Brei) Medela Medizintechnik GmbH, Co. Handels KG, Dietersheim, Germany
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Thoracic chest drains are placed after cardiac surgery
allowing for the clearance of blood, fluid, and air to prevent
post-operative complications. Despite its importance, there is little data
on the application of digital chest drainage systems in cardiac surgery.
Therefore, the differences between an analog and a digital chest drainage
system in cardiac surgery patients were investigated in a randomized
controlled trial. <br/>Method(s): A total of 354 elective cardiac surgery
patients were preoperatively randomized 1:1 between September 2016 and
September 2017 to either an analog (Ocean) or a digital
(Thopaz⁺) chest drainage system aiming to compare
drainage-associated postoperative outcome parameters. <br/>Result(s): A
total of 340 patients were included in the analysis (analog: 188; digital:
152) with no significant differences in preoperative baseline parameters.
Incidence of X-rays to detect air leaks was significantly lower in the
digital group (analog: 20.2%; digital: 8.6%; P<0.01). Patients treated
with the digital system showed a 3.3% reduction of re-thoracotomies,
however, not statistically significant (analog: 5.3%; digital: 2.0%;
P=0.19). Median total fluid amount did not significantly differ between
study groups [median (P25; P75); analog: 705 (400; 1,333) mL; digital: 686
(404; 1,229) mL; P=0.83]; however, the use of the digital drainage system
resulted in a quicker removal with a reduced median drainage duration of
16 hours (analog: 65 hours; digital: 49 hours; P<=0.01).
<br/>Conclusion(s): The study provides evidence that digital drainage
systems can be safely applied in cardiac surgery patients. The use of the
digital management system led to a decreased incidence of
drainage-associated complications as well as to shortened chest tube
duration. Findings require confirmation by additional
studies.<br/>Copyright &#xa9; 2019 Journal of Thoracic Disease. All rights
reserved.

<54>
Accession Number
630468125
Title
A meta-analysis comparing transaxillary and transfemoral transcatheter
aortic valve replacement.
Source
Journal of Thoracic Disease. 11 (12) (pp 5140-5151), 2019. Date of
Publication: 01 Dec 2019.
Author
Zhan Y.; Saadat S.; Soin A.; Kawabori M.; Chen F.Y.
Institution
(Zhan, Saadat, Soin, Kawabori, Chen) Division of Cardiac Surgery, Tufts
Medical Center, Tufts University School of Medicine, 800 Washington
Street, #266, Boston, MA 02111, United States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: While transfemoral (TF) approach is considered as the default
access for transcatheter aortic valve replacement (TAVR), the alternative
access route of choice remains to be elucidated. Transaxillary (TAx)
approach has shown promise as an excellent option. We performed a
meta-analysis of the studies comparing the TF and TAx approaches using one
type of self-expandable transcatheter valve to avoid device-related bias.
<br/>Method(s): We searched PubMed/MEDLINE, EMBASE, and the Cochrane
Library from inception to December 2018 to identify articles comparing
TAx-TAVR and TF-TAVR. The studies included in this meta-analysis contain
data related to the use of the CoreValve device. Patients' baseline
characteristics, procedural outcomes, and clinical outcomes were extracted
from the articles and pooled for analysis. <br/>Result(s): The
meta-analysis included five studies comprising 1,414 patients in the TF
group and 489 patients in the TAx group. The average EuroScores of the TF
and TAx groups were 20.04+/-13.89 and 22.73+/-14.73, respectively. The TAx
group has higher rates of major comorbidities. No difference was found
between the two groups with regard to vascular complications (P=0.71; OR
1.08; 95% CI, 0.71-1.65), aortic regurgitation (P=0.90; OR 1.03; 95% CI,
0.71-1.49), and permanent pacemaker (PPM) implantation (P=0.42; OR 1.12;
95% CI, 0.86-1.46). The TAx group has a lower incidence of acute kidney
injury (AKI) (P=0.05; OR 1.63; 95% CI, 1.01-2.62). No difference was
observed in 30-day mortality (P=0.32; OR 1.30; 95% CI, 0.78-2.17) or
1-year mortality (P=0.21; OR 0.76; 95% CI, 0.50-1.16). <br/>Conclusion(s):
TAx-TAVR is associated with overall comparable outcomes to TF TAVR in
high-risk patient cohorts, despite higher incidences of major
comorbidities in the TAx-TAVR patient population. The rate of AKI appears
to be lower after TAx-TAVR.<br/>Copyright &#xa9; 2019 Journal of Thoracic
Disease. All rights reserved.

<55>
Accession Number
630468101
Title
Impact of postprocedural permanent pacemaker implantation on clinical
outcomes after transcatheter aortic valve replacement: A systematic review
and meta-analysis.
Source
Journal of Thoracic Disease. 11 (12) (pp 5130-5139), 2019. Date of
Publication: 01 Dec 2019.
Author
Xi Z.; Liu T.; Liang J.; Zhou Y.-J.; Liu W.
Institution
(Xi, Liu, Liang, Zhou, Liu) Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing Institute of Heart Lung and
Blood Vessel Diseases, Anzhen Road, Chaoyang District, Beijing 100029,
China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: The incidence of conduction disturbances requiring permanent
pacemaker (PPM) implantation following transcatheter aortic valve
replacement (TAVR) have remained a common concern. The purpose of this
study was to evaluate the impact of postprocedural PPM implantation
following TAVR on clinical outcomes. <br/>Method(s): We performed a
systematic search in PubMed and EMBASE databases for studies that reported
raw data on clinical outcomes of patients with and without PPM
implantation after TAVR and followed up patients for 10 months or longer.
The primary endpoint was all-cause death. The secondary endpoints were
cardiovascular death, heart failure and a composite of stroke and
myocardial infarction (MI). <br/>Result(s): Data from 20 studies with a
total of 21,666 patients undergoing TAVR, of whom 12.5% required PPM
implantation after intervention, were analysed and the mean duration
follow-up was 16.9 months. The rate of PPM ranged from 6.2% to 32.8% among
different studies. A total of 6,753 (31.2%) patients underwent TAVR with
self-expandable prosthesis and 14,913 (68.8%) with balloon-expandable
prosthesis. The incidence of postprocedural PPM implantation was higher
with the self-expandable prosthesis (n=1,717, 25.4%) compared with the
balloon-expandable prosthesis (n=996, 6.7%). PPM after TAVR was associated
with a higher risk of all-cause death (RR: 1.13; 95% CI: 1.01-1.25;
P=0.03) but not incidence of stroke and MI (RR: 0.85; 95% CI: 0.64-1.13;
P=0.27). <br/>Conclusion(s): In patients undergoing TAVR, the PPM
implantation after intervention was associated higher all-cause mortality
but not cardiovascular mortality, heart failure and stroke or MI, which
remain an unsolved issue of TAVR.<br/>Copyright &#xa9; 2019 Journal of
Thoracic Disease. All rights reserved.

<56>
Accession Number
630468433
Title
Clinical outcomes of transcatheter versus surgical pulmonary valve
replacement: A meta-analysis.
Source
Journal of Thoracic Disease. 11 (12) (pp 5343-5351), 2019. Date of
Publication: 01 Dec 2019.
Author
Zhou Y.; Xiong T.; Bai P.; Chu C.; Dong N.
Institution
(Zhou, Xiong, Bai, Chu, Dong) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan 430022, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Transcatheter pulmonary valve replacement (TPVR) has currently
been a well-established alternative operation method to surgical pulmonary
valve replacement (SPVR) in patients with pulmonary valve dysfunction in
the form of stenosis and/or regurgitation. We conducted a meta-analysis to
evaluate the main clinical outcomes after TPVR and SPVR. <br/>Method(s):
We systematically searched the references of relevant literatures from
PubMed and the Cochrane Library published between January 2000 and
December 2018 and followed The Preferred Reporting Items for Systematic
reviews and Meta-analysis (PRISMA) for this study. <br/>Result(s): Eleven
studies with 4,364 patients were included in the study. Compared with
SPVR, TPVR results in a significant decreased in-hospital mortality [odds
ratio (OR): 0.18; 95% confidence interval (CI): 0.03-0.98] and mortality
at the longest reported follow-up time point (OR: 0.43; 95% CI:
0.22-0.87), though 30-day mortality (OR: 0.38; 95% CI: 0.11-1.33) has no
significant difference between groups. Days of hospital stay [(mean
difference (MD): -4.38; 95% CI: -6.24-2.53] is shorter with TPVR than
SPVR. Besides, rates of 30-day readmission (OR: 0.67; 95% CI: 0.50-0.91)
and recurrent pulmonary regurgitation (OR: 0.17; 95% CI: 0.07-0.42) are
lower with TPVR, whereas postprocedural infective endocarditis (IE) (OR:
4.56; 95% CI: 2.03-10.26) are higher with TPVR. SPVR carries a decreased
risk of re-operation (OR: 2.19; 95% CI: 0.62-7.76) though without
statistically significance. <br/>Conclusion(s): In conclusion, TPVR is
associated with a significantly decreased mortality, a shorter length of
hospital-stay, a lower rate of 30-day readmission and recurrent pulmonary
regurgitation as compared to SPVR throughout the follow-up duration,
whereas SPVR results in a significantly lower rate of postprocedural IE
than TPVR. In addition, SPVR carries a decreased risk of re-operation with
statistically insignificance.<br/>Copyright &#xa9; 2019 Journal of
Thoracic Disease. All rights reserved.

<57>
Accession Number
613879052
Title
Perioperative supplementation of polyunsaturated omega-3 fatty acid for
the prevention of atrial fibrillation after cardiothoracic surgery.
Source
American Journal of Health-System Pharmacy. 74 (1) (pp e17-e23), 2017.
Date of Publication: 01 Jan 2017.
Author
Joss J.D.; Hernan J.; Collier R.; Cardenas A.
Institution
(Joss, Collier) Good Samaritan Regional Medical Center, Corvallis, OR,
United States
(Hernan) CarePro Home Infusion and Ambulatory Care, Cedar Rapids, IA,
United States
(Cardenas) Harvard T. H. Chan School of Public Health, Boston, MA, United
States
Publisher
American Society of Health-Systems Pharmacy (E-mail: info@idsociety.org)
Abstract
Purpose. The effect of perioperative supplementation of polyunsaturated
omega-3 fatty acid (PUFA) on the frequency of atrial fibrillation (AF) in
patients without a history of AF was evaluated. Methods. A total of 561
patients were randomized to receive either 1 g of PUFA or placebo twice
daily. Treatment was started up to five days before surgery or within 24
hours after surgery, depending on when consent was received. Treatment was
continued until the patient's follow-up visit with the cardiologist up to
four weeks after surgery. The primary endpoint of the study was AF before
hospital discharge. Secondary endpoints included AF within one week after
surgery, AF within one month after surgery, length of hospital stay,
postoperative bleeding complications, and readmission within one month
after surgery. Results. No significant reduction in the risk of AF was
observed at hospital discharge (relative risk [RR], 0.98; p = 0.922) or at
three weeks after surgery (RR, 0.98; p = 0.844). After restricting the
analysis to treatmentadherent patients, the association remained
nonsignificant at hospital discharge (RR, 0.90; p = 0.374) and at three
weeks after surgery (RR, 0.90; p = 0.330). No significant differences were
observed between treatments for rates of readmission, death, and bleeding
complications or the length of hospital stay. Conclusion. Perioperative
supplementation with PUFA did not decrease the risk of AF in the immediate
postoperative period. PUFA also had no effect on the length of hospital
stay, postoperative bleeding complications, and readmissions within one
month after surgery.

<58>
Accession Number
613566794
Title
Meta-analysis of ascorbic acid for prevention of postoperative atrial
fibrillation after cardiac surgery.
Source
American Journal of Health-System Pharmacy. 73 (24) (pp 2056-2066), 2016.
Date of Publication: 15 Dec 2016.
Author
Baker W.L.; Coleman C.I.
Institution
(Baker, Coleman) Department of Pharmacy Practice, School of Pharmacy,
University of Connecticut, Storrs, CT, United States
Publisher
American Society of Health-Systems Pharmacy (E-mail: info@idsociety.org)
Abstract
Purpose. Results of a systematic review and meta-analysis of published
data on use of ascorbic acid to prevent postoperative atrial fibrillation
(POAF) after cardiac surgery are presented. Methods. MEDLINE and other
sources were searched for reports on trials evaluating the effects of
preoperative and/or postoperative use of ascorbic acid in patients
undergoing cardiac surgery. For each study selected for meta-analysis, an
assessment for risks of methodological bias was performed. Data on POAF
frequency and length of stay (LOS) outcomes were pooled and analyzed via
random-effects modeling. Results. The 11 identified studies involved
patients receiving coronary artery bypass grafts with or without valve
replacement; both i.v. and oral ascorbic acid formulations were used.
Analysis of pooled outcomes data on treatment and control groups indicated
that ascorbic acid prophylaxis was associated with reductions in POAF
frequency (odds ratio, 0.44; 95% confidence interval [CI], 0.32 to 0.61),
intensive care unit (ICU) LOS (difference in means, -0.24 day; 95% CI,
-0.45 to -0.03 day), and total hospital LOS (difference in means, -0.94
day; 95% CI, -1.65 to -0.23 day). Significant statistical, methodological,
and clinical heterogeneity were observed. Conclusion. A meta-analysis
revealed that, compared with use of a placebo or a nonplacebo control,
perioperative administration of ascorbic acid to patients undergoing
cardiac surgery was associated with a reduced frequency of POAF and a
shorter ICU LOS and total hospital LOS.<br/>&#xa9; Copyright 2016,
American Society of Health-System Pharmacists, Inc. All rights.

<59>
Accession Number
362543655
Title
Effect of ascorbic acid on inflammatory markers after cardiothoracic
surgery.
Source
American Journal of Health-System Pharmacy. 68 (17) (pp 1632-1639), 2011.
Date of Publication: 01 Sep 2011.
Author
Colby J.A.; Chen W.T.; Baker W.L.; Coleman C.I.; Reinhart K.; Kluger J.;
White C.M.
Institution
(Colby, Chen) Hartford Hospital (HH), Hartford, CT, United States
(Baker) School of Pharmacy, University of Connecticut (UC), Farmington,
CT, United States
(Baker) Department of Medicine, School of Medicine, University of
Connecticut (UC), Farmington, CT, United States
(Coleman) Department of Pharmacy Practice, School of Pharmacy, UC,
Hartford, United States
(Coleman, White) UC/HH Evidence-Based Practice Center, Hartford, United
States
(Reinhart) Department of Pharmacy, School of Pharmacy, Wingate University,
Asheville, NC, United States
(Kluger) Arrhythmia Services, United States
(White) Department of Pharmacy, School of Pharmacy, UC, United States
Publisher
American Society of Health-Systems Pharmacy (E-mail: info@idsociety.org)
Abstract
Purpose. The effect of ascorbic acid on inflammatory markers after
cardiothoracic surgery (CTS) was studied. Methods. In this randomized,
doubleblind, placebo-controlled trial, patients undergoing cardiopulmonary
bypass graft surgery or valve replacement surgery from April 2009 through
March 2010 at Hartford Hospital were randomized to receive ascorbic acid
(2-g loading dose followed by 500 mg every 12 hours) or matching placebo
the evening before surgery and for four days postoperatively. Inflammatory
mediators were measured preoperatively and on postoperative days 1-4.
Intergroup comparisons were performed using two-tailed t tests and
Fisher's exact test. Multiple comparisons were conducted using repeated
analyses of variance with Bonferroni tests. Results. Of the 62 patients
screened, 24 met the study inclusion criteria. Of these, 13 were assigned
to receive ascorbic acid and 11 received placebo. Ascorbic acid did not
affect the natural course of inflammatory marker rise for C-reactive
protein (CRP)concentration, white blood cell (WBC) count, or fibrinogen
concentration versus placebo at any evaluated time point (p > 0.05 for all
intergroup comparisons). Intragroup analyses demonstrated significant
differences among baseline and postoperative measures of all inflammatory
mediators (p < 0.05). No significant differences were noted in
inflammatory markers between patients undergoing cardiothoracic surgery
with or without cardiopulmonary bypass, regardless of treatment group.
Conclusion. Ascorbic acid did not attenuate the rise in inflammatory
markers after CTS when compared with placebo. The use of off-pump surgery
did not significantly change the levels of CRP and fibrinogen or the WBC
count postoperatively when compared with on-pump surgery with a
biocompatible polymer coating. Copyright &#xa9; 2011, American Society of
Health-System Pharmacists, Inc. All rights reserved.

<60>
Accession Number
355340159
Title
International Normalized Ratio values in group versus individual
appointments in a pharmacist-managed anticoagulation clinic.
Source
American Journal of Health-System Pharmacy. 66 (13) (pp 1218-1223), 2009.
Date of Publication: 01 Jul 2009.
Author
Griffin B.L.; Burkiewicz J.S.; Peppers L.R.; Warholak T.L.
Institution
(Griffin, Burkiewicz) Pharmacy Practice, Chicago College of Pharmacy,
Midwestern University, 555 31st Street, Downers Grove, IL 60515, United
States
(Peppers) Global Medical Information, Abbott Park, IL, United States
(Warholak) Pharmacy Practice and Science, College of Pharmacy, University
of Arizona, Tucson, AZ, United States
Publisher
American Society of Health-Systems Pharmacy
Abstract
Purpose. The clinical effectiveness of a group-visit model versus
individual point-of-care visits is compared by International Normalized
Ratio (INR) monitoring in a pharmacist-managed anticoagulation clinic.
Methods. This study was a prospective, randomized, repeated-measures,
two-group, intention-to-treat comparison and survey at a
pharmacist-managed anticoagulation clinic in a managed-care ambulatory
care setting. Patients were eligible for this study if they were taking
warfarin therapy for at least 30 days, had a goal INR range, and provided
consent. At a routine point-of-care visit, eligible patients were randomly
invited to participate in group visits. The number of visits and INR
values were documented prospectively for both groups during the 16-week
study period. Results. Of the 45 patients who consented and enrolled in
group visits, 28 patients participated for the 16-week study period. The
control group included 108 patients seen by a pharmacist for individual
anticoagulation appointments. No significant difference in the percentage
of INR values within the therapeutic range was detected between patients
in the group-visit model versus patients receiving individual visits (59%
versus 56.6%, respectively; p = 0.536). Seventy-three percent of INR
values for patients who attended group visits were within +/-0.2 of the
desired INR range compared with 71.9% of those in the control group (p =
0.994). In addition, 79% of group-visit patients were within the
therapeutic range at their last clinic visit compared with 67% of patients
who attended individual appointments (p = 0.225). Group visits were
preferred by 51% (n = 38) of patients who completed the satisfaction
survey. Of the 92 patients who declined group-visit participation, 36%
indicated that the time of day that group visits were offered was
inconvenient. There were no thromboembolic or hemorrhagic events
documented in either group during the study period. Conclusion. Group
visits in a pharmacist-managed anticoagulation clinic may provide a safe
and effective alternative to individual appointments. Copyright &#xa9;
2009, American Society of Health-System Pharmacists, Inc. All rights
reserved.

<61>
Accession Number
629385587
Title
Complex interaction of obesity, intentional weight loss and heart failure:
A systematic review and meta-analysis.
Source
Heart. 106 (1) (pp 58-68), 2020. Date of Publication: 01 Jan 2020.
Author
Mahajan R.; Stokes M.; Elliott A.; Munawar D.A.; Khokhar K.B.;
Thiyagarajah A.; Hendriks J.; Linz D.; Gallagher C.; Kaye D.; Lau D.;
Sanders P.
Institution
(Mahajan, Stokes, Elliott, Munawar, Khokhar, Thiyagarajah, Hendriks, Linz,
Gallagher, Lau, Sanders) Centre for Heart Rhythm Disorders, University of
Adelaide, Adelaide, SA, Australia
(Mahajan) Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale,
SA, Australia
(Stokes, Elliott, Munawar, Khokhar, Thiyagarajah, Hendriks, Linz,
Gallagher, Lau, Sanders) Department of Cardiology, Royal Adelaide
Hospital, Adelaide, SA, Australia
(Kaye) Department of Cardiology, Alfred Hospital, Melbourne, VIC,
Australia
(Kaye) Heart Research, Baker IDI Heart and Diabetes Institute, Melbourne,
VIC, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The aim of the meta-analysis was to determine the association of
obesity and heart failure (HF) and the cardiac impact of intentional
weight loss following bariatric surgery on cardiac structure and
myocardial function in obese subjects. Methods MEDLINE, Embase and Web of
Science were searched up to 3 April 2018. Studies reporting association
and prognostic impact of obesity in HF and the impact of intentional
weight loss following bariatric surgery on cardiac structure and
myocardial function in obesity were included in the meta-analysis. Results
4959 citations were reviewed. After exclusions, 29 studies were analysed.
A 'J curve' relationship was observed between body mass index (BMI) and
risk of HF with maximum risk in the morbidly obese (1.73 (95% CI 1.30 to
2.31), p<0.001, n=11). Although 'obesity paradox' was observed for
all-cause mortality, the overweight group was associated with lower
cardiovascular (CV) mortality (OR=0.86 (95% CI 0.79 to 0.94), n=11) with
no significant differences across other BMI groups. Intentional weight
loss induced by bariatric surgery in obese patients (n=9) without
established HF, atrial fibrillation or known coronary artery disease, was
associated with a reduction in left ventricular mass index (p<0.0001),
improvement in left ventricular diastolic function (p<=0.0001) and a
reduction in left atrial size (p=0.02). Conclusions Despite the increased
risk of HF with obesity, an 'obesity paradox' is observed for all-cause
mortality. However, the nadir for CV mortality is observed in the
overweight group. Importantly, intentional weight loss was associated with
improvement in indices of cardiac structure and myocardial function in
obese patients. Trial registration number APP 74412.<br/>Copyright &#xa9;
Author(s) (or their employer(s)) 2020. No commercial re-use. See rights
and permissions. Published by BMJ.

<62>
Accession Number
627325391
Title
Preventive Effects of Nicorandil Against Contrast-Induced Nephropathy in
Patients With Moderate Renal Insufficiency Undergoing Percutaneous
Coronary Intervention.
Source
Angiology. 71 (2) (pp 183-188), 2020. Date of Publication: 01 Feb 2020.
Author
Zhang P.; Li W.-Y.; Yang S.-C.; Fu N.-K.; Liu X.-G.; Zhang X.; Cong H.-L.;
Lin W.-H.; Tian F.-S.; Lu C.-Z.; Zhang J.
Institution
(Zhang, Li, Zhang) Graduate School of Tianjin Medical University, Tianjin,
China
(Zhang, Yang, Fu, Liu, Cong, Zhang) Department of Cardiology, Tianjin
Chest Hospital, Tianjin, China
(Lin) Department of Cardiology, Taida International Cardiovascular
Hospital, Tianjin, China
(Tian) Department of Cardiology, Tianjin Fourth Central Hospital, Tianjin,
China
(Lu) Department of Cardiology, Tianjin First Central Hospital, Tianjin,
China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
We investigated the preventive effect of nicorandil on contrast-induced
nephropathy (CIN) in patients with moderate renal insufficiency undergoing
percutaneous coronary intervention (PCI). A total of 250 patients with a
creatinine clearance (crCl) <=60 mL/min undergoing PCI were randomly
assigned to either a nicorandil group (nicorandil 10 mg 3 times/d and
hydration; n = 125) or a control group (hydration only; n = 125). The
first end point was the incidence of CIN defined as an increase in serum
creatinine (Scr) levels by >=0.5 mg/dL or >=25% within 72 hours after
exposure to the contrast medium. The secondary end points were (1) changes
in Scr, blood urea nitrogen, and crCl and (2) the incidence of major
adverse events during hospitalization. The incidence of CIN was 1.6%
(2/125) in the nicorandil group and 9.6% (12/125) in the control group (P
=.011). There was no obvious difference in the incidence of major adverse
events during hospitalization between the nicorandil and the control group
(4.0% vs 4.8%, P = 1.000). Multivariate logistic regression analysis
showed that nicorandil was a protective factor for CIN (odds ratios =
0.126, 95% confidence interval: -19.996 to -0.932, P =.012). Prophylactic
administration of nicorandil may prevent against CIN in patients with
moderate renal insufficiency undergoing PCI.<br/>Copyright &#xa9; The
Author(s) 2019.

<63>
Accession Number
2003447321
Title
Effect of two different colloid priming strategies in infants weighing
less than 5 kg undergoing on-pump cardiac surgeries.
Source
Artificial Organs. 44 (1) (pp 58-66), 2020. Date of Publication: 01 Jan
2020.
Author
Zhou C.; Tong Y.; Feng Z.; Cui Y.; Zhao M.; Hu J.; Liu K.; Zhao J.; Liu J.
Institution
(Zhou, Tong, Feng, Cui, Zhao, Hu, Liu, Zhao, Liu) State Key Laboratory of
Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Our aim was to explore the effect of two different priming strategies
(artificial colloid only vs. artificial colloid combined with human serum
albumin) on the prognosis of children weighing less than 5 kg undergoing
on-pump congenital heart disease (CHD) surgery. A total of 65 children
weighing less than 5 kg who underwent on-pump CHD surgery in our hospital
from September 2016 to December 2017 were enrolled in this study. The
children were randomly divided into two groups: artificial colloid priming
group (AC group, n = 33) and artificial colloid combined albumin priming
group (ACA group, n = 32). The primary clinical endpoint was the peri-CPB
colloid osmotic pressure (COP). Secondary clinical endpoints included
perioperative blood product and hemostatic drug consumption, postoperative
renal function, coagulation function, postoperative renal function, and
postoperative recovery parameters. COP values were not significant in the
priming system as well as peri-CPB time points between the two groups (P
>.05). Platelet consumption in the AC group was significantly lower than
that in the ACA group (P <.05). There were no significant differences in
the use of other blood products and hemostatic drugs as well as
perioperative coagulation parameters between the two groups (P >.05).
Postoperative length of stay in the AC group was significantly lower than
that in the ACA group (P <.05). There were no significant differences in
mortality, postoperative mechanical ventilation time, ICU time, and
perioperative adverse events (including postoperative AKI) occurrences
between the two groups (P >.05). In the on-pump cardiac surgeries of
patients weighing less than 5 kg, total colloidal priming would not affect
peri-CPB COP values, postoperative coagulation function, and blood
products consumption. Total artificial colloidal priming strategy is
feasible in low-weight patients.<br/>Copyright &#xa9; 2019 International
Center for Artificial Organs and Transplantation and Wiley Periodicals,
Inc.

<64>
Accession Number
2003725449
Title
Intrinsic properties of medical devices: considerations for economic
evaluation.
Source
Expert Review of Pharmacoeconomics and Outcomes Research. 19 (6) (pp
619-626), 2019. Date of Publication: 02 Nov 2019.
Author
Basu R.; Eggington S.
Institution
(Basu) Health Economics and Outcomes Research, Minimally Invasive
Therapies Group (MITG), Medtronic, Mansfield, MA, United States
(Eggington) Global Health Policy, Reimbursement and Health Economics,
Medtronic International Trading Sarl, Tolochenaz, Switzerland
Publisher
Taylor and Francis Ltd
Abstract
Introduction: In recent decades, medical devices (MDs) have increasingly
become an integral part of patient care. However, when it comes to
designing and appraising economic models, researchers typically follow
pharmaceutical templates (e.g. CHEERS) to assess their economic viability.
This study evaluates the generalizability of four device-specific
criteria, as recommended by the recent MedtechHTA project, of learning
curve, incremental innovation, dynamic pricing, and organizational impact
with a broader group of MDs including diagnostics and implantables. The
purpose was to determine the applicability of these criteria to a broader
range of MDs. Areas Covered: We determined the extent to which these
criteria could be applied to each device type and attempted to identify
common themes. We performed a literature search using PubMed and Google of
a range of devices to understand the clinical significance, operation, and
economic viability. Expert Opinion: Our findings suggest that the four
characteristics are not applicable to all device types. Prior evaluation
of a device's intrinsic properties (such as longevity and device location)
and its FDA risk classification could help to indicate the applicability
of the criteria. Documenting this process when assessing the additional
four criteria on the CHEERS checklist would improve the transparency of
future economic evaluations.<br/>Copyright &#xa9; 2019, &#xa9; 2019
Informa UK Limited, trading as Taylor & Francis Group.

<65>
Accession Number
630285985
Title
Prognostic value of adiponectin level in patients with coronary artery
disease: A systematic review and meta-analysis.
Source
Lipids in Health and Disease. 18 (1) (no pagination), 2019. Article
Number: 227. Date of Publication: 23 Dec 2019.
Author
Yang L.; Li B.; Zhao Y.; Zhang Z.
Institution
(Yang, Li, Zhao, Zhang) Department of General Medicine, Lanzhou University
Second Hospital, No. 82 Cuiyingmen, Lanzhou, Gansu Province 730030, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Conflicting results on the prognostic value of blood
adiponectin level in patients with coronary artery disease (CAD) have been
reported. This meta-analysis aimed to investigate the prognostic value of
elevated adiponectin level in CAD patients. <br/>Method(s): A
comprehensive literature search was conducted in PubMed and Embase
databases up to May 10, 2019. Studies evaluating the association between
adiponectin level and major adverse cardiovascular events (death, stroke,
acute coronary syndrome or coronary revascularisation), cardiovascular
mortality, and all-cause mortality in CAD patients were included. Pooled
multivariable adjusted risk ratios (RR) and 95% confidence intervals (CI)
was calculated for the highest vs the lowest category of adiponectin
level. <br/>Result(s): Twelve studies including 10,974 CAD patients were
included. Elevated adiponectin level was independently associated with
higher risk of cardiovascular (RR 1.93; 95% CI 1.55-2.42; p < 0.001) and
all-cause mortality (RR 1.96; 95% CI 1.64-2.34; p < 0.001) in CAD
patients. However, CAD patients with higher adiponectin level did not
significantly increase major cardiovascular events risk (RR 1.12; 95% CI
0.86-1.45; p = 0.407) after adjustment for potential confounders.
<br/>Conclusion(s): This meta-analysis indicates that elevated adiponectin
level is an independent predictor of cardiovascular and all-cause
mortality in CAD patients. Measurement of blood adiponectin level has
potential to identify CAD patients who have high risk of
death.<br/>Copyright &#xa9; 2019 The Author(s).

<66>
Accession Number
630243693
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement for severe aortic stenosis in people with low surgical risk.
Source
Cochrane Database of Systematic Reviews. 2019 (12) (no pagination), 2019.
Article Number: CD013319. Date of Publication: 20 Dec 2019.
Author
Kolkailah A.A.; Doukky R.; Pelletier M.P.; Volgman A.S.; Kaneko T.; Nabhan
A.F.
Institution
(Kolkailah) Cook County Health, Department of Medicine, Chicago, IL,
United States
(Doukky) Cook County Health, Division of Cardiology, Chicago, IL, United
States
(Pelletier) University Hospitals, Case Western Reserve University,
Division of Cardiac Surgery, Cleveland, OH, United States
(Volgman) Rush University Medical Center, Division of Cardiology, Chicago,
IL, United States
(Kaneko) Brigham and Women's Hospital, Harvard Medical School, Division of
Cardiac Surgery, Boston, MA, United States
(Nabhan) Ain Shams University, Department of Obstetrics and Gynaecology,
Faculty of Medicine, 16 Ali Fahmi Kamel Street, Heliopolis, Cairo 11351,
Egypt
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Severe aortic valve stenosis (AS) is a major cause of
morbidity and mortality worldwide. The definitive management for severe AS
is aortic valve replacement (AVR). The choice of transcatheter approach
versus open-heart surgery for AVR in people with severe AS and low
surgical risk remains a matter of debate. <br/>Objective(s): To assess the
benefits and harms of transcatheter aortic valve implantation (TAVI)
compared to surgical aortic valve replacement (SAVR) in people with severe
AS and low surgical risk. <br/>Search Method(s): We searched the following
databases for randomised controlled trials (RCTs) on 29 April 2019:
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase,
and Web of Science Core Collection. We also searched ClinicalTrials.gov
and the World Health Organization International Clinical Trials Registry
Platform. We searched all databases from inception to present and imposed
no restriction on language or date of publication. <br/>Selection
Criteria: We included RCTs that compared TAVI and SAVR in adults (18 years
of age or older) with severe AS and low surgical risk. <br/>Data
Collection and Analysis: We used the standard methodological procedures
expected by Cochrane. Two authors independently screened titles and
abstracts for inclusion, performed data extraction, and assessed risk of
bias in the studies included. We analysed dichotomous data using the risk
ratio (RR) and continuous data using the mean difference (MD), with
respective 95% confidence intervals (CI). We assessed the certainty of
evidence for each outcome using the GRADE approach. Our outcomes of
interest were assessed in the short term (i.e. during hospitalisation and
up to 30 days of follow-up). Primary outcomes were all-cause mortality,
stroke, and rehospitalisation. Secondary outcomes were myocardial
infarction (MI), cardiac death, length of hospital stay (LOS), permanent
pacemaker (PPM) implantation, new-onset atrial fibrillation, acute kidney
injury (AKI), and any bleeding. <br/>Main Result(s): We identified four
studies (13 reports), with 2818 participants, and one ongoing study.
Overall certainty of evidence ranged from high to very low. There is
probably little or no difference between TAVI and SAVR for the following
short-term outcomes: all-cause mortality (RR 0.69, 95% CI 0.33 to 1.44;
SAVR 11 deaths per 1000, TAVI 8 deaths per 1000 (95% CI 4 to 16); 2818
participants; 4 studies; moderate-certainty evidence); stroke (RR 0.73,
95% CI 0.42 to 1.25; SAVR 21 strokes per 1000, TAVI 16 strokes per 1000
(95% CI 9 to 27); 2818 participants; 4 studies; moderate-certainty
evidence); MI (RR 0.82, 95% CI 0.42 to 1.58; SAVR 14 MI per 1000, TAVI 11
MI per 1000 (95% CI 6 to 21); 2748 participants; 3 studies;
moderate-certainty evidence); and cardiac death (RR 0.71, 95% CI 0.32 to
1.56; SAVR 10 cardiac deaths per 1000, TAVI 7 cardiac deaths per 1000 (95%
CI 3 to 16); 2818 participants; 4 studies; moderate-certainty evidence).
TAVI may reduce the risk of short-term rehospitalisation, although the
confidence interval also includes the possibility of no difference in risk
between groups (RR 0.64, 95% CI 0.39 to 1.06; SAVR 30 cases per 1000, TAVI
19 cases per 1000 (95% CI 12 to 32); 2468 participants; 2 studies;
low-certainty evidence). TAVI, compared with SAVR, probably increases the
risk of PPM implantation (RR 3.65, 95% CI 1.50 to 8.87; SAVR 47 per 1000,
TAVI 170 cases per 1000 (95% CI 70 to 413); number needed to treat for an
additional harmful outcome (NNTH) = 7; 2683 participants; 3 studies;
moderate-certainty evidence). We are uncertain whether TAVI, compared with
SAVR, affects the LOS in days, although it appears to be associated with
shorter LOS. TAVI, compared with SAVR, reduces the risk of atrial
fibrillation (RR 0.21, 95% CI 0.15 to 0.30; 2683 participants; 3 studies),
AKI (RR 0.30, 95% CI 0.16 to 0.58; 2753 participants; 4 studies), and
bleeding (RR 0.31, 95% CI 0.16 to 0.62; 2753 participants; 4 studies) (all
high-certainty evidence). Authors' conclusions: Our meta-analysis
indicates that, in the short term, TAVI probably has little or no
mortality difference compared to SAVR for severe AS in individuals with
low surgical risk. Similarly, there is probably little or no difference in
risk of stroke, MI, and cardiac death between the two approaches. TAVI may
reduce the risk of rehospitalisation, but we are uncertain about the
effects on LOS. TAVI reduces the risk of atrial fibrillation, AKI, and
bleeding. However, this benefit is offset by the increased risk of PPM
implantation. Long-term follow-up data are needed to further assess and
validate these outcomes, especially durability, in the low surgical risk
population.<br/>Copyright &#xa9; 2019 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<67>
Accession Number
629458840
Title
Time-Varying Outcomes with the Absorb Bioresorbable Vascular Scaffold
during 5-Year Follow-up: A Systematic Meta-analysis and Individual Patient
Data Pooled Study.
Source
JAMA Cardiology. 4 (12) (pp 1261-1269), 2019. Date of Publication:
December 2019.
Author
Stone G.W.; Kimura T.; Gao R.; Kereiakes D.J.; Ellis S.G.; Onuma Y.;
Chevalier B.; Simonton C.; Dressler O.; Crowley A.; Ali Z.A.; Serruys P.W.
Institution
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, 1700 Broadway, New York, NY 10019, United
States
(Stone, Ali) Cardiovascular Research Foundation, New York, NY, United
States
(Kimura) Kyoto University Hospital, Kyoto, Japan
(Gao) Fu Wai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences, Beijing, China
(Kereiakes) Christ Hospital, Heart and Vascular Center, Lindner Research
Center, Cincinnati, OH, United States
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Onuma) Erasmus Medical Center, Rotterdam, Netherlands
(Chevalier) Institut Cardiovasculaire Paris Sud, Massy, France
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Dressler, Crowley, Ali) Columbia University Medical Center, New York, NY,
United States
(Serruys) International Centre for Cardiovascular Health, Imperial
College, London, United Kingdom
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Bioresorbable scaffolds were designed to provide clinical
benefits after their complete bioresorption. Prior studies demonstrated
early risks with the Absorb polymeric bioresorbable vascular scaffold
(BVS). Whether this risk profile changes over time during the course of
its bioresorption is unknown. <br/>Objective(s): To examine outcomes of
the first-generation BVS before and after 3 years, the point of its
complete bioresorption in animals. <br/>Data Sources: We searched MEDLINE
and the Cochrane database, conference proceedings, and public websites for
relevant studies. Study Selection: Eligible studies were randomized
clinical trials of BVS vs metallic drug-eluting stents in patients with
coronary artery disease with at least 5-year follow-up. Four trials of BVS
vs everolimus-eluting stents (EES) with 3384 patients met criteria. Data
Extraction and Synthesis: Individual patient data from the 4 trials were
pooled, and summary-level meta-analysis was performed. <br/>Main Outcomes
and Measures: The major effectiveness and safety measures were target
lesion failure (TLF; cardiac death, target vessel-related myocardial
infarction, or ischemia-driven target lesion revascularization) and device
thrombosis. Outcomes were examined through 5-year follow-up and between 0
to 3 and 3 to 5 years. <br/>Result(s): Mean age for the 3384 patients was
62.8 years; 2452 patients were men (72.5%), and diabetes was present in
1020 patients (30.2%). Through 5-year follow-up, treatment with BVS
compared with EES was associated with higher rates of TLF (14.9% vs 11.6%;
HR, 1.26; 95% CI, 1.03-1.54; P =.03) and device thrombosis (2.5% vs 0.8%;
HR, 2.87; 95% CI, 1.46-5.65; P =.002). Target lesion failure occurred in
11.6% of BVS-treated patients vs 7.9% of EES-treated patients between 0 to
3 years (HR, 1.42; 95% CI, 1.12-1.80), and 4.3% of BVS-treated patients vs
4.5% of EES-treated patients between 3 to 5 years (HR, 0.92; 95% CI,
0.64-1.31) (P for interaction =.046). Device thrombosis occurred in 2.4%
of BVS-treated patients vs 0.6% of EES-treated patients between 0 to 3
years (HR, 3.86; 95% CI, 1.75-8.50) and 0.1% of BVS-treated patients vs
0.3% of EES-treated patients between 3 to 5 years (HR, 0.44; 95% CI,
0.07-2.70) (P for interaction =.03). These results were consistent by
spline analysis and after multiple imputation and multivariable analysis.
<br/>Conclusions and Relevance: The period of excess risk for the
first-generation Absorb BVS ends at 3 years. These data provide
mechanistic insights into the timing of adverse events after BVS and
identify the hurdles to be overcome for bioresorbable technology to be
accepted as a valid alternative for patients with coronary artery
disease.<br/>Copyright &#xa9; 2019 American Medical Association. All
rights reserved.

<68>
Accession Number
2004358707
Title
Long-term safety and efficacy of alirocumab in South African patients with
heterozygous familial hypercholesterolaemia: The ODYSSEY Open-Label
Extension study.
Source
Cardiovascular Journal of Africa. 30 (5) (pp 279-284), 2019. Date of
Publication: 2019.
Author
Blom D.J.; Breedt J.; Burgess L.J.; Ebrahim I.O.; Ellis G.; Soma P.; Van
Der Walt E.; Naidoo P.; Van Tonder A.; Raal F.J.
Institution
(Blom) Department of Medicine, Division of Lipidology and Hatter,
Institute for Cardiovascular Research in Africa, University of Cape Town,
Cape Town, South Africa
(Breedt) Emmed Research, Pretoria West, South Africa
(Burgess) Tread Research, Department of Cardiology, Faculty of Medicine
and Health Science, University of Stellenbosch, Stellenbosch, South Africa
(Ebrahim) Netcare Unitas Hospital, Centurion, South Africa
(Ellis) Synexus Helderberg Clinical Trial Centre, Somerset West, South
Africa
(Soma) Clinical Research Unit, Department of Clinical Research, University
of Pretoria, Pretoria, South Africa
(Van Der Walt) Roodepoort Medicross Clinical Research Centre, Synexus
Affiliated Site, Roodepoort, South Africa
(Naidoo, Van Tonder) Sanofi, Johannesburg, South Africa
(Raal) Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health
Sciences, University of Witwatersrand, Johannesburg, South Africa
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Background: Alirocumab reduces low-density lipoprotein cholesterol (LDL-C)
levels by up to 61%. The ODYSSEY Open-Label Extension study investigated
the effect of alirocumab in patients with heterozygous familial
hypercholesterolaemia (HeFH) over 144 weeks. <br/>Method(s): Eligible
patients with HeFH had completed an earlier double-blind, randomised,
placebo-controlled parent study. Patients were initiated on 75 mg
alirocumab Q2W subcutaneous (SC) unless baseline LDL-C was > 8.9 mmol/l,
in which case they received 150 mg alirocumab Q2W. Dose titration to 150
mg Q2W was at the investigator's discretion. <br/>Result(s): The study
enrolled 167 patients and the parent study mean (+/- SD) baseline LDL-C
level was 3.65 +/- 1.9 mmol/l. Mean LDL-C level was reduced by 48.7% at
week 144; mean on-treatment LDL-C was 2.30 +/- 1.24 mmol/l. Eight patients
reported injection-site reactions, with one treatment discontinuation.
Treatment emergent anti-drug antibodies were identified in five patients
but these did not affect the efficacy. <br/>Conclusion(s): Alirocumab
effectively and safely reduced LDL-C in these patients.<br/>Copyright
&#xa9; 2019 Clinics Cardive Publishing (PTY)Ltd. All rights reserved.

<69>
Accession Number
2004368705
Title
Efficacy and safety of transcarotid transcatheter aortic valve
replacement: A systematic review.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Bob-Manuel T.; Almusawi H.; Rezan T.; Khaira H.; Akingbola A.; Nasir A.;
Soto J.T.; Jenkins J.; Ibebuogu U.N.
Institution
(Bob-Manuel, Rezan, Khaira, Akingbola, Nasir, Soto, Jenkins) John Ochsner
Heart and Vascular Center, New Orleans, LA, United States
(Almusawi) Department of Hospital Medicine, Leonard J Charbert Medical
Center, Houma, LA, United States
(Ibebuogu) Division of Cardiology, University of Tennessee Health Science
Center, Memphis, TN, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: In patients who are not suitable for traditional access routes
for transcatheter aortic valve replacement (TAVR) due to severe peripheral
vascular disease (PVD) or prohibitive surgical risk, carotid artery (CA)
access is an emerging route for TAVR. This study represents the most up to
date on outcomes of carotid access TAVR. <br/>Method(s): A systematic
review was conducted as per the Preferred Reporting Instructions for
Systematic Reviews and Meta-analysis (PRISMA). We performed a thorough
electronic search through Pubmed, SCOPUS and Embase databases. Statistical
analyses were performed using SPSS version 24 (IBM Corporation, Armonk,
New York, USA). <br/>Result(s): A total of 15 non-randomized studies were
included in this systematic review comprising of patients that received
TAVR via 4 vascular access sites, transcarotid (TC) (N = 1035),
transfemoral (TF) (N = 1116), transapical (TAP) (N = 307), transaortic
(TAO) (N = 176) and transaxillary (TAX) (N = 90). In the Transcarotid
cases, device success was achieved in 95.6% of patients (n = 748). The
30-day and 1-yr mortality was 4.2% and 10.5% respectively. 15.3% of
patients required new pacemaker implantation. In-hospital stroke or TIA
occurred in 4% of cases. 30-day stroke or TIA occurred in 5% of cases.
There were no hemorrhagic strokes. 30-day Mortality was significantly
higher in the Transaortic group (12.1%) compared to the Transcarotid group
(2.6%) [RR = 2.93 95% CI = 1.15-7.58; p = 0.027]. There were no
differences in outcomes between the Transcarotid group and the Transapical
or Transaxillary groups. <br/>Conclusion(s): The most contemporary data on
Carotid access TAVR shows impressive device success, low rates of stroke
and pacemaker implantation and an acceptable 30-day and 1-year mortality.
30-day mortality was significantly lower in TC compared to TAO
patients.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<70>
Accession Number
2004367821
Title
Intraoperative Optimization of Both Depth of Anesthesia and Cerebral
Oxygenation in Elderly Patients Undergoing Coronary Artery Bypass Graft
Surgery-A Randomized Controlled Pilot Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Kunst G.; Gauge N.; Salaunkey K.; Spazzapan M.; Amoako D.; Ferreira N.;
Green D.W.; Ballard C.
Institution
(Kunst, Salaunkey, Amoako, Ferreira, Green) Department of Anaesthetics and
Pain Medicine, King's College Hospital NHS Foundation Trust, London,
United Kingdom
(Kunst, Spazzapan) School of Cardiovascular Medicine and Sciences, King's
College London British Heart Foundation Centre of Excellence, Faculty of
Life Sciences and Medicine, London, United Kingdom
(Gauge, Ferreira, Ballard) Wolfson Centre for Age-Related Diseases,
Institute of Psychiatry, Psychology and Neuroscience, Kings College
London, London, United Kingdom
(Salaunkey) Royal Papworth Hospital, Cambridge, United Kingdom
(Ballard) University of Exeter Medical School, Exeter, United Kingdom
Publisher
W.B. Saunders
Abstract
Objectives: Does intraoperative optimization of both depth of anesthesia
and regional cerebral tissue oxygenation (rScO<inf>2</inf>) in elderly
patients reduce postoperative cognitive decline (primary outcome) or
delirium (secondary outcome)? Design: Prospective randomized controlled
single blind trial. <br/>Setting(s): A single major urban teaching and
university hospital and tertiary referral center. <br/>Participant(s):
Patients, 65 years of age and older, undergoing elective coronary artery
bypass graft surgery on cardiopulmonary bypass. <br/>Intervention(s):
Intraoperative depth of anesthesia bispectral index (BIS) values were
targeted at 50 +/- 10. Regional cerebral tissue desaturations of more than
15% of the pre-induction value, or below 50%, were avoided.
<br/>Measurements and Main Results: Eighty-two patients were included, and
mean depth of anesthesia values using BIS were significantly higher during
surgery in the intervention group with 40.6 (7.3) versus 35.4 (6.7) in the
control group, mean (standard deviation), p = 0.004. The cognitive
function was similar between the treatment and control groups at 6 weeks
postoperatively with a Mini Mental State Examination (MMSE) of 27 (26,29)
in the intervention group and an MMSE of 29 (27,29) in the control group,
median (interquartile range), with p = 0.12. The authors observed a
reduction in the incidence of delirium, occurring in 2.4% (n = 1) of
patients in the intervention group and in 20% (n = 8) in the control group
(p = 0.01). <br/>Conclusion(s): This pilot trial demonstrates that
noninvasive target-controlled depth of anesthesia monitoring is feasible.
Cognitive function at 6 weeks showed no difference between the treatment
and control groups; however, postoperative delirium was reduced in the
intervention group.<br/>Copyright &#xa9; 2019 The Authors

<71>
Accession Number
2004352172
Title
The prognostic implication of perioperative cardiac enzyme elevation in
patients with fractured neck of femur: A systematic review and
meta-analysis.
Source
Injury. (no pagination), 2019. Date of Publication: 2019.
Author
Lowe M.J.; Lightfoot N.J.
Institution
(Lowe) Department of Anaesthesia, Auckland City Hospital, Auckland, New
Zealand
(Lightfoot) Department of Anaesthesia and Pain Medicine, Middlemore
Hospital, Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Background:: Neck of Femur (NOF) fractures are a common injury in comorbid
elderly patients which are associated with increased rates of morbidity
and mortality following fracture. Because of their injury, patients can
experience reductions in quality of life and independent living leading to
transfer to nursing home or dependent levels of care. Numerous factors are
associated with either complications or reductions in survival following
fractured NOF. From the VISION cohort there is evidence that troponin
elevation in the post-operative period following a diverse range of
non-cardiac surgical procedures may lead to an increased risk of mortality
in the absence of classical ischaemic or cardiac symptoms. The aim of this
systematic review and meta-analysis is to validate the utility of
perioperative troponin elevation as a prognostic indicator for mortality
and cardiac morbidity in those with fractured NOF. <br/>Method(s):: The
PRISMA guidelines for the conduct of meta-analyses were followed. An
electronic search was conducted of the EMBASE, MEDLINE (Ovid) and Biosis
databases. Studies were included for analysis if they stratified outcomes
by perioperative troponin elevation in surgically managed fractured NOF
and reported sufficient data on troponin elevation and mortality following
surgery. Primary and secondary outcomes assessed were all-cause
post-operative mortality and a composite measure of cardiac complications
(myocardial infarction, cardiac failure and arrhythmia) respectively.
<br/>Result(s):: Eleven studies met inclusion criteria giving a total of
1363 patients. Overall, 497 patients (36.5%) experienced an elevation in
troponin levels following surgery. Perioperative troponin elevation was
significantly associated with all-cause mortality (OR 2.6; 95% CI 1.5 -
4.6; p <0.001) and cardiac complications (OR 7.4; 95% CI 3.5 - 15.8; p
<0.001). Patient factors significantly associated with troponin elevation
included pre-existing coronary artery disease, cardiac failure,
hypertension, previous stroke and previous myocardial infarction.
<br/>Conclusion(s):: Perioperative troponin elevation is significantly
associated with increased mortality and post-operative cardiac
complications following fractured NOF and may be a useful prognostic
indicator in these patients. Future research should further stratify
patients by the magnitude of troponin elevation and further refine the
risk factors.<br/>Copyright &#xa9; 2019

<72>
Accession Number
629590208
Title
Rectal Diclofenac administration for prevention of post-Endoscopic
Retrograde Cholangio-Pancreatography (ERCP) acute pancreatitis. Randomized
prospective study.
Source
La Clinica terapeutica. 170 (5) (pp e332-e336), 2019. Date of Publication:
01 Sep 2019.
Author
Geraci G.; Palumbo V.D.; D'Orazio B.; Maffongelli A.; Fazzotta S.; Lo
Monte A.I.
Institution
(Geraci, Palumbo, D'Orazio, Maffongelli, Fazzotta, Lo Monte) University
Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and
Thoracic Surgery, Palermo, Italy
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Post-Endoscopic Retrograde Cholangio-Pancreatography
pancreatitis (PEP) is a relevant (1-4%) complication of biliopancreatic
operative endoscopy. Rectal nonsteroidal anti-inflammatory drugs
(specifically, 100 mg of diclofenac) have shown promising prophylactic
activity in PEP. The aim of our prospective study is to report whether
prophylactic oral versus rectal suppository versus intramuscular
diclofenac versus placebo are able to reduce the incidence and the
severity of ERCP-induced pancreatitis. MATERIALS AND METHODS: In this
randomized, double-blinded, prospective study, 100 patients (49 male, 51
female), similar with regard to indication for ERCP, were enrolled between
January 2016 and November 2017 to undergo ERCP in the Section of General
and Thoracic Surgery of University Hospital of Palermo. They were
randomized into five groups, respectively 20 patients with placebo by
mouth; 20 patients with 50 mg diclofenac sodium enteric-coated capsules by
mouth; 20 with 100 mg rectal suppository diclofenac, 20 with 75 mg/3 ml
intramuscular diclofenac sodium, 20 with 75 mg/3 ml intramuscular
diclofenac sodium and 20 with 75 mg/3 ml intravenous diclofenac. All drugs
were administered 30 to 90 minutes before ERCP. All clinical data were
collected one day before and 2, 12 and 24 hour after ERCP. <br/>RESULT(S):
Data were prospectively collected and to demonstrate the preventive effect
of rectal diclofenac on PEP, a two-by-two table and chi-square test with
Yates correction were used: the incidence of PEP was significantly lower
(p < 0.001) in the rectal diclofenac group respect to other groups and, in
the same way, the incidence of post-ERCP pain was significantly lower in
the rectal diclofenac group than in the other groups (p = 0.001) and
patients discharge was consequently earlier (p < 0.01).
<br/>CONCLUSION(S): 100 mg dose rectal diclofenac administered 30-60
minutes before ERCP can effectively prevent PEP.

<73>
Accession Number
630461815
Title
Review of kerma-area product, effective dose and dose conversion
coefficients for non-cardiac interventional fluoroscopy procedures.
Source
Medical physics. (no pagination), 2019. Date of Publication: 27 Dec 2019.
Author
Miller D.L.
Institution
(Miller) Center for Devices, Radiological Health U.S. Food and Drug
Administration Silver Spring, MD 20993, United States
Publisher
NLM (Medline)
Abstract
PURPOSE: To provide current data on average air kerma-area product (PKA )
and effective dose (E) for non-cardiac interventional fluoroscopy
procedures and suggested values of dose coefficients (DCE ) for conversion
of PKA to estimates of effective dose. <br/>METHOD(S): A PubMed literature
search covering the time period from 2006 to August 2019 was performed to
obtain recent data on PKA , E and DCE for interventional fluoroscopy
procedures. <br/>RESULT(S): There is very wide variation in the reported
values of PKA , E, and DCE in the literature. A number of factors are
involved in this variability and the resultant uncertainty in average
values of these dose quantities. <br/>CONCLUSION(S): The values of PKA ,
average E and suggested DCE presented here can be of use for comparison of
the radiation detriment from different procedures and may be useful for
categorizing detriment within an order of magnitude or so. They do not
represent actual or expected radiation dose or detriment from any specific
procedure or for a specific patient and should be not be used as
such.<br/>Copyright &#xa9; 2019 American Association of Physicists in
Medicine.

<74>
Accession Number
630457841
Title
Percutaneous coronary angioplasty versus coronary artery bypass grafting
in the treatment of unprotected left main stenosis: updated 5-year
outcomes from the randomised, non-inferiority NOBLE trial.
Source
Lancet (London, England). (no pagination), 2019. Date of Publication: 23
Dec 2019.
Author
Holm N.R.; Makikallio T.; Lindsay M.M.; Spence M.S.; Erglis A.; Menown
I.B.A.; Trovik T.; Kellerth T.; Kalinauskas G.; Mogensen L.J.H.; Nielsen
P.H.; Niemela M.; Lassen J.F.; Oldroyd K.; Berg G.; Stradins P.; Walsh
S.J.; Graham A.N.J.; Endresen P.C.; Frobert O.; Trivedi U.; Anttila V.;
Hildick-Smith D.; Thuesen L.; Christiansen E.H.
Institution
(Holm, Mogensen, Christiansen) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Makikallio, Niemela) Department of Cardiology, Oulu University Hospital,
Oulu, Finland
(Lindsay, Oldroyd) Department of Cardiology, Golden Jubilee National
Hospital, Clydebank, United Kingdom
(Spence, Walsh, Graham) Belfast Heart Centre, Belfast Trust, Belfast,
United Kingdom
(Erglis, Stradins) Latvia Centre of Cardiology, Paul Stradins Clinical
Hospital, Riga, Latvia
(Menown) Craigavon Cardiac Centre, Craigavon, United Kingdom
(Trovik) Department of Cardiology, University Hospital of North Norway,
Tromso, Norway
(Kellerth, Frobert) Department of Cardiology, Faculty of Health, Orebro
University, Sweden
(Kalinauskas) Vilnius University, Clinic of Cardiac and Vascular Diseases,
Vilnius, Lithuania
(Nielsen) Department of Cardiac Surgery, Aarhus University Hospital,
Aarhus, Denmark
(Lassen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Berg) Department of Cardiac Surgery, Golden Jubilee National Hospital,
Clydebank, United Kingdom
(Endresen) Department of Cardiovascular Surgery, University Hospital of
North Norway, Tromso, Norway
(Trivedi, Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex
University Hospital, Brighton, United Kingdom
(Anttila) Department of Cardiac Surgery, Oulu University Hospital, Oulu,
Finland
(Thuesen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
Publisher
NLM (Medline)
Abstract
BACKGROUND: Percutaneous coronary intervention (PCI) is increasingly used
in revascularisation of patients with left main coronary artery disease in
place of the standard treatment, coronary artery bypass grafting (CABG).
The NOBLE trial aimed to evaluate whether PCI was non-inferior to CABG in
the treatment of left main coronary artery disease and reported outcomes
after a median follow-up of 3.1 years. We now report updated 5-year
outcomes of the trial. <br/>METHOD(S): The prospective, randomised,
open-label, non-inferiority NOBLE trial was done at 36 hospitals in nine
northern European countries. Patients with left main coronary artery
disease requiring revascularisation were enrolled and randomly assigned
(1:1) to receive PCI or CABG. The primary endpoint was major adverse
cardiac or cerebrovascular events (MACCE), a composite of all-cause
mortality, non-procedural myocardial infarction, repeat revascularisation,
and stroke. Non-inferiority of PCI to CABG was defined as the upper limit
of the 95% CI of the hazard ratio (HR) not exceeding 1.35 after 275 MACCE
had occurred. Secondary endpoints included all-cause mortality,
non-procedural myocardial infarction, and repeat revascularisation.
Outcomes were analysed in the intention-to-treat population. This trial is
registered with ClinicalTrials.gov, NCT01496651. FINDINGS: Between Dec 9,
2008, and Jan 21, 2015, 1201 patients were enrolled and allocated to PCI
(n=598) or CABG (n=603), with 17 subsequently lost to early follow-up. 592
patients in each group were included in this analysis. At a median of 4.9
years of follow-up, the predefined number of events was reached for
adequate power to assess the primary endpoint. Kaplan-Meier 5-year
estimates of MACCE were 28% (165 events) for PCI and 19% (110 events) for
CABG (HR 1.58 [95% CI 1.24-2.01]); the HR exceeded the limit for
non-inferiority of PCI compared to CABG. CABG was found to be superior to
PCI for the primary composite endpoint (p=0.0002). All-cause mortality was
estimated in 9% after PCI versus 9% after CABG (HR 1.08 [95% CI
0.74-1.59]; p=0.68); non-procedural myocardial infarction was estimated in
8% after PCI versus 3% after CABG (HR 2.99 [95% CI 1.66-5.39]; p=0.0002);
and repeat revascularisation was estimated in 17% after PCI versus 10%
after CABG (HR 1.73 [95% CI 1.25-2.40]; p=0.0009). INTERPRETATION: In
revascularisation of left main coronary artery disease, PCI was associated
with an inferior clinical outcome at 5 years compared with CABG. Mortality
was similar after the two procedures but patients treated with PCI had
higher rates of non-procedural myocardial infarction and repeat
revascularisation. FUNDING: Biosensors.<br/>Copyright &#xa9; 2019 Elsevier
Ltd. All rights reserved.

<75>
Accession Number
630452557
Title
Enhanced Recovery After Surgery: A Narrative Review of its Application in
Cardiac Surgery.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 23 Dec 2019.
Author
Baxter R.; Squiers J.; Conner W.; Kent M.; Fann J.; Lobdell K.; DiMaio
J.M.
Institution
(Baxter, Squiers) Department of Surgery, Baylor University Medical Center;
Dallas,TX
(Conner) Cardiothoracic and Vascular Surgeons, PA; Austin,TX
(Kent) Division of Thoracic Surgery, Beth Israel Deaconess Medical Center;
Boston,MA
(Fann) Department of Cardiothoracic Surgery, Stanford University Medical
Center; Stanford,CA
(Lobdell) Sanger Heart and Vascular Institute, Atrium Health; Charlotte,NC
(DiMaio) Department of Surgery, Baylor Scott and White, The Heart
Hospital; Plano,TX
Publisher
NLM (Medline)
Abstract
BACKGROUND: Enhanced recovery after surgery (ERAS) is a perioperative
patient management strategy that is being adopted rapidly across surgical
specialties worldwide. Components of ERAS work collaboratively throughout
the perioperative course to achieve significant benefits for both the
patient and the entire healthcare system. The use of ERAS in cardiac
surgery (ERAS-C) could lead to similar improvements, but currently use of
ERAS-C programs are lacking and not well-defined. <br/>METHOD(S): A search
of the literature was performed of the Medline database to capture
relevant studies discussing enhanced recovery after cardiac surgery. Key
concepts were extracted from these articles and grouped according to
appropriate perioperative stages. Supporting literature was also included
briefly discussing the historical progression of cardiac surgery to
enhanced recovery pathways, potential limitations to these pathways in
cardiac surgery, and the first studies evaluating he use of an ERAS
program with cardiac surgery patients. <br/>RESULT(S): Initial results of
ERAS-C studies have shown similar benefits to those of other surgical
fields including decreased hospital and intensive care unit lengths of
stay (1-4 days and 4-20 hours, respectively, improved perioperative pain
control (25-60% decreased opioid usage), and improvements in early
postoperative mobility and oral diets. Results especially beneficial to
cardiac surgery have also been reported such as an 8-14% decreased
incidence of postoperative atrial fibrillation. <br/>CONCLUSION(S): This
manuscript aims to present pertinent current research related to the
implementation of ERAS programs in the field of cardiac surgery and
provide a call to action for further investigation and adaption of ERAS in
cardiac surgery.<br/>Copyright &#xa9; 2019. Published by Elsevier Inc.

<76>
Accession Number
630246355
Title
Cerebral Amyloid Angiopathy-Related Inflammation in the Immunosuppressed:
A Case Report.
Source
Frontiers in Neurology. 10 (no pagination), 2019. Article Number: 1283.
Date of Publication: 06 Dec 2019.
Author
Nelson T.; Leung B.; Bannykh S.; Shah K.S.; Patel J.; Dumitrascu O.M.
Institution
(Nelson, Leung, Dumitrascu) Department of Neurology, Cedars-Sinai Medical
Center, Los Angeles, CA, United States
(Bannykh) Division of Neuropathology, Department of Pathology,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Shah, Patel) Division of Heart Transplantation, Department of Cardiology,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an
immune-mediated disorder of the central nervous system characterized by an
inflammatory response to amyloid-beta (Abeta) deposition within cerebral
blood vessel walls. Immunosuppressive therapy is the mainstay of
treatment. We present a case of CAA-ri in a subject already on
immunosuppressive therapy after orthotopic heart transplantation (OHT). A
57-year-old man 8 months post-OHT for sarcoid cardiomyopathy developed
headaches and staring spells while hospitalized for disseminated
mycobacterial infection. His brain MRI revealed bi-hemispheric T2-weighted
fluid-attenuated inversion recovery white matter hyperintensities and
widespread microhemorrhages. Two weeks later, he developed gait ataxia and
alterations in mental status, and repeat brain MRI showed more extensive
confluent white matter hyperintensities. Leptomeningeal and cortex biopsy
revealed changes consistent with amyloid angiitis, with perivascular and
intramural histiocyte and lymphocyte collections. Mass spectroscopy
confirmed Abeta deposition. Notably, the patient was on immunosuppression
with daily 5 mg oral prednisone and tacrolimus before biopsy. After
high-dose intravenous followed by oral corticosteroids, he demonstrated
significant clinical and radiographic improvement. No relapse was noted
despite the relatively rapid tapering of the prednisone therapy over 3
months, as mandated by his systemic infection. Despite the lack of a
standard treatment protocol for CAA-ri, case series have reinforced the
benefit of prolonged courses of glucocorticoids as single agent or in
combination with other immunomodulatory agents. Hence, management of
CAA-ri in patients with disseminated mycobacterial infections or OHT is
challenging. Our case is unique, as review of existing literature has not
revealed any similar cases of patients on chronic immunosuppression at the
time of CAA-ri diagnosis, which one would expect to protect against this
disorder. In addition, CAA-ri in association with cardiopulmonary
sarcoidosis was not previously reported; however, a common
immunopathogenic mechanism may exist.<br/>&#xa9; Copyright &#xa9; 2019
Nelson, Leung, Bannykh, Shah, Patel and Dumitrascu.

<77>
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

<78>
Accession Number
2003523636
Title
Population Pharmacokinetic/Pharmacodynamic Modeling of Methylprednisolone
in Neonates Undergoing Cardiopulmonary Bypass.
Source
CPT: Pharmacometrics and Systems Pharmacology. 8 (12) (pp 913-922), 2019.
Date of Publication: 01 Dec 2019.
Author
Hornik C.P.; Gonzalez D.; Dumond J.; Wu H.; Graham E.M.; Hill K.D.;
Cohen-Wolkowiez M.
Institution
(Hornik, Wu, Hill, Cohen-Wolkowiez) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Gonzalez, Dumond) Division of Pharmacotherapy and Experimental
Therapeutics, University of North Carolina Eshelman School of Pharmacy,
The University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States
(Graham) Department of Pediatrics, Medical University of South Carolina,
Charleston, SC, United States
Publisher
American Society for Clinical Pharmacology and Therapeutics
Abstract
Methylprednisolone is used in neonates to modulate cardiopulmonary bypass
(CPB)-induced inflammation, but optimal dosing and exposure are unknown.
We used plasma methylprednisolone and interleukin (IL)-6 and IL-10
concentrations from neonates enrolled in a randomized trial comparing one
vs. two doses of methylprednisolone to develop indirect response
population pharmacokinetic/pharmacodynamic models characterizing the
exposure-response relationships. We applied the models to simulate
methylprednisolone dosages resulting in the desired IL-6 and -10
exposures, known mediators of CPB-induced inflammation. A total of 64
neonates (median weight 3.2 kg, range 2.2-4.3) contributed 290 plasma
methylprednisolone concentrations (range 1.07-12,700 ng/mL) and IL-6
(0-681 pg/mL) and IL-10 (0.1-1125 pg/mL). Methylprednisolone plasma
exposure following a single 10 mg/kg intravenous dose inhibited IL-6 and
stimulated IL-10 production when compared with placebo. Higher (30 mg/kg)
or more frequent (twice) dosing did not confer additional benefit.
Clinical efficacy studies are needed to evaluate the effect of optimized
dosing on outcomes.<br/>Copyright &#xa9; 2019 The Authors. CPT:
Pharmacometrics & Systems Pharmacology published by Wiley Periodicals,
Inc. on behalf of the American Society for Clinical Pharmacology and
Therapeutics.

<79>
Accession Number
630154198
Title
Diffuse endoscopically visible, predominantly low grade dysplasia in
Barrett's esophagus (with video).
Source
Endoscopy International Open. 7 (12) (pp E1742-E1747), 2019. Date of
Publication: 2019.
Author
Tsoi E.H.; Fehily S.; Williams R.; Desmond P.; Taylor A.
Institution
(Tsoi, Fehily, Desmond, Taylor) St. Vincent's Hospital, Department of
Gastroenterology, Fitzroy, VIC 3065, Australia
(Tsoi, Desmond, Taylor) University of Melbourne, Faculty of Medicine,
Dentistry and Health Sciences, VIC, Australia
(Williams) St. Vincent's Hospital, Department of Pathology, Fitzroy, VIC,
Australia
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Low grade dysplasia (LGD) in Barrett's esophagus (BE) has
generally been considered as undetectable endoscopically. Aim To describe
a phenotype which consists of diffuse, endoscopically visible,
predominantly low grade dysplasia in Barrett's esophagus (DEVLB), with
often subtle but visible endoscopic changes seen with high definition
white light (HDWL) and narrow-band imaging (NBI). Method A systematic
search of a prospectively collected database for patients satisfying
predefined criteria for DEVLB and a review of endoscopic and histological
features of biopsies and endoscopic mucosal resection (EMR) specimens.
Results Out of a total of 419 patients referred to our expert center for
assessment of dysplastic Barrett's esophagus during the period January
2009 to March 2018, there were 7 patients (1.7%) who satisfied the
criteria defined for DEVLB, identified on their initial assessment
endoscopy. All patients were treated by EMR of visible abnormal mucosa
during their assessment endoscopy at our tertiary referral center. There
was a total of 47 EMR specimens obtained, with a median of 6 (IQR 5-9) EMR
resection pieces per patient, of which 36 (77%) contained LGD, 8 (17%)
high grade dysplasia (HGD), 2 (4%) non-dysplastic Barrett's esophagus
(NDBE), and 1 (2%) contained early esophageal adenocarcinoma (EAC).
Conclusion DEVLB is a distinct phenotype seen in a small but significant
proportion of individuals with dysplastic Barrett's esophagus. Patients
with DEVLB have widespread LGD, with many having areas of focal HGD or
early cancer within this area. We believe these patients are best treated
with extensive EMR of the visibly abnormal area.<br/>Copyright &#xa9; 2019
Georg Thieme Verlag KG Stuttgart * New York.

<80>
Accession Number
626972357
Title
Everolimus Initiation With Early Calcineurin Inhibitor Withdrawal in De
Novo Heart Transplant Recipients: Long-term Follow-up From the Randomized
SCHEDULE Study.
Source
Transplantation. 104 (1) (pp 154-164), 2020. Date of Publication: 01 Jan
2020.
Author
Gustafsson F.; Andreassen A.K.; Andersson B.; Eiskjaer H.; Radegran G.;
Gude E.; Jansson K.; Solbu D.; Karason K.; Arora S.; Dellgren G.;
Gullestad L.
Institution
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Gustafsson) Department of Clinical Medicine, University of Copenhagen,
Denmark
(Andreassen, Gude, Arora, Gullestad) Department of Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Andersson, Karason) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Skejby,
Denmark
(Radegran) Section for Heart Failure and Valvular Disease, Skane
University Hospital and Department of Clinical Sciences, Cardiology, Lund
University
(Jansson) Department of Cardiology, Heart and Medicine Center County
Council of Ostergotland and Linkoping University, Linkoping, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gullestad) K.G. Jebsen Cardiac Research Center and Center for Heart
Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
Publisher
NLM (Medline)
Abstract
BACKGROUND: A calcineurin inhibitor (CNI)-free immunosuppressive regimen
has been demonstrated to improve renal function early after heart
transplantation, but long-term outcome of such a strategy has not been
well described. <br/>METHOD(S): In the randomized SCHEDULE trial, de novo
heart transplant recipients received (1) everolimus with reduced-exposure
CNI (cyclosporine) followed by CNI withdrawal at week 7-11 posttransplant
or (2) standard-exposure cyclosporine, both with mycophenolate mofetil and
corticosteroids; 95/115 randomized patients were followed up at 5-7 years
posttransplant. <br/>RESULT(S): Mean measured glomerular filtration rate
was 74.7 mL/min and 62.4 mL/min with everolimus and CNI, respectively. The
mean difference was in favor of everolimus by 11.8 mL/min in the
intent-to-treat population (P = 0.004) and 17.2 mL/min in the per protocol
population (n = 75; P < 0.001). From transplantation to last follow-up,
the incidence of biopsy-proven acute rejection (BPAR) was 77% (37/48) and
66% (31/47) (P = 0.23) with treated BPAR in 50% and 23% (P < 0.01) in the
everolimus and CNI groups, respectively; no episode led to hemodynamic
compromise. Coronary allograft vasculopathy (CAV) assessed by coronary
intravascular ultrasound was present in 53% (19/36) and 74% (26/35) of
everolimus- and CNI-treated patients, respectively (P = 0.037). Graft
dimensions and function were similar between the groups. Late adverse
events were comparable. <br/>CONCLUSION(S): These results suggest that de
novo heart transplant patients randomized to everolimus and low-dose CNI
followed by CNI-free therapy maintain significantly better long-term renal
function as well as significantly reduced CAV than patients randomized to
standard CNI treatment. Increased BPAR in the everolimus group during year
1 did not impair long-term graft function.

<81>
Accession Number
629383463
Title
Preoperative VolumE Replacement therapy in DIabetic patients undergoing
coronary artery bypass grafting surgery: results from an open parallel
group randomized Controlled Trial (VeRDiCT).
Source
Interactive cardiovascular and thoracic surgery. 30 (1) (pp 54-63), 2020.
Date of Publication: 01 Jan 2020.
Author
Sarkar K.; Harris R.A.; Wells S.; Harris T.; Clout M.; Taylor J.;
Culliford L.; Angelini G.D.; Pike K.; Ashton K.; Narayan P.; Reeves B.;
Hillier J.; Rogers C.A.; Ascione R.
Institution
(Sarkar, Narayan) Rabindranath Tagore International Institute of Cardiac
Sciences (RTIICS), Kolkata, India
(Harris, Wells, Harris, Clout, Taylor, Culliford, Pike, Ashton, Reeves,
Rogers) Clinical Trials and Evaluation Unit, Bristol Trials Centre,
University of Bristol, Bristol, United Kingdom
(Angelini, Hillier, Ascione) Faculty of Health Sciences, Bristol Heart
Institute, University of Bristol, Bristol, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To investigate the effect of preoperative volume replacement
therapy (VRT) on renal function, health outcome and time to fitness for
discharge in diabetic patients undergoing coronary artery bypass grafting
(CABG). <br/>METHOD(S): In 2 parallel randomized controlled trials,
diabetic patients were allocated to preoperative VRT (1ml/kg/h of
Hartmann's solution for 12h) or usual care. Primary outcome was time to
fitness for discharge. Secondary outcomes included acute kidney injury,
postoperative complications, patient-reported quality of life (QoL),
hospital resource use and markers of renal, cardiac and inflammatory
injury. <br/>RESULT(S): In total, 169 patients were randomized (84 VRT, 85
usual care; mean age 64years; 88% male). Time to fitness for discharge was
similar between groups [median 6days; interquartile range 5.0-9.0 in both
groups; hazard ratio 0.95, 95% confidence interval (CI) 0.65-1.38;
P=0.78]. Postoperative acute kidney injury was not statistically different
(VRT: 27.7% vs usual care: 18.8%, odds ratio 1.72, 95% CI 0.82-3.59;
P=0.15). Estimated glomerular filtration rate (mean difference -0.92, 95%
CI -4.18 to 2.25; P=0.56), microalbumin/creatinine ratio [geometric mean
ratio (GMR) 1.16, 95% CI 0.94-1.42; P=0.16],
N-acetyl-beta-d-glucosaminidase (GMR 1.08, 95% CI 0.83-1.40; P=0.57),
C-reactive protein (GMR 1.00, 95% CI 0.88-1.13; P=0.94), troponin T
(Trop-T; GMR 1.18, 95% CI 0.78-1.79; P=0.39) and other secondary health
outcomes were similar between groups. QoL improved in both groups at 3
months with no difference observed. <br/>CONCLUSION(S): The use of
preoperative VRT is not superior to usual care in diabetic patients
undergoing CABG. CLINICAL TRIAL REGISTRATION NUMBER:
ISRCTN02159606.<br/>Copyright &#xa9; The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<82>
Accession Number
2004322340
Title
Remote Ischaemic Preconditioning Attenuates Cardiac Biomarkers During
Vascular Surgery: A Randomised Clinical Trial.
Source
European Journal of Vascular and Endovascular Surgery. (no pagination),
2019. Date of Publication: 2019.
Author
Kepler T.; Kuusik K.; Lepner U.; Starkopf J.; Zilmer M.; Eha J.; Vahi M.;
Kals J.
Institution
(Kepler, Lepner, Kals) Department of Surgery, Institute of Clinical
Medicine, University of Tartu, Tartu, Estonia
(Kepler, Kuusik, Zilmer, Kals) Department of Biochemistry, Institute of
Biomedicine and Translational Medicine, Centre of Excellence for Genomics
and Translational Medicine, University of Tartu, Tartu, Estonia
(Kuusik, Eha) Department of Cardiology, Institute of Clinical Medicine,
University of Tartu, Tartu, Estonia
(Lepner, Starkopf, Eha, Kals) Tartu University Hospital, Tartu, Estonia
(Starkopf) Department of Anaesthesiology and Intensive Care, Institute of
Clinical Medicine, University of Tartu, Tartu, Estonia
(Vahi) Institute of Mathematics and Statistics, University of Tartu,
Tartu, Estonia
Publisher
W.B. Saunders Ltd
Abstract
Objective: The main aim of this study was to evaluate the effect of remote
ischaemic preconditioning (RIPC) on preventing the leakage of cardiac
damage biomarkers in patients undergoing vascular surgery. <br/>Method(s):
This is a randomised, sham-controlled, double-blinded, single-centre
study. Patients undergoing open abdominal aortic aneurysm repair, surgical
lower limb revascularisation surgery or carotid endarterectomy were
recruited non-consecutively. The RIPC protocol consisting of 4 cycles of 5
minutes of ischaemia, followed by 5 minutes of reperfusion, was applied. A
RIPC or a sham procedure was performed noninvasively along with
preparation for anaesthesia. High sensitivity troponin T level was
measured preoperatively and 2, 8 and 24 hours after surgery and pro b-type
natriuretic peptide was measured preoperatively and 24 hours after
surgery. <br/>Result(s): There was significantly higher leakage of high
sensitivity troponin T (peak change median 2 ng/L, IQR 0.9-6.2 ng/L vs 0.6
ng/L, IQR 0.7-2.1 ng/L, p = .0002) and pro b-type natriuretic peptide
(change median 144 pg/mL, IQR 17-318 pg/mL vs 51 pg/mL, IQR 12-196 pg/mL,
p = .02) in the sham group compared to the RIPC group. <br/>Conclusion(s):
RIPC reduces the leakage of high sensitivity troponin T and pro b-type
natriuretic peptide. Therefore, it may offer cardioprotection in patients
undergoing non-cardiac vascular surgery. The clinical significance of RIPC
has to be evaluated in larger studies excluding the factors known to
influence its effect.<br/>Copyright &#xa9; 2019 European Society for
Vascular Surgery

<83>
Accession Number
630417429
Title
A Prospective Randomised Blinded Trial of Remote Ischaemic Preconditioning
in children undergoing cardiac surgery.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2019.
Date of Publication: 20 Dec 2019.
Author
Rodriguez M.V.; Spenceley N.; Ilina M.; Danton M.
Institution
(Rodriguez) University of Glasgow, Glasgow, United Kingdom
(Spenceley, Ilina, Danton) Royal Children's Hospital, Glasgow, United
Kingdom
Publisher
NLM (Medline)
Abstract
Remote ischaemic preconditioning (RIPC) has been proposed as an
intervention to protect myocardium and attenuate end-organ dysfunction
associated with cardiopulmonary bypass (CPB). We investigated the effect
of RIPC in children undergoing CPB involving clinical outcome, cardiac and
end-organ function, inflammatory response and myocardial gene expression.
A prospective, investigator-blinded, randomized, controlled trial was
performed. Patients were randomised into RIPC or control; RIPC consisted
of three 5-minute cycles of limb ischemia-reperfusion taking place one and
twelve hours pre-operatively. Clinical outcomes included cardiac function,
ICU surveillance and renal function. In addition, inflammatory markers and
myocardial gene expression were evaluated. RIPC patients required shorter
ICU stay (days), RIPC: 1.8 (0.94-3.88) vs Control: 4.9 (1.63-7.20),
p=0.029. Echocardiography parameters demonstrated reduced bi-ventricular
function following surgery showing no difference between groups. A
non-significant trend for reduced Troponin was observed following RIPC:
AUC analysis, RIPC: 393.05 (98.85-1038.73) versus control: 596.10
(225.38-954.24) p=0.75. BNP and renal function parameters were similar
between groups. Post-operative TNF-alpha was significantly reduced after
RIPC, RIPC: 15.42 (7.81-114.86) versus control: 108.98 (42.28-301.19)
p=0.02. Remaining inflammatory markers demonstrated no significant
difference between groups. HSP-60 showed lower myocardial expression
following RIPC, RIPC: 3.95 (2.69-6.28) vs Control: 6.83 (4.74-8.81),
p=0.05. Expression of other analysed genes was not influenced by RIPC.
RIPC was associated with shorter ICU stay and reduced TNF-alpha but did
not influence other clinical outcomes, not confer protection against
cardiac injury or renal dysfunction. The association between RIPC and ICU
stay may be influenced by unaccounted latent variables, including cardiac
morphology.<br/>Copyright &#xa9; 2019. Published by Elsevier Inc.

<84>
Accession Number
630427313
Title
Hemocoagulase reduces postoperative bleeding and blood transfusion in
cardiac surgical patients: A PRISMA-compliant systematic review and
meta-analysis.
Source
Medicine. 98 (52) (pp e18534), 2019. Date of Publication: 01 Dec 2019.
Author
Yao Y.-T.; Yuan X.; Fang N.-X.
Institution
(Yao, Fang) Department of Anesthesiology
(Yuan) Department of Adult Cardiac Surgery, Fuwai Hospital, National
Center for Cardiovascular Diseases, Peking Union Medical College and
Chinese Academy of Medical Sciences, Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Hemocoagulase is isolated and purified from snake venoms.
Hemocoagulase agents have been widely used in the prevention and treatment
of surgical bleeding. A systematic review was performed to evaluate the
effects of hemocoagulase on postoperative bleeding and transfusion in
patients who underwent cardiac surgery. <br/>METHOD(S): Electronic
databases were searched to identify all clinical trials comparing
hemocoagulase with placebo/blank on postoperative bleeding and transfusion
in patients undergoing cardiac surgery. Two authors independently
extracted perioperative data and outcome data. For continuous variables,
treatment effects were calculated as weighted mean difference and 95%
confidential interval (CI). For dichotomous data, treatment effects were
calculated as odds ratio and 95% CI. Each outcome was tested for
heterogeneity, and randomized-effects or fixed-effects model was used in
the presence or absence of significant heterogeneity. Sensitivity analyses
were done by examining the influence of statistical model and individual
trial on estimated treatment effects. Publication bias was explored
through visual inspection of funnel plots of the outcomes. Statistical
significance was defined as P < .05. <br/>RESULT(S): Our search yielded 12
studies including 900 patients, and 510 patients were allocated into
hemocoagulase group and 390 into control group. Meta-analysis suggested
that, hemocoagulase-treated patients had less bleeding volume, reduced red
blood cells and fresh frozen plasma transfusion, and higher hemoglobin
level than those of controlled patients postoperatively. Meta-analysis
also showed that, hemocoagulase did not influence intraoperative heparin
or protamine dosages and postoperative platelet counts. Meta-analysis
demonstrated that, hemocoagulase-treated patients had significantly
shorter postoperative prothrombin time, activated partial thromboplastin
time, and thrombin time, higher fibrinogen level and similar D-dimer level
when compared to control patients. <br/>CONCLUSION(S): This meta-analysis
has found some evidence showing that hemocoagulase reduces postoperative
bleeding, and blood transfusion requirement in patients undergoing cardiac
surgery. However, these findings should be interpreted rigorously. Further
well-conducted trials are required to assess the blood-saving effects and
mechanisms of Hemocoagulase.