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<1>
Accession Number
629408212
Title
Investigating the Impact of Early Valve Surgery on Survival in
Staphylococcus aureus Infective Endocarditis Using a Marginal Structural
Model Approach: Results of a Large, Prospectively Evaluated Cohort.
Source
Clinical Infectious Diseases. 69 (3) (pp 487-492), 2019. Date of
Publication: 18 Jul 2019.
Author
Rieg S.; Von Cube M.; Kaasch A.J.; Bonaventura B.; Bothe W.; Wolkewitz M.;
Peyerl-Hoffmann G.; Deppe A.-C.; Wahlers T.; Beyersdorf F.; Seifert H.;
Kern W.V.
Institution
(Rieg, Bonaventura, Bothe, Peyerl-Hoffmann, Beyersdorf, Kern) Division of
Infectious Diseases, Department of Medicine II, Faculty of Medicine and
Medical Center, University of Freiburg, Hugstetter Strase 55, Freiburg
D-79106, Germany
(Von Cube, Wolkewitz) Institute of Medical Biometry and Statistics,
Faculty of Medicine and Medical Center, University of Freiburg, Germany
(Kaasch) Institute of Medical Microbiology and Hospital Hygiene,
Heinrich-Heine-University Dusseldorf, Germany
(Bothe, Beyersdorf) Department of Cardiovascular Surgery, Heart Center,
Medical Center, University of Freiburg, Germany
(Deppe, Wahlers) Department of Cardiothoracic Surgery, University Hospital
of Cologne, Germany
(Seifert) Institute for Medical Microbiology, Immunology and Hygiene,
University of Cologne, Germany
(Seifert) German Centre for Infection Research, Partner Site Bonn-Cologne,
Germany
Publisher
Oxford University Press
Abstract
Background: The impact of valve surgery on outcomes of Staphylococcus
aureus infective endocarditis (SAIE) remains controversial. We tested the
hypothesis that early valve surgery (EVS) improves survival by using a
novel approach that allows for inclusion of major confounders in a
time-dependent way. Method(s): EVS was defined as valve surgery
within 60 days. Univariable and multivariable Cox regression analyses were
performed. To account for treatment selection bias, we additionally used a
weighted Cox model (marginal structural model) that accounts for
time-dynamic imbalances between treatment groups. To address survivor
bias, EVS was included as a time-dependent variable. Follow-up of patients
was 1 year. Result(s): Two hundred and three patients were included
in the analysis; 50 underwent EVS. All-cause mortality at day 30 was 26%.
In the conventional multivariable Cox regression model, the effect of EVS
on the death hazard was 0.85 (95% confidence interval [CI],. 47-1.52).
Using the weighted Cox model, the death hazard rate (HR) of EVS was 0.71
(95% CI,. 34-1.49). In subgroup analyses, no survival benefit was observed
in patients with septic shock (HR, 0.80 [CI,. 26-2.46]), in NVIE (HR, 0.76
[CI,. 33-1.71]) or PVIE (HR, 1.02 [CI,. 29-3.54]), or in patients with EVS
within 14 days (HR, 0.97 [CI,. 46-2.07]). Conclusion(s): Using both a
conventional Cox regression model and a weighted Cox model, we did not
find a survival benefit for patients who underwent EVS in our cohort.
Until results of randomized controlled trials are available, EVS in SAIE
should be based on individualized decisions of an experienced
multidisciplinary team. Clinical Trials Registration: German Clinical
Trials registry (DRKS00005045). Copyright © 2018 The Author(s)
2018. Published by Oxford University Press for the Infectious Diseases
Society of America. All rights reserved.

<2>
Accession Number
620585026
Title
Minimally invasive epicardial surgical ablation alone versus hybrid
ablation for atrial fibrillation: A systematic review and meta-analysis.
Source
Arrhythmia and Electrophysiology Review. 6 (4) (pp 202-209), 2017. Date of
Publication: Winter 2017.
Author
Pearman C.M.; Poon S.S.; Bonnett L.J.; Haldar S.; Wong T.; Mediratta N.;
Gupta D.
Institution
(Pearman, Poon, Gupta) Department of Cardiology, Liverpool Heart and Chest
Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom
(Mediratta) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, United Kingdom
(Pearman) Division of Cardiovascular Sciences, School of Medical Sciences,
Manchester Academic Health Science Centre, University of Manchester,
United Kingdom
(Bonnett) Department of Biostatistics, University of Liverpool, United
Kingdom
(Haldar, Wong) Heart Rhythm Centre, NIHR Cardiovascular Biomedical
Research Unit, Royal Brompton and Harefield NHS Foundation Trust,
Institute of Cardiovascular Medicine and Science, Imperial College London,
United Kingdom
Publisher
Radcliffe Cardiology
Abstract
Maintaining sinus rhythm in patients with non-paroxysmal AF is an elusive
goal. Some suggest that hybrid ablation, combining minimally invasive
epicardial surgical ablation with endocardial catheter ablation, may be
more effective than either modality alone. However, randomised trials are
lacking. We investigated whether hybrid ablation is more effective than
epicardial ablation alone at preventing recurrent AF by performing a
systematic review and meta-analysis. The review was prospectively
registered with PROSPERO (CRD42016043389). MEDLINE and EMBASE were
searched for studies of standalone minimally invasive epicardial ablation
of AF and/or hybrid ablation, identifying 41 non-overlapping studies
comprising 2737 patients. A random-effects meta-analysis, meta-regression
and sensitivity analysis were performed. Single-procedure survival free
from atrial arrhythmias without antiarrhythmic drugs was similar between
epicardial-alone and hybrid approaches at 12 months (epicardial alone 71.5
%; [95 % CI 66.1-76.9], hybrid 63.2 %; [95 % CI 51.5-75.0]) and 24 months
(epicardial alone 68.5 %; [95 % CI 57.7-79.3], hybrid 57.0 %; [95 % CI
33.6-80.4]). Freedom from atrial arrhythmias with AADs and rates of
unplanned additional catheter ablations were also similar between groups.
Major complications occurred more often with hybrid ablation (epicardial
alone 2.9 %; [95 % CI 1.9-3.9], hybrid 7.3 %; [95 % CI 4.2-10.5]).
Meta-regression suggested that bipolar radiofrequency energy and
thoracoscopic access were associated with greater efficacy, but adjusting
for these factors did not unmask any difference between epicardial-alone
and hybrid ablation. Hybrid and epicardial ablation alone appear to be
equally effective treatments for AF, although hybrid ablation may be
associated with higher complication rates. These data derived from
observational studies should be verified with randomised
data. Copyright © 2017 RADCLIFFE CADIOLOGY.

<3>
Accession Number
372415724
Title
Acute coronary syndrome in pre- and post-partum women - a review.
Source
Interventional Cardiology (London). 8 (1) (pp 8-13), 2013. Date of
Publication: March 2013.
Author
Aprigliano G.; Palloshi A.; Morici N.; Ferraresi R.; Bianchi M.; Anzuini
A.
Institution
(Aprigliano, Palloshi, Ferraresi, Bianchi) Interventional Cardiovascular
Unit, Cardiology Department, Istituto Clinico Citta Studi, Milan, Italy
(Morici) Cardiologia 1, Azienda Ospedaliera Ospedale Niguarda Ca' Granda,
Milan, Italy
(Anzuini) Cardiology Department, Istituto Clinico Mater Domini,
Castellanza, Italy
Publisher
Radcliffe Cardiology
Abstract
Acute coronary syndrome (ACS) during pregnancy and the post-partum period
are weighed by a high mortality rate for the mother and foetus. They
should be considered as multifactorial diseases with a special role for
sexual hormones. In this setting, ACS is mostly related to an early
atherosclerotic disease, even if other conditions are responsible. Indeed,
an important part is due to spontaneous coronary artery dissection, more
common during delivery and the post-partum period. In the remaining
situation, an isolated intracoronary thrombus or a normal angiographic
pattern can be found at angiography. Pathophysiology is still uncertain
with different hypothetical mechanisms. Prompt diagnosis of ACS and
aetiology are essential for an optimal therapeutic strategy. Difficulties
in treatment management is a matter for debate, especially in pre-partum
women. In the last two decades improvements of diagnostic tools, coronary
angiography and subsequent percutaneous treatment have changed the natural
history of this rare condition. © RADCLIFFE 2013.

<4>
Accession Number
627301708
Title
Impact of low-dose prasugrel on platelet reactivity and cardiac
dysfunction in acute coronary syndrome patients requiring primary
drug-eluting stent implantation: A randomized comparative study.
Source
Catheterization and Cardiovascular Interventions. 95 (1) (pp E8-E16),
2020. Date of Publication: 01 Jan 2020.
Author
Kitano D.; Takayama T.; Fukamachi D.; Migita S.; Morikawa T.; Tamaki T.;
Kojima K.; Mineki T.; Murata N.; Akutsu N.; Sudo M.; Hiro T.; Hirayama A.;
Okumura Y.
Institution
(Kitano, Takayama, Fukamachi, Migita, Morikawa, Tamaki, Kojima, Mineki,
Murata, Akutsu, Sudo, Hiro, Hirayama, Okumura) Division of Cardiology,
Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
(Kitano, Sudo, Hiro) Division of Advanced Cardiovascular Imaging,
Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
(Takayama) Department of General Medicine, Nihon University School of
Medicine, Tokyo, Japan
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The aim of this study was to compare how prasugrel and
clopidogrel affect platelet aggregation reactivity, cardiac enzyme
release, cardiac remodeling, and the formation of in-stent thrombi after
primary percutaneous coronary intervention (PCI). Background(s): The
advantages of using prasugrel over clopidogrel in cardiac injury following
acute coronary syndrome (ACS) remain unclear. Method(s): A total of
78 ACS patients were randomly allocated into clopidogrel (300 mg
loading/75 mg maintenance) or prasugrel (20 mg loading/3.75 mg
maintenance) treatment groups, followed by undergoing primary PCI.
Platelet reactivity and cardiac enzymes were measured before and after
primary PCI. Moreover, cardiac function was measured by ultrasound
echocardiography and coronary angioscopic observation was after primary
PCI up to 8 months later. Result(s): Antiplatelet reactivity in the
prasugrel treatment group reached optimal levels (P2Y<inf>12</inf>
reaction units [PRU] less than 262) immediately after the administration
and was maintained even at 8 months, independently of the CYP2C19
genotype. Prasugrel treatment significantly suppressed creatine kinase
elevation compared to clopidogrel treatment (median value 404 IU/L to 726
IU/L vs. 189 IU/L to 1,736 IU/L, p = 0.018 for maximum values) and reduced
left ventricular mass (217.2-168.8 g in prasugrel, p = 0.045; 196.9-176.4
g in clopidogrel, p = 0.061). There were no significant differences in the
incidence of in-stent attached thrombi between the two groups.
 Conclusion(s): Compared to clopidogrel, prasugrel produced a stable
platelet aggregation inhibitory effect in patients with ACS regardless of
CYP2C19 genotype, reduced cardiac enzyme release, and prevented cardiac
remodeling after ACS. Copyright © 2019 Wiley Periodicals, Inc.

<5>
Accession Number
626823153
Title
A randomized controlled trial to assess operator radiation exposure from
cardiac catheterization procedures using RAD BOARD with standard pelvic
shielding versus standard pelvic shielding alone.
Source
Catheterization and Cardiovascular Interventions. 95 (1) (pp 83-88), 2020.
Date of Publication: 01 Jan 2020.
Author
Suryadevara R.; Brown E.D.; Green S.M.; Scott T.D.; Nordberg C.M.;
Blankenship J.C.
Institution
(Suryadevara) Department of Cardiology, Harton Regional Medical Center,
Tullahoma, TN, United States
(Brown) Department of Cardiology, University of New Mexico, Albuquerque,
NM, United States
(Green, Scott, Blankenship) Department of Cardiology, Geisinger Medical
Center, Danville, PA, United States
(Nordberg) Department of Biomedical and Translational Informatics,
Geisinger Health System, Danville, PA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To study radiation exposure to the primary operator during
diagnostic cardiac catheterizations using a radio-dense RAD BOARD radial
access arm board. Background(s): The use of radial access for
catheterization in the United States has increased from 1% in 2007 to 41%
in 2018. Compared to femoral access, operator radiation exposure from
radial access is similar or higher. The RAD BOARD radio-dense radial
access arm board has been marketed as reducing radiation to operators by
44%. Material(s) and Method(s): We randomized 265 patients undergoing
catheterization via right radial access to standard pelvic lead drape
shielding (nonboard group) versus RAD BOARD in addition to pelvic drape
(board group). Operator radiation exposure was measured using Landauer
Microstar nanoDotTM badges worn by the operator. Result(s): Board and
nonboard groups were similar with respect to demographic and procedural
variables. Mean operator dose per case was higher in the board group
(.65mSieverts) than in the nonboard group (.56mSieverts, P < 0.0001). In
sub-group analyses, radiation doses were higher in the board group
compared to the nonboard group in patients across all body mass index
groups (P < 0.03). In multivariate analysis, operator dose correlated with
use of the RAD BOARD more closely than any other variable (P < 0.001).
Post hoc analysis of the table setup with RAD BOARD revealed that use of
RAD BOARD prevented placement of a shield normally inserted into the top
of the standard below-table shield. Conclusion(s): RAD BOARD with the
pelvic shield was associated with higher radiation exposure to the
operator compared with pelvic shield alone, likely due to inability to use
standard radiation shielding along with the RAD BOARD. Copyright
© 2019 Wiley Periodicals, Inc.

<6>
Accession Number
630448479
Title
Intraoperative glycemic control in patients undergoing Orthotopic liver
transplant: A single center prospective randomized study.
Source
BMC Anesthesiology. 20 (1) (no pagination), 2020. Article Number: 3. Date
of Publication: 04 Jan 2020.
Author
Kumar S.S.; Pelletier S.J.; Shanks A.; Thompson A.; Sonnenday C.J.; Picton
P.
Institution
(Kumar, Shanks, Thompson, Picton) Department of Anesthesiology, Michigan
Medicine, 1H247 UH, 1500 East Medical Center Drive, SPC 5048, Ann Arbor,
MI 48109-5048, United States
(Pelletier) University of Virginia, 1215 Lee st, Charlottesville, VA
22908, United States
(Sonnenday) Department of Surgery, Michigan Medicine, Ann Arbor, MI,
United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Perioperative hyperglycemia is associated with poor outcomes
yet evidence to guide intraoperative goals and treatment modalities during
non-cardiac surgery are lacking. End-stage liver disease is associated
with altered glucose homeostasis; patients undergoing liver
transplantation display huge fluctuations in blood glucose (BG) and
represent a population of great interest. Here, we conduct a randomized
trial to compare the effects of strict versus conventional glycemic
control during orthotopic liver transplant (OLT). Method(s):
Following approval by the Institutional Review Board of the University of
Michigan Medical School and informed consent, 100 adult patients
undergoing OLT were recruited. Patients were randomized to either strict
(target BG 80-120 mg/dL) or conventional (target BG 180-200 mg/dL) BG
control with block randomization for diabetic and nondiabetic patients.
The primary outcomes measured were 1-year patient and graft survival
assessed on an intention to treat basis. Graft survival is defined as
death or needing re-transplant (www.unos.org). Three and 5-year patient
and graft survival, infectious and biliary complications were measured as
secondary outcomes. Data were examined using univariate methods and
Kaplan-Meir survival analysis. A sensitivity analysis was performed to
compare patients with a mean BG of <=120 mg/dL and those > 120 mg/dL
regardless of treatment group. Result(s): There was no statistically
significant difference in patient survival between conventional and strict
control respectively;1 year, 88% vs 88% (p-0.99), 3 years, 86% vs 84% (p-
0.77), 5 years, 82% vs 78. % (p-0.36). Graft survival was not different
between conventional and strict control groups at 1 year, 88% vs 84%
(p-0.56), 3 years 82% vs 76% (p-0.46), 5 years 78% vs 70% (p-0.362).
 Conclusion(s): There was no difference in patient or graft survival
between intraoperative strict and conventional glycemic control during
OLT. Trial registration: Clinical trial number and registry:
www.clinicaltrials.gov NCT00780026. This trial was retrospectively
registered on 10/22/2008. Copyright © 2020 The Author(s).

<7>
Accession Number
2003509274
Title
The Healthy Heart-Mind Trial: Randomized Controlled Trial of Melatonin for
Prevention of Delirium.
Source
Journal of the American Geriatrics Society. 68 (1) (pp 112-119), 2020.
Date of Publication: 01 Jan 2020.
Author
Ford A.H.; Flicker L.; Kelly R.; Patel H.; Passage J.; Wibrow B.; Anstey
M.; Edwards M.; Almeida O.P.
Institution
(Ford, Flicker, Kelly, Patel, Wibrow, Anstey, Almeida) Medical School,
University of Western Australia, Perth, WA, Australia
(Ford, Flicker) WA Centre for Health & Ageing, University of Western
Australia, Perth, WA, Australia
(Passage) School of Medicine, University of Notre Dame and Department of
Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA,
Australia
(Wibrow, Anstey) Intensive Care Unit, Sir Charles Gairdner Hospital,
Perth, WA, Australia
(Edwards) Department of Cardiothoracic Surgery, Fiona Stanley Hospital,
Perth, WA, Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
OBJECTIVES: Delirium is a serious medical condition with increased
incidence in at-risk surgical populations. We sought to determine if
melatonin use reduces the incidence of delirium in individuals undergoing
major cardiac surgery. DESIGN: Randomized double-blind placebo-controlled
clinical trial (two arms, 1:1 allocation, parallel design). SETTING: The
trial took place in two metropolitan hospitals (public tertiary and
private) in Perth, Western Australia. PARTICIPANTS: We recruited 210
adults aged 50 years or older who were due to undergo coronary artery
bypass grafting or valve replacement surgery. INTERVENTION: Participants
were randomly assigned (1:1) to 7 days of treatment with melatonin 3 mg at
night or matching placebo, starting 2 days before the surgery.
MEASUREMENTS: The primary outcome of interest was incident delirium within
7 days of surgery as assessed via daily clinical assessment that included
the Confusion Assessment Method. Secondary outcomes of interest included
duration and severity of delirium, length of hospital stay, cognitive
function, and mood and anxiety symptoms at discharge and 3 months after
the surgery. RESULT(S): The groups were well balanced for demographic
and clinical parameters. Forty-two participants developed delirium, but it
was evenly distributed between the groups (melatonin 21/98, 21.4%; placebo
21/104, 20.2%; adjusted odds ratio [OR] =.78; 95% confidence interval [CI]
=.35-1.75). The median duration of delirium was 3 (interquartile range
[IQR] = 2-4) and 2 (IQR = 1-3) days for people treated with melatonin and
placebo, respectively (z = -1.03; P =.304). A similar proportion of
participants experienced severe episodes of delirium in each group
(melatonin 9/21, 42.9% vs placebo 6/21, 28.6%; chi2 =.93; P
=.334; adjusted OR = 1.98; 95% CI =.40-9.78). The groups did not differ in
terms of length of stay, mood, anxiety, and cognitive performance.
 CONCLUSION(S): The findings of this randomized double-blind
placebo-controlled trial do not support the prophylactic use of melatonin
to prevent delirium after major cardiac surgery. J Am Geriatr Soc
68:112-119, 2019. Copyright © 2019 The American Geriatrics
Society

<8>
Accession Number
630547707
Title
Sutured and sutureless repair of postinfarction left ventricular free-wall
rupture: A systematic review.
Source
European Journal of Cardio-thoracic Surgery. 56 (5) (pp 840-848), 2019.
Date of Publication: 01 Nov 2019.
Author
Matteucci M.; Fina D.; Jiritano F.; Blankesteijn W.M.; Raffa G.M.;
Kowalewski M.; Beghi C.; Lorusso R.
Institution
(Matteucci, Fina, Jiritano, Lorusso) Department of Cardiothoracic Surgery,
Heart and Vascular Centre, Maastricht University Medical Centre,
Maastricht, Netherlands
(Matteucci, Beghi) Department of Cardiac Surgery, Circolo Hospital,
University of Insubria, Varese, Italy
(Fina) Department of Cardiology, IRCCS Policlinico San Donato, University
of Milan, Milan, Italy
(Jiritano) Department of Cardiac Surgery, University Magna Graecia of
Catanzaro, Catanzaro, Italy
(Blankesteijn) Department of Pharmacology and Toxicology, Cardiovascular
Research Institute Maastricht, Maastricht University, Maastricht,
Netherlands
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, ISMETT-IRCCS (Instituto Mediterraneo
per i Trapianti e Terapie Ad Alta Specializzazione), Palermo, Italy
(Kowalewski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
(Lorusso) Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Postinfarction left ventricular free-wall rupture is a potentially
catastrophic event. Emergency surgical intervention is almost invariably
required, but the most appropriate surgical procedure remains
controversial. A systematic review, from 1993 onwards, of all available
reports in the literature about patients undergoing sutured or sutureless
repair of postinfarction left ventricular free-wall rupture was European
Journal of Cardio-Thoracic Surgery 56 (2019) 840-848 REVIEW
doi:10.1093/ejcts/ezz101 Advance Access publication 1 April 2019
performed. Twenty-five studies were selected, with a total of 209 patients
analysed. Sutured repair was used in 55.5% of cases, and sutureless repair
in the remaining cases. Postoperative in-hospital mortality was 13.8% in
the sutured group, while it was 14% in the sutureless group. A trend
towards a higher rate of in-hospital rerupture was observed in the
sutureless technique. The most common cause of inhospital mortality (44%)
was low cardiac output syndrome. In conclusion, sutured and sutureless
repair for postinfarction left ventricular free-wall rupture showed
comparable in-hospital mortality. However, because of the limited number
of patients and the variability of surgical strategies in each reported
series, further studies are required to provide more consistent data and
lines of evidence. Copyright © 2019 The Author(s) 2019. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<9>
Accession Number
630547694
Title
Clinical outcomes of paediatric patients supported by the Berlin Heart
EXCOR: A systematic review.
Source
European Journal of Cardio-thoracic Surgery. 56 (5) (pp 830-839), 2019.
Date of Publication: 01 Nov 2019.
Author
Rohde S.; Antonides C.F.J.; Dalinghaus M.; Muslem R.; Bogers A.J.J.C.
Institution
(Rohde, Antonides, Muslem, Bogers) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Dalinghaus) Department of Paediatric Cardiology, Erasmus University
Medical Centre, Rotterdam, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Ventricular assist devices (VADs) are widely accepted as therapy to bridge
children to heart transplantation. We provide a systematic review of the
current state of clinical outcomes in children after paediatric VAD
support by the Berlin Heart EXCOR (BH EXCOR) device. A systematic
literature search was performed in April 2018. Studies reporting clinical
outcomes in at least 15 children supported by a BH EXCOR VAD were
included. Additionally, we focused on outcomes in small children and
compared outcomes of children supported by a left ventricular assist
device (LVAD) versus children supported by a biventricular assist device
(BiVAD). Eighteen publications fulfilled the inclusion criteria and were
included in this systematic review. Mortality rates ranged from 6.3%
[confidence interval (CI) 0.0-18.1%] to 38.9% (2.8-75.0%) while
transplantation rates ranged from 37.0% (CI 18.8-55.2%) to 72.5% (CI
63.9-81.2%) and successful weaning rates from 0.0% to 20.7% (CI
6.0-35.5%). In children under 1 year of age, mortality rates ranged from
20.0% to 55.5% and transplantation rates ranged from 0.0% to 62.5%. BiVAD
support seemed to result in worse clinical outcomes than LVAD support.
Incidence of stroke ranged from 5.0% to 47.0% in all children supported
with the BH EXCOR. Although a high incidence of adverse events such as
stroke and pump thrombosis is reported, VAD support should be considered
in children with end-stage heart failure awaiting heart transplantation.
Further research is warranted, especially on optimal timing of device
implantation and anticoagulation regimens. Copyright © 2019 The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<10>
Accession Number
630547681
Title
Chest tube drainage versus video-assisted thoracoscopic surgery for a
first episode of primary spontaneous pneumothorax: A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 56 (5) (pp 819-829), 2019.
Date of Publication: 01 Nov 2019.
Author
Daemen J.H.T.; Lozekoot P.W.J.; Maessen J.G.; Gronenschild M.H.M.; Bootsma
G.P.; Hulsewe K.W.E.; Vissers Y.J.L.; De Loos E.R.
Institution
(Daemen, Lozekoot, Hulsewe, Vissers, De Loos) Division of General Thoracic
Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen,
Netherlands
(Maessen) Department of Cardiothoracic Surgery, Maastricht University
Medical Centre, Maastricht, Netherlands
(Gronenschild, Bootsma) Department of Pulmonology, Zuyderland Medical
Centre, Heerlen, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Primary spontaneous pneumothorax affects up to 28 patients per 100 000
population yearly and is commonly resolved by chest tube drainage.
However, drainage is also known to be associated with ipsilateral
recurrence rates ranging from 25% to 43%. Preventive videoassisted
thoracoscopic surgery (VATS) may be an effective alternative to diminish
these recurrence rates and its associated morbidity. The aim of this study
was to compare the efficacy of chest tube drainage and VATS as first line
treatments of an initial episode of primary spontaneous pneumothorax. The
MEDLINE, EMBASE, CENTRAL and Clinicaltrials.gov databases were searched
through 16 September 2018. Data regarding the ipsilateral recurrence rate
and the length of hospitalization were extracted and submitted to
meta-analysis using the random-effects model and the I2 test for
heterogeneity. Two randomized controlled trials and 2 observational
studies were included, enrolling a total of 479 patients. Pairwise
analysis demonstrated significantly reduced ipsilateral recurrence rates
[odds ratio 0.15, 95% REVIEW European Journal of Cardio-Thoracic Surgery
56 (2019) 819-829 REVIEW doi:10.1093/ejcts/ezz116 Advance Access
publication 24 April 2019 confidence interval (CI) 0.07-0.33; P > 0.00001]
and length of hospitalization (standardized mean difference -2.19, 95% CI
-4.34 to -0.04; P = 0.046) in favour of VATS. However, a significant level
of heterogeneity was detected for the length of hospitalization (I2 = 97%;
P > 0.00001). Subgroup analysis that stratified study design found no
statistical differences regarding recurrence rate. In conclusion, VATS can
be an effective and attractive alternative to standard chest tube
drainage, with reduced ipsilateral recurrence rates and length of
hospitalization. However, given the low quality of the majority of
included studies, more well-designed randomized controlled trials are
necessary to strengthen the current evidence. Copyright © 2019
The Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<11>
Accession Number
2004309270
Title
Cost-effectiveness of routine transoesophageal echocardiography during
cardiac surgery: a discrete-event simulation study.
Source
British Journal of Anaesthesia. 124 (2) (pp 136-145), 2020. Date of
Publication: February 2020.
Author
Dieleman J.M.; Myles P.S.; Bulfone L.; Younie S.; van Zaane B.; McGiffin
D.; Moodie M.; Gao L.
Institution
(Dieleman) Department of Anaesthesia, Westmead Hospital, Sydney, Australia
(Dieleman, Myles) Department of Anaesthesia and Perioperative Medicine,
Monash University, Melbourne, Australia
(Bulfone, Younie, Moodie, Gao) Deakin Health Economics, Institute for
Health Transformation, Faculty of Health, Deakin University, Melbourne,
Australia
(van Zaane) Department of Anesthesiology, University Medical Center
Utrecht, Utrecht, Netherlands
(McGiffin) Department of Cardiothoracic Surgery, The Alfred Hospital,
Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: The aim of this study was to simulate and compare the
healthcare and economic outcomes associated with routine use of
intraoperative transoesophageal echocardiography (TOE) in patients
undergoing cardiac surgery with those associated with a scenario where TOE
is not routinely used. Method(s): The impact of TOE on surgical
decision-making was estimated through a systematic literature review.
Individual short-term morbidity and mortality estimates were generated by
application of the Society of Thoracic Surgeons risk calculator. Long-term
event rates, unit costs, and utility weights were sourced from published
literature and expert opinion. A discrete-event simulation model was then
constructed to simulate both the in-hospital and post-discharge outcomes
for patients undergoing cardiac surgery. Robustness of the base case
results was examined through deterministic and probabilistic sensitivity
analyses. An incremental cost-effectiveness ratio of 30 000 per
quality-adjusted life-year gained was assumed to represent acceptable
cost-effectiveness. Result(s): Routine use of intraoperative TOE was
associated with lower costs and higher benefits per patient, which
indicates that use of TOE is a dominant strategy. The intervention
resulted in the avoidance of 299 cardiac complications, 20 strokes, and 11
all-cause deaths per 10 000 patients. Routine intraoperative TOE was
associated with an increased occurrence of bleeding owing to more valvular
surgery and subsequent long-term anticoagulation. Conclusion(s):
Routine intraoperative TOE is a cost-effective procedure for patients
undergoing cardiac surgery, leading to lower overall costs. It was
associated with a decrease in long-term complications including stroke,
cardiac complications, and death, although there was a slight increase in
extracranial bleeding events. Copyright © 2019 British Journal of
Anaesthesia

<12>
Accession Number
2004554822
Title
Cochrane Corner: Perioperative beta-blockers for preventing
surgery-related mortality and morbidity.
Source
Revista Portuguesa de Cardiologia. (no pagination), 2020. Date of
Publication: 2020.
Author
Alegria S.; Costa J.; Vaz-Carneiro A.; Caldeira D.
Institution
(Alegria) Servico de Cardiologia, Hospital Garcia de Orta, Almada,
Portugal
(Costa, Vaz-Carneiro) Centro de Estudos de Medicina Baseada na Evidencia,
Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
(Costa, Vaz-Carneiro) Centro Colaborador Portugues da Rede Cochrane
Iberoamericana, Faculdade de Medicina, Universidade de Lisboa, Lisboa,
Portugal
(Costa, Caldeira) Laboratorio de Farmacologia Clinica e Terapeutica,
Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas
Moniz, Lisboa 1649-028, Portugal
(Costa, Caldeira) Instituto de Medicina Molecular, Faculdade de Medicina,
Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa 1649-028,
Portugal
(Caldeira) Servico de Cardiologia, Hospital Universitario de Santa Maria
(CHLN), CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL,
Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas
Moniz, Lisboa 1649-028, Portugal
Publisher
Sociedade Portuguesa de Cardiologia (E-mail: secretariado@mail.spc.pt)
Abstract
Randomized controlled trials have yielded conflicting results regarding
the impact of beta-blockers on perioperative cardiovascular morbidity and
mortality. This Cochrane systematic review assessed the impact of this
intervention on mortality and cardiovascular events. Eighty-eight
randomized controlled trials with 19 161 participants were included (53
trials on cardiac surgery and 35 trials on non-cardiac surgery). In
cardiac surgery perioperative beta-blockers had a protective effect
against supraventricular and ventricular arrhythmias but had no
significant effect on mortality or on the occurrence of acute myocardial
infarction (AMI), stroke, heart failure, hypotension or bradycardia. In
non-cardiac surgery, beta-blockers had a protective effect against AMI and
arrhythmias, but this was counterbalanced by an increased risk of death
and stroke. In conclusion, perioperative use of beta-blockers appears
overall to be beneficial in cardiac surgery. However, in non-cardiac
surgery the substantial reduction in rhythm disturbances and AMI appears
to be offset by an increase in mortality and stroke, and so the systematic
use of beta-blockers in this setting is not recommended. Copyright
© 2019 Sociedade Portuguesa de Cardiologia

<13>
Accession Number
2004537926
Title
Double or triple antithrombotic therapy after coronary stenting and atrial
fibrillation: A systematic review and meta-analysis of randomized clinical
trials.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Ando G.; Costa F.
Institution
(Ando, Costa) Department of Clinical and Experimental Medicine, University
of Messina, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Aims: Double or triple antithrombotic therapy (DAT/TAT) including or
excluding aspirin in association with oral anticoagulant and P2Y12
inhibitor are currently two available options in patients with atrial
fibrillation (AF) undergoing percutaneous coronary intervention (PCI). We
evaluated efficacy and safety outcomes for DAT vs. TAT. Methods and
Results: Four non-vitamin K oral anticoagulants (NOAC)-based randomized
controlled trials comparing DAT vs. TAT with a total of 10,938 patients
were pooled. Bleeding events occurred more frequently than ischemic
events. DAT as compared to TAT was associated to an increased risk of
stent thrombosis (RR 1.54, 95% CI 1.10-2.14; p = 0.03), myocardial
infarction (RR 1.23, 95% CI 1.04-1.46; p = 0.03) and cardiovascular
mortality (RR 1.09, 95% CI 1.01-1.19; p = 0.04) and to a reduced risk of
ISTH major or clinically relevant non-major bleeding (RR 0.59, 95% CI
0.62-0.93; p = 0.03). A consistent effect was observed in all safety
endpoints. Intracranial haemorrhage was numerically reduced by DAT. No
difference for all-cause death was observed. Conclusion(s):
Antithrombotic treatment in patients with AF undergoing PCI represents a
trade-off between ischemia and bleeding. A careful patient selection based
on baseline ischemic and bleeding risk may optimize the net clinical
balance in this population. Copyright © 2019 Elsevier B.V.

<14>
Accession Number
616230675
Title
Transmyocardial revascularization as an adjunct to coronary artery bypass
surgery.
Source
US Cardiology Review. 9 (1) (pp 12-15), 2012. Date of Publication: 2012.
Author
Allen K.B.
Institution
(Allen) Department of Cardiothoracic Surgery, Heart Center of Indiana,
United States
Publisher
Radcliffe Cardiology
Abstract
Many patients with angina secondary to coronary artery disease (CAD)
respond to medical management or can be completely revascularized using
available percutaneous coronary interventions or coronary artery bypass
grafting (CABG). There is evidence, however, to indicate that up to 25% of
patients are incompletely revascularized following CABG, and that
incomplete revascularization is a significant independent predictor of
early and late mortality and adverse events. Transmyocardial
revascularization (TMR) is a surgical option for patients with
debilitating angina due to CAD in areas of the heart not amenable to
complete revascularization using conventional treatments. In randomized,
one-year controlled trials with long-term follow-up and in additional
clinical experience, TMR performed adjunctively to CABG in patients who
would be incompletely revascularized by CABG alone has yielded
significantly improved clinical outcomes. Based on these published
results, the Society of Thoracic Surgeons (STS) and the International
Society for Minimally Invasive Cardiaothoracic Surgery (ISMICS) have
issued practice guidelines recommending adjunctive TMR in this difficult
patient group.

<15>
Accession Number
630596692
Title
Comparison of effectiveness of tranexamic acid and
epsilon-amino-caproic-acid in decreasing postoperative bleeding in
off-pump CABG surgeries: A prospective, randomized, double-blind study.
Source
Annals of cardiac anaesthesia. 23 (1) (pp 65-69), 2020. Date of
Publication: 01 Jan 2020.
Author
Verma S.; Srinivas U.; Sathpathy A.K.; Mittal P.
Institution
(Verma, Srinivas, Sathpathy, Mittal) Department of Anaesthesia, Apollo
Hospital, Jubilee Hills, Hyderabad, Telangana, India
Publisher
NLM (Medline)
Abstract
Context: Off-pump coronary artery bypass graft (CABG) surgeries have been
shown to have increased fibrinolysis due to tissue plasminogen activator
release. There are no trials comparing the two available antifibrinolytics
(tranexemic acid and epsilon-amino-caproic acid) in off-pump CABG
surgeries. Aim(s): The aim of the present study was to compare the
effectiveness of tranexamic acid and epsilon-amino-caproic acid with
respect to postoperative bleeding at 4 and 24 hours as the primary
outcome, and rate of postoperative transfusion, re-operations,
complication rate, serum fibrinogen, and D-dimer levels as secondary
outcomes. Settings and Design: The study was carried out at a
tertiary-level hospital between June 2017 and June 2018. It was a
prospective, randomized, double-blind study. Material(s) and
Method(s): Eighty patients undergoing off-pump CABG, were randomly
allocated to receive tranexamic acid or epsilon-amino-caproic acid. The
patients were followed up in the postoperative period and were assessed
for primary and secondary outcomes. Statistical Analysis Used: Statistical
analysis was performed using SPSS software, version 19.0 (SPSS Inc.,
Chicago, IL). Nonparametric data were expressed as median with
interquartile range and compared using Mann-Whitney U-test, parametric
data was represented as mean with standard deviation and analyzed using
Student's t-test. Nominal data were analyzed using Chi-square test.
 Result(s): Bleeding at 4 hours did not show significant difference
between groups, 180 ml (80-250) vs 200 ml (100-310). Bleeding at 24 hours
was significantly lesser in tranexamic acid group as compared to
epsilon-amino-caproic acid group, 350 ml (130-520) vs 430 ml (160-730) (P
= 0.0022) The rate of transfusion, re-operations, seizures, renal
dysfunction, fibrinogen levels, and D-dimer levels did not show
significant difference between the groups. Conclusion(s): Tranexamic
acid significantly reduced postoperative bleeding in off-pump CABG at 24
hours as compared to epsilon-amino-caproic-acid.

<16>
Accession Number
630597551
Title
Early postoperative statin administration does not affect the rate of
atrial fibrillation after cardiac surgery.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 13 Jan 2020.
Author
Khan J.A.; Laurikka J.O.; Jarvinen O.H.; Khan N.K.; Jarvela K.M.
Institution
(Khan, Laurikka, Jarvela) Department of Cardio-Thoracic Surgery, Tays
Heart Hospital, Tampere University Hospital, Tampere, Finland
(Laurikka, Jarvinen) Faculty of Medicine and Health Technology, Tampere
University, Tampere, Finland
(Khan) Centre for Vascular Surgery and Interventional Radiology, Tampere
University Hospital, Tampere, Finland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Postoperative atrial fibrillation is the most frequent
complication after cardiac surgery, and the use of statins in preventing
them is being extensively studied. The aim of this study was to
investigate whether a pause in the administration of statins affects the
occurrence of atrial fibrillation after cardiac surgery in a prospective
randomized and controlled setting. METHOD(S): A total of 301 patients
without chronic atrial fibrillation with prior statin medication scheduled
for elective or urgent cardiac surgery involving the coronary arteries
and/or heart valves were prospectively recruited and randomized for statin
re-initiation on either the first (immediate statin group) or the fifth
(late statin group) postoperative day, using the original medication and
dosage. The immediate statin group comprised 146 patients and the late
statin group 155 patients. Except for a somewhat higher rate of males (85%
vs 73%, P=0.016) in the immediate statin group, the baseline
characteristics and the distribution of procedures performed within the
groups were comparable. The occurrence of postoperative atrial
fibrillation and the clinical course of the patients were compared between
the groups. RESULT(S): The incidence of atrial fibrillation was 46%
and the median delay after surgery before the onset of atrial fibrillation
was 3 days in both groups (P=NS). No differences were observed in the
frequency of the arrhythmia in any subgroup analyses or in other major
complications or clinical parameters. No adverse effects related to early
statin administration were detected. CONCLUSION(S): Early
re-initiation of statins does not appear to affect the occurrence of
postoperative atrial fibrillation. CLINICAL TRIAL REGISTRATION: European
Union Drug Regulating Authorities Clinical Trials Database
(EudraCT)-2016-001655-44. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<17>
Accession Number
630595542
Title
Current clinical management of dysfunctional bioprosthetic pulmonary
valves.
Source
Expert review of cardiovascular therapy. (no pagination), 2020. Date of
Publication: 11 Jan 2020.
Author
Aggarwal V.; Spigel Z.; Hiremath G.; Binsalamah Z.; Qureshi A.M.
Institution
(Aggarwal, Hiremath) Division of Pediatric Cardiology, Department of
Pediatrics, University of Minnesota Masonic Children's Hospital,
Minneapolis, United States
(Spigel, Binsalamah) Department of Pediatric Surgery, Texas Children's
Hospital and Baylor College of Medicine, Houston TX 77030, United States
(Qureshi) Lillie Frank Abercrombie Section of Cardiology, Department of
Pediatric Cardiology, Texas Children's Hospital, Baylor College of
Medicine, Houston TX 77030, United States
Publisher
NLM (Medline)
Abstract
Introduction: As with any bioprosthetic valve, bioprosthetic valves in the
pulmonary position have a finite life span and patients with bioprosthetic
pulmonary valves require lifetime management to treat valve
dysfunction.Areas covered: In this article, authors discuss the current
medical management for treatment of dysfunctional bioprosthetic valves.
This review is based on both an extensive review of the recent cardiac
surgical/interventional cardiology literature (PubMed and MEDLINE database
searches from 1958 - 2019) and personal experience.Expert opinion: Valve
technology is rapidly progressing and with a coordinated effort from
cardiac surgeons and interventional cardiologists, patients suffering from
bioprosthetic pulmonary valve dysfunction can expect to have a decreased
number of procedures and less invasive procedures over their lifetime now.

<18>
Accession Number
630591174
Title
A prospective, randomized, single-blind, multicentre, phase III study on
organ preservation with Custodiol-N solution compared with Custodiol
solution in organ transplantation (kidney, liver and pancreas).
Source
Trials. 21 (1) (pp 62), 2020. Date of Publication: 10 Jan 2020.
Author
Kniepeiss D.; Houben P.; Stiegler P.; Berghold A.; Riedl R.; Kahn J.;
Schemmer P.
Institution
(Kniepeiss, Stiegler, Kahn, Schemmer) General, Visceral and Transplant
Surgery, Department of Surgery, Medical University of Graz,
Auenbruggerplatz 29, Graz 8036, Austria
(Kniepeiss, Stiegler, Kahn, Schemmer) Transplant Center Graz (TCG),
Medical University of Graz, Auenbruggerplatz 29, Graz 8036, Austria
(Houben) Department of General, Visceral and Transplant Surgery,
University Hospital of Heidelberg, Heidelberg, Germany
(Berghold, Riedl) Institute for Medical Informatics, Statistics and
Documentation, Medical University Graz, Graz, Austria
Publisher
NLM (Medline)
Abstract
BACKGROUND: Organ preservation before transplantation is still a
challenge. Both the University of Wisconsin and Bretschneider's
histidine-tryptophan-ketoglutarate (HTK; Custodiol) solution are standard
for liver, kidney and pancreas preservation. Organ preservation with both
solutions is comparable; recently, however, Custodiol solution has been
modified to Custodiol-N according to the needs of today. Thus, our study
was defined to study its effect in clinical transplantation.
 METHOD(S): Patients undergoing kidney transplantation (n =412)
(including approximately 30 combined kidney-pancreas) or liver
transplantation (n =202) receive grafts that have been cold stored in
either Custodiol or Custodiol-N to demonstrate noninferiority of
Custodiol-N regarding both graft function and graft injury after
transplantation. DISCUSSION: Preclinical data have clearly shown that
Custodiol-N is superior to Custodiol in cold static organ preservation via
mechanisms including inhibition of hypoxic cell injury, cold-induced cell
injury and avoidance of adverse effects during warm exposure to the
solution. Further clinical safety data on Custodiol-N for cardioplegia are
available. Thus, this study was designed to compare Custodiol with
Custodiol-N for the first time in a prospective, randomized,
single-blinded, multicentre, phase III clinical transplantation trial.
TRIAL REGISTRATION: Eudra-CT, 2017-002198-20. Registered on 28 November
2018.

<19>
Accession Number
630590689
Title
A Multinational Observational Study Exploring Adherence With the Kidney
Disease: Improving Global Outcomes Recommendations for Prevention of Acute
Kidney Injury After Cardiac Surgery.
Source
Anesthesia and analgesia. (no pagination), 2020. Date of Publication: 08
Jan 2020.
Author
Kullmar M.; Weiss R.; Ostermann M.; Campos S.; Grau Novellas N.; Thomson
G.; Haffner M.; Arndt C.; Wulf H.; Irqsusi M.; Monaco F.; Di Prima A.L.;
Garcia-Alvarez M.; Italiano S.; Felipe Correoso M.; Kunst G.; Nair S.;
L'Acqua C.; Hoste E.; Vandenberghe W.; Honore P.M.; Kellum J.A.; Forni L.;
Grieshaber P.; Wempe C.; Meersch M.; Zarbock A.
Institution
(Kullmar, Weis, Wempe, Meersch, Zarbock) From the Department of
Anaesthesiology, Intensive Care Medicine and Pain Medicine, University
Hospital Munster, Munster, Germany
(Ostermann, Campos, Grau Novellas, Thomson, Haffner) Department of
Critical Care, Guy's & St Thomas' NHS Foundation Hospital, London, United
Kingdom
(Arndt, Wulf) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Marburg, Marburg, Germany
(Irqsusi) Department of Cardiac Surgery, University Hospital Marburg,
Marburg, Germany
(Monaco, Di Prima) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Garcia-Alvarez, Italiano, Felipe Correoso) Department of Anesthesiology,
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(Kunst, Nair) Department of Anaesthetics, King's College Hospital, Denmark
Hill, London, United Kingdom
(L'Acqua) Centro Cardiologico Monzino IRCCS, Milan, Italy
(Hoste, Vandenberghe) Department of Intensive Care Medicine, University
Hospital Gent, Gent, Belgium
(Honore) Department of Intensive Care, CHU Brugmann University Hospital,
Belgium
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, PA
(Forni) Department of Intensive Care Medicine, Royal Surrey County
Hospital, Guildford, United Kingdom
(Grieshaber) Department of Cardiac Surgery, University Hospital Giessen,
Giessen, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Kidney Disease: Improving Global Outcomes (KDIGO)
guidelines recommend a bundle of different measures for patients at
increased risk of acute kidney injury (AKI). Prospective, single-center,
randomized controlled trials (RCTs) have shown that management in
accordance with the KDIGO recommendations was associated with a
significant reduction in the incidence of postoperative AKI in high-risk
patients. However, compliance with the KDIGO bundle in routine clinical
practice is unknown. METHOD(S): This observational prevalence study
was performed in conjunction with a prospective RCT investigating the role
of the KDIGO bundle in high-risk patients undergoing cardiac surgery. A
2-day observational prevalence study was performed in all participating
centers before the RCT to explore routine clinical practice. The
participating hospitals provided the following data: demographics and
surgical characteristics, AKI rates, and compliance rates with the
individual components of the bundle. RESULT(S): Ninety-five patients
were enrolled in 12 participating hospitals. The incidence of AKI within
72 hours after cardiac surgery was 24.2%. In 5.3% of all patients,
clinical management was fully compliant with all 6 components of the
bundle. Nephrotoxic drugs were discontinued in 52.6% of patients, volume
optimization was performed in 70.5%, 52.6% of the patients underwent
functional hemodynamic monitoring, close monitoring of serum creatinine
and urine output was undertaken in 24.2% of patients, hyperglycemia was
avoided in 41.1% of patients, and no patient received radiocontrast
agents. The patients received on average 3.4 (standard deviation [SD]
+/-1.1) of 6 supportive measures as recommended by the KDIGO guidelines.
There was no significant difference in the number of applied measures
between AKI and non-AKI patients (3.2 [SD +/-1.1] vs 3.5 [SD +/-1.1]; P =
.347). CONCLUSION(S): In patients after cardiac surgery, compliance
with the KDIGO recommendations was low in routine clinical practice.

<20>
Accession Number
630596807
Title
Peritoneal dialysis for the prevention of fluid overload in infants after
cardiac surgery - A systematic review and meta-analysis.
Source
Saudi journal of kidney diseases and transplantation : an official
publication of the Saudi Center for Organ Transplantation, Saudi Arabia.
30 (6) (pp 1222-1235), 2019. Date of Publication: 01 Nov 2019.
Author
Bhatt G.C.; Das R.R.; Chaudhary B.; Satapathy A.K.; Malik S.
Institution
(Bhatt, Malik) Department of Pediatrics, All India Institute of Medical
Sciences, Bhopal, Madhya Pradesh, India
(Das, Satapathy) Department of Pediatrics, All India Institute of Medical
Sciences, Bhubaneswar, Odisha, India
(Chaudhary) Department of Pediatrics, All India Institute of Medical
Sciences, Jodhpur, Rajasthan, India
Publisher
NLM (Medline)
Abstract
The objective is to compare peritoneal dialysis with standard care therapy
for the prevention of fluid overload in infants after cardiac surgery. We
searched published literature through the major database up to December
2017. Randomized controlled trials (RCTs), quasi-randomized trials, and
observational studies were included in the study. The primary outcome
measures were as follows: all-cause mortality and duration of
hospitalization. Of the 392-citation retrieved, full text of 7 was finally
assessed for eligibility. Of these, a total of five studies (RCTs = 3, and
observational studies = 2) were included. There was no significant
difference between the prophylactic PD and the standard therapy group for
any of the primary outcomes. The present systematic review shows that
prophylactic PD is not beneficial compared to standard care in infants
postcardiac surgery for congenital heart disease. The GRADE evidence
generated was of "very low quality."

<21>
Accession Number
2004601742
Title
Deep Venous Thrombosis and Pulmonary Embolism in Cardiac Surgical
Patients.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Khoury H.; Lyons R.; Sanaiha Y.; Rudasill S.; Shemin R.J.; Benharash P.
Institution
(Khoury, Sanaiha, Rudasill, Benharash) Cardiovascular Outcomes Research
Laboratories (CORELAB), University of California Los Angeles, Los Angeles,
CA, United States
(Lyons, Sanaiha, Shemin, Benharash) Division of Cardiac Surgery,
University of California Los Angeles, Los Angeles, CA, United States
Publisher
Elsevier USA
Abstract
Background: Deep venous thrombosis and pulmonary embolism are
life-threatening complications after surgery, warranting prophylaxis.
However prophylaxis is not uniformly practiced among cardiac surgical
patients. This study aimed to characterize the national incidence,
mortality, and costs associated with thromboembolism after cardiac
surgery. Method(s): The 2005 to 2015 National Inpatient Sample was
used to identify all adult patients undergoing coronary artery bypass
grafting or valve surgery. International Classification of Disease codes
were used to identify patients with deep venous thrombosis and pulmonary
embolism. Result(s): Of approximately 3 million patients undergoing
cardiac surgery, 1.62% developed deep venous thrombosis and 0.38%
pulmonary embolism. Those with deep venous thrombosis and pulmonary
embolism were more commonly women (33.2% and 36.2 vs 31.2%, P < .001),
older (68.1 and 66.0% vs 65.7 years, P < .001), and had a higher
Elixhauser comorbidity index (4.0 and 4.7 vs 3.7, P < .001). Deep venous
thrombosis and pulmonary embolism were associated with increased mortality
(4.95% and 14.8% vs 2.67%, P < .001). After adjustment for baseline
differences, deep venous thrombosis was associated with an incremental
increase in cost of $12,308, whereas pulmonary embolism was associated
with $13,879 cost increase after cardiac surgery. Pulmonary embolism was
an independent predictor of mortality (adjusted odds ratio, 3.39; 95%
confidence interval, 2.74-4.18). Conclusion(s): The mortality and
financial burden related to thromboembolism in cardiac surgery are
significant. Prophylaxis may be indicated in cardiac surgery patients to
improve quality of care and reduce healthcare costs. Future controlled
randomized trials investigating the benefit of thromboembolism prophylaxis
in cardiac surgery are warranted. Copyright © 2020 The Society of
Thoracic Surgeons

<22>
Accession Number
2003438948
Title
Efficacy and safety of ketoconazole combined with calmodulin inhibitor in
solid organ transplantation: A systematic review and meta-analysis.
Source
Journal of Clinical Pharmacy and Therapeutics. 45 (1) (pp 29-34), 2020.
Date of Publication: 01 Feb 2020.
Author
Xue T.; Yang T.; Chen C.; Wu S.; Li M.; Ma L.; Zhou Y.; Cui Y.
Institution
(Xue, Yang, Chen, Wu, Li, Ma, Zhou, Cui) Department of Pharmacy, Peking
University First Hospital, Beijing, China
(Xue, Wu, Li, Zhou, Cui) Department of Pharmacy Administration and
Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University
Health Science Center, Beijing, China
Publisher
Blackwell Publishing Ltd
Abstract
What is known and objective: Calcineurin inhibitors (CNIs) can
significantly improve the results of solid organ transplantation regarding
graft and patient survival. However, the high cost, chronic nephrotoxicity
and other side effects are major challenges for the long-term use of these
drugs. Ketoconazole can significantly increase the plasma concentration of
CNIs by inhibiting the activity of the cytochrome P450 enzyme. The
combination of ketoconazole-CNIs can reduce the cost of medication for
patients by reducing the dosage of CNIs, but its safety is still
controversial. Therefore, this study was designed to assess the safety and
efficacy of this combination. Method(s): We performed a systematic
literature search in PubMed, Embase, Cochrane Library and
clinicaltrials.gov for randomized controlled trials on ketoconazole and
CNI (cyclosporin or tacrolimus) co-administration in solid organ
transplantation. Two authors independently selected studies, assessed the
risk of bias and extracted data. The meta-analysis was performed in RevMan
5.3 provided by the Cochrane Collaboration. PROSPERO registration number:
CRD42019118796. Results and discussion: Five relevant trials with 326
patients were included. Compared with the controls, ketoconazole combined
with CNIs can significantly reduce the dose of CNIs in patients receiving
solid organ transplantation (WMD = -203.04 mg/day; 95% CI: -310.51 to
-95.57, P =.0002). There was no significant difference in serum creatinine
between the experimental group and the control group (WMD = -0.19 mg/mL;
95% CI: -0.52 to 0.14, P =.26). In addition, there was no significant
difference in the number of rejections between the two groups (OR = 0.58;
95% CI: 0.27 to 1.22, P =.15). What's new and conclusion: The
co-administration of ketoconazole and CNIs can significantly reduce the
dose of CNIs. This combination may be safely used as a CNI-sparing agent
from the time of solid organ transplantation with low-dose ketoconazole,
based on the findings of this review. Copyright © 2019 The
Authors. Journal of Clinical Pharmacy and Therapeutics published by John
Wiley & Sons Ltd

<23>
Accession Number
630531213
Title
European Heart Rhythm Association (EHRA) international consensus document
on how to prevent, diagnose, and treat cardiac implantable electronic
device infections - Endorsed by the Heart Rhythm Society (HRS), the Asia
Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm
Society (LAHRS), International Society for Cardiovascular Infectious
Diseases (ISCVID) and the European Society of Clinical Microbiology and
Infectious Diseases (ESCMID) in collaboration with the European
Association for Cardio-Thoracic Surgery (EACTS).
Source
European Journal of Cardio-thoracic Surgery. 57 (1) (pp E1-E31), 2020.
Date of Publication: 01 Jan 2020.
Author
Blomstrom-Lundqvist C.; Traykov V.; Erba P.A.; Burri H.; Nielsen J.C.;
Bongiorni M.G.; Poole J.; Boriani G.; Costa R.; Deharo J.-C.; Epstein
L.M.; Saghy L.; Snygg-Martin U.; Starck C.; Tascini C.; Strathmore N.;
Kalarus Z.; Boveda S.; Dagres N.; Rinaldi C.A.; Biffi M.; Geller L.; Sokal
A.; Birgersdotter-Green U.; Lever N.; Tajstra M.; Kutarski A.; Rodriguez
D.A.; Hasse B.; Zinkernagel A.; Mangoni E.
Institution
(Blomstrom-Lundqvist) Department of Medical Science and Cardiology,
Uppsala University, Uppsala, Sweden
(Traykov) Department of Invasive Electrophysiology and Cardiac Pacing,
Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
(Erba) Nuclear Medicine, Department of Translational Research and New
Technology in Medicine, University of Pisa, Pisa, Italy
(Burri) Department of Cardiology, University Hospital of Geneva, Geneva,
Switzerland
(Nielsen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Bongiorni) Division of Cardiology and Arrhythmology, CardioThoracic and
Vascular Department, University Hospital of Pisa, Pisa, Italy
(Poole) Division of Cardiology, University of Washington, Seattle, WA,
United States
(Boriani) Division of Cardiology, Department of Biomedical, Metabolic and
Neural Sciences, University of Modena and Reggio Emilia, Policlinico di
Modena, Modena, Italy
(Costa) Department of Cardiovascular Surgery, Heart Institute (InCor) of
the University of Sao Paulo, Sao Paulo, Brazil
(Deharo) Department of Cardiology, Aix Marseille Universite, CHU la
Timone, Marseille, France
(Epstein) Electrophysiology, Northwell Health, Hofstra/Northwell School of
Medicine, Manhasset, NY, United States
(Saghy) Division of Electrophysiology, 2nd Department of Medicine and
Cardiology Centre, University of Szeged, Szeged, Hungary
(Snygg-Martin) Department of Infectious Diseases, Institute of
Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Starck) Department of Cardiothoracic and Vascular Surgery, German Heart
Center Berlin, Berlin, Germany
(Tascini) First Division of Infectious Diseases, Cotugno Hospital, Azienda
Ospedaliera Dei Colli, Naples, Italy
(Strathmore) Department of Cardiology, Royal Melbourne Hospital,
Melbourne, Australia
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac
resynchronization therapy devices are potentially life-saving treatments
for a number of cardiac conditions, but are not without risk. Most
concerning is the risk of a cardiac implantable electronic device (CIED)
infection, which is associated with significant morbidity, increased
hospitalizations, reduced survival, and increased healthcare costs.
Recommended preventive strategies such as administration of intravenous
antibiotics before implantation are well recognized. Uncertainties have
remained about the role of various preventive, diagnostic, and treatment
measures such as skin antiseptics, pocket antibiotic solutions,
anti-bacterial envelopes, prolonged antibiotics post-implantation, and
others. Guidance on whether to use novel device alternatives expected to
be less prone to infections and novel oral anticoagulants is also limited,
as are definitions on minimum quality requirements for centres and
operators and volumes. Moreover, an international consensus document on
management of CIED infections is lacking. The recognition of these issues,
the dissemination of results from important randomized trials focusing on
prevention of CIED infections, and observed divergences in managing
device-related infections as found in an European Heart Rhythm Association
worldwide survey, provided a strong incentive for a 2019 International
State-of-the-art Consensus document on risk assessment, prevention,
diagnosis, and treatment of CIED infections. Copyright © 2019
European Heart Rhythm Association 2019. All rights reserved; no part of
this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, without prior written permission of
the Publishers. For Permissions, please email:
journals.permissions@oup.com.

<24>
Accession Number
630529994
Title
Minimally invasive surgical approaches to left main and left anterior
descending coronary artery revascularization are superior compared to
first- and second-generation drug-eluting stents: A network meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 57 (1) (pp 18-27), 2020. Date
of Publication: 01 Jan 2020.
Author
Indja B.; Woldendorp K.; Black D.; Bannon P.G.; Wilson M.K.; Vallely M.P.
Institution
(Indja, Woldendorp, Bannon) Sydney Medical School, University of Sydney,
Camperdown, NSW, Australia
(Woldendorp, Bannon) Baird Institute of Applied Heart and Lung Surgical
Research, Sydney, Australia
(Woldendorp, Bannon) Department of Cardiothoracic Surgery, Royal Prince
Alfred Hospital, Camperdown, Sydney, NSW, Australia
(Black) Faculty of Health Sciences, University of Sydney, Camperdown, NSW,
Australia
(Wilson, Vallely) Sydney Heart and Lung Surgeons, Camperdown, NSW,
Australia
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: There are a number of minimally invasive approaches to
revascularization of coronary artery disease that involve the left main or
proximal left anterior descending artery; however, studies to date provide
mixed results. METHOD(S): A Bayesian network meta-analysis was
performed to compare early and late postoperative outcomes between
percutaneous coronary intervention with first- and second-generation
drug-eluting stents (DESs), off-pump coronary artery bypass and minimally
invasive direct coronary artery bypass (MIDCAB) in patients with
involvement of left main or left anterior descending disease.
 RESULT(S): A total of 37 studies with 31 728 patients were included
in the analysis. There were no significant differences in early mortality
rates, strokes or myocardial infarctions (MIs). The long-term all-cause
mortality rate was equivalent between the groups. Patients who had
off-pump coronary artery bypass had fewer late MI compared with those who
had first-generation DES (DES1) [odds ratio (OR) 0.38, 95% confidence
interval (CI) 0.20-0.72] and MIDCAB (OR 0.41, 95% CI 0.17-0.97) and
reduced late target vessel revascularization compared with DES1 (OR 0.17,
95% CI 0.09-0.32) and second-generation DES (DES2) (OR 0.32, 95% CI
0.14-0.72). The rate of late major adverse cardiac events was lower with
off-pump coronary artery bypass compared with that with DES1 (OR 0.33, 95%
CI 0.26-0.43) and DES2 (OR 0.62, 95% CI 0.45-0.90). The rate of late major
adverse cardiac events with MIDCAB was lower than that with DES1 (OR 0.43,
95% CI 0.31-0.62) as was that with DES2 compared with DES1 (OR 0.53, 95%
CI 0.39-0.70). CONCLUSION(S): Surgical approaches to left main or
proximal left anterior descending disease remain superior to first- or
second-generation DES in terms of long-term freedom from MI and target
vessel revascularization as well as improved overall long-term survival.
Conflicting rates of late MI and target vessel revascularization in
patients who underwent MIDCAB suggest disease in alternate vessels that
may best be approached via hybrid techniques. Copyright © 2019
The Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<25>
Accession Number
2001630099
Title
Outcomes of Evolut R Versus CoreValve After Transcatheter Aortic Valve
Implantation: A Meta-Analysis.
Source
Heart Lung and Circulation. 29 (2) (pp 288-294), 2020. Date of
Publication: February 2020.
Author
Sun Y.; Li J.; Fan R.; Li G.; Fu M.; Luo S.; Ding H.; Luo J.
Institution
(Sun, Li, Li, Fu, Luo, Ding, Luo) Department of Cardiology, Vascular
Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key
Laboratory of Coronary Heart Disease Prevention, Guangdong General
Hospital, Guangdong Academy of Medical Sciences
(Fan) Department of Cardiovascular Surgery, Vascular Center, Guangdong
Cardiovascular Institute, Guangdong Provincial Key Laboratory of South
China Structural Heart Disease, Guangdong General Hospital, Guangdong
Academy of Medical Sciences
Publisher
Elsevier Ltd
Abstract
Background: Superiority of the new-generation, self-expanding Evolut R
compared with the first-generation CoreValve on outcomes after
transcatheter aortic valve implantation (TAVI) is unclear. This
meta-analysis sought to investigate the outcomes of Evolut R vs CoreValve
after TAVI. Method(s): A systematic review of studies comparing
outcomes of Evolut R and CoreValve after TAVI was performed through
PubMed, EMBASE and Cochrane Library. Crude risk ratios (RRs) were
calculated with 95% confidence intervals using a random effects model.
Outcomes of interest were mortality, myocardial infarction (MI), stroke or
transient ischaemic attack (TIA), severe bleeding, acute kidney injury
(AKI), major vascular complications (MVC), permanent pacemaker
implantation (PPI), moderate or severe paravalvular regurgitation (PVR),
and device failure. Result(s): Six studies involving 11,530 patients
(4,597 receiving Evolut R and 6,933 receiving CoreValve) were included.
There was no significant difference in 30-day all-cause mortality between
Evolut R and CoreValve (3.4% vs 5.0%, p = 0.10). The incidence of MI (0.2%
vs 0.5%, p = 0.02), AKI (6.0% vs 9.2%, p = 0.001), moderate or severe PVR
(6.4% vs 8.0%, p = 0.04), and device failure (3.5% vs 5.2%, p = 0.04) were
significantly lower in Evolut R than CoreValve. There were trends toward
less severe bleeding (7.2% vs 8.8%, p = 0.05) and PPI (18.6% vs 20.8%, p =
0.05) in Evolut R. The rates of stroke or TIA and MVC were similar between
the two prostheses. Conclusion(s): Compared with CoreValve, Evolut R
did not reduce 30-day all-cause mortality, but significantly improved
periprocedural complications after TAVI. Copyright © 2019
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<26>
Accession Number
2004046162
Title
Critical Differences Between Dietary Supplement and Prescription Omega-3
Fatty Acids: A Narrative Review.
Source
Advances in Therapy. (no pagination), 2020. Date of Publication: 2020.
Author
Hilleman D.E.; Wiggins B.S.; Bottorff M.B.
Institution
(Hilleman) School of Pharmacy and Health Professions, Creighton
University, Omaha, NE, United States
(Wiggins) Medical University of South Carolina, Charleston, SC, United
States
(Bottorff) Department of Pharmacy Practice, Manchester University, Fort
Wayne, IN, United States
Publisher
Adis
Abstract
Introduction: Currently available omega-3 (OM-3) fatty acid products in
the US are either nonprescription dietary supplements (e.g., fish oils) or
prescription (Rx) medications. As such, we aimed to describe critical
therapeutic differences among the OM-3 fatty acids, focusing on
differences between fish oil supplements and Rx OM-3s. Method(s): A
narrative review of known papers salient to this topic was conducted.
 Result(s): Despite the multiple purported clinical benefits, the
published evidence for OM-3 dietary supplements is generally insufficient,
inconsistent, or negative. Rx OM-3 products are indicated as an adjunct to
diet to reduce triglycerides (TG) in adults with severe
hypertriglyceridemia (TG >= 500 mg/dl). Recently, the Rx eicosapentaenoic
acid (EPA)-only OM-3, icosapent ethyl, demonstrated cardiovascular (CV)
risk reduction among statin-treated patients at high risk of CV disease in
a large CV outcomes trial (CVOT), and is now also indicated as an adjunct
to maximally tolerated statin therapy to reduce the risk of myocardial
infarction, stroke, coronary revascularization, and unstable angina
requiring hospitalization in adult patients with elevated TG (>= 150
mg/dL) and established CVD or diabetes mellitus and >= 2 additional risk
factors for CVD. In contrast to the rigorous regulatory standards for
safety, efficacy, and manufacturing of medications (whether Rx or over the
counter), the Food and Drug Administration manages dietary supplements as
food. Issues specific to OM-3 dietary supplements include variable
content, labeling inconsistencies, and poor product quality/impurity.
Given these issues, OM-3 dietary supplements should not be substituted for
Rx OM-3 products. The efficacy of the EPA-only Rx OM-3 product in a large
CVOT cannot be extrapolated to other OM-3 products. Conclusion(s):
Consumers and health care providers need to recognize critical differences
between Rx and OM-3 dietary supplements to ensure appropriate use of each
OM-3 product. Copyright © 2020, The Author(s).

<27>
Accession Number
629882231
Title
Reduced Leaflet Motion after Transcatheter Aortic-Valve Replacement.
Source
The New England journal of medicine. 382 (2) (pp 130-139), 2020. Date of
Publication: 09 Jan 2020.
Author
De Backer O.; Dangas G.D.; Jilaihawi H.; Leipsic J.A.; Terkelsen C.J.;
Makkar R.; Kini A.S.; Veien K.T.; Abdel-Wahab M.; Kim W.-K.; Balan P.; Van
Mieghem N.; Mathiassen O.N.; Jeger R.V.; Arnold M.; Mehran R.; Guimaraes
A.H.C.; Norgaard B.L.; Kofoed K.F.; Blanke P.; Windecker S.; Sondergaard
L.
Institution
(De Backer, Dangas, Jilaihawi, Leipsic, Terkelsen, Makkar, Kini, Veien,
Abdel-Wahab, Kim, Balan, Van Mieghem, Mathiassen, Jeger, Arnold, Mehran,
Guimaraes, Norgaard, Kofoed, Blanke, Windecker, Sondergaard) From the
Heart Center, Rigshospitalet, Copenhagen University Hospital, University
of Copenhagen, Copenhagen (O.D.B., K.F.K., L.S.); the Zena and Michael A.
Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai
Hospital (G.D.D., A.S.K., R. Mehran), and NYU Langone Health (H.J.) - both
in New York; National and Kapodistrian University of Athens, Athens
(G.D.D.); the Department of Medical Imaging, St. Paul's Hospital,
University of British Columbia, Vancouver, Canada (J.A.L., P. Blanke); the
Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T.,
O.N.M., B.L.N.), and the Department of Cardiology, Odense University
Hospital, Odense (K.T.V.) - both in Denmark; Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles (R. Makkar); the Department of
Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg (M.A.-W.),
Heart Center Leipzig, University of Leipzig, Leipzig (M.A.-W.), Kerckhoff
Heart Center, Department of Cardiology and Cardiac Surgery, Bad Nauheim
(W.-K.K.), and Kardiologie und Angiologie, Universitatsklinikum Erlangen,
Erlangen (M.A.) - all in Germany; the Department of Internal Medicine,
University of Texas Health Science Center, Houston (P. Balan);
Thoraxcentrum, Erasmus Medisch Centrum (N.V.M.), European Cardiovascular
Research Institute (A.H.C.G.), and Cardialysis, Academic Research
Organization (A.H.C.G.) - all in Rotterdam, the Netherlands; and the
Department of Cardiology, Basel University Hospital, University of Basel,
Basel (R.V.J.), and the Department of Cardiology, Inselspital, Bern
University Hospital, University of Bern, Bern (S.W.) - both in Switzerland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Subclinical leaflet thickening and reduced leaflet motion of
bioprosthetic aortic valves have been documented by four-dimensional
computed tomography (CT). Whether anticoagulation can reduce these
phenomena after transcatheter aortic-valve replacement (TAVR) is not
known. METHOD(S): In a substudy of a large randomized trial, we
randomly assigned patients who had undergone successful TAVR and who did
not have an indication for long-term anticoagulation to a
rivaroxaban-based antithrombotic strategy (rivaroxaban [10 mg] plus
aspirin [75 to 100 mg] once daily) or an antiplatelet-based strategy
(clopidogrel [75 mg] plus aspirin [75 to 100 mg] once daily). Patients
underwent evaluation by four-dimensional CT at a mean (+/-SD) of 90+/-15
days after randomization. The primary end point was the percentage of
patients with at least one prosthetic valve leaflet with grade 3 or higher
motion reduction (i.e., involving >50% of the leaflet). Leaflet thickening
was also assessed. RESULT(S): A total of 231 patients were enrolled.
At least one prosthetic valve leaflet with grade 3 or higher motion
reduction was found in 2 of 97 patients (2.1%) who had scans that could be
evaluated in the rivaroxaban group, as compared with 11 of 101 (10.9%) in
the antiplatelet group (difference, -8.8 percentage points; 95% confidence
interval [CI], -16.5 to -1.9; P=0.01). Thickening of at least one leaflet
was observed in 12 of 97 patients (12.4%) in the rivaroxaban group and in
33 of 102 (32.4%) in the antiplatelet group (difference, -20.0 percentage
points; 95% CI, -30.9 to -8.5). In the main trial, the risk of death or
thromboembolic events and the risk of life-threatening, disabling, or
major bleeding were higher with rivaroxaban (hazard ratios of 1.35 and
1.50, respectively). CONCLUSION(S): In a substudy of a trial
involving patients without an indication for long-term anticoagulation who
had undergone successful TAVR, a rivaroxaban-based antithrombotic strategy
was more effective than an antiplatelet-based strategy in preventing
subclinical leaflet-motion abnormalities. However, in the main trial, the
rivaroxaban-based strategy was associated with a higher risk of death or
thromboembolic complications and a higher risk of bleeding than the
antiplatelet-based strategy. (Funded by Bayer; GALILEO-4D
ClinicalTrials.gov number, NCT02833948.). Copyright © 2019
Massachusetts Medical Society.

<28>
Accession Number
629882032
Title
A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve
Replacement.
Source
The New England journal of medicine. 382 (2) (pp 120-129), 2020. Date of
Publication: 09 Jan 2020.
Author
Dangas G.D.; Tijssen J.G.P.; Wohrle J.; Sondergaard L.; Gilard M.;
Mollmann H.; Makkar R.R.; Herrmann H.C.; Giustino G.; Baldus S.; De Backer
O.; Guimaraes A.H.C.; Gullestad L.; Kini A.; von Lewinski D.; Mack M.;
Moreno R.; Schafer U.; Seeger J.; Tchetche D.; Thomitzek K.; Valgimigli
M.; Vranckx P.; Welsh R.C.; Wildgoose P.; Volkl A.A.; Zazula A.; van
Amsterdam R.G.M.; Mehran R.; Windecker S.
Institution
(Dangas, Tijssen, Wohrle, Sondergaard, Gilard, Mollmann, Makkar, Herrmann,
Giustino, Baldus, De Backer, Guimaraes, Gullestad, Kini, von Lewinski,
Mack, Moreno, Schafer, Seeger, Tchetche, Thomitzek, Valgimigli, Vranckx,
Welsh, Wildgoose, Volkl, Zazula, van Amsterdam, Mehran, Windecker) From
the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York (G.D.D., G.G., A.K., R. Mehran);
National and Kapodistrian University of Athens, Athens (G.D.D.); Amsterdam
University Medical Centers-University of Amsterdam, Amsterdam (J.G.P.T.),
and Cardialysis, Academic Research Organization, Rotterdam (J.G.P.T.,
A.H.C.G., R.G.M.A.) - both in the Netherlands; the Department of Internal
Medicine II, University of Ulm, Ulm (J.W., J.S.), the Department of
Internal Medicine I, St. Johannes Hospital Dortmund, Dortmund (H.M.), the
Department of Internal Medicine III, Heart Center, University Hospital of
Cologne, Cologne (S.B.), the Department of General and Interventional
Cardiology, University Hospital Hamburg-Eppendorf, Hamburg (U.S.), and
Bayer, Berlin (K.T.) - all in Germany; the Heart Center, Rigshospitalet,
University of Copenhagen, Copenhagen (L.S., O.D.B.); La Cavale Blanche
University Hospital, Cardiology Department, Brest (M.G.), and Clinique
Pasteur, Toulouse (D.T.) - both in France; Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles (R.R.M.); the University of
Pennsylvania, Philadelphia (H.C.H.); the Department of Cardiology, Oslo
University Hospital Rikshospitalet, and the Institute of Clinical
Medicine, University of Oslo - all in Oslo (L.G.); the Department of
Cardiology, Medical University of Graz, Graz, Austria (D.L.); Baylor Scott
and White Health, Temple, TX (M.M.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Whether the direct factor Xa inhibitor rivaroxaban can prevent
thromboembolic events after transcatheter aortic-valve replacement (TAVR)
is unclear. METHOD(S): We randomly assigned 1644 patients without an
established indication for oral anticoagulation after successful TAVR to
receive rivaroxaban at a dose of 10 mg daily (with aspirin at a dose of 75
to 100 mg daily for the first 3 months) (rivaroxaban group) or aspirin at
a dose of 75 to 100 mg daily (with clopidogrel at a dose of 75 mg daily
for the first 3 months) (antiplatelet group). The primary efficacy outcome
was the composite of death or thromboembolic events. The primary safety
outcome was major, disabling, or life-threatening bleeding. The trial was
terminated prematurely by the data and safety monitoring board because of
safety concerns. RESULT(S): After a median of 17 months, death or a
first thromboembolic event (intention-to-treat analysis) had occurred in
105 patients in the rivaroxaban group and in 78 patients in the
antiplatelet group (incidence rates, 9.8 and 7.2 per 100 person-years,
respectively; hazard ratio with rivaroxaban, 1.35; 95% confidence interval
[CI], 1.01 to 1.81; P=0.04). Major, disabling, or life-threatening
bleeding (intention-to-treat analysis) had occurred in 46 and 31 patients,
respectively (4.3 and 2.8 per 100 person-years; hazard ratio, 1.50; 95%
CI, 0.95 to 2.37; P=0.08). A total of 64 deaths occurred in the
rivaroxaban group and 38 in the antiplatelet group (5.8 and 3.4 per 100
person-years, respectively; hazard ratio, 1.69; 95% CI, 1.13 to 2.53).
 CONCLUSION(S): In patients without an established indication for oral
anticoagulation after successful TAVR, a treatment strategy including
rivaroxaban at a dose of 10 mg daily was associated with a higher risk of
death or thromboembolic complications and a higher risk of bleeding than
an antiplatelet-based strategy. (Funded by Bayer and Janssen
Pharmaceuticals; GALILEO ClinicalTrials.gov number,
NCT02556203.). Copyright © 2019 Massachusetts Medical Society.

<29>
Accession Number
628731886
Title
Meta-analysis of prognostic impact of peripheral arterial disease on
mortality after transcatheter aortic valve implantation.
Source
The Journal of cardiovascular surgery. 60 (6) (pp 723-732), 2019. Date of
Publication: 01 Dec 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Takagi) Department of Cardiovascular Surgery, Kitasato University School
of Medicine, Sagamihara, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, NY,
NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, MI, Detroit,
United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The aim of this study was to determine whether peripheral
arterial disease (PAD) is an independent predictor of mortality in
patients who undergo transcatheter aortic valve implantation (TAVI) and we
performed meta-analysis of currently available studies. EVIDENCE
ACQUISITION: MEDLINE and EMBASE were searched through June 2018 using
Web-based search engines (PubMed and OVID). We included comparative
studies of patients with PAD versus those without PAD and cohort studies
which investigated PAD as one of prognostic factors of mortality, which
used the multivariable analysis and reported an adjusted odds and hazard
ratio (OR/HR) for early (30-day or in-hospital) and late (including early)
mortality after TAVI. Study-specific estimates were combined using inverse
variance-weighted averages of logarithmic ORs/HRs in the random-effects
model. EVIDENCE SYNTHESIS: The primary meta-analysis which pooled all the
ORs/HRs demonstrated that PAD was associated with a statistically
significant increase in both early (OR, 1.21; P=0.02) and midterm (1-year
to 7-year) mortality (HR, 1.31; P<0.00001). The secondary meta-analysis
which exclusively pooled approach-adjusted/stratified ORs/HRs demonstrated
that PAD was associated with a strong trend toward (though statistically
non-significant) an increase in early mortality (OR, 1.18; P=0.07) and a
still statistically significant increase in midterm mortality (OR, 1.24;
P=0.0001). Meta-regression coefficients for the proportion of patients who
underwent transfemoral TAVI were not statistically significant (P for
early/midterm mortality =0.24/0.52). CONCLUSION(S): The present
meta-analysis clearly highlighted that PAD was an independent predictor of
both early and midterm mortality in patients who underwent TAVI.

<30>
Accession Number
628330701
Title
Effects of Exercise after Percutaneous Coronary Intervention on Cardiac
Function and Cardiovascular Adverse Events in Patients with Coronary Heart
Disease: Systematic Review and Meta-Analysis.
Source
Journal of sports science & medicine. 18 (2) (pp 213-222), 2019. Date of
Publication: 01 Jun 2019.
Author
Zhang H.; Chang R.
Institution
(Zhang) Department of Cardiology, China-Japan Friendship Hospital,
Beijing, China
(Chang) Department of Cardiology, Qinghai Provincial People's Hospital,
Qinghai Province, Xining, China
Publisher
NLM (Medline)
Abstract
Exercise program has been associated with improved cardiovascular outcomes
in patients sustaining coronary artery disease. However, little is known
about the role of exercise after percutaneous coronary intervention (PCI).
Published literature was searched from Embase, PubMed, Wanfang Data,
Cochrane Database of Systematic Reviews, China National Knowledge
Infrastructure (CNKI) and Central Database. Exercise versus no exercise
following PCI in the patients with coronary heart disease (CHD) was
investigated in randomized trials. Left ventricular end diastolic diameter
(LVEDD), left ventricular ejection fraction (LVEF), 6-minute walking
distance (6MWD), cardiac death, myocardial infarction, coronary
angioplasty, coronary artery bypass surgery (CABG), and angina pectoris or
restenosis per randomized patients were analyzed by meta-analytic
procedure to compare the curative effect of exercise program with
exclusive exercise program after PCI. Ten randomized controlled trials
including 1274 subjects (636 in exercise group and 638 in control group)
were analyzed. The meta-analysis demonstrated that LVEF was significantly
improved in exercise group (MD = 2.82, 95% CI [1.50, 4.14], p < 0.05). In
contrast, the incidence rate of cardiac death (RR = 0.24, 95% CI [007,
0.76], p = 0.02), myocardial infarction (RR = 0.23, 95% CI [0.09, 0.57], p
= 0.002), coronary angioplasty (RR = 0.47, 95% CI [0.26, 0.84], p = 0.01),
angina pectoris (RR = 0.39, 95% CI [0.24, 0.64], p = 0.0002) and
restenosis (RR = 0.36, 95% CI [0.16, 0.83], p = 0.02) were significantly
lower in exercise group. LVEDD (MD = -2.01, 95% CI [-4.72, 0.70]), 6MWD
(MD = 50.85, 95% CI [-13.24, 114.94]), and CABG (RD = -0.01, 95% CI
[-0.05, 0.03]) were not significantly different in the patients with or
without exercise (p = 0.71). Trial sequential analysis reflected
traditional meta-analysis might generate a false positive conclusion for
MI and cardiac death. There was no firm evidence to support the beneficial
effects of exercise after PCI for the CHD patients to improve heart
function or to reduce the incidence of adverse cardiovascular events.

<31>
Accession Number
2003291445
Title
Canadian Cardiovascular Congress 2019.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp A1-A18), 2019. Date of
Publication: October 2019.
Author
Anonymous
Publisher
Elsevier Inc.
Abstract
The proceedings contains 344 papers. The topics discussed include:
OUTCOMES AFTER TRANSCATHETER TRICUSPID VALVE INTERVENTIONS COMPARED TO
MEDICAL THERAPY ALONE;UPSTREAM EFFECTS OF TRANSCATHETER MITRAL VALVE
REPAIR : IMPACT ON TRICUSPID VALVE REGURGITATION;A NOVEL ARRHYTHMOGENIC
RIGHT VENTRICULAR CARDIOMYOPATHY (ARVC) BIOMARKER ANTI-DSG2 IS ABSENT IN
ATHLETES WITH RIGHT VENTRICULAR ENLARGEMENT;FROM 'IT MAKES ME FEEL FREE'
TO 'THEY WON'T LET ME PLAY': THE BODY AND PHYSICAL ACTIVITY-RELATED
PERCEPTIONS AND EXPERIENCES OF CHILDREN WITH CONGENITAL HEART
DISEASE;ARTIFICIAL INTELLIGENCE ASSESSMENT OF LEFT VENTRICULAR VOLUMES AND
FUNCTION ON POCUS IMAGING;MACHINE LEARNING TO FACILITATE ASSESSMENT OF
DIASTOLIC FUNCTION BY ECHOCARDIOGRAPHY;STROKE RISK PREDICTION IN PATIENTS
WITH ATRIAL FIBRILLATION AND RHEUMATIC HEART DISEASE: RESULTS FROM THE
RE-LY AF REGISTRY;PROVISION OF EMERGENCY DEPARTMENT PRESCRIPTIONS FOR ORAL
ANTICOAGULATION AND SUBSEQUENT LONG-TERM USE IN PATIENTS WITH ATRIAL
FIBRILLATION;LOSS OF ENDOTHELIAL CELL-SPECIFIC INTRAFLAGELLAR TRANSPORT
PROTEIN 88 ENHANCES DOXORUBICIN-INDUCED CARDIOTOXICITY-RELATED
PHENOTYPES;BENEFITS OF SLEEP APNEA SCREENING FOR RAPID ASSESSMENT AND
MANAGEMENT OF DISEASE PROCESSES IN CARDIOVASCULAR PATIENTS;EX SITU HEART
PERFUSION IMPROVES PRESERVATION OF ENDOTHELIAL FUNCTION IN BOTH DBD AND
DCD HEARTS;ASSESSMENT OF CEREBRAL PERFUSION AND ACTIVITY DURING
NORMOTHERMIC REGIONAL PERFUSION IN A PORCINE MODEL OF DONATION AFTER
CIRCULATORY DEATH;DUAL ANTITHROMBOTIC THERAPY WITH DIRECT-ACTING ORAL
ANTICOAGULANTS AFTER ACUTE CORONARY SYNDROME OR PCI IN ATRIAL
FIBRILLATION: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS;THE IMPACT
OF A REGIONAL ST ELEVATION MYOCARDIAL INFARCTION PROTOCOL ON REPERFUSION
DELIVERY AND CLINICAL OUTCOMES OVER 11 YEARS: INSIGHTS FROM THE VANCOUVER
COASTAL HEALTH AUTHORITY ST ELEVATION MYOCARDIAL INFARCTION PROGRAM;A
RANDOMIZED CLINICAL TRIAL OF MIDODRINE FOR THE PREVENTION OF VASOVAGAL
SYNCOPE BY THE POST4 INVESTIGATORS;VALIDATION OF HEART FAILURE PATIENT
BOOKLETS;CADAVERIC ECMO CANNULATION SIMULATOR

<32>
Accession Number
630520160
Title
Preoperative exercise and recovery after cardiac surgery: A meta-analysis.
Source
BMC Cardiovascular Disorders. 20 (1) (no pagination), 2020. Article
Number: 2. Date of Publication: 08 Jan 2020.
Author
Zheng Y.-T.; Zhang J.-X.
Institution
(Zheng) Department of Interventional Vascular Surgery, Fourth Affiliated
Hospital of Harbin Medical University, Harbin, China
(Zhang) Minimally Invasive Tumor Therapies Center, Beijing Hospital, No. 1
Dongdan Dahua Road, Dongcheng District, Beijing 100730, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: To evaluate the association between preoperative exercise and
recovery after cardiac surgery. Method(s): Literature comparing
preoperative exercise and the control group for patients receiving cardiac
surgery was retrieved in multiple databases. Review Manager 5.2 was
adopted for meta-analysis, sensitivity analysis and bias analysis.
 Result(s): Finally, 6 relevant studies satisfied the inclusion
criteria. There was significant difference in length of stay in intensive
care unit (ICU) (MD- = 1.35, 95%CI [- 2.64, - 0.06], P = 0.04; P for
heterogeneity < 0.0001, I 2 = 88%) and physical function after
operation (P of heterogeneity = 0.32, I 2 = 12%, Z = 9.92, P of
over effect< 0.00001). The meta-analysis suggested that there was no
significant difference in white blood cell count (WBC) at postoperative
day 7 and mental health after operation between the exercise group and the
control group. Limited publication bias was observed in this study.
 Conclusion(s): Preoperative exercise including inhaled muscle
training, aerobics, resistance training and stretching could promote
recovery after cardiac surgery. Copyright © 2020 The Author(s).

<33>
Accession Number
630579995
Title
Late clinical outcomes of myocardial hybrid revascularization versus
coronary artery bypass grafting for complex triple-vessel disease:
Long-term follow-up of the randomized MERGING clinical trial.
Source
Catheterization and cardiovascular interventions : official journal of the
Society for Cardiac Angiography & Interventions. (no pagination), 2020.
Date of Publication: 10 Jan 2020.
Author
Esteves V.; Oliveira M.A.P.; Feitosa F.S.; Mariani J.; Campos C.M.; Hajjar
L.A.; Lisboa L.A.; Jatene F.B.; Filho R.K.; Lemos Neto P.A.
Institution
(Esteves, Mariani, Campos, Lemos Neto) Department of Interventional
Cardiology, Heart Institute - InCor, University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Oliveira, Lisboa, Jatene) Division of Cardiovascular Surgery, Heart
Institute - InCor, University of Sao Paulo Medical School, Sao Paulo,
Brazil
(Feitosa, Hajjar, Filho) Division of Clinical Cardiology, Heart Institute
- InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
(Mariani, Campos, Lemos Neto) Interventional Cardiology, Hospital
Israelita Albert Einstein, Sao Paulo, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This article aimed to compare the outcomes after hybrid
revascularization with conventional coronary artery bypass grafting (CABG)
surgery. BACKGROUND: The concept of hybrid coronary revascularization
combines the advantages of CABG and percutaneous coronary intervention to
improve the treatment of patients with complex multivessel disease.
 METHOD(S): The Myocardial hybrid revascularization versus coronary
artERy bypass GraftING for complex triple-vessel disease-MERGING study is
a pilot randomized trial that allocated 60 patients with complex
triple-vessel disease to treatment with hybrid revascularization or
conventional CABG (2:1 ratio). The primary outcome was the composite of
all-cause death, myocardial infarction, stroke, or unplanned repeat
revascularization at 2years. RESULT(S): Clinical and anatomical
characteristics were similar between groups. After a mean follow-up of
802+/-500days, the primary endpoint rate was 19.3% in the hybrid arm and
5.9% in the CABG arm (p = NS). The incidence of unplanned
revascularization increased over time in both groups, reaching 14.5 versus
5.9% in the hybrid and in the CABG groups, respectively (p =.4). Of note,
in the hybrid group, there were no reinterventions driven by the
occurrence of stent restenosis. CONCLUSION(S): Hybrid myocardial was
feasible but associated with increasing rates of major adverse
cardiovascular events during 2years of clinical follow-up, while the
control group treated with conventional surgery presented with low rates
of complications during the same period. In conclusion, before more
definitive data arise, hybrid revascularization should be applied with
careful attention in practice, following a selective case-by-case
indication. Copyright © 2020 Wiley Periodicals, Inc.

<34>
Accession Number
630579612
Title
Pre-procedural Elevated Cardiac Troponin Predict Risk of Long-term
All-cause Mortality after Transcatheter Aortic Valve Replacement: A
Meta-Analysis of Prospective Studies.
Source
Biomarkers : biochemical indicators of exposure, response, and
susceptibility to chemicals. (pp 1-21), 2020. Date of Publication: 10 Jan
2020.
Author
Li Y.; Pei H.; Zhou C.; Lou Y.
Institution
(Li, Lou) Department of Cardiology, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
(Pei) Department of Cardiology, First Affiliated Hospital of Baotou
Medical College, Baotou, Inner Mongolia, China
(Zhou) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Disease, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing 100037, China
Publisher
NLM (Medline)
Abstract
Background: The purpose of this meta-analysis was to evaluate the
relationship between elevated cardiac troponin pre- transcatheter aortic
valve replacement (TAVR) and long-term all-cause mortality.
 Method(s): Prospective studies with the endpoint of all-cause
mortality were included. We primarily used the fixed-effect model weighted
by inverse variance. Meta-regression and subgroup analyses were conducted
to explore the potential sources of heterogeneity by specified study
characteristics. Result(s): Seven prospective studies comprising of
3049 subjects were included in our meta-analysis. Pre-procedural elevated
cardiac troponin was associated with increased risk of long-term mortality
post TAVR [hazard ratio (HR) 2.25, 95% CI 1.83 to 2.78, p=0.000, I2 =
30.3%, p for heterogeneity 0.197]. In addition, Subgroup analyses has
shown that the group with an younger age (<82y) seemed to have a higher
risk of all-cause mortality than the group with older age (>=82y) [HR 4.08
(2.41 to 6.89) VS 2.01 (1.60 to 2.53), P=0.016 for subgroup difference].
 Conclusion(s): Pre-procedural elevated cardiac troponin was
associated with increased long-term all-cause mortality in patients
undergoing TAVR.

<35>
Accession Number
2004593538
Title
Are Serum Potassium and Magnesium Levels Associated with Atrial
Fibrillation After Cardiac Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Howitt S.H.; Grant S.W.; Campbell N.G.; Malagon I.; McCollum C.
Institution
(Howitt, Grant, Campbell, Malagon, McCollum) Division of Cardiovascular
Sciences, University of Manchester, ERC, Manchester University Hospitals
Foundation Trust, Manchester, United Kingdom
(Malagon) Department of Cardiothoracic Anesthesia and Critical Care,
Wythenshawe Hospital, Manchester University Hospitals Foundation Trust,
Manchester, United Kingdom
Publisher
W.B. Saunders
Abstract
Objectives: Potassium and magnesium are frequently administered after
cardiac surgery to reduce the risk of atrial fibrillation (AF). The
evidence for this practice is unclear. This study was designed to evaluate
the relationship between serum potassium and magnesium levels and AF after
cardiac surgery. Design(s): Observational cohort study.
 Setting(s): A cardiac intensive care unit in the United Kingdom.
 Participant(s): Patients undergoing cardiac surgery between January
2013 and November 2017. Intervention(s): None. Measurements and
Main Results: Cardiac rhythm was assessed using continuous
electrocardiogram (ECG) monitoring in 3,068 patients on the cardiac
intensive care unit. Associations between serum potassium and magnesium
concentrations extracted from hospital databases and postoperative AF were
assessed using univariable and multivariable analyses. The association
between electrolyte supplementation therapy and AF was also analyzed. AF
developed within 72 hours of cardiac surgery in 545 (17.8%) of the 3,068
patients. After adjusting for logistic EuroSCORE, surgery type,
cardiopulmonary bypass time and age, mean serum potassium concentration
<4.5 mmol/L was associated with an increased risk of AF (odds ratio [OR]
1.43 (95% confidence interval (CI): 1.17-1.75), p < 0.001). Mean magnesium
concentration <1.0 mmol/L was not associated with an increased risk of AF
(OR 0.89, 0.71-1.13, p = 0.342), but the administration of magnesium was
associated with increased risk of developing AF (OR 1.61, 1.33-1.96, p <
0.001). Conclusion(s): Maintaining a serum potassium concentration
>=4.5 mmol/L after cardiac surgery may reduce the incidence of
postoperative AF. Magnesium supplementation was associated with an
increased risk of postoperative AF. Prospective randomized trials are
required to clarify these associations. Copyright © 2019

<36>
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. 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. 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. 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). 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) Copyright © 2020 American College of Cardiology
Foundation

<37>
[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. Copyright © 2019 Italian Federation of Cardiology - I.F.C.
All rights reserved.

<38>
[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. Copyright © 2019 Italian Federation
of Cardiology - I.F.C. All rights reserved.

<39>
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. Method(s): A
narrative review of the available literature was performed.
 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.
 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. Copyright © 2019 The Acta Anaesthesiologica
Scandinavica Foundation. Published by John Wiley & Sons Ltd

<40>
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.
 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. 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. 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. Copyright © 2019 European Society for Vascular Surgery

<41>
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. Copyright © 2019 Elsevier Inc.

<42>
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. Copyright © 2019 Elsevier Inc.

<43>
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. Method(s): In a prospective, blinded trial, 31 patients were
randomized to receive either milrinone (0.4 and 0.8 micro g/kg/min, n
= 16) or levosimendan (0.1 and 0.2 micro 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. 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).
 Conclusion(s): The direct RV inotropic and lusitropic effects of
levosimendan and milrinone were comparable at clinically relevant infusion
rates. Copyright © 2019 The Acta Anaesthesiologica Scandinavica
Foundation. Published by John Wiley & Sons Ltd

<44>
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. 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. 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). 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. Copyright © 2019 Forum Multimedia Publishing, LLC.

<45>
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. 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. 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. 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. Copyright © 2019 Journal of
Thoracic Disease. All rights reserved.

<46>
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. 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. 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).
 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. Copyright © 2019 Journal of Thoracic Disease. All rights
reserved.

<47>
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.
 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. 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). 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. Copyright © 2019 Journal of Thoracic
Disease. All rights reserved.

<48>
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. 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). 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). 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. Copyright © 2019 Journal of
Thoracic Disease. All rights reserved.

<49>
Accession Number
630420104
Title
Effect of Ulinastatin Combined With Dexmedetomidine on Postoperative
Cognitive Dysfunction in Patients Who Underwent Cardiac Surgery.
Source
Frontiers in Neurology. 10 (no pagination), 2019. Article Number: 1293.
Date of Publication: 19 Dec 2019.
Author
Zhou M.; Lyu Y.; Zhu Y.; Jiang T.; Wu C.; Yang J.; Wang L.
Institution
(Zhou, Yang) Department of Anesthesiology, Intensive Care Medicine and
Pain Medicine, First Affiliated Hospital of Soochow University, Suzhou,
China
(Zhou, Zhu, Jiang, Wu, Wang) Department of Anesthesiology, Xuzhou Central
Hospital, Xuzhou, China
(Lyu) Department of Anesthesiology, Minhang Hospital, Fudan University,
Shanghai, China
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: Recent studies have shown that early diagnosis and
intervention promote the patient's good prognosis. For patients who
underwent cardiac surgery and require extracorporeal circulation support,
the incidence of postoperative cognitive dysfunction (POCD) is higher than
in other types of surgery due to greater changes in brain perfusion
compared with normal physiological conditions. Recent studies have
confirmed that the use of ulinastatin or dexmedetomidine in the
perioperative period effectively reduces the incidence of POCD. In this
study, ulinastatin was combined with dexmedetomidine to assess whether the
combination of the two drugs could reduce the incidence of POCD.
 Method(s): One hundred and eighty patients with heart valve
replacement surgery undergoing cardiopulmonary bypass from August 2017 to
December 2018 were enrolled, with age 60-80 years, American Society of
Anesthesiologists (ASA) grades I-III, education level above elementary
school, and either gender. According to the random number table method,
patients were grouped into ulinastatin + dexmedetomidine (U+D) group,
ulinastatin (U) group, dexmedetomidine (D) group, and normal saline (N)
control group. Group U was pumped 20,000 UI/kg immediately after induction
and the first day after surgery, group D continued to pump 0.4 mug/kg/h
from induction to 2 h before extubation, group U+D dexmedetomidine 0.4
mug/kg/h + ulinastatin 20,000 UI/kg, and group N equal volume of
physiological saline. The patients were enrolled with Mini-Mental State
Examination (MMSE) before surgery. The cognitive function was assessed by
Montreal Cognitive Assessment (MoCA) on the first day before surgery and
on the seventh day after surgery. Inflammatory factors, such as S100beta
protein, interleukin (IL)-6, matrix metalloproteinase (MMP)-9, and tumor
necrosis factor (TNF)-alpha, were detected in peripheral blood before
anesthesia (T0), immediately after surgery (T1), and immediately after
extubation (T2). Result(s): One hundred and fifty-four patients
enrolled in this study. Compared with group N, the incidence of POCD in
group U+D was the lowest (P < 0.05), followed by group U and group D.
Group U+D had the lowest concentration of inflammatory factors at the T1
and T2 time points, followed by group U and group D. Conclusion(s):
Both ulinastatin and dexmedetomidine can reduce the perioperative
inflammatory response and the incidence of POCD in patients with heart
valve surgery, and their combination can better reduce the incidence of
POCD. © Copyright © 2019 Zhou, Lyu, Zhu, Jiang, Wu, Yang and
Wang.

<50>
Accession Number
2003443964
Title
A randomized control trial comparing prophylactic dexmedetomidine versus
clonidine on rates and duration of delirium in older adult patients
undergoing coronary artery bypass grafting.
Source
Journal of Clinical Anesthesia. 61 (no pagination), 2020. Article Number:
109622. Date of Publication: May 2020.
Author
Shokri H.; Ali I.
Institution
(Shokri, Ali) Ain Shams University, Cairo, Egypt
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: Postoperative delirium occurs in 20-50% of elderly
patients undergoing cardiac surgery and increases morbidity and mortality.
We investigated whether prophylactic dexmedetomidine could reduce delirium
incidence in elderly patients after coronary artery bypass grafting
(CABG), compared with clonidine. Design(s): Prospective observational
trial. Setting(s): Academic university hospital. Participant(s):
Patients (60-70 years old) who underwent CABG and received either
dexmedetomidine or clonidine infusion postoperatively.
 Intervention(s): Patients were randomly allocated to dexmedetomidine
or clonidine groups. In the dexmedetomidine group, patients received an
initial infusion of 0.7-1.2 mug/kg/h; sedation and analgesia were
evaluated after 45-60 min. If the Richmond assessment sedation score
(RASS) increased from +1 to +4, the infusion rate was increased by 0.1-0.2
mug/kg/h every 30 min, up to 1-1.4 mug/kg body-weight/h. Dexmedetomidine
infusion was not discontinued pre-extubation; thereafter, infusion was
reduced by 0.1 mug/kg/h until 0.2 mug/kg/h. The maximum infusion duration
was 72 h. In the clonidine group, patients received an initial infusion of
0.5 mug/kg, followed by 1-2 mug/kg/h, if the RASS changed from +1 to +4.
This was continued throughout mechanical ventilation. Measurements:
Patients were followed up to 5 days post-surgery. Delirium incidence,
extubation time, lengths of intensive care unit (ICU) and hospital stay,
need for inotropic support or vasopressors, mean arterial blood pressure
and heart rate, hospital mortality rate, total postoperative morphine
dose, number of patients receiving haloperidol, and adverse events were
recorded. Main Result(s): Two-hundred-and-eighty-six patients
(dexmedetomidine, 144; clonidine, 142) were studied. Dexmedetomidine was
associated with lower risk and duration of delirium, shorter mechanical
ventilation duration and ICU stay, lower mortality rate, and lower
morphine consumption than the clonidine group. Dexmedetomidine
significantly decreased heart rates after ICU admission.
 Conclusion(s): Postoperative infusion of dexmedetomidine provides a
feasible option for postoperative control of delirium after CABG in adult
patients. Copyright © 2019 Elsevier Inc.

<51>
Accession Number
2003895247
Title
Toward a robust tool for pharmacokinetic-based personalization of
treatment with tacrolimus in solid organ transplantation: A model-based
meta-analysis approach.
Source
British Journal of Clinical Pharmacology. 85 (12) (pp 2793-2823), 2019.
Date of Publication: 01 Dec 2019.
Author
Nanga T.M.; Doan T.T.P.; Marquet P.; Musuamba F.T.
Institution
(Nanga, Doan, Marquet) INSERM UMR 1248, Universite de Limoges, FHU
support, Limoges Cedex 87025, France
(Musuamba) Federal Agency for Medicines and Health Products, Brussels,
Belgium
(Musuamba) Faculte des sciences pharmaceutiques, Universite de Lubumbashi,
Lubumbashi, Congo
Publisher
Blackwell Publishing Ltd
Abstract
Aims: The objective of this study is to develop a generic model for
tacrolimus pharmacokinetics modelling using a meta-analysis approach, that
could serve as a first step towards a prediction tool to inform
pharmacokinetics-based optimal dosing of tacrolimus in different
populations and indications. Method(s): A systematic literature
review was performed and a meta-model developed with NONMEM software using
a top-down approach. Historical (previously published) data were used for
model development and qualification. In-house individual rich and sparse
tacrolimus blood concentration profiles from adult and paediatric kidney,
liver, lung and heart transplant patients were used for model validation.
Model validation was based on successful numerical convergence, adequate
precision in parameter estimation, acceptable goodness of fit with respect
to measured blood concentrations with no indication of bias, and
acceptable performance of visual predictive checks. External validation
was performed by fitting the model to independent data from 3 external
cohorts and remaining previously published studies. Result(s): A
total of 76 models were found relevant for meta-model building from the
literature and the related parameters recorded. The meta-model developed
using patient level data was structurally a 2-compartment model with
first-order absorption, absorption lag time and first-time varying
elimination. Population values for clearance, intercompartmental
clearance, central and peripheral volume were 22.5 L/h, 24.2 L/h, 246.2 L
and 109.9 L, respectively. The absorption first-order rate and the lag
time were fixed to 3.37/h and 0.33 hours, respectively. Transplanted organ
and time after transplantation were found to influence drug apparent
clearance whereas body weight influenced both the apparent volume of
distribution and the apparent clearance. The model displayed good results
as regards the internal and external validation. Conclusion(s): A
meta-model was successfully developed for tacrolimus in solid organ
transplantation that can be used as a basis for the prediction of
concentrations in different groups of patients, and eventually for
effective dose individualization in different subgroups of the
population. Copyright © 2019 The British Pharmacological Society

<52>
Accession Number
630549632
Title
Sternal precautions and prone positioning of infants following cardiac
surgery: A nationwide survey.
Source
Cardiopulmonary Physical Therapy Journal. Conference: Combined Sections
Meeting of the American Physical Therapy Association, CSM 2020. United
States. 31 (1) (pp e7-e8), 2020. Date of Publication: January 2020.
Author
Clifton A.J.; Cahalin L.P.; Moore J.G.; Cruz G.; Patel Y.
Publisher
Lippincott Williams and Wilkins
Abstract
PURPOSE/HYPOTHESIS: There is insufficient evidence to guide current
practice of pediatric sternal precautions (PSP) and prone positioning
restrictions (PPR) for infants following cardiac surgery. The purpose of
this study is to describe current use of PSP and PPR following median
sternotomy in infants, birth to 12 months. NUMBER OF SUBJECTS:
Sixty-eight. MATERIALS AND METHODS: A Web-based survey was developed from
a review of current literature and consultation with cardiopulmonary and
pediatric clinical specialists with acute care experience. The final
survey contained 21 questions regarding: location of institution (n = 1),
profession and experience (n = 4), institutional practice of PSP (n = 8),
and institutional practice of PSP related to prone positioning (n = 8). A
snowball sampling resulted in 68 respondents: cardiologists (25%),
registered nurses (5.9%), advanced registered nurse practitioners (22.1%),
physical therapists (38.2%), occupational therapists (5.9%), and physician
assistants (2.9%). Regional representation included: South (45%), Midwest
(24%), West (21%), and Northeast (10%). RESULT(S): 82.4% of
respondents reported their institutions had an established protocol for
PSP with a duration of 1-2 weeks (3.9%), 3-4 weeks (15.8%), 5-6 weeks
(51.3%), and 7-8 weeks (10.5%). Use and duration of PSP were dependent on
sternal (11.8%) and hemodynamic (3.9%) stability. 78.2% of respondents
reported that the PSP were the same duration for every patient. Most
common PSP included: no lifting at the axillae (37.6%) and no pulling of
arms (36.9%) to achieve sitting. 57.9% of institutions with PSP included
PPR: no modifications allowed (6.1%), patient held against the mother's
chest with mother leaning forward (40.8%), crib/isolette inclined (14.3%).
Almost 40% of respondents selected "other" PPR with 12 respondents
reporting that placement in prone was appropriate as long as an incline
was provided and 10 reported no prone precautions. Respondent opinion of
PPR were: modified PPR (66.7%), strict PPR (3.0%), no PPR (30.3%). Opinion
of ideal length (in weeks) of PPR varied: no PPR (21.5%), 1-2 (20%), 3-4
(20%), 5-6 (4.6%). 33.8% of respondents believed that the ideal length of
PPR depended on patient stability. CONCLUSION(S): Most common PSP for
infants following median sternotomy included no lifting at the axillae and
no pulling of arms to sitting. PSP included PPR in 57.9% of the reported
institutions. PPR varied across respondents with the majority of
respondents (66.7%) favoring modified PPR. Respondents believed the ideal
length of PPR was dependent on patient stability (33.8%).

<53>
Accession Number
630549157
Title
How effective is exercise training in improving cardiovascular response
after heart transplant? systematic review.
Source
Cardiopulmonary Physical Therapy Journal. Conference: Combined Sections
Meeting of the American Physical Therapy Association, CSM 2020. United
States. 31 (1) (pp e2-e3), 2020. Date of Publication: January 2020.
Author
Groen K.E.; Ignarska P.; Xiong A.W.; Evans C.C.
Publisher
Lippincott Williams and Wilkins
Abstract
PURPOSE/HYPOTHESIS: Cardiac rehabilitation involving aerobic and
resistance training are recommended for patients recovering from heart
transplant (HTx). However, determining post-HTx exercise capacity, heart
rate response, and blood pressure response are difficult given a lack of
data for these patients in the current literature. A systematic review of
research within the last 10 years has not been completed. The purpose of
this study was to determine the expected improvements in exercise capacity
of post-HTx patients undergoing exercise training. The secondary purpose
was to determine changes in resting and peak heart rate, as well as the
changes in blood pressure following post-exercise training in this
population. NUMBER OF SUBJECTS: Seven randomized clinical trials with a
total of 215 subjects were included for final review. MATERIALS AND
METHODS: Inclusion criteria were: published between 2008 and 2018;
included post-HTx subjects who participated in an exercise program beyond
usual care; randomized clinical trial or cohort study design; included
pre/post exercise results; reported peak VO<inf>2</inf>. The following
databases were searched: Sportdiscus, Cochrane, Medline Complete, and
CINAHL. Study quality was assessed using the PEDro Scale (mean score =
4.85, range = 2-7) and risk of bias was assessed using the Cochrane
Collaboration tool. RESULT(S): Five out of the 7 included studies had
a control variable of "usual care. " Exercise training programs included
moderate aerobic exercise (5), high intensity interval training (3), and
resistance training (2). All 7 studies concluded that HTx patients in the
aerobic exercise or resistance groups demonstrated improved peak
VO<inf>2</inf> post-exercise (mean change in peak VO<inf>2</inf> = 3.37
ml/kg/min, range = 1.1-4.6 ml/kg/min; mean initial peak VO<inf>2</inf> =
20.03 ml/kg/min, range = 12.1-27.2 ml/kg/min; mean final peak
VO<inf>2</inf> = 23.44 ml/kg/min, range = 13.2-30.9 ml/kg/min).
 CONCLUSION(S): Exercise programs, including high intensity interval
training, are effective in boosting aerobic capacity beyond the level seen
with usual care for patients post-HTX. A meta-analysis is being conducted
on these studies to determine the standardized effect size for post HTx
exercise training on peak VO<inf>2</inf>.

<54>
Accession Number
630551384
Title
Stereotactic body radiotherapy (SBRT) or surgery in early stage (I & II)
non small cell lung cancer (NSCLC).
Source
Journal of Global Oncology. Conference: ASCO Breakthrough Summit, ASCOBT
2019. Thailand. 5 (Supplement) (pp 99), 2019. Date of Publication: October
2019.
Author
Koyi H.; Daham K.; Al-Ameri M.; Branden E.
Institution
(Koyi, Daham, Al-Ameri, Branden) Dept of Resp Medicine, Gavle Hospital,
Gavle, Sweden; Department of Respiratory Medicine and Allergy, Karokinska
University Hospital-Solna, Stockholm, Sweden; Department of Surgery,
Karolinska University Hospital-Solna, Stockholm, Taiwan; Gavle Hospital,
Gavle, Sweden
Publisher
American Society of Clinical Oncology
Abstract
Background: For patients with NSCLC clinical stages I and II disease with
no medical contraindications, surgery is treatment of choice showing
5-year survival rates of about 60-80% for stage I and 40-50% for stage II,
respectively. However, for patients who are medically or technically unfit
for surgery and for patients refusing surgery, SBRT is an alternative with
local control rates > 90% at 3 years. Method(s): Medical journals in
all patients with stage I or II NSCLC who were underwent surgery and
treated with SBRT at the Department of oncology or thoracic surgery,
Karolinska University Hospital, Sweden from 2003 to 2010 were
retrospectively reviewed. Result(s): In all, 267 (74.8%) underwent
surgery and 90 (25.2%) were treated with SBRT. Mean, median and range of
age among the surgery group was 69.2, 70.0 and 41-85 years, while in the
SBRT group, these figures were 77.6, 79.0 and 52-90 years. The difference
in age between the groups was significant (p < 0.001).There were
significantly more comorbidites in the SBRT group. Among the surgery
group, 90.2% were smokers or former smokers. The figures for SBRT group
was 91.1%. The difference in smoking habits between the groups was not
significant (p < 0.713). There was a significant difference in performance
status (PS) between the groups (p < 0.001) with with PS 0-1 in 99.3% in
the surgery group compared with 66.7% in the SBRT group. There was a
significant difference in lung function with median FEV1 2.11 liter in
surgery group compared to 1.3 in the SBRT group. The figures for median
FEV1% was 85.0% respectively 57.0%. The median overall survival was 7.7
years for the surgery group and 3.72 years for the SBRT group (p < 0.001).
Five years survival was 65.5% in the surgery group and 31.6% in the SBRT
group (p < 0.001). Conclusion(s):The much worse median overall
survival in the SBRT group can be explained by the selection of patients,
but still, a median survival for nearly 4 years in an elderly group with
so many comorbidities and a poor PS indicates that SBRT has been of value.

<55>
Accession Number
2004564744
Title
ASMBS 36th Annual Meeting at Obesity Week 2019 Abstracts.
Source
Surgery for Obesity and Related Diseases. Conference: The 36th ASMBS
Annual Meeting. United States. 15 (10 Supplement) (pp S1-S268), 2019. Date
of Publication: October 2019.
Author
Anonymous
Publisher
Elsevier Inc.
Abstract
The proceedings contains 552 papers. The topics discussed include:
Individualized Diabetes Complications Risk Scores: Future Risk of Diabetes
End-Organ Complications with and without Metabolic Surgery;Metabolic
Surgery prevents Systolic Heart Failure and reduces mortality due to
recurrent-myocardial infarction in patients with history of Coronary
Artery Disease: a nationwide case-control analysis;Long-Term Outcomes of
Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy;Long-Term
Cost-Effectiveness of Bariatric Surgery vs Conventional Treatment in
Swedish Obese Subjects By Baseline Glycemic Status;Is it Worth it?
Determining the Health Benefits of Sleeve Gastrectomy in Patients with a
Body Mass Index Less than 35 kg/m2;Gastroesophageal reflux disease in
patients with severe obesity and type 2 diabetes one year after sleeve
gastrectomy or Roux-en-Y gastric bypass. A randomized controlled
trial.;Association between weight loss and serum biomarkers with risk of
incident cancer in the Longitudinal Assessment of Bariatric Surgery
cohort;Does Bariatric Surgery prevent cancer in the obese population? A
nationwide case-control analysis;The Prevalence of Thrombophilia Disorder
in a Diverse Group of Patients Seeking Laparoscopic Sleeve Gastrectomy;
Utilizing Extended Chemoprophylaxis to Decrease the Rate of Portal Vein
Thrombosis Postoperatively;Efficacy of liposomal bupivacaine versus
bupivacaine in port site injections on postoperative pain within enhanced
recovery after bariatric surgery (ERABS) program; A Randomized Clinical
Trial;Impact of Enhanced Recovery After Bariatric Surgery (ERAS) on
Patient Experience, Surgical Outcomes and Healthcare Costs: Electronic
Medical Records (EMR) and Highmark Health claims data analysis;Estimated
Exercise Workload is a Predictor for Emergency Department Visits Following
Bariatric Surgery;Long-term outcomes of bariatric surgery in patients with
cirrhosis.

<56>
Accession Number
630552046
Title
An unusual case of central diabetes insipidus.
Source
Indian Journal of Endocrinology and Metabolism. Conference: 49th Annual
Conference Endocrine Society of India, ESICON 2019. India. 23 (7
Supplement) (pp S44-S45), 2019. Date of Publication: November 2019.
Author
Gadage S.N.; Mulchandani J.D.; Shah V.; Gupta S.; Patil M.
Institution
(Gadage, Mulchandani, Shah, Gupta, Patil) Inlaks and Budhrani Hospital,
Pune, Maharashtra, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Introduction: Central diabetes insipidus (CDI) is a heterogeneous
condition characterized by the presence of polyuria and polydipsia due to
a deficiency of vasopressin. In 1950, the first case of CDI associated
developing in the setting of infective endocarditis was reported. We
hereby report a similar case of diabetes insipidus (DI) complicating a
case of bacterial endocarditis. Aims and Objective: We aim to discuss the
rare case of DI with infective endocarditis and to review the literature.
 Material(s) and Method(s): A 54-year-old woman presented with
high-grade fever and loss of appetite. She had undergone aortic valve
replacement with coronary artery bypass graft surgery 1 month back.
Investigations revealed prosthetic valve endocarditis secondary to
coagulase-negative Staphylococcus. During a hospital stay, the patient had
a cardiac arrest. Postresuscitation patient developed refractory shock.
Echocardiography showed new-onset septoapical hypokinesia and paravalvular
abscess. The diagnosis of myocardial infarction due to embolism of the
vegetation was considered. The patient showed gradual improvement with
antibiotics, mechanical ventilation, and supportive care. While
recovering, the patient developed persistent polyurea. Laboratory
abnormalities included hypernatremia, elevated serum osmolality, and low
urine osmolality. She improved with fluid, desmopressin and sodium levels
were stabilized. Based on clinical, laboratory, and magnetic resonance
imaging findings and response to desmopressin, the diagnosis of CDI was
made. On follow-up, the patient is maintaining sodium and urine output on
daily 100 mcg desmopressin. Result(s): Thus, we report a case of
permanent DI developing in the setting of infective endocarditis.
Discussion and Conclusion(s): The ischemic insult to pituitary either
due to embolization of posterior pituitary or hypoperfusion secondary to
cardiac arrest may have resulted in DI. The case highlights monitoring for
DI in the setting of cardiac arrest and infective endocarditis. Early
recognition and correction of hypernatremia may prevent further brain
injury.

<57>
Accession Number
630567817
Title
Advances in transcatheter mitral and tricuspid therapies.
Source
BMC cardiovascular disorders. 20 (1) (pp 1), 2020. Date of Publication: 07
Jan 2020.
Author
Overtchouk P.; Piazza N.; Granada J.; Soliman O.; Prendergast B.; Modine
T.
Institution
(Overtchouk) Department of Cardiology, University Hospital of Bern, Bern,
Switzerland
(Overtchouk, Piazza) Interventional cardiology, McGill University Health
Centre, QC, 1001 Boulevard Decarie, Montreal H4A 3J1, Canada
(Granada) Cardiovascular Research Foundation, Columbia University Medical
Center, CRF Skirball Center for Innovation, NY, United States
(Soliman) Thoraxcenter, Erasmus University Medical Center Rotterdam,
Medical Director Structural Heart & Heart Failure Research, Cardialysis,
Rotterdam, Netherlands
(Soliman) Department of Cardiology, University Hospital of Antwerp,
Antwerp, Belgium
(Prendergast) Department of Cardiology, St Thomas' Hospital, London,
United Kingdom
(Modine) Cardiology and Cardiovascular Surgery Department, Heart Valve
Center, Institut Coeur Poumon CHU de Lille, 2 Av Oscar Lambret, Lille
59037, France
(Modine) Jioa Tong university, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: While rheumatic mitral stenosis has been effectively treated
percutaneously for more than 20years, mitral and tricuspid regurgitation
treatment appear as a contemporary unmet need. The advent of transcatheter
therapies offer new treatment options to often elderly and frail patients
at high risk for open surgery. We aimed at providing an updated review of
fast-growing domain of transcatheter mitral and tricuspid technology. MAIN
BODY: We reviewed the existing literature on mitral and tricuspid
transcatheter therapies. Mitraclip is becoming an established therapy for
secondary mitral regurgitation in selected patients with
disproportionately severe regurgitation associated with moderate left
ventricle dysfunction. Evidence is less convincing for primary mitral
regurgitation. Transcatheter mitral valve replacement is a promising
emerging alternative to transcatheter repair, for secondary as well as
primary mitral regurgitation. But further development is needed to improve
delivery. Transcatheter tricuspid intervention arrives late after similar
technologies have been developed for aortic and mitral valves and is
currently at its infancy. This is likely due in part to previously
under-recognized impact of tricuspid regurgitation on patient outcomes.
Edge-to-edge repair is the most advanced transcatheter solution in
development. Data on tricuspid annuloplasty and replacement is limited,
and more research is warranted. CONCLUSION(S): The future appears
bright for transcatheter mitral therapies, albeit their place in clinical
practice is yet to be clearly defined. Tricuspid transcatheter therapies
might address the unmet need of tricuspid regurgitation treatment.

<58>
Accession Number
630575948
Title
The impact of Centre's heart transplant status and volume on in-hospital
outcomes following extracorporeal membrane oxygenation for refractory
post-cardiotomy cardiogenic shock: a meta-analysis.
Source
BMC cardiovascular disorders. 20 (1) (pp 10), 2020. Date of Publication:
09 Jan 2020.
Author
Kowalewski M.; Raffa G.M.; Zielinski K.; Alanazi M.; Gilbers M.; Heuts S.;
Natour E.; Bidar E.; Schreurs R.; Delnoij T.; Driessen R.; Sels J.-W.; van
de Poll M.; Roekaerts P.; Meani P.; Maessen J.; Suwalski P.; Lorusso R.
Institution
(Kowalewski, Suwalski) Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior, Centre of Postgraduate Medical
Education, Warsaw, Poland
(Kowalewski, Alanazi, Gilbers, Heuts, Natour, Bidar, Schreurs, Maessen,
Lorusso) Cardio-Thoracic Surgery Department, Maastricht University Medical
Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Kowalewski) Cardiothoracic Research Centre, Innovative Medical Forum,
Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, Palermo, Italy
(Zielinski) Medical University of Warsaw, Warsaw, Poland
(Delnoij, Driessen, Sels, Meani) Cardiology Department, Maastricht
University Medical Centre, Maastricht, Netherlands
(Delnoij, Driessen, Sels, van de Poll, Roekaerts, Meani) Department of
Intensive Care, Maastricht University Medical Centre, Maastricht,
Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postcardiotomy cardiogenic shock (PCS) that is refractory to
inotropic support remains a major concern in cardiac surgery and is almost
universally fatal unless treated with mechanical support. While reported
mortality rates on ECMO vary from center to center, aim of the current
report is assess if the outcomes differ between centres according to
volume and heart transplantation status. METHOD(S): A systematic
search was performed according to PRISMA statement using PubMed/Medline
databases between 2010 and 2018. Relevant articles were scrutinized and
included in the meta-analysis only if reporting in-hospital/30-day
mortality and heart transplantation status of the centre. Paediatric and
congenital heart surgery-related studies along with those conducted in the
setting of veno-venous ECMO for respiratory distress syndrome were
excluded. Differences were assessed by means of subgroup meta-analysis and
meta-regression. RESULT(S): Fifty-four studies enrolling N=4421 ECMO
patients were included. Of those, 6 series were performed in non-HTx
centres (204 pts.;4.6%). Overall 30-day survival (95% Confidence
Intervals) was 35.3% (32.5-38.2%) and did not statistically differ between
non-HTx: 33.3% (26.8-40.4%) and HTx centres: 35.7% (32.7-38.8%);
Pinteraction=0.531. There was no impact of centre volume on survival as
well: scoef=0.0006; P=0.833. No statistical differences were seen between
HTx and non-HTx with respect to ECMO duration, limb complications,
reoperations for bleeding, kidney injury and sepsis. There were however
significantly less neurological complications in the HTx as compared to
non-HTx centres: 11.9% vs 19.5% respectively; P=0.009; an inverse
relationship was seen for neurologic complications in centres performing
more ECMOs annually scoef=-0.0066; P=0.031. Weaning rates and bridging to
HTx and/or VADs were higher in HTx facilities. CONCLUSION(S): There
was no apparent difference in survival after ECMO implantation for
refractory PCS according to centre's ECMO volume and transplantation
status. Potentially different risk profiles of patients in these centres
must be taken account for before definite conclusions are drawn.

<59>
Accession Number
630570468
Title
Cardiac and vascular causes of persistent fever: A systematic review.
Source
Reviews in cardiovascular medicine. 20 (4) (pp 255-261), 2019. Date of
Publication: 30 Dec 2019.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Fujian Province, Putian
351100, China
Publisher
NLM (Medline)
Abstract
Fever of unknown origin refers to a prolonged fever with an unknown cause
despite adequate medical evaluations. This condition often leads to
unnecessary extensive laboratory work-ups and antimicrobial therapies. The
atypical presentations often cause a delayed diagnosis and an improper
treatment with an increased morbidity rate. In cardiac surgical patients,
fever of unknown origin remains an intriguing problem during the
diagnostic process of cardiac surgical diseases. Cardiac myxoma or aortic
dissection are often misdiagnosed when patients present with fever of
unknown origin as an onset symptom. Under such circumstances, medical
examinations by echocardiography and chest computed tomography,
particularly fluorodeoxyglucose-positron emission tomography/computed
tomography, have been proved crucial for early diagnosis. A better
understanding of the clinical features of cardiac surgical disorders
presenting with fever of unknown origin would facilitate early diagnosis
of fever of unknown origin. A further decision-making of prompt treatment
of choices of a cardiac operation is important for improving patients'
outcomes. Copyright © 2019 Yuan Published by IMR press.

<60>
Accession Number
2004572825
Title
Fractional flow reserve derived from computed tomography coronary
angiography in the assessment and management of stable chest pain:
Rationale and design of the FORECAST trial.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Mahmoudi M.; Nicholas Z.; Nuttall J.; Bresser M.; Maishman T.; Berry C.;
Hlatky M.A.; Douglas P.; Rajani R.; Fox K.; Curzen N.
Institution
(Mahmoudi, Curzen) Faculty of Medicine, University of Southampton, United
Kingdom
(Nicholas, Curzen) Coronary Research Group, University Hospital
Southampton, Southampton, United Kingdom
(Nuttall, Bresser, Maishman) Clinical Trials Unit, University of
Southampton, Southampton, United Kingdom
(Berry) British Heart Foundation Glasgow Cardiovascular Research Centre,
University of Glasgow, United Kingdom
(Hlatky) Stanford University School of Medicine, Stanford, CA, United
States
(Douglas) Duke University School of Medicine, Durham, NC, United States
(Rajani) Guy's & St Thomas' NHS Trust, London, United Kingdom
(Fox) Imperial College, London, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Fractional flow reserve measurement based on computed
tomography (FFR<inf>CT</inf>) is a novel, well validated, non-invasive
method for determining the presence and extent of coronary artery disease
(CAD) combined with a physiological assessment of vessel-specific ischemia
in patients with chest pain. Previous studies indicate that
FFR<inf>CT</inf> reduces the uptake of invasive angiography that shows no
significant CAD, without compromising patient safety. The clinical
effectiveness and economic impact of using FFR<inf>CT</inf> instead of
other tests in the initial evaluation of patients with stable chest pain
has not been tested in a randomized trial. Method(s): The FORECAST
trial will randomise 1400 patients with stable chest pain to receive
either FFR<inf>CT</inf> or routine clinical assessment as directed by the
National Institute for Health and Care Excellence (NICE) CG95 guideline
for Chest Pain of Recent Onset. The primary endpoint will be resource
utilisation over the subsequent nine months, including non-invasive
cardiac investigations, invasive coronary angiography, coronary
revascularization, hospitalization for cardiac events, and the use of
cardiac medications. Key pre-specified secondary endpoints will be major
adverse cardiac events, angina severity, quality of life, patient
satisfaction, time to definitive management plan, time to completion of
initial evaluation, number of hospital attendances, and working days lost
in patients who are in employment. Conclusion(s): The FORECAST
randomized trial will assess the clinical and economic outcomes of using
FFR<inf>CT</inf> as the primary test to evaluate patients presenting with
stable chest pain. Copyright © 2019 Elsevier Inc.

<61>
Accession Number
2004566482
Title
Neuro-oncological features of spinal meningiomas: Systematic review.
Source
Neurochirurgie. (no pagination), 2020. Date of Publication: 2020.
Author
Jamilson Araujo Pereira B.; Nogueira de Almeida A.; Silva Paiva W.;
Henrique Pires de Aguiar P.; Jacobsen Teixeira M.; Kazue Nagahashi Marie
S.
Institution
(Jamilson Araujo Pereira, Silva Paiva, Henrique Pires de Aguiar, Jacobsen
Teixeira, Kazue Nagahashi Marie) Departamento de Neurologia da Faculdade
de Medicina da Universidade de Sao Paulo, Rua Martiniano de Carvalho, 669,
Edificio Paulista Paradise Life, Apto 1105, Brazil
(Nogueira de Almeida) Divisao de Neurocirurgia Funcional IPQ. Hospital das
Clinicas da Universidade de Sao Paulo, Sao Paulo, Brazil
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Purpose: Review the published data on spinal meningioma (SM) to create a
more comprehensive picture of its natural history. Method(s): A
review of the published SM literature was carried out through a Medline
search up to December 2018. The search using the keyword "spinal
meningiomas" returned 248 papers and the parameters analyzed in our
present study were examined in those publications. Papers without a
detailed description of clinical findings, neuroimaging confirmation of
the spinal tumor, minimum follow-up of 5 years, or a clear description of
the clinical findings were excluded. Result(s): In the 24 manuscripts
reviewed, 1811 (1450 females/361 males) patients with SM were analyzed.
The thoracic spine (1181-64.6%) and cervical spine (394-22.7%) were the
more prevalent levels. The psammomatous (27.8%) and meningothelial
variants (25.2%) were the most prevalent histopathological subtypes. Gross
total resection (Simpson I and II) was achieved in 94.5% of cases and
subtotal resection (Simpson III or more) in 5.5%. The tumor recurrence
rate was 4.4%, and the mortality rate related to surgery or disease
progression was 3%. Conclusion(s): WHO grade I predominance was
observed among spinal meningiomas, analogous to intracranial meningiomas.
SMs predominated in the thoracic spine. Surgery with gross total resection
was achieved in the vast majority of cases, resulting in low recurrence
and mortality rates. Copyright © 2019 Elsevier Masson SAS

<62>
Accession Number
2003817794
Title
Clinical outcomes after TAVR with heparin or bivalirudin as periprocedural
anticoagulation in patients with and without peripheral arterial disease:
Results from the BRAVO-3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Zilberszac R.; Chandiramani R.; Hengstenberg C.; Sartori S.; Cao D.;
Chandrasekhar J.; Schafer U.; Tchetche D.; Violini R.; Jeger R.; Van Belle
E.; Boekstegers P.; Hambrecht R.; Tron C.; Dumenteil N.; Linke A.; ten
Berg J.M.; Deliargyris E.N.; Anthopoulos P.; Mehran R.; Dangas G.
Institution
(Zilberszac, Hengstenberg) Department of Cardiology, Medical University of
Vienna, Vienna, Austria
(Chandiramani, Sartori, Cao, Chandrasekhar, Mehran, Dangas) The Zena and
Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Schafer) Department of Cardiology, University Heart Center, Hamburg,
Germany
(Schafer) Department of Cardiology, Asklepios Clinics St. Georg, Hamburg,
Germany
(Tchetche, Dumenteil) Department of General and Interventional Cardiology,
Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse,
France
(Violini) Interventional Cardiology Unit, San Camillo Hospital, Rome,
Italy
(Jeger) Department of Cardiology, University Hospital Basel, University of
Basel, Switzerland
(Van Belle) Department of Cardiology and INSERM UMR 1011, University
Hospital and CHRU Lille, Lille, France
(Boekstegers) Department of Cardiology, Helios Heart Center Siegburg,
Siegburg, Germany
(Hambrecht) Department of Cardiology, Klinikum Links der Weser, Bremen,
Germany
(Tron) Department of Cardiology, Rouen University Hospital, Rouen, France
(Linke) Department of Cardiology, Universitat Leipzig, Herzzentrum,
Leipzig, Germany
(ten Berg) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Deliargyris) PLx Pharma Inc., Sparta, NJ, United States
(Anthopoulos) Division of Cardiology, The Medicines Company, Zurich,
Switzerland
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This study sought to investigate the clinical outcomes of
patients with and without peripheral artery disease (PAD) in the BRAVO-3
trial with respect to the effect of bivalirudin versus unfractionated
heparin (UFH). Background(s): PAD is found frequently in patients
undergoing transcatheter aortic valve replacement (TAVR) and is reported
to confer an increased risk of adverse events. It is unknown whether
patients with and without PAD may demonstrate a differential response to
bivalirudin versus UFH. Method(s): BRAVO-3 was a randomized
multicenter trial comparing transfemoral TAVR with bivalirudin versus UFH
(31 centers, n = 802). Major adverse cardiovascular events (MACE) were a
composite of 30-day death, myocardial infarction, or cerebrovascular
accidents (CVA). Net adverse cardiovascular events (NACE) were a composite
of major bleeding or MACE. Result(s): The total cohort included 119
patients with PAD. Vascular complications occurred significantly more
frequently in patients with PAD both in-hospital (25.2 vs. 16.7%; OR 1.68)
and at 30 days (29.4 vs. 17.3%; OR 1.99). No significant differences were
observed regarding mortality, NACE, MACE, major bleeding or CVA with
bivalirudin versus UFH among patients with or without PAD. In patients
with PAD, bivalirudin was associated with an increased risk of minor
vascular complications at 30 days. Conclusion(s): Patients with PAD
undergoing transfemoral TAVR did not exhibit an increased risk of any
major adverse events, according to the procedural anticoagulant
randomization. However, patients treated with Bivalirudin had
significantly higher rates of minor vascular complications. Copyright
© 2019 The Authors. Catheterization and Cardiovascular Interventions
published by Wiley Periodicals, Inc.

<63>
Accession Number
2003720664
Title
Comparison of Outcomes Following Infrapopliteal Plain Balloon Angioplasty
in the BASIL Trial (1999-2004) and in a Contemporary Series (2009-2013).
Source
Vascular and Endovascular Surgery. 54 (2) (pp 141-146), 2020. Date of
Publication: 01 Feb 2020.
Author
Popplewell M.A.; Davies H.O.B.; Renton M.; Bate G.; Patel S.; Deeks J.J.;
Bradbury A.W.
Institution
(Popplewell, Davies, Bate, Bradbury) Department of Vascular Surgery,
University of Birmingham, United Kingdom
(Renton) Heart of England Foundation Trust, Birmingham, United Kingdom
(Patel, Deeks) Birmingham Clinical Trials Unit, University of Birmingham,
United Kingdom
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objectives: To compare outcomes in patients randomized to infrapopliteal
(IP) plain balloon angioplasty (PBA) for chronic limb-threatening ischemia
within the Bypass versus Angioplasty in Severe Ischemia of the Leg
(BASIL)-1 trial between 1999 and 2004 with outcomes in consecutive
patients undergoing IP PBA at an academic vascular unit a decade later
(2009-2013, Contemporary series [CS]). Method(s): Individual patient
data were obtained from prospective BASIL-1 (48 patients) and CS databases
(73 patients). All had a minimum of 3-years of follow-up. Outcomes studied
were amputation-free survival (AFS), overall survival (OS), major (above
ankle) limb amputation, arterial reintervention, immediate technical
success, and length of hospital stay for the index procedure and during
the following 12-month period. Statistical analysis was performed using
SAS version 9.4. Result(s): The BASIL and CS cohorts were well
matched for gender, age, diabetes, previous stroke, myocardial infarction
and arterial intervention, and presence of tissue loss. More patients in
BASIL-1 underwent concomitant treatment of the superficial femoral (60% vs
37%, P =.01) and above knee popliteal (60% vs 34%, P =.005) arteries.
Immediate technical success increased from 73% in BASIL-1 to 90% in the CS
(P =.01). Between the two cohorts, there were no differences in AFS
(hazard ratio [HR] = 1.00, 95% confidence interval [CI]: 0.65-1.54, P =
1.0), OS (HR = 1.04, 95% CI: 0.66-1.62, P =.9), major amputation (HR =
0.86, 95% CI: 0.37-1.97, P =.7), or reintervention (HR = 0.61, 95% CI:
0.29-1.27, P =.2). Contemporary series patients spent significantly fewer
days in hospital following the index procedure (P =.02) and also over the
following 12 months (P =.002). Conclusion(s): Despite improvements in
the immediate technical angiographic success of IP PBA between BASIL and
the CS, there were no significant improvements in survival outcomes.
Results from BASIL-2 and BEST-CLI are required in order to properly define
the clinical and cost-effectiveness of endovascular treatment in such
patients. Copyright © The Author(s) 2019.

<64>
Accession Number
2004389301
Title
A randomized, double-blind, placebo-controlled trial investigating the
effect of ticagrelor on saphenous vein graft patency in patients
undergoing coronary artery bypass grafting surgery-Rationale and design of
the POPular CABG trial.
Source
American Heart Journal. 220 (pp 237-245), 2020. Date of Publication:
February 2020.
Author
Willemsen L.M.; Janssen P.W.A.; Hackeng C.M.; Kelder J.C.; Tijssen J.G.P.;
van Straten A.H.M.; Soliman-Hamad M.A.; Deneer V.H.M.; Daeter E.J.; Sonker
U.; Klein P.; ten Berg J.M.
Institution
(Willemsen, Janssen, Kelder, Daeter, Sonker, Klein, ten Berg) Department
of Cardiology and Cardiothoracic Surgery, St Antonius Hospital,
Nieuwegein, Netherlands
(Hackeng) Department of Clinical Chemistry, St Antonius Hospital,
Nieuwegein, Netherlands
(Tijssen) Department of Cardiology, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(van Straten, Soliman-Hamad) Department of Cardiothoracic Surgery,
Catharina Hospital, Eindhoven, Netherlands
(Deneer) Department of Clinical Pharmacy, Division of Laboratories,
Pharmacy, and Biomedical Genetics, University Medical Center Utrecht,
Utrecht, Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Rationale: An estimated 15% of saphenous vein grafts (SVGs) occlude in the
first year after coronary artery bypass grafting (CABG) despite aspirin
therapy. Graft occlusion can result in symptoms, myocardial infarction,
and death. SVG occlusion is primarily caused by atherothrombosis, in which
platelet activation plays a pivotal role. Evidence regarding the effect of
stronger platelet inhibition on SVG patency after CABG is limited. The
main objective of the POPular CABG trial is to determine whether dual
antiplatelet therapy with aspirin plus ticagrelor improves SVG patency
when compared to aspirin alone. Study: The POPular CABG is a randomized,
double-blind, placebo-controlled, multicenter trial investigating the
effect of adding ticagrelor to standard aspirin therapy on the rate of SVG
occlusion. A total of 500 patients undergoing CABG with >= 1 SVG are
randomized to ticagrelor or placebo. The primary end point is SVG
occlusion rate, assessed with coronary computed tomography angiography at
1 year. Secondary end points are stenoses and occlusions in both SVGs and
arterial grafts and SVG failure at 1 year, defined as a composite of SVG
occlusion on coronary computed tomography angiography or coronary
angiography, SVG revascularization, myocardial infarction in the territory
supplied by an SVG, or sudden death. Safety end points are bleeding events
at 30 days and 1 year. Conclusion(s): The POPular CABG trial
investigates whether adding ticagrelor to standard aspirin after CABG
reduces the rate of SVG occlusion at 1 year. Copyright © 2019

<65>
[Use Link to view the full text]
Accession Number
630375820
Title
Dexmedetomidine's Relationship to Delirium in Patients Undergoing Cardiac
Surgery: A Systematic Review.
Source
Critical Care Nursing Quarterly. 43 (1) (pp 28-38), 2020. Date of
Publication: 01 Jan 2020.
Author
Halpin E.; Inch H.; O'Neill M.
Institution
(Halpin, Inch, O'Neill) Surgical Critical Care Unit, University of
Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
This systematic review aims to determine the relationship between
postoperative delirium and the use of dexmedetomidine in comparison with
commonly used sedatives/analgesics in the postoperative cardiac surgery
patient. A systematic literature search of PubMed plus, CINAHL, Scopus,
and Ovid, and limited to the English language in the last 10 years, was
performed. Randomized controlled trials, observational and retrospective
studies, and meta-analyses with at least 1 delirium assessment tool were
included. The search found 196 potential articles; however, only 12 met
the criteria outlined. The systematic review revealed a decrease in
postoperative delirium for patients receiving dexmedetomidine in all
studies. Seven studies demonstrated statistically significant reductions
in postoperative delirium with dexmedetomidine compared with other
sedatives/analgesics. One study also revealed reduction of delirium with
dexmedetomidine as compared with normal saline. Two studies showed a
delayed time to delirium onset in patients receiving dexmedetomidine
versus propofol or morphine. The 2 meta-analyses found that all included
studies had a statistically significant reduction in postoperative
delirium when using dexmedetomidine. Postoperative use of dexmedetomidine
in cardiac surgery patients may reduce the incidence of postoperative
delirium. Copyright © 2020 Wolters Kluwer Health, Inc. All rights
reserved.

<66>
Accession Number
2003638963
Title
In vivo comparison of the optiflow and EZ glide aortic dispersion
cannulas.
Source
Journal of Cardiac Surgery. 35 (1) (pp 158-162), 2020. Date of
Publication: 01 Jan 2020.
Author
Gennari M.; Rossi F.; Polvani G.; Bertera A.; Riva G.; Fave A.D.; Rassiga
C.; Agrifoglio M.
Institution
(Gennari, Rossi, Polvani, Bertera, Riva, Agrifoglio) Department of
Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
(Polvani, Agrifoglio) Department of Cardiovascular Sciences and Community
Health, University of Milan, Italy
(Fave) Department of Pathophysiology and Transplantation, University of
Milan, Italy
(Rassiga) Neurology Unit, ASST Santi Paolo e Carlo, Presidio San Paolo,
Milan, Italy
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Morbidity associated with coronary artery bypass grafts and
embolization during aortic cannulation is strongly related to patient
characteristics/comorbidities, arterial cannulation site used and the
shape of arterial cannulae tips. The desired features of an arterial
cannula should be to mitigate the morbid effects of these cannulas and to
focus on achieving higher blood flows with lower cannula pressures (CPs).
 Material(s) and Method(s): To evaluate the in vivo performance of two
aortic dispersion flow cannulas: the Optiflow (Sorin Group, Italy) and EZ
Glide (Edwards Lifesciences). They were evaluated for CPs, pump-flow rates
(FRs), and plasma-free hemoglobin (Hb) over a 12-month period. Data were
collected in a prospective, randomized (1:1), nonblinded, monocentric
study with a cohort of 30 patients (optiflow group N = 15; EZ Glide group
N = 15). Result(s): The optiflow cannula was found to have decreasing
CPs as the pump FRs were increased (112.3 +/- 10.9 vs 131.1 +/- 11.4 mm
Hg; P <.001). Results indicated no significant differences between groups
for increases in plasma free Hb (P =.41) and total microembolic signals
counts during the period of cardiac surgery (P =.63). Conclusion(s):
Both optiflow and EZ Glide dispersion flow arterial cannulas performed
well, but the optiflow cannula demonstrated an ability to increase pump
FRs with lower arterial line and CPs than the EZ Glide cannula. This
implies an ability to improve peripheral perfusion while reducing cannula
shear stress and the risk of endothelial damage, thereby having the
potential to reduce the risk of atherosclerotic plaque
dislodgement. Copyright © 2019 Wiley Periodicals, Inc.

<67>
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). 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. 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. Copyright © 2019 The
Author(s).

<68>
Accession Number
630302380
Title
Comparison of intensive insulin therapy and conventional glucose
management in patients undergoing coronary artery bypass grafting.
Source
Journal of Anaesthesiology Clinical Pharmacology. 35 (4) (pp 493-497),
2019. Date of Publication: October-December 2019.
Author
Mohod V.; Ganeriwal V.; Bhange J.
Institution
(Mohod, Ganeriwal, Bhange) Department of Anaesthesiology and Critical
Care, Grant Medical College and Sir JJ Group of Hospital, 4/31, Swastik
Building, J J Hospital Campus, Byculla, Mumbai, Maharashtra, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Hyperglycemia during cardiac surgery is a risk factor for postoperative
outcomes. Because incidence of diabetes mellitus is increasing in Indian
population, we tried to evaluate the western protocol for strict control
of blood sugar perioperatively. The main aim of the study was to evaluate
glycemic control during coronary artery bypass grafting and to determine
whether intensive insulin therapy (IIT) is better than the conventional
one. Material(s) and Method(s): A prospective randomized comparative
study was conducted to evaluate IIT and conventional management of glucose
in 40 patients undergoing on-pump coronary artery bypass grafting.
Outcomes measured were incidence of hyperglycemia or hypoglycemia,
incidence of hypokalemia, prolonged intubation, wound infections, strokes,
acute renal failure, new onset arrhythmias, length of stay in ICU and
hospital, cardiac arrest and mortality. The statistical analysis was done
by using Chi-square test, and paired and unpaired t test. Result(s):
The diabetic patients had significantly higher mean blood sugar and
insulin requirement. The incidence of hyperglycemia was significantly
higher in conventional management of blood sugar (P = 0.001), whereas
hypoglycemia (P = 0.047) and hypokalemia (P = 0.020) were significantly
higher in IIT. There were no significant difference in the incidence of
prolonged intubation, wound infection, length of ICU and hospital stay,
strokes, acute renal failure, new onset arrhythmias, cardiac arrest, and
mortality. Conclusion(s): The IIT did not improve the morbidity and
mortality in our patients undergoing coronary artery bypass
grafting. Copyright © 2019 Journal of Anaesthesiology Clinical
Pharmacology Published by Wolters Kluwer - Medknow.

<69>
Accession Number
630285059
Title
Multicenter randomized study on the comparison between electronic and
traditional chest drainage systems.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 730. Date of
Publication: 16 Dec 2019.
Author
Marulli G.; Comacchio G.M.; Nosotti M.; Rosso L.; Mendogni P.; Natale G.;
Andriolo L.; Imbriglio G.; Larocca V.; Brascia D.; Rea F.
Institution
(Marulli, Brascia) Thoracic Surgery Unit, Department of Organ
Transplantation and Emergency, University Hospital of Bari, Piazza Giulio
Cesare 11, Bari 70124, Italy
(Comacchio, Natale, Rea) Thoracic Surgery Unit, Department of Cardiologic,
Thoracic and Vascular Sciences, University Hospital of Padova, Padova,
Italy
(Nosotti, Rosso, Mendogni) Thoracic Surgery Unit, Fondazione IRCCS Ca'
Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
(Andriolo, Imbriglio, Larocca) Thoracic Surgery Unit, V Fazzi Hospital,
Lecce, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In patients submitted to major pulmonary resection, the
postoperative length of stay is mainly influenced by the duration of air
leaks and chest tube removal. The measurement of air leaks largely relies
on traditional chest drainage systems which are prone to subjective
interpretation. Difficulty in differentiating between active air leaks and
bubbles due to a pleural space effect may also lead to tentative drain
clamping and prolonged time for chest drain removal. New digital systems
allow continuous monitoring of air leaks, identifying subtle leakage that
may be not visible during daily patient evaluation. Moreover, an objective
assessment of air leaks may lead to a reduced interobserver variability
and to an optimized timing for chest tube removal. Method(s): This
study is a prospective randomized, interventional, multicenter trial
designed to compare an electronic chest drainage system (DrentechTM Palm
Evo) with a traditional system (DrentechTM Compact) in a cohort of
patients undergoing pulmonary lobectomy through a standard three-port
video-assisted thoracic surgery approach for both benign and malignant
disease. The study will enroll 382 patients in three Italian centers. The
duration of chest drainage and the length of hospital stay will be
evaluated in the two groups. Moreover, the study will evaluate whether the
use of a digital chest system compared with a traditional system reduces
the interobserver variability. Finally, it will evaluate whether the
digital drain system may help in distinguishing an active air leak from a
pleural space effect, by the digital assessment of intrapleural
differential pressure, and in identifying potential predictors of
prolonged air leaks. Discussion(s): To date, few studies have been
performed to evaluate the clinical impact of digital drainage systems. The
proposed prospective randomized trial will provide new knowledge to this
research area by investigating and comparing the difference between
digital and traditional chest drain systems. In particular, the objectives
of this project are to evaluate the feasibility and usefulness of digital
chest drainages and to provide new tools to identify patients at higher
risk of developing prolonged air leaks. Trial registration:
ClinicalTrials.gov, NCT03536130. Retrospectively registered on 24 May
2018. Copyright © 2019 The Author(s).

<70>
Accession Number
2004365113
Title
Pericardial tamponade as a complication of invasive cardiac procedures: A
review of the literature.
Source
Postepy w Kardiologii Interwencyjnej. 15 (4) (pp 394-403), 2019. Date of
Publication: 2019.
Author
Adamczyk M.; Wasilewski J.; Niedziela J.; Rozentryt P.; Gasior M.
Institution
(Adamczyk, Wasilewski, Niedziela, Rozentryt, Gasior) 3rd Department of
Cardiology, Medical University of Silesia, Silesian Centre for Heart
Diseases, 9 Sklodowskiej St, Zabrze 41-800, Poland
Publisher
Termedia Publishing House Ltd. (Kleeberqa St.2, Poznan 61-615, Poland)
Abstract
Cardiac tamponade (CT) is a rare but often life-threatening complication
after invasive cardiac procedures. Some procedures favor CT. Furthermore,
the incidence depends on patients' comorbidities, sex and age and
operators' skills. In this paper we review studies and meta-analyses
concerning the rate of iatrogenic CT. We define the risk factors of CT and
show concise characteristics for each invasive cardiac procedure
separately. According to our analysis CT occurs especially after
procedures requiring transseptal puncture or perioperative
anticoagulation. The overall rate of CT after such procedures varies among
published studies from 0.089% to 4.8%. For this purpose we searched the
PubMed database for clinical studies published up to December 2018. We
included only those studies in which a defined minimum of procedures were
performed (1000 for atrial fibrillation ablation, 6000 for percutaneous
coronary intervention, 900 for permanent heart rhythm devices, 90 for left
atrial appendage closure, 300 for transcatheter aortic valve implantation
and percutaneous mitral valve repair with the Mitra-Clip system). The
search was structured around the key words and variants of these terms. In
addition, secondary source documents were identified by manual review of
reference lists, review articles and guidelines. The search was limited to
humans and adults (18+ years). Copyright © 2019 Termedia
Publishing House Ltd.. All rights reserved.

<71>
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. Evidence Acquisition: a
meta-analysis of eligible studies of patients undergoing Tavr which
reported our outcomes of postoperative daPT in comparison with saPT, was
carried out. The outcomes included the all-cause mortality, stroke,
major/life-threatening bleeding, myocardial infarction and a composite
endpoint of mortality, stroke, bleeding and myocardial infarction.
 Evidence Synthesis: Three randomized controlled trials (rCTs, n.=421)
and 5 observational studies (n.=6683) were included in this updated
meta-analysis. all-cause mortality was comparable between the two groups
(or 1.13 [95% Ci: 0.70-1.81], P=0.619). Besides, daPT resulted in an
augmented risk of major/life-threatening bleeding (OR 2.45 [95% CI:
1.08-5.59], P=0.032). No statistically significant difference was found
between the two groups in the rates of stroke (or 0.83 [95% Ci:
0.62-1.10], P=0.212) and myocardial infarction (or 1.17 [95% Ci:
0.47-2.91], P=0.728). and daPT led to an increased rate of the composite
endpoint (or 2.39 [95% Ci: 1.63-3.50], P<0.0001). 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. Copyright © 2019
Edizioni Minerva Medica.

<72>
Accession Number
2004398900
Title
The impact of atorvastatin reload in patients undergoing percutaneous
coronary intervention and its correlation with the Toll-like receptors.
Source
Systematic Reviews in Pharmacy. 10 (2) (pp 53-59), 2019. Date of
Publication: 2019.
Author
Hadi N.R.; Ghazi A.; Amber K.I.; Majeed S.A.; Al-Aubaidy H.A.
Institution
(Ghazi) Ministry of Health, Karbalaa, Iraq
(Amber) Al Najaf Cardiac Centre, Kufa University of Medicine, Iraq
(Al-Aubaidy) School of Life Sciences, College of Science, Health and
Engineering, La Trobe University, Bundoora, VIC 3086, Australia
(Hadi, Majeed) Department of Pharmacology and Therapeutics, Kufa
University of Medicine, Al-Najaf, Iraq
Publisher
EManuscript Technologies (E-mail: journals@emanuscript.in)
Abstract
The present study aims to evaluate the effect of pre percutaneous coronary
intervention (PCI) atorvastatin reload on peripheral monocyte of toll-like
receptor 2 and toll like receptor 4 expression and their correlation with
cardiac injury markers (troponin I and creatine kinase Muscle brain
isoenzyme) in a patient with stable angina. A double-blind randomized
prospective trial in which 60 stable angina patients scheduled for an
elective PCI were randomly allocated into two groups after, control group:
30 patients who received low dose atorvastatin 40 mg daily without reload.
Atorvastatin reloads group: 30 patients who were already on the usual dose
of atorvastatin with further 80 mg and 40 mg at 12 & 2 hrs. before PCI,
respectively. TLR2 and TLR4 levels were assayed in peripheral monocyte by
flow cytometry and cardiac troponin I, CK-MB, MCP-1 and HMG-box-1 protein
were also measured before and at 4 hrs, 12 hrs after PCI. Stent
implantation was associated with an elevation in TLR2 and TLR4 expression
in peripheral monocyte in both study groups after stenting but
significantly higher expression level was observed among the control group
(P<0.05) at 4 hr and 12 hr post PCI. Inflammatory cytokine (HMG Box-1
protein MCP-1) were remarkably elevated after stenting in both. study
groups (P < 0.005) but significantly higher in control group as compared
to the atorvastatin reload group (P < 0. 0 5) also myocardial
injury markers (CKMB, troponin I) were significantly higher in control
group than atorvastatin reload group (P < 0. 0 5) there is a positive
correlation between TLR2 and TLR4 expression with serum level of cardiac
troponin I and CK-MB Atorvastatin reload before coronary artery
interventions attenuate toll-like receptor 2 and 4 expressions on
peripheral monocyte and significantly reduce serum level of HMG-box-1
protein, MCP-1 and cardiac injury markers (CK_MB and cardiac troponin I)
and Increase peripheral monocyte expression of TLR2 and TLR4 associated
with elevated serum level of cardiac injury markers (CK_MB and cardiac
troponin I). Copyright © Advanced Scientific Research. All rights
reserved

<73>
Accession Number
2003962886
Title
Meta-Analysis of Transcatheter Aortic Valve Implantation Versus Surgical
Aortic Valve Replacement in Patients With Low Surgical Risk.
Source
American Journal of Cardiology. 125 (3) (pp 459-468), 2020. Date of
Publication: 1 February 2020.
Author
Vipparthy S.C.; Ravi V.; Avula S.; Kambhatla S.; Mahmood M.; Kabour A.;
Ali S.S.; Barzallo M.; Mungee S.
Institution
(Vipparthy, Barzallo, Mungee) OSF St. Francis Medical Center, UICOMP,
Peoria, IL, United States
(Ravi) Rush University Medical Center, Chicago, IL, United States
(Avula, Mahmood, Kabour, Ali) Mercy St Vincent Medical Center, Toledo, OH,
United States
(Kambhatla) John H Stroger Jr. Hospital of Cook County, Chicago, IL,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) is the current standard of
care for patients with severe aortic stenosis who are at high risk for
surgery. However, several recent studies have demonstrated the comparable
safety and efficacy of TAVI in low-risk patients as well. We sought to
pool the existing data to further assert its comparability. MEDLINE,
Cochrane, and Embase databases were evaluated for relevant articles
published from January 2005 to June 2019. Studies comparing outcomes of
TAVI versus surgical aortic valve replacement in patients who are at low
risk for surgery were included. Twelve studies (5 randomized controlled
trials and 7 observational studies) totaling 27,956 patients were
included. Follow-up ranged from 3 months to 5 years. Short-term all-cause
mortality, short-term, and 1-year cardiac mortality were significantly
lower in the TAVI group. One-year all-cause mortality, short-term, and
1-year stroke and myocardial infarction were similar in both groups. Rate
of acute kidney injury and new-onset atrial fibrillation were lower in the
TAVI group, whereas permanent pacemaker implantation and major vascular
complications were higher in the TAVI group. Subgroup analysis of
randomized controlled trials showed significantly lower 1-year all-cause
mortality in the TAVI group. In conclusion, in severe aortic stenosis
patients at low surgical risk, TAVI when compared with surgical aortic
valve replacement, demonstrated a lower rate of short-term all-cause
mortality, short-term, and 1-year cardiac mortality and similar in terms
of 1-year all-cause mortality. TAVI is emerging as a safe and efficacious
alternative for low surgical risk patients. Copyright © 2019
Elsevier Inc.

<74>
Accession Number
2002885901
Title
A Pilot, Double-Blind, Randomized, Controlled Trial of High-Dose
Intravenous Vitamin C for Vasoplegia After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (2) (pp 409-416),
2020. Date of Publication: February 2020.
Author
Yanase F.; Bitker L.; Hessels L.; Osawa E.; Naorungroj T.; Cutuli S.L.;
Young P.J.; Ritzema J.; Hill G.; Latimer-Bell C.; Hunt A.; Eastwood G.M.;
Hilton A.; Bellomo R.
Institution
(Yanase, Bitker, Hessels, Osawa, Naorungroj, Cutuli, Eastwood, Hilton,
Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Yanase, Bellomo) Australian and New Zealand Intensive Care Research
Centre, Monash University School of Public Health and Preventive Medicine,
Melbourne, Australia
(Bitker) Service de medecine intensive et reanimation, Hopital de la Croix
Rousse, Hospices Civils de Lyon, Lyon, France
(Hessels) Department of Critical Care, University of Groningen, University
Medical Center Groningen, Groningen, Netherlands
(Naorungroj) Department of Intensive Care, Siriraj Hospital, Mahidol
University, Bangkok, Thailand
(Young, Ritzema, Hill, Latimer-Bell, Hunt) Department of Intensive Care,
Wellington Hospital, Wellington, New Zealand
(Bellomo) Centre for Integrated Critical Care, Department of Medicine &
Radiology, University of Melbourne, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objective: To conduct a pilot feasibility and physiologic efficacy study
of high-dose vitamin C in patients with vasoplegia after cardiac surgery.
 Design(s): Prospective, double-blind, randomized, controlled trial.
 Setting(s): Two tertiary intensive care units (ICUs).
 Participant(s): Post-cardiac surgery patients with vasoplegia.
 Intervention(s): The authors randomly assigned the patients to
receive either high-dose intravenous vitamin C (1,500 mg every 6 hours) or
placebo. The primary outcome was time from randomization to resolution of
vasoplegia. Secondary outcomes included total norepinephrine equivalent
dose in the first 2 days, ICU length of stay, ICU mortality, and
in-hospital mortality. Measurements and Main Results: The authors
studied 50 patients (25 patients in each arms). The mean (standard
deviation) time to resolution of vasoplegia was 27.0 (16.5) hours in the
vitamin C group versus 34.7 (41.1) hours in the placebo group (mean
decrease with vitamin C of 7.7 hours, 95% confidence interval -10.5 to
25.9, p = 0.40). The median (interquartile range) norepinephrine
equivalent dose in the first 2 days was 64.9 (23.5-236.5) micro g/kg
versus 47.4 (21.4-265.9) micro g/kg in the vitamin C and placebo group
(p = 0.75). The median duration of ICU admission was similar (1.4
[0.5-2.5] days and 1.5 [0.5-3.3] days in the vitamin C and placebo group;
p = 0.36). Only 1 patient, in the vitamin C arm, died. Conclusion(s):
In patients with post-cardiac surgery vasoplegia, high-dose vitamin C
infusion was feasible, appeared safe, and, within the limitations of a
pilot study, did not achieve statistically faster resolution of
vasoplegia. Copyright © 2019 Elsevier Inc.

<75>
Accession Number
2002467081
Title
Impact of telephone follow-up and 24/7 hotline on 30-day readmission rates
following aortic valve replacement -A randomized controlled trial.
Source
International Journal of Cardiology. 300 (pp 66-72), 2020. Date of
Publication: 1 February 2020.
Author
Danielsen S.O.; Moons P.; Sandvik L.; Leegaard M.; Solheim S.; Tonnessen
T.; Lie I.
Institution
(Danielsen, Lie) Center for Patient-centered Heart and Lung Research,
Department of Cardiothoracic Surgery, Division of Cardiovascular and
Pulmonary Diseases, Oslo University Hospital, Ulleval, Oslo, Norway
(Danielsen, Tonnessen) Institute of Clinical Medicine, Faculty of
Medicine, University of Oslo, Oslo, Norway
(Danielsen, Moons) KU Leuven Department of Public Health and Primary Care,
KU Leuven-University of Leuven, Leuven, Belgium
(Moons) Institute of Health and Care Sciences, University of Gothenburg,
Gothenburg, Sweden
(Moons) Department of Paediatrics and Child Health, University of Cape
Town, South Africa
(Sandvik) Oslo Centre of Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Tonnessen) Department of Cardiothoracic Surgery, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ulleval,
Oslo, Norway
(Solheim) Center for Clinical Heart Research, Department of Cardiology,
Division of Medicine, Oslo University Hospital, Ulleval, Oslo, Norway
(Leegaard) Department of Nursing and Health Promotion, Faculty of Health
Sciences, Oslo Metropolitan University, Oslo, Norway
Publisher
Elsevier Ireland Ltd
Abstract
Background: Thirty-day all-cause readmissions are high after aortic valve
replacement (AVR). We aimed to assess the effectiveness of a structured
telephone follow-up (TFU) and a 24/7 hotline on reducing 30-day all-cause
readmission (30-DACR) after AVR, on reducing symptoms of anxiety and
depression and on improving perceived health state. Method(s): A
prospective randomized controlled trial was conducted. Patients (n = 288)
were randomly allocated to either post-discharge usual care or to care
that provided TFU and access to a 24/7 hotline after AVR. Ancillary
endpoints were time-to-event (readmission), proportion of avoidable versus
unavoidable readmissions after AVR, and predictors of 30-DACR after AVR.
 Result(s): 30-DACR was 22.3%. The structured TFU and 24/7 hotline
intervention failed to reduce 30-DACR rates after AVR (P = 0.274).
Symptoms of anxiety were significantly reduced 30 days after surgery (P =
0.031), an effect that did not persist one year after surgery (P = 0.108).
Most readmissions occurred before 15 days post-discharge, and 75% of them
were deemed to be unavoidable. Pleural drainage before hospital discharge
(P = 0.027) and symptoms of anxiety before surgery (P = 0.003) were
predictors of 30-DACR after AVR. Conclusion(s): The TFU and 24/7
hotline had no effect on reducing 30-DACR after AVR. However, we did
measure reduced symptoms of anxiety the first month after AVR. Anxiety
reduction appeared to be an important target for intervention, because we
found it to be a risk factor for readmission. Future research should focus
on the effectiveness of interventions to prevent avoidable unplanned
readmissions. Trial registration: ClinicalTrial.gov,
NCT02522663. Copyright © 2019 Elsevier B.V.

<76>
Accession Number
2003430332
Title
Dynamic predictive model for postoperative nausea and vomiting for
intravenous fentanyl patient-controlled analgesia.
Source
Anaesthesia. 75 (2) (pp 218-226), 2020. Date of Publication: 01 Feb 2020.
Author
Chae D.; Kim S.Y.; Song Y.; Baek W.; Shin H.; Park K.; Han D.W.
Institution
(Chae, Park) Department of Pharmacology, Severance Hospital, Anaesthesia
and Pain Research Institute, Yonsei University College of Medicine, Seoul,
South Korea
(Kim, Baek, Shin) Department of Anaesthesiology and Pain Medicine,
Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Song, Han) Department of Anesthesiology and Pain Medicine, Gangnam
Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
Postoperative nausea and vomiting is the most common side-effect of
opioid-based intravenous patient-controlled analgesia. Apfel's simplified
risk score is popular but it has some limitations. We developed and
validated a dynamic predictive model for nausea or vomiting up to 48
postoperative hours, available as an online web application. Fentanyl was
used by 22,144 adult patients for analgesia after non-cardiac surgery
under general anaesthesia: we randomly divided them into development (80%)
and validation (20%) cohorts, repeated 100 times. We used linear
discriminant analysis to select variables for multivariate logistic
regression. The incidences of postoperative nausea or vomiting were: 0-48
h, 5691/22,144 (26%); 0-6 h, 2749/22,144 (12%); 6-12 h, 2687/22,144 (12%);
12-18 h, 2624/22,144 (12%); 18-24 h, 1884/22,144 (9%); and 24-48 h,
1082/22,144 (5%). The median (95%CI) area under the receiver operating
characteristic curve was 0.72 (0.71-0.73) up to 48 postoperative hours
compared with 0.65 (0.64-0.66) for the Apfel model, p < 0.001. The
equivalent areas for 0-6 h, 6-12 h, 12-18 h, 18-24 h and 24-48 h were:
0.70 (0.69-0.72); 0.71 (0.69-0.73); 0.69 (0.68-0.71); 0.70 (0.67-0.72);
and 0.69 (0.66-0.71), respectively. Our web application allows clinicians
to calculate incidences of nausea and vomiting in patients receiving
intravenous fentanyl for patient-controlled analgesia. Copyright
© 2019 Association of Anaesthetists

<77>
Accession Number
2003283159
Title
Preoperative Risk Assessment and Management in Adults Receiving
Maintenance Dialysis and Those With Earlier Stages of CKD.
Source
American Journal of Kidney Diseases. 75 (2) (pp 245-255), 2020. Date of
Publication: February 2020.
Author
Bahrainwala J.Z.; Gelfand S.L.; Shah A.; Abramovitz B.; Hoffman B.;
Leonberg-Yoo A.K.
Institution
(Bahrainwala, Gelfand, Hoffman, Leonberg-Yoo) Renal-Electrolyte and
Hypertension Division, Department of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Shah) Division of Kidney Disease & Hypertension, Department of Medicine,
Brown University, Providence, RI, United States
(Shah) Division of Nephrology, Medical Service, Providence Veterans
Affairs Medical Center, Providence, RI, United States
(Abramovitz) Division of Renal-Electrolyte, Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
Publisher
W.B. Saunders
Abstract
With an increasingly aging population and improved mortality in
individuals with end-stage kidney disease, more surgeries are being
performed on patients with all stages of chronic kidney disease (CKD).
This high-risk population carries unique risk factors that have been
associated with increased adverse perioperative outcomes, including acute
kidney injury, cardiovascular events, and mortality. In this article, we
review the literature describing absolute risks associated with common
surgeries performed in patients with CKD and patients receiving
maintenance dialysis. We also review perioperative optimization with
special risk assessment including evaluation of cardiovascular and
bleeding risk evaluation, hypertension management, and timing of dialysis.
Predictive model scores are reviewed as a method to stratify risk for
acute kidney injury, major adverse cardiac events, or other serious
complications with elective surgeries. A multidisciplinary approach with
individualized counseling is necessary to counsel the patient with
advanced CKD or patients treated with maintenance dialysis considering
elective surgery. Copyright © 2019 National Kidney Foundation,
Inc.

<78>
Accession Number
2001986702
Title
Efficacy of an Ultrasound-Guided Erector Spinae Plane Block for
Postoperative Analgesia Management After Video-Assisted Thoracic Surgery:
A Prospective Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (2) (pp 444-449),
2020. Date of Publication: February 2020.
Author
Ciftci B.; Ekinci M.; Celik E.C.; Tukac I.C.; Bayrak Y.; Atalay Y.O.
Institution
(Ciftci, Ekinci, Tukac, Atalay) Istanbul Medipol University, School of
Medicine, Mega Medipol University Hospital, Department of Anesthesiology
and Reanimation, Istanbul, Turkey
(Celik) Erzurum Regional Training and Research Hospital, Department of
Anesthesiology and Reanimation, Yakutiye, Erzurum, Turkey
(Bayrak) Istanbul Medipol University, Mega Medipol University Hospital,
Department of Thoracic Surgery, Istanbul, Turkey
Publisher
W.B. Saunders
Abstract
Objectives: Investigate whether an ultrasound-guided erector spinae plane
block (ESPB) can be used to manage postoperative pain in video-assisted
thoracic surgery (VATS) patients. Design(s): Prospective, randomized
study. Setting(s): Single institution, academic university hospital.
 Participant(s): Adult patients who underwent VATS under general
anesthesia between September 2018 and March 2019. Intervention(s):
This study was an interventional study. Measurements and Main
Results: A total of 60 patients were randomly assigned into 2 groups (n =
30 per group): an ESPB group and a control group. In the ESPB group, a
single-shot ultrasound-guided ESPB was administered preoperatively. The
control group received no such intervention. All of the patients received
intravenous patient-controlled postoperative analgesia, and they were
assessed using visual analogue scale (VAS) scores, opioid consumption, and
adverse events. There were no statistically significant intergroup
differences with respect to the age, sex, weight, American Society of
Anesthesiologists status, anesthesia duration, and surgery length (p >
0.05 for each). The opioid consumption at 1, 2, 4, 8, 16, and 24 hours and
the active and passive VAS scores at 0, 2, 4, 8, 16, and 24 hours were
statistically lower in the ESPB group at all of the time periods when
compared with the control group (p < 0.05). In the control group, the
nausea and itching rates were higher, but there were no intergroup
differences in terms of other adverse effects. Conclusion(s): A
preemptive single-shot ESPB may provide effective analgesia management
after VATS. Copyright © 2019 Elsevier Inc.

<79>
Accession Number
626474510
Title
Pretreatment with glucose-insulin-potassium improves ventricular
performances after coronary artery bypass surgery: a randomized controlled
trial.
Source
Journal of Clinical Monitoring and Computing. 34 (1) (pp 29-40), 2020.
Date of Publication: 01 Feb 2020.
Author
Licker M.; Reynaud T.; Garofano N.; Sologashvili T.; Diaper J.;
Ellenberger C.
Institution
(Licker, Reynaud, Garofano, Diaper, Ellenberger) Department of
Anaesthesiology, Pharmacology and Intensive Care, University Hospital of
Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland
(Licker) Faculty of Medicine, University of Geneva, Geneva, Switzerland
(Sologashvili) Division of Cardiovascular Surgery, University Hospital of
Geneva, Geneva, Switzerland
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
Heart failure is the main cause of poor outcome following open heart
surgery and experimental studies have demonstrated that
glucose-insulin-potassium (GIK) infusion exerts cardioprotective effects
by reducing myocardial ischemia-reperfusion injuries. This randomized
controlled trial was designed to assess the effects of GIK on left
ventricular function in moderate-to-high risk patients undergoing on-pump
isolated coronary artery bypass surgery (CABGS), or combined with aortic
valve replacement. The primary outcomes were the effects of GIK on two-
and three-dimensional left ventricular ejection fraction (2D and 3D-LVEF),
and on transmitral flow propagation velocity (Vp), that occurred between
the pre- and post-CPB periods. GIK administration was associated with
favorable interaction effects (p < 0.001) on 2D-LVEF, 3D-LVEF and Vp
changes over the study periods. In GIK pretreated patients (N = 54), 2-D
and 3D-LVEF and Vp increased slightly during surgery (mean difference [MD]
+ 3.5%, 95% confidence interval [95% CI] - 0.2 to 7.1%, MD + 4.0%, 95% CI
0.6-7.4%, and MD + 22.2%, 95% CI 16.0-28.4%, respectively). In contrast,
in the Placebo group (N = 46), 2D-and 3D-LVEF, as well as Vp all decreased
after CPB (MD - 7.5% [- 11.6 to - 3.4%], MD - 12.0% [- 15.2 to - 8.8%] and
MD - 21.3% [- 25.7 to - 16.9%], respectively). In conclusion, the
administration of GIK resulted in better preservation of systolic and
diastolic ventricular function in the early period following weaning from
CPB. Copyright © 2019, Springer Nature B.V.

<80>
Accession Number
626473153
Title
Intraoperative reduction of vasopressors using processed
electroencephalographic monitoring in patients undergoing elective cardiac
surgery: a randomized clinical trial.
Source
Journal of Clinical Monitoring and Computing. 34 (1) (pp 71-80), 2020.
Date of Publication: 01 Feb 2020.
Author
Sponholz C.; Schuwirth C.; Koenig L.; Hoyer H.; Coldewey S.M.; Schelenz
C.; Doenst T.; Kortgen A.; Bauer M.
Institution
(Sponholz, Schuwirth, Koenig, Coldewey, Schelenz, Kortgen, Bauer)
Department of Anesthesiology and Intensive Care Medicine, Jena University
Hospital, Jena, Germany
(Hoyer) Institute of Medical Statistics, Computer Sciences and Data
Sciences, Jena University Hospital, Jena, Germany
(Coldewey) ZIK Septomics Research Centre, Jena University Hospital,
Friedrich Schiller University Jena, Jena, Germany
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Jena, Germany
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
Intraoperative vasopressor and fluid application are common strategies
against hypotension. Use of processed electroencephalographic monitoring
(pEEG) may reduce vasopressor application, a known risk factor for organ
dysfunction, in elective cardiac surgery patients. Randomized
single-centre clinical trial at Jena University Hospital. Adult patients
operated on cardiopulmonary bypass or off-pump coronary artery bypass
grafting were randomised to receive anesthesia with visible or blinded
pEEG using NarcotrendTM. In blinded-Narcotrend (NT) depth of anesthesia
was extrapolated from clinical signs, hemodynamic response and anesthetic
concentration, supplemented by target indices between 37 and 64 in the
visible-NT group. Intraoperative norepinephrine requirement (primary
endpoint), fluid balance, extubation time, delirium occurrence and adverse
events were evaluated. Patients of the intent-to-treat population
(visible-NT: n = 123, blinded-NT: n = 122) had similar patient and
procedural characteristics. Adjusted for type of surgery intraoperative
Norepinephrine application was significantly reduced in visible-NT (n =
120, robust mean of cumulative dose 4.71 micro g/kg bodyweight)
compared to blinded-NT patients (n = 119, 6.14 micro g/kg bodyweight)
(adjusted robust mean difference 1.71 (95% CI 0.33-3.10) micro g/kg
bodyweight). Although reduction in patients operated on cardiopulmonary
bypass was higher the interaction was not significant in post-hoc subgroup
analysis. Intraoperative fluid balance was similar among both groups and
strata. Extubation time was non-significantly lower in visible than in
blinded-NT group. Overall postoperative delirium risk was 16.4% without
differences among the groups. Adverse events-sudden movement/coughing,
perspiration or hypertension-occurred more often with visible-NT, while
one blinded-NT patient experienced intraoperative awareness. Titration of
depth of anesthesia in elective cardiac surgery patients using pEEG allows
to reduce application of norepinephrine. Copyright © 2019,
Springer Nature B.V.

<81>
Accession Number
628600912
Title
Influence of preoperative information support on anxiety, pain and
satisfaction with postoperative analgesia in children and adolescents
after thoracic surgery: A randomized double blind study.
Source
Biomedical papers of the Medical Faculty of the University Palacky,
Olomouc, Czechoslovakia. 163 (2) (pp 172-178), 2019. Date of Publication:
01 Jun 2019.
Author
Tomaszek L.; Cepuch G.; Fenikowski D.
Institution
(Tomaszek, Fenikowski) Department of Thoracic Surgery, Institute for
Tuberculosis and Lung Diseases, Pediatric Division, Poland
(Cepuch) Collegium Medicum, Faculty of Health Sciences, Jagiellonian
University, Poland Corresponding author: Lucyna Tomaszek, Krakow, Poland
Publisher
NLM (Medline)
Abstract
AIMS/BACKGROUND: The proportion of patients who experience anxiety prior
to planned surgery, even a minimally invasive one, is estimated at 50-70%.
Thoracic surgery, causes significant preoperative anxiety, especially in
children. The aim of this study was to determine the effect of an
important component of psychological preparation for a surgery as
information support on levels of anxiety, pain and satisfaction with
postoperative analgesia. METHOD(S): The randomized double blind study
including patients aged 9-18 years qualified for lateral thoracotomy or
Ravitch procedure. The subjects were randomized to the control group
(n=56) provided with a routine preoperative information by a nurse, and
the experimental group (n=56) offered additional psychological
consultation. Data were collected via the State-Trait Anxiety Inventory.
 RESULT(S): In the experimental group, the level of state anxiety at
48 h post-surgery was significantly lower than prior to the procedure, but
only in subjects with preoperative trait anxiety Conclusion(s):
Information support from a psychologist offered prior to a thoracic
surgery decrease the level of postoperative state anxiety solely in
children with lower levels of trait anxiety. Higher level of postoperative
state anxiety negatively affect patients' satisfaction with post-surgical
analgesia. TRIAL REGISTRATION: ClinicalTrials.gov; Influence of
Preoperative Support on Anxiety, Pain and Satisfaction With Postoperative
Analgesia; NCT03488459,
https://clinicaltrials.gov/ct2/show/record/NCT03488459?cntry=PL&city=Rabka
-Zdr%C3%B3j&rank=1.

<82>
Accession Number
2003850589
Title
Treatment strategies for mixed aortic valve disease in nonelderly
patients.
Source
Expert Review of Cardiovascular Therapy. 17 (12) (pp 873-882), 2019. Date
of Publication: 02 Dec 2019.
Author
Von Stumm M.; Petersen J.; Westermann D.; Reichenspurner H.; Girdauskas E.
Institution
(Von Stumm, Petersen, Reichenspurner, Girdauskas) Department of
Cardiovascular Surgery, University Heart Center, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Westermann) Department of Cardiology, University Heart Center, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Mixed aortic valve disease (MAVD) is defined by simultaneous
occurrence of aortic stenosis (AS) and aortic regurgitation (AR). In our
review, we focus on treatment options for nonelderly MAVD patients (age<55
years), who suffer from congenital aortic valve disease
(unicuspid/bicuspid aortic valves). Areas covered: A systematic literature
search was performed on PubMed and Embase databases using the following
terms: mixed aortic valve disease, aortic stenosis/regurgitation,
bicuspid/unicuspid aortic valve, mechanical/bioprosthetic aortic valve
replacement, TAVR, Ross procedure. After preselection of title and
abstracts, two authors (M.S. and E.G.) assessed the methodological quality
of the full-text articles prior to final inclusion in the manuscript.
Expert opinion: Currently, no ideal valvular substitutes are available in
the treatment of nonelderly MAVD patients. Mechanical valves are
associated with a reduced life expectancy due to a combination of
prothesis-associated factors, mainly thrombotic and bleeding
complications. Bioprostheses degenerate in the second decade and
re-operations are inevitable, which also limit life expectancy. Long-term
outcomes and durability of transcatheter aortic valve replacement are
currently unknown. Finally, only Ross procedure is a therapeutic option
with excellent long-term outcomes comparable to the healthy population.
However, the Ross procedure has some important drawbacks and should
therefore be only performed in expert centers and in well-selected
patients. Copyright © 2019, © 2019 Informa UK Limited,
trading as Taylor & Francis Group.

<83>
Accession Number
630522047
Title
Comparative efficacy of continuous infusion of bupivacaine/fentanyl and
ropivacaine/fentanyl for paediatric pain control after the Ravitch
procedure and thoracotomy. A prospective randomized study.
Source
Biomedical papers of the Medical Faculty of the University Palacky,
Olomouc, Czechoslovakia. 163 (4) (pp 366-373), 2019. Date of Publication:
01 Dec 2019.
Author
Tomaszek L.; Fenikowski D.; Gawron D.; Komotajtys H.
Institution
(Tomaszek, Fenikowski, Gawron, Komotajtys) Department of Thoracic Surgery,
Institute for Tuberculosis and Lung Diseases, Pediatric Division, Poland
Publisher
NLM (Medline)
Abstract
AIMS: (1) To compare the efficacy of bupivacaine/fentanyl and
ropivacaine/fentanyl for postoperative pain control (2). To identify the
predictors of acute post-operative pain at rest, during deep breathing and
coughing. METHOD(S): The study was performed in patients aged 6-18
years after thoracic surgery. The subjects were randomized to the
bupivacaine 0.125%/fentanyl 5.0 mug/mL (n=46) or ropivacaine 0.2%/fentanyl
5.0 mug/mL (n=48) group; analgesic mixtures were administered through
epidural catheter. All the patients received paracetamol and non-steroidal
anti-inflammatory drugs. The observation period after surgery lasted 72 h.
Pain intensity was assessed at rest, during deep breathing and coughing
and was based on the Numerical Rating Scale and the FLACC scale (range
0-10). If the pain was above 2/10, the analgesia was modified.
 RESULT(S): Median pain scores at rest (0.4 vs. 0.5), during deep
breathing (0.3 vs. 0.3) and coughing (0.6 vs. 0.6) were comparable in BF
and RF group. The intensity of pain at rest was associated with the number
of drains inserted into the thorax (beta=0.39), the number of pain
intensity measurements (beta=0.36) and the number of nursing interventions
undertaken to relieve pain (beta=0.16). Pain intensity at rest determined
the intensity of pain during deep breathing (beta=0.60), which in turn
decided on the severity of pain during coughing (beta=0.80). The intensity
of pain was increased by age. CONCLUSION(S): Thoracic epidural
bupivacaine/fentanyl provided adequate pain relief and similar analgesia
to ropivacaine/fentanyl. The effectiveness of analgesia depended on the
number of pain measurements and interventions by nurses to relieve the
pain. TRIAL REGISTRATION: ClinicalTrials.gov; Multimodal Analgesia in
Children and Adolescents After the Ravitch Procedure and Thoracotomy;
NCT03444636; https://clinicaltrials.gov/ct2/show/NCT03444636.

<84>
[Use Link to view the full text]
Accession Number
630550164
Title
Hemocoagulase reduces postoperative bleeding and blood transfusion in
cardiac surgical patients: A PRISMA-compliant systematic review and
meta-analysis.
Source
Medicine (United States). 98 (52) (no pagination), 2019. Article Number:
e18534. Date of Publication: 01 Dec 2019.
Author
Yao Y.-T.; Yuan X.; Fang N.-X.
Institution
(Yao, Fang) Department of Anesthesiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy
of Medical Sciences, No. 167, Beilishi Road, Xicheng District, Beijing
100037, China
(Yuan) Department of Adult Cardiac Surgery, Fuwai Hospital, National
Center for Cardiovascular Diseases, Peking Union Medical College, Chinese
Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District,
Beijing 100037, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
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. 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. 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. 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. Copyright © 2019 the Author(s).
Published by Wolters Kluwer Health, Inc.

<85>
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. 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. 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. 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. Copyright © 2020 BJS Society Ltd Published by John
Wiley & Sons Ltd

<86>
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. 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. 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. 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. Copyright © 2020
BJS Society Ltd Published by John Wiley & Sons Ltd

<87>
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. 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. 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%).
 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. Copyright © 2020, ©
2020 The Author(s). Published by Informa UK Limited, trading as Taylor &
Francis Group.

<88>
Accession Number
627998545
Title
Estimated treatment effect of ticagrelor versus aspirin by
investigator-assessed events compared with judgement by an independent
event adjudication committee in the SOCRATES trial.
Source
International Journal of Stroke. 14 (9) (pp 908-914), 2019. Date of
Publication: 01 Dec 2019.
Author
Easton J.D.; Denison H.; Evans S.R.; Knutsson M.; Amarenco P.; Albers
G.W.; Ladenvall P.; Minematsu K.; Molina C.A.; Wang Y.; Wong K.S.L.;
Johnston S.C.
Institution
(Easton) Department of Neurology, University of California, San Francisco,
United States
(Denison, Knutsson, Ladenvall) Global Medicines Development, AstraZeneca,
Gothenburg, Sweden
(Evans) Biostatistics Center, George Washington University, WA, United
States
(Amarenco) Department of Neurology and Stroke Centre, Bichat Hospital,
Paris University, Paris, France
(Albers) Stanford Stroke Center, Stanford University, Stanford, United
States
(Minematsu) Department of Cerebrovascular Medicine, National Cerebral and
Cardiovascular Center, Suita, Japan
(Molina) Stroke Unit, Hospital Vall d'Hebron, Barcelona, Spain
(Wang) Department of Neurology, Beijing Tiantan Hospital, Beijing, China
(Wong) Department of Medicine Therapeutics, Chinese University of Hong
Kong, Shatin, Hong Kong
(Johnston) Dean's Office, Dell Medical School, University of Texas at
Austin, Austin, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Adjudication of endpoints is a standard procedure in
cardiovascular clinical trials. However, several studies indicate that the
benefit of adjudication in estimating treatment effect may be limited.
 Aim(s): This post hoc analysis of SOCRATES (NCT01994720) compared the
treatment effects and investigated the agreement of clinical event
assessment by site investigators and independent adjudicators.
 Method(s): SOCRATES compared ticagrelor and aspirin in 13,199
patients with acute minor stroke or high-risk transient ischemic attack.
The primary endpoint was stroke, myocardial infarction, or death. Stroke
was the major component of the primary endpoint and a secondary endpoint.
The endpoints were adjudicated by a blinded independent committee. We
compared the treatment effect on the primary endpoint and stroke alone
based on the investigators' and adjudicators' assessments, and
investigated the agreement rate on the stroke endpoint and major
hemorrhages. Result(s): The hazard ratios (95% confidence interval)
for ticagrelor versus aspirin therapy for the primary endpoint were 0.89
(0.78-1.01) when calculated on adjudicator-assessed events and 0.88
(0.78-1.00) for investigator-assessed events. The hazard ratios (95%
confidence intervals) for stroke were 0.86 (0.75-0.99) based on the
adjudicators' diagnoses and 0.85 (0.75-0.97) based on the investigators'
diagnoses. The overall agreement between adjudicator- and
investigator-diagnosed stroke was 91%, and for major hemorrhages was 88%.
 Conclusion(s): In SOCRATES, there was no clinically meaningful
difference in the estimated treatment effect, on either the primary
endpoint or stroke, by using investigator- or adjudicator-assessed events.
Double-blind treatment outcome studies with stroke endpoints may not
benefit from adjudication. Trial Registration: ClinicalTrials.gov
Identifier: NCT01994720. Copyright © 2019 World Stroke
Organization.

<89>
Accession Number
627998047
Title
Case report and systematic review of iatrogenic left atrial dissection in
different cardiovascular specialties: A common treatment for an uncommon
complication?.
Source
Catheterization and Cardiovascular Interventions. 95 (1) (pp E30-E36),
2020. Date of Publication: 01 Jan 2020.
Author
Cereda A.F.; De Luca F.; Lanzone A.M.; Cottini M.; Pastori L.; Sangiorgi
G.
Institution
(Cereda) Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo,
Italy
(De Luca) Department of Cardiothoracic Surgery, Humanitas Gavazzeni
Hospital, Bergamo, Italy
(Lanzone, Pastori, Sangiorgi) Cardiac Cath Laboratory, Humanitas Gavazzeni
Hospital, Bergamo, Italy
(Cottini) Department of Cardiac Surgery and Heart Transplantation, De
Gasperis Center, Niguarda Hospital, Milan, Italy
(Sangiorgi) Department of Systemic Medicine, Division of Cardiology,
University of Rome Tor Vergata, Rome, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: Left atrial dissection (LatD) is a rare and heterogeneous
condition affecting many cardiovascular areas. The present article, by the
means of personal case report illustration and systemic review of
different clinical management, is aimed to give to clinicians further
knowledge on this controversial topic. Background(s): LatD is an
exceedingly rare but potentially fatal complication of cardiac surgery or
catheter-based interventional procedures. Most of the cases are iatrogenic
and its incidence is expected to grow due to an increase in the number of
percutaneous coronary intervention and structural heart disease
procedures. The management of this complication is controversial, and it
may depend on related etiologies. Method(s): We have reported our
single-case experience and review of the scientific literature, focusing
on the decision-making process and the strategical approach by
multimodality imaging techniques. Result(s): Our case of LatD with
initial hemodynamic instability was surgically treated. Conservative
approach is often employed in literature despite the fact that
conservative versus surgical approach is debatable, depending on clinical
presentation, hemodynamic stability, multimodal imaging findings, and
personal experience of the center. Conclusion(s): According to
systematic literature review, a watchful-waiting strategy supported by
multimodality imaging could be a safe and effective management in stable
LatD. Copyright © 2019 Wiley Periodicals, Inc.

<90>
Accession Number
2002604850
Title
Impact of complete percutaneous revascularization in elderly patients with
chronic total occlusion.
Source
Catheterization and Cardiovascular Interventions. 95 (1) (pp 145-153),
2020. Date of Publication: 01 Jan 2020.
Author
Valenti R.; Migliorini A.; De Gregorio M.G.; Martone R.; Berteotti M.;
Bernardini A.; Carrabba N.; Vergara R.; Marchionni N.; Antoniucci D.
Institution
(Valenti, Migliorini, De Gregorio, Martone, Berteotti, Bernardini,
Carrabba, Vergara, Marchionni, Antoniucci) Cardiothoracic and Vascular
Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The aim of the study was to assess the prognostic impact of
successful chronic total occlusion (CTO) percutaneous coronary
intervention (PCI) and completeness of revascularization in the elderly.
 Background(s): Successful CTO-PCI is associated with clinical
benefit. Notwithstanding elderly patients are currently underrepresented
in CTO-PCI randomized controlled trials and registries. Method(s):
From the Florence CTO-PCI registry 1,405 patients underwent CTO-PCI
between 2004 and 2015; out of these, 460 consecutive patients were >=75
years. End point of the study was long-term cardiac survival. The
prognostic impact of successful CTO-PCI and complete revascularization on
survival was assessed by Kaplan-Meier estimation and by Cox multivariable
regression analysis. Result(s): Patients were stratified according to
success (72%) or failure of CTO-PCI. Completeness of revascularization was
achieved in 57% of patients. Five-year cardiac survival was significantly
higher in the successful CTO-PCI group (84 +/- 3% vs. 72 +/- 6%; p =.006)
and it was further improved if complete coronary revascularization was
achieved (90 +/- 3% vs. 68 +/- 5%; p <.001). At multivariable analysis,
increasing age (hazard ratio [HR] 1.08; p =.001), diabetes (HR 1.55; p
=.033), chronic kidney disease (HR 1.96, p =.002), left ventricular
ejection fraction <0.40 (HR 2.10; p <.001), and completeness of
revascularization (HR 0.58; p <.005) resulted independently associated
with long-term cardiac survival. Conclusion(s): In the elderly
successful CTO-PCI is associated with a long-term survival benefit. The
results of this study suggest that, even in the elderly, a CTO-PCI attempt
should be considered to achieve complete coronary
revascularization. Copyright © 2019 Wiley Periodicals, Inc.

<91>
Accession Number
630443536
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) (no pagination), 2019. Article Number: e035787. 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
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Following cardiac surgery, patients currently attend an
outpatient review 6 weeks after hospital discharge, where recovery is
assessed and suitability to commence cardiac rehabilitation (CR) is
determined. CR is then started from 8 weeks. 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. Copyright © Author(s) (or their
employer(s)) 2019.

<92>
Accession Number
630510873
Title
A comparison of spinal laser interstitial thermotherapy with open surgery
for metastatic thoracic epidural spinal cord compression.
Source
Journal of neurosurgery. Spine. (pp 1-9), 2020. Date of Publication: 03
Jan 2020.
Author
de Almeida Bastos D.C.; Everson R.G.; de Oliveira Santos B.F.; Habib A.;
Vega R.A.; Oro M.; Rao G.; Li J.; Ghia A.J.; Bishop A.J.; Yeboa D.N.;
Amini B.; Rhines L.D.; Tatsui C.E.
Institution
(de Almeida Bastos, de Oliveira Santos, Habib, Vega, Oro, Rao, Rhines,
Tatsui) Departments of1Neurosurgery
(Everson) Department of Neurosurgery, David Geffen School of Medicine at
UCLA, Los Angeles, CA, Mexico
(Li, Ghia, Bishop, Yeboa) 3Radiation Oncology
(Amini) 4Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Texas; and
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The proximity of the spinal cord to compressive metastatic
lesions limits radiosurgical dosing. Open surgery is used to create safe
margins around the spinal cord prior to spinal stereotactic radiosurgery
(SSRS) but carries the risk of potential surgical morbidity and
interruption of systemic oncological treatment. Spinal laser interstitial
thermotherapy (SLITT) in conjunction with SSRS provides local control with
less morbidity and a shorter interval to resume systemic treatment. The
authors present a comparison between SLITT and open surgery in patients
with metastatic thoracic epidural spinal cord compression to determine the
advantages and disadvantages of each method. METHOD(S): This is a
matched-group design study comprising patients from a single institution
with metastatic thoracic epidural spinal cord compression that was treated
either with SLITT or open surgery. The two cohorts defined by the surgical
treatment comprised patients with epidural spinal cord compression (ESCC)
scores of 1c or higher and were deemed suitable for either treatment.
Demographics, pre- and postoperative ESCC scores, histology, morbidity,
hospital length of stay (LOS), complications, time to radiotherapy, time
to resume systemic therapy, progression-free survival (PFS), and overall
survival (OS) were compared between groups. RESULT(S): Eighty
patients were included in this analysis, 40 in each group. Patients were
treated between January 2010 and December 2016. There was no significant
difference in demographics or clinical characteristics between the
cohorts. The SLITT cohort had a smaller postoperative decrease in the
extent of ESCC but a lower estimated blood loss (117 vs 1331 ml, p <
0.001), shorter LOS (3.4 vs 9 days, p < 0.001), lower overall complication
rate (5% vs 35%, p = 0.003), fewer days until radiotherapy or SSRS (7.8 vs
35.9, p < 0.001), and systemic treatment (24.7 vs 59 days, p = 0.015). PFS
and OS were similar between groups (p = 0.510 and p = 0.868,
respectively). CONCLUSION(S): The authors' results have shown that
SLITT plus XRT is not inferior to open decompression surgery plus XRT in
regard to local control, with a lower rate of complications and faster
resumption of oncological treatment. A prospective randomized controlled
study is needed to compare SLITT with open decompressive surgery for ESCC.

<93>
Accession Number
2004011154
Title
Randomized clinical trial of intraoperative dexmedetomidine to prevent
delirium in the elderly undergoing major non-cardiac surgery.
Source
British Journal of Surgery. 107 (2) (pp e123-e132), 2020. Date of
Publication: 01 Jan 2020.
Author
Li C.-J.; Wang B.-J.; Mu D.-L.; Hu J.; Guo C.; Li X.-Y.; Ma D.; Wang D.-X.
Institution
(Li, Wang, Mu, Hu, Guo, Wang) Department of Anaesthesiology and Critical
Care Medicine, Beijing, China
(Li) Department of Biostatistics, Peking University First Hospital,
Beijing, China
(Ma) Section of Anaesthetics, Pain Medicine and Intensive Care, Department
of Surgery and Cancer, Imperial College London, Chelsea and Westminster
Hospital, London, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Delirium is common in elderly patients after surgery and is
associated with poor outcomes. This study aimed to investigate the impact
of intraoperative dexmedetomidine on the incidence of delirium in elderly
patients undergoing major surgery. Method(s): This was a randomized
double-blind placebo-controlled trial. Elderly patients (aged 60 years or
more) scheduled to undergo major non-cardiac surgery were randomized into
two groups. Patients in the intervention group received a loading dose of
dexmedetomidine 0.6 mug/kg 10 min before induction of anaesthesia followed
by a continuous infusion (0.5 mug per kg per h) until 1 h before the end
of surgery. Patients in the control group received volume-matched normal
saline in the same schedule. The primary outcome was the incidence of
delirium during the first 5 days after surgery. Delirium was assessed with
the Confusion Assessment Method (CAM) for non-ventilated patients and CAM
for the Intensive Care Unit for ventilated patients. Result(s): In
total, 309 patients who received dexmedetomidine and 310 control patients
were included in the intention-to-treat analysis. The incidence of
delirium within 5 days of surgery was lower with dexmedetomidine
treatment: 5.5 per cent (17 of 309) versus 10.3 per cent (32 of 310) in
the control group (relative risk (RR) 0.53, 95 per cent c.i. 0.30 to 0.94;
P = 0.026). The overall incidence of complications at 30 days was also
lower after dexmedetomidine (19.4 per cent (60 of 309) versus 26.1 per
cent (81 of 310) for controls; RR 0.74, 0.55 to 0.99, P = 0.047).
 Conclusion(s): Intraoperative dexmedetomidine halved the risk of
delirium in the elderly after major non-cardiac surgery. Registration
number: ChiCTR-IPR-15007654 (www.chictr.org.cn). Copyright © 2020
BJS Society Ltd Published by John Wiley & Sons Ltd

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