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<1>
Accession Number
605166715
Title
What is the best anticoagulant therapy during primary percutaneous
coronary intervention for acute myocardial infarction?.
Source
Polskie Archiwum Medycyny Wewnetrznej. 125 (6) (pp 461-470), 2015. Date of
Publication: 2015.
Author
Gurbel P.A.; Navarese E.P.; Tantry U.S.
Institution
(Gurbel, Tantry) Sinai Center for Thrombosis Research, Cardiac
Catheterization Laboratory, 2401 W. Belvedere Ave, Baltimore, MD 21215,
United States
(Navarese) Department of Internal Medicine Pulmonology and Vascular
Medicine, Division of Cardiology, Heinrich-Heine-University, Dusseldorf,
Germany
Publisher
Medycyna Praktyczna (E-mail: listy@mp.pl)
Abstract
Both ST-segment elevation myocardial infarction and percutaneous coronary
intervention (PCI) are associated with a highly prothrombotic state, and
thrombin plays a critical role during occlusive clot generation and
subsequent occurrence of an ischemic event. Therefore, a strategy of
anticoagulation plus dual antiplatelet therapy has been regarded as de
facto standard therapy during primary PCI (pPCI). Recently, there has been
great controversy surrounding the role of bivalirudin versus
unfractionated heparin in pPCI. Earlier, the results of the HORIZONS-AMI
trial, particularly those regarding the long-lasting mortality benefit,
provided a strong rationale for recommending bivalirudin therapy in pPCI.
However, the mortality benefit of bivalirudin observed in HORIZONS-AMI has
not been repeated in more contemporary studies or demonstrated in recent
meta-analyses. The current report will provide a concise review of the
controversy surrounding the optimal anticoagulant therapy for pPCI. Recent
evidence suggests that unfractionated heparin deserves strong
reconsideration despite the reports of pharmacologic weaknesses,
particularly when used with a strategy of selective glycoprotein IIb/IIIa
therapy, and it appears that a strategy of bivalirudin therapy in pPCI
should be reserved for patients at high bleeding risk.<br/>Copyright
&#xa9; by Medycyna Praktyczna, Krakow 2015.

<2>
Accession Number
366014394
Title
Troponin T level and mortality risk after noncardiac surgery: Practical
implications of the VISION study.
Source
Polskie Archiwum Medycyny Wewnetrznej. 122 (10) (pp 499-503), 2012. Date
of Publication: 2012.
Author
Szczeklik W.; Devereaux P.J.
Institution
(Szczeklik) 2nd Department of Medicine, Jagiellonian University Medical
College, Krakow, Poland
(Devereaux) Departments of Clinical Epidemiology and Biostatistics and
Medicine, McMaster University, Hamilton, ON, Canada
Publisher
Medycyna Praktyczna (E-mail: listy@mp.pl)
Abstract
This review article presents the current state of knowledge about major
perioperative cardiovascular complications in noncardiac surgery patients
and the role of the currently available stratification models and
biomarkers in risk prediction. The authors discuss a recent paper
presented by the VISION Investigators in the June edition of the Journal
of the American Medical Association and its practical implications in
day-to-day perioperative practice. According to this study, the authors
conclude that troponin (Tn) measurement up to 3 days after noncardiac
surgery substantially improves perioperative risk estimation, and peak Tn
values (even the levels previously considered as normal) strongly predict
30-day mortality. One in 25 patients with a peak fourth generation
troponin T (TnT) measurement of 0.02 mug/l, 1 in 11 patients with a peak
TnT measurement of 0.03 to 0.29 mug/l, and 1 in 6 patients with a peak TnT
measurement of 0.30 mug/l or higher will die within 30 days of surgery.
Postoperative monitoring of TnT measurements substantially improves risk
stratification after noncardiac surgery and may help identify patients
requiring further therapeutic interventions. Copyright by Medycyna
Praktyczna, 2012.

<3>
Accession Number
361756160
Title
A single dose of aprotinin prevents platelet hyporeactivity after coronary
artery bypass graft surgery.
Source
Polskie Archiwum Medycyny Wewnetrznej. 120 (9) (pp 321-327), 2010. Date of
Publication: 2010.
Author
Szczeklik W.; Morawski W.; Sanak M.; Jakiela B.; Bolkowski M.; Cisowski
M.; Szczeklik M.; Bochenek A.; Musial J.
Institution
(Szczeklik, Sanak, Jakiela, Musial) 2nd Department of Medicine,
Jagiellonian University Medical Collage, Krakow, Poland
(Morawski, Bolkowski, Cisowski, Szczeklik, Bochenek) 1St Department of
Cardiac Surgery, Medical University of Silesia, Katowice, Poland
Publisher
Medycyna Praktyczna (E-mail: listy@mp.pl)
Abstract
INTRODUCTION: Bleeding after coronary artery bypass graft (CABG) surgery
is associated with a significant increase in mortality. Even though
aprotinin significantly reduces bleeding in patients undergoing cardiac
surgery, its use has been recently substantially limited because of
serious cardiovascular complications. The exact mechanism of its action,
particularly its effect on platelet function, remains unclear.
<br/>OBJECTIVE(S): The aim of the study was to assess the effect of
aprotinin on platelet function in patients undergoing CABG. <br/>PATIENTS
AND METHODS: In a randomized placebo-controlled double-blind study, we
investigated the effect of a single dose of aprotinin on platelet function
in 24 patients who underwent CABG between 2005 and 2006. Before surgery
and in the postoperative period, we measured platelet activation markers
(P-selectin and activated form of glycoprotein IIb/IIIa) at baseline and
following in vitro platelet activation with adenosine diphosphate (ADP) or
protease-activated receptor 1 (PAR-1) agonist - thrombin receptor
activator for peptide 6 (TRAP-6). Perioperative bleeding and urinary
metabolites of thromboxane A<inf>2</inf> were also determined.
<br/>RESULT(S): Aprotinin reduced perioperative bleeding by 26% (P <0.01)
and prevented a decrease in platelet sensitivity to ADP immediately after
CABG. In vitro platelet reactivity to TRAP-6 remained unchanged. Aprotinin
did not affect blood platelet count or urinary thromboxane A2 metabolite
excretion after CABG. <br/>CONCLUSION(S): Our results indicate that
aprotinin may reduce perioperative bleeding by its interference with ADP
pathway of platelet activation, thereby preventing postoperative
hyporeactivity of platelets to ADP. Platelet reactivity to PAR-1 receptor
agonist was not affected by aprotinin. Copyright by Medycyna Praktyczna,
2010.

<4>
Accession Number
2003186106
Title
Effect of Dexmedetomidine on Cardiac Surgery-Associated Acute Kidney
Injury: A Meta-Analysis With Trial Sequential Analysis of Randomized
Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (3) (pp 603-613),
2020. Date of Publication: March 2020.
Author
Peng K.; Li D.; Applegate R.L.; Lubarsky D.A.; Ji F.-H.; Liu H.
Institution
(Peng, Ji) Department of Anesthesiology, First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu, China
(Peng, Li, Applegate, Lubarsky, Liu) Department of Anesthesiology and Pain
Medicine, University of California Davis Health, Sacramento, CA, United
States
Publisher
W.B. Saunders
Abstract
Objective: Cardiac surgery-associated acute kidney injury (CS-AKI) is
associated with high mortality rates. This study aimed to determine the
effects of perioperative dexmedetomidine (DEX) administration on CS-AKI in
adult patients. <br/>Design(s): A meta-analysis with trial sequential
analysis of randomized controlled trials. <br/>Setting(s): PubMed, EMBASE,
Cochrane Library, and China National Knowledge Infrastructure databases
were searched up to March 11, 2019 for relevant articles. The study
protocol was registered at the International Prospective Register of
Systematic Reviews (registration number: CRD42019128139).
<br/>Participant(s): Adult patients undergoing cardiac surgery.
<br/>Intervention(s): Dexmedetomidine compared with controls.
<br/>Measurements and Main Results: Nine randomized controlled trials with
a total of 1,308 patients were included. Use of DEX significantly reduced
the incidence of CS-AKI (risk ratio = 0.60, 95% confidence interval =
0.41-0.87, p = 0.008, I² = 30%), without significant
publication bias. The trial sequential analysis result suggested that
there was enough evidence for this outcome. Sensitivity analysis confirmed
the robustness of the result. The improvement of CS-AKI was primarily
significant in preoperative and/or intraoperative administration of DEX
with or without postoperative continuation, patients with age >=60 years,
and studies with low risk of bias. The subgroup analysis did not show
statistical differences. Dexmedetomidine use also was associated with less
prolonged ventilation and lower incidences of pulmonary complications and
delirium postoperatively. The level of evidence was high for the incidence
of CS-AKI on the Grading of Recommendations Assessment, Development and
Evaluation profile. <br/>Conclusion(s): Perioperative DEX administration
provided protective effects against CS-AKI, especially when initiated
before and during surgery in elderly patients.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<5>
Accession Number
2002668358
Title
Sustained endothelial dysfunction in the infarct-related coronary artery
is associated with left ventricular adverse remodeling in survivors of
ST-segment elevation myocardial infarction.
Source
Journal of Cardiology. 75 (3) (pp 261-269), 2020. Date of Publication:
March 2020.
Author
Obata J.-E.; Horikoshi T.; Nakamura T.; Kugiyama K.
Institution
(Obata, Horikoshi, Nakamura, Kugiyama) Department of Internal Medicine II,
University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Ischemia-reperfusion causes endothelial injury and dysfunction
in the infarct-related coronary artery (IRA). Using serial assessment of
coronary endothelial vasomotor function and left ventriculography (LVG),
this study prospectively investigated the clinical impact of endothelial
vasomotor dysfunction in the patent IRA on left ventricular (LV)
remodeling in survivors of ST-elevation myocardial infarction (STEMI).
<br/>Method(s): This study included 78 patients with STEMI due to
occlusion of the left anterior descending coronary artery (LAD) and
successful reperfusion therapy with percutaneous coronary intervention.
All of them had LV ejection fraction (LVEF) <55%. LVG and the vasomotor
responses to acetylcholine (ACh) in the LAD were examined within 2 weeks
(1st test) and 6 months (2nd test) after MI. Cut-off values for coronary
vasomotor dysfunction in response to ACh were based on the lower 10% of
the distribution of coronary vasomotor responses to ACh in 20 control
subjects. <br/>Result(s): LV adverse remodeling, defined as a >10%
increase in either LV end-diastolic volume index (LVEDVI) and/or
end-systolic volume index (LVESVI) from the 1st to the 2nd test, occurred
in 21 (70%) of 30 patients with sustained impairment of the coronary flow
response to ACh at both the 1st and 2nd tests and 14 (29%) of 48 in the
other coronary flow response group (p < 0.01). In multivariate logistic
regression analysis, a >10% increase in LVEDVI and LVESVI was respectively
associated with sustained impairment of the coronary diameter and flow
responses to ACh (OR 4.9 and 3.5, 95% CI 1.7-14.1 and 1.1-10.9, p < 0.01
and p = 0.03, respectively), that was independent of hypertension, peak
creatine phosphokinase, and the baseline coronary flow response to ACh at
the 1st test. <br/>Conclusion(s): Sustained endothelial vasomotor
dysfunction in the IRA was associated with LV adverse remodeling in STEMI
survivors with successful reperfusion therapy.<br/>Copyright &#xa9; 2019

<6>
Accession Number
2003681781
Title
Intraoperative Ketamine for Analgesia Post-Coronary Artery Bypass Surgery:
A Randomized, Controlled, Double-Blind Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (3) (pp 586-591),
2020. Date of Publication: March 2020.
Author
Cameron M.; Tam K.; Al Wahaibi K.; Charghi R.; Beique F.
Institution
(Cameron, Tam, Charghi, Beique) Department of Anesthesiology, Jewish
General Hospital, Montreal, Quebec, Canada
(Cameron, Al Wahaibi, Charghi, Beique) Department of Anesthesia, McGill
University, Montreal, Quebec, Canada
Publisher
W.B. Saunders
Abstract
Objectives: To determine whether the administration of ketamine during
coronary artery bypass grafting (CABG) surgery leads to a reduction in the
quantity of opioids required over the first 48 hours after surgery.
<br/>Design(s): Randomized, controlled, double-blind clinical trial.
<br/>Setting(s): Single university academic center. <br/>Participant(s):
Patients undergoing CABG surgery with a normal left ventricular ejection
fraction. <br/>Intervention(s): Ketamine administered intravenously as a
bolus dose of 0.5 mg/kg before skin incision, followed by an infusion of
0.5 mg/kg/h until the end of surgery. <br/>Measurements and Main Results:
One hundred eighty-three patients were screened, and 80 patients were
randomized. Baseline characteristics were similar between the 2 groups.
The intervention group received 53.6 mg (95% confidence interval [CI]
47.1-60.1 mg) of morphine equivalents in the first 48 hours after surgery,
whereas the placebo group received 55.7 mg (95% CI 48.4-63.1 mg) over the
same time period (p = 0.66). No significant difference was noted in
morphine equivalents over the first 6, 12, or 24 hours postoperatively or
in maximum, minimum, or average pain scores on postoperative days 1 or 2.
<br/>Conclusion(s): The administration of ketamine during CABG surgery did
not result in reduced opioid consumption or pain scores
postoperatively.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<7>
Accession Number
2004670444
Title
Infective endocarditis post-transcatheter aortic valve implantation
(TAVI), microbiological profile and clinical outcomes: A systematic
review.
Source
PLoS ONE. 15 (1) (no pagination), 2020. Article Number: e0225077. Date of
Publication: 2020.
Author
Khan A.; Aslam A.; Satti K.N.; Ashiq S.
Institution
(Khan, Aslam, Ashiq) Sharif Medical and Dental College, Lahore, Pakistan
(Satti) Senior Registrar Rawalpindi Institute of Cardiology, Rawalpindi,
Pakistan
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The data on infective endocarditis after transcatheter aortic
valve implantation (TAVI) is scarce and limited to case reports and case
series in the literature. It is the need of the hour to analyze the
available data on post-TAVI infective endocarditis from the available
literature. The objectives of this systematic review were to evaluate the
incidence of infective endocarditis after transcatheter aortic valve
implantation, its microbiological profile and clinical outcomes. It will
help us to improve the antibiotic prophylaxis strategies and treatment
options for infective endocarditis in the context of TAVI. Methods EMBASE,
Medline and the CENTRAL trials registry of the Cochrane Collaboration were
searched for articles on infective endocarditis in post-TAVI patients till
October 2018. Eleven articles were included in the systematic review. The
outcomes assessed werethe incidence of infective endocarditis, its
microbiological profile andclinical outcomes including major adverse
cardiac event (MACE), net adverse clinical event (NACE), surgical
intervention and valve-in-valve procedure. Results The incidence of
infective endocarditis varied from 0%-14.3% in the included studies, the
mean was3.25%. The average duration of follow-up was 474 days (1.3 years).
Enterococci were the most common causative organism isolated from 25.9% of
cases followed by Staphylococcus aureus (16.1%) and coagulase-negative
Staphylococcus species (14.7%). The mean in-hospital mortality and
mortality at follow-up was 29.5% and 29.9%, respectively. The cumulative
incidence of heart failure, stroke and major bleeding were 37.1%, 5.3% and
11.3%,respectively. Only a single study by Martinez-Selles et al. reported
arrhythmias in 20% cases. The septic shock occurred in 10% and 27.7%
post-TAVI infective endocarditis patients according to 2 studies. The
surgical intervention and valve-in-valve procedure were reported in 11.4%
and 6.4% cases, respectively. Conclusion The incidence of post-TAVI
infective endocarditis is low being 3.25% but it is associated with high
mortality and complications. The most common complication is heart failure
with a cumulative incidence of 37.1%. Enterococciare the most common
causative organism isolated from 25.9% of cases followed by Staphylococcus
aureus in 16.1% of cases. Appropriate measures should be taken to prevent
infective endocarditis in post-TAVI patients including adequate
antibiotics prophylaxis directed specifically against these
organisms.<br/>Copyright &#xa9; 2020 Khan et al.

<8>
Accession Number
2003639606
Title
Percutaneous repair or medical treatment for secondary mitral
regurgitation: outcomes at 2 years.
Source
European Journal of Heart Failure. 21 (12) (pp 1619-1627), 2019. Date of
Publication: 01 Dec 2019.
Author
Iung B.; Armoiry X.; Boutitie F.; Mewton N.; Trochu J.-N.; Lefevre T.;
Messika-Zeitoun D.; Cormier B.; Brochet E.; Thibault H.; Himbert D.;
Thivolet S.; Leurent G.; Bonnet G.; Donal E.; Piriou N.; Piot C.; Habib
G.; Rouleau F.; Carrie D.; Nejjari M.; Ohlmann P.; Saint Etienne C.;
Leroux L.; Gilard M.; Samson G.; Rioufol G.; Maucort-Boulch D.; Obadia
J.F.; Obadia J.-F.; Barthelet M.; Grinberg D.; Furber A.; Benard T.;
Debrux J.-L.; Pinaud F.; Chocron S.; Chopard R.; Meneveau N.; Schiele F.;
Boschat J.; Castellant P.; Jobic Y.; Le Ven F.; Romain D.; Beygui F.;
Sabatier R.; Saloux E.; Motreff P.; Clerfond G.; Azarnoush K.; Lusson
J.R.; Vorilhon C.; Teiger E.; Antoine C.; Champagne S.; Couetil J.-P.;
Damy T.; Dubois-Rande J.-L.; Ernande L.; Guendouz S.; Lim P.; Monin J.-L.;
Nguyen A.; Riant E.; Ternacle J.; Zerbib C.; Bertrand B.; Bouvaist H.;
Saunier C.; Vaislic C.; Khelifa R.C.; Favereau X.; Hilpert L.; Maribas P.;
Azmoun A.; Angel J.-Y.; Baruteau A.; Brenot P.; Deleuze P.; Garcon P.;
Raoux F.; Slama M.; Van Belle E.; Prat A.; Coisne A.; Duvapentiah A.;
Juthier F.; Modine T.; Polge A.-S.; Richardson M.; Rousse N.; Spillemaeker
H.; Sudre A.; Vincent F.; Vincentelli A.; Jeu A.; Ketelers R.; Bonnet
J.-L.; Michel N.; Pankert M.; Salaun E.; Collart F.; Houel R.; Bille J.;
Commeau P.; Joly P.; Philip E.; Collet F.; Armero S.; Bayet G.; Giacomoni
M.-P.; Maximovitch A.; Romano M.; Leclercq F.; Albat B.; Cade S.; Cransac
F.; Macia J.-C.; Francois F.; Pons M.; Raczka F.; Sportouch C.; Juilliere
Y.; Folliguet T.; Huttin O.; Popovic B.; Selton-Suty C.; Venner C.; Guerin
P.; Baron O.; Letocart V.; Letourneau T.; Belliard O.; Allouch P.;
Bensouda C.; Janower S.; Makowski S.; Pasquier D.; Pilliere R.; Rosencher
J.; Moceri P.; Vahanian A.; Nataf P.; Spaulding C.; Achouh P.; Berrebi A.;
Jouan J.; Karam N.; Mirabel M.; Puscas T.; Suen P.W.; Caussin C.; Diakov
C.; Philippe F.; Veugeois A.; Collet J.P.; Choussat R.; Isnard R.;
Montalescot G.; Coste P.; Dijos M.; Labrousse L.; Lafitte S.; Picard F.;
Raud-Raynier P.; Degrand B.; Bedossa M.; Corbineau H.; Eltchaninoff H.;
Bauer F.; Tron C.; Attias D.; Gerbay A.; Pierrard R.; Fuzellier J.-F.;
Drogoul L.; Elebeze J.-P.; Lopez S.; Mariottini C.; Meyer P.; Mihoubi A.;
Tapia M.; Teboul J.; Goette-Dimarco P.; Kretz J.-G.; Mommerot A.; Morel
O.; Petit-Eisenmann H.; Samet A.; Trinh A.; Gautier M.; Badie Y.L.;
Lhermusier T.; Marcheix B.; Tchetche D.; Abouliatim I.; Bonfils L.;
Dumonteil N.; Farah B.; Fondard O.; Pathak A.; Etienne C.S.; Bernard A.;
Dion F.; Loardi C.; Quilliet L.; Seemann A.; Arnoult M.A.; Meurisse Y.;
Wautot F.; Champagnac D.; Dementhon J.; Doisy V.; Frieh J.-P.; Garrier O.;
Jamal F.; Lamartine S.; Leroux P.-Y.; Lienhart Y.; Staat P.; Zouaghi O.
Institution
(Iung, Messika-Zeitoun, Brochet, Himbert) Universite de Paris and INSERM
1148, Paris, France
(Iung, Vahanian) APHP, Hopital Bichat, DHU FIRE, Paris, France
(Armoiry) Pharmacy Department and Laboratoire MATEIS, Hospices Civils de
Lyon and Claude Bernard University, Lyon, France
(Boutitie, Maucort-Boulch) LyonFrance
(Mewton, Samson) Hopital Cardiovasculaire Louis Pradel, Clinical
Investigation Center & Heart Failure Department, INSERM 1407, Hospices
Civils de Lyon and Claude Bernard University, Lyon, France
(Trochu, Guerin, Piriou) CHU Nantes, INSERM, Nantes Universite, Clinique
Cardiologique et des Maladies Vasculaires, CIC 1413, Institut du Thorax,
Nantes, France
(Lefevre, Cormier) Institut Jacques Cartier, Massy, France
(Messika-Zeitoun) Division of Cardiology, University of Ottawa Heart
Institute, Ottawa, Canada
(Thibault, Thivolet) Hopital Cardiovasculaire Louis Pradel, Service des
Explorations Fonctionnelles Cardiovasculaires, Hospices Civils de Lyon and
Claude Bernard University, Lyon, France
(Leurent, Donal) CHU Rennes, Hopital Pontchaillou, Rennes, France
(Bonnet, Habib) APHM, Hopital de la Timone, Marseille, France
(Piot) Clinique du Millenaire, Montpellier, France
(Rouleau) CHU Angers, Angers, France
(Carrie) CHU Toulouse, Hopital Rangueil, Toulouse, France
(Nejjari) Centre Cardiologique du Nord, Saint-Denis, France
(Ohlmann) Hopitaux Universitaires de Strasbourg, Nouvel Hopital Civil,
Strasbourg, France
(Saint Etienne) CHRU de Tours, Hopital Trousseau, Tours, France
(Leroux) CHU Bordeaux, Hopital Haut-Leveque, Pessac, France
(Gilard) CHRU Brest, Hopital de La Cavale Blanche, Brest, France
(Rioufol) Hopital Cardiovasculaire Louis Pradel, Service d'Hemodynamique
et Cardiologie Interventionnelle, Hospices Civils de Lyon and Claude
Bernard University, Lyon, France
(Obadia) Hopital Cardiovasculaire Louis Pradel, Chirurgie
Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon
and Claude Bernard University, Lyon, France
(Boutitie, Maucort-Boulch) Universite Lyon 1, Villeurbanne, France
(Boutitie, Maucort-Boulch) CNRS, UMR5558, Laboratoire de Biometrie et
Biologie Evolutive, Equipe Biostatistique-Sante, Service de Biostatistique
- Bioinformatique, Pole Sante Publique, Hospices Civils de Lyon,
Villeurbanne, France
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Aims: The MITRA-FR trial showed that among symptomatic patients with
severe secondary mitral regurgitation, percutaneous repair did not reduce
the risk of death or hospitalization for heart failure at 12 months
compared with guideline-directed medical treatment alone. We report the
24-month outcome from this trial. <br/>Methods and Results: At 37 centres,
we randomly assigned 304 symptomatic heart failure patients with severe
secondary mitral regurgitation (effective regurgitant orifice area >20
mm² or regurgitant volume >30 mL), and left ventricular
ejection fraction between 15% and 40% to undergo percutaneous valve repair
plus medical treatment (intervention group, n = 152) or medical treatment
alone (control group, n = 152). The primary efficacy outcome was the
composite of all-cause death and unplanned hospitalization for heart
failure at 12 months. At 24 months, all-cause death and unplanned
hospitalization for heart failure occurred in 63.8% of patients (97/152)
in the intervention group and 67.1% (102/152) in the control group [hazard
ratio (HR) 1.01, 95% confidence interval (CI) 0.77-1.34]. All-cause.
mortality occurred in 34.9% of patients (53/152) in the intervention group
and 34.2% (52/152) in the control group (HR 1.02, 95% CI 0.70-1.50).
Unplanned hospitalization for heart failure occurred in 55.9% of patients
(85/152) in the intervention group and 61.8% (94/152) in the control group
(HR 0.97, 95% CI 0.72-1.30). <br/>Conclusion(s): In patients with severe
secondary mitral regurgitation, percutaneous repair added to medical
treatment did not significantly reduce the risk of death or
hospitalization for heart failure at 2 years compared with medical
treatment alone.<br/>Copyright &#xa9; 2019 The Authors. European Journal
of Heart Failure &#xa9; 2019 European Society of Cardiology

<9>
Accession Number
2004704469
Title
Outcome of pitavastatin versus atorvastatin therapy in patients with
hypercholesterolemia at high risk for atherosclerotic cardiovascular
disease.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Moroi M.; Nagayama D.; Hara F.; Saiki A.; Shimizu K.; Takahashi M.; Sato
N.; Shiba T.; Sugimoto H.; Fujioka T.; Chiba T.; Nishizawa K.; Usui S.;
Iwasaki Y.; Tatsuno I.; Sugi K.; Yamasaki J.; Yamamura S.; Shirai K.
Institution
(Moroi, Sugi) Division of Cardiovascular Medicine (Ohashi), Department of
Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
(Nagayama) Nagayama Clinic, Oyama City, Tochigi, Japan
(Hara, Yamasaki) Division of Cardiovascular Medicine (Omori), Department
of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
(Saiki, Tatsuno, Shirai) Division of Diabetes, Endocrinology and
Metabolism (Sakura), Department of Internal Medicine, Faculty of Medicine,
Toho University, Chiba, Japan
(Shimizu, Takahashi) Division of Cardiovascular Medicine (Sakura),
Department of Internal Medicine, Faculty of Medicine, Toho University,
Chiba, Japan
(Sato) Pharmaceutical Unit, Toho University Sakura Medical Center, Chiba,
Japan
(Shiba) Division of Diabetes and Metabolism (Ohashi), Department of
Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
(Sugimoto, Fujioka) Division of Neurology (Ohashi), Department of Internal
Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
(Chiba, Nishizawa) Department of Pharmacy, Toho University Omori Medical
Center, Tokyo, Japan
(Usui) Division of Diabetes, Endocrinology and Metabolism (Omori),
Department of Internal Medicine, Faculty of Medicine, Toho University,
Tokyo, Japan
(Iwasaki) Division of Neurology (Omori), Department of Internal Medicine,
Faculty of Medicine, Toho University, Tokyo, Japan
(Yamamura) Faculty of Pharmaceutical Sciences, Josai International
University, Chiba, Japan
Publisher
Elsevier Ireland Ltd
Abstract
Background: There has been no report about outcome of pitavastatin versus
atorvastatin therapy in high-risk patients with hypercholesterolemia.
<br/>Method(s): Hypercholesterolemic patients with one or more risk
factors for atherosclerotic diseases (n = 664, age = 65, male = 54%,
diabetes = 76%, primary prevention = 74%) were randomized to receive
pitavastatin 2 mg/day (n = 332) or atorvastatin 10 mg/day (n = 332).
Follow-up period was 240 weeks. The primary end point was a composite of
cardiovascular death, sudden death of unknown origin, nonfatal myocardial
infarction, nonfatal stroke, transient ischemic attack, or heart failure
requiring hospitalization. The secondary end point was a composite of the
primary end point plus clinically indicated coronary revascularization for
stable angina. <br/>Result(s): The mean low-density lipoprotein
cholesterol (LDL-C) level at baseline was 149 mg/dL. The mean LDL-C levels
at 1 year were 95 mg/dL in the pitavastatin group and 94 mg/dL in the
atorvastatin group. There were no differences in LDL-C levels between both
groups, however, pitavastatin significantly reduced the risk of the
primary end point, compared to atorvastatin (pitavastatin = 2.9% and
atorvastatin = 8.1%, HR, 0.366; 95% CI 0.170-0.787; P = 0.01 by
multivariate Cox regression) as well as the risk of the secondary end
point (pitavastatin = 4.5% and atorvastatin = 12.9%, HR = 0.350; 95%CI =
0.189-0.645, P = 0.001). The results for the primary and secondary end
points were consistent across several prespecified subgroups. There were
no differences in incidence of adverse events between the statins.
<br/>Conclusion(s): Pitavastatin therapy compared with atorvastatin more
may prevent cardiovascular events in hypercholesterolemic patients with
one or more risk factors for atherosclerotic diseases despite similar
effects on LDL-C levels.<br/>Copyright &#xa9; 2020 The Authors

<10>
Accession Number
2004680999
Title
Efficacy and Safety of Tranexamic Acid in Major Non-Cardiac Surgeries at
High Risk for Transfusion: A Systematic Review and Meta-Analysis.
Source
Transfusion Medicine Reviews. (no pagination), 2020. Date of Publication:
2020.
Author
Houston B.L.; Uminski K.; Mutter T.; Rimmer E.; Houston D.S.; Menard C.E.;
Garland A.; Ariano R.; Tinmouth A.; Abou-Setta A.M.; Rabbani R.; Neilson
C.; Rochwerg B.; Turgeon A.F.; Falk J.; Breau R.H.; Fergusson D.A.;
Zarychanski R.
Institution
(Houston, Uminski, Rimmer, Houston, Menard, Garland, Zarychanski) Rady
Faculty of Health Sciences, Max Rady College of Medicine, Department of
Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
(Houston, Rimmer, Houston, Menard, Zarychanski) Department of Medical
Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
(Houston, Ariano, Falk, Zarychanski) Rady Faculty of Health Sciences,
College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
(Mutter) Rady Faculty of Health Sciences, Max Rady College of Medicine,
Department of Anesthesiology, Perioperative and Pain Medicine, University
of Manitoba, Winnipeg, Manitoba, Canada
(Tinmouth, Breau, Fergusson) Clinical Epidemiology Program, Ottawa
Hospital Research Institute (OHRI), Department of Medicine, University of
Ottawa, Ottawa, Ontario, Canada
(Abou-Setta, Rabbani) George & Fay Yee Center for Healthcare Innovation,
University of Manitoba/Winnipeg Regional Health Authority, Winnipeg,
Manitoba, Canada
(Rabbani) Department Community Health Sciences, Max Rady College of
Medicine, Rady Faculty of Health Sciences, University of Manitoba,
Winnipeg, Manitoba, Canada
(Neilson) University of Manitoba, MHIKNET program, Winnipeg, Manitoba,
Canada
(Rochwerg) Division of Critical Care, Department of Medicine, McMaster
University, Ontario, Hamilton, Canada
(Turgeon) Universite Laval / CHU de Quebec - Universite Laval Research
Centre, Quebec, Quebec, Canada
Publisher
W.B. Saunders
Abstract
Tranexamic acid (TXA) reduces transfusion requirements in cardiac surgery
and total hip and knee arthroplasty, where it has become standard of care.
Our objective is to determine the efficacy and safety of TXA in other
surgeries associated with a high risk for red blood cell (RBC)
transfusion. We identified randomized controlled trials in Medline,
Embase, CENTRAL, and CAB abstracts from inception to June 2019. We
included trials evaluating intraoperative IV TXA in adult patients
undergoing a non-cardiac and non-hip and knee arthroplasty surgeries at
high-risk for RBC transfusion, defined as a baseline transfusion rate >=5%
in comparator arm. We assessed risk of bias using the Cochrane Risk of
Bias tool. We used GRADE methodology to assess certainty of evidence. From
8565 citations identified, we included 69 unique trials, enrolling 6157
patients. TXA reduces both the proportion of patients transfused RBCs
(relative risk (RR) 0.59; 95% confidence interval (CI) 0.48 to 0.72; low
certainty evidence) and the volume of RBC transfused (MD -0.51 RBC units;
95%CI -0.13 to -0.9 units; low certainty evidence) when compared to
placebo or usual care. TXA was not associated with differences in deep
vein thrombosis, pulmonary embolism, all-cause mortality, hospital length
of stay, need for re-operation due to hemorrhage, myocardial infarction,
stroke or seizure. In patients undergoing a broad range of non-cardiac and
non-hip and knee arthroplasty surgeries at high risk for RBC transfusion,
perioperative TXA reduced exposure to RBC transfusion. No differences in
thrombotic outcomes were identified; however, summary effect estimates
were limited by lack of systemic screening and short duration of
follow-up.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<11>
Accession Number
630731428
Title
Part VII: Behavioral economics-A framework for donor organ decision-making
in pediatric heart transplantation.
Source
Pediatric transplantation. (pp e13655), 2020. Date of Publication: 27 Jan
2020.
Author
Butler A.; Chapman G.; Johnson J.N.; Amodeo A.; Bohmer J.; Camino M.;
Davies R.R.; Dipchand A.I.; Godown J.; Miera O.; Perez-Blanco A.;
Rosenthal D.N.; Zangwill S.; Kirk R.
Institution
(Butler, Chapman) Carnegie Mellon University, Pittsburgh, United States
(Johnson) Division of Pediatric Cardiology, Mayo Clinic, MN, Rochester,
United States
(Amodeo) Bambino Gesu Children's Hospital, Rome, Italy
(Bohmer) Queen Silvia Children's Hospital, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Camino) Madrid Hospital Gregorio Maranon, Madrid, Spain
(Davies) Department of Cardiovascular and Thoracic Surgery, University of
Texas Southwestern Medical Center, Children's Medical Center, TX, Dallas,
United States
(Dipchand) Labatt Family Heart Centre, Hospital for Sick Children,
University of Toronto, ON, Toronto, Canada
(Godown) Vanderbilt University Medical Center, TN, Nashville, United
States
(Miera) Department of Congenital Heart Disease/Pediatric Cardiology,
Deutsches Herzzentrum, Berlin, Germany
(Perez-Blanco) Spanish National Transplant Organization, Madrid, Spain
(Rosenthal) Stanford University, Palo Alto, CA, USA
(Zangwill) Phoenix Children's Hospital, AZ, Phoenix, United States
(Kirk) Division of Pediatric Cardiology, University of Texas Southwestern
Medical Center, Children's Medical Center, TX, Dallas, United States
Publisher
NLM (Medline)
Abstract
The high discard rate of pediatric donor hearts presents a major challenge
for children awaiting heart transplantation. Recent literature identifies
several factors that contribute to the disparities in pediatric donor
heart usage, including regulatory oversight, the absence of guidelines on
pediatric donor heart acceptance, and variation among transplant programs.
However, a likely additional contributor to this issue are the behavioral
factors influencing transplant team decisions in donor offer scenarios, a
topic that has not yet been studied in detail. Behavioral economics and
decision psychology provide an excellent foundation for investigating
decision-making in the pediatric transplant setting, offering key insights
into the behavior of transplant professionals. We conducted a systematic
review of published literature in pediatric heart transplant related to
behavioral economics and the psychology of decision-making. In this
review, we draw on paradigms from these two domains in order to examine
how existing aspects of the transplant environment, including regulatory
oversight, programmatic variation, and allocation systems, may precipitate
potential biases surrounding donor offer decisions. Recognizing how human
decision behavior influences donor acceptance is a first step toward
improving utilization of potentially viable pediatric donor
hearts.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<12>
Accession Number
630734780
Title
Physical Exercise Combined With CPAP in Subjects Who Underwent Surgical
Myocardial Revascularization: A Randomized Clinical Trial.
Source
Respiratory care. 65 (2) (pp 150-157), 2020. Date of Publication: 01 Feb
2020.
Author
Windmoller P.; Bodnar E.T.; Casagrande J.; Dallazen F.; Schneider J.;
Berwanger S.A.; Borghi-Silva A.; Winkelmann E.R.
Institution
(Windmoller, Bodnar, Casagrande, Dallazen) Undergraduate Program in
Physical Therapy at the Regional University of Northwestern Rio Grande do
Sul (UNIJUI), Ijui, Brazil
(Windmoller, Winkelmann) Graduate Program in Comprehensive Health Care
(UNICRUZ/UNIJUI), Ijui, Brazil
(Dallazen, Schneider, Berwanger) Cardiovascular Surgery Unit of the Heart
Institute of Ijui Charity Hospital, Ijui, Brazil
(Borghi-Silva) Graduate Program in Physical Therapy of the Federal
University of Sao Carlos (UFSCar), Brazil
(Winkelmann) Undergraduate Program in Physical Therapy at the Regional
University of Northwestern Rio Grande do Sul (UNIJUI), Ijui, Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: Aerobic exercise and CPAP benefit patients in the
postoperative period of cardiac surgery. To our knowledge, the association
of aerobic exercise on an exercise bicycle with CPAP has not yet been
demonstrated. Therefore, we aimed to evaluate the effectiveness of
physical exercise on a cycle ergometer combined with CPAP in the
postoperative period after coronary artery bypass graft surgery.
<br/>METHOD(S): This was a randomized clinical trial, with recruitment
from May 2017 to December 2017 (registered in the Brazilian Clinical
Trials Registry: RBR-69CDYF). The step group (n = 16 subjects) started
rehabilitation in the immediate postoperative period with breathing
exercises and passive mobilization in the sitting position, progressing to
active exercises, ambulation, and stair training. For the intervention
group (n = 15 subjects), dynamic exercises on a cycle ergometer combined
with CPAP were added to the step program from the second to the fourth
postoperative day in a single daily session. <br/>RESULT(S): Functional
capacity decreased in both groups, but this reduction was not significant
in the intervention group (P = .11). The length of stay in ICU was lower
in the intervention group (P = .050). In both groups there was a decrease
in maximum inspiratory and expiratory pressure, as well as in the 1-min
sit-to-stand test on the fourth postoperative day compared to the
preoperative period. <br/>CONCLUSION(S): Physical exercise combined with
CPAP promoted the maintenance of functional capacity and reduced the
length of stay in the ICU.<br/>Copyright &#xa9; 2020 by Daedalus
Enterprises.

<13>
Accession Number
2004744336
Title
Mortality After Repeat Revascularization Following PCI or CABG for Left
Main Disease: The EXCEL Trial.
Source
JACC: Cardiovascular Interventions. 13 (3) (pp 375-387), 2020. Date of
Publication: 10 February 2020.
Author
Giustino G.; Serruys P.W.; Sabik J.F.; Mehran R.; Maehara A.; Puskas J.D.;
Simonton C.A.; Lembo N.J.; Kandzari D.E.; Morice M.-C.; Taggart D.P.;
Gershlick A.H.; Ragosta M.; Kron I.L.; Liu Y.; Zhang Z.; McAndrew T.;
Dressler O.; Genereux P.; Ben-Yehuda O.; Pocock S.J.; Kappetein A.P.;
Stone G.W.
Institution
(Giustino, Mehran, Stone) The Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Mehran, Maehara, Lembo, Liu, Zhang, McAndrew, Dressler, Genereux,
Ben-Yehuda, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Maehara, Lembo, Ben-Yehuda) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Puskas) Mount Sinai Heart at Mount Sinai St Luke's, New York, NY, United
States
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Morice) Ramsay Generale de Sante, Hopital Prive Jacques Cartier, Massy,
France
(Taggart) Department Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
(Gershlick) University Hospitals of Leicester, Leicester, United Kingdom
(Ragosta, Kron) Division of Cardiovascular Medicine, University of
Virginia Health System, Charlottesville, VA, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Pocock) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
(Kappetein) Erasmus University Medical Center, Rotterdam, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to investigate the incidence and
impact on mortality of repeat revascularization after index percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG) for
left main coronary artery disease (LMCAD). <br/>Background(s): The impact
on mortality of the need of repeat revascularization following PCI or CABG
in patients with unprotected LMCAD is unknown. <br/>Method(s): All
patients with LMCAD and site-assessed low or intermediate SYNTAX (Synergy
Between PCI With Taxus and Cardiac Surgery) scores randomized to PCI (n =
948) or CABG (n = 957) in the EXCEL (Evaluation of XIENCE Versus Coronary
Artery Bypass Surgery for Effectiveness of Left Main Revascularization)
trial were included. Repeat revascularization events were adjudicated by
an independent clinical events committee. The effect of repeat
revascularization on mortality through 3-year follow-up was examined in
time-varying Cox regression models. <br/>Result(s): During 3-year
follow-up, there were 346 repeat revascularization procedures among 185
patients. PCI was associated with higher rates of any repeat
revascularization (12.9% vs. 7.6%; hazard ratio: 1.73; 95% confidence
interval: 1.28 to 2.33; p = 0.0003). Need for repeat revascularization was
independently associated with increased risk for 3-year all-cause
mortality (adjusted hazard ratio: 2.05; 95% confidence interval: 1.13 to
3.70; p = 0.02) and cardiovascular mortality (adjusted hazard ratio: 4.22;
95% confidence interval: 2.10 to 8.48; p < 0.0001) consistently after both
PCI and CABG (p<inf>int</inf> = 0.85 for both endpoints). Although target
vessel revascularization and target lesion revascularization were both
associated with an increased risk for mortality, target vessel non-target
lesion revascularization and non-target vessel revascularization were not.
<br/>Conclusion(s): In the EXCEL trial, repeat revascularization during
follow-up was performed less frequently after CABG than PCI and was
associated with increased mortality after both procedures. Reducing the
need for repeat revascularization may further improve long-term survival
after percutaneous or surgical treatment of LMCAD. (EXCEL Clinical Trial;
NCT01205776)<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<14>
Accession Number
2004744322
Title
Complete 2-Year Results Confirm Bayesian Analysis of the SURTAVI Trial.
Source
JACC: Cardiovascular Interventions. 13 (3) (pp 323-331), 2020. Date of
Publication: 10 February 2020.
Author
Van Mieghem N.M.; Popma J.J.; Deeb G.M.; Yakubov S.J.; Serruys P.W.;
Windecker S.; Sondergaard L.; Gada H.; Chetcuti S.; Kleiman N.S.; Kodali
S.; George I.; Teefy P.; Kiaii B.; Oh J.K.; Chang Y.; Mugglin A.S.;
Reardon M.J.; Sorajja P.; Sun B.; Agarwal H.; Langdon T.; den Heijer P.;
Bentala M.; O'Hair D.; Bajwa T.; Byrne T.; Caskey M.; Paulus B.; Garrett
E.; Stoler R.; Hebeler R.; Khabbaz K.; Lim D.S.; Bladergroen M.; Fail P.;
Feinberg E.; Rinaldi M.; Skipper E.; Chawla A.; Hockmuth D.; Makkar R.;
Cheng W.; Aji J.; Bowen F.; Schreiber T.; Henry S.; Hengstenberg C.;
Bleiziffer S.; Harrison J.K.; Hughes C.; Joye J.; Gaudiani V.; Babaliaros
V.; Thourani V.; van Mieghem N.; Kappetein A.P.; Dauerman H.; Schmoker J.;
Skelding K.; Casale A.; Kovac J.; Spyt T.; Seshiah P.; Smith J.M.; McKay
R.; Hagberg R.; Matthews R.; Starnes V.; O'Neill W.; Paone G.; Hernandez
Garcia J.M.; Such M.; Moris de la Tassa C.; Llosa Cortina J.C.; Carrel T.;
Whisenant B.; Doty J.; Resar J.; Conte J.; Aharonian V.; Pfeffer T.; Ruck
A.; Corbascio M.; Blackman D.; Kaul P.; Kliger C.; Brinster D.; Leya F.;
Bakhos M.; Sandhu G.; Pochettino A.; Piazza N.; de Varennes B.; van Boven
A.; Boonstra P.; Waksman R.; Bafi A.; Asgar A.; Cartier R.; Kipperman R.;
Brown J.; Lin L.; Rovin J.; Sharma S.; Adams D.; Katz S.; Hartman A.;
Al-Jilaihawi H.; Williams M.; Crestanello J.; Lilly S.; Ghani M.;
Bodenhamer R.M.; Rajagopal V.; Kauten J.; Mumtaz M.; Bachinsky W.;
Nickenig G.; Welz A.; Olsen P.S.; Yakubov S.; Watson D.; Chhatriwalla A.;
Allen K.; Teirstein P.; Tyner J.; Mahoney P.; Newton J.; Merhi W.; Keiser
J.; Yeung A.; Miller C.; ten Berg J.; Heijmen R.; Petrossian G.; Robinson
N.; Brecker S.; Jahangiri M.; Davis T.; Batra S.; Hermiller J.; Heimansohn
D.; Radhakrishnan S.; Fremes S.; Maini B.; Bethea B.; Brown D.; Ryan W.;
Reardon M.; Kleiman N.; Spies C.; Lau J.; Herrmann H.; Bavaria J.; Horlick
E.; Feindel C.; Neumann F.-J.; Beyersdorf F.; Binder R.; Maisano F.; Costa
M.; Markowitz A.; Tadros P.; Zorn G.; de Marchena E.; Salerno T.; Labinz
M.; Ruel M.; Sup Lee J.; Gleason T.; Ling F.; Knight P.; Robbins M.; Ball
S.; Giacomini J.; Burdon T.; Applegate R.; Kon N.; Schwartz R.; Schubach
S.; Forrest J.; Mangi A.
Institution
(Van Mieghem) Department of Interventional Cardiology, Erasmus University
Medical Centre, Rotterdam, Netherlands
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Deeb) Cardiac Surgery, University of Michigan, Ann Arbor, MI, United
States
(Yakubov) Interventional Cardiology, OhioHealth Riverside Methodist
Hospital, Columbus, OH, United States
(Serruys) Cardiovascular Science Division of the National Heart and Lung
Institute, Imperial College London, London, United Kingdom
(Windecker) Department of Interventional Cardiology, University Hospital
Bern, Bern, Switzerland
(Sondergaard) The Heart Center, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Mumtaz) Cardiac Surgery, University of Pittsburgh Medical Center Pinnacle
Health, Harrisburg, PA, United States
(Gada) Interventional Cardiology, University of Pittsburgh Medical Center
Pinnacle Health, Harrisburg, PA, United States
(Chetcuti) Interventional Cardiology, University of Michigan, Ann Arbor,
MI, United States
(Kleiman) Cardiology, Methodist DeBakey Heart and Vascular Center,
Houston, TX, United States
(Kodali, George) Structural Heart and Valve Center, Columbia University
Medical Center, New York, NY, United States
(Teefy) Department of Medicine, Cardiology Division, London Health
Sciences Centre, University Hospital, London, Ontario, Canada
(Kiaii) Department of Cardiovascular and Thoracic Surgery, London Health
Sciences Centre, University Hospital, London, Ontario, Canada
(Oh) Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN, United
States
(Kappetein) Baaken Research Center, Medical Affairs, Medtronic,
Maastricht, Netherlands
(Chang) Clinical, Medtronic, Mounds View, MN, United States
(Mugglin) Paradigm Biostatistics, Anoka, MN, United States
(Reardon) Department of Cardiothoracic Surgery, Methodist DeBakey Heart
and Vascular Center, Houston, TX, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to report the 2-year results of the
SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation)
trial and confirm the interim Bayesian analysis. <br/>Background(s):
Transcatheter aortic valve replacement (TAVR) with a self-expanding valve
was noninferior to surgery in patients with severe aortic stenosis and
intermediate operative risk using Bayesian statistical methods. Novel
Bayesian designs have been used to shorten the time to primary endpoint
analysis in randomized clinical trials, although the predictive value of
Bayesian analysis compared with frequentist approaches remains debated.
<br/>Method(s): The SURTAVI trial randomized 1,660 patients. An interim
analysis was performed 1 year after the 1,400th patient was treated to
estimate the primary 2-year endpoint of all-cause mortality or disabling
strokes for all patients. <br/>Result(s): The Kaplan-Meier rate for the
complete 2-year primary endpoint was 12.7% in the TAVR group and 12.6% in
the surgery group (0.0% difference; 95% confidence interval: -3.4% to
3.5%), compared with 12.6% with TAVR and 14.0% with surgery (-1.4%
difference; Bayesian credible interval: -5.2% to 2.3%) in the interim
Bayesian analysis. A comparison of individual clinical, hemodynamic, and
quality-of-life endpoints using Bayesian and frequentist methods found no
significant differences. <br/>Conclusion(s): The complete analysis of all
patients with aortic stenosis at intermediate risk for surgery in the
SURTAVI trial confirmed the noninferiority, with respect to the frequency
of all-cause mortality or disabling stroke, of TAVR to surgery, as
determined in the interim Bayesian analysis. Follow-up will extend out to
10 years.<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<15>
Accession Number
2004747861
Title
Intraoperative xenon for prevention of delirium after on-pump cardiac
surgery: a randomised, observer-blind, controlled clinical trial.
Source
British Journal of Anaesthesia. (no pagination), 2020. Date of
Publication: 2020.
Author
Al tmimi L.; Verbrugghe P.; Van de Velde M.; Meuris B.; Meyfroidt G.;
Milisen K.; Fieuws S.; Rex S.
Institution
(Al tmimi, Van de Velde, Rex) Department of Anaesthesiology, University
Hospitals Leuven, Leuven, Belgium
(Al tmimi, Verbrugghe, Van de Velde, Meuris, Rex) Department of
Cardiovascular Sciences, KU Leuven, Leuven, Belgium
(Verbrugghe, Meuris) Department of Cardiac Surgery, University Hospitals
Leuven, Leuven, Belgium
(Meyfroidt) Department of Intensive Care Medicine, University Hospitals
Leuven, Leuven, Belgium
(Meyfroidt) Department of Cellular and Molecular Medicine, KU Leuven,
Leuven, Belgium
(Milisen) Department of Public Health and Primary Care, KU Leuven, Leuven,
Belgium
(Fieuws) Leuven Biostatistics and Statistical Bioinformatics Centre
(L-BioStat), KU Leuven, Leuven, Belgium
Publisher
Elsevier Ltd
Abstract
Background: Older patients undergoing cardiac surgery have a 40-60% risk
of developing postoperative delirium (POD), which is associated with
increased morbidity and mortality. In animals, xenon has been found to be
neuroprotective. Little is known about its neuroprotective effects in
humans. We evaluated whether xenon anaesthesia prevents POD in patients
undergoing cardiac surgery. <br/>Method(s): We conducted a randomised,
observer-blind, controlled trial in which 190 patients 65 yr or older
undergoing on-pump cardiac surgery were randomly allocated to xenon or
sevoflurane anaesthesia. During cardiopulmonary bypass, propofol infusion
was used for anaesthetic maintenance. Subjects were screened for POD daily
during the first 5 postoperative days using the 3-Minute Diagnostic
Interview for Confusion Assessment Method (CAM) or with a CAM version for
patients in ICU (CAM-ICU). Other methods to detect delirium, such as chart
review, were also used. Secondary outcomes included the duration and
severity of POD, and postoperative cognitive function. <br/>Result(s): The
overall incidence of POD was 41% (78/190). There was no statistically
significant difference in the POD incidence between the xenon and
sevoflurane groups (42.7% [41/96] vs 39.4% [37/94], P=0.583). The odds
ratio for POD when comparing xenon with sevoflurane was 1.18 (95%
confidence interval, 0.65-2.16). <br/>Conclusion(s): In older patients
undergoing cardiac surgery, xenon anaesthesia did not result in a
significant reduction in POD. Based on these results alone, use of xenon
cannot be recommended for this purpose. Clinical trial registration:
EudraCT: 2014-005370-11 (May 13, 2015;
https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-005370-
11).<br/>Copyright &#xa9; 2020 British Journal of Anaesthesia

<16>
Accession Number
2004144097
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. (no pagination), 2020. Date of Publication: 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, China
(Pei) Department of Cardiology, The First Affiliated Hospital of Baotou
Medical College, Baotou, 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, China
Publisher
Taylor and Francis Ltd
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.
<br/>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. <br/>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 1.83-2.78, p = 0.000,
I² = 30.3%, p for heterogeneity 0.197]. In addition, subgroup
analyses have shown that the group with an younger age (<82 y) seemed to
have a higher risk of all-cause mortality than the group with older age
(>=82 y) [HR 4.08 (2.41 to 6.89) VS 2.01 (1.60 to 2.53), p = 0.016 for
subgroup difference]. <br/>Conclusion(s): Pre-procedural elevated cardiac
troponin was associated with increased long-term all-cause mortality in
patients undergoing TAVR.<br/>Copyright &#xa9; 2020, &#xa9; 2020 Informa
UK Limited, trading as Taylor & Francis Group.

<17>
Accession Number
630724427
Title
Percutaneous mitral commissurotomy versus surgical commissurotomy for
rheumatic mitral stenosis: A systematic review and meta-analysis of
randomised controlled trials.
Source
Heart. (no pagination), 2020. Article Number: 315906. Date of Publication:
2020.
Author
Singh A.D.; Mian A.; Devasenapathy N.; Guyatt G.; Karthikeyan G.
Institution
(Singh) Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH,
United States
(Mian) Oncology, Cleveland Clinic Foundation, Cleveland, OH, United States
(Devasenapathy) Indian Institute of Public Health, Delhi, Gurgaon, India
(Guyatt) Clinical Epidemiology and Biostatistics, McMaster University,
Hamilton, ON, Canada
(Karthikeyan) Cardiology, All India Institute of Medical Sciences, New
Delhi 110029, India
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Aim: Patients with severe mitral stenosis (MS) and their clinicians
typically choose percutaneous transvenous mitral commissurotomy (PTMC)
over surgical commissurotomy (SC). However, the durability of PTMC
relative to SC is uncertain. We compared the efficacy, safety and
durability of PTMC with SC for the treatment of MS. <br/>Method(s): We
searched EMBASE, MEDLINE and WHO ICTRP registers for randomised controlled
trials (RCTs) comparing PTMC, and open and/or closed mitral
commissurotomy. The principal outcomes were rate of re-intervention and
symptomatic improvement as inferred from the surrogate measures of
immediate postprocedural mitral valve area (MVA), MVA at >=6 month
follow-up, incidence of mitral regurgitation (MR) and restenosis. We
calculated weighted mean differences (WMD) for continuous outcomes,
relative risks (RR) for binary outcomes and pooled outcomes using
random-effects models and assessed the quality of evidence using the
Grading of Recommendations, Assessment, Development and Evaluation (GRADE)
approach. <br/>Result(s): Seven RCTs with 553 patients proved eligible.
Pooled estimates showed no convincing difference in the risk of restenosis
or re-intervention (15/100 fewer with PTMC, 95% CI (-20 to +8); quality of
evidence: moderate) or in symptoms as inferred from immediate MVA (WMD
0.15, 95% CI (-0.18 to 0.48): very low), from the incidence of
postprocedural severe MR (3/100 more with PTMC, 95% CI (-1 to +10):
moderate) or from MVA at 30 months. <br/>Conclusion(s): Until data
demonstrating convincing superiority of SC over PTMC become available, our
results support the current practice of recommending PTMC to young
patients with MS and favourable valve morphology, as it is associated with
lower peri-procedural morbidity. PROSPERO registration number: PROSPERO
2017 (CRD42017079512).<br/>Copyright &#xa9; Author(s) (or their
employer(s)) 2020. No commercial re-use. See rights and permissions.
Published by BMJ.

<18>
Accession Number
2002946741
Title
Sustained High-dose Thiamine Supplementation in High-risk Cardiac Patients
Undergoing Cardiopulmonary Bypass: A Pilot Feasibility Study (The APPLY
trial).
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (3) (pp 594-600),
2020. Date of Publication: March 2020.
Author
Lomivorotov V.V.; Moroz G.; Ismoilov S.; Shmyrev V.; Efremov S.;
Abubakirov M.; Batalov V.; Landoni G.; Lembo R.; Bogachev-Prokophiev A.;
Sapegin A.; Bellomo R.
Institution
(Lomivorotov, Moroz, Ismoilov, Shmyrev, Abubakirov, Batalov,
Bogachev-Prokophiev, Sapegin) E. Meshalkin National Medical Research
Center, Novosibirsk, Russian Federation
(Lomivorotov) Novosibirsk State University, Novosibirsk, Russian
Federation
(Efremov) Saint Petersburg State University Hospital, Saint Petersburg,
Russian Federation
(Landoni, Lembo) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Bellomo) Centre for Integrated Critical Care, The University of
Melbourne, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objective: To test the feasibility and investigate possible cardiovascular
effects of a sustained high-dose intravenous thiamine protocol in patients
undergoing combined valvular and coronary artery bypass graft surgery.
<br/>Design(s): Randomized, placebo-controlled, pilot feasibility trial.
<br/>Setting(s): Cardiac surgery department of a tertiary hospital.
<br/>Participant(s): Forty patients undergoing combined valvular and
coronary artery bypass surgery. <br/>Intervention(s): Intravenous thiamine
(600 mg on the day of surgery, and 400 mg/day on postoperative days 1, 2,
and 3) or placebo. <br/>Measurements and Main Results: The primary
feasibility endpoints were recruitment rate and protocol compliance.
Secondary endpoints included markers of possible biological and
physiological effects. The mean recruitment rate was 8 patients per month
and protocol compliance was 97.5%. There were no differences in median
peak postoperative lactate (2.7 mmol/L [interquartile range [IQR] 1.4-4.6]
for thiamine v 2.5 mmol/L [IQR 1.4-3.6] for placebo; p = 0.53), median
peak postoperative creatinine (104 micro&#32;mol/L [IQR 92.5-129] for
thiamine v 99 micro&#32;mol/L [IQR 86.5-109.5] for placebo; p = 0.53),
median nadir postoperative cardiac index (1.8 L/min/m² [IQR
1.5-2.1] for thiamine v 2.2 L/min/m² [IQR 1.5-2.5] for placebo;
p = 0.25), or the number of patients on vasopressor/inotropic agents
(thiamine, 12 [63%]; placebo, 12 [60%]; p = 0.80), or in the total
inotrope/vasopressor dose 0.14 micro&#32;g/kg for thiamine v 0.12
micro&#32;g/kg for placebo; p = 0.88). <br/>Conclusion(s): A double-blind
trial of sustained high-dose intravenous thiamine supplementation in
higher-risk cardiac surgery patients was feasible and appeared to be safe.
However, such treatment did not demonstrate evidence of biological or
physiological effects.<br/>Copyright &#xa9; 2019

<19>
Accession Number
2002548399
Title
Thrombocytosis: Perioperative Considerations for Patients Undergoing
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (3) (pp 772-781),
2020. Date of Publication: March 2020.
Author
Smith B.B.; Boswell M.R.; Matzek L.J.; Smith M.M.
Institution
(Smith, Boswell, Matzek, Smith) Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic College of Medicine and Science,
Rochester, MN, United States
Publisher
W.B. Saunders
Abstract
Thrombocytosis is an uncommon yet important laboratory abnormality with
significant considerations for patients undergoing cardiac surgery. The
etiology of thrombocytosis can be categorized by those related to reactive
processes; acquired platelet disorders (ie, myeloproliferative neoplasms,
hematologic malignancies); or inherited platelet disorders (ie, hereditary
thrombocythemia). A foundational understanding of the normal physiologic
function of platelets and the abnormalities associated with each of these
disorders is critical when considering implications and optimization to
prevent perioperative complications. This review systematically outlines
the platelet disorders that cause thrombocytosis with an emphasis on how
the disorder affects normal physiologic processes, summarizes the
literature related to the disorder, and the describes the implications and
recommendations for patients undergoing cardiac surgery.<br/>Copyright
&#xa9; 2019 Elsevier Inc.

<20>
Accession Number
2004681075
Title
Reduced rate of revascularization in schizophrenic patients with acute
myocardial infarction: A systematic review and meta-analysis.
Source
Progress in Neuro-Psychopharmacology and Biological Psychiatry. 99 (no
pagination), 2020. Article Number: 109870. Date of Publication: 20 April
2020.
Author
Shao M.; Zhuo C.; Gao X.; Chen C.; Xu Y.; Tian H.; Li G.; Jiang D.; Wang
W.
Institution
(Shao) National Integrated Traditional and Western Medicine Center for
Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
(Zhuo, Li) Department of psychiatry, School of Mental Health, Jining
University, Jining, Shandong Province 27211, China
(Zhuo, Chen, Jiang) Department of Psychiatry, Wenzhou Seventh People's
Hospital, Wenzhou 325000, China
(Zhuo, Tian) Psychiatric-Neuroimging-Genetics and Comorbidity Laboratory
(PNGC-Lab), Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin
300222, China
(Zhuo, Xu) Department of Psychiatry, First Hospital/First Clinical Medical
College of Shanxi Medical University, Taiyuan, China
(Zhuo, Xu) MDT Center for Cognitive Impairment and Sleep Disorders, First
Hospital of Shanxi Medical University, Taiyuan 030001, China
(Zhuo, Wang) Co-collaboration Laboratory of China and Canada, Xiamen
Xianyue Hospital and University of Alberta, Xiamen Xianyue Hospital,
Xiamen 361000, China
(Gao) Center for Health Statistics, Big data center of chronic disease,
Health Management Institute, 301 Hospital of Chinese People's Liberation
Army, General Hospital of Chinese People's Liberation Army, Beijing
100191, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Importance: It has been suggested that patients with schizophrenia have
higher than expected mortality following acute coronary events. However,
the in-hospital revascularization rate in patients with schizophrenia and
acute myocardial infarction (AMI) compared to mentally healthy patients
remains unknown. <br/>Objective(s): To evaluate the revascularization rate
in schizophrenic patients after AMI with a meta-analysis of observational
studies. Data sources: PubMed and Embase electronical databases. Study
selection: Observational studies that evaluate the likelihood of
revascularization in AMI patients with schizophrenia compared to those
without schizophrenia, after adjustment for potential influencing factors.
Data extraction and synthesis: Data regarding study design,
characteristics of the AMI patients and schizophrenic patients, and
strategies of revascularization were extracted. Results were pooled and
analyzed with a random effect model to incorporate the potential
heterogeneity. Main outcome and measures: The likelihood of
revascularization in AMI patients with schizophrenia compared to those
without schizophrenia, after adjustment for potential influencing factors.
<br/>Result(s): Overall, 3,260,754 hospitalized AMI patients from six
follow-up studies were included, of which 17,875 patients had a prior
diagnosis of schizophrenia. Results of this meta-analysis suggest that
revascularization was significantly lower in AMI patients with
schizophrenia compared to those without schizophrenia (odds ratio [OR]:
0.48, 95% confidence interval [CI]: 0.38 to 0.62, p < .001; I²
= 93%), after adjustment for demographic characteristics, comorbidities,
and hospital and regional factors. Specifically, AMI patients with
schizophrenia had significantly fewer percutaneous coronary interventions
(OR: 0.48, 95% CI: 0.41 to 0.56, p < .001; I² = 49%) and
coronary artery bypass grafts (OR: 0.61, 95% CI: 0.53 to 0.70, p < .001;
I² = 20%) compared to those without schizophrenia. Conclusions
and relevance: Patients with schizophrenia and AMI have a lower rate of
coronary revascularization as compared with patients without
schizophrenia, which is an important cause of higher-than-expected
mortality rate in this population.<br/>Copyright &#xa9; 2020

<21>
Accession Number
2004658699
Title
Durability of Mitral Valve Bioprostheses: A Meta-Analysis of Long-Term
Follow-up Studies.
Source
Annals of Thoracic Surgery. 109 (2) (pp 603-611), 2020. Date of
Publication: February 2020.
Author
Malvindi P.G.; Mastro F.; Kowalewski M.; Ringold M.; Margari V.; Suwalski
P.; Speziale G.; Paparella D.
Institution
(Malvindi, Margari, Paparella) Cardiothoracic Department, Santa Maria
Hospital, GVM Care & Research, Bari, Italy
(Mastro, Ringold, Paparella) Department of Emergency and Organ Transplant,
University of Bari Aldo Moro, Bari, Italy
(Kowalewski, Suwalski) Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior, Centre of Postgraduate Medical
Education, Warsaw, Poland
(Kowalewski) Cardiothoracic Research Centre, Innovative Medical Forum,
Bydgoszcz, Poland
(Kowalewski) Cardio-Thoracic Surgery Department, Heart and Vascular
Centre, Maastricht University Medical Centre, Maastricht, Netherlands
(Speziale) Cardiothoracic and Vascular Department, Maria Cecilia Hospital,
GVM Care & Research, Cotignola (RA), Italy
Publisher
Elsevier USA
Abstract
Background: Porcine and pericardial valves exhibited similar freedom from
structural valve deterioration after aortic valve replacement. Limited
data exist regarding their durability at long-term follow-up in the mitral
position. <br/>Method(s): A literature search was performed through online
databases. Papers reporting freedom from tissue valve deterioration after
mitral valve replacement with a follow-up longer than 5 years were
retrieved. Four porcine valves (Carpentier-Edwards [Edwards Lifesciences,
Irvine, CA] and Hancock, Hancock II, and Mosaic [Medtronic, Inc,
Minneapolis, MN]) and 1 pericardial prosthesis (Carpentier-Edwards) were
the objects of the study. The structural valve deterioration (SVD) rate
per year was calculated for each type of prosthesis. Kaplan-Meier curves
and log-rank test analysis were performed to compare the long-term
durability of porcine and pericardial valves. <br/>Result(s): Forty
full-text papers including more than 15,000 patients were considered for
the meta-analysis. Porcine valves were generally implanted in younger
patients in the first period after their introduction. The mean age of the
patients receiving a mitral bioprosthesis increased from 50 to 70 years
over the decades. In patients operated after 1980 who had similar mean age
at the time of implant, freedom from SVD was higher in the group of
porcine valves with Mosaic prosthesis, showing the lowest rate of SVD.
Long-term survival was higher for Mosaic porcine and Carpentier
pericardial valves. <br/>Conclusion(s): In surgical populations that
underwent mitral valve replacement after 1980 with new generation tissue
valves and similar mean age at the implant time, we found, at long-term
follow-up, a higher freedom from SVD in the group of porcine
prostheses.<br/>Copyright &#xa9; 2020 The Society of Thoracic Surgeons

<22>
Accession Number
2004217606
Title
Pregnancy outcomes in women with cardiothoracic transplants: A Systematic
review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. 39 (2) (pp 93-102), 2020. Date
of Publication: February 2020.
Author
Acuna S.; Zaffar N.; Dong S.; Ross H.; D'Souza R.
Institution
(Acuna, D'Souza) Institute of Health Policy, Management & Evaluation,
University of Toronto, Toronto, Ontario, Canada
(Zaffar, Dong, D'Souza) Division of Maternal-Fetal Medicine, Department of
Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto,
Toronto, Ontario, Canada
(Dong) Faculty of Medicine, University of Toronto, Toronto, Ontario,
Canada
(Ross) Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada
(D'Souza) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
Toronto, Ontario, Canada
Publisher
Elsevier USA
Abstract
Increasing numbers of women with thoracic transplants are planning and
continuing pregnancies. However, pregnancy outcomes and risks to the
mother and baby have not been systematically assessed. MEDLINE, EMBASE,
and Cochrane Central were searched from their inception to January 2018,
to identify studies reporting outcomes on 3 or more pregnancies following
thoracic transplants. Pooled incidences were calculated using a
random-effect meta-analysis. Risk-of-bias was assessed using the Joanna
Briggs Checklist for case series. Subgroup analysis was conducted based on
the organ transplanted. Of the 3,658 records identified, 12 studies were
included that reported on 385 pregnancies in 272 thoracic transplant
recipients. Maternal complications included mortality (pooled incidence
0.5% [95% confidence intervals 0, 1.1%] during pregnancy and 15.4% [10.4,
20.3%] during follow-up, which ranged between 3 and 7 years), graft
rejection (7.4% [4.2, 10.5%]), hypertensive disorders of pregnancy [26.6%
[13.7, 39.6%]), and cesarean deliveries (41.4% [33.4, 48.7%]). Maternal
mortality was more common in recipients of lung vs heart transplants
(41.4% [23.4, 59.3] vs 10.8% [5.9, 15.8]), respectively. Although 78.4%
(69.8, 86.9%) of the pregnancies resulted in live births, 51.2% (31,
71.3%) were born preterm and neonatal deaths occurred in 3.4% (1.3, 5.6%).
Congenital anomalies affected 4.3% (1.8, 6.8%) of the newborns. Although
few maternal deaths occurred during pregnancy, in keeping with median
survival data, delayed mortality for thoracic transplant recipients
remains high. Despite the high numbers of live births, these pregnancies
continue to be at risk for hypertensive disorders, graft rejection,
preterm birth, and neonatal mortality. Prospectively gathered data from
international registries should supplement these findings to better inform
clinical counseling and practice.<br/>Copyright &#xa9; 2019 International
Society for Heart and Lung Transplantation

<23>
Accession Number
2004671110
Title
Network analysis of outcomes in patients undergoing transcatheter aortic
valve replacement for stenotic bicuspid aortic valves according to valve
type.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Quintana R.A.; Monlezun D.; Davogustto G.; Saenz H.; Lugo Baruqui D.;
Denktas A.E.; Jneid H.; Paniagua D.
Institution
(Quintana) Andreas Gruentzig Cardiovascular Center, Division of
Cardiology, Department of Medicine, Emory University School of Medicine,
Atlanta, GA, United States
(Monlezun) Department of Internal Medicine, McGovern Medical School,
University of Texas Health Science Center at Houston, Houston, TX, United
States
(Davogustto) Division of Cardiology, Department of Medicine, Vanderbilt
University Medical Center, Nashville, TN, United States
(Saenz) Division of Geriatrics, Department of Internal Medicine,
University of California San Diego, San Diego, CA, United States
(Lugo Baruqui) Department of Internal Medicine, Mount Sinai Medical
Center, Miami, FL, United States
(Denktas, Jneid, Paniagua) Division of Cardiology, Department of Medicine,
Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: It is currently unknown if outcomes after transcatheter aortic
valve replacement (TAVR) differ according to the prosthetic valve deployed
in patients with bicuspid aortic valves (BAV). <br/>Objective(s): This
study evaluated valve-specific outcomes post-TAVR in patients with BAV.
<br/>Method(s): Literature search was performed using the Cochrane
databases, PubMed, ClinicalTrials, SCOPUS and EMBASE databases from
inception until July 2018. We computed risk ratios and their 95%
confidence intervals for all outcomes of interest. For each outcome, the
data were pooled using a multivariate random-effects meta-analysis
including multiple treatment as well as direct and indirect comparisons.
<br/>Result(s): Ten studies enrolling a total of 1547 BAV patients
undergoing TAVR using 6 different prosthetic valve types were analyzed.
There were no significant differences in 30-day all-cause mortality,
life-threatening bleeding and device success among the diverse prosthetic
valve types implanted. However, 2nd generation balloon-expandable valves
had consistently lower risk of moderate-to-severe prosthetic valve
regurgitation. <br/>Conclusion(s): In patients with BAV, there were no
significant differences in 30-day all-cause mortality after TAVR among the
various prosthetic valve types.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<24>
Accession Number
2004671053
Title
Industry compensation and self-reported financial conflicts of interest
among authors of highly cited peripheral artery disease studies.
Source
Journal of Vascular Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Bellomo T.R.; Hwang C.; Spector-Bagdady K.; Stanley J.C.; Corriere M.A.
Institution
(Bellomo, Hwang, Stanley, Corriere) Department of Surgery, Section of
Vascular Surgery, University of Michigan, Ann Arbor, Mich, United States
(Spector-Bagdady, Corriere) Center for Bioethics and Social Sciences in
Medicine, University of Michigan, Ann Arbor, Mich, United States
(Spector-Bagdady) Department of Obstetrics and Gynecology, University of
Michigan, Ann Arbor, Mich, United States
(Corriere) Center for Health Outcomes and Policy, University of Michigan,
Ann Arbor, Mich, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Industry compensation to authors may influence the
interpretation of study results. Scientific journals often require author
disclosure of a relevant financial conflict of interest (FCOI) but seldom
quantify compensation and leave reporting up to the author's discretion.
Professional and public concerns related to potential bias introduced into
medical research by FCOI have arisen, especially when physician
compensation from manufacturers is not disclosed. Little is known,
however, about the prevalence of industry compensation to authors of
related publications, payment amounts, or how this information compares
with self-reported FCOI. The objective of this study was to compare
industry compensation and disclosed FCOI among highly referenced
publications related to treatment of peripheral artery disease, a disease
that affects approximately 8.5 million Americans and is often treated with
medications and devices. <br/>Method(s): "Peripheral artery disease" was
used as a Web of Science search term to identify publications from 2013 to
2016, excluding review articles, conference proceedings, book chapters,
abstract publications, and non-English language publications. The top 99
most cited publications were abstracted for self-reported FCOI by author.
Industry compensation to authors was queried using a ProPublica Dollars
for Docs custom data set based on Centers for Medicare and Medicaid
Services Open Payments data. Providers practicing in the United States in
any of the following specialties were included: cardiology, cardiothoracic
surgery, vascular and interventional radiology, or vascular surgery.
Payment transactions were matched to physician authors on the basis of
provider name, specialty, and geographic location. Statistical analysis
included descriptive statistics and categorical tests. Descriptive
statistics are reported as frequency (percentage) or median (interquartile
range). <br/>Result(s): Among 1008 vascular specialist authors identified,
218 (22%) self-reported FCOI. Fifty-six physician authors had compensation
reported to the Centers for Medicare and Medicaid Services by industry
during the study period. Among those identified as recipients of industry
compensation, 28 (50%) self-reported FCOI. Industry payments to the 56
authors totaled $11,139,987, with a median total payment of $18,827
(interquartile range, $152,084) per author. Food and beverage was the most
frequently identified nature of payment (n = 8981 [74%]), promotional
speaking involved the largest total amount of payments ($3,256,431), and
royalty or license was the highest median payment ($51,431 [$72,215]).
Physicians reporting FCOI received a total of $9,435,340 during the study
period vs $1,706,647 for those who did not report any FCOI. Median total
payments were higher among authors reporting FCOI vs not ($81,224
[$324,171] vs $9494 [$43,448]; P <.001). <br/>Conclusion(s): Nondisclosed
author compensation from industry is relatively uncommon among highly
cited peripheral artery disease research studies but may be associated
with substantial payments. These results suggest that self-reported FCOI
does not provide a comprehensive overview of industry compensation.
Reporting all payments rather than only those deemed relevant by the
author might provide a more complete and transparent report of potential
FCOI, allowing independent assessment of relevance in interpreting study
findings.<br/>Copyright &#xa9; 2019 Society for Vascular Surgery

<25>
Accession Number
2004664348
Title
Cost-effectiveness of transcatheter aortic valve intervention (TAVI)
compared to surgical aortic valve replacement (SAVR) in low-intermediate
surgical risk patients.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Azraai M.; Gao L.; Ajani A.E.
Institution
(Azraai, Ajani) Royal Melbourne Hospital, Melbourne, Australia
(Azraai, Ajani) University of Melbourne, Melbourne, Australia
(Gao) Deakin University, Melbourne, Australia
(Ajani) NHMRC Centre of Clinical Research Excellence in Therapeutics,
Department of Epidemiology and Preventive Medicine, Monash University,
Melbourne, Australia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Transcatheter aortic valve intervention (TAVI) is known to
be non-inferior to surgical aortic valve replacement (SAVR) in
low-intermediate surgical risk patients. This present systematic review
was conducted to analyse the cost-effectiveness of TAVI in this patient
population. <br/>Method(s): Four electronic databases from January 2010 to
November 2019 were used to identify relevant cost-effectiveness studies of
TAVI versus SAVR in low-intermediate risk patients. The primary endpoints
were the incremental cost-effectiveness ratio (ICER) and the probability
of cost effectiveness. The eligible studies for the present systematic
review included those in which the cost-effectiveness data were measured
or projected for TAVI and SAVR. <br/>Result(s): Eight studies were
included in this review, where six studies involved intermediate risk
patients and two studies with low risk patients. The reported ICER for
TAVI compared to SAVR in low-intermediate risk patients were below the
ICER threshold of acceptability in all studies. The probability of TAVI
being cost-effective compared to SAVR ranged from 78%-97%.
<br/>Conclusion(s): TAVI is likely to be a cost-effective alternative to
SAVR in low-intermediate risk patients. More studies on low risk patients
is needed.<br/>Copyright &#xa9; 2020

<26>
Accession Number
2004090837
Title
Natriuretic peptides in acute kidney injury - A sojourn on parallel
tracks?.
Source
European Journal of Internal Medicine. 71 (pp 39-44), 2020. Date of
Publication: January 2020.
Author
Dass B.; Beaver T.M.; Shimada M.; Alquadan K.F.; Koratala A.; Singhania
G.; Singh A.; Ejaz A.A.
Institution
(Dass, Alquadan, Koratala, Singhania, Singh, Ejaz) Division of Nephrology,
Hypertension and Transplantation, University of Florida, P.O. Box 100224,
Gainesville, FL 32610, United States
(Beaver) Division of Cardiovascular Surgery, University of Florida,
Gainesville, United States
(Shimada) Division of Nephrology, Hirosaki University Graduate School of
Medicine, Hirosaki, Japan
Publisher
Elsevier B.V.
Abstract
Objective: The focus of this review was to elicit the mechanistic logic of
the experimental and clinical study designs of natriuretic peptides (NP)
in acute kidney injury (AKI) and to understand their respective outcomes.
<br/>Method(s): Online search of PubMed and manual review of articles.
Randomized trials, observational and physiologic studies of NPs and AKI
were extracted. Rationale, design and study outcomes were analyzed.
<br/>Result(s): In experimental models of AKI, infusion of NP prevented
post-ischemic fall in renal blood flow (RBF) or improvement in RBF, GFR,
diuresis and natriuresis and demonstrated anti-inflammatory properties.
NPs were most effective in the early stages of AKI, also in established
phase of AKI but their effectiveness were limited to the time of infusion.
Hypotension was a major side-effect. Based on these observations,
preliminary clinical studies were performed which demonstrated improved
urine output, RBF and GFR and reduced need for dialysis. However,
randomized, controlled trials failed to demonstrate improvement in
dialysis-free survival in different cohorts and study designs. Although
NPs reduced the incidence of AKI in the postoperative period in cardiac
surgery, it was not associated with improved long-term survival. In
contrast to randomized trials, meta-analysis reported favorable results.
<br/>Conclusion(s): Reasons for the divergence of experimental and
clinical outcomes of NPs in AKI are discussed in this review
article.<br/>Copyright &#xa9; 2019

<27>
Accession Number
630719141
Title
Successful recovery in a paediatric patient with polytrauma following
multiple gunshot wounds: Case report and review of literature.
Source
JPMA. The Journal of the Pakistan Medical Association. Suppl. 70 1) (2)
(pp S122-S124), 2020. Date of Publication: 01 Feb 2020.
Author
Salim A.; Ahmed R.; Aziz A.; Dogar S.A.
Institution
(Salim, Ahmed, Aziz, Dogar) Department of Surgery, Aga Khan University,
Karachi, Pakistan
Publisher
NLM (Medline)
Abstract
Our case report evaluates a 21/2 year old boy who presented to emergency
care, following multiple gunshot injuries and was managed emergently using
a multidisciplinary surgical approach at our center. The patient was
unresponsive, had poor perfusion, bilaterally decreased air entry, a
distended abdomen, and multiple entry and exit wounds. A multidisciplinary
team including Paediatric Surgery, Cardiothoracic Surgery, Paediatric
anaesthesiology team and Orthopaedic surgery were taken on board.
Following effective immediate management and stabilization, the patient
was admitted to the ward under careful observation. He was discharged on
post-operative day 28 after a successful recovery and on his 6 month
follow-up, the patient had shown significant improvement, with normal
bowel and pulmonary function. Rapid intervention along with a
multidisciplinary surgical approach helped ensure the success of the
treatment. Prior permission from the patient's guardians was acquired
before the preparation of this manuscript.

<28>
Accession Number
630707809
Title
Supplemental Cardioplegia During Donor Heart Implantation: A Systematic
Review and Meta-Analysis.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 20 Jan 2020.
Author
Ribeiro R.V.P.; Friedrich J.O.; Ouzounian M.; Yau T.; Lee J.; Yanagawa B.
Institution
(Ribeiro, Yau) Division of Cardiovascular Surgery, Peter Munk Cardiac
Centre, Toronto General Hospital, University Health Network, Toronto, ON;
Institute of Medical Science, University of Toronto, Toronto, ON
(Friedrich) Critical Care and Medicine Departments and Li Ka Shing
Knowledge Institute, St. Michael's Hospital, Department of Medicine and
Interdepartmental Division of Critical Care, University of Toronto, ON,
Toronto, United States
(Ouzounian) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, ON, University Health Network, Toronto, United
States
(Lee, Yanagawa) Division of Cardiovascular Surgery, St. Michael's
Hospital, ON, Toronto, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal donor heart preservation and management strategy
during heart transplantation remains controversial. Here, we perform a
systematic review and meta-analysis of the effect of supplemental
cardioplegia administration during donor heart implant for
transplantation. <br/>METHOD(S): We searched MEDLINE and EMBASE databases
until February 2019 for studies comparing patients who received
transplants with the donor heart given supplemental cardioplegia or not.
Data was extracted by two independent investigators. The main outcomes
were early morbidity and mortality. <br/>RESULT(S): Seven retrospective
observational studies (four comparing to historical controls) and 3
randomized controlled trials enrolling 1125 patients were included.
Supplemental cardioplegia included crystalloid, and blood cardioplegia
given continuous retrograde or as terminal "hot shots". Supplemental
cardioplegia was associated with improved early mortality (risk ratio
[RR]:0.55; 95%CI:0.35 to 0.87; p<0.01), greater rates of spontaneous
return of sinus rhythm (RR:2.62; 95%CI:1.50 to 4.56; p<0.01), shorter
intensive care stay (MD:-3.4 days; 95%CI:-5.1 to -1.6; p<0.01), and lower
incidence of ischemic changes seen on endomyocardial biopsy (RR:0.49;
95%CI:0.35 to 0.69; p<0.01) compared to controls. Mid-term mortality was
not different between groups (incident rate ratio:0.80; 95%CI:0.51 to
1.26; p=0.34). <br/>CONCLUSION(S): Administration of supplemental
cardioplegia may be associated with a reduction in organ ischemic injury
and shorter intensive care stay as well as improvement in early survival
post-transplantation. This strategy may be a simple and cost-effective
adjunct to improve outcomes of heart transplantation, especially in an era
of increasing use of marginal donor organs. Further investigation will be
needed to confirm the findings of this hypothesis-generating
study.<br/>Copyright &#xa9; 2020. Published by Elsevier Inc.

<29>
Accession Number
630707575
Title
The efficacy and safety of prophylactic corticosteroids for the prevention
of adverse outcomes in patients undergoing heart surgery using
cardiopulmonary bypass: a systematic review and meta-analysis of
randomized controlled trials.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 23 Jan 2020.
Author
Ng K.T.; Van Paassen J.; Langan C.; Sarode D.P.; Arbous M.S.; Alston R.P.;
Dekkers O.M.
Institution
(Ng) Department of Anaesthesiology, Faculty of Medicine, University of
Malaya, Kuala Lumpur, Malaysia
(Van Paassen, Arbous) Department of Intensive Care, Leiden University
Medical Center, Leiden, Netherlands
(Langan, Sarode) Department of General Surgery, NHS Greater Glasgow &
Clyde, United Kingdom
(Arbous, Dekkers) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
(Alston) Department of Anaesthesia, Critical Care and Pain Medicine, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
Publisher
NLM (Medline)
Abstract
Corticosteroids are often administered prophylactically to attenuate the
inflammatory response associated with cardiac surgery using
cardiopulmonary bypass (CPB). However, the efficacy and safety profile of
corticosteroids remain uncertain. The primary aim of this systematic
review and meta-analysis was to investigate the effect of corticosteroids
on mortality in adult cardiac surgery using CPB. Secondary aims were to
examine the effect of corticosteroids on myocardial adverse events,
pulmonary adverse events, atrial fibrillation, surgical site infection,
gastrointestinal bleeding and duration of stay in the intensive care unit
and hospital. Randomized controlled trials (RCTs) were systematically
searched in electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL and Web
of Science) from their inception until March 2019. Observational studies,
case reports, case series and literature reviews were excluded. Sixty-two
studies (n=16 457 patients) were included in this meta-analysis. There was
no significant difference in mortality between the corticosteroid and
placebo groups [odds ratio (OR) 0.96, 95% confidence interval (CI)
0.81-1.14; P=0.65, participants=14 693, studies=24, evidence of certainty:
moderate]. Compared to those receiving a placebo, patients who were given
corticosteroids had a significantly higher incidence of myocardial adverse
events (OR 1.17, 95% CI 1.03-1.33; P=0.01, participants=14 512,
studies=23) and a lower incidence of pulmonary adverse events (OR 0.86,
95% CI 0.75-0.98; P=0.02, participants=13 426, studies=17). The incidences
of atrial fibrillation (OR 0.87, 95% CI 0.81-0.94; P<0.001,
participants=14 148, studies=24) and surgical site infection (OR 0.81, 95%
CI 0.73-0.90; P<0.001, participants=13 946; studies=22) were all lower in
patients who were given corticosteroids. In the present meta-analysis of
62 RCTs (16 457 patients), including the 2 major RCTs (SIRS and DECS
trials: 12 001 patients), we found that prophylactic corticosteroids in
cardiac surgery did not reduce mortality. The clinical significance of an
increase in myocardial adverse events remains unclear as the definition of
a relevant myocardial end point following cardiac surgery varied greatly
between RCTs.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<30>
Accession Number
630707331
Title
Effect of remote ischaemic conditioning on coagulation function as
measured by whole blood impedance aggregometry and rotational
thromboelastometry in off-pump coronary artery bypass surgery: A
randomised controlled trial.
Source
Thrombosis research. 187 (pp 72-78), 2020. Date of Publication: 15 Jan
2020.
Author
Kim T.K.; Nam K.; Cho Y.J.; Choi S.; Row H.S.; Jeon Y.
Institution
(Kim, Choi, Row) Department of Anaesthesiology and Pain Medicine, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, Republic of Korea; Department of Anaesthesiology and Pain
Medicine, SMG-SNU Boramae Medical Centre, Seoul National University
College of Medicine, Seoul, Republic of Korea
(Nam, Cho, Jeon) Department of Anaesthesiology and Pain Medicine, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Remote ischaemic conditioning (RIC) has been shown to
prevent platelet activation during ablation for atrial fibrillation. RIC
has also been associated with more postoperative transfusion in the
off-pump coronary artery bypass graft surgery (OPCAB) patients. We
evaluated the effects of RIC on coagulation function in OPCAB patients.
<br/>METHOD(S): A total of 58 patients undergoing OPCAB were randomised to
the RIC or control group. In the RIC group, four cycles of 5 min of
ischaemia and 5 min of reperfusion were applied twice to the upper arm
after the induction of anaesthesia (preconditioning), and after the
completion of coronary anastomoses (postconditioning). Whole blood
impedance aggregometry (Multiplate) and rotational thromboelastometry
(ROTEM) were performed before the induction of anaesthesia, at the end of
surgery, and at postoperative day 1. <br/>RESULT(S): The trend towards a
decrease in adenosine diphosphate-induced whole blood aggregation at the
end of surgery was greater in the RIC group than in the control group, but
this effect was not statistically significant (-10.4 [18.1] vs. -5.7
[24.8] U, P = 0.424). In ROTEM analysis, the EXTEM area under the velocity
curve was lower in the RIC group than in the control group at the end of
surgery (3567 [1399-5794] vs. 5693 [4718-6179] mm*100, respectively; P =
0.030). A tendency of larger perioperative blood loss was identified in
the RIC group. <br/>CONCLUSION(S): Although some parameters indicated a
tendency for hypocoagulation in the RIC group at the end of surgery, most
effects were not statistically significant. RIC does not significantly
affect perioperative platelet aggregability and coagulation in patients
undergoing OPCAB.<br/>Copyright &#xa9; 2020. Published by Elsevier Ltd.

<31>
Accession Number
630717129
Title
A systematic review and meta-analysis of the effects of early mobilization
therapy in patients after cardiac surgery: A protocol for systematic
review.
Source
Medicine. 99 (4) (pp e18843), 2020. Date of Publication: 01 Jan 2020.
Author
Chen B.; You X.; Lin Y.; Dong D.; Xie X.; Zheng X.; Li D.; Lin W.
Publisher
NLM (Medline)
Abstract
BACKGROUND: Prolonged hospitalization and immobility of critical care
patients elevates the risk of long-term physical and cognitive
impairments. However, the therapeutic effects of early mobilization have
been difficult to interpret due to variations in study populations,
interventions, and outcome measures. This systematic review and
meta-analysis aims to assess the effects of early mobilization therapy for
non-emergency cardiac surgery patients in the intensive care unit (ICU).
<br/>METHOD(S): The following databases will be used to search for
relevant keywords: PubMed, Embase, CINAHL, PEDro, and the Cochrane Library
from inception to September 2018 by 2 researchers independently.
Randomized controlled trials (RCTs), will be included if patients are
adults (>=18 years) admitted to any ICU for cardiac surgery due to
cardiovascular disease and who are treated with experimental physiotherapy
initiated in the ICU (pre, post, or perioperative). The Review Manager 5.3
will be used for meta-analysis and the evidence level will be assessed by
using the method for Grading of Recommendations Assessment, Development,
and Evaluation (GRADE). Continuous outcomes will be presented as the
weighted mean difference (WMD) or standardized mean difference (SMD) with
95% confidence interval (CI), while dichotomous data will be expressed as
relative risk (RR) with 95% CI. If the included studies have existing
heterogeneity (P < 0.1), a random-effects model will be used. Otherwise,
we will calculate using a fixed effects model. <br/>RESULT(S): This review
will evaluate the effects of early mobilization on length of ICU and
hospital stay, physical function and adverse events in patients with
cardiac surgery patients in the ICU. <br/>CONCLUSION(S): This systematic
review will comprehensively provide conclusive evidence of the therapeutic
effect of early mobilization on cardiac surgery patients in the
ICU.PROSPERO Research registration identifying number: CRD42019135338.

<32>
Accession Number
630640148
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) (no pagination), 2020. Article
Number: 10. 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, 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, ISMETT-IRCCS, 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
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
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. <br/>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. <br/>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%);
P<inf>interaction</inf> = 0.531. There was no impact of centre volume on
survival as well: s<inf>coef</inf> = 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 s<inf>coef</inf> = - 0.0066; P =
0.031. Weaning rates and bridging to HTx and/or VADs were higher in HTx
facilities. <br/>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.<br/>Copyright &#xa9; 2020 The Author(s).

<33>
Accession Number
2004705745
Title
Association of obstructive sleep apnea and postoperative cardiac
complications: A systematic review and meta-analysis with trial sequential
analysis.
Source
Journal of Clinical Anesthesia. 62 (no pagination), 2020. Article Number:
109731. Date of Publication: June 2020.
Author
Ng K.T.; Lee Z.X.; Ang E.; Teoh W.Y.; Wang C.Y.
Institution
(Ng, Wang) Department of Anaesthesiology, Faculty of Medicine, University
of Malaya, Jalan Universiti, Kuala Lumpur 50603, Malaysia
(Lee, Ang) University Hospital of Wales, Health Park, Cardiff CF14 4XN,
United Kingdom
(Teoh) University of Liverpool, School of Medicine, Cedar House, Ashton
Street, Liverpool L69 3GE, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The repetitive hypoxic and hypercapnia events of obstructive
sleep apnea (OSA) are believed to adversely affect cardiopulmonary
function, which make them vulnerable to a higher incidence of
postoperative complications. The primary aim of this systematic review and
meta-analysis was to examine the association of OSA and the composite
endpoints of postoperative cardiac or cerebrovascular complications in
adult undergoing non-cardiac surgery. Data sources: MEDLINE, EMBASE and
CENTRAL were systematically searched from its inception until May 2019.
Review methods: All observational studies were included. <br/>Result(s):
Twenty-two studies (n = 3,033,814; 184,968 OSA vs 2,848,846 non-OSA) were
included for quantitative meta-analysis. In non-cardiac surgery, OSA was
significantly associated with a higher incidence of the composite
endpoints of postoperative cardiac or cerebrovascular complications (odd
ratio: 1.44, 95%CI: 1.17 to 1.78, rho = 0.007, trial sequential analysis =
conclusive; certainty of evidence = very low). In comparison to non-OSA,
OSA patients were reported to have nearly 2.5-fold risk of developing
pulmonary complications (odd ratio: 2.52, 95%CI: 1.92 to 3.31, rho <
0.001, certainty of evidence = very low), postoperative delirium (odd
ratio: 2.45, 95%CI: 1.50 to 4.01, rho < 0.001, certainty of evidence =
low) and acute kidney injury (odd ratio: 2.41, 95%CI: 1.93 to 3.02, rho <
0.001, certainty of evidence = very low). <br/>Conclusion(s): This
meta-analysis of 22 comparative studies demonstrated that OSA is a
potential risk factor to postoperative adverse complications in adults
undergoing non-cardiac surgery. However, the conclusions need to be
interpreted with caution due to the nature of included observational
studies with significant heterogeneity and low quality of evidence.
PROSPERO: CRD42019136564.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<34>
Accession Number
2003608464
Title
Efficacy and safety of dual antiplatelet therapy on graft patency after
coronary artery bypass graft surgery: A randomized controlled trial.
Source
Iranian Heart Journal. 21 (1) (pp 6-16), 2020. Date of Publication: 2020.
Author
Abdi S.; Momtahen M.; Bassiri H.-A.; Shafiei A.; Sadeghipour P.; Madani
M.; Bakhshandeh H.
Institution
(Abdi, Momtahen, Bassiri, Shafiei, Sadeghipour, Madani) Cardiovascular
Intervention Research Center, Rajaie Cardiovascular, Medical, and Research
Center, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Bakhshandeh) Rajaie Cardiovascular, Medical, and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: Early vein graft occlusion after coronary artery bypass
grafting (CABG) is one of the major problems after the surgery which
directly impacts its short-and long-term outcomes. One of the potential
explanations is aspirin resistance. The aim of this study was to evaluate
the efficacy and safety of dual antiplatelet therapy (DAPT) with
clopidogrel and aspirin compared with aspirin alone on the reduction of
early graft occ usion. <br/>Method(s): In a multicenter randomized
controlled trial with a parallel design, from 2012 to 2015 among 1165
patients, we compared 140 candidates for CABG: 71 in the DAPT group (300
mg c of clopidogrel and 80-325 mg of aspirin) and 69 in the aspirin group.
The primary outcome was graft patency assessed by coronary computed
tomography angiography performed at 6 months' follow-up. Bleeding
complications were considered the secondary outcome. <br/>Result(s):
Saphenous vein grafts were occluded in 10 (14.1%) patients in the DAPT and
11 (15.9%) in the control group (P = 0.758). After adjustments for study
centers, the associations remained unchanged (OR [95% CI]: 1.49
[0.59-3.74]). Bleeding endpoints were also similar in the 2 groups (P >
0.05). <br/>Conclusion(s): Our study did not demonstrate the superiority
of the DAPT regimen over aspirin monotherapy in patients undergoing
elective CABG. Larger multicenter studies may provide more
evidence.<br/>Copyright &#xa9; 2020, Iranian Heart Association. All rights
reserved.

<35>
Accession Number
2003604691
Title
Comparison of epidural analgesia combined with general anesthesia and
general anesthesia for postoperative cognitive dysfunction in elderly
patients.
Source
Ulusal Travma ve Acil Cerrahi Dergisi. 26 (1) (pp 30-36), 2020. Date of
Publication: January 2020.
Author
Orhun G.; Sungur Z.; Koltka K.; Karadeniz M.S.; Yavru H.A.; Gurvit H.;
Senturk M.
Institution
(Orhun, Sungur, Koltka, Karadeniz, Yavru, Senturk) Department of
Anesthesiology and Intensive Care, Istanbul University Istanbul, Faculty
of Medicine, Istanbul, Turkey
(Gurvit) Department of Neurology, Behavioral Neurology and Movement
Disorders Unit, Istanbul University Istanbul, Faculty of Medicine,
Istanbul, Turkey
Publisher
Turkish Association of Trauma and Emergency Surgery
Abstract
BACKGROUND: Cognitive dysfunction in the early postoperative course is
common for the elderly population. Anesthetic management may affect
postoperative cognitive decline. Effective analgesia, early recovery and
modulation of the stress response are advantages of neuraxial blocks. This
study aims to compare the effects of general anesthesia and the
combination of general anesthesia with epidural analgesia for
postoperative cognitive dysfunction (POCD). We hypothesized that neuraxial
block combined with general anesthesia (GA) would have a favorable
influence on POCD prevention. <br/>METHOD(S): Patients above 60 years
undergoing non-cardiac surgery were included in this randomized,
prospective study and randomized into two groups. Patients in the first
group (GI) were treated under GA, whereas in the second group (GII),
epidural analgesia was combined with GA. Patients' cognitive function was
assessed before and one week after surgery using a neuropsychological test
battery. POCD was defined as a drop of one standard deviation from
baseline on two or more tests. <br/>RESULT(S): A total of 116 patients
were allocated for the final analysis. Demographic and operative data were
similar between groups, except maximum pain scores, which were
significantly higher in GI than GII (4.9+/-2.8 vs. 1.7+/-1.7; p<0.001,
respectively). The incidence of POCD was comparable between groups (26% in
GI and 24% in GII). Memory performance, visuospatial functions, and
language skills tests were significantly higher in GII compared to GI.
<br/>CONCLUSION(S): General anesthesia and epidural analgesia combined
with general anesthesia resulted in similar POCD in elderly patients
undergoing abdominal surgery. However, in combined anesthesia group
memory, language skills and visuospatial functions appeared to be better
preserved. Effective pain control might contribute to preventing cognitive
decline in some domains.<br/>Copyright &#xa9; 2019 Turkish Association of
Trauma and Emergency Surgery.

<36>
Accession Number
630714190
Title
OPRM1 and COMT polymorphisms: Implications on postoperative acute, chronic
and experimental pain after cardiac surgery.
Source
Pharmacogenomics. 21 (3) (pp 181-193), 2020. Date of Publication: 2020.
Author
Matic M.; De Hoogd S.; De Wildt S.N.; Tibboel D.; Knibbe C.A.J.; Van
Schaik R.H.N.
Institution
(Matic, Van Schaik) Department of Clinical Chemistry, Erasmus MC -
University Medical Center Rotterdam, Wytemaweg 80, Rotterdam 3015 CN,
Netherlands
(Matic, De Wildt, Tibboel) Intensive Care and Department of Paediatric
Surgery, Erasmus MC - University Medical Center Rotterdam, Sophia
Children's Hospital, Wytemaweg 80, Rotterdam 3015 CN, Netherlands
(De Hoogd, Knibbe) Department of Clinical Pharmacy, St Antonius Hospital,
Koekoeklaan 1, Nieuwegein 3435 CM, Netherlands
(De Wildt) Department of Pharmacology and Toxicology, Radboud University,
Nijmegen, Netherlands
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Aim: Investigate the potential role of OPRM1 (mu-opioid receptor) and COMT
(catechol-O-methyltransferase enzyme) polymorphisms in postoperative
acute, chronic and experimental thermal pain. <br/>Method(s): A secondary
analysis of 125 adult cardiac surgery patients that were randomized
between fentanyl and remifentanil during surgery and genotyped.
<br/>Result(s): Patients in the fentanyl group with the COMT high-pain
sensitivity haplotype required less postoperative morphine compared with
the average-pain sensitivity haplotype (19.4 [16.5; 23.0] vs 34.6 [26.2;
41.4]; p = 0.00768), but not to the low-pain sensitivity group (30.1
[19.1; 37.7]; p = 0.13). No association was found between COMT haplotype
and other pain outcomes or OPRM1 polymorphisms and the different pain
modalities. <br/>Conclusion(s): COMT haplotype appears to explain part of
the variability in acute postoperative pain in adult cardiac surgery
patients.<br/>Copyright &#xa9; 2020 &#xa9; 2020 Future Medicine Ltd.

<37>
Accession Number
2003394770
Title
Fetal heart rate monitoring in nonobstetric surgery: a systematic review
of the evidence.
Source
American Journal of Obstetrics and Gynecology MFM. 1 (4) (no pagination),
2019. Article Number: 100048. Date of Publication: November 2019.
Author
Higgins M.F.; Pollard L.; McGuinness S.K.; Kingdom J.C.
Institution
(Higgins, Kingdom) Maternal Fetal Medicine, Mount Sinai Hospital, Toronto,
ON, Canada
(Higgins) Perinatal Research Center, Obstetrics and Gynaecology, School of
Medicine and Medical Sciences, University College Dublin, National
Maternity Hospital, Dublin, Ireland
(Pollard) Department of Nursing, Mount Sinai Hospital, Toronto, ON, Canada
(McGuinness) Department of Anaesthesia, St. Vincent's University Hospital,
Dublin, Ireland
(Kingdom) Obstetrics and Gynaecology, University of Toronto, ON, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: Concern for fetal well-being during maternal nonobstetric
surgery may result in obstetricians and other maternity care providers
being asked to perform intraoperative fetal heart rate (FHR) monitoring.
We systematically reviewed the evidence regarding the use of FHR
monitoring during nonobstetric surgery after potential fetal viability
(>22 weeks gestational age), and examined the FHR patterns and outcomes
reported. Data sources: A systematic review of the evidence was performed.
Sources included databases (MEDLINE, EMBASE, Cochrane, and CENTRAL), hand
searching, guidelines, conference proceedings, and literature reviews.
Online searching was performed to include literature published from 1966
to May 2019. Study eligibility criteria: All studies reviewing care of
pregnant women undergoing nonobstetric surgery where FHR monitoring was
performed intraoperatively. Data were extracted from appropriate full-text
articles using a data abstraction form. Study appraisal and synthesis:
Case reports and case series only were identified. A total of 74 cases
were reviewed, encompassing maternal general surgery (n = 41,
cardiovascular surgery (n = 13) and neurosurgery/orthopedics (n = 20).
Median gestational age at time of maternal surgery was 30 weeks (range,
22-36 weeks). In 41 cases, findings of FHR monitoring were not reported.
Abnormal tracings were observed in 29 cases, as either reduced variability
(n = 13) or fetal bradycardia (n = 17). All but 3 bradycardias reported
occurred during maternal cardiac surgery involving aortic clamping and
cardiopulmonary bypass. In 1 case, FHR monitoring was not possible because
of a surgical pneumoperitoneum; there was 1 fetal tachycardia associated
with maternal pyrexia, and three cases in which FHR monitoring was deemed
stable or normal. Three preterm infants were delivered simultaneously at
the time of general surgery as a result of FHR abnormalities (at 30, 33,
and 34 weeks respectively), 2 as a result of fetal bradycardia and 1
because of protracted reduced variablity. <br/>Conclusion(s): The evidence
for intraoperative fetal monitoring is based on case reports and cases
series. Maternal cardiac surgery involving cardiopulmonary bypass commonly
results in fetal bradycardia, which may be challenging to interpret.
Obstetricians should be aware of FHR pattern changes in response to
anesthesia and surgery that do not justify iatrogenic preterm cesarean
delivery.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<38>
Accession Number
2004122677
Title
Tolvaptan can limit postoperative paroxysmal atrial fibrillation
occurrence after open-heart surgery.
Source
Surgery Today. (no pagination), 2020. Date of Publication: 2020.
Author
Nakamura Y.; Kishimoto Y.; Harada S.; Onohara T.; Otsuki Y.; Horie H.;
Nishimura M.
Institution
(Nakamura, Kishimoto, Harada, Onohara, Otsuki, Horie, Nishimura)
Department of Cardiovascular Surgery, Tottori University Faculty of
Medicine, Tottori University Hospital, 36-1 Nishi-cho, Yonago 683-8504,
Japan
Publisher
Springer ( Singapore)
Abstract
Purpose: Tolvaptan administration in the early postoperative period after
cardiac surgery rapidly treats fluid retention without affecting the renal
function. Tolvaptan also has the benefit of not stimulating the
renin-angiotensin and sympathetic nervous systems, which are risk factors
for postoperative paroxysmal atrial fibrillation. In this study, we
examined the hypothesis that tolvaptan administration reduces
postoperative paroxysmal atrial fibrillation and worsening of the renal
function incidence in patients who have undergone open-heart surgery.
<br/>Method(s): From our previous randomized study, we selected 166
open-heart surgery patients, divided them into 2 groups [tolvaptan group,
83 patients; control (non-tolvaptan) group, 83 patients], and compared the
incidence of postoperative paroxysmal atrial fibrillation and worsening of
the renal function in the postoperative period between the groups.
<br/>Result(s): The incidence of worsening of the renal function was
significantly lower in the tolvaptan group than in the control group (4.8%
vs. 15.7%; P = 0.04). The incidence of postoperative paroxysmal atrial
fibrillation within 14 days was also significantly lower in the tolvaptan
group than in the control group (26.5% vs. 42.2%; P = 0.011).
<br/>Conclusion(s): Tolvaptan administration in the early postoperative
period after open-heart surgery may reduce the incidence of postoperative
paroxysmal atrial fibrillation and worsening of the renal
function.<br/>Copyright &#xa9; 2020, Springer Nature Singapore Pte Ltd.

<39>
Accession Number
614094607
Title
Transcatheter Mitral Valve Replacement for Patients With Symptomatic
Mitral Regurgitation: A Global Feasibility Trial.
Source
Journal of the American College of Cardiology. 69 (4) (pp 381-391), 2017.
Date of Publication: 31 Jan 2017.
Author
Muller D.W.M.; Farivar R.S.; Jansz P.; Bae R.; Walters D.; Clarke A.;
Grayburn P.A.; Stoler R.C.; Dahle G.; Rein K.A.; Shaw M.; Scalia G.M.;
Guerrero M.; Pearson P.; Kapadia S.; Gillinov M.; Pichard A.; Corso P.;
Popma J.; Chuang M.; Blanke P.; Leipsic J.; Sorajja P.; Muller D.;
Conellan M.; Spina R.; Pedersen W.; Sun B.; Scalia G.; Grayburn P.; Stoler
R.; Hebeler R.; Fiane A.; Feldman T.; Salinger M.; Smart S.; Mick S.;
Krishnaswamy A.; Carroll J.; George I.; Missov E.; Kiser A.
Institution
(Muller, Jansz, Shaw) Departments of Cardiology and Cardiothoracic
Surgery, St. Vincent's Hospital, Sydney, Australia
(Farivar, Bae, Sorajja) Center for Valve and Structural Heart Disease and
Cardiothoracic Surgery Service, Minneapolis Heart Institute at Abbott
Northwestern Hospital, Minneapolis, Minnesota, United States
(Walters, Clarke, Scalia) Departments of Cardiology and Cardiothoracic
Surgery, Prince Charles Hospital, Brisbane, Australia
(Grayburn, Stoler) Divisions of Cardiology and Cardiothoracic Surgery,
Baylor University Medical Center, Dallas, Texas, United States
(Dahle, Rein) Departments of Cardiology and Cardiothoracic Surgery, Oslo
University Hospital, Oslo, Norway
(Guerrero, Pearson) Divisions of Cardiology and Cardiothoracic Surgery,
Evanston Hospital, Evanston, Illinois, United States
(Kapadia, Gillinov) Departments of Cardiovascular Medicine and
Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio,
United States
(Pichard, Corso) Division of Cardiology and Department of Cardiothoracic
Surgery, Medstar Washington Hospital Center, Washington DC, United States
(Popma, Chuang) Beth Israel Deaconness Medical Center, Boston,
Massachusetts, United States
(Blanke, Leipsic) St. Paul's Hospital, Vancouver, British Columbia, Canada
Publisher
Elsevier USA
Abstract
Background Symptomatic mitral regurgitation (MR) is associated with high
morbidity and mortality that can be ameliorated by surgical valve repair
or replacement. Despite this, many patients with MR do not undergo
surgery. Transcatheter mitral valve replacement (TMVR) may be an option
for selected patients with severe MR. Objectives This study aimed to
examine the effectiveness and safety of TMVR in a cohort of patients with
native valve MR who were at high risk for cardiac surgery. Methods
Patients underwent transcatheter, transapical delivery of a self-expanding
mitral valve prosthesis and were examined in a prospective registry for
short-term and 30-day outcomes. Results Thirty patients (age 75.6 +/- 9.2
years; 25 men) with grade 3 or 4 MR underwent TMVR. The MR etiology was
secondary (n = 23), primary (n = 3), or mixed pathology (n = 4). The
Society of Thoracic Surgeons Predicted Risk of Mortality was 7.3 +/- 5.7%.
Successful device implantation was achieved in 28 patients (93.3%). There
were no acute deaths, strokes, or myocardial infarctions. One patient died
13 days after TMVR from hospital-acquired pneumonia. Prosthetic leaflet
thrombosis was detected in 1 patient at follow-up and resolved after
increased oral anticoagulation with warfarin. At 30 days, transthoracic
echocardiography showed mild (1+) central MR in 1 patient, and no residual
MR in the remaining 26 patients with valves in situ. The left ventricular
end-diastolic volume index decreased (90.1 +/- 28.2 ml/m² at
baseline vs. 72.1 +/- 19.3 ml/m² at follow-up; p = 0.0012), as
did the left ventricular end-systolic volume index (48.4 +/- 19.7
ml/m² vs. 43.1 +/- 16.2 ml/m²; p = 0.18).
Seventy-five percent of the patients reported mild or no symptoms at
follow-up (New York Heart Association functional class I or II).
Successful device implantation free of cardiovascular mortality, stroke,
and device malfunction at 30 days was 86.6%. Conclusions TMVR is an
effective and safe therapy for selected patients with symptomatic native
MR. Further evaluation of TMVR using prostheses specifically designed for
the mitral valve is warranted. This intervention may help address an unmet
need in patients at high risk for surgery. (Early Feasibility Study of the
Tendyne Mitral Valve System [Global Feasibility Study];
NCT02321514)<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<40>
Accession Number
2004628749
Title
Exploring Current Evidence on the Past, the Present, and the Future of the
Heart Team: A Narrative Review.
Source
Cardiovascular Therapeutics. 2020 (no pagination), 2020. Article Number:
9241081. Date of Publication: 2020.
Author
Burlacu A.; Covic A.; Cinteza M.; Lupu P.M.; Deac R.; Tinica G.
Institution
(Burlacu) Department of Interventional Cardiology, Cardiovascular Diseases
Institute, Iasi, Romania
(Burlacu, Covic, Lupu, Tinica) "grigore T. Popa" University of Medicine
and Pharmacy, Iasi, Romania
(Covic) Nephrology Clinic, Dialysis and Renal Transplant Center, "c.I.
Parhon" University Hospital, Iasi, Romania
(Covic) Academy of Romanian Scientists (AOSR), Bucharest, Romania
(Cinteza) Department of Cardiology, Emergency University Hospital,
Bucharest, Romania
(Cinteza) "Carol Davila" University of Medicine and Pharmacy, Bucharest,
Romania
(Deac) Romanian Academy of Medical Sciences, Bucharest, Romania
(Tinica) Department of Cardiovascular Surgery, Cardiovascular Diseases
Institute, Iasi, Romania
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Introduction. Including healthcare professionals dealing with
cardiovascular diseases, Heart Team is a concept/structure designed for
selecting diagnostic strategies, facilitating therapeutic decisions, and
improving cardiovascular outcomes in patients with complex heart
pathologies, requiring input from different subspecialties and the
necessity of a multidisciplinary approach. The aim of this narrative
review is to search for and to summarize current evidence regarding Heart
Team and to underline the future directions for the development of this
concept. Methods. We searched the electronic database of PubMed, SCOPUS,
and Cochrane CENTRAL for studies including Heart Team. Forty-eight studies
were included, if reference was made to Heart Team structure and
functionality. Results. We depicted the structure and the timeline of
Heart Team, along with actual evidence-based recommendations from European
Guidelines. We underlined the importance of quality of knowledge-sharing
and decision-making inside the Team, analyzing bad decisions which did not
reflect members' true beliefs due to "uniformity pressure, closed
mindedness, and illusion of invulnerability." The observation that
Guidelines' indications regarding Heart Team carry a level C indication
underlines the very future of this Team: randomized controlled trials
proving solid benefits in an evidence-based world. Conclusions. Envisioned
as a tool for optimizing the management of various complex cardiovascular
pathologies, Heart Team should simplify and facilitate the activity in the
cardiovascular ward. Finally, these facts should be translated into better
cardiovascular outcomes and a lower psychological distress among Team
participants. Despite all future changes, there must always be a constant
part: the patient should remain at the very center of the
Team.<br/>Copyright &#xa9; 2020 Alexandru Burlacu et al.

<41>
Accession Number
2004065140
Title
Clinical Prediction Models for Valvular Heart Disease.
Source
Journal of the American Heart Association. 8 (20) (no pagination), 2019.
Article Number: e011972. Date of Publication: 15 Oct 2019.
Author
Wessler B.S.; Lundquist C.M.; Koethe B.; Park J.G.; Brown K.; Williamson
T.; Ajlan M.; Natto Z.; Lutz J.S.; Paulus J.K.; Kent D.M.
Institution
(Wessler, Lundquist, Koethe, Park, Brown, Williamson, Ajlan, Lutz, Paulus,
Kent) Predictive Analytics and Comparative Effectiveness (PACE) Center,
Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts
Medical Center, Boston, MA, United States
(Wessler) Division of Cardiology, Tufts Medical Center, Boston, MA, United
States
(Natto) Department of Dental Public Health, Faculty of Dentistry, King
Abdulaziz University, Jeddah, Saudi Arabia
Publisher
American Heart Association Inc.
Abstract
Background: While many clinical prediction models (CPMs) exist to guide
valvular heart disease treatment decisions, the relative performance of
these CPMs is largely unknown. We systematically describe the CPMs
available for patients with valvular heart disease with specific attention
to performance in external validations. <br/>Methods and Results: A
systematic review identified 49 CPMs for patients with valvular heart
disease treated with surgery (n=34), percutaneous interventions (n=12), or
no intervention (n=3). There were 204 external validations of these CPMs.
Only 35 (71%) CPMs have been externally validated. Sixty-five percent
(n=133) of the external validations were performed on distantly related
populations. There was substantial heterogeneity in model performance and
a median percentage change in discrimination of -27.1% (interquartile
range, -49.4%--5.7%). Nearly two-thirds of validations (n=129) demonstrate
at least a 10% relative decline in discrimination. Discriminatory
performance of EuroSCORE II and Society of Thoracic Surgeons (2009) models
(accounting for 73% of external validations) varied widely: EuroSCORE II
validation c-statistic range 0.50 to 0.95; Society of Thoracic Surgeons
(2009) Models validation c-statistic range 0.50 to 0.86. These models
performed well when tested on related populations (median related
validation c-statistics: EuroSCORE II, 0.82 [0.76, 0.85]; Society of
Thoracic Surgeons [2009], 0.72 [0.67, 0.79]). There remain few (n=9)
external validations of transcatheter aortic valve replacement CPMs.
<br/>Conclusion(s): Many CPMs for patients with valvular heart disease
have never been externally validated and isolated external validations
appear insufficient to assess the trustworthiness of predictions. For
surgical valve interventions, there are existing predictive models that
perform reasonably well on related populations. For transcatheter aortic
valve replacement (CPMs additional external validations are needed to
broadly understand the trustworthiness of predictions.<br/>Copyright
&#xa9; 2019 The Authors. Published on behalf of the American Heart
Association, Inc., by Wiley.

<42>
Accession Number
630658493
Title
Non-invasive assessment of the arrhythmogenic substrate in Brugada
syndrome using signal-averaged electrocardiogram: Clinical implications
from a prospective clinical trial.
Source
Europace. 21 (12) (pp 1900-1910), 2019. Date of Publication: 01 Dec 2019.
Author
Ciconte G.; Santinelli V.; Vicedomini G.; Borrelli V.; Monasky M.M.;
Micaglio E.; Giannelli L.; Negro G.; Giordano F.; Mecarocci V.; Mazza
B.C.; Locati E.; Anastasia L.; Calovic Z.; Pappone C.
Institution
(Ciconte, Santinelli, Vicedomini, Borrelli, Monasky, Micaglio, Giannelli,
Negro, Giordano, Mecarocci, Mazza, Locati, Calovic, Pappone) Department of
Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato
Milanese, Milano 20097, Italy
(Anastasia) Department of Stem Cells Tissue, Stem Cells for Tissue
Engineering Lab, IRCCS Policlinico San Donato, San Donato Milanese,
Milano, Italy
Publisher
Oxford University Press
Abstract
Aims: Brugada syndrome (BrS) represents a major cause of sudden cardiac
death in young individuals. The risk stratification to forecast future
life-threatening events is still controversial. Non-invasive assessment of
late potentials (LPs) has been proposed as a risk stratification tool.
However, their nature in BrS is still undetermined. The purpose of this
study is to assess the electrophysiological determinants of non-invasive
LPs. <br/>Methods and Results: Two hundred and fifty consecutive patients
with (Group 1, n = 96) and without (Group 2, n = 154) BrS-related symptoms
were prospectively enrolled in the registry. Signal-averaged
electrocardiogram (SAECG) was performed in all subjects before undergoing
epicardial mapping. Group 1 patients exhibited larger arrhythmogenic
substrates (AS; 5.8 +/- 2.8 vs. 2.6 +/- 2.1 cm², P < 0.001)
with more delayed potentials (220.4 +/- 46.0 vs. 186.7 +/- 42.3 ms, P <
0.001). Late potentials were present in 82/96 (85.4%) Group 1 and in
31/154 (20.1%) Group 2 individuals (P < 0.001). Patients exhibiting LPs
had more frequently a spontaneous Type 1 pattern (30.1% vs. 10.9%, P <
0.001), SCN5A mutation (34.5% vs. 21.2%, P = 0.02), and exhibited a larger
AS with longer potentials (5.8 +/- 2.7 vs. 2.2 +/- 1.7 cm²;
231.2 +/- 37.3 vs. 213.8 +/- 39.0 ms; P < 0.001, respectively).
Arrhythmogenic substrate dimension was the strongest predictor of the
presence of LPs (odds ratio 1.9; P < 0.001). An AS area of at least 3.5
cm² identified patients with LPs (area under the curve 0.88,
95% confidence interval 0.843-0.931; P < 0.001) with a sensitivity of 86%,
specificity 88%, positive predictive value 85%, and negative predictive
value 89%. <br/>Conclusion(s): The results of this study support the role
of the epicardial AS as an electrophysiological determinant of
non-invasive LPs, which may serve as a tool in the non-invasive assessment
of the BrS substrate, as SAECG-LPs could be considered an expression of
the abnormal epicardial electrical activity. ClinicalTrials.gov number
(NCT02641431; NCT03106701).<br/>Copyright &#xa9; 2019 Published on behalf
of the European Society of Cardiology. All rights reserved. &#xa9; The
Author(s) 2019.

<43>
Accession Number
2003824279
Title
When is the optimal time to discontinue clopidogrel before in-hospital
coronary bypass surgery? A closer look at the current literature.
Source
Journal of Cardiac Surgery. 35 (2) (pp 413-421), 2020. Date of
Publication: 01 Feb 2020.
Author
Mokhtar A.T.; Baghaffar A.; Jackson S.D.; Horne D.
Institution
(Mokhtar, Jackson) Division of Cardiology, Department of Medicine,
Dalhousie University, Halifax, NS, Canada
(Mokhtar) Department of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Baghaffar, Horne) Division of Cardiac Surgery, Department of Surgery,
Dalhousie University, Halifax, NS, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Clopidogrel and other P2Y12 inhibitors have become the
standard of care among patients presenting with acute coronary syndromes.
A substantial proportion of these patients require surgical
revascularization during index hospitalization. Hypothesis: Guidelines
recommend a 5-day waiting period off clopidogrel before coronary artery
bypass grafting (CABG) to reduce hemorrhagic complications. These
recommendations are not routinely followed in clinical practice, while
recent studies also propose shorter waiting periods off clopidogrel for
patients awaiting in-hospital CABG. <br/>Method(s): A preliminary PubMed
search was conducted using the following MeSH terms under the publication
type "Hemorrhage:" "Clopidogrel," AND "Coronary Artery Bypass." Relevant
studies and guidelines were then reviewed and selected based on a
predetermined criteria. Studies that formulated the current
recommendations for stopping clopidogrel preoperative to CABG are
discussed in detail this review. <br/>Result(s): A comprehensive review of
recent evidence illustrates mixed bleeding and transfusion outcomes among
CABG patients with preoperative exposure to clopidogrel in less than 5
days. <br/>Conclusion(s): The optimal discontinuation time of clopidogrel
before CABG is still poorly defined. The recommendation of a 5-day washout
period for clopidogrel should be reconsidered to be on par with current
clinical practice.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<44>
Accession Number
2003731409
Title
Prospective, multicenter, randomized, controlled trial evaluating the
performance of a novel combination powder vs hemostatic matrix in
cardiothoracic operations.
Source
Journal of Cardiac Surgery. 35 (2) (pp 313-319), 2020. Date of
Publication: 01 Feb 2020.
Author
Dang N.C.; Ardehali A.; Bruckner B.A.; Parrino P.E.; Gillen D.L.; Hoffman
R.W.; Spotnitz R.; Cavoores S.; Shorn I.J.; Manson R.J.; Spotnitz W.D.
Institution
(Dang) Department of Surgery, Kaiser Moanalua Medical Center, Honolulu,
HI, United States
(Ardehali) Department of Surgery, University of California at Los Angeles,
Los Angeles, CA, United States
(Bruckner) Methodist DeBakey Heart and Vascular Center, Houston Methodist
Hospital, Houston, TX, United States
(Parrino) Thoracic and Cardiovascular Surgery Section, Ochsner Medical
Center, New Orleans, LA, United States
(Gillen) Department of Statistics, University of California, Irvine, CA,
United States
(Hoffman, Spotnitz, Cavoores, Shorn, Manson, Spotnitz) Biom'up SA, Lyon,
France
(Manson) Department of Surgery, Duke University, Durham, NC, United States
(Manson) Department of Mechanical Engineering and Materials Science, Duke
University, Durham, NC, United States
(Spotnitz) Department of Surgery, University of Virginia, Charlottesville,
VA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Aim: This trial compared the hemostatic performance of a novel combination
powder (CP) to a control hemostatic matrix (HM) in cardiothoracic
operations. <br/>Method(s): Patients meeting eligibility criteria were
enrolled after providing informed consent. Subjects were randomized
intraoperatively to receive CP (HEMOBLAST Bellows; Biom'up, France) or HM
(FLOSEAL Hemostatic Matrix; Baxter Healthcare Corporation, Hayward, CA).
Bleeding was assessed using a clinically validated, quantitative bleeding
severity scale. The primary endpoint was total time to hemostasis (TTTH),
from the start of device preparation, as an indicator of when a surgeon
asks for a surgical hemostat until hemostasis was achieved. TTTH at 3
minutes was utilized for the primary analysis, while TTTH at 5 minutes was
considered as a secondary endpoint. <br/>Result(s): A total of 105
subjects were enrolled across four institutions. The primary efficacy
endpoint for the superiority of CP relative to HM for success at achieving
hemostasis within 3 minutes was met, with 64.2% of the CP group achieving
hemostasis compared with 9.6% of the HM group, a difference of 54.54%
(37.4%-71.6%; P <.001 for superiority). The secondary efficacy endpoint
was also met, with 92.5% of the CP group achieving hemostasis at 5 minutes
versus 44.2% in the HM group, a difference of 48.2% (31.1%-65.4%; P <.001
for noninferiority). There were no device-related adverse events.
<br/>Conclusion(s): In this multicenter, randomized, controlled trial,
comparison of CP to HM revealed CP superiority and noninferiority for TTTH
at 3 and 5 minutes, respectively.<br/>Copyright &#xa9; 2019 The Authors.
Journal of Cardiac Surgery published by Wiley Periodicals, Inc.

<45>
Accession Number
2003638940
Title
Intraoperative graft flow profiles in coronary artery bypass surgery: A
meta-analysis.
Source
Journal of Cardiac Surgery. 35 (2) (pp 279-285), 2020. Date of
Publication: 01 Feb 2020.
Author
Silva M.; Rong L.Q.; Naik A.; Rahouma M.; Hameed I.; Robinson B.; Ruan Y.;
Jiang Y.; Abed A.W.; Girardi L.N.; Gaudino M.
Institution
(Silva, Naik, Rahouma, Hameed, Robinson, Ruan, Jiang, Abed, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York, NY, United States
(Rong) Department of Anesthesiology, Weill Cornell Medicine, New York, NY,
United States
(Silva) Department of Cardiothoracic Surgery, Hospital Santa Marta -
CHULC, Lisbon, Portugal
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Conduits used in coronary artery bypass artery grafting (CABG)
have different properties and flow profiles. We compared intraoperative
mean graft flow (MGF) between arterial and venous conduits, off-pump CABG
(OPCABG) and on-pump CABG (ONCABG) procedures, skeletonized and pedicled
internal mammary artery (IMA) grafts, and pulsatility index (PI) between
OPCABG and ONCABG, in pairwise meta-analyses. <br/>Method(s): Following a
systematic literature search, all studies comparing MGF in arterial and
venous grafts, were included. The primary endpoint was comparison of
pooled MGF between arterial and venous grafts. Secondary endpoints were
comparisons of pooled MGF in OPCABG vs ONCABG, anastomosed skeletonized vs
pedicled IMA grafts, free skeletonized vs pedicled IMA grafts and PI in
OPCABG versus ONCABG. <br/>Result(s): A total of 25 studies with 4443
patients were included. Compared with venous grafts, arterial grafts had
lower MGF (standardized mean difference [SMD], -0.28; 95% confidence
interval [CI, -0.34; -0.22]; P <.001). OPCABG was associated with
significantly lower MGF compared to ONCABG (SMD, -0.29; 95%CI, -0.50;
-0.08]; P =.01). No differences were found in MGF between skeletonized vs
pedicled IMA after anastomosis (SMD, 0.32; 95%CI [-0.08; 0.71]; P =.11) or
in free flow (SMD, 0.76; 95%CI [-0.14; 1.65]; P =.10). No difference was
found in PI between OPCABG and ONCABG. At meta-regression, age was
associated with higher MGF, while OPCABG was associated with lower MGF.
<br/>Conclusion(s): Intraoperative flow of venous conduits is higher than
that of arterial grafts. Compared to OPCABG surgery, graft flow is higher
in ONCABG. In skeletonized and pedicled IMA conduits, no difference in
flow profiles was found.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<46>
Accession Number
2002266195
Title
Randomized clinical trial of an elastomeric sealant for hemostasis in
thoracic aortic surgery.
Source
General Thoracic and Cardiovascular Surgery. 68 (2) (pp 112-121), 2020.
Date of Publication: 01 Feb 2020.
Author
Morita S.; Matsuda T.; Tashiro T.; Komiya T.; Ogino H.; Mukohara N.;
Tominaga R.
Institution
(Morita) Department of Thoracic and Cardiovascular Surgery, Clinical
Research Institute, National Hospital Organization Kyushu Medical Center,
1-8-1 Jigyohama, Fukuoka 810-8563, Japan
(Matsuda) Division of Biomedical Engineering, Graduate School of Medical
Science, Kyushu University, Fukuoka, Japan
(Tashiro) Department of Cardiovascular Surgery, University of Fukuoka
Medical School, Fukuoka, Japan
(Komiya) Department of Cardiovascular Surgery, Kurashiki Central Hospital,
Kurashiki, Okayama, Japan
(Ogino) Department of Cardiovascular Surgery, National Cardiovascular and
Research Center, Suita, Osaka, Japan
(Mukohara) Department of Cardiovascular Surgery, Hyogo Brain and Heart
Center, Himeji, Japan
(Tominaga) Division of Cardiovascular Surgery, Graduate School of Medical
Science, Kyushu University, Fukuoka, Japan
Publisher
Springer
Abstract
Objectives: This study aimed to demonstrate the efficacy and safety of a
newly developed elastomeric sealant, which does not require any blood
coagulation system to exert its effect, during thoracic aortic surgery.
<br/>Method(s): This is a multicenter, randomized study conducted in six
hospitals in Japan. A total of 81 patients undergoing replacement surgery
of a thoracic aortic aneurysm using cardiopulmonary bypass were randomized
with a ratio of 2-:1 for those patients designated to receive the sealant
(Group S, 54 patients) or those without the usage of the sealant (Group C,
27 patients). The primary endpoints were bleeding from each anastomosis at
two time points: (1) immediately before applying protamine and (2) 15 min
after applying protamine. The patients were followed for 6 months.
<br/>Result(s): The number of anastomoses checked for bleeding was 196 in
Group S and 117 in Group C. Before protamine sulfate administration,
complete hemostasis was obtained in 155 anastomoses (79%) in Group S
compared to 45 anastomoses (38%) in Group C (p < 0.001). Fifteen minutes
after the administration of protamine sulfate infusion, bleeding stopped
completely in 173 anastomoses (88%) in Group S and in 71 anastomoses (61%,
p < 0.001) in Group C. Between the two groups, there were no marked
differences in the patient background or in the incidence of major adverse
events. <br/>Conclusion(s): The sealant is effective in achieving
hemostasis, even under fully heparinized conditions. The novel sealant is
safe and effective in thoracic aortic surgery, one of the most demanding
surgical situations for hemostasis.<br/>Copyright &#xa9; 2019, The
Author(s).

<47>
Accession Number
2004698345
Title
Effect of remote ischemic preconditioning on myocardial ischemia in
patients undergoing coronary artery bypass graft surgery: A randomized
controlled trial.
Source
Journal of the Medical Association of Thailand. 103 (1) (pp 1-7), 2020.
Date of Publication: 2020.
Author
Wongthep A.; Karunasumetta C.; Tourthong W.; Senarak P.
Institution
(Wongthep, Karunasumetta, Tourthong, Senarak) Division of Cardiothoracic
Surgery, Department of Surgery, Srinagarind Hospital, Queen Sirikit Heart
Center of the Northeast, Faculty of Medicine, Khon Kaen University, Khon
Kaen 40002, Thailand
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: To determine whether the remote ischemic pre-conditioning
(RIPC) reduces myocardial ischemia in patients undergoing elective
coronary artery bypass graft (CABG) surgery. <br/>Material(s) and
Method(s): The present study was a single-center, triple-blinded,
randomized controlled trial. Fifty patients undergoing elective coronary
artery bypass graft surgery were assigned to either RIPC or control
treatment. Ischemic preconditioning consisted of three cycles of 5-minute
of lower limb ischemia and reperfusion (cuff inflation and deflation)
after anesthesia induction. Myocardial ischemia was assessed based on
serum high-sensitivity cardiac troponin T (hs-cTnT). <br/>Result(s): There
was no significant difference in hs-cTnT levels between the RIPC group and
the control group. Furthermore, there were no significant differences in
inotropic drug use, acute kidney injury, mechanical ventilation time,
hospital stay, or 30-day mortality. However, patients in the RIPC group
had a significantly shorter length of stay in the intensive care unit
(ICU). <br/>Conclusion(s): Although RIPC did not reduce myocardial
ischemia after CABG surgery, it did decrease the length of patients' stays
in the ICU.<br/>Copyright &#xa9; JOURNAL OF THE MEDICAL ASSOCIATION OF
THAILAND <br/> 2020.

<48>
Accession Number
630624044
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) (no pagination), 2020. Article Number: 62. 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
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
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.
<br/>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. <br/>Discussion(s): 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.<br/>Copyright &#xa9; 2020 The Author(s).

<49>
Accession Number
2004693095
Title
Preoperative Pulse Pressure and Adverse Postoperative Outcomes: A
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (3) (pp 624-631),
2020. Date of Publication: March 2020.
Author
Zeng J.; Zheng G.; Li Y.; Yang Y.
Institution
(Zeng, Zheng, Li) Department of Anesthesiology, The First Affiliated
Hospital of Jinan University, Guangzhou, China
(Zeng) Department of Anesthesiology, Liuzhou People's Hospital, Liuzhou,
China
(Yang) Out-patient Department, Liuzhou People's Hospital, Liuzhou, China
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the association between preoperative pulse pressure
(PP) and the incidences of renal, neurologic, cardiac, and mortality
outcomes after surgery. <br/>Design(s): Systematic review and
meta-analysis of cohort studies. <br/>Setting(s): Hospitals.
<br/>Participant(s): Patients who underwent cardiac or noncardiac
surgeries. <br/>Intervention(s): The preoperative PP was measured.
Measurement and Main Results: Relevant cohort studies were obtained by
systematic search of PubMed and Embase databases. A randomized effect
model was used to pool the results. The multivariate adjusted risk ratio
(RR) and its 95% confidence intervals (CI) were calculated to reflect the
association between preoperative PP and adverse postoperative outcomes.
Twelve cohort studies that included 40,143 patients who had undergone
cardiac, vascular, or noncardiac surgery were included in the
meta-analysis. The results showed that above a threshold of 40 mmHg, an
increase in preoperative PP of 10 mmHg was independently associated with
increased risk for renal events (adjusted RR: 1.13, 95% CI 1.08-1.19, p <
0.001; I² = 0%), neurologic events (adjusted RR: 1.75, 95% CI
1.01-3.02, p = 0.04; I² = 70%), cardiac events (adjusted RR:
1.19, 95% CI 1.03-1.37, p = 0.01; I² = 0%), major
cardiovascular adverse events (adjusted RR: 1.62, 95% CI 1.10-2.41, p =
0.02; I² = 0%), and overall mortality (adjusted RR: 1.13, 95%
CI 1.07-1.20, p < 0.001; I² = 0%) after surgery.
<br/>Conclusion(s): Patients with higher-than-normal preoperative PP are
at increased risk for adverse postoperative outcomes.<br/>Copyright &#xa9;
2019

<50>
Accession Number
630679103
Title
Nonopioid analgesics for perioperative and cardiac surgery pain in
children: Current evidence and knowledge gaps.
Source
Annals of Pediatric Cardiology. 13 (1) (pp 46-55), 2020. Date of
Publication: January-March 2020.
Author
Saini A.; Maher K.; Deshpande S.
Institution
(Saini) Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta,
GA, United States
(Maher) Division of Pediatric Cardiology, Sibley Heart Center Cardiology,
Emory University School of Medicine, Atlanta, GA, United States
(Deshpande) Heart Transplant and Advanced Cardiac Therapies Program,
Children's National Health Institute, Washington, DC, United States
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The purpose of this review is to present the available
literature on the use of nonopioid analgesics such as nonsteroidal
anti-inflammatory drugs in postcardiac surgery pediatric patients, mainly
to focus on patients <1 year of age, and to provide the foundation for
future research. <br/>Material(s) and Method(s): Published studies that
address the use on nonopioid medications for postoperative sedation and
analgesia in infants and children undergoing cardiac surgery were
identified from online sources. Studies were reviewed by two authors
independently to assess the quality of the data as well as the evidence.
Due to limited availability of such studies, the review was then expanded
to include use in noncardiac procedures as well as to expanded age groups.
All studies that met the primary objective were included. Results/Data
Synthesis: Majority of the studies in the population of interest were
related to use of ketorolac. Five studies specifically addressed ketorolac
use in cardiac patients. In addition, studies were reviewed for nonopioid
analgesia in noncardiac patients and included as a part of the available
evidence as in the case of acetaminophen use. Newer agents as well as
agents with very limited information were also acknowledged.
<br/>Conclusion(s): Nonopioid medications appear to show promise for
analgesia in infants undergoing cardiac surgery, with ketorolac being the
most potent agent as a potential substitute for opioids. These agents
demonstrate a reasonable safety profile even in the very young. There
continue to be significant gaps in knowledge before their adoption becomes
routine. However, gives the awareness regarding short-term and long-term
impact of opioid use in this vulnerable population, and studies of such
agents are an urgent need.<br/>Copyright &#xa9; 2019 Annals of Pediatric
Cardiology <br/> Published by Wolters Kluwer - Medknow.

<51>
Accession Number
630679083
Title
An evolving anesthetic protocol fosters fast tracking in pediatric cardiac
surgery: A comparison of two anesthetic techniques.
Source
Annals of Pediatric Cardiology. 13 (1) (pp 31-37), 2020. Date of
Publication: January-March 2020.
Author
Sharma V.; Kumar G.; Joshi S.; Tiwari N.; Kumar V.; Ramamurthy H.
Institution
(Sharma, Joshi) Department of Cardio-Thoracic Anaesthesia, Army Hospital
Research and Referral, New Delhi, India
(Kumar, Tiwari) Department of Cardio-Thoracic Surgery, Army Hospital
Research and Referral, New Delhi, India
(Kumar, Ramamurthy) Department of Pediatric Cardiology, Army Hospital
Research and Referral, New Delhi, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: The past two decades have seen rapid development of new
surgical techniques for repair as well as palliation of complex congenital
heart diseases. For a better patient outcome, minimal postoperative
ventilation remains one of the most important endpoints of an effectual
perioperative management. Aims and Objectives: The aim of this randomized
open-label trial was to compare postoperative extubation time and
intensive care unit (ICU) stay when two different anesthetic regimens,
comprising of induction with ketamine and low-dose fentanyl versus
high-dose fentanyl, are used, in pediatric patients undergoing
corrective/palliative surgery. <br/>Material(s) and Method(s): Patients
with congenital cardiac defects, under 14 years of age undergoing cardiac
surgery under cardiopulmonary bypass (CPB) and epidural analgesia, were
enrolled into two groups - Group K (ketamine with low-dose fentanyl) and
Group F (high-dose fentanyl) - over a period of 10 months, starting from
January 2018. The effect of both these drugs on postoperative extubation
time and ICU stay was compared using Mann-Whitney U-test. <br/>Result(s):
A total of 70 patients were assessed with equal distribution in both the
groups. In Group K, 32 of 35 patients were extubated in the operation
room, whereas extubation time in Group F was18.1 +/- 11 h. Total ICU stay
in Group K and Group F was 45.2 +/- 30.1 and 60.1 +/- 24.5 h, respectively
(P = 0.02). Systolic blood pressure was significantly higher in Group K.
<br/>Conclusion(s): Ketamine along with low-dose fentanyl, when used for
anesthetic induction, in comparison to high-dose fentanyl, reduces
postoperative extubation time and ICU stay, in pediatric patients
undergoing corrective/palliative surgery under CPB and epidural analgesia
for congenital cardiac defects.<br/>Copyright &#xa9; 2019 Annals of
Pediatric Cardiology <br/> Published by Wolters Kluwer - Medknow.

<52>
Accession Number
2004098669
Title
Papillary muscle intervention vs mitral ring annuloplasty in ischemic
mitral regurgitation.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Micali L.R.; Qadrouh M.N.; Parise O.; Parise G.; Matteucci F.; de Jong M.;
Tetta C.; Moula A.I.; Johnson D.M.; Gelsomino S.
Institution
(Micali, Qadrouh, Parise, Parise, Matteucci, de Jong, Tetta, Moula,
Johnson, Gelsomino) Department of Cardiothoracic Surgery, Maastricht
University Hospital, Maastricht, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aims: The main pathophysiological factor of chronic
ischemic mitral regurgitation (MR) is the outward displacement of the
papillary muscles (PMs) leading to leaflet tethering. For this reason,
papillary muscle intervention (PMI) in combination with mitral ring
annuloplasty (MRA) has recently been introduced into clinical practice to
correct this displacement, and to reduce the recurrence of regurgitation.
<br/>Method(s): A meta-analysis was conducted comparing the outcomes of
PMI and MRA performed in combination vs MRA performed alone, in terms of
MR recurrence and left ventricular reverse remodeling (LVRR). A
meta-regression was carried out to investigate the impact of the type of
PMI procedure on the outcomes. <br/>Result(s): MR recurrence in patients
undergoing both PMI and MRA was lower than in those who only had MRA (log
incidence rate ratio, -0.66; lower-upper limits, -1.13 to 0.20;
I² = 0.0%; p =.44; Egger's test: intercept 0.35 [-0.78 to
1.51]; p =.42). The group with both PMI and MRA and that with only MRA
showed a slightly higher reduction in left ventricular diameters (-5.94%;
-8.75% to 3.13%,). However, in both groups, LVRR was <10%. No difference
was detected between PM relocation/repositioning and papillary muscle
approximation in terms of LVRR (p =.33). <br/>Conclusion(s): Using PMI and
MRA together has a lower MR recurrence than using MRA alone. No
significant LVRR was observed between the two groups nor between the PMI
techniques employed.<br/>Copyright &#xa9; 2020 The Authors. Journal of
Cardiac Surgery published by Wiley Periodicals, Inc.

<53>
Accession Number
2004098379
Title
Evaluating the role of transesophageal echocardiography (TEE) or
intracardiac echocardiography (ICE) in left atrial appendage occlusion: a
meta-analysis.
Source
Journal of Interventional Cardiac Electrophysiology. (no pagination),
2020. Date of Publication: 2020.
Author
Akella K.; Murtaza G.; Turagam M.; Sharma S.; Madoukh B.; Amin A.;
Gopinathannair R.; Lakkireddy D.
Institution
(Akella, Murtaza, Gopinathannair, Lakkireddy) The Kansas City Heart Rhythm
Institute (KCHRI) HCA MidWest, Overland Park Regional Medical Center,
12200 W 106th Street, Overland Park, KS 66215, United States
(Turagam) Division of Cardiology, Icahn School of Medicine at Mount Sinai,
New York, NY, United States
(Sharma) Department of Cardiology, Garden City Hospital, Garden City, MI,
United States
(Madoukh) Department of Internal Medicine, Overland Park Regional Medical
Center, Overland Park, KS, United States
(Amin) Section of Cardiac Electrophysiology, Department of Cardiology,
OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital,
3535 Olentangy River Road, Columbus, OH 43214, United States
Publisher
Springer
Abstract
Purpose: Intracardiac echocardiography (ICE) is increasingly common among
periprocedural imaging modalities used during complex cardiac procedures.
We sought to perform a meta-analysis comparing transesophageal
echocardiography (TEE) and ICE in endocardial left atrial appendage
occlusion (LAAO). <br/>Method(s): We searched PubMed and Google Scholar
regarding abstracts and manuscripts using keywords: atrial fibrillation,
left atrial appendage occlusion, Watchman, Amplatzer Cardiac Plug, Amulet,
intracardiac echocardiography, and transesophageal echocardiography from
their inception to July 12, 2019. Data extraction was performed using
standard form for the following: title, year of publication, sample size,
comorbid conditions, LAAO device, type of pre-procedural imaging,
intraprocedural imaging, and clinical outcomes including the following:
acute procedural success, fluoroscopy, and total procedure time and
complications. <br/>Result(s): A total of 42 relevant studies were
screened resulting in inclusion of 8 observational studies comparing TEE
and ICE in endocardial LAAO. Outcomes assessed including procedural
success (RR 1.00, 95% CI (0.97-1.03, p = 0.98)), complications (RR 0.77,
95% CI (0.52 to 1.15, p = 0.20)), fluoroscopy time (mean difference -
0.40, 95% CI (-3.12-2.32, p = 0.77)), and procedural time (mean difference
- 8.02, 95% CI (-22.81 to 6.76, p = 0.29)) were found to be similar
between both groups. <br/>Conclusion(s): While TEE is the gold standard
for perioperative imaging with LAAO, ICE is a feasible and safe
alternative that reduces exposure to general anesthesia and associated
potential risks.<br/>Copyright &#xa9; 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<54>
Accession Number
2004117251
Title
Impact of Physician Race on Patient Decision-Making and Ratings of
Physicians: a Randomized Experiment Using Video Vignettes.
Source
Journal of General Internal Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Saha S.; Beach M.C.
Institution
(Saha) Section of General Internal Medicine, VA Portland Health Care
System, 3710 SW U.S. Veterans Hospital Rd. (P3HSRD), Portland, OR, United
States
(Saha) Division of General Internal Medicine & Geriatrics, Oregon Health
and Science University, Portland, OR, United States
(Beach) Department of Medicine, Johns Hopkins University, Baltimore, MD,
United States
Publisher
Springer
Abstract
Background: Studies suggest that black patients have better interactions,
on average, with physicians of their own race. Whether this reflects
greater "cultural competence" in race-concordant relationships, or other
effects of race unrelated to physician behavior, is unclear. It is also
unclear if physician race influences patient decision-making.
<br/>Objective(s): To determine whether physician race affects patients'
ratings of physicians and decision-making, independent of physician
behavior. <br/>Design(s): Randomized study using standardized video
vignettes. <br/>Participant(s): Primary care patients with coronary risk
factors or disease. <br/>Intervention(s): Each participant viewed one of
16 vignettes depicting a physician reviewing cardiac catheterization
results and recommending coronary artery bypass graft (CABG) surgery.
Vignettes varied only in terms of physicians' race, gender, age, and
communication style (high vs. low patient-centeredness). Main Measures:
Participants rated the video physician's communication, interpersonal
style, competence, trustworthiness, likability, and overall performance
(0-4 Likert scales). They also rated the necessity of CABG (0-5 scale) and
whether they would undergo CABG or obtain a second opinion if they were
the video patient (0-3 scales). Key Results: Participants included 107
black and 131 white patients (72% participation rate). Black participants
viewing a black (vs. white) video physician gave higher ratings on all
physician attributes (e.g., overall rating 3.22 vs. 2.34, p < 0.001) and
were more likely to perceive CABG as necessary (4.05 vs. 3.72, p = 0.03)
and say they would undergo CABG if they were the video patient (2.43 vs.
2.09, p = 0.004). Patient-centered communication style reduced, but did
not eliminate, the impact of race concordance. Physician race was not
associated with any outcomes among white patients. <br/>Conclusion(s):
Black patients viewed the doctor in a scripted vignette more positively,
and were more receptive to the same recommendation, communicated in the
same way, with a black vs. white physician. Patient-centered communication
reduced but did not eliminate the effect of physician race.<br/>Copyright
&#xa9; 2020, Society of General Internal Medicine (This is a U.S.
government work and not under copyright protection in the U.S.; foreign
copyright protection may apply).

<55>
Accession Number
2004112484
Title
Adjusted tight control blood glucose management in diabetic patients
undergoing on pump coronary artery bypass graft. A randomized clinical
trial.
Source
Journal of Diabetes and Metabolic Disorders. (no pagination), 2020. Date
of Publication: 2020.
Author
Javaherforoosh zadeh F.; Azemati S.
Institution
(Javaherforoosh zadeh) Department of Anesthesia, Ahvaz Anesthesiology and
Pain Research Center, Ahvaz Jundishapur University of Medical Sciences,
Ahvaz, Iran, Islamic Republic of
(Azemati) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Springer
Abstract
Background: Many of the patients who are undergoing Coronary Artery Bypass
Graft have diabetes mellitus or metabolic syndrome and are at risk for
hyperglycemia events. <br/>Objective(s): The present study aimed to
compare conventional glucose control with adjusted tight control in
patients undergoing on-pump CABG. <br/>Method(s): This double -blind
randomized clinical trial study was conducted in Shiraz, Iran, from
September 2017-March 2018. Two consecutive groups of 75 patients
undergoing elective on- pump coronary artery bypass graft surgery.
<br/>Intervention(s): The patients were divided into adjusted tight
control of the blood glucose between 100 and 120 mg/dl and conventional
method that the blood glucose maintained <=200 mg/dl. Primary outcomes
were: mortality, sternal wound infection, cardiac arrhythmia,
cerebrovascular attack, and acute renal failure. Secondary outcomes
included: duration of mechanical ventilation and length of ICU staying.
The same main outcomes were evaluated after one month. Statistical
analysis: The data were analyzed using SPSS version 20(SPSS, Chicago, IL).
Group comparisons were performed using t-tests and Chi-square tests.
Repeated measurement test was used for comparing blood glucose in two
groups. Mann Whitney U test was compared duration of the mechanical
ventilation and length of ICU staying. Statistical significance was
defined as a p value <0.05. <br/>Result(s): There were no significant
differences between main and secondary outcomes. About late outcomes,
sternal wound infection was in the control group (7 patients) more than
intervention (1 patient) (P < 0.05). No differences between other
complications in both groups were observed. The occurrence of hypoglycemia
was low in both groups. Hypokalemia was significantly higher in the
intervention than in control (P < 0.001). <br/>Conclusion(s): The findings
showed using adjusted tight glycemic control to a level that is nearby to
normal values during cardiac surgery may reduce episodes of hypoglycemia
and thus reduces its side effects. As well as reduce hyperglycemic
complications such as sternal wound infection. Trial registration number:
IRCT2013041713052N1). 2013-07-09.<br/>Copyright &#xa9; 2020, The
Author(s).

<56>
Accession Number
2004101424
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. (no pagination), 2020.
Date of Publication: 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
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This article aimed to compare the outcomes after hybrid
revascularization with conventional coronary artery bypass grafting (CABG)
surgery. <br/>Background(s): 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. <br/>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 2 years. <br/>Result(s):
Clinical and anatomical characteristics were similar between groups. After
a mean follow-up of 802 +/- 500 days, 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. <br/>Conclusion(s): Hybrid
myocardial was feasible but associated with increasing rates of major
adverse cardiovascular events during 2 years 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.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<57>
Accession Number
2004628600
Title
Randomized Clinical Trial of Surgical vs. Percutaneous vs. Hybrid
Revascularization in Multivessel Coronary Artery Disease: Residual
Myocardial Ischemia and Clinical Outcomes at One Year - Hybrid coronary
REvascularization Versus Stenting or Surgery (HREVS).
Source
Journal of Interventional Cardiology. 2020 (no pagination), 2020. Article
Number: 5458064. Date of Publication: 2020.
Author
Ganyukov V.; Kochergin N.; Shilov A.; Tarasov R.; Skupien J.; Szot W.;
Kokov A.; Popov V.; Kozyrin K.; Barbarash O.; Barbarash L.; Musialek P.
Institution
(Ganyukov, Kochergin, Shilov, Tarasov, Kokov, Kozyrin, Barbarash,
Barbarash) Federal State Budgetary Institution research Institute for
Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
(Skupien, Szot, Musialek) Jagiellonian University School of Medicine,
Krakow, Poland
(Szot) Dept. of Nuclear Medicine, John Paul II Hospital, Krakow, Poland
(Popov) Federal State Budgetary Institution A. V. Vishnevsky Institute of
Surgery, Moscow, Russian Federation
(Musialek) Jagiellonian University Dept. of Cardiac and Vascular Diseases,
John Paul II Hospital, Krakow, Poland
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Aim. Optimal revascularization strategy in multivessel (MV) coronary
artery disease (CAD) eligible for percutaneous management (PCI) and
surgery remains unresolved. We evaluated, in a randomized clinical trial,
residual myocardial ischemia (RI) and clinical outcomes of MV-CAD
revascularization using coronary artery bypass grafting (CABG), hybrid
coronary revascularization (HCR), or MV-PCI. Methods. Consecutive MV-CAD
patients (n = 155) were randomized (1: 1: 1) to conventional CABG
(LIMA-LAD plus venous grafts) or HCR (MIDCAB LIMA-LAD followed by PCI for
remaining vessels) or MV-PCI (everolimus-eluting CoCr stents) under Heart
Team agreement on equal technical and clinical feasibility of each
strategy. SPECT at 12 months (primary endpoint of RI that the trial was
powered for; a measure of revascularization midterm efficacy and an
independent predictor of long-term prognosis) preceded routine
angiographic control. Results. Data are given, respectively, for the CABG,
HCR, and MV-PCI arms. Incomplete revascularization rate was 8.0% vs. 7.7%
vs. 5.7% (p=0.71). Hospital stay was 13.8 vs. 13.5 vs. 4.5 days (p<0.001),
and sick-leave duration was 23 vs. 16 vs. 8 weeks (p<0.001). At 12 months,
RI was 5 (2, 9)% vs. 5 (3, 7)% vs. 6 (3, 10)% (median; Q1, Q3) with
noninferiority p values of 0.0006 (HCR vs. CABG) and 0.016 (MV-PCI vs.
CABG). Rates of angiographic graft stenosis/occlusion or in-segment
restenosis were 20.4% vs. 8.2% vs. 5.9% (p=0.05). Clinical target
vessel/graft failure occurred in 12.0% vs. 11.5% vs. 11.3% (p=0.62). Major
adverse cardiac and cerebral event (MACCE) rate was similar (12% vs. 13.4%
vs. 13.2%; p=0.83). Conclusion. In this first randomized controlled study
comparing CABG, HCR, and MV-PCI, residual myocardial ischemia and MACCE
were similar at 12 months. There was no midterm indication of any added
value of HCR. Hospital stay and sick-leave duration were shortest with
MV-PCI. While longer-term follow-up is warranted, these findings may
impact patient and physician choices and healthcare resources utilization.
This trial is registered with NCT01699048.<br/>Copyright &#xa9; 2020
Vladimir Ganyukov et al.

<58>
Accession Number
2003557397
Title
Impact of Aortic Atherosclerosis Burden on Outcomes of Surgical Aortic
Valve Replacement.
Source
Annals of Thoracic Surgery. 109 (2) (pp 465-471), 2020. Date of
Publication: February 2020.
Author
Iribarne A.; Pan S.; McCullough J.N.; Mathew J.P.; Hung J.; Zeng X.;
Voisine P.; O'Gara P.T.; Sledz N.M.; Gelijns A.C.; Taddei-Peters W.C.;
Messe S.R.; Moskowitz A.J.; Thourani V.H.; Argenziano M.; Groh M.A.;
Giustino G.; Overbey J.R.; DiMaio J.M.; Smith P.K.
Institution
(Iribarne, McCullough) Section of Cardiac Surgery, Dartmouth-Hitchcock
Medical Center, New Hampshire, Lebanon
(Pan, Sledz, Gelijns, Moskowitz, Giustino, Overbey) Department of
Population Health Science & Policy, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Mathew) Division of Cardiothoracic Anesthesiology, Duke University
Medical Center, Durham, NC, United States
(Hung, Zeng) Division of Cardiology, Massachusetts General Hospital,
Boston, MA, United States
(Voisine) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Quebec, Quebec, Canada
(O'Gara) Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
MA, United States
(Taddei-Peters) Division of Cardiovascular Sciences, National Heart, Lung,
and Blood Institute, Bethesda, MD, United States
(Messe) Department of Neurology, Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, United States
(Thourani) Department of Cardiac Surgery, MedStar Heart and Vascular
Institute, Washington, DC, United States
(Argenziano) Division of Cardiothoracic Surgery, Department of Surgery,
New York-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Groh) Cardiovascular and Thoracic Surgery, Mission Health and Hospitals,
Asheville, NC, United States
(DiMaio) Department of Cardiothoracic Surgery, The Heart Hospital Baylor
Plano, Baylor Scott & White Health, Plano, TX, United States
(Smith) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke University Medical Center, Durham, NC, United States
Publisher
Elsevier USA
Abstract
Background: Epiaortic ultrasound detects and localizes ascending aortic
atherosclerosis. In this analysis we investigated the association between
epiaortic ultrasound-based atheroma grade during surgical aortic valve
replacement (SAVR) and perioperative adverse outcomes. <br/>Method(s):
SAVR patients in a randomized trial of 2 embolic protection devices
underwent a protocol-defined 5-view epiaortic ultrasound read at a core
laboratory. Aortic atherosclerosis was quantified with the Katz atheroma
grade, and patients were categorized as mild (grade I-II) or
moderate/severe (grade III-V). Multivariable logistic regression was used
to estimate associations between atheroma grade and adverse outcomes,
including death, clinically apparent stroke, cerebral infarction on
diffusion-weighted magnetic resonance imaging, delirium, and acute kidney
injury (AKI) by 7 and 30 days. <br/>Result(s): Precannulation epiaortic
ultrasound data were available for 326 of 383 randomized patients (85.1%).
Of these, 106 (32.5%) had moderate/severe Katz atheroma grade at any
segment of the ascending aorta. Although differences in the composite of
death, stroke, or cerebral infarction on diffusion-weighted magnetic
resonance imaging by 7 days were not statistically significant,
moderate/severe atheroma grade was associated with a greater risk of AKI
by 7 days (adjusted odds ratio, 2.63; 95% confidence interval, 1.24-5.58;
P = .01). At 30 days, patients with moderate/severe atheroma grade had a
greater risk of death, stroke, or AKI (adjusted odds ratio, 1.97; 95%
confidence interval, 1.04-3.71; P = .04). <br/>Conclusion(s):
Moderate/severe aortic atherosclerosis was associated with an increased
risk of adverse events after SAVR. Epiaortic ultrasound may serve as a
useful adjunct for identifying patients who may benefit from strategies to
reduce atheroembolic complications during SAVR.<br/>Copyright &#xa9; 2020
The Society of Thoracic Surgeons

<59>
Accession Number
630647300
Title
An original backup technique to assess the correct positioning of
right-sided double-lumen tubes without fiberoptic bronchoscopy: A pilot
feasibility study.
Source
Annals of Cardiac Anaesthesia. 23 (1) (pp 75-79), 2020. Date of
Publication: January-March 2020.
Author
Khalifa C.; Fossoul S.; Momeni M.; Lacroix V.; Watremez C.
Institution
(Khalifa, Momeni, Watremez) Department of Anesthesiology, Cliniques
Universitaires Saint-Luc, Hippocrate Avenue, Brussels 10-1200, Belgium
(Fossoul) Department of Acute and Emergency Medicine, Cliniques
Universitaires Saint-Luc, Brussels, Belgium
(Lacroix) Department of Cardiothoracic and Vascular Surgery, Cliniques
Universitaires Saint-Luc, Brussels, Belgium
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Accurate positioning of a right-sided double-lumen tube is
essential but challenging due to the location and the potential
obstruction of the right upper lobe bronchus. Fiberoptic bronchoscopy is,
therefore, necessary but requires a specific training period for the
anesthesiologist and might not always be available. <br/>Objective(s): We
describe an original backup technique to assess the correct placement of
these tubes in cases a fiberopetic bronchoscopy is lacking.
<br/>Design(s): Prospective pilot feasibility study with 10 adult patients
scheduled for a left thoracic surgery. <br/>Setting(s): Operating theater
in a universitary hospital. <br/>Material(s) and Method(s): The new
technique uses a fluoroscopy and an adult central venous catheter wire.
The time needed to perform the new technique, its success rate and its
efficacy in properly exclude the left lung were evaluated. Any oxygen
desaturation episode (SpO<inf>2</inf> <90%) was considered. The technique
was performed by two anesthesiologists with different experience in
thoracic anesthesia. <br/>Result(s): The success rate of our technique was
90%, which did not depend on the anesthesiologist's experience. The range
of time to successfully place the tube in the dorsal decubitus position
and subsequently in the right lateral decubitus position was respectively
1 min-6 min and 1 min-15 min. None of the patients presented any
desaturation episodes. <br/>Conclusion(s): We describe an original, safe,
and acceptable backup technique to properly insert right-sided
double-lumen endobronchial tubes, whenever a fiberoptic bronchoscopy is
not available. Moreover, this technique is easy enough to be performed by
anesthesiologists with limited experience in thoracic
anesthesia.<br/>Copyright &#xa9; 2020 Annals of Cardiac Anaesthesia <br/>
Published by Wolters Kluwer - Medknow.

<60>
Accession Number
630647257
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: January-March 2020.
Author
Verma S.; Srinivas U.; Sathpathy A.; Mittal P.
Institution
(Verma, Srinivas, Sathpathy, Mittal) Department of Anaesthesia, Apollo
Hospital, CTOT, International Block, First Floor Jubilee Hills, Hyderabad,
Telangana, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
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. <br/>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. <br/>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.
<br/>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. <br/>Conclusion(s): Tranexamic
acid significantly reduced postoperative bleeding in off-pump CABG at 24
hours as compared to epsilon-amino-caproic-acid.<br/>Copyright &#xa9; 2020
Annals of Cardiac Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<61>
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&#32;g/kg bodyweight)
compared to blinded-NT patients (n = 119, 6.14 micro&#32;g/kg bodyweight)
(adjusted robust mean difference 1.71 (95% CI 0.33-3.10) micro&#32;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.<br/>Copyright &#xa9; 2019,
Springer Nature B.V.

<62>
Accession Number
630568712
Title
A controlled trial of rivaroxaban after transcatheter aortic-valve
replacement.
Source
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, Giustino, Kini, Mehran) Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicine, Mount Sinai, NY, United States
(Dangas) National and Kapodistrian University of Athens, Athens, Greece
(Tijssen) Amsterdam University Medical Centers-University of Amsterdam,
Amsterdam, Netherlands
(Tijssen, Guimaraes, van Amsterdam) Cardialysis, Academic Research
Organization, Rotterdam, Netherlands
(Wohrle, Seeger) Department of Internal Medicine II, University of Ulm,
Ulm, Germany
(Mollmann) Department of Internal Medicine I, St. Johannes Hospital
Dortmund, Dortmund, Germany
(Baldus) Department of Internal Medicine III, Heart Center, University
Hospital of Cologne, Cologne, Germany
(Schafer) Department of General and Interventional Cardiology, University
Hospital Hamburg-Eppendorf, Hamburg, Germany
(Thomitzek) Bayer, Berlin, Germany
(Sondergaard, de Backer) Heart Center, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Gilard) La Cavale Blanche University Hospital, Cardiology Department,
Brest, France
(Tchetche) Clinique Pasteur, Toulouse, France
(Makkar) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
United States
(Herrmann) University of Pennsylvania, Philadelphia, United States
(Gullestad) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Institute of Clinical Medicine, University of Oslo, Oslo,
Norway
(von Lewinski) Department of Cardiology, Medical University of Graz, Graz,
Austria
(Mack) Baylor Scott and White Health, Temple, TX, United States
(Moreno) Department of Cardiology, University Hospital of La Paz, Hospital
La Paz Institute for Health Research, Madrid, Spain
(Valgimigli, Windecker) Department of Cardiology, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Faculty of Medicine and Life Sciences, University of Hasselt,
Hasselt, Belgium
(Welsh) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
(Wildgoose, Volkl) Janssen Pharmaceuticals, Titusville, NJ, United States
(Zazula) Bayer, Sao Paulo, Brazil
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Whether the direct factor Xa inhibitor rivaroxaban can prevent
thromboembolic events after transcatheter aortic-valve replacement (TAVR)
is unclear. METHODS 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. RESULTS 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).
CONCLUSIONS 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.<br/>Copyright &#xa9; 2019 Massachusetts
Medical Society.

<63>
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. <br/>Method(s): The impact of TOE on surgical
decision-making was estimated through a systematic literature review.
Individual short-term morbidity and mortality estimates were generated by
application of the Society of Thoracic Surgeons risk calculator. Long-term
event rates, unit costs, and utility weights were sourced from published
literature and expert opinion. A discrete-event simulation model was then
constructed to simulate both the in-hospital and post-discharge outcomes
for patients undergoing cardiac surgery. Robustness of the base case
results was examined through deterministic and probabilistic sensitivity
analyses. An incremental cost-effectiveness ratio of 30 000 per
quality-adjusted life-year gained was assumed to represent acceptable
cost-effectiveness. <br/>Result(s): Routine use of intraoperative TOE was
associated with lower costs and higher benefits per patient, which
indicates that use of TOE is a dominant strategy. The intervention
resulted in the avoidance of 299 cardiac complications, 20 strokes, and 11
all-cause deaths per 10 000 patients. Routine intraoperative TOE was
associated with an increased occurrence of bleeding owing to more valvular
surgery and subsequent long-term anticoagulation. <br/>Conclusion(s):
Routine intraoperative TOE is a cost-effective procedure for patients
undergoing cardiac surgery, leading to lower overall costs. It was
associated with a decrease in long-term complications including stroke,
cardiac complications, and death, although there was a slight increase in
extracranial bleeding events.<br/>Copyright &#xa9; 2019 British Journal of
Anaesthesia

<64>
Accession Number
2004644782
Title
Meta-analysis Comparing Direct Oral Anticoagulants Versus Vitamin K
Antagonists After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Ueyama H.; Kuno T.; Ando T.; Briasoulis A.; Fox J.; Hayashida K.; Takagi
H.
Institution
(Ueyama, Kuno) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Beth Israel, New York, NY, United States
(Ando) Division of Cardiology, Center for Interventional Vascular Therapy,
New York-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Briasoulis) Division of Cardiology, Heart failure, and Transplantation,
University of Iowa, Iowa city, IA, United States
(Fox) Division of Cardiology, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
(Hayashida) Division of Cardiology, Keio University School of Medicine,
Tokyo, Japan
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Atrial fibrillation (AF) is a common co-morbidity in patients undergoing
transcatheter aortic valve implantation (TAVI), but whether direct oral
anticoagulants (DOACs) confer similar safety and efficacy compared with
vitamin K antagonist (VKA) remains unclear in this population. The aim of
our study was to investigate the safety and efficacy of DOACs compared
with VKA in patients undergoing TAVI with concomitant indication of oral
anticoagulation. PUBMED and EMBASE were searched through October 2019 for
studies comparing DOACs versus VKA in patients undergoing TAVI with
indication of oral anticoagulation. The main efficacy outcomes were
all-cause mortality and stroke whereas the main safety outcome was major
and/or life-threatening bleeding. Our search identified 5 eligible studies
including 2,569 patients. Majority of patients had atrial fibrillation as
indication of anticoagulation. There were no significant differences in
all-cause mortality, major and/or life-threatening bleeding, and stroke in
patients treated with DOACs versus VKA (odds ratio [OR] 1.07, 95%
confidence interval [CI] [0.73 to 1.57], p = 0.72, OR = 0.85, 95% CI [0.64
to 1.12], p = 0.24, OR 1.52, 95% CI [0.93 to 2.48], p = 0.09,
respectively). In conclusion, in patients undergoing TAVI with concomitant
indication for oral anticoagulation, all-cause mortality, major and/or
life-threatening bleeding, and stroke were similar between DOACs and VKA.
Further large scale randomized controlled trials are needed to search the
optimal oral anticoagulation regimen in this population.<br/>Copyright
&#xa9; 2020 Elsevier Inc.

<65>
Accession Number
630677266
Title
Global longitudinal strain assessment of the left ventricle by speckle
tracking echocardiography detects acute cellular rejection in orthotopic
heart transplant recipients: A systematic review and meta-analysis.
Source
Echocardiography (Mount Kisco, N.Y.). (no pagination), 2020. Date of
Publication: 22 Jan 2020.
Author
Elkaryoni A.; Altibi A.M.; Khan M.S.; Okasha O.; Ellakany K.; Hassan A.;
Singh A.; Qarajeh R.; Mehta S.; Nanda N.C.
Institution
(Elkaryoni, Okasha, Singh, Qarajeh, Mehta) Division of Internal Medicine,
University of Missouri Kansas City, Kansas City, MO, USA
(Altibi) Division of Internal Medicine, Henry Ford Allegiance Health, MI,
Detroit, United States
(Altibi) Harvard T.H. Chan School of Public Health, Harvard University,
MA, Boston, United States
(Khan) Division of Internal Medicine, John H Stroger Jr Hospital of Cook
County, Chicago, United States
(Ellakany) Division of Cardiovascular Disease, University of Alexandria
School of medicine, Alexandria, Egypt
(Hassan) Divison of Internal Medicine, University of Iowa Hospitals and
Clinics, IA, Iowa City, United States
(Nanda) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, USA
Publisher
NLM (Medline)
Abstract
BACKGROUND: In orthotopic heart transplant recipients, surveillance with
endomyocardial biopsy is crucial to detect acute cellular rejection (ACR)
early. ACR is a common and serious complication of transplantation with
substantial morbidity and mortality. Speckle tracking echocardiography
with global longitudinal strain (GLS) assessment of the left ventricle has
emerged as a possible noninvasive screening modality. We have conducted a
systematic literature review and meta-analysis to evaluate the role of GLS
in diagnosing ACR. <br/>METHOD(S): The following databases were queried:
PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus,
and Embase. We compiled all articles evaluating changes in GLS in
comparison to endomyocardial biopsy in ACR dated prior to September 2019.
Weighted mean differences (WMD) and 95% confidence intervals (CIs) were
pooled by using a random effects model. In order to determine the risk of
bias, we used the revised version of the Quality Assessment of Diagnostic
Accuracy Studies (QUADAS-2) tool. <br/>RESULT(S): Twelve studies met
inclusion criteria of which ten were chosen. These studies encompassed 511
patients and 1267 endomyocardial biopsies. There was a significant
difference in GLS between patients who did and did not have ACR proven by
biopsy (WMD = 2.18; 95% CI: 1.57-2.78, P = <.001; I2 = 76%). The overall
sensitivity for GLS in detecting ACR was 78% (CI: 63%-90%, P = .123; I2 =
52.2%) while the overall specificity was 68% (CI: 50%-83%, P = <.001; I2 =
88.3%). <br/>CONCLUSION(S): Global longitudinal strain assessment of the
left ventricle by speckle tracking echocardiography is useful in detecting
ACR and could potentially reduce the burden of frequent endomyocardial
biopsies in heart transplant recipients.<br/>Copyright &#xa9; 2020 Wiley
Periodicals, Inc.

<66>
Accession Number
630695820
Title
Relaxin Positively Influences Ischemia-Reperfusion Injury in Solid Organ
Transplantation: A Comprehensive Review.
Source
International journal of molecular sciences. 21 (2) (no pagination), 2020.
Date of Publication: 17 Jan 2020.
Author
Jakubauskiene L.; Jakubauskas M.; Leber B.; Strupas K.; Stiegler P.;
Schemmer P.
Institution
(Jakubauskiene, Jakubauskas, Leber, Stiegler, Schemmer) General, Visceral
and Transplant Surgery, Department of Surgery, Medical University of Graz,
Graz 8036, Austria
(Jakubauskiene, Jakubauskas, Strupas) Faculty of Medicine, Vilnius
University, Vilnius 03101, Lithuania
Publisher
NLM (Medline)
Abstract
In recent decades, solid organ transplantation (SOT) has increased the
survival and quality of life for patients with end-stage organ failure by
providing a potentially long-term treatment option. Although the
availability of organs for transplantation has increased throughout the
years, the demand greatly outweighs the supply. One possible solution for
this problem is to extend the potential donor pool by using extended
criteria donors. However, organs from such donors are more prone to
ischemia reperfusion injury (IRI) resulting in higher rates of delayed
graft function, acute and chronic graft rejection and worse overall SOT
outcomes. This can be overcome by further investigating donor
preconditioning strategies, graft perfusion and storage and by finding
novel therapeutic agents that could reduce IRI. relaxin (RLX) is a peptide
hormone with antifibrotic, antioxidant, anti-inflammatory and
cytoprotective properties. The main research until now focused on heart
failure; however, several preclinical studies showed its potentials for
reducing IRI in SOT. The aim of this comprehensive review is to overview
currently available literature on the possible role of RLX in reducing IRI
and its positive impact on SOT.

<67>
Accession Number
2003914641
Title
Vascular Complications after Transfemoral Transcatheter Aortic Valve
Implantation: A Systematic Review and Meta-Analysis.
Source
Structural Heart. 4 (1) (pp 62-71), 2020. Date of Publication: 02 Jan
2020.
Author
Rahhab Z.; Ramdat Misier K.; El Faquir N.; Kroon H.; Ziviello F.; Kardys
I.; Daemen J.; De Jaegere P.; Reardon M.J.; Popma J.; Van Mieghem N.M.
Institution
(Rahhab, Ramdat Misier, El Faquir, Kroon, Ziviello, Kardys, Daemen, De
Jaegere, Van Mieghem) Department of Cardiology, Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Reardon) Department of Cardiovascular Surgery, Houston Methodist
Hospital, Houston, TX, United States
(Popma) Department of Cardiology, Beth Israel Deaconess Medical Center,
Harvard University, Boston, MA, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Vascular complications (VCs) after transcatheter aortic valve
implantation (TAVI) are associated with impaired outcome. We performed a
meta-analysis to determine in-hospital/30-day major VCs rate after
transfemoral-TAVI adjudicated by an independent clinical-event-committee,
and to compare the major VCs rate with regard to consecutive generations
of balloon-expandable and self-expanding platforms, device profile,
experience and patient risk-profile. <br/>Method(s): A systematic,
computerized search with predefined criteria was performed in PubMed,
Embase and Cochrane on March 27, 2018. The overall pooled proportion of VC
was calculated using a random-effects model. Subgroups were examined based
on sheath size, STS-score and start-date of inclusion (early (< January
2012); late-phase (>= January 2012) studies). <br/>Result(s): A total of
24 studies with 14308 patients were included. The pooled major VCs rate
was 7.71% and was lower in low-profile vs. high-profile device studies
(5.51% vs. 8.46%, p = 0.0015). Major VCs rate decreased significantly with
transition to newer generation balloon-expandable valves ((Sapien vs.
Sapien XT (15.18% vs. 8.48%, p < 0.00001); Sapien XT vs. Sapien 3 (8.48%
vs. 4.48%, p = 0.005)) and there was a tendency towards fewer major VCs in
EvolutR vs. CoreValve (5.98% vs. 7.97%, p = 0.094). Major VC rate was
lower in late-phase vs. early-phase studies (5.82% vs. 7.84%, p = 0.048)
and a tendency towards a lower rate was seen in intermediate vs. high-risk
studies (7.09% vs. 9.62%, p = 0.059). <br/>Conclusion(s): The pooled rate
of independently adjudicated major VCs after transfemoral-TAVI was 7.71%.
Experience and device profile are associated with fewer major
VCs.<br/>Copyright &#xa9; 2019, &#xa9; 2019 The Author(s). Published with
license by Taylor & Francis Group, LLC.

<68>
Accession Number
2004621435
Title
Percutaneous coronary angioplasty versus coronary artery bypass grafting
in the treatment of unprotected left main stenosis: updated 5-year
outcomes from the randomised, non-inferiority NOBLE trial.
Source
The Lancet. 395 (10219) (pp 191-199), 2020. Date of Publication: 18 - 24
January 2020.
Author
Holm N.R.; Makikallio T.; Lindsay M.M.; Spence M.S.; Erglis A.; Menown
I.B.A.; Trovik T.; Kalinauskas G.; Nielsen P.H.; Niemela M.; Lassen J.F.;
Oldroyd K.; Stradins P.; Walsh S.J.; Graham A.N.J.; Endresen P.C.; Frobert
O.; Trivedi U.; Hildick-Smith D.; Thuesen L.; Christiansen E.H.; Lindsay
M.; Eskola M.; Romppanen H.; Kellerth T.; Jensen L.O.; Linder R.B.A.;
Pentikainen M.; Hervold A.; Banning A.; Zaman A.; Cotton J.; Eriksen E.;
Margus S.; Mogensen L.J.H.; Kervinen K.; Berg G.; Hanratty C.G.; Kumsars
I.; Steigen T.K.; Graham A.N.; Corbascio M.; Kajander O.; Hartikainen J.;
Anttila V.
Institution
(Holm, Mogensen, Christiansen) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Nielsen) Department of Cardiac Surgery, Aarhus University Hospital,
Aarhus, Denmark
(Makikallio, Niemela) Department of Cardiology, Oulu University Hospital,
Oulu, Finland
(Anttila) Department of Cardiac Surgery, Oulu University Hospital, Oulu,
Finland
(Lindsay, Oldroyd) Department of Cardiology, Golden Jubilee National
Hospital, Clydebank, United Kingdom
(Berg) Department of Cardiac Surgery, Golden Jubilee National Hospital,
Clydebank, United Kingdom
(Spence, Walsh, Graham) Belfast Heart Centre, Belfast Trust, Belfast,
United Kingdom
(Erglis, Stradins) Latvia Centre of Cardiology, Paul Stradins Clinical
Hospital, Riga, Latvia
(Menown) Craigavon Cardiac Centre, Craigavon, United Kingdom
(Trovik) Department of Cardiology, University Hospital of North Norway,
Tromso, Norway
(Endresen) Department of Cardiovascular Surgery, University Hospital of
North Norway, Tromso, Norway
(Kellerth, Frobert) Department of Cardiology, Faculty of Health, Orebro
University, Orebro, Sweden
(Kalinauskas) Vilnius University, Clinic of Cardiac and Vascular Diseases,
Vilnius, Lithuania
(Lassen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Trivedi, Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex
University Hospital, Brighton, United Kingdom
(Thuesen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Percutaneous coronary intervention (PCI) is increasingly used
in revascularisation of patients with left main coronary artery disease in
place of the standard treatment, coronary artery bypass grafting (CABG).
The NOBLE trial aimed to evaluate whether PCI was non-inferior to CABG in
the treatment of left main coronary artery disease and reported outcomes
after a median follow-up of 3.1 years. We now report updated 5-year
outcomes of the trial. <br/>Method(s): The prospective, randomised,
open-label, non-inferiority NOBLE trial was done at 36 hospitals in nine
northern European countries. Patients with left main coronary artery
disease requiring revascularisation were enrolled and randomly assigned
(1:1) to receive PCI or CABG. The primary endpoint was major adverse
cardiac or cerebrovascular events (MACCE), a composite of all-cause
mortality, non-procedural myocardial infarction, repeat revascularisation,
and stroke. Non-inferiority of PCI to CABG was defined as the upper limit
of the 95% CI of the hazard ratio (HR) not exceeding 1.35 after 275 MACCE
had occurred. Secondary endpoints included all-cause mortality,
non-procedural myocardial infarction, and repeat revascularisation.
Outcomes were analysed in the intention-to-treat population. This trial is
registered with ClinicalTrials.gov, NCT01496651. <br/>Finding(s): Between
Dec 9, 2008, and Jan 21, 2015, 1201 patients were enrolled and allocated
to PCI (n=598) or CABG (n=603), with 17 subsequently lost to early
follow-up. 592 patients in each group were included in this analysis. At a
median of 4.9 years of follow-up, the predefined number of events was
reached for adequate power to assess the primary endpoint. Kaplan-Meier
5-year estimates of MACCE were 28% (165 events) for PCI and 19% (110
events) for CABG (HR 1.58 [95% CI 1.24-2.01]); the HR exceeded the limit
for non-inferiority of PCI compared to CABG. CABG was found to be superior
to PCI for the primary composite endpoint (p=0.0002). All-cause mortality
was estimated in 9% after PCI versus 9% after CABG (HR 1.08 [95% CI
0.74-1.59]; p=0.68); non-procedural myocardial infarction was estimated in
8% after PCI versus 3% after CABG (HR 2.99 [95% CI 1.66-5.39]; p=0.0002);
and repeat revascularisation was estimated in 17% after PCI versus 10%
after CABG (HR 1.73 [95% CI 1.25-2.40]; p=0.0009). <br/>Interpretation(s):
In revascularisation of left main coronary artery disease, PCI was
associated with an inferior clinical outcome at 5 years compared with
CABG. Mortality was similar after the two procedures but patients treated
with PCI had higher rates of non-procedural myocardial infarction and
repeat revascularisation. <br/>Funding(s): Biosensors.<br/>Copyright
&#xa9; 2020 Elsevier Ltd

<69>
Accession Number
2004065819
Title
Clinical and radiological outcome of non-surgical management of thoracic
and lumbar spinal fracture-dislocations - a historical analysis in the era
of modern spinal surgery.
Source
Journal of Spinal Cord Medicine. 43 (1) (pp 3-9), 2020. Date of
Publication: 02 Jan 2020.
Author
Joaquim A.F.; Schroeder G.D.; Patel A.A.; Vaccaro A.R.
Institution
(Joaquim) Neurosurgery Division, State University of Campinas,
Campinas-SP, Brazil
(Schroeder, Vaccaro) Department of Orthopaedic Surgery and Neurosurgery at
Thomas Jefferson University, Philadelphia, PA, United States
(Patel) Department of Orthopaedic Surgery, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Context: It is well established that traumatic spinal dislocations (AO
Type C injuries) should be surgically treated. However, no recent
comparative study of surgical versus non-surgical management of type C
injuries was found attesting the superiority of surgical treatment.
<br/>Objective(s): Due to the lack of information about the natural
history of non-surgical management of type C injuries, we evaluated the
outcome of historical conservative treatment of type C injuries.
<br/>Method(s): An extensive manual search of articles was performed in
the Pubmed Database. We included articles that reported the clinical and/
or the radiological outcome of non-surgical management of thoracic and/ or
lumbar spinal fracture-dislocations. <br/>Result(s): Three well described
retrospective studies where fracture-dislocations of the thoracolumbar
spine were managed non-surgically were included. Non-surgical management
typically consisted in postural reduction and prolonged bed rest (about
10-13 weeks on average). Residual deformity was common, and some studies
reported a high rate of post treatment pain syndromes. Some studies
reported surgery for gibbus deformity after conservative treatment or
persistent instability requiring further bed rest. Neurological
deterioration was rare, and some patients had some improvement, although
the vast majority of the patients had persistent, severe neurological
deficits. <br/>Conclusion(s): Compared with historical non-surgical care,
surgery for type C injuries decreases the chances of post-operative pain,
late spinal deformity and also allowed early rehabilitation, once no bed
restriction is necessary. Ethical issues based on this historical analysis
may preclude performing a comparative study of non-surgical versus
surgical management of these injuries in the modern spine
era.<br/>Copyright &#xa9; 2018, &#xa9; The Academy of Spinal Cord Injury
Professionals, Inc. 2018.

<70>
[Use Link to view the full text]
Accession Number
630628734
Title
Cardiac complications in systemic sclerosis: Early diagnosis and
treatment.
Source
Chinese Medical Journal. 132 (23) (pp 2865-2871), 2019. Date of
Publication: 05 Dec 2019.
Author
Nie L.-Y.; Wang X.-D.; Zhang T.; Xue J.
Institution
(Nie, Wang, Zhang, Xue) Department of Rheumatology, Second Affiliated
Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang
310009, China
(Wang) Department of Rheumatology, People's Hospital of Lishui, Lishui,
Zhejiang 323000, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective:Systemic sclerosis (SSc) is a remarkably systemic heterogeneous
connective tissue disease with many organs involved. The heart is one of
the major organs involved, carrying the threat of sudden cardiac death,
especially in diffuse cutaneous SSc. This review summarizes the
pathophysiology, types, new diagnostic approaches, and imaging and novel
therapies of primary cardiac complications while underlining the effects
of recently developed non-contrast cardiovascular magnetic resonance (CMR)
in early diagnosis.Data sources:Medline and Embase were searched for
articles published up to July 2019. A combination of Medical Subject
Headings (MeSH) terms and keywords pertaining to SSc ("Scleroderma,
Systemic" OR "Systemic sclerosis" OR" SSc"), AND cardiology ("cardiology"
OR "heart" OR "cardiac") were applied to the search strategies.Study
selection:Literature was mainly printed in English and Chinese about
cardiac complications in systemic sclerosis. After selected simply on the
title and abstract, the articles were included for the full text. Article
type was not limited. <br/>Result(s):Relevant cardiac manifestations are
complex, including arrhythmias, pericardial effusion, myocardial
dysfunction, and valvular diseases. Even though the symptoms of cardiac
complications are well known, unfortunately, they appear to be poor
prognostic factors. As systemic sclerosis with cardiac complications has a
high mortality rate and patients might have a poor quality of life, it is
essential to promote early diagnosis and treatment. With the advent of
non-invasive imaging techniques, such as CMR, early diagnosis of cardiac
complications in SSc is becoming more effective.
<br/>Conclusion(s):Cardiac complications play an essential role in SSc and
carry the threat of sudden cardiac death. More basic and clinical studies
are warranted to develop better management of cardiac involvement in
patients with SSc.<br/>Copyright &#xa9; 2019 The Chinese Medical
Association, produced by Wolters Kluwer, Inc.

<71>
Accession Number
629526609
Title
High-Sensitivity Cardiac Troponin and the Universal Definition of
Myocardial Infarction.
Source
Circulation. 141 (3) (pp 161-171), 2020. Date of Publication: 21 Jan 2020.
Author
Chapman A.R.; Adamson P.D.; Shah A.S.V.; Anand A.; Strachan F.E.; Ferry
A.V.; Ken Lee K.; Berry C.; Findlay I.; Cruikshank A.; Reid A.; Gray A.;
Collinson P.O.; Apple F.; McAllister D.A.; Maguire D.; Fox K.A.A.;
Vallejos C.A.; Keerie C.; Weir C.J.; Newby D.E.; Mills N.L.
Institution
(Chapman, Adamson, Shah, Anand, Strachan, Ferry, Ken Lee, Fox, Newby,
Mills) BHF Centre for Cardiovascular Science (A.R.C., A.A., D.E.N.,
University of Edinburgh, F.E.S, United Kingdom
(Adamson) Christchurch Heart Institute, University of Otago
(Berry) Institute of Cardiovascular and Medical Sciences (C.B.),
University of Glasgow, United Kingdom
(Findlay) Department of Cardiology, Royal Alexandra Hospital, United
Kingdom (I.F.), Paisley
(Cruikshank, Reid) Department of Biochemistry, Queen Elizabeth University
Hospital, United Kingdom (A.C., Glasgow
(Gray) Emergency Medicine Research Group Edinburgh, Royal Infirmary of
Edinburgh, United Kingdom (A.G.)
(Collinson) Departments of Clinical Blood Sciences and Cardiology,
University Hospitals NHS Trust and St George's University of London,
United Kingdom (P.O.C.), St George's
(Apple) Department of Laboratory Medicine and Pathology, Hennepin
Healthcare/Hennepin County Medical Center & University of Minnesota,
Minneapolis (F.A.)
(McAllister) Institute of Health and Wellbeing (D.A.McA.), University of
Glasgow, United Kingdom
(Maguire) Emergency Medicine Department, United Kingdom (D.M), Glasgow
Royal Infirmary
(Vallejos) MRC Human Genetics Unit (C.A.V.), University of Edinburgh,
United Kingdom
(Vallejos) Alan Turing Institute, United Kingdom (C.A.V.), London
(Keerie, Weir) Edinburgh Clinical Trials Unit (C.K., University of
Edinburgh, United Kingdom
(Keerie, Weir, Mills) Usher Institute of Population Health Sciences and
Informatics (C.K., University of Edinburgh, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: The introduction of more sensitive cardiac troponin assays has
led to increased recognition of myocardial injury in acute illnesses other
than acute coronary syndrome. The Universal Definition of Myocardial
Infarction recommends high-sensitivity cardiac troponin testing and
classification of patients with myocardial injury based on pathogenesis,
but the clinical implications of implementing this guideline are not well
understood. <br/>METHOD(S): In a stepped-wedge cluster randomized,
controlled trial, we implemented a high-sensitivity cardiac troponin assay
and the recommendations of the Universal Definition in 48282 consecutive
patients with suspected acute coronary syndrome. In a prespecified
secondary analysis, we compared the primary outcome of myocardial
infarction or cardiovascular death and secondary outcome of
noncardiovascular death at 1 year across diagnostic categories.
<br/>RESULT(S): Implementation increased the diagnosis of type 1
myocardial infarction by 11% (510/4471), type 2 myocardial infarction by
22% (205/916), and acute and chronic myocardial injury by 36% (443/1233)
and 43% (389/898), respectively. Compared with those without myocardial
injury, the rate of the primary outcome was highest in those with type 1
myocardial infarction (cause-specific hazard ratio [HR] 5.64 [95% CI,
5.12-6.22]), but was similar across diagnostic categories, whereas
noncardiovascular deaths were highest in those with acute myocardial
injury (cause specific HR 2.65 [95% CI, 2.33-3.01]). Despite modest
increases in antiplatelet therapy and coronary revascularization after
implementation in patients with type 1 myocardial infarction, the primary
outcome was unchanged (cause specific HR 1.00 [95% CI, 0.82-1.21]).
Increased recognition of type 2 myocardial infarction and myocardial
injury did not lead to changes in investigation, treatment or outcomes.
<br/>CONCLUSION(S): Implementation of high-sensitivity cardiac troponin
assays and the recommendations of the Universal Definition of Myocardial
Infarction identified patients at high-risk of cardiovascular and
noncardiovascular events but was not associated with consistent increases
in treatment or improved outcomes. Trials of secondary prevention are
urgently required to determine whether this risk is modifiable in patients
without type 1 myocardial infarction. CLINICAL TRIAL REGISTRATION:
https://www.clinicaltrials.gov. Unique identifier: NCT01852123.

<72>
[Use Link to view the full text]
Accession Number
627451196
Title
Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in
Surgical Patients: Results From a Systematic Review and Meta-analysis.
Source
Anesthesia and analgesia. 128 (5) (pp 981-992), 2019. Date of Publication:
01 May 2019.
Author
Cho B.C.; Serini J.; Zorrilla-Vaca A.; Scott M.J.; Gehrie E.A.; Frank
S.M.; Grant M.C.
Institution
(Cho, Frank, Grant) From the Department of Anesthesiology/Critical Care
Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States
(Serini) Department of Anesthesiology/Critical Care Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, United States
(Zorrilla-Vaca) Universidad del Valle School of Medicine, Cali, Columbia
(Scott) Department of Anesthesiology, Virginia Commonwealth University
School of Medicine, Richmond, VA
(Gehrie) Departments of Pathology
(Gehrie) Surgery, Johns Hopkins Medical Institutions, Baltimore, MD,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Erythropoietic-stimulating agents such as erythropoietin have
been used as part of patient blood management programs to reduce or even
avoid the use of allogeneic blood transfusions. We review the literature
to evaluate the effect of preoperative erythropoietin use on the risk of
exposure to perioperative allogeneic blood transfusions. <br/>METHOD(S):
The study involved a systematic review and meta-analysis of randomized
controlled trials evaluating the use of preoperative erythropoietin. The
primary outcome was the reported incidence of allogeneic red blood cell
transfusions during inpatient hospitalizations. Secondary outcomes
included phase-specific allogeneic red blood cell transfusions (ie,
intraoperative, postoperative), intraoperative estimated blood loss,
perioperative hemoglobin levels, length of stay, and thromboembolic
events. <br/>RESULT(S): A total of 32 randomized controlled trials (n =
4750 patients) were included, comparing preoperative erythropoietin (n =
2482 patients) to placebo (n = 2268 patients). Preoperative erythropoietin
is associated with a significant decrease in incidence of allogeneic blood
transfusions among all patients (n = 28 studies; risk ratio, 0.59; 95% CI,
0.47-0.73; P < .001) as well as patients undergoing cardiac (n = 9
studies; risk ratio, 0.55; 95% CI, 0.37-0.81; P = .003) and elective
orthopedic (n = 5 studies; risk ratio, 0.36; 95% CI, 0.28-0.46; P < .001)
surgery compared to placebo, respectively. Preoperative erythropoietin was
also associated with fewer phase-specific red blood cell transfusions.
There was no difference between groups in incidence of thromboembolic
events (n = 28 studies; risk ratio, 1.02; 95% CI, 0.78-1.33; P = .68).
<br/>CONCLUSION(S): Preoperative erythropoietin is associated with a
significant reduction in perioperative allogeneic blood transfusions. This
finding is also confirmed among the subset of patients undergoing cardiac
and orthopedic surgery. Furthermore, our study demonstrates no significant
increase in risk of thromboembolic complications with preoperative
erythropoietin administration.

<73>
[Use Link to view the full text]
Accession Number
630671423
Title
Prognostic Significance of Left Ventricular Noncompaction: Systematic
Review and Meta-Analysis of Observational Studies.
Source
Circulation. Cardiovascular imaging. 13 (1) (pp e009712), 2020. Date of
Publication: 01 Jan 2020.
Author
Aung N.; Doimo S.; Ricci F.; Sanghvi M.M.; Pedrosa C.; Woodbridge S.P.;
Al-Balah A.; Zemrak F.; Khanji M.Y.; Munroe P.B.; Naci H.; Petersen S.E.
Institution
(Aung, Sanghvi, Pedrosa, Woodbridge, Zemrak, Khanji, Munroe, Petersen)
William Harvey Research Institute, NIHR Cardiovascular Biomedical Research
Centre at Barts, Queen Mary University of London, United Kingdom (N.A.,
M.M.S., C.P., S.P.W., Charterhouse Square
(Aung, Sanghvi, Zemrak, Khanji, Munroe, Petersen) Barts Heart Centre, St
Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London,
United Kingdom (N.A., M.M.S., F.Z., M.Y.K., P.B.M., S.E.P.)
(Doimo) Cardiovascular Department, Azienda Sanitaria Universitaria
Integrata, University of Trieste
(Ricci) Department of Neuroscience, Imaging and Clinical Sciences,
Institute of Advanced Biomedical Technologies, "G. d'Annunzio" University,
Chieti, Italy
(Al-Balah) Imperial College London, United Kingdom (A.A.-B.), Kensington,
United States
(Munroe) Clinical Pharmacology, William Harvey Research Institute, Queen
Mary University of London, United Kingdom (P.B.M.), Barts and The London
School of Medicine and Dentistry
(Naci) Department of Health Policy, London School of Economics and
Political Science, United Kingdom (H.N.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although left ventricular noncompaction (LVNC) has been
associated with an increased risk of adverse cardiovascular events, the
accurate incidence of cardiovascular morbidity and mortality is unknown.
We, therefore, aimed to assess the incidence rate of LVNC-related
cardiovascular events. <br/>METHOD(S): We systematically searched
observational studies reporting the adverse outcomes related to LVNC. The
primary end point was cardiovascular mortality. <br/>RESULT(S): We
identified 28 eligible studies enrolling 2501 LVNC patients (mean age, 46
years; male/female ratio, 1.7). After a median follow-up of 2.9 years, the
pooled event rate for cardiovascular mortality was 1.92 (95% CI,
1.54-2.30) per 100 person-years. LVNC patients had a similar risk of
cardiovascular mortality compared with a dilated cardiomyopathy control
group (odds ratio, 1.10 [95% CI, 0.18-6.67]). The incidence rates of
all-cause mortality, stroke and systemic emboli, heart failure admission,
cardiac transplantation, ventricular arrhythmias, and cardiac device
implantation were 2.16, 1.54, 3.53, 1.24, 2.17, and 2.66, respectively,
per 100 person-years. Meta-regression and subgroup analyses revealed that
left ventricular ejection fraction, not the extent of left ventricular
trabeculation, had an important influence on the variability of incidence
rates. The risks of thromboembolism and ventricular arrhythmias in LVNC
patients were similar to dilated cardiomyopathy patients. However, LVNC
patients had a higher incidence of heart failure hospitalization than
dilated cardiomyopathy patients. <br/>CONCLUSION(S): Patients with LVNC
carry a similar cardiovascular risk when compared with dilated
cardiomyopathy patients. Left ventricular ejection fraction-a conventional
indicator of heart failure severity, not the extent of
trabeculation-appears to be an important determinant of adverse outcomes
in LVNC patients. Registration: https://www.crd.york.ac.uk/PROSPERO/
Unique identifier: CRD42018096313.

<74>
Accession Number
630667033
Title
Association of Clinical Outcomes with Left Ventricular Assist Device Use
by Bridge to Transplant or Destination Therapy Intent: The Multicenter
Study of MagLev Technology in Patients Undergoing Mechanical Circulatory
Support Therapy with HeartMate 3 (MOMENTUM 3) Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Goldstein D.J.; Naka Y.; Horstmanshof D.; Ravichandran A.K.; Schroder J.;
Ransom J.; Itoh A.; Uriel N.; Cleveland J.C.; Raval N.Y.; Cogswell R.;
Suarez E.E.; Lowes B.D.; Kim G.; Bonde P.; Sheikh F.H.; Sood P.; Farrar
D.J.; Mehra M.R.
Institution
(Goldstein) Montefiore Einstein Center for Heart and Vascular Care, New
York, NY, United States
(Naka, Uriel) Columbia University College of Physicians, New
York-Presbyterian Hospital, New York, United States
(Horstmanshof) Integris Baptist Medical Center, Oklahoma City, OK, United
States
(Ravichandran) St Vincent Heart Center, Indianapolis, IN, United States
(Schroder) Duke University Medical Center, Durham, NC, United States
(Ransom) Baptist Health Medical Center, Little Rock, AR, United States
(Itoh) Washington University School of Medicine, St Louis, MO, United
States
(Cleveland) University of Colorado School of Medicine, Aurora, United
States
(Raval) Advent Health Transplant Institute, Orlando, FL, United States
(Cogswell) University of Minnesota, Minneapolis, United States
(Suarez) Houston Methodist Hospital, Houston, TX, United States
(Lowes) University of Nebraska Medical Center, Omaha, United States
(Kim) Pritzker School of Medicine, University of Chicago, Chicago, IL,
United States
(Kim) University of Chicago Medical Center, Chicago, IL, United States
(Bonde) Yale Medical School, New Haven, CT, United States
(Sheikh) MedStar Washington Hospital Center, Washington, DC, United States
(Sood, Farrar) Abbott Laboratories, Abbott Park, IL, United States
(Mehra) Heart and Vascular Center, Brigham AndWomen's Hospital, 75 Francis
St, Boston, MA 02115, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Left ventricular assist devices (LVADs) are well established
in the treatment of advanced heart failure, but it is unclear whether
outcomes are different based on the intended goal of therapy in patients
who are eligible vs ineligible for heart transplant. <br/>Objective(s): To
determine whether clinical outcomes in the Multicenter Study of MagLev
Technology in Patients Undergoing Mechanical Circulatory Support Therapy
With HeartMate 3 (MOMENTUM 3) trial differed by preoperative categories of
bridge to transplant (BTT) or bridge to transplant candidacy (BTC) vs
destination therapy (DT). <br/>Design, Setting, and Participant(s): This
study was a prespecified secondary analysis of the MOMENTUM 3 trial, a
multicenter randomized clinical trial comparing the magnetically levitated
centrifugal-flow HeartMate 3 (HM3) LVAD to the axial-flow HeartMate II
(HMII) pump. It was conducted in 69 centers with expertise in managing
patients with advanced heart failure in the United States. Patients with
advanced heart failure were randomized to an LVAD, irrespective of the
intended goal of therapy (BTT/BTC or DT). <br/>Main Outcomes and Measures:
The primary end point was survival free of disabling stroke or reoperation
to remove or replace a malfunctioning device at 2 years. Secondary end
points included adverse events, functional status, and quality of life.
<br/>Result(s): Of the 1020 patients with implants (515 with HM3 devices
[50.5%] and 505 with HMII devices [49.5%]), 396 (38.8%) were in the
BTT/BTC group (mean [SD] age, 55 [12] years; 310 men [78.3%]) and 624
(61.2%) in the DT group (mean [SD] age, 63 [12] years; 513 men [82.2%]).
Of the patients initially deemed as transplant ineligible, 84 of 624
patients (13.5%) underwent heart transplant within 2 years of LVAD
implant. In the primary end point analysis, HM3 use was superior to HMII
use in patients in the BTT/BTC group (76.8% vs 67.3% for survival free of
disabling stroke and reoperation; hazard ratio, 0.62 [95% CI, 0.40-0.94];
log-rank P =.02) and patients in the DT group (73.2% vs 58.7%; hazard
ratio, 0.61 [95% CI, 0.46-0.81]; log-rank P <.001). For patients in both
BTT/BTC and DT groups, there were not significantly different reductions
in rates of pump thrombosis, stroke, and gastrointestinal bleeding with
HM3 use relative to HMII use. Improvements in quality of life and
functional capacity for either pump were not significantly different
regardless of preimplant strategy. <br/>Conclusions and Relevance: In this
trial, the superior treatment effect of HM3 over HMII was similar for
patients in the BTT/BTC or DT groups. It is possible that use of arbitrary
categorizations based on current or future transplant eligibility should
be clinically abandoned in favor of a single preimplant strategy: To
extend the survival and improve the quality of life of patients with
medically refractory heart failure. Trial Registration: ClinicalTrials.gov
identifier: NCT02224755.<br/>Copyright &#xa9; 2019 BMJ Publishing Group.
All rights reserved.