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

<2>
Accession Number
2003385963
Title
Secukinumab dosing optimization in patients with moderate-to-severe plaque
psoriasis: results from the randomized, open-label OPTIMISE study.
Source
British Journal of Dermatology. 182 (2) (pp 304-315), 2020. Date of
Publication: 01 Feb 2020.
Author
Reich K.; Puig L.; Szepietowski J.C.; Paul C.; Lacour J.P.; Tsianakas A.;
Sieder C.; Rissler M.; Pournara E.; Orsenigo R.
Institution
(Reich) Institute for Health Services Research in Dermatology and Nursing,
University Medical Center Hamburg-Eppendorf, Skinflammation Center,
Hamburg, Germany
(Reich) Dermatologikum Berlin, Berlin, Germany
(Puig) Department of Dermatology, Hospital de la Santa Creu i Sant Pau,
Universitat Autonoma de Barcelona, Barcelona, Spain
(Szepietowski) Department of Dermatology, Venereology and Allergology,
Wroclaw Medical University, Wroclaw, Poland
(Paul) Department of Dermatology, Toulouse University and Larrey Hospital,
Toulouse, France
(Lacour) Hopital Archet, CHU de Nice, Nice, France
(Tsianakas) University of Munster, Munster, Germany
(Sieder) Novartis Pharma GmbH, Nuremberg, Germany
(Rissler, Pournara) Novartis Pharma AG, Basel, Switzerland
(Orsenigo) Novartis Farma SpA, Origgio, Italy
Publisher
Blackwell Publishing Ltd
Abstract
Background: Secukinumab is a fully human monoclonal antibody that
selectively binds to and neutralizes interleukin-17A. <br/>Objective(s):
To assess the efficacy and safety of different maintenance dosing regimens
of secukinumab 300 mg based on Psoriasis Area and Severity Index (PASI)
response at week 24 in patients with moderate-to-severe plaque psoriasis.
<br/>Method(s): OPTIMISE was a randomized, open-label, rater-blinded phase
IIIb study. Patients (n = 1647) received secukinumab 300 mg at baseline;
weeks 1, 2, 3 and 4; and every 4 weeks (q4w) to week 24. At week 24, PASI
90 responders (>= 90% improvement in PASI; n = 1306) were randomized to
secukinumab 300 mg q4w (n = 644) or q6w (n = 662) to week 52, and PASI >=
75 to < 90 responders (n = 206) were randomized to secukinumab 300 mg q4w
(n = 114) or q2w (n = 92) to week 52. <br/>Result(s): PASI 90 response was
maintained at week 52 by 85.7% of patients with q4w dosing vs. 74.9% with
q6w dosing (odds ratio 1.91, 95% confidence interval 1.44-2.55). The
primary end point, noninferiority of q6w vs. q4w dosing, was not met. In
PASI >= 75 to < 90 responders, the proportion of patients with PASI 90
response at week 52 was numerically higher in the q2w vs. the q4w group
(57% vs. 46.5%, respectively, P = 0.10). Heavier patients (>= 90 kg)
demonstrated numerically higher PASI 90 response with the q2w (57.1%) vs.
the q4w regimen (40%, P = 0.11). <br/>Conclusion(s): Standard q4w dosing
of secukinumab 300 mg is the optimal dosing regimen to achieve and
maintain clear or almost clear skin. Patients with body weight >= 90 kg
not achieving PASI 90 at week 24 may benefit from the q2w dosing regimen.
What's already known about this topic?. Individual responses to biologics
in patients with psoriasis vary considerably and there may be a need to
individualize treatment. Dose optimization strategies of currently
available biologic drugs have been investigated mainly in rheumatic
disorders. Secukinumab has shown long-term PASI 90/100 responses
(percentage improvement in Psoriasis Area and Severity Index) to year 5 in
patients with moderate-to-severe plaque psoriasis when used at the dose of
300 mg every 4 weeks. What does this study add?. Standard every 4 week
(q4w) dosing of secukinumab 300 mg is the optimal regimen to achieve and
maintain clear or almost clear skin at week 52; the majority of the
patients (85.7%) maintain PASI 90 at week 52. Superiority of intensified
(q2w) dosing over the q4w regimen could not be claimed. However, patients
with a higher body weight (>= 90 kg) not achieving PASI 90 response at
week 24 may benefit from q2w dosing.<br/>Copyright &#xa9; 2019 British
Association of Dermatologists

<3>
Accession Number
624056737
Title
The role of robotics in cardiac surgery: a systematic review.
Source
Journal of Robotic Surgery. 13 (1) (pp 41-52), 2019. Date of Publication:
11 Feb 2019.
Author
Doulamis I.P.; Spartalis E.; Machairas N.; Schizas D.; Patsouras D.;
Spartalis M.; Tsilimigras D.I.; Moris D.; Iliopoulos D.C.; Tzani A.;
Dimitroulis D.; Nikiteas N.I.
Institution
(Doulamis, Spartalis, Patsouras, Tsilimigras, Iliopoulos, Tzani, Nikiteas)
Laboratory for Experimental Surgery and Surgical Research "N.S Christeas",
Athens Medical School, National and Kapodistrian University of Athens,
Agiou Thoma Str, 11b, Goudi, Athens 11527, Greece
(Doulamis, Spartalis, Machairas, Schizas, Patsouras, Dimitroulis,
Nikiteas) Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study
Group, Athens, Greece
(Machairas) 3rd Department of Surgery, Attikon University Hospital,
National and Kapodistrian University of Athens, Medical School, Athens,
Greece
(Schizas) 1st Department of Surgery, National and Kapodistrian University
of Athens, Medical School, Athens, Greece
(Spartalis) Division of Cardiology, Onassis Cardiac Surgery Center,
Athens, Greece
(Moris) Department of Surgery, Duke University Medical Center, Durham, NC,
United States
(Dimitroulis) 2nd Department of Propaedeutic Surgery, National and
Kapodistrian University of Athens, Medical School, Athens, Greece
Publisher
Springer London
Abstract
The application of robotic technologies in cardiac surgery has provided
the possibility for minimally invasive access inside the thorax and
avoidance of a median sternotomy. Given that current evidence seems
promising, we sought to systematically review the existing literature
regarding the efficacy, feasibility and mortality rate associated with
robotic cardiac surgery. The PubMed and Cochrane bibliographical databases
were thoroughly searched for the following MeSH terms: "robotic", "cardiac
surgery" and "heart surgery". Original studies on robotic cardiac surgery
in more than ten cases and reporting on the associated peri- or
post-operative mortality were deemed eligible. Twenty-eight studies were
included and provided data for 5993 patients with a mean age of 59.8
years. Approximately, one out of two patients (49.2%) underwent robotic
CABG, while the other half (49.9%) underwent robotic MVR. Robotic atrial
septal defect repair and atrial tumor resection were performed in a small
proportion (0.9%) of the patients. Mean 30-day mortality was 0.7% ranging
from 0 to 0.8% among the different types of surgery, while late mortality
was 0.8% ranging from 0 to 1% with a mean follow-up period of 40.1 months.
Our findings demonstrate that the application of robotics in cardiac
surgery has provided a safe and efficacious alternative to the traditional
techniques. However, more trials are necessary to elucidate all of its
aspects.<br/>Copyright &#xa9; 2018, Springer-Verlag London Ltd., part of
Springer Nature.

<4>
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Accession Number
2004197896
Title
Magna Ease versus Trifecta Early Hemodynamics: A Systematic Review and
Meta-analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (4) (pp 267-272), 2018. Date of Publication: 01 Jul 2018.
Author
Yanagawa B.; Tam D.Y.; Hong K.; Mazine A.; Bagai A.; Shahbaz N.K.;
Ouzounian M.; Verma S.
Institution
(Yanagawa, Tam, Hong, Mazine, Shahbaz, Verma) Divisions of Cardiac
Surgery, University of Toronto, Toronto, ON, Canada
(Bagai) Divisions of Cardiology, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Ouzounian) Division of Cardiac Surgery, Toronto General Hospital,
Toronto, ON, Canada
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: This meta-analysis compares the early echocardiographic
outcomes of aortic valve replacement using the two most commonly implanted
stented bioprostheses. <br/>Method(s): We searched MEDLINE and EMBASE
databases until 2017 for studies comparing Magna or Magna Ease (Edwards
Lifesciences, Irvine, CA USA) versus Trifecta (St Jude Medical, St. Paul,
MN USA) aortic bioprosthetic valves. A random-effects meta-analysis was
performed for the primary outcome of mean gradient on echocardiography and
secondary outcomes of effective orifice area, indexed effective orifice
area, and in-hospital mortality. <br/>Result(s): There were two randomized
controlled trial, three matched, and six unmatched retrospective
observational studies with 2119 patients [median reported follow-up = 6
months (interquartile range = 6 to 12)]. The Magna/Magna Ease valve was
associated with higher early mean gradient (mean difference = 4.09, 95%
confidence interval = 3.48 to 4.69, P < 0.0001) and smaller effective
orifice area (mean difference = 0.30, 95% confidence interval = -0.38 to
-0.22, P < 0.0001). There were no differences in 30-day mortality between
Magna/Magna Ease and Trifecta (relative risk = 1.01, 95% confidence
interval = 0.41 to 2.50, P = 1.0). <br/>Conclusion(s): Trifecta may offer
a small hemodynamic advantage compared with the Magna/Magna Ease valve
with no differences in early mortality. Long-term follow-up is required to
determine whether these differences persist and translate into differences
in clinical outcomes.<br/>Copyright &#xa9; 2018 International Society for
Minimally Invasive Cardiothoracic Surgery.

<5>
Accession Number
2004868838
Title
Reduction of Inflammation by High-Dose Methylprednisolone Does not
Attenuate Oxidative Stress in Children Undergoing Bidirectional Glenn
Procedure With or Without Aortic Arch or Pulmonary Arterial Repair.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Keski-Nisula J.; Arvola O.; Jahnukainen T.; Andersson S.; Pesonen E.
Institution
(Keski-Nisula) Division of Anaesthesiology, Department of Anaesthesiology,
Intensive Care and Pain Medicine, Children's Hospital, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
(Arvola) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University School of Medicine, Stanford, CA, United States
(Jahnukainen) Department of Pediatric Nephrology and Transplantation,
Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Andersson) Department of Neonatology, Pediatric Research Center,
Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Pesonen) Division of Anaesthesiology, Department of Anaesthesiology,
Intensive Care and Pain Medicine, Kirurginen sairaala, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
Publisher
W.B. Saunders
Abstract
Objective: Corticosteroids attenuate an inflammatory reaction in pediatric
heart surgery. Inflammation is a source of free oxygen radicals. Children
with a cyanotic heart defect are prone to increased radical stress during
heart surgery. The authors hypothesized that high-dose methylprednisolone
reduces inflammatory reaction and thereby also oxidative stress in infants
with a univentricular heart defect undergoing the bidirectional Glenn
procedure. <br/>Design(s): A double-blind, placebo-controlled, randomized
clinical trial. <br/>Setting(s): Operating room and pediatric intensive
care unit of a university hospital. <br/>Participant(s): The study
comprised 29 infants undergoing the bidirectional Glenn procedure with or
without aortic arch or pulmonary arterial repair. <br/>Intervention(s):
After anesthesia induction, the patients received intravenously either 30
mg/kg of methylprednisolone (n = 15) or the same volume of saline as
placebo (n = 14). <br/>Measurements and Main Results: Plasma
interleukin-6, interleukin-8, interleukin-10 (biomarkers of inflammation),
and 8-hydroxydeoxyguanosine concentrations (a biomarker of oxidative
stress) were measured at the following 4 time points: preoperatively,
during cardiopulmonary bypass, after protamine administration, and 6 hours
postoperatively. The study parameters did not differ between the study
groups preoperatively. Methylprednisolone reduced the proinflammatory
cytokines interleukin-6 and interleukin-8 and increased the
anti-inflammatory cytokine interleukin-10 postoperatively. Despite reduced
inflammation, there were no differences in 8-hydroxydeoxyguanosine between
the methylprednisolone and placebo groups. <br/>Conclusion(s): The
proinflammatory reaction and increase in free radical stress were not
interrelated during congenital heart surgery in cyanotic infants with a
univentricular heart defect undergoing the bidirectional Glenn procedure.
High-dose methylprednisolone was ineffective in attenuating free radical
stress.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<6>
Accession Number
2004846084
Title
Lack of Association Between Gaseous Microembolisms Assessed by a Single
Detection Device and Cerebral Complications in Cardiac Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Wiberg S.; Vedel A.G.; Holmgaard F.; Kjaergaard J.; Langkilde A.R.;
Hassager C.; Steensgaard J.; Rasmussen L.S.; Nilsson J.-C.
Institution
(Wiberg, Kjaergaard, Hassager) Department of Cardiology, Copenhagen
University Hospital Rigshospitalet, Copenhagen, Denmark
(Vedel, Holmgaard, Steensgaard, Nilsson) Department of Cardiothoracic
Anesthesia, Copenhagen University Hospital Rigshospitalet, Copenhagen,
Denmark
(Langkilde) Department of Radiology, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Hassager, Rasmussen) Department of Clinical Medicine, University of
Copenhagen, Copenhagen, Denmark
(Rasmussen) Department of Anesthesia, Center of Head and Orthopedics,
Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Publisher
W.B. Saunders
Abstract
Objective: To assess the association between total volume and number of
gaseous microemboli (GME) in the cardiopulmonary bypass (CPB) circuit and
the occurrence of new postoperative cerebral infarctions and postoperative
cognitive dysfunction (POCD) in patients undergoing cardiac surgery.
<br/>Design(s): Predefined subanalyses of the randomized controlled
Perfusion Pressure Cerebral Infarcts (PPCI) trial. <br/>Setting(s):
Primary heart center in a university hospital. <br/>Participant(s): A
total of 143 adult patients undergoing cardiac surgery with CPB.
<br/>Intervention(s): Patients were allocated 1:1 to a low-target mean
arterial pressure (MAP) of 40 to 50 mmHg or a high-target MAP of 70 to 80
mmHg during CPB with a fixed pump flow of 2.4 liters per minute per square
meter body surface area plus 10% to 20%. <br/>Measurements and Main
Results: The total volume and number of GME in the CPB circuit were
assessed by the Bubble Counter Clinical 200 (GAMPT GmbH). New cerebral
infarcts were identified by diffusion-weighted magnetic resonance imaging
(DWI) 3 to 6 days after surgery. The median number of GME per patient was
8069 (range 1,523-204,095) with a median total volume of 1.2 muL (range
0.07-48 muL). A total of 66 (46%) patients had DWI detected cerebral
infarcts postoperatively, and 36 (28%) patients had POCD after 7 days. The
authors found no significant association between volume or number of GME
with MAP target allocation, presence of cerebral infarction, or POCD.
<br/>Conclusion(s): The authors found no significant associations between
volume or number of GME with the occurrence of cerebral infarction or
cognitive dysfunction in cardiac surgery patients.<br/>Copyright &#xa9;
2019 Elsevier Inc.

<7>
Accession Number
2002935782
Title
Critical appraisal on the impact of preoperative rehabilitation and
outcomes after major abdominal and cardiothoracic surgery: A systematic
review and meta-analysis.
Source
Surgery (United States). 167 (3) (pp 540-549), 2020. Date of Publication:
March 2020.
Author
Kamarajah S.K.; Bundred J.; Weblin J.; Tan B.H.L.
Institution
(Kamarajah) Institute of Cellular Medicine, University of Newcastle,
Newcastle-Upon-Tyne, United Kingdom
(Kamarajah) Department of Hepatobiliary, Pancreatic, and Transplant
Surgery, Freeman Hospital, Newcastle University Trust Hospitals,
Newcastle-Upon-Tyne, United Kingdom
(Bundred) College of Medical and Dental Sciences, University of
Birmingham, United Kingdom
(Weblin) Department of Physiotherapy, Queen Elizabeth Hospital Birmingham,
United Kingdom
(Tan) Department of Upper Gastrointestinal Surgery, Queen Elizabeth
Hospital Birmingham, United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: There has been increasing interest in the prehabilitation of
patients undergoing major abdominal surgery to improve perioperative
outcomes. This systematic review and meta-analysis aims to evaluate and
compare the current literature on prehabilitation in major abdominal
surgery and cardiothoracic surgery Methods: A systematic literature search
was conducted for studies reporting prehabilitation in patients undergoing
major abdominal and cardiothoracic surgery. Meta-analysis of postoperative
outcomes (overall and major complications, pulmonary and cardiac
complications, postoperative pneumonia, and length of hospital stay) was
performed using random effects models. <br/>Result(s): Five thousand nine
hundred and twenty-one patients underwent prehabilitation in 61 studies,
of which 35 studies (n = 3,402) were in major abdominal surgery and 26
studies were in cardiothoracic surgery (n = 2,519). Only 45 studies
compared the impact of prehabilitation versus no prehabilitation on
postoperative outcomes (abdominal, n = 26; cardiothoracic, n = 19).
Quality of evidence for prehabilitation in major abdominal and
cardiothoracic surgery appear equivalent. Patients receiving
prehabilitation for major abdominal surgery have significantly lower rates
of overall (n = 10, odds ratio: 0.61, confidence interval 95%: 0.43-0.86,
P = .005), pulmonary (n = 15, odds ratio: 0.41, confidence interval 95%:
0.25-0.67, P < .001), and cardiac complications (n = 4, odds ratio: 0.46,
confidence interval 95%: 0.22-0.96, P = .044). Sensitivity analysis
including randomized controlled trials only did not alter the findings of
this study. <br/>Conclusion(s): Prehabilitation has the potential to
improve surgical outcomes in patients undergoing major abdominal and
cardiothoracic surgery. However, current evidence from randomized studies
remains weak owing to variation in prehabilitation regimes, limiting the
assessment of current postoperative outcomes.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<8>
Accession Number
2002314631
Title
Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in
Patients with Functional Mitral Regurgitation and Heart Failure.
Source
Cardiovascular Revascularization Medicine. 21 (1) (pp 52-60), 2020. Date
of Publication: January 2020.
Author
Benito-Gonzalez T.; Estevez-Loureiro R.; Villablanca P.A.; Armeni P.;
Iglesias-Garriz I.; Minguito C.; Garrote C.; de Prado A.P.; Tundidor-Sanz
E.; Gualis J.; Fernandez-Vazquez F.
Institution
(Benito-Gonzalez, Estevez-Loureiro, Iglesias-Garriz, Minguito, Garrote, de
Prado, Tundidor-Sanz, Fernandez-Vazquez) Department of Cardiology,
University Hospital of Leon, Leon, Spain
(Villablanca) Department of Cardiology, Center for Structural Heart
Disease, Henry Ford Hospital, Detroit, United States
(Armeni) SDA Bocconi School of Management/CERGAS SDA Bocconi, Italy
(Gualis) Department of Cardiac Surgery, University Hospital of Leon, Leon,
Spain
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Functional mitral regurgitation (FMR) is a common finding
among patients with heart failure (HF) and it is related to adverse
events. Outcomes in patients undergoing transcatheter mitral valve repair
(TMVR) are still a matter of debate. We performed a meta-analysis to
assess mid- and long-term outcomes of patients with FMR treated with
MitraClip compared to medical management. <br/>Method(s): We conducted an
electronic database search of all published data PubMed Central, Embase,
the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov,
and Google Scholar databases. The primary end-point was all-cause
mortality. The secondary end-points were hospitalizations for HF, need for
heart transplantation or left ventricular assist device, unplanned mitral
valve surgery, myocardial infarction and stroke. <br/>Result(s): Five
studies (n = 1513 patients) were included in the analysis. The summary
estimate including all the available studies showed a statistically
significant reduction in all-cause mortality favoring MitraClip (HR 0.56,
CI 95% [0.38-0.84]) and HF hospitalizations (HR 0.65; CI 95% [0.46-0.92]).
A significant reduction in the indication for advanced HF therapies (OR
0.48; CI 95% [0.25-0.90]) or the need for unplanned mitral valve surgery
(OR 0.20; CI 95% [0.07-0.57]) was also found in the group of patients that
underwent TMVR. No differences in the incidence of myocardial infarction
or stroke were found between both groups of treatment. No publication bias
was detected. <br/>Conclusion(s): TMVR with MitraClip system was related
to a significant reduction in all-cause mortality, hospitalizations for HF
and the need for HF transplant, left ventricular assist device or
unplanned surgery beyond 1-year follow up.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<9>
Accession Number
625395478
Title
Outcome postponement as a potential patient centred measure of therapeutic
benefit: examples in cardiovascular medicine.
Source
Acta Cardiologica. (no pagination), 2018. Date of Publication: 2018.
Author
Ennezat P.V.; Le Jemtel T.; Cosgrove S.; Hallas J.; Hansen M.R.
Institution
(Ennezat) Centre Hospitalier Regional Universitaire Grenoble-Alpes,
Service de Cardiologie, Grenoble, France
(Le Jemtel) Tulane School of Medicine, Tulane University Heart and
Vascular Institute, New Orleans, LA, United States
(Cosgrove) Mater Misericordiae University Hospital, Dublin, Ireland
(Hallas, Hansen) Department of Clinical Pharmacology and Pharmacy,
University of Southern Denmark, Odense, Denmark
(Hallas, Hansen) Department of Clinical Biochemistry and Pharmacology,
Odense University Hospital, Odense, Denmark
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background: The impact of randomised controlled trials (RCTs) depends
heavily on the presentation of the findings. <br/>Objective(s):
Classically, RCT findings are presented in the form of absolute risk
reduction (ARR), number needed to treat (NNT) to prevent one adverse
outcome, and relative risk reduction (RRR) or hazard ratio (the most
favourable means for drug marketing). However, the estimation of average
survival gain (i.e. outcome postponement between a trial intervention and
comparator) is an alternative and informative means of presenting the
findings of RCTs. Study selection: Recent cardiovascular RCTs evaluating
ezetimibe added to simvastatin, evolocumab, canakinumab, ticagrelor,
rivaroxaban, ivabradine, LCZ 696 (sacubitril/valsartan), and transfemoral
aortic valve replacement are analysed and discussed. <br/>Finding(s): The
average survival gains ranged between 4.9 days on a composite end point
with ticagrelor versus clopidogrel in randomised patients with acute
coronary syndrome and 117 days of life expectancy obtained with TAVR
versus standard therapy in patients with severe aortic stenosis deemed
ineligible for surgery. <br/>Conclusion(s): Using outcome postponement as
an additional measure of treatment effect is likely to be more easily
understood than hazard ratio or RRR by both patients and physicians and
could help when evaluating drugs.<br/>Copyright &#xa9; 2018, &#xa9; 2018
Belgian Society of Cardiology.

<10>
Accession Number
626026884
Title
Previous coronary artery bypass graft is not associated with higher
mortality in transcatheter aortic valve replacement: systemic review and
meta-analysis.
Source
Acta Cardiologica. (no pagination), 2018. Date of Publication: 2018.
Author
Prasitlumkum N.; Kewcharoen J.; Kanitsoraphan C.; Rattanawong P.;
Mekritthikrai R.; Gillaspie E.A.; Mao M.A.; Cheungpasitporn W.
Institution
(Prasitlumkum, Kewcharoen, Kanitsoraphan, Rattanawong, Mekritthikrai)
Internal Medicine Residency Program, University of Hawaii, Honolulu, HI,
United States
(Rattanawong) Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
(Gillaspie) Department of Thoracic Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Mao) Division of Internal Medicine, Mayo Clinic, Rochester, MN, United
States
(Cheungpasitporn) Department of Medicine, University of Mississippi
Medical Center, Jackson, MS, United States
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Introduction: Patients with previous coronary artery bypass graft (CABG)
are usually considered as high-risk groups perioperatively. Recent studies
suggest that previous CABG is not associated with mortality in patients
with severe aortic stenosis (AS) who underwent transcatheter aortic valve
replacement (TAVR). However, systematic review and meta-analysis of the
literature has not been done. Thus, we conducted this systematic review
and meta-analysis to assess the association between previous CABG and
mortality in patients undergoing TAVR. <br/>Method(s): We comprehensively
searched the databases of MEDLINE and EMBASE from inception to July 2018.
Included studies were published prospective or retrospective cohort
studies that evaluated the effects of previous CABG status on mortality
risk among patients undergoing TAVR. Data from each study were combined
using the random-effects, generic inverse variance method of DerSimonian
and Laird to calculate risk ratios and 95% confidence intervals.
<br/>Result(s): Eleven cohort studies from March 2010 to April 2018 were
included in this meta-analysis involving 7299 subjects with severe AS
undergoing TAVR (1890 with and 5409 without previous CABG). Previous CABG
was not associated with all-cause mortality (pooled risk ratio = 0.96, 95%
confidence interval: 0.80-1.16, p=.66, I²=21%) and
cardiovascular (CV) mortality (pooled risk ratio = 1.23, 95% confidence
interval: 0.64-2.39, p=.72, I²=35%). <br/>Conclusion(s):
Previous CABG is not associated with either all-cause mortality or CV
mortality in patients with severe AS undergoing TAVR. TAVR should be
considered as an alternative or first-line treatment option among severe
AS patient, regardless of previous CABG status.<br/>Copyright &#xa9; 2019,
&#xa9; 2019 Belgian Society of Cardiology.

<11>
Accession Number
630874462
Title
The impact of pre-existing peripheral artery disease on transcatheter
aortic valve implantation outcomes: A systematic review and meta-analysis.
Source
Giornale Italiano di Cardiologia. Conference: 40. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica - GISE 2019. Italy.
20 (10 Supplement 1) (pp e23), 2019. Date of Publication: 2019.
Author
Barioli A.; Ueshima D.; Fovino L.N.; D'Amico G.; Fabris T.; Fraccaro C.;
Pavei A.; Napodano M.; Brener S.J.; Tarantini G.
Institution
(Barioli, Ueshima, Fovino, D'Amico, Fabris, Fraccaro, Pavei, Napodano,
Tarantini) Department of Cardiac,Thoracic and Vascular Sciences,
University of Padua Medical School, Padova, Italy
(Brener) Cardiac Catheterization Laboratory, New York-Presbyterian
Brooklyn Methodist Hospital, Brooklin, New York, NY, United States
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Peripheral arterial disease (PAD) plays a decisive role in the
pre-interventional selection process of the optimal vascular access site
in patients undergoing transcatheter aortic valve implantation (TAVI).
However, the impact of PAD on mortality and vascular complications (VC) in
TAVI-treated patients remains unclear. Accordingly, we aimed to assess the
outcomes of patients with and without PAD undergoing TAVI, by performing a
meta-regression analysis. Methods. Studies published between January 2002
and March 2018 and reporting outcomes according to the presence of PAD in
TAVI patients were identified. Outcome measures analyzed were short-, mid-
and longterm mortality, and peri-procedural VC. The interaction between
sheath size and PAD on outcomes was also assessed. Results. A total of 26
studies (68,581 TAVI patients, of whom 17,326 with pre-procedural PAD)
were included in the analysis. Patients with PAD had higher risk of
mortality at short- (HR 1.36, 95% confidence interval [CI] 1.13-1.63, p =
0.0009), mid- (HR 1.18, 95% CI 1.08-1.30, p = 0.0005), and long-term (HR
1.36, 95% CI 1.24-1.48, p<0.0001) follow-up, and higher risk of VC (RR
1.55, 95% CI 1.27; 1.89, p < 0.0001). Moreover, the adoption of smaller
sheaths during TAVI procedures was associated with fewer VC both in PAD
and non-PAD patients, but the latter group had a more pronounced benefit.
Conclusions. Patients with pre-existent PAD are at increased risk of
allcause mortality and VC after TAVI. The adoption of smaller sheaths
during the procedure seems to be associated with fewer peri-procedural VC
both in PAD and non-PAD patients.

<12>
Accession Number
630874394
Title
TOCILIZUMAB: Is out of sight really out of mind?.
Source
Rheumatology Advances in Practice. Conference: 2019 Case-based Conference
of the British Society for Rheumatology. United Kingdom. 3 (Supplement 1)
(pp i13-i14), 2019. Date of Publication: September 2019.
Author
Khalid S.; Smith R.; Cole Z.
Institution
(Khalid, Smith, Cole) Rheumatology, Salisbury District Hospital,
Salisbury, United Kingdom
Publisher
Oxford University Press
Abstract
Introduction Giant cell arteritis (GCA) is the most common form of
vasculitis in adults with visual complications, in particular loss of
vision, constituting the most feared manifestation. Tocilizumab (TCZ), an
IL-6 receptor blocker, has been shown to induce lasting remission.
However, the optimal duration of treatment with tocilizumab and risk of
relapse once treatment is stopped, is currently unknown. We present an
unusual case of a patient with GCA who developed visual loss after
stopping a three year course of tocilizumab for surgical indications. Case
description A 73-year-old lady presented to her GP in 2011 with headache
and lower limb stiffness. At that time CRP was greater than 200 and ESR
was 126. The GP commenced her on high dose prednisolone with an excellent
response. A temporal artery biopsy was not done. She was then referred 14
months later to the rheumatology clinic due to bilateral hip pain and
difficulty weaning off steroids, with an increase in inflammatory markers
and return of symptoms, upon dose reduction. She was still on 30mg
prednisolone at the time of referral. Methotrexate was introduced as a
steroid sparing agent, but was stopped a few months later due to side
effects. In 2012, while on prednisolone, she developed avascular necrosis
of both hips requiring bilateral total hip replacements. An IFR was
granted to start TCZ in 2014. She remained well on it with good clinical
and serological response and eventually came off steroids completely in
2016. In July 2017, TCZ was stopped for aortic valve replacement for 4
months. This was then restarted at the beginning of December 2017. In
February 2018, she developed frontal headaches and PMR-like symptoms. CRP
was 2 and ESR 27 at this time. She was commenced on 15 mg daily of
prednisolone and TCZ was continued at 8mg/kg. Unfortunately, a few days
after her TCZ infusion, she was admitted to hospital with anterior
ischaemic optic neuropathy (AION) in the left eye, resulting in partial
blindness. Inflammatory markers were found to be completely normal.
Intravenous methyl prednisolone was commenced. The patient was referred to
a tertiary referral centre and TCZ 162 mg subcutaneously weekly was
commenced in combination with leflunomide while tapering the dose of
prednisolone. She is currently well with no new visual symptoms.
Discussion This is an unusual case as the patient developed AION whilst on
15 mg of prednisolone following cessation and then re-institution of
tocilizumab. The GiACTA trial showed that treatment with TCZ, while
extremely efficacious, did not prevent disease flares in all patients,
with 24% of patients in TCZ groups experiencing at least 1 or more disease
flares. The trial proposed that the flares might be attributable to Th-1
cells, which are not affected directly by IL-6 receptor blockade, and may
play an important role in some patients with GCA. Recently, the long-term
safety and maintenance of efficacy in GCA patients was assessed in a
2-year extension of the GiACTA trial. Among the 81 patients in the once
weekly TCZ arm, who were in clinical remission at week 52, 38 (47%)
maintained clinical remission through part 2. However, only 25 of these 38
patients (66%) were treatment-free (no TCZ and no glucocorticoid
treatment) at the end of the trial. Similarly, the risk of relapse after
discontinuation of TCZ in GCA was assessed in a study by Adler et al. 17
of 20 patients randomised to the TCZ treatment arm were in remission after
12 months. Only half stayed in clinical remission after cessation of TCZ.
No clinical or laboratory marker was found to be a reliable predictor of
relapse. These two studies show that the odds of relapse after
discontinuation are very high, as seen in our case. Furthermore, Adler et
al reported that the mean time to relapse was 6.3 months. This shows that
the risk of relapse is highest in the first few months, as is the case in
our patient. Key learning points The optimal strategies for monitoring
disease progress in GCA remain uncertain, and currently rely on assessing
clinical features and measuring inflammatory markers. However, this has
become even more challenging with the use of TCZ, which suppresses the
acute phase response via IL-6 receptor blockade. CRP and ESR remain low in
nearly all TCZ-treated patients who experience disease flares. This
underlines the importance of clinical assessment, particularly poignant
history-taking and clinical experience in assessing whether GCA activity
might be present. Clinicians should have a very low threshold for
suspecting a flare-up, as even the mildest of symptoms could be a
harbinger of a full blown flare. As discussed above, studies have shown
that effectively half the patients relapse after TCZ is discontinued and
most do so within the first few months. This emphasizes the need for
careful clinical observation during this time and immediate resumption of
treatment in those with new symptoms. Furthermore, it raises the
possibility that patients may need to be on TCZ long term and in certain
cases indefinitely, given the very high risk of recurrence once the
patient is off the drug. Further research and deeper understanding is
needed of the pathways that lead to a flare of GCA while on optimal
treatment. Finally, this case underscores the dire need for advances in
the development of clinically useful biomarkers to help monitor disease
activity and predict relapses in patients on TCZ. This case brings to
light the fact that AION is possible following cessation and
re-institution of tocilizumab. It is axiomatic that clinicians keep a
close eye on patients stopping TCZ after the NICE guideline 12 month
recommended course.

<13>
Accession Number
630874320
Source
Giornale Italiano di Cardiologia. Conference: 40. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica - GISE 2019. Italy.
20 (10 Supplement 1) (no pagination), 2019. Date of Publication: 2019.
Author
Anonymous
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
The proceedings contain 127 papers. The topics discussed include: a
less-invasive totally endovascular (LITE) technique for transfemoral
transcatheter aortic valve replacement; mid-term outcomes of transfemoral
transcatheter aortic valve implantation using the new generation acurate
NEO device: experience of a single center; the impact of pre-existing
peripheral artery disease on transcatheter aortic valve implantation
outcomes: a systematic review and meta- analysis; real world single-equip
proficiency evaluation of transchatheter aortic valve implantation;
systematic cerebral protection during TAVI: well spent or wasted time?;
valve-in-valve transcatheter aortic valve replacement in a patient with
late failure of a bioprosthetic bentall procedure; a case of aortic
complex rupture after transcatheter aortic valve implantation with acurate
NEO; incidence of acute kidney injury in patients undergoing transcatheter
aortic valve implantation: a novel parameter to choose the better valve?;
and coronary-pulmonary artery fistula arising from the left anterior
descending coronary artery draining into the pulmonary artery: a clinical
case and the state of the art.

<14>
Accession Number
630877981
Title
Identifying critically important cardiovascular outcomes for trials in
hemodialysis: an international survey with patients, caregivers and health
professionals.
Source
Nephrology, dialysis, transplantation : official publication of the
European Dialysis and Transplant Association - European Renal Association.
(no pagination), 2020. Date of Publication: 10 Feb 2020.
Author
O'Lone E.; Howell M.; Viecelli A.K.; Craig J.C.; Tong A.; Sautenet B.;
Herrington W.G.; Herzog C.A.; Jafar T.H.; Jardine M.; Krane V.; Levin A.;
Malyszko J.; Rocco M.V.; Strippoli G.; Tonelli M.; Wang A.Y.-M.; Wanner
C.; Zannad F.; Winkelmayer W.C.; Wheeler D.C.
Institution
(O'Lone, Howell, Tong, Strippoli) Sydney School of Public Health,
University of Sydney, NSW, Sydney, Australia
(O'Lone, Howell, Tong, Strippoli) Centre for Kidney Research, Children's
Hospital at Westmead, NSW, Sydney, Australia
(Viecelli) Department of Nephrology, Princess Alexandra Hospital,
Brisbane, Australia
(Viecelli) Australasian Kidney Trials Network, University of Queensland,
Brisbane, Australia
(Craig) College of Medicine and Health, Flinders University, SA, Adelaide,
Australia
(Sautenet) Department of Nephrology and Clinical Immunology, Tours
University, Tours, France
(Sautenet) Department of Nephrology-Hypertension, Dialysis, Renal
Transplantation, Tours Hospital, Tours, France
(Sautenet) ToursFrance
(Herrington) Nuffield Department of Population Health, University of
Oxford, Medical Research Council Population Health Research Unit, Clinical
Trial Service Unit and Epidemiological Studies Unit, Oxford, United
Kingdom
(Herzog) Department of Medicine, Division of Cardiology, Hennepin County
Medical Center, University of Minnesota, MN, Minneapolis, United States
(Jafar) Program in Health Services and Systems Research, Duke-NUS Graduate
Medical School, Singapore
(Jafar) Department of Renal Medicine, Singapore General Hospital,
Singapore
(Jafar) Department of Medicine, Section of Nephrology, Aga Khan
University, Karachi, Pakistan
(Jardine) George Institute for Global Health, NSW, Sydney, Australia
(Jardine) Concord Repatriation General Hospital, NSW, Sydney, Australia
(Krane, Wanner) Department of Medicine I, Division of Nephrology,
University Hospital, Wurzburg, Germany
(Levin) Division of Nephrology, University of British Columbia, Vancouver,
Canada
(Malyszko) Department of Nephrology, Dialysis and Internal Medicine Warsaw
Medical University, Warsaw, Poland
(Rocco) Wake Forest School of Medicine, Section on Nephrology,
Winston-Salem, United States
(Strippoli) Department of Emergency and Organ Transplantation, University
of Bari, Bari, Italy
(Strippoli) Medical Scientific Office, Diaverum Sweden AB, Lund, Sweden
(Strippoli) Diaverum Academy, Bari, Italy
(Tonelli) Department of Medicine, Division of Nephrology, University of
Calgary, AB, Calgary, Canada
(Wang) Department of Medicine, Queen Mary Hospital, University of Hong
Kong, Hong Kong, China
(Zannad) Universite de Lorraine, Inserm CIC 1433 and INI-CRCT, CHU, Nancy,
France
(Winkelmayer) Selzman Institute for Kidney Health, Section of Nephrology,
Baylor College of Medicine, TX, Houston
(Wheeler) Department of Renal Medicine, University College London, London,
United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiovascular disease (CVD) is a major contributor to
morbidity and mortality in people on hemodialysis (HD). Cardiovascular
outcomes are reported infrequently and inconsistently across trials in HD.
This study aimed to identify the priorities of patients/caregivers and
health professionals (HPs) for CVD outcomes to be incorporated into a core
outcome set reported in all HD trials. <br/>METHOD(S): In an international
online survey, participants rated the absolute importance of 10
cardiovascular outcomes (derived from a systematic review) on a 9-point
Likert scale, with 7-9 being critically important. The relative importance
was determined using a best-worst scale. Likert means, medians and
proportions and best-worst preference scores were calculated for each
outcome. Comments were thematically analyzed. <br/>RESULT(S): Participants
included 127 (19%) patients/caregivers and 549 (81%) HPs from 53
countries, of whom 530 (78%) completed the survey in English and 146 (22%)
in Chinese. All but one cardiovascular outcome ('valve replacement') was
rated as critically important (Likert 7-9) by all participants; 'sudden
cardiac death', 'heart attack', 'stroke' and 'heart failure' were all
rated at the top by patients/caregivers (median Likert score 9).
Patients/caregivers ranked the same four outcomes as the most important
outcomes with mean preference scores of 6.2 (95% confidence interval
4.8-7.5), 5.9 (4.6-7.2), 5.3 (4.0-6.6) and 4.9 (3.6-6.3), respectively.
The same four outcomes were ranked most highly by HPs. We identified five
themes underpinning the prioritization of outcomes: 'clinical equipoise
and potential for intervention', 'specific or attributable to HD',
'severity or impact on the quality of life', 'strengthen knowledge and
education', and 'inextricably linked burden and risk'. <br/>CONCLUSION(S):
Patients and HPs believe that all cardiovascular outcomes are of critical
importance but consistently identify sudden cardiac death, myocardial
infarction, stroke and heart failure as the most important outcomes to be
measured in all HD trials.<br/>Copyright &#xa9; The Author(s) 2020.
Published by Oxford University Press on behalf of ERA-EDTA. All rights
reserved.

<15>
Accession Number
630876952
Title
Extracorporeal membrane oxygenation without therapeutic anticoagulation in
adults: A systematic review of the current literature.
Source
The International journal of artificial organs. (pp 391398820904372),
2020. Date of Publication: 10 Feb 2020.
Author
Fina D.; Matteucci M.; Jiritano F.; Meani P.; Lo Coco V.; Kowalewski M.;
Maessen J.; Guazzi M.; Ballotta A.; Ranucci M.; Lorusso R.
Institution
(Fina, Ballotta, Ranucci) Department of Cardiovascular Anesthesia and ICU,
IRCCS Policlinico San Donato, Milan, Italy
(Fina, Matteucci, Jiritano, Meani, Lo Coco, Kowalewski, Maessen, Lorusso)
Department of Cardiothoracic Surgery, Maastricht University Medical
Centre, Maastricht, Netherlands
(Matteucci) Department of Cardiac Surgery, Circolo Hospital, University of
Insubria, Varese, Italy
(Jiritano) Department of Cardiac Surgery, Magna Graecia University of
Catanzaro, Catanzaro, Italy
(Kowalewski) Thoracic Research Centre, Nicolaus Copernicus University,
Collegium Medicum in Bydgoszcz, Innovative Medical Forum, Bydgoszcz,
Poland
(Guazzi) University of Milan, IRCCS Policlinico San Donato, Milan, Italy
(Lorusso) Cardiovascular Research Institute, Maastricht University,
Maastricht, Netherlands
Publisher
NLM (Medline)
Abstract
Extracorporeal membrane oxygenation is essential for the treatment of
refractory cardiopulmonary failure. Its use may be complicated by worse
haemorrhagic complications exacerbated by extracorporeal membrane
oxygenation-related therapeutic anticoagulation. Progressive technological
advancements have made extracorporeal membrane oxygenation components less
thrombogenic, potentially allowing its application with temporary
avoidance of systemic anticoagulants. A systematic review of all the
available experiences, reporting the use of extracorporeal membrane
oxygenation without systemic anticoagulation in the published literature
was performed. Only patient series were included, irrespective of the
clinical indication. The survival, extracorporeal membrane oxygenation
system-related dysfunction and complications rates, as well as in-hospital
outcome, were analysed. Six studies were selected for the analysis.
Veno-arterial extracorporeal membrane oxygenation was used in 84% of
patients, while veno-venous extracorporeal membrane oxygenation was
applied in the remaining cases. Anticoagulation was avoided because of the
high risk of bleeding after cardiac surgery (64%), active major bleeding
(23%) or presence of severe traumatic injury (9%). Duration of support
ranged from 0.3 to 1128h. Heparin was antagonized by protamine in all the
post-cardiotomy cases. Successfully extracorporeal membrane oxygenation
weaning was achieved in 74% of the treated cases, with a hospital
discharge of 58% of patients. Rates of extracorporeal membrane oxygenation
malfunctioning due to clot formation and blood transfusion requirement
varied remarkably in the published series. Extracorporeal membrane
oxygenation without systemic anticoagulation appears feasible in selected
circumstances. Further investigations are warranted to elucidate actual
aspects regarding extracorporeal membrane oxygenation system performance,
related adverse events and benefits associated with this management.

<16>
Accession Number
630876187
Title
Current Use and Trends in Unprotected Left Main Coronary Artery
Percutaneous Intervention.
Source
Current cardiology reports. 22 (4) (pp 16), 2020. Date of Publication: 08
Feb 2020.
Author
Nagarajarao H.S.; Ojha C.P.; Mulukutla V.; Ibrahim A.; Mares A.C.; Paul
T.K.
Institution
(Nagarajarao, Ojha, Ibrahim) Texas Tech University of Health Sciences, TX,
4800 Alberta Avenue, El Paso 79905, United States
(Mulukutla) University Medical Center, TX, El Paso, United States
(Mares) University of Texas at El Paso, TX, El Paso, United States
(Paul) East Tennessee State University, TN, Johnson City, United States
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: To review the clinical evidence on the use of
percutaneous coronary intervention (PCI) revascularization options in left
main (LM) disease in comparison with coronary artery bypass graft (CABG).
Coronary artery disease (CAD) involving the LM is associated with high
morbidity and mortality. Though CABG remains the gold standard for complex
CAD involving the LM artery, recent trials have shown a trend towards
non-inferiority of the LM PCI when compared with CABG in certain subset of
patients. RECENT FINDINGS: Two recent major randomized trials compared the
outcomes of PCI versus CABG in the LM and multi-vessel disease with LM
involvement. The NOBLE trial included patients with all range of Synergy
Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery
(SYNTAX) scores and utilized biolimus drug-eluting stent (DES). The trial
concluded that MACCE (major adverse cardiac and cerebrovascular event) was
significantly higher with PCI (28%) when compared with CABG (18%) but
overall stroke and motility were not different. EXCEL trial evaluated the
same treatment option in low to intermediate SYNTAX score population with
third-generation everolimus DES platform as PCI option. Results showed no
significant differences in the composite primary endpoints of death,
stroke, and myocardial infarction (MI) at the end of 30 days (22% versus
19.2%, p =0.13), although repeat revascularization was higher in PCI group
(16.9% versus 10%). Recent evidence suggests that PCI is an acceptable
alternative to treat symptomatic LM stenosis in select group of patients.
In low to medium SYNTAX score, particularly in patients without diabetes
mellitus, PCI remains a viable option. Future trials focusing on
evaluating subset of patients who would benefit from one particular
revascularization option in comparison with other is warranted.

<17>
Accession Number
630871983
Title
Biatrial vs. bicaval orthotopic heart transplantation: a systematic review
and meta-analysis.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 05 Feb 2020.
Author
Zijderhand C.F.; Veen K.M.; Caliskan K.; Schoonen T.; Mokhles M.M.;
Bekkers J.A.; Manintveld O.C.; Constantinescu A.A.; Brugts J.J.; Bogers
A.J.J.C.; Takkenberg J.J.M.
Institution
(Zijderhand, Veen, Schoonen, Mokhles, Bekkers, Bogers, Takkenberg)
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
(Caliskan, Manintveld, Constantinescu, Brugts) Department of Cardiology,
Erasmus MC, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Orthotopic heart transplantation (OHT) is the gold standard
treatment in end-stage heart disease. Controversy remains whether bicaval
OHT is superior to biatrial OHT in both early and late outcomes. This
study aimed to provide an overview of the early and late outcomes in
patients who underwent a bicaval or biatrial OHT. <br/>METHOD(S): A
systematic literature search was performed for articles published before
December 2017. Studies comparing adult patients undergoing biatrial OHT
and bicaval OHT were included. Early outcomes were pooled in odds ratios
and late outcomes were pooled in rate ratios. Late survival was visualized
by a pooled Kaplan-Meier curve. <br/>RESULT(S): In the meta-analysis 36
publications were included, counting 3555 patients undergoing biatrial OHT
and 3208 patients undergoing bicaval OHT. Early outcomes in mortality,
tricuspid regurgitation, mitral regurgitation and permanent pacemaker
implantation differed significantly in favor of the bicaval OHT patients.
Long-term survival was significantly better in patients undergoing bicaval
versus biatrial OHT [hazard ratio 1.32, 95% confidence interval (CI) (1.1
to 1.6), P=0.008]. Also, late tricuspid regurgitation was less frequently
seen in the bicaval OHT patients [rate ratio 2.14, CI 95% (1.17 to 3.94),
P = 0.014]. <br/>CONCLUSION(S): This systematic review with meta-analysis
shows that, bicaval OHT results in more favorable early and late outcomes
for patients undergoing a bicaval OHT compared with biatrial OHT.
Therefore, the bicaval OHT should be considered as preferable technique
for OHT.<br/>Copyright &#xa9; 2020. Published by Elsevier Inc.

<18>
Accession Number
630825923
Title
Computerised cognitive training to improve cognition including delirium
following coronary artery bypass grafting surgery: Protocol for a blinded
randomised controlled trial.
Source
BMJ Open. 10 (2) (no pagination), 2020. Article Number: e034551. Date of
Publication: 05 Feb 2020.
Author
Greaves D.; Psaltis P.J.; Lampit A.; Davis D.H.J.; Smith A.E.; Bourke A.;
Worthington M.G.; Valenzuela M.J.; Keage H.A.D.
Institution
(Greaves, Keage) Cognitive Ageing and Impairment Neurosciences Laboratory
(CAIN), School of Psychology, Social Work and Social Policy, University of
South Australia Division of Education, Arts and Social Sciences, Adelaide,
SA, Australia
(Psaltis) Adelaide Medical School, University of Adelaide, Adelaide, SA,
Australia
(Psaltis) Vascular Research Centre, South Australian Health and Medical
Research Institute, Adelaide, SA, Australia
(Psaltis) Department of Cardiology, Royal Adelaide Hospital, Central
Adelaide Local Health Network, Adelaide, SA, Australia
(Lampit) Academic Unit for Psychiatry of Old Age, Department of
Psychiatry, University of Melbourne, Melbourne, VIC, Australia
(Lampit) Department of Neurology, Charite Universitatsmedizin Berlin,
Berlin, Germany
(Davis) MRC Unit for Lifelong Health and Ageing, University College
London, London, United Kingdom
(Smith) Alliance for Research in Exercise, Nutrition and Activity (ARENA),
University of South Australia Division of Health Sciences, Adelaide, SA,
Australia
(Bourke) Department of Geriatric and Rehabilitation Medicine, Royal
Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA,
Australia
(Worthington) Department of Cardiothoracic Surgery, Royal Adelaide
Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
(Valenzuela) Brain and Mind Centre and Sydney Medical School, University
of Sydney, Sydney, NSW, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Coronary artery bypass grafting (CABG) surgery is known to
improve vascular function and cardiac-related mortality rates; however, it
is associated with high rates of postoperative cognitive decline and
delirium. Previous attempts to prevent post-CABG cognitive decline using
pharmacological and surgical approaches have been largely unsuccessful.
Cognitive prehabilitation and rehabilitation are a viable yet untested
option for CABG patients. We aim to investigate the effects of
preoperative cognitive training on delirium incidence, and preoperative
and postoperative cognitive training on cognitive decline at 4 months
post-CABG. Methods and analysis This study is a randomised,
single-blinded, controlled trial investigating the use of computerised
cognitive training (CCT) both pre-CABG and post-CABG (intervention group)
compared with usual care (control group) in older adults undergoing CABG
in Adelaide, South Australia. Those in the intervention group will
complete 1-2 weeks of CCT preoperatively (45-60 min sessions, 3.5
sessions/week) and 12 weeks of CCT postoperatively (commencing 1 month
following surgery, 45-60 min sessions, 3 sessions/week). All participants
will undergo cognitive testing preoperatively, over their hospital stay
including delirium, and postoperatively for up to 1 year. The primary
delirium outcome variable will be delirium incidence (presence vs
absence); the primary cognitive decline variable will be at 4 months
(significant decline vs no significant decline/improvement from baseline).
Logistic regression modelling will be used, with age and gender as
covariates. Secondary outcomes include cognitive decline from baseline to
discharge, and at 6 months and 1 year post-CABG. Ethics and dissemination
Ethics approval was obtained from the Central Adelaide Local Health
Network Human Research Ethics Committee (South Australia, Australia) and
the University of South Australia Human Ethics Committee, with original
approval obtained on 13 December 2017. It is anticipated that
approximately two to four publications and multiple conference
presentations (national and international) will result from this research.
Trial registration number This clinical trial is registered with the
Australian New Zealand Clinical Trials Registry and relates to the
pre-results stage. Registration number: ACTRN12618000799257.<br/>Copyright
&#xa9; Author(s) (or their employer(s)) 2020. Re-use permitted under CC
BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

<19>
Accession Number
2003730690
Title
Transcatheter versus surgical aortic valve replacement in low-risk
patients for the treatment of severe aortic stenosis.
Source
Journal of Clinical Medicine. 9 (2) (no pagination), 2020. Article Number:
439. Date of Publication: February 2020.
Author
Polimeni A.; Sorrentino S.; De Rosa S.; Spaccarotella C.; Mongiardo A.;
Sabatino J.; Indolfi C.
Institution
(Polimeni, Sorrentino, De Rosa, Spaccarotella, Mongiardo, Sabatino,
Indolfi) Division of Cardiology, Department of Medical and Surgical
Sciences, "Magna Graecia" University, Catanzaro 88100, Italy
(Indolfi) URT-CNR, Department of Medicine, Consiglio Nazionale delle
Ricerche, Catanzaro 88100, Italy
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Recently, two randomized trials, the PARTNER 3 and the Evolut Low Risk
Trial, independently demonstrated that transcatheter aortic valve
replacement (TAVR) is non-inferior to surgical aortic valve replacement
(SAVR) for the treatment of severe aortic stenosis in patients at low
surgical risk, paving the way to a progressive extension of clinical
indications to TAVR. We designed a meta-analysis to compare TAVR versus
SAVR in patients with severe aortic stenosis at low surgical risk. The
study protocol was registered in PROSPERO (CRD42019131125). Randomized
studies comparing one-year outcomes of TAVR or SAVR were searched for
within Medline, Scholar and Scopus electronic databases. A total of three
randomized studies were selected, including nearly 3000 patients. After
one year, the risk of cardiovascular death was significantly lower with
TAVR compared to SAVR (Risk Ratio (RR) = 0.56; 95% CI 0.33-0.95; p =
0.03). Conversely, no differences were observed between the groups for
one-year all-cause mortality (RR = 0.67; 95% CI 0.42-1.07; p = 0.10).
Among the secondary endpoints, patients undergoing TAVR have lower risk of
new-onset of atrial fibrillation compared to SAVR (RR = 0.26; 95% CI
0.17-0.39; p < 0.00001), major bleeding (RR = 0.30; 95% CI 0.14-0.65; p <
0.002) and acute kidney injury stage II or III (RR = 0.28; 95% CI 0.14-
0.58; p = 0.0005). Conversely, TAVR was associated to a higher risk of
aortic regurgitation (RR = 3.96; 95% CI 1.31-11.99; p = 0.01) and
permanent pacemaker implantation (RR = 3.47; 95% CI 1.33-9.07; p = 0.01)
compared to SAVR. No differences were observed between the groups in the
risks of stroke (RR= 0.71; 95% CI 0.41-1.25; p = 0.24), transient ischemic
attack (TIA; RR = 0.98; 95% CI 0.53-1.83; p = 0.96), and MI (RR = 0.75;
95% CI 0.43-1.29; p = 0.29). In conclusion, the present meta-analysis,
including three randomized studies and nearly 3000 patients with severe
aortic stenosis at low surgical risk, shows that TAVR is associated with
lower CV death compared to SAVR at one-year follow-up. Nevertheless,
paravalvular aortic regurgitation and pacemaker implantation still
represent two weak spots that should be solved.<br/>Copyright &#xa9; 2020
by the author. Licensee MDPI, Basel, Switzerland.

<20>
Accession Number
2004902275
Title
The difficult balance between thrombosis and bleeding after transcatheter
aortic valve replacement: A translational review.
Source
Archives of Cardiovascular Diseases. (no pagination), 2020. Date of
Publication: 2020.
Author
Trimaille A.; Marchandot B.; Park S.-H.; Schini-Kerth V.; Morel O.
Institution
(Trimaille, Marchandot, Morel) Pole d'Activite Medico-Chirurgicale
Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire,
Universite de Strasbourg, BP 426, Strasbourg 67091, France
(Park, Schini-Kerth, Morel) Regenerative NanoMedicine, UMR 1260, Inserm,
Universite de Strasbourg, Strasbourg 67085, France
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as the treatment
of choice for patients with severe aortic stenosis deemed at high or
intermediate risk for cardiac surgery. In light of the latest literature
advances, TAVR will undoubtedly concern a growing number of patients
because of the progressive extension of its indications. Whereas
significant efforts have been made to reduce the burden of periprocedural
complications, TAVR still exposes patients to a sizeable number of adverse
outcomes, including thrombotic and bleeding events. Although
contradictory, these two phenomena are closely related to
pathophysiological processes inherent to flow disturbances induced by
aortic stenosis itself, but also to a complex interaction between
bioprosthetic valves and native tissues in frail patients clustering
various co-morbidities. Reinforcing this paradigm, multiple TAVR studies
have emphasized the view that both thrombosis and bleeding events have a
deleterious effect on patient outcomes. Therefore, we sought to perform a
comprehensive translational review of the current literature addressing
the pathophysiological mechanisms leading to thrombosis and bleeding after
TAVR, and underline innovative strategies aimed at reducing these
complications.<br/>Copyright &#xa9; 2020 Elsevier Masson SAS

<21>
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

<22>
Accession Number
603516695
Title
Acupuncture accelerates recovery after general anesthesia: A prospective
randomized controlled trial.
Source
Journal of Integrative Medicine. 13 (2) (pp 99-104), 2015. Date of
Publication: 01 Mar 2015.
Author
Gemma M.; Nicelli E.; Gioia L.; Moizo E.; Beretta L.; Calvi M.R.
Institution
(Gemma, Nicelli, Gioia, Moizo, Beretta, Calvi) Department of Anesthesia
and Neurointensive Care, San Raffaele Scientific Institute, Milan 20132,
Italy
Publisher
Elsevier (Singapore) Pte Ltd (3 Killiney Road, 08-01, Winsland House I,
Singapore 239519, Singapore)
Abstract
Background Acupuncture anesthesia was created in the 1950's in China and
continues to be used there today during most major surgeries. It is widely
used in China for such complex operations as brain, heart, and abdominal
surgery. It is popular in China because it is economical, practical, and
beneficial to the patients. With acupuncture anesthesia there is less
bleeding during surgery and there is also quicker post-operative recovery.
Objective This randomized prospective study aims at comparing the effect
of two acupoints (Yongquan, KI1 and Renzhong, DU26) with sham acupuncture
and no acupuncture on the time to recovery of consciousness after general
anesthesia by means of the Bispectral Index monitor (BIS). Design,
setting, participants and interventions This is a prospective randomized
controlled study. We randomly assigned 50 patients to 5 groups during
recovery from surgical anesthesia. Four groups had acupuncture on KI1
(group A), DU26 (groups B), both KI1 and DU26 (group C), and sham points
(group D), and one had no acupuncture (group E). Main outcome measures
Bispectral Index (BIS), time to spontaneous eye opening, time to tracheal
extubation, and time to following commands were measured as the main
outcome measures. Results Time to spontaneous eye opening differed among
groups (P=0.002), as well as time to tracheal extubation (P<0.000 1) and
time to following commands (P=0.000 6). BIS values differed significantly
among groups both 5 and 10 min after the end of anesthesia (P<0.000 1 and
P=0.000 4, respectively). BIS values of groups D and E were lower than
those of the other groups and those of group C were higher. The same
pattern was observed also 15 and 30 min after the end of anesthesia,
although the difference among groups was not significant at these time
points (P=0.164 and P=0.104, respectively). Conclusion Acupuncture on DU26
and KI1 accelerates recovery of consciousness after general anesthesia.
Moreover, a possible synergistic effect of DU26 and KI1 is suggested. This
issue may play a role in the optimization of operating room management and
raise interest about the usefulness of acupuncture on unconsciousness
states of different nature.<br/>Copyright &#xa9; 2015 Journal of
Integrative Medicine Editorial Office. E-edition published by Elsevier
(Singapore) Pte Ltd. All rights reserved.

<23>
Accession Number
53272308
Title
Meta-analysis of mortality outcomes and mitral regurgitation evolution in
4,839 patients having transcatheter aortic valve implantation for severe
aortic stenosis.
Source
American Journal of Cardiology. 114 (6) (pp 875-882), 2014. Date of
Publication: 15 September 2014.
Author
Sannino A.; Losi M.A.; Schiattarella G.G.; Gargiulo G.; Perrino C.;
Stabile E.; Toscano E.; Giugliano G.; Brevetti L.; Franzone A.; Cirillo
P.; Imbriaco M.; Trimarco B.; Esposito G.
Institution
(Sannino, Losi, Schiattarella, Gargiulo, Perrino, Stabile, Toscano,
Giugliano, Brevetti, Franzone, Cirillo, Imbriaco, Trimarco, Esposito)
Division of Cardiology, Department of Advanced Biomedical Sciences,
Federico II University, Naples, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective alternative
therapy in selected patients with severe aortic stenosis. The role and
effects of coexistent moderate to severe mitral regurgitation (msMR) in
patients who undergo TAVI remain unclear. Thirteen studies enrolling 4,839
patients who underwent TAVI, including patients with msMR, were considered
in a meta-analysis and analyzed for all-cause-mortality; a further
metaanalysis was performed to assess mitral regurgitation (MR) evolution
after TAVI. In patients with msMR, all-cause-mortality after TAVI was
significantly increased at 30-day (effect size [ES] L0.18, 95% confidence
interval [CI] L0.31 to L0.04, I2 [ 46.51, Q [ 7.48), 1-year (ES L0.22, 95%
CI L0.36 to L0.08, I2 [ 56.20, Q [ 11.41), and 2-year (ES L0.15, 95% CI
L0.27 to L0.02, I2 [ 0.00, Q [ 2.64) follow-up compared with patients with
absent or mild MR, independent of baseline left ventricular ejection
fraction. Interestingly, the impact of msMR on outcomes was statistically
stronger when the CoreValve system was used. TAVI was also associated with
an improvement in MR entity at 3- and 6-month follow-up (overall ES L0.19,
95% CI L0.37 to L0.01, I2 [ 61.52, Q [ 10.39). In conclusion, the presence
of preoperative msMR in patients with severe, symptomatic aortic stenosis
who undergo TAVI negatively affects outcomes after TAVI. In addition, in
the same group of patients, a trend toward a reduction in MR severity was
observed. Whether the decrease in MR severity affects mortality after TAVI
remains to be defined.<br/>Copyright &#xa9; 2014 Elsevier Inc. All rights
reserved.

<24>
Accession Number
630017422
Title
Parathyroidectomy Influences Coronary Artery Calcium Score in Asymptomatic
Hemodialysis Patients with Secondary Hyperparathyroidism.
Source
American Journal of Nephrology. 51 (1) (pp 65-73), 2020. Date of
Publication: 01 Jan 2020.
Author
Ma Q.; Su D.; Liu F.; Xing H.; Han X.; Ma D.
Institution
(Ma, Su, Liu, Xing, Han, Ma) Beijing Friendship Hospital Affiliated to
Capital Medical University, 95 YongAn Road, Beijing 100050, China
Publisher
S. Karger AG
Abstract
Background: Successful parathyroidectomy (PTX) with stable postoperative
parathyroid hormone (PTH) levels is associated with the stabilization of
coronary artery calcification score (CACS) in patients with severe
secondary hyperparathyroidism (SHPT) undergoing hemodialysis. To use
computed tomography (CT) to evaluate the influence of PTX on CACS in
asymptomatic patients. <br/>Method(s): This study was performed with
institutional review board approval. Written consent was obtained from
each patient. Forty-eight patients (mean age +/- SD 54.50 +/- 13.14 years;
range 33-77 years) undergoing maintenance hemodialysis who underwent PTX
and 56 patients (mean age 55.28 +/- 12.32 years; range 35-76 years) who
did not undergo PTX received prospective follow-up for 2 years. CACS was
quantitatively performed using the Agatston method after CT scan. The
differences between baseline and end-of-study PTX parameters were analyzed
with the paired Student t test. <br/>Result(s): For patients who underwent
PTX, mean square root of CACS did not increase from 23.16 +/- 18.58 to
23.68 +/- 18.16 (t = 1.846, p = 0.072) from baseline to follow-up. In
patients who did not undergo PTX, mean square root of CACS increased from
20.21 +/- 16.47 to 28.72 +/- 20.95 (t = 10.110, p < 0.001) from baseline
to follow-up. In addition, the median annual progression rate of CACS was
lower among PTX patients (4.89%), compared with the marked annual
progression rate of CACS in non-PTX patients (52.81%; t = 11.264, p <
0.001). <br/>Conclusion(s): Dysregulation of calcium and phosphate
metabolism caused by SHPT may result in significant CAC progression in
asymptomatic hemodialysis patients. Low PTH state after PTX may stabilize
CAC progression in hemodialysis patients.<br/>&#xa9; 2019 S. Karger AG,
Basel. Copyright: All rights reserved.

<25>
Accession Number
2004836775
Title
Are person- And work-directed interventions effective for enhancing
return-to-work in patients with coronary heart disease? A Cochrane Review
summary with commentary.
Source
Turkish Journal of Physical Medicine and Rehabilitation. 65 (4) (pp
402-405), 2019. Date of Publication: 2019.
Author
Oral A.; Sindel D.
Institution
(Oral, Sindel) Department of Physical Medicine and Rehabilitation,
Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
Publisher
Turkish Society of Physical Medicine and Rehabilitation

<26>
Accession Number
2004841792
Title
A systematic review of chyle leaks and their management following axillary
surgery.
Source
European Journal of Surgical Oncology. (no pagination), 2020. Date of
Publication: 2020.
Author
Farkas N.; Wong J.; Monib S.; Thomson S.
Institution
(Farkas, Wong, Monib, Thomson) West Hertfordshire Breast Care Unit, West
Hertfordshire Hospitals NHS Trust, United Kingdom
Publisher
W.B. Saunders Ltd
Abstract
Introduction: Chyle leaks following surgery to the axilla are seldom
encountered with an incidence <0.7%. Management varies with no consensus
in the literature. Injury to branching tributaries of the thoracic duct
may require lengthy management at significant cost to patient and clinical
team. This paper aims to provide an up-to-date review to support clinical
management. <br/>Method(s): The term 'chyle' was combined with 'breast' or
'axilla.' EMBASE, Medline and PubMed database searches were conducted. All
papers published in English were included with no exclusion date limits.
<br/>Result(s): 51 cases from 31 papers. All were female (mean age =
53.3yrs). 47/51 leaks were left-sided. 5/51 underwent sentinel node
biopsy, 19/51 level II axillary node clearance (ANC), 23/51 level III ANC,
5/51 not specified. 59% (30/51) of leaks were identified within 2
postoperative days (mean = 3.3days). 96% initially managed conservatively:
Drain = 38/51; low-fat diet = 34/51; compression bandaging = 20/51;
Aspiration = 6/51. 40/51 (78%) were successfully managed conservatively,
11 patients returned to theater for secondary management. 7/11 recorded
volumes >500mls/24 hrs before secondary surgery. Mean resolution time from
initial surgery was 17.3days (range = 4-64days). No statistically
significant difference (p = 0.72) in time to resolution between
conservatively and surgically managed patients. <br/>Conclusion(s): Chyle
leaks are rarely seen following axillary surgery. Aberrant thoracic duct
anatomy represents the likeliest aetiology. We advocate early recognition
and tailored individual management. Conservative management with
non-suction drainage, low-fat diet and axillary compression bandaging
appear effective where output <500ml/24 hrs. Secondary surgical management
should be considered in high chylous output (<500mls/24 hrs) patients
unresponsive to conservative measures. We propose a management algorithm
to aide clinicians.<br/>Copyright &#xa9; 2020

<27>
Accession Number
2003514857
Title
Prevalence and patterns of cognitive impairment in acute coronary syndrome
patients: A systematic review.
Source
European Journal of Preventive Cardiology. 27 (3) (pp 284-293), 2020. Date
of Publication: 01 Feb 2020.
Author
Zhao E.; Lowres N.; Woolaston A.; Naismith S.L.; Gallagher R.
Institution
(Zhao, Lowres, Naismith, Gallagher) Charles Perkins Centre, University of
Sydney, Australia
(Zhao, Woolaston) Sydney Nursing School, University of Sydney, Australia
(Lowres, Gallagher) Stroke Prevention, Heart Research Institute, Sydney,
Australia
(Naismith) Healthy Brain Ageing Program, Brain and Mind Centre, University
of Sydney, Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Minimising risk factors through secondary prevention behaviour
is challenging for patients following an acute coronary syndrome.
Cognitive impairment can potentially make these changes more difficult.
However, cognitive impairment prevalence in acute coronary syndrome
patients is poorly understood. <br/>Design(s): This study was based on a
systematic review. <br/>Method(s): A systematic review was conducted of
PubMed, Medline, PsycINFO and Cochrane databases up to March 2019, to
identify studies reporting the prevalence of cognitive impairment in acute
coronary syndrome patients. Predefined inclusion criteria were specified,
including use of a validated cognitive impairment screening tool. Studies
were excluded if patients had diagnosed dementia or coronary artery bypass
graft surgery. Strengthening The Reporting of Observational Studies in
Epidemiology and Cochrane Risk of Bias tools were used to assess quality.
<br/>Result(s): From 747 potential studies, nine were included. The total
sample size was 6457 (range 53-2174), mean age range was 51.3-77.4 years,
and range of proportions of males was 57-100%. Reported cognitive
impairment prevalence rates varied substantially (9-85%) with no clear
pattern over time. From the two studies which examined domains, verbal
fluency, memory and language were affected the most. Meta-analysis could
not be undertaken due to diverse screening tools (n = 9), cut-off scores
and screening timepoints. <br/>Conclusion(s): Cognitive impairment in
acute coronary syndrome patients is currently poorly described, and likely
affects a substantial number of acute coronary syndrome patients who
remain undetected and have the potential to develop to dementia in the
future. As domains are most affected, this could impact understanding and
retention of health education. Research is needed to accurately determine
the prevalence of cognitive impairment in acute coronary syndrome patients
and create suitable standardised measures and thresholds.<br/>Copyright
&#xa9; The European Society of Cardiology 2019.

<28>
Accession Number
2001765138
Title
Sex Difference and Outcome after Percutaneous Intervention in Patients
with Chronic Total Occlusion: A Systematic Review and Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 21 (1) (pp 25-31), 2020. Date
of Publication: January 2020.
Author
Mannem S.; Rattanawong P.; Riangwiwat T.; Vutthikraivit W.; Putthapiban
P.; Sukhumthammarat W.; Kanitsoraphan C.; Chongsathidkiet P.
Institution
(Mannem) The Queen's Medical Center, Honolulu, HI, United States
(Rattanawong, Riangwiwat, Kanitsoraphan) University of Hawaii Internal
Medicine Residency Program, Honolulu, HI, United States
(Rattanawong) Faculty of Medicine Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
(Vutthikraivit) Department of Medicine, Texas Tech University Health
Sciences Center, Lubbock, TX, United States
(Putthapiban, Sukhumthammarat) Department of Medicine, Einstein Medical
Center, Philadelphia, PA, United States
(Chongsathidkiet) Department of Pathology, Duke University Medical Center,
Durham, NC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Recent studies suggest that sex difference is an outcome
predictor in chronic total occlusion (CTO) patients who are undergoing
percutaneous intervention (PCI). However, a systematic review and
meta-analysis of the literature have not been done. We assessed the
outcome of PCI in CTO between male and female. <br/>Method(s): We
comprehensively searched the databases of MEDLINE and EMBASE from
inception to September 2017. Included studies were published cohort
(prospective or retrospective) and case control studies of CTO patients
who underwent PCI that compared successful procedure and major cardiac
event (MACE), including cardiac death, target vessel revascularization,
myocardial infarction, and stroke, between male and female. Data from each
study were combined using the random-effects, generic inverse variance
method of DerSimonian and Laird to calculate risk ratios and 95%
confidence intervals. <br/>Result(s): Nine studies were included in this
meta-analysis involving 30,830 CTO subjects (8350 female and 22,480 male)
who underwent PCI. Females were not significantly associated with reduced
risk of MACE (pooled risk ratio = 0.86, 95% confidence interval:
0.66-1.12, p = 0.262, I² = 47.0%) as well as successful rate of
PCI (pooled risk ratio = 1.04, 95% confidence interval: 0.99-1.10, p =
0.161, I² = 76.6%) in CTO patients who underwent PCI.
<br/>Conclusion(s): Our study suggests that sex is not an independent risk
factor of MACE or successful procedure in CTO patients who underwent
PCI.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<29>
Accession Number
630842691
Title
Beyond myxomas-a benign tumour on the anterior mitral valve leaflet-a rare
case of lipoma.
Source
European Heart Journal Cardiovascular Imaging. Conference: 22nd Annual
Meeting of the European Association of Echocardiography, EUROECHO 2018.
Italy. 20 (Supplement 1) (pp i295), 2019. Date of Publication: January
2019.
Author
Zurawska M.A.; Kuriata J.; Zielinski J.; Wojcik A.; Siudalska H.; Szwed
H.; Kusmierczyk M.
Institution
(Zurawska, Szwed) Institute of Cardiology, 2nd Department of Coronary
Artery Disease, Warsaw, Poland
(Kuriata, Zielinski, Siudalska, Kusmierczyk) Institute of Cardiology,
Department of Cardiac Surgery and Transplantology, Warsaw, Poland
(Wojcik) Institute of Cardiology, Department of Congenital Heart Diseases,
Warsaw, Poland
Publisher
Oxford University Press
Abstract
Introduction: Primary cardiac tumours (PCT) are extremely rare with
prevalence of up to 0,19% and lipomas account for up to 8,4% of these. We
present a case of lipoma of the anterior mitral leaflet mistaken for
myxoma and urgently resected. As a result, mitral regurgitation occurred.
Case report: A 33-year-old female was admitted to the hospital due to a
tumour in the left atrium. The history of the patient included:
subclinical autoimmune hypothyroidism, resected uterine myoma and right
ovarian teratoma. The tumour was found incidentally in the outpatient
clinic, however, the patient fainted the day before transthoracic
echocardiography (TTE). No other cardiac symptoms occurred. Her physical
examination and laboratory data were unremarkable. TTE showed a
hyperechoic 20 mm tumour attached to the anterior mitral leaflet (AML),
with no signs of left ventricular inflow obstruction and a competent
mitral valve. The patient urgently underwent cardiac surgery because a
myxoma was suspected at first. Unexpectedly, the morphology of the tumour
suggested a lipoma. The mass was excised incompletely. Histopathology
confirmed a benign lipoma. As a consequence of debulking, the AML was
perforated, which resulted in more than mild mitral regurgitation. The
postoperative course was uneventful (the mitral valve incompetence proved
insignificant) and the patient was discharged on the 8th day. Nine months
into her follow-up, the patient is in the NYHA 2nd class of heart failure
and the mitral regurgitation is at least moderate. <br/>Discussion(s):
Given the low prevalence of PCT, there is no randomized data to guide the
treatment. Myxomas comprise the majority of PCT and a myxoma was in the
differential. The unexplained syncope, suggestive of transient ischaemic
attack, justified the urgent surgical approach with no further imaging.
Echocardiography often cannot conclusively differentiate between lipomas
and other PCT, and other cardiac imaging modalities may characterize the
tissue better. The risk of embolization is low because lipomas are
encapsulated contrary to other PCT. Mitral valve is affected exceptionally
with subendocardium of the right atrium and the left ventricle being the
most common location. There was no dysfunction of the mitral valve prior
to surgery in our patient and the symptomatology was unclear. The complete
resection of the tumour could not be done as the tumour had a wide stalk.
The perforation of the anterior mitral leaflet remained untreated as the
mitral regurgitation seemed moderate and sparing mitral valve in a young
woman was the priority. As the symptoms have occurred and the mitral
regurgitation has worsened, the patient needs close monitoring to
determine the time for intervention. Assuming that lipomas grow slowly,
the grade of mitral regurgitation and its symptoms will lead the way.
<br/>Conclusion(s): PCT require an individual approach and a careful
imaging which are essential to guide the management (Figure Presented).

<30>
Accession Number
630840432
Title
Effectiveness of extracorporeal shockwave myocardial revascularization
therapy in stable angina patients using a cardiac magnetic resonance
feature tracking technique.
Source
European Heart Journal Cardiovascular Imaging. Conference: 22nd Annual
Meeting of the European Association of Echocardiography, EUROECHO 2018.
Italy. 20 (Supplement 1) (pp i1114), 2019. Date of Publication: January
2019.
Author
Rimkus A.; Burneikaite G.; Glaveckaite S.; Celutkiene J.; Palionis D.;
Valeviciene N.; Laucevicius A.
Institution
(Rimkus) Vilnius University, Faculty Of Medicine, Vilnius, Lithuania
(Burneikaite, Glaveckaite, Celutkiene, Laucevicius) Vilnius University,
Clinic of Cardiac and Vascular diseases, Center of Cardiology and
Angiology, Vilnius, Lithuania
(Palionis, Valeviciene) Vilnius University, Department of Radiology,
Nuclear Medicine and Medical Physics, Vilnius, Lithuania
Publisher
Oxford University Press
Abstract
Introduction: Ultrasound-guided cardiac shock-wave therapy (CSWT) is a
promising non-invasive modality in patients with stable refractory angina
(SRA). The effectiveness of CSWT in a randomized, sham-controlled,
triple-blind study, analyzing changes in left ventricular (LV) myocardial
deformation indices by transthoracic echocardiography (TTE) speckle
tracking (ST) technique and a novel cardiovascular magnetic resonance
(CMR) feature tracking (FT) technique (Figure 1), has not been examined.
<br/>Aim(s): To determine the reproducibility of CMR-FT strain
measurements between 2 experienced reviewers (n = 10), the correlation
between CMR-FT and TTE-ST longitudinal strains (LS) in all patients before
treatment (n = 37) and the efficacy of CSWT compared with placebo, based
on changes in CMR-FT and TTE-ST strains. <br/>Method(s): A randomized,
sham-controlled, triple-blind study included 37 SRA patients who were
randomized to CSWT (n = 21) and control (n = 16) groups. TTE-ST and CMR-FT
were performed before and 6 months after 9 weeks of CSWT or placebo.
CMR-FT was conducted using Circle cvi42 by 2 independent, experienced
reviewers. The data was analyzed using SPSS 23. <br/>Result(s): There was
a good reproducibility of CMR-FT 4-, 3-chamber LS and basal radial (RS),
circumferential (CS) strain measurements between 2 reviewers (interclass
correlation coefficients 0.93, 0.84, 0.75, 0.77, respectively). We found
moderate correlations between global, 3-, 2-chamber CMR-FT and TTE-ST LS
[r = 0.56 (p = 0.001), r = 0.41 (p = 0.032), r = 0.45 (p = 0.01),
respectively] in all patients at baseline. At baseline, CMR-FT 4-chamber
LS and midsegmental CS were lower in the control versus treatment group
[-11.60 +/- 4.97 vs -15.25 +/- 3.88 (p = 0.017) and -14.59 +/- 3.75 vs
-17.39 +/- 4.40 (p = 0.049), respectively]. 6 months after treatment,
CMR-FT global, 4-, 3-, 2-chamber LS remained lower in the placebo compared
with treatment group [-11.55 +/- 5.59 vs -15.87 +/- 4.51 (p = 0.014);
-10.62 +/- 5.04 vs -14.01 +/- 4.69 (p = 0.042); -13.15 +/- 6.19 vs -17.34
+/- 5.73 (p = 0.040); -10.89 +/- 8.52 vs -16.26 +/- 5.49 (p = 0.026),
respectively]. There were no significant differences in TTE-ST LS or LV EF
and volumes before and after treatment in either group, as assessed by
CMR. CMR-FT 2-chamber LS, global, midsegmental CS and LV EF changes were
significant 6 months after treatment in all patients [2.14 (p = 0.037);
1.02 (p = 0.038); 1.17 (p = 0.034); 2.31 (p = 0.045), respectively]. We
found no significant changes in CMR-FT LS, RS, CS; TTE-ST LS or LV EF and
volumes, as evaluated by CMR, between the treatment and control groups 6
months after treatment compared with baseline. <br/>Conclusion(s): There
was good reproducibility of CMR-FT strains between the 2 experienced,
independent reviewers regarding LV 4-, 3- chamber LS and basal RS and CS
measurements. The correlation between LV global, 3-, 2-chamber CMR-FT and
TTE-ST LS was moderate. CSWT was not effective compared with placebo,
based on CMR-FT LS, RS, CS; TTE-ST LS; LV EF and volumes, as assessed by
CMR. (Figure Presented) .

<31>
Accession Number
630839313
Title
Prognostic effect and modulation of cardiac sympathetic function in heart
failure patients treated with cardiac resynchronization therapy.
Source
European Heart Journal Cardiovascular Imaging. Conference: 22nd Annual
Meeting of the European Association of Echocardiography, EUROECHO 2018.
Italy. 20 (Supplement 1) (pp i268), 2019. Date of Publication: January
2019.
Author
Ilhao Moreira R.; Abreu A.; Portugal G.; Oliveira L.; Oliveira M.;
Rodrigues I.; Coutinho Cruz M.; Silva Cunha P.; Santos V.; Santa Clara H.;
Cruz Ferreira R.; Mota Carmo M.
Institution
(Ilhao Moreira, Abreu, Portugal, Oliveira, Rodrigues, Oliveira, Rodrigues,
Coutinho Cruz, Silva Cunha, Santos, Santa Clara, Cruz Ferreira, Mota
Carmo) Hospital De Santa Marta, Cardiology, Lisbon, Portugal
Publisher
Oxford University Press
Abstract
Background: Cardiac autonomic dysfunction as assessed by
123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy is associated with
poor prognosis in heart failure (HF) patients. Although cardiac
resynchronization therapy (CRT) has emerged as an effective therapy in
improving outcomes on HF patients, its effect on cardiac sympathetic
nervous function is still not fully understood. We aimed to study the
value of pre-implantation 123I-mIBG late HMR as a predictor of response
and outcomes after CRT and to correlate modification in this parameter
with CRT response and functional improvement. <br/>Methods and Results:
BETTER-HF is a prospective randomized clinical trial including HF patients
submitted CRT (mean LVEF 24 +/- 8%, 74% NYHA class >= III) who underwent a
clinical, echocardiographic, and scintigraphic assessment before and 6
months after CRT. Onehundred and twenty one patients were included.
Echocardiographic response was observed in 54% and composite outcome of
cardiac mortality, cardiac transplant or heart failure hospitalization in
24% of patients. Baseline late heart-to-mediastinum ratio (HMR) was an
independent predictor of CRT response (regression coefficient 2.906, 95%
CI 0.293-3.903, 0.029) and outcomes (HR 0.066 95% CI 0.005-0.880, p
0.040). At follow-up, 123I-mIBG imaging showed positive changes in cardiac
sympathetic nerve activity only in responders to CRT (1.36 +/- 0.14 prior
vs. 1.42 +/- 0.16 after CRT, p 0.039). There was a significant correlation
between improvement in late HMR and improvement in peak oxygen consumption
(r 0.547, p < 0.001). <br/>Conclusion(s): In our study, baseline cardiac
denervation predicted response and clinical outcomes after CRT
implantation. Cardiac sympathetic function was improved only in patients
who responded to CRT and these positive changes were correlated with
improvement in functional capacity.

<32>
Accession Number
2003718618
Title
Meta-analysis of the impact of pre-procedural serum albumin on mortality
in patients undergoing transcatheter aortic valve replacement.
Source
International Heart Journal. 61 (1) (pp 67-76), 2020. Date of Publication:
2020.
Author
Liu G.; Hu X.; Long M.; Du Z.-M.; Li Y.; Hu C.-H.
Institution
(Liu, Hu, Long, Du, Li, Hu) Department of Cardiology, The First Affiliated
Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted
Circulation, Ministry of Health, Guangzhou, China
Publisher
International Heart Journal Association (E-mail: : jhj-office@umin.ac.jp)
Abstract
Pre-procedural serum albumin's impact on prognosis after transcatheter
aortic valve replacement (TAVR) has been studied. Literature on the
prognostic role of serum albumin in the survival of patients undergoing
TAVR shows conflicting results. This meta-analysis was conducted to
evaluate the impact of pre-procedural serum albumin on outcomes after
TAVR. A comprehensive literature search of EMBASE, MEDLINE, and the
Cochrane Library was undertaken through July 2019. The primary end points
were 30-day and one-year all-cause mortality after TAVR. Risk ratios (HRs)
and 95% confidence intervals (CIs) were calculated using the random-effect
model. Ten eligible studies with 8,236 patients were analyzed. Of the
8,236 patients undergoing TAVR, with a mean age of 83 years, 48.8% were
men and were categorized into two groups according to low and normal serum
albumin (cut-off value: 3.5 or 4 g/dL). Overall, low albumin was
significantly associated with an approximately two-fold increase in 30-day
all-cause mortality (HR, 2.09; 95% CI, 1.53-2.86) and a 61% increase risk
for one-year mortality (HR, 1.61; 95% CI, 1.31-1.98) in patients after
TAVR. Sensitivity analyses showed the results to be robust. The
association of low albumin level with an increase in one-year mortality
risk was not modified by study design, albumin cut-off value, Society of
Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), and study
quality. In conclusion, low albumin levels were associated with poor
prognosis in patients after TAVR. Pre-procedural albumin can be used as a
simple tool related to prognosis after TAVR.<br/>Copyright &#xa9; 2020,
International Heart Journal Association. All rights reserved.

<33>
Accession Number
2003718617
Title
Perioperative outcomes of adjunctive hypnotherapy compared with conscious
sedation alone for patients undergoing transfemoral transcatheter aortic
valve implantation.
Source
International Heart Journal. 61 (1) (pp 60-66), 2020. Date of Publication:
2020.
Author
Takahashi M.; Mouillet G.; Khaled A.; Boukantar M.; Gallet R.; Rubimbura
V.; Lim P.; Dubois-Rande J.-L.; Teiger E.
Institution
(Takahashi, Mouillet, Boukantar, Gallet, Rubimbura, Lim, Dubois-Rande,
Teiger) Department of Cardiology, Henri Mondor University Hospital,
Creteil, France
(Takahashi) Department of Cardiovascular Medicine, Jichi Medical
University School of Medicine, Tochigi, Japan
(Khaled) Department of Anesthesiology, Henri Mondor University Hospital,
Creteil, France
Publisher
International Heart Journal Association (E-mail: : jhj-office@umin.ac.jp)
Abstract
Transcatheter aortic valve implantation (TAVI) using a transfemoral
approach under local anesthesia with conscious sedation (LACS) is becoming
an increasingly common TAVI strategy. However, patients who are awake
during the TAVI procedure can experience stress, anxiety, and pain, even
when LACS is used. Clinical hypnotherapy is an anxiolytic intervention
that can be beneficial for patients undergoing invasive surgery. This
study aimed to assess the perioperative outcomes of adjunctive
hypnotherapy undergoing transfemoral TAVI with LACS. Consecutive patients
(n = 143) with symptomatic severe aortic stenosis who underwent
transfemoral TAVI with LACS only (n = 107) or with LACS and hypnotherapy
(n = 36) between January 2015 and April 2016 were retrospectively included
in the study. The clinical outcomes were compared between the two groups.
The LACS with hypnotherapy group had a significantly shorter length of
stay in the intensive care unit (ICU; LACS only versus LACS with
hypnotherapy: 4.0 (4.0-5.5) days versus 3.0 (3.0-5.0) days, P < 0.01).
Moreover, the use of anesthetics (propofol and remifentanil) and
norepinephrine was significantly lower in the LACS with hypnotherapy group
(e.g., for propofol, LACS only versus LACS with hypnotherapy: 96.4 +/-
104.7 mg versus 15.0 +/- 31.8 mg, P < 0.001). The multiple regression
analysis showed that being male, hypnotherapy, and the composite
complication score were independently associated with the length of stay
in the ICU. The adjunctive hypnotherapy on LACS among transfemoral TAVI
patients may facilitate perioperative management. However, a prospective
randomized study is necessary to confirm the efficacy of hypnotherapy
among TAVI patients.<br/>Copyright &#xa9; 2020, International Heart
Journal Association. All rights reserved.

<34>
Accession Number
2003718139
Title
Maximum inspiratory pressure of the patients after open-heart surgery
following physiotherapy.
Source
National Journal of Physiology, Pharmacy and Pharmacology. 10 (2) (pp
155-158), 2020. Date of Publication: 2020.
Author
Mehta J.N.; Kamat H.; Ganjiwale J.
Institution
(Mehta) Department of Physiotherapy, KM Patel Institute of Physiotherapy,
Karamsad, Gujarat, India
(Kamat) Department of Anaesthesia, Pramukhswami Medical College, Karamsad,
Gujarat, India
(Ganjiwale) Department of Central Research Services, Charutar Arogya
Mandal, Karamsad, Gujarat, India
Publisher
Mr Bhawani Singh (E-mail: drjaykaran@yahoo.co.in)
Abstract
Background: After open-heart surgery, various complications require
specific care, especially in the respiratory system. To reestablish it,
several strategies should be used, such as respiratory muscle training,
which aims to improve respiratory muscle strength, leading to a reduction
in post-operative pulmonary complications in patients undergoing cardiac
surgery. Aims and Objectives: The objective of the study was to measure
and compare maximum inspiratory pressure (MIP) in open-heart surgery
patients following conventional physiotherapy group and conventional
physiotherapy plus inspiratory muscle training (IMT) group.
<br/>Material(s) and Method(s): The study was an experimental design and
it was a prospective randomized control study where participants were
taken from cardiac hospital using balance block computer-generated
randomization method. Fifty participants were divided into two groups of
25 each. Group A received conventional physiotherapy and Group B received
conventional plus inspiratory muscle exercise (B) by pressure threshold
IMT instrument. Physiotherapy treatment was delivered by qualified
physiotherapy, twice a day preoperatively and after extubation, 4-5
sessions per day were given until they discharged. The pre-operative, at
discharge, and at the 1^st follow-up, patient MIP was measured.
<br/>Result(s): There was no statistically significant change in
inspiratory muscle strength in patients exposed to an IMT program compared
to the control group (P > 0.05). <br/>Conclusion(s): There was no
difference in MIP in conventional physiotherapy and conventional plus
inspiratory muscle trainer group in "pre-operative," "discharged," and
"1^st follow-up" in open-heart surgery patient.<br/>Copyright
&#xa9; 2020 Jigar N Mehta, et al.

<35>
Accession Number
2004212986
Title
LDL-cholesterol lowering with evolocumab, and outcomes according to age
and sex in patients in the FOURIER Trial.
Source
European Journal of Preventive Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Sever P.; Gouni-Berthold I.; Keech A.; Giugliano R.; Pedersen T.R.; Im K.;
Wang H.; Knusel B.; Sabatine M.S.; O'Donoghue M.L.
Institution
(Sever) National Heart and Lung Institute, Imperial College London, United
Kingdom
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes and Preventive
Medicine, University of Cologne, Germany
(Keech) NHMRC Clinical, Trials Centre, University of Sydney, Australia
(Giugliano, Im, Sabatine, O'Donoghue) TIMI Study Group, Brigham and
Women's Hospital, Harvard Medical School, United States
(Pedersen) Centre for Preventive Medicine, Ulleval University Hospital,
Norway
(Wang, Knusel) Clinical Development, Amgen Inc, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aims: Some trials have reported diminished efficacy for statins in the
elderly, and in women compared with men. We examined the efficacy and
safety of evolocumab by patient age and sex in the FOURIER trial, the
first major cardiovascular outcome trial of a PCSK9 inhibitor.
<br/>Methods and Results: FOURIER was a randomised, double blind trial,
comparing evolocumab with placebo in 27,564 patients with atherosclerotic
cardiovascular disease receiving statin therapy (median follow-up 2.2
years). The primary endpoint was cardiovascular death, myocardial
infarction, stroke, hospitalisation for unstable angina or coronary
revascularisation. Cox proportional hazards models were used to assess the
efficacy of evolocumab versus placebo stratified by quartiles of patient
age and by sex. There were small variations in the cardiovascular event
rate across the age range (for the primary endpoint, Kaplan-Meier at 3
years 15.6%, >69 years, vs. 15.1%, <=56 years, P = 0.45); however, the
relative efficacy of evolocumab was consistent regardless of patient age
(for the primary endpoint (Q1 hazard ratio, 95% confidence interval) 0.83,
0.72-0.96, Q2 0.88, 0.76-1.01, Q3 0.82, 0.71-0.95, Q4 0.86, 0.74-1.00;
P<inf>interaction</inf> = 0.91), and the key secondary endpoint
(cardiovascular death, myocardial infarction, stroke) (Q1 0.74
(0.61-0.89), Q2 0.83 (0.69-1.00), Q3 0.78 (0.65-0.94), Q4 0.82
(0.69-0.98)); P<inf>interaction</inf> = 0.81). Women had a lower primary
endpoint rate than men (Kaplan-Meier at 3 years 12.5 vs. 15.3%,
respectively, P < 0.001). Relative risk reductions in the primary endpoint
and key secondary endpoint were similar in women (0.81 (0.69-0.95) and
0.74 (0.61-0.90), respectively) compared with men (0.86 (0.80-0.94) and
0.81 (0.73-0.90), respectively), P<inf>interaction</inf> = 0.48 and 0.44,
respectively. Adverse events were more common in women and with increasing
age but, with the exception of injection site reactions, there were no
important significant differences reported by those assigned evolocumab
versus placebo. <br/>Conclusion(s): The efficacy and safety of evolocumab
are similar throughout a broad range of ages and in both men and
women.<br/>Copyright &#xa9; The European Society of Cardiology 2020.

<36>
Accession Number
2004209886
Title
Current clinical management of dysfunctional bioprosthetic pulmonary
valves.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2020. Date of
Publication: 2020.
Author
Aggarwal V.; Spigel Z.A.; Hiremath G.; Binsalamah Z.; Qureshi A.M.
Institution
(Aggarwal, Hiremath) Division of Pediatric Cardiology, Department of
Pediatrics, University of Minnesota Masonic Children's Hospital,
Minneapolis, MN, United States
(Spigel, Binsalamah) Department of Pediatric Surgery, Texas Children's
Hospital and Baylor College of Medicine, Houston, TX, United States
(Qureshi) The Lillie Frank Abercrombie Section of Cardiology, Department
of Pediatric Cardiology, Texas Children's Hospital, Baylor College of
Medicine, Houston, TX, United States
Publisher
Taylor and Francis Ltd
Abstract
Introduction: As with any bioprosthetic valve, bioprosthetic valves in the
pulmonary position have a finite life span and patients with bioprosthetic
pulmonary valves require lifetime management to treat valve dysfunction.
Areas covered: In this article, authors discuss the current medical
management for the treatment of dysfunctional bioprosthetic valves. This
review is based on both an extensive review of the recent cardiac
surgical/interventional cardiology literature (PubMed and MEDLINE database
searches from 1958 to 2019) and personal experience. Expert opinion: Valve
technology is rapidly progressing and with a coordinated effort from
cardiac surgeons and interventional cardiologists, patients suffering from
bioprosthetic pulmonary valve dysfunction can expect to have a decreased
number of procedures and less invasive procedures over their lifetime
now.<br/>Copyright &#xa9; 2020, &#xa9; 2020 Informa UK Limited, trading as
Taylor & Francis Group.

<37>
Accession Number
2004776548
Title
Association of body mass index and all-cause mortality in patients after
cardiac surgery: A dose-response meta-analysis.
Source
Nutrition. 72 (no pagination), 2020. Article Number: 110696. Date of
Publication: April 2020.
Author
Liu X.; Xie L.; Zhu W.; Zhou Y.
Institution
(Liu) Department of Critial Care Medicine, The First Affiliated Hosptial
of Gannan Medical University, Ganzhou of Jiangxi, China
(Xie) Department of Respiratory Diseases, The Second Affiliated Hospital
of Nanchang University, Nanchang, China
(Zhu) Department of Cardiology, The First Affiliated Hospital of Sun
Yat-Sen University, Guangzhou, Guangdong, China
(Zhou) Department of Pediatric Ophthalmology, The Second Affiliated
Hospital of Nanchang University, Jiangxi, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Ample studies have reported the effect of body mass index (BMI) on the
prognosis of patients undergoing cardiac surgery, but the results remain
inconsistent. Therefore, we aimed to conduct a dose-response meta-analysis
to clarify the relationship between BMI and all-cause mortality in this
population. A systematic search was performed in the PubMed and Embase
databases through April 2019 for studies that reported the impact of BMI
on all-cause mortality in patients after cardiac surgery. Pooled risk
ratios (RRs) were calculated using a random-effects model. Non-linear
associations were explored with restricted cubic spline models. Forty-one
studies with a total of 54,300 cases/1,774,387 patients were included. The
pooled RR for all-cause mortality was 0.93 (95% CI 0.89-0.97) for every
5-unit increment in BMI, indicating that higher BMI did not increase the
risk of all-cause mortality in patients after cardiac surgery. A U-shaped
association with the nadir of risk at a BMI of 25-27.5 kg/m²
was observed, as well as a higher mortality risk for the underweight and
the extremely obese patients. The subgroup analysis revealed that this
phenomenon remained regardless of mean age, surgery type, geographic
location and number of cases. Overall, for patients after cardiac surgery,
a slightly higher BMI may be instrumental in survival, whereas underweight
and extreme obesity is associated with a worse prognosis.<br/>Copyright
&#xa9; 2019 Elsevier Inc.

<38>
Accession Number
627535332
Title
Comparison of long-term clinical outcomes in multivessel coronary artery
disease patients treated either with bioresoarbable polymer
sirolimus-eluting stent or permanent polymer everolimus-eluting stent:
5-year results of the CENTURY II randomized clinical trial.
Source
Catheterization and Cardiovascular Interventions. 95 (2) (pp 175-184),
2020. Date of Publication: 01 Feb 2020.
Author
Iniguez A.; Chevalier B.; Richardt G.; Neylon A.; Jimenez V.A.; Kornowski
R.; Carrie D.; Moreno R.; Barbato E.; Serra-Penaranda A.; Guiducci V.;
Valdes-Chavarri M.; Yajima J.; Wijns W.; Saito S.
Institution
(Iniguez, Jimenez) Cardiology Department, Hospital Alvaro Cunqueiro,
University Hospital of Vigo, Vigo, Spain
(Chevalier) Interventional Cardiology Department, Institut
Cardiovasculaire Paris Sud, Massy, France
(Richardt) Department of Cardiology, Segeberger Kliniken, Bad Segeberg,
Germany
(Neylon) SAOLTA Health Care Group, Galway University Hospital and NUI,
Galway, Ireland
(Kornowski) Cardiology Department, Rabin Medical Centre, Petah Tikva,
Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel
(Carrie) Department of Cardiology, Rangueil University Hospital, Toulouse,
France
(Moreno) Interventional Cardiology Department, La Paz University Hospital,
Madrid, Spain
(Barbato) Cardiovascular Centre, Onze Lieve Vrouwe Ziekenhuis, Aalst,
Belgium and Division of Cardiology, Department of Advanced Biomedical
Sciences, University of Naples Federico II, Naples, Italy
(Serra-Penaranda) Cardiology Department, Hospital de la Santa Creu i Sant
Pau, IIB-SantPau, CIBERCV, Universidad Autonoma de Barcelona, Barcelona,
Spain
(Guiducci) Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio
Emilia, Italy
(Valdes-Chavarri) Cardiology Department, Hospital Universitario Virgen de
la Arrixaca, IMIB-Arrixaca, Murcia, Spain
(Yajima) Department of Cardiovascular Medicine, The Cardiovascular
Institute, Tokyo, Japan
(Wijns) The Lambe Institute, NUI Galway, Ireland
(Saito) Department of Cardiology and Catheterization Laboratory, Shonan
Kamakura General Hospital, Kamakura, Japan
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To assess the long-term safety and efficacy of a
sirolimus-eluting stent with bioresorbable polymer (BP-SES; Ultimaster),
in comparison to a benchmark everolimus-eluting, permanent polymer stent
(PP-EES; Xience), in a prespecified subgroup of patients with multivessel
coronary artery disease (MVD) enrolled in the CENTURY II trial.
<br/>Background(s): The use of coronary stenting in high-risk subgroups,
like MVD patients, is rising. The clinical evidence, including long-term
comparative analysis of the efficacy and safety benefits of different
new-generation drug eluting stents, however, remains insufficient.
<br/>Method(s): Among 1,119 patients (intention-to-treat) enrolled in the
CENTURY II prospective, randomized, single-blind, multicenter trial, a
prespecified subgroup of 456 MVD patients were allocated by stratified
randomization to treatment with BP-SES (n = 225) or PP-EES (n = 231). The
previously reported primary endpoint of this study was freedom from target
lesion failure (TLF: a composite of cardiac death, target vessel-related
myocardial infarction [MI] and clinically-indicated target lesion
revascularization) at 9 months. <br/>Result(s): In this MVD substudy,
baseline patient, lesion and procedure characteristics were similar
between the treatment arms. At 1 and 5 years, both BP-SES and PP-EES
displayed low and comparable rates of TLF (5.3 vs. 7.8%; p =.29 and 10.2
vs. 13.4%; p =.29), and definite or probable stent thrombosis (0.4 vs.
1.3%; p =.33 and 0.9 vs. 1.7%; p =.43), respectively. Composite endpoint
of cardiac death and MI, and patient-oriented composite endpoint of any
death, MI, and coronary revascularizations were also similar.
<br/>Conclusion(s): These results confirm good long-term safety and
efficacy of the studied bioresorbable polymer stent in this high-risk
patient population.<br/>Copyright &#xa9; 2019 The Authors. Catheterization
and Cardiovascular Interventions published by Wiley Periodicals, Inc.

<39>
Accession Number
2003936389
Title
Hyperoxia and antioxidants during major non-cardiac surgery and risk of
cardiovascular events: Protocol for a 2 x 2 factorial randomised clinical
trial.
Source
Acta Anaesthesiologica Scandinavica. 64 (3) (pp 400-409), 2020. Date of
Publication: 01 Mar 2020.
Author
Petersen C.; Loft F.C.; Aasvang E.K.; Vester-Andersen M.; Rasmussen L.S.;
Wetterslev J.; Jorgensen L.N.; Christensen R.; Meyhoff C.S.
Institution
(Petersen, Loft, Meyhoff) Department of Anaesthesia and Intensive Care,
Bispebjerg and Frederiksberg Hospital, University of Copenhagen,
Copenhagen, Denmark
(Petersen, Loft, Meyhoff) Copenhagen Center for Translational Research,
Bispebjerg and Frederiksberg, Copenhagen University Hospital, Copenhagen,
Denmark
(Aasvang, Rasmussen, Meyhoff) Department of Clinical Medicine, University
of Copenhagen, Copenhagen, Denmark
(Aasvang) Department of Anaesthesia, Centre for Cancer and Organ Diseases,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Vester-Andersen) Herlev Anaesthesia Critical and Emergency Care Science
Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital
Herlev-Gentofte, Herlev, Denmark
(Rasmussen) Department of Anaesthesia, Center of Head and Orthopaedics,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Wetterslev) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Department 7812, Copenhagen University Hospital, Rigshospitalet,
Copenhagen, Denmark
(Jorgensen) Digestive Disease Center, Bispebjerg and Frederiksberg
Hospital, University of Copenhagen, Copenhagen, Denmark
(Christensen) Musculoskeletal Statistics Unit, The Parker Institute,
Bispebjerg and Frederiksberg Hospital, University of Copenhagen,
Copenhagen, Denmark
(Christensen) Research Unit of Rheumatology, Department of Clinical
Research, University of Southern Denmark, Odense University Hospital,
Odense, Denmark
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Myocardial injury after non-cardiac surgery occurs in a high
number of patients, resulting in increased mortality in the post-operative
period. The use of high inspiratory oxygen concentrations may cause
hyperoxia, which is associated with impairment of coronary blood flow.
Furthermore, the surgical stress response increases reactive oxygen
species, which is involved in several perioperative complications
including myocardial injury and death. Avoidance of hyperoxia and
substitution of reactive oxygen species scavengers may be beneficial. Our
primary objective is to examine the effect of oxygen and added
antioxidants for prevention of myocardial injury assessed by area under
the curve for troponin measurements during the first three post-operative
days. <br/>Method(s): The VIXIE trial (VitamIn and oXygen Interventions
and cardiovascular Events) is an investigator-initiated, blinded, 2 x 2
factorial multicentre clinical trial. We include 600 patients with
cardiovascular risk factors undergoing major non-cardiac surgery.
Participants are randomised to an inspiratory oxygen fraction of 0.80 or
0.30 during and for 2 hours after surgery and either an intravenous bolus
of vitamin C and an infusion of N-acetylcysteine or matching placebo of
both. The primary outcome is the area under the curve for high-sensitive
cardiac troponin release during the first three post-operative days as a
marker of the extent of myocardial injury. Secondary outcomes are
mortality, non-fatal myocardial infarction and non-fatal serious adverse
events within 30 days. <br/>Perspective(s): The current trial will provide
further evidence for clinicians on optimal administration of perioperative
oxygen in surgical patients with cardiovascular risks and the clinical
effects of two common antioxidants.<br/>Copyright &#xa9; 2019 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<40>
Accession Number
2003713328
Title
Clinical interventions and all-cause mortality of patients with chronic
kidney disease: An umbrella systematic review of meta-analyses.
Source
Journal of Clinical Medicine. 9 (2) (no pagination), 2020. Article Number:
394. Date of Publication: February 2020.
Author
Kim J.Y.; Steingroever J.; Lee K.H.; Oh J.; Choi M.J.; Lee J.; Larkins
N.G.; Schaefer F.; Hong S.H.; Jeong G.H.; Shin J.I.; Kronbichler A.
Institution
(Kim, Choi) Yonsei University College of Medicine, Seoul 03722, South
Korea
(Steingroever, Oh) Department of Pediatric Nephrology, University Medical
Center Hamburg-Eppendorf, Martinistrase 52, Hamburg 20251, Germany
(Lee, Shin) Department of Pediatrics, Yonsei University College of
Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, South
Korea
(Lee, Shin) Division of Pediatric Nephrology, Severance Children's
Hospital, Seoul 03722, South Korea
(Lee) Department of Pediatric Nephrology, Chungnam National University
Hospital, Daejeon 35015, South Korea
(Larkins) Department of Nephrology, Perth Children's Hospital, 15 Hospital
Ave, Nedlands, WA 6909, Australia
(Larkins) Centre for Kidney Research, Kids Research Institute, Westmead,
NSW 2031, Australia
(Schaefer) Division of Pediatric Nephrology, Center for Pediatrics and
Adolescent Medicine, Heidelberg University Hospital, Heidelberg 69120,
Germany
(Hong) Department of Global Health and Population, Harvard T. H. Chan
School of Public Health, 677 Huntington Ave, Boston, MA 02115, United
States
(Jeong) College of Medicine, Gyeongsang National University, Jinju 52727,
South Korea
(Kronbichler) Department of Internal Medicine IV (Nephrology and
Hypertension), Medical University Innsbruck, Anichstrase 35, Innsbruck
6020, Austria
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Patients with chronic kidney disease (CKD) have altered physiologic
processes, which result in different treatment outcomes compared with the
general population. We aimed to systematically evaluate the efficacy of
clinical interventions in reducing mortality of patients with CKD. We
searched PubMed, MEDLINE, Embase, and Cochrane Database of Systematic
Reviews for meta-analyses of randomized controlled trials (RCT) or
observational studies (OS) studying the effect of treatment on all-cause
mortality of patients with CKD. The credibility assessment was based on
the random-effects summary estimate, heterogeneity, 95% prediction
intervals, small study effects, excess significance, and credibility
ceilings. Ninety-two articles yielded 130 unique meta-analyses. Convincing
evidence from OSs supported mortality reduction with three treatments:
angiotensin-converting-enzyme inhibitors or angiotensin II receptor
blockers for patients not undergoing dialysis, warfarin for patients with
atrial fibrillation not undergoing dialysis, and (at short-term)
percutaneous coronary intervention compared to coronary artery bypass
grafting for dialysis patients. Two treatment comparisons were supported
by highly credible evidence from RCTs in terms of all-cause mortality.
These were high-flux hemodialysis (HD) versus low-flux HD as a maintenance
HD method and statin versus less statin or placebo for patients not
undergoing dialysis. Most significant associations identified in OSs
failed to be replicated in RCTs. Associations of high credibility from
RCTs were in line with current guidelines. Given the heterogeneity of CKD,
it seems hard to assume mortality reductions based on findings from
OSs.<br/>Copyright &#xa9; 2020 by the authors. Licensee MDPI, Basel,
Switzerland.

<41>
Accession Number
630834764
Title
Postpericardiotomy syndrome after cardiac operations.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30 (1) (pp
62-66), 2020. Date of Publication: 01 Jan 2020.
Author
Yuan S.-M.
Institution
(Yuan) Division of Cardiac Surgery, Department of Cardiothoracic Surgery,
First Hospital of Putian, Teaching Hospital, Fujian Medical University,
Chengxiang District, Fujian Province, China
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
The postpericardiotomy syndrome (PPS) is an important cause of morbidity
and mortality following heart operation. This systematic review reviewed
the literature regarding PPS. It was found to occur on day 18.3 +/-15.9
after cardiac operations, most often after coronary artery bypass
grafting, and mitral valve replacement. The most common symptoms were
new/worsening pericardial effusions, pleuritic chest pain, and fever. The
inflammation markers, such as C-reactive protein and erythrocyte
sedimentation rate, were found to increase significantly in each patient
who had these parameters examined. The subjects were managed
conservatively in 472 (83.5%) patients, by surgical pericardial drainage
in 85 (15.0%) patients, by thora-/pericardio-centesis in 3 (0.5%)
patients, and were under surveillance without being treated in 5 (0.9%)
patients. Conservative treatment was likely to be associated with a higher
recovery rate. Surgical trauma and cardiopulmonary bypass trigger the
systemic inflammatory response, which results in antiheart autoantigen
release, and the deposited immune complex could be found in the
pericardial, pleural, and lung tissues, thereby provoking the occurrence
of PPS. Therapeutic options for the refractory cases are long-term oral
corticoids or pericardiectomy. Surgical intervention was warranted in 2.6%
of the cases due to cardiac tamponade.<br/>Copyright &#xa9; 2020 College
of Physicians and Surgeons Pakistan. All rights reserved.

<42>
Accession Number
2003604729
Title
Hypotheses, rationale, design, and methods for evaluation of a randomized
controlled trial using tocotrienol, an isomer of vitamin e derived from
palm oil, on the prevention of atrial fibrillation after coronary artery
bypass grafting surgery [version 2; peer review: 1 approved, 1 approved
with reservations].
Source
F1000Research. 7 (no pagination), 2018. Article Number: 215. Date of
Publication: 2018.
Author
Musa A.F.; Dillon J.; Md Taib M.E.; Yunus A.M.; Nordin R.B.; Hay Y.K.
Institution
(Musa, Nordin) Jeffrey Cheah School of Medicine and Health Sciences,
Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
(Dillon, Md Taib, Yunus) Department of Cardiothoracic Surgery, National
Heart Institute, Kuala Lumpur, Malaysia
(Hay) School of Pharmaceutical Sciences, Universiti Sains Malaysia,
Penang, Malaysia
Publisher
F1000 Research Ltd
Abstract
Background: One of the most common complications following coronary artery
bypass grafting (CABG) surgery is atrial fibrillation (AF), which
contributes towards increasing morbidity and mortality, length of hospital
stay (LoHS) and reduced quality of life (QoL) of patients.
<br/>Objective(s): To determine whether the intake of Tocotrienol, a
Vitamin E isomer derived from palm oil, before and immediately following
CABG prevents AF, reduces LoHS, and improves the QoL of patients.
Protocol: The study is registered with the National Medical Research
Register with a trial number NMRR-17-1994-34963 and designed as a
prospective, randomized controlled trial (RCT) with parallel groups. The
experimental group will receive two 200mg Tocotrienol capsules each day,
while the control group will receive two identical placebo (palm Super
Olein) capsules per day. ECG readings will be used to detect AF post
operatively, LoHS will be measured by checking the records from the
National Heart Institute Hospital register, and the health-related Quality
of Life (HRQoL) analysis (the Malay version of the Short Form 36
Questionnaire) will be used to analyse QoL. The sample size was calculated
to be 140 in each arm of the RCT for a power of 0.8 and a significance
level of 0.05.<br/>Copyright &#xa9; 2018 Musa AF et al.

<43>
Accession Number
606426494
Title
Perioperative statin therapy in patients at high risk for cardiovascular
morbidity undergoing surgery: A review.
Source
British Journal of Anaesthesia. 114 (1) (pp 44-52), 2015. Date of
Publication: January 2015.
Author
De Waal B.A.; Buise M.P.; Van Zundert A.A.J.
Institution
(De Waal) Department of Anesthesiology, Maastricht University Medical
Centre, P. Debyelaan 25, HX Maastricht 6229, Netherlands
(Buise) Department of Anesthesiology, Catharina Hospital, Postbus 1350, ZA
Eindhoven 5602, Netherlands
(Van Zundert) Discipline of Anesthesiology, University of Queensland,
Faculty of Medicine and Biomedical Sciences, Royal Brisbane and Women's
Hospital, Herston Campus, Brisbane, QLD 4029, Australia
Publisher
Oxford University Press
Abstract
Statins feature documented benefits for primary and secondary prevention
of cardiovascular disease and are thought to improve perioperative
outcomes in patients undergoing surgery. To assess the clinical outcomes
of perioperative statin treatment in statin-naive patients undergoing
surgery, a systematic review was performed. Studies were included if they
met the following criteria: randomized controlled trials, patients aged
A18 yr undergoing surgery, patients not already on long-term statin
treatment, reported outcomes including at least one of the following:
mortality, myocardial infarction, atrial fibrillation, stroke, and length
of hospital stay. The following randomized clinical trials were excluded:
retrospective studies, trials without surgical procedure, trials without
an outcome of interest, studies with patients on statin therapy before
operation, or papers not written in English. The literature search
revealed 16 randomized controlled studies involving 2275 patients. Pooled
results showed a significant reduction in (i) mortality [risk ratio (RR)
0.53, 95% confidence interval (CI) 0.30.0.94, P=0.03], (ii) myocardial
infarction (RR 0.54, 95% CI 0.38.0.76, P<0.001), (iii) perioperative
atrial fibrillation (RR 0.53, 95% CI 0.43.0.66, P<0.001), and (iv) length
of hospital stay (days, mean difference 20.58, 95% CI -0.79 to -0.37,
P<0.001) in patients treated with a statin. Subgroup analysis in patients
undergoing non-cardiac surgery showed a decrease in the perioperative
incidence of mortality and myocardial infarction. Consequently,
anaesthetists should consider prescribing a standarddose statin before
operation to statin-naive patients undergoing cardiac surgery. However,
there are insufficient data to support final recommendations on
perioperative statin therapy for patients undergoing non-cardiac
surgery.<br/>Copyright &#xa9; The Author 2014. Published by Oxford
University Press on behalf of the British Journal of Anaesthesia. All
rights reserved.

<44>
Accession Number
2004790415
Title
Detecting patients with PMI post-CABG based on cardiac troponin-T
profiles: A latent class mixed modeling approach.
Source
Clinica Chimica Acta. 504 (pp 23-29), 2020. Date of Publication: May 2020.
Author
Deneer R.; Boxtel A.G.M.V.; Boer A.-K.; Hamad M.A.S.; Riel N.A.W.V.;
Scharnhorst V.
Institution
(Deneer, Boer, Scharnhorst) Clinical Laboratory, Catharina Hospital
Eindhoven, Netherlands
(Deneer, Riel, Scharnhorst) Department of Biomedical Engineering,
Eindhoven University of Technology, Netherlands
(Boxtel, Hamad) Department of Cardiothoracic Surgery, Catharina Hospital
Eindhoven, Netherlands
(Riel) Department of Vascular Medicine, Amsterdam University Medical
Centers, Netherlands
Publisher
Elsevier B.V.
Abstract
Background: Diagnosis of perioperative myocardial infarction (PMI) after
coronary artery bypass grafting (CABG) is fraught with complexity since it
is primarily based on a single cut-off value for cardiac troponin (cTn)
that is exceeded in over 90% of CABG patients, including non-PMI patients.
In this study we applied an unsupervised statistical modeling approach to
uncover clinically relevant cTn release profiles post-CABG, including PMI,
and used this to improve diagnostic accuracy of PMI. <br/>Method(s): In
624 patients that underwent CABG, cTnT concentration was serially measured
up to 24 h post aortic cross clamping. 2857 cTnT measurements were
available to fit latent class linear mixed models (LCMMs). <br/>Result(s):
Four classes were found, described by: normal, high, low and rising cTnT
release profiles. With the clinical diagnosis of PMI as golden standard,
the rising profile had a diagnostic accuracy of 97%, compared to 83% for
an optimally chosen cut-off and 21% for the guideline recommended cut-off
value. <br/>Conclusion(s): Clinically relevant subgroups, including
patients with PMI, can be uncovered using serially measured cTnT and a
LCMM. The LCMM showed superior diagnostic accuracy of PMI. A rising cTnT
profile is potentially a better criterion than a single cut-off value in
diagnosing PMI post-CABG.<br/>Copyright &#xa9; 2020 Elsevier B.V.

<45>
Accession Number
626397461
Title
Use of nalbuphine as a substitute for butorphanol in combination with
dexmedetomidine and tiletamine/zolazepam: a randomized non-inferiority
trial.
Source
Journal of Feline Medicine and Surgery. 22 (2) (pp 100-107), 2020. Date of
Publication: 01 Feb 2020.
Author
Kreisler R.E.; Cornell H.N.; Smith V.A.; Kelsey S.E.; Hofmeister E.H.
Institution
(Kreisler, Cornell) Department of Pathology and Population Medicine,
Animal Health Institute, College of Veterinary Medicine, Midwestern
University, Glendale, AZ, United States
(Smith, Kelsey) College of Veterinary Medicine, Midwestern University,
Glendale, AZ, United States
(Hofmeister) Department of Surgery, Animal Health Institute, College of
Veterinary Medicine, Midwestern University, Glendale, AZ, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objectives: The goal of this study was to determine whether a drug
combination using nalbuphine with dexmedetomidine and tiletamine/zolazepam
is non-inferior to one that uses butorphanol. <br/>Method(s): All healthy
cats presenting solely for gonadectomy to two trap-neuter-return mobile
clinic days were randomly assigned to induction with a combination of
tiletamine/zolazepam 3 mg/kg, dexmedetomidine 7.5 micro&#32;g/kg and
either butorphanol or nalbuphine at 0.15 mg/kg. All participants were
blinded to the identity of the combinations. The primary endpoint was
clinician satisfaction, comprised of the mean of four satisfaction ratings
on a 7-point Likert scale (highly dissatisfied through to highly
satisfied) recorded for induction, maintenance of anesthesia, surgery and
recovery. Exploratory endpoints included each individual score, number of
injections, duration of induction, duration of recovery and need for
reversal agent. To assess non-inferiority for the primary endpoint and
individual scores, the difference and 95% confidence intervals (CIs) of
the difference between the mean clinical scores for the nalbuphine and
butorphanol-based combinations were calculated and compared with a
prespecified non-inferiority margin of 20% (1.4 points). <br/>Result(s):
Seventy-two cats were enrolled, 36 in each group. The mean +/- SD
composite score for the combination with nalbuphine was 6.06 +/- 0.59 (95%
CI 5.86-6.25) points, while the combination with butorphanol was 6.22 +/-
0.62 (95% CI 6.01-6.43). The difference between mean scores was 0.17
(-0.12 to 0.45), which did not exceed the prespecified boundary of 1.4,
establishing the non-inferiority of nalbuphine. No individual clinical
score for nalbuphine was inferior to butorphanol, and there were no
significant differences for any secondary endpoints. Conclusions and
relevance: The clinical experience of the nalbuphine-based combination was
non-inferior to the butorphanol-based combination. Nalbuphine is an
effective substitute for butorphanol, providing another option if
butorphanol is unavailable due to shortage, controlled status or cost,
without requiring a change in anesthetic workflow.<br/>Copyright &#xa9;
The Author(s) 2019.

<46>
Accession Number
629661322
Title
Effect of the Tailored, Family-Involved Hospital Elder Life Program on
Postoperative Delirium and Function in Older Adults: A Randomized Clinical
Trial.
Source
JAMA Internal Medicine. 180 (1) (pp 17-25), 2020. Date of Publication:
January 2020.
Author
Wang Y.-Y.; Yue J.-R.; Xie D.-M.; Carter P.; Li Q.-L.; Gartaganis S.L.;
Chen J.; Inouye S.K.
Institution
(Wang, Yue, Xie) Department of Geriatrics, National Clinical Research
Center for Geriatrics, West China Hospital, Sichuan University, No. 37
Guoxue Xiang, Chengdu 610041, China
(Wang, Carter) School of Nursing, University of Texas at Austin, Austin,
United States
(Li) School of Nursing, Johns Hopkins University, Baltimore, MD, United
States
(Gartaganis, Inouye) Hinda and Arthur Marcus Institute for Aging Research,
Hebrew SeniorLife, Boston, MA, United States
(Chen) Department of Breast Surgery, West China Hospital, Sichuan
University, Chengdu, Sichuan Province, China
(Inouye) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Postoperative delirium (POD) is a common condition for older
adults, contributing to their functional decline. <br/>Objective(s): To
investigate the effectiveness of the Tailored, Family-Involved Hospital
Elder Life Program (t-HELP) for preventing POD and functional decline in
older patients after a noncardiac surgical procedure. <br/>Design,
Setting, and Participant(s): A 2-arm, parallel-group, single-blind,
cluster randomized clinical trial was conducted from August 24, 2015, to
February 28, 2016, on 6 surgical floors (gastric, colorectal, pancreatic,
biliary, thoracic, and thyroid) of West China Hospital in Chengdu, China.
Eligible participants (n = 281) admitted to each of the 6 surgical floors
were randomized into a nursing unit providing t-HELP (intervention group)
or a nursing unit providing usual care (control group). All randomized
patients were included in the intention-to-treat analyses for the primary
outcome of POD incidence. Statistical analysis was performed from April 3,
2016, to December 30, 2017. <br/>Intervention(s): In addition to receiving
usual care, all participants in the intervention group received the t-HELP
protocols, which addressed each patient's risk factor profile. Besides
nursing professionals, family members and paid caregivers were involved in
the delivery of many of the program interventions. <br/>Main Outcomes and
Measures: The primary outcome was the incidence of POD, evaluated with the
Confusion Assessment Method. Secondary outcomes included the pattern of
functional and cognitive changes (activities of daily living [ADLs],
instrumental activities of daily living [IADLs], Short Portable Mental
Status Questionnaire [SPMSQ]) from hospital admission to 30 days after
discharge, and the length of hospital stay (LOS). <br/>Result(s): Of the
475 patients screened for eligibility, 281 (171 [60.9%] male, mean [SD]
age 74.7 [5.2] years) were enrolled and randomized to receive t-HELP (n =
152) or usual care (n = 129). Postoperative delirium occurred in 4
participants (2.6%) in the intervention group and in 25 (19.4%) in the
control group, with a relative risk of 0.14 (95% CI, 0.05-0.38). The
number needed to treat to prevent 1 case of POD was 5.9 (95% CI,
4.2-11.1). Participants in the intervention group compared with the
control group showed less decline in physical function (median
[interquartile range] for ADLs: -5 [-10 to 0] vs -20 [-30 to -10]; P
<.001; for IADLs: -2 [-2 to 0] vs -4 [-4 to -2]; P <.001) and cognitive
function (for the SPMSQ level: 1 [0.8%] vs 8 [7.0%]; P =.009) at
discharge, as well as shorter mean (SD) LOS (12.15 [3.78] days vs 16.41
[4.69] days; P <.001). <br/>Conclusions and Relevance: The findings
suggest that t-HELP, with family involvement at its core, is effective in
reducing POD for older patients, maintaining or improving their physical
and cognitive functions, and shortening the LOS. The results of this
t-HELP trial may improve generalizability and increase the implementation
of this program. Trial Registration: Chinese Clinical Trial Registry
Identifier: ChiCTR-POR-15006944.<br/>Copyright &#xa9; 2019 American
Medical Association. All rights reserved.

<47>
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. 34 (1) (pp 51-62), 2020. Date of
Publication: January 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.

<48>
Accession Number
2004322340
Title
Remote Ischaemic Preconditioning Attenuates Cardiac Biomarkers During
Vascular Surgery: A Randomised Clinical Trial.
Source
European Journal of Vascular and Endovascular Surgery. 59 (2) (pp
301-308), 2020. Date of Publication: February 2020.
Author
Kepler T.; Kuusik K.; Lepner U.; Starkopf J.; Zilmer M.; Eha J.; Vahi M.;
Kals J.
Institution
(Kepler, Lepner, Kals) Department of Surgery, Institute of Clinical
Medicine, University of Tartu, Tartu, Estonia
(Kepler, Kuusik, Zilmer, Kals) Department of Biochemistry, Institute of
Biomedicine and Translational Medicine, Centre of Excellence for Genomics
and Translational Medicine, University of Tartu, Tartu, Estonia
(Kuusik, Eha) Department of Cardiology, Institute of Clinical Medicine,
University of Tartu, Tartu, Estonia
(Lepner, Starkopf, Eha, Kals) Tartu University Hospital, Tartu, Estonia
(Starkopf) Department of Anaesthesiology and Intensive Care, Institute of
Clinical Medicine, University of Tartu, Tartu, Estonia
(Vahi) Institute of Mathematics and Statistics, University of Tartu,
Tartu, Estonia
Publisher
W.B. Saunders Ltd
Abstract
Objective: The main aim of this study was to evaluate the effect of remote
ischaemic preconditioning (RIPC) on preventing the leakage of cardiac
damage biomarkers in patients undergoing vascular surgery. <br/>Method(s):
This is a randomised, sham-controlled, double-blinded, single-centre
study. Patients undergoing open abdominal aortic aneurysm repair, surgical
lower limb revascularisation surgery or carotid endarterectomy were
recruited non-consecutively. The RIPC protocol consisting of 4 cycles of 5
minutes of ischaemia, followed by 5 minutes of reperfusion, was applied. A
RIPC or a sham procedure was performed noninvasively along with
preparation for anaesthesia. High sensitivity troponin T level was
measured preoperatively and 2, 8 and 24 hours after surgery and pro b-type
natriuretic peptide was measured preoperatively and 24 hours after
surgery. <br/>Result(s): There was significantly higher leakage of high
sensitivity troponin T (peak change median 2 ng/L, IQR 0.9-6.2 ng/L vs 0.6
ng/L, IQR 0.7-2.1 ng/L, p = .0002) and pro b-type natriuretic peptide
(change median 144 pg/mL, IQR 17-318 pg/mL vs 51 pg/mL, IQR 12-196 pg/mL,
p = .02) in the sham group compared to the RIPC group. <br/>Conclusion(s):
RIPC reduces the leakage of high sensitivity troponin T and pro b-type
natriuretic peptide. Therefore, it may offer cardioprotection in patients
undergoing non-cardiac vascular surgery. The clinical significance of RIPC
has to be evaluated in larger studies excluding the factors known to
influence its effect.<br/>Copyright &#xa9; 2019 European Society for
Vascular Surgery

<49>
Accession Number
2004192412
Title
Effect of atrial pacing on post-operative atrial fibrillation following
coronary artery bypass grafting: Pairwise and network meta-analyses.
Source
International Journal of Cardiology. 302 (pp 103-107), 2020. Date of
Publication: 1 March 2020.
Author
Ruan Y.; Robinson N.B.; Naik A.; Silva M.; Hameed I.; Rahouma M.; Oakley
C.; Di Franco A.; Zamvar V.; Girardi L.N.; Gaudino M.
Institution
(Ruan, Robinson, Naik, Silva, Hameed, Rahouma, Oakley, Di Franco, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Cornell Medicine, New York,
NY, United States
(Zamvar) Department of Cardiothoracic Surgery, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom
(Ruan) Department of Cardiovascular Surgery, Renmin Hospital of Wuhan
University, Wuhan, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: To determine the effect of atrial pacing on the rate of
post-operative atrial fibrillation (POAF) following coronary artery bypass
grafting. <br/>Method(s): After a systematic literature search, randomized
clinical trials (RCTs) comparing any combination of no pacing (NP),
bi-atrial (BiA) pacing, left-atrial (LA) pacing and right-atrial (RA)
pacing were included. Pairwise and network meta-analyses were performed
using the generic inverse variance method. The primary outcome was POAF
incidence. Secondary outcomes were postoperative bleeding, infection, and
operative mortality. Leave-one-out and meta-regression were done.
<br/>Result(s): Fourteen RCTs were included with a total of 1727 patients.
Compared with NP, any form of atrial pacing was significantly associated
with lower incidence of POAF (odds ratio [OR]: 0.49; 95% confidence
interval [CI]: 0.35-0.69). BiA pacing was associated with the larger risk
reduction (OR: 0.36; 95% CI: 0.20-0.64 vs. 0.59; 95% CI: 0.34-1.02 for LA
and 0.64; 95% CI: 0.38-1.07 for RA). Secondary outcomes were similar
between the no pacing and pacing groups. On meta-regression, age and the
use of continuous monitoring were associated with lower reduction of the
incidence of POAF. In the network meta-analysis, BiA pacing ranked the
best strategy for the prevention of POAF (OR: 0.34; 95% CI: 0.21-0.55).
<br/>Conclusion(s): Compared to other pacing modalities, BiA pacing is
associated with lower rates of POAF following CABG.<br/>Copyright &#xa9;
2019 Elsevier B.V.

<50>
Accession Number
629168285
Title
The combined effect of Vitamin C and omega-3 polyunsaturated fatty acids
on fatigue following coronary artery bypass graft surgery: A triple-blind
clinical trial.
Source
Journal of Complementary and Integrative Medicine. 16 (4) (no pagination),
2019. Article Number: jcim-2018-0113. Date of Publication: 01 Dec 2019.
Author
Gholami M.; Najafizadeh H.; Teimouri H.; Ardalan A.; Pooria A.; Tarrahi
M.J.
Institution
(Gholami) School of Nursing and Midwifery, Lorestan University of Medical
Sciences, Khorramabad, Iran, Islamic Republic of
(Najafizadeh) Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran, Islamic Republic of
(Teimouri, Pooria) Department of Cardiac Surgery, School of Medicine,
Lorestan University of Medical Sciences, Khorramabad, Iran, Islamic
Republic of
(Ardalan) 563 hampshire Rd,Apt 273, Westlake Village, CA 91361, United
States
(Tarrahi) Department of Epidemiology and Biostatistics, School of Health,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
De Gruyter (E-mail: peter.golla@degruyter.com)
Abstract
Fatigue is a common compliant among patients who undergo coronary artery
bypass graft (CABG) surgery. This may affect patients' function in all
aspects. A few studies have already assessed the influence of
complementary therapies on minimizing fatigue. This study aimed to
investigate the combined effect of Vitamin C and omega-3 polyunsaturated
fatty acids (n-3 PUFA) on fatigue following CABG surgery. In this
randomized, triple-blind placebo-controlled trial, 160 patients who
already underwent CABG surgery were randomly assigned into an experimental
or a control groups. Each group consisted of 80 patients. The experimental
group was given both n-3 PUFA and Vitamin C the day before surgery. They
also received the same supplements in the first 5 days of operation. The
control group received only placebo. Subjects in both groups responded to
Multidimensional Fatigue Inventory (MFI-20) scale in the beginning, and at
the end of the intervention as well as on the fifth day of the operation.
Chi-square test and independent t-test were used for data analysis. The
mean fatigue score in experimental and control groups came up to 62.01 +/-
4.06 and 67.92 +/- 4.95 (p<0.0001), respectively, which was greater than
that of the values we had before intervention. The mean difference of
fatigue score was 3.97 +/- 3.49 and 9.56 +/- 6.41 (p<0.0001) prior and
following the intervention, correspondingly. Combination of Vitamin C and
n-3 PUFA effectively reduces post-operative fatigue among patients who
undergo CABG surgery.<br/>Copyright &#xa9; 2019 2019 Walter de Gruyter
GmbH, Berlin/Boston.

<51>
Accession Number
2003795670
Title
Synchronous versus Staged Carotid Endarterectomy and Coronary Artery
Bypass Graft for Patients with Concomitant Severe Coronary and Carotid
Artery Stenosis: A Systematic Review and Meta-analysis.
Source
Annals of Vascular Surgery. 63 (pp 427-438.e1), 2020. Date of Publication:
February 2020.
Author
Tzoumas A.; Giannopoulos S.; Texakalidis P.; Charisis N.; Machinis T.;
Koullias G.J.
Institution
(Tzoumas) Department of Internal Medicine, Medical School Aristotle
University of Thessaloniki, Thessaloniki, Greece
(Giannopoulos) Department of Surgery, 251 HAF and VA Hospital, Athens,
Greece
(Texakalidis) Department of Neurosurgery, Emory University School of
Medicine, Atlanta, GA, United States
(Charisis) Division of Surgical Oncology, Department of Surgery, Stony
Brook University Hospital, Stony Brook, NY, United States
(Machinis) Department of Neurosurgery, Virginia Commonwealth University,
Richmond, VA, United States
(Koullias) Division of Vascular and Endovascular Surgery, Department of
Surgery, Stony Brook University Hospital, Stony Brook, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Due to the systemic nature of atherosclerosis, arteries at
different sites are commonly simultaneously affected. As a result, severe
coronary artery disease (CAD) requiring coronary artery bypass grafting
(CABG) frequently coexists with significant carotid stenosis that warrants
revascularization. To compare simultaneous carotid endarterectomy (CEA)
and CABG versus staged CEA and CABG for patients with concomitant CAD and
carotid artery stenosis in terms of perioperative outcomes.
<br/>Method(s): This study was performed according to the Preferred
Reporting Items for Systematic reviews and Meta-Analyses guidelines. A
meta-analysis was conducted with the use of a random effects model. The
I² statistic was used to assess for heterogeneity.
<br/>Result(s): Eleven studies comprising 44,895 patients were included in
this meta-analysis (21,710 in the synchronous group and 23,185 patients in
the staged group). The synchronous CEA and CABG group had a statistically
significant lower risk for myocardial infarction (MI) (odds ratio [OR]
0.15, 95% CI 0.04-0.61, I² = 0%) and higher risk for stroke (OR
1.51, 95% CI 1.34-1.71, I² = 0%) and death (OR 1.33, 95% CI
1.01-1.75, I² = 47.8%). Transient ischemic attacks (TIAs) (OR
1.27, 95% CI 1.00-1.61, I² = 0.0%), postoperative bleeding (OR
0.82, 95% CI 0.22-3.05, I² = 0.0%), and pulmonary complications
(OR 1.52, 95% CI 0.24-9.60, I² = 67.5%) were similar between
the 2 groups. <br/>Conclusion(s): Patients in the simultaneous CEA and
CABG group had a significantly higher risk of 30-day mortality and stroke
and lower risk for MI as compared to staged CEA and CABG group. The rates
of TIA, postoperative bleeding, and pulmonary complications were similar
between the 2 groups. Future randomized trials or prospective cohorts are
needed to validate our results.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<52>
Accession Number
630084623
Title
A Randomized Trial of Intravenous Thyroxine for Brain-Dead Organ Donors
With Impaired Cardiac Function.
Source
Progress in transplantation (Aliso Viejo, Calif.). 30 (1) (pp 48-55),
2020. Date of Publication: 01 Mar 2020.
Author
Dhar R.; Stahlschmidt E.; Marklin G.
Institution
(Dhar) Division of Neurocritical Care, Department of Neurology, Washington
University School of Medicine in St Louis, MO, United States
(Stahlschmidt, Marklin) Mid-America Transplant, St Louis, MO, USA
Publisher
NLM (Medline)
Abstract
RATIONALE: Brain death (BD) precipitates cardiac dysfunction impairing the
ability to transplant hearts from eligible organ donors. Retrospective
studies have suggested that thyroid hormone may enhance myocardial
recovery and increase hearts transplanted. We performed a randomized trial
evaluating whether intravenous thyroxine (T4) improves cardiac function in
BD donors with impaired ejection fraction (EF). <br/>METHOD(S): All
heart-eligible donors managed at a single-organ procurement organization
(OPO) underwent protocolized fluid resuscitation. Those weaned off
vasopressors underwent transthoracic echocardiography (TTE) within 12
hours of BD and, if EF was below 60%, were randomized to T4 infusion or no
T4 for 8 hours, after which TTE was repeated. <br/>RESULT(S): Of 77
heart-eligible donors, 36 were weaned off vasopressors. Ejection fraction
was depressed in 30, of whom 28 were randomized to T4 (n = 17) vs control
(n = 11). Baseline EF was comparable (45%, interquartile range [IQR]
42.5-47.5 vs 40%, 40-50, P = .32). Ejection fraction did not improve more
with T4 (10%, IQR 5-15 vs 5%, 0-12.5, P = .24), although there was a trend
to more hearts transplanted (59% vs 27%, P = .14). This difference
appeared to be accounted for by more donors with a history of drug use in
the T4 group, who exhibited greater improvements in EF (15% vs 0% without
drug use, P = .01) and more often had hearts transplanted (12 of 19 vs 1
of 9, P = .01). <br/>CONCLUSION(S): In this small randomized study of BD
donors with impaired cardiac function, T4 infusion did not result in
greater cardiac recovery. A larger randomized trial comparing T4 to
placebo appears warranted but would require collaboration across multiple
OPOs.

<53>
Accession Number
629700820
Title
Does concurrent use of intra-aortic balloon pumps improve survival in
patients with cardiogenic shock requiring venoarterial extracorporeal
membrane oxygenation?.
Source
Interactive cardiovascular and thoracic surgery. 30 (2) (pp 312-315),
2020. Date of Publication: 01 Feb 2020.
Author
Wang D.; Chao V.; Yap K.H.; Tan T.E.
Institution
(Wang, Chao, Yap, Tan) Department of Cardiothoracic Surgery, National
Heart Centre Singapore, Singapore
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Does concurrent use of
intra-aortic balloon pump (IABP) improve survival in patients with
cardiogenic shock requiring venoarterial extracorporeal membrane
oxygenation (VA-ECMO)?'. Altogether 472 papers were found using the
reported search, of which 3 level 2 systematic reviews represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. The reported
comparative outcomes were mortality, weaning off extracorporeal membrane
oxygenation (ECMO), vascular complications and non-vascular complications.
One systematic review demonstrated significantly lower in-hospital
mortality with concurrent use of IABP and VA-ECMO, while the other 2
studies showed no difference in mortality. One paper reported on the
weaning success from ECMO and demonstrated significantly higher weaning
success with concurrent IABP usage. Another paper reported on the
complications and showed no differences in vascular and non-vascular
complications. We conclude that there was no significant improvement in
survival with the concurrent use of IABP and VA-ECMO for a cardiogenic
shock as compared to the use of VA-ECMO alone. However, the concurrent use
of IABP with VA-ECMO improved weaning success from VA-ECMO. The incidence
of vascular and non-vascular complications was similar with or without
IABP usage.<br/>Copyright &#xa9; The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<54>
Accession Number
630824826
Title
Warfarin anticoagulation following pediatric heart surgery: Comparing home
versus traditional lab monitoring.
Source
Journal of Investigative Medicine. Conference: 2020 Western Medical
Research Conference. United States. 68 (1) (pp A6), 2020. Date of
Publication: January 2020.
Author
Ligsay A.; Griffin D.; Frazer J.; Sah S.
Institution
(Ligsay, Sah) University of California San Diego, San Diego, CA, United
States
(Griffin, Sah) Rady Children's Hospital, San Diego, CA, United States
(Frazer) University of California Los Angeles, Los Angeles, CA, United
States
(Frazer) Santa Barbara Cottage Hospital, Santa Barbara, CA, United States
Publisher
BMJ Publishing Group
Abstract
Purpose of study Warfarin is commonly used following placement of
mechanical heart valves or an extracardiac conduit in the Fontan procedure
in order to minimize risk of thrombotic events. The degree of
anticoagulation is monitored by the patient's international normalized
ratio (INR), which is traditionally done by serial outpatient blood draws.
The goal of this pilot study is to determine if anticoagulation can be
better managed using a home INR monitoring system compared to traditional
laboratory monitoring. Methods used Patients who underwent artificial
mechanical valve placement and/or an extracardiac Fontan procedure were
consented and randomized to one of two 3-month arms: INR testing via 1)
traditional laboratory monitoring (venipuncture), or 2) a home INR monitor
(finger stick test). After 3 months, patients were crossed-over to the
other arm (6 months total in the study). Frequency of INR checks was
determined per cardiologists' clinical judgement. A questionnaire was
completed after each arm of the study. Eleven subjects have been enrolled
into the study thus far: 10 have completed at least one arm of the study,
5 have completed both arms, and 1 patient was withdrawn after the first
arm due to non-compliance. Student t-tests were performed to compare time
and cost differences between the two arms. Summary of results The ease of
obtaining INR value between home and laboratory monitoring was rated as
similar (3.4/5 vs 3.8/5), with similar pain rating experience by the
subject (2/5 vs 2.4/5). However, parents were more satisfied with using
the home INR system (4/5 vs 2.9/5) and were more likely to recommend to
others (4.2/5 vs 2.5/5). The average time it took to use the home INR
monitor versus lab monitoring was also significant (3.8 minutes vs 53.3
minutes; p<0.0001). The percentage of INR in therapeutic range for
subjects was also similar between arms (home 46.9% vs lab 43.4%;
p=0.6396). Conclusions Overall, preliminary data show similar outcomes
between home vs lab INR monitoring, with the former showing improved
patient satisfaction and time saved. Ongoing cost-effective analysis is
being conducted as the pilot study continues.

<55>
Accession Number
630824657
Title
Surgical interventions for mitral valve bacterial endocarditis in
pediatric patients: A systematic review.
Source
Journal of Investigative Medicine. Conference: 2020 Western Medical
Research Conference. United States. 68 (1) (pp A218), 2020. Date of
Publication: January 2020.
Author
Rodriguez D.; Rosenow C.; Frey M.; Arbon J.; Jahanyar J.
Institution
(Rodriguez, Rosenow, Arbon) Mayo Clinic Alix School of Medicine,
Scottsdale, AZ, United States
(Frey) Midwestern University Chicago College of Osteopathic Medicine,
Glendale, AZ, United States
(Jahanyar) Mayo Clinic, Phoenix, AZ, United States
Publisher
BMJ Publishing Group
Abstract
Purpose of study Bacterial endocarditis is an infection of the heart's
endothelial lining, causing the formation of bacterial vegetations most
commonly around the lining of the mitral valve. In 52% of cases, surgical
intervention is required. Mitral valve (MV) repair and replacement are the
most common corrective procedures, however, there is scarce literature
comparing the outcomes of both procedures in a pediatric cohort. Methods
used A systematic literature review using PubMed, Ovid EMBASE, Cochrane
Database of Systematic Reviews, Scopus, and Web of Science identified 20
case reports for data extraction. Papers were selected through the
systematic use of search terms and were manually assessed for relevance
and inclusion of pertinent data. Data parameters included postoperative
complications and outcomes. Review and meta-analysis were conducted
according to PRISMA guidelines. Summary of results The mean age of the
patients was 6.4 years. 10 patients underwent MV repair and 10 underwent
MV replacement. 1 patient had 2 repairs of the MV that resulted in the
failure of each procedure. This ultimately led to the replacement of the
previously repaired valve. Although MV repair had more overall
complications, MV replacement resulted in more severe complications such
as heart block (10%) and valve thrombosis (40%). In the MV repair group,
MV regurgitation and MV stenosis were present post-opera-tively in 40% and
20% of patients, respectively. Conclusions We recommend that MV repair
should be the treatment of choice since complications are less grave, as
they are mainly comprised of residual regurgitation or novel stenosis. The
major adverse outcomes seen in patients after valve replacement are
associated with more severe sequelae and future implications for patients.
Improving outcomes for MV repair in this patient cohort should be the
focus of possible future studies.

<56>
Accession Number
2004862283
Title
Industry Compensation To Physician Vascular Specialist Authors Of Highly
Cited Aortic Aneurysm Manuscripts.
Source
Annals of Vascular Surgery. Conference: Vascular & Endovascular Surgery
Society, Scientific Program Abstracts, 44th Annual Meeting, Steamboat.
United States. 63 (pp 2), 2020. Date of Publication: February 2020.
Author
Bellomo T.R.; Hwang C.; Kim G.; Osborne N.; Stanley J.; Corriere M.A.
Institution
(Bellomo, Hwang, Kim, Osborne, Stanley, Corriere) University of Michigan
Medical School, Ann Arbor, MI, United States
Publisher
Elsevier Inc.
Abstract
Introduction and objectives: Industry compensation may influence physician
attitudes toward medical devices and products. Disclosure of industry
compensation by authors of manuscripts is often left up to authors
themselves and is not routinely audited. The purpose of this analysis was
to characterize industry compensation among highly cited research studies
related to AA. <br/>Method(s): A Web of Science search of "Aortic
Aneurysm" excluding review articles and non-English language publications
identified publications from 2013-2017. The top 100 most-cited
publications were abstracted by author. Industry compensation to physician
authors registered as Medicare providers were queried using the ProPublica
Dollars for Docs search tool (linked to Centers for Medicare and Medicaid
Services Open Payments data) based on provider name, specialty, and
geographic location. Statistical analysis included descriptive statistics
and categorical tests. <br/>Result(s): Industry compensation was
identified for 126 authors of highly cited AA manuscripts. Physician
specialties included Vascular Surgery (44%), Cardiothoracic Surgery (34%),
Interventional Cardiology (10%), Pediatric Cardiology (7%) and Vascular &
Interventional Radiology (5%). Physician authors received 14,170 payments
totaling $6,301,536 over the study period. Median total industry
compensation per physician author (among those with reported payments)
ranged from $18 to $810,483 (median $6,932, interquartile range $47,588).
Categories accounting for the largest share of physician compensation were
consulting ($2,014,757), promotional speaking ($1,008.046), Royalty or
Licensing ($504,631), and Honoraria ($474,742). Food and beverage
accounted for the largest number of transactions (10,148 payments with a
median amount of $31, IQR $76), while the largest payment amounts per
transaction were related to royalties or licensing fees (median of
$15,418). <br/>Conclusion(s): Although only a minority of physician
authors of highly cited AA manuscripts receive industry compensation,
payments may be significant and potentially influential. Transparent
reporting of any industry compensation should be advocated so that readers
can assess potential bias, which may be underestimated based on selective
self-reporting.<br/>Copyright &#xa9; 2019

<57>
Accession Number
2004820875
Title
Disseminated Histoplasmosis in a Heart Transplant Recipient In Saudi
Arabia: A Case Report.
Source
Journal of Infection and Public Health. Conference: Abstracts of GCCMID
2019. Saudi Arabia. 13 (2) (pp 368), 2020. Date of Publication: February
2020.
Author
Alamri M.; Albarrag A.; Khogeer H.; Halim M.A.; AlMaghrabi R.
Publisher
Elsevier Ltd
Abstract
Background Histoplasmosis is a dimorphic fungi. North and Central America
are the main endemic areas. By far there are no reported cases of
Histoplasmosis in our region. We describe a case of disseminated
histoplasmosis in a Heart Transplant Recipient. Case A 68-year-old
gentleman known to have dilated cardiomyopathy. In 2017 he underwent left
ventricular assist device (LVAD) implantation and aortic valve repair in
India. In 2019 he underwent heart transplant in our Hospital. 6 weeks
after the transplant he presented with headache for 10 days, systemic
review was only remarkable for fever, Labs were normal. Lumbar puncture
(LP) was done and patient was started on empirical meningitis treatment.
LP results including gram stain and culture, molecular studies for viruses
and bacteria, Brucella, toxoplasma, cryptococcal serology, Rapid MTB was
negative. 4 days after discharge he presented to the emergency room with
headache, fever, blurred vision and an episode of loss of consciousness.
Examination showed an ill looking patient, Temp 39.8, heart rate 100,
normal blood pressure, no meningeal signs, focal neurological deficit,
lymphadenopathy or organomegaly. Repeated work up was positive for
pancytopenia and a repeat LP remained negative. Bone marrow (BM) biopsy
showed Small intracellular organisms inside the histiocytes. Brain MRI was
only positive for small vessel disease. Extended work up revealed a
positive Histoplasma urinary antigen, Positive Histoplasma PCR of the BM
biopsy. Patient was started on Liposomal Amphotericin for 3 weeks followed
by Itraconazole and showed marked improvement and resolution of symptoms.
Discussion This is the first reported case of disseminated Histoplasmosis
in Saudi Arabia. Our patient had likely a reactivation of infection that
was acquired at the time of LVAD insertion in India. Conclusion
Histoplasmosis can occur in our region with atypical presentation in
immunocompromised patients. High index of suspicion is required for timely
diagnosis and effective management.<br/>Copyright &#xa9; 2020

<58>
Accession Number
630829161
Title
Stent-Only Versus Adjunctive Balloon Angioplasty Approach for Saphenous
Vein Graft Percutaneous Coronary Intervention: Insights From DIVA Trial.
Source
Circulation. Cardiovascular interventions. 13 (2) (pp e008494), 2020. Date
of Publication: 01 Feb 2020.
Author
Latif F.; Uyeda L.; Edson R.; Bhatt D.L.; Goldman S.; Holmes D.R.; Rao
S.V.; Shunk K.; Aggarwal K.; Uretsky B.; Bolad I.; Ziada K.; McFalls E.;
Irimpen A.; Truong H.T.; Kinlay S.; Papademetriou V.; Velagaleti R.S.;
Rangan B.V.; Mavromatis K.; Shih M.-C.; Banerjee S.; Brilakis E.S.
Institution
(Latif) VA Medical Center
(Latif) University of Oklahoma
(Uyeda, Edson, Kinlay, Shih) VA Cooperative Studies Program Coordinating
Center, Mountain View, R.E
(Bhatt, Velagaleti) VA Boston Healthcare System
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Boston
(Bhatt) Harvard Medical School, Boston
(Goldman) University of Arizona Sarver Heart Center
(Holmes) Mayo Clinic, Rochester
(Rao) Durham VA Medical Center
(Shunk) San Francisco VA Medical Center
(Aggarwal) Harry S Truman VA Hospital, Columbia, United States
(Aggarwal) University of Missouri Healthcare
(Uretsky) Central Arkansas Veterans Health System
(Uretsky) University of Arkansas for Medical Sciences
(Bolad) Indiana University School of Medicine
(Bolad) Roudebush VA Medical Center, Indianapolis, United States
(Ziada) University of Kentucky
(McFalls) VA Medical Center, Minneapolis, United States
(McFalls) University of Minnesota, Minneapolis (E.M.)
(Irimpen) Southeast Louisiana Veterans Health Care System
(Irimpen) Tulane University Heart and Vascular Institute, New Orleans,
United States
(Truong) VA Loma Linda Medical Center
(Papademetriou) VA Medical center Washington DC (V.P.)
(Papademetriou) Georgetown University
(Rangan, Brilakis) Minneapolis Heart Institute Foundation
(Mavromatis) Atlanta VA Healthcare System
(Mavromatis) Emory University, Atlanta, United States
(Banerjee) Dallas VA Medical Center
(Banerjee) University of Texas Southwestern Medical Center
(Brilakis) Minneapolis Heart Institute
(Brilakis) Abbott Northwestern Hospital, Minneapolis, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Direct stenting without pre-dilation or post-dilation has been
advocated for saphenous vein graft percutaneous coronary intervention to
decrease the incidence of distal embolization, periprocedural myocardial
infarction, and target lesion revascularization. <br/>METHOD(S): We
performed a post hoc analysis of patients enrolled in the DIVA
(Drug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft
Angioplasty; NCT01121224) prospective, double-blind, randomized controlled
trial. Patients were stratified into stent-only and balloon-stent groups.
Primary end point was 12-month incidence of target vessel failure (defined
as the composite of cardiac death, target vessel myocardial infarction, or
target vessel revascularization). Secondary end points included all-cause
death, stent thrombosis, myocardial infarction, and target lesion
revascularization during follow-up. <br/>RESULT(S): Of the 575 patients
included in this substudy, 185 (32%) patients underwent stent-only
percutaneous coronary intervention. Patients in the stent-only versus
balloon-stent group had similar baseline characteristics and similar
incidence of target vessel failure at 12-months (15% versus 19%; hazard
ratio, 1.34 [95% CI, 0.86-2.08]; P=0.19). During long-term follow-up
(median of 2.7 years), the incidence of definite stent thrombosis (1%
versus 5%; hazard ratio, 9.20 [95% CI, 1.23-68.92]; P=0.0085), the
composite of definite or probable stent thrombosis (5% versus 11%; hazard
ratio, 2.52 [95% CI, 1.23-5.18]; P=0.009), and target vessel myocardial
infarction (8% versus 14%; hazard ratio, 1.92 [95% CI, 1.08-3.40];
P=0.023) was lower in the stent-only group. Multivariable analysis showed
that a higher number of years since coronary artery bypass grafting and >1
target saphenous vein graft lesions were associated with increased target
vessel failure during entire follow-up, while preintervention Thrombolysis
in Myocardial Infarction-3 flow was protective. <br/>CONCLUSION(S): In
patients undergoing percutaneous coronary intervention of de novo
saphenous vein graft lesions, there was no difference in target vessel
failure at 12 months and long-term follow-up in the stent-only versus the
balloon-stent group; however, the incidence of stent thrombosis was lower
in the stent-only group, as was target vessel myocardial infarction.
Registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT01121224.

<59>
Accession Number
630831316
Title
Treatment targets based on autoregulation parameters in neurocritical care
patients.
Source
Current opinion in critical care. (no pagination), 2020. Date of
Publication: 04 Feb 2020.
Author
Czosnyka M.; Hutchinson P.; Smielewski P.
Institution
(Czosnyka) Division of Neurosurgery, Department of Clinical Neurosciences,
Cambridge University Hospitals, Biomedical Campus, Cambridge, United
Kingdom
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: This review summarizes the physiological basis of
autoregulation-oriented therapy in critically ill patients, with a
particular emphasis on individual targets based on parameters that
describe autoregulation of cerebral blood flow. RECENT FINDINGS: The
concepts of optimal cerebral perfusion (CPPopt) and arterial pressures
(ABPopt), which both take advantage of continuous measures of cerebral
autoregulation, recently have been introduced into clinical practice. It
is hypothesized that if both pressures are used as individual targets and
followed, the incidence and severity of dysautoregulation will diminish
sufficiently to improve outcomes across the spectrum of acute neurological
illnesses. These parameters have not been tested in randomized trials.
However, a Phase II trial for CPPopt in Traumatic Brain Injury (COGITATE)
is underway. Clinical series suggest that delirium following cardiac
surgery may be reduced if blood pressure is actively regulated above the
lower limit of autoregulation. In traumatic brain injury, using CPPopt as
a single target allows monitoring of the upper and lower limits of
autoregulation that provide a well tolerated 'corridor' for treatment.
Pilot studies in which ABPopt is monitored in preterm newborns suggest
fewer haemorrhagic events if blood pressure is closer to its optimal
target. Brain imaging studies suggest worse tissue outcomes when blood
pressure is below ABPopt. SUMMARY: Targeted control of brain and systemic
blood pressures to optimize cerebral autoregulation is of substantial
interest to the neurocritical care and anaesthesia community, as this
strategy may help to avoid secondary brain insults associated with
ischemia or hyperaemia. The same strategy can be used outside the ICU
(e.g. cardiac surgery, or in stroke patients after mechanical
thrombectomy); this requires further research.

<60>
[Use Link to view the full text]
Accession Number
2004197949
Title
Comparison of Automated Titanium Fasteners to Hand-Tied Knots in Open
Aortic Valve Replacement.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (1) (pp 29-34), 2018. Date of Publication: 01 Jan 2018.
Author
Lee C.Y.; Johnson C.A.; Siordia J.A.; Lehoux J.M.; Knight P.A.
Institution
(Lee, Johnson, Siordia, Lehoux, Knight) Division of Cardiac Surgery,
University of Rochester Medical Center, Rochester, NY, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: Aortic cross-clamp and cardiopulmonary bypass times are
independent predictors of postoperative morbidity and mortality. Reducing
ischemic times with automated titanium fasteners may improve surgical
outcomes. This study compared operative times and costs of titanium
fasteners versus hand-tied knots for prosthesis securement in open aortic
valve replacement. <br/>Method(s): A randomized control trial was
conducted during a 16-month period at a single university medical center.
Patients undergoing elective aortic valve replacement were randomized to
the titanium fastener (n = 37) or hand-tied groups (n = 36). Knotting,
aortic cross-clamp, cardiopulmonary bypass, and total operating room times
were recorded. Hospital charges were also calculated for these procedures.
<br/>Result(s): Baseline characteristics, concomitant procedures,
prosthetic valve size, and sutures were similar between groups. The
titanium fastener group had significantly reduced knotting (7.4 vs. 13.0
minutes, P < 0.001), aortic cross-clamp (69 vs. 90 minutes, P < 0.05),
cardiopulmonary bypass (86 vs. 114 minutes, P < 0.05), and total operating
room times (234 vs. 266 minutes, P < 0.05). Intraoperative complications
occurred more frequently in the hand-tied group compared with the titanium
fastener group. Postoperative complications were similar between groups.
Operating room costs were significantly higher in the titanium fastener
group (US $10,428 vs. US $9671, P = 0.01). Hospitalization costs did not
differ significantly between the titanium fastener and hand-tied group (US
$23,987 vs. US $21,068, P = 0.12). <br/>Conclusion(s): Titanium fastener
use was associated with shorter knotting, aortic cross-clamp,
cardiopulmonary bypass, and operating room times and fewer intraoperative
complications in open aortic valve replacement, without significantly
increasing hospitalization cost.<br/>Copyright &#xa9; 2018 International
Society for Minimally Invasive Cardiothoracic Surgery.

<61>
[Use Link to view the full text]
Accession Number
2004197920
Title
Management of Atrial Fibrillation in Patients Undergoing Coronary Artery
Bypass Grafting: Review of the Literature.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (6) (pp 383-390), 2018. Date of Publication: 01 Nov 2018.
Author
Khiabani A.J.; Adademir T.; Schuessler R.B.; Melby S.J.; Moon M.R.;
Damiano R.J.
Institution
(Khiabani, Adademir, Schuessler, Melby, Moon, Damiano) Division of
Cardiothoracic Surgery, Department of Surgery, Washington University
School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Untreated atrial fibrillation is associated with an increased risk of
all-cause mortality and morbidity. Despite the current guidelines
recommending surgical ablation of atrial fibrillation at the time of
coronary artery bypass surgery, most patients with concomitant atrial
fibrillation and coronary artery disease do not receive surgical ablation
for their atrial fibrillation. This review reports the efficacy of
different surgical ablation techniques used for the treatment of atrial
fibrillation during coronary artery bypass. PubMed was systematically
searched for studies reporting outcomes of concomitant surgical ablation
in coronary artery bypass patients between January 2002 and March 2018.
Data were independently extracted and analyzed by two investigators.
Twenty-four studies were included. Twelve studies exclusively reported
outcomes of surgical ablation in patients undergoing coronary artery
bypass, whereas the remaining 12 reported outcomes of concomitant cardiac
surgery with subgroup analysis. Only four studies performed the
concomitant Cox-Maze procedure. Freedom from atrial tachyarrhythmia was
reported as high as 98% at 1 year and 76% at 5 years with Cox-Maze
procedure, whereas lesser lesion sets had more variable outcomes, ranging
from 35% to 93%. In most studies, the addition of surgical ablation was
not associated with increased morbidity and mortality. Although the
Cox-Maze procedure had the greatest short- and long-term success rates,
most studies comprising the evidence documenting the safety and efficacy
of adding surgical ablation were of low or moderate quality. There was a
great deal of heterogeneity among study populations, follow-up times,
methods, and definition of failure. To establish a consensus regarding a
surgical ablation technique for atrial fibrillation in coronary artery
bypass population, larger multicenter randomized controlled studies need
to be designed.<br/>Copyright &#xa9; 2018 International Society for
Minimally Invasive Cardiothoracic Surgery.

<62>
[Use Link to view the full text]
Accession Number
2004197919
Title
Robotic Thoracic Surgery Training for Residency Programs: A Position Paper
for an Educational Curriculum.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (6) (pp 417-422), 2018. Date of Publication: 01 Nov 2018.
Author
Raad W.N.; Ayub A.; Huang C.-Y.; Guntman L.; Rehmani S.S.; Bhora F.Y.
Institution
(Raad, Ayub, Guntman, Rehmani, Bhora) Department of Thoracic Surgery,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Huang) Department of General Surgery, Brookdale University Hospital and
Medical Center, Brooklyn, NY, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: Robotic-assisted surgery is increasingly being used in thoracic
surgery. Currently, the Integrated Thoracic Surgery Residency Program
lacks a standardized curriculum or requirement for training residents in
robotic-assisted thoracic surgery. In most circumstances, because of the
lack of formal residency training in robotic surgery, hospitals are
requiring additional training, mentorship, and formal proctoring of cases
before granting credentials to perform robotic-assisted surgery.
Therefore, there is necessity for residents in Integrated Thoracic Surgery
Residency Program to have early exposure and formal training on the
robotic platform. We propose a curriculum that can be incorporated into
such programs that would satisfy both training needs and hospital
credential requirements. <br/>Method(s): We surveyed all 26 Integrated
Thoracic Surgery Residency Program Directors in the United States. We also
performed a PubMed literature search using the key word "robotic surgery
training curriculum." We reviewed various robotic surgery training
curricula and evaluation tools used by urology, obstetrics gynecology, and
general surgery training programs. We then designed a proposed curriculum
geared toward thoracic Integrated Thoracic Surgery Residency Program
adopted from our credentialing experience, literature review, and survey
consensus. <br/>Result(s): Of the 26 programs surveyed, we received 17
responses. Most Integrated Thoracic Surgery Residency Program directors
believe that it is important to introduce robotic surgery training during
residency. Our proposed curriculum is integrated during postgraduate years
2 to 6. In the preclinical stage postgraduate years 2 to 3, residents are
required to complete introductory online modules, virtual reality
simulator training, and in-house workshops. During clinical stage
(postgraduate years 4-6), the resident will serve as a supervised bedside
assistant and progress to a console surgeon. Each case will have defined
steps that the resident must demonstrate competency. Evaluation will be
based on standardized guidelines. <br/>Conclusion(s): Expansion and
utilization of robotic assistance in thoracic surgery have increased. Our
proposed curriculum aims to enable Integrated Thoracic Surgery Residency
Program residents to achieve competency in robotic-assisted thoracic
surgery and to facilitate the acquirement of hospital privileges when they
enter practice.<br/>Copyright &#xa9; 2018 International Society for
Minimally Invasive Cardiothoracic Surgery.

<63>
[Use Link to view the full text]
Accession Number
2004197918
Title
Stented versus Stentless Aortic Valve Replacement in Patients with Small
Aortic Root: A Systematic Review and Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (6) (pp 404-416), 2018. Date of Publication: 01 Nov 2018.
Author
Harky A.; Wong C.H.M.; Hof A.; Froghi S.; Ahmad M.U.; Howard C.; Rimmer
L.; Bashir M.
Institution
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Chester, United Kingdom
(Wong) Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
(Hof) Department of Cardiovascular Surgery, Heinrich-Heine-University,
Medical Faculty, Dusseldrof, Germany
(Froghi) Department of Surgery, Imperial College NHS Trust, Hammersmith,
London, United Kingdom
(Ahmad, Howard, Rimmer) School of Medicine, University of Liverpool,
Liverpool, United Kingdom
(Bashir) Manchester Royal Infirmary, Manchester, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: The aim of the study was to compare hemodynamic and
perioperative outcomes of stented against stentless aortic valve
replacement in patients with small aortic root (21 mm or less).
<br/>Method(s): A comprehensive search was undertaken among the four major
databases (PubMed, Embase, Scopus, and Ovid) to identify all randomized
and nonrandomized controlled trials comparing stentless to stented
bioprosthetic valves in small aortic root patients. Odds ratios, weighted
mean differences, or standardized mean differences and their 95%
confidence intervals were analyzed. <br/>Result(s): A total of seven
studies with a total of 965 patients fulfilled the inclusion criteria.
There was no significant difference in preoperative baselines including
mean age between both groups (P = 0.08), peak aortic valve gradient (P =
0.06), and effective orifice area (P = 0.28), whereas higher mean aortic
valve gradient in the stented group (P = 0.007). No difference in
cardiopulmonary bypass time (P = 0.74), aortic cross-clamp times (P =
0.88), intensive care unit stay (P = 0.13), and stroke rate (P = 0.56)
were noted. However, stented group of patients showed higher rate of
patient prosthesis mismatch (P = 0.0001) and longer total hospital stay (P
= 0.002). Postoperatively, stentless group showed lower peak and mean
aortic valve gradient (P = 0.003 and P = 0.008, respectively) with a
better effective orifice area (P < 0.00001) at 6 months of follow-up.
Mortality rates while in-hospital and at 1 year were similar in both
groups (P = 0.94 and P = 0.86, respectively). <br/>Conclusion(s):
Stentless aortic valves offer superior short-term hemodynamic outcomes in
patients with small aortic root when compared with stented aortic valves.
Although both groups have similar perioperative complications rates,
stentless valves bring about a shorter hospital stay. A further large
multicenter randomized controlled trial should address the longer-term
benefit of stentless aortic valve over stented valve.<br/>Copyright &#xa9;
2018 International Society for Minimally Invasive Cardiothoracic Surgery.

<64>
[Use Link to view the full text]
Accession Number
2004197868
Title
Mitral Valve Annuloplasty Rings: Review of Literature and Comparison of
Functional Outcome and Ventricular Dimensions.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 9 (6) (pp 399-415), 2014. Date of Publication: 01 Nov 2014.
Author
Khamooshian A.; Buijsrogge M.P.; De Heer F.; Grundeman P.F.
Institution
(Khamooshian) University Medical Center Groningen, Utrecht, Netherlands
(Buijsrogge, De Heer, Grundeman) University Medical Center Utrecht,
Utrecht, Netherlands
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
In the past decades, more than 40 mitral valve annuloplasty rings of
various shapes and consistency were marketed for mitral regurgitation
(MR), although the effect of ring type on clinical outcome remains
unclear. Our objective was to review the literature and apply a
simplification method to make rings of different shapes and rigidity more
comparable. We studied relevant literature from MEDLINE and EMBASE
databases related to clinical studies as well as animal and finite element
models. Annuloplasty rings were clustered into 3 groups as follows: rigid
(R), flexible (F), and semirigid (S). Only clinical articles regarding
degenerative (DEG) or ischemic/dilated cardiomyopathy (ICM) MR were
included and stratified into these groups. A total of 37 rings were
clustered into R, F, and S subgroups. Clinical studies with a mean
follow-up of less than 1 year and a reported mean etiology of valve
incompetence of less than 60% were excluded from the analysis. Forty-one
publications were included. Preimplant and postimplant end points were New
York Heart Association class, left ventricular ejection fraction (LVEF),
left ventricular end-systolic dimension (LVESD), and left ventricular
end-diastolic dimension (LVEDD). Statistical analysis included
paired-samples t test and analysis of variance with post hoc Bonferroni
correction. P < 0.05 indicated statistical difference. Mean +/- SD
follow-up was 38.6 +/- 27 and 29.7 +/- 13.2 months for DEG and ICM,
respectively. In DEG, LVEF remained unchanged, and LVESD decreased in all
subgroups. In our analysis, LVEDD decreased only in F and R, and S did not
change; however, the 4 individual studies showed a significant decline. In
ICM, New York Heart Association class improved in all subgroups, and LVEF
increased. Moreover, LVESD and LVEDD decreased only in F and S; R was
underpowered (1 study). No statistical difference among R, F, and S in
either ICM or DEG could be detected for all end points. Overall, owing to
underpowered data sets derived from limited available publications, major
statistical differences in clinical outcome between ring types could not
be substantiated. Essential end points such as recurrent MR and survival
were incomparable. In conclusion, ring morphology and consistency do not
seem to play a major clinical role in mitral valve repair based on the
present literature. Hence, until demonstrated otherwise, surgeons may
choose their ring upon their judgment, tailored to specific patient
needs.<br/>Copyright &#xa9; 2014 International Society for Minimally
Invasive Cardiothoracic Surgery.

<65>
Accession Number
2004200028
Title
Retrograde autologous priming to reduce allogeneic blood transfusion
requirements: a systematic review.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Vranken N.P.A.; Babar Z.U.D.; Montoya J.A.; Weerwind P.W.
Institution
(Vranken, Babar, Weerwind) Department of Cardiothoracic Surgery,
Maastricht University Medical Center, Maastricht, Netherlands
(Vranken, Weerwind) Cardiovascular Research Institute Maastricht,
Maastricht University Medical Center, Maastricht, Netherlands
(Montoya) Department of Pharmacology, The University of Arizona, Tucson,
AZ, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Efforts have been made to minimize transfusion of packed red
blood cells in patients undergoing cardiac surgery with cardiopulmonary
bypass. One method concerns retrograde autologous priming. Although the
technique has been used for decades, results remain contradictory in terms
of transfusion requirements. <br/>Objective(s): This systematic literature
review aimed to summarize the evidence for the efficacy of retrograde
autologous priming in terms of decreasing perioperative packed red blood
cell requirements in adults. <br/>Method(s): Two researchers independently
searched PubMed for articles published in the past 10 years. The modified
Cochrane collaboration Risk of Bias Tool and the Research Triangle
Institute Item Bank were used to assess bias. <br/>Result(s): Eight
studies were included, of which two randomized and six observational
studies. Five studies, including one randomized study, report a
significant decrease in packed red blood cell use in the retrograde
autologous priming group compared to no retrograde autologous priming
used. All studies are flawed by at least a high risk bias of bias score on
one item of the bias assessment. <br/>Conclusion(s): Although most studies
reported significantly fewer packed red blood cell transfusions in the
retrograde autologous priming group, it is important to note that
relatively few articles are available which are flawed by several types of
bias. Prospective, randomized multi-center trials are warranted to
conclude decisively on the benefits of retrograde autologous
priming.<br/>Copyright &#xa9; The Author(s) 2020.

<66>
Accession Number
2002383281
Title
Pecs and Serratus Blocks: Current State of Chest Wall Analgesia.
Source
Current Anesthesiology Reports. 9 (3) (pp 308-313), 2019. Date of
Publication: 15 Sep 2019.
Author
Godlewski C.
Institution
(Godlewski) Department of Anesthesiology & Perioperative Medicine,
Division of Multispecialty Anesthesia, University of Alabama at
Birmingham, JT 923, 619 19th Street South, Birmingham, AL 35249-6810,
United States
Publisher
Springer
Abstract
Purpose of Review: This article seeks to provide a current review of
pertinent literature with regards to analgesia for chest wall
surgery-specifically Pecs and serratus blocks. Recent Findings:
Intermuscular plane blocks have been shown to be clinically efficacious in
the setting of chest wall surgery, especially in the setting of oncologic
breast surgery. <br/>Summary: Pecs and serratus blocks provide a safe and
effective alternative to neuraxial analgesia while avoiding many of the
associated technical difficulties and potential
complications.<br/>Copyright &#xa9; 2019, Springer Science+Business Media,
LLC, part of Springer Nature.

<67>
Accession Number
2004011154
Title
Randomized clinical trial of intraoperative dexmedetomidine to prevent
delirium in the elderly undergoing major non-cardiac surgery.
Source
British Journal of Surgery. 107 (2) (pp e123-e132), 2020. Date of
Publication: 01 Jan 2020.
Author
Li C.-J.; Wang B.-J.; Mu D.-L.; Hu J.; Guo C.; Li X.-Y.; Ma D.; Wang D.-X.
Institution
(Li, Wang, Mu, Hu, Guo, Wang) Department of Anaesthesiology and Critical
Care Medicine, Beijing, China
(Li) Department of Biostatistics, Peking University First Hospital,
Beijing, China
(Ma) Section of Anaesthetics, Pain Medicine and Intensive Care, Department
of Surgery and Cancer, Imperial College London, Chelsea and Westminster
Hospital, London, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Delirium is common in elderly patients after surgery and is
associated with poor outcomes. This study aimed to investigate the impact
of intraoperative dexmedetomidine on the incidence of delirium in elderly
patients undergoing major surgery. <br/>Method(s): This was a randomized
double-blind placebo-controlled trial. Elderly patients (aged 60 years or
more) scheduled to undergo major non-cardiac surgery were randomized into
two groups. Patients in the intervention group received a loading dose of
dexmedetomidine 0.6 mug/kg 10 min before induction of anaesthesia followed
by a continuous infusion (0.5 mug per kg per h) until 1 h before the end
of surgery. Patients in the control group received volume-matched normal
saline in the same schedule. The primary outcome was the incidence of
delirium during the first 5 days after surgery. Delirium was assessed with
the Confusion Assessment Method (CAM) for non-ventilated patients and CAM
for the Intensive Care Unit for ventilated patients. <br/>Result(s): In
total, 309 patients who received dexmedetomidine and 310 control patients
were included in the intention-to-treat analysis. The incidence of
delirium within 5 days of surgery was lower with dexmedetomidine
treatment: 5.5 per cent (17 of 309) versus 10.3 per cent (32 of 310) in
the control group (relative risk (RR) 0.53, 95 per cent c.i. 0.30 to 0.94;
P = 0.026). The overall incidence of complications at 30 days was also
lower after dexmedetomidine (19.4 per cent (60 of 309) versus 26.1 per
cent (81 of 310) for controls; RR 0.74, 0.55 to 0.99, P = 0.047).
<br/>Conclusion(s): Intraoperative dexmedetomidine halved the risk of
delirium in the elderly after major non-cardiac surgery. Registration
number: ChiCTR-IPR-15007654 (www.chictr.org.cn).<br/>Copyright &#xa9; 2020
BJS Society Ltd Published by John Wiley & Sons Ltd

<68>
Accession Number
2004788864
Title
The angiography-guided spot versus entire stenting in patients with long
coronary lesions trial: Study design and rationale for a randomized
controlled trial protocol.
Source
Contemporary Clinical Trials Communications. 17 (no pagination), 2020.
Article Number: 100523. Date of Publication: March 2020.
Author
Baek J.Y.; Rha S.W.; Choi B.G.; Choi C.U.; Park K.-H.; Hwang B.H.; Lee
S.-J.; Ahn Y.K.; Choi J.W.; Chae I.-H.; Choi W.H.; Lim Y.-H.; Ahn J.H.;
Choi W.G.
Institution
(Baek) Division of Cardiology, Department of Internal Medicine, Seoul St.
Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
(Rha, Choi, Choi) Division of Cardiology, Department of Internal Medicine,
Korea University Guro Hospital, Seoul, South Korea
(Park) Division of Cardiology, Department of Internal Medicine, Hallym
University Medical Center, Hangang Sacred Heart Hospital, Seoul, South
Korea
(Hwang) Department of Internal Medicine, St. Paul's Hospital, College of
Medicine, The Catholic University of Korea, Seoul, South Korea
(Lee) Department of Internal Medicine, Soonchunhyang University Medical
College, Cheonan, South Korea
(Ahn) Department of Cardiovascular Medicine, Chonnam National University
Medical School, Gwangju, South Korea
(Choi) Division of Cardiology, Department of Internal Medicine, Eulji
General Hospital, Eulji Medical College, Seoul, South Korea
(Chae) Department of Internal Medicine, Seoul National University Bundang
Hospital, Gyeonggi, South Korea
(Choi) Division of Cardiology, Department of Internal Medicine, H PLUS
Yangji Hospital, Seoul, South Korea
(Lim) Department of Internal Medicine, Hanyang University College of
Medicine, Seoul, South Korea
(Ahn) Division of Cardiology, Department of Internal Medicine,
Soonchunhyang University Gumi Hospital, Gumi, South Korea
(Choi) Division of Cardiology, Konkuk University Chungju Hospital,
Chungju, South Korea
Publisher
Elsevier Inc
Abstract
Background: /Purpose: Long-stenting, even with a second-generation
drug-eluting stent (DES), is an independent predictor of restenosis and
stent thrombosis in patients with long coronary lesions. Spot-stenting,
i.e., selective stenting of only the most severe stenotic segments of a
long lesion, may be an alternative to a DES. The purpose of this study is
to compare the one-year clinical outcomes of patients with spot versus
entire stenting in long coronary lesions using a second-generation DES.
<br/>Method(s): This study is a randomized, prospective, multi-center
trial comparing long-term clinical outcomes of angiography-guided spot
versus entire stenting in patients with long coronary lesions (>=25 mm in
length). The primary endpoint is target vessel failure (TVF) at 12 months,
a composite of cardiac death, target vessel-related myocardial infarction,
and target vessel revascularization (TVR). A total of 470 patients are
enrolled for this study according to sample size calculations. This study
will be conducted to evaluate the non-inferiority of spot stenting
compared to entire stenting with zotarolimus-eluting stents (ZES).
<br/>Result(s): This study is designed to evaluate the clinical impact of
spot-stenting with ZESs for TVF due to possible edge restenosis or
non-target lesion revascularization. Theoretically, spot-stenting may
decrease the risk of TVR and the extent of endothelial dysfunction.
<br/>Conclusion(s): This SPOT trial will provide clinical insight into
spot-stenting with a current second-generation DES as a new strategy for
long coronary lesions.<br/>Copyright &#xa9; 2020 The Authors

<69>
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.

<70>
Accession Number
2004537926
Title
Double or triple antithrombotic therapy after coronary stenting and atrial
fibrillation: A systematic review and meta-analysis of randomized clinical
trials.
Source
International Journal of Cardiology. 302 (pp 95-102), 2020. Date of
Publication: 1 March 2020.
Author
Ando G.; Costa F.
Institution
(Ando, Costa) Department of Clinical and Experimental Medicine, University
of Messina, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Aims: Double or triple antithrombotic therapy (DAT/TAT) including or
excluding aspirin in association with oral anticoagulant and P2Y12
inhibitor are currently two available options in patients with atrial
fibrillation (AF) undergoing percutaneous coronary intervention (PCI). We
evaluated efficacy and safety outcomes for DAT vs. TAT. <br/>Methods and
Results: Four non-vitamin K oral anticoagulants (NOAC)-based randomized
controlled trials comparing DAT vs. TAT with a total of 10,938 patients
were pooled. Bleeding events occurred more frequently than ischemic
events. DAT as compared to TAT was associated to an increased risk of
stent thrombosis (RR 1.54, 95% CI 1.10-2.14; p = 0.03), myocardial
infarction (RR 1.23, 95% CI 1.04-1.46; p = 0.03) and cardiovascular
mortality (RR 1.09, 95% CI 1.01-1.19; p = 0.04) and to a reduced risk of
ISTH major or clinically relevant non-major bleeding (RR 0.59, 95% CI
0.62-0.93; p = 0.03). A consistent effect was observed in all safety
endpoints. Intracranial haemorrhage was numerically reduced by DAT. No
difference for all-cause death was observed. <br/>Conclusion(s):
Antithrombotic treatment in patients with AF undergoing PCI represents a
trade-off between ischemia and bleeding. A careful patient selection based
on baseline ischemic and bleeding risk may optimize the net clinical
balance in this population.<br/>Copyright &#xa9; 2019 Elsevier B.V.

<71>
Accession Number
629818908
Title
REDUCE-IT USA: Results From the 3146 Patients Randomized in the United
States.
Source
Circulation. 141 (5) (pp 367-375), 2020. Date of Publication: 04 Feb 2020.
Author
Bhatt D.L.; Miller M.; Brinton E.A.; Jacobson T.A.; Steg P.G.; Ketchum
S.B.; Doyle R.T.; Juliano R.A.; Jiao L.; Granowitz C.; Tardif J.-C.;
Olshansky B.; Chung M.K.; Gibson C.M.; Giugliano R.P.; Budoff M.J.;
Ballantyne C.M.
Institution
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston
(Miller) Department of Medicine, University of Maryland School of Medicine
(Brinton) Utah Lipid Center
(Jacobson) Lipid Clinic and Cardiovascular Risk Reduction Program,
Department of Medicine, Emory University School of Medicine, Atlanta,
United States
(Steg) French Alliance for Cardiovascular Trials, Hopital Bichat, Paris,
United States
(Steg) Universite de Paris, INSERM Unite 1148, Assistance
Publique-Hopitaux de Paris, Paris, United States
(Ketchum, Doyle, Juliano, Jiao, Granowitz) Amarin Pharma, Inc., R.T.D.,
R.A.J., L.J., Bridgewater, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, QC
(Olshansky) University of Iowa
(Chung) Cleveland Clinic
(Gibson) Beth Israel Deaconess Hospital, Boston
(Gibson) Baim Clinical Research Institute, Boston
(Giugliano) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, Boston
(Budoff) Los Angeles Biomedical Research Institute at Harbor UCLA Medical
Center, Torrance
(Ballantyne) Department of Medicine, Baylor College of Medicine, Houston
Publisher
NLM (Medline)
Abstract
BACKGROUND: Some trials have found that patients from the United States
derive less benefit than patients enrolled outside the United States. This
prespecified REDUCE-IT (Reduction of Cardiovascular Events with Icosapent
Ethyl - Intervention Trial) subgroup analysis was conducted to determine
the degree of benefit of icosapent ethyl in the United States.
<br/>METHOD(S): REDUCE-IT randomized 8179 statin-treated patients with
qualifying triglycerides >=135 and <500 mg/dL and low-density lipoprotein
cholesterol >40 and <=100 mg/dL and a history of atherosclerosis or
diabetes mellitus to icosapent ethyl 4 g/d or placebo. The primary
composite end point was cardiovascular death, nonfatal myocardial
infarction, nonfatal stroke, coronary revascularization, or
hospitalization for unstable angina. The key secondary composite end point
was cardiovascular death, nonfatal myocardial infarction, or nonfatal
stroke. A hierarchy was prespecified for examination of individual and
composite end points. <br/>RESULT(S): A total of 3146 US patients (38.5%
of the trial) were randomized and followed for a median of 4.9 years;
32.3% were women and 9.7% were Hispanic. The primary composite end point
occurred in 24.7% of placebo-treated patients versus 18.2% of icosapent
ethyl-treated patients (hazard ratio [HR], 0.69 [95% CI, 0.59-0.80];
P=0.000001); the key secondary composite end point occurred in 16.6%
versus 12.1% (HR, 0.69 [95% CI, 0.57-0.83]; P=0.00008). All prespecified
hierarchical end points were meaningfully and significantly reduced,
including cardiovascular death (6.7% to 4.7%; HR, 0.66 [95% CI,
0.49-0.90]; P=0.007), myocardial infarction (8.8% to 6.7%; HR, 0.72 [95%
CI, 0.56-0.93]; P=0.01), stroke (4.1% to 2.6%; HR, 0.63 [95% CI,
0.43-0.93]; P=0.02), and all-cause mortality (9.8% to 7.2%; HR, 0.70 [95%
CI, 0.55-0.90]; P=0.004); for all-cause mortality in the US versus non-US
patients, Pinteraction=0.02. Safety and tolerability findings were
consistent with the full study cohort. <br/>CONCLUSION(S): Whereas the
non-US subgroup showed significant reductions in the primary and key
secondary end points, the US subgroup demonstrated particularly robust
risk reductions across a variety of individual and composite end points,
including all-cause mortality. CLINICAL TRIAL REGISTRATION: URL:
https://www.clinicaltrials.gov. Unique identifier: NCT01492361.

<72>
Accession Number
628212487
Title
Analysis of survival after coronary endarterectomy combined with coronary
artery bypass grafting compared with isolated coronary artery bypass
grafting: a meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 29 (3) (pp 393-401),
2019. Date of Publication: 01 Sep 2019.
Author
Wang C.; Chen J.; Gu C.; Li J.
Institution
(Wang, Gu, Li) Department of Cardiac Surgery, Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
(Chen) People's Hospital of Deyang City, Sichuan, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this analysis was to compare survival outcomes of
coronary endarterectomy (CE) combined with coronary artery bypass grafting
(CABG) with those of conventional CABG. <br/>METHOD(S): Eight
observational studies were included in this analysis, including 10 529
different patients in Asia, Europe and North America, from 1985 to 2012,
among whom 1925 underwent CE+CAGB and 8604 underwent conventional CAGB.
The follow-up period ranged from 4 to 14years. This meta-analysis was
performed with the fixed-effects model. <br/>RESULT(S): After rigorous
assessment of the quality of the studies included, this analysis showed
that CE+CABG had a statistically significant weaker short-term outcome,
with a higher risk of mortality [odds ratio (OR)] 1.61; P=0.002]. Further,
this phenomenon was exacerbated in the midterm. One-year and 2-year
results indicated that death was, respectively, 163% (OR 2.63; P<0.001)
and 133% (OR 2.60; P<0.001) more likely to occur in the CE+CABG group.
However, the long-term results indicated no difference between the 2
groups. The 4-year hazard ratio (1.13; P=0.10) did not show significant
differences between the groups, and the Kaplan-Meier survival curves had
the same level and pattern. <br/>CONCLUSION(S): CE+CABG had a
significantly weaker short-term outcome than conventional CABG, and this
trend continued in the midterm. The survival rate had the largest gap in
the midterm. However, there was no significant difference between these 2
groups in the long run.<br/>Copyright &#xa9; The Author(s) 2019. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<73>
[Use Link to view the full text]
Accession Number
628800100
Title
A meta-analysis of impact of low-flow/low-gradient aortic stenosis on
survival after transcatheter aortic valve implantation.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 20 (10) (pp
691-698), 2019. Date of Publication: 01 Oct 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, NY
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
NLM (Medline)
Abstract
AIMS: To determine whether low-flow/low-gradient (LF/LG) aortic stenosis
affects survival after transcatheter aortic valve implantation (TAVI), we
performed a meta-analysis of currently available studies. <br/>METHOD(S):
MEDLINE and EMBASE were searched through January 2019 using PubMed and
OVID. Observational studies comparing all-cause mortality after TAVI for
patients with classical LF/LG (C/LF/LG) aortic stenosis versus
normal-flow/high-gradient (NF/HG) aortic stenosis, paradoxical LF/LG
(P/LF/LG) aortic stenosis versus NF/HG aortic stenosis, and (3) C/LF/LG
aortic stenosis versus P/LF/LG aortic stenosis were included.
Study-specific estimates, risk and hazard ratios of mortality, were
combined in the random-effects model. <br/>RESULT(S): Our search
identified nine eligible studies including a total of 5512 TAVI patients.
Pooled analysis demonstrated significantly higher early mortality in
C/LF/LG aortic stenosis than NF/HG aortic stenosis (risk ratio, 1.72; P =
0.02) and no statistically significant difference in early mortality
between P/LF/LG aortic stenosis and NF/HG aortic stenosis (P = 0.67) and
between C/LF/LG aortic stenosis and P/LF/LG aortic stenosis (P = 0.51).
Midterm mortality in C/LF/LG (risk ratio/hazard ratio, 1.73; P = 0.0003)
and P/LF/LG aortic stenosis (risk ratio/hazard ratio, 1.48; P < 0.0001)
was significantly higher than that in NF/HG aortic stenosis. There was no
statistically significant difference in midterm mortality between C/LF/LG
aortic stenosis and P/LF/LG aortic stenosis (P = 0.63).
<br/>CONCLUSION(S): After TAVI, C/LF/LG aortic stenosis is associated with
increased early mortality compared with NF/HG, and C/LF/LG and P/LF/LG
aortic stenosis is associated with increased midterm mortality compared
with NF/HG aortic stenosis despite no difference in early mortality
between P/LF/LG aortic stenosis and NF/HG aortic stenosis. There is no
difference in early and midterm mortality between C/LF/LG aortic stenosis
and P/LF/LG aortic stenosis.

<74>
Accession Number
627413382
Title
Impact of risk factors and surgical techniques in coronary endarterectomy:
a network meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 29 (3) (pp 355-364),
2019. Date of Publication: 01 Sep 2019.
Author
Wang C.; Chen J.; Gu C.; Qiao R.; Li J.
Institution
(Wang, Gu, Qiao, Li) Department of Cardiac Surgery, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
(Chen) People's Hospital of Deyang City, Sichuan, China
Publisher
NLM (Medline)
Abstract
The goal of this network meta-analysis was to compare the early mortality
rate of patients who underwent coronary endarterectomy (CE) combined with
coronary artery bypass grafting (CABG) with different techniques and with
isolated CABG. This analysis also evaluated potential risk factors in
patients who undergo CE. Eighteen studies were included, covering 21 752
different patients, among whom 3352 underwent CE+CABG with either open or
closed techniques and 18 400 underwent isolated CABG. Patients who had
CE+CABG had a statistically significant higher mortality rate [odds ratio
(OR) 1.76; P<0.001]. Subgroup analyses showed that, with closed CE,
mortality was 52% (OR 1.52, P=0.001) more likely to occur, whereas with
open CE, mortality was 279% (OR 3.79, P<0.001) more likely to occur, when
both were compared with isolated CABG. A network meta-analysis indicated
that both the open and closed methods had poorer results than CABG alone
and that the open method had a higher risk of mortality than the closed
one. For risk factors, diabetes mellitus (DM), hypertension, prior
myocardial infarction, peripheral vascular disease and renal failure were
significant contributors to inclusion in the CE group, whereas other risk
factors showed no significant difference. However, none of these factors
indicated significant correlations with the incidence of mortality between
the groups. CE+CABG has a significantly higher risk of death than isolated
CABG, and open CE is more risky than closed CE, even though most of the
individual studies did not show that CE had a higher risk of mortality.
Moreover, DM, hypertension, prior myocardial infarction, peripheral
vascular disease and renal failure were more common in the patients who
had CE+CABG, but these factors may not necessarily increase the mortality
risk of patients who have CE.<br/>Copyright &#xa9; The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<75>
Accession Number
2004835121
Title
A Prospective Randomized Blinded Trial of Remote Ischemic Preconditioning
in Children Undergoing Cardiac Surgery.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Verdesoto Rodriguez M.C.; Spenceley N.; Ilina M.; Danton M.H.D.
Institution
(Verdesoto Rodriguez) University of Glasgow, Glasgow, United Kingdom
(Spenceley, Ilina, Danton) Royal Children's Hospital, Glasgow, United
Kingdom
Publisher
W.B. Saunders
Abstract
Remote ischemic preconditioning (RIPC) has been proposed as an
intervention to protect myocardium and attenuate end-organ dysfunction
associated with cardiopulmonary bypass. We investigated the effect of RIPC
in children undergoing cardiopulmonary bypass involving clinical outcome,
cardiac and end-organ function, inflammatory response, and myocardial gene
expression. A prospective, investigator-blinded, randomized, controlled
trial was performed. Patients were randomized into RIPC or Control; RIPC
consisted of three 5-minute cycles of limb ischemia-reperfusion taking
place 1 and 12 hours preoperatively. Clinical outcomes included cardiac
function, ICU surveillance, and renal function. In addition, inflammatory
markers and myocardial gene expression were evaluated. RIPC patients
required shorter ICU stay (days), RIPC: 1.8 (0.94-3.88) vs Control: 4.9
(1.63-7.20), P = 0.029. Echocardiography parameters demonstrated reduced
biventricular function following surgery showing no difference between
groups. A nonsignificant trend for reduced troponin was observed following
RIPC: AUC analysis, RIPC: 393.05 (98.85-1038.73) vs Control: 596.10
(225.38-954.24) P = 0.75. B-type natriuretic peptide and renal function
parameters were similar between groups. Postoperative TNF-alpha was
significantly reduced after RIPC, RIPC: 15.42 (7.81-114.86) vs Control:
108.98 (42.28-301.19) P = 0.02. Remaining inflammatory markers
demonstrated no significant difference between groups. HSP-60 showed lower
myocardial expression following RIPC, RIPC: 3.95 (2.69-6.28) vs Control:
6.83 (4.74-8.81), P = 0.05. Expression of other analyzed genes was not
influenced by RIPC. RIPC was associated with shorter ICU stay and reduced
TNF-alpha but did not influence other clinical outcomes, not confer
protection against cardiac injury or renal dysfunction. The association
between RIPC and ICU stay may be influenced by unaccounted latent
variables, including cardiac morphology.<br/>Copyright &#xa9; 2019
Elsevier Inc.