EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 100

Results Generated From:
Embase <1980 to 2020 Week 08>
Embase (updates since 2020-02-14)

<1>
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.

<2>
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.

<3>
Accession Number
2004858918
Title
Analysis of Myocardial Ischemia Parameters after Coronary Artery Bypass
Grafting with Minimal Extracorporeal Circulation and a Novel Microplegia
versus Off-Pump Coronary Artery Bypass Grafting.
Source
Mediators of Inflammation. 2020 (no pagination), 2020. Article Number:
5141503. Date of Publication: 2020.
Author
Koechlin L.; Zenklusen U.; Doebele T.; Rrahmani B.; Gahl B.; Schaeffer T.;
Berdajs D.; Eckstein F.S.; Reuthebuch O.
Institution
(Koechlin, Zenklusen, Doebele, Rrahmani, Gahl, Schaeffer, Berdajs,
Eckstein, Reuthebuch) Department of Cardiac Surgery, University Hospital
Basel, Basel, Switzerland
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. To compare the performance of our institutionally refined
microplegia protocol in conjunction with minimal extracorporeal
circulation system (MiECC) with off-pump coronary artery bypass grafting
(OPCAB). Methods. We conducted a single center study including patients
undergoing isolated CABG surgery performed either off-pump or on-pump
using our refined microplegia protocol in conjunction with MiECC. We used
propensity modelling to calculate the inverse probability of treatment
weights (IPTW). Primary endpoints were peak values of high-sensitivity
cardiac troponin T (hs-cTnT) during hospitalization, and respective first
values on the first postoperative day. Endpoint analysis was adjusted for
intraoperative variables. Results. After IPTW, we could include 278
patients into our analyses, 153 of which had received OPCAB and 125 of
which had received microplegia. Standardized differences indicated that
treatment groups were comparable after IPTW. The multivariable quantile
regression yielded a nonsignificant median increase of first hs-cTnT by 39
ng/L (95% CI -8 to 87 ng/L, p=0.11), and of peak hs-cTnT by 35 ng/L (CI
-13 to 84, p=0.16), when microplegia was used, as compared to OPCAB. Major
adverse cardiac and cerebrovascular events (MACCE) occurred with equal
frequency in both groups (7.8% vs. 5.0%; p=0.51), and length of stay in
the intensive care unit (ICU) was significantly shorter after the use of
microplegia (geometric mean 1.6 days versus 1.3 days; p=0.01). Conclusion.
The use of our institutionally refined microplegia in conjunction with
MiECC was associated with similar results with regard to ischemic injury,
expressed in hs-cTnT compared to OPCAB. MACCE was seen equally frequent.
ICU discharge was earlier if microplegia was used.<br/>Copyright &#xa9;
2020 Luca Koechlin et al.

<4>
Accession Number
625395478
Title
Outcome postponement as a potential patient centred measure of therapeutic
benefit: examples in cardiovascular medicine.
Source
Acta Cardiologica. 75 (1) (pp 10-19), 2020. Date of Publication: 02 Jan
2020.
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.

<5>
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

<6>
Accession Number
2004244391
Title
Invasive haemodynamics in de novo everolimus vs. calcineurin inhibitor
heart transplant recipients.
Source
ESC Heart Failure. (no pagination), 2020. Date of Publication: 2020.
Author
Bergh N.; Gude E.; Bartfay S.-E.; K Andreassen A.; Arora S.; Dahlberg P.;
Dellgren G.; Gullestad L.; Gustafsson F.; Karasson K.; Radegran G.;
Bollano E.; Andersson B.
Institution
(Bergh, Bartfay, Dahlberg, Bollano, Andersson) Department of Cardiology,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Bergh, Bartfay, Dahlberg, Karasson, Bollano) Institute of Medicine,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
(Gude, K Andreassen, Arora, Gullestad) Department of Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Gustafsson) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Radegran) The Section for Heart Failure and Valvular Disease, VO Heart
and Lung Medicine, Skane University Hospital, Lund, Sweden
(Dellgren, Radegran) Department of Clinical Sciences, Lund University,
Lund, SwedenTransplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(K Andreassen, Arora, Gullestad) KG Jebsen Center for Cardiac Research,
University of Oslo, Oslo, Norway
(K Andreassen, Arora, Gullestad) Center for Heart Failure Research, Oslo
University Hospital, Oslo, Norway
(Gullestad) Faculty of Medicine, University of Oslo, Oslo, Norway
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Aims: Invasive haemodynamic profiles at rest and during exercise after
heart transplantation (HTx) have never been described in a randomized
trial where de novo everolimus (EVR)-based therapy with early calcineurin
inhibitor (CNI) withdrawal has been compared with conventional CNI
treatment. We report central invasive haemodynamic parameters at rest and
exercise during a 3 year follow-up after HTx in a sub-study of the
SCandiavian Heart transplant Everolimus De novo stUdy with earLy
calcineurin inhibitor avoidancE trial. We hypothesized that the
nephroprotective properties, the less development of cardiac allograft
vasculopathy (CAV), and the antifibrotic properties of EVR, in comparison
with CNI-based immunosuppression, would demonstrate favourable invasive
haemodynamic profiles in patients at rest and during exercise.
<br/>Methods and Results: Ninety of 115 HTx recipients randomized to EVR
or CNI treatment performed right heart catheterization at rest and 68
performed right heart catheterization at exercise up to 3 years after HTx.
Haemodynamic profiles were compared between EVR and CNI treatment groups.
Resting haemodynamics improved in both groups from pre-HTx to the first
follow-up at 7-11 weeks post-HTx and thereafter remained unchanged up to 3
years of follow-up. During follow-up, cardiac reserve during exercise
increased with higher levels of maximum heart rate (118 to 148 b.p.m., P <
0.001), mean arterial pressure (103 to 128 mmHg, P < 0.001), and cardiac
output (10.3 to 12.2 l/min, P < 0.001). No significant differences in
haemodynamic parameters were observed between the EVR and CNI groups at
rest or exercise. Isolated post-capillary pulmonary hypertension (mean
pulmonary arterial pressure > 20 mmHg, pulmonary arterial wedge pressure
>= 15 mmHg, and pulmonary vascular resistance <3) were measured in 11% of
the patients at 7-11 weeks, 5% at 12 months, and 6% at 36 months after
HTx. The EVR group had significantly better kidney function (76 mL/min/1
vs. 60 mL/min/1, P < 0.001) and reduced CAV (P < 0.01) but an increased
rate of early biopsy-proven treated rejections (21.2% vs 5.7%, P < 0.01)
compared with the CNI group at any time point. The differences in renal
function, CAV, or early biopsy-proven treated acute rejections were not
associated with altered haemodynamics. <br/>Conclusion(s): De novo EVR
treatment with early CNI withdrawal compared with conventional CNI therapy
did not result in differences in haemodynamics at rest or during exercise
up to 3 years after HTx despite significant differences in renal function,
reduced CAV, and number of early biopsy-proven treated
rejections.<br/>Copyright &#xa9; 2020 The Authors. ESC Heart Failure
published by John Wiley & Sons Ltd on behalf of the European Society of
Cardiology

<7>
Accession Number
630950365
Title
Randomized trial of two endoscopic radial artery harvesting devices -
immunofluorescence assessment.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 10 Feb 2020.
Author
Van Linden A.; Hecker F.; Lehmann-Grube J.; Arsalan M.; Richter M.; Matzke
B.; Holubec T.; Walther T.
Institution
(Van Linden, Hecker, Arsalan, Holubec, Walther) Department of
Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt,
Germany
(Lehmann-Grube) Medical School, Justus Liebig University Giessen, Germany
(Richter) Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim,
Germany
(Matzke) Max-Planck-Institute for Heart and Lung Research Bad Nauheim,
Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Various devices are available for endoscopic radial artery
harvesting (ERAH) during coronary artery bypass grafting (CABG). Thermal
spread and graft damage, however, are common concerns. Aim of this study
was to compare the MiFusion TLS2TM system (Endotrust, Germany) with direct
heat technique and the LigaSureTM Maryland system (Medtronic, USA) using
advanced bipolar technique in a prospective randomized study.
<br/>METHOD(S): 100 consecutive patients undergoing CABG with ERAH were
prospectively included and randomized 1:1. The proximal (brachial) ends of
the grafts were analyzed using fluorescence microscopy with focus on graft
integrity. In addition, harvesting time, graft sealing, residual bleeding
and incidence of neurological disorders were compared. <br/>RESULT(S):
Patient age was 67+/-8 years. Mean harvesting time was 26.5+/-9 minutes
for the TLS2TM and 23.2+/-8 minutes for the LigaSure (p=0.049). Overall
graft integrity was good in both groups. A significantly better graft
integrity was observed in the LigaSure group (scale 0 to 3; 3=best) with
2.5+/-0.6 for TLS2TM and 2.8+/-0.4 for LigaSure (p=0.031). LigaSureTM
provided significantly better graft sealing (scale 0 to 2; 0=best) and
less residual bleeding (scale 1 to 5; 1=best) with 0.6+/-0.7 vs. 1.0+/-0.6
(p=0.006) and 1.4+/-0.6 vs 2.0+/-0.9 (p<0.001). Transient sensibility
disorders were less frequently observed with LigaSure (2% vs. 16%,
p=0.015). <br/>CONCLUSION(S): ERAH can be performed with excellent results
and good graft integrity using both devices. Compared to MiFusion TLS2TM,
the LigaSure device led to faster procedural times and resulted in better
graft integrity. Along with providing a better sealing, LigaSure was
associated with less sensibility disorders.<br/>Copyright &#xa9; 2020.
Published by Elsevier Inc.

<8>
Accession Number
630947785
Title
Septal flash is a prevalent and early dyssynchrony marker in transcatheter
aortic valve replacement-induced left bundle branch block.
Source
The international journal of cardiovascular imaging. (no pagination),
2020. Date of Publication: 13 Feb 2020.
Author
Calle S.; Coeman M.; Desmet K.; De Backer T.; De Buyzere M.; De Pooter J.;
Timmermans F.
Institution
(Calle, Coeman, Desmet, De Backer, De Buyzere, De Pooter, Timmermans)
Department of Cardiology, University Hospital Ghent, Ghent 9000, Belgium
Publisher
NLM (Medline)
Abstract
New-onset left bundle branch block (LBBB) is a frequent complication after
transcatheter aortic valve replacement (TAVR) and provides an opportunity
to study dyssynchrony immediately following acute LBBB. This study aims to
(1) assess echocardiographic dyssynchrony in acute TAVR-induced LBBB
(TAVR-LBBB), and (2) compare dyssynchrony parameters among different
patient groups with LBBB. The study enrolled all TAVR-LBBB patients at
Ghent University Hospital between 2013 and 2019. First, acute TAVR-LBBB
dyssynchrony was assessed by: (1) septal flash (SF); (2) interventricular
mechanical delay (IVMD; cut-off>=40 ms) and (3) presence of 'classical
dyssynchronous strain pattern' assessed with speckle tracking. Secondly,
acute TAVR-LBBB patients with SF (LBBBTAVR+SF) were compared to randomly
selected LBBB-SF patients with preserved (LBBBSF+PEF) and reduced ejection
fraction (LBBBSF+REF). In TAVR-LBBB patients (n=25), SF was detected in
72% of patients, whereas only 5% of TAVR-LBBB patients showed a classical
dyssynchronous strain pattern. IVMD in these TAVR-LBBB patients was 39 ms.
In 90% of LBBBTAVR+SF patients, SF was observed within 24 h after LBBB
onset. Among LBBB-SF patients, a classical strain pattern was more
prevalent in LBBBSF+REF patients compared to LBBBTAVR+SF patients (80% vs.
7%; p<0.001). IVMD was significantly longer in LBBBSF+PEF patients (52 ms;
p=0.002) and LBBBSF+REF patients (57 ms; p=0.009) compared to LBBBTAVR+SF
patients (37 ms). SF is an early and prevalent marker of LV dyssynchrony
in acute TAVR-LBBB, whereas strain-based measures and IVMD do not appear
to capture dyssynchrony at this early stage. Our findings from the
comparative analysis generate the hypothesis that progressive LBBB-induced
LV remodeling may be required for a 'classical dyssynchrony strain
pattern' or significant IVMD to occur in TAVR-LBBB patients.

<9>
Accession Number
630945379
Title
Oral health complications after a heart transplant: a review.
Source
British dental journal. 228 (3) (pp 177-182), 2020. Date of Publication:
01 Feb 2020.
Author
Gruter M.O.; Brand H.S.
Institution
(Gruter, Brand) Department of Oral Biochemistry, Academic Centre of
Dentistry Amsterdam (ACTA), Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
Background Heart transplants have become a successful treatment for some
cardiovascular diseases. To prevent rejection of the transplanted heart,
patients have to take immunosuppressive medication.Aims The aims of this
study were to identify and review oral health complications after heart
transplantation.Methods The electronic database PubMed was searched for
relevant articles. The search yielded 332 papers, of which 24 matched the
criteria for this review.Results Gingival hyperplasia was observed in
8.3-67% of the patients. Heart transplant patients who received
professional periodontal treatment starting six months after
transplantation showed significantly better scores on the Gingival Index
(GI) and gingival hyperplasia. In comparison to a control group, heart
transplant patients did not differ significantly in the DMF(T) index. The
incidence of fungal infection in patients receiving a heart transplant
varied between 10% and 25%. Heart transplant patients had a 4.3 times
higher chance of developing oral cancer.Conclusion Patients who underwent
a heart transplant and subsequently used immunosuppressive medicines
appear to have a higher risk of gingival hyperplasia, periodontal
conditions, the presence of Candida species and oral malignancies, in
comparison to healthy individuals. The association between heart
transplants and dental caries was unclear. It is recommended that heart
transplant patients receive frequent oral examination and professional
dental cleaning.

<10>
Accession Number
2003713325
Title
Transcatheter aortic valve replacement with self-expandable ACURATE neo as
compared to balloon-expandable SAPIEN 3 in patients with severe aortic
stenosis: Meta-analysis of randomized and propensity-matched studies.
Source
Journal of Clinical Medicine. 9 (2) (no pagination), 2020. Article Number:
397. Date of Publication: February 2020.
Author
Gozdek M.; Zielinski K.; Pasierski M.; Matteucci M.; Fina D.; Jiritano F.;
Meani P.; Raffa G.M.; Malvindi P.G.; Pilato M.; Paparella D.; Slomka A.;
Kubica J.; Jagielak D.; Lorusso R.; Suwalski P.; Kowalewski M.
Institution
(Gozdek, Kubica) Department of Cardiology and Internal Medicine, Nicolaus
Copernicus University, Collegium Medicum, Bydgoszcz 85067, Poland
(Gozdek, Zielinski, Pasierski, Slomka, Kowalewski) Thoracic Research
Centre, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz,
Innovative Medical Forum, Bydgoszcz 85067, Poland
(Zielinski) Department of Cardiology, Warsaw Medical University, Warsaw
02091, Poland
(Pasierski, Suwalski, Kowalewski) Clinical Department of Cardiac Surgery,
Central Clinical Hospital of the Ministry of Interior and Administration,
Centre of Postgraduate Medical Education, Warsaw 02607, Poland
(Matteucci, Fina, Jiritano, Meani, Lorusso, Kowalewski) Department of
Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University
Medical Centre, Maastricht 6229 HX, Netherlands
(Matteucci) Department of Cardiac Surgery, Circolo Hospital, University of
Insubria, Varese 21100, Italy
(Fina) Department of Cardiology, IRCCS Policlinico San Donato, University
of Milan, Milan 20097, Italy
(Jiritano) Department of Cardiac Surgery, University Magna Graecia of
Catanzaro, Catanzaro 88100, Italy
(Meani) Department of Intensive Care Unit, Maastricht University Medical
Centre (MUMC+), Maastricht 6229 HX, Netherlands
(Raffa, Pilato) Department for the Treatment and Study of Cardiothoracic
Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto
Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo
90127, Italy
(Malvindi) Wessex Cardiothoracic Centre, University Hospital Southampton,
Southampton SO16 6YD, United Kingdom
(Paparella) GVM Care & Research, Department of Cardiovascular Surgery,
Santa Maria Hospital, Bari 70124, Italy
(Paparella) Department of Emergency and Organ Transplant, University of
Bari Aldo Moro, Bari 70121, Italy
(Slomka) Department of Pathophysiology, Nicolaus Copernicus University,
Collegium Medicum, Bydgoszcz 85067, Poland
(Jagielak) Department of Cardiac Surgery, Gdansk Medical University,
Gdansk 80210, Poland
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Frequent occurrence of paravalvular leak (PVL) after transcatheter aortic
valve replacement (TAVR) was the main concern with earlier-generation
devices. Current meta-analysis compared outcomes of TAVR with
next-generation devices: ACURATE neo and SAPIEN 3. In random-effects
meta-analysis, the pooled incidence rates of procedural, clinical and
functional outcomes according to VARC-2 definitions were assessed. One
randomized controlled trial and five observational studies including 2818
patients (ACURATE neo n = 1256 vs. SAPIEN 3 n = 1562) met inclusion
criteria. ACURATE neo was associated with a 3.7-fold increase of
moderate-to-severe PVL (RR (risk ratio): 3.70 (2.04-6.70); P < 0.0001),
which was indirectly related to higher observed 30-day mortality with
ACURATE valve (RR: 1.77 (1.03-3.04); P = 0.04). Major vascular
complications, acute kidney injury, periprocedural myocardial infarction,
stroke and serious bleeding events were similar between devices. ACURATE
neo demonstrated lower transvalvular pressure gradients both at discharge
(P < 0.00001) and at 30 days (P < 0.00001), along with lower risk of
patient-prosthesis mismatch (RR: 0.29 (0.10-0.87); P = 0.03) and pacemaker
implantation (RR: 0.64 (0.50-0.81); P = 0.0002), but no differences were
observed regarding composite endpoints early safety and device success. In
conclusion, ACURATE neo, as compared with SAPIEN 3, was associated with
higher rates of moderate-to-severe PVL, which were indirectly linked with
increased observed 30-day all-cause mortality.<br/>Copyright &#xa9; 2020
by the authors. Licensee MDPI, Basel, Switzerland.

<11>
Accession Number
630946716
Title
A case report of a late left atrial appendage perforation 4 months after
occluder implant: Reason for or caused by a resuscitation?.
Source
European Heart Journal - Case Reports. 3 (4) (no pagination), 2019. Date
of Publication: 01 Dec 2019.
Author
Schenke K.; Geidel S.; Keller C.; Gronefeld G.
Institution
(Schenke, Gronefeld) Medical Clinic/Cardiology, Asklepios Klinik Barmbek,
Ruebenkamp 220, Hamburg 22291, Germany
(Geidel) Department of Cardiac Surgery, Asklepios Klinik St. Georg,
Lohmuehlenstrase 5, Hamburg 20099, Germany
(Keller) Medical Clinic/Cardiology, Asklepios Klinik Altona,
Paul-Ehrlich-Strase 1, Hamburg 22763, Germany
Publisher
Oxford University Press
Abstract
Background Atrial fibrillation (AF) is a common disease and can lead to
cardioembolic stroke. Stroke prevention according to the
CHA<inf>2</inf>DS<inf>2</inf>VASc score is achieved via oral
anticoagulation. In recent years, interventional occlusion of the left
atrial appendage (LAA) has become a common alternative. Besides showing
non-inferiority in large trials compared with warfarin interventional LAA
occlusion can lead to serious adverse events with most of them occurring
peri-interventionally. Case summary A 75-year-old man with AF and
recurrent gastrointestinal bleedings was referred for an interventional
closure of the LAA. The intervention was successful with an
ABBOTT^VR Amulet device. Four months later, the patient had to
be resuscitated. Return of spontaneous circulation occurred after 10 min.
On hospital arrival, echocardiography revealed a pericardial tamponade and
2 L of blood were drained. A coronary angiogram revealed a lesion with
active leakage of contrast agent in the proximal circumflex artery. The
patient was transferred to the cardiac surgery department immediately.
Intra-operatively a perforation of the tissue at the basis of the LAA
close to the left main coronary artery was discovered. The occluder was
excised and the LAA was closed by endocardial sutures. Discussion In this
report, we review the literature concerning interventional LAA occlusion
and the reported cases of LAA perforation. Retrospectively, it remains
unclear whether the perforation caused the resuscitation or was induced by
it. To our knowledge, this is the first reported case of a laceration of a
coronary artery by an occlusion device.<br/>Copyright &#xa9; The Author(s)
2019. Published by Oxford University Press on behalf of the European
Society of Cardiology.

<12>
[Use Link to view the full text]
Accession Number
630945706
Title
Women's Health Initiative clinical trials: Potential interactive effect of
calcium and vitamin D supplementation with hormonal therapy on
cardiovascular disease.
Source
Menopause. 26 (8) (pp 841-849), 2019. Date of Publication: 01 Aug 2019.
Author
Jiang X.; Nudy M.; Aragaki A.K.; Robbins J.A.; Manson J.E.; Stefanick
M.L.; O'Sullivan D.M.; Shikany J.M.; Leblanc E.S.; Kelsey A.M.; Cauley J.;
Martin L.W.; Payne M.E.; Johnson K.C.; Howard B.; Schnatz P.F.
Institution
(Jiang, O'Sullivan, Schnatz) Department of ObGyn, Reading Hospital,
Reading, PA, United States
(Jiang, Schnatz) Department of ObGyn, Sidney Kimmel Medical College,
Thomas Jefferson University, Philadelphia, PA, United States
(Nudy) Department of Internal Medicine, Penn State Hershey Medical Center,
Hershey, PA, United States
(Aragaki) Division of Public Health Sciences, Fred Hutchinson Cancer
Research Center, Seattle, WA, United States
(Robbins) UC Davis Medical Center, Sacramento, CA, United States
(Manson) Division of Preventive Medicine, Brigham and Women's
Hospital/Harvard Medical School, Boston, MA, United States
(Stefanick) Department of Medicine, Stanford Prevention Research Center,
Stanford University School of Medicine, Stanford University, Stanford, CA,
United States
(Shikany) Division of Preventive Medicine, School of Medicine, University
of Alabama at Birmingham, Birmingham, AL, United States
(Leblanc) Kaiser Permanente Center for Health Research NW, Portland, OR,
United States
(Kelsey) Division of Cardiology, Saint Francis Hospital and Medical
Center, Hartford, CT, United States
(Cauley) Department of Epidemiology, Graduate School of Public Health,
University of Pittsburgh, Pittsburgh, PA, United States
(Martin) Division of Cardiology, Department of Internal Medicine, George
Washington University School of Medicine and Health Sciences, Washington,
DC, United States
(Payne) Office of Research Development, Duke University School of
Medicine, Durham, NC, United States
(Johnson) Department of Preventive Medicine, University of Tennessee
Health Science Center, Memphis, TN, United States
(Howard) MedStar Health Research Institute, Georgetown/Howard Universities
Center for Clinical and Translational Science, Washington, DC, United
States
(Schnatz) Department of Internal Medicine, Reading Hospital, Reading, PA,
United States
(Schnatz) Department of Internal Medicine, Sidney Kimmel Medical College,
Thomas Jefferson University, Philadelphia, PA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Data in humans and nonhuman primates have suggested a possible
synergistic effect of vitamin D and calcium (CaD) and estrogen on the
cardiovascular disease (CVD) risk factors. Using randomized trial data we
explored whether the effect of menopausal hormone therapy (HT) on CVD
events is modified by CaD supplementation. <br/>Method(s): A prospective,
randomized, double-blind, placebo-controlled trial was implemented among
postmenopausal women in the Women's Health Initiative. A total of 27,347
women were randomized to the HT trials (0.625mg/d of conjugated equine
estrogens [CEE] alone for women without a uterus vs placebo; or 0.625mg of
CEE in addition to 2.5mg of medroxyprogesterone acetate daily [CEE + MPA]
for women with a uterus vs placebo). After 1 year, 16,089 women in the HT
trial were randomized to the CaD trial and received either 1,000mg of
elemental calcium carbonate and 400 IU of vitamin D3 daily or placebo. The
mean (SD) duration of follow-up after CaD randomization was 6.2 (1.3)
years for the CEE trial and 4.6 (1.1) years for the CEE + MPA trial. CVD
and venous thromboembolism events evaluated in this subgroup analysis
included coronary heart disease, stroke, pulmonary embolism, all-cause
mortality, plus select secondary endpoints (total myocardial infarction,
coronary revascularization, deep venous thrombosis, cardiovascular death,
and all CVD events). Time-to-event methods were used and models were fit
with a Cox proportional hazards regression model. <br/>Result(s): In the
CEE trial, CaD significantly modified the effect of CEE on stroke (P
interaction = 0.04). In the CaD-placebo group, CEE's effect on stroke was
harmful (hazard ratio [95% confidence interval] = 2.19[1.34-3.58]);
however, it was neutral in the CaD-supplement group (hazard ratio [95%
confidence interval] = 1.07[0.66-1.73]). We did not observe significant
CEE-CaD interactions for coronary heart disease, total CVD events, or any
of the remaining endpoints. In the CEE + MPA trial, there was no evidence
that the effect of CEE + MPA on any of CVD endpoints was modified by CaD
supplementation. <br/>Conclusion(s): CaD did not consistently modify the
effect of CEE therapy or CEE + MPA therapy on CVD events. However, the
increased risk of stroke due to CEE therapy appears to be mitigated by CaD
supplementation. In contrast, CaD supplementation did not influence the
risk of stroke due to CEE + MPA.<br/>Copyright &#xa9; 2019 by The North
American Menopause Society.

<13>
Accession Number
2004247942
Title
Extracorporeal membrane oxygenation without therapeutic anticoagulation in
adults: A systematic review of the current literature.
Source
International Journal of Artificial Organs. (no pagination), 2020. Date of
Publication: 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) IRCCS Policlinico San Donato, University of Milan, Milan, Italy
(Lorusso) Cardiovascular Research Institute, Maastricht University,
Maastricht, Netherlands
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
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 1128 h. 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.<br/>Copyright &#xa9; The Author(s) 2020.

<14>
Accession Number
2001998265
Title
Systematic review and consensus definitions for the Standardised Endpoints
in Perioperative Medicine initiative: clinical indicators.
Source
British Journal of Anaesthesia. 123 (2) (pp 228-237), 2019. Date of
Publication: 01 Aug 2019.
Author
Bampoe S.; Cook T.; Fleisher L.A.; Grocott M.P.W.; Neuman M.; Story D.;
Myles P.S.; Biccard B.; Blazeby J.; Boney O.; Chan M.; Diouf E.; Kalkman
C.; Kurz A.; Moonesinghe R.; Wijeysundera D.; Gan T.J.; Peyton P.; Sessler
D.; Tramer M.; Cyna A.; De Oliveira G.S.; Wu C.; Jensen M.; Kehlet H.;
Botti M.; Haller G.; Gruen R.; Evered L.; Scott D.; Silbert B.; van Dijk
D.; Grocott H.; Eckenhoff R.; Rasmussen L.; Eriksson L.; Beattie S.;
Landoni G.; Leslie K.; Howell S.; Nagele P.; Richards T.; Lamy A.; Lalu
M.; Pearse R.; Mythen M.; Canet J.; Moller A.; Gin T.; Schultz M.; Pelosi
P.; Gabreu M.; Futier E.; Creagh-Brown B.; Abbott T.; Klein A.; Corcoran
T.; Jamie Cooper D.; Dieleman S.; McIlroy D.; Bellomo R.; Shaw A.; Prowle
J.; Karkouti K.; Billings J.; Mazer D.; Jayarajah M.; Murphy M.; Bartoszko
J.; Sneyd R.; Morris S.; George R.; Shulman M.; Lane-Fall M.; Nilsson U.;
Stevenson N.; Cooper J.D.J.; van Klei W.; Cabrini L.; Miller T.; Pace N.;
Jackson S.; Buggy D.; Short T.; Riedel B.; Gottumukkala V.; Alkhaffaf B.;
Johnson M.
Institution
(Haller) Department of Anaesthesiology, Geneva University Hospitals,
Geneva, Switzerland
(Haller, Myles) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Bampoe) Centre for Perioperative Medicine, University College London,
United Kingdom
(Cook) Department of Anaesthesia and Intensive Care, Royal United
Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
(Fleisher, Neuman) Departments of Anesthesiology and Critical Care and
Medicine, Perelman School of Medicine of the University of Pennsylvania,
Philadelphia, PA, United States
(Grocott) Integrative Physiology and Critical Illness Group, Clinical and
Experimental Sciences, Faculty of Medicine, University Hospital
Southampton, Southampton, United Kingdom
(Grocott) Anaesthesia, Perioperative and Critical Care Research Group,
Southampton NIHR Biomedical Research Centre, University Hospital
Southampton, Southampton, United Kingdom
(Story) Centre for Integrated Critical Care, University of Melbourne,
Melbourne, Australia
(Myles) Department of Anaesthesiology and Perioperative Medicine, Alfred
Hospital and Monash University, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: Clinical indicators are powerful tools to quantify the safety
and quality of patient care. Their validity is often unclear and
definitions extremely heterogeneous. As part of the International
Standardised Endpoints in Perioperative Medicine (StEP) initiative, this
study aimed to derive a set of standardised and valid clinical outcome
indicators for use in perioperative clinical trials. <br/>Method(s): We
identified clinical indicators via a systematic review of the anaesthesia
and perioperative medicine literature (PubMed/OVID, EMBASE, and Cochrane
Library). We performed a three-stage Delphi consensus-gaining process that
involved 54 clinician-researchers worldwide. Indicators were first
shortlisted and the most suitable definitions for evaluation of quality
and safety interventions determined. Indicators were then assessed for
validity, reliability, feasibility, and clarity. <br/>Result(s): We
identified 167 clinical outcome indicators. Participation in the three
Delphi rounds was 100% (n=13), 68% (n=54), and 85% (n= 6), respectively. A
final list of eight outcome indicators was generated: surgical site
infection at 30 days, stroke within 30 days of surgery, death within 30
days of coronary artery bypass grafting, death within 30 days of surgery,
admission to the intensive care unit within 14 days of surgery,
readmission to hospital within 30 days of surgery, and length of hospital
stay (with or without in-hospital mortality). They were rated by the
majority of experts as valid, reliable, easy to use, and clearly defined.
<br/>Conclusion(s): These clinical indicators can be confidently used as
endpoints in clinical trials measuring quality, safety, and improvement in
perioperative care. Registration: PROSPERO 2016 CRD42016042102
(http://www.crd.york.ac.uk/PROSPERO/display_record.php?
ID=CRD42016042102).<br/>Copyright &#xa9; 2019 British Journal of
Anaesthesia

<15>
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.

<16>
[Use Link to view the full text]
Accession Number
630600451
Title
Efficacy of paravertebral block techniques in thoracic surgery: Systematic
literature review.
Source
Colombian Journal of Anesthesiology. 48 (1) (pp 20-29), 2020. Date of
Publication: 01 Jan 2020.
Author
Cadavid-Puentes A.M.; Casas-Arroyave F.D.; Palacio-Montoya L.M.;
Valencia-Gallon E.
Institution
(Cadavid-Puentes, Casas-Arroyave) Anesthesiology and Reanimation Division,
Universidad de Antioquia, Hospital Universitario San Vicente Fundacion,
Calle 64 No. 51D-154, Medellin, Colombia
(Palacio-Montoya, Valencia-Gallon) IPS Universitaria, Universidad de
Antioquia, Medellin, Colombia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction:Postoperative pain in thoracic surgery in adults is usually
severe, and to control it there are many analgesic methods that include
paravertebral blockade (PVB). Until now, there is no clarity on which is
the most effective technique to perform this blockade.
<br/>Objective(s):To describe the different PVB techniques and its
analgesic effect in thoracic surgery. <br/>Method(s):A systematic review
of the literature was performed. We included studies that analyzed
patients in open chest surgery and used PVB as analgesic technique. The
Cochrane and Grading of Recommendation Assessment, Development and
Evaluation strategies were used to analyze biases and evidence. The
results are presented graphically by means of a visual analog scale (VAS)
pain and opioid consumption equivalent to morphine for each technique
found. We summarize the results with a qualitative approach without
meta-analysis. <br/>Result(s):A total of 38 articles were analyzed (2188
patients). 13 using PVB guided by surface anatomy (SA-PVB), 7
Ultrasound-guided PVB (US-PVB), 1 neurostimulation guided PVB (NE-PVB) and
the remaining using PVB performed under direct visualization by the
surgeon (S-PVB). A VAS of less than 3 was found in studies with SA-PVB and
US-PVB, and greater than 5 in studies with S-PVB; however, opioid
consumption in the postoperative period was similar between the techniques
described. <br/>Conclusion(s):PVB can be performed through 4 techniques.
Techniques of US-PVB or SA-PVB have shown better consistency to manage
postoperative acute pain in thoracic surgery.<br/>Copyright &#xa9; 2019
Sociedad Colombiana de Anestesiologia y Reanimacion (S.C.A.R.E.).
Published by Wolters Kluwer.

<17>
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.

<18>
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.

<19>
Accession Number
2003985877
Title
Prevalence and patterns of cognitive impairment in acute coronary syndrome
patients: A systematic review.
Source
European Journal of Preventive Cardiology. 27 (3) (pp 281-283), 2020. Date
of Publication: 01 Feb 2020.
Author
Pottle A.
Institution
(Pottle) Royal Brompton and Harefield Foundation Trust, Harefield
Hospital, Harefield, United Kingdom
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)

<20>
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

<21>
Accession Number
2004705745
Title
Association of obstructive sleep apnea and postoperative cardiac
complications: A systematic review and meta-analysis with trial sequential
analysis.
Source
Journal of Clinical Anesthesia. 62 (no pagination), 2020. Article Number:
109731. Date of Publication: June 2020.
Author
Ng K.T.; Lee Z.X.; Ang E.; Teoh W.Y.; Wang C.Y.
Institution
(Ng, Wang) Department of Anaesthesiology, Faculty of Medicine, University
of Malaya, Jalan Universiti, Kuala Lumpur 50603, Malaysia
(Lee, Ang) University Hospital of Wales, Health Park, Cardiff CF14 4XN,
United Kingdom
(Teoh) University of Liverpool, School of Medicine, Cedar House, Ashton
Street, Liverpool L69 3GE, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The repetitive hypoxic and hypercapnia events of obstructive
sleep apnea (OSA) are believed to adversely affect cardiopulmonary
function, which make them vulnerable to a higher incidence of
postoperative complications. The primary aim of this systematic review and
meta-analysis was to examine the association of OSA and the composite
endpoints of postoperative cardiac or cerebrovascular complications in
adult undergoing non-cardiac surgery. Data sources: MEDLINE, EMBASE and
CENTRAL were systematically searched from its inception until May 2019.
Review methods: All observational studies were included. <br/>Result(s):
Twenty-two studies (n = 3,033,814; 184,968 OSA vs 2,848,846 non-OSA) were
included for quantitative meta-analysis. In non-cardiac surgery, OSA was
significantly associated with a higher incidence of the composite
endpoints of postoperative cardiac or cerebrovascular complications (odd
ratio: 1.44, 95%CI: 1.17 to 1.78, rho = 0.007, trial sequential analysis =
conclusive; certainty of evidence = very low). In comparison to non-OSA,
OSA patients were reported to have nearly 2.5-fold risk of developing
pulmonary complications (odd ratio: 2.52, 95%CI: 1.92 to 3.31, rho <
0.001, certainty of evidence = very low), postoperative delirium (odd
ratio: 2.45, 95%CI: 1.50 to 4.01, rho < 0.001, certainty of evidence =
low) and acute kidney injury (odd ratio: 2.41, 95%CI: 1.93 to 3.02, rho <
0.001, certainty of evidence = very low). <br/>Conclusion(s): This
meta-analysis of 22 comparative studies demonstrated that OSA is a
potential risk factor to postoperative adverse complications in adults
undergoing non-cardiac surgery. However, the conclusions need to be
interpreted with caution due to the nature of included observational
studies with significant heterogeneity and low quality of evidence.
PROSPERO: CRD42019136564.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<22>
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. 75 (1) (pp 26-34), 2020. Date of Publication: 02 Jan
2020.
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.

<23>
Accession Number
2004209886
Title
Current clinical management of dysfunctional bioprosthetic pulmonary
valves.
Source
Expert Review of Cardiovascular Therapy. 18 (1) (pp 7-16), 2020. Date of
Publication: 02 Jan 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.

<24>
Accession Number
2004068892
Title
Current advances in biodegradable synthetic polymer based cardiac patches.
Source
Journal of Biomedical Materials Research - Part A. 108 (4) (pp 972-983),
2020. Date of Publication: 01 Apr 2020.
Author
McMahan S.; Taylor A.; Copeland K.M.; Pan Z.; Liao J.; Hong Y.
Institution
(McMahan, Taylor, Copeland, Liao, Hong) Department of Bioengineering,
University of Texas at Arlington, Arlington, TX, United States
(Pan) College of Nursing and Health Innovation, University of Texas at
Arlington, Arlington, TX, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
The number of people affected by heart disease such as coronary artery
disease and myocardial infarction increases at an alarming rate each year.
Currently, the methods to treat these diseases are restricted to lifestyle
change, pharmaceuticals, and eventually heart transplant if the condition
is severe enough. While these treatment options are the standard for
caring for patients who suffer from heart disease, limited regenerative
ability of the heart restricts the effectiveness of treatment and may lead
to other heart-related health problems in the future. Because of the
increasing need for more effective therapeutic technologies for treating
diseased heart tissue, cardiac patches are now a large focus for
researchers. The cardiac patches are designed to be integrated into the
patients' natural tissue to introduce mechanical support and healing to
the damaged areas. As a promising alternative, synthetic biodegradable
polymer based biomaterials can be easily manipulated to customize material
properties, as well as possess certain desired characteristics for cardiac
patch use. This comprehensive review summarizes recent works on synthetic
biodegradable cardiac patches implanted into infarcted animal models. In
addition, this review describes the basic requirements that should be met
for cardiac patch development, and discusses the inspirations to designing
new biomaterials and technologies for cardiac patches.<br/>Copyright
&#xa9; 2020 Wiley Periodicals, Inc.

<25>
[Use Link to view the full text]
Accession Number
630933865
Title
Ulinastatin reduces postoperative bleeding and red blood cell transfusion
in patients undergoing cardiac surgery: A PRISMA-compliant systematic
review and meta-analysis.
Source
Medicine. 99 (7) (pp e19184), 2020. Date of Publication: 01 Feb 2020.
Author
Yao Y.-T.; Fang N.-X.; Liu D.-H.; Li L.-H.
Institution
(Yao, Fang, Li) Department of Anesthesiology, Fuwai Hospital, National
Center for Cardiovascular Diseases, Peking Union Medical College and
Chinese Academy of Medical Sciences, Beijing, China
(Liu) Department of Clinical Laboratory, University-Town Hospital of
Chongqing Medical University, Chongqing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Ulinastatin is a type of glycoprotein and a nonspecific
wide-spectrum protease inhibitor like antifibrinolytic agent aprotinin.
Whether Ulinastatin has similar beneficial effects on blood conservation
in cardiac surgical patients as aprotinin remains undetermined. Therefore,
a systematic review and meta-analysis were performed to evaluate the
effects of Ulinastatin on perioperative bleeding and transfusion in
patients who underwent cardiac surgery. <br/>METHOD(S): Electronic
databases were searched to identify all clinical trials comparing
Ulinastatin with placebo/blank on postoperative bleeding and transfusion
in patients undergoing cardiac surgery. Primary outcomes included
perioperative blood loss, blood transfusion, postoperative re-exploration
for bleeding. Secondary outcomes include perioperative hemoglobin level,
platelet counts and functions, coagulation tests, inflammatory cytokines
level, and so on. For continuous variables, treatment effects were
calculated as weighted mean difference (WMD) and 95% confidential interval
(CI). For dichotomous data, treatment effects were calculated as odds
ratio and 95% CI. Statistical significance was defined as P < .05.
<br/>RESULT(S): Our search yielded 21 studies including 1310 patients, and
617 patients were allocated into Ulinastatin group and 693 into Control
(placebo/blank) group. There was no significant difference in
intraoperative bleeding volume, postoperative re-exploration for bleeding
incidence, intraoperative red blood cell transfusion units, postoperative
fresh frozen plasma transfusion volumes and platelet concentrates
transfusion units between the 2 groups (all P > .05). Ulinastatin reduces
postoperative bleeding (WMD = -0.73, 95% CI: -1.17 to -0.28, P = .001) and
red blood cell (RBC) transfusion (WMD = -0.70, 95% CI: -1.26 to -0.14, P =
.01), inhibits hyperfibrinolysis as manifested by lower level of
postoperative D-dimer (WMD = -0.87, 95% CI: -1.34 to -0.39, P = .0003).
<br/>CONCLUSION(S): This meta-analysis has found some evidence showing
that Ulinastatin reduces postoperative bleeding and RBC transfusion in
patients undergoing cardiac surgery. However, these findings should be
interpreted rigorously. Further well-conducted trials are required to
assess the blood-saving effects and mechanisms of Ulinastatin.

<26>
Accession Number
630928674
Title
Letter to the editor for the article entitled 'Comparison of
ultrasound-guided erector spinae plane block and thoracic paravertebral
block for postoperative analgesia after video-assisted thoracic surgery: a
randomized controlled non-inferiority clinical trial'.
Source
Regional anesthesia and pain medicine. (no pagination), 2020. Date of
Publication: 10 Feb 2020.
Author
Wang K.; An N.; Jiang X.; Yuan H.
Institution
(Wang, An, Jiang, Yuan) Department of Anesthesiology, Changzheng Hospital,
Shanghai, China
Publisher
NLM (Medline)

<27>
Accession Number
630928239
Title
Comparison of newer generation self-expandable vs. balloon-expandable
valves in transcatheter aortic valve implantation: the randomized
SOLVE-TAVI trial.
Source
European heart journal. (no pagination), 2020. Date of Publication: 12 Feb
2020.
Author
Thiele H.; Kurz T.; Feistritzer H.-J.; Stachel G.; Hartung P.; Eitel I.;
Marquetand C.; Nef H.; Doerr O.; Lauten A.; Landmesser U.; Abdel-Wahab M.;
Sandri M.; Holzhey D.; Borger M.; Ince H.; Oner A.; Meyer-Saraei R.;
Wienbergen H.; Fach A.; Frey N.; Konig I.R.; Vonthein R.; Ruckert Y.;
Funkat A.-K.; de Waha-Thiele S.; Desch S.
Institution
(Thiele, Feistritzer, Stachel, Hartung, Abdel-Wahab, Sandri, Holzhey,
Borger, Desch) Heart Center Leipzig at University of Leipzig,
Strumpellstr. 39, Leipzig 04289, Germany
(Thiele, Feistritzer, Stachel, Hartung, Abdel-Wahab, Sandri, Holzhey,
Borger, Ruckert, Funkat, Desch) Leipzig Heart Institute, Leipzig D-04289,
Germany
(Kurz, Eitel, Marquetand, Meyer-Saraei, de Waha-Thiele) University Clinic
Schleswig-Holstein and University Heart Center Lubeck, Ratzeburger Allee
160, D-23538 Lubeck, Germany
(Kurz, Eitel, Marquetand, Lauten, Landmesser, Meyer-Saraei, Frey, Konig,
de Waha-Thiele, Desch) German Center for Cardiovascular Research (DZHK),
Ratzeburger Allee 160, D-23538 Lubeck, Germany
(Nef, Doerr) Abteilung fur Kardiologie, Medizinische Klinik IKlinikstr.
33, Germany
(Lauten, Landmesser) Universitatsklinikum Charite, Campus Benjamin
Franklin, Hindenburgdamm 30, Berlin D-12200, Germany
(Ince, Oner) Universitatsklinikum Rostock, Ernst-Heydemann-Str. 6, Germany
(Wienbergen, Fach) Klinikum Links der Weser, Herzzentrum Bremen, D-28277
Bremen, Germany
(Frey) Department of Cardiology, University Clinic Schleswig-Holstein,
Campus Kiel ,Schittenhelmstr. 12, Kiel D-24105, Germany
(Konig, Vonthein) Institut fur Medizinische Biometrie und Statistik,
Universitat zu Lubeck, Universitatsklinikum Schleswig-Holstein, Campus
Lubeck ,Ratzeburger Allee 160, D-23562 Lubeck, Germany
Publisher
NLM (Medline)
Abstract
AIMS: Transcatheter aortic valve implantation (TAVI) has emerged as
established treatment option in patients with symptomatic aortic stenosis.
Technical developments in valve design have addressed previous limitations
such as suboptimal deployment, conduction disturbances, and paravalvular
leakage. However, there are only limited data available for the comparison
of newer generation self-expandable valve (SEV) and balloon-expandable
valve (BEV). METHODS AND RESULTS: SOLVE-TAVI is a multicentre, open-label,
2 x 2 factorial, randomized trial of 447 patients with aortic stenosis
undergoing transfemoral TAVI comparing SEV (Evolut R, Medtronic Inc.,
Minneapolis, MN, USA) with BEV (Sapien 3, Edwards Lifesciences, Irvine,
CA, USA). The primary efficacy composite endpoint of all-cause mortality,
stroke, moderate/severe prosthetic valve regurgitation, and permanent
pacemaker implantation at 30days was powered for equivalence (equivalence
margin 10% with significance level 0.05). The primary composite endpoint
occurred in 28.4% of SEV patients and 26.1% of BEV patients meeting the
prespecified criteria of equivalence [rate difference -2.39 (90%
confidence interval, CI -9.45 to 4.66); Pequivalence=0.04]. Event rates
for the individual components were as follows: all-cause mortality 3.2%
vs. 2.3% [rate difference -0.93 (90% CI -4.78 to 2.92);
Pequivalence<0.001], stroke 0.5% vs. 4.7% [rate difference 4.20 (90% CI
0.12 to 8.27); Pequivalence=0.003], moderate/severe paravalvular leak 3.4%
vs. 1.5% [rate difference -1.89 (90% CI -5.86 to 2.08);
Pequivalence=0.0001], and permanent pacemaker implantation 23.0% vs. 19.2%
[rate difference -3.85 (90% CI -10.41 to 2.72) in SEV vs. BEV patients;
Pequivalence=0.06]. <br/>CONCLUSION(S): In patients with aortic stenosis
undergoing transfemoral TAVI, newer generation SEV and BEV are equivalent
for the primary valve-related efficacy endpoint. These findings support
the safe application of these newer generation percutaneous valves in the
majority of patients with some specific preferences based on individual
valve anatomy.<br/>Copyright Published on behalf of the European Society
of Cardiology. All rights reserved. &#xa9; The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

<28>
Accession Number
630926946
Title
Anticoagulation regimens during pregnancy in patients with mechanical
heart valves: a protocol for a systematic review and network
meta-analysis.
Source
BMJ open. 10 (2) (pp e033917), 2020. Date of Publication: 10 Feb 2020.
Author
He S.; Zou Y.; Li J.; Liu J.; Zhao L.; Yang H.; Su Z.; Ye H.
Institution
(He, Zou) School of Public Health, Xiamen University, Xiamen, China
(Li, Liu, Ye) Department of Clinical Laboratory, Women and Children's
Hospital, School of Medicine, Xiamen University, Xiamen, China
(Zhao, Ye) School of Medicine, Xiamen University, Xiamen, China
(Yang) Department of Obstetrics, Women and Children's Hospital, School of
Medicine, Xiamen University, Xiamen, China
(Su) Department of Obstetrics, Women and Children's Hospital, School of
Medicine, Xiamen University, Xiamen, China
(Ye) School of Public Health, Xiamen University, Xiamen, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Pregnancy in patients with mechanical heart valves (MHVs) is
associated with high maternal complications and fetal
complications.Anticoagulation treatments serve to decrease their venous
clotting risk. Although some anticoagulation regimens have been used for
patients during pregnancy with MHVs, no one is definitively superior among
different regimens in recent studies. For a better understanding of the
clinical treatment which anticoagulation regimen is more effective and
safer during the pregnancy in patients with MHVs, a Bayesian network
meta-analysis is necessary. METHODS AND ANALYSIS: This protocol has been
reported according to the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses Protocols. Related studies until April 2019 will be
searched in the following databases: PubMed, Embase,SinoMed and the using
the OVID interface to search for evidence-based medicine reviews. A
clinical trial registry (www.ClinicalTrials.gov) was also searched for
unpublished trials. Both experimental studies (randomised clinical trials)
and observational studies (cohort studies, case-control studies and case
series studies) will be included in this study. Quality assessment will be
conducted using Cochrane Collaboration's tool or Newcastle-Ottawa Scale
based on their study designs. The primary outcomes of interest will be the
frequencies of serious maternal and fetal events. The additional outcomes
of interest will be adverse maternal events, mode of delivery and adverse
fetal events. Pairwise and network meta-analysis will be conducted using R
(V.3.4.4, R Foundation for Statistical Computing, Vienna, Austria) and
Stata (V.14, StataCorp). The ranking probabilities will be estimated at
each possible rank for each anticoagulation regimen using the surface
under the cumulative ranking curve. Statistical inconsistency assessment,
subgroup analysis, sensitivity analysis and publication bias assessment
will be performed. ETHICS AND DISSEMINATION: Either ethics approval or
patient consent is not necessary, because this study will be based on
literature. The results of this study will be published in a peer-reviewed
journal. PROSPERO REGISTRATION NUMBER: CRD42019130659.<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.

<29>
Accession Number
2004243557
Title
Impact of left ventricular ejection fraction on clinical outcomes after
left main coronary artery revascularization: results from the randomized
EXCEL trial.
Source
European Journal of Heart Failure. (no pagination), 2020. Date of
Publication: 2020.
Author
Thuijs D.J.F.M.; Milojevic M.; Stone G.W.; Puskas J.D.; Serruys P.W.;
Sabik J.F.; Dressler O.; Crowley A.; Head S.J.; Kappetein A.P.
Institution
(Thuijs, Milojevic, Head, Kappetein) Department of Cardiothoracic Surgery,
Erasmus MC, University Medical Centre, Rotterdam, Netherlands
(Stone) Division of Cardiology, New York-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Stone, Dressler, Crowley) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Heart at Mount
Saint Luke's, New York, NY, United States
(Serruys) Department of Cardiology, Imperial College London, London,
United Kingdom
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Aim: To evaluate the impact of left ventricular ejection fraction (LVEF)
on 3-year outcomes in patients with left main coronary artery disease
(LMCAD) undergoing percutaneous coronary intervention (PCI) or coronary
artery bypass grafting (CABG) in the EXCEL trial. <br/>Methods and
Results: The EXCEL trial randomized patients with LMCAD to PCI with
everolimus-eluting stents (n = 948) or CABG (n = 957). Among 1804 patients
with known baseline LVEF, 74 (4.1%) had LVEF <40% [heart failure with
reduced ejection fraction (HFrEF)], 152 (8.4%) LVEF 40-49% [heart failure
with mid-range ejection fraction (HFmrEF)] and 1578 (87.5%) LVEF >=50%
(heart failure with preserved ejection fraction). Patients with HFrEF vs.
HFmrEF vs. preserved LVEF experienced a longer postoperative hospital stay
(9.0 vs. 7.0 vs. 6.0 days, P = 0.02) with greater peri-procedural
complications after CABG, while hospital stay after PCI was unaffected by
LVEF (1.5 vs. 2.0 vs. 1.0 days, P = 0.20). The composite primary endpoint
of death, stroke, or myocardial infarction at 3 years was 29.3% (PCI) vs.
27.6% (CABG) in patients with HFrEF, 16.2% vs. 15.0% in patients with
HFmrEF, and 14.5% vs. 14.6% in those with preserved LVEF, respectively
(P<inf>interaction</inf> = 0.90). Smoothing spline analysis demonstrated
that the 3-year risk of all-cause death increased when LVEF decreased,
both in patients undergoing CABG and PCI. <br/>Conclusion(s): In the EXCEL
trial, the composite rate of death, stroke or myocardial infarction at 3
years was significantly higher in patients with HFrEF compared with HFmrEF
or preserved LVEF, driven by an increased rate of all-cause death. No
significant differences after PCI vs. CABG were observed among patients
with HFrEF, HFmrEF and preserved LVEF. Longer-term follow-up could provide
important insights on differences in clinical outcomes that might emerge
over time. Clinical Trial Registration: ClinicalTrials.gov ID
NCT01205776.<br/>Copyright &#xa9; 2020 The Authors. European Journal of
Heart Failure published by John Wiley & Sons Ltd on behalf of European
Society of Cardiology.

<30>
Accession Number
2004239755
Title
Association of postoperative fluid overload with adverse outcomes after
congenital heart surgery: a systematic review and dose-response
meta-analysis.
Source
Pediatric Nephrology. (no pagination), 2020. Date of Publication: 2020.
Author
Bellos I.; Iliopoulos D.C.; Perrea D.N.
Institution
(Bellos, Iliopoulos, Perrea) Laboratory of Experimental Surgery and
Surgical Research N.S. Christeas, Athens University Medical School,
National and Kapodistrian University of Athens, Athens, Greece
Publisher
Springer
Abstract
Background: Pediatric cardiac surgery is commonly associated with acute
kidney injury (AKI) and significant fluid retention, which complicate
postoperative management and lead to increased rates of morbidity. This
meta-analysis aimed to accumulate current literature evidence and evaluate
the correlation of fluid overload degree with adverse outcome in patients
undergoing congenital heart surgery. <br/>Method(s): Medline, Scopus,
CENTRAL, Clinicaltrials.gov, and Google Scholar were systematically
searched from inception. All studies reporting the effects of fluid
overload on postoperative clinical outcomes were selected. A dose-response
meta-analytic method using restricted cubic splines was implemented in
R-3.6.1. <br/>Result(s): Twelve studies were included, with a total of
3111 pediatric patients. Qualitative synthesis indicated that fluid
overload was linked to significantly higher risk of mortality, AKI,
prolonged hospital, and intensive care unit (ICU) stay, as well as with
increased duration of mechanical ventilation, inotrope need, and infection
rate. Meta-analysis demonstrated a linear correlation between fluid
overload and the risk of mortality (chi² = 6.22, p value =
0.01) and AKI (chi² = 35.84, p value < 0.001), while a positive
curvilinear relationship was estimated for the outcomes of hospital
(chi² = 18.84, p value = 0.0001) and ICU stay (chi²
= 63.69, p value = 0.0001). <br/>Conclusion(s): The present meta-analysis
supports that postoperative fluid overload is significantly linked to
elevated risk of prolonged hospital stay, AKI development, and mortality
in pediatric patients undergoing cardiac surgery. These findings warrant
replication by future prospective studies, which should define the optimal
cutoff values and assess the effectiveness of therapeutic strategies to
limit fluid overload in the postoperative setting.<br/>Copyright &#xa9;
2020, IPNA.

<31>
Accession Number
2004850389
Title
The role of 3D printing in pediatric airway obstruction: A systematic
review.
Source
International Journal of Pediatric Otorhinolaryngology. 132 (no
pagination), 2020. Article Number: 109923. Date of Publication: May 2020.
Author
Stramiello J.A.; Saddawi-Konefka R.; Ryan J.; Brigger M.T.
Institution
(Stramiello, Saddawi-Konefka, Brigger) Division of Otolaryngology-Head &
Neck Surgery, Department of Surgery, University of California San Diego,
200 W Arbor Dr, MC8895, San Diego, CA 92103, United States
(Ryan) 3D Innovations Lab, Rady Children's Hospital, 3020 Children's Way
MC5166, San Diego, CA 92123, United States
(Brigger) Division of Pediatric Otolaryngology, Department of Surgery,
Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, United
States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Tracheomalacia and tracheal stenosis are complicated,
patient-specific diseases that require a multidisciplinary approach to
diagnose and treat. Surgical interventions such as aortopexy, slide
tracheoplasty, and stents potentially have high rates of morbidity. Given
the emergence of three-dimensional (3D) printing as a versatile adjunct in
managing complex pathology, there is a growing body of evidence that there
is a strong role for 3D printing in both surgical planning and implant
creation for pediatric airway obstruction. <br/>Method(s): A structured
PubMed.gov literature search was utilized, and a two-researcher systematic
review was performed following the PRISMA criteria. The following search
query was utilized: (((((3D printing) OR three-dimensional printing) OR 3D
printed) OR three-dimensional printed) AND trachea) OR airway.
<br/>Result(s): Over 23,000 publications were screened. Eight literature
reviews and thirty-seven original papers met inclusion criteria. Of the
thirty-seven original papers, eleven discussed 3D printing for surgical
planning and twenty-six discussed 3D printing implants for interventions.
<br/>Conclusion(s): The reported application of 3D printing for management
of pediatric airway obstruction is emerging with positive and broad
applications. 3D printing for surgical planning not only improves
pre-operative assessment of surgical approach and stent customization, but
also helps facilitate patient/family education. 3D printing for custom
implantable interventions is focused on bioresorbable external airway
splints and biological grafts, with both animal studies and human case
reports showing good results in improving symptoms.<br/>Copyright &#xa9;
2020

<32>
Accession Number
2004556179
Title
Racial and Ethnic Differences in Treatment and Outcomes of Severe Aortic
Stenosis: A Review.
Source
JACC: Cardiovascular Interventions. 13 (2) (pp 149-156), 2020. Date of
Publication: 27 January 2020.
Author
Wilson J.B.; Jackson L.R.; Ugowe F.E.; Jones T.; Yankey G.S.A.; Marts C.;
Thomas K.L.
Institution
(Wilson) Albany State University, Albany, Georgia
(Jackson, Thomas) Duke Clinical Research Institute, Durham, NC, United
States
(Ugowe, Yankey) Duke University Medical Center, Durham, NC, United States
(Jones, Marts) Duke University Medical School, Durham, NC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Aortic stenosis (AS) is among the most common valvular heart diseases
encountered in the United States. In this review the authors examine
differences between racial and ethnic groups in the epidemiology and
management of severe AS, explore potential explanations for these
findings, and discuss the implications for improving the delivery of care
to racially and ethnically diverse populations. Underrepresented racial
and ethnic groups experience a paradoxically lower prevalence or incidence
of AS relative to white subjects, despite having a higher prevalence of
traditional risk factors. Historically, UREGs with severe AS have had
lower rates of both surgical and transcatheter aortic valve replacement
and experienced more post-surgical complications, including, bleeding,
worsening heart failure, and rehospitalization. Last, UREGs with severe AS
have an increased risk for morbidity and mortality relative to white
patients. To date much of the research on AS has examined black-white
differences, so there is a need to understand how other racial and ethnic
groups with severe AS are diagnosed and treated, with examination of their
resulting outcomes. Overall, racial and ethnic disparities in health care
access and care delivery are a public health concern given the changing
demographics of the U.S. population. These differences in AS management
and outcomes highlight the need for additional research into contributing
factors and appropriate interventions to address the lower rates of aortic
valve replacement and higher morbidity and mortality among
UREGs.<br/>Copyright &#xa9; 2020 American College of Cardiology Foundation

<33>
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.

<34>
Accession Number
2001986702
Title
Efficacy of an Ultrasound-Guided Erector Spinae Plane Block for
Postoperative Analgesia Management After Video-Assisted Thoracic Surgery:
A Prospective Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (2) (pp 444-449),
2020. Date of Publication: February 2020.
Author
Ciftci B.; Ekinci M.; Celik E.C.; Tukac I.C.; Bayrak Y.; Atalay Y.O.
Institution
(Ciftci, Ekinci, Tukac, Atalay) Istanbul Medipol University, School of
Medicine, Mega Medipol University Hospital, Department of Anesthesiology
and Reanimation, Istanbul, Turkey
(Celik) Erzurum Regional Training and Research Hospital, Department of
Anesthesiology and Reanimation, Yakutiye, Erzurum, Turkey
(Bayrak) Istanbul Medipol University, Mega Medipol University Hospital,
Department of Thoracic Surgery, Istanbul, Turkey
Publisher
W.B. Saunders
Abstract
Objectives: Investigate whether an ultrasound-guided erector spinae plane
block (ESPB) can be used to manage postoperative pain in video-assisted
thoracic surgery (VATS) patients. <br/>Design(s): Prospective, randomized
study. <br/>Setting(s): Single institution, academic university hospital.
<br/>Participant(s): Adult patients who underwent VATS under general
anesthesia between September 2018 and March 2019. <br/>Intervention(s):
This study was an interventional study. <br/>Measurements and Main
Results: A total of 60 patients were randomly assigned into 2 groups (n =
30 per group): an ESPB group and a control group. In the ESPB group, a
single-shot ultrasound-guided ESPB was administered preoperatively. The
control group received no such intervention. All of the patients received
intravenous patient-controlled postoperative analgesia, and they were
assessed using visual analogue scale (VAS) scores, opioid consumption, and
adverse events. There were no statistically significant intergroup
differences with respect to the age, sex, weight, American Society of
Anesthesiologists status, anesthesia duration, and surgery length (p >
0.05 for each). The opioid consumption at 1, 2, 4, 8, 16, and 24 hours and
the active and passive VAS scores at 0, 2, 4, 8, 16, and 24 hours were
statistically lower in the ESPB group at all of the time periods when
compared with the control group (p < 0.05). In the control group, the
nausea and itching rates were higher, but there were no intergroup
differences in terms of other adverse effects. <br/>Conclusion(s): A
preemptive single-shot ESPB may provide effective analgesia management
after VATS.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<35>
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.

<36>
Accession Number
2002885901
Title
A Pilot, Double-Blind, Randomized, Controlled Trial of High-Dose
Intravenous Vitamin C for Vasoplegia After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (2) (pp 409-416),
2020. Date of Publication: February 2020.
Author
Yanase F.; Bitker L.; Hessels L.; Osawa E.; Naorungroj T.; Cutuli S.L.;
Young P.J.; Ritzema J.; Hill G.; Latimer-Bell C.; Hunt A.; Eastwood G.M.;
Hilton A.; Bellomo R.
Institution
(Yanase, Bitker, Hessels, Osawa, Naorungroj, Cutuli, Eastwood, Hilton,
Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Yanase, Bellomo) Australian and New Zealand Intensive Care Research
Centre, Monash University School of Public Health and Preventive Medicine,
Melbourne, Australia
(Bitker) Service de medecine intensive et reanimation, Hopital de la Croix
Rousse, Hospices Civils de Lyon, Lyon, France
(Hessels) Department of Critical Care, University of Groningen, University
Medical Center Groningen, Groningen, Netherlands
(Naorungroj) Department of Intensive Care, Siriraj Hospital, Mahidol
University, Bangkok, Thailand
(Young, Ritzema, Hill, Latimer-Bell, Hunt) Department of Intensive Care,
Wellington Hospital, Wellington, New Zealand
(Bellomo) Centre for Integrated Critical Care, Department of Medicine &
Radiology, University of Melbourne, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objective: To conduct a pilot feasibility and physiologic efficacy study
of high-dose vitamin C in patients with vasoplegia after cardiac surgery.
<br/>Design(s): Prospective, double-blind, randomized, controlled trial.
<br/>Setting(s): Two tertiary intensive care units (ICUs).
<br/>Participant(s): Post-cardiac surgery patients with vasoplegia.
<br/>Intervention(s): The authors randomly assigned the patients to
receive either high-dose intravenous vitamin C (1,500 mg every 6 hours) or
placebo. The primary outcome was time from randomization to resolution of
vasoplegia. Secondary outcomes included total norepinephrine equivalent
dose in the first 2 days, ICU length of stay, ICU mortality, and
in-hospital mortality. <br/>Measurements and Main Results: The authors
studied 50 patients (25 patients in each arms). The mean (standard
deviation) time to resolution of vasoplegia was 27.0 (16.5) hours in the
vitamin C group versus 34.7 (41.1) hours in the placebo group (mean
decrease with vitamin C of 7.7 hours, 95% confidence interval -10.5 to
25.9, p = 0.40). The median (interquartile range) norepinephrine
equivalent dose in the first 2 days was 64.9 (23.5-236.5) micro&#32;g/kg
versus 47.4 (21.4-265.9) micro&#32;g/kg in the vitamin C and placebo group
(p = 0.75). The median duration of ICU admission was similar (1.4
[0.5-2.5] days and 1.5 [0.5-3.3] days in the vitamin C and placebo group;
p = 0.36). Only 1 patient, in the vitamin C arm, died. <br/>Conclusion(s):
In patients with post-cardiac surgery vasoplegia, high-dose vitamin C
infusion was feasible, appeared safe, and, within the limitations of a
pilot study, did not achieve statistically faster resolution of
vasoplegia.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<37>
Accession Number
2003607205
Title
Circadian-timed quick-release bromocriptine lowers elevated resting heart
rate in patients with type 2 diabetes mellitus.
Source
Endocrinology, Diabetes and Metabolism. 3 (1) (no pagination), 2020.
Article Number: e00101. Date of Publication: 01 Jan 2020.
Author
Chamarthi B.; Vinik A.; Ezrokhi M.; Cincotta A.H.
Institution
(Chamarthi, Ezrokhi, Cincotta) VeroScience LLC, Tiverton, RI, United
States
(Vinik) Eastern Virginia Medical School Strelitz Diabetes Center, Norfolk,
VA, United States
Publisher
Wiley-Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Objective: Sympathetic nervous system (SNS) overactivity is a risk factor
for insulin resistance and cardiovascular disease (CVD). We evaluated the
impact of bromocriptine-QR, a dopamine-agonist antidiabetes medication, on
elevated resting heart rate (RHR) (a marker of SNS overactivity in
metabolic syndrome), blood pressure (BP) and the relationship between
bromocriptine-QR's effects on RHR and HbA1c in type 2 diabetes subjects.
Design and Subjects: RHR and BP changes were evaluated in this post hoc
analysis of data from a randomized controlled trial in 1014 type 2
diabetes subjects randomized to bromocriptine-QR vs placebo added to
standard therapy (diet +/- <=2 oral antidiabetes medications) for 24 weeks
without concomitant antihypertensive or antidiabetes medication changes,
stratified by baseline RHR (bRHR). <br/>Result(s): In subjects with bRHR
>=70 beats/min, bromocriptine-QR vs placebo reduced RHR by -3.4 beats/min
and reduced BP (baseline 130/79; systolic, diastolic, mean arterial BP
reductions [mm Hg]: -3.6 [P =.02], -1.9 [P =.05], -2.5 [P =.02]). RHR
reductions increased with higher baseline HbA1c (bHbA1c) (-2.7 [P =.03],
-5 [P =.002], -6.1 [P =.002] with bHbA1c <=7, >7, >=7.5%, respectively] in
the bRHR >=70 group and more so with bRHR >=80 (-4.5 [P =.07], -7.8 [P
=.015], -9.9 [P =.005]). Subjects with bRHR <70 had no significant change
in RHR or BP. With bHbA1c >=7.5%, %HbA1c reductions with bromocriptine-QR
vs placebo were -0.50 (P =.04), -0.73 (P =.005) and -1.22 (P =.008) with
bRHR <70, >=70 and >=80, respectively. With bRHR >=70, the magnitude of
bromocriptine-QR-induced RHR reduction was an independent predictor of
bromocriptine-QR's HbA1c lowering effect. <br/>Conclusion(s):
Bromocriptine-QR lowers elevated RHR with concurrent decrease in BP and
hyperglycaemia. These findings suggest a potential sympatholytic mechanism
contributing to bromocriptine-QR's antidiabetes effect and potentially its
previously demonstrated effect to reduce CVD events.<br/>Copyright &#xa9;
2019 VeroScience Llc. Endocrinology, Diabetes & Metabolism published by
John Wiley & Sons Ltd.

<38>
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.

<39>
Accession Number
2001900864
Title
Optimizing cerebral oxygenation in cardiac surgery: A randomized
controlled trial examining neurocognitive and perioperative outcomes.
Source
Journal of Thoracic and Cardiovascular Surgery. 159 (3) (pp 943-953.e3),
2020. Date of Publication: March 2020.
Author
Uysal S.; Lin H.-M.; Trinh M.; Park C.H.; Reich D.L.
Institution
(Uysal, Trinh, Park, Reich) Department of Anesthesiology, Perioperative
and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Lin) Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to determine whether targeted therapy
to optimize cerebral oxygenation is associated with improved
neurocognitive and perioperative outcomes. <br/>Method(s): In a
prospective trial, intraoperative cerebral oximetry monitoring using
bilateral forehead probes was performed in cardiac surgical patients who
were randomly assigned to an intervention group in which episodes of
cerebral oxygen desaturation (<60% for >60 consecutive seconds at either
probe) triggered an intervention protocol or a control group in which the
cerebral oximetry data were hidden from the clinical team, and no
intervention protocol was applied. Cognitive testing was performed
preoperatively and at postoperative months 3 and 6; domains studied were
response speed, processing speed, attention, and memory. Perioperative
outcomes studied were death, hospital length of stay, intensive care unit
length of stay, postoperative day of extubation, time on mechanical
ventilation, intensive care unit delirium, Sequential Organ Failure
Assessment on intensive care unit admission, and intensive care unit blood
transfusion. <br/>Result(s): Group mean memory change scores were
significantly better in the intervention group at 6 months (0.60 [standard
error, 0.30] vs -0.17 [standard error, 0.33], adjusted P = .008). However,
presence, duration, and severity of cerebral desaturation were not
associated with cognitive change scores. Perioperative outcomes did not
differ between the intervention and control groups. <br/>Conclusion(s):
Targeted therapy to optimize cerebral oxygenation was associated with
better memory outcome in a group of cardiac surgical patients. Some
aspects of the protocol other than desaturation duration and severity
contributed to the observed neuroprotective effect.<br/>Copyright &#xa9;
2019 The American Association for Thoracic Surgery

<40>
Accession Number
630925839
Title
Clinicians for care: How a systematic literature review informs clinicians
on engaging caregivers as part of the cardiovascular care team.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Knowles K.A.; Xun H.; Jang S.Y.; Singh R.; Pang S.; Shan R.; Marvel F.A.;
Martin S.S.
Institution
(Knowles, Xun, Jang, Singh, Pang, Shan, Marvel, Martin) Medicine, Johns
Hopkins Univ Sch of Medicine, Baltimore, MD2Medicine, Johns Hopkins Sch of
Medicine, Baltimore, MD3Johns Hopkins Hosp, Baltimore, MD4Medicine, Johns
Hopkins Hosp, Baltimore, MD
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Caregivers play a vital role in the care of patients with
chronic diseases, including cardiovascular disease (CVD). As a result they
often face added strain that impacts their health and quality of life and
that of the patient. Recent legislation like the CARE Act and RAISE Family
Caregiver Act have been established to recognize and assist caregivers.
However, there remains a lack of cohesive, evidence-based recommendations
to guide the clinical team in supporting caregivers. We set out to
determine what evidence-based guidelines and interventions exist to aid
the medical team in supporting caregivers of patients with CVD.
<br/>Method(s): We performed a systematic review of the literature for
randomized controlled trials (RCT) of interventions used to support
caregivers of patients with CVD. We also reviewed the websites of national
CVD organizations for consensus guidelines. <br/>Result(s): We reviewed
4273 articles in Pubmed according to our search criteria, revealing 42
RCTs. Studies were done in heart failure (26), myocardial infarction and
coronary artery disease (7), coronary artery bypass surgery (6), and mixed
CVD populations (3). Most interventions combined education with
psychosocial or disease management support. Overall, the majority of
studies indicated a positive impact on caregiver or patient outcomes. We
synthesized recommendations based on the results of the studies and
evidence in the caregiver literature with the acronym "CARE" (Figure 1).
To support clinicians in practice, we also assembled "Clinicians for CARE"
resources, including billing codes, references to resources provided by
the AHA and other national organizations, and best practice guidelines.
<br/>Conclusion(s): Synthesizing RCTs and guidelines, our team created
"CARE" to aid clinicians in effectively engaging and supporting
caregivers.

<41>
Accession Number
630925835
Title
Impact of extent of coronary revascularization on mortality after
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Ahsan M.J.; Lateef N.; Malik S.U.; Anwar M.F.; Zubair H.M.Z.; Latif A.;
Mirza M.M.; Holmberg M.J.
Institution
(Ahsan, Lateef, Malik, Anwar, Zubair, Latif, Mirza, Holmberg) Internal
medicine, Creighton Univ, Omaha, NE2Creighton Univ, Omaha, NE3Univ of
Arizona, Tucson, AZ4Creighton Univ, omaha, NE5Sisters of Charity Hosp,
Buffalo, NY
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The concurrent incidence of aortic stenosis (AS) and coronary
artery disease is estimated to be 50 - 60%. Coronary intervention in
patients with severe CAD leads to improved outcomes, however impact of
completeness of revascularization remains unknown. <br/>Objective(s): The
primary objective was to evaluate the prognostic impact of completeness of
coronary revascularization on all-cause mortality in patients undergoing
TAVR. <br/>Method(s): Literature search was performed using MEDLINE,
EMBASE, Google Scholar and Scopus databases. Three sets of comparisons
were performed: 1) Patients with no CAD versus CAD patients with high
residual syntax score(rSS) >10, 2) Patients with no CAD versus CAD
patients with low rSS <10, 3) CAD Patients with low rSS versus CAD
patients with high rSS. Data on all-cause mortality was extracted
digitally form the Kaplan-Meier curves. Hazard ratios were calculated
using Palmer method and meta-analysis was performed using random effects
model. Heterogeneity was calculated using Q statistic and I. The main
summary estimate was random effects hazard Ratio (HR) with 95% confidence
intervals (CIs). <br/>Result(s): Eight studies including 4,237 patients
were included to look for prognostic effect of revascularization
completeness before TAVR using rSS. Follow up period ranged from 0.7 to
4.8 years. Our results showed that CAD Patients with high rSS (>10) had
increased risk of all-cause mortality as compared to patients with no CAD
at longest follow up (HR=1.40, 95% CI: 1.10-1.78, l=38.826). Whereas,
there was no difference in patients with CAD and low rSS (^10) versus no
CAD (HR=1.12, 95% CI: 0.85 -1.60, l=57.632). Interestingly, comparison of
CAD patients with low rSS and high rSS also revealed no difference in
all-cause mortality (HR = 1.05, 95% CI: 0.76 -1.44,l=58.88).
<br/>Conclusion(s): Completeness of coronary revascularization with PCI or
CABG in patients undergoing TAVR for AS did not significantly impact
long-term all-cause mortality.

<42>
Accession Number
630925549
Title
Association of ischemic mitral regurgitation proportionality with outcomes
after mitral valve surgery: A cardiothoracic surgical trials network
analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Giustino G.; Overbey J.; O'Gara P.T.; Gelijns A.C.; Stevenson L.W.;
Moskowitz A.J.; Voisine P.; Mack M.J.; Acker M.A.; Gillinov A.M.; Mancini
D.M.; Bagiella E.; Lala A.; Woo Y.J.; Hung J.; Grayburn P.A.
Institution
(Giustino, Overbey, O'Gara, Gelijns, Stevenson, Moskowitz, Voisine, Mack,
Acker, Gillinov, Mancini, Bagiella, Lala, Woo, Hung, Grayburn) Population
Health Science and Policy, Icahn Sch of Medicine at Mount Sinai, New York,
NY2Cardiovascular Medicine, Brigham and Women's Hosp, Boston, MA3Medicine,
Vanderbilt Univ Med Cntr, Nashville, TN4IUCPQ, Quebec,
Canada5Cardiovascular Surgery, Baylor Scott & White Health, Plano,
TX6DIVISION OF CARDIOVASCULAR SURGERY, Univ of Pennsylvania, Philadelphia,
PA7Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland,
OH8Cardiology, Mount Sinai Hosp, New York, NY9Cardiovascular Surgery,
Mount Sinai Hosp, New York, NY10Cardiothoracic Surgery, Stanford Univ Sch
Medicine, Stanford, CA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The severity of secondary mitral regurgitation (MR) relative
to left ventricular (LV) volume might predict the clinical response to
treatments directed to either the mitral valve (MV) or to the left
ventricle. Whether this concept applies to MV surgery for severe ischemic
MR (SIMR) is unknown. <br/>Method(s): We evaluated the outcomes of
patients with SIMR according to the baseline effective regurgitant orifice
area (EROA)-to-LV end-diastolic volume (LVEDV) ratio (divided into
tertiles) enrolled in a randomized trial comparing surgical MV replacement
versus repair +/- CABG. Patients were followed for 2 years. Endpoints were
all-cause mortality, major adverse cardiac and cerebrovascular events
(MACCE), and the mean percent changes in LVEDV and end-systolic volume
(LVESV) from baseline through 2 years assessed by an echo core-lab.
<br/>Result(s): A total of 240 patients out of 251 randomized were
included. Baseline characteristics across tertiles of EROA/LVEDV ratio are
reported in the table. Compared with patients in tertile 1 (lowest ratio),
those in tertile 3 (highest ratio) had higher risk of 2-year all-cause
mortality (15% vs. 28.8%; adjusted HR: 2.98; 95% CI: 1.38-6.47) and MACCE
(40% vs. 47.5%; adjusted HR: 1.95; 95% CI: 1.15-3.31). The extent of
reverse LV remodeling at 2 years was greatest in patients in the lowest
tertile (table), especially among those who underwent concomitant CABG.
<br/>Conclusion(s): Patients with SIMR and highest tertile EROA/LVEDV
ratios had greater risk of mortality after MV surgery. Greater degrees of
reverse LV remodeling were observed in patients with lower ratios. Further
research is needed to evaluate whether surgical interventions alter the
relationship between proportionality of SIMR and outcomes.

<43>
Accession Number
630925318
Title
WT1 as a regulator of adipocyte derived stem cell mediated cardiac
revascularization and regeneration.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Aljabban J.; Aljabban I.; Camarda R.; Salhi H.; El-Sayed O.; Hadley D.;
Beygui R.E.
Institution
(Aljabban, Aljabban, Camarda, Salhi, El-Sayed, Hadley, Beygui) Internal
Medicine, Ohio State Univ College of Medicine, Columbus, OH2General
Surgery, Penn State College of Medicine, Hershey, PA3Biomedical Sciences,
Univ of California San Francisco, San Francisco, CA4Internal Medicine,
Univ of Illinois College of Medicine, Chicago, IL5Pediatrics, Pathology
and Laboratory Medicine, Univ of California San Francisco, San Francisco,
CA6CARDIOTHORACIC SURGERY, Univ of California San Francisco, San
Francisco, CA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Cardiovascular disease (CVD) is significant cause of
morbidity and mortality in the world. Cardiac regeneration technology can
serve to mitigate this healthcare burden, but clinical applications are
still lacking. Adipocyte-like stem cells (ASCs) from pericardial fat holds
potential in cardiac remodeling. Hypothesis: IL6-receptor signaling in
ASCs increases the expression of WT1, promoting a mesenchymal-endothelial
transition and regeneration of cardiac structures. <br/>Method(s): We
employed our STARGEO platform to conduct meta-analysis on patient samples
from Gene Expression Omnibus. We tagged 121 samples of pericardial fat
using 121 samples of subcutaneous fat as a control. We analyzed the gene
signature using Ingenuity Pathway Analysis. Western Blot analysis of GATA4
and WT1 was done on ASCs recovered from patient omental, epicardial, and
pericardial fat samples. <br/>Result(s): Our analysis demonstrated
increased expression, compared to subcutaneous fat, of several mesenchymal
stem cell markers in pericardial fat involved in cardiomyocyte
differentiation including GATA4, CBX2, CD9, DNMT3B, ITGB1, and TBX2.The
top upstream regulator found with IPA analysis was interleukin-6 (IL6). A
few of the top upregulated genes involved in angiogenesis,
vascularization, and cardiomyogenesis include Wilms tumor protein (WT1),
pleiotrophin (PTN), and prostaglandin-endoperoxide synthase 2 (PTGS2)
(figure 1). We noted variable GATA4 expression across patient fat samples
and selective WT1 expression in the pericardial fat of ischemic patients
(figure 2). <br/>Conclusion(s): ASCs have been shown to differentiate into
cardiomyocytes and may be involved in cardiac remodeling following
myocardial or coronary injury. Our analysis suggests that IL6-receptor
signaling in ASCs increases the expression of WT1, and other synergistic
proteins, promoting a mesenchymal-endothelial transition, resulting in
revascularization or regeneration of cardiac structures.

<44>
Accession Number
630925261
Title
Acute kidney injury after transcatheter aortic valve replacement vs.
surgical aortic valve replacement - A meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Siddiqui W.J.; Mazhar R.; Abbas R.; Sadaf M.; Zain M.; Omer Z.; Al-Saghir
Y.
Institution
(Siddiqui, Mazhar, Abbas, Sadaf, Zain, Omer, Al-Saghir) Medicine, Div of
Cardiology, Orange Park Med Cntr, Orange Park Med Cntr, FL2Medicine,
Orange Park Med Cntr, Orange Park, FL3Yale-Waterbury Internal Med Program,
Waterbury, CT4Sheikh Zayed Hosp Rahim Yar Kha, Rahim Yar Khan, Punjab,
Pakistan5Medicine, Div of Cardiology, Orange Park Med Cntr, Orange Park,
FL
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Acute kidney injury post aortic valve replacement is
associated with poor prognosis. Transcatheter aortic valve replacement
(TAVR) is a novel strategy with a percutaneous approach and early recovery
time. We conducted a meta-analysis comparing TAVR to surgical aortic valve
replacement (SAVR) and their renal outcomes. Hypothesis: TAVR can reduce
the renal injury compared to SAVR. <br/>Method(s): We searched for
randomized control trials using MEDLINE, PUBMED, and Google Scholar
databases and included eight randomized control trials comparing TAVR to
SAVR that reported acute kidney injury. We used the Mantel-Haenszel method
for the statistical analysis of dichotomous data to calculate the odds
ratio and random effects model in RevMan Version 5.3 Copenhagen for review
and analysis. <br/>Result(s): We included eight RCT's with 7,889 patients
(4,017 with TAVR and 3,872 with SAVR) in our analysis. There was a
significant reduction in AKIs at 30 days after TAVR, 66vs.160, OR=0.38,
Cl=0.28-0.51, p<0.00001, l=0%). There was a reduced trend of persistent
renal injury at 1 year after TAVR, 74vs.129 (OR=0.57, Cl=0.32-1.01,
p=0.05, l=69%). With sensitivity analysis without Smith et al. results
became significant favoring TAVR (OR=0.45, CI=0.28-0.73, p=0.001, l=49%).
There was no difference in the need for renal replacement therapy (RRT),
(20vs.23, OR=0.87, Cl=0.47-1.62, p=0.67, l=0%). Secondary outcomes are
summarized in table 1. <br/>Conclusion(s): From our analysis, we
understand TAVR is associated with reduced renal injury compared to SAVR.
Whether this effect has any direct implication on the long term survival
needs further investigation.

<45>
Accession Number
630925077
Title
A systematic review and meta-analysis of transeptal vs left atrial
approach for mitral valve surgery.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Harky A.; Noshirwani A.; Pousios D.; Muir A.D.
Institution
(Harky, Noshirwani, Pousios, Muir) Cardiothoracic Surgery, Liverpool Heart
and Chest Hosp, Liverpool, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: We sought to compare the clinical outcomes of mitral valve
surgery through conventional left atriotomy [LA] and transeptal approach
[TS] Methods: Electronic database search performed from inception to March
2019. Only articles including both approaches were included. Primary
outcomes were operative times and secondary outcomes were new onset of
atrial fibrillation, re-operation for bleeding, permanent pacemaker need
and operative mortality. <br/>Result(s): Fifteen articles met the
inclusion criteria. A total of 4,457 patients were included (n=3,025 LA
and n=1,432 TS). There were no differences in preoperative patient
demographics. Mitral valve replacement took place in 67%. No differences
noted in operative mortality (OR=0.92, 95% CI [0.60, 1.40], p=0.69), rate
of concomitant procedures (66% vs 55%, OR=0.85, 95% CI [0.51, 1.42],
p=0.54), rate of new onset atrial fibrillation (OR=0.82, 95%CI [0.62,
1.07], p=0.15), and reoperation for bleeding (OR=0.95, 95% CI [0.58,
1.53], p=0.82). Cardiopulmonary bypass and aortic cross clamp times were
longer with TS (130+/-32 vs 113+/-31 mins, p=0.03; 88+/-23 vs 75+/-23
mins, p=0.0007), and permanent pacemaker was higher in with TS (5% vs 3%,
OR 0.61, 95%CI [0.43, 0.87], p=0.006). <br/>Conclusion(s): Transeptal
approach for mitral valve surgery is associated with longer operative
times and higher postoperative pacemaker requirement; however no
significant differences in other outcomes are evident. A randomized
controlled trial is required to confirm those findings.

<46>
Accession Number
630924961
Title
Clinical implications of dual antiplatelet therapy cessation within 12
months of coronary stenting in men and women: A pooled analysis from the
platinum diversity and promus element plus post-approval studies.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Chandiramani R.; Cao D.; Mehran R.; Blum M.; Roumeliotis A.; Goel R.;
Sartori S.; Davis S.; Tami L.; Wang J.; Othman I.; Gigliotti O.; Boran K.;
Liberman H.; Underwood P.; Allocco D.; Batchelor W.
Institution
(Chandiramani, Cao, Mehran, Blum, Roumeliotis, Goel, Sartori, Davis, Tami,
Wang, Othman, Gigliotti, Boran, Liberman, Underwood, Allocco, Batchelor)
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn Sch of
Medicine at Mount Sinai, New York, NY2Interventional Cardiology, Baptist
Hosp, Little Rock, AR3Interventional Cardiology, Rsch Physicians Network
Alliance, Hollywood, FL4Interventional Cardiology, MedStar Union Memorial
Hosp, Baltimore, MD5Interventional Cardiology, Duke Univ Health System,
Durham, NC6Interventional Cardiology, Seton Heart Institute, Austin,
TX7The Zena and Michael A. Wiener Cardiovascular Institute, Cardiovascular
Consultants Heart Cntr, Fresno, CA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Cessation of dual antiplatelet therapy (DAPT) after
percutaneous coronary intervention (PCI) may increase the risk of
recurrent ischemic events. While the incidence and patterns of stopping
DAPT have been reported to vary between women and men, the clinical impact
of DAPT cessation after PCI according to gender remain unknown.
Hypothesis: We sought to evaluate the incidence of DAPT cessation during
the first year after PCI in men and women and its association with
clinical outcomes. <br/>Method(s): Two prospective multicenter PCI
registries evaluating the everolimus-eluting stent were pooled. The
population was stratified into men (n=2,319) and women (n=1,863). DAPT
cessation was defined as any discontinuation lasting >3 days. The primary
endpoint was major adverse cardiac events (MACE; composite of cardiac
death, myocardial infarction (MI) or stent thrombosis). A multivariate Cox
regression model with DAPT cessation entered as a time-updated variable
was used to account only for events occurring after cessation up to 1
year. <br/>Result(s): Out of 4,182 patients, 477 had a DAPT cessation
within 1 year of PCI. Although rates of DAPT cessation at 1 year were
similar between men and women, the cessations tended to occur earlier in
women (Figure). Women with DAPT cessation had a marginally significant
increased risk of MACE compared to women without [adjusted HR 2.12, 95% CI
0.99-4.56]. Conversely, no association between risk of MACE and DAPT
cessation was observed in men [adjusted HR 1.32, 95% CI 0.54-3.24]. There
was no difference in the risk for cardiac death after DAPT cessations in
either gender, however, the risk of MI after cessation tended to be
increased in women [adjusted HR 2.25, 95% CI 0.91-5.58] (Figure).
<br/>Conclusion(s): Occurrence of DAPT cessation within 1 year of PCI
might be associated with higher risk of adverse events in women.
Understanding patterns of DAPT cessation and focusing on their prevention,
particularly in women, will help improve outcomes after PCI.

<47>
Accession Number
630923608
Title
Impact of intraoperative methylprednisolone on neurodevelopmental outcomes
in neonates undergoing cardiac surgery.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Zyblewski S.C.; Martin R.H.; Shipes V.B.; Hamlin-Smith K.; Atz A.M.;
Bradley S.M.; Kavarana M.N.; Mahle W.T.; Everett A.D.; Graham E.M.
Institution
(Zyblewski, Martin, Shipes, Hamlin-Smith, Atz, Bradley, Kavarana, Mahle,
Everett, Graham) Pediatrics, Med Univ of South Carolina, Charleston,
SC2Med Univ of South Carolina, Charleston, SC3Public Health Sciences, Med
Univ of South Carolina, Charleston, SC4Med Univ of South Carolina, Mt
Pleasant, SC5Surgery, Med Univ of South Carolina, Charleston, SC6Emory,
Atlanta, GA7Johns Hopkins, Glenwood, MD
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Neurodevelopmental impairment is the most significant
consequence for survivors of critical congenital heart disease. This study
sought to determine if intraoperative methylprednisolone during neonatal
cardiac surgery is associated with neurodevelopmental outcomes at 12
months of age and to identify risk factors for adverse outcomes.
<br/>Method(s): A secondary analysis of a multicenter, double-blind,
randomized, placebo-controlled trial of intraoperative methylprednisolone
in neonates undergoing cardiac surgery with cardiopulmonary bypass was
performed. Bayley Scales of Infant and Toddler Development III (BSID) was
performed at 12 months of age. Two sample t-tests were used to compare
mean BSID scores between treatment groups. One-way ANOVA was used to
explore an association between continuous prognostic variables and BSID
composite scores. <br/>Result(s): There were 129 subjects (n = 61
methylprednisolone, n = 68 placebo) who had cardiac surgery at a mean of 9
+/- 5.5 days and completed a BSID at a mean of 12.6 +/- 0.64 months of
age. There were no significant differences in BSID cognitive, language,
and motor scores between methylprednisolone and placebo groups. Subjects
who underwent a palliative (vs. corrective) procedure had lower mean BSID
cognitive scores (101 +/- 15 vs. 106 +/- 14, p=0.03) and lower mean BSID
motor scores (85 +/- 18 vs. 94 +/- 16, p=0.003). Longer ventilator time
was associated with lower BSID motor scores (p< 0.001). Longer cardiac
intensive care unit (CICU) stay was associated with lower BSID cognitive
(p<0.001), language (p<0.001), and motor (p<0.001) scores. Cardiopulmonary
bypass time, aortic cross clamp time, and deep hypothermic circulatory
arrest were not associated with BSID scores. <br/>Conclusion(s):
Neurodevelopmental outcomes were not associated with prophylactic
methylprednisolone or intraoperative variables. Subjects who underwent a
neonatal palliative (vs. corrective) procedure and had longer CICU stays
had worse neurodevelopmental outcomes at 1 year. This work suggests that
neurodevelopmental injury is complex, cumulative and multifactorial;
therefore, medical interventions focused solely on the operative period
may not be associated with a long-term benefit.

<48>
Accession Number
630923551
Title
Evaluation of a tummy time intervention to improve motor skill development
in infants after cardiac surgery.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Uzark K.; Smith C.; Yu S.; Lowery R.; Tapley C.; Romano J.; Butcher J.
Institution
(Uzark, Smith, Yu, Lowery, Tapley, Romano, Butcher) Pediatrics/Cardiac
Surgery, Univ of Ml Mott Children's Hosp, Ann Arbor, MI2Pediatrics, Univ
of Ml Mott Children's Hosp, Ann Arbor, MI3PMR, Univ of Ml Mott Children's
Hosp, Ann Arbor, MWCardiac Surgery, Univ of Ml Mott Children's Hosp, Ann
Arbor, MI5Pediatrics, Univ of Michigan CS Mott Children's Hosp, Ann Arbor,
Ml
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Children who require open heart surgery in the
1^st year of life are vulnerable to developmental delays and are
at significantly greater risk for gross motor impairment than healthy
infants. Early delays in gross motor function have implications for
learning and psychosocial development through adulthood. We sought to
evaluate the feasibility and efficacy of a tummy time intervention to
improve motor skill development in infants after cardiac surgery Methods:
Infants < 4 months of age who underwent cardiac surgery were randomly
assigned to a tummy time (TT) intervention or standard of care (SOC). The
Alberta Infant Motor Scale (AIMS) was administered to each infant prior to
hospital discharge and at 3 months after discharge. Groups were compared
and the association between parent-reported tummy time at home and AIMS
scores at follow-up (F/U) were examined. <br/>Result(s): Parents of
infants (n=64) who had cardiac surgery at a median age of 5 days (range 2
days -3.4 months) including 35 (55%) males, were randomly assigned to
inpatient TT instruction (n=20), inpatient + outpatient (n=21), or SOC
(n=23). Forty-nine (77%) returned for F/U at a median gestational age of
3.7 months (interquartile range 3.3-4.5). There were no significant
differences between the groups including hospital length of stay,
pre-discharge AIMS scores, or receipt of developmental services. At F/U,
reported daily TT varied within groups but was not significantly different
between groups. There was a trend toward higher AIMS scores in infants who
received either inpatient or inpatient/outpatient TT intervention (mean
13.8 +/-4.4) versus SOC (mean 11.5 +/- 3.1), p=0.07. Parents of 15 babies
reported < 15 minutes of TT daily. In the overall group, F/U AIMS scores
adjusted for age were significantly lower in infants who received < 15
minutes of TT daily (mean score 11.6) than in infants who received > 15
minutes of TT daily (mean score 13.7), p =.04. <br/>Conclusion(s): Less
than 15 minutes of TT in infants following early cardiac surgery is
associated with increased motor skill impairment. Further research is
needed to elucidate factors associated with parental compliance with tummy
time recommendations and to identify interventions to optimize
neurodevelopmental outcomes in children with heart disease.

<49>
Accession Number
630923500
Title
Long-term effects on cardiovascular events and costs of home blood
pressure telemonitoring with pharmacist management in patients with
uncontrolled hypertension.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Margolis K.L.; Dehmer S.P.; MacIosek M.V.; Sperl-Hillen J.M.; Asche S.E.;
Bergdall A.R.; Green B.B.; Nyboer R.A.; Pawloski P.A.; Trower N.K.;
O'Connor P.J.
Institution
(Margolis, Dehmer, MacIosek, Sperl-Hillen, Asche, Bergdall, Green, Nyboer,
Pawloski, Trower, O'Connor) Rsch, Healthpartners Institute, Minneapolis,
MN2Washington Health Rsch Institute, Kaiser Permanente, Seattle, WA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Uncontrolled hypertension is a leading contributor to
cardiova disease. We previously reported that home blood pressure (BP)
telemonitori management intervention lowered BP more than usual care for
24 months. Hypothesis: The intervention group will have fewer CV events
and lower co follow-up. <br/>Method(s): The Hyperlink trial randomized 16
primary care clinics with 450 p uncontrolled hypertension to
Telemonitoring Intervention (TI, n=228) or usual CV events were confirmed
by medical records review by blinded adjudicators. The primary endpoint
included non-fatal myocardial infarction (MI), non-fatal stroke,
hospitalized heart failure (HF), and CV death. Coronary revascularization
was included in a secondary endpoint. Generalized estimating equations
with robust standard errors were used to test differences in CV incidence
by treatment group. Literature-based event costs were applied to the
observed outcomes to estimate net costs over 5 years of follow-up. A
microsimulation model was used to predict outcomes up to 30 years,
assuming only legacy effects of the intervention for the study population
after the 5 years of observed follow-up. <br/>Result(s): There were 15 CV
events (5 MI, 4 stroke, 5 HF, 1 CV death) among 10 patients in the TI
group and 26 events (11 MI, 12 stroke, 3 HF) among 19 patients in the UC
group. The incidence of the primary CV composite endpoint was 4.4% in the
TI group vs. 8.6% in the UC group (OR = 0.49, 95% CI: 0.21 - 1.13, p=.09).
Including 2 coronary revascularizations in the TI group and 10 in the UC
group, the incidence of the secondary CV composite endpoint was 5.3% in
the TI group vs. 10.4% in the UC group (OR = 0.48, 95% CI: 0.22-1.08,
p=.08). Intervention costs (all in 2017 U.S. dollars) were $1,511 per
patient. Over 5 years, event costs were estimated to total $758,000 in the
TI group and $1,538,000 in the UC group for a return on investment of 126%
and a net cost savings of about $1,900 per patient. Over 30 years, the TI
group is predicted to live 4.5 months longer on average, with a savings of
almost $6,000 per person in CV costs. <br/>Conclusion(s): The intervention
lowered BP and reduced costs by avoiding CV events over 5 years, with
enduring benefits predicted over 30 years.

<50>
Accession Number
630923373
Title
Anticoagulation in patients with atrial fibrillation after a transcatheter
aortic valve replacement: A systematic review.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Galo J.; Al Halban F.; Chambers S.; De Marchena E.; Croix G.R.S.; Milford
B.; Olorunfem O.
Institution
(Galo, Al Halban, Chambers, De Marchena, Croix, Milford, Olorunfem) Dept
of Internal Medicine, Univ of Miami/Jackson Memorial Hosp, Miami, FL2Univ
of Miami/Jackson Memorial Hosp, Hollywood, FL3Univ of Miami/Jackson
Memorial Hosp, Miami, FL4Jackson Memorial Hosp, Miami, FL5Dept of
Cardiology, Univ of Miami/Jackson Memorial Hosp, Miami, FL6Rochester
General Hosp, Rochester, NY
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve replacement is the treatment of
choice for patients with severe aortic stenosis. A significant portion of
TAVR patients have concomitant atrial fibrillation leading to worse
prognosis. Studies about the safety and efficacy of anticoagulation in
this group are scarce. Hence, this systematic review aims to assess the
differential clinical outcomes of the type of anticoagulation after a year
on patients who underwent TAVR with concomitant atrial fibrillation.
<br/>Method(s): We performed a systematic literature review to identify
randomized and nonrandomized clinical studies that reported
anticoagulation atrial fibrillation after a TAVR for high and intermediate
surgical risk patients with aortic stenosis. A total of 8 databases
including Pubmed (Medline), Embase, Cochrane Library, ACP Journal Club,
Scopus, DARE and Ovid containing articles from January 2000 to May 2019
were analyzed. <br/>Result(s): We identified 421 potential eligible
publications through the databases and we found 2 relevant non randomized
controlled trials for a total of 1215 participants. The first study
evaluated the impact of continued versus interrupted anticoagulation with
warfarin versus NOAC and found that the rate of early safety events was
lowest in NOAC (13.2%) and not increased in continued warfarin (19.7%)
compared to interrupted warfarin (23.1%). In addition, all-cause 1-year
mortality was 20.1% in interrupted warfarin, 13.7% in continued warfarin
and 8.8% in NOAC. Stroke (p = 0.527) and major bleeding (p- 0.097) did not
differ between groups. The second study had 51.8% (151) persons treated
with apixaban and 48.2% (131) treated with warfarin and found a
significantly lower rate of early safety endpoint in the group treated
with apixaban (13.5%) compared to vitamin K (30.5%) with a p <0.01 and a
numerically lower stroke rate at 12 months (1.2% vs 2%, p =0.73).
<br/>Conclusion(s): This systematic review confirms that all-cause
mortality after a year is statistically significantly lower in the NOAC
group. There is a lower rate of early safety endpoint in this group as
well but no difference in incidence of stroke or major bleeding after a
year. Further study is needed to assess the optimal antiplatelet and
anticoagulant therapy in these patients.

<51>
Accession Number
630923334
Title
Short-term and long-term mortality after transcatheter aortic valve
replacement for severe aortic stenosis among patients with malignancy: A
systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Siddiqui M.U.; Bader W.; Siddiqui M.D.; Pasha A.K.; Siddiqu M.
Institution
(Siddiqui, Bader, Siddiqui, Pasha, Siddiqu) Medicine, Marshfield Clinic,
Rice Lake, WI2Internal Medicine, Univ of South Dakota, Sioux Falls,
SD3Mayo Clinic Health System, North Mankato, MN4Internal Medicine,
Presence St Joseph Hosp, Chicago, IL
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: With advancement in cancer treatments, the life expectancy
of oncology patients has improved. Therefore, transcatheter aortic valve
replacement (TAVR) can now be considered as a feasible option for oncology
patients with severe aortic stenosis (AS) to avoid adverse outcomes from
valvular disease. Hypothesis: Short-term and long-term mortality is
similar in cancer and non-cancer patients treated with TAVR for severe AS.
<br/>Method(s): MEDLINE, Pubmed, and Cochrane Central Register of
Controlled Trials were searched from inception of the respective database
through May 2019. Patients with cancer who underwent treatment with TAVR
for severe AS were included and compared to identical population but
without cancer. Studies that used surgical aortic valve replacement (SAVR)
as treatment for AS were excluded. Primary endpoint was short-term and
long-term mortality. <br/>Result(s): Of 890 studies identified, 5 studies
met inclusion criteria. 3 studies analyzed short-term mortality and showed
no significant difference in patients treated with TAVR with and without
cancer (RR, 0.63; 95% CI, 0.35-1.14; P=0.12) (Figure 1). In contrast, 5
studies analyzed long-term mortality and identified that cancer patients
had significantly higher long-term mortality after treatment with TAVR
when compared to patients without cancer (RR, 1.77; 95% CI, 1.35-2.31;
P=<0.0001) (Figure 2). <br/>Conclusion(s): Patients with cancer and severe
AS have higher long-term mortality after TAVR while having relatively
similar short-term mortality when compared to patients without cancer. The
decision to perform TAVR in cancer patients should be individualized based
on life expectancy and co-morbidities.

<52>
Accession Number
630923333
Title
Progression of tricuspid regurgitation after surgery for ischemic mitral
regurgitation: From the cardiothoracic surgical trials network.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Bertrand P.; Zeng X.; Overbey J.R.; Ailawadi G.; Acker M.A.; Smith P.K.;
Thourani V.H.; Bagiella E.; Miller M.; Gupta L.; Mack M.J.; Gillinov A.M.;
Giustino G.; Moskowitz A.J.; Gelijns A.C.; Bowdish M.; O'Gara P.T.; Gammie
J.S.; Hung J.
Institution
(Bertrand, Zeng, Overbey, Ailawadi, Acker, Smith, Thourani, Bagiella,
Miller, Gupta, Mack, Gillinov, Giustino, Moskowitz, Gelijns, Bowdish,
O'Gara, Gammie, Hung) Div of Cardiology, Massachusetts General Hosp,
Boston, MA2Population Health Science and Policy, Icahn Sch of Medicine at
Mount Sinai, New York, NY3Section of Adult Cardiac Surgery, Univ of
Virginia, Charlottesville, VA4Univ of Pennsylvania, Philadelphia,
PA5SURGERY, Duke Univ Med Cntr, Durham, NC6Medstar Washington Hosp Cntr,
Washington, DC7Div of Cardiovascular Sciences, National Heart Lung and
Blood Institute, Bethesda, MD8Cardiovascular Surgery, Baylor Scott & White
Health, Plano, TX9Thoracic and Cardiovascular Surgery, Cleveland Clinic,
Cleveland, OH
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Whether to repair non-severe tricuspid regurgitation (TR) in
patients undergoing surgery for ischemic mitral regurgitation (IMR) is an
open question. We investigated the incidence, predictors and clinical
significance of TR progression and >moderate TR at 2 years.
<br/>Method(s): 492 patients with untreated <= moderate TR who received
surgery for IMR in 2 trials were included: in the moderate IMR trial
patients received CABG+/-MV repair and in the severe IMR trial patients
received MV repair or replacement (+/- CABG). Echo outcomes were analyzed
by a core lab. The key echo outcomes were TR progression from baseline
(surgery for TR/progression of TR by >=2 grades or severe TR at 2 years)
and presence of >= moderate TR at 2 years. <br/>Result(s): Mean patient
age was 66+/-10 years (67% male). Baseline distribution of TR was 60% <=
trace, 31% mild and 9% moderate. Tricuspid annular size was 38.3+/-5.2mm.
Baseline annular dilation (>= 40mm or 21mm/m) was present in 55% of
patients. Among 2-year survivors, TR progression was observed in only
20/325 (6%) patients. Baseline annular dimension (indexed or not) was a
poor predictor of progression (AUC <= 0.58). At 2 years, 37/323 (11%)
patients had >= moderate TR (2 patients were excluded due to interim TR
surgery). Baseline TR grade, indexed tricuspid annular dimension and
concomitant maze were associated with >= moderate TR at 2 years. However,
annular dimension alone (indexed or not) had poor discrimination (AUC
<=0.65). Patients with >=moderate TR at 2 years had higher incidence of MR
recurrence and permanent pacemakers/ICDs (Table). Higher clinical event
rates (composite of >=1 NYHA class increase, HF hospitalizations, MV
surgery, stroke) were observed in patients with TR progression (p=0.003)
and >= moderate TR at 2 years (p=0.04). <br/>Conclusion(s): After IMR
surgery, progression of unrepaired non-severe TR is uncommon and not
predicted by baseline annular dilation. TR progression and the presence of
>=moderate TR at 2 years are associated with high adverse events.

<53>
Accession Number
630923286
Title
Relationship between baseline trs2p score and ldl-c alone or in
combination in predicting the absolute benefits of more versus less
intensive statin therapy in an ascvd: Analysis from the tnt trial.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Nishikido T.; Fayyad R.; Melamed S.A.; Ray K.K.
Institution
(Nishikido, Fayyad, Melamed, Ray) Cardiovascular Medicine, Saga Univ,
Saga, Japan2Pfizer Inc., New York, NY3Pfizer inc., Chappaqua, NY4Primary
Care and Public Health, Imperial College London, London, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Guidelines recommend intensive statin therapy for those with
ASCVD but implementation is poor. Understanding the determinants of
absolute benefit may help improve guideline implementation. The TRS2P
(TIMI Risk Score for Secondary Prevention) identifies residual risk in
ASCVD & predicts benefit from further LDL-C lowering on top of statins but
its utility in comparing statin intensity & benefit is unknown.
Additionally, absolute benefits from intensive therapy may also depend
upon baseline LDL-C. Hypothesis: TRS2P & LDL-C separately & in combination
identify those that derive most benefit in the TNT trial. <br/>Method(s):
10,001 patients with established CHD were randomized to receive either
atorvastatin 10mg (ATV10) or 80mg (ATV80) & divided into 4 groups on the
basis of TRS2P & LDL-C at baseline: <Median TRS2P & <Median LDL-C
(Groupl), <Median TRS2P & >Median LDL-C (Group2), >Median TRS2P & <Median
LDL-C (Group3), and >Median TRS2P & >Median LDL-C (Group4). The effect of
ATV80 compared to ATV10 on the risk of first any CV event defined as CV
death, resuscitated cardiac arrest, Ml, UA, coronary revascularization,
stroke, congestive heart failure, or PAD was assessed among groups.
<br/>Result(s): The median TRS2P was 2 and the median LDL-C was 97.0
mg/dl. Mean percent reduction in LDL-C with ATV80 was consistent across
subgroups, while mean absolute reduction was approximately 11 mg/dl
greater when baseline LDL-C were > median. Among patients with ATV10,
>Median TRS2P and/or >Median LDL-C were associated with higher event rates
(Group1-4=21.5, 28.1, 36.3, and 40.5%; Group 4 vs Groupl HR 2.12; 95% CI
1.82-2.47). ARR from ATV80 was lowest when both scores were < median
(1.3%, Groupl) and highest when both scores were > median (7.2%, Group4).
ARR in Group 2 and 3 were similar. <br/>Conclusion(s): Both TRS2P & LDL-C
identify those that derived greatest absolute benefit from intensive
therapy. Attention to comorbidities & baseline LDL-C may encourage
optimisation of statin prescribing.

<54>
Accession Number
630923192
Title
Clinical predictors of readmission to the hospital at 1-year following
elective vascular surgery.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Khan A.A.; Carlson S.; Mbai M.; Johnson D.; Santilli S.; Green D.; Garcia
S.; Kelly R.F.; Gravely A.; Adabag S.; McFalls E.O.
Institution
(Khan, Carlson, Mbai, Johnson, Santilli, Green, Garcia, Kelly, Gravely,
Adabag, McFalls) Cardiology, Univ of Minnesota, Minneapolis,
MN2Cardiology, VA Med Cntr, Minneapolis, MN3Univ of Minnesota, Plymouth,
MN4Vascular Surgery, VA Med Cntr Univ MN, Minneapolis, MN5Minneapolis
Heart Institute, Edina, MN6Univ of Minnesota, Minneapolis, MN7Minneapolis
VA Med Cntr, Minneapolis, MN8Cardiology, VA Med Cntr Univ MN, Minneapolis,
MN
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Identification of preoperative clinical variables that
predict readmission to the hospital following elective vascular surgery is
important. Hypothesis: We tested whether preoperative administration of
COQ10 prior to elective vascular surgery reduces NT-Pro BNP levels in
patients undergoing vascular surgery and improves outcomes.
<br/>Method(s): A double-blind randomized controlled trial was implemented
at a single institution (NCT03956017). Patients were randomly assigned to
CoQ<inf>10</inf> (400 mg per day) versus Placebo for 3 days prior to
surgery. Biomarkers including NT-Pro BNP and C-reactive protein were
obtained prior to and following surgery. The primary end-point was
postoperative NT-Pro BNP levels and secondary end-points included
readmission rates to the hospital. <br/>Result(s): One hundred and
twenty-three patients were randomized to receive either CoQ<inf>10</inf>
(N=62) versus Placebo (N=61) for 3 days before vascular surgery.
Preoperative cardiac risks included ischemic heart disease (N=52), CHF
(N=12), stroke (N=23) and diabetes mellitus (N=48) and the planned
vascular procedures were infra-inguinal (N=78), carotid (N=36), and
intraabdominal (N=9). No intergroup differences were noted in these
clinical variables. Among the patients receiving CoQ10, NT-Pro BNP was
lower post-surgery (600+/-620 versus 1557+/-2561 pg/ml; P<0.01) but
readmission rates were not reduced. 38 patients (31%) required
readmission, most often for an additional vascular problem. The
preoperative clinical variables that predicted readmissions are shown
(Figure 1). <br/>Conclusion(s): In this randomized controlled pilot study,
preoperative administration of CoQ<inf>10</inf> lowers NT-Pro BNP levels
following elective vascular surgery but does not reduce readmissions to
the hospital within 1 year post-discharge. Preoperative predictors of
readmission include an elevated C-reactive protein, diabetes and smoking
history.

<55>
Accession Number
630923125
Title
Incidence of atrial fibrillation in patients treated with transcatherter
versus surgical aortic valve replacement in low risk patients: A
meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Shah J.; Kumar A.; Thakkar S.J.; Khan M.; Gullapalli N.; Meraj P.M.; Dosh
R.P.
Institution
(Shah, Kumar, Thakkar, Khan, Gullapalli, Meraj, Dosh) Internal Medicine,
Mercy St. Vincent Med Cntr, Toledo, OH2Critical Care Medicine, Saint
John's Med College Hosp, Bangalore, lndia3Rochester General Hosp,
Rochester, NY4Internal Medicine, Univ of Nevada Reno Sch of Medicine,
Reno, NV5Cardiology, North Shore Univ Hosp, Manhasset, NY6Internal
Medicine, Univ of Nevada Reno SOM, Reno, NV
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: New onset atrial fibrillation (NOAF) commonly develops
following surgical aortic valve replacement (SAVR) and transcatheter
aortic valve replacement (TAVR). NOAF is independently associated with
adverse outcomes. We therefore performed a meta-analysis of randomized
control trials (RCTs) assessing NOAF rates at one year follow up following
treatment with TAVR as compared to SAVR in low surgical risk patients.
Hypothesis: We hypothesize that treatment with TAVR is associated with
lower NOAF rates in low surgical risk patients. Methodology: A
comprehensive search of PubMed and EMBASE databases was conducted from
inception to April 2019, for all RCTs that compared TAVR versus SAVR in
low surgical risk patients and reported NOAF. We calculated comprehensive
odds ratio (ORs) and 95% confidence intervals (CIs) using a random-effects
model. The analysis was conducted as per the recommendations of the
Cochrane Collaboration. <br/>Result(s): We included 5 RCTs totaling 2793
procedures (1452 TAVR and 1341 SAVR). NOAF was reported in a total of 704
patients (153 post TAVR and 551 post SAVR). Our analysis demonstrated that
TAVR was associated with significantly lower incidence of NOAF as compared
to SAVR at one year follow up in low surgical risk patients (OR = 0.16;
95% CI: 0.12-0.21, l= 34%, P value<0.01). We also generated egger's plot
to detect publication bias which showed minimal publication bias.
<br/>Conclusion(s): In patient with low surgical risk, treatment with TAVR
is associated with lower incidence of NOAF as compared to SAVR. TAVR could
be preferred treatment option for patients with severe aortic stenosis and
low surgical risk.

<56>
Accession Number
630923122
Title
A cost-effectiveness analysis of ventricular assist devices (vad) for the
treatment of systolic heart failure in pediatric patients.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Priromprintr B.; Song N.; Owens D.K.; Salomon J.; Cho S.-H.; Ton S.; Zhao
D.Y.; Almond C.S.; Rosenthal D.N.; Goldhaber-Fibert J.D.; Shin A.
Institution
(Priromprintr, Song, Owens, Salomon, Cho, Ton, Zhao, Almond, Rosenthal,
Goldhaber-Fibert, Shin) Pediatric Cardiology, Stanford, Palo Alto, CA2Sch
of Medicine, Stanford, Palo Alto, CA3Veterans Affairs Palo Alto Health
Care System, Stanford, Palo Alto, CA4Cntr for Health Policy and Cntr for
Primary Care Outcomes Rsch, Stanford, Palo Alto, CA5Stanford Prevention
Rsch Cntr, Stanford, Palo Alto, CA6Pediatric Nephrology, Stanford, Palo
Alto, CA7Dept of Public Policy, Stanford, Palo Alto, CA8Stanford, Palo
Alto, CA9PED CARDIOLOGY, Stanford Univ, Palo Alto, CA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Costs for treating pediatric heart failure are substantial
and increasing with utilization of ventricular assist devices (VAD) as a
bridge to cardiac transplant. Given the potential health benefits from
improved quality of life and immediate post-transplantation outcomes,
there may be lifetime cost reductions with VADs for this population. A
cost-effectiveness analysis for the use of VAD in children compared to
medical therapy (inotrope infusion) alone has not yet been performed.
<br/>Method(s): We designed a decision analytic, computer-based simulation
model of the progression of cohorts of pediatric patients with severe
heart failure. The model begins with the decision to implant a VAD or
continue with inotropic infusion as medical therapy through cardiac
transplant, during which the two cohorts differ in cost, clinical
outcomes, and quality of life. We derived model inputs from studies of
pediatric heart failure identified via PubMed and Google Scholar. Outcomes
included lifetime costs, life expectancy, and quality adjusted life years
(QALYs) discounted at 3% annually. The analysis was conducted from a
healthcare sector perspective. <br/>Result(s): Despite an increase in
undiscounted life expectancy of 0.57 years, VADs were not a cost-effective
addition to the treatment pathway for pediatric heart failure, with an
incremental cost-effectiveness ratio (ICER) of $999,172 per QALY gained.
The ICER depended on the rate of transplantation, the costs of VAD
implantation, and initial hospitalization. By increasing the likelihood of
transplantation by 6 months after VAD implantation from 45% to 81%, the
ICER improves to $407,205/QALY gained. <br/>Conclusion(s): VADs are not
yet a cost-effective treatment when compared to a willingness-to-pay (WTP)
threshold of $100,000/QALY and to ICERs of other well-accepted
interventions. Further analysis should account for limitations of this
study and assess the cost-effectiveness of VADs in various scenarios.

<57>
Accession Number
630922693
Title
Frailty associated with increased bleeding in elderly with acute
myocardial infarction : a systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Putthapiban P.; Vutthikraivit W.; Sukhumthammarat W.; Rattanawong P.;
Kanjanahattakij N.; Amanullah A.
Institution
(Putthapiban, Vutthikraivit, Sukhumthammarat, Rattanawong,
Kanjanahattakij, Amanullah) Internal Medicine, Einstein Med Cntr,
Philadelphia, PA2Internal Medicine, Texas Tech Univ, Lubbock, TX3Internal
Medicine, Univ of Hawaii Internal Medicine Residency Program, Honolulu,
HI4Einstein Med Cntr, Philadelphia, PA5Albert Einstein Med Ctr,
Philadelphia, PA
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Frailty is a multidimensional syndrome defined as
physiological vulnerability to stress that reflects physiological reserve
of elderly. It has been shown to be related to unfavorable outcome
including bleeding in cardiac surgery as well as transcatheter aortic
valve implantation. We conducted a systematic review and meta-analysis of
the association between frailty and bleeding among elderly with acute
myocardial infarction (AMI). <br/>Method(s): We comprehensively searched
the databases of MEDLINE and EMBASE from inception to March 2019. The
studies that reported significant bleeding in AMI patients who were
evaluated and classified by frailty status were included. Data from each
study were combined using the random-effects, generic inverse variance
method of DerSimonian and Laird to calculate hazard ratio (HR) and 95%
confidence intervals (CI). <br/>Result(s): Seven studies from 2011 to 2019
were included in this meta-analysis involving 134,640 subjects (mean age:
75+ year-old, 60% of male). Frailty status was evaluated using different
methods including Fried Frailty Index, Frailty Point Scoring System,
SBARE-FI index and FRAIL scale. Significant bleeding was defined as
hemoglobin decrease >= 4 g/dl, intracranial or retroperitoneal bleed, or
bleeding leading to blood transfusion. Frailty was statistically
associated with increase incidence of significant bleeding (pooled HR
1.34, 95% CI: 1.12 - 1.59, P 0.001, I=4.7%) (Figure 1).
<br/>Discussion(s): Frailty was significantly associated with bleeding in
elderly with AMI. Frailty assessment should be considered as an additional
risk factor of bleeding and used to guide toward personalized treatment
strategies.

<58>
Accession Number
630922571
Title
Metaanalysis comparing safety and outcomes after transcatheter aortic
valve replacement in bicuspid aortic stenosis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Sridhara S.; Gavhane P.U.; Pandya B.; Kumar A.; Kanwar N.; Rodriguez J.;
Prakash M.; Kohli V.; Tse G.; Liu T.; Pancha H.B.
Institution
(Sridhara, Gavhane, Pandya, Kumar, Kanwar, Rodriguez, Prakash, Kohli, Tse,
Liu, Pancha) Cardiology, Banner Univ Med Cntr-Phoenix, Phoenix,
AZ2Cardiology, Staten Island Univ Hosp, Northwell Health, Staten Island,
NY3Cardiology, Emory Univ Sch of Medicine, Atlanta, GA4Cardiology, Univ of
Arizona, Phoenix, AZ5Cardiology, East Tennessee State Univ, Johnson City,
TN6Medicine and Therapeutics, The Chinese Univ of Hong Kong, Shatin,
China7Cardiology, Tianjin Institute of Cardiology, Tianjin, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients with bicuspid aortic stenosis (AS) have traditionally
been excluded in randomized clinical trials comparing surgical vs.
Transcatheter Aortic Valve Replacement (TAVR) and outcomes post-TAVR is
limited in scientific literature. <br/>Method(s): PubMed, Embase, and
Cochrane Library databases were searched through 30th May 2019 and we
identified 13 relevant studies. Random & fixed effect models with
heterogeneity statistics were used to assess the odds of 30-day, long-term
mortality and complications post-TAVR. <br/>Result(s): In 11,223 patients
the 30-day [OR: 1.35(95%CI: 0.93-1.98;p=0.11)] and long-term mortality
[OR: 0.92(95%CI: 0.72,1.18;p=0.51)] were similar among patients undergoing
TAVR for bicuspid vs. tricuspid AS (Figure 1 A, B). Major bleeding [OR:
1.11(95%CI: 0.77-1.61 ;p=0.56)], vascular complications [OR: 1.05(95%CI:
0.70-1.57;p=0.83)], stroke [OR: 1.22 (95%CI: 0.75-1.99;p=0.41)] and
pacemaker implantation [OR: 1.04 (95%CI: 0.81-1.35;p=0.74)] did not differ
significantly among bicuspid vs. tricuspid AS. Interestingly, tricuspid AS
patients were more likely to experience para-valvular leak [OR:
1.53(95%CI: 1.16-2.01 ;p=0.003)] and conversion to surgery OR: 2.56
(95%CI: 1.47-4.48;p<0.001)], as shown in Figure 1 C, D.
<br/>Conclusion(s): In a metaanalysis comparing TAVR in bicuspid vs.
tricuspid AS both short and long-term mortality and complications were
similar with higher odds of para-valvular leak and conversion to surgery
in tricuspid AS patients. Future randomized studies evaluating these
findings are warranted.

<59>
Accession Number
630922471
Title
The effect of influenza vaccination on the systemic inflammatory response
and myocardial protection in patients undergoing cardiac surgery: A
randomized controlled trial.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Ebrahim F.; Mireau J.; Saroka K.; McElhaney J.; Atoui R.
Institution
(Ebrahim, Mireau, Saroka, McElhaney, Atoui) Anesthesiology, Health
Sciences North, Sudbury, Canada2Cardiac Surgery, Health Sciences North,
Sudbury, Canada3Health Sciences North Rsch Institute, Health Sciences
North, Sudbury, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Despite improvement in cardioprotective strategies,
myocardial dysfunction after cardiac surgery remains an ongoing problem.
CABG with cardiopulmonary bypass (CPB) induces an acute inflammatory
reaction that is associated with several postoperative complications.
Hypothesis: Studies have shown an association between influenza and an
increase in the inflammatory reaction. Furthermore, influenza vaccination
has been associated with a decrease in cardiovascular events.
Interestingly, some of this association has been attributed to possible
anti-inflammatory properties of the vaccine. Therefore, we hypothesize
that influenza vaccination would attenuate the systemic inflammatory
reaction after CPB. <br/>Method(s): This is a prospective, double-blind
trial of 30 CABG patients who were randomized to receive preoperatively
the influenza vaccine (group 1, N=15) or a placebo (group 2, N=15). Blood
samples of proinflammatory markers (TNFalpha, IL-8, IL-6) as well as
anti-inflammatory cytokines (IL-10) were collected at different time
points. Assessment of myocardial protection was investigated by measuring
hemodynamic and echocardiographic data as well as lactate and troponin
levels. <br/>Result(s): Patients in both groups had similar preoperative
characteristics including CPB and cross-clamp times. There were
significantly lower levels of proinflammatory markers such as IL-8 (65.03
vs 118.56 pg/mL, p<0.03), and TNFalpha (12.05 vs 20.8 pg/mL, p<0.05) in
group 1. This difference lasted for several hours postoperatively.
Interestingly, the level of the anti-inflammatory marker IL-10 was
significantly higher in group 1 (83.3 vs 15.15 pg/mL, p<0.01). This
difference also persisted for 24 hours postoperatively. There was also a
clear trend of improved myocardial protection in group 1 as seen by a
decreased troponin levels (6.02 vs 12.1 ng/mL, p<0.03).
<br/>Conclusion(s): Influenza vaccination blunts the acute inflammatory
reaction seen following CPB as reflected by a decreased level of
proinflammatory markers IL-8, TNFalpha and an increased level of the
anti-inflammatory cytokine IL-10. There was also a trend towards improved
myocardial protection and early metabolic recovery in group 1 as seen by a
decrease in the troponin release and improved hemodynamics.

<60>
Accession Number
630922374
Title
Arm versus treadmill exercise for detection of cardiac ischemia.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Agarwala A.; Kapoor D.; Balke C.; Ou J.; Xian H.; Martin W.
Institution
(Agarwala, Kapoor, Balke, Ou, Xian, Martin) Internal Medicine, Washington
Univ Sch of Medicine, Saint Louis, MO2Internal Medicine, St. Louis VA
Healthcare System, St. Louis, MO3Internal Medicine, St. Louis VA
Healthcare System, Saint Louis, MO4Epidemiology and Biostatistics, St.
Louis Univ Sch of Medicine, Saint Louis, MO
Publisher
Lippincott Williams and Wilkins
Abstract
Treadmill exercise testing (ETT) provides powerful prognostic and
important clinical information on functional capacity and cardiovascular
responses to the relevant physiologic stress of exercise. However, many
patients are unable to perform ETT. Arm exercise stress testing (ARM) is a
potential alternative for these individuals, but virtually no data exist
directly comparing ARM and ETT results. We hypothesized that ARM would be
an equivalent alternative in patients who are unable to perform ETT. We
conducted ARM and ETTs in randomized order and on different days using
progressive multi-stage protocols in 71 veterans ages 66 +/- 9 years
referred for cardiac stress testing. Patient characteristics included
history of hypertension (n=59), dyslipidemia (n=59), diabetes (n=34),
current smoking (n=15), previous myocardial infarction (MI, n=19),
percutaneous coronary intervention (n=31), coronary bypass surgery (n=12),
and heart failure (n=2). ARM exercise capacity was 72 +/- 20 peak watts.
Resting metabolic equivalents (METs) were significantly lower in ARM than
for ETT (3.2 +/- 0.7 vs 6.4 +/- 2.1 METs; p < 0.0001). The mean Duke
Treadmill Score was 2.9 +/-5.1. Peak heart rates (HR) were not
significantly different (135 +/- 20 vs 138 +/- 20 bpm; p=0.14; 88% vs 90%
age-predicted maximum). Peak systolic blood pressure was 7% lower (168 +/-
28 vs. 181 +/- 30 mmHg; p < 0.01) and peak rate-pressure product 9% lower
(22.8 +/- 5.0 vs 25.0 +/- 5.1 x 10 bpm x mmHg; p < 0.01) for ARM vs. ETT.
Recovery HR for ARM was faster at 1 minute compared to ETT (24 +/- 10 vs
15 +/- 8 bpm; p < 0.0001) but not at 2 minutes (35 +/- 12 vs 33 +/- 14
bpm; p = 0.23). Angina was elicited in 2 vs 5 patients (p= 0.24) and
ischemic ST changes were observed in 8 vs 14 patients (p = 0.16; p=0.08
for both) with ARM vs ETT, respectively. Over follow-up of 4.6 +/- 2.9
months, there was 1 MI and 12 coronary revascularizations. Both ARM and
ETT predicted these composite events (both p < 0.05) and C-statistics were
similar for ARM vs ETT. In conclusion, ARM METs are lower than for ETT and
ARM may be slightly less sensitive than ETT in the detection of cardiac
ischemia, but elicits a similar peak HR and only slightly lower
rate-pressure product. Thus, ARM may be a nearly equivalent alternative to
ETT to predict clinical outcomes in patients unable to perform leg
exercise.

<61>
Accession Number
630922345
Title
Postoperative bnp levels predict myocardial injury following vascular
surgery and can be lowered with preoperative administration of
coq<inf>10</inf>.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Carlson S.; Khan A.A.; Johnson D.; Mbai M.; Gravely A.; Hocum-Stone L.;
Kelly R.F.; Santilli S.; Green D.; Garcia S.; Adabag S.; McFalls E.O.
Institution
(Carlson, Khan, Johnson, Mbai, Gravely, Hocum-Stone, Kelly, Santilli,
Green, Garcia, Adabag, McFalls) Cardiology, VA Med Cntr, Univ of
Minnesota, Minneapolis, MN2Cardiology, Univ of Minnesota, Minneapolis,
MN3cardiology, VA Med Cntr Univ MN, Minneapolis, MN4Cardiology, VA Med
Cntr, Minneapolis, MN5CV Surgery, VA Med Cntr Univ MN, Minneapolis,
MN6Vascular Surgery, VA Med Cntr, Univ of Minnesota, Minneapolis,
MN7Minneapolis Heart Institute, Edina, MN
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: BNP levels in the perioperative period are a useful means of
risk-stratification among patients undergoing high-risk surgery.
Hypothesis: We tested whether preoperative administration of COQ10 prior
to elective vascular surgery reduces NT-Pro BNP levels in patients
undergoing vascular surgery. <br/>Method(s): A double-blind randomized
controlled trial was implemented at a single institution (NCT03956017).
Patients were screened during their preoperative vascular clinic
appointment and randomly assigned to CoQ<inf>10</inf> (400 mg per day)
versus Placebo for 3 days prior to surgery. Biomarkers including NT-Pro
BNP, troponin I and C-reactive protein were obtained prior to and
following surgery. The primary end-point was postoperative NT-Pro BNP
levels at 24 hours post-surgery and secondary end-point measures included
myocardial injury, defined by an elevated cardiac troponin level.
<br/>Result(s): One hundred and twenty-three patients were randomized to
receive either CoQ<inf>10</inf> (N=62) versus Placebo (N=61) for 3 days
before vascular surgery. Preoperative cardiac risks included ischemic
heart disease (N=52), CHF (N=12), stroke (N=23) and diabetes mellitus
(N=48) and the planned vascular procedures were infra-inguinal (N=78),
carotid (N=36), and intraabdominal (N=9). No intergroup differences were
noted in these clinical variables. NT-Pro BNP levels at 24 hours following
surgery were lower in the group receiving CoQ10 (Figure A). Among those
patients with an elevated NT-Pro BNP, a higher incidence of myocardial
injury, defined by an elevated troponin level was noted compared with
individuals without an elevated NT-Pro BNP level (Figure B).
<br/>Conclusion(s): In this randomized controlled pilot study, NT-Pro BNP
levels predict adverse events following elective vascular surgery and can
be lowered in those patients administered a 3-day preoperative course of
CoQ<inf>10</inf>.

<62>
Accession Number
630922259
Title
Evaluation of anticoagulation and amiodarone use for new post-operative
atrial fibrillation after coronary artery bypass grafting.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Matos J.D.; McIlvaine S.; Grau-Sepulveda M.; Jawitz O.; Brennan J.M.;
Khabbaz K.; Sellke F.W.; Yeh R.; Zimetbaum P.
Institution
(Matos, McIlvaine, Grau-Sepulveda, Jawitz, Brennan, Khabbaz, Sellke, Yeh,
Zimetbaum) INTERNAL MEDICINE, Beth Israel Deaconess Med Cntr and Harvard
Med Sch, Boston, MA2Dept of Medicine, Div of Cardiology, Beth Israel
Deaconess Med Cntr and Harvard Med Sch, Boston, MA3Duke Clinical Rsch
Institute, Durham, NC4Dept of Cardiac Surgery, Beth Israel Deaconess Med
Cntr and Harvard Med Sch, Boston, MA5Dept of Cardiothoracic Surgery, Brown
Med Sch and Lifespan Hosps, Providence, RI
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Post-coronary artery bypass grafting surgery (CABG) atrial
fibrillation (AF) is associated with increased morbidity and mortality.
Despite its high incidence and clinical importance, management of AF
following CABG is not standardized. We sought to elucidate national
practice patterns regarding anticoagulation and antiarrhythmic medication
use at discharge and examine short-term patient outcomes. <br/>Method(s):
We analyzed patient data from the STS Adult Cardiac Surgery Database
(ACSD) from July 2011-June 2018 who underwent first-time CABG with no
valve procedure and developed new post-CABG AF without significant
complication. We examined prescription rates of anticoagulation and
amiodarone at discharge, as well as 30-day readmission rates for stroke or
bleeding and 30-day mortality. <br/>Result(s): 832,958 patients with no
prior AF or stroke underwent isolated first-time CABG and 23.8%
(n=198,244) developed new post-CABG AF. Of these, 166,747 patients met
study criteria. 25.7% of patients were discharged on anticoagulation with
an average CHA2DS2-VASc score of 3.2 +/-1.3. Anticoagulation use at
discharge was not associated with lower 30-day stroke readmissions
[Adjusted Odds Ratio (AOR) 0.87, 95% CI 0.65-1.16, p=0.35]. Adjusted
30-day readmissions for major bleeding were significantly more common in
anticoagulated patients (AOR 4.30, 95%CI 3.69-5.03, p<.0001). Among those
discharged off anticoagulation, there was no significant difference in
adjusted 30-day stroke rates based on amiodarone use at discharge (AOR
1.19, 95% CI 0.85-1.66, p=0.31). <br/>Conclusion(s): Post-CABG
anticoagulation for new AF is associated with increased bleeding and no
difference in stroke at 30 days. Prospective randomized studies are needed
to formalize safe and efficacious short- and long-term management
strategies.

<63>
Accession Number
630922239
Title
Reduction in stroke rates with embolic protection device during
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Thakkar S.J.; Kumar A.; Shah J.; Gullapalli N.; Meraj P.M.; Doshi R.P.
Institution
(Thakkar, Kumar, Shah, Gullapalli, Meraj, Doshi) Internal Medicine,
Rochester General Hosp, Rochester, NY2Saint Johns Med College Hospita,
Bangalore, lndia3Mercy Saint Vincent Med Cntr, Toledo, OH4Internal
Medicine, Univ of Nevada Reno SOM, Reno, NV5Cardiology, North Shore Univ
Hosp, Manhasset, NY
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Periprocedural stroke is one of the most important and
debilitating adverse events in patients undergoing transcatheter aortic
valve replacement (TAVR). This led to the development of embolic
protection devices (EPD) to prevent periprocedural stroke. Previous
meta-analyses did not show significant reduction in stroke rates with the
use of EPDs. Hypothesis: We hypothesize that the use of EPD can reduce
stroke rates in patients undergoing TAVR. <br/>Method(s): A comprehensive
search of PubMed and EMBASE databases was conducted for all randomized
control trials (RCTs) and propensity score matched (PSM) observational
studies that studied efficacy of EPDs during TAVR procedure. We calculated
comprehensive odds ratio (ORs) and 95% confidence intervals (CIs) using a
fixed-effects model. Additionally, to revamp the results for possible type
I error, we also performed a trial sequential analysis (TSA) to support
our results. <br/>Result(s): We included 6 studies (5 RCTs and 1
propensity score matched study) totaling 1,181 procedures. Our results
demonstrated that use of EPD resulted in significant reduction in the
incidence of periprocedural stroke (OR = 0.51; 95% CI: 0.29-0.90, l= 0%, P
valueO.01) (Panel A). We also generated Egger's plot to analyze
publication bias which did not demonstrate significant publication
bias(Panel B). The trial sequential analysis however indicated the
presence of type I error associated with the conclusion, and need for
further procedures to reach the diversity adjusted information size of
1,768. (Panel C). <br/>Conclusion(s): This meta-analysis demonstrated that
use of EPD significantly reduced the incidence of periprocedural stroke
during TAVR. Use of EPD during TAVR might be very promising in preventing
the periprocedural strokes and therefore, use of EPD during TAVR is highly
recommended. Identifying future subsets of patients that would benefit
from EPD is warranted.

<64>
Accession Number
630922109
Title
Transcatheter aortic valve replacement in low surgical risk patients with
severe aortic stenosis: A systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Olarte N.I.; Rivera M.; Toirac A.; Vincent L.; Vaz I.; Fernandes M.;
Ferreira T.; Alfonso C.; Cohen M.G.; De Marchena E.
Institution
(Olarte, Rivera, Toirac, Vincent, Vaz, Fernandes, Ferreira, Alfonso,
Cohen, De Marchena) Internal Medicine, Univ of Miami, Miami, FL2Univ of
Miami, Miami, FL3Cardiovascular Disease, Emory Univ, Atlanta, GA4Univ of
Miami, Miami Beach, FL5Univ of Miami Sch of Med, Miami, FL6Cardiovascular
Disease, Univ of Miami, Miami, FL
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) is a safe and
effective treatment for severe aortic stenosis (AS) in patients who are at
intermediate and high surgical risk. TAVR has not been well-studied in low
risk patients until recently. This updated meta-analysis assesses the
safety and efficacy of TAVR compared to surgical aortic valve replacement
(SAVR) for low risk patients with severe AS. <br/>Method(s): PubMed,
EMBASE, Scopus, Web of Science, and Cochrane Library were searched for
randomized controlled trials (RCT) and cohort studies comparing TAVR to
SAVR in low risk patients with severe AS. Studies were stratified based on
study design. Odds ratios (OR) and 95% confidence intervals (CI) were
calculated for all endpoints with P < 0.05 set for significance.
<br/>Result(s): Six studies (3 RCTs and 3 cohort studies) were included
for this analysis pooling 24,156 patients total. At 1 year, all-cause
mortality did not differ between treatment arms (OR: 0.99, 95% CI:
0.70-1.41) while cardiovascular mortality and incidence of disabling
stroke both favored TAVR over SAVR (OR: 0.56, 95% CI: 0.31-0.98; and OR:
0.33, 95% CI: 0.14-0.75, respectively). The combined endpoint of all-cause
death or disabling stroke at 1 year also favored TAVR over SAVR (OR: 0.49,
95% CI: 0.30-0.81). Short-term, TAVR was associated with more perivalvular
leak (OR: 7.28, 95% CI: 3.44-15.39), conduction abnormalities requiring
permanent pacemaker implantation (OR: 2.50, 95% CI: 1.71-3.66), and
vascular complications (OR: 2.81, 95% CI: 1.09-7.24), but with less
perioperative acute kidney injury stage > 2 (OR:0.42, 95% CI: 0.24-0.72)
and major bleeding (OR: 0.23, 95% CI: 0.13-0.38). <br/>Conclusion(s): For
1 year outcomes in elderly, low risk patients with calcific, tricuspid
aortic stenosis, TAVR is superior to SAVR for cardiovascular mortality and
for the combined outcome of all-cause death or disabling stroke.
Short-term outcomes post-TAVR are congruent with previous studies.

<65>
Accession Number
630922031
Title
Derivation and validation of a score system to stratify post-op valvular
patients in cardiac rehab.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Maranta F.; Pistoni A.; Cartella I.; Cianfanelli L.; Cerea P.; Sacchi S.;
Pala M.G.; Avitabile M.; Meloni C.; De Bonis M.; Castiglioni A.; Alfieri
O.; Cianflone D.
Institution
(Maranta, Pistoni, Cartella, Cianfanelli, Cerea, Sacchi, Pala, Avitabile,
Meloni, De Bonis, Castiglioni, Alfieri, Cianflone) Cardiovascular
Rehabilitation, San Raffaele Hosp, Milano, ltaly2Cardiology, Univ of
Milano Bicocca, Monza, Italy3Vita-Salute San Raffaele Univ, Milano,
ltaly4Cardiac Surgery, San Raffaele Hosp, Milano, ItalyoCardiac
Rehabilitation, Vita-Salute San Raffaele Univ, Milano, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The importance of Cardiovascular Rehabilitation (CR) in
post-surgical valvular patients both for the functional recovery and the
monitoring of complications is well-known. However, indicators to better
categorize their risk and to identify the real probability of recovery are
not available. <br/>Purpose(s): The aim of this study is to define and
validate a scoring system to stratify post-surgical valvular patients in
order to appropriately individualize CR programs. <br/>Method(s): A
retrospective study was conducted on 1480 consecutive post-surgical
valvular patients hospitalized in our CR Unit (902 M; median age 64
years): 485 underwent single valve repair, 408 single valve replacement,
237 single valve surgery and additional interventions, 249 multiple valve
interventions and 101 multiple valves and additional interventions. For
data analysis subjects were randomized in a Derivation (D; n = 1000) and a
Validation (V; n = 480) Group. In Group D the predictive value of
anamnestic, clinical and laboratory variables for major complications and
functional recovery was assessed. Two scoring systems for the outcomes
were created and validated on Group V. Finally, we interlaced them in an
operative algorithm. <br/>Result(s): Chronic kidney disease (OR 2.588;
p=0.012), sternal surgical re-synthesis (OR 7.757; p=0.003), post-surgical
transfusions (OR 2.419; p=0.001) and troponin T peak > 1400 ug/L (OR 2.441
; p=0.001) were independent predictors for the occurrence of major
complications in Group D and age (OR 0.958; p<0.001), post-surgical
transfusions (OR 1.981; p<0.001) and METS at admission (OR 0.032; p<0.001)
were independent predictors of a higher functional recovery. The
validation confirmed the reliability of model for the two obtained scoring
systems (z score of 0.07 p=0.941 and of 1.23 p=0.219 respectively). An
operative algorithm was then built to stratify patients and propose
personalized CR strategies. <br/>Conclusion(s): We identified predictors
to stratify the risk of complications and to define the probability of
recovery in post-surgical valvular patients undergoing CR. The proposed
final algorithm may support cardiologists to tailor rehabilitation
programs, leading to better outcomes and optimizing available resources.

<66>
Accession Number
630921957
Title
Preventive effect of empagliflozin on neointimal hyperplasia after drug
eluting stent implantation in patients with type2 diabetes.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Hashikata T.; Kishi M.; Ikutomi M.; Jimba T.; Matsushita M.; Shindo A.;
Katsushika S.; Sato T.; Ohnishi S.; Yamasaki M.; Kakuda N.
Institution
(Hashikata, Kishi, Ikutomi, Jimba, Matsushita, Shindo, Katsushika, Sato,
Ohnishi, Yamasaki, Kakuda) Dept of Cardiovascular Medicine, Stanford Univ,
stanford, CA2Dept of Cardiovascular Medicine, NTT Med Cntr Tokyo, Tokyo,
Japan3NTT Med Cntr Tokyo, Tokyo, Japan4Tokyo Univ, Sch of Medicine, Tokyo,
Japan5Tokyo Univ, Sch of Medicine, tokyo, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The effects of sodium-glucose co-transporter 2 inhibitor
(SGLT2i) after drug eluting stent (DES) implantation remains unknown.
Here, we evaluated whether empagliflozin, a SGLT2i, affects neointimal
condition in patients with type 2 diabetes who received DES implantation.
<br/>Method(s): Uncontrolled diabetic patients with coronary disease
planned for DES stenting were consecutively enrolled. The patients were
randomly assigned to receive empagliflozin in addition to standard therapy
or intensive therapy using other glucose-lowering drugs (oGLD).
Bioresorbable-polymer DESs (Ultimaster or Synergy stent) were used in all
cases. Optical coherence tomography (OCT) was performed at 12 months to
assess the neointimal reaction after DES placement. <br/>Result(s): A
total of 30 patients (33 lesions) were analyzed (n=16 in empagliflozin
group, n=14 in oGLD group). The levels of hemoglobin A1c were not
significantly different between the groups both at baseline [8.3 +/- 1.3
vs 8.1 +/- 0.5%, P = 0.73] and follow-up [7.2 +/- 0.8 vs 7.3 +/- 0.9%, P =
0.46]. In OCT analysis, neointima was significantly less in empagliflozin
group than oGLT group (neointimal volume: 1.19 +/- 0.29 vs 1.48 +/- 0.27
mm/mm, P = 0.02, maximal neointimal thickness: 247 +/- 49 vs 295 +/- 34
mum, P = 0.01), although the other standard variables were equivalent (P >
0.05 for each). No significant between-group difference was shown in the
ratio of neointimal coverage and malapposed stent strut. In addition,
neointimal volume was positively correlated with changes of BMI as well as
systolic and diastolic blood pressure, whereas no correlation was seen in
the other parameters including changes of blood glucose.
<br/>Conclusion(s): In patients with type 2 diabetes, empagliflozin plus
standard therapy reduced neointimal progression as compared with oGLD at
12 months after DES implantation. Our data possibly support a beneficial
effect of empagliflozin in type2 diabetes required for coronary
revascularization therapy.

<67>
Accession Number
630921885
Title
Does race influence decision-making for advanced heart failure therapies?.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Breathett K.; Yee E.; Pool N.; Hebdon M.; Crist J.; Knapp S.; Larsen A.;
Solola S.; Luy L.; Herrera-Theut K.; Zabala L.; Stone J.; McEwen M.;
Calhoun E.; Sweitzer N.
Institution
(Breathett, Yee, Pool, Hebdon, Crist, Knapp, Larsen, Solola, Luy,
Herrera-Theut, Zabala, Stone, McEwen, Calhoun, Sweitzer) Cardiovascular
Diseases, Univ of Arizona, Tucson, AZ2Sarver Heart Cntr, Univ of Arizona,
Tucson, AZ3Univ of Arizona, Tucson4College of Nursing, Univ of Arizona,
Tucson, AZ5Statistics Consulting, Univ of Arizona, Tucson, AZ6Univ of
Arizona, Tucson, AZ7Undergraduate Studies, Univ of Rochester, Rochester,
NY8Med Sch, Univ of Arizona, Tucson, AZ9Psychology, Univ of Arizona,
Tucson, AZ10Nursing, Univ of Arizona, Tucson, AZ11UNIVERSITY OF ARIZONA,
Tucson, AZ
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Race influences medical decision-making, but its impact on the
allocation of advanced heart failure (HF) therapies is unknown. We
hypothesized that race would influence allocation of advanced HF
therapies. <br/>Method(s): A mixed-methods study was conducted among
members of a national HF organization. Participants were randomized to
clinical vignettes which varied by patient race (African-American or
White). Participants (N=422) completed a survey exploring factors
contributing to decision for advanced therapies and qualitative
think-aloud interviews (n=44). Survey results were analyzed by least
absolute shrinkage and selection operator (LASSO) and multivariable
regression to identify factors that influence allocation and interactions
with vignette race and participant demographics. Grounded theory was
performed for analysis of interviews. <br/>Result(s): Surveys revealed no
differences in overall racial ratings support for each advanced therapy.
LASSO regression selected no interactions between race vignette and
clinical factors as important in the allocation for advanced therapies.
However, the interaction of participant age 40+ years with
African-American vignette negatively influenced allocation to heart
transplant modestly [-0.58(95%CI:-1.15,-0.0002)], with adherence and
social history the most influential factors. Interviews revealed a
sequence in the decision-making process: forming an impression,
identifying urgency, evaluating appropriateness of care, anticipating
challenges, and evaluating trust while making final recommendations. Race
influenced these steps: avoiding discussing race, believing photos may
contribute to racial bias, believing the African-American was sicker and
possibly undertreated compared to the White man, developing greater
concern for trust and adherence with the African-American, and ultimately
offering the White man a transplant and the African-American a ventricular
assist device. <br/>Conclusion(s): African-American race negatively
influenced the decision-making process for heart transplant, particularly
during conversations. Since advanced therapy selection meetings are
conversations rather than surveys, race may contribute significantly to
decisions.

<68>
Accession Number
630921847
Title
Evolocumab and cardiovascular outcomes in patients with recent myocardial
infarction: Analysis from fourier.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Gencer B.; Mach F.; Murphy S.A.; De Ferrari G.M.; Huber K.; Lewis B.S.;
Ferreira J.; Kurtz C.E.; Wang H.; Honarpour N.; Keech A.C.; Sever P.S.;
Pedersen T.R.; Sabatine M.S.; Giugliano R.P.
Institution
(Gencer, Mach, Murphy, De Ferrari, Huber, Lewis, Ferreira, Kurtz, Wang,
Honarpour, Keech, Sever, Pedersen, Sabatine, Giugliano) Brigham and
Women's Hosps, TIMI Study Group, Boston, MA2Cardiology Div, Univ Hosp
Geneva, Geneva, Switzerland3IRCCS Policlinico San Matteo, Pavia,
Italy4Cardiology, Wilhelminenspital, Vienna, Austria5CARDIOVASCULAR
CLINICAL RESEARCH, Lady Davis Carmel Med Ctr, Haifa, Israel6Cardiology
Dept, Hosp de Santa Cruz, Carnaxide, Portugal7Cardiovascular and
Metabolic, AMGEN, Thousand Oaks, CA8AMGEN, Newbury Park, CA9Global Product
General Manager, AMGEN, Thousand Oaks, CA
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The 2018 Cholesterol Guideline identified pts with recent MI
(within 12 months) as very-high risk and for whom it is reasonable to add
a PCSK9 inhibitor antibody to maximal statin if LDL-C >=70 mg/dL. We
report the clinical efficacy of evolocumab in pts with recent MI in
FOURIER. <br/>Method(s): FOURIER randomized 27,564 pts with stable ASCVD
treated with statin to evolocumab vs placebo followed for 2.2 years
median. In this analysis pts with known date of prior MI (n=22,320) were
stratified as recent MI (between 1-12 months) vs remote MI (>12 months
prior to randomization). We assessed the efficacy of evolocumab on the
primary endpoint (PEP: CV death, MI, stroke, UA, or coronary
revascularization) and the key secondary EP (SEP: CV death, MI or stroke)
in these subgroups. <br/>Result(s): The 5711 pts with a recent MI were
more likely to be younger and treated with high-intensity statin (77.3 %
vs. 69.3 %) and less likely to have a history of stroke, PAD, CABG,
hypertension, metabolic syndrome, renal dysfunction, diabetes compared
with the 16,609 pts with a remote MI. In pts with a recent MI, evolocumab
reduced the risk of the PEP & key SEP by 19% (HR 0.81, 95% CI 0.70-0.93)
and 25% (HR 0.75, 0.62-0.91), respectively. In contrast, in pts with a
remote MI, the respective relative risk reductions were 8% (HR 0.92,
0.84-1.01) and 15% (HR 0.85, 0.76-0.96) (P-int 0.13 & 0.24). Given the
higher event rate in pts with a recent MI, the absolute risk reductions
over 3 years with evolocumab for the PEP and key SEP tended to be greater:
3.7% and 3.2%, respectively, vs. 1.1% and 1.3% (Figure).
<br/>Conclusion(s): Patients with a recent MI (between 1-12 months) were
at higher risk for CV events and tended to experience greater relative and
absolute risk reductions with evolocumab than those with more remote MIs.
These findings support guideline recommendations to lower LDL-C
intensively after a recent MI.

<69>
Accession Number
630921808
Title
Tricuspid valve regurgitation and shunt type in association with
transplant-free survival after norwood: An analysis of the single
ventricle reconstruction trial database.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Devlin P.J.; McCrindle B.W.; Pourmoghadam K.
Institution
(Devlin, McCrindle, Pourmoghadam) Cardiothoracic Surgery, Northwestern
Univ, Chicago, IL2HOSPITAL SICK CHILDREN, Toronto, Canada3Pediatric
Cardiac Surgery, Arnold Palmer Hosp For Children, Orlando, FL
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The Single Ventricle Reconstruction (SVR) Trial found higher
12 month transplant-free survival in Norwood patients who received right
ventricle to pulmonary artery (RVPA) shunts compared with modified Blalock
Taussig (mBT) shunts. We used the SVR Trial dataset to assess if the
association of shunt type and transplant-free survival depends on baseline
tricuspid valve regurgitation (TVR) severity and analyzed the burden of
TVR after the Norwood procedure. <br/>Method(s): The SVR trial included
549 Norwood patients randomized to either mBT or RVPA shunt. We analyzed
the transplant-free survival with stratified Kaplan-Meier analysis for the
534 patients with a qualitative assessment of baseline TVR based on shunt
type received, using Norwood date as time zero. Mixed effects modeling was
used to analyze degree of TVR over time. <br/>Result(s): Of the 534
patients (mBT: 260 RVPA: 274), a total of 65 (mBT:37 RVPA: 28) had >=
moderate baseline TVR. On bivariable analysis, 1 year transplant-free
survival was best in the group with RVPA shunts and <= mild baseline TVR
(77%), while it was worst in the group with RVPA shunts and >= moderate
baseline TVR (54%), p=0.01. Within the mBT shunt group, 1 year
transplant-free survival was not significantly different between those
with <= mild baseline TVR (65%) and those with >= moderate baseline TVR
(57%), p=0.4. Of the 65 patients with >= moderate baseline TVR, 13
underwent atrioventricular valve (AVV) operations. There were no
significant differences in AVV operation rates between the different shunt
groups. Shunt type was not associated with progression of TVR in those
with >= moderate baseline TVR, mBT parameter estimate: -0.02, p=0.9.
<br/>Conclusion(s): There is a significant decrease in transplant-free
survival in Norwood patients with RVPA shunts who have >= moderate
baseline TVR that is not present in mBT shunt patients. Further
investigation into this interaction is necessary to inform Norwood shunt
choice in this rare and challenging patient population.

<70>
Accession Number
630921486
Title
Effects of bisoprolol transdermal patch for perioperative myocardial
injury in patients undergoing non-cardiac surgery: MUlti-center randomized
controlled trial.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Iwano T.; Nakamura K.; Toda H.; Ejiri K.; Nakagawa K.; Yoshida M.;
Watanabe A.; Miyoshi T.; Nishii N.; Shimizu K.; Hayashi M.; Morita H.;
Morimatsu H.; Ito H.
Institution
(Iwano, Nakamura, Toda, Ejiri, Nakagawa, Yoshida, Watanabe, Miyoshi,
Nishii, Shimizu, Hayashi, Morita, Morimatsu, Ito) Dept of Cardiovascular
Medicine, Okayama Univ, Okayama, Japan2Dept of Anesthesiology, Okayama
Univ, Okayama, Japan3Dept of Ansthesiology, Okayama Univ, Okayama, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Perioperative myocardial injury (PMI) is associated with an
increased risk of the morbidity and mortality. Routine use of beta-blocker
in perioperative period is not recommended. However, the efficacy of
beta-blocker is controversial even among high risk patients. Hypothesis:
We assessed the hypothesis that the beta blocker patch, which shows more
stable blood concentration than oral one and can be used during operation,
is effective at prevention of PMI for high risk patients. <br/>Method(s):
This study was a multicenter, prospective randomized, controlled,
open-label study in Japan. Elderly patients aged over 60 years with
hypertension and high RCRI score (2) who undergo high risk non-cardiac
surgery were randomly assigned to receive transdermal patch of bisoprolol,
a beta-blocker, 7 days before surgery or not. The primary endpoint is the
prevalence of PMI defined as postoperative hs-cTnT >0.014 ng/mL and
relative hs-cTnT change of 20%. The secondary endpoints are
cardiovascular events and 30-days mortality. From November 2014 to
February 2019, 240 patients from 5 hospitals were enrolled in this study
(mean age 76 years and, male patients 77% at baseline). <br/>Result(s): A
total of 240 patients were assigned to control group (n=120) or bisoprolol
group (n=120). The primary outcome occurred in 49 (44.5%) versus 40
(35.7%) in the control and bisoprolol group (p=0.18). No significant
difference in 30-days mortality was noted between two groups. In
bisoprolol group, the rate of tachyarrhythmia was lower than control
group. Safety outcomes, including hypotension and bradycardia, were no
significant differences between two groups. <br/>Conclusion(s): In high
risk patients undergoing non-cardiac surgery, bisoprolol patch does not
reduce prevalence of PMI. On the other hands, the safety of using
bisoprolol patch in perioperative period was proved from this trial.
IMAGING AND NUCLEAR MEDICINE SESSION TITLE: MELVIN JUDKINS EARLY CAREER
INVESTIGATOR COMPETITI.

<71>
Accession Number
630921247
Title
Impact of right ventricular dysfunction on outcomes after transcatheter
aortic valve replacement: A systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
El Nawaa S.; Vutthikraivit W.; Paz P.; Elmassry M.; Rahman M.R.;
Rattanawong P.; Putthapiban P.; Mantilla B.; Zitun M.; Souka A.M.; Tikue
A.; Shurmur S.W.
Institution
(El Nawaa, Vutthikraivit, Paz, Elmassry, Rahman, Rattanawong, Putthapiban,
Mantilla, Zitun, Souka, Tikue, Shurmur) Internal Medicine, Texas Tech Univ
HSC, Lubbock, TX2Texas Tech Health Sciences Cntr, Lubbock, TX3Texas Tech
Univerdity Health Sciences Cntr, Lubbock, TX4Texas Tech Univ Health S C,
Lubbock, TX5Texas Tech Univ, Lubbock, TX6Univ of Hawaii, Honolulu,
HI7Einstein Med Cntr, Philadelphia, PA8TBD, TBD, Lubbock, TX9Univ of
Cincinnati, Cincinnati, OHIOTexas Tech Univ, Lubbock, TX
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Over the past decade, transcatheter aortic valve replacement
(TAVR) has been widely used as an alternative treatment for aortic
stenosis patients. Risk stratification for short- and long-term mortality
has been studied. Several risk factors are well established, including
reduced left ventricular ejection fraction, aortic regurgitation, and
pulmonary artery hypertension. Recent studies demonstrated the association
between right ventricular (RV) dysfunction and the clinical outcomes after
TAVR. However, results were controversial. We aimed to assess the
association of RV dysfunction and outcomes after TAVR using systematic
review and meta-analysis. <br/>Method(s): We comprehensively searched the
databases of MEDLINE and EMBASE from inception to May 2019. Included
studies were published propensity score matching cohorts (prospective or
retrospective) that reported data on the association between RV
dysfunction and outcomes after 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): Nine studies from 2013 to 2019 were included in this
meta-analysis involving 5,087 patients (1,496 with RV dysfunction and
3,591 with normal RV systolic function. All-cause mortality was
significantly increased in patients with RV dysfunction underwent TAVR
([RR] 1.86, 95% CI 1.51-2.30, l=61.4%, p<0.001). Funnel plot did not
reveal publication bias. <br/>Conclusion(s): Our study demonstrated that
RV dysfunction worsening prognosis after TAVR. Right heart function
assessed by echocardiogram may be a useful risk stratification in
prediction of mortality in aortic stenosis patients underwent TAVR.

<72>
Accession Number
630921220
Title
Safety and effectiveness of trans-catheter versus surgical aortic valve
replacement in nonagenarians with severe aortic stenosis: A systematic
review and meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Ahsan M.J.; Fazeel H.M.; Malik S.U.; Ud Din A.T.; Hassan S.; Khan B.A.;
Hashmi M.S.; Mirza M.M.
Institution
(Ahsan, Fazeel, Malik, Ud Din, Hassan, Khan, Hashmi, Mirza) Internal
medicine, Creighton Univ, Omaha, NE2Services Institute of Med Sci.,
Lahore, Pakistan3Univ of Arizona, Tucson, AZ4Rawalpindi Med College,
Rawalpindi, Pakistan5Fatima Jinnah Med Univ, Lahore, Pakistan6Internal
medicine, Services Institute of Med Sciences, Lahore, Pakistan7Internal
medicine, Army Med College, Rawalpindi, Pakistan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Nonagenarians i.e. age > 90 are usually not considered for
surgical aortic valve replacement (SAVR) owing to their increased surgical
risk. This patient population is also under represented in clinical trials
that have evaluated the role of trans-catheter aortic valve replacement
(TAVR) for severe aortic stenosis.So the effectiveness of TAVR as compared
to SAVR remains unknown. <br/>Objective(s): To compare safety and
effectiveness of TAVR versus SAVR in nonagenarians. <br/>Method(s):
Literature search was performed using PubMed, Embase, Web of science,
Cochrane library and clinicaltrials.gov. Databases were systematically
searched up to 5-21-2019. Primary end point was 30-day mortality.
Secondary end points were post-operative incidences of stroke or transient
ischemic attacks, vascular access related complications, acute renal
failure, transfusion requirement, length of hospital stay,
respectively.The main summary estimate was random effects Risk ratio(RR)
with 95% confidence intervals (CIs). <br/>Result(s): Four retrospective
studies were included (N= 8389). TAVR was performed in 3112 patients while
5277 patients underwent SAVR. Our study found no difference in 30-days
mortality between TAVR and SAVR [RR = 0.91 (0.76 -1.10), p= 0.318]. TAVR
was associated with a significantly reduced risk of post-operative ARF [RR
= 0.72 (0.62 - 0.83), p<0.001] and a lower transfusion requirement [RR =
0.71 (0.62 - 0.81), p < 0.001], respectively. There was no difference in
risk of stroke/TIA between two groups [RR = 1.01 (0.70 -1.45), p= 0.957]
and risk of vascular access complications was significantly higher with
TAVR [RR = 3.39 (2.65 - 4.333), p<0.001].On an average, Length of hospital
stay was 3 days less in patients undergoing TAVR (p= 0.037).
<br/>Conclusion(s): TAVR was not shown to have an increased risk of short
term mortality or stroke along with a better post-operative outcomes when
weighed against SAVR in nonagenarians.

<73>
Accession Number
630921096
Title
Northern New England's multicenter experience with percutaneous coronary
intervention among patients with coronary artery disease undergoing
transcatheter aortic valve replacement.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Shah J.; Kvasic J.; Frey P.; Butzel D.; Robich M.P.; Quinn R.; Jayne J.;
Malenka D.J.; Vasaiwala S.
Institution
(Shah, Kvasic, Frey, Butzel, Robich, Quinn, Jayne, Malenka, Vasaiwala)
Cardiology, Maine Med Cntr, Portland, ME2Maine Med Partners, Portland,
ME3Dartmouth-Hitchcock Med Cntr, Lebanon, NH4Dartmouth-Hitchcock Med Ctr,
Lebanon, NH
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction and Background: The incidence of coronary artery disease in
patients undergoing transcatheter aortic valve replacement (TAVR) averages
nearly 70%. According to current guidelines, coronary artery bypass
grafting (CABG) should be performed concurrently at the time of surgical
AVR, however this combined procedure has been associated with worse
postoperative outcomes. Another recent option being utilized is
percutaneous coronary intervention (PCI) prior to TAVR. In our
multi-centered study, we evaluated outcomes in patients who had PCI within
the 60 days prior to TAVR. <br/>Methods and Results: In a retrospective
fashion, data of patients undergoing TAVR between 2015 and 2018, who also
had coronary artery disease (CAD), was collected from the Northern New
England Cardiovascular Disease Study Group (NNE). The NNE, is a voluntary
and multidisciplinary group, including 6 medical centers across Maine, New
Hampshire and Vermont, developed to share information concerning the
treatment of cardiovascular diseases. Three hundred and twelve patients
(32.7%) underwent PCI out of the 954 patients with commitment CAD and
severe aortic valve stenosis undergoing TAVR. There were no differences in
in-hospital mortality, 30-day mortality, stroke rate, or acute kidney
injury among patients with CAD prior to TAVR regardless of percutaneous
revascularization. 40.9% of the patients had left main and/or left
anterior descending artery interventions. Amongst the TAVR and CAD
patients who underwent PCI, we noted higher rates of pacer/ICD placement
(9.6% vs 5.3% p = 0.012) regardless of prior CABG history.
<br/>Conclusion(s): Our observational analysis demonstrates that there are
no adverse 30-day mortality outcomes with regards to revascularization
amongst patients with CAD undergoing TAVR. However, we did notice a higher
rate of Cardiovascular Implantable Electronic Device (CIED) placement in
patients undergoing PCI. Randomized clinical trials are needed to further
explore the burden of coronary artery disease, incomplete or complete
revascularization and clinical outcomes.

<74>
Accession Number
630920964
Title
Derivation and validation of the bridge to transplantation with left
ventricular assist device score for one year mortality after heart
transplantation. the BTT-LVAD-score.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Okoh A.K.; Fugar S.; Ozturk E.; Schultheis M.; Russo M.; Zucker M.;
Camacho M.
Institution
(Okoh, Fugar, Ozturk, Schultheis, Russo, Zucker, Camacho) Dept of
Medicine, Div of Cardiology, RWJ Barnabas Health NBIMC, Newark, NJ2Rush
Univ Med Cntr, Chicago, IL3Columbia Univ, New York, NY4Newark Beth Israel
Med Cntr, Newark, NJ
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The purpose of this study is to derive and validate a risk
score that accurately predicts one-year mortality after orthotopic heart
transplantation (OHT) in advanced heart failure patients brigdged to
transplant (BTT) with a left ventricular assist device (LVAD).
<br/>Method(s): A prospectively maintained database of the United Network
for Organ Sharing (UNOS) was queried to identify consecutive patients
implanted with an LVAD (Heartmate II, Heartware HVAD, and Heartmate III)
as a BTT between 2008 and 2018. Patients with >= 1-year follow up were
randomly divided into derivation (70%) and validation (30%) cohorts. The
primary endpoint was 1-year mortality after OHT. Multivariable logistic
regression models were constructed using variables that improved the
explanatory power of the model, which was determined using multiple
methods. A simple additive risk score was developed based on the relative
effect on the odds of 1-year mortality after OHT. Risk groups were
created, and survival was estimated and compared with Kaplan Meier
survival curves and the log-rank test respectively. <br/>Result(s): A
total of 7,759 patients who had at least one year follow up were randomly
assigned to derivation (n= 5431) and validation (n= 2328) cohorts. The
mean +/- SD age was 52 +/- 12 years and 82% of the patients were males.
One-year post-transplant mortality was 9.8 % (n=760). A 33-point scoring
was created from 6 recipient variables and 2 donor variables. Mean +/- SD
score of the derivation group was 8 +/- 4 and ranged between 0 and 27;
These values were similar in the validation cohort. Risk groups were
classified as low (0 to 5), intermediate (6- 10) and high (> 10). In the
validation cohort, the predicted 1-year mortality was significantly higher
in the high-risk group than the intermediate and low-risk groups, 14.7%
vs. 9% vs. 6.1% respectively (Log-rank test: p < 0.0001).
<br/>Conclusion(s): The BTT-LVAD Score can serve as a clinical decision
tool to guide therapeutic decisions in advanced heart failure patients.
The investigators herein present a novel, cross-validated score that
accurately predicted 1-year mortality after OHT in patients bridged with
an LVAD.

<75>
Accession Number
630920728
Title
ACCURACY of initial everolimus dosing in the teammate trial: How well does
it work in pediatric heart transplantation?.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Lee J.; Castleberry C.D.; Bock M.; Auerbach S.R.; Rossano J.W.; Hollander
S.A.; Lal A.K.; Pahl E.; Barkoff L.; Klein G.L.; Almond C.S.; Sleeper
L.A.; Daly K.P.
Institution
(Lee, Castleberry, Bock, Auerbach, Rossano, Hollander, Lal, Pahl, Barkoff,
Klein, Almond, Sleeper, Daly) Cardiology, Lucile Packard Children's Hosp
Stanford, Palo Alto, CA2Cardiology, Washington Univ in St. Louis, Saint
Louis, MO3Loma Linda Univ, Loma Linda, CA4Cardiology, Children's Hosp
Colorado, Aurora, CO5Cardiology, Children's Hosp of Philadelphia,
Haverford, PA6Pediatrics, Stanford Univ, Palo Alto, CA7Cardiology, U of
Utah Primary Children's Hos, Salt Lake City, UT8Ann & Robert H. Lurie
Childs Hosp, Chicago, IL9Cardiology, Boston Children's Hosp, Boston, MA
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The TEAMMATE Trial is the first randomized clinical trial in
pediatric heart transplantation (HT) and compares outcomes in children
randomized to everolimus (EVL) vs. tacrolimus as the primary
immunosuppressant. The initial dosing strategy for everolimus has not been
evaluated in pediatric HT patients. <br/>Method(s): Children newly
randomized to EVL in the TEAMMATE Trial at 6 months post-HT were analyzed
to determine how effective the initial dosing strategy (1.4 mg/m/day
rounded to the nearest 0.25 mg; Table) was in achieving a therapeutic EVL
level (3-8 ng/mL). The primary endpoint was time to the therapeutic range
(TTR) defined as the time between the first dose of EVL and the first
therapeutic EVL level. Secondary endpoints included the proportion of
patients who achieved a therapeutic level using the initial EVL dose, and
the dose required to achieve a steady-state level. <br/>Result(s): Among
53 children studied, the median age at HT was 4.3 years (IQR, 0.6, 12.5);
36% had a transplant for congenital heart disease (CHD); at randomization,
median weight was 17.1 kg (8.5, 34.6) and GFR was 119+/-30 mL/kg/1.73m.
Over half (n=29, 55%) received EVL in tablet form; 24 (45%) as liquid
preparation. During the study, 51 (96%) of the patients achieved a
therapeutic EVL level with a median TTR of 10 days (6, 24): 16 days (5.5,
30) in the tablet group and 9 days (6, 13) in the liquid preparation group
(P=0.14). The steady state dose of EVL was equal to the initial dose of
EVL in 45% of the patients who achieved a therapeutic level. The median
steady state dose of EVL to achieve the therapeutic level was 1.6 mg/m/day
(range 0.7-8.0; IQR, 1.3, 2.6). <br/>Conclusion(s): The everolimus dosing
strategy used in the TEAMMATE Trial appears to be working well with most
children reaching the therapeutic EVL level within two weeks. Patients
receiving liquid preparation of EVL achieved goal levels at least as
quickly as patients receiving tablets. A therapeutic EVL level was
achieved with a median dose of 1.6 mg/m/day.

<76>
Accession Number
630920543
Title
Type 2 myocardial infarction: Incidence, risk factors, and outcomes among
41,581 patients enrolled in 3 large randomized clinical trials.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Melloni C.; Alexander K.P.; Wu A.; Jones W.S.; Mehta R.H.; Harrison R.W.;
Kong D.; Mathews R.; Povsic T.J.; Patel M.R.; Al-Khatib S.M.; Mahaffey K.;
Holman R.; Lopes R.D.
Institution
(Melloni, Alexander, Wu, Jones, Mehta, Harrison, Kong, Mathews, Povsic,
Patel, Al-Khatib, Mahaffey, Holman, Lopes) Cardiology, Duke Clinical Rsch
Institute, Durham, NC2Duke Univ Med Cntr, Durham, NC3Biostatistics, Duke
Clinical Rsch Institute, Durham, NC4Duke Clinical Rsch Inst, Durham,
NC5Duke Univ, Durham, NC6Duke Clinical Reseach Institute, Durham, NC7Duke
Clinical Rsch Institute, Durham, NC8Duke Univ Med Ctr, Chapel Hill,
NC9Duke Med Cntr, Durham, NC10Stanford Univ, Stanford, CA11Univ of Oxford,
Oxford, Ukraine12Duke Clinical Rsch, Durham, NC
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Type 2 myocardial infarction (MI), defined as myocardial
necrosis due to myocardial supply and/or demand imbalance, is an
increasingly recognized diagnosis that still lacks proper clinical and
diagnostic characterization. We determined incidence, clinical
characteristics, and prognosis of type 2 MI using data from 3 large-scale
completed randomized cardiovascular (CV) outcomes trials. <br/>Method(s):
We used datasets from TRACER (non-ST-segment elevation acute coronary
syndrome, N=12,944), EUCLID (peripheral arterial disease, N=13,885), and
EXSCEL (type 2 diabetes mellitus with or without atherosclerotic CV
disease, N=14,752) trials. In all 3 trials, MI events were adjudicated by
independent committees, which determined the MI type according to the
Third Universal MI Definition. <br/>Result(s): The number of participants
experiencing type 2 MI within the first year of follow-up was: 57 in
TRACER (1.4 years follow-up, incidence 0.48/100pyr, 95%CI 0.37-0.63); 97
in EUCLID (2.5 years follow-up, incidence 0.71/100pyr, 95%CI 0.58-0.87),
and 112 in EXSCEL (3.2 years follow-up, incidence 0.77/100pyr, 95%CI
0.64-0.92). In all 3 trials, compared with patients without an MI, those
who suffered type 2 MI were older and more frequently black, with
hypertension, dyslipidemia, and diabetes (TRACER and EUCLID). Patients
with type 2 MI also had higher prevalence of pre-existing CV conditions
(congestive heart failure, prior MI, prior coronary revascularization, and
prior stroke). Following type 2 MI, the unadjusted incidence of any
subsequent recurrent MI ranged from 15- 30/100pyr, CV death ranged from
17-29/100pyr, and all-cause death ranged from 29-37/100pyr in 1 year
(Figure). <br/>Conclusion(s): Patients with type 2 MI are at increased
risk of death and recurrent CV events in the first year. Further research
is needed to better characterize and risk stratify these high-risk
patients to potentially allow for more aggressive early intervention and
improved outcomes.

<77>
Accession Number
630920333
Title
A comparison of outcomes between patients at low and intermediate-risk
with aortic stenosis undergoing transcatheter or surgical valve repair.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Khan M.R.; Kayani W.T.; Manan M.; Munir A.; Hamzeh L.; Virani S.S.;
Birnbaum Y.; Jneid H.; Alam M.
Institution
(Khan, Kayani, Manan, Munir, Hamzeh, Virani, Birnbaum, Jneid, Alam)
Internal Medicine, Mclaren Regional Med Cntr, Flint, MI2Internal Medicine,
Baylor College of Medicine, Houston, TX3Internal Medicine, King Edward Med
Univ, Lahore, Pakistan45Michael E Debakey Va-Baylor, Bellaire, TX6Baylor
College Medicine, Houston, TX7Baylor College of Medicine, Pearland, TX
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In view of paucity of robust data and to improve precision
of effect size, we aim to compare safety and efficacy of transcatheter
aortic valve replacement (TAVR) with surgical aortic valve replacement
(SAVR) in patients with aortic stenosis (AS) at low-intermediate risk.
<br/>Method(s): We performed an aggregate data meta-analysis of 7 RCTs
(6778 patients) comparing TAVR with SAVR for AS in low-intermediate risk
patients (Society of Thoracic Surgeons risk score <8%), with inter-group
comparisons of clinical outcomes between studies reporting outcomes in low
and intermediate-risk patients using random-effects model. Our primary
outcome was all-cause mortality at 30-days, 1-year and 2-years of follow
up. Secondary outcomes included cardiac mortality, stroke, acute kidney
injury (AKI), atrial fibrillation (AF), permanent pacemaker (PPM)
implantation, major bleeding, moderate-severe paravalvular leak (PVL) and
re-hospitalisation. <br/>Result(s): All-cause mortality, cardiac mortality
and stroke rates were comparable between the two groups at all follow-up
periods. TAVR was associated with a lower risk of AKI (OR 0.37
[0.25-0.54]). AF was higher with SAVR at 30-day (OR-0.17 [0.12-0.24])
thorough to 2-years (OR-0.34 [0.21- 0.55]), while PPM implantation was
higher with TAVR (30-days: OR-3.31 [1.64-6.66], 2-years: OR-3.17
[1.02-9.86]). Moderate-severe PVL was more prevalent with TAVR at all
follow-ups. On inter-group comparison, patients in the low-risk group had
an even lower risk of AF and re-hospitalization but a higher risk of PPM
implantation compared to patients at intermediate-risk undergoing TAVR.
<br/>Conclusion(s): TAVR may be an acceptable option for AS in
low-intermediate risk patients in view of current data but longer-term
follow-up is needed to weigh the overall effect of factors such as AF, PPM
implantation and PVL on morbidity and mortality.

<78>
Accession Number
630920303
Title
Arm exercise ecg is equivalent to regadenoson stress for detection of
obstructive coronary artery disease.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Agarwala A.; Balke C.; Kapoor D.; Ou J.; Xian H.; Osman M.; Chenoweth J.;
Martini W.H.
Institution
(Agarwala, Balke, Kapoor, Ou, Xian, Osman, Chenoweth, Martini) Internal
Medicine, Washington Univ Sch of Medicine, Saint Louis, MO2Internal
Medicine, St. Louis Veterans Administration Healthcare System, Saint
Louis, MO3Internal Medicine, St. Louis Veterans Administration Heathcare
System, St louis, MO4Internal Medicine, St. Louis Veterans Administration
Healthcare System, St. Louis, MO5Epidemiology and Biostatistics, St. Louis
Univ, Saint Louis, MO6Radiology, St. Louis Univ Sch of Medicine, Saint
Louis, MO
Publisher
Lippincott Williams and Wilkins
Abstract
Arm exercise ECG stress testing (ARM) is much less expensive and may be a
valuable alternative to regadenoson myocardial perfusion imaging (RMPI) in
patients unable to perform leg exercise. ARM provides powerful prognostic
and relevant clinical information from exercise responses without
requiring ionizing radiation. However, prediction of obstructive coronary
artery disease (CAD) with these 2 stress testing modalities has never been
directly compared in the same patients. We hypothesized that ARM would be
equivalent to RMPI for prediction of obstructive CAD. We performed ARM and
RMPI studies in randomized order on different days in 72 veterans aged 66
+/-10 yrs. who were referred for stress testing. Coronary artery calcium
(CAC) scoring and cardiac computed tomographic angiography (CTA) were
performed in 50 and invasive coronary arteriography (ICA) in 8 patients.
<br/>Result(s): Patient characteristics included history of hypertension
(n=59), dyslipidemia (n=58), diabetes (n=34), current smoking (n=17),
previous myocardial infarction (n=18), percutaneous coronary intervention
(n=31), coronary bypass surgery (n=13), and heart failure (n=3). Peak
heart rate was greater for ARM vs RMPI (135 +/- 20 vs 97 +/-14 bpm; p <
0.0001). ARM elicited ischemic ST segment changes in 9 and angina in 2
patients versus 0 for both with RMPI ECG. An abnormal RMPI study was
observed in 25 patients, of whom a reversible or mixed perfusion defect
was evident in 10, fixed perfusion defect in 14, and left ventricular
ejection fraction (LVEF) < 50% in 7. Mean LVEF = 65 +/-11%. Mean CAC score
= 625 +/- 718 Agatston units. <br/>Conclusion(s): Sensitivity,
specificity, + and - predictive values (PPV and NPV, respectively) of ARM
are equivalent to RMPI for detection of severe obstructive (> 70%) left
main or 3-vessel (3VD) or > 70% CAD in any artery or graft (ANY) by CTA or
ICA in veterans referred for cardiac stress testing. Thus, ARM may be a
viable and cost-effective alternative in patients unable to perform leg
exercise.

<79>
Accession Number
630920202
Title
Outcomes of patients with bicuspid aortic valves undergoing transcatheter
aortic valve implantation stratified by valve type used.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Quezada R.A.Q.; Monlezun D.; Davogustto G.; Saenz H.R.; Baruqui D.L.;
Denktas A.; Jneid H.; Paniagua D.
Institution
(Quezada, Monlezun, Davogustto, Saenz, Baruqui, Denktas, Jneid, Paniagua)
Medicine, Emory Univ, Atlanta, GA2Medicine, Univ of Texas at Houston,
Houston, TX3Vanderbilt Univ, Nashville, TN4Medicine, Univ of California
San Diego, San Diego, CA5Medicine, Mount Sinai Med Cntr, Miami, FL6Baylor
College of Medicine, Houston, TX7Medicine, Div of Cardiology, Baylor
College of Medicine and Michael E. DeBakey VA Med Cntr, Houston, TX
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Outcomes after transcatheter aortic valve replacement (TAVR)
are currently unknown and could potentially differ according to the
prosthetic valve deployed in patients with bicuspid aortic valves (BAV).
This study evaluated valve-specific outcomes after post-TAVR in patients
with BAV. <br/>Method(s): Literature search was performed through the
Cochrane databases, PubMed, ClinicalTrials, SCOPUS and EMBASE databases
from inception until July 2018. We used risk ratio and 95% confidence
intervals for all outcomes of interest. For each outcome, the data was
pooled using a multivariate random-effects meta-analysis including
multiple treatment as well as direct and indirect comparisons.
<br/>Result(s): Ten studies enrolling a total of 1547 BAV patients and 6
different prosthetic valve types used for TAVR were analyzed. There was no
significant difference in 30-day all-cause mortality (Figure 1a),
life-threatening bleeding (Figure 1b) and device success (Figure 1c) among
the diverse prosthetic valve types implanted. First generation
balloon-expandable valves (1B) were found to have significantly lower risk
of permanent pacemaker (PPM) implantation compared to 1st generation
self-expanding valves (1S) (RR 0.60, 95%CI 0.41-0.88) (Figure 1d).
Comparisons showing significantly lower moderate-to-severe paravalvular
regurgitation (PAR) were: 2nd generation balloon-expandable valves versus
1B (RR 0.16, 95%CI 0.04-0.63) and 1S (RR 0.17, 95%CI 0.05-0.66); 2nd
generation self-expanding valves versus 1B (RR 0.29, 95%CI 0.10-0.81) and
1S (0.30, 95%CI 0.09-0.99) (Figure 1e). <br/>Conclusion(s): In patients
with BAVs, second generation valves are associated with less
moderate-to-severe PAR compared to 1st generation valves.
Balloon-expandable valves had lower risk of (PPM) implantation. However,
there is no significant difference in 30-day all-cause mortality among the
diverse prosthetic valve types implanted during TAVR.

<80>
Accession Number
630920198
Title
Transcatheter versus surgical aortic valve replacement in patients with
prior cardiac surgery: A systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Lateef N.; Ahsan M.J.; Malik S.U.; Minhas A.M.; Haseeb A.; Mirza M.M.;
Doukky R.; Koster N.
Institution
(Lateef, Ahsan, Malik, Minhas, Haseeb, Mirza, Doukky, Koster) Internal
Medicine, Creighton Univ, Omaha, NE2Creighton Univ, Omaha, NE3Internal
Medicine, Rawalpindi Med College, Rawalpindi, Pakistan4Internal Medicine,
Orange Park Med Cntr, Orange Park, FL5Internal Medicine, Wright Graduate
Med Cntr, Scranton, PA6Internal Medicine, John H. Stroger, Jr. Hosp of
Cook County, Chicago, IL7Cardiovascular Disease, Creighton Univ, Omaha, NE
Publisher
Lippincott Williams and Wilkins
Abstract
Background: An increasing number of patients with severe aortic stenosis
(AS) have history of prior cardiac surgery which is associated with
increased risk of aortic valve replacement. In such cases, the proposed
benefit of surgical (SAVR) versus transcatheter aortic valve replacement
(TAVR) remains unknown. <br/>Objective(s): To evaluate the impact of prior
cardiac surgery on clinical end points in patients undergoing TAVR versus
SAVR for severe AS. <br/>Method(s): Literature search was performed using
MEDLINE (via PUBMED), EMBASE, Google Scholar and Scopus databases. The
included outcomes were procedural time, acute kidney injury (AKI),
bleeding complications, stroke, permanent pacemaker implantation (PPI),
duration of hospital stay, 30-day all-cause mortality and 1-2 year
all-cause mortality, The main summary estimate was random effects Odds
ratio (OR) with 95% confidence intervals (CIs). <br/>Result(s): 7 studies
(3 randomized trials, 4 cohort) including 8,922 patients with mean age 80
+/- 6.6/78 +/- 6.3 and 75.5%/75.5% males in the TAVR and SAVR groups,
respectively, were included. Our study found that, compared with SAVR,
TAVR was associated with lower incidence of stroke (OR = 0.65 (95% CI:
0.44 - 0.97), p = 0.03) and bleeding complications (OR = 0.36 (95% CI:
0.21 -0.59), p = <0.01). There was no difference in terms of AKI (OR =
0.71 (95% CI: 0.49 - 1.02), p = 0.06), PPI (OR = 1.56 (95% CI:
0.97-12.54), p = 0.06), 30-day all-cause mortality (OR = 0.87 (95% CI:
0.56 - 1.37), p = 0.54) and 1-2 year all-cause mortality (OR = 1.15 (95%
CI: 0.71 - 1.86), p = 0.57) between the two groups (Figure 1). The average
procedure time and duration of hospital stay were 170 minutes less (95%
CI: -249.37, -92.53), p = <0.01) and 3.6 days shorter (95% CI: -5.43,
-1.95), p <0.01) in patients with TAVR, respectively. <br/>Conclusion(s):
In patients with prior cardiac surgery and severe AS, both TAVR and SAVR
are reasonable options. However, TAVR may be associated with lower
incidence of outcomes like stroke and perioperative bleeding.

<81>
Accession Number
630920062
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
for acute myocardial infarction with cardiogenic shock in the United
States.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2019. United States. 140 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Smilowitz N.R.; Alviar C.L.; Katz S.D.; Hochman J.S.
Institution
(Smilowitz, Alviar, Katz, Hochman) Medicine (Cardiology), New York Univ
Med Cntr, New York, NY2New York Univ, New York, NY3New York Univ Sch Med,
New York, NY4NYU Sch of Medicine, New York, NY
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Myocardial infarction (MI) complicated by cardiogenic shock
(CS) is associated with high mortality. Early coronary revascularization
improves survival, but the optimal mode of revascularization remains
uncertain. We sought to characterize practice patterns and outcomes of
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) in patients with MI complicated by CS. <br/>Method(s):
Patients hospitalized for MI with CS between 1/2002 and 12/2014 were
identified from the United States National Inpatient Sample. Trends in
management were evaluated over time. Propensity score matching was
performed to identify cohorts with similar baseline characteristics and MI
presentations who underwent PCI and CABG. The primary outcome was
in-hospital all-cause mortality. <br/>Result(s): A total of 386,811
hospitalizations for MI with CS were identified (67% STEMI). Overall,
62.4% of patients underwent revascularization, with PCI in 44.9%, CABG in
14.1%, and a hybrid approach in 3.4%. Coronary revascularization for MI
and CS increased over time, from 51.5% in 2002 to 67.4% in 2014
(p-for-trend<0.001), driven by increases in PCI (Figure). Patients who
underwent CABG were more likely to have diabetes mellitus (35.5% vs.
29.2%, p<0.001) and less likely to present with STEMI (48.7% vs. 80.9%,
p<0.001) or cardiac arrest (11.0% vs. 21.8%, p<0.001) than those who
underwent PCI. CABG (without PCI) was associated with lower mortality than
PCI (without CABG) overall (18.9% vs. 29.0%, p<0.001; adjusted OR 0.58
[0.55-0.61]) and in a propensity-matched subgroup of 20,058 patients
(18.9% vs. 26.3%, p<0.001). <br/>Conclusion(s): CABG was associated with
lower in-hospital mortality than PCI among patients with MI complicated by
CS. Due to the likelihood of residual confounding, a randomized trial of
PCI versus CABG in patients with MI, CS, and multi-vessel coronary disease
is warranted to determine the optimal revascularization strategy in this
high-risk population.

<82>
Accession Number
630919232
Title
Postoperative neutrophil-to-lymphocyte ratio in nonintubated lung
resection surgery.
Source
European Respiratory Journal. Conference: 29th International Congress of
the European Respiratory Society, ERS. Spain. 54 (Supplement 63) (no
pagination), 2019. Date of Publication: September 2019.
Author
Choi H.; Jeon J.P.; Hwang W.
Institution
(Choi, Jeon, Hwang) Department of anesthesiology, Seoul St. Mary's
Hospital, Seoul, South Korea
Publisher
European Respiratory Society
Abstract
Introduction: The postoperative neutrophil-to-lymphocyte ratio (NLR) and
change in NLR (DELTANLR) can predict survival in patients after complete
resection of stage I non-small cell lung cancer (NSCLC). Non-intubated
thoracic surgery has been performed recently. The aim of this study was to
compare postoperative NLR and DELTANLR between intubated and non-intubated
patients. <br/>Method(s): This prospective randomized-controlled study
included 40 patients who underwent surgical resection for stage I NSCLC.
Differential counts of leukocytes were obtained before anesthesia, at the
end of surgery, and 24 hours after surgery. Preoperative and postoperative
NLR and DELTANLR were compared between intubated and nonintubated
patients. <br/>Result(s): Preoperative values were similar in two groups.
In both groups, total leukocyte, neutrophil count and NLR increased, and
lymphocyte count decreased after surgery (Fig. 1). Postoperative NLR and
DELTANLR were significantly lower in non-intubated patients compared to
intubated patients (Fig. 2). <br/>Conclusion(s): Postoperative NLR and
DELTANLR were significantly lower in non-intubated patients compared to
intubated patients during lung resection surgery. (Figure Presented) .

<83>
Accession Number
630919187
Title
Automated oxygen administration vs manual oxygen therapy after major
abdominal or thoracic surgery. an international multicenter randomized
controlled study.
Source
European Respiratory Journal. Conference: 29th International Congress of
the European Respiratory Society, ERS. Spain. 54 (Supplement 63) (no
pagination), 2019. Date of Publication: September 2019.
Author
L'Her E.; Jaber S.; Verzilli D.; Jacob C.; Huiban B.; Futier E.; Kerforne
T.; Pateau V.; Bouchard P.-A.; Gouillou M.; Nowak E.; Lellouche F.
Institution
(L'Her, Jacob, Huiban, Pateau, Gouillou, Nowak) CHU Brest, Brest, France
(Jaber, Verzilli) CHU Montpellier, Montpellier, France
(Futier) CHU Clermont-Ferrand, Clermont-Ferrand, France
(Kerforne) CHU Poitiers, Poitiers, France
(Bouchard, Lellouche) IUCPQ, QC, Canada
Publisher
European Respiratory Society
Abstract
Background: Hypoxemia and hyperoxia may occur after surgery with related
complications. Automated oxygen titration and weaning (FreeO<inf>2</inf>)
may improve oxygenation and outcome. Aims and Objectives: To evaluate the
impact of FreeO<inf>2</inf> vs conventional O<inf>2</inf> after surgeries
at risk of desaturation, on the oxygenation parameters and patient's
outcome. <br/>Method(s): This study is a prospective, multicenter,
randomized, controlled, open trial. After thoracic or abdominal surgery,
patients were randomly assigned to the manual O<inf>2</inf> administration
or automated O<inf>2</inf> administration (FreeO<inf>2</inf>). Primary
outcome was the percentage of time spent in the SpO<inf>2</inf> target
zone, during a 3-days time frame. Secondary outcomes were the nursing
workload, the time spent with severe desaturation (SpO<inf>2</inf> <85%),
with severe hyperoxemia (SpO<inf>2</inf> >98%); the O<inf>2</inf>
consumption, the duration of O<inf>2</inf> administration during
hospitalization, the frequency of use of ventilation (invasive or
noninvasive) the hospitalization length of stay and the survival rate.
<br/>Result(s): 200 patients were enrolled and 180 randomized and
analyzed. There was no significant difference in baseline characteristics.
Oxygenation and primary outcome are presented in the table:
<br/>Conclusion(s): Automated oxygen titration and weaning significantly
improves oxygenation parameters, decrease both severe hypoxemia and severe
hyperoxemia after major horacic or abdominal surgery.

<84>
Accession Number
630919076
Title
Comparison of postoperative immunological changes between intubated and
non-intubated patients during lung cancer resection surgery.
Source
European Respiratory Journal. Conference: 29th International Congress of
the European Respiratory Society, ERS. Spain. 54 (Supplement 63) (no
pagination), 2019. Date of Publication: September 2019.
Author
Oh S.-A.; Jeon J.; Hwang W.
Institution
(Oh, Jeon, Hwang) Seoul St. Mary's Hospital, Seoul, South Korea
Publisher
European Respiratory Society
Abstract
Background: Postoperative immunological changes have an impact on
oncological outcomes. Unlike conventional thoracic surgery performed under
general anesthesia with tracheal intubation, non-intubated thoracic
surgery with sedation and regional anesthesia has been performed recently.
The aim of this study was to compare postoperative immunological changes
between intubated and non-intubated patients who underwent lung cancer
resection surgery. <br/>Method(s): This prospective randomized-controlled
study included 30 patients who underwent surgical resection for stage I
non-small cell lung cancer. Blood samples for cytokine analysis were
collected just before induction, at the 1 hour and 24 hours after surgery.
Levels of the pro-inflammatory cytokine interleukin(IL)-6 and
anti-inflammatory cytokines IL-10 were measured using quantitative
sandwich enzyme immunoassay kits. <br/>Result(s): There was no significant
difference in preoperative values between two groups. Significant increase
in IL-6 and decrease in IL-10 were observed at all time points after
surgery in both groups. IL-6 at 24 hours after surgery was significantly
lower in non-intubated patients compared with intubated patients (20.8
[16.0-24.4] vs. 28.4 [21.2-41.6], P=0.04). Postoperative levels of IL-10
were not different between two groups. <br/>Conclusion(s): Postoperative
immunological change was lesser in non-intubated patients compared with
intubated patients during lung cancer resection surgery.

<85>
Accession Number
630918756
Title
Treatment and management of cardiac sarcoidosis.
Source
European Respiratory Journal. Conference: 29th International Congress of
the European Respiratory Society, ERS. Spain. 54 (Supplement 63) (no
pagination), 2019. Date of Publication: September 2019.
Author
Quijano-Campos J.C.; Thillai M.; Bravo-Teijeira M.; Sekhri N.; Kearl F.;
Parfrey H.; Harris E.; Harding K.; Rowe R.; Sanders J.
Institution
(Quijano-Campos, Thillai, Bravo-Teijeira, Parfrey, Harris, Harding, Rowe)
Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
(Sekhri, Kearl, Sanders) Barts NHS Health, London, United Kingdom
Publisher
European Respiratory Society
Abstract
Introduction: Sarcoidosis is a multisystem disease characterised by
granulomas that may affect any organ. The causes of sarcoidosis remain
poorly understood, but it might be influenced by genetic predisposition,
immune dysregulations and environmental factors (Arkema and Cozier, 2018).
Cardiac sarcoidosis (CS) is a potentially life-threatening condition
characterised by formation of granulomas in the heart. The clinical
presentation is highly variable from asymptomatic to palpitations,
syncope, heart block, arrhythmia, cardiac pump failure or even sudden
death (Hamzeh et al., 2015). <br/>Aim(s): The aim of this review is to
provide an overview for nurses and allied health professionals of the
treatment and management of cardiac sarcoidosis. <br/>Method(s): A
systematic review was conducted using the following databases: CINAHL,
BNI, AMED, MEDLINE, EMBASE, PsyclNFO, Cuiden Plus, Scopus, Cochrane
Library, JBI, Campbell Library, and Web-of-Science. <br/>Result(s): The
management of cardiac sarcoidosis is guided by individual symptoms,
tolerance and response to treatment. These options may include: a)
inmunosupression therapy, b) antiarrhytmic medication, c) catheter
ablation, d) pacemaker implantation, e) implantable cardioverter
defibrilator (ICD), f) heart transplantation. <br/>Conclusion(s): The
management of active cardiac sarcoidosis (CS) requires regular follow-up
to assess patients' response to their individualised treatment plan.
Furthermore, clinical monitoring is important to detect changes or early
recurrence of CS. Cardiac specialist nurses are vital to coordinate the
management and monitoring of CS, to facilitate communication between
CS-patients and CS-clinicians, and to minimise the impact of CS in
patients' quality of life.

<86>
Accession Number
630918569
Title
Effects of a fully automated vs conventional ventilation on ventilator
settings during postoperative ventilation in cardiac surgery patients: A
randomized clinical.
Source
European Respiratory Journal. Conference: 29th International Congress of
the European Respiratory Society, ERS. Spain. 54 (Supplement 63) (no
pagination), 2019. Date of Publication: September 2019.
Author
De Bie Dekker A.; Serpa Neto A.; Van Meenen D.; Bouwman A.; Roos A.;
Lameijer J.; Korsten E.; Schultz M.; Bindels A.
Institution
(De Bie Dekker, Bouwman, Roos, Lameijer, Korsten, Bindels) Catharina
Hospital Eindhoven, Eindhoven, Netherlands
(Serpa Neto) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Van Meenen, Schultz) Amsterdam University Medical Centers, Amsterdam,
Netherlands
Publisher
European Respiratory Society
Abstract
Background: It is uncertain whether fully automated ventilation improves
ventilator settings during postoperative ventilation after cardiac
surgery. Aims and Objectives: To investigate the effect of automated
compared to conventional ventilation on proportions of time [and breaths]
in previously used safety zones of ventilation (Fig 1A), and time to
spontaneous breathing. <br/>Method(s): 220 patients were randomized to
automated or conventional postoperative ventilation. The tested automated
mode adjusted tidal volume, rate, FiO<inf>2</inf> and PEEP on a
breath-by-breath basis, based on ventilation and oxygenation targets set
at start of ventilation. With conventional ventilation, settings were
adjusted by experienced ICU nurses. <br/>Result(s): Proportions of time
[and breaths] in critical, acceptable and optimal zones changed from
3.0+/-8.3 to 0.5+/-2.9% [5.5 to 2.7%], 50.0+/-34.0 to 16.7+/-16.7% [61.7
to 27.3%], and 25.5+/-29.3 to 55.2+/-28.0% [32.8 to 70.0%] with automated
ventilation (all P<0.01) (Fig 1B). An almost direct and sustained
improvement with automated ventilation was observed (Fig 1C). Time to
spontaneous breathing was shorter (HR 1.38 [1.05 to 1.83]; P=0.02).
<br/>Conclusion(s): The tested automated ventilation mode improved
ventilator settings in cardiac surgery patients. Automated ventilation has
great potential for improving ventilation in various patient groups in the
ICU. (Figure Presented) .

<87>
Accession Number
630917890
Title
The preoperative use of stair climbing test to predict postoperative
complications in thoracic surgery : A meta analysis.
Source
European Respiratory Journal. Conference: 29th International Congress of
the European Respiratory Society, ERS. Spain. 54 (Supplement 63) (no
pagination), 2019. Date of Publication: September 2019.
Author
Boujibar F.; Baste J.-M.; Cuvelier A.; Gillibert A.
Institution
(Boujibar, Baste) CHU Rouen,Inserm 1096, Rouen, France
(Cuvelier) CHU Rouen,UPRES EA 3830, Rouen, France
(Gillibert) CHU Rouen, Rouen, France
Publisher
European Respiratory Society
Abstract
Objective: To assess the ability of the stair climbing test to predict
postoperative morbidity following thoracic surgery <br/>Material(s) and
Method(s): We conducted a systematic review and a meta-analysis on the
association between the stair climb test result, commonly used in
preoperative routine, and morbidity/mortality after thoracic surgery. The
following databases were searched: Pubmed/Medline, Pedro, The Cochrane
Library, Embase, CINAHL. The research strategy was conducted from October
2018 to January 2019, in accordance with the PRISMA recommendations. The
risk of bias was assessed using the Quality in Prognosis Studies (QUIPS)
tool. <br/>Result(s): 13 articles were included in the systematic review
for a total of 2038 patients, 6 in the meta-analysis. There are a variety
of test evaluation criteria (rise time, height climbing, desaturation,
heart rate change). For the metaanalysis we were able to pool data on the
height climbed Risk ratio 2.34 95% CI (1.59 - 3.43). There was no
significant heterogeneity of the data observed (p = 0.06, I²=
53%). For each study, a step-up threshold was determined, the risk of
having a complication is higher in patients below the threshold than in
patients exceeding it. <br/>Conclusion(s): Based on the current
literature, it can be suggested that the height climbed during the stair
climbing test is predictive of complications after pulmonary resection
surgery.

<88>
Accession Number
630915316
Title
Inspiratory muscle training based on the anaerobiosis threshold on the
functional capacity of patients submitted to coronary arterial bypass
grafting: Randomized and controlled clinical trial.
Source
European Respiratory Journal. Conference: 29th International Congress of
the European Respiratory Society, ERS. Spain. 54 (Supplement 63) (no
pagination), 2019. Date of Publication: September 2019.
Author
Cordeiro A.L.; Barbosa H.M.; Landerson L.; Lima C.; Araujo J.; Souza A.;
Lago D.; Guimaraes A.; Petto J.
Institution
(Cordeiro, Barbosa, Petto) Escola Bahiana De Medicina e Saude Publica,
Salvador, Brazil
(Landerson, Lima, Araujo, Souza) Faculdade Nobre, Feira De Santana, Brazil
(Lago) Hospital Universitario Da Universidade Federal do Maranhao, Sao
Luis, Brazil
(Guimaraes) Instituto Nobre De Cardiologia, Feira De Santana, Brazil
Publisher
European Respiratory Society
Abstract
Introduction: Coronary artery bypass grafting (CABG) is associated with
reduced ventilatory muscle strength and consequent worsening of functional
capacity. In this scenario, Inspiratory Muscular Training (IMT) gains
space, but there is still a lack of knowledge if the anaerobic threshold
can be used as a basis for prescription. <br/>Objective(s): To test the
hypothesis that the IMT based on the anaerobic threshold (AT) modifies the
functional capacity of patients submitted to CABG. <br/>Method(s): This is
a clinical trial. Patients were divided into two groups: the conventional
group (IMT-C), which performed inspiratory muscle training based on 40% of
maximal inspiratory pressure (MIP); group (IMT-AT), in which patients
performed IMT based in AT. All patients underwent preoperative and
postoperative assessment of MIP and performed a six-minute walk test
(6MWT). <br/>Result(s): 42 patients were evaluated, 21 of them for each
group. The mean age of participants was 61.4+/-10 years and 27(64%) were
male. There was a reduction of inspiratory muscle strength with a delta of
23+/-13cmH2O in IMT-C vs. 11+/-10 cmH2O in the IMT-AT (p <0.01) and the
distance covered in the 6MWT with a delta of 94+/-34 meters in the TMI-C
vs. 57+/-30 meters in the IMT-AT (p = 0.04). There was a reduction in the
length of hospital stay of patients who received the individualized
training 8.2 +/- 1.3 (IMT-C) vs 7 +/- 1.3 (IMT-AT), p<0.01.
<br/>Conclusion(s): IMT based on the anaerobic threshold minimized the
loss of functional capacity of patients submitted to CABG.

<89>
Accession Number
630915029
Title
ERS International Congress 2019 Abstracts.
Source
European Respiratory Journal. Conference: 29th International Congress of
the European Respiratory Society, ERS. Spain. 54 (Supplement 63) (no
pagination), 2019. Date of Publication: September 2019.
Author
Anonymous
Publisher
European Respiratory Society
Abstract
The proceedings contain 4060 papers. The topics discussed include: effects
of a fully automated vs conventional ventilation on ventilator settings
during postoperative ventilation in cardiac surgery patients: a randomized
clinical; restricted access oral antibiotics vs placebo for exacerbations
of pediatric bronchiectasis; restricted access SUPRANAV: a clinical trial
evaluating the efficacy and safety of a new invention device designed for
continuous supraglottic aspiration in mechanically ventilated patients;
-the efficacy of heated humidifier high-flow nasal cannula compared with
noninvasive positive-pressure ventilation in prevention of reintubation in
patients with prolonged mechanical ventilation; restricted access high
flow nasal oxygen therapy usage in the adult intensive care units in
turkey: multi-center, prospective study; restricted access Physical and
functional profile of ICU patients and correlation between functional
scales; restricted access Clinical utility of EBUS-TBNA sampling in the
diagnosis of metastatic non-lung primary carcinoma at a UK teaching
hospital; and endobronchial ultrasound guided transbronchial needle
aspiration cytology and cellblock in evaluation of mediastinal
lymphadenopathy in adults - an initial experience from eastern India.

<90>
[Use Link to view the full text]
Accession Number
630890807
Title
Crossover study comparing bioavailability of captisol-enabled iohexol
injection to reference iohexol injection in healthy subjects.
Source
Investigative Radiology. Conference: Contrast Media Research Symposium,
CMR 2019. Italy. 54 (12) (pp 792-793), 2019. Date of Publication: December
2019.
Author
Marschke K.; Larouche R.; Boudreault S.; Lapointe C.; Antle V.; Vajda E.;
Zhi L.; Pipkin J.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose: Iodinated contrast agents may place patients with certain risk
factors at an increased risk for acute kidney injury during cardiac
imaging procedures. Studies in renally compromised mice and rats
demonstrated that the addition of sulfobutylether beta-cyclodextrin
(Captisol) to a clinically administered dose of iohexol significantly
reduced renal pathology scores and increased survival in rats from50%to
88%. A phase 1, single-center, randomized, double-blind, 2-period
crossover study was conducted to determine relative bioavailability of
Captisol-enabled (CE) iohexol and a reference iohexol injection
(Omnipaque) after intravenous (IV) administration in healthy adults.
Methods and Materials: A total of 24 subjects were enrolled in the study
as 2 groups of 12 subjects in 2 treatment periods. Subjects received each
of the following treatments as a single IV dose (80 mL infused over 20
seconds): CE-iohexol, 755 mg/mL iohexol (350mg I/mL)/50
mgCaptisol/mL;Omnipaque, 755 mg/mL iohexol (350 mg I/mL). Serial blood
samples were collected for iohexol plasma concentration determination, and
safety was assessed during the 48 hours after each dose. Subjects were
discharged on day 3. <br/>Result(s): Twenty-two subjects completed the
study; 2 subjects were withdrawn for technical reasons. Bioequivalence was
demonstrated by calculation of geometric mean ratios (GMRs) between
CE-iohexol and Omnipaque for key pharmacokinetic parameters. The geometric
mean values for area under the concentration-time curve for time
0-infinity (AUC<inf>0-inf</inf>) for CE-iohexol and Omnipaque were 11,216
and 11,213 h mug/mL, respectively, and aGMR of 1.00 (94.12%confidence
interval, 0.98-1.02). The geometricmean values for maximum concentration
(Cmax) for CE-iohexol and Omnipaque were 6243 and 6231 mug/mL,
respectively, and a GMR of 1.00 (94.12% confidence interval, 0.95-1.06).
Other PK parameters, including time to maximum observed concentration
(T<inf>max</inf>), half-life (t<inf>1/2</inf>), and elimination rate
constant (K<inf>el</inf>), were similar between treatments. All
treatment-emergent adverse events during the study were mild to moderate
in severity and in line with the known safety profile of Omnipaque. No
subject had a serious adverse event or discontinued from the study due to
an adverse event. <br/>Conclusion(s): The observed PK profile supports
clinical development of CE-iohexol as a next-generation contrast agent
with a reduced risk of renal toxicity (NCT03869983).

<91>
Accession Number
630925857
Title
Evaluation of Pain Management after Surgery: An Observational Study.
Source
Medicina (Kaunas, Lithuania). 56 (2) (no pagination), 2020. Date of
Publication: 07 Feb 2020.
Author
Sierzantowicz R.; Lewko J.; Bitiucka D.; Lewko K.; Misiak B.; Ladny J.R.
Institution
(Sierzantowicz, Bitiucka) Department of Surgical Nursing, Medical
University of Bialystok; Szpitalna 37, 15-295 Bialytsok, Poland
(Lewko) Department of Integrated Medical Care, Medical University of
Bialystok, M. Sklodowskiej-Curie str. 7a, Bialystok 15-096, Poland
(Lewko) Medical University of Bialystok, Kilinskiego 1, Bialystok 15-089,
Poland
(Misiak) University of Medical Science, Krakowska 9, Bialystok 15-875,
Poland
(Ladny) Department of General and Endocrine Surgery, Medical University of
Bialystok; M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
Publisher
NLM (Medline)
Abstract
Background and Objectives: Choosing a pain management strategy is
essential for improving recovery after surgery. Effective pain management
reduces the stress response, facilitates mobilization, and improves the
quality of the postoperative period. The aim of the study was to assess
the effectiveness of pain management in patients after surgery.
<br/>Material(s) and Method(s): The study included 216 patients operated
on in the following surgical wards: the Department of Cardiosurgery and
the Department of General and Endocrine Surgery. Patients were
hospitalized on average for 6 +/- 4.5 days. Patients were randomly
selected for the study using a questionnaire technique with a numerical
rating scale. <br/>Result(s): Immediately after surgery, pre-emptive
analgesia, multimodal analgesia, and analgosedation were used
significantly more frequently than other methods (p < 0.001). In the
subsequent postoperative days, the method of administering drugs on demand
was used most often. Patients with confirmed complications during
postoperative wound healing required significantly more frequent use of
drugs from Steps 2 and 3 of the World Health Organization (WHO) analgesic
ladder compared with patients without complications. <br/>Conclusion(s):
The mode of patient admission for surgery significantly affected the level
of pain perception. Different pain management methods were used and not
every method was effective.

<92>
Accession Number
2004928849
Title
Outcome impact of different tranexamic acid regimens in cardiac surgery
with cardiopulmonary bypass (OPTIMAL): Rationale, design, and study
protocol of a multicenter randomized controlled trial.
Source
American Heart Journal. 222 (pp 147-156), 2020. Date of Publication: April
2020.
Author
Shi J.; Zhou C.; Liu S.; Sun H.; Wang Y.; Yan F.; Pan W.; Zheng Z.
Institution
(Shi, Zhou, Yan) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences & Peking Union Medical
College, Beijing 100037, China
(Liu, Sun, Zheng) Department of Cardiovascular Surgery, State Key
Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking
Union Medical College, Beijing 100037, China
(Wang) Department of Medical Research & Biometrics Center, State Key
Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking
Union Medical College, Beijing 100037, China
(Pan) Department of Anesthesiology, Baylor College of Medicine and Texas
Heart Institute, Houston, TX, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Tranexamic acid (TxA) reduces perioperative blood transfusion in cardiac
surgery; however, the optimal dose of TxA remains unknown. <br/>Methods
and Results: This large-scale, double-blind, randomized controlled trial
with a 1-year follow-up enrolls patients undergoing elective cardiac
surgery with cardiopulmonary bypass. Patients are randomly assigned 1:1
into either the high-dose TxA group (intravenous bolus [30 mg/kg] after
anesthesia followed by intravenous maintenance [16 mg/kg/h] throughout the
operation, and a pump prime dose of 2 mg/kg) or the low-dose TxA group
(intravenous bolus and maintenance are 10 mg/kg and 2 mg/kg/h,
respectively, and a pump prime dose of 1 mg/kg). The primary efficacy end
point is the rate of perioperative allogeneic red blood cell (RBC)
transfusion defined as the number (%) of patients who will receive at
least 1 RBC unit from operation day to discharge. The primary safety end
point is the 30-day rate of the composite of perioperative seizures, renal
dysfunction, myocardial infarction, ischemic stroke, deep vein thrombosis,
pulmonary embolism, and all-cause mortality. The secondary end points are
perioperative allogeneic RBC transfusion volume, the non-RBC blood
transfusion rate, postoperative bleeding, reoperation rate, mechanical
ventilation duration, intensive care unit stay, hospital length of stay,
total hospitalization cost, each component of composite primary safety end
point, and the 6-month/1-year follow-up mortality and morbidity. We
estimated a sample size of 3,008 participants. <br/>Conclusion(s): The
study is designed to identify a TxA dose with maximal efficacy and minimal
complications. We hypothesize that the high dose has superior efficacy and
noninferior safety to the low dose.<br/>Copyright &#xa9; 2019

<93>
Accession Number
630858590
Title
Vitamin C may reduce the duration of mechanical ventilation in critically
ill patients: A meta-regression analysis.
Source
Journal of Intensive Care. 8 (1) (no pagination), 2020. Article Number:
15. Date of Publication: 07 Feb 2020.
Author
Hemila H.; Chalker E.
Institution
(Hemila) Department of Public Health, University of Helsinki, POB 41,
Helsinki FI-00014, Finland
(Chalker) University of Sydney, Sydney, Australia
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Our recent meta-analysis indicated that vitamin C may shorten
the length of ICU stay and the duration of mechanical ventilation. Here we
analyze modification of the vitamin C effect on ventilation time, by the
control group ventilation time (which we used as a proxy for severity of
disease in the patients of each trial). <br/>Method(s): We searched
MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials
and reference lists of relevant publications. We included controlled
trials in which the administration of vitamin C was the only difference
between the study groups. We did not limit our search to randomized trials
and did not require placebo control. We included all doses and all
durations of vitamin C administration. One author extracted study
characteristics and outcomes from the trial reports and entered the data
in a spreadsheet. Both authors checked the data entered against the
original reports. We used meta-regression to examine whether the vitamin C
effect on ventilation time depends on the duration of ventilation in the
control group. <br/>Result(s): We identified nine potentially eligible
trials, eight of which were included in the meta-analysis. We pooled the
results of the eight trials, including 685 patients in total, and found
that vitamin C shortened the length of mechanical ventilation on average
by 14% (P = 0.00001). However, there was significant heterogeneity in the
effect of vitamin C between the trials. Heterogeneity was fully explained
by the ventilation time in the untreated control group. Vitamin C was most
beneficial for patients with the longest ventilation, corresponding to the
most severely ill patients. In five trials including 471 patients
requiring ventilation for over 10 h, a dosage of 1-6 g/day of vitamin C
shortened ventilation time on average by 25% (P < 0.0001).
<br/>Conclusion(s): We found strong evidence that vitamin C shortens the
duration of mechanical ventilation, but the magnitude of the effect seems
to depend on the duration of ventilation in the untreated control group.
The level of baseline illness severity should be considered in further
research. Different doses should be compared directly in future
trials.<br/>Copyright &#xa9; 2020 The Author(s).

<94>
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.

<95>
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.

<96>
Accession Number
2004081214
Title
Overview and surgical aspects of Uhls anomaly.
Source
Expert Opinion on Orphan Drugs. 8 (1) (pp 27-31), 2020. Date of
Publication: 02 Jan 2020.
Author
Cherian K.M.; Lydia Jeris W.; Thayub M.
Institution
(Cherian) Department of Cardiothoracic Surgery, Frontier Lifeline Hospital
and Dr. K. M. Cherian Heart Foundation, Chennai, India
(Lydia Jeris) Department of Clinical Laboratory and Blood Bank, Frontier
Lifeline Hospital and Dr. K. M. Cherian Heart Foundation, Chennai, India
(Thayub) Department of Clinical Pharmacy, Frontier Lifeline Hospital and
Dr. K. M. Cherian Heart Foundation, Chennai, India
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Uhls anomaly is an extremely rare congenital heart defect
characterized by partial or complete absence of right ventricular
myocardium. Less than 100 cases have been reported in the literature.
Survival depends on the severity of the right ventricular dysfunction. The
age at presentation is varied but usually presents in infancy or found
during autopsy. Diagnosis is made by echocardiogram (ECHO), magnetic
resonance imaging (MRI), and histopathological examination. Medical
management of this condition understanding the pathology is not possible.
Surgical treatment includes single ventricle strategy, one and a half
ventricle repair with partial right ventriculectomy, Fontan procedure, and
cardiac transplantation. Early recognition of the anomaly, institution of
drugs that improves cardiac function and right surgical planning may
improve the quality of life. Areas covered: An extensive literature search
has been done from many Pubmed and Scopus-indexed journals pertaining to
various aspects of Uhls anomaly including history of the disease,
etiology, clinical presentation, differential diagnosis, diagnostic aids,
and medical and surgical management. Expert opinion: Depending on the
hemodynamics, a bidirectional Glenn which is septectomy or a single
ventricle pathway would be a better approach. Of course heart
transplantation would be the last choice when other surgical options are
defied.<br/>Copyright &#xa9; 2019, &#xa9; 2019 Informa UK Limited, trading
as Taylor & Francis Group.

<97>
Accession Number
630773222
Title
Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement.
Source
The New England journal of medicine. 382 (9) (no pagination), 2020. Date
of Publication: 29 Jan 2020.
Author
Makkar R.R.; Thourani V.H.; Mack M.J.; Kodali S.K.; Kapadia S.; Webb J.G.;
Yoon S.-H.; Trento A.; Svensson L.G.; Herrmann H.C.; Szeto W.Y.; Miller
D.C.; Satler L.; Cohen D.J.; Dewey T.M.; Babaliaros V.; Williams M.R.;
Kereiakes D.J.; Zajarias A.; Greason K.L.; Whisenant B.K.; Hodson R.W.;
Brown D.L.; Fearon W.F.; Russo M.J.; Pibarot P.; Hahn R.T.; Jaber W.A.;
Rogers E.; Xu K.; Wheeler J.; Alu M.C.; Smith C.R.; Leon M.B.
Institution
(Makkar, Thourani, Mack, Kodali, Kapadia, Webb, Yoon, Trento, Svensson,
Herrmann, Szeto, Miller, Satler, Cohen, Dewey, Babaliaros, Williams,
Kereiakes, Zajarias, Greason, Whisenant, Hodson, Brown, Fearon, Russo,
Pibarot, Hahn, Jaber, Rogers, Xu, Wheeler, Alu, Smith, Leon) From
Cedars-Sinai Medical Center, Los Angeles (R.R.M., S.-H.Y., A.T.), Stanford
University, Stanford (D.C.M., W.F.F.), and Edwards Lifesciences, Irvine
(E.R., K.X., J.W.) - all in California; the Department of Cardiovascular
Surgery, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) -
both in Atlanta; Baylor Scott and White Healthcare, Plano (M.J.M.,
D.L.B.), and Medical City Dallas Hospital, Dallas (T.M.D.) - both in
Texas; Columbia University Medical Center/New York-Presbyterian Hospital
(S.K.K., R.T.H., M.C.A., C.R.S., M.B.L.) and NYU Langone Medical Center
(M.R.W.) - both in New York; Cleveland Clinic, Cleveland (S.K., L.G.S.,
W.A.J.); St. Paul's Hospital, Vancouver, BC (J.G.W.), and Institut
Universitaire de Cardiologie et de Pneumologie de Quebec, Universite
Laval, Quebec, QC (P.P.) - both in Canada; University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); Medstar Washington Hospital Center,
Washington, DC (L.S.); University of Missouri-Kansas City School of
Medicine, Kansas City (D.J.C.); Christ Hospital, Cincinnati (D.J.K.);
Barnes-Jewish Hospital, Washington University, St. Louis (A.Z.); Mayo
Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake
City (B.K.W.); Providence St. Vincent Medical Center, Portland, OR
(R.W.H.); and Rutgers-Robert Wood Johnson Medical School, New Brunswick,
NJ (M.J.R.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: There are scant data on long-term clinical outcomes and
bioprosthetic-valve function after transcatheter aortic-valve replacement
(TAVR) as compared with surgical aortic-valve replacement in patients with
severe aortic stenosis and intermediate surgical risk. <br/>METHOD(S): We
enrolled 2032 intermediate-risk patients with severe, symptomatic aortic
stenosis at 57 centers. Patients were stratified according to intended
transfemoral or transthoracic access (76.3% and 23.7%, respectively) and
were randomly assigned to undergo either TAVR or surgical replacement.
Clinical, echocardiographic, and health-status outcomes were followed for
5 years. The primary end point was death from any cause or disabling
stroke. <br/>RESULT(S): At 5 years, there was no significant difference in
the incidence of death from any cause or disabling stroke between the TAVR
group and the surgery group (47.9% and 43.4%, respectively; hazard ratio,
1.09; 95% confidence interval [CI], 0.95 to 1.25; P=0.21). Results were
similar for the transfemoral-access cohort (44.5% and 42.0%, respectively;
hazard ratio, 1.02; 95% CI, 0.87 to 1.20), but the incidence of death or
disabling stroke was higher after TAVR than after surgery in the
transthoracic-access cohort (59.3% vs. 48.3%; hazard ratio, 1.32; 95% CI,
1.02 to 1.71). At 5 years, more patients in the TAVR group than in the
surgery group had at least mild paravalvular aortic regurgitation (33.3%
vs. 6.3%). Repeat hospitalizations were more frequent after TAVR than
after surgery (33.3% vs. 25.2%), as were aortic-valve reinterventions
(3.2% vs. 0.8%). Improvement in health status at 5 years was similar for
TAVR and surgery. <br/>CONCLUSION(S): Among patients with aortic stenosis
who were at intermediate surgical risk, there was no significant
difference in the incidence of death or disabling stroke at 5 years after
TAVR as compared with surgical aortic-valve replacement. (Funded by
Edwards Lifesciences; PARTNER 2 ClinicalTrials.gov number,
NCT01314313.).<br/>Copyright &#xa9; 2020 Massachusetts Medical Society.

<98>
Accession Number
630890755
Title
Ventricular Arrhythmias Following Continuous-flow Left Ventricular Assist
Device Implantation: A Systematic Review.
Source
Artificial organs. (no pagination), 2020. Date of Publication: 11 Feb
2020.
Author
Gordon J.S.; Maynes E.J.; Choi J.H.; Wood C.T.; Weber M.P.; Morris R.J.;
Massey H.T.; Tchantchaleishvili V.
Institution
(Gordon, Maynes, Choi, Wood, Weber, Morris, Massey, Tchantchaleishvili)
Division of Cardiac Surgery, Thomas Jefferson University Hospital,
Philadelphia, United States
Publisher
NLM (Medline)
Abstract
Ventricular arrhythmias (VA) are not uncommon after continuous-flow left
ventricular assist device (CF-LVAD) implantation. In this systematic
review, we sought to identify the patterns of VA that occurred following
CF-LVAD implantation and evaluate their outcomes. An electronic search was
performed to identify all articles reporting the development of VA
following CF-LVAD implantation. VA was defined as any episode of
ventricular fibrillation (VF) or sustained (>30 seconds) ventricular
tachycardia (VT). Eleven studies were pooled for the analysis that
included 393 CF-LVAD patients with VA. The mean patient age was 57 years
[95%CI: 54; 61] and 82% [95%CI: 73; 88] were male. Overall, 37% [95%CI:
19; 60] of patients experienced a new onset VA after CF-LVAD implantation
while 60% [95%CI: 51; 69] of patients had a prior history of VA. Overall,
88% of patients [95%CI: 78; 94] were supported on HeartMate II CF-LVAD, 6%
[95%CI: 3;14] on Heartware HVAD, and 6% [95%CI: 2; 13] on other CF-LVADs.
VA was symptomatic in 47% [95%CI: 28; 68] of patients and in 50% [95%CI:
37; 52], early VA (< 30 days from CF-LVAD) was observed. The 30-day
mortality rate was 7% [95%CI: 5; 11]. Mean follow-up was 22.9 months
[95%CI: 4.8; 40.8], during which 27% [95%CI: 17; 39] of patients underwent
heart transplantation. In conclusion, approximately a third of patients
had new VA following CF-LVAD placement. VA in CF-LVAD patients is often
symptomatic, necessitates treatment, and carries a worse
prognosis.<br/>Copyright This article is protected by copyright. All
rights reserved.

<99>
Accession Number
630890240
Title
The Safety and Efficacy of Checkpoint Inhibitors in Transplant Recipients:
A Case Series and Systematic Review of Literature.
Source
The oncologist. (no pagination), 2020. Date of Publication: 11 Feb 2020.
Author
Kumar V.; Shinagare A.B.; Rennke H.G.; Ghai S.; Lorch J.H.; Ott P.A.;
Rahma O.E.
Institution
(Kumar, Lorch, Ott, Rahma) Department of Medical Oncology, Dana Farber
Cancer Institute and Brigham and Women's Hospital, Boston, MA, United
States
(Shinagare) Department of Radiology, Brigham and Women's Hospital, Boston,
MA, United States
(Rennke) Department of Pathology, Brigham and Women's Hospital, Boston,
MA, United States
(Ghai) Transplant Nephrology, Boston Medical Center, Boston, MA, United
States
Publisher
NLM (Medline)
Abstract
Limited data exist on safety and efficacy of immune checkpoint inhibitors
(ICIs) among organ transplant recipients. The objective of this study was
to report a case series of two patients with renal transplant who received
treatment with an ICI and to conduct a pooled analysis of published cases
to describe the safety and efficacy of ICIs in organ transplant patients.
A systematic search in the Google Scholar and PubMed databases was carried
out to include all the published cases of organ transplant patients who
received treatment with ICIs including programmed cell death protein 1
(PD-1), programmed death-ligand 1, or cytotoxic lymphocyte antigen-4
inhibitors since their inscription to January 31, 2019. In the present
series of two cases with renal allografts who received pembrolizumab, one
patient with squamous cell carcinoma of the skin experienced complete
response (CR), whereas another patient with melanoma had a mixed response.
Both patients experienced allograft rejection, but graft was salvaged. The
pooled analysis of 64 patients published in literature showed that overall
allograft rejection rate is 41% in organ transplant recipients following
ICI therapy. The graft rejection rate was 44% (17/39) for renal, 39%
(7/19) for liver, and 20% (1/5) for cardiac allografts. The highest risk
was seen among patients who were treated with PD-1 inhibitors, 20/42
(48%)-13/24 (54%) on nivolumab and 7/18 (39%) on pembrolizumab. The risk
was lowest with ipilimumab, 23% (3/13). The overall response rate (CR +
partial response [PR]) was 20% with ipilimumab, 26% with nivolumab, and
53% with pembrolizumab, whereas disease control rate (CR + PR + stable
disease) was 35% with ipilimumab, 37% with nivolumab, and 53% with
pembrolizumab. None of the variables including age, gender, type of
cancer, type of allograft, type of immunosuppression, time since
transplantation to initiation of ICI, and prior history of rejection were
significantly associated with the transplant rejection on univariate
analysis. The efficacy of ICI among patients with organ transplant appears
promising, warranting testing in prospective clinical trials. The risk of
rejection and allograft loss is considerable; therefore, the risk and
alternative form of therapies should be thoroughly discussed with the
transplant patients prior to initiating ICI therapy. IMPLICATIONS FOR
PRACTICE: Transplant recipients are at higher risk of developing cancers.
Although immune checkpoint inhibitors have been shown to improve the
outcome in more than one cancer type, transplant recipients were excluded
from these trials. Most of the data on the safety and efficacy of immune
checkpoint inhibitors in transplant patients are based upon case series
and case reports. The pooled data from these reports suggest that
anti-programmed death-ligand 1 inhibitors have reasonable safety and
efficacy among organ transplant patients, which warrants testing in
clinical trials.<br/>Copyright &#xa9; AlphaMed Press 2020.

<100>
Accession Number
2004234254
Title
Current Use and Trends in Unprotected Left Main Coronary Artery
Percutaneous Intervention.
Source
Current Cardiology Reports. 22 (4) (no pagination), 2020. Article Number:
16. Date of Publication: 01 Apr 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,
4800 Alberta Avenue, El Paso, TX 79905, United States
(Mulukutla) University Medical Center, El Paso, TX, United States
(Mares) University of Texas at El Paso, El Paso, TX, United States
(Paul) East Tennessee State University, Johnson City, TN, United States
Publisher
Springer
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%). <br/>Summary: 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.<br/>Copyright &#xa9; 2020, Springer Science+Business Media,
LLC, part of Springer Nature.