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<1>
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Accession Number
629649728
Title
Effect of High-Intensity Interval Training in De Novo Heart Transplant
Recipients in Scandinavia: One-Year Follow-Up of the HITTS Randomized,
Controlled Study.
Source
Circulation. 139 (19) (pp 2198-2211), 2019. Date of Publication: 07 May
2019.
Author
Nytroen K.; Rolid K.; Andreassen A.K.; Yardley M.; Gude E.; Dahle D.O.;
Bjorkelund E.; Relbo Authen A.; Grov I.; Philip Wigh J.; Have Dall C.;
Gustafsson F.; Karason K.; Gullestad L.
Institution
(Nytroen, Rolid, Andreassen, Yardley, Gude, Bjorkelund, Relbo Authen,
Grov, Gullestad) Departments of Cardiology, Oslo University Hospital
Rikshospitalet, Postbox 4950, Nydalen, Oslo 0424, Norway
(Dahle) Transplantation Medicine, Oslo University Hospital Rikshospitalet,
Norway
(Nytroen, Rolid, Andreassen, Yardley, Gullestad) Institute of Clinical
Medicine, Faculty of Medicine, University of Oslo, Norway
(Nytroen, Rolid, Gude, Gullestad) KG Jebsen Center for Cardiac Research,
University of Oslo, Norway
(Rolid, Yardley) Norwegian Health Association, Oslo, Norway
(Philip Wigh, Karason) Transplant Institute, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Have Dall) Department of Cardiology, Bispebjerg University Hospital,
Copenhagen, Denmark
(Have Dall, Gustafsson) University of Copenhagen, Denmark
(Gustafsson) Rigshospitalet, Copenhagen, Denmark
(Nytroen, Rolid, Gude, Gullestad) Center for Heart Failure Research, Oslo
University Hospital, Norway
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: There is no consensus on how, when, or at what intensity
exercise should be performed after heart transplantation (HTx). We have
recently shown that high-intensity interval training (HIT) is safe, well
tolerated, and efficacious in the maintenance state after HTx, but studies
have not investigated HIT effects in the de novo HTx state. We
hypothesized that HIT could be introduced early after HTx and that it
could lead to clinically meaningful increases in exercise capacity and
health-related quality of life. Method(s): This multicenter,
prospective, randomized, controlled trial included 81 patients a mean of
11 weeks (range, 7-16 weeks) after an HTx. Patients were randomized 1:1 to
9 months of either HIT (4x4-minute intervals at 85%-95% of peak effort) or
moderate-intensity continuous training (60%-80% of peak effort). The
primary outcome was the effect of HIT versus moderate-intensity continuous
training on the change in aerobic exercise capacity, assessed as the peak
oxygen consumption (Vo<inf>2</inf>peak). Secondary outcomes included
tolerability, safety, adverse events, isokinetic muscular strength, body
composition, health-related quality of life, left ventricular function,
hemodynamics, endothelial function, and biomarkers. Result(s): From
baseline to follow-up, 96% of patients completed the study. There were no
serious exercise-related adverse events. The population comprised 73% men,
and the mean+/-SD age was 49+/-13 years. At the 1-year follow-up, the HIT
group demonstrated greater improvements than the moderate-intensity
continuous training group; the groups showed significantly different
changes in the Vo<inf>2</inf>peak (mean difference between groups, 1.8
mL.kg-1.min-1), the anaerobic threshold (0.28
L/min), the peak expiratory flow (11%), and the extensor muscle exercise
capacity (464 J). The 1.8-mL.kg-1.min-1 difference
was equal to =0.5 metabolic equivalents, which is regarded as clinically
meaningful and relevant. Health-related quality of life was similar
between the groups, as indicated by results from the Short Form-36
(version 2), Hospital Anxiety and Depression Scale, and a visual analog
scale. Conclusion(s): We demonstrated that HIT was a safe, efficient
exercise method in de novo HTx recipients. HIT, compared with
moderate-intensity continuous training, resulted in a clinically
significantly greater change in exercise capacity based on the
Vo<inf>2</inf>peak values (25% versus 15%), anaerobic threshold, peak
expiratory flow, and muscular exercise capacity. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov. Unique identifier
NCT01796379. Copyright © 2019 American Heart Association, Inc.

<2>
Accession Number
615612401
Title
Quality and Value of Subspecialty Reinterpretation of Thoracic CT Scans of
Patients Referred to a Tertiary Cancer Center.
Source
Journal of the American College of Radiology. 14 (8) (pp 1109-1118), 2017.
Date of Publication: 01 Aug 2017.
Author
Carter B.W.; Erasmus J.J.; Truong M.T.; Shepard J.-A.O.; Hofstetter W.;
Clarke R.; Munden R.F.; Steele J.R.
Institution
(Carter, Erasmus, Truong) Department of Diagnostic Radiology, The
University of Texas MD Anderson Cancer Center, Houston, Texas, United
States
(Shepard) Department of Radiology, Massachusetts General Hospital, Boston,
Massachusetts, United States
(Hofstetter) Department of Thoracic and Cardiovascular Surgery, The
University of Texas MD Anderson Cancer Center, Houston, Texas, United
States
(Clarke) Emory Healthcare, Atlanta, United States
(Munden) Department of Radiology, Wake Forest School of Medicine,
Winston-Salem, North Carolina, United States
(Steele) Department of Interventional Radiology, The University of Texas
MD Anderson Cancer Center, Houston, Texas, United States
Publisher
Elsevier B.V.
Abstract
Introduction Patients referred to tertiary cancer centers often present
with imaging studies performed and interpreted at other health care
institutions. Although reinterpretation of imaging performed at another
health care institution can reduce repeat imaging, unnecessary radiation
dose, and cost, the benefit is uncertain. The purpose of this study is to
evaluate the quality of initial imaging studies of patients seeking a
second opinion at a tertiary cancer center, to compare the accuracy of
initial interpretations to reinterpretations performed by subspecialty
trained radiologists at a tertiary oncologic center, and to determine the
potential impact on patient management. Methods An institutional review
board-approved retrospective, single-institution database review was
performed in 120 new patients presenting to the thoracic surgery clinics
at our institution from 2010 through 2013, with initial chest CTs
performed at another institution. Two thoracic radiologists blinded to the
interpretation independently assessed the quality and performed a
reinterpretation of 52 CTs. Fisher's exact tests were used to compare the
frequency with which clinically important staging parameters appeared in
the reinterpretations and initial reports. Discrepancies between the
reinterpretations and initial interpretations were adjudicated
independently by two thoracic radiologists at different tertiary cancer
institutions to determine which interpretations were more accurate. The
impact of discrepancies on clinical management was evaluated based on
National Comprehensive Cancer Network guidelines. Results Of the 52 CTs,
32 (62%) were of inadequate image quality for staging. In 17 of 52 (33%),
discrepancies were identified between reinterpretations and initial
interpretations. For discrepancies, the reinterpretation was judged to be
more accurate for staging than the initial interpretation. In nine of
these patients, staging parameters were omitted in the initial
interpretations that precluded adequate staging. In the remaining eight
patients, six were upstaged, one was downstaged, and one was unchanged by
the reinterpretation. Conclusions Imaging studies from outside
institutions are of variable image quality and often not adequate for
appropriate staging of thoracic malignancies. Reinterpretation can
decrease repeat imaging and associated technical costs. Additionally, the
accuracy of staging is improved by reinterpretation of CTs by subspecialty
trained radiologists and can significantly impact clinical
management. Copyright © 2017 American College of Radiology

<3>
Accession Number
2003766014
Title
The efficacy and safety of paravertebral block combined with parecoxib
during video-assisted thoracic surgery: A randomized controlled trial.
Source
Journal of Pain Research. 13 (pp 355-366), 2020. Date of Publication:
2020.
Author
Yang J.; Hao Z.; Li W.; Duan C.; Fan X.; Xin J.; Ren C.
Institution
(Yang, Hao, Li, Duan, Fan, Xin) Department of Anesthesiology, Ordos
Central Hospital, Ordos, China
(Ren) Department of Anesthesiology, Liaocheng People's Hospital,
Liaocheng, Shandong, China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Although video-assisted thoracoscopic surgery (VATS) is
increasingly used, the optimal analgesia strategy is still unknown. We
explore the efficacy and safety of preemptive ultrasound-guided
paravertebral block (PVB) combined with parecoxib during VATS.
 Method(s): Seventy-four patients were divided into two groups. PVBs
were performed before anesthesia induction under real-time ultrasound
guidance. Visual analog scale (VAS) score with coughing at 48 h after
surgery, postoperative sufentanil consumption and level of sedation (LOS)
at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics,
satisfaction scores of patients and surgeons, remedial measures, time to
chest tube removed and mobilization, adverse effects and hospital stay
length were recorded. We also recorded inflammatory markers, respiratory
function and the prevalence of chronic pain after surgery. Result(s):
VAS scores at rest and with coughing during the first 24 h after surgery
were significantly lower in the P group (P<0.05). Consumption of
sevoflurane, remifentanil, and dexmedetomidine was all significantly
reduced in the P group (P<0.05). The consumption of sufentanil within 48 h
after surgery, time to first dose and total dose of rescue ketorolac was
significantly lower in the P group (P<0.05). The FEV1/FVC ratio was
significantly higher in the P group at 1 and 3 d after surgery (P<0.05).
Times to chest tube removal and mobilization were significantly shorter in
the P group (P<0.05). Compared with the C group, the level of both ACTH
and cortisol was significantly reduced in the P group at 1 and 3 d after
surgery (P<0.05). Conclusion(s): PVB combined with parecoxib was
associated with better pain relief, decreased sufentanil and ketorolac
consumption, less hemodynamic instability, and a lower surgery-related
stress response. However, the incidences of chronic pain 3 and 6 months
after surgery and the risk of complication except urinary retention were
not significantly different between groups. Copyright © 2020 Yang
et al.

<4>
Accession Number
2004566482
Title
Neuro-oncological features of spinal meningiomas: Systematic review.
Source
Neurochirurgie. 66 (1) (pp 41-44), 2020. Date of Publication: February
2020.
Author
Jamilson Araujo Pereira B.; Nogueira de Almeida A.; Silva Paiva W.;
Henrique Pires de Aguiar P.; Jacobsen Teixeira M.; Kazue Nagahashi Marie
S.
Institution
(Jamilson Araujo Pereira, Silva Paiva, Henrique Pires de Aguiar, Jacobsen
Teixeira, Kazue Nagahashi Marie) Departamento de Neurologia da Faculdade
de Medicina da Universidade de Sao Paulo, Rua Martiniano de Carvalho, 669,
Edificio Paulista Paradise Life, Apto 1105, Brazil
(Nogueira de Almeida) Divisao de Neurocirurgia Funcional IPQ. Hospital das
Clinicas da Universidade de Sao Paulo, Sao Paulo, Brazil
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Purpose: Review the published data on spinal meningioma (SM) to create a
more comprehensive picture of its natural history. Method(s): A
review of the published SM literature was carried out through a Medline
search up to December 2018. The search using the keyword "spinal
meningiomas" returned 248 papers and the parameters analyzed in our
present study were examined in those publications. Papers without a
detailed description of clinical findings, neuroimaging confirmation of
the spinal tumor, minimum follow-up of 5 years, or a clear description of
the clinical findings were excluded. Result(s): In the 24 manuscripts
reviewed, 1811 (1450 females/361 males) patients with SM were analyzed.
The thoracic spine (1181-64.6%) and cervical spine (394-22.7%) were the
more prevalent levels. The psammomatous (27.8%) and meningothelial
variants (25.2%) were the most prevalent histopathological subtypes. Gross
total resection (Simpson I and II) was achieved in 94.5% of cases and
subtotal resection (Simpson III or more) in 5.5%. The tumor recurrence
rate was 4.4%, and the mortality rate related to surgery or disease
progression was 3%. Conclusion(s): WHO grade I predominance was
observed among spinal meningiomas, analogous to intracranial meningiomas.
SMs predominated in the thoracic spine. Surgery with gross total resection
was achieved in the vast majority of cases, resulting in low recurrence
and mortality rates. Copyright © 2019 Elsevier Masson SAS

<5>
Accession Number
2004983505
Title
Fluid-structure interaction modeling in cardiovascular medicine - A
systematic review 2017-2019.
Source
Medical Engineering and Physics. (no pagination), 2020. Date of
Publication: 2020.
Author
Hirschhorn M.; Tchantchaleishvili V.; Stevens R.; Rossano J.; Throckmorton
A.
Institution
(Hirschhorn, Throckmorton) BioCirc Research Laboratory, School of
Biomedical Engineering, Science, and Health Systems, Drexel University,
Philadelphia, PA, United States
(Tchantchaleishvili) Division of Cardiothoracic Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Stevens) St. Christopher's Hospital for Children, Tower Health Hospitals,
Philadelphia, PA, United States
(Stevens) Pediatrics, Drexel University College of Medicine, Philadelphia,
PA, United States
(Rossano) Division of Pediatric Cardiology, The Children's Hospital of
Philadelphia, Philadelphia, PA, United States
Publisher
Elsevier Ltd
Abstract
Finite element analysis (FEA) and computational fluid dynamics (CFD) are
generally insufficient independently to model the physics of the
cardiovascular system. Individually, they are unable to resolve the
interplay between the solid and fluid domains, and the interplay is
integral to the functioning of the system. The use of fluid-structure
interaction (FSI) methods overcomes these shortcomings by providing the
means to couple the fluid and structural domains. In the last decade, the
utilization of FSI has greatly increased in cardiovascular engineering. In
this study, we conducted a systematic review process of more than 1000
journal articles to investigate the implementation of One-Way and Two-Way
FSI for cardiovascular applications. We explored the utility of FSI to
study aneurysms, the hemodynamics of patient anatomies, native and
prosthetic heart valve dynamics, flow and hemodynamics of blood pumps, and
atherosclerosis. Computational resource requirements, implementation
strategies and future directions of FSI for cardiovascular applications
are also discussed. Copyright © 2020

<6>
Accession Number
2002303566
Title
Feasibility and acceptability of continuous postoperative pericardial
flushing for blood loss reduction in patients undergoing coronary artery
bypass grafting.
Source
General Thoracic and Cardiovascular Surgery. 68 (3) (pp 219-226), 2020.
Date of Publication: 01 Mar 2020.
Author
Kara H.; Erden T.
Institution
(Kara) Department of Cardiovascular Surgery, Giresun Ada Hospital,
Giresun, Turkey
(Erden) Department of Cardiovascular Surgery, Faculty of Medicine,
Karadeniz Technical University, Trabzon, Turkey
Publisher
Springer
Abstract
Introduction: Postoperative bleeding requires blood transfusion and
surgical re-exploration that can affect the short- and long-term
postoperative outcomes. Interventions that can be used in the
postoperative period to reduce blood loss should be developed. Continuous
postoperative pericardial flushing (CPPF) with an irrigation solution may
reduce blood loss by preventing the accumulation of clots. This study
examined the feasibility and acceptability of CPPF for reducing bleeding
after coronary artery bypass surgery. Method(s): This pilot study
adopted a prospective and group comparison design. Between January and
April 2018, 42 patients who underwent isolated coronary artery bypass
surgery received CPPF from sternal closure up to 8 h postoperative. The
mean actual blood loss in the CPPF group was compared to the mean of
retrospectively group (n = 58). In the CPPF group, an extra infusion
catheter was inserted through one of the tube incision holes and an
irrigation solution (0.9% NaCl at 38 degreeC) was delivered to the
pericardial cavity by using a volumetric pump. Safety aspects, feasibility
issues, and complications were documented. The primary outcome was blood
loss, and it was assessed 18 h after the surgery. Result(s): CPPF was
successfully completed in 40 patients (95.24%). Method-related
complications were not observed. Feasibility was good in this experimental
setting. Blood loss was lower in the CPPF group (257.24 mL) than non-CPPF
group (p < 0.001). Conclusion(s): CPPF after coronary artery bypass
grafting surgery is safe, effective, feasible, and acceptable. However,
standardized randomized clinical trials are necessary to draw definitive
conclusions. Copyright © 2019, The Japanese Association for
Thoracic Surgery.

<7>
Accession Number
629928786
Title
Meta-analysis of impact of troponins on mortality after transcatheter
aortic valve implantation.
Source
The Journal of cardiovascular surgery. 61 (1) (pp 98-106), 2020. Date of
Publication: 01 Feb 2020.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Takagi) Department of Cardiovascular Surgery, Kitasato University School
of Medicine, Sagamihara, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, NY,
NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, MI, Detroit,
United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: To determine whether troponin (Tn) can predict mortality
after transcatheter aortic valve implantation (TAVI), we performed a
meta-analysis of currently available studies investigating impact of
baseline and postprocedural Tn. EVIDENCE ACQUISITION: MEDLINE and EMBASE
were searched through April 2019 using PubMed and OVID. Studies considered
for inclusion met the following criteria: the study investigating impact
of baseline and postprocedural Tn on mortality; the study population was
patients undergoing TAVI for aortic stenosis (AS); outcomes included early
(30-day or in-hospital)/late (including early) mortality. For each study,
data regarding early/late mortality in both high and low (defined in each
study) level of baseline/postprocedural Tn groups were used to generate
odds ratios (ORs) and 95% confidence intervals (CIs), or reported ORs and
hazard ratios (HRs) with 95% CIs were directly extracted. Study-specific
estimates were combined using inverse variance-weighted averages of
logarithmic ORs/HRs in the random-effects model. EVIDENCE SYNTHESIS: We
identified 19 eligible studies including a total of 7555 patients
undergoing TAVI. Pooled analyses demonstrated associations of high levels
of baseline Tn with statistically significant increases in both 30-day
(P=0.002) and midterm mortality (P<0.00001), no correlation of high
postprocedural Tn with 30-day mortality (P=0.13), and an association of
high postprocedural Tn with a statistically significant increase in
midterm mortality (P=0.002). High levels of baseline/postprocedural TnT
predicted statistically significant increases in both 30-day
(P=0.002/<0.0001) and midterm mortality (P<0.00001/0.0003).
 CONCLUSION(S): Both baseline and postprocedural Tn, especially TnT,
may predict mortality after TAVI for AS.

<8>
Accession Number
629732064
Title
A meta-analysis of >=5-year mortality after transcatheter versus surgical
aortic valve replacement.
Source
The Journal of cardiovascular surgery. 61 (1) (pp 107-116), 2020. Date of
Publication: 01 Feb 2020.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Takagi) Department of Cardiovascular Surgery, Kitasato University School
of Medicine, Sagamihara, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, NY,
NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, MI, Detroit,
United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: It remains unclear whether long-term survival is superior
following transcatheter aortic valve implantation (TAVI) than following
surgical aortic valve replacement (SAVR). We performed a meta-analysis of
mortality with >=5-year follow-up in randomized controlled trials (RCTs)
and propensity-score matched (PSM) studies of TAVI versus SAVR. EVIDENCE
ACQUISITION: MEDLINE, EMBASE, and the Cochrane Central Register of
Controlled Trials were searched through March 2019. Eligible studies were
RCTs or PSM studies of TAVI versus SAVR enrolling patients with severe
aortic stenosis and reporting all-cause mortality with >=5-year follow-up
as an outcome. A hazard ratio of mortality for TAVI versus SAVR was
extracted from each individual study. EVIDENCE SYNTHESIS: Our search
identified 3 RCTs and 7 PSM studies enrolling 5498 patients. A pooled
analysis of all 10 studies demonstrated a statistically significant 38%
increase in mortality with TAVI relative to SAVR. A subgroup meta-analysis
showed no statistically significant difference between TAVI and AVR in
RCTs and a statistically significant 68% increase with TAVI relative to
SAVR in PSM studies. CONCLUSION(S): On the basis of a meta-analysis
of 7 PSM studies, TAVI is associated with greater all-cause mortality with
>=5-year follow-up than SAVR. However, another meta-analysis of 3 RCTs
suggests no difference in mortality between TAVI and SAVR.

<9>
Accession Number
631006869
Title
Integrating quality of life and survival outcomes in cardiovascular
clinical trials: Results from the PARTNER trial.
Source
Circulation: Cardiovascular Quality and Outcomes. 12 (6) (no pagination),
2019. Article Number: e005420. Date of Publication: 01 Jun 2019.
Author
Spertus J.V.; Hatfield L.A.; Cohen D.J.; Arnold S.V.; Ho M.; Jones P.G.;
Leon M.; Zuckerman B.; Spertus J.A.
Institution
(Spertus) Department of Statistics, University of California, Berkeley,
United States
(Hatfield) Department of Health Care Policy, Harvard Medical School,
Boston, MA, United States
(Cohen, Arnold, Jones, Spertus) Saint Luke's Mid America Heart Institute,
Kansas City, MO, United States
(Cohen, Arnold, Spertus) Department of Biomedical and Health Informatics,
University of Missouri - Kansas City, Kansas City, MO, United States
(Ho, Zuckerman) Center for Devices and Radiologic Health, Food and Drug
Administration, Bethesda, MD, United States
(Leon) Division of Cardiology, Columbia University, New York, NY, United
States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Survival and health status (eg, symptoms and quality of life)
are key outcomes in clinical trials of heart failure treatment. However,
health status can only be recorded on survivors, potentially biasing
treatment effect estimates when there is differential survival across
treatment groups. Joint modeling of survival and health status can address
this bias. Methods and Results: We analyzed patient-level data from
the PARTNER 1B trial (Placement of Aortic Transcatheter Valves) of
transcatheter aortic valve replacement versus standard care. Health status
was quantified with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at
randomization, 1, 6, and 12 months. We compared hazard ratios for survival
and mean differences in KCCQ scores at 12 months using several models: the
original growth curve model for KCCQ scores (ignoring death), separate
Bayesian models for survival and KCCQ scores, and a Bayesian joint
longitudinal-survival model fit to either 12 or 30 months of survival
follow-up. The benefit of transcatheter aortic valve replacement on
12-month KCCQ scores was greatest in the joint-model fit to all survival
data (mean difference, 33.7 points; 95% credible intervals [CrI],
24.2-42.4), followed by the joint-model fit to 12 months of survival
follow-up (32.3 points; 95% CrI, 22.5-41.5), a Bayesian model without
integrating death (30.4 points; 95% CrI, 21.4-39.3), and the original
growth curve model (26.0 points; 95% CI, 18.7-33.3). At 12 months, the
survival benefit of transcatheter aortic valve replacement was also
greater in the joint model (hazard ratio, 0.50; 95% CrI, 0.32-0.73) than
in the nonjoint Bayesian model (0.54; 95% CrI, 0.37-0.75) or the original
Kaplan-Meier estimate (0.55; 95% CI, 0.40-0.74). Conclusion(s): In
patients with severe symptomatic aortic stenosis and prohibitive surgical
risk, the estimated benefits of transcatheter aortic valve replacement on
survival and health status compared with standard care were greater in
joint Bayesian models than other approaches. Copyright © 2019
Lippincott Williams and Wilkins. All rights reserved.

<10>
Accession Number
2005046316
Title
SuperNO2VATM and general anesthesia postoperative care.
Source
Trends in Anaesthesia and Critical Care. Conference: World Airway
Management Meeting. Netherlands. 30 (pp e186), 2020. Date of Publication:
February 2020.
Author
Burnett T.; Tan J.; Hancher-Hodges S.; Arnold B.; Syed T.; Rice J.;
Andrabi T.; Popovich S.; French K.; Hagberg C.
Institution
(Burnett, Tan, Hancher-Hodges, Arnold, Syed, Rice, Andrabi, Popovich,
French, Hagberg) University of Texas MD Anderson Cancer Center, Houston,
United States
Publisher
Churchill Livingstone
Abstract
Hypoxemia is a common complication in postoperative patients who have
undergone non-cardiac surgery in the general population.1
Patients with morbid obesity or obstructive sleep apnea (OSA) are at an
increased risk of cardiopulmonary complications compared to the general
population, likely as a result of upper airway obstruction during
anesthesia, emergence, and recovery.2,3 The
SuperNO<inf>2</inf>VATM is a new, commercially available nasal mask that
provides both intra-operative and post-operative nasal positive pressure
ventilation, as well as nasal mask oxygenation. The objective of this
study was to compare the incidence, duration, and severity of respiratory
complications when using the SuperNO<inf>2</inf>VATM nasal mask versus a
standard oxygen facemask or nasal cannula, postoperatively, during the
recovery phase of anesthesia. Following IRB approval (IRB 1 IRB00000121)
and written informed consent, 80 adult patients, ASA I-IV, with a body
mass index (BMI) >= 35 kg/m2 and/or documented OSA requiring
general anesthesia for a scheduled elective surgery were enrolled into
this single-center, randomized controlled trial. Patients were randomized
to one of two groups: standard of care (SOC; N = 40) or
SuperNO<inf>2</inf>VATM (N = 40). Demographics, cardiopulmonary
complications, as well as Results from the STOP-BANG questionnaire were
all recorded prior to surgery. Immediately after extubation, the
designated oxygen delivery device was utilized and a 60 min timer was
started for patient monitoring purposes. The primary endpoint was oxygen
desaturation, defined as SpO<inf>2</inf> <= 90% (i.e. a hypoxemic episode)
for at least 15 sec or more, during the 60 min monitoring period. A total
of 72 patients were evaluated; 38 patients assigned to SOC and 34 to
SuperNO<inf>2</inf>VATM. The overall desaturation rate was 6.9% (exact
95%CI: 0.02, 0.15). There were no statistically significant differences in
desaturation rates identified between the 2 groups (5.3% for SOC versus
8.8% for SuperNO<inf>2</inf>VATM; P = 0.553). Of the 5 patients that
experienced desaturation, the median duration of desaturation was 23.9
sec. The highest desaturation duration was 148.3 sec, which occurred with
one patient in the SOC group experiencing 6 episodes, reaching a
desaturation level of 82%. Overall, the median STOP-BANG score was 5, and
the prevalence of known OSA was 34.7%. Based on these interim Results, the
SuperNO<inf>2</inf>VATM is a viable alternative oxygen delivery device, as
compared to a simple mask or nasal cannula, in the postoperative setting.
The SuperNO<inf>2</inf>VATM may signify an improved method for oxygenation
and ventilation in patients suffering from a history of OSA or other
possible upper airway obstruction. Funding Source: Revolutionary Medical
Devices, Inc. (Vyaire Medical) References [1] Sun Z, Sessler D, Dalton J
et al. Anesth Analg 2015; 121: 709-15. [2] Mutter TC, Chateau D, Moffiult
M et al. Anes 2014; 121: 707-718. [3] Abdelsattar Z, Hendren S, Wong S et
al. Sleep 2015; 38: 1205-1210. Copyright © 2020

<11>
Accession Number
631009758
Title
New Evidence Supporting a Novel Conceptual Framework for Distinguishing
Proportionate and Disproportionate Functional Mitral Regurgitation.
Source
JAMA cardiology. (no pagination), 2020. Date of Publication: 19 Feb 2020.
Author
Packer M.; Grayburn P.A.
Institution
(Packer, Grayburn) Baylor Scott & White Heart and Vascular Hospital,
Division of Cardiology, Department of Internal Medicine, Baylor University
Medical Center, Dallas, TX, United States
(Packer) Imperial College London, London, United Kingdom
Publisher
NLM (Medline)
Abstract
Importance: Traditionally, physicians distinguished between mitral
regurgitation (MR) as a determinant of outcomes and MR as a biomarker of
left-ventricular (LV) dysfunction by designating the lesions as primary or
secondary, respectively. In primary MR, leaflet abnormalities cause the
MR, resulting in modest increases in LV end-diastolic volume over time,
whereas in patients with classic secondary MR, LV dysfunction and
dilatation lead to MR without structural leaflet abnormalities. However,
certain patients with global LV disease (eg, those with left bundle branch
block or regional wall motion abnormalities) have the features of primary
MR and might respond favorably to interventions that aim to restore the
proper functioning of the mitral valve apparatus. Observations: A novel
conceptual framework is proposed, which classifies patients with
meaningful LV disease based on whether the severity of MR is proportionate
or disproportionate to the LV end-diastolic volume. Treatments that reduce
LV volumes (eg, neurohormonal antagonists) are effective in proportionate
MR but not disproportionate MR. Conversely, procedures that restore mitral
valve function (eg, cardiac resynchronization and mitral valve repair) are
effective in patients with disproportionate MR but not in those with
proportionate MR. The proposed framework explains the discordant findings
in the Multicentre Randomized Study of Percutaneous Mitral Valve Repair
MitraClip Device in Patients With Severe Secondary Mitral Regurgitation
(MITRA-FR) and the Cardiovascular Outcomes Assessment of the MitraClip
Percutaneous Therapy for Heart Failure Patients with Functional Mitral
Regurgitation (COAPT) trials; differences in procedural success and
medical therapy in the 2 studies cannot explain the different results. In
addition, the small group of patients in the COAPT trial who had the
features of proportionate MR and were similar to those enrolled in the
MITRA-FR trial did not respond favorably to transcatheter mitral valve
repair. Conclusions and Relevance: The characterization of patients
with functional MR into proportionate and disproportionate subtypes may
explain the diverse range of responses to drug and device interventions
that have been observed.

<12>
Accession Number
631015271
Title
An Appraisal of the Association of Clinical Outcomes With the Severity of
Regurgitant Volume Relative to End-Diastolic Volume in Patients With
Secondary Mitral Regurgitation.
Source
JAMA cardiology. (no pagination), 2020. Date of Publication: 19 Feb 2020.
Author
Gaasch W.H.; Aurigemma G.P.; Meyer T.E.
Institution
(Gaasch, Aurigemma, Meyer) Department of Cardiovascular Medicine, Lahey
Hospital and Medical Center, Burlington, MA, United States
(Gaasch, Aurigemma, Meyer) Tufts University School of Medicine, Boston, MA
(Gaasch, Aurigemma, Meyer) University of Massachusetts Medical School,
Worcester
Publisher
NLM (Medline)
Abstract
Importance: Two randomized clinical trials of transcatheter edge-to-edge
mitral valve repair in patients with secondary mitral regurgitation (the
Multicentre Randomized Study of Percutaneous Mitral Valve Repair MitraClip
Device in Patients With Severe Secondary Mitral Regurgitation [MITRA-FR]
and the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous
Therapy for Heart Failure Patients with Functional Mitral Regurgitation
[COAPT]) report clinical outcome disparities that are largely unexplained.
This appraisal sought to provide insight and an explanation for the
differences in clinical outcomes (survival and hospitalization rates) in
the 2 clinical trials. The mean echocardiogram Doppler results (and
derived volume parameters) from each of the 2 clinical trials were
compared and examined relative to the clinical outcomes. Special emphasis
was placed on the assessment of mitral regurgitation proportionality
coefficients that were determined as the ratio of effective regurgitant
orifice area (EROA) to end-diastolic volume and the ratio of mitral
regurgitant volume to end-diastolic volume. Observations: In this analysis
of the differences in the clinical outcomes of the MITRA-FR and COAPT
clinical trials, the ratio of the EROA to the end-diastolic volume in the
COAPT study was found to be twice that of the MITRA-FR study (0.002 cm-1
vs 0.001 cm-1, respectively). The finding of a larger proportional EROA in
the COAPT study suggests more severe mitral regurgitation compared with
the MITRA-FR study, thereby providing a potential explanation for the
different outcomes in the 2 clinical trials. In contrast, the ratio of the
mitral regurgitant volume to the end-diastolic volume in the COAPT study
was similar to (but slightly lower than) that of the MITRA-FR study (0.15
vs 0.18, respectively), indicating that the proportional mitral
regurgitant volume was comparable in the 2 clinical trials. This finding
contradicts the conclusions of the EROA analysis. Conclusions and
Relevance: The results of proportionality analyses based on EROA differ
from those based on a volume analysis. This disparity casts doubt on the
notion that an EROA analysis alone can explain the different results of
the 2 randomized clinical trials.

<13>
Accession Number
631026746
Title
Intraoperative localization of cardiac conduction tissue regions using
real-time fibre-optic confocal microscopy: first in human trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 21 Feb 2020.
Author
Kaza A.K.; Mondal A.; Piekarski B.; Sachse F.B.; Hitchcock R.
Institution
(Kaza, Mondal, Piekarski) Department of Cardiac Surgery, Boston Children's
Hospital, Harvard Medical School, MA, Boston, United States
(Sachse, Hitchcock) Department of Biomedical Engineering, University of
Utah, UT, Salt Lake City, United States
(Sachse) Nora Eccles Harrison Cardiovascular Research and Training
Institute, University of Utah, UT, Salt Lake City, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to evaluate the feasibility and
safety of fibre-optic confocal microscopy (FCM) using fluorescein sodium
dye for the intraoperative location of conduction tissue regions during
paediatric heart surgery. METHOD(S): The pilot study included 6
patients undergoing elective surgery for the closure of isolated secundum
atrial septal defect aged 30days to 21years. FCM imaging was integrated
within the normal intraoperative protocol for atrial septal defect repair.
Fluorescein sodium dye was applied on the arrested heart. FCM images were
acquired at the atrioventricular node region, sinus node region and right
ventricle (RV). Total imaging time was limited to 3min. Any adverse events
related to the study were recorded and analysed. Subjects received
standard postoperative care. Trained reviewers (n=9) classified,
de-identified and randomized FCM images (n=60) recorded from the patients
as presenting striated, reticulated or indistinguishable microstructures.
The reliability of reviewer agreement was assessed using Fleiss' kappa.
 RESULT(S): The FCM imaging instruments were integrated effectively
into the cardiac surgery operating room. All adverse events found in the
study were deemed expected and not related to FCM imaging. Reticulated
myocardial microstructures were found during FCM imaging at
atrioventricular node and sinus node regions, while striated
microstructures were observed in RV. Reliability of agreement of reviewers
classifying the FCM images was high (Fleiss' kappa: 0.822).
 CONCLUSION(S): FCM using fluorescein sodium dye was found to be safe
for use during paediatric heart surgery. The study demonstrates the
potential for FCM to be effective in identifying conduction tissue regions
during congenital heart surgery. CLINICAL TRIAL REGISTRATION NUMBER:
NCT03189134. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<14>
[Use Link to view the full text]
Accession Number
631027174
Title
Chinese Patients with Heart Valve Replacement Do Not Benefit from Warfarin
Pharmacogenetic Testing on Anticoagulation Outcomes.
Source
Therapeutic Drug Monitoring. 41 (6) (pp 748-754), 2019. Date of
Publication: 01 Dec 2019.
Author
Hao Y.; Yang J.; Zheng X.; Hu Y.; Yan X.; Zhang L.
Institution
(Hao, Yang, Yan, Zhang) Department of Clinical Laboratory, Wuhan Asia
Heart Hospital, Wuhan, Hubei 420022, China
(Zheng, Hu) Laboratory of Molecular Cardiology, Wuhan Asia Heart Hospital,
Wuhan University, Wuhan, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Genotype-guided warfarin dosing has been shown in some
randomized trials to improve anticoagulation outcomes in individuals of
European ancestry; yet, its utility in Chinese patients with heart valve
replacement remains unresolved. Method(s):A total of 2264 patients
who underwent heart valve replacement at Wuhan Asia Heart Hospital were
enrolled in this study. Patients were randomly divided into 2 groups,
namely, a genotype-guided and a traditional clinically guided warfarin
dosing group. In the genotype-guided group (n = 1134), genotyping for
CYP2C9 and VKORC1 (-1639 G->A) was performed using TaqMan genotyping
assay. Warfarin doses were predicted with the International Warfarin
Pharmacogenetics Consortium algorithm. Patients in the control group (n =
1130) were clinically guided. The primary outcome was to compare the
incidence of adverse events (major bleeding and thrombotic) during a
90-day follow-up period between 2 groups. Secondary objectives were to
describe effects of the pharmacogenetic intervention on the first
therapeutic-target-achieving time, the stable maintenance dose, and the
hospitalization days. Result(s):A total of 2245 patients were
included in the analysis. Forty-nine events occurred during follow-up.
Genotype-guided dosing strategy did not result in a reduction in major
bleeding (0.26% versus 0.63%; hazard ratio, 0.44; 95% confidence interval,
0.13-1.53; P = 0.20) and thrombotic events (0.89% versus 1.61%; hazard
ratio, 0.56; 95% confidence interval, 0.27-1.17; P = 0.12) compared with
clinical dosing group. Compared with traditional dosing, patients in the
genotype-guided group reached their therapeutic international normalized
ratio in a shorter time (3.8 +/- 2.0 versus 4.4 +/- 2.0 days, P < 0.001).
There was no difference in hospitalization days (P = 0.28).
 Conclusion(s):Warfarin pharmacogenetic testing according to the
International Warfarin Pharmacogenetics Consortium algorithm cannot
improve anticoagulation outcomes in Chinese patients with heart valve
replacement. Copyright © 2019 Wolters Kluwer Health, Inc.

<15>
Accession Number
2003657835
Title
A study on the effect of haruan fish extract (Channa striatus) on wound
healing and quality of life of coronary artery bypass grafting (CABG)
patients: A prospective, double-blind, randomized, controlled trial
[version 1; peer review: 1 approved].
Source
F1000Research. 7 (no pagination), 2018. Article Number: 469. Date of
Publication: 2018.
Author
Farouk Musa A.; Dillion J.; Mohd Taib M.E.; Mohd Yunos A.; Baie S.; Bin
Nordin R.
Institution
(Farouk Musa, Bin Nordin) Jeffrey Cheah School of Medicine and Health
Sciences, Monash Univeristy Malaysia, Subang Jaya 47500, Australia
(Dillion, Mohd Taib, Mohd Yunos) Department of Cardiothoracic Surgery,
National Heart Institute, Kuala Lumpur 50400, Malaysia
(Baie) School of Pharmaceutical Sciences, Science University of Malaysia,
Penang 11800, Malaysia
Publisher
F1000 Research Ltd
Abstract
Background: Wound healing remains a primary problem in all surgical cases
especially so when the length of incision is very significant as with
cardiac bypass patients. The main objective of this study is therefore to
assess the effect of Haruan fish extract (Channa striatus) on chest and
leg wounds post-coronary artery bypass grafting (CABG) surgery with the
optimum and standard patient care in two groups of randomized patients.
 Method(s): This is a randomized, double blind clinical trial being
conducted at the National Heart Institute, Kuala Lumpur. Two randomized
groups of similar demographic and co-morbid histories planned for CABG
were enrolled into the study. Both groups were blinded to the capsules
being given to them pre-and post-operatively. Assessments were also made
on wound pain, mobilization and on the health-related quality of life
(HRQOL) of patients using the Nottingham Health Profile (NHP).
 Result(s): The group that received Haruan capsule showed better would
healing objectively. They had better pain scores, though there was no
significant difference in terms of mobilization. Overall, the HRQOL in the
study group showed improved quality of life. Conclusion(s): Our study
shows the superior effect of using Channa striatus, a local Haruan fish
which is easily processed into capsules in promoting wound healing,
reducing pain via its anti-nociceptive effect and improving quality of
life of patients after coronary artery bypass grafting surgery. It is
inferred that a faster recovery from surgery confers an advantage in terms
of resources to overall economic benefits. Reduction in the percentage of
wound infection also resulted in reduced hospital cost. All these factors
could lead to the successful commercialization of Haruan as a
nutraceutical product. Trial registration: The trial was conducted from
January 2012 until August 2014 and the trial number as registered with the
National Medical Research Registry is NMRR-17-360-34772 (Registered
13/03/2017). Copyright © 2018 Farouk Musa A et al.

<16>
Accession Number
2005045659
Title
Gait and fate: Baseline gait speed and mortality after transcatheter
aortic valve implantation.
Source
Journal of Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Takagi H.; Kato M.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kato) Department of Shizuoka Physical Therapy, Faculty of Health Science,
Tokoha University, Shizuoka, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Division of Interventional Cardiology, Department of Cardiology,
New York Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: To determine whether baseline gait speed predicts mortality
after transcatheter aortic valve implantation (TAVI), a meta-analysis of
currently available studies was performed. Method(s): To identify all
studies researching the impact of preprocedural gait speed on mortality
after TAVI, PubMed and Web of Science were searched through May 2019.
Adjusted (if unavailable, unadjusted) hazard/odds ratios (ORs/HRs) with
their confidence interval of mortality for slow (if available, the
slowest) versus fast (if available, the fastest) gait speed (with cut-off
values defined in each study) and those for unable to walk versus walker
(if available, with the fastest gait speed) were extracted from each
study, and then separately pooled by means of inverse variance-weighted
averages of logarithmic ORs/HRs in the random-effects model.
 Result(s): Twelve eligible studies (7 and 5 based on the
distance-limited and time-limited walk test, respectively) were identified
and integrated in the present meta-analysis. The pooled analysis of all
ORs/HRs demonstrated that slow walkers (primary meta-analysis; OR/HR,
2.38; p < 0.00001) and unable to walk (OR/HR, 1.75; p = 0.01) were
significantly associated with increased mortality. The subgroup analysis
for the primary meta-analysis indicated no significant subgroup difference
between studies utilizing the 4-m/5-m/15-foot walk test and those applying
the 6-min walk test (p = 0.45). Combining studies with 1-year follow-up
did not alter the primary result (p < 0.0001). Pooling studies with
adjusted ORs/HRs did not change the principal result (p = 0.0002). No
funnel plot asymmetry for the primary meta-analysis was identified.
 Conclusion(s): Slow baseline gait speed (and unable to walk) is
associated with increased mortality after TAVI. Copyright © 2020

<17>
[Use Link to view the full text]
Accession Number
614735343
Title
Prediction of waitlist mortality in adult heart transplant candidates: The
candidate risk score.
Source
Transplantation. 101 (9) (pp 2175-2182), 2017. Date of Publication: 2017.
Author
Jasseron C.; Legeai C.; Jacquelinet C.; Leprince P.; Cantrelle C.; Audry
B.; Porcher R.; Bastien O.; Dorent R.
Institution
(Jasseron, Legeai, Jacquelinet, Cantrelle, Audry, Bastien, Dorent)
Direction Prelevement Greffe Organes-Tissus, Saint-Denis La Plaine 93212,
France
(Leprince) Service de Chirurgie Cardio-vasculaire, Hopital de la Pitie
Salpetriere, Paris, France
(Porcher) Centre d'Epidemiologie Clinique, Universite Paris Descartes,
Paris U1153, France
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The cardiac allocation system in France is currently based on urgency and
geography.Medical urgency is defined by therapies without considering
objective patient mortality risk factors. This study aimed to develop a
waitlist mortality risk score from commonly available candidate variables.
Methods. The study included all patients, aged 16 years or older,
registered on the national registry CRISTAL for first single-organ heart
transplantation between January 2010 and December 2014. This population
was randomly divided in a 2:1 ratio into derivation and validation
cohorts. The association of variables at listing with 1-year waitlist
death or delisting for worsening medical condition was assessed within the
derivation cohort. The predictors were used to generate a candidate risk
score (CRS). Validation of the CRS was performed in the validation cohort.
Concordance probability estimation (CPE) was used to evaluate the
discriminative capacity of the models. Results. During the study period,
2333 patients were newly listed. The derivation (n =1 555) and the
validation cohorts (n = 778) were similar. Short-term mechanical
circulatory support, natriuretic peptide decile, glomerular filtration
rate, and total bilirubin level were included in a simplified model and
incorporated into the score. The Concordance probability estimation of the
CRS was 0.73 in the derivation cohort and 0.71 in the validation cohort.
The correlation between observed and expected 1-year waitlist mortality in
the validation cohort was 0.87. Conclusions. The candidate risk score
provides an accurate objective prediction of waitlist mortality. It is
currently being used to develop a modified cardiac allocation system in
France. Copyright © 2017 Wolters Kluwer.

<18>
Accession Number
604625390
Title
Rationale and design of the Cyclosporine to ImpRove Clinical oUtcome in
ST-elevation myocardial infarction patients (the CIRCUS trial).
Source
American Heart Journal. 169 (6) (pp 758-766.e6), 2015. Date of
Publication: 01 Jun 2015.
Author
Mewton N.; Cung T.T.; Morel O.; Cayla G.; Bonnefoy-Cudraz E.; Rioufol G.;
Angoulvant D.; Guerin P.; Elbaz M.; Delarche N.; Coste P.; Vanzetto G.;
Metge M.; Aupetit J.-F.; Jouve B.; Motreff P.; Tron C.; Labeque J.-N.;
Steg P.G.; Cottin Y.; Range G.; Clerc J.; Coussement P.; Prunier F.;
Moulin F.; Roth O.; Belle L.; Dubois P.; Barragan P.; Gilard M.; Piot C.;
Colin P.; Morice M.-C.; Monassier J.-P.; Ider O.; Dubois-Rande J.L.P.;
Unterseeh T.; Lebreton H.; Beard T.; Blanchard D.; Grollier G.; Malquarti
V.; Staat P.; Sudre A.; Hansson M.J.; Elmer E.; Boussaha I.; Jossan C.;
Torner A.; Claeys M.; Garcia-Dorado D.; Ovize M.
Institution
(Mewton, Boussaha, Jossan, Ovize) Hopital Cadiovasculaire Louis Pradel,
Clinical Investigation Center, Hospices Civils de Lyon, 28, Avenue Doyen
Lepine, BRON Cedex 69677, France
(Cung) Centre Hospitalier Universitaire Arnaud de Villeneuve, Montpellier,
France
(Morel) Hopitaux Universitaires de Strasbourg, NHC, Strasbourg, France
(Cayla) Centre Hospitalier Universitaire de Nimes, Nimes, France
(Bonnefoy-Cudraz, Rioufol) Centre Hospitalier Universitaire, Hopital
Cardiovasculaire Louis Pradel, Lyon, France
(Angoulvant) Centre Hospitalier Universitaire de Tours, Tours, France
(Guerin) Hopital Guillaume et Rene Laennec, Nantes, France
(Elbaz) Centre Hospitalier Universitaire de Rangueil, Toulouse, France
(Delarche) Centre Hospitalier de Pau, Pau, France
(Coste) Hopital Haut Leveque, Bordeaux, France
(Vanzetto) Hopital A. Michallon, Centre Hospitalier Universitaire,
Grenoble, France
(Metge) Hopital Henri Duffau, Avignon, France
(Aupetit) Centre Hospitalier St Luc St Joseph, Lyon, France
(Jouve) Centre Hospitalier du Pays d'Aix, Aix en provence, France
(Motreff) Centre Hospitalier Universitaire, Hopital Gabriel Montpied,
Clermont Ferrand, France
(Tron) Hopital Charles Nicolle, Rouen, France
(Labeque) Clinique de la Fourcade, Bayonne, France
(Steg) APHP, Hopital Bichat, Paris, France
(Cottin) Hopital du Bocage, Dijon, France
(Range) Centre Hospitalier General, Chartres, France
(Clerc) Centre Hospitalier de Compiegne, Compiegne, France
(Coussement) Algemeen Ziekenhuis Sint Jan, Brugge, Belgium
(Prunier) Centre Hospitalier Universitaire, Angers, France
(Moulin) Centre Hospitalier Universitaire de Nancy Brabois, Nancy, France
(Roth) Centre Hospitalier Universitaire de Mulhouse, Mulhouse, France
(Belle) Centre Hospitalier d'Annecy, Annecy, France
(Dubois) Centre Hospitalier Henri Mondor, Creteil, France
(Barragan) Polyclinique des Fleurs, Ollioules, France
(Gilard) Hopital de la Cavale Blanche, Brest, France
(Piot) Clinique du Millenaire, Montpellier, France
(Colin) Clinique Esquirol, Agen, France
(Morice) Institut Jacques Cartier, Massy, France
(Monassier, Ider) Clinique du Diaconat, Mulhouse, France
(Dubois-Rande) Centre Hospitalier Universitaire Charleroi, Charleroi,
Belgium
(Unterseeh) Hopital Claude Galien, Quincy sous senat, France
(Lebreton) Hopital Pontchaillou, Rennes, France
(Beard) Clinique de l'Ormeau - CCV des Pyrenees, Tarbes, France
(Blanchard) Clinique Saint-Gatien, Tours, France
(Grollier) Centre Hospitalier Regional et Universitaire, Hopital de la
Cote de Nacre, Caen, France
(Malquarti) Clinique de la Sauvegarde, Lyon, France
(Staat) Clinique du Tonkin, Lyon, France
(Sudre) Centre Hospitalier Regional et Universitaire, Hopital
Cardiologique Calmette, Lille, France
(Hansson, Elmer) Department of Physiology, Lund University, Lund, Sweden
(Torner) Scandinavian Development Services, Danderyd, Sweden
(Claeys) University Hospital Antwerp, Edegem, Belgium
(Garcia-Dorado) Hospital Universitari Vall D 'Hebron, Barcelona, Spain
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Both acute myocardial ischemia and reperfusion contribute to
cardiomyocyte death in ST-elevation myocardial infarction (STEMI). The
final infarct size is the principal determinant of subsequent clinical
outcome in STEMI patients. In a proof-of-concept phase II trial, the
administration of cyclosporine prior to primary percutaneous coronary
intervention (PPCI) has been associated with a reduction of infarct size
in STEMI patients. Methods CIRCUS is an international, prospective,
multicenter, randomized, double-blinded, placebo-controlled trial. The
study is designed to compare the efficacy and safety of cyclosporine
versus placebo, in addition to revascularization by PPCI, in patients
presenting with acute anterior myocardial infarction within 12 hours of
symptoms onset and initial TIMI flow <=1 in the culprit left anterior
descending coronary artery. Patients are randomized in a 1:1 fashion to
2.5 mg/kg intravenous infusion of cyclosporine or matching placebo
performed in the minutes preceding PCI. The primary efficacy end point of
CIRCUS is a composite of 1-year all-cause mortality, rehospitalization for
heart failure or heart failure worsening during initial hospitalization,
and left ventricular adverse remodeling as determined by sequential
transthoracic echochardiography. Secondary outcomes will be tested using a
hierarchical sequence of left ventricular (LV) ejection fraction and
absolute measurements of LV volumes. The composite of death and
rehospitalization for heart failure or heart failure worsening during
initial hospitalization will be further assessed at three years after the
initial infarction. Results Recruitment lasted from April 2011 to February
2014. The CIRCUS trial has recruited 975 patients with acute anterior
myocardial infarction. The 12-months results are expected to be available
in 2015. Conclusions The CIRCUS trial is testing the hypothesis that
cyclosporine in addition to early revascularization with PPCI compared to
placebo in patients with acute anterior myocardial infarction reduces the
incidence of death, heart failure and adverse LV remodeling at one-year
follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.

<19>
Accession Number
361666293
Title
Patients with severe aortic valve stenosis and impaired platelet function
benefit from preoperative desmopressin infusion.
Source
Annals of Thoracic Surgery. 91 (5) (pp 1420-1426), 2011. Date of
Publication: May 2011.
Author
Steinlechner B.; Zeidler P.; Base E.; Birkenberg B.; Ankersmit H.J.;
Spannagl M.; Quehenberger P.; Hiesmayr M.; Jilma B.
Institution
(Steinlechner, Zeidler, Base, Birkenberg, Hiesmayr) Division of
Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical
University of Vienna, Vienna, Austria
(Ankersmit) Department of Thoracic Surgery, Medical University of Vienna,
Vienna, Austria
(Spannagl) Department of Laboratory Medicine, Medical University of
Vienna, Vienna, Austria
(Quehenberger, Jilma) Department of Clinical Pharmacology, Medical
University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
(Jilma) Department of Transfusion Medicine and Haemostaseology,
Ludwig-Maximilians-University, Munich, Germany
Publisher
Elsevier USA
Abstract
Background: Patients with severe aortic valve stenosis have a markedly
reduced platelet function as measured by a prolonged collagen adenosine
diphosphate closure time (CADP-CT) determined by the platelet function
analyzer PFA-100. We hypothesized that such patients may benefit from
desmopressin when they present with prolonged CADP-CT due to the specific
action of desmopressin on von Willebrand factor (VWF) and CADP-CT.
 Method(s): In this double-blind, randomized placebo controlled trial,
43 patients undergoing aortic valve replacement (due to severe aortic
valve stenosis with CADP-CT > 170 seconds) were given desmopressin 0.3
mug/kg or saline intravenously after induction of anesthesia. Measurement
of CADP-CT, factor VIII activity, von Willebrand factor antigen, GpIb
binding activity, ristocetin cofactor activity, collagen-binding activity,
and multimers were performed after induction of anesthesia, one hour after
desmopressin infusion, and 24 hours postoperatively. Result(s): In
the majority of patients, baseline values of von Willebrand factor related
indices were normal, but increased one hour after infusion of desmopressin
by 73% to 90% as compared with placebo. Selective loss of high molecular
weight multimers was seen only in a minority of patients. The CADP-CT was
greater than 170 seconds in 92% of screened patients, and desmopressin
shortened CADP-CT by 48% versus baseline and reduced postoperative blood
loss by 42% (p < 0.001). Conclusion(s): Prolonged CADP-CT indicates
platelet dysfunction in severe aortic valve stenosis, and can guide the
use of desmopressin as an effective prohemostatic agent in patients with
severe aortic valve stenosis. © 2011 The Society of Thoracic
Surgeons.

<20>
Accession Number
2003536526
Title
Neointimal characteristics comparison between biodegradable-polymer and
durable-polymer drug-eluting stents: 3-month follow-up optical coherence
tomography light property analysis from the RESTORE registry.
Source
International Journal of Cardiovascular Imaging. 36 (2) (pp 205-215),
2020. Date of Publication: 01 Feb 2020.
Author
Kobayashi T.; Sotomi Y.; Suzuki S.; Hamanaka Y.; Nakatani S.; Dijkstra J.;
Onuma Y.; Serruys P.W.; Sakata Y.; Hirayama A.; Higuchi Y.
Institution
(Kobayashi, Sotomi, Suzuki, Hamanaka, Nakatani, Hirayama, Higuchi)
Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji,
Osaka 543-0035, Japan
(Dijkstra) Department of Radiology, Leiden University Medical Center,
Leiden, Netherlands
(Onuma) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Onuma) Cardialysis, Rotterdam, Netherlands
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
(Sakata) Department of Cardiovascular Medicine, Osaka University Graduate
School of Medicine, Osaka, Japan
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
We aimed to quantitatively assess a possible difference of the neointimal
quality between biodegradable polymer- (BP-) and durable polymer
drug-eluting stents (DP-DESs). We conducted a single-center all-comer
prospective cohort study: the RESTORE registry (UMIN000033009). All
patients who received successful OCT examination at planned 3-month
follow-up after DES implantation were analyzed. Study population was
divided into 2 groups, BP-DES versus DP-DES groups. We evaluated standard
OCT variables, coverage percent, and the quantitative light property
values including light intensity, attenuation, and backscatter. We
performed OCT analyses of 121 lesions in 98 patients (BP-DES 55 lesions in
51 patients vs. DP-DES 66 lesions in DP-DES 53 patients). Lesion and
procedural characteristics were overall well-balanced between both groups.
At 3-month follow-up, neointimal thickness (BP-DES 49.3 [38.2, 57.7]
micro m versus DP-DES 54.7 [45.1, 70.7] micro m, p = 0.059) and
coverage percent (BP-DES 94.5 [89.8, 97.0]% vs. DP-DES 95.8 [91.1, 98.1]%,
p = 0.083) did not significantly differ. Light intensity of superficial
neointima in the BP-DES was lower than that in the DP-DES, whereas that of
deep neointima did not differ between both groups. Both superficial and
deep neointima of the BP-DES presented significantly lower light
attenuation and backscatter than those of the DP-DES did. Almost complete
coverage at 3 months in both contemporary BP- and DP-DES would support the
ultra-short DAPT strategy in the upcoming decade. Nevertheless, there was
a significant difference in the neointimal characteristics on OCT light
property 3 months after BP- versus DP-DES implantation. Trial Registration
UMIN000033009. Copyright © 2019, Springer Nature B.V.

<21>
Accession Number
2003530225
Title
Quantification of mitral valve regurgitation by 2D and 3D echocardiography
compared with cardiac magnetic resonance a systematic review and
meta-analysis.
Source
International Journal of Cardiovascular Imaging. 36 (2) (pp 279-289),
2020. Date of Publication: 01 Feb 2020.
Author
Skoldborg V.; Madsen P.L.; Dalsgaard M.; Abdulla J.
Institution
(Skoldborg, Abdulla) Division of Cardiology, Department of Medicine,
Glostrup University Hospital, Nordre Ringvej 54, Glostrup, Copenhagen
2600, Denmark
(Madsen, Dalsgaard) Department of Cardiology, Herlev-Gentofte University
Hospital, Copenhagen, Denmark
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
By means of systematic literature review and meta-analysis, we compared
results of studies examining different echocardiographic methods assessing
severity of mitral valve regurgitation volume (MVR) with cardiac magnetic
resonance imaging (CMR) as standard reference. A systematic search of
electronic databases revealed twenty studies eligible for meta-analysis.
Results of 2D- and 3D-trans-thoracic (TTE) and trans-esophageal
echocardiographic (TEE) proximal isovelocity surface area (PISA) and
volumetric methods were compared with CMR. Mean differences (ml) with 95%
limits of agreement (LoA) derived from Bland-Altman tests and correlations
coefficients [(R) 95% confidence interval (CI)] were pooled together.
Overall 1187 patients [mean age = 59 +/- 13 years and 678(57%) males] with
primary or secondary mild to severe MVR were included. Comparing all
echocardiographic methods with CMR showed an overestimation and moderate
agreement with difference and 95% LoA of 8.05(- 3.40, 19.49) ml, R =
0.73(95% CI 0.71-0.76) p < 0.001. 3D-PISA followed by 3D-volumetric
methods showed the better agreement with an underestimation of - 3.20(-
12.33, 5.92) ml, R = 0.84(95% CI 0.78-0.89) p < 0.001 and overestimation
of 3.73(- 9.17, 16.61) ml, R = 0.90(95% CI 0.87, 0.94) p < 0.001,
respectively. 2D-volumetric method showed the poorest agreement with
difference and 95% LoA of 23.56(- 4.19, 51.31) ml, R = 0.64(95% CI
0.54-0.73) p < 0.001. In patients (n = 280) with severe MVR, 2D technique
incorrectly estimated regurgitation volume severity in 106 (38%) compared
to 4(14%) patients using 3D technique. Among echocardiographic methods
3D-PISA agreed best with CMR as reference, making 3D-PISA the most
reliable method to quantify MVR. CMR can be considered in severe MVR where
uncertainties arise and a decision-making prior valve surgery is required.
Further powerful studies are needed to assess the accuracy of different
echocardiographic methods. Copyright © 2019, Springer Nature B.V.

<22>
Accession Number
629698186
Title
Mini-extracorporeal circulation surgery produces less inflammation than
off-pump coronary surgery.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 57 (3) (pp 496-503),
2020. Date of Publication: 01 Mar 2020.
Author
Permanyer E.; Munoz-Guijosa C.; Padro J.-M.; Ginel A.; Montiel J.;
Sanchez-Quesada J.L.; Vila L.; Camacho M.
Institution
(Permanyer) Department of Cardiac Surgery, Barcelona, Spain
(Permanyer, Padro, Ginel, Montiel) Department of Cardiac Surgery, Hospital
de la Santa Creu i Sant Pau, Research Institute Hospital Sant Pau, IIB
Sant Pau, Barcelona, Spain
(Munoz-Guijosa) Department of Cardiac Surgery, University Hospital Germans
Trias i Pujol, Badalona, Spain
(Sanchez-Quesada) Cardiovascular Research Group, CIBERDEM, Research
Institute Hospital Sant Pau, IIB Sant Pau, Barcelona, Spain
(Vila, Camacho) Laboratory of Angiology, Vascular Biology and
Inflammation, Research Institute Hospital Sant Pau, IIB Sant Pau,
Barcelona, Spain
(Camacho) Genomics of Complex Diseases, Research Institute Hospital Sant
Pau, IIB Sant Pau, Barcelona, Spain
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Both off-pump coronary artery bypass grafting surgery (OPCABG)
and mini-extracorporeal circulation (MECC) have been associated with lower
morbidity and mortality and less inflammation than conventional
cardiopulmonary bypass. However, studies comparing the 2 techniques are
scarce and the results are controversial. We compared the clinical
outcomes and inflammatory response of low-risk patients undergoing
coronary bypass grafting with MECC versus OPCABG. METHOD(S): We
conducted a prospective, randomized study in patients undergoing coronary
heart surgery. Two hundred and thirty consecutive low-risk patients were
randomly assigned to either receive OPCABG (n=117) or MECC (n=113).
Clinical outcomes and postoperative biochemical results were analysed in
both groups. We also analysed 19 circulating inflammatory markers in a
subgroup of 40 patients at 4 perioperative time points. The area under the
curve for each marker was calculated to monitor differences in the
inflammatory response. RESULT(S): No significant differences were
found between groups regarding perioperative clinical complications and no
deaths occurred during the trial. Plasma levels in 9 of the 19
inflammatory markers were undetectable or showed no temporal variation, 3
were higher in the MECC group [interleukin (IL)-10, macrophage
inflammatory protein-1beta and epidermal growth factor] and 7 were higher
in the OPCABG group (growth regulator oncogene, IL-6, IL-8, soluble CD40
ligand, monocyte chemoattractant protein-1, monocyte chemoattractant
protein-3 and tumour necrosis factor-alpha). Differences in 2
proinflammatory cytokines, IL-6 and monocyte chemoattractant protein 1,
between the 2 surgical procedures were statistically significant.
 CONCLUSION(S): No clinical differences were observed between in
low-risk patients undergoing MECC or OPCABG surgery, but OPCABG was
associated with an increased release of proinflammatory cytokines compared
with MECC. Studies in larger cohorts and in patients at higher risk are
needed to confirm these findings. CLINICAL TRIAL REGISTRATION NUMBER:
NCT02118025. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<23>
Accession Number
629459895
Title
Ticagrelor-based antiplatelet regimens in patients treated with coronary
artery bypass grafting: a meta-analysis of randomized controlled trials.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 57 (3) (pp 520-528),
2020. Date of Publication: 01 Mar 2020.
Author
von Scheidt M.; Bongiovanni D.; Tebbe U.; Nowak B.; Stritzke J.; Zhao Q.;
Zhu Y.; Kastrati A.; Cassese S.; Schunkert H.
Institution
(von Scheidt, Kastrati, Cassese, Schunkert) Klinik fur Herz- und
Kreislauferkrankungen, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(von Scheidt, Bongiovanni, Kastrati, Schunkert) DZHK (German Center for
Cardiovascular Research), partner site Munich Heart Alliance, Munich,
Germany
(Bongiovanni) Medical Department I, Cardiology, Klinikum rechts der Isar,
Technical University, Munich, Germany
(Tebbe) Department of Cardiology, Angiology, Intensive Care Medicine,
District Hospital Lippe-Detmold, Detmold, Germany
(Nowak) CCB, Cardiovascular Center Bethanien, Frankfurt, Germany
(Stritzke) ListGermany
(Zhao, Zhu) Ruijin Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The optimal antiplatelet strategy in patients undergoing CABG
remains unclear. This is the first meta-analysis investigating the
clinical outcomes associated with ticagrelor-based antiplatelet regimens
in patients receiving CABG. METHOD(S): Relevant scientific databases
were searched for studies investigating antiplatelet regimens after CABG
from inception until April 1, 2019. Studies which randomly assigned CABG
patients to either ticagrelor-based or control antiplatelet regimens were
eligible. The primary outcome of this analysis was all-cause death. The
main secondary outcome was MI. Other outcomes of interest were cardiac
death, major adverse cardiac events, stroke and bleeding. This study is
registered with PROSPERO, number CRD42019122192. RESULT(S): Five
trials comprising 3996 patients (2002 assigned to ticagrelor-based and
1994 to control antiplatelet regimens) were eligible for quantitative
synthesis. The median follow-up was 12months. Control antiplatelet
regimens consisted of either aspirin or clopidogrel or both. As compared
to control, ticagrelor-based regimens reduced the risk of all-cause death
[0.61 (0.43-0.87); P=0.007], cardiac death [0.58 (0.39-0.86); P=0.007] and
major adverse cardiac events [0.79 (0.63-0.98); P=0.03], without
difference in the risk of MI [0.76 (0.50-1.18); P=0.22], stroke [0.99
(0.56-1.78); P=0.98] or bleeding [1.04 (0.95-1.14); P=0.41]. There was a
treatment effect modification for the primary outcome associated with
trials enrolling predominantly patients with acute coronary syndrome (P
for interaction=0.038). CONCLUSION(S): In patients receiving CABG,
ticagrelor-based regimens reduce mortality and major adverse cardiac
events without excess bleeding risk as compared with aspirin monotherapy
or the combination of aspirin and clopidogrel. The benefit of
ticagrelor-based regimens is more relevant in those studies enrolling
predominantly patients with acute coronary syndrome. These findings
require further confirmation in randomized trials focused on this subset
of patients and powered for clinical outcomes. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<24>
Accession Number
622992525
Title
Prognostic effect and modulation of cardiac sympathetic function in heart
failure patients treated with cardiac resynchronization therapy.
Source
Journal of Nuclear Cardiology. 27 (1) (pp 283-290), 2020. Date of
Publication: 01 Feb 2020.
Author
Moreira R.I.; Abreu A.; Portugal G.; Oliveira L.; Oliveira M.; Rodrigues
I.; Cruz M.C.; Cunha P.S.; Santos V.; Clara H.S.; Carmo M.M.; Ferreira
R.C.
Institution
(Moreira, Abreu, Portugal, Oliveira, Rodrigues, Cruz, Cunha, Carmo,
Ferreira) Department of Cardiology, Hospital de Santa Marta, Centro
Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, Lisbon 1169-024,
Portugal
(Oliveira) Nuclear Medicine Department, Medical and Diagnosis Clinic
Quadrantes, Lisbon, Portugal
(Santos, Clara) CIPER, Human Kinetics Faculty, University of Lisbon,
Lisbon, Portugal
(Carmo) NOVA Medical School, New University of Lisbon, Lisbon, Portugal
Publisher
Springer
Abstract
Background: Cardiac autonomic dysfunction as assessed by
123I-metaiodobenzylguanidine (123I-mIBG)
scintigraphy is associated with poor prognosis in heart failure (HF)
patients. Although cardiac resynchronization therapy (CRT) has emerged as
an effective therapy in improving outcomes on HF patients, its effect on
cardiac sympathetic nervous function is still not fully understood. We
aimed to study the value of pre-implantation 123I-mIBG late
heart-to-mediastinum ratio (HMR) as a predictor of response and outcomes
after CRT and to correlate modification in this parameter with CRT
response and functional improvement. Methods and Results: BETTER-HF
(Benefit of exercise training therapy and cardiac resynchronization in HF
patients) is a prospective randomized clinical trial including HF patients
submitted CRT (mean LVEF 24 +/- 8%, 74% NYHA class >= III) who underwent a
clinical, echocardiographic, and scintigraphic assessment before and 6
months after CRT. One-hundred and twenty-one patients were included.
Echocardiographic response was observed in 54% and composite outcome of
cardiac mortality, cardiac transplant or heart failure hospitalization in
24% of patients. Baseline late HMR was an independent predictor of CRT
response (regression coefficient 2.906, 95% CI 0.293-3.903, P.029) and
outcomes (HR 0.066 95% CI 0.005-0.880, P.040). At follow-up,
123I-mIBG imaging showed positive changes in cardiac
sympathetic nerve activity only in responders to CRT (1.36 +/- 0.14 prior
vs. 1.42 +/- 0.16 after CRT, P.039). There was a significant correlation
between improvement in late HMR and improvement in peak oxygen consumption
(r 0.547, P <.001). Conclusion(s): In our study, baseline cardiac
denervation predicted response and clinical outcomes after CRT
implantation. Cardiac sympathetic function was improved only in patients
who responded to CRT and these positive changes were correlated with
improvement in functional capacity. Copyright © 2018, American
Society of Nuclear Cardiology.

<25>
Accession Number
622613183
Title
18F-fluorodeoxyglucose use after cardiac transplant: A comparative study
of suppression of physiological myocardial uptake.
Source
Journal of Nuclear Cardiology. 27 (1) (pp 173-181), 2020. Date of
Publication: 01 Feb 2020.
Author
Felix R.C.M.; Gouvea C.M.; Reis C.C.W.; dos Santos Miranda J.S.; Schtruk
L.B.C.E.; Colafranceschi A.S.; Mesquita C.T.
Institution
(Felix, Mesquita) Federal Fluminense University, Av. Marques do Parana,
303 - Centro, Niteroi, RJ 24033-900, Brazil
(Gouvea, Reis, dos Santos Miranda, Schtruk, Colafranceschi) National
Institute of Cardiology, Rio de Janeiro, Brazil
Publisher
Springer
Abstract
Background: 18F-fluorodeoxyglucose (FDG) has been useful in the evaluation
of myocardial inflammatory processes. However, it is challenging to
identify them due to physiological 18F-FDG uptake. There are no
publications demonstrating the application of FDG in post-transplant
rejection in humans yet. The aim of this study is to determine the
feasibility of suppression of myocardial FDG uptake in post-transplant
patients, comparing three different protocols of preparation.
 Method(s): Ten patients after heart transplantation were imaged by
FDG associated with three endomyocardial biopsies (EMB), scheduled in the
first year after the procedure. Before each imaging, patients were
randomized to one of three preparations: (1) hyperlipidic-hypoglycemic
diet; (2) fasting longer than 12 hours; and (3) fasting associated with
intravenous heparin. All patients would undergo the three methods. FDG
images were analyzed using visual analysis scores and relative radiotracer
cardiac uptake (RRCU). Result(s): The suppression rate of radiotracer
activity ranged from 55% to 62%. Visual analysis showed that preparation 3
presented less efficacy in the suppression compared to the others.
However, RRCU did not show difference between the preparations.
 Conclusion(s): Suppression of physiological myocardial FDG uptake
after cardiac transplantation is feasible. The usefulness of heparin in
the suppression is unclear. Copyright © 2018, American Society of
Nuclear Cardiology.

<26>
Accession Number
2004992972
Title
Meta-Analysis Comparing Percutaneous to Surgical Access in Trans-Femoral
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Abdelaziz H.K.; Megaly M.; Debski M.; Rahbi H.; Kamal D.; Saad M.; Wiper
A.; More R.; Roberts D.H.
Institution
(Abdelaziz, Debski, Wiper, More, Roberts) Lancashire Cardiac Center,
Blackpool Victoria Hospital, Blackpool, United Kingdom
(Abdelaziz, Kamal, Saad) Department of Cardiovascular Medicine, Ain Shams
University, Cairo, Egypt
(Megaly) Minneapolis Heart Institute, Abbott Northwestern Hospital,
Minneapolis, MN, United States
(Rahbi) Wiltshire Cardiac Center, Great Western Hospital, Swindon, United
Kingdom
(Saad) Cardiovascular Institute, The Warren Alpert Medical School of Brown
University and Lifespan Cardiovascular Institute, Providence, RI, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To compare the outcomes in trans-femoral transcatheter aortic valve
implantation (TF-TAVI) performed with percutaneous approach (PC) versus
surgical cut-down (SC). In 13 trials including 5,859 patients (PC = 3447,
SC = 2412), the outcomes based on Valve Academic Research Consortium
criteria were compared between PC and SC in TF-TAVI. Compared with SC, PC
was associated with similar major vascular complications (VCs) (8.7% vs
8.5%; odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.76 to 1.15,
p = 0.53), major bleeding (OR = 1.09, 95% CI = 0.66 to 1.8, p = 0.73),
perioperative mortality (5.7% vs 5.2%; OR = 1.13, 95% CI = 0.85 to 1.49, p
= 0.4), urgent surgical repair (OR = 1.27, 95% CI = 0.81 to 2.02, p =
0.3), stroke (3.3% vs 3.9%; OR = 0.85, 95% CI = 0.53 to 1.36, p = 0.5),
myocardial infarction (1.3% vs 1.1%; OR = 1.06, 95% CI = 0.53 to 2.12, p =
0.86), and renal failure (5.2% vs 5.9%; OR = 0.68, 95% CI = 0.38 to 1.22,
p = 0.2), but shorter hospital stay (9.1 +/- 8.5 vs 9.6 +/- 9.5 days; mean
difference = -1.07 day, 95% CI = -2.0 to -0.15, p = 0.02) and less blood
transfusion (18.5% vs 25.7%; OR = 0.61, 95% CI = 0.43-0.86, p = 0.005).
Minor VCs occurred more frequently in PC compared to SC (11.9% vs 6.9%; OR
= 1.67, 95% CI = 1.04-2.67, p = 0.03). In conclusion, in TF-TAVI, PC is a
safe and feasible alternative to SC, and adopting either approach depends
on operator experience after ensuring that vascular access could be safely
achieved with that specific technique. Copyright © 2020 Elsevier
Inc.

<27>
Accession Number
2004297581
Title
Effect of 6% hydroxyethyl starch 130/0.4 on kidney and haemostatic
function in cardiac surgical patients: a randomised controlled trial.
Source
Anaesthesia. (no pagination), 2020. Date of Publication: 2020.
Author
Duncan A.E.; Jia Y.; Soltesz E.; Leung S.; Yilmaz H.O.; Mao G.; Timur
A.A.; Kottke-Marchant K.; Rogers H.J.; Ma C.; Ince I.; Karimi N.; Yagar
S.; Trombetta C.; Sessler D.I.
Institution
(Duncan) Departments of Cardiothoracic Anesthesiology and Outcomes
Research, Cleveland Clinic, Cleveland, OH, United States
(Jia, Leung, Yilmaz, Ince, Karimi, Yagar, Sessler) Department of Outcomes
Research, Cleveland Clinic, Cleveland, OH, United States
(Soltesz) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Mao, Ma) Departments of Quantitative Health Sciences and Outcomes
Research, Cleveland Clinic, Cleveland, OH, United States
(Timur, Rogers) Department of Laboratory Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Kottke-Marchant) Department of Pathology and Laboratory Administration,
Cleveland Clinic, Cleveland, OH, United States
(Trombetta) Department of Cardiothoracic Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
Publisher
Blackwell Publishing Ltd
Abstract
Whether third-generation hydroxyethyl starch solutions provoke kidney
injury or haemostatic abnormalities in patients having cardiac surgery
remains unclear. We tested the hypotheses that intra-operative
administration of a third-generation starch does not worsen postoperative
kidney function or haemostasis in cardiac surgical patients compared with
human albumin 5%. This triple-blind, non-inferiority, clinical trial
randomly allocated patients aged 40-85 who underwent elective aortic valve
replacement, with or without coronary artery bypass grafting, to plasma
volume replacement with 6% starch 130/0.4 vs. 5% human albumin. Our
primary outcome was postoperative urinary neutrophil gelatinase-associated
lipocalin concentrations, a sensitive and early marker of postoperative
kidney injury. Secondarily, we evaluated urinary interleukin-18; acute
kidney injury using creatinine RIFLE criteria, coagulation measures,
platelet count and function. Non-inferiority (delta 15%) was assessed with
correction for multiple comparisons. We enrolled 141 patients (69 starch,
72 albumin) as planned. Results of the primary analysis demonstrated that
postoperative urine neutrophil gelatinase-associated lipocalin (median
(IQR [range])) was slightly lower with hydroxyethyl starch (5 (1-68
[0-996]) ng.ml-1) vs. albumin (5 (2-74 [0-1604])
ng.ml-1), although not non-inferior [ratio of geometric means
(95%CI) 0.91 (0.57, 1.44); p = 0.15] due to higher than expected
variability. Urine interleukin-18 concentrations were reduced, but
interleukin-18 and kidney injury were again not non-inferior. Of 11
individual coagulation measures, platelet count and function, nine were
non-inferior to albumin. Two remaining measures, thromboelastographic R
value and arachidonic acid-induced platelet aggregation, were clinically
similar but with wide confidence intervals. Starch administration during
cardiac surgery produced similar observed effects on postoperative kidney
function, coagulation, platelet count and platelet function compared with
albumin, though greater than expected variability and wide confidence
intervals precluded the conclusion of non-inferiority. Long-term mortality
and kidney function appeared similar between starch and
albumin. Copyright © 2020 The Authors. Anaesthesia published by
John Wiley & Sons Ltd on behalf of Association of Anaesthetists

<28>
Accession Number
2004191012
Title
Prospective comparison of periprocedural coagulation markers among
uninterrupted anticoagulants for atrial fibrillation ablation.
Source
Heart Rhythm. 17 (3) (pp 391-397), 2020. Date of Publication: March 2020.
Author
Nagao T.; Higo S.; Suzuki H.; Teshima Y.; Matsunaga S.; Shinoda N.; Harada
K.; Kato M.; Marui N.; Amano T.; Inden Y.; Murohara T.
Institution
(Nagao, Higo, Suzuki, Teshima, Matsunaga, Harada, Shinoda, Harada, Kato,
Marui) Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
(Amano) Department of Cardiology, Aichi-Medical University, Nagakute,
Japan
(Inden, Murohara) Department of Cardiology, Nagoya University Graduate
School of Medicine, Nagoya, Japan
Publisher
Elsevier B.V.
Abstract
Background: The difference in coagulation state during the periprocedural
period of atrial fibrillation (AF) ablation among patients with
uninterrupted anticoagulation has not been fully elucidated.
 Objective(s): The purpose of this study was to compare periprocedural
trends in coagulation markers among patients on uninterrupted
anticoagulation for AF ablation. Method(s): In total, 275 consecutive
patients who underwent AF ablation were evaluated. These patients were
divided according to the anticoagulant they received into the dabigatran
group (DG) (n = 64); rivaroxaban group (RG) (n = 62); apixaban group (AG)
(n = 60); edoxaban group (EG) (n = 59); and warfarin group (WG) (n = 30).
The trends in coagulation markers and the rate of silent stroke (SS)
confirmed by postoperative magnetic resonance imaging were evaluated.
 Result(s): The fibrin monomer complex (FMC) level on postoperative
day 1 and the prothrombin fragment 1+2 (PF1+2) levels on the operative day
and postoperative day 1 were higher in DG than in the other groups (P
<.05, <.001, and <.001, respectively). The incidence of SS in DG (17%) was
significantly higher than in RG (6%), AG (3%, EG (7%), or WG (4%) (P
<.05). Dabigatran use independently predicted the occurrence of SS (odds
ratio 4.12; 95% confidence interval 1.37-12.7; P <.05).
 Conclusion(s): FMC and PF1+2 levels during the periprocedural period
of AF ablation were higher in DG than in the other groups. Dabigatran use
independently predicted the occurrence of SS. Copyright © 2019
Heart Rhythm Society

<29>
Accession Number
630834148
Title
Diagnosis and treatment of heart failure with preserved left ventricular
ejection fraction.
Source
World Journal of Cardiology. 12 (1) (pp 7-25), 2020. Date of Publication:
26 Jan 2020.
Author
Henning R.J.
Institution
(Henning) College of Public Health, University of South Florida, Tampa, FL
33612, United States
Publisher
Baishideng Publishing Group Co (7901 Stoneridge Drive, Suite 501,
Pleasanton, California 94588, United States. E-mail: bpg@baishideng.com)
Abstract
Nearly six million people in United States have heart failure. Fifty
percent of these people have normal left ventricular (LV) systolic heart
function but abnormal diastolic function due to increased LV myocardial
stiffness. Most commonly, these patients are elderly women with
hypertension, ischemic heart disease, atrial fibrillation, obesity,
diabetes mellitus, renal disease, or obstructive lung disease. The annual
mortality rate of these patients is 8%-12% per year. The diagnosis is
based on the history, physical examination, laboratory data,
echocardiography, and, when necessary, by cardiac catheterization.
Patients with obesity, hypertension, atrial fibrillation, and volume
overload require weight reduction, an exercise program, aggressive control
of blood pressure and heart rate, and diuretics. Miniature devices
inserted into patients for pulmonary artery pressure monitoring provide
early warning of increased pulmonary pressure and congestion. If
significant coronary heart disease is present, coronary revascularization
should be considered. Copyright © The Author(s) 2020. Published
by Baishideng Publishing Group Inc. All rights reserved.

<30>
Accession Number
2003572044
Title
Sex-mismatch influence on survival after heart transplantation: A
systematic review and meta-analysis of observational studies.
Source
Clinical Transplantation. 33 (12) (no pagination), 2019. Article Number:
e13737. Date of Publication: 01 Dec 2019.
Author
Ayesta A.; Urrutia G.; Madrid E.; Vernooij R.W.M.; Vicent L.;
Martinez-Selles M.
Institution
(Ayesta) Servicio de cardiologia, Hospital Universitario Central de
Asturias, Oviedo, Spain
(Urrutia) Institut d'Investigacio Biomedica Sant Pau (IIB Sant Pau),
Barcelona, Spain
(Urrutia) CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
(Urrutia, Madrid, Vernooij) Centro Iberoamericano Cochrane, Barcelona,
Spain
(Madrid) Centro de Investigacion Biomedica, Facultad de Medicina,
Universidad de Valparaiso, Valparaiso, Chile
(Madrid) Centro Interdisciplinar para Estudios de la Salud, Facultad de
Medicina, Universidad de Valparaiso, Valparaiso, Chile
(Vicent, Martinez-Selles) Servicio de Cardiologia, Hospital Universitario
Gregorio Maranon, Instituto de Investigacion Sanitaria Gregorio Maranon
(IiSGM), CIBERCV, Madrid, Spain
(Vicent, Martinez-Selles) Universidad Complutense de Madrid, Madrid, Spain
(Martinez-Selles) Universidad Europea de Madrid, Madrid, Spain
Publisher
Blackwell Publishing Ltd
Abstract
Introduction and objectives: Heart transplantation (HT) is the treatment
for patients with end-stage heart disease. Despite contradictory reports,
survival seems to be worse when donor/recipient sex is mismatched. This
systematic review and meta-analysis aims to synthesize the evidence on the
effect of donor/recipient sex mismatch after HT. Method(s): We
searched PubMed and EMBASE until November 2017. Comparative cohort and
registry studies were included. Published articles were systematically
selected and, when possible, pooled in a meta-analysis. The primary
endpoint was one-year mortality. Result(s): After retrieving 556
articles, ten studies (76 175 patients) were included in the quantitative
meta-analysis. Significant differences were found in one-year survival
between sex-matched and mismatched recipients (odds ratio (OR) 1.30, 95%
confidence interval (CI) 1.25-1.35, P <.001). In female recipients, we
found that sex mismatch was not a risk factor for one-year mortality (OR =
0.93, 95% CI = 0.85-1.00, P =.06). However, in male recipients, we found
that it was a risk factor for one-year mortality (OR = 1.38, 95% CI =
1.31-1.44, P <.001). Conclusion(s): Sex mismatch increases one-year
mortality after HT in male recipients. Its influence in long-term survival
should be further explored with high-quality studies. Copyright ©
2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<31>
Accession Number
630958851
Title
A Systematic Review for Variables to Be Collected in a Transplant Database
for Improving Risk Prediction.
Source
Transplantation. 103 (12) (pp 2591-2601), 2019. Date of Publication: 01
Dec 2019.
Author
Almasri J.; Tello M.; Benkhadra R.; Morrow A.S.; Hasan B.; Farah W.;
Alvarez Villalobos N.; Mohammed K.; Allen J.-S.P.; Prokop L.J.; Wang Z.;
Kasiske B.L.; Israni A.K.; Murad M.H.
Institution
(Almasri, Tello, Benkhadra, Morrow, Hasan, Farah, Alvarez Villalobos,
Mohammed, Allen, Wang, Murad) Evidence-Based Practice Research Program,
Mayo Clinic, MN, United States
(Almasri, Tello, Benkhadra, Morrow, Hasan, Farah, Alvarez Villalobos,
Mohammed, Allen, Wang, Murad) Robert D. and Patricia E. Kern Center for
the Science of Health Care Delivery, Mayo Clinic, MN, United States
(Prokop) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
(Kasiske, Israni) Scientific Registry of Transplant Recipients,
Minneapolis Medical Research Foundation, Minneapolis, MN, United States
(Kasiske, Israni) Department of Medicine, Hennepin Healthcare, University
of Minnesota, Minneapolis, MN, United States
(Israni) Division of Epidemiology and Community Health, School of Public
Health, University of Minnesota, Minneapolis, MN, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background. This systematic review was commissioned to identify new
variables associated with transplant outcomes that are not currently
collected by the Organ Procurement and Transplantation Network (OPTN).
Methods. We identified 81 unique studies including 1 193 410 patients with
median follow-up of 36 months posttransplant, reporting 108 unique risk
factors. Results. Most risk factors (104) were recipient related; few (4)
were donor related. Most risk factors were judged to be practical and
feasible to routinely collect. Relative association measures were small to
moderate for most risk factors (ranging between 1.0 and 2.0). The
strongest relative association measure for a heart transplant outcome with
a risk factor was 8.6 (recipient with the previous Fontan operation), for
a kidney transplant 2.8 (sickle cell nephropathy as primary cause of
end-stage renal disease), for a liver transplant 14.3 (recipient serum
ferritin >500 mug/L), and for a lung transplant 6.3 (Burkholderia cepacia
complex infection for 1 y or less). OPTN may consider some of these 108
variables for future collection to enhance transplant research and
clinical care. Conclusions. Evidence-based approaches can be used to
determine variables collected in databases and registries. Several
candidate variables have been identified for OPTN. Copyright ©
2019 Wolters Kluwer Health, Inc. All rights reserved.

<32>
[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. 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. 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. 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. Copyright © 2019 by The North
American Menopause Society.

<33>
[Use Link to view the full text]
Accession Number
630803804
Title
A meta-analysis of bridging anticoagulation between low molecular weight
heparin and heparin.
Source
Medicine. 99 (3) (pp e18729), 2020. Date of Publication: 01 Jan 2020.
Author
Tao E.; Luo Y.L.; Tao Z.; Wan L.
Institution
(Tao, Wan) Department of Cardiovascular Surgery of The First Affiliated
Hospital of Nanchang University
(Luo) Department of Neurosurgery of Guandong 39 Brain Hospital, Guan dong
(Tao) Department of Anesthesiology of The First Affiliated Hospital of
Nanchang University, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients with mechanical heart valves (MHV) have an increased
risk of thromboembolic complications. Low molecular weight heparin (LMWH)
and unfractionated heparin (UFH) are often recommended for bridging
anticoagulation; however, it is not clear which strategy is more
beneficial. METHOD(S): The PubMed, EMBASE, and Cochrane databases
were searched from January 1960 to March 2019. Randomized controlled
trials and observational studies were analyzed. The Newcastle-Ottawa Scale
(NOS) was used to evaluate the quality of the studies. Stata 11.0 was used
for the meta-analysis. RESULT(S): A total of 6 publications were
included; 1366 events were selected, involving 852 events with LMWH and
514 events with UFH. The thromboembolism risk of the LMWH group was lower
than that of the UFH group (risk ratio [RR] = 0.34, 95% confidence
interval [CI] 0.12-0.95, P = .039). The incidence of major bleeding was
lower in the LMWH group than in the UFH group, albeit without statistical
significance (RR = 0.94, 95% CI 0.68-1.30, P = .728), as was mortality (RR
= 0.52, 95% CI 0.16-1.66, P = .271). Subgroup analysis showed that LMWH
cardiac surgery patients had a higher risk of major bleeding compared with
UFH cardiac surgery patients (RR = 1.17, 95% CI 0.72-1.90, P = .526); but
among non-cardiac surgery patients, the LMWH group had a lower risk of
major bleeding than the UFH group (RR = 0.79, 95% CI 0.51-1.22, P = .284),
although the difference was not statistically significant.
 CONCLUSION(S): Our meta-analysis suggests that LMWH not only reduces
the risk of thromboembolism in patients with MHV but also does not
increase the risk of major bleeding. LMWH may provide safer and more
effective bridging anticoagulation than UFH in patients with MHV. It is
still necessary to conduct future randomized studies to verify this
conclusion.

<34>
[Use Link to view the full text]
Accession Number
630996442
Title
Arterial Grafts for Coronary Bypass: A Critical Review After the
Publication of ART and RADIAL.
Source
Circulation. 140 (15) (pp 1273-1284), 2019. Date of Publication: 08 Oct
2019.
Author
Gaudino M.; Bakaeen F.G.; Benedetto U.; Di Franco A.; Fremes S.; Glineur
D.; Girardi L.N.; Grau J.; Puskas J.D.; Ruel M.; Tam D.Y.; Taggart D.P.
Institution
(Gaudino, Di Franco, Girardi) Department of Cardio-Thoracic Surgery, Weill
Cornell Medicine, 525 E 68th St, New York, NY 10065, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, United Kingdom
(Fremes, Tam) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Toronto, ON, Canada
(Glineur, Grau, Ruel) Division of Cardiac Surgery, University of Ottawa
Heart Institute, ON, Canada
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York, United States
(Taggart) Department of Cardiovascular Surgery, University of Oxford,
Oxford, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Observational and randomized evidence shows that arterial grafts have
better patency rates than saphenous vein grafts (SVGs) in coronary artery
bypass grafting. Observational studies suggest that the use of multiple
arterial grafts is associated with longer postoperative survival, but this
must be interpreted in the context of treatment allocation bias and hidden
confounders intrinsic to the study designs. Recently, a pooled analysis of
6 randomized trials comparing the radial artery with the SVG as the second
conduit and the largest randomized trial comparing the use of single and
bilateral internal thoracic arteries have provided apparently divergent
results about a clinical benefit with the use of >1 arterial conduit.
However, both analyses have methodological limitations that may have
influenced their results. At present, it is unclear whether the
well-documented increased patency rate of arterial grafts translates into
clinical benefits in the majority of patients undergoing coronary artery
bypass grafting. A large randomized trial testing the arterial grafts
hypothesis (ROMA [Randomized Comparison of the Clinical Outcome of Single
Versus Multiple Arterial Grafts]) is underway and will report the results
in a few years. Copyright © 2019 American Heart Association, Inc.

<35>
Accession Number
2005028704
Title
The effect of preoperative erector spinae plane vs. paravertebral blocks
on patient-controlled oxycodone consumption after video-assisted thoracic
surgery: A prospective randomized, blinded, non-inferiority study.
Source
Journal of Clinical Anesthesia. 62 (no pagination), 2020. Article Number:
109737. Date of Publication: June 2020.
Author
Zhao H.; Xin L.; Feng Y.
Institution
(Zhao, Xin, Feng) Department of Anesthesiology, Peking University People's
Hospital, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: To investigate the effective analgesia for video-assisted
thoracic surgery. Design(s): In this prospective non-inferiority
study, we evaluated the postoperative analgesic effect of preoperative
ultrasound-guided Erector Spinae Plane blocks (ESPB) on T4 and T6 levels
in patients undergoing video-assisted thoracic surgery in comparison with
paravertebral block (PVB) at the same intervertebral spaces.
 Setting(s): A university hospital. Patient(s): 66 patients
scheduled to undergo video-assisted thoracic surgery under general
anesthesia were included. Intervention(s): Patients were randomly
allocated to receive ultrasound-guided ESP blocks on T4 and T6 levels
(Group ESPB, n = 33) or PVB (Group PVB, n = 33) with 30 mL 0.4%
ropivacaine 30 min before anesthesia induction. A continuous flurbiprofen
(8 mg/h) was infused postoperatively through a single-use infusion device
and intravenous oxycodone supplied as analgesic rescue if needed, with
bolus of oxycodone (1 mg) and lockout time being 10 min. Measurements: The
primary outcome was the postoperative oxycodone consumption at 48 h.
 Main Result(s): Intraoperative use of sufentanil and remifentanil
were comparable between these two groups. Pain scores, oxycodone rescue
and Quality of Recovery (QoR) 15 on postoperative day 1 and 2 were
equivalent between these two groups. Postoperative oxycodone consumption
was 7.9 +/- 8.7 boluses in ESPB group and 6.9 +/- 6.3 boluses in PVB group
at 48 h. The cumulative 48 h difference i.e. Oxycodone boluses<inf>with
ESPB</inf> minus Oxycodone boluses<inf>with PVB</inf> was 2 (95% CI -1,
5.6). The lower limit of the 95% CI for this difference was -1, which was
within the predefined non-inferiority margin of -10 (DELTA).
 Conclusion(s): Ultrasound-guided ESPB applied before video assisted
thoracic surgery was non-inferior in analgesic effect compared with PVB in
terms of pain score, analgesic rescue consumption and quality of recovery.
Brief summary statement: Preoperative Erector spinae plane blocks (ESPB),
when in combination with round-the-clock NSAIDs, offered equivalent
analgesia and quality of recovery after video assisted thoracic lung
surgery compared with paravertebral blocks. Patients who received ESP
blocks had similar consumption of oxycodone and length of hospital
stay. Copyright © 2020 Elsevier Inc.

<36>
Accession Number
2003766017
Title
N-methyl-d-aspartate antagonists and steroids for the prevention of
persisting post-surgical pain after thoracoscopic surgeries: A randomized
controlled, factorial design, international, multicenter pilot trial.
Source
Journal of Pain Research. 13 (pp 377-387), 2020. Date of Publication:
2020.
Author
Shanthanna H.; Turan A.; Vincent J.; Saab R.; Shargall Y.; O'hare T.;
Davis K.; Fonguh S.; Balasubramaniam K.; Paul J.; Gilron I.; Kehlet H.;
Sessler D.I.; Bhandari M.; Thabane L.; Devereaux P.J.
Institution
(Shanthanna, O'hare, Paul) Department of Anesthesia, McMaster University,
Hamilton, ON, Canada
(Turan, Saab, Sessler) Department of Outcomes Research, Anesthesiology
Institute, Cleveland Clinic, Cleveland, OH, United States
(Vincent, Fonguh, Balasubramaniam) Population Health Research Institute,
Hamilton, ON, Canada
(Shargall) Department of Surgery, St Joseph's Healthcare Hamilton,
Hamilton, ON, Canada
(Davis) Acute Pain Service, St. Joseph Healthcare Hamilton, Hamilton, ON,
Canada
(Gilron) Departments of Anesthesiology and Perioperative Medicine,
Biomedical and Molecular Sciences, Centre for Neuroscience Studies and
School of Policy Studies, Queen's University, Kingston, ON, Canada
(Kehlet) Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen,
Denmark
(Bhandari) Department of Surgery, McMaster University, Hamilton, ON,
Canada
(Thabane, Devereaux) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, ON, Canada
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Purpose: We conducted a feasibility 2x2 factorial trial comparing
N-methyl-D-aspartate (NMDA) antagonists (intravenous ketamine and oral
memantine) versus placebo and intravenous steroids versus placebo, in
patients having elective video-assisted thoracic surgery lobectomies, at
St. Joseph's Hamilton, Canada, and Cleveland Clinic, Cleveland, USA. Our
feasibility objectives were: 1) recruitment rate/week; 2) recruitment of
>=90% of eligible patients; and 3) >90% follow-up. Secondary objectives
were incidence and intensity of persistent post-surgical pain (PPSP) and
other clinical and safety outcomes. Method(s): Using computerized
randomization, patients were allocated to one of four groups: NMDA active
with steroid placebo; NMDA placebo with steroid active; both NMDA and
steroid active; both NMDA and steroid placebo. Patients, health providers,
and data analysts were blinded to allocation. Patients were followed for 3
months after randomization. Result(s): The trial was initiated in May
2017 at Hamilton and, after subsequent regulatory and ethics approval, in
April 2018 at Cleveland. The trial had to be stopped after only 1 month of
recruitment in Cleveland because the packaged study medications
(memantine) expired and we were unable to procure the dosage required.
Among 41 eligible patients, 27 (66%) were randomized. The recruitment
rate/week was 0.63, 95% confidence interval (CI): 0.47-0.79 in Hamilton;
and 1, 95% CI: 0.83-1.17 in Cleveland. Follow-up was complete for all 24
patients (100%) in Hamilton, and 3 of 4 patients in Cleveland. In total,
only 4 patients (15%), and 2 patients (7%) had persistent pain at rest and
with movement, respectively. There were no significant differences between
groups for other outcomes. Conclusion(s): The trial had to be stopped
prematurely due to non-availability of study medications. Trial
feasibility objectives of recruiting 90% of eligible patients and
recruiting at least one patient/week per site were not met. Consideration
for protocol changes will be necessary for the full trial. Copyright
© 2020 Shanthanna et al.

<37>
[Use Link to view the full text]
Accession Number
630995928
Title
The Impact of Left Ventricular Assist Device Infections on Postcardiac
Transplant Outcomes: A Systematic Review and Meta-Analysis.
Source
ASAIO Journal. 65 (8) (pp 827-836), 2019. Date of Publication: 01 Nov
2019.
Author
Chahal D.; Sepehry A.A.; Nazzari H.; Wright A.J.; Toma M.
Institution
(Chahal) Postgraduate Medicine Program, University of British Columbia,
Vancouver, BC, Canada
(Sepehry) Division of Neurology, University of British Columbia,
Vancouver, BC, Canada
(Nazzari, Toma) Division of Cardiology, University of British Columbia,
Vancouver, BC, Canada
(Wright) Division of Infectious Diseases, University of British Columbia,
Vancouver, BC, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Left ventricular assist devices (LVADs) are associated with numerous
short-and long-term complications, including infection. The impact LVAD
infections have on clinical outcomes after transplantation is not well
established. We sought to determine whether the presence of infection
while on LVAD support negatively influences outcomes after cardiac
transplantation. We searched electronic databases and bibliographies for
full text studies that identified LVAD infections during support and also
reported on posttransplant outcomes. A meta-analysis of posttransplant
survival was conducted using a random effects model. Of 2,373 records, 13
bridge to transplant (BTT) cohort studies were selected (n = 6,631, 82%
male, mean age 50.7 +/- 2.7 years). A total of 6,067 records (91.5%)
received transplant. There were 3,718 (56.1%) continuous-flow LVADs
(CF-LVADs), 1,752 (26.4%) pulsatile LVADs, and 1,161 (17.5%) unknown type
records. A total of 2,586 records (39.0%) developed LVAD infections.
Patients with LVAD infections were younger (50.5 +/- 1.5 vs. 51.3 +/- 1.5,
p = 0.02), had higher body mass indeices (BMIs) (28.4 +/- 0.7 vs. 26.8 +/-
0.4, p < 0.01), and longer LVAD support times (347.0 +/- 157.6 days vs.
180.2 +/- 106.0 days, p < 0.01). Meta-analysis demonstrated increased
posttransplant mortality in those patients who had an LVAD infection
(hazard ratio [HR] 1.30, 95% CI: 1.16-1.46, p < 0.001). Subgroup
meta-analyses by continuous-flow and pulsatile device type demonstrated
significant increased risk of death for both types of devices (HR 1.47,
95% CI: 1.22-1.76, p < 0.001 and 1.71, 95% CI: 1.19-2.45, p = 0.004,
respectively). Patients who develop LVAD infections are younger, have
higher BMIs and longer LVAD support times. Our data suggests that
LVAD-related infections result in a 30% increase in postcardiac
transplantation mortality. Strategies to prevent LVAD infections should be
implemented to improve posttransplant outcomes in this high-risk
population. Copyright © 2019 by the ASAIO.

<38>
[Use Link to view the full text]
Accession Number
630993155
Title
Methylprednisolone Does Not Reduce Acute Postoperative Pain After Cardiac
Surgery: Subanalysis of a Randomized Clinical Trial.
Source
Anesthesia and Analgesia. 129 (6) (pp 1468-1473), 2019. Date of
Publication: 01 Dec 2019.
Author
Turan A.; Cohen B.; Whitlock R.P.; Essber H.; Niazi A.; Makarova N.;
Saasouh W.; Alfirevic A.; Marciniak D.; Sessler D.I.
Institution
(Turan, Cohen, Essber, Niazi, Makarova, Saasouh, Sessler) Departments of
Outcomes Research, Cleveland Clinic, Anesthesiology Institute, 9500 Euclid
Ave, P77, Cleveland, OH 44195, United States
(Turan) Departments of General Anesthesia, Cleveland Clinic, Cleveland,
OH, United States
(Cohen) Division of Anesthesia, Critical Care and Pain Management,
Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University,
Israel
(Whitlock) Population Health Research Institute, Hamilton Health Sciences
and McMaster University, Hamilton, ON, Canada
(Makarova) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Saasouh) Department of Anesthesiology, Detroit Medical Center, Detroit,
MI, United States
(Alfirevic, Marciniak) Department of Cardiothoracic Anesthesia Cleveland
Clinic, Cleveland, OH, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Pain after cardiac surgery is largely treated with opioids,
but their poor safety profile makes nonopioid medications attractive as
part of multimodal pathways. Anti-inflammatory drugs reduce acute
postoperative pain, but the role of steroids in reducing acute
poststernotomy pain is unclear. We evaluated the association between the
intraoperative administration of methylprednisolone and postoperative
analgesia, defined as a composite of pain scores and opioid consumption,
during the initial 24 hours after cardiac surgery. METHOD(S): We
conducted a post hoc retrospective analysis of a large clinical trial in
which adults having cardiac surgery were randomized 1:1 to receive 2
intraoperative doses of 250 mg IV methylprednisolone or placebo. Pain
scores and opioid consumption were collected during the initial 24 hours
after surgery. Methylprednisolone was considered to be associated with
better pain control than placebo if proven noninferior (not worse) on both
pain scores (defined a priori with delta of 1 point) and opioid
consumption (delta of 20%) and superior to placebo in at least 1 of the 2
outcomes. This test was repeated in the opposite direction (testing
whether placebo is better than methylprednisolone on postoperative pain
management). RESULT(S): Of 251 eligible patients, 127 received
methylprednisolone and 124 received placebo. Methylprednisolone was
noninferior to placebo on pain with difference in mean (CI) pain scores of
-0.25 (-0.71 to 0.21); P <.001. However, methylprednisolone was not
noninferior to placebo on opioid consumption (ratio of geometric means
[CI]: 1.11 [0.64-1.91]; P =.37). Because methylprednisolone was not
noninferior to placebo on both outcomes, we did not proceed to superiority
testing based on the a priori stopping rules. Similar results were found
when testing the opposite direction. CONCLUSION(S): In this post hoc
analysis, we could not identify a beneficial analgesic effect after
cardiac surgery associated with methylprednisolone administration. There
are currently no data to suggest that methylprednisolone has significant
analgesic benefit in adults having cardiac surgery. Copyright ©
2019 International Anesthesia Research Society.

<39>
Accession Number
630995166
Title
Ramelteon for Prevention of Postoperative Delirium: A Randomized
Controlled Trial in Patients Undergoing Elective Pulmonary
Thromboendarterectomy*.
Source
Critical Care Medicine. (pp 1751-1758), 2020. Date of Publication: 2020.
Author
Jaiswal S.J.; Vyas A.D.; Heisel A.J.; Ackula H.; Aggarwal A.; Kim N.H.;
Kerr K.M.; Madani M.; Pretorius V.; Auger W.R.; Fernandes T.M.; Malhotra
A.; Owens R.L.
Institution
(Jaiswal, Aggarwal) Scripps Research Translational Institute, San diego,
CA, United States
(Jaiswal, Heisel) Division of Hospital Medicine, Scripps Clinic/Scripps
Green Hospital, San diego, CA, United States
(Vyas, Ackula, Kim, Kerr, Madani, Pretorius, Auger, Fernandes, Malhotra,
Owens) Division of Pulmonary, Critical Care and Sleep Medicine, University
of California, San Diego School of Medicine, San diego, CA, United States
(Owens) Division of Cardiovascular and Thoracic Surgery, University of
California, San Diego School of Medicine, San diego, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: To assess the efficacy of ramelteon in preventing delirium, an
acute neuropsychiatric condition associated with increased morbidity and
mortality, in the perioperative, ICU setting. Design(s):
Parallel-arm, randomized, double-blinded, placebo-controlled trial.
 Setting(s): Academic medical center in La Jolla, California.
 Patient(s): Patients greater than or equal to 18 years undergoing
elective pulmonary thromboendarterectomy. Intervention(s): Ramelteon
8 mg or matching placebo starting the night prior to surgery and for a
maximum of six nights while in the ICU. Measurements and Main
Results: Incident delirium was measured twice daily using the Confusion
Assessment Method-ICU. The safety outcome was coma-free days assessed by
the Richmond Agitation-Sedation Scale. One-hundred twenty participants
were enrolled and analysis completed in 117. Delirium occurred in 22 of 58
patients allocated to placebo versus 19 of 59 allocated to ramelteon
(relative risk, 0.8; 95% CI, 0.5-1.4; p = 0.516). Delirium duration, as
assessed by the number of delirium-free days was also similar in both
groups (placebo median 2 d [interquartile range, 2-3 d] vs ramelteon 3 d
[2-5 d]; p = 0.181). Coma-free days was also similar between groups
(placebo median 2 d [interquartile range, 1-3 d] vs ramelteon 3 d [2-4 d];
p = 0.210). We found no difference in ICU length of stay (median 4 d
[interquartile range, 3-5 d] vs 4 d [3-6 d]; p = 0.349), or in-hospital
mortality (four vs three deaths; relative risk ratio, 0.7; 95% CI,
0.2-3.2; p = 0.717), all placebo versus ramelteon, respectively.
 Conclusion(s): Ramelteon 8 mg did not prevent postoperative delirium
in patients admitted for elective cardiac surgery. Copyright ©
2019 Wolters Kluwer Health, Inc.

<40>
Accession Number
2003305329
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
in patients with three-vessel or left main coronary artery disease:
10-year follow-up of the multicentre randomised controlled SYNTAX trial.
Source
The Lancet. 394 (10206) (pp 1325-1334), 2019. Date of Publication: 12 Oct
2019.
Author
Thuijs D.J.F.M.; Kappetein A.P.; Serruys P.W.; Mohr F.-W.; Morice M.-C.;
Mack M.J.; Holmes D.R.; Curzen N.; Davierwala P.; Noack T.; Milojevic M.;
Dawkins K.D.; da Costa B.R.; Juni P.; Head S.J.; Casselman F.; de Bruyne
B.; Hoj Christiansen E.; Ruiz-Nodar J.M.; Vermeersch P.; Schultz W.;
Sabate M.; Guagliumi G.; Grubitzsch H.; Stangl K.; Darremont O.; Bentala
M.; den Heijer P.; Preda I.; Stoler R.; Szerafin T.; Buckner J.K.; Guber
M.S.; Verberkmoes N.; Akca F.; Feldman T.; Beyersdorf F.; Drieghe B.;
Oldroyd K.; Berg G.; Jeppsson A.; Barber K.; Wolschleger K.; Heiser J.;
van der Harst P.; Mariani M.A.; Reichenspurner H.; Stark C.; Laine M.; Ho
P.C.; Chen J.C.; Zelman R.; Horwitz P.A.; Bochenek A.; Krauze A.;
Grothusen C.; Dudek D.; Heyrich G.; Kolh P.; LeGrand V.; Coelho P.;
Ensminger S.; Nasseri B.; Ingemansson R.; Olivecrona G.; Escaned J.; Guera
R.; Berti S.; Chieffo A.; Burke N.; Mooney M.; Spolaor A.; Hagl C.;
Nabauer M.; Suttorp M.J.; Stine R.A.; McGarry T.; Lucas S.; Endresen K.;
Taussig A.; Accola K.; Canosi U.; Horvath I.; Cannon L.; Talbott J.D.;
Akins C.W.; Kramer R.; Aschermann M.; Killinger W.; Narbute I.; Burzotta
F.; Bogers A.; Zijlstra F.; Eltchaninoff H.; Berland J.; Stefanini G.;
Cruz Gonzalez I.; Hoppe U.; Kiesz S.; Gora B.; Ahlsson A.; Corbascio M.;
Bilfinger T.; Carrie D.; Tchetche D.; Hauptman K.-E.; Stahle E.; James S.;
Sandner S.; Laufer G.; Lang I.; Witkowski A.; Thourani V.; Suryapranata
H.; Redwood S.; Knight C.; MacCarthy P.; de Belder A.; Banning A.;
Gershlick A.
Institution
(Thuijs, Kappetein, Milojevic, Head) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Kappetein) Medtronic, Maastricht, Netherlands
(Serruys) Department of Cardiology, Imperial College London, London,
United Kingdom
(Mohr, Davierwala, Noack) University Department of Cardiac Surgery, Heart
Centre Leipzig, Leipzig, Germany
(Morice) Department of Cardiology, Cardiovascular Institute Paris-Sud,
Hopital Prive Jacques Cartier, Ramsay Generale de Sante, Massy, France
(Mack) Department of Cardiothoracic Surgery, Baylor University Medical
Centre, Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Curzen) University Hospital Southampton NHS Foundation Trust and School
of Medicine, University of Southampton, Southampton, United Kingdom
(Dawkins) Shockwave Medical Inc., Santa Clara, CA, United States
(da Costa, Juni) Applied Health Research Centre, Li Ka Shing Knowledge
Institute of St Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Juni) Department of Medicine, Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, ON, Canada
(da Costa) Institute of Primary Health Care, University of Bern, Bern,
Switzerland
(Head) Medtronic, Minneapolis, MN, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The Synergy between PCI with Taxus and Cardiac Surgery
(SYNTAX) trial was a non-inferiority trial that compared percutaneous
coronary intervention (PCI) using first-generation paclitaxel-eluting
stents with coronary artery bypass grafting (CABG) in patients with
de-novo three-vessel and left main coronary artery disease, and reported
results up to 5 years. We now report 10-year all-cause death results.
 Method(s): The SYNTAX Extended Survival (SYNTAXES) study is an
investigator-driven extension of follow-up of a multicentre, randomised
controlled trial done in 85 hospitals across 18 North American and
European countries. Patients with de-novo three-vessel and left main
coronary artery disease were randomly assigned (1:1) to the PCI group or
CABG group. Patients with a history of PCI or CABG, acute myocardial
infarction, or an indication for concomitant cardiac surgery were
excluded. The primary endpoint of the SYNTAXES study was 10-year all-cause
death, which was assessed according to the intention-to-treat principle.
Prespecified subgroup analyses were performed according to the presence or
absence of left main coronary artery disease and diabetes, and according
to coronary complexity defined by core laboratory SYNTAX score tertiles.
This study is registered with ClinicalTrials.gov, NCT03417050.
 Finding(s): From March, 2005, to April, 2007, 1800 patients were
randomly assigned to the PCI (n=903) or CABG (n=897) group. Vital status
information at 10 years was complete for 841 (93%) patients in the PCI
group and 848 (95%) patients in the CABG group. At 10 years, 244 (27%)
patients had died after PCI and 211 (24%) after CABG (hazard ratio 1.17
[95% CI 0.97-1.41], p=0.092). Among patients with three-vessel disease,
151 (28%) of 546 had died after PCI versus 113 (21%) of 549 after CABG
(hazard ratio 1.41 [95% CI 1.10-1.80]), and among patients with left main
coronary artery disease, 93 (26%) of 357 had died after PCI versus 98
(28%) of 348 after CABG (0.90 [0.68-1.20], p<inf>interaction</inf>=0.019).
There was no treatment-by-subgroup interaction with diabetes
(p<inf>interaction</inf>=0.66) and no linear trend across SYNTAX score
tertiles (p<inf>trend</inf>=0.30). Interpretation(s): At 10 years, no
significant difference existed in all-cause death between PCI using
first-generation paclitaxel-eluting stents and CABG. However, CABG
provided a significant survival benefit in patients with three-vessel
disease, but not in patients with left main coronary artery disease.
 Funding(s): German Foundation of Heart Research (SYNTAXES study,
5-10-year follow-up) and Boston Scientific Corporation (SYNTAX study,
0-5-year follow-up). Copyright © 2019 Elsevier Ltd

<41>
Accession Number
51963850
Title
Spinal cord stimulation therapy for patients with refractory angina who
are not candidates for revascularization.
Source
Neuromodulation. 15 (6) (pp 550-559), 2012. Date of Publication:
November-December 2012.
Author
Zipes D.P.; Svorkdal N.; Berman D.; Boortz-Marx R.; Henry T.; Lerman A.;
Ross E.; Turner M.; Irwin C.
Institution
(Zipes) Indiana University School of Medicine, Krannert Institute of
Cardiology, 1800 North Capitol Ave., Indianapolis, IN 46202-4800, United
States
(Svorkdal) Vancouver Island Pain Program, Royal Jubilee Hospital,
Victoria, BC, Canada
(Berman) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Boortz-Marx) Gundersen Lutheran Medical Center, LaCrosse, WI, United
States
(Boortz-Marx) University of North Carolina, Chapel Hill, NC, United States
(Henry) Minneapolis Heart Institute Foundation, Abbott Northwestern
Hospital, Minneapolis, MN, United States
(Lerman) Mayo Clinic, Rochester, MN, United States
(Ross) Brigham and Women's Hospital, Chestnut Hill, MA, United States
(Turner) Indianapolis Neurosurgical Group, Indianapolis, IN, United States
(Irwin) Medtronic, Inc., Minneapolis, MN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The aim of this study was to evaluate the safety and efficacy
of spinal cord stimulation (SCS) for refractory angina. Material(s)
and Method(s): This multicenter, randomized, single-blind, controlled
trial evaluated SCS in two patient groups: high stimulation (HS)
(treatment) and low stimulation (LS) (control). The HS group controlled
SCS with a programmer for a minimum of two hours four times daily. The LS
group received SCS therapy above the paresthesia threshold for one min
once daily. The primary efficacy endpoint was number of angina attacks
recorded by patients at six months. The primary safety endpoint was the
major adverse cardiac event (MACE) rate at six months. Result(s): Due
to slow enrollment, a futility analysis was performed, resulting in early
termination of the study. Sixty-eight patients were randomized after
implantation. Mean change in angina attacks per day from baseline to six
months was -1.19 +/- 2.13 (HS) and -1.29 +/- 1.66 (LS). The difference
from baseline was significant within each group (both p < 0.001) but not
between groups (p = 0.45). Total exercise time and time to angina onset
increased significantly from baseline to six months within each group
(both p = 0.02 and 0.002) but not between groups (p = 0.52 and 0.51). MACE
was similar between groups. Conclusion(s): Although this study was
terminated early, the results obtained at six months suggest that SCS (HS)
is not more effective than the control (LS) in patients with refractory
angina. © 2012 International Neuromodulation Society.

<42>
Accession Number
2004447315
Title
Meta-analysis of the Relation of Body Mass Index to Cardiovascular
Outcomes in Patients Receiving Intensive Low-Density Lipoprotein
Cholesterol Lowering Therapy.
Source
American Journal of Cardiology. 125 (5) (pp 727-734), 2020. Date of
Publication: 1 March 2020.
Author
Khan S.U.; Khan M.U.; Riaz H.; Raggi P.; Valavoor S.; Khan M.Z.;
Kolodziejczak M.; Khan M.S.; Krupica T.; Alkhouli M.; Navarese E.P.
Institution
(Khan, Khan, Valavoor, Khan, Krupica) Department of Medicine, West
Virginia University, Morgantown, WV, United States
(Riaz) Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Raggi) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Alberta, Canada
(Kolodziejczak, Navarese) Systematic Investigation and Research on
Interventions and Outcomes (SIRIO) MEDICINE Cardiovascular Research
Network, Dusseldorf, Germany
(Kolodziejczak, Navarese) Cardiovascular Institute, Ludwik Rydygier
Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
(Khan) Department of Medicine, John H. Stroger J. Hospital of Cook County,
Chicago, IL, United States
(Alkhouli) Department of Cardiovascular Medicine, West Virginia
University, Morgantown, WV, United States
(Navarese) Interventional Cardiology and Cardiovascular Medicine Research,
Mater Dei Hospital, Bari, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The impact of body mass index (BMI) on cardiovascular outcomes in patients
receiving intensive low-density lipoprotein cholesterol (LDL-C) lowering
therapy is uncertain. We performed meta-analysis of 29 randomized
controlled trials using PubMed, Embase, and CENTRAL through April 2019.
Therapies were grouped as more intensive LDL-C lowering therapy (statins,
ezetimibe + statin or PCSK9 inhibitors) and less intensive LDL-C lowering
therapy (less potent active control or placebo). Random effects
meta-regressions and meta-analyses were performed to evaluate association
of BMI with cardiovascular endpoints. In 265,766 patients, for every 1
kg/m2 increase in BMI, more intensive therapy compared with
less intensive therapy was associated with hazard ratio (HR) of 1.07 for
cardiovascular mortality (95% confidence interval 1.02 to 1.13); HR of
1.03 for all-cause mortality (0.99 to 1.06) HR of 1.06 for myocardial
infarction (1.02 to 1.09), HR of 1.08 (1.03 to 1.12) for revascularization
and HR of 1.04 for MACE (1.01 to 1.07). Meta-analysis showed that patients
with BMI <25 kg/m2 had the highest risk reduction in mortality
and cardiovascular outcomes compared with patients with BMI >=30
kg/m2 (p-interaction <=0.05). In conclusion, patients with
normal BMI treated with intensive LDL-C lowering regimens may derive a
larger clinical benefit compared with patients with larger BMI. The
results could be due to the higher mortality rate of obese patients that
may artificially lower the efficacy of therapy, or due to a true
therapeutic limitation in these patients. Copyright © 2019
Elsevier Inc.

<43>
Accession Number
2003718115
Title
Continuous wound infiltration of local anesthetics in postoperative pain
management: Safety, efficacy and current perspectives.
Source
Journal of Pain Research. 13 (pp 285-294), 2020. Date of Publication:
2020.
Author
Paladini G.; Carlo S.D.; Musella G.; Petrucci E.; Scimia P.; Ambrosoli A.;
Cofini V.; Fusco P.
Institution
(Paladini, Musella, Ambrosoli) Department of Anesthesia, Perioperative
Medicine and Intensive Care Therapy, Filippo Del Ponte Women and
Children's Hospital, ASST Sette Laghi, Varese, Italy
(Carlo) Department of Medical, Oral and Biotechnological Sciences,
University of Chieti, Chieti, Italy
(Petrucci, Fusco) Department of Anesthesia and Intensive Care, San
Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
(Scimia) Department of Anesthesia and Intensive Care, ASUR Marche AV5, San
Benedetto Del Tronto, Italy
(Cofini) Department of Life, Health and Environmental Sciences, University
of L'Aquila, L'Aquila, Italy
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Local infiltration and continuous infusion of surgical wound with
anesthetics are parts of multimodal analgesia for postoperative pain
control. The techniques, given the simplicity of execution that does not
increase the timing of the intervention and does not require additional
technical skills, are applied in several kinds of surgeries. The
continuous wound infiltration can be used for days and a variety of
continuous delivery methods can be chosen, including patient-controlled
analgesia, continuous infusion or intermittent bolus. The purpose of this
narrative review is to analyze the literature, in particular by
researching the safety, efficacy and current perspectives of continuous
wound infiltration for postoperative pain management in different surgical
settings. We have identified 203 articles and 95 of these have been taken
into consideration: 17 for the lower limb surgery; 7 for the upper limb
surgery, 51 for the laparotomy/ laparoscopic surgery of the abdominopelvic
area, 13 studies regarding breast surgery and 7 for cardiothoracic
surgery. The analysis of these studies reveals that the technique has a
variable effectiveness based on the type of structure involved: it is
better in structures rich in subcutaneous and connective tissue, while the
effectiveness is limited in anatomic districts with a greater variability
of innervation. However, regardless the heterogeneity of results, a
general reduction in pain intensity and in opioid consumption has been
observed with continuous wound infiltration: it is an excellent analgesic
technique that can be included in the multimodal treatment of
postoperative pain or represents a valid alternative when other options
are contraindicated. Copyright © 2020 Paladini et al.

<44>
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. Copyright © 2020
by the authors. Licensee MDPI, Basel, Switzerland.

<45>
Accession Number
630435845
Title
Steroids as a possible effective therapy in the management of large
isolated chylopericardium following open heart surgery.
Source
Cardiology in the Young. 29 (12) (pp 1426-1431), 2019. Date of
Publication: 01 Dec 2019.
Author
Fakhri G.; Abutaqa M.; Abdulhalim N.; Houssein H.B.; Al Halees Z.;
El-Rassi I.; Bitar F.; Arabi M.
Institution
(Fakhri, Abutaqa, Abdulhalim, Houssein, Bitar, Arabi) Division of
Cardiology, Department of Pediatrics and Adolescent Medicine, American
University of Beirut Medical Center, Fetal Heart Program-Children's Heart
Center, PO Box: 11-0236, Beirut 1107 2020, Lebanon
(Al Halees) Department of Surgery, King Faisal Specialist Hospital and
Research Center, Riyadh, Saudi Arabia
(El-Rassi) Department of Surgery, American University of Beirut Medical
Center, Beirut, Lebanon
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background: Chylopericardium is the collection of lymph fluid inside the
pericardial cavity. The incidence of chylopericardium is very low, as this
diagnosis is rarely reported following cardiac procedures in children.
While some reports were published worldwide on isolated chylopericardium
after cardiac surgeries for diverse reasons, it has never been reported
after repair for partial anomalous pulmonary venous return. In addition,
management of this diagnosis ends up being surgical with minimal
concentration on medical treatment which proved unsuccessful. We present a
medical approach with corticosteroids as an effective method to treat
isolated chylopericardium.Case presentation: In this manuscript, we
present an approach to treat isolated post-operative chylopericardium in a
child following repair of partial anomalous pulmonary venous return.
Chylous drainage responded to corticosteroids and completely ceased. There
was no need for surgical intervention. Conclusion(s): Until now,
isolated chylopericardium has never been reported to occur with partial
anomalous pulmonary venous return repair. A review of the literature
showed that most patients follow a conservative approach consisting of
diuretics and non-steroidal anti-inflammatory agents with some of them
undergoing surgical re-intervention. With future research on the topic
still needed, we hope that this will encourage physicians worldwide to
consider administering a trial of corticosteroids as an option to treat
chylopericardium. Copyright © Cambridge University Press 2019.

<46>
[Use Link to view the full text]
Accession Number
629471278
Title
Prevention of Early Postoperative Decline: A Randomized, Controlled
Feasibility Trial of Perioperative Cognitive Training.
Source
Anesthesia and analgesia. 130 (3) (pp 586-595), 2020. Date of Publication:
01 Mar 2020.
Author
O'Gara B.P.; Mueller A.; Gasangwa D.V.I.; Patxot M.; Shaefi S.; Khabbaz
K.; Banner-Goodspeed V.; Pascal-Leone A.; Marcantonio E.R.; Subramaniam B.
Institution
(O'Gara, Mueller, Gasangwa, Patxot, Shaefi, Banner-Goodspeed, Subramaniam)
From the Department of Anesthesia, Critical Care and Pain Medicine
(Khabbaz) Department of Surgery, Division of Cardiac Surgery
(Pascal-Leone) Department of Neurology, Division of Cognitive Neurology,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
(Pascal-Leone) Neurorehabilitation, Universitat Autonoma Barcelona,
Bellaterra, Spain
(Marcantonio) Department of Medicine, Division of General Medicine and
Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative delirium and postoperative cognitive dysfunction
(POCD) are common after cardiac surgery and contribute to an increased
risk of postoperative complications, longer length of stay, and increased
hospital mortality. Cognitive training (CT) may be able to durably improve
cognitive reserve in areas deficient in delirium and POCD and, therefore,
may potentially reduce the risk of these conditions. We sought to
determine the feasibility and potential efficacy of a perioperative CT
program to reduce the incidence of postoperative delirium and POCD in
older cardiac surgery patients. METHOD(S): Randomized controlled
trial at a single tertiary care center. Participants included 45 older
adults age 60-90 undergoing cardiac surgery at least 10 days from
enrollment. Participants were randomly assigned in a 1:1 fashion to either
perioperative CT via a mobile device or a usual care control. The primary
outcome of feasibility was evaluated by enrollment patterns and adherence
to protocol. Secondary outcomes of postoperative delirium and POCD were
assessed using the Confusion Assessment Method and the Montreal Cognitive
Assessment, respectively. Patient satisfaction was assessed via a
postoperative survey. RESULT(S): Sixty-five percent of eligible
patients were enrolled. Median (interquartile range [IQR]) adherence (as a
percentage of prescribed minutes played) was 39% (20%-68%), 6% (0%-37%),
and 19% (0%-56%) for the preoperative, immediate postoperative, and
postdischarge periods, respectively. Median (IQR) training times were 245
(136-536), 18 (0-40), and 122 (0-281) minutes for each period,
respectively. The incidence of postoperative delirium (CT group 5/20 [25%]
versus control 3/20 [15%]; P = .69) and POCD (CT group 53% versus control
37%; P = .33) was not significantly different between groups for either
outcome in this limited sample. CT participants reported a high level of
agreement (on a scale of 0-100) with statements that the program was easy
to use (median [IQR], 87 [75-97]) and enjoyable (85 [79-91]). CT
participants agreed significantly more than controls that their memory
(median [IQR], 75 [54-82] vs 51 [49-54]; P = .01) and thinking ability
(median [IQR], 78 [64-83] vs 50 [41-68]; P = .01) improved as a result of
their participation in the study. CONCLUSION(S): A CT program
designed for use in the preoperative period is an attractive target for
future investigations of cognitive prehabilitation in older cardiac
surgery patients. Changes in the functionality of the program and
enrichment techniques may improve adherence in future trials. Further
investigation is necessary to determine the potential efficacy of
cognitive prehabilitation to reduce the risk of postoperative delirium and
POCD.

<47>
[Use Link to view the full text]
Accession Number
629227464
Title
Fibrinogen Concentrate as an Alternative to Cryoprecipitate in a
Postcardiopulmonary Transfusion Algorithm in Infants Undergoing Cardiac
Surgery: A Prospective Randomized Controlled Trial.
Source
Anesthesia and analgesia. 130 (3) (pp 740-751), 2020. Date of Publication:
01 Mar 2020.
Author
Downey L.A.; Andrews J.; Hedlin H.; Kamra K.; McKenzie E.D.; Hanley F.L.;
Williams G.D.; Guzzetta N.A.
Institution
(Downey, Guzzetta) From the Department of Anesthesiology, Perioperative
and Pain Medicine, Emory University, Children's Healthcare of Atlanta,
Atlanta, Georgia
(Andrews) Departments of Pathology, Microbiology, Immunology
(Andrews) Pediatrics, Vanderbilt University Medical Center, Nashville, TN,
United States
(Hedlin) Department of Quantitative Sciences Unit, Stanford University
School of Medicine, Palo Alto, CA, Mexico
(Kamra, Williams) Department of Anesthesiology, Stanford University School
of Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, Mexico
(McKenzie) Division of Congenital Heart Surgery, Department of Surgery,
Baylor College of Medicine, Texas Children's Hospital, Houston, TX
(Hanley) Departments of Cardiovascular Surgery
(Hanley) Pediatric Cardiac Surgery, Stanford University School of
Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, Mexico
Publisher
NLM (Medline)
Abstract
BACKGROUND: Infants undergoing cardiac surgery are at risk for bleeding
and massive transfusion due to an immature coagulation system, complex
surgeries, and cardiopulmonary bypass (CPB) effects. Hemodilution from CPB
promotes an acquired hypofibrinogenemia that results in impaired fibrin
formation, inadequate clot formation, and increased bleeding. In North
America, the current standard of care to supplement fibrinogen is
cryoprecipitate. An alternative option is the off-label use of fibrinogen
concentrate (FC; RiaSTAP; CSL Behring, Marburg, Germany), a purified
fibrinogen. Because perioperative allogenic transfusions are associated
with increased morbidity and mortality, we sought to determine whether FC
would be an acceptable alternative to cryoprecipitate in a post-CPB
transfusion algorithm in infants undergoing open-heart surgery.
 METHOD(S): We randomized 60 infants (<12 months) undergoing
nonemergent cardiac surgery with CPB at 2 tertiary care children's
hospitals to receive either cryoprecipitate or FC in a post-CPB
transfusion algorithm. Infants underwent a stratified randomization based
on institution and surgical complexity. The primary outcome was the
difference in number of intraoperative allogenic blood product
transfusions. Secondary outcomes included 24-hour chest tube output (CTO),
mechanical ventilation time, adverse events (AEs), intensive care unit
(ICU) length of stay (LOS), hospital LOS, postoperative thrombosis, and
death within 30 days of surgery. The primary analysis followed the
intent-to-treat (ITT) principle and was performed using linear regression
adjusted for institution and complexity of surgery. A per-protocol (PP)
analysis was also performed. RESULT(S): Between June 2016 and January
2018, we enrolled 60 patients with complete data available for 25 patients
who received cryoprecipitate and 29 patients who received FC. Patients in
the cryoprecipitate group (median age: 4 months [2-6 months]) received 5.5
(4.0-7.0) allogeneic blood units in the ITT analysis and 6.0 units
(5.0-7.0 units) in the PP analysis. Patients in the FC group (median age:
4 months [2-5]) received 4 units (3.0-5.0 units) in the ITT analysis and
4.0 units (3.0-5.0 units) in the PP analysis. In the adjusted ITT
analysis, the FC group received 1.79 units (95% confidence interval [CI],
0.64-2.93; P = .003) less than the cryoprecipitate group. In the adjusted
PP analysis, the FC group received 2.67 units (95% CI, 1.75-3.59; P <
.001) less than the cryoprecipitate group. There were no significant
differences in secondary outcomes or AEs. CONCLUSION(S): Our findings
suggest that FC may be considered as an alternative to cryoprecipitate for
the treatment of hypofibrinogenemia in infants with bleeding after CPB.
Although we found no significant differences between secondary outcomes or
AEs, further studies are needed to assess safety.

<48>
Accession Number
629224966
Title
Routinary use of fibrin sealants to prevent prolonged air leak in thoracic
surgery: our experience.
Source
Il Giornale di chirurgia. 40 (3) (pp 170-173), 2019. Date of Publication:
01 May 2019.
Author
Porrello C.; Iadicola D.; Grutta E.M.; Palazzolo M.; Vaglica A.; Gagliardo
C.; Giangregorio F.; Gulotta E.; Lo Faso F.; Gullo R.; Carini F.;
Tomasello G.; Cocorullo G.
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Prolonged air leak (PAL) is one of the most common
postoperative complications after lung surgery. It is associated with
increased significant morbidity, lower quality of life, longer hospital
stay and higher hospital costs. Since its great clinical and economic
burden, it is important to establish the feasibility and the effectiveness
of the routinary preventive use of a fibrin sealant in order to reduce the
incidence of prolonged air leaks. PATIENTS AND METHODS: This is a
randomized study on 189 adult patients - 118 men (62.4%) and 71 women
(37.6%) aged from 39 to 87 y.o. (mean age 68.3 y.o.) - who underwent lung
surgery (lobectomy or bilobectomy) with intraoperatory detection of air
leakage, from January 2013 to December 2017, at Department of Thoracic
Surgery in "Ospedale Maggiore Carlo Alberto Pizzardi" (Bologna, Italy) and
Department of Thoracic Surgery in "Paolo Giaccone" Teaching Hospital
(Palermo, Italy). Patients were randomly assigned to the "Glue" arm (90
patients) or the "Control" group (99 patients). We only used stapler or
manual suture to achieve aerostasis. In addition, we used a fibrin sealant
("glue") to cover the suture line on patients in the "Glue" arm. The
primary endpoints were incidence of prolonged air leaks, days with chest
tube and mean hospital stay. RESULT(S): In the "Glue" arm we
experienced only 1 prolonged air leak (1.1%), while in the "Control" group
there were 8 leaks (8.1%). Patients kept chest tube for average 4.15 days
in the "Glue" arm and 4.45 days in the "Control" group. The mean hospital
stay was average 7.4 days for the "Glue" arm, while 9.1 days in the
"Control" group. CONCLUSION(S): According to our experience it seems
that the routinary preventive use of a fibrin sealant results in a lower
incidence of prolonged air leaks, a shorter hospital stay with lower
hospital costs, representing a cost-effective, feasible and effective
system to decrease morbility and mortality among surgical patients.

<49>
Accession Number
630951017
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) (no pagination), 2020. Article Number: e033917. 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, Ye) 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, Su) Department of Obstetrics, Women and Children's Hospital, School
of Medicine, Xiamen University, Xiamen, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
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 Copyright ©
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.

<50>
Accession Number
630975186
Title
Intraoperative hypotension: Pathophysiology, clinical relevance, and
therapeutic approaches.
Source
Indian Journal of Anaesthesia. 64 (2) (pp 90-96), 2020. Date of
Publication: February 2020.
Author
Kouz K.; Hoppe P.; Briesenick L.; Saugel B.
Institution
(Kouz, Hoppe, Briesenick, Saugel) Department of Anesthesiology, Center of
Anesthesiology and Intensive Care Medicine, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Saugel) Outcomes Research Consortium, Cleveland, OH, United States
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Intraoperative hypotension (IOH) i.e., low arterial blood pressure (AP)
during surgery is common in patients having non-cardiac surgery under
general anaesthesia. It has a multifactorial aetiology, and is associated
with major postoperative complications including acute kidney injury,
myocardial injury and death. Therefore, IOH may be a modifiable risk
factor for postoperative complications. However, there is no uniform
definition for IOH. IOH not only occurs during surgery but also after the
induction of general anaesthesia before surgical incision. However, the
optimal therapeutic approach to IOH remains elusive. There is evidence
from one small randomised controlled trial that individualising AP targets
may reduce the risk of postoperative organ dysfunction compared with
standard care. More research is needed to define individual AP harm
thresholds, to develop therapeutic strategies to treat and avoid IOH, and
to integrate new technologies for continuous AP monitoring. Copyright
© Indian Society of Anaesthetists. All rights reserved.

<51>
[Use Link to view the full text]
Accession Number
630982178
Title
Impact of Procedural Bleeding in Peripheral Artery Disease: An Analysis
from EUCLID Trial.
Source
Circulation: Cardiovascular Interventions. 12 (10) (no pagination), 2019.
Article Number: e008069. Date of Publication: 01 Oct 2019.
Author
Kansal A.; Huang Z.; Rockhold F.W.; Baumgartner I.; Berger J.S.; Blomster
J.I.; Fowkes F.G.; Katona B.; Mahaffey K.W.; Norgren L.; Hiatt W.R.; Patel
M.R.; Jones W.S.
Institution
(Kansal, Patel, Jones) Division of Cardiology, Duke Heart Center, Duke
University, Durham, NC, United States
(Huang, Rockhold, Patel, Jones) Duke Clinical Research Institute, Duke
University School of Medicine, Duke University, Durham, NC, United States
(Baumgartner) Swiss Cardiovascular Centre, Inselspital, Bern University
Hospital, University of Bern, Switzerland
(Berger) Department of Medicine and Surgery, New York University School of
Medicine, United States
(Blomster) Turku University Hospital, Turku University, Finland
(Fowkes) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, United Kingdom
(Katona) AstraZeneca Gaithersburg, MD, United States
(Mahaffey) Stanford Center for Clinical Research, Stanford University
School of Medicine, CA, United States
(Norgren) Faculty of Medicine and Health, Orebro University, Sweden
(Hiatt) University of Colorado School of Medicine, Division of Cardiology
and CPC Clinical Research, Aurora, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The relationship between invasive vascular procedures and
bleeding in patients with peripheral artery disease has not been well
described in the literature. This post hoc analysis from the EUCLID trial
(Examining Use of Ticagrelor in Peripheral Artery Disease) aimed to
describe the incidence of major and minor postprocedural bleeding and
characterize the timing and severity of bleeding events relative to the
procedure. Method(s): EUCLID was a multicenter, randomized controlled
trial of 13 885 patients with symptomatic peripheral artery disease that
tested the efficacy and safety of ticagrelor compared with clopidogrel for
the prevention of major adverse cardiovascular events. A total of 2661
patients underwent 3062 coronary revascularization, peripheral
revascularization, and amputation during the study. The primary safety end
point was Thrombolysis in Myocardial Infarction major or minor bleeding.
All bleeding events were formally adjudicated by a clinical end point
classification group. Result(s): Major bleeding events most often
occurred <=7 days following the procedure. The incidence of Thrombolysis
in Myocardial Infarction major or minor bleeding <=7 days following
peripheral revascularization (3.3%; 95% CI, 2.5%-4.1%) was similar to
rates after coronary revascularization (4.0%; 95% CI, 2.6%-5.4%) and lower
extremity amputation (2.3%; 95% CI, 0.8%-3.8%). The severity of bleeding
events (as graded by drop in hemoglobin, need for transfusion, bleeding in
a critical location, and fatal bleeding) was also similar following
peripheral, coronary revascularization, and lower extremity amputation.
 Conclusion(s): The incidence of Thrombolysis in Myocardial Infarction
major/minor bleeding following peripheral revascularization is comparable
to rates after coronary revascularization and lower extremity amputation,
and the majority of bleeding events occur within 7 days following the
procedure. The severity of periprocedural bleeding is also similar after
procedures, with the most frequently adjudicated reason being a drop in
hemoglobin >=2 g/dL. Future studies should be performed to enhance our
understanding of bleeding risk related to revascularization and amputation
procedures in peripheral artery disease patients. Copyright ©
2019 Lippincott Williams and Wilkins. All rights reserved.

<52>
[Use Link to view the full text]
Accession Number
630982117
Title
Comparison of a complete percutaneous versus surgical approach to aortic
valve replacement and revascularization in patients at intermediate
surgical risk results from the randomized SURTAVI trial.
Source
Circulation. 140 (16) (pp 1296-1305), 2019. Date of Publication: 15 Oct
2019.
Author
Sondergaard L.; Popma J.J.; Reardon M.J.; Van Mieghem N.M.; Deeb G.M.;
Kodali S.; George I.; Williams M.R.; Yakubov S.J.; Kappetein A.P.; Serruys
P.W.; Grube E.; Schiltgen M.B.; Chang Y.; Engstrom T.
Institution
(Sondergaard, Engstrom) Department of Cardiology, Heart Centre,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Popma) Department of Internal Medicine, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Reardon) Department of Cardiovascular Surgery, Methodist DeBakey Heart
and Vascular Center, Houston, TX, United States
(Van Mieghem, Kappetein) Departments of Cardiology and Cardiothoracic
Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
(Deeb) Department of Cardiac Surgery, University of Michigan, Ann Arbor,
United States
(Kodali, George) Department of Surgery, Columbia University Medical
Center, New York, United States
(Williams) Departments of Medicine (Cardiology) and Cardiothoracic
Surgery, NYU-Langone Medical Center, NY, United States
(Yakubov) Department of Cardiology, OhioHealth Riverside Methodist
Hospital, Columbus, United States
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
(Grube) Department of Medicine II, Heart Center Bonn, Bonn, Germany
(Kappetein, Schiltgen, Chang) Structural Heart, Medtronic Plc,
Minneapolis, MN, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: For patients with severe aortic stenosis and coronary artery
disease, the completely percutaneous approach to aortic valve replacement
and revascularization has not been compared with the standard surgical
approach. METHOD(S): The prospective SURTAVI trial (Safety and
Efficiency Study of the Medtronic CoreValve System in the Treatment of
Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need
Aortic Valve Replacement) enrolled intermediate-risk patients with severe
aortic stenosis from 87 centers in the United States, Canada, and Europe
between June 2012 and June 2016. Complex coronary artery disease with
SYNTAX score (Synergy Between PCI with Taxus and Cardiac Surgery Trial)
>22 was an exclusion criterion. Patients were stratified according to the
need for revascularization and then randomly assigned to treatment with
transcatheter aortic valve replacement (TAVR) or surgical aortic valve
replacement (SAVR). Patients assigned to revascularization in the TAVR
group underwent percutaneous coronary intervention, whereas those in the
SAVR group had coronary artery bypass grafting. The primary end point was
the rate of all-cause mortality or disabling stroke at 2 years.
 RESULT(S): Of 1660 subjects with attempted aortic valve implants, 332
(20%) were assigned to revascularization. They had a higher Society of
Thoracic Surgeons risk score for mortality (4.8+/-1.7% versus 4.4+/-1.5%;
P<0.01) and were more likely to be male (65.1% versus 54.2%; P<0.01) than
the 1328 patients not assigned to revascularization. After randomization
to treatment, there were 169 patients undergoing TAVR and percutaneous
coronary intervention, 163 patients undergoing SAVR and coronary artery
bypass grafting, 695 patients undergoing TAVR, and 633 patients undergoing
SAVR. No significant difference in the rate of the primary end point was
found between TAVR and percutaneous coronary intervention and SAVR and
coronary artery bypass grafting (16.0%; 95% CI, 11.1-22.9 versus 14.0%;
95% CI, 9.2-21.1; P=0.62), or between TAVR and SAVR (11.9%; 95% CI,
9.5-14.7 versus 12.3%; 95% CI, 9.8-15.4; P=0.76). CONCLUSION(S): For
patients at intermediate surgical risk with severe aortic stenosis and
noncomplex coronary artery disease (SYNTAX score <=22), a complete
percutaneous approach of TAVR and percutaneous coronary intervention is a
reasonable alternative to SAVR and coronary artery bypass
grafting. Copyright © 2019 American Heart Association, Inc.

<53>
[Use Link to view the full text]
Accession Number
630982089
Title
More- Versus Less-Intensive Lipid-Lowering Therapy: Systematic Review and
Meta-Analysis.
Source
Circulation: Cardiovascular Quality and Outcomes. 12 (8) (no pagination),
2019. Article Number: e005460. Date of Publication: 01 Aug 2019.
Author
Toyota T.; Morimoto T.; Yamashita Y.; Shiomi H.; Kato T.; Makiyama T.;
Nakagawa Y.; Saito N.; Shizuta S.; Ono K.; Kimura T.
Institution
(Toyota) Department of Cardiovascular Medicine, Kobe City Medical Center
General Hospital, Kobe, Japan
(Toyota, Morimoto) Department of Clinical Epidemiology, Hyogo College of
Medicine, Nishinomiya, Japan
(Yamashita, Shiomi, Kato, Makiyama, Nakagawa, Saito, Shizuta, Ono, Kimura)
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto
University, Kyoto, Japan
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: It has not been yet adequately addressed whether the addition
of the nonstatin LDL-C (low-density lipoprotein cholesterol)-lowering
agents on top of statins has the same magnitude of risk reduction in the
cardiovascular events as compared with more-intensive statin therapy.
 Methods and Results: We performed a systematic review and
meta-analysis of RCTs (randomized controlled trials) comparing more-
versus less-intensive lipid-lowering therapy (LLT) on clinical outcomes in
patients with atherosclerotic cardiovascular risk. We included 23 studies
involving 133 037 patients (more-intensive LLT: 67 691 patients and
less-intensive LLT: 65 346 patients). We evaluated 3 types of more- versus
less-intensive LLT including more versus less statins (57 672 patients),
combination therapy of ezetimibe versus statins alone (20 688 patients),
or a PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitor with
statins versus statins alone (54 677 patients). The odds for major adverse
cardiovascular events (MACE; equivalent to the composite of coronary heart
death, nonfatal myocardial infarction, stroke, or coronary
revascularization) were significantly lower in the more-intensive LLT
group compared with the less-intensive LLT group in the entire study
population (odds ratio, 0.84; 95% CI, 0.79-0.88; P<0.001), and in all the
3 categories of more-intensive LLT strategies (more-intensive statin
therapy: odds ratio, 0.83; 95% CI, 0.76-0.90; P<0.001, ezetimibe: odds
ratio, 0.90; 95% CI, 0.85-0.96; P<0.001, and PCSK9 inhibitors: odds ratio,
0.81; 95% CI, 0.73-0.90; P<0.001) with numerically greater relative odds
reduction by more-intensive statin therapy and PCSK9 inhibitors than by
ezetimibe. Odds reduction for MACE per 20 mg/dL LDL-C reduction was also
different across the 3 types of more-intensive LLT (more-intensive statin
therapy: 17.4%, ezetimibe: 11.0%, and PCSK9 inhibitors: 6.6%).
 Conclusion(s): In this meta-analysis, more-intensive LLT as compared
with less-intensive LLT was associated with significant odds reduction for
MACE in the entire study population and in all the 3 categories of
more-intensive LLT such as more-intensive statin therapy, ezetimibe, and
PCSK9 inhibitors. However, overall odds reduction for MACE and odds
reduction for MACE per 20 mg/dL LDL-C reduction were different across the
3 types of more-intensive LLT. Copyright © 2019 American Heart
Association, Inc.

<54>
[Use Link to view the full text]
Accession Number
630982058
Title
Angiographically Guided Complete Revascularization Versus Selective Stress
Echocardiography-Guided Revascularization in Patients with
ST-Segment-Elevation Myocardial Infarction and Multivessel Disease: The
CROSS-AMI Randomized Clinical Trial.
Source
Circulation: Cardiovascular Interventions. 12 (10) (no pagination), 2019.
Article Number: e007924. Date of Publication: 01 Oct 2019.
Author
Calvino-Santos R.; Estevez-Loureiro R.; Peteiro-Vazquez J.;
Salgado-Fernandez J.; Rodriguez-Vilela A.; Franco-Gutierrez R.;
Bouzas-Mosquera A.; Rodriguez-Fernandez J.A.; Mesias-Prego A.;
Gonzalez-Juanatey C.; Aldama-Lopez G.; Pinon-Esteban P.; Flores-Rios X.;
Soler-Martin R.; Seoane-Pillado T.; Vazquez-Gonzalez N.; Muniz J.;
Vazquez-Rodriguez J.M.
Institution
(Calvino-Santos, Peteiro-Vazquez, Salgado-Fernandez, Bouzas-Mosquera,
Rodriguez-Fernandez, Aldama-Lopez, Pinon-Esteban, Flores-Rios,
Soler-Martin, Seoane-Pillado, Vazquez-Gonzalez, Vazquez-Rodriguez)
Department of Cardiology, Hospital Universitario A Coruna, INIBIC, Spain
(Estevez-Loureiro) Department of Cardiology, Hospital Alvaro Cunqueiro,
Vigo, Spain
(Muniz) CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades
Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain
(Rodriguez-Vilela, Mesias-Prego) Department of Cardiology, Hospital
Universitario Arquitecto Marcide, Ferrol, Spain
(Franco-Gutierrez, Gonzalez-Juanatey) Department of Cardiology, Hospital
Universitario Lucus Augusti, Lugo, Spain
(Muniz) Instituto Universitario de Ciencias de la Salud, Universidad de A
Coruna, INIBIC (Instituto de Investigacion Biomedica de A Coruna), Spain
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Recent trials suggest that complete revascularization in
patients with acute ST-segment-elevation myocardial infarction and
multivessel disease is associated with better outcomes than
infarct-related artery (IRA)-only revascularization. There are different
methods to select non-IRA lesions for revascularization procedures. We
assessed the clinical outcomes of complete angiographically guided
revascularization versus stress echocardiography-guided revascularization
in patients with ST-segment-elevation myocardial infarction.
 Method(s): We performed a randomized clinical trial in patients with
multivessel disease who underwent a successful percutaneous coronary
intervention of the IRA to test differences in prognosis (composite end
point included cardiovascular mortality, nonfatal reinfarction, coronary
revascularization, and readmission for heart failure after 12 months of
follow-up) between complete angiographically guided revascularization
(n=154) or stress echocardiography-guided revascularization (n=152) of the
non-IRA lesions in an elective procedure before hospital discharge.
 Result(s): The trial was prematurely stopped after the inclusion of
77% of the planned study population. As many as 152 (99%) patients in the
complete revascularization group and 44 (29%) patients in the selective
revascularization group required a percutaneous coronary intervention
procedure of a non-IRA lesion before discharge. The primary end point
occurred in 21 (14%) patients of the stress echocardiography-guided
revascularization group and 22 (14%) patients of the complete
angiographically guided revascularization group (hazard ratio, 0.95; 95%
CI, 0.52-1.72; P=0.85). Conclusion(s): In patients with
ST-segment-elevation myocardial infarction and multivessel disease, stress
echocardiography-guided revascularization may not be significantly
different to complete angiographically guided revascularization, thereby
reducing the need for elective revascularization before hospital
discharge. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT01179126. Copyright © 2019 Lippincott Williams and Wilkins.
All rights reserved.

<55>
[Use Link to view the full text]
Accession Number
630982763
Title
Left Main Coronary Artery Disease Revascularization According to the
SYNTAX Score: Analysis from the EXCEL Trial.
Source
Circulation: Cardiovascular Interventions. 12 (9) (no pagination), 2019.
Article Number: e008007. Date of Publication: 01 Sep 2019.
Author
Shlofmitz E.; Genereux P.; Chen S.; Dressler O.; Ben-Yehuda O.; Morice
M.-C.; Puskas J.D.; Taggart D.P.; Kandzari D.E.; Crowley A.; Redfors B.;
Mehdipoor G.; Kappetein A.P.; Sabik J.F.; Serruys P.W.; Stone G.W.
Institution
(Shlofmitz, Genereux, Chen, Dressler, Ben-Yehuda, Crowley, Redfors,
Mehdipoor, Stone) Cardiovascular Research Foundation, NY, United States
(Shlofmitz, Ben-Yehuda, Stone) New York-Presbyterian Hospital, Columbia
University Medical Center, United States
(Genereux) Morristown Medical Center, NJ, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Quebec, QC, Canada
(Morice) Institut Cardiovasculaire Paris Sud, Ramsay Generale de Sante,
Massy, France
(Puskas) Mount Sinai Saint Luke's, NY, United States
(Taggart) John Radcliffe Hospital, Oxford, United Kingdom
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Redfors) Sahlgrenska University Hospital, Gothenburg, Sweden
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) UH Cleveland Medical Center, Cleveland, OH, United States
(Serruys) Imperial College London, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The SYNTAX (Synergy Between Percutaneous Coronary Intervention
With Taxus and Cardiac Surgery) score (SS), a measure of anatomic coronary
artery disease (CAD) extent and complexity, has proven useful in past
studies to determine the absolute and relative prognosis after
revascularization with percutaneous coronary intervention (PCI) versus
coronary artery bypass grafting (CABG). We sought to assess contemporary
outcomes after PCI and CABG in patients with left main CAD according to SS
and revascularization type from a large randomized trial. Method(s):
The EXCEL trial (Evaluation of XIENCE Versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization) randomized
patients with left main CAD and site-assessed SS<=32 to PCI with
everolimus-eluting stents or CABG. Four-year outcomes were examined
according to angiographic core laboratory-assessed SS using multivariable
Cox proportional hazards regression. Result(s): A total of 1840
patients with left main CAD randomized to PCI (n=914) versus CABG (n=926)
had angiographic core laboratory SS assessment. The mean SS was 26.5+/-9.3
(range 5-74); 24.1% of patients had angiographic core laboratory-assessed
SS >=33. The 4-year rate of the primary major adverse cardiac event end
point of death, stroke, or myocardial infarction was similar between PCI
and CABG (18.6% versus 16.7%, respectively; P=0.40) and did not vary
according to SS (P<inf>interaction</inf>=0.33). Rates of ischemia-driven
revascularization rose with increasing SS after PCI, but not after CABG.
As a result, the major secondary composite end point of major adverse
cardiac or cerebrovascular events (major adverse cardiac event or
ischemia-driven revascularization) occurred more frequently with PCI than
CABG (28.0% versus 22.0%, P=0.01), a difference which rose progressively
with increasing SS (P<inf>interaction</inf>=0.03). Conclusion(s): In
the EXCEL trial, the 4-year primary composite major adverse cardiac event
end point of death, myocardial infarction, or stroke was similar after PCI
with everolimus-eluting stents and CABG and was independent of the
baseline anatomic complexity and extent of CAD. In contrast, the relative
and absolute hazard of major adverse cardiac or cerebrovascular events
with PCI compared with CABG rose progressively with the SS. These data
should be considered by the heart team when deciding between PCI versus
CABG for revascularization in patients with left main CAD. Copyright
© 2019 American Heart Association, Inc.

<56>
Accession Number
630982749
Title
Dynamic Changes in the Molecular Signature of Adverse Left Ventricular
Remodeling in Patients with Compensated and Decompensated Chronic Primary
Mitral Regurgitation.
Source
Circulation: Heart Failure. 12 (9) (no pagination), 2019. Article Number:
e005974. Date of Publication: 01 Sep 2019.
Author
McCutcheon K.; Dickens C.; Van Pelt J.; Dix-Peek T.; Grinter S.;
McCutcheon L.; Patel A.; Hale M.; Tsabedze N.; Vachiat A.; Zachariah D.;
Duarte R.; Janssens S.; Manga P.
Institution
(McCutcheon, Grinter, McCutcheon, Tsabedze, Vachiat, Zachariah, Manga)
Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke
Johannesburg Academic Hospital, University of the Witwatersrand,
Johannesburg, South Africa
(Patel) Department of Cardiothoracic Surgery, Charlotte Maxeke
Johannesburg Academic Hospital, University of the Witwatersrand,
Johannesburg, South Africa
(Janssens) Department of Cardiovascular Diseases, University Hospitals
Leuven, Belgium
(Dickens, Dix-Peek, Duarte) Molecular Biology Laboratory, Department of
Internal Medicine, University of the Witwatersrand, Johannesburg, South
Africa
(Dickens, Hale) Department of Anatomical Pathology, University of the
Witwatersrand, Johannesburg, South Africa
(Van Pelt) Department of Clinical Digestive Oncology, Faculty of Medicine,
Katholieke Universiteit, Leuven and Leuven Cancer Institute, Leuven,
Belgium
(Van Pelt) Department of Cardiovascular Sciences, Katholieke Universiteit,
Leuven, Belgium
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: There is no proven medical therapy that attenuates adverse
left ventricular remodeling in patients with chronic primary mitral
regurgitation (CPMR). Identification of molecular pathways important in
the progression of left ventricular remodeling in patients with CPMR may
lead to development of new therapeutic strategies. Methods and
Results: We performed baseline echocardiographic, cardiac catheterization,
and serum NT-pro-BNP analysis in patients with severe CPMR awaiting mitral
valve surgery and stratified the study population into compensated or
decompensated CPMR. We obtained left ventricular endomyocardial biopsies
(n=12) for mRNA expression analysis, and compared baseline transcript
levels of 109 genes important in volume-overload left ventricular
remodeling with levels in normal hearts (n=5) and between patients with
compensated (n=6) versus decompensated (n=6) CPMR. Patients were then
randomized to treatment with and without carvedilol and followed until the
time of surgery (mean follow-up 8.3 months) when repeat endomyocardial
biopsies were obtained to correlate transcriptional dynamics with indices
of adverse remodeling. CPMR was associated with increased NPPA expression
levels (21.6-fold, P=0.004), decreased transcripts of genes important in
cell survival, and enrichment of extracellular matrix genes. Decompensated
CPMR was associated with downregulation of SERCA2 (0.77-fold, P=0.009) and
mitochondrial gene expression levels and upregulation of genes related to
inflammation, the extracellular matrix, and apoptosis, which were
refractory to carvedilol therapy. Conclusion(s): Transition to
decompensated CPMR is associated with calcium dysregulation, increased
expression of inflammatory, extracellular matrix and apoptotic genes, and
downregulation of genes important in bioenergetics. These changes are not
attenuated by carvedilol therapy and highlight the need for development of
specific combinatorial therapies, targeting myocardial inflammation and
apoptosis, together with urgent surgical or percutaneous valve
interventions. Copyright © 2019 American Heart Association, Inc.

<57>
[Use Link to view the full text]
Accession Number
630982471
Title
Electrical Stimulation of the Greater Auricular Nerve to Reduce
Postoperative Atrial Fibrillation.
Source
Circulation: Arrhythmia and Electrophysiology. 12 (10) (no pagination),
2019. Article Number: e007711. Date of Publication: 01 Oct 2019.
Author
Andreas M.; Arzl P.; Mitterbauer A.; Ballarini N.M.; Kainz F.-M.; Kocher
A.; Laufer G.; Wolzt M.
Institution
(Andreas, Arzl, Mitterbauer, Kainz, Kocher, Laufer) Department of Cardiac
Surgery, Medical University of Vienna, Austria
(Ballarini) Center for Medical Statistics, Informatics, and Intelligence
Systems (CeMSIIS), Medical University of Vienna, Austria
(Wolzt) Section for Medical Statistics, Department of Clinical
Pharmacology, Medical University of Vienna, Austria
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Postoperative atrial fibrillation (POAF) occurs in up to 40%
of patients undergoing cardiac surgery. Invasive stimulation of the vagal
nerve previously demonstrated a reduced risk of POAF. Therefore, we
examined the antiarrhythmic and anti-inflammatory effects of noninvasive
low-level transcutaneous electrical stimulation (LLTS) of the greater
auricular nerve in a pilot trial including patients undergoing cardiac
surgery. Method(s): Patients were randomized into a sham (n=20) or a
treatment group (n=20) for LLTS. After cardiac surgery, electrodes were
applied in the triangular fossa of the ear. Stimulation (amplitude 1 mA,
frequency 1 Hz for 40 minutes, followed by a 20 minutes break) was
performed for up to 2 weeks after cardiac surgery. Heart rhythm was
recorded continuously using an ECG during the observation period. CRP
(C-reactive protein) and IL (interleukin)-6 plasma concentrations were
measured immediately after surgery as well as on day 2 and 7 postsurgery.
 Result(s): Patients receiving LLTS had a significantly reduced
occurrence of POAF (4 of 20) when compared with controls (11 of 20,
P=0.022) during a similar mean Holter recording period. The median
duration of POAF was comparable between the treatment and the control
group (878 [249; 1660] minutes versus 489 [148; 1775] minutes; P=0.661).
No effect of LLTS on CRP or IL-6 levels was detectable.
 Conclusion(s): LLTS of the greater auricular nerve may be a potential
therapy for POAF. We demonstrated the feasibility to conduct a randomized
trial of neurostimulation as an outlay for a multisite clinical
trial. Copyright © 2019 Lippincott Williams and Wilkins. All
rights reserved.

<58>
Accession Number
2004270080
Title
High-dose nitroglycerin administered during rewarming preserves
erythrocyte deformability in cardiac surgery with cardiopulmonary bypass.
Source
Microcirculation. (no pagination), 2020. Article Number: e12608. Date of
Publication: 2020.
Author
Tai Y.-H.; Chu Y.-H.; Wu H.-L.; Lin S.-M.; Tsou M.-Y.; Huang C.-H.; Chang
H.-H.; Lu C.-C.
Institution
(Tai, Chu, Wu, Lin, Tsou, Lu) Department of Anesthesiology, Taipei
Veterans General Hospital, Taipei, Taiwan (Republic of China)
(Tai, Wu, Lin, Tsou, Huang) School of Medicine, National Yang-Ming
University, Taipei, Taiwan (Republic of China)
(Tai) Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical
University, New Taipei City, Taiwan (Republic of China)
(Tai) Department of Anesthesiology, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chu, Lu) Graduate Institute of Life Sciences, National Defense Medical
Center, Taipei, Taiwan (Republic of China)
(Huang, Chang) Division of Cardiovascular Surgery, Department of Surgery,
Taipei Veterans General Hospital, Taipei, Taiwan (Republic of China)
(Lu) Institute of Aerospace Medicine, National Defense Medical Center,
Taipei, Taiwan (Republic of China)
Publisher
Wiley Blackwell (E-mail: info@wiley.com)
Abstract
Objective: We aimed to determine whether high-dose nitroglycerin, a nitric
oxide donor, preserves erythrocyte deformability during cardiopulmonary
bypass and examines the signaling pathway of nitric oxide in erythrocytes.
 Method(s): In a randomized and controlled fashion, forty-two patients
undergoing cardiac surgery with hypothermic cardiopulmonary bypass were
allocated to high-dose (N = 21) and low-dose groups (N = 21). During
rewarming period, patients were given intravenous nitroglycerin with an
infusion rate 5 and 1 micro g.kg-1.min-1 in
high-dose and low-dose groups, respectively. Tyrosine phosphorylation
level of non-muscle myosin IIA in erythrocyte membrane was used as an
index of erythrocyte deformability and analyzed using immunoblotting.
 Result(s): Tyrosine phosphorylation of non-muscle myosin IIA was
significantly enhanced after bypass in high-dose group (3.729 +/- 1.700
folds, P =.011) but not low-dose group (1.545 +/- 0.595 folds, P =.076).
Phosphorylation of aquaporin 1, vasodilator-stimulated phosphoprotein, and
focal adhesion kinase in erythrocyte membrane was also upregulated in
high-dose group after bypass. Besides, plasma nitric oxide level was
highly correlated with fold change of non-muscle myosin IIA
phosphorylation (Pearson's correlation coefficient.871).
 Conclusion(s): High-dose nitroglycerin administered during
cardiopulmonary bypass improves erythrocyte deformability through
activating phosphorylation of aquaporin 1, vasodilator-stimulated
phosphoprotein, and focal adhesion kinase in erythrocytes. Copyright
© 2020 John Wiley & Sons Ltd

<59>
Accession Number
2004269128
Title
Septal flash is a prevalent and early dyssynchrony marker in transcatheter
aortic valve replacement-induced left bundle branch block.
Source
International Journal of Cardiovascular Imaging. (no pagination), 2020.
Date of Publication: 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, Corneel Heymanslaan
10, Ghent 9000, Belgium
Publisher
Springer (E-mail: editorial@springerplus.com)
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 (LBBB<inf>TAVR+SF</inf>) were compared to
randomly selected LBBB-SF patients with preserved (LBBB<inf>SF+PEF</inf>)
and reduced ejection fraction (LBBB<inf>SF+REF</inf>). 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 LBBB<inf>TAVR+SF</inf>
patients, SF was observed within 24 h after LBBB onset. Among LBBB-SF
patients, a classical strain pattern was more prevalent in
LBBB<inf>SF+REF</inf> patients compared to LBBB<inf>TAVR+SF</inf> patients
(80% vs. 7%; p < 0.001). IVMD was significantly longer in
LBBB<inf>SF+PEF</inf> patients (52 ms; p = 0.002) and
LBBB<inf>SF+REF</inf> patients (57 ms; p = 0.009) compared to
LBBB<inf>TAVR+SF</inf> 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. Copyright © 2020, Springer Nature B.V.

<60>
Accession Number
2004262973
Title
The Safety and Efficacy of Checkpoint Inhibitors in Transplant Recipients:
A Case Series and Systematic Review of Literature.
Source
Oncologist. (no pagination), 2020. Date of Publication: 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
Wiley-Blackwell (E-mail: info@wiley.com)
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. Copyright © AlphaMed Press 2020

<61>
Accession Number
2004270367
Title
The role of serratus anterior plane and pectoral nerves blocks in cardiac
surgery, thoracic surgery and trauma: a qualitative systematic review.
Source
Anaesthesia. (no pagination), 2020. Date of Publication: 2020.
Author
Jack J.M.; McLellan E.; Versyck B.; Englesakis M.F.; Chin K.J.
Institution
(Jack, Chin) Department of Anaesthesia, Toronto Western Hospital,
University of Toronto, Toronto, ON, Canada
(McLellan) Department of Anaesthesia and Peri-operative Medicine, Royal
Brisbane and Women's Hospital, Brisbane, QLD, Australia
(Versyck) Department of Anaesthesia and Pain Medicine, AZ Turnhout,
Turnhout, Belgium
(Englesakis) Library and Information Services, University Health Network,
Toronto, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
Serratus anterior plane and pectoral nerves blocks are recently described
alternatives to established regional anaesthesia techniques in cardiac
surgery, thoracic surgery and trauma. We performed a systematic review to
establish the current state of evidence for the analgesic role of these
fascial plane blocks in these clinical settings. We identified relevant
studies by searching multiple databases and trial registries from
inception to June 2019. Study heterogeneity prevented meta-analysis and
studies were instead qualitatively summarised and stratified by type of
surgery and comparator. We identified 51 studies: nine randomised control
trials; 13 cohort studies; 19 case series; and 10 case reports. The
majority of randomised controlled trials studied the serratus anterior
plane block in thoracotomy or video-assisted thoracoscopic surgery, with
only two investigating pectoral nerves blocks. The evidence in thoracic
trauma comprised only case series and reports. Results indicate that
single-injection serratus anterior plane and the pectoral nerves blocks
reduce pain scores and opioid consumption compared with systemic analgesia
alone in cardiothoracic surgery, cardiac-related interventional procedures
and chest trauma for approximately 6-12 h. The duration of action appears
longer than intercostal nerve blocks but may be shorter than thoracic
paravertebral blockade. Block duration may be prolonged by a continuous
catheter technique with potentially similar results to thoracic epidural
analgesia. There were no reported complications and the risk of
haemodynamic instability appears to be low. The current evidence, though
limited, supports the efficacy and safety of serratus anterior plane and
the pectoral nerves blocks as analgesic options in cardiothoracic
surgery. Copyright © 2020 Association of Anaesthetists

<62>
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. 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. 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. Copyright © 2019

<63>
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. Copyright © 2019, © 2019 Informa UK Limited, trading
as Taylor & Francis Group.

<64>
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. 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. 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. 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. Copyright ©
2019 The American Association for Thoracic Surgery

<65>
Accession Number
2001880554
Title
The impact of obesity on early postoperative atrial fibrillation burden.
Source
Journal of Thoracic and Cardiovascular Surgery. 159 (3) (pp 930-938.e2),
2020. Date of Publication: March 2020.
Author
Serban C.; Arinze J.T.; Starreveld R.; Lanters E.A.H.; Yaksh A.; Kik C.;
Acardag Y.; Knops P.; Bogers A.J.J.C.; de Groot N.M.S.
Institution
(Serban, Arinze, Starreveld, Lanters, Acardag, Knops, de Groot) Department
of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
(Yaksh) Department of Cardiology, Radboud University, Nijmegen,
Netherlands
(Kik, Bogers) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Obesity has been linked to the development of postoperative
atrial fibrillation. This study is aimed at investigating the role of body
mass index in the evolution of de novo, early postoperative atrial
fibrillation by assessing differences between obese and nonobese patients
undergoing cardiac surgery. Method(s): Patients with early de novo
postoperative atrial fibrillation were included. Continuous cardiac
rhythms were recorded during the first 5 postoperative days in obese (N =
67, 66 +/- 9 years; 51 [76%] male) and nonobese (N = 89, 69 +/- 9; 75
[84%] male) patients without a history of atrial fibrillation undergoing
cardiac surgery. Postoperative atrial fibrillation burden was defined as
the ratio between total duration of all atrial fibrillation episodes and
total recording time (atrial fibrillation burden, %). Result(s): A
total of 1191 (median: 5/patient) postoperative atrial fibrillation
episodes were identified in the obese group compared with 1218 (median:
4/patient) in the nonobese group. The median duration and number of
prolonged (>60 minutes) postoperative atrial fibrillation episodes were
higher in obese patients (250 vs 145 minutes, P = .003, and median of 2 vs
1 episode, P = .031). Obesity was associated with a larger early
postoperative atrial fibrillation burden (obese patients: median, 7%;
interquartile range, 2.5-19.7 vs nonobese patients: median, 3.2%;
interquartile range, 0.5-8.8, P = .001) mainly on the third postoperative
day (P = .021). Conclusion(s): Obesity predisposes to a larger number
of prolonged atrial fibrillation episodes in the early postoperative
period after cardiac surgery for coronary artery disease or valvular heart
disease. The higher atrial fibrillation burden in the early postoperative
period occurred particularly on the third day. Future studies will
determine whether obesity prevention may play a key role in reducing the
incidence of postoperative atrial fibrillation in patients undergoing
cardiac surgery. Copyright © 2019 The American Association for
Thoracic Surgery

<66>
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. 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.
 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%). 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. Copyright © 2019,
© 2019 Belgian Society of Cardiology.

<67>
Accession Number
630910430
Title
Small Diameter Xenogeneic Extracellular Matrix Scaffolds for Vascular
Applications.
Source
Tissue Engineering - Part B: Reviews. 26 (1) (pp 26-45), 2020. Date of
Publication: February 2020.
Author
Lopera Higuita M.; Griffiths L.G.
Institution
(Lopera Higuita) Mayo Graduate School of Biomedical Sciences, Mayo Clinic,
Rochester, MN, United States
(Griffiths) Department of Cardiovascular Diseases, Mayo Clinic, 200 First
Street SW Rochester, Rochester, MN 55905, United States
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Currently, despite the success of percutaneous coronary intervention
(PCI), coronary artery bypass graft (CABG) remains among the most commonly
performed cardiac surgical procedures in the United States. Unfortunately,
the use of autologous grafts in CABG presents a major clinical challenge
as complications due to autologous vessel harvest and limited vessel
availability pose a significant setback in the success rate of CABG
surgeries. Acellular extracellular matrix (ECM) scaffolds derived from
xenogeneic vascular tissues have the potential to overcome these
challenges, as they offer unlimited availability and sufficient length to
serve as "off-the-shelf" CABGs. Unfortunately, regardless of numerous
efforts to produce a fully functional small diameter xenogeneic ECM
scaffold, the combination of factors required to overcome all failure
mechanisms in a single graft remains elusive. This article covers the
major failure mechanisms of current xenogeneic small diameter vessel ECM
scaffolds, and reviews the recent advances in the field to overcome these
failure mechanisms and ultimately develop a small diameter ECM xenogeneic
scaffold for CABG. Currently, the use of autologous vessel in coronary
artery bypass graft (CABG) is common practice. However, the use of
autologous tissue poses significant complications due to tissue harvest
and limited availability. Developing an alternative vessel for use in CABG
can potentially increase the success rate of CABG surgery by eliminating
complications related to the use of autologous vessel. However, this
development has been hindered by an array of failure mechanisms that
currently have not been overcome. This article describes the currently
identified failure mechanisms of small diameter vascular xenogeneic
extracellular matrix scaffolds and reviews current research targeted to
overcoming these failure mechanisms toward ensuring long-term graft
patency. © Copyright 2020, Mary Ann Liebert, Inc., publishers
2020.

<68>
Accession Number
2004859189
Title
Angiographic Restenosis in Coronary Bifurcations Treatment with Regular
Drug Eluting Stents and Dedicated Bifurcation Drug-Eluting BiOSS Stents:
Analysis Based on Randomized POLBOS i and POLBOS II Studies.
Source
Cardiovascular Therapeutics. 2020 (no pagination), 2020. Article Number:
6760205. Date of Publication: 2020.
Author
Gil R.J.; Bil J.; Kern A.; Inigo-Garcia L.A.; Formuszewicz R.; Dobrzycki
S.; Vassilev D.; Mehran R.
Institution
(Gil, Bil) Department of Invasive Cardiology, Centre of Postgraduate
Medical Education, Central Clinical Hospital, Ministry of Interior and
Administration, Warsaw, Poland
(Kern) Department of Cardiology and Cardiosurgery, University of Varmia
and Masuria, Olsztyn, Poland
(Inigo-Garcia) Costa Del Sol Hospital, Marbella, Spain
(Formuszewicz) 10th Clinical Military Hospital, Bydgoszcz, Poland
(Dobrzycki) Department of Invasive Cardiology, Medical University in
Bialystok, Bialystok, Poland
(Vassilev) Alexandrovska University Hospital, Sofia, Bulgaria
(Mehran) Cardiovascular Institute, Mount Sinai Medical Center, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Aim. The marked variation in bifurcation anatomy has brought about an
ongoing search for stents specifically constructed for coronary
bifurcations. This study aimed to analyze the angiographic restenosis
prevalence and patterns and predictors of different patterns in dedicated
bifurcation BiOSS vs. current generation drug-eluting stents implanted in
coronary bifurcation lesions based on data from two clinical trials POLBOS
I and II. Methods. Dedicated bifurcation BiOSS stents were compared with
drug-eluting stents (DES) in patients with stable coronary artery disease
(CAD) or nonST elevation acute coronary syndrome (NSTE-ACS) (POLBOS I:
paclitaxel eluting BiOSS Expert vs. DES; POLBOS II: sirolimus eluting
BiOSS LIM vs. DES). Provisional T-stenting was the default treatment.
Morphological pattern of in-stent restenosis according to the modified
Mehran classification adopted for bifurcation lesions was assessed with
bifurcation dedicated quantitative coronary angiographic software (CAAS
5.11, Pie Medical Imaging BV, the Netherlands). Results. In total, 445
patients (222 patients in BiOSS group and 223 patients in DES group) were
included into the analysis. In BiOSS group 24 cases of angiographic
restenosis (10.8%) were recorded, and in DES group - 17 cases (7.6%) at 12
months follow-up (angiographic control rate at follow-up - 90.3%). In the
BiOSS group most frequent medina classification in restenotic cases was
0.0.1 (25%), whereas in DES - 0.0.1 and 0.1.1 (23.5% each). In
multivariate regression analysis proximal optimization technique was
associated with the lowest chance for restenosis (OR 0.15, 95% CI
0.06-0.33), whereas diabetes on insulin was associated with the highest
risk of restenosis (OR 4.21, 95% CI 1.48-11.44). Conclusions. The
angiographic restenosis pattern and rate was similar between BiOSS stents
and DES in coronary bifurcation lesions. Copyright © 2020 Robert
J. Gil et al.

<69>
Accession Number
2003691344
Title
Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A
Meta-Analysis.
Source
Annals of Thoracic Surgery. 109 (3) (pp 737-744), 2020. Date of
Publication: March 2020.
Author
Moscarelli M.; Fattouch K.; Gaudino M.; Nasso G.; Paparella D.; Punjabi
P.; Athanasiou T.; Benedetto U.; Angelini G.D.; Santarpino G.; Speziale G.
Institution
(Moscarelli) Imperial College NHLI, and Cardiothoracic and Vascular
Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA,
Italy, Italy
(Fattouch, Nasso, Speziale) Cardiothoracic and Vascular Department, Maria
Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy, Italy
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Paparella) Santa Maria Hospital, GVM Care & Research, Department of
Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
(Punjabi, Athanasiou) Imperial College of London, Hammersmith Hospital,
London, United Kingdom
(Benedetto, Angelini) Bristol Heart Institute, University of Bristol,
Bristol, United Kingdom
(Santarpino) GVM Care and Research, Department of Cardiovascular Surgery,
Bari, Italy
Publisher
Elsevier USA
Abstract
Background: There is high demand for minimally invasive mitral valve
repair; however, it is unclear whether the minimally invasive approach
provides the same performance as conventional sternotomy in a context of
complex mitral valve disease. Here, we compared outcomes of minimally
invasive and sternotomy procedures for bileaflet and Barlow's mitral valve
disease. Method(s): We performed a pooled meta-analysis of studies
reporting early and late follow-up of mitral valve repair for complex
mitral valve regurgitation. The primary outcome was moderate mitral valve
regurgitation recurrence and need for reoperation. Secondary outcomes
included operation time, reopening for bleeding, associated tricuspid
procedures, failed repair, and inhospital mortality. Incidence rates were
calculated for long-term follow-up. Effect estimates were calculated as
incidence rates with 95% confidence intervals. When Kaplan-Meier curves
were available, event rates were estimated from the curves with Plot
Digitizer software; otherwise, reported event rates were used to calculate
incidence rates. Result(s): Eighteen studies including 1905 patients
(654 minimally invasive and 1251 sternotomy) with a mean follow-up of 51.6
months (range, 14 to 138) were meta-analyzed with a random model. There
were no significant between-group differences in moderate mitral valve
regurgitation recurrence and reoperation (minimally invasive vs
sternotomy, 1.7% [95% confidence interval, 1.0% to 2.9%] vs 1.3% [95%
confidence interval, 0.9% to 1.8%], P =.22). Patients in the minimally
invasive group were exposed to significantly longer cross-clamp and
cardiopulmonary bypass times (P <.01); however, there were no additional
between-group differences in secondary outcomes. Conclusion(s): This
meta-analysis has demonstrated that minimally invasive and sternotomy
approaches produce comparable results for complex mitral valve
repair. Copyright © 2020 The Society of Thoracic Surgeons

<70>
Accession Number
2003377263
Title
Postoperative Atrial Fibrillation Following Noncardiac Surgery Increases
Risk of Stroke.
Source
American Journal of Medicine. 133 (3) (pp 311-322.e5), 2020. Date of
Publication: March 2020.
Author
Koshy A.N.; Hamilton G.; Theuerle J.; Teh A.W.; Han H.-C.; Gow P.J.; Lim
H.S.; Thijs V.; Farouque O.
Institution
(Koshy, Hamilton, Theuerle, Teh, Han, Lim, Farouque) Department of
Cardiology, Austin Health, Melbourne, Victoria, Australia
(Koshy, Teh, Han, Gow, Lim, Thijs, Farouque) Department of Medicine, The
University of Melbourne, Victoria, Australia
(Gow) Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria,
Australia
(Thijs) Stroke Division, Florey Institute of Neuroscience and Mental
Health and Department of Neurology, Austin Health, Melbourne, Victoria,
Australia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: New-onset postoperative atrial fibrillation is well recognized
to be an adverse prognostic marker in patients undergoing noncardiac
surgery. Whether postoperative atrial fibrillation confers an increased
risk of stroke remains unclear. Method(s): A systematic review and
meta-analysis was performed to assess the risk of stroke after
postoperative atrial fibrillation in noncardiac surgery. MEDLINE,
Cochrane, and EMBASE databases were searched for articles published up to
May 2019 for studies of patients undergoing noncardiac surgery that
reported incidence of new atrial fibrillation and stroke. Event rates from
individual studies were pooled and risk ratios (RR) were pooled using a
random-effects model. Result(s): Fourteen studies of 3,536,291
patients undergoing noncardiac surgery were included in the quantitative
analysis (mean follow-up 1.4 +/- 1 year). New atrial fibrillation occurred
in 26,046 (0.74%), patients with a higher incidence following thoracic
surgery. Stroke occurred in 279 (1.5%) and 6199 (0.4%) patients with and
without postoperative atrial fibrillation, respectively. On pooled
analysis, postoperative atrial fibrillation was associated with a
significantly increased risk of stroke (RR 2.51; 95% confidence interval,
1.76-3.59), with moderate heterogeneity. The stroke risk was significantly
higher with atrial fibrillation following nonthoracic, compared with
thoracic, surgery (RR 3.09 vs RR 1.95; P =. 01). Conclusion(s): New
postoperative atrial fibrillation following noncardiac surgery was
associated with a 2.5-fold increase in the risk of stroke. This risk was
highest among patients undergoing nonthoracic noncardiac surgery. Given
the documented efficacy of newer anticoagulants, randomized controlled
trials are warranted to assess whether they can reduce the risk of stroke
in these patients. Copyright © 2019 Elsevier Inc.

<71>
Accession Number
2004991035
Title
United States Administrative Databases and Cancer Registries for Thoracic
Surgery Health Services Research.
Source
Annals of Thoracic Surgery. 109 (3) (pp 636-644), 2020. Date of
Publication: March 2020.
Author
Groth S.S.; Habermann E.B.; Massarweh N.N.
Institution
(Groth) Department of Surgery, Division of General Thoracic Surgery,
Baylor College of Medicine, Houston, TX, United States
(Habermann) Division of Health Care Policy & Research, Department of
Health Sciences Research, Mayo Clinic, Rochester, MN, United States
(Massarweh) Center for Innovations in Quality, Effectiveness and Safety,
Michael E. DeBakey VA Medical Center, Houston, TX, United States
(Massarweh) Department of Surgery, Division of Surgical Oncology, Baylor
College of Medicine, Houston, TX, United States
Publisher
Elsevier USA
Abstract
Background: Data from administrative claims and cancer registries have an
ever-expanding role in thoracic surgery health services and health policy
research. However, their strengths, limitations, and appropriate
applications are often poorly understood, leading to errors in study
design and data interpretation. The intent of this review is to discuss
relevant and crucial considerations when conducting research with some of
the most common national thoracic surgery data sources. Method(s):
Information on the National Cancer Database; National Inpatient Sample;
American College of Surgeons National Surgical Quality Improvement
Project; Surveillance, Epidemiology, and End Results (SEER) Database;
SEER-linked databases; The Society of Thoracic Surgery General Thoracic
Surgery Database; and state cancer registries were obtained from the
official webpages for these databases and from a review of PubMed (1990 to
July 1, 2019). Result(s): We provided a review of the above-mentioned
commonly used administrative databases and cancer registries in thoracic
surgery health services research, with particular attention toward their
strengths and limitations. Conclusion(s): An appreciation of the
strengths, limitations, and differences between various sources of data
from administrative, hospital-based, and population-based cancer
registries is equally essential for investigators to improve the quality
and accuracy of their research and for readers to properly interpret the
results of such studies. Copyright © 2020 The Society of Thoracic
Surgeons

<72>
Accession Number
2004267180
Title
A Cost-Effectiveness Analysis Comparing the VivaSight Double-Lumen Tube
and a Conventional Double-Lumen Tube in Adult Patients Undergoing Thoracic
Surgery Involving One-Lung Ventilation.
Source
PharmacoEconomics - Open. 4 (1) (pp 159-169), 2020. Date of Publication:
01 Mar 2020.
Author
Larsen S.; Holm J.H.; Sauer T.N.; Andersen C.
Institution
(Larsen) Aalborg University, Niels Jernes Vej 10, Aalborg 9220, Denmark
(Holm, Sauer, Andersen) Odense University Hospital, J.B. Winslows Vej 4,
Odense 5000, Denmark
Publisher
Adis
Abstract
Background: One-lung ventilation (OLV) procedures are essential for most
thoracic surgeries, and the most common method is intubation with a
conventional double-lumen tube (cDLT) and bronchoscopy to verify correct
tube placement. Objective(s): The objective of this study was to
conduct a cost-effectiveness analysis comparing the VivaSight double-lumen
tube (DL) and a cDLT for OLV procedures. Method(s): A
cost-effectiveness analysis was conducted from a healthcare sector
perspective in Denmark using a decision analytic model to assess the
potential effects and costs of using VivaSight-DL as an alternative to a
cDLT with a reusable bronchoscope. Costs were determined using a
micro-costing approach. The effectiveness measure was the number of times
that fiberoptic confirmation of the tube placement during intubation or
surgery was unnecessary and thus avoided. The effectiveness input was from
a randomized controlled trial (n = 52). Both deterministic and
probabilistic sensitivity analyses were conducted to assess the robustness
of the results. Result(s): Fiberoptic confirmation of tube placement
was only necessary in two (6.66%) procedures using VivaSight-DL. The cost
of using VivaSight-DL was $US299.96 per procedure versus $US347.61 for a
cDLT with a reusable bronchoscope. The incremental cost-effectiveness
ratio was - $US51.06 per bronchoscopy avoided. The base-case analysis
indicated that the use of VivaSight-DL was cost effective compared with
the use of a cDLT with reusable bronchoscope. Sensitivity analyses showed
that the results were robust and that VivaSight-DL was more effective and
less costly. Conclusion(s): This study suggests that VivaSight-DL is
associated with cost savings and reductions in bronchoscope use to verify
correct tube placement. The conclusion is based on the results from a
single institution. To clarify whether VivaSight-DL is cost effective in
larger or global clinical settings, further economic evaluations should be
performed. Copyright © 2019, The Author(s).

<73>
[Use Link to view the full text]
Accession Number
630958137
Title
Effect of Home-Based Cardiac Rehabilitation in a Lower-Middle Income
Country: RESULTS from A CONTROLLED TRIAL.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 40 (1) (pp
29-34), 2020. Date of Publication: 01 Jan 2020.
Author
Joshi V.L.; Moniruzzaman M.; Karim R.; Uddin J.; Siraj M.; Rashid M.A.;
Rossau H.K.; Taylor R.S.; Zwisler A.-D.
Institution
(Uddin) Department of Cardiac Surgery, Physiotherapy Unit, Dhaka,
Bangladesh
(Uddin, Siraj) Department of Cardiac Surgery, Dhaka, Bangladesh
(Karim, Rashid) Department of Cardiology, Dhaka, Bangladesh
(Uddin, Joshi, Rossau, Taylor, Zwisler) Ibrahim Cardiac Hospital and
Research Institute, Shagbag, Dhaka, Bangladesh
(Uddin, Joshi, Rossau, Taylor, Zwisler) Danish Knowledge Centre for
Rehabilitation and Palliative Care (REHPA), Odense University Hospital and
University of Southern Denmark, Studiestrade 6, Copenhagen 1455, Denmark
(Moniruzzaman, Uddin) Department of Noncommunicable Disease, Bangladesh
University of Health Sciences (BUHS), Dhaka, Bangladesh
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, United Kingdom
(Taylor) Institute of Health and Well Being, University of Glasgow,
Glasgow, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: Cardiovascular disease is the leading cause of mortality and
morbidity in lower-middle income countries (LMICs), including Bangladesh.
Cardiac rehabilitation (CR) as part of secondary prevention of
cardiovascular disease has been shown to reduce mortality and morbidity
and improve quality of life and exercise capacity. However, to date, very
few controlled trials of CR have been conducted in LMICs. Method(s):
A quasi-randomized controlled trial comparing home-based CR plus usual
care with usual care alone was undertaken with patients following coronary
artery bypass graft surgery. Participants in the CR group received an
in-hospital CR class and were introduced to a locally developed
educational booklet with details of a home-based exercise program and then
received monthly telephone calls for 12 mo. Primary outcomes were coronary
heart disease (CHD) risk factors, health-related quality of life (HRQOL),
and mental well-being. Maximal oxygen uptake as a measure of exercise
capacity was a secondary outcome. Result(s): In total, 142 of 148
eligible participants took part in the trial (96%); 71 in each group. At
12-mo follow-up, 61 patients (86%) in the CR group and 40 (56%) in the
usual care group provided complete outcome data. Greater reductions in CHD
risk factors and improvements in HRQOL, mental well-being, and exercise
capacity were seen for the CR group compared with the usual care group.
 Conclusion(s): In the context of a single-center LMIC setting, this
study demonstrated the feasibility of home-based CR programs and offers a
model of service delivery that could be replicated on a larger
scale. Copyright © 2020 Lippincott Williams and Wilkins. All
rights reserved.

<74>
Accession Number
2004253870
Title
The prognostic value of late gadolinium enhancement in myocarditis and
clinically suspected myocarditis: systematic review and meta-analysis.
Source
European Radiology. (no pagination), 2020. Date of Publication: 2020.
Author
Yang F.; Wang J.; Li W.; Xu Y.; Wan K.; Zeng R.; Chen Y.
Institution
(Yang, Wang, Li, Xu, Zeng, Chen) Department of Cardiology, West China
Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan
610041, China
(Wan) Department of Geriatrics, West China Hospital, Sichuan University,
Chengdu, Sichuan Province 610041, China
(Chen) Center of Rare diseases, West China Hospital, Sichuan University,
Chengdu, Sichuan Province 610041, China
Publisher
Springer
Abstract
Objective: To evaluate the prognostic value of late gadolinium enhancement
(LGE) in myocarditis and clinically suspected myocarditis. Method(s):
The study was registered in PROSPERO (CRD42019144976). A systematic search
of PubMed, Ovid Medline, Embase, Web of Science and the Cochrane Central
Register of Controlled Trials was completed. Major adverse cardiac event
(MACE) was defined as the combination of all-cause mortality or
cardiovascular death, resuscitated cardiac arrest, heart transplantation,
appropriate implantable cardioverter-defibrillator shock,
rehospitalisation following a cardiac event and recurrent acute
myocarditis. Combined outcome was defined as the combination of all
adverse events. Pooled odds ratios (ORs) and 95% confidence intervals
(CIs) were calculated to evaluate the prognostic value of LGE.
 Result(s): Eight articles including 1319 patients (mean age, 38.8 +/-
12.9 years) were included in the meta-analysis. The study showed that
positive LGE was strongly associated with an increased risk of combined
outcome (pooled OR, 5.85; 95% CI, 2.88 to 11.86; p < 0.001) and of MACE
(pooled OR, 4.57; 95% CI, 2.18 to 9.59; p < 0.001). Additionally, in a
subgroup analysis with mean ejection fraction (EF) point of 50%, the
pooled ORs for the combined outcome were 6.46 for left ventricular EF
(LVEF) > 50% and 7.90 for LVEF <= 50%, and the pooled ORs for MACE were
9.03 and 3.45, respectively. After 3 years of follow-up, the worse
outcomes occurred mainly in patients with positive LGE.
 Conclusion(s): Positive LGE is a powerful prognosticator of adverse
outcome in myocarditis and clinically suspected myocarditis, irrespective
of LVEF. Key Points: * Forty-four percent to 100% of myocarditis patients
have positive late gadolinium enhancement. * Positive LGE was a powerful
prognosticator of adverse outcome in myocarditis and clinically suspected
myocarditis, irrespective of LVEF. * LGE-CMR is important tool for risk
stratification in myocarditis and clinically suspected
myocarditis. Copyright © 2020, European Society of Radiology.

<75>
Accession Number
2004246906
Title
Combined transepicardial and transseptal implantation of autologous CD
133+ bone marrow cells during bypass grafting improves cardiac function in
patients with low ejection fraction.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Soetisna T.W.; Sukmawan R.; Setianto B.; Mansyur M.; Murni T.W.;
Listiyaningsih E.; Santoso A.
Institution
(Soetisna) Department of Cardiothoracic and Vascular Surgery, National
Cardiovascular Center Harapan Kita, Jakarta, Indonesia
(Soetisna) Department of Surgery, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Sukmawan, Setianto) Department of Cardiology and Vascular Medicine,
National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
(Sukmawan, Setianto, Santoso) Department of Cardiology and Vascular
Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
(Mansyur) Department of Community Medicine, Faculty of Medicine,
Universitas Indonesia, Jakarta Pusat, Indonesia
(Murni) Department of Cardiothoracic and Vascular Surgery, Hasan Sadikin
Hospital, Universitas Padjadjaran, Bandung, Indonesia
(Listiyaningsih) Molecular Laboratory & Stem Cell Facility, National
Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Autologous CD133+ bone marrow stem cells may improve cardiac
function. This randomized, single-blind clinical trial inquired whether a
combined transepicardial and transseptal implantation of CD133+ stem cells
during coronary artery bypass grafting (CABG) improve cardiac function
with ejection fraction (EF) changes as a primary endpoint in patients with
low EF. Method(s): Thirty patients with coronary heart disease and EF
<35% were randomized to undergo CABG alone or CABG with transseptal and
transepicardial implantation of CD133+. Cardiac function was evaluated
using cardiac magnetic resonance imaging (MRI) before and 6 months after
CABG. Result(s): Preoperative EF was lower in the intervention group
(25.88% +/- 5.66%) than in the control group (30.18% +/- 3.85%; P =.04).
The adverse event incidence was similar between both groups. At 6 months,
EF changes were significantly higher (8.69% +/- 9.49; P =.04) in the
CD133+ group than in the CABG-only group. Compared to the control group,
significant improvements were seen in the wall motion score index (P
=.003) and scar size proportion (P =.047) in the CD133+ group. The quality
of life (QOL), assessed by a 6-minute walking test, showed considerable
improvement in the CD133+ group compared to that in the control group (P
=.03). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) scale
did not show improvement in the intervention group (P =.09, vs control).
 Conclusion(s): Combined transepicardial and transseptal autologous
CD133+ BMC implantation during bypass grafting improved cardiac function
in low EF coronary artery disease patients. Copyright © 2020 The
Authors. Journal of Cardiac Surgery Published by Wiley Periodicals, Inc.

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