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<1>
Accession Number
631091524
Title
Long-Term Effects of Transcatheter Aortic Valve Implantation on Coronary
Hemodynamics in Patients With Concomitant Coronary Artery Disease and
Severe Aortic Stenosis.
Source
Journal of the American Heart Association. 9 (5) (pp e015133), 2020. Date
of Publication: 03 Mar 2020.
Author
Vendrik J.; Ahmad Y.; Eftekhari A.; Howard J.P.; Wijntjens G.W.M.;
Stegehuis V.E.; Cook C.; Terkelsen C.J.; Christiansen E.H.; Koch K.T.;
Piek J.J.; Sen S.; Baan J.
Institution
(Vendrik, Wijntjens, Stegehuis, Koch, Piek, Baan) Heart Centre Amsterdam
UMC Amsterdam the Netherlands
(Ahmad, Howard, Cook, Sen) National Heart and Lung Institute Imperial
College London London United Kingdom
(Eftekhari, Terkelsen, Christiansen) Department of Cardiology Aarhus
Universitetshospital Skejby Aarhus Denmark
Publisher
NLM (Medline)
Abstract
Background As younger patients are being considered for transcatheter
aortic valve implantation (TAVI), the assessment and treatment of
concomitant coronary artery disease is taking on increased importance.
Methods and Results Thirteen contemporary lower-risk patients with TAVI
with severe aortic stenosis (AS) and moderate-severe coronary lesions were
included. Patients underwent assessment of coronary hemodynamics in the
presence of severe AS (pre-TAVI), in the absence of severe AS (immediately
post-TAVI), and at longer-term follow-up (6 months post-TAVI). Fractional
flow reserve decreased from 0.85 (0.76-0.88) pre-TAVI to 0.79 (0.74-0.83)
post-TAVI, and then to 0.71 (0.65-0.77) at 6-month follow-up (P<0.001 for
all comparisons). Conversely, instantaneous wave-free ratio was not
significantly different: 0.82 (0.80-0.90) pre-TAVI, 0.83 (0.77-0.88)
post-TAVI, and 0.83 (0.73-0.89) at 6 months (P=0.735). These changes are
explained by the underlying coronary flow. Hyperemic whole-cycle coronary
flow (fractional flow reserve flow) increased from 26.36 cm/s (23.82-31.82
cm/s) pre-TAVI to 30.78 cm/s (29.70-34.68 cm/s) post-TAVI (P=0.012), to
40.20 cm/s (32.14-50.00 cm/s) at 6-month follow-up (P<0.001 for both
comparisons). Resting flow during the wave-free period of diastole was not
significantly different: 25.48 cm/s (21.12-33.65 cm/s) pre-TAVI, 24.54
cm/s (20.74-27.88 cm/s) post-TAVI, and 25.89 cm/s (22.57-28.96 cm/s) at 6
months (P=0.500). Conclusions TAVI acutely improves whole-cycle hyperemic
coronary flow, with ongoing sustained improvements at longer-term
follow-up. This enhanced response to hyperemic stimuli appears to make
fractional flow reserve assessment less suitable for patients with severe
AS. Conversely, resting diastolic flow is not significantly influenced by
the presence of severe AS. Resting indices of coronary stenosis severity,
therefore, appear to be more appropriate for this patient population,
although large-scale prospective randomized trials will be required to
determine the role of coronary physiology in patients with severe AS.

<2>
Accession Number
2005010545
Title
Bacteremia caused by neisseria elongata in an infective endocarditis
patient: Case report and review of literature.
Source
Clinical Laboratory. 66 (1-2) (pp 221-224), 2020. Date of Publication:
2020.
Author
Chen Y.; Liu X.; Ai L.; Guo P.; Huang H.
Institution
(Chen, Ai, Guo, Huang) Department of Laboratory Medicine, First Affiliated
Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
(Liu) Department of Laboratory Medicine, Sun Yat-sen University,
Guangzhou, Guangdong, China
Publisher
Verlag Klinisches Labor GmbH (E-mail:
Cecile.Leugner@clin-lab-publications.com)
Abstract
Background: Neisseria elongata (N. elongate) is a strictly aerobic and
gram-negative rod bacterium which is a constituent of the commensal
bacterial flora in the pharynx. Infection caused by Neisseria elongata is
rarely reported. Here we describe a case of endocarditis in a patient
after aortic mechanical valve replacement caused by N. elongate in China.
<br/>Method(s): A 30-year-old man suffered infective endocarditis after
aortic mechanical valve replacement. Blood cultures were positive and the
organism was identified as Neisseria elongata by MALDI-TOF MS as well as
the 16S rRNA sequencing. <br/>Result(s): The patient was treated with
ofloxacin and meropenem. He was successfully treated with the 6-week
course of antibiotic therapy. <br/>Conclusion(s): N. elongate endocarditis
is rarely reported. Our report expands the range of infection caused by N.
elongate.<br/>&#xa9; Copyright

<3>
Accession Number
2003836425
Title
Vitamin c for cardiac surgery patients: Several errors in a published
meta-analysis. comment on "effects of vitamin c on organ function in
cardiac surgery patients: A systematic review and meta-analysis. Nutrients
2019, 11, 2103".
Source
Nutrients. 12 (2) (no pagination), 2020. Article Number: 586. Date of
Publication: February 2020.
Author
Hemila H.; Chalker E.
Institution
(Hemila) Department of Public Health, University of Helsinki, POB 41,
Helsinki FI-00014, Finland
(Chalker) School of Public Health, University of Sydney, Sydney 2006,
Australia
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)

<4>
Accession Number
628492245
Title
Perioperative takotsubo cardiomyopathy: Implications for anesthesiologist.
Source
Annals of Cardiac Anaesthesia. 22 (3) (pp 309-315), 2019. Date of
Publication: 01 Jul 2019.
Author
Agarwal S.; Sanghvi C.; Odo N.; Castresana M.
Institution
(Agarwal, Sanghvi, Odo, Castresana) Department of Anesthesiology and
Perioperative Medicine, Medical College of Georgia, Augusta University,
Augusta, GA, United States
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by transient ventricular
dysfunction in the absence of obstructive coronary artery disease that may
be triggered by an acute medical illness or intense physical or emotional
stress. TCM is often confused with acute myocardial infarction given the
similar electrocardiographic changes, cardiac enzymes, hemodynamic
perturbations, and myocardial wall motion abnormalities. In the
perioperative setting, the clinical picture may be more confusing because
of the effect of anesthesia as well as hemodynamic changes related to the
surgery itself. However, awareness of various other diagnostic modalities
may enable clinicians to distinguish between the two, more systematically
and with greater certainty. Despite the large body of literature, there
still seems to be an overall paucity in our understanding of the
etiopathogenesis, clinical characteristics, natural history, and
management of this syndrome, especially in the perioperative setting. This
narrative review seeks to present and synthesize the most recent
literature on TCM and to identify gaps in current knowledge which can
become the basis for future research.<br/>Copyright &#xa9; 2019 Annals of
Cardiac Anaesthesia.

<5>
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Accession Number
631011104
Title
Unrestricted use of polymer-free sirolimus eluting stents in routine
clinical practice.
Source
Medicine (United States). 99 (8) (no pagination), 2020. Article Number:
e19119. Date of Publication: 2020.
Author
Krackhardt F.; Kocka V.; Waliszewski M.; Tousek P.; Janek B.; Trencan M.;
Krajci P.; Lozano F.; Roman K.G.-S.; Otaegui I.; Del Blanco B.G.; Del Olmo
V.V.; Nofrerias E.F.; Wachowiak L.; Heang T.M.; Ahn T.H.; Jeong M.H.; Jung
B.-C.; Han K.-R.; Piot C.; Sebagh L.; Rischner J.; Pansieri M.; Leschke
M.; Rosa S.D.
Institution
(Krackhardt, Waliszewski) Department of Internal Medicine and Cardiology,
Charite - Universitatsmedizin Berlin, Campus Virchow Klinikum, Berlin,
Germany
(Kocka, Tousek) University Hospital Kralovske Vinohrady Prague, Czechia
(Waliszewski) Medical Scientific Affairs, B.Braun Melsungen AG, Berlin,
Germany
(Janek) IKEM Prague, Czechia
(Trencan, Krajci) SUSCCH, A.s. Banska Bystrica, Slovakia
(Lozano) Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
(Roman) Hospital Universitario de Cruces, Bilbao, Spain
(Otaegui, Del Blanco) Hospital Universitari Vall d'Hebron, Spain
(Del Olmo, Nofrerias) Hospital Universitari Germans Trias i Pujol,
Badalona, Spain
(Wachowiak) Medical Scientific Affairs, B.Braun France, Saint Cloud,
France
(Heang) Pantai Ayer Keroh Hospital, Malaysia
(Ahn) Gachon University Gil Medical Center, Incheon, South Korea
(Jeong) Chonnam National University, Gwangju, South Korea
(Jung) Daegu Fatima Hospital, South Korea
(Han) Kangdong Sacred Heart Hospital, South Korea
(Piot) Clinique du Millenaire, Montpellier, France
(Sebagh) Clinique Turin Paris, France
(Rischner) Hopital Albert Schweitzer Colmar, France
(Pansieri) Centre Hospitalier d'Avignon, Avignon, France
(Leschke) Stadtische Kliniken Esslingen, Esslingen, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Stent designs with ultrathin struts may further increase the procedural
success of challenging lesion subsets. The objective of this study was to
assess the safety and efficacy of ultrathin strut, polymer-free sirolimus
eluting stent (PF-SES) implantations in a large scale, unselected patient
population.Adult patients underwent percutaneous coronary interventions
(PCI) with a thin-strut PF-SES. Data from two all-comers observational
studies having the same protocol (ClinicalTrials.gov Identifiers:
NCT02629575 and NCT02905214) were pooled. The accumulated target lesion
revascularization (TLR) rate at 9-12 months was the primary endpoint. All
dual antiplatelet therapy strategies according to the applicable
guidelines were permissible.In total, 7243 patients were prospectively
enrolled for PCI with PF-SES in stable coronary artery disease or acute
coronary syndrome (ACS). Major risk factors in the overall cohort were
diabetes (37.3%), ST elevation myocardial infarction (18.1%) and non-ST
myocardial infarction (24.6%). The follow-up rate was 88.6% in the overall
population. The TLR rate in the overall cohort was 2.2% whereas
definite/probable stent thrombosis (ST) occurred in 0.7%. In patients with
in-stent restenosis lesions, the major adverse cardiac events rate was
6.4% whereas the corresponding rate for isolated left main coronary artery
(LMCA) disease was highest with 6.7% followed by patients with culprit
lesions in vein bypasses (VB, 7.1%). The mortality rate in patients
treated in VB lesions was highest with 5.4%, followed by the isolated LMCA
subgroup (3.4%) and ACS (2.6%).PCI with PF-SES in an unselected patient
population, is associated with low clinical event and ST rates.
Furthermore, PF-SES angioplasty in niche indications demonstrated
favorable safety and efficacy outcomes with high procedural success
rates.<br/>Copyright &#xa9; 2020 the Author(s). Published by Wolters
Kluwer Health, Inc.

<6>
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. <br/>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. <br/>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%. <br/>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.<br/>Copyright &#xa9; 2019 Elsevier Masson SAS

<7>
Accession Number
630992035
Title
Proposed pathway for patients undergoing enhanced recovery after spinal
surgery: Protocol for a systematic review.
Source
Systematic Reviews. 9 (1) (no pagination), 2020. Article Number: 39. Date
of Publication: 21 Feb 2020.
Author
Licina A.; Silvers A.; Laughlin H.; Russell J.; Wan C.
Institution
(Licina, Laughlin, Russell) Austin Health, 145 Studley Road, Heidelberg,
VIC 3084, Australia
(Silvers) Monash Health, 246 Clayton Road, Clayton, Australia
(Wan) St Vincent's Health, 41 Victoria Parade, Fitzroy, VIC 3065,
Australia
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The best evidence-enhanced recovery care pathway is yet to be
defined for patients undergoing spinal surgery. Minimally invasive
surgery, multimodal analgesia, early mobilization, and early postoperative
nutrition have been considered as critical components of enhanced recovery
in spinal surgery (ERSS). The objective of this study will be to
synthesize the evidence underpinning individual components of a proposed
multidisciplinary enhanced recovery pathway for patients undergoing spinal
surgery. <br/>Method(s): This is the study protocol for a systematic
review of complex interventions. Our team identified 22 individual care
components of a proposed pathway based on clinical practice guidelines and
published reviews. We will include systematic reviews and meta-analysis,
randomized controlled trials, non-randomized controlled trials, and
observational studies in adults or pediatric patients evaluating any one
of the pre-determined care components. Our primary outcomes will be
all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal,
surgical complications), patient-reported outcomes and experiences (e.g.,
pain, quality of care experience), and health services outcomes (e.g.,
length of stay and costs). We will search the following databases (1990
onwards) MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of
Systematic Reviews and CENTRAL). Two reviewers will independently screen
all citations, full-text articles, and abstract data. Potential conflicts
will be resolved through discussion. The risk of bias for individual
studies will be appraised using appropriate tools. A narrative synthesis
will be provided with the information presented in the text and tables to
summarize and explain the characteristics and findings of the included
studies. Due to clinical and methodological heterogeneity, we do not
anticipate to conduct meta-analyses. Confidence in cumulative evidence for
each component of care will be classified according to the GRADE system.
<br/>Discussion(s): This systematic review will identify, evaluate, and
integrate the evidence underpinning individual components of a pathway for
patients undergoing spinal surgery. The formation of an evidence-based
pathway will allow for the standardization of clinical care delivery
within the context of enhanced recovery in spinal surgery. Systematic
review registration: PROSPERO CRD42019135289<br/>Copyright &#xa9; 2020 The
Author(s).

<8>
Accession Number
630399757
Title
Epidemiology and management of primary spontaneous pneumothorax: a
systematic review.
Source
Interactive cardiovascular and thoracic surgery. 30 (3) (pp 337-345),
2020. Date of Publication: 01 Mar 2020.
Author
Mendogni P.; Vannucci J.; Ghisalberti M.; Anile M.; Aramini B.; Congedo
M.T.; Nosotti M.; Bertolaccini L.; D'Ambrosio A.E.; De Vico A.; Guerrera
F.; Imbriglio G.; Pardolesi A.; Schiavon M.; Russo E.
Institution
(Mendogni, Nosotti) Thoracic Surgery and Lung Transplant Unit, Foundation
IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
(Vannucci, Anile) Department of Thoracic Surgery, Umberto I Hospital,
University of Rome Sapienza, Rome, Italy
(Ghisalberti) Thoracic Surgery Unit, University Hospital of Siena, Siena,
Italy
(Aramini) Division of Thoracic Surgery, Department of Medical and Surgical
Sciences for Children & Adults, University Hospital of Modena and Reggio
Emilia, Modena, Italy
(Congedo) Division of Thoracic Surgery, Catholic University of Sacred
Heart, Rome, Italy
(Bertolaccini) Division of Thoracic Surgery, IEO, European Institute of
Oncology IRCCS, Milan, Italy
(D'Ambrosio) Thoracic Surgery Unit, Catania, Italy
(De Vico) Thoracic Surgery Unit, Brescia, Italy
(Guerrera) Department of Thoracic Surgery, University of Torino, Torino,
Italy
(Imbriglio) Thoracic Surgery Unit, Vito Fazzi Hospital, Lecce, Italy
(Pardolesi) Unit of Thoracic Surgery, Foundation IRCCS National Cancer
Institute of Milan, Milan, Italy
(Schiavon) Thoracic Surgery Unit, Department of Cardiac, Thoracic,
Vascular Sciences and Public Health, University of Padova, Padova, Italy
(Russo) Division of Thoracic Surgery and Lung Transplantation, Department
for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic
Transplantation, Palermo, Italy
Publisher
NLM (Medline)
Abstract
Primary spontaneous pneumothorax (PSP) is one of the most common thoracic
diseases affecting adolescents and young adults. Despite the high
incidence of PSP and the availability of several international guidelines
for its diagnosis and treatment, a significant behavioural heterogeneity
can be found among those management recommendations. A working group of
the Italian Society of Thoracic Surgery summarized the best evidence
available on PSP management with the methodological tool of a systematic
review assessing the quality of previously published guidelines with the
Appraisal of Guidelines for Research and Evaluation (AGREE) II. Concerning
PSP physiopathology, the literature seems to be equally divided between
those who support the hypothesis of a direct correlation between changes
in atmospheric pressure and temperature and the incidence of PSP, so it is
not currently possible to confirm or reject this theory with reasonable
certainty. Regarding the choice between conservative treatment and chest
drainage in the first episode, there is no evidence on whether one option
is superior to the other. Video-assisted thoracic surgery represents the
most common and preferred surgical approach. A primary surgical approach
to patients with their first PSP seems to guarantee a lower recurrence
rate than that of a primary approach consisting of a chest drainage
positioning; conversely, the percentage of futile surgical interventions
that would entail this aggressive attitude must be carefully evaluated.
Surgical pleurodesis is recommended and frequently performed to limit
recurrences; talc poudrage offers efficient pleurodesis, but a
considerable number of surgeons are concerned about administering this
inert material to young patients. CLINICAL TRIAL REGISTRATION NUMBER:
International Prospective Register of Systematic Reviews (PROSPERO):
CRD42018084247.<br/>Copyright &#xa9; The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<9>
Accession Number
2003376600
Title
Prior Percutaneous Coronary Interventions May Be Associated With Increased
Mortality After Coronary Bypass Grafting: A Meta-Analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. 32 (1) (pp 59-74), 2020.
Date of Publication: Spring 2020.
Author
Luthra S.; Leiva-Juarez M.M.; Shine B.; Al-Attar N.; Ohri S.; Taggart D.P.
Institution
(Luthra, Ohri) Southampton University Hospitals, Southampton, United
Kingdom
(Leiva-Juarez) Department of Surgery, Brookdale University Hospital and
Medical Center, Brooklyn, NY, United States
(Shine, Taggart) University of Oxford, Oxford, United Kingdom
(Al-Attar) Golden Jubilee National Hospital, Glasgow, United Kingdom
Publisher
W.B. Saunders
Abstract
There is conflicting evidence for adverse outcomes after coronary artery
bypass surgery (CABG) with prior percutaneous intervention (PCI). A
literature search was performed from 1998 to 2017 and articles with
primary or secondary outcomes of survival, major adverse cardiovascular
events (MACE), and myocardial infarction in CABG patients with prior PCI
were included. Forest plots were generated from odds ratios for survival,
MACE, and myocardial infarction for unmatched and propensity-matched data.
Heterogeneity between studies was assessed for all outcomes using
I². Funnel plots were generated for early survival, survival at
5 years, survival at >5 years, and MACE. Thirty-one studies were included
over 18 years with 194,544 patients without PCI prior to CABG and 23,519
patients (12.09%) with prior PCI. Prior PCI did not adversely affect
survival among the included studies (inverse rate ratio: 1.12, 95%
confidence interval: 0.98-1.27, P = 0.110. MACE was significantly worse
for those with prior PCI (odds ratio: 1.26, confidence interval:
1.02-1.55, P = 0.03). The relative risk of mortality associated with prior
PCI has decreased significantly over the last 2 decades. Studies with
higher percentage of prior PCI patients had higher relative mortalities.
There was significant heterogeneity between studies for the treatment
effects. PCI prior to CABG in recent times does not adversely affect
survival despite adverse early and late MACE rates. However, high
institutional rates of prior PCI may be associated with increasing
mortality after CABG.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<10>
Accession Number
2002841812
Title
The Eternal Debate With a Consistent Answer: CABG vs PCI.
Source
Seminars in Thoracic and Cardiovascular Surgery. 32 (1) (pp 14-20), 2020.
Date of Publication: Spring 2020.
Author
Farina P.; Gaudino M.F.L.; Taggart D.P.
Institution
(Farina) Department of Cardiothoracic Surgery, Mater Misericordiae
University Hospital, Dublin, Ireland
(Gaudino) Department of Cardiothoracic Surgery, John Radcliffe Hospital,
Oxford, United Kingdom
(Taggart) Department of Cardiothoracic Surgery, Weill Cornell Medical
College, New York, NY, United States
Publisher
W.B. Saunders
Abstract
An ongoing debate exists over the role of percutaneous coronary
intervention and coronary artery bypass grafting for revascularization in
patients with multivessel or left main disease. Despite improvements in
stent technology, bypass surgery still provides the best long-term results
in the majority of patients. The present review focuses on randomized
controlled trials and a meta-analysis published over the last 4
years.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<11>
Accession Number
2002841390
Title
Efficacy of Bilateral Erector Spinae Plane Block in Management of Acute
Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a
Midline Sternotomy.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (4) (pp 981-986),
2020. Date of Publication: April 2020.
Author
Kaushal B.; Chauhan S.; Magoon R.; Krishna N.S.; Saini K.; Bhoi D.; Bisoi
A.K.
Institution
(Kaushal, Chauhan, Magoon, Krishna) Department of Cardiac Anesthesiology,
Cardio, and Neurosciences Center, AIIMS, New Delhi, India
(Saini, Bhoi) Department of Anesthesiology, Pain Medicine and Critical
Care, AIIMS, New Delhi, India
(Bisoi) Department of Cardiothoracic and Vascular Surgery, Cardio, and
Neurosciences Center, AIIMS, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: Regional analgesia continues to evolve with the introduction of
ultrasound-guided fascial plane blocks. Erector spinae plane block (ESPB)
is a novel technique gaining recent acceptability as a perioperative
modality of analgesia in various thoracic and abdominal surgeries.
However, literature on the use of ESPB in pediatric cardiac surgery is
limited. <br/>Design(s): A prospective, randomized, single-blind,
comparative study. <br/>Setting(s): Single-institution tertiary referral
cardiac center. <br/>Participant(s): Eighty children with acyanotic
congenital heart disease undergoing cardiac surgery through midline
sternotomy. <br/>Intervention(s): The subjects were allocated randomly
into 2 groups: ESPB (group B, n = 40) received ultrasound-guided bilateral
ESPB at the level of T<inf>3</inf> transverse process and control (group
C, n = 40) receiving no block. <br/>Measurements and Main Results: The
postoperative pain was assessed using Modified Objective Pain Scores
(MOPS) which were evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours after
extubation. Group B demonstrated significantly reduced MOPS as compared
with group C until the 10th postoperative hour (p < 0.0001), with
comparable MOPS at the 12th hour. The consumption of postoperative rescue
fentanyl was also significantly less in group B in comparison to group C
(p < 0.0001) with a longer duration to first rescue dose requirement in
group B. In addition, the group B showed lower postoperative sedation
scores and intensive care unit stay in contrast to group C.
<br/>Conclusion(s): Ultrasound-guided bilateral ESPB presents a simple,
innovative, reliable, and effective postoperative analgesic modality for
pediatric cardiac surgeries contemplated through a midline
sternotomy.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<12>
Accession Number
2002249474
Title
Hands-On Surgical Simulation in Congenital Heart Surgery: Literature
Review and Future Perspective.
Source
Seminars in Thoracic and Cardiovascular Surgery. 32 (1) (pp 98-105), 2020.
Date of Publication: Spring 2020.
Author
Hussein N.; Honjo O.; Haller C.; Hickey E.; Coles J.G.; Williams W.G.; Yoo
S.-J.
Institution
(Hussein, Honjo, Haller, Hickey, Coles, Williams, Yoo) Division of
Cardiology, Department of Paediatrics, Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada
(Hussein, Honjo, Haller, Hickey, Coles, Williams) Division of
Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada
(Yoo) Department of Diagnostic Imaging, Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada
Publisher
W.B. Saunders
Abstract
Congenital heart surgery is a technically demanding specialty resulting in
a prolonged training period. With the growing expectation of perfect
patient outcomes, there is a need for improved training methods by
implementing simulation. We assess the utilization of simulation in the
training of congenital heart surgeons and discuss its future implications.
A keyword-based PubMed literature search was conducted for hands-on
surgical simulation in congenital heart surgery. The abstracts/titles of
the search were reviewed and papers using simulation specific to
congenital cardiac surgery were selected. Studies that did not include
surgeons operating on the simulator, or did not incorporate assessment
methods were excluded. Analysis included the problem addressed,
simulator-type, methodology, assessment methods, results,
benefits/limitations, and reproducibility. Five papers fulfilled our
selection criteria of hands-on surgical simulation in congenital heart
surgery with an assessment of the simulator or procedural performance. One
simulation used animal models and 4 utilized 3D-printed models. Simulators
covered either single or multiple complex procedures. All studies
highlight usefulness of simulation; however, only 1 study has been
replicated with >10 participants. The studies demonstrate how hands-on
surgical simulation is possible within congenital heart surgery. Although
primarily proof of concept studies, the next step would involve using a
greater number of participants and demonstrate how repetition and
deliberate practice will improve outcomes. Congenital heart surgery is one
of the most technically demanding surgical specialties; therefore, we
should lead the way in utilizing simulation to complement the training of
our surgeons as we face the challenges ahead.<br/>Copyright &#xa9; 2019

<13>
Accession Number
2002085697
Title
Thyroid Hormone (Triiodothyronine) Therapy in Children After Congenital
Heart Surgery: A Meta-Analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. 32 (1) (pp 87-95), 2020.
Date of Publication: Spring 2020.
Author
Flores S.; Loomba R.S.; Checchia P.A.; Graham E.M.; Bronicki R.A.
Institution
(Flores, Checchia, Bronicki) Section of Critical Care and Cardiology,
Department of Pediatrics, Texas Children's Hospital, Baylor College of
Medicine, Houston, TX, United States
(Loomba) Division of Cardiology, Advocate Children's Hospital, Oak Lawn,
IL, United States
(Graham) Division of Cardiology, Department of Pediatrics, Medical
University of South Carolina, Charleston, SC, United States
Publisher
W.B. Saunders
Abstract
Thyroid hormone modifies metabolic, immune and cardiovascular functions
and has been administered perioperatively to treat a relative reduction of
thyroid function in children following cardiopulmonary bypass (CPB) for
correction of congenital heart disease. However, it remains unclear
whether its use is associated with improved outcomes. We performed a
meta-analysis of studies that evaluated the impact of thyroid hormone
supplementation on clinical outcomes in children undergoing repair of
congenital heart disease using CPB. A systematic review of published
trials was conducted to identify studies of children randomized to thyroid
hormone supplementation or placebo undergoing congenital heart surgery. A
meta-analysis was then conducted to determine the clinical impact of
thyroid hormone replacement on cardiac function and postoperative
characteristics. The following outcomes were included for the study:
duration of mechanical ventilation, duration of intensive care unit (ICU)
stay, duration of postoperative hospital stay, inotrope score, cardiac
index at 24 hours postoperatively, and inpatient mortality. A total of 9
studies with 711 patients were included in the analyses. All included
studies were prospective and patients were randomized to either thyroid
hormone or placebo. There was wide variation in thyroid hormone dosing,
ranging from 0.4 mug/kg up to 5 mug/kg over a 24-hour period, and duration
of therapy, ranging from a single dose after cessation of CPB to continued
thyroid hormone for the duration of the ICU stay. There was a significant
difference in the mean inotrope score between the 2 groups of -1.249 (95%
confidence interval -1.570 to -0.929, P < 0.001), with the inotrope score
being significantly lower in the thyroid group. There was no difference in
duration of mechanical ventilation, duration of ICU stay, duration of
hospital stay, cardiac index, and mortality between groups. In this
meta-analysis, routine thyroid hormone replacement with approximately 1-5
mug/kg administered over 24 hours does not significantly alter the
postoperative course in children following CPB. However, given a
clinically small but significant difference in respect to lower inotrope
score and shorter duration of ICU and hospital stays with higher thyroid
replacement additional studies are warranted.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<14>
Accession Number
2004191107
Title
Cost-Effectiveness Analysis of Landiolol, an Ultrashort-Acting
Beta-Blocker, for Prevention of Postoperative Atrial Fibrillation for the
Germany Health Care System.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (4) (pp 888-897),
2020. Date of Publication: April 2020.
Author
Walter E.; Heringlake M.
Institution
(Walter) IPF Institute for Pharmaeconomic Research, Vienna, Austria
(Heringlake) Department of Anesthesiology and Intensive Care Medicine,
University of Lubeck, Lubeck, Germany
Publisher
W.B. Saunders
Abstract
Objectives: Landiolol is an ultrashort-acting beta-blocker with high
beta-1 receptor affinity and less blood pressure-lowering properties than
other beta-blockers available for intravenous use in Germany. The present
analysis aimed to determine whether perioperative treatment with landiolol
in cardiac surgical patients is cost-effective under the conditions of the
German Diagnosis-Related Groups health cost reimbursement system.
<br/>Design(s): On the basis of clinical outcome data from a meta-analysis
that included 622 patients from 7 randomized controlled trials, a
decision-model was developed to determine the cost-effectiveness of
landiolol versus standard-of-care (SoC). <br/>Setting(s): Hospital
setting. <br/>Participant(s): Hospital patients undergoing a
representative mix of cardiac surgical procedures (MIX-CS) and isolated
coronary artery bypass grafting (CABG). <br/>Intervention(s): Landiolol
versus SoC in prevention of atrial fibrillation immediately after cardiac
surgery. <br/>Measurements and Main Results: The model benefit was
expressed in a reduction of postoperative atrial fibrillation (POAF)
episodes and reduced complications. The model calculated total inpatient
costs over the hospital length of stay. Costs from published sources were
used for the German hospital perspective. SoC was associated with POAF
rates of 36.0% to 39.2% and 24.4% to 30.1% in the MIX-CS and CABG
populations, respectively. Patients with POAF had a higher morbidity and
mortality. Estimated total costs for SoC patients in the MIX-CS and CABG
groups were 28.792 and 25.630 , respectively. Landiolol reduced the
incidence of POAF to 12.6% in the MIX-CS and 12.1% in the CABG groups.
This was associated with a cost reduction of 2.209 and 1.470 .
<br/>Conclusion(s): This analysis suggests that preventing POAF with
landiolol is highly cost-effective. Additional studies are needed to
assess whether a comparable reduction in POAF and associated cost savings
may be achieved using conventional intravenous beta-blockers or
amiodarone.<br/>Copyright &#xa9; 2019 The Authors

<15>
Accession Number
2004001126
Title
Microvascular Alterations During Cardiac Surgery Using a Heparin or
Phosphorylcholine-Coated Circuit.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (4) (pp 912-919),
2020. Date of Publication: April 2020.
Author
Dekker N.A.M.; Veerhoek D.; van Leeuwen A.L.I.; Vonk A.B.A.; van den Brom
C.E.; Boer C.
Institution
(Dekker, Boer) Department of Anesthesiology, Amsterdam UMC, Vrije
Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam,
Netherlands
(Dekker, van Leeuwen, van den Brom) Department of Physiology, Amsterdam
UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences,
Amsterdam, Netherlands
(Dekker, Veerhoek, van Leeuwen, Vonk, van den Brom) Department of
Cardio-thoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam,
Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Heparin biocompatible coating frequently is used to reduce
inflammation and blood coagulation during cardiopulmonary bypass (CPB) in
cardiac surgery. Whether heparin coating is protective or damaging to the
vascular endothelium is unclear. The authors investigated whether
heparin-coated (HC) circuits are associated with better preservation of
microcirculatory perfusion and glycocalyx dimensions compared with
nonheparin phosphorylcholine-coated (PC) circuits. <br/>Design(s):
Prospective, randomized blinded study. <br/>Setting(s): Tertiary
university hospital. <br/>Participant(s): A total of 26 adults undergoing
elective coronary artery bypass graft surgery with CPB.
<br/>Intervention(s): PC (n = 13) versus HC circuits (n = 13).
<br/>Measurements and Main Results: Sublingual microcirculatory perfusion
was measured before, during, and after CPB using sidestream dark field
imaging and analyzed for perfused vessel density and perfused boundary
region, an inverse parameter for glycocalyx dimensions. Onset of CPB was
associated with an increase in perfused boundary region in the PC group
that continued until the third postoperative day (2.0 +/- 0.2 to 2.5 +/-
0.2 micro&#32;m; p = 0.018). This was paralleled by increased plasma
syndecan-1 levels in the PC group. Contrastingly, both parameters remained
unaltered in the HC group compared with baseline levels. CPB decreased
perfused vessel density in both groups (CPB v pre-CPB: PC: 17 +/- 2 to 13
+/- 2 mm/mm², p = 0.006; HC: 16 +/- 2 to 11 +/- 2
mm/mm², p = 0.003) and remained equally altered in the first 3
postoperative days. <br/>Conclusion(s): The use of an HC circuit is
associated with better preservation of the endothelial glycocalyx compared
with PC circuits, whereas microcirculatory perfusion was disturbed equally
in both groups. Hence, CPB-induced microcirculatory perfusion disturbances
seem to be coating independent.<br/>Copyright &#xa9; 2019 The Authors

<16>
Accession Number
631091089
Title
Comparing sedation vs. general anaesthesia in transoesophageal
echocardiography-guided percutaneous transcatheter mitral valve repair: a
meta-analysis.
Source
European heart journal cardiovascular Imaging. (no pagination), 2020. Date
of Publication: 26 Feb 2020.
Author
Banga S.; Hafiz A.M.; Chami Y.; Gumm D.C.; Banga P.; Howard C.; Kim M.;
Sengupta P.P.
Institution
(Banga, Sengupta) Division of Cardiology, West Virginia University School
of Medicine, 1 Medical Center Drive, Morgantown, United States
(Hafiz, Chami) Division of Cardiology, Southern Illinois University School
of Medicine, Springfield, United States
(Gumm) Division of Cardiology, University of Illinois College of Medicine
at Peoria, OSF Saint Francis Medical Center, Peoria, United States
(Banga) University of Illinois College of Medicine at Peoria, OSF Saint
Francis Medical Center, Peoria, United States
(Howard) Library of the Health Sciences at Peoria, University of Illinois
at Chicago, Peoria, United States
(Kim) Center of Outcomes Research, Department of Internal Medicine,
University of Illinois College of Medicine at Peoria, Peoria, United
States
Publisher
NLM (Medline)
Abstract
AIMS: Transoesophageal echocardiography-guided percutaneous transcatheter
mitral valve repair (TOE-guided PMVR) using edge-to-edge leaflet plication
is typically performed under general anaesthesia (GA). Increasing evidence
supports the efficacy and safety of PMVR performed under conscious
sedation (CS) or deep sedation (DS). We performed a meta-analysis
comparing safety and efficacy of CS/DS vs. GA in PMVR. METHODS AND
RESULTS: A comprehensive search was performed using PubMed, CINAHL, Ovid
MEDLINE, Embase, and the Cochrane Library. Study characteristics,
participant demographics, and procedural outcomes with both types of
anaesthesia were analysed. Out of 73 articles, five met inclusion
criteria. Overall, there was no significant difference in the primary
outcome of procedural success rate [odds ratio (OR) 0.75; 95% confidence
interval (CI) 0.30-1.88, I2= 0.0%, P=0.538] or post-procedure in-hospital
mortality (OR 1.02; 95% CI 0.38-2.71, I2= 0.0%, P=0.970) in the patients
undergoing PMVR under CS/DS vs. GA. The secondary endpoint of intensive
care unit (ICU) length of stay (LOS) was significantly shorter in patients
under CS/DS vs. GA (standardized mean difference, SMD = -0.97; 95% CI
-1.75 to -0.20; P=0.014), but the hospital LOS (SMD = 0.36; 95% CI -0.77
to 0.04, P=0.078) did not show a statistically significant difference
between the groups, although it was shorter in the CS/DS group. No
difference was observed between CS/DS and GA in fluoroscopy time,
procedure time, or complications, including pneumonia, stroke/transient
ischaemic attack, and major bleeding. <br/>CONCLUSION(S): CS or DS has
lower ICU LOS, but comparable procedural success rate and in-hospital
mortality, making it a potential alternative to GA for TOE-guided
PMVR.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

<17>
Accession Number
631090981
Title
Impact of Induction Immunosuppression on Post-Transplant Outcomes of
Patients Bridged with Contemporary Left Ventricular Assist Devices.
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992). 66
(3) (pp 261-267), 2020. Date of Publication: 01 Mar 2020.
Author
Truby L.K.; Batra J.; Jennings D.L.; Takeda K.; DeFilippis E.M.; Takayama
H.; Naka Y.; Farr M.A.; Topkara V.K.
Institution
(Truby) From the Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC
(Batra, Jennings, DeFilippis, Farr, Topkara) Division of Cardiology,
Department of Medicine, Columbia University College of Physicians and
Surgeons, NY
(Takeda, Takayama, Naka) Division of Cardiothoracic Surgery, Department of
Surgery, Columbia University College of Physicians and Surgeons, NY
Publisher
NLM (Medline)
Abstract
For patients bridged to transplant (BTT) with left ventricular assist
devices (LVAD), data regarding the use of induction immunosuppressive
therapy remain limited. The objectives of the current study were to
describe the current trends and clinical consequences of IT in patients
BTT with LVAD. The United Network of Organ Sharing database was queried to
identify adult, single-organ heart transplant recipients who were BTT with
LVAD between 2008 and 2018. Propensity score matching was then used to
balance clinical covariates between those patient who did and did not
receive IT. The primary outcomes of interest were graft survival,
hospitalization for rejection and infection, and freedom from transplant
coronary artery disease (TCAD). In the overall cohort, 49.1% (n = 3,978)
received IT, with basiliximab being the most commonly used agent followed
by antithymocyte globulin. After propensity score matching, 4,388 patients
(2,194 without induction and 2,194 with induction) were identified.
Between those who did and did not receive IT, there was no significant
difference in graft survival, freedom from hospitalization for rejection,
and freedom from hospitalization for infection. Patients who received IT
experienced increased freedom from TCAD (p = 0.004) with unadjusted hazard
ratio of 0.81 (95% Cardiac Index: 0.70-0.93). For freedom from TCAD,
antithymocyte globulin was associated with better outcomes than
basiliximab (80.2% vs. 73.1% at 5 years, log rank p value = 0.004). In a
sensitivity analysis, there was no significant increase in hospitalization
for infection in those patients with an infected LVAD before transplant.
Use of induction therapy in patients BTT with LVAD appears to be safe and
feasible, without a significant increase in the risk of infection or
rejection, even in those patients with pretransplant device-related
infections. IT, particularly antithymocyte globulin, was associated with
increased time to development of TCAD. Routine use of IT in patients BTT
with LVAD may be considered, and further randomized control trials are
warranted to further support these data.

<18>
Accession Number
631081440
Title
The short-term and long-term outcomes of transcatheter or surgical aortic
valve replacement in elderly patients: A protocol for a systematic review.
Source
Medicine (United States). 99 (9) (no pagination), 2020. Article Number:
e19307. Date of Publication: 2020.
Author
Lei X.; Wei Z.; Liu S.; Liang F.; Song B.
Institution
(Lei, Wei, Liu, Liang) First Clinical Medical College, Lanzhou University,
Lanzhou, China
(Lei, Liu, Liang, Song) Department of Cardiovascular Surgery, First
Hospital of Lanzhou University, Lanzhou, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has become an
essential alternate option for people suffering from aortic stenosis.
However, the efficacy and safety of TAVR for elderly population (aged over
80 years) is still unclear. <br/>Method(s): We plan to perform a
systematic review and meta-analysis of clinical controlled trials and
propensity-match cohort studies to evaluate the short- and long-term
outcomes in elderly aortic stenosis patients who undergo a transcatheter
or surgical aortic valve replacement. We will search PubMed, EMBASE, and
Cochrane Library using a comprehensive strategy. The related conference
proceedings and reference lists of the included studies will also be
checked to identify additional studies. Two reviewers will screen
retrieved records, extract information, and assess the risk of bias
independently. STATA software will be used to conduct data synthesis.
There is no requirement of ethical approval and informed consent.
<br/>Result(s): This study will be submitted to a peer-reviewed journal
for publication. <br/>Conclusion(s): This is the first systematic
assessment of TAVR for elderly patients with aortic stenosis. We hope it
will provide a relatively comprehensive reference for clinical practice
and future relevant clinical trials.Ethics and dissemination:Ethics
approval and patient consent are not required as this study is a
systematic review and meta-analysis.PROSPERO registration
number:CRD42019140857.Study protocol registry:The protocol has been
registered in PROSPERO, which is an International Prospective Register of
Systematic Reviews. The registration number is
CRD42019140857.<br/>Copyright &#xa9; 2020 the Author(s). Published by
Wolters Kluwer Health, Inc.

<19>
Accession Number
2005098927
Title
The Use of Bivalirudin in Pediatric Cardiac Surgery and in the
Interventional Cardiology Suite.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Goswami D.; DiGiusto M.; Wadia R.; Barnes S.; Schwartz J.; Steppan D.;
Nelson-McMillan K.; Ringel R.; Steppan J.
Institution
(Goswami, DiGiusto, Wadia, Barnes, Schwartz, Steppan, Nelson-McMillan,
Steppan) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins University, School of Medicine, Baltimore, MD, United States
(DiGiusto, Nelson-McMillan, Ringel) Department of Pediatrics, Johns
Hopkins University, School of Medicine, Baltimore, MD, United States
Publisher
W.B. Saunders
Abstract
Anticoagulation is an essential component for patients undergoing
cardiopulmonary bypass or extracorporeal membrane oxygenation and for
those with ventricular assist devices. However, thrombosis and bleeding
are common complications. Heparin continues to be the agent of choice for
most patients, likely owing to practitioners' comfort and experience and
the ease with which the drug's effects can be reversed. However,
especially in pediatric cardiac surgery, there is increasing interest in
using bivalirudin as the primary anticoagulant. This drug circumvents
certain problems with heparin administration, such as heparin resistance
and heparin-induced thrombocytopenia, but it comes with additional
challenges. In this manuscript, the authors review the literature on the
emerging role of bivalirudin in pediatric cardiac surgery, including its
use with cardiopulmonary bypass surgery, extracorporeal membrane
oxygenation, ventricular assist devices, and interventional cardiology.
Moreover, they provide an overview of bivalirudin's pharmacodynamics and
monitoring methods.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<20>
Accession Number
2004340497
Title
Effects of vascular morphological features and ultrasound-guided vascular
cannulation techniques on the success of femoral artery catheterisation in
newborns.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2020. Date
of Publication: 2020.
Author
Boran O.F.; Urfalioglu A.; Arslan M.; Yazar F.M.; Bilal B.; Orak Y.;
Eroglu E.
Institution
(Boran, Urfalioglu, Arslan, Bilal, Orak) Department of Anesthesiology and
Reanimation, Sutcu Imam University School of Medicine, C Blok Kat 5, Daire
11, Kahramanmaras 46100, Turkey
(Yazar) Department of General Surgery, Sutcu Imam University School of
Medicine, Kahramanmaras, Turkey
(Eroglu) Department of Cardiovascular Surgery, Sutcu Imam University
School of Medicine, Kahramanmaras, Turkey
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
Ultrasound-guided vascular access is a technique that can increase safety
as well as technical and procedural success when performing invasive
cardiovascular procedures. The aim of this study was to evaluate the
effects of two cannulation techniques and vascular morphological
properties on the success of femoral artery catheterisation in neonatal
patients. We recruited 65 consecutive patients requiring femoral artery
catheterisation and randomly divided them into two groups: Group 1,
in-plane technique (n = 31) and Group 2, out-of-plane technique (n = 34).
We compared the preparation duration, puncture duration, number of
punctures, number of arterial punctures, number of unsuccessful
interventions, hematoma incidence and vascular morphological
characteristics between the groups. The mean age of Group 1 was 17.16 +/-
7.04 days, and the mean age of Group 2 was 17.20 +/- 7.40 days, with no
difference observed between the groups (p > 0.05). Four patients in Group
1 and nine patients in Group 2 developed hematoma (p = 0.172). Hematoma
was strongly correlated with the number of venous punctures (r = 0.632; p
= 0.001) and the number of needle advancements (r = 0.415; p = 0.001). In
terms of artery-vein position, patients whose artery overlapped the vein
by > 50% required clearly longer artery cannulation durations than the
other patients (p < 0.001). Although the in-plane technique has a steep
learning curve, it was found superior in terms of procedure-related
factors such as the number of trials, the incidence of hematoma and
arterial puncture counts, as it offers advantages such as the ability to
evaluate the lumen and a better control of the needle advancement
direction.<br/>Copyright &#xa9; 2020, Springer Nature B.V.

<21>
[Use Link to view the full text]
Accession Number
627473689
Title
Therapeutic challenges in patients with noncardioembolic acute ischemic
stroke in need of double antiplatelet therapy for coronary artery disease.
Source
American Journal of Therapeutics. 26 (2) (pp E213-E221), 2019. Date of
Publication: 01 Mar 2019.
Author
Oana Darabont R.; Stoicescu C.; Tiu C.
Institution
(Oana Darabont, Stoicescu) Discipline of Internal Medicine and Cardiology,
University Emergency Hospital Bucharest, University of Medicine and
Pharmacy Carol Davila, 169 Splaiul Independentei, 5th District, Bucharest
050098, Romania
(Tiu) Discipline of Neurology, University Emergency Hospital Bucharest,
University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:The risk of ischemic stroke (IS) is significant within 6-12
months from the myocardial revascularization for an acute cardiac event.
Consequently, we can expect to have patients with an acute IS occurring
right in the time frame of dual antiplatelet therapy (DAPT) imposed by the
coronary heart disease (CHD).Areas of Uncertainty:Until present, there are
no evidence-based guidelines for the management of patients with acute IS
in need of DAPT for ischemic heart disease. The aim of this article was to
go through the available data and to depict the appropriate therapeutic
strategy for this category of patients. <br/>Data Sources:We have
performed a systematic review of the literature through June 2018, using
Medline/PubMed database.Therapeutic Advances:DAPT (aspirin and only
clopidogrel among all P2Y<inf>12</inf> inhibitors) might be maintained or
initiated for CHD in patients with minor acute stroke and high-risk
transient ischemic attack patient with IS attributable to an important
intracranial stenosis, as long as this drug combination proved to be safe
for them in the prevention of stroke recurrence. In patients with IS
receiving thrombolysis, with increased size of infarction or high National
Institute of Health Stroke Score (NIHSS), the risk of hemorrhagic
transformation under DAPT must be weighed against the risk of stent
thrombosis in the coronary arteries, which, on its turn, depends on the
clinical form for which myocardial revascularization was performed, the
time interval from the complexity of a certain interventional procedure.
<br/>Conclusion(s):In the acute phase of an IS, maintenance or initiation
of DAPT therapy imposed by CHD relies, on one hand, on the risk of
hemorrhagic transformation of the brain injury and, on the other hand, on
the risk of stent thrombosis in the coronary arteries. The management of
these patients must be carried on by a vascular team, on an individualized
basis.<br/>Copyright &#xa9; 2019 Wolters Kluwer Health, Inc. All rights
reserved.

<22>
Accession Number
2004991044
Title
Repair of Less Than Severe Tricuspid Regurgitation During Left-Sided Valve
Surgery: A Meta-Analysis.
Source
Annals of Thoracic Surgery. 109 (3) (pp 950-958), 2020. Date of
Publication: March 2020.
Author
Cao J.Y.; Wales K.M.; Zhao D.F.; Seco M.; Celermajer D.S.; Bannon P.G.
Institution
(Cao, Wales, Seco, Celermajer, Bannon) Sydney Medical School, The
University of Sydney, Sydney, Australia
(Cao, Wales, Seco, Celermajer, Bannon) Department of Cardiology, Royal
Prince Alfred Hospital, Sydney, Australia
(Zhao) The Baird Institute of Applied Heart and Lung Surgical Research,
Sydney, Australia
(Wales, Seco, Bannon) Cardiothoracic Surgical Unit, Royal Prince Alfred
Hospital, Sydney, Australia
Publisher
Elsevier USA
Abstract
Background: This systematic review and meta-analysis was undertaken to
investigate the short- and long-term clinical outcomes of concurrent
repair of mild or moderate tricuspid regurgitation (TR) during left-sided
valve surgery. <br/>Method(s): Medline, PubMed, EMBASE, and Cochrane
Libraries were searched, and 12 studies were identified, comprising 1373
patients who underwent TR repair during left-sided valve surgery and 1553
patients who did not. Of these studies, 6 were classified as having a low
risk of bias (randomized controlled trials or propensity-matched studies),
and 6 were considered as having a high risk of bias (nonmatched
observational studies). The primary analysis included only studies with a
low risk of bias (399 repair and 426 nonrepair). <br/>Result(s): Primary
analysis of studies at low risk of bias demonstrated that the addition of
TR repair compared with nonrepair was associated with reduced risks of
cardiovascular mortality, all-cause mortality, and progression of TR over
a median of 5.3 years of follow-up (cardiovascular mortality: relative
risk [RR], 0.46; 95% confidence interval [CI], 0.28 to 0.75; P =.002;
all-cause mortality: RR, 0.68; 95% CI, 0.49 to 0.96; P =.03; and TR
progression: RR, 0.26; 95% CI, 0.12 to 0.56; P <.001). Cardiopulmonary
bypass time was significantly shorter in the nonrepair group (mean
weighted difference, 18 minutes; 95% CI, 6 to 30; P =.003), although the
risk of perioperative mortality was comparable between the 2 groups (RR,
0.72; 95% CI, 0.27 to 1.97; P >.05). <br/>Conclusion(s): Concurrent repair
of mild or moderate TR during left-sided valve surgery is associated with
improved long-term clinical outcomes without adversely affecting early
survival. Should these results be validated by ongoing trials, there
should be a revision of current guidelines to recommend a more aggressive
approach toward TR repair.<br/>Copyright &#xa9; 2020 The Society of
Thoracic Surgeons

<23>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright
&#xa9; 2020 Shanthanna et al.

<24>
Accession Number
2003414326
Title
Prasugrel effectively reduces the platelet reactivity units in patients
with genetically metabolic dysfunction of cytochrome P450 2C19 who are
treated with long-term dual antiplatelet therapy after undergoing
drug-eluting stent implantation.
Source
Heart and Vessels. 35 (3) (pp 312-322), 2020. Date of Publication: 01 Mar
2020.
Author
Shimamatsu J.; Sasaki K.-I.; Katsuki Y.; Kawasaki T.; Murasato Y.; Ajisaka
H.; Yokoi H.; Tashiro H.; Harada A.; Hirakawa Y.; Ishizaki Y.; Ishimatsu
T.; Kagiyama K.; Fukumoto Y.; Kakuma T.; Ueno T.
Institution
(Shimamatsu, Sasaki, Ishizaki, Ishimatsu, Kagiyama, Fukumoto, Ueno)
Division of Cardiovascular Medicine, Department of Internal Medicine,
Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka
830-0011, Japan
(Shimamatsu) Division of Cardiovascular Internal Medicine, Tanushimaru
Chuo Hospital, Kurume, Japan
(Katsuki) Division of Cardiology, Sugi Hospital, Omuta, Japan
(Kawasaki) Department of Cardiology, Cardiovascular Center, Shin Koga
Hospital, Kurume, Japan
(Murasato) Department of Cardiology, National Hospital Organization Kyushu
Medical Center, Fukuoka, Japan
(Ajisaka) Division of Cardiovascular Internal Medicine, Asakura Medical
Association Hospital, Asakura, Japan
(Yokoi) Division of Cardiovascular Internal Medicine, Fukuoka Sanno
Hospital, Fukuoka, Japan
(Tashiro) Division of Cardiovascular Internal Medicine, St. Mary's
Hospital, Kurume, Japan
(Harada, Hirakawa) Daiichi Sankyo Co., Ltd., Tokyo, Japan
(Kakuma) Biostatistics Center, Kurume University, Kurume, Japan
Publisher
Springer
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and P2Y<inf>12</inf>
inhibitor is administered following percutaneous coronary intervention
(PCI) with coronary stent implantation. Several studies have reported the
effects of switching between P2Y<inf>12</inf> inhibitors on platelet
reactivity (P2Y<inf>12</inf> reaction units: PRU), from acute to late
phase after PCI. However, the effect of switching at very late phase is
unknown. This study examined the effect on PRU in Japanese coronary heart
disease patients with long-term DAPT (aspirin + clopidogrel) when
switching from clopidogrel to prasugrel. Ninety-six patients were enrolled
in this study. The median DAPT duration at enrollment was 1824.0 days.
Twenty-three patients with PRU >= 208 at enrollment were randomly assigned
into either continuing to receive clopidogrel (Continued Group; n = 11) or
switching to prasugrel (Switched Group; n = 12). The primary endpoint was
the rate of patients who achieved PRU < 208 at the end of 12 weeks of
treatment, which was significantly higher in Switched Group relative to
Continued Group (90.0% vs. 36.4%; P = 0.024). The secondary endpoint was
the PRU at week 12 in groups subdivided according to cytochrome P450 (CYP)
2C19 genotypes. At week 12, extensive metabolizers (EM Group) had 202.3
+/- 60.0 and 174.5 +/- 22.3 in Continued Group and Switched Group (P =
0.591), respectively; intermediate and poor metabolizers (non-EM Group)
had 229.4 +/- 36.9 and 148.4 +/- 48.4 in Continued Group and Switched
Group (P = 0.002), respectively. The PRU for non-EM Group was
significantly reduced in Switched Group. Thus, for patients with long-term
DAPT (aspirin + clopidogrel) after PCI with coronary stent implantation,
switching from clopidogrel to prasugrel resulted in a stable reduction in
PRU, regardless of CYP2C19 polymorphism.<br/>Copyright &#xa9; 2019, The
Author(s).

<25>
[Use Link to view the full text]
Accession Number
631011111
Title
Hospital-Based Quality Improvement Interventions for Patients with Acute
Coronary Syndrome: A Systematic Review.
Source
Circulation: Cardiovascular Quality and Outcomes. 12 (9) (no pagination),
2019. Article Number: e005513. Date of Publication: 01 Sep 2019.
Author
Bahiru E.; Agarwal A.; Berendsen M.A.; Baldridge A.S.; Temu T.; Rogers A.;
Farquhar C.; Bukachi F.; Huffman M.D.
Institution
(Bahiru) Department of Medicine, University of California, Division of
Cardiology, David Geffen UCLA School of Medicine, 650 Charles E. Young Dr
S A2-237 CHS, MC 167917, Los Angeles, CA 90095, United States
(Agarwal, Huffman) Department of Medicine, Northwestern University,
Feinberg School of Medicine, Chicago, IL, United States
(Berendsen) Galter Health Sciences Library, Northwestern University,
Feinberg School of Medicine, Chicago, IL, United States
(Baldridge, Huffman) Department of Preventive Medicine, Northwestern
University, Feinberg School of Medicine, Chicago, IL, United States
(Temu) Departments of Global Health, University of Washington, Seattle,
United States
(Farquhar) Departments of Epidemiology and Medicine, University of
Washington, Seattle, United States
(Rogers) Department of Medicine, Stanford University School of Medicine,
Palo Alto, CA, United States
(Bukachi) Department of Physiology, University of Nairobi, Kenya
(Huffman) George Institute for Global Health, Food Policy Division,
Sydney, Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Quality improvement initiatives have been developed to improve
acute coronary syndrome care largely in high-income country settings. We
sought to synthesize the effect size and quality of evidence from
randomized controlled trials (RCTs) and nonrandomized studies for
hospital-based acute coronary syndrome quality improvement interventions
on clinical outcomes and process of care measures for their potential
implementation in low- A nd middle-income country settings. <br/>Methods
and Results: We conducted a bibliometric search of databases and trial
registers and a hand search in 2016 and performed an updated search in May
2018 and May 2019. We performed data extraction, risk of bias assessment,
and quality of evidence assessments in duplicate. We assessed differences
in outcomes by study design comparing RCTs to nonrandomized
quasi-experimental studies and by country income status. A meta-analysis
was not feasible due to substantial, unexplained heterogeneity among the
included studies, and thus, we present a qualitative synthesis. We
screened 5858 records and included 32 studies (14 RCTs [n=109 763] and 18
nonrandomized quasi-experimental studies [n=54-423]). In-hospital
mortality ranged from 2.1% to 4.8% in the intervention groups versus 3.3%
to 5.1% in the control groups in 5 RCTs (n=55 942). Five RCTs (n=64 313)
reported 3.0% to 31.0% higher rates of reperfusion for patients with
ST-segment-elevation myocardial infarction in the intervention groups. The
effect sizes for in-hospital and discharge medical therapies in a majority
of RCTs were 3.0% to 10.0% higher in the intervention groups. There was no
significant difference in 30-day mortality evaluated by 4 RCTs (n=42 384),
which reported 2.5% to 15.0% versus 5.9% to 22% 30-day mortality rates in
the intervention versus control groups. In contrast, nonrandomized
quasi-experimental studies reported larger effect sizes compared to RCTs.
There were no significant consistent differences in outcomes between
high-income and middle-income countries. Low-income countries were not
represented in any of the included studies. <br/>Conclusion(s):
Hospital-based acute coronary syndrome quality improvement interventions
have a modest effect on process of care measures but not on clinical
outcomes with expected differences by study design. Although quality
improvement programs have an ongoing and important role for acute coronary
syndrome quality of care in high-income country settings, further research
will help to identify key components for contextualizing and implementing
such interventions to new settings to achieve their desired
effects.<br/>Copyright &#xa9; 2019 American Heart Association, Inc.

<26>
Accession Number
2004313999
Title
Paroxysmal supraventricular tachycardia and risk of ischemic stroke: A
systematic review and meta-analysis.
Source
Journal of Arrhythmia. 35 (3) (pp 499-505), 2019. Date of Publication: 01
Jun 2019.
Author
Rujirachun P.; Wattanachayakul P.; Winijkul A.; Ungprasert P.
Institution
(Rujirachun, Wattanachayakul) Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
(Winijkul) Division of Cardiology, Department of Medicine, Faculty of
Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Ungprasert) Clinical Epidemiology Unit, Department of Research and
Development, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Background: Paroxysmal supraventricular tachycardia (PSVT) has been
traditionally considered as a benign rhythm disorder. However, recent
studies have suggested that patients with PSVT may have a higher risk of
ischemic stroke although the data are limited and inconclusive. The
current systematic review and meta-analysis was conducted with the aims to
identify all available studies and summarize their results together to
better characterize the risk of ischemic stroke among patients with PSVT.
<br/>Method(s): A comprehensive literature review was conducted by
searching for published articles indexed in MEDLINE and EMBASE databases
from inception through November 11, 2018 to identify all observational
studies that compared the risk of ischemic stroke between patients with
PSVT and individuals without PSVT. Pooled risk ratio (RR) and 95%
confidence interval (CI) were calculated using a random-effect, generic
inverse variance method of DerSimonian and Laird. <br/>Result(s): A total
5 studies (4 cohort studies and 1 case-control study) with 4 886 977
participants met the eligibility criteria and were included into the
meta-analysis. The risk of ischemic stroke among patients with PSVT was
significantly higher than individuals without PSVT with the pooled RR of
2.03 (95% CI, 1.22-3.38, I² = 89%). <br/>Conclusion(s): This
study found that PSVT is associated with a higher risk of ischemic stroke.
Whether this association is causal and how it should be addressed in
clinical practice require further investigations.<br/>Copyright &#xa9;
2019 The Authors. Journal of Arrhythmia published by John Wiley & Sons
Australia, Ltd on behalf of the Japanese Heart Rhythm Society.

<27>
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.
<br/>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).
<br/>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. <br/>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).<br/>Copyright &#xa9; 2018 Farouk Musa A et al.

<28>
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. <br/>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.
<br/>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.
<br/>Conclusion(s): Slow baseline gait speed (and unable to walk) is
associated with increased mortality after TAVI.<br/>Copyright &#xa9; 2020

<29>
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. <br/>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.
<br/>Setting(s): A university hospital. <br/>Patient(s): 66 patients
scheduled to undergo video-assisted thoracic surgery under general
anesthesia were included. <br/>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.
<br/>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).
<br/>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.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<30>
Accession Number
2004144097
Title
Pre-procedural elevated cardiac troponin predict risk of long-term
all-cause mortality after transcatheter aortic valve replacement: a
meta-analysis of prospective studies.
Source
Biomarkers. 25 (2) (pp 164-170), 2020. Date of Publication: 17 Feb 2020.
Author
Li Y.; Pei H.; Zhou C.; Lou Y.
Institution
(Li, Lou) Department of Cardiology, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
(Pei) Department of Cardiology, The First Affiliated Hospital of Baotou
Medical College, Baotou, China
(Zhou) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Disease, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
Publisher
Taylor and Francis Ltd
Abstract
Background: The purpose of this meta-analysis was to evaluate the
relationship between elevated cardiac troponin pre-transcatheter aortic
valve replacement (TAVR) and long-term all-cause mortality.
<br/>Method(s): Prospective studies with the endpoint of all-cause
mortality were included. We primarily used the fixed-effect model weighted
by inverse variance. Meta-regression and subgroup analyses were conducted
to explore the potential sources of heterogeneity by specified study
characteristics. <br/>Result(s): Seven prospective studies comprising of
3049 subjects were included in our meta-analysis. Pre-procedural elevated
cardiac troponin was associated with increased risk of long-term mortality
post TAVR [hazard ratio (HR) 2.25, 95% CI 1.83-2.78, p = 0.000,
I² = 30.3%, p for heterogeneity 0.197]. In addition, subgroup
analyses have shown that the group with an younger age (<82 y) seemed to
have a higher risk of all-cause mortality than the group with older age
(>=82 y) [HR 4.08 (2.41 to 6.89) VS 2.01 (1.60 to 2.53), p = 0.016 for
subgroup difference]. <br/>Conclusion(s): Pre-procedural elevated cardiac
troponin was associated with increased long-term all-cause mortality in
patients undergoing TAVR.<br/>Copyright &#xa9; 2020, &#xa9; 2020 Informa
UK Limited, trading as Taylor & Francis Group.

<31>
Accession Number
2005085466
Title
Lung cancer surveillance after definitive curative-intent therapy: ASCO
guideline.
Source
Journal of Clinical Oncology. 38 (7) (pp 753-766), 2020. Date of
Publication: 01 Mar 2020.
Author
Schneider B.J.; Ismaila N.; Aerts J.; Chiles C.; Daly M.E.; Detterbeck
F.C.; Hearn J.W.D.; Katz S.I.; Leighl N.B.; Levy B.; Meyers B.; Murgu S.;
Nekhlyudov L.; Santos E.S.; Singh N.; Tashbar J.; Yankelevitz D.; Altorki
N.
Institution
(Schneider, Hearn) University of Michigan Health System, Ann Arbor, MI,
United States
(Ismaila) American Society of Clinical Oncology, 2318 Mill Rd, Alexandria,
VA 22314, United States
(Aerts) Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
(Chiles) Wake Forest Health Science Center, Winston-Salem, NC, United
States
(Daly) University of California, Davis Comprehensive Cancer Center,
Sacramento, CA, United States
(Detterbeck) Yale University, New Haven, CT, United States
(Katz) University of Pennsylvania, Perelman School of Medicine,
Philadelphia, PA, United States
(Leighl) Princess Margaret Cancer Centre, University Health Network,
Toronto, ON, Canada
(Levy) Johns Hopkins Sidney Kimmel Cancer Center, Sibley Memorial
Hospital, Washington, DC, United States
(Meyers) Washington University, St Louis, MO, United States
(Murgu) University of Chicago, Chicago, IL, United States
(Nekhlyudov) Brigham and Women's Hospital, Boston, MA, United States
(Santos) Florida Precision Oncology/21st Century Oncology, Aventura, FL,
United States
(Singh) Postgraduate Institute of Medical Education and Research,
Chandigarh, India
(Tashbar) Circle of Hope for Cancer Research, Orlando, FL, United States
(Yankelevitz) Mount Sinai Hospital, New York, NY, United States
(Altorki) Weill Cornell Medicine/Cornell University, New York, NY, United
States
Publisher
American Society of Clinical Oncology (E-mail: jcoservice@asco.org)
Abstract
PURPOSE To provide evidence-based recommendations to practicing clinicians
on radiographic imaging and biomarker surveillance strategies after
definitive curative-intent therapy in patients with stage I-III
non-small-cell lung cancer (NSCLC) and SCLC. METHODS ASCO convened an
Expert Panel of medical oncology, thoracic surgery, radiation oncology,
pulmonary, radiology, primary care, and advocacy experts to conduct a
literature search, which included systematic reviews, meta-analyses,
randomized controlled trials, and prospective and retrospective
comparative observational studies published from 2000 through 2019.
Outcomes of interest included survival, disease-free or recurrence-free
survival, and quality of life. Expert Panel members used available
evidence and informal consensus to develop evidence-based guideline
recommendations. RESULTS The literature search identified 14 relevant
studies to inform the evidence base for this guideline. RECOMMENDATIONS
Patients should undergo surveillance imaging for recurrence every 6 months
for 2 years and then annually for detection of new primary lung cancers.
Chest computed tomography imaging is the optimal imaging modality for
surveillance. Fluorodeoxyglucose positron emission tomography/computed
tomography imaging should not be used as a surveillance tool. Surveillance
imaging may not be offered to patients who are clinically unsuitable for
or unwilling to accept further treatment. Age should not preclude
surveillance imaging. Circulating biomarkers should not be used as a
surveillance strategy for detection of recurrence. Brain magnetic
resonance imaging should not be used for routine surveillance in stage
I-III NSCLC but may be used every 3 months for the first year and every 6
months for the second year in patients with stage I-III small-cell lung
cancer who have undergone curative-intent treatment.<br/>Copyright &#xa9;
2019 by American Society of Clinical Oncology.

<32>
[Use Link to view the full text]
Accession Number
631070895
Title
Ezetimibe Lipid-Lowering Trial on Prevention of Atherosclerotic
Cardiovascular Disease in 75 or Older (EWTOPIA 75): A Randomized,
Controlled Trial.
Source
Circulation. 140 (12) (pp 992-1003), 2019. Date of Publication: 17 Sep
2019.
Author
Ouchi Y.; Sasaki J.; Arai H.; Yokote K.; Harada K.; Katayama Y.; Urabe T.;
Uchida Y.; Hayashi M.; Yokota N.; Nishida H.; Otonari T.; Arai T.; Sakuma
I.; Sakabe K.; Yamamoto M.; Kobayashi T.; Oikawa S.; Yamashita S.; Rakugi
H.; Imai T.; Tanaka S.; Ohashi Y.; Kuwabara M.; Ito H.
Institution
(Ouchi, Kuwabara) Toranomon Hospital, University of Tokyo, 2-2-2
Toranomon, Minato-ku, Tokyo 105-8470, Japan
(Sasaki) International University of Health and Welfare, Fukuoka, Japan
(Arai) National Center for Geriatrics and Gerontology, Obu, Japan
(Yokote) Chiba University, Chiba, Japan
(Harada, Ito) Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
(Katayama) General Tokyo Hospital, Tokyo, Japan
(Urabe) Juntendo University, Urayasu Hospital, Urayasu, Japan
(Uchida) Saga Memorial Hospital, Saga, Japan
(Hayashi) Nagahama City Hospital, Nagahama, Japan
(Yokota) Yokota Clinic, Miyazaki, Japan
(Nishida) Nishida Clinic, Neyagawa, Japan
(Otonari) Otonari Clinic, Chikushino, Japan
(Arai) Arai Clinic, Yamagata, Japan
(Sakuma) Caress Sapporo Hokko Memorial Clinic, Sapporo, Japan
(Sakabe) Sakabe Clinic, Kyoto, Japan
(Yamamoto) Yamamoto Clinic, Shimoniikawa, Japan
(Kobayashi) Jyuzen General Hospital, Niihama, Japan
(Oikawa) Fukujuji Hospital, Tokyo, Japan
(Yamashita) Rinku General Medical Center, Izumisano, Japan
(Rakugi) Osaka University, Suita, Japan
(Imai, Tanaka) Kyoto University, Japan
(Ohashi) Chuo University, Tokyo, Japan
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Evidence regarding the primary prevention of coronary artery
disease events by low-density lipoprotein cholesterol (LDL-C) lowering
therapy in older individuals, aged >=75 years, is insufficient. This trial
tested whether LDL-C-lowering therapy with ezetimibe is useful for the
primary prevention of cardiovascular events in older patients.
<br/>Method(s): This multicenter, prospective, randomized, open-label,
blinded end-point evaluation conducted at 363 medical institutions in
Japan examined the preventive efficacy of ezetimibe for patients aged >=75
years, with elevated LDL-C without history of coronary artery disease.
Patients, who all received dietary counseling, were randomly assigned
(1:1) to receive ezetimibe (10 mg once daily) versus usual care with
randomization stratified by site, age, sex, and baseline LDL-C. The
primary outcome was a composite of sudden cardiac death, myocardial
infarction, coronary revascularization, or stroke. <br/>Result(s):
Overall, 3796 patients were enrolled between May 2009 and December 2014,
and 1898 each were randomly assigned to ezetimibe versus control. Median
follow-up was 4.1 years. After exclusion of 182 ezetimibe patients and 203
control patients because of lack of appropriate informed consent and other
protocol violations, 1716 (90.4%) and 1695 (89.3%) patients were included
in the primary analysis, respectively. Ezetimibe reduced the incidence of
the primary outcome (hazard ratio [HR], 0.66; 95% CI, 0.50-0.86; P=0.002).
Regarding the secondary outcomes, the incidences of composite cardiac
events (HR, 0.60; 95% CI, 0.37-0.98; P=0.039) and coronary
revascularization (HR, 0.38; 95% CI, 0.18-0.79; P=0.007) were lower in the
ezetimibe group than in the control group; however, there was no
difference in the incidence of stroke, all-cause mortality, or adverse
events between trial groups. <br/>Conclusion(s): LDL-C-lowering therapy
with ezetimibe prevented cardiovascular events, suggesting the importance
of LDL-C lowering for primary prevention in individuals aged >=75 years
with elevated LDL-C. Given the open-label nature of the trial, its
premature termination and issues with follow-up, the magnitude of benefit
observed should be interpreted with caution. Clinical Registration: URL:
https://www.umin.ac.jp. Unique identifier: UMIN000001988.<br/>Copyright
&#xa9; 2019 American Heart Association, Inc.

<33>
Accession Number
2004336018
Title
Insulin Glargine in Critically ill Patients: Once/Day versus Twice/Day
Dosing.
Source
Pharmacotherapy. (no pagination), 2020. Date of Publication: 2020.
Author
Fox M.A.; Perry M.C.; Liu-DeRyke X.
Institution
(Fox, Perry, Liu-DeRyke) Pharmacy Services, Orlando Regional Medical
Center, Orlando, FL, United States
Publisher
Pharmacotherapy Publications Inc.
Abstract
Objective: Twice/day dosing of insulin glargine has been used to treat
hyperglycemia in clinical practice; however, data supporting its use in
the critically ill population are lacking. This study was designed to
evaluate the safety and efficacy of twice/day insulin glargine in
critically ill patients. <br/>Method(s): A retrospective study was
conducted in adult patients admitted to the intensive care units between
February 2013 and June 2017 who received insulin glargine twice/day or 40
units or more once/day for 48 hours or longer. Post cardiovascular surgery
patients were excluded. Data were collected for up to 14 patient-days. The
efficacy outcomes included the incidence of hyperglycemia (blood glucose
[BG] above 180 mg/dl), predose hyperglycemia rate (BG above 180 mg/dl
within 4 hrs before the dose), and BG variability (standard deviation).
The safety outcome was assessed by the development of hypoglycemia (BG
below 70 mg/dl). <br/>Result(s): A total of 58 patients (twice/day = 23;
once/day = 35) were included in the analysis. Demographics were similar
between the groups including history of diabetes mellitus, baseline
hemoglobin A<inf>1C</inf>, and home insulin use. No difference was
observed between the twice/day and once/day groups in the mean BG (153 vs
154 mg/dl, p=0.95, respectively), and BG variability (46 vs 44 mg/dl,
p=0.29, respectively). Although the overall incidence of hyperglycemia was
similar between twice/day and once/day groups (96% vs 97%, p=1.00,
respectively), the twice/day group had a significantly lower predose
hyperglycemia rate (twice/day 0.27 vs once/day 0.43, p=0.02).
Additionally, the twice/day group did not experience an increased
incidence of hypoglycemia (twice/day 23% vs once/day 34%, p=0.57) or
hypoglycemia without having anything by mouth (twice/day 0% vs once/day
9%, p=0.27). <br/>Conclusion(s): This is the first study demonstrating
that twice/day insulin glargine reduced the rate of predose hyperglycemia
without increasing the risk of hypoglycemia in critically ill patients. A
large randomized study is needed to confirm the safety and efficacy of
twice/day glargine in the critically ill.<br/>Copyright &#xa9; 2020
Pharmacotherapy Publications, Inc.

<34>
Accession Number
2004334320
Title
Mitral valve prosthesis choice in patients <70 years: A systematic review
and meta-analysis of 20 219 patients.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Yanagawa B.; Lee J.; Ouzounian M.; Bagai A.; Cheema A.; Verma S.;
Friedrich J.O.
Institution
(Yanagawa, Lee, Verma) Divisions of Cardiac Surgery, St Michael's
Hospital, University of Toronto, Toronto, ON, Canada
(Ouzounian) Division of Cardiac Surgery, Toronto General Hospital,
University of Toronto, Toronto, ON, Canada
(Bagai, Cheema) Department of Cardiology, St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Friedrich) Department of Critical Care and Medicine, St Michael's
Hospital, University of Toronto, Toronto, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The optimal mitral prosthesis in young patients is unclear.
This systematic review and meta-analysis were performed to compare
outcomes between bileaflet mechanical mitral valve replacement (mMVR) and
bioprosthesis mitral valve replacement (bioMVR) for MVR patients aged less
than 70 years. <br/>Method(s): We searched MEDLINE and EMBASE databases
from inception to July 2018 for studies comparing surgical outcomes of
mMVR vs bioMVR. <br/>Result(s): There were 14 observational studies with
20 219 patients (n = 14 658 mMVR and n = 5561 bioMVR). Patients receiving
an mMVR were younger with fewer comorbidities including renal failure,
dialysis, and less-infective endocarditis (P <.001). The estimated 10-year
mortality ranged from 19% to 49% for mMVR and 22% to 58% for bioMVR among
studies. Comparing matched or adjusted data, mMVR was associated with
lower operative (risk ratio [RR]: 0.61; 95% confidence interval [CI]:
0.39, 0.94; P =.03) and long-term (HR: 0.81; 95% CI: 0.71, 0.92; P =.002)
mortality at a median follow-up of 8 years (IQR: 6-10 years). Estimated
10-year risk for mitral valve reoperation ranged from 0% to 8% for mMVR
and 8% to 22% for bioMVR among matched/adjusted studies. mMVR was
associated with lower matched/adjusted risk of reoperation (HR: 0.35; 95%
CI: 0.19, 0.65; P =.001) but with greater risk of bleeding (HR: 1.59; 95%
CI: 1.19, 2.13; P =.002) and a trend to greater risk of stroke and
embolism (HR: 1.70; 95% CI: 0.92, 3.15; P =.09). <br/>Conclusion(s):
Mechanical MVR in patients aged less than 70 years is associated with a
lower risk of operative mortality as well as a 20% lower risk of long-term
death and 65% lower risk of mitral valve reoperation but 60% greater risk
of bleeding compared with bioMVR in matched or adjusted
data.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<35>
Accession Number
2003963263
Title
Transfusing Platelets During Bypass Rewarming in Neonates Improves
Postoperative Outcomes: A Randomized Controlled Trial.
Source
World Journal for Pediatric and Congenital Heart Surgery. 11 (1) (pp
71-76), 2020. Date of Publication: 01 Jan 2020.
Author
Gautam N.K.; Pierre J.; Edmonds K.; Pawelek O.; Griffin E.; Xu Z.;
Dodge-Khatami A.; Salazar J.
Institution
(Gautam, Pierre, Edmonds, Pawelek, Griffin, Xu) Department of
Anesthesiology, McGovern Medical School, University of Texas Health
Science Center at Houston, TX, United States
(Dodge-Khatami, Salazar) Division of Pediatric Congenital Heart Surgery,
McGovern Medical School, University of Texas Health Science Center at
Houston, TX, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: In neonates, transfusion of platelets after hemodilution from
cardiopulmonary bypass (CPB) has been standard. We hypothesize that
platelet administration during the rewarming phase before termination of
CPB would reduce coagulopathy, enhance hemostasis, reduce transfusion, and
improve postoperative outcomes after neonatal cardiac surgery.
<br/>Method(s): A prospective, randomized trial was performed in 46
neonates. Controls received platelets only at the end of bypass with other
blood products to assist in hemostasis. The treatment group received 10
mL/kg of platelets during the rewarming phase of bypass after cross-clamp
release. After protamine, transfusion and perioperative management
protocols were identical and constant among groups. <br/>Result(s): Two
neonates in each group were excluded secondary to postoperative need for
extracorporeal support. Controls (n = 21) and treatment patients (n = 21)
were similar in age, weight, case complexity, associated syndromes, single
ventricle status, and CPB times. Compared to controls, the treatment group
required 40% less postbypass blood products (58 +/- 29 vs 103 +/- 80
mL/kg, P =.04), and case completion time after protamine administration
was 28 minutes faster (P =.016). The treatment group required fewer
postoperative mediastinal explorations for bleeding (P =.045) and had a
lower fluid balance (P =.04). The treatment group had shorter mechanical
ventilation (P =.016) and length of intensive care unit times (P =.033).
There were no 30-day mortalities in either group. <br/>Conclusion(s):
Platelet transfusion during the rewarming phase of neonatal cardiac
surgery was associated with reduced bleeding and improved postoperative
outcomes, compared to platelets given after coming off bypass. Further
studies are necessary to understand mechanisms and benefits of this
strategy.<br/>Copyright &#xa9; The Author(s) 2019.

<36>
Accession Number
2003963260
Title
Budesonide for Protein Losing Enteropathy in Patients with Fontan
Circulation: A Systematic Review and Meta-Analysis.
Source
World Journal for Pediatric and Congenital Heart Surgery. 11 (1) (pp
85-91), 2020. Date of Publication: 01 Jan 2020.
Author
Kewcharoen J.; Mekraksakit P.; Limpruttidham N.; Kanitsoraphan C.;
Charoenpoonsiri N.; Poonsombudlert K.; Pattison R.J.; Rattanawong P.
Institution
(Kewcharoen, Limpruttidham, Kanitsoraphan, Poonsombudlert, Pattison,
Rattanawong) University of Hawaii Internal Medicine Residency Program,
Honolulu, HI, United States
(Mekraksakit) Department of Medicine, Phramongkutklao College of Medicine,
Bangkok, Thailand
(Charoenpoonsiri) Faculty of Medicine, Chulalongkorn University Hospital,
Bangkok, Thailand
(Rattanawong) Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Recent studies have shown that oral budesonide can be used to
improve albumin level in patients with protein-losing enteropathy (PLE)
following Fontan procedure. However, there has never been a systematic
review and meta-analysis to confirm this finding. We performed a
systematic review and meta-analysis to explore the therapeutic effect of
budesonide in patients with PLE post-Fontan procedure. <br/>Method(s): We
searched the databases of MEDLINE and EMBASE from inception to January
2019. Included studies were published studies that evaluate albumin level
before and after budesonide therapy in patients with PLE following Fontan
procedure. Data from each study were combined using the random-effects
model. <br/>Result(s): Five studies with 36 post-Fontan operation patients
with PLE were included. In random-effects model, there was a statistically
significant difference in albumin level between before and after
budesonide treatment (weighted mean difference = 1.28, 95% confidence
interval: 0.76-1.79). No publication bias was observed on a funnel plot
and Egger test with a P value of.676. <br/>Conclusion(s): The results of
this systematic review and meta-analysis show that budesonide can be used
to increase albumin level in patients with PLE following Fontan operation.
Further studies may focus on the impact of outcome of budesonide in this
population.<br/>Copyright &#xa9; The Author(s) 2019.

<37>
Accession Number
2002867702
Title
Modified Single-Patch versus Two-Patch Repair for Atrioventricular Septal
Defect: A Systematic Review and Meta-Analysis.
Source
World Journal for Pediatric and Congenital Heart Surgery. 10 (5) (pp
616-623), 2019. Date of Publication: 01 Sep 2019.
Author
Loomba R.S.; Flores S.; Villarreal E.G.; Bronicki R.A.; Anderson R.H.
Institution
(Loomba) Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn,
IL, United States
(Flores, Villarreal, Bronicki) Critical Care and Cardiology, Pediatrics,
Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Anderson) Institute of Genetics, Newcastle University, Newcastle Upon
Tyne, United Kingdom
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: We performed a meta-analysis of studies to determine whether
the modified single-patch technique offers benefits when compared to the
two-patch repair. The postoperative outcomes examined in this study were
cardiopulmonary bypass time, cross-clamp time, duration of mechanical
ventilation, intensive care unit length of stay, total hospital length of
stay, need for reoperation, need for reoperation for left ventricular
outflow tract obstruction or left atrioventricular valve regurgitation,
need for pacemaker implantation, and mortality during follow-up.
<br/>Method(s): A review was conducted to identify studies comparing a
modified single-patch repair versus two-patch repair. A fixed-effects
model was utilized for end points with low heterogeneity and a
random-effects model for end points with significant heterogeneity.
Meta-regression was also performed to determine the influence of other
factors on the variables of interest. <br/>Result(s): A total of 964
unique manuscripts were screened, with 10 being included in the final
analyses. There were a total of 724 patients, with 353 (49%) having
undergone repair utilizing a modified single-patch repair. Mean age at
repair for modified single-patch repair and two-patch repair was 8.81 and
9.03 months, respectively. Significant differences were noted in
cardiopulmonary bypass time and cross-clamp time with mean difference of
-28.53 and -22.69 minutes, respectively. In comparison to the two-patch
repair, both times were decreased in modified single-patch repair. No
significant difference was noted in any other variables.
<br/>Conclusion(s): Modified single-patch repair for atrioventricular
septal defects requires less cardiopulmonary bypass and cross-clamp time
but does not significantly impact the examined postoperative
outcomes.<br/>Copyright &#xa9; The Author(s) 2019.

<38>
Accession Number
624459567
Title
Antiplatelet Effect of Ketorolac in Children After Congenital Cardiac
Surgery.
Source
World Journal for Pediatric and Congenital Heart Surgery. 9 (6) (pp
651-658), 2018. Date of Publication: 01 Nov 2018.
Author
Kim J.S.; Kaufman J.; Patel S.S.; Manco-Johnson M.; Di Paola J.; da Cruz
E.M.
Institution
(Kim, Kaufman, Patel, da Cruz) Department of Pediatrics, Heart Institute,
Children's Hospital Colorado, University of Colorado Denver School of
Medicine, Aurora, CO, United States
(Manco-Johnson, Di Paola) Department of Pediatrics, Hemophilia and
Thrombosis Center, Children's Hospital Colorado, University of Colorado
Denver School of Medicine, Aurora, CO, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Ketorolac is used for pediatric analgesia after surgery
despite its known platelet inhibition via the arachidonic acid (AA)
pathway. The degree of platelet inhibitory effect after cardiac surgery is
not well characterized. Thromboelastography with platelet mapping (TEG-PM)
is emerging as a frequently used test to evaluate platelet inhibition via
the AA pathway. <br/>Method(s): Post hoc analysis of a data set collected
in a prospective observational cohort study evaluating platelet inhibition
in children after congenital heart surgery with cardiopulmonary bypass
(CPB). Categorization into two groups: (1) received ketorolac and (2) did
not receive ketorolac for analgesia after surgery. The TEG-PM was
evaluated at two time points (prior to surgery and 12-48 hours after CPB).
<br/>Result(s): Fifty-three children were studied; mean age was 6.6
(range: 0.07-16.7) years and 45% (n = 24) were female. Participants were
distributed into two groups by ketorolac use, 41 within the ketorolac
group and 12 in the no ketorolac group. All 41 participants who received
ketorolac had platelet inhibition and 11 (91.7%) of 12 participants who
did not receive ketorolac had normal platelet function after surgery (P
<.0001). There was no difference in patient characteristics or clinical
data between the two groups. <br/>Conclusion(s): Ketorolac use in a cohort
of children after congenital cardiac surgery was associated with platelet
inhibition via the AA pathway when evaluated by TEG-PM.<br/>Copyright
&#xa9; The Author(s) 2018.

<39>
Accession Number
621323224
Title
Early Outcomes of Hypoplastic Left Heart Syndrome Infants: Meta-Analysis
of Studies Comparing the Hybrid and Norwood Procedures.
Source
World Journal for Pediatric and Congenital Heart Surgery. 9 (2) (pp
224-233), 2018. Date of Publication: 01 Mar 2018.
Author
Cao J.Y.; Lee S.Y.; Phan K.; Ayer J.; Celermajer D.S.; Winlaw D.S.
Institution
(Cao, Lee, Phan, Ayer, Celermajer, Winlaw) Sydney Medical School,
University of Sydney, Sydney, NSW, Australia
(Phan) NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private
Hospital, Sydney, NSW, Australia
(Ayer, Winlaw) Heart Centre for Children, The Children's Hospital at
Westmead, Sydney, NSW, Australia
(Celermajer) Cardiology, Royal Prince Alfred Hospital, Sydney, NSW,
Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The hybrid strategy is an alternative to the traditional Norwood procedure
for initial palliation of infants with hypoplastic left heart syndrome
(HLHS) who are deemed to be at high surgical risk. Numerous single-center
studies have compared the two procedures, showing similar early outcomes,
although the cohort sizes are likely insufficiently powered to detect
significant differences. The current meta-analysis aims to explore the
early morbidity and mortality associated with the hybrid compared to the
Norwood procedure. MEDLINE, Cochrane Libraries, and Embase were
systematically searched, and 14 studies were included for statistical
synthesis, comprising 263 hybrid and 426 Norwood patients. Early mortality
was significantly higher in the hybrid patients (relative risk [RR] =
1.54, P <.05, 95% confidence interval [CI]: 1.02-2.34), whereas interstage
mortality was comparable between the two groups (RR = 0.88, P >.05, 95%
CI: 0.46-1.70). Six-month (RR = 0.89, P <.05, 95% CI: 0.80-1.00) and
one-year (RR = 0.88, P <.05, 95% CI: 0.78-1.00) transplant-free survival
was also inferior among the hybrid patients. Furthermore, the hybrid
patients required more reinterventions following initial surgical
palliation (RR = 1.48, P <.05, 95% CI: 1.09-2.01), although the two groups
had comparable length of hospital and intensive care unit stay
postoperatively. In conclusion, our results suggest that the hybrid
procedure is associated with worse early survival compared to the
traditional Norwood when used for initial palliation of infants with HLHS.
However, due to the hybrid being used preferentially for high-risk
patients, definitive conclusions regarding the efficacy of the procedure
cannot be drawn.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s) 2018.

<40>
Accession Number
620193774
Title
The Perspective of the Intensivist on Inotropes and Postoperative Care
Following Pediatric Heart Surgery: An International Survey and Systematic
Review of the Literature.
Source
World Journal for Pediatric and Congenital Heart Surgery. 9 (1) (pp
10-21), 2018. Date of Publication: 01 Jan 2018.
Author
Roeleveld P.P.; de Klerk J.C.A.
Institution
(Roeleveld) Department of Pediatric Intensive Care, Leiden University
Medical center, Leiden, Netherlands
(de Klerk) Department of Neonatal Intensive Care, Erasmus MC-Sophia
Children's Hospital, Rotterdam, Netherlands
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Inotropes are frequently being used in children undergoing
heart surgery to prevent or treat low cardiac output syndrome (LCOS).
There is only limited evidence that inotropes actually positively
influence postoperative outcome. Our aim was to describe the current
international practice variation in the use of inotropes following
congenital heart surgery. <br/>Method(s): We developed an online survey
regarding the postoperative use of inotropes. We sent an invitation to all
197 registered members of the Pediatric Cardiac Intensive Care Society
(PCICS) to participate in the survey. We also performed a systematic
review of the literature. <br/>Result(s): Ninety-eight people (50%)
responded, representing 62 international centers. Milrinone is routinely
used perioperatively by 90 respondents (97%). Adrenaline/epinephrine is
routinely used by 43%, dopamine by 36%, dobutamine by 11%, and
levosimendan by 6%. Steroids are used routinely by 54% before initiating
cardiopulmonary bypass. Vasopressin is used by 44% of respondents. The
development of LCOS is monitored with lactate in 99% of respondents,
physical examination (98%), intermittent mixed venous saturation (76%),
continuous mixed venous saturation (13%), echocardiography (53%),
core-peripheral temperature gap (29%), near-infrared spectrometry (25%),
and 4% use cardiac output monitors (PiCCO, USCOM). To improve cardiac
output, 42% add/increase milrinone, 37% add adrenaline, and 15% add
dopamine. Rescue therapy is titrated individually, based on the patients'
pathophysiology. A systematic review of the literature failed to show
compelling evidence with regard to the benefit of inotropes.
<br/>Conclusion(s): Despite the lack of sufficient evidence, milrinone is
used by the vast majority of caregivers following congenital heart
surgery.<br/>Copyright &#xa9; 2017, &#xa9; The Author(s) 2017.

<41>
Accession Number
618308563
Title
Cardiac Tumors in Pediatric Patients: A Systematic Review.
Source
World Journal for Pediatric and Congenital Heart Surgery. 8 (5) (pp
624-632), 2017. Date of Publication: 01 Sep 2017.
Author
Tzani A.; Doulamis I.P.; Mylonas K.S.; Avgerinos D.V.; Nasioudis D.
Institution
(Tzani, Doulamis, Mylonas, Avgerinos, Nasioudis) Surgery Working Group,
Society of Junior Doctors, Athens, Greece
(Mylonas) Division of Pediatric Surgery, Department of Surgery,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Avgerinos) Department of Cardiothoracic Surgery, New York Presbyterian
Medical Center, Weill Cornell College of Medicine, New York, NY, United
States
(Nasioudis) Department of Obstetrics and Gynecology, Hospital of the
University of Pennsylvania, Philadelphia, PA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
This systematic review sought to investigate the current evidence
regarding surgical management of primary cardiac tumors in children and
adolescents. Twenty-eight studies were deemed eligible, reporting on 745
pediatric patients. Rhabdomyoma was the most prevalent histologic type and
echocardiography was the most common diagnostic tool. Cumulative 30-day
mortality rate was 6.7%. Rhabdomyomas and teratomas had the highest 30-day
mortality. The higher percentage of tumor relapse was noted for myxoma and
teratoma. Although cardiac tumors are rare, their atypical clinical
presentation, potential for recurrence, and the poor prognosis associated
with recurrence elucidate the need for reliable diagnostic and therapeutic
management.<br/>Copyright &#xa9; 2017, &#xa9; The Author(s) 2017.

<42>
Accession Number
614028466
Title
Clinical Databases and Registries in Congenital and Pediatric Cardiac
Surgery, Cardiology, Critical Care, and Anesthesiology Worldwide.
Source
World Journal for Pediatric and Congenital Heart Surgery. 8 (1) (pp
77-87), 2017. Date of Publication: 01 Jan 2017.
Author
Vener D.F.; Gaies M.; Jacobs J.P.; Pasquali S.K.
Institution
(Vener) Department of Anesthesiology, Perioperative and Pain Medicine,
Pediatric Cardiovascular Anesthesia, Texas Children's Hospital, Baylor
College of Medicine, Houston, TX, United States
(Gaies, Pasquali) Department of Pediatric Cardiology, C. S. Mott
Children's Hospital, University of Michigan, Ann Arbor, MI, United States
(Jacobs) Cardiovascular Surgery, Johns Hopkins All Children's Hospital, St
Petersburg, FL, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The growth in large-scale data management capabilities and the successful
care of patients with congenital heart defects have coincidentally
paralleled each other for the last three decades, and participation in
multicenter congenital heart disease databases and registries is now a
fundamental component of cardiac care. This manuscript attempts for the
first time to consolidate in one location all of the relevant databases
worldwide, including target populations, specialties, Web sites, and
participation information. Since at least 1,992 cardiac surgeons and
cardiologists began leveraging this burgeoning technology to create
multi-institutional data collections addressing a variety of specialties
within this field. Pediatric heart diseases are particularly well suited
to this methodology because each individual care location has access to
only a relatively limited number of diagnoses and procedures in any given
calendar year. Combining multiple institutions data therefore allows for a
far more accurate contemporaneous assessment of treatment modalities and
adverse outcomes. Additionally, the data can be used to develop outcome
benchmarks by which individual institutions can measure their progress
against the field as a whole and focus quality improvement efforts in a
more directed fashion, and there is increasing utilization combining
clinical research efforts within existing data structures. Efforts are
ongoing to support better collaboration and integration across data sets,
to improve efficiency, further the utility of the data collection
infrastructure and information collected, and to enhance return on
investment for participating institutions.<br/>Copyright &#xa9; 2016,
&#xa9; The Author(s) 2016.

<43>
Accession Number
611155490
Title
Comparison of Feeding Strategies for Infants With Hypoplastic Left Heart
Syndrome: A Randomized Controlled Trial.
Source
World Journal for Pediatric and Congenital Heart Surgery. 7 (4) (pp
446-453), 2016. Date of Publication: 01 Jul 2016.
Author
Spillane N.T.; Kashyap S.; Bateman D.; Weindler M.; Krishnamurthy G.
Institution
(Spillane) Department of Pediatrics, Hackensack UMC, Rutgers University
New Jersey Medical School, Hackensack, NJ, United States
(Kashyap, Bateman, Weindler, Krishnamurthy) Department of Pediatrics,
Columbia University Medical Center, New York, NY, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Infants with hypoplastic left heart syndrome are at risk for
growth failure, particularly after stage 1 procedures. The effect of
continuous enteral feedings on weight gain has not been previously
investigated. <br/>Method(s): A randomized controlled trial was performed
in infants with hypoplastic left heart syndrome and single ventricle
variants after stage 1 procedures. Eligible infants were randomized to a
continuous and intermittent feeding regimen or an exclusive intermittent
feeding regimen after stage 1 procedures and continued until hospital
discharge. Anthropometric measures and markers of nutritional status were
assessed throughout hospitalization. <br/>Result(s): Twenty-six infants
completed the study. There were no significant differences in weight gain,
growth, or nutritional status. Weight gain on full enteral feedings was
24.3 versus 23.6 g/d (P =.88) for the combination (continuous and
intermittent) versus intermittent feeding groups. Weight-for-age Z scores
at discharge were -1.37 versus -1.2 (P =.59) for the combination versus
intermittent groups. <br/>Conclusion(s): No significant differences in
weight gain, growth, or nutritional status were observed at hospital
discharge between the two feeding strategies. Despite both groups
achieving target daily weight gain after attaining full feeds, growth
failure continued to be a problem after stage 1 procedures. Further
strategies to improve growth during initial hospitalization are
needed.<br/>Copyright &#xa9; The Author(s) 2016.

<44>
Accession Number
604704698
Title
The Expanding Indications for the Lecompte Maneuver.
Source
World Journal for Pediatric and Congenital Heart Surgery. 5 (2) (pp
291-296), 2014. Date of Publication: 2014.
Author
Talwar S.; Muthukkumaran S.; Choudhary S.K.; Airan B.
Institution
(Talwar, Muthukkumaran, Choudhary, Airan) Department of Cardiothoracic &
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Since the anterior translocation of the pulmonary arteries in relation to
the aorta (Lecompte maneuver) was first described in 1981, its indications
have continued to expand. In this review, we discuss the physiological
basis and the expanding indications for this maneuver.<br/>Copyright
&#xa9; The Author(s) 2013

<45>
Accession Number
604281647
Title
Comparison of Cardioprotective Effects of Volatile Anesthetics in Children
Undergoing Ventricular Septal Defect Closure.
Source
World Journal for Pediatric and Congenital Heart Surgery. 4 (1) (pp
24-29), 2013. Date of Publication: 2013.
Author
Singh P.; Chauhan S.; Jain G.; Talwar S.; Makhija N.; Kiran U.
Institution
(Singh, Chauhan, Makhija, Kiran) Department of Cardiac Anaesthesia, All
India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
(Jain) Department of Anesthesia and Intensive care, Teerthankar Mahaveer
Medical College, Moradabad, UP, India
(Talwar) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Volatile anesthetic agents may precondition the myocardium and
protect against ischemia and infarction. Preconditioning by volatile
anesthetic agents is well documented in adults but is underinvestigated in
children. The present study compares the effect of preconditioning in
children by three volatile anesthetic agents along with several other
variables associated with cardioprotection. <br/>Method(s): Eighty
children scheduled for ventricular septal defect closure under
cardioplegic arrest were assigned to preconditioning for five minutes
after commencement of cardiopulmonary bypass (CPB) with one minimum
alveolar concentration (MAC) of one of the following agents: isoflurane,
sevoflurane, desflurane, or placebo (oxygen-air mixture). The plasma
concentration of creatine kinase MB (CK-MB) was determined after
initiation of CPB, and again 6 and 24 hours after admission to the
intensive care unit (ICU) after surgery. Duration of inotropic support,
mechanical ventilation, and length of ICU stay in all the groups were also
recorded. <br/>Result(s): Preconditioning with isoflurane, sevoflurane,
and desflurane was associated with significantly decreased postoperative
release of CK-MB as compared to placebo group at 6 (group 1: 237.2 +/-
189, group 2: 69.8 +/- 15.8, group 3: 64.7 +/- 37.8, and group 4: 70.4 +/-
26.7) and 24 hours (group 1: 192.4 +/- 158.2, group 2: 67.7 +/- 25.0,
group 3: 85.7 +/- 66.8, and group 4: 50.4 +/- 31.6) after admission to
ICU. No significant differences were observed in the CK-MB levels among
the three volatile anesthetic agents. Duration of inotropic support,
mechanical ventilation, and length of ICU stay were greater in placebo
group as compared to other groups without reaching statistical
significance. <br/>Conclusion(s): Volatile anesthetic appear to provide
definite cardioprotection to pediatric myocardium. No conclusion can be
drawn regarding the best preconditioning agent among isoflurane,
sevoflurane, and desflurane.<br/>Copyright &#xa9; The Author(s) 2012

<46>
Accession Number
368408847
Title
Comparison of Cardioprotective Effects of Volatile Anesthetics in Children
Undergoing Ventricular Septal Defect Closure.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 4 (1) (pp
24-29), 2013. Date of Publication: January 2013.
Author
Singh P.; Chauhan S.; Jain G.; Talwar S.; Makhija N.; Kiran U.
Institution
(Singh, Chauhan, Makhija, Kiran) Department of Cardiac Anaesthesia, All
India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
(Jain) Department of Cardiac Anaesthesia, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi, India
(Talwar) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Volatile anesthetic agents may precondition the myocardium and
protect against ischemia and infarction. Preconditioning by volatile
anesthetic agents is well documented in adults but is underinvestigated in
children. The present study compares the effect of preconditioning in
children by three volatile anesthetic agents alongwith several other
variables associated with cardioprotection. <br/>Method(s): Eighty
children scheduled for ventricular septal defect closure under
cardioplegic arrest were assigned to preconditioning for five minutes
after commencement of cardiopulmonary bypass (CPB) with one minimum
alveolar concentration (MAC)of oneof the following agents: isoflurane,
sevoflurane, desflurane, or placebo(oxygen-air mixture).The plasma
concentration of creatine kinaseMB(CK-MB) was determined after initiation
ofCPB, and again 6 and 24 hours after admission to the intensive care unit
(ICU) after surgery. Duration of inotropic support, mechanical
ventilation, and length of ICUstay in all the groups were also recorded.
<br/>Result(s): Preconditioning with isoflurane, sevoflurane, and
desflurane was associated with significantly decreased postoperative
release of CK-MB as compared to placebo group at 6 (group 1: 237.2+/-189,
group 2: 69.8+/-15.8, group 3: 64.7+/-37.8, and group 4: 70.4+/-26.7) and
24 hours (group 1: 192.4+/-158.2, group 2: 67.7+/-25.0, group 3:
85.7+/-66.8, and group 4: 50.4+/-31.6) after admission toICU. No
significant differenceswereobserved in theCK-MBlevels among the three
volatile anesthetic agents.Duration of inotropic support, mechanical
ventilation, and length of ICU stay were greater in placebo group as
compared to other groups without reaching statistical significance.
<br/>Conclusion(s): Volatile anesthetic appear to provide definite
cardioprotection to pediatricmyocardium. No conclusion can be drawn
regarding the best preconditioning agent among isoflurane, sevoflurane,
and desflurane. &#xa9; The Author(s) 2012.

<47>
Accession Number
368408895
Title
Controlling Oxygenation During Initiation of Cardiopulmonary Bypass: Can
It Improve Immediate Postoperative Outcomes in Cyanotic Children
Undergoing Cardiac Surgery? A Prospective Randomized Study.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 3 (3) (pp
310-316), 2012. Date of Publication: July 2012.
Author
Babu B.; Bhat S.; Prabuswamy H.P.; Kamalapurkar G.; Kumar H.V.J.; Libu
G.K.; Shilpa S.; Lokesh B.K.
Institution
(Babu) Department of Cardiothoracic Surgery, Apollo Hospitals, 154/11,
Bannerghatta Road, Bangalore 560076, India
(Babu, Bhat, Prabuswamy, Kamalapurkar, Kumar, Shilpa) Department of
Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences
and Research, Bangalore, India
(Libu) Department of Community Medicine and Statistics, Karakonam Medical
College, Trivandrum, India
(Lokesh) Department of Perfusion, Sri Jayadeva Institute of Cardiovascular
Sciences and Research, Bangalore, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: Cardiopulmonary bypass (CPB) initiated with high oxygen levels
may expose cyanotic children to reoxygenation injury. The ideal method of
initiation of bypass to prevent this phenomenon still remains largely
unproven. This study tested the hypothesis that controlling oxygenation
during initiation of CPB improves early postoperative outcomes.
<br/>Method(s): Thirty-one cyanotic children were randomized to two
treatment arms of the study. In group A (intervention), CPB was initiated
with fraction of inspired oxygen (Fio2) 0.21, and after one minute of full
bypass, Fio2 was increased at increments of 0.1 per minute to reach 0.6.
In group B (hyperoxemic), CPB was initiated using Fio2 > 0.6. Aortic cross
clamp time (minutes), CPB time (minutes), creatine phosphokinase-MB
(CPK-MB) levels (U/L), lactate levels (mmol/L), duration of ventilator
support (hours), inotropic support (hours), and intensive care unit (ICU)
stay (hours) as well as hospital mortality were measured. <br/>Result(s):
Levels of CPK-MB (group A mean = 59.6 U/L, 95% confidence interval [CI]:
45.9-73.3; group B mean = 82.6 U/L, 95% CI: 66.1-99.1, P = .016) and
ventilation time (group A median = 16.5 hours; interquartile range [IQR] =
11.25-23; group B median = 27.5 hours; IQR = 17-54, P = .045) were
significantly lower in the intervention group. Other parameters showed no
significant differences: CPB time (group A median = 71.5 minutes, IQR =
64-100; group B median = 95.5 minutes, IQR = 58-145, P = .71), cross clamp
time (group A mean = 59.2 minutes, 95% CI: 47.6-70.8; group B mean = 66.57
minutes, 95% CI: 47.6-88.5, P =.57), lactate levels (mmol/L; group A
median = 1.8, IQR = 1.48-2.59; group B median = 2.1, IQR = 1.29-2.62, P =
1), inotropic support (group A median = 47.5 hours, IQR = 36-73.75; group
B median = 59.5 hours, IQR = 41.75-92.5, P = .27), ICU stay (group A
median = 59.5 hours, IQR = 48.25-118.5; group B median = 85 hours, IQR =
47.75-137.50, P = .21), and mortality (group A n = 2, group B n = 2).
<br/>Conclusion(s): A controlled oxygenation protocol was associated with
significantly lower postoperative CPK-MB levels. Evaluation of other end
points including ventilation times requires a study with larger sample
size for validation. &#xa9; The Author(s) 2012.

<48>
Accession Number
368408871
Title
The Effects of Multiple Doses of Glucocorticoids on the Inflammatory
Response to Cardiopulmonary Bypass in Children.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 3 (4) (pp
439-445), 2012. Date of Publication: October 2012.
Author
Bronicki R.A.; Checchia P.A.; Stuart-Killion R.B.; Dixon D.J.; Backer C.L.
Institution
(Bronicki) Department of Pediatric Critical Care Medicine, Children's
Hospital of Orange County, Orange, CA, United States
(Checchia) Division of Critical Care Medicine, St Louis Children's
Hospital, Washington University, St Louis, MO, United States
(Stuart-Killion) Division of Pediatric Cardiology, Lucile Packard
Children's Hospital, Stanford University, Stanford, CA, United States
(Dixon) Division of Biostatistics, Washington University School of
Medicine, St Louis, MO, United States
(Backer) Division of Cardiovascular-Thoracic Surgery Ann and Robert H.
Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., mc 22, Chicago,
IL 60611-2605, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: We previously demonstrated that a dose of glucocorticoids
(GCs) administered prior to cardiopulmonary bypass (CPB) is effective at
suppressing the inflammatory response to CPB and leads to an improved
postoperative course. We evaluated whether an additional dose of GC
administered eight hours prior to CPB would lead to further clinical
benefit. <br/>Method(s): We conducted a prospective study in which
patients were randomized to receive placebo or GC eight hours prior to
CPB, in addition to a dose of GC administered following induction of
anesthesia. We measured serum inflammatory mediator levels and
postoperative clinical parameters. <br/>Result(s): Thirty-one patients
were included in the study. Eighteen patients received two doses of GC and
13 patients received a single does of GC. Complement C3a levels were
significantly lower at 24 hours following surgery in those patients who
received two doses of GC (3136 +/- 1650 vs 1779 +/- 1616 ng/mL, P = .04).
There was no significant difference in tumor necrosis factor (TNF)-alpha
or interleukin (IL)-6 levels at any time between groups. There was no
significant difference in core body temperature or renal function (based
on serum creatinine levels) between groups. There was no significant
difference between groups in duration of mechanical ventilation (2.4 +/-
1.5 vs 3.6 +/- 3.7 days, two vs one dose, respectively, P = .33) or length
of stay in the intensive care unit ([ICU]; 3.4 +/- 1.4 vs 4.9 +/- 3.6
days, 2 vs 1 dose, respectively, P = .15). <br/>Conclusion(s): While those
patients who received two doses of GC prior to surgery had significantly
less complement activation postoperatively, clinical outcomes did not
differ between groups. We conclude that the practice of administering an
additional dose of GC prior to CPB is not supported. However, a large
randomized study is needed to conclusively discount the potential benefit
of this strategy. &#xa9; The Author(s) 2012.

<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<br/>Copyright &#xa9;
Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<50>
[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.<br/>Copyright &#xa9; 2019 by the ASAIO.

<51>
[Use Link to view the full text]
Accession Number
630995915
Title
Outcomes with Deferred Versus Performed Revascularization of Coronary
Lesions with Gray-Zone Fractional Flow Reserve Values.
Source
Circulation: Cardiovascular Interventions. 12 (12) (no pagination), 2019.
Article Number: e008315. Date of Publication: 01 Dec 2019.
Author
Megaly M.; Khalil C.; Saad M.; Xenogiannis I.; Omer M.; Anantha Narayanan
M.; Pershad A.; Garcia S.; Seto A.H.; Burke M.N.; Brilakis E.S.
Institution
(Megaly, Xenogiannis, Omer, Garcia, Burke, Brilakis) Minneapolis Heart
Institute, Abbott Northwestern Hospital, MN, United States
(Megaly, Omer) Hennepin Healthcare, Minneapolis, MN, United States
(Khalil) Department of Medicine, University at Buffalo, NY, United States
(Saad) Division of Cardiovascular Medicine, Warren Alpert School of
Medicine at Brown University, Providence, RI, United States
(Saad) Department of Cardiovascular Medicine, Ain Shams University
Hospitals, Cairo, Egypt
(Anantha Narayanan) Division of Vascular Medicine, Yale New Haven
Hospital, CT, United States
(Pershad) Division of Cardiology, Banner University Medical Center and
University of Arizona, Phoenix, AZ, United States
(Seto) Division of Cardiology, Long Beach VA Medical Center, Orange, CA,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Management of coronary lesions with fractional flow reserve
values in the gray zone (0.75-0.80) remains controversial due to
conflicting data on the performance versus deferral of revascularization.
<br/>Method(s): We performed a systematic review and meta-Analysis of 7
observational studies including 2683 patients that compared the outcomes
of deferred versus performed revascularization of coronary lesions with
gray-zone fractional flow reserve values. <br/>Result(s): During a mean
follow-up of 31+/-9 months, the incidence of major adverse cardiovascular
events (12.54 % versus 11.25%; odds ratio [OR], 1.64 [95% CI, 0.78-3.44];
P=0.19, I2=84%), cardiac mortality (1.25% versus 0.72%; OR, 1.78 [95% CI,
0.58-5.46]; P=0.31, I2=18%), and myocardial infarction (1.28% versus
2.66%; OR, 0.79 [95% CI, 0.22-2.79]; P=0.71, I2=65%) was similar with
deferral versus performance of revascularization in coronary lesions with
gray-zone fractional flow reserve. Deferral of revascularization was
associated with a higher incidence of target vessel revascularization
(9.12% versus 5.78%; OR, 1.85 [95% CI, 1.03-3.33]; P=0.04, I2=62%). When
the analysis was limited only to studies that used percutaneous coronary
intervention for revascularization, deferred revascularization remained
associated with a higher risk of target vessel revascularization (18%
versus 7.3%; OR, 3.04 [95% CI, 1.53-6.02]; P<0.001) and was associated
with a higher risk of major adverse cardiovascular event (23.2% versus
13.4%; OR, 3.38 [95% CI, 1.92-5.95]; P<0.001). <br/>Conclusion(s): In
lesions with gray-zone fractional flow reserve, revascularization was
associated with a similar incidence of major adverse cardiovascular event
but a lower incidence of target vessel revascularization over a mean
follow-up of approximately 2.5 years. Clinical Trial Registration: URL:
https://www.crd.york.ac.uk/prospero/. Unique identifier:
CRD42019128076.<br/>Copyright &#xa9; 2019 American Heart Association, Inc.

<52>
Accession Number
2003716133
Title
Patient blood management (PBM) in pregnancy and childbirth: literature
review and expert opinion.
Source
Archives of Gynecology and Obstetrics. 301 (2) (pp 627-641), 2020. Date of
Publication: 01 Feb 2020.
Author
Surbek D.; Vial Y.; Girard T.; Breymann C.; Bencaiova G.A.; Baud D.;
Hornung R.; Taleghani B.M.; Hosli I.
Institution
(Surbek) Department of Obstetrics and Gynaecology, Bern University
Hospital, Insel Hospital, University of Bern, Friedbuhlstrasse 19, Bern
3010, Switzerland
(Bencaiova, Hosli) Clinic of Obstetrics and Gynaecology, University
Hospital Basel, Basel, Switzerland
(Vial, Baud) Service of Obstetrics, Department Woman-Mother-Child,
University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne,
Switzerland
(Girard) Department of Anaesthesiology, University Hospital Basel, Basel,
Switzerland
(Breymann) Obstetric Research-Feto Maternal Haematology Unit, University
Hospital Zurich, Zurich, Switzerland
(Hornung) Department of Obstetrics and Gynaecology, St. Gallen Cantonal
Hospital, St. Gallen, Switzerland
(Taleghani) Department of Haematology, Inselspital, University and
University Hospital Bern, Bern, Switzerland
Publisher
Springer
Abstract
Purpose: Patient blood management [PBM] has been acknowledged and
successfully introduced in a wide range of medical specialities, where
blood transfusions are an important issue, including anaesthesiology,
orthopaedic surgery, cardiac surgery, or traumatology. Although pregnancy
and obstetrics have been recognized as a major field of potential
haemorrhage and necessity of blood transfusions, there is still little
awareness among obstetricians regarding the importance of PBM in this
area. This review, therefore, summarizes the importance of PBM in
obstetrics and the current evidence on this topic. <br/>Method(s): We
review the current literature and summarize the current evidence of PBM in
pregnant women and postpartum with a focus on postpartum haemorrhage (PPH)
using PubMed as literature source. The literature was reviewed and
analysed and conclusions were made by the Swiss PBM in obstetrics working
group of experts in a consensus meeting. <br/>Result(s): PBM comprises a
series of measures to maintain an adequate haemoglobin level, improve
haemostasis and reduce bleeding, aiming to improve patient outcomes.
Despite the fact that the WHO has recommended PBM early 2010, the majority
of hospitals are in need of guidelines to apply PBM in daily practice. PBM
demonstrated a reduction in morbidity, mortality, and costs for patients
undergoing surgery or medical interventions with a high bleeding
potential. All pregnant women have a significant risk for PPH. Risk
factors do exist; however, 60% of women who experience PPH do not have a
pre-existing risk factor. Patient blood management in obstetrics must,
therefore, not only be focused on women with identified risk factor for
PPH, but on all pregnant women. Due to the risk of PPH, which is inherent
to every pregnancy, PBM is of particular importance in obstetrics.
Although so far, there is no clear guideline how to implement PBM in
obstetrics, there are some simple, effective measures to reduce anaemia
and the necessity of transfusions in women giving birth and thereby
improving clinical outcome and avoiding complications. <br/>Conclusion(s):
PBM in obstetrics is based on three main pillars: diagnostic and/or
therapeutic interventions during pregnancy, during delivery and in the
postpartum phase. These three main pillars should be kept in mind by all
professionals taking care of pregnant women, including obstetricians,
general practitioners, midwifes, and anaesthesiologists, to improve
pregnancy outcome and optimize resources.<br/>Copyright &#xa9; 2019, The
Author(s).

<53>
Accession Number
2005045412
Title
Percutaneous mitral valve repair for secondary mitral valve regurgitation:
A systematic review and meta-analysis.
Source
European Journal of Internal Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Kumar A.; Al-khafaji J.; Shariff M.; Vaz I.P.; Adalja D.; Doshi R.
Institution
(Kumar, Shariff) Department of Critical Care, St John's Medical college
hospital, Bengaluru, Karnataka, India
(Al-khafaji, Doshi) Department of Internal Medicine, University of Nevada
Reno School of Medicine, Reno, NV, United States
(Vaz) Department of internal medicine, Jackson Memorial
Hospital/University of Miami, Florida, United States
(Adalja) GMERS Gotri Medical College, Gotri Medical Education and Research
Center, Vadodara, Gujarat, India
Publisher
Elsevier B.V.
Abstract
Background: The first two randomized control trials (RCTs) studying the
role of MitraClip in patients with secondary mitral regurgitation (MR) had
antagonizing results. We, therefore, performed an updated meta-analysis of
RCTs and propensity score-matched observational studies investigating the
role of MitraClips in patients with secondary MR. A novel method of Kaplan
Meier Curve reconstruction from derived individual patient data will be
used to compare the survival probability of control groups in COAPT and
MITRA HF trail, and hence, access inter-study heterogeneity.
<br/>Method(s): Medline and Cochrane databases was used for systematic
search. We used the Mantel-Haenszel method with a random-effect model to
calculate risk ratio (RR) with 95% confidence interval (CI) and inverse
variance method with a random-effect model to calculate the mean
difference (MD) with 95% confidence interval (CI). We used a fixed-effect
approach for meta-regression. <br/>Result(s): MitraClip reduced the risk
of all-cause mortality [RR: 0.72, CI: 0.55-0.95, P value = 0.02, I2 = 55%,
chi²P-value = 0.08] and readmission [RR: 0.62, CI: 0.42-0.92, P
value = 0.02, I² = 90%, chi²P-value<0.01] at two
years follow-up. There was no effect of MitraClip on change in
cardiovascular mortality and 6 m walking distance at 12 months follow-up.
Meta-regression indicated left ventricular end diastolic volume and age
among the factors affecting outcomes. Reconstructed Kaplan Meier curves
confirmed considerable heterogeneity among patients randomized in MITRA HF
and COAPT trial. <br/>Conclusion(s): The present meta-analysis confirms
the beneficial role of percutaneous mitral valve repair in patients with
secondary MR. However, all the results were associated with considerable
heterogeneity.<br/>Copyright &#xa9; 2020 European Federation of Internal
Medicine

<54>
Accession Number
627905355
Title
Children's Heart Assessment Tool for Transplantation (CHAT) Score: A Novel
Risk Score Predicts Survival After Pediatric Heart Transplantation.
Source
World Journal for Pediatric and Congenital Heart Surgery. 10 (3) (pp
296-303), 2019. Date of Publication: 01 May 2019.
Author
Fraser C.D.; Grimm J.C.; Zhou X.; Lui C.; Giuliano K.; Suarez-Pierre A.;
Crawford T.C.; Magruder J.T.; Hibino N.; Vricella L.A.
Institution
(Fraser, Grimm, Zhou, Lui, Giuliano, Suarez-Pierre, Crawford, Magruder,
Hibino, Vricella) Division of Cardiac Surgery, The Johns Hopkins Hospital,
Baltimore, MD, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Given the shortage of donor organs in pediatric heart
transplantation (HTx), pretransplant risk stratification may assist in
organ allocation and recipient optimization. We sought to construct a
scoring system to preoperatively stratify a patient's risk of one-year
mortality after HTx. <br/>Method(s): The United Network for Organ Sharing
database was queried for pediatric (<18 years) patients undergoing HTx
between 2000 and 2016. The population was randomly divided in a 4:1
fashion into derivation and validation cohorts. A multivariable logistic
regression model for one-year mortality was constructed within the
derivation cohort. Points were then assigned to independent predictors (P
<.05) based on relative odds ratios (ORs). Risk groups were established
based on easily applicable, whole-integer score cutoffs. <br/>Result(s): A
total of 5,700 patients underwent HTx; one-year mortality was 10.7%. There
was a similar distribution of variables between derivation (n = 4,560) and
validation (n = 1,140) cohorts. Of the 12 covariates included in the final
model, nine were allotted point values. The low-risk (score 0-9),
intermediate-risk (10-20), and high-risk (>20) groups had a 5.18%, 10%,
and 28% risk of one-year mortality (P <.001), respectively. Both
intermediate-risk (OR = 2.46, 95% confidence interval [95% CI]: 1.93-3.15;
P <.001) and high-risk (OR = 9.24, 95% CI: 6.92-12.35; P <.001) scores
were associated with an increased risk of one-year mortality when compared
to the low-risk group. <br/>Conclusion(s): The Children's Heart Assessment
Tool for Transplantation score represents a pediatric-specific,
recipient-based system to predict one-year mortality after HTx. Its use
could assist providers in identification of patients at highest risk of
poor outcomes and may aid in pretransplant optimization of these
children.<br/>Copyright &#xa9; The Author(s) 2019.

<55>
Accession Number
627020321
Title
Lipid-Lowering Agents in Older Individuals: A Systematic Review and
Meta-Analysis of Randomized Clinical Trials.
Source
The Journal of clinical endocrinology and metabolism. 104 (5) (pp
1585-1594), 2019. Date of Publication: 01 May 2019.
Author
Ponce O.J.; Larrea-Mantilla L.; Hemmingsen B.; Serrano V.;
Rodriguez-Gutierrez R.; Spencer-Bonilla G.; Alvarez-Villalobos N.;
Benkhadra K.; Haddad A.; Gionfriddo M.R.; Prokop L.J.; Brito J.P.; Murad
M.H.
Institution
(Ponce, Larrea-Mantilla, Prokop, Murad) Evidence-Based Practice Center,
Mayo Clinic, Rochester, MN
(Ponce) Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana
Cayetano Heredia, Lima, Peru
(Ponce, Larrea-Mantilla, Serrano, Rodriguez-Gutierrez, Spencer-Bonilla,
Alvarez-Villalobos, Brito) Knowledge and Evaluation Research Unit,
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department
of Medicine, Mayo Clinic, Rochester, MN
(Hemmingsen) Department of Internal Medicine, Herlev University Hospital,
Herlev, Denmark
(Serrano) Department of Nutrition, Diabetes and Metabolism, Escuela de
Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
(Rodriguez-Gutierrez, Alvarez-Villalobos) Universidad Autonoma de Nuevo
Leon, Hospital Universitario "Dr. Jose E. Gonzalez, Plataforma INVEST-KER
Mexico, Monterrey, Nuevo Leon, Mexico
(Spencer-Bonilla) University of Puerto Rico Medical Sciences Campus, San
Juan, Puerto Rico
(Benkhadra) Department of Internal Medicine, School of Medicine, Wayne
State University, Detroit, MI, United States
(Haddad) Department of Medicine, Saint Clair Memorial Hospital,
Pittsburgh, PA, United States
(Gionfriddo) Center for Pharmacy Innovation and Outcomes, Geisinger,
Danville, PA, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The efficacy of lipid-lowering agents on patient-important
outcomes in older individuals is unclear. <br/>METHOD(S): We included
randomized trials that enrolled individuals aged 65 years or older and
that included at least 1 year of follow-up.Pairs of reviewers selected and
appraised the trials. <br/>RESULT(S): We included 23 trials that enrolled
60,194 elderly patients. For primary prevention, statins reduced the risk
of coronary artery disease [CAD; relative risk (RR): 0.79, 95% CI: 0.68 to
0.91] and myocardial infarction (MI; RR: 0.45, 95% CI: 0.31 to 0.66) but
not all-cause or cardiovascular mortality or stroke. These effects were
imprecise in patients with diabetes, but there was no significant
interaction between diabetes status and the intervention effect. For
secondary prevention, statins reduced all-cause mortality (RR: 0.80, 95%
CI: 0.73 to 0.89), cardiovascular mortality (RR: 0.68, 95% CI: 0.58 to
0.79), CAD (RR: 0.68, 95% CI: 0.61 to 0.77), MI (RR: 0.68, 95% CI: 0.59 to
0.79), and revascularization (RR: 0.68, 95% CI: 0.61 to 0.77). Intensive
(vs less-intensive) statin therapy reduced the risk of CAD and heart
failure. Niacin did not reduce the risk of revascularization, and fibrates
did not reduce the risk of stroke, cardiovascular mortality, or CAD.
<br/>CONCLUSION(S): High-certainty evidence supports statin use for
secondary prevention in older individuals. Evidence for primary prevention
is less certain. Data in older individuals with diabetes are limited;
however, no empirical evidence has shown a significant difference based on
diabetes status.<br/>Copyright &#xa9; 2019 Endocrine Society.

<56>
Accession Number
626128441
Title
Hammock Mitral Valve Repair in Infancy: Operative Steps Toward a
Customized Reconstruction After Preoperative Planning.
Source
World Journal for Pediatric and Congenital Heart Surgery. (no pagination),
2019. Date of Publication: 2019.
Author
VanLoozen D.; Jensen M.A.; Lutin W.A.; Polimenakos A.C.
Institution
(VanLoozen, Lutin) Department of Pediatric Cardiology, Children's Hospital
of Georgia, Augusta University, Augusta, GA, United States
(Jensen) Department of Medical Illustration, College of Allied Health,
Augusta University, Augusta, GA, United States
(Polimenakos) Department of Pediatric Cardiothoracic Surgery, Children's
Hospital of Georgia, Augusta University, Augusta, GA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Hammock mitral valve (MV) repair is historically technically difficult
with a guarded prognosis. Surgical experience is extremely limited and
variable outcomes are reported. The perioperative strategy and technical
details of hammock MV repair in an infant who presented with severe mitral
stenosis are described and review of the existing literature was
undertaken.<br/>Copyright &#xa9; The Author(s) 2019.

<57>
Accession Number
628615825
Title
Medical Thoracoscopy-Assisted Argon Plasma Coagulation Combined with
Electrosurgical Unit for the Treatment of Refractory Pneumothorax in
Elderly Patients.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 25 (5) (pp
237-245), 2019. Date of Publication: 20 Oct 2019.
Author
Guo H.-Y.; Pan X.-Q.; Hu M.; Liang Y.-F.; Qiu X.-C.; Chen Z.-H.
Institution
(Guo, Liang, Qiu, Chen) Department of Respiratory Medicine, Nanhai
Hospital, Affiliated Hospital of Southern Medical University, Foshan,
China
(Pan) Department of Emergency and Critical Care Medicine, Sixth People's
Hospital of Nanhai, Foshan, China
(Hu) Department of Urology Medicine, Nanhai Hospital, Affiliated Hospital
of Southern Medical University, Foshan, China
Publisher
NLM (Medline)
Abstract
PURPOSE: This study aims to compare the effects and prognosis of medical
thoracoscopy-assisted argon plasma coagulation (APC) combined with
electrosurgical unit (ESU) surgery, video-assisted thoracic surgery
(VATS), and pleurodesis surgery, in providing appropriate treatment for
elderly refractory pneumothorax patients. <br/>METHOD(S): Patients with
refractory pneumothorax aged over 65 years were divided into three groups:
APC combined with ESU (N = 20), VATS (N = 26), and pleurodesis (N = 24).
Data on demographic characteristics, lung function evaluation, and short-
and long-term prognoses were collected. <br/>RESULT(S): Following surgery,
compared with the APC-ESU and pleurodesis groups, patients in the VATS
group demonstrated poor short-term prognoses, with high pleural effusion
drainage levels and high visual analog scores (VAS; P <0.05). After the
surgery, St. George's Respiratory Questionnaire (SGRQ) scores in the
pleurodesis group were slightly elevated, whereas SGRQ scores in both the
APC-ESU and VATS groups demonstrated a continual decrease. Finally,
medical resource consumption analysis demonstrated a significant
difference in hospitalization costs among the three groups; the VATS group
being the most expensive. <br/>CONCLUSION(S): Medical
thoracoscopy-assisted APC combined with ESU is a safe, effective, and
affordable treatment for elderly patients with refractory pneumothorax.

<58>
Accession Number
631055934
Title
Efficacy and safety of catheter ablation of postincisional atrial
tachycardias in patients with prior history of mitral valve surgery: A
meta-analysis.
Source
Giornale Italiano di Cardiologia. Conference: 80. Congresso Nazionale SIC.
Italy. 20 (12 Supplement 1) (pp 47S-48S), 2019. Date of Publication:
December 2019.
Author
Marazzato J.; Crippa M.; Golino M.; Cappabianca G.; Doni L.A.; Giani R.;
Telli G.; Marazzi R.; De Ponti R.
Institution
(Marazzato, Crippa, Golino, Cappabianca, Doni, Giani, Telli, Marazzi, De
Ponti) Dipartimento Cardiovascolare - Ospedale Di Circolo, Universita
Degli Studi Dell'Insubria - Varese, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction. Data regarding catheter ablation (CA) of post-incisional
atrial tachycardias (AT) are scarce in literature, especially in patients
with prior history of mitral valve surgery (MVS) where mechanical
protheses and thick fibrosis around the MV anulus may pose a challenge for
a safe and effective procedure. Aim of this study is to assess the
efficacy and safety of CA of post-incisional AT in these patients and to
investigate specific features of these arrhythmias through a systematic
review of the literature. Methods. A systematic search on PubMed/MEDLINE,
EMBASE, and Web of Science was performed. An adult population undergoing
radiofrequency CA procedure for post-incisional AT with prior history of
MVS and with/without concomitant Maze procedure was considered. Articles
published before 2000 were excluded because the use of 3D electro-anatomic
mapping systems was not well established yet. The haemorrhagic,
thromboembolic complications and deaths were recorded. The periprocedural
success rate (i.e. restoration to sinus rhythm due to radiofrequency
delivery during CA procedure) and mid-long term outcome (i.e. persistence
of sinus rhythm after single/multiple procedures on/off antiarrhythmic
drugs) were carefully looked for. Finally, the most frequent
pathophysiologic mechanism (focal vs. macro-reentrant), site of origin of
the ablated AT (left atrium vs. right atrium) and association of the
surgical scar location with specific AT morphologies were investigated.
Results. After systematic review, 8 studies were regarded as eligible for
the analysis. One-hundred seventy-three patients without severely impaired
FEVS (42-72.1%) and with mild-to-severe atrial dilatation (37 - 63 mm)
were considered with prior history of MV replacement (59.5%) or
valvuloplasty (40.5%) and concomitant Maze procedure (56%). All the
patients underwent 239 CA procedures (1.4 procedure/patient) and in all
cases a 3D electro-anatomic mapping system was used. Major complications
were recorded in 3/173 cases (1.7%) with 2 retroperitoneal haemorrhages
(1.2%), 1 intracranial haemorrhage leading to death (0.06%). Acute success
rate was achieved in 167/173 patients (95.6%) and 112/173 patients (65%)
were in sinus rhythm at follow-up (2.1-60 months). In 97% of patients the
whole number of AT morphologies were specified: 272 AT (92.2%) were
macro-reentrant and 23 (7.8%) were focal in origin. In the macro-reentrant
AT group, CA was performed in the right atrium in 144 morphologies (53%)
and in most of these cases ablation was performed at the cavo-tricuspid
isthmus (CTI) (63%). When CA was performed in the left atrium (47% of
cases), mitral isthmus was the main target for ablation (55%). Type of
surgical incision was reported in 112 patients (65%). In these patients,
most of the AT were found in the right atrium (133/215 morphologies - 62%)
with involvement of CTI in 55% of cases. In these patients a trans-septal
approach was very frequently encountered (52%) either as superior
trans-septal one or via a lateral free wall incision in the right atrium.
Conclusions. After a systematic literature review, CA of post-incisional
AT in patients with prior MVS should be regarded as a safe and effective
procedure. A trans-septal surgical incision is the main surgical approach
in this population associated with late-onset macro-reentrant AT most
frequently and quite surprisingly located in the right atrial chamber with
involvement, in many cases, of the CTI.

<59>
Accession Number
631055624
Title
Left ventricular size predicts clinical benefit after percutaneous mitral
valve repair for secondary mitral regurgitation: A systematic review and
metaregression analysis.
Source
Giornale Italiano di Cardiologia. Conference: 80. Congresso Nazionale SIC.
Italy. 20 (12 Supplement 1) (pp 156S), 2019. Date of Publication: December
2019.
Author
Verrengia E.; Zimarino M.; Ricci F.; Capodanno D.; De Innocentiis C.;
Swaans M.J.; Lombardi C.; Brouwer J.; Gallina S.; Grasso C.; De Caterina
R.; Tamburino C.
Institution
(Verrengia, Zimarino, De Innocentiis, Gallina) Institute of Cardiology, G.
D'annunzio University, Chieti, Italy
(Ricci) Institute for Advanced Biomediucal Technologies, Department of
Neuroscience, Imaging and Clinical Sciences, G. D'annunzio University,
Chieti, Italy
(Capodanno, Grasso, Tamburino) Division of Cardiology, Ferrarotto
Hospital, University of Catania, Catania, Italy
(Swaans, Brouwer) Department of Cardiology, ST. Antonius Hospital,
Nieuwegein, Netherlands
(Lombardi) Cardiology, Department of Medical and Surgical Specialties,
University of Brescia, Italy
(De Caterina) Institute of Cardiology, University of Pisa, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. The benefit of percutaneous mitral valve repair (PMVR) in
patients with secondary MR is still debated. We aimed to compare the
outcome of PMVR with optimal medical therapy (OMT) versus OMT alone in
patients with secondary mitral regurgitation (MR), and to assess the role
of potential effect modifiers. Methods. We performed a systematic review
and meta-analysis of 2 randomized clinical trials (RCT) and 7
non-randomized observational studies (nROS). Hazard ratios (HR) and 95%
confidence intervals (CI) were pooled through inverse variance
random-effect model to compute the summary effect size for all-cause
death, cardiovascular death and cardiac-related hospitalization. Subgroup
and meta-regression analysis were also performed. Results. An overall
population of 3,118 individuals (67% men; mean age, 73 years) was
included: 1,775 PMVR+OMT and 1,343 OMT patients, with mean follow-up of
24+/-15 months. PMVR+OMT was associated with a lower risk of all-cause
death (HR: 0.77; 95% CI: 0.68-0.87), cardiovascular death (HR: 0.55; 95%
CI: 0.34-0.89) and cardiac-related hospitalization (HR:0.77; 95% CI:
0.64-0.92). Meta-regression analysis showed that larger left ventricular
end-diastolic volume index (LVEDVI) portends higher risk of all-cause
death, cardiovascular death and cardiacrelated hospitalization after PMVR
(p<0.001 for all). Conclusions. This study-level meta-analysis shows that
PMVR+OMT is associated with reduced all-cause death, cardiovascular death
and cardiac-related hospitalization when compared with OMT alone in
secondary MR. LVEDVI is a predictive marker of efficacy, as patients with
smaller LVEDVI have been shown to derive the largest benefit from PMVR.

<60>
Accession Number
631055554
Title
Prognostic accuracy of multiparametric scores for heart failure with
reduced ejection fraction in patients with severe mitral regurgitation
undergoing mitraclip treatment.
Source
Giornale Italiano di Cardiologia. Conference: 80. Congresso Nazionale SIC.
Italy. 20 (12 Supplement 1) (pp 39S), 2019. Date of Publication: December
2019.
Author
Iannicelli A.; Silverio A.; Di Maio M.; Esposito L.; Fierro G.; Di Feo F.;
Di Muro M.R.; Citro R.; Baldi C.; Ciccarelli M.; Vecchione C.; Galasso G.
Institution
(Iannicelli, Silverio, Esposito, Fierro, Di Feo, Di Muro, Citro, Baldi,
Ciccarelli, Vecchione, Galasso) Cardio-Thoracic Department, University
Hospital San Giovanni Di Dio E Ruggi D'aragona, Salerno, Italy
(Di Maio) Division of Cardiology, Department of Cardiothoracic and
Respiratory Sciences, University of Campania Luigi Vanvitelli, Naples,
Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. The selection of patients with severe functional mitral
regurgitation (FMR) to candidate to MitraClip treatment is based on a
multiparametric approach. To date, prognostic scores derived and
externally validated in this particular clinical setting are not
available. Aim. To assess the discrimination and calibration accuracy in
terms of cardiac death and all-cause death at long-term of heart failure
with reduced ejection fraction (HFrEF) prognostic scores in patients with
severe FMR undergoing percutaneous mitral valve repair with MitraClip
device. Materials and methods. We prospectively enrolled all patients with
severe FMR who consecutively underwent percutaneous mitral valve repair
with MitraClip from March 2012 to November 2018 at our Institution.
Demographic, clinical, echocardiographic and laboratory data were
collected. Cardiopulmonary exercise test (CPET) was performed in all
patients before the procedure. The following HFrEF scores were
retrospectively calculated: Metabolic Exercise, Cardiac, Kidney Index
(MECKI), Cardiac and Comorbid Conditions Heart Failure (3C-HF), (HFSS),
Heart Failure Survival Score (SHFM) and meta-analysis group in chronic
heart failure (MAGGIC). Two outcomes were assessed at the longest
available follow-up: all-cause death and cardiac death. Results. The study
population included 75 patients (mean age: 70.6+/-8.68 years; 79.5%
males). The patients showed a high surgical risk (EuroSCORE logistic:
20.0+/-14.2%; EuroSCORE II: 8.0+/-6.0%) and impaired average CPET values
(peak oxygen uptake, VO2: 10.5+/-3.1 ml/kg/min; ventilation/carbon dioxide
consumption ratio, VE/VCO2: 44.8+/-12.2). Mean follow-up was 891.6 days.
During the study period, 38 deaths were observed; of them, 24 were
secondary to cardiac cause. In terms of cardiac death, the MECKI score
showed a higher discrimination ability than the other scores. Moreover, an
upward trend in the the area under the curve (AUC) values of the MECKI
score from the first to the fifth year of observation was observed. The
MECKI score showed the highest discriminative power for all-cause death
for each time frame analyzed and increasing AUC values through the years
of observation. The MECKI score had a significantly better discrimination
ability than the other scores, except for the HFSS, for the occurrence of
cardiac death and all-cause death at 3, 4 and 5 years (p<0.05).
Hosmer-Lemeshow analysis showed a good calibration accuracy for all the
scores in terms of cardiac death. MECKI score had a suboptimal calibration
ability for all-cause death event. Conclusions. HFrEF scores might improve
the pre-procedural prognostic stratification in patients with FMR
candidate to MitraClip treatment. The MECKI score, which includes two
parameters from CPET, showed the best discriminative performance in terms
of all-cause death and cardiac death, especially at long term follow-up.

<61>
Accession Number
631055488
Title
Acute inflammatory cardiomiopathy: Prevalence, characterization and
prognostic impact of immunosuppressive therapy.
Source
Giornale Italiano di Cardiologia. Conference: 80. Congresso Nazionale SIC.
Italy. 20 (12 Supplement 1) (pp 213S), 2019. Date of Publication: December
2019.
Author
Gentile P.; Ballaben A.; Artico J.; Porcari A.; Castrichini M.; Cannata
A.; Perkan A.; Barbati G.; Bussani R.; Merlo M.; Sinagra G.
Institution
(Gentile, Ballaben, Artico, Porcari, Castrichini, Cannata, Perkan, Merlo,
Sinagra) Cardiovascular Department, Azienda Sanitaria Universitaria
(Asuits), University of Trieste, Italy
(Barbati) Biostatics Unit, Department of Medical Sciences, University of
Trieste, Italy
(Bussani) Department of Pathology, Azienda Sanitaria Universitaria
(Asuits), University of Trieste, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Inflammatory cardiomyopathy (IC) belongs to the spectrum of
dilated cardiomyopathy (DCM). The real efficacy and indication to
immunosuppressive therapy in acute (i.e. <6 months) IC remain debated.
Aim. To assess the prevalence of biopsy-proven IC in a population with
acute left ventricular (LV) dysfunction and indications for endomyocardial
biopsy (EMB). Moreover, we evaluated the prognostic impact of
immunosuppressive therapy in that population. Methods. We analyzed
retrospectively all the patients with acute (<6 months) LV systolic
dysfunction and indications for EMB consecutively admitted between 2000
and 2018. According to EMB results, we divided the whole population in two
groups: IC and DCM. Thereafter, we divided the IC group in two subgroups:
patients treated or no treated with immunosuppressive therapy. The study
outcome measure was a composite of death from any cause or heart
transplant (HTx) or major ventricular arrhythmias (MVAs). Finally, we
evaluated the prevalence of left ventricular reverse remodelling (LVRR),
defined as previously reported, at 24 months (range 9 to 36 months).
Results. The study population included 81 patients (45+/-16 years, 59%
males; mean LV ejection fraction 29+/-10% and LV end-diastolic diameter
61+/-8 mm). The IC group included 65 (80.2%) subjects. There were no
significant differences between IC and DCM group, except for the NYHA IV
class, that was slightly more frequent in the IC group (p=0.049). At a
mean follow-up of 163+/-12 months, no differences were found between IC
and DCM (p= 0.743) in terms of Death/Htx/MVAs. In the IC group,
immunosuppression therapy was administered in 52% (N=34). Descriptive
analysis showed no significant differences between the group treated or no
treated with immunosuppressive therapy. At Kaplan-meier analysis, no
differences in terms of the combined endpoint experience were found in
immunosuppressed compared to the non-immunosuppressed group (23.5% Vs
22.6% respectively; p =0.845). At 24 months of follow-up, LVRR was found
in 19 patients (70.4%) in the immunosuppressed group and in 12 patients
(63.2%) in non-immunosuppressed group (p=0.607). Conclusions. To the best
of our knowledge, this study is the first that evaluates the prevalence of
IC and the impact of immunosuppressive therapy in a cohort of patients
with acute LV dysfunction and indication to EMB according the most recent
international statements. In patients with high clinical suspect of acute
IC, EMB confirmed the diagnosis in 80% of cases. The use of
immunosuppressive therapy in this setting seems not to impact on LVRR or
on the rate of major events during long term follow-up. New prospective,
randomized, controlled trials will be necessary to clarify the role of
immunosuppressive therapy in patients with biopsy-proven acute IC.

<62>
Accession Number
631055479
Title
Clinical impact of atrial fibrillation in stable coronary artery disease:
A meta-analysis.
Source
Giornale Italiano di Cardiologia. Conference: 80. Congresso Nazionale SIC.
Italy. 20 (12 Supplement 1) (pp 9S), 2019. Date of Publication: December
2019.
Author
Saglietto A.; Varbella V.; Anselmino M.; Giustetto C.; De Ferrari G.M.
Institution
(Saglietto, Varbella, Anselmino, Giustetto, De Ferrari) Division of
Cardiology, Department of Medical Sciences, University of Turin, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Atrial fibrillation (AF) is the most common supraventricular
arrhythmia and is often associated with stable coronary artery disease
(SCAD). Recent computational studies suggest that AF can exert influence
on coronary circulation. Aims. Given the likely influence of AF on
coronary hemodynamics, we aimed to explore the clinical impact that
super-imposed AF can exert in SCAD patients, in terms of mortality,
cerebral vascular accidents (CVA) and coronary events (myocardial
infarction - MI, and coronary revascularization). Methods. PUBMED/Embase
databases were screened for observational studies on SCAD patients
providing adjusted estimates on the risk of mortality, CVA, MI or TLR for
AF patients with respect to patients without any history of the
arrhythmia. Meta-analysis of the adjusted risk estimates was performed
using a random-effect model. Results. After bibliographic search, 5
studies were finally selected, with a total of 30,230 subjects included
(2,844 in the AF group, 27,386 in the non-AF group). Meta-analysis of the
included studies indicates an increased risk of mortality (HR 1.39, 95% CI
1.17-1.66) and CVA (HR 1.88, 95% CI 1.45-2.45) in SCAD patients with AF;
on the contrary, there was no significant differences between AF and
non-AF groups in terms of MI (HR = 0.90, 95% CI 0.66-1.22) and coronary
revascularization (HR = 0.96, 95% CI 0.79-1.16). Conclusions. AF in SCAD
patients is an independent negative prognostic factor, associated with
mortality and risk of cerebral vascular accidents. However, in terms of
coronary events, the risk of MI or coronary revascularization was not
different in patients with AF with respect to patients without the
arrhythmia.

<63>
Accession Number
631055446
Title
Transcatheter aortic valve implantation with core valve prosthesis: Five
year durability.
Source
Giornale Italiano di Cardiologia. Conference: 80. Congresso Nazionale SIC.
Italy. 20 (12 Supplement 1) (pp 251S-252S), 2019. Date of Publication:
December 2019.
Author
Carrabba N.; Ciatti F.; Berteotti M.; Taborchi G.; Ceschia N.; Migliorini
A.; Stefano P.; Marchionni N.; Valenti R.
Institution
(Carrabba, Ciatti, Berteotti, Taborchi, Ceschia, Migliorini, Stefano,
Marchionni, Valenti) Department of Cardiology, Careggi Hospital, Florence,
Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Transcatheter aortic valve implantation (TAVI) has emerged as
a valid option for patients with severe aortic stenosis (SAO) who are at
intermediate or high/prohibitive surgical risk. Multiple trials are
currently evaluating TAVI for treating patients who are at low surgical
risk. However, the treatment of younger patients with longer life
expectancies has raised questions regarding valve durability, due to the
biological tissue that is prone to structural valve degeneration (SVD).
Purpose. We sought to evaluate five-year durability of TAVI using the
current technology of self-expanding CoreValve prosthesis. Methods. All
consecutive patients with SAO who underwent TAVI with the third generation
18-F CoreValve device in our centre were prospectively included in a
quality improvement registry of our Hospital. In this registry we included
all consecutive patients (n=182) treated from January 2009 to December
2017. All TAVI cases were discussed and approved by interdisciplinary
Heart Team. SVD and all outcomes were reported according to VARC (Valve
Academic Research Consortium)- 2 criteria. Results. Overall, at average
time of 772+/-717 days all-cause mortality was 34% (62/182 patients); the
neurological event rate was 4.9% (1 case fatal stroke); 94 (52%) patients
were re-hospitalized for cardiovascular reason: 73 (40.1%) patients for
recurrent heart failure (HF) and 21 (11.6%) patients for permanent
pacemaker implantation. Two patients underwent upgrade from bicameral to
biventricular pacing due to symptomatic HF associated with large QRS. All
causes mortality rates at 1, 2, 3, 4, and 5-year completed follow-up (93
patients) were 20.4%, 47.3%, 59.1%, 62.3%, and 65.5%, respectively. On
echocardiography, mean trans aortic gradients decreased from 54 +/- 13.9
mm Hg (pre-TAVI) to 11.2 +/- 9.4 mm Hg (5-year post-TAVI) (p< 0.001). Late
non SVD occurred in 2 patients (2.15%); among these, surgical replacement
of aortic valve was successfully carried out in 1 patient presenting with
recurrent symptoms of heart failure due to a prosthesis migration,
determining an aortic pseudo-aneurysm. The second case of non SVD did not
undergo further invasive interventions. Late SVD was found in 3 patients
(3.2%) showing mild stenosis with a mean trans aortic gradient ranging
from 20 to 40 mm Hg by echo, in one case combined with moderate aortic
regurgitation. None patients with SVD needed reintervention. Throughout
follow-up, prosthetic valve thrombosis or late valve embolization were not
observed. Conclusions. Using CoreValve for TAVI procedures, a 3.2% low
rate of SVD was observed in our registry, none of them requiring
reintervention. These findings appear reassuring in term of TAVI 5-year
durability. However, results of ongoing large randomized trials with
long-term follow-up are needed before extending the indication to TAVI for
low-risk young patients.

<64>
Accession Number
631055435
Title
Subclinical leaflet thrombosis after transcatheter aortic valve
replacement: Prevalence and prognostic implications.
Source
Giornale Italiano di Cardiologia. Conference: 80. Congresso Nazionale SIC.
Italy. 20 (12 Supplement 1) (pp 149S), 2019. Date of Publication: December
2019.
Author
Fortuni F.; Ferlini M.; Mauri S.; Rebuffi C.; Rossini R.; Ferrario M.;
Visconti L.O.
Institution
(Fortuni, Ferlini, Mauri, Ferrario, Visconti) Division of Cardiology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Fortuni) University of Pavia, Pavia, Italy
(Rossini) Division of Cardiology, Santa Croce E Carle Hospital, Cuneo,
Italy
(Rebuffi) Scientific Documentation Center, Fondazione IRCCS Policlinico
San Matteo, Pavia, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Subclinical leaflet thrombosis (SLT) following transcatheter
aortic valve replacement (TAVR) has been increasingly detected on
multidetector computed tomography (MDCT). Its actual prevalence and
consequences are unclear. Therefore the aim of this study-level
metaanalysis was to investigate the prevalence of SLT detected by MDCT
after TAVR and its prognostic impact in terms of stroke or transient
ischemic attack (TIA) incidence and all-cause mortality. Methods. We
searched the literature for studies reporting SLT after TAVR detected by
MDCT. Pooled analysis of incidence was performed with a random effect
model. Endpoints of interest were stroke or transient ischemic attack
(TIA) and all-cause mortality. A univariate metaregression analysis was
conducted to explore the potential moderator effect of age, gender,
ejection fraction (EF), dual antiplatelet therapy and oral anticoagulation
therapy after TAVR (continuous variables were expressed as mean and
dichotomous variables were expressed as percentage). Results. Overall, 8
observational studies met our inclusion criteria, with a total of 2257
patients; mean age was 82.8 +/- 1.8; 42% were male and mean follow-up was
9.5 +/- months. 35.5% of patients received oral anticoagulation and 54%
received dual antiplatelet therapy. Mean EF was 56%. Meta-analytic pooling
of event rates showed an SLT rate of 13.5% (95% CI 8.4%-18.6%; I2:
94%-Fig. 1A). At meta-regression analysis none of the parameters taken
into account showed an interaction with SLT. SLT was associated with an
increased risk of stroke or TIA (OR 4.73; 95% 1.32-17.04; P = 0.017-Fig.
1B) and with a non-significant increased risk of all-cause mortality (OR
1.63; 95% CI 0.43-6.22; P = 0.47-Fig 1C) compared with the absence of SLT
at MDCT. Discussion. Our meta-analysis, pooling the largest cohort of
patients who underwent TAVR that were systematically screened for SLT with
MDCT shows that SLT has an important prevalence in this population.
Moreover, our results demonstrate that SLT may affect prognosis as its
presence is associated with an increased risk of stroke or TIA. Therefore
strategies aimed at detecting, with MDCT scan, and treating or preventing
SLT, such as with oral anticoagulation, may be indicated especially in
patients at increased risk for it. (Figure Presented) .

<65>
Accession Number
631055422
Title
Pre-operative growth differentiation factor-15 (GDF-15) levels in aortic
valve stenosis: Role as potential bio-humoral link between remodeling and
frailty.
Source
Giornale Italiano di Cardiologia. Conference: 80. Congresso Nazionale SIC.
Italy. 20 (12 Supplement 1) (pp 192S), 2019. Date of Publication: December
2019.
Author
Fabiani I.; Santoni T.; Angelillis M.; Petricciuolo S.; Pellegrini G.;
Tognetti I.; Mazzei D.; Petronio A.S.; De Caterina R.
Institution
(Fabiani, Petricciuolo, De Caterina) U.O. Malattie Cardio-Vascolari I
Universitaria, Dipartimento Di Patologia Chirurgica, Medica, Molecolare E
Dell'area Critica, Universita Di Pisa - Ospedale Cisanello, Italy
(Angelillis, Petronio) S.D. Emodinamica, Dipartimento Di Patologia
Chirurgica, Medica, Molecolare E Dell'area Critica, Universita Di Pisa -
Ospedale Cisanello, Italy
(Santoni) S.D. Cardio-Angiologia Universitaria, Dipartimento Di Patologia
Chirurgica, Medica, Molecolare E Dell'area Critica, Universita Di Pisa -
Opsedale Cisanello, Italy
(Pellegrini, Tognetti, Mazzei) U.O. Laboratorio Analisi Cliniche, AOUP,
Ospedale Cisanello, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Aortic valve stenosis (AVS) is the most frequent surgical
indication to valve replacement in Western countries. Transcatheter aortic
valve implantation (TAVI) has emerged as a treatment of AVS in patients at
high and intermediate surgical risk. In the preoperative risk assessment,
frailty tests have been recently introduced in the pivotal randomized
clinical trials on percutaneous devices, and allow for a more
comprehensive patient characterization and stratification. Growth
differentiation factor 15 (GDF-15) is a stress-responsive member of the
transforming growth factor beta cytokine superfamily, and may play a role
in the pathophysiology of left ventricular remodeling. Objective. To
evaluate pre-operative GDF-15 levels in patients candidate to aortic valve
replacement, to test its association with frailty, echocardiographic
parameters, and its predictive power in terms of reverse remodeling.
Methods and Results. Sixty-two patients (79.3+/-7.8 yrs; 34, 54.8% Female)
with severe aortic valve stenosis and preserved ejection fraction
(60.2+/-10.2%), undergoing Transcatheter Aortic Valve Implantation (31,
50% TAVI) were prospectively included and followed-up for one year.
Frailty was assessed using the Katz score. We evaluated pre-operative
GDF-15 and NT-pro-BNP levels (Roche Diagnostics), together with a complete
echocardiographic examination. Patients addressed to TAVI were older, with
a higher Euroscore II (p<0.0001). GDF-15 levels correlated with left
atrial volume (r 0.33; p=0.01) and NT-pro-BNP levels (r=0.65; p<0.0001).
We found an inverse relationship with estimated glomerular filtration rate
(eGFR, r=-0.4; p=0.006) and ejection fraction (r=-0.3; p=0.04). Patients
with an indication to TAVI had higher plasma levels of GDF-15 (p<0.0001)
than in the age-matched surgical population. The Katz score showed a low
frailty in the vast majority of TAVI candidates (5 and 6; 8, 25.8% and 15,
48.3% patients, respectively), with a low prevalence of higher frailty
grades (3 and 4; 3, 9.6% and 5, 16.1% patients, respectively). We found a
trend, at the verge of statistical significance, in the distribution of
GDF-15 according to the Katz Score, with higher levels reported for higher
frailty grades (p=0.06). At the one year follow-up, baseline GDF-15 levels
were independent predictors of left ventricular mass reduction, respective
to aortic valve and peak transvalvular velocity reduction (R20.24; r
=-0.38; p=0.016). Conclusion. GDF-15 levels reflect a load of increased
comorbidities (worse systolic function; increased end-diastolic pressure;
impaired renal function) in patients with aortic valve stenosis. This may
be further linked with higher frailty grades in patients candidate to
TAVI.

<66>
Accession Number
631055379
Title
Tavi for low-risk patients: Comparison between patients enrolled in notion
trial and in florence real world registry.
Source
Giornale Italiano di Cardiologia. Conference: 80. Congresso Nazionale SIC.
Italy. 20 (12 Supplement 1) (pp 250S), 2019. Date of Publication: December
2019.
Author
Carrabba N.; Ciatti F.; Taborchi G.; Berteotti M.; Migliorini A.; Stefano
P.; Marchionni N.; Valenti R.
Institution
(Carrabba, Ciatti, Taborchi, Berteotti, Migliorini, Stefano, Marchionni,
Valenti) Department of Cardiology, Careggi Hospital, Florence, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. In the randomized NOTION trial at 5 years no significant
difference between transcatheter aortic valve implantation (TAVI) and
surgical aortic valve replacement (SAVR) was found for the composite rate
of death for any cause, stroke and myocardial infarction in lower-risk
patients. However, patients were excluded from this trial if they had
another severe valve disease or coronary artery disease (CAD) requiring
intervention, or previous cardiac surgery, myocardial infarction or
stroke, and severe renal failure or severe lung disease. Purpose. To
assess long-term clinical outcomes among patients with estimated surgical
low risk patients undergoing TAVI in clinical practice, without exclusion
criteria adopted in randomized NOTION trial. Methods and Results. This
study was a quality improvement registry aimed to evaluate outcomes in
patients admitted for TAVI to our tertiary center. From January 2009 to
December 2017, 182 consecutive patients who underwent TAVI were
categorized according to the Society of Thoracic Surgeons (STS) score into
low (<4%; n=78, 43%), intermediate (STS >=4% and <= 8%; n=70, 38.4%), and
high risk (STS>8%; n=34, 18.6%). All TAVI cases were discussed and
approved by interdisciplinary Heart Team. The transfemoral access was the
most common approach adopted (97.8%) for the procedures. Among low risk
patients: 4 have history of CABG, 11 mitral valve surgery, 9 chest
radiation, 6 cancer, 7 chronic renal failure, 9 chronic lung failure, 1
myasthenia gravis, 12 severe CAD, 3 recent myocardial infarction, 1 recent
stroke, 4 porcelain aorta and the remaining 11 patients gave consent only
for TAVI procedure. Significant differences were found between the groups
(low vs. intermediate vs. high risk) for age (79.2+/-5.1 yrs vs.
85.2+/-4.8 yrs vs. 86.5+/-5.3 yrs, p <.0001), chronic renal failure (7.6%
vs. 28.6% vs. 50%, p<.0001), and left ventricular ejection fraction<=40%
(15.3% vs. 27.1% vs. 41.2%, p =.015), but not for previous acute
myocardial infarction (8.9% vs. 15.7% vs. 17.6%, p=.334), chronic
obstructive pulmonary disease (17.9% vs. 14.3% vs. 26.8%, p=.270) and
peripheral arterial vascular disease (3.8% vs. 14.3% vs. 14.7%, p=.061).
By Kaplan Meier analysis, all-cause mortality at 1-year follow up was
significantly lower in low vs. intermediate and high risk group (6.4% vs.
12.8%, vs. 38%, P<0001) and progressively increased during the follow-up
(median time 772+/-717 days) remaining significantly lower in low risk
patients (28% vs. 24.3% vs. 55.8%, P<.0001). Conclusions. Our findings
suggest that in clinical practice low risk patients, without exclusion
criteria, can benefit from TAVI's procedure, showing a long-term mortality
rate quite similar to the 27.7% 5-year mortality rate reported in NOTION
trial in both TAVI and SAVR groups. However, given the inherent
limitations of any registry, results of ongoing large randomized trials
are needed before extending the indication to TAVI in low-risk patients.

<67>
Accession Number
631055355
Title
Amiodarone therapy for ICD intervention prevention. An observational
single center cohort study.
Source
Giornale Italiano di Cardiologia. Conference: 80. Congresso Nazionale SIC.
Italy. 20 (12 Supplement 1) (pp 190S), 2019. Date of Publication: December
2019.
Author
Bissolino A.; Fioravanti F.; Andreis A.; Saglietto A.; Mazzilli S.; Errigo
D.; Peyracchia M.; Magnano M.; Castagno D.; Budano C.; Golzio P.G.;
Giustetto C.; De Ferrari G.M.
Institution
(Bissolino, Fioravanti, Andreis, Saglietto, Mazzilli, Errigo, Peyracchia,
Magnano, Castagno, Budano, Golzio, Giustetto, De Ferrari) Aou San Giovanni
Battista, Ospedale Molinette, Torino, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction and aim. Medicine evolution, particularly in the Cardiology
field, bring us longer survivals to acute coronary syndrome and
cardiovascular diseases. Nonetheless, the other face of the medal is the
increasing number of patients suffering from Heart Failure (HF) in its
broad spectrum of manifestations, from acute HF to life-threatening
arrhythmias. Implantable Cardioverter Defibrillators (ICDs) represent a
clear answer to the latter clinical problem. However, even an appropriate
ICD intervention has a huge impact on patients' life. For this reason, in
our paper, we tried to assess whether Amiodarone could reduce ICD
appropriate interventions. Methods. This work represents an observational
study of a cohort of consecutive patients from a single institution. The
study was carried out according to the latest international guidelines and
to the Declaration of Helsinki. We screened 4157 implantation procedures
performed in our centre, identifying 637 consecutive patients who received
an ICD in primary or secondary prevention, considering the period
2010-2016. Other inclusion criteria were: clinical follow-up at least
every 6 months, assessing symptoms, recent medical history, medications
and technical functioning of the device. Considering pre-implantation
clinical and psychological screening and the prognosis evaluation, no
exclusion criteria was applied. For patients who underwent heart
transplantation, the follow-up was closed on that date. Clinical decision
to prescribe or not amiodarone, was not influenced by the authors and was
leaved to single physician choice. Every patient was on optimal medical
therapy (OMT). Every ICD intervention was assessed through direct ICD
interrogation, excluding those not confirmable. In every case, an
experienced electrophysiologist was consulted for independent
adjudication. Statistical analysis was performed applying SPSS 24.0.
Continuous variables were compared with t-test. Categorical data were
tested with chi-square test. Results. 521 patients matched the inclusion
criteria and were enrolled. The major indication for ICD implantation was
Ischemic Heart Disease (276 patients, 53%), followed by non-ischemic
Dilated Cardiomyopathy (DCM) (156 patients, 30%). 405 patients received
ICD for primary prevention (Ip), while 116 for secondary prevention (IIp).
Mean Left Ventricular Ejection Fraction (LVEF) was 27% (+/- 6%) in Ip and
38% (+/- 12.8%) in IIp. No statistically significant differences resulted
between Ip and IIp considering QRS width and medical therapy. 19% of Ip
and 41% of IIp were on amiodarone (A). After a mean follow-up of 67
months, in Ip patients, there were no differences in the rate of
appropriate shock (15.3% A vs 13.7% nA, p= 0.699) and ATP intervention
(16% A vs 15.2% nA, p=0.965). These results were also confirmed for IIp
patients (Shock 15.9% A vs 18% nA, p=0.541; ATP 16% A vs 15.2% nA,
p=0.231). Conclusion. In our study, amiodarone did not show a significant
reduction of ICD intervention in primary and secondary prevention ICD
patients. The observational nature of our work is an intrinsic limit of
these findings and further randomized clinical trial are needed to confirm
our results.

<68>
Accession Number
631064026
Title
Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative
Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery-
Multicenter Randomized Controlled Study.
Source
Circulation journal : official journal of the Japanese Circulation
Society. (no pagination), 2020. Date of Publication: 21 Feb 2020.
Author
Toda H.; Nakamura K.; Shimizu K.; Ejiri K.; Iwano T.; Miyoshi T.; Nakagawa
K.; Yoshida M.; Watanabe A.; Nishii N.; Hikasa Y.; Hayashi M.; Morita H.;
Morimatsu H.; Ito H.
Institution
(Toda, Nakamura, Ejiri, Iwano, Miyoshi, Nakagawa, Yoshida, Watanabe,
Nishii, Morita, Ito) Department of Cardiovascular Medicine, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences
(Shimizu, Hikasa, Hayashi, Morimatsu) Department of Anesthesiology,
Okayama University Graduate School of Medicine, Dentistry and
Pharmaceutical Sciences
(Morita) Department of Cardiovascular Therapeutics, Okayama University
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this study was to evaluate the efficacy and safety
of transdermal beta-blocker patches, which offer stable blood
concentration and easy availability during operation, for prevention of
perioperative myocardial injury (PMI) in high-risk patients.Methods and
Results:In this randomized controlled trial, patients aged >60 years with
hypertension and high revised cardiac risk index (>=2) undergoing
non-cardiac surgery were randomly assigned to a bisoprolol patch or
control group. Primary efficacy outcome was incidence of PMI, defined as
postoperative high-sensitivity cardiac troponin T (hs-cTnT) >0.014ng/mL
and relative hs-cTnT change >=20%. Secondary efficacy outcomes were number
of cardiovascular events and 30-day mortality. From November 2014 to
February 2019, 240 patients from 5 hospitals were enrolled in this study.
The incidence of PMI was 35.7% in the bisoprolol patch group and 44.5% in
the control group (P=0.18). Incidence of major adverse cardiac events
including non-critical myocardial infarction, strokes, decompensated heart
failure and tachyarrhythmia was similar between the 2 groups.
Tachyarrhythmia tended to be higher in the control group. There were no
significant differences in safety outcomes including significant
hypotension and bradycardia requiring any treatment between the 2 groups.
<br/>CONCLUSION(S): Bisoprolol patches do not influence the incidence of
PMI and cardiovascular events in high-risk patients undergoing non-cardiac
surgery, but perioperative use of these patches is safe.

<69>
Accession Number
631044487
Title
The clinical utility of remote ischemic preconditioning in protecting
against cardiac surgery-associated acute kidney injury: A pilot randomized
clinical trial.
Source
Advances in clinical and experimental medicine : official organ Wroclaw
Medical University. (no pagination), 2020. Date of Publication: 24 Feb
2020.
Author
Stokfisz K.; Ledakowicz-Polak A.; Zagorski M.; Jander S.; Przybylak K.;
Zielinska M.
Institution
(Stokfisz, Ledakowicz-Polak, Przybylak, Zielinska) Intensive Cardiac
Therapy Clinic, Department of Invasive Cardiology and Electrocardiology,
Medical University of Lodz, Poland
(Zagorski, Jander) Department of Cardiology and Cardiosurgery, Medical
University of Lodz, Poland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a
well-known, serious complication and a well-recognized independent risk
factor for higher morbidity and mortality among patients undergoing
cardiac surgery. <br/>OBJECTIVE(S): The aim of the study was to assess the
efficacy of remote ischemic preconditioning (RIPC) in reducing the
incidence of CSA-AKI, measured with the standard creatinine technique and
using neutrophil gelatinase-associated lipocalin (NGAL) serum
concentrations as a potential new biomarker of kidney damage. The ethics
committee of the Medical University of Lodz prospectively approved the
protocol (approval No. RNN/286/13/KE). The study was retrospectively
registered with the U.S. National Institutes of Health - NIH (29 June
2017; ClinicalTrials.gov identifier: NCT03205410). MATERIAL AND METHODS:
We conducted a prospective single-center double-blind randomized and
controlled tudy. Data was collected from patients admitted to the
Cardiosurgery Clinic at the Medical University of Lodz (Poland) between
January and December 2014, scheduled for elective cardiac surgery (an
off-pump coronary artery bypass). A total of 28 patients were randomized
to receive either RIPC (n = 14) or sham RIPC (n = 14). After the induction
of anesthesia, the patients assigned to the RIPC group underwent 3 cycles
of 5-minute inflation to 200 mm Hg and 5-minute deflation of the upper-arm
cuff. The control group had a deflated cuff placed on the upper arm for 30
min. The authors measured the patients' serum creatinine concentration to
check for the occurrence of a CSA-AKI within 48 h after cardiac surgery,
and NGAL serum concentration to check its level within 3 h after the
operation. <br/>RESULT(S): Fewer patients in RIPC group developed CSA-AKI
within 48 h after cardiac surgery than in the control group (29% vs 93%; p
= 0.003). Fewer patients in the RIPC group presented an increase in NGAL 3
h after surgery (medians: 124 vs 176.7; p = 0.0003). <br/>CONCLUSION(S):
In patients undergoing an off-pump coronary artery bypass, RIPC
significantly reduces the occurrence of CSA-AKI and protects against
increased postoperative NGAL levels.

<70>
[Use Link to view the full text]
Accession Number
631046885
Title
A meta-analysis of bridging anticoagulation between low molecular weight
heparin and heparin.
Source
Medicine (United States). 99 (3) (no pagination), 2020. Article Number:
e18729. Date of Publication: 2020.
Author
Tao E.; Luo Y.L.; Tao Z.; Wan L.
Institution
(Tao, Wan) Department of Cardiovascular Surgery, First Affiliated Hospital
of Nanchang University, NanChang, Jiang Xi, China
(Luo) Department of Neurosurgery, Guandong 39 Brain Hospital, Guan Zhou,
Guan dong, China
(Tao) Department of Anesthesiology, First Affiliated Hospital of Nanchang
University, NanChang, Jiang Xi, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
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. <br/>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. <br/>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. <br/>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.<br/>Copyright
&#xa9; 2020 the Author(s). Published by Wolters Kluwer Health, Inc.

<71>
Accession Number
2004326702
Title
Tolerability and Effects of the Use of Energy-Enriched Infant Formula
After Congenital Heart Surgery: A Randomized Controlled Trial.
Source
Journal of Parenteral and Enteral Nutrition. 44 (2) (pp 348-354), 2020.
Date of Publication: 01 Feb 2020.
Author
Scheeffer V.A.; Ricachinevsky C.P.; Freitas A.T.; Salamon F.; Rodrigues
F.F.N.; Brondani T.G.; Sutil A.T.; Ferreira C.H.T.; Matte U.S.; da
Silveira T.R.
Institution
(Scheeffer, Rodrigues, Sutil, da Silveira) Hospital da Crianca Santo
Antonio, Porto Alegre, Brazil
(Ricachinevsky, Brondani) Intensive Care Unit at Hospital da Crianca Santo
Antonio, Porto Alegre, Brazil
(Freitas, Salamon) Fundacao Faculdade Federal de Ciencias da Saude de
Porto Alegre, Porto Alegre, Brazil
(Scheeffer, Ferreira) Department of Pediatric Gastroenterology, Hospital
da Crianca Santo Antonio, Porto Alegre, Brazil
(Ferreira, da Silveira) Postgraduate Programme of Pediatrics, Universidade
Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
(Scheeffer, Matte) Postgraduate Programme of Child and Adolescent Health,
Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Undernutrition is a common problem among children with
congenital heart disease (CHD) and may lead to poorer surgical outcomes. A
higher intake of energy during the postoperative period of CHD surgery
seems to be associated with better outcomes. This study aimed to
investigate the effect of the use of energy-enriched formula (EE-formula)
compared with normocaloric formula during 30 days after CHD surgery.
<br/>Method(s): A randomized controlled trial with patients undergoing
heart surgery in a tertiary hospital in southern Brazil from March 2017 to
December 2017 was performed. The intervention group received EE-formula (1
kcal/mL), and the control group received normocaloric formula (0.67
kcal/mL). The researcher in charge of anthropometric evaluation was
blinded to the randomization. <br/>Result(s): Fifty-nine patients were
included; 30 in control group and 29 in intervention group. There were no
statistically significant differences between groups regarding age,
gender, anthropometry, and surgical risk classification after
randomization. A statistically significant difference in z-score of weight
for age and in weight gain variation rate between groups after
intervention was observed. Antibiotic use was less frequent in the
intervention group, and hospital length of stay was shorter. General
gastrointestinal side effects were similar between groups, whereas
diarrhea was more frequent in the intervention group. However, this side
effect was limited and had spontaneous resolution in 4 out of 6 cases.
<br/>Conclusion(s): This study demonstrates that EE-formula use after
heart surgery of patients with CHD is well tolerated and may improve
short-term nutrition outcome, decrease hospital stay, and reduce
antibiotic use.<br/>Copyright &#xa9; 2019 American Society for Parenteral
and Enteral Nutrition

<72>
Accession Number
2005058835
Title
Non-vitamin K oral anticoagulants at the time of cardiac rhythm device
surgery: A systematic review and meta-analysis.
Source
Thrombosis Research. 188 (pp 90-96), 2020. Date of Publication: April
2020.
Author
Creta A.; Finlay M.; Hunter R.J.; Chow A.; Sporton S.; Muthumala A.;
Dhillon G.; Papageorgiou N.; Waddingham P.; Ahsan S.; Dhinoja M.; Earley
M.J.; Khan F.; Lowe M.; Ahmad M.; Ricciardi D.; Grigioni F.; Di Sciascio
G.; Lambiase P.D.; Schilling R.J.; Providencia R.
Institution
(Creta, Finlay, Hunter, Chow, Sporton, Muthumala, Dhillon, Papageorgiou,
Waddingham, Ahsan, Dhinoja, Earley, Khan, Lowe, Lambiase, Schilling,
Providencia) Barts Heart Centre, St. Bartholomew's Hospital, London,
United Kingdom
(Creta, Ricciardi, Grigioni, Di Sciascio) Campus Bio-Medico University of
Rome, Rome, Italy
(Ahmad) Royal Free Hospital, London, United Kingdom
Publisher
Elsevier Ltd
Abstract
Introduction: Use of non-vitamin K oral anticoagulants (NOACs) has rapidly
increased worldwide. We aimed to systematically assess the available
evidence regarding the safety and efficacy of NOACs in patients undergoing
cardiac implantable electronic device (CIED) surgery. <br/>Method(s): We
performed a systematic literature search. Eligible randomised controlled
trials and cohort studies were included. The primary outcome measures were
clinically significant device-pocket haematoma and thromboembolic events.
<br/>Result(s): A total of 12 studies were included, equating to 2120
patients. The separate pooling of rate of events showed a low incidence of
clinically significant device-pocket haematoma, although numerically
higher in patients on continued (1.5%; CI<inf>95%</inf>0.8-3.0) versus
interrupted NOAC (0.9%; CI<inf>95%</inf>0.5-1.7). The rate of any
device-pocket haematoma was numerically higher in the continued versus
interrupted NOAC group (5.4%; CI<inf>95%</inf>3.8-7.7 versus 2.4%;
CI<inf>95%</inf>1.8-3.3). The incidence of thromboembolic events (0.4%;
CI<inf>95%</inf>0.2-0.8) was low and comparable. From a meta-analysis of 3
studies (equating to 773 subjects) allowing for a comparison of continued
versus interrupted NOAC, we found no significant difference between the 2
strategies in terms of clinically significant pocket haematoma (RR1.14;
CI<inf>95%</inf>0.43-3.06, p = 0.79), thromboembolic complications
(RR1.03; CI<inf>95%</inf>0.06-16.37, p = 0.98), and any pocket haematoma
(RR1.19; CI<inf>95%</inf>0.65-2.20, p = 0.57). <br/>Conclusion(s): Use of
NOACs at the time of CIEDs surgery appears to be safe, and either strategy
of peri-procedure continuation or interruption might be reasonable.
However, continuation of NOAC seems to be associated with a numerically
higher rate of bleeding complications. Certainty of the evidence is low,
and further studies are required to confirm these findings.<br/>Copyright
&#xa9; 2020 Elsevier Ltd

<73>
Accession Number
631054418
Title
Ulinastatin reduces postoperative bleeding and red blood cell transfusion
in patients undergoing cardiac surgery: A PRISMA-compliant systematic
review and meta-analysis.
Source
Medicine (United States). 99 (7) (no pagination), 2020. Article Number:
e19184. Date of Publication: 2020.
Author
Yao Y.-T.; Fang N.-X.; Liu D.-H.; Li L.-H.
Institution
(Yao, Fang, Li) Department of Anesthesiology, Fuwai Hospital, National
Center for Cardiovascular Diseases, Peking Union Medical College, Chinese
Academy of Medical Sciences, Beijing, China
(Liu) Department of Clinical Laboratory, University-Town Hospital of
Chongqing Medical University, Chongqing, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Ulinastatin is a type of glycoprotein and a nonspecific
wide-spectrum protease inhibitor like antifibrinolytic agent aprotinin.
Whether Ulinastatin has similar beneficial effects on blood conservation
in cardiac surgical patients as aprotinin remains undetermined. Therefore,
a systematic review and meta-analysis were performed to evaluate the
effects of Ulinastatin on perioperative bleeding and transfusion in
patients who underwent cardiac surgery. <br/>Method(s):Electronic
databases were searched to identify all clinical trials comparing
Ulinastatin with placebo/blank on postoperative bleeding and transfusion
in patients undergoing cardiac surgery. Primary outcomes included
perioperative blood loss, blood transfusion, postoperative re-exploration
for bleeding. Secondary outcomes include perioperative hemoglobin level,
platelet counts and functions, coagulation tests, inflammatory cytokines
level, and so on. For continuous variables, treatment effects were
calculated as weighted mean difference (WMD) and 95% confidential interval
(CI). For dichotomous data, treatment effects were calculated as odds
ratio and 95% CI. Statistical significance was defined as P < .05.
<br/>Result(s):Our search yielded 21 studies including 1310 patients, and
617 patients were allocated into Ulinastatin group and 693 into Control
(placebo/blank) group. There was no significant difference in
intraoperative bleeding volume, postoperative re-exploration for bleeding
incidence, intraoperative red blood cell transfusion units, postoperative
fresh frozen plasma transfusion volumes and platelet concentrates
transfusion units between the 2 groups (all P > .05). Ulinastatin reduces
postoperative bleeding (WMD = -0.73, 95% CI: -1.17 to -0.28, P = .001) and
red blood cell (RBC) transfusion (WMD = -0.70, 95% CI: -1.26 to -0.14, P =
.01), inhibits hyperfibrinolysis as manifested by lower level of
postoperative D-dimer (WMD = -0.87, 95% CI: -1.34 to -0.39, P = .0003).
<br/>Conclusion(s):This meta-analysis has found some evidence showing that
Ulinastatin reduces postoperative bleeding and RBC transfusion in patients
undergoing cardiac surgery. However, these findings should be interpreted
rigorously. Further well-conducted trials are required to assess the
blood-saving effects and mechanisms of Ulinastatin.<br/>Copyright &#xa9;
2020 the Author(s). Published by Wolters Kluwer Health, Inc.

<74>
[Use Link to view the full text]
Accession Number
630978731
Title
Effects of Pre-Cardiopulmonary Bypass Administration of Dexmedetomidine on
Cardiac Injuries and the Inflammatory Response in Valve Replacement
Surgery with a Sevoflurane Postconditioning Protocol: A Pilot Study.
Source
Journal of Cardiovascular Pharmacology. 74 (2) (pp 91-97), 2019. Date of
Publication: 01 Aug 2019.
Author
Zhou H.; Zhou D.; Lu J.; Wu C.; Zhu Z.
Institution
(Zhou, Zhou, Lu, Wu, Zhu) Department of Anesthesiology, Second Affiliated
Hospital, Jiaxing University, No. 1518 North HuanCheng Rd, Jiaxing City
314000, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Preventing myocardial ischemia-reperfusion injury in on-pump
cardiac surgeries remains an enormous challenge. Sevoflurane
postconditioning has been effective at overcoming this challenge by
modulating inflammatory mediators and ameliorating antioxidative stress.
Dexmedetomidine (DEX) is a commonly used medication for cardiac patients
with organ-protective properties that lead to positive outcomes. Whether
DEX also has cardiac-protective properties and the associated mechanism in
sevoflurane postconditioning-based valve replacement surgeries are
unknown. <br/>Objective(s):This study was conducted to observe the effect
of DEX administration before cardiopulmonary bypass (CPB) on myocardial
injury, oxidative stress, and inflammatory response indicators in the
peripheral blood. <br/>Method(s):Twenty-eight eligible cardiac patients
who underwent valve replacement surgery with standard sevoflurane
postconditioning were included in the study. The patients were randomly
divided into a DEX group and a non-DEX group according to whether DEX
(0.5-micro&#32;g/kg overload dose for 10 minutes and a 0.5-g/kg/h
maintenance dose) or saline was administered from induction to the
beginning of CPB. The primary outcome was the cardiac troponin I
concentration (cTnI) in the blood 24 hours after CPB. The levels of
malondialdehyde (MDA), superoxide dismutase, tumor necrosis factor-alpha
(TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8) were also
measured. <br/>Result(s):The mean cTnI at 24 hours after CPB was clearly
decreased in the DEX group compared with that in the non-DEX group (4.16
+/- 1.58 vs. 6.90 +/- 3.73, P < 0.05). TNF-alpha levels were lower in the
DEX group after CPB (T1-T5), with a significant difference found at 1-6
hours after CPB (1 hour, 19.03 vs. 28.09; 6 hours, 20.74 vs. 30.94, P <
0.05). The IL-6 and IL-8 concentrations in the DEX group were dramatically
increased at 6 hours after CPB (P < 0.05). The MDA content and superoxide
dismutase activity were comparable between the 2 groups. A lower
proportion of anemia cases were noted after CPB in the DEX group than in
the non-DEX group (non-DEX, 10% vs. DEX, 5%, P < 0.05).
<br/>Conclusion(s):In valve replacement surgery with sevoflurane
postconditioning, pre-CPB administration of DEX can reduce the cTnI level
at 24 hours after CPB and brings synergic benefits of the inflammatory
response.<br/>Copyright &#xa9; 2019 The Author(s). Published by Wolters
Kluwer Health, Inc.

<75>
Accession Number
631046994
Title
Letter to the editor for the article entitled Comparison of
ultrasound-guided erector spinae plane block and thoracic paravertebral
block for postoperative analgesia after video-assisted thoracic surgery: A
randomized controlled non-inferiority clinical trial'.
Source
Regional Anesthesia and Pain Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Wang K.; An N.; Jiang X.; Yuan H.
Institution
(Wang, An, Jiang, Yuan) Department of Anesthesiology, Changzheng Hospital,
Shanghai, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)

<76>
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. <br/>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. <br/>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. <br/>Conclusion(s): This
meta-analysis has demonstrated that minimally invasive and sternotomy
approaches produce comparable results for complex mitral valve
repair.<br/>Copyright &#xa9; 2020 The Society of Thoracic Surgeons

<77>
[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. <br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2020 Lippincott Williams and Wilkins. All
rights reserved.

<78>
[Use Link to view the full text]
Accession Number
630957267
Title
Clinical and angiographic predictors of patient-reported angina 1 year
after coronary artery bypass graft surgery.
Source
Circulation: Cardiovascular Quality and Outcomes. 12 (4) (no pagination),
2019. Article Number: e005119. Date of Publication: 01 Apr 2019.
Author
Hattler B.; Carr B.M.; Messenger J.; Spertus J.; Ebrahimi R.; Bishawi M.;
Quin J.A.; Almassi G.H.; Collins J.F.; Kozora E.; Grover F.L.; Shroyer
A.L.W.
Institution
(Hattler, Grover) Rocky Mountain Regional Va Medical Center, Aurora, CO,
United States
(Hattler, Messenger, Kozora, Grover) University of Colorado School of
Medicine at the Anschutz Medical Campus, Aurora, CO, United States
(Carr, Bishawi, Shroyer) Northport Veterans Affairs Medical Center,
Northport, NY, United States
(Spertus) Saint Luke's Mid America Heart Institute, University of Missouri
at Kansas City, Kansas City, MO, United States
(Ebrahimi) Greater Los Angeles Va Medical Center, Los Angeles, CA, United
States
(Ebrahimi) University of California, Los Angeles, United States
(Bishawi) Duke University, Durham, NC, United States
(Quin) Va Boston Healthcare System, West Roxbury, MA, United States
(Quin) Harvard Medical School, Boston, MA, United States
(Almassi) Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United
States
(Almassi) Medical College of Wisconsin, Milwaukee, United States
(Collins) Cooperative Studies Program Coordinating Center, Va Medical
Center, Perry Point, MD, United States
(Kozora) National Jewish Health, Denver, CO, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Studies of the relationship between patient self-reported
angina symptoms using the Seattle Angina Questionnaire (SAQ) and
angiographic findings after coronary artery bypass grafting surgery (CABG)
are lacking. Nested within a randomized controlled trial, this prospective
observational cohort comparison study aimed to assess which clinical
characteristics and angiographic findings are associated with
self-reported angina 1 year after CABG. <br/>Methods and Results: Patients
from the ROOBY trial (Randomized On/Off Bypass) with protocol-specified
1-year post-CABG coronary angiography and SAQ assessments were included
(n=1258). Patients reporting no angina (62.3%) within 4 weeks before the
1-year post-CABG study visit on the SAQ angina frequency domain were
compared with patients reporting angina (37.7%). Multivariable modeling
identified clinical variables and angiographic findings associated with
angina. Sequential univariate and multivariable modeling found the
following demographic and clinical factors were associated with angina
after CABG: younger age, worse preoperative SAQ angina frequency score,
smoking, diabetes mellitus, and pre-CABG depression. The only 1-year
angiographic finding significantly associated with angina was incomplete
revascularization of the left anterior descending (LAD) territory. Graft
occlusions, incomplete revascularization of non-LAD territories, and >=70%
lesions in nonrevascularized native coronary arteries were not correlated
with the presence or absence of angina. Further, only 30.6% of subjects
reporting angina at 1 year had a residual major coronary artery stenosis
of >=70%. <br/>Conclusion(s): Self-reported angina 1 year after CABG is
associated with younger age, worse baseline SAQ angina frequency score,
smoking, diabetes mellitus, and depression. The only angiographic finding
associated with angina was a poorly revascularized LAD territory. These
results may help guide physicians when counseling patients on expected
improvements in angina symptoms and in making decisions regarding the need
for coronary angiography after CABG. Whether intensive treatment of these
comorbidities improves post-CABG angina symptoms requires further
study.<br/>Copyright &#xa9; 2019 American Heart Association, Inc.

<79>
[Use Link to view the full text]
Accession Number
630975414
Title
A randomized controlled trial of naloxone for optimization of hypoxemia in
lung donors after brain death.
Source
Transplantation. 103 (7) (pp 1433-1438), 2019. Date of Publication: 01 Jul
2019.
Author
Dhar R.; Stahlschmidt E.; Paramesh A.; Marklin G.
Institution
(Dhar) Division of Neurocritical Care, Department of Neurology, Washington
University in St. Louis School of Medicine, St. Louis, MO, United States
(Stahlschmidt, Marklin) Mid-America Transplant, St. Louis, MO, United
States
(Paramesh) Department of Surgery, Tulane University School of Medicine,
New Orleans, LA, United States
(Paramesh) Louisiana Organ Procurement Agency, Covington, LA, United
States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background. Persistent hypoxemia is the principal reason lungs from
otherwise eligible brain dead (BD) organ donors are not transplanted.
Experimental models and retrospective studies have suggested that naloxone
attenuates neurogenic pulmonary edema and reverses hypoxemia after brain
death. We undertook a multisite, randomized, placebo-controlled trial to
evaluate whether naloxone is able to improve oxygenation in BD donors with
hypoxemia. Methods. BD organ donors at 4 organ procurement organizations
were randomized in a blinded manner to naloxone 8 mg or saline placebo if
lung were being considered for allocation but exhibited hypoxemia (partial
pressure of oxygen in arterial blood to fraction of inspired oxygen ratio
[PFR] below 300 mm Hg). The primary outcome was change in PFR from
baseline to final arterial blood gas. Secondary outcomes included early
improvement in PFR and proportion of lungs transplanted. Results. A total
of 199 lung-eligible BD donors were randomized to naloxone (n = 98) or
placebo (n = 101). Groups were comparable at baseline. Both groups
exhibited similar improvements in oxygenation (median improvement in PFR
of 81 with naloxone versus 80 with saline, P = 0.68), with 37 (39%) versus
38 (40%) exhibiting reversal of hypoxemia. There was no difference in the
rate of lungs transplanted (19% in both groups, P = 0.97) although it was
significantly higher in those with reversal of hypoxemia (32/69 versus
2/111, P < 0.001). Conclusions. Naloxone does not improve oxygenation more
than placebo in hypoxemic organ donors. However, reversal of hypoxemia was
a powerful predictor of lung utilization regardless of drug therapy.
Further organ procurement organization-led research is needed to assess
optimal interventions to improve oxygenation in BD donors with
hypoxemia.<br/>Copyright &#xa9; 2019 Wolters Kluwer Health, Inc. All
rights reserved.

<80>
Accession Number
2005044536
Title
The Prognostic Value of Elevated Perioperative Neutrophil-Lymphocyte Ratio
in Predicting Postoperative Atrial Fibrillation After Cardiac Surgery: A
Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Liu Z.; Nguyen Khuong J.; Borg Caruana C.; Jackson S.M.; Campbell R.;
Ramson D.M.; Penny-Dimri J.C.; Kluger M.; Segal R.; Perry L.A.
Institution
(Liu, Nguyen Khuong, Borg Caruana, Jackson, Kluger, Segal, Perry)
Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Vic,
Australia
(Liu, Nguyen Khuong, Jackson) Melbourne Medical School, University of
Melbourne, Melbourne, Vic, Australia
(Campbell) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Ramson, Penny-Dimri) Department of Surgery, Monash University, Melbourne,
Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: The neutrophil-lymphocyte ratio (NLR) is an emerging
inflammatory perioperative biomarker which has been studied to predict the
incidence of postoperative atrial fibrillation (POAF) after cardiac
surgery. This systematic review and meta-analysis aimed to evaluate the
prognostic accuracy of elevated perioperative NLR in predicting POAF after
cardiac surgery. <br/>Method(s): Multiple databases were searched from
inception to May 2019 for prognostic studies on perioperative NLR and POAF
following cardiac surgery. Maximally adjusted odds ratios (OR) with
associated confidence intervals were obtained from each included study and
pooled using random effects inverse variance modelling for preoperative
NLR measurements, while standardised mean differences were pooled for
postoperative NLR values. The significance of inter- and intra-study
heterogeneity was explored using meta-regression. <br/>Result(s): 1,799
unique studies satisfied selection criteria, from which 12 studies
incorporating 9,262 participants were included. Elevated preoperative NLR
significantly predicted POAF, with a pooled OR of 1.42 (95% CI 1.16-1.72).
Multiple predefined covariates contributed to inter-study heterogeneity;
however, only prevalence of hypertension (p=0.0055), history of congestive
cardiac failure (p=0.0282) and average ejection fraction (p=0.0359) were
significant effect modifiers. Elevated postoperative NLR was not a
significant predictor of POAF (standardised mean difference 1.60 [95% CI
-0.56-3.77] between POAF+ and POAF- groups). <br/>Conclusion(s): Elevated
preoperative NLR is a promising prognostic biomarker for POAF, but
residual sources of heterogeneity remain. Larger scale validation studies
are required to justify the integration of preoperative NLR testing into
routine clinical practice.<br/>Copyright &#xa9; 2019 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<81>
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.<br/>Copyright &#xa9; 2020 Elsevier
Inc.

<82>
Accession Number
2005046046
Title
First clinical experience with the novel Intubation Laryngeal Tube
Disposable (iLTS-D) in cardiac surgery patients.
Source
Trends in Anaesthesia and Critical Care. Conference: World Airway
Management Meeting. Netherlands. 30 (pp e145), 2020. Date of Publication:
February 2020.
Author
Kriege M.; Heid F.
Institution
(Kriege, Heid) University Medical Center Mainz, Mainz, Germany
Publisher
Churchill Livingstone
Abstract
Background: In unanticipated difficult airways supraglottic airway devices
globally represent the first choice to perform ventilation. Secondary
endotracheal intubation through such supraglottic devices is frequently
challenging. Though, this study aimed to evaluate a modified iLTS-DTM
(VBM, Sulz a.N, Germany) regarding feasibility, safety and efficacy in
cardiac surgical patients. <br/>Method(s): This study was approved by the
local ethics committee (ClinicalTrials.gov NCT03942809). Patients
scheduled for elective cardiac surgery we induced general anesthesia by
sufentanil, propofol and rocuronium. We inserted the iLTS-D after
sufficient neuromuscular blockade (TOF = 0) and a bispectral index less
than 60. Prior to insufflation and deflation of the cuffs, we measured
cerebral oxygenation by Near-Infrared-Spectroscopy (NIRS). After
sufficient ventilation via iLTS-D, the tracheal tube was inserted through
the iLTS-D. Exclusion criteria were age < 18 y and risk of aspiration.
Primary endpoints were the time to insertion of the iLTS-D and time to
ventilation via endotracheal tube. Secondary endpoints were
insertion/intubation success rate, NIRS values during cuff
insufflation/deflation, signs of airway morbidity (e.g. traces of blood on
device, sore throat). A t-test was used to compared NIRS. Data are
expressed as the median (interquartile range [IQR]) for non-Gaussian
variables. <br/>Result(s): A total of 25 adult cardiac surgery patients
with an ASA class of IV were examined. Initial iLTS-D placement took a
median of 11 s [8-16] and enabled sufficient ventilation in all patients.
Tracheal intubation through the iLTS-D was achieved in 24/25 (96%)
patients at the first attempt and in 1/25 (4%) with a second attempt. The
median time required for tracheal intubation was 13 s [9-19]. The median
time for removal of the iLTS-D after successful intubation was 20 s
[15-23]. NIRS values were not altered by cuff-inflation and documented
cuff pressures of more than 120 cmH<inf>2</inf>O. Traces of blood on the
devices (after removing the iLTS-D) or sore throat (evaluated 2 h after
removing the tracheal tube) were not observed in any patient.
<br/>Conclusion(s): Our Results indicate a high success rate combined with
a short insertion time using the iLTS-D/tracheal tube. Cerebral
oxygenation remained unaffected though recommended inflation volumes led
to exceeding cuff-pressures. Based on these results, the iLTS-D may be
considered in patients with an unexpected difficult airway, but more data
is needed. No funding.<br/>Copyright &#xa9; 2020

<83>
Accession Number
631017733
Title
Mycobacterium chimaera infection: A case report and review of literature.
Source
American Journal of Clinical Pathology. Conference: 2019 American Society
for Clinical Pathology, ASCP Annual Meeting. United States. 152
(Supplement 1) (pp S131), 2019. Date of Publication: October 2019.
Author
Salas D.; Zhao X.; Cavalieri S.
Institution
(Salas, Zhao, Cavalieri) Creighton University
Publisher
Oxford University Press
Abstract
Mycobacterium chimaera (MCH) is a non-tuberculous mycobacterium commonly
found in the environment. It is a member of the M. avium complex (MAC),
and rarely causes infections in humans. However, invasive MCH infections
have been reported associated with heater-cooler devices during cardiac
surgery. Detection of MCH infections in this setting has been impeded by
inadequate clinical awareness and laboratory tests. A 77-year-old man had
aorta valve replacement 3 years ago. He recently presented with
constitutional symptoms, including fatigue, night sweats, and 50 pounds of
weight loss. PET CT showed ground-glass and nodular opacities in the
lungs. Bone marrow biopsy demonstrated noncaseating granulomas.
Transesophageal echocardiogram revealed severe stenosis and regurgitation
of aortic valves. Despite antibiotics and heart surgery to relieve
stenosis, the patient succumbed. Autopsy showed multiple small granulomas
in the lung and multifocal chronic inflammation in the heart. Premortem
mycobacterial cultures of aortic valves were performed, which grew MAC by
DNA probe in 1 week. Subsequently, it was identified as MCH by sequencing
of the ITS1/ITS2 region. The cause of death was heart failure due to MCH
endocarditis. MCH infection is rare but potentially fatal if not promptly
treated. Therefore, it is critical to identify patients at risk for
infection. Since 2013, over 100 cases of MCH endocarditis have been
reported worldwide, specifically associated with contaminated
heater-cooler units during heart surgery. Characteristically, MCH
infection has a long incubation period after exposure (median 17 months,
range 3-72 months). Signs and symptoms are generally nonspecific and often
include fatigue, fever, and weight loss. The risk of MCH infection in
patients undergoing open heart surgery is low, but clinicians should be
aware of the risks especially when heater-cooler units are utilized. A
close follow-up over a long period may be necessary due to the long
incubation period of this infection.

<84>
Accession Number
631042050
Title
Efficacy and Safety of Combined Endocardial/Epicardial Catheter Ablation
for Ventricular Tachycardia in Chagas Disease. A Randomized Controlled
Study.
Source
Heart rhythm. (no pagination), 2020. Date of Publication: 19 Feb 2020.
Author
Pisani C.F.; Romero J.; Lara S.; Hardy C.; Chokr M.; Sacilotto L.; Wu
T.C.; Darrieux F.; Hachul D.; Kalil-Filho R.; Di Biase L.; Scanavacca M.
Institution
(Pisani, Lara, Hardy, Chokr, Sacilotto, Wu, Darrieux, Hachul, Kalil-Filho,
Scanavacca) Arrhythmia Unit - Heart Institute(InCor) - University of Sao
Paulo Medical School
(Romero, Di Biase) Montefiore-Einstein Center for Heart and Vascular Care,
Albert Einstein College of Medicine
Publisher
NLM (Medline)
Abstract
BACKGROUND: Epicardial mapping and ablation are frequently necessary to
eliminate ventricular tachycardia (VT) in Chagas disease patients.
Nonetheless, there are no randomized controlled trials demonstrating the
role of this strategy. <br/>OBJECTIVE(S): We conducted this randomized
controlled trial to evaluate the efficacy and safety of combined
epicardial ablation in Chagas disease patients. <br/>METHOD(S): We
randomized patients with Chagas disease and VT in a 1:1 fashion to either
endocardial (endo) mapping and ablation group or combined
endocardial/epicardial (endo/epi) mapping and ablation group. The efficacy
endpoints were measured by VT inducibility and all-ventricular arrhythmia
recurrence. Safety was assessed by the rate of periprocedural
complications. <br/>RESULT(S): Thirty patients were enrolled, most were
male, the median age was 67 (58;70) years on endo-only and 58 (43;66)
years on the endo/epi group. Left ventricular ejection fraction was
33.0+/-9.5% and 35.2+/-11.5%, respectively. Acute success
(non-reinducibility of clinical VT) was obtained in 13 (86%) patients in
the endo/epi group and in six (40%) patients in the endo-only group
(p=0.021). There were 12 patients with VT recurrence (80%) in the
endo-only group and six patients (40%) in the endo/epi group (P=0.02) (by
intention-to-treat). Epicardial ablation was ultimately performed in nine
(60%) patients in the endo-only group due to an absence of endocardial
scar or maintenance of VT inducibility. There was no difference in
complications between groups. <br/>CONCLUSION(S): Combining endo/epi VT
catheter ablation in patients with Chagas disease significantly increases
short and long-term freedom from all-ventricular arrhythmias. Epicardial
access did not increase periprocedural complication rates.<br/>Copyright
&#xa9; 2020. Published by Elsevier Inc.

<85>
Accession Number
631041291
Title
Two decades on - cardiothoracic surgical care practitioners in the UK: a
narrative review.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 39), 2020. Date of
Publication: 22 Feb 2020.
Author
Shegafi M.B.; Nashef S.; Starodub R.; Lee G.
Institution
(Shegafi, Starodub, Lee) Kings College London, Florence Nightingale
Faculty of Nursing, James Clerk Maxwell Building ,57 Waterloo Road, London
SE1 8WA, United Kingdom
(Shegafi) King Abdullah Medical city, Makkah, Saudi Arabia
(Nashef) Papworth Hospital, Papworth Road ,Cambridge Biomedical Campus,
Cambridge, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: The role of Surgical Care Practitioner (SCP) was first
introduced by the NHS in the field of cardiothoracic surgery more than two
decades ago to overcome the chronic shortage of junior doctors, and
subsequently evolved into other surgical specialties. This review aims to
provide evidence on the current situation of SCPs' clinical outcomes
within their surgical extended role, with an emphasis on the
cardiothoracic surgical field. <br/>METHOD(S): A systematic search of
PubMed, Scopus, Embase via Ovid, Web of Science and TRIP was conducted
with no time restriction to explore the evidence on SCPs. All included
articles were reviewed by three researchers using the selection criteria,
and a narrative synthesis was undertaken. FINDINGS: Ten out of the 38
studies identified were selected for inclusion. Only one study
specifically investigated cardiothoracic SCPs. Three themes were
identified: (1) clinical outcomes (six studies), (2) workforce impact (two
studies) and (3) colleagues' opinions (two studies). All studies
demonstrated that SCPs provided safe practice, added value and were of
benefit to workforce environments and surgical teams. <br/>CONCLUSION(S):
Although the current literature provides assurances that the presence of
SCPs within surgical teams is beneficial in terms of their clinical
outcomes, their impact on the workforce and colleagues' opinions, a
significant gap was identified around the SCPs' role within their surgical
extended role, specifically in cardiac surgery. Thus, prospective clinical
research is required to evaluate SCPs' clinical impact.

<86>
Accession Number
631038468
Title
Effectiveness of comprehensive cardiac rehabilitation in coronary artery
disease patients treated according to contemporary evidence based
medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-II).
Source
European journal of preventive cardiology. (pp 2047487320905719), 2020.
Date of Publication: 23 Feb 2020.
Author
Salzwedel A.; Jensen K.; Rauch B.; Doherty P.; Metzendorf M.-I.; Hackbusch
M.; Voller H.; Schmid J.-P.; Davos C.H.
Institution
(Salzwedel, Voller) Department of Rehabilitation Research, University of
Potsdam, Germany
(Jensen, Hackbusch) Institute of Medical Biometry and Informatics (IMBI),
University of Heidelberg, Germany
(Rauch) Institut fur Herzinfarktforschung Ludwigshafen, Germany
(Doherty) Department of Health Sciences, University of York, United
Kingdom
(Metzendorf) Cochrane Metabolic and Endocrine Disorders Group, Heinrich
Heine University Dusseldorf, Germany
(Schmid) Department of Cardiology, Clinic Barmelweid, Switzerland
(Davos) Cardiovascular Research Laboratory, Academy of Athens, Greece
Publisher
NLM (Medline)
Abstract
BACKGROUND: Despite numerous studies and meta-analyses the prognostic
effect of cardiac rehabilitation is still under debate. This update of the
Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and
practice focused approach including only cardiac rehabilitation
interventions based on published standards and core components to evaluate
cardiac rehabilitation delivery and effectiveness in improving patient
prognosis. DESIGN: A systematic review and meta-analysis. <br/>METHOD(S):
Randomised controlled trials and retrospective and prospective controlled
cohort studies evaluating patients after acute coronary syndrome, coronary
artery bypass grafting or mixed populations with coronary artery disease
published until September 2018 were included. <br/>RESULT(S): Based on
CROS inclusion criteria out of 7096 abstracts six additional studies
including 8671 patients were identified (two randomised controlled trials,
two retrospective controlled cohort studies, two prospective controlled
cohort studies). In total, 31 studies including 228,337 patients were
available for this meta-analysis (three randomised controlled trials, nine
prospective controlled cohort studies, 19 retrospective controlled cohort
studies; 50,653 patients after acute coronary syndrome 14,583, after
coronary artery bypass grafting 163,101, mixed coronary artery disease
populations; follow-up periods ranging from 9 months to 14 years).
Heterogeneity in design, cardiac rehabilitation delivery, biometrical
assessment and potential confounders was considerable. Controlled cohort
studies showed a significantly reduced total mortality (primary endpoint)
after cardiac rehabilitation participation in patients after acute
coronary syndrome (prospective controlled cohort studies: hazard ratio
(HR) 0.37, 95% confidence interval (CI) 0.20-0.69; retrospective
controlled cohort studies HR 0.64, 95% CI 0.53-0.76; prospective
controlled cohort studies odds ratio 0.20, 95% CI 0.08-0.48), but the
single randomised controlled trial fulfilling the CROS inclusion criteria
showed neutral results. Cardiac rehabilitation participation was also
associated with reduced total mortality in patients after coronary artery
bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI
0.54-0.70, one single randomised controlled trial without fatal events),
and in mixed coronary artery disease populations (retrospective controlled
cohort studies HR 0.52, 95% CI 0.36-0.77; two out of 10 controlled cohort
studies with neutral results). <br/>CONCLUSION(S): CROS II confirms the
effectiveness of cardiac rehabilitation participation after acute coronary
syndrome and after coronary artery bypass grafting in actual clinical
practice by reducing total mortality under the conditions of current
evidence-based coronary artery disease treatment. The data of CROS II,
however, underscore the urgent need to define internationally accepted
minimal standards for cardiac rehabilitation delivery as well as for
scientific evaluation.

<87>
Accession Number
2005054012
Title
Combined Tricuspid and Mitral Versus Isolated Mitral Valve Repair for
Severe MR and TR: An Analysis From the TriValve and TRAMI Registries.
Source
JACC: Cardiovascular Interventions. 13 (5) (pp 543-550), 2020. Date of
Publication: 9 March 2020.
Author
Mehr M.; Karam N.; Taramasso M.; Ouarrak T.; Schneider S.; Lurz P.; von
Bardeleben R.S.; Fam N.; Pozzoli A.; Lubos E.; Boekstegers P.; Schillinger
W.; Plicht B.; Eggebrecht H.; Baldus S.; Senges J.; Maisano F.; Hausleiter
J.; Connelly K.; Denti P.; Schiavi D.; Weber M.; Nickenig G.; Frerker C.;
Sievert H.; Vaskelyte L.; Schafer U.; Kalbacher D.; Deuschl F.; Kuck
K.-H.; Allessandrini H.; Besler C.; Rommel K.-P.; Ruf T.; Orban M.;
Stocker T.; Deseive S.; Braun D.; Nabauer M.; Massberg S.; Bekeredjian R.;
Meyer-Zuern C.S.; Pedrazzini G.; Biasco L.
Institution
(Mehr, Karam, Hausleiter) Medizinische Klinik und Poliklinik I, Klinikum
der Universitat Munchen, Ludwig-Maximilians-Universitat, Munich, Germany
(Mehr, Hausleiter) German Centre for Cardiovascular Research, Partner Site
Munich Heart Alliance, Munich, Germany
(Karam) European Hospital Georges Pompidou (Cardiology Department) and
Paris Cardiovascular Research Center (INSERMU970), Paris, France
(Taramasso, Pozzoli, Maisano) Department of Cardiovascular Surgery,
University Hospital of Zurich, University of Zurich, Zurich, Switzerland
(Ouarrak, Schneider, Senges) Stiftung fur Herzinfarktforschung,
Ludwigshafen, Germany
(Lurz) Leipzig Heart Center, University of Leipzig, Leipzig, Germany
(von Bardeleben) Heart Valve Center Mainz, Center of Cardiology University
Medical Center, Mainz, Germany
(Fam) Division of Cardiology, St. Michael's Hospital, University of
Toronto, Toronto, Ontario, Canada
(Lubos) University Heart Center Hamburg, University of Hamburg, Hamburg,
Germany
(Boekstegers) Klinikum Siegburg, Siegburg, Germany
(Schillinger) Helios Albert-Schweitzer-Klinik, Northeim, Germany
(Plicht) Klinikum Westfalen, Dortmund, Germany
(Eggebrecht) Cardioangiologisches Centrum Bethanien, Frankfurt am Main,
Germany
(Baldus) Cologne University Hospital, Cologne, Germany
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to retrospectively compare the
characteristics, procedural courses, and outcomes of patients presenting
with concomitant mitral regurgitation (MR) and tricuspid regurgitation
(TR) in the TriValve (Transcatheter Tricuspid Valve Therapies) and TRAMI
(Transcatheter Mitral Valve Interventions) registries. <br/>Background(s):
Transcatheter mitral edge-to-edge valve repair (TMVR) has been shown to be
successful in patients with severe MR. Lately, edge-to-edge repair has
also emerged as a possible treatment for severe TR in patients at high
risk for cardiac surgery. In patients with both severe MR and TR, the
yield of concomitant transcatheter mitral and tricuspid valve repair
(TMTVR) for patients at high surgical risk is unknown. <br/>Method(s): The
characteristics, procedural data, and 1-year outcomes of all patients in
the international multicenter TriValve registry and the German multicenter
TRAMI registry, who presented with both severe MR and TR, were
retrospectively compared. Patients in TRAMI (n = 106) underwent isolated
TMVR, while those in TriValve (n = 122) additionally underwent concurrent
TMTVR in compassionate and/or off-label use. <br/>Result(s): All 228
patients (mean age 77 +/- 8 years, 44.3% women) presented with significant
dyspnea at baseline (New York Heart Association functional class III or IV
in 93.9%), without any differences in the rates of pulmonary hypertension
and chronic pulmonary disease. The proportion of patients with left
ventricular ejection fraction <30% was higher in the TMVR group (34.9% vs.
18.0%; p < 0.001), while patients in the TMTVR group had lower glomerular
filtration rates. At discharge, MR was comparably reduced in both groups.
At 1 year, overall all-cause mortality was 34.0% in the TMVR group and
16.4% in the TMTVR group (p = 0.035, Cox regression). On multivariate
analysis, TMTVR was associated with a 2-fold lower mortality rate (hazard
ratio: 0.52; p = 0.02). The rate of patients in New York Heart Association
functional class <=II at 1 year did not differ (69.4% vs. 67.0%; p =
0.54). <br/>Conclusion(s): Concurrent TMTVR was associated with a higher
1-year survival rate compared with isolated TMVR in patients with both MR
and TR. Further randomized trials are needed to confirm these
results.<br/>Copyright &#xa9; 2020

<88>
Accession Number
2005054010
Title
Prior Balloon Valvuloplasty Versus Direct Transcatheter Aortic Valve
Replacement: Results From the DIRECTAVI Trial.
Source
JACC: Cardiovascular Interventions. 13 (5) (pp 594-602), 2020. Date of
Publication: 9 March 2020.
Author
Leclercq F.; Robert P.; Akodad M.; Macia J.-C.; Gandet T.; Delseny D.;
Chettouh M.; Schmutz L.; Robert G.; Levy G.; Targosz F.; Maupas E.;
Roubille F.; Marin G.; Nagot N.; Albat B.; Lattuca B.; Cayla G.
Institution
(Leclercq, Robert, Akodad, Macia, Delseny, Chettouh, Roubille) Department
of Cardiology, CHU Montpellier, Montpellier University, Montpellier,
France
(Akodad, Roubille) PhyMedExp, INSERM U1046, CNRS UMR 9214, Montpellier,
France
(Gandet, Albat) Department of Cardiovascular Surgery, University Hospital
of Montpellier, France
(Schmutz, Lattuca, Cayla) Department of Cardiology, CHU Nimes, Montpellier
University, Nimes, France
(Robert) St. Pierre Clinic, Perpignan, France
(Levy) Millenaire Clinic, Montpellier, France
(Targosz) Perpignan Hospital, Perpignan, France
(Maupas) Franciscaines Clinic, Nimes, France
(Marin, Nagot) Department of Medical Information, University Hospital of
Montpellier, Montpellier, France
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to evaluate device success of
transcatheter aortic valve replacement (TAVR) using new-generation
balloon-expandable prostheses with or without balloon aortic valvuloplasty
(BAV). <br/>Background(s): Randomized studies are lacking comparing TAVR
without BAV against the conventional technique of TAVR with BAV.
<br/>Method(s): DIRECTAVI (Direct Transcatheter Aortic Valve Implantation)
was an open-label noninferiority study that randomized patients undergoing
TAVR using the Edwards SAPIEN 3 valve with or without prior balloon
valvuloplasty. The primary endpoint was the device success rate according
to Valve Academic Research Consortium-2 criteria, which was evaluated
using a 7% noninferiority margin. The secondary endpoint included
procedural and 30-day adverse events. <br/>Result(s): Device success was
recorded for 184 of 236 included patients (78.0%). The rate of device
success in the direct implantation group (n = 97 [80.2%]) was noninferior
to that in the BAV group (n = 87 [75.7%]) (mean difference 4.5%; 95%
confidence interval: -4.4% to 13.4%; p = 0.02 for noninferiority). No
severe prosthesis-patient mismatch or severe aortic regurgitation occurred
in any group. In the direct implantation group, 7 patients (5.8%) required
BAV to cross the valve. Adverse events were related mainly to pacemaker
implantation (20.9% in the BAV group vs. 19.0% in the direct implantation
group; p = 0.70). No significant difference was found between the 2
strategies in duration of procedure, contrast volume, radiation exposure,
or rate of post-dilatation. <br/>Conclusion(s): Direct TAVR without prior
BAV was noninferior to the conventional strategy using BAV with
new-generation balloon-expandable valves, but without procedural
simplification. BAV was needed to cross the valve in a few patients,
suggesting a need for upstream selection on the basis of patient anatomy.
(TAVI Without Balloon Predilatation [of the Aortic Valve] SAPIEN 3
[DIRECTAVI]; NCT02729519)<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<89>
Accession Number
2005053319
Title
Survival After Coronary Revascularization With Paclitaxel-Coated Balloons.
Source
Journal of the American College of Cardiology. 75 (9) (pp 1017-1028),
2020. Date of Publication: 10 March 2020.
Author
Scheller B.; Vukadinovic D.; Jeger R.; Rissanen T.T.; Scholz S.S.; Byrne
R.; Kleber F.X.; Latib A.; Clever Y.P.; Ewen S.; Bohm M.; Yang Y.; Lansky
A.; Mahfoud F.
Institution
(Scheller, Vukadinovic, Scholz, Clever, Ewen, Bohm, Mahfoud) Internal
Medicine III-Cardiology, Angiology and Intensive Care Medicine, Saarland
University Hospital, Saarland University, Homburg/Saar, Germany
(Scheller) Clinical and Experimental Interventional Cardiology, University
of Saarland, Homburg/Saar, Germany
(Jeger) University Hospital Basel, University of Basel, Basel, Switzerland
(Rissanen) Heart Center, North Karelia Central Hospital, Siun Sote,
Joensuu, Finland
(Byrne) Department of Cardiology, Deutsches Herzzentrum Munchen,
Technische Universitat Munchen, Munich, Germany
(Kleber) Evangelisches Krankenhaus Paul Gerhardt Stift,
Paul-Gerhardt-Strase 42-45, Lutherstadt Wittenberg, Germany
(Latib) Montefiore Medical Center, New York, NY, United States
(Yang, Lansky) Section of Cardiology, Yale University School of Medicine,
New Haven, CT, United States
Publisher
Elsevier USA
Abstract
Background: Drug-coated balloons (DCBs) are accepted treatment strategies
for coronary in-stent restenosis and are under clinical investigation for
lesions without prior stent implantation. A recently published
meta-analysis suggested an increased risk of death associated with the use
of paclitaxel-coated devices in the superficial femoral artery. The
reasons are incompletely understood as potential underlying
pathomechanisms remain elusive, and no relationship to the administered
dose has been documented. <br/>Objective(s): The purpose of this analysis
was to investigate the available data on survival after coronary
intervention with paclitaxel-coated balloons from randomized controlled
trials (RCTs). <br/>Method(s): PubMed, Web of science, and the Cochrane
library database were searched, and a meta-analysis from RCT was performed
comparing DCB with non-DCB devices (such as conventional balloon
angioplasty, bare-metal stents, or drug-eluting stents) for the treatment
of coronary in-stent restenosis or de novo lesions. The primary outcome
was all-cause death. The number of patients lost to follow-up was observed
at different time points. Risk estimates are reported as risk ratios (RRs)
with 95% confidence intervals (CIs). <br/>Result(s): A total of 4,590
patients enrolled in 26 RCTs published between 2006 and 2019 were
analyzed. At follow-up of 6 to 12 months, no significant difference in
all-cause mortality was found, however, with numerically lower rates after
DCB treatment (RR: 0.74; 95% CI: 0.51 to 1.08; p = 0.116). Risk of death
at 2 years (n = 1,477, 8 RCTs) was similar between the 2 groups (RR: 0.84;
95% CI: 0.51 to 1.37; p = 0.478). After 3 years of follow-up (n = 1,775, 9
RCTs), all-cause mortality was significantly lower in the DCB group when
compared with control treatment (RR: 0.73; 95% CI: 0.53 to 1.00; p =
0.047) with a number needed to treat of 36 to prevent 1 death. A similar
reduction was seen in cardiac mortality (RR: 0.53; 95% CI: 0.33 to 0.85; p
= 0.009). <br/>Conclusion(s): In this meta-analysis, the use of paclitaxel
DCBs for treatment of coronary artery disease was not associated with
increased mortality, as has been suggested for peripheral arteries. On the
contrary, use of coronary paclitaxel-coated balloons was associated with a
trend toward lower mortality when compared with control
treatments.<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<90>
Accession Number
2005044540
Title
Meta-Analysis of Transcatheter Versus Surgical Aortic Valve Replacement in
Low Surgical Risk Patients.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Levett J.Y.; Windle S.B.; Filion K.B.; Brunetti V.C.; Eisenberg M.J.
Institution
(Levett, Windle, Filion, Brunetti, Eisenberg) Division of Clinical
Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill
University, Montreal, Quebec, Canada
(Levett, Filion, Eisenberg) Department of Medicine, McGill University,
Montreal, Quebec, Canada
(Filion, Brunetti, Eisenberg) Department of Epidemiology, Biostatistics
and Occupational Health, McGill University, Montreal, Quebec, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital/McGill
University, Montreal, Quebec, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Current guidelines recommend transcatheter aortic valve implantation
(TAVI) for patients with severe aortic stenosis at elevated surgical risk,
but not for patients at low surgical risk. Our objective is to compare
major clinical outcomes and procedural complications with TAVI versus
surgical aortic valve replacement in patients with severe aortic stenosis
at low surgical risk. We conducted a systematic review and meta-analysis
of randomized controlled trials, identified through a systematic search of
the MEDLINE, Embase, and Cochrane databases. Count data were pooled across
trials using random-effects models with inverse variance weighting to
obtain relative risks (RRs) and corresponding 95% confidence intervals
(CIs). Three randomized controlled trials (n = 2,629) were included. At 30
days, TAVI was associated with a substantial reduction in all-cause
mortality (RR: 0.45, 95%CI: 0.20 to 0.99), atrial fibrillation (RR: 0.27,
95%CI: 0.17 to 0.41), life threatening/disabling bleeding (RR: 0.29,
95%CI: 0.12 to 0.69), and acute kidney injury (RR: 0.28, 95%CI: 0.14 to
0.57). The reduction in atrial fibrillation persisted at 12 months (RR:
0.32, 95%CI: 0.21 to 0.49). However, TAVI patients had an increased risk
of permanent pacemaker implantation at both 30 days (RR: 3.13, 95%CI: 1.36
to 7.21) and 12 months (RR: 2.99, 95%CI: 1.19 to 7.51). Due to the low
absolute numbers of events, results were inconclusive at 30 days and 12
months for cardiovascular mortality, stroke, transient ischemic attack,
and myocardial infarction. In conclusion, while some outcomes remained
inconclusive, these data suggest that TAVI should be considered as a
first-line therapy for the treatment of severe aortic stenosis in low
surgical risk patients.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<91>
Accession Number
2005044340
Title
Meta-Analysis of Hospital-Volume Relationship in Transcatheter Aortic
Valve Implantation.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Ando T.; Villablanca P.A.; Takagi H.; Briasoulis A.
Institution
(Ando) Department of Medicine, Division of Cardiology, Wayne State
University/Detroit Medical Center, Detroit, MI, United States
(Villablanca) Department of Medicine, Division of Cardiology, Henry Ford
Hospital, Detroit, MI, United States
(Takagi) Department of Surgery, Division of Cardiovascular Surgery,
Shizuoka Medical Center, Shizuoka, Japan
(Briasoulis) Department of Medicine, Division of Cardiology, University of
Iowa Hospitals and Clinics, Iowa City, IA, United States
Publisher
Elsevier Ltd
Abstract
Background: Whether a volume-outcome relationship, that is, higher volume
centres have better outcomes compared with lower volume hospitals, exists
in transcatheter aortic valve implantation (TAVI) has not yet been
systematically explored. <br/>Method(s): We performed a systematic review
and meta-analysis to evaluate whether highest or intermediate annual TAVI
volume hospitals has better short-term (in-hospital or 30-days) mortality
compared with the lowest volume hospitals. Odds ratio (OR) and 95%
confidence interval (CI) was calculated with the Mantel-Haenszel method.
<br/>Result(s): We identified 10 publications from nine different
countries including TAVI performed between 2005-2017. Included patients
were mainly high-risk cohorts. We included five and six studies to assess
volume-outcome relationship in the highest and intermediate volume
hospitals compared with the lowest volume hospitals, respectively. Our
results showed that in both the highest (OR 0.66, 95%CI 0.53-0.83,
p=0.0003, I²=78%) and intermediate (OR 0.85, 95%CI 0.79-0.92,
p<0.0001, I²=0%) volume hospitals, there was a statistically
significant volume-outcome relationship for short-term mortality compared
with the lowest volume hospitals. <br/>Conclusion(s): Our review suggests
a significant volume-outcome relationship post-TAVI in both the highest
and intermediate volume hospitals compared with the lowest volume
hospitals mainly in high surgical risk patients. The high heterogeneity in
this relationship between the highest and the lowest volume hospitals
warrant cautious interpretation. Whether this relationship remains
significant in low-risk cohort requires further study.<br/>Copyright
&#xa9; 2019 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ)