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<1>
Accession Number
631144489
Title
Long-term prognostic value of stress myocardial perfusion echocardiography
in patients with coronary artery disease: a meta-analysis.
Source
European heart journal cardiovascular Imaging. (no pagination), 2020. Date
of Publication: 03 Mar 2020.
Author
Qian L.; Xie F.; Xu D.; Porter T.R.
Institution
(Qian, Xu) Department of Geriatrics, First Affiliated Hospital of Nanjing
Medical University, Nanjing, China
(Xie, Porter) Division of Cardiovascular Medicine, University of Nebraska
Medical Center, Omaha, NE, 69198-1165, USA
Publisher
NLM (Medline)
Abstract
AIMS : To evaluate the prognostic value of myocardial perfusion (MP)
imaging during contrast stress echocardiography (cSE) in patients with
known or suspected coronary artery disease (CAD). METHODS AND RESULTS : A
search in PubMed, Embase databases, and the Cochrane library was conducted
through May 2019. The Cochran Q statistic and the I2 statistic were used
to assess heterogeneity, and the results were analysed by RevMan V5.3 and
Stata V15.1 software. Twelve studies (seven dipyridamole and five
exercise/dobutamine) without evidence of patient overlap (same institution
publishing results over a similar time period) enrolling 5953 subjects
(47% female, 8-80months of follow-up) were included in the analysis. In
all studies, total adverse cardiovascular events were defined as either
cardiac death, non-fatal myocardial infarction (NFMI), or need for urgent
revascularization. Hazard ratios (HRs) revealed that a MP abnormality
[pooled HR 4.75; 95% confidence interval (CI) 2.47-9.14] was a higher
independent predictor of total events than abnormal wall motion (WM,
pooled HR 2.39; 95% CI 1.58-3.61) and resting left ventricular ejection
fraction (LVEF, pooled HR 1.92; 95% CI 1.44-2.55) with significant
subgroup differences (P=0.002 compared with abnormal WM and 0.01 compared
with abnormal LVEF). Abnormal MP was associated with higher risks for
death [Risk ratio (RR) 5.24; 95% CI 2.91-9.43], NFMI (RR 3.09; 95% CI
1.84-5.21), and need for coronary revascularization (RR 16.44; 95% CI
6.14-43.99). CONCLUSION : MP analysis during stress echocardiography is an
effective prognostic tool in patients with known or suspected CAD and
provides incremental value over LVEF and WM in predicting clinical
outcomes. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

<2>
Accession Number
631144044
Title
Effet des strategies de transfusion restrictives vs liberales sur les
devenirs a plus long terme apres une chirurgie cardiaque : une revue
systematique et meta-analyse avec analyse sequentielle des etudes, The
effect of restrictive versus liberal transfusion strategies on longer-term
outcomes after cardiac surgery: a systematic review and meta-analysis with
trial sequential analysis.
Source
Canadian journal of anaesthesia = Journal canadien d'anesthesie. (no
pagination), 2020. Date of Publication: 28 Feb 2020.
Author
Kashani H.H.; Lodewyks C.; Kavosh M.S.; Jeyaraman M.M.; Neilson C.; Okoli
G.; Rabbani R.; Abou-Setta A.M.; Zarychanski R.; Grocott H.P.
Institution
(Kashani, Kavosh, Grocott) Department of Anesthesiology, Perioperative and
Pain Medicine, St. Boniface Hospital, University of Manitoba, MB, Winnipeg
R2H 2A6, Canada
(Lodewyks) Section of Cardiac Surgery, Department of Surgery, University
of Manitoba, MB, Winnipeg, Canada
(Jeyaraman, Okoli, Rabbani, Abou-Setta) George & Fay Yee Center for
Healthcare Innovation, University of Manitoba, MB, Winnipeg, Canada
(Jeyaraman, Okoli, Rabbani, Abou-Setta, Zarychanski) Department of
Community Health Sciences, University of Manitoba, MB, Winnipeg, Canada
(Neilson) Neil John Maclean Health Sciences Library, University of
Manitoba, MB, Winnipeg, Canada
(Zarychanski) Department of Internal Medicine, University of Manitoba, MB,
Winnipeg, Canada
(Zarychanski) Department of Medical Oncology and Hematology, Cancer Care
Manitoba, MB, Winnipeg, Canada
Publisher
NLM (Medline)

<3>
Accession Number
631141942
Title
External Stents for Vein Grafts in Coronary Artery Bypass Grafting:
Targeting Intimal Hyperplasia.
Source
Surgical technology international. 35 (no pagination), 2019. Date of
Publication: 02 Mar 2019.
Author
Weltert L.P.; Wolf L.G.; Garufi L.; Scaffa R.; Salica A.; Ricci A.; Irace
F.G.; Fusca S.; D'Aleo S.; Chirichilli I.; Bellisario A.; de Paulis R.
Institution
(Weltert) Heart Surgery Unit, European Hospital, Department of Statistics,
San Camillus International University for Health Sciences, Rome, Italy
(Wolf, Scaffa, Salica, Ricci, Irace, Fusca, D'Aleo, Bellisario, de Paulis)
Heart Surgery Unit, European Hospital, Rome, Italy
(Garufi) Cardiac Surgery, Department of Cardiac, Thoracic and Vascular
Sciences, University of Padua, Padova, Italy
(Chirichilli) Department of Cardiac Surgery and Heart Transplantation, San
Camillo Forlanini Hospital Rome, Italy
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Progressive saphenous vein graft (SVG) failure remains a key
limitation to the long-term success of coronary artery bypass grafting
(CABG). SVG disease after the first year is dominated by intimal
hyperplasia, which predisposes the SVG to thrombosis and accelerated
atherosclerosis. The objective of this study was to review and summarize
the latest experimental and clinical data on the use of mechanical
external stents for vein grafts. METHOD(S): In January 2020, the
PubMed database was searched using the terms "external stent", "CABG",
"saphenous vein graft" and "intimal hyperplasia". The results were
reviewed and only randomized experimental and clinical studies that
analyzed the effect of external stenting on venous intimal hyperplasia
were included in the analysis, together with studies that investigated the
clinical benefit of external stenting. RESULT(S): Eight experimental
and four clinical trials met the search criteria. Controlled trials in
different large animal models concluded that external stenting
significantly reduced intimal hyperplasia 3-6 months post implantation,
and reduced both thrombosis rates and the development of lumen
irregularities. Data from randomized controlled trials with a follow-up
period of 1-4.5 years supported the pre-clinical findings and demonstrated
that external stents significantly reduced vein graft disease.
 CONCLUSION(S): Strong evidence indicates that supporting the vein
with external stents is safe and leads to clear advantages at both the
anatomical and cellular levels. With the further accumulation of
consistent positive results, external stenting of SVG may become the
standard of care in future CABG.

<4>
Accession Number
2003932597
Title
Effects of liraglutide on myocardial function after cardiac surgery: A
secondary analysis of the randomised controlled GLOBE trial.
Source
Journal of Clinical Medicine. 9 (3) (no pagination), 2020. Article Number:
673. Date of Publication: March 2020.
Author
Hulst A.H.; Visscher M.J.; Cherpanath T.G.V.; van de Wouw L.; Godfried
M.B.; Thiel B.; Gerritse B.M.; Scohy T.V.; Bouwman R.A.; Willemsen M.G.A.;
Hollmann M.W.; Devries J.H.; Preckel B.; Hermanides J.
Institution
(Hulst, Visscher, van de Wouw, Hollmann, Preckel, Hermanides) Department
of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9,
Postbus 22660, Amsterdam 1105 AZ, Netherlands
(Hulst, Godfried, Thiel) Department of Anesthesiology, OLVG, Oosterpark 9,
Amsterdam 1091 AC, Netherlands
(Hulst, Gerritse, Scohy) Department of Anesthesiology, Amphia, Molengracht
21, Breda 4818 CK, Netherlands
(Cherpanath) Department of Intensive Care, Amsterdam UMC, University of
Amsterdam, Meibergdreef 9, Postbus 22660, Amsterdam 1105 AZ, Netherlands
(Bouwman, Willemsen) Department of Anesthesiology, Catharina Hospital,
Michelangelolaan 2, Eindhoven 5623 EJ, Netherlands
(Devries) Department of Endocrinology, Amsterdam UMC, University of
Amsterdam, Meibergdreef 9, Postbus 22660, Amsterdam 1105 AZ, Netherlands
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Introduction: Previous studies demonstrated the cardioprotective
properties of glucagon-like peptide-1 receptor agonists in patients with
diabetes or cardiac disease. We investigated whether preoperative
subcutaneous liraglutide improves myocardial function after cardiac
surgery. Method(s): We performed a pre-planned secondary analysis of
adult patients undergoing cardiac surgery included in the GLOBE trial.
Patients were randomised to receive 0.6 mg subcutaneous liraglutide on the
evening before surgery and 1.2 mg after induction of anaesthesia, or
matching placebo. Perioperative echocardiographic assessments,
haemodynamic parameters, doses of vasoactive inotropic support and
postoperative measurements of troponin, Creatine Kinase-MB, creatinine and
lactate were compared between groups. Result(s): The study population
consisted of the entire intention-to-treat cohort of the GLOBE trial. In
this study, 129 patients received liraglutide and 132 patients placebo.
Baseline characteristics were comparable between groups. Postoperatively,
170 (65%) patients underwent echocardiography. In the liraglutide group,
more patients had a normal left ventricular systolic function (68%, 59
patients) compared to placebo (53%, 44 patients), difference = 15%, 95%CI
= 0-30, p = 0.049. Assessment of the right ventricle revealed no
difference in function. Conclusion(s): Patients receiving short-term
preoperative liraglutide treatment better maintained normal myocardial
function after cardiac surgery. This study warrants further evaluation of
the potential beneficial effects of GLP-1 receptor agonists in cardiac
surgery patients. Copyright © 2020 by the authors. Licensee MDPI,
Basel, Switzerland.

<5>
Accession Number
631146426
Title
Comparing cardiac troponin levels using sevoflurane and isoflurane in
patients undergoing cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Cardiovascular and Thoracic Research. 12 (1) (pp 1-9), 2020.
Date of Publication: 2020.
Author
Hosseinifard H.; Ghadimi N.; Kaveh S.; Shabaninejad H.; Lijassi A.;
Azarfarin R.
Institution
(Hosseinifard) Biostatistics, School of Health Management and Information
Sciences, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Kaveh) Health Technology Assessment, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Shabaninejad) Department of Health Services Management, School of Health
Management and Information Sciences, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Shabaninejad) Population Health Sciences Institute, Newcastle University,
Newcastle, United Kingdom
(Lijassi) Faculty of Medicine and Pharmacy of Rabat, Mohammed V University
of Rabat, Rabat, Morocco
(Azarfarin) Echocardiography Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Publisher
Tabriz University of Medical Sciences (E-mail: tmj@taibahu.edu.sa)
Abstract
Introduction: Cardiac troponin is one of the heart biomarkers and its high
levels correlates with a high risk of cardiomyocytes damage. This study
aimed to compare sevoflurane and isoflurane effect on troponin levels in
patients undergoing cardiac surgery. Method(s): We systematically
searched for RCTs which had been published in Cochrane library, PubMed,
Web of science, CRD, Scopus, and Google Scholar by the end of February
30th, 2019. The quality of articles was evaluated with the Cochrane
checklist. GRADE was used for quality of evidence for this meta-analysis.
Meta-analysis was done based on random or fixed effect model.
 Result(s): Five studies with total of 190 (sevoflurane) and 191
(isoflurane) patients were included. The results showed that pooled mean
difference of troponin levels between the two groups was significant at
ICU admission time and 24 hours after entering. The comparison of troponin
level changes between the two groups (baseline = at time ICU) in 24 and 48
hours after ICU admission was significant. Conclusion(s): This
meta-analysis showed that blood troponin levels were significantly lower
at the time of arrival in ICU with isoflurane and after 24 hours with
sevoflurane. Generally, given the small mean difference between isoflurane
and sevoflurane, it seems that none of the medications has a negative
effect on the cardiac troponin level. Copyright © 2020 The
Author(s). This is an open access article distributed under the terms of
the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original
work is properly cited.

<6>
Accession Number
2005127868
Title
Does Intraoperative Cell Salvage Reduce Postoperative Infection Rates in
Cardiac Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
van Klarenbosch J.; van den Heuvel E.R.; van Oeveren W.; de Vries A.J.
Institution
(van Klarenbosch) Department of Anesthesiology, University Medical Center
Utrecht, Utrecht, Netherlands
(van den Heuvel) Department of Mathematics & Computer Science, Eindhoven
University of Technology, Eindhoven, Netherlands
(van Oeveren) HaemoScan BV, Groningen, Netherlands
(de Vries) Department of Anesthesiology, University Medical Center
Groningen, Groningen, Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Primary outcome was the risk for infections after cell salvage
in cardiac surgery. Design(s): Data of a randomized controlled trial
on cell salvage and filter use (ISRCTN58333401). Setting(s): Six
cardiac surgery centers in the Netherlands. Participant(s): All 716
patients undergoing elective coronary artery bypass grafting, valve
surgery, or combined procedures over a 4-year period who completed the
trial. Intervention(s): Postoperative infection data were assessed
according to Centre of Disease Control and Prevention/National Healthcare
Safety Network surveillance definitions. Measurements and Main
Results: Fifty-eight (15.9%) patients with cell salvage had infections,
compared with 46 (13.1%) control patients. Mediation analysis was
performed to estimate the direct effect of cell salvage on infections (OR
2.291 [1.177;4.460], p = 0.015) and the indirect effects of allogeneic
transfusion and processed cell salvage blood on infections. Correction for
confounders, including age, seks and body mass index was performed.
Allogeneic transfusion had a direct effect on infections (OR = 2.082
[1.133;3.828], p = 0.018), but processed cell salvage blood did not (OR =
0.999 [0.999; 1.001], p = 0.089). There was a positive direct effect of
cell salvage on allogeneic transfusion (OR = 0.275 [0.176;0.432], p <
0.001), but a negative direct effect of processed cell salvage blood
(1.001 [1.001;1.002], p < 0.001) on allogeneic transfusion. Finally, there
was a positive direct effect of cell salvage on the amount of processed
blood. Conclusion(s): Cell salvage was directly associated with
higher infection rates, but this direct effect was almost completely
eliminated by its indirect protective effect through reduced allogeneic
blood transfusion. Copyright © 2020 The Authors

<7>
Accession Number
2005079509
Title
A systematic review and meta-analysis on the effectiveness of an invasive
strategy compared to a conservative approach in patients > 65 years old
with non-ST elevation acute coronary syndrome.
Source
PLoS ONE. 15 (2) (no pagination), 2020. Article Number: e0229491. Date of
Publication: 2020.
Author
Reano J.D.P.; Shiu L.A.B.; Miralles K.V.; Dimalala M.G.C.; Pestano N.S.;
Punzalan F.E.R.; Tumanan-Mendoza B.; Reyes M.J.T.; Castillo R.R.
Institution
(Reano, Shiu, Miralles, Pestano, Punzalan, Tumanan-Mendoza, Reyes,
Castillo) Adult Cardiology, Manila Doctors Hospital, Manila, Philippines
(Dimalala, Reyes) Interventional Cardiology, Manila Doctors Hospital,
Manila, Philippines
(Punzalan) Division of Cardiology, Department of Medicine, Philippine
General Hospital, College of Medicine University of the Philippines,
Manila, Philippines
(Castillo) Cardiovascular Medicine, Adventist University of the
Philippines, Silang, Philippines
(Castillo) FAME Leaders Academy, Makati, Philippines
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Patients 65 years old and older largely represent (>50%)
hospital-admitted patients with acute coronary syndrome (ACS). Data are
conflicting comparing efficacy of early routine invasive (within 48-72
hours of initial evaluation) versus conservative management of ACS in this
population. Objective We aimed to determine the effectiveness of routine
early invasive strategy compared to conservative treatment in reducing
major adverse cardiovascular events in patients 65 years old and older
with non-ST elevation (NSTE) ACS. Data sources We conducted a systematic
review of randomized controlled trials (RCTs) through PubMed, Cochrane,
and Google Scholar database. Study selection The studies included were
RCTs that evaluated the effectiveness of invasive strategy compared to
conservative treatment among patients >= 65 years old diagnosed with
NSTEACS. Studies were included if they assessed any of the following
outcomes of death, cardiovascular mortality, myocardial infarction (MI),
stroke, recurrent angina, and need for revascularization. Six articles
were subsequently included in the meta-analysis. Data extraction Three
independent reviewers extracted the data of interest from the articles
using a standardized data collection form that included study quality
indicators. Disparity in assessment was adjudicated by another reviewer.
Data synthesis All pooled analyses were initially done using Fixed Effects
model. For pooled analyses with significant heterogeneity (I2>=
50%), the Random Effects model was used. A total of 3,768 patients were
included, 1,986 in the invasive strategy group, and 1,782 in the
conservative treatment group. Results Meta-analysis showed less incidence
of revascularization in the invasive (2%) over conservative treatment
groups (8%), with overall risk ratio of 0.29 (95% CI 0.14 to 0.59). Across
all pooled studies, no significant effect of invasive strategy on
all-cause mortality, cardiovascular mortality, stroke, and MI was
observed. Only one study assessed the outcome of recurrent angina.
Conclusion There was a significantly lower rate of revascularization in
the invasive strategy group compared to the conservative treatment group.
In the reduction of all-cause mortality, cardiovascular mortality, MI, and
stroke there was no significant effect of invasive strategy versus
conservative treatment. This finding does not support the bias against
early routine invasive intervention in patients >= 65 years old with
NSTEACS. Further studies focusing on these patients with larger population
sizes are still needed. Copyright © 2020 Reano et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<8>
Accession Number
2004160279
Title
A prospective study examining the impact of uniportal video-assisted
thoracic surgery on the short-term quality of life in patients with lung
cancer.
Source
Thoracic Cancer. 11 (3) (pp 612-618), 2020. Date of Publication: 01 Mar
2020.
Author
Xu G.-W.; Xie M.-R.; Wu H.-R.; Xiong R.; Li C.-W.; Xu S.-B.; Xu M.-Q.; Li
T.
Institution
(Xu, Xie, Wu, Xiong, Li, Xu, Xu, Li) Department of Thoracic Surgery, The
First Affiliated Hospital of USTC, Division of Life Sciences and Medicine,
University of Science and Technology of China, Hefei, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The aim of this study was to evaluate the effect of uniportal
and three-portal VATS in lung cancer patients on the postoperative
short-term quality of life (QOL). Method(s): A single-center,
prospective, nonrandomized study was performed on patients who underwent
uniportal or three-portal video-assisted thoracoscopic surgery (VATS)
lobectomy and systemic mediastinal lymph node dissection. QOL was measured
before surgery at baseline and at one, two, four, and eight weeks after
the operation. The measured data of normal distribution were indicated by
the mean +/- standard deviation, the independent sample t-test was used
among the groups, and the chi2 test was used to compare the counting.
Non-normal distribution of the measurement data was carried out using the
Mann-Whitney test. Result(s): Preoperative functional areas, symptom
areas and overall health scores were similar in the two groups. The
physical, role, emotional and social functions and overall health status
of the uniportal group were significantly higher than those of the
three-portal group in postoperative time. The score of symptom field was
higher in one week after operation, the score of two, four and eight weeks
decreased gradually, but it was still above the preoperative level, and
the fatigue and pain of the uniportal group were significantly lower than
that of the three-portal group. Conclusion(s): The advantages of
uniportal VATS include a shorter hospital stay, more rapid recovery and
superior cosmetic results compared to three-portal VATS. Additionally,
uniportal VATS is superior to three-portal thoracoscopic surgery in terms
of the immediate postoperative short-term QOL. Copyright © 2020
The Authors. Thoracic Cancer published by China Lung Oncology Group and
John Wiley & Sons Australia, Ltd

<9>
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Accession Number
631095670
Title
Systematic Evaluation of the Robustness of the Evidence Supporting Current
Guidelines on Myocardial Revascularization Using the Fragility Index.
Source
Circulation: Cardiovascular Quality and Outcomes. 12 (12) (no pagination),
2019. Article Number: e006017. Date of Publication: 01 Dec 2019.
Author
Gaudino M.; Hameed I.; Biondi-Zoccai G.; Tam D.Y.; Gerry S.; Rahouma M.;
Khan F.M.; Angiolillo D.J.; Benedetto U.; Taggart D.P.; Girardi L.N.; Crea
F.; Ruel M.; Fremes S.E.
Institution
(Gaudino, Hameed, Rahouma, Khan, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Napoli, Italy
(Tam, Fremes) Schulich Heart Centre Sunnybrook Health Sciences Centre,
University of Toronto, Canada
(Gerry) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, University of Oxford, United Kingdom
(Angiolillo) Department of Cardiology, University of Florida,
Jacksonville, United States
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, United Kingdom
(Taggart) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, University of Oxford, United Kingdom
(Crea) Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
(Crea) Department of Cardiovascular and Thoracic Sciences, Universita
Cattolica de Sacro Cuore, Roma, Italy
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: RCTs (randomized controlled trials) are the preferred source
of evidence to support professional societies' guidelines. The fragility
index (FI), defined as the minimum number of patients whose status would
need to switch from nonevent to event to render a statistically
significant result nonsignificant, quantitatively estimates the robustness
of RCT results. We evaluate RCTs supporting current guidelines on
myocardial revascularization using the FI and FI minus number of patients
lost to follow-up. Methods and Results: The FI and FI minus number of
patients lost to follow-up of RCTs supporting the 2012 American College of
Cardiology/American Heart Association Guideline for the Diagnosis and
Management of Patients with Stable Ischemic Heart Disease, the 2014
Focused Update of the American College of Cardiology/American Heart
Association Guideline for the Diagnosis and Management of Patients with
Stable Ischemic Heart Disease, and the 2018 European Society of
Cardiology/European Association for Cardio-Thoracic Surgery Guidelines for
Myocardial Revascularization were calculated. Of 414 RCTs identified, 160
were eligible for FI calculation. The median FI was 8.0 (95% CI, 5.0-9.0)
and the median FI minus number of patients lost to follow-up was 1.0 (95%
CI, 0.0-3.0). FI was <=3, indicating very limited robustness, in 44
(27.5%) RCTs, and was lower than the number LTF, indicating limited
robustness, in 68 (42.5%) RCTs. FI was significantly (all P<0.05)
correlated with the sample size, number of events, statistical power,
journal impact factor, use of intention-To-Treat analysis, and of
composite end points and negatively correlated with the use of
percutaneous interventions in the treatment arm and the P-value level.
 Conclusion(s): More than a quarter of RCTs that support current
guidelines on myocardial revascularization have a FI of 3 or lower, and
over 40% of trials reveal a FI that is lower than the number of patients
lost to follow-up. These findings suggest that the robustness of the
findings that support current myocardial revascularization guidelines is
tenuous and vulnerable to change as new evidence from RCTs
appears. Copyright © 2019 American Heart Association, Inc.

<10>
Accession Number
2004378853
Title
Active chest tube clearance after aortic valve surgery did not influence
amount residual pericardial fluid after aortic valve replacement in a
randomised trial.
Source
Scandinavian Cardiovascular Journal. (no pagination), 2020. Date of
Publication: 2020.
Author
Malgerud L.; Maret E.; Reitan C.; Ivert T.
Institution
(Malgerud, Ivert) Department of Cardiothoracic Surgery, Karolinska
University Hospital, Stockholm, Sweden
(Malgerud) Department of Molecular Medicine and Surgery, Karolinska
Institutet, Stockholm, Sweden
(Maret) Department of Clinical Physiology, Karolinska University Hospital,
and Karolinska Institutet, Stockholm, Sweden
(Reitan) Department of Cardiothoracic Surgery, Karolinska University
Hospital, Stockholm and Department of Cardiology, Lund University, Lund,
Sweden
Publisher
Taylor and Francis Ltd
Abstract
Objective. Evaluate if the use of active clearance of chest tubes after
aortic valve surgery influenced bleeding and reduced postoperative
residual pericardial effusion. Design. Prospective randomised trial
comparing PleuraFlow 32 F chest tube with FlowGlideTM active
clearance to a standard Argyle 32 F chest tube in 100 patients
undergoing aortic valve surgery. Chest tube outputs and pericardial
effusion measurements assessed by two-dimensional transthoracic
echocardiography were recorded before hospital discharge. Results.
Postoperative chest tube outputs per hour did not differ between the two
groups. The median chest tube output was 400 mL for patients who had a
PleuraFlow chest tube vs. 490 mL for patients with an
Argyle chest tube (p =.08). Pericardial effusions >= 2 mm were
detected in 76% vs. 68% of the patients (p =.50) and postoperative atrial
fibrillation occurred in 42% vs. 34% (p =.54), respectively. Conclusions.
Use of active clearance chest tubes, compared to standard chest tubes
after aortic valve surgery did not differ significantly regarding
postoperative bleeding or degree of pericardial effusion as measured by
echocardiography prior to hospital discharge. Copyright © 2020,
© 2020 Informa UK Limited, trading as Taylor & Francis Group.

<11>
Accession Number
2004336018
Title
Insulin Glargine in Critically ill Patients: Once/Day versus Twice/Day
Dosing.
Source
Pharmacotherapy. 40 (3) (pp 186-190), 2020. Date of Publication: 01 Mar
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. 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). 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). 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. Copyright © 2020
Pharmacotherapy Publications, Inc.

<12>
Accession Number
630636279
Title
Long-Term Outcomes of Unprotected Left Main Coronary Artery Disease:
Comparison of Coronary Artery Bypass Grafting and Percutaneous Coronary
Intervention.
Source
The Journal of invasive cardiology. 32 (3) (pp 111-116), 2020. Date of
Publication: 01 Mar 2020.
Author
Song K.; Kim M.H.; Li J.X.; Kim S.J.; Lee K.M.; Cho Y.-R.; Park J.S.; Park
T.H.; Kim Y.D.; Lee M.S.
Institution
(Kim) Department of Cardiology, Dong-A University Hospital, 32
Daesingongwon-ro ,Seo-gu, Busan 602-714, South Korea
Publisher
NLM (Medline)
Abstract
OBJECTIVE: We compared the long-term outcomes of coronary artery bypass
grafting (CABG) and percutaneous coronary intervention (PCI) for
unprotected left main coronary artery (ULMCA) disease in a real-world
population. BACKGROUND: CABG is the standard of care for ULMCA disease.
Contemporary randomized trials have reported conflicting results with the
two revascularization strategies for the treatment of ULMCA disease at
intermediate-term follow-up. METHOD(S): We evaluated 422 consecutive
patients with ULMCA disease who underwent CABG (n = 273) or PCI (n = 149)
from 1998-2008. The primary outcome measure was major adverse cardiac and
cerebrovascular event (MACCE) rate, defined as the composite of all-cause
death, myocardial infarction (MI), stroke, or target-vessel
revascularization (TVR) at 10 years. Propensity-score matched (PSM)
analysis was used to assess long-term MACCE. RESULT(S): The
cumulative 10-year incidence of risk for MACCE was not significantly
different between the PCI and CABG groups (24.8% vs 20.5%, respectively;
log rank P=.22; log rank PSM P=.45). The risk for all-cause death was not
significantly different between the two groups (log rank P=.09; PSM log
rank P=.51). The risk for stroke was significantly lower with PCI (log
rank P=.02), but was not significant after matching (PSM log rank P=.27).
The risk for TVR was significantly higher with PCI vs CABG prior to and
after matching (log rank P<.001; log rank PSM P=.01). There were no
significant differences in MACCE between the two groups when stratified by
SYNTAX scores <=22% (log rank P=.61) and >23% (log rank P=.06).
 CONCLUSION(S): In patients with ULMCA disease, PCI was comparable
with CABG for long-term MACCE and death rates. The TVR rate was higher in
the PCI group.

<13>
Accession Number
629732064
Title
A meta-analysis of >=5-year mortality after transcatheter versus surgical
aortic valve replacement.
Source
The Journal of cardiovascular surgery. 61 (1) (pp 107-116), 2020. Date of
Publication: 01 Feb 2020.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Takagi) Department of Cardiovascular Surgery, Kitasato University School
of Medicine, Sagamihara, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, NY,
NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, MI, Detroit,
United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: It remains unclear whether long-term survival is superior
following transcatheter aortic valve implantation (TAVI) than following
surgical aortic valve replacement (SAVR). We performed a meta-analysis of
mortality with >=5-year follow-up in randomized controlled trials (RCTs)
and propensity-score matched (PSM) studies of TAVI versus SAVR. EVIDENCE
ACQUISITION: MEDLINE, EMBASE, and the Cochrane Central Register of
Controlled Trials were searched through March 2019. Eligible studies were
RCTs or PSM studies of TAVI versus SAVR enrolling patients with severe
aortic stenosis and reporting all-cause mortality with >=5-year follow-up
as an outcome. A hazard ratio of mortality for TAVI versus SAVR was
extracted from each individual study. EVIDENCE SYNTHESIS: Our search
identified 3 RCTs and 7 PSM studies enrolling 5498 patients. A pooled
analysis of all 10 studies demonstrated a statistically significant 38%
increase in mortality with TAVI relative to SAVR. A subgroup meta-analysis
showed no statistically significant difference between TAVI and AVR in
RCTs and a statistically significant 68% increase with TAVI relative to
SAVR in PSM studies. CONCLUSION(S): On the basis of a meta-analysis
of 7 PSM studies, TAVI is associated with greater all-cause mortality with
>=5-year follow-up than SAVR. However, another meta-analysis of 3 RCTs
suggests no difference in mortality between TAVI and SAVR.

<14>
Accession Number
629928786
Title
Meta-analysis of impact of troponins on mortality after transcatheter
aortic valve implantation.
Source
The Journal of cardiovascular surgery. 61 (1) (pp 98-106), 2020. Date of
Publication: 01 Feb 2020.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Takagi) Department of Cardiovascular Surgery, Kitasato University School
of Medicine, Sagamihara, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, NY,
NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, MI, Detroit,
United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: To determine whether troponin (Tn) can predict mortality
after transcatheter aortic valve implantation (TAVI), we performed a
meta-analysis of currently available studies investigating impact of
baseline and postprocedural Tn. EVIDENCE ACQUISITION: MEDLINE and EMBASE
were searched through April 2019 using PubMed and OVID. Studies considered
for inclusion met the following criteria: the study investigating impact
of baseline and postprocedural Tn on mortality; the study population was
patients undergoing TAVI for aortic stenosis (AS); outcomes included early
(30-day or in-hospital)/late (including early) mortality. For each study,
data regarding early/late mortality in both high and low (defined in each
study) level of baseline/postprocedural Tn groups were used to generate
odds ratios (ORs) and 95% confidence intervals (CIs), or reported ORs and
hazard ratios (HRs) with 95% CIs were directly extracted. Study-specific
estimates were combined using inverse variance-weighted averages of
logarithmic ORs/HRs in the random-effects model. EVIDENCE SYNTHESIS: We
identified 19 eligible studies including a total of 7555 patients
undergoing TAVI. Pooled analyses demonstrated associations of high levels
of baseline Tn with statistically significant increases in both 30-day
(P=0.002) and midterm mortality (P<0.00001), no correlation of high
postprocedural Tn with 30-day mortality (P=0.13), and an association of
high postprocedural Tn with a statistically significant increase in
midterm mortality (P=0.002). High levels of baseline/postprocedural TnT
predicted statistically significant increases in both 30-day
(P=0.002/<0.0001) and midterm mortality (P<0.00001/0.0003).
 CONCLUSION(S): Both baseline and postprocedural Tn, especially TnT,
may predict mortality after TAVI for AS.

<15>
[Use Link to view the full text]
Accession Number
629819338
Title
Stent Thrombosis in Patients With Atrial Fibrillation Undergoing Coronary
Stenting in the AUGUSTUS Trial.
Source
Circulation. 141 (9) (pp 781-783), 2020. Date of Publication: 03 Mar 2020.
Author
Lopes R.D.; Leonardi S.; Wojdyla D.M.; Vora A.N.; Thomas L.; Storey R.F.;
Vinereanu D.; Granger C.B.; Goodman S.G.; Aronson R.; Windecker S.; Thiele
H.; Valgimigli M.; Mehran R.; Alexander J.H.
Institution
(Lopes, Wojdyla, Thomas, Granger, Alexander) Duke Clinical Research
Institute, Duke University School of Medicine, L.T., C.B.G., Durham
(Leonardi) University of Pavia and Fondazione IRCCS Policlinico S. Matteo
(Vora) UPMC Pinnacle, Harrisburg, United States
(Storey) University of Sheffield
(Vinereanu) University of Medicine and Pharmacy Carol Davila, University
and Emergency Hospital of Bucharest
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
(Goodman) Terrence Donnelly Heart Centre, St Michael's Hospital,
University of Toronto, ON
(Aronson) Bristol-Myers Squibb, Lawrenceville, United States
(Windecker, Valgimigli) Bern University Hospital, Inselspital, University
of Bern
(Thiele) Heart Center Leipzig at the University of Leipzig, Department of
Internal Medicine/Cardiology and Leipzig Heart Institute, Germany (H.T.)
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, Cardiovascular Research Foundation
Publisher
NLM (Medline)

<16>
Accession Number
631131052
Title
Comparison of Levosimendan Versus IABP in Patients with Poor Left
Ventricular Function Undergoing Coronary Artery Bypass Graft Surgery.
Source
The heart surgery forum. 23 (1) (pp E093-E097), 2020. Date of Publication:
27 Feb 2020.
Author
Omar A.; Eldegwy M.; Allam M.; Rouchdy A.; Soliman S.A.H.; Dawou O.;
Elshihy E.
Institution
(Omar) Cardiothoracic Surgery Department, Faculty of Medicine, Cairo
University, Cairo, Egypt
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to compare the use of levosimendan
versus intra-aortic balloon pump (IABP) in patients with poor left
ventricular function undergoing coronary artery bypass grafting (CABG)
with ejection fraction less than 35%. METHOD(S): Between February
2016 and March 2019, a prospective randomized study was performed on a
group of 279 consecutive patients with left ventricular ejection fraction
< 35%, who underwent elective CABG without concomitant procedures. These
patients were divided into 2 groups, according to the treatment they
received - either levosimendan (Group A) or intra-aortic balloon
counterpulsation (Group B). RESULT(S): There was no statistically
significant difference between the 2 groups, regarding mortality and
morbidity. In the IABP group, the mean arterial blood pressure (2 hours
post cardiopulmonary bypass) significantly was higher, and the heart rate
in postoperative Day 1 significantly was lower. The levosimendan group had
a significantly lower ICU stay than the IABP group. CONCLUSION(S): We
found that starting levosimendan infusion after induction of anesthesia is
an acceptable option in comparison to IABP. The use of levosimendan in
high-risk cardiac patients is comparable to IABP in improving hemodynamics
during and after conventional on-pump CABG and results in a shorter ICU
stay.

<17>
Accession Number
631130984
Title
Effect of Perioperative Glucose-Insulin-Potassium Therapy in Patients
Undergoing On-Pump Cardiac Surgery: A Meta-Analysis.
Source
The heart surgery forum. 23 (1) (pp E063-E069), 2020. Date of Publication:
25 Feb 2020.
Author
Li Q.; Zhang J.; Yang C.; Fan Z.; Yang Y.; Zheng T.; Yang J.
Institution
(Li) Department of Cardiology, First College of Clinical Medical Science,
China Three Gorges University, Yichang, Hubei, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The role of glucose-insulin-potassium (GIK) infusion during
cardiac surgery has held interest for so many years without a clear
answer. The aim of this meta-analysis was to evaluate the effect of GIK
therapy on outcomes in patients undergoing on-pump cardiac surgery.
 METHOD(S): A comprehensive online review was performed in The Web of
Science, Embase, Medline, PubMed, and The Cochrane Library databases from
2000 to 2019. Eligible studies included randomized controlled trials
(RCTs) that compared GIK treatment with placebo or standard care during
on-pump cardiac surgery. Risk ratios (RR) were used for binary outcomes
and mean difference (MD) was used for continuous variables; both with
their 95% confidence intervals (CI). RESULT(S): A total of 18 RCTs
involving 2,131 patients met the inclusion criteria. Compared with the
control group, the GIK treatment significantly reduced in-hospital
mortality (RR = 0.56, 95% CI: 0.32-0.97; P = .04), postoperative
myocardial infarctions (MI) (RR = 0.71, 95% CI: 0.56-0.91; P = .006), the
use of inotropic support (RR = 0.53, 95% CI: 0.45-0.63; P < .00001), and
length of stay in the intensive care unit (ICU) (MD = -0.33, 95% CI:
-0.52--0.14; P = .0007). Moreover, GIK treatment seemed to be associated
with fewer postoperative atrial fibrillation (AF) (RR = 0.81, 95% CI:
0.64-1.03; P = .09). CONCLUSION(S): In patients undergoing on-pump
cardiac surgery, GIK infusion has a beneficial role in mortality during
hospital stay and demonstrates superior efficacy versus standard care for
reduction in postoperative MI, AF, ICU length of stay as well as inotropic
agent requirements.

<18>
Accession Number
631130829
Title
Intravenous Tranexamic Acid Decreases Blood Transfusion in Off-Pump
Coronary Artery Bypass Surgery: A Meta-analysis.
Source
The heart surgery forum. 23 (1) (pp E039-E049), 2020. Date of Publication:
25 Feb 2020.
Author
Sun L.; An H.; Feng Y.
Institution
(Sun) Department of Anesthesiology, Peking University People's Hospital,
Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Tranexamic acid (TXA) has been widely used during on-pump
coronary artery bypass graft (CABG) surgery owing to its antifibrinolytic
effect. However, the efficacy and safety of TXA in off-pump CABG surgery
remains unconfirmed, especially intravenous (IV) administration.
 OBJECTIVE(S): The aim of this study was to evaluate the effectiveness
and safety of IV administration of TXA in off-pump CABG settings. METHODS
AND RESULTS: A comprehensive literature search was performed to identify
randomized controlled trials (RCTs) that compared IV use of TXA with
placebo in the reduction of postoperative 24-hour blood transfusion, as
well as postoperative death and thrombotic events. The combined
estimations were compiled with a fixed-effects model or, if heterogeneity
existed, a random-effects model. Funnel plots and Egger's test were used
to assess potential publication bias. Subgroup analyses were used to
explore possible sources of heterogeneity. In total, 12 RCTs met the
inclusion criteria. IV administration of TXA significantly reduced the
risk of packed red blood cell (PRBC) transfusion [risk ratio (RR) = 0.61,
95% confidence interval (CI) 0.503 to 0.756, P < .001, I2 = 0.0%) during
the 24 hours after surgery. However, there was no statistical significance
in platelet (RR = 0.613, 95% CI 0.112 to 3.348, P = .572, I2 = 0.0%) or
total fresh frozen plasma (FFP) (RR = 0.511, 95% CI 0.246 to 1.063, P =
.073, I2 = 0.0%) transfusion. Also, no significant difference was found in
major adverse events (death or thrombotic complications) (RR = 0.917, 95%
CI 0.532 to 1.581, P = .756, I2 = 0.0%) between the 2 groups.
Interestingly, further subgroup analysis demonstrated that IV TXA
decreased the risk of prothrombin time (PT)- and international normalized
ratio (INR)-guided FFP transfusion (RR = 0.462, 95% CI 0.296 to 0.721, P =
.001, I2 = 0.0%). CONCLUSION(S): IV TXA was effective in reducing
allogeneic blood component transfusion (PRBCs and PT- or INR-guided FFP
transfusion), without increasing the incidence of postoperative death or
thrombotic complications in off-pump CAB surgery.

<19>
Accession Number
629552424
Title
Effects of dexmedetomidine on post-operative recovery and mental status in
patients receiving robotic-assisted thoracic surgery.
Source
Annals of palliative medicine. 8 (4) (pp 469-475), 2019. Date of
Publication: 01 Sep 2019.
Author
Zhang L.-Y.; Zhang Y.-H.; Shen J.; Luo Y.
Institution
(Zhang, Zhang, Shen) Department of Anesthesiology, Ruijin Hospital,
Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
(Luo) Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai 200025, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: This study aimed to investigate the effects of dexmedetomidine
on the post-operative recovery and mental status in patients receiving
robotic-assisted thoracic surgery (RATS). METHOD(S): One hundred
patients who received selective RATS under general anesthesia were
recruited and assigned into control group (C) and dexmedetomidine group
(D). The anesthesia induction and maintenance were consistent between
groups. Midazolam, sufentanil, propofol and rocuronium were intravenously
injected for anesthesia induction, followed by mechanical ventilation
after endotracheal intubation. Sevoflurane inhalation at a minimum
alveolar concentration (MAC) of 0.5 was administered, propofol and
remifentanil were intravenously injected to maintain the bispectral index
(BIS) at 40-60, and rocuronium was intravenously injected once every 30
min. In the D group, dexmedetomidine was intravenously injected after
endotracheal intubation, and then it was injected before the end of
surgery. In the C group, normal saline of equal volume was injected. The
hemodynamic parameters, blood loss, urine volume, time of surgery, time of
anesthesia, total dose of propofol, time of thoracic tube indwelling,
hospital stay and pulmonary complications were recorded; blood gas
analysis was performed after extubation; the QoR-15 and mini-mental state
examination (MMSE) questionnaires were employed for the assessment of
mental status at 1 and 3 days after surgery. RESULT(S): The mean
arterial pressure (MAP), heart rate (HR) and brain oxygenation were
similar between groups at different time points (P>0.05). There were no
significant differences in the operation time, time of anesthesia and
intra-operative urine volume between groups. As compared to the C group,
the blood loss and dose of propofol reduced significantly (P<0.05). After
extubation, the respiratory frequency reduced and PaO2 increased markedly
(P<0.05). After surgery, the time of thoracic tube indwelling and hospital
stay reduced dramatically in the D group as compared to the C group
(P<0.05). The QoR-15 score and MMSE score in the D group were markedly
higher than in the C group (P<0.05). CONCLUSION(S): Dexmedetomidine
can improve the post-operative recovery and mental status after RATS.

<20>
Accession Number
631140695
Title
Sutureless versus Stented Bioprostheses for Aortic Valve Replacement: The
Randomized PERSIST-AVR Study Design.
Source
The Thoracic and cardiovascular surgeon. 68 (2) (pp 114-123), 2020. Date
of Publication: 01 Mar 2020.
Author
Lorusso R.; Folliguet T.; Shrestha M.; Meuris B.; Kappetein A.P.; Roselli
E.; Klersy C.; Nozza M.; Verhees L.; Larracas C.; Goisis G.; Fischlein T.
Institution
(Lorusso) Department of Cardio-Thoracic Surgery, Heart and Vascular
Centre, Maastricht University Medical Centre (MUMC + ), Maastricht,
Netherlands
(Folliguet) Chirurgie Cardiaque & Transplantation, Assistance Publique,
Hopital, Henri Mondor, France
(Shrestha) Department of Thoracic and Cardiovascular Surgery, Hannover
Medical School, Hannover, Germany
(Meuris) Cardiac Surgery Department, Universitaire Ziekenhuizen Leuven,
Leuven, Belgium
(Kappetein) Thoraxcenter, Erasmus Medical Centre, Rotterdam, Netherlands
(Roselli) Thoracic and Cardiovascular Surgery, Cleveland Clinic,
Cleveland, OH, United States
(Klersy) Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
(Nozza, Verhees, Larracas, Goisis) LivaNova Plc, London, United Kingdom
(Fischlein) Department of Cardiac Surgery, Klinikum Nurnberg, Paracelsus
Medical University, Nuremberg, Germany
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Sutureless biological valves for surgical aortic valve
replacement (SAVR), characterized by the absence of anchoring sutures at
the aortic annulus, are gaining popularity because of ease and
reproducibility of implant, shorter operating times, and enhancement of
minimally invasive approaches. The stentless configuration of the
sutureless valve was designed to achieve optimal hemodynamic performance.
MATERIALS AND METHODS: PERSIST-AVR (PERceval Sutureless Implant versus
STandard Aortic Valve Replacement) is a prospective, randomized, adaptive,
open-label, international, postmarket trial (NCT02673697). The primary
objective of the trial is to assess the safety and efficacy of the
Perceval (LivaNova, London, UK) sutureless bioprosthesis among patients
undergoing SAVR in the presence of severe aortic stenosis to demonstrate
the noninferiority of Perceval as compared with standard sutured stented
bioprosthetic aortic valve as an isolated procedure or combined with
coronary artery bypass grafting. Sample size will be determined adaptively
through interim analyses performed by an Independent Statistical Unit till
a maximum of 1,234 patients, enrolled at ~60 sites in countries where the
device is commercially available. Patients will be followed up for 5 years
after implant. The primary end point is the number of patients free from
major adverse cardiac and cerebrovascular-related events at 1 year.
Additional secondary outcomes will be assessed up to 5 years. DISCUSSION:
PERSIST-AVR is the first prospective, randomized study comparing
in-hospital and postdischarge outcomes in a robust population of patients
undergoing SAVR with either the Perceval sutureless bioprosthesis or a
conventional sutured stented bioprosthesis up to 5 years. Copyright
Georg Thieme Verlag KG Stuttgart . New York.

<21>
Accession Number
2003941892
Title
Smart mode of mechanical lung ventilation during early activation of
cardiosurgical patients.
Source
Obshchaya Reanimatologiya. 16 (1) (pp 4-15), 2020. Date of Publication:
2020.
Author
Eremenko A.A.; Komnov R.D.
Institution
(Eremenko, Komnov) Petrovsky National Research Center for Surgery, 2
Abrikosovsky Lane, Moscow 119991, Russian Federation
Publisher
V.A. Negovsky Research Institute of General Reanimatology (E-mail:
journal_or@mail.ru)
Abstract
Purpose of the study: a comparative assessment of safety and quality of
respiratory support carried out using the ASV mode vs. conventional
protocol, in which ventilation parameters are set by an ICU physician
during early postoperative period in cardiosurgical patients. Materials
and methods. The modes of a respiratory support included automated ASV
ventilation (40 pa-tients) versus conventional ventilation (38 patients)
managed by 8 ICU physicians were compared in a cohort of cardiosurgical
patients in a randomized controlled study. The comparison included
ventilation parameters, all efforts of physicians to adjust ventilator
settings and time it took, duration of respiratory support in ICU,
incidence of adverse events in the course of weaning, total time in ICU
and hospital, postoperative complications and mortality. Results. There
was no reliable difference in the duration of postoperative trachea
intubation, which was equal to 267+/-76 minutes (the ASV group) and
271+/-80 minutes (the control group). The number of manual adjustments,
which was 2 vs. 4 (P<0.00001), and the time spent by a clinical physician
near a ventilator, which was 99+/-35 seconds vs. 166+/-70 seconds, were
reliably lower in the ASV group (P=0.00001). The time between restoration
of patient's own respiratory activity and transfer to the assisted
breathing mode was longer in the control group and amounted to 30 (0-90)
min. while in the smart mode, the transfer took place immediately after
restoration (P=0.004969). When ASV was used, the driving pressure was
reliably lower during all phases of respiratory support: P 7.2+/-1.6 vs.
9.3+/-2.1 cm H<inf>2</inf>O, (P=0.000001); there was no reliable
difference in the tidal volume: 7.0 (6-8.5) (ASV) vs. 7 (6-10) ml/kg/ideal
body mass (the control group). Conclusion. ASV represents a
lung-protective ventilation that reduces physician's time cost and medical
staff efforts in ALV management without compromising patient's safety and
respiratory support quality. Copyright © 2020, V.A. Negovsky
Research Institute of General Reanimatology. All rights reserved.

<22>
Accession Number
2005162858
Title
Risk Prediction Model for Cardiac Implantable Electronic Device
Implantation After Transcatheter Aortic Valve Replacement.
Source
JACC: Clinical Electrophysiology. 6 (3) (pp 295-303), 2020. Date of
Publication: March 2020.
Author
Tsushima T.; Nadeem F.; Al-Kindi S.; Clevenger J.R.; Bansal E.J.; Wheat
H.L.; Kalra A.; Attizzani G.F.; Elgudin Y.; Markowitz A.; Costa M.A.;
Simon D.I.; Arruda M.S.; Mackall J.A.; Thal S.G.
Institution
(Tsushima, Wheat) Department of Medicine, Case Western Reserve University,
University Hospitals Cleveland Medical Center, Cleveland, OH, United
States
(Nadeem, Al-Kindi, Clevenger, Bansal, Kalra, Attizzani, Costa, Simon,
Arruda, Mackall, Thal) Department of Medicine, Division of Cardiology,
Case Western Reserve University, Harrington Heart and Vascular Institute,
University Hospitals Cleveland Medical Center, Cleveland, OH, United
States
(Elgudin, Markowitz) Department of Surgery, Division of Cardiac Surgery,
Case Western Reserve University, Harrington Heart and Vascular Institute,
University Hospitals Cleveland Medical Center, Cleveland, OH, United
States
Publisher
Elsevier Inc
Abstract
Objectives: The aim of this study was to develop and validate a risk
prediction model for high-grade atrioventricular block requiring cardiac
implantable electronic device (CIED) implantation after transcatheter
aortic valve replacement (TAVR). Background(s): High-grade
atrioventricular block requiring CIED remains a significant sequelae
following TAVR. Although several pre-operative characteristics have been
associated with the risk of post-operative CIED implantation, an accurate
and validated risk prediction model is not established yet.
 Method(s): This was a single center, retrospective study of
consecutive patients who underwent TAVR from March 10, 2011, to October 8,
2018. This cohort sample was randomly divided into a derivation cohort
(group A) and a validation cohort (group B). A scoring system for risk
prediction of post-TAVR CIED implantation was devised using logistic
regression estimates in group A and the calibration and validation were
done in group B. Result(s): A total of 1,071 patients underwent TAVR
during the study period. After excluding pre-existing CIED, a total of 888
cases were analyzed (group A: 507 and group B: 381). Independent
predictive variables were as follows: self-expanding valve (1 point),
hypertension (1 point), pre-existing first-degree atrioventricular block
(1 point), and right bundle branch block (2 points). The resulting score
was calculated from the total points. The internal validation in group B
showed an ideal linear relationship in calibration plot (R2 =
0.933) and a good predictive accuracy (area under the curve: 0.693; 95%
confidence interval: 0.627 to 0.759). Conclusion(s): This prediction
model accurately predicts post-operative risk of CIED implantation with
simple pre-operative parameters. Copyright © 2020 American
College of Cardiology Foundation

<23>
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. 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.
 Result(s): This study will be submitted to a peer-reviewed journal
for publication. 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. Copyright © 2020 the Author(s). Published by
Wolters Kluwer Health, Inc.

<24>
[Use Link to view the full text]
Accession Number
631081435
Title
Effect of Banxia Baizhu Tianma Tang for H-type hypertension: A protocol
for a systematic review.
Source
Medicine (United States). 99 (9) (no pagination), 2020. Article Number:
e19309. Date of Publication: 2020.
Author
Chen D.; Li C.; Cai H.; Zhuang J.; Peng X.; Li S.; Huang Y.; Wang P.; Luo
Y.; Zhan Z.
Institution
(Chen, Huang, Peng, Li, Huang, Wang) Department of Critical Care Medicine,
Beijing University of Chinese Medicine Shenzhen Hospital, No. 1 Dayun Road
Longgang District, Sports New City, Shenzhen, Guangdong Province 518172,
China
(Li) Basic Medicine College of Guangzhou, University of Chinese Medicine,
China
(Cai, Zhuang) Second Clinical Medical School, Guangzhou University of
Chinese Medicine, China
(Luo, Zhan) Department of Emergency, Panyu District Central Hospital of
Guangzhou, No. 8 Fuyu East Road, Qiaonan Street Panyu District, Guangzhou,
Guangdong Province 511400, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:H-type hypertension is a kind of cardiovascular disease that
threatens human life and health seriously. Banxia Baizhu Tianma Tang
(BBTT) has been used widely for H-type hypertension while its effective
evidence is not clear. Hence, we provide a systematic review protocol to
evaluate the efficacy and safety of BBTT in the treatment of H-type
hypertension. Method(s):Nine databases including Cochrane Library,
PubMed, EMBASE, WOS, Medline, CNKI, WangFang, CBM, and VIP will be
searched from their inception to October 2019. All randomized controlled
trials (RCTs) of BBTT for H-type hypertension will be included. The
language is limited to Chinese and English. The primary outcome measure
will be the major adverse cardiac and cerebral events (MACCE). The entire
process will include study selection, data extraction, assessment of bias
risk, data synthesis. Data analysis will be performed using RevMan V.5.3.5
(The Cochrane Collaboration, Oxford, UK). Result(s):This study will
evaluate the efficacy and safety of BBTT in the treatment of H-type
hypertension from several aspects, including MACCE, blood pressure (BP),
blood lipids, inflammation indicators and homocysteine (Hcy).
 Conclusion(s):This systematic review will provide evidence for
determining whether or not BBTT is an effective and safe intervention for
H-type hypertension.PROSPERO registration number:PROSPERO CRD
42019131491. Copyright © 2020 the Author(s). Published by Wolters
Kluwer Health, Inc.

<25>
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. Design(s):
Prospective, randomized blinded study. Setting(s): Tertiary
university hospital. Participant(s): A total of 26 adults undergoing
elective coronary artery bypass graft surgery with CPB.
 Intervention(s): PC (n = 13) versus HC circuits (n = 13).
 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 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. 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. Copyright © 2019 The Authors

<26>
Accession Number
2004644782
Title
Meta-analysis Comparing Direct Oral Anticoagulants Versus Vitamin K
Antagonists After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 125 (7) (pp 1102-1107), 2020. Date of
Publication: 1 April 2020.
Author
Ueyama H.; Kuno T.; Ando T.; Briasoulis A.; Fox J.; Hayashida K.; Takagi
H.
Institution
(Ueyama, Kuno) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Beth Israel, New York, NY, United States
(Ando) Division of Cardiology, Center for Interventional Vascular Therapy,
New York-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Briasoulis) Division of Cardiology, Heart failure, and Transplantation,
University of Iowa, Iowa city, IA, United States
(Fox) Division of Cardiology, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
(Hayashida) Division of Cardiology, Keio University School of Medicine,
Tokyo, Japan
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Atrial fibrillation (AF) is a common co-morbidity in patients undergoing
transcatheter aortic valve implantation (TAVI), but whether direct oral
anticoagulants (DOACs) confer similar safety and efficacy compared with
vitamin K antagonist (VKA) remains unclear in this population. The aim of
our study was to investigate the safety and efficacy of DOACs compared
with VKA in patients undergoing TAVI with concomitant indication of oral
anticoagulation. PUBMED and EMBASE were searched through October 2019 for
studies comparing DOACs versus VKA in patients undergoing TAVI with
indication of oral anticoagulation. The main efficacy outcomes were
all-cause mortality and stroke whereas the main safety outcome was major
and/or life-threatening bleeding. Our search identified 5 eligible studies
including 2,569 patients. Majority of patients had atrial fibrillation as
indication of anticoagulation. There were no significant differences in
all-cause mortality, major and/or life-threatening bleeding, and stroke in
patients treated with DOACs versus VKA (odds ratio [OR] 1.07, 95%
confidence interval [CI] [0.73 to 1.57], p = 0.72, OR = 0.85, 95% CI [0.64
to 1.12], p = 0.24, OR 1.52, 95% CI [0.93 to 2.48], p = 0.09,
respectively). In conclusion, in patients undergoing TAVI with concomitant
indication for oral anticoagulation, all-cause mortality, major and/or
life-threatening bleeding, and stroke were similar between DOACs and VKA.
Further large scale randomized controlled trials are needed to search the
optimal oral anticoagulation regimen in this population. Copyright
© 2020 Elsevier Inc.

<27>
Accession Number
2004512568
Title
Cerebral Hyperperfusion Syndrome After Revascularization Surgery in
Patients with Moyamoya Disease: Systematic Review and Meta-Analysis.
Source
World Neurosurgery. 135 (pp 357-366.e4), 2020. Date of Publication: March
2020.
Author
Yu J.; Li J.; Zhang J.; Chen J.
Institution
(Yu, Zhang, Li, Zhang, Chen) Department of Neurosurgery, Zhongnan Hospital
of Wuhan University, Wuhan, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Cerebral hyperperfusion syndrome (CHS) after bypass surgery is
known as a complication of moyamoya disease (MMD). However, the incidence
of CHS has not been accurately reported, and there is no consensus on
related risk factors. Objective(s): To evaluate the incidence and
characteristics of CHS in patients with MMD after revascularization
surgery via meta-analysis. Method(s): Relevant cohort studies were
retrieved through a literature search of PubMed, Embase, and Ovid until
December 1, 2018. Eligible studies were identified per search criteria. A
systematic review and meta-analysis were used to assess the CHS total
incidence, incidence in pediatric patients with MMD and adult patients
with MMD, incidence for direct and combined bypass surgery, progress rate,
and proportion of each symptom (including transient neurologic deficits
[TNDs], hemorrhage, and seizure). Result(s): A total of 27 cohort
studies with 2225 patients were included in this meta-analysis. The
weighted proportions per random-effects model were 16.5% (range,
11.3%-22.3%) for CHS total incidence, 3.8% (range, 0.3%-9.6%) for
pediatric patients with MMD, 19.9% (range, 11.7%-29.4%) for adult patients
with MMD, 15.4% (range, 5.4%-28.8%) for direct bypass surgery, and 15.2%
(range, 8.4%-23.2%) for combined bypass surgery. Progress rate was 39.5%
(range, 28.7%-50.8%). The most common CHS-related symptom was TNDs (70.2%;
range, 56.3%-82.7%), followed by hemorrhage (15.0%; range, 5.5%-26.9%) and
seizure (5.3%; range, 0.6%-12.9%). Conclusion(s): CHS is a common
complication after revascularization surgery in MMD. It is more frequently
seen in adult patients. The most common CHS-related symptom was TNDs,
followed by hemorrhage and seizure. Copyright © 2019 Elsevier
Inc.

<28>
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. Design(s): A prospective, randomized, single-blind,
comparative study. Setting(s): Single-institution tertiary referral
cardiac center. Participant(s): Eighty children with acyanotic
congenital heart disease undergoing cardiac surgery through midline
sternotomy. 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. 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.
 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. Copyright © 2019 Elsevier Inc.

<29>
Accession Number
2004098669
Title
Papillary muscle intervention vs mitral ring annuloplasty in ischemic
mitral regurgitation.
Source
Journal of Cardiac Surgery. 35 (3) (pp 645-653), 2020. Date of
Publication: 01 Mar 2020.
Author
Micali L.R.; Qadrouh M.N.; Parise O.; Parise G.; Matteucci F.; de Jong M.;
Tetta C.; Moula A.I.; Johnson D.M.; Gelsomino S.
Institution
(Micali, Qadrouh, Parise, Parise, Matteucci, de Jong, Tetta, Moula,
Johnson, Gelsomino) Department of Cardiothoracic Surgery, Maastricht
University Hospital, Maastricht, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aims: The main pathophysiological factor of chronic
ischemic mitral regurgitation (MR) is the outward displacement of the
papillary muscles (PMs) leading to leaflet tethering. For this reason,
papillary muscle intervention (PMI) in combination with mitral ring
annuloplasty (MRA) has recently been introduced into clinical practice to
correct this displacement, and to reduce the recurrence of regurgitation.
 Method(s): A meta-analysis was conducted comparing the outcomes of
PMI and MRA performed in combination vs MRA performed alone, in terms of
MR recurrence and left ventricular reverse remodeling (LVRR). A
meta-regression was carried out to investigate the impact of the type of
PMI procedure on the outcomes. Result(s): MR recurrence in patients
undergoing both PMI and MRA was lower than in those who only had MRA (log
incidence rate ratio, -0.66; lower-upper limits, -1.13 to 0.20;
I2 = 0.0%; p =.44; Egger's test: intercept 0.35 [-0.78 to
1.51]; p =.42). The group with both PMI and MRA and that with only MRA
showed a slightly higher reduction in left ventricular diameters (-5.94%;
-8.75% to 3.13%,). However, in both groups, LVRR was <10%. No difference
was detected between PM relocation/repositioning and papillary muscle
approximation in terms of LVRR (p =.33). Conclusion(s): Using PMI and
MRA together has a lower MR recurrence than using MRA alone. No
significant LVRR was observed between the two groups nor between the PMI
techniques employed. Copyright © 2020 The Authors. Journal of
Cardiac Surgery published by Wiley Periodicals, Inc.

<30>
Accession Number
2004052081
Title
Baseline left ventricular diastolic dysfunction affects midterm mortality
after transcatheter aortic valve implantation.
Source
Journal of Cardiac Surgery. 35 (3) (pp 536-543), 2020. Date of
Publication: 01 Mar 2020.
Author
Takagi H.; Hari Y.; Nakashima K.; Yokoyama Y.; Ueyama H.; 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
(Yokoyama) Department of Surgery, Easton Hospital, Easton, PA, United
States
(Ueyama, 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
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To determine whether preprocedural left ventricular (LV)
diastolic dysfunction impairs midterm mortality after transcatheter aortic
valve implantation (TAVI) for patients with severe aortic stenosis (AS),
we performed a meta-analysis of currently available evidence.
 Method(s): We identified all studies investigating impact of
preprocedural severity of LV diastolic dysfunction on midterm (>=1-year)
all-cause mortality after TAVI for patients with AS through a search of
databases (MEDLINE and EMBASE) until September 2019. From each study, we
extracted an adjusted (if unavailable, unadjusted) hazard ratio (HR) of
midterm mortality. We pooled study-specific estimates in the
random-effects model. Result(s): Ten eligible studies with a total of
2380 patients with AS undergoing TAVI were identified. In accordance with
pooled analyses, higher-grade preprocedural LV diastolic dysfunction was
associated with significantly worse midterm all-cause mortality after TAVI
compared to lower-grade dysfunction (HR for grade II vs I, 1.15; P =.002;
HR for grade III vs I, 1.35; P =.001; HR for grade III vs II; 1.16, P
=.002; HR for grade II-III vs I, II-III vs 0-I, or III vs I-II, 1.34; P
<.00001 [primary meta-analysis]; HR per grade, 1.16; P =.003). No funnel
plot asymmetry for the primary meta-analysis (for grade II-III vs I,
II-III vs 0-I, or III vs I-II) was identified, which probably indicated no
publication bias (P =.381 by the linear-regression test).
 Conclusion(s): Higher-grade preprocedural LV diastolic dysfunction
was associated with worse midterm all-cause mortality after TAVI for
patients with AS compared to lower-grade dysfunction. Copyright ©
2019 Wiley Periodicals, Inc.

<31>
Accession Number
2003909432
Title
Liraglutide for perioperative management of hyperglycaemia in cardiac
surgery patients: a multicentre randomized superiority trial.
Source
Diabetes, Obesity and Metabolism. 22 (4) (pp 557-565), 2020. Date of
Publication: 01 Apr 2020.
Author
Hulst A.H.; Visscher M.J.; Godfried M.B.; Thiel B.; Gerritse B.M.; Scohy
T.V.; Bouwman R.A.; Willemsen M.G.A.; Hollmann M.W.; Preckel B.; DeVries
J.H.; Hermanides J.
Institution
(Hulst, Visscher, Hollmann, Preckel, Hermanides) Department of
Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam,
Netherlands
(Hulst, Godfried, Thiel) Department of Anesthesiology, OLVG, Amsterdam,
Netherlands
(Hulst, Gerritse, Scohy) Department of Anesthesiology, Amphia Hospital,
Breda, Netherlands
(Bouwman, Willemsen) Department of Anesthesiology, Catharina Hospitals,
Eindhoven, Netherlands
(DeVries) Department of Endocrinology, Amsterdam UMC, University of
Amsterdam, Amsterdam, Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
Aims: Most cardiac surgery patients, with or without diabetes, develop
perioperative hyperglycaemia, for which intravenous insulin is the only
therapeutic option. This is labour-intensive and carries a risk of
hypoglycaemia. We hypothesized that preoperative administration of the
glucagon-like peptide-1 receptor agonist liraglutide reduces the number of
patients requiring insulin for glycaemic control during cardiac surgery.
 Material(s) and Method(s): In this randomized, blinded,
placebo-controlled, parallel-group, balanced (1:1), multicentre
randomized, superiority trial, adult patients undergoing cardiac surgery
in four Dutch tertiary hospitals were randomized to receive 0.6 mg
subcutaneous liraglutide on the evening before surgery and 1.2 mg after
induction of anaesthesia or matching placebo. Blood glucose was measured
hourly and controlled using an insulin-bolus algorithm. The primary
outcome was insulin administration for blood glucose >8.0 mmol/L in the
operating theatre. Research pharmacists used centralized, stratified,
variable-block, randomization software. Patients, care providers and study
personnel were blinded to treatment allocation. Result(s): Between
June 2017 and August 2018, 278 patients were randomized to liraglutide
(139) or placebo (139). All patients receiving at least one study drug
injection were included in the intention-to-treat analyses (129 in the
liraglutide group, 132 in the placebo group). In the liraglutide group, 55
(43%) patients required additional insulin compared with 80 (61%) in the
placebo group and absolute difference 18% (95% confidence interval
5.9-30.0, P = 0.003). Dose and number of insulin injections and mean blood
glucose were all significantly lower in the liraglutide group. We observed
no difference in the incidence of hypoglycaemia, nausea and vomiting,
mortality or postoperative complications. Conclusion(s): Preoperative
liraglutide, compared with placebo, reduces insulin requirements while
improving perioperative glycaemic control during cardiac
surgery. Copyright © 2019 The Authors. Diabetes, Obesity and
Metabolism published by John Wiley & Sons Ltd.

<32>
Accession Number
631112627
Title
Simulation of TAVI in patient-specific testing inserts at physiologic flow
conditions.
Source
Thoracic and Cardiovascular Surgeon. Conference: 49th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery. Germany. 68
(Supplement 1) (no pagination), 2020. Date of Publication: January 2020.
Author
Konig F.; Kramer A.; Grab M.; Mehilli J.; Hagl C.; Thierfelder N.
Institution
(Konig, Mehilli, Hagl, Thierfelder) MunichGermany
(Kramer, Grab) Garching bei MunchenGermany
Publisher
Georg Thieme Verlag
Abstract
Objectives: Transcatheter aortic valve implantation (TAVI) evolved to be
the standard treatment in high-risk patients with aortic stenosis. The
prosthesis landing zone, characterized by the anatomy of the aortic root
and the calcifications of the aortic valve, is associated to the
prevalence of complications during TAVI. This study aims to develop a
process that allows the simulation of TAVI in patient-specific anatomies.
 Method(s): A total of 100 computed tomography (CT) datasets of
patients who underwent a TAVI in our clinic have been randomly selected,
rendered anonymous and were digitally analyzed (3-Mensio) as follows.
Classifications of the total aortic root calcium as well as calcium
distribution on the aortic leaflets were conducted. Findings were
correlated to the occurrence of complications (e.g., paravalvular leaks
and atrioventricular blocks). Based on these results, specific anatomies
were selected for 3D printing. 3D models of the aortic valve and the
aortic valve calcium were generated based on the CT data. A commercial
polymer printer was used to produce flexible aortic roots. These were used
for in vitro simulations of TAVI procedures in a newly developed pulsatile
flow system under physiologic conditions. Result(s): The evaluation
of the CT datasets allowed a classification of the patients based on
calcification volume and distribution. We were further able to create
anatomical models of a representative of each group based on the patients'
CT data. These models were successfully printed and inserted into our
testing device to simulate the TAVI procedure under physiologic flow and
pressure conditions. We were finally able to correlate the simulation data
to the original outcome. Conclusion(s): In this study, we
successfully analyzed and correlated CT scans to TAVI-related
complications. Based on these results a set of 3D-printed aortic roots
were manufactured for in vitro testing. TAVI prosthesis evaluation under
pulsatile flow conditions was possible and enabled good insights in
patho-mechanical causes of TAVI-related complications. The similar
behavior of our simulation compared to the actual outcome of the procedure
validates our process. The potential of this process, including simulation
of patient-specific TAVI in complex cases with different implants, will
have to be proven with additional experiments.

<33>
Accession Number
631112574
Title
Remote ischemic preconditioning in elective cardiac surgery: Long-term
overall survival benefit in a single-center randomized double-blinded
controlled trial.
Source
Thoracic and Cardiovascular Surgeon. Conference: 49th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery. Germany. 68
(Supplement 1) (no pagination), 2020. Date of Publication: January 2020.
Author
Thielmann M.; Vaghiri S.; Dirkmann D.; Neuhauser M.; Peters J.; Heusch G.;
Jakob H.; Ruhparwar A.; Kamler M.; Kleinbongard P.
Institution
(Thielmann, Vaghiri, Dirkmann, Neuhauser, Peters, Heusch, Jakob,
Ruhparwar, Kamler, Kleinbongard) EssenGermany
Publisher
Georg Thieme Verlag
Abstract
Objectives: Remote ischemic preconditioning (RIPC) by repeated brief
cycles of limb ischemia/reperfusion can reduce myocardial injury and
improve patients' prognosis following cardiac surgery in proof-of-concept
and smaller randomized controlled trials (RCT), while two recent large
Phase III RCTs were neutral for troponin release and outcome after 90 days
and 1 year. Method(s): Between April 2008 and August 2018, a total of
1,204 patients scheduled for elective cardiac surgery with the use of
isoflurane anesthesia, cardiopulmonary bypass, and crystalloid
cardioplegic arrest were allocated to receive either RIPC (n = 607; three
cycles of 5-min transient left upper arm ischemia with 5-min reperfusion
after induction of anesthesia) or served as controls (n = 597).
 Result(s): Patient characteristics and intraoperative data did not
differ between the two groups. The primary short-term endpoint was
myocardial injury following surgery as reflected by the perioperative
cardiac troponin (cTn) serum concentration over 72 hours and its area
under the curve (AUC). The mean troponin AUC profiles in the RIPC group
were lower (geometric mean [confidence interval, CI]: 137.97 [122.26;
155.71] for controls vs. 131.60 [116.55; 148.60] for RIPC group; ratio
[CI] 0.95 [0.80; 1.13], but did not reach statistical significance,
neither in the intention-to-treat (ITT; p = 0.589) nor in the per-protocol
(PP) analysis (p = 0.482). The primary long-term endpoint was all-cause
mortality, and the secondary endpoint was the rate of major adverse
cardiac and cerebrovascular events (MACCE). In the ITT analysis, there
were 111 deaths in the control group and 85 in the RIPC group (p = 0.031),
but 80 deaths in the control group versus 71 in the RIPC group in the PP
analysis (p = 0.252) over a total follow-up of 4.0 +/- 2.5 years. The
Kaplan-Meier overall survival in the ITT analysis was superior with RIPC
(p = 0.024), but did not reach statistical significance in the PP analysis
(p = 0.234), whereas MACCE rate was superior with RIPC in the ITT (p =
0.040) as well as in the PP analysis (p = 0.045). Conclusion(s): Our
extended RCT confirms that RIPC provides no significant difference in
perioperative cardiac troponin AUC profiles, but demonstrates a continued
robust prognostic benefit with superior survival and MACCE rate in
patients undergoing elective cardiac surgery with isoflurane anesthesia,
cardiopulmonary bypass, and crystalloid cardioplegic arrest.

<34>
Accession Number
631112567
Title
Negative pressure therapy after median sternotomy on closed incision: A
randomized controlled study.
Source
Thoracic and Cardiovascular Surgeon. Conference: 49th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery. Germany. 68
(Supplement 1) (no pagination), 2020. Date of Publication: January 2020.
Author
Darwisch A.; Fajfrova Z.
Institution
(Darwisch, Fajfrova) DresdenGermany
Publisher
Georg Thieme Verlag
Abstract
Objectives: Surgical site infections (SSIs) are serious complications
after cardiothoracic surgery and contribute significantly to postoperative
morbidity, mortality, and healthcare costs. Negative pressure wound
therapy (NPWT), in this case PICO dressing, is a concept introduced
initially to assist in the treatment of chronic open wounds. Recently,
there has been growing interest in using the technique on closed incisions
after surgery to prevent potentially severe surgical site infections and
other wound complications, but has not yet been rigorously tested in a
randomized controlled trial. The purpose of this study was to evaluate
NPWT as a prevention and therapy of superficial infection. Method(s):
In this single-center, superiority designed prospective randomized
controlled trial, patients after cardiac surgery performed via median
sternotomy (n = 528) were after stratification according to the marker
body mass index (BMI >=35 yes/no) randomized to receive either a
disposable PICO dressing (PD) (Smith & Nephew, the Netherlands) (n =
56/193) or a standard dry dressing (SDD) (n = 66/213) over the incision
immediately at the conclusion of surgery. We have examined the development
of infection depending on the type of dressing. The primary end point was
SSIs within 30 days. Result(s): The study showed no significant
difference in the number of infections after operation in patients with
BMI >=35 (p = 0.622). In patients with BMI <35, there was no significant
difference in the number of infections after operation (PD/SDD 20.8%/16%;
p = 0.2926), but there was significant difference in the progress of the
infection. In the PD group, 57.7% of infections remained superficial and
42.3% emerged a deep infection. Compared with SDD group, 32.5% of
infections remained superficial and 67.5% emerged a deep infection (p =
0.0432). Conclusion(s): These results suggest that the use of PD
compared with SDD did not improve the rate of SSIs in 30 days, but PD
treatment reduced the rate of deep type of SSIs; so, there is a shift
toward more superficial and thus less feared and also less costly SSIs. It
should be a standard to use the PD in patients with BMI <35 suffering from
superficial infection in the surgical wound after median sternotomy.

<35>
Accession Number
631112518
Title
External stenting of saphenous vein grafts in coronary artery bypass
grafting: Two-year angiographic and intravascular ultrasound follow-up
from a single-center randomized cohort.
Source
Thoracic and Cardiovascular Surgeon. Conference: 49th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery. Germany. 68
(Supplement 1) (no pagination), 2020. Date of Publication: January 2020.
Author
Paraforos A.; Donovan J.; Donovan D.; Kraiker P.; Friedrich I.
Institution
(Paraforos, Donovan, Donovan, Kraiker, Friedrich) TrierGermany
Publisher
Georg Thieme Verlag
Abstract
Objectives: Degeneration of saphenous vein grafts (SVG) continues to be an
Achilles' heel of bypass surgery. High wall tension and in the arterial
circulation coupled with high and turbulent flow profiles trigger
pathological remodeling of the bypass vessel and intimal hyperplasia which
leads to SVG failure. External stenting was shown to reduce intimal
hyperplasia, improve lumen uniformity SVG flow pattern 1 year after CABG.
Our objective was to evaluate the effect of external stenting on SVG
disease 2 years after CABG. Method(s): Thirty-five patients were
enrolled in our center as part of the VEST III multicenter randomized
trial (n = 184). In addition to an internal mammary artery graft, each
patient received one external stent to a single SVG, randomized to either
the right or left coronary territories, while one or more non-stented SVG
served as control(s). Graft patency was confirmed at 6 months using CT
angiography. At 2 years, angiography and intravascular ultrasound (IVUS)
were performed to assess graft patency, Fitzgibbon classification for
lumen irregularities and intimal hyperplasia (area + thickness). All
angiographic and IVUS analysis were performed by independent core-lab
(Mount Sinai, New York). Result(s): Clinical follow-up for MACCE was
completed for 33 patients (94%) and angiographic follow up was completed
for 26 patients (76%). Two patients died during 24-month follow-up, 5
patients refused control angiography, and 2 patients were contraindicated
due to impaired kidney function. At 2 years, event-free survival was 85.8%
with 2.8% of patients having perioperative MI and 2.8% target vessel
re-revascularizations. Patency rates at 6 months were 100, 100, and 97% in
the LIMA-LAD grafts, externally stented SVG, and nonstented SVG,
respectively. At 2 years, all SVGs were patent. 88, 12, and 0% of stented
SVG were classified as Fitzgibbon I, II, and III, respectively, compared
to 73, 19, and 8% of SVG. Intimal hyperplasia area was 2.53 mm2
in the stented SVG and 3.18 mm2 in nonstented SVG (p < 0.01).
Intimal thickness was reduced by 24% (p < 0.001) in the stented SVG.
 Conclusion(s): External stenting of vein grafts is safe and effective
in mitigating SVG disease progression 2 years after CABG by significantly
reducing intimal hyperplasia and improving perfect patency rates
(Fitzgibbon I). Further studies will show whether clinical endpoints are
improved by reducing graft degeneration.

<36>
Accession Number
631112511
Title
Complete versus incomplete revascularization and influence of
postoperative antiplatelet therapy in coronary artery bypass grafting:
Results from the ticab study.
Source
Thoracic and Cardiovascular Surgeon. Conference: 49th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery. Germany. 68
(Supplement 1) (no pagination), 2020. Date of Publication: January 2020.
Author
Schafer A.; Conradi L.; Schneeberger Y.; Sill B.; Reichenspurner H.;
Kastrati A.; Von Scheidt M.; Schunkert H.
Institution
(Schafer, Conradi, Schneeberger, Sill, Reichenspurner) HamburgGermany
(Kastrati, Von Scheidt, Schunkert) MunichGermany
Publisher
Georg Thieme Verlag
Abstract
Objectives: The recently published results of the TiCAB trial showed no
significant differences of outcomes, regarding major cardiovascular events
or bleeding, in patients receiving aspirin or ticagrelor adjunctive to
coronary artery bypass grafting (CABG). We herein aimed to analyze
subgroups of patients who received complete (CR) or incomplete
revascularization (ICR) during CABG and determine possible impact of the
different antiplatelet therapies. Method(s): In this randomized
controlled trial (RCT), 1,859 patients were enrolled between April 2013
and April 2017 and randomly assigned to aspirin or ticagrelor therapy
adjunctive to CABG. Of these, 1,550 patients (83.4%; 14.9% female, age
60-75 years: 60.8%) received CR and 309 patients (16.6%; 15.9% female, age
60-75: 57.9%) received ICR. Outcomes were evaluated based on the primary
outcomes of cardiovascular death, myocardial infarction (MI), repeat
revascularization, PTCA, and stroke 12 months after CABG. Result(s):
Baseline parameters revealed significant differences regarding clinical
presentation (stable angina pectoris [AP]: CR 68.9 vs. ICR 71.2%, instable
AP: 14.1 vs. 7.8%, NSTEMI: 17.0 vs. 21.0%, p = 0.005), lesion
characteristics (chronic total occlusion [CTO]: CR 91.3 vs. ICR 96.8%, p =
0.001), operative technique (off-pump coronary artery bypass grafting
[OPCAB]: CR 3.0 vs. ICR 6.1%, p = 0.005) and number of utilized grafts
(venous grafts: CR 1.02/patient vs. ICR 0.86/patient, p = 0.01; total
number of grafts: 2.69/patient vs. 2.49/patient, p = 0.0002). Patients
with ICR presented with significantly higher rates of PTCA (CR: 3.3% vs.
ICR: 6.3%, p = 0.02) and repeat revascularization (CR: 3.9% vs. ICR: 7.3%,
0.01) up to 12 months after the index procedure. No significant
differences were found regarding stroke, MI, cardiovascular death, or
BARC-adjudicated clinical endpoints. Also, no differences were found
between subgroups receiving aspirin or ticagrelor. Conclusion(s): In
this large RCT, patients who received ICR for coronary vessel disease were
significantly more frequently exposed to repeat revascularization or PTCA
up to 12 months following the index procedure. Patients who were
incompletely revascularized presented more stable at the time of admission
and received less grafts, highly likely due to the presence of
significantly more CTO of coronary arteries and were significantly more
often provided with OPCAB. Although mortality presented no differences
between groups, our results suggest that patients benefit from CR with
regards to prevention of re-revascularization. Therefore, concept of CR
should be taken into consideration even if CTO or challenging operative
circumstances are present.

<37>
Accession Number
631112501
Title
Ten year survival after coronary artery bypass grafting versus
percutaneous coronary intervention: The syntax extended survival
(SYNTAXES) study.
Source
Thoracic and Cardiovascular Surgeon. Conference: 49th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery. Germany. 68
(Supplement 1) (no pagination), 2020. Date of Publication: January 2020.
Author
Noack T.; Thuijs D.; Kappetein P.; Serruys P.; Mohr F.W.; Morice M.C.;
Mack M.; Holmes D.; Davierwala P.; Head S.
Institution
(Noack, Mohr, Davierwala) LeipzigGermany
(Thuijs, Kappetein, Head) RotterdamNetherlands
(Serruys) LondonUnited Kingdom
(Morice) ParisFrance
(Mack) DallasUnited States
(Holmes) RochesterUnited States
Publisher
Georg Thieme Verlag
Abstract
Objectives: Ten-year survival outcomes from contemporaneous randomized
trials comparing percutaneous coronary intervention (PCI) with drug
eluting stents and coronary artery bypass grafting (CABG) in patients with
de novo three vessel (3VD) or left main coronary artery disease (LMCAD)
have not been reported. Method(s): The randomized synergy between PCI
with TAXUS and cardiac surgery (SYNTAX) trial reported comparable survival
rates between PCI with paclitaxel-eluting stents and CABG at 5 years.
Therefore, the SYNTAX extended survival study (SYNTAXES) aims to determine
10-year survival in the SYNTAX randomized patients (n = 1,800; CABG = 897,
PCI = 903). Follow-up was performed in accordance with local law and
regulations of each of the currently 76-participating institutions.
Cumulative time-to-death is estimated by Kaplan-Meier analysis and
compared with log-rank tests. Hazard ratios (HR) with 95% confidence
intervals (CI), of CABG versus PCI, are established by Cox's proportional
hazard models. Prespecified subgroup analyses of CABG versus PCI are
performed in cohorts of patients with three vessel disease, left main
disease, in patients with and without medically treated diabetes and
according to SYNTAX scores. Result(s): From March, 2005, to April,
2007, 1,800 patients were randomly assigned to the PCI (n = 903) or CABG
(n = 897) group. Vital status information at 10 years was complete for 841
(93%) patients in the PCI group and 848 (95%) patients in the CABG group.
At 10 years, 244 (27%) patients had died after PCI and 211 (24%) after
CABG (HR = 1.17 [95% CI: 0.97-1.41], p = 0.092). Among patients with
three-vessel disease, 151 (28%) of 546 had died after PCI versus 113 (21%)
of 549 after CABG (HR = 1.41 [95% CI: 1.10-1.80]), and among patients with
left main coronary artery disease, 93 (26%) of 357 had died after PCI
versus 98 (28%) of 348 after CABG (0.90 [0.68-1.20], p for interaction =
0.019). There was no treatment-by-subgroup interaction with diabetes (p
for interaction = 0.66) and no linear trend across SYNTAX score tertiles
(p = 0.30). Conclusion(s): At 10 years, no significant difference
existed in all-cause death between PCI using first-generation
paclitaxeleluting stents and CABG. However, CABG provided a significant
survival benefit in patients with three-vessel disease, but not in
patients with left main coronary artery disease.

<38>
Accession Number
631112422
Title
Long-term durability and valve integrity of aortic valve bioprostheses:
Single-center experience with patients under 50 years of age.
Source
Thoracic and Cardiovascular Surgeon. Conference: 49th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery. Germany. 68
(Supplement 1) (no pagination), 2020. Date of Publication: January 2020.
Author
Polat E.; Muller C.; Sinani L.; Neumann-Schniedewind P.; Peterss S.;
Juchem G.; Pichlmaier M.; Hagl C.
Institution
(Polat, Muller, Sinani, Neumann-Schniedewind, Peterss, Juchem, Pichlmaier,
Hagl) MunichGermany
Publisher
Georg Thieme Verlag
Abstract
Objectives: There is no consensus for the lower age limit of bioprosthesis
in aortic position for surgical aortic valve replacement (SAVR) and
current available long-term data is insufficient. The objective of this
retrospective analysis is to add clinical echocardiographic evidence and
provide decision guidance for the choice of an age-appropriate prosthesis
in patients younger than 50 years. Method(s): From January 2000 to
December 2017, a total of 3,519 patients underwent isolated SAVR with a
biological prosthesis at our institution. A total of 120 patients younger
than 50 years at the time of surgery were identified, of whom 95 patients
contributed follow-up data. Data were retrospectively analyzed, including
clinical and echocardiographic assessment. Mean follow-up was 8 +/- 4.4
years with a maximum of 19 years and a total of 677 valve years.
 Result(s): Mean age at the time of surgery was 41 +/- 8.6 years.
Eighty-three percent of patients were male. There was no perioperative
mortality. Mean diameter of implanted bioprostheses was 25 +/- 2.1 mm. Six
patients died during follow-up (6.3%). Structural valve deterioration
(SVD) occurred in 22 patients (23.2%), followed by redo surgical aortic
valve replacement with a bioprosthesis in 11 patients, mechanical
prosthesis in 8 patients, and transcatheter valve-in-valve implantations
in 3 patients, respectively. Other major adverse cardiac events including
endocarditis and thromboembolic events were seen in 16.3% of patients.
 Conclusion(s): In the present cohort of patients < 50 years of age,
new-generation bioprostheses provide satisfying results for bleeding and
thromboembolic events, hemodynamic performance, and SVD. The inherent need
for repeat valve intervention in young adults remains the major drawback
for bioprostheses. Further large-number studies and randomized long-term
outcome in younger cohorts are mandatory to substantiate whether this
practice is justified.

<39>
Accession Number
631112418
Title
Randomized controlled trial: Use of hydrocolloid silver-containing wound
dressing after sternotomy to reduce wound complications after cardiac
surgery.
Source
Thoracic and Cardiovascular Surgeon. Conference: 49th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery. Germany. 68
(Supplement 1) (no pagination), 2020. Date of Publication: January 2020.
Author
Dohle K.; Chaban R.; Oberhoffer M.; Dohle D.S.; Vahl C.F.
Institution
(Dohle, Chaban, Oberhoffer, Dohle, Vahl) MainzGermany
Publisher
Georg Thieme Verlag
Abstract
Objectives: Surgical site infections (SSIs) are a serious complication
after cardiac surgery. New wound dressing techniques could reduce the
incidence of SSIs. This prospective randomized industry-independent
clinical trial investigates the influence of a hydrocolloid
silver-containing wound dressing (AQUACEL Ag Surgical, HD) on the
incidence of SSIs compared to the standard procedure. Method(s): A
total of 423 elective CABG patients operated between January 2018 and July
2019 were randomized into conventional and HD wound management groups.
According to our study protocol, 73 randomized patients were excluded
(ventilation > 48 hours, n = 29; rethoracotomy, n = 10; HD not received, n
= 10; no IMA, n = 8; no OP, n = 6; mortality, n = 5; immunosuppression
drugs, n = 3; no CABG, n = 2). 350 patients (mean age 68 +/- 9.4, 80%
male) were randomized into control (n = 173) and study group (n = 177) and
treated according to the study protocol. The HD was applied
intraoperatively and remained five days. In the control group regular
wound dressing was applied intraoperatively and changed the first time
after 48 hours. After the fifth postoperative day, wounds in both groups
remained without further dressings. Wounds were monitored daily until the
7th and on the 30th postoperative days. SSIs were classified into three
categories (superficial, deep, and organ SSI) according to severity and
need for treatment. Result(s): No differences in demographics,
cardiovascular risk factors, intraoperative process and postoperative care
were found between both groups. The total SSI rate was 9.14% with 14
patients (8.1%) in the control and 18 patients (10.2%) in the study group
(p = 0.5). The extent of SSIs in control and study group according to
superficial (2.3 vs. 3.4%), deep (4.1 vs. 5.1%), and organ SSI (1.7 vs.
1.7%) showed no significant differences (p = 0.895). Twenty-five patients
required surgical wound revision (6.4 vs. 7.9%; p = 0.573) 23.8 +/- 12.9
days after primary surgery. Sixteen patients required VAC therapy and
secondary closure (4.6 vs. 4.5%; p = 0.52). Conclusion(s): No
difference was found in the incidence or extent of wound healing disorder.
The type of dressing therefore does not seem to have any influence on
wound healing. Known patient-specific and intraoperative factors seem to
play a significantly greater role in the development of wound healing
disorders and should therefore be consistently considered.

<40>
Accession Number
631130951
Title
Mortality after drug-eluting stents vs. coronary artery bypass grafting
for left main coronary artery disease: a meta-analysis of randomized
controlled trials.
Source
European heart journal. (no pagination), 2020. Date of Publication: 02 Mar
2020.
Author
Ahmad Y.; Howard J.P.; Arnold A.D.; Cook C.M.; Prasad M.; Ali Z.A.; Parikh
M.A.; Kosmidou I.; Francis D.P.; Moses J.W.; Leon M.B.; Kirtane A.J.;
Stone G.W.; Karmpaliotis D.
Institution
(Ahmad, Prasad, Ali, Parikh, Kosmidou, Moses, Leon, Kirtane, Karmpaliotis)
Center for Interventional Vascular Therapy, Columbia University Medical
Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, NY, NY
10032, United States
(Ahmad, Howard, Arnold, Cook, Francis) National Heart and Lung Institute,
Imperial College London, Du Cane Road, London W12 0HS, United Kingdom
(Ali, Kosmidou, Moses, Leon, Kirtane, Stone) The Cardiovascular Research
Foundation, 1700 Broadway, New York, NY 10019, USA
(Stone) Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital1190
Fifth Avenue, NY, NY 10029, United States
Publisher
NLM (Medline)
Abstract
AIMS : The optimal method of revascularization for patients with left main
coronary artery disease (LMCAD) is controversial. Coronary artery bypass
graft surgery (CABG) has traditionally been considered the gold standard
therapy, and recent randomized trials comparing CABG with percutaneous
coronary intervention (PCI) with drug-eluting stents (DES) have reported
conflicting outcomes. We, therefore, performed a systematic review and
updated meta-analysis comparing CABG to PCI with DES for the treatment of
LMCAD. METHODS AND RESULTS : We systematically identified all randomized
trials comparing PCI with DES vs. CABG in patients with LMCAD. The primary
efficacy endpoint was all-cause mortality. Secondary endpoints included
cardiac death, myocardial infarction (MI), stroke, and unplanned
revascularization. All analyses were by intention-to-treat. There were
five eligible trials in which 4612 patients were randomized. The weighted
mean follow-up duration was 67.1months. There were no significant
differences between PCI and CABG for the risk of all-cause mortality
[relative risk (RR) 1.03, 95% confidence interval (CI) 0.81-1.32; P=0.779]
or cardiac death (RR 1.03, 95% CI 0.79-1.34; P=0.817). There were also no
significant differences in the risk of stroke (RR 0.74, 95% CI 0.35-1.50;
P=0.400) or MI (RR 1.22, 95% CI 0.96-1.56; P=0.110). Percutaneous coronary
intervention was associated with an increased risk of unplanned
revascularization (RR 1.73, 95% CI 1.49-2.02; P<0.001). CONCLUSION : The
totality of randomized clinical trial evidence demonstrated similar
long-term mortality after PCI with DES compared with CABG in patients with
LMCAD. Nor were there significant differences in cardiac death, stroke, or
MI between PCI and CABG. Unplanned revascularization procedures were less
common after CABG compared with PCI. These findings may inform clinical
decision-making between cardiologists, surgeons, and patients with
LMCAD. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<41>
Accession Number
631111371
Title
Effect and safety of 4% albumin in the treatment of cardiac surgery
patients: study protocol for the randomized, double-blind, clinical ALBICS
(ALBumin In Cardiac Surgery) trial.
Source
Trials. 21 (1) (pp 235), 2020. Date of Publication: 28 Feb 2020.
Author
Vlasov H.; Juvonen T.; Hiippala S.; Suojaranta R.; Peltonen M.; Schramko
A.; Arvonen K.; Salminen U.-S.; Kleine Budde I.; Eranen T.; Mazanikov M.;
Meinberg M.; Vahasilta T.; Wilkman E.; Pettila V.; Pesonen E.
Institution
(Vlasov, Hiippala, Schramko, Arvonen, Mazanikov, Meinberg, Wilkman,
Pettila, Pesonen) Department of Anesthesiology and Intensive Care and Pain
Medicine, University of Helsinki and Helsinki University Hospital,
Helsinki, Finland
(Juvonen, Suojaranta, Salminen, Vahasilta) Department of Cardiac Surgery,
Heart and Lung Center, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Peltonen) National Institute for Health and Welfare, Helsinki, Finland
(Kleine Budde) Department of Clinical Operations, Sanquin Plasma Products
B.V., Amsterdam, Netherlands
(Eranen) HUS Pharmacy, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
Publisher
NLM (Medline)
Abstract
BACKGROUND: In cardiac surgery with cardiopulmonary bypass (CPB), large
amounts of fluids are administered. CPB priming with crystalloid solution
causes marked hemodilution and fluid extravasation. Colloid solutions may
reduce fluid overload because they have a better volume expansion effect
than crystalloids. The European Medicines Agency does not recommend the
use of hydroxyethyl starch solutions (HES) due to harmful renal effects.
Albumin solution does not impair blood coagulation but the findings on
kidney function are conflicting. On the other hand, albumin may reduce
endothelial glycocalyx destruction and decrease platelet count during CPB.
No large randomized, double-blind, clinical trials have compared albumin
solution to crystalloid solution in cardiac surgery. METHODS/DESIGN: In
this single-center, double-blind, randomized controlled trial comprising
1386 adult cardiac surgery patients, 4% albumin solution will be compared
to Ringer's acetate solution in CPB priming and volume replacement up to
3200mL during surgery and the first 24h of intensive care unit stay. The
primary efficacy outcome is the number of patients with at least one major
adverse event (MAE) during 90 postoperative days (all-cause death, acute
myocardial injury, acute heart failure or low output syndrome,
resternotomy, stroke, major arrhythmia, major bleeding, infection
compromising post-procedural rehabilitation, acute kidney injury).
Secondary outcomes are total number of MAEs, incidence of major adverse
cardiac events (MACE; cardiac death, acute myocardial injury, acute heart
failure, arrhythmia), amount of each type of blood product transfused (red
blood cells, fresh frozen plasma, platelets), total fluid balance at the
end of the intervention period, total measured blood loss, development of
acute kidney injury, days alive without mechanical ventilation in 90days,
days alive outside intensive care unit at 90days, days alive at home at
90days, and 90-day mortality. DISCUSSION: The findings of this study will
provide new evidence regarding efficacy and safety of albumin solution in
adult patients undergoing cardiac surgery with CPB. TRIAL REGISTRATION:
EudraCT (clinicaltrialsregister.eu) 2015-002556-27 Registered 11 Nov 2016
and ClinicalTrials.gov NCT02560519. Registered 25 Sept 2015.

<42>
[Use Link to view the full text]
Accession Number
631132394
Title
A systematic review and meta-analysis of the effects of early mobilization
therapy in patients after cardiac surgery: A protocol for systematic
review.
Source
Medicine (United States). 99 (4) (no pagination), 2020. Article Number:
e18843. Date of Publication: 2020.
Author
Chen B.; You X.; Lin Y.; Dong D.; Xie X.; Zheng X.; Li D.; Lin W.
Institution
(Chen, You, Lin, Dong, Xie, Zheng, Li, Lin) Department of Rehabilitation,
Affiliated People's Hospital, Fujian University of Traditional Chinese
Medicine, No 602, 817 Middle Road, Fuzhou, Fujian Province 350004, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Prolonged hospitalization and immobility of critical care
patients elevates the risk of long-term physical and cognitive
impairments. However, the therapeutic effects of early mobilization have
been difficult to interpret due to variations in study populations,
interventions, and outcome measures. This systematic review and
meta-analysis aims to assess the effects of early mobilization therapy for
non-emergency cardiac surgery patients in the intensive care unit (ICU).
 Method(s):The following databases will be used to search for relevant
keywords: PubMed, Embase, CINAHL, PEDro, and the Cochrane Library from
inception to September 2018 by 2 researchers independently. Randomized
controlled trials (RCTs), will be included if patients are adults (>=18
years) admitted to any ICU for cardiac surgery due to cardiovascular
disease and who are treated with experimental physiotherapy initiated in
the ICU (pre, post, or perioperative). The Review Manager 5.3 will be used
for meta-analysis and the evidence level will be assessed by using the
method for Grading of Recommendations Assessment, Development, and
Evaluation (GRADE). Continuous outcomes will be presented as the weighted
mean difference (WMD) or standardized mean difference (SMD) with 95%
confidence interval (CI), while dichotomous data will be expressed as
relative risk (RR) with 95% CI. If the included studies have existing
heterogeneity (P < 0.1), a random-effects model will be used. Otherwise,
we will calculate using a fixed effects model. Result(s):This review
will evaluate the effects of early mobilization on length of ICU and
hospital stay, physical function and adverse events in patients with
cardiac surgery patients in the ICU. Conclusion(s):This systematic
review will comprehensively provide conclusive evidence of the therapeutic
effect of early mobilization on cardiac surgery patients in the
ICU.PROSPERO Research registration identifying number:
CRD42019135338. Copyright © 2020 the Author(s). Published by
Wolters Kluwer Health, Inc.

<43>
Accession Number
2005124894
Title
The efficacy and adverse effects of the Uniblocker and left-side
double-lumen tube for one-lung ventilation under the guidance of chest CT.
Source
Experimental and Therapeutic Medicine. 19 (4) (pp 2751-2756), 2020. Date
of Publication: 2020.
Author
Liu Z.; Zhao L.; Zhu Y.; Bao L.; Jia Q.-Q.; Yang X.-C.; Liang S.-J.
Institution
(Liu, Zhu, Bao, Jia, Yang, Liang) Department of Anesthesiology, Hebei
066000, China
(Zhao) Department of Thoracic Surgery, First Hospital of Qinhuangdao,
Qinhuangdao, Hebei 066000, China
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
One-lung ventilation (OLV) is essential in numerous clinical procedures,
in which the left-sided double-lumen tube (LDLT) is the most commonly used
device. The application of bronchial blockers, including the Uniblocker or
Arndt blocker, has increased in OLV. The present study aimed to compare
the efficacy and adverse effects of the Uniblocker and LDLT for OLV under
the guidance of chest CT. A total of 60 adult patients undergoing elective
left-side thoracic surgery requiring OLV were included in the study. The
patients were randomly assigned to the Uniblocker group (U group, n=30) or
the LDLT group (D group, n=30). The time for initial tube placement, the
number of optimal positions of the tube upon blind insertion, the number
of attempts to adjust the tube to the optimal position, incidence of
airway device displacement, injury to the bronchi and carina, the duration
until lung collapse and the occurrence of sore throat and hoarseness over
24 h following surgery were recorded. The time for successful placement of
the LDLT was 83.9+/-19.4 sec and that for the Uniblocker was 84.3+/-17.1
sec (P>0.05). The degree of lung collapse 1 min following opening of the
pleura was greater in the D group than that in the U group (P<0.01) and
the time required for the lung to completely collapse was shorter in the D
group (3.3+/-0.5 min) than that in the U group (8.4+/-1.2 min; P<0.01). On
the contrary, the incidence of injury to the bronchi and carina was lower
in the U group (2/30 cases) than in the D group (10/30 cases; P=0.02); the
incidence of sore throat was also lower in the U group (2/30 cases)
compared with that in the D group (9/30 cases). The mean arterial pressure
of patients immediately following intubation was lower in the U group
(122.0+/-13.4 mmHg) than that in the D group (129.2+/-12.1 mmHg; P<0.05).
The results of the present study indicated that the extraluminal use of
the Uniblocker under guidance of chest CT is an efficient method with few
adverse effects in left-side thoracic surgery. The study was registered at
ClinicalTrials.gov on 16th December 2017 (no. NCT03392922). Copyright
© 2020 Spandidos Publications. All rights reserved.

<44>
Accession Number
2004361795
Title
Disagreement Between Randomized and Observational Evidence on the Use of
Bilateral Internal Thoracic Artery Grafting: A Meta-Analytic Approach.
Source
Journal of the American Heart Association. 8 (23) (no pagination), 2019.
Article Number: e014638. Date of Publication: 03 Dec 2019.
Author
Gaudino M.; Rahouma M.; Hameed I.; Khan F.M.; Taggart D.P.; Flather M.;
Biondi-Zoccai G.; Fremes S.E.
Institution
(Gaudino, Rahouma, Hameed, Khan) Department of Cardiothoracic Surgery,
Weill Cornell Medicine, New York City, NY, United States
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
United Kingdom
(Flather) University of East Anglia, Norwich, United Kingdom
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Napoli, Italy
(Fremes) Schulich Heart Centre, Division of Cardiac Surgery, Department of
Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON,
Canada
Publisher
American Heart Association Inc.
Abstract
Background: The ART (Arterial Revascularization Trial) showed no
difference in survival at 10 years between patients assigned to the single
versus bilateral internal thoracic artery grafting strategies. This
finding is in contrast with the results of most observational studies,
where the use of 2 internal thoracic arteries has been associated with
improved survival. Methods and Results: We selected
propensity-matched studies from the most comprehensive observational
meta-analysis on the long-term outcomes of patients receiving 1 versus 2
internal thoracic arteries. Individual participant survival data from each
study and the ART were reconstructed using an iterative algorithm that was
applied to solve the Kaplan-Meier equations. The reconstructed individual
participant survival data were aggregated to obtain combined survival
curves and Cox regression hazard ratios with 95% CIs. Individual
participant survival data were obtained from 14 matched observational
studies (24 123 patients) and the ART. The 10-year survival of the control
group of ART was significantly higher than that of the matched
observational studies (hazard ratio, 0.86; 95% CI, 0.80-0.93). The 10-year
survival of the experimental group of ART was significantly lower than
that of the bilateral internal thoracic artery group of the observational
studies (hazard ratio, 1.11; 95% CI, 1.03-1.20). Conclusion(s): Both
the improved outcome of the control arm and the lower beneficial effect of
the intervention had played a role in the difference between observational
evidence and ART. Copyright © 2019 The Authors. Published on
behalf of the American Heart Association, Inc., by Wiley.

<45>
Accession Number
2004366494
Title
Does Race Influence Decision Making for Advanced Heart Failure Therapies?.
Source
Journal of the American Heart Association. 8 (22) (no pagination), 2019.
Article Number: e013592. Date of Publication: 19 Nov 2019.
Author
Breathett K.; Yee E.; Pool N.; Hebdon M.; Crist J.D.; Knapp S.; Larsen A.;
Solola S.; Luy L.; Herrera-Theut K.; Zabala L.; Stone J.; McEwen M.M.;
Calhoun E.; Sweitzer N.K.
Institution
(Breathett, Sweitzer) Division of Cardiovascular Medicine, Department of
Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ, United
States
(Yee, Larsen) Sarver Heart Center, Clinical Research Office, University of
Arizona, Tucson, AZ, United States
(Pool, Hebdon, Crist, McEwen) College of Nursing, University of Arizona,
Tucson, AZ, United States
(Knapp) Statistics Consulting Lab, Bio5 Institute, University of Arizona,
Tucson, AZ, United States
(Solola) Department of Medicine, University of Arizona, Tucson, AZ, United
States
(Luy) University of Rochester, Rochester, NY, United States
(Herrera-Theut, Zabala) University of Arizona Medical School, Tucson, AZ,
United States
(Stone) Department of Psychology, University of Arizona, Tucson, AZ,
United States
(Calhoun) Center for Population Health Sciences, University of Arizona,
Tucson, AZ, United States
Publisher
American Heart Association Inc.
Abstract
Background: Race influences medical decision making, but its impact on
advanced heart failure therapy allocation is unknown. We sought to
determine whether patient race influences allocation of advanced heart
failure therapies. Methods and Results: Members of a national heart
failure organization were randomized to clinical vignettes that varied by
patient race (black or white man) and were blinded to study objectives.
Participants (N=422) completed Likert scale surveys rating factors for
advanced therapy allocation and think-aloud interviews (n=44). Survey
results were analyzed by least absolute shrinkage and selection operator
and multivariable regression to identify factors influencing advanced
therapy allocation, including interactions with vignette race and
participant demographics. Interviews were analyzed using grounded theory.
Surveys revealed no differences in overall racial ratings for advanced
therapies. Least absolute shrinkage and selection operator regression
selected no interactions between vignette race and clinical factors as
important in allocation. However, interactions between participants aged
>=40 years and black vignette negatively influenced heart transplant
allocation modestly (-0.58; 95% CI, -1.15 to -0.0002), with adherence and
social history the most influential factors. Interviews revealed
sequential decision making: forming overall impression, identifying
urgency, evaluating prior care appropriateness, anticipating challenges,
and evaluating trust while making recommendations. Race influenced each
step: avoiding discussing race, believing photographs may contribute to
racial bias, believing the black man was sicker compared with the white
man, developing greater concern for trust and adherence with the black
man, and ultimately offering the white man transplantation and the black
man ventricular assist device implantation. Conclusion(s): Black race
modestly influenced decision making for heart transplant, particularly
during conversations. Because advanced therapy selection meetings are
conversations rather than surveys, allocation may be vulnerable to racial
bias. Copyright © 2019 The Authors. Published on behalf of the
American Heart Association, Inc., by Wiley.

<46>
Accession Number
2004366119
Title
Three-Dimensional Echocardiography for Transcatheter Aortic Valve
Replacement Sizing: A Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. 8 (19) (no pagination), 2019.
Article Number: e013463. Date of Publication: 01 Oct 2019.
Author
Rong L.Q.; Hameed I.; Salemi A.; Rahouma M.; Khan F.M.; Wijeysundera H.C.;
Angiolillo D.J.; Shore-Lesserson L.; Biondi-Zoccai G.; Girardi L.N.;
Fremes S.E.; Gaudino M.
Institution
(Rong) Department of Anesthesiology, Weill Cornell Medicine, New York, NY,
United States
(Hameed, Salemi, Rahouma, Khan, Girardi, Gaudino) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Wijeysundera, Fremes) Schulich Heart Centre, Sunnybrook Health Science,
University of Toronto, Canada
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, FL, United States
(Shore-Lesserson) Department of Anesthesiology, North Shore University
Hospital, Manhasset, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Napoli, Italy
Publisher
American Heart Association Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is the standard
of care for many patients with severe symptomatic aortic stenosis and
relies on accurate sizing of the aortic annulus. It has been suggested
that 3-dimensional transesophageal echocardiography (3D TEE) may be used
instead of multidetector computed tomography (MDCT) for TAVR planning.
This systematic review and meta-analysis compared 3D TEE and MDCT for
pre-TAVR measurements. Methods and Results: A systematic literature
search was performed. The primary outcome was the correlation coefficient
between 3D TEE- and MDCT-measured annular area. Secondary outcomes were
correlation coefficients for mean annular diameter, annular perimeter, and
left ventricular outflow tract area; interobserver and intraobserver
agreements; mean differences between 3D TEE and MDCT measurements; and
pooled sensitivities, specificities, and receiver operating characteristic
area under curve values of 3D TEE and MDCT for discriminating post-TAVR
paravalvular aortic regurgitation. A random effects model was used.
Meta-regression and leave-one-out analysis for the primary outcome were
performed. Nineteen studies with a total of 1599 patients were included.
Correlations between 3D TEE and MDCT annular area, annular perimeter,
annular diameter, and left ventricular outflow tract area measurements
were strong (0.86 [95% CI, 0.80-0.90]; 0.89 [CI, 0.82-0.93]; 0.80 [CI,
0.70-0.87]; and 0.78 [CI, 0.61-0.88], respectively). Mean differences
between 3D TEE and MDCT between measurements were small and
nonsignificant. Interobserver and intraobserver agreement and
discriminatory abilities for paravalvular aortic regurgitation were good
for both 3D TEE and MDCT. Conclusion(s): For pre-TAVR planning, 3D
TEE is comparable to MDCT. In patients with renal dysfunction, 3D TEE may
be potentially advantageous for TAVR measurements because of the lack of
contrast exposure. Copyright © 2019 The Authors. Published on
behalf of the American Heart Association, Inc., by Wiley.

<47>
Accession Number
2004361553
Title
Physiological Versus Angiographic Guidance for Myocardial
Revascularization in Patients Undergoing Transcatheter Aortic Valve
Implantation.
Source
Journal of the American Heart Association. 8 (22) (no pagination), 2019.
Article Number: e012618. Date of Publication: 19 Nov 2019.
Author
Lunardi M.; Scarsini R.; Venturi G.; Pesarini G.; Pighi M.; Gratta A.;
Gottin L.; Barbierato M.; Caprioglio F.; Piccoli A.; Ferrero V.; Ribichini
F.
Institution
(Lunardi, Scarsini, Venturi, Pesarini, Pighi, Gratta, Piccoli, Ferrero,
Ribichini) Division of Cardiology, Department of Medicine, University of
Verona, Italy
(Gottin) Division of Anaesthesiology, Department of Surgery, University of
Verona, Italy
(Barbierato, Caprioglio) Division of Cardiology, Ospedale di Mestre,
Venezia, Italy
Publisher
American Heart Association Inc.
Abstract
Background: Management of coronary artery disease in patients undergoing
transcatheter aortic valve implantation is uncertain. Fractional flow
reserve (FFR) has never been clinically validated in aortic stenosis. The
study aim was to analyze the clinical outcome of FFR-guided
revascularization in patients undergoing transcatheter aortic valve
implantation. Methods and Results: Patients with severe aortic
stenosis and coronary artery disease at coronary angiography were included
in this retrospective analysis and divided in 2 groups: angiography guided
(122/216; 56.5%) versus FFR-guided revascularization (94/216; 43.5%).
Patients were clinically followed up and evaluated for the occurrence of
major adverse cardiac and cerebrovascular events at 2-year follow-up. Most
lesions in the FFR group resulted negative according to the conventional
0.80 cutoff value (111/142; 78.2%) and were deferred. The FFR-guided group
showed a better major adverse cardiac and cerebrovascular event-free
survival compared with the angio-guided group (92.6% versus 82.0%; hazard
ratio, 0.4; 95% CI, 0.2-1.0; P=0.035). Patients with deferred lesions
based on FFR presented better outcome compared with patients who underwent
angio-guided percutaneous coronary intervention (91.4% versus 68.1%;
hazard ratio, 0.3; 95% CI, 0.1-0.6; P=0.001). Conclusion(s): FFR
guidance was associated with favorable outcome in this observational study
in patients undergoing transcatheter aortic valve implantation. Randomized
trials are needed to investigate the long-term effects of FFR-guided
revascularization against angiographic guidance alone in patients with
aortic stenosis. Copyright © 2019 The Authors. Published on
behalf of the American Heart Association, Inc., by Wiley.

<48>
Accession Number
2004361545
Title
Five-Year Outcomes in Patients With Diabetes Mellitus Treated With
Biodegradable Polymer Sirolimus-Eluting Stents Versus Durable Polymer
Everolimus-Eluting Stents.
Source
Journal of the American Heart Association. 8 (22) (no pagination), 2019.
Article Number: e013607. Date of Publication: 19 Nov 2019.
Author
Iglesias J.F.; Heg D.; Roffi M.; Tuller D.; Lanz J.; Rigamonti F.; Muller
O.; Moarof I.; Cook S.; Weilenmann D.; Kaiser C.; Cuculi F.; Valgimigli
M.; Juni P.; Windecker S.; Pilgrim T.
Institution
(Iglesias, Roffi, Rigamonti) Division of Cardiology, Geneva University
Hospitals, Geneva, Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, Bern University Hospital, Bern, Switzerland
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Lanz, Valgimigli, Windecker, Pilgrim) Department of Cardiology, Bern
University Hospital, Bern, Switzerland
(Muller) Department of Cardiology, Lausanne University Hospital, Lausanne,
Switzerland
(Moarof) Department of Cardiology, Kantonsspital Aarau, Switzerland
(Cook) Department of Cardiology, University and Hospital Fribourg,
Switzerland
(Weilenmann) Department of Cardiology, Kantonsspital St Gallen,
Switzerland
(Kaiser) Department of Cardiology, Basel University Hospital, Basel,
Switzerland
(Cuculi) Department of Cardiology, Kantonsspital, Luzern, Switzerland
(Juni) Department of Medicine and Institute of Health Policy, Management
and Evaluation, Applied Health Research Centre, Li Ka Shing Knowledge
Institute of St Michael's Hospital, University of Toronto, Canada
Publisher
American Heart Association Inc.
Abstract
Background: The choice of optimal drug-eluting stent therapy for patients
with diabetes mellitus (DM) undergoing percutaneous coronary intervention
remains uncertain. We aimed to assess the long-term clinical outcomes
after percutaneous coronary intervention with biodegradable polymer
sirolimus-eluting stents (BP-SES) versus durable polymer
everolimus-eluting stents (DP-EES) in patients with DM. Methods and
Results: In a prespecified subgroup analysis of the BIOSCIENCE (Ultrathin
Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer
Everolimus-Eluting Stent for Percutaneous Coronary Revascularization)
trial (NCT01443104), patients randomly assigned to ultrathin-strut BP-SES
or thin-strut DP-EES were stratified according to diabetic status. The
primary end point was target lesion failure, a composite of cardiac death,
target vessel myocardial infarction, and clinically indicated target
lesion revascularization, at 5 years. Among 2119 patients, 486 (22.9%)
presented with DM. Compared with individuals without DM, patients with DM
were older and had a greater baseline cardiac risk profile. In patients
with DM, target lesion failure at 5 years occurred in 74 patients
(cumulative incidence, 31.0%) treated with BP-SES and 57 patients (25.8%)
treated with DP-EES (risk ratio, 1.23; 95% CI, 0.87-1.73 [P=0.24]). In
individuals without DM, target lesion failure at 5 years occurred in 124
patients (16.8%) treated with BP-SES and 132 patients (16.8%) treated with
DP-EES (risk ratio, 0.98; 95% CI, 0.77-1.26 [P=0.90; P for
interaction=0.31]). Cumulative 5-year incidence rates of cardiac death,
target vessel myocardial infarction, clinically indicated target lesion
revascularization, and definite stent thrombosis were similar among
patients with DM treated with BP-SES or DP-EES. There was no interaction
between diabetic status and treatment effect of BP-SES versus DP-EES.
 Conclusion(s): In a prespecified subgroup analysis of the BIOSCIENCE
trial, we found no difference in clinical outcomes throughout 5 years
between patients with DM treated with ultrathin-strut BP-SES or thin-strut
DP-EES. Clinical Trial Registration: URL: https://www.clinicaltrials.gov/.
Unique identifier: NCT01443104. Copyright © 2019 The Authors.
Published on behalf of the American Heart Association, Inc., by Wiley.

<49>
Accession Number
2004361399
Title
Association of Acute Venous Thromboembolism With In-Hospital Outcomes of
Coronary Artery Bypass Graft Surgery.
Source
Journal of the American Heart Association. 8 (19) (no pagination), 2019.
Article Number: e013246. Date of Publication: 01 Oct 2019.
Author
Panhwar M.S.; Ginwalla M.; Kalra A.; Gupta T.; Kolte D.; Khera S.; Bhatt
D.L.; Sabik J.F.
Institution
(Panhwar) Tulane University Heart and Vascular Institute, Tulane
University School of Medicine, New Orleans, LA, United States
(Khera) Division of Cardiology, Icahn School of Medicine at Mount Sinai,
New York, NY, United States
(Kalra) Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland
Clinic Lerner College of Medicine of Case Western Reserve University,
Cleveland, OH, United States
(Gupta) Montefiore Medical Center, Albert Einstein College of Medicine,
New York, NY, United States
(Kolte) Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Ginwalla) Division of Cardiovascular Medicine, Harrington Heart &
Vascular Institute, University Hospitals Cleveland Medical Center, Case
Western Reserve University School of Medicine, Cleveland, OH, United
States
(Bhatt) Brigham & Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
(Sabik) Department of Surgery, Harrington Heart & Vascular Institute,
University Hospitals Cleveland Medical Center, Case Western Reserve
University School of Medicine, Cleveland, OH, United States
Publisher
American Heart Association Inc.
Abstract
Background: While venous thromboembolism (VTE) prophylaxis is a strong
recommendation after most surgeries, it is controversial in cardiac
surgeries such as coronary artery bypass grafting (CABG), because of
perceived low VTE incidence and increased bleeding risk. Prior studies may
not have been adequately powered to study outcomes of VTE in this
population. We sought to investigate the postoperative incidence and
outcomes of CABG patients using a large national inpatient database.
 Methods and Results: We utilized the 2013 to 2014 National Inpatient
Sample to identify all patients >18 years of age who underwent CABG
(without concomitant valvular procedures), and had VTE during the hospital
stay. We then compared clinically relevant outcomes in patients with and
without VTE. We identified 331 950 CABG procedures. Of these, 1.3%
(n=4205) had VTE. Patients with VTE were more likely to be older (mean
67.2+/-10.4 years versus 65.2+/-10.4 years, P<0.001). VTE was associated
with higher incidence of inpatient mortality (6.8% versus 1.7%; adjusted
odds ratio 1.92 [95% CI 1.40-2.65]; P<0.001) and complications. VTE was
also associated with higher cost (mean+/-SE $81 995+/-$923 versus $48
909+/-$55) and longer length of stay (mean+/-SE 17.06+/-0.16 days versus
8.52+/-0.01 days). Conclusion(s): Our analysis of >330 000 CABG
procedures suggests that while postoperative VTE after CABG is rare, it is
associated with increased morbidity and mortality. Randomized controlled
trials are needed to identify optimal strategies for VTE prophylaxis in
these patients. Copyright © 2019 The Authors. Published on behalf
of the American Heart Association, Inc., by Wiley.

<50>
Accession Number
631095759
Title
Outcomes of percutaneous temporary biventricular mechanical support: A
systematic review.
Source
ASAIO Journal. Conference: 65th Annual Conference of the American Society
for Artificial Internal Organs, ASAIO 2019. United States. 65 (Supplement
1) (pp 97), 2019. Date of Publication: May-June 2019.
Author
Weber M.P.; Choi J.; Maynes E.J.; Prochno K.W.; Austin M.A.; Patel S.;
Morris R.J.; Massey H.T.; Tchantchaleishvili V.
Institution
(Weber, Choi, Maynes, Prochno, Austin, Patel, Morris, Massey,
Tchantchaleishvili) Sidney Kimmel Medical College, Thomas Jefferson
University, Philadelphia, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Study: Biventricular use of percutaneous ventricular assist devices
(BiVAD) is a recently developed treatment option for severe cardiogenic
shock. The aim of this systematic review is to identify indications and
outcomes of patients placed on percutaneous BiVAD support. Method(s):
An electronic search was performed to identify all relevant case reports
or series. All devices were placed percutaneously. After assessment for
inclusion and exclusion criteria, 15 studies were identified.
 Result(s): All 20 patients were supported with a micro-axial LVAD,
12/20 (60%) of those patients were supported with a micro-axial RVAD
(RMS), and the remaining 8/20 (40%) patients were supported with a
centrifugal extracorporeal RVAD (RCS) (table). All patients presented with
cardiogenic shock and of these, 12/20 (60%) presented with a non-ischemic
etiology vs 8/20 (40%) with ischemic disease. For the RMS group, RVAD
support was significantly longer [RMS 5 (IQR 4-7) days vs RCS 1 (IQR 1-2)
days, p=0.03]. Intravascular hemolysis post-BiVAD occurred in three
patients (27.3%) [RMS 3 (33.3%) vs RCS 0 (0%), p=0.94]. Two patients were
transitioned to extracorporeal membrane oxygenation (n=1) and intra-aortic
balloon pump (n=1) support. One patient received a durable VAD, one
patient received a total artificial heart and one patient received heart
transplantation. Estimated 30-day mortality was 15.0% and 78.6% were
discharged alive from the hospital. Kaplan-Meier analysis of estimated
survival is shown. Conclusion(s): Both strategies for percutaneous
BiVAD support appear to be viable options for severe cardiogenic shock.
Selection and reporting bias should be kept in mind when interpreting the
outcomes that appear favorable. (Table Presented).

<51>
Accession Number
631095742
Title
Ventricular arrhythmias following continuous-flow left ventricular assist
device implantation: A systematic review.
Source
ASAIO Journal. Conference: 65th Annual Conference of the American Society
for Artificial Internal Organs, ASAIO 2019. United States. 65 (Supplement
1) (pp 96), 2019. Date of Publication: May-June 2019.
Author
Gordon J.S.; Maynes E.J.; Choi J.; Wood C.T.; Weber M.P.; Morris R.J.;
Massey H.T.; Tchantchaleishvili V.
Institution
(Gordon, Maynes, Choi, Wood, Weber, Morris, Massey, Tchantchaleishvili)
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia,
PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Study: Ventricular arrhythmias (VA) are not uncommon after continuous-
flow left ventricular assist device (CF-LVAD) implantation. In this
systematic review, we sought to identify the patterns of ventricular
arrhythmias that occurred following CF-LVAD implantation and evaluate
their outcomes. Method(s): An electronic search was performed to
identify all articles reporting the development of VA following CF-LVAD
implantation. VA was defined as any episode of ventricular fibrillation or
sustained (>30 seconds) ventricular tachycardia. Eleven studies were
pooled for the analysis that included 393 CF-LVAD patients with VA.
 Result(s): The mean patient age was 57.4 years (95%CI 53.5; 61.4) and
82% [95%CI 73; 88] were male. Overall, 37% [95%CI 19; 60] of patients
experienced new VA after CF-LVAD implantation while 60% [95%CI 51; 69] of
patients had a prior history of VA. Overall, 88% [95%CI 78; 94] were
supported on HeartMate II, 6% [95%CI 3;14] on Heartware HVAD, and 6%
[95%CI 2; 13] on other CF-LVADs. CF-LVAD was implanted as bridge to
transplant in 59% [95%CI 49; 71] and destination therapy in 41% [29; 54].
VA was symptomatic in 47% [95%CI 28; 68] of patients and in 50% [95%CI 37;
52], early VA (< 30 days from CF-LVAD) was observed. Suction events were
believed to be the cause of VA in 3% [95%CI 1; 9]. Ablation therapy was
administered in 82% [95%CI 28; 98] of those with VA. The 30-day mortality
rate was 7% [95%CI 5; 11] and long-term survival is shown (figure). Mean
follow up was 22.6 months [95%CI 4.8; 40.8], during which 27% [95%CI 17;
39] of patients underwent heart transplantation. Conclusion(s): A
significant number of patients had new onset VA following CF-LVAD
placement. VA in CF-LVAD patients is often symptomatic, necessitates
treatment, and carries a worse prognosis. (Figure Presented).

<52>
Accession Number
631095579
Title
Characteristics and outcomes of gastrointestinal bleeding in patients with
continuous-flow left ventricular assist devices: A systematic review.
Source
ASAIO Journal. Conference: 65th Annual Conference of the American Society
for Artificial Internal Organs, ASAIO 2019. United States. 65 (Supplement
1) (pp 61), 2019. Date of Publication: May-June 2019.
Author
Carlson L.A.; Choi J.; Maynes E.J.; Horan D.P.; Deb A.K.; Patel S.;
Samuels L.E.; Morris R.J.; Entwistle J.W.; Massey H.T.; Tchantchaleishvili
V.
Institution
(Carlson, Choi, Maynes, Horan, Patel, Samuels, Morris, Entwistle, Massey,
Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Deb) Philadelphia College of Osteopathic Medicine, Philadelphia, PA,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Study: Gastrointestinal bleeding (GIB) is a common complication after
continuous-flow left ventricular assist device (CF-LVAD). We sought to
evaluate patterns of GIB development and related outcomes in CF-LVAD
patients. Method(s): An electronic search was performed to identify
all articles related to GIB associated with CF-LVAD implantation, and a
total of 34 studies consisting of 1,087 patients with GIB after CF-LVAD
placement were pooled for a systematic review. Result(s): Mean
patient age was 60 years (95%CI 57-64) and 24% (95%CI 21-28%) were female.
History of GIB prior to CF-LVAD implantation was present in 12% (95%CI
7-18%). The mean time from CF-LVAD implantation to the first GIB was 54
days (95%CI 24-84), with 40% (95%CI 34-45%) of patients having multiple
episodes of GIB. Anemia was present in 75% (95%CI 41-93%), and the most
common bleeding source were arteriovenous malformations (36%, 95%CI
24-50%) (Table). The mean duration of follow-up was 14.6 months (95%CI
6.9-22.3), during which the overall mortality rate was 21% (95%CI 12-36%)
and the mortality rate from GIB was 4% (95%CI 2-9%). Overall
thromboembolic events occurred in 32% (95%CI 22-44%) of the patients, with
a specific stroke rate of 16% (95%CI 3-51%) and a pump thrombosis rate of
8% (95%CI 3-22%). Heart transplantation was performed in 31% (95%CI
18-47%) of the patients, after which 0% (95%CI 0-10%) experienced
recurrent GIB. Conclusion(s): Morbidity and mortality in patients
with GIB is not directly related to the bleeding event and could be
secondary to the associated events such sequelae of thromboembolic
complications. Heart transplant in these patients appears to reliably
resolve GIB. (Figure Presented).

<53>
Accession Number
368245700
Title
Comparison between preoperative administration of methylprednisolone with
its administration before and during congenital heart surgery on serum
levels of IL-6 and IL-10.
Source
Iranian Red Crescent Medical Journal. 15 (2) (no pagination), 2013. Date
of Publication: 2013.
Author
Tashnizi M.A.; Soltani G.; Moeinipour A.A.; Ayatollahi H.; Tanha A.S.;
Jarahi L.; Shamloo A.S.; Zirak N.
Institution
(Tashnizi, Moeinipour, Shamloo) Department of Cardiac Surgery, Imam Reza
Hospital, Mashhad University of Medical, Iran, Islamic Republic of
(Soltani, Tanha, Zirak) Departments of Anesthesiology, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Ayatollahi) Department of Anatomical and Clinical Pathology, Imam Reza
Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Jarahi) Departments of Community Medicine, Mashad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Iranian Red Crescent Society (E-mail: editor@anesthpain.com)
Abstract
Background: Steroid administration during cardiopulmonary bypass is
considered to improve cardiopulmonary function by modulating inflammations
caused by bypass. Objective(s): This study was performed to compare
effectiveness of preoperative and intraoperative methylprednisolone (MP)
to preoperative methylprednisolone alone in post bypass inflammatory
(IL-6) and anti-inflammatory (IL-10) factors. Patients and Methods:
Fifty pediatric patients undergoing cardiopulmonary bypass surgery from
August 2011 to 2012 in the cardiac surgery department of Imam Reza
Hospital, the major center for CPB, in Mashhad, Iran were randomly
assigned to receive preoperative and intraoperative MP (30 mg/kg, 4 hours
before bypass and in bypass prime, number 25) or preoperative MP only (30
mg/kg, number 25). Before and after bypass, four and 24 hours after
bypass, serum IL-6 and IL-10 were measured by ELISA. Result(s): In
both groups, no significant different with variation of expression for
IL-6 (inflammatory factor) and IL-10 (anti-inflammatory factor) in
different times after bypass, was observed. Conclusion(s): No
significant different in reducing post bypass inflammation between
preoperative steroid treatment and combined preoperative and
intraoperative steroid administration reported and they have the same
effects.

<54>
Accession Number
50370084
Title
Tranexamic Acid Reduces Blood Loss in Off-Pump Coronary Artery Bypass
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 23 (3) (pp 312-315),
2009. Date of Publication: June 2009.
Author
Taghaddomi R.J.; Mirzaee A.; Attar A.S.; Shirdel A.
Institution
(Taghaddomi, Attar) Department of Anesthesiology, Ghaem Hospital, Mashhad
University of Medical Sciences, Mashad, Iran, Islamic Republic of
(Mirzaee) Department of Cardiosurgery, Chaem Hospital, Mashad University
of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Shirdel) Department of Hematology, Ghaem Hospital, Mashhad University of
Medical Sciences, Mashad, Iran, Islamic Republic of
Publisher
W.B. Saunders
Abstract
Objective: This study was designed to evaluate the hemostatic effect of
tranexamic acid in off-pump coronary artery bypass surgery.
 Design(s): A prospective, randomized, double-blind,
placebo-controlled study. Setting(s): The Department of
Anesthesiology and Cardiac Surgery, Medical Sciences University.
 Participant(s): One hundred eight patients undergoing off-pump
coronary artery bypass surgery were enrolled into the study. Eight
patients were withdrawn, and 100 patients were divided into 2 groups.
 Intervention(s): Fifty patients received tranexamic acid (bolus 1 g
before skin incision and followed by maintenance dose of 400 mg/h during
surgery), and 50 patients received saline. Measurement and Main Results:
Hematologic parameters, volume of blood loss, blood transfusion, and other
clinical data were recorded throughout the perioperative period.
Twenty-four-hour postoperative blood loss was significantly less in the
tranexamic acid group compared with the control group (471 +/- 182 v 844
+/- 303). Patients in the tranexamic acid group received significantly
less allogeneic blood (8 v 31 units). Conclusion(s): Bleeding and
hemorrhagic complications and the consequent need for allogeneic
transfusion are still major problems after off-pump coronary artery bypass
surgery. Tranexamic acid appears to be effective in reducing postoperative
bleeding and the need for allogeneic blood products. © 2009 Elsevier
Inc. All rights reserved.

<55>
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). Background(s): Randomized studies are lacking comparing TAVR
without BAV against the conventional technique of TAVR with BAV.
 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. 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. 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) Copyright © 2020 American College of
Cardiology Foundation

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Accession Number
631046967
Title
Safety and efficacy of bivalirudin monotherapy in patients with
non-ST-segment elevation acute coronary syndromes with positive biomarkers
undergoing percutaneous coronary intervention: A report from the Acute
Catheterization and Urgent Intervention Triage Strategy trial.
Source
Coronary Artery Disease. 31 (1) (pp 59-65), 2020. Date of Publication: 01
Jan 2020.
Author
Huang X.; Chen S.; Redfors B.; Zhang Y.; Souza C.F.; Mehran R.; Bansilal
S.; Kirtane A.J.; Brener S.J.; Feite F.; Dangas G.D.; Ben-Yehuda O.; Stone
G.W.
Institution
(Huang) Department of Cardiology, First Affiliated Hospital, Xi'An
Jiaotong University, Xi'an, China
(Huang, Chen, Redfors, Zhang, Souza, Mehran, Kirtane, Dangas, Ben-Yehuda,
Stone) Clinical Trials Center, Cardiovascular Research Foundation,
Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY
10019, United States
(Mehran, Bansilal, Dangas) Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicine at Mount Sinai, United States
(Kirtane, Ben-Yehuda, Stone) Zena and Michael A. Wiener Cardiovascular
Institute, NewYork-Presbyterian Hospital, Columbia University Medical
Center, United States
(Feite) NYU School of Medicine, New York, United States
(Brener) NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY,
United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Souza) Federal University of Sao Paulo, Sao Paulo, Brazil
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objectives There are limited data on bivalirudin monotherapy in patients
with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) with
positive biomarkers of myocardial necrosis (troponin and/or creatine
kinase-myocardial band isoenzyme). We sought to evaluate the safety and
efficacy of bivalirudin monotherapy in patients with positive biomarkers
from the Acute Catheterization and Urgent Intervention Triage Strategy
(ACUITY) trial. Patients and methods We compared the net adverse clinical
events [composite ischemia-(death, myocardial infarction, or unplanned
ischemic revascularization)-or noncoronary artery bypass graft surgery
(CABG)-related major bleeding] among patients with biomarker-positive
NSTE-ACS in the ACUITY trial overall and by antithrombotic strategy.
Results Among 13 819 patients with NSTE-ACS enrolled in ACUITY, 4728
patients presented with positive biomarkers and underwent an early
invasive strategy. Of those, 1547 were randomized to heparin plus a
glycoprotein IIb/IIIa inhibitor (GPI), 1555 to bivalirudin plus GPI, and
1626 to bivalirudin monotherapy. Compared with biomarker-negative
patients, biomarker-positive patients had higher 30-day rates of net
adverse clinical events (14.0 vs. 12.4%; P = 0.04), all-cause death (1.3
vs. 0.5%; P = 0.001), cardiac death (1.1 vs. 0.5%; P = 0.005), and
non-CABG-related major bleeding (6.5 vs. 5.2%, P = 0.03). At 30 days,
bivalirudin monotherapy was associated with significantly less
non-CABG-related major bleeding (bivalirudin monotherapy 4.1% vs.
bivalirudin plus GPI 8.4% vs. heparin plus GPI 7.1%) with comparable rates
of composite ischemia (bivalirudin monotherapy 9.2% vs. bivalirudin plus
GPI 9.9% vs. heparin plus GPI 8.4%). In a multivariable model, bivalirudin
monotherapy was associated with a significant reduction in
non-CABG-related major bleeding but was not associated with an increased
risk of death, myocardial infarction, unplanned revascularization or stent
thrombosis. Conclusion Compared with heparin plus GPI or bivalirudin plus
GPI, bivalirudin monotherapy provides similar protection from ischemic
events with less major bleeding at 30 days among patients with NSTE-ACS
and positive biomarkers. Copyright © 2019 Wolters Kluwer Health,
Inc. All rights reserved.

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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. Method(s):The PubMed, EMBASE, and Cochrane databases were
searched from January 1960 to March 2019. Randomized controlled trials and
observational studies were analyzed. The Newcastle-Ottawa Scale (NOS) was
used to evaluate the quality of the studies. Stata 11.0 was used for the
meta-analysis. Result(s):A total of 6 publications were included;
1366 events were selected, involving 852 events with LMWH and 514 events
with UFH. The thromboembolism risk of the LMWH group was lower than that
of the UFH group (risk ratio [RR]=0.34, 95% confidence interval [CI]
0.12-0.95, P=.039). The incidence of major bleeding was lower in the LMWH
group than in the UFH group, albeit without statistical significance
(RR=0.94, 95% CI 0.68-1.30, P=.728), as was mortality (RR=0.52, 95% CI
0.16-1.66, P=.271). Subgroup analysis showed that LMWH cardiac surgery
patients had a higher risk of major bleeding compared with UFH cardiac
surgery patients (RR=1.17, 95% CI 0.72-1.90, P=.526); but among
non-cardiac surgery patients, the LMWH group had a lower risk of major
bleeding than the UFH group (RR=0.79, 95% CI 0.51-1.22, P=.284), although
the difference was not statistically significant. Conclusion(s):Our
meta-analysis suggests that LMWH not only reduces the risk of
thromboembolism in patients with MHV but also does not increase the risk
of major bleeding. LMWH may provide safer and more effective bridging
anticoagulation than UFH in patients with MHV. It is still necessary to
conduct future randomized studies to verify this conclusion. Copyright
© 2020 the Author(s). Published by Wolters Kluwer Health, Inc.

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Accession Number
631036663
Title
Quality Control Measures and Validation in Gene Association Studies:
Lessons for Acute Illness.
Source
Shock. 53 (3) (pp 256-268), 2020. Date of Publication: 01 Mar 2020.
Author
Cohen M.; Lamparello A.J.; Schimunek L.; El-Dehaibi F.; Namas R.A.; Xu Y.;
Kaynar A.M.; Billiar T.R.; Vodovotz Y.
Institution
(Cohen, Xu, Kaynar) Department of Anesthesiology and Perioperative
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Lamparello, Schimunek, El-Dehaibi, Namas, Billiar, Vodovotz) Department
of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
(Kaynar) Clinical Research, Investigation, and Systems Modeling of Acute
Illness (CRISMA) Laboratory, Department of Critical Care Medicine,
University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
(Billiar, Vodovotz) Center for Inflammation and Regeneration Modeling,
McGowan Institute for Regenerative Medicine, University of Pittsburgh,
Pittsburgh, PA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Acute illness is a complex constellation of responses involving
dysregulated inflammatory and immune responses, which are ultimately
associated with multiple organ dysfunction. Gene association studies have
associated single-nucleotide polymorphisms (SNPs) with clinical and
pharmacological outcomes in a variety of disease states, including acute
illness. With approximately 4 to 5 million SNPs in the human genome and
recent studies suggesting that a large portion of SNP studies are not
reproducible, we suggest that the ultimate clinical utility of SNPs in
acute illness depends on validation and quality control measures. To
investigate this issue, in December 2018 and January 2019 we searched the
literature for peer-reviewed studies reporting data on associations
between SNPs and clinical outcomes and between SNPs and pharmaceuticals
(i.e., pharmacogenomics) published between January 2011 to February 2019.
We review key methodologies and results from a variety of clinical and
pharmacological gene association studies, including trauma and sepsis
studies, as illustrative examples on current SNP association studies. In
this review article, we have found three key points which strengthen the
potential accuracy of SNP association studies in acute illness and other
diseases: providing evidence of following a protocol quality control
method such as the one in Nature Protocols or the OncoArray QC Guidelines;
enrolling enough patients to have large cohort groups; and validating the
SNPs using an independent technique such as a second study using the same
SNPs with new patient cohorts. Our survey suggests the need to standardize
validation methods and SNP quality control measures in medicine in
general, and specifically in the context of complex disease states such as
acute illness. Copyright © 2020 by the Shock Society.

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Accession Number
631035391
Title
A Partially structured postoperative handoff protocol improves
communication in 2 mixed surgical intensive care units: Findings from the
handoffs and transitions in critical care (hatricc) prospective cohort
study.
Source
Annals of Surgery. 271 (3) (pp 484-493), 2020. Date of Publication: 01 Mar
2020.
Author
Lane-Fall M.B.; Pascual J.L.; Peifer H.G.; Di Taranti L.J.; Collard M.L.;
Jablonski J.; Gutsche J.T.; Halpern S.D.; Barg F.K.; Fleisher L.A.
Institution
(Lane-Fall, Peifer, Di Taranti, Collard, Gutsche, Barg, Fleisher)
Department of Anesthesiology and Critical Care, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA, United States
(Lane-Fall, Fleisher) Center for Perioperative Outcomes Research and
Transformation, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Lane-Fall, Halpern, Fleisher) Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, PA, United States
(Lane-Fall) Center for Healthcare Improvement and Patient Safety, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Lane-Fall) Robert Wood Johnson Foundation Harold AmosMedical Faculty
Development Program, Indianapolis, IN, United States
(Lane-Fall) Palliative and Acute Illness Research Center, Perelman School
of Medicine, University of Pennsylvania, Philadelphia, PA, United States
(Pascual) Department of Surgery, Perelman School of Medicine, University
of Pennsylvania, Surgical Critical Care and Emergency Surgery,
Philadelphia, PA, United States
(Jablonski) Hospital of University of Pennsylvania, Philadelphia, PA,
United States
(Fleisher) Department of Medicine, Perelman School of Medicine, University
of Pennsylvania, Allergy, and Critical Care Medicine, Philadelphia, PA,
United States
(Barg) Perelman School of Medicine, University of Pennsylvania, Family
Medicine, Philadelphia, PA, United States
(Barg) Department of Anthropology, School of Arts and Sciences, University
of Pennsylvania, Philadelphia, PA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective:To assess the effectiveness of standardizing operating room (OR)
to intensive care unit (ICU) handoffs in a mixed surgical
population.Summary of Background Data:Standardizing OR to ICU handoffs
improves information transfer after cardiac surgery, but there is limited
evidence in other surgical contexts. Method(s):This prospective
interventional cohort study (NCT02267174) was conducted in 2 surgical ICUs
in 2 affiliated hospitals. From 2014 to 2016, we developed, implemented,
and assessed the effectiveness of a new standardized handoff protocol
requiring bedside clinician communication using an information template.
The primary study outcome was number of information omissions out of 13
possible topics, recorded by trained observers. Data were analyzed using
descriptive statistics, bivariate analyses, and multivariable regression.
 Result(s):We observed 165 patient transfers (68 pre-, 97
postintervention). Before standardization, observed handoffs had a mean
4.7+/-2.9 information omissions each. After standardization, information
omissions decreased 21.3% to 3.7+/-1.9 (P = 0.023). In a pre-specified
subanalysis, information omissions for new ICU patients decreased 36.2%
from 4.7+/-3.1 to 3.0+/-1.6 (P = 0.008, interaction term P = 0.008). The
decrement in information omissions was linearly associated with the number
of protocol steps followed (P < 0.001). After controlling for patient
stability, the intervention was still associated with reduced omissions.
Handoff duration increased after standardization from 4.1+/-3.3 to
8.0+/-3.9minutes (P < 0.001). ICU mortality and length of stay did not
change postimplementation. Conclusion(s):Standardizing OR to ICU
handoffs significantly improved information exchange in 2 mixed surgical
ICUs, with a concomitant increase in handoff duration. Additional research
is needed to identify barriers to and facilitators of handoff protocol
adherence. Copyright © 2020 Wolters Kluwer Health, Inc. All
rights reserved.

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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.
 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. 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. 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. Copyright
© 2019 American Heart Association, Inc.

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Accession Number
631070851
Title
A Randomized Trial of a 1-Hour Troponin T Protocol in Suspected Acute
Coronary Syndromes: The Rapid Assessment of Possible Acute Coronary
Syndrome in the Emergency Department with High-Sensitivity Troponin T
Study (RAPID-TnT).
Source
Circulation. 140 (19) (pp 1543-1556), 2019. Date of Publication: 05 Nov
2019.
Author
Chew D.P.; Lambrakis K.; Blyth A.; Seshadri A.; Edmonds M.J.R.; Briffa T.;
Cullen L.A.; Quinn S.; Karnon J.; Chuang A.; Nelson A.J.; Wright D.;
Horsfall M.; Morton E.; French J.K.; Papendick C.
Institution
(Chew, Blyth, Seshadri, Karnon, Chuang, Morton) College of Medicine and
Public Health, Flinders University of South Australia, Adelaide, Australia
(Chew, Chuang, Nelson) South Australian Health and Medical Research
Institute, Adelaide, Australia
(Chew, Lambrakis, Blyth, Seshadri, Edmonds, Wright, Horsfall, Papendick)
South Australian Department of Health, Adelaide, Australia
(Nelson) School of Medicine, University of Adelaide, Australia
(Briffa) School of Population and Global Health, University of Western
Australia, Perth, Australia
(Cullen) Department of Emergency Medicine, Royal Brisbane and Women's
Hospital, Australia
(Cullen) School of Public Health, Queensland University of Technology,
Brisbane, Australia
(Cullen) School of Medicine, University of Queensland, Brisbane, Australia
(Quinn) Department of Statistics, Data Science and Epidemiology, Swinburne
University of Technology, Melbourne, Australia
(French) Department of Cardiology, University of New South Wales, Sydney,
Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: High-sensitivity troponin assays promise earlier
discrimination of myocardial infarction. Yet, the benefits and harms of
this improved discriminatory performance when incorporated within rapid
testing protocols, with respect to subsequent testing and clinical events,
has not been evaluated in an in-practice patient-level randomized study.
This multicenter study evaluated the noninferiority of a 0/1-hour
high-sensitivity cardiac troponin T (hs-cTnT) protocol in comparison with
a 0/3-hour masked hs-cTnT protocol in patients with suspected acute
coronary syndrome presenting to the emergency department (ED).
 Method(s): Patients were randomly assigned to either a 0/1-hour
hs-cTnT protocol (reported to the limit of detection [<5 ng/L]) or masked
hs-cTnT reported to <=29 ng/L evaluated at 0/3-hours (standard arm). The
30-day primary end point was all-cause death and myocardial infarction.
Noninferiority was defined as an absolute margin of 0.5% determined by
Poisson regression. Result(s): In total, 3378 participants with an
emergency presentation were randomly assigned between August 2015 and
April 2019. Ninety participants were deemed ineligible or withdrew
consent. The remaining participants received care guided either by the
0/1-hour hs-cTnT protocol (n=1646) or the 0/3-hour standard masked hs-cTnT
protocol (n=1642) and were followed for 30 days. Median age was 59 (49-70)
years, and 47% were female. Participants in the 0/1-hour arm were more
likely to be discharged from the ED (0/1-hour arm: 45.1% versus standard
arm: 32.3%, P<0.001) and median ED length of stay was shorter (0/1-hour
arm: 4.6 [interquartile range, 3.4-6.4] hours versus standard arm: 5.6
(interquartile range, 4.0-7.1) hours, P<0.001). Those randomly assigned to
the 0/1-hour protocol were less likely to undergo functional cardiac
testing (0/1-hour arm: 7.5% versus standard arm: 11.0%, P<0.001). The
0/1-hour hs-cTnT protocol was not inferior to standard care (0/1-hour arm:
17/1646 [1.0%] versus 16/1642 [1.0%]; incidence rate ratio, 1.06 [
0.53-2.11], noninferiority P value=0.006, superiority P value=0.867),
although an increase in myocardial injury was observed. Among patients
discharged from ED, the 0/1-hour protocol had a negative predictive value
of 99.6% (95% CI, 99.0-99.9%) for 30-day death or myocardial infarction.
 Conclusion(s): This in-practice evaluation of a 0/1-hour hs-cTnT
protocol embedded in ED care enabled more rapid discharge of patients with
suspected acute coronary syndrome. Improving short-term outcomes among
patients with newly recognized troponin T elevation will require an
evolution in management strategies for these patients. Clinical Trial
Registration: URL: https://www.anzctr.org.au. Unique identifier:
ACTRN12615001379505. Copyright © 2019 American Heart Association,
Inc.

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

<63>
[Use Link to view the full text]
Accession Number
630995166
Title
Ramelteon for Prevention of Postoperative Delirium: A Randomized
Controlled Trial in Patients Undergoing Elective Pulmonary
Thromboendarterectomy*.
Source
Critical Care Medicine. 47 (12) (pp 1751-1758), 2019. Date of Publication:
01 Dec 2019.
Author
Jaiswal S.J.; Vyas A.D.; Heisel A.J.; Ackula H.; Aggarwal A.; Kim N.H.;
Kerr K.M.; Madani M.; Pretorius V.; Auger W.R.; Fernandes T.M.; Malhotra
A.; Owens R.L.
Institution
(Jaiswal, Aggarwal) Scripps Research Translational Institute, San Diego,
CA, United States
(Jaiswal, Heisel) Division of Hospital Medicine, Scripps Clinic/Scripps
Green Hospital, San Diego, CA, United States
(Vyas, Ackula, Kim, Kerr, Madani, Pretorius, Auger, Fernandes, Malhotra,
Owens) Division of Pulmonary, Critical Care and Sleep Medicine, University
of California San Diego, School of Medicine, San Diego, CA, United States
(Owens) Division of Cardiovascular and Thoracic Surgery, University of
California San Diego, School of Medicine, San Diego, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: To assess the efficacy of ramelteon in preventing delirium, an
acute neuropsychiatric condition associated with increased morbidity and
mortality, in the perioperative, ICU setting. Design(s):
Parallel-arm, randomized, double-blinded, placebo-controlled trial.
 Setting(s): Academic medical center in La Jolla, California.
 Patient(s): Patients greater than or equal to 18 years undergoing
elective pulmonary thromboendarterectomy. Intervention(s): Ramelteon
8 mg or matching placebo starting the night prior to surgery and for a
maximum of six nights while in the ICU. Measurements and Main
Results: Incident delirium was measured twice daily using the Confusion
Assessment Method-ICU. The safety outcome was coma-free days assessed by
the Richmond Agitation-Sedation Scale. One-hundred twenty participants
were enrolled and analysis completed in 117. Delirium occurred in 22 of 58
patients allocated to placebo versus 19 of 59 allocated to ramelteon
(relative risk, 0.8; 95% CI, 0.5-1.4; p = 0.516). Delirium duration, as
assessed by the number of delirium-free days was also similar in both
groups (placebo median 2 d [interquartile range, 2-3 d] vs ramelteon 3 d
[2-5 d]; p = 0.181). Coma-free days was also similar between groups
(placebo median 2 d [interquartile range, 1-3 d] vs ramelteon 3 d [2-4 d];
p = 0.210). We found no difference in ICU length of stay (median 4 d
[interquartile range, 3-5 d] vs 4 d [3-6 d]; p = 0.349), or in-hospital
mortality (four vs three deaths; relative risk ratio, 0.7; 95% CI,
0.2-3.2; p = 0.717), all placebo versus ramelteon, respectively.
 Conclusion(s): Ramelteon 8 mg did not prevent postoperative delirium
in patients admitted for elective cardiac surgery. Copyright ©
2019 by the Society of Critical Care Medicine and Wolters Kluwer Health,
Inc. All Rights Reserved.

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