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<1>
Accession Number
2001613472
Title
Self-made thoracic needled suspending device with a snare: An excellent
aid for uniportal video-assisted thoracic lobectomy and segmentectomy for
lung cancer.
Source
Oncology Letters. 17 (4) (pp 3671-3676), 2019. Date of Publication: April
2019.
Author
Wang S.; Meng C.; Jiang Z.; Gonzalez-Rivas D.; Ruan J.; Xu W.; Liu C.;
Zhang L.; Gao G.; Yu G.; Teng H.; Ju J.
Institution
(Wang, Jiang) Department of Thoracic Surgery, Mount Qianfuo Attatched
Hospital of Shandong University, Jinan, Shandong 250000, China
(Wang, Meng, Ruan, Xu, Liu, Zhang, Gao, Yu, Teng, Ju) Department of
Thoracic Surgery, Weihai Municipal Hospital, Weihai, Shandong 264200,
China
(Gonzalez-Rivas) Department of Thoracic Surgery, Coruna University
Hospital, Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruna 15008,
Spain
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
Safety and feasibility of the self-made thoracic needled suspending device
with a snare in the uniportal video-assisted thoracic lobectomy and
segmentectomy for the treatment of non-small cell lung cancer were
explored. In total, 80 pulmonary lung major resections (including
lobectomy and segmental resections) with systematic mediastinal
lymphadenectomy were retrospectively analyzed. Patients were randomly
divided into an observation group and a control group. In the observation
group, the device was used to hang affected lungs, left and right vagus
nerve at the level of tracheal bifurcation, the arch of azygos vein, left
phrenic nerve and left and right bronchus on the chest wall to offer a
better exposure of the operation field. In the control group, the
conventional uniportal video-assisted thoracic surgery was performed
without using the self-made device. Systematic mediastinal lymphadenectomy
was performed in both groups. Operation time, intraoperative blood loss,
postoperative extubation time, hospital stay and perioperative
complications in the early stage of patients in both groups were compared.
The operation time 120.2+/-40.32 min, intraoperative blood loss
100.51+/-50.23ml<inf>/</inf>dayml, and postoperative suction drainage
volume 208+/-97.56 in the observation group were significantly different
from those in the control group (P<0.05), and there were no significant
differences in postoperative extubation time, hospital stay and
perioperative complications between the two groups (P>0.05). The self-made
thoracic needled suspending device with a snare is an excellent helper for
uniportal video-assisted thoracic surgery, because it helps to expose
surgical field and has no postoperative cicatrisation at puncture point on
the wall of the chest. The device and its use are worthy of
promotion.<br/>Copyright &#xa9; 2019, Spandidos Publications. All rights
reserved.

<2>
Accession Number
2004179725
Title
Ultrasound-guided continuous deep serratus anterior plane block versus
continuous thoracic paravertebral block for perioperative analgesia in
videoscopic-assisted thoracic surgery.
Source
European Journal of Pain (United Kingdom). 24 (4) (pp 828-838), 2020. Date
of Publication: 01 Apr 2020.
Author
Hanley C.; Wall T.; Bukowska I.; Redmond K.; Eaton D.; Ni Mhuircheartaigh
R.; Hearty C.
Institution
(Hanley, Wall, Bukowska, Ni Mhuircheartaigh, Hearty) Department of
Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
(Redmond, Eaton) Department of Cardiothoracic Surgery, Mater Misericordiae
University Hospital, Dublin, Ireland
Publisher
Blackwell Publishing Ltd
Abstract
Background: The deep serratus anterior plane block (SAPB) is a promising
novel regional anaesthesia technique for blockade of the anterolateral
chest wall. Evidence for the efficacy of SAPB versus other analgesic
techniques in thoracic surgery remains inadequate. <br/>Aim(s): This study
compared ultrasound-guided continuous SAPB with a surgically placed
continuous thoracic paravertebral block (SPVB) technique in patients
undergoing videoscopic-assisted thoracic surgery (VATS). <br/>Method(s):
In a single-centre, double-blinded, randomized, non-inferiority study, we
allocated 40 patients undergoing VATS to either SAPB or SPVB, with both
groups receiving otherwise standardized treatment, including multimodal
analgesia. The primary outcome was 48-hr opioid consumption. Secondary
outcomes included numerical rating scale (NRS) for postoperative pain,
patient-reported worst pain score (WPS) as well as functional measures
(including mobilization distance and cough strength). <br/>Result(s): A
48-hr opioid consumption for the SAPB group was non-inferior compared with
SPVB. SAPB was associated with improved NRS pain scores at rest, with
cough and with movement at 24 hr postoperatively (p =.007, p =.001 and p
=.012, respectively). SAPB was also associated with a lower WPS (p =.008).
Day 1 walking distance was improved in the SAPB group (p =.012), whereas
the difference in cough strength did not reach statistical significance (p
=.071). There was no difference in haemodynamics, opioid side effects,
length of hospital stay or patient satisfaction between the two groups.
<br/>Conclusion(s): The SAPB, as part of a multimodal analgesia regimen,
is non-inferior in terms of 48-hr opioid consumption compared to SPVB and
is associated with improved functional measures in thoracic surgical
patients. ClinicalTrials.gov Identifier: NCT03768193. <br/>Significance:
The SAPB interfascial plane block is an efficacious alternative method of
opioid-sparing analgesia in high-risk thoracic surgical patients as part
of an enhanced recovery programme.<br/>Copyright &#xa9; 2020 European Pain
Federation - EFIC

<3>
Accession Number
2004050756
Title
Effects of the Discontinuation of Angiotensin-Converting Enzyme Inhibitors
12 and 24 Hours Before Open-Heart Surgery on Hemodynamics During and After
Surgery.
Source
Iranian Heart Journal. 21 (2) (pp 27-33), 2020. Date of Publication: 2020.
Author
Azarasa M.; Faritous Z.; Bokharaei M.; Ghadrdoost B.; Changizi A.
Institution
(Azarasa, Bokharaei, Changizi) Bou Ali Sina Hospital, Qazvin University of
Medical sciences, Qazvin, IR, Iran, Islamic Republic of
(Faritous, Ghadrdoost) Rajaie Cardiovascular, Medical, and Research
Center, Iran University of Medical Sciences, Tehran, IR, Iran, Islamic
Republic of
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: Preoperative use of angiotensin-converting enzyme inhibitors
(ACEIs) is an independent predictor of the need for inotropic support
postoperatively and hypotension during surgery; consequently, some
surgeons suggest that ACEIs be discontinued prior to coronary artery
bypass graft surgery (CABG). However, the optimal time of ACEI
discontinuation before CABG remains controversial. In this study, we
compared the effects of ACEI discontinuation 12 and 24 hours before
open-heart surgery on the hemodynamic status of patients during surgery.
<br/>Method(s): This randomized controlled trial was conducted on patients
undergoing elective CABG. The patients were randomly divided into 2
groups: in the first group, ACEIs were discontinued 12 hours before CABG
and in the second group, ACEIs were discontinued 24 hours before CABG.
Hemodynamic evaluations including blood pressure (systolic, diastolic, and
mean arterial pressures), the heart rate, and the hemoglobin level were
performed. <br/>Result(s): The trends of changes in systolic blood
pressure (P = 0.41), diastolic blood pressure (P = 0.360), the heart rate
(P = 0.11), and the hemoglobin level (P = 0.92) were not significantly
different between the 2 groups over time. The mean arterial pressure was
significantly different between the groups over time (P = 0.038).
Likewise, the mean arterial pressure in the 24-hour group was
significantly higher than that of the other group until the time of
sternotomy, after which time the mean arterial pressure in the 12-hour
group was significantly higher. <br/>Conclusion(s): ACEI discontinuation
before CABG had some effects on the hemodynamics of our patients during
anesthetic induction, including the prevention of hypotension during
surgery; nonetheless, our data did not show the optimal time to stop ACEIs
prior to CABG.<br/>Copyright &#xa9; 2020, Iranian Heart Association. All
rights reserved.

<4>
Accession Number
631074200
Title
Five-year outcomes of transcatheter or surgical aortic-valve replacement.
Source
New England Journal of Medicine. 382 (9) (pp 799-809), 2020. Date of
Publication: 27 Feb 2020.
Author
Makkar R.R.; Thourani V.H.; Mack M.J.; Kodali S.K.; Kapadia S.; Webb J.G.;
Yoon S.-H.; Trento A.; Svensson L.G.; Herrmann H.C.; Szeto W.Y.; Miller
D.C.; Satler L.; Cohen D.J.; Dewey T.M.; Babaliaros V.; Williams M.R.;
Kereiakes D.J.; Zajarias A.; Greason K.L.; Whisenant B.K.; Hodson R.W.;
Brown D.L.; Fearon W.F.; Russo M.J.; Pibarot P.; Hahn R.T.; Jaber W.A.;
Rogers E.; Xu K.; Wheeler J.; Alu M.C.; Smith C.R.; Leon M.B.; PARTNER 2
Investigators
Institution
(Makkar, Yoon, Trento) Cedars-Sinai Medical Center, Los Angeles, CA,
United States
(Miller, Fearon) Stanford University, Stanford, CA, United States
(Rogers, Xu, Wheeler) Edwards Lifesciences, Irvine, CA, United States
(Thourani) Department of Cardiovascular Surgery, Piedmont Heart Institute,
Atlanta, GA, United States
(Babaliaros) Emory University, Atlanta, GA, United States
(Mack, Brown) Baylor Scott and White Healthcare, Plano, TX, United States
(Dewey) Medical City Dallas Hospital, Dallas, TX, United States
(Kodali, Hahn, Alu, Smith, Leon) Columbia University Medical Center, New
York-Presbyterian Hospital, New York, NY, United States
(Williams) NYU Langone Medical Center, New York, NY, United States
(Kapadia, Svensson, Jaber) Cleveland Clinic, Cleveland, OH, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Pibarot) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Universite Laval, Quebec, QC, Canada
(Herrmann, Szeto) University of Pennsylvania, Philadelphia, PA, United
States
(Satler) Medstar Washington Hospital Center, Washington, DC, United States
(Cohen) University of Missouri, Kansas City School of Medicine, Kansas
City, KS, United States
(Kereiakes) Christ Hospital, Cincinnati, OH, United States
(Zajarias) Barnes-Jewish Hospital, Washington University, St. Louis, WA,
United States
(Greason) Mayo Clinic, Rochester, MN, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Hodson) Providence St. Vincent Medical Center, Portland, OR, United
States
(Russo) Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
Publisher
Massachussetts Medical Society
Abstract
Background: There are scant data on long-term clinical outcomes and
bioprosthetic-valve function after transcatheter aortic-valve replacement
(TAVR) as compared with surgical aorticvalve replacement in patients with
severe aortic stenosis and intermediate surgical risk. <br/>Method(s): We
enrolled 2032 intermediate-risk patients with severe, symptomatic aortic
stenosis at 57 centers. Patients were stratified according to intended
transfemoral or transthoracic access (76.3% and 23.7%, respectively) and
were randomly assigned to undergo either TAVR or surgical replacement.
Clinical, echocardiographic, and healthstatus outcomes were followed for 5
years. The primary end point was death from any cause or disabling stroke.
<br/>Result(s): At 5 years, there was no significant difference in the
incidence of death from any cause or disabling stroke between the TAVR
group and the surgery group (47.9% and 43.4%, respectively; hazard ratio,
1.09; 95% confidence interval [CI], 0.95 to 1.25; P = 0.21). Results were
similar for the transfemoral-access cohort (44.5% and 42.0%, respectively;
hazard ratio, 1.02; 95% CI, 0.87 to 1.20), but the incidence of death or
disabling stroke was higher after TAVR than after surgery in the
transthoracic-access cohort (59.3% vs. 48.3%; hazard ratio, 1.32; 95% CI,
1.02 to 1.71). At 5 years, more patients in the TAVR group than in the
surgery group had at least mild paravalvular aortic regurgitation (33.3%
vs. 6.3%). Repeat hospitalizations were more frequent after TAVR than
after surgery (33.3% vs. 25.2%), as were aortic-valve reinterventions
(3.2% vs. 0.8%). Improvement in health status at 5 years was similar for
TAVR and surgery. <br/>Conclusion(s): Among patients with aortic stenosis
who were at intermediate surgical risk, there was no significant
difference in the incidence of death or disabling stroke at 5 years after
TAVR as compared with surgical aortic-valve replacement.<br/>Copyright
&#xa9; 2020 Massachusetts Medical Society.

<5>
[Use Link to view the full text]
Accession Number
631106244
Title
Avoidance of Vagal Response During Circumferential Pulmonary Vein
Isolation: Effect of Initiating Isolation From Right Anterior Ganglionated
Plexi.
Source
Circulation: Arrhythmia and Electrophysiology. 12 (12) (no pagination),
2019. Article Number: e007811. Date of Publication: 01 Dec 2019.
Author
Hu F.; Zheng L.; Liu S.; Shen L.; Liang E.; Ding L.; Wu L.; Chen G.; Fan
X.; Yao Y.
Institution
(Hu, Zheng, Liu, Shen, Liang, Ding, Wu, Chen, Fan, Yao) Cardiac Arrhythmia
Center, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Circumferential pulmonary vein isolation (CPVI) often cause
unavoidable vagal reflexes during procedure due to the coincidental
modification of ganglionated plexus which are located on pulmonary vein
(PV) antrum. The right anterior ganglionated plexi (RAGP) which located at
superoanterior area of right superior PV antrum is an essential station to
regulate the cardiac autonomic nerve activities and is easily
coincidentally ablated during CPVI. The aim of this study is to assess the
effect of RAGP ablation on vagal response (VR) during CPVI.
<br/>Method(s): A total of 80 patients with paroxysmal atrial fibrillation
who underwent the first time CPVI were prospectively enrolled and randomly
assigned to 2 groups: group A (n=40), CPVI started with right PVs at RAGP
site; group B (n=40): CPVI started with left PVs first, and the last
ablation site is RAGP. Electrophysiological parameters include basal cycle
length, A-H interval, H-V interval, sinus node recovery time, and
atrioventricular node Wenckebach point were recorded before and after CPVI
procedure. <br/>Result(s): During CPVI, the positive VR were only observed
on 1 patient in group A and 25 patients in group B (P<0.001). A total of
21 patients with positive VR in group B needed for temporary ventricular
pacing during procedure, while the only patient with positive VR in group
A did not need for temporary ventricular pacing (P<0.001). Compared with
baseline, basal cycle length, sinus node recovery time, and
atrioventricular node Wenckebach point were decreased significantly after
CPVI procedure in both groups (all P<0.05) and without differences between
2 groups. <br/>Conclusion(s): Circumferential PV isolation initiated from
RAGP could effectively inhibit VR occurrence and significantly increase
heart rate during procedure.<br/>Copyright &#xa9; 2019 Circulation:
Arrhythmia and Electrophysiology. All rights reserved.

<6>
Accession Number
631362409
Title
Is surgical resection of primary tumour superior to exploratory
thoracotomy without resection in treating lung cancer patients with
unexpected pleural metastasis detected during operation?.
Source
Interactive cardiovascular and thoracic surgery. 30 (4) (pp 582-587),
2020. Date of Publication: 01 Apr 2020.
Author
Deng H.-Y.; Zheng X.; Zhu D.-X.; Zhou Q.
Institution
(Deng, Zheng, Zhu, Zhou) Lung Cancer Center, West China Hospital, Sichuan
University, Chengdu, China
Publisher
NLM (Medline)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'In lung cancer patients
with unexpected pleural metastasis detected during operation, is surgical
resection of primary tumour superior to exploratory thoracotomy without
resection in improving long-term survival?'. Altogether, 1443 papers were
found using the reported search, of which 1 meta-analysis and 10
retrospective observational cohort studies represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers were tabulated. One meta-analysis and 9 cohort
studies found that surgical resection of the primary tumour, on the
discovery of pleural metastases, yielded a better overall survival than
exploratory thoracotomy alone, while 1 cohort study showed no difference.
Six studies found that main tumour resection was an independent favourable
prognostic factor for overall survival in lung cancer patients with
unexpected pleural metastasis detected during operation, while 3 cohort
studies also showed improved progression-free survival over exploratory
thoracotomy. Therefore, we conclude that surgical resection of the primary
tumour is superior to exploratory thoracotomy in treating lung cancer
patients with unexpected pleural metastasis detected during
operation.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<7>
Accession Number
627954922
Title
Delirium is associated with higher mortality in transcatheter aortic valve
replacement: systemic review and meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. 35 (2) (pp 168-176), 2020.
Date of Publication: 01 Apr 2020.
Author
Prasitlumkum N.; Mekritthikrai R.; Kewcharoen J.; Kanitsoraphan C.; Mao
M.A.; Cheungpasitporn W.
Institution
(Prasitlumkum, Mekritthikrai, Kewcharoen, Kanitsoraphan) Internal Medicine
Residency Program, University of Hawaii, 1356 Lusitana St, Honolulu, HI
96813, United States
(Mao) Department of Internal Medicine, Mayo Clinic, Rochester, MN, United
States
(Cheungpasitporn) Department of Medicine, University of Mississippi
Medical Center, Jackson, MS, United States
Publisher
Springer
Abstract
Post-operative delirium (POD) has been recognized as an independent risk
factor for mortality. Recent studies suggest that POD is associated with
higher mortality rates in patients undergoing transcatheter aortic valve
replacement (TAVR). However, a systematic review and meta-analysis of the
literature has not been performed. This study assessed the association
between POD and TAVR by performing a systematic review and meta-analysis
of the literature. We comprehensively searched the databases of MEDLINE
and EMBASE from inception to April 2018. Included studies were prospective
or retrospective cohort studies that compared mortality among patients
undergoing TAVR both with and without POD. Data from each study were
combined using the random-effects, generic inverse variance method of
DerSimonian and Laird to calculate risk ratios and 95% confidence
intervals. Seven studies consisting of 20,086 subjects undergoing TAVR
(1517 with POD and 18,569 without POD) were included in this
meta-analysis. POD demonstrated a trend towards higher all-cause mortality
(pooled odd ratio 1.52, 95% confidence interval 0.98-2.37, p = 0.062,
I² = 72%). POD was associated with a significant increased
long-term mortality (pooled odd ratio 2.11, 95% confidence interval
1.21-3.68, p = 0.009, I² = 62.5%). POD was associated with an
increased risk of long-term all-cause mortality in patients undergoing
TAVR. Our study suggests POD could be a potential risk factor of mortality
among patients undergoing TAVR. Further studies implementing preventative
and treatment strategies against delirium and its effect on POD and its
associated mortality are needed.<br/>Copyright &#xa9; 2019, Japanese
Association of Cardiovascular Intervention and Therapeutics.

<8>
[Use Link to view the full text]
Accession Number
631366609
Title
Effect of sub-hypothermia blood purification technique in cardiac shock
after valvular disease surgery.
Source
Medicine. 99 (13) (pp e19476), 2020. Date of Publication: 01 Mar 2020.
Author
Fang J.; Xu M.; Liu B.; Wang B.; Ren H.; Yang H.; Dong Y.; Song L.; Xiao
H.
Institution
(Fang, Xu, Wang, Song) Department of Cardiac Surgery
(Liu, Ren) Department of Intensive Care Unit, Wuhan Asia Heart Hospital,
Wuhan, China
(Yang) Department of Urinary Surgery, Dongfeng Maojian Hospital, Shiyan,
China
(Dong) Department of Cardiology, Wuhan Asia Heart Hospital
(Xiao) Department of Intensive Care Unit, Asia Heart Hospital, Wuhan
University of Science and Technology, Wuhan, China
Publisher
NLM (Medline)
Abstract
To observe the effect of sub-hypothermia (HT) blood purification technique
in the treatment of cardiac shock after heart valve disease.The patients
were randomly divided into normothermic (NT) continuous blood purification
(CBP) group (NT group) and HT CBP group (HT group). Observe the cardiac
index (CI), the oxygen delivery (DO2) and oxygen consumption (VO2) ratio,
Acute Physiology and Chronic Health Evaluation III(APACHE III) score,
multiple organ dysfunction syndrome (MODS) score, dynamic monitoring of
electrocardiograph, blood loss with or without muscle tremors, intensive
care unit stay, mechanical ventilation time, CBP time, and the cases of
infection and mortality at 0 day, 1 day, 2 day, 3 day; all above
indicators were compared between 2 groups.Ninety-five patients were
randomly assigned into HT group (48 cases) and NT group (47 cases); there
were no significant differences between the 2 groups for age, gender,
pre-operative cardiac function, cardiothoracic ratio, and type of valve
replacement (P > .05). There were no significant differences among the 1
day, 2 day, 3 day after recruited for CI, DO2/VO2 ratio, APACHE III score,
MODS score (P > .05). But in HT group, DO2/VO2 ratio had been
significantly improved after treatment for 1 day (2.5 +/- 0.7 vs 1.8 +/-
0.4, P = .024), and CI (3.0 +/- 0.5 vs 1.9 +/- 0.7, P = .004), APACHE III
score (50.6 +/- 6.2 vs 77.5 +/- 5.5 P = .022), MODS score (6.0 +/- 1.5 vs
9.3 +/- 3.4, P = .013) also had been significantly improved after
treatment for 3 days. In clinical outcomes, there were no significant
differences between 2 groups for blood loss (617.0 +/- 60.7 ml vs 550.9
+/- 85.2 ml, P = .203), infection ratio (54.17% vs 53.19%, P = .341), the
incidence of ventricular arrhythmia (31.25% vs 36.17%, P = .237), and
muscle tremors (14.58% vs 8.51%, P = .346), while there were significant
differences between 2 groups for intensive care unit stay (6.9 +/- 3.4
days vs 12.5 +/- 3.5 days, P = .017,), mechanical ventilation time (4.2
+/- 1.3 days vs 7.5 +/- 2.7 days, P = .034,), CBP time (4.6 +/- 1.4 days
vs 10.5 +/- 4.0 days, P = .019), mortality (12.50% vs 23.40%, P = .024).
But the incidence of bradycardia in HT group was much higher than the NT
group (29.16% vs 14.89%, P = .029).HT blood purification is a safer and
more effective treatment than NT blood purification for patients who
suffered from cardiac shock after valve surgery.

<9>
Accession Number
631321388
Title
Prognostic power of cardiopulmonary exercise testing in Fontan patients: A
systematic review.
Source
Open Heart. 5 (1) (no pagination), 2018. Article Number: e000812. Date of
Publication: 2018.
Author
Udholm S.; Aldweib N.; Hjortdal V.E.; Veldtman G.R.
Institution
(Udholm, Hjortdal) Department of Cardiothoracic and Vascular Surgery,
Aarhus University Hospital, Aarhus, Denmark
(Aldweib) Cardiovascular Medicine Department, Allegheny General Hospital,
Pittsburgh, PA, United States
(Veldtman) Adult Congenital Heart Disease Program, Heart Institute,
Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, United
States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Exercise impairment is common in Fontan patients. Our aim is to
systematically review previous literature to determine the prognostic
value of exercise capacity in older adolescent and adult Fontan patients
with respect to late outcome. Additionally, we reviewed the determinants
of exercise capacity in Fontan patients and changes in exercise capacity
over time. Methods PubMed, CINAHL, Embase, The Cochrane Library and Scopus
were searched systematically for studies reporting exercise capacity and
late outcome such as mortality, cardiac transplantation and
hospitalisation. Studies were eligible for inclusion if more than 30
patients were included and mean age was >=16 years. Results Four thousand
and seven hundred and twenty-two studies were identified by the systematic
search. Seven studies fulfilled the inclusion and exclusion criteria. The
total number of patients was 1664 adult Fontan patients. There were 149
deaths and 35 heart transplantations. All eligible studies were
retrospective cohort studies. The correlation between exercise capacity
and late outcome was identified, and HRs were reported. Conclusion In
Fontan patients, the best predictors of death and transplantation were a
decline in peak VO<inf>2</inf>, heart rate variables and exercise
oscillatory ventilation. Peak VO<inf>2</inf> was not strongly predictive
of mortality or hospitalisation in Fontan patients. Several variables were
strong and independent predictors of hospitalisation and
morbidity.<br/>Copyright &#xa9; Article author(s) (or their employer(s)
unless otherwise stated in the text of the article) 2018. All rights
reserved. No commercial use is permitted unless otherwise expressly
granted.

<10>
Accession Number
631367750
Title
Anticoagulation with or without Clopidogrel after Transcatheter
Aortic-Valve Implantation.
Source
The New England journal of medicine. (no pagination), 2020. Date of
Publication: 29 Mar 2020.
Author
Nijenhuis V.J.; Brouwer J.; Delewi R.; Hermanides R.S.; Holvoet W.; Dubois
C.L.F.; Frambach P.; De Bruyne B.; van Houwelingen G.K.; Van Der Heyden
J.A.S.; Tousek P.; van der Kley F.; Buysschaert I.; Schotborgh C.E.;
Ferdinande B.; van der Harst P.; Roosen J.; Peper J.; Thielen F.W.F.;
Veenstra L.; Chan Pin Yin D.R.P.P.; Swaans M.J.; Rensing B.J.W.M.; van 't
Hof A.W.J.; Timmers L.; Kelder J.C.; Stella P.R.; Baan J.; Ten Berg J.M.
Institution
(Nijenhuis, Brouwer, Delewi, Hermanides, Holvoet, Dubois, Frambach, De
Bruyne, van Houwelingen, Van Der Heyden, Tousek, van der Kley,
Buysschaert, Schotborgh, Ferdinande, van der Harst, Roosen, Peper,
Thielen, Veenstra, Chan Pin Yin, Swaans, Rensing, van 't Hof, Timmers,
Kelder, Stella, Baan, Ten Berg) From the Department of Cardiology, St.
Antonius Hospital, Nieuwegein (V.J.N., J. Brouwer, J.P., D.R.P.P.C.P.Y.,
M.J.S., B.J.W.M.R., L.T., J.C.K., J.M.B.), the Department of Cardiology,
Amsterdam University Medical Centers, Location AMC, Amsterdam (R.D., J.
Baan), the Department of Cardiology, Isala Hospital, Zwolle (R.S.H.), the
Department of Cardiology, Maastricht University Medical Center and
Cardiovascular Research Institute, Maastricht (W.H., L.V., A.W.J.H.), the
Department of Cardiology, Medisch Spectrum Twente, Enschede (G.K.H.), the
Department of Cardiology, Leiden University Medical Center, Leiden (F.K.),
the Department of Cardiology, Haga Hospital, The Hague (C.E.S.), the
Department of Cardiology, University Medical Center Groningen, Groningen
(P.H.), Erasmus School of Health Policy and Management, Erasmus
University, Rotterdam (F.W.F.T.), the Department of Cardiology, Zuyderland
Medical Center, Heerlen (A.W.J.H.), and the Department of Cardiology,
Division of Heart and Lungs, University Medical Center Utrecht, Utrecht
University, Utrecht (P.R.S.) - all in the Netherlands; the Department of
Cardiology, University Hospital Leuven, Leuven (C.L.F.D.), the Department
of Cardiology, Onze Lieve Vrouwe Hospital (B.D.B.), and the Department of
Cardiology, Algemeen Stedelijk Hospital Aalst (I.B.), Aalst, the
Department of Cardiology, Sint-Jan Hospital, Brugge (J.A.S.V.D.H.), the
Department of Cardiology, Hospital Oost-Limburg, Genk (B.F.), and the
Department of Cardiology, Imelda Hospital, Bonheiden (J.R.) - all in
Belgium; the Department of Cardiology, Institut National de Chirurgie
Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
(P.F.); and the Department of Cardiology, University Hospital Kralovske
Vinohrady and Third Medical Faculty, Charles University, Prague, Czech
Republic (P.T.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The roles of anticoagulation alone or with an antiplatelet
agent after transcatheter aortic-valve implantation (TAVI) have not been
well studied. <br/>METHOD(S): We performed a randomized trial of
clopidogrel in patients undergoing TAVI who were receiving oral
anticoagulation for appropriate indications. Patients were assigned before
TAVI in a 1:1 ratio not to receive clopidogrel or to receive clopidogrel
for 3 months. The two primary outcomes were all bleeding and
non-procedure-related bleeding over a period of 12 months.
Procedure-related bleeding was defined as Bleeding Academic Research
Consortium type 4 severe bleeding, and therefore most bleeding at the
puncture site was counted as non-procedure-related. The two secondary
outcomes were a composite of death from cardiovascular causes,
non-procedure-related bleeding, stroke, or myocardial infarction at 12
months (secondary composite 1) and a composite of death from
cardiovascular causes, ischemic stroke, or myocardial infarction
(secondary composite 2), both tested for noninferiority (noninferiority
margin, 7.5 percentage points) and superiority. <br/>RESULT(S): Bleeding
occurred in 34 of the 157 patients (21.7%) receiving oral anticoagulation
alone and in 54 of the 156 (34.6%) receiving oral anticoagulation plus
clopidogrel (risk ratio, 0.63; 95% confidence interval [CI], 0.43 to 0.90;
P=0.01); most bleeding events were at the TAVI access site.
Non-procedure-related bleeding occurred in 34 patients (21.7%) and in 53
(34.0%), respectively (risk ratio, 0.64; 95% CI, 0.44 to 0.92; P=0.02).
Most bleeding occurred in the first month and was minor. A secondary
composite 1 event occurred in 49 patients (31.2%) receiving oral
anticoagulation alone and in 71 (45.5%) receiving oral anticoagulation
plus clopidogrel (difference, -14.3 percentage points; 95% CI for
noninferiority, -25.0 to -3.6; risk ratio, 0.69; 95% CI for superiority,
0.51 to 0.92). A secondary composite 2 event occurred in 21 patients
(13.4%) and in 27 (17.3%), respectively (difference, -3.9 percentage
points; 95% CI for noninferiority, -11.9 to 4.0; risk ratio, 0.77; 95% CI
for superiority, 0.46 to 1.31). <br/>CONCLUSION(S): In patients undergoing
TAVI who were receiving oral anticoagulation, the incidence of serious
bleeding over a period of 1 month or 1 year was lower with oral
anticoagulation alone than with oral anticoagulation plus clopidogrel.
(Funded by the Netherlands Organization for Health Research and
Development; POPular TAVI EU Clinical Trials Register number,
2013-003125-28; ClinicalTrials.gov number, NCT02247128.).<br/>Copyright
&#xa9; 2020 Massachusetts Medical Society.

<11>
Accession Number
2005432654
Title
Validation of the long-term prognostic capability of the SYNTAX score II
in patients undergoing biodegradable polymer-based Sirolimus-eluting
stents: 2-year outcomes from the PANDA III trial.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Song Y.; Guan C.; Cao X.; Qin L.; Li Y.; Li Z.; Nie S.; Hou S.; Zhang M.;
Gao R.; Yuan J.; Xu B.
Institution
(Song, Gao, Yuan) Fu Wai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, Beijing, China
(Guan, Xu) Catheterization Laboratories, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing,
China
(Cao) Chinese PLA 252 Hospital, Baoding, China
(Qin) Kaifeng Central Hospital, Kaifeng, China
(Li) Yunnan St. John's Hospital, Kunming, China
(Li) Liaoning Provincial People's Hospital, Shenyang, China
(Nie) Affiliated Anzhen Hospital of Capital Medical University, Beijing,
China
(Hou, Zhang) China Cardiovascular Research Foundation Inc., Beijing, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: This study aimed to assess the prognostic ability of SYNTAX
(Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac
Surgery) Score II (SS-II) in LM and/or TVD patients undergoing
biodegradable polymer-based drug-eluting stents (BP-DES) in the
multi-central randomized PANDA III trial. <br/>Method(s): A total of 723
patients in PANDA III population were enrolled in this study. According to
SS-II tertiles, patients were stratified as follow: SS-II <= 23 (n = 224),
23 < SS II <= 31 (n = 255), SS II > 31 (n = 244). The predictive abilities
for 2-year cardiac death were compared between angiographic scores and
scores combining both angiographic and clinical variables. <br/>Result(s):
Mean anatomic SS was 20.6 +/- 9.4, SS-II for PCI was 28.7 +/- 8.6. During
2-year follow up, cardiac death (0.00% vs. 1.7% vs. 4.3%, p = 0.003) and
target lesion failure (5.9% vs. 9.1% vs. 13.6%, p = 0.020) was
significantly higher in the upper tertile group than in intermedian and
low tertile. At multivariate analysis, SS-II for PCI was an independent
risk factor of cardiac death (Hazard ratio: 2.41, 95%CI: 1.47-3.97, p <
0.005) and TLF (Hazard ratio: 1.29, 95%CI: 1.01-1.65, p = 0.040). The ROC
curve analysis showed that SS-II for PCI had better ability than other
SYNTAX scoring systems to predict cardiac death (AUC: 0.746,
95%CI:0.63-0.87, p = 0.010). <br/>Conclusion(s): The SS-II had superiority
than other SYNTAX scoring systems in predicting 2-year cardiac death in LM
and/or TVD patients undergoing PCI with biodegradable polymer drug-eluting
stents.<br/>Copyright &#xa9; 2020

<12>
Accession Number
2005280146
Title
Levosimendan Versus Milrinone for Inotropic Support in Pediatric Cardiac
Surgery: Results From a Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Thorlacius E.M.; Wahlander H.; Ojala T.; Ylanen K.; Keski-Nisula J.;
Synnergren M.; Romlin B.S.; Ricksten S.-E.; Castellheim A.
Institution
(Thorlacius, Romlin, Ricksten, Castellheim) Department of Anesthesiology
and Intensive Care Medicine, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden
(Wahlander) Department of Pediatric Cardiology, Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Thorlacius, Wahlander, Romlin, Ricksten, Castellheim) Region Vastra
Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
(Ojala, Ylanen) Department of Pediatric Cardiology, Children's Hospital,
Helsinki University Hospital, Helsinki University, Helsinki, Finland
(Keski-Nisula) Department of Anesthesia and Intensive Care, Children's
Hospital, Helsinki University Hospital, Helsinki University, Helsinki,
Finland
(Synnergren) Department of Pediatric Thoracic Surgery, Sahlgrenska
University Hospital, Gothenburg, Sweden
Publisher
W.B. Saunders
Abstract
Objective: The present study aimed to determine the differential effects
of intraoperative administration of milrinone versus levosimendan on
myocardial function after pediatric cardiac surgery. Transthoracic
echocardiography was used for myocardial function evaluation using
biventricular longitudinal strain with 2-dimensional speckle tracking
echocardiography in addition to conventional echocardiographic variables.
<br/>Design(s): A secondary analysis of a randomized, prospective,
double-blinded clinical drug trial. <br/>Setting(s): Two pediatric
tertiary university hospitals. <br/>Participant(s): Infants between 1 and
12 months old diagnosed with ventricular septal defect, complete
atrioventricular septal defect, or tetralogy of Fallot who were scheduled
for corrective surgery with cardiopulmonary bypass. <br/>Intervention(s):
The patients were randomly assigned to receive an infusion of milrinone or
levosimendan at the start of cardiopulmonary bypass and for 26 consecutive
hours. <br/>Measurements and Main Results: Biventricular longitudinal
strain and conventional echocardiographic variables were measured
preoperatively, on the first postoperative morning, and before hospital
discharge. The association between perioperative parameters and
postoperative myocardial function also was investigated. Images were
analyzed for left ventricular (n = 67) and right ventricular (n = 44)
function. The day after surgery, left ventricular longitudinal strain
deteriorated in both the milrinone and levosimendan groups (33% and 39%,
respectively). The difference was not significant. The corresponding
deterioration in right ventricular longitudinal strain was 42% and 50%
(nonsignificant difference). For both groups, biventricular longitudinal
strain approached preoperative values at hospital discharge. Preoperative
N-terminal pro-brain natriuretic peptide could predict the left
ventricular strain on postoperative day 1 (p = 0.014). <br/>Conclusion(s):
Levosimendan was comparable with milrinone for left and right ventricular
inotropic support in pediatric cardiac surgery.<br/>Copyright &#xa9; 2020
Elsevier Inc.

<13>
Accession Number
2005227019
Title
Low-Dose Alteplase During Primary Percutaneous Coronary Intervention
According to Ischemic Time.
Source
Journal of the American College of Cardiology. 75 (12) (pp 1406-1421),
2020. Date of Publication: 31 March 2020.
Author
McCartney P.J.; Maznyczka A.M.; Eteiba H.; McEntegart M.; Oldroyd K.G.;
Greenwood J.P.; Maredia N.; Schmitt M.; McCann G.P.; Fairbairn T.;
McAlindon E.; Tait C.; Welsh P.; Sattar N.; Orchard V.; Corcoran D.; Ford
T.J.; Radjenovic A.; Ford I.; McConnachie A.; Berry C.
Institution
(McCartney, Maznyczka, Eteiba, McEntegart, Welsh, Sattar, Corcoran, Ford,
Radjenovic, Berry) British Heart Foundation Glasgow Cardiovascular
Research Center, University of Glasgow, Glasgow, United Kingdom
(McCartney, Maznyczka, Eteiba, McEntegart, Oldroyd, Orchard, Berry) West
of Scotland Heart and Lung Center, Golden Jubilee National Hospital,
Clydebank, United Kingdom
(Greenwood) Leeds University and Leeds Teaching Hospitals National Health
Service (NHS) Trust, Leeds, United Kingdom
(Maredia) South Tees Hospitals NHS Foundation Trust, Middlesbrough, United
Kingdom
(Schmitt) Manchester University NHS Foundation Trust, Manchester, United
Kingdom
(McCann) University of Leicester and the National Institute for Health
Research Leicester Biomedical Research Center, Leicester, United Kingdom
(Fairbairn) Liverpool Heart and Chest Hospital NHS Foundation Trust,
Liverpool, United Kingdom
(McAlindon) New Cross Hospital, Royal Wolverhampton NHS Trust,
Wolverhampton, United Kingdom
(Tait) Department of Hematology, Royal Infirmary, Glasgow, United Kingdom
(Ford) Department of Cardiology, Gosford Hospital, Gosford, New South
Wales, Australia
(Ford, McConnachie) Robertson Centre for Biostatistics, Institute of
Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
Publisher
Elsevier USA
Abstract
Background: Microvascular obstruction affects one-half of patients with
ST-segment elevation myocardial infarction and confers an adverse
prognosis. <br/>Objective(s): This study aimed to determine whether the
efficacy and safety of a therapeutic strategy involving low-dose
intracoronary alteplase infused early after coronary reperfusion
associates with ischemic time. <br/>Method(s): This study was conducted in
a prospective, multicenter, parallel group, 1:1:1 randomized, dose-ranging
trial in patients undergoing primary percutaneous coronary intervention.
Ischemic time, defined as the time from symptom onset to coronary
reperfusion, was a pre-specified subgroup of interest. Between March 17,
2016, and December 21, 2017, 440 patients, presenting with ST-segment
elevation myocardial infarction within 6 h of symptom onset (<2 h, n =
107; >=2 h but <4 h, n = 235; >=4 h to 6 h, n = 98), were enrolled at 11
U.K. hospitals. Participants were randomly assigned to treatment with
placebo (n = 151), alteplase 10 mg (n = 144), or alteplase 20 mg (n =
145). The primary outcome was the amount of microvascular obstruction
(MVO) (percentage of left ventricular mass) quantified by cardiac magnetic
resonance imaging at 2 to 7 days (available for 396 of 440).
<br/>Result(s): Overall, there was no association between alteplase dose
and the extent of MVO (p for trend = 0.128). However, in patients with an
ischemic time >=4 to 6 h, alteplase increased the mean extent of MVO
compared with placebo: 1.14% (placebo) versus 3.11% (10 mg) versus 5.20%
(20 mg); p = 0.009 for the trend. The interaction between ischemic time
and alteplase dose was statistically significant (p = 0.018).
<br/>Conclusion(s): In patients presenting with ST-segment elevation
myocardial infarction and an ischemic time >=4 to 6 h, adjunctive
treatment with low-dose intracoronary alteplase during primary
percutaneous coronary intervention was associated with increased MVO.
Intracoronary alteplase may be harmful for this subgroup. (A Trial of
Low-Dose Adjunctive Alteplase During Primary PCI [T-TIME];
NCT02257294)<br/>Copyright &#xa9; 2020 The Authors

<14>
Accession Number
631187266
Title
Transcatheter aortic valve replacement in patients with severe aortic
stenosis and active cancer: A systematic review and meta-analysis.
Source
Open Heart. 7 (1) (no pagination), 2020. Article Number: e001131. Date of
Publication: 11 Mar 2020.
Author
Bendary A.; Ramzy A.; Bendary M.; Salem M.
Institution
(Bendary, Ramzy, Salem) Cardiology, Benha University Faculty of Medicine,
Benha, Egypt
(Bendary) Biostatisitcs, National Cancer Institute, Cairo University,
Cairo, Egypt
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Patients with severe aortic stenosis and concomitant active
cancer (AC) are considered high-risk patients and usually are not allowed
to undergo surgical valve replacement. Transcatheter aortic valve
replacement (TAVR) may be an attractive option for them; however, little
is known about the outcomes of TAVR in this subset of complex patients.
Methods and results In this meta-analysis, Medline, Cochrane Library and
Scopus databases were searched (anytime up to April 2019) for studies
evaluating the outcomes of TAVR in patients with or without AC. We
assessed pooled estimates (with their 95% CIs) of the risk ratio (RR) for
the all-cause mortality at the 30-day and 1-year follow-ups, a 4-point
safety outcome (any bleeding, stroke, need for a pacemaker and acute
kidney injury) and a 2-point efficacy outcome (device success and residual
mean gradient (mean difference)). Three studies (5162 patients) were
included. Of those patients, a total of 368 (7.1%) had AC. Apart from a
significantly higher need for a postprocedural pacemaker (RR 1.29, 95% CI
1.06 to 1.58, p=0.01), TAVR in patients with AC resulted in similar
outcomes for safety and efficacy at the 30-day follow-up compared with
those without AC. Patients with AC experienced similar rates of the
all-cause mortality at the 30-day follow-up compared with those without
(RR 0.92, 95% CI 0.53 to 1.59, p=0.76); however, the all-cause mortality
was significantly higher in patients with AC at the 1-year follow-up (RR
1.71, 95% CI 1.26 to 2.33, p=0.0006). This mortality difference was
independent of cancer stage (advanced or limited) at the 30-day follow-up
but not at the 1-year follow-up; only patients with limited cancer stages
showed similar all-cause mortality rates compared with those without
cancer at the 1-year follow-up (RR 1.22, 95% CI 0.79 to 1.91, p=0.37).
Conclusion TAVR in patients with AC is associated with similar 30-day and
potentially worse 1-year outcomes compared with those in patients without
AC. The 1-year all-cause mortality appears to be dependent on the cancer
stage. Involving a specialised oncologist who usually considers cancer
stage in the decision-making process and applying additional preoperative
scores such as frailty indices might refine the risk assessment process
among these patients. PROSPERO registration number
CRD42019120416.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<15>
Accession Number
627259567
Title
A prospective randomized comparison of airway seal using the novel
vision-guided insertion of LMA-Supreme and LMA-Protector.
Source
Journal of Clinical Monitoring and Computing. 34 (2) (pp 285-294), 2020.
Date of Publication: 01 Apr 2020.
Author
van Zundert A.A.J.; Wyssusek K.H.; Pelecanos A.; Roets M.; Kumar C.M.
Institution
(van Zundert, Wyssusek, Roets) Department of Anaesthesia and Perioperative
Medicine, Royal Brisbane and Women's Hospital, The University of
Queensland, Brisbane, QLD, Australia
(Pelecanos) Statistics Unit, QIMR Berghofer Medical Research Institute,
The University of Queensland, Brisbane, QLD, Australia
(Kumar) Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun
Central, Singapore
(Kumar) Newcastle University, Newcastle, United Kingdom
(van Zundert) Queensland University of Technology, Brisbane, QLD,
Australia
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
The laryngeal mask airways supreme (LMA-SupremeTM) and protector
(LMA-ProtectorTM) are generally placed blindly, often resulting in a less
than optimal position and vision-guided placement has been recommended.
This prospective, randomized controlled study compared the efficacy of
airway seal by measuring the oropharyngeal leak pressure in 100 surgical
patients who underwent a variety of non-thoracic surgery under general
anaesthesia, suitable with a supraglottic airway device. Patients were
allocated to either the LMA-Supreme (n = 50) or LMA-Protector (n = 50)
group. All insertions were performed under vision of a videolaryngoscope
using an 'insert-detect-correct-as-you-go' technique with standardized
corrective measures. Our primary endpoint, mean oropharyngeal leak
pressure, was significantly higher in the LMA-Protector (31.7 +/- 2.9 cm
H<inf>2</inf>O) compared to the LMA-Supreme (27.7 +/- 3.5 cm
H<inf>2</inf>O) group (mean difference 4.0 cm H<inf>2</inf>O, 95%
confidence interval (CI) 2.7-5.3 cm H<inf>2</inf>O, p < 0.001) after
achieving a near-optimal fibreoptic position in the LMA-Protector (94%)
and LMA-Supreme (96%) groups. No statistically significant differences
were shown for secondary outcomes of alignment, number of insertion
attempts and malpositions, and final anatomical position as scored by
fibreoptic evaluation. Corrective manoeuvres were required in virtually
all patients to obtain a correct anatomically positioned LMA. Position
outcomes of the two devices were similar except for the proportion of
procedures with folds in the proximal cuff (90% LMA-Supreme vs. 2%
LMA-Protector, p < 0.001), the need for intracuff pressure adjustments
(80% LMA-Supreme vs. 48% LMA-Protector, p = 0.001) and size correction
(18% LMA-Supreme vs. 4% LMA-Protector, p = 0.025). In conclusion, a higher
oropharyngeal leak pressure can be achieved with LMA-Protector compared to
LMA-Supreme with optimal anatomical position when insertion is
vision-guided.<br/>Copyright &#xa9; 2019, Springer Nature B.V.

<16>
Accession Number
2003705597
Title
Vasoplegia after cardiac surgery.
Source
Netherlands Journal of Critical Care. 28 (1) (pp 28-32), 2020. Date of
Publication: 2020.
Author
Duivenvoorden M.M.; Hermens J.A.J.
Institution
(Duivenvoorden, Hermens) Department of Intensive Care Medicine, University
Medical Center Utrecht, Utrecht, Netherlands
Publisher
Netherlands Society of Intensive Care
Abstract
A case of severe refractory hypotension following a cardiac transplant is
presented. In the hours after surgery, vasoplegia was diagnosed in the
intensive care unit after exclusion of common causes of hypotension after
cardiac surgery. Vasoplegia after cardiac surgery is a condition
characterised by severe systemic hypotension, low systemic vascular
resistance and a normal to high cardiac output which is often refractory
to conventional vasopressor therapy and fluid administration. The
pathophysiology is still incompletely understood but seems to be related
to several preoperative factors as well as the use of the cardiopulmonary
bypass. As this phenomenon is associated with an increased morbidity and
mortality, proper recognition is essential although treatment options are
limited.<br/>Copyright &#xa9; 2020, Netherlands Society of Intensive Care.
All rights reserved.

<17>
Accession Number
2003657138
Title
Targeting high-sensitivity C-reactive protein levels in acute coronary
syndrome patients undergoing contemporary lipid-lowering therapy: a
sub-analysis of the HIJ-PROPER trial.
Source
Journal of Cardiology. 75 (5) (pp 500-506), 2020. Date of Publication: May
2020.
Author
Kawada-Watanabe E.; Yamaguchi J.; Sekiguchi H.; Arashi H.; Ogawa H.;
Hagiwara N.
Institution
(Kawada-Watanabe, Yamaguchi, Sekiguchi, Arashi, Ogawa, Hagiwara)
Department of Cardiology, The Heart Institute of Japan, Tokyo Women's
Medical University, Tokyo, Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: The effects of high-sensitivity C-reactive protein (hs-CRP)
levels on clinical outcomes in chronic-phase acute coronary syndrome (ACS)
patients undergoing aggressive lipid-lowering therapy remain unclear. We
examined the effects of hs-CRP levels on the prognosis of ACS patients who
underwent aggressive lipid-lowering therapy and determined treatment
targets for hs-CRP value. <br/>Method(s): This post-hoc sub-analysis of a
prospective randomized control trial (HIJ-PROPER) included 1734 ACS
patients with dyslipidemia, who were divided into hs-CRP quartiles after 3
months of treatment. Primary endpoints were combined all-cause death,
non-fatal myocardial infarction, non-fatal stroke, unstable angina, and
ischemia-driven coronary revascularization. Secondary endpoint was
all-cause death. <br/>Result(s): The median follow-up period was 3.7
years. Overall, 1415 patients were evaluated retrospectively. No
significant among-group differences were noted in low-density lipoprotein
cholesterol (LDL-C) levels over time (p = 0.44). Kaplan-Meier analyses
revealed that the incidence of the primary and secondary endpoints was
significantly higher in the highest hs-CRP group than in the other groups
[hazard ratio (HR) = 1.52, 95% confidence interval (CI) = 1.16-2.00, p <
0.01; HR = 5.30, 95% CI = 2.47-11.32, p < 0.01, respectively]. The cut-off
hs-CRP level to predict all-cause death was 0.74 mg/L (receiver operating
characteristic curve: sensitivity: 68%, specificity: 62%). Multivariate
analyses revealed that hs-CRP >=0.74 mg/L at 3 months was correlated with
an increased risk of all-cause death (adjusted HR = 3.68, 95% CI =
2.22-6.10, p < 0.01). <br/>Conclusion(s): Elevated hs-CRP levels
independently predicted a worse prognosis, regardless of LDL-C levels,
suggesting that interventions against elevated inflammatory responses plus
intensive lipid-lowering therapy and coronary revascularization are
encouraging options for secondary prevention in ACS patients. Trial
registration: This trial is registered with the UMIN Clinical Trials
Registry number UMIN000002742. Trial name: Proper level of lipid lowering
with pitavastatin and ezetimibe in acute coronary syndrome (HIJ-PROPER)
URL:
https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr-view.cgi?recptno=R000003334
<br/>Copyright &#xa9; 2019 Japanese College of Cardiology

<18>
Accession Number
631312472
Title
Beneficial effect of left atrial appendage closure during cardiac surgery:
A meta-analysis of 280 585 patients.
Source
European Journal of Cardio-thoracic Surgery. 57 (2) (pp 252-262), 2020.
Date of Publication: 01 Feb 2020.
Author
Gutierrez E.M.; Castano M.; Gualis J.; Martinez-Comendador J.M.; Maiorano
P.; Castillo L.; Laguna G.
Institution
(Gutierrez, Castano, Gualis, Maiorano, Castillo, Laguna) Servicio de
Cirugia Cardiaca, Hospital Universitario de Leon-CAULE, Leon, Spain
(Martinez-Comendador) Servicio de Cirugia Cardiaca, Complexo Hospitalario
Universitario A Coruna (CHUAC), A Coruna, Spain
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
In non-rheumatic atrial fibrillation (AF), left atrial appendage (LAA) is
thought to be the source of embolism in 90% of the strokes. Thus, as
recent clinical trials have shown the non-inferiority of percutaneous LAA
closure (LAAc) in comparison to medical treatment, and despite a IIb
recommendation in the latest guidelines for concomitant surgical LAAc, we
sought to investigate the beneficial effect of LAAc in the surgical
population. A meta-analysis model was performed comparing studies
including any cardiac surgery with or without concomitant surgical LAAc
reporting stoke/embolic events and/or mortality, from inception to January
2019. Twenty-two studies (280 585 patients) were included in the model.
Stroke/embolic events both in the perioperative period [relative risk (RR)
0.66, 95% confidence interval (CI) 0.53-0.82; P = 0.0001] and during
follow-up of >2 years (RR 0.67, 95% CI 0.51-0.89; P < 0.005) were
significantly reduced in patients who underwent surgical LAAc (RR 0.71,
95% CI 0.58-0.87; P = 0.001). Regarding the rate of preoperative AF, LAAc
showed protective effect against stroke/embolic events in studies with
>70% preoperative AF (RR 0.64, 95% CI 0.53-0.77; P < 0.00001) but no
benefit in the studies with <30% of preoperative AF (RR 0.77, 95% CI
0.46-1.28; P = 0.31). Postoperative mortality was also significantly lower
in surgical patients with LAAc at the mid-and long-term follow-up. (RR
0.72, 95% CI 0.67-0.78; P < 0.00001; I² = 0%). Based on these
findings, concomitant surgical LAAc is associated with lower rates of
embolic events and stroke in the postoperative period in patients with
preoperative AF and also improves postoperative mortality in the mid-and
long-term follow-up.<br/>Copyright &#xa9; 2019 The Author(s).

<19>
Accession Number
626156333
Title
Evaluation of Albumin 25% Use in Critically Ill Patients at a Tertiary
Care Medical Center.
Source
Hospital Pharmacy. 55 (2) (pp 90-95), 2020. Date of Publication: 01 Apr
2020.
Author
Torbic H.; Bauer S.R.; Militello M.; Welch S.; Udeh C.; Richardson S.
Institution
(Torbic, Bauer, Militello, Welch, Udeh) Cleveland Clinic, OH, United
States
(Richardson) Kaweah Delta Health Care District, Visalia, CA, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Albumin 25% has been studied and has demonstrated benefit in a
limited number of patient populations. The use of albumin 25% is
associated with higher costs compared with crystalloid therapy. The aim of
this study was to describe the prescribing practices of albumin 25% at a
tertiary-care medical center and identify opportunities for restriction
criteria related to its use to help generate cost savings. <br/>Method(s):
This evaluation was a retrospective, noninterventional, descriptive study
of albumin 25% use between June 2015 and February 2016. Inclusion criteria
consisted of patients >=18 years old and who received at least one dose of
albumin 25% while admitted to a Cleveland Clinic main campus intensive
care unit (ICU). Inclusion was restricted to 150 randomly selected
patients. <br/>Result(s): A total of 539 albumin 25% orders were placed
for the 150 included patients. The cardiovascular ICU more frequently
prescribed albumin 25% compared with the medical, surgical, neurosciences,
and coronary ICUs (51% vs 23% vs 11% vs 9% vs 6%, respectively). Although
the cardiovascular surgery ICU most frequently prescribed albumin 25%
compared with other ICUs, the medical ICU prescribed a larger total
quantity of albumin 25% compared with the cardiovascular, surgical,
neurosciences, and coronary ICUs (8705 g vs 7275 g vs 3205 g vs 2162 g vs
625 g, respectively). The majority of patients (61%) did not have an
indication listed for albumin 25% use and only 9% of patients were
prescribed for indications supported by primary literature. Of the
patients prescribed albumin for other indications not supported by primary
literature (30%), the most common reasons for albumin 25% were
hypotension, acute kidney injury, and volume resuscitation. The median
cost per patient of albumin 25% was $417 with a total cost of $122 164 for
the cohort. Only 19% of the total cost aligned with dosing regimens
evaluated in primary literature. <br/>Conclusion(s): Prescribing patterns
of albumin 25% at a tertiary academic medical center do not align with
indications supported by primary literature. These findings identified a
major opportunity for prescriber education and implementation of
restriction criteria to target cost savings.<br/>Copyright &#xa9; The
Author(s) 2019.

<20>
Accession Number
2005366453
Title
Subclinical valve thrombosis in transcatheter aortic valve implantation: A
systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Woldendorp K.; Doyle M.P.; Black D.; Ng M.; Keech A.; Grieve S.M.; Bannon
P.G.
Institution
(Woldendorp, Black, Ng, Keech, Grieve, Bannon) Sydney Medical School, The
University of Sydney, Sydney, Australia
(Woldendorp, Doyle, Black, Bannon) The Baird Institute of Applied Heart
and Lung Surgical Research, Sydney, Australia
(Woldendorp, Doyle, Bannon) Cardiothoracic Surgical Unit, Royal Prince
Alfred Hospital, Sydney, Australia
(Ng, Keech) Cardiology Department, Royal Prince Alfred Hospital, Sydney,
Australia
(Grieve) Department of Radiology, Royal Prince Alfred Hospital, Sydney,
Australia
(Grieve) Sydney Translational Imaging Laboratory, Heart Research Institute
& Charles Perkins Centre, Sydney Medical School, University of Sydney,
Sydney, Australia
(Bannon) Institute of Academic Surgery, Royal Prince Alfred Hospital,
Sydney, Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Recent high-resolution computed tomography studies after
transcatheter aortic valve insertion (TAVI) have reported a high
prevalence of subclinical valve thrombosis (SCVT), potentially
contributing to increased risk of late stroke. We aimed to investigate
SCVT in patients after TAVI, with a focus on prevalence, predisposing
factors, management, and potential sequelae. <br/>Method(s): A
comprehensive literature review of patients with SCVT after TAVI was
carried out on all published studies in 3 major electronic databases from
their inception until October 2019. Studies with sufficient data were
included in a meta-analysis comparing the risk of stroke between patients
with SCVT and those with normal valve function, as well as the protective
effects of antiplatelet and anticoagulation on preventing SCVT.
<br/>Result(s): From 3456 patients examined in a comprehensive review, 398
patients (11.5%) demonstrated evidence of SCVT during follow-up. Dual
antiplatelet therapy was given in 45.5% of cases, single antiplatelet
therapy in 19.8%, and oral anticoagulation in 28.5%. A meta-analysis
demonstrated that rates of stroke were more than 3 times greater in
patients with SCVT compared with those without (logistic odds, 1.10; 95%
confidence interval, 0.63-1.57, P < .0001). Oral anticoagulation was
superior to dual antiplatelet therapy or single antiplatelet therapy,
preventing the formation of SCVT (logistic odds, -1.05, 95% confidence
interval, -1.71 to -0.39, P < .0001). <br/>Conclusion(s): Subclinical
valve thrombosis is seen in 11.5% of patients after TAVI and is associated
with increased risk of stroke. When oral anticoagulation is used
postprocedurally, it is more effective than either dual or
single-antiplatelet therapy in preventing subclinical valve thrombosis.
These findings suggest that further studies are needed to define the
optimal antithrombotic regimen to mitigate thrombotic and embolic sequelae
after TAVI.<br/>Copyright &#xa9; 2020

<21>
Accession Number
631064026
Title
Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative
Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery-
Multicenter Randomized Controlled Study.
Source
Circulation journal : official journal of the Japanese Circulation
Society. 84 (4) (pp 642-649), 2020. Date of Publication: 25 Mar 2020.
Author
Toda H.; Nakamura K.; Shimizu K.; Ejiri K.; Iwano T.; Miyoshi T.; Nakagawa
K.; Yoshida M.; Watanabe A.; Nishii N.; Hikasa Y.; Hayashi M.; Morita H.;
Morimatsu H.; Ito H.
Institution
(Toda, Nakamura, Ejiri, Iwano, Miyoshi, Nakagawa, Yoshida, Watanabe,
Nishii, Morita, Ito) Department of Cardiovascular Medicine, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences
(Shimizu, Hikasa, Hayashi, Morimatsu) Department of Anesthesiology,
Okayama University Graduate School of Medicine, Dentistry and
Pharmaceutical Sciences
(Morita) Department of Cardiovascular Therapeutics, Okayama University
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this study was to evaluate the efficacy and safety
of transdermal beta-blocker patches, which offer stable blood
concentration and easy availability during operation, for prevention of
perioperative myocardial injury (PMI) in high-risk patients.Methods and
Results:In this randomized controlled trial, patients aged >60 years with
hypertension and high revised cardiac risk index (>=2) undergoing
non-cardiac surgery were randomly assigned to a bisoprolol patch or
control group. Primary efficacy outcome was incidence of PMI, defined as
postoperative high-sensitivity cardiac troponin T (hs-cTnT) >0.014ng/mL
and relative hs-cTnT change >=20%. Secondary efficacy outcomes were number
of cardiovascular events and 30-day mortality. From November 2014 to
February 2019, 240 patients from 5 hospitals were enrolled in this study.
The incidence of PMI was 35.7% in the bisoprolol patch group and 44.5% in
the control group (P=0.18). Incidence of major adverse cardiac events
including non-critical myocardial infarction, strokes, decompensated heart
failure and tachyarrhythmia was similar between the 2 groups.
Tachyarrhythmia tended to be higher in the control group. There were no
significant differences in safety outcomes including significant
hypotension and bradycardia requiring any treatment between the 2 groups.
<br/>CONCLUSION(S): Bisoprolol patches do not influence the incidence of
PMI and cardiovascular events in high-risk patients undergoing non-cardiac
surgery, but perioperative use of these patches is safe.

<22>
[Use Link to view the full text]
Accession Number
629634397
Title
Nanocrystalline-Coated Silver Dressings for Patients with Type 2 Diabetes
after Surgical Coronary Revascularization.
Source
Advances in skin & wound care. 32 (11) (pp 521-524), 2019. Date of
Publication: 01 Nov 2019.
Author
Parys M.; Jazwiec T.; Kowalczuk-Wieteska A.; Majchrzyk I.; Gancarczyk H.;
Skoczen A.; Kumor J.; Mijacz M.; Kubacki K.; Zembala M.O.; Zembala M.
Institution
(Parys) In the Department of Cardiac Surgery, Heart and Lung
Transplantation and Mechanical Support, at the Silesian Center for Heart
Disease, in Zabrze, Poland, Monika Parys, BSN, RN, is Head Nurse; Tomasz
Jazwiec, MD, is a cardiac surgery resident; Anetta Kowalczuk-Wieteska,
PhD, MD, is Senior Assistant; Iwona Majchrzyk, RN, is a nurse; Halina
Gancarczyk, RN, is a nurse; Aleksandra Skoczen, RN, is a nurse; Julita
Kumor, RN, is a nurse; Monika Mijacz, RN, is a nurse; Krzysztof Kubacki,
MD, is a physician; Michal Oskar Zembala, MD, is Chief; and Marian
Zembala, MD, is Director. Acknowledgments: This study was supported by
grants from the Medical University of Silesia in Katowice: KNW-1-167 / N /
3/0, KNW-1-166 / N / 4/0, and KNW-1-210 / N / 6 / K. The authors have
disclosed no other financial relationships related to this article.
Submitted March 24, 2019; accepted in revised form May 31, 2019
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To assess the suitability of nanocrystalline-coated silver
dressings versus standard wound dressings in patients with type 2 diabetes
after coronary revascularization. <br/>METHOD(S): The study involved 194
patients who were divided into two homogeneous groups. The control group
(n = 97) received a standard sterile dressing. The intervention group (n =
97) received silver dressings. Glycosylated hemoglobin, fructosamine, and
creatinine were assessed in all patients. The emergence of superficial
wound infection within 30 days was the primary endpoint of the study, and
deep wound infections were a secondary endpoint. MAIN RESULTS: Superficial
wound infections were documented in 26 patients: 11 patients in the study
group and 15 in the control group. There were no statistically significant
differences between the analyzed groups regarding the occurrence of the
primary endpoint. No deep wound infections were found in either the study
or control group. <br/>CONCLUSION(S): The frequency of sternotomy wound
infection in patients with type 2 diabetes is comparable between patients
treated with traditional dressings and those receiving silver dressings;
therefore, to maximize cost savings, providers should consider using
standard wound dressings in this patient population.

<23>
Accession Number
631348919
Title
Evaluation viability in patients with ventricular dysfunction by 2D
speckle tracking echocardiography: The impact of low dose dobutamine. A
meta-analysis of prospective trials.
Source
European Heart Journal Cardiovascular Imaging. Conference: Annual Meeting
of the European Association of Echocardiography, EUROECHO 2019. Australia.
21 (Supplement 1) (pp i662), 2020. Date of Publication: January 2020.
Author
Ballo H.; Doghman F.; Saraste A.; Knuuti J.
Institution
(Ballo, Saraste, Knuuti) Turku PET Centre, Turku, Finland
(Doghman) Turku University Hospital, Turku, Finland
Publisher
Oxford University Press
Abstract
Background: 2D-Speckle tracking echocardiography (2DSTE) has been used for
the assessment of myocardial viability in patients with artery disease and
left ventricular (LV) dysfunction. <br/>Aim(s): The purpose of this
analysis was to evaluate the diagnostic accuracy of 2DSTE using
longitudinal (LS) and rest circumferential strain (CS) in this setting
with or without low dose dobutamine (LDD) infusion. <br/>Method(s): A
systematic review of MEDLINE, Cochrane, and Embase for all the prospective
trials using 2DSTE to assess myocardial viability until January 2019 was
done. Studies that utilized 2DSTE before coronary revascularisation and
used the wall motion evaluation in the long term after the
revascularisation as a reference were included. A standard approach of
meta-analysis for diagnostic tests and a bivariate analysis of
sensitivity, specificity, positive likelihood ratio(+LR), and negative
likelihood (-LR) were performed. In addition, direct comparison analysis
was done to only studies that compared the tests in the same patients.
<br/>Result(s): A total of 24 studies of 2DSTE evaluating myocardial
viability with 1173 patients (mean age 66 years, 72% male, and mean left
ventricular ejection fraction was 45%) fulfilled the inclusion criteria.
Eight studies used LS, 8 studies used CS, 4 studies used LS with LDD, and
4 studies used CS with LDD. LS and CS with LDD provided higher +LR ( 4.2
and 4, respectively) as well as a best specificity when compared with LS
and CS (81% CI: 65- 92% vs 68% CI: 60- 75%, p = 0.04, and 81% CI: 64-91%
vs 66% CI: 59-72%, p= 0.02, respectively) for predicting improved
segmental LV contractile function after revascularization. The
sensitivities of different 2DSTE tests for detection the viability were
not statistically different. The direct comparison of the studies with the
same patients yielded similar results. <br/>Conclusion(s): Using LDD with
LS and CS analysis significantly improve specificity of the tests.
Therefore, the use of a low dose of the dobutamine can be recommended to
improve the accuracy of the 2DSTE for detection of viable myocardium
following myocardial infarction. (Figure Presented).

<24>
Accession Number
631350378
Title
Global longitudinal strain in chronic asymptomatic aortic regurgitation: A
meta-analysis.
Source
European Heart Journal Cardiovascular Imaging. Conference: Annual Meeting
of the European Association of Echocardiography, EUROECHO 2019. Australia.
21 (Supplement 1) (pp i868), 2020. Date of Publication: January 2020.
Author
De Campos D.; Teixeira R.; Botelho A.; Saleiro C.; Lopes J.; Puga L.;
Ribeiro J.M.; Sousa J.; Goncalves L.
Institution
(De Campos, Teixeira, Botelho, Saleiro, Lopes, Puga, Ribeiro, Sousa,
Goncalves) University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
Publisher
Oxford University Press
Abstract
BACKGROUND Previous studies have shown that left ventricle global
longitudinal strain (GLS) assessed with 2D-speckle tracking
echocardiography, is an independent predictor of outcome in asymptomatic
moderate to severe chronic aortic regurgitation (AR) patients.
<br/>OBJECTIVE(S): To assess GLS impact on mortality and need for aortic
valve replacement (AVR) or symptom development in chronic asymptomatic AR
patients and preserved left ventricular ejection fraction (LVEF). METHODS
A literature search was performed according with these key terms "aortic
regurgitation" and "longitudinal strain." The primary endpoint was
all-cause mortality. Secondary end-points were: a composite of all-cause
mortality, need for AVR or symptom development; and only AVR plus symptom
development. Data was pooled using random-effects meta-analysis models.
Pooled Hazard Ratio (HR) was performed using its log transformation and
inverse variances as weights were then calculated for each study . RESULTS
Six studies were included, with a total of 1,571 asymptomatic patients
with at least moderate AR and preserved LVEF. There were 996 events
(death, AVR, symptom development) reported during follow-up. Pooled
adjusted mortality HR tended to be higher for patients with worse GLS
(1.14 [0.96-1.35], P = 0.13, I2 51%). GLS performed better in predicting
AVR or symptom development (mean difference-0.72 [-1.29,-0.15], P = 0.01,
I2 88%), with an estimated HR of 1.36 ([1.01-1.84], P = 0.04, I2 65%).
CONCLUSIONS In asymptomatic chronic moderate to severe AR patients,
impaired GLS was associated with adverse cardiac outcomes. Left
ventricular GLS may offer incremental value on risk stratification as well
as on decision-making.

<25>
Accession Number
631349921
Title
Cost-effectiveness analysis of 3D versus 2D transesophageal
echocardiography for the evaluation of patients with primary mitral
regurgitation with indication of surgical treatment.
Source
European Heart Journal Cardiovascular Imaging. Conference: Annual Meeting
of the European Association of Echocardiography, EUROECHO 2019. Australia.
21 (Supplement 1) (pp i73), 2020. Date of Publication: January 2020.
Author
Miglioranza M.; Le Bihan D.; De Resende M.V.C.; Oliveira W.P.; Nunes
C.G.O.; Lucchetta R.C.; Dos Santos W.M.; Holanda P.; Rosim M.P.; Okumura
L.; Nita M.E.; Riveros B.; Pedro G.O.; Vieira M.
Institution
(Miglioranza) Institute of Cardiology of Rio Grande do Sul, University
Foundation of Cardiology, Porto Alegre, Brazil
(Le Bihan) Instituto Dante Pazzanese, Sao Paulo, Brazil
(De Resende) Hospital Samaritano, Sao Paulo, Brazil
(Oliveira, Nunes, Lucchetta, Dos Santos, Holanda, Rosim, Okumura, Nita,
Riveros, Pedro) Department of Cardiovascular Imaging - SBC, Sao Paulo,
Brazil
(Vieira) InCor, Sao Paulo, Brazil
Publisher
Oxford University Press
Abstract
OBJECTIVES: To perform the cost-effectiveness analysis of
three-dimensional transesophageal echocardiography (3DTEE) in comparison
to two-dimensional transesophageal echocardiography (2DTEE) for the
anatomic-functional evaluation and surgical planning of severe primary
mitral regurgitation. <br/>METHOD(S): a complete economic study was based
on a systematic review of 3DTEE and 2DTEE accuracy and private health
system costs of two different surgical interventions: mitral valve plasty
and mitral valve replacement. The prevalence of common postoperative
complications was also predicted for elective procedures: atrial
fibrillation (8.6%); acute myocardial infarction (1.4%); thrombosis
(3.5%); bleeding (1.5%); endocarditis (6.3%). The decision tree method was
adopted as a data analysis model. The Bayes' theorem was used based on
sensitivity and specificity measurements. The costs, considering
literature and professional tables, were: 3DTEE = US$ 349; 2DTEE = US$
204; diagnostic evaluation = US$ 597; surgical procedure = US$ 3,643;
surgical treatment = US$ 374. <br/>RESULT(S): The deterministic analysis
of the diagnostic test shows that 3DTEE (non-dominated) is superior to
2DTEE (absolutely dominated). The 3DTEE presents a cost reduction of US$
1,147 and incremental effectiveness (true identification) of 22% when
compared to 2DTEE. The multivariate probabilistic sensitivity analysis
showed that after 100,000 iterations, the diagnosis based on the 3DTEE
becomes the first choice regardless of the willingness to pay threshold.
<br/>CONCLUSION(S): 3DTEE was cost-effective compared to 2DTEE. Thus,
3DTEE is a potential device to promote health compared to 2DTEE for
surgical planning of severe primary mitral regurgitation(Figure
Presented).

<26>
Accession Number
631349675
Title
Non-bacterial endocarditis in patients with antiphospholipid syndrome
treated with direct oral anticoagulants.
Source
European Heart Journal Cardiovascular Imaging. Conference: Annual Meeting
of the European Association of Echocardiography, EUROECHO 2019. Australia.
21 (Supplement 1) (pp i46), 2020. Date of Publication: January 2020.
Author
Munoz Pousa I.; Calvo Iglesias F.E.; Cespon Fernandez M.; Lopez Rodriguez
E.; Pradas Montilla G.; Legarra Calderon J.J.; Fernandez Martin J.J.
Institution
(Munoz Pousa, Calvo Iglesias, Cespon Fernandez, Lopez Rodriguez, Fernandez
Martin) Hospital Alvaro Cunqueiro, Vigo, Spain
(Pradas Montilla, Legarra Calderon) Hospital Vithas Fatima, Cardiac
Surgery, Vigo, Spain
Publisher
Oxford University Press
Abstract
Introduction. Primary antiphospholipid syndrome (APS) is a
hypercoagulability state of autoimmune origin. Vitamin K- antagonists
remain the mainstay therapy though the difficulties in maintaining target
therapeutic range contributed to prescriptions of direct oral
anticoagulants (ACOD). A recent randomized trial reported an excess in
thromboembolic events in patients under rivaroxaban therapy compared with
warfarin. Purpose. Description of two cases of Libman-Sacks endocarditis
in APS patients on therapy with rivaroxaban due to poor control with
coumadin. Methods and results. Case 1 is a 47-year-old woman and case 2 a
69-yo man with APS with high antibody titers of 3 classes and previous
thrombotic events (pulmonary embolism in case 1 and acute coronary
syndrome in case 2). In both cases, coumadin was switched to rivaroxaban
because of poor control. During follow-up the diagnosis of blood
culture-negative endocarditis was stablished in both cases. Echo
examinations in case 1 revealed a 12 mm mobile vegetation in the
ventricular face of the non-coronary aortic cusp, which resolved after 2
months high-dose warfarin therapy. Case 2 was admitted to hospital because
of heart failure. TTE and TOE revealed a 26 mm mass attached to the atrial
face of posterior mitral leaflet and moderate mitral regurgitation. He
underwent mitral valve replacement with a mechanical prosthesis and the
final pathologic diagnosis was Libman-Sacks endocarditis. Conclusions.
Libman-Sacks endocarditis as a thrombotic feature of high-risk APS
patients can occur under rivaroxaban therapy. In one of our 2 cases,
high-dose coumadin therapy resolved this complication(Figure Presented).

<27>
Accession Number
631348477
Title
2018 AATS Focus Meeting on Thoracic Surgery.
Source
Journal of Thoracic Disease. Conference: AATS Focus Meeting on Thoracic
Surgery. China. 11 (Supplement 13) (no pagination), 2019. Date of
Publication: August 2019.
Author
Anonymous
Publisher
AME Publishing Company
Abstract
The proceedings contain 2 papers. The topics discussed include:
perioperative outcomes of radical lobectomies using robotic-assisted
thoracoscopic techniques vs. traditional video-assisted thoracoscopic
techniques: retrospective study of 1,075 consecutive p-stage I NSCLC
cases; and open three-stage transthoracic oesophagectomy versus minimally
invasive thoraco-laparoscopic oesophagectomy for oesophageal cancer: a
multicentre, open-label, randomized controlled trial.

<28>
Accession Number
631349206
Title
False hope, capitalising on fear, and cultural obstacles to heeding
randomised trial evidence concerning secondary surveillance and
metastasectomy in colorectal cancer.
Source
BMJ Evidence-Based Medicine. Conference: 7th International Preventing
Overdiagnosis Scientific Conference. Australia. 24 (Supplement 2) (pp A9),
2019. Date of Publication: December 2019.
Author
Treasure T.
Institution
(Treasure) University College London, London, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Objectives The body's total blood volume is filtered through the lungs
about once every minute and circulating 'seeds' of carcinoma find a
fertile 'soil' in the lung's interstices. Growing there, metastases are
easily visualised against the radiolucent air-filled lung and in the
course of cancer surveillance. Increasing numbers of people are sent for
surgery. What we already know is that patients considered for these
operations have no symptoms from their metastases and these low volume
deposits do not contribute to symptoms or the terminal course of disease.
So there was no palliative role for these operations. The hope is that
removing these nodules cure the cancer. Benefit is assumed. Long-term
survival is reported anecdotally but is this attributable to the operation
or the selection of natural survivors? Is detection for metastasectomy an
instance of overdiagnosis leading to unavailing treatment? We embarked on
stepwise studies to find answers to these questions. Method 1. Systematic
review and quantitative synthesis was conducted with colleagues in the
Clinical Operational Research Unit at University College London (UCL). By
far the commonest lung metastases operated on are from colorectal cancer
so we searched for clinical reports and extracted all available data to
build a full picture of practice and outcomes. 2. Systematic review and
meta-analysis of randomised trials (RCTs) of surveillance of increasing
intensity for recurrence of colorectal cancer was conducted in
collaboration with Erasmus University Rotterdam, Cambridge MRC
Biostatistics Unit, the Surgical and Interventional Trials Unit (UCL) 3. A
'Big data' analysis was conducted to re-examine published NHS data 4. The
PulMiCC trial (Pulmonary Metastasectomy in Colorectal Cancer) is an RCT
recruiting participants referred for consideration of lung metastasectomy
into a registered cohort. Those eligible, and willing to accept randomised
treatment assignment, and for whom the clinician could reach equipoise,
entered the PulMiCC trial. Results 1. Systematic Review and Quantitative
synthesis. There were no RCTs. 51 observational reports 1971-2007
described 3504 patients with consistent features. 60% had a single
metastasis, the median interval since primary cancer was 36 months, and
60% were dead within five years. There were no data on symptoms, quality
of life or of comparable non-operated patients. (JRSM 2010;103:60-66)
2.Meta-analysis. 16 RCTs. Surveillance advanced the diagnosis of cancer by
1-2 years, providing opportunities for metastasectomy, but with a
detrimental (non-significant) effect on survival. (BJS 2016;103:1259-1268)
3.Big data analysis. 114,155 people had colorectal cancer surgery and
3,116 (2.7%) had liver resections. Analysis of the survival curve showed a
plateau characteristic of selection and immortal time biases. (Cancer
Epidemiology 2017;49:152-155; 2018;52:160-161) 4.Pul- MiCC: 512 patients
were recruited but only 65 were analysable in the RCT. Analysis of reasons
for not randomising revealed overwhelming clinician bias. There was no
evident benefit from metastasectomy. (Publication pending) Conclusions
This methodical succession of studies failed to find evidence for a
survival benefit, reasonably attributable to the detection and surgical
removal of lung metastases. The reason for a clinical impression of
benefit is selection of <3%, i.e the most favourable cases. Similarly
selected patients, assigned to a non-operated control arm, had similar
survival, much better than assumed, without the predicted burden of
anxiety. Timely diagnosis and interventions for local recurrence are of
benefit but probably not lung metastasectomy. But recruitment into PulMICC
was actively prejudiced by a thoracic surgical journal Editorial opening
'Surgery for pulmonary metastases is a pillar of modern thoracic Surgery',
decrying the trial, and alluding to the parachute analogy. It will be
difficult to roll back this practice. Monitoring for cancer recurrence is
generally seen as the right thing to do. There would be financial
consequences for imagers and surgeons if a halt were to be called.

<29>
Accession Number
631353854
Title
Dexmedetomidine in the prevention of postoperative delirium in elderly
patients following non-cardiac surgery: a systematic review and
meta-analysis.
Source
Clinical and experimental pharmacology & physiology. (no pagination),
2020. Date of Publication: 25 Mar 2020.
Author
Shen Q.-H.; Li H.-F.; Zhou X.-Y.; Yuan X.-Z.
Institution
(Shen, Zhou, Yuan) Department of Anesthesiology, Affiliated Hospital of
Jiaxing University, First Hospital of Jiaxing, Zhejiang, China
(Li) Department of Gynecology, Tongxiang Maternal and Child Health Care
Hospital, Zhejiang, China
Publisher
NLM (Medline)
Abstract
The efficacy of dexmedetomidine in the prevention of postoperative
delirium (POD) remains ambiguous, however, it has been used to reduce the
incidence of delirium in elderly patients. Here, we conducted a
meta-analysis study for assessing the effects of dexmedetomidine on POD
among elderly patients following non-cardiac surgery. A systematic
literature search was performed against the PubMed, EMBASE, Cochrane
Library, and Web of Science databases, and all relevant literature
published till November 30, 2019, were considered. Our analysis included
16 randomised controlled trials conducted with 4534 patients for exploring
the effects of dexmedetomidine on POD in elderly patients following
non-cardiac surgery. It was observed that the overall incidence of POD was
significantly lower in the dexmedetomidine group than in the control group
(risk ratio (RR)0.51, 95% confidence interval (CI) 0.43-0.61, P<0.01).
Similar results were obtained from subgroup analysis upon comparison of
the placebo (RR 0.52, 95% CI 0.41-0.66, P<0.01, moderate quality of
evidence), propofol-treated (RR 0.55, 95% CI 0.38-0.78, P<0.01, low
quality of evidence), and midazolam-treated (RR 0.38, 95% CI 0.20-0.71,
P<0.01, low quality of evidence) groups. Trial sequential analysis
revealed that the cumulative z-value superseded the monitoring boundary
and reached the required information size. However, patients who received
dexmedetomidine had a higher incidence of bradycardia and hypotension. In
conclusion, the meta-analysis revealed that dexmedetomidine appears to
decrease the risk of POD in elderly patients following non-cardiac
surgery. However, as some of the studies were heterogeneous and of low
quality, high quality trials are necessary for drawing more definitive
conclusions.<br/>Copyright This article is protected by copyright. All
rights reserved.

<30>
Accession Number
631352358
Title
Long-Term Outcomes of Absorb Bioresorbable Vascular Scaffold vs.
Everolimus-Eluting Metallic Stent- A Randomized Comparison Through 5 Years
in Japan.
Source
Circulation journal : official journal of the Japanese Circulation
Society. (no pagination), 2020. Date of Publication: 26 Mar 2020.
Author
Kozuma K.; Tanabe K.; Hamazaki Y.; Okamura T.; Ando J.; Ikari Y.; Nakagawa
Y.; Kusano H.; Ediebah D.; Kimura T.
Institution
(Kozuma) Department of Cardiology, Teikyo University
(Tanabe) Department of Cardiology, Mitsui Memorial Hospital
(Hamazaki) Division of Cardiology, Ootakanomori Hospital
(Okamura) Department of Medicine and Clinical Science, Yamaguchi
University Graduate School of Medicine
(Ando) Department of Cardiovascular Medicine, University of Tokyo Hospital
(Ikari) Department of Cardiology, Tokai University Hospital
(Nakagawa) Department of Cardiovascular Medicine, Shiga University of
Medical Science
(Kusano, Ediebah) Abbott Vascular
(Kimura) Department of Cardiovascular Medicine/Graduate School of
Medicine, Kyoto University
Publisher
NLM (Medline)
Abstract
BACKGROUND: Bioresorbable vascular scaffolds (BVS) are promising
alternatives to metallic drug-eluting stents (DES) in percutaneous
coronary interventions. Absorb BVS was comparable to XIENCE (DES) for
patient- and device-oriented composite endpoints through 1 year
post-procedure. Mid-term results showed increased rates of device-oriented
events with Absorb. The objective of this study was to evaluate the
long-term safety and effectiveness of Absorb BVS compared with XIENCE
metallic DES when implanted in patients in Japan with de novo coronary
artery lesions.Methods and Results:ABSORB Japan randomized 400 patients
into either Absorb (n=266) or XIENCE (n=134) treatment arm. Through 5-year
follow-up, the composite endpoints of DMR (death, myocardial infarction
[MI], and all revascularization), target vessel failure (TVF), major
adverse cardiac events (MACE), target lesion failure (TLF), and cardiac
death/all MI were evaluated. Individual endpoints included death, MI,
coronary revascularization, and scaffold/stent thrombosis. There were no
significant differences in the composite or individual endpoint outcomes
between the Absorb and XIENCE arms through 5 years or between 3 and 5
years. Numerically lower TVF, MACE, and all MI rates were observed for the
Absorb vs. XIENCE arm after 3 years. No scaffold/stent thrombosis was
reported beyond 3 years. Post-procedure imaging subgroups showed
comparable event rates. <br/>CONCLUSION(S): Following resorption of the
scaffold, between 3 and 5 years post-procedure, the Absorb BVS performed
comparably to XIENCE in all patient- and device-oriented endpoints
(ClinicalTrials.gov, #NCT01844284).

<31>
Accession Number
631352211
Title
Analgesic Efficacy and Adverse Effects of Meperidine in Managing
Postoperative or Labor Pain: A Narrative Review of Randomized Controlled
Trials.
Source
Pain physician. 23 (2) (pp 175-201), 2020. Date of Publication: 01 Mar
2020.
Author
Ching Wong S.S.; Cheung C.W.
Institution
(Ching Wong) Laboratory and Clinical Research Institute for Pain, Dept of
Anesthesiology, University of Hong Kong
Publisher
NLM (Medline)
Abstract
BACKGROUND: Meperidine, a synthetic opioid, has a rapid onset and short
duration of action. Mounting evidence has challenged meperidine's
analgesic benefits, and concerns have been raised about its safety
profile. Despite recommendations to restrict the prescription of
meperidine, the drug remains frequently used. <br/>OBJECTIVE(S): The aim
of this study was to evaluate the evidence regarding the efficacy and
safety of meperidine for acute postoperative and labor pain. STUDY DESIGN:
This was a narrative review of the analgesic efficacy and side effects of
meperidine compared to other analgesic drugs for acute postoperative and
labor pain in adults. SETTING: Randomized controlled trials that compared
the analgesic efficacy and side effect profile of meperidine versus
another analgesic drug in adult patients were evaluated. <br/>METHOD(S): A
systemized search of randomized controlled trials studying meperidine for
acute postoperative or labor pain in the adult patient population from
PubMed, Medline, and EMBASE was performed. Included studies reported on
different routes of meperidine administration including intramuscular,
intravenous, and patient-controlled analgesia in various surgical
procedures such as abdominal surgery, Cesarean section, gynecological
surgery, orthopedic surgery, cardiothoracic surgery, as well as for labor
analgesia. Meperidine's analgesic efficacy and safety profile were
compared to other opioids (morphine, tramadol, fentanyl, buprenorphine,
nalbuphine, and pentazocine), nonsteroidal anti-inflammatory drugs
(ketorolac, diclofenac, and indomethacin), dipyrone, ketamine, and
bupivacaine. <br/>RESULT(S): A total of 62 randomized controlled trials
published between 1972 and 2018 were reviewed. Meperidine had a similar or
inferior analgesic efficacy compared to other analgesics for acute
postoperative or labor pain. Meperidine was associated with more sedation
and respiratory depression. LIMITATIONS: The sample sizes of many clinical
studies were small, and therefore probably insufficiently powered to
detect differences in uncommon side effects, such as central nervous
system toxicity. In addition, some of the included clinical studies were
old. <br/>CONCLUSION(S): Considering the availability of other effective
analgesics with potentially fewer side effects, the use of meperidine for
acute postoperative or labor pain should not be recommended. KEY WORDS:
Acute postoperative pain, adverse effects, labor analgesia, meperidine,
pethidine.

<32>
Accession Number
631350864
Title
Effect of peer support on patient anxiety during the coronary angiography
or percutaneous coronary intervention perioperative period: a protocol for
a systematic review and meta-analysis of randomised controlled trials.
Source
BMJ open. 10 (3) (pp e031952), 2020. Date of Publication: 25 Mar 2020.
Author
Qin S.; Gu Y.; Song T.
Institution
(Qin, Gu) College of Nursing, Hebei University of Chinese Medicine,
Shijiazhuang, Hebei, China
(Song) Faculty of Health and Medical Sciences, University of Adelaide,
Adelaide, SA, Australia
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The purpose of this study is to investigate the effect of
peer support on patient anxiety during the perioperative period of
coronary angiography or percutaneous coronary intervention (PCI). METHODS
AND ANALYSIS: We will search the following databases (PubMed, Web of
Science, EMBASE, Cochrane Library, CINAHL, Clinicaltrials.gov, WHO
International Clinical Trials Registry Platform, Google Scholar, Chinese
National Knowledge Infrastructure, Chinese Science and Technology
Periodicals Database, Chinese BioMedical Database and Wanfang Data) from
the date of database inception to January 2019. Only randomised controlled
trials will be included. For the data analysis, we will use RevMan V.5.3.5
software to evaluate the risk of bias, and the heterogeneity will be
investigated using the Q statistic and P index. Additionally, the Grading
of Recommendations Assessment, Development and Evaluation system will be
used to assess the quality of evidence. ETHICS AND DISSEMINATION: No
ethics approval will be required since this is a systematic review of
published studies. We aim to report information regarding the effects of
peer support on patient anxiety during the perioperative period of
coronary angiography or PCI. This systematic review and meta-analysis will
be submitted to a peer-reviewed journal for publication. PROSPERO
REGISTRATION NUMBER: CRD42019123290.<br/>Copyright &#xa9; Author(s) (or
their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial
re-use. See rights and permissions. Published by BMJ.

<33>
Accession Number
2005415073
Title
Comparison of levosimendan versus IABP in patients with poor left
ventricular function undergoing coronary artery bypass graft surgery.
Source
Heart Surgery Forum. 23 (1) (pp E93-E97), 2020. Date of Publication: 2020.
Author
Omar A.; Eldegwy M.; Allam M.; Rouchdy A.; Soliman S.A.H.; Dawoud O.;
Elshihy E.
Institution
(Omar, Eldegwy, Allam, Rouchdy, Soliman, Dawoud, Elshihy) Cardiothoracic
Surgery Department, Faculty of Medicine, Cairo University, 14 Mossaddak
St. Dokki, Cairo, Egypt
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
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%. <br/>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). <br/>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. <br/>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.<br/>Copyright &#xa9; 2020 Forum Multimedia Publishing, LLC.

<34>
Accession Number
2005415068
Title
Effect of perioperative glucose-insulin-potassium therapy in patients
undergoing on-pump cardiac surgery: A meta-analysis.
Source
Heart Surgery Forum. 23 (1) (pp E63-E69), 2020. Date of Publication: 2020.
Author
Li Q.; Zhang J.; Yang C.; Fan Z.; Yang Y.; Zheng T.; Yang J.
Institution
(Li, Yang, Fan, Yang, Zheng, Yang) Department of Cardiology, First College
of Clinical Medical Science, China Three Gorges University, Yichang,
Hubei, China
(Li, Yang, Zhang, Yang, Fan, Yang, Zheng, Yang) Institute of
Evidence-Based and Translational Medicine, China Three Gorges University,
Yichang, Hubei, China
(Zhang, Yang) Central Laboratory, Yichang Central People's Hospital,
Yichang, Hubei, China
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
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.
<br/>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). <br/>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). <br/>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.<br/>Copyright &#xa9; 2020 Forum Multimedia Publishing,
LLC.

<35>
Accession Number
2005415063
Title
Intravenous tranexamic acid decreases blood transfusion in off-pump
coronary artery bypass surgery: A meta-analysis.
Source
Heart Surgery Forum. 23 (1) (pp E39-E49), 2020. Date of Publication: 2020.
Author
Sun L.; An H.; Feng Y.
Institution
(Sun, An, Feng) Department of Anesthesiology, Peking University People's
Hospital, Beijing, China
(Sun) Department of Anesthesiology and Critical Care, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA, United States
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
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.
<br/>Objective(s): The aim of this study was to evaluate the effectiveness
and safety of IV administration of TXA in off-pump CABG settings.
<br/>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%).
<br/>Conclusion(s): IV TXA was effective in reducing allogeneic blood
component transfusion (PRBCs and PT- or INRguided FFP transfusion),
without increasing the incidence of postoperative death or thrombotic
complications in off-pump CAB surgery.<br/>Copyright &#xa9; 2020 Forum
Multimedia Publishing, LLC.

<36>
Accession Number
2005414993
Title
Review of alternative access in transcatheter aortic valve replacement.
Source
Cardiovascular Diagnosis and Therapy. 10 (1) (pp 72-82), 2020. Date of
Publication: 2020.
Author
Banks A.; Gaca J.; Kiefer T.
Institution
(Banks, Kiefer) Division of Cardiology, Duke University Medical Center,
Durham, NC, United States
(Gaca) Cardiac Surgery, Duke University Medical Center, Durham, NC, United
States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Transcatheter aortic valve replacement (TAVR) has surpassed surgical
aortic valve replacement (SAVR) as the most common treatment strategy for
severe symptomatic aortic stenosis over the past decade. As TAVR
technology has continued to advance, it has been expanded from being an
option only for extreme risk patients to now being the preferred option
for the majority of patients with severe aortic stenosis. Recent trials
have shown that TAVR is superior or non-inferior to SAVR even in patients
at low surgical risk. One limitation of TAVR is the need for large bore
vascular access. This has improved over time with smaller sheath sizes and
improved delivery systems, but is still a significant issue in a patient
population that often has many comorbidities including peripheral arterial
disease. Early in the TAVR experience the only option for alternative
access was transapical access, which has consistently been linked to
increased procedural complications and worsened clinical outcomes.
However, in recent years several centers have demonstrated the safety and
efficacy of several alternative access strategies including transaxillary,
transcarotid, transcaval, and direct aortic. There are no randomized data
comparing these strategies, so access site approach is chosen by the
multidisciplinary heart team based on patient anatomy and site expertise.
We will review the current data in alternative access that in our view
supports prioritizing a transaxillary or transcarotid strategy. In
addition, we will describe our center's pre-procedural planning,
peri-procedural approach, and propose an algorithm for alternative
access.<br/>Copyright &#xa9; 2020 Cardiovascular Diagnosis and Therapy.

<37>
Accession Number
2005414992
Title
Transcatheter aortic valve replacement in low risk patients: A review of
PARTNER 3 and Evolut low risk trials.
Source
Cardiovascular Diagnosis and Therapy. 10 (1) (pp 59-71), 2020. Date of
Publication: 2020.
Author
Braghiroli J.; Kapoor K.; Thielhelm T.P.; Ferreira T.; Cohen M.G.
Institution
(Braghiroli, Kapoor, Thielhelm, Ferreira, Cohen) Cardiovascular Division,
Department of Medicine, University of Miami, Miller School of Medicine,
Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University
of Miami Hospitals and Clinics, 1400 NW 12th Avenue, Miami, FL 33136,
United States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Transcatheter aortic valve replacement (TAVR) has become a mainstay in
treatment for patients with severe aortic stenosis who are considered
high-risk surgical candidates. The use of TAVR in low-risk patients with
severe aortic stenosis is being explored as an alternative to surgical
aortic valve replacement (SAVR). Recent results from the Medtronic Evolut
Low Risk trial and the Placement of Aortic Transcatheter Valves (PARTNER)
3 trial shed light on the use of TAVR in low-risk surgical candidates. The
Evolut Low Risk trial compared TAVR with a self-expanding supra-annular
bioprosthesis to SAVR in 1468 patients with severe aortic stenosis who
were low surgical risk. Patients with a mean age of 74 and a mean Society
of Thoracic Surgeons (STS) risk score of 1.9% were randomized to either
TAVR or SAVR groups. Using the composite end point of death or disabling
stroke at 24 months, the study found an incidence of 5.3% in the TAVR arm
and 6.7% in the surgical arm. The Evolut Low Risk trial thus concluded
that TAVR was statistically noninferior but not superior to SAVR
(difference, -1.4 percentage points; 95% Bayesian credible interval for
the difference, -4.9 to 2.1; posterior probability of noninferiority,
>0.999). The PARTNER 3 trial assigned 1,000 patients with severe aortic
stenosis and low surgical risk to either TAVR with transfemoral placement
of balloon expandable valve or SAVR. Patients with a mean age of 73 and a
mean STS score of 1.9% were randomized to either TAVR or SAVR groups. With
respect to the primary endpoint of composite death from any cause, stroke,
or rehospitalization, the study found an occurrence of 8.5% in TAVR and
15.1% in SAVR, confirming both noninferiority and superiority in the TAVR
group [absolute difference, -6.6 percentage points; 95% confidence
interval (CI), -10.8 to -2.5; P<0.001 for noninferiority; hazard ratio,
0.54; 95% CI, 0.37 to 0.79; P=0.001 for superiority]. Both the Evolut low
risk trial and the PARTNER 3 trial provide evidence that the use of TAVR
extends beyond the scope of high and intermediate risk surgical patients
and is at the very least equivalent to SAVR in the treatment low-risk
surgical candidates when using a transfemoral approach in patients without
bicuspid aortic valves. In this article we provide an extensive review on
the Evolute low risk and PARTNER 3 trials, including a discussion on
clinically relevant outcomes.<br/>Copyright &#xa9; 2020 Cardiovascular
Diagnosis and Therapy.

<38>
Accession Number
2005408763
Title
Cardiac Imaging With ¹²³I-meta-iodobenzylguanidine and
Analogous PET Tracers: Current Status and Future Perspectives.
Source
Seminars in Nuclear Medicine. (no pagination), 2020. Date of Publication:
2020.
Author
Wan N.; Travin M.I.
Institution
(Wan, Travin) Division of Nuclear Medicine, Department of Radiology, and
Division of Cardiology, Department of Medicine, Montefiore Medical Center
and The Albert Einstein College of Medicine, Bronx, NY, United States
Publisher
W.B. Saunders
Abstract
Autonomic innervation plays an important role in proper functioning of the
cardiovascular system. Altered cardiac sympathetic function is present in
a variety of diseases, and can be assessed with radionuclide imaging using
sympathetic neurotransmitter analogues. The most studied adrenergic
radiotracer is cardiac ¹²³I-meta-iodobenzylguanidine
(¹²³I-mIBG). Cardiac ¹²³I-mIBG uptake can be
evaluated using both planar and tomographic imaging, thereby providing
insight into global and regional sympathetic innervation. Standardly
assessed imaging parameters are the heart-to-mediastinum ratio and washout
rate, customarily derived from planar images. Focal tracer deficits on
tomographic imaging also show prognostic utility, with some data
suggesting that the best approach to tomographic image interpretation may
differ from conventional methods. Cardiac ¹²³I-mIBG image
findings strongly correlate with the severity and prognosis of many
cardiovascular diseases, especially heart failure and ventricular
arrhythmias. Cardiac ¹²³I-mIBG imaging in heart failure is FDA
approved for prognostic purposes. With the robustly demonstrated ability
to predict occurrence of potentially fatal arrhythmias, cardiac
¹²³I-mIBG imaging shows promise for better selecting patients
who will benefit from an implantable cardioverter defibrillator, but
clinical use has been hampered by lack of the randomized trial needed for
incorporation into societal guidelines. In patients with ischemic heart
disease, cardiac ¹²³I-mIBG imaging aids in assessing the extent
of damage and in identifying arrhythmogenic regions. There have also been
studies using cardiac ¹²³I-mIBG for other conditions, including
patients following heart transplantation, diabetic related cardiac
abnormalities and chemotherapy induced cardiotoxicity. Positron emission
tomographic adrenergic radiotracers, that improve image quality, have been
investigated, especially ¹¹C-meta-hydroxyephedrine, and most
recently ¹⁸F-fluorbenguan. Cadmium-zinc-telluride cameras also
improve image quality. With better spatial resolution and quantification,
PET tracers and advanced camera technologies promise to expand the
clinical utility of cardiac sympathetic imaging.<br/>Copyright &#xa9; 2020
Elsevier Inc.

<39>
Accession Number
2005408275
Title
Multi-omic analysis of the effects of low frequency ventilation during
cardiopulmonary bypass surgery.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Durham A.L.; Al Jaaly E.; Graham R.; Brook P.O.; Bae J.H.; Heesom K.J.;
Postle A.D.; Lavender P.; Jazrawi E.; Reeves B.; Fiorentino F.; Mumby S.;
Angelini G.D.; Adcock I.M.
Institution
(Durham, Graham, Brook, Bae, Jazrawi, Mumby, Adcock) Airways Disease
Section, National Heart and Lung Institute, Imperial College London,
Dovehouse Street, London SW3 6LY, United Kingdom
(Al Jaaly, Reeves, Fiorentino, Angelini) Cardiothoracic Surgery, National
Heart and Lung Institute, Imperial College London, Hammersmith Hospital,
London, United Kingdom
(Heesom) University of Bristol, Proteomics Facility, BioMedical Sciences
Building, University Walk, Bristol, United Kingdom
(Postle) Faculty of Medicine, University of Southampton, Building 85, Life
Sciences Building, Highfield Campus, Southampton, United Kingdom
(Lavender) Department of Asthma, Allergy, and Respiratory Science, King's
College London, London, United Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, Bristol Royal
Infirmary, Level 7, Marlborough Street, Bristol, United Kingdom
(Durham) Immunobiology, Blizard Institute, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, 4 Newark St,
London, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Heart surgery with cardio-pulmonary bypass (CPB) is associated
with lung ischemia leading to injury and inflammation. It has been
suggested this is a result of the lungs being kept deflated throughout the
duration of CPB. Low frequency ventilation (LFV) during CPB has been
proposed to reduce lung dysfunction. <br/>Method(s): We used a semi-biased
multi-omic approach to analyse lung biopsies taken before and after CPB
from 37 patients undergoing coronary artery bypass surgery randomised to
both lungs left collapsed or using LFV for the duration of CPB. We also
examined inflammatory and oxidative stress markers from blood samples from
the same patients. <br/>Result(s): 30 genes were induced when the lungs
were left collapsed and 80 by LFV. Post-surgery 26 genes were
significantly higher in the LFV vs. lungs left collapsed, including genes
associated with inflammation (e.g. IL6 and IL8) and hypoxia/ischemia (e.g.
HIF1A, IER3 and FOS). Relatively few changes in protein levels were
detected, perhaps reflecting the early time point or the importance of
post-translational modifications. However, pathway analysis of proteomic
data indicated that LFV was associated with increased "cellular component
morphogenesis" and a decrease in "blood circulation". Lipidomic analysis
did not identify any lipids significantly altered by either intervention.
<br/>Discussion(s): Taken together these data indicate the keeping both
lungs collapsed during CPB significantly induces lung damage, oxidative
stress and inflammation. LFV during CPB increases these deleterious
effects, potentially through prolonged surgery time, further decreasing
blood flow to the lungs and enhancing hypoxia/ischemia.<br/>Copyright
&#xa9; 2020

<40>
Accession Number
2004502243
Title
Can we reduce conduction disturbances following transcatheter aortic valve
replacement?.
Source
Expert Review of Medical Devices. (no pagination), 2020. Date of
Publication: 2020.
Author
Alperi Garcia A.; Muntane-Carol G.; Junquera L.; del Val D.; Faroux L.;
Philippon F.; Rodes-Cabau J.
Institution
(Alperi Garcia, Muntane-Carol, Junquera, del Val, Faroux, Philippon,
Rodes-Cabau) Quebec Heart & Lung Institute, Laval University, Quebec City,
QC, Canada
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has been
demonstrated to be a good alternative to surgery for treating severe
aortic stenosis (AS) across the whole range of surgical risk patients.
Whereas most periprocedural TAVR complications have significantly
decreased over time, conduction disturbances remain high. Approaches to
decrease this shortcoming are under continuous investigation. Areas
covered: Overview of the actual evidence regarding conduction disturbances
in the TAVR setting, focusing on modifiable factors. PubMed and Embase
databases were used for literature search. Expert opinion: Several factors
have been associated with an increased risk of conduction disturbances
post-TAVR, and some of them may be modifiable. While some transcatheter
valve systems have been associated with higher rates of conduction
disturbances, additional randomized data are needed to draw definite
conclusions about newer generation transcatheter valve systems. Nowadays,
good hemodynamic valve function can be obtained without excessive valve
oversizing, which has been associated with an increased risk of conduction
disturbances in some studies. Also, contemporary data regarding valve
implantation depth and new anatomical landmarks such as membranous septum
length have provided valuable insights for procedural planning. Finally,
homogenization of the management of conduction abnormalities post-TAVR
should be emphasized to allow a better understanding and generalization of
available evidence.<br/>Copyright &#xa9; 2020, &#xa9; 2020 Informa UK
Limited, trading as Taylor & Francis Group.

<41>
Accession Number
2005273695
Title
Effects of remote ischemic preconditioning on prognosis in patients with
lung injury: A meta-analysis.
Source
Journal of Clinical Anesthesia. 63 (no pagination), 2020. Article Number:
109795. Date of Publication: August 2020.
Author
Zheng L.; Han R.; Tao L.; Yu Q.; Li J.; Gao C.; Sun X.
Institution
(Zheng, Han, Tao, Yu, Li, Gao, Sun) Department of Anesthesiology, Tangdu
Hospital, Air Force Military Medical University, Xian, Shanxi Province
710038, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: A number of trials have shown that remote ischemic
preconditioning (RIPC) could reduce lung injury of patients suffering
cardiovascular surgery, pulmonary transplantation surgery and thoracic
surgery with one-lung ventilation. However, there is still a controversy
over the lung protection of RIPC in patients who suffers different types
of surgery. We undertook meta-analysis of the randomized controlled trials
to evaluate the effect of remote ischemic preconditioning on clinical
outcomes of patients with lung injury. <br/>Design(s): Systematic review
and meta-analysis. <br/>Setting(s): Perioperative care areas.
<br/>Patient(s): Adults and infants suffering cardiovascular surgery with
lung injury. <br/>Intervention(s): Remote ischemic preconditioning.
Measurements: The literatures were selected complying with the inclusive
and exclusive criteria from the following databases as PubMed, Embase,
Medline, Chinese Biomedical Literature and Journal Databases, Chinese
Academic and VIP journal full-text Databases. Inclusion criteria includes:
(1) Human clinical randomized and controlled trial; (2) the article we
included is a clinical randomized controlled study; (3) the article
discusses the effect of RIPC on lung injury of patients; (4) the primary
evaluation indicators of the inclusive studies included postoperative
intensive care unit stay time and mechanical ventilation time; (5)
published in the form of full text, any language; (6) the type of
operation is cardiovascular surgery; (7) there is no serious COPD, ARDS,
respiratory failure and other lung diseases. Articles were excluded if
they reported none of the outcomes as follows: postoperative intensive
care unit stay time and mechanical ventilation time, human clinical
controlled trails, pulmonary protection of RIPC, prospective clinical
controlled trials. Two independent reviewers screened abstracts and
titles, and selected records following full-text review. Software
RevMan5.3 and STATA 12.0 were adopted to perform Meta-analysis.
<br/>Result(s): The search finally includes10 studies of 708 patients, 352
patients in RIPC group and 356 patients in control group. The baseline
characteristics of patients are no differences in two groups (P > 0.05).
Compared with control group, RIPC significantly reduced the duration of
ICU (P < 0.05) and mechanical ventilation time (P < 0.05) in RIPC group.
In addition, the serum TNF-alpha and MDA concentration 24 h after
operation in RIPC group are significantly lower than control group (P <
0.05). However, there are no significant differences between RIPC group
and control group in terms of serum IL-6, IL-8 concentrations,
A-aDO<inf>2</inf>, PaO<inf>2</inf>/FiO<inf>2</inf> and respiratory index
24 h after operation. <br/>Conclusion(s): RIPC can decrease pulmonary
inflammatory responses, reduce the duration of ICU and mechanical
ventilation time, and improve the clinical outcomes of patients with lung
injury.<br/>Copyright &#xa9; 2020

<42>
Accession Number
2005253818
Title
Systematic review and meta-analysis of interventional emergency treatment
of decompensated severe aortic stenosis.
Source
Journal of Invasive Cardiology. 33 (1) (pp 30-36), 2020. Date of
Publication: 2020.
Author
Wernly B.; Jirak P.; Lichtenauer M.; Veulemans V.; Zeus T.; Piayda K.;
Hoppe U.C.; Lauten A.; Frerker C.; Jung C.
Institution
(Wernly, Jirak, Lichtenauer, Hoppe) Clinic of Internal Medicine II,
Department of Cardiology, Paracelsus Medical University of Salzburg,
Salzburg, Austria
(Veulemans, Zeus, Piayda, Jung) Division of Cardiology, Pulmonology, and
Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf,
Germany
(Lauten) Department of Cardiology, Charite - Universitaetsmedizin Berlin,
Berlin, Germany
(Frerker) Department of Cardiology, Asklepios Klinik St. Georg, Hamburg,
Germany
Publisher
HMP Communications
Abstract
Aims. Patients in cardiogenic shock (CS) due to decompensated aortic
stenosis (AS) evidence poor prognosis. Both emergency transcatheter aortic
valve replacement (eTAVR) and emergency balloon aortic valvuloplasty
(eBAV) have been reported in CS patients. We aimed to summarize and
compare available studies on eBAV and eTAVR in patients suffering from CS
due to decompensated AS with regard to safety and efficacy. Methods and
Results. Study-level data were analyzed. Heterogeneity was assessed using
the I² statistic. Pooled proportions, ie, event rates, were
calculated and obtained using a random-effects model (DerSimonian and
Laird). Eight studies were found suitable for the final analysis,
including 311 patients. Primary endpoint was mortality at 30 days. For
eBAV (n = 238), 30-day mortality rate was 46.2% (95% confidence interval
[CI], 30.3%-62.5%; I²=74%), major bleeding rate was 10% (95%
CI, 5.4%-15.7%; I²=13%), and stroke rate was 0.7% (95% CI,
0.0%-2.7%; I²=0%). Aortic regurgitation (AR) >=II was present
in 8.6% (95% CI, 0.4%-23.5%; I²=86%). For eTAVR (n = 73),
30-day mortality rate was 22.6% (95% CI, 12.0%-35.2%; I²=26%),
major bleeding rate was 5.8% (95% CI, 0.5%-14.7%; I²=0%), and
stroke rate was 5.8% (95% CI, 0.5%-14.7%; I²=0%). AR >=II was
present in 4% (95% CI, 0.0%-12.1%; I²=0%). Conclusion.
Mortality in CS patients due to decompensated severe AS is high,
regardless of interventional treatment strategy. Both eBAV and eTAVR seem
feasible. As eTAVR is associated with better initial improvements in
hemodynamics and simultaneously avoids sequential interventions, it might
be favorable to eBAV in select patients. If eTAVR is not available, eBAV
might serve as a "bridge" to elective TAVR.<br/>Copyright &#xa9; 2020 HMP
Communications. All rights reserved.

<43>
Accession Number
631287430
Title
Ticagrelor-based antiplatelet regimens in patients treated with coronary
artery bypass grafting: A meta-analysis of randomized controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 57 (3) (pp 520-528), 2020.
Date of Publication: 01 Mar 2020.
Author
Von Scheidt M.; Bongiovanni D.; Tebbe U.; Nowak B.; Stritzke J.; Zhao Q.;
Zhu Y.; Kastrati A.; Cassese S.; Schunkert H.
Institution
(Von Scheidt, Kastrati, Cassese, Schunkert) Klinik fur Herz- und
Kreislauferkrankungen, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Lazarettstrasse 36, Munich 80636, Germany
(Von Scheidt, Bongiovanni, Kastrati, Schunkert) DZHK (German Center for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Bongiovanni) Medical Department i, Cardiology, Klinikum Rechts der Isar,
Technical University, Munich, Germany
(Tebbe) Department of Cardiology, Angiology and Intensive Care Medicine,
District Hospital Lippe-Detmold, Detmold, Germany
(Nowak) CCB, Cardiovascular Center Bethanien, Frankfurt, Germany
(Stritzke) Lanserhof Sylt, Marienstein Privatklinik, List, Germany
(Zhao, Zhu) Ruijin Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The optimal antiplatelet strategy in patients undergoing CABG
remains unclear. This is the first meta-analysis investigating the
clinical outcomes associated with ticagrelor-based antiplatelet regimens
in patients receiving CABG. <br/>METHOD(S): Relevant scientific databases
were searched for studies investigating antiplatelet regimens after CABG
from inception until April 1, 2019. Studies which randomly assigned CABG
patients to either ticagrelor-based or control antiplatelet regimens were
eligible. The primary outcome of this analysis was all-cause death. The
main secondary outcome was MI. Other outcomes of interest were cardiac
death, major adverse cardiac events, stroke and bleeding. This study is
registered with PROSPERO, number CRD42019122192. <br/>RESULT(S): Five
trials comprising 3996 patients (2002 assigned to ticagrelor-based and
1994 to control antiplatelet regimens) were eligible for quantitative
synthesis. The median follow-up was 12 months. Control antiplatelet
regimens consisted of either aspirin or clopidogrel or both. As compared
to control, ticagrelor-based regimens reduced the risk of all-cause death
[0.61 (0.43-0.87); P = 0.007], cardiac death [0.58 (0.39-0.86); P = 0.007]
and major adverse cardiac events [0.79 (0.63-0.98); P = 0.03], without
difference in the risk of MI [0.76 (0.50-1.18); P = 0.22], stroke [0.99
(0.56-1.78); P = 0.98] or bleeding [1.04 (0.95-1.14); P = 0.41]. There was
a treatment effect modification for the primary outcome associated with
trials enrolling predominantly patients with acute coronary syndrome (P
for interaction = 0.038). <br/>CONCLUSION(S): In patients receiving CABG,
ticagrelor-based regimens reduce mortality and major adverse cardiac
events without excess bleeding risk as compared with aspirin monotherapy
or the combination of aspirin and clopidogrel. The benefit of
ticagrelor-based regimens is more relevant in those studies enrolling
predominantly patients with acute coronary syndrome. These findings
require further confirmation in randomized trials focused on this subset
of patients and powered for clinical outcomes.<br/>Copyright &#xa9; 2019
The Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<44>
Accession Number
631287426
Title
Mini-extracorporeal circulation surgery produces less inflammation than
off-pump coronary surgery.
Source
European Journal of Cardio-thoracic Surgery. 57 (3) (pp 496-503), 2020.
Date of Publication: 01 Mar 2020.
Author
Permanyer E.; Munoz-Guijosa C.; Padro J.-M.; Ginel A.; Montiel J.;
Sanchez-Quesada J.L.; Vila L.; Camacho M.
Institution
(Permanyer) Department of Cardiac Surgery, Quironsalud Teknon Heart
Institute, C. Vilana 12, Barcelona 08022, Spain
(Permanyer, Padro, Ginel, Montiel) Department of Cardiac Surgery, Hospital
de la Santa Creu i Sant Pau, Research Institute Hospital Sant Pau, IIB
Sant Pau, Barcelona, Spain
(Munoz-Guijosa) Department of Cardiac Surgery, University Hospital Germans
Trias i Pujol, Badalona, Spain
(Sanchez-Quesada) Cardiovascular Research Group, CIBERDEM, Research
Institute Hospital Sant Pau, IIB Sant Pau, Barcelona, Spain
(Vila, Camacho) Laboratory of Angiology, Vascular Biology and
Inflammation, Research Institute Hospital Sant Pau, IIB Sant Pau,
Barcelona, Spain
(Camacho) Genomics of Complex Diseases, Research Institute Hospital Sant
Pau, IIB Sant Pau, Barcelona, Spain
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Both off-pump coronary artery bypass grafting surgery (OPCABG)
and mini-extracorporeal circulation (MECC) have been associated with lower
morbidity and mortality and less inflammation than conventional
cardiopulmonary bypass. However, studies comparing the 2 techniques are
scarce and the results are controversial. We compared the clinical
outcomes and inflammatory response of low-risk patients undergoing
coronary bypass grafting with MECC versus OPCABG. <br/>METHOD(S): We
conducted a prospective, randomized study in patients undergoing coronary
heart surgery. Two hundred and thirty consecutive low-risk patients were
randomly assigned to either receive OPCABG (n = 117) or MECC (n = 113).
Clinical outcomes and postoperative biochemical results were analysed in
both groups. We also analysed 19 circulating inflammatory markers in a
subgroup of 40 patients at 4 perioperative time points. The area under the
curve for each marker was calculated to monitor differences in the
inflammatory response. <br/>RESULT(S): No significant differences were
found between groups regarding perioperative clinical complications and no
deaths occurred during the trial. Plasma levels in 9 of the 19
inflammatory markers were undetectable or showed no temporal variation, 3
were higher in the MECC group [interleukin (IL)-10, macrophage
inflammatory protein-1beta and epidermal growth factor] and 7 were higher
in the OPCABG group (growth regulator oncogene, IL-6, IL-8, soluble CD40
ligand, monocyte chemoattractant protein-1, monocyte chemoattractant
protein-3 and tumour necrosis factor-alpha). Differences in 2
proinflammatory cytokines, IL-6 and monocyte chemoattractant protein 1,
between the 2 surgical procedures were statistically significant.
<br/>CONCLUSION(S): No clinical differences were observed between in
low-risk patients undergoing MECC or OPCABG surgery, but OPCABG was
associated with an increased release of proinflammatory cytokines compared
with MECC. Studies in larger cohorts and in patients at higher risk are
needed to confirm these findings. Clinical trial registration number:
NCT02118025.<br/>Copyright &#xa9; 2019 The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<45>
Accession Number
631106918
Title
Sutureless versus Stented Bioprostheses for Aortic Valve Replacement: The
Randomized PERSIST-AVR Study Design.
Source
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 +), P. Debyelaan, 25,
Maastricht 6202 AZ, Netherlands
(Folliguet) Chirurgie Cardiaque and Transplantation, Assistance Publique
Hopital, Henri Mondor, Universite Paris 12, UPEC, 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
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
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.<br/>Copyright
&#xa9; 2020 American Institute of Physics Inc.. All rights reserved.

<46>
[Use Link to view the full text]
Accession Number
631105779
Title
Impact of postprocedural thrombocytopenia on mortality after transcatheter
aortic valve implantation.
Source
Journal of Cardiovascular Medicine. 21 (4) (pp 318-324), 2020. Date of
Publication: 01 Apr 2020.
Author
Takagi H.; Hari Y.; Nakashima K.; Ueyama H.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ueyama, Kuno) Department of Medicine, Mount Sinai Beth Israel Medical
Center, United States
(Ando) Division of Interventional Cardiology, Department of Cardiology,
New York Presbyterian Hospital, Columbia University Medical Center, New
York, NY, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
AimsWe performed a meta-analysis of currently available studies
investigating the impact of postprocedural thrombocytopenia on mortality
after transcatheter aortic valve implantation (TAVI).MethodsAll studies
researching the impact of postprocedural thrombocytopenia on mortality
after TAVI were identified after searching PubMed and Web of Science
through July 2019. The outcome of interest was early (in-hospital or
30-day) and overall (1- to 2-year) all-cause mortality after TAVI. From
each study, the number of deaths in both patients with major
(moderate/severe or higher postprocedural drop platelet counts defined in
each study) and nonmajor (no/minor or lower drop platelet counts defined
in each study) postprocedural thrombocytopenia was extracted. Then, odds
ratios (ORs) of mortality for major vs. no/minor thrombocytopenia and
their confidence intervals were generated. Alternatively, ORs and hazard
ratios of mortality for major vs. no/minor thrombocytopenia (if available,
adjusted) were directly extracted. Study-specific estimates were pooled in
both the fixed-effect and random-effects models.ResultsThe principal
pooled analysis demonstrated that postprocedural thrombocytopenia was
associated with statistically significant increases in early (OR, 3.79; P
for effect <0.00001; P for heterogeneity=0.89) and overall mortality
(OR/hazard ratio, 1.22; P for effect=0.009; P for heterogeneity=0.17) in
the fixed-effect model. All sensitivity analyses did not substantively
alter the results of the principal analysis. No funnel plot asymmetry of
the principal analysis was detected (P for early mortality=0.88; P for
overall mortality=0.14), which suggested probably no publication
bias.ConclusionPostprocedural thrombocytopenia is associated with
increased early and overall mortality after TAVI.<br/>Copyright &#xa9;
2020 Italian Federation of Cardiology - I.F.C. All rights reserved.

<47>
Accession Number
631189517
Title
Epidemiology and management of primary spontaneous pneumothorax: A
systematic review.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (3) (pp 337-345),
2020. Date of Publication: March 2020.
Author
Mendogni P.; Vannucci J.; Ghisalberti M.; Anile M.; Aramini B.; Congedo
M.T.; Nosotti M.; Bertolaccini L.; D'Ambrosio A.E.; de Vico A.; Guerrera
F.; Imbriglio G.; Pardolesi A.; Schiavon M.; Russo E.
Institution
(Mendogni, Nosotti) Thoracic Surgery and Lung Transplant Unit, Foundation
IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
(Vannucci, Anile) Department of Thoracic Surgery, Umberto I Hospital,
University of Rome Sapienza, Rome, Italy
(Ghisalberti) Thoracic Surgery Unit, University Hospital of Siena, Siena,
Italy
(Aramini) Division of Thoracic Surgery, Department of Medical and Surgical
Sciences for Children and Adults, University Hospital of Modena and Reggio
Emilia, Modena, Italy
(Congedo) Division of Thoracic Surgery, Fondazione Policlinico Gemelli
IRCCS, Catholic University of Sacred Heart, Rome, Italy
(Bertolaccini) Division of Thoracic Surgery, IEO, European Institute of
Oncology IRCCS, Via Ripamonti 435, Milan 20141, Italy
(D'Ambrosio) Thoracic Surgery Unit, A.O.R.N.A.S. Garibaldi Nesima,
Catania, Italy
(de Vico) Thoracic Surgery Unit, ASST Spedali Civili Brescia, Brescia,
Italy
(Guerrera) Department of Thoracic Surgery, University of Torino, Torino,
Italy
(Imbriglio) Thoracic Surgery Unit, Vito Fazzi Hospital, Lecce, Italy
(Pardolesi) Unit of Thoracic Surgery, Foundation IRCCS National Cancer
Institute of Milan, Milan, Italy
(Schiavon) Thoracic Surgery Unit, Department of Cardiac, Thoracic,
Vascular Sciences and Public Health, University of Padova, Padova, Italy
(Russo) Division of Thoracic Surgery and Lung Transplantation, Department
for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic
Transplantation, IRCCS ISMETT, UPMC, Palermo, Italy
Publisher
Oxford University Press
Abstract
Primary spontaneous pneumothorax (PSP) is one of the most common thoracic
diseases affecting adolescents and young adults. Despite the high
incidence of PSP and the availability of several international guidelines
for its diagnosis and treatment, a significant behavioural heterogeneity
can be found among those management recommendations. A working group of
the Italian Society of Thoracic Surgery summarized the best evidence
available on PSP management with the methodological tool of a systematic
review assessing the quality of previously published guidelines with the
Appraisal of Guidelines for Research and Evaluation (AGREE) II. Concerning
PSP physiopathology, the literature seems to be equally divided between
those who support the hypothesis of a direct correlation between changes
in atmospheric pressure and temperature and the incidence of PSP, so it is
not currently possible to confirm or reject this theory with reasonable
certainty. Regarding the choice between conservative treatment and chest
drainage in the first episode, there is no evidence on whether one option
is superior to the other. Video-assisted thoracic surgery represents the
most common and preferred surgical approach. A primary surgical approach
to patients with their first PSP seems to guarantee a lower recurrence
rate than that of a primary approach consisting of a chest drainage
positioning; conversely, the percentage of futile surgical interventions
that would entail this aggressive attitude must be carefully evaluated.
Surgical pleurodesis is recommended and frequently performed to limit
recurrences; talc poudrage offers efficient pleurodesis, but a
considerable number of surgeons are concerned about administering this
inert material to young patients.<br/>Copyright VC The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<48>
Accession Number
631172562
Title
Development and usability testing of HEARTPAN: Protocol for a mixed
methods strategy to develop an integrated smartphone and web-based
intervention for women with cardiac pain.
Source
BMJ Open. 10 (3) (no pagination), 2020. Article Number: e033092. Date of
Publication: 09 Mar 2020.
Author
Parry M.; Dhukai A.; Clarke H.; Bjornnes A.K.; Cafazzo J.A.; Cooper L.;
Harvey P.; Katz J.; Lalloo C.; Leegaard M.; Legare F.; Lovas M.;
McFetridge-Durdle J.; McGillion M.; Norris C.; Parente L.; Patterson R.;
Pilote L.; Pink L.; Price J.; Stinson J.; Uddin A.; Victor J.C.;
Watt-Watson J.; Auld C.; Faubert C.; Park D.; Park M.; Rickard B.; DeBonis
V.S.
Institution
(Parry, Dhukai) University of Toronto Lawrence S Bloomberg Faculty of
Nursing, Toronto, ON, Canada
(Clarke) Pain Research Unit, University Health Network, Toronto, ON,
Canada
(Clarke, Cafazzo, Harvey, Victor) University of Toronto, Toronto, ON,
Canada
(Bjornnes) Department of Nursing and Health Promotion, Oslo Metropolitan
University, Oslo, Norway
(Cafazzo, Lovas, Parente, Uddin) Healthcare Human Factors, University
Health Network, Toronto, ON, Canada
(Cooper, Auld, Faubert, Park, Park, DeBonis) Patient Advisor, Toronto, ON,
Canada
(Harvey, Price) Women's College Hospital, Toronto, ON, Canada
(Katz) Faculty of Health - Department of Psychology, York University,
Toronto, ON, Canada
(Lalloo, Stinson) Peter Gilgan Centre for Research and Learning, Toronto,
ON, Canada
(Leegaard) Institute of Nursing, Oslo Metropolitan University, Oslo,
Akershus, Norway
(Legare) Medecine Familiale, Universite Laval, Quebec, QC, Canada
(McFetridge-Durdle) College of Nursing, Florida State University,
Tallahassee, FL, United States
(McGillion) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Norris) Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
(Patterson) Anishnawbe Health, Toronto, ON, Canada
(Pilote) Medicine, McGill University, Montreal, QC, Canada
(Pink) Wasser Pain Management Centre, Sinai Health System, Toronto, ON,
Canada
(Stinson, Watt-Watson) Lawrence S Bloomberg Faculty of Nursing, University
of Toronto, Toronto, ON, Canada
(Rickard) Moose Factory, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: More women experience cardiac pain related to coronary
artery disease and cardiac procedures compared with men. The overall goal
of this programme of research is to develop an integrated smartphone and
web-based intervention (HEARTPAN) to help women recognise and self-manage
cardiac pain. Methods and analysis: This protocol outlines the mixed
methods strategy used for the development of the HEARTPAN content/core
feature set (phase 2A), usability testing (phase 2B) and evaluation with a
pilot randomised controlled trial (RCT) (phase 3). We are using the
individual and family self-management theory, mobile device functionality
and pervasive information architecture of mHealth interventions, and
following a sequential phased approach recommended by the Medical Research
Council to develop HEARTPAN. The phase 3 pilot RCT will enable us to
refine the prototype, inform the methodology and calculate the sample size
for a larger multisite RCT (phase 4, future work). Patient partners have
been actively involved in setting the HEARTPAN research agenda, including
defining patient-reported outcome measures for the pilot RCT: pain and
health-related quality of life (HRQoL). As such, the guidelines for
Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols
(SPIRIT-PRO) are used to report the protocol for the pilot RCT (phase 3).
Quantitative data (eg, demographic and clinical information) will be
summarised using descriptive statistics (phases 2AB and 3) and a content
analysis will be used to identify themes (phase 2AB). A process evaluation
will be used to assess the feasibility of the implementation of the
intervention and a preliminary efficacy evaluation will be undertaken
focusing on the outcomes of pain and HRQoL (phase 3). Ethics and
dissemination: Ethics approval was obtained from the University of Toronto
(36415; 26 November 2018). We will disseminate knowledge of HEARTPAN
through publication, conference presentation and national public forums
(Cafe Scientifique), and through fact sheets, tweets and
webinars.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2020.

<49>
Accession Number
628469114
Title
Resolute zotarolimus-eluting stent in ST-elevation myocardial infarction
(resolute-STEMI): A prespecified prospective register from the DAPT-STEMI
trial.
Source
Catheterization and Cardiovascular Interventions. 95 (4) (pp 706-710),
2020. Date of Publication: 01 Mar 2020.
Author
Postma W.; Fabris E.; Van der Ent M.; Hermanides R.; Buszman P.; Von
Birgelen C C.; Cook S.; Wedel H.; De Luca G.; Delewi R.; Zijlstra F.;
Kedhi E.
Institution
(Postma, Fabris, Hermanides, Kedhi) Isala Hartcentrum, Zwolle, Netherlands
(Fabris) Cardiovascular Department, University of Trieste, Trieste, Italy
(Van der Ent) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Buszman) American Heart of Poland, Ustron, Poland
(Buszman) Medical University of Silesia, Katowice, Poland
(Von Birgelen C, Zijlstra) Thoraxcenter, Erasmus Medisch Centrum,
Rotterdam, Netherlands
(Von Birgelen C) Medisch Spectrum Twente, Enschede, Netherlands
(Cook) Department of Cardiology, University and Hospital, Fribourg,
Switzerland
(Wedel) Sahlgrenska Academy, University of Gothenburg and Nordic School of
Public Health, Gothenburg, Sweden
(De Luca) Department of Cardiology, Eastern Piedmont University, Novara,
Italy
(Delewi) Heart Centre, Academic Medical Centre, University Medical Center
Amsterdam, Amsterdam, Netherlands
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To evaluate the safety and efficacy outcomes after primary
percutaneous coronary intervention (pPCI) with second-generation
ResoluteTM zotarolimus-eluting stent (R-ZES) in patients enrolled in the
DAPT-STEMI Trial (NCT01459627). <br/>Background(s): R-ZES is one of the
most used drug eluting stents worldwide. To date, the safety and efficacy
data of this stent in setting of STEMI is limited. <br/>Method(s): The
Resolute-STEMI is a prespecified prospective register that reports the
safety and efficacy of R-ZES in setting of ST-Elevation Myocardial
Infarction (STEMI) at 6 months for the following endpoints: a composite
endpoint of all-cause mortality, any myocardial infarction (MI), any
(unscheduled) revascularization, stroke and TIMI major bleeding, as well
as target lesion failure and stent thrombosis (ST). <br/>Result(s): From a
total of 1,100 STEMI patients enrolled in the trial, 998 received a R-ZES.
At 6 months the PE occurred in 42 (4.2%) patients. All-cause death, MI,
revascularization, stroke and TIMI major bleeding was respectively 8
(0.8%), 9 (0.8%), 34 (3.4%), 2 (0.2%), and 4 (0.4%). The rate of target
lesion revascularizations involving the culprit lesion was 1.1%. Target
lesion failure was 1.5%. The rate of definite ST was 0.5%. The rate of
both definite or probable ST was 0.7%. <br/>Conclusion(s): The present
analysis is the largest to date reporting short-term and mid-term clinical
outcomes with the R-ZES stent in setting of STEMI. At 30 days and 6-months
R-ZES has an outstanding safety and efficacy even in this high-risk
category of patients.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<50>
Accession Number
2002561005
Title
Antibiotic Management for Delayed Sternal Closure Following Pediatric
Cardiac Surgery: A Systematic Review of Recent Literature.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (5) (pp 1333-1340),
2020. Date of Publication: May 2020.
Author
Silvetti S.; Landoni G.; Castagnola E.; Nuri H.; Pome G.; Moscatelli A.
Institution
(Silvetti, Moscatelli) Neonatal and Pediatric Intensive Care Unit,
Department of Surgery and Critical Care, IRCCS Istituto Giannina Gaslini,
Genova, Italy
(Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, University Vita-Salute San Raffaele, Milano, Italy
(Castagnola) Infectious Disease Unit, Department of Pediatrics, IRCCS
Istituto Giannina Gaslini, Genova, Italy
(Nuri, Pome) Cardiac Surgery Unit, Department of Surgery and Critical
Care, IRCCS Istituto Giannina Gaslini, Genova, Italy
Publisher
W.B. Saunders
Abstract
Delayed sternal closure after pediatric cardiac surgery is a management
option for the treatment of patients with severely impaired heart
function. The optimal antimicrobial treatment strategy for this condition
is unknown. The aim of this systematic review was to evaluate the current
antibiotic administration attitudes in pediatric cardiac surgery patients
needing an open chest in terms of infection with a focus on surgical site
infection rate. The authors performed a systematic review and
meta-analysis of all articles, which described the antibiotic
administration strategy and surgical site infection rate in pediatric
patients with an open chest after cardiac surgery. The authors performed a
subgroup analysis on "standard" versus "non-standard" (defined as any
antimicrobial drugs different from the adult guidelines recommendations)
therapy for one-proportion meta-analysis with a random effect model. The
authors identified 12 studies published from January 1, 2000 to July 1,
2019 including a total of 2,203 patients requiring an open chest after
cardiac surgery, 350 of whom (15.9%) developed infections and 182 (8.3%)
developed a surgical site infection. The surgical site infection rate in
patients with "non-standard" strategy was higher than in patients with
"standard" strategy: 8.8% (140 reported infections/1,582 patients) versus
6.8% (42 reported infections/621 patients), p = 0.001. The "standard"
antibiotic management proposed by guidelines for adult cardiac surgery
patients could be used an acceptable strategy to treat pediatric patients
with an open chest after cardiac surgery.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<51>
Accession Number
628898043
Title
Effect of Autotransfusion Using Intraoperative Predonated Autologous Blood
on Coagulopathy during Thoracic Aortic Surgery: A Randomized Controlled
Trial.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 25 (6) (pp
311-317), 2019. Date of Publication: 20 Dec 2019.
Author
Suzuki R.; Mikamo A.; Matsuno Y.; Fujita A.; Kurazumi H.; Yamashita A.;
Hamano K.
Institution
(Suzuki, Mikamo, Matsuno, Fujita, Kurazumi, Hamano) Department of Surgery
and Clinical Science, Division of Cardiac Surgery, Yamaguchi University
Graduate School of Medicine, Ube, Yamaguchi, Japan
(Yamashita) Department of Anesthesiology, Yamaguchi University Graduate
School of Medicine, Ube, Yamaguchi, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intraoperative predonated autologous blood transfusion is
thought to replenish platelets and coagulation factors and ameliorate
coagulopathy. This study aimed to evaluate whether intraoperative
predonated autotransfusion improves coagulopathy during thoracic aortic
surgery. <br/>METHOD(S): Patients who underwent thoracic aortic surgery
were randomized into two groups as follows: those who received
intraoperative predonated blood (group A: n = 31) and those who did not
receive (group N: n = 22). In group A, autologous blood was retransfused
immediately after cessation of cardiopulmonary bypass (c-CPB).
<br/>RESULT(S): The mean intraoperative allogenic blood or blood product
transfusion requirements were significantly lesser in group A than in
group N (packed red blood cells [RBCs]: 6.3 +/- 5.1 vs. 9.1 +/- 4.3 units,
p = 0.04; fresh frozen plasma [FFP]: 3.0 +/- 4.1 vs. 6.1 +/- 5.7 units, p
= 0.03). After c-CPB, hemoglobin (Hb) level, platelet count, and
coagulopathy became significantly worse than those at the start of surgery
in both the groups. However, the values significantly improved 30 min
after c-CPB only in group A. Renal function was significantly worse in
group N. <br/>CONCLUSION(S): Intraoperative predonated autotransfusion
significantly improved coagulopathy, with reduced allogeneic blood
transfusion volume during thoracic aortic surgery. Furthermore, reduction
of allogeneic blood transfusion may reduce the adverse effects on renal
function.

<52>
Accession Number
628783614
Title
A Double-Blind Randomized Controlled Trial to Determine the Preventive
Effect of Hangekobokuto on Aspiration Pneumonia in Patients Undergoing
Cardiovascular Surgery.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 25 (6) (pp
318-325), 2019. Date of Publication: 20 Dec 2019.
Author
Kawago K.; Nishibe T.; Shindo S.; Inoue H.; Motohashi S.; Akasaka J.;
Ogino H.
Institution
(Kawago, Shindo, Inoue, Motohashi, Akasaka) Department of Cardiovascular
Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji,
Tokyo, Japan
(Kawago, Nishibe, Ogino) Department of Cardiovascular Surgery, Tokyo
Medical University, Tokyo, Japan
Publisher
NLM (Medline)
Abstract
PURPOSE: This study aimed to assess whether hangekobokuto (HKT) can
prevent aspiration pneumonia in patients undergoing cardiovascular
surgery. <br/>METHOD(S): We performed a single-center, double-blinded,
randomized, placebo-controlled study of HKT in patients undergoing
cardiovascular surgery. JPS HKT extract granule (JPS-16) was used as HKT.
The primary endpoint was defined as the prevention of postoperative
aspiration pneumonia. The secondary endpoints included complete recovery
from swallowing and coughing disorders. <br/>RESULT(S): Between August
2014 and August 2015, a total of 34 patients were registered in this
study. The rate of subjects with postoperative aspiration pneumonia was
significantly lower in the HKT group than in the placebo group (p =
0.017). In high-risk patients for aspiration pneumonia, the rate was
significantly lower in the HKT group than in the placebo group (p =
0.015). The rate of subjects with swallowing disorders tended to be lower
in the HKT group than in the placebo group (p = 0.091), and in high-risk
patients, the rate was significantly lower in the HKT group than in the
placebo group (p = 0.038). <br/>CONCLUSION(S): HKT can prevent aspiration
pneumonia in patients undergoing cardiovascular surgery. In high-risk
patients for aspiration pneumonia, HKT can prevent aspiration pneumonia
and improve swallowing disorders.

<53>
Accession Number
628751700
Title
The Relationship between the Use of Cold and Isothermic Blood Cardioplegia
Solution for Myocardial Protection during Cardiopulmonary Bypass and the
Ischemia-Reperfusion Injury.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 25 (6) (pp
296-303), 2019. Date of Publication: 20 Dec 2019.
Author
Sacli H.; Kara I.; Diler M.S.; Percin B.; Turan A.I.; Kirali K.
Institution
(Sacli, Kara, Kirali) Faculty of Medicine, Department of Cardiovascular
Surgery, Sakarya University, Turkey
(Diler, Percin, Turan) Department of Cardiovascular Surgery, Sakarya
University Education and Research Hospital, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: In this study, we aimed to assess myocardial protection and
ischemia-reperfusion injury in patients undergoing open heart surgery with
isothermic blood cardioplegia (IBC) or hypothermic blood cardioplegia
(HBC). MATERIALS AND METHODS: A total of 48 patients who underwent
isolated coronary artery bypass grafting or isolated mitral valve surgery
between March 2017 and October 2017 were evaluated as randomized
prospective study. Study groups (HBC: Group 1, IBC: Group 2) were compared
in terms of interleukin 6 (IL-6), IL-8, IL-10, and complement factor 3a
(C3a) levels, metabolic parameters, creatine kinase-muscle/brain (CK-MB)
and high-sensitivity Troponin I (hsTn-I), and clinical outcomes.
<br/>RESULT(S): Comparison of the markers of ischemia-reperfusion injury
showed significantly higher levels of the proinflammatory cytokine IL-6 in
the early postoperative period as well as IL-8, in Group 2 (p <0.001),
whereas the anti-inflammatory cytokine IL-10 was significantly higher
during the X1 time period (p = 0.11) in Group 2, and subsequently it was
higher in Group 1. Using myocardial temperature probes, the target
myocardial temperatures were measured in the patients undergoing open
heart surgery with different routes of cardioplegia, and significant
differences were noted (p = 0.000). <br/>CONCLUSION(S): HBC for open heart
surgery is associated with less myocardial injury and intraoperative and
postoperative morbidity, indicating superior myocardial protection versus
IBC.

<54>
Accession Number
2005416602
Title
Efficacy of Tafamidis in Transthyretin Amyloid Cardiomyopathy in the
ATTR-ACT Trial.
Source
Heart and Lung. Conference: AAHFN 15th ANNUAL MEETING. JW Marriott Austin,
United States. 49 (2) (pp 209-210), 2020. Date of Publication: March -
April 2020.
Author
Berk J.; Damy T.; Drachman B.; Elliott P.; Gottlieb S.; Grogan M.;
Gundapaneni B.; Hanna M.; Hoffman J.; Hummel S.; Judge D.; Lenihan D.;
Merlini G.; Patterson T.; Rapezzi C.; Schwartz J.; Shah S.; Sultan M.;
Velazquez E.; Cruz M.W.; Witteles R.
Institution
(Berk) Boston University School of Medicine
(Damy) French Referral Center for Cardiac Amyloidosis, Amyloidosis Mondor
Network, GRC Amyloid Research Institute
(Drachman) Penn Presbyterian Medical Center
(Elliott) University College London
(Gottlieb) University of Maryland School of Medicine
(Grogan) Department of Cardiovascular Diseases
(Gundapaneni, Patterson, Schwartz, Sultan) Pfizer
(Hanna) Cleveland Clinic
(Hoffman) University of Miami
(Hummel) University of Michigan
(Judge) Medical University of South Carolina
(Lenihan) Washington University School of Medicine in St. Louis
(Merlini) Amyloidosis Center, IRCCS Policlinico San Matteo and University
of Pavia
(Rapezzi) Cardiology, Department of Experimental, Diagnostic and Specialty
Medicine
(Shah) Division of Cardiology, Department of Medicine
(Velazquez) Heart and Vascular Center
(Cruz) Federal University of Rio de Janeiro, National Amyloidosis Referral
Center, CEPARM
(Witteles) Stanford University School of Medicine
Publisher
Mosby Inc.
Abstract
Background: Transthyretin cardiomyopathy (ATTR-CM) is an underdiagnosed,
fatal disease caused by the deposition of transthyretin amyloid fibrils in
the heart leading to heart failure (HF). It can be hereditary due to
mutations in the TTR gene (ATTRm) or acquired (wild-type [ATTRwt]).
Tafamidis is a selective transthyretin stabilizer which prevents tetramer
dissociation and amyloidogenesis. The Tafamidis in Transthyretin
Cardiomyopathy Clinical Trial (ATTR-ACT) was an international,
multicenter, double-blind, placebo-controlled, randomized trial of
Tafamidis in patients with ATTR-CM. <br/>Objective(s): Given the limited
number of patients with ATTR-CM, a novel study design was utilized to
enable rigorous testing of the efficacy of tafamidis on hard
cardiovascular (CV) endpoints in a study of relatively modest size
compared with traditional CV trials. The primary results of this trial
were further supported through the application of pre-specified
sensitivity analyses. <br/>Method(s): Patients with ATTR-CM were
randomized (2:1:2) to tafamidis (80 mg or 20 mg of tafamidis meglumine),
or placebo (orally, once daily), for 30 months. Enrollment was stratified
by NYHA class and genotype. The primary efficacy analysis was a
hierarchical combination of all-cause mortality and frequency of
CV-related hospitalizations comparing the pooled tafamidis groups (20 mg
and 80 mg) vs. the placebo group using the Finkelstein-Schoenfeld (F-S)
method. The primary efficacy analysis result was examined using a series
of sensitivity analyses. Key secondary endpoints were change from baseline
to Month 30 in the six-minute walk test distance and the Kansas City
Cardiomyopathy Questionnaire (KCCQ) overall score. Safety assessments
included adverse events, vital signs, and clinical laboratory tests.
<br/>Result(s): A total of 441 patients were randomized (tafamidis=264,
placebo=177). Tafamidis was associated with a significant reduction in the
hierarchical combination of all-cause mortality and CVrelated
hospitalizations (P<0.001). Tafamidis also significantly reduced the
decline in both the six-minute walk distance (by 75.68 m [standard error,
9.24]; P<0.001]), and KCCQ overall score (by 13.65 [2.13]; P<0.001) as
compared with placebo. Sensitivity analyses consistently confirmed the
efficacy of tafamidis in patients with ATTR-CM: there was a 30% reduction
in risk of all-cause mortality (heart transplant and implantation of a
cardiac mechanical assist device treated as death) with tafamidis compared
with placebo (P=0.0259); and when heart transplant and implantation of a
cardiac mechanical assist device were not treated as death, there was a
33% reduction in risk of all-cause mortality with tafamidis compared with
placebo (P=0.018). Tafamidis was safe and well tolerated in this
population. <br/>Conclusion(s): ATTR-ACT, the largest randomized
controlled trial in ATTR-CM, showed that tafamidis is the first treatment
to improve survival and quality of life in ATTR-CM. Significant and
clinically meaningful improvements were observed in functional capacity as
measured by the six-minute walk distance and quality of life by KCCQ
overall score. Sensitivity analyses confirmed the robustness of these
results. Tafamidis was safe and well tolerated. The primary trial results,
along with the sensitivity analyses described here, provide strong
rationale for the use of tafamidis as first-line therapy in
ATTR-CM.<br/>Copyright &#xa9; 2020

<55>
Accession Number
2005042915
Title
TRANSCATHETER VERSUS SURGICAL AORTIC-VALVE REPLACEMENT IN PATIENTS AGE 80
YEARS AND OLDER.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1250), 2020. Date of
Publication: 24 Mar 2020.
Author
Phichaphop A.; Buddhari W.
Institution
(Phichaphop, Buddhari) Siriraj Hospital, Bangkok, Thailand, Siriraj
Hospital, Bangkok, Thailand; King Chulalongkorn Memorial Hospital,
Bangkok, Thailand, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Publisher
Elsevier USA
Abstract
Background Extreme Aging is associated with increasing perioperative risk.
Many trials showed comparable survival rate of transcatheter aortic-valve
replacement (TAVR) and surgical aortic-valve replacement(SAVR) in
high/intermediate surgical risk patients. We evaluated short- and mid-term
outcomes between TAVR and SAVR in elderly patients age 80 years and older
regardless of surgical risk. Methods We analyzed data of all patients age
80 years and older who underwent aortic valve replacement between Jan 2010
and Sep 2016. Fifty patients underwent TAVR and 45 underwent SAVR.
Baseline characteristics, short- and mid-term outcomes were compared.
Primary outcome was cardiovascular mortality at 30 days. Secondary outcome
were stroke, vascular complications, need for permanent pacemaker and
atrial fibrillation Results Thirty-day cardiovascular mortality was not
different between TAVR and SAVR (8.0% vs 11.1%, P = 0.731). Thirty-day
stroke was numerically lower in TAVR group but not statistically
significant (2.0% vs 4.4%, P = 0.602). More vascular complications and
need for permanent pacemaker were observed in TAVR group, whereas atrial
fibrillation was more common in surgery group. Mean duration of follow up
was 22 months. Two-year survival was higher in TAVR group as figured.
Conclusion Outcomes of TAVR in patients age 80 years and older regardless
of surgical risk are at least as good as those who underwent SAVR. A
proper randomized control trial is needed to further clarify these
findings. [Figure presented]<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<56>
Accession Number
2005042673
Title
PERCUTANEOUS INTERVENTION OR CORONARY ARTERY BYPASS GRAFTING FOR LEFT MAIN
STEM CORONARY ARTERY DISEASE? A META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1396), 2020. Date of
Publication: 24 Mar 2020.
Author
Ullah W.; Sattar Y.; Susheela A.; Ullah I.; Mukhtar M.
Institution
(Ullah, Sattar, Susheela, Ullah, Mukhtar) Abington Jefferson Health,
Abington, PA, United States
Publisher
Elsevier USA
Abstract
Background The relative safety and efficacy of percutaneous coronary
intervention (PCI) versus coronary artery bypass grafting (CABG) for left
main coronary artery disease (LMCAD) remain controversial. Methods Digital
databases were searched, and data on major adverse cardiovascular and
cerebrovascular events (MACCE), myocardial infarction (MI),
revascularization, stroke, and mortality for PCI and CABG were recorded.
Unadjusted odds ratio (OR) was computed using RevMan 5.3. Results A total
of 41 studies, including 30605 patients, were included in our study. The
in-hospital MACCE (OR 0.32, p=0.01), MI (OR 0.16, p=<0.00001], and stroke
(OR 0.27, p=0.002) rate were significantly lower in the PCI group, while
no difference in the revascularization (OR 1.68, p=0.23) was recorded.
Thirty-day follow-up also showed a trend favoring PCI for MACCE (OR 0.54,
p=<0.0001), and stroke (OR 0.46, p=0.02) but not for MI (OR 0.71, p-0.06).
CABG turned the tables on longer follow-ups (1 & 5 years), showing lower
MACCE (OR 1.41, p=<0.00001), MI (OR 1.35, p=0.004), and revascularization
(OR 2.91, p=<0.00001) risk but higher stroke risk (OR 0.34, p=0.0002)
compared to PCI. The mortality between the two groups was not
significantly different across all timelines (p>0.05, figure). Conclusion
PCI of LMCAD was associated with lower complications rate on short term
follow-ups. However, CABG was superior in the long run except for stroke
rate. There was no difference in the mortality irrespective of the
follow-up duration. [Figure presented]<br/>Copyright &#xa9; 2020 American
College of Cardiology Foundation

<57>
Accession Number
2005042636
Title
ELECTIVE INTRA-AORTIC BALLOON PUMP VERSUS OPTIMAL MEDICAL THERAPY FOR
HIGH-RISK PERCUTANEOUS CORONARY INTERVENTION.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 226), 2020. Date of
Publication: 24 Mar 2020.
Author
Javed H.; Khalid N.; Torguson R.; Zhang C.; Shlofmitz E.; Chen Y.;
Musallam A.; Khan J.; Rogers T.; Hashim H.D.; Chezar-Azerrad C.; Yerasi
C.; Ben-Dor I.; Forrestal B.; Case B.; Bernardo N.L.; Waksman R.
Institution
(Javed, Khalid, Torguson, Zhang, Shlofmitz, Chen, Musallam, Khan, Rogers,
Hashim, Chezar-Azerrad, Yerasi, Ben-Dor, Forrestal, Case, Bernardo,
Waksman) Medstar Washngton Hospital Center, Washington, DC, United States
Publisher
Elsevier USA
Abstract
Background Data regarding hemodynamic benefits of intra-aortic balloon
pump (IABP) before high-risk percutaneous coronary intervention (HRPCI) is
conflicting. We evaluated whether elective IABP support before HRPCI
reduced major adverse cardiovascular events as compared to optimal medical
therapy (OMT). Methods 4344 patients met HRPCI criteria (unprotected left
main disease, last remaining conduit, ejection fraction <35%, three-vessel
coronary disease, severe aortic stenosis or mitral regurgitation) between
2003-2018. 213 patients received elective IABP prior to PCI, and 4131
patients received OMT. Major in-hospital cardiovascular outcomes were
assessed. Results Baseline characteristics were comparable except more
chronic renal failure, congestive heart failure and previous coronary
artery bypass surgery (CABG) history in the IABP group. In-hospital
outcomes including death, cardiac death, a need for CABG, acute renal
failure, access site complications (major bleeding, groin hematoma > 4cm,
and pseudoaneurysm), duration of hospitalization and intensive care unit
length of stay were higher in the IABP group. Bailout IABP was required in
60/4113 (1.5%) of patients in the OMT group. Conclusion OMT without
elective IABP support is safe and feasible in majority of HRPCI patients,
with low rate of bailout IABP. Our findings do not support routine IABP
support strategy before HRPCI. Randomized trial comparing IABP vs. OMT in
patients meeting contemporary HRPCI criteria is warranted. [Figure
presented]<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<58>
Accession Number
2005042611
Title
COMPARISON OF ULTRASOUND GUIDED, ULTRASOUND ASSISTED AND "BLIND"
PERICARDIOCENTESIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 3616), 2020. Date of
Publication: 24 Mar 2020.
Author
Petri N.; Kloker J.; Voelker W.G.
Institution
(Petri, Kloker, Voelker) University Hospital Wuerzburg, Department of
Internal Medicine I, Wuerzburg, Germany
Publisher
Elsevier USA
Abstract
Background A pericardiocentesis is a procedure associated with potential
life-threatening complications, such as liver and lung perforation. A
"blind" pericardiocentesis is performed by orientation according to
certain anatomic landmarks only. As a safer option, ultrasound can be
employed to guide the needle placement. In this study, we compare "blind"
pericardiocentesis (group a) with an ultrasound assisted procedure (group
b) and an ultrasound guided procedure (group c), where a needle attachment
is used to keep the puncture needle in plane. Methods 164 medical students
were randomly assigned to one of the three groups. After an introduction,
the students performed a pericardiocentesis with their assigned method on
a pericardiocentesis simulator. A bk5000 ultrasound machine by BK Medical
with the N11C5s burr-hole probe was used in this study. Results The
success rate of group a (blind pericardiocentesis) was 90.9% and took on
average 24.3s. Group b had the lowest success rate with 83.6% and took the
longest with 27.9s. Group c had the highest success rate with 92.6% and
took with 20.9s the least amount of time. Conclusion Students had the
highest success rate performing a pericardiocentesis employing an
ultrasound guided method with a needle attachment to keep the needle
visible during the procedure. Whether this translates into clinical
practice should be evaluated in a clinical study.<br/>Copyright &#xa9;
2020 American College of Cardiology Foundation

<59>
Accession Number
2005042532
Title
FETAL OUTCOMES AFTER CARDIAC SURGERY DURING PREGNANCY: A META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 2123), 2020. Date of
Publication: 24 Mar 2020.
Author
Gupta A.; Umapathi K.K.; Gupta M.
Institution
(Gupta, Umapathi, Gupta) Lincoln Medical and Mental Health Center, The
Bronx, NY, USA, Lincoln Medical and Mental Health Center, The Bronx, NY,
USA; Children's Hospital at Montefiore, The Bronx, NY, USA, Children's
Hospital at Montefiore, The Bronx, NY, USA
Publisher
Elsevier USA
Abstract
Background Cardiac surgery during pregnancy is rarely required. We
performed a meta-analysis of all studies to assess fetal and maternal
mortality after cardiac surgery performed during pregnancy Methods The
MEDLINE, Embase, and Cochrane library were searched to find studies from
1991 to 2018. Studies that included at least 4 patients to report outcomes
were included. The primary outcome was fetal/neonatal death. Secondary
outcome - maternal mortality and preterm deliveries. Stats were done using
the DerSimonian-Laird random effects model. Heterogeneity was assessed by
I² statistic Results Seventeen studies, including 263 women,
were eligible for inclusion. Valvular heart surgery (80.6%) and Aortic
surgery (11.7%) were the most common surgeries. All patients underwent
cardiac operations involving cardiopulmonary bypass. As calculated per 100
pregnancies, the pooled unadjusted estimate of fetal/neonatal mortality
was 25.9 (95% CI, 19.7 to 32) and maternal mortality rate was 7.3 (95%CI,
0.4-14.1). Mortality was significantly lower in surgeries in third
trimester vs those done in first and second trimester. (11.8% vs 38.9%,
p<0.001). Risk of preterm labor was 40.4 per 100 pregnancies (95% CI, 30.3
to 50.6) and significantly higher in surgeries done in third trimester
(75.9% vs 9.9%, p<0.001) Conclusion Fetal and neonatal mortality after
cardiac operation during pregnancy is relatively high with decrease in
mortality noted in third trimester surgeries albeit an increase in preterm
delivery. [Figure presented]<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<60>
Accession Number
2005042526
Title
AORTIC VALVE MYXOMA: A SYSTEMATIC REVIEW OF PUBLISHED CASES.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 2187), 2020. Date of
Publication: 24 Mar 2020.
Author
Shamim S.; Desai R.; Sachdeva S.; Hanna B.; Patel P.; Farheen N.; Thakkar
S.; Sachdeva R.; Kumar G.
Institution
(Shamim, Desai, Sachdeva, Hanna, Patel, Farheen, Thakkar, Sachdeva, Kumar)
Atlanta VA Medical Center/Emory University, Atlanta, GA, USA, Atlanta VA
Medical Center/Emory University, Atlanta, GA, USA; Morehouse School of
Medicine, Atlanta, GA, USA, Morehouse School of Medicine, Atlanta, GA, USA
Publisher
Elsevier USA
Abstract
Background Due to the rarity of aortic valve myxomas, there is little
published literature regarding the clinical presentation, diagnosis, and
outcomes of patients with this condition. Methods A systematic review of
the literature using PUBMED, EMBASE, SCOPUS and WEB OF SCIENCE was
performed and demonstrated 16 cases of aortic valve myxomas through
October 2019. The data was reported using descriptive statistics. Results
Aortic valve myxomas were more prevalent in young (mean age 41 yrs) male
(12/16, 75%) patients (Table 1.1). The right coronary cusp was most
frequently involved (8/16, 50%). The most frequent clinical presentations
were cerebrovascular events (25%), dyspnea (18.8%) and evidence of
peripheral embolization (18.8%). 18.8% of the cases were discovered
incidentally. The most common comorbidity was hypertension (6/16, 37.5%).
Echocardiography was used as a diagnostic imaging modality in all cases
where imaging was performed. All cases were confirmed with histopathologic
examination. Most cases were treated with surgical excision (15/16);
concomitant aortic valve repair was performed in 25% (4/16) of cases and
mechanical aortic valve replacement in 37.5% of cases (6/16) (Table 1.2).
One patient (6.25%) had sudden cardiac death. Conclusion Aortic valve
myxomas are sometimes discovered in the context of embolic phenomena or a
patient presenting with dyspnea. Stroke is the most feared complication,
however, the mortality remains low with successful surgical management.
[Figure presented]<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<61>
Accession Number
2005042506
Title
PLATELET AND MONOCYTE ACTIVATION AFTER TRANSCATHETER AORTIC VALVE
REPLACEMENT (POTENT-TAVR): A RANDOMIZED CONTROLLED TRIAL OF TICAGRELOR
VERSUS CLOPIDOGREL BEFORE TAVR.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1470), 2020. Date of
Publication: 24 Mar 2020.
Author
Zidar D.A.; Al-Kindi S.; Main A.; Osnard M.; Tashtish N.; Parikh S.;
Funderburg N.; Juchnowski S.; Longenecker C.; Jenkins T.; Nmai C.;
Tatsuoka C.; Costa M.; Blackstone E.; Lederman M.; Attizzani G.; Simon
D.I.
Institution
(Zidar, Al-Kindi, Main, Osnard, Tashtish, Parikh, Funderburg, Juchnowski,
Longenecker, Jenkins, Nmai, Tatsuoka, Costa, Blackstone, Lederman,
Attizzani, Simon) Harrington Heart & Vascular Institute, Cleveland Medical
Center, Cleveland, OH, United States
Publisher
Elsevier USA
Abstract
Background Inflammation and thrombosis can arise from shared mechanisms,
and both lead to poor outcomes after Transcatheter Aortic Valve
Replacement (TAVR). We tested the hypothesis that platelet activation via
the P2Y12 receptor might contribute to monocyte activation after TAVR.
Methods Patients undergoing TAVR (n=60) were randomly assigned to receive
Clopidogrel (300mg load, 75mg daily) or Ticagrelor (180mg load, 90 mg
twice daily) pre-procedurally and for 30 days thereafter. The co-primary
endpoints were platelet P2Y12 responsiveness (Platelet Reactivity Units,
PRU; VerifyNow) and the proportion of non-classical inflammatory
(CD14+CD16+) monocytes one day after TAVR (ClinicalTrials.gov Identifier:
NCT02486367). Results Among patients randomized to Clopidogrel, 63.3% had
high residual platelet reactivity (HRPR, PRU > 208). Compared to
Clopidogrel-treated patients, Ticagrelor led to greater platelet
inhibition (median PRU 157 versus 232, p<0.001) after TAVR. Ticagrelor and
Clopidogrel resulted in similar CD16+CD14+ proportions (Clopidogrel: 22.7%
vs Ticagrelor: 25.1%, p=0.234) and levels of interleukin-6 and C-reactive
protein. Patients with HRPR had CD16+CD14+ monocyte proportions comparable
to Ticagrelor-treated patients but markedly higher than
Clopidogrel-responders (25.7% vs 25.1 vs 15.7%, p<0.01). Adverse events
including major bleeding (BARC 3a or above), the post-procedural decline
in hemoglobin, and 1-year survival were similar between treatment groups.
Conclusion The majority of patients undergoing TAVR did not achieve
substantial P2Y12 inhibition after Clopidogrel treatment and HRPR was
associated with a higher proportion of inflammatory monocytes. Ticagrelor
led to more potent P2Y12 inhibition but did not reduce markers of monocyte
activation or systemic inflammation. Together, these findings position
clopidogrel hypo-responsiveness as a potential effect of, not necessarily
a contributor to, a vigorous inflammatory milieu in the peri-TAVR setting.
Ticagrelor was well-tolerated without an excess of bleeding, and thus
additional studies are warranted to determine the optimal approach to
P2Y12 inhibition for patients undergoing TAVR.<br/>Copyright &#xa9; 2020
American College of Cardiology Foundation

<62>
Accession Number
2005042159
Title
5-YEAR HEALTH STATUS OUTCOMES AFTER SELF-EXPANDING TRANSCATHETER OR
SURGICAL AORTIC VALVE REPLACEMENT IN HIGH-RISK PATIENTS WITH SEVERE AORTIC
STENOSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1109), 2020. Date of
Publication: 24 Mar 2020.
Author
Arnold S.; Chinnakondepalli K.; Magnuson E.; Reardon M.; Popma J.J.; Deeb
G.M.; Gleason T.G.; Yakubov S.J.; Cohen D.J.
Institution
(Arnold, Chinnakondepalli, Magnuson, Reardon, Popma, Deeb, Gleason,
Yakubov, Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
Publisher
Elsevier USA
Abstract
Background In the CoreValve US Pivotal High-Risk Trial, patients with
severe aortic stenosis (AS) had similar clinical outcomes with TAVR or
SAVR over 5 years of follow-up, with mortality rates of ~55% in both
groups. The long-term health status of surviving patients has not been
described. Methods Among high risk patients randomized to TAVR with a
self-expanding bioprosthesis or SAVR, health status was assessed at
baseline, 1 month, 6 months, 1 year, and yearly thereafter using the KCCQ
and SF-12. Changes over time were assessed by generalized linear mixed
models. Results Among 797 patients randomized at 45 US sites, mean age was
83 years and STS score was 7.4%. Prior to treatment, mean KCCQ-OS was
47+/-22, indicating substantial health status impairment. Among surviving
patients, the KCCQ-OS increased significantly in both groups with greater
early benefit with TAVR (1-month DELTA14.3 points, 95% CI 10.2-18.4). This
treatment difference was no longer apparent by 6 months, with no
significant difference in health status between groups through 5 years
(Figure). Results were similar for KCCQ subscales and the SF-12. At 5
years, 62% of surviving TAVR patients had KCCQ-OS >60 vs 66% of SAVR
patients (p=0.58). Conclusion In high risk patients with severe AS, there
was an early health status benefit with self-expanding TAVR vs SAVR but no
difference between groups in long-term health status. Although mortality
at 5 years is high in this population, the majority of surviving patients
continue to report good quality of life. [Figure presented]<br/>Copyright
&#xa9; 2020 American College of Cardiology Foundation

<63>
Accession Number
2005042070
Title
THE IMPACT OF COMPLETE SURGICAL REVASCULARIZATION ON OUTCOMES OF PATIENTS
UNDERGOING CORONARY ARTERY BYPASS GRAFTING SURGERY: INSIGHTS FROM THE
REGROUP TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1518), 2020. Date of
Publication: 24 Mar 2020.
Author
Ramadan R.; Kinlay S.; Stock E.M.; Phillips A.; Dematt E.J.; Bhatt D.;
Zenati M.
Institution
(Ramadan, Kinlay, Stock, Phillips, Dematt, Bhatt, Zenati) Harvard Medical
School, Boston, MA, USA, Harvard Medical School, Boston, MA, USA; Boston
VA Healthcare System, Boston, MA, USA, Boston VA Healthcare System,
Boston, MA, USA
Publisher
Elsevier USA
Abstract
Background There is growing evidence in support of complete coronary
revascularization (CR). Nonetheless, there is no universally accepted
definition of CR in those undergoing Coronary Artery Bypass Grafting
(CABG) surgery. We sought to investigate the outcomes of CR defined as
surgical revascularization of any territory supplied by a coronary artery
with at least 70% stenosis. Methods We performed a post hoc analysis of
the randomized REGROUP clinical trial. Of the 1150 patients randomized,
852 (74%) patients underwent CR. The primary outcome was a composite of
major adverse cardiac events, including death from any cause, nonfatal
myocardial infarction, or repeat revascularization (MACE). Secondary
outcomes were postoperative outcomes including need for mechanical and/or
inotropic hemodynamic support and 30-day postoperative mortality. Results
Over a median follow up of 2.8 years, MACE occurred in 111 patients (13%)
in the CR group and 54 patients (19.2%) in the incomplete
revascularization (IR) group (hazard ratio, 0.67; 95% confidence interval
[CI], 0.49 to 0.93; p=0.01). A total of 56 patients (6.6%) in the CR group
and 25 patients (8.9%) in the IR group died (hazard ratio, 0.77; 95% CI,
0.48 to 1.23; p=0.27); myocardial infarctions occurred in 35 patients
(4.1%) in the CR group and 23 patients (8.2%) in the IR group (hazard
ratio, 0.50; 95% CI, 0.29 to 0.85; p=0.01), and repeat revascularization
occurred in 41 patients (4.8%) in the CR group and 25 patients (8.9%) in
the IR group (hazard ratio, 0.53; 95% CI, 0.32 to 0.87; p=0.01). Notably,
secondary outcomes were not significantly different in those with CR as
compared to those without CR. Conclusion Among patients undergoing CABG,
complete revascularization was associated with significantly reduced risk
of major adverse events.<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<64>
Accession Number
2005041916
Title
A MORTALITY RISK SCORE FOR SEPTUAGENARIANS UNDERGOING HEART
TRANSPLANTATION.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 960), 2020. Date of
Publication: 24 Mar 2020.
Author
Seese L.; Hickey G.W.; Mathier M.; Keebler M.; Sultan I.; Gleason T.G.;
Kilic A.
Institution
(Seese, Hickey, Mathier, Keebler, Sultan, Gleason, Kilic) University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
Publisher
Elsevier USA
Abstract
Background In this study we derive and validate a risk score for one-year
mortality in adults >70 years undergoing orthotopic heart transplantation
(OHT Methods The United Network for Organ Sharing registry was used to
identify adults >70 years who underwent OHT between 1987 and 2018. Primary
outcome was 1-year mortality. Patients were randomly divided into
derivation and validation cohorts. Associated covariates (univariate
p<0.2) were entered into a multivariable logistic regression model, as was
year of OHT to account for temporal changes in outcomes. A risk score was
created using the magnitudes of the odds ratios from the derivation
cohort, and its ability to predict 1-year mortality was tested in the
validation cohort. Results 1,156 patients were randomly divided into
derivation (66.7%, n=771) and validation (33.3%, n=385) cohorts. An
11-point risk score incorporating 4 variables was created (Figure A). The
predicted 1-year mortality was 8.7% in the low risk (<= 2 points) group,
19.0% in the high risk (3-5 points) and 34.8% (>= 6 points), p<0.001. In
weighted regression analysis, there was a strong correlation between
predicted and observed 1-year mortality (r²=0.99, p<0.001). The
c-index of the composite score was 0.68. Risk scores above 3 points
portended a survival disadvantage at 1-year follow-up (p<0.001) (Figure
B). Conclusion This risk score for septuagenarians is predictive of
mortality within 1-year of OHT and can be used for optimizing recipient
selection. [Figure presented]<br/>Copyright &#xa9; 2020 American College
of Cardiology Foundation

<65>
Accession Number
631333792
Title
Resource utilization associated with hospital and office-based insertion
of a miniaturized insertable cardiac monitor: Results from the RIO 2
randomized US study.
Source
Journal of medical economics. (pp 1), 2020. Date of Publication: 24 Mar
2020.
Author
Rogers J.D.; Piorkowski C.; Sohail M.R.; Anand R.; Kowalski M.; Rosemas
S.; Stromberg K.; Sanders P.
Institution
(Rogers) Department of Cardiology, Scripps Green Hospital, La Jolla, CA,
United States
(Piorkowski) Department of Electrophysiology, Herzzentrum Dresden,
Dresden, Germany
(Sohail) Divisions of Infectious Diseases and Cardiovascular Diseases, MN,
Mayo Clinic College of Medicine, Rochester, United States
(Anand) Electrophysiology Laboratory, Holy Cross Hospital, FL, Fort
Lauderdale, United States
(Kowalski) Division of Electrophysiology, Department of Cardiology, Staten
Island University Hospital and Northwell Health System, Manhasset, NY, USA
(Rosemas, Stromberg) Cardiac Rhythm and Heart Failure, Medtronic, Inc.,
Mounds View, MN, United States
(Sanders) Centre for Heart Rhythm Disorders, University of Adelaide and
Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
Publisher
NLM (Medline)
Abstract
Background: Previous studies support operational benefits when moving
insertable cardiac monitor (ICM) insertions outside the cardiac
catheterization/electrophysiology laboratories, but this has not been
directly assessed in a randomized trial or when the procedure is
specifically moved to the office setting. To gain insight, the RIO 2US
study collected resource utilization and procedure time intervals for ICM
insertion in-office and in-hospital and these data were used to calculate
costs associated with staff time and supply use in each setting.Methods
and results: The Reveal LINQ In-Office 2US study (randomized [1:1],
multicenter, unblinded) included 482 patients to undergo insertion of the
ICM in-hospital (in an operating room, or CATH/EP laboratory) (n=251) or
in-office (n=231). Detailed information on resource utilization was
collected prospectively by the study and used to compare resource
utilization and procedure time intervals during ICM insertion procedures
performed in-office vs. in-hospital. In addition, costs associated with
staff time and supply use in each setting were calculated retrospectively.
Total visit duration (check-in to discharge) was 107min shorter in-office
vs. in-hospital (95% CI: 97 - 116min; P<0.001). Patient preparation and
education in-office were more likely to occur in the same room as the
procedure, compared with in-hospital (91.6% vs. 34.2%, P<0.001 and 87.3%
vs. 22.1%, P<0.001, respectively). There was a reduction in registered
nurse and cardiovascular/operating room technologist involvement
in-office, accompanied by higher physician and medical assistant
participation. Overall staff time spent per case was 75% higher
in-hospital, leading to 50% higher staffing costs compared to in-office.
<br/>Conclusion(s): ICM insertion in a physician's office vs. a hospital
setting resulted in reduced patient visit time and reduced overall staff
time, with a consequent reduction in staffing costs.Clinical trial
registration: ClinicalTrials.gov NCT02395536.

<66>
Accession Number
631332170
Title
Volatile Anesthetics versus Propofol for Cardiac Surgery with
Cardiopulmonary Bypass: Meta-analysis of Randomized Trials.
Source
Anesthesiology. (no pagination), 2020. Date of Publication: 17 Mar 2020.
Author
Bonanni A.; Signori A.; Alicino C.; Mannucci I.; Grasso M.A.; Martinelli
L.; Deferrari G.
Institution
(Bonanni) From the Departments of Cardionephrology, (A.B., l.M., G.D.)
Intensive Care Unit (M.A.G.) Cardiac Surgery (L.M.), Clinical Ligurian
Institute of High Specialty, Villa Maria Group (GVM) Care and Research,
Rapallo, Italy the Division of Internal Medicine, International
Evangelical Hospital, Genoa, Italy (A.B.) the Department of Health Science
(A.S.) the Department of Internal Medicine (G.D.), University of Genoa,
Italy the ASL-2-Regional Health System of Liguria, Italy (C.A.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this systematic review and meta-analysis was to
assess the effect of anesthesia maintenance with volatile agents compared
with propofol on both short- and long-term mortality (primary outcomes)
and major clinical events in adults undergoing cardiac surgery with
cardiopulmonary bypass. <br/>METHOD(S): Randomized clinical trials on the
effects of current volatile anesthetics versus propofol in adults
undergoing cardiac surgery with cardiopulmonary bypass were searched (1965
to September 30, 2019) in PubMed, the Cochrane Library, and article
reference lists. A random effect model on standardized mean difference for
continuous outcomes and odds ratio for dichotomous outcomes were used to
meta-analyze data. <br/>RESULT(S): In total, 37 full-text articles (42
studies, 8,197 participants) were included. The class of volatile
anesthetics compared with propofol was associated with lower 1-yr
mortality (5.5 vs. 6.8%; odds ratio, 0.76 [95% CI, 0.60 to 0.96]; P =
0.023), myocardial infarction (odds ratio, 0.60 [95% CI, 0.39 to 0.92]; P
= 0.023), cardiac troponin release (standardized mean difference, -0.39
[95% CI, -0.59 to -0.18], P = 0.0002), need for inotropic medications
(odds ratio, 0.40 [95% CI, 0.24 to 0.67]; P = 0.0004), extubation time
(standardized mean difference, -0.35 [95% CI, -0.68 to -0.02]; P = 0.038),
and with higher cardiac index/output (standardized mean difference, 0.70
[95% CI, 0.37 to 1.04]; P < 0.0001). The class of volatile anesthetics was
not associated with changes in short-term mortality (1.63 vs. 1.65%; odds
ratio, 1.04 [95% CI, 0.73 to 1.49]; P = 0.820) and acute kidney injury
(odds ratio, 1.25 [95% CI, 0.77 to 2.03]; P = 0.358). <br/>CONCLUSION(S):
In adults undergoing cardiac surgery with cardiopulmonary bypass, the
class of volatile anesthetics was superior to propofol with regard to
long-term mortality, as well as to many secondary outcomes indicating
myocardial protection. : WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Prior
meta-analyses of studies comparing mortality in cardiac surgical patients
who received intraoperative volatile anesthetics versus propofol have
reported conflicting findings. WHAT THIS ARTICLE TELLS US THAT IS NEW:
This systematic review and meta-analysis included data from randomized
clinical trials published through the year 2019 and assessed 8,197
patients undergoing cardiac surgery with cardiopulmonary bypass. Although
early postoperative mortality did not differ significantly between the
anesthetic groups, 1-yr mortality was significantly lower in the patients
who received volatile anesthetics.Additionally, patients in the volatile
anesthetic group had significantly lower occurrence of perioperative
myocardial infarction and troponin release and had higher postoperative
cardiac index.

<67>
Accession Number
631341867
Title
Development and Validation of a Semi-Automated Surveillance Algorithm for
Cardiac Device Infections: Insights from the VA CART program.
Source
Scientific reports. 10 (1) (pp 5276), 2020. Date of Publication: 24 Mar
2020.
Author
Asundi A.; Stanislawski M.; Mehta P.; Mull H.J.; Schweizer M.L.; Baron
A.E.; Ho P.M.; Gupta K.; Branch-Elliman W.
Institution
(Asundi) Division of Infectious Diseases, Boston Medical Center, Boston,
MA, United States
(Stanislawski, Ho) Seattle-Denver Center of Innovation for
Veteran-Centered and Value-Driven Care, Seattle, CO, United States
(Stanislawski) Division of Biomedical Informatics and Personalized
Medicine, University of Colorado School of Medicine, Aurora, CO, United
States
(Stanislawski, Ho) Cardiology Section, Rocky Mountain Regional VA Medical
Center, Aurora, CO, United States
(Mehta, Gupta) Department of Medicine, Division of Infectious Diseases,
Boston VA Healthcare System, West Roxbury, MA, United States
(Mull, Gupta) Center for Healthcare Organization and Implementation
Research (CHOIR), Boston VA Healthcare System, Boston, MA, United States
(Mull) Department of Surgery, Boston University School of Medicine,
Boston, MA, United States
(Schweizer) Center for Access and Delivery Research and Evaluation, Iowa
City VA Health Care System, Iowa City, IA, United States
(Baron) Department of Biostatistics & Informatics, Colorado School of
Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO,
United States
(Ho) Department of Medicine, Division of Cardiology, University of
Colorado School of Medicine, Aurora, CO, United States
(Gupta) Boston University School of Medicine, Boston, MA, United States
(Branch-Elliman) Department of Medicine, Division of Infectious Diseases,
Boston VA Healthcare System, West Roxbury, MA, United States
(Branch-Elliman) Center for Healthcare Organization and Implementation
Research (CHOIR), Boston VA Healthcare System, Boston, MA, United States
(Branch-Elliman) Harvard Medical School, Boston, MA, United States
Publisher
NLM (Medline)
Abstract
Procedure-related cardiac electronic implantable device (CIED) infections
have high morbidity and mortality, highlighting the urgent need for
infection prevention efforts to include electrophysiology procedures. We
developed and validated a semi-automated algorithm based on structured
electronic health records data to reliably identify CIED infections. A
sample of CIED procedures entered into the Veterans' Health Administration
Clinical Assessment Reporting and Tracking program from FY 2008-2015 was
reviewed for the presence of CIED infection. This sample was then randomly
divided into training (2/3) validation sets (1/3). The training set was
used to develop a detection algorithm containing structured variables
mapped from the clinical pathways of CIED infection. Performance of this
algorithm was evaluated using the validation set. 2,107 unique CIED
procedures from a cohort of 5,753 underwent manual review; 97 CIED
infections (4.6%) were identified. Variables strongly associated with true
infections included presence of a microbiology order, billing codes for
surgical site infections and post-procedural antibiotic prescriptions. The
combined algorithm to detect infection demonstrated high c-statistic
(0.95; 95% confidence interval: 0.92-0.98), sensitivity (87.9%) and
specificity (90.3%) in the validation data. Structured variables derived
from clinical pathways can guide development of a semi-automated detection
tool to surveil for CIED infection.

<68>
Accession Number
631335637
Title
Treatment-related complications in patients with esophageal cancer: A
systematic review and network meta-analysis.
Source
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and
Ireland. (no pagination), 2020. Date of Publication: 21 Mar 2020.
Author
Holakouie-Naieni K.; Ali Mansournia M.; Doosti-Irani A.; Rahimi-Foroushani
A.; Haddad P.
Institution
(Holakouie-Naieni, Rahimi-Foroushani) Department of Epidemiology and
Biostatistics, School of Public Health, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Ali Mansournia) Department of Epidemiology and Biostatistics, School of
Public Health, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Doosti-Irani) Department of Epidemiology, School of Public Health,
Hamadan University of Medical Sciences, Hamadan, Iran; Department of
Epidemiology and Biostatistics, School of Public Health, Tehran University
of Medical Sciences, Tehran, Iran
(Haddad) Radiation Oncology Research Center, Cancer Institute, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this review was to compare the available treatments
of esophageal cancer, in terms of pulmonary, cardiovascular complications,
anastomotic leakage, and esophagitis after treatment in patients with
esophageal squamous cell carcinoma (SCC). <br/>METHOD(S): Medline, Web of
Science, Scopus, the Cochrane Library and Embase were searched. The
randomized controlled trials (RCT) that had compared the treatment
-related complications of treatments for esophageal SCC were included. We
included 39 randomized control trials in a network meta-analysis. The
Chi2-test was used to assess of heterogeneity. The loop-specific and
design-by-treatment interaction methods were used for assessment of
consistency assumption. The risk ratio with 95% confidence interval (CI)
was used to report the effect-sizes in the network meta-analysis.
<br/>RESULT(S): The pulmonary complication, cardiac complication,
anastomotic leakage, and esophagitis were reported in 31, 11, 17, and 15
RCTs respectively. Video-assisted thoracoscopy + laparoscopy (VATS) was
rank as the first and second treatment in terms of lower risk for
pulmonary complication and anastomotic leakage. There was no statistically
significant difference between treatments in terms of lower risk of
cardiovascular complications. However, Surgery + Cisplatin + Fluorouracil
(SCF) was ranked as better treatment. 3-dimensional conformal radiotherapy
+ Docetaxel + Cisplatin (3DCRTDC) was the best treatment in terms of lower
risk for esophagitis. <br/>CONCLUSION(S): According to the results of this
study, it seems the risk of pulmonary, cardiovascular, anastomotic leakage
and esophagitis complications for VATS, SCF, surgery + radiotherapy (SRT),
and 3DCRTDC was lower than other treatments respectively in the
networks.<br/>Copyright &#xa9; 2020 Royal College of Surgeons of Edinburgh
(Scottish charity number SC005317) and Royal College of Surgeons in
Ireland. Published by Elsevier Ltd. All rights reserved.

<69>
Accession Number
2005268682
Title
Randomized Trial of 2 Endoscopic Radial Artery Harvesting
Devices-Immunofluorescence Assessment.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Van Linden A.; Hecker F.; Lehmann-Grube J.; Arsalan M.; Richter M.; Matzke
B.; Holubec T.; Walther T.
Institution
(Van Linden, Hecker, Arsalan, Holubec, Walther) Department of
Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt,
Frankfurt, Germany
(Lehmann-Grube) Medical School, Justus Liebig University Giessen, Giessen,
Germany
(Richter) Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim,
Germany
(Matzke) Max-Planck-Institute for Heart and Lung Research, Bad Nauheim,
Germany
Publisher
Elsevier USA
Abstract
Background: Various devices are available for endoscopic radial artery
harvesting during coronary artery bypass grafting. Thermal spread and
graft damage, however, are common concerns. The aim of this study was to
compare the MiFusion TLS2 system (Endotrust, Nettetal Germany) with direct
heat technique and the LigaSure Maryland system (Medtronic, Dublin,
Ireland) using advanced bipolar technique in a prospective randomized
study. <br/>Method(s): One hundred consecutive patients undergoing
coronary artery bypass grafting with endoscopic radial artery harvesting
were prospectively included and randomized 1:1. The proximal (brachial)
ends of the grafts were analyzed using fluorescence microscopy with focus
on graft integrity. In addition, harvesting time, graft sealing, residual
bleeding, and incidence of neurological disorders were compared.
<br/>Result(s): Patient age was 67 +/- 8 years. Mean harvesting time was
26.5 +/- 9 minutes for the TLS2 and 23.2 +/- 8 minutes for the LigaSure (P
=.049). Overall graft integrity was good in both groups. A significantly
better graft integrity was observed in the LigaSure group (scale 0 to 3; 3
= best) with 2.5 +/- 0.6 for TLS2 and 2.8 +/- 0.4 for LigaSure (P =.031).
LigaSure provided significantly better graft sealing (scale 0 to 2; 0 =
best) with 0.6 +/- 0.7 vs 1.0 +/- 0.6 (TLS2) (P =.006) and less residual
bleeding (scale 1 to 5; 1 = best) with 1.4 +/- 0.6 vs 2.0 +/- 0.9 (TLS2)
(P <.001). Transient sensibility disorders were less frequently observed
with LigaSure (2% vs 16%, P =.015). <br/>Conclusion(s): Endoscopic radial
artery harvesting can be performed with excellent results and good graft
integrity using both devices. Compared with the MiFusion TLS2, the
LigaSure device led to faster procedural times and resulted in better
graft integrity. Along with providing a better seal, LigaSure was
associated with less sensibility disorders.<br/>Copyright &#xa9; 2020

<70>
Accession Number
631336317
Title
Association of FADS1/2 Locus Variants and Polyunsaturated Fatty Acids with
Aortic Stenosis.
Source
JAMA Cardiology. (no pagination), 2020. Article Number: 0246. Date of
Publication: 2020.
Author
Chen H.Y.; Cairns B.J.; Small A.M.; Burr H.A.; Ambikkumar A.; Martinsson
A.; Theriault S.; Munter H.M.; Steffen B.; Zhang R.; Levinson R.T.;
Shaffer C.M.; Rong J.; Sonestedt E.; Dufresne L.; Ljungberg J.; Naslund
U.; Johansson B.; Ranatunga D.K.; Whitmer R.A.; Budoff M.J.; Nguyen A.;
Vasan R.S.; Larson M.G.; Harris W.S.; Damrauer S.M.; Stark K.D.; Boekholdt
S.M.; Wareham N.J.; Pibarot P.; Arsenault B.J.; Mathieu P.; Gudnason V.;
O'Donnell C.J.; Rotter J.I.; Tsai M.Y.; Post W.S.; Clarke R.; Soderberg
S.; Bosse Y.; Wells Q.S.; Smith J.G.; Rader D.J.; Lathrop M.; Engert J.C.;
Thanassoulis G.
Institution
(Chen, Burr, Engert, Thanassoulis) Division of Experimental Medicine,
McGill University, Montreal, QC, Canada
(Chen, Burr, Ambikkumar, Zhang, Dufresne, Nguyen, Engert, Thanassoulis)
Preventive and Genomic Cardiology, McGill University Health Centre and
Research Institute, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
(Cairns, Clarke) MRC (Medical Research Council) Population Health Research
Unit, Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Cairns, Clarke) Clinical Trial Service Unit, Nuffield Department of
Population Health, University of Oxford, Oxford, United Kingdom
(Cairns, Clarke) Epidemiological Studies Unit, Nuffield Department of
Population Health, University of Oxford, Oxford, United Kingdom
(Small) Department of Medicine, Perelman School of Medicine University of
Pennsylvania, Philadelphia, United States
(Martinsson) Department of Cardiology, Clinical Sciences, Lund University,
Lund, Sweden
(Martinsson, Smith) Department of Cardiology, Skane University Hospital,
Lund, Sweden
(Theriault, Pibarot, Arsenault, Mathieu, Bosse) Quebec Heart and Lung
Institute, Laval University, Quebec City, QC, Canada
(Munter, Lathrop) McGill University and Genome Quebec Innovation Centre,
Montreal, QC, Canada
(Steffen, Tsai) Department of Laboratory Medicine and Pathology,
University of Minnesota, Minneapolis, MN, United States
(Levinson, Shaffer, Wells) Vanderbilt Translational and Clinical
Cardiovascular Research Center, Vanderbilt University Medical Center,
Nashville, TN, United States
(Rong, Vasan, Larson, O'Donnell) National Heart, Lung, and Blood
Institute, Bethesda, MD, United States
(Rong, Vasan, Larson, O'Donnell) Boston University's Framingham Heart
Study, Boston, MA, United States
(Sonestedt) Nutritional Epidemiology, Department of Clinical Sciences
Malmo, Lund University, Malmo, Sweden
(Ljungberg, Naslund, Johansson, Soderberg) Department of Public Health and
Clinical Medicine, Umea University, Umea, Sweden
(Ranatunga) Division of Research, Kaiser Permanente of Northern
California, Oakland, United States
(Whitmer) Department of Public Health Sciences, University of California,
Davis, United States
(Budoff, Rotter) Los Angeles Biomedical Research Institute, Torrance, CA,
United States
(Budoff, Rotter) Departments of Pediatrics and Medicine at Harbor-UCLA
Medical Center, Torrance, United States
(Harris) Department of Medicine, Sanford School of Medicine, University of
South Dakota, Sioux Falls, SD, United States
(Harris) OmegaQuant Analytics LLC, Sioux Falls, SD, United States
(Damrauer) Department of Surgery, Perelman School of Medicine, University
of Pennsylvania, Philadelphia, United States
(Stark) Department of Kinesiology, University of Waterloo, Waterloo, ON,
Canada
(Boekholdt) Department of Cardiology, Amsterdam University Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Wareham) MRC Epidemiology Unit, University of Cambridge, Cambridge,
United Kingdom
(Gudnason) Faculty of Medicine, University of Iceland, Reykjavik, Iceland
(Post) Division of Cardiology, Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Smith) Wallenberg Center for Molecular Medicine, Lund University, Lund,
Sweden
(Smith) Lund University Diabetes Center, Lund University, Lund, Sweden
(Rader) Department of Genetics, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, United States
(Rader) Department of Medicine, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, United States
(Lathrop, Engert) Department of Human Genetics, McGill University,
Montreal, QC, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Aortic stenosis (AS) has no approved medical treatment.
Identifying etiological pathways for AS could identify pharmacological
targets. <br/>Objective(s): To identify novel genetic loci and pathways
associated with AS. <br/>Design, Setting, and Participant(s): This
genome-wide association study used a case-control design to evaluate 44703
participants (3469 cases of AS) of self-reported European ancestry from
the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort
(from January 1, 1996, to December 31, 2015). Replication was performed in
7 other cohorts totaling 256926 participants (5926 cases of AS), with
additional analyses performed in 6942 participants from the Cohorts for
Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium.
Follow-up biomarker analyses with aortic valve calcium (AVC) were also
performed. Data were analyzed from May 1, 2017, to December 5, 2019.
Exposures: Genetic variants (615643 variants) and polyunsaturated fatty
acids (omega-6 and omega-3) measured in blood samples. <br/>Main Outcomes
and Measures: Aortic stenosis and aortic valve replacement defined by
electronic health records, surgical records, or echocardiography and the
presence of AVC measured by computed tomography. <br/>Result(s): The mean
(SD) age of the 44703 GERA participants was 69.7 (8.4) years, and 22019
(49.3%) were men. The rs174547 variant at the FADS1/2 locus was associated
with AS (odds ratio [OR] per C allele, 0.88; 95% CI, 0.83-0.93; P = 3.0 x
10^-6), with genome-wide significance after meta-analysis with 7
replication cohorts totaling 312118 individuals (9395 cases of AS) (OR,
0.91; 95% CI, 0.88-0.94; P = 2.5 x 10^-8). A consistent
association with AVC was also observed (OR, 0.91; 95% CI, 0.83-0.99; P
=.03). A higher ratio of arachidonic acid to linoleic acid was associated
with AVC (OR per SD of the natural logarithm, 1.19; 95% CI, 1.09-1.30; P =
6.6 x 10^-5). In mendelian randomization, increased FADS1 liver
expression and arachidonic acid were associated with AS (OR per unit of
normalized expression, 1.31 [95% CI, 1.17-1.48; P = 7.4 x
10^-6]; OR per 5-percentage point increase in arachidonic acid
for AVC, 1.23 [95% CI, 1.01-1.49; P =.04]; OR per 5-percentage point
increase in arachidonic acid for AS, 1.08 [95% CI, 1.04-1.13; P = 4.1 x
10^-4]). <br/>Conclusions and Relevance: Variation at the
FADS1/2 locus was associated with AS and AVC. Findings from biomarker
measurements and mendelian randomization appear to link omega-6 fatty acid
biosynthesis to AS, which may represent a therapeutic
target..<br/>Copyright &#xa9; 2020 American Medical Association. All
rights reserved.

<71>
Accession Number
610963848
Title
Comparison of clinical outcomes between bioresorbable vascular stents
versus conventional drug-eluting and metallic stents: A systematic review
and meta-analysis.
Source
EuroIntervention. 12 (2) (pp e175-e189), 2016. Date of Publication: June
2016.
Author
Banach M.; Serban M.-C.; Sahebkar A.; Garcia-Garcia H.M.; Mikhailidis
D.P.; Martin S.S.; Brie D.; Rysz J.; Toth P.P.; Jones S.R.; Hasan R.K.;
Mosteoru S.; Rifai M.A.; Pencina M.J.; Serruys P.W.
Institution
(Banach, Rysz) Department of Hypertension, Medical University of Lodz, WAM
University Hospital in Lodz, Zeromskiego 113, Lodz 90-549, Poland
(Serban) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
(Serban) Department of Functional Sciences, Discipline of Pathophysiology,
Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
(Sahebkar) Biotechnology Research Center, Imam Reza Hospital, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Sahebkar) Metabolic Research Centre, Royal Perth Hospital, School of
Medicine and Pharmacology, University of Western Australia, Perth,
Australia
(Garcia-Garcia) Department of Interventional Cardiology, Thoraxcenter,
Erasmus MC, Rotterdam, Netherlands
(Mikhailidis) Department of Clinical Biochemistry, Royal Free Campus,
University College London Medical School, University College London (UCL),
London, United Kingdom
(Martin, Toth, Jones, Hasan) Johns Hopkins Ciccarone Center for the
Prevention of Heart Disease, Baltimore, MD, United States
(Brie, Mosteoru, Rifai) Cardiology Department, Institute for
Cardiovascular Medicine Timisoara, University of Medicine and Pharmacy
Victor Babes, Timisoara, Romania
(Toth) Preventive Cardiology, CGH Medical Center, Sterling, IL, United
States
(Pencina) Duke Clinical Research Institute (DCRI), Biostatistics and
Bioinformatics, Duke University, Durham, NC, United States
(Serruys) International Centre for Cardiovascular Health, Imperial College
London, London, United Kingdom
Publisher
Europa Group
Abstract
Aims: Several studies have suggested good procedural and similar clinical
outcomes between everolimus-eluting Absorb bioresorbable stents (BRS)
versus conventional drug-eluting stents (DES), but the evidence is not
definitive. Our aim was to perform a systematic review and meta-analysis
to investigate the effects of BRS versus conventional drug-eluting and
bare metallic stents on the cardiovascular endpoints and all-cause
mortality. <br/>Methods and Results: The follow-up in the included studies
was up to 13 months. The following endpoints were evaluated: all-cause
mortality, cardiac death, patient-oriented major adverse cardiac events
(POCE), device-oriented major adverse cardiac events (DOCE), any-cause
myocardial infarction (MI), target vessel MI (TVMI), target vessel
revascularisation (TVR) and target lesion revascularisation (TLR). The
results of 10 studies with 5,773 subjects showed a statistically
significant increase in the risk of TVMI between BRS and conventional
stents (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.03-2.05,
p=0.032). None of the other differences reached statistical significance:
all-cause mortality (OR: 0.67, 95% CI: 0.30-1.49, p=0.333), cardiac death
(OR: 1.00, 95% CI: 0.47-2.12, p=0.996), POCE (OR: 0.91, 95% CI: 0.68-1.22,
p=0.546), DOCE (OR: 1.12, 95% CI: 0.86-1.46, p=0.387), any-cause MI (OR:
1.34, 95% CI: 0.98-1.82, p=0.064), TVR (OR: 0.99, 95% CI: 0.73-1.33,
p=0.934) and TLR (OR: 0.92, 95% CI: 0.66-1.29, p=0.641). Similar results
were observed after restricting the meta-analysis to the comparison of BRS
vs. EES. <br/>Conclusion(s): Our meta-analysis suggests a significantly
higher risk of TVMI with BRS compared with conventional stents and no
significant differences in the rates of occurrence of the other outcomes
during one-year follow-up. Further studies with larger samples sizes,
longer follow-up, different clinical scenarios and more complex lesions
are required to confirm or refute our findings.<br/>Copyright &#xa9; 2016
Europa Digital & Publishing. All rights reserved.

<72>
Accession Number
631192653
Title
Prothrombin complex concentrate in cardiac surgery for the treatment of
non-surgical bleeding.
Source
Cochrane Database of Systematic Reviews. 2020 (3) (no pagination), 2020.
Article Number: CD013551. Date of Publication: 12 Mar 2020.
Author
Hayes K.; Fernando M.C.; Young L.; Jordan V.
Institution
(Hayes) Auckland City Hospital, Department of Cardiothoracic and ORL
Anaesthesia, Auckland, New Zealand
(Fernando) Auckland District Health Board, Department of Cardiothoracic
and ORL Anaesthesia, Auckland, New Zealand
(Young) Auckland District Health Board, Cancer and Blood Services, 2 Park
Road, Grafton, Auckland 1023, New Zealand
(Jordan) University of Auckland, Department of Obstetrics and Gynaecology,
Private Bag 92019, Auckland 1003, New Zealand
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives
are as follows:. To assess the benefits and harms of prothrombin complex
concentrate in people undergoing cardiac surgery who have coagulopathic
non-surgical bleeding.<br/>Copyright &#xa9; 2020 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<73>
Accession Number
2005253816
Title
Transcatheter aortic valve replacement influence on coronary hemodynamics:
A quantitative meta-analysis and proposed decision-making algorithm.
Source
Journal of Invasive Cardiology. 33 (1) (pp 37-40), 2020. Date of
Publication: 2020.
Author
Kotronias R.A.; Scarsini R.; Rajasundaram S.; de Maria G.L.; Ciofani J.L.;
Ribichini F.; Kharbanda R.K.; Banning A.P.
Institution
(Kotronias, Scarsini, Rajasundaram, de Maria, Ciofani, Kharbanda, Banning)
Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford,
United Kingdom
(Kotronias) Department of Cardiovascular Medicine, University of Oxford,
Oxford, United Kingdom
(Scarsini, Ribichini) Department of Medicine, Division of Cardiology,
University of Verona, Verona, Italy
Publisher
HMP Communications
Abstract
Background. As transcatheter aortic valve replacement (TAVR) expands to
younger and lower-risk severe aortic stenosis patients, appropriate
coronary artery disease treatment is key to reducing long-term adverse
cardiovascular outcomes. Recently, studies have been exploring the role of
coronary-physiology guided revascularization strategies. Our aim was to
investigate whether TAVR influences coronary physiology measurements using
quantitative meta-analytic methods. Methods. We performed a Medline and
Embase search for studies evaluating coronary physiology indices before
and after TAVR. Double independent screening and extractions of baseline,
procedural, angiographic, and echocardiographic data were performed. Risk
of bias was assessed using the ACROBAT-NRSI tool. Pooled mean difference
estimates of coronary hemodynamic indices before and after TAVR were
derived using random-effects models with the inverse variance method
(RevMan, Review Manager, version 5.3.5; Nordic Cochrane Centre). Results.
Five studies evaluating 250 coronary vessels in 169 severe aortic stenosis
patients were quantitatively synthesized. Coronary flow reserve did not
change immediately after TAVR in non-diseased vessels (n = 3; mean
difference, 0.11; 95% confidence interval [CI], -0.10-0.32; P=.29;
I²=0%; P=.68). Importantly, fractional flow reserve also did
not vary significantly following TAVR in both non-diseased (n = 3; mean
difference, -0.01; 95% CI, -0.04-0.03; P=.75; I²=41; P=.19) and
diseased coronaries (n = 3; mean difference, -0.01; 95% CI, -0.03-0.01;
P=.49; I²=0%; P=.46). Similarly, instantaneous wave-free ratio
remained stable following TAVR (n = 2; mean difference, 0.00; 95% CI,
-0.02-0.02; P>.99; I²=0; P>.99. Conclusions. Pooled coronary
physiology measurements before and after TAVR are similar, but data on
variation within individual lesions are limited.<br/>Copyright &#xa9; 2020
HMP Communications. All rights reserved.

<74>
Accession Number
2005166561
Title
Impact of trimetazidine on incidence of contrast induced nephropathy in
diabetic patients with renal insufficiency undergoing percutaneous
coronary intervention.
Source
Systematic Reviews in Pharmacy. 11 (2) (pp 329-341), 2020. Date of
Publication: 2020.
Author
Hadi N.R.; Amber K.I.; Alsalkhi H.A.; Muhammad-Baqir B.M.; Ahmed M.H.
Institution
(Hadi) Department of Pharmacology & Therapeutics, Faculty of Medicine,
University of Kufa, Iraq
(Amber) Al-Sader Teaching Hospital, Al-Najaf Center for Cardiac Surgery
and Trans Catheter Therapy, Iraq
(Alsalkhi) Department of Pediatric Cardiology, Faculty of Medicine,
University of Kufa, Iraq
(Muhammad-Baqir) Department of Clinical Pharmacy, Faculty of Pharmacy,
University of Kufa, Iraq
(Ahmed) Al-Sader Teaching Hospital, Specialist Centre for Nephrology and
Kidney Transplantation, Iraq
Publisher
EManuscript Technologies (E-mail: journals@emanuscript.in)
Abstract
The main objective of this study is to assess the possible protective role
of Trimetazidine in the prevention of contrast induced nephropathy in
patients with renal impairment undergoing coronary angiography or
percutaneous coronary intervention. This was a randomized single-blind
clinical trial study. A total of 100 consecutive diabetic patients with
symptomatic ischemic heart disease and chronic kidney disease (CKD) were
subjected to an elective percutaneous coronary intervention, at ALSADR
teaching hospital/Al-Najaf Center for Cardiac surgery and Tran Catheter
Therapy, Najaf, Iraq, in period between May and December 2018. The
Patients were divided into two groups: Group I-Control Group (n=45) these
patients with chronic kidney disease and critical coronary stenosis and
they were needed to be subjected to coronary intervention. Group
II-Treatment Group (n=44) also these patients with chronic kidney disease
and critical coronary stenosis and they were need to be subjected to
coronary intervention and treated with 35 mg tablet/twice daily of
Trimetazidine for the period of three days, starting 48 hours before
surgical procedure and for 24 hours post the procedure. Trimetazidine
significantly reduce the elevation in serum levels of nuclear factor kappa
B, high-mobility group box 1, expression of Tolllike receptor 2 (p<0.05)
while insignificantly reduce the elevation in serum levels of creatinine
and urine level of Neutrophils gelatinase-associated lipocalinis (p >
0.05). Our study concluded that Trimetazidine reduce the acute kidney
injury response and systemic inflammatory response induced by contrast
administration after coronary intervention.<br/>Copyright &#xa9; Advanced
Scientific Research. All rights reserved.

<75>
Accession Number
2005269743
Title
Two year efficacy and safety of small versus large ABSORB bioresorbable
vascular scaffolds of <=18 mm device length: A subgroup analysis of the
German-Austrian ABSORB RegIstRy (GABI-R).
Source
IJC Heart and Vasculature. 27 (no pagination), 2020. Article Number:
100501. Date of Publication: April 2020.
Author
Zaczkiewicz M.; Wein B.; Graf M.; Zimmermann O.; Kastner J.; Wohrle J.;
Thomas R.; Hamm C.; Torzewski J.
Institution
(Zaczkiewicz, Wein, Graf, Zimmermann, Torzewski) Cardiovascular Center
Oberallgau-Kempten, Kempten, Germany
(Kastner) Department of Cardiology, University of Vienna Medical School,
Vienna, Austria
(Wohrle) Department of Internal Medicine II, University of Ulm, Ulm,
Germany
(Thomas) IHF GmbH - Institut fur Herzinfarktforschung, Ludwigshafen,
Germany
(Hamm) Kerckhoff Heart and Thorax Center, Department of Cardiology,
Benekestrasse 2-8, Bad Nauheim 61231, Germany
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Aims: The ABSORB bioresorbable vascular scaffold raised safety concerns
due to higher rates of scaffold thrombosis (ScT) and adequate scaffold
diameter and length for scaffold technology. Smaller scaffold diameter
(SScD, 2.5 mm) was an infrequently quoted predictor of major adverse
cardiac events (MACE). Therefore, we evaluated the impact of SScD compared
to large scaffold diameter (LScD, >=3 mm) of <=18 mm device length on 2
year outcome in the all-comer real life GABI-R cohort. <br/>Methods and
Results: We compared patients with implanted LScD (1341 patients) vs. SScD
(444 patients) of <=18 mm device length. Patients with LScD more often
presented with ST-elevation myocardial infarction (35.8% vs. 20.6%, p <
0.0001) and single-vessel disease (50.6% vs. 36.5% p < 0.0001). After a 24
months follow-up, there was no difference in regard of MACE (9.66% vs.
12.31%, p = 0.14) or definite/probable ST (2.47% vs. 2.82%, p = 0.71).
Despite no difference in target lesion revascularisations (TLR) (5.81% vs.
7.71%, p = 0.18), there was a higher need for target vessel
revascularisation (TVR) in the SScD-group (11.57% vs. 7.51%, p < 0.05).
<br/>Conclusion(s): Compared to LScD, SScD of <=18 mm device length
demonstrated comparable safety in regard to MACE and ScT as well as
efficacy in regard to TLR. Resorbable scaffold technology should not be
restricted to large vessel diameters. Clinical Trial Registration:
https://clinicaltrials.gov/ct2/show/NCT02066623.<br/>Copyright &#xa9; 2020
The Authors

<76>
Accession Number
2003991625
Title
NT-Pro BNP Predicts Myocardial Injury Post-vascular Surgery and is Reduced
with CoQ<inf>10</inf>: A Randomized Double-Blind Trial.
Source
Annals of Vascular Surgery. 64 (pp 292-302), 2020. Date of Publication:
April 2020.
Author
Khan A.; Johnson D.K.; Carlson S.; Hocum-Stone L.; Kelly R.F.; Gravely
A.A.; Mbai M.; Green D.L.; Santilli S.; Garcia S.; Adabag S.; McFalls E.O.
Institution
(Khan, Carlson, Mbai, Adabag, McFalls) Division of Cardiology, University
of Minnesota, Minneapolis, MN, United States
(Johnson, Carlson, Hocum-Stone, Mbai, Adabag, McFalls) Division of
Cardiology, Minneapolis VA Medical Center, Minneapolis, MN, United States
(Hocum-Stone, Kelly) Division of Cardiothoracic Surgery, University of
Minnesota, Minneapolis, MN, United States
(Gravely) Department of Research Statistical Center, Minneapolis VA
Medical Center, Minneapolis, MN, United States
(Green, Santilli) Division of Vascular Surgery, Minneapolis VA Medical
Center, Minneapolis, MN, United States
(Garcia) Division of Cardiology, Minneapolis Heart Institute, Minneapolis,
MN, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: NT-Pro BNP levels provide incremental value in perioperative
risk assessment prior to major noncardiac surgery. Whether they can be
pharmacologically modified in patients prior to an elective vascular
operation is uncertain. <br/>Method(s): A double-blind, randomized
controlled trial was implemented at a single institution. Patients were
screened during their preoperative vascular clinic appointment and
randomly assigned to CoQ<inf>10</inf> (400 mg per day) versus Placebo for
3 days prior to surgery. Biomarkers, including NT-Pro BNP, troponin I and
C-reactive protein were obtained prior to and following surgery for up to
48 hours. The primary endpoint was postoperative NT-Pro BNP levels, and
secondary endpoint measures included myocardial injury, defined by an
elevated cardiac troponin level and length of stay. <br/>Result(s): One
hundred and twenty-three patients were randomized to receive either
CoQ<inf>10</inf> (N = 62) versus Placebo (N = 61) for 3 days before
vascular surgery. Preoperative cardiac risks included ischemic heart
disease (N = 52), CHF (N = 12), stroke (N = 23), and diabetes mellitus (N
= 48) and the planned vascular procedures were infrainguinal (N = 78),
carotid (N = 36), and intraabdominal (N = 9). There were no intergroup
differences in these clinical variables. NT-Pro BNP levels (median; IQs)
in the CoQ<inf>10</inf> and Placebo groups were 179 (75-347) and 217
(109-585) pg/ml, respectively, (P = 0.08) preoperatively, and 397
(211-686) and 591 (288-1,433) pg/ml respectively, (P = 0.01) at 24 hours
following surgery. Patients with an elevated NT-Pro BNP had a higher
incidence of myocardial injury, (58% vs. 20%; P < 0.01) and a longer
hospital stay (4.4 +/- 3.8 vs. 2.8 +/- 3.2 days; P < 0.02) compared with
individuals without an elevated NT-Pro BNP level. <br/>Conclusion(s):
NT-Pro BNP levels predict adverse events post-vascular surgery and are
lowered in those patients assigned to preoperative administration of
CoQ<inf>10</inf>. Trial Registration: clinicaltrials.gov Identifier:
NCT03956017. Among patients undergoing elective vascular surgery, 123
patients were randomized to either CoQ<inf>10</inf> (400 mg/day) versus
placebo for three days preoperatively. NT-Pro BNP levels (median; IQs) in
the CoQ<inf>10</inf> and Placebo groups were 179 (75-347) and 217
(109-585) pg/ml, respectively, (P = 0.08) preoperatively, and 397
(211-686) and 591 (288-1,433) pg/ml, respectively, (P = 0.01)
post-surgery. Patients with an elevated NT-Pro BNP had a higher incidence
of myocardial injury (58% vs. 20%; P < 0.01) and a longer hospital stay
(4.4 +/- 3.8 vs. 2.8 +/- 3.2 days; P < 0.02) compared with individuals
without an NT-Pro BNP elevation. In conclusion, BNP predicts adverse
outcomes and can be reduced with preoperative
CoQ<inf>10</inf>.<br/>Copyright &#xa9; 2019

<77>
Accession Number
2005253802
Title
Dedicated bifurcation stents for coronary bifurcation lesions: A
systematic review and meta-analysis of randomized-controlled trials.
Source
Journal of Invasive Cardiology. 32 (12) (pp E344-E355), 2019. Date of
Publication: 2019.
Author
Mohamed M.O.; Mamas M.A.; Nagaraja V.; Chadi Alraies M.; Lamelas P.;
Tzemos N.; Ayan D.; Lavi S.; Bagur R.
Institution
(Mohamed, Mamas, Nagaraja, Bagur) Keele Cardiovascular Research Group,
Centre for Prognosis Research, Institutes of Applied Clinical Science and
Primary Care and Health Sciences, Keele University, Keele, United Kingdom
(Chadi Alraies) Wayne State University, Detroit Medical Center, Detroit
Heart Hospital, Detroit, MI, United States
(Lamelas) Department of Interventional Cardiology and Endovascular
Therapeutics, Instituto, Cardiovascular de Buenos Aires, Buenos Aires,
Argentina
(Tzemos, Ayan, Lavi, Bagur) London Health Sciences Centre, London, ON,
Canada
(Bagur) Department of Epidemiology and Biostatistics, Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
Publisher
HMP Communications
Abstract
Background. Percutaneous coronary intervention (PCI) of coronary
bifurcation lesions (CBL) remains a challenge in contemporary practice due
to the procedural and technical difficulties involved. We sought to review
the current evidence on the safety and clinical outcomes of dedicated
bifurcation stent (DBS) implantation in comparison with established
treatment strategies for CBL-PCI. Methods. We conducted a comprehensive
search to identify randomized control trials (RCTs) reporting 1-year
clinical and angiographic outcomes of patients undergoing CBL-PCI with DBS
vs conventional CBL-PCI strategies. Random-effects meta-analyses were
performed to estimate the effect of DBS compared with conventional CBL-PCI
using aggregate data. Results. A total of 5 RCTs comprising 1249
participants met the inclusion criteria. The use of DBS was comparable to
conventional stenting techniques in terms of major adverse cardiovascular
event (MACE) rate (odds ratio [OR], 1.28; 95% confidence interval [CI],
0.90-1.82; I²=0%), all-cause mortality (OR, 0.80; 95% CI,
0.31-2.07; I²=0%), cardiac mortality (OR, 0.16; 95% CI,
0.02-1.39; I²=0%), myocardial infarction (OR, 1.26; 95% CI,
0.84-1.89; I²=0%), definite stent thrombosis (OR, 1.75; 95% CI,
0.36-8.52; I²=0%), cumulative target-lesion revascularization
(OR, 1.39; 95% CI, 0.85-2.27; I²=0%), clinically driven
target-lesion revascularization (OR, 1.23; 95% CI, 0.68-2.22;
I²=0%), or target-vessel revascularization (OR, 1.43; 95% CI,
0.92-2.22; I²=0%). Conclusion. The present analysis suggests
that CBL-PCI with DBS may be associated with similar 1-year clinical and
angiographic outcomes compared with conventional CBL-PCI strategies.
However, the low quality of evidence and limited follow-up warrant further
studies to ascertain any significant differences in patient-important
outcomes before the adoption of DBS into routine CBL-PCI
practice.<br/>Copyright &#xa9; 2019 HMP Communications. All rights
reserved.

<78>
Accession Number
2003484329
Title
Impact of Perioperative Levosimendan Administration on Risk of Bleeding
After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials.
Source
American Journal of Cardiovascular Drugs. 20 (2) (pp 149-160), 2020. Date
of Publication: 01 Apr 2020.
Author
Yan S.-B.; Wang X.-Y.; Shang G.-K.; Wang Z.-H.; Deng Q.-M.; Song J.-W.;
Sai W.-W.; Song M.; Zhong M.; Zhang W.
Institution
(Yan, Shang, Wang, Deng, Song, Sai, Song, Zhong, Zhang) The Key Laboratory
of Cardiovascular Remodeling and Function Research, Chinese Ministry of
Education, Chinese National Health Commission and Chinese Academy of
Medical Sciences, The State and Shandong Province Joint Key Laboratory of
Translational Cardiovascular Medicine, Department of Cardiology, Qilu
Hospital of Shandong University, No.107, Wen Hua Xi Road, Jinan 250012,
China
(Wang) Department of Pharmacy, Qilu Children's Hospital of Shandong
University, Children's Hospital of Jinan, Jinan, Shandong, China
(Wang) Department of Geriatric Medicine, Qilu Hospital of Shandong
University, Key Laboratory of Cardiovascular Proteomics of Shandong
Province, Jinan, Shandong, China
Publisher
Adis
Abstract
Background: Levosimendan, a calcium sensitizer and potassium channel
opener, has been demonstrated to improve myocardial function without
increasing oxygen consumption and to show protective effects in other
organs. Recently, a prospective, randomized controlled trial (RCT)
revealed an association between levosimendan use and a possible increased
risk of bleeding postoperatively. Levosimendan's anti-platelet effects
have been shown in in vitro studies. Current studies do not provide
sufficient data to support a relation between perioperative levosimendan
administration and increased bleeding risk. <br/>Purpose(s): Our goal was
to investigate the relation between perioperative levosimendan
administration and increased bleeding risk using a meta-analysis study
design. <br/>Method(s): The PubMed, Ovid, EMBASE and Cochrane Library
databases were searched for relevant RCTs before July 1, 2019. The outcome
parameters included reoperation secondary to increased bleeding in the
postoperative period, the amount of postoperative recorded blood loss, and
the need for transfusion of packed red blood cells (RBCs) and other blood
products. <br/>Result(s): A total of 1160 patients in nine RCTs (576 in
the levosimendan group and 584 in the control group) were included
according to our inclusion criteria. Analysis showed that perioperative
levosimendan administration neither increased the rate of reoperation
secondary to bleeding nor increased the amount of postoperative chest tube
drainage when compared with the control group. In terms of blood product
transfusion, levosimendan did not influence the requirement for RBC
transfusion, platelet transfusion nor fresh frozen plasma (FFP)
transfusion. Levosimendan also did not shorten or prolong the aortic
cross-clamp time or the cardiopulmonary bypass time. <br/>Conclusion(s):
The analyzed parameters, including reoperations due to bleeding,
postoperative chest drainage and the requirement for blood products,
revealed that levosimendan did not increase postoperative bleeding risk.
More studies with a larger sample size are needed to address a more
reliable conclusion due to study limitations.<br/>Copyright &#xa9; 2019,
Springer Nature Switzerland AG.

<79>
Accession Number
2005044540
Title
Meta-Analysis of Transcatheter Versus Surgical Aortic Valve Replacement in
Low Surgical Risk Patients.
Source
American Journal of Cardiology. 125 (8) (pp 1230-1238), 2020. Date of
Publication: 15 April 2020.
Author
Levett J.Y.; Windle S.B.; Filion K.B.; Brunetti V.C.; Eisenberg M.J.
Institution
(Levett, Windle, Filion, Brunetti, Eisenberg) Division of Clinical
Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill
University, Montreal, Quebec, Canada
(Levett, Filion, Eisenberg) Department of Medicine, McGill University,
Montreal, Quebec, Canada
(Filion, Brunetti, Eisenberg) Department of Epidemiology, Biostatistics
and Occupational Health, McGill University, Montreal, Quebec, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital/McGill
University, Montreal, Quebec, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Current guidelines recommend transcatheter aortic valve implantation
(TAVI) for patients with severe aortic stenosis at elevated surgical risk,
but not for patients at low surgical risk. Our objective is to compare
major clinical outcomes and procedural complications with TAVI versus
surgical aortic valve replacement in patients with severe aortic stenosis
at low surgical risk. We conducted a systematic review and meta-analysis
of randomized controlled trials, identified through a systematic search of
the MEDLINE, Embase, and Cochrane databases. Count data were pooled across
trials using random-effects models with inverse variance weighting to
obtain relative risks (RRs) and corresponding 95% confidence intervals
(CIs). Three randomized controlled trials (n = 2,629) were included. At 30
days, TAVI was associated with a substantial reduction in all-cause
mortality (RR: 0.45, 95%CI: 0.20 to 0.99), atrial fibrillation (RR: 0.27,
95%CI: 0.17 to 0.41), life threatening/disabling bleeding (RR: 0.29,
95%CI: 0.12 to 0.69), and acute kidney injury (RR: 0.28, 95%CI: 0.14 to
0.57). The reduction in atrial fibrillation persisted at 12 months (RR:
0.32, 95%CI: 0.21 to 0.49). However, TAVI patients had an increased risk
of permanent pacemaker implantation at both 30 days (RR: 3.13, 95%CI: 1.36
to 7.21) and 12 months (RR: 2.99, 95%CI: 1.19 to 7.51). Due to the low
absolute numbers of events, results were inconclusive at 30 days and 12
months for cardiovascular mortality, stroke, transient ischemic attack,
and myocardial infarction. In conclusion, while some outcomes remained
inconclusive, these data suggest that TAVI should be considered as a
first-line therapy for the treatment of severe aortic stenosis in low
surgical risk patients.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<80>
Accession Number
2004992972
Title
Meta-Analysis Comparing Percutaneous to Surgical Access in Trans-Femoral
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 125 (8) (pp 1239-1248), 2020. Date of
Publication: 15 April 2020.
Author
Abdelaziz H.K.; Megaly M.; Debski M.; Rahbi H.; Kamal D.; Saad M.; Wiper
A.; More R.; Roberts D.H.
Institution
(Abdelaziz, Debski, Wiper, More, Roberts) Lancashire Cardiac Center,
Blackpool Victoria Hospital, Blackpool, United Kingdom
(Abdelaziz, Kamal, Saad) Department of Cardiovascular Medicine, Ain Shams
University, Cairo, Egypt
(Megaly) Minneapolis Heart Institute, Abbott Northwestern Hospital,
Minneapolis, MN, United States
(Rahbi) Wiltshire Cardiac Center, Great Western Hospital, Swindon, United
Kingdom
(Saad) Cardiovascular Institute, The Warren Alpert Medical School of Brown
University and Lifespan Cardiovascular Institute, Providence, RI, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To compare the outcomes in trans-femoral transcatheter aortic valve
implantation (TF-TAVI) performed with percutaneous approach (PC) versus
surgical cut-down (SC). In 13 trials including 5,859 patients (PC = 3447,
SC = 2412), the outcomes based on Valve Academic Research Consortium
criteria were compared between PC and SC in TF-TAVI. Compared with SC, PC
was associated with similar major vascular complications (VCs) (8.7% vs
8.5%; odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.76 to 1.15,
p = 0.53), major bleeding (OR = 1.09, 95% CI = 0.66 to 1.8, p = 0.73),
perioperative mortality (5.7% vs 5.2%; OR = 1.13, 95% CI = 0.85 to 1.49, p
= 0.4), urgent surgical repair (OR = 1.27, 95% CI = 0.81 to 2.02, p =
0.3), stroke (3.3% vs 3.9%; OR = 0.85, 95% CI = 0.53 to 1.36, p = 0.5),
myocardial infarction (1.3% vs 1.1%; OR = 1.06, 95% CI = 0.53 to 2.12, p =
0.86), and renal failure (5.2% vs 5.9%; OR = 0.68, 95% CI = 0.38 to 1.22,
p = 0.2), but shorter hospital stay (9.1 +/- 8.5 vs 9.6 +/- 9.5 days; mean
difference = -1.07 day, 95% CI = -2.0 to -0.15, p = 0.02) and less blood
transfusion (18.5% vs 25.7%; OR = 0.61, 95% CI = 0.43-0.86, p = 0.005).
Minor VCs occurred more frequently in PC compared to SC (11.9% vs 6.9%; OR
= 1.67, 95% CI = 1.04-2.67, p = 0.03). In conclusion, in TF-TAVI, PC is a
safe and feasible alternative to SC, and adopting either approach depends
on operator experience after ensuring that vascular access could be safely
achieved with that specific technique.<br/>Copyright &#xa9; 2020 Elsevier
Inc.

<81>
Accession Number
2004983505
Title
Fluid-structure interaction modeling in cardiovascular medicine - A
systematic review 2017-2019.
Source
Medical Engineering and Physics. 78 (pp 1-13), 2020. Date of Publication:
April 2020.
Author
Hirschhorn M.; Tchantchaleishvili V.; Stevens R.; Rossano J.; Throckmorton
A.
Institution
(Hirschhorn, Throckmorton) BioCirc Research Laboratory, School of
Biomedical Engineering, Science, and Health Systems, Drexel University,
Philadelphia, PA, United States
(Tchantchaleishvili) Division of Cardiothoracic Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Stevens) St. Christopher's Hospital for Children, Tower Health Hospitals,
Philadelphia, PA, United States
(Stevens) Pediatrics, Drexel University College of Medicine, Philadelphia,
PA, United States
(Rossano) Division of Pediatric Cardiology, The Children's Hospital of
Philadelphia, Philadelphia, PA, United States
Publisher
Elsevier Ltd
Abstract
Finite element analysis (FEA) and computational fluid dynamics (CFD) are
generally insufficient independently to model the physics of the
cardiovascular system. Individually, they are unable to resolve the
interplay between the solid and fluid domains, and the interplay is
integral to the functioning of the system. The use of fluid-structure
interaction (FSI) methods overcomes these shortcomings by providing the
means to couple the fluid and structural domains. In the last decade, the
utilization of FSI has greatly increased in cardiovascular engineering. In
this study, we conducted a systematic review process of more than 1000
journal articles to investigate the implementation of One-Way and Two-Way
FSI for cardiovascular applications. We explored the utility of FSI to
study aneurysms, the hemodynamics of patient anatomies, native and
prosthetic heart valve dynamics, flow and hemodynamics of blood pumps, and
atherosclerosis. Computational resource requirements, implementation
strategies and future directions of FSI for cardiovascular applications
are also discussed.<br/>Copyright &#xa9; 2020

<82>
Accession Number
2004474535
Title
Reply to the article: Nicholas C. Dang, Abbas Ardehali, Brian A. Bruckner,
Patrick E. Parrino, Daniel L. Gillen, Rachel W. Hoffman, Russell Spotnitz,
Stephanie Cavoores, Ian J. Shorn, Roberto J. Manson, William D. Spotnitz.
Prospective, multicenter, randomized, controlled trial evaluating the
performance of a novel combination powder vs hemostatic matrix in
cardiothoracic operations. J Card Surg. 2019;1-7. DOI: 10.1111/jocs.14376.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Spazierer D.; Moersdorf G.
Institution
(Spazierer) Surgical Sciences and Engineering, Baxter Medical Products
GmbH, Vienna, Austria
(Moersdorf) Advanced Surgery DACH, Baxter Deutschland GmbH,
Unterschleissheim, Germany
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)

<83>
Accession Number
2004474517
Title
Dual antiplatelet therapy after coronary artery bypass grafting: A safe
option after all? Comment on a published meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Rocha-Gomes J.N.; Saraiva F.A.; Leite-Moreira A.F.
Institution
(Rocha-Gomes, Saraiva, Leite-Moreira) Department of Surgery and
Physiology, Faculty of Medicine, Cardiovascular R&D Center, University of
Porto, Porto, Portugal
(Leite-Moreira) Department of Cardiothoracic Surgery, Centro Hospitalar
Universitario Sao Joao, Porto, Portugal
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)

<84>
Accession Number
631313685
Title
Combination ventilation for severe aerophagia.
Source
Journal of Clinical Neuromuscular Disease. Conference: 42nd Annual
Carrell-Krusen Neuromuscular Symposium. United States. 21 (3) (pp 183),
2020. Date of Publication: March 2020.
Author
Pan T.; McCormack D.; Scott K.; Davis S.; Lee W.; Lussier B.
Institution
(Pan, McCormack, Scott, Davis, Lee, Lussier) DallasTXUnited States
Publisher
Lippincott Williams and Wilkins
Abstract
A 35 year old man with Emery-Dreifuss muscular dystrophy and prior
orthotopic heart transplant required nightly noninvasive ventilation (NIV)
for chronic restrictive lung disease. Despite excellent compliance, he
experienced progressive issues with gastroparesis and significant
aerophagia. The aerophagia was causing significant abdominal distension
leading to poor appetite and a dangerous degree of weight loss despite
attempts to adjust the settings on his ventilator and mask. He
subsequently underwent a titration study in the sleep lab with a biphasic
cuirass ventilator study rather than empiric therapy given concern for
craniofacial anatomy and potential for exacerbation of sleep disordered
breathing. He was noted to have moderate obstructive sleep apnea with the
BCV in place, which was resolved with initiation of continuous positive
airway pressure at 6 cmH2O. The following morning, the patient denied any
significant aerophagia or abdominal distension. NIV is necessary for many
neuromuscular patients to treat chronic respiratory failure. Observational
studies in patients with Duchenne muscular dystrophy and a randomized
controlled trial in patients with amyotrophic lateral sclerosis (ALS)
support that NIV in patients with neuromuscular disease have mortality
benefit. Positive pressure ventilation can lead to aerophagia and gastric
distension making it difficult to tolerate. However, negative pressure
ventilation may exacerbate obstructive sleep apnea. In this case, the
patient experienced significant aerophagia with NIV causing significant
weight loss over time. This case stresses the importance of identifying
comorbidities that may be exacerbated by negative pressure ventilation, as
well as the use of negative pressure ventilation as a safe alternative
when conservative measures fail to treat debilitating aerophagia.
Management of chronic respiratory failure is necessary to improve
mortality as well as quality of life for neuromuscular patients. The
combination of negative and positive pressure ventilation may be useful in
those who have significant intolerability and adverse effects from
conventional NIV.

<85>
Accession Number
2005042943
Title
ISOLATED SURGICAL TRICUSPID REPAIR VERSUS REPLACEMENT: META-ANALYSIS OF
15,069 PATIENTS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 2136), 2020. Date of
Publication: 24 Mar 2020.
Author
Wang T.K.M.; Griffin B.P.; Miyasaka R.; Xu B.; Popovic Z.; Pettersson G.;
Gillinov A.M.; Desai M.Y.
Institution
(Wang, Griffin, Miyasaka, Xu, Popovic, Pettersson, Gillinov, Desai)
Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier USA
Abstract
Background Tricuspid valve disease is increasingly encountered, but
surgery is rarely performed in isolation, in part because of a reported
higher risk than other single-valve operations. Although guidelines
recommend valve repair, there is sparse literature for the optimal
surgical approach in isolated tricuspid valve disease. We performed a
meta-analysis examining outcomes of isolated tricuspid valve repair versus
replacement. Methods We searched Pubmed, Embase, Scopus and Cochrane from
1 January 1980-30 June 2019 for studies reporting the outcomes of both
isolated tricuspid valve repair and replacement, and excluding congenital
tricuspid valve etiologies. Data was extracted and pooled using
random-effects models and Review Manager 5.3 software. Results There were
811 records screened, 52 full-text articles reviewed and 16 studies
included, totalling 6,808 repairs and 8,261 replacements. Mean age ranged
from 36-68 years, females made up 24-92%, and etiology was inconsistently
reported. Pooled outcomes are summarized in the table. Isolated tricuspid
repair had lower operative mortality, renal failure and pacemaker
implantation but higher stroke rates than replacement. Conclusion Isolated
tricuspid valve repair was associated with significantly reduced
in-hospital mortality, renal failure and pacemaker implantation compared
to replacement, and is therefore recommended where feasible for isolated
tricuspid disease, although its higher stroke rate warrants further
research. [Figure presented]<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<86>
Accession Number
2005042743
Title
TRANSCATHETER AORTIC VALVE REPLACEMENT OUTCOMES IN RADIATION-ASSOCIATED
AORTIC STENOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 2184), 2020. Date of
Publication: 24 Mar 2020.
Author
Haseeb A.; Saqib N.; Mian R.; Bilal M.; Hafeez H.; Ahmad M.M.; Rajagopalan
S.; Pir M.S.; Lateef N.; Pancholy S.B.
Institution
(Haseeb, Saqib, Mian, Bilal, Hafeez, Ahmad, Rajagopalan, Pir, Lateef,
Pancholy) The Wright Center for GME, Scranton, PA, United States
Publisher
Elsevier USA
Abstract
Background Radiation-associated aortic stenosis (RXT) is the most frequent
valvular manifestation in patients with prior exposure to chest radiation
for thoracic malignancy. Surgical aortic valve replacement (SAVR) in
patients with RXT has shown worse outcomes than patients with
non-radiation-associated aortic stenosis (NRXT) and transcatheter aortic
valve replacement (TAVR) has emerged as an alternative. We conducted a
meta-analysis to investigate the outcomes of TAVR in patients with RXT as
compared to NRXT. Methods PubMed, Medline and Google Scholar databases
were searched for studies comparing the TAVR outcomes in patients with RXT
and NRXT. Three prospective cohort studies (1345 participants) met the
inclusion criteria. Odds-ratios (OR) were calculated using random-effect
model. Results Thirty-day cardiovascular (CV) mortality was similar in
TAVR with RXT and NRXT [OR=0.69; 95% CI=0.17-2.87]. Similar risk was found
for 6-month All-cause mortality as well in both groups [OR=1.16; 95%
CI=0.35-3.90]. Additionally, there was no significant difference in stroke
[OR=1.53; 95% CI=0.26-9.09], major bleeding [OR=0.89; 95% CI=0.32-2.47],
pericardial effusion [OR=1.35; 95% CI=0.43-4.26] and new-pacemaker implant
[OR=0.95; 95% CI=0.42-2.17]. Conclusion Our results demonstrated that TAVR
in RXT had similar early and late outcomes when compared to NRXT in
contrary to SAVR which has shown to have worse outcomes in RXT group in
previous literature. [Figure presented]<br/>Copyright &#xa9; 2020 American
College of Cardiology Foundation

<87>
Accession Number
2005042108
Title
CLINICAL OUTCOMES FOLLOWING TRANSCATHETER MITRAL VALVE REPAIR VERSUS
MEDICAL THERAPY FOR SECONDARY MITRAL REGURGITATION IN PATIENTS WITH
PREVIOUSLY IMPLANTED CARDIAC RESYNCHRONIZATION THERAPY: THE COAPT TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1111), 2020. Date of
Publication: 24 Mar 2020.
Author
Kosmidou I.; Lindenfeld J.; Abraham W.; Kar S.; Kar; Lim S.; Mishell J.M.;
Whisenant B.; Kipperman R.M.; Boudoulas K.; Zhang Y.; Zhang Z.; Mack M.;
Stone G.W.
Institution
(Kosmidou, Lindenfeld, Abraham, Kar, Kar, Lim, Mishell, Whisenant,
Kipperman, Boudoulas, Zhang, Zhang, Mack, Stone) Cardiovascular Research
Foundation, New York, NY, USA, Cardiovascular Research Foundation, New
York, NY, USA; Columbia University Medical Center, New York, NY, USA,
Columbia University Medical Center, New York, NY, USA
Publisher
Elsevier USA
Abstract
Background Patients with heart failure (HF) who remain symptomatic despite
cardiac resynchronization therapy (CRT) have a poor prognosis. The impact
of transcatheter mitral valve repair (TMVr) for secondary mitral
regurgitation (MR) in patients with previously implanted CRT is unknown.
Methods In the COAPT trial, 614 HF patients with moderate-to-severe or
severe secondary MR who remained symptomatic despite maximally-tolerated
guideline-directed medical therapy (GDMT) were randomized to TMVr with the
MitraClip plus GDMT (n=302) vs GDMT alone (n=314). Clinical outcomes at 2
years were analyzed according to prior CRT use. Results Among 614
patients, 224 (36.5%) had prior CRT (including 115 and 109 randomized to
TMVr vs GDMT alone) and 390 (63.5%) had no CRT (including 187 and 203
randomized to TMVr vs GDMT alone). Baseline LVEF was lower in patients
with vs without CRT (29.0+/-8.1 vs 32.6+/-9.7, p<0.0001). Patients with
CRT had non-significantly different 2-year rates of death (30.1% vs 24.3%,
p=0.21), HF hospitalization (HFH; 32.4% vs 32.2%, p=0.90) and composite
death or HFH (45.3% vs 39.1%, p=0.26) compared with patients with no CRT.
Death or HFH at 2 years was lower following TMVr vs GDMT in patients with
prior CRT (48.6% vs 66.8%, HR 0.61, 95% CI 0.43-0.87) and no CRT (42.1% vs
66.8%, HR 0.52, 95% CI 0.39-0.69) (adjusted pinteraction=0.51). The
effects of TMVr on reducing the individual 2-year rates of all-cause death
(adjusted pinteraction=0.30) and HFH (adjusted pinteraction=0.68) were
also consistent in patients with and without CRT. Conclusion In the COAPT
trial, MitraClip improved the 2-year prognosis of patients with HF and
moderate-to-severe or severe secondary MR who remained symptomatic despite
maximally tolerated GDMT, regardless of whether they had a prior CRT
implant.<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<88>
Accession Number
2005042094
Title
DIAGNOSIS OF NATIVE VALVE, PROSTHETIC VALVE AND IMPLANTABLE CARDIAC DEVICE
LEAD INFECTIVE ENDOCARDITIS USING 18F-FLUORODEOXYGLUCOSE POSITRON EMISSION
TOMOGRAPHY/COMPUTED TOMOGRAPHY: A CONTEMPORARY META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1644), 2020. Date of
Publication: 24 Mar 2020.
Author
Wang T.K.M.; Sanchez A.; Igbinomwanhia E.; Cremer P.; Griffin B.P.; Xu B.
Institution
(Wang, Sanchez, Igbinomwanhia, Cremer, Griffin, Xu) Cleveland Clinic,
Cleveland, OH, USA, Cleveland Clinic, Cleveland, OH, USA; Advocate
Illinois Masonic Medical Center, Chicago, IL, USA, Advocate Illinois
Masonic Medical Center, Chicago, IL, USA
Publisher
Elsevier USA
Abstract
Background Infective endocarditis (IE) remains a difficult to diagnose
condition of high mortality. 18F-fluorodeoxyglucose positron emission
tomography/computed tomography (18F-FDG-PET/CT) has recently emerged as
another IE imaging modality, although accuracy varies across observational
studies and types of IE. This meta-analysis assessed the diagnostic
performance of 18F-FDG PET/CT for IE and its subtypes. Methods We searched
Pubmed, Cochrane and Embase from January 1980-September 2019 for studies
reporting both sensitivity and specificity of 18F-FDG PET/CT for IE.
Meta-Disc 1.4 was used to pool data for IE and its subgroups of native
valve (NVIE), prosthetic valve (PVIE) and cardiovascular implantable
electronic device lead endocarditis (CIEDIE). Results In 2,566 records
with 52 full-text articles assessed, 26 studies totalling 1,358 patients
with 509 cases of IE were included. Pooled sensitivity and specificity
(95% confidence intervals, inconsistency I-square statistic) were: 1. all
IE (Figure): 0.74 (0.70-0.77, 71.5%) and 0.88 (0.86-0.91, 78.5%); 2.NVIE:
0.31 (0.21-0.41, 29.4%) and 0.98 (0.95-0.99, 34.4%); 3. PVIE: 0.86
(0.81-0.89, 60.0%) and 0.84 (0.79-0.88, 75.2%); 4. CIEDIE: 0.74
(0.64-0.82, 75.9%) and 0.86 (0.80-0.91, 82.5%). Conclusion 18F-FDG PET/CT
has moderate sensitivity and high specificity overall, although
sensitivity was markedly lower for NVIE than PVIE and CIEDIE. It is a
useful adjunct especially for assessing the challenging scenarios of PVIE
and CIEDIE. [Figure presented]<br/>Copyright &#xa9; 2020 American College
of Cardiology Foundation

<89>
Accession Number
2005041892
Title
EFFECT OF INSTITUTIONAL TRANS-CATHETER AORTIC VALVE REPLACEMENT (TAVR)
VOLUME ON MORTALITY: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1415), 2020. Date of
Publication: 24 Mar 2020.
Author
Kir D.; Shapero K.; Chatterjee S.; Grimshaw A.; Oddleifson A.; Spatz E.;
Goldsweig A.; Desai N.R.
Institution
(Kir, Shapero, Chatterjee, Grimshaw, Oddleifson, Spatz, Goldsweig, Desai)
Yale School of Medicine, New Haven, CT, United States
Publisher
Elsevier USA
Abstract
Background TAVR has revolutionized the treatment of aortic stenosis and
there has been an exponential increase in the number of TAVR centers since
its introduction in 2011. Multiple studies have been conducted to evaluate
if there is any relationship between institutional TAVR volume and patient
outcomes. Methods We performed a systematic literature search for relevant
articles in Ovid Medline All, Ovid Embase, the Cochrane Library, Google
Scholar, PubMed, and Web of Science. Databases were searched using a
combination of controlled vocabulary and free text terms in the
title/abstract related to volume, TAVR and patient outcomes. Two reviewers
independently screened all titles/abstracts for eligibility based on
pre-specified inclusion and exclusion criteria. All-cause 30-day mortality
data was pooled from the eligible studies and centers were categorized as
low, intermediate and high volume based on their annual TAVR volumes. We
performed a network meta-analysis with random effect models, each analysis
was based on vague priors for effect sizes. Results Our systematic search
yielded an initial list of 11,153 citations, 120 studies were selected for
full text review and after careful review of these full text-articles,
only 7 studies met all inclusion and exclusion criteria, yielding a total
of 193,498 patients undergoing TAVR across the world, categorized
according to the center&apos;s annual TAVR volume; 25,062 TAVRs were
performed in low volume centers, 75,906 in intermediate volume centers and
92,530 in high volume centers. Network meta-analysis showed a 37% relative
reduction in 30-day mortality rates for high volume centers compared to
low volume centers, there was a 23% relative reduction in mortality rates
when high volume centers were compared to intermediate volume centers and
19% relative reduction when intermediate volume centers were compared to
low volume centers. Conclusion Meta-analysis of existing research clearly
shows an inverse relationship between annual procedural volume and
all-cause mortality for TAVR. We need more research on access-to-care and
outcome disparities in TAVR to better understand the impact of more
stringent procedural volume thresholds.<br/>Copyright &#xa9; 2020 American
College of Cardiology Foundation

<90>
Accession Number
2005041852
Title
VITAMIN C SUPPLEMENTATION FOR POST-OPERATIVE ATRIAL FIBRILLATION
PROPHYLAXIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 522), 2020. Date of
Publication: 24 Mar 2020.
Author
Saleem M.; Osman M.; Balla S.
Institution
(Saleem, Osman, Balla) WVU, Morgantown, WV, United States
Publisher
Elsevier USA
Abstract
Background Vitamin C supplement is an option in preventing postoperative
atrial fibrillation (AF) after cardiac surgery. However, studies yielded
conflicting results regarding the efficacy of vitamin C in this context.
Hence, we performed a systematic review and meta-analysis to assess the
efficacy of vitamin C supplement after cardiac surgery to reduce the
incidence of AF. Methods A literature search of PubMed, EMBASE, and the
Cochrane library databases from inception to September 2019 was conducted.
Studies that evaluated the efficacy and safety of vitamin C in prevention
of postoperative AF in adult patients after cardiac surgery were
identified. The outcome of interestwas the incidence of postoperative AF.
Data was pooled together using the fixed effect model. Results A total of
16 studies with 3,350 patients (VitaminC=1,154 and Control=1,196) were
included in the current analysis. The use of vitamin C reduced the
incidence of postoperative AF compared to control (23% versus 32%, RR0.73
(95% CI 0.64-0.84; p=0.006) as shown in Figure 1. Conclusion Short-term
treatment with vitamin C is effective in reducing the incidence of
postoperative AF after cardiac surgery. [Figure presented]<br/>Copyright
&#xa9; 2020 American College of Cardiology Foundation

<91>
Accession Number
2005041556
Title
CONSISTENT BENEFIT OF DAPAGLIFLOZIN ACCORDING TO BACKGROUND THERAPY IN
PATIENTS WITH HFREF: AN ANALYSIS OF THE DAPA-HF TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 656), 2020. Date of
Publication: 24 Mar 2020.
Author
Docherty K.; Jackson A.; Inzucchi S.E.; Jhund P.; Kober L.; Kosiborod M.;
Langkilde A.M.; Martinez F.; Bengtsson O.; Ponikowski P.; Sabatine M.;
Sjoestrand M.; Solomon S.D.; Desai A.S.; Diez M.; Howlett J.; Ljungman
C.E.A.; O'Meara E.; Petrie M.; Schou M.; Pham V.; McMurray J.
Institution
(Docherty, Jackson, Inzucchi, Jhund, Kober, Kosiborod, Langkilde,
Martinez, Bengtsson, Ponikowski, Sabatine, Sjoestrand, Solomon, Desai,
Diez, Howlett, Ljungman, O'Meara, Petrie, Schou, Pham, McMurray) BHF
Cardiovascular Research Centre, Glasgow, United Kingdom
Publisher
Elsevier USA
Abstract
Background In DAPA-HF, dapagliflozin (10mg qd) compared with placebo,
reduced the risk of worsening HF and CV death. It is important to
understand whether the effects of dapagliflozin vary according to
background HF therapy. Methods Key inclusion criteria: 1) NYHA class
II-IV, 2) LVEF <=40%, and 3) elevated plasma NT-proBNP. Key exclusion
criteria: systolic BP <95 mmHg & eGFR <30 ml/min/1.73m².
<br/>Primary Outcome: composite of a 1st episode of worsening HF
(hospitalization for HF or an urgent HF visit requiring IV therapy) or CV
death. We examined the effect of dapagliflozin according to background
pharmacologic and device therapy, and prior coronary revascularization. As
>90% of patients received a RAS blocker & beta-blocker, we examined the
effect of dapagliflozin according to dose of these drugs (>=50% or <50% of
target). Results Baseline characteristics of the 4744 patients randomized:
mean age 66 years, 23% women, 56% ischemic etiology, 45% type 2 diabetes,
68% NYHA class II, & mean LVEF 31%. Treatments included: Diuretic 93%, RAS
blocker 94%, B-blocker 96%, MRA 71%, digoxin 19%, ICD 26%, CRT 7% & prior
coronary revascularization 43%. The overall dapagliflozin vs placebo
hazard ratio for the primary outcome was 0.74 (95% CI 0.65, 0.85; P<0.001)
and the benefit of dapagliflozin was consistent across all treatment
subgroups examined (Table). Conclusion In DAPA-HF, dapagliflozin improved
outcomes irrespective of background pharmacologic treatment, device
therapy or prior coronary revascularization. [Figure
presented]<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<92>
Accession Number
2005041518
Title
PROGNOSTIC UTILITY OF GLOBAL LONGITUDINAL STRAIN IN SURGERY FOR PRIMARY
MITRAL REGURGITATION: A SYSTEMATIC REVIEW.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1596), 2020. Date of
Publication: 24 Mar 2020.
Author
Kaur S.; Jain V.; Sadana D.; Desai M.Y.; Gillinov A.M.; Griffin B.P.; Xu
B.
Institution
(Kaur, Jain, Sadana, Desai, Gillinov, Griffin, Xu) Cleveland Clinic
Foundation, Cleveland, OH, United States
Publisher
Elsevier USA
Abstract
Background The role of left ventricular (LV) global longitudinal strain
(GLS) for prognostication of patients undergoing mitral valve surgery for
primary mitral regurgitation (MR) is unclear. Methods A systematic review
using keywords: LV GLS, primary MR, mitral valve replacement/repair, in
PubMed (from 1946), EMBASE (from 1974) and Cochrane databases till August
8, 2019 was performed. Studies assessing impact of LV GLS on outcomes of
mitral valve surgery were included. Studies with < 30 subjects, functional
MR and mitral valve surgery not performed in all subjects were excluded.
Results Review of 319 initial records yielded 37 articles for full text
review, and 7 studies met the inclusion criteria with a total of 1960
patients. Of these, 6 studies examined the correlation of GLS with
post-operative LV dysfunction and 5 found worse outcomes. Two studies
found associations with increased all-cause mortality. Mean pre-operative
ejection fraction (EF) was 64 +/-1.9%. In 4 studies, receiver operating
curve analysis identified cut-off values of LV GLS, ranging from -18% to
-20.5% for prediction of postoperative LV dysfunction. Conclusion In this
systematic review of 1960 patients, LV GLS is found to be an important
prognostic factor for surgery in primary MR. Reduced LV GLS
pre-operatively (worse than -18% to -20.5%) predicted post-operative LV
dysfunction and worse outcomes. LV GLS may enable potential early
identification of patients with primary MR warranting surgery. [Figure
presented]<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<93>
Accession Number
2005041465
Title
ANTITHROMBOTIC THERAPY AFTER PERCUTANEOUS CORONARY INTERVENTION USING
DRUG-ELUTING STENTS IN PATIENTS WITH ATRIAL FIBRILLATION.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 121), 2020. Date of
Publication: 24 Mar 2020.
Author
Lu W.; Wang Y.; Li Y.; Zhang R.; Chen Z.; Yan J.I.; Yang M.; Han B.; Wang
Z.; He S.; Chen L.; Wu X.; Zeng H.; Ma L.; Shi G.; Yin J.; Sun L.; Yao Y.;
Chen J.; Ma G.
Institution
(Lu, Wang, Chen, Li, Zhang, Chen, Yan, Yang, Han, Wang, He, Chen, Wu,
Zeng, Ma, Shi, Yin, Sun, Yao, Chen, Ma) ZhongDa Hospital, Nanjing, China
Publisher
Elsevier USA
Abstract
Background Long-term anticoagulation is recommended for atrial
fibrillation (AF) patients with CHA2DS2VASc score >= 2. Antiplatelet
therapy is also necessary when these patients undergo percutaneous
coronary intervention with drug-eluting stents (PCI-eS). But the
antithrombotic regimens for these patients remain controversial. Methods A
multicenter, active-controlled, open-label, randomized trial was performed
to compare the safety of dual (ticagrelor + warfarin) with triple
(clopidogrel + aspirin + warfarin) antithrombotic therapies in AF patients
after PCI-eS. The primary endpoint was the overall bleeding events
according to Thrombolysis in Myocardial Infarction (TIMI) criteria at 6
months. The secondary endpoints were the major bleeding events over 6
months, according to TIMI criteria. Cardiovascular events (re-PCI,
surgical bypass, MI, heart failure, re-hospital due to angina pectoris,
stent thrombosisand death due to cardiovascular causes) at the end were
also collected. Results A total of 296 patients were enrolled and
randomized from 12 medical centers. Randomization factors showed no
significant effects on the occurrence of primary and secondary endpoints
in the two groups. The rate of the overall bleeding events at 6 months is
36.49% in dual antithrombotic therapy group, while the rate is 35.62% in
triple therapy group (hazard ratio, 0.932; 95% confidence interval [CI],
0.637 to 1.365; p=0.7176). The rate of secondary endpoint over 6 months is
4.73 % in dual antithrombotic group and 1.37 % in triple therapy group
(hazard ratio, 0.275; 95% confidence interval [CI], 0.057 to 1.322;
p=0.0843). Patients in both groups had a comparable incidence of
cardiovascular events (18.24% vs. 16.44%; hazard ratio, 0.852; 95% CI,
0.491 to1.476; P=0.5669) at the end. Conclusion AF patients undergoing
PCI-eS treated with ticagrelor and warfarin resulted in comparable
bleeding events compared with traditional triple antithrombotic regimen.
Additionally, antithrombotic therapy with ticagrelor and warfarin did not
increase the incidence of ischemic events.<br/>Copyright &#xa9; 2020
American College of Cardiology Foundation

<94>
Accession Number
2005041275
Title
A SYSTEMIC REVIEW AND META-ANALYSIS OF VALVE IN VALVE TRANSCATHETER AORTIC
VALVE REPLACEMENT COMPARING BALLOON AND SELF EXPANDING VALVES.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1253), 2020. Date of
Publication: 24 Mar 2020.
Author
Hamilton G.; Koshy A.; Murphy A.; Fulcher J.; Theuerle J.; Farouque O.;
Horrigan M.; Yudi M.
Institution
(Hamilton, Koshy, Murphy, Fulcher, Theuerle, Farouque, Horrigan, Yudi)
Austin Health, Department of Cardiology, Melbourne, Australia
Publisher
Elsevier USA
Abstract
Background Valve-in-valve (ViV) transcatheter aortic valve replacement
(TAVR) is approved in high-risk patients with failed surgical
bioprostheses. It is unclear whether outcomes vary when using self- (SE)
or balloon-expanding (BE) valves. Methods A systematic review of PubMed,
MEDLINE and EMBASE was performed. Event rates among eligible studies were
pooled using a random effects model. The primary outcome was all-cause
mortality at 12-months. Secondary outcomes included maximal follow-up
mortality and VARC-2 clinical outcomes. Results 17 studies reporting
outcomes for 1,772 patients were included (SE=924, BE=848). Mortality at
12 months did not differ by valve type (SE 10.3% vs BE 12.6%, p=0.165).
However, mortality at maximal follow-up was significantly lower in the SE
group (11.6% vs 22.5%, p=0.02, figure). This persisted on multiple
sensitivity analyses. The SE group had lower bioprosthetic gradients and
AKI, but higher rates of pacemaker insertion and >=moderate paravalvular
leak (PVL) (all p<0.05). There were no differences in stroke, coronary
obstruction or major bleeding. Conclusion No difference in 12-month
mortality was noted between valve types when ViV TAVR was performed in
failed surgical bioprostheses. While rates of pacemaker insertion and PVL
were higher in the SE group, these patients had lower post-procedure
gradients and AKI. Higher mortality at maximal follow-up in the BE group
is hypothesis generating and highlights a need for studies with longer
follow-up. [Figure presented]<br/>Copyright &#xa9; 2020 American College
of Cardiology Foundation

<95>
Accession Number
2005041253
Title
PREVALENCE OF POST-TRANSPLANT MALIGNANCIES IN HEART TRANSPLANT RECIPIENTS:
A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 963), 2020. Date of
Publication: 24 Mar 2020.
Author
Lateef N.; Khan M.S.; Farooq M.Z.; Arif A.M.; Usman M.S.; Siddiqi T.J.;
Wahab A.; Khan S.U.; Doukky R.; Krasuski R.A.
Institution
(Lateef, Khan, Farooq, Arif, Usman, Siddiqi, Wahab, Khan, Doukky,
Krasuski) Creighton University, Omaha, NE, USA, Creighton University,
Omaha, NE, USA; Cook County Hospital, Chicago, IL, USA, Cook County
Hospital, Chicago, IL, USA
Publisher
Elsevier USA
Abstract
Background Solid organ transplant recipients are at an increased risk of
developing de novo malignancies. However, the prevalence of different
cancers after heart transplantation is unclear due to small and
conflicting studies. In this review, we highlight the pattern of
post-transplant malignancies in heart transplant (HT) patients. Methods
Extensive literature search was conducted on PubMed, Scopus, and Embase
for observational or randomized studies reporting malignancies after HT.
The proportions from each study were subjected to arcsine transformation
and pooled using random-effects model. This yielded the pooled estimate
with 95% confidence intervals (CI). Results We identified 55 studies
comprising 60,684 HT recipients. In total, 7,759 cancers were identified
during a mean follow-up of 9.8 +/- 5.9 years, with an overall incidence of
15.3% (95% CI = 12.7% - 18.1%). Mean time from HT to cancer diagnosis was
5.1 +/- 4 years. The most frequent cancers were gastrointestinal (7.6%),
skin (5.7%) and hematologic/blood (2.5%) [Figure]. Meta-regression showed
no association between incidence of cancer and mean age at HT (coeff:
-0.008; p=0.25), percentage of male recipients (coeff: -0.001; p=0.81),
donor age (coeff: -0.011; p=0.44) 5-year (coeff: 0.003; p=0.12) and
10-year (coeff: 0.02; p=0.68) post-transplant survival. Conclusion Risk is
most marked for gastrointestinal, skin and hematologic cancers post HT,
but without any impact on survival. [Figure presented]<br/>Copyright
&#xa9; 2020 American College of Cardiology Foundation

<96>
Accession Number
2005041230
Title
ATORVASTATIN REDUCES TOTAL EVENTS OVERALL AND ACROSS VASCULAR BEDS IN THE
SPARCL TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 2202), 2020. Date of
Publication: 24 Mar 2020.
Author
Szarek M.; Amarenco P.; Callahan A.; DeMicco D.; Fayyad R.; Goldstein L.;
Laskey R.; Sillesen H.; Welch K.M.
Institution
(Szarek, Amarenco, Callahan, DeMicco, Fayyad, Goldstein, Laskey, Sillesen,
Welch) SUNY Downstate Health Sciences University, Brooklyn, NY, United
States
Publisher
Elsevier USA
Abstract
Background In SPARCL, first vascular event was reduced from 687 for
placebo to 530 for atorvastatin (hazard ratio [HR] 0.74; p<0.001), with
significant reductions in stroke or TIA, coronary events, and
revascularization procedures. Here we describe treatment effects on total
(first and subsequent) vascular events to quantify the totality of
atorvastatin efficacy after recent stroke or TIA. Methods 4731 patients
with stroke or TIA 1-6 months before study entry, LDL-C 100 - 190 mg/dL,
and no known CHD were randomized 1:1 to atorvastatin 80mg or placebo.
Treatment effects on total adjudicated vascular events (vascular death;
nonfatal stroke; nonfatal MI; unstable angina; hospitalized angina or
ischemia; resuscitation after cardiac arrest; coronary, carotid, or
peripheral revascularization; clinically significant PVD), overall and by
vascular bed (cerebrovascular, coronary, or peripheral), are summarized by
mean cumulative function rates and HRs from marginal proportional hazards
models. Results There were 390 fewer total vascular events with
atorvastatin (HR 0.68; p<0.001), including 177 fewer cerebrovascular, 170
fewer coronary, and 43 fewer peripheral events (figure). Over 6 years, 20
vascular events per 100 patients were avoided with atorvastatin treatment.
Conclusion Atorvastatin prevented more than twice the number of total
events than first events, with reductions in all vascular beds. Total
event reduction is a useful metric to gauge atorvastatin efficacy after
recent stroke or TIA. [Figure presented]<br/>Copyright &#xa9; 2020
American College of Cardiology Foundation

<97>
Accession Number
2005041178
Title
TEMPORAL TRENDS AND CONTEMPORARY USE OF MULTIVESSEL PERCUTANEOUS CORONARY
REVASCULARIZATION FOR ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN THE
US: AN NCDR RESEARCH TO PRACTICE (R2P) PROJECT.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1128), 2020. Date of
Publication: 24 Mar 2020.
Author
Secemsky E.A.; Khera R.; Maddox T.M.; Bhatt D.; Armstrong E.J.; Curtis
J.P.; Bao H.; Yeh R.W.
Institution
(Secemsky, Khera, Maddox, Bhatt, Armstrong, Curtis, Bao, Yeh) Beth Israel
Deaconess Medical Center, Boston, MA, USA, Beth Israel Deaconess Medical
Center, Boston, MA, USA; Smith Center for Outcomes Research in Cardiology,
Boston, MA, USA, Smith Center for Outcomes Research in Cardiology, Boston,
MA, USA
Publisher
Elsevier USA
Abstract
Background After disparate results from observational and small randomized
studies, the 4,041 patient COMPLETE trial, published 10/2019, demonstrated
superiority of multivessel percutaneous coronary intervention (MVD PCI)
for ST-segment elevation myocardial infarction (STEMI). Temporal trends
and contemporary use of MVD PCI in national practice have not been
explored. Methods Trends in in-hospital MVD PCI use were studied in
359,879 STEMI PCIs at 1,598 institutions from 7/1/09-3/30/18 in the
CathPCI Registry. Shock patients were excluded. Practice patterns were
evaluated by quintiles of institutions with increasing MVD PCI use.
Results MVD PCI was performed in 25.5% STEMIs and of these, 73.3% received
complete revascularization by discharge. Use of MVD PCI was stable from
2009-2013, followed by an increase from 2014 onwards (Figure). Small
positive randomized trials had a substantial impact on MVD PCI use.
Institutional use of MVD PCI ranged from 0-93.3%, with median use of
24.3%. Between hospital quintiles with the lowest (0-16%) and highest
(>34%) MVD PCI use, lower use hospitals had smaller annual PCI volumes,
were more often located in the Northeast and Midwest, and in suburban
locations. Patient and procedural characteristics did not differ between
groups. Conclusion In this large, nationwide analysis, MVD PCI for STEMI
has increased since 2014, but is currently used in the minority of
patients. The COMPLETE trial has the opportunity to have a major impact on
clinical practice in the US. [Figure presented]<br/>Copyright &#xa9; 2020
American College of Cardiology Foundation

<98>
Accession Number
2005041045
Title
META-ANALYSIS OF DIRECT ORAL ANTICOAGULANT VERSUS VITAMIN K ANTAGONIST
AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1262), 2020. Date of
Publication: 24 Mar 2020.
Author
Ueyama H.; Kuno T.; Ando T.; Briasoulis A.; Fox J.; Hayashida K.; Takagi
H.
Institution
(Ueyama, Kuno, Ando, Briasoulis, Fox, Hayashida, Takagi) Icahn School of
Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United
States
Publisher
Elsevier USA
Abstract
Background Atrial fibrillation (AF) is a common comorbidity of patient
undergoing transcatheter aortic valve replacement (TAVR), but the optimal
antithrombotic regimen in this population remains unclear. The aim of our
study was to investigate the safety and efficacy profile of direct oral
anticoagulants (DOACs) compared to vitamin K antagonist (VKA) in patient
undergoing TAVR with concomitant indication of oral anticoagulation.
Methods MEDLINE and EMBASE were searched through October 2019 for studies
comparing DOACs versus VKA in patient undergoing TAVR with indication of
oral anticoagulation. The main outcomes were all-cause mortality, major
and/or life-threatening bleeding and stroke. Results Our search identified
five observational studies eligible for our study. A total of 2,569
patients were included (831 in DOACs arm, 1,738 in VKA arm). The mean age
of overall population was 82.1+/-6.3 years and 55.1% was male. Majority of
patients had AF as indication of oral anticoagulation. There were no
significant differences in all-cause mortality, major and/or
life-threatening bleeding and stroke among patient treated with DOACs
versus VKA (OR=1.07, 95% CI [0.73-1.57], p=0.72, OR=0.85, 95% CI
[0.64-1.12], p=0.24, OR=1.52, 95% CI [0.93-2.48], p=0.09 respectively)
(Figure). Conclusion In patient undergoing TAVR with concomitant
indication of oral anticoagulation, all-cause mortality, major and/or
life-threatening bleeding, and stroke were similar among DOACs and VKA.
[Figure presented]<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<99>
Accession Number
2005041000
Title
5-YEAR OUTCOME OF PERCUTANEOUS CORONARY INTERVENTION VS. CORONARY ARTERY
BYPASS SURGERY FOR PATIENTS PRESENTING WITH UNPROTECTED LEFT MAIN CORONARY
ARTERY DISEASE: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS AND
PROPENSITY SCORE ADJUSTED STUDIES.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1536), 2020. Date of
Publication: 24 Mar 2020.
Author
Vutthikraivit W.; Kewcharoen J.; Prasitlumkum N.; Putthapiban P.; Ajmal
R.; Klomjit S.; Rahman M.R.; Mantilla B.; Rattanawong P.
Institution
(Vutthikraivit, Kewcharoen, Prasitlumkum, Putthapiban, Ajmal, Klomjit,
Rahman, Mantilla, Rattanawong) Texas Tech University Health Sciences
Center, Lubbock, TX, United States
Publisher
Elsevier USA
Abstract
Background With the advance in stent, imaging and pharmacotherapy in the
past decade, percutaneous coronary intervention (PCI) has been accepted as
a treatment in selected patients with unprotected left main coronary
artery disease (ULMCAD). However, the long-term outcomes of PCI vs
coronary artery bypass surgery (CABG) are still controversial. Methods We
comprehensively searched the databases of MEDLINE and EMBASE from
inception to Oct 2019. Included studies were published cohort with
propensity score matching analysis (PSM) or randomized control trials
(RCT) that compared 5-year all-cause death and major adverse cardiac and
cerebrovascular events (MACCE) with PCI and CABG in ULMCAD patients. Data
from each study were combined using the random-effects model. Results Nine
studies, 4 RCTs and 5 PSMs, were included involving 6,993 ULMCAD patients
(3,483 underwent PCI). There was no difference in all-cause death between
PCI and CABG groups ([RR] 1.06, 95% CI 0.91-1.23, I²=18.7%,
p=0.485). There was significantly increased incidence of MACCE in the PCI
group compared with the CABG group ([RR] 1.27, 95% CI 1.15-1.39,
I²=0.0%, p<0.001). Subgroup analysis with study type showed the
similar outcome in both outcome. Conclusion As compared to CABG, our study
showed that PCI was associated with similar long-term survival rate;
however, there was a significant reduction in MACCE in CABG group at
5-year follow up. This reduction could be due to the reduction in
revascularization in patients who underwent CABG. [Figure
presented]<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<100>
Accession Number
2005040937
Title
DO EARLY CHANGES IN LEFT VENTRICULAR EJECTION FRACTION PREDICT LONG-TERM
OUTCOMES AFTER TRANSCATHETER MITRAL VALVE REPAIR OF SECONDARY MITRAL
REGURGITATION? THE COAPT TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1304), 2020. Date of
Publication: 24 Mar 2020.
Author
Lerakis S.; Kini A.S.; Asch F.M.; Weissman N.J.; Grayburn P.A.; Kar S.;
Kar; Lim S.; Mishell J.M.; Whisenant B.; Rinaldi M.; Kapadia S.R.;
Rajagopal V.; Sarembock I.J.; Brieke A.; Tang G.; Crowley A.; Sharma S.K.;
Lindenfeld J.; Abraham W.; Mack M.; Stone G.W.
Institution
(Lerakis, Kini, Asch, Weissman, Grayburn, Kar, Kar, Lim, Mishell,
Whisenant, Rinaldi, Kapadia, Rajagopal, Sarembock, Brieke, Tang, Crowley,
Sharma, Lindenfeld, Abraham, Mack, Stone) Icahn School of Medicine at
Mount Sinai, New York, NY, USA, Icahn School of Medicine at Mount Sinai,
New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA,
Cardiovascular Research Foundation, New York, NY, USA
Publisher
Elsevier USA
Abstract
Background In the COAPT trial, transcatheter mitral valve repair with the
MitraClip plus guideline directed medical therapy (GDMT) improved 2-year
clinical outcomes in comparison to GDMT alone in symptomatic patients with
heart failure (HF) and 3+ or 4+ secondary mitral regurgitation (SMR) due
to LV dysfunction. We evaluated 30-day to 2-year outcomes in patients with
an increase in LVEF (iLVEF group) compared with decreased or no change in
LVEF (dLVEF group) at 30 days compared with baseline as assessed at an
echocardiographic core laboratory. Methods The principal effectiveness
outcomes were all HF hospitalizations (HFH) and all-cause death between 30
days and 2 years of follow-up. Subgroup analysis with interaction testing
was performed according to change in LVEF at 30 days. Results There were
182 patients in the iLVEF group (mean DELTALVEF 6.0% +/- 4.9%; range 0.4%
to 24.0%) and 250 patients in the dLVEF group (mean DELTALVEF -6.6% +/-
5.6%; range -27.0% to 0.0%). All HFHs between 30 days and 2 years occurred
in 45.6% vs. 41.1% of patients in the iLVEF and dLVEF groups respectively
(p=0.48). All-cause death in this period occurred in 37.6% vs. 28.6% of
patients respectively (p=0.06). By multivariable analysis DELTALVEF at 30
days, per 5% increment increase as a continuous variable was a predictor
of a decrease in all HFHs (adjusted HR 0.86; 95% CI: 0.78, 0.95; P=0.003)
but not of all-cause death. Among patients randomized to MitraClip vs.
GDMT alone, 72/218 (33.0%) vs. 110/214 (51.4%) respectively had an
increase in LVEF from baseline to 30 days (p=0.0001). The effect of
MitraClip in reducing all HFHs between 30 days and 2 years was consistent
in pts with iLVEF (HR 0.44; 95% CI: 0.26, 0.75) and dLVEF (HR 0.46; 95%CI:
0.31, 0.69); P<inf>int</inf>=0.95. MitraClip also consistently reduced
all-cause death in iLVEF (HR 0.51; 95% CI: 0.30, 0.88) and dLVEF (HR 0.70;
95% CI: 0.44, 1.12); P<inf>int</inf>=0.39. Conclusion Among patients with
HF and moderate to 3+ or 4+ SMR due to LV dysfunction, an early
improvement in LVEF predicted subsequent freedom from HFH but not improved
survival. The MitraClip was effective in improving prognosis regardless of
early LVEF changes at 30 days.<br/>Copyright &#xa9; 2020 American College
of Cardiology Foundation

<101>
Accession Number
2005039789
Title
IMPACT OF PATIENT PROSTHESIS MISMATCH IN THE REPRISE III RANDOMIZED
CONTROLLED TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1479), 2020. Date of
Publication: 24 Mar 2020.
Author
Asch F.M.; Weissman N.J.; Bajwa T.; Kereiakes D.; Stoler R.; Ihlberg L.;
Allocco D.; Rizik D.G.
Institution
(Asch, Weissman, Bajwa, Kereiakes, Stoler, Ihlberg) Michael Reardon,
MedStar Health Research Institute, MA, United States
(Allocco, Rizik) Michael Reardon, MedStar Health Research Institute,
Washington, DC, United States
Publisher
Elsevier USA
Abstract
Background Patient-prosthesis mismatch (PPM) is common after aortic valve
replacement but its significance is controversial. Though PPM has been
linked to worse outcomes post SAVR, its impact after TAVR is still
unclear. We present 3-year outcomes in REPRISE III by degree of PPM.
Methods In REPRISE III, 912 patients with high/extreme risk and severe
symptomatic aortic stenosis were randomized (2:1) to receive either the
Lotus or CoreValve transcatheter aortic valve. PPM was evaluated at 30-day
echocardiograms and categorized as normal (indexed effective orifice area
>0.85 cm²/m²), moderate (0.65-0.85
cm²/m²) or severe (<0.65
cm²/m²) based on core laboratory analysis. Clinical
outcomes, stratified by PPM, were evaluated at 3 years. Results In REPRISE
III, 55% of patients had no PPM, 27% had moderate PPM and 18% had severe
PPM at 30 days. Outcomes through 3 years, based on PPM, are shown in the
table. There were no significant differences in the rates of death, stroke
or hospitalization between patients with normal compared to moderate or
severe PPM. Conclusion In the REPRISE III study compared with no PPM,
moderate or severe PPM were not associated with an increase in mid-term
mortality (3 years) and did not predict other negative clinical outcomes.
As expected, mean gradient and effective orifice area among survivors were
significantly worse in patients with PPM. [Figure presented]<br/>Copyright
&#xa9; 2020 American College of Cardiology Foundation

<102>
Accession Number
2005039785
Title
THE EFFECT OF TRANSCATHETER MITRAL VALVE REPAIR ON SHORT-TERM MORTALITY IN
PATIENTS WITH CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1181), 2020. Date of
Publication: 24 Mar 2020.
Author
Dave P.; Abunassar J.; Sayed N.; Babiolakis C.; Bisleri G.; Abuzeid W.
Institution
(Dave, Abunassar, Sayed, Babiolakis, Bisleri, Abuzeid) Queen's University,
Kingston, Canada
Publisher
Elsevier USA
Abstract
Background Transcatheter Mitral Valve Repair (TMVR) offers clinically
significant benefit to select symptomatic patients with severe Mitral
Regurgitation (MR). Appropriate patient selection is crucial to ensure
that patients most likely to benefit are treated. There is limited data on
the effect of TMVR on mortality in patients with chronic kidney disease
(CKD). Methods We conducted a systematic review and meta-analysis of
clinical trials and observational studies reporting on outcomes of
patients with CKD undergoing TMVR. We searched three databases on the Ovid
platform (Ovid MEDLINE, EMBASE, EBM reviews) from inception to October 13,
2019. A random-effects model was used to estimate the pooled odds ratio
across the included studies. Results We identified 1037 articles of which
12 articles were included based on pre-specified inclusion criteria. A
total of 6828 patients were treated with TMVR from August 2008 to June
2016 with follow up ranging from 30 days to 2 years. 4465 patients (65%)
of patients had CKD defined as a GFR below 60 mL/min/1.73m².
Overall, TMVR is associated with increased 30-day mortality in patients
with CKD (OR: 1.72, P<0.05). Further subgroup analysis confirmed this
signal in patients with a GFR < 30 mL/min/1.73m² (OR: 3.14,
P<0.05) but not in patients with a GFR 30-60 mL/min/1.73m² (OR:
1.27, P=0.26). Conclusion CKD is a predictor of 30-day mortality in
patients undergoing TMVR. Specifically, a GFR < 30mL/min/1.73m²
conveys a significant increase in 30-day mortality. [Figure
presented]<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<103>
Accession Number
2005039672
Title
A SWEET PERICARDIAL EFFUSION.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 3115), 2020. Date of
Publication: 24 Mar 2020.
Author
Freytes L.; Rodriguez R.; Bermudez E.; Rodriguez P.S.
Institution
(Freytes, Rodriguez, Bermudez, Rodriguez) San Lucas, Ponce, PR, United
States
Publisher
Elsevier USA
Abstract
Background Sweet syndrome (acute febrile neutrophilic dermatosis) is an
inflammatory disorder characterized by fever, neutrophilia, a dense dermal
infiltrate on histology, and characteristic skin lesions with rapid
response to treatment with systemic steroids. Systemic involvement is
extremely rare with very few reports describing cardiac involvement. Case
A 66-year-old woman presents with a seven day history of worsening dyspnea
and malaise with associated arthralgias, fever, and chills. She has a past
medical history of dyslipidemia, diabetes, hypertension, a prior transient
ischemic attack, and Sweet syndrome confirmed by skin biopsy one year ago
and treated with steroids. Recently she had been treated for a urinary
tract infection with quinolone. The patient reported that her symptoms
were very similar to those she had when initially diagnosed with Sweet
syndrome. Physical exam was remarkable for distant heart sounds and a
friction rub. ECG showed sinus tachycardia and low voltage. Laboratory
tests showed elevated CRP and ESR. A chest X-ray revealed an enlarged
heart and interstitial lung disease. A transthoracic echocardiogram showed
a large pericardial effusion with signs of mild hemodynamic compromise
despite essentially stable vitals. Chest and abdominopelvic CT scans were
otherwise negative. Decision-making A pericardiocentesis was performed
both therapeutically and for diagnostic purposes. The etiology of her
large pericardial effusion was unclear at this point and inflammatory,
malignant, and infectious etiologies were entertained. Workup of
pericardial fluid revealed an exudate and ruled out infection. After
pericardiocentesis and treatment with steroids, she had complete
resolution of symptoms and hemodynamic stability. Conclusion A complete
review of our patient&apos;s medical record suggests that this cardiac
involvement is a rare complication of Sweet syndrome and is most likely
secondary to neutrophilic infiltration from a current flair.cardiac
manifestations of Sweet syndrome are poorly reported. Review of literature
demonstrate that quinolones are associated with drug induced Sweet
syndrome as our patient.<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<104>
Accession Number
2005039516
Title
HYBRID CORONARY REVASCULARIZATION VERSUS CORONARY ARTERY BYPASS GRAFT IN
PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE: A META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1145), 2020. Date of
Publication: 24 Mar 2020.
Author
SayedAhmad Z.; Darmoch F.; Pacha H.M.; Soud M.; Al-Khadra Y.; Zaitoun A.;
Kajy M.; Hakim Z.; Kaki A.; Alraies M.C.
Institution
(SayedAhmad, Darmoch, Pacha, Soud, Al-Khadra, Zaitoun, Kajy, Hakim, Kaki,
Alraies) Saint Louis University Hospital, Saint Louis, MO, USA, Saint
Louis University Hospital, Saint Louis, MO, USA; Detroit Medical Center,
Detroit, MI, USA, Detroit Medical Center, Detroit, MI, USA
Publisher
Elsevier USA
Abstract
Background Hybrid coronary artery revascularization (HCR) refers to
complete or near complete revascularization using the combination of
single vessel coronary artery bypass graft (CABG) with left internal
mammary artery (LIMA) to left anterior descending (LAD) and percutaneous
coronary intervention (PCI) of other significant coronary lesions.
Multiple studies have compared the safety and outcomes of HCR versus CABG
for multivessel coronary artery disease (MCAD). The purpose of this
meta-analysis is to study short-term and long-term outcomes of HCR
compared to CABG for patients with MCAD. Methods A search of PubMed,
Medline and Cochrane Central Register from January 1969 through February
2019 for studies comparing the outcomes of HCR versus CABG for MCAD. The
data were pooled for the primary outcome measure using the random-effects
model as pooled Rate Ratio (RR). The primary outcomes were all-cause
mortality rate, myocardial infarction, and stroke. Results A total of 9112
patients (73.6% males) from 16 studies were included. 1484 patients
underwent HCR and 7628 underwent CABG. HCR group had comparable 30 days
mortality rates (OR, 1.21; 95% CI, 0.55-2.66, P= 0.64), myocardial
infarction (OR, 0.91; 95% CI, 0.47-1.74, P=0.77), and stroke (OR, 0.73;
95% CI, 0.37-1.47, P=0.35). In further analysis assessing secondary
outcomes, There was no significant difference between the two groups in
developing post op atrial fibrillation (OR, 0.76; 95% CI, 0.58-1.00) or
developing acute renal failure requiring hemodialysis (OR, 0.60; 95% CI,
0.30-1.18). HCR patients had shorter intensive care unit stay (weighted
mean difference 15.68 hours; 95% CI 9.17 to 22.19 hours), shorter hospital
length of stay (mean difference 1.49 days; 95% CI 0.75 to 2.23 days) and
required fewer blood transfusions (OR, 0.37; 95% CI, 0.26-0.52). After a
mean follow up time of (20.5months in HCR group/ 20.7 months for CABG
group), HCR group had lower incidence of stroke (OR, 0.25; 95% CI,
0.07-0.87). Conclusion The outcome of HCR was comparable to CABG for
patients with MCAD with no difference in mortality or major adverse
events. This suggests that HCR might be an attractive option for selected
patients with MCAD.<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<105>
Accession Number
2005038611
Title
THE IMPACT OF CHRONIC TOTAL OCCLUSIONS ON OUTCOMES OF PATIENTS UNDERGOING
CORONARY ARTERY BYPASS GRAFTING SURGERY: INSIGHTS FROM THE REGROUP TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1461), 2020. Date of
Publication: 24 Mar 2020.
Author
Ramadan R.; Kinlay S.; Stock E.M.; Phillips A.; DeMatt E.J.; Bhatt D.;
Zenati M.
Institution
(Ramadan, Kinlay, Stock, Phillips, DeMatt, Bhatt, Zenati) Harvard Medical
School, Boston, MA, USA, Harvard Medical School, Boston, MA, USA; Boston
VA Healthcare System, Boston, MA, USA, Boston VA Healthcare System,
Boston, MA, USA
Publisher
Elsevier USA
Abstract
Background Chronic total occlusions (CTOs) of coronary arteries are common
in patients undergoing coronary artery bypass grafting (CABG) surgery. The
surgical literature on the impact of baseline CTO on the operative and
long-term outcomes of patients undergoing CABG is limited. Methods We
performed a post hoc analysis of the randomized REGROUP clinical trial. Of
the 1150 patients randomized, 453 (39.4%) patients had at least one CTO.
The primary outcome was a composite of major adverse cardiac events,
including death from any cause, nonfatal myocardial infarction, and repeat
revascularization. Secondary outcomes were postoperative outcomes
including need for mechanical and/or inotropic hemodynamic support and
30-day postoperative mortality. Results Patients with baseline CTOs were
younger (65.8 vs. 66.8; p=0.006), had lower ejection fraction (52.7% vs.
54.9%; p=<0.001), and a higher SYNTAX score (32.0 vs. 24.0; p <0.001).
Over a median follow up of 2.8 years, the primary outcome occurred in 67
patients (14.8%) in the CTO group and 102 patients (14.7%) in the non-CTO
group (hazard ratio, 0.88; 95% confidence interval [CI], 0.63 to 1.22;
p=0.44). A total of 33 patients (7.3%) in the CTO group and 50 patients
(7.2%) in the non-CTO group died (hazard ratio, 0.84; 95% CI, 0.53 to
1.34; p=0.47); myocardial infarctions occurred in 22 patients (4.9%) in
the CTO group and 39 patients (5.6%) in the non-CTO group (hazard ratio,
0.91; 95% CI, 0.51 to 1.62; p=0.74), and revascularization occurred in 23
patients (5.1%) in the CTO group and 43 patients (6.2%) in the non-CTO
group (hazard ratio, 0.76; 95% CI, 0.44 to 1.32; p=0.33). Moreover,
secondary outcomes including operative mortality were similar between the
two groups irrespective of the location or the territory of the CTO.
Conclusion Among patients with CTOs undergoing CABG, we did not find a
significant difference in the risk of postoperative and/or long-term major
adverse events.<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<106>
Accession Number
631321122
Title
Pre-operative cardio surgery protocol implementation with Sucrosomial
iron.
Source
Blood Transfusion. Conference: 7th International Multidisciplinary Course
on Iron Deficiency. Italy. 18 (Supplement 1) (pp s7), 2020. Date of
Publication: February 2020.
Author
Weltert L.P.
Institution
(Weltert) European Hospital, Rome, San Camillus University for Health
Sciences, Rome, Italy
Publisher
Edizioni SIMTI
Abstract
Background. Patient Blood Management (PBM) in heart surgery is a
multi-stage multi-factorial effort, whose burden not only relies on the
surgeon but instead on the whole hospital team. It is long know, from the
creator of the very first definition of PBM, that it stretches through the
preoperative, intraoperative, and postoperative moments. However, the
content of these three perioperative frames has changed countless times,
as it should for a young science searching for optimal results. Heart
surgery is on itself responsible of one third of red blood cell
transfusion (RBCT) in Western countries, and the detrimental effect of
RBCT is now widely recognised. However, it is hard to refrain from using
RBCT because most patient undergoing heart surgery arrives at the
operation with poor haemoglobin (Hb) level, often under 11 g/dL. The very
reason of this anaemic state is incompletely understood, as the patients
are not bleeding prior to surgery. Some recent publications suggested that
heart failure per se might trigger the pathway of chronic inflammatory
disease with overexpression of hepcidin, thus leading to iron-restricted
erythropoiesis. Methods. The European Hospital in Rome is a heart surgery
centre dedicated to optimal Patient Blood Management and the location for
previous studies on the effects of erythropoietin and perioperative blood
salvage and reinfusion. We planned a prospective randomised study to treat
patient one month prior to surgery with oral Sucrosomial iron at a single
dose of 60 mg per day (Cardiosideral, 2 capsules per day) in comparison to
no treatment (ClinicalTrials.gov identifier NCT03560687). The study
enrolment started in November 2018 and we plan to recruit 1,000
consecutive patients, which will probably happen by the end of 2020. The
primary end points will focus on preoperative Hb value and even more on Hb
at postoperative days 1 and 2, where the generally reduced erythropoietic
activity leads to an Hb drift of 1 or 2 g/dL that frequently triggers
RBCT. The tolerance of the product and the adherence to treatment will be
carefully evaluated. Results. Preliminary data from the first 148 patients
show a complete adherence to protocol, with 0% reported intolerance cases.
The prescription was easily understood by the patient, the name of the
drug is simple to remember, the single dosage avoids confusions, the low
cost is welcome by the patients, the fact that Cardiosideral is a
nutritional support and not a strict medicine makes it even easier for
patients to acquire it and undergo long term therapy. On day of surgery,
mean preoperative Hb level was around 1 g/dL higher that in control
patients, and the Hb drift between postoperative days 1 and 2 was reduced
by 70%, which is far better than expected. Conclusions. Although this
regards to just a 15% of the final population and could be totally
contradicted in future, the initial data already show some consistency,
thus making the protocol a promising solution.

<107>
Accession Number
2005041149
Title
PERCUTANEOUS OR SURGICAL ACCESS IN TRANSFEMORAL TRANSCATHETER AORTIC VALVE
IMPLANTATION: SYSTEMATIC REVIEW AND UPDATED META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1261), 2020. Date of
Publication: 24 Mar 2020.
Author
Abdelaziz H.; Megaly M.; Debski M.; Rahbi H.; Kamal D.; Saad M.; Wiper A.;
More R.; Roberts D.
Institution
(Abdelaziz, Megaly, Debski, Rahbi, Kamal, Saad, Wiper, More, Roberts)
Lancashire Cardiac Centre, Blackpool, United Kingdom
Publisher
Elsevier USA
Abstract
Background Vascular and bleeding complications after transfemoral
transcatheter aortic valve implantation (TF-TAVI) are associated with
significant morbidity and mortality. Whether percutaneous approach (PC) or
surgical cut-down (SC) is superior is still widely debated. Methods
PubMed, EMBASE and Cochrane library were searched for randomized studies
and high quality observational cohort studies comparing outcomes of PC and
SC in TF-TAVI based on Valve Academic Research Consortium (VARC) criteria.
Main outcomes were major vascular complications and bleeding. Secondary
outcomes included minor vascular complications and bleeding, blood
transfusion, myocardial infarction, stroke, renal failure, surgical
intervention for vascular complications, perioperative all-cause
mortality, procedural time and hospital stay duration. Random effects
DerSimonian-Laird risk ratios (RRs) for outcomes were calculated. Results
A total of 13 studies (1 randomised controlled trial and 12 observational
cohort studies) including 5,859 patients (PC=3,447, SC=2,412) were
available for analysis. Compared with SC, PC was associated with similar
incidence of major vascular complications (8.7% vs. 8.5%; OR=0.93, 95% CI
0.76-1.15, p=0.53), major bleeding (OR=1.09, 95% CI 0.66-1.8, p=0.73),
perioperative mortality (5.7% vs. 5.2%; OR=1.13, 95% CI 0.85-1.49, p=0.4),
urgent surgical repair (OR=1.27, 95% CI 0.81-2.02, p=0.3), stroke (3.3%
vs. 3.9%; OR=0.85, 95% CI 0.53-1.36, p=0.5), myocardial infarction (1.3%
vs.1.1%; OR=1.06, 95% CI 0.53-2.12, p=0.86) renal failure (5.2% vs. 5.9%;
OR=0.68, 95% CI 0.38-1.22, p=0.2), but shorter length of hospital stay
(9.1+/-8.5 vs. 9.6+/-9.5 days; mean difference= -1.07 day, 95% CI -2.0 to
-0.15, p=0.02) and less blood transfusion (18.5% vs. 25.7%; OR=0.61, 95%
CI 0.43-0.86, p=0.005). Minor vascular complications occurred more
frequently in PC compared to SC (11.9% vs. 6.9%; OR=1.67, 95% CI
1.04-2.67, p=0.03). Conclusion In TF-TAVI PC is a safe and feasible
alternative to SC. Adopting either approach depends on operator experience
after ensuring that vascular access could be safely achieved with that
specific technique.<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<108>
Accession Number
2005041093
Title
BASELINE RENAL DYSFUNCTION IS ASSOCIATED WITH INCREASED MORTALITY IN
PATIENTS UNDERGOING PERCUTANEOUS MITRAL VALVE REPAIR: A SYSTEMATIC REVIEW
AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1173), 2020. Date of
Publication: 24 Mar 2020.
Author
Kewcharoen J.; Techorueangwiwat C.; Kittipibul V.; Kanitsoraphan C.;
Leesutipornchai T.; Thangjui S.; Vutthikraivit W.; Rattanawong P.;
Banerjee D.
Institution
(Kewcharoen, Techorueangwiwat, Kittipibul, Kanitsoraphan, Leesutipornchai,
Thangjui, Vutthikraivit, Rattanawong, Banerjee) University of Hawaii,
Honolulu, HI, United States
Publisher
Elsevier USA
Abstract
Background Renal dysfunction is commonly observed in patients with severe
mitral regurgitation (MR) undergoing percutaneous mitral valve repair
(PMVR). Renal dysfunction has been known to be associated with worse
cardiovascular outcomes after PMVR, but there has never been a systematic
review and meta-analysis to confirm this. Thus, we performed a systematic
review and meta-analysis to explore the effect of baseline renal
dysfunction on mortality in this population. Methods We searched the
databases of MEDLINE and EMBASE from inception to August 2019. Included
studies were published articles reporting univariate or multivariate
analysis of the effects of renal dysfunction on mortality among patients
with severe MR undergoing PMVR. Data from each study were combined using
the random-effects model. Results Ten studies were included in this
meta-analysis comprising a total of 5,956 patients. Baseline renal
dysfunction was associated with increased risk of mortality following PMVR
(pooled HR=2.49, 95%CI: 1.82-3.40) (Figure 1). Subgroup analysis was
performed based on the differing definitions of renal dysfunction used in
each study. Renal dysfunction was associated with increased risk of
mortality across all subgroups (Figure 1.1-1.4). Conclusion Baseline renal
dysfunction increases the risk of mortality in patients with severe MR
undergoing PMVR. The presence of renal dysfunction provides prognostic
information that should be taken into consideration when evaluating a
patient for PMVR. [Figure presented]<br/>Copyright &#xa9; 2020 American
College of Cardiology Foundation

<109>
Accession Number
2005041091
Title
EFFECT OF LOW DOSE COLCHICINE ON THE INCIDENCE OF ATRIAL FIBRILLATION IN
OPEN HEART SURGERY PATIENTS: END-AF LOW DOSE TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 464), 2020. Date of
Publication: 24 Mar 2020.
Author
Tabbalat R.A.; Barakat J.; Khader Y.; Hammoudeh A.; Alhaddad I.; AbuKhalaf
H.; Obaidat M.
Institution
(Tabbalat, Barakat, Khader, Hammoudeh, Alhaddad, AbuKhalaf, Obaidat)
Abdali Medical Center, Amman, Jordan, Abdali Medical Center, Amman,
Jordan; Khalidi Hospital and Medical Center, Amman, Jordan, Khalidi
Hospital and Medical Center, Amman, Jordan
Publisher
Elsevier USA
Abstract
Background Atrial fibrillation (AF) commonly occurs in patients undergoing
cardiac surgery and contributes to increased morbidity and prolonged
hospital stay. Studies using 1 mg of colchicine for the prevention of
post-operative AF (POAF) showed conflicting results. Moreover, the use of
colchicine was associated with significant gastrointestinal (GI) side
effects leading to early discontinuation of therapy. The aim of this study
was to determine if administering low-dose colchicine preoperatively till
hospital discharge is effective in the prevention of POAF, while
simultaneously reducing colchicine-induced GI side effects Methods In this
prospective, randomized, double-blinded, placebo-controlled clinical
study, consecutive adult patients (n=190) who were admitted to three
participating hospitals in Jordan for elective cardiac surgeries were
screened for eligibility upon admission. Main exclusion criteria included
history of supraventricular arrhythmias including AF, absence of sinus
rhythm upon enrollment, hypersensitivity to colchicine, renal or hepatic
impairment, and pregnancy or lactation. 152 patients were randomized to
receive colchicine (n = 81) or placebo (n = 71). Colchicine or matching
placebo was administered orally at a dose of 1 mg 12-24 hours before
surgery and continued at a dose of 0.5 mg once daily from day of surgery
until hospital discharge. The primary efficacy end point was the
development of at least one episode of AF of >= 5 minutes in duration. The
primary safety end point was the development of adverse-effects,
especially diarrhea Results A total of 26 patients (17.1%) developed AF.
Colchicine group patients showed no reduction in AF incidence as compared
to placebo group patients (16.1% versus 18.3%, respectively; p = 0.85).
Diarrhea occurred in 4 patients-two in each group and led to
discontinuation of treatment in 2 patients-one in each group. Six patients
died in hospital of surgical complications unrelated to AF; 4 in the
colchicine group and 2 in the placebo group Conclusion In patients
admitted for elective cardiac surgery, perioperative administration of low
dose colchicine until hospital discharge, failed to reduce the incidence
of POAF<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<110>
Accession Number
2005040978
Title
COMPARISON OF SHORT-TERM, MID-TERM AND LONG-TERM MORTALITY IN PATIENTS
WITH UNPROTECTED LEFT MAIN CORONARY ARTERY DISEASE TREATED WITH
DRUG-ELUTING STENTS VS. BYPASS SURGERY: INSIGHTS FROM AN UPDATED
META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1534), 2020. Date of
Publication: 24 Mar 2020.
Author
Kundu A.; Sardar P.; Chakrabarty S.; Hassan A.; Ogunsua A.; Qureshi W.
Institution
(Kundu, Sardar, Chakrabarty, Hassan, Ogunsua, Qureshi) University of
Massachusetts Medical School, Worcester, MA, United States
Publisher
Elsevier USA
Abstract
Background There is considerable debate regarding the overall benefits of
percutaneous coronary intervention (PCI), compared with coronary artery
bypass grafting (CABG) for the treatment of unprotected left main coronary
artery disease (ULMCAD). This meta-analysis compared mortality outcomes
with PCI and CABG for revascularization of ULMCAD, at various follow-up
intervals. Methods Databases were searched through October
15^th, 2019. Randomized controlled trials (RCTs) reporting
outcomes with PCI vs. CABG for ULMCAD were identified. The primary outcome
of interest was all-cause mortality evaluated at short term (30 day),
mid-term (1 year) and long-term (>5 year) follow-up. We calculated summary
odds ratios (OR) and 95% Confidence Intervals (CI) using the
random-effects model. Results The analysis included 4,700 patients from 6
RCTs. Compared to CABG, there was no significant difference in short-term
all-cause mortality in patients assigned to the PCI arm (OR 0.63, 95% CI
0.31 to 1.29, n=5). At mid-term follow-up, PCI was associated with a
reduced risk of all-cause mortality, compared with patients undergoing
CABG (OR 0.66, 95% CI 0.47 to 0.91, n=6). However, both PCI and CABG had
similar rates of all-cause mortality at long-term follow-up (OR 1.05, 95 %
CI 0.80 to 1.37, n=5). Conclusion Our meta-analysis of RCTs showed that
compared to CABG, PCI with DES has similar short-term and long-term
mortality in ULMCAD. At mid-term follow-up, PCI was associated with a 44 %
reduction in all-cause mortality. [Figure presented]<br/>Copyright &#xa9;
2020 American College of Cardiology Foundation

<111>
Accession Number
2005039821
Title
OUTCOMES OF TRANSCATHETER MITRAL VALVE REPAIR IN ISCHEMIC VERSUS
NON-ISCHEMIC CARDIOMYOPATHY: THE COAPT TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1178), 2020. Date of
Publication: 24 Mar 2020.
Author
Al-Azizi K.; Grayburn P.A.; Szerlip M.; Smith R.; Hamandi M.; Sannino A.;
Weissman N.J.; Kapadia S.R.; Puri R.; Reed G.W.; Krishnaswamy A.; Zhang
Y.; Lindenfeld J.; Abraham W.; Stone G.W.; Mack M.
Institution
(Al-Azizi, Grayburn, Szerlip, Smith, Hamandi, Sannino, Weissman, Kapadia,
Puri, Reed, Krishnaswamy, Zhang, Lindenfeld, Abraham, Stone, Mack) Baylor
Scott & White Medical Center, Plano, TX, USA, Baylor Scott & White Medical
Center, Plano, TX, USA; Cardiovascular Research Foundation, New York, NY,
USA, Cardiovascular Research Foundation, New York, NY, USA
Publisher
Elsevier USA
Abstract
Background The mechanisms and prognosis of secondary mitral regurgitation
(MR) may be different in patients (pts) with ischemic (ICM) and
nonischemic cardiomyopathy (NICM). Whether transcatheter mitral valve
repair with MitraClip is equally effective in ICM and NICM is unknown.
Methods In COAPT, 614 pts with heart failure (HF) and 3+ or 4+ MR who
remained symptomatic despite maximally-tolerated guideline-directed
medical therapy (GDMT) were randomized to MitraClip plus GDMT vs GDMT
alone. We examined outcomes according to ICM vs NICM. Results ICM and NICM
were present in 373 (60.7%) and 241 (39.3%) pts respectively. ICM pts were
older, more frequently male and had a higher STS risk score compared with
NICM pts (all p<0.0001). ICM pts also had smaller left ventricles (LVs)
(mean LV end-diastolic volume index 98.5 mL/m2 vs 106 mL/m2, p=0.01) and
greater mean LVEF (32.4% vs 29.6%, p=0.0005). In the device group, there
were no differences in the mean number of clips used in ICM and NICM (1.7
vs 1.6, p=0.38) or core lab MR grade 2+ at 24 months (99% vs 100.0%,
p=0.41). In all pts, there was no significant difference in the 2-year
rate of death or HF hospitalization (HFH) in pts with ICM vs NICM (42.8%
vs 39.2%, p=0.63). Treatment with MitraClip compared with GDMT alone
consistently improved outcomes in ICM and NICM (Table). Conclusion Despite
baseline differences in pts with ICM and NICM and severe secondary MR,
both etiologies demonstrated substantial improvement after MitraClip
treatment at 24 months. [Figure presented]<br/>Copyright &#xa9; 2020
American College of Cardiology Foundation

<112>
Accession Number
2005039817
Title
OUTCOMES OF DEATH OR HEART TRANSPLANTATION IN HYBRID PALLIATION OF
HYPOPLASTIC LEFT HEART SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 647), 2020. Date of
Publication: 24 Mar 2020.
Author
Kulkarni A.; Patel N.; Cooper R.; Singh T.
Institution
(Kulkarni, Patel, Cooper, Singh) Cohen Children's Medical Center, Queens,
NY, USA, Cohen Children's Medical Center, Queens, NY, USA; Boston
Children's Hospital, Boston, MA, USA, Boston Children's Hospital, Boston,
MA, USA
Publisher
Elsevier USA
Abstract
Background Data on death/heart transplantation (D-HT) in patients with
hypoplastic left heart syndrome (HLHS) who undergo hybrid palliation (hyb)
is available mostly from single centers. We sought to evaluate risk
factors (RF) for D-HT in HLHS with a systematic review and meta-analysis
(SR-MA). Methods We included hybrid palliation outcome studies of D-HT in
HLHS, from a MESH search for HLHS and D-HT in CINAHL, CINAHL PLUS and
MEDLINE, in English between January 1998-December 2017. Case reports,
systematic reviews, mixed lesions, database duplicates and prenatal
outcomes were excluded. Cochrane ROBINS-I risk of bias (ROB) tool for
non-randomized studies was used to assess ROB & MA was performed if RF
data was available for >=3 studies. Results The search yielded 10,913
citations, reduced to 284 full text screening of which 26 studies met
inclusion criteria. All were observational retrospective analysis (22
single centers, 1 from 2 centers and 3 using registries). ROB was critical
in 9 studies, serious in 12, moderate in 4 and low in 1 study. In all, 377
pts underwent hyb in 13 centers, of which 170 (45%) died and 31 (8%)
underwent HT. There were 386 hyb pts in registries of which 166 (43%)
died. In single ctrs, pulmonary artery banding was performed in 366 pts
(97%), PDA stenting in 224 pts (59%) and prostaglandin infusion was
continued to comprehensive stage 2 surgery in 164 pts (43.5%). 120 pts
(32%) were described as high risk of which 69 died (58%). A sensitivity
analysis of individual risk factors for D-HT in recent decade (2008-2017)
compared to previous (1998-2007) revealed that outcomes have improved in
low birth weight pts (OR 9 [0.6-144] to OR 0.9 [0.4-2.2],
I²46.8%) and in obstructed pulmonary venous return (OR 2.7
[0.7-10.7] to OR 0.2 [0.2-2.6], I² 54%). There remains high
heterogeneity in pts with aortic atresia (OR 1.6 [0.6-4.4], I²
73.5%) and post hyb coarctation (OR1.2 [0.6-2.5], I² 79.9%),
likely due to individual center variations. Conclusion Our systematic
review and meta-analysis found a very high mortality rate in hyb HLHS pts,
likely related to inclusion of high-risk pts. Certain centers have
demonstrated improving outcomes in recent decade from better recognition
and management of RF.<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<113>
Accession Number
2005039642
Title
REVIEW OF RE-OPERATIVE SURGICAL MITRAL VALVE REPLACEMENT VERSUS
TRANSCATHETER MITRAL VALVE-IN-VALVE REPLACEMENT.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1212), 2020. Date of
Publication: 24 Mar 2020.
Author
Sengupta A.; Yazdchi F.; Premkumar A.; Percy E.; Hirji S.; Shekar P.S.;
Kaneko T.; Tang G.
Institution
(Sengupta, Yazdchi, Premkumar, Percy, Hirji, Shekar, Kaneko, Tang) Mount
Sinai Hospital, New York, NY, USA, Mount Sinai Hospital, New York, NY,
USA; Brigham and Women's Hospital, Boston, MA, USA, Brigham and Women's
Hospital, Boston, MA, USA
Publisher
Elsevier USA
Abstract
Background Bioprosthetic mitral structural valve degeneration (SVD) often
requires surgical mitral valve replacement (redo-SMVR), which is
associated with significant mortality and morbidities. Transcatheter
mitral valve-in-valve (MVIV) and valve-in-ring (MVIR) replacement are now
feasible but data comparing these approaches to redo-SMVR are lacking.
Methods A systematic review of the literature was performed in PubMed,
Embase, and the Cochrane Central Register of Controlled Trials. Studies
were included if they involved either redo-SMVR or MVIV/MVIR. Results
Redo-SMVR was required in ~35% of patients after index surgery at 10
years, with 6-15% 30-day mortality (Figure 1A). Preoperative ejection
fraction, New York Heart Association class, and prosthetic valve
endocarditis consistently predicted adverse outcomes. MVIV resulted in
>95% procedural success with 30-day and 1-year mortality of 0-8% and
11-16%, respectively (1B). Recognized complications of MVIV included left
ventricular outflow tract obstruction, valve migration and thrombosis, and
residual regurgitation. Comparisons of redo-SMVR and MVIV showed no
differences in mortality, albeit higher rates of major bleeding and
arrhythmias with redo-SMVR. Outcomes with MVIR were not as desirable, with
23-32% mortality at 1 year (1C). Conclusion MVIV is preferred to redo-SMVR
for SVD. Given suboptimal results with MVIR, re-operative mitral valve
repair or replacement is preferred in suitable candidates. [Figure
presented]<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<114>
Accession Number
2005039546
Title
IMPACT OF PULMONARY HYPERTENSION IN PATIENTS UNDERGOING TRANSCATHETER
MITRAL VALVE REPAIR FOR SECONDARY MITRAL REGURGITATION: THE COAPT TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1210), 2020. Date of
Publication: 24 Mar 2020.
Author
Ben-Yehuda O.; Shahim B.; Chen S.; Liu M.; Redfors B.; Hahn R.T.; Asch
F.M.; Weissman N.J.; Medvedofsky D.; Puri R.; Kapadia S.R.; Sannino A.;
Grayburn P.A.; Kar S.; Kar; Lim S.; Lindenfeld J.; Abraham W.; Mack M.;
Stone G.W.
Institution
(Ben-Yehuda, Shahim, Chen, Liu, Redfors, Hahn, Asch, Weissman,
Medvedofsky, Puri, Kapadia, Sannino, Grayburn, Kar, Kar, Lim, Lindenfeld,
Abraham, Mack, Stone) Cardiovascular Research Foundation, New York, NY,
United States
Publisher
Elsevier USA
Abstract
Background The impact of pulmonary hypertension (PHTN) after transcatheter
mitral valve repair (TMVr) for secondary mitral regurgitation (MR) remains
unknown. Methods 614 symptomatic heart failure (HF) pts on
maximally-tolerated guideline directed medical therapy (GDMT) with 3+ to
4+ MR were randomized to TMVr with the MitraClip plus GDMT (n=302) vs GDMT
alone (n=314). Pulmonary artery systolic pressure (PASP) estimated from
baseline echocardiography was categorized as substantially increased (>=50
mmHg) vs. not substantially increased (<50 mmHg). Results Among 528 pts,
184 (82 TMVr and 102 GDMT) had PASP >=50 mmHg (mean 59.1 +/- 8.8 mmHg) and
344 (171 TMVr and 173 GDMT) had PASP <50 mmHg (mean 36.3 +/- 8.1 mmHg). By
multivariable analysis, pts with PASP >=50 mmHg had higher 2-year rates of
death or heart failure hospitalization (HFH) compared to those with PASP
<50 mmHg (adjusted HR 1.50, 95% CI 1.16, 1.93, p=0.002). TMVr consistently
reduced 2-year rates of death or HFH in pts with PASP >=50 mmHg and <50
mmHg (Fig). TMVr reduced PASP at 30 days compared to GDMT (least squares
mean change from baseline -4.0 vs. -0.9 mmHg, p=0.006). Reduction in PASP
at 30 days was independently associated with reduced risk of death or HFH
between 30 days and 2 years (adjusted HR 0.83 per -10 mmHg, 95% CI 0.74,
0.92, p=0.0009). Conclusion HF pts with 3+/4+ MR in COAPT had a worse
prognosis if substantial PHTN was present. TMVr reduced PASP and 2-year
rates of death or HFH regardless of baseline pulmonary pressures. [Figure
presented]<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<115>
Accession Number
2005039472
Title
LONG TERM DURABILITY OF TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR): A
SYSTEMATIC REVIEW OF 5-YEAR VALVE DURABILITY AND BEYOND.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1486), 2020. Date of
Publication: 24 Mar 2020.
Author
Marashly Q.; Al Danaf J.; Ibrahim H.; Welt F.
Institution
(Marashly, Al Danaf, Ibrahim, Welt) University of Utah, Salt Lake City,
UT, United States
Publisher
Elsevier USA
Abstract
Background Transcatheter aortic valve replacement (TAVR) is becoming very
widely used in the treatment of aortic stenosis. Recently, TAVR was
demonstrated to be superior to SAVR in regard to death, stroke, and
rehospitalization in low risk patients. However, little is known about
transcatheter heart valve (THV) long-term durability. We sought to
investigate the long-term, 5 years or more, durability of TAVR. Methods
Literature search using electronic databases was performed up to April
2019. Studies with maximal follow up data for at least 5 years and
reported valve hemodynamic data were included. The primary outcome of
interest is the incidence of structural valve degeneration (SVD) in
studies that have a follow-up duration of 5 years or longer. SVD
definition differed among the studies. Results Fourteen studies were
identified, with a total of 10,398 patients. (age 79.3-84.1, male
36.6%-60%). Eleven studies reported SVD incidence rate of 0.85% to 9.1%.
Among these studies, the incidence of SVD increased over time (Figure 1).
Three studies reported no cases of SVD between 5-10 years. Conclusion The
limited available data regarding THV durability at 5 years and beyond
demonstrate low incidence of SVD and non-structural complications but with
an increasing trend. Long term follow up from clinical trials including
younger patients with longer survival expectancy would definitely provide
better understanding of THV long-term durability. [Figure
presented]<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<116>
Accession Number
2005039313
Title
IMPROVEMENT IN PATIENT CENTERED OUTCOMES FOLLOWING MITRAL VALVE SURGERY
FOR SEVERE ISCHEMIC MITRAL REGURGITATION.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 2168), 2020. Date of
Publication: 24 Mar 2020.
Author
Lala A.A.; Kirkwood K.; Iribarne A.; Moskowitz A.; Overbey J.; Charles
E.J.; Goldstein D.J.; O'Gara P.T.; Puskas J.; Bagiella E.; Taddei-Peters
W.; O'sullivan K.; Miller M.; Laurin C.; Giustino G.; Yerokun B.; Gillinov
A.; Gelijns A.; Acker M.; Stevenson L.
Institution
(Lala, Kirkwood, Iribarne, Moskowitz, Overbey, Charles, Goldstein, O'Gara,
Puskas, Bagiella, Taddei-Peters, O'sullivan, Miller, Laurin, Giustino,
Yerokun, Gillinov, Gelijns, Acker, Stevenson) CTSN Investigators, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background Beyond survival, patients care about quality of life (QOL)
after surgery. Understanding factors associated with better QOL in severe
ischemic mitral regurgitation (SIMR) patients at 1 year following mitral
valve (MV) surgery may help inform patient decisions and expectations.
Methods QOL was assessed using the Minnesota Living with Heart Failure
questionnaire (MLHF, range 0-105) at baseline and 1 yr among pts enrolled
in a randomized trial of MV replacement vs repair in pts with SIMR
(N=251). Multivariable regression was used to identify baseline
characteristics associated with improved 1-year QOL. A favorable composite
outcome [survival with reasonable QOL (MLHF<40) and no substantial decline
from baseline (MLHF change >=10)] was assessed and predictors analyzed
using logistic regression. Results Impaired QOL was observed at baseline
(mean MLHF 48 +/-27; n=217/251). One-year mortality was 16%. In patients
with assessments (n=158) at baseline and 1 yr, QOL improved substantially
(mean MLHF change of -24.5 +/-25.9). QOL improvement was associated with
lower BMI, no prior ICD, and better baseline QOL, but not with MV repair.
At 1 year, 60% (123/204) of pts had a favorable composite outcome, which
was associated with better baseline QOL and non-smoking history.
Conclusion A majority of pts who underwent MV surgery for SIMR were alive
and had favorable outcome at 1 year. Impaired baseline QOL portends worse
outcomes; identifying a vulnerable group in need of targeted
interventions. [Figure presented]<br/>Copyright &#xa9; 2020 American
College of Cardiology Foundation

<117>
Accession Number
2005039010
Title
CAROTID ARTERY AS AN ALTERNATE ACCESS SITE FOR TRANSCATHETER AORTIC VALVE
REPLACEMENT.
Source
Journal of the American College of Cardiology. Conference: ACC.20 - World
Congress of Cardiology. United States. 75 (11) (pp 1475), 2020. Date of
Publication: 24 Mar 2020.
Author
Sharma S.; Raval A.; Ghuneim A.; Patel K.; Harder W.; Marsh C.; Frank K.;
Rudraraju P.; Kassab E.; Kondur A.
Institution
(Sharma, Raval, Ghuneim, Patel, Harder, Marsh, Frank, Rudraraju, Kassab,
Kondur) Garden City Hospital, Garden City, MI, United States
Publisher
Elsevier USA
Abstract
Background Carotid artery has been used as a novel access site for
transcatheter aortic valve replacement (TAVR) in patients who are not
suitable for traditional access routes such as transfemoral, transapical
or transaortic approach. We aim to assess the feasibility and safety of
transcarotid artery approach for TAVR by metanalytic technique. Methods We
searched PubMed, EMBASE, CINAHL and Cochrane CENTRAL for any study on TAVR
via carotid artery that enrolled at least 5 patients and reported on any
clinical outcome. The main outcomes analyzed were procedural success,
access site complications, all-cause mortality, TIA/Stroke and length of
hospital stay. Results Our study included a total of 553 patients from 11
studies. Average age of the patient was 80+/-7. Peripheral artery disease
was the most common cause for alternate access. Left common carotid was
used in 80%. Corevalve was the commonly used valve type (58%). Procedural
success rate was 100%. Included patients were high risk with average STS
score of 14+/-6 %. Average follow up period was 5+/-6.5 months. The pooled
rate of all-cause mortality at the end of follow up was 11% (range 8% to
14%, P<0.001, I ² = 3%). Access-site complication was seen in
2.6% (range 1.3% to 5.2%, P<0.001, I ² = 0%). Pooled TIA/Stroke
rate in our study cohort was 4.7% (range 3.2% to 6.8%, P<0.001, I
² = 0%). The rate of heart block requiring permanent pacemaker
implantation was 15.1% (range 10.9 to 20.5, P<0.001, I ² =
38%). Pericardial tamponade occurred in 1.8% (10/553). Mean length of
hospital stay was 7.6+/-1.6 days (95% CI, 4.3-10.9; p<0.001, I
² = 99%). Conclusion Our analysis showed that carotid TAVR is
safe and feasible in high risk patients who are not candidates for
traditional access routes.<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<118>
Accession Number
631305310
Title
Preoperative urinary dickkopf-3 (DKK3) predicts postoperative acute kidney
injury and transition into CKD in patients undergoing cardiac surgery.
Source
Nephrology Dialysis Transplantation. Conference: 56th Annual Congress of
the European Renal Association-European Dialysis and Transplant
Association, ERA-EDTA 2019. Hungary. 34 (Supplement 1) (pp a351), 2019.
Date of Publication: June 2019.
Author
Schunk S.; Zarbock A.; Meersch M.; Kullmar M.; Kellum J.A.; Schmit D.;
Wagner M.; Sarah T.; Wagenpfeil S.; Grone H.-J.; Schafers H.-J.; Fliser
D.; Zewinger S.; Speer T.
Institution
(Schunk, Schmit, Wagner, Sarah, Wagenpfeil, Schafers, Zewinger, Speer)
Saarland University Hospital, Homburg/Saar, Germany
(Zarbock, Meersch, Kullmar) University Hospital Munster, Munster, Germany
(Kellum) University of Pittsburgh, Pittsburgh, United States
(Grone) German Cancer Research Center, Heidelberg, Germany
(Fliser) Saarland University Medical Centre, Homburg/Saar, Germany
Publisher
Oxford University Press
Abstract
INTRODUCTION: Cardiac surgery is associated with high risk for
postoperative acute kidney injury (AKI) and subsequent loss of kidney
function. Preoperative identification of patients who will develop AKI is
challenging, but necessary in order to deploy preventive strategies. We
explored the clinical utility of urinary Dickkopf-3 (DKK3), a tubular
stress marker, for preoperative identification of patients at risk for AKI
and subsequent kidney function loss. <br/>METHOD(S): The study comprises
733 patients undergoing elective cardiac surgery, and 216 patients with
pre-defined high risk for postoperative AKI enrolled in the prospective
RenalRIP trial, randomized to remote ischemic preconditioning (RIPC) or
sham procedure. The association between preoperative urinary
DKK3/creatinine concentrations and postoperative AKI and subsequent kidney
function loss was assessed. <br/>RESULT(S): Urinary DKK3/creatinine levels
>500 pg/mg were associated with significantly increased risk for AKI (OR
2.61; 95% CI 1.86-3.67, P<0.001). Compared to clinical/laboratory
parameters or EuroScore-II, urinary DKK3/creatinine significantly improved
AKI prediction. High urinary DKK3/creatinine levels were independently
associated with significantly lower kidney function at discharge and after
follow-up (median 820 days). In the RenalRIP trial, preoperative urinary
DKK3/ creatinine >500 pg/mg was associated with a significantly higher
risk for AKI (OR 1.90, 95% CI 1.09-3.30, P=0.023), persistent kidney
dysfunction, and persistent renal replacement therapy after 90 days as
compared to DKK3/creatinine>=500 pg/mg. RIPC was associated with
significantly lower risk for AKI and persistent renal dysfunction only in
subjects with urinary DKK3/creatinine >500 pg/mg. <br/>CONCLUSION(S):
Preoperative urinary DKK3 is a novel and independent predictor for
postoperative AKI and for subsequent loss of kidney function. Urinary DKK3
might aid in the identification of patients in whom preventive treatment
strategies are effective.

<119>
Accession Number
631324383
Title
Retained Temporary Epicardial Pacing Wires: A Systematic Review and
Treatment Algorithm.
Source
Annals of plastic surgery. (no pagination), 2020. Date of Publication: 19
Mar 2020.
Author
Wald G.; Van Y.-V.R.; Pain K.J.; Otterburn D.M.
Institution
(Wald) From the Weill Cornell Medicine
(Van) New York Presbyterian Hospital, Weill Cornell and Columbia Plastic
Surgery Residency Programr
(Pain) Weill Cornell Medicine, Samuel J. Wood Library & C.V. Starr
Biomedical Information Center
(Otterburn) Weill Cornell Medicine, Division of Plastic Surgery, NY, NY
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Temporary epicardial pacing wires (TEPW) are used in the
immediate postoperative cardiac surgery period for the identification,
diagnosis, and treatment of acute arrhythmias. They are usually removed
before discharge, but are sometimes clipped and left to retract into the
skin and are thus retained. Rare complications from these retained wires
have been documented in numerous case reports. We describe a case of a
57-year-old man with chronically draining wounds due to infected retained
pacing wires. This case prompted a systematic review of these patients to
delineate complications and to create a novel treatment algorithm.
<br/>METHOD(S): The authors conducted a systematic review of MEDLINE,
Embase, and the Cochrane Library databases and retrieved relevant,
English-language articles published between 1986 and 2018. Two reviewers
critically appraised the studies that met inclusion and exclusion
criteria. <br/>RESULT(S): Thirty-one articles met inclusion criteria with
a total of 35 patients included. The existing articles represent either
level IV or level V evidence. Mean +/- SD time of presentation from
initial TEPW placement was 4.9 +/- 5.9 years, with a range of 1 month to
24 years and 77% of patients were symptomatic. The TEPW wire migration
occurred in 74% of patients, with invasion into vasculature, visceral
organs, and subcutaneous tissue. Most of the patients who underwent wire
removal had complete recovery. The relevant literature suggests that there
is a wide range of complications, and migration is more often associated
with need for surgical intervention. <br/>CONCLUSION(S): In patients with
severe symptoms or evidence of migration, surgical intervention and
removal should be strongly considered to prevent potentially deadly
complications. We propose an algorithm to minimize these complications
based on a literature analysis in accordance with PRISMA guidelines.

<120>
Accession Number
631324170
Title
Acute pain after serratus anterior plane or thoracic paravertebral blocks
for video-assisted thoracoscopic surgery: A randomised trial.
Source
European journal of anaesthesiology. (no pagination), 2020. Date of
Publication: 19 Mar 2020.
Author
Qiu Y.; Wu J.; Huang Q.; Lu Y.; Xu M.; Yang D.; Ince I.; Sessler D.I.
Institution
(Qiu) From the Department of Anesthesiology, Shanghai Chest Hospital,
Shanghai Jiao Tong University, Shanghai, China (YQ, JW, QH, YL, MX);
Department of Outcomes Research, Anesthesiology Institute (YQ, DY, II,
DIS); Outcomes Research Consortium (JW); Department of Quantitative Health
Sciences, Cleveland Clinic, Cleveland, Ohio, USA (DY); Department of
Anesthesiology and Reanimation, Ataturk University School of Medicine,
Erzurum, Turkey (II)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Serratus anterior and paravertebral blocks can both be used
for video-assisted thoracic surgery. However, serratus anterior blocks are
easier to perform, and possibly safer. We therefore tested the primary
hypothesis that serratus anterior plane blocks and thoracic paravertebral
blocks provide comparable analgesia for video-assisted thoracic surgery.
Secondarily, we tested the hypothesis that both blocks lengthen the time
to onset of surgical pain and reduce the need for rescue tramadol.
<br/>METHOD(S): Patients having video-assisted thoracic lobectomy or
segmentectomy were randomly allocated to ultrasound-guided thoracic
paravertebral blocks, n = 30; ultrasound-guided serratus anterior plane
blocks, n = 30; or, general anaesthesia alone, n = 30. Visual analogue
visual analogue pain scores at rest, during coughing and Prince-Henry pain
scores were used to assess postoperative analgesia. Our primary analysis
was noninferiority of serratus anterior blocks compared with paravertebral
blocks. <br/>RESULT(S): Baseline characteristics were comparable among the
three groups. Two hours after surgery, the mean difference in visual
analogue pain scores between the serratus anterior and paravertebral
blocks was 0.0 (96.8% CI -0.4 to 0.3) cm at rest, -0.2 (-0.8 to 0.4) cm
during coughing and -0.1(-0.5 to 0.3) for Prince-Henry pain scores. After
24 h, the mean difference was 0.0 (-0.7 to 0.8) cm at rest, 0.1 (-0.8 to
0.9) cm during coughing and 0.1(-0.4 to 0.6) for Prince-Henry pain scores.
All differences were significantly noninferior. Time to onset of pain
after surgery was 19 +/- 5 (SD) hours with serratus anterior blocks, 16
+/- 5 h with paravertebral blocks and 12 +/- 5 h with general anaesthesia.
Anaesthesia with either block was associated with significantly less
intra-operative propofol and sufentanil, reduced postoperative rescue
analgesia (tramadol) and less postoperative nausea and vomiting compared
with general anaesthesia alone. Patients with serratus anterior block had
a significantly lower incidence of intra-operative hypotension and
requirement for intra-operative vasopressor (3.4%), compared with general
anaesthesia alone. Serratus anterior block took less time to perform than
paravertebral block (5.1 +/- 1.1 min versus 10.1 +/- 2.9 min).
<br/>CONCLUSION(S): Serratus anterior plane blocks, which are easier and
quicker than paravertebral blocks, provide comparable analgesia in
patients having video-assisted thoracic surgery. CLINICAL TRIAL NUMBER AND
REGISTRY URL: ChiCTR1800017671;
http://www.chictr.org.cn/hvshowproject.aspx?id=13510.

<121>
Accession Number
631326433
Title
Comparison of inhaled nitric oxide with aerosolized prostacyclin or
analogues for the postoperative management of pulmonary hypertension: a
systematic review and meta-analysis.
Source
Annals of medicine. (pp 1-25), 2020. Date of Publication: 24 Mar 2020.
Author
Chen S.-H.; Chen L.-K.; Teng T.-H.; Chou W.-H.
Institution
(Chen, Chou) Department of Anesthesiology, National Taiwan University
Hospital, Taipei City, Taipei, Taiwan (Republic of China)
(Chen) Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu
Chi Medical Foundation, New Taipei City, Taiwan (Republic of China)
(Chen) Institute of Molecular Medicine, National Tsing Hua University,
Hsinchu, Taiwan (Republic of China)
(Chen) Department of Anesthesiology, Chung Shan Medical University,
Taichung City, Taiwan (Republic of China)
(Chen) Department of Anesthesiology, Chung Shan Medical University
Hospital, Taichung City, Taiwan (Republic of China)
(Teng) Department of Pathology, St. Martin De Porres Hospital, Taiwan
(Republic of China)
Publisher
NLM (Medline)
Abstract
Background: This study aims to compare the effectiveness of inhaled
prostacyclin or its analoguesversus nitric oxide (NO) in treating
pulmonary hypertension (PH) after cardiac or pulmonary surgery remains
unclear. <br/>Method(s): PubMed, Cochrane, and Embase databaseswere
searched for literature publishedprior toDecember 2019using the following
keywords: inhaled, nitric oxide, prostacyclin, iloprost, treprostinil,
epoprostenol, Tyvaso, flolan, and pulmonary hypertension. Randomized
controlled trials and multiple-armed prospective studies that evaluated
inhaled NO versus prostacyclin (or analogues) in patients for
perioperative and/or postoperativePH after either cardiac or pulmonary
surgery were included. Retrospective studies, reviews, letters, comments,
editorials, and case reportswere excluded. <br/>Result(s): Seven studies
with a total of 195 patients were included. No difference in the
improvement of mean pulmonary arterial pressure (pooled difference in
meanchange= -0.10, 95% CI: -3.98 to 3.78, P=0.959) or pulmonary vascular
resistance (pooled standardized difference in mean change= -0.27, 95% CI:
-0.60 to 0.05, P=0.099) were foundbetween the two treatments. Similarly,
no difference was found in other outcomes between the two treatments or
subgroup analysis. <br/>Conclusion(s): Inhaled prostacyclin (or
analogues)was comparable to inhaled NO in treating PH after cardiac or
pulmonary surgery. Key Messages:This study compared the efficacy of
inhaled prostacyclin or its analogues versus inhaledNO to treat PH after
surgery.The two types of agent exhibited similar efficacy in managingMPAP,
PVR, heart rate, and cardiac output was observed.Inhaled prostacyclin may
serve as an alternative treatment option for PH after cardiac or pulmonary
surgery.

<122>
Accession Number
2004479112
Title
Melatonin and its analogues for the prevention of postoperative delirium:
A systematic review and meta-analysis.
Source
Journal of Pineal Research. (no pagination), 2020. Date of Publication:
2020.
Author
Han Y.; Wu J.; Qin Z.; Fu W.; Zhao B.; Li X.; Wang W.; Sha T.; Sun M.; Li
J.; Zeng Z.; Chen Z.
Institution
(Han, Qin, Zhao) Department of Anaesthesiology, Nanfang Hospital, Southern
Medical University, Guangzhou, China
(Wu, Fu, Wang, Sha, Sun, Li, Zeng, Chen) Department of Critical Care
Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
(Li) Department of Anaesthesiology, People's Hospital of Ningxia Hui
Autonomous Region, Northwest University for Nationalities, Yinchuan, China
Publisher
Blackwell Publishing Ltd
Abstract
It remains unclear whether melatonin and its analogues prevent
postoperative delirium (POD). Therefore, we conducted a systematic review
and meta-analysis to evaluate the effect of melatonin and its analogues on
POD prevention. PubMed, Cochrane Library, Web of Science, Embase and
CINAHL databases were searched. Primary outcome was the incidence of POD.
Six randomized controlled trials, 2 cohort studies and 1 case-control
study were included in this meta-analysis. Results showed that melatonin
and its analogue ramelteon decreased the incidence of POD in the entire
adult surgical population (odds ratio [OR] = 0.45, 95% confidence interval
[CI] 0.24-0.84, P =.01). When administered at a higher dose (5 mg),
melatonin was effective in reducing the POD incidence (OR = 0.32, 95% CI
0.20-0.52, P <.00001). Melatonin administered less than 5 elimination
half-lives before the surgery significantly reduced the POD incidence (OR
= 0.31, 95% CI 0.19-0.49, P <.00001). Current literature supports the
effectiveness of melatonin and its analogue ramelteon in POD prevention.
However, the present study was limited by the significant heterogeneity of
the included studies. More studies are needed to ascertain the preventive
effect of melatonin and its analogues on the incidence of delirium after
cardiac and noncardiac surgeries.<br/>Copyright &#xa9; 2020 John Wiley &
Sons A/S. Published by John Wiley & Sons Ltd

<123>
Accession Number
2004474916
Title
Percutaneous mitral valve repair: the necessity to redefine secondary
mitral regurgitation.
Source
Netherlands Heart Journal. (no pagination), 2020. Date of Publication:
2020.
Author
Halim J.; Van den Branden B.; Coussement P.; Kedhi E.; Van der Heyden J.
Institution
(Halim, Coussement, Kedhi, Van der Heyden) Department of Cardiology,
Sint-Jan Hospital, Bruges, Belgium
(Van den Branden) Department of Cardiology, Amphia Hospital, Breda,
Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Interest in percutaneous mitral valve repair has increased during recent
years. This is mainly driven by the significant number of patients being
declined for mitral valve surgery because of a high risk of
surgery-related complications or death. In this subset of patients,
percutaneous edge-to-edge repair using the MitraClip device (Abbott, Menlo
Park, CA, USA) has become an established treatment option, proven to be
safe, efficient and associated with improved functional status. In
contrast to primary mitral regurgitation (MR), clinical outcomes after
mitral valve surgery appear to be less favourable as regards secondary MR
due to heart failure. In the MITRA-FR and COAPT trials, patients with
moderate to severe and severe secondary MR with reduced left ventricular
function received either medical treatment (control group) or MitraClip
implantation plus medical treatment (device group). Results were
conflicting, with only the COAPT trial showing better clinical outcomes in
the device group. However, both trials are now seen as complementary and
provide useful information especially regarding patient selection for
MitraClip therapy. The goal of this review is to delineate which subset of
patients with secondary MR will potentially benefit from percutaneous
mitral valve repair.<br/>Copyright &#xa9; 2020, The Author(s).

<124>
Accession Number
368408847
Title
Comparison of Cardioprotective Effects of Volatile Anesthetics in Children
Undergoing Ventricular Septal Defect Closure.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 4 (1) (pp
24-29), 2013. Date of Publication: January 2013.
Author
Singh P.; Chauhan S.; Jain G.; Talwar S.; Makhija N.; Kiran U.
Institution
(Singh, Chauhan, Makhija, Kiran) Department of Cardiac Anaesthesia, All
India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
(Jain) Department of Cardiac Anaesthesia, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi, India
(Talwar) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Volatile anesthetic agents may precondition the myocardium and
protect against ischemia and infarction. Preconditioning by volatile
anesthetic agents is well documented in adults but is underinvestigated in
children. The present study compares the effect of preconditioning in
children by three volatile anesthetic agents alongwith several other
variables associated with cardioprotection. <br/>Method(s): Eighty
children scheduled for ventricular septal defect closure under
cardioplegic arrest were assigned to preconditioning for five minutes
after commencement of cardiopulmonary bypass (CPB) with one minimum
alveolar concentration (MAC)of oneof the following agents: isoflurane,
sevoflurane, desflurane, or placebo(oxygen-air mixture).The plasma
concentration of creatine kinaseMB(CK-MB) was determined after initiation
ofCPB, and again 6 and 24 hours after admission to the intensive care unit
(ICU) after surgery. Duration of inotropic support, mechanical
ventilation, and length of ICUstay in all the groups were also recorded.
<br/>Result(s): Preconditioning with isoflurane, sevoflurane, and
desflurane was associated with significantly decreased postoperative
release of CK-MB as compared to placebo group at 6 (group 1: 237.2+/-189,
group 2: 69.8+/-15.8, group 3: 64.7+/-37.8, and group 4: 70.4+/-26.7) and
24 hours (group 1: 192.4+/-158.2, group 2: 67.7+/-25.0, group 3:
85.7+/-66.8, and group 4: 50.4+/-31.6) after admission toICU. No
significant differenceswereobserved in theCK-MBlevels among the three
volatile anesthetic agents.Duration of inotropic support, mechanical
ventilation, and length of ICU stay were greater in placebo group as
compared to other groups without reaching statistical significance.
<br/>Conclusion(s): Volatile anesthetic appear to provide definite
cardioprotection to pediatricmyocardium. No conclusion can be drawn
regarding the best preconditioning agent among isoflurane, sevoflurane,
and desflurane. &#xa9; The Author(s) 2012.

<125>
Accession Number
368408895
Title
Controlling Oxygenation During Initiation of Cardiopulmonary Bypass: Can
It Improve Immediate Postoperative Outcomes in Cyanotic Children
Undergoing Cardiac Surgery? A Prospective Randomized Study.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 3 (3) (pp
310-316), 2012. Date of Publication: July 2012.
Author
Babu B.; Bhat S.; Prabuswamy H.P.; Kamalapurkar G.; Kumar H.V.J.; Libu
G.K.; Shilpa S.; Lokesh B.K.
Institution
(Babu) Department of Cardiothoracic Surgery, Apollo Hospitals, 154/11,
Bannerghatta Road, Bangalore 560076, India
(Babu, Bhat, Prabuswamy, Kamalapurkar, Kumar, Shilpa) Department of
Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences
and Research, Bangalore, India
(Libu) Department of Community Medicine and Statistics, Karakonam Medical
College, Trivandrum, India
(Lokesh) Department of Perfusion, Sri Jayadeva Institute of Cardiovascular
Sciences and Research, Bangalore, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: Cardiopulmonary bypass (CPB) initiated with high oxygen levels
may expose cyanotic children to reoxygenation injury. The ideal method of
initiation of bypass to prevent this phenomenon still remains largely
unproven. This study tested the hypothesis that controlling oxygenation
during initiation of CPB improves early postoperative outcomes.
<br/>Method(s): Thirty-one cyanotic children were randomized to two
treatment arms of the study. In group A (intervention), CPB was initiated
with fraction of inspired oxygen (Fio2) 0.21, and after one minute of full
bypass, Fio2 was increased at increments of 0.1 per minute to reach 0.6.
In group B (hyperoxemic), CPB was initiated using Fio2 > 0.6. Aortic cross
clamp time (minutes), CPB time (minutes), creatine phosphokinase-MB
(CPK-MB) levels (U/L), lactate levels (mmol/L), duration of ventilator
support (hours), inotropic support (hours), and intensive care unit (ICU)
stay (hours) as well as hospital mortality were measured. <br/>Result(s):
Levels of CPK-MB (group A mean = 59.6 U/L, 95% confidence interval [CI]:
45.9-73.3; group B mean = 82.6 U/L, 95% CI: 66.1-99.1, P = .016) and
ventilation time (group A median = 16.5 hours; interquartile range [IQR] =
11.25-23; group B median = 27.5 hours; IQR = 17-54, P = .045) were
significantly lower in the intervention group. Other parameters showed no
significant differences: CPB time (group A median = 71.5 minutes, IQR =
64-100; group B median = 95.5 minutes, IQR = 58-145, P = .71), cross clamp
time (group A mean = 59.2 minutes, 95% CI: 47.6-70.8; group B mean = 66.57
minutes, 95% CI: 47.6-88.5, P =.57), lactate levels (mmol/L; group A
median = 1.8, IQR = 1.48-2.59; group B median = 2.1, IQR = 1.29-2.62, P =
1), inotropic support (group A median = 47.5 hours, IQR = 36-73.75; group
B median = 59.5 hours, IQR = 41.75-92.5, P = .27), ICU stay (group A
median = 59.5 hours, IQR = 48.25-118.5; group B median = 85 hours, IQR =
47.75-137.50, P = .21), and mortality (group A n = 2, group B n = 2).
<br/>Conclusion(s): A controlled oxygenation protocol was associated with
significantly lower postoperative CPK-MB levels. Evaluation of other end
points including ventilation times requires a study with larger sample
size for validation. &#xa9; The Author(s) 2012.

<126>
Accession Number
368408871
Title
The Effects of Multiple Doses of Glucocorticoids on the Inflammatory
Response to Cardiopulmonary Bypass in Children.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 3 (4) (pp
439-445), 2012. Date of Publication: October 2012.
Author
Bronicki R.A.; Checchia P.A.; Stuart-Killion R.B.; Dixon D.J.; Backer C.L.
Institution
(Bronicki) Department of Pediatric Critical Care Medicine, Children's
Hospital of Orange County, Orange, CA, United States
(Checchia) Division of Critical Care Medicine, St Louis Children's
Hospital, Washington University, St Louis, MO, United States
(Stuart-Killion) Division of Pediatric Cardiology, Lucile Packard
Children's Hospital, Stanford University, Stanford, CA, United States
(Dixon) Division of Biostatistics, Washington University School of
Medicine, St Louis, MO, United States
(Backer) Division of Cardiovascular-Thoracic Surgery Ann and Robert H.
Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., mc 22, Chicago,
IL 60611-2605, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: We previously demonstrated that a dose of glucocorticoids
(GCs) administered prior to cardiopulmonary bypass (CPB) is effective at
suppressing the inflammatory response to CPB and leads to an improved
postoperative course. We evaluated whether an additional dose of GC
administered eight hours prior to CPB would lead to further clinical
benefit. <br/>Method(s): We conducted a prospective study in which
patients were randomized to receive placebo or GC eight hours prior to
CPB, in addition to a dose of GC administered following induction of
anesthesia. We measured serum inflammatory mediator levels and
postoperative clinical parameters. <br/>Result(s): Thirty-one patients
were included in the study. Eighteen patients received two doses of GC and
13 patients received a single does of GC. Complement C3a levels were
significantly lower at 24 hours following surgery in those patients who
received two doses of GC (3136 +/- 1650 vs 1779 +/- 1616 ng/mL, P = .04).
There was no significant difference in tumor necrosis factor (TNF)-alpha
or interleukin (IL)-6 levels at any time between groups. There was no
significant difference in core body temperature or renal function (based
on serum creatinine levels) between groups. There was no significant
difference between groups in duration of mechanical ventilation (2.4 +/-
1.5 vs 3.6 +/- 3.7 days, two vs one dose, respectively, P = .33) or length
of stay in the intensive care unit ([ICU]; 3.4 +/- 1.4 vs 4.9 +/- 3.6
days, 2 vs 1 dose, respectively, P = .15). <br/>Conclusion(s): While those
patients who received two doses of GC prior to surgery had significantly
less complement activation postoperatively, clinical outcomes did not
differ between groups. We conclude that the practice of administering an
additional dose of GC prior to CPB is not supported. However, a large
randomized study is needed to conclusively discount the potential benefit
of this strategy. &#xa9; The Author(s) 2012.

<127>
Accession Number
2004313047
Title
Distraction-based surgeries increase thoracic sagittal spine length after
ten lengthening surgeries for patients with idiopathic early-onset
scoliosis.
Source
Spine Deformity. 8 (2) (pp 303-309), 2020. Date of Publication: 01 Apr
2020.
Author
El-Hawary R.; Chukwunyerenwa C.K.; Gauthier L.E.; Spurway A.J.; Hilaire
T.S.; McClung A.M.; El-Bromboly Y.; Johnston C.E.
Institution
(El-Hawary, Chukwunyerenwa, Gauthier, Spurway) IWK Health Centre, Halifax,
NS B3K-6R8, Canada
(Hilaire, McClung) Pediatric Spine Study Group, P.O. Box 397, Valley
Forge, PA, United States
(El-Bromboly) Zagazig University, Zagazig, Egypt
(Johnston) Department of Orthopaedics, Texas Scottish Rite Hospital for
Children Growing Spine Study Group, Children' Spine Study Group, Dallas,
TX, United States
Publisher
Springer
Abstract
Study design: Retrospective, comparative, multicenter. <br/>Objective(s):
To determine if the choice of proximal anchor affects thoracic sagittal
spine length (SSL) for children with idiopathic early-onset scoliosis
(EOS). <br/>Summary: Debate exists as to whether spine growth is
maintained during treatment for EOS. As rib- (RB) and spine-based (SB)
distraction procedures may be kyphogenic, the traditional measurement of
spine growth on coronal radiographs may not identify out-of-plane increase
in spine length. A measure of SSL, along the spine's sagittal arc of
curvature, has been validated to reliably assess the length of the
thoracic spine. <br/>Method(s): Patients with idiopathic EOS treated with
distraction-based systems (minimum 5-year follow-up, five lengthening
surgeries) with radiographic analysis preoperatively, postimplant (L1),
and during lengthening periods (L2-L5, L6-L10) were evaluated with primary
outcome of T1-T12 SSL. <br/>Result(s): We identified 34 patients (14 RB,
20 SB) with preoperative age 4.9 years (4.2 RB vs. 5.4 SB), scoliosis
72degree (60degree RB vs. 77degree SB; p < 0.05), kyphosis 39degree
(50degree RB vs. 34degree SB; p < 0.05), and SSL 17.8 cm (15.5 RB vs. 18.5
SB; p < 0.05). After initial scoliosis correction from implantation,
scoliosis remained constant over time. RB patients had greater kyphosis
than SB patients: L1, 46degree RB vs. 19degree SB (p < 0.05); L2-L5,
50degree RB vs. 27degree SB (p < 0.05); L6-L10, 56degree RB vs. 26degree
SB (p < 0.05). SSL increased for both groups from preoperative to the
tenth lengthening (p < 0.05). As compared with RB patients, SB patients
had higher SSL preoperatively and maintained this difference to the tenth
lengthening (p < 0.05). After ten lengthening surgeries, when normalized
to preoperative SSL, relative thoracic growth was greater for RB (27%)
than for SB patients (19%) (p < 0.05). <br/>Conclusion(s): Regardless of
proximal anchor choice, thoracic length continued to increase during the
distraction phase of treatment for idiopathic EOS. <br/>Level of Evidence:
Level III.<br/>Copyright &#xa9; 2020, Scoliosis Research Society.

<128>
Accession Number
2004292316
Title
PCI in patients with cancer: What is the evidence?.
Source
International Journal of Cardiology. 304 (pp 150-151), 2020. Date of
Publication: 1 April 2020.
Author
Piroth Z.
Institution
(Piroth) Hungarian Institute of Cardiology, 29 Haller str., Budapest 1096,
Hungary
Publisher
Elsevier Ireland Ltd

<129>
Accession Number
2005260660
Title
Cardiac tumors prevalence and mortality: A systematic review and
meta-analysis.
Source
International Journal of Surgery. 76 (pp 178-189), 2020. Date of
Publication: April 2020.
Author
Arisha M.J.; Elmously A.; El-Sayed Ahmed M.M.; Spadaccio C.; Mehta K.;
Baudo M.; Kamel M.; Mansor E.; Ruan Y.; Morsi M.; Shmushkevich S.;
Eldessouki I.; Rahouma M.; Mohamed A.; Gambardella I.; Girardi L.; Gaudino
M.
Institution
(Rahouma, Elmously, Mehta, Baudo, Kamel, Ruan, Morsi, Shmushkevich,
Gambardella, Girardi, Gaudino) Cardiothoracic Surgery Department, Weill
Cornell Medicine/New York Presbyterian Hospital, New York, United States
(Rahouma, Kamel, Mohamed) Surgical Oncology Department, National Cancer
Institute, Cairo University, Egypt
(Arisha, Mansor) Internal Medicine Department, West Virginia University
Charleston Division, Charleston Area Medical Center, Charleston, WV,
United States
(El-Sayed Ahmed) Cardiovascular Surgery, Mayo Clinic College of Medicine,
Jacksonville, FL, United States
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Clydebank, Glasgow G814DY, United Kingdom
(Spadaccio) Institute of Cardiovascular and Medical Sciences, Veterinary
and Life Sciences, College of Medical, University of Glasgow, Glasgow
G128QQ, United Kingdom
(Eldessouki) Medical Oncology Department, University of Cincinnati Cancer
Institute, Cincinnati, OH, United States
(Rahouma) Information Technology Department, National Cancer Institute,
Cairo University, Egypt
Publisher
Elsevier Ltd
Abstract
Objectives: Cardiac tumors and their associated outcomes are poorly
characterized. This study sought to comprehensively assess the
epidemiology and natural history of primary and secondary malignant
cardiac tumors (PMCT and SMCT), a well as establish predictors of
mortality. <br/>Method(s): A comprehensive literature review was performed
to identify articles reporting on PMCTs and SMCTs. The prevalence of
important cardiac tumor (CT) subtypes was evaluated and further stratified
based on the continental region. Outcomes of interest included short- and
long-term mortality and utilization of heart transplantation (HTX). A
random effect model was adopted, and a meta-regression was performed to
determine predictors of the prevalence of CTs as well as predictors of
operative mortality. <br/>Result(s): Of the 1,226 retrieved articles, 74
were included in our study (n = 8,849 patients). The mean follow-up was
2.27 years, mean age was 42.9 years, and 55% of the patients were females.
There was a total number of 7,484 benign primary cardiac tumors (PCTs)
(5,140 were myxoma), 862 (9.7%) malignant PCTs, and 355 secondary cardiac
tumors. The prevalence of PMCTs among PCTs was 10.83% [95%CI = 09.11;
12.83%] with a trend towards being lower in South America compared to
other continents (Prevalence = 5.80%). The prevalence of HTX among all
patients was 2.45% [1.36; 4.38%]. The pooled short-term mortality was
5.90% [4.70; 7.39%] and the incidence of late mortality in all CTs, benign
CT and PMCTs was 2.55% [1.76; 3.72%], 0.79% [0.46; 1.37%] and 14.77%
[9.32; 23.40%], respectively. On meta-regression, the annual volume of
cardiac tumor cases per center was the only predictor of lower early
mortality (Beta = -0.14 +/- 0.03, P < 0.0001). <br/>Conclusion(s): PMCTs
represent the minority of PCT (~10%) and have a higher prevalence in
Europe and North America. Survival is higher in benign pathology and is
significantly improved by treatment in specialized high-volume centers.
Approximately 2% of patients with CTs undergo heart
transplantation.<br/>Copyright &#xa9; 2020

<130>
Accession Number
2005246215
Title
Beta-blocker exposure for short-term outcomes following non-cardiac
surgery: A meta-analysis of observational studies.
Source
International Journal of Surgery. 76 (pp 153-162), 2020. Date of
Publication: April 2020.
Author
Nan Y.; Jia F.; Du X.; Mei Z.
Institution
(Nan, Du) Department of Cardiology, The Fifth Central Hospital of Tianjin,
Tianjin, China
(Jia) Department of General Surgery, The Fifth Central Hospital of
Tianjin, Tianjin, China
(Mei) Department of Anorectal Surgery, Shuguang Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
(Mei) Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
Publisher
Elsevier Ltd
Abstract
Background: It remains uncertain whether there is a benefit to
perioperative beta-blocker use on outcomes after non-cardiac surgery. This
meta-analysis aims to update the evidence regarding the associations
between beta-blocker exposure and patient major short-term outcomes
following non-cardiac surgery. <br/>Method(s): Pubmed, Embase, and the
Cochrane Central Register from their inception to May 2019 were searched
by two independent authors. Observational studies reporting associations
between perioperative beta-blocker treatment and short-term outcomes
including 30-day all-cause mortality (ACM), 30-day major adverse
cardiovascular events (MACE) and 30-day stroke risk were selected for
inclusion. Meta-analyses were carried out by using random effects models.
<br/>Result(s): Nineteen studies with a total of 1,711,766 participants
were identified. Beta-blocker exposure was associated with reduced 30-day
all-cause mortality (ACM) (RR 0.83, 95% CI 0.72 to 0.96). No evidence of
publication bias was observed. Subgroup analyses revealed that significant
30-day survival benefits were observed in prospective, population-based
studies, drug exposure period last till 1-2 months after surgery, patients
having abdominal gastrointestinal surgery or having 3-4 cardiac risk
factors. Beta-blocker exposure was associated with increased 30-day ACM
among patients with no cardiac risk factors (RR 1.30, 95% CI 1.19 to
1.43). However, meta-analysis demonstrated a non-significant risk
reduction in 30-day MACE (RR 1.03; 95% CI 0.85 to 1.25) or 30-day stroke
risk (RR 0.86; 95% CI 0.44 to 1.68) with beta-blocker exposure.
<br/>Conclusion(s): The results of the current meta-analysis indicate
beta-blocker exposure may be a significant indicator for 30-day ACM, but
not for 30-day MACE or 30-day stroke risk. The association between
beta-blocker exposure and long-term outcomes deserves further
investigation.<br/>Copyright &#xa9; 2020 IJS Publishing Group Ltd

<131>
Accession Number
2005245269
Title
Preoperative beta-Blockers as a Coronary Surgery Quality Metric: The Lack
of Evidence of Efficacy.
Source
Annals of Thoracic Surgery. 109 (4) (pp 1150-1158), 2020. Date of
Publication: April 2020.
Author
Filardo G.; da Graca B.; Sass D.M.; Hamilton J.; Pollock B.D.; Edgerton
J.R.
Institution
(Filardo, Sass, Pollock, Edgerton) Epidemiology Department, Baylor Scott &
White Health, Dallas, TX, United States
(Filardo, da Graca, Pollock) Robbins Institute for Health Policy and
Leadership, Baylor University, Waco, TX, United States
(Filardo) Department of Cardiothoracic Surgery, Baylor Scott & White The
Heart Hospital-Plano, Plano, TX, United States
(da Graca) Center for Clinical Effectiveness, Baylor Scott & White Health,
Dallas, United States
(Hamilton) University of North Carolina, Chapel Hill, NC, United States
Publisher
Elsevier USA
Abstract
Background: Two quality measures used in public reporting and value-based
payment programs require beta-blockers be administered less than 24 hours
before isolated coronary artery bypass graft surgery to prevent atrial
fibrillation and mortality. Questions have arisen about continued use of
these measures. <br/>Method(s): We conducted a systematic search for
randomized controlled trials (RCTs) examining the impact of preoperative
beta-blockers on atrial fibrillation or mortality after isolated coronary
artery bypass graft surgery to determine what evidence of efficacy
supports the measures. <br/>Result(s): We identified 11 RCTs. All
continued beta-blockers postoperatively, making it unfeasible to separate
the benefits of preoperative vs postoperative administration.
Meta-analysis was precluded by methodologic variation in beta-blocker
utilized, timing and dosage, and supplemental and comparison treatments.
Of the eight comparisons of beta-blockers/beta-blocker plus digoxin versus
placebo (n = 826 patients), six showed significant reductions in atrial
fibrillation/supraventricular arrhythmias. Of the three comparisons (n =
444) of beta-blockers versus amiodarone, two found no significant
difference in atrial fibrillation; the third showed significantly lower
incidence with amiodarone. One RCT compared beta-blocker plus amiodarone
versus each of those drugs separately; the combination reduced atrial
fibrillation significantly better than the beta-blocker alone, but not
amiodarone alone. Seven RCTs reported short-term mortality, but this
outcome was too rare and the sample sizes too small to provide any
meaningful comparisons. <br/>Conclusion(s): Existing RCT evidence does not
support the structure of quality measures that require beta-blocker
administration specifically within 24 hours before coronary artery bypass
graft surgery to prevent postoperative atrial fibrillation or short-term
mortality. Quality measures should be revised to align with the evidence,
and further studies conducted to determine optimal timing and method of
prophylaxis.<br/>Copyright &#xa9; 2020 The Society of Thoracic Surgeons

<132>
Accession Number
2003969691
Title
CHA<inf>2</inf>DS<inf>2</inf>-VASc Score for Identifying Patients at High
Risk of Postoperative Atrial Fibrillation After Cardiac Surgery: A
Meta-analysis.
Source
Annals of Thoracic Surgery. 109 (4) (pp 1210-1216), 2020. Date of
Publication: April 2020.
Author
Chen Y.-L.; Zeng M.; Liu Y.; Xu Y.; Bai Y.; Cao L.; Ling Z.; Fan J.; Yin
Y.
Institution
(Chen, Zeng, Xu, Cao, Ling, Fan, Yin) Department of Cardiology, the 2nd
Affiliated Hospital of Chongqing Medical University, Chongqing, China
(Liu) Biostatistics & Bioinformatics Shared Resource at Winship Cancer
Institute, Emory University, Atlanta, Georgia
(Liu) Department of Biostatistics & Bioinformatics, Rollins School of
Public Health, Emory University, Atlanta, Georgia
(Bai) Department of Respiratory and Critical Care Medicine, the 1st
Affiliated Hospital of Chongqing Medical University, Chongqing, China
(Fan) Department of Biomedical Engineering and Pediatrics, Emory
University, Atlanta, Georgia
Publisher
Elsevier USA
Abstract
Background: Postoperative atrial fibrillation (POAF) is a common
complication after cardiac surgery, resulting in an increased risk of
morbidity and longer hospital stay. Pharmacologic prophylaxis has been
recommended to improve the outcome in patients at high risk of developing
POAF after cardiac surgery. Several studies have applied the
CHA<inf>2</inf>DS<inf>2</inf>-VASc (Congestive heart failure, Hypertension
Age [>=65 = 1 point, >=75 = 2 points], Diabetes, and Stroke/transient
ischemic attack (2 points)-vascular disease [peripheral arterial disease,
previous myocardial infarction, aortic atheroma]) score in the risk
stratification of POAF but yielded contradicting results. This study aims
to determine the association between CHA<inf>2</inf>DS<inf>2</inf>-VASc
score and POAF and further to explore its discriminative ability for the
prediction of POAF. <br/>Method(s): We systematically searched the
Medline, Embase, Cochrane library, and other data sources with key terms
"CHA<inf>2</inf>DS<inf>2</inf>-VASc," "atrial fibrillation," and "cardiac
surgery." Studies designed for CHA<inf>2</inf>DS<inf>2</inf>-VASc score in
stratifying the risks of POAF in patients undergoing cardiac surgery were
included. Statistical analyses were performed with R 3.5.1 and STATA 13.0.
<br/>Result(s): Seven hundred twenty-one studies were identified, of which
12 studies with 18,086 patients were finally included in our analysis. The
CHA<inf>2</inf>DS<inf>2</inf>-VASc score was found to be an independent
predictor of POAF after cardiac surgery (odds ratio, 1.46; 95% confidence
interval [CI], 1.25-1.72) and exhibited a relatively strong specificity
(0.70; 95% CI, 0.61-0.78) and sensitivity (0.72; 95% CI, 0.54-0.85) for
predicting POAF. The bivariate model-based pooled area under the receiver
operating curve was estimated to be 0.76 (95% CI, 0.72-0.79).
<br/>Conclusion(s): The CHA<inf>2</inf>DS<inf>2</inf>-VASc score has
relatively good performance in predicting POAF after cardiac surgery and
may help identify the patients at high risk of POAF.<br/>Copyright &#xa9;
2020 The Society of Thoracic Surgeons

<133>
Accession Number
631245183
Title
Efficacy of erector spinae plane block for postoperative analgesia in
total mastectomy and axillary clearance: A randomized controlled trial.
Source
Saudi Journal of Anaesthesia. 14 (2) (pp 186-191), 2020. Date of
Publication: April-June 2020.
Author
Sharma S.; Arora S.; Jafra A.; Singh G.
Institution
(Sharma, Arora, Jafra) Department of Anaesthesia and Intensive Care, Post
Graduate Institute of Medical Education and Research, Chandigarh 160012,
India
(Singh) Department of Surgery, Post Graduate Institute of Medical
Education and Research, Chandigarh, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: The erector spinae plane block is a newer technique of
analgesia to the chest wall. <br/>Objective(s): The study was carried out
to establish the efficacy and safety of this block in patients undergoing
total mastectomy and axillary clearance. <br/>Design(s): Prospective
randomized controlled study. <br/>Setting(s): Single tertiary care center,
the study was conducted over a period of 1 year. <br/>Patient(s): 65
patients were included; final analysis was done for 60 female patients
undergoing total mastectomy and axillary clearance under general
anesthesia were randomly allocated to two groups. <br/>Intervention(s):
Group B (block group) received ultrasound-guided erector spinae plane
block at T5 level with ropivacaine (0.5%, 0.4 mL/kg) while the control
group did not receive any intervention. Postoperatively, patients in both
groups received morphine via intravenous patient-controlled analgesia
device. Patients were followed up for 24 h postoperatively. <br/>Main
Outcome Measure(s): The 24-hour morphine consumption was considered as the
primary outcome and secondary outcomes included time to first rescue
analgesia, pain scores at 0, 1/2, 1, 2, 4, 6, 8, 12, and 24 h and
characteristics and complications associated with block procedure.
<br/>Result(s): The 24-hour morphine consumption was 42% lower in block
group compared to control group [mean (SD), 2.9 (2.5) mg vs 5.0 (2.1) mg
in group B and group C, respectively, P = 0.01]. The postoperative pain
score was lower in group B vs group C at 0, 1/2, 1, 2, 4, 6, 12, and 24 h
(P < 0.05). 26 patients in group C against 14 in group B used rescue
analgesia within 1 h of surgery (P = 0.01). <br/>Conclusion(s): Erector
spinae block may prove to be a safe and reliable technique of analgesia
for breast surgery. Further studies comparing this technique with other
regional techniques are required to identify the most appropriate
technique.<br/>Copyright &#xa9; 2020 Saudi Journal of Anesthesia.

<134>
Accession Number
631300804
Title
Sex-Related Differences in Early- and Long-Term Mortality After
Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review
and Meta-Analysis.
Source
The Journal of invasive cardiology. (no pagination), 2020. Date of
Publication: 20 Mar 2020.
Author
Parikh P.B.; Wang T.-Y.; Sharma N.; Kort S.; Skopicki H.A.; Gruberg L.;
Jeremias A.; Pyo R.; Chikwe J.; Butler J.
Institution
(Parikh) Department of Medicine, Stony Brook University Medical Center,
Health Sciences Center T16-080, Stony Brook
Publisher
NLM (Medline)
Abstract
BACKGROUND: Observational data suggest that early- and long-term outcomes
of transcatheter aortic valve replacement (TAVR) and surgical aortic valve
replacement (SAVR) differ significantly between men and women, but have
demonstrated conflicting results. This study sought to examine early- and
long-term mortality with TAVR and SAVR in women versus men.
<br/>METHOD(S): Electronic search was performed until February 2018 for
studies reporting sex-specific mortality following TAVR or isolated SAVR.
Data were pooled using random-effects models. Outcomes included rates of
early mortality (in hospital or 30 days) and long term (1 year or longer).
<br/>RESULT(S): With 35 studies, a total of 80,928 patients were included
in our systematic review and meta-analysis, including 40,861 men and
40,067 women. Pooled analyses suggested considerable sex-related
differences in longterm mortality following TAVR and SAVR. Following SAVR,
women had higher long-term mortality (odds ratio [OR], 1.35; 95%
confidence interval [CI], 1.16-1.56; P<.001) and a trend toward higher
early mortality (OR, 1.69; 95% CI, 0.97-2.97; P=.07) compared to men.
Following TAVR, women had lower long-term mortality (OR, 0.78; 95% CI,
0.71-0.86; P<.001) and no difference in early mortality (OR, 1.09; 95% CI,
0.96-1.23; P=.17) compared to men. <br/>CONCLUSION(S): In this systematic
review and meta-analysis, women had higher long-term mortality and a trend
toward higher early mortality compared to men following SAVR. Following
TAVR, women had lower long-term mortality and no difference in early
mortality compared with men.