EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 86

Results Generated From:
Embase <1980 to 2020 Week 16>
Embase (updates since 2020-04-10)

<1>
Accession Number
2003718115
Title
Continuous wound infiltration of local anesthetics in postoperative pain
management: Safety, efficacy and current perspectives.
Source
Journal of Pain Research. 13 (pp 285-294), 2020. Date of Publication:
2020.
Author
Paladini G.; Carlo S.D.; Musella G.; Petrucci E.; Scimia P.; Ambrosoli A.;
Cofini V.; Fusco P.
Institution
(Paladini, Musella, Ambrosoli) Department of Anesthesia, Perioperative
Medicine and Intensive Care Therapy, Filippo Del Ponte Women and
Children's Hospital, ASST Sette Laghi, Varese, Italy
(Carlo) Department of Medical, Oral and Biotechnological Sciences,
University of Chieti, Chieti, Italy
(Petrucci, Fusco) Department of Anesthesia and Intensive Care, San
Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
(Scimia) Department of Anesthesia and Intensive Care, ASUR Marche AV5, San
Benedetto Del Tronto, Italy
(Cofini) Department of Life, Health and Environmental Sciences, University
of L'Aquila, L'Aquila, Italy
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Local infiltration and continuous infusion of surgical wound with
anesthetics are parts of multimodal analgesia for postoperative pain
control. The techniques, given the simplicity of execution that does not
increase the timing of the intervention and does not require additional
technical skills, are applied in several kinds of surgeries. The
continuous wound infiltration can be used for days and a variety of
continuous delivery methods can be chosen, including patient-controlled
analgesia, continuous infusion or intermittent bolus. The purpose of this
narrative review is to analyze the literature, in particular by
researching the safety, efficacy and current perspectives of continuous
wound infiltration for postoperative pain management in different surgical
settings. We have identified 203 articles and 95 of these have been taken
into consideration: 17 for the lower limb surgery; 7 for the upper limb
surgery, 51 for the laparotomy/ laparoscopic surgery of the abdominopelvic
area, 13 studies regarding breast surgery and 7 for cardiothoracic
surgery. The analysis of these studies reveals that the technique has a
variable effectiveness based on the type of structure involved: it is
better in structures rich in subcutaneous and connective tissue, while the
effectiveness is limited in anatomic districts with a greater variability
of innervation. However, regardless the heterogeneity of results, a
general reduction in pain intensity and in opioid consumption has been
observed with continuous wound infiltration: it is an excellent analgesic
technique that can be included in the multimodal treatment of
postoperative pain or represents a valid alternative when other options
are contraindicated.<br/>Copyright &#xa9; 2020 Paladini et al.

<2>
Accession Number
629147287
Title
Cardiopulmonary bypass and dual antiplatelet therapy: a strategy to
minimise transfusions and blood loss.
Source
Perfusion (United Kingdom). 35 (3) (pp 236-245), 2020. Date of
Publication: 01 Apr 2020.
Author
Karlsson M.; Hannuksela M.; Appelblad M.; Hallgren O.; Johagen D.; Wahba
A.; Svenmarker S.
Institution
(Karlsson, Appelblad, Hallgren, Johagen, Svenmarker) Department of Public
Health and Clinical Medicine, Heart Centre, Umea University, Umea, Sweden
(Hannuksela) Department of Surgical and Perioperative Sciences, Heart
Centre, Umea University, Umea, Sweden
(Wahba) Department of Circulation and Medical Imaging, Norwegian
University of Science and Technology, Trondheim, Norway
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Patients with preoperative dual antiplatelet therapy prior to
coronary artery bypass surgery are at risk of bleeding and blood component
transfusion. We hypothesise that an optimised cardiopulmonary bypass
strategy reduces postoperative blood loss and transfusions.
<br/>Method(s): In total, 60 patients admitted for coronary artery bypass
grafting with ticagrelor and aspirin medication withdrawn <96 hours before
surgery were prospectively randomised into two equal sized groups.
Cardiopulmonary bypass combined a closed Cortiva heparin-coated
circuit with low systemic heparinisation (activated clotting time < 250
seconds) and intraoperative cell salvage in the study group, whereas the
control group used a Balance coated open circuit, full systemic
heparinisation (activated clotting time > 480 seconds) and conventional
cardiotomy suction. This perfusion strategy was evaluated by the chest
drain volume after 24 hours, perioperative haemoglobin and platelet loss
accompanied by global coagulation assessments. <br/>Result(s): Patients in
the study group demonstrated significantly better outcomes signified by
lower blood loss 554 +/- 224 versus 1,100 +/- 989 mL (p < 0.001), reduced
packed red cell transfusion 7% versus 53% (p < 0.001), reduced haemoglobin
-28 +/- 15 versus -40 +/- 14 g/L (p = 0.004) and platelet loss -35 +/- 36
versus -82 +/- 67 x 10⁹/L (p = 0.001). Indices of rotational
thromboelastometry indicated shorter clotting times within the internal
and external pathways. Adenosine diphosphate activated platelet function
was within normal range based on Multiplate aggregometry, while
ROTEM platelet analyses indicated inhibited function both
preoperatively and post-bypass. Platelet inhibition by aspirin was
verified throughout the perioperative period. Platelet function showed no
intergroup differences. <br/>Conclusion(s): A stringent perfusion strategy
reduced blood loss and transfusions in dual antiplatelet therapy patients
requiring urgent surgery.<br/>Copyright &#xa9; The Author(s) 2019.

<3>
Accession Number
2005166502
Title
The role of Trimetazidine in prevention of contrast induced nephropathy in
diabetic patients with renal insufficiency undergoing cardiac
intervention.
Source
Systematic Reviews in Pharmacy. 11 (1) (pp 337-348), 2020. Date of
Publication: 2020.
Author
Rajeeb A.N.; Amber K.I.; Hadi N.R.; Alsalkhi H.A.; Muhammad-Baqir B.M.;
Ahmed M.H.
Institution
(Rajeeb) Kufa University Medical College, Consultant Cardiologist, Najaf
Cardiac Center
(Amber) Al Najaf Cardiac Center, Al-Najaf center for cardiac Surgery and,
Trans Catheter Therapy, Iraq
(Hadi) Department of Pharmacology and therapeutics, Faculty of Medicine,
University of Kufa, 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 / the specialist centre for Nephrology
and Kidney Transplantation, Iraq
Publisher
EManuscript Technologies (E-mail: journals@emanuscript.in)
Abstract
This study aims 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 l-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. Trimetazidine significantly reduce the elevation in serum level of
monocyte chemo tactic proteinl, expression of Toll-like receptor 2 and the
urine levels of kidney injury molecule-1,F2-isoprostanes (p<0.05) while
insignificantly reduce the elevation in serum level of creatinine . (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

<4>
Accession Number
2005124894
Title
The efficacy and adverse effects of the Uniblocker and left-side
double-lumen tube for one-lung ventilation under the guidance of chest CT.
Source
Experimental and Therapeutic Medicine. 19 (4) (pp 2751-2756), 2020. Date
of Publication: 2020.
Author
Liu Z.; Zhao L.; Zhu Y.; Bao L.; Jia Q.-Q.; Yang X.-C.; Liang S.-J.
Institution
(Liu, Zhu, Bao, Jia, Yang, Liang) Department of Anesthesiology, Hebei
066000, China
(Zhao) Department of Thoracic Surgery, First Hospital of Qinhuangdao,
Qinhuangdao, Hebei 066000, China
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
One-lung ventilation (OLV) is essential in numerous clinical procedures,
in which the left-sided double-lumen tube (LDLT) is the most commonly used
device. The application of bronchial blockers, including the Uniblocker or
Arndt blocker, has increased in OLV. The present study aimed to compare
the efficacy and adverse effects of the Uniblocker and LDLT for OLV under
the guidance of chest CT. A total of 60 adult patients undergoing elective
left-side thoracic surgery requiring OLV were included in the study. The
patients were randomly assigned to the Uniblocker group (U group, n=30) or
the LDLT group (D group, n=30). The time for initial tube placement, the
number of optimal positions of the tube upon blind insertion, the number
of attempts to adjust the tube to the optimal position, incidence of
airway device displacement, injury to the bronchi and carina, the duration
until lung collapse and the occurrence of sore throat and hoarseness over
24 h following surgery were recorded. The time for successful placement of
the LDLT was 83.9+/-19.4 sec and that for the Uniblocker was 84.3+/-17.1
sec (P>0.05). The degree of lung collapse 1 min following opening of the
pleura was greater in the D group than that in the U group (P<0.01) and
the time required for the lung to completely collapse was shorter in the D
group (3.3+/-0.5 min) than that in the U group (8.4+/-1.2 min; P<0.01). On
the contrary, the incidence of injury to the bronchi and carina was lower
in the U group (2/30 cases) than in the D group (10/30 cases; P=0.02); the
incidence of sore throat was also lower in the U group (2/30 cases)
compared with that in the D group (9/30 cases). The mean arterial pressure
of patients immediately following intubation was lower in the U group
(122.0+/-13.4 mmHg) than that in the D group (129.2+/-12.1 mmHg; P<0.05).
The results of the present study indicated that the extraluminal use of
the Uniblocker under guidance of chest CT is an efficient method with few
adverse effects in left-side thoracic surgery. The study was registered at
ClinicalTrials.gov on 16th December 2017 (no. NCT03392922).<br/>Copyright
&#xa9; 2020 Spandidos Publications. All rights reserved.

<5>
Accession Number
628168611
Title
Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis.
Source
The Thoracic and cardiovascular surgeon. 68 (3) (pp 212-218), 2020. Date
of Publication: 01 Apr 2020.
Author
Habbab L.M.; Semelhago L.; Lamy A.
Institution
(Habbab, Semelhago, Lamy) Division of Cardiac Surgery, Hamilton General
Hospital, McMaster University, Hamilton, Ontario, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: This meta-analysis was conducted to investigate the evidence
for the efficacy and safety of intrapericardial tranexamic acid (TXA) in
cardiac surgery. <br/>METHOD(S): We searched MEDLINE from 2000 to 2017
for randomized controlled trials that compared intrapericardial TXA to
placebo. We performed a meta-analysis for the eligible trials that focused
on chest tube drainage measured during the first 24 hours after surgery as
a primary outcome. We also examined the secondary outcome measures of
these trials such as the incidence of transfusion requirements following
surgery and the evidence for any increase in complication rates.
<br/>RESULT(S): A total of seven randomized controlled trials (six
on-pump and one off-pump) comparing topical application of TXA to placebo
in 692 patients were eligible for the blood loss outcome data. These
trials randomized 372 patients to receive TXA and 320 patients as
controls. The use of intrapericardial TXA was associated with a
considerable reduction in 24-hour blood loss in all seven studies and a
weighted mean difference of -343.56 mL (95% confidence interval: -316.41,
-370.72) significantly differed from zero (p=0.005) with a heterogeneity
of I2=0%. The incidence of packed RBC transfusion in TXA patients was
significantly lower in one study and was not significant but with trend in
favor of TXA in five out of the six studies in which it was reported. In
one trial, TXA was not detected in any patient and in another the studied
groups were similar in postoperative complications, such as graft patency,
myocardial infarction, cerebral infarction, atrial fibrillation, seizures,
and infections. <br/>CONCLUSION(S): Findings from this meta-analysis
suggest that intrapericardial use of TXA in patients undergoing cardiac
surgery can decrease postoperative bleeding without increasing the risk of
postoperative seizures. Future large randomized, double-blind, controlled
clinical trials are needed to confirm these promising
findings.<br/>Copyright Georg Thieme Verlag KG Stuttgart . New York.

<6>
Accession Number
2005485541
Title
Perioperative Dexmedetomidine Supplement Decreases Delirium Incidence
After Adult Cardiac Surgery: A Randomized, Double-Blind, Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Likhvantsev V.V.; Landoni G.; Grebenchikov O.A.; Ovezov A.M.; Skripkin
Y.V.; Lembo R.; Gaevskiy D.I.; Tereshina A.A.; Yavorovskiy A.G.
Institution
(Likhvantsev, Grebenchikov, Ovezov, Skripkin, Gaevskiy, Tereshina) Moscow
Regional Research and Clinical Institute, Moscow, Russian Federation
(Likhvantsev, Yavorovskiy) IM Sechenov First Moscow State Medical
University of the Ministry of Health of the Russian Federation (Sechenov
University), Moscow, Russian Federation
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Landoni, Lembo) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Grebenchikov) VA Negovsky Research Institute of General Reanimatology,
Federal Research and Clinical Center of Intensive Care Medicine and
Rehabilitology, Moscow, Russian Federation
Publisher
W.B. Saunders
Abstract
Objective: Conflicting data exist on the effect of dexmedetomidine on
delirium. For the present study, a randomized trial was performed to
investigate the effect of perioperative dexmedetomidine on the rate of
postoperative delirium after cardiac surgery. <br/>Design(s): A randomized
controlled trial. <br/>Setting(s): University hospital.
<br/>Participant(s): Patients (n = 169) undergoing elective cardiac
surgery (coronary artery bypass graft surgery, valve surgery, or combined
surgery) with cardiopulmonary bypass. <br/>Intervention(s): Patients
received a sevoflurane-based general anesthesia and were randomly assigned
1:1 to receive a dexmedetomidine infusion that started in the operating
room (0.7 mug/kg/h) and continued into the intensive care unit (0.4
mug/kg/h) or an equivolume infusion of placebo. <br/>Measurements and Main
Results: A decrease in the rate of delirium in the dexmedetomidine group
compared with the placebo group was demonstrated (6 of 84 [7.1%] v 16 of
85 [18.8%]; p = 0.02; odds ratio [OR] 0.33 [95% confidence interval {CI}
0.12-0.90]). Reduced intensive care unit and hospital lengths of stay also
were observed (18 [18-22] hours v 22 [18-39] hours; p = 0.002 and 17
[7-20] days v 19 [8-21] days; p = 0.04, respectively). Mortality at 30
days was 2 (2.4%) in both groups. On multivariate analysis, only
dexmedetomidine administration (OR 0.24 [95% CI 0.08-0.74]) and
cardiopulmonary bypass time (OR 1.02 [95% CI 1.01-1.03] for increases of 1
min) were independent predictors of delirium development.
<br/>Conclusion(s): Dexmedetomidine administered during and after general
anesthesia for cardiac surgery with cardiopulmonary bypass decreased the
rate of postoperative delirium and intensive care unit and hospital
lengths of stay.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<7>
Accession Number
2004594703
Title
The effect of aromatherapy with rose and lavender on anxiety, surgical
site pain, and extubation time after open-heart surgery: A double-center
randomized controlled trial.
Source
Phytotherapy Research. (no pagination), 2020. Date of Publication: 2020.
Author
Babatabar Darzi H.; Vahedian-Azimi A.; Ghasemi S.; Ebadi A.; Sathyapalan
T.; Sahebkar A.
Institution
(Babatabar Darzi, Vahedian-Azimi, Ghasemi) Trauma Research Center, Nursing
Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Ebadi) Behavioral Sciences Research Center, Life Style Institute, Nursing
Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Sathyapalan) Department of Academic Diabetes, Endocrinology and
Metabolism, Hull York Medical School, University of Hull, Hull, United
Kingdom
(Sahebkar) Halal Research Center of IRI, FDA, Tehran, Iran, Islamic
Republic of
(Sahebkar) Neurogenic Inflammation Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Sahebkar) Biotechnology Research Center, Pharmaceutical Technology
Institute, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
To determine the effect of aromatherapy with rose and lavender on the
patient outcomes after open-heart surgery (OHS). In the clinical trial,
patients were randomized to four groups. One group received routine care,
the placebo group received a cotton swab soaked in water and the other two
groups received either a cotton swab containing three drops of rose or
lavender essence (0.2 ml). A total of 160 patients were randomized into
four groups. Intergroup anxiety was not significantly different; however,
the reciprocal time-group effect was significant among the four groups.
The extubation time was significant among the four groups which related to
rose essence group compared with the control group (p <.001) and placebo
group (p =.029). The surgical site pain was significant in the rose
essence and lavender groups compared to the control group. Aromatherapy
can reduce extubation time, surgical site pain severity, and anxiety in
patients undergoing OHS.<br/>Copyright &#xa9; 2020 John Wiley & Sons, Ltd.

<8>
Accession Number
2004551269
Title
Three contemporary thin-strut drug-eluting stents implanted in severely
calcified coronary lesions of participants in a randomized all-comers
trial.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2020.
Date of Publication: 2020.
Author
Buiten R.A.; Ploumen E.H.; Zocca P.; Doggen C.J.M.; van Houwelingen K.G.;
Danse P.W.; Schotborgh C.E.; Stoel M.G.; Scholte M.; Linssen G.C.M.; de
Man F.H.A.F.; von Birgelen C.
Institution
(Buiten, Ploumen, Zocca, van Houwelingen, Stoel, de Man, von Birgelen)
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente,
Enschede, Netherlands
(Buiten, Ploumen, Zocca, Doggen, von Birgelen) Department of Health
Technology and Services Research, Faculty BMS, Technical Medical Centre,
University of Twente, Enschede, Netherlands
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Schotborgh) Department of Cardiology, Haga Hospital, The Hague,
Netherlands
(Scholte) Department of Cardiology, Albert Schweitzer Hospital, Dordrecht,
Netherlands
(Linssen) Department of Cardiology, Hospital Group Twente, Almelo and
Hengelo, Netherlands
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The objective was to assess the 2-year clinical performance of
three drug-eluting stents in all-comer patients with severely calcified
coronary lesions. <br/>Background(s): Severe lesion calcification
increases cardiovascular event risk after coronary stenting, but there is
a lack of data on the clinical outcome of all-comers with severely
calcified lesions who were treated with more recently introduced
drug-eluting stents. <br/>Method(s): The BIO-RESORT trial
(clinicaltrials.gov: NCT01674803) randomly assigned 3,514 all-comer
patients to biodegradable polymer Synergy everolimus-eluting stents (EES)
or Orsiro sirolimus-eluting stents (SES), versus durable polymer Resolute
Integrity zotarolimus-eluting stents (ZES). In a post hoc analysis, we
assessed 783 patients (22.3%) with at least one severely calcified target
lesion. <br/>Result(s): At 2-year follow-up (available in 99% of
patients), the main composite endpoint target vessel failure occurred in
19/252 (7.6%) of the EES and in 33/265 (12.6%) of the ZES-treated patients
(p =.07). Target vessel failure occurred in 24/266 (9.1%) of the
SES-treated patients (vs. ZES: p = 0.21). There was a difference in target
vessel revascularization, which was required in EES in 6/252 (2.4%)
patients and in ZES in 20/265 (7.7%) patients (p =.01); the target vessel
revascularization rate in SES was 9/266 (3.4%, vs. ZES: p =.04).
Multivariate analysis showed that implantation of EES, but not SES, was
independently associated with lower target vessel revascularization rates
than in ZES. <br/>Conclusion(s): In BIO-RESORT participants with severely
calcified target lesions, treatment with EES was associated with a lower
2-year target vessel revascularization rate than treatment with
ZES.<br/>Copyright &#xa9; 2020 The Authors. Catheterization and
Cardiovascular Interventions published by Wiley Periodicals, Inc.

<9>
Accession Number
2004547235
Title
Upper gastrointestinal mucosal injury associated with ticagrelor plus
aspirin, ticagrelor alone, or aspirin alone at 1-year after coronary
artery bypass grafting.
Source
Journal of Gastroenterology and Hepatology (Australia). (no pagination),
2020. Date of Publication: 2020.
Author
Tang C.; Zhu Y.; Yang X.; Xu B.; Ye C.; Yang Y.; Zhong J.; Zhao Q.; Yu L.
Institution
(Tang, Xu, Zhong, Yu) Department of Gastroenterology, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
(Zhu, Ye, Yang, Zhao) Department of Cardiovascular Surgery, Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Yang) Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
Publisher
Blackwell Publishing
Abstract
Background and Aim: The presence and severity of upper gastrointestinal
mucosal lesions have not been evaluated using esophagogastroduodenoscopy
(EGD) in patients receiving ticagrelor plus aspirin or alone after
myocardial revascularization. We assessed upper gastrointestinal mucosal
injury and the use of proton pump inhibitors (PPIs) in patients receiving
1 year of antiplatelet therapy after coronary artery bypass grafting
(CABG). <br/>Method(s): In this single-center prospective substudy of a
randomized trial, 231 patients completing 1-year antiplatelet therapy
(ticagrelor 90 mg twice daily plus aspirin 100 mg once daily, ticagrelor
90 mg twice daily, or aspirin 100 mg once daily, in 81, 80, and 70
patients, respectively) after CABG underwent ¹³C urea breath
testing and EGD. Gastroduodenal lesions were assessed by modified Lanza
score, and reflux esophagitis was evaluated according to Los Angeles
classification. Additionally, at least one ulcer >= 5 mm was separately
analyzed. <br/>Result(s): Among 231 patients, EGD showed 28 (12.1%) with
ulcers >= 5 mm, which were detected in 13.6% (11/81) of ticagrelor plus
aspirin recipients, 8.8% (7/80) of ticagrelor recipients, and 14.3%
(10/70) of aspirin recipients, and 24 (10.4%) had reflux esophagitis.
Eighty-eight (38.1%) patients had a positive ¹³C urea breath
testing after 1 year of treatment, and one patient received eradication
therapy during follow up. Nineteen (8.2%) patients received a PPI for >= 6
months. <br/>Conclusion(s): Severe upper gastrointestinal mucosal lesions
were more frequently observed in patients treated with ticagrelor plus
aspirin and aspirin monotherapy than in patients treated with ticagrelor
monotherapy for 1 year post-CABG. Prophylactic use of PPIs might be
inadequate.<br/>Copyright &#xa9; 2020 Journal of Gastroenterology and
Hepatology Foundation and John Wiley & Sons Australia, Ltd

<10>
Accession Number
2004545445
Title
Pivotal Clinical Study to Evaluate the Safety and Effectiveness of the
MANTA Vascular Closure Device During Percutaneous EVAR and TEVAR
Procedures.
Source
Journal of Endovascular Therapy. (no pagination), 2020. Date of
Publication: 2020.
Author
Krajcer Z.; Wood D.A.; Strickman N.; Bernardo N.; Metzger C.; Aziz M.;
Bacharach J.M.; Nanjundappa A.; Campbell J.; Lee J.T.; Dake M.D.; Lumsden
A.; Nardone S.
Institution
(Krajcer, Strickman) Texas Heart Institute and Baylor St Luke's Hospital,
Houston, TX, United States
(Wood) Center for Cardiovascular Innovation, University of British
Columbia, Vancouver, BC, Canada
(Bernardo) MedStar Health, Washington, DC, United States
(Metzger, Aziz) Ballad CVA Heart Institution, Kingsport, TN, United States
(Bacharach) Avera Heart Hospital, Sioux Falls, SD, United States
(Nanjundappa, Campbell) Charleston Area Medical Center, Charleston, WV,
United States
(Lee, Dake) Stanford University Medical Center, Palo Alto, CA, United
States
(Lumsden) The Houston Methodist Hospital, Houston, TX, United States
(Nardone) Teleflex Inc, Exton, PA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Purpose: To evaluate the safety and effectiveness of the MANTA
percutaneous vascular closure device in patients undergoing percutaneous
endovascular aneurysm repair (PEVAR) or thoracic endovascular aortic
repair (TEVAR). <br/>Material(s) and Method(s): The SAFE MANTA Study
(ClinicalTrials.gov identifier NCT02908880) was a prospective, single-arm,
multicenter trial in patients undergoing endovascular interventions using
large-bore sheaths (transcatheter aortic valve replacement, PEVAR, or
TEVAR) at 20 sites in North America. Patient selection intended to test
the MANTA device in populations without morbid obesity, severe
calcification, or a severely scarred femoral access area. Of the 263
patients enrolled in the primary analysis cohort, 53 (20.2%) patients
(mean age 74.9+/-8.9 years; 41 men) underwent PEVAR (n=51) or TEVAR (n=2)
procedures and form the cohort for this subgroup analysis. Per protocol a
single MANTA device was deployed in all PEVAR/TEVAR cases. <br/>Result(s):
The mean time to hemostasis in the PEVAR/TEVAR cohort was 35+/-91 seconds,
with a median time of 19 seconds vs 24 seconds in the overall SAFE MANTA
population. The MANTA device met the definition for technical success in
52 (98%) of 53 PEVAR/TEVAR cases compared with 97.7% in the overall SAFE
MANTA population. One (1.9%) major complication (access-site stenosis)
occurred in this subgroup compared to 14 (5.3%) events in the SAFE
population. In the PEVAR/TEVAR group, 1 pseudoaneurysm was noted prior to
discharge, another at 30-day follow-up, and one at 60 days. One (1.9%) of
the 3 minor pseudoaneurysms was treated with ultrasound-guided compression
and the other 2 required no treatment. <br/>Conclusion(s): The MANTA
device demonstrated a short time to hemostasis and low complication rates
compared with published literature results of other percutaneous closure
devices. Time to hemostasis and complication rates were comparable between
the PEVAR/TEVAR patients and the full SAFE MANTA study cohort. The MANTA
device provides reliable closure with a single percutaneous device for
PEVAR/TEVAR procedures.<br/>Copyright &#xa9; The Author(s) 2020.

<11>
Accession Number
2002106080
Title
Single-dose cardioplegia protects myocardium as well as traditional
repetitive dosing: A noninferiority randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. 159 (5) (pp 1857-1863.e1),
2020. Date of Publication: May 2020.
Author
Vivacqua A.; Robinson J.; Abbas A.E.; Altshuler J.M.; Shannon F.L.;
Podolsky R.H.; Sakwa M.P.
Institution
(Vivacqua, Abbas, Altshuler, Shannon, Sakwa) Department of Cardiovascular
Surgery, Beaumont Hospital, Royal Oak, Mich, United States
(Robinson) Wayne State University School of Medicine, Detroit, Mich,
United States
(Podolsky) Beaumont Research Institute, Royal Oak, Mich, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The present prospective noninferiority randomized trial was
designed to demonstrate the safety and efficacy of a single dose of
Custodiol histidine-tryptophan-ketoglutarate compared with repetitive
cold-blood cardioplegia. <br/>Method(s): From October 2012 to May 2014,
110 patients were randomly assigned to 1 of 2 groups: Group 1 (55
patients) received repetitive cold-blood cardioplegia, and group 2 (55
patients) received single-dose Custodiol
histidine-tryptophan-ketoglutarate. Isolated aortic valve replacement,
isolated mitral valve replacement, and multivalve procedures represented
the most frequent operations, with 39 cases (71%) in group 1 and 49 cases
(89%) in group 2. There was no difference in cardiopulmonary bypass time
(102 +/- 26 minutes vs 99 +/- 19 minutes, P = .70) or aortic crossclamp
time (77 +/- 19 minutes vs 74 +/- 17 minutes, P = .33). All patients
underwent preoperative electrocardiogram and determination of creatine
kinase-MB, troponin I, left ventricular ejection fraction, and regional
wall motion. Postoperative cardiac biomarkers were checked at 7, 24, and
48 hours, and an echocardiogram was obtained to check for left ventricular
function abnormalities. <br/>Result(s): There was no difference in cardiac
biomarkers release between the 2 groups at baseline and 7, 24, and 48
hours postoperatively (creatine kinase, P = .18, troponin P = .23). Left
ventricular function was similar between groups preoperatively and at 24
hours after surgery. No death or myocardial infarction was observed in
either group. There were no differences in intensive care unit length of
stay, incidence of atrial fibrillation, use of inotropes or vasopressors
support, time of intubation, or creatinine levels. <br/>Conclusion(s): A
single dose of Custodiol histidine-tryptophan-ketoglutarate cardioplegia
is not inferior to repeated cold-blood cardioplegia during elective
cardiac surgery.<br/>Copyright &#xa9; 2019 The American Association for
Thoracic Surgery

<12>
Accession Number
631227593
Title
Perioperative dexmedetomidine and postoperative delirium in non-cardiac
surgery: a meta-analysis.
Source
Annals of palliative medicine. 9 (2) (pp 264-271), 2020. Date of
Publication: 01 Mar 2020.
Author
Ming S.; Zhang X.; Gong Z.; Xie Y.
Institution
(Ming) Department of Anesthesiology, First Affiliated Hospital of Guangxi
Medical University, Nanning 530021, China
(Zhang) Department of Anesthesiology, second Affiliated Hospital Of Guilin
Medical University
(Gong) Department of Anesthesiology, People's Hospital of Guangxi Zhuang
Autonomous Region, Nanning 530021, China
(Xie) Department of Anesthesiology, Second Affiliated Hospital of Guangxi
Medical University, Nanning 530021, China
(Xie) Department of Anesthesiology, First Affiliated Hospital of Guangxi
Medical University, Nanning 530021, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: To compare the effects of perioperative dexmedetomidine with
placebo (or other sedation) on the rate of postoperative delirium in adult
patients who underwent non-cardiac surgeries. <br/>METHOD(S): A
meta-analysis was performed on randomized, controlled trials. MEDLINE, the
Cochrane Central Register of Controlled Trials, and Embase (to March 20,
2019) were searched for literature retrieval. The standardized primary
outcome was postoperative delirium. We pooled risk ratios using a
random-effects model. <br/>RESULT(S): From 10 trials with 2,286 total
participants, we recorded 363 postoperative delirium events during the
follow-up periods. Compared with the control group, patients in the
dexmedetomidine group had a postoperative delirium relative risk of 0.53
[95% confidence interval (CI), 0.37-0.76]. When the dexmedetomidine
infusion rate was higher than 0.2 mug/kg/h, the relative risk of
postoperative delirium reduced significantly by 34%, compared with other
sedation methods (relative risk =0.66; 95% CI, 0.47-0.94; P=0.02), with no
heterogeneity (I2=31%, P=0.18). While it reduced by 62% when the
dexmedetomidine infusion rate was lower than 0.2 mug/kg/h (relative risk
=0.38; 95% CI, 0.27-0.54). <br/>CONCLUSION(S): Compared to the placebo (or
other sedation methods), perioperative dexmedetomidine sedation resulted
in lower rates of postoperative delirium in adult patients who underwent
non-cardiac surgery.

<13>
Accession Number
631458014
Title
Extending inferences from a randomized trial to a new target population.
Source
Statistics in medicine. (no pagination), 2020. Date of Publication: 06 Apr
2020.
Author
Dahabreh I.J.; Robertson S.E.; Steingrimsson J.A.; Stuart E.A.; Hernan
M.A.
Institution
(Dahabreh, Robertson) Center for Evidence Synthesis in Health, Brown
University, Providence, RI, United States
(Dahabreh, Robertson) Department of Health Services, Policy & Practice,
Brown University, Providence, RI, United States
(Dahabreh) Department of Epidemiology, Brown University, Providence, RI,
United States
(Dahabreh, Hernan) Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, MA
(Steingrimsson) Department of Biostatistics, School of Public Health,
Brown University, Providence, RI, United States
(Stuart) Departments of Mental Health, Biostatistics, Health Policy and
Management, Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD, United States
(Hernan) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA
(Hernan) Harvard-MIT Division of Health Sciences and Technology, Boston,
MA
Publisher
NLM (Medline)
Abstract
When treatment effect modifiers influence the decision to participate in a
randomized trial, the average treatment effect in the population
represented by the randomized individuals will differ from the effect in
other populations. In this tutorial, we consider methods for extending
causal inferences about time-fixed treatments from a trial to a new target
population of nonparticipants, using data from a completed randomized
trial and baseline covariate data from a sample from the target
population. We examine methods based on modeling the expectation of the
outcome, the probability of participation, or both (doubly robust). We
compare the methods in a simulation study and show how they can be
implemented in software. We apply the methods to a randomized trial nested
within a cohort of trial-eligible patients to compare coronary artery
surgery plus medical therapy versus medical therapy alone for patients
with chronic coronary artery disease. We conclude by discussing issues
that arise when using the methods in applied analyses.<br/>Copyright
&#xa9; 2020 John Wiley & Sons, Ltd.

<14>
Accession Number
631456772
Title
Perioperative Beta-Blocker for Atrial Fibrillation after Cardiac Surgery:
A Meta-Analysis.
Source
The Thoracic and cardiovascular surgeon. (no pagination), 2020. Date of
Publication: 06 Apr 2020.
Author
Kim S.H.; Jang M.-J.; Hwang H.Y.
Institution
(Kim, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: This meta-analysis was conducted to evaluate the impact of
perioperative use of beta-blocker (BB) on postoperative atrial
fibrillation (POAF) after cardiac surgery other than isolated coronary
artery bypass grafting (CABG). <br/>METHOD(S): Five online databases were
searched. Studies were included if they (1) enrolled patients who
underwent cardiac surgery other than isolated CABG and (2) demonstrated
the impact of perioperative use of BB on POAF based on the randomized
controlled trial or adjusted analysis. The primary outcome was the
occurrence rates of POAF after cardiac surgery. A meta-regression and
subgroup analysis were performed according to the proportion of patients
with cardiac surgery other than isolated CABG and the timing of BB use,
respectively. <br/>RESULT(S): Thirteen articles (5 randomized and 8
nonrandomized studies: n=25,496) were selected. Proportion of enrolled
patients undergoing cardiac surgery other than isolated CABG ranged from 7
to 100%. The BBs were used in preoperative, postoperative, and both
periods in 5, 5, and 3 studies, respectively. The pooled analyses showed
that the risk of POAF was significantly lower in patients with
perioperative BB than those without (odds ratio, 95% confidence
interval=0.56, 0.35-0.91 and 0.70, 0.55-0.91 in randomized and
nonrandomized studies, respectively). The risk of POAF was lower in the BB
group irrespective of the proportion of nonisolated CABG. Benefit
regarding in-hospital mortality was inconclusive. Perioperative stroke and
length of stay were not significantly different between BB and non-BB
groups. <br/>CONCLUSION(S): Perioperative use of BB is effective in
preventing POAF even in patients undergoing cardiac surgery other than
isolated CABG, although it did not translate into improved clinical
outcomes.<br/>Copyright Georg Thieme Verlag KG Stuttgart . New York.

<15>
Accession Number
631467671
Title
Infra-Abdominal Muscles Activation Brings Benefits to the Pulmonary
Function of Patients with Sternal Instability after Cardiac Surgery.
Source
Brazilian journal of cardiovascular surgery. 35 (1) (pp 41-49), 2020. Date
of Publication: 01 May 2020.
Author
Nozawa E.; Goncalves C.D.; Almeida P.O.; Hajjar L.A.; Galas F.R.G.;
Feltrim M.I.Z.
Institution
(Nozawa, Goncalves, Almeida, Feltrim) Universidade de Sao Paulo Faculdade
de Medicina Hospital das Clinicas Sao Paulo SP Brazil Department of
Physiotherapy of the Instituto do Coracao do Hospital das Clinicas da
Faculdade de Medicina da Universidade de Sao Paulo (InCor/HC-FMUSP), Sao
Paulo, Brazil
(Hajjar) Universidade de Sao Paulo Faculdade de Medicina Hospital das
Clinicas Sao Paulo SP Brazil Department of Critical Patients of the
Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da
Universidade de Sao Paulo (InCor/HC-FMUSP), Sao Paulo, Brazil
(Galas) Universidade de Sao Paulo Faculdade de Medicina Hospital das
Clinicas Sao Paulo SP Brazil Department of Anesthesia and Surgical
Intensive Care of the Instituto do Coracao do Hospital das Clinicas da
Faculdade de Medicina da Universidade de Sao Paulo (InCor/HC-FMUSP), Sao
Paulo, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To compare physical therapy strategies involving abdominal
muscle stabilization, with and without upper limb movement, in patients
with sternal instability after heart surgery and during in-hospital care.
<br/>METHOD(S): This prospective, longitudinal, randomized, and
comparative clinical study included 20 patients, which were divided into
two groups: ARM, the arm group (n=10), and LEG, the leg group (n=10). The
study involved the evaluation of scores of visual analog scales for
sternal instability, pain, discomfort, functional impairment, lung
function, and maximum inspiratory pressure (MIP) and maximum expiratory
pressure (MEP) before and after the interventions. Two protocols
consisting of abdominal exercises in both groups with upper limb movements
(ARM) and just abdominal activation with leg movements (LEG) were used for
three weeks. <br/>RESULT(S): There were statistically significant
(P<=0.01) improvements in pain, discomfort, and functional impairment
scores, and in MIP (P=0.04) and MEP (P<=0.01) after intervention in both
groups and just LEG showed improvement in forced vital capacity (P=0.043)
and forced expiratory volume in one second (P=0.011). <br/>CONCLUSION(S):
Both strategies promoted improvement in pain, discomfort, and functional
impairment scores and in the values of inspiratory and expiratory
pressures. Perhaps they were influenced by the time and resolution of the
infection process, although exercises with upper limb movements seem to be
safe in this population. The activation of the infra-abdominal muscles
through leg movements seems to bring more benefits to lung function.

<16>
Accession Number
631467463
Title
Should Doctors Know Their Patients' Attachment Style? A Psychological
Perspective and its Impact on Cardiac Surgery Outcomes.
Source
Brazilian journal of cardiovascular surgery. 35 (1) (pp 100-108), 2020.
Date of Publication: 01 May 2020.
Author
Bithas C.; Harky A.
Institution
(Bithas) University of Liverpool School of Medicine Liverpool UK School of
Medicine, University of Liverpool, Liverpool, United Kingdom
(Harky) Liverpool Heart and Chest Hospital Department of Cardiothoracic
Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart
and Chest Hospital, Liverpool, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To increase our understanding of the psychological attachment
styles in order to develop a preventative strategy that could potentially
improve patients' perioperative outcomes. <br/>METHOD(S): A comprehensive
literature search was performed utilizing major electronic databases. The
search was done from inception to January 2019. All of the relevant papers
have been extracted and critically appraised in this review.
<br/>RESULT(S): Understanding the psychological aspects of patients is
crucial for a satisfactory postoperative outcome. Depression and anxiety
have been shown to increase both mortality and morbidity after coronary
artery bypass graft surgery, independently of medical factors, although
the behavioural and biological mechanisms are poorly understood.
Psychosocial assessment is an important part of the pre-transplant
evaluation process. The majority of individuals undergoing a transplant
have significant psychosocial problems and can either be deferred or
denied the transplant until these psychosocial issues are approached and
managed. Psychological distress has been shown to affect long-term
prognosis of cardiac patients and as a result, it should be addressed
during follow-up of cardiac arrest survivors due to cardiac cause. Several
studies have considered different approaches and analyses of different
psychological attachments, and the understanding of such parameters
perioperatively could possibly minimise perioperatively complications.
<br/>CONCLUSION(S): Since psychological distress affects long-term
prognosis of cardiac surgery patients, it should be addressed during
follow-up of cardiac arrest survivors due to cardiac cause.

<17>
Accession Number
631467411
Title
Does Prior Percutaneous Coronary Intervention Influence the Outcomes of
Coronary Artery Bypass Surgery?.
Source
Brazilian journal of cardiovascular surgery. 35 (1) (pp 1-8), 2020. Date
of Publication: 01 May 2020.
Author
Miguel G.S.V.; Sousa A.G.; Silva G.S.; Colosimo F.C.; Stolf N.A.G.
Institution
(Miguel) Clinica Girassol Cardiothoracic Surgeon Luanda Angola
Cardiothoracic Surgeon, Clinica Girassol, Luanda, Angola
(Sousa) Hospital Beneficencia Portuguesa Clinical Research Physician Sao
Paulo SP Brazil Clinical Research Physician, Hospital Beneficencia
Portuguesa, Sao Paulo, Brazil
(Silva, Colosimo) Hospital Beneficencia Portuguesa Center for Education
and Research Research Nurse Sao Paulo SP Brazil Research Nurse, Center for
Education and Research of the Hospital Beneficencia Portuguesa, Sao Paulo,
Brazil
(Stolf) University of Sao Paulo Medical School Sao Paulo SP Brazil
University of Sao Paulo Medical School, Sao Paulo, Brazil
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Percutaneous coronary intervention (PCI) has been
increasingly performed to treat coronary artery disease. The performance
of multiple PCI has also been increasing. Consequently, the percentage of
patients presenting for coronary artery bypass graft (CABG) surgery is
reported to vary from 13 to 40%. The influence of previous PCI on CABG
outcomes has been studied in single center, regional studies, registries
and meta-analyses. Some reports showed a negative effect on mortality and
morbidity in early or long-term follow-up, but others did not find this
influence. METHODS AND RESULTS: A cohort of 3007 patients consecutively
operated for CABG, 261 of them with previous PCI, were included in this
analysis. Comparison of the groups "previous PCI" and "primary CABG" was
made in the original cohort and in a propensity score matched cohort of
261 patients. There were some differences in preoperative clinical
characteristics in both types of cohort, even in the matched one. Outcomes
were compared at 30 days, 1 year and 5 years of follow-up. There were no
statistically significant differences in mortality in any period or
cohort. There were some differences in other outcomes as readmission and
composite events, including cardiovascular death at 1 and 5 years of
follow-up. These differences, neverthless, were not confirmed in
comparison with the matched cohort. <br/>CONCLUSION(S): Although there are
some limitations in this study, it was not found consistent negative
influence of previous PCI on CABG.

<18>
Accession Number
631467146
Title
Pericardial fluids or Cardiopulmonary Bypass-Is There a Major Culprit for
Changes in Coagulation and Inflammation?.
Source
The Thoracic and cardiovascular surgeon. 68 (3) (pp 219-222), 2020. Date
of Publication: 01 Apr 2020.
Author
Gorki H.; Nakamura J.; Kunert A.; Hoenicka M.; Liebold A.
Institution
(Gorki, Nakamura, Kunert, Hoenicka, Liebold) Thorax- und Gefaschirurgie,
Universitatsklinik Ulm, Ulm, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: From the results of a previous study, it remained to be
investigated if a perioperative rise of few tested coagulation and
inflammation markers is caused by conventional cardiopulmonary bypass
(CPB) itself or rather by direct recirculation of pericardial fluids.
<br/>METHOD(S): Forty-eight patients operated on with conventional CPB
for myocardial revascularization were randomized either for direct
recirculation of pericardial suction fluids or for cell saving (CS).
<br/>RESULT(S): Thrombin-antithrombin complexes showed lower values
intraoperatively in the CS group (p<0.0001), and D-dimers tended to remain
lower at intensive care unit arrival (p=0.095). Tests of inflammation
markers were less meaningful. <br/>CONCLUSION(S): Direct recirculation of
pericardial fluids rather than conventional CPB itself causes major
intraoperative changes of some coagulation markers. Pericardial blood loss
with direct recirculation should be kept to a minimum to avoid unnecessary
activation of coagulation. Inflammation markers need further
investigations.<br/>Copyright Georg Thieme Verlag KG Stuttgart . New York.

<19>
Accession Number
631462421
Title
Biomarker-guided implementation of the KDIGO guidelines to reduce the
occurrence of acute kidney injury in patients after cardiac surgery
(PrevAKI-multicentre): protocol for a multicentre, observational study
followed by randomised controlled feasibility trial.
Source
BMJ open. 10 (4) (pp e034201), 2020. Date of Publication: 06 Apr 2020.
Author
Kullmar M.; Massoth C.; Ostermann M.; Campos S.; Grau Novellas N.; Thomson
G.; Haffner M.; Arndt C.; Wulf H.; Irqsusi M.; Monaco F.; Di Prima A.;
Garcia Alvarez M.; Italiano S.; Cegarra SanMartin V.; Kunst G.; Nair S.;
L'Acqua C.; Hoste E.A.J.; Vandenberghe W.; Honore P.; Kellum J.; Forni L.;
Grieshaber P.; Weiss R.; Gerss J.; Wempe C.; Meersch M.; Zarbock A.
Institution
(Kullmar, Massoth, Wempe, Meersch, Zarbock) Anesthesiology, Intensive Care
and Pain Medicine, Universitatsklinikum Munster, Nordrhein-Westfalen,
Munster, Germany
(Ostermann, Campos, Grau Novellas, Thomson, Haffner) Department of
Critical Care, King's College London, Guy's & St Thomas' Hospital, London,
United Kingdom
(Arndt) Department of Anesthesiology and Operative Intensive Care,
University Hospital Marburg, Marburg, United Kingdom
(Wulf) Anesthesiology & Intensive Care Medicine, Philipps-Universitat
Marburg Fachbereich Medizin, Marburg, Germany
(Irqsusi) Department of Cardiothoracic Surgery, Philipps-Universitat
Marburg Fachbereich Medizin, Marburg, Germany
(Monaco, Di Prima) Intensive Care and Anesthesia Unit, Scientific
Institute San Raffaele, Milano, Italy
(Garcia Alvarez, Italiano, Cegarra SanMartin) Department of
Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona,
Catalunya, Spain
(Kunst, Nair) Department of Anesthesia, Critical Care and Pain, King's
College London, London, United Kingdom
(L'Acqua) Department of Anesthesia and Critical Care, Centro Cardiologico
Monzino IRCCS, Milano, Lombardia, Italy
(Hoste, Vandenberghe) ICU, Universiteit Gent, Gent, Belgium
(Honore) Department of Intensive Care, CHU Brugmann, Brussels, Belgium
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Forni) Department of Intensive Care Medicine, Royal Surrey County
Hospital NHS Trust, Guildford, Surrey, UK
(Grieshaber) Department of Cardiac Surgery, Justus Liebig Universitat
Giessen Fachbereich Medizin, Giessen, Hessen, Germany
(Weiss) Department of Anaesthesiology, University Hospital Munster,
Munster, Germany
(Gerss) Institute of Biostatistics and Clinical Research, Westfalische
Wilhelms-Universitat Munster, Munster, Germany
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Acute kidney injury (AKI) is a frequent complication after
cardiac surgery with adverse short-term and long-term outcomes. Although
prevention of AKI (PrevAKI) is strongly recommended, the optimal strategy
is uncertain. The Kidney Disease: Improving Global Outcomes (KDIGO)
guideline recommended a bundle of supportive measures in high-risk
patients. In a single-centre trial, we recently demonstrated that the
strict implementation of the KDIGO bundle significantly reduced the
occurrence of AKI after cardiac surgery. In this feasibility study, we aim
to evaluate whether the study protocol can be implemented in a multicentre
setting in preparation for a large multicentre trial. METHODS AND
ANALYSIS: We plan to conduct a prospective, observational survey followed
by a randomised controlled, multicentre, multinational clinical trial
including 280 patients undergoing cardiac surgery with cardiopulmonary
bypass. The purpose of the observational survey is to explore the
adherence to the KDIGO recommendations in routine clinical practice. The
second phase is a randomised controlled trial. The objective is to
investigate whether the trial protocol is implementable in a large
multicentre, multinational setting. The primary endpoint of the
interventional part is the compliance rate with the protocol. Secondary
endpoints include the occurrence of any AKI and moderate/severe AKI as
defined by the KDIGO criteria within 72 hours after surgery, renal
recovery at day 90, use of renal replacement therapy (RRT) and mortality
at days 30, 60 and 90, the combined endpoint major adverse kidney events
consisting of persistent renal dysfunction, RRT and mortality at day 90
and safety outcomes. ETHICS AND DISSEMINATION: The PrevAKI multicentre
study has been approved by the leading Research Ethics Committee of the
University of Munster and the respective Research Ethics Committee at each
participating site. The results will be used to design a large, definitive
trial. TRIAL REGISTRATION NUMBER: NCT03244514.<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.

<20>
Accession Number
2004143085
Title
A randomized controlled trial comparing novel triple-cuffed double-lumen
endobronchial tubes with conventional double-lumen endobronchial tubes for
lung isolation.
Source
Journal of Clinical Medicine. 9 (4) (no pagination), 2020. Article Number:
977. Date of Publication: April 2020.
Author
Kim N.; Byon H.-J.; Kim G.E.; Park C.; Joe Y.E.; Suh S.M.; Oh Y.J.
Institution
(Kim, Byon, Kim, Joe, Suh, Oh) Department of Anesthesiology and Pain
Medicine, Anesthesia and Pain Research Institute, Yonsei University
College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South
Korea
(Park) Department of Anesthesiology and Pain Medicine, Gil Medical Center,
Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil,
Namdong-gu, Incheon 21565, South Korea
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Placing a double-lumen endobronchial tube (DLT) in an appropriate position
to facilitate lung isolation is essential for thoracic procedures. The
novel ANKOR DLT is a DLT developed with three cuffs with a newly added
carinal cuff designed to prevent further advancement by being blocked by
the carina when the cuff is inflated. In this prospective study, the
direction and depth of initial placement of ANKOR DLT were compared with
those of conventional DLT. Patients undergoing thoracic surgery (n = 190)
with one-lung ventilation (OLV) were randomly allocated into either
left-sided conventional DLT group (n = 95) or left-sided ANKOR DLT group
(n = 95). The direction and depth of DLT position were compared via
fiberoptic bronchoscopy (FOB) after endobronchial intubation between the
groups. There was no significant difference in the number of right
mainstem endobronchial intubations between the two groups (p = 0.468). The
difference between the initial depth of DLT placement and the target depth
confirmed by FOB was significantly lower in the ANKOR DLT group than in
the conventional DLT group (1.8 +/- 1.8 vs. 12.9 +/- 9.7 mm; p < 0.001).
In conclusion, the ANKOR DLT facilitated its initial positioning at the
optimal depth compared to the conventional DLT.<br/>Copyright &#xa9; 2020
by the authors. Licensee MDPI, Basel, Switzerland.

<21>
Accession Number
631460456
Title
Cardiac interventions in patients with achondroplasia: A systematic
review.
Source
Journal of Thoracic Disease. 12 (3) (pp 998-1006), 2020. Date of
Publication: 01 Mar 2020.
Author
Sukhavasi A.; O'Malley T.J.; Maynes E.J.; Choi J.H.; Gordon J.S.; Phan K.;
Tchantchaleishvili V.
Institution
(Sukhavasi, O'Malley, Maynes, Choi, Gordon, Tchantchaleishvili) Division
of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, PA,
United States
(Phan) Southwest Sydney Clinical School, University of New South Wales
(UNSW), Liverpool Hospital, Sydney, Australia
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Patients with achondroplasia and other causes of dwarfism suffer from
increased rates of cardiovascular disease relative to the remainder of the
population. Few studies have examined these patients when undergoing
cardiac surgery or percutaneous intervention. This systematic review
examines the literature to determine outcomes following cardiac
intervention in this unique population. An electronic search was performed
in the English literature to identify all reports of achondroplasia,
dwarfism, and cardiac intervention. Of the 5,274 articles identified, 14
articles with 14 cases met inclusion criteria. Patient-level data was
extracted and analyzed. Median patient age was 55.5 [interquartile ranges
(IQR), 43.8, 59.8] years, median height 102.0 [98.8, 112.5] cm, median BMI
32.1 [27.0, 45.9], and 57.1% (8/14) were male. Of these 14 patients, nine
had the following documented skeletal abnormalities: 66.7% (6/9) had
scoliosis, 66.7% (6/9) had kyphosis, 11.1% (1/9) had lordosis, 11.1% (1/9)
pectus carinatum and 11.1% (1/9) spinal stenosis. Coronary artery disease
was present in 53.8% (7/13), and 30.8% (4/13) patients previously suffered
a myocardial infarction. Of the eight patients who underwent cardiac
surgery, 37.5% (3/8) underwent multivessel coronary artery bypass
grafting, 37.5% (3/8) underwent aortic valve replacement, 25.0% (2/8)
underwent type A aortic dissection repair, and the remaining 12.5% (1/8)
underwent pulmonary thromboendarterectomy. Six patients underwent
percutaneous intervention. Median cardiopulmonary bypass time was 136.5
[110.0, 178.8] minutes. Median arterial cannula size was 20.0 [20.0, 24.0]
Fr. Bicaval cannulation was performed in all cases describing cannulation
strategy (5/5). Median superior vena cava cannula size was 28.0 [28.0,
28.0] Fr, and inferior vena cava cannula size was 28.0 [28.0, 28.0] Fr. No
mortality was reported with a median follow up time of 6.0 [6.0, 10.5]
months. In conclusion, Common cardiac procedures can be performed with
reasonable safety in this patient population. Operative adjustments may
need to be made with respect to equipment to accommodate patient-specific
needs.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<22>
Accession Number
631460417
Title
Transcatheter aortic valve replacement with Lotus and Sapien 3 prosthetic
valves: A systematic review and meta-analysis.
Source
Journal of Thoracic Disease. 12 (3) (pp 893-906), 2020. Date of
Publication: 01 Mar 2020.
Author
Gozdek M.; Ratajczak J.; Arndt A.; Zielinski K.; Pasierski M.; Matteucci
M.; Fina D.; Jiritano F.; Meani P.; Raffa G.M.; Malvindi P.G.; Pilato M.;
Paparella D.; Slomka A.; Landes U.; Kornowski R.; Kubica J.; Lorusso R.;
Suwalski P.; Kowalewski M.
Institution
(Gozdek, Ratajczak, Kubica) Department of Cardiology and Internal
Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz,
Poland
(Arndt) Department of Anesthesiology and Intensive Therapy, Collegium
Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
(Zielinski) Warsaw Medical University, Warsaw, Poland
(Pasierski, Suwalski, Kowalewski) Clinical Department of Cardiac Surgery,
Central Clinical Hospital of the Ministry of Interior and Administration,
Centre of Postgraduate Medical Education, Warsaw, Poland
(Matteucci, Fina, Jiritano, Meani, Lorusso, Kowalewski) Department of
Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University
Medical Centre, Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
(Matteucci) Department of Cardiac Surgery, Circolo Hospital, University of
Insubria, Varese, Italy
(Fina) Cardiovascular Intensive Care, IRCCS Policlinico San Donato, Milan,
Italy
(Jiritano) Cardiac Surgery Unit, Department of Experimental and Clinical
Medicine, Magna Graecia University, Catanzaro, Italy
(Meani) Department of Intensive Care Unit, Maastricht University Medical
Centre (MUMC+), Maastricht, Netherlands
(Raffa, Pilato) Department for the Treatment and Study of Cardiothoracic
Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto
Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo,
Italy
(Malvindi, Paparella) Wessex Cardiothoracic Centre, University Hospital
Southampton, Southampton, United Kingdom
(Paparella) Department of Emergency and Organ Transplant, University of
Bari Aldo Moro, Bari, Italy
(Slomka) Department of Pathophysiology, Collegium Medicum, Nicolaus
Copernicus University, Bydgoszcz, Poland
(Landes, Kornowski) Department of Cardiology, Institute of Interventional
Cardiology, Rabin Medical Center, Petach Tikva and Tel Aviv University,
Tel Aviv, Israel
(Kowalewski) Thoracic Research Centre, Collegium Medicum, Nicolaus
Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Frequent occurrence of paravalvular leak (PVL) after
transcatheter aortic valve replacement (TAVR) was the main concern with
early-generation devices and focused technological improvements. Current
systematic review and meta-analysis sought to compare outcomes of TAVR for
severe native valve stenosis with next-generation devices: Lotus and
Sapien 3. <br/>Method(s): Electronic databases were screened for studies
comparing outcomes of TAVR with Lotus and Sapien 3. In a random-effects
meta-analysis, the pooled incidence rates of procedural, clinical and
functional outcomes according to VARC-2 definitions were assessed.
<br/>Result(s): Eleven observational studies including 2,836 patients
(Lotus N=862 vs. Sapien 3 N=1,974) met inclusion criteria. No differences
were observed regarding composite endpoints-device success and early
safety. Similarly, 30-day mortality, major vascular complications, acute
kidney injury and serious bleeding events were similar with both devices.
Lotus valve demonstrated 35% reduction of the risk for mild PVL: risk
ratio (RR) 0.65, 95% confidence interval (CI): 0.49-0.85, P=0.002; but
there were no statistical differences with regard to moderate/severe PVL
(RR 0.56, 95% CI: 0.18-1.77, P=0.320). Lotus valves produced significantly
higher mean transaortic gradients: mean difference (MD) 0.88 mmHg, 95% CI,
0.24-1.53 mmHg, P=0.007; however, without translation into higher rate of
prosthesis-patient mismatch (RR 1.10, 95% CI: 0.82-1.47, P=0.540). As
compared to Sapien 3, Lotus device placement was associated with
significantly higher rate of permanent pacemaker implantation (RR 2.30,
95% CI: 1.95-2.71, P<0.00001) and cerebrovascular events (RR 1.76, 95% CI:
1.03-2.99, P=0.040). <br/>Conclusion(s): Lotus valve, as compared with
Sapien 3, was associated with lower risk for PVL but higher risk for
permanent pacemaker implantation and cerebrovascular events.<br/>Copyright
&#xa9; Journal of Thoracic Disease. All rights reserved.

<23>
Accession Number
631460332
Title
A Prospective Randomized Clinical Trial of Efficacy of Algorithm-Based
Point of Care Guided Hemostatic Therapy in Cyanotic Congenital Heart
Disease Surgical Patients.
Source
Journal of Cardiac Critical Care. 3 (1) (pp 8-16), 2019. Date of
Publication: 2019.
Author
Karanjkar A.; Kapoor P.M.; Sharan S.; Bhardwaj V.; Malik V.; Hasija S.;
Choudhury A.; Chowdhury U.K.; Rajashekar P.
Institution
(Karanjkar, Kapoor, Sharan, Bhardwaj, Malik, Hasija, Choudhury) Department
of Cardiac Anaesthesia, Cardiothoracic Centre, All India Institute of
Medical Sciences, New Delhi, India
(Chowdhury, Rajashekar) Department of Cardiothoracic and Vascular Surgery,
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi,
India
(Kapoor) Department of Cardiac Anaesthesia, Cardiothoracic Centre, All
India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
Publisher
Thieme India
Abstract
Objective Point of care (POC) testing-based algorithm-guided hemostatic
therapy has been used in adult as well as pediatric cardiac surgical
patients to administer blood components. The authors hypothesized that
implementation of POC-based algorithm in pediatric cyanotic congenital
surgical patients would reduce the exposure to blood component therapy and
improve the clinical outcome. Design Prospective randomized control trial.
Setting Single-center academic institute. Participants One hundred seventy
pediatric congenital cyanotic surgical patients. Intervention
Implementation of POC and conventional tests-based algorithms.
Measurements and Main Results Algorithm-based blood component therapy was
administered in each group. There were no group differences regarding the
demographic, clinical, and laboratory characteristics. Amount of packed
red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and
cryoprecipitate (primary outcomes) administered was significantly lower in
POC group than that in the conventional group (p < 0.001). Among the
secondary outcomes, the chest drain output at 6, 12, and 24 hours and
number of re-explorations was comparable among both the groups. The
duration of mechanical ventilation, duration of intensive care unit (ICU)
stay, and hospital stay was significantly short in POC group (p = 0.008,
<0.001 and 0.019, respectively). Conclusion Implementation of POC-based
algorithm-guided hemostatic therapy reduced the exposure to blood and
blood component therapy and was associated with reduced ICU and hospital
stay in pediatric congenital cyanotic surgical patients.<br/>Copyright
&#xa9; 2020 Official Publication of The Simulation Society (TSS),
accredited by International Society of Cardiovascular Ultrasound (ISCU).

<24>
Accession Number
631460325
Title
Vitamin D Deficiency and Its Response to Supplementation as Stoss Therapy
in Children with Cyanotic Congenital Heart Disease Undergoing Open Heart
Surgery.
Source
Journal of Cardiac Critical Care. 3 (1) (pp 17-23), 2019. Date of
Publication: 2019.
Author
Sahu M.K.; Bipin C.; Niraghatam H.V.; Karanjkar A.; Singh S.P.; Rajashekar
P.; Ramakrishnan L.; Devagourou V.; Upadhyay A.D.; Choudhary S.K.
Institution
(Sahu, Bipin, Niraghatam, Singh, Rajashekar, Devagourou, Choudhary)
Department of Cardiothoracic and Vascular Surgery, CN Centre, All India
Institute of Medical Sciences, New Delhi, India
(Karanjkar) Department of Cardiac Anaesthesiology, CN Centre, All India
Institute of Medical Sciences, New Delhi, India
(Ramakrishnan) Department of Laboratory Medicine, CN Centre, All India
Institute of Medical Sciences, New Delhi, India
(Upadhyay) Department of Biostatistics, All India Institute of Medical
Sciences, New Delhi, India
(Sahu) Department of Cardiothoracic and Vascular Surgery, CTVS Office, CN
Centre, All India Institute of Medical Sciences, New Delhi 110029, India
Publisher
Thieme India
Abstract
Background Data from many studies suggest that patients with congenital
heart disease are vitamin D (vitD) deficient. Following cardiac surgery as
a result of intraoperative institution of cardiopulmonary bypass (CPB),
serum vitD levels become even low. This may affect postoperative
convalescence in terms of mechanical ventilation, inotropic support,
infection, and so forth. Objective We intended to study the prevalence of
vitD deficiency pre and post cardiac surgery and the effect of vitD
supplementation (stoss therapy) on postoperative convalescence of the
children with tetralogy of Fallot (TOF) undergoing intracardiac repair
(ICR). Methodology In this randomized controlled trial (RCT), 60 children
younger than 18 years with TOF and serum vitD levels < 20ng/dL were
randomized into two groups. The study group received vitD supplementation
as stoss therapy at 10,000 units/kg body weight. All these children
underwent ICR with CPB. Demographic data, preoperative, intraoperative,
and postoperative variables were compared between the study and the
control groups. Results Prevalence of severe vitD deficiency was 93.1%.
When compared with the control group, study group showed higher serum vitD
levels in the immediate preoperative period (p = 0.001), postoperative
period following CPB (p = 0.012), and on the first postoperative day (p =
0.003). No statistically significant difference was observed in
postoperative mechanical ventilation (p = 0.35), intensive care unit (ICU)
stay (p = 0.15), and inotropic duration (p = 0.19). Conclusion Children
with TOF are highly deficient of vitD, its level falls further after CPB,
and supplementing vitD preoperatively does not influence postoperative
recovery pattern. Supplementation of vitD as stoss therapy was useful in
raising the serum levels before and after cardiac surgery.<br/>Copyright
&#xa9; 2020 Official Publication of The Simulation Society (TSS),
accredited by International Society of Cardiovascular Ultrasound (ISCU).

<25>
Accession Number
2005565438
Title
Biatrial vs Bicaval Orthotopic Heart Transplantation: A Systematic Review
and Meta-Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Zijderhand C.F.; Veen K.M.; Caliskan K.; Schoonen T.; Mokhles M.M.;
Bekkers J.A.; Manintveld O.C.; Constantinescu A.A.; Brugts J.J.; Bogers
A.J.J.C.; Takkenberg J.J.M.
Institution
(Zijderhand, Veen, Schoonen, Mokhles, Bekkers, Bogers, Takkenberg)
Department of Cardiothoracic Surgery, Erasmus University Medical Center,
Rotterdam, Netherlands
(Caliskan, Manintveld, Constantinescu, Brugts) Department of Cardiology,
Erasmus University Medical Center, Rotterdam, Netherlands
Publisher
Elsevier USA
Abstract
Background: Orthotopic heart transplantation (OHT) is the gold standard
treatment in end-stage heart disease. Controversy remains whether bicaval
OHT is superior to biatrial OHT in both early and late outcomes. This
study aimed to provide an overview of the early and late outcomes in
patients who underwent a bicaval or biatrial OHT. <br/>Method(s): A
systematic literature search was performed for articles published before
December 2017. Studies comparing adult patients undergoing biatrial OHT
and bicaval OHT were included. Early outcomes were pooled in odds ratios
and late outcomes were pooled in rate ratios. Late survival was visualized
by a pooled Kaplan-Meier curve. <br/>Result(s): A total of 36 publications
were included in the meta-analysis, counting 3555 patients undergoing
biatrial OHT and 3208 patients undergoing bicaval OHT. Early outcomes in
mortality, tricuspid regurgitation, mitral regurgitation, and permanent
pacemaker implantation differed significantly in favor of the bicaval OHT
patients. Long-term survival was significantly better in patients
undergoing bicaval vs biatrial OHT (hazard ratio, 1.32; 95% confidence
interval, 1.1-1.6; P = .008). Also, late tricuspid regurgitation was less
frequently seen in the bicaval OHT patients (rate ratio, 2.14; 95% CI,
1.17-3.94; P = .014). Conclusions. This systematic review with
meta-analysis shows that bicaval OHT results in more favorable early and
late outcomes for patients undergoing a bicaval OHT compared with a
biatrial OHT. Therefore, bicaval OHT should be considered as preferable
technique for OHT.<br/>Copyright &#xa9; 2020

<26>
Accession Number
2005442925
Title
Bright light therapy for depressive symptoms in hospitalized cardiac
patients: A randomized controlled pilot trial.
Source
PLoS ONE. 15 (3) (no pagination), 2020. Article Number: e0230839. Date of
Publication: 2020.
Author
Eisenberg M.J.; Habib B.; Alcaraz M.; Thombs B.D.; Filion K.B.
Institution
(Eisenberg, Habib, Alcaraz, Thombs, Filion) Center for Clinical
Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC,
Canada
(Eisenberg, Thombs, Filion) Department of Medicine, McGill University,
Montreal, QC, Canada
(Eisenberg, Thombs, Filion) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Thombs) Departments of Psychiatry, of Psychology, and of Educational and
Counselling Psychology, McGill University, Montreal, QC, Canada
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Depression is common among cardiac patients and associated with adverse
cardiovascular outcomes. Bright light therapy has emerged as a promising
treatment for depressive symptoms, however it has not yet been
investigated in this population. We conducted a double-blind, randomized,
placebo-controlled pilot trial to assess the feasibility of a larger-scale
trial testing bright light therapy for depressive symptoms in cardiac
patients. Patients hospitalized for an acute coronary syndrome or
undergoing cardiac surgery were randomized to either bright light (10,000
lux) or dim light placebo (500 lux) lamps for 30 minutes each day over 4
weeks, beginning in-hospital. Depression was quantified using the Patient
Health Questionnaire 9 (PHQ-9) and Depression Anxiety and Stress Scales
(DASS-21). The Short-Form Health Survey 36 (SF-36) was used to measure
quality of life. A total of 175 patients were screened and 15 were
randomized (8 treatment, 7 placebo) (8.6%) over 10 months. Despite
protocol amendments which broadened the inclusion criteria, the trial was
terminated early for infeasibility based on the rate of enrollment (1-2
participants/month), with 39.5% of the target sample (38 participants)
enrolled. Future trials should take into account the timing of the onset
of depressive symptoms in these patients, and consider a less conservative
approach to eligibility as well as ways to increase the acceptability of
bright light therapy in hospitalized cardiac patients. Once enrolled, our
findings suggest that most participants will adhere to the assigned
treatment and complete follow-up.<br/>Copyright &#xa9; 2020 Eisenberg et
al. This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.

<27>
Accession Number
629289024
Title
Baseline surgical status and short-term mortality after extracorporeal
membrane oxygenation for post-cardiotomy shock: a meta-analysis.
Source
Perfusion (United Kingdom). 35 (3) (pp 246-254), 2020. Date of
Publication: 01 Apr 2020.
Author
Kowalewski M.; Raffa G.; Zielinski K.; Meani P.; Alanazi M.; Gilbers M.;
Heuts S.; Natour E.; Bidar E.; Schreurs R.; Delnoij T.; Driessen R.; Sels
J.W.; van de Poll M.; Roekaerts P.; Maessen J.; Suwalski P.; Lorusso R.
Institution
(Kowalewski, Suwalski) Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior, Centre of Postgraduate Medical
Education, Warsaw, Poland
(Kowalewski, Alanazi, Gilbers, Heuts, Natour, Bidar, Schreurs, Maessen,
Lorusso) Department of Cardiothoracic Surgery, Maastricht University
Medical Centre, Maastricht, Netherlands
(Kowalewski) Cardiothoracic Research Centre, Innovative Medical Forum,
Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, ISMETT-IRCCS, Palermo, Italy
(Zielinski) Medical University of Warsaw, Warsaw, Poland
(Meani, Delnoij, Driessen, Sels) Department of Cardiology, Maastricht
University Medical Centre, Maastricht, Netherlands
(Meani, Delnoij, Driessen, Sels, van de Poll, Roekaerts) Department of
Intensive Care, Maastricht University Medical Centre, Maastricht,
Netherlands
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: While reported mortality rates on post-cardiotomy
extracorporeal membrane oxygenation vary from center to center, impact of
baseline surgical status (elective/urgent/emergency/salvage) on mortality
is still unknown. <br/>Method(s): A systematic search was performed
according to Preferred Reporting Items for Systematic Reviews and
Meta-Analyses statement using PubMed/Medline databases until March 2018
using the keywords "postcardiotomy," "cardiogenic shock," "extracorporeal
membrane oxygenation," and "extracorporeal life support." Relevant
articles were scrutinized and included in the meta-analysis only if
reporting in-hospital/30-day mortality and baseline surgical status. The
correlations between mortality and percentage of elective/urgent/emergency
cases were investigated. Inference analysis of baseline status and
extracorporeal membrane oxygenation complications was conducted as well.
<br/>Result(s): Twenty-two studies (conducted between 1993 and 2017)
enrolling N = 2,235 post-cardiotomy extracorporeal membrane oxygenation
patients were found. Patients were mostly of non-emergency status (65.2%).
Overall in-hospital/30-day mortality event rate (95% confidence intervals)
was 66.7% (63.3-69.9%). There were no differences in in-hospital/30-day
mortality with respect to baseline surgical status in the subgroup
analysis (test for subgroup differences; p = 0.406). Similarly, no
differences between mortality in studies enrolling <50 versus 50% of
emergency/salvage cases was found: respective event rates were 66.9%
(63.1-70.4%) versus 64.4% (57.3-70.8%); p = 0.525. Yet, there was a
significant positive association between increasing percentage of
emergency/salvage cases and rates of neurological complications (p <
0.001), limb complications (p < 0.001), and bleeding (p = 0.051).
Incidence of brain death (p = 0.099) and sepsis (p = 0.134) was increased
as well. <br/>Conclusion(s): Other factors than baseline surgical status
may, to a higher degree, influence the mortality in patients treated with
extracorporeal membrane oxygenation for post-cardiotomy cardiogenic shock.
Baseline status, however, strongly influences the complication occurrence
while on extracorporeal membrane oxygenation.<br/>Copyright &#xa9; The
Author(s) 2019.

<28>
Accession Number
631379388
Title
Machine learning for screening prioritization in systematic reviews:
Comparative performance of Abstrackr and EPPI-Reviewer.
Source
Systematic Reviews. 9 (1) (no pagination), 2020. Article Number: 73. Date
of Publication: 02 Apr 2020.
Author
Tsou A.Y.; Treadwell J.R.; Erinoff E.; Schoelles K.
Institution
(Tsou, Treadwell, Erinoff, Schoelles) Center for Clinical Excellence and
Guidelines, ECRI Institute, Evidence-based Practice Center, 5200 Plymouth
Meeting, PA 19462-1298, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Improving the speed of systematic review (SR) development is
key to supporting evidence-based medicine. Machine learning tools which
semi-automate citation screening might improve efficiency. Few studies
have assessed use of screening prioritization functionality or compared
two tools head to head. In this project, we compared performance of two
machine-learning tools for potential use in citation screening.
<br/>Method(s): Using 9 evidence reports previously completed by the ECRI
Institute Evidence-based Practice Center team, we compared performance of
Abstrackr and EPPI-Reviewer, two off-the-shelf citations screening tools,
for identifying relevant citations. Screening prioritization functionality
was tested for 3 large reports and 6 small reports on a range of clinical
topics. Large report topics were imaging for pancreatic cancer, indoor
allergen reduction, and inguinal hernia repair. We trained Abstrackr and
EPPI-Reviewer and screened all citations in 10% increments. In Task 1, we
inputted whether an abstract was ordered for full-text screening; in Task
2, we inputted whether an abstract was included in the final report. For
both tasks, screening continued until all studies ordered and included for
the actual reports were identified. We assessed potential reductions in
hypothetical screening burden (proportion of citations screened to
identify all included studies) offered by each tool for all 9 reports.
<br/>Result(s): For the 3 large reports, both EPPI-Reviewer and Abstrackr
performed well with potential reductions in screening burden of 4 to 49%
(Abstrackr) and 9 to 60% (EPPI-Reviewer). Both tools had markedly poorer
performance for 1 large report (inguinal hernia), possibly due to its
heterogeneous key questions. Based on McNemar's test for paired
proportions in the 3 large reports, EPPI-Reviewer outperformed Abstrackr
for identifying articles ordered for full-text review, but Abstrackr
performed better in 2 of 3 reports for identifying articles included in
the final report. For small reports, both tools provided benefits but
EPPI-Reviewer generally outperformed Abstrackr in both tasks, although
these results were often not statistically significant.
<br/>Conclusion(s): Abstrackr and EPPI-Reviewer performed well, but
prioritization accuracy varied greatly across reports. Our work suggests
screening prioritization functionality is a promising modality offering
efficiency gains without giving up human involvement in the screening
process.<br/>Copyright &#xa9; 2020 The Author(s).

<29>
Accession Number
629030842
Title
A risk prediction model in asymptomatic patients with severe aortic
stenosis: CURRENT-AS risk score.
Source
European heart journal. Quality of care & clinical outcomes. 6 (2) (pp
166-174), 2020. Date of Publication: 01 Apr 2020.
Author
Minamino-Muta E.; Kato T.; Morimoto T.; Taniguchi T.; Ando K.; Kanamori
N.; Murata K.; Kitai T.; Kawase Y.; Miyake M.; Izumi C.; Mitsuoka H.; Kato
M.; Hirano Y.; Matsuda S.; Nagao K.; Murakami T.; Takeuchi Y.; Yamane K.;
Toyofuku M.; Ishii M.; Inoko M.; Ikeda T.; Ishii K.; Hotta K.; Jinnai T.;
Kato Y.; Inuzuka Y.; Maeda C.; Morikami Y.; Saito N.; Minatoya K.; Kimura
T.
Institution
(Minamino-Muta, Kato, Taniguchi, Matsuda, Saito, Kimura) Department of
Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54
Shogoin Kawahara-cho ,Sakyo-ku, Kyoto 606-8507, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
1-1 Mukogawa-cho, Hyogo 663-8501, Japan
(Ando) Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano,
Fukuoka 802-8555, Japan
(Kanamori) Division of Cardiology, Shimada Municipal Hospital, 1200-5
Noda, Shimada, Shizuoka 427-8502, Japan
(Murata) Department of Cardiology, Shizuoka City Shizuoka Hospital, 10-93
Otemachi, Shizuoka 420-8630, Japan
(Kitai) Department of Cardiovascular Medicine, Kobe City Medical Center
General Hospital, 2-1-1 Minatojimaminamimachi, Hyogo 650-0047, Japan
(Kawase) Department of Cardiovascular Medicine, Kurashiki Central
Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
(Miyake) Department of Cardiology, Tenri Hospital, Tenri, Japan
(Izumi) Division of Heart Failure, National Cerebral and Cardiovascular
Center, 200 Mishima-cho, Tenri, Nara 632-8555, Japan
(Mitsuoka) Division of Cardiology, Nara Hospital, Kinki University Faculty
of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293, Japan
(Kato) Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto
615-8087, Japan
(Hirano) Department of Cardiology, Kinki University Hospital, 377-2
Ohno-higashi, Sayama, Osaka 589-8511, Japan
(Nagao) Department of Cardiovascular Center, Osaka Red Cross Hospital,
Osaka 543-8555, Japan
(Murakami) Department of Cardiology, Koto Memorial Hospital, 2-1
Hiramatsu-cho, Shiga 527-0134, Japan
(Takeuchi) Department of Cardiology, Shizuoka General Hospital, 4-27-1
Kitaando-cho, Shizuoka 420-8257, Japan
(Yamane) Department of Cardiology, Nishikobe Medical Center, Nishi-ku,
Kobe 651-2273, Japan
(Toyofuku) Department of Cardiology, Japanese Red Cross Wakayama Medical
Center, 4-20 Komatsubara-dori, Wakayama 640-8558, Japan
(Ishii) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, 1-1 Fukakusamukaihata-cho ,Fushimi-ku, Kyoto 612-8555,
Japan
(Inoko) Cardiovascular Center, Tazuke Kofukai Medical Research Institute,
Kitano Hospital, 2-4-20 Ohgimachi ,Kita-ku, Osaka 530-8480, Japan
(Ikeda) Department of Cardiology, Hikone Municipal Hospital, Hikone, Shiga
522-8539, Japan
(Ishii) Department of Cardiology, Kansai Electric Power Hospital, 2-1-7
Fukushima, Fukushima-ku, Osaka 553-0003, Japan
(Hotta) Department of Cardiology, Hyogo Prefectural Amagasaki General
Medical Center, 2-17-77 Higashi-naniwa-cho, Amagasaki, Hyogo 660-8550,
Japan
(Jinnai) Department of Cardiology, Japanese Red Cross Otsu Hospital,
1-1-35 Nagara, Otsu, Shiga 520-0046, Japan
(Kato) Department of Cardiology, Saiseikai Noe Hospital, Osaka 536-0001,
Japan
(Inuzuka) Department of Cardiology, Shiga Medical Center for Adults, 5-4-3
Moriyama, Moriyama, Shiga 524-8524, Japan
(Maeda) Department of Cardiology, Hamamatsu Rosai Hospital, Higashi-ku, 25
Shogen-cho, Hamamatsu, Shizuoka 430-8525, Japan
(Morikami) Department of Cardiology, Hirakata Kohsai Hospital, Hirakata,
Osaka 573-0153, Japan
(Minatoya) Department of Cardiovascular Surgery, Kyoto University Graduate
School of Medicine, 54 Shogoin Kawahara-cho ,Sakyo-ku, Kyoto 606-8507,
Japan
Publisher
NLM (Medline)
Abstract
AIMS: Early aortic valve replacement (AVR) might be beneficial in selected
high-risk asymptomatic patients with severe aortic stenosis (AS),
considering their poor prognosis when managed conservatively. This study
aimed to develop and validate a clinical scoring system to predict
AS-related events within 1 year after diagnosis in asymptomatic severe AS
patients. METHODS AND RESULTS: We analysed 1274 asymptomatic severe AS
patients derived from a retrospective multicentre registry enrolling
consecutive patients with severe AS in Japan (CURRENT AS registry), who
were managed conservatively and completed 1-year follow-up without AVR.
From a randomly assigned derivation set (N=849), we developed CURRENT AS
risk score for the AS-related event (a composite of AS-related death and
heart failure hospitalization) within 1 year using a multivariable
logistic regression model. The risk score comprised independent risk
predictors including left ventricular ejection fraction <60%, haemoglobin
<=11.0g/dL, chronic lung disease (2 points), diabetes mellitus,
haemodialysis, and any concomitant valve disease (1 point). The predictive
accuracy of the model was good with the area under the curve of 0.79 and
0.77 in the derivation and validation sets (N=425). In the validation set,
the 1-year incidence of AS-related events was much higher in patients with
score >=2 than in patients with score <=1 (Score 0: 2.2%, Score 1: 1.9%,
Score 2: 13.4%, Score 3: 14.3%, and Score >=4: 22.7%, P<0.001).
<br/>CONCLUSION(S): The CURRENT-AS risk score integrating clinical and
echocardiographic factors well-predicted the risk of AS-related events at
1 year in asymptomatic patients with severe AS and was validated
internally.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2019. For
permissions, please email: journals.permissions@oup.com.

<30>
Accession Number
2005459747
Title
Meta-analysis Comparing Valve-In-Valve Transcatheter Aortic Valve
Implantation With Self-Expanding Versus Balloon-Expandable Valves.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Hamilton G.W.; Koshy A.N.; Fulcher J.; Tang G.H.L.; Bapat V.; Murphy A.;
Horrigan M.; Farouque O.; Yudi M.B.
Institution
(Hamilton, Koshy, Fulcher, Murphy, Horrigan, Farouque, Yudi) Department of
Cardiology, Austin Health, Melbourne, Victoria, Australia
(Koshy, Farouque, Yudi) Department of Medicine, The University of
Melbourne, Victoria, Australia
(Tang) Department of Cardiovascular Surgery, Mount Sinai Health System,
New York, NY, United States
(Bapat) Department of Cardiothoracic Surgery, New York Presbyterian
Hospital, Columbia University Medical Centre, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is an
alternative to redo-surgery in patients with failed surgical
bioprostheses. It remains unclear whether outcomes vary when using either
self-expanding (SE) or balloon-expandable (BE) valves. The aim of this
study was to compare outcomes between SE and BE transcatheter heart valves
when used for ViV TAVI. A systematic review of PubMed, MEDLINE, and EMBASE
was performed identifying studies reporting outcomes following ViV TAVI.
Event rates were pooled for meta-analysis using a random-effects model.
The primary outcome was all-cause mortality at 12 months. Secondary
outcomes included 30-day and 3-year mortality in addition to standard
safety outcomes after the procedure as per the Valve Academic Research
Consortium criteria. Nineteen studies reporting outcomes for 1,772
patients were included: 924 in the SE group and 848 patients in the BE
group. There was no significant difference in all-cause mortality at 12
months (SE 10.3% vs BE 12.6%, p = 0.165, I² = 0%), or 3 years
(SE 21.2% vs BE 31.2%, p = 0.407, I² = 63.79). SE valves had
lower transvalvular gradients after procedure and acute kidney injury, but
higher rates of pacemaker insertion, moderate or severe paravalvular
regurgitation and need for >=2 valves (all p < 0.05). There were no
differences in stroke, coronary obstruction, bleeding, or vascular
complications. Despite significant differences in key procedural outcomes
between SE and BE valves when used for ViV TAVI, we found no difference in
12-month mortality. Tailored device selection may further reduce the risk
of adverse procedural outcomes, particularly over the longer
term.<br/>Copyright &#xa9; 2020

<31>
Accession Number
2004400913
Title
Meta-analysis of results of subvalvular repair for severe ischemic mitral
regurgitation.
Source
Journal of Cardiac Surgery. 35 (4) (pp 886-896), 2020. Date of
Publication: 01 Apr 2020.
Author
Meco M.; Lio A.; Montisci A.; Panisi P.; Ferrarini M.; Miceli A.; Glauber
M.
Institution
(Meco, Panisi) Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo,
Italy
(Lio, Glauber) Department of Cardiac Surgery and Transplantation, S.
Camillo Hospital, Rome, Italy
(Lio, Montisci, Ferrarini, Miceli, Glauber) Cardiothoracic Center,
Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan,
Italy
(Montisci) University of Milan, Milan, Italy
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim of the Study: The aim of this meta-analysis was to
compare short- and long-term outcomes of patients undergoing mitral
annuloplasty (MA) with or without papillary muscle surgery (PMS) for the
treatment of ischemic mitral regurgitation (IMR). <br/>Method(s): A
systematic review and meta-analysis in accordance with the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
statement were performed. <br/>Result(s): Nine studies met the inclusion
criteria. This meta-analysis identified 478 patients: 228 patients
underwent MA alone and 250 patients underwent concomitant PMS. Early
mortality was similar between two groups (odds ratio [OR] 1.14, 95%
confidence interval [CI], 0.51-2.53; P =.75). PMS was associated at
follow-up with a higher freedom from cardiac-related events (P =.050);
moreover, although both surgical techniques had a positive impact on
ventricular remodeling, the PMS group showed a significant higher
reduction of left ventricle end-diastolic diameter (OR, 4.89, 95% CI,
2.77-7.01; P <.001) and left ventricle end-systolic diameter values (OR,
4.11, 95% CI, 1.98-6.24; P <.001). Finally, PMS compared with MA alone was
associated with a significant reduction of recurrent mitral regurgitation
at follow-up (OR, 3.25, 95% CI, 1.60-6.59; P =.001). <br/>Conclusion(s):
This meta-analysis demonstrated superiority in terms of ventricular
remodeling of a combined approach encompassing PMS and MA over MA alone in
IMR. Moreover, the association of subvalvular surgery with restrictive MA
decreases the incidence of mitral regurgitation recurrence and
cardiac-related events at follow-up.<br/>Copyright &#xa9; 2020 Wiley
Periodicals, Inc.

<32>
Accession Number
2004334320
Title
Mitral valve prosthesis choice in patients <70 years: A systematic review
and meta-analysis of 20 219 patients.
Source
Journal of Cardiac Surgery. 35 (4) (pp 818-825), 2020. Date of
Publication: 01 Apr 2020.
Author
Yanagawa B.; Lee J.; Ouzounian M.; Bagai A.; Cheema A.; Verma S.;
Friedrich J.O.
Institution
(Yanagawa, Lee, Verma) Divisions of Cardiac Surgery, St Michael's
Hospital, University of Toronto, Toronto, ON, Canada
(Ouzounian) Division of Cardiac Surgery, Toronto General Hospital,
University of Toronto, Toronto, ON, Canada
(Bagai, Cheema) Department of Cardiology, St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Friedrich) Department of Critical Care and Medicine, St Michael's
Hospital, University of Toronto, Toronto, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The optimal mitral prosthesis in young patients is unclear.
This systematic review and meta-analysis were performed to compare
outcomes between bileaflet mechanical mitral valve replacement (mMVR) and
bioprosthesis mitral valve replacement (bioMVR) for MVR patients aged less
than 70 years. <br/>Method(s): We searched MEDLINE and EMBASE databases
from inception to July 2018 for studies comparing surgical outcomes of
mMVR vs bioMVR. <br/>Result(s): There were 14 observational studies with
20 219 patients (n = 14 658 mMVR and n = 5561 bioMVR). Patients receiving
an mMVR were younger with fewer comorbidities including renal failure,
dialysis, and less-infective endocarditis (P <.001). The estimated 10-year
mortality ranged from 19% to 49% for mMVR and 22% to 58% for bioMVR among
studies. Comparing matched or adjusted data, mMVR was associated with
lower operative (risk ratio [RR]: 0.61; 95% confidence interval [CI]:
0.39, 0.94; P =.03) and long-term (HR: 0.81; 95% CI: 0.71, 0.92; P =.002)
mortality at a median follow-up of 8 years (IQR: 6-10 years). Estimated
10-year risk for mitral valve reoperation ranged from 0% to 8% for mMVR
and 8% to 22% for bioMVR among matched/adjusted studies. mMVR was
associated with lower matched/adjusted risk of reoperation (HR: 0.35; 95%
CI: 0.19, 0.65; P =.001) but with greater risk of bleeding (HR: 1.59; 95%
CI: 1.19, 2.13; P =.002) and a trend to greater risk of stroke and
embolism (HR: 1.70; 95% CI: 0.92, 3.15; P =.09). <br/>Conclusion(s):
Mechanical MVR in patients aged less than 70 years is associated with a
lower risk of operative mortality as well as a 20% lower risk of long-term
death and 65% lower risk of mitral valve reoperation but 60% greater risk
of bleeding compared with bioMVR in matched or adjusted
data.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<33>
Accession Number
2004171377
Title
Rivaroxaban in patients undergoing surgical mitral valve repair.
Source
Journal of Thrombosis and Thrombolysis. 49 (3) (pp 475-479), 2020. Date of
Publication: 01 Apr 2020.
Author
Noohi F.; Sadeghipour P.; Kordrostami S.; Shafe O.; Maleki M.; Kyavar M.;
Bakhshandeh H.; Rezaei Y.; Rokni M.; Moosavi J.; Amin A.; Tashakori
Beheshti A.; Hosseini S.
Institution
(Noohi, Kordrostami, Rezaei, Hosseini) Heart Valve Diseases Research
Center, Rajaie Cardiovascular, Medical, and Research Center, Iran
University of Medical Sciences, Vali-Asr Ave, Tehran 1995614331, Iran,
Islamic Republic of
(Noohi, Sadeghipour, Shafe, Maleki, Kyavar, Moosavi) Cardiovascular
Intervention Research Center, Rajaie Cardiovascular, Medical, and Research
Center, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Sadeghipour, Bakhshandeh) Clinical Trial Center, Rajaie Cardiovascular,
Medical, and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Bakhshandeh, Rokni, Amin, Tashakori Beheshti) Rajaie Cardiovascular,
Medical, and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Publisher
Springer
Abstract
In patients undergoing mitral valve repair (MVre), a 3-month course of
anticoagulation is currently recommended. The role of the non-vitamin K
antagonist oral anticoagulants has here been scarcely studied. In the
present mixed cohort study, the safety and efficacy of rivaroxaban
(prospective analysis) were compared with those of warfarin (retrospective
analysis) in patients undergoing MVre. Anticoagulation therapy was
continued for at least 3 months, and the patients were followed for 1 year
following surgery. The present study recruited 736 patients undergoing
MVre with or without concomitant coronary artery bypass or surgical repair
on the other valves. Concomitant valvular replacement and severe chronic
kidney diseases were the most important exclusion criteria. The final
analysis was conducted on 153 patients treated with rivaroxaban and 144
patients treated with warfarin. Dissimilarities in baseline
characteristics necessitated propensity score matching, in which 104
patients in each group were compared. No major bleeding or cerebrovascular
accident occurred during the 1-year follow-up. Clinically relevant
non-major bleeding was reported in 2 patients in the rivaroxaban group and
4 patients in the warfarin group, a difference non-statistically
significant before and after propensity score matching (P = 0.371 and P =
0.407, respectively). The type of anticoagulation did not predict the
1-year outcome (HR 2.165, 95% CI 0.376 to 12.460; P = 0.387). In this
mixed cohort study, rivaroxaban was both safe and efficient in patients
with MVre. Such preliminary results should prompt larger randomized
controlled trials.<br/>Copyright &#xa9; 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<34>
Accession Number
2004088178
Title
The prophylactic use of fibrinogen concentrate in high-risk cardiac
surgery.
Source
Acta Anaesthesiologica Scandinavica. 64 (5) (pp 602-612), 2020. Date of
Publication: 01 May 2020.
Author
Kwapisz M.M.; Kent B.; DiQuinzio C.; LeGare J.-F.; Garnett S.; Swyer W.;
Whynot S.; Mingo H.; Scheffler M.
Institution
(Kwapisz, Kent, DiQuinzio, Garnett, Whynot, Mingo, Scheffler) Department
of Anesthesia, Pain Management and Perioperative Medicine, Queen Elizabeth
II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
(LeGare) Department of Surgery, Division of Cardiac Surgery, New Brunswick
Heart Centre, Saint John, NB, Canada
(Swyer) Department of Surgery, Perfusion Services, Queen Elizabeth II
Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Perioperative blood loss is a major contributor to morbidity
and mortality in cardiac surgery. Plasma fibrinogen levels play an
essential role in hemostasis and deplete quickly during hemorrhage. The
objective of this study was to determine whether prophylactic fibrinogen
concentrate administration lowers overall blood product transfusion
requirements in high-risk cardiac surgery in patients with low fibrinogen
plasma levels. <br/>Method(s): The study was performed in a prospective,
randomized, and double-blinded design. The investigation included 62
patients undergoing elective, high-risk cardiac surgery. After weaning
from cardiopulmonary bypass and reversal of heparin patients received
either fibrinogen concentrate or placebo. The primary outcome variable was
overall blood product usage 24 hours after intervention. <br/>Result(s):
The fibrinogen group received numerically fewer total units of blood
products than the placebo group, but the difference was not statistically
or clinically significant (for groups n = 27; n = 29 and 19 vs 37 units,
respectively, P =.908). The overall transfusion rate in both groups was
significantly lower than the institutional average suggested (fibrinogen
group 26%, placebo group 28%). The fibrinogen group showed significantly
higher fibrinogen levels (2.38 vs 1.83 g/L (end of surgery), P <.001; 3.33
vs 2.68 g/L (12 hours after intervention), P =.003) and improved
viscoelastic coagulation parameters (FIBTEM MCF, 27 vs 23 mm, P =.022).
<br/>Conclusion(s): This randomized, controlled trial demonstrates that
point-of-care guided and prophylactic treatment with fibrinogen
concentrate does not reduce transfusion of blood products in a setting of
unexpectedly low transfusion rate as tested in this cohort, but may
improve coagulation parameters in the setting of high-risk cardiac
surgery.<br/>Copyright &#xa9; 2019 The Acta Anaesthesiologica Scandinavica
Foundation. Published by John Wiley & Sons Ltd

<35>
Accession Number
2003829240
Title
Preemptive Anti-Stress Response Effects of Oxycodone Versus Sufentanil for
Patients Undergoing Cardiac Valve Replacement-A Randomized Controlled
Trial.
Source
Clinical Pharmacology in Drug Development. 9 (3) (pp 321-329), 2020. Date
of Publication: 01 Apr 2020.
Author
Zhang J.; Tu Q.; Gan J.; Miao S.; Zhou Y.; Li Q.; Zheng C.
Institution
(Zhang) Department of Anesthesiology, Sichuan Provincial Hospital for
Women and Children/Affiliated Women and Children's Hospital of Chengdu
Medical College, Chengdu, China
(Tu) Department of Anesthesiology, Shanghai General Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China
(Gan) Department of Anesthesiology, Tangshan People's Hospital, Tangshan,
China
(Miao) Department of Anesthesiology, Wuxi People's Hospital, Nanjing
Medical University, Wuxi, China
(Zhou, Li, Zheng) Department of Anesthesiology, the Third People's
Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China
Publisher
Blackwell Publishing Ltd
Abstract
Patients undergoing cardiac valve replacement may experience
cardiovascular adverse events during the preoperative period before
anesthesia. The study was to compare the preemptive anti-stress response
effects of oxycodone versus sufentanil for patients undergoing cardiac
valve replacement. Ninety-four patients were enrolled and assigned to
group Oxy, group Suf and group NS. Patients in group Oxy were
administrated with oxycodone 0.1 mg/kg, group Suf received sufentanil 0.1
mug/kg and group NS were given equivalent volume of normal saline. The
primary outcomes included serum levels of cortisol, norepinephrine, and
adrenaline. The secondary outcomes involved bispectral index value and the
observer's assessment of awareness/sedation grade, levels of mean arterial
pressure, heart rate, and the adverse reactions. Compared to group NS, the
serum levels of cortisol at T<inf>1</inf> to T<inf>5</inf> (P <.05), and
levels of norepinephrine and adrenaline at T<inf>3</inf> to T<inf>5</inf>
(P <.05) in group Oxy and Suf were lower. The bispectral index value and
observer's assessment of awareness/sedation grade T<inf>1</inf> to
T<inf>2</inf> (P <.05) in group Suf were lower than those in group Oxy and
NS. Compared with group NS, the levels of mean arterial pressure and heart
rate in group Oxy and Suf at T<inf>3</inf> to T<inf>5</inf> (P <.05) were
lower. The incidence of coughing was significantly higher in group Suf
(23.3%), but not in group NS (6.7%), than that in group Oxy (3.3%). The
preemptive analgesia of oxycodone may be used to inhibit the stress
response, without leading to excessive sedation and respiratory
depression, which may also help to stabilize hemodynamics during
preoperative period.<br/>Copyright &#xa9; 2019, The American College of
Clinical Pharmacology

<36>
Accession Number
630361971
Title
Discharge Education Intervention to Reduce Anxiety and Depression in
Cardiac Surgery Patients: A Randomized Controlled Study.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. 35 (2) (pp 185-192), 2020. Date of
Publication: 01 Apr 2020.
Author
Yaman Aktas Y.; Gok Ugur H.; Orak O.S.
Institution
(Yaman Aktas) Department of Surgical Nursing, Faculty of Health Sciences,
Giresun University, Giresun, Turkey
(Gok Ugur) Department of Public Health Nursing, Faculty of Health
Sciences, Ordu University, Ordu, Turkey
(Orak) Department of Psychiatric Nursing, Faculty of Health Sciences,
Ondokuz Mayis University, Samsun, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: This study aimed to determine possible effects of a discharge
education intervention on anxiety and depression among cardiac surgery
patients in a private hospital in the city of Ordu, Turkey. DESIGN: A
randomized controlled trial. <br/>METHOD(S): Thirty-three patients were
placed in standard care group and 33 into standard care plus discharge
education group. Patients in the discharge education group were provided
an individual training from the first day of the hospital admission until
the day of the discharge. The standard care group received usual discharge
instructions. FINDINGS: The Hospital Anxiety and Depression Scale-anxiety
subscale scores were not significantly different between patients in the
discharge and standard care groups (group: F = 1.58; P > .05). There was a
significant difference for depression, indicating that the discharge
education group had significantly lower depression than the standard care
group (group: F = 19.23; P < .01). <br/>CONCLUSION(S): Our findings
supported that the discharge education intervention reduced depression in
cardiac surgery patients.<br/>Copyright &#xa9; 2019 American Society of
PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

<37>
Accession Number
631443460
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention in unprotected left main coronary artery disease: A
systematic review.
Source
Reviews in cardiovascular medicine. 21 (1) (pp 65-73), 2020. Date of
Publication: 30 Mar 2020.
Author
Macovei L.; Magopet R.; Tanasa A.; Raileanu C.; Prisacariu C.; Presura
M.R.; Balasanian M.O.
Institution
(Macovei, Magopet, Tanasa, Raileanu, Prisacariu, Balasanian) Institute of
Cardiovascular Diseases "Prof. dr. George I.M. Georgescu", Iasi 700503,
Romania
(Macovei, Tanasa, Prisacariu, Balasanian) University of Medicine and
Pharmacy "Grigore T. Popa", Iasi 700115, Romania
(Presura) Cardiology Clinic of Piatra Neamt General Hospital, Neamt
610136, Romania
Publisher
NLM (Medline)
Abstract
Critical lesion of the unprotected left main coronary disease carries a
tremendous mortality burden, often associated with a diabetes status or
multivessel disease, with coronary artery bypass grafting being the
standard treatment for over 40 years. Percutaneous coronary intervention
with drug eluting stents should be taken into consideration and could be a
better option for patients with low SYNTAX score as validated by the
recently published studies. This review summarizes the major randomized
clinical trials and meta-analyses concerning the debate regarding
percutaneous coronary intervention with drug eluting stents versus
coronary artery bypass grafting for unprotected left main coronary
disease, along with the latest European and American revascularization
guidelines and tries to shed light on this matter. The most results
advocate that there is no convincing difference in survival rate for both
therapies, especially in patients with isolated left main disease but with
fewer major ischemic events for coronary artery bypass grafting when
compared with percutaneous coronary intervention in multivessel coronary
artery disease, at the rate of a higher stroke incidence. The gaps in
evidence are also highlighted, especially the lack of randomized clinical
trials with new generation drug eluting stents versus coronary artery
bypass grafting or those regarding the best revascularization strategy for
an acute coronary syndrome when unprotected left main coronary disease is
involved.<br/>Copyright &#xa9; 2020 Macovei et al. Published by IMR press.

<38>
Accession Number
2004134612
Title
The effect of hypoalbuminema on postoperative mortality and morbidity in
open heart surgery.
Source
International Journal of Clinical and Experimental Medicine. 13 (3) (pp
1704-1711), 2020. Article Number: IJCEM0101994. Date of Publication: 2020.
Author
Ozyaprak B.; Kahraman N.
Institution
(Ozyaprak) Department of Anesthesiology and Reanimation, Bursa Yuksek
Ihtisas Training and Research Hospital, Health Sciences University, Bursa,
Turkey
(Kahraman) Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas
Training and Research Hospital, Health Sciences University, Bursa, Turkey
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Introduction: Hypoalbuminemia is a key factor which increases mortality
and morbidity among various patient groups. The aim of this study is to
evaluate the effects of hypoalbuminemia on the postoperative mortality and
morbidity in open heart surgery patients and contribute to the literature.
<br/>Material(s) and Method(s): This retrospective study was conducted on
patients who had open heart surgery with cardiopulmonary bypass in our
clinic between 1 April 2014 and 31 March 2017. Ethical approval was
obtained in accordance with the guidelines of Declaration of Helsinki. In
total, 52 patients in Group 1 and 47 patients in Group 2 were randomly
selected. The preoperative serum albumin levels of the patients in Group 1
were 3.5 g/dL and higher. The preoperative serum albumin levels of the
patients in Group 2 were lower than 3.5 g/dL. <br/>Result(s): There was no
statistically significant difference between the groups with regards to
age, gender, ejection fraction and Europe Cardicac Operational Risk
Evaluation System scores (EuroSCORE). Any significant difference was not
found in terms of intraoperative findings among the groups. Mean time
until extubation, length of stay in the intensive care unit (ICU) and
hospitalization duration of Group 1 were significantly shorter than group
2 (intubation duration: 8.46+/-2.01 hours vs. 9.23+/-2.25 hours, P=0.032,
ICU stay: 50.75+/-10.01 hours vs. 62.15+/-13.57 hours, P<0.001 and
post-operative hospitalization: 7.83+/-0.94 days vs. 8.47+/-1.56 days,
P=0.047, respectively). Arrythmia incidences of Groups 1 and 2 were 5.8%
and 21.3%, respectively (P=0.023). Group 1 received significantly less
blood transfusions than Group 2 (Erythrocyte Suspension Transfusion:
1.62+/-0.87 Units vs 2.72+/-0.95 Units, P<0.001 and Fresh Frozen Plasma
Transfusion: 1.29+/-0.78 Units vs 3.40+/-1.21 Units, P<0.001,
respectively). During the postoperative period, serum albumin and
hematocrit values of both groups decreased significantly (P<0.001) while
blood creatinine levels increased, which was significant in the
hypoalbuminemia group only (P<0.001). <br/>Conclusion(s): Hypoalbuminemia
may negatively affect postoperative prognosis. We believe that providing
necessary nutritional support to hypoalbuminemic patients due for open
heart surgery may contribute to shortening the time until extubation, ICU
length of stay and duration of hospitalization as well as decreasing blood
transfusions and postoperative morbidity and mortality.<br/>Copyright
&#xa9; 2020, E-Century Publishing Corporation. All rights reserved.

<39>
Accession Number
2004133279
Title
Anxiety administrated by dexmedetomidine to prevent new-onset of
postoperative atrial fibrillation in patients undergoing off-pump coronary
artery bypass graft.
Source
International Heart Journal. 61 (2) (pp 263-272), 2020. Date of
Publication: 2020.
Author
Zi J.; Fan Y.; Dong C.; Zhao Y.; Li D.; Tan Q.
Institution
(Zi, Dong, Zhao, Li, Tan) Department of Cardiovascular Surgery, Shandong
Provincial Hospital Affiliated to Shandong First Medical University,
Jinan, China
(Zi, Dong, Zhao, Li, Tan) Department of Cardiovascular Surgery, Shandong
Provincial Hospital Affiliated to Shandong University, Jinan, China
(Fan) Department of Toxicological and Functional Test, Shandong Centers
for Disease Control and Prevention, Jinan, China
Publisher
International Heart Journal Association (E-mail: : jhj-office@umin.ac.jp)
Abstract
This study aims to evaluate the effect of dexmedetomidine (DEX) sedation
for relieving anxiety and the incidence of atrial fibrillation (AF) after
off-pump coronary artery bypass graft (OPCABG). This randomized,
double-blind, controlled trial was conducted on 196 patients who underwent
OPCABG in Shandong Provincial Hospital from July 2017 to June 2018. The
patients were randomly assigned to two groups, intervention of DEX group
and Propofol (PROP) group. Episodes of postoperative AF (POAF) were
identified within 5 days after OPCABG. Perioperative anxiety status was
assessed using Zung's Self-Rating Anxiety Scale (SAS). The baseline
demographic and surgical characteristics of the population and other
outcome variables were evaluated. We analyzed 62 patients in the DEX group
and 61 patients in the PROP group. There was no significant difference in
SAS anxiety scores between two groups before surgery (P = 0.104), while
SAS had significantly after surgery (P = 0.018). The incidence of POAF in
the DEX group was lower than that of the PROP group (16.1% versus 32.8%, P
= 0.037), and a total of 30 patients (30/123, 24.4%) manifested POAF after
OPCABG. Some univariable predictors of POAF were detected. The conceptual
model of mediator analyses showed DEX was not only directly related to
POAF but was also indirectly related through the independent effect of
anxiety level. The findings indicated that patients receiving DEX were
more likely to have less incidence of POAF, also uniquely showed DEX
administration and POAF processes as a function of anxiety
status.<br/>Copyright &#xa9; 2020, International Heart Journal
Association. All rights reserved.

<40>
[Use Link to view the full text]
Accession Number
631402592
Title
Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in
Surgical Patients: Results from a Systematic Review and Meta-analysis.
Source
Anesthesia and Analgesia. 128 (5) (pp 981-992), 2019. Date of Publication:
2019.
Author
Cho B.C.; Serini J.; Zorrilla-Vaca A.; Scott M.J.; Gehrie E.A.; Frank
S.M.; Grant M.C.
Institution
(Cho, Frank, Grant) Department of Anesthesiology/Critical Care Medicine,
Johns Hopkins Medical Institutions, Baltimore, MD, United States
(Serini) Department of Anesthesiology/Critical Care Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, United States
(Zorrilla-Vaca) Universidad Del Valle School of Medicine, Cali, Colombia
(Scott) Department of Anesthesiology, Virginia Commonwealth University
School of Medicine, Richmond, VA, United States
(Gehrie) Departments of Pathology, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
(Grant) Departments of Surgery, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Erythropoietic-stimulating agents such as erythropoietin have
been used as part of patient blood management programs to reduce or even
avoid the use of allogeneic blood transfusions. We review the literature
to evaluate the effect of preoperative erythropoietin use on the risk of
exposure to perioperative allogeneic blood transfusions. <br/>METHOD(S):
The study involved a systematic review and meta-analysis of randomized
controlled trials evaluating the use of preoperative erythropoietin. The
primary outcome was the reported incidence of allogeneic red blood cell
transfusions during inpatient hospitalizations. Secondary outcomes
included phase-specific allogeneic red blood cell transfusions (ie,
intraoperative, postoperative), intraoperative estimated blood loss,
perioperative hemoglobin levels, length of stay, and thromboembolic
events. <br/>RESULT(S): A total of 32 randomized controlled trials (n =
4750 patients) were included, comparing preoperative erythropoietin (n =
2482 patients) to placebo (n = 2268 patients). Preoperative erythropoietin
is associated with a significant decrease in incidence of allogeneic blood
transfusions among all patients (n = 28 studies; risk ratio, 0.59; 95% CI,
0.47-0.73; P <.001) as well as patients undergoing cardiac (n = 9 studies;
risk ratio, 0.55; 95% CI, 0.37-0.81; P =.003) and elective orthopedic (n =
5 studies; risk ratio, 0.36; 95% CI, 0.28-0.46; P <.001) surgery compared
to placebo, respectively. Preoperative erythropoietin was also associated
with fewer phase-specific red blood cell transfusions. There was no
difference between groups in incidence of thromboembolic events (n = 28
studies; risk ratio, 1.02; 95% CI, 0.78-1.33; P =.68). <br/>CONCLUSION(S):
Preoperative erythropoietin is associated with a significant reduction in
perioperative allogeneic blood transfusions. This finding is also
confirmed among the subset of patients undergoing cardiac and orthopedic
surgery. Furthermore, our study demonstrates no significant increase in
risk of thromboembolic complications with preoperative erythropoietin
administration.<br/>Copyright &#xa9; 2020 American Society of Civil
Engineers (ASCE). All rights reserved.

<41>
Accession Number
631123962
Title
'Organisation of delivery of care in operating suite recovery rooms within
48 hours postoperatively and patient outcomes after adult non-cardiac
surgery: A systematic review'.
Source
BMJ Open. 10 (3) (no pagination), 2020. Article Number: e027262. Date of
Publication: 04 Mar 2020.
Author
Lloyd C.; Ludbrook G.; Story D.; Maddern G.
Institution
(Lloyd, Ludbrook) Faculty of Health and Medical Sciences, University of
Adelaide, Adelaide, SA, Australia
(Story) Perioperative and Pain Medicine Unit, Melbourne Medical School,
University of Melbourne, Parkville, VIC, Australia
(Maddern) Discipline of Surgery, Faculty of Health and Medical Sciences,
University of Adelaide, Adelaide, SA, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Context Postoperative recovery rooms have existed since 1847, however,
there is sparse literature investigating interventions undertaken in
recovery, and their impact on patients after recovery room discharge.
Objective This review aimed to investigate the organisation of care
delivery in postoperative recovery rooms; and its effect on patient
outcomes; including mortality, morbidity, unplanned intensive care unit
(ICU) admission and length of hospital stay. Data sources NCBI PubMed,
EMBASE and Cumulative Index to Nursing and Allied Health Literature. Study
selection Studies published since 1990, investigating health system
initiatives undertaken in postoperative recovery rooms. One author
screened titles and abstracts, with two authors completing full-text
reviews to determine inclusion based on predetermined criteria. A total of
3288 unique studies were identified, with 14 selected for full-text
reviews, and 8 included in the review. Data extraction EndNote V.8
(Clarivate Analytics) was used to manage references. One author extracted
data from each study using a data extraction form adapted from the
Cochrane Data Extraction Template, with all data checked by a second
author. Data synthesis Narrative synthesis of data was the primary outcome
measure, with all data of individual studies also presented in the summary
results table. Results Four studies investigated the use of the
postanaesthesia care unit (PACU) as a non-ICU pathway for postoperative
patients. Two investigated the implementation of physiotherapy in PACU,
one evaluated the use of a new nursing scoring tool for detecting patient
deterioration, and one evaluated the implementation of a two-track
clinical pathway in PACU. Conclusions Managing selected postoperative
patients in a PACU, instead of ICU, does not appear to be associated with
worse patient outcomes, however, due to the high risk of bias within
studies, the strength of evidence is only moderate. Four of eight studies
also examined hospital length of stay; two found the intervention was
associated with decreased length of stay and two found no association.
PROSPERO registration number This protocol is registered on the
International Prospective Register of Systematic Reviews (PROSPERO)
database, registration number CRD42018106093.<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.

<42>
[Use Link to view the full text]
Accession Number
631072587
Title
The effect of intravenous magnesium on postoperative morphine consumption
in noncardiac surgery: A systematic review and meta-analysis with trial
sequential analysis.
Source
European Journal of Anaesthesiology. 37 (3) (pp 212-223), 2020. Date of
Publication: 01 Mar 2020.
Author
Ng K.T.; Yap J.L.L.; Izham I.N.; Teoh W.Y.; Kwok P.E.; Koh W.J.
Institution
(Ng) Department of Anaesthesiology, Faculty of Medicine, University of
Malaya, Jalan Universiti, Kuala Lumpur 50603, Malaysia
(Yap, Izham, Kwok) Department of Medicine, International Medical
University, Kuala Lumpur, Malaysia
(Teoh) Department of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Koh) Department of Dental Health, International Medical University, Kuala
Lumpur, Malaysia
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUNDSeveral studies suggest that systemic magnesium reduces
postoperative opioid consumption and the intensity of pain, but others
report conflicting results. The efficacy and safety profile of intravenous
magnesium in noncardiac surgery remain uncertain.OBJECTIVESThe aim of this
review was to investigate the effect of intravenous magnesium on the
consumption of postoperative morphine in the first 24h in adults
undergoing noncardiac surgery.DESIGNSystematic review and meta-analysis
with trial sequential analysis.DATA SOURCESMEDLINE, EMBASE, CENTRAL from
their inception until January 2019.ELIGIBILITY CRITERIAAll randomised
clinical trials comparing intravenous magnesium versus placebo in
noncardiac surgery were systematically searched in the databases.
Observational studies, case reports, case series and nonsystematic reviews
were excluded.RESULTSFifty-one trials (n=3311) were included for
quantitative meta-analysis. In comparison with placebo, postoperative
morphine consumption at 24-h was significantly reduced in the magnesium
group, with a mean difference [95% confidence interval (CI)] of -5.6mg
(-7.54 to -3.66, P<0.001, I²=92%, level of evidence low). The
trial sequential analysis for the effect of magnesium on postoperative
morphine consumption was conclusive. Patients who received magnesium had a
longer time to the first analgesia request [143 (103 to 183)min, P<0.001,
I²=99%, level of evidence low] and a lower incidence of
shivering [0.26 (0.15 to 0.44), P<0.001, I²=35%, level of
evidence very low]. However, no significance differences were demonstrated
in postoperative pain scores in the first 24h (mean difference, 95% CI)
-0.30 (-0.69 to 0.09, P=0.13, I²=91%, level of evidence low),
bradycardia (odds ratio, 95% CI) 1.13 (0.43 to 2.98, P=0.80,
I²=35%, level of evidence very low) and postoperative nausea
and vomiting (odds ratio, 95% CI) 0.90 (0.67 to 1.22, P=0.49,
I²=25%, level of evidence moderate).CONCLUSIONThe current
meta-analysis demonstrates that the use of intravenous magnesium as part
of multimodal analgesia may reduce morphine consumption in the first 24h
after surgery and delay the time to the first request for analgesia in
patients undergoing noncardiac surgery. However, the included studies were
of low-quality with substantial heterogeneity.TRIAL
REGISTRATIONCRD42018086846.<br/>Copyright &#xa9; 2019 European Society of
Anaesthesiology. All rights reserved.

<43>
Accession Number
631385902
Title
Assessing efficacy of CytoSorb haemoadsorber for prevention of organ
dysfunction in cardiac surgery patients with infective endocarditis:
REMOVE-protocol for randomised controlled trial.
Source
BMJ Open. 10 (3) (no pagination), 2020. Article Number: e031912. Date of
Publication: 30 Mar 2020.
Author
Diab M.; Platzer S.; Guenther A.; Sponholz C.; Scherag A.; Lehmann T.;
Velichkov I.; Hagel S.; Bauer M.; Brunkhorst F.M.; Doenst T.
Institution
(Diab, Velichkov, Doenst) Department of Cardiothoracic Surgery, Jena
University Hospital-Friedrich Schiller University of Jena, Jena,
Thuringia, Germany
(Diab, Platzer, Scherag, Lehmann, Hagel, Bauer, Brunkhorst) Center for
Sepsis Control and Care, Jena University Hospital-Friedrich Schiller
University, Jena, Thuringia, Germany
(Guenther) Department of Neurology, Jena University Hospital-Friedrich
Schiller University of Jena, Jena, Thuringia, Germany
(Sponholz, Bauer, Brunkhorst) Department of Anaesthesiology and Critical
Care Medicine, Jena University Hospital-Friedrich Schiller University of
Jena, Jena, Thuringia, Germany
(Scherag, Brunkhorst) Center of Clinical Studies, Jena University
Hospital-Friedrich Schiller University of Jena, Jena, Thuringen, Germany
(Scherag) Institute of Medical Statistics, Computer and Data Sciences,
Jena University Hospital-Friedrich Schiller University, Jena, Thuringia,
Germany
(Hagel) Center for Infectious Diseases and Infection Control, Jena
University Hospital-Friedrich Schiller University, Jena, Thuringia,
Germany
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Infective endocarditis (IE) is associated with high mortality
and morbidity. Multiple organ failure is the main cause of death after
surgery for IE. Cardiopulmonary bypass (CPB) can cause a systemic
inflammatory response. In a pilot study (REMOVE-pilot (Revealing
mechanisms and investigating efficacy of hemoad-sorption for prevention of
vasodilatory shock in cardiac surgery patients with infective
endocarditis-a multicentric randomized controlled group sequential
trial)), we found that plasma profiles of cytokines during and after CPB
were higher in patients with IE compared with patients with non-infectious
valvular heart disease. Sequential Organ Failure Assessment (SOFA) scores
on the first and second postoperative days and in-hospital mortality were
also higher in IE patients. This protocol describes the design of the
REMOVE trial on cytokine-adsorbing columns, for example, CytoSorb, for
non-selective removal of cytokines. The aim of the REMOVE study is to
demonstrate efficacy of CytoSorb on the prevention of multiorgan
dysfunction in patients with IE undergoing cardiac surgery. Methods and
analysis The REMOVE study is an interventional randomised controlled
multicenter trial with a group sequential (Pocock) design for assessing
efficacy of CytoSorb in patients undergoing cardiac surgery for IE. The
change in mean total SOFA (DELTA SOFA) score between preoperative and
postoperative care will be used as primary endpoint. Data on 30-day
mortality, changes in cytokines levels, duration of mechanical
ventilation, length of intensive care unit and hospital stay, and
postoperative stroke will be collected as secondary endpoints. An interim
analysis will be conducted after including 25 participating patients per
study arm (with a focus on feasibility of the recruitment as well as
differences in cytokines and cell-free DNA levels). Ethics and
dissemination The protocol was approved by the institutional review board
and ethics committee of the University of Jena as well as by the
corresponding ethics committee of each participating study centre. The
results will be published in a renowned international medical journal,
irrespective of the outcomes of the study. Trial registration number The
ClinicalTrials.gov registry (NCT03266302).<br/>Copyright &#xa9; &#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.

<44>
Accession Number
2005197866
Title
Impact of ultrasound-guided erector spinae plane block on postoperative
quality of recovery in video-assisted thoracic surgery: A prospective,
randomized, controlled trial.
Source
Journal of Clinical Anesthesia. 63 (no pagination), 2020. Article Number:
109783. Date of Publication: August 2020.
Author
Yao Y.; Fu S.; Dai S.; Yun J.; Zeng M.; Li H.; Zheng X.
Institution
(Yao, Dai, Zeng, Li, Zheng) Department of Anesthesiology, Shengli Clinical
Medical College of Fujian Medical University, Fuzhou, China
(Fu) Department of Pathology, Union Hospital of Fujian Medical University,
Fuzhou, Fujian, China
(Yun) The 95th Clinical Department, The 900th Hospital of Joint Service
Support Force of the PLA, Putian, China
(Zheng) Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou,
China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: Regional anesthesia improves postoperative analgesia and
enhances the quality of recovery (QoR) after surgery. We examine the
efficacy of ultrasound-guided erector spinae plane block (ESPB) on QoR
after video-assisted thoracic surgery (VATS). <br/>Design(s): Prospective,
randomized, double-blinded, placebo-controlled trial. <br/>Setting(s):
Single institution, tertiary university hospital. <br/>Patient(s): Adult
patients who scheduled for VATS under general anesthesia were enrolled in
the study. <br/>Intervention(s): We randomly allocated patients to receive
preoperative ultrasound-guided ESPB with 25 ml of either 0.5% ropivacaine
(ESPB group) or normal saline (Control group). Measurements: The primary
outcome was QoR as measured by the 40-item QoR questionnaire (QoR-40)
score at postoperative day 1. Secondary results were post-anesthesia care
unit (PACU) discharge time, acute postoperative pain, cumulative opioid
consumption, the incidence of postoperative nausea or vomiting (PONV), and
patient satisfaction. <br/>Main Result(s): The global QoR-40 score at
postoperative day 1 (median, interquartile range) was significantly higher
in the ESPB group (174, 170 to 177) than the control group (161.5, 160 to
165), estimated median difference 11 (95% CI 9 to 13, P < 0.001). Compared
with the control group, single-injection of ESPB reduced PACU discharge
time, acute postoperative pain, and cumulative opioid consumption.
Correspondingly, the median patient satisfaction scores were higher in the
ESPB group than the control group (9 versus 7, P < 0.001).
<br/>Conclusion(s): Preoperative single-injection thoracic ESPB with
ropivacaine improves QoR, postoperative analgesia, and patient
satisfaction after VATS.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<45>
Accession Number
2005182617
Title
Effects of Preoperative HbA1c Levels on the Postoperative Outcomes of
Coronary Artery Disease Surgical Treatment in Patients with Diabetes
Mellitus and Nondiabetic Patients: A Systematic Review and Meta-Analysis.
Source
Journal of Diabetes Research. 2020 (no pagination), 2020. Article Number:
3547491. Date of Publication: 2020.
Author
Wang J.; Luo X.; Jin X.; Lv M.; Li X.; Dou J.; Zeng J.; An P.; Chen Y.;
Chen K.; Mu Y.
Institution
(Wang, Jin, Li, Dou, Zeng, An, Chen, Mu) Department of Endocrinology,
Chinese PLA General Hospital, Beijing 100853, China
(Wang, Zeng) Departmentof Endocrinology, South Hospital District, Fifth
Medical Center of PLA General Hospital, Beijing 100071, China
(Luo, Lv) School of Public Health, Lanzhou University, Lanzhou 730000,
China
(Luo, Chen) Evidence-Based Medicine Center, Basic Medical Sciences,
Lanzhou University, Lanzhou 730000, China
(Luo, Chen) Key Laboratory of Evidence Based Medicine and Knowledge
Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
(Luo, Chen) WHO Collaborating Centre for Guideline Implementation and
Knowledge Translation, Lanzhou 730000, China
(Li) Department of Gerontology, First Affiliated Hospital of Kunming
Medical University, Kunming 650031, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Aims. To investigate the effect of preoperative HbA1c levels on the
postoperative outcomes of coronary artery disease surgery in diabetic and
nondiabetic patients. Methods and Results. The MEDLINE (via PubMed),
Cochrane Library, Web of Science, Embase, Wanfang Data, China National
Knowledge Infrastructure (CNKI), and Chinese Biology Medicine (CBM)
databases were used to search the effects of different preoperative HbA1c
levels on the postoperative outcomes of coronary artery disease surgical
treatment in diabetic and nondiabetic patients from inception to December
2018. Two review authors worked in an independent and duplicate manner to
select eligible studies, extract data, and assess the risk of bias of the
included studies. We used a meta-analysis to synthesize data and analyze
subgroups, sensitivity, and publication bias as well as the GRADE
methodology if appropriate. The literature search retrieved 886 records
initially, and 23 cohort studies were included in the meta-analysis. In
this meta-analysis, we found that there was a reduced incidence of
surgical site infections (OR=2.94, 95% CI 2.18-3.98), renal failure events
(OR=1.63, 95% CI 1.13-2.33), and myocardial infarction events (OR=1.69,
95% CI 1.16-2.47), as well as a shortened hospital stay (MD=1.08, 95% CI
0.46-1.71), in diabetic patients after coronary artery disease surgical
treatment with lower preoperative HbA1c levels. For nondiabetic patients,
a higher preoperative HbA1c level resulted in an increase in the incidence
of mortality (OR=2.23, 95% CI 1.01-4.90) and renal failure (OR=2.33, 95%
CI 1.32-4.12). No significant difference was found between higher and
lower preoperative HbA1c levels in the incidence of mortality (OR=1.06,
95% CI 0.88-1.26), stroke (OR=1.49, 95% CI 0.94-2.37), or atrial
fibrillation (OR=0.94, 95% CI 0.67-1.33); the length of ICU stay (MD=0.20,
95% CI-0.14-0.55); or sepsis incidence (OR=2.49, 95% CI 0.99-6.25) for
diabetic patients or for myocardial infarction events (OR=1.32, 95% CI
0.27-6.31) or atrial fibrillation events (OR=0.99, 95% CI 0.74-1.33) for
nondiabetic patients. The certainty of evidence was judged to be moderate
or low. Conclusion. This meta-analysis showed that higher preoperative
HbA1c levels may potentially increase the risk of surgical site
infections, renal failure, and myocardial infarction and reduce the length
of hospital stay in diabetic subjects after coronary artery disease
surgical treatment and increase the risk of mortality and renal failure in
nondiabetic patients. However, there was great inconsistency in defining
higher preoperative HbA1c levels in the studies included; we still need
high-quality RCTs with a sufficiently large sample size to further
investigate this issue in the future. This trial is registered with
CRD42019121531.<br/>Copyright &#xa9; 2020 Jinjing Wang et al.

<46>
Accession Number
2005110530
Title
Non-invasive ventilation during surgery under neuraxial anaesthesia: A
pathophysiological perspective on application and benefits and a
systematic literature review.
Source
Anaesthesiology Intensive Therapy. 51 (4) (pp 1-10), 2019. Date of
Publication: 2019.
Author
Corcione N.; Karim H.M.R.; Mina B.A.; Pisano A.; Dikmen Y.; Kondili E.;
Nicolini A.; Fiorentino G.; Caldeira V.; Ubeda A.; Papadakos P.;
Wittenstein J.; Singha S.K.; Sovani M.P.; Panda C.K.; Tani C.; Khatib
M.I.; Perren A.; Ho K.M.; Esquinas A.M.
Institution
(Corcione) Department of Anesthesia, Critical Care and Emergency,
Fondazione IRCCS ca'Granda, Ospedale Maggiore Policlinico, via Francesco
Sforza 35, Milan 20122, Italy
(Karim) Department of Anaesthesiology and Critical Care, All India
Institute of Medical Sciences (AIIMS), Raipur, India
(Mina) Department of Pulmonary and Critical Care Medicine, Hofstra
Northwell School of Medicine, Lenox Hill Hospital, New York, NY, United
States
(Pisano) Cardiac Anesthesia and Intensive Care Unit, AORN Dei Colli -
Monaldi Hospital, Naples, Italy
(Dikmen) Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine,
Department of Intensive Care, Istanbul, Turkey
(Kondili) Medical School, University of Crete Greece, ICU University
Hospital of Heraklion, Crete, Greece
(Nicolini) Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri
Levante, Italy
(Fiorentino) Respiratory Unit, AORN Dei Colli - Monaldi Hospital, Naples,
Italy
(Caldeira) Department of Pneumology, Hospital Santa Marta, Lisboa,
Portugal
(Ubeda) Unidad de Cuidados Intensivos, Hospital Punta de Europa,
Algeciras, Cadiz, Spain
(Papadakos) Department of Anesthesiology and Surgery, University of
Rochester, Rochester, NY, United States
(Wittenstein) Department of Anesthesiology and Intensive Care Medicine,
Pulmonary Engineering Group, University Hospital Carl Gustav Carus,
Technische Universitat Dresden, Dresden, Germany
(Singha, Panda) Department of Anaesthesia and Critical Care, All India
Institute of Medical Sciences (AIIMS), Raipur, India
(Sovani) Department of Respiratory Medicine, Nottingham University
Hospitals NHS Trust, Nottingham, United Kingdom
(Tani) Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
(Khatib) Department of Anesthesiology, American University of Beirut -
Medical Center, School of Medicine, Beirut, Lebanon
(Perren) Department of Intensive Care Medicine EOC, Ospedale Regionale
Bellinzona e Valli, Bellinzona, Switzerland
(Ho) School of Medicine, University of Western Australia, Australia
(Esquinas) Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain
Publisher
Termedia Publishing House Ltd. (Kleeberqa St.2, Poznan 61-615, Poland)
Abstract
Unlike general anaesthesia, neuraxial anaesthesia (NA) reduces the burden
and risk of respiratory adverse events in the post-operative period.
However, both patients affected by chronic obstructive pulmonary disease
(COPD) and chest wall disorders and/or neuromuscular diseases may
experience the development or the worsening of respiratory failure, even
during surgery performed under NA; this latter negatively affects the
function of accessory respiratory muscles, resulting in a blunted central
response to hypercapnia and possibly in an exacerbation of cardiac
dysfunction (NA-induced relative hypovolemia). According to European
Respiratory Society (ERS) and American Thoracic Society (ATS) guidelines,
non-invasive ventilation (NIV) is effective in the post-operative period
for the treatment of both impaired pulmonary gas exchange and ventilation,
while the intra-operative use of NIV in association with NA is just
anecdotally reported in the literature. Whilst NIV does not assure a
protected patent airway and requires the patient's cooperation, it is a
handy tool during surgery under NA: NIV is reported to be successful for
treatment of acute respiratory failure; it may be delivered through the
patient's home ventilator, may reverse hypoventilation induced by
sedatives or inadvertent spread of anaesthetic up to cervical dermatomes,
and allow the avoidance of intubation in patients affected by chronic
respiratory failure, prolonging the time of non-invasiveness of
respiratory support (i.e., neuromuscular patients needing surgery). All
these advantages could make NIV preferable to oxygen in carefully selected
patients.<br/>Copyright &#xa9; 2019 Via Medica. All rights reserved.

<47>
Accession Number
2005045659
Title
Gait and fate: Baseline gait speed and mortality after transcatheter
aortic valve implantation.
Source
Journal of Cardiology. 75 (6) (pp 600-605), 2020. Date of Publication:
June 2020.
Author
Takagi H.; Kato M.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kato) Department of Shizuoka Physical Therapy, Faculty of Health Science,
Tokoha University, Shizuoka, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Division of Interventional Cardiology, Department of Cardiology,
New York Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: To determine whether baseline gait speed predicts mortality
after transcatheter aortic valve implantation (TAVI), a meta-analysis of
currently available studies was performed. <br/>Method(s): To identify all
studies researching the impact of preprocedural gait speed on mortality
after TAVI, PubMed and Web of Science were searched through May 2019.
Adjusted (if unavailable, unadjusted) hazard/odds ratios (ORs/HRs) with
their confidence interval of mortality for slow (if available, the
slowest) versus fast (if available, the fastest) gait speed (with cut-off
values defined in each study) and those for unable to walk versus walker
(if available, with the fastest gait speed) were extracted from each
study, and then separately pooled by means of inverse variance-weighted
averages of logarithmic ORs/HRs in the random-effects model.
<br/>Result(s): Twelve eligible studies (7 and 5 based on the
distance-limited and time-limited walk test, respectively) were identified
and integrated in the present meta-analysis. The pooled analysis of all
ORs/HRs demonstrated that slow walkers (primary meta-analysis; OR/HR,
2.38; p < 0.00001) and unable to walk (OR/HR, 1.75; p = 0.01) were
significantly associated with increased mortality. The subgroup analysis
for the primary meta-analysis indicated no significant subgroup difference
between studies utilizing the 4-m/5-m/15-foot walk test and those applying
the 6-min walk test (p = 0.45). Combining studies with 1-year follow-up
did not alter the primary result (p < 0.0001). Pooling studies with
adjusted ORs/HRs did not change the principal result (p = 0.0002). No
funnel plot asymmetry for the primary meta-analysis was identified.
<br/>Conclusion(s): Slow baseline gait speed (and unable to walk) is
associated with increased mortality after TAVI.<br/>Copyright &#xa9; 2020
Japanese College of Cardiology

<48>
Accession Number
2005534459
Title
Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in
Low-Risk Patients.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Koshy A.N.; Murphy A.; Farouque O.; Horrigan M.; Yudi M.B.
Institution
(Koshy, Murphy, Farouque, Horrigan, Yudi) Department of Cardiology, Austin
Health, Melbourne, Vic, Australia
(Koshy, Murphy, Farouque, Horrigan, Yudi) The University of Melbourne,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has
revolutionised the treatment of severe aortic stenosis (AS), though its
safety and efficacy in low-risk patients remains to be established.
<br/>Method(s): A systematic review of PubMed, Medline and EMBASE
identified four randomised controlled trials (RCTs) in patients at low
surgical risk comparing TAVR to surgical aortic valve replacement (SAVR).
A meta-analysis was performed with a primary outcome of a composite of
all-cause mortality and stroke at longest available follow-up.
<br/>Result(s): A total of four RCTs with 2,836 patients was included in
the final analysis. 1,363 patients were randomised to SAVR and 1,473 to
TAVR. The composite of all-cause mortality and stroke was significantly
lower in patients undergoing TAVR compared with SAVR (OR 0.59, 95%CI
0.37-0.95, p=0.03) with low heterogeneity (I²=31%). The
difference in the primary composite outcome was driven by a difference in
mortality (OR 0.66, 95%CI 0.44-0.98, p=0.04; I²=0%) without
significant differences in stroke (OR 0.75 95%CI 0.45-1.26, p=0.28;
I²=37%). Weighted absolute risk difference (ARD) of the primary
composite outcome also favoured TAVR (ARD -2.0% 95%CI -3.3 to -0.7%,
p=0.002) with a number needed to treat (NNT) of 50 to prevent one death or
stroke. Patients undergoing TAVR had a significantly higher risk of
permanent pacemaker implantation (OR 3.9, 95%CI 1.8-8.4, p<0.001,
I²=84%) and moderate or severe paravalvular leak (OR 5.0, 95%CI
1.6-15.7, p=0.01; I2=19%). <br/>Conclusion(s): In patients with severe AS
at low surgical risk, the rate of the composite of death and stroke was
significantly lower with TAVR than with SAVR. Longer-term follow-up with a
focus on the impact of permanent pacemaker (PPM) implantation,
paravalvular leak (PVL) and structural valve deterioration is essential
before the use of TAVR can be generalised to the broader population of
patients with AS.<br/>Copyright &#xa9; 2020 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<49>
Accession Number
2005516606
Title
Enhanced Recovery After Surgery: A Narrative Review of its Application in
Cardiac Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Baxter R.; Squiers J.; Conner W.; Kent M.; Fann J.; Lobdell K.; DiMaio
J.M.
Institution
(Baxter, Squiers) Department of Surgery, Baylor University Medical Center,
Dallas, TX, United States
(Conner) Cardiothoracic and Vascular Surgeons, PA, Austin, TX, United
States
(Kent) Division of Thoracic Surgery, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Fann) Department of Cardiothoracic Surgery, Stanford University Medical
Center, Stanford, CA, United States
(Lobdell) Sanger Heart and Vascular Institute, Atrium Health, Charlotte,
NC, United States
(DiMaio) Department of Surgery, Baylor Scott and White, The Heart
Hospital, Plano, TX, United States
Publisher
Elsevier USA
Abstract
Background: Enhanced Recovery After Surgery (ERAS) is a perioperative
patient management strategy that is being adopted rapidly across surgical
specialties worldwide. Components of ERAS work collaboratively throughout
the perioperative course to achieve significant benefits for both the
patient and the entire health care system. The use of ERAS in cardiac
surgery (ERAS-C) could lead to similar improvements, but currently, use of
ERAS-C programs is lacking and not well defined. <br/>Method(s): A
literature search was performed of the Medline database to capture
relevant studies discussing ERAS-C. Key concepts were extracted from these
articles and grouped according to appropriate perioperative stages.
Supporting literature was also included, briefly discussing the historical
progression of cardiac surgery to enhanced recovery pathways, potential
limitations to these pathways in cardiac surgery, and the first studies
evaluating the use of an ERAS program with cardiac surgery patients.
<br/>Result(s): Initial results of ERAS-C studies have shown similar
benefits to those of other surgical fields, including decreased hospital
and intensive care unit lengths of stay (1-4 days and 4-20 hours,
respectively), improved perioperative pain control (25%-60% decreased
opioid usage), and improvements in early postoperative mobility and oral
diets. Results especially beneficial to cardiac surgery have also been
reported, such as an 8% to 14% decreased incidence of postoperative atrial
fibrillation. <br/>Conclusion(s): This review presents pertinent current
research related to the implementation of ERAS programs in the field of
cardiac surgery and provides a call to action for further investigation
and adaption of ERAS in cardiac surgery.<br/>Copyright &#xa9; 2020

<50>
Accession Number
2004367821
Title
Intraoperative Optimization of Both Depth of Anesthesia and Cerebral
Oxygenation in Elderly Patients Undergoing Coronary Artery Bypass Graft
Surgery-A Randomized Controlled Pilot Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (5) (pp 1172-1181),
2020. Date of Publication: May 2020.
Author
Kunst G.; Gauge N.; Salaunkey K.; Spazzapan M.; Amoako D.; Ferreira N.;
Green D.W.; Ballard C.
Institution
(Kunst, Salaunkey, Amoako, Ferreira, Green) Department of Anaesthetics and
Pain Medicine, King's College Hospital NHS Foundation Trust, London,
United Kingdom
(Kunst, Spazzapan) School of Cardiovascular Medicine and Sciences, King's
College London British Heart Foundation Centre of Excellence, Faculty of
Life Sciences and Medicine, London, United Kingdom
(Gauge, Ferreira, Ballard) Wolfson Centre for Age-Related Diseases,
Institute of Psychiatry, Psychology and Neuroscience, Kings College
London, London, United Kingdom
(Salaunkey) Royal Papworth Hospital, Cambridge, United Kingdom
(Ballard) University of Exeter Medical School, Exeter, United Kingdom
Publisher
W.B. Saunders
Abstract
Objectives: Does intraoperative optimization of both depth of anesthesia
and regional cerebral tissue oxygenation (rScO<inf>2</inf>) in elderly
patients reduce postoperative cognitive decline (primary outcome) or
delirium (secondary outcome)? Design: Prospective randomized controlled
single blind trial. <br/>Setting(s): A single major urban teaching and
university hospital and tertiary referral center. <br/>Participant(s):
Patients, 65 years of age and older, undergoing elective coronary artery
bypass graft surgery on cardiopulmonary bypass. <br/>Intervention(s):
Intraoperative depth of anesthesia bispectral index (BIS) values were
targeted at 50 +/- 10. Regional cerebral tissue desaturations of more than
15% of the pre-induction value, or below 50%, were avoided.
<br/>Measurements and Main Results: Eighty-two patients were included, and
mean depth of anesthesia values using BIS were significantly higher during
surgery in the intervention group with 40.6 (7.3) versus 35.4 (6.7) in the
control group, mean (standard deviation), p = 0.004. The cognitive
function was similar between the treatment and control groups at 6 weeks
postoperatively with a Mini Mental State Examination (MMSE) of 27 (26,29)
in the intervention group and an MMSE of 29 (27,29) in the control group,
median (interquartile range), with p = 0.12. The authors observed a
reduction in the incidence of delirium, occurring in 2.4% (n = 1) of
patients in the intervention group and in 20% (n = 8) in the control group
(p = 0.01). <br/>Conclusion(s): This pilot trial demonstrates that
noninvasive target-controlled depth of anesthesia monitoring is feasible.
Cognitive function at 6 weeks showed no difference between the treatment
and control groups; however, postoperative delirium was reduced in the
intervention group.<br/>Copyright &#xa9; 2019 The Authors

<51>
Accession Number
2005423048
Title
Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention in
Patients With Prior Bypass Surgery.
Source
JACC: Cardiovascular Interventions. 13 (7) (pp 900-902), 2020. Date of
Publication: 13 April 2020.
Author
Megaly M.; Abraham B.; Pershad A.; Rinfret S.; Alaswad K.; Garcia S.;
Azzalini L.; Gershlick A.; Burke M.N.; Brilakis E.S.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<52>
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.

<53>
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.

<54>
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.

<55>
Accession Number
631398149
Title
Outcomes after surgery for functional tricuspid regurgitation: A
systematic review and meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 6 (1) (pp
10-18), 2020. Date of Publication: 01 Jan 2020.
Author
Veen K.M.; Etnel J.R.G.; Quanjel T.J.M.; Mokhles M.M.; Huygens S.A.;
Rasheed M.; Oei F.B.S.; ten Cate F.J.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Veen, Etnel, Quanjel, Mokhles, Huygens, Rasheed, Oei, Bogers, Takkenberg)
Department of Cardiothoracic Surgery, Thoraxcenter, Rg-619, Erasmus MC,
University Medical Center Rotterdam, Dr Molewaterplein 40, Rotterdam 3015
GD, Netherlands
(ten Cate) Department of Cardiology, Thoraxcenter, Rg-619, Erasmus MC,
University Medical Center Rotterdam, Dr Molewaterplein 40, Rotterdam 3015
GD, Netherlands
Publisher
Oxford University Press
Abstract
Aims This study aims to provide a contemporary overview of outcomes after
tricuspid valve (TV) surgery for functional tricuspid regurgitation (TR).
Methods The literature was systematically searched for papers published
between January 2005 and December 2017 report- and results ing on
clinical/echocardiographic outcomes after TV surgery for functional TR. A
random effects meta-analysis was conducted for outcome variables, and late
outcomes are visualized by pooled Kaplan-Meier curves. Subgroup analyses
were performed for studies with a within-study comparison of suture vs.
ring repair and flexible vs. rigid ring repair. Eighty-seven publications
were included, encompassing 13 184 patients (mean age: 62.1 +/- 11.8
years, 55% females). A mitral valve procedure was performed in 92% of
patients. Pooled mean follow-up was 4.0 +/- 2.8 years. Pooled early
mortality was 3.9% (95% CI: 3.2-4.6), and late mortality rate was
2.7%/year (95% CI: 2.0-3.5), of which approximately half was
cardiac-related 1.2%/year (95% CI: 0.8-1.9). Pooled risk of early
moderate-to-severe TR at discharge was 9.4% (95% CI: 7.0-12.1). Late
moderate-to-severe TR rate after discharge was 1.9%/year (95% CI:
1.0-3.5). Late reintervention rate was 0.3%/year (95% CI: 0.2-0.4).
Mortality and overall (early and late) TR rate were comparable between
suture vs. ring annuloplasty (14 studies), whereas overall TR rate was
higher after flexible ring vs. rigid ring annuloplasty (6 studies)
(7.5%/year vs. 3.9%/year, P = 0.002). Conclusion This study shows that
patients undergoing surgery for functional tricuspid regurgitation (FTR)
have an acceptable early and late mortality. However, TR remains prevalent
after surgery. The results of this study can be used to inform patients
and clinicians about the expected outcome after surgery for FTR and can
results serve as a benchmark for the performance of emerging transcatheter
TV interventions.<br/>Copyright Published on behalf of the European
Society of Cardiology. All rights reserved. VC The Author(s) 2019. For
permissions,

<56>
Accession Number
631368671
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) (no pagination), 2020. Article Number: e031952. 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
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
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.

<57>
Accession Number
631296304
Title
Pericardial hernias in adults: A systematic review of the literature.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (3) (pp 353-358),
2020. Date of Publication: 01 Mar 2020.
Author
Schizas D.; Katsaros I.; Karatza E.; Theochari N.A.; Kykalos S.; Nastos
C.; Michalopoulos N.; Avgerinos D.V.; Chatzimavroudis G.; Arkadopoulos N.
Institution
(Schizas, Katsaros, Theochari) First Department of Surgery, National and
Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17,
Athens 11527, Greece
(Karatza, Kykalos) Second Propaedeutic Department of Surgery, National and
Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
(Nastos) Third Department of Surgery, National and Kapodistrian University
of Athens, Attikon University Hospital, Athens, Greece
(Michalopoulos, Arkadopoulos) Fourth Department of Surgery, National and
Kapodistrian University of Athens, Attikon University Hospital, Athens,
Greece
(Avgerinos) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York Presbyterian, New York, NY, United States
(Chatzimavroudis) Second Department of Surgery, Aristotle University of
Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
Publisher
Oxford University Press
Abstract
OBJECTIVES: A pericardial hernia is defined as the protrusion of abdominal
viscera through the central tendon of the diaphragm into the pericardial
sac. It is a rare clinical entity whose symptoms vary considerably. The
objective of this study was to evaluate the clinical manifestations of and
the optimal surgical treatments for pericardial hernias. <br/>METHOD(S):
PubMed and the Cochrane bibliographical databases were searched (last
search: 20 April 2019) for studies on pericardial diaphragmatic hernias in
the adult population. <br/>RESULT(S): Eighty studies met our inclusion
criteria and reported on 85 patients (62 men and 23 women) with a mean age
of 55.86 +/- 15.79 years (mean +/- standard deviation) presenting with a
pericardial hernia at health care facilities. The leading aetiology was
trauma (56.5%) followed by iatrogenic interventions (30.6%). The most
common herniated organs were the transverse colon (49.4%) and the greater
omentum (48.2%). Seventy-one patients (83.5%) underwent an open surgical
repair, whereas 14 (16.5%) had a laparoscopic approach. Mesh or a patch
was applied in 41.9% of cases. A postoperative morbidity rate of 16.9% was
recorded, whereas the mortality rate reached 2.4%. <br/>CONCLUSION(S):
Pericardial hernia is a rare disease characterized by abdominal organs
herniating into the pericardium. It requires a high degree of suspicion
for early diagnosis, and all medical professionals should be encouraged to
report such cases to clarify the best available therapeutic
approach.<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.

<58>
Accession Number
631269395
Title
Cross-cultural adaptation and validation of the 3D-CAM Chinese version in
surgical ICU patients.
Source
BMC Psychiatry. 20 (1) (no pagination), 2020. Article Number: 133. Date of
Publication: 24 Mar 2020.
Author
Mu D.-L.; Ding P.-P.; Zhou S.-Z.; Liu M.-J.; Sun X.-Y.; Li X.-Y.; Wang
D.-X.
Institution
(Mu, Ding, Liu, Wang) Department of Anesthesiology and Critical Care
Medicine, Peking University First Hospital, Beijing, China
(Zhou, Sun) Department of Geriatric Psychiatry, Peking University Sixth
Hospital, Beijing 100191, China
(Li) Department of Biostatistics, Peking University First Hospital,
Beijing, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Accurate diagnosis of delirium is very important for
prevention and treatment. Present study was designed to validate the
3-Minute Diagnostic Interview for CAM-defined Delirium Chinese version
(3D-CAM-CN) in surgical ICU patients. <br/>Method(s): In this prospective
diagnostic study, the 3D-CAM was translated into Chinese with culture
adaption. Two interviewers (Roles A and B) independently administrated
3D-CAM-CN assessment in adult patients from postoperative days 1 to day 3.
At the meantime, a panel of psychiatrists diagnosed delirium according to
the Diagnostic and Statistical Manual of Mental Disorders-fifth edition as
the reference standard. The sensitivity and specificity were calculated to
analyze the diagnostic character of the 3D-CAM-CN. Kappa coefficient was
used to evaluate interrater reliability. <br/>Result(s): Two hundred
forty-five adult patients were assessed for at least 2 days, resulting a
total of 647 paired-assessments. When compared with the reference
standard, the sensitivity and specificity of the 3D-CAM-CN assessment were
87.2 and 96.7%, respectively, by Role A and 84.6 and 97.4%, respectively,
by Role B, with good interrater reliability (Kappa coefficient = 0.82, P <
0.001). It also performed well in patients with mild cognitive impairment,
with the sensitivity from 85.7 to 100% and the specificity from 95.7 to
96.4%. <br/>Conclusion(s): Our results showed that the 3D-CAM-CN can be
used as a reliable and accurate instrument for delirium assessment in
surgical patients. Trial registration: This trail was approved by the
Clinical Research Ethic Committee of Peking University First Hospital (No.
2017-1321) and registered on Chinese clinical trial registry on July 6,
2017 (ChiCTR-OOC-17011887).<br/>Copyright &#xa9; 2020 The Author(s).

<59>
[Use Link to view the full text]
Accession Number
630982950
Title
Low-value transthoracic echocardiography, healthcare utilization, and
clinical outcomes in patients with coronary artery disease.
Source
Circulation: Cardiovascular Quality and Outcomes. 12 (11) (no pagination),
2019. Article Number: e006123. Date of Publication: 01 Nov 2019.
Author
Tharmaratnam T.; Bouck Z.; Sivaswamy A.; Wijeysundera H.C.; Chu C.; Yin
C.X.; Nesbitt G.C.; Edwards J.; Yared K.; Wong B.; Weinerman A.;
Thavendiranathan P.; Rakowski H.; Dorian P.; Anderson G.; Austin P.C.;
Dudzinski D.M.; Ko D.T.; Weiner R.B.; Bhatia R.S.
Institution
(Tharmaratnam) School of Medicine, Royal College of Surgeons in Ireland,
Dublin, United States
(Bouck, Chu, Yin, Bhatia) Institute for Health Systems Solutions and
Virtual Care, Women's College Hospital, Toronto, ON, Canada
(Bouck) Dalla Lana School of Public Health, University of Toronto, ON,
Canada
(Wijeysundera, Anderson, Austin, Ko) Institute for Health Policy,
Management, and Evaluation, University of Toronto, ON, Canada
(Wijeysundera, Ko) Schulich Heart Centre, Sunnybrook Health Sciences
Centre, University of Toronto, ON, Canada
(Wong, Weinerman) Department of Medicine, University of Toronto, ON,
Canada
(Sivaswamy) Institute for Clinical and Evaluative Sciences, Toronto, ON,
Canada
(Wijeysundera, Wong, Weinerman, Ko) Sunnybrook Research Institute,
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Nesbitt) Cardiology Division, Mount Sinai Hospital, Toronto, ON, Canada
(Edwards, Dorian) Division of Cardiology, St. Michael's Hospital, Toronto,
ON, Canada
(Yared) Department of Cardiology, Scarborough Hospital, Toronto, ON,
Canada
(Thavendiranathan, Rakowski) Peter Munk Cardiac Centre, University Health
Network, Toronto, ON, Canada
(Dudzinski, Weiner) Division of Cardiology, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The relationship between ordering frequency of rarely
appropriate transthoracic echocardiograms on healthcare utilization and
patient outcomes in coronary artery disease (CAD) is not known. Our
objective was to investigate practice patterns of cardiologists who order
a high frequency of low-value transthoracic echocardiograms in patients
with CAD and whether practice behavior influences patient outcomes.
<br/>Methods and Results: A retrospective cohort of outpatient CAD
patients was accrued by identifying patients with at least 1 visit to 1 of
35 Ontario-based cardiologists in the EchoWISELY randomized clinical trial
(Will Inappropriate Scenarios for Echocardiography Lessen Significantly)
control group. The main outcomes of interest were patient-level receipt of
diagnostic tests, physician visits, medication prescriptions, and clinical
outcomes at 1 year. Our cohort consisted of 3966 patients with CAD (mean
[SD] age, 67.8 [12.0] years; 72% men), with an outpatient visit to 1 of 35
eligible cardiologists, stratified into 3 ordering tertiles. Patients of
cardiologists in the top ordering tertile of rarely appropriate
transthoracic echocardiograms had significantly lower odds of receiving
the following services at 1 year compared with patients in the low
ordering group: cholesterol assessment (odds ratio [OR], 0.77 [95% CI,
0.65-0.91]); hemoglobin A1c assessment (OR, 0.79 [95% CI, 0.66-0.94]);
beta-blocker prescription (OR, 0.70 [95% CI, 0.55-0.90]); and aldosterone
receptor antagonist prescription (OR, 0.46 [95% CI, 0.22-0.98]). Patients
of high ordering cardiologists had greater odds of all-cause mortality at
1 year (OR, 1.54 [95% CI, 1.04-2.28]), although all other outcomes were
similar. <br/>Conclusion(s): Patients with CAD seen by cardiologist who
ordered a high rate of rarely appropriate transthoracic echocardiograms
were less likely to receive potentially high-value screening tests and
evidence-based medications than low ordering cardiologists. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT02038101.<br/>Copyright &#xa9; 2019 Lippincott Williams and Wilkins.
All rights reserved.

<60>
[Use Link to view the full text]
Accession Number
630982742
Title
Clinical Outcomes following Implantation of Thin-Strut, Bioabsorbable
Polymer-Coated, Everolimus-Eluting SYNERGY Stents: Final 5-Year Results of
the EVOLVE II Randomized Trial.
Source
Circulation: Cardiovascular Interventions. 12 (9) (no pagination), 2019.
Article Number: e008152. Date of Publication: 01 Sep 2019.
Author
Kereiakes D.J.; Windecker S.; Jobe R.L.; Mehta S.R.; Sarembock I.J.;
Feldman R.L.; Stein B.; Dubois C.; Grady T.; Saito S.; Kimura T.;
Underwood P.; Allocco D.J.; Meredith I.T.
Institution
(Kereiakes, Sarembock) Christ Hospital Heart and Vascular Center, Lindner
Research Center, Cincinnati, OH, United States
(Windecker) Bern University Hospital, Inselspital, University of Bern,
Switzerland
(Jobe) UNC-Rex Healthcare, Raleigh, NC, United States
(Mehta) McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Feldman) MediQuest Research AdventHealth, Ocala, FL, United States
(Stein) Morton Plant Mease Healthcare System, Clearwater, FL, United
States
(Dubois) University Hospital Leuven, Belgium
(Grady) Aspirus Research Institute, Wausau, WI, United States
(Saito) Shonan Kamakura General Hospital, Kanagawa, Japan
(Kimura) Kyoto University Hospital, Japan
(Underwood, Allocco, Meredith) Boston Scientific Corporation, Marlborough,
MA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The thin-strut SYNERGY stent has an abluminal
everolimus-eluting bioabsorbable polymer coating designed to facilitate
vascular healing and reduce risk of stent thrombosis. In the multicenter,
randomized EVOLVE II trial (The EVOLVE II Clinical Trial to Assess the
SYNERGY Stent System for the Treatment of Atherosclerotic Lesion[s]),
SYNERGY was noninferior to the durable polymer PROMUS Element Plus
everolimus-eluting stent for the primary end point of 1-year target lesion
failure. Longer-term clinical follow-up will support the relative efficacy
and safety of SYNERGY. <br/>Method(s): Patients with <=3 native coronary
lesions (reference vessel diameter >=2.25-<=4.00 mm; length <=34 mm) in
<=2 major epicardial vessels were randomized 1:1 to SYNERGY (N=838) or
PROMUS Element Plus (N=846). EVOLVE II included a Diabetes substudy which
pooled patients with diabetes mellitus from the randomized controlled
trial (n=263) and from a sequential, single-arm substudy (N=203).
<br/>Result(s): The 5-year target lesion failure rate was 14.3% for
SYNERGY and 14.2% for PROMUS Element Plus (P=0.91). Landmark analysis
demonstrated similar rates of target lesion failure from discharge to
1-year (P=0.90) and from 1 to 5 years (P=0.94). Definite/probable stent
thrombosis was infrequent in both arms (SYNERGY 0.7% versus PROMUS Element
Plus 0.9%; P=0.75). There were no significant differences in the rates of
cardiac death, myocardial infarction, or revascularization. Among patients
with diabetes mellitus, the target lesion failure rate to 1-year was
noninferior to a prespecified performance goal and to 5 years was 17.0%.
<br/>Conclusion(s): SYNERGY demonstrated comparable outcomes to PROMUS
Element Plus, with low rates of stent thrombosis and adverse events
through 5 years of follow-up. Five-year clinical outcomes were favorable
in patients with diabetes mellitus. These data support the long-term
safety and effectiveness of SYNERGY in a broad range of
patients.<br/>Copyright &#xa9; 2019 American Heart Association, Inc.

<61>
[Use Link to view the full text]
Accession Number
630982191
Title
Durability and Clinical Outcomes of Transcatheter Aortic Valve Replacement
for Failed Surgical Bioprostheses.
Source
Circulation: Cardiovascular Interventions. 12 (10) (no pagination), 2019.
Article Number: e008155. Date of Publication: 01 Oct 2019.
Author
Dauerman H.L.; Deeb G.M.; O'Hair D.P.; Waksman R.; Yakubov S.J.; Kleiman
N.S.; Chetcuti S.J.; Hermiller J.B.; Bajwa T.; Khabbaz K.; De Marchena E.;
Salerno T.; Dries-Devlin J.L.; Li S.; Popma J.J.; Reardon M.J.
Institution
(Dauerman) University of Vermont Larner College of Medicine, Burlington,
United States
(Deeb) Department of Cardiac Surgery, University of Michigan, Ann Arbor,
United States
(Waksman) Section of Interventional Cardiology, MedStar Washington
Hospital Center, DC, United States
(Yakubov) Department of Cardiology, Riverside Methodist Hospital,
Columbus, OH, United States
(Kleiman, Reardon) Departments of Cardiology and Cardiothoracic Surgery,
Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United
States
(Chetcuti) Division of Cardiology, University of Michigan, Ann Arbor,
United States
(Hermiller) Division of Cardiovascular Medicine, St Vincent's Medical
Center, IN, United States
(O'Hair, Bajwa) Departments of Cardiac Surgery and Cardiology, Aurora
Healthcare, Milwaukee, WI, United States
(Khabbaz, Popma) Departments of Cardiovascular Surgery and Internal
Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(De Marchena, Salerno) Divisions of Cardiology and Cardiothoracic Surgery,
University of Miami Miller School of Medicine, Miami, FL, United States
(Dries-Devlin, Li) Coronary and Structural Heart Clinical Operations,
Medtronic, Mounds View, MN, United States
(O'Hair) Boulder Heart, CO, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Valve-in-valve transcatheter aortic valve replacement (TAVR)
is an option when a surgical valve demonstrates deterioration and
dysfunction. This study reports 3-year results following valve-in-valve
with self-expanding TAVR. <br/>Method(s): The CoreValve US Expanded Use
Study is a prospective, nonrandomized, single-arm study that evaluates
safety and effectiveness of TAVR in extreme risk patients with symptomatic
failed surgical biologic aortic valves. Study end points include all-cause
mortality, need for valve reintervention, hemodynamic changes over time,
and quality of life through 3 years. Patients were stratified by presence
of preexisting surgical valve prosthesis-patient mismatch. <br/>Result(s):
From March 2013 to May 2015, 226 patients deemed extreme risk (STS-PROM
[Society of Thoracic Surgeons Predicted Risk of Mortality] 9.0+/-7%) had
attempted valve-in-valve TAVR. Preexisting surgical valve
prosthesis-patient mismatch was present in 47.2% of the cohort. At 3
years, all-cause mortality or major stroke was 28.6%, and 93% of patients
were in New York Heart Association I or II heart failure. Valve
performance was maintained over 3 years with low valve reintervention
rates (4.4%), an improvement in effective orifice area over time and a
2.7% rate of severe structural valve deterioration. Preexisting severe
prosthesis-patient mismatch was not associated with 3-year mortality but
was associated with significantly less improvement in quality of life at
3-year follow-up (P=0.01). <br/>Conclusion(s): Self-expanding TAVR in
patients with failed surgical bioprostheses at extreme risk for surgery
was associated with durable hemodynamics and excellent clinical outcomes.
Preexisting surgical valve prosthesis-patient mismatch was not associated
with mortality but did limit patient improvement in quality of life over
3-year follow-up. Clinical Trial Registration: URL:
http://www.clinicaltrials.gov. Unique identifier:
NCT01675440.<br/>Copyright &#xa9; 2019 Lippincott Williams and Wilkins.
All rights reserved.

<62>
[Use Link to view the full text]
Accession Number
630982178
Title
Impact of Procedural Bleeding in Peripheral Artery Disease: An Analysis
from EUCLID Trial.
Source
Circulation: Cardiovascular Interventions. 12 (10) (no pagination), 2019.
Article Number: e008069. Date of Publication: 01 Oct 2019.
Author
Kansal A.; Huang Z.; Rockhold F.W.; Baumgartner I.; Berger J.S.; Blomster
J.I.; Fowkes F.G.; Katona B.; Mahaffey K.W.; Norgren L.; Hiatt W.R.; Patel
M.R.; Jones W.S.
Institution
(Kansal, Patel, Jones) Division of Cardiology, Duke Heart Center, Duke
University, Durham, NC, United States
(Huang, Rockhold, Patel, Jones) Duke Clinical Research Institute, Duke
University School of Medicine, Duke University, Durham, NC, United States
(Baumgartner) Swiss Cardiovascular Centre, Inselspital, Bern University
Hospital, University of Bern, Switzerland
(Berger) Department of Medicine and Surgery, New York University School of
Medicine, United States
(Blomster) Turku University Hospital, Turku University, Finland
(Fowkes) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, United Kingdom
(Katona) AstraZeneca Gaithersburg, MD, United States
(Mahaffey) Stanford Center for Clinical Research, Stanford University
School of Medicine, CA, United States
(Norgren) Faculty of Medicine and Health, Orebro University, Sweden
(Hiatt) University of Colorado School of Medicine, Division of Cardiology
and CPC Clinical Research, Aurora, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The relationship between invasive vascular procedures and
bleeding in patients with peripheral artery disease has not been well
described in the literature. This post hoc analysis from the EUCLID trial
(Examining Use of Ticagrelor in Peripheral Artery Disease) aimed to
describe the incidence of major and minor postprocedural bleeding and
characterize the timing and severity of bleeding events relative to the
procedure. <br/>Method(s): EUCLID was a multicenter, randomized controlled
trial of 13 885 patients with symptomatic peripheral artery disease that
tested the efficacy and safety of ticagrelor compared with clopidogrel for
the prevention of major adverse cardiovascular events. A total of 2661
patients underwent 3062 coronary revascularization, peripheral
revascularization, and amputation during the study. The primary safety end
point was Thrombolysis in Myocardial Infarction major or minor bleeding.
All bleeding events were formally adjudicated by a clinical end point
classification group. <br/>Result(s): Major bleeding events most often
occurred <=7 days following the procedure. The incidence of Thrombolysis
in Myocardial Infarction major or minor bleeding <=7 days following
peripheral revascularization (3.3%; 95% CI, 2.5%-4.1%) was similar to
rates after coronary revascularization (4.0%; 95% CI, 2.6%-5.4%) and lower
extremity amputation (2.3%; 95% CI, 0.8%-3.8%). The severity of bleeding
events (as graded by drop in hemoglobin, need for transfusion, bleeding in
a critical location, and fatal bleeding) was also similar following
peripheral, coronary revascularization, and lower extremity amputation.
<br/>Conclusion(s): The incidence of Thrombolysis in Myocardial Infarction
major/minor bleeding following peripheral revascularization is comparable
to rates after coronary revascularization and lower extremity amputation,
and the majority of bleeding events occur within 7 days following the
procedure. The severity of periprocedural bleeding is also similar after
procedures, with the most frequently adjudicated reason being a drop in
hemoglobin >=2 g/dL. Future studies should be performed to enhance our
understanding of bleeding risk related to revascularization and amputation
procedures in peripheral artery disease patients.<br/>Copyright &#xa9;
2019 Lippincott Williams and Wilkins. All rights reserved.

<63>
[Use Link to view the full text]
Accession Number
630982106
Title
Society of Cardiovascular Anesthesiologists Clinical Practice Improvement
Advisory for Management of Perioperative Bleeding and Hemostasis in
Cardiac Surgery Patients.
Source
Anesthesia and Analgesia. 129 (5) (pp 1209-1221), 2019. Date of
Publication: 01 Nov 2019.
Author
Raphael J.; Mazer C.D.; Subramani S.; Schroeder A.; Abdalla M.; Ferreira
R.; Roman P.E.; Patel N.; Welsby I.; Greilich P.E.; Harvey R.; Ranucci M.;
Heller L.B.; Boer C.; Wilkey A.; Hill S.E.; Nuttall G.A.; Palvadi R.R.;
Patel P.A.; Wilkey B.; Gaitan B.; Hill S.S.; Kwak J.; Klick J.; Bollen
B.A.; Shore-Lesserson L.; Abernathy J.; Schwann N.; Lau W.T.
Institution
(Raphael) University of Virginia Health System, Charlottesville, VA 22908,
United States
(Mazer) St Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Subramani) University of Iowa, Iowa City, IA, United States
(Schroeder) University of Wisconsin Medical Center, Madison, WI, United
States
(Abdalla) Cleveland Clinic, Cleveland, OH, United States
(Ferreira) University of Washington Medical Center, Seattle, WA, United
States
(Roman) Centura St Anthony Hospital, Lakewood, CO, United States
(Patel) University of California San Francisco, San Francisco, CA, United
States
(Welsby) Duke University Hospital, Durham, NC, United States
(Greilich) UT Southwestern Medical Center, Dallas, TX, United States
(Harvey) UCLA Medical Center, Los Angeles, CA, United States
(Ranucci) IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
(Heller) Swedish Medical Center, Seattle, WA, United States
(Boer) VU University Medical Center, Amsterdam, Netherlands
(Wilkey) Abbott Northwestern Hospital, Minneapolis, MN, United States
(Hill) Mayo Clinic, Rochester, MN, United States
(Nuttall) Baylor College of Medicine, Houston, TX, United States
(Palvadi) University of Pennsylvania Medical Center, Philadelphia, PA,
United States
(Patel) University of Colorado, Denver, CO, United States
(Wilkey) Mayo Clinic, Phoenix, AZ, United States
(Gaitan) Weill Cornell Medical Center, New York, NY, United States
(Hill) Loyola University Medical Center, Maywood, IL, United States
(Kwak) Case Western University Medical Center, Cleveland, OH, United
States
(Klick) Missoula Anesthesiology, Missoula, MT, United States
(Bollen) Zucker School of Medicine at Hofstra/Northwell, Northshore
University Hospital, Manhasset, NY, United States
(Shore-Lesserson) Johns Hopkins Medical Center, Baltimore, MD, United
States
(Abernathy) Lehigh Valley Health Network, University of South Florida
Morsani College of Medicine, Tampa, FL, United States
(Schwann) AAA Anesthesia Associates, PhyMed Healthcare Group, Allentown,
PA, United States
(Lau) Pacific Anesthesia, Honolulu, HI, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Bleeding after cardiac surgery is a common and serious complication
leading to transfusion of multiple blood products and resulting in
increased morbidity and mortality. Despite the publication of numerous
guidelines and consensus statements for patient blood management in
cardiac surgery, research has revealed that adherence to these guidelines
is poor, and as a result, a significant variability in patient transfusion
practices among practitioners still remains. In addition, although
utilization of point-of-care (POC) coagulation monitors and the use of
novel therapeutic strategies for perioperative hemostasis, such as the use
of coagulation factor concentrates, have increased significantly over the
last decade, they are still not widely available in every institution.
Therefore, despite continuous efforts, blood transfusion in cardiac
surgery has only modestly declined over the last decade, remaining at
>=50% in high-risk patients. Given these limitations, and in response to
new regulatory and legislature requirements, the Society of Cardiovascular
Anesthesiologists (SCA) has formed the Blood Conservation in Cardiac
Surgery Working Group to organize, summarize, and disseminate the
available best-practice knowledge in patient blood management in cardiac
surgery. The current publication includes the summary statements and
algorithms designed by the working group, after collection and review of
the existing guidelines, consensus statements, and recommendations for
patient blood management practices in cardiac surgery patients. The
overall goal is creating a dynamic resource of easily accessible
educational material that will help to increase and improve compliance
with the existing evidence-based best practices of patient blood
management by cardiac surgery care teams.<br/>Copyright &#xa9; 2019
International Anesthesia Research Society.

<64>
[Use Link to view the full text]
Accession Number
630982089
Title
More- Versus Less-Intensive Lipid-Lowering Therapy: Systematic Review and
Meta-Analysis.
Source
Circulation: Cardiovascular Quality and Outcomes. 12 (8) (no pagination),
2019. Article Number: e005460. Date of Publication: 01 Aug 2019.
Author
Toyota T.; Morimoto T.; Yamashita Y.; Shiomi H.; Kato T.; Makiyama T.;
Nakagawa Y.; Saito N.; Shizuta S.; Ono K.; Kimura T.
Institution
(Toyota) Department of Cardiovascular Medicine, Kobe City Medical Center
General Hospital, Kobe, Japan
(Toyota, Morimoto) Department of Clinical Epidemiology, Hyogo College of
Medicine, Nishinomiya, Japan
(Yamashita, Shiomi, Kato, Makiyama, Nakagawa, Saito, Shizuta, Ono, Kimura)
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto
University, Kyoto, Japan
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: It has not been yet adequately addressed whether the addition
of the nonstatin LDL-C (low-density lipoprotein cholesterol)-lowering
agents on top of statins has the same magnitude of risk reduction in the
cardiovascular events as compared with more-intensive statin therapy.
<br/>Methods and Results: We performed a systematic review and
meta-analysis of RCTs (randomized controlled trials) comparing more-
versus less-intensive lipid-lowering therapy (LLT) on clinical outcomes in
patients with atherosclerotic cardiovascular risk. We included 23 studies
involving 133 037 patients (more-intensive LLT: 67 691 patients and
less-intensive LLT: 65 346 patients). We evaluated 3 types of more- versus
less-intensive LLT including more versus less statins (57 672 patients),
combination therapy of ezetimibe versus statins alone (20 688 patients),
or a PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitor with
statins versus statins alone (54 677 patients). The odds for major adverse
cardiovascular events (MACE; equivalent to the composite of coronary heart
death, nonfatal myocardial infarction, stroke, or coronary
revascularization) were significantly lower in the more-intensive LLT
group compared with the less-intensive LLT group in the entire study
population (odds ratio, 0.84; 95% CI, 0.79-0.88; P<0.001), and in all the
3 categories of more-intensive LLT strategies (more-intensive statin
therapy: odds ratio, 0.83; 95% CI, 0.76-0.90; P<0.001, ezetimibe: odds
ratio, 0.90; 95% CI, 0.85-0.96; P<0.001, and PCSK9 inhibitors: odds ratio,
0.81; 95% CI, 0.73-0.90; P<0.001) with numerically greater relative odds
reduction by more-intensive statin therapy and PCSK9 inhibitors than by
ezetimibe. Odds reduction for MACE per 20 mg/dL LDL-C reduction was also
different across the 3 types of more-intensive LLT (more-intensive statin
therapy: 17.4%, ezetimibe: 11.0%, and PCSK9 inhibitors: 6.6%).
<br/>Conclusion(s): In this meta-analysis, more-intensive LLT as compared
with less-intensive LLT was associated with significant odds reduction for
MACE in the entire study population and in all the 3 categories of
more-intensive LLT such as more-intensive statin therapy, ezetimibe, and
PCSK9 inhibitors. However, overall odds reduction for MACE and odds
reduction for MACE per 20 mg/dL LDL-C reduction were different across the
3 types of more-intensive LLT.<br/>Copyright &#xa9; 2019 American Heart
Association, Inc.

<65>
[Use Link to view the full text]
Accession Number
630982058
Title
Angiographically Guided Complete Revascularization Versus Selective Stress
Echocardiography-Guided Revascularization in Patients with
ST-Segment-Elevation Myocardial Infarction and Multivessel Disease: The
CROSS-AMI Randomized Clinical Trial.
Source
Circulation: Cardiovascular Interventions. 12 (10) (no pagination), 2019.
Article Number: e007924. Date of Publication: 01 Oct 2019.
Author
Calvino-Santos R.; Estevez-Loureiro R.; Peteiro-Vazquez J.;
Salgado-Fernandez J.; Rodriguez-Vilela A.; Franco-Gutierrez R.;
Bouzas-Mosquera A.; Rodriguez-Fernandez J.A.; Mesias-Prego A.;
Gonzalez-Juanatey C.; Aldama-Lopez G.; Pinon-Esteban P.; Flores-Rios X.;
Soler-Martin R.; Seoane-Pillado T.; Vazquez-Gonzalez N.; Muniz J.;
Vazquez-Rodriguez J.M.
Institution
(Calvino-Santos, Peteiro-Vazquez, Salgado-Fernandez, Bouzas-Mosquera,
Rodriguez-Fernandez, Aldama-Lopez, Pinon-Esteban, Flores-Rios,
Soler-Martin, Seoane-Pillado, Vazquez-Gonzalez, Vazquez-Rodriguez)
Department of Cardiology, Hospital Universitario A Coruna, INIBIC, Spain
(Estevez-Loureiro) Department of Cardiology, Hospital Alvaro Cunqueiro,
Vigo, Spain
(Muniz) CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades
Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain
(Rodriguez-Vilela, Mesias-Prego) Department of Cardiology, Hospital
Universitario Arquitecto Marcide, Ferrol, Spain
(Franco-Gutierrez, Gonzalez-Juanatey) Department of Cardiology, Hospital
Universitario Lucus Augusti, Lugo, Spain
(Muniz) Instituto Universitario de Ciencias de la Salud, Universidad de A
Coruna, INIBIC (Instituto de Investigacion Biomedica de A Coruna), Spain
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Recent trials suggest that complete revascularization in
patients with acute ST-segment-elevation myocardial infarction and
multivessel disease is associated with better outcomes than
infarct-related artery (IRA)-only revascularization. There are different
methods to select non-IRA lesions for revascularization procedures. We
assessed the clinical outcomes of complete angiographically guided
revascularization versus stress echocardiography-guided revascularization
in patients with ST-segment-elevation myocardial infarction.
<br/>Method(s): We performed a randomized clinical trial in patients with
multivessel disease who underwent a successful percutaneous coronary
intervention of the IRA to test differences in prognosis (composite end
point included cardiovascular mortality, nonfatal reinfarction, coronary
revascularization, and readmission for heart failure after 12 months of
follow-up) between complete angiographically guided revascularization
(n=154) or stress echocardiography-guided revascularization (n=152) of the
non-IRA lesions in an elective procedure before hospital discharge.
<br/>Result(s): The trial was prematurely stopped after the inclusion of
77% of the planned study population. As many as 152 (99%) patients in the
complete revascularization group and 44 (29%) patients in the selective
revascularization group required a percutaneous coronary intervention
procedure of a non-IRA lesion before discharge. The primary end point
occurred in 21 (14%) patients of the stress echocardiography-guided
revascularization group and 22 (14%) patients of the complete
angiographically guided revascularization group (hazard ratio, 0.95; 95%
CI, 0.52-1.72; P=0.85). <br/>Conclusion(s): In patients with
ST-segment-elevation myocardial infarction and multivessel disease, stress
echocardiography-guided revascularization may not be significantly
different to complete angiographically guided revascularization, thereby
reducing the need for elective revascularization before hospital
discharge. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT01179126.<br/>Copyright &#xa9; 2019 Lippincott Williams and Wilkins.
All rights reserved.

<66>
[Use Link to view the full text]
Accession Number
630978731
Title
Effects of Pre-Cardiopulmonary Bypass Administration of Dexmedetomidine on
Cardiac Injuries and the Inflammatory Response in Valve Replacement
Surgery with a Sevoflurane Postconditioning Protocol: A Pilot Study.
Source
Journal of Cardiovascular Pharmacology. 74 (2) (pp 91-97), 2019. Date of
Publication: 01 Aug 2019.
Author
Zhou H.; Zhou D.; Lu J.; Wu C.; Zhu Z.
Institution
(Zhou, Zhou, Lu, Wu, Zhu) Department of Anesthesiology, Second Affiliated
Hospital, Jiaxing University, No. 1518 North HuanCheng Rd, Jiaxing City
314000, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Preventing myocardial ischemia-reperfusion injury in on-pump
cardiac surgeries remains an enormous challenge. Sevoflurane
postconditioning has been effective at overcoming this challenge by
modulating inflammatory mediators and ameliorating antioxidative stress.
Dexmedetomidine (DEX) is a commonly used medication for cardiac patients
with organ-protective properties that lead to positive outcomes. Whether
DEX also has cardiac-protective properties and the associated mechanism in
sevoflurane postconditioning-based valve replacement surgeries are
unknown. <br/>Objective(s):This study was conducted to observe the effect
of DEX administration before cardiopulmonary bypass (CPB) on myocardial
injury, oxidative stress, and inflammatory response indicators in the
peripheral blood. <br/>Method(s):Twenty-eight eligible cardiac patients
who underwent valve replacement surgery with standard sevoflurane
postconditioning were included in the study. The patients were randomly
divided into a DEX group and a non-DEX group according to whether DEX
(0.5-micro&#32;g/kg overload dose for 10 minutes and a 0.5-g/kg/h
maintenance dose) or saline was administered from induction to the
beginning of CPB. The primary outcome was the cardiac troponin I
concentration (cTnI) in the blood 24 hours after CPB. The levels of
malondialdehyde (MDA), superoxide dismutase, tumor necrosis factor-alpha
(TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8) were also
measured. <br/>Result(s):The mean cTnI at 24 hours after CPB was clearly
decreased in the DEX group compared with that in the non-DEX group (4.16
+/- 1.58 vs. 6.90 +/- 3.73, P < 0.05). TNF-alpha levels were lower in the
DEX group after CPB (T1-T5), with a significant difference found at 1-6
hours after CPB (1 hour, 19.03 vs. 28.09; 6 hours, 20.74 vs. 30.94, P <
0.05). The IL-6 and IL-8 concentrations in the DEX group were dramatically
increased at 6 hours after CPB (P < 0.05). The MDA content and superoxide
dismutase activity were comparable between the 2 groups. A lower
proportion of anemia cases were noted after CPB in the DEX group than in
the non-DEX group (non-DEX, 10% vs. DEX, 5%, P < 0.05).
<br/>Conclusion(s):In valve replacement surgery with sevoflurane
postconditioning, pre-CPB administration of DEX can reduce the cTnI level
at 24 hours after CPB and brings synergic benefits of the inflammatory
response.<br/>Copyright &#xa9; 2019 The Author(s). Published by Wolters
Kluwer Health, Inc.

<67>
Accession Number
2005367474
Title
Randomized Trials in Cardiac Surgery: JACC Review Topic of the Week.
Source
Journal of the American College of Cardiology. 75 (13) (pp 1593-1604),
2020. Date of Publication: 7 April 2020.
Author
Gaudino M.; Kappetein A.P.; Di Franco A.; Bagiella E.; Bhatt D.L.; Boening
A.; Charlson M.E.; Flather M.; Gelijns A.C.; Grover F.; Head S.J.; Juni
P.; Lamy A.; Miller M.; Moskowitz A.; Reents W.; Shroyer A.L.; Taggart
D.P.; Tam D.Y.; Zenati M.A.; Fremes S.E.
Institution
(Gaudino, Di Franco) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
(Kappetein, Head) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Rotterdam, Netherlands
(Bagiella, Gelijns, Moskowitz) Department of Population Health Science and
Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Bhatt) Brigham and Women's Hospital, Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Boening) Department of Cardiovascular Surgery, Justus-Liebig University
Giesen, Giesen, Germany
(Charlson) Division of Clinical Epidemiology and Evaluative Science
Research, Department of Medicine, Weill Cornell Medicine, New York, NY,
United States
(Flather) Norwich Medical School, University of East Anglia and Norfolk
and Norwich University Hospital, Norwich, United Kingdom
(Grover) Division of Cardiothoracic Surgery, Department of Surgery,
University of Colorado School of Medicine, Anschutz Medical Campus,
Aurora, CO, United States
(Juni) Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute of St. Michael's Hospital, Department of Medicine and Institute
of Health Policy, Management, and Evaluation, University of Toronto,
Toronto, Ontario, Canada
(Lamy) Population Health Research Institute, Department of Surgery,
McMaster University, Hamilton, Ontario, Canada
(Miller) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, Bethesda, MD, United States
(Reents) Department Cardiac Surgery, Cardiovascular Center Bad
Neustadt/Saale, Bad Neustadt/Saale, Germany
(Shroyer) Northport Veterans Affairs Medical Center, Northport, NY, United
States
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
Oxford, United Kingdom
(Tam, Fremes) Division of Cardiac Surgery, Schulich Heart Centre,
Sunnybrook Health Sciences Centre, University of Toronto, Toronto,
Ontario, Canada
(Zenati) Division of Cardiac Surgery, Veterans Affairs Boston Healthcare
System, Department of Surgery, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier USA
Abstract
Compared with randomized controlled trials (RCTs) in medical specialties,
RCTs in cardiac surgery face specific issues. Individual and collective
equipoise, rapid evolution of the surgical techniques, as well as
difficulties in obtaining funding, and limited education in clinical
epidemiology in the surgical community are among the most important
challenges in the design phase of the trial. Use of complex interventions
and learning curve effect, differences in individual operators' expertise,
difficulties in blinding, and slow recruitment make the successful
completion of cardiac surgery RCTs particularly challenging. In fact, over
the course of the last 20 years, the number of cardiac surgery RCTs has
declined significantly. In this review, a team of surgeons, trialists, and
epidemiologists discusses the most important challenges faced by RCTs in
cardiac surgery and provides a list of suggestions for the successful
design and completion of cardiac surgery RCTs.<br/>Copyright &#xa9; 2020
American College of Cardiology Foundation

<68>
Accession Number
2003720455
Title
Tafamidis: A First-in-Class Transthyretin Stabilizer for Transthyretin
Amyloid Cardiomyopathy.
Source
Annals of Pharmacotherapy. 54 (5) (pp 470-477), 2020. Date of Publication:
01 May 2020.
Author
Park J.; Egolum U.; Parker S.; Andrews E.; Ombengi D.; Ling H.
Institution
(Park, Ling) Philadelphia College of Osteopathic Medicine, Suwanee, GA,
United States
(Egolum) The Heart Center of Northeast Georgia Medical Center,
Gainesville, GA, United States
(Parker, Andrews) Hampton University, Hampton, VA, United States
(Ombengi) Medical College of Wisconsin, Milwaukee, WI, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: To review the pharmacology, efficacy, and safety of the
selective transthyretin inhibitor tafamidis for transthyretin amyloid
cardiomyopathy (ATTR-CM). <br/>Data Sources: A PubMed (1966 to October
2019) and ClinicalTrials. gov search was conducted using the keywords
tafamidis, Fx-1006A, Vyndaqel, and Vyndamax. Additional articles were
identified from references. Study Selection and Data Extraction: We
included English-language clinical studies evaluating the pharmacology,
efficacy, or safety of tafamidis in humans for ATTR-CM. <br/>Data
Synthesis: Tafamidis binds to the thyroxine-binding sites of the
transthyretin tetramer and inhibits its dissociation into monomers, which
is the rate-limiting step in the amyloidogenic process. Treatment with
tafamidis was significantly associated with a significant reduction in
mortality, lowered cardiovascular-related hospitalizations, less
functional decline, and improved transthyretin stabilization compared with
placebo. Additionally, tafamidis was found to have fewer adverse events,
with no difference found compared with placebo. Relevance to Patient Care
and Clinical Practice: Historically, symptomatic management for ATTR-CM
was the only option, and the treatment of the underlying disease was
limited to liver or heart transplantation. Tafamidis is the first
medication approved for the treatment of ATTR-CM and the only medication
that showed a reduction in all-cause mortality and cardiovascular-related
hospitalizations in patients with amyloidosis. However, the role of
tafamidis in patients with the New York Heart Association class III/IV
heart failure or mutated transthyretin remains unclear.
<br/>Conclusion(s): Tafamidis is an effective and safe oral medication for
the treatment of the cardiomyopathy of transthyretin-mediated amyloidosis
in adults to reduce cardiovascular mortality and cardiovascular-related
hospitalization.<br/>Copyright &#xa9; The Author(s) 2019.

<69>
Accession Number
631417788
Title
A case of combined aortic bioprosthetic valve degeneration and
patient-prosthesis mismatch during pregnancy: decision-making and
implications after pregnancy.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). (no pagination),
2020. Date of Publication: 23 Mar 2020.
Author
Sciatti E.; Orabona R.; Prefumo F.; Vizzardi E.; Valcamonico A.; Repossini
A.; Sartori E.; Metra M.; Chiari E.
Institution
(Sciatti, Vizzardi, Metra, Chiari) Cardiology Unit
(Sciatti, Orabona) Edoardo Sciatti and Rossana Orabona equally contributed
to the article
(Orabona, Prefumo, Valcamonico, Sartori) Department of Obstetrics and
Gynecology
(Repossini) Cardiac Surgery Unit, ASST Spedali Civili and University of
Brescia, Brescia, Italy
Publisher
NLM (Medline)
Abstract
: A 36-year-old Egyptian women with both mitral and aortic valve
bioprostheses and tricuspid annuloplasty became pregnant and was referred
to our centre for very severe aortic prosthetic valve stenosis (mean
gradient 87 mmHg) and New York Heart Association III dyspnea.
Echocardiography revealed aortic bioprosthesis degeneration with
patient-prosthesis mismatch. This is the first case reported about a
pregnant women with a patient-prosthesis mismatch involving a
bioprosthesis. The management is discussed and, in conclusion, a review of
the literature performed.

<70>
Accession Number
631417786
Title
Mortality in trials on transcatheter aortic valve implantation versus
surgical aortic valve replacement: a pooled meta-analysis of
Kaplan-Meier-derived individual patient data.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 01 Apr 2020.
Author
Barili F.; Freemantle N.; Pilozzi Casado A.; Rinaldi M.; Folliguet T.;
Musumeci F.; Gerosa G.; Parolari A.
Institution
(Barili, Pilozzi Casado) Department of Cardiac Surgery, S. Croce Hospital,
Cuneo, Italy
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Rinaldi) Department of Cardiac Surgery, AOU "Citta della Salute e della
Scienza di Torino", University of Turin, Turin, Italy
(Folliguet) Department of Cardiac Surgery, Hopital Henri Mondor, Paris,
France
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
(Gerosa) Department of Cardiac Surgery, University of Padua, Padua, Italy
(Parolari) Unit of Cardiac Surgery and Translational Research, IRCCS
Policlinico S. Donato, University of Milan, Milan, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This meta-analysis of Kaplan-Meier-estimated individual
patient data was designed to evaluate the effects of transcatheter aortic
valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on
the long-term all-cause mortality rate, to examine the potential
time-varying effect and to model their hazard ratios (HRs) over time.
Moreover, we sought to compare traditional meta-analytic tools and
estimated individual patient data meta-analyses. <br/>METHOD(S): Trials
comparing TAVI versus SAVR were identified through Medline, Embase,
Cochrane databases and specialist websites. The primary outcome was death
from any cause at follow-up. Enhanced secondary analyses of survival
curves were performed estimating individual patient time-to-event data
from published Kaplan-Meier curves. Treatments were compared with the
random effect Cox model in a landmark framework and fully parametric
models. <br/>RESULT(S): We identified 6 eligible trials that included 6367
participants, randomly assigned to undergo TAVI (3252) or SAVR (3115).
According to the landmark analysis, the incidence of death in the first
year after implantation was significantly lower in the TAVI group
[risk-profile stratified HR 0.85, 95% confidence interval (CI) 0.73-0.99;
P=0.04], whereas there was a reversal of the HR after 40months
(risk-profile stratified HR 1.31, 95% CI 1.01-1.68; P=0.04) favouring SAVR
over TAVI. This time-varying trend of HRs was also confirmed by a fully
parametric time-to-event model. Traditional meta-analytic tools were shown
to be biased because they did not intercept heterogeneity and the
time-varying effect. <br/>CONCLUSION(S): The mortality rates in trials of
TAVI versus SAVR are affected by treatments with a time-varying effect.
TAVI is related to better survival in the first months after implantation
whereas, after 40months, it is a risk factor for all-cause
mortality.<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.

<71>
Accession Number
631415431
Title
A randomized trial comparing the effects of sternal band and plate
fixation of the sternum with that of figure-of-8 wires on sternal edge
motion and quality of recovery after cardiac surgery.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 01 Apr 2020.
Author
Royse A.G.; El-Ansary D.; Hoang W.; Lui E.; McCusker M.; Tivendale L.;
Yang Y.; Canty D.J.; Royse C.F.
Institution
(Royse, El-Ansary, Tivendale, Yang, Canty, Royse) Department of Surgery,
The University of Melbourne, Parkville, VIC, Australia
(Royse, El-Ansary, Hoang, Tivendale, Royse) Department of Surgery, The
Royal Melbourne Hospital, Melbourne, VIC, Australia
(Royse, El-Ansary, Royse) Department of Health Professions, Faculty of
Art, Design and Health, Swinburne University of Technology, Melbourne,
VIC, Australia
(Lui, McCusker) Department of Radiology, The University of Melbourne,
Parkville, VIC, Australia
(Yang) Department of Intensive Care, Western Hospital, Melbourne, VIC,
Australia
(Canty) Department of Anaesthesia and Pain Management, Monash Medical
Centre, Melbourne, VIC, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Royse) Outcomes Research Consortium, The Cleveland Clinic, Cleveland, OH,
USA
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We sought to compare the effects of conventional wire cerclage
with that of the band and plate fixation of the sternum. <br/>METHOD(S): A
parallel randomized open-label trial with 1:1 allocation ratio compared
healing after adult cardiac surgery using 'figure-of-8' stainless steel
wire cerclage or a band and plate system (plates). The primary end point
was maximal sternal edge displacement during active coughing of >=2mm in
>=2 of 4 sites measured with ultrasound by 2 assessors blinded to the
other at 6weeks postoperatively. Secondary end points at 12weeks included
ultrasound assessment, computed tomography (CT) scan and multidimensional
assessment of quality of recovery using the Postoperative Quality of
Recovery Scale. <br/>RESULT(S): Of 50 patients, 26 received plates and 24
wires. Two patients died and 1 withdrew consent leaving 25 plates and 22
wires for primary end point analysis. Operations included 37 coronary, 5
valve and 8 combined coronary and valve procedures. At 6weeks, less
sternal movement was observed in patients with plates than those with
wires, 4% (1/25) vs 32% (7/22), P=0.018. Agreement between observers was
high, kappa=0.850. At 12weeks, less ultrasound motion was seen in patients
with plates, 0% (0/23) than those with wires, 25% (5/20), P=0.014.
Recovery from pain was higher for patients with plates 92% (22/24) than
those with wires 67% (14/21), P=0.004. CT bone edge separation was less
for plates 38% (9/24) than wires 71% (15/21), P=0.036. CT mild bone
synthesis or greater was similar between patients with plates 21% (5/24)
and wires 14% (3/21), P=0.71. <br/>CONCLUSION(S): Patients receiving the
band and plate system had significantly less sternal edge motion than
those receiving wires, 6 and 12weeks after cardiac surgery and experienced
less pain. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov
NCT03282578.<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.

<72>
Accession Number
631414366
Title
Do perioperative protocols of enhanced recovery after cardiac surgery
improve postoperative outcome?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 01 Apr 2020.
Author
Kamal Y.A.; Hassanein A.
Institution
(Kamal) Department of Cardiothoracic Surgery, Minia University, Egypt
(Hassanein) Department of Anaesthesia and intensive care, Minia
University, Egypt
Publisher
NLM (Medline)
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether the application of an enhanced recovery
protocol or pathway improves patient outcomes after cardiac surgery. A
total of 3091 papers were found using the reported search. Finally, 12
papers represented the best available 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
are tabulated. Six studies referred to enhanced recovery protocol as fast
track (FT) and another 6 studies referred to it as enhanced recovery after
surgery (ERAS). Significant differences from conventional care were
reported for time to extubation or intubation time in 4 studies (3 FT, 1
ERAS), duration of intensive care unit stay in 6 studies (4 FT, 2 ERAS),
length of hospital stay (LOS) in 8 studies (5 FT, 3 ERAS), cost in 5
studies (4 FT, 1 ERAS), pain scores in 2 studies (2 ERAS) and opioid use
in 3 studies (3 ERAS). We conclude that FT or ERAS improve postoperative
outcomes including length of stay and pain control, without increasing
morbidity, mortality or readmission. However, there is a need for
prospective studies and standardized protocols.<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.

<73>
Accession Number
631419619
Title
Leaflet Thickening or Immobility Following Aortic Valve Replacement:
Results from the Evolut Low Risk Sub-study.
Source
Journal of the American College of Cardiology. (no pagination), 2020. Date
of Publication: 18 Mar 2020.
Author
Blanke P.; Leipsic J.A.; Popma J.J.; Yakubov S.J.; Deeb G.M.; Gada H.;
Mumtaz M.; Ramlawi B.; Kleiman N.S.; Sorajja P.; Askew J.; Meduri C.U.;
Kauten J.; Melnitchouk S.; Inglessis I.; Huang J.; Boulware M.; Reardon
M.J.
Institution
(Blanke, Leipsic) Center for Heart Lung Innovation, St. Paul's Hospital,
University of British Columbia, Vancouver, Canada
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, MA, Boston
(Yakubov) Department of Interventional Cardiology, OhioHealth Riverside
Methodist Hospital, Columbus, OH
(Deeb) Department of Cardiac Surgery, University of Michigan Health System
- University Hospital, MI, Ann Arbor, United States
(Gada, Mumtaz) Departments of Thoracic Surgery and Interventional
Cardiology(, UPMC Pinnacle, Harrisburg, United States
(Ramlawi) Department of Cardiothoracic Surgery, Winchester Medical Center,
VA, Winchester
(Kleiman) Department of Cardiology, Methodist DeBakey Heart and Vascular
Center, TX, Houston
(Sorajja, Askew) Departments of Thoracic Surgery and Interventional
Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN,
Minneapolis, United States
(Meduri, Kauten) Departments of Cardiac Surgery and Interventional
Cardiology, Piedmont Atlanta Hospital, Atlanta, United States
(Melnitchouk, Inglessis) Departments of Cardiac Surgery and Interventional
Cardiology, Massachusetts General Hospital, MA, Boston
(Huang, Boulware) Department of Statistics, Medtronic, MN, Minneapolis,
United States
(Reardon) Department of Cardiothoracic Surgery, Methodist DeBakey Heart
and Vascular Center, TX, Houston
Publisher
NLM (Medline)
Abstract
BACKGROUND: Subclinical leaflet thrombosis has been reported after
bioprosthetic aortic valve replacement, characterized using 4-dimensional
computed tomographic (CT) imaging by hypoattenuated leaflet thickening
(HALT) and reduced leaflet motion (RLM). The incidence and clinical
implications of these findings remain unclear. <br/>OBJECTIVE(S): This
study sought to determine the frequency, predictors and hemodynamic and
clinical correlates of HALT and RLM after aortic bioprosthetic
replacement. <br/>METHOD(S): A prospective subset of patients not on oral
anticoagulation enrolled in the Evolut Low Risk randomized trial underwent
CT imaging 30 days and 1 year after TAVR or surgery. The primary endpoint
was the frequency of HALT at 30 days and 1 year, analyzed by an
independent core laboratory using standardized definitions. Secondary
endpoints included RLM, mean aortic gradient, and clinical events at 30
days and 1 year. <br/>RESULT(S): At 30 days, the frequency of HALT was
31/179 (17.3%) for TAVR and 23/139 (16.5%) for surgery; the frequency of
RLM was 23/157 (14.6%) for TAVR and 19/133 (14.3%) for surgery. At 1 year,
the frequency of HALT was 47/152 (30.9%) for TAVR and 33/116 (28.4%) for
surgery; the frequency of RLM was 45/145 (31.0%) in TAVR and 30/111
(27.0%) for surgery. Aortic valve hemodynamics were not influenced by the
presence or severity of HALT or RLM at either time point. The rates of
HALT and RLM were similar after implantation of supraannular,
self-expanding transcatheter or surgical bioprostheses.
<br/>CONCLUSION(S): We found that the presence of CT imaging abnormalities
of aortic bioprostheses were frequent but dynamic in the first year after
self-expanding transcatheter and surgical aortic valve replacement, but
that these findings did not correlated with aortic valve hemodynamics
after aortic valve replacement in patients at low risk for
surgery.<br/>Copyright &#xa9; 2020. Published by Elsevier Inc.

<74>
Accession Number
631413632
Title
Is it safe and effective to reduce the target anticoagulation range for
patients with mechanical prosthetic aortic valves?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 01 Apr 2020.
Author
Mohamed W.; Asimakopoulos G.
Institution
(Mohamed) Department of Cardiac Surgery, Glenfield Hospital, Leicester,
United Kingdom
(Asimakopoulos) Department of Cardiac Surgery, Royal Brompton Hospital,
London, United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Is it safe and effective
to reduce the target anticoagulation range for patients with mechanical
aortic valves?' Altogether 922 papers were found using the reported
search, of which 7 represented the best evidence to answer the clinical
question. Only studies that compared high (target international normalized
ratio 2-3) versus low (target international normalized ratio <2-3)
intensity anticoagulation were included. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. We conclude that there
is growing evidence for the reduction of the target anticoagulation range
for patients with mechanical prosthetic aortic valves, especially
bileaflet valves with presumed better haemodynamic properties. Several
large randomized controlled trials and a meta-analysis have concluded that
reducing the target international normalized ratio range (below the
conventional range of 2-3) for mechanical aortic valves in patients with
no thrombogenic risk factors produces less bleeding and does not increase
thromboembolic events.<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.

<75>
Accession Number
2005468767
Title
Anthracycline-induced cardiotoxicity prevention with
angiotensin-converting enzyme inhibitor ramipril in women with low-risk
breast cancer: Results of a prospective randomized study.
Source
Kardiologia Polska. 78 (2) (pp 131-137), 2020. Date of Publication: 25 Feb
2020.
Author
Slowik A.J.; Jagielski P.; Potocki P.; Streb J.; Ochenduszko S.; Wysocki
P.; Gajos G.; Konduracka E.
Institution
(Slowik, Potocki, Streb, Wysocki) Department of Oncology, Jagiellonian
University Medical College, Krakow, Poland
(Jagielski) Human Nutrition Department, Faculty of Health Science,
Jagiellonian University Medical College, Krakow, Poland
(Ochenduszko) Department of Medical Oncology, Dr. Peset University
Hospital, Valencia, Spain
(Gajos, Konduracka) Department of Coronary Disease and Heart Failure,
Jagiellonian University Medical College, Krakow, Poland
(Gajos, Konduracka) Institute of Cardiology, John Paul II Hospital,
Krakow, Poland
Publisher
Medycyna Praktyczna Cholerzyn (E-mail: listy@mp.pl)
Abstract
Background: Anthracycline-induced cardiotoxicity (AIC) remains the main
long-term irreversible side effect in malignancy survivors. Cardiotoxicity
prevention is one of the most reasonable approaches. <br/>Aim(s): In this
prospective randomized open-label study, we aimed to verify whether
ramipril protects from early-onset AIC in women with breast cancer (BC).
<br/>Method(s): We analyzed data from 96 women (median age, 47 years) with
BC after breast surgery, without significant cardiovascular diseases, who
were eligible for adjuvant anthracyclines. They were randomized to a
ramipril or control arm. Cardiotoxicity was estimated with repeat
echocardiography and the measurement of troponin I and N-terminal fragment
of the prohormone brain natriuretic peptide (NT-proBNP) levels over 1-year
follow-up. Anthracycline-induced cardiotoxicity was defined as a decrease
in left ventricular ejection fraction (LVEF), elevated biomarker levels,
and/or occurrence of heart failure (HF) or cardiac death. <br/>Result(s):
A decrease in LVEF above 10-percent points occurred in 6.3% of ramipril
patients and 18.5% of controls (P = 0.15). No cases of HF, cardiac death,
or LVEF decline below 50% were reported. The percentage of patients with
elevated NT-proBNP levels increased with time in controls (P = 0.003) and
remained unchanged in the ramipril arm. At the end of follow-up, an
increase in NT-proBNP levels was more common and decline was less common
in the control than ramipril arm (P = 0.01). No significant differences in
troponin levels were found between the study arms. Ramipril was well
tolerated in normotensive women. <br/>Conclusion(s): In relatively young
women with BC without serious comorbidities, who received anthracyclines,
1-year treatment with ramipril exerts potentially protective effects on
cardiotoxicity assessed with NT-proBNP levels.<br/>Copyright &#xa9; 2020
by the Author(s).

<76>
Accession Number
631401808
Title
Isolated surgical tricuspid repair versus replacement: Meta-analysis of 15
069 patients.
Source
Open Heart. 7 (1) (no pagination), 2020. Article Number: e001227. Date of
Publication: 17 Mar 2020.
Author
Wang T.K.M.; Griffin B.P.; Miyasaka R.; Xu B.; Popovic Z.B.; Pettersson
G.B.; Gillinov A.M.; Desai M.Y.
Institution
(Wang, Griffin, Miyasaka, Xu, Popovic, Desai) Section of Cardiovascular
Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH,
United States
(Pettersson, Gillinov) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: Tricuspid valve disease is increasingly encountered, but
surgery is rarely performed in isolation, in part because of a reported
higher operative 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. <br/>Method(s): We searched Pubmed, Embase,
Scopus and Cochrane from January 1980 to June 2019 for studies reporting
outcomes of both isolated tricuspid valve repair and replacement,
excluding congenital tricuspid aetiologies. Data were extracted and pooled
using random-effects models and Review Manager 5.3 software.
<br/>Result(s): There were 811 article abstracts screened, from which 52
full-text articles reviewed and 16 studies included, totalling 6808
repairs and 8261 replacements. Mean age ranged from 36 to 68 years and
females made up 24%-92% of these studies. Pooled operative mortality rates
and odds ratios (95% confidence intervals) for isolated tricuspid repair
and replacement surgery were 8.4% vs 9.9%, 0.80 (0.64 to 1.00). Tricuspid
repair was also associated with lower in-hospital acute renal failure
12.4% vs 15.6%, 0.82 (0.72 to 0.93) and pacemaker implantation 9.4% vs
21.0%, 0.37 (0.24 to 0.58), but higher stroke rate 1.5% vs 0.9%, 1.63
(1.10 to 2.41). There were no differences in rates of prolonged
ventilation, mediastinitis, return to operating room or late mortality.
<br/>Conclusion(s): Isolated tricuspid valve repair was associated with
significantly reduced in-hospital mortality, renal failure and pacemaker
implantation compared with replacement and is therefore recommended where
feasible for isolated tricuspid valve disease, although its higher stroke
rate warrants further research.<br/>Copyright &#xa9; 2020 Author(s).

<77>
Accession Number
2004586328
Title
The Effect of a Surgery-Specific Cardiac Output-Guided Haemodynamic
Algorithm on Outcomes in Patients Undergoing Pancreaticoduodenectomy in a
High-Volume Centre: A Retrospective Comparative Study.
Source
Anaesthesia and Intensive Care. 45 (5) (pp 569-580), 2017. Date of
Publication: 01 Sep 2017.
Author
Weinberg L.; Banting J.; Churilov L.; McLeod R.L.; Fernandes K.; Chao I.;
Ho T.; Ianno D.; Liang V.; Muralidharan V.; Christophi C.; Nikfarjam M.
Institution
(Weinberg) Department of Surgery, Austin Hospital, The University of
Melbourne, Melbourne, VIC, Australia
(Banting, Ianno) University of Melbourne, Melbourne, VIC, Australia
(Churilov) Statistics and Decision Analysis Academic Platform, The Florey
Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
(McLeod, Fernandes) Monash Medical Centre, Melbourne, VIC, Australia
(Chao, Ho, Liang) Department of Anaesthesia, Austin Hospital, Melbourne,
VIC, Australia
(Muralidharan, Nikfarjam) Department of Surgery, Austin Hospital, The
University of Melbourne, Melbourne, VIC, Australia
(Christophi) Department of Surgery, University of Melbourne, Melbourne,
VIC, Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
In this retrospective observational study performed in a high-volume
hepatobiliary-pancreatic unit, we evaluated the effect of a
surgery-specific goal-directed therapy (GDT) physiologic algorithm on
complications and length of hospital stay. We compared patients who
underwent pancreaticoduodenectomy with either a standardised Enhanced
Recovery After Surgery program (usual care group), or a standardised
Enhanced Recovery After Surgery program in combination with a
surgery-specific cardiac output-guided algorithm (GDT group). We included
145 consecutive patients: 47 in the GDT group and 98 in the usual care
group. Multivariable associations between GDT and lengths of stay and
complications were investigated using negative binomial regression.
Postoperative complications were common and occurred at similar
frequencies amongst the GDT and usual care groups: 64% versus 68%
respectively, P=0.71; odds ratio 0.82; (95% confidence interval
0.39-1.70). There were fewer cardiorespiratory complications in the GDT
group. Median (interquartile range) length of hospital stay was ten days
(8.0-14.0) in the GDT group compared to 13 days (8.8-21.3) in the usual
care group, P=0.01. Median (interquartile range) total intraoperative
fluid was 3,000 ml (2,050-4,175) in the GDT group compared to 4,500 ml
(3,275-5,325) in the usual care group, P <0.0001; but by day one, the
median (interquartile range) fluid balance was similar (1,198 ml
[700-1,729] in the GDT group versus 977 ml [419-2,044] in the usual care
group, P=0.96). Use of vasoactive medications was higher in the GDT group.
In our patients undergoing pancreaticoduodenectomy, GDT was associated
with restrictive intraoperative fluid intervention, fewer
cardiorespiratory complications and a shorter hospital length of stay
compared to usual care. However, we could not exclude an influence of
surgical caseload, which we have previously found to be an important
variable. We also could not relate the increased hospital length of stay
to cardiorespiratory complications in individual patients. Therefore,
these observational retrospective findings would require confirmation in a
prospective randomised study.<br/>Copyright &#xa9; 2017 Australian Society
of Anaesthetists.

<78>
Accession Number
2004583389
Title
The Effect of a Perioperative Ketamine Infusion on the Incidence of
Chronic Postsurgical Pain-A Pilot Study.
Source
Anaesthesia and Intensive Care. 45 (4) (pp 459-465), 2017. Date of
Publication: 01 Jul 2017.
Author
Peyton P.J.; Wu C.; Jacobson T.; Hogg M.; Zia F.; Leslie K.
Institution
(Peyton) Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne
Medical School, University of Melbourne, Australia
(Wu) Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
(Jacobson) University of Melbourne, Austin Health Medical Education,
Melbourne, VIC, Australia
(Hogg) Head of Pain Services, Melbourne Health, Melbourne, VIC, Australia
(Zia) Ballarat Health Services, Department of Anaesthesia, Ballarat, VIC,
Australia
(Leslie) Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne
Medical School, Department of Pharmacology and Therapeutics, University of
Melbourne, Australia
(Peyton) Department of Surgery, Austin Health, University of Melbourne,
Australia
(Peyton) Dept of Anaesthesia, Austin Health, Melbourne, VIC, Australia
(Leslie) Department of Epidemiology and Preventive Medicine, Monash
University, Australia
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Chronic postsurgical pain (CPSP) is a common and debilitating complication
of major surgery. We undertook a pilot study at three hospitals to assess
the feasibility of a proposed large multicentre placebo-controlled
randomised trial of intravenous perioperative ketamine to reduce the
incidence of CPSP. Ketamine, 0.5 mg/kg pre-incision, 0.25 mg/kg/hour
intraoperatively and 0.1 mg/kg/hour for 24 hours, or placebo, was
administered to 80 patients, recruited over a 15-month period, undergoing
abdominal or thoracic surgery under general anaesthesia. The primary
endpoint was CPSP in the area of the surgery reported at six-month
telephone follow-up using a structured questionnaire. Fourteen patients
(17.5%) reported CPSP (relative risk [95% confidence interval] if received
ketamine 1.18 [0.70 to 1.98], P=0.56). Four patients in the treatment
group and three in the control group reported ongoing analgesic use to
treat CPSP and two patients in each group reported their worst pain in the
previous 24 hours at >=3/10 at six months. There were no significant
differences in adverse event rates, quality of recovery scores, or
cumulative morphine equivalents consumption in the first 72 hours. Numeric
Rating Scale pain scores (median [interquartile range]) for average pain
in the previous 24 hours among those patients reporting CPSP were 17.5 [0
to 40] /100 with no difference between treatment groups. A large (n=4,000
to 5,000) adequately powered multicentre trial is feasible using this
population and methodology.<br/>Copyright &#xa9; 2017 Australian Society
of Anaesthetists.

<79>
Accession Number
2005524071
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
for myocardial infarction complicated by cardiogenic shock.
Source
American Heart Journal. (no pagination), 2020. Date of Publication: 2020.
Author
Smilowitz N.R.; Alviar C.L.; Katz S.D.; Hochman J.S.
Institution
(Smilowitz, Alviar, Katz, Hochman) Leon H. Charney Division of Cardiology,
Department of Medicine, New York University School of Medicine, New York,
NY, United States
(Smilowitz) Division of Cardiology, Department of Medicine, New York, NY,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Myocardial infarction (MI) complicated by cardiogenic shock
(CS) is associated with high mortality. Early coronary revascularization
improves survival, but the optimal mode of revascularization remains
uncertain. We sought to characterize practice patterns and outcomes of
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) in patients with MI complicated by CS. <br/>Method(s):
Patients hospitalized for MI with CS between 2002 and 2014 were identified
from the United States National Inpatient Sample. Trends in management
were evaluated over time. Propensity score matching was performed to
identify cohorts with similar baseline characteristics and MI
presentations who underwent PCI and CABG. The primary outcome was
in-hospital all-cause mortality. <br/>Result(s): A total of 386,811
hospitalizations for MI with CS were identified; 67% were STEMI. Overall,
62.4% of patients underwent revascularization, with PCI in 44.9%, CABG in
14.1%, and a hybrid approach in 3.4%. Coronary revascularization for MI
and CS increased over time, from 51.5% in 2002 to 67.4% in 2014 (P for
trend < .001). Patients who underwent CABG were more likely to have
diabetes mellitus (35.5% vs. 29.2%, P < .001) and less likely to present
with STEMI (48.7% vs. 80.9%, P < .001) than those who underwent PCI. CABG
(without PCI) was associated with lower mortality than PCI (without CABG)
overall (18.9% vs. 29.0%, P < .001) and in a propensity-matched subgroup
of 19,882 patients (19.0% vs. 27.0%, P < .001). <br/>Conclusion(s): CABG
was associated with lower in-hospital mortality than PCI among patients
with MI complicated by CS. Due to the likelihood of residual confounding,
a randomized trial of PCI versus CABG in patients with MI, CS, and
multi-vessel coronary disease is warranted.<br/>Copyright &#xa9; 2020

<80>
Accession Number
2004590425
Title
Randomised comparison of a balloon-expandable and self-expandable valve
with quantitative assessment of aortic regurgitation using magnetic
resonance imaging.
Source
Netherlands Heart Journal. (no pagination), 2020. Date of Publication:
2020.
Author
Kooistra N.H.M.; Abawi M.; Voskuil M.; Urgel K.; Samim M.; Nijhoff F.;
Nathoe H.M.; Doevendans P.A.F.M.; Chamuleau S.A.J.; Leenders G.E.H.;
Leiner T.; Abrahams A.C.; van der Worp H.B.; Agostoni P.; Stella P.R.
Institution
(Kooistra, Abawi, Voskuil, Urgel, Samim, Nijhoff, Nathoe, Doevendans,
Chamuleau, Leenders, Agostoni, Stella) Department of Cardiology,
University Medical Centre Utrecht, Utrecht, Netherlands
(Samim, Agostoni) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Doevendans) Netherlands Heart Institute (ICIN), Utrecht, Netherlands
(Leiner) Department of Radiology, University Medical Centre Utrecht,
Utrecht, Netherlands
(Abrahams) Department of Nephrology and Hypertension, University Medical
Centre Utrecht, Utrecht, Netherlands
(van der Worp) Department of Neurology and Neurosurgery, Brain Centre
Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) is a safe and
effective treatment for inoperable, intermediate- or high-risk patients
with severe symptomatic aortic stenosis and has been associated with
excellent clinical outcomes. A clinically relevant remaining problem is
aortic regurgitation (AR) post-TAVI, which is associated with increased
mortality. Therefore, we conducted a prospective randomised trial to
assess the safety and efficacy of a first-generation self-expandable valve
(SEV; CoreValve) and a third-generation balloon-expandable valve (BEV;
Sapien 3) with respect to clinical outcomes and AR as determined
quantitatively by magnetic resonance imaging (MRI). <br/>Method(s): The
ELECT study was an investigator-initiated, single-centre trial involving
patients with severe symptomatic aortic stenosis and with a clinical
indication for transfemoral TAVI. Fifty-six patients were randomly
assigned to the BEV or SEV group. <br/>Result(s): AR determined
quantitatively by MRI was lower in the BEV than in the SEV group
[regurgitant fraction: 1.1% (0-8.0) vs 8.7% (3.0-14.8) for SEV; p= 0.01].
Secondary endpoints according to the criteria of the Second Valve Academic
Research Consortium (VARC-2) showed BEV to have better early safety [0
(0%) vs 8 (30%); p= 0.002] at 30 days and a lower risk of stroke [0 (0%)
vs 5 (21%); p= 0.01], major adverse cardiac and cerebrovascular events [0
(0%) vs 10 (38%); p< 0.001] or death [0 (0%) vs 5 (19%); p= 0.02] in the
1st year compared with SEV. <br/>Conclusion(s): The use of the latest
generation of BEV was associated with less AR as quantitatively assessed
by MRI. Although the use of MRI to quantify AR is not feasible in daily
clinical practice, it should be considered as a surrogate endpoint for
clinical outcomes in comparative studies of valves for TAVI.
ClinicalTrials.gov number NCT01982032.<br/>Copyright &#xa9; 2020, The
Author(s).

<81>
Accession Number
2004583420
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. (no pagination), 2020. Date of Publication: 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, 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) Anesthesiology Department of China Medical University, Taichung
City, Taiwan (Republic of China)
(Chen) Anesthesiology Department of China Medical University Hospital,
Taichung City, Taiwan (Republic of China)
(Teng) Department of Pathology, St. Martin De Porres Hospital, Chiayi
City, Taiwan (Republic of China)
Publisher
Taylor and Francis Ltd
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 databases were
searched for literature published prior to December 2019 using 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 postoperative PH after either cardiac or pulmonary
surgery were included. Retrospective studies, reviews, letters, comments,
editorials, and case reports were 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 mean
change= -0.10, 95% CI: -3.98 to 3.78, p =.959) or pulmonary vascular
resistance (pooled standardized difference in mean change= -0.27, 95% CI:
-0.60 to 0.05, p =.099) were found between 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 inhaled NO to treat PH after surgery.
The two types of agent exhibited similar efficacy in managing MPAP, PVR,
heart rate, and cardiac output was observed. Inhaled prostacyclin may
serve as an alternative treatment option for PH after cardiac or pulmonary
surgery.<br/>Copyright &#xa9; 2020, &#xa9; 2020 Informa UK Limited,
trading as Taylor & Francis Group.

<82>
Accession Number
2004562105
Title
Pharmacokinetics of an intravenous bolus dose of clonidine in children
undergoing surgery.
Source
Paediatric Anaesthesia. (no pagination), 2020. Date of Publication: 2020.
Author
Nielsen B.N.; Anderson B.J.; Falcon L.; Henneberg S.W.; Lauritsen T.;
Lomstein E.; Ydemann M.; Afshari A.
Institution
(Nielsen, Falcon, Henneberg, Lauritsen, Afshari) Department of
Anaesthesia, The Juliane Marie Centre, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Anderson) Department of Anaesthesiology, University of Auckland,
Auckland, New Zealand
(Lomstein) Center for Laboratory, Food and Environmental Technology, The
Business Academy Aarhus, Aarhus, Denmark
(Ydemann) Department of Neuroanaethestesiology, Copenhagen University
Hospital, Copenhagen, Denmark
Publisher
Blackwell Publishing Ltd
Abstract
Background: Clonidine is used off-label in children but only limited
pediatric pharmacokinetic data are available for intravenously
administered clonidine. <br/>Objective(s): To determine pharmacokinetic
parameter estimates of clonidine in healthy children undergoing surgery
and to investigate age-related differences. Furthermore, to investigate
possible pharmacokinetic differences of clonidine between this group of
children and a cohort with cardiac diseases. <br/>Method(s): In a
randomized placebo-controlled trial (The PREVENT AGITATION trial), blood
samples for clonidine pharmacokinetic analysis were collected in a
proportion of the enrolled patients. Healthy children with ASA score 1-2
in the age-groups 1 to <2 years and 2-5 years were randomized for blood
sampling. Clonidine was administered as a single intravenous bolus of 3
micro&#32;g/kg intraoperatively. Blood samples were drawn at baseline, 5,
10, 15, 30, 60 minutes after dosing and additionally every hour until
discharge from the PACU. Clonidine analysis was performed on liquid
chromatography-mass spectrometry. <br/>Result(s): Data form eighteen
children were available for pharmacokinetic analysis (ASA I; male/female:
17/1; age: 1-5 years; weight 8.7-24 kg). Population parameter estimates
for the 2-compartment model were similar to previous published data for
children who underwent cardiac surgery. A pooled analysis including data
from 59 children indicated clearance of 14.4 L h^-1 70
kg^-1 and volume of distribution of 192.6 L 70 kg^-1.
No age-related pharmacokinetic differences and no difference in time from
administration of study medication to awakening were found. Children 1 to
<2 years had a shorter PACU stay than children 2-5 years (mean difference
17% 95% CI:3%-34%, P =.02). <br/>Conclusion(s): Pharmacokinetic parameter
estimates were similar for children undergoing general surgery and cardiac
surgery given a single dose of intravenous clonidine. These results
indicated that no dose reduction is needed in children aged 1 to <2 years
compared with those 2-5 years, which was supported by pharmacodynamic
observations.<br/>Copyright &#xa9; 2020 John Wiley & Sons Ltd

<83>
Accession Number
2004562035
Title
Combined non-intubated anaesthesia and paravertebral nerve block in
comparison with intubated anaesthesia in children undergoing
video-assisted thoracic surgery.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2020. Date of
Publication: 2020.
Author
Wei W.; Fan Y.; Liu W.; Zhao T.; Tian H.; Xu Y.; Tan Y.; Song X.; Ma D.
Institution
(Wei, Fan, Zhao, Tian, Xu, Tan, Song) Department of Anaesthesiology,
Guangzhou Women and Children's Medical Center, Guangzhou Medical
University, Guangzhou, China
(Liu) Department of Thoracic Surgery, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
(Ma) Anaethetics, Pain Medicine and Intensive Care, Department of Surgery
and Cancer, Faculty of Medicine, Imperial College London, Chelsea and
Westminster Hospital, London, United Kingdom
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: This study is to investigate if non-intubated anaesthesia
combined with paravertebral nerve block (PVNB) can enhance recovery in
children undergoing video-assisted thoracic surgery (VATS).
<br/>Method(s): A randomized controlled trial including 60 patients aged 3
to 8 years old who underwent elective VATS was performed. They were
randomly assigned to receive non-intubated anaesthesia combined with PVNB
or general anaesthesia with tracheal intubation (1:1 ratio). The primary
outcome was the length of postoperative in-hospital stay. The secondary
outcomes included emergence time, the incidence of emergence delirium,
time to first feeding, time to first out-of-bed activity, pain score and
in-hospital complications. <br/>Result(s): The non-intubated group had
shorter postoperative in-hospital stay than the control group (4 days
[IQR, 4-6] vs 5 days [IQR, 5-8], 95% CI 0-2; P =.013). When compared to
the control group, the incidence of emergence delirium (odds ratio [OR]
3.39, 95% CI 1.01-11.41; P =.043), emergence time, duration in the PACU,
time to first eating food, first out-of-bed activity, pain score and
consumption of sufentanil (at 6 and 12 hours after surgery) were decreased
in the intervention group. In contrast, the incidence of airway
complications was higher in the control than the intervention group (27.6%
vs 6.9%, P =.037). There was no statistical significance in the occurrence
of PONV, pneumothorax and other complications between the two groups.
<br/>Conclusion(s): Non-intubated anaesthesia combined with PVNB enhances
recovery in paediatric patients for video-assisted thoracic surgery
although further multi-centre study is needed.<br/>Copyright &#xa9; 2020
The Acta Anaesthesiologica Scandinavica Foundation. Published by John
Wiley & Sons Ltd

<84>
Accession Number
2003713328
Title
Clinical interventions and all-cause mortality of patients with chronic
kidney disease: An umbrella systematic review of meta-analyses.
Source
Journal of Clinical Medicine. 9 (2) (no pagination), 2020. Article Number:
394. Date of Publication: February 2020.
Author
Kim J.Y.; Steingroever J.; Lee K.H.; Oh J.; Choi M.J.; Lee J.; Larkins
N.G.; Schaefer F.; Hong S.H.; Jeong G.H.; Shin J.I.; Kronbichler A.
Institution
(Kim, Choi) Yonsei University College of Medicine, Seoul 03722, South
Korea
(Steingroever, Oh) Department of Pediatric Nephrology, University Medical
Center Hamburg-Eppendorf, Martinistrase 52, Hamburg 20251, Germany
(Lee, Shin) Department of Pediatrics, Yonsei University College of
Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, South
Korea
(Lee, Shin) Division of Pediatric Nephrology, Severance Children's
Hospital, Seoul 03722, South Korea
(Lee) Department of Pediatric Nephrology, Chungnam National University
Hospital, Daejeon 35015, South Korea
(Larkins) Department of Nephrology, Perth Children's Hospital, 15 Hospital
Ave, Nedlands, WA 6909, Australia
(Larkins) Centre for Kidney Research, Kids Research Institute, Westmead,
NSW 2031, Australia
(Schaefer) Division of Pediatric Nephrology, Center for Pediatrics and
Adolescent Medicine, Heidelberg University Hospital, Heidelberg 69120,
Germany
(Hong) Department of Global Health and Population, Harvard T. H. Chan
School of Public Health, 677 Huntington Ave, Boston, MA 02115, United
States
(Jeong) College of Medicine, Gyeongsang National University, Jinju 52727,
South Korea
(Kronbichler) Department of Internal Medicine IV (Nephrology and
Hypertension), Medical University Innsbruck, Anichstrase 35, Innsbruck
6020, Austria
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Patients with chronic kidney disease (CKD) have altered physiologic
processes, which result in different treatment outcomes compared with the
general population. We aimed to systematically evaluate the efficacy of
clinical interventions in reducing mortality of patients with CKD. We
searched PubMed, MEDLINE, Embase, and Cochrane Database of Systematic
Reviews for meta-analyses of randomized controlled trials (RCT) or
observational studies (OS) studying the effect of treatment on all-cause
mortality of patients with CKD. The credibility assessment was based on
the random-effects summary estimate, heterogeneity, 95% prediction
intervals, small study effects, excess significance, and credibility
ceilings. Ninety-two articles yielded 130 unique meta-analyses. Convincing
evidence from OSs supported mortality reduction with three treatments:
angiotensin-converting-enzyme inhibitors or angiotensin II receptor
blockers for patients not undergoing dialysis, warfarin for patients with
atrial fibrillation not undergoing dialysis, and (at short-term)
percutaneous coronary intervention compared to coronary artery bypass
grafting for dialysis patients. Two treatment comparisons were supported
by highly credible evidence from RCTs in terms of all-cause mortality.
These were high-flux hemodialysis (HD) versus low-flux HD as a maintenance
HD method and statin versus less statin or placebo for patients not
undergoing dialysis. Most significant associations identified in OSs
failed to be replicated in RCTs. Associations of high credibility from
RCTs were in line with current guidelines. Given the heterogeneity of CKD,
it seems hard to assume mortality reductions based on findings from
OSs.<br/>Copyright &#xa9; 2020 by the authors. Licensee MDPI, Basel,
Switzerland.

<85>
Accession Number
2003806603
Title
Marine omega-3 (N-3) fatty acids for cardiovascular health: An update for
2020.
Source
International Journal of Molecular Sciences. 21 (4) (no pagination), 2020.
Article Number: 1362. Date of Publication: 02 Feb 2020.
Author
Innes J.K.; Calder P.C.
Institution
(Innes, Calder) School of Human Development and Health, Faculty of
Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
(Calder) National Institute for Health Research, Southampton Biomedical
Research Centre, University Hospital Southampton NHS Foundation Trust and
University of Southampton, Southampton SO16 6YD, United Kingdom
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
The omega-3 (n-3) fatty acids, eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA), are found in seafood (especially fatty fish),
supplements and concentrated pharmaceutical preparations. Long-term
prospective cohort studies consistently demonstrate an association between
higher intakes of fish, fatty fish and marine n-3 fatty acids (EPA + DHA)
or higher levels of EPA and DHA in the body and lower risk of developing
cardiovascular disease (CVD), especially coronary heart disease (CHD) and
myocardial infarction (MI), and cardiovascular mortality in the general
population. This cardioprotective effect of EPA and DHA is most likely due
to the beneficial modulation of a number of known risk factors for CVD,
such as blood lipids, blood pressure, heart rate and heart rate
variability, platelet aggregation, endothelial function, and inflammation.
Evidence for primary prevention of CVD through randomised controlled
trials (RCTs) is relatively weak. In high-risk patients, especially in the
secondary prevention setting (e.g., post-MI), a number of large RCTs
support the use of EPA + DHA (or EPA alone) as confirmed through a recent
meta-analysis. This review presents some of the key studies that have
investigated EPA and DHA in the primary and secondary prevention of CVD,
describes potential mechanisms for their cardioprotective effect, and
evaluates the more recently published RCTs in the context of existing
scientific literature.<br/>Copyright &#xa9; 2020 by the authors. Licensee
MDPI, Basel, Switzerland.

<86>
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