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<1>
Accession Number
2002075752
Title
Prophylactic Intra-Aortic Balloon Counterpulsation in High Risk Cardiac
Surgery: The PINBALL Pilot Multicentre, Registry-Linked, Randomised,
Controlled Feasibility Trial.
Source
Heart Lung and Circulation. 29 (5) (pp 710-718), 2020. Date of
Publication: May 2020.
Author
Litton E.; Bass F.; Dickson C.; Hillis G.; Inskip D.; Jacques T.; McGiffin
D.; McGuiness S.; Miller J.; Parke R.; Playford H.; Reid C.; Smith J.;
Solman N.; Tran L.; Yarad E.; Delaney A.
Institution
(Litton) Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
(Litton, Hillis) School of Medicine, University of Western Australia,
Perth, WA, Australia
(Bass, Yarad, Delaney) Malcolm Fischer Department of Intensive Care
Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
(Dickson) Department of cardiothoracic surgery, Westmead Hospital, Sydney,
NSW, Australia
(Hillis) Department of Cardiology, Royal Perth Hospital, Perth, WA,
Australia
(Inskip, Jacques, Miller) Intensive Care Unit, The St George Hospital,
Sydney, NSW, Australia
(McGiffin, McGuiness) Department of Cardiothoracic Surgery, The Alfred
Hospital, Melbourne, Vic, Australia
(Parke) Cardiovascular Intensive Care Unit, Auckland City Hospital,
Auckland, New Zealand
(Playford) Department of Anaesthesia, Westmead Hospital, Sydney, NSW,
Australia
(Reid, Solman, Tran) School of Public Health and Preventive Medicine,
Monash University, Melbourne Vic, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Melbourne,
Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: Prophylactic intra-aortic balloon counterpulsation (IABC) is
commonly used in selected patients undergoing coronary artery bypass graft
(CABG) surgery, but definitive evidence is lacking. The aim of the
multicentre PINBALL Pilot randomised controlled trial (RCT) was to assess
the feasibility of performing a definitive trial to address this question.
<br/>Method(s): Patients listed for CABG surgery with impaired left
ventricular function and at least one additional risk factor for
postoperative low cardiac output syndrome were eligible for inclusion if
the treating surgical team was uncertain as to the benefit of prophylactic
IABC. The primary outcome of feasibility was based on exceeding a
pre-specified recruitment rate, protocol compliance and follow-up.
<br/>Result(s): The recruitment rate of 0.5 participants per site per
month did not meet the feasibility threshold of two participants per site
per month and the study was stopped early after enrolment of 24 out of the
planned sample size of 40 participants. For 20/24 (83%) participants,
preoperative IABC use occurred according to study assignment. Six
(6)-month follow-up was available for all enrolled participants, [IABC 1
death (8%) vs. control 1 death (9%), p = 0.95]. <br/>Conclusion(s): The
PINBALL Pilot recruitment rate was insufficient to demonstrate feasibility
of a multicentre RCT of prophylactic IABC in high risk patients undergoing
CABG surgery.<br/>Copyright &#xa9; 2019

<2>
Accession Number
631634368
Title
Impact of non-respect of SYNTAX score II recommendation for surgery in
patients with left main coronary artery disease treated by percutaneous
coronary intervention: An EXCEL substudy.
Source
European Journal of Cardio-thoracic Surgery. 57 (4) (pp 676-683), 2020.
Date of Publication: 01 Apr 2020.
Author
Modolo R.; Chichareon P.; Van Klaveren D.; Dressler O.; Zhang Y.; Sabik
J.F.; Onuma Y.; Kappetein A.P.; Stone G.W.; Serruys P.W.
Institution
(Modolo, Chichareon) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Modolo) Cardiology Division, Department of Internal Medicine, University
of Campinas (UNICAMP), Campinas, Brazil
(Chichareon) Division of Cardiology, Department of Internal Medicine,
Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
(Van Klaveren) Department of Biomedical Data Sciences, Leiden University
Medical Center, Leiden, Netherlands
(Dressler, Zhang, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Onuma) Department of Cardiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Onuma) Cardialysis Clinical Trials Management and Core Laboratories,
Rotterdam, Netherlands
(Kappetein) Medtronic, Maastricht, Netherlands
(Stone) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Serruys) Imperial College London, London, United Kingdom
(Serruys) Erasmus University Medical Center, PO Box 2125, Rotterdam, CC
3000, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The SYNTAX score II (SSII) was developed from the SYNTAX trial
to predict the 4-year all-cause mortality after left main or multivessel
disease revascularization and to facilitate the decision-making process.
The SSII provides the following treatment recommendations: (i) coronary
artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)
(equipoise risk), (ii) CABG preferred (excessive risk for PCI) or (iii)
PCI preferred (excessive risk for CABG). We sought to externally validate
SSII and to investigate the impact of not abiding by the SSII
recommendations in the randomized EXCEL trial of PCI versus CABG for left
main disease. <br/>METHOD(S): The calibration plot of predicted versus
observed 4-year mortality was constructed from individual values of SSII
in EXCEL. To assess overestimation versus underestimation of predicted
mortality risk, an optimal fit regression line with slope and intercept
was determined. Prospective treatment recommendations based on SSII were
compared with actual treatments and all-cause mortality at 4 years.
<br/>RESULT(S): SSII variables were available from EXCEL trial in
1807/1905 (95%) patients. For the entire cohort, discrimination was
possibly helpful (C statistic = 0.670). SSII-predicted all-cause mortality
at 4 years overestimated the observed mortality, particularly in the
highest-risk percentiles, as confirmed by the fit regression line
[intercept 2.37 (1.51-3.24), P = 0.003; slope 0.67 (0.61-0.74), P <
0.001]. When the SSII-recommended treatment was CABG, randomized EXCEL
patients treated with PCI had a trend towards higher mortality compared
with those treated with CABG (14.1% vs 5.3%, P = 0.07) in the as-treat
population. In the intention-to-treat population, patients randomized to
PCI had higher mortality compared with those randomized to CABG (15.1% vs
4.1%, P = 0.02), when SSII recommended CABG. <br/>CONCLUSION(S): In the
EXCEL trial of patients with left main disease, the SSII-predicted 4-year
mortality overestimated the 4-year observed mortality with a possibly
helpful discrimination. Non-compliance with SSII CABG treatment
recommendations (i.e. randomized to PCI) was associated with higher 4-year
all-cause mortality.<br/>Copyright &#xa9; 2019 The Author(s).

<3>
Accession Number
631634338
Title
The efficacy and safety of prophylactic corticosteroids for the prevention
of adverse outcomes in patients undergoing heart surgery using
cardiopulmonary bypass: A systematic review and meta-analysis of
randomized controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 57 (4) (pp 620-627), 2020.
Date of Publication: 01 Apr 2020.
Author
Ng K.T.; Van Paassen J.; Langan C.; Sarode D.P.; Arbous M.S.; Alston R.P.;
Dekkers O.M.
Institution
(Ng) Department of Anaesthesiology, Faculty of Medicine, University of
Malaya, Kuala Lumpur 50603, Malaysia
(Van Paassen, Arbous) Department of Intensive Care, Leiden University
Medical Center, Leiden, Netherlands
(Langan, Sarode) Department of General Surgery, NHS Greater Glasgow and
Clyde, United Kingdom
(Alston) Department of Anaesthesia, Critical Care and Pain Medicine, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
(Arbous, Dekkers) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Corticosteroids are often administered prophylactically to attenuate the
inflammatory response associated with cardiac surgery using
cardiopulmonary bypass (CPB). However, the efficacy and safety profile of
corticosteroids remain uncertain. The primary aim of this systematic
review and meta-analysis was to investigate the effect of corticosteroids
on mortality in adult cardiac surgery using CPB. Secondary aims were to
examine the effect of corticosteroids on myocardial adverse events,
pulmonary adverse events, atrial fibrillation, surgical site infection,
gastrointestinal bleeding and duration of stay in the intensive care unit
and hospital. Randomized controlled trials (RCTs) were systematically
searched in electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL and Web
of Science) from their inception until March 2019. Observational studies,
case reports, case series and literature reviews were excluded. Sixty-two
studies (n = 16 457 patients) were included in this meta-analysis. There
was no significant difference in mortality between the corticosteroid and
placebo groups [odds ratio (OR) 0.96, 95% confidence interval (CI)
0.81-1.14; P = 0.65, participants = 14 693, studies = 24, evidence of
certainty: Moderate]. Compared to those receiving a placebo, patients who
were given corticosteroids had a significantly higher incidence of
myocardial adverse events (OR 1.17, 95% CI 1.03-1.33; P = 0.01,
participants = 14 512, studies = 23) and a lower incidence of pulmonary
adverse events (OR 0.86, 95% CI 0.75-0.98; P = 0.02, participants = 13
426, studies = 17). The incidences of atrial fibrillation (OR 0.87, 95% CI
0.81-0.94; P < 0.001, participants = 14 148, studies = 24) and surgical
site infection (OR 0.81, 95% CI 0.73-0.90; P < 0.001, participants = 13
946; studies = 22) were all lower in patients who were given
corticosteroids. In the present meta-analysis of 62 RCTs (16 457
patients), including the 2 major RCTs (SIRS and DECS trials: 12 001
patients), we found that prophylactic corticosteroids in cardiac surgery
did not reduce mortality. The clinical significance of an increase in
myocardial adverse events remains unclear as the definition of a relevant
myocardial end point following cardiac surgery varied greatly between
RCTs.<br/>Copyright &#xa9; 2020 The Author(s).

<4>
Accession Number
631567574
Title
Effects of interventions targeting the systemic inflammatory response to
cardiac surgery on clinical outcomes in adults.
Source
Cochrane Database of Systematic Reviews. 2020 (4) (no pagination), 2020.
Article Number: CD013584. Date of Publication: 24 Apr 2020.
Author
Abbasciano R.G.; Roman M.A.; Rizzello A.; Pathak S.; Ramzi J.; Lucarelli
C.; Layton G.; Lai F.; Kumar T.; Wozniak M.J.; Murphy G.
Institution
(Abbasciano, Rizzello, Kumar, Wozniak, Murphy) Department of
Cardiovascular Sciences, University of Leicester, Leicester, United
Kingdom
(Roman) Department of Cardiothoracic Surgery / Cardiovascular Sciences,
University Hospitals of Leicester / University of Leicester, Leicester,
United Kingdom
(Pathak) Department of Cardiothoracic Surgery, Glenfield Hospital,
Leicester, United Kingdom
(Ramzi) Leicester Medical School, University of Leicester, Leicester,
United Kingdom
(Lucarelli) Department of Cardiac Surgery, University of Verona, Verona,
Italy
(Layton) University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Lai) Leicester Clinical Trials Unit, University of Leicester, Glenfield
Hospital, Leicester, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The
objectives are as follows:. Primary objective:. To identify and summarise
the findings of RCTs evaluating interventions that target the inflammatory
response to cardiac surgery and measure both markers of inflammation and
clinical outcomes. Secondary objective:. To evaluate whether interventions
that target different drivers of inflammation during cardiac surgery
influence the nature of the inflammatory response or clinical
outcomes.<br/>Copyright &#xa9; 2020 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<5>
Accession Number
2005769784
Title
Opportunities for patients to engage in postoperative recovery following
cardiac surgery: A systematic narrative review.
Source
Patient Education and Counseling. (no pagination), 2020. Date of
Publication: 2020.
Author
McDonall J.; Heynsbergh N.; Oxley S.; Botti M.; Hutchinson A.
Institution
(McDonall, Heynsbergh, Botti, Hutchinson) Faculty of Health, School of
Nursing and Midwifery, Centre for Quality and Patient Safety Research,
Deakin University, Melbourne 3220, Australia
(Oxley, Botti, Hutchinson) Epworth HealthCare, Bridge Road, Melbourne
3121, Australia
Publisher
Elsevier Ireland Ltd
Abstract
Objective: To compare patient booklets with clinical guidelines and care
pathways to assess: gaps in content and depth of information delivered,
opportunities for patients participation and to review the trajectory of
care to inform recovery. <br/>Method(s): A systematic review of the grey
literature was conducted using Google search engine and a variety of terms
related to cardiac surgery, patient outcomes and recovery pathways.
Patient books and care pathways were obtained from major hospitals in
Melbourne. Resources were included if they were published between January
2013-August 2018 and written in English. <br/>Result(s): A total of 31
resources were included in the review, (n = 14 patient booklets, n = 17
clinician guides). Twenty-one topics of recovery were identified. Patient
booklets provided information on more topics of recovery than clinician
guides (50 % and 24 % respectively). Clinician guides provided more depth
on information on topics of recovery than patient booklets (85 % and 73 %
respectively). The majority of patient booklets outlined patient
participation was in five topics of recovery. <br/>Conclusion(s): Gaps in
the type and depth of information exist between patient and clinician
guidelines. Clearer guidelines on how patients can participate in care are
needed. Practice implications: Nurses are key drivers in facilitating
patient participation in postoperative recovery.<br/>Copyright &#xa9; 2020

<6>
Accession Number
2004340497
Title
Effects of vascular morphological features and ultrasound-guided vascular
cannulation techniques on the success of femoral artery catheterisation in
newborns.
Source
Journal of Clinical Monitoring and Computing. 34 (3) (pp 607-614), 2020.
Date of Publication: 01 Jun 2020.
Author
Boran O.F.; Urfalioglu A.; Arslan M.; Yazar F.M.; Bilal B.; Orak Y.;
Eroglu E.
Institution
(Boran, Urfalioglu, Arslan, Bilal, Orak) Department of Anesthesiology and
Reanimation, Sutcu Imam University School of Medicine, C Blok Kat 5, Daire
11, Kahramanmaras 46100, Turkey
(Yazar) Department of General Surgery, Sutcu Imam University School of
Medicine, Kahramanmaras, Turkey
(Eroglu) Department of Cardiovascular Surgery, Sutcu Imam University
School of Medicine, Kahramanmaras, Turkey
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
Ultrasound-guided vascular access is a technique that can increase safety
as well as technical and procedural success when performing invasive
cardiovascular procedures. The aim of this study was to evaluate the
effects of two cannulation techniques and vascular morphological
properties on the success of femoral artery catheterisation in neonatal
patients. We recruited 65 consecutive patients requiring femoral artery
catheterisation and randomly divided them into two groups: Group 1,
in-plane technique (n = 31) and Group 2, out-of-plane technique (n = 34).
We compared the preparation duration, puncture duration, number of
punctures, number of arterial punctures, number of unsuccessful
interventions, hematoma incidence and vascular morphological
characteristics between the groups. The mean age of Group 1 was 17.16 +/-
7.04 days, and the mean age of Group 2 was 17.20 +/- 7.40 days, with no
difference observed between the groups (p > 0.05). Four patients in Group
1 and nine patients in Group 2 developed hematoma (p = 0.172). Hematoma
was strongly correlated with the number of venous punctures (r = 0.632; p
= 0.001) and the number of needle advancements (r = 0.415; p = 0.001). In
terms of artery-vein position, patients whose artery overlapped the vein
by > 50% required clearly longer artery cannulation durations than the
other patients (p < 0.001). Although the in-plane technique has a steep
learning curve, it was found superior in terms of procedure-related
factors such as the number of trials, the incidence of hematoma and
arterial puncture counts, as it offers advantages such as the ability to
evaluate the lumen and a better control of the needle advancement
direction.<br/>Copyright &#xa9; 2020, Springer Nature B.V.

<7>
Accession Number
628341413
Title
Detection of gastric inflation using transesophageal echocardiography
after different level of pressure-controlled mask ventilation: a
prospective randomized trial.
Source
Journal of Clinical Monitoring and Computing. 34 (3) (pp 535-540), 2020.
Date of Publication: 01 Jun 2020.
Author
Zeng J.; Jia Z.-J.; Peng L.; Wei W.
Institution
(Zeng, Peng, Wei) Department of Anesthesiology, West China Hospital,
Sichuan University, 37# GuoXue Xiang, Chengdu, Sichuan 610041, China
(Jia) Department of Anesthesiology, The First Affiliated Hospital of
XinXiang Medical University, Henan 453100, China
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
This study aimed to assess the technique of using transesophageal
echocardiography (TEE) to detect gastric inflation and to determine the
optimal level of inspiratory pressure during face mask ventilation (FMV).
In this prospective and randomized trial, seventy-five adults scheduled
for cardiac surgery were enrolled to one of the three groups
(P<inf>12</inf>, P<inf>15</inf>, P<inf>20</inf>) defined by the applied
inspiratory pressure during FMV. After induction, mask ventilation was
performed with the corresponding level of pressure-control ventilation for
2 min in each patient. Respiratory and hemodynamic parameters were
recorded every 15 s. Arterial blood gases were tested before induction and
at the time of intubation. Gastric cross-section area was detected using
transesophageal echocardiography after intubation. The gastric
cross-section areas were 3.1 +/- 0.81, 3.8 +/- 1.37 and 4.8 +/- 2.29
cm² respectively. It statistically increased in group
P<inf>20</inf> compared with group P<inf>12</inf> and P<inf>15</inf>.
PaCO<inf>2</inf> before intubation statistically increased compared with
the baseline in groups P<inf>12</inf> and P<inf>15</inf>, while decreased
in group P<inf>20</inf>. The mean values of PaCO<inf>2</inf> equaled to
44.4 mmHg (40-51.5), 42.9 mmHg (34-50.5) and 36.9 mmHg (30.9-46)
respectively in three groups. Peak airway pressure of 12-20
cmH<inf>2</inf>O could provide acceptable sufficient ventilation during
mask ventilation, but 20 cmH<inf>2</inf>O result in higher incidence of
gastric inflation. TEE is useful to detect the gastric inflation related
to the entry of air into the stomach during pressure-controlled face mask
ventilation. Trial Registration Number ChiCTR-IOR-14005325.<br/>Copyright
&#xa9; 2019, Springer Nature B.V.

<8>
Accession Number
631701737
Title
Development and validation of the DIabetes Severity SCOre (DISSCO) in 139
626 individuals with type 2 diabetes: a retrospective cohort study.
Source
BMJ open diabetes research & care. 8 (1) (no pagination), 2020. Date of
Publication: 01 May 2020.
Author
Zghebi S.S.; Mamas M.A.; Ashcroft D.M.; Salisbury C.; Mallen C.D.;
Chew-Graham C.A.; Reeves D.; Van Marwijk H.; Qureshi N.; Weng S.; Holt T.;
Buchan I.; Peek N.; Giles S.; Rutter M.K.; Kontopantelis E.
Institution
(Zghebi, Ashcroft, Reeves, Kontopantelis) NIHR School for Primary Care
Research, Centre for Primary Care and Health Services Research, Manchester
Academic Health Science Centre (MAHSC), University of Manchester,
Manchester, United Kingdom
(Zghebi, Mamas, Reeves, Buchan, Giles, Kontopantelis) Division of
Population Health, Health Services Research and Primary Care, School of
Health Sciences, Faculty of Biology, Medicine and Health, Manchester
Academic Health Science Centre (MAHSC), University of Manchester,
Manchester, United Kingdom
(Mamas) Keele Cardiovascular Research Group, Centre for Prognosis
Research, School of Primary, Community and Social Care, Keele University,
Stoke-on-Trent, United Kingdom
(Ashcroft) Division of Pharmacy and Optometry, School of Health Sciences,
Faculty of Biology, Medicine and Health, Manchester Academic Health
Science Centre (MAHSC), University of Manchester, Manchester, United
Kingdom
(Ashcroft, Peek, Giles) NIHR Greater Manchester Patient Safety
Translational Research Centre, University of Manchester, Manchester,
United Kingdom
(Ashcroft, Peek) NIHR Manchester Biomedical Research Centre, Manchester
Academic Health Science Centre (MAHSC), Manchester, United Kingdom
(Salisbury) Centre for Academic Primary Care, Population Health Sciences,
Bristol Medical School, University of Bristol, Bristol, United Kingdom
(Mallen, Chew-Graham) School of Primary, Community and Social Care,
Faculty of Medicine and Health Sciences, Keele University, Staffordshire,
United Kingdom
(Reeves) Centre for Biostatistics, School of Health Sciences, Faculty of
Biology, Medicine and Health, Manchester Academic Health Science Centre
(MAHSC), University of Manchester, Manchester, United Kingdom
(Van Marwijk) Department of Primary Care and Public Health, Brighton and
Sussex Medical School, University of Sussex, Falmer, United Kingdom
(Qureshi, Weng) Primary Care Stratified Medicine (PRISM) Research Group,
Division of Primary Care, School of Medicine, University of Nottingham,
Nottingham, United Kingdom
(Holt) Nuffield Department of Primary Care Health Sciences, University of
Oxford, Oxford, United Kingdom
(Buchan) Institute of Population Health, University of Liverpool,
Liverpool, United Kingdom
(Buchan, Peek, Kontopantelis) Division of Informatics, Imaging and Data
Sciences, School of Health Sciences, Faculty of Biology, Medicine and
Health, Manchester Academic Health Science Centre (MAHSC), University of
Manchester, Manchester, United Kingdom
(Rutter) Manchester Diabetes Centre, Manchester University NHS Foundation
Trust, Manchester Academic Health Science Centre (MAHSC), Manchester,
United Kingdom
(Rutter) Division of Diabetes, Endocrinology and Gastroenterology, School
of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester
Academic Health Science Centre (MAHSC), University of Manchester,
Manchester, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Clinically applicable diabetes severity measures are lacking,
with no previous studies comparing their predictive value with glycated
hemoglobin (HbA1c). We developed and validated a type 2 diabetes severity
score (the DIabetes Severity SCOre, DISSCO) and evaluated its association
with risks of hospitalization and mortality, assessing its additional risk
information to sociodemographic factors and HbA1c. RESEARCH DESIGN AND
METHODS: We used UK primary and secondary care data for 139 626
individuals with type 2 diabetes between 2007 and 2017, aged >=35 years,
and registered in general practices in England. The study cohort was
randomly divided into a training cohort (n=111 748, 80%) to develop the
severity tool and a validation cohort (n=27 878). We developed baseline
and longitudinal severity scores using 34 diabetes-related domains. Cox
regression models (adjusted for age, gender, ethnicity, deprivation, and
HbA1c) were used for primary (all-cause mortality) and secondary
(hospitalization due to any cause, diabetes, hypoglycemia, or
cardiovascular disease or procedures) outcomes. Likelihood ratio (LR)
tests were fitted to assess the significance of adding DISSCO to the
sociodemographics and HbA1c models. <br/>RESULT(S): A total of 139 626
patients registered in 400 general practices, aged 63+/-12 years were
included, 45% of whom were women, 83% were White, and 18% were from
deprived areas. The mean baseline severity score was 1.3+/-2.0. Overall,
27 362 (20%) people died and 99 951 (72%) had >=1 hospitalization. In the
training cohort, a one-unit increase in baseline DISSCO was associated
with higher hazard of mortality (HR: 1.14, 95% CI 1.13 to 1.15, area under
the receiver operating characteristics curve (AUROC)=0.76) and
cardiovascular hospitalization (HR: 1.45, 95% CI 1.43 to 1.46,
AUROC=0.73). The LR tests showed that adding DISSCO to sociodemographic
variables significantly improved the predictive value of survival models,
outperforming the added value of HbA1c for all outcomes. Findings were
consistent in the validation cohort. <br/>CONCLUSION(S): Higher levels of
DISSCO are associated with higher risks for hospital admissions and
mortality. The new severity score had higher predictive value than the
proxy used in clinical practice, HbA1c. This reproducible algorithm can
help practitioners stratify clinical care of patients with type 2
diabetes.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2020.
Re-use permitted under CC BY. Published by BMJ.

<9>
Accession Number
631699739
Title
Physiologic perfusion monitoring methods during endovascular
revascularization for atherosclerotic peripheral arterial disease:
protocol for a systematic review.
Source
Systematic reviews. 9 (1) (pp 107), 2020. Date of Publication: 08 May
2020.
Author
Rockley M.; Jetty P.; Wells G.
Institution
(Rockley, Jetty) Division of Vascular and Endovascular Surgery, Department
of Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, Ottawa
K1Y4E9, Canada
(Wells) School of Epidemiology and Public Health, Cardiovascular Research
Methods Centre, University of Ottawa Heart Institute, Ottawa K1Y4W7,
Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Endovascular therapy is a fundamental treatment for peripheral
arterial disease. However, the success rate of endovascular therapy
remains poor, as a third of patients with critical limb ischemia
ultimately require a major amputation for gangrene despite endovascular
treatment. This failure rate has prompted investigation into methods of
determining physiologic procedural success before and after treatment,
before clinically apparent outcomes occur such as gangrene. The aim of
this systematic review is to evaluate if in patients undergoing
endovascular surgery for lower extremity atherosclerotic peripheral
arterial disease, do changes in physiologic measures of perfusion during
surgery correlate with clinical outcomes. <br/>METHOD(S): We registered
and designed a study protocol for a systematic review. Literature searches
will be conducted in MEDLINE, EMBASE, and CENTRAL (from January 1977
onwards). Grey literature will be identified through OpenGrey and clinical
trial registries, and supplemented by citation searches. We will include
randomized controlled trials, quasi-experimental trials, and observational
(cohort, case-control) studies conducted in human adults (age 18 or older)
who received elective arterial angioplasty for atherosclerotic peripheral
vascular disease. The primary outcome of interest will be major adverse
limb events. Two investigators will independently screen all citation,
full-text articles, and abstract data. The study quality (risk of bias)
will be appraised appropriate tools. Data analysis and synthesis will be
qualitative; no meta-analysis is planned, as the anticipated homogeneity
of measurement and outcome reporting standardization is low. DISCUSSION:
The treatment of peripheral arterial disease is unique in that the tissue
of the ischemic leg is easily accessible for direct monitoring during
procedures. This is contrasted with cardiac and neurologic monitoring
during cardiac and cerebral procedures, where indirect or invasive
measures are required to monitor organ perfusion. Currently synthesized
evidence describing limb perfusion focuses on static states of ischemia,
and does not evaluate the value of change in perfusion measurement as an
indicator of endovascular treatment success. These methods could
potentially be applied to optimize procedural outcomes by guiding
perfusion-based decision-making during surgery. SYSTEMATIC REVIEW
REGISTRATION: PROSPERO CRD42019138192.

<10>
Accession Number
631514970
Title
Metabolic Disorders with Kidney Transplant.
Source
Clinical journal of the American Society of Nephrology : CJASN. 15 (5) (pp
732-742), 2020. Date of Publication: 07 May 2020.
Author
Cohen E.; Korah M.; Callender G.; Belfort de Aguiar R.; Haakinson D.
Institution
(Cohen) Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT,
United States
(Korah) Yale University School of Medicine, New Haven, CT, United States
(Callender) Department of Surgery, Section of Endocrine Surgery, Yale
University, New Haven, CT, United States
(Belfort de Aguiar) Department of Medicine, Section of Endocrinology, Yale
University, New Haven, CT, United States
(Haakinson) Department of Surgery, Section of Transplant, Yale University,
New Haven, CT, United States
Publisher
NLM (Medline)
Abstract
Metabolic disorders are highly prevalent in kidney transplant candidates
and recipients and can adversely affect post-transplant graft outcomes.
Management of diabetes, hyperparathyroidism, and obesity presents distinct
opportunities to optimize patients both before and after transplant as
well as the ability to track objective data over time to assess a
patient's ability to partner effectively with the health care team and
adhere to complex treatment regimens. Optimization of these particular
disorders can most dramatically decrease the risk of surgical and
cardiovascular complications post-transplant. Approximately 60% of
nondiabetic patients experience hyperglycemia in the immediate
post-transplant phase. Multiple risk factors have been identified related
to development of new onset diabetes after transplant, and it is estimated
that upward of 7%-30% of patients will develop new onset diabetes within
the first year post-transplant. There are a number of medications studied
in the kidney transplant population for diabetes management, and recent
data and the risks and benefits of each regimen should be optimized.
Secondary hyperparathyroidism occurs in most patients with CKD and can
persist after kidney transplant in up to 66% of patients, despite an
initial decrease in parathyroid hormone levels. Parathyroidectomy and
medical management are the options for treatment of secondary
hyperparathyroidism, but there is no randomized, controlled trial
providing clear recommendations for optimal management, and
patient-specific factors should be considered. Obesity is the most common
metabolic disorder affecting the transplant population in both the pre-
and post-transplant phases of care. Not only does obesity have
associations and interactions with comorbid illnesses, such as diabetes,
dyslipidemia, and cardiovascular disease, all of which increase morbidity
and mortality post-transplant, but it also is intimately inter-related
with access to transplantation for patients with kidney failure. We review
these metabolic disorders and their management, including data in patients
with kidney transplants.<br/>Copyright &#xa9; 2020 by the American Society
of Nephrology.

<11>
Accession Number
631380442
Title
Use of Coagulation Point-of-Care Tests in the Management of
Anticoagulation and Bleeding in Pediatric Cardiac Surgery: A Systematic
Review.
Source
Anesthesia and analgesia. 130 (6) (pp 1594-1604), 2020. Date of
Publication: 01 Jun 2020.
Author
Bianchi P.; Beccaris C.; Norbert M.; Dunlop B.; Ranucci M.
Institution
(Bianchi) From the Department of Anesthesia and Intensive Care, Royal
Brompton and Harefield NHS Foundation Trust, London, United Kingdom
(Beccaris) Great Ormond Street Hospital NHS Foundation Trust, Cardiac
Intensive Care Unit, London, United Kingdom
(Norbert, Dunlop) Brunel University, London, United Kingdom
(Ranucci) Department of Cardiothoracic, Vascular Anesthesia and Intensive
Care, IRCCS Policlinico San Donato, Milan, Italy
Publisher
NLM (Medline)
Abstract
Bleeding and coagulation management are essential aspects in the
management of neonates and children undergoing cardiac surgery. The use of
point-of-care tests (POCTs) in a pediatric setting is not as widely used
as in the adult setting. This systematic review aims to summarize the
evidence showed by the literature regarding the use of POCTs in children
undergoing cardiac surgery. We included all studies examining the
pediatric population (<18 years old) undergoing cardiac surgery in which
the coagulation profile was assessed with POCTs. Three electronic
databases (PubMed, Embase, and the Cochrane Controlled Clinical Trials
register) were searched. Tests involved were heparin effect tests,
viscoelastic tests, and platelet function tests. Due to the wide
heterogeneity of the patients and tests studied, a formal meta-analysis
was impossible, and the results are therefore presented through a
systematic review. Eighty articles were found, of which 47 are presented
in this review. At present, literature data are too weak to define POCTs
as a "gold standard" for the treatment of perioperative bleeding in
pediatric cardiac surgery. Nevertheless, introduction of POCTs into
postoperative algorithms has shown to improve bleeding management, patient
outcome, and cost efficiency.

<12>
Accession Number
631299900
Title
Minute ventilation stabilization during all pressure-control / support
mechanical ventilation modes.
Source
Physiological research. 69 (2) (pp 275-282), 2020. Date of Publication: 30
Apr 2020.
Author
Candik P.; Depta F.; Imrecze S.; Sabol F.; Kolesar A.; Jankajova M.;
Pauliny M.; Benova J.; Galkova K.; Donic V.; Torok P.
Institution
(Candik) Department of Human Physiology, Faculty of Medicine, Safarik
University, Slovak Republic, Kosice
Publisher
NLM (Medline)
Abstract
The main goal of our prospective randomized study was comparing compare
the effectiveness of ventilation control method "Automatic proportional
minute ventilation (APMV) "versus manually set pressure control
ventilation modes in relationship to lung mechanics and gas exchange. 80
patients undergoing coronary artery bypass grafting (CABG) were randomized
into 2 groups. 40 patients in the first group No.1 (APMV group) were
ventilated with pressure control (PCV) or pressure support ventilation
(PSV) mode with APMV control. The other 40 patients (control group No.2)
were ventilated with synchronized intermittent mandatory ventilation
(SIMV-p) or pressure control modes (PCV) without APMV. Ventilation control
with APMV was able to maintain minute ventilation more precisely in
comparison with manual control (p<0.01), similarly deviations of ETCO(2)
were significantly lower (p<0.01). The number of manual corrections of
ventilation settings was significantly lower when APMV was used (p<0.01).
The differences in lung mechanics and hemodynamics were not statistically
significant. Ventilation using APMV is more precise in maintaining minute
ventilation and gas exchange compared with manual settings. It required
less staff intervention, while respiratory system mechanics and
hemodynamics are comparable. APMV showed as effective and safe method
applicable on top of all pressure control ventilation modes.

<13>
Accession Number
2005810746
Title
Sevoflurane- And propofol-based regimens show comparable effect on
oxygenation in patients undergoing cardiac valve replacement with
cardiopulmonary bypass.
Source
Cardiovascular Journal of Africa. 31 (2) (pp 71-74), 2020. Date of
Publication: April 2020.
Author
Luo Z.; Wei X.; Zuo Y.; Du G.
Institution
(Luo, Wei, Zuo, Du) Department of Anaesthesiology, West China Hospital,
Sichuan University, Chengdu, China
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Background: Our study aimed to compare the effects of sevoflurane- and
propofol-based anaesthetic regimens on oxygenation during the early period
of cardiopulmonary bypass (CPB) in patients undergoing cardiac
valve-replacement surgery. <br/>Method(s): Patients undergoing mechanical
mitral, aortic or double valve replacement were enrolled and randomly
divided into two groups: the sevoflurane-based anaesthetic regimen group
consisted of patients who received 1-3% sevoflurane inhalation during
anaesthesia maintenance and the propofol-based anaesthetic regimen group
consisted of patients who received 6-10 mg/kg/h of propofol infusion
during anaesthesia maintenance. The partial pressure of oxygen/fraction of
inspired oxygen (PaO<inf>2</inf>/FiO<inf>2</inf>), respiratory mechanics
and haemodynamics were recorded during CPB. <br/>Result(s): Forty-two
patients met the eligibility criteria for the study. The groups did not
differ in terms of clinical and demographic characteristics, and pre- and
intra-operative features. Changes in oxygenation were mild (mean
PaO<inf>2</inf>/FiO<inf>2</inf> from 358 +/- 82 to 471 +/- 106 mmHg)
within one hour of CPB in our patients. There were no differences in
PaO<inf>2</inf>/FiO<inf>2</inf>, respiratory mechanics and haemodynamics
between the sevoflurane and propofol groups. <br/>Conclusion(s): In
patients undergoing cardiac valve replacement with CPB, lung injury was
mild, and sevoflurane- and propofol-based anaesthetic regimens showed
similar effect on oxygenation, respiratory mechanics and haemodynamics
during the early stage of CPB.<br/>Copyright &#xa9; 2020 Clinics Cardive
Publishing (PTY)Ltd. All rights reserved.

<14>
Accession Number
2005714677
Title
Long-Term Outcomes With Drug-Eluting Stents or Coronary Artery Bypass
Surgery for Unprotected Left Main Coronary Disease: A Meta-Analysis and
Trial Sequential Analysis of Randomized Trials.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Elgendy I.Y.; Mahmoud A.N.; Gad M.; Elgendy A.Y.; Bhatt D.L.
Institution
(Elgendy) Division of Cardiology, Massachusetts General Hospital and
Harvard Medical School, Boston, MA, United States
(Mahmoud) Division of Cardiology, University of Washington, Seattle, WA,
United States
(Gad) Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH,
United States
(Elgendy) Division of Cardiovascular Medicine, University of Florida,
Gainesville, FL, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<15>
Accession Number
631719720
Title
Does percutaneous transthoracic needle biopsy increase the risk of pleural
recurrence in patients with stage I lung cancer?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 11 May 2020.
Author
Cheng D.; Wang Z.; Cui J.; Liu L.
Institution
(Cheng, Wang, Cui, Liu) West China School of Medicine, Sichuan University,
Chengdu, China
(Wang, Liu) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
Publisher
NLM (Medline)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: does percutaneous
transthoracic needle biopsy (PTNB) increase the risk of pleural recurrence
in patients with stage I lung cancer? Altogether, 298 papers were found
using the reported search, of which 7 cohort studies and 1 meta-analysis
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers were tabulated.
Four cohort studies suggested an association between PTNB and pleural
recurrence in patients with stage I lung cancer, while the other 3 cohort
studies found that PTNB had no impact. One meta-analysis (the largest
study) including 5 of the cohort studies above concluded that PTNB
increased the risk of pleural recurrence among patients with stage I lung
cancer with subpleural lesions. Based on the available evidence, it was
suggested that there may be an association between PTNB and pleural
recurrence in patients with stage I lung cancer, especially for patients
with subpleural lesion.<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.

<16>
Accession Number
631716346
Title
Comparison of the Zurich Observation Pain Assessment with the behavioural
Pain Scale and the Critical Care Pain Observation Tool in nonverbal
patients in the intensive care unit: A prospective observational study.
Source
Intensive & critical care nursing. (pp 102874), 2020. Date of Publication:
07 May 2020.
Author
Frohlich M.R.; Meyer G.; Spirig R.; Bachmann L.M.
Institution
(Frohlich) Kantonsspital Aarau (Switzerland), Department of Clinical
Nursing Science & Department of Perioperative Medicine; Martin Luther
University Halle-Wittenberg (Germany), Institute for Health and Nursing
Science. Electronic address: martin.froehlich@ksa.ch
(Meyer) Martin Luther University Halle-Wittenberg (Germany), Institute for
Health and Nursing Science
(Spirig) University of Basel (Switzerland), Institute for Nursing Science
(Bachmann) Zurich (Switzerland)Switzerland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To determine the concordance of Zurich Observation Pain
Assessment (ZOPA) with the behavioural Pain Scale (BPS) and the Critical
Care Pain Observation Tool (CPOT) to detect pain in nonverbal ICU
patients. DESIGN: Prospective observational study [BASEC-Nr.
PB_2016-02324]. SETTING: A total of 49 ICU patients from cardiovascular,
visceral and thoracic surgery and neurology and neurosurgery were
recruited. Data from 24 patients were analyzed. MAIN OUTCOME MEASUREMENTS:
Three independent observers assessed pain with the BPS, the CPOT or ZOPA
prior, during and after a potential painful nursing intervention. Tools
were randomized concerning the pain management after each pain assessment.
Frequency of nine additional pain indicating items from a previous
qualitative, explorative study was calculated. <br/>RESULT(S): ZOPA was
positive in 32 of 33 measuring cycles (97.0%; 95%CI: 84.2-99.9%), followed
by the CPOT (28/33 cycles, 84.8%; 95%CI: 68.1-94.9%) and the BPS (23/33
cycles, 67.0%; 95%CI: 51.3-84.4%). In 22/33 cycles all tools were
concordant (66.7%; 95%CI: 48.2-82.0%). Analgesics were provided in 29 out
of 33 cycles (87.9%; 95%CI: 71.8-96.6%). Additional pain indicating items
were inconsistently reported. <br/>CONCLUSION(S): ZOPA is concordant with
the BPS and the CPOT to indicate pain but detects pain earlier due to the
low threshold value. Inclusion of further items does not improve pain
assessment.<br/>Copyright &#xa9; 2020 Elsevier Ltd. All rights reserved.

<17>
Accession Number
631716208
Title
A Comparison of Different Remifentanil Effect-Site Concentrations to Allow
for Early Extubation After Cardiac Surgery.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2020.
Date of Publication: 19 Apr 2020.
Author
Khidr A.M.; Khalil M.A.; Abdulfattah D.; El Tahan M.R.
Institution
(Khidr) King Fahd Hospital of the University, College of Medicine, Imam
Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
(Khalil) King Fahd Hospital of the Imam Abdulrahman Bin Faisal University,
Al Khobar, Saudi Arabia; Faculty of Medicine, Cairo University, Cairo,
Egypt
(Abdulfattah) Clinical Nursing Supervisor Operating Room, Day Surgery,
King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al
Khobar, Saudi Arabia
(El Tahan) King Fahd Hospital of the University, College of Medicine, Imam
Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Assess different remifentanil effect-site concentrations (Ce)
for readiness for extubation time after cardiac surgery. DESIGN:
Prospective, randomized, blinded, controlled study. DESIGN: Single
university hospital. PARTICIPANTS: Seventy-three patients scheduled for
cardiac surgery. INTERVENTIONS: After ethical approval, patients scheduled
for cardiac surgery with target-controlled propofol infusion were randomly
assigned to receive remifentanil effect-site concentrations (Ce) of 1, 2,
or 3 ng/mL (n = 25, 25, and 23, respectively). MEASUREMENTS AND MAIN
RESULTS: The primary endpoint was readiness for extubation. Secondary
outcomes were also recorded, including the cumulative doses and number of
changes of propofol and remifentanil, hemodynamic variables, time to
spontaneous eye opening and breathing, actual extubation, incidences of
light anesthesia and myocardial ischemia, need for vasopressors and
inotropes, and intensive care unit (ICU) and hospital stays. There was no
difference in the time to readiness for extubation in any of the groups
(0.1 ng/mL: 11.5 min (5-37); 0.2 ng/mL: 22 min (10-35); and 0.3 ng/mL: 21
min (10-49), p < 0.532); however, there was a significant difference among
the 3 groups regarding the cumulative remifentanil doses (p < 0.001). Time
to spontaneous eye opening and breathing, actual extubation, use of
vasopressors and inotropes, incidences of light anesthesia and myocardial
ischemia, and length of ICU and hospital stay were similar for all groups.
Forty-six of the 73 patients were extubated on-table. <br/>CONCLUSION(S):
Remifentanil Ce 1, 2, and 3 ng/mL produced comparative effects on time to
extubation and hemodynamic responses to cardiac surgery. The 3 Ce resulted
in immediate on-table extubation in 50% of patients.<br/>Copyright &#xa9;
2020 Elsevier Inc. All rights reserved.

<18>
Accession Number
631719954
Title
Renal function and coronary bypass surgery in patients with ischemic heart
failure.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination), 2020.
Date of Publication: 03 Apr 2020.
Author
Doenst T.; Haddad H.; Stebbins A.; Hill J.A.; Velazquez E.J.; Lee K.L.;
Rouleau J.L.; Sopko G.; Farsky P.S.; Al-Khalidi H.R.
Institution
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Friedrich-Schiller-University of Jena, Jena, Germany
(Haddad) Department of Medicine, College of Medicine, University of
Saskatchewan, Saskatoon, SK, Canada
(Stebbins) Duke Clinical Research Institute, Durham
(Hill) Division of Cardiovascular Medicine, Department of Medicine,
University of Florida, Malcom Randal VAMC, Gainesville, Fla
(Velazquez) Section of Cardiovascular Medicine, Department of Internal
Medicine, Yale School of Medicine, New Haven, United States
(Lee, Al-Khalidi) Department of Biostatistics and Bioinformatics, Duke
University School of Medicine, Duke Clinical Research Institute, Durham
(Rouleau) Montreal Heart Institute, University of Montreal, Montreal,
Quebec, Canada
(Sopko) Division of Cardiovascular Sciences, National Heart, Lung, Blood
Institute, National Institutes of Health, Md, Bethesda, United States
(Farsky) Department of Cardiology, Instituto Dante Pazzanese de
Cardiologia, Sao Paulo, Brazil; Department of Cardiology, Hospital
Israelita Albert Einstein, Sao Paulo, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Chronic kidney disease is a known risk factor in cardiovascular
disease, but its influence on treatment effect of bypass surgery remains
unclear. We assessed the influence of chronic kidney disease on 10-year
mortality and cardiovascular outcomes in patients with ischemic heart
failure treated with medical therapy (medical treatment) with or without
coronary artery bypass grafting. <br/>METHOD(S): We calculated the
baseline estimated glomerular filtration rate (Chronic Kidney Disease
Epidemiology Collaboration formula, chronic kidney disease stages 1-5)
from 1209 patients randomized to medical treatment or coronary artery
bypass grafting in the Surgical Treatment for IsChemic Heart failure trial
and assessed its effect on outcome. <br/>RESULT(S): In the overall
Surgical Treatment for IsChemic Heart failure cohort, patients with
chronic kidney disease stages 3 to 5 were older than those with stages 1
and 2 (66-71 years vs 54-59 years) and had more comorbidities.
Multivariable modeling revealed an inverse association between estimated
glomerular filtration rate and risk of death, cardiovascular death, or
cardiovascular rehospitalization (all P < .001, but not for stroke, P =
.697). Baseline characteristics of the 2 treatment arms were equal for
each chronic kidney disease stage. There were significant improvements in
death or cardiovascular rehospitalization with coronary artery bypass
grafting (stage 1: hazard ratio, 0.71; confidence interval, 0.53-0.96, P =
.02; stage 2: hazard ratio, 0.71; confidence interval, 0.59-0.84, P <
.0001; stage 3: hazard ratio, 0.76; confidence interval, 0.53-0.96, P =
.03). These data were inconclusive in stages 4 and 5 for insufficient
patient numbers (N = 28). There was no significant interaction of
estimated glomerular filtration rate with the treatment effect of coronary
artery bypass grafting (P = .25 for death and P = .54 for death or
cardiovascular rehospitalization). <br/>CONCLUSION(S): Chronic kidney
disease is an independent risk factor for mortality in patients with
ischemic heart failure with or without coronary artery bypass grafting.
However, mild to moderate chronic kidney disease does not appear to
influence long-term treatment effects of coronary artery bypass
grafting.<br/>Copyright &#xa9; 2020 The American Association for Thoracic
Surgery. All rights reserved.

<19>
Accession Number
2004153735
Title
Evaluating the therapeutic efficacy and safety of landiolol hydrochloride
for management of arrhythmia in critical settings: Review of the
literature.
Source
Vascular Health and Risk Management. 16 (pp 111-123), 2020. Date of
Publication: 2020.
Author
Matsuishi Y.; Mathis B.J.; Shimojo N.; Kawano S.; Inoue Y.
Institution
(Matsuishi, Shimojo, Kawano, Inoue) Department of Emergency and Critical
Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba,
Ibaraki, Japan
(Mathis) Medical English Communication Center, Faculty of Medicine,
University of Tsukuba, Tsukuba, Ibaraki, Japan
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Landiolol hydrochloride, a highly cardio-selective beta-1
blocker with an ultra-short-acting half-life of 4 minutes, was originally
approved by Japan for treatment of intraoperative tachyarrhythmias. This
review aims to provide an integrated overview of the current state of
knowledge of landiolol hydrochloride in the management of arrhythmia in
critical settings. <br/>Method(s): We searched MEDLINE, EMBASE, and the
Cochrane Library to retrieve relevant articles with a total of 65 records
identified. <br/>Result(s): The high beta1 selectivity (beta1/beta2 ratio
of 255:1) of landiolol causes a more rapid heart rate (HR) decrease
compared to esmolol while avoiding decreases in mean arterial blood
pressure. Recently, it has been found useful in left ventricular
dysfunction patients and fatal arrhythmia requiring emergency treatment.
Recent random clinical trials (RCT) have revealed therapeutic and
prophylactic effects on arrhythmia, and very low-dose landiolol might be
effective for preventing postoperative atrial fibrillation (POAF) and
sinus tachycardia. Likewise, landiolol is an optimal choice for
perioperative tachycardia treatment during cardiac surgery. The high beta1
selectivity of landiolol is useful in heart failure patients as a
first-line therapy for tachycardia and arrhythmia as it avoids the typical
depression of cardiac function seen in other beta-blockers. Application in
cardiac injury after percutaneous coronary intervention (PCI), protection
for vital organs (lung, kidney, etc.) during sepsis, and stabilizing
hemodynamics in pediatric patients are becoming the new frontier of
landiolol use. <br/>Conclusion(s): Landiolol is useful as a first-line
therapy for the prevention of POAF after cardiac/non-cardiac surgery,
fatal arrhythmias in heart failure patients and during PCI. Moreover, the
potential therapeutic effect of landiolol for sepsis in pediatric patients
is currently being explored. As positive RCT results continue to be
published, new clinical uses and further clinical studies in various
settings by cardiologists, intensivists and pediatric cardiologists are
being conducted.<br/>Copyright &#xa9; 2020 Matsuishi et al.

<20>
Accession Number
631707729
Title
Prognostic Value of Late Gadolinium Enhancement for the Prediction of
Cardiovascular Outcomes in Dilated Cardiomyopathy: An International,
Multi-Institutional Study of the MINICOR Group.
Source
Circulation: Cardiovascular Imaging. (no pagination), 2020. Article
Number: e010105. Date of Publication: 2020.
Author
Alba A.C.; Gaztanaga J.; Foroutan F.; Thavendiranathan P.; Merlo M.;
Alonso-Rodriguez D.; Vallejo-Garcia V.; Vidal-Perez R.; Corros-Vicente C.;
Barreiro-Perez M.; Pazos-Lopez P.; Perez-David E.; Dykstra S.; Flewitt J.;
Perez-Rivera J.A.; Vazquez-Caamano M.; Katz S.D.; Sinagra G.; Kober L.;
Poole J.; Ross H.; Farkouh M.E.; White J.A.
Institution
(Alba, Foroutan, Thavendiranathan, Ross, Farkouh) Peter Munk Cardiac
Centre, Department of Medicine, Toronto General Hospital, University
Health Network, ON, Canada
(Gaztanaga) Division of Cardiology, Department of Medicine, NYU Winthrop
Hospital, Mineola, NY, United States
(Merlo, Sinagra) Cardiovascular Department, Azienda Sanitaria
Universitaria Giuliano Isontina (ASUGI), Universita Degli Studi di
Trieste, Trieste, Italy
(Alonso-Rodriguez) Department of Cardiology, Complejo Asistencial
Universitario de Leon, Spain
(Vallejo-Garcia, Barreiro-Perez) Department of Cardiology, Hospital
Clinico Universitario de Salamanca, Spain
(Vidal-Perez) Department of Cardiology, Hospital Universitario Lucus
Augusti, Lugo, Spain
(Corros-Vicente) Department of Cardiology, Hospital Universitario Central
de Asturias, Oviedo, Spain
(Pazos-Lopez) Department of Cardiology, Complejo Hospitalario
Universitario de Vigo, Spain
(Perez-David) Department of Cardiology, Hospital General Universitario
Gregorio Maranon, Madrid, Spain
(Dykstra, Flewitt, White) Departments of Cardiac Sciences and Diagnostic
Imaging, Libin Cardiovascular Institute of Alberta, Calgary, Canada
(Perez-Rivera) Hospital Universitario de Burgos, Spain
(Vazquez-Caamano) Hospital Povisa, Vigo, Spain
(Katz) NYU Langone Health, Leon H. Charney Division of Cardiology, NY,
United States
(Kober) Rigshospitalet, Copenhagen University Hospital, Denmark
(Poole) Division of Cardiology, Department of Medicine, University of
Washington, Seattle, WA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Dilated cardiomyopathy is associated with increased risk of
major cardiovascular events. Late gadolinium enhancement (LGE) cardiac
magnetic resonance imaging is a unique tissue-based marker that, in
single-center studies, suggests strong prognostic value. We
retrospectively studied associations between LGE presence and adverse
cardiovascular events in patients with dilated cardiomyopathy in a
multicenter setting as part of an emerging global consortium (MINICOR
[Multi-Modal International Cardiovascular Outcomes Registry]).
<br/>Method(s): Consecutive patients with dilated cardiomyopathy referred
for cardiac magnetic resonance (2000-2017) at 12 institutions in 4
countries were studied. Using multivariable Cox proportional hazard and
semiparametric Fine and Gray models, we evaluated the association between
LGE and the composite primary end point of all-cause mortality, heart
transplantation, or left ventricular assist device implant and a secondary
arrhythmic end point of sudden cardiac death or appropriate implantable
cardioverter-defibrillator shock. <br/>Result(s): We studied 1672
patients, mean age 56+/-14 years (29% female), left ventricular ejection
fraction 33+/-11%, and 25% having New York Heart Association class III to
IV; 650 patients (39%) had LGE. During 2.3 years (interquartile range,
1.0-4.3) follow-up, 160 patients experienced the primary end point, and 88
experienced the arrhythmic end point. In multivariable analyses, LGE was
associated with 1.5-fold (hazard ratio, 1.45 [95% CI, 1.03-2.04]) risk of
the primary end point and 1.8-fold (hazard ratio, 1.82 [95% CI,
1.20-3.06]) risk of the arrhythmic end point. Primary end point risk was
increased in patients with multiple LGE patterns, although arrhythmic risk
was higher among patients receiving primary prevention implantable
cardioverter-defibrillator and widening QRS. <br/>Conclusion(s): In this
large multinational study of patients with dilated cardiomyopathy, the
presence of LGE showed strong prognostic value for identification of
high-risk patients. Randomized controlled trials evaluating LGE-based care
management strategies are warranted.<br/>Copyright &#xa9; 2020 American
Heart Association, Inc.

<21>
Accession Number
2005667800
Title
Active SB-P Versus Conventional Approach to the Protection of High-Risk
Side Branches: The CIT-RESOLVE Trial.
Source
JACC: Cardiovascular Interventions. 13 (9) (pp 1112-1122), 2020. Date of
Publication: 11 May 2020.
Author
Dou K.; Zhang D.; Pan H.; Guo N.; Li L.; Li Y.; Zhang Q.; Liu B.; Shen Z.;
Zhang B.; Liu J.; Han W.; Wang Y.; Zhao Y.; Yang Y.; Chen S.; Xie L.; Guan
C.; Kirtane A.J.; Xu B.
Institution
(Dou, Zhang, Yang) State Key Laboratory of Cardiovascular Disease,
Beijing, China
(Dou, Zhang, Yang) Department of Cardiology, Fu Wai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
(Dou, Zhang, Yang, Xu) National Clinical Research Center for
Cardiovascular Diseases, Beijing, China
(Pan) Department of Cardiology, Hunan Provincial People's Hospital, the
First Affiliated Hospital of Hunan Normal University, Changsha, China
(Guo) Department of Cardiology, the First Affiliated Hospital of Xi'an
Jiaotong University, Xi'an, China
(Li) Department of Cardiology, the First Affiliated Hospital of Guangxi
Medical University, Nanning, China
(Li) Department of Cardiology, the First Affiliated Hospital of Harbin
Medical University, Harbin, China
(Zhang) Department of Cardiology, Shanghai East Hospital, Tongji
University, Shanghai, China
(Liu) Department of Cardiology, the Second Hospital of Jilin University,
Changchun, China
(Shen) Department of Cardiology, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
(Zhang) Department of Cardiology, Guangdong General Hospital, Guangzhou,
China
(Liu) Departments of Cardiology, Peking University People's Hospital,
Beijing, China
(Han) Department of Cardiology, the Third Medical Center of the Chinese
People's Liberation Army General Hospital, Beijing, China
(Wang, Zhao) Medical Research and Biometrics Center, National Center for
Cardiovascular Diseases, Beijing, China
(Chen) Department of Cardiology, Nanjing First Hospital, Nanjing Medical
University, Nanjing, China
(Xie, Guan, Xu) Catheterization Laboratories, Fu Wai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
(Kirtane) Center for Interventional Vascular Therapy, Columbia University
Medical Center/NewYork-Presbyterian Hospital, and the Cardiovascular
Research Foundation, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to determine whether an active side
branch protection (SB-P) strategy is superior to the conventional strategy
in reducing side branch (SB) occlusion in high-risk bifurcation treatment.
<br/>Background(s): Accurate prediction of SB occlusion after main vessel
stenting followed by the use of specific strategies to prevent occlusion
would be beneficial during bifurcation intervention. <br/>Method(s):
Eligible patients who had a bifurcation lesions with high risk for
occlusion as determined using the validated V-RESOLVE (Visual Estimation
for Risk Prediction of Side Branch Occlusion in Coronary Bifurcation
Intervention) score were randomized to an active SB-P strategy group
(elective 2-stent strategy for large SBs and jailed balloon technique for
small SBs) or a conventional strategy group (provisional stenting for
large SBs and jailed wire technique for small SBs) in a 1:1 ratio
stratified by SB vessel size. The primary endpoint of SB occlusion was
defined as an angiography core laboratory-assessed decrease in TIMI
(Thrombolysis In Myocardial Infarction) flow grade or absence of flow in
the SB immediately after full apposition of the main vessel stent to the
vessel wall. <br/>Result(s): A total of 335 subjects at 16 sites were
randomized to the SB-P group (n = 168) and conventional group (n = 167).
Patients in the SB-P versus conventional strategy group had a
significantly lower rate of SB occlusion (7.7% [13 of 168] vs. 18.0% [30
of 167]; risk difference: -9.1%; 95% confidence interval: -13.1% to -1.8%;
p = 0.006), driven mainly by the difference in the small SB subgroup
(jailed balloon technique vs. jailed wire technique: 8.1% vs. 18.5%; p =
0.01). <br/>Conclusion(s): An active SB-P strategy is superior to a
conventional strategy in reducing SB occlusion when treating high-risk
bifurcation lesions. (Conventional Versus Intentional Strategy in Patients
With High Risk Prediction of Side Branch Occlusion in Coronary Bifurcation
Intervention [CIT-RESOLVE]; NCT02644434)<br/>Copyright &#xa9; 2020
American College of Cardiology Foundation

<22>
Accession Number
2005667780
Title
Transcatheter Aortic Valve Replacement in Low-Risk Patients With
Symptomatic Severe Bicuspid Aortic Valve Stenosis.
Source
JACC: Cardiovascular Interventions. 13 (9) (pp 1019-1027), 2020. Date of
Publication: 11 May 2020.
Author
Waksman R.; Craig P.E.; Torguson R.; Asch F.M.; Weissman G.; Ruiz D.;
Gordon P.; Ehsan A.; Parikh P.; Bilfinger T.; Levitt R.; Hahn C.; Roberts
D.; Ingram M.; Hanna N.; Comas G.; Zhang C.; Ben-Dor I.; Satler L.F.;
Garcia-Garcia H.M.; Shults C.; Rogers T.
Institution
(Waksman, Craig, Torguson, Ruiz, Zhang, Ben-Dor, Satler, Garcia-Garcia,
Rogers) Section of Interventional Cardiology, MedStar Washington Hospital
Center, Washington, DC, United States
(Asch) MedStar Health Research Institute, MedStar Washington Hospital
Center, Washington, DC, United States
(Weissman) Department of Cardiology, MedStar Washington Hospital Center,
Washington, DC, United States
(Gordon) Division of Cardiology, The Miriam Hospital, Providence, RI,
United States
(Ehsan) Division of Cardiothoracic Surgery, Lifespan Cardiovascular
Institute, Providence, RI, United States
(Parikh) Department of Medicine, Stony Brook Hospital, Stony Brook, NY,
United States
(Bilfinger) Department of Surgery, Stony Brook Hospital, Stony Brook, NY,
United States
(Levitt) Department of Cardiology, Henrico Doctors' Hospital, Richmond,
VA, United States
(Hahn) Department of Cardiothoracic Surgery, Henrico Doctors' Hospital,
Richmond, VA, United States
(Roberts, Ingram) Sutter Medical Center, Sacramento, Sutter Heart and
Vascular Institute, Research, Sacramento, CA, United States
(Hanna) St. John Heart Institute Cardiovascular Consultants, St. John
Health System, Tulsa, OK, United States
(Comas) St. John Clinic Cardiovascular Surgery, St. John Heart Institute
Cardiovascular Consultants, St. John Health System, Tulsa, OK, United
States
(Shults) Department of Cardiac Surgery, MedStar Washington Hospital
Center, Washington, DC, United States
(Rogers) Cardiovascular Branch, Division of Intramural Research, National
Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda,
MD, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to evaluate clinical outcomes and
transcatheter heart valve hemodynamic parameters after transcatheter
aortic valve replacement (TAVR) in low-risk patients with bicuspid aortic
stenosis (AS). <br/>Background(s): TAVR is approved for low-risk patients
in the United States. However, patients with bicuspid AS were excluded
from the randomized cohorts of the pivotal low-risk trials.
<br/>Method(s): The LRT (Low Risk TAVR) trial was an
investigator-initiated, prospective, multicenter study and was the first
and only U.S. Food and Drug Administration-approved investigational device
exemption trial to evaluate the feasibility of TAVR with either
balloon-expandable or self-expanding valves in low-risk patients with
bicuspid AS. The primary endpoint was all-cause mortality at 30 days.
Baseline and follow-up echocardiography and computed tomography to detect
leaflet thickening were analyzed in an independent core laboratory.
<br/>Result(s): Sixty-one low-risk patients with symptomatic, severe AS
and bicuspid aortic valves (78.3% Sievers type 1 morphology) underwent
TAVR at 6 centers from 2016 to 2019. The mean age was 68.6 years, and
42.6% were men. At 30 days, there was zero mortality and no disabling
strokes. The rate of new permanent pacemaker implantation was 13.1%; just
1 patient had a moderate paravalvular leak at 30 days. Hypoattenuated
leaflet thickening was observed in 10% of patients at 30 days.
<br/>Conclusion(s): TAVR appears to be safe in patients with bicuspid AS,
with short length of hospital stay, zero mortality, and no disabling
strokes at 30 days. Subclinical leaflet thrombosis was observed in a
minority of patients at 30 days but did not appear to be associated with
clinical events.<br/>Copyright &#xa9; 2020

<23>
Accession Number
2005729357
Title
The clinical utility of remote ischemic preconditioning in protecting
against cardiac surgery-associated acute kidney injury: A pilot randomized
clinical trial.
Source
Advances in Clinical and Experimental Medicine. 29 (2) (pp 189-196), 2020.
Date of Publication: 01 Feb 2020.
Author
Stokfisz K.; Ledakowicz-Polak A.; Zagorski M.; Jander S.; Przybylak K.;
Zielinska M.
Institution
(Stokfisz, Ledakowicz-Polak, Przybylak, Zielinska) Intensive Cardiac
Therapy Clinic, Department of Invasive Cardiology and Electrocardiology,
Medical University of Lodz, Lodz, Poland
(Zagorski, Jander) Cardiosurgery Clinic, Department of Cardiology and
Cardiosurgery, Medical University of Lodz, Lodz, Poland
Publisher
Wroclaw University of Medicine
Abstract
Background. Cardiac surgery-associated acute kidney injury (CSA-AKI) is a
well-known, serious complication and a well-recognized independent risk
factor for higher morbidity and mortality among patients undergoing
cardiac surgery. Objectives. The aim of the study was to assess the
efficacy of remote ischemic preconditioning (RIPC) in reducing the
incidence of CSA-AKI, measured with the standard creatinine technique and
using neutrophil gelatinase-associated lipocalin (NGAL) serum
concentrations as a potential new biomarker of kidney damage. The ethics
committee of the Medical University of Lodz prospectively approved the
protocol (approval No. RNN/286/13/KE). The study was retrospectively
registered with the U.S. National Institutes of Health - NIH (29 June
2017; ClinicalTrials.gov identifier: NCT03205410). Material and methods.
We conducted a prospective single-center double-blind randomized and
controlled tudy. Data was collected from patients admitted to the
Cardiosurgery Clinic at the Medical University of Lodz (Poland) between
January and December 2014, scheduled for elective cardiac surgery (an
off-pump coronary artery bypass). A total of 28 patients were randomized
to receive either RIPC (n = 14) or sham RIPC (n = 14). After the induction
of anesthesia, the patients assigned to the RIPC group underwent 3 cycles
of 5-minute inflation to 200 mm Hg and 5-minute deflation of the upper-arm
cuff. The control group had a deflated cuff placed on the upper arm for 30
min. The authors measured the patients' serum creatinine concentration to
check for the occurrence of a CSA-AKI within 48 h after cardiac surgery,
and NGAL serum concentration to check its level within 3 h after the
operation. Results. Fewer patients in RIPC group developed CSA-AKI within
48 h after cardiac surgery than in the control group (29% vs 93%; p =
0.003). Fewer patients in the RIPC group presented an increase in NGAL 3 h
after surgery (medians: 124 vs 176.7; p = 0.0003). Conclusions. In
patients undergoing an off-pump coronary artery bypass, RIPC significantly
reduces the occurrence of CSA-AKI and protects against increased
postoperative NGAL levels.<br/>Copyright &#xa9; 2020 by Wroclaw Medical
University.

<24>
Accession Number
631175774
Title
An Appraisal of the Association of Clinical Outcomes with the Severity of
Regurgitant Volume Relative to End-Diastolic Volume in Patients with
Secondary Mitral Regurgitation.
Source
JAMA Cardiology. 5 (4) (pp 476-481), 2020. Date of Publication: April
2020.
Author
Gaasch W.H.; Aurigemma G.P.; Meyer T.E.
Institution
(Gaasch, Aurigemma, Meyer) Department of Cardiovascular Medicine, Lahey
Hospital and Medical Center, Burlington, MA, United States
(Gaasch, Aurigemma, Meyer) Tufts University School of Medicine, Boston,
MA, United States
(Gaasch, Aurigemma, Meyer) University of Massachusetts Medical School,
Worcester, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Two randomized clinical trials of transcatheter edge-to-edge
mitral valve repair in patients with secondary mitral regurgitation (the
Multicentre Randomized Study of Percutaneous Mitral Valve Repair MitraClip
Device in Patients With Severe Secondary Mitral Regurgitation [MITRA-FR]
and the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous
Therapy for Heart Failure Patients with Functional Mitral Regurgitation
[COAPT]) report clinical outcome disparities that are largely unexplained.
This appraisal sought to provide insight and an explanation for the
differences in clinical outcomes (survival and hospitalization rates) in
the 2 clinical trials. The mean echocardiogram Doppler results (and
derived volume parameters) from each of the 2 clinical trials were
compared and examined relative to the clinical outcomes. Special emphasis
was placed on the assessment of mitral regurgitation proportionality
coefficients that were determined as the ratio of effective regurgitant
orifice area (EROA) to end-diastolic volume and the ratio of mitral
regurgitant volume to end-diastolic volume. Observations: In this analysis
of the differences in the clinical outcomes of the MITRA-FR and COAPT
clinical trials, the ratio of the EROA to the end-diastolic volume in the
COAPT study was found to be twice that of the MITRA-FR study (0.002
cm^- ¹ vs 0.001 cm^- ¹,
respectively). The finding of a larger proportional EROA in the COAPT
study suggests more severe mitral regurgitation compared with the MITRA-FR
study, thereby providing a potential explanation for the different
outcomes in the 2 clinical trials. In contrast, the ratio of the mitral
regurgitant volume to the end-diastolic volume in the COAPT study was
similar to (but slightly lower than) that of the MITRA-FR study (0.15 vs
0.18, respectively), indicating that the proportional mitral regurgitant
volume was comparable in the 2 clinical trials. This finding contradicts
the conclusions of the EROA analysis. <br/>Conclusions and Relevance: The
results of proportionality analyses based on EROA differ from those based
on a volume analysis. This disparity casts doubt on the notion that an
EROA analysis alone can explain the different results of the 2 randomized
clinical trials.<br/>Copyright &#xa9; 2020 American Medical Association.
All rights reserved.

<25>
Accession Number
2004184271
Title
RNAs and gene expression predicting postoperative atrial fibrillation in
cardiac surgery patients undergoing coronary artery bypass grafting.
Source
Journal of Clinical Medicine. 9 (4) (no pagination), 2020. Article Number:
1139. Date of Publication: April 2020.
Author
Khan M.S.; Yamashita K.; Sharma V.; Ranjan R.; Dosdall D.J.
Institution
(Khan, Yamashita, Ranjan, Dosdall) Nora Eccles Harrison Cardiovascular
Research and Training Institute, The University of Utah, Salt Lake City,
UT 84112, United States
(Yamashita, Ranjan, Dosdall) Division of Cardiovascular Medicine, The
University of Utah-Health, Salt Lake City, UT 84132, United States
(Sharma, Dosdall) Division of Cardiothoracic Surgery, The University of
Utah-Health, Salt Lake City, UT 84132, United States
(Ranjan, Dosdall) Department of Biomedical Engineering, The University of
Utah, Salt Lake City, UT 84112, United States
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Postoperative atrial fibrillation (POAF) is linked with increased
morbidity, mortality rate and financial liability. About 20-50% of
patients experience POAF after coronary artery bypass graft (CABG)
surgery. Numerous review articles and meta-analyses have investigated
links between patient clinical risk factors, demographic conditions, and
pre-, peri-and post-operative biomarkers to forecast POAF incidence in
CABG patients. This narrative review, for the first time, summarize the
role of micro-RNAs, circular-RNAs and other gene expressions that have
shown experimental evidence to accurately predict the POAF incidence in
cardiac surgery patients after CABG. We envisage that identifying specific
genomic markers for predicting POAF might be a significant step for the
prevention and effective management of this type of post-operative
complication and may provide critical perspective into arrhythmogenic
substrate responsible for POAF.<br/>Copyright &#xa9; 2020 by the authors.
Licensee MDPI, Basel, Switzerland.

<26>
Accession Number
2003824856
Title
Effect of exercise on endothelial function in heart transplant recipients:
systematic review and meta-analysis.
Source
Heart Failure Reviews. 25 (3) (pp 487-494), 2020. Date of Publication: 01
May 2020.
Author
de Souza J.A.F.; Araujo B.T.S.; de Lima G.H.C.; Dornelas de Andrade A.;
Campos S.L.; de Aguiar M.I.R.; Carneiro R.M.D.; Brandao D.C.
Institution
(de Souza, Araujo, de Lima, Dornelas de Andrade, Campos, de Aguiar,
Brandao) Physiotherapy Department, Federal University of Pernambuco
(UFPE), Av. Jornalista Anibal Fernandes, s/n, Cidade Universitaria, Recife
CEP 50740-560, Brazil
(Carneiro) Institute of Integral Medicine Professor Fernando Figueira
(IMIP), Recife, Brazil
Publisher
Springer
Abstract
Endothelial dysfunction is associated with increased cardiovascular risk
and death in heart transplant recipients (HTx). Although the measurement
of peripheral endothelial function is considered a significant predictor
of cardiovascular events in several populations, few studies have
investigated this outcome after therapeutic strategies, including
different exercise types, duration, and intensity. This systematic review
and meta-analysis aimed to investigate the effects of continuous moderate
exercise (CON) or high-intensity interval training (HIIT) to improve
endothelial function (EF) in HTx. The search was conducted in Cochrane
Central Registry of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Web
of Science and Scopus/Elsevier, CINAHL/Ebsco, Physiotherapy Evidence
Database (PEDro), LILACS/BIREME, and SciELO databases. Quality of the
evidence was assessed using the Grading of Recommendations Assessment
Development and Evaluation (GRADE). The search strategy retrieved 5192
titles. A total of four articles met the inclusion criteria and were
included for the qualitative analysis. Meta-analysis showed that exercises
improved EF ([mean difference-MD] 3.48 95% CI - 0.29 to 7.25, p = 0.007)
when compared with the control. However, there was a poor quality of
evidence to demonstrate that CON or HIIT is better than usual care to
improve EF. Exercise training provides benefits to patients, but the poor
quality of evidence does not allow us to state that exercise is related to
endothelial function improvement in HTx.<br/>Copyright &#xa9; 2019,
Springer Science+Business Media, LLC, part of Springer Nature.

<27>
Accession Number
631561662
Title
What are the results of venoarterial extracorporeal membrane oxygenation
bridging to heart transplantation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (4) (pp 632-634),
2019. Date of Publication: 01 Oct 2019.
Author
Urban M.; Siddique A.; Merritt-Genore H.; Um J.
Institution
(Urban, Siddique, Merritt-Genore, Um) Division of Cardiothoracic Surgery,
Department of Surgery, University of Nebraska Medical Center, University
Tower 1, Omaha, NE 68198-2315, United States
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether heart
transplantation is a viable treatment option in patients in refractory
cardiogenic shock who could not be weaned off venoarterial extracorporeal
membrane oxygenation (VA ECMO). Altogether, 373 papers were found using
the reported search, of which 7 papers represented the best evidence to
answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. Evidence is derived from 3 papers
based on registry analysis, 1 multi-institutional study and 3
singleinstitution reviews. Early post-transplant mortality of ECMO-bridged
recipients ranges from 18.7% to 33.3% and 1-year survival from 44.6% to
72.0%. High acuity of recipient illness reflected by poor renal function,
mechanical ventilation, advanced age, elevated serum lactate predict
inferior outcome. We conclude that heart transplantation results in
patients bridged with VA ECMO are inferior when compared to published
outcome of non-bridged recipients. In the era of severe organ shortage and
intense public and regulatory scrutiny of the results, the decision to
transplant a patient directly of VA ECMO needs to be made on a
case-by-case basis. Potential gain in decreasing the waiting list
mortality of these critically ill patients needs to be weighed against
poorer post-transplantation mortality rates and mid- and long-term
outcomes.<br/>Copyright &#xa9; The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<28>
Accession Number
2005760960
Title
Comparison of Different Anticoagulation Regimens Regarding Maternal and
Fetal Outcomes in Pregnant Patients With Mechanical Prosthetic Heart
Valves (from the Multicenter ANATOLIA-PREG Registry).
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Guner A.; Kalcik M.; Gursoy M.O.; Gunduz S.; Astarcioglu M.A.; Bayam E.;
Kalkan S.; Yesin M.; Karakoyun S.; Ozkan M.
Institution
(Guner, Gunduz, Bayam, Kalkan, Ozkan) Department of Cardiology, Kosuyolu
Kartal Heart Training and Research Hospital, Istanbul, Turkey
(Kalcik) Department of Cardiology, Faculty of Medicine, Hitit University,
Corum, Turkey
(Gursoy) Department of Cardiology, Izmir Katip Celebi University, Ataturk
Training and Research Hospital, Izmir, Turkey
(Astarcioglu) Department of Cardiology, Dumlupinar University, Kutahya
Evliya Celebi Education and Research Hospital, Dumlupinar, Turkey
(Yesin, Karakoyun) Department of Cardiology, Faculty of Medicine, Kars
Kafkas University, Kars, Turkey
(Ozkan) Faculty of Health Sciences, Ardahan University, Ardahan, Turkey
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Mechanical prosthetic heart valves (MPHVs) are highly thrombogenic, and a
pregnancy-induced procoagulant status increases the risk of MPHV
thrombosis. Despite numerous case reports, 2 major registries and
meta-analyses/systematic reviews, optimal anticoagulation therapy during
pregnancy remains controversial. The goal of this study was to evaluate
different anticoagulation regimens in pregnant patients with MPHVs. The
outcomes of anticoagulation regimens were assessed retrospectively in
pregnant women (110 women; 155 pregnancies) with MPHVs. The study
population was divided into 5 groups according to anticoagulation regimens
used; high-dose warfarin (>5 mg/d) throughout pregnancy (group 1),
low-dose warfarin (<=5 mg/d) throughout pregnancy (group 2), low molecular
weight heparin (LMWH) throughout pregnancy (group 3), first trimester
LMWH, 2nd and 3rd trimester warfarin (group 4), first 2 trimester LMWH,
and 3rd trimester warfarin (group 5). Of 155 pregnancies, 55 (35%)
resulted in fetal loss; whereas 41 (27%) cases with abortion (miscarriage
and therapeutic) and 14 (9%) stillbirths occurred. The comparison of the
groups showed that the whole abortion rates including therapeutic abortion
were significantly higher in Group 1, and lower in groups 3 and 5 (p
<0.001). However, miscarriage rates were similar between the groups. A
total of 53 pregnancies (34%) suffered from prosthetic valves thrombosis
(PVT) during pregnancy or in the postpartum period. Group 2 had
significantly lower rates of PVT than the other groups (p <0.001). In
conclusion, the current data suggests that there is no optimal therapy,
and that all managements have advantages and disadvantages. Low-dose
warfarin (<=5 mg/day) regimen with therapeutic international normalized
ratio levels may provide effective maternal protection throughout
pregnancy with acceptable fetal outcomes.<br/>Copyright &#xa9; 2020
Elsevier Inc.

<29>
Accession Number
2005460097
Title
Remifentanil and perioperative glycaemic response in cardiac surgery: an
open-label randomised trial.
Source
British Journal of Anaesthesia. 124 (6) (pp 684-692), 2020. Date of
Publication: June 2020.
Author
Subramaniam K.; Sciortino C.; Ruppert K.; Monroe A.; Esper S.; Boisen M.;
Marquez J.; Hayanga H.; Badhwar V.
Institution
(Subramaniam, Monroe, Esper, Boisen, Marquez) Department of Anesthesiology
and Perioperative Medicine, University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States
(Sciortino) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
(Ruppert) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Hayanga, Badhwar) Department of Cardiovascular and Thoracic Surgery, West
Virginia University, Morgantown, WV, United States
Publisher
Elsevier Ltd
Abstract
Background: This study investigated whether remifentanil infusion
decreased intraoperative hyperglycaemia and insulin resistance compared
with intermittent fentanyl administration in patients undergoing elective
cardiac surgery. <br/>Method(s): This was a randomised, prospective,
open-label trial. Patients undergoing elective cardiac surgery (n=116)
were randomised to receive either continuous intravenous remifentanil
infusion or intermittent fentanyl boluses. Hourly blood glucose values
were obtained for 24 h starting from induction of anaesthesia. The
difference in percentage of patients with >=2 intraoperative blood glucose
concentrations >10 mM (180 mg dl^-1) between the groups was the
primary outcome measure. Secondary outcome measures included insulin
requirements, select stress hormone and inflammatory cytokine
concentrations, and safety events and adverse outcomes. <br/>Result(s):
The trial included 106 subjects in the final intention-to-treat analysis.
There were fewer patients with >=2 intraoperative blood glucose values >10
mM (180 mg dl^-1) in the remifentanil group (17 [31.5%])
compared with the fentanyl group (33 [63.5%]) (relative risk: 0.50; 95%
confidence interval [CI]: 0.32-0.77; P=0.001). The administered
intraoperative insulin was a median of 8.1 units (range: 0-46.7) in the
fentanyl group and 2.9 units (range: 0-35.1) in the remifentanil group
(median difference=5 units; 95% CI: 1-7; P=0.004). Cortisol and
adrenocorticotropic hormone were increased less in the remifentanil group
(P<0.001), but there was no relative decrease in this group in select
inflammatory cytokines. Postoperative measures of glycaemic control and
adverse clinical outcomes were not significantly different between groups.
<br/>Conclusion(s): Compared with patients treated with intermittent
fentanyl, patients receiving continuous remifentanil infusion had fewer
episodes of hyperglycaemia and less need for insulin administration during
the intraoperative period of cardiac surgery. Clinical trial registration:
NCT02349152.<br/>Copyright &#xa9; 2020 British Journal of Anaesthesia

<30>
Accession Number
2005451465
Title
Intravenous sildenafil citrate and post-cardiac surgery acute kidney
injury: a double-blind, randomised, placebo-controlled trial.
Source
British Journal of Anaesthesia. 124 (6) (pp 693-701), 2020. Date of
Publication: June 2020.
Author
Kumar T.; Aujla H.; Wozniak M.; Dott W.; Sullo N.; Joel-David L.; Pais P.;
Smallwood D.; Miller D.; Eagle-Hemming B.; Di Paola A.S.; Barber S.;
Brookes C.; Brunskill N.J.; Murphy G.J.
Institution
(Kumar, Aujla, Wozniak, Dott, Sullo, Joel-David, Pais, Smallwood, Miller,
Eagle-Hemming, Murphy) Department of Cardiovascular Sciences and National
Institute for Health Research Leicester Biomedical Research Unit in
Cardiovascular Medicine, University of Leicester, Clinical Sciences Wing,
Glenfield General Hospital, Leicester, United Kingdom
(Sullo) University of Nottingham, Royal Derby Hospital, Derby, United
Kingdom
(Smallwood) School of Allied Health Sciences, De Montfort University,
Leicester, United Kingdom
(Di Paola, Barber, Brookes, Murphy) Leicester Clinical Trials Unit,
University of Leicester, Leicester, United Kingdom
(Brunskill) Department of Infection, Immunity and Inflammation, University
of Leicester, Leicester, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: This study assessed whether i.v. sildenafil citrate prevented
acute kidney injury in at-risk patients undergoing cardiac surgery with
cardiopulmonary bypass. <br/>Method(s): In a double-blind RCT, adults at
increased risk of acute kidney injury undergoing cardiac surgery in a
single UK tertiary centre were randomised to receive sildenafil citrate
12.5 mg kg^-1 i.v. over 150 min or dextrose 5% at the
commencement of surgery. The primary outcome was serum creatinine measured
at six post-randomisation time points. The primary analysis used a linear
mixed-effects model adjusted for the stratification variables, baseline
estimated glomerular filtration rate, and surgical procedure. Secondary
outcomes considered clinical events and potential disease mechanisms.
Effect estimates were expressed as mean differences (MDs) or odds ratios
with 95% confidence intervals. <br/>Result(s): The analysis population
comprised eligible randomised patients that underwent valve surgery or
combined coronary artery bypass graft and valve surgery, with
cardiopulmonary bypass, between May 2015 and June 2018. There were 60
subjects in the sildenafil group and 69 in the placebo control group. The
difference between groups in creatinine concentration was not
statistically significant (MD: 0.88 mumol L^-1 [-5.82, 7.59]).
There was a statistically significant increase in multiple organ
dysfunction scores in the sildenafil group (MD: 0.54 [0.02, 1.07];
P=0.044). Secondary outcomes, and biomarkers of kidney injury, endothelial
function, and inflammatory cell activation, were not significantly
different between the groups. <br/>Conclusion(s): These results do not
support the use of i.v. sildenafil citrate for kidney protection in adult
cardiac surgery. Clinical trial registration:
ISRCTN18386427.<br/>Copyright &#xa9; 2020 The Author(s)

<31>
Accession Number
2004700352
Title
Continuous-flow left ventricular assist device implantation in patients
with preexisting mechanical mitral valves: a systematic review.
Source
Expert Review of Medical Devices. 17 (5) (pp 399-404), 2020. Date of
Publication: 03 May 2020.
Author
Gordon J.S.; O'Malley T.J.; Maynes E.J.; Wood C.T.; Kalantri N.; Morris
R.J.; Samuels L.E.; Massey H.T.; Tchantchaleishvili V.
Institution
(Gordon, O'Malley, Maynes, Wood, Kalantri, Morris, Samuels, Massey,
Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
Publisher
Taylor and Francis Ltd
Abstract
Introduction: A preexisting mechanical mitral valve (MMV) is thought to be
a thrombogenic risk factor after continuous-flow left ventricular assist
device (CF-LVAD) implantation. We sought to evaluate the management and
outcomes of preexisting MMVs in patients following CF-LVAD implantation.
Areas covered: An electronic search was performed to identify the presence
of an MMV at the time of CF-LVAD implantation. Of the 1,168 studies
identified, only five studies consisting of seven CF-LVAD patients met the
inclusion criteria. Patient-level data were extracted and analyzed. Expert
opinion: The median patient age was 54 (IQR: 42-61) years and 71.4% (5/7)
were male. Non-ischemic cardiomyopathy was the predominant etiology
(83.3%, 5/6) of heart failure, and bridge-to-transplant the predominant
indication (85.7%, 6/7) for CF-LVAD. Aortic valve prosthesis was present
in 42.9% (3/7) of patients. Median time from MMV to CF-LVAD placement was
6.0 years (IQR: 1.3-15.0). The median lower limit of the INR range was 2.8
(IQR: 2.1-3.0) and upper limit of the INR range was 3.5 (IQR: 3.1-3.5).
During a median follow-up time of 120 (IQR: 70-201) days, there were no
major GI bleeds or clinically significant thromboembolic complications.
With adequate anticoagulation, preexisting MMVs in CF-LVAD patients did
not result in clinically significant thromboembolic events.<br/>Copyright
&#xa9; 2020, &#xa9; 2020 Informa UK Limited, trading as Taylor & Francis
Group.

<32>
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. 52 (3-4) (pp 120-130), 2020. Date of Publication: 18
May 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.

<33>
Accession Number
631691826
Title
Association of Neurodevelopmental Outcomes With Environmental Exposure to
Cyclohexanone During Neonatal Congenital Cardiac Operations: A Secondary
Analysis of a Randomized Clinical Trial.
Source
JAMA network open. 3 (5) (pp e204070), 2020. Date of Publication: 01 May
2020.
Author
Everett A.D.; Buckley J.P.; Ellis G.; Yang J.; Graham D.; Griffiths M.;
Bembea M.; Graham E.M.
Institution
(Everett, Yang, Griffiths) Division of Pediatric Cardiology, Department of
Pediatrics, Johns Hopkins University, Baltimore, MD, United States
(Buckley) Johns Hopkins Bloomberg School of Public Health, Department of
Environmental Health and Engineering, Johns Hopkins University, Baltimore,
MD, United States
(Ellis, Graham) Molecular Determinants Core, Johns Hopkins All Children's
Hospital, St Petersburg, FL, United States
(Graham, Bembea) Department of Anesthesia and Critical Care Medicine,
Johns Hopkins University, Baltimore, MD, United States
(Graham) Department of Pediatrics, Division of Cardiology, Medical
University of South Carolina; Charleston
Publisher
NLM (Medline)
Abstract
Importance: Cyclohexanone is an industrial solvent used as a coupling
agent in medical plastics. Perioperative exposure to cyclohexanone could
play a role in lower scores on measures of neurodevelopmental outcomes
after neonatal cardiac operations. <br/>Objective(s): To examine the
presence and association of serum cyclohexanone level with neonatal
cardiac operations and neurodevelopmental outcomes. <br/>Design, Setting,
and Participant(s): This ad hoc secondary analysis used data from the
Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass
randomized clinical trial. The cohort included neonates younger than 31
days and with at least 37 weeks postgestational age at surgical treatment
who were enrolled at a single center between June 1, 2012, and October 31,
2016, and who had completed a neurodevelopmental assessment at age 12
months. Data were analyzed from July 8 to August 20, 2019. Exposures:
Serum cyclohexanone and its metabolites were measured preoperatively
(prior to skin incision), postoperatively (immediately after the surgical
procedure was completed), and 12 hours postoperatively. Cyclohexanone and
the molar sum of its metabolites were examined at each point and as a
geometric mean of all 3 points. <br/>Main Outcomes and Measures:
Neurodevelopment was assessed at age 12 months with the Bayley Scales of
Infant and Toddler Development III, assessing cognitive, language, and
motor function composite scores standardized to a population mean (SD) of
100 (15). Linear regression models were used to determine
covariate-adjusted differences in 12-month cognitive, language, and motor
composite scores per interquartile range increase in cyclohexanone level
or summed metabolite molar concentrations. <br/>Result(s): Among 85
included neonates, mean (SD) age at surgical treatment was 9.7 (5.3) days,
49 (58%) were boys, and 54 (64%) underwent corrective repair. Mean (SD)
Bayley Scales of Infant and Toddler Development III composite scores were
108.2 (12.2) for cognitive function, 104.7 (11.0) for language function,
and 94.7 (15.7) for motor function. Median (interquartile range)
cyclohexanone levels increased approximately 3-fold from immediately prior
to surgical treatment to immediately after surgical treatment (572
[389-974] vs 1744 [1469-2291] mug/L; P=.001). In adjusted analyses, higher
geometric mean cyclohexanone levels were associated with significantly
lower composite scores for cognitive (-4.23; 95% CI, -7.39 to -1.06;
P=.01) and language (-3.65; 95% CI, -6.41 to -0.88; P=.01) function. The
difference in composite scores for motor function among infants with
higher geometric mean cyclohexanone levels was not statistically
significant(-3.93, 95% CI: -8.19 to 0.33, P=.07). <br/>Conclusions and
Relevance: The findings of this secondary analysis of a randomized
clinical trial suggest that infants who underwent neonatal cardiac
surgical treatment with cardiopulmonary bypass had substantial
cyclohexanone levels, which were associated with adverse
neurodevelopmental function at age 12 months. Trial Registration:
ClinicalTrials.gov identifier: NCT01579513.

<34>
Accession Number
631691994
Title
Postoperative Mortality of Indigenous Populations Compared With
Nonindigenous Populations: A Systematic Review.
Source
JAMA surgery. (no pagination), 2020. Date of Publication: 06 May 2020.
Author
McLeod M.; Signal V.; Gurney J.; Sarfati D.
Institution
(McLeod, Signal, Gurney, Sarfati) Department of Public Health, University
of Otago Wellington, Wellington, New Zealand
Publisher
NLM (Medline)
Abstract
Importance: A range of factors have been identified as possible
contributors to racial/ethnic differences in postoperative mortality that
are also likely to hold true for indigenous populations. Yet despite its
severity as an outcome, death in the period following a surgical procedure
is underresearched for indigenous populations. <br/>Objective(s): To
describe postoperative mortality experiences for minority indigenous
populations compared with numerically dominant nonindigenous populations
and examine the factors that drive any differences observed. Evidence
Review: This review was conducted according to PRIMSA guidelines and
registered on PROSPERO. Articles were identified through searches of the
Embase, Ovid MEDLINE, Scopus, and Cumulative Index to Nursing and Allied
Health Literature databases, with manual review of references and gray
literature searches conducted. Eligible articles included those that
reported associations between ethnicity/indigeneity and mortality up to 90
days following surgery and published in English between January 1, 1990,
and March 26, 2019. Data on the study design, setting, participants
(including indigeneity), and results were extracted. A modified
Newcastle-Ottawa Quality Assessment Scale was used to determine study
quality. <br/>Finding(s): A total of 442 abstracts were screened, 92
articles were reviewed in full text, and 21 articles (from 20 studies) and
7 reports underwent data extraction. All included studies were cohort
studies (3 prospective and the remainder retrospective) investigating a
wide range of surgical procedures in the US, Australia, or New Zealand.
Seven studies were from single facilities, while the remainder used data
from national databases. Sample sizes ranged, with indigenous sample sizes
ranging from 20 to 3052 patients and a number of studies reporting less
than 10 indigenous deaths. The postoperative mortality experience for
minority indigenous populations compared with the nonindigenous
populations was mixed. There was evidence from several studies that
indigenous populations may be more likely to die following cardiac
procedures. However, the available evidence has overall poor study
quality, with methods to identify the indigenous populations being a major
limitation of most of the studies. <br/>Conclusions and Relevance:
Postoperative mortality experiences for indigenous populations should not
be interpreted in isolation from the broader context of inequities across
the health care pathway and must take into account the quality of data
used for indigenous identification.

<35>
Accession Number
631691687
Title
Validation process of a high-resolution database in a paediatric intensive
care unit-Describing the perpetual patient's validation.
Source
Journal of evaluation in clinical practice. (no pagination), 2020. Date of
Publication: 05 May 2020.
Author
Mathieu A.; Sauthier M.; Jouvet P.; Emeriaud G.; Brossier D.
Institution
(Mathieu, Sauthier, Jouvet, Emeriaud, Brossier) Pediatric Intensive Care
Unit, CHU Sainte Justine, University of Montreal, Montreal, QC, Canada
(Mathieu, Sauthier, Jouvet, Emeriaud, Brossier) CHU Sainte Justine
Research Institute, CHU Sainte Justine, Montreal, QC, Canada
(Brossier) CHU de Caen, Pediatric Intensive Care Unit, Caen, France
(Brossier) Universite Caen Normandie, school of medicine, Caen, France
(Brossier) Laboratoire de Psychologie Caen Normandie, Universite Caen
Normandie, Caen, France
Publisher
NLM (Medline)
Abstract
RATIONALE: High data quality is essential to ensure the validity of
clinical and research inferences based on it. However, these data quality
assessments are often missing even though these data are used in daily
practice and research. AIMS AND OBJECTIVES: Our objective was to evaluate
the data quality of our high-resolution electronic database (HRDB)
implemented in our paediatric intensive care unit (PICU). <br/>METHOD(S):
We conducted a prospective validation study of a HRDB in a 32-bed
paediatric medical, surgical, and cardiac PICU in a tertiary care
freestanding maternal-child health centre in Canada. All patients admitted
to the PICU with at least one vital sign monitored using a
cardiorespiratory monitor connected to the central monitoring station.
<br/>RESULT(S): Between June 2017 and August 2018, data from 295 patient
days were recorded from medical devices and 4645 data points were video
recorded and compared to the corresponding data collected in the HRDB.
Statistical analysis showed an excellent overall correlation (R2 = 1),
accuracy (100%), agreement (bias = 0, limits of agreement = 0),
completeness (2% missing data), and reliability (ICC = 1) between recorded
and collected data within clinically significant pre-defined limits of
agreement. Divergent points could all be explained. <br/>CONCLUSION(S):
This prospective validation of a representative sample showed an excellent
overall data quality.<br/>Copyright &#xa9; 2020 John Wiley & Sons, Ltd.

<36>
Accession Number
631690773
Title
Preventive effect of low-dose landiolol on postoperative atrial
fibrillation study (PELTA study).
Source
General thoracic and cardiovascular surgery. (no pagination), 2020. Date
of Publication: 05 May 2020.
Author
Sasaki K.; Kumagai K.; Maeda K.; Akiyama M.; Ito K.; Matsuo S.; Katahira
S.; Suzuki T.; Suzuki Y.; Kaiho Y.; Sugawara Y.; Tsuji I.; Saiki Y.
Institution
(Sasaki, Maeda, Akiyama, Ito, Matsuo, Katahira, Suzuki, Suzuki, Saiki)
Division of Cardiovascular Surgery, Tohoku University Graduate School of
Medicine, 1-1 Seiryo-machi ,Aoba-ku, Sendai 980-8574, Japan
(Kumagai, Saiki) Research Division of Sciences for Aortic Disease, Tohoku
University Graduate School of Medicine, Sendai, Japan
(Kaiho, Sugawara, Tsuji) Division of Epidemiology, Department of Health
Informatics and Public Health, Tohoku University School of Public Health,
Graduate School of Medicine, Sendai, Japan
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To investigate the efficacy of prophylactic administration of
low-dose landiolol on postoperative atrial fibrillation (POAF) in patients
after cardiovascular surgery. <br/>METHOD(S): Consecutive 150 patients
over 70 years of age who underwent cardiovascular surgery for valvular,
ischemic heart, and aortic diseases were enrolled in this single-center
prospective randomized control study from 2010 to 2014. They were assigned
to three treatment groups: 1gamma group (landiolol at 1 mug/kg/min),
2gamma group (landiolol at 2 mug/kg/min), or control group (no landiolol).
In the two landiolol groups, landiolol hydrochloride was intravenously
administered for a period of 4 days postoperatively. Electrocardiography
was continuously monitored during the study period, and cardiologists
eventually assessed whether POAF occurred or not. <br/>RESULT(S): POAF
occurred in 24.4% of patients in the control group, 18.2% in 1gamma group,
and 11.1% in 2gamma group (p=0.256). Multivariate logistic regression
analysis showed that the incidence of POAF tended to decrease depending on
the dose of landiolol (trend-p=0.120; 1gamma group: OR=0.786, 95% CI
0.257-2.404; 2gamma group: OR=0.379, 95% CI 0.112-1.287). Subgroup
analysis showed a significant dose-dependent reduction in POAF among
categories of female sex, non-use of angiotensin II receptor blockers
(ARBs) before surgery, and valve surgery (each trend-p=0.02, 0.03, and
0.004). <br/>CONCLUSION(S): These findings indicate that prophylactic
administration of low-dose landiolol may not be effective for preventing
the occurrence of POAF in overall patients after cardiovascular surgery,
but the administration could be beneficial to female patients, patients
not using ARBs preoperatively, and those after valvular surgery.

<37>
Accession Number
631700727
Title
Coronary Computed Tomography Angiography in the Clinical Workflow of
Athletes With Anomalous Origin of Coronary Arteries From the Contralateral
Valsalva Sinus.
Source
Journal of thoracic imaging. (no pagination), 2020. Date of Publication:
06 May 2020.
Author
Marano R.; Merlino B.; Savino G.; Natale L.; Rovere G.; Paciolla F.;
Muciaccia M.; Flammia F.C.; Larici A.R.; Palmieri V.; Zeppilli P.;
Manfredi R.
Institution
(Marano, Merlino, Savino, Natale, Larici, Manfredi) Department of
Diagnostic Imaging, Oncological Radiotherapy and Hematology, Diagnostic
Imaging Area
(Marano, Merlino, Savino, Natale, Larici, Palmieri, Zeppilli, Manfredi)
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
(Marano, Merlino, Natale, Rovere, Paciolla, Muciaccia, Flammia, Larici,
Palmieri, Manfredi) Universita Cattolica del Sacro Cuore, Rome, Italy
(Palmieri, Zeppilli) Sports Medicine Unit-Orthopedics, Aging and
Rehabilitation Area
Publisher
NLM (Medline)
Abstract
PURPOSE: This study aimed to assess the role of coronary computed
tomography-angiography (CCTA) in the workflow of competitive sports
eligibility in a cohort of athletes with anomalous origin of the
left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery
(AORCA) in an attempt to outline relevant computed tomography features
likely to impact diagnostic assessment and clinic management. MATERIALS
AND METHODS: Patients with suspected AOLCA/AORCA at transthoracic
echocardiography or with inconclusive transthoracic echocardiography
underwent CCTA to rule out/confirm and characterize the anatomic findings:
partially interarterial course or full-INT, high-take-off,
acute-take-off-angle (ATO), slit-like origin, intramural course (IM),
interarterial-course-length, and lumen-reduction/hypoplasia (HYPO).
<br/>RESULT(S): CCTA identified 28 athletes: 6 AOLCA (3 males;
20.3+/-11.0y) and 22 AORCA (18 males; 29.1+/-16.5y). Symptoms were present
only in 13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had
abnormal rest electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal
stress-electrocardiogram. The INT course was observed in 15 athletes
(53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in
7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA
(50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No
statistically significant differences were found between
asymptomatic/symptomatic patients in the prevalence of partially INT/INT
courses, high-take-off/ATO, and slit-like ostium. A slightly significant
relationship between suspected proximal-IM (r=0.47, P<0.05) and
proximal-HYPO of anomalous vessel (r=0.65, P<0.01) resulted in AORCA and
was confirmed on AOLCA/AORCA pooled analysis (r=0.58, P<0.01 for HYPO).
All AOLCA/AORCA athletes were disqualified from competitive sports and
warned to avoid vigorous physical efforts. Surgery was recommended to all
AOLCA athletes and to 13 AORCA (3 asymptomatic), but only 6 underwent
surgery. No major cardiovascular event/ischemic symptoms/signs developed
during a mean follow-up of 49.6+/-39.5 months. <br/>CONCLUSION(S): CCTA
provides essential information for safe/effective clinical management of
athletes, with important prognostic/sport-activity implications.

<38>
Accession Number
2003988446
Title
Portable normothermic cardiac perfusion system in donation after
cardiocirculatory death: A health technology assessment.
Source
Ontario Health Technology Assessment Series. 20 (3) (pp 1-90), 2020. Date
of Publication: March 2020.
Author
Anonymous
Publisher
Health Quality Ontario (130 Bloor Street West, 10th floor, Toronto,
Ontario M5S 1N5, Canada. E-mail: HTA@HQOntario.ca)
Abstract
Background: Heart transplantation is the most effective treatment for
people experiencing end-stage heart failure whose quality of life and life
expectancy are unacceptable. However, there is a chronic shortage of donor
hearts to meet the demand, so it is essential to expand the donor pool and
increase supply. Heart donation mainly occurs after brain death
(neurological determination of death [NDD]), but it may also be feasible
after cardiocirculatory death (when the heart has stopped beating and
there is no longer blood flow or a pulse), provided specialized
preservation techniques are used. An investigational device, a portable
normothermic cardiac perfusion system, could make it possible to procure,
preserve, and transport hearts donated after cardiocirculatory death
(DCD). We conducted a health technology assessment of a portable
normothermic cardiac perfusion system for the preservation and
transportation of DCD hearts for adult transplantation. This included an
evaluation of the effectiveness, safety, value for money, and budget
impact of publicly funding this system, as well as an evaluation of
patient preferences and values. <br/>Method(s): We performed a systematic
review of the clinical literature published since 1998 that examined the
clinical safety and effectiveness of a portable normothermic cardiac
perfusion system for DCD heart transplantation. We assessed the risk of
bias of each included study and the quality of the body of evidence
according to the Grading of Recommendations Assessment, Development, and
Evaluation (GRADE) Working Group criteria. We also reviewed the economic
evidence published during the same time period for the cost-effectiveness
of a portable normothermic cardiac perfusion system for DCD hearts
compared with cold storage for NDD hearts. We further estimated the 5-year
net budget impact of publicly funding a normothermic cardiac perfusion
system for DCD heart transplantation for adults on Ontario's waitlist. To
contextualize the potential value of a portable normothermic cardiac
perfusion system, we spoke with people waiting for a heart transplant,
people who had received a heart transplant, and family members of organ
donors. <br/>Result(s): We screened 2,386 clinical citations. One study
and two case reports met the inclusion criteria. The survival of
recipients of DCD hearts procured with a portable normothermic cardiac
perfusion system did not differ significantly from the survival of
recipients of hearts donated after NDD at 30 days or 90 days, nor was
there a significant difference in cumulative survival at 1 year
post-transplant (GRADE: Very Low). The occurrence of rejection and graft
failure also did not significantly differ between the groups (GRADE: Very
Low). Cardiac function in the early post-operative period was better in
DCD hearts than NDD hearts (GRADE: Very Low). There were no differences in
outcomes between DCD procurement techniques. The economic literature
search yielded 62 citations. One report met the inclusion criteria but was
not directly applicable to the Ontario context. Given the lack of clinical
and economic evidence on long-term outcomes, we did not conduct a primary
economic evaluation. In the budget impact analysis, based on the number of
DCD donors under 40 years of age in the last 5 years, we estimated that
the increased availability of donor hearts made possible by the technology
would result in an additional seven transplants in year 1, increasing to
12 in year 5. The annual net budget impact of publicly funding a
normothermic cardiac perfusion system for the transplantation of DCD
hearts in Ontario over the next 5 years is about $2.0 million in the first
year and about $0.9 million in each of years 2 through 5, yielding a total
net budget impact of about $5.6 million. This number increases to about
$10.3 million if the transplant volume increases to 18 hearts in year 1
(meaning a subsequent increase of up to 21 hearts in year 5). If
transplantation were limited to people who do not qualify for a
ventricular assistive device or who qualify but do not wish to receive
one, the total 5-year net budget impact would be about $7.9 million.
People waiting for a heart transplant or who had received a heart
transplant and family members of organ donors expressed no substantial
concerns about the potential use of a portable normothermic cardiac
perfusion system. They hope that it may increase the number of donor
hearts available for transplant. For family members of organ donors, a
perfusion system may provide comfort and value if it can increase the
successful procurement of donor hearts. <br/>Conclusion(s): Based on very
low quality of evidence, the outcomes for recipients of DCD hearts
preserved using a portable normothermic cardiac perfusion system appear to
be similar to outcomes for recipients of NDD hearts. Owing to a lack of
evidence relevant to the Ontario context, we were unable to determine
whether a portable normothermic perfusion system may be cost-effective. We
estimate that publicly funding a portable normothermic cardiac perfusion
system for DCD heart transplantation over the next 5 years will cost about
$5.6 million. The people we spoke with believe that the system may
increase the number of hearts available for transplant and therefore
increase the number of heart transplants that can be done.<br/>Copyright
&#xa9; Queen's Printer for Ontario, 2020.

<39>
Accession Number
2003988445
Title
Transcatheter aortic valve implantation in patients with severe,
symptomatic aortic valve stenosis at intermediate surgical risk: A health
technology assessment.
Source
Ontario Health Technology Assessment Series. 20 (2) (pp 1-121), 2020. Date
of Publication: March 2020.
Author
Anonymous
Publisher
Health Quality Ontario (130 Bloor Street West, 10th floor, Toronto,
Ontario M5S 1N5, Canada. E-mail: HTA@HQOntario.ca)
Abstract
Background: Surgical aortic valve replacement (SAVR) is the conventional
treatment in patients at low or intermediate surgical risk. Transcatheter
aortic valve implantation (TAVI) is a less invasive procedure, originally
developed as an alternative for patients at high or prohibitive surgical
risk. <br/>Method(s): We conducted a health technology assessment of TAVI
versus SAVR in patients with severe, symptomatic aortic valve stenosis at
intermediate surgical risk, which included an evaluation of effectiveness,
safety, cost-effectiveness, budget impact, and patient preferences and
values. We performed a literature search to retrieve systematic reviews
and selected one that was relevant to our research question. We
complemented the systematic review with a literature search to identify
randomized controlled trials published after the review. Applicable,
previously published cost-effectiveness analyses were available, so we did
not conduct a primary economic evaluation. We analyzed the net budget
impact of publicly funding TAVI in people at intermediate surgical risk in
Ontario. To contextualize the potential value of TAVI for people at
intermediate surgical risk, we spoke with people who had aortic valve
stenosis and their families. <br/>Result(s): We identified two randomized
controlled trials; they found that in patients with severe, symptomatic
aortic valve stenosis, TAVI was noninferior to SAVR with respect to the
composite endpoint of all-cause mortality or disabling stroke within 2
years of follow-up (GRADE: High). However, compared with SAVR, TAVI had a
higher risk of some complications and a lower risk of others.
Device-related costs for TAVI (approximately $23,000) are much higher than
for SAVR (approximately $6,000). Based on two published cost-effectiveness
analyses conducted from the perspective of the Ontario Ministry of Health,
TAVI was more expensive and, on average, more effective (i.e., it produced
more quality-adjusted life-years) than SAVR. The incremental
cost-effectiveness ratios showed that TAVI may be cost-effective, but the
probability of TAVI being cost-effective versus SAVR was less than 60% at
a willingness-to-pay value of $100,000 per quality-adjusted life-year. The
net budget impact of publicly funding TAVI in Ontario would be about $2
million to $3 million each year for the next 5 years. This cost may be
reduced if people receiving TAVI have a shorter hospital stay (<= 3 days).
We interviewed 13 people who had lived experience with aortic valve
stenosis. People who had undergone TAVI reported reduced physical and
psychological effects and a shorter recovery time. Patients and caregivers
living in remote or northern regions reported lower out-of-pocket costs
with TAVI because the length of hospital stay was reduced. People said
that TAVI increased their quality of life in the short-term immediately
after the procedure. <br/>Conclusion(s): In people with severe,
symptomatic aortic valve stenosis at intermediate surgical risk, TAVI was
similar to SAVR with respect to the composite endpoint of all-cause
mortality or disabling stroke. However, the two treatments had different
patterns of complications. The study authors also noted that longer
follow-up is needed to assess the durability of the TAVI valve. Compared
with SAVR, TAVI may provide good value for money, but publicly funding
TAVI in Ontario would result in additional costs over the next 5 years.
People with aortic valve stenosis who had undergone TAVI appreciated its
less invasive nature and reported a substantial reduction in physical and
psychological effects after the procedure, improving their quality of
life.<br/>Copyright &#xa9; Queen's Printer for Ontario, 2020.

<40>
Accession Number
2005824774
Title
Prognostic Value of SYNTAX Score in Patients With Infarct-Related
Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial.
Source
JACC: Cardiovascular Interventions. 13 (10) (pp 1198-1206), 2020. Date of
Publication: 25 May 2020.
Author
Guedeney P.; Barthelemy O.; Zeitouni M.; Hauguel-Moreau M.; Hage G.;
Kerneis M.; Lattuca B.; Overtchouk P.; Rouanet S.; Fuernau G.; de
Waha-Thiele S.; Zeymer U.; Sandri M.; Akin I.; Desch S.; Thiele H.;
Montalescot G.
Institution
(Guedeney, Barthelemy, Zeitouni, Hauguel-Moreau, Hage, Kerneis, Lattuca,
Overtchouk, Montalescot) ACTION Study Group, INSERM UMRS_1166, Institut de
cardiologie, Assistance Publique-Hopitaux de Paris, Sorbonne Universite,
Paris, France
(Rouanet) ACTION Study Group, Statistician Unit, StatEthic,
Levallois-Perret, France
(Fuernau, de Waha-Thiele) University Heart Center Lubeck, Lubeck, Germany
(Zeymer) Klinikum Ludwigshafen, Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Sandri, Desch, Thiele) Heart Center Leipzig, Leipzig Heart Institute,
University of Leipzig, Leipzig, Germany
(Akin) First Department of Medicine-Cardiology, University Medical Centre
Mannheim, University of Heidelberg, Mannheim, Germany
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to evaluate the prognostic value of the
SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) scores in
patients undergoing percutaneous coronary intervention (PCI) for
multivessel coronary disease with infarct-related cardiogenic shock (CS).
<br/>Background(s): The prognostic value of the SYNTAX score in this
high-risk setting remains unclear. <br/>Method(s): The CULPRIT-SHOCK
(Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock)
trial was an international, open-label trial, where patients presenting
with infarct-related CS and multivessel disease were randomized to a
culprit-lesion-only or an immediate multivessel PCI strategy. Baseline
SYNTAX score was assessed by a central core laboratory and categorized as
low SYNTAX score (SS <=22), intermediate SYNTAX score (22<SS<=32) and high
SYNTAX score (SS>32). Adjudicated endpoints of interest were the 30-day
risk of death or renal replacement therapy (RRT) and 1-year death.
Associations between baseline SYNTAX score and outcomes were assessed
using multivariate logistic regression. <br/>Result(s): Pre-PCI SYNTAX
score was available in 624 patients, of whom 263 (42.1%), 207 (33.2%) and
154 (24.7%) presented with low, intermediate and high SYNTAX score,
respectively. A stepwise increase in the incidence of adverse events was
observed from low to intermediate and high SYNTAX score for the 30-day
risk of death or RRT and the 1-year risk of death (p < 0.001, for all).
After multiple adjustments, intermediate and high SYNTAX score remained
strongly associated with 30-day risk of death or renal replacement therapy
and 1-year risk of all-cause death. There was no significant interaction
between SYNTAX score and the coronary revascularization strategy for any
outcomes. <br/>Conclusion(s): In patients presenting with multivessel
disease and infarct-related CS, the SYNTAX score was strongly associated
with 30-day death or RRT and 1-year mortality.<br/>Copyright &#xa9; 2020
American College of Cardiology Foundation

<41>
Accession Number
631656788
Title
Beta-blocker efficacy across different cardiovascular indications: An
umbrella review and meta-analytic assessment.
Source
BMC Medicine. 18 (1) (no pagination), 2020. Article Number: 103. Date of
Publication: 05 May 2020.
Author
Ziff O.J.; Samra M.; Howard J.P.; Bromage D.I.; Ruschitzka F.; Francis
D.P.; Kotecha D.
Institution
(Ziff, Kotecha) University of Birmingham Institute of Cardiovascular
Sciences, Medical School, Birmingham B15 2TT, United Kingdom
(Ziff, Samra, Bromage) University College London, London WC1E 6BT, United
Kingdom
(Howard, Francis) Imperial College London, London SW7 2AZ, United Kingdom
(Bromage) Kings College London, London WC2R 2LS, United Kingdom
(Ruschitzka) University Hospital Zurich, Zurich 8091, Switzerland
(Kotecha) Monash Centre of Cardiovascular Research and Education in
Therapeutics, Monash University, Melbourne, VIC 3004, Australia
(Kotecha) University Hospitals Birmingham NHS Foundation Trust, Queen
Elizabeth Hospital, Institute of Translational Medicine, Birmingham B15
2GW, United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Beta-blockers are widely used for many cardiovascular
conditions; however, their efficacy in contemporary clinical practice
remains uncertain. <br/>Method(s): We performed a prospectively designed,
umbrella review of meta-analyses of randomised controlled trials (RCTs)
investigating the evidence of beta-blockers in the contemporary management
of coronary artery disease (CAD), heart failure (HF), patients undergoing
surgery or hypertension (registration: PROSPERO CRD42016038375). We
searched MEDLINE, EMBASE and the Cochrane Library from inception until
December 2018. Outcomes were analysed as beta-blockers versus control for
all-cause mortality, myocardial infarction (MI), incident HF or stroke.
Two independent investigators abstracted the data, assessed the quality of
the evidence and rated the certainty of evidence. <br/>Result(s): We
identified 98 meta-analyses, including 284 unique RCTs and 1,617,523
patient-years of follow-up. In CAD, 12 meta-analyses (93 RCTs, 103,481
patients) showed that beta-blockers reduced mortality in analyses before
routine reperfusion, but there was a lack of benefit in contemporary
studies where >= 50% of patients received thrombolytics or intervention.
Beta-blockers reduced incident MI at the expense of increased HF. In HF
with reduced ejection fraction, 34 meta-analyses (66 RCTs, 35,383
patients) demonstrated a reduction in mortality and HF hospitalisation
with beta-blockers in sinus rhythm, but not in atrial fibrillation. In
patients undergoing surgery, 23 meta-analyses (89 RCTs, 19,211 patients)
showed no effect of beta-blockers on mortality for cardiac surgery, but
increased mortality in non-cardiac surgery. In non-cardiac surgery,
beta-blockers reduced MI after surgery but increased the risk of stroke.
In hypertension, 27 meta-analyses (36 RCTs, 260,549 patients) identified
no benefit versus placebo, but beta-blockers were inferior to other agents
for preventing mortality and stroke. <br/>Conclusion(s): Beta-blockers
substantially reduce mortality in HF patients in sinus rhythm, but for
other conditions, clinicians need to weigh up both benefit and potential
risk.<br/>Copyright &#xa9; 2020 The Author(s).

<42>
Accession Number
631645833
Title
Exercise for preventing hospitalization and readmission in adults with
congestive heart failure.
Source
Cardiology in Review. 27 (1) (pp 41-48), 2019. Date of Publication: 2019.
Author
Aronow W.S.; Shamliyan T.A.
Institution
(Aronow) Division of Cardiology, Department of Medicine, New York Medical
College, Westchester Medical Center, Valhalla, NY, United States
(Shamliyan) Evidence-Based Medicine Center Elsevier, 1600 JFK Blvd,
Philadelphia, PA 19103, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
We critically appraised all available evidence regarding exercise
interventions for improving patient survival and reducing hospital
admissions in adults with chronic heart failure (HF). We searched 4
databases up to April 2018 and graded the quality of evidence according to
the Grading of Recommendations Assessment, Development and Evaluation
working group approach. We reviewed 7 meta-analyses and the publications
of 48 randomized controlled trials (RCTs). In HF with reduced ejection
fraction, low-quality evidence suggests that exercise prevents all-cause
hospitalizations [Relative risk (RR), 0.77; 95% confidence interval (CI),
0.63 to 0.93; 1328 patients in 15 RCTs] and hospitalizations due to HF
(RR, 0.57; 95% CI, 0.37 to 0.88; 1073 patients in 13 RCTs) and improves
quality of life (standardized mean difference, -0.37; 95% CI, -0.60 to
-0.14; 1270 patients in 25 RCTs) but has no effect on mortality. In HF
with preserved ejection fraction, low-quality evidence suggests that
exercise improves peak oxygen uptake (mean difference, 2.36; 95% CI, 1.16
to 3.57; 171 patients in 3 RCTs) and quality of life (mean difference,
-4.65; 95% CI, -8.46 to -0.83; 203 patients in 4 RCTs). In patients after
heart transplantation, lowquality evidence suggests that exercise improves
peak oxygen uptake (standardized mean difference, 0.68; 95% CI, 0.43 to
0.93; 284 patients in 9 RCTs) but does not improve quality of life. In
order to reduce hospitalization and improve quality of life for adults
with HF and reduced ejection fraction, clinicians should recommend
exercise interventions. For adults with HF and preserved ejection fraction
and in those undergoing heart transplantation, clinicians may recommend
exercise interventions in order to improve peak oxygen
uptake.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health, Inc.

<43>
Accession Number
631690144
Title
Effect of preoperative education and ICU tour on patient and family
satisfaction and anxiety in the intensive care unit after elective cardiac
surgery: A randomised controlled trial.
Source
BMJ Quality and Safety. (no pagination), 2020. Article Number:
bmjqs-2019-010667. Date of Publication: 2020.
Author
Lai V.K.W.; Ho K.M.; Wong W.T.; Leung P.; Gomersall C.D.; Underwood M.J.;
Joynt G.M.; Lee A.
Institution
(Lai, Wong, Leung, Gomersall, Joynt, Lee) Department of Anaesthesia and
Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital,
New Territories, Shatin, Hong Kong
(Ho) Department of Anaesthesia and Intensive Care, Prince of Wales
Hospital, New Territories, Shatin, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, New Territories, Shatin, Hong Kong
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: Preoperative education may help participants to
psychologically prepare themselves for surgery, but the outcomes of such
preparation have rarely been assessed in patients requiring postoperative
care in the intensive care unit (ICU) as well as in family members.
<br/>Objective(s): To assess the effect of a preoperative multifaceted
education intervention on patient and family satisfaction levels in the
ICU and measures of perioperative patients' anxiety and depression. Trial
design: Single-centre, two-armed, parallel, superiority, randomised
controlled trial. Healthcare professionals in ICU and outcome assessor
were blinded to treatment allocation. <br/>Participant(s): 100 elective
coronary artery bypass grafting+/-valve surgery patients and their family
members. <br/>Intervention(s): Preoperative education comprising of a
video and ICU tour in addition to standard care (treatment), versus
standard care (control). <br/>Outcome(s): Patient and family satisfaction
levels with ICU using validated PS-ICU23 and FS-ICU24 questionnaires
(0-100), respectively; change in perioperative anxiety and depression
scores between 1 day presurgery and 3 days postsurgery. <br/>Result(s):
Among 100 (50 treatment, 50 control) patients and 98 (49 treatment, 49
control) family members, 94 (48 treatment, 46 control) patients and 94 (47
treatment, 47 control) family members completed the trial. Preoperative
education was associated with higher overall patient (mean difference (MD)
6.7, 95% CI 0.2 to 13.2) and family (MD 10.0, 95% CI 3.8 to 16.3)
satisfaction scores. There was a weak association between preoperative
education and a reduction in patient's anxiety scores over time (MD-1.7,
95% CI-3.5 to 0.0). However, there was no evidence of a treatment effect
on patient's depression scores over time (MD-0.6, 95% CI-2.3 to 1.2).
<br/>Conclusion(s): Providing comprehensive preoperative information about
ICU to elective cardiac surgical patients improved patient and family
satisfaction levels and may decrease patients' anxiety
levels.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2020. No
commercial re-use. See rights and permissions. Published by BMJ.

<44>
Accession Number
2005762010
Title
Bioprosthetic Aortic Valve Leaflet Thickening in the Evolut Low Risk
Sub-Study.
Source
Journal of the American College of Cardiology. 75 (19) (pp 2430-2442),
2020. Date of Publication: 19 May 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 Valve Innovation, St. Paul's Hospital,
University of British Columbia, Vancouver, British Columbia, Canada
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Yakubov) Department of Interventional Cardiology, OhioHealth Riverside
Methodist Hospital, Columbus, OH, United States
(Deeb) Department of Cardiac Surgery, University of Michigan Health
System-University Hospital, Ann Arbor, MI, United States
(Gada, Mumtaz) Departments of Thoracic Surgery and Interventional
Cardiology, UPMC Pinnacle, Harrisburg, PA, United States
(Ramlawi) Department of Cardiothoracic Surgery, Winchester Medical Center,
Winchester, Virginia, United States
(Kleiman) Department of Cardiology, Methodist DeBakey Heart and Vascular
Center, Houston, TX, United States
(Sorajja, Askew) Departments of Thoracic Surgery and Interventional
Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital,
Minneapolis, MN, United States
(Meduri, Kauten) Departments of Cardiac Surgery and Interventional
Cardiology, Piedmont Atlanta Hospital, Atlanta, Georgia, Georgia
(Melnitchouk, Inglessis) Departments of Cardiac Surgery and Interventional
Cardiology, Massachusetts General Hospital, Boston, MA, United States
(Huang, Boulware) Department of Statistics, Medtronic, Minneapolis, MN,
United States
(Reardon) Department of Cardiothoracic Surgery, Methodist DeBakey Heart
and Vascular Center, Houston, TX, United States
Publisher
Elsevier USA
Abstract
Background: Subclinical leaflet thrombosis has been reported after
bioprosthetic aortic valve replacement, characterized using 4-dimensional
computed tomographic imaging by hypoattenuated leaflet thickening (HALT)
and reduced leaflet motion (RLM). The incidence and clinical implications
of these findings remain unclear. <br/>Objective(s): The aim of this study
was 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
computed tomographic imaging 30 days and 1 year after transcatheter aortic
valve replacement (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 of 179 (17.3%)
for TAVR and 23 of 139 (16.5%) for surgery; the frequency of RLM was 23 of
157 (14.6%) for TAVR and 19 of 133 (14.3%) for surgery. At 1 year, the
frequency of HALT was 47 of 152 (30.9%) for TAVR and 33 of 116 (28.4%) for
surgery; the frequency of RLM was 45 of 145 (31.0%) for TAVR and 30 of 111
(27.0%) for surgery. Aortic valve hemodynamic status was not influenced by
the presence or severity of HALT or RLM at either time point. The rates of
HALT and RLM were similar after the implantation of supra-annular,
self-expanding transcatheter, or surgical bioprostheses.
<br/>Conclusion(s): The presence of computed tomographic imaging
abnormalities of aortic bioprostheses were frequent but dynamic in the
first year after self-expanding transcatheter and surgical aortic valve
replacement, but these findings did not correlate with aortic valve
hemodynamic status after aortic valve replacement in patients at low risk
for surgery. (Medtronic Evolut Transcatheter Aortic Valve Replacement in
Low Risk Patients; NCT02701283)<br/>Copyright &#xa9; 2020 American College
of Cardiology Foundation

<45>
Accession Number
2005685109
Title
Sugammadex versus neostigmine for reversal of rocuronium-induced
neuromuscular blockade: A randomized, double-blinded study of thoracic
surgical patients evaluating hypoxic episodes in the early postoperative
period.
Source
Journal of Clinical Anesthesia. 64 (no pagination), 2020. Article Number:
109804. Date of Publication: September 2020.
Author
Moon T.S.; Reznik S.; Pak T.; Jan K.; Pruszynski J.; Kim A.; Smith K.M.;
Lu R.; Chen J.; Gasanova I.; Fox P.E.; Ogunnaike B.
Institution
(Moon, Pak, Jan, Kim, Smith, Lu, Chen, Gasanova, Fox, Ogunnaike)
University of Texas Southwestern Medical Center, Department of
Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390,
United States
(Reznik, Pruszynski) University of Texas Southwestern Medical Center,
Department of Cardiovascular and Thoracic Surgery, 5323 Harry Hines
Boulevard, Dallas, TX 75390, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: This objective of this study was to determine if reversal
of rocuronium-induced neuromuscular blockade with sugammadex versus
neostigmine results in a decreased number of hypoxic episodes in the early
postoperative period in patients undergoing thoracic surgery with single
lung ventilation. <br/>Design(s): Single-center, randomized, double-blind,
two-arm clinical trial. <br/>Setting(s): Operating room and postanesthesia
care unit. <br/>Patient(s): 92 subjects aged >=18, American Society of
Anesthesiologists physical status II-IV, and undergoing a thoracic
operation necessitating single lung ventilation. <br/>Intervention(s):
Subjects received either 2 mg/kg sugammadex or 50 mug/kg neostigmine with
8 mug/kg glycopyrrolate for reversal of moderate neuromuscular blockade.
Measurements: For the first 90 min postoperatively, all episodes of
hypoxia were recorded. Neuromuscular monitoring was performed with
acceleromyography (TOF-Watch SX) and the train of four (TOF) was recorded
at 2, 5, 10, and 15 min after administration of the neuromuscular reversal
agent. <br/>Main Result(s): Subjects who received neostigmine had a median
of 1 episode (interquartile range IQR: 0-2.2) of hypoxia versus subjects
who received sugammadex who had a median of 0 episodes (IQR: 0-1) (p =
0.009). The mean time to recovery of TOF >= 0.9 was significantly faster
with sugammadex at 10 min (95% confidence interval CI: 5-15) compared with
neostigmine at 40 min (95% CI: 15-53) (p < 0.001). <br/>Conclusion(s): In
thoracic surgical patients necessitating single lung ventilation,
sugammadex provides faster reversal of moderate neuromuscular blockade and
results in a decreased number of postoperative hypoxic episodes compared
with neostigmine.<br/>Copyright &#xa9; 2020

<46>
Accession Number
2005667775
Title
5-Year Outcomes After TAVR With Balloon-Expandable Versus Self-Expanding
Valves: Results From the CHOICE Randomized Clinical Trial.
Source
JACC: Cardiovascular Interventions. 13 (9) (pp 1071-1082), 2020. Date of
Publication: 11 May 2020.
Author
Abdel-Wahab M.; Landt M.; Neumann F.-J.; Massberg S.; Frerker C.; Kurz T.;
Kaur J.; Toelg R.; Sachse S.; Jochheim D.; Schafer U.; El-Mawardy M.;
Robinson D.R.; Richardt G.
Institution
(Abdel-Wahab) Heart Center Leipzig at the University of Leipzig, Leipzig,
Germany
(Landt, Kaur, Toelg, Sachse, Richardt) Heart Center, Segeberger Kliniken,
Bad Segeberg, Germany
(Neumann) University Heart Center Freiburg-Bad Krozingen, Bad Krozingen,
Germany
(Massberg, Jochheim) Munich University Clinic, Munich, Germany
(Frerker, Schafer) Cardiology Department, Asklepios Clinic St. Georg,
Hamburg, Germany
(Kurz) Cardiology Department, Lubeck University Hospital, Lubeck, Germany
(El-Mawardy) Cardiology Department, Vivantes Wenckebach Hospital, Berlin,
Germany
(Robinson) Mathematics Department, University of Sussex, Brighton,
England, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The purpose of this study was to evaluate clinical and
echocardiographic outcome data of the CHOICE (Randomized Comparison of
Transcatheter Heart Valves in High Risk Patients with Severe Aortic
Stenosis: Medtronic CoreValve Versus Edwards SAPIEN XT) trial at 5 years.
<br/>Background(s): The CHOICE trial was designed to compare device
performance of a balloon-expandable (BE) transcatheter heart valve (THV)
versus a self-expanding (SE) THV. <br/>Method(s): The CHOICE trial is an
investigator-initiated trial that randomized 241 high-risk patients with
severe symptomatic aortic stenosis and an anatomy suitable for treatment
with both BE and SE THVs to transfemoral transcatheter aortic valve
replacement with either device. The primary endpoint was device success.
Patients were followed up to 5 years, with assessment of clinical
outcomes, and echocardiographic evaluation of valve function and THV
durability. <br/>Result(s): After 5 years, there were no statistically
significant differences between BE and SE valves in the cumulative
incidence of death from any cause (53.4% vs. 47.6%; p = 0.38), death from
cardiovascular causes (31.6% vs. 21.5%; p = 0.12), all strokes (17.5% vs.
16.5%; p = 0.73), and repeat hospitalization for heart failure (28.9% vs.
22.5%; p = 0.75). SE patients had larger prosthetic valve area (1.6 +/-
0.5 cm² vs. 1.9 +/- 0.5 cm²; p = 0.02) with a lower
mean transprosthetic gradient (12.2 +/- 8.7 mm Hg vs. 6.9 +/- 2.7 mm Hg; p
= 0.001) at 5 years. No differences were observed in the rates of
paravalvular regurgitation. Clinical valve thrombosis occurred in 7 BE
patients (7.3%) and 1 SE patient (0.8%; p = 0.06), and moderate or severe
structural valve deterioration in 6 BE patients (6.6%) and no SE patient
(0%; p = 0.018). The rate of bioprosthetic valve failure was low and not
significantly different between both groups (4.1% vs. 3.4%; p = 0.63).
<br/>Conclusion(s): Five-year follow-up of patients in the CHOICE trial
revealed clinical outcomes after transfemoral transcatheter aortic valve
replacement with early-generation BE and SE valves that were not
statistically significantly different, with limited statistical power.
Forward flow hemodynamics were significantly better with the SE valve.
Moderate or severe structural valve deterioration was uncommon but
occurred more frequently with the BE valve. (A Comparison of Transcatheter
Heart Valves in High Risk Patients With Severe Aortic Stenosis: The CHOICE
Trial [CHOICE]; NCT01645202)<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<47>
Accession Number
631486048
Title
Can hypnosis and virtual reality reduce anxiety, pain and fatigue among
patients who undergo cardiac surgery: A randomised controlled trial.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 330. Date of
Publication: 15 Apr 2020.
Author
Rousseaux F.; Faymonville M.-E.; Nyssen A.-S.; Dardenne N.; Ledoux D.;
Massion P.B.; Vanhaudenhuyse A.
Institution
(Rousseaux, Nyssen) Laboratory of Cognitive Ergonomics and Work
Intervention, University of Liege, ULiege (B32), Quartier Agora-Place des
Orateurs, 2, Liege 4000, Belgium
(Rousseaux, Faymonville, Vanhaudenhuyse) Algology Department, University
Hospital of Liege, CHU Sart Tilman Domaine Universitaire du Sart Tilman
B35, Liege 4000, Belgium
(Rousseaux, Faymonville, Nyssen, Vanhaudenhuyse) Sensation and Perception
Research Group, Giga Consciousness, University of Liege, GIGA (B34),
Quartier Hopital-Avenue de l'Hopital, 11, Liege 4000, Belgium
(Dardenne) Public Health Department, Biostatistics, University of Liege,
CHU (B35) Quartier Hopital-Avenue de l'Hopital, 11, Liege 4000, Belgium
(Ledoux, Massion) Intensive Care Units, University Hospital of Liege, CHU
(B35)Quartier Hopital-Avenue de l'Hopital, 11, Liege 4000, Belgium
(Ledoux) Anesthesia and Intensive Care, Giga Consciousness, University of
Liege, GIGA (B34)Quartier Hopital-Avenue de l'Hopital, 11, Liege 4000,
Belgium
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Different non-pharmacological techniques, including hypnosis
and virtual reality (VR) are currently used as complementary tools in the
treatment of anxiety, acute and chronic pain. A new technique called
virtual reality hypnosis (VRH), which encompasses a combination of both
tools, is regularly used although its benefits and underlying mechanisms
remain unknown to date. With the goal to improve our understanding of VRH
combination effects, it is necessary to conduct randomised and controlled
research trials in order to understand their clinical interest and
potential benefits. <br/>Method(s): Patients (n = 100) undergoing cardiac
surgery at the Liege University Hospital will be randomly assigned to one
of four conditions (control, hypnosis, VR or VRH). Each patient will
receive two sessions of one of the techniques: One the day before the
surgery and one the day after. Physiological assessments will be made on
the monitor and patients will rate their levels of anxiety, fatigue, pain,
absorption and dissociation. <br/>Discussion(s): This study will help to
expand knowledge on the application of virtual reality, hypnosis and VRH
in the specific context of cardiac and intensive care procedures, and the
influence of these non-pharmacological techniques on patient's anxiety,
fatigue, pain and phenomenological experience. Trial registration:
ClinicalTrials.gov: NCT03820700. Date registered on 29 January 2019. Study
recruitment date: October 6, 2018. Study anticipated completion date:
December 28, 2020.<br/>Copyright &#xa9; 2020 The Author(s).

<48>
Accession Number
627340324
Title
Efficacy and safety of figure-of-eight suture versus manual pressure for
venous access closure: a systematic review and meta-analysis.
Source
Journal of Interventional Cardiac Electrophysiology. 57 (3) (pp 379-385),
2020. Date of Publication: 01 Apr 2020.
Author
Atti V.; Turagam M.K.; Garg J.; Alratroot A.; Abela G.S.; Rayamajhi S.;
Lakkireddy D.
Institution
(Atti, Alratroot, Abela, Rayamajhi) Michigan State University-Sparrow
Hospital, East Lansing, MI, United States
(Turagam, Garg) Helmsley Electrophysiology Center, Icahn School of
medicine at Mount Sinai, New York City, NY, United States
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Kansas City, KS, United States
Publisher
Springer
Abstract
Background: Vascular hemostasis after venous access in cardiovascular
procedures remains a challenge. Figure-of-eight (FoE) emerged as an
alternative technique to manual pressure. However, its feasibility and
safety is unknown. <br/>Method(s): A comprehensive search in
clinicalTrials.gov, PubMed, Web of Science, EBSCO Services, Cochrane
Central Register of Controlled Trials, Google Scholar, and various
scientific conference sessions from inception to December 1, 2018, was
performed. A meta-analysis was performed using random effects model to
calculate risk ratio (RR) and mean difference (MD) with 95% confidence
interval (CI). <br/>Result(s): Seven studies were eligible and included
1978 patients, of whom 982 patients received the FoE suture, while 996
received manual pressure. There was no difference in the risk of access
site pseudoaneurysm (RR 0.48, 95%CI 0.13 to 1.73, p = 0.26) and fistula
(RR 0.90, 95%CI 0.22 to 3.75, p = 0.89) between the two techniques.
Compared with manual pressure, FoE was associated with lower risk of
access site complications (RR 0.37, 95%CI 0.24 to 0.58, 0.65, p < 0.0001)
including bleeding (RR 0.30, 95%CI 0.18 to 0.50, p < 0.00001) and hematoma
(RR 0.41, 95%CI 0.25 to 0.68, 0.83, p = 0.0005). Time to hemostasis was
significantly lower in FoE group compared with manual pressure (MD - 21.04
min, 95%CI - 35.66 to - 6.42, p = 0.005). <br/>Conclusion(s): The results
of our meta-analysis showed that there was no difference in the risk of
access site pseudoaneurysm and fistula between FoE and manual pressure.
FoE was associated with lower risk of access site hematoma and bleeding
compared with manual pressure. Our results reiterate the safety and
feasibility of FoE suture for venous access closure.<br/>Copyright &#xa9;
2019, Springer Science+Business Media, LLC, part of Springer Nature.

<49>
Accession Number
2004007970
Title
Measurement of health-related quality of life in pediatric organ
transplantation recipients: a systematic review of the PedsQL transplant
module.
Source
Quality of Life Research. 29 (5) (pp 1137-1146), 2020. Date of
Publication: 01 May 2020.
Author
Killian M.O.; Triplett K.N.; Masood S.S.; Boehler J.; Mayersohn G.S.
Institution
(Killian, Boehler) College of Social Work, Florida State University, 296
Champions Way, UCC 3407, Tallahassee, FL 32306, United States
(Killian, Triplett) Solid Organ Transplant Program, Children's Health -
Children's Medical Center, Dallas, TX, United States
(Triplett, Masood) The University of Texas Southwestern Medical Center,
Dallas, TX, United States
(Mayersohn) St. Louis Children's Hospital, St. Louis, MO, United States
(Mayersohn) Washington University School of Medicine, St. Louis, MO,
United States
Publisher
Springer
Abstract
Objective: To collect and assess the extant empirical literature assessing
disease-specific health-related quality of life (HRQOL) in pediatric
transplant recipients using the PedsQL 3.0 Transplant Module (PedsQL-TM)
assessment. Study design: A systematic search and review procedure was
conducted of research reporting use and results of the PedsQL-TM with
samples of pediatric heart, liver, kidney, and lung transplantation.
Searches were conducted in nine scholarly databases and two additional
sources to identify unpublished research. Multiple reviewers screened
studies meeting inclusion criteria in accordance with PRISMA guidelines.
<br/>Result(s): A final sample of nine studies reported findings for the
PedsQL-TM with pediatric organ transplant recipients. Most studies relied
on either kidney or liver transplant recipients from single pediatric
transplant centers. Factor validity of the PedsQL-TM and inter-rater
reliability (IRR) between patients and parents have not been adequately
determined. Internal consistency reliability was found as acceptable or
excellent across multiple studies. PedsQL-TM scores were found to vary
with other HRQOL issues, yet few studies examined their association with
medication adherence or posttransplant health outcomes.
<br/>Conclusion(s): With the goal of enhancing and sustaining HRQOL in
pediatric organ transplant recipients, the need for a psychometrically
valid and reliable measure of transplant-specific HRQOL is apparent.
Research on the PedsQL-TM supports the promise of this measure although
future efforts should be taken to examine measurement issues such as
factor validity and IRR. Assessing transplant-specific HRQOL in these
patients is paramount for their care and appropriate decision-making by
patients, families, and the transplant team.<br/>Copyright &#xa9; 2020,
Springer Nature Switzerland AG.

<50>
Accession Number
2002254836
Title
Mitral Paravalvular Leak Closure: Transcatheter and Surgical Solutions.
Source
Cardiovascular Revascularization Medicine. 21 (3) (pp 422-431), 2020. Date
of Publication: March 2020.
Author
Okutucu S.; Mach M.; Oto A.
Institution
(Okutucu, Oto) Department of Cardiology, Memorial Ankara Hospital, Ankara,
Turkey
(Mach) Division of Cardiac Surgery, Medical University Graz, Austria
(Mach) Heart Team Austria and Karl Landsteiner Institute for
Cardiovascular Research, Austria
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Paravalvular leak (PVL) is an important complication after surgical valve
replacement and might lead to serious clinical results, including heart
failure and/or hemolytic anemia. PVLs are the result of an incomplete seal
between the sewing ring and annulus. It frequently affects surgical valves
in the mitral position, occurring in 5% to 15% of valve replacements. For
years, surgery has been considered the only treatment for symptomatic
patients with PVLs. However, surgical re-intervention for PVLs is
associated with a high risk of morbidity and mortality. Therefore,
percutaneous treatment of PVL has become first-line therapy for most
patients with symptomatic PVL. In this review, we will briefly summarize
clinical findings, diagnostic modalities, laboratory assessment, surgical
treatment, transcatheter approaches, device choice and outcomes of
interventions in mitral PVLs.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<51>
Accession Number
2002129621
Title
Optimal Treatment Strategy for Coronary Artery Stenoses with Grey Zone
Fractional Flow Reserve Values. A Systematic Review and Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 21 (3) (pp 392-397), 2020. Date
of Publication: March 2020.
Author
Andreou C.; Zimmermann F.M.; Tonino P.A.L.; Maniotis C.; Koutouzis M.;
Poulimenos L.E.; Triantafyllis A.S.
Institution
(Andreou) Department of Cardiology, Limassol General Hospital, Limassol,
Cyprus
(Zimmermann, Tonino, Triantafyllis) Heart Center, Catharina Hospital
Eindhoven, Eindhoven, Netherlands
(Maniotis) Cardiology Department, Hygeia Hospital, Athens, Greece
(Koutouzis) 2nd Department of Cardiology, Hellenic Red Cross Hospital,
Athens, Greece
(Poulimenos, Triantafyllis) Department of Cardiology, Asklepeion General
Hospital, Athens, Greece
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: We conducted a review and meta-analysis of published data to
compare revascularization to deferral strategy for coronary lesions with
grey zone fractional flow reserve (FFR). <br/>Background(s): Optimal
treatment for coronary stenoses with FFR values between 0.75 and 0.80, the
so-called grey zone, remains a matter of debate. <br/>Method(s): We
included all studies evaluating revascularization versus deferral for
lesions with grey zone FFR. The primary outcome was study-defined major
adverse cardiac events (MACE). Secondary outcomes were the composite of
death or MI and target vessel revascularization (TVR). A total of 2362
patients were included, of whom 1181 underwent revascularization
(revascularization group) and 1181 received medical treatment only
(deferral group). <br/>Result(s): After a mean follow-up period of 2.4
years, no difference was found for the primary outcome of the
study-defined MACE between the two groups [RR = 1.33 (0.73-2.44), p =
0.35]. In addition, there was no difference for the secondary outcomes of
death or MI and TVR between the two groups [RR = 1.39 (0.56-3.47), p =
0.48 and RR = 1.49 (0.89-2.51), p = 0.13, respectively].
<br/>Conclusion(s): In this meta-analysis revascularization of coronary
stenoses with grey zone FFR showed no advantage over a deferral strategy
in terms of study-defined MACE. Case by case judgment should be
implemented to guide treatment in this special subset of
patients.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<52>
Accession Number
2002104605
Title
Native Coronary Disease Progression Post Coronary Artery Bypass Grafting.
Source
Cardiovascular Revascularization Medicine. 21 (3) (pp 295-302), 2020. Date
of Publication: March 2020.
Author
Jabagi H.; Chong A.-Y.; So D.; Glineur D.; Rubens F.D.
Institution
(Jabagi, Glineur, Rubens) Division of Cardiac Surgery, University of
Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
(Chong, So) Division of Cardiology, University of Ottawa Heart Institute,
40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: It remains unclear if graft type impacts native disease
progression in the target coronary artery post coronary artery bypass
grafting (CABG). <br/>Method(s): Patients who underwent repeat angiograms
at least 6 months post CABG with >=1 arterial graft were included.
Pre/post CABG angiograms were examined by 2 experienced readers.
Progression was defined as new stenosis of >=50% in a previously normal
coronary, an increase in previous stenosis of >=20%, or a new occlusion.
Primary outcome was the occurrence of native disease progression in
bypassed vessels. Secondary outcomes included complete occlusion, left
main (LM) and distal disease progression. Cox-proportional hazard
regression models were used for time-to-event outcomes. <br/>Result(s):
Study population included 98 patients comprising 263 grafts (143
arterial/120 venous grafts). Median time from surgery to catheterization
was 559 days (Interquartile Range 374,910).Ninety-one target vessels
showed progression (34.6%) with 75 to complete occlusion (28.5%).
Progression was not associated with graft choice (HR 0.74(0.49,1.13) p =
0.163),but was significantly associated with age(p = 0.034),previous PCI(p
= 0.002),ACE inhibitor (ACEi) use(p < 0.001),CAD severity (p < 0.001),CCS
class III/IV(p = 0.016) and NYHA class III/IV(p < 0.001). Progression to
occlusion was significantly associated with SVG (p = 0.019), as well as
previous percutaneous coronary intervention (p = 0.007) and ACEi use (p <
0.001). LM disease progression was significantly associated with
peripheral vascular disease (HR 5.44(1.92, 15.46), p = 0.001), and not
affected by graft type (p = 0.754). <br/>Conclusion(s): Native CAD
progression in non-LM coronaries is multifactorial, while SVG use was only
associated with occlusion of non-LM coronaries. The implications of this
study warrant consideration for increased arterial grafting in CABG
patients, while the negative associations of previous PCI and ACEi use
carry important clinical implications, which require further
investigation.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<53>
Accession Number
631561862
Title
Outcomes of left atrial appendage occlusion using the AtriClip device: A
systematic review.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (5) (pp 655-662),
2019. Date of Publication: 01 Nov 2019.
Author
Toale C.; Fitzmaurice G.J.; Eaton D.; Lyne J.; Redmond K.C.
Institution
(Toale, Fitzmaurice, Eaton, Redmond) Department of Thoracic Surgery, Mater
Misericordiae University Hospital, Dublin, Ireland
(Lyne) Department of Cardiology, Blackrock Clinic, Dublin, Ireland
Publisher
Oxford University Press
Abstract
Atrial fibrillation increases lifetime stroke risk. The left atrial
appendage (LAA) is thought to be the source of embolic strokes in up to
90% of cases, and occlusion of the LAA may be safer than the alternative
of oral anticoagulation. Occlusion devices, such as the
AtriClip^TM (AtriCure, Mason, OH, USA) enable safe and
reproducible epicardial clipping of the LAA. A systematic review was
performed in May 2018, based on the Preferred Reporting Items for
Systematic Reviews and Meta-analyses guidelines, using the keyword
'AtriClip'. A total of 68 papers were identified and reviewed; 11 studies
were included. Data including demographics, medical history
intervention(s) performed, periprocedural outcomes and follow-up were
assessed and analysed. A total of 922 patients were identified. LAA
occlusion was achieved in 902 out of 922 patients (97.8%). No
device-related adverse events were reported across the studies. The
reported incidence of stroke or transient ischaemic attack post-clip
placement ranged from 0.2 to 1.5/100 patient-years. Four hundred and
seventy-seven of 798 patients (59.7%) had ceased anticoagulation on
follow-up. The AtriClip device is safe and effective in the management of
patients with atrial fibrillation, either as an adjunct in patients
undergoing cardiac surgery or as a stand-alone thoracoscopic
procedure.<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.

<54>
Accession Number
631561761
Title
Is local anaesthesia superior to general anaesthesia in endovascular
repair of abdominal aortic aneurysm?.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (4) (pp 599-603),
2019. Date of Publication: 01 Oct 2019.
Author
Harky A.; Grafton-Clarke C.; Chan J.
Institution
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Chester CH1 2UL, United Kingdom
(Grafton-Clarke) College of Life Sciences, University of Leicester,
Leicester, United Kingdom
(Chan) Department of Cardiothoracic Surgery, Morriston Hospital, Swansea,
United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiovascular surgery was written in accordance
to a structured protocol. The question addressed was: in patients
undergoing endovascular repair of abdominal aortic aneurysm (EVAR), is
local anaesthetic (LA) superior to general anaesthetic in terms of
perioperative outcomes? Altogether, 630 publications were found using the
reported search protocol, of which 3 represented the best evidence to
answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type and primary outcomes were
tabulated. The 3 included studies are systematic reviews with
meta-analyses, with no randomized trials identified. Within the studies,
there is a degree of heterogeneity in terms of surgical case-mix (elective
or emergency EVAR or both) and anaesthetic technique (LA, regional
anaesthetic, local-regional anaesthetic and general anaesthetic). With 1
study not providing pooled estimates, the second study demonstrated
statistical significance in favour of local-regional anaesthetic within
the elective setting in terms of mortality [pooled odds ratio (OR) 0.70,
95% confidence interval (CI) 0.52-0.95; P = 0.02], morbidity (pooled OR
0.73, 95% CI 0.55-0.96; P = 0.0006) and total length of hospital admission
(pooled mean difference: -1.53, 95% CI -2.53 to -0.53; P = 0.00001). The
third study failed to demonstrate a statistically significant mortality
benefit with LA (pooled OR 0.54, 95% CI 0.21-1.41; P = 0.211). While the
results of these studies fail to provide a clear answer to a complex
surgical problem, it would be appropriate, in the light of current
evidence, to recommend LA as non-inferior to general anaesthetic in both
emergency and elective settings.<br/>Copyright &#xa9; The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<55>
Accession Number
631561445
Title
Impact of risk factors and surgical techniques in coronary endarterectomy:
A network meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (3) (pp 355-364),
2019. Date of Publication: 01 Sep 2019.
Author
Wang C.; Chen J.; Gu C.; Qiao R.; Li J.
Institution
(Wang, Gu, Qiao, Li) Department of Cardiac Surgery, Beijing Anzhen
Hospital, Capital Medical University, 2 Anzhen Road, Beijing 100029, China
(Chen) People's Hospital of Deyang City, Sichuan, China
Publisher
Oxford University Press
Abstract
The goal of this network meta-analysis was to compare the early mortality
rate of patients who underwent coronary endarterectomy (CE) combined with
coronary artery bypass grafting (CABG) with different techniques and with
isolated CABG. This analysis also evaluated potential risk factors in
patients who undergo CE. Eighteen studies were included, covering 21 752
different patients, among whom 3352 underwent CE + CABG with either open
or closed techniques and 18 400 underwent isolated CABG. Patients who had
CE + CABG had a statistically significant higher mortality rate [odds
ratio (OR) 1.76; P < 0.001]. Subgroup analyses showed that, with closed
CE, mortality was 52% (OR 1.52, P = 0.001) more likely to occur, whereas
with open CE, mortality was 279% (OR 3.79, P < 0.001) more likely to
occur, when both were compared with isolated CABG. A network meta-analysis
indicated that both the open and closed methods had poorer results than
CABG alone and that the open method had a higher risk of mortality than
the closed one. For risk factors, diabetes mellitus (DM), hypertension,
prior myocardial infarction, peripheral vascular disease and renal failure
were significant contributors to inclusion in the CE group, whereas other
risk factors showed no significant difference. However, none of these
factors indicated significant correlations with the incidence of mortality
between the groups. CE + CABG has a significantly higher risk of death
than isolated CABG, and open CE is more risky than closed CE, even though
most of the individual studies did not show that CE had a higher risk of
mortality. Moreover, DM, hypertension, prior myocardial infarction,
peripheral vascular disease and renal failure were more common in the
patients who had CE + CABG, but these factors may not necessarily increase
the mortality risk of patients who have CE.<br/>Copyright &#xa9; The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<56>
Accession Number
631561276
Title
Should surgical treatment of catamenial pneumothorax include diaphragmatic
repair?.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (6) (pp 906-910),
2019. Date of Publication: 01 Dec 2019.
Author
Pathak S.; Caruana E.; Chowdhry F.
Institution
(Pathak, Chowdhry) Department of Thoracic Surgery, Glenfield Hospital,
Leicester, United Kingdom
(Caruana) Department of Thoracic Surgery, Nottingham City Hospital,
Nottingham, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether treatment with
hormones or pleural symphysis is better than operative procedures such as
diaphragmatic repair with mesh to surgically manage recurrent
pneumothoraces in patients with catamenial pneumothorax. Diaphragmatic
repair with synthetic meshes, hormonal treatment and pleural symphysis are
all accepted interventions for the treatment of recurrent catamenial
pneumothoraces; however, there is uncertainty over the best combination of
treatment. Altogether, 396 papers were found using the reported search, of
which 13 represented the best evidence to answer the clinical question.
However, it should be noted that the studies included were small in terms
of sample size, and have demonstrated significant bias and surgical
heterogeneity. Our literature review found that the recurrence rates of
pneumothorax were greatly reduced in the treatment group where surgery and
hormone therapy were combined (pooled average recurrence rate of 0%);
however, the recurrence rates were significantly higher when these
interventions were used alone: hormone therapy alone (58.5%),
diaphragmatic repair alone (33.3%) and surgery alone (63.3%). Our results
therefore demonstrate that a multimodality approach is required to reduce
pneumothorax recurrence rates in patients with catamenial
pneumothorax.<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.

<57>
Accession Number
631555688
Title
A meta-analysis of the performance of small tissue versus mechanical
aortic valve prostheses.
Source
European Journal of Cardio-thoracic Surgery. 56 (3) (pp 510-517), 2019.
Date of Publication: 01 Sep 2019.
Author
Moscarelli M.; Fattouch K.; Speziale G.; Nasso G.; Santarpino G.; Gaudino
M.; Athanasiou T.
Institution
(Moscarelli) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Moscarelli, Fattouch, Speziale, Nasso, Santarpino) Department of Cardiac
Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Athanasiou) Department of Surgery and Cancer, Imperial College,
Paddington, London, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Small aortic prosthetic valves have been associated with
suboptimal performance due to patient-prosthesis mismatch (PPM). This
meta-analysis compared the outcomes of patients with a small root who
received tissue versus mechanical aortic valves. <br/>METHOD(S): A
systematic literature review identified 7 candidate studies+ADs- of these,
5 met the meta-analysis criteria. We analysed outcomes for a total of 680
patients (227 tissue valves and 453 mechanical valves) using random
effects modelling. Each study was assessed for heterogeneity and quality.
The primary end point was mortality at follow-up. Secondary end points
included intraoperative and postoperative outcomes, the rate of PPM and
left ventricle mass regression and major cardiac and prosthesis-related
adverse events at follow-up. <br/>RESULT(S): There was no between-group
difference in mortality at follow-up +AFs-incidence rate ratio 1, 95+ACU-
confidence interval (CI) 0.50-2.01+ADs- P +AD0- 0.99+AF0-. The tissue
group had a higher rate of PPM (odds ratio 17.19, 95+ACU- CI
8.6-25.78+ADs- P +AD0- 0.002) and significantly less reduction in
ventricular mass (weighted mean difference 40.79, 95+ACU- CI
4.62-76.96+ADs- P +AD0- 0.02). There were no significant differences in
the incidence of structural valve disease at follow-up compared to that in
the mechanical valve group. There was also no between-group difference in
aggregated adverse events at follow-up (P +AD0- 0.68). <br/>CONCLUSION(S):
Tissue and mechanical valves were associated with similar mortality
rates+ADs- however, patients receiving tissue valves had a higher rate of
PPM and significantly less left ventricle mass regression. These findings
indicate that patients receiving small tissue valves may require closer
clinical surveillance than those receiving mechanical valves.
+ACY-copy+ADs- 2019 The Author(s). Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.<br/>Copyright &#xa9; 2019 Oxford University Press. All rights
reserved.

<58>
Accession Number
631551084
Title
Incidence, predictors and cerebrovascular consequences of leaflet
thrombosis after transcatheter aortic valve implantation: A systematic
review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 56 (3) (pp 488-494), 2019.
Date of Publication: 01 Sep 2019.
Author
D'Ascenzo F.; Salizzoni S.; Saglietto A.; Cortese M.; Latib A.; Franzone
A.; Barbanti M.; Nietlispach F.; Holy E.W.; Burriesci G.; De Paoli A.;
Fonio P.; Atzeni F.; Moretti C.; Perl L.; D'Amico M.; Rinaldi M.; Conrotto
F.
Institution
(D'Ascenzo, Saglietto, Cortese, Moretti, D'Amico, Conrotto) Division of
Cardiology, Department of Medical Sciences, University of Turin, Turin,
Italy
(Salizzoni, Atzeni, Rinaldi) Division of Cardiac Surgery, Cardiovascular
and Thoracic Department, University of Turin, Turin, Italy
(Latib) Interventional Cardiology Unit, Cardiothoracic and Vascular
Department, San Raffaele Scientific Institute, Milan, Italy
(Franzone) Department of Cardiology, Swiss Cardiovascular Center Bern,
Bern University Hospital, Bern, Switzerland
(Barbanti) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Nietlispach, Holy) Cardiology Clinic, University Hospital of Zurich,
Zurich, Switzerland
(Burriesci) UCL Mechanical Engineering, University College London, London,
United Kingdom
(Burriesci) Ri.MED Foundation, Palermo, Italy
(De Paoli, Fonio) Radiology Unit, Department of Surgical Science,
University of Turin, Turin, Italy
(Perl) Department of Cardiology, Rabin Medical Center, Petach-Tikva,
Israel
(Perl) Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: We examined the incidence, the impact of subsequent
cerebrovascular events and the clinical or procedural predictors of
leaflet thrombosis (LT) in patients undergoing transcatheter aortic valve
implantation (TAVI). <br/>METHOD(S): MEDLINE/PubMed was systematically
screened for studies reporting on LT in TAVI patients. Incidence [both
clinical and subclinical, i.e. detected with computed tomography (CT)] of
LT was the primary end point of the study. Predictors of LT evaluated at
multivariable analysis and impact of LT on stroke were the secondary ones.
<br/>RESULT(S): Eighteen studies encompassing 11 124 patients evaluating
incidence of LT were included. Pooled incidence of LT was 0.43% per month
[5.16% per year, 95% confidence interval (CI) 0.21-0.72, I² =
98%]. Pooled incidence of subclinical LT was 1.36% per month (16.32% per
year, 95% CI 0.71-2.19, I² = 94%). Clinical LT was less
frequent (0.04% per month, 0.48% per year, 95% CI 0.00-0.19, I²
= 93%). LT increased the risk of stroke [odds ratio (OR) 4.21, 95% CI
1.27-13.98], and was more frequent in patients with a valve diameter of
28-mm (OR 2.89: 1.55-5.8), for balloon-expandable (OR 8: 2.1-9.7) or after
valve-in-valve procedures (OR 17.1: 3.1-84.9). Oral anticoagulation
therapy reduced the risk of LT (OR 0.43, 95% CI: 0.22-0.84, I²
= 64%), as well as the mean transvalvular gradient. <br/>CONCLUSION(S): LT
represents an infrequent event after TAVI, despite increasing risk of
stroke. Given its full reversal with warfarin, in high-risk patients
(those with valve-in-valve procedures, balloon expandable or large-sized
devices), a protocol which includes a control CT appears
reasonable.<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.

<59>
Accession Number
2005724346
Title
Role of psychiatric, cardiovascular, socioeconomic, and demographic risk
factors on idiopathic normal pressure hydrocephalus: A retrospective
case-control study.
Source
Clinical Neurology and Neurosurgery. 193 (no pagination), 2020. Article
Number: 105836. Date of Publication: June 2020.
Author
Ghaffari-Rafi A.; Gorenflo R.; Hu H.; Viereck J.; Liow K.
Institution
(Ghaffari-Rafi, Gorenflo, Hu, Viereck, Liow) University of Hawai'i at
Manoa, John A. Burns School of Medicine, Honolulu, Hawai'i, United States
(Ghaffari-Rafi) University College London, Queen Square Institute of
Neurology, London, England, United Kingdom
(Viereck, Liow) Hawaii Pacific Neuroscience, Honolulu, Hawai'i, United
States
Publisher
Elsevier B.V.
Abstract
Objectives: Currently, predicting and preventing idiopathic normal
pressure hydrocephalus (iNPH) remains challenging, especially for patients
without a history of cerebrovascular disease. By exploring the role of
cardiovascular and psychiatric history, demographics, and socioeconomic
status in iNPH, will provide better direction for elucidating the etiology
or addressing healthcare inequalities. <br/>Patients and Methods: To
investigate iNPH with respect to the selected risk factors, we conducted a
retrospective case-control study from a neuroscience institute in Hawaii
with a patient pool of 25,843. After excluding patients with a history of
cerebrovascular disease, we identified 29 cases which meet the
American-European guidelines for iNPH diagnosis. Meanwhile, 116 controls
matched to age, sex, and race were also randomly selected. <br/>Result(s):
Median age at diagnosis was 83 (IQR: 74-88), with cases estimated 22 years
older than controls (95 % CI: 14.00-29.00; p = 0.0000001). Patients with
iNPH were more likely to be White (OR 4.01, 95 % CI: 1.59-10.11; p =
0.0042) and less likely Native Hawaiian and other Pacific Islander (OR
0.010, 95 % CI: 0.00-0.78; p = 0.014). Median household income was $2874
(95 % CI: 0.000089-6905; p = 0.088) greater amongst iNPH cases. Effect
size amongst cardiovascular risk factors was not found statistically
significant (i.e., body mass index, hyperlipidemia, type 2 diabetes
mellitus, hypertension, coronary artery disease or prior myocardial
infarction history, peripheral vascular disease, smoking status,
congestive heart failure, atrial fibrillation/flutter, and history of
prosthetic valve replacement). However, iNPH patients were more likely to
have a history of alcohol use disorder (OR 8.29, 95 % CI: 0.99-453.87; p =
0.050) and history of a psychiatric disorder (OR 2.48; 95 % CI: 1.08-5.68;
p = 0.029). Odds ratio for autoimmune disorder, thyroid disorder,
glaucoma, and seizures did not reach statistical significance.
<br/>Conclusion(s): Patient race (i.e., White; Native Hawaiian or other
Pacific Islander) was found associated with iNPH development. Meanwhile,
after excluding those with cerebrovascular disease, cardiovascular risk
factors were not found associated with iNPH. Lastly, iNPH cases were more
inclined to have a history of alcohol use disorder and prior psychiatric
disorder. Overall, this data reveals that a racial disparity exists
amongst iNPH, as well as highlights the role of various cardiovascular and
psychiatric risk factors, which can potentially provide direction in
etiology elucidation.<br/>Copyright &#xa9; 2020 Elsevier B.V.

<60>
Accession Number
631680374
Title
Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive
Literature Review.
Source
Brazilian journal of cardiovascular surgery. 35 (2) (pp 211-224), 2020.
Date of Publication: 01 Apr 2020.
Author
Harky A.; Joshi M.; Gupta S.; Teoh W.Y.; Gatta F.; Snosi M.
Institution
(Harky, Gatta, Snosi) Liverpool Heart and Chest Department of
Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery,
Liverpool Heart and Chest, Liverpool, United Kingdom
(Joshi) Countess of Chester Hospital Department of Cardiology Chester UK
Department of Cardiology, Countess of Chester Hospital, Chester, United
Kingdom
(Gupta, Teoh) University of Liverpool School of Medicine Liverpool UK
School of Medicine, University of Liverpool, Liverpool, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To comprehensively understand cardiac surgeryassociated acute
kidney injury (CSA-AKI) and methods of prevention of such complication in
cardiac surgery patients. <br/>METHOD(S): A comprehensive literature
search was performed using the electronic database to identify articles
describing acute kidney injury (AKI) in patients that undergone cardiac
surgery. There was neither time limit nor language limit on the search.
The results were narratively summarized. <br/>RESULT(S): All the relevant
articles have been extracted; results have been summarized in each related
section. CSA-AKI is a serious postoperative complication and it can
contribute to a significant increase in perioperative morbidity and
mortality rates. Optimization of factors that can reduce CSA-AKI,
therefore, contributes to a better postoperative outcome.
<br/>CONCLUSION(S): Several factors can significantly increase the rate of
AKI; identification and minimization of such factors can lead to lower
rates of CSA-AKI and lower perioperative morbidity and mortality rates.

<61>
Accession Number
631678169
Title
Topical rifampicin for prevention of deep sternal wound infections in
patients undergoing coronary artery bypass grafting.
Source
Scientific reports. 10 (1) (pp 7400), 2020. Date of Publication: 04 May
2020.
Author
De Santo L.S.; Rubino A.S.; Torella M.; De Feo M.; Galgano V.; Guarente
N.; Mango E.; Savarese L.; Iorio F.; Zebele C.
Institution
(De Santo, Rubino, Torella, De Feo, Galgano) University of Campania Luigi
Vanvitelli, Department of Translational Medical Sciences, Monaldi
Hospital, Cardiac Surgery Unit, Naples, Italy
(Guarente) Casa di Cura Montevergine, Intensive Care Unit, Mercogliano,
Avellino, Italy
(Mango, Savarese, Iorio, Zebele) Clinica Montevergine, Cardiac Surgery
Unit, Mercogliano, Avellino, Italy
Publisher
NLM (Medline)
Abstract
Deep sternal wound infections (DSWI), although an infrequent complication,
significantly impair postoperative outcomes after coronary artery bypass
grafting (CABG) surgery. Among several preventive strategies, topical
antibiotic therapy immediately before sternal closure has been strongly
advocated. In this retrospective analysis, the incidence of DSWI in 517
patients undergoing isolated CABG and receiving rifampicin irrigation of
mediastinum, sternum and suprasternal tissues was compared to an
historical consecutive cohort of 448 patients. To account for the inherent
selection bias, a 1:1 propensity matched analysis was performed. Patients
receiving topical rifampicin experienced significantly less occurrence of
postoperative DSWI (0.2% vs 2.5%, p=0.0016 in the unmatched analysis; 0.3%
vs 2.1%, p=0.0391 in the matched analysis). Intensive care unit stay,
hospital stay, and operative mortality were similar between groups. This
study shows that topical rifampicin in combination with commonly
prescribed preventative strategies significantly reduces the incidence of
DSWI to less than 0.3% in unselected patients undergoing a full median
sternotomy for CABG. Further studies, including a larger number of
patients and with a randomization design, would establish the potential
preventative role of topical rifampicin in reducing the occurrence of
DSWI.

<62>
Accession Number
631677568
Title
Chelation therapy for atherosclerotic cardiovascular disease.
Source
The Cochrane database of systematic reviews. 5 (pp CD002785), 2020. Date
of Publication: 05 May 2020.
Author
Villarruz-Sulit M.V.; Forster R.; Dans A.L.; Tan F.N.; Sulit D.V.
Institution
(Villarruz-Sulit) Asia-Pacific Center for Evidence-Based Healthcare,
Ermita, Manila, Philippines
(Forster) Usher Institute, University of Edinburgh, Edinburgh, United
Kingdom
(Dans) Section of Adult Medicine, College of Medicine, University of the
Philippines, Ermita, Philippines
(Tan) Emergency Department, Montefiore Westchester Square Campus, NY,
United States
(Sulit) Department of Internal Medicine, Cardinal Santos Medical Center,
San Juan City, Metro Manila, Philippines
Publisher
NLM (Medline)
Abstract
BACKGROUND: Chelation therapy is promoted and practiced around the world
as a form of alternative medicine in the treatment of atherosclerotic
cardiovascular disease. It has been suggested as a safe, relatively
inexpensive, non-surgical method of restoring blood flow in
atherosclerotic vessels. However, there is currently limited high-quality,
adequately-powered research informing evidence-based medicine on the
topic, specifically regarding clinical outcomes. Due to this limited
evidence, the benefit of chelation therapy remains controversial at
present. This is an update of a review first published in 2002.
<br/>OBJECTIVE(S): To assess the effects of ethylene diamine tetra-acetic
acid (EDTA) chelation therapy versus placebo or no treatment on clinical
outcomes among people with atherosclerotic cardiovascular disease.
<br/>SEARCH METHOD(S): For this update, the Cochrane Vascular Information
Specialist searched the Cochrane Vascular Specialised Register, Cochrane
Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and
Cumulative Index to Nursing and Allied Health Literature (CINAHL)
databases, the World Health Organization International Clinical Trials
Registry Platform and ClinicalTrials.gov trials register to 6 August 2019.
We searched the bibliographies of the studies retrieved by the literature
searches for further trials. SELECTION CRITERIA: We included studies if
they were randomised controlled trials of EDTA chelation therapy versus
placebo or no treatment in participants with atherosclerotic
cardiovascular disease. The main outcome measures we considered include
all-cause or cause-specific mortality, non-fatal cardiovascular events,
direct or indirect measurement of disease severity, and subjective
measures of improvement or adverse events. DATA COLLECTION AND ANALYSIS:
Two review authors independently extracted data and assessed trial quality
using standard Cochrane procedures. A third author considered any
unresolved issues, and we discussed any discrepancies until a consensus
was reached. We contacted study authors for additional information. MAIN
RESULTS: We included five studies with a total of 1993 randomised
participants. Three studies enrolled participants with peripheral vascular
disease and two studies included participants with coronary artery
disease, one of which specifically recruited people who had had a
myocardial infarction. The number of participants in each study varied
widely (from 10 to 1708 participants), but all studies compared EDTA
chelation to a placebo. Risk of bias for the included studies was
generally moderate to low, but one study had high risk of bias because the
study investigators broke their randomisation code halfway through the
study and rolled the placebo participants over to active treatment.
Certainty of the evidence, as assessed by GRADE, was generally low to very
low, which was mostly due to a paucity of data in each outcome's
meta-analysis. This limited our ability to draw any strong conclusions. We
also had concerns about one study's risk of bias regarding blinding and
outcome assessment that may have biased the results. Two studies with
coronary artery disease participants reported no evidence of a difference
in all-cause mortality between chelation therapy and placebo (risk ratio
(RR) 0.97, 95% CI 0.73 to 1.28; 1792 participants; low-certainty). One
study with coronary artery disease participants reported no evidence of a
difference in coronary heart disease deaths between chelation therapy and
placebo (RR 1.02, 95% CI 0.70 to 1.48; 1708 participants; very
low-certainty). Two studies with coronary artery disease participants
reported no evidence of a difference in myocardial infarction (RR 0.81,
95% CI 0.57 to 1.14; 1792 participants; moderate-certainty), angina (RR
0.95, 95% CI 0.55 to 1.67; 1792 participants; very low-certainty), and
coronary revascularisation (RR 0.46, 95% CI 0.07 to 3.25; 1792
participants). Two studies (one with coronary artery disease participants
and one with peripheral vascular disease participants) reported no
evidence of a difference in stroke (RR 0.88, 95% CI 0.40 to 1.92; 1867
participants; low-certainty). Ankle-brachial pressure index (ABPI; also
known as ankle brachial index) was measured in three studies, all
including participants with peripheral vascular disease; two studies found
no evidence of a difference in the treatment groups after three months
after treatment (mean difference (MD) 0.02, 95% CI -0.03 to 0.06; 181
participants; low-certainty). A third study reported an improvement in
ABPI in the EDTA chelation group, but this study was at high risk of bias.
Meta-analysis of maximum and pain-free walking distances three months
after treatment included participants with peripheral vascular disease and
showed no evidence of a difference between the treatment groups (MD
-31.46, 95% CI -87.63 to 24.71; 165 participants; 2 studies;
low-certainty). Quality of life outcomes were reported by two studies that
included participants with coronary artery disease, but we were unable to
pool the data due to different methods of reporting and varied criteria.
However, there did not appear to be any major differences between the
treatment groups. None of the included studies reported on vascular
deaths. Overall, there was no evidence of major or minor adverse events
associated with EDTA chelation treatment. AUTHORS' <br/>CONCLUSION(S):
There is currently insufficient evidence to determine the effectiveness or
ineffectiveness of chelation therapy in improving clinical outcomes of
people with atherosclerotic cardiovascular disease. More high-quality,
randomised controlled trials are needed that assess the effects of
chelation therapy on longevity and quality of life among people with
atherosclerotic cardiovascular disease.<br/>Copyright &#xa9; 2020 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<63>
Accession Number
631666292
Title
Evaluation of Serratus Anterior Plane Block for Pain Relief in Patients
Undergoing MIDCAB Surgery.
Source
Innovations (Philadelphia, Pa.). 15 (2) (pp 148-154), 2020. Date of
Publication: 01 Mar 2020.
Author
Gautam S.; Pande S.; Agarwal A.; Agarwal S.K.; Rastogi A.; Shamshery C.;
Singh A.
Institution
(Gautam, Agarwal, Rastogi, Shamshery, Singh) 30093 Department of
Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow, India
(Pande, Agarwal) 30093 Department of Cardiovascular and Thoracic Surgery,
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The minimally invasive direct coronary artery bypass (MIDCAB)
surgery is associated with severe chest pain in the first 2 to 3
postoperative days; this may delay the patient recovery. In this
randomized controlled trial we evaluated the role of serratus anterior
plane (SAP) block for postoperative pain relief in patients undergoing
MIDCAB surgery. <br/>METHOD(S): Patients undergoing MIDCAB surgery were
randomized into 2 groups of 25 each; SAP group received 20 mL of 0.2%
ropivacaine with 1 mug/mL fentanyl as bolus followed by infusion at 8
mL/h; control group received saline for both bolus and infusion. Primary
outcome measure was postoperative pain when supine, and during deep
inspiration, coughing, and patient movement; secondary outcome measures
were requirement of postoperative intravenous fentanyl and opioid-related
side effects. All patients were followed at 6-hourly intervals for 48
hours in the postoperative period. Results were analyzed by the Student's
t -test, chi2 test, Mann-Whitney U-test and Kruskall-Wallis test. A
P-value <0.05 was considered significant. <br/>RESULT(S): The 2 groups
were similar with respect to patient characteristics. Static and dynamic
pain visual analog scale scores were significantly reduced in the SAP
group as compared to the control group at most of the time points of
assessment (P < 0.05). Patient-controlled fentanyl requirements were
reduced in the SAP group as compared to control group on the second
postoperative day (P < 0.05). <br/>CONCLUSION(S): SAP block reduced the
postoperative pain scores and opioid requirements in patients undergoing
MIDCAB surgery.

<64>
Accession Number
631664775
Title
Effect of Evolocumab on Type and Size of Subsequent Myocardial Infarction:
A Prespecified Analysis of the FOURIER Randomized Clinical Trial.
Source
JAMA cardiology. (no pagination), 2020. Date of Publication: 29 Apr 2020.
Author
Wiviott S.D.; Giugliano R.P.; Morrow D.A.; De Ferrari G.M.; Lewis B.S.;
Huber K.; Kuder J.F.; Murphy S.A.; Forni D.M.; Kurtz C.E.; Honarpour N.;
Keech A.C.; Sever P.S.; Pedersen T.R.; Sabatine M.S.
Institution
(Wiviott, Giugliano, Morrow, Murphy, Forni, Sabatine) Cardiovascular
Division, Brigham and Women's Hospital, Boston, MA
(Giugliano, Kuder, Murphy, Sabatine) Thrombolysis in Myocardial Infarction
(TIMI) Study Group, Division of Cardiovascular Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA
(De Ferrari) Department of Medical Sciences, University of Torino,
Cardiology AOU Citta della Salute e della Scienza, Torino, Italy
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Huber) Wilhelminen Hospital, Vienna, Austria
(Kurtz, Honarpour) Amgen, Thousand Oaks, CA
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Center, University of Sydney, Sydney Australia
(Sever) National Heart and Lung Institute, Imperial College, London,
United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo
(Sabatine) Deputy Editor
Publisher
NLM (Medline)
Abstract
Importance: The PCSK9 inhibitor evolocumab reduced major vascular events
in the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in
Subjects With Elevated Risk (FOURIER) trial, yet the types and sizes of
myocardial outcomes in FOURIER have not been previously explored.
<br/>Objective(s): To assess the types and sizes of myocardial infarction
(MI) and the effect of evolocumab on MI by subtype. <br/>Design, Setting,
and Participant(s): A prespecified analysis of a multicenter double-blind
randomized clinical trial. Patients were randomized to evolocumab or
placebo and followed up for a median of 2.2 years. The study included
27564 patients with stable atherosclerotic disease receiving statin
therapy. Clinical end points were evaluated by the Thrombolysis in
Myocardial Infarction clinical events committee. Rates presented are
3-year Kaplan-Meier estimates. Data were collected from 2013 to 2016 and
analyzed from June 2017 to December 2019. <br/>Main Outcomes and Measures:
Myocardial infarction was defined based on the third universal MI
definition, and further classified according to MI type (universal MI
subclass, ST-segment elevation myocardial infarction [STEMI] vs non-STEMI)
and by MI size (determined by peak troponin level). <br/>Result(s): A
total of 27564 patients were randomized, with a mean (SD) age of 62.5
(9.0) years, and 20795 (75%) were male. Of these, 1107 patients
experienced a total of 1288 MIs. Most MIs (68%) were atherothrombotic
(type 1), with 15% from myocardial oxygen supply-demand mismatch (type 2)
and 15% percutaneous coronary intervention-related (type 4). Sudden death
(type 3) and coronary artery bypass grafting-related (type 5) accounted
for a total of 21 MIs (<2%). Evolocumab significantly reduced the risk of
first MI by 27% (4.4% vs 6.3%; hazard ratio [HR], 0.73; 95% CI, 0.65-0.82;
P<.001), type 1 by 32% (2.9% vs 4.5%; HR, 0.68; 95% CI, 0.59-0.79;
P<.001), and type 4 by 35% (0.8% vs 1.1%; HR, 0.65; 95% CI, 0.48-0.87;
P=.004), with no effect on type 2 (0.9% vs 0.8%; HR, 1.09; 95% CI,
0.82-1.45; P=.56). Most MIs (688 [59.8%]) had troponin levels greater than
or equal to 10 times the upper limit of normal. The benefit was highly
significant and consistent regardless of the size of MI with a 34%
reduction in MIs with troponin level greater than or equal to 10 times the
upper limit of normal (2.6% vs 3.7%; HR, 0.66; 95% CI, 0.56-0.77; P<.001)
and a 36% reduction in the risk of STEMI (1.0% vs 1.5%; HR, 0.64; 95% CI,
0.49-0.84; P<.001). <br/>Conclusions and Relevance: Low-density
lipoprotein cholesterol lowering with evolocumab was highly effective in
reducing the risk of MI. This reduction with evolocumab included benefit
across multiple subtypes of MI related to plaque rupture, smaller and
larger MIs, and both STEMI and non-STEMI. These data are consistent with
the known benefit of low-density lipoprotein cholesterol lowering and
underscore the reduction in clinically meaningful events. Trial
Registration: ClinicalTrials.gov Identifier: NCT01764633.

<65>
Accession Number
631686707
Title
Systematic Review of Viscoelastic Testing (TEG/ROTEM) in Obstetrics and
Recommendations from the Women's SSC of the ISTH.
Source
Journal of thrombosis and haemostasis : JTH. (no pagination), 2020. Date
of Publication: 01 May 2020.
Author
Amgalan A.; Allen T.; Othman M.; Ahmadzia H.K.
Institution
(Amgalan) Georgetown University School of Medicine, DC, WA, United States
(Allen) Department of Anesthesiology, Duke University Hospital, Durham,
United States
(Othman) Department of Biomedical and Molecular Sciences, School of
Medicine, Queen's University, Kingston, Canada
(Othman) School of Baccalaureate Nursing, St. Lawrence College, Kingston,
Canada
(Ahmadzia) Department of Obstetrics and Gynecology, Division of Maternal
Fetal Medicine, George Washington University School of Medicine and Health
Sciences, DC, WA, United States
Publisher
NLM (Medline)
Abstract
Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are
point-of-care viscoelastic devices that use whole blood samples to assess
coagulation and fibrinolysis. These devices have been studied extensively
in cardiac surgery, but there is limited robust evidence supporting its
use in obstetrics. The hesitancy toward its routine use in obstetrics may
be due to the current lack of randomized controlled trials and large
observational studies. The study aims to systematically review studies
that investigated TEG/ROTEM use in pregnancy or peripartum, and to provide
recommendations for future studies to fill current research gaps. We
performed a systematic review of studies on viscoelastic testing in
obstetrics. Included studies were original research, utilizing TEG or
ROTEM during pregnancy or peripartum, and published in English. 93
studies, spanning 31 years from 1989 to 2020 and with a total of 32,817
participants, were included. 62 (66.7 %) of the studies used TEG and 31
(33.3 %) used ROTEM. To date, there are a total of two randomized
controlled trials on TEG/ROTEM use in obstetrics. ROTEM may be used to
guide transfusion therapy for post-partum hemorrhage (PPH). TEG and ROTEM
can detect the hypercoagulable changes associated with pregnancy.
Variability between study protocols and results suggests the need for
future large prospective high-quality studies with standardized protocols
to investigate the utility of TEG/ROTEM in assessing risk for thrombosis
and hemorrhage as well as in guiding prophylaxis and treatment in
obstetric patients. This review identifies the gaps and provides concrete
recommendations for future studies to fill those gaps.<br/>Copyright This
article is protected by copyright. All rights reserved.

<66>
Accession Number
2005718793
Title
Ultrasound-guided radial artery cannulation using dynamic needle tip
positioning versus conventional long-axis in-plane techniques in cardiac
surgery patients: A randomized, controlled trial.
Source
Minerva Anestesiologica. 86 (1) (pp 30-37), 2020. Date of Publication:
January 2020.
Author
Nam K.; Jeon Y.; Yoon S.; Kwon S.M.; Kang P.; Cho Y.J.; Kim T.K.
Institution
(Nam, Jeon, Yoon, Kwon, Kang, Cho, Kim) Department of Anesthesiology and
Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University
College of Medicine, Seoul, South Korea
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Anovel ultrasound imaging technique, dynamic needle tip
positioning (DNTP), enables continuous visualization of the needle tip
during ultrasound-guided cannulation. The purpose of this study was to
compare the rate of successful first-attempt radial artery cannulations
between DNTP and the conventional long-axis in-plane (LAX-IP) technique.
<br/>METHOD(S): Adult patients undergoing cardiac surgery requiring radial
artery cannulation were included and randomly allocated into either a DNTP
or LAX-IP group. Radial artery cannulation was performed by a single
experienced practitioner. The primary outcome was the first-attempt
success rate of radial artery cannulation. Secondary outcomes included the
length of time needed for cannulation and overall incidence of
complications. <br/>RESULT(S): A total of 136 patients were studied. The
first-attempt success rate of cannulation was 94% in the DNTP group
(N.=70) and 68% in the LAX-IP group (N.=66; OR 7.70, 95% CI 2.48-24.94,
P<0.001). The total procedure time was also shorter in the DNTP group
(median [IQR]; 87 [72-108] seconds) versus the LAX-IP group (118 [93-182]
seconds; P<0.001). During cannulation, vasospasm occurred less often in
the DNTP (4%) group compared to the LAX-IP group (17%; P=0.018).
<br/>CONCLUSION(S): The DNTP technique had a greater first-attempt success
rate of radial artery cannulation compared to the conventional LAX-IP
technique. Also, DNTP required significantly less time for cannulation and
had fewer complications.<br/>Copyright &#xa9; 2019 EDIZIONI MINERVA MEDICA

<67>
Accession Number
2004312090
Title
Anesthetic-induced myocardial conditioning: Molecular funda-mentals and
scope.
Source
Current Medicinal Chemistry. 27 (13) (pp 2147-2160), 2020. Date of
Publication: 2020.
Author
Orriach J.L.G.; Belmonte J.J.E.; Aliaga M.R.; Fernandez A.R.; Ponferrada
A.R.; Navarro M.R.; Manas J.C.
Institution
(Orriach) Institute of Biomedical Research in Malaga [IBIMA], Malaga,
Spain
(Orriach, Belmonte, Aliaga, Fernandez, Ponferrada, Navarro, Manas)
Department of Cardio-Anaesthesiology, Virgen de la Victoria University
Hospital, Malaga, Spain
(Orriach) Department of Phar-macology and Pediatrics, School of Medicine,
University of Malaga, Malaga, Spain
Publisher
Bentham Science Publishers (P.O. Box 294, Bussum 1400 AG, Netherlands)
Abstract
Background: The pre-and post-conditioning effects of halogenated
anesthetics make them most suitable for cardiac surgery. Several studies
have demonstrated that the mechanism of drug-induced myocardial
conditioning is enzyme-mediated via messenger RNA and miRNA regulation.
The objective of this study was to investigate the role that miRNAs play
in the cardioprotective effect of halogenated anesthetics. For such
purpose, we reviewed the literature to determine the expression profile of
miRNAs in ischemic conditioning and in the complications prevented by
these phenomena. <br/>Method(s): A review was conducted of more than 100
studies to identify miRNAs involved in anesthetic-induced myocardial
conditioning. Our objective was to determine the miRNAs that play a
relevant role in ischemic disease, heart failure and arrhythmogenesis,
which expression is modulated by the perioperative administration of
halogenated anesthetics. So far, no studies have been performed to assess
the role of miRNAs in anesthetic-induced myocardial conditioning. The
potential of miRNAs as biomarkers and miRNAs-based therapies involving the
synthesis, inhibition or stimulation of miRNAs are a promising avenue for
future research in the field of cardiology. <br/>Result(s): Each of the
cardioprotective effects of myocardial conditioning is related to the
expression of several (not a single) miRNAs. The cumulative evidence on
the role of miRNAs in heart disease and myocardial conditioning opens new
therapeutic and diagnostic opportunities. <br/>Conclusion(s): Halogenated
anesthetics regulate the expression of miRNAs involved in heart
conditions. Further research is needed to determine the expression profile
of miRNAs after the administration of halogenated drugs. The results of
these studies would contribute to the development of new hypnotics for
cardiac surgery patients.<br/>Copyright &#xa9; 2020 Bentham Science
Publishers.

<68>
Accession Number
2005760512
Title
The Optimal Length of Insertion for Central Venous Catheters Via the Right
Internal Jugular Vein in Pediatric Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Maddali M.M.; Al-Shamsi F.; Arora N.R.; Panchatcharam S.M.
Institution
(Maddali) Department of Cardiac Anesthesia, National Heart Center, Royal
Hospital, Muscat, Oman
(Al-Shamsi) Anesthesia Residency Training Program, Oman Medical Specialty
Board, Muscat, Oman
(Arora) Department of Cardiac Anesthesia, National Heart Center, Royal
Hospital, Muscat, Oman
(Panchatcharam) Department of Studies and Research, Oman Medical Specialty
Board, Muscat, Oman
Publisher
W.B. Saunders
Abstract
Objectives: The primary objective was to identify the best among 4
techniques that could predict the length of central venous catheter
insertion through the right internal jugular vein, which, in turn, would
ensure the ideal placement of the catheter tip in pediatric cardiac
surgical patients. The techniques evaluated were those based on operator
experience, topography/landmark methods, and one that relied on a
patient's height-related formula. Based on the outcome of the study, the
possibility of arriving at a formula was investigated that would predict
with reasonable certainty the ideal length of catheter to be inserted for
the correct catheter placement through the right internal jugular vein in
pediatric cardiac surgical patients belonging to the authors' geographic
area. <br/>Design(s): A prospective observational study. <br/>Setting(s):
Tertiary care cardiac center. <br/>Participant(s): Children younger than 5
years of age undergoing cardiac surgery. <br/>Intervention(s): Right
internal jugular vein cannulation by the Seldinger technique method.
<br/>Measurements and Main Results: A total of 120 children aged younger
than 5 years undergoing cardiac surgery were included in the study. The
participants were randomized to 4 groups: group 1 (n = 30), the length of
the central venous catheter was determined empirically by the operator
based on clinical experience; group 2 (n = 30), the depth of insertion of
the catheter was determined by the distance from the site of skin puncture
to the second intercostal space; group 3 (n = 30), the depth of insertion
of the catheter was determined by the distance from the skin puncture site
to the third intercostal space; and group 4 (n = 30), the length of
catheter was determined by a height-based formula that was followed
routinely at the authors' institution. Central venous catheterization
through the right internal jugular vein was performed according to
out-of-plane ultrasound guidance in all patients. The ideal catheter tip
location was assumed to be at the level of the carina or within 1.5 cm
proximal to it. The number of patients who had ideal catheter tip
placement were recorded from postoperative chest radiograph in all groups.
Any relationship between acceptable catheter tip and demographic data
(mean ranks of age, height, weight, and body surface area) of the patients
were studied. <br/>Result(s): The central vein catheter tip was at the
level of the carina or within 1.5 cm in more patients in group 2 (39%, p =
0.02) compared with the other groups. This was followed by group 4 (40%),
group 3 (30%), and group 1 (23%). There was a statistically significant
difference in the mean distance between catheter tip and carina, with
group 2 patients having the tip closest to the carina (p = 0.03). There
was a significant correlation between acceptable catheter tip positioning
and a patient's height (p = 0.04). A new formula was developed based on
this correlation. <br/>Conclusion(s): A landmark-based topographic method
in which the length of insertion of the catheter was determined by the
distance from the skin puncture site to the second intercostal space for
achieving correct placement of the catheter tip was found to be more
reliable compared with other techniques. Height-based formula has the
disadvantage of being affected by the skin puncture site. Assuming that a
skin puncture at the midpoint between the right mastoid process and
clavicular insertion of sternocleidomastoid muscle insertion is ensured, a
new formula based on height has been proposed.<br/>Copyright &#xa9; 2020
Elsevier Inc.

<69>
Accession Number
629599809
Title
Protocol for the electroencephalography guidance of anesthesia to
alleviate geriatric syndromes (Engages-canada) study: A pragmatic,
randomized clinical trial.
Source
F1000Research. 8 (no pagination), 2019. Article Number: 1165. Date of
Publication: 2019.
Author
Deschamps A.; Saha T.; El-Gabalawy R.; Jacobsohn E.; Overbeek C.; Palermo
J.; Robichaud S.; Dumont A.A.; Djaiani G.; Carroll J.; Kavosh M.S.;
Tanzola R.; Schmitt E.M.; Inouye S.K.; Oberhaus J.; Mickle A.; Abdallah
A.B.; Avidan M.S.
Institution
(Deschamps) Department of Anesthesiology and Pain Medicine, Montreal Heart
Institute and Universite de Montreal, Montreal, QC H1T 1C8, Canada
(Saha, Tanzola) Department of Anesthesiology and Perioperative Medicine,
Queen's University, Kingston, Kingston, ON, Canada
(El-Gabalawy) Department of Clinical Health Psychology, Anesthesiology,
Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB,
Canada
(Jacobsohn) Departments of Anesthesia and Internal Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Overbeek, Palermo) Department of Anesthesiology and Pain Medicine,
University of Montreal, Montreal, QC, Canada
(Robichaud) Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
(Dumont) Montreal Health Innovation Coordinating Center, Montreal Heart
Institute, Montreal, QC, Canada
(Djaiani, Carroll) Department of Anesthesia, University of Toronto,
Toronto, ON, Canada
(Kavosh) Department of Anesthesiology, Perioperative and Pain Medicine,
Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Schmitt, Inouye) Department of Medicine, Beth Israel Deaconess Medical
Center, Boston, Massachussetts, United States
(Oberhaus, Mickle, Abdallah, Avidan) Department of Anesthesiology,
Washington University School of Medicine, St-Louis, MO, United States
Department of Anesthesia, University of Manitoba, Winnipeg, MB, Canada
Publisher
F1000 Research Ltd
Abstract
Background: There is some evidence that electroencephalography guidance of
general anesthesia can decrease postoperative delirium after non-cardiac
surgery. There is limited evidence in this regard for cardiac surgery. A
suppressed electroencephalogram pattern, occurring with deep anesthesia,
is associated with increased incidence of postoperative delirium (POD) and
death. However, it is not yet clear whether this electroencephalographic
pattern reflects an underlying vulnerability associated with increased
incidence of delirium and mortality, or whether it is a modifiable risk
factor for these adverse outcomes. <br/>Method(s): The
Electroencephalography Guidance of Anesthesia to Alleviate Geriatric
Syndromes (ENGAGES-Canada) is an ongoing pragmatic 1200 patient trial at
four Canadian sites. The study compares the effect of two anesthetic
management approaches on the incidence of POD after cardiac surgery. One
approach is based on current standard anesthetic practice and the other on
electroencephalography guidance to reduce POD. In the guided arm,
clinicians are encouraged to decrease anesthetic administration, primarily
if there is electroencephalogram suppression and secondarily if the EEG
index is lower than the manufacturers recommended value (bispectral index
(BIS) or WAVcns below 40 or Patient State Index below 25). The aim in the
guided group is to administer the minimum concentration of anesthetic
considered safe for individual patients. The primary outcome of the study
is the incidence of POD, detected using the confusion assessment method or
the confusion assessment method for the intensive care unit; coupled with
structured delirium chart review. Secondary outcomes include unexpected
intraoperative movement, awareness, length of intensive care unit and
hospital stay, delirium severity and duration, quality of life, falls, and
predictors and outcomes of perioperative distress and dissociation.
<br/>Discussion(s): The ENGAGES-Canada trial will help to clarify whether
or not using the electroencephalogram to guide anesthetic administration
during cardiac surgery decreases the incidence, severity, and duration of
POD. Registration: ClinicalTrials.gov (NCT02692300)
26/02/2016.<br/>Copyright &#xa9; 2019 Deschamps A et al.

<70>
Accession Number
2003657835
Title
A study on the effect of haruan fish extract (Channa striatus) on wound
healing and quality of life of coronary artery bypass grafting (CABG)
patients: A prospective, double-blind, randomized, controlled trial.
Source
F1000Research. 7 (no pagination), 2018. Article Number: 469. Date of
Publication: 2018.
Author
Farouk Musa A.; Dillion J.; Mohd Taib M.E.; Mohd Yunos A.; Baie S.; Bin
Nordin R.
Institution
(Farouk Musa, Bin Nordin) Jeffrey Cheah School of Medicine and Health
Sciences, Monash Univeristy Malaysia, Subang Jaya 47500, Australia
(Dillion, Mohd Taib, Mohd Yunos) Department of Cardiothoracic Surgery,
National Heart Institute, Kuala Lumpur 50400, Malaysia
(Baie) School of Pharmaceutical Sciences, Science University of Malaysia,
Penang 11800, Malaysia
Publisher
F1000 Research Ltd
Abstract
Background: Wound healing remains a primary problem in all surgical cases
especially so when the length of incision is very significant as with
cardiac bypass patients. The main objective of this study is therefore to
assess the effect of Haruan fish extract (Channa striatus) on chest and
leg wounds post-coronary artery bypass grafting (CABG) surgery with the
optimum and standard patient care in two groups of randomized patients.
<br/>Method(s): This is a randomized, double blind clinical trial being
conducted at the National Heart Institute, Kuala Lumpur. Two randomized
groups of similar demographic and co-morbid histories planned for CABG
were enrolled into the study. Both groups were blinded to the capsules
being given to them pre-and post-operatively. Assessments were also made
on wound pain, mobilization and on the health-related quality of life
(HRQOL) of patients using the Nottingham Health Profile (NHP).
<br/>Result(s): The group that received Haruan capsule showed better would
healing objectively. They had better pain scores, though there was no
significant difference in terms of mobilization. Overall, the HRQOL in the
study group showed improved quality of life. <br/>Conclusion(s): Our study
shows the superior effect of using Channa striatus, a local Haruan fish
which is easily processed into capsules in promoting wound healing,
reducing pain via its anti-nociceptive effect and improving quality of
life of patients after coronary artery bypass grafting surgery. It is
inferred that a faster recovery from surgery confers an advantage in terms
of resources to overall economic benefits. Reduction in the percentage of
wound infection also resulted in reduced hospital cost. All these factors
could lead to the successful commercialization of Haruan as a
nutraceutical product. Trial registration: The trial was conducted from
January 2012 until August 2014 and the trial number as registered with the
National Medical Research Registry is NMRR-17-360-34772 (Registered
13/03/2017).<br/>Copyright &#xa9; 2018 Farouk Musa A et al.

<71>
Accession Number
2005408275
Title
Multi-omic analysis of the effects of low frequency ventilation during
cardiopulmonary bypass surgery.
Source
International Journal of Cardiology. 309 (pp 40-47), 2020. Date of
Publication: 15 June 2020.
Author
Durham A.L.; Al Jaaly E.; Graham R.; Brook P.O.; Bae J.H.; Heesom K.J.;
Postle A.D.; Lavender P.; Jazrawi E.; Reeves B.; Fiorentino F.; Mumby S.;
Angelini G.D.; Adcock I.M.
Institution
(Durham, Graham, Brook, Bae, Jazrawi, Mumby, Adcock) Airways Disease
Section, National Heart and Lung Institute, Imperial College London,
Dovehouse Street, London SW3 6LY, United Kingdom
(Al Jaaly, Reeves, Fiorentino, Angelini) Cardiothoracic Surgery, National
Heart and Lung Institute, Imperial College London, Hammersmith Hospital,
London, United Kingdom
(Heesom) University of Bristol, Proteomics Facility, BioMedical Sciences
Building, University Walk, Bristol, United Kingdom
(Postle) Faculty of Medicine, University of Southampton, Building 85, Life
Sciences Building, Highfield Campus, Southampton, United Kingdom
(Lavender) Department of Asthma, Allergy, and Respiratory Science, King's
College London, London, United Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, Bristol Royal
Infirmary, Level 7, Marlborough Street, Bristol, United Kingdom
(Durham) Immunobiology, Blizard Institute, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, 4 Newark St,
London, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Heart surgery with cardio-pulmonary bypass (CPB) is associated
with lung ischemia leading to injury and inflammation. It has been
suggested this is a result of the lungs being kept deflated throughout the
duration of CPB. Low frequency ventilation (LFV) during CPB has been
proposed to reduce lung dysfunction. <br/>Method(s): We used a semi-biased
multi-omic approach to analyse lung biopsies taken before and after CPB
from 37 patients undergoing coronary artery bypass surgery randomised to
both lungs left collapsed or using LFV for the duration of CPB. We also
examined inflammatory and oxidative stress markers from blood samples from
the same patients. <br/>Result(s): 30 genes were induced when the lungs
were left collapsed and 80 by LFV. Post-surgery 26 genes were
significantly higher in the LFV vs. lungs left collapsed, including genes
associated with inflammation (e.g. IL6 and IL8) and hypoxia/ischemia (e.g.
HIF1A, IER3 and FOS). Relatively few changes in protein levels were
detected, perhaps reflecting the early time point or the importance of
post-translational modifications. However, pathway analysis of proteomic
data indicated that LFV was associated with increased "cellular component
morphogenesis" and a decrease in "blood circulation". Lipidomic analysis
did not identify any lipids significantly altered by either intervention.
<br/>Discussion(s): Taken together these data indicate the keeping both
lungs collapsed during CPB significantly induces lung damage, oxidative
stress and inflammation. LFV during CPB increases these deleterious
effects, potentially through prolonged surgery time, further decreasing
blood flow to the lungs and enhancing hypoxia/ischemia.<br/>Copyright
&#xa9; 2020

<72>
Accession Number
2005225389
Title
Are recurrence of ischemic mitral regurgitation and left ventricular
reverse remodeling after restrictive annuloplasty ring dependent?.
Source
International Journal of Cardiology. 309 (pp 55-62), 2020. Date of
Publication: 15 June 2020.
Author
Micali L.R.; Parise G.; Moula A.I.; Alayed Y.; Parise O.; Matteucci F.; de
Jong M.; Tetta C.; Gelsomino S.
Institution
(Micali, Parise, Moula, Alayed, Parise, Matteucci, de Jong, Tetta,
Gelsomino) Cardiovascular Research Institute Maastricht - CARIM,
Maastricht University Medical Centre, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Objective: This meta-analysis investigates MR recurrence and degree of
left ventricular reverse remodeling (LVRR) in CIMR patients in mitral
annuloplasty employing different ring designs. <br/>Background(s): The
deeper understanding of complex changes caused by chronic ischemic mitral
regurgitation (CIMR) have led to new generations of rings that, by
maintaining normal 3D annular geometry are supposed to enhance long-term
repair durability. <br/>Method(s): A meta-analysis of all available
reports in literature of MV repair through different ring design was
conducted. Meta-regression was performed to investigate the impact of
mitral ring characteristics related to flexibility, planarity, symmetry
and single type utilized. Twenty studies encompassing a total of 1876
patients were included at the end of the selection process.
<br/>Result(s): At meta-regression recurrence of MR was not influenced by
the ring employed. Nonetheless, the event rate of MR recurrence in planar
rings was 19%. Vs. 11% observed with non-planar rings. Recurrence rate in
patients implanted with symmetric rings was 14% whereas it was 7% in
asymmetric rings. The non-planar asymmetric IMR-ETlogix showed the lowest
recurrence rate (6%). Furthermore, in planar group the reduction of pre-
and post-operative LVEDD was - 4%. In the non-planar group, the LVEDD was
reduced by 8.6%. In patients implanted with symmetric rings LVEDD
reduction was 10.8%. LVRR in the asymmetric group was -5.8%.
<br/>Conclusion(s): MR recurrence occurred the least with asymmetric rings
with less disproportionate asymmetry. In contrast, LVRR occurred at a
greater extent in symmetric rings.<br/>Copyright &#xa9; 2020 Elsevier B.V.

<73>
Accession Number
2004698345
Title
Effect of remote ischemic preconditioning on myocardial ischemia in
patients undergoing coronary artery bypass graft surgery: A randomized
controlled trial.
Source
Journal of the Medical Association of Thailand. 103 (1) (pp 1-7), 2020.
Date of Publication: 2020.
Author
Wongthep A.; Karunasumetta C.; Tourthong W.; Senarak P.
Institution
(Wongthep, Karunasumetta, Tourthong, Senarak) Division of Cardiothoracic
Surgery, Department of Surgery, Srinagarind Hospital, Queen Sirikit Heart
Center of the Northeast, Faculty of Medicine, Khon Kaen University, Khon
Kaen 40002, Thailand
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: To determine whether the remote ischemic pre-conditioning
(RIPC) reduces myocardial ischemia in patients undergoing elective
coronary artery bypass graft (CABG) surgery. <br/>Material(s) and
Method(s): The present study was a single-center, triple-blinded,
randomized controlled trial. Fifty patients undergoing elective coronary
artery bypass graft surgery were assigned to either RIPC or control
treatment. Ischemic preconditioning consisted of three cycles of 5-minute
of lower limb ischemia and reperfusion (cuff inflation and deflation)
after anesthesia induction. Myocardial ischemia was assessed based on
serum high-sensitivity cardiac troponin T (hs-cTnT). <br/>Result(s): There
was no significant difference in hs-cTnT levels between the RIPC group and
the control group. Furthermore, there were no significant differences in
inotropic drug use, acute kidney injury, mechanical ventilation time,
hospital stay, or 30-day mortality. However, patients in the RIPC group
had a significantly shorter length of stay in the intensive care unit
(ICU). <br/>Conclusion(s): Although RIPC did not reduce myocardial
ischemia after CABG surgery, it did decrease the length of patients' stays
in the ICU.<br/>Copyright &#xa9; JOURNAL OF THE MEDICAL ASSOCIATION OF
THAILAND <br/> 2020.

<74>
Accession Number
2004239755
Title
Association of postoperative fluid overload with adverse outcomes after
congenital heart surgery: a systematic review and dose-response
meta-analysis.
Source
Pediatric Nephrology. 35 (6) (pp 1109-1119), 2020. Date of Publication: 01
Jun 2020.
Author
Bellos I.; Iliopoulos D.C.; Perrea D.N.
Institution
(Bellos, Iliopoulos, Perrea) Laboratory of Experimental Surgery and
Surgical Research N.S. Christeas, Athens University Medical School,
National and Kapodistrian University of Athens, Athens, Greece
Publisher
Springer
Abstract
Background: Pediatric cardiac surgery is commonly associated with acute
kidney injury (AKI) and significant fluid retention, which complicate
postoperative management and lead to increased rates of morbidity. This
meta-analysis aimed to accumulate current literature evidence and evaluate
the correlation of fluid overload degree with adverse outcome in patients
undergoing congenital heart surgery. <br/>Method(s): Medline, Scopus,
CENTRAL, Clinicaltrials.gov, and Google Scholar were systematically
searched from inception. All studies reporting the effects of fluid
overload on postoperative clinical outcomes were selected. A dose-response
meta-analytic method using restricted cubic splines was implemented in
R-3.6.1. <br/>Result(s): Twelve studies were included, with a total of
3111 pediatric patients. Qualitative synthesis indicated that fluid
overload was linked to significantly higher risk of mortality, AKI,
prolonged hospital, and intensive care unit (ICU) stay, as well as with
increased duration of mechanical ventilation, inotrope need, and infection
rate. Meta-analysis demonstrated a linear correlation between fluid
overload and the risk of mortality (chi² = 6.22, p value =
0.01) and AKI (chi² = 35.84, p value < 0.001), while a positive
curvilinear relationship was estimated for the outcomes of hospital
(chi² = 18.84, p value = 0.0001) and ICU stay (chi²
= 63.69, p value = 0.0001). <br/>Conclusion(s): The present meta-analysis
supports that postoperative fluid overload is significantly linked to
elevated risk of prolonged hospital stay, AKI development, and mortality
in pediatric patients undergoing cardiac surgery. These findings warrant
replication by future prospective studies, which should define the optimal
cutoff values and assess the effectiveness of therapeutic strategies to
limit fluid overload in the postoperative setting.<br/>Copyright &#xa9;
2020, IPNA.

<75>
Accession Number
2004083783
Title
Inflammatory cardiomyopathies: short- and long-term outcomes after heart
transplantation-a protocol for a systematic review and meta-analysis.
Source
Heart Failure Reviews. 25 (3) (pp 481-485), 2020. Date of Publication: 01
May 2020.
Author
Bobbio E.; Lingbrant M.; Nwaru B.I.; Hessman E.; Lehtonen J.; Karason K.;
Bollano E.
Institution
(Bobbio, Lingbrant, Bollano) Department of Cardiology, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Nwaru) Krefting Research Centre, Institute of Medicine, University of
Gothenburg, Gothenburg, Sweden
(Hessman) University Library, University of Gothenburg, Gothenburg, Sweden
(Lehtonen) Heart and Lung Center, Helsinki University and Helsinki
University Hospital, Helsinki, Finland
(Karason) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Karason) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Bobbio, Lingbrant, Karason, Bollano) Institute of Medicine at Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
Publisher
Springer
Abstract
Heart transplantation (HTx) for patients with "giant cell myocarditis"
(GCM) or "cardiac sarcoidosis" (CS) is still controversial. However, no
single center has accumulated enough experience to investigate post-HTx
outcome. The primary aim of this systematic review is to identify,
appraise, and synthesize existing literature investigating whether
patients who have undergone HTx because of GCM or CS have worse outcomes
as compared with patients transplanted because of other etiologies. A
systematic and comprehensive search will be performed using PubMed,
Scopus, Web of Science, EMBASE, and Google Scholar, for studies published
up to December 2019. Observational and interventional population-based
studies will be eligible for inclusion. The quality of observational
studies will be assessed using the Newcastle-Ottawa scale, while the
interventional studies will be assessed using the Cochrane Effective
Practice Organization of Care tool. The collected evidence will be
narratively synthesized; in addition, we will perform a meta-analysis to
pool estimates from studies considered to be homogenous. Reporting of the
systematic review and meta-analysis will be in accordance with the
Meta-analysis of Observational Studies in Epidemiology Preferred Reporting
Items for Systematic reviews and Meta-Analysis guidelines. To our
knowledge, this will be the first synthesis of outcomes, including
survival, acute cellular rejection, and disease recurrence, in patients
with either GCM or CS treated with HTx. Reviewing the suitability of HTx
in this population and highlighting areas for further research will
benefit both patients and healthcare providers. Trial registration:
CRD42019140574.<br/>Copyright &#xa9; 2020, The Author(s).

<76>
Accession Number
2003857232
Title
A systematic review of the cost-effectiveness of heart valve replacement
with a mechanical versus biological prosthesis in patients with heart
valvular disease.
Source
Heart Failure Reviews. 25 (3) (pp 495-503), 2020. Date of Publication: 01
May 2020.
Author
Azari S.; Rezapour A.; Omidi N.; Alipour V.; Tajdini M.; Sadeghian S.;
Bragazzi N.L.
Institution
(Azari) Department of Health Economics, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Rezapour, Alipour) Health Management and Economics Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Omidi, Tajdini, Sadeghian) Department of Cardiology, Tehran Heart Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bragazzi) Laboratory for industrial and applied mathematics (LIAM),
Department of mathematics and statistics, York university, Toronto, Canada
Publisher
Springer
Abstract
Heart valve disease (HVD) affects 2.5% of the US population and one
million individuals aged 65 years and older in the UK. Given its burden,
the aim of the present review was to assess the cost-effectiveness of
heart valve replacement with mechanical versus biological prosthesis in
HVD patients. We performed a systematic search in various electronic
databases from January 1990 to June 2019. Five out of 542 articles were
entered into the study, from which 2 papers were subsequently excluded not
meeting the minimum number of items of the CHEERS checklist.
Quality-Adjusted Life Year, Life Years Gained, and the Incremental
Cost-Effectiveness Ratio (ICER) regarding the type of replaced heart valve
were extracted and reported. Studies were conducted in three different
countries (Iran, France, and USA). ICER ranged from $1253 in Iran to
54,634 in France. Survival rate of mitral mechanical versus biological
valves at 10 and 20 years was 72.9% versus 76.0% and 51% versus 30%,
respectively. Survival rate at 20 years in patients undergoing atrial
valve replacement was 20%. Ten- and 20-year death rates for biological
valves were higher with respect to mechanical prosthesis (15.5% versus
8.4% at 10 years), with this difference becoming more relevant at 20 years
(36.9% versus 13.9%). Due to higher ICER, mortality rate, and lower
success rates in the long term for biological prostheses compared to
mechanical ones, these appear to be more suitable for older patients (aged
>= 70 years).<br/>Copyright &#xa9; 2019, Springer Science+Business Media,
LLC, part of Springer Nature.

<77>
Accession Number
631654344
Title
Antifibrinolytics and cardiac surgery: The past, the present, and the
future.
Source
Annals of Cardiac Anaesthesia. 23 (2) (pp 193-199), 2020. Date of
Publication: April-June 2020.
Author
Aggarwal N.K.; Subramanian A.
Institution
(Aggarwal, Subramanian) Department of Cardiac Anesthesia, Manipal
Hospitals, New Delhi, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Cardiac surgery is usually associated with significant blood loss, which
often necessitates blood transfusion. In order to decrease the risks
associated with the latter, pharmacological as well as nonpharmacological
strategies have been used to reduce blood loss. Among the pharmacological
approaches, antifibrinolytic drugs are the mainstay. Aprotinin, which was
the first ubiquitously used drug, fell into disrepute only to re-emerge
after much debate. The decline of aprotinin paved the way for the lysine
analogs. However, we must be aware with the side effects of these drugs as
well as the dose modification required in special situations.
Nonsaccharide glycosaminoglycans have been under investigation to overcome
the drawbacks of the lysine analogs. It remains to be seen whether these
drugs can replace the traditional antifibrinolytics.<br/>Copyright &#xa9;
2020 Annals of Cardiac Anaesthesia <br/> Published by Wolters
Kluwer-Medknow.

<78>
Accession Number
631654341
Title
A comparative study of the analgesic effects of intravenous ketorolac,
paracetamol, and morphine in patients undergoing video-assisted
thoracoscopic surgery: A double-blind, active-controlled, randomized
clinical trial.
Source
Annals of Cardiac Anaesthesia. 23 (2) (pp 177-182), 2020. Date of
Publication: April-June 2020.
Author
Dastan F.; Langari Z.M.; Salamzadeh J.; Khalili A.; Aqajani S.;
Jahangirifard A.
Institution
(Dastan, Aqajani) Department of Clinical Pharmacy, School of Pharmacy,
Shahid Beheshti University of Medical Sciences, Iran, Islamic Republic of
(Langari) Department of Pharmacovigilance, National Research Institute of
Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Salamzadeh) Food Safety Research Center, School of Pharmacy, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Khalili) Anesthesiology Research Center, National Research Institute of
Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Dastan, Jahangirifard) Chronic Respiratory Diseases Research Center,
National Research Institute of Tuberculosis and Lung Diseases (NRITLD),
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Opioids are traditionally used as the drug of choice for the
management of postoperative pain. However, their use is limited in
patients undergoing Video-assisted thoracic surgery (VATS), due to their
side effects, such as respiratory depression, nausea, and vomiting.
<br/>Aim(s): In this double-blind active-controlled randomized study, we
have compared the analgesic effects of ketorolac and paracetamol to
morphine. <br/>Method(s): Patients were randomly chosen from a pool of
candidates who were undergoing VATS and were divided into three groups.
During the first 24 h postsurgery, patients in the control group received
a cumulative dose of morphine 20 mg, while patients in two treatment
groups received ketorolac 120 mg and paracetamol 4 g in total. Doses were
administered as bolus immediately after surgery and infusion during the
first 24 h. Patients' pain severity was evaluated by visual analogue scale
rating (VAS) at rest and during coughing episodes. <br/>Result(s): The
average pain score at recovery time was 2.29 +/- 2.13 and 2.26 +/- 2.16
for ketorolac and paracetamol, respectively, and it was significantly
lower than the morphine group with an average pain score of 3.87 (P =
0.003). Additionally, the VAS score during cough episodes was
significantly higher in the control group throughout the study period
compared to study groups. Comparison of mean morphine dose utilized as
liberation analgesic (in case of patients had VAS >3) between three groups
was not significantly different (P = 0.17). <br/>Conclusion(s): Our study
demonstrates the non-inferiority of ketorolac and paracetamol to morphine
in controlling post-VATS pain without causing any significant side
effects. We also show that ketorolac and paracetamol are superior to
morphine in controlling pain during 2 h postsurgery.<br/>Copyright &#xa9;
2020 Annals of Cardiac Anaesthesia <br/> Published by Wolters
Kluwer-Medknow.

<79>
Accession Number
631654340
Title
Combined effect of left stellate ganglion blockade and topical
administration of papaverine on left internal thoracic artery blood flow
in patients undergoing coronary revascularization.
Source
Annals of Cardiac Anaesthesia. 23 (2) (pp 170-176), 2020. Date of
Publication: April-June 2020.
Author
Chandran R.; Sreedhar R.; Gadhinglajkar S.; Dash P.; Karunakaran J.;
Pillai V.
Institution
(Chandran) Department of Cardiac Anaesthesia, Freeman Hospital, Newcastle
Upon Tyne, United Kingdom
(Sreedhar, Gadhinglajkar, Dash) Department of Anesthesia, Sree Chitra
Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala,
India
(Karunakaran, Pillai) Department of CVTS, Sree Chitra Tirunal Institute
for Medical Sciences and Technology, Trivandrum, Kerala, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Left stellate ganglion blockade (LSGB) may have additive
effect to topical administration of papaverine on prevention of vasospasm
of left internal thoracic artery (LITA). <br/>Aim(s): This study aims to
compare LITA blood flow with topical application of papaverine alone or in
combination with LSGB. <br/>Setting(s): Tertiary care hospital.
<br/>Design(s): Prospective randomized controlled study. <br/>Material(s)
and Method(s): A total of 100 patients operated for coronary
revascularization were randomly and equally allocated into two groups. In
control Group-C, papaverine was applied topically during the dissection of
LITA. In Group-S, the additional LSGB was performed. Blood flow was
measured from cut end of the LITA for 15 s. Primary objectives of the
evaluation were to observe differences in the LITA blood flow. Observing
incidence of radial-femoral arterial pressure difference after
cardiopulmonary bypass (CPB) was secondary objective. Statistical
Analysis: Student's unpaired t-test and Fisher's exact test to find out a
significant difference between the groups. <br/>Result(s): LITA flow in
Group-S was insignificantly more (49.28 +/- 7.88 ml/min) than Group-C
(47.12 +/- 7.24 ml/min), (P = 0.15). Radio-femoral arterial pressure
difference remained low for 40 min after termination of CPB in the Group-S
compared to the Group-C (-0.99 +/- 1.85 vs.-1.92 +/- 2.26).
<br/>Conclusion(s): Combining LSGB with papaverine does not increase the
LITA blood flow compared to when the papaverine is used alone. However,
ganglion blockade reduces radial-femoral arterial pressure difference
after CPB. Blockade can be achieved successfully under the ultrasound
guidance without any complications.<br/>Copyright &#xa9; 2020 Annals of
Cardiac Anaesthesia <br/> Published by Wolters Kluwer-Medknow.

<80>
Accession Number
631654337
Title
High thoracic epidural decreases perioperative myocardial ischemia and
improves left ventricle function in aortic valve replacement alone or in
addition to cabg surgery even with increased left ventricle mass index.
Source
Annals of Cardiac Anaesthesia. 23 (2) (pp 154-160), 2020. Date of
Publication: April-June 2020.
Author
Elgebaly A.S.; Fathy S.M.; Elbarbary Y.; Sallam A.A.
Institution
(Elgebaly, Fathy) Department of Anesthesia Surgical Intensive Care and
Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
(Elbarbary) Department of Cardiology, Faculty of Medicine, Tanta
University, Tanta, Egypt
(Sallam) Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta
University, Tanta, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Introduction: High thoracic epidural (HTE) may reduce perioperative
tachyarrhythmias, respiratory complications and myocardial ischemia (MI)
and it may increase coronary perfusion and myocardial oxygen balance
through sympatholysis and pain control. The aim of this study is to
investigate the benefit of HTE in patients undergoing aortic valve
replacement (AVR) alone or in addition to coronary artery bypass graft
(CABG). <br/>Method(s): This prospective randomized controlled study was
conducted on 80 patients (40 with increased left ventricular mass index
(LVMI) and 40 with normal LVMI) who were equally randomised (n = 40) to
receive either GA with HTE (HTE group) or GA alone (GA group). Heart rate
(HR), mean arterial blood pressure (MAP) and the incidence of ischemic ECG
changes were recorded. LV functions (preoperative and postoperative by
transthoracic echocardiography and intraoperative by transoesophageal
echocardiography) were measured preoperative, intraoperative and till 48 H
postoperative. <br/>Result(s): There was no significant difference in the
baseline values of all measurements. HR and MAP were lower, and LV
functions were improved in HTE group intraoperatively and postoperatively.
Ischemic ECG changes were significantly lower in HTE group; with 42.9%
intraoperative risk reduction (95% CI: 0.195-0.943) and 46.6%
postoperative risk reduction (95% CI 0.227-0.952) as compared to GA group.
The risk of ischemia was significantly higher in patients with increased
LVMI in GA group (2.25 times compared to normal LVMI patients with 95% CI:
1.195-4.236), but it wasn't increased in HTE group. LV functions were
significantly improved from the induction to 48 H postoperative in HTE
group as compared to GA group. <br/>Conclusion(s): HTE reduced the
incidence of MI and improved the LV function, even with increased LVM, in
patients undergoing AVR alone or in addition to CABG.<br/>Copyright &#xa9;
2020 Annals of Cardiac Anaesthesia <br/> Published by Wolters
Kluwer-Medknow.

<81>
Accession Number
631654333
Title
A randomized control trial to compare thoracic epidural with intercostal
block plus intravenous morphine infusion for postoperative analgesia in
patients undergoing elective thoracotomy.
Source
Annals of Cardiac Anaesthesia. 23 (2) (pp 127-133), 2020. Date of
Publication: April-June 2020.
Author
Vilvanathan S.; Kuppuswamy B.; Sahajanandan R.
Institution
(Vilvanathan) Department of Cardiothoracic Anaesthesiology, Sree Chitra
Tirunal Institute for Medical Sciences, Trivandrum, Kerala, India
(Kuppuswamy, Sahajanandan) Department of Anaesthesiology, Christian
Medical College Hospital, Vellore, Tamil Nadu, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The objective of the study is to compare the efficacy of
Thoracic epidural with Intercostal block plus intravenous morphine
infusion for postoperative analgesia in patients undergoing elective
thoracotomy. Methodology and Design: This study is designed as a
prospective randomized clinical trial. <br/>Setting(s): Christian Medical
College Hospital, Vellore, India. <br/>Participant(s): Patients undergoing
elective thoracic surgery through posterolateral thoracotomy.
<br/>Intervention(s): In Group A (TEA) patients epidural catheter was
inserted at T5-6 level before induction of GA and analgesia was activated
using 0.25% of bupivacaine towards the end of the surgery, before chest
closure and infusion of 0.1% bupivacaine with 2 mcg/ml of fentanyl was
started. In Group B (ICN) patients, an intercostal blockade of the 5
intercostal spaces was performed by the surgeon just before chest closure
using 0.25% bupivacaine and a continuous intravenous morphine infusion of
0.015-0.02 mg/kg/hr was started. Measurements: Assessment of resting and
dynamic pain intensity using Numerical rating scale and sedation using
Ramsay sedation scale was done and recorded at 1, 6,12,18,24 hours during
the first postoperative day. The other parameters that were measured
include side effects and the requirement of rescue analgesia.
<br/>Result(s): Resting and Dynamic (NRS) pain scores were less in Group A
(TEA) than Group B (ICN). In the first 12 hours, the differences in both
the resting (P = 0.0505) and dynamic (P = 0.0307) pain scores were
statistically significant. By the end of the first postoperative day,
sedation scores were more or less similar in both groups. The incidence of
side effects and requirement of rescue analgesia were found to be similar
in both the groups. <br/>Conclusion(s): To summarize, though the results
show a slightly better quality of analgesia with the thoracic epidural,
the difference being clinically insignificant intercostal blockade could
be considered as a valid alternative.<br/>Copyright &#xa9; 2020 Annals of
Cardiac Anaesthesia <br/> Published by Wolters Kluwer-Medknow.

<82>
Accession Number
631613687
Title
The MB score: A new risk stratification index to predict the need for
advanced tools in lead extraction procedures.
Source
Europace. 22 (4) (pp 613-621), 2020. Date of Publication: 01 Apr 2020.
Author
Bontempi L.; Curnis A.; Della Bella P.; Cerini M.; Radinovic A.; Inama L.;
Melillo F.; Salghetti F.; Marzi A.; Gargaro A.; Giacopelli D.; Mazzone P.
Institution
(Bontempi, Curnis, Cerini, Salghetti) Division of Cardiology, Spedali
Civili Hospital, Piazzale Spedali Civili 1, Brescia 25123, Italy
(Della Bella, Radinovic, Melillo, Marzi, Mazzone) Arrhythmology Unit, San
Raffaele Hospital, Milan, Italy
(Inama) Division of Cardiology, Manerbio Hospital, Manerbio, Italy
(Gargaro, Giacopelli) Clinical Research, Biotronik Italia, Milano, Italy
Publisher
Oxford University Press
Abstract
Aims: A validated risk stratification schema for transvenous lead
extraction (TLE) could improve the management of these procedures. We
aimed to derive and validate a scoring system to efficiently predict the
need for advanced tools to achieve TLE success. <br/>Methods and Results:
Between November 2013 and March 2018, 1960 leads were extracted in 973
consecutive TLE procedures in two national referral sites using a stepwise
approach. A procedure was defined as advanced extraction if required the
use of powered sheaths and/or snares. The study population was a
posteriori 1:1 randomized in derivation and validation cohorts. In the
derivation cohort, presence of more than two targeted leads (odds ratio
[OR] 1.76, P = 0.049), 3-year-old (OR 3.04, P = 0.001), 5-year-old (OR
3.48, P < 0.001), 10-year-old (OR 3.58, P = 0.008) oldest lead,
implantable cardioverter-defibrillator (OR 3.84, P < 0.001), and passive
fixation lead (OR 1.91, P = 0.032) were selected by a stepwise procedure
and constituted the MB score showing a C-statistics of 0.82. In the
validation group, the MB score was significantly associated with the risk
of advanced extraction (OR 2.40, 95% confidence interval 2.02-2.86, P <
0.001) and showed an increase in event rate with increasing score. A low
value (threshold = 1) ensured 100% sensibility and 100% negative
predictive value, while a high value (threshold = 5) allowed a specificity
of 92.8% and a positive predictive value of 91.9%. <br/>Conclusion(s): In
this study, we developed and tested a simple point-based scoring system
able to efficiently identify patients at low and high risk of needing
advanced tools during TLE procedures.<br/>Copyright &#xa9; 2020 Published
on behalf of the European Society of Cardiology. All rights reserved.

<83>
Accession Number
631561817
Title
Reported outcomes after aortic valve resuspension for acute type A aortic
dissection: A systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (3) (pp 331-338),
2019. Date of Publication: 01 Sep 2019.
Author
Chen S.-K.; Qiu Z.-H.; Fang G.-H.; Wu X.-J.; Chen L.-W.
Institution
(Chen, Qiu, Fang, Wu, Chen) Department of Cardiac Surgery, Union Hospital,
Fujian Medical University, 29 Xinquan Rd, Fuzhou, Fujian 350001, China
Publisher
Oxford University Press
Abstract
In the majority of patients presenting with acute type A aortic dissection
(AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can
be preserved by AV resuspension. A meta-analysis was performed to
investigate the outcomes following AV resuspension for AAD. A systematic
literature search for publications reporting outcomes after AV
resuspension in AAD published between January 1998 and June 2018 was
conducted. Early outcome events and linearized occurrence rates for late
outcome events were derived. The retrieval process yielded 18 unique
studies involving 3295 patients with a total of 17 532 patient-years
(pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95%
CI) 11.5-19.4%, I² = 91.9%], and the linearized late mortality
rate was 3.21%/pt-yrs (95% CI 2.49-3.77, I² = 29%). The
linearized occurrence rates for aortic root reintervention was 1.4%/pt-yrs
(95% CI 0.88-1.79, I² = 48%); for recurrent significant aortic
valve insufficiency (>2+), it was 1.12%/pt-yrs (95% CI 0.79-1.45,
I² = 68%); and for endocarditis, it was 0.01%/pt-yrs (95% CI
0-0.04, I² = 7%). The composite rate of thromboembolism and
bleeding was 1.41%/pt-yrs (95% CI 0.18-2.63, I² = 82%). A more
recent surgical period was associated with a decreased hazard of
reoperation on the aortic root (P < 0.001). Requirement of AV resuspension
alone in AAD is a risk factor for mortality. The long-term durability of
AV resuspension is excellent, with low rates of endocarditis and
thromboembolism and bleeding. Root reoperation hazard has become
acceptable in recent years. Preoperative aortic valve insufficiency grade
exceeding 2+ is a predictor for root reoperation.<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.

<84>
Accession Number
631555306
Title
The Impact of Alvimopan on Return of Bowel Function after Major Spine
Surgery - A Prospective, Randomized, Double-Blind Study.
Source
Neurosurgery. 85 (2) (pp E233-E239), 2019. Date of Publication: 01 Aug
2019.
Author
Dunn L.K.; Thiele R.H.; Lin M.C.; Nemergut E.C.; Durieux M.E.; Tsang S.;
Shaffrey M.E.; Smith J.S.; Shaffrey C.I.; Naik B.I.
Institution
(Dunn, Thiele, Lin, Nemergut, Durieux, Naik) Department of Anesthesiology,
University of Virginia, PO BOX 800710, Charlottesville, VA 22911, United
States
(Thiele) Department of Biomedical Engineering, University of Virginia,
Charlottesville, VA, United States
(Nemergut, Durieux, Shaffrey, Smith, Shaffrey, Naik) Department of
Neurological Surgery, University of Virginia, Charlottesville, VA, United
States
(Tsang) Department of Nutrition and Exercise Physiology, Washington State
University, Pullman, WA, United States
Publisher
Oxford University Press
Abstract
BACKGROUND: Pain management following major spine surgery requires high
doses of opioids and is associated with a risk of opioid-induced
constipation. Peripheral mu-receptor antagonists decrease the
gastrointestinal complications of perioperative systemic opioid
administration without antagonizing the analgesic benefits of these drugs.
<br/>OBJECTIVE(S): To investigate the impact of alvimopan in opioid-naive
patients undergoing major spine surgery. <br/>METHOD(S): Patients
undergoing >3 levels of thoracic and/or lumbar spine surgery were enrolled
in this prospective, randomized, double-blind study to receive either
alvimopan or placebo prior to and following surgery. Opioid consumption;
pain scores; and time of first oral intake, flatus, and bowel movement
were recorded. <br/>RESULT(S): A total of 24 patients were assigned to the
active group and 25 were assigned to the placebo group. There was no
significant difference in demographics between the groups.
Postoperatively, the alvimopan group reported earlier time to first solid
intake [median (range): alvimopan: 15 h (3-25) vs placebo: 17 h (3-46), P
<. 001], passing of flatus [median (range): alvimopan: 22 h (7-63) vs
placebo: 28 h (10-58), P <. 001], and first bowel movement [median
(range): alvimopan: 50 h (22-80) vs placebo: 64 h (40-114), P <. 001]. The
alvimopan group had higher pain scores (maximum, minimum, and median);
however, there was no significant difference between the groups with
postoperative opioid use. <br/>CONCLUSION(S): This study shows that the
perioperative use of alvimopan significantly reduced the time to return of
bowel function with no increase in postoperative opioid use despite a
slight increase in pain scores.<br/>Copyright &#xa9; 2019 by the Congress
of Neurological Surgeons.

<85>
Accession Number
2005199500
Title
Comparison between erector spinal plane block and epidural block
techniques for postoperative analgesia in open cholecystectomies: a
randomized clinical trial.
Source
Brazilian Journal of Anesthesiology. 70 (1) (pp 22-27), 2020. Date of
Publication: January - February 2020.
Author
Sakae T.M.; Yamauchi L.H.I.; Takaschima A.K.K.; Brandao J.C.; Benedetti
R.H.
Institution
(Sakae, Yamauchi, Takaschima, Benedetti) Servico de Anestesiologia
SIANEST, Florianopolis, SC, Brazil
(Sakae, Benedetti) Universidade do Sul de Santa Catarina (UNISUL),
Florianopolis, SC, Brazil
(Yamauchi, Takaschima, Benedetti) Hospital Florianopolis, Florianopolis,
SC, Brazil
(Yamauchi, Takaschima, Brandao, Benedetti) TSA Sociedade Brasileira de
Anestesiologia (SBA), Rio de Janeiro, RJ, Brazil
Publisher
Elsevier Editora Ltda
Abstract
Introduction and objectives: Blockade of the Erector Spinal Muscle (ESP
block) is a relatively new block, initially described for chronic thoracic
pain analgesia, but it has already been described for anesthesia and
analgesia in thoracic surgical procedures and, more recently, for high
abdominal surgeries. The aim of the study was to compare two techniques,
ESP Block and Epidural block with morphine and local anesthetic for
postoperative analgesia of open cholecystectomy surgeries. <br/>Method(s):
Controlled single-blind randomized clinical trial with 31 patients (ESP
block, n = 15; Epidural, n = 16), of both genders, ages between 27 and 77
years. The ESP block was performed at the T8 level with injection of 20 mL
of 0.5% ropivacaine bilaterally. The epidural block was performed at the
T8-T9 space with 20 mL of 0.5% ropivacaine and 1 mg of morphine.
<br/>Result(s): The ESP block group presented higher mean Numeric Pain
Scale (NPS) values for pain in the up to 2 hour (p = 0.001) and in the 24
hour (p = 0.001) assessments. The ESP block group had a three-fold
increased risk (43.7% vs. 13.3%) of rescue opioid use in the 24
postoperative hours when compared to the epidural group (RR = 3.72, 95%
CI: 0.91 to 15.31, p = 0.046). <br/>Conclusion(s): ESP block did not prove
to be an effective technique for postoperative analgesia of open
cholecystectomy, at the doses performed in this study, having required
more use of rescue opioid, and without differences in NPS. More
comprehensive studies are required to assess the efficacy of ESP block for
the visceral and abdominal somatic component, considering the specific
blockade level.<br/>Copyright &#xa9; 2020

<86>
Accession Number
631655602
Title
Association of Isolated Coronary Microvascular Dysfunction With Mortality
and Major Adverse Cardiac Events: A Systematic Review and Meta-Analysis of
Aggregate Data.
Source
Journal of the American Heart Association. 9 (9) (pp e014954), 2020. Date
of Publication: 05 May 2020.
Author
Gdowski M.A.; Murthy V.L.; Doering M.; Monroy-Gonzalez A.G.; Slart R.;
Brown D.L.
Institution
(Gdowski, Brown) Cardiovascular Division Washington University School of
Medicine St. Louis MO
(Gdowski, Doering, Brown) Washington University School of Medicine St.
Louis MO
(Murthy) Frankel Cardiovascular Center University of Michigan Ann Arbor MI
(Monroy-Gonzalez, Slart) Medical Imaging Center Departments of Nuclear
Medicine and Molecular Imaging and Radiology University of Groningen
University Medical Center Groningen the Netherlands
(Slart) TechMed Centre Department of Biomedical Photonic Imaging
University of Twente Enschede the Netherlands
Publisher
NLM (Medline)
Abstract
Background The impact of coronary microvascular dysfunction (CMD), as
diagnosed by reduced coronary flow reserve, on the outcomes of patients
with symptoms of myocardial ischemia and nonobstructive coronary artery
disease is poorly understood. We performed a systematic review and
meta-analysis of observational studies to determine the association of CMD
with outcomes. Methods and Results We searched online databases for
studies where coronary flow reserve was measured invasively or
noninvasively, clinical events were recorded after determination of
coronary flow reserve, and the frequency of those events was reported for
patients with and without CMD. The primary outcome was all-cause
mortality. The secondary outcome was major adverse cardiac events,
including cardiac or cardiovascular death, nonfatal myocardial infarction,
cardiac hospitalization, or coronary revascularization. Estimates of
effect were calculated from crude event rates with a random-effects model.
There were 122 deaths in the 4661 patients without CMD (2.6%) and 183
deaths in the 1970 patients with CMD (9.3%). The odds ratio for mortality
in patients with CMD compared with those without CMD was 3.93 (95% CI,
2.91-5.30; P<0.001). There were 167 major adverse cardiac events in the
3742 patients without CMD (4.5%) and 245 events in the 1447 patients with
CMD (16.9%). The odds ratio for major adverse cardiac events in patients
with CMD compared with those without CMD was 5.16 (95% CI, 2.81-9.47;
P<0.001). Conclusions CMD is associated with a nearly 4-fold increase in
mortality and a 5-fold increase in major adverse cardiac events. Future
studies are needed to identify effective strategies to diagnose and treat
CMD.

<87>
Accession Number
628189698
Title
--Statins in the perioperative period.
Source
F1000Research. 8 (no pagination), 2019. Article Number: 688. Date of
Publication: 2019.
Author
Mohebi R.; Rosenson R.
Institution
(Mohebi, Rosenson) Department of Medicine (Cardiology), Icahn school of
Medicine at Mount Sinai, New York 10029, United States
Publisher
F1000 Research Ltd
Abstract
In this review, we discuss clinical evidence-based data regarding the
potential benefit of statin therapy in the perioperative period of
non-cardiac surgery. Results from meta-analyses of prospective
observational studies have provided conflicting evidence. Moreover,
comparison among studies is complicated by varying data sources, outcome
definitions, types of surgery, and preoperative versus perioperative
statin therapy. However, results of two recent large prospective cohort
studies showed that statin use on the day of or the day after non-cardiac
surgery (or both) is associated with lower 30-day all-cause mortality and
reduction in a variety of postoperative complications, predominantly
cardiac, compared with non-use during this period. There is a paucity of
data from randomized controlled trials assessing the benefit of statin
therapy in non-cardiac surgery. No randomized controlled trials have shown
that initiating a statin in statin-naive patients may reduce the risk of
cardiovascular complications in non-cardiac surgeries. One randomized
clinical trial demonstrated that the use of a preoperative statin in
patients with stable coronary heart disease treated with long-term statin
therapy had a significant reduction in the incidence of myocardial
necrosis and major adverse cardiovascular events after non-cardiac
surgery. In conclusion, it is important that all health-care professionals
involved in the care of the surgical patient emphasize the need to resume
statin therapy, particularly in patients with established atherosclerotic
cardiovascular disease. However, initiating a statin in statin-naive
patients undergoing non-cardiac surgery needs more evidence-based
data.<br/>Copyright &#xa9; 2019 Mohebi R and Rosenson R.

<88>
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. 28 (5) (pp 253-265), 2020. Date of Publication:
01 May 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).

<89>
Accession Number
2004465444
Title
Preoperative frailty parameters as predictors for outcomes after
transcatheter aortic valve implantation: a systematic review and
meta-analysis.
Source
Netherlands Heart Journal. 28 (5) (pp 280-292), 2020. Date of Publication:
01 May 2020.
Author
van Mourik M.S.; Velu J.F.; Lanting V.R.; Limpens J.; Bouma B.J.; Piek
J.J.; Baan J.; Henriques J.P.S.; Vis M.M.
Institution
(van Mourik, Velu, Lanting, Bouma, Piek, Baan, Henriques, Vis) Department
of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam
Cardiovascular Sciences, Amsterdam, Netherlands
(Limpens) Medical Library, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Guidelines suggest using frailty characteristics in the work-up for a
transcatheter aortic valve implantation (TAVI). There are many
frailty-screening tools with different components. The prognostic value of
the individual parameters in frailty is as yet unclear. The objective of
this systematic review and meta-analysis was to find and pool predictors
for 1-year mortality after TAVI. We followed a two-step approach. First,
we searched for randomised controlled trials on TAVI to identify frailty
parameters used in these studies. Second, we searched for publications on
these frailty parameters. Articles were included for pooled analysis if
the studied frailty parameters were dichotomised with clear cut-off values
based on common standards or clinical practice and reported adjusted
hazard ratios (HR) of 1-year mortality after TAVI. We calculated pooled
effect estimates of 49 studies based on dichotomised frailty scores (HR:
2.16, 95% CI: 1.57-3.00), chronic lung disease (HR: 1.57, 95% CI:
1.45-1.70), estimated glomerular filtration rate <30ml/min (HR: 1.95, 95%
CI: 1.68-2.29), body mass index <20kg/m² (HR: 1.49, 95% CI:
1.09-2.03), hypoalbuminaemia (HR: 1.77, 95% CI: 1.38-2.25), anaemia (HR:
2.08, 95% CI: 0.93-4.66), low gait speed (HR: 13.33, 95% CI: 1.75-101.49)
and Katz activities of daily living (ADL) score of 1 or more deficits (HR:
5.16, 95% CI: 0.77-34.47). Chronic lung disease, chronic kidney disease,
underweight, hypoalbuminaemia, a low frailty score, anaemia, low gait
speed and an ADL deficiency were associated with worse 1-year outcomes
after TAVI.<br/>Copyright &#xa9; 2020, The Author(s).

<90>
Accession Number
2004242524
Title
Effect of single-dose crystalloid cardioplegic agent compared to bloody
cardioplegic agent in cardiac surgery in children with tetralogy of
fallot.
Source
ARYA Atherosclerosis. 16 (1) (pp 24-32), 2020. Date of Publication: 2020.
Author
Bigdelian H.; Hosseini A.
Institution
(Bigdelian) Department of Cardiac Surgery, School of Medicine, Cardiac
Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Hosseini) Department of Cardiac Surgery, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Cardioplegia is one of the main post-operative cardiac
protective factors widely used in recent decades in the form of
crystalloid (St. Thomas) and bloody solutions [del Nido (DN)]. The purpose
of this study was to compare the effect of a crystalloid cardioplegic
agent (St. Thomas) with that of a bloody cardioplegic agent (DN) in
pediatric cardiac surgery among children with Tetralogy of Fallot (TOF).
<br/>METHOD(S): This study was performed on 60 children with TOF, who were
candidates for heart repair surgery. The participants were randomly
divided into two groups of crystalloid cardioplegic agent and bloody
cardioplegic agent. Operative outcomes such as required time for onset of
heart arrest, duration of returning to normal heart rhythm, and
cardiopulmonary bypass (CPB) time, and operative complications were
compared between the two groups. <br/>RESULT(S): The duration of returning
to normal heart rhythm (50.43 +/- 10.93 seconds vs. 43.03 +/- 16.35
seconds; P = 0.044) and duration of inotropy (80.40 +/- 27.14 hours vs.
63.20 +/- 26.91 hours; P = 0.017) were significantly higher in the DN
group compared to the St. Thomas group. However, there were no significant
differences between the two groups in terms of heart arrest time,
cross-clamp time, CPB time, supplementary lasix time, duration of
intubation, and intensive care unit (ICU) and hospital length of stay
(LOS) (P > 0.050). <br/>CONCLUSION(S): The use of St. Thomas cardioplegic
solution was more effective in reducing the duration of returning to
normal heart rhythm and inotropy compared with DN cardioplegic agent, and
a single dose of these two cardioplegic agents can keep the mean cardiac
arrest duration within the range of 50-70 minutes. It seems that the use
of St. Thomas cardioplegic solution can be suggested in pediatric heart
surgery.<br/>Copyright &#xa9; 2020, Isfahan University of Medical
Sciences(IUMS). All rights reserved.

<91>
Accession Number
2003720783
Title
The effects of a comprehensive rehabilitation and intensive education
program on anxiety, depression, quality of life, and major adverse cardiac
and cerebrovascular events in unprotected left main coronary artery
disease patients who underwent coronary artery bypass grafting.
Source
Irish Journal of Medical Science. 189 (2) (pp 477-488), 2020. Date of
Publication: 01 May 2020.
Author
Ma L.; Deng L.; Yu H.
Institution
(Ma, Deng, Yu) Department of Cardiovascular Surgery, The First Affiliated
Hospital of Harbin Medical University, 23 Youzheng Street, Harbin,
Heilongjiang 150001, China
Publisher
Springer
Abstract
Objective: This study aimed to explore the effect of a comprehensive
rehabilitation and intensive education (CRIE) program on anxiety,
depression, quality of life (QoL), and major adverse cardiac and
cerebrovascular events (MACCE) risk in unprotected left main coronary
artery disease (ULMCAD) patients who underwent coronary artery bypass
grafting (CABG). <br/>Method(s): In total, 300 ULMCAD patients who
underwent CABG were randomly assigned to the CRIE group or usual care (UC)
group in a 1:1 ratio. During a 12-month intervention, anxiety and
depression were evaluated by Hospital Anxiety and Depression Scale (HADS),
QoL was evaluated by 12-Item Short-Form Health Survey (SF-12), on
discharge day from hospital (M0), and at 3 months after the discharge
(M3), M6, and M12. All patients were further followed up until occurrence
of MACCE or for an additional 24 months, and MACCE accumulating occurrence
rate was calculated. <br/>Result(s): At M12, HADS-anxiety score and
anxiety prevalence (17.3% vs. 29.3%) were decreased in the CRIE group than
those in the UC group, meanwhile HADS-depression score and depression
prevalence (15.3% vs. 24.7%) were also reduced in the CRIE group than
those in the UC group. For QoL, SF-12 Physical Component Summary (PCS)
score at M6/M12, and SF-12 PCS score change (M12 - M0) were increased in
the CRIE group than those in the UC group; meanwhile, SF-12 Mental
Component Summary (MCS) score at M12 and SF-12 PCS score change (M12 - M0)
were increased in the CRIE group than those in the UC group as well.
Besides, MACCE accumulating occurrence rate was numerically lower in the
CRIE group compared with that in the UC group but without statistical
significance. <br/>Conclusion(s): CRIE is an effective approach in
improving anxiety, depression, and QoL in ULMCAD patients who underwent
CABG.<br/>Copyright &#xa9; 2019, Royal Academy of Medicine in Ireland.

<92>
Accession Number
2002073987
Title
Coronary Embolism: A Systematic Review.
Source
Cardiovascular Revascularization Medicine. 21 (3) (pp 367-374), 2020. Date
of Publication: March 2020.
Author
Lacey M.J.; Raza S.; Rehman H.; Puri R.; Bhatt D.L.; Kalra A.
Institution
(Lacey) Department of Medicine, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
(Raza) Harrington Heart & Vascular Institute, University Hospitals
Cleveland Medical Center, Case Western Reserve University School of
Medicine, Cleveland, United States
(Rehman) Methodist DeBakey Heart & Vascular Center, Houston Methodist
Hospital, Houston, TX, United States
(Puri, Kalra) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Coronary embolism is a rare and potentially fatal phenomenon
that occurs primarily in patients with valvular heart disease and atrial
fibrillation. There is a lack of consensus regarding the diagnosis,
treatment, and management of coronary embolism, leaving management at the
discretion of the treating physician. Through this review, we aim to
establish a better understanding of coronary embolism, and to identify
treatment options - invasive and non-invasive - that may be used to manage
coronary embolism. <br/>Methods and Results: Our systematic review
included 147 documented cases of coronary embolism from case reports and
case series. The average age of our population was 54.2 +/- 17.6 years.
The most common causes of coronary embolism included infective
endocarditis (22.4%), atrial fibrillation (17.0%), and prosthetic heart
valve thrombosis (16.3%). Initial presentation was indistinguishable from
an acute coronary syndrome (ACS) due to coronary atherosclerosis, and the
diagnosis required a high level of suspicion and evaluation with
angiography. Treatment strategies included, but were not limited to,
thrombectomy, thrombolysis, balloon angioplasty and stent placement.
Myocardial dysfunction on echocardiography was observed in over 80% of
patients following coronary embolism. "Good outcomes" were reported in
68.7% of case reports and case series, with a mortality rate of 12.9%.
<br/>Conclusion(s): Coronary embolism is an under-recognized etiology of
myocardial infarction with the potential for significant morbidity and
mortality. To improve outcomes, physicians should strive for early
diagnosis and intervention based on the underlying etiology. Thrombectomy
may be considered with the goal of rapid restoration of coronary
flow.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<93>
Accession Number
631561764
Title
Tricuspid valve intervention at the time of mitral valve surgery: A
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (2) (pp 193-200),
2019. Date of Publication: 01 Aug 2019.
Author
Tam D.Y.; Tran A.; Mazine A.; Tang G.H.L.; Gaudino M.F.L.; Calafiore A.M.;
Friedrich J.O.; Fremes S.E.
Institution
(Tam, Tran, Mazine, Fremes) Division of Cardiac Surgery, Department of
Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
(Tam) Dalla Lana School of Public Health, Institute of Health Policy,
Management and Evaluation, University of Toronto, Toronto, ON, Canada
(Tang) Department of Cardiovascular Surgery, Mount Sinai Medical Center,
New York, NY, United States
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Calafiore) Department of Cardiovascular Disease, John Paul II Foundation,
Campobasso, Italy
(Friedrich) Department of Critical Care and Medicine, St. Michael's
Hospital, University of Toronto, Toronto, ON, Canada
Publisher
Oxford University Press
Abstract
OBJECTIVES: The surgical management of tricuspid regurgitation (TR) at the
time of mitral valve surgery remains controversial. Our objectives were to
determine the safety and efficacy of tricuspid valve (TV) repair during
mitral valve surgery in a meta-analysis. <br/>METHOD(S): MEDLINE and
EMBASE were searched from 1946 to 2017 for all studies comparing TV repair
to no intervention at the time of mitral valve surgery on early and late
mortality and late TR. A random-effects meta-analysis of all outcomes was
performed. <br/>RESULT(S): One thousand four hundred and seventeen studies
were retrieved and a total of 17 studies [2 randomized clinical trial (n =
211), 11 adjusted observational studies (n = 3848) and 4 unadjusted
observational studies (n = 67 010)] that compared TV repair (n = 11 787)
to no intervention (n = 56 027) at a mean follow-up of 6.0 +/- 0.64 years
were included. There was no difference in 30-day/in-hospital mortality
between repair and no repair [risk ratio (RR) 1.19, 95% confidence
interval (95% CI) 0.70-2.02; P = 0.52]. The incidence of new permanent
pacemaker implantation was higher in the TV repair group (RR 2.73, 95% CI
2.57-2.89; P < 0.01). TV repair was protective against late moderate or
greater TR [incident rate ratio (IRR) 0.28, 95% CI 0.17-0.47; P < 0.01]
and severe TR (IRR 0.38, 95% CI 0.17-0.84). There was a numerically lower
rate of late TV reoperation (IRR 0.39, 95% CI 0.12-1.25; P = 0.11) that
did not reach statistical significance. Overall, there was no difference
in late mortality between the 2 treatments (IRR 0.87, 95% CI 0.63-1.24; P
= 0.43). <br/>CONCLUSION(S): TV repair appears safe in the perioperative
period and may reduce future recurrent TR without any survival
benefit.<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.

<94>
Accession Number
631561670
Title
Postoperative atrial fibrillation after aortic valve replacement is a risk
factor for long-term atrial fibrillation.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (3) (pp 378-385),
2019. Date of Publication: 01 Sep 2019.
Author
Carter-Storch R.; Dahl J.S.; Christensen N.L.; Pecini R.; Sondergard E.V.;
Ovrehus K.A.; Moller J.E.
Institution
(Carter-Storch, Dahl, Christensen, Pecini, Sondergard, Ovrehus, Moller)
Department of Cardiology, Odense University Hospital, J.B. Winslows Vej 4,
Odense C 5000, Denmark
(Carter-Storch, Moller) OPEN Odense Patient Data Explorative Network,
Denmark
Publisher
Oxford University Press
Abstract
OBJECTIVES: Postoperative atrial fibrillation (POAF) is a common
complication following cardiac surgery. However, knowledge on the rate of
long-term atrial fibrillation (LTAF) after POAF remains unclear. We
investigated predictors of POAF in patients with aortic stenosis
undergoing surgical aortic valve replacement, and assessed the rate of
LTAF during follow-up. <br/>METHOD(S): We prospectively included 96 adult
patients with severe aortic stenosis undergoing surgical aortic valve
replacement. Patients with previous atrial fibrillation (AF) were
excluded. Patients underwent echocardiography, cardiac computed tomography
and magnetic resonance imaging immediately prior to surgery. Surgical
aortic clamp time and postoperative C-reactive protein (CRP) were
documented. POAF was defined as AF recorded within 7 days of surgery.
Through chart review, patients were followed up for documented episodes of
LTAF occurring more than 7 days after surgery. <br/>RESULT(S): POAF
occurred in 51 patients (53%). It was associated with larger preoperative
echocardiographic left atrial volume index (44 +/- 12 vs 37 +/- 8
ml/m², P = 0.004), longer aortic clamp time [80 (70-102) vs 72
(62-65) min, P = 0.04] and higher CRP on first postoperative day [80
(64-87) vs 65 (44-83) mg/l, P = 0.001]. Multivariable logistic regression
revealed that left atrial volume index [odds ratio (OR) 1.07, 95%
confidence interval (CI) 1.02-1.13; P = 0.005] and postoperative CRP (OR
1.03, 95% CI 1.01-1.05; P = 0.006) were the only independent predictors of
POAF. During 695 days (25th-75th percentile: 498-859 days) of follow-up,
LTAF occurred in 11 patients of whom 10 were in the POAF group (hazard
ratio 9.4, 95% CI 1.2-74; P = 0.03). <br/>CONCLUSION(S): POAF is predicted
by left atrial volume index and postoperative CRP. Patients with POAF have
a 9-fold increase risk of developing symptomatic LTAF during follow-up.
Clinical trial registration number: ClinicalTrials.gov
(NCT02316587).<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.

<95>
Accession Number
631561280
Title
Bilateral internal thoracic artery versus single internal thoracic artery:
A meta-analysis of propensity score-matched observational studies.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (2) (pp 163-172),
2019. Date of Publication: 01 Aug 2019.
Author
Urso S.; Nogales E.; Gonzalez J.M.; Sadaba R.; Tena M.A.; Bellot R.; Rios
L.; Portela F.
Institution
(Urso, Tena, Bellot, Rios, Portela) Cardiac Surgery Department, Hospital
Universitario Dr. Negrin, Barranco de la Ballena, s/n, Las Palmas de Gran
Canaria 35010, Spain
(Nogales) Cardiology Department, Hospital Universitario Insular, Las
Palmas de Gran Canaria, Spain
(Gonzalez) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
(Sadaba) Cardiac Surgery Department, Complejo Hospitalario de Navarra,
Pamplona, Spain
Publisher
Oxford University Press
Abstract
The lack of benefit in terms of mid-term survival and the increase in the
risk of sternal wound complications published in a recent randomized
controlled trial have raised concerns about the use of bilateral internal
thoracic artery (BITA) in myocardial revascularization surgery. For this
reason, we decided to explore the current evidence available on the
subject by carrying out a meta-analysis of propensity score-matched
studies comparing BITA versus single internal thoracic artery (SITA).
PubMed, EMBASE and Google Scholar were searched for propensity
score-matched studies comparing BITA versus SITA. The generic inverse
variance method was used to compute the combined hazard ratio (HR) of
long-term mortality. The DerSimonian and Laird method was used to compute
the combined risk ratio of 30-day mortality, deep sternal wound infection
and reoperation for bleeding. Forty-five BITA versus SITA matched
populations were included. Meta-analysis showed a significant benefit in
terms of long-term survival in favour of the BITA group [HR 0.78; 95%
confidence interval (CI) 0.71-0.86]. These results were consistent with
those obtained by a pooled analysis of the matched populations comprising
patients with diabetes (HR 0.65; 95% CI 0.43-0.99). When compared with the
use of SITA plus radial artery, BITA did not show any significant benefit
in terms of long-term survival (HR 0.86; 95% CI 0.69-1.07). No differences
between BITA and SITA groups were detected in terms of 30-day mortality or
in terms of reoperation for bleeding. Compared with the SITA group,
patients in the BITA group had a significantly higher risk of deep sternal
wound infection (risk ratio 1.66; 95% CI 1.41-1.95) even when the pooled
analysis was limited to matched populations in which BITA was harvested
according to the skeletonization technique (risk ratio 1.37; 95% CI
1.04-1.79). The use of BITA provided a long-term survival benefit compared
with the use of SITA at the expense of a higher risk of sternal deep wound
infection. The long-term survival advantage of BITA is undetectable when
compared with SITA plus radial artery.<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.

<96>
Accession Number
2002209086
Title
Non-Transfemoral Transcatheter Aortic Valve Replacement Approach is
Associated with a Higher Risk of New-Onset Atrial Fibrillation: A
Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 29 (5) (pp 748-758), 2020. Date of
Publication: May 2020.
Author
Angsubhakorn N.; Kittipibul V.; Prasitlumkum N.; Kewcharoen J.;
Cheungpasitporn W.; Ungprasert P.
Institution
(Angsubhakorn) Department of Medicine, University of Minnesota Medical
School, Minneapolis, MN, United States
(Kittipibul) Department of Internal Medicine, University of Miami Miller
School of Medicine, Miami, FL, United States
(Prasitlumkum, Kewcharoen) University of Hawaii Internal Medicine
Residency Program, Honolulu, HI, United States
(Cheungpasitporn) Division of Nephrology, University of Mississippi
Medical Center, Jackson, MS, United States
(Ungprasert) Clinical Epidemiology Unit, Department of Research and
Development, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Publisher
Elsevier Ltd
Abstract
Background: New-onset atrial fibrillation (NOAF) is a frequent arrhythmic
complication following transcatheter aortic valve replacement (TAVR).
Choice of access routes for TAVR could be a factor that determines the
risk of NOAF although the data is still not well-characterised. We aimed
to assess the association between different access routes for TAVR
(transfemoral versus non-transfemoral) and the risk of NOAF.
<br/>Method(s): A comprehensive literature review was performed through
September 2018 using EMBASE and Medline. Eligible studies must compare the
incidence of NOAF in patients without pre-existing atrial fibrillation who
underwent TAVR. Relative risk (RR) and 95% confidence intervals (CI) were
extracted from each study and combined together using the random-effects
model, generic inverse variance method of DerSimonian and Laird.
<br/>Result(s): Seven (7) retrospective studies with 18,425 patients who
underwent TAVR (12,744 with the transfemoral approach and 5,681 with the
non-transfemoral approach) met the eligibility criteria. After the
procedures, 2,205 (12.0%) patients developed NOAF (656 [5.1%] patients in
the transfemoral group and 1,549 [27.3%] patients in the non-transfemoral
group). There was a significant association between the non-transfemoral
approach and an increased risk of NOAF with the pooled RR of 2.94 (95%CI,
2.53-3.41; p < 0.00001). Subgroup analysis showed the highest risk of NOAF
in the transapical subgroup with the pooled RR of 3.20 (95% CI, 2.69-3.80;
I² 33%). <br/>Conclusion(s): A significantly increased risk of
NOAF following TAVR among those who underwent a non-transfemoral approach
compared with transfemoral approach was observed in this
meta-analysis.<br/>Copyright &#xa9; 2019 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<97>
Accession Number
2002010322
Title
Meta-Analysis and Meta-Regression of Transcatheter Aortic Valve
Implantation for Pure Native Aortic Regurgitation.
Source
Heart Lung and Circulation. 29 (5) (pp 729-741), 2020. Date of
Publication: May 2020.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Ltd
Abstract
Aim: To assess outcomes of transcatheter aortic valve implantation (TAVI)
for pure native aortic regurgitation (AR) and to evaluate whether 30-day
all-cause mortality is modulated by patient characteristics, we performed
a meta-analysis and meta-regression of currently available studies.
<br/>Method(s): Studies enrolling >=20 patients undergoing TAVI for AR
were considered for inclusion. Study-specific estimates (incidence rates
of outcomes) were combined using one-group meta-analysis in a
random-effects model. Subgroup meta-analysis of studies exclusively using
early-generation devices (EGD) and new-generation devices (NGD) and
stepwise random-effects multivariate meta-regression were also performed.
<br/>Result(s): The search identified 11 eligible studies including a
total of 911 patients undergoing TAVI for AR. Pooled analysis demonstrated
an incidence of device success of 80.4% (NGD 90.2%, EGD 67.2%; p < 0.001),
moderate or higher paravalvular aortic regurgitation (PAR) of 7.4% (NGD
3.4%, EGD 17.3%; p < 0.001), 30-day all-cause mortality of 9.5% (NGD 6.1%,
EGD 14.7%; p < 0.001), mid-term (4 mo - 1 yr) all-cause mortality of 18.8%
(NGD 11.8%, EGD 32.2%; p < 0.001), life-threatening/major bleeding
complications (BC) 5.7% (NGD 3.5%, EGD 12.4%; p = 0.015), and major
vascular complications (MVC) of 3.9% (NGD 3.0%, EGD 6.2%; p = 0.041). All
coefficients in the multivariate meta-regression adjusting simultaneously
for the proportion of diabetes mellitus, chronic obstructive pulmonary
disease, peripheral arterial disease, concomitant moderate or higher
mitral regurgitation, and mean left ventricular ejection fraction (with
significant coefficients in the univariate meta-regression) were not
statistically significant. <br/>Conclusion(s): Thirty (30)-day all-cause
mortality after TAVI for AR was high (9.5%) with a high incidence of
moderate or higher PAR (7.4%). Compared with EGD, NGD was associated with
significantly higher device success rates and significantly lower rates of
second-valve deployment, moderate or higher PAR, 30-day/mid-term all-cause
mortality, serious BC, and MVC.<br/>Copyright &#xa9; 2019 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<98>
Accession Number
2005758893
Title
A comparison of spinal laser interstitial thermotherapy with open surgery
for metastatic thoracic epidural spinal cord compression.
Source
Journal of Neurosurgery: Spine. 32 (5) (pp 667-675), 2020. Date of
Publication: May 2020.
Author
de Almeida Bastos D.C.; Everson R.G.; de Oliveira Santos B.F.; Habib A.;
Vega R.A.; Oro M.; Rao G.; Li J.; Ghia A.J.; Bishop A.J.; Yeboa D.N.;
Amini B.; Rhines L.D.; Tatsui C.E.
Institution
(de Almeida Bastos, de Oliveira Santos, Habib, Vega, Oro, Rao, Rhines,
Tatsui) Department of Neurosurgery, University of Texas MD Anderson Cancer
Center, Houston, TX, United States
(Li, Ghia, Bishop, Yeboa) Department of, Radiation Oncology, University of
Texas MD Anderson Cancer Center, Houston, TX, United States
(Amini) Department of, Diagnostic Radiology, University of Texas MD
Anderson Cancer Center, Houston, TX, United States
(Everson) Department of Neurosurgery, David Geffen School of Medicine at
UCLA, Los Angeles, CA, United States
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE The proximity of the spinal cord to compressive metastatic
lesions limits radiosurgical dosing. Open surgery is used to create safe
margins around the spinal cord prior to spinal stereotactic radiosurgery
(SSRS) but carries the risk of potential surgical morbidity and
interruption of systemic oncological treatment. Spinal laser interstitial
thermotherapy (SLITT) in conjunction with SSRS provides local control with
less morbidity and a shorter interval to resume systemic treatment. The
authors present a comparison between SLITT and open surgery in patients
with metastatic thoracic epidural spinal cord compression to determine the
advantages and disadvantages of each method. METHODS This is a
matched-group design study comprising patients from a single institution
with metastatic thoracic epidural spinal cord compression that was treated
either with SLITT or open surgery. The two cohorts defined by the surgical
treatment comprised patients with epidural spinal cord compression (ESCC)
scores of 1c or higher and were deemed suitable for either treatment.
Demographics, pre- and postoperative ESCC scores, histology, morbidity,
hospital length of stay (LOS), complications, time to radiotherapy, time
to resume systemic therapy, progression-free survival (PFS), and overall
survival (OS) were compared between groups. RESULTS Eighty patients were
included in this analysis, 40 in each group. Patients were treated between
January 2010 and December 2016. There was no significant difference in
demographics or clinical characteristics between the cohorts. The SLITT
cohort had a smaller postoperative decrease in the extent of ESCC but a
lower estimated blood loss (117 vs 1331 ml, p < 0.001), shorter LOS (3.4
vs 9 days, p < 0.001), lower overall complication rate (5% vs 35%, p =
0.003), fewer days until radiotherapy or SSRS (7.8 vs 35.9, p < 0.001),
and systemic treatment (24.7 vs 59 days, p = 0.015). PFS and OS were
similar between groups (p = 0.510 and p = 0.868, respectively).
CONCLUSIONS The authors' results have shown that SLITT plus XRT is not
inferior to open decompression surgery plus XRT in regard to local
control, with a lower rate of complications and faster resumption of
oncological treatment. A prospective randomized controlled study is needed
to compare SLITT with open decompressive surgery for ESCC.<br/>Copyright
&#xa9; A ANS 2020, except where prohibited by US copyright law

<99>
Accession Number
2005746073
Title
Meta-analysis of prognostic impact of peripheral arterial disease on
mortality after transcatheter aortic valve implantation.
Source
Journal of Cardiovascular Surgery. 60 (6) (pp 723-732), 2019. Date of
Publication: December 2019.
Author
Takagi H.; 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
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: The aim of this study was to determine whether peripheral
arterial disease (PAD) is an independent predictor of mortality in
patients who undergo transcatheter aortic valve implantation (TAVI) and we
performed meta-analysis of currently available studies. EVIDENCE
ACQUISITION: MEDLINE and EMBASE were searched through June 2018 using
Web-based search engines (PubMed and OVID). We included comparative
studies of patients with PAD versus those without PAD and cohort studies
which investigated PAD as one of prognostic factors of mortality, which
used the multivariable analysis and reported an adjusted odds and hazard
ratio (OR/HR) for early (30-day or in-hospital) and late (including early)
mortality after TAVI. Study-specific estimates were combined using inverse
variance-weighted averages of logarithmic ORs/HRs in the random-effects
model. EVIDENCE SYNTHESIS: The primary meta-analysis which pooled all the
ORs/HRs demonstrated that PAD was associated with a statistically
significant increase in both early (OR, 1.21; P=0.02) and midterm (1-year
to 7-year) mortality (HR, 1.31; P<0.00001). The secondary metaanalysis
which exclusively pooled approach-adjusted/stratified ORs/HRs demonstrated
that PAD was associated with a strong trend toward (though statistically
non-significant) an increase in early mortality (OR, 1.18; P=0.07) and a
still statistically significant increase in midterm mortality (OR, 1.24;
P=0.0001). Meta-regression coefficients for the proportion of patients who
underwent transfemoral TAVI were not statistically significant (P for
early/midterm mortality =0.24/0.52). <br/>CONCLUSION(S): The present
meta-analysis clearly highlighted that PAD was an independent predictor of
both early and midterm mortality in patients who underwent
TAVI.<br/>Copyright &#xa9; 2019 EDIZIONI MINERVA MEDICA Online version at
http://www.minervamedica.it

<100>
Accession Number
2004814345
Title
Coagulation ability when separating from cardiopulmonary bypass with and
without fresh frozen plasma: a pilot study.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2020. Date
of Publication: 2020.
Author
Tamura T.; Yokota S.; Ito T.; Ando M.; Kubo Y.; Waters J.H.; Nishiwaki K.
Institution
(Tamura, Nishiwaki) Department of Anesthesiology, Nagoya University
Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya 466-8550,
Japan
(Tamura, Waters) Department of Anesthesiology, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
(Yokota) Division of Anesthesiology, Japanese Red Cross Nagoya Daiichi
Hospital, Nagoya, Japan
(Ito) Division of Cardiovascular Surgery, Japanese Red Cross Nagoya
Daiichi Hospital, Nagoya, Japan
(Ando) Center for Advanced Medicine and Clinical Research, Nagoya
University Hospital, Nagoya, Japan
(Kubo) Department of Preventive Medicine, Nagoya University Hospital,
Nagoya, Japan
Publisher
Springer
Abstract
Objective: Several strategies are employed for administering fresh frozen
plasma (FFP) during weaning from cardiopulmonary bypass (CPB). This study
evaluated by coagulation function aimed to compare two strategies of
administering FFP in cardiovascular surgery: administering 4 units of FFP
before separating from CPB or administering it after weaning from CPB.
<br/>Method(s): Thirty patients who underwent CPB and were expected to
receive 8 units of FFP and 20 units of platelet concentrate were randomly
allocated into group A (8 units of FFP and 20 units of platelet
concentrate administered after separating from CPB) and group B (4 units
of FFP administered before separation, and 4 units of FFP and 20 units of
platelet concentrate administered after separating from CPB).
Thromboelastography (TEG6s, HAEMONETICS Japan GK, Tokyo, Japan)
was conducted at four time points before and after separation. Blood test
results, blood loss, and required amounts of blood transfusion were
compared. The primary outcome was the difference in coagulation function
evaluated by TEG6s 90 min after protamine administration. <br/>Result(s):
Twenty-eight patients were enrolled in the study. Coagulation function
after separating from CPB was not significantly different between the
groups. Additionally, no significant differences were found in intensive
care unit outcomes, such as 24-h transfusion requirements.
<br/>Conclusion(s): Coagulation function 90 min after separating from CPB
was not significantly different between the groups. Prior FFP
administration before separation did not provide significant improvement
in coagulation function.<br/>Copyright &#xa9; 2020, The Japanese
Association for Thoracic Surgery.

<101>
Accession Number
631671314
Title
Motor outcome after early surgery for infants less than 12 months of age
with congenital heart defects: A systematic review.
Source
Developmental Medicine and Child Neurology. Conference: American Academy
for Cerebral Palsy and Developmental Medicine. United States. 61
(Supplement 3) (pp 115-116), 2019. Date of Publication: October 2019.
Author
Aljuhani T.; Zyblewski S.; Jenkins D.; Shaw Bonilha H.; Coker-Bolt P.
Institution
(Aljuhani, Zyblewski, Jenkins, Shaw Bonilha, Coker-Bolt) Medical
University of South Carolina, Charleston, SC, United States
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objective(s): Congenital heart defects (CHD) are the most
common congenital defects in newborn infants. Neurodevelopmental delays
(ND) are a common complication that infants undergoing cardiac surgery.
Early assessment and early referral to therapy might mitigate these
developmental deficits, but current medical practices for infants with CHD
do not encourage early handling pre-and post-surgery [1]. Therefore, CHD
infants rarely receive therapeutic interventions in the 1 year of life
[2]. There are no systematic reviews that have aggregated data on early
development in infants with CHD who have undergone surgery less than 6
months of age. Since recent studies indicate that developmental treatment
may be feasible and safe in these fragile infants, we performed a
systematic review of the literature to determine what was known about
early motor outcomes in post-surgical CHD infants less than 12 months of
age. <br/>Study Design: A Systematic review which examined studies of
motor outcomes after cardiac surgery in infant less than one year of age
who were diagnosed with CHD. This review was performed according to the
PRISMA guidelines for systematic reviews [3]. The review included all
randomized control trials, prospective cohort studies or reports of
multiple cohorts that met the inclusion criteria for both patients and
outcome measures. Case reports and editorials were excluded. Study
Participants and Settings: Not Applicable. <br/>Material(s) and Method(s):
Studies that reported infants' surgical repair or palliation of CHD up to
6 months of age were considered both infants with single or 2-ventricle
physiology were included. Studies were excluded if they participants were
preterm infants or infants with birth asphyxia because. Moreover, excluded
were studies that included infants diagnosed with genetic/chromosomal
anomalies known to affect motor outcomes. We included studies that
reported motor outcomes using a standardized assessment tool. The results
we reported are limited to infants aged 12 months or less.
Non-standardized and/or questionnaire methods of evaluating motor outcomes
were not included. The search was limited to peer-reviewed articles
published in English using PubMed and Scopus databases from 2008 to April
2018. Additional relevant studies were reviewed in the references of the
included. To assess the quality of the selected articles Newcastle-Ottawa
Quality Assessment Scale was used. The search terms and MeSH terms that
were used ?congenital heart defects?, ?heart defects, congenital?, ?heart
septal defect?, ?motor skills?, ?infants?, ?neurodevelopment?, and
?psychomotor?. <br/>Result(s): Initial search of PubMed and Scopus
databases resulted in a total of 58 articles. Of those, 33 articles
underwent full text reviews; 17 articles were excluded due to the
following observations: the study did not report motor developmental
scores, the age of participants was above 12 months, a questionnaire was
used for assessment, or the patient was diagnosed with a genetic disorder.
A total of 16 studies were identified for inclusion in the review. 5
studies provided data regarding motor outcomes of infants before 6 months
of age, while 11 studies provided motor outcomes of infants between 6 and
12 months of age. 15 of the 16 studies reported lower motor mean scores,
and all studies for infants less than 6 months of age show a significant
delay in motor developmental scores. Infants with single-ventricle anatomy
scored consistently lower in motor tests compared with infants with
2-ventricle physiology. Conclusions or Significance: Infants with CHD are
at significant risk for early motor delays that might be identified using
systematic screening and assessment protocols prior to hospital discharge.
The review reveals that motor delays in infants with CHD are common and
evident as early as 2-4 months of age. Moreover, this review shows that it
is feasible and safe to perform developmental assessment of newborns with
CHD after cardiac surgery and prior to discharge. Studies that used
targeted early rehabilitation interventions to optimize activitydependent
and developmental neuroplasticity show that improvement in motor
developmental is feasible for infants with CHD [4,5]. Yet to date, few
research studies have investigated the advantage of early rehabilitation
for infants with CHD. This maybe is due to the lack of standardized
neurodevelopmental assessments validated for use in these fragile infants,
and the limited use of neuroimaging techniques.

<102>
Accession Number
631654345
Title
Pain relief following sternotomy in conventional cardiac surgery: A review
of non neuraxial regional nerve blocks.
Source
Annals of Cardiac Anaesthesia. 23 (2) (pp 200-208), 2020. Date of
Publication: April-June 2020.
Author
Kar P.; Ramachandran G.
Institution
(Kar, Ramachandran) Department of Anesthesia and Intensive Care, Nizams
Institute of Medical Sciences, Hyderabad, Telangana, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Acute post-operative pain following sternotomy in cardiac surgery should
be adequately managed so as to avoid adverse hemodynamic consequences and
pulmonary complications. In the era of fast tracking, adequate and
efficient technique of post-operative analgesia enables early extubation,
mobilization and discharge from intensive care unit. Due to increasing
expertise in ultrasound guided blocks there is a recent surge in trial of
bilateral nerve blocks for pain relief following sternotomy. The aim of
this article was to review non-neuraxial regional blocks for analgesia
following sternotomy in cardiac surgery. Due to the paucity of similar
studies and heterogeneity, the assessment of bias, systematic review or
pooled analysis/meta-analysis was not feasible. A total of 17 articles
were found to be directly related to the performance of non-neuraxial
regional nerve blocks across all study designs. Due to scarcity of
literature, comments cannot be made on the superiority of these blocks
over each other. However, most of the reviewed techniques were found to be
equally efficacious or better than conventional and established
techniques.<br/>Copyright &#xa9; 2020 Annals of Cardiac Anaesthesia <br/>
Published by Wolters Kluwer-Medknow.

<103>
Accession Number
631658377
Title
Clinical Prognosis of Right-Sided Infective Endocarditis not Associated
with Cardiac Devices or Intravenous Drug use: a Cohort Study and
Meta-Analysis.
Source
Scientific reports. 10 (1) (pp 7179), 2020. Date of Publication: 28 Apr
2020.
Author
Rigau P.V.; Moral S.; Bosch D.; Morales M.; Frigola J.M.; Albert X.;
Robles R.; Ballesteros E.; Roque M.; Aboal J.; Brugada R.
Institution
(Rigau, Moral, Bosch, Morales, Frigola, Albert, Robles, Aboal, Brugada)
Cardiology Department, Hospital Universitari Doctor Josep Trueta, Girona,
Spain
(Ballesteros) Radiology Department, Centre d'Atencio Primaria Pare Claret,
Institut Catala de la Salut, Barcelona, Spain
(Roque) Iberoamerican Cochrane Centre, Biomedical Research Institute Sant
Pau (IIB Sant Pau), CIBER Epidemiologia y Salud Publica (CIBERESP),
Barcelona, Spain
Publisher
NLM (Medline)
Abstract
Right-sided infective endocarditis (RSIE), classically associated with
intravenous drug use or intracardiac devices, is considered a
good-prognosis infective endocarditis (IE) form. However, predisposing
factors and prognosis for "NODID" RSIE (NOt associated with cardiac
Devices or Intravenous Drug use) remain unclear. The aim of this study was
to evaluate predisposing factors and prognosis of NODID RSIE compared to
other RSIE forms. A retrospective cohort study (January 2008-January 2019)
was conducted in a reference center on 300 patients diagnosed with IE.
Endocarditis-related events were defined as related to IE in mortality or
open-heart surgery during follow-up. A review and meta-analysis of
associated literature (January 2008-January 2019) were also performed.
Fifty-seven patients presented RSIE (19%), 22 of which were NODID RSIE
(39%). Use of intravascular catheters (23% vs 3%; p=0.027) and congenital
heart diseases (18% vs 0%; p=0.019) were associated with NODID RSIE. This
group had a higher in-hospital mortality (23% vs 3%; p=0.027) and
endocarditis-related event rates (41% vs 6%; p=0.001) than non-NODID RSIE.
Furthermore, NODID RSIE was independently associated with in-hospital
endocarditis-related events (OR=19.29; 95%CI:2.23-167.16; p=0.007). Our
meta-analysis evaluated four studies and identified 96 cases (30%) of
NODID RSIE from 320 total RSIE cases. NODID RSIE patients demonstrated
higher in-hospital mortality (RR=2.81; 95%CI:1.61-4.90; p<0.001; I2=0.0%)
and necessity of open-heart surgery (RR=13.89; 95%CI:4.14-46.60; p<0.001;
I2=0.0%) than non-NODID RSIE cases. Our study suggests that NODID RSIE has
the highest endocarditis-related event rate and in-hospital mortality
among RSIE cases and therefore should not be considered a good-prognosis
IE.

<104>
Accession Number
631657526
Title
An Exploratory Analysis of Proprotein Convertase Subtilisin/Kexin Type 9
Inhibition and Aortic Stenosis in the FOURIER Trial.
Source
JAMA cardiology. (no pagination), 2020. Date of Publication: 29 Apr 2020.
Author
Bergmark B.A.; O'Donoghue M.L.; Murphy S.A.; Kuder J.F.; Ezhov M.V.; Ceska
R.; Gouni-Berthold I.; Jensen H.K.; Tokgozoglu S.L.; Mach F.; Huber K.;
Gaciong Z.; Lewis B.S.; Schiele F.; Jukema J.W.; Pedersen T.R.; Giugliano
R.P.; Sabatine M.S.
Institution
(Bergmark, O'Donoghue, Murphy, Kuder, Giugliano, Sabatine) TIMI Study
Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
(Ezhov) National Medical Research Center of Cardiology, Moscow, Russian
Federation
(Ceska) Third Internal Medicine Clinic, Center for Preventive Cardiology,
University General Hospital, First Medical Faculty, Charles University,
Prague, Czechia
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes and Preventive
Medicine, University of Cologne, Cologne, Germany
(Jensen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Jensen) Department of Clinical Medicine, Health, Aarhus University,
Aarhus, Denmark
(Tokgozoglu) Department of Cardiology, Hacettepe University, Ankara,
Turkey
(Mach) Cardiology Division, Geneva University Hospitals, Geneva,
Switzerland
(Huber) Cardiology and Intensive Care Medicine, Wilhelminenhospital, Third
Department of Medicine, Sigmund Freud University, Medical Faculty, Vienna,
Austria
(Gaciong) Department of Internal Medicine, Hypertension and Vascular
Disease, Medical University of Warsaw, Warsaw, Poland
(Lewis) Ruth and Bruce Rappaport School of Medicine, Lady Davis Carmel
Medical Center, Technion-IIT, Haifa, Israel
(Schiele) University Hospital Center Besancon, Besancon, France
(Jukema) Department of Cardiology, Leiden University Medical Center,
Netherlands
(Jukema) Netherlands Heart Institute, Utrecht, Netherlands
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Publisher
NLM (Medline)
Abstract
Importance: Despite recent advances in treatment of severe aortic valve
stenosis (AS), AS remains a life-threatening condition with no proven
disease-modifying therapy. Low-density lipoprotein cholesterol (LDL-C) and
lipoprotein(a) (Lp[a]) have been implicated in the pathobiology of AS. The
proprotein convertase subtilisin/kexin type 9 inhibitor evolocumab reduces
circulating LDL-C concentrations by 50% to 60% and Lp(a) by 20% to 30%.
<br/>Objective(s): To determine whether evolocumab reduces the risk of AS
events in patients with atherosclerotic cardiovascular disease.
<br/>Intervention(s): Patients were randomized 1:1 to evolocumab or
placebo. <br/>Design, Setting, and Participant(s): Exploratory analysis of
the FOURIER trial, which enrolled 27564 patients with stable
atherosclerotic cardiovascular disease who were taking statin therapy at
1242 sites in 49 countries from February 2013 to November 2016. Patients
were randomized to evolocumab or placebo and followed up for a median
(interquartile range) of 2.2 (1.8-2.5) years. This post hoc analysis was
performed from September 2019 to February 2020. <br/>Main Outcomes and
Measures: Site-reported adverse events of new or worsening AS or aortic
valve replacement (termed AS events). The adjusted risk of AS events was
calculated with a multivariable model including concentrations of Lp(a)
and LDL-C corrected for Lp(a) content, plus age, sex, diabetes,
hypertension, current smoking, and estimated glomerular filtration rate.
Evolocumab efficacy was tested using a Cox proportional hazards model.
<br/>Result(s): Aortic stenosis events occurred in 63 patients (48 men
[76%]; mean [SD] age, 69 [9] years) over a median of 2.2 years. Elevated
Lp(a) concentration was associated with higher rates of AS events
(adjusted hazard ratio [aHR], 1.55 [95% CI, 1.17-2.05] per SD; P=.002),
including aortic valve replacement (aHR, 2.22 [95% CI, 1.38-3.58] per SD;
P=.001), after multivariable adjustment. The corrected LDL-C concentration
was not significantly associated with AS events (aHR, 1.23 [95% CI,
0.93-1.61] per SD; P=.14). The overall HR for AS events with evolocumab
was 0.66 (95% CI, 0.40-1.09), with no apparent association in the first
year (HR, 1.09 [95% CI, 0.48-2.47]) but an HR of 0.48 (95% CI, 0.25-0.93)
after the first year of treatment. <br/>Conclusions and Relevance: In this
exploratory analysis of the FOURIER trial, higher Lp(a) levels, but not
Lp(a)-corrected LDL-C levels, were associated with a higher risk of
subsequent AS events, including aortic valve replacement. Long-term
therapy with evolocumab may reduce AS events, and this raises the
possibility that specific pharmacologic lipid-lowering therapy could offer
a means to prevent or slow the progression of AS. These exploratory
findings merit further investigation with a dedicated randomized clinical
trial. Trial Registration: ClinicalTrials.gov Identifier: NCT01764633.

<105>
Accession Number
631655743
Title
Dexmedetomidine versus propofol for prolonged sedation in critically ill
trauma and surgical patients.
Source
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and
Ireland. (no pagination), 2020. Date of Publication: 25 Apr 2020.
Author
Winings N.A.; Daley B.J.; Bollig R.W.; Roberts R.F.; Radtke J.; Heidel
R.E.; Taylor J.E.; McMillen J.C.
Institution
(Winings) 1924 Alcoa Highway, Box 41, Department of Pharmacy, The
University of Tennessee Medical Center Knoxville, Tennessee, 37920 USA
(Daley, Bollig, Roberts, Radtke, Taylor) 1924 Alcoa Highway, Box U-11,
Department of Surgery, Division of Trauma & Critical Care Surgery the
University of Tennessee Medical Center, Knoxville, TN, 37920 USA
(Heidel) University of Tennessee Graduate School of Medicine, TN, 1924
Alcoa Highway, Knoxville 37920, United States
(McMillen) 1924 Alcoa Highway, Box 41, Department of Pharmacy, The
University of Tennessee Medical Center Knoxville, Tennessee, 37920 USA.
Electronic address: jc.mcmil@gmail.com
Publisher
NLM (Medline)
Abstract
BACKGROUND: and Purpose: Currently, dexmedetomidine versus propofol has
primarily been studied in medical and cardiac surgery patients with
outcomes indicating safe and effective sedation. The purpose of this study
was to assess the efficacy of dexmedetomidine versus propofol for
prolonged sedation in trauma and surgical patients. <br/>METHOD(S): This
was a single-center prospective study conducted in the Trauma/Surgical
Intensive Care Unit (ICU) at a Level I academic trauma center. It included
patients 18 years of age or older requiring mechanical ventilation who
were randomly assigned based on unit bed location to receive either
dexmedetomidine or propofol. The primary outcome was duration of
mechanical ventilation. Secondary outcomes included mortality; proportion
of time in target sedation; incidence of delirium, hypotension, and
bradycardia; and ICU and hospital length of stay (LOS). <br/>RESULT(S): A
total of 57 patients were included. Baseline characteristics were similar
between groups. There was no significant difference in duration of
mechanical ventilation (median [IQR]) between the dexmedetomidine
(78.5[125] hours) and propofol (105[130] hours; p = 0.15) groups. There
was no difference between groups in ICU mortality, ICU and hospital LOS,
or incidence of delirium. Safety outcomes were also similar. Patients in
the dexmedetomidine group spent a significantly greater percentage of time
in target sedation (98[8] %) compared to propofol group (92[10] %; p =
0.02). <br/>CONCLUSION(S): Our results suggest that, similar to medical
and cardiac surgery patients, dexmedetomidine and propofol are safe and
effective sedation agents in critically ill trauma and surgical patients;
however, dexmedetomidine achieves target sedation better than propofol for
this specific population.<br/>Copyright &#xa9; 2020 Royal College of
Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College
of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

<106>
Accession Number
631661507
Title
Laparoscopic Sleeve Gastrectomy in Patients with Left Ventricular Assist
Device-Case Series and Review of Literature.
Source
Obesity surgery. (no pagination), 2020. Date of Publication: 30 Apr 2020.
Author
Van Aelst P.; Deleus E.; Van der Schueren B.; Meyns B.; Vandersmissen K.;
Lannoo M.
Institution
(Van Aelst, Deleus, Lannoo) Department of Abdominal Surgery, University
Hospitals Leuven, Leuven, Belgium
(Van der Schueren) Department of Endocrinology, University Hospitals
Leuven, Leuven, Belgium
(Meyns, Vandersmissen) Department of Clinical Cardiac Surgery, University
Hospitals Leuven, Leuven, Belgium
Publisher
NLM (Medline)
Abstract
For patients with advanced heart failure, left ventricular assist device
(LVAD) can serve as a bridge to heart transplantation. Patients with class
II obesity are eligible for implantation of LVAD but do not meet criteria
for cardiac transplant listing. Laparoscopic sleeve gastrectomy (LSG) is
proposed as weight losing modality in order to reach the New York Heart
Association (NYHA) criteria for listing. In our center, three patients on
LVAD with need for weight-reducing therapy were treated with laparoscopic
sleeve gastrectomy. We reviewed our data retrospectively and compared it
with the literature. Successful weight loss was achieved in all patients,
without postoperative adverse events. Two out of three were listed on
transplant waiting list. Our results are similar to those described in
other series.

<107>
Accession Number
631660811
Title
Noteworthy Literature in Cardiac Anesthesia for 2019.
Source
Seminars in cardiothoracic and vascular anesthesia. (pp 1089253220921588),
2020. Date of Publication: 29 Apr 2020.
Author
Clendenen N.; Abrams B.; Morabito J.; Grae L.; Mosca M.S.; Weitzel N.
Institution
(Clendenen, Abrams, Morabito, Grae, Weitzel) University of Colorado School
of Medicine, CO, Aurora, United States
(Mosca) University of Colorado Hospital, CO, Aurora, United States
Publisher
NLM (Medline)
Abstract
This article represents a selective review of literature published in
2019. Initial results from PubMed searching for a combination of terms,
including cardiac anesthesiology and anesthesiology outcomes, yielded more
than 1400 publications. From there, we manually screened the results and
identified 5 major themes for the year of 2019, including transcatheter
techniques, delirium and anesthesiology, coagulation management following
cardiopulmonary bypass, perfusion management with del Nido cardioplegia,
and applied clinical research. The following research accomplishments have
expanded what is possible and set ambitious goals for the future.

<108>
Accession Number
631652324
Title
Effect of Nalmefene on Delayed Neurocognitive Recovery in Elderly Patients
Undergoing Video-assisted Thoracic Surgery with One Lung Ventilation.
Source
Current medical science. 40 (2) (pp 380-388), 2020. Date of Publication:
01 Apr 2020.
Author
Li M.-Y.; Chen C.; Wang Z.-G.; Ke J.-J.; Feng X.-B.
Institution
(Li, Chen, Wang, Ke) Department of Anesthesiology, Zhongnan Hospital,
Wuhan University, Wuhan 430071, China
(Feng) Department of Anesthesiology, Zhongnan Hospital, Wuhan University,
Wuhan 430071, China
Publisher
NLM (Medline)
Abstract
The intravenous use of nalmefene has been found to exert neuroprotective
effect in patients with severe traumatic brain injury and acute cerebral
infarction; nonetheless, it is unknown whether nalmefene alleviates
delayed neurocognitive recovery. Our purpose of the current research was
to clarify the impact of nalmefene on delayed neurocognitive recovery in
aged patients experiencing video-assisted thoracic surgery (VATS) with
intraoperative use of one lung ventilation (OLV). The present study
involved 120 patients undergoing selective VATS, randomized to accept
low-dose nalmefene (N1 group, n=40), high-dose nalmefene (N2 group, n=40)
or equal volume of physiologic saline (control group, n=40). A battery of
neuropsychological tests were used to estimate cognitive function 1 day
before surgery (t0) and 10 days after surgery or before discharge (t1).
Regional cerebral oxygen saturation (rSO2) was detected 5 min before
induction (t0), 5 min after induction (t1), 15 and 60 min after onset of
OLV (t2 and t3), and 15 min after termination of OLV (t4). The plasma
values of interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha
and adiponectin (ADP) were also detected prior to induction of anesthesia
(T0), 1 h, 2 h and 6 h after surgery (T1, T2, T3). On t1, delayed
neurocognitive recovery occurred in 5/40 (12.5%) patients of N1 group, in
5/40 (12.5%) patients of N2 group and in 13/40 (32.5%) patients of control
group (P0.05). There were no statistical differences in rSO2 among three
groups at different time points. At T1, T2 and T3, IL-1beta, IL-6 and
TNF-alpha values significantly increased and ADP value significantly
decreased (P0.05) in control group. In contrast, at T1, T2 and T3,
IL-1beta, IL-6 and TNF-alpha values decreased and ADP value decreased less
in N1 and N2 groups (P0.05). At T1, T2 and T3, IL-1beta, IL-6 and
TNF-alpha concentrations presented a trend of N2 group N1 group control
group and ADP presented a trend of N2 groupN1 groupcontrol group (P0.05).
The result of our present research supports the hypothesis that the
perioperative intravenous treatment with nalmefene to VATS with OLV
ameliorates postoperative cognitive function and decreases the incidence
of delayed neurocognitive recovery, most likely by suppression of
inflammatory responses.

<109>
Accession Number
631647836
Title
Long-term Graft Patency after Off-Pump and On-Pump Coronary Artery Bypass:
A CORONARY Trial Cohort.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 24 Apr 2020.
Author
Yang L.; Lin S.; Zhang H.; Gu D.; Chen S.; Shi Y.; Zheng Z.
Institution
(Yang, Lin, Zhang, Gu, Chen, Shi) National Clinical Research Center of
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing,
China
(Zheng) National Clinical Research Center of Cardiovascular Diseases,
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Randomized controlled trials have compared the early and
mid-term prognosis of on-pump coronary artery bypass grafting (CABG) and
off-pump CABG. However, the results are controversial, and there is
limited information on graft patency and long-term outcomes.
<br/>METHOD(S): Betweeen May 2007 and October 2011, 349 patients were
randomized to off-pump or on-pump CABG as part of the CORONARY trial at
Fuwai Hospital. The primary outcome was coronary bypass graft patency,
which was assessed at a mean of 6.7+/-1.7 years after surgery by
multidetector computed tomography. A secondary endpoint was a composite
outcome of death, nonfatal myocardial infarction, repeat coronary
revascularization, or stroke; mean follow-up was 6.5+/-1.7 years. Graft
patency was compared between the off-pump and on-pump CABG treatment arms
in the 206 patients with follow-up computed tomography. <br/>RESULT(S):
There were 107 patients in the off-pump CABG group and 99 in the on-pump
group during the follow-up period. These patients underwent a total of 723
grafts, and the overall rate of graft patency did not differ significantly
between the off-pump and on-pump groups (87.4% vs 88.9%, P=0.527). The
patency rate of the posterior descending branch was lower than average.
Higher incidence of mortality, nonfatal myocardial infarction and repeat
revascularization was found in the off-pump patients however it did not
reach significance. <br/>CONCLUSION(S): There were no statistical
differences in graft patency rates in off-pump versus on-pump CABG
patients during the long-term follow-up. On-pump CABG group appeared to
offer a better long-term prognosis even with no statistical differences
for the limited study population.<br/>Copyright &#xa9; 2020. Published by
Elsevier Inc.

<110>
Accession Number
631640798
Title
Lung protective ventilation in infants undergoing cardiopulmonary bypass
surgery for congenital heart disease: a prospective randomized controlled
trial.
Source
Paediatric anaesthesia. (no pagination), 2020. Date of Publication: 27 Apr
2020.
Author
Sun Y.; Shen S.-E.; Deng X.-M.; Cai Y.; Du Y.
Institution
(Sun, Shen, Cai, Du) Department of Anesthesiology and Critical Care
Medicine, Xin Hua Hospital affiliated to, Jiaotong University School of
Medicine, Shanghai 200092, China
(Deng) Department of Anesthesiology and Intensive Care Medicine, Changhai
Hospital affiliated to, Naval Medical University, Shanghai 200092, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Lung protective ventilation (LPV) has been applied to surgical
adults with normal pulmonary function for optimizing mechanic ventilation
and reducing postoperative pulmonary complications. Few studies have
reported the use of LPV in infants undergoing cardiac surgery with
cardiopulmonary bypass (CPB). AIMS: To explore safety and effectiveness of
LPV in infants undergoing CPB surgery for congenital heart disease (CHD).
<br/>METHOD(S): Included in this study were 77 infants who underwent CPB
surgery for CHD from November 2017 to September 2018. They were randomized
into the LPV group and conventional ventilation (CV) group. In LPV group,
small-tidal-volume (6-8ml/kg) ventilation, lung recruitment by PEEP
increment to the maximum level of 15cmH2 O after CPB, and individualized
optimal PEEP titration were applied. In CV group, traditional tidal volume
(10-12ml/kg with zero PEEP) was applied. The primary outcome was the ratio
of arterial partial pressure of oxygen to inspiratory oxygen fraction
(PaO2 /FiO2 ). The secondary outcomes were respiratory dynamics
parameters, hypoxemia, prognostic indexes and postoperative pulmonary
complications. <br/>RESULT(S): PaO2 /FiO2 in LPV group(416.86,
95%CI:381.60-452.12) was significantly higher than that in CV
group(263.37, 95%CI:227.65-299.09) after intervention (P<0.001). There was
significant difference in the trend of change in dynamic compliance,
alveolar-arterial oxygen difference, arterial-end expired carbon dioxide
difference, driving pressure and Respiratory Index between the two groups
at different time points from weaning from CPB to 2 hours after operation.
There was no significant difference in PaO2 /FiO2, alveolar-arterial
oxygen difference, Respiratory Index and dynamic compliance 2 hours
postoperative and in the incidence of postoperative pulmonary
complications, prognostic indexes between the two groups.
<br/>CONCLUSION(S): LPV could be used safely in infants undergoing CPB in
that it can improve oxygenation, alveolar aeration and dynamic compliance;
reduce driving pressure, pulmonary shunting, dead-space. Its effect on
oxygenation, pulmonary gas exchange and pulmonary compliance was
relatively short, and had less impact on postoperative pulmonary
complications and prognosis.<br/>Copyright This article is protected by
copyright. All rights reserved.

<111>
Accession Number
631561923
Title
Does pregabalin effectively and safely relieve postoperative pain in
patients undergoing pulmonary resections?.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (4) (pp 555-560),
2019. Date of Publication: 01 Oct 2019.
Author
Li S.; Zhang W.; Cheng S.; Li Y.
Institution
(Li, Zhang) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Guoxue Alley No. 37, Chengdu 610041, China
(Li, Zhang, Cheng, Li) West China Medical Center, West China Hospital,
Sichuan University, Chengdu, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether pregabalin could
effectively and safely reduce postoperative pain in patients undergoing
pulmonary resections. Altogether 23 papers were found using the reported
search, of which 6 randomized controlled trials represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Five of 6 randomized
controlled trials demonstrated that the application of oral pregabalin
during the perioperative period could effectively reduce postoperative
pain after pulmonary resections without compromising patients' safety. One
randomized controlled trial reported no difference in the postoperative
pain levels between the pregabalin group and the control group. The rates
of adverse effects were generally found to be decreased in patients who
received pregabalin compared to the patients who received routine
analgesia, although 2 studies reported significantly higher incidences of
mild drowsiness and dizziness among the pregabalin-treated patients.
Currently available evidence supports that the perioperative
administration of pregabalin can effectively and safely relieve
postoperative pain for patients undergoing pulmonary
resections.<br/>Copyright &#xa9; The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<112>
Accession Number
631561524
Title
Does prehabilitation improve outcomes in cardiac surgical patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (4) (pp 608-611),
2019. Date of Publication: 01 Oct 2019.
Author
Sandhu M.S.; Akowuah E.F.
Institution
(Sandhu, Akowuah) Department of Cardiothoracic Surgery, James Cook
University Hospital, Middlesbrough TS4 3BW, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: does prehabilitation
improve outcomes in cardiac surgical patients? Altogether more than 483
papers were found using the reported search, of which 10 represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Four meta-analyses
concluded that prehabilitation reduced postoperative pulmonary
complications (PPCs). The 6 randomized controlled trials (RCT) included,
differed significantly in the type of prehabilitation delivered. There was
replication of some RCTs across the meta-analyses. The consensus across
the meta-analyses was a reduction in PPCs and 3 of 4 meta-analyses finding
a reduction in length of stay (LOS). There were no adverse events or
difference in mortality found. Two small RCTs showed feasibility and
modest improvements in physiological parameters. Three RCTs demonstrated a
reduction in LOS and a reduction in PPCs. One RCT found no difference in
quality of life scores, LOS or postoperative atrial fibrillation. None of
the RCTs found negative evidence of prehabilitation interventions. We
conclude that the prehabilitation is a positive preoperative intervention,
most favourably in older patients and in those who are at risk of PPCs.
Specifically inspiratory muscle training is the intervention with most
favourable evidence.<br/>Copyright &#xa9; The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<113>
Accession Number
631561391
Title
In thoracic aortic surgery, is innominate artery cannulation a safe and
effective alternative to axillary artery cannulation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (4) (pp 604-607),
2019. Date of Publication: 01 Oct 2019.
Author
Harky A.; Grafton-Clarke C.; Hadlett M.; Shuttleworth E.
Institution
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Thomas drive, Liverpool L14 3PE, United Kingdom
(Grafton-Clarke) College of Life Sciences, University of Leicester,
Leicester, United Kingdom
(Hadlett, Shuttleworth) Department of Surgery, Countess of Chester
Hospital, Chester, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: in a patient undergoing
thoracic aortic surgery, is innominate artery cannulation superior to
axillary artery cannulation in terms of postoperative outcomes? Five
hundred and thirty-one papers were found using the reported search
strategy, of which 5 represented the best evidence to answer the clinical
question. A total of 1338 participants were included across the 5 studies.
Seven hundred and twenty-two patients were cannulated via the axillary
artery and 616 were cannulated via the innominate artery. The included 5
studies were 2 prospective observational cohorts, 2 retrospective
case-series analysis and a single-blinded randomized trial. Thirty-day or
in-hospital mortality rates were reported in all 5 studies. There were no
significant differences in mortality with innominate artery cannulation
compared to axillary artery cannulation (P > 0.05), with slightly lower
mortality rates in 2 studies, slightly higher mortality rates in 2 and
equal in 1 study. Though statistical significance was not demonstrated (P
> 0.05), a stroke occurred slightly less frequently in patients receiving
innominate artery cannulation compared to axillary artery cannulation in 3
of the 4 studies. Innominate artery cannulation is non-inferior to
axillary artery cannulation for thoracic aortic surgery, with a similar
level of neuroprotection and is not associated with increased levels of
mortality.<br/>Copyright &#xa9; The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<114>
Accession Number
631653403
Title
REDUCE-IT USA: Results from the 3146 Patients Randomized in the United
States.
Source
Circulation. (pp 367-375), 2020. Date of Publication: 2020.
Author
Bhatt D.L.; Miller M.; Brinton E.A.; Jacobson T.A.; Steg P.G.; Ketchum
S.B.; Doyle R.T.; Juliano R.A.; Jiao L.; Granowitz C.; Tardif J.-C.;
Olshansky B.; Chung M.K.; Gibson C.M.; Giugliano R.P.; Budoff M.J.;
Ballantyne C.M.
Institution
(Bhatt) Brigham and Women's Hospital, Heart and Vascular Center, Harvard
Medical School, 75 Francis Street, Boston, MA 02115, United States
(Miller) Department of Medicine, University of Maryland, School of
Medicine, Baltimore, United States
(Brinton) Utah Lipid Center, Salt Lake City, United States
(Jacobson) Lipid Clinic and Cardiovascular Risk Reduction Program,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Steg) French Alliance for Cardiovascular Trials, Hopital Bichat, Paris,
France
(Steg) Assistance Publique-Hopitaux de Paris, Universite de Paris, INSERM
Unite 1148, Paris, France
(Ketchum, Doyle, Juliano, Jiao, Granowitz) Amarin Pharma, Inc.,
Bridgewater, NJ, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, QC, Canada
(Olshansky) University of Iowa, Iowa City, United States
(Chung) Cleveland Clinic, OH, United States
(Gibson) Beth Israel Deaconess Hospital, Boston, MA, United States
(Gibson) Baim Clinical Research Institute, Boston, MA, United States
(Giugliano) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Budoff) Los Angeles Biomedical Research Institute, Harbor UCLA Medical
Center, Torrance, CA, United States
(Ballantyne) Department of Medicine, Baylor College of Medicine, Houston,
TX, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Some trials have found that patients from the United States
derive less benefit than patients enrolled outside the United States. This
prespecified REDUCE-IT (Reduction of Cardiovascular Events with Icosapent
Ethyl - Intervention Trial) subgroup analysis was conducted to determine
the degree of benefit of icosapent ethyl in the United States.
<br/>Method(s): REDUCE-IT randomized 8179 statin-treated patients with
qualifying triglycerides >=135 and <500 mg/dL and low-density lipoprotein
cholesterol >40 and <=100 mg/dL and a history of atherosclerosis or
diabetes mellitus to icosapent ethyl 4 g/d or placebo. The primary
composite end point was cardiovascular death, nonfatal myocardial
infarction, nonfatal stroke, coronary revascularization, or
hospitalization for unstable angina. The key secondary composite end point
was cardiovascular death, nonfatal myocardial infarction, or nonfatal
stroke. A hierarchy was prespecified for examination of individual and
composite end points. <br/>Result(s): A total of 3146 US patients (38.5%
of the trial) were randomized and followed for a median of 4.9 years;
32.3% were women and 9.7% were Hispanic. The primary composite end point
occurred in 24.7% of placebo-treated patients versus 18.2% of icosapent
ethyl-treated patients (hazard ratio [HR], 0.69 [95% CI, 0.59-0.80];
P=0.000001); the key secondary composite end point occurred in 16.6%
versus 12.1% (HR, 0.69 [95% CI, 0.57-0.83]; P=0.00008). All prespecified
hierarchical end points were meaningfully and significantly reduced,
including cardiovascular death (6.7% to 4.7%; HR, 0.66 [95% CI,
0.49-0.90]; P=0.007), myocardial infarction (8.8% to 6.7%; HR, 0.72 [95%
CI, 0.56-0.93]; P=0.01), stroke (4.1% to 2.6%; HR, 0.63 [95% CI,
0.43-0.93]; P=0.02), and all-cause mortality (9.8% to 7.2%; HR, 0.70 [95%
CI, 0.55-0.90]; P=0.004); for all-cause mortality in the US versus non-US
patients, P<inf>interaction</inf>=0.02. Safety and tolerability findings
were consistent with the full study cohort. <br/>Conclusion(s): Whereas
the non-US subgroup showed significant reductions in the primary and key
secondary end points, the US subgroup demonstrated particularly robust
risk reductions across a variety of individual and composite end points,
including all-cause mortality. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT01492361.<br/>Copyright &#xa9; 2020 Lippincott Williams and Wilkins.
All rights reserved.